한국인 소장 및 대장종양에 관한 임상 및 병리조직학적 연구

Abstract

[한글]

Clinical and Histopathological Studies on Tumor of the Small and Large Intestine

among koreans

Woon Sup Han

Department of Medical Science The Graduate School Yonsei University

(Directed by Prof. Dong Sik Kim, M.D. Prof. Yoo Book Lee, M.D.)

The tumors of the small and large intestine have been investigated by many

workers in both clinical and pathological aspects. It is of interest that although

the small bowel tumors in the small bowel are rare (Botsford and Seibel, 1947;

small bowel, malignancy is more common than benign tumor, and the former consist of

adenocarcinoma, lymphosarcoma, carcinoids, etc. The carcinoma of the large

intestine is the most frequent malignant tumor throughout the gastrointestinal

tract in the U.S.A. But the incidence of this tumor was preceded by the carcinoma

of the stomach in Korea (Lee et al., 1965; Kim, et al.,1967).

The incidence of carcinoma of the colon and rectum in the Asian and African

counties is less high than that of the Europe and America (Burkitt, 1971).

Carcinoma of the large bowel occures mostly in the 5th and 6th decade of life. In

the right colon carcinoma grows as fungating mass, while the distal colon shows

"napkin-ring" configuration. The prognosis of a patient with cancer of the large

bowel is dependent upon the spread may occur though the lymphatics, by direct

extension and by the blood stream.

Dukes (1932) devided his cases of carcinoma of the rectum into three groups: Type

A; Limited to the rectal wall without nodal involvement Type B; Penetrating through

bowel wall into adjacent tissue without nodal involvement. Type C; Penetrating

through bowel with nodal involvement. This classification by Dukes has been adopted

as a useful prognostic guide in dealing with carcinoma of the large bowel, and its

modifications were also reported.

The polypoid lesions of the large bowel can be identified to be adenomatous

polyp, villous adenoma, etc. The adenomatous polyp is almost always benign, the

incidence of malignant being less than 1 per cent. Villous adenoma is premalignant,

the incidence of malignancy varying from 5 to 50 per cent, depending upon the

series quoted.

But some investigators suggested that these two lesions were growth variants of

the same tumor (Hellwig, 1963; Hertz, et al.,; Ross and Ferrara). There are several

reports on carcinoma of the colon and rectum in Korea, which based on clinical and

statistical aspects. The present study is attempt to compare with reports of other

countries, and extend to tumors of the small bowel as well as those of the large

intestine.

Materials and Methode

The materials used in this study consist of 408 surgically resected or biopaied

tissue from tumors of the large and small bowel for 12 years from 1960 to 1971.

At first gross examination was made to observe size, location and growing

characteristic of tumors. Regional lymphnodes were dissected and obtained as

possibile as we could. All specimens were fixed in 10% formalin. For histological

examinations, paraffin embeded blocks were cut in 6micron thickness and sections

were stained by routine hematoxylineosin method.

Histopathological studies on the cases available for microscopic examination are

preformed as follows: 1. histopathological grading of carcinoma of the large bowel

according to the Broders grade (1925) except the mucoid carcinoma was made; 2. The

grades were comared with metastasis to regional lymphnodes of carcinoma of the

large intestine and also with venous or lymphatic invasion by carcinoma of the

large bowel.; 3. The carcinoma of the large bowel were classified as the Dukes'

classification and staings by Smith's method were also made, and then they were

made a comparison in relation to each grade of carcinoma. ; 4. The influences of

size of carcinoma of the colon and rectum on metastasis to the regional lymphnodes;

5. The influences of the growing pattern of the tumor margin, infiltrating or

pushing, on metastasis to the regional lymphnodes; 6. The tumors of the small bowel

devided into benign and malignanttumors with location of the tumor. At the duodenum

carcinomas arising from the ampullar of Vater were included in this study.; 7. The

benign tumors of the large bowel also were classified in histopathological findings

and associated malignant change was considered in the polyp.

For the all cases which clinical redords were available, sex, age, chief

complaints, duration of symptom and value of the serum hemoglobin were reviewed.

The duration of recurcent carcinoma, of the large bowel was studied in relation

to the staging in which readmissions for the treatment of 5-F.U. were not included.

