びまん浸潤型胃癌と鑑別を要する炎症性疾患

Non Neoplastic Gastric Lesions Mimicking Diffusely Infiltrating Gastric Cancer

要旨　過去22年間にびまん浸潤型胃癌と鑑別を要した非腫瘍性病変のX線・内視鏡所見を検討した．潰瘍性病変を主体とする壁内線維化群11例（胃梅毒，腐食性胃炎，部分的脾動脈塞栓術後の胃病変）では伸展不良の程度はびまん浸潤型胃癌と同様であったが，粘膜面の変化がより顕著であった．一方，胃壁外の炎症を主体とする壁外群5例（Crohn病，膵炎ないし結核性腹膜炎）では癌よりも伸展不良の程度は軽く皺襞腫大も軽度であった．これに対し，浮腫ないし皺襞腫大を主体とする壁内非線維化群15例（胃アニサキス症，急性胃粘膜病変，Ménétrier病を含む巨大皺襞性胃炎）では，伸展不良を欠如するかあっても軽度で，粘膜面の変化に乏しかった．したがって，胃のびまん性非腫瘍性病変では，伸展不良の程度，皺襞の性状，および粘膜面の変化に着目すれば，びまん浸潤型胃癌との鑑別のみならず質的診断がある程度可能と考えられた．

　We retrospectively analyzed radiographic and endoscopic findings of patients with non-neoplastic gastric lesions which mimicked diffusely infiltrating gastric cancer. The patients were divided into three groups ; ulcerous rigidity (group A, 11 patients ; gastric syphilis, corrosive gastritis and partial splenic embolism-induced gastric damage), nonulcerous rigidity (group B, 5 patients ; tuberculosis peritonitis and chronic pancreatitis) and edematous lesion or lesion of thickened folds (group C, 15 patients ; acute gastritis and giant fold gastritis) . Group A, there were less extensive rigidity and significant mucosal damage. In group B, variable degrees of rigidity and obvious gastric folds were noted. In group C was characterized by less severe rigidity and less severe mucosal alterations. Comparing these groups with one another and with patients with diffusely infiltrating gastric cancer one or more differences in rigidity or in mucosal change or in pattern of gastric change were able to be identified. These finidngs suggest that the degree of rigidity, mucosal change and patterns of gastric folds are valuable in distinguishing diffusely infiltrating gastric cancer from nonneoplastic diffuse gastric pathology.