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Stomach and Intestine(Tokyo) Volume 15, Issue 2 （February 1980）

胃と腸 15巻2号（1980年2月発行）

Japanese English

今月の主題腺境界と胃病変

主題

胃底腺粘膜領域の癌のX線診断 Radiologic Diagnosis of Cancer in Fundic Gland Area 杉山憲義 ¹ , 竹腰隆男 ¹ , 丸山雅一 ¹ , 馬場保昌 ¹ , 二宮健 ¹ , 田尻久雄 ¹ , 佐藤治 ¹ , 大崎康世 ¹ , 高木国夫 ² , 加藤洋 ³ , 中村恭一 ^3,4 N. Sugiyama ¹ ¹癌研究会附属病院内科 ²癌研究会附属病院外科 ³癌研究会附属病院病理 ⁴筑波大学基礎医学系病理 ¹Department of Internal Medicine, Cancer Institute Hospital pp.145-154

発行日 1980年2月25日 Published Date 1980/2/25

DOI https://doi.org/10.11477/mf.1403106712

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　胃の腺境界の重要性は，腺境界によって分かたれた各粘膜領域ごとに病変の種類も頻度も異なることであり，とりわけ胃癌では組織型や発育進展様式も異なっている．

　胃癌のなかでも胃底腺粘膜領域の癌（99％が未分化型）は他領域の癌と比べるととりわけ異なった浸潤様式を示す．胃底腺粘膜領域の癌は極めて粘膜内癌巣の小なる内に広汎な粘膜下浸潤を示す傾向がある．このことは，胃底腺粘膜領域の癌はLinitis Plastica状態になる可能性が極めて大であると言える．Linitis Plastica状態の胃癌はその切除率も低く，5年生存はほとんど不可能である．しかしながら，その発生当初はやはり早期癌であり，その時点での発見がなされればLinitis Plastica状態の胃癌の撲滅も期待できる．

　1. What we call “F”-boundary line is a line limiting the lesser curvature side border of the mucosal folds, revealed on a double contrast radiograph, which are located on the greater curvature side of the gastric body.

　The greater curvature side of F-line is fundic gland area.

　A depressed type lesion located entirely on the greater curvature side of F-line can be diagnosed as cancer.

　2. F-line revealed on a radiograph is effective in diagnosing the invasion depth and the limit of spread of cancer located in fundic gland area.

　When the spread of mucosal cancer located on the lesser curvature side of F-line measures less than 4 cm in the largest diameter, its invasion depth is, with high possibility, limited within pm. On the other hand, when mucosal cancer is located on the greater curvature side of F-line, it shows no relation between its size and the invasion depth. In many cases cancer invades into deeper layers while its size of spread stays small.

　With mucosal cancer located on the lesser curvature side of F-line, very few cases are observed in which the size of its submucosal spread measures more than double the size of mucosal lesion in their largest diameters.

　On the contrary, with the cases of mucosal cancer located on the greater curvature side of F-line, 42% of them show that the size of submucosal spread measures more than double the size of mucosa] lesion in their largest diameters.

　3. The proximal limit of subrnucosal spread has been observed on the greater curvature side in the cases we experienced.

　With a case accompanied by a slight narrowing or without narrowing, the proximal limit is discernible by the changes of mucosal folds on the greater curvature side, thus revealing the extreme limit of cancer spread.