Journal of Pathology and Translational Medicine

Volume 19(3); September 1985

Original Articles

Ultrastructural Changes in the Exocrine and Endocrine Cells of Rat Pancreas in Endotoxin Shock.: Kun Young Kwon, Chai Hong Chung, Tae Joong Sohn; Korean J Cytopathol. 1985;19(3):255-289.

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Abstract PDF: This study was carried out to investigate the morphological changes in the exocrine and endocrine glands of rat pancreas treated with endotoxin. Thirty-five male Sprague-Dawley rats, maintained on a stock diet, weight 200.0 gm. average. were divided into two experimental groups. Group 1. Control group. Five rats. Intraperitoneal infections of 0.3 ml normal saline only. Group 2. Endotoxin-treated group. Thirty rats. 7.6 mg of endotoxin per kg. of body weight was administered intraperitoneally. Each of 5 experimental animal was sacrificed 30 minutes, 1, 2, 4, 6 and 8 hours after endotoxin treatment, followed by examinations of histochemical, light and electron microscopy of both transmission and scanning modes. The results were as follows: A. Light microscopic findings: A mild interstitial edema and hyperemia were noted 1-hour after endotoxin treatment. Cytoplasmic vacuolization at 2-hour level(2-hours after endotoxin administration), diminished staining quality of both endocrine and exocrine cells at 6-hour level. B. Electron microscopic examination: a. Transmission electron microscopy. The acinar cells of pancreas showed a mildly increased pre-lysosome at 30-minute level. At 1-hour level, appearance of secondary lysosome was noted in addition to the findings of mitochondrial swelling and decreased cristae; disarray and vacuolization of the RER; vacuolar change of Golgi apparatus. At 6-hour level, post-lysosomes. The changes in the endocrine glands were similar to the findings of exocrine glands just described with time lag of 1 to 2 hours. The endothelial cells of capillaries show swelling and pinocytotic vesicle formation, protrusion of the cytoplasmic processes into the capillary lumen and increased heterochromatin at 1-hour level. These findings became more prominent as time lapses. The lumen of the endothelium tends to be narrowed, filled with fibrin and other blood cell components which later terminated with occasional complete occlusion by the formation of thrombi. b. Histochemical study: Primary lysosomes of the control group revealed a strong reaction of the acid phosphatase whereas the endotoxin treated group with less reactivity limited in the peripheral zones of the lysosomes. Secondary lysosomes with partial reactions. However, the pre-lysosomes and post-lysosomes failed to demonstrate any acid phosphatase activity at all. c. Scanning electron microscopy. The endothelial cells of the capillaries, arterioles and venules demonstrated increased microvillous activity, broad bled formation, cytoplasmic protrusion into the luminal spaces and microthrombi formation at 1-hour level. Six-hour level onward there noted a junctional disruption and partial detachment from the subendothelium of the wall. It can be concluded, therefore: When the endotoxin enters the blood stream, it elicits endothelial injury followed by both exudation with resultant edema of the surrounding tissue and concomitant vascular occlusions due to thrombosis. This vascular occlusion, in turn, causes ischemic degenerative change of the cells of exocrine and endocrine glands of the pancreas which are followed by digestions of degradational materials from the injured cells through the lysosomal phagocytic system. Besides the above pathogenetic pathway, one can not rule out the possibility of the direct effects of the endotoxin to the cells of exocrine and endocrine cells of the pancreas also so rendered.

Ultrastructural Changes of Liver Cell Mitochondria in Autolysis.: Yoon Kyung Sohn, Il Hoon Kwon, Tae Joong Sohn; Korean J Cytopathol. 1985;19(3):290-301.

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Abstract PDF: The authors studied the ultrastructural changes of liver cell mitochondria in autolysis. The male Sprague-Dawley rats, weighting 140~160 gm were sacrificed for extract liver tissue. The slices of the liver tissue were incubated in 37 degrees C aseptic normal saline, and those were examined by following intervals; 10, 20 and 30 minutes and 1, 2, 6, 12 and 24 hours with light and electron microscope. The results obtained by light microscopy were summerized as follow. Several fine intracytoplasmic vacuoles were observed 1 hour after incubation. After 3 hours, focal destruction of cytoplasmic membrane with pyknosis of nuclei were observed. More delicate intracytoplasmic architectural changes could not be detected at light microscopic studies. The cord arrangement and cellular boundaries were relatively well preserved until 24 hours after incubation. Electronmicroscopically, mild intramitochondrial swelling with diminution of intramatrical granules were observed at 20 minutes. These were the earliest findings. Both high amplitude swelling and destruction of mitochondrial membrane were observed concurrently at 1 hour after incubation. The earlier membrane changes were observed at inner membrane with cristae and followed by degeneration of the outer membrane. The intramatrical amorphous dense deposits were observed at 30 minutes when the membranes were not destroyed. These deposits were noted in the other experimental groups which were incubated longer than 30 minutes. More electron dense deposits were observed after 1 hour at that time the membrane changes appeared. Vhe results suggest in this experiment that the earliest autolytic changes of liver cell mitochondria is loss of intramitochondrial granules and the membraneous changes led to the irreversible mitochondiral injury. The appearance of two types of intramitochondrial dense deposits would be an interesting finding needed to require further investigation for the chemical stucture and mechanism of dense deposit formation.

