Linitis plasticaの原発巣についての病理組織学的研究―胃底腺粘膜から発生した癌とlinitis plasticaとの関係

Histopathological Study on Primary Locus of Linitis Plastica: Relation between carcinoma arisen from the fundic gland mucosa and linitis plastica

　胃癌のうちで最も予後の悪い型とされている“Linitis plastica”はBrinton（1865）によって命名されたのであるが，当時はlinitis plasticaの成り立ちについて，炎症および癌腫の両方が考えられていた．その後，Saphir and Parker（1943）はlinitis plasticaの大部分は癌によるものであることを指摘し，そしてlinitis plasticaは胃癌の一つの状態像であることから“Linitis plastica type of carcinoma”とした．現在では，linitis plasticaは一つの独立した疾患ではなく，胃癌の一つの状態像であると理解されている．

　Linitis plastica状態の胃癌の原発巣は一般的にその形態からして不明の場合が多くその原発巣に触れている文献は極めて少ない．Saphir and Parkerは，幽門前庭部に発生した癌が胃体部へびまん性に拡がることによってlinitis plastica状態となる場合が多いと述べている．Stout（1953）は，linitis plasticaは胃粘膜あるいは異所性胃粘膜から発生した癌が胃壁全層をびまん性に拡がった状態である，とのみ記載している．最近，佐野ら（1974）はⅡc型のある癌がlinitis plastica状態になると述べている．

　The carcinoma arising from the fundic gland mucosa is very important, because it has a close connection with so-called “Linitis plastica (Leather bottle stomach)”. Its connection is demonstrated by two conditional syllogisms (Table 12).

　Namely, the histological type of carcinoma arising from the fundic gland mucosa is of undifferentiated variety (Table 6) (Figs. 8～11) 〔Table 12-(1)〕, and the undifferentiated carcinoma can sometimes reach on an advanced phase, linitis plastica 〔Table 12-(2)〕. Accordingly, the carcinoma arising from the fundic gland mucosa can develop into linitis plastica (Figs. 2, 3 and 4～7) 〔Table 12-(3)〕.

　However, converses are not generally true. In other words, the undifferentiated carcinoma arises not only from the fundic gland mucosa but also from the pyloric gland mucosa. To assert a close connection between carcinoma arising from the fundic gland mucosa and linitis plastica, it is necessary to demonstrate that primary locus of linitis plastica is frequent in the upper half of the stomach 〔Table 12-(4)〕. because its portion except the lesser curvature site is usually lined by the fundic gland mucosa 〔Table 12-(5)〕. The upper half of the stomach predominates in primary locus of linitis plastica (Tables 3 and 5). Accordingly, it is able to say that major part of linitis plastica developed from the fundic gland mucosa 〔Table 12-(6)〕.

　As mentioned above, there is a close connection between carcinoma arising from the fundic gland mucosa and linitis plastica 〔Table 12-(7)〕. It is clinically difficult to disclose a small lesion in the upper portion of the stomach except the lesser curvature site. Therefore, the undifferentiated carcinoma arising from the fundic gland mucosa is shown to be “Linitis plastica” in many instances.