Journal of Pathology and Translational Medicine

Volume 23(3); September 1989

Original Articles

A Study on Total Lactic Dehydrogenase (LD) Activity and Its Isoenzymes in Neoplastic Tissue of Stomach Carcinoma.: Seo Hee Rha, Sun Kyung Lee; Korean J Pathol. 1989;23(3):279-286.

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Abstract PDF: This sutdy was performed to find out a LD isoenzyme pattern in neoplastic tissue of gastric carcinoma and in gastric mucosa with intestinal metaplasia, which has been known as premalignant lesion. The specimens used in this study were 18 stomachs with caarcinoma and 8 stomachs with peptic ulcer as control, and wer obtained by subtotal or total gastrectomy at Pusan National University Hsopital from Oct. 1987 to Sept. 1988. Total LD activity and its isoenzymes in body and antral mucosae and neoplastic tissue of stomach were assayed, and analysed statistically from several points of view. The results obtained were summarized as follows: 1) There was no significant difference in total LD activity between univolved body and antral mucosae of stomach with carcinoma, and between mucosa of stomach with peptic ulcer and univolved mucosa of stomach with carcinoma. 2) Total LD activity in the neoplastic tissue of gastric carcinoma was significantly higher than those of univolved body and antral mucosae of stomach with carcinoam or that of stomach with peptic ulcer, but no significant difference was observed among histological types of gastric carcinoma. 3) The uninvolved body mucosa of stomach with carcinoma or peptic ulcer showed a pattern of LD1 predominance and increas of H to M ratio, while the antral mucosa of stomach with carcinoma or peptic ulcer showed a pattern of LD3 predominance and decrease of H to M ratio. 4) The LD4 and LD5 fractions in antral mucosa with moderate to severe intestinal metaplasia were slightly increased than those of antral mucosa with nil to mild intestinal metaplasia, but did not show statistically significant difference. 5) Marked increase of LD5 fraction was found in neoplastic tissue of gastric carcinoma, and thus ratio of H to M subunit in neoplastic tissue was significantly lower, as compared with body or antral univolved mucosa of stomach. In conclusion, the neoplastic tissue of gastric carcinoma and gastric mucosa with intestinal metaplasia show substantially predominant "M" subunit as well as increased total LD activity.

Biologic Significance of Hepatocyte Hepatitis B Core Antigen Expression in Chronic Hepatitis B Virus Infection.: Hye Kung Lee, Sang Ho Kim; Korean J Pathol. 1989;23(3):287-291.

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Abstract PDF: To elucidate the biologic significause of hepatocyte B core antigen (HBcAg) expression and its relation to the natural course of hepatitis B virus (HBV) infection, we tried to correlate the patterns of HBcAg with the HBV replication state and with disease activity in 40 needle biopsies performed on hepatitis B surface antigen (HBsAg) carriers aged from 15 to 46 years. In 32 of 40 cases, HBcAg was present in the hepatocyte nucleus (nHBcAg), in the cytoplams (cHBcAg) or in both (mixed). Pure nHBcAg was seen only in minimal hepatitis, but a diffuse pattern of expression of cytoplasmic HBcAg and mixed cytoplasmic and nuclear expression of HBcAg were seen in active hepatitis. There was also a good correlation between liver HBcAg and serum HBeAg.
Case
s in which HBcAg expression were observed were positive for serum HBeAg (81%) and the cases negative for HBcAg were all positive for serum anti-HBe.

Histologic Pattern of Alcoholic Liver Disease in Korea.: Chan Il Park, Ho Guen Kim, So Young Jin, Mi Kyung Lee, Yoo Bock Lee; Korean J Pathol. 1989;23(3):292-304.

