Macroscopic Feature of“Gastritis-like Cancer”with Little Malignant Appearance in Early Gastric Cancer Takuji Gotoda 1 , Tadakazu Shimoda 2 , Mitsuhiro Fujishiro 1 , Shigeaki Yoshida 3 1Department of Internal Medicine, National Cancer Center Hospital 2Department of Clinical Laboratory, National Cancer Center Hospital 3Department of Internal Medicine, National Cancer Center Hospital East Keyword: “胃炎類似型”早期胃癌 , 平坦褪色型 , 平坦発赤型 , 凹凸主体型 pp.1495-1503
Published Date 1999/11/25
DOI https://doi.org/10.11477/mf.1403102864
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 Recently, the number of biopsies taken from the stomach has been increasing. This method is useful technique for the diagnosis of cancers with little malignant appearance. On the other hand, in our retrospective study, the endoscopic appearance of the original lesion of gastric cancer which had grown from early to advanced cancer in a short period of time was occasionally similar to gastritis-like findings, such as discoloration, reddness and/or granular appearance. To clarify the macroscopic features of gastritis-like cancer, we investigated patients undergoing endoscopic examination during the period between July,1997 and June,1999 at the National Cancer Center Hospital. During this period,10,703 biopsy specimens were obtained from the patients. Of 8,572 lesions which were endoscopically diagnosed as benign,127 (1.5%) were histologically confirmed as malignant. Of these 127 lesions,75 (59%) showed gastritis-like findings with little malignant appearance. These gastritis-like cancers accounted for 11% of all early gastric cancers in the period of the time mentioned.

 The endoscopic appearance of 75 gastritis-like cancers, the subjects of this study, were divided into the following three groups; flat discolored, flat reddish and granular types, according to the surface structure and color of the lesion. Histological grading of the cancer was divided into low- or high-grade atypia.

 In the flat discolored type, cancerous lesions with a margin were seen in young females, and the histological type was usually undifferentiated carcinoma. In the flat reddish type, the lesions with an unclear margin showed a high incidence of carcinoma (2.8%), in contrast with those with a clear margin (0.5%). Also, 48% of these were difficult to diagnose as cancer by review of the endoscopic films. In the granular type, the lesions were generally located in the distal stomach, and detected in elder males. Moreover, 66% of these were difficult to diagnose as cancer by review of endoscopic films.

 Histologically, the incidence of cancer with low-grade atypia in the cancer with little malignant appearance was higher (72%) than the incidence of cancer with apparent cancerous findings (46%) . It was confirmed that there was a higher rate of cancer occurrence (66%) among lesions with little malignant appearance, than among the other two groups (48% and 30%) .

 These results suggest that the cancers with low-grade atypia are difficult to diagnose as cancer by conventional endoscopic criteria, because these reveal lateral growth by replacement in non-cancerous gland. Attention to slight mucosal change and recognition of cancers with low-grade atypia is necessary during endoscopic examination.

Copyright © 1999, Igaku-Shoin Ltd. All rights reserved.


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