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要旨 内視鏡技術の発展やESDの普及により,早期胃癌の診断・治療の質は向上している.一方,近年,早期胃癌の中で境界不明瞭な病変が注目されてきている.境界不明瞭となる原因は腫瘍の全体,あるいは一部が隆起・陥凹を伴わないIIb型の進展をしていることである.IIb進展が認められる腫瘍は組織学的には,いわゆる“手つなぎ型”と呼ばれる中分化型腺癌や,表層が分化型で,浸潤部が低分化型の腫瘍(未分化混合型)が挙げられる.これらの病理学的特徴としては粘液形質が胃型あるいは胃優位型が多いことを認識しておく必要がある.早期胃癌の治療に際し,このような腫瘍の存在を念頭に置きつつ治療方針決定に当たる必要がある.
Recent advances in imaging diagnosis, endoscopic technology and endoscopic submucosal dissection(ESD)have provided improvement in diagnosis and treatment of early gastric cancer. Based on these advances, a lot of endoscopists have focused on cases of intramucosal gastric cancer with ill-defined margins. One of the significant causes of the ill-defined cancer margins is that the cancers have absolutely flat areas, i.e. areas of IIb-type intramucosal spreading cancer. Histopathologically, the IIb-type intramucosal spreading areas are frequently composed of(a)moderately differentiated tubular adenocarcinoma in a fused-gland pattern or(b)well differentiated tubular adenocarcinoma associated with invasive poorly differentiated components. These IIb-type adenocarcinomas mainly show gastric phenotype with mucin. When gastric biopsy shows gastric-phenotype adenocarcinoma, early gastric cancer with IIb-type ill-defined margin should be listed as one of the main differential diagnoses.
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