Krukenberg Tumor: Clinico-pathologic analysis of 36 cases.: Yeon Lim Suh, Geung Hwan Ahn, Yong Il Kim, Eui Keun Ham; Korean J Cytopathol. 1985;19(3):305-312.

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Abstract PDF: A total of 36 typical Krukenberg tumors of the ovary was obtained from the pathology file of the Department of Pathology, College of Medicine, Seoul National University during a period of 17 years from January 1968 to December 1984. By definition, all were characterized by the presence of mucin containg signet ring cells within the cellular, nonneoplastic ovarian stroma. The clinico-pathologic characteristics of 36 Krukenberg tumors were as follow: The Krukenberg tumors accounted for 16.3% of all ovarian malignancies. The age of the patient at the time of diagnosis of the Krukenberg tumor ranged from 28 to 69 years with an average of 43 years. A primary carcinoma of stomach (31 cases) of colon (1 case) was found in 32 (88.9%) of 36 patients. The primary carcinomas was not detected in four cases, and autopsy was not performed in any case. In 22 cases the primary carcinomas had been diagnosed before ovarian tumors were found. The ovarian and the primary carcinomas were identified synchronously in 6 cases, while in 8 cases the primary carcinomas were not discovered until after the ovarian tumors had been treated. The gross diameter of the ovarian tumor ranged from 1.5cm to 28cm with an average of 10.3cm. The largest weighed 4,550gm. The Krukenberg tumors typically formed rounded or reniform, solid mass that were coarsely lobulated or bosselated. The cut surface was yellow white and associated frequently with nodular, myxoid or gelatinous area and cystic changes of various size. Both ovaries were involved in 29(80.6%) of the cases and one ovary in 7(19.4%). Krukenberg tumors classified into the three major types on the basis of the characteristic morphologic patterns of signet ring cells. The first type was classic Krukenberg tumor(28 cases) represented by predominent components of typical signet ring cells. The second type was tubular Krukenberg tumor(5 cases) characterized by tubular structures resembling a Sertoli-Leydig cell tumor. The third type was re tiform Krukenberg tumor (3 cases) characterized by an irregular network of elongated, often slitlike tubules and cysts, which resembled the rete testis.

The Patterns of Invasion and Lymph Node Metastasis of Stomach Cancer by Histopathological Types.: Kyi Beom Lee, Kwang Kil Lee, Yoo Bock Lee; Korean J Cytopathol. 1985;19(3):313-324.

