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Endoscopic diagnosis of type iic early gastric cancer located in the fundic gland mucosa



Endoscopic diagnosis of type iic early gastric cancer located in the fundic gland mucosa



Stomach & Intestine (Tokyo) 22(9): 1037-1046



IIc type of early gastric cancer located in the fundic gland mucosa has been considered to be very rare compared with the frequency for IIc in the pyloric gland mucosa. In fact, in our Institute, only 29 lesions out of 220 lesions of IIc (13.2%) have been detected endoscopically in the last 3 years (1984-1986). Therefore, histopathological and endoscopic findings concerning them were studied in this report. Twenty nine lesions of IIc were histologically classified into two groups: in one group, IIc was located partially in contact with a boundary line (F-line) between the fundic gland mucosa and the pyloric gland mucosa as F-a group. In another group, IIc was located completely in the fundic gland mucosa as F-b group. A difference in age between the two groups was not significant, but, in sex, F-b group was relatively dominant in the female. Localization of these IIc lesions in the stomach was markedly distributed on the posterior wall of the corpus and cardiac in both groups. In endoscopic features of the lesions, converging folds of the gastric mucosa were dominantly recognized in 92% of both groups. Partial covering folds were recognized in the lesions of F-a group and severe converging folds were seen around all the lesion in F-b group. A border showing the extent of the invasion of the carcinoma was unclear in 68% of the lesions. White colored mucosal depression was observed in 44% of the lesions. Especially in the cases with undifferentiated carcinoma, white discoloration of the lesion was observed in 68.8%. In the cases with differentiated carcinoma, red colored mucosal discoloration of the lesion was observed in 77.8% of the lesion. Therefore, when the endoscope detects a depressed lesion located on the posterior wall of the corpus and cardia, probability that the lesion is malignant must be admitted.

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