粘膜下腫瘍の形態を示した胃癌のX線診断

Radiological Study of Gastric Cancer with the Appearance of a Submucosal Tumor

要旨　粘膜下腫瘍の形態を示した低分化腺癌の2例，膠様腺癌の1例，リンパ球浸潤性髄様癌の2例を挙げ，主にこれらの症例のX線所見について述べた。報告症例と照らし合わせてみても，呈示した症例はこれらの症例にみられる特徴的な所見を備えていた．低分化腺癌の充実型では，クラーテルの形，辺縁の不整，硬さ，また周堤，腫瘍の形のいびつさ，硬さ，表面の凹凸不整から悪性リンパ腫との鑑別が可能である．膠様腺癌では柔らかな腫瘍の表面に浅い陥凹がみられ，その描出，診断に難しさがある．リンパ球浸潤性髄様癌では，硬い感じのする腫瘤の表面に浅い不整陥凹がみられた．また，腫瘤と陥凹に位置的なずれが認められた．これらの症例では，腫瘤の形，表面の性状，またX線的な硬さ，そして陥凹の形，硬さ，またその辺縁の微細な不整さを描出するとX線診断上，胃癌の診断が可能である．

　Two cases of poorly differentiated adenocarcinoma, one of mucinous adenocarcinoma and two of medullary carcinoma with lymphoid stroma were presented with special attention to their radiological findings. They showed the characteristic features described in other reported cases.

　In the case of the medullary type of pooly differentiated adenocarcinoma, the differential diagnosis from gastric malignant lymphoma should be made taking into consideration the shape of the ulcer crater, marginal lrregularity and rigidity of the crater, the irregular formation of the ulcer mound and submucosal mass, and the irregularity and rigidity of the surface over the submucosal mass. In the case of mucinous adenocarcinoma, it was rather difficult to discern its soft submucosal mass with shallow depression. In the cases of the medullary carcinoma with lymphoid stroma, characteristic findings were submucosal mass with stiffness of shape and surface and shallow irregular depression.

　It is possible to arrive as a correct diagnosis of gastric cancers when their shape and surface charcteristics, radiological stiffness, depressed configuration with irregularity and stiffness are well demonstrated radiologically.