Scirrhous carcinoma of the stomach was macroscopically classified into 4 types: giant rugal type, giant rugal and erosive type, erosive type and nodular type. Giant rugal types were most frequent in young females (Figure 5). Accuracy of endoscopic diagnosis was worst in giant rugal type (68.8%) (Figure 8), especially biopsy specimens obtained from giant folds with acid-secreting function failed to reveal any tumor cells (Figure 13). In order to diagnose giant rugal type of scirrhous carcinoma, we devised the endoscopic aspiration cytology. By this method good results have been obtained (Figure 9 &10). Retrospective studies showed that scirrhous carcinoma of the stomach might develop from early cancer of type IIc without converging folds. Scirrhous carcinoma developed not only in the normal oxyntic gland mucosa, but also in the areas of fundal gastritis (Figure 11). Tumors in the normal oxyntic gland mucosa developed into scirrhous carcinoma with giant folds. On the other hand tumors in the areas of fundal gastritis developed into that with marked erosions (Figure 12). The former developed faster than the latter. For early diagnosis of scirrhous carcinoma of the stomach, it is necessary to find and subsequently biopsy small erosions without converging folds. With the endoscopic Congo red-methylene blue test developed in our clnic, gastric cancers can be observed as areas where both dyes are bleached to white, or as non-discolorated areas surrounded with discolorated areas. We conclude that the endoscopic Congo red-methylene blue test is very useful in early diagnosis of scirrhous carcinoma of the stomach.