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Abstract PDF: To elucidate the histologic pattern of alcoholic liver disease (ALD) in Korea, liver biopsies from 173 chronic alcoholics with clinical liver diseases were classified according to the pathologic parameters. One hundred and seventeen cases, the sum of 91 of 116 serum HBsAg negative and 26 of 57 HBsAg positive patients, had the histologic evidence of ALD. Fatty change(23.9%), alcoholic fibrosis (AF)(23.1%) and cirrhosis (23.1%), comprised the three major ALDs, and only 8.5% of cases fit the criteria of alcoholic hepatitis. Chronic sclerosing hyaline disease (CSHD), chronic active alcoholic hepatitis (CAAH) and AF, where non-cirrhotic fibrosis is the predominant change, comprised 44.5% of ALD. Both features of ALD and HBV liver disease (HBV-LD) were found in 17 cases that included 8 AF and 7 cirrhosis. These 17 patients tended to consume less alcohol than patients with other types of pure ALD except alcoholic heaptitis. Patients with the serum HBsAg positive ALD (37.4years) were about 8 years younger than those with the serum HBsAg negative ALD (45.1years). More or less fatty change and foamy degeneration were seen in 77.4% and 31.6% of ALD respectively. Mallory bodies, megamitochondria, iron deposition and perihepatocellular fibrosis were found in 20.5%, 29.9%, 42.7% and 77.8%, respectively. These findings indicate that non-cirrhotic chronic ALD such as CSHD, CAAH and AF are the important histologic patterns of ALD in Korea, and that chronic alcohol consumption and HBV may act synergistically in developing liver disease.

Kupffer Cells in Hepatocellular Carcinoma.: Young Nyun Park, Soon Hee Jung, Chan Il Park; Korean J Pathol. 1989;23(3):305-310.

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Abstract PDF: Kupffer cells are tissue macrophages (histiocytes) fixed in hepatie sinusoids. Since malignant hepatocytes are the only tumor parencymal cells of the hepatocellular carcinoma, theoretically there are no Kupffer cells within the hepatocellular carcinoma. To clarify whether it is true or not, 12 cases of hepatocellular carcinoma of the trabecular type with some extents of the non-neoplastic surrounding liver were subjected to immunoperoxidase staining for lysozyme and S-100 protein and the results are as follows. 1) Kupffer cells were stained positively by the immunoperoxidase staining for lysozyme but not for S-100 protein, indicating that they are monocyte derived macrophages. 2) Kupffer cells were also present within the hepatocellular carcinoma, but were 2-7 times fewer within the hepatocellular carcinoma than in the non-neoplastic areas (p<0.05). 3) The non-neoplastic hepatic tissue of patients with serum HBsAg shows a tendency to have more kupffer cells than those without HBsAg.

Pathologic Study on Carcinomas of Extrahepatic Biliary Tract.: Byung Tae Park, Eun Kyung Hong, Jung Dal Lee; Korean J Pathol. 1989;23(3):311-321.

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Abstract PDF: The authors reviewed surgical materials from 20 patients with carcinoma of the extrahepatic biliary system, and a correlation between macroscopic appearance of the tumors with various clinical features and histopathologic findings was made. Microscopically, the tumors were classified into four types; Four (21%) patients had polypoid tumors, six (32%) had nodular growths, five (26%) were scirrhous constricting in type, and four (21%) had diffusely infiltrating type. Histologically all the differentiation in two cases. The degree of differentiation of the tumors was classified into 3 types: 11 (55%) patients were well differentiated, 3(15%) were moderately well and 6(30%) were poorly differentiated. All polypoid tumors were well differentiated and had low stage. No correlation in the degree of differentiation of the tumor with the stage was present. No correlation in clinical symptoms, duration of symptoms, laboratory findings with morphologic findings of the tumors was noted.

A Pathological Study of Renal Cell Carcinoma.: Kwang Hwa Park, Dong Hwan Shin, In Joon Choi; Korean J Pathol. 1989;23(3):322-330.

