スキルス胃癌の特徴と診断の基本―内視鏡の立場から

Endoscopic Diagnosis Based on Typical Findings of Scirrhous Gastric Cancer

要旨　典型的なスキルス胃癌の内視鏡所見の特徴は，伸展不良，ひだの変化（巨大皺襞，ひだ肥厚，直線化，蛇行，横走ひだ），primary lesion（初期病変）の存在である．特にひだの所見は，巨大皺襞や伸展不良を来す他疾患との鑑別に重要であり，その特徴を知ることが重要である．当院のスキルス胃癌41例の検討ではひだ肥厚，蛇行所見の出現頻度は胃底腺領域型で81％，幽門腺領域型で44％であった．横走ひだは両者とも約10％の症例で認められ，area模様の拡大所見は前者のみ，16％に指摘できた．幽門腺領域に発生するスキルス胃癌はひだの変化を伴いにくく，幽門狭窄を来しやすい傾向があった．

　The characteristic findings of scirrhous gastric cancer are poor distension of the gastric wall, morphological changes of folds（giant, swelling, straightening, furrowed, and crossing folds）, and the presence of the primary lesion（usually a small depression）. Particularly, morphological changes of folds are important to distinguish it from the other diseases which demonstrate giant folds or poor distension. According to our analyzed 41 cases of scirrhous gastric cancer, swelling or furrowed folds are recognized in 81％ of cases arising in the fundic gland area, but in 44％ of cases arising in the pyloric gland area. Crossing folds are recognized in about 10％ of both types and enlarged gastric area pattern is noticed in 16％ of the latter type. Scirrhous gastric cancer arising in the pyloric gland area doesn’t demonstrate frequently distinct morphological changes of folds, but is liable to manifest pyloric stricture.