목적 : 위에 발생한 반지세포암종(Signet Ring Cell Carcinoma)은 진단 당시 연령 및 병기가 낮으며, 또한 예후가 불량한 것이 특징이다. 그러나 반지세포암종의 임상적, 조직병리학적 특징에 관하여 여러 논란이 있으며, 내시경적 특징에 관해서는 충분한 자료가 없는 실정이다. 따라서 저자들은 위에 발생한 반지세포암종의 임상적, 조직병리학적, 내시경적 특징을 파악하고, 비반지세포암종(Non-Signet Ring Cell Carcinoma) 군과의 차이점을 알아보고자 하였다. 방법 : 1996년 3월부터 2006년 5월까지 강릉아산병원 소화기 내과에서 상부 위장관 내시경 검사를 통한 조직검사 및 근치적 위 절제술을 통해 위암으로 확진된 환자들에 대해 후향적으로 의무기록을 조사하였고, 반지세포암종 환자군과 무작위로 추출된 비반지세포암종 환자군 사이의 임상적 특징(나이, 성별, 비만도, 음주력, 흡연력 등), 내시경적 특징(병변 크기, 형태, 위치, 헬리코박터균 유무 등), 그리고 조직병리학적 특징(병변 형태, 침범 깊이, 병기 등)을 통계학적으로 분석하였다. 결과 : 같은 기간 동안 위암으로 확진된 환자 1,840명 중에서 반지세포암종으로 진단받은 환자는 총 117명(6.4%)이었다. 임상적으로 반지세포암종 군에서 여자(p=0.005), 60세 미만(p<0.001), 비흡연자(p=0.031), 비음주자(p=0.045)가 더 많은 경향을 보였고, 내시경적으로 병변이 체부에 위치하는 비율(p=0.003)과 헬리코박터균 감염율(p<0.001)과 진행성 위암의 Borrmann 4형의 비율(p=0.003)이 높은 경향을 보였다. 이 중 다변량분석을 통한 반지세포암종의 유의한 독립적인 특징은 60세 미만의 연령, 헬리코박터균 감염, 진행성 위암에서의 Borrmann 4형이었다. 결론 : 진단 당시 상대적으로 낮은 연령, 높은 헬리코박터균 감염률, 진행성 위암의 Borrmann 4형의 높은 비율이 위 반지세포암종의 내시경적 또는 임상병리학적 특징이었다. 앞으로 더 많은 환자들을 대상으로 예후와 헬리코박터균 감염률 등에 대한 추가적인 연구가 필요할 것으로 생각된다.

Background : Signet ring cell carcinoma (SRCC) of the stomach has a young age prevalence and is associated with advanced gastric cancer (AGC) on diagnosis and a poor prognosis. However, the clinical and histopathological characteristics of the disease have been controversial and its endoscopic characteristics are not clear. Thus, we examined the clinical, endoscopic and histopathological characteristics of SRCC of the stomach and analyzed them in comparison with non-signet ring cell carcinoma (NSRCC). Methods : We retrospectively investigated the medical records of cases definitely diagnosed as stomach cancer by upper gastrointestinal endoscopy or radical gastrectomy from March 1996 to May 2006, and statistically analyzed the clinical, endoscopic and histopathological characteristics of the SRCC and NSRCC group selected at random. Results : During the study period, 1,840 patients were diagnosed as stomach cancer, and 117 (6.4%) of the patients were found to have SRCC. Clinically, the SRCC group showed a higher frequency in female (p=0.005), those aged below 60 years (p<0.001), non-smokers (p=0.031) and non-drinkers (p=0.045), and endoscopically the SRCC group was higher in the percentage of lesions located in the body part of stomach (p=0.003), the Helicobacter pylori (H. pylori) infection rate (p<0.001) and the Borrmann 4 type AGC (p=0.003). Significant independent characteristics of SRCC identified through multivariate analysis were an age below 60 years, H. pylori infection and a Borrmann 4 type AGC. Conclusions : The endoscopic and clinicopathological characteristics of SRCC of the stomach are relatively young age on diagnosis, a high H. pylori infection rate, and a high percentage of Borrmann 4 type AGC. (Korean J Med 73:596-602, 2007)

Background : Signet ring cell carcinoma (SRCC) of the stomach has a young age prevalence and is associated with advanced gastric cancer (AGC) on diagnosis and a poor prognosis. However, the clinical and histopathological characteristics of the disease have been controversial and its endoscopic characteristics are not clear. Thus, we examined the clinical, endoscopic and histopathological characteristics of SRCC of the stomach and analyzed them in comparison with non-signet ring cell carcinoma (NSRCC). Methods : We retrospectively investigated the medical records of cases definitely diagnosed as stomach cancer by upper gastrointestinal endoscopy or radical gastrectomy from March 1996 to May 2006, and statistically analyzed the clinical, endoscopic and histopathological characteristics of the SRCC and NSRCC group selected at random. Results : During the study period, 1,840 patients were diagnosed as stomach cancer, and 117 (6.4%) of the patients were found to have SRCC. Clinically, the SRCC group showed a higher frequency in female (p=0.005), those aged below 60 years (p<0.001), non-smokers (p=0.031) and non-drinkers (p=0.045), and endoscopically the SRCC group was higher in the percentage of lesions located in the body part of stomach (p=0.003), the Helicobacter pylori (H. pylori) infection rate (p<0.001) and the Borrmann 4 type AGC (p=0.003). Significant independent characteristics of SRCC identified through multivariate analysis were an age below 60 years, H. pylori infection and a Borrmann 4 type AGC. Conclusions : The endoscopic and clinicopathological characteristics of SRCC of the stomach are relatively young age on diagnosis, a high H. pylori infection rate, and a high percentage of Borrmann 4 type AGC. (Korean J Med 73:596-602, 2007)

Stomach cancer, Signet ring cell carcinoma, Helicobacter pylori