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Abstract PDF: The most common malignant renal neoplasm is renal cell carcinoma. It is estimated that renal cell carcinoma accounts for 1% of all primary malignancies in Korea. Rell cell carcinoma presents diverse clinical courses with gross, histopathologic features. It has been known to be very difficult tumor to predict its clinical prognosis. In Korea, many studies have been reported concerning the clinical aspects of renal cell carcinoma. However, pathological studies of renal cell carcinoma are very few even though studies of nuclear grade have been attempted recently. We reviewed 93 cases of renal cell carcinoma examined in the period from 1978 to 1987 in the department of pathology, Yonsei university college of medicine, Yongdong Severance hospital, Wonju college of medicine and analyzed the histopathologic classification, including nuclear grade according to the Fuhrman's method. We abtained the following results by studying the relationship of the factors which had been known as correlated with the prognosis. 1) The ages of patients ranged from 9 to 74 years with a peak in the 6th decade. 2) The most common symptoms of the patients were hematuria, mass and pain, in that oder, and 7 patients complained to specific symptoms. The incidentally found cases characterized stage I, nuclear grade 2 small tumor size (not more than 4 cm) and clear cell type. 3) The renal cell carcinoma was more frequently located in the left kidney than the right by a ratio of 1.25 : 1. The incidence of intrarenal location was divided to the upper pole, 40% : mid portion, 29% : lower pole, 23% : diffuse involvement, 8%. The tumor shoing diffuse growth pattern had a large size, high nuclear grade and mixed cells. 4) The tumor size averaged 8 cm and there was no significant relationship between the size and stage. Seven cases of neoplasms not more than 3 cm were seen, of which 2 cases revealed an outcome of distant metastasis. 5) The histological pattern showed major solid, 53% : tubular, 11% : mixed, 18% : papillary, 9% and sarcomatoid type 9%. The sarcomatoid type was characterized by grade 4, a larger size(more than 10 cm), advanced stage. 6) There was no special relationship between the stage and grade but mostly grade 2 occupied the stage I. 7) The clear cell type was predominantly noted at grade 2 (65%), at the stage I (63%), granular or mixed cell type at grade 3 (87%), 4 (70%). According to these results, the tumors showing a sarcomatoid histologic pattern, diffuse growth pattern had unfavorable prognostic factors, and are thus estimated to have a poor prognosis. But the case which were incidentally found have favorable prognostic factors and probably a better prognosis. The tumor size alone can not exactly predict the metastasis and is not correlated with the stage. Small renal cell neoplasm (not more than 3 cm) generally has unfavorable prognostic factors and should be considered potentially malignant. The high grade frequently has granular cytoplasm. This represents the relationship between grade and cytoplasm, poor prognosis in the granular cell than the clear. The renal cell carcinoma shows variable prognosis and thus the prognosis should be estimated by all the factors. Nuclear grade can be used as one of the useful prognostic factors.

Case Report

Pathologic Study of Primitive Neuroectodermal Tumor: Report of 5 cases.: Sook Nyo Lee, Jong Eun Joo, Dong Soo Suk, Hyung Dong Kim, Soo Hyu Kim, Jae Hong Sim, Je G Chi; Korean J Pathol. 1989;23(3):331-341.

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Abstract PDF: Primitive neuroectodermal tumor (PNET) occuring in the brain (especially in the cereburm) of young individuals is a rare and highly malignant neoplasm. The authors analyzed 5 cases of primitive neuroectodermal tumor, operated from January 1986 to September 1987. They had characteristic clinical, radiologic and pathologic features. Patient's age ranged from 2 years to 14 years old (mean 8.2 years old) and there were 3 boys and 2 girls. They were rapidly growing tumor, with a brief duration of symptoms taking a rapidly progessive course. Computerized tomographic findings were characteristic, revealing the large, irregular, typically iso-to hyper-dense mass lesions with calcification and cystic or necrotic areas, and showing dense heterogeneous contrast enhancement of the mass in the cerebral hemisphere. Grossly all of the 5 cases showed hemorrhage and necrosis with sharp border and 2 cases showed calcification and cystic change grossly. Microscopically, they were predominantly composed of undifferentiated small dark cells with evidence of focal differentiation along glial and or neuronal lines. Four cases showed glial differentiation and three cases showed neuronal differentiation. Mesenchymal components were predominant in 3 cases.

