한국인 위암(胃癌)에 관한 병리학적 연구

Abstract

[한글]

[영문]

Gastric carcinoma is a relatively common malignancy throughout the world and unfortunately the over-all cure rate is still low. The incidence of gastric carcinoma is different geographically and racially. Highest incidence in the world is reported in Japan, Finland, Iceland and Chile. Korea is also one of the highest incidence of gastric carcinoma.

Gastric carcinoma may appear at any age in either sex. However, it is rarely encountered in persons under the age of 30 years. About 65 per cent of reported cases occurred in patients between the age of 50 and 69 years and approximately 80 per cant in patients above the age of 50 years. The mean average is 55 years.

Cancer of the stomach predominates in the male sex in the proportion of approximately two to one.

Carcinoma may develop anywhere in the stomach from the cardia to pylorus but the majority grow from the antrum and pylorus, more particularly along the lesser curvature.

The gross pathological anatomy of gastric carcinoma is most important and is dependent upon the was in which the different kinds of carcinomas grow.

There are many methods of classifying gastric carcinomas, the best known of which in that of Borrmann. He recognize four gross types and type Ⅰ is the least malignant and type Ⅳ the most malignant. Stout classified 470 carcinomas reported in 1953 as follows, giving the frequency rates; fungating (22.7%), penetrating or ulcerating (27.5%), spreading (12.8%) and no special type (37.0%). McNeer et al utilize a similar classification in reporting five-year survival rates. Their cases

were catalogued as polypoid, ulcerocancer, ulcerating and infiltrating, and infiltrating.

All carcinomas of the stomach are glandular in origin, but the extent to which glandular differentiation appears in them varies widely from tumor to tumor and also in different parts of one tumor.

The pathogenesis of the gastric carcinoma is unknown but genetic factor, envirommental factor, and foods are important role and the precancerous lesions are considered from chronic atrophic gastritis, pernicious anemia, achlorhydria, polyps

and peptic ulcer.

There are numerous reports on gastric carcinoma among Koreans based on clinical and statistical aspects but there is no report on gastric carcinoma based on morphology, especially histopathological observation, of gastric carcinoma.

The present study is an attempt to investigate mainly histopathological characteristics, such as histopathological classification of gastric carcinoma, penetration of gastric wall, degree of lymphatic permeation, regional lymphnodes and omental metastases, types of chronic gastritis and degree of intestinal

metaplasia, and relationship between spread of gastric carcinoma and histologic type, of gastric carchinoma among Koreans on gastric carcinoma obtained by subtotal gastric resections.

Material and Methods.

The materials used in this study consist of 744 gastric resections removed subtotally at the Yonsei University, College of Medicine and Severance Hospital during the last 11 years from Jan. 1, 1959 to Dec. 31, 1969. Among those, 446 cases of gastric carcinoma had been diagnosed at the Department of Pathology Yonsei University College of Medicine for same duration. All specimens were fixed in 10% formalin. Grossly, the location, size and gross type according to Borrmann's classification of each gastric carcinoma were examined. For histologic examinations, paraffin embedded blocks were cut in 6 thickness and sections were stained by hematoxylin-eosin method.

Borrmann recognized four gross types which he describes as follows; Type Ⅰ; Circumscribed, solitary, polypoid carcinomas without important ulceration; Type Ⅱ; Ulcerated carcinoma with wall-like marginal elevation on sharply defined borders; Type Ⅲ; Ulcerated carcinoma in part with marginal elevation and in part with diffuse spread; Type Ⅳ; diffuse carcinoma. These four varieties are arranged in an ascending order of malignancy, i.e. Group Ⅰ is the least malignant and Group Ⅳ the most malignant.

The histopathological study on all cases is performed as follows;

1. Histopathological classification; 2. penetration of gastric wall; 3. Degree of lymphatic permeation; 4. Regional lymphnodes and omental metastases; 5. Types of chronic gastritis and degree of intestinal metaplasia; 6. Relationship between regional lymphnodes metastases and histologic type; 7. Relationship between regional lymphnode metastases and lymphatic permeation; 8. Relationship between lymphatic permeation and histologic type; 9. Changes in remaining portion (chronic gastritis and intestinal metaplasia); 10. Relationship between intestinal metaplasia and histologic type.

For the 446 cases whose records were available, sex, age, blood, group, chief complaints, duration of the chief complain, and gastric acidity were reviewed.

Result and Summary

1. Among 744 stomach examined during last 11 years, gastric carcinoma was found in 446 cases, giving incidence of 59.95% for subtotally removed stomach.

2. Male to female ratio was 2.28 to 1. The peak age incidence is between 50 and 59 years accounting 172 cases(35.77%).

3. There is no relation between blood group and incidence of gastric carcinoma.

4. Clinical symptoms in order of frequency were as follows: Epigastric discomfort and pain (86%), indigestion (66.67%), weight lose (35.67%), nausea and vomiting (35.33%) and palpable epigastric mass (23.33%). The duration of chief complains was

most common within six months (54.66%).

5. The gastric acidity disclosed that achlorhydria was found in 36.21%, hypochlorhydira in 32.26% and hyperchlorhydria in 2.15%.

6. The location of the tumor was as follows: 44.86% at pyloric canal, and 26.53% at antrua(??). The size of the tumor varied. The most frequent size was 3-5 cm(43.43%) and 6-10 cm(42.90%).

7. On the macroscopical examination, the classification based on Borrmann's gross types and their incidences were as follows:

Type Ⅰ (3.71%), type Ⅱ (11.22%), type Ⅲ (62.18%), type Ⅳ (23.64%)

8. On the histological classification, 70% of the cases were adenocarcinomas. The serosal involvement was found in most cases (86.89%).

9. The metastases to the regional lymphnodes disclosed 68.84%, and direct extension of the omentum is 21.39%.

10. According to the relationship between regional lymphnode metastases and lymphatic permeation, and relationship between lymphatic permeation and histologic type, the degree of lymphatic permeation is more, the more metastases to regional lymphnode is found. And metastasis to regional lymphnode and lymphatic permeation is more common in adenocarcinoma than other types.

11. There is no relationship between intestinal metaplasia and histologic type. But each histologic type was accompanied by intestinal metaplasia frequently.

In conclusion based on the above findings, it can be stated that gastric carcinoma among Koreans examined in gastrectomy specimens exhibited far advanced stage, both clinically and morphologically.