Changes in Endoscopic Diagnosis of Primary Malignant Lymphoma of the Stomach Minoru Kawaguchi 1 1The Fourth Department of Internal Medicine, Tokyo Medical College Keyword: 原発性胃悪性リンパ腫 , 佐野の肉眼分類 , 内視鏡診断 , 超音波内視鏡 , 内視鏡的胃粘膜切除術 , EMR pp.1053-1063
Published Date 1993/9/25
DOI https://doi.org/10.11477/mf.1403106261
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 Changes in endoscopic diagnosis of primary malignant lymphoma of the stomach were reported at our institution. In view of the high correlation of Sano's macroscopic classification with the depth of invasion, we examined the primary malignant lymphoma of the stomach according to macroscopic type.

 The depth of invasion is most likely to be sm in the superficial type, and the diagnosis of superficial-type malignant lymphoma of the stomach is most important.

 Cobblestone appearance (one of the endoscopic findings in superficial type) has already been recognized by many endoscopists, so, at present, almost all superficial-type lesions can be picked up as a lesion.

 In our institution, superficial type has represented 50% of resected malignant lymphomas of the stomach since 1987. However, we have found it important to pick up ‘shallow, depressed, localized faded areas' as lesions. In ulcerated type and excavated-type lesions, it was difficult to differentiate whether they were cancers or ulcers. However, the differentiation became possible by paying attention to the regularity of the ulcer margin, and to whether or not the tumor was submucosal etc. Pure giant-fold type and protruded type are rather rare. Diagnosis of these types has become possible by recognizing greatly varied changes of the mucosa and good extensibility, etc.

 At present, ultrasonoendoscopy is used as auxiliary diagnostic method for malignant lymphoma of the stomach in determining the depth of invasion and the presence or absence of lymph node metastasis. It is also used in evaluating the efficacy of chemotherapy.

 Endoscopic mucosal resection (EMR), which makes it possible to massively remove the lesion, is very useful for pathological confirmation of diagnosis. However, EMR should be performed carefully because it has been used in only a few patients and many problems remain unsolved.

Copyright © 1993, Igaku-Shoin Ltd. All rights reserved.


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