Original Article

Needle Aspiration Cytology in the Lesions of Central Nervous System: An Experience on the Accuracy of Cytologic Diagnosis.: Hye Rim Park, Yang Seok Chae, Kap No Lee, Seung Yong Paik, Hung Seob Chung, Ki Chan Lee; Korean J Pathol. 1989;23(3):342-349.

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Abstract PDF: The cyto-histologic correlation and cytologic accuracy are reported in thirty cases of consecutive aspirated cells and their biopsied tissues of patients with clinical and neuroradiologic evidences of central nervous system tumors and other lesions investigated at the Pathology and Neurosurgery Department, Korea University Hospital, from Apr. 1987 to Apr. 1988. The series comprised of 17 benign and 12 malignant histopathologically verified brain neoplasms and 1 infectious lesion. In 78% of the cases, the cytologic diagnosis was concordant with the histologic diagnosis provided adequate sample was obtained. In 17 benign tumors, the diagnostic rate was 87% ; the diagnostic accuracy for 12 malignant CNS tumors was 63% cytologically. In almost all cases, differentiation of non-neoplastic lesion from neoplastic one and that of benign tumors from malignant ones were possible. Most discordance stemmed from failure to distinguish different types of malignant tumors. In meningioma, neurilemmoma, pituitary adenoma, and medulloblastoma, cytologic diagnostic accuracy was high, but germinoma, malignant ependymoma, and hemangioblastoma were difficult to diagnose by cytology alone.

Case Reports

Congenital Subglottic Stenosis of the Larynx Associated with Tracheoesophageal Fistula: 1 autopsy case.: In Sook Kim, Tae Jung Kwon, Dong Wha Lee; Korean J Pathol. 1989;23(3):350-354.

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Abstract PDF: Congenital subglottic stenosis of the larynx is one of the most common cause of chronic airway obstruction im infancy and childhood. It is defined as narrowing of the space bounded inferiorly by the inferior margin of the cricoid cartilage amd superiorly by the insertion of the fibers of the conus elasticus into the true vocal cords. In case we experienced was a female full-term baby delivered by Cesarean section. The stenosis was believed by hypertrophy of stromal soft tissue and cricoid cartilage in the subglottic area. The lesion was associated with tracheoesophageal fistula of H1 type. A brief review of the literature was done.

Fine Needle Aspiration Cytology of Pulmonary Hamartoma: 3 cases.: Na Hye Myong, Kyung Ja Cho, Ja June Jang; Korean J Pathol. 1989;23(3):355-358.

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Abstract PDF: Fine needle aspiration cytology of three cases of pulmonary hamartoma is presented. Case 1 was in a 67-year-old man with a 7 cm-sized left lung mass. Case 2 and 3 were in 47 and 53 year old females and consisted of 3 cm and 2 cm-sized right lung nodules, respectively. Fine needle aspiration of the masses revealed several fragments of irregularly shaped mature hyaline cartilage or fibromyxoid mesenchyme and sheets of benign epithelial cells in scanty to acellular background. Also scattered were inflammatory cells including lymphocytes, neutrophils and histiocytes and mature fat cells. These features were diagnostic for pulmonary hamartoma and case 1 was histologically confirmed by following surgical excision of the mass. Differential diagnoses about pulmonary hamartoma in the respect of conditions capable of producing cartilage on fine needle aspiration, were discussed.

Hyperinfection Syndrome with Strongyloides Stercoralis: Report of a case.: Soo Im Choi, Soon Won Hong, Kwang Gil Lee; Korean J Pathol. 1989;23(3):359-364.

