胃粘膜下腫瘍のX線診断―拾い上げ診断を中心に

Radiological Diagnosis of Submucosal Tumor of the Stomach

要旨　病理組織が確認できた粘膜下腫瘍46例48病変を研究材料とした．（1）隆起全体の要素：腫瘍の長径，厚さと粘膜面上での大きさ，高さとを比較し，粘膜面上20mm未満の場合，腫瘍の大きさに相関せず，粘膜面上20mmを越えると腫瘍の大きさとほぼ相関する傾向を得た．X線診断の限界は粘膜面からの高さが3mmであった．（2）隆起の辺縁の要素：山田分類による肉眼型は腫瘍の主座と腫瘍の厚さとに関係があったが，胃壁外への発育を判定できなかった．X線では山田Ⅰ型のうち主座がsmでは厚さ3mm以下，pmでは6mm以下を診断できなかった．（3）隆起の表面形態の要素：bridging foldは高率にみられたが部位に関係なかった．中心陥凹は組織学的に潰瘍形成するものに悪性の頻度が高かった．（4）X線の見逃し例の検討で辺縁の二重輪郭として描出されるものがみられた．

　The author treated 48 submucosal tumors (37 benign tumors, 7 leiomyomas and 4 metastatic tumors) of the stomach between 1969 and 1988. The size of the tumor, the site of the tumor mainly in the gastric wall, and the macroscopic appearance of the specimen were investigated from a radiological point of view and the results were as follows.

　(1) In cases of submucosal tumors less than 10 mm in size, there was no correlation between the size of the tumor and the macroscopic view of the specimen. The sumucosal tumors with a height of more than 3 mm macroscopically were pictured by x-ray. It seems that the limits of diagnosis may be placed at 3 mm in height.

　(2) Yamada's classification was provided for the site and the thickness of submucosal tumors and it is impossible for it to diagnose exogastric tumors.

　(3) The central depression consisting of ulceration was highly suspected malignant submucosal tumor.

　(4) Radiological findings of flat and small submucosal tumors overlooked by x-ray were recognized as double contours or faint radiolucent shadows.