胃隆起性病変（GroupⅢ病変）の経過

Clinical Course of GroupⅢ Elevated Lesion of the Stomach

要旨　胃腺腫の予後を知る目的で，初回の胃生検でGroupⅢと診断され3年以上の経過を有する隆起性病変49例52病変の追跡調査を行った．結果は，16病変が増大し（30％），36病変が大きさ不変であった．増大例の最終診断は癌6病変，腺腫内癌2病変，腺腫8病変であった．増大群と不変群は初回のX線像，内視鏡像，生検像では鑑別不可能で，また，増大群の中でも最終診断癌と組織異型度不変例（腺腫）との鑑別は不可能であり，両群とも同一疾患（腺腫）として取り扱わざるを得なかった．更に，7例（14％）に他部位に胃癌の合併をみた，腺腫は高率に増大し癌化し，腺腫を有する胃は高率に胃癌の発生母地となる．

　Gastric adenoma is histologically diagnosed as group Ⅲ by biopsy and it has been described that cancerous degeneration of such a lesion is rare. During the period from April, 1980 to December, 1985, we have followed the clinical course of 104 patients with histologically group Ⅲ elevated lesions of the stomach at the initial diagnosis in the Institute of Gastroenterology of Matsuyama Red Cross Hospital. The subject of the present study was 52 lesions in 49 patients who were followedup for more than three years. They were eventually classified into one of the two groups according to the change in size, namely, group A (36 lesions) in which the size of the lesion remained unchanged, and group B (16 lesions) in which the size of the lesion increased. Forty patients with elevated type early gastric cancer who underwent gastrectomy during the study period without follow-up examinations were selected for control (group C). There was no significant difference between the three groups in age, and in male to female ratio. The period of observation was 4.3 ± 1.5 years for group A and 5.1± 2.2 years for group B; no significant difference between the two groups. Differentiation based on roentgenography, endoscopy, and histological study of biopsy specimens was easy between group C and other groups. It was, however, hardly possible between group A and B. The final diagnoses of the lesions in group B were carcinoma in six, carcinoma in adenoma in two, and adenoma in eight lesions. Moreover, early gastric cancer developed at other site of the stomach in seven of those 49 patients during the follow-up period.

　As a result, gastric adenoma (group Ⅲ lesion) is shown to have a potential of cancerous degeneration and, therefore, careful and long-term follow-up is mandatory.