한국에 있어서 간흡충증과 원발성 간암과의 상관 관계 -- 서울 및 부산지방 주민 간암 예에 대한 역학적 및 병리학적 관찰-
Relationship Between Clonorchis sinensis Infestation and Cholangiocarcinoma of the Liver in Korea -Epidemiological and Pathologic Reappraisal of 495 Consecutive Primary Carcinomas of the Liver in Seoul and Pusan Areas-
- 김용일; 양덕호; 장기려
- Issue Date
- 서울대학교 의과대학
- Seoul J Med, Vol.15 No.3, pp. 247-255
- Among the influences thought to contribute to
the development of the primary carcinoma of the
liver in Korea, the most important are viral hepatitis,
cirrhosis, and clonorchiasis. The latter is not
only an epidemiologically nationwide parasitic disease
in the southern part of Korea especially among
residents of Nak-Dong river, but also has been well
documented being complicated infrequently by a
series of intrahepatic alterations such as ascending
cholangitis, intrahepatic lithiasis, cirrhosis and primary
carcinoma of the liver.
Because of high prevalence rate of both Clonorchiasis
sinensis and primary carcinoma of the liver
among Koreans, Clonorchis has been considered to
be implicated in causation of carcinoma in spite of
persisting opinions that they might represent a
coincidental and concommitant phenomenon rather
than cause-result relation.
Experimental evidences as with the previous study
by means of chronological sequence of neoplastic transformation
from clonorchis-induced hepatic lesions have been established by one of authors, claiming
that cholangicellular carcinoma develops from the
preexisting clonorchis-induced adenomatous changes
of intrahepatic bile ducts. However, its epidemiological
significance for the conclusive proof of its
causal role has remained unclarified.
The objective of this paper is to identify the
epidemiological significance of clonorchis-induced
cholangiocarcinoma of the liver in Korea by comparison
of histologically verified primary carcinomas
of the liver and clonorchiasis sinensis from two
cities and to illustrate its histo-pathologic characteristics.
Seoul National University Hospital and Pusan
Gospel Hospital were selected for study, each representing
the less and the heavy endemic area of clonorchiasis;
386 and 109 consecutive cases of primary
carcinomas of the liver were analized from 1. 447
and 396 cases of histologically examined hepatic
tissues by necrosy, hepatic lobectomy or by diagnostic
surgical wedge biopsy during the period of 1962
to 1972. The results are as follows:
1. Majority of primary carcinomas of the liver
among Koreans were hepatocellular variety but the
prevalence rate of cholangiocellular carcinoma in
Pusan area. (the downstream of Nak-Dong River)
appeared much higher than in Seoul area.
2. Infestation rate of Clonorchis sinensis in cholangiocellular
carcinoma was higher twice than in
hepatocellular carcinomas in both areas, and such
figures were more apparent in Pusan areas.
3. There were strong histological evidences to
reemphasize the neoplastic transformation from adenomatous
bile duct changes to cholangiocellular carcinoma
or mixed type in 9 out of 21 cases of Clonorchis-
infested cholangiocellular carcinoma.
4. Many of cholangiocellular carcinoma revealed
abundant mucinous changes of stroma as with
neoplastic cell proper.
With the above epidemiological and hlstopatholcgical
findings clonorchiasis appears to predispose to
the oncogenesis of mucin-producing cholangiocellular
carcinoma of the liver in Korea, eapecially among
residents of Nak-Dong River.