体外式超音波が診断に有用であったスキルス胃癌

Sonographic Diagnosis of Scirrhous Gastric Cancer, Report of a Case

要旨●患者は80歳代，男性．食思不振と体重減少を主訴に受診した．体外式超音波では胃体部から前庭部まで胃全体に層構造が温存された連続性びまん性の壁肥厚と硬化が描出され，特に幽門部に強い内腔の狭小化を伴っていた．上部内視鏡検査においても壁の伸展不良とひだの肥厚がみられたが，計3回の生検はいずれも陰性であった．姑息的胃全摘術が施行され，最終的にスキルス胃癌（por>sig）と診断されたが，超音波像はその病理組織学的所見をよく反映していた．スキルス胃癌のスクリーニングおよび診断において，体外式超音波は有用な補助的診断法となることが示唆された．

　A man in his 80s was admitted to our hospital due to anorexia and weight loss. However, physical examination showed no remarkable abnormalities. Most of his laboratory data were within normal limits, except for Hgb（the hemoglobin level）at 9.2g/dL, which was an indication of anemia. The transabdominal ultrasound showed diffuse gastric wall thickening of the whole stomach, accompanied by luminal narrowing. Wall stratification was demonstrable despite irregular thickness of each layer and blurred margins between layers. Moreover, strain elastography showed increased stiffness of the gastric wall. Although the preoperative diagnosis was not confirmed by frequent biopsies, surgical resection was executed, and the result of the histopathological examination of the resected specimen revealed scirrhous gastric cancer（por>sig）. The sonographic feature of the lesion represented the rough histopathological findings of the resected specimen. As introduced in this case, it is not always easy to come up with a definitive diagnosis of scirrhous gastric cancer through a biopsy. Hence, transabdominal ultrasound can be a useful diagnostic method.