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Endoscopic Diagnosis of Ⅱa Type Early Gastric Carcinoma: Protruding Type of Early Gastric Carcinoma Hisayuki Fukutomi 1 , Hisatake Takezawa 1 , Norio Tani 1 , Masami Kobayashi 1 , Takao Sakita 1 1National Cancer Center Hospital pp.55-61
Published Date 1971/1/25
DOI https://doi.org/10.11477/mf.1403111394
  • Abstract
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 Two ways of classification have been tried for protruding lesions of the stomach according to their configurations as seen in the profile and frontal views. The profile views of protruding lesions have been divided into four types: (1) gently sloping, (2) sessile, (3) subpedunculated and (4) pedunculated types. The frontal views have been classified into nine types. They are (1) round, (2) gourd-like, (3) mulberry-like, (4) elliptical, (5) club-like, (6) serpentine, (7) roundish, (8)irregu1ar-shaped and (9) centrally depressed types. Details of profile view have already been published (Stomach and Intestine, 2).

 In the latter classification, round and elliptical types were mostly benign; in the gourd-like type was atypical epithelium often seen. The mulberryshaped type was frequently of Ⅱa, and the club-like and serpentine types were often of I. The irregularshaped and centrally depressed types were seen in the malignant protruding lesions.

 Some features of Ⅱa type early gastric carcinoma are: (1) in most instances it is a fiat, broad-based plateau-like elevation sharply circumscribed against surrounding areas, (2) belonging to sessile type in the first classification and to either mulberry-shaped, irregular-shapecl or centrally depressed type according to the second. (3) The surface is uneven and irregular, sometimes granular and sometimes nodular, with its color mostly pale White or grayish white. Although erosion or bleeding is seldom seen on its surface, either can be seen in a having submucosal invasion where central depression is also apt to occur. (4) Differentiation from ATP depends on the size, type and surface irregularity. The Ⅱa must be taken into account when a lesion is more than 2cm in diameter, of irregular shape, or when the surface of the mucosa is small nodular, or further, when protrusions are of varying sizes and irregular-shaped. The Ⅱa must also be suspected when erosions are seen or when the center of elevation tends to be depressed. (5) It is often seen in the mucosa of atrophic gastritis associated with intestinal metaplasia; more often observed in older people. The gastric juice shows either hypoacidity or anacidity even when the stomach is stimulated with gastrin. The Ⅱa often appears as multiple lesions. This fact must always be borne in mind in the endoscopic examination of early gastric carcinoma.


Copyright © 1971, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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