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Abstract PDF: Strongyloides stercoralis is a nematodes and is prevalent in the tropical regions. In Korea, 6 cases have been reported in which the parasites were identified in feces. We report a case of hyperinfection syndrome with Strongyloides stercoralis confirmed in the tissue sections. A 52-year-old woman was admitted to the hospital because of generalized edema and weakness. She received steroid therapy for 30 years because of rheumatoid arthritis. One year ago, generalized edema and dyspnea were developed and she was diagnosed as minimal change nephrotic syndrome for which she received cyclosporin. On admission, she complained of generalized weakness and edema, multiple arthralgia and abdominal discomfort with nausea. The white-cell count was 14,600 without eosinophilia. A stool specimen was negative for occult blood, ova or parasites. Right lower quadrant abdominal pain and tenderness were developed, and the exploratory laparotomy was done under the impression of the acute appendicitis. An appendectomy with a biopsy of mesenteric lymph nodes was performed. From the 5th day after operation, the patient began to complain of the abdominal pain and constipation. Under the impression of adhesion bad formation, the laparotomy was done and disclosed that the proximal ileum was markedly dilated. On jejunotomy, a great amount of formed stool and barium was noticed in the proximal portion of small bowel. The jejunal tissue was biopsied. Grossly, the appendix was unremarkable. Microscopically, the inflammatory reaction was nearly absent, but in serosa, minute granulomas were found which contain a part of the parasite. Same feature was noted in the mesenteric lymph node. The biopsied jejunum contains numerous adult female, filariform and rhabdidiform larvae and eggs in the mucosa, submucosa and muscle wall. Their morphology was compatible with Strongyloides stercoralis. The patient died 5 days later in the state of multiple organ failure.

Three Cases of Giant Lymph Node Hyperplasia in Unusual Location.: Hye Kyung An, Ill Hyang Ko; Korean J Pathol. 1989;23(3):365-370.

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Abstract PDF: Giant lymph node hyperplasia (Castleman's disease) was first described by Castleman and associates. In the first accounts of giant lymph node hyperplasia, the lesions were described as solitary and localized to the mediastinum. Recently, we have experienced three cases of Castleman's disease, first of which is a 54 year old male with plasma cell type in the mesentery, second is 27 year old femal with hyaline vascular type in the inguinal region and third is a 29 year old female with hyaline vascular tye in neck.

Original Article

Renomedullary Interstitial Cell Tumor.: Eon Sub Park, Mi Kyung Kim, Jae Hyung Yoo, Kye Yong Song; Korean J Pathol. 1989;23(3):371-373.

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Abstract PDF: We present an ultrastructure of an incidentally found renomedullary interstitial tumor also called as medullary fibroma in a 77 year-old female who had a metastatic adenocarcinoma of colon to the ureter. This tumor was a small and grayish white nodule in renal medulla, measuring 0.4 x 0.4 cm. Microscopically the tumor composed of spindle cells, with some vacuolation and intercellular collagen fibers. The electron microscopic observation of the spindle cells reveal that nuclei are spindle to oval shape and cytoplasm contain abundant rough endoplasmic reticulum, polyribosome without microfilaments and cisterna like structures supporting that the renomedullary interstitial cell tumor is renal interstitial cell origin than fibroblasts.

Case Reports

Benign Teratomas of the Fallopian Tubes: A report of two cases.: Hee Na Kim, Mi Kyung Jee, Ki Hwa Yang, Seok Jin Gang, Eun Joo Seo, Byung Kee Kim, Sun Moo Kim; Korean J Pathol. 1989;23(3):374-378.

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Abstract PDF: Teratomas of the fallopian tubes are very rarely encountered in the western literature, and not a single case has been documented in Korea. The authors experienced two cases of tubal teratomas. Both patients developed a teratoma in an ampullary portion of the right fallopian tubes. One case occured as an incidental finding, and the other case was presented with a tubal mass. The gross and light microscopic features of these teratomas were described, and a brief review of the literature on the tubal teratomas is made.

Adenoid Cystic Carcinoma of Skin: A case report.: Eun Duk Chang, Young Hee Jee, Sun Moo Kim; Korean J Pathol. 1989;23(3):378-381.

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Abstract: A primary skin adenoid cystic carcinoma first described by Boggio in 1975, is one of the rarest type of eccrine sweat gland carcinoma. Histologically, a tumor with typical morphologic features closely resembles adenoid cystic carcinoma was found in other tissues but in the skin must be distinguished from aggressive basal cell carcinoma. The natural history of this tumor is not yet fully determined but suggests a long indolent and progressive course. We report a case of a 77-year-old male with a small skin nodule in the abdomen.

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