Ⅱa＋Ⅱc型早期胃癌の綜合診断

Comprehensive Diagnosis of Ⅱa+Ⅱc Type Early Gastric Cancer

　Ⅱa＋Ⅱcの診断が特に取上げられた意味を考えると，Ⅱa＋ⅡcはⅡaの亜型と考えられると同時に，Ⅱcの深部増殖型とも考えられていて，共にBorrmann Ⅱ型への移行段階の早期癌の形態像として注目されて来ている点がまずあげられる．発見せられたⅡa＋Ⅱc病変は多少とも粘膜下浸潤を伴ったものが多く，より小さいものの内に，かつ粘膜内に癌のとどまるうちにより早期に診断されることが望まれる．これらの観点からX線検査，内視鏡検査を駆使しての総合診断の効果が期待されるものである．

　陥凹型と隆起型とにほぼ2大別される早期胃癌の肉眼分類に於いて，Ⅱa＋Ⅱc型は時には隆起が目立ち，時には陥凹が目立ち，観察による形状診断の範囲で組織形態像をまで想定することは容易ではない．早期癌を診断する立場にたつものとしてこの病変型の示す意味あいを考え，あくまでも患者の予後を考慮した立場にたって綜合診断を行なう観点についてふれてみたい．

　The Ⅱa+Ⅱc type early gastric cancer is regarded not only as a subtype of Ⅱa but also as a deep invasive subtype of Ⅱc, so that it is now drawing a morphological pattern of an intermediate stage to Borrmann type Ⅱ advanced cancer. It has the nature of protruding type of early gastric cancer and the rate of metastasis to the liver is said to be especially high. Because it is always visualized as a growth having various forms of protrusion, it often becomes difiicult to differentiate it from other gastric lesions when it is co-existent with gastritis having protruding changes on the mucosal surface, or with other protruding and diffuse gastric diseases.

　The site of predilection often corresponds with that of verrucous change of gastritis. Its characteristics are seen either as a circular or protuberant erosive form. When convergency of the mucosal folds is recognized in addition, the deeper layers are mostly involved as well.

　Because of its early metasiasis to the liver, this variety needs detection as early as possible. For this purpose, slight change in the distensibility of the gastric wall must always be looked for both by x-ray and endoscopy. Accurate diagnosis by biopsy is essential, and periodical check-up of any suspicious by various examinations including biopsy is desirable.