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Stomach and Intestine(Tokyo) Volume 30, Issue 10 （September 1995）

胃と腸 30巻10号（1995年9月発行）

Japanese English

今月の主題微小胃癌

主題

微小胃癌とびらんの鑑別診断 Differential Diagnosis of Minute Gastric Cancer and Gastric Erosion 冨松久信 ¹ , 藤谷幹浩 ¹ , 早川尚男 ¹ , 光永憲央 ¹ , 瀬ノ口洋史 ¹ , 河野通康 ¹ , 斎藤彰一 ¹ , 浜本順博 ¹ , 西村克人 ¹ , 加藤久人 ¹ , 高木直行 ¹ , 池延東男 ¹ , 池上雅博 ² , 和田了 ³ , 市川平三郎 ¹ Hisanobu Tomimatsu ¹ ¹早期胃癌検診協会中央診療所 ²東京慈恵会医科大学第1病理 ³自衛隊中央病院病理 ¹The Medical Assosiation for Early Gastric Cancer Detection キーワード：微小胃癌 , 小胃癌 , びらん活動期 , びらん修復期 , 鑑別診断 Keyword: 微小胃癌 , 小胃癌 , びらん活動期 , びらん修復期 , 鑑別診断 pp.1261-1278

発行日 1995年9月25日 Published Date 1995/9/25

DOI https://doi.org/10.11477/mf.1403105530

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要旨　良性びらんの個々の病変を用いて，微小・小胃癌と比較検討した．微小・小胃癌の初回診断でびらんと診断した頻度は微小胃癌20.5％，小胃癌14.3％であった．びらんの初回診断でⅡcあるいはⅡc疑いとした頻度は8.9％であった．X線検査におけるびらんと微小胃癌の鑑別点で有意差の認められた所見は，陥凹境界の形態，棘状ニッシェの有無，辺縁隆起部の粘膜性状の3項目であった．X線検査で癌が推定され，びらんとの鑑別に有用な所見は，陥凹境界の不整像，棘状ニッシェ，粗大顆粒状の辺縁隆起を認める病変であった．内視鏡検査における微小胃癌とびらんとの鑑別点は，びらん活動期では陥凹境界の形態，棘状のはみ出しの有無，辺縁隆起部の粘膜性状，色調の4項目に，びらん修復期では辺縁隆起部の粘膜性状の1項目に有意差を認めた．びらん修復期の6病変は微小胃癌との鑑別が困難であった．内視鏡検査における鑑別点で癌が推定され，びらんとの鑑別に有用な所見は，陥凹境界の不整像，辺縁隆起部の粘膜性状が平滑浮腫状でなく粗大顆粒状，棘状のはみ出しを認め，色調では強発赤を呈し，白苔の程度が軽い病変であった．

　Benign erosions were compared with the minute or small gastric cancer lesions. Twenty point five percent of minute gastric cancer and 14.3% of small gastric cancer were diagnosed as benign erosions by the initial evaluation. On the other hand, 8.9% of benign erosion was diagnosed or suspected as the type Ⅱc gastric cancer by the initial assessment. Significant differences between gastric erosion and minute cancer by the radiologic examination were the following three points: 1) shape of border around the depressed lesion, 2) presence or absence of spine-shaped extension, and 3) appearance of the overlying mucosa of the marginal elevated area. Useful radiologic findings which differentiated a cancer from an erosion were irregularity around the depressed area, spine-shaped extension, and rough granular shaped elevation around the lesion.

　Significant differences between gastric erosion and minute cancer by the endoscopic examination were as follows: in the active phase of erosion; 1) shape of border around the depressed area, 2) presence or absence of spine-shaped extension, 3) appearance of the overlying mucosa of the marginal elevated area, and 4) color; in the repair phase of erosion, appearance of the overlying mucosa of the marginal elevated area. It was difficult to exclude minute gastric cancer from six lesions of erosion in the repair phase. Useful endoscopic findings which differentiated a cancer from an erosion were as follows: 1) irregularity around the depressed area, 2) instead of smooth edematous mucosa, rough granular shaped overlying mucosa of the marginal elevated area, 3) strong reddening in the color tone, and 4) thin slough.