肉眼所見からみた胃潰瘍の良・悪性の鑑別診断

Macroscopic Differential Diagnosis of Ulcerating Lesion of the Stomach

要旨　開放性潰瘍性病変の良・悪性の肉眼診断の問題点を知る目的で，開放性潰瘍を有する早期癌160個と開放性潰瘍392個を用いて肉眼的誤診を来しやすい所見を抽出した．癌の肉眼診断は粘膜内進展部と粘膜下層癌塊の判定に分けられた．粘膜内進展部の判定では(1)癌の見落とし，(2)癌と非癌（再生粘膜，随伴性胃炎，腺境界など）との鑑別が，粘膜下層癌塊の判定では(1)癌塊と浮腫・線維症の鑑別，(2)未分化型癌と線維症の皺襞集中像の鑑別が指摘された．癌の深達度判定では，過小診断には(1)粘膜下層への微少浸潤が，過大診断には(1)活動期潰瘍の浮腫，(2)治癒期潰瘍の線維症，(3)治癒期潰瘍の皺襞集中像が関与することが多かった．開放性潰瘍性病巣の肉眼診断では，消化性潰瘍の各時相での肉眼所見と，癌の組織型別にみた肉眼所見の違いとを組み合わせて肉眼所見を分析することが重要であった．

　One hundred and sixteen early gastric cancers with open ulcer (type Ⅲ, Ⅲ+Ⅱc, and Ⅱc+Ⅲ cancers) and 392 open benign gastric ulcers were examined to make macroscopic differential diagnosis of ulcerating lesions of the stomach. Macroscopic diagnosis of cancers of these types depended on detecting intramucosal cancer spreading and submucosal cancer mass around the ulcer. As concerns macroscopic diagnosis of intramucosal cancer, it is important to avoid overlooking cancerous lesion and to differentiate between cancer and benign lesions such as regenerating mucosa, ulcer-associated gastritis and glandular border line. As concerns macroscopic diagnosis of submucosal cancer mass, it is important to differentiate between cancer mass, edema, and fibrosis due to associated ulcer, and ascertain whether converging mucosal folds were due to undifferentiated scirrhous cancer or due to fibrosis after associated ulcer. Macroscopic diagnosis of depth of cancer invasion was affected by amount of submucosal cancer mass, and edema, fibrosis and converging mucosal folds due to asociated ulcer.