In order to elucidate the relationship between stomach cancer and gastritis the histopathologic changes of the mucosa of stomach cancer were studied with special reference to cellular infiltration, intestinal metaplasia, mitotic rate of gastric mucosa, thickness of mucosal and glandular layer and the ratio of glandular layer to mucosal layer.
The tissue specimens from 16 cases of gastric cancer (3 cases of them being early gastric cancer), 3 cases of gastric ulcer, 4 cases of gastritis and one case of normal subject, to the total of 24 cases were selected for the present study.
The stomachs surgically removed were opened along the greater curvature for macroscopic observations and fixed in 10% formol solution. A number of specimens from 11 to 33 with average of 22 were prepared to cover the entire area of the resected stomach. The specimens were stained with the hematoxylin-eosin solution. Practically, the entire area of stomach was divided into 6 areas, namely, anterior, posterior wall and lesser curvature of fundus and pyloric area. The vicinity of the lesion was added to above 6 areas in case of gastric cancer and ulcer. The specimeus were taken from the areas as evenly as possible.
According to the extent of cellular infiltration and intestinal metaplasia the changes were classified into 0 Point 3 Points. The mitotic rate was determined by Teir's method. The measurements were carried out with the mitotic areas of the glandular tubules cut continuously from gastric pit to base of the gland and arranged perpendicular to muscularis mucosae. The rate was measured in the areas of gastric, pyloric and intestinal type gland in separate. The mitotic rate was expressed by the percentage of mitotic cells to the total cell count.
As for the thickness of the mucosal and the glandular layers, serial sections were cut from gastric pit to base of the gland. The measurements were made with the gastric and the pyloric gland arranged perpendicular to muscularis mucosae. The thickness between the surface of muscularis mucosae and the mucosal surface was taken as the thickness of the mucosal layer, and that of lamina propria excepting the gastric pit was taken as the thickness of the glandular layer. The ratio of the glandular layer to the mucosal layer was calculated by measuring the thickness from corresponding glandular layer to mucosal layer. The results of the measurment were as follows.
1. The cellular infiltration in gastric cancer was more intense than other stomach diseases. The entire resected specimens of the stomach cancer were given about 2 Points of the cellular infiltration in average. The specimens of stomach cancer having carcinoma focus in the area of the gastric gland revealed more intense cellular infiltration than the ones having the foci in the area of pyloric gland. Furthermore, the change was related to the stage of the disease, namely more intense cell infiltration was observed in the advanced cases of gastric canccr.
2. The incidence and the extent of intestinal metaplasia of gastric mucosa were highest in gastric cancer, notably in the area of pyloric gland. The intestinal metaplasia was not related to the depth of the gastric wall involved by carcinoma and the site of carcinoma foci.
3. The mitotic rate of both gastric gland and pyloric gland was proved to be equal between gastric cancer and other stomach diseases. However, in the resected specimens of stomach carcinoma the rate was higher in the area of pyloric gland than the area of gastric gland and it was least in the vicinity of the lesion.
4. The mitotic rate of intestinal type gland showed no difference between gastric cancer and other stomach diseases. In the resected specimens of stomach carcinoma having the carcinoma foci in the area of gastric gland showed a higher mitotic rate than those having the lesion in the area of pyloric gland.

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走査電子顕微鏡で, 犬胃粘膜表面の性状をみた.正常胃粘膜: 胃底腺領域は, 胃小窩が円形の腺腔構造をとり, 周堤は均一の厚さ, 腺腔内は多分枝である.領域は, 胃小窩が楕円形に近い腺腔構造をとり, 周堤は厚く, 腺腔は単一である.中間帯領域では, 胃底腺と領域の性状が混在している.ENNG投与で生じた異常胃粘膜: 隆起性病変: 悪性の場合は, 著明な変形または構造配列が不明な腺腔で, 粘膜表面は凹凸不整が強い.良性の場合は, 腺腔を認め難い棍棒状膨隆で, 平坦である.陥凹性病変: 癌が露出していれば, 無構造な配列構造であるが, 癌が露出してない場合でも, 腺腔の変形がみられる.少ない症例数であるが, 早期胃癌の場合, signet-ring cellcaでは, 胃小窩は, ほぼ円形で腺腔内の構造は凹凸不整である.tubular adenoca.では, 胃小窩は, ほぼ楕円形で, 周堤が厚く不整であることが特徴であった.

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An attempt has been made to the analysis of the damage of the gastric mucosa and its repair by regeneration in lesions of chronic gastritis and gastric ulcer. The animals used were Wistar rats. Three main arteries of the stomach, together with veins, were cut off and the neighboring organs and tissues were also seperated as thoroughly as possible. All rats were necropsied from 30 minutes to 55 days postoperatively. The acidity of the gastric juice at the time of sacrifice was determined by histamine test. The experimental results and conclusions were as follows.
1) The damage of the gastric mucosa is mainly due to arterial ischemia, but venous factors, such as congestion, edema and so on, are partly concerned.
2) The damage of the gastric mucosa occurs constantly at the f undic area, which is considered to be most differentiated. The damage begins symmetrically from the greater curvature gradually. At the lesser curvature, the f undic area adjacent to the fold-like ridge and the pyloric area near the duodenum are fairly well preserved. The areas are considered to be the site of the later regeneration of the mucosa. As to the extent of the damage of the mucosa at the pyloric area and the ampulla (Vormagen), there is considerable variation and no clear cut rules are present. This may be partly due to the variety of the vasculature and the manual skill of the ligation.
3) Histologically the damage begins with degeneration and breakdown of parenchymatous cells of fundic glands followed by necrotic foci of varing depth and breadth. The spreading of necrotic area becomes most prominent on the 3rd or 4th day after operation. At the base of lesions leukocytic infiltration is marked and lesions are demarcated. Crusted necrotic foci fall off and denuded area (ulcer) is formed. The base of the ulcer is formed by inflammatory granulation tissue. As the result of the perforation of the entire gastric walls due to necrotic breakdown, the formation of the granulation tissue of foreign body type is also present till about the 20th day. The adhesion of the neighboring tissues and organs also takes place.
4) About the 5th day the surface of the ulcer is gradually cleaned up, the regeneration of glandular epithelia from the remaining gastric mucosa occurs and the repair takes place. Both epithelial regeneration from the fundic and pyloric area are of f oveola gastricae type and resemble pyloric gland (uncomplete regeneration of the fundic area) .
5) The regeneration of the gastric mucosa becomes prominent from the 7th or 8th day and the greater part of the surface of the ulcer is covered with newly formed epithelia on about the 15th day. About the 20th day the area of uncomplete regeneration becomes narrower and the fundic area spreads and this indicates the progress of the repair of the fundic parenchyma.
6) The regeneration of the fundic parenchyma completes on the 30th day. But the gastric juice proves to be acid-free. The discrepancy between the nummerical recovery of parietal cells and the functional recovery of gastric acid secretion exists, but this discrepancy disappears on the 40th day, as histamine test is concerned.
7) Chief cells regenerate in the latest stage and they are less in number. Intraplasmic thionine granules of regenerated chief cells are decreased in number. Whether or not the regeneration of chief cells is resulted from the differentiation from mucoid cells cannot be clarified by this experiment.

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