Ⅲ型早期胃癌の診断

Diagnosis of Type Ⅲ Early Garly Gastric Cancer

　近年の胃疾患に対する診断学の進歩によって，早期胃癌は，特殊な技術を用いなくても，いわゆるroutine検査の中から数多く発見され，確実な診断がつけられるようになってきている．しかし早期胃癌を肉眼型別にわけて考えてみると，なお鑑別診断に苦しむ症例が決して少なくない．特にⅡb型の診断は，今後検討されるべき多くの問題が残されているが，ここでその対象としてとり上げるⅢ型も確定診断の困難な型に属していると思われる．このⅢ型の診断について，症例の検討を加えながら，問題点を幾つかあげてみたい．

　Out of type Ⅲ early gastric cancer encountered by us, several chosen cases have been demonstrated here together with the problems involved in its diagnosis.

　Since we have never experienced genuine type Ⅲ that can satisfy the definition of its gross morphology, our interest has been centered on those of Ⅲ＋Ⅱc type that have narrow areas of Ⅱc, and the results are that discovery and confirmation of such Ⅱc lesions have led directly to the qualitative diagnosis of type Ⅲ. Detection of minute strips of Ⅱc endoscopically requires their extremely close-up views, and roentgenologically it calls for exposures of detailed compression picture.

　Cases of advanced carcinoma simulating type Ⅲ have also been examined for their x-ray and endoscopy pictures as to how cancer infiltration in the submucosa presents itself. When submucosal cancer invasion becomes massive to a certain degree, the angle from the margins of the normal mucosa to the marginal elevations of ulcer becomes more definite in x-ray pictures, and endoscopically it can be visualized as a more solid elevation.

　Reference has also been made not only to the vicissitude of ulcer within cancer but also to the fact that the findings presented by ulcer lesions sometimes make it easier and sometimes harder to recognize Ⅱc depending on the lapse of time.