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Abstract PDF: Stomach cancer is the most common malignant neoplasm among Korean men and considered as one of the most important malignant disease in many countries. Thus, many studies have been established about factors affecting prognosis of stomach cancer. These include studies of histopathological pattern which were performed by Mulligan and Rember (1954), Lauren (1965), Ming (1977), and Teglbjerg and Vetner(1977). The present study is aimed to evaluate the useful factors to predict the prognosis of patient of stomach cancer in relation to the histopathological patterns. The material consisted of 284 cases which were diagnosed as gastric carcinoma at the Department of Pathology, Yonsei University, College of Medicine from January, 1981 through December, 1982. After the classification of gastric carcinoma by Ming (1977), Willis (1967), and Mulligan and Rember (1954), age and six of the patients, histopathologic patterns, depth of invasion, degree and major component of inflammatory reaction, lymphatic permeation and metastatic incidence to the regional lymph nodes were investigated, and the results obtained were as follows; 1) The overall male to female ratio was 1.4 : 1 and mean age was 51.6 years old. The mean age of patients with EGC was 46.8 years old, while that of patients with invasive cancer was 52.2 years old, indicating about 5 years difference. 2) The classification of 284 cases by Ming's method showed 36.3% of expanding type and 63.7% of infiltrative one. The incidence of metastasis to regional lymph nodes was 58.3% in expanding type and 72.4% in infiltrative one. 3) The classification of 284 cases by Willis' method showed 45.8% of adenocarcinoma and 23.2% and of signet ring cell carcinoma. Adenocarcinoma anaplastic carcinoma had high degree of desmoplasia. Among them, moderately well differentiated adenocarcinoma and anaplastic carcinoma showed markedly lower metastatic rate to regional lymph nodes than others. 4) The classification of 284 cases by Mulligan and Rember's method showed 15.1% of intestinal cell carcinoma, 21.5% of pyloro-cardiac gland cell carcinoma and 61.6% of mucous cell carcinoma. Highly differentiated intestinal cell and pylorocardiac gland cell carcinomas and desmoplastic mucous cell carcinoma had high degree of desmoplasia. Among them, highly differentiated intestinal cell carcinoma and desmoplastic mucous cell carcinoma showed markedly low metastatic rate to regional lymph nodes. 5) Adenocarcinoma with good differentiation showed higher mean age and male predominancy in comparison to carcinoma with poor differentiation. 6) The degree of inflammatory reaction did not show significant difference in relation to the patterns of gastric carcinoma and the rate of regional node metastasis. However, according to the cell types involved in inflammatory reaction, plasma cell-predominant inflammatory reaction showed low metastatic rate to regional lymph nodes. 7) The more the degree of desmoplasia was observed, the less the rate of metastasis to regional nodes was noted and the difference was statistically significant. 8) The rate of metastasis to regional nodes showed marked difference by the depth of cancer invasion; confined to mucosa, 0% : to submucosa, 15.4%; to muscular layer, 66.7%; and to serosa and perigastric area, 76.5%. In summary, the results of this study indicated several factors suggesting good prognosis, such as; (1) expanding growth pattern, (2) good differentiation, (3) high degree of desmoplasia as stromal reaction, (4) plasma cell-predominant infiltration, and (5) lesser deep invasion. These factors were better evaluated by Mulligan and Rember's classification.

Case Report

11 Cases of Aspergillosis.: Ho Won Hwang, Jang Shin Sohn, Chae Hong Suh; Korean J Cytopathol. 1985;19(3):325-331.

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Abstract PDF: Genus of aspergilli are ubiquitous saprophytic molds in nature, which are recognized about 700 species, at least eight are pathologic for human. Pulmonary aspergillosis is rare disease, most frequent presenting as secondary invasion, and aspergillosis of the nasal cavity is the most common sites of the extrapulmonary aspergillosis. Predisposing factors for pulmonary aspergillosis are chronic lung disease, tuberculosis, antibiotics, cytotoxins and neoplasia, hematologic disorders, and histoplasmosis etc. Authors have experienced 10 cases of pulmonary aspergillosis and a case of aspergillosis of nasal cavity in Dept. of Pathol. Chosun univ. hospital and christian hospital from Feb. 1981 to July 1984. Patient of pulmonary aspergillosis are received surgical resection and survived well without complications.

Original Article

Rapid Section: A simple technique useful to the practicing pathologist.: Byungwon Park; Korean J Cytopathol. 1985;19(3):332-338.

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Abstract PDF: The "RAPID SECTION", a very simple, quick and also quite accurate method in reaching an immediate tissue diagnosis in the operating room and post-mortem examination has been used exclusively by pathologists with a combined experience of 40 years at this hospital. The procedure is described briefly and the advantages, limitations and a study for the accuracy of the method are discussed. The method would be particularly useful to the practicing pathologist in a community hospital setting with limited monetary and personnel resources as was our experience in the past 30 years.

Case Reports

Ovarian Pregnancy: 12 cases analysis.: Kwan Kyu Park, Sang Sook Lee, Eun Sook Chang, Chae Hong Chung; Korean J Cytopathol. 1985;19(3):339-344.

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Abstract PDF: From January, 1972 to August 1983, 12 cases of ovarian pregnancy out of 1202 total ectopic pregnancy were studied and the incidence constituted 0.9%. The gross and microscopic findings were reviewed according to gross description and gross photographs, and microscopic description and reviewing all microscopic slides. All cases were shown to meet Spiegelberg's criteria for primary ovarian pregnancy.

Gastrointestinal Tumors Associated with von Recklinghausen's Neurofibromatosis: A report of two cases.: Mee Ja Park, Hye Yeon Kim, Nam Hee Won, In Sun Kim, Kap No Lee, Seung Yong Paik; Korean J Cytopathol. 1985;19(3):345-349.

