결과지 해석 부탁 드립니다.

[우연과인연]

수술명

- Left Lobectomy of liver

수술전 진단명

- Metastatic cancer to the liver

수술방법 및 소견

Method

open 개복

Position supine

Incision inverted L

Skin to peritoneum free

Peritoneal cavity

Adhesion yes mild low midline prev. op

Seeding No

Liver

Lesion

cholestatic No

mass lesion

mass metastasis

location S4

size (cm) 2

number x2

invasion

portal vein no

Operation curative

liver resection Lt. hemihepatectomy

frozen biopsy no

Drain

Yes

drain

종류 J-P 위치 subphrenic

Op time (min) 160

EBL (cc) 100

Procedure

*Uneventful

*Lt. hemihepatectomy, Cholecystectomy 시행함

#1 under general anesthesia

#2 supine position

#3 inverted L skin incision

#4 Lt. liver mobilization

#5 cholecystectomy

#6 S4 tumore was inspected. liver parenchymal dissection with CUSA

#7 It. hemihepatectomy

#8 bleeding control

#9 JO dreain was inseted

#10 wound closure

#11 aspetic dressing

임상진단

MICRO (1 HE)

DIAGNOSIS:

Stomach, low body, endoscopic biopsy:

Atypical glands in lamina propria

suggestive of ADENOCARCINOMA (see note)

병리진단

-Cytokeratin 7 : negative

-Cytokeratin 20 : positive

-CDX 2 : positive

Summary

Favor metastatic adenocarcinoma from colon

임상진단

MICRO (1 HE)

DIAGNOSIS:

Stomach, low body, endoscopic biopsy:

Atypical glands in lamina propria

suggestive of ADENOCARCINOMA (see note)

병리진단

-Cytokeratin 7 : negative

-Cytokeratin 20 : positive

-CDX 2 : positive

Summary

Favor metastatic adenocarcinoma from colon

병리진단 ( S 160040661)

MICRO (1 HE)

-------------------------------------------------------------------- Site H.pylori Neutrophils Mononuclear Atrophy Intestinal

colonization cells metaplasia

-------------------------------------------------------------------

body - - + NA -

-------------------------------------------------------------------

-:absent, +:mild, ++:moderate, +++:marked, NA:non-applicable

DIAGNOSIS:

Stomach, body, endoscopic biopsy:

Chronic gastritis (see note)

(Note) No submucosal layer is included.

임상진단 : Rectal cancer, pT3N2, M0 c liver meta

받은 검체 수 : 총 4개

1. Left hepatectomy specimen : liver (17.0 x 13.0 x 5.0cm, 412gm)

A. 종괴 및 결절성 병변 : 총 2개

1) 위치 S4, 크기 1.7 x 1.2 x 1.0cm, 괴사 20% 피막거리 0cm, 절연거리 3.4cm

2) 위치 S4, 크기 1.6 x 1.2 x 1.0cm, 피막 거리 1.5cm 절연거리 4.5cm

B. 혈관 및 담관 : 이상 소견 없음.

C. 주위 간 실질 : 이상 소견 없음.

2.LN: 림프절 골라 포매함.

3.Falciform ligament: 9.0 x 2.5 x 1.5cm 지방성 조직임. 이상소견 없음.

4.GB : 6.5 x 6.0cm 평균 벽 두께 0.3cm 이상소견 없음. 대표적 절편 포매함.

(slide key :1: S4 첫 번째 종괴, 2 : 두 번째 종괴, 3: falciform ligament, 4:담낭

(microscopy Examined by GIL)

MICRO (4 HE)

DIAGNOSIS:

Liver, left hepatectomy:

MESTASTATIC ADENOCARCINOMA, clinically from rectum (x2) with

1)size : 1.7 x 1.2 x 1.0cm

2) clear resection margins

Tissue laveled "falciform ligament", excision:

No tumor involvement

Gallbladder, cholecystectomy:

No diagnostic abnormalities recognized with

no tumor involvement.

임상진단 :Polyp

MICRO (2 HE)

DIAGNOSIS:

Cecum, endoscopic biopsy:

Nonspecific change with

lymphoid aggregate (#1)and(#2)

MICRO (5 (5) Pap, 1 DQ)

DIAGNOSIS:

Lymph node, "Lt, axillary", aspiration cytology:

Negative for malignant cells

MICRO (12 HE)

AJCC 7th ed. 2010.1.1

DIAGNOSIS:

Rectum, low anterior resection:

ADENOCARCINOMA, moderately differentiated

-Neoadjuvant treatment: no

-Gross type: ulcerofungating

-Location of tumor: rectum

-Size of tumor: 6.5 x 3.3 x 1.0 cm

-Depth of invasion

invades non-peritonealized pericolic

or perirectal structure (pT3)

1mm to 5mm beyond the border of the muscularis propria (pT3b)

-Surgical margins : free from tumor

safety margin:

proximal, 8.7cm; distal, 2.1cm ; radial margin, 1.0cm

-lymph node: metastasis in eight out of 20 lymph nodes (pN2b)

(peritumoral LN, 3/4; pericolic LN,

F-18 Fdg pet 토르소 (두개골기저-대퇴부)

[finding]

2016-10-12 1)핵종과 방사성의약품

F-18 FDG

2)임상 진단:

#Rectal ca(pT3bN2b, 8/20)M0, III3

s/p lapa LAR (2012.1.26) by pf 정승용

--> s/p CCRT with Fl#2 (2012.27 - 4.9)

-->Fl #4후 안하기로 함. pf김태용

#M/liver

s/p lt/ liver lobectomy (2013.12.5) by pf 이남준

-->s/p FOLFOX #12 (2014.1.17 - 10.20)

#(16.7.14)EGD: stomach GC mass

-R/O metatatic lesion from rectum

-R/0 GIST, R/O AGC

3)검사 이유 : metastasis w/u

4) 영상 소견

F-18 FDG IV injection 후 cerebellum이하부터 pelvis까지 Whole body 영상을 촬영함.

괄호안의 숫자는 maximal SUV값임

1. Hypermetabolic mass in poterior rectum (11.8)

2. HYpermetabolic LNs in right diaphramatic (5.3), presacral (3.1) and perirectal(7.5) area.

3. Hypermetabolic mass in stomach greater curvature area (15.2)

[Conclusion]

1. Suggestive of tumor recurrence in poterior rectum.

2. Suggestive of metastatic LAPs in right diaphragmatic, presacral and perirectal LNs.

3. Suggestive of metastasis in stomch greater curvature area.

항목명	검사결과	참고치
Helm, ova	No parasite(s) seen	No parasite(s) seen
P. cyst	No parasite(s) seen	No parasite(s) seen
P. troph	No parasite(s) seen	No parasite(s) seen
Human Hb	Negative	Negative(<99ng/mL)

[승리의 힘]

답글로 드렸습니다.

[우연과인연]

빠른 답글 감사드립니다