Result and Summary

Clinical and histopathological studies were made on 408 surgically removed cases

of tumors of the small and large intestine, that were submitted to the Department

of Pathology, Yonsei University College of Medicine, during the period of 12 years

from 1960 to 1971.

1. Among 41 cases of tumors of the small intestine, 37 cases were malignant

tumors and the ratio of malignancy and benignancy was 9.5:1.

Peutz-Jeghens syndrome was found in benign tumors of the small bowel.

2. The malignant tumors of the small intestine consisted of 11 cases of

adenocarcinoma, 16 cases of lymphoma, 2 cases of carcinoid, 1 case of

undifferentiated carcinoma and 7 cases of metastation malignant tumors.

3. The lymphoma occured at the ileum in total 10 cases. The carcinoids throughout

the large and small intestine had its origin in extraappendiceal areas, and it

showed difference from the reports of the foreign countries.

4. the ratio of the benign tumors mdfd malignant tumors in the large intestine

was 1:4.8. And also the ratio of the malignant tumors of the large bowel and those

of the small bowel was 8.3:1.

5. The adenomatous polyps occupid 85.9% of the benign tumors of the large

intestine and 93.7% of them occured at the rectum. The 34 cases of the benign

polypoid lesions of the large intestine were less that 1.5 cm of is diameter.

6. The malignant tumors of the large intestine were 4.3% of the total malignancy

of surgical specimens or the same period.

7. Carcinoma of the large intestine showed different clinical symptoms according

to the location.

8. The size of carcinoma of the large bowel had no much influence on the

metastasis of the regional lymphnodes.

9. The grade of carcinoma of the large intestine had much effects on the venous

or lymphatic invasion by carcinoma and also metastasis of the regional lymphnodes.

10. Stage 0was not identified in the cases examined and the higher the stage of

carcinoma of the large intestine was, the higher the grade was.

11. The characteristics of local spread of carcinoma, infiltrating margin or

pushing margin, gave much effects on the metastasis to the regional lymphnodes.

12. The tendency was seen that the recurrent period in less advanced stage of

carcinoma was a little short, compared with more advanced stage.

In conclusion based on above findings it can be stated that it is important to

observe venous or lymphatic invasion by carcinoma, metastasis of the regional

lymphnodes and to make stage of the carcinoma of the large bowel showed relatively

advanced stage, and among the tumors of the small intestine the carcinoid had

different location from that reported at foreign countries.

[영문]

The tumors of the small and large intestine have been investigated by many workers in both clinical and pathological aspects. It is of interest that although the small bowel tumors in the small bowel are rare (Botsford and Seibel, 1947; small bowel, malignancy is more common than benign tumor, and the former consist of adenocarcinoma, lymphosarcoma, carcinoids, etc. The carcinoma of the large intestine is the most frequent malignant tumor throughout the gastrointestinal tract in the U.S.A. But the incidence of this tumor was preceded by the carcinoma of the stomach in Korea (Lee et al., 1965; Kim, et al.,1967).

The incidence of carcinoma of the colon and rectum in the Asian and African counties is less high than that of the Europe and America (Burkitt, 1971).

Carcinoma of the large bowel occures mostly in the 5th and 6th decade of life. In the right colon carcinoma grows as fungating mass, while the distal colon shows "napkin-ring" configuration. The prognosis of a patient with cancer of the large bowel is dependent upon the spread may occur though the lymphatics, by direct extension and by the blood stream.

Dukes (1932) devided his cases of carcinoma of the rectum into three groups: Type A; Limited to the rectal wall without nodal involvement Type B; Penetrating through bowel wall into adjacent tissue without nodal involvement. Type C; Penetrating through bowel with nodal involvement. This classification by Dukes has been adopted as a useful prognostic guide in dealing with carcinoma of the large bowel, and its modifications were also reported.

The polypoid lesions of the large bowel can be identified to be adenomatous polyp, villous adenoma, etc. The adenomatous polyp is almost always benign, the incidence of malignant being less than 1 per cent. Villous adenoma is premalignant, the incidence of malignancy varying from 5 to 50 per cent, depending upon the

series quoted.

