Imaging Diagnosis of the Extent of Esophageal Invasion of Gastric Carcinoma, from the Viewpoints of Radiologic and Endoscopic Diagnosis Takashi Ohyama 1 , Yasumasa Baba 1,2 1Department of Internal Medicine, Cancer Institute Hospital Keyword: 噴門部 , 胃癌 , 食道浸潤 , X線診断 , 内視鏡診断 pp.1039-1052
Published Date 1997/7/25
DOI https://doi.org/10.11477/mf.1403104966
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 Seventy-two cases (72 lesions) of the gastric carcinoma with histologically proven esophageal invasion were analyzed clinicopathologically (35 cases of radiological evaluation and 59 cases of endoscopic evaluation). Majority of the primary lesions was located in the C area (81%), and macroscopically the advanced type 4 (46%) and advanced type 3 (25%) were commonly seen. Concerning the depth of invasion at the oral edge of invasion, subepithelial invasion with deeper than lpm was significantly common (76.4%, p<0.01), especially invasion to the multiple layers which were located mainly in the sm layer was popular. The esophagogastric junction (EGJ) destructive type was more likely to be seen in the undifferentiated type. There were some tendency in the radiologic findings of esophageal invasion; a filling detect of the well-demarcated area (type A) was popular in the differentiated carcinoma, whereas irregular narrowing (type B) was common in the undifferentiated carcinoma. The type D which was not detected by radiological examination (six cases) had following features; most of them were undifferentiated carcinoma, length of esophageal invasion was less than 11 mm, and the depth of invasion at the oral edge was limited to the subepithelium within the lpm layer. In the endoscopic findings, the majority of epithelial invasion of the EGJ destructive type was seen as protrusion (84.6%), and a few of them were seen as depressed lesions. The only one case with epithelial invasion found in the EGJ non-destructive type was undifferentiated type carcinoma (protrusion with depression). Findings suggesting subepithelial invasion at the oral edge of invasion in the EGJ undestructive type undifferentiated carcinoma were less commonly seen than in the EGJ undestructive type differentiated carcinoma. There were seven cases whose esophageal invasion was not detected endoscopically; all of them were undifferentiated carcinoma, length of invasion was less than 12 mm, and invasion was located in single or multiple layers of lpm or deeper. Radiologic and endoscopic diagnosis should be made carefully with following points: 1) consider whether it is the differentiated or undifferentiated carcinoma,2) seek for findings suggesting epithelial invasion such as filling defects and destruction of the EGJ,3) look for findings suggesting subepithelial invasion such as narrowing, poor wall expansion, marginal abnormality, and hypertrophy of the longitudinal folds in the lower esophagus.

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