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Endoscopic Diagnosis of Ⅱa+Ⅱc Type Early Gastric Cancer T. Miwa 1 , G. Anan 1 , N. Ushiyama 1 , S. Muto 1 , T. Sakita 1 1Dept. of Internal Medicine, National Cancer Center of Japan. pp.1679-1687
Published Date 1971/12/25
DOI https://doi.org/10.11477/mf.1403111417
  • Abstract
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 Early gastric cancer of Ⅱa+Ⅱc type requires earliest possible detection not only because it is biologically very malignant but also because its incidence in metastases to the liver and lymph nodes is very high.

 Based on the histopathological findings, Sano has classified this variety into three groups: polypous, erosive and deep penetrating. Their endoscopic characteristics are as follows:-  In the polypous type, its Ⅱa part is mostly seen as an open circle or as a cluster of small lesions. White coat over the Ⅱc portion is slight, if at all. This makes it difficult to differentiate it from Ⅱa type early cancer, Erosive type displays no definite characteristics. Even though white coat is often observed over it, discrimination from Ⅱa is mostly difficult. Most typical findings of Ⅱa+Ⅱc type are presented by the deep penetrating type. It is seen either as a whole circle or open circle, sometimes accompanied with mucosal convergency, so that it is liable to be mistaken for an advanced carcinoma. Thick white coat is invariably seen over it. This type always involves the submucosa.

 A Ⅱa+Ⅱc type lesion 1 to 2 cm in dimensions eventually needs biopsy for its confirmation and that 2 to 4 cm in diameter calls for differentiation from advanced carcinoma. Generally speaking, mucosal overhang around the ulcer in advanced carcinoma is over the usual height of a Ⅱa early cancer. A Ⅱa+Ⅱc lesion more than 4 cm in diameter should be considered advanced cancer.

 In retrospective follow-up studies of Ⅱa+Ⅱc early gastric cancer, its earlier stage is said to consists of small Ⅱ a lesions. More earlier still, minute Ⅱa or Ⅱb is reported to account for the initial stage of Ⅱa+Ⅱc early cancer. At present, further confirmation is required.


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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