X線学的にみた胃癌の発育進展過程

A Study of Growing Pattern of Gastric Cancer Based on Retrospective Evaluation of X-ray Findings

要旨　国立がんセンター病院において胃切除の行われた胃癌症例のうち，国立がんセンター放射線診断部で撮影された直接胃X線写真により，1年以上の逆追跡が可能であった進行胃癌30例，早期胃癌46例を対象としてX線学的な胃癌の発育進展過程の検討を行った．X線学的にはBorrmann 2型，3型，Ⅱc類似進行癌ともに，先行病変としてⅡcを認めるものが多かった．そのⅡcにはBorrmann 2型，3型とⅡc類似進行癌の間に明瞭な相違はみられなかった．早期胃癌，進行胃癌の発育過程での形態変化をみると，隆起を主徴とするものは初期より隆起型として経過し，陥凹を主徴とするものは初期より陥凹型として経過するものがほとんどであった．かつ，経過の間に径の増大を示すものが多かった．

　Thirty cases of advanced and 46 cases of early gastric cancer were collected. The records of upper GI x-ray examination, at least one year or more prior to operation, are kept at the National Cancer Center, and the quality of the x-ray pictures is good enough for us to evaluate the delicate mucosal pattern. Cases of linitis plastica type advanced cancer, and cancer at the gastric stump were excluded from this study.

　The abnormality preceding Borrmann 2, 3 and Ⅱc-like advanced cancer most commonly culminated in the Ⅱc type. However, the configuration of the abnormality preceding this Ⅱc type does not differ specifically from the configuration of the abnormality preceding the Borrmann 2, 3-like advanced cancer.

　On the other hand, protruded advanced cancer such as Borrmann1 was preceded by a small and faintly elevated mucosal lesion such as is found in minimal Ⅱa type. The size of the mucosal abnormality gradually increases and consequently becomes the tumor.

　It may be concluded that the initial changes of mucosal pattern in cases of protruded type carcinoma can be said to be minimal faint mucosal elevations. In cases of depressed type carcinoma, the mucosal abnormality can be said to be a very shallow mucosal depression.