逆追跡されたスキルス胃癌の1例

Retrospective Investigation of a Case of Scirrhous Gastric Carcinoma, Report of a Case

要旨●幽門腺領域から発生し幽門狭窄を来したスキルス胃癌症例を内視鏡的に振り返り，所見の検討を行った．一般にスキルス胃癌の診断は，①粘膜ひだの腫大・蛇行・横走ひだなどの走行異常，②胃壁の肥厚と硬化，③原発巣のびらん・潰瘍形成，の3点が重要である．本症例はひだの所見，伸展不良が出現するまでの経過と原発巣の初期像が捉えられた貴重な症例であった．胃体部のひだの変化は腫大する前の段階で走行異常として指摘することができ，初期病変は通常観察では褪色調の平坦な領域として，色素撒布像でわずかな溝状の微小陥凹として認識できた．

　The purpose of this case study was to do a retrospective analysis of the endoscopic findings of a scirrhous gastric carcinoma derived from the pyloric gland region and causing pyloric stenosis. In general, the diagnosis of scirrhous gastric cancer relies particularly on the following three points：（1）swelling of mucosal folds and abnormal running such as meandering and lateral folds,（2）thickening and hardening of the stomach wall, and（3）erosion and ulceration of the primary lesion. This case was particularly informative since the initial image allowed observation of the primary lesion before the appearance of the fold features and poor extension were observed. By white light observation, the initial lesion was recognized as a flat area with a fading tone, and dye-spraying revealed a slight groove-shaped micro-depression in the area.