胃癌肉眼分類の問題点―肉眼診断の立場から

Macroscopic Classification of Advanced Carcinoma of the Stomach

要旨　わが国では，進行胃癌は肉眼的に，1型，2型，3型，4型（以上Borrmann分類に準ずる）と5型の癌に分類され，この分類法が1962年より正式に用いられてきた．しかし，各型の具体的な肉眼記述が不足であるために，またBorrmann分類の記述の不明確さとその解釈の違いのために，肉眼型の判定に混乱が生じているのが現状である．本稿では，進行胃癌の肉眼型を腫瘍の表面形態から分類するという基本姿勢に立って，粘膜面からみた病変の高低と胃壁内での発育・進展様式との2点から，進行胃癌の肉眼分類を行った．その結果，Table4のように分類された．そして，各々の肉眼型の判定法やできるだけ具体的な説明を加えた．

　In Japan, advanced carcinoma of the stomach has been classified since 1962 as Type 1, Type 2, Type 3, Type 4 (these correspond to Borrmann's classification) and Type 5 by Japanese Research Society for Gastric Cancer.

　However, assessment of macroscopic type of advanced carcinoma is now in confusion, because of lack of precise description in Borrmann's classification resulting in discrepancy in its interpretation.

　We here classified advanced carcinoma of the stomach based on the degree of elevation or depression of carcinoma and its growth pattern in the gastric wall, which were assessed by macroscopic surfaceappearance of the tumor.

　As a result, the following classification of advanced carcinoma was advanced:

　1.Protuberant carcinoma

　　Papillonodular type

　　Plateau-like type

　　Intramural type

　2.Ulcerating carcinoma

　　Expansive ulcerating type

　　Infiltrative ulcerating type

　　Expansivo-infiltrative ulcerating type

　3.Diffusely infiltrating carcinoma

　　Non-circular type

　　Circular type

　　Body type

　　Antrum type

　4.Early carcinoma-like advanced carcinoma

　　This type includes all depressed types.