小さな未分化型胃癌の内視鏡診断

Endoscopic Diagnosis of Small Undif-ferentiated Type Gastric Cancer

要旨　1982年1月から1988年12月までの7年間に当センターで切除された早期胃癌は549例645病巣であった．その中で，10mm以下の小さい未分化型癌について，11～20mmの未分化型癌36病巣および10mm以下の分化型癌85病巣と対比しながら，臨床病理学的特徴および内視鏡像を中心に検討し，以下の結論を得た．(1)10mm以下の小さな未分化型癌は13例14病巣で，10mm以下の早期胃癌99病巣の14.1％であった．(2)臨床病理学的には比較的若年男性のM領域の単発Ⅱc型癌が多く，深達度はm癌が多かった．(3)m癌のうちからUlを伴いやすく，粘膜内浸潤は中間・深層型が多かった．また，分化型癌に比べ，小さいうちからsm浸潤しやすい傾向があり，sm内は浸潤性に発育する傾向があった．(4)内視鏡的には“発赤斑を伴う褪色”が最も重要な所見と考えられた．(5)胃底腺領域の小さな未分化型癌に特徴的な内視鏡像は見出せなかった．

　There were 645 early gastric cancers in 549 patients who underwent gastrectomy at our center from 1982 to 1988. Using these cases, we reviewed clinicopathological findings and endoscopic diagnosis of small undifferentiated type early gastric cancers measuring 10 mm or less in diameter. The results were as follows;

　1) There were 14 lesions of small undifferentiated type early gastric cancer in 13 patients, which accounted for 14.1% of early gastric cancers, 10 mm or less in sine.

　2) Clinicopathologically, 12 lesions (85.7%) of small undifferentiated early gastric cancer were at M-site, 10 lesions (71.5%) were type Ⅱc and there were 11 lesions (78.6%) with the depth of invasion limited to the mucosa.

　3) Small undifferentiated early gastric cancers were frequently associated with a peptic ulcer or an ulcer scar, showing infiltrative invasion to the submucosa.

　4) Endoscopically, it was important to look for a discolored and red lesion.

　5) It seemed difficult to identify endoscopic findings characteristic to small undifferentiated early gastric cancer in the fundic gland area.