早期胃癌診断の実際―ひだ集中を伴う陥凹性病変：内視鏡所見

Basic Findings and Pitfalls in the Diagnosis of Early Gastric Cancer (Depressed Lesion with Converging Folds)

要旨　335病変の陥凹性早期胃癌のうち，116病変（34.6％）に集中皺襞を認めた，集中皺襞の性状としては先細りと断裂が全体の約90％を占め，先太りと癒合は10％にすぎなかった．特に，癒合はsm癌にのみ認め，sm浸潤を診断する良い指標になると考えられた．Ⅲ型を含む陥凹性早期胃癌では，潰瘍が活動期にあるとき，良悪性ならびに深達度診断に難渋することも多いが，その際，胃粘膜微細模様（fine gastric mucosal pattern；FGMP）の観察は良悪性鑑別診断に有用であると考えられた，病変の大きさと集中皺襞の数との間に相関はなく，約半数の病変で皺襞は病変の一部に偏在していた．このような症例では病変の全体像を見失わないように注意する必要がある．

　Out of 335 depressed type early gastric cancers, converging folds were recognized in 116 lesions (34.6%) .

　Tapering and abrupt cessation were properties of the converging folds, and clubbing and fusion were found more frequently with sm cancer. Fusion, especially, was recognized only with sm cancer. It seemed to be a good indicator for diagnosing sm invasion.

　In cases of depressed-type early gastric cancer of Ⅲ type, diagnosis is difficult when there is an ulcer in the active period present. However, it is possible that diagnostic accuracy can be improved by observing the fine gastric mucosal pattern of the ulcer margin.

　There is no correlation between the number of converging folds and the size of the lesion. In cases of big lesions with converging folds, care must be taken not to miss the whole image of the lesion.