But some investigators suggested that these two lesions were growth variants of the same tumor (Hellwig, 1963; Hertz, et al.,; Ross and Ferrara). There are several reports on carcinoma of the colon and rectum in Korea, which based on clinical and statistical aspects. The present study is attempt to compare with reports of other countries, and extend to tumors of the small bowel as well as those of the large intestine.

Materials and Methode

The materials used in this study consist of 408 surgically resected or biopaied tissue from tumors of the large and small bowel for 12 years from 1960 to 1971.

At first gross examination was made to observe size, location and growing characteristic of tumors. Regional lymphnodes were dissected and obtained as possibile as we could. All specimens were fixed in 10% formalin. For histological examinations, paraffin embeded blocks were cut in 6micron thickness and sections were stained by routine hematoxylineosin method.

Histopathological studies on the cases available for microscopic examination are preformed as follows: 1. histopathological grading of carcinoma of the large bowel

according to the Broders grade (1925) except the mucoid carcinoma was made; 2. The grades were comared with metastasis to regional lymphnodes of carcinoma of the large intestine and also with venous or lymphatic invasion by carcinoma of the large bowel.; 3. The carcinoma of the large bowel were classified as the Dukes'

classification and staings by Smith's method were also made, and then they were made a comparison in relation to each grade of carcinoma. ; 4. The influences of size of carcinoma of the colon and rectum on metastasis to the regional lymphnodes; 5. The influences of the growing pattern of the tumor margin, infiltrating or pushing, on metastasis to the regional lymphnodes; 6. The tumors of the small bowel devided into benign and malignanttumors with location of the tumor. At the duodenum

carcinomas arising from the ampullar of Vater were included in this study.; 7. The benign tumors of the large bowel also were classified in histopathological findings and associated malignant change was considered in the polyp.

For the all cases which clinical redords were available, sex, age, chief complaints, duration of symptom and value of the serum hemoglobin were reviewed.

The duration of recurcent carcinoma, of the large bowel was studied in relation to the staging in which readmissions for the treatment of 5-F.U. were not included.

Result and Summary

Clinical and histopathological studies were made on 408 surgically removed cases of tumors of the small and large intestine, that were submitted to the Department of Pathology, Yonsei University College of Medicine, during the period of 12 years from 1960 to 1971.

1. Among 41 cases of tumors of the small intestine, 37 cases were malignant tumors and the ratio of malignancy and benignancy was 9.5:1.

Peutz-Jeghens syndrome was found in benign tumors of the small bowel.

2. The malignant tumors of the small intestine consisted of 11 cases of adenocarcinoma, 16 cases of lymphoma, 2 cases of carcinoid, 1 case of undifferentiated carcinoma and 7 cases of metastation malignant tumors.

3. The lymphoma occured at the ileum in total 10 cases. The carcinoids throughout the large and small intestine had its origin in extraappendiceal areas, and it showed difference from the reports of the foreign countries.

4. the ratio of the benign tumors mdfd malignant tumors in the large intestine was 1:4.8. And also the ratio of the malignant tumors of the large bowel and those of the small bowel was 8.3:1.

5. The adenomatous polyps occupid 85.9% of the benign tumors of the large intestine and 93.7% of them occured at the rectum. The 34 cases of the benign polypoid lesions of the large intestine were less that 1.5 cm of is diameter.

6. The malignant tumors of the large intestine were 4.3% of the total malignancy of surgical specimens or the same period.

7. Carcinoma of the large intestine showed different clinical symptoms according to the location.

8. The size of carcinoma of the large bowel had no much influence on the metastasis of the regional lymphnodes.

9. The grade of carcinoma of the large intestine had much effects on the venous or lymphatic invasion by carcinoma and also metastasis of the regional lymphnodes.

10. Stage 0was not identified in the cases examined and the higher the stage of carcinoma of the large intestine was, the higher the grade was.

11. The characteristics of local spread of carcinoma, infiltrating margin or pushing margin, gave much effects on the metastasis to the regional lymphnodes.

12. The tendency was seen that the recurrent period in less advanced stage of carcinoma was a little short, compared with more advanced stage.

In conclusion based on above findings it can be stated that it is important to observe venous or lymphatic invasion by carcinoma, metastasis of the regional lymphnodes and to make stage of the carcinoma of the large bowel showed relatively

advanced stage, and among the tumors of the small intestine the carcinoid had different location from that reported at foreign countries.