逆追跡されたスキルスの原発巣と経時的変化―X線診断の立場から

Retrospective Radiological Study of Linitis Plastica: Primary focus and growing process

　スキルスのX線学的早期発見の診断は固まっていない．したがって，臨床では，心ならずも，スキルスの経過をみてきた実態がある．早期発見が難しいのは，次のようなことがあるからである．

　部位：病変が胃体部から噴門の領域にある，大彎側に寄っている，または，前庭部に限局する．X線検査のときに，きれいな写真を撮りにくい部位である．

　Of 498 patients with advanced gastric cancer detected and operated upon in our department in the past 11 years (December 1968～December 1979), linitis plastica type was encountered in 81 (16.3%). Seven of the 81 patients had a previous barium meal study done 2～90 months (an average of 30 months) prior to the establishment of a diagnosis of linitis plastica.

　In this paper, radiographs of previous barium meal studies in the 7 patients were retrospectively reviewed in order to search a primary focus and growing process of linitis plastica type cancer

　Various mucosal abnormalities could be retrospectively detected on the radiographs of previous barium meal studies in all the 7 patients, two patients were retrospectively thought to have early cancer and another 3 were also considered as having Ⅱa+Ⅱc or Ⅱc+Ⅲ like advanced cancer. X-ray findings of these 5 patients do not include any pathognomonic features suggesting that cancers develop into linitis plastica. In the remaining 2 patients, a diagnosis of localized diffuse type carcinoma was retrospectively made.

　It is suggested by the retrospective radiological analyses of linitis plastica that there are two different developing patterns into linitis plastica from its early form as follows: type (1) cancerous infiltration first reaches down to the submucosa mainly around the ulceration and spreads over the submucosa or far deeper layers, and type (2) cancerous infiltration first spreads over the mucosa and then reaches down to deep layers. Type 1 developing pattern was seen in a patient with linitis plastica at the fornix, body and antrum, while type 2 pattern was encountered in a patient with linitis plastica at the body and antrum.

　Thus, early focus of linitis plastica could be retrospectively diagnosed as being cancer but there could not be found any pathognomonic features suggesting that it would grow up to linitis plastica.