スキルス胃癌と鑑別を要する腫瘍性疾患―胃悪性リンパ腫

Differential Diagnosis of Gastric Lymphoma from Scirrhous Carcinoma of the Stomach

要旨　胃悪性リンパ腫のうち，肉眼型が巨大皺襞型を呈する症例はスキルス胃癌との鑑別を要する．低悪性度胃悪性リンパ腫は巨大皺襞型を呈する症例はなく，aggressive lymphomaの一部がこのような形態を示す．いずれも皺襞の腫大を認めるが，胃壁の伸展性が保たれているか否かが最も重要な鑑別のポイントである．胃壁の伸展性は内視鏡よりもX線造影検査のほうが評価しやすい．病変内の潰瘍の形態だけでは両者の鑑別が難しい場合がある．生検による鑑別は有用であるが，生検の採取部位に留意する必要がある．

　When we encounter patients who have gastric tumor with giant fold, we must carefully distinguish between giant fold type of primary gastric lymphoma（GFPGL）and scirrhous carcinoma of the stomach（SC）. Extensibility of the affected gastric wall is the most important differential point between them. An affected gastric wall of GFPGL usually preserve good extensibility under air injection compared with that of SC. X-ray examination has an advantage over esophagogastroduodenoscopy concerning evaluation of the extensibility of the affected gastric wall. The form of the ulceration of the tumor is not a very convincing differential point. Histological examination is a useful procedure to make a correct diagnosis, but we must take biopsy specimens from a suitable part of the tumor.