Journal of Pathology and Translational Medicine

Volume 14(3); September 1980

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Normal Value of Serum Total LDH Activity and LDH Isoenzyme of Koreans: Song Ja Chin, Choon Won Kim, Seung Hahm Park, Ki Hong Kim; Korean J Cytopathol. 1980;14(3):1-8.

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Abstract: Measurement of serum total LDH activity has proved to be a useful means of following the course of variety diseases. An elevated serum total LDH activities, however, is in itself of limited value in establishing the specific site of tissue damage because of the wide distribution of the enzyme. Electrophoretic studies of the isoenzyme of serum and tissue LDH can provide more specific information to the diagnosis of specific organ injury. By electrophoresis, five distinct bands of LDH are separated, with LDH1(heart fraction) migrating the most rapidly to anode, LDH5 (liver fraction) migrating the most slowly to cathod and LDH2-4 migrating between LDH1 and LDH5. Authors have studied for obtaining of normal value of serum total LDH activity and LDH isoenzyme by agarose gel electrophoretic procedure in healthy Koreans(186 cases). The following results are obtained. 1) Normal value of serum total LDH activity and quantitated percentage of LDH isoenzyme in Korean male and female are 221.0±138.0(±2SD) unit and LDH2=36.6±7.2(±2SD)%>LDH1=3l,0±5.2(±2SD)%>LDH>3= 27.0±7.6(±2SD)%>LDH4=4.7±4.6(±2SD)%>LDH5=0.9±2.0(±2SD)% in decreasing order. 2) Serum total LDH activity and quantitated percentage of LDH isoenzyme according to age and sex have no significant difference. 3) After storage of serum at room temperature, 4℃ and -20℃ because of the LDH4,5 fraction has low stability. The serum total LDH activity is not significant, but the LDH5 fraction is not defected in 2 cases of 7 cases after 4℃ storage and in 5 cases of 7 cases after -20℃ storage. 4) Reproducibility of serum LDH isoenzyme is within ±2SD range.

Cervical Lymphnode Metastasis as the first Manifestation of Extramedullary Plasmacytoma: Myung Hee Kang, Woon Sup Han, Jung Dal Lee, Doo Yon Lee*, Soo Sang Sohn*; Korean J Cytopathol. 1980;14(3):9-14.

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Abstract: A 22-year-old male who had cervical lymphnode metastasis as the first symptom of an extramedullary plasmacytoma was described. The recurrent plasmacytoma arising in the soft tissue of the neck was diagnosed 3 years after excision of the cervical lymphnode metastasis. The primary site of the plasmacytoma bas not yet been defected in spite of vigorous clinical approaches. Classical multiple myeloma was excluded by electrophoresis of serum and x-ray studies of the skeleton. The unusual clinical manifestation and atypical histologic features of both metastatic and recurrent plasmacytomas were discussed in detail.

Early Detection of Mycobacterium tuberculosis in Sputum by Slide Culture: Won Kil Lee, Jae Sik Kim, Jyung Myung Kim; Korean J Cytopathol. 1980;14(3):15-20.

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Abstract: An early detection of Mycobacterium tuberculosis in the sputum was attempted by slide culture method instead of the ordinary culture media and the authors obtained the following results. The elongation of bacterial cells was only observed on the slide of the first day culture. There was increases of the number of the elongated cells on the third day culture. There were many groups which composed of the elongated cells of mycobacteria containing granules in the cells on the slide of the fifth day culture. On the seventy day culture the microcolony formation of the elongated cells was prominent. Also the elongated cells, the cells with granules and the divided cells were seen scattered. The rate of the culture positivity from 102 sputums was 9.8% on the Ogawa's media and 10.8% on the Kirchner's media. The rate of positivity of slide culture method was the same as the culture on the Kirchner media. The rate of positivity by the direct smear staining of the sputum was 9.8%. The microscopically positive 2 cases were negative in the cultures while the microscopically negative 3 cases were positive in the culture. The slide culture method was thought to be useful for the early detection of the Mycobacterium tuberculosis in the sputum.

Sequential Hematological and Chemical Changes of Acid-Citrate-Dextrose(ACD) Preserved Blood: Heum Rea Park, In Sun Kim, Seung Yong Paik; Korean J Cytopathol. 1980;14(3):21-26.

