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Stomach and Intestine(Tokyo) Volume 15, Issue 11 （November 1980）

胃と腸 15巻11号（1980年11月発行）

Japanese English

今月の主題逆追跡された胃のlinitis plastica―早期発見のために(1)

主題

Linitis plastica状態の胃癌の臨床経過の検討―癌の発育曲線と臨床経過の比較検討 A Study of the Clinical Course of Linitis Plastica Type Cancer of the Stomach: Comparison between the clinical course and the development curve of gastric cancer 杉山憲義 ¹ , 馬場保昌 ¹ , 竹腰隆男 ¹ , 丸山雅一 ¹ , 佐々木喬敏 ¹ , 二宮健 ¹ , 大橋計彦 ¹ , 田尻久雄 ¹ , 横山善文 ¹ , 権藤守男 ¹ , 大崎康世 ¹ , 高木国夫 ² , 加藤洋 ³ , 中村恭一 ^3,4 , 小松原登 ⁵ N. Sugiyama ¹ , Y. Baba ¹ , K. Takagi ² , K. Nakamura ^3,4 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 ⁵佼成病院内科 ¹Department of Internal Medicine, Cancer Institute Hospital ²Department of Surgery, Cancer Institute Hospital ³Department of Pathology, Cancer Institute Hospital pp.1153-1163

発行日 1980年11月25日 Published Date 1980/11/25

DOI https://doi.org/10.11477/mf.1403112757

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　胃癌の診断法が完成に近づいているなかで，いまだにその牙城のべ一ルを取り去ることのできない領域が残っている．

　それがlinitis plastica状態の胃癌である．臨床病理学的には，linitis plastica状態の胃癌は，胃底腺粘膜領域から発生した未分化型癌からなる確率が高いことはわかっているが，どのような条件で，そしてどのような経過で完成されていくかについては，いまだ十分に解明されていない．

　1) Clinical observations have been made on 13 cases of linitis plastica type cancer of the stomach, of which 8 cases were operated on and 5 cases were not operated on. The clinical course of these cases is studied comparing with the development curve of gastric cancer.

　2) Linitis plastica type cancer is defined as follows: no localized tumor exists as a primary lesion; the extent of submucosal spread of cancer doubles or more in size than that of intramucosal spread of cancer. It is subdivided into three: typical linitis plastica with the extent of submucosal spread of cancer exceeding more than one-fourth of the stomach in size and with the narrowing of the gastric lumen: latent linitis plastica with the extent of submucosal spread of cancer exceeding more than one-fourth of the stomach in size and without the narrowing of the gastric lumen; and pre-linitis plastica with the extent of submucosal spread not exceeding one-fourth of the stomach in size.

　3) Primary lesions are located in the body in 11 cases, and in the angle in 2 cases.

　4) Depressed lesions, i.e. the primary lesions, are delineated on the radiographs at the first x-ray examination in 8 cases, and they are not delineated in the other 5. In the former group 3 out of 8 cases present the findings of Ⅱc or Ⅱc-like cancer and 5 out of 8 cases reveal the thickening and zig-zagging of the mucosal folds surrounding a depression.

　5) Compared with Nakamura's development curve of gastric cancer, 7 out of the operated or autopsied 9 cases show approximately the same development curve. Especially the similarity is marked in 3 cases in which the development of m is measurable.

　6) Early diagnosis of linitis plastica type cancer depends on the detection of erosion (Ⅱc) in the fundic gland area on the greater curvature of the body.