陥凹性早期胃癌診断困難例の克服―細胞診を中心に

Overcoming of Diagnostic Difficulties in the Depressed Type of Early Gastric Cancer with Emphasis Laid on its Cytological Diagnosis

　胃癌早期診断の進歩はめざましく，早期胃癌として診断される病変は漸次小さくなり，病変の直径1cm以下の微小病変も的確に診断されるようになった．しかし胃内のいかなる部位の微小病変も存在診断は可能となったが，その良性・悪性の鑑別には生検・細胞診によらなければならない．また生検・細胞診の立場でも境界領域病変の診断にはなお多くの問題があり，胃生検検討会，各種の研究会などで種々議論されていることは周知のところである．

　本稿では陥凹型早期胃癌の診断困難例ないし限界例について，細胞診の立揚から症例をあげて検討してみる．

　By dint of recent technical progress in the diagnosis of gastric diseases, more and more smaller lesions are now confirmed as early gastric cancer. However, biopsy and cytological diagnosis are still faced with mamy problems such as differentiation from border lesions and atypical epithelium originating from regenerated epithelium.

　We have studied in this paper problems of the day in the cytological diagnosis of depressed type of early gastric cancer. Its positive rate in our series of examinations was 91 per cent, a not unsatisfactory result, but there still remain many diagnostic difficulties as far as minute cancer lesion less than 1 mm in the largest diameter, lesions in the upper portion of the stomach, cancer in the gastric remnant and differentiated adenocarcinorna hard to distinguish from border lesions are concerned.

　In order to surmount these diagnostic difficulties, we now employ enzyme cytochemical staining besides the current methods; chiefly phosphorylase leucine aminopeptidase, alkaline phosphatase and DNA-diaphorase stainings are supplemented for improving diagnostic accuracy.