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Abstract: The sequential changes of formed blood elements and chemical components that occur in acid-citrate-dextrose blood in plastic bag during storage at 4℃ for 21 days have been observed. With the storage time, hemoglobin, hematocrit, and red blood cell, white blood cell and platelet courts were decreased, especially in platelet count. The level of potassium, ammonia, LDH, plasma hemoglobin and acid phosphatase were marked1y increased whereas dextrose, sodium and chloride were decreased. BUN, uric acid, GOT, protein and albumin were not changed.

Histopathological Study of Gastric Carcinoma According to Criteria Presented by Lauren: Jyung Sik Kwak, Suck Jae Hong, Dong Koo Lee; Korean J Cytopathol. 1980;14(3):27-32.

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Abstract: In the Department of Pathology, Kyungpook National University School of Medicine, 273 cases of gastric carcinoma obtainable adequate histopathological information were diagnosed during the year 1975∼1978. The authors classified above cases of gastric carcinoma as intestinal type carcinoma and diffuse carcinoma presented by Lauren. Then the authors assorted distributions according to age and sex and occurrence of intestinal metaplasia in each type. The results were as follows and compared with other papers. 1) The great majority, 186 cases were men and 87 cases women. The men to women ratio was 2.14 to 1. 2) Intestinal type carcinoma accounted for 56.4% (154 cases) and diffuse carcinoma for 33.3% (91 cases). 3) The mean age of the patients with intestinal type carcinoma was 52.0 years and that of diffuse carcinoma 46.5 years. Intestinal type carcinoma was distinctly frequent in men but the preponderance of men was less marked among the patients with diffuse carcinoma 4) Intestinal metaplasia occurred more frequently in intestinal carcinoma.

Malignant Schwannoma -A report of 2 cases-: Seok Jin Gang, Sun Moo Kim, Chong Moo Lee; Korean J Cytopathol. 1980;14(3):33-36.

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Abstract: During the past 3 years, the authors experienced 2 cases of malignant schwannoma. The first case was a 27 years old male who had clinical manifestations of von Recklinghausen's disease. A well circumscribed, ovoid tumor mass was located at extrapleural space at the level of 4th rib, measuring 9×7×7cm. Microscopically, the tumor consists of uniform, elongated, spindle cells and small number of bizzare, plump cells with frequent mitoses, and was in direct continuity with a neurofibroma. The second case was a 25 years old female. The tumor was situated in a nerve trunk of the thigh, and formed a multilobular bulbous swelling within the nerve. Microscopically, the tumor showed monomorphic spindle cells and revealed invasion of the epineurium and surrounding soft tissue. A brief review of the literature and a discussion on he histogenesis of the tumor were made.

A Pathological Study on Seven Cases of the Congenital Hyperbilirubinemia: Seok Jin Gang, Chin Hee Cho, Chong Moo Lee, Whan Kook Chung*; Korean J Cytopathol. 1980;14(3):37-42.

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Abstract: During the 5 years period from Jan. 1, 1974 to Dec. 31, 1978, we experienced seven cases of congenital hyperbilirubinemia diagnosed by the clinical, laboratory, and histopathological findings. Of the nine cases, four cases were Dubin-Johnson syndrome, two cases Rotor's syndromes, and one case Gilbert's disease. The four Dubin-Johnson syndromes occurred in one family, and the jaundice developed intermittently and remitted spontaneously in all four cases. Among the four cases, two cases revealed conjugated hyperbilirubinemia, and one case unconjugated hyperbilirubinemia. Remaining one case had a history of chronic, intermittent jaundice. The specimens of the two cases were obtained by needle biopsy, and these specimens were grossly tan brown to black. Microscopically, the basic liver architecture was preserved. Abundant brown pigments were found in the liver cells of the centrolobular area, and often in kupffer cells also. With Fontana-Masson stain, these pigments stained black, whereas Prussian blue reactions was negative. The Rotor's syndromes of two cases without family history had a chronic intermittent jaundice with raised conjugated bilirubin in the plasma. In one case, BSP retention was 51%/45min. After the injection, and there was no secondary rise of BSP retention on 90min.(15%). In the microscopical findings of liver biopsies, lobular architecture was preserved. There was a normal morphology of liver cells without pigments, inflammation and fibrosis. However, in one case, few, fat vacuoles are found. The case of Gilbert's disease manifested icteric sclera and skin without any discomfort. Liver function tests and liver scan were normal except for the raised plasma unconjugated bilirubin concentration. In the microscopical findings, lobular architecture and morphology of the liver cells were normal. Pigments, inflammation and fibrosis were not found.

