J.Jpn. Surg. Soc.. 59(7): 1170-1183, 1958
HISTOPATHOLOGIC STUDIES OF CHRONIC PEPTIC ULCER, WITH SPECIAL REFERENCE TO THE RELATIONS OF INWARD ULCER EXTENSION WITH CHANGES IN THE MUCOUS MEMBRANE OF THE ULCER MARGIN
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Prof. M. Muto's Surgical Clinic, Tohoku University, Sendai Tsunashige KAIEDA |
(1) By examination of the ulcer bases of the 355 chronic ulcers, and the state of epithelial regeneration and cicatrized ulcers, the following findings were obtained as to inward extension of ulcer or its healing by suspension of ulceration :
a) In reference to inward ulcer extension, the ulcers examined were divided into three groups: The group of active extension (129 ulcers), in which nearly all the part of the ulcer base showed an intense inward ulceration with a remarkable stratified structur : The group of slow extension (162 ulcers), in which most of the ulcer base showed a slow inward ulceration with an extensive but slight structure; and the extension suspending group (64 ulcers), in which most of the ulcer base showed little inward ulcer extension, exposing a granulated or cicatrized layer in the stratified tructure.
b) The rate of occurrence of pithelial regeneration at the ulcer base was 55% in simple ulcers, and 31% in callous ulcers, the difference between them being significant. In either case, however, the area of epithelial regeneration was mostly less than 2 mm. (5 mm. at most).
c) As to the relation of epithelial regeneration with inward ulcer extension, the rats of occurrence of epithelial regeneration was 29% in teh group of active extension and 31% in the group of slow extension, both group showing a remarkable destruction in the regenerated epithelium. On the other hand, the suspending group gave a high rats of 53% and showed an active proliferation in regenerating epithelium.
d) The 39 cicatrized ulcers were star-shaped and 0.3 to 0.5 cm. in diameter, or linear and less than 0.5 cm. wide, all showing cicatricial contraction. In 24 of these healed ulcers, ulceration did not extend beyond the muscular layer or the subserosa. Even in the remaining ulcers, in which the muscular layer was completly pierced by ulceration, callous thickening of the omentum was only slight.
From the findings mentioned above it has been pointed out that not only toppage of inward ulcer extension and regeneration of the epithelium but also reduction of the ulcer surface and approximation of the ulcer margins due to cicatricial contration play important factors in the healing of ulcer.
(2) The relations of changes in the mucous membrane of the ulcer margin with atypical epithelial proliferation were as follows :
a) In respect to the state of changes in the mucous membrane of the ulcers were divided into three groups : Group I, in which the imperfectness of destruction still existed or that the affected part failed to rebuild the same structure as before, was not remarkable; group II, in which the imperfectness was remarkable ; and group III, in which there occurred proliferation of indifferent cells such as seen in the early stage of epithelial regeneration. The distribution of the chronic simple ulcers among these groups was 24% for group I, 41% for group II, and 35% for group III, whereas the callous ulcers was 7% for group I, 65% for group II, and 28% for group III. Thus it will be seen that the repair of the glandular tissue was remarkably imperfect in the majority of the callous ulcers.
b) There occurred atypical epithelial proliferation in 1 chronic simple ulcers, and 1 cicatrized ulcer : 31 of these ulcers showed early malignant degeneration that agreed with the criteria of Hauser for ulcer -carcinoma.
c) As to the relation of inward ulcer extension with atypical epithelial proliferation, the rate of occurrence of atypical proliferation was as high as 28% in the extension suspending group of 64 ulcers, 17% in th slow extension group of 162 ulcers, and a small as 7% in the active extension group of 129 ulcers. The rate of ocurrence of atypical epithelial proliferation in the three groups concening the stat of changes in the mucous membrane of the ulcer margin was 0,5, and 41% in group I, II , and III, respectively.
From the findings mentioned above it has been concluded that atypical epithelial proliferation is closely related with the regeneration of the mucous membrane, and ii) that in those ulcers (such as callous ones) in which epithelial regeneration is not complet and repair of the mucous membrane is remarkably imperfect, atypical epithelial proliteration is seen more frequently, and eventually leads to malignant degeneration.
(auther's abstract)
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