Ⅲ型早期胃癌の診断

On the Diagnosis of Type Ⅲ Early Gastric Cancer

　日本における早期胃癌の診断学の進歩は顕著なものであるが，まだ多くの問題を残している．その一つにⅢ型早期癌の診断がある．本論文ではⅢ型早期癌の症例を見直して，診断学をもう一度考え直してみることにする．

　In spite of tremendous progress made in the diagnosis of early gastric cancer as a whole, many problems remain still unsolved as exemplified in the accurate diagnosis of type Ⅲ early cancer. In the present paper we have reviewed this problem on the basis of retrospective case studies of this variety.

　1. When a certain early cancer is diagnosed as type Ⅲ in conformity with the classification of early gastric cancer, the distinction should be made only after the study of resected specimens with strict attention to the criteria of its division.

　2. Retrospective studies of about 400 cases of early gastric cancer seen in our hospital revealed that only five cases belonged to this cathegory.

　3. Evaluation of resected specimens of the type Ⅲ has shown three following items as abnormal findings in some cases:

　(1) Irregularity on the margins of excavation

　(2) Irregularity of the areae gastricae

　(3) Fading of the normal color on the mucosal surface

　Irregularity on the margins of excavation represents a marginal picture of ulcer (excavation) in the type Ⅲ, while that of the areae and fading of the normal mucosal surface show where Ⅱb is to be seen.

　4. Irregular areae have been demonstrated by x-ray in some cases.

　5. This areal irregularity is not specific to the type Ⅲ, and its diagnosis, if based on this particular finding, is similar to that of Ⅱb.

　6. Improvement in the diagnosis of the type Ⅲ calls for more detailed follow-up studies of all suspicious cases.