びまん浸潤型胃癌と鑑別を要する炎症性病変

Differential Diagnosis of the Inflammatory Gastric Diseases and Diffuse Infiltrating Carcinomas

要旨　びまん性変化を呈し，びまん浸潤型胃癌（スキルス）との鑑別を要する炎症性胃疾患について述べた．びまん性病変の基本的な捉え方と考え方は1．病変の部位と範囲を決め，2．病変を胃壁における場で分けて考え，すなわち主に粘膜面および粘膜下層の急性浮腫性変化であるびらん，小潰瘍，ひだの腫大と主に粘膜下層以深の線維性変化である胃壁の硬化（伸展不良，変形）に分けて所見の程度を判定し，3．この粘膜面の変化と胃壁の硬化の程度とを組み合わせて種々の疾患の鑑別を行うことである．胃壁の硬化は急性胃炎や特殊な感染症や帯状胃潰瘍で認められ，ひだの腫大は肥厚性胃炎が最も多く，急性胃炎やMénétrier病においても認められる．これらの所見はX線による二重造影像あるいは圧迫像で容易に捉えやすくびまん浸潤型胃癌と鑑別しやすい．急性病変では発症の仕方（急性発症した激痛や吐血など）や薬（NSAID，抗生物質など）の服薬歴，アルコールや食品（サバなど）の摂取歴も鑑別診断に役立つ．

　From the morphological point of view, inflammatory diseases of the stomach were discussed for the sake of differentiating them from diffuse infiltrating carcinomas. The findings of rigidity of the gastric wall and giant folds were characteristic in diffuse infiltrating carcinomas. But the former pathologically caused by fibrosis of the submucosa or adhesion of the serosa was also recognized in corrosive gastritis, infectious disease (syphillis), trench ulcers and acute pancreatitis. On the other hand, the latter caused by inflammation and edema of the mucosa and submucosa were often recognized in hypertrophic gastritis, acute gastritis and Ménétrier's disease. To discuss whether these findings exist or not on x-ray examination was very useful for differential diagnosis. It was also important to ask the patient about the onset of their symptoms, medication and foods. Most of the findings improved after therapy in inflammatory diseases.