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胃粘膜의 腸型化生에 關한 病理組織學的 硏究

A Histologic Study on the Intestinal Metaplasia of the Gastric Mucosa

경북의대잡지 1966년 7권 1호 p.57 ~ 78
허만하 (  ) - 경북대학교 의과대학 병리학교실

Abstract


The incidence and histogenesis of intestinal metaplasia and its significance as a passible precancerous change has not heretofore been investigate? in the Korean people. Such a study is ofgeographicopathologic value and interest.
Accordingly, histologic observations were made upon the gastric mucosa of two groups. The first, a normal control group, consisted of 50 stomachs obtained at autopsy, 12 fetal stomachs, and 75 biopsy specimens (obtained by means of a flexible biopsy tube). Thus, 137 cases were incluced in the control group. The second abnormal group consisted of 112 cases. Sixty-two of these were obtained by gastrectomy performed for gastric and .duodenal ulcer and gastric carcinoma. Fifty of the abnormal group were biopsies from patients diagnosed clinically as having gastritis and proven histologically to be chronic gastritis. All specimens were studied with the aid of five necessary special stains as well as the standard H-E stain.
The following observations and conclusions were made from this study:
1) Histological and histochemical investigation confirmed the view that intestinal epithelium observed in gastric mucosa was essentially identical to the intestinal epithelium proper.
Several morphological features specific to the metaplastic epithelium were introduced.
2) Histopathologic features of gastric mucosa associated with intestinalization were discussed with respect to type and degree of inflammation, occurence ´ of nonspecefic cell and frequent formation of microcysts.
An attempt is made to introduce the nonspecific cell as another independent type of the mucosal epithelium metaplasia.
3) A series of results were obtained to corroborate that intestinalization of gastric mucosa is the metaplastic product in the gastric epithelium and is related to chronic irritation affected to it.
4) It was shown that the control stomachs obtained at autopsy exhibited intestinal metaplasia in 2 cases (20.0%) in the third decade, in 2 cases (18.1%) in the fourth decade, and in 1 case (33.3%) in the fifthe decade.
Intestinal epithelium was not encountered below the age of 30. In fetal stomachs and biopsy specimens from normal adults was presented no intestinalization of gastric mucosa.
5) Intestinal epithelium was found in _the gastric mucosa in 42 specimens (74.2%) of the partial gastrectomy series and in 11 specimens(22.9%) of biopsy series.
6) It was noted that the incidence of intestinal met~iplasia was greatest in the stomachs of gastric carcinoma (92.0%) followed by the gastric ulcer (72.70), chronic atrophic gastritis (57.9%) and duodenal ulcer (46.7%) , in that order.
7) It was shown that the extent of intestinal metaplasia was often proportional to the degree of mucosal injury, especially to the atrophy of glands. Thus the incidence of intestinal metaplasia wa.s greatest in Grade IV (79.3%), followed by Grade III (51.3%) and Grade II (13.6%) in that order. No case of intestinal metaplasia was observed in histologically normal or nearly normal gastric mucosa.
8) It cvas revealed that the incidence of intestinal metaplasia was greatest at the pyloric area (72.6%) and least at the greater cur~.-ature (41.9%1, with the area of lesser curvature (50.8 %) taking an intermediate position, whatever series of stomachs was considered.
9) The amount of intestinal metaplasia vas largest in the stomachs of carcinoma, followed by stomachs of gastric ulcer and stomachs of duodenal ulcer, in that order.
10) It was noted that the presence of intestinal metaplasia was, more or less, confined to the pyloric region in the stomachs with duodenal ulcer, vvhile it was usually diffuse in the stomachs co~itaining carcinoma and containing chronic atrophic. gastritis. The stomachs containing ulcer were intermediate position in the distribution.
11) It vas demonstrated that, in both normal and pathological group, extent as ~yell as incidence of intestinal metaplasia increased with age.
12) An investigation into the stare of Gastric mucosa in normal Korean objects reti-ealed various degree cf inflammation in 23 cases (~6. C´;) in autopsy series, and in 41 cases (54.7%) in biopsy series.
13) Detailed discussion was made in support of the view that area of intestinalization, especially in its unstable stage, might be a precursor of carcinoma and some gastric carcinomas arise on this base.

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