한국에 있어서 간흡충증과 원발성 간암과의 상관 관계 -- 서울 및 부산지방 주민 간암 예에 대한 역학적 및 병리학적 관찰-

Abstract

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.