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Endoscopic classification of type iib early gastric cancer

Endoscopic classification of type iib early gastric cancer

Stomach & Intestine 16(12): 1321-1324

Of 973 lesions of early gastric cancer operated on during 15 yr, only 41 cases or 46 lesions (4.7%) were type IIb. Fourteen of the 46 lesions (30.4%) were diagnosed endoscopically and the other 32 lesions (69.6%) were detected by a histopathological examination of the surgical specimens with other diseases. The diagnostic process of the endoscopically detected IIb lesions (14) was analyzed and it was classified into 3 courses: the 1st course in which carcinoma was found in the biopsy specimens obtained from small reddish areas (8 lesions); the 2nd in which carcinoma was found in the biopsy specimens obtained from large white areas (4 lesions) and the 3rd in which carcinoma was found unexpectedly in the biopsy specimens obtained from other lesions (2 lesions). In the 3rd course, the endoscopic findings of IIb lesions were not at all clear. Gastroscopic findings of IIb lesions apparently consist of 2 types of mucosal discoloration: the red type and white type. Histopathological examination of 2 types showed a well-differentiated type of adenocarcinoma in the red type and poorly-differentiated adenocarcinoma including signet ring cell carcinoma in the white type. This discoloration of the white type of IIb lesions may be caused by the number of signet ring cells and the invasion of carcinoma cells to the submucosa. In order to diagnose endoscopically more cases of type IIb lesions of early gastric cancer, these 2 types of mucosal discoloration must be detected and the biopsy specimen must be obtained accurately from these 2 lesions.

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Accession: 005359140

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