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Abstract PDF: Neurofibromatosis, first clearly described by von Recklinghausen in 1882, is a dominantly inherited mesodermal and ectodermal dysplasia with a broad spectrum of clinical findings. Most common is the classical neurofibromatosis, which has three major features: (1) multiple neural tumors dispersed anywhere on or in the body; (2) numerous pigmented skin lesions, some of which are "cafe au lait" spots; and (3) pigmented iris hamartomas also called Lisch nodules. Other lesions sometimes seen in patients with von Recklinghausen's disease include congenital malformations of various types, vascular lesions, neurilemoma meningioma and other intracranial neoplasms, pheochromocytoma, medullary carcinoma of thyroid gland, neuroblastoma, ganglioneuroma and Wilms' tumor. Approximately 10% of the patients with neurofibromatosis have the gastrointestinal tract tumors as neurofibroma, ganglioneuroma and leiomyoma. Some of them show evidence of malignancy. Increased activity of the protein "nerve growth factor" in the sera of the patients with disseminated neurofibromatosis has been reported. We would like to report here two cases of von Recklinghausen's neurofibromatosis with involvement of the gastrointestinal tract.

Metaplastic Variant of the Gallbladder Adenoma: A report of a case.: Eun Sil Yu, Yong Il Kim; Korean J Cytopathol. 1985;19(3):350-354.

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Abstract PDF: A case of papillary adenoma of the gallbladder in a sixty seven-year-old female with varietise of epithelial components in metaplastic nature is presented. This adenoma was bordered by hyperplastic epithelium with intervening Paneth cells and enterochromaffin cells, but goblet cells were rarely participated, as with focal epithelial change resembling gastric foveolar epithelium and aggregation of antral type mucous glands. Based on its morphologically distinct type of gallbladder adenoma and histogenetic point of view, we propose this neoplasm to be designated as a metaplastic adenoma or polyp, and the relationship of various metaplastic changes to adenoma or carcinoma is discussed.

Original Article

Unknow Primary Melanoma.: Taie Seung Kim, Kyu Rae Kim, Byung Sun Roh; Korean J Cytopathol. 1985;19(3):355-359.

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Abstract PDF: Unknown primary melanoma shows only metastatic malignant malanoma without obvious primary tumor. These unusual instances of unknown primary melanoma have reported incidences of 1.0~8.7%. This 51 year old patient had many intra-abdominal and mesenteric masses without visible primary tumor. The most commonly accepted explanation for unknown primary melanoma is spontaneous regression of a primary skin lesion.

Case Reports

A Case of Primary Orbital Hemangiopericytoma.: Hwan Ju Choi, Kang Suek Suh, Sun Kyung Lee; Korean J Cytopathol. 1985;19(3):360-364.

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Abstract PDF: Hemangiopericytoma is a rather uncommon neoplasm composed mainly of cells derived from the vascular pericytes of Zimmermann, which are normally found in close apposition to the endothelial cells of capillaries and postcapillary venules. Authors studied a case in which primary hemangiopericytoma located in the left orbit of a 54-year-old woman. Review of the literatures about incidence, clinical symptoms, histological features and biological behavior of the orbital hemangiopericytoma was presented.

Chromomycosis: A case report.: So Young Jin, Chan Il Park, Yoo Bock Lee; Korean J Cytopathol. 1985;19(3):365-367.

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Abstract PDF: Chromomycosis is a chronic localized infection of the cutaneous and subcutaneous tissues and characterized by verrucoid, ulcerated and crusted lesions with sclerotic margins. It histologically show confluent granulomatous nodules containing large giant cells of the foreign body type. The organisms are differ from other yeastform fungi by the characteristic chestnut-brown color and by the septate division. A case of 51 year old woman with chromomycosis at submental area is presented.

Mucous Gland Adenoma of the Bronchus: A case report.: So Young Jin, Kwang Gil Lee; Korean J Cytopathol. 1985;19(3):368-373.

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Abstract PDF: Mucous gland adenoma, one type of bronchial adenoma, is first introduced by Rosenblum and Klein2) in 1935 and very rare. Only twenty-one cases had been reported in english literature. This tumor must be differentiated from other types of bronchial adenoma because of completely benign clinical course. A case of mucous gland adenoma is presented which showed marked secondary calcification.

Original Article

A Pathologic and Immunopathologic Study of Behcet's Syndrome.: Hyeon Joo Jeong, In Joon Choi; Korean J Cytopathol. 1985;19(3):374-376.

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Abstract PDF: The pathologic and immunopathologic findings of 15 skin biopsies of Behcet's syndrome were studied to investigate the pathogenetic mechanism of this syndrome. The age range was 28 to 50 years; male to female ratio was 1 : 1.2. Ulceration with acute necrotizing and chronic nonspecific inflammation was present in most cases with leukocytoclastic vasculitis and perivascular lymphohistiocytic, plasmocytic infiltrations. Eight of 15 cases showed C3 deposit in the walls of venules and capillaries, one of them was associated with IgM and fibrinogen deposits. With these findings humoral factor seemed to play a main role in the pathogenesis of vasculitis observed in Behcet's syndrome, but the possibility of other mechanisms operative in complex pattern was also considered.

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