胃癌の発生部位別にみた癌の胃壁浸潤に関する臨床病理学的研究

A Clinicopathological Study on Infiltrating Pattern of Gastric Cancer in Relation to its Site of Origin

　おおよそ胃癌の診断レベルは，その極致に達したかにみえるが，日常の臨床の場においては今日でもなおlinitis plastica状態になって外来受診する患者の数は少なくない．さらにまた，こういった患者がわずか数カ月前に胃X線検査を受け何らの異常所見を指摘されなかったという事実を聞くに及んで切歯拒腕することもわれわれは少なからず経験している．本研究はこのような状況のなかでlinitis plastica状態の胃癌の早期診断を目的としたものである．

　具体的には，胃癌は粘膜から発生し経時的に縦と横への三次元的な発育を示すから，この胃壁浸潤の型式を組織型と胃癌の占める粘膜領域別に検討し，さらに粘膜下浸潤部のX線診断について検討した．

　In order to clarify time-related infiltrating pattern of gastric cancer, especially that of linitis plastica, demensions ratio(m/sm↓) between intramucosaI spread (m) and infiltrated surface of the submucosa (sm) was studied on the cancerous lesions which were located in each gastric gland area, according to their histologic type (differentiated and undifferentiated).

　There was no marked difference in the dimensions ratio (m/sm↓) between the differentiated and undifferentiated cancers which were located in the pyloric gland area and the intermediate zone. The dimensions ratio (m/sm↓) of the undifferentiated carcinomas of the fundic gland area was extremely small and it was suggested that rapid submucosal invasion took place in an early phase of them. Moreover, most of the undifferentiated carcinomas of the corpus ventriculi were involved in the fundic gland area, showing very extensive submucosal involvement. These were considered to have developed finally into linitis plastica.

　For the radiologic recognition of submucosal invasion in case of linitis plastica, filling image as well as double contrast radiograph is indispensable. A detailed interpretation of filling image is very important not only to discover linitis plastica but also to determine an extent of submucosal involvement along both curvatures. An incipient phase of linitis plastica can be regarded as to be early cancer, Type Ⅱc which originates in the fundic gland area.