The present study was conducted with the purpose to clarify endoscopic findings of early stomach cancer and the relationship between endoscopic findings and the histopathological findings with special reference to the depth of the gastric wall involved by carcinoma.
Out of the 1, 492 cases who were examined by endoscopy 65 cases were diagnosed as gastric cancer, one case was gastric ulcer and another one case was gastric polyposis. The total of 67 cases were send to the surgery clinic for gastrectomy. With the resected stomach specimens of these cases macroscopic as well as histopathologic observations were carried out. As a control study, similar observations were made with the tissue specimens obtained from gastric polyp and polypoid carcinoma. Those cases diagnosed as stomach cancer with simply radiological examination were excluded in the present study.
For the endoscopic examinations, gastrocameras of type III, IV and V were employed, and the gastrocamera findings were studied. For histopathologic observations sections of 5mm in width were prepared with the area involved by carcinoma and these tissue sections were stained with the hematoxylin-eosin solution. Early stomach cancer was defined as the cases involved only the mucosa and the submucosa with carcinomatous tissue. Those cases involved the muscle layer were excluded from the designation.
According to the classification established by the Japan Endoscopic Society, these samples were classified into three types, I, II and III. The Type II was further subdivided into three types, IIa, IIb and IIc (Fig. 1). The results of these examinations were as follows.
1. Of the 67 cases examined, 51 cases were stomach cancer by histopathologic examination. Among them 14 cases were proved to be the cases of early stomach cancer. The incidence of early stomach cancer was 27.4% in those cases performed gastrectomy. As for type of early stomach cancer, a predominant incidence was observed in Type IIc, which amounted to one half of the total cases.
2. The principal endoscopic findings of Type I were unevenness of the surface of the elevated mucosa, hyperemia and discoloration of the mucosa.
3. As for Type IIc, irregularity of margin of the depressed mucosa, bleeding cr hyperemia of the edge, irregular shaped coat or adherent mucus were main endoscopic findings.
4. In Type III, converging folds, discoloration, unevenness and irregularity of the floor of the depressed mucosa were observed by endoscopy, however, none of these findings were thought to be pathognomonic for early stomach cancer.
5. As for the endoscopic findings that enable to decide the depth of the gastric wall involved by carcinoma, cessation of the fold, stiffness of the angle, unevenness and irregularity of the edge may be pointed out. The cessation of the fold paralleled with the depth of the gastric wall involved by carcinoma. The findings of unevenness and irregularity of the edge were also in accordance with the depth of the gastric wall involved by carcinoma, though the relation was not observed in Type III.