Holotelencephaly, Alobar type, without Facial Anomaly (an autopsy case): Jong Eun Joo, Jung Hee Lee, In Sook Lim, Ill Hyang Ko; Korean J Cytopathol. 1980;14(3):43-47.

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Abstract: This case was a stillborn male infant to 26 years old multiparous mother, who was born after 41 weeks of gestation. During this gestational period, the mother was careful and uneventful. Antenatal roentgenogram of simple abdomen revealed severe hydrocephalic appearance and craniotomy followed by induced vaginal delivery was performed. This infant was 3.1㎏ in weight and 50㎝ in height, showing enlarged head with increased occipitofrontal length of 15.0㎝ There were no anomalies in face, extremities and others on external examination. In internal examination, a typical alobar holotelenceptaly was observed without other extracranial anomalies except for Meckel's diverticulum. In the past history of the mother, she delivered first baby, male, 2 years ago. The baby was dead within several hours after birth and was anencephaly with mongoloid feature and short extremities. Reviewing of literatures and pathogenesis of the anomaly have been discussed.

Primary Adenocarcinoma of Appendix with Metastasis to Both Ovaries: Bock Hee Park, Soon Ho Kim; Korean J Cytopathol. 1980;14(3):48-55.

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Abstract: A case of primary adenocarcinoma of the appendix with metastasis to both ovaries was reported. A 23 years old korean female was admitted to the department of Ob. & Gy. in BNUH, 1975, because of fever, chill and lower abdominal pain. She had experienced two artificial abortions, the last one performed 17 days prior to admission. On physical examination at admission, a double adult fist-sized mass was noticed in the posterior fornix on palpation and it was attached to the posterior part of the uterus. A plain x-ray of the abdomen showed a space occupying mass in the lower abdomen and pelvis. An operation was performed under the clinical diagnosis of adnexal tumor. On operation, both ovaries were enlarged and adhered to the uterine wall and rectum. Incidentally, there was also noticed a gray white discoloration in the distal third of the appendix and a small nodular mass in the tip on close examination. Both salphingo-oophorectomies and appendectomy were performed. The patient was expired 23 months after the operation. Grossly, there was a gray white discoloration in the distal third of the appendix which had a small gray white nodule at the tip. On cut surface the lumen of the appendix was filled with gray white tissue, and the thickened wall also appeared gray white. The right and left ovaries measured 10×7×3㎝ and 11×7×3㎝ in size respectively. Both ovaries had brownish gray white and lobulated surface tinged by dark reddish hemorrage. The cut surface of both ovarian tumors showed massive necrosis and appeared dark yellow brown tissue in part with small cystic spaces. No ovarian tissues could be seen in both ovarian tumors. Histopathologically, sections from the distal third of the appendix showed neoplastic glands extended from the mucosa through submucosa and muscle layer to the serosa. There was the neoplastic cells invaded into vessels in the muscle and subserosa layers. The neoplastic glands were lined by single to few layers of anaplastic columnar cells. Sections from both ovarian tumors showed massive necrosis and in part non-necrotic neoplastic columnar epithelial cells. Neoplastic glandular lumens were filled with a small amount of mucinous material.

Exencephalus (Two autopsy cases report): Su Ja Chu, Je G. Chi; Korean J Cytopathol. 1980;14(3):56-61.

