Journal of Pathology and Translational Medicine

Volume 26(2); April 1992

Original Article

Small Hepatocellular Carcinoma: Pathologic Features of 39 Cases A Comparison with Large Hepatocellular Carcinoma.: Yong Il Kim, Geon Kook Lee, Sang Yong Song; Korean J Pathol. 1992;26(2):103-116.

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Abstract PDF: With advance of diagnostic imaging technics, the detection rate of small hepatocellular carcinoma (HCC) has become much increased, but the questions whether the growth pattern and histologic nature of the HCC keep maintain the original gross and microscopic features with its advancement of tumor size remain still unclear. We reviewed 39 surgically resected hepatocellular carcinomas(HCCs) with a tumor size less than or equal to 3 cm in diameter(s-HCC), and their gross and microscopic features were compared with the HCCs bigger than 3 cm (i-HCC, 199 cases). Single nodular type(SN) was the most common gross type(60%) in s-HCCs, and was followed by single nodular type with perinodular extension(SNPE; 15.4%), multinodular-discrete type(10.3%) and multinodular-confluent type(5.1%). These figures contrasted to SNPE(42.2%) and SN(20.6%) in the i-HCCs. Of the 39 s-HCCs, 25 cases(64.1%) were encapsulated, and 14 cases(36%) demonstrated intratumoral fibrous septations, being contrasted to the i-HCCs in which fibrous septa formation was mord prominent but complete capsule formation was found only in 40.2% of the larger ones. Microscopically, the trabecular type was the most frequent one(53.9%), and increased with their size while the compact type transformed into trabecular one. Thirty three cases(84.6%) were associated with macronodular cirrhosis. Seropositivity for HBsAg was found in 26 cases(66.6%), and high serum alpha-fetoprotein level over 500 IU/L was found in 15 s-HCC cases(38.4%), while 53.3% in i-HCC. The above results suggest that HCCs change their pathologic features by increase of their size, and a comparison of the details with regard to the possible mechanisms involved is discussed.

Comparative Study

Comparative Study of the Breast Carcinoma by the Measurement of Nucleolar Organizer Regions and the Flow Cytometric DNA Analysis.: Ki Jung Yun, Weon Cheol Han, Chan Choi, Hyung Bae Moon; Korean J Pathol. 1992;26(2):117-124.

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Abstract PDF: It is important to predict the prognosis of patient with cancer. Well known parameters predicting the prognosis are staged and degree of differentiation. Recently, the prognostic and diagnostic significance of silver-stained nucleolar organizer regions(Ag-NORs) and flow cytometric DNA analysis are introduced. This study aims to detect the diagnostic significance of Ag-NORs in breast lesions, and to correlate the number of Ag-NORs and cellular ploidies in breast carcinoma. In addition, the existence of heterogeneity according to the sample in the same patient is studied Sixty six paraffin blocks(two primary lesions and the two metastatic lymph nodes in 13 patients, and one primary lesion and one metastatic lymph node I 10 patients) of breast carcinoma, 30 paraffin blocks of fibroadenoma and 23 paraffin blocks of normal breast are studied. The numbe of Ag-NORs increase from normal breast(mean 1.45) through fibroadenoma(mean 1.60) to carcinoma(mean 2.43). It was significantly different between each lsions(P<0.0005). The number of Ag-NORs increased in the aneuploidy carcinoma than that in the euploidy one(P<0.05). But, there was difference between the number of Ag-NORs and DNA index according to the sample area in the same patient with carcinoma. In conclusion, the number of Ag-NORs is diagnostically significant in breast lesions and is correlated with cellular ploidies in breast carcinoma. In addition, Ag-NORs and cellular ploidies are heterogenous in the same patient.

Original Articles

Histopathologic Study of the Myoepithