Abstract

The pathologenesis of Gastric cancer is not clearly proved although some of the mucosal changes are considered to play a role in the development of cancer by many investigators. The present study is aimed to investigate the nature of mucosubstance in various gastric lesions and their surrounding mucosa to determine the possible role on the histogenesis of cancer. The material used in this study consisted of 102 cases of stomach cancer and 35 cases of benign gastric ulcer. All gastrectomized specimens are fixed in 10% neutral formalin and prepared by Swiss roll technique to examine the lesion and its surrounding mucosa. 5 sections are cut in 5 micron thickness serially from paraffin embedded blocks. For histologic examination, sections are stained by routine hematoxylin and eosin method. Sections are also stained by alcian blue at pH 2.5 for the detection of acid mucosubstance, and by alcian blue at pH 1.0 and by Spicer's diamine method(HID) for the detection of acid sulfomucin and by periodic acid-schiff(PAS) alone for the detection of neutral mucosubstances. The results are as follows: 1. Intestinal metaplasia and chronic atrophic gastritis were observed more frequently in cancers than benign gastric ulcers. Of the 102 cases of cancers, intestinal metaplasia was observed in 83(81.4%) and chronic atrophic gastritis in 42(41.2%) Of the 35 cases of benign gastric ulcers, intestinal metaplasia was observed in 19(54.3%) and chronic atrophic gastritis in 5(14.3%). 2. The intestinal metaplasia was classified as colonic and enteric types by its histologic characteristics, and the colonic type intestinal metaplasia was considered to be more closely related to the gastric cancer. In cancers, 36(43.3%) of the 83 cases of intestinal metaplasia were enteric type and the remaining 47(56.7%) were colonic type while in benign gastric ulcer, 15(78.9%) of the 19 cases of intestinal metaplasia were enteric type and the remaining 4(21.1%) were colonic type. 3. Histochemically the mucin composition of the two types of intestinal metaplasia was quite different: In sixty (95.8%) of the 62 cases of enteric metaplasia contained only acid sialomucin but in 38(95%) of the 40 cases of colonic metaplasia acid sulfomucin was also detected. In cancers 60(58.8%) of the 102 cases contained the mucosubstances intracellularly and extracellularly. Moreover, in 45 out of 60 cases contained predominantly acid sulfomucin. These results indicated that the colonic type intestinal metaplasia of gastric mucosa has close relationship to the development of gastric cancer histochemically.