“pre-linitis plastica”型胃癌の内視鏡所見の検討

Endoscopic Study on Gastric Cancer of Pre-linitis Plastica Type

要旨　linitis plastica型胃癌を初期像（“pre-linitis plastica”）の段階で発見するための検討を行った．遡及的追跡例の内視鏡フィルム再検討では，胃底腺粘膜領域の皺襞の局所的な太まりや屈曲，蛇行などの所見に隠れて，小さな陥凹病巣の存在が疑われた．切除した胃底腺領域の深達度smおよびmpの未分化型癌78例中，癌浸潤範囲が粘膜内より粘膜下で広く，粘膜下の線維化より癌が広いpre-linitis plastica型は14例（17.9％）であった．非pre-linitis plastica型と比較してpre-linitisplastica型は癌巣径，粘膜内癌巣径ともに小さく，mp癌の比率が高く，内視鏡的には陥凹面が比較的平滑で，全周が隆起で取り囲まれているものが多かった．

　In order to clarify the features of gastric cancer of linitis plastica type in the early stage (pre-linitis plastica), we investigated followed‐up and resected cases. Endoscopic review of linitis plastica in followed-up cases showed pre-linitis plastica would be suspected if a small-depressed lesion was detected with slightly thickened and tortuous gastric folds hidden in the fundic gland area.

　Of 78 resected cases of undifferentiated-type gastric cancer, invading the submucosa or the muscularis propria and located in the fundic gland area, pre-linitis plastica was verified in 14 cases (17.9%). It was defined histologically as a lesion in which submucosal invasion of the cancer was not only more extensive than the mucosal spread of the cancer but also more extensive than submucosal fibrosis. In cases of pre-linitis plastica type, the size of the tumors and the diameter of the mucosal spread were smaller than non pre-linitis plastica types and cancer cells invaded the muscularis propria more often than in non pre-linitis plastica types. Endoscopically, the depressed lesions of pre-linitis plastica had smooth surfaces and were surrounded with circumferential protrusions.