逆追跡症例からみた“pre-linitis plastica”型胃癌の形態的特徴

The Endoscopical and Radiological Findings of Pre-linitis Plastica Type Gastric Cancer

要旨　linitis plastica型胃癌のより早期の像について逆追跡的検討と比較的限局したびまん性浸潤癌切除例の検討から，pre-linitis plastica型胃癌の形態は，多くは胃底腺粘膜領域に存するひだ集中のないpunched out ulcer，または小さいⅡc様所見であり，陥凹周囲にわずかの隆起所見を伴うのが特徴であった，またこれより更に早期の所見（leather bottle状態より21か月前）は褪色した小さいⅡc様所見であった．毎年，年1回の内視鏡検査を注意深く施行することによって，早期診断は可能であると思われた．

　In order to evaluate the development of pre-linitis plastica with reference to the extent of submucosal spread not exceeding one-fourth of the stomach in size, we have studied six cases retrospectively, and three cases resected at the localized infiltrating stage.

　The result were as follows; 　1) In most cases the primary lesion was located in the fundic gland area.

　2) The indications of pre-linitis plastica type gastric cancer were punched out ulcer or Ⅱc like lesion without converging folds in the fundic gland area, and the depressions were associated with surrounding elevation. This sorrounding elevation was the characteristic that suggests infiltrating gastric cancer.

　3) In one case, before an ulcerated lesions was observed, a discolored small Ⅱc like lesion was observed endoscopically in the fundic gland area (Case 6, Fig.11 a). This lesion was observed 21 months before leather-bottle stomach was verified. If we carry out endoscopic examination carefully every year, it seems that we can find the early lesion of linitis plastica type gastric cancer.