“胃癌の三角”：場と肉眼型と組織型と

So-called "The Triangle of Gastric Carcinoma" for Diagnosing Carcinoma in Early Phase: The Relationship between the Mucosa of Cancer-development, Histologic Type, and Macroscopic Type of Carcinoma

要旨　胃癌の発生の場と組織型と肉眼型とは，F境界線の経時的変化と癌組織発生でもって強く結ばれていて，いわば“胃癌の三角（the triangle of stomachcancer）”とも言うべきものを形成している．早期胃癌診断のための基本とは，それらの関係についてである．胃癌の場と組織型と肉眼型とに関する情報は，X線・内視鏡・生検によって術前に得ることができるのであるが，それらから良質な情報が1つしか得られなくとも，“胃癌の三角”を考慮することによって他のことを推測することができる．更には，それらの術前の情報に基づいて最善の処置が可能となる．癌発生の場｛F線内部領域，F線近傍領域，F線外部領域｝を3つに分けることによって，それぞれの場における“胃癌の三角”を早期胃癌診断の基本とすることができる．

　The mucosa of cancer-development, histologic type, and macroscopic type of the gastric carcinomas are closely related each other with 2 functions, the his-togenesis of gastric carcinoma and the shifting of F-line with age, provided that the F-line is defined as the boundary line limited to area of the fundinc gland mu-cosa without intestinal metaplasia. Those 3 categories form so-called"The triangle of gastric carcinoma"con-nected with the 2 functions.

　The histogenesis of gastric carcinoma, one of the functions, is that the carcinoma not forming tubuli in the mucosa (the undifferentiated carcinoma) arises from the ordinary gastric mucosae (the fundic and pyloric gland mucosae), meanwhile the carcinoma forming tubuli in the mucosa (the differentiated carcinoma) does from metaplastic mucosa of intestinal type.

　The shifting of F-line with age, another of the functions, is that the F-line shifts toward a reduced area of the fundic gland mucosa lapse of time, as a result of intestinalization of the ordinary gastric mucosa, and the shifting of F-line is irreversible.

　Good informations for knowing preoperatively the aspect of a gastric carcinoma are not always obtained with x-ray and endoscopic examinations and biopsy. However, the major part of the aspect may be preoperatively deduced with taking the triangle into consideration, even if sufficient informations on all matters pertaining to a gastric carcinoma are not obtained with the examinations above-mentioned. The reasion is that the histologic and macroscopic types of gastric carcinomas correspond well each other. Furthermore, dividing the gastric mucosa area into 3 fields, the interior, exterior, and neighboring areas of the F-line, the histologic type of carcinomas may be deduced in high posibility from the macroscopic type or the field where the carcinoma exists. The triangle is fundamental principles for diagnosing gastric carcinoma in early phase. For example, when an ulcerative or a depressed lesion located at the interior area of the F-line is disclosed with endoscopic or x-ray examinations, it is the undifferentiated carcinoma (mucocellular or anaplastic adenocarcinoma) in high possibility. The interior area histologically consisting of the fundic gland mucosa without intestinal metaplasia almost corresponds macroscopically to the area with mucosal folds.