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Abstract: Exencephalus is a variant of anencephaly. It probably sits morphologically between classic anencephaly and encephaloele. A significant portion of prosencephalon can be recognized in the head where vertex structure is regularly missing. Diencephalon and rhombencephalon are fairly well preserved in almost every case. Microscopically isocortical lamination is present and cerebral vessels are relatively well developed. Recently authors experienced two autopsy cases of these rare anomalies. The first case was a product after 29 weeks gestation from a 26 years old female who had a history of carbon monoxide poisioning during the ear]y gestation period. The baby died 2 hours after delivery. She weighed 1.02㎏. and measured 47.5㎝. in height. She had typical massive exencephalic acrania along with facial and phalangeal anomalies. The exencephalic mass was 9.0×5.0×4.0㎝. and weighed 120gm. Structures suggestive of gyri and sulci were noted, and these structures were confirmed by microscopic examination. The second case was a product after 30 weeks gestation from a 25 years old female who had no noticeable abnormalities during early gestation period. The baby died soon after delivery. He weighed 1.2㎏. and measured 53㎝. in height. He also had typical massive exencephalic acrania. The exencephalic mass was 8.0×6.0×4.0㎝. and was 150gm. in weight. Structures of gyri and sulci were noted, along with opendyma-lined thalamic structure.

A Case of Endometriosis of the Ureter: Song Ja Chin, Kun Ju Hahm, Wha Soon Chung, Choon Won Kim, Seung Hahm Park, Ki Hong Kim; Korean J Cytopathol. 1980;14(3):62-67.

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Abstract: Endometriosis is a tumorous condition composed of endometrial tissue, either progressing into the uterine wall from the endometrium itself(adenomyosis) or found outside the uterus(endometriosis) usually in the pelvic organ, on the pelvic peritoneum, or in the retroperitoneal tissue. Endometriosis involving the ureter is an uncommon disease and has been reported sporadically since Cullen(1917) first reported a case of bilateral involvement of the ureter. In a recent review of literature, there have been below than 90 cases of endometriosis of the ureter recorded. Authors have experienced a case of endometriosis of the ureter with adenomyosis in a 49-year-old multiparous woman who complained of intermittent gross hematuria for one year. On physical examination, a palpable mass was noted at pelvic portion. IVP and RGP findings showed a hydronephrosis with ureteral stricture on distal portion of the right ureter. Under the impression of the uterine myoma and right ureteral stricture, total abdominal hysterectomy, right salpingo-oophorectomy and uretero-ureterostomy were performed.

Adrenal Cortical Adenoma -A report of 8 cases-: Sung Sim Kim, Sang In Shim, Chong Moo Lee; Korean J Cytopathol. 1980;14(3):68-74.

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Abstract: During the past ten years from 1970 to 1979, we have experienced eight cases of adrenal cortical adenoma which were diagnosed by histopathological examination in the course of the routine surgical pathology service at Department of Clinical Pathology, Catholic Medical Center in Seoul. Of the eight cases of adenoma, seven were found in the left side and one in the right side. Seven were functioning endocrinologically, while the remaining one was nonfunctioning. Of the seven functioning tumors, six were associated with Cushing's syndrome, and the remaining one Conn's syndrome. One of the patients with Cushing's syndrome manifested morphology of black adenoma of the left adrenal gland. The sex and age distribution of the cortical adenomas are summarized in Table 1, the symptoms and signs in Table 2, the endocrine findings in Table 3, and the gross and microscopic findings in Table 4.

Cryptococcosis -A report of four cases-: Young Hee Jee, Sang In Shim, Chong Moo Lee; Korean J Cytopathol. 1980;14(3):75-80.

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Abstract: Cryptococcosis is widespread throughout the world, which may arise in healthy individuals, but more commonly it occurs as an opportunistic infection, particularly in the immunodeficient persons and those having some form of leukemia, lymphoma or Hodgikin's disease etc. We experienced 4 cases of cryptococcosis. The first case was associated with probable malignant lymphoma in a 64-year old woman who was admitted with complaint of high fever. The second case followed kidney transplantation in a 24-year old man, who was admitted with complaint of multiple subcutaneous nodule on the whole body. The third case involved the cervical lymphnode in a 8-year old boy who was admitted with complaint of palpable mass on the neck. The last case of the four was a disseminated cryptococcosis in a 21-year old woman who was admitted with complaints of high fever and maculopapular eruption. The current concept on the pathogenesis and biological behavior of this entity was discussed, with a brief review of the literature.

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