The author classified polypoid lesions of the stomach into four groups in accordance with the direction of growing, taking their sideview, and defined A as the group extending to vertical direction against the stomach wall, B as the group having the same nature as A group and showing segmental growing, C as the group growing along the stomach wall and D as the group showing irregularly massive growing. According to the above definition, classification was made with 165 cases of polypoid lesions of the stomach about which histological study was performed, and some findings were obtained as follows;
1) It was found that A and B groups had a tendency to benignancy, and C and D groups malignancy.
2) The author could divide a benign figure and a malignant one by observing a bird's-eye view of polypoid lesions in each group classified into by the author, that is, the percentage of malignancy was 2.3% (4 out of the total 128 cases) in the former and 70.3% (26 out of the total 37 cases) in the latter. The malignant figure included one having low, uneven surface (C group), one showing center-depression, having the same nature as the above (C group), one like a green caterpillar (C group) and massive one (D group).
3) All the cases of polypoid lesions over 3 cm in diameter and 62.7% (22 out of the total 35 cases) over 2 cm in diameter indicated to be malignant. According to the author's classification, all the cases of polypoid lesions over 2 cm in diameter in C group and over 3 cm in D group indicated to be malignant. It was therefore confirmed that the size of polypoid lesions regarded as malignancy varied from group to group. Then it was ascertained that the atypical epithelium about which discussions and studies were recently made could, to some extent, be differentiated from II a type of early stomach cancer in size.
4) It was found that the color on the surface of polypoid lesions was not useful for differentiating a benign polypoid lesion from a malignant one, while both erosion and bleeding on the surface were observed more among the cases of malignancy, 70% (21 out of the total 30 malignant cases) 23.7% (7out of 30 cases) respectively. However, according to the author's classification, erosion was a sign of malignancy only in A group, and bleeding only in A and C group. Therefore, it was con-firmed that erosion and bleeding were the signs valuable for diagnosis only in some group.
Then, Shichijo's reaction, a non-specific, biological test for diagnosis of the stomach cancer which originated with Prof. Shichijo, was examined with above cases of polypoid lesions and following findings were obtained.
1) In the positive type of Shichijo's reaction, the reaction was useful as a supplemental method of diagnosis for differentiating a malignant polypoid lesion from a benign one, since the percentage of malignancy was 81.8% (9 out of the total 11 cases).
2) In the positive group of Shichijo's reaction (inclusive of the intermediate type), the percentage of malignancy became higher in each following case.
a) over 2 cm in diameter …100.0% (all of 10 cases)
b) C group under the author's classification …87.5% (7 of 8 cases)
D group under the author's classification …100.0% (all of 4 cases)
malignant figure under the author's division …91.7% (11 of 12 cases)
c) showing erosion on the surface …81.8% (9 of 11 cases)
d) showing bleeding on the surface …100.0% (all of 5 cases)
As stated above, in case examination was made in such a case as the size, figure and nature on the surface of polypoid lesions, Shichijo's reaction was useful as a supplemental method of diagnosis for the differentiation. However, only 46.4% (13 out of the total 28 cases) of malignant polypoid lesions was the positive group of Shichijo's reaction. Therefore, it was a question that the subject of diagnosis was about half the number of malignant polypoid lesions.
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