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Stomach and Intestine(Tokyo) Volume 43, Issue 5 （April 2008）

胃と腸 43巻5号（2008年4月発行）

Japanese English

今月の主題 linitis plastica型胃癌―病態と診断・治療の最前線

主題

linitis plastica型胃癌の自然史 Studies on the Growth of “Linitis Plastica” Gastric Cancer 入口陽介 ¹ , 細井董三 ¹ , 小田丈二 ¹ , 水谷勝 ¹ , 大野康寛 ¹ , 篠原知明 ¹ , 高柳聡 ¹ , 冨野泰弘 ¹ , 岸大輔 ¹ , 大村秀俊 ¹ , 霧生信昭 ¹ , 細井亜希子 ¹ , 藤崎聡 ¹ , 板橋浩一 ¹ , 高倉裕一 ¹ , 大浦通久 ¹ , 山田耕三 ¹ , 中村尚志 ² , 中橋栄太 ³ , 山村彰彦 ⁴ Yosuke Iriguchi ¹ , Tozo Hosoi ¹ , Jyoji Oda ¹ , Masaru Mizutani ¹ , Yasuhiro Oono ¹ , Tomoaki Shinohara ¹ , Satoshi Takayanagi ¹ , Yasuhiro Tomino ¹ , Daisuke Kishi ¹ , Hidetoshi Oomura ¹ , Nobuaki Kiryu ¹ , Akiko Hosoi ¹ , Tadashi Fujisaki ¹ , Kohichi Itabashi ¹ , Yuichi Takakura ¹ , Michihisa Ooura ¹ , Kozo Yamada ¹ , Hisashi Nakamura ² , Eita Nakahashi ³ , Akihiko Yamamura ⁴ ¹東京都多摩がん検診センター消化器科 ²調布外科消化器科内科クリニック ³横浜菊名記念病院消化器科 ⁴東京都多摩がん検診センター検査科 ¹Department of Gastroenterology, Tokyo Metropolitan Tama Cancer Detection Center, Tokyo ²Department of Gastroenterology, Chofu Surgical Clinic, Tokyo ³Department of Gastroenterology, Kikuna Memorial Hospital, Yokohama, Japan ⁴Department of Pathology, Tokyo Metropolitan Tama Cancer Detection Center, Tokyo キーワード：胃癌 , X線診断 , 早期胃癌 , linitis plastica , 原発巣 Keyword: 胃癌 , X線診断 , 早期胃癌 , linitis plastica , 原発巣 pp.751-763

発行日 2008年4月25日 Published Date 2008/4/25

DOI https://doi.org/10.11477/mf.1403101362

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要旨　linitis plastica（以下，LP）型胃癌の自然史について，原発巣の形態学的・病理組織学的分析とX線学的遡及例をもとに検討した．LP型49例を原発巣の性状から，原発巣が胃底腺領域に発生した胃底腺領域型19例と腺境界部に発生した腺境界領域型20例に大別した．前者の原発巣は，大きさが25mm以下で陥凹は深く，組織型はすべて未分化型腺癌であった．これに対して後者の原発巣は，大きさが50mm以上で陥凹は浅く，組織型は未分化型腺癌が多かったが，なかには中～高分化型腺癌と未分化型腺癌との組織混在型を示すものがあり，20例中5例に認めた．この結果から，腺境界領域に発生した組織混在型胃癌のうち一部は，LP型胃癌に類似した発育進展形式をとることが推測された．X線的遡及例からは，typical LPは，胃体部の管状狭窄と特徴的な悪性レリーフを呈し癌浸潤が漿膜面に露出していた．その1年前は，ひだの肥大は広範囲に及んでいたが，胃壁の伸展障害は局所的であり，latent LPの状態を呈していた．typical LPが形成される少なくとも3年以上前のX線像では，原発巣の陰影斑は，ひだ集中を伴わないⅡc様の所見として現れており，その時点では深達度はm～smと推定された．

　Thirty nine cases with the ‘Linitis plastica’ type of gastric cancer were pathologically and radiologically analyzed in an attempt to enable earlier diagnosis and to select right effective therapy.

　The following results were obtained:

　1. Pathological analysis suggested: (1) that the primary focus of linitis plastica cancer occurring at the fundic gland area in 19 cases, was a Ⅱc-like carcinoma of the poorly differentiated type less than 25 mm at it's largest diameter, without mucosal fold convergence, and a depth of ulceration in the focus deeper than UL-Ⅱdegree, and (2) that the primary focus of linitis plastica gastric cancer occurring at the intermediate zone in 20 cases, was a Ⅱc-like carcinoma of poorly differentiated type in 15 cases and a mixture of differentiated type in 5 cases, without mucosal fold convergence but with a focus of more than 50 mm in the largest diameter often accompanied with depression of UL-Ⅰdegree. Early diagnosis of linitis plastica gastric cancer could well be made by the detection of these cancer lesions.

　2. The radiological findings of the previous examination were retrospectively analyzed to determine the possible primary focus, and it was found that in about 70％of cases with linitis plastica gastric cancer, the focus could have been detected 2 to 3 years earlier if the findings had been more carefully interpreted. The results suggest that the primary focus of linitis plastica gastric cancer can be detected and the depth of invasion at the time of possible detection was estimated to be limited to the proper muscle or subserosal layer.

　Thus, radiological manifestations of cancerous lesions involving the proper muscle layer in the growth of linitis plastica gastric cancer can be defined by pathological and radiological analysis, and early diagnosis of linitis plastica gastric cancer can be made by detecting these radiological manifestations.