Scirrhous carcinoma of the stomach versus hypertrophic gastritis: findings at endoscopic US.

To differentiate scirrhous carcinoma from hypertrophic gastritis, 16 patients with scirrhous carcinoma of the stomach and seven patients with hypertrophic gastritis were examined with endoscopic ultrasonography (US) between August 1987 and October 1990. US images of the normal gastric walls of 16 patients with gastric ulcers served as controls. Characteristic features of scirrhous carcinoma included an irregular hypoechoic enlargement of the third (submucosa) and fourth (muscularis propria) layers. The mean thickness of the third and fourth layers was increased sixfold and threefold, respectively, compared with thickness in healthy subjects. In the patients with scirrhous carcinoma, the mucosal layer remained normal in appearance at US, and it was possible to distinguish the five-layer structure of the gastric wall. These findings were prospectively correlated with histopathologic findings in the resected specimens. In contrast, only the mucosal layer was thickened in cases of hypertrophic gastritis. Recognition of these patterns at US can aid in the differential diagnosis of scirrhous carcinoma and such benign diseases as hypertrophic gastritis with a thickened gastric wall.