転移性胃腫瘍の形態的特徴―内視鏡像を中心に

Endoscopic Features of Metastatic Tumors of the Stomach

要旨　内視鏡検査を施行するうえで転移性胃腫瘍の内視鏡像を熟知していなければ時に治療方針を誤り患者に不利益を被らせてしまうおそれがある．今回，当センターで1968～2002年の34年間に経験した転移性胃腫瘍88症例の内視鏡像を中心にその特徴について検討した．転移性胃腫瘍の原発巣としては，悪性黒色腫，肺癌，乳癌，食道癌が多かった．また転移性胃腫瘍の内視鏡像は粘膜下腫瘍様の形態を呈することが多いが，原発巣別に検討してみると悪性黒色腫では多発する小黒色斑，乳癌では多発するびらん様所見あるいは4型進行胃癌様所見にも注意をはらう必要がある．

　At the National Cancer Center Hospital, in the period from the 1968 to 2002, 88 cases of metastatic tumors of the stomach were detected and diagnosed by endoscopic examination and biopsy. In our study, primary cancers were frequently found in lung (22％), breast (20％), malignant melanoma (19％) and esophagus (18％).

　Multiple lesions were seen in only 43％ of these cases ; solitary metastases were more common than multiple metastases. Most of the metastatic tumors were located in the middle and upper gastric body, mainly on the greater curvature. Endoscopic appearance was broadly classified into 3 categories, which were (1) submucosal tumor-like formation (50％), (2) cancer-like formation (33％) and (3) others (17％). In category (1), 70％ of them had a central depression. Concerning category (2), 23 out of 29 cases resembled advanced cancer. In conclusion, it is necessary to have a better understanding of the appearance of metastatic tumors of the stomach, so we analyzed their endoscopic features. Endoscopic examination is helpful both for detecting tumors and for indicating their proper treatment.