腺領域からみた胃癌の診断

Clinicopathological Studies on Early Gastric Cancer-Especially, its Relationship with the Fundic-pyloric Gland Area

要旨　早期胃癌863病変（未分化型284病変，分化型579病変）と，そのうち微小胃癌80病変（未分化型17病変，分化型63病変），表層拡大型胃癌48病変（未分化型17病変，分化型31病変）について腺領域からみた検討を行った．早期胃癌の存在は幽門腺領域80％，中間帯領域14％，胃底腺領域6％と幽門腺領域に多かった．幽門腺領域の組織型，肉眼型，深達度をみると，分化型癌は74％，隆起型28％，m癌68％であった．胃底腺領域では未分化型癌の比率は83％，陥凹型95％，m癌38％と腺領域による頻度に違いがあった．更に，胃底腺領域の微小胃癌は全例が陥凹型を呈する未分化型癌であった．表層拡大型胃癌はC領域（38％）で小彎（73％）のものが多かったが，腺領域からみると全例が幽門腺領域を主座として拡がり，胃底腺領域への浸潤はまれであった．腺領域を知り観察することは，胃癌の存在，質，量を予測でき，臨床診断に大きく寄与するものと考えられる．

　Eight hundred and sixty three early gastric cancers consisted of 284 undifferentiated-type cases and 579 differentiated-type cases were evaluated in terms of the background mucosa in which the lesion were located. Eighty minute gastric cancers (17 undifferentiated-type cases and 63 differentiated-type cases) and 48 superficially-spreading type gastric cancers (17 undifferentiated-type cases and 31 differentiated-type cases) selected from the above cases were also studied under the same aspect.

　Early gastric cancers were mostly distributed in the pyloric gland area (80%), and the remaining were located in the intermediate zone (14%) or in the fundic gland area (6%). In the pyloric gland area, differentiated-type was found in 74% of the cases, while undifferentiated-type was found in 83% of the cases in the fundic gland area. Macroscopically, protruded type was seen in 28% of the cases in the pyloric gland area, while depressed type was seen in 95% of the cases in the fundic gland area. The ratio of cancer invasion limited to the mucosa was 68% of the cases in the pyloric gland area, but 38% of the cases in the fundic gland area. Furthermore, all of the minute gastric cancers located in the fundic gland area were undifferentiated-type showing macroscopically depressed features. The majority of the superficially-spreading type gastric cancers were distributed on the lessor curvature (38%) in C area (73%). Histologically, all of them were mainly located in the pyloric gland area, and invasion of the fundic gland area was rarely seen.

　These results suggest that the existence, characteristics and size of an early gastric cancer may be estimated when endoscopic study considering the background mucosa in which the lesion is located is performed. We believe this knowledge may contribute significantly to clinical diagnosis of early gastric cancer.