Elevated Type of Early Gastric Cancer with Endoscopically Less Malignant Appearance: Recent Advance of Endoscopic Diagnosis H. Yamaguchi 1 , S. Yoshida 1 , H. Tajiri 1 , Y. Oguro 1 , H. Kitaoka 2 , T. Hirota 3 1Department of Internal Medicine, National Cancer Center Hospital 2Department of Surgery, National Cancer Center Hospital 3Department of Pathology, National Cancer Center Hospital pp.571-576
Published Date 1983/6/25
DOI https://doi.org/10.11477/mf.1403109454
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 During the period from 1962 to 1981, 242 cases of solitary elevated type of early gastric cancer (Ⅰ, Ⅱa, Ⅱa+Ⅱc) were resected at National Cancer Center Hospital. Out of the 242, 150 lesions showed definitely malignant appearance endoscopically, and in the remaining 92 (38%) differential diagnosis from benign lesions was necessary, because their endoscopic appearance resembled more or less to hyperplastic polyp (31 cases), gastric adenoma (32), verrucous (6), and nonspecific (23) gastritis.

 Chronologically, these benign-like cancers have been increasing year by year, and endoscopic appearance has been changing to be smaller and flatter. These results may be due to recent advance of endoscopic diagnosis, especially to popularization in biopsy sampling. In the 150 cases with definitely malignant appearance, however, the mean age was younger and the incidence of sm invasion was higher than that observed in 92 cases with benign-like appearance. This discrepancy was quite wide in the cases with the appearance similar to hyperplastic polyp or gastric adenoma. These results are paradoxical according to morphogenetic consideration, and may reveal that most of the cancers with benign-like appearance which have been detected until recently are not earlier lesions of the cancers with definitely malignant appearance.

 To make the detection of early gastric cancer more perfectly, much more attention should be paid not on the endoscopic appearance of hyperplastic polyp or gastric adenoma but on the other flat elevated appearances, such as hyperplastic or granular change of gastric mucosa as shown in case presentation of this paper. Because the mean age of these cases was younger than those that resembled hyperplastic polyp or gastric adenoma.

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