スキルス胃癌と鑑別を要する非腫瘍性疾患―好酸球性胃腸炎

Differential Diagnosis of Eosinophilic Gastroenteritis from Scirrhous Carcinoma of the Stomach

要旨　好酸球性胃腸炎は，好酸球浸潤の部位や程度によりさまざまな症状と検査所見を呈し，特異的な所見もないため確定診断に到達できないこともある．なかでも粘膜および筋層に優位な病変が存在すると，スキルス胃癌との鑑別が必要となる場合があり，注意を要する．本疾患の存在を認知し，アレルギー疾患の既往や末梢血好酸球の増多などから本疾患の可能性を念頭に置くことが鑑別診断において重要である．病変が粘膜優位であれば，数か所の粘膜生検により診断は可能であるが，筋層以深に優位である場合は全層生検や，腹水採取が必要になることもある．

　Eosinophilic gastroenteritis displays many kinds of symptoms and findings according to the region examined and the degree of eosinophil infiltration. We sometimes can not make a definite diagnosis, because it displays no specific symptoms and findings. We must evaluate these findings very carefully to differentiate between scirrhous carcinoma of the stomach and eosinophilic gastroenteritis especially when eosinophil infiltration is predominant in the mucosal layer and muscle layer. It is necessary to know and recognize eosinophilic gastroenteritis and to list it in the differential diagnosis when a patient with abdominal symptoms has a history of allergy disease and, or increase of eosinophil in peripheral blood. Predominant mucosal layer disease can be diagnosed by taking some biopsies from the gastric mucosa, but predominant muscle and subserosal layer disease may need full-thickness biopsy or an ascites sample.