早期胃癌診断の実際―ひだ集中のない陥凹性病変：X線所見

Clinical Diagnosis of Early Gastric Cancer: Roentgenographic Findings of Depressed Lesions without Converging Folds

要旨　ひだ集中のない陥凹型早期胃癌の基本的所見と鑑別診断についてX線検査の立場から述べた．陥凹面の境界，陥凹底の所見が質的診断および浸潤範囲の診断に重要である．本症はある程度しっかりした輪郭を有する陥凹面を有し，その辺縁は蚕食像あるいは虫食い像と呼ばれる不整な境界を呈する．この所見はX線像では境界に不整な凹凸がみられるバリウム斑として描出される．この基本的な所見を十分に理解したうえで鑑別診断が行われる．鑑別診断は悪性リンパ腫，胃潰瘍，びらん，急性胃粘膜病変，胃梅毒，陥凹型腺腫，限局性の慢性胃炎，異所性胃底腺粘膜，成人T細胞白血病，Crohn病の胃病変などが重要である．

　We described the fundamental findings for differential diagnosis of depressed type early gastric cancers without converging folds. For clinical diagnosis, it is important to assess the findings of the margin and depressed area. Depressed type early gastric cancers without converging folds reveal, macroscopically, generally depressed areas with the obviously clear and irregular margins. These findings were observed roentgenographically as areas of barium with irregular margin. These findings should be kept well in mind to differentiate these lesions from other lesions i.e. malignant lymphoma, gastric ulcer, erosion, acute gastric mucosal lesion, gastric syphilis, depressed type adenoma, localized chronic gastritis, ectopic fundic gland mucosa, adult type T-cell leukemia, and gastric lesions of Crohn disease.