胃生検の臨床的評価に関する研究 : 特に良性悪性境界領域性病変の検討
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概要
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In the present study, Group III consisting of benign-malignant borderline lesions were subdivided into Group IIIa (closer to Group II), Group IIIc (closer to Group IV) and Group IIIb (lying between them) by their cellular and histo-structural atypism, and 193 lesions from 190 patients diagnosed as Group III by gastric biopsy were evaluated in comparison with their endoscopical diagnosis. 1. By subgrouping of Group III, it was found that Group IIIa was largest in number, followed by Group IIIb and Group IIIc. 2. Endoscopically, Group III was most frequently seen in the excavated lesion, next in the elevated lesion, and less frequently in chronic gastritis such as erosive gastritis or hyperplastic gastritis. 3. Group III was predominant in elder patients of more than 50 years old and in male patie.nts by sexuality ; the sites of predilection were antral area and portion of the body. 4. Histologically, Group III were composed of such different types of the lesions as those reversible to benign ones or irreversible ones that terminate as atypical epithelium ; in particular, the irreversible lesions were often noted in Group IIIb and Group IIIc. 5. In case of Group IIIa and Group IIIb in the elevated lesions which are found benign endoscopically, a gastric biopsy should be performed at an interval of every six months or twelve months under the follow-up observations; in case of Group IIIc, the lesions of less than 2cm in size should be followed up at every three months, while those of larger than 2cm should surgically be treated in view of possible association with carcinoma. On the other hand, in the elevated lesions which prove malignant by endoscopy, priority should be given to the endoscopical diagnosis, and in case where the lesions are histologically diagnosed as Group IIIb or severer one on the second biopsy, a surgical operation is needed. 6. In case of Group IIIa and Group IIIb in the excavated lesions which are considered benign endoscopically, most of the lesions appear to be of atypical regenerative gastric epithelium, and such lesions should undergo a biopsy at every six months for the follow-up observation ; in case of Group IIIc, the lesions should immediately be re-examined and their diagnosis should be defined by endoscopy as well as by histological findings on the biopsy specimen. On the other hand, in case of Group IIIa and Group IIIb in the malignant lesions, the lesions should immediately be re-examined histologically ; in case of Group IIIc, a surgical operation for cancer is requisite. 7. In chronic gastritis, the follow-up observations may be sufficient, although there were only few cases available for permitting an adequate examination. 8. The subgrouping of Group III described in this report, in combination with the endoscopical diagnosis, seems to be useful clinically for an accurate differentiation of the lesions falling under Group III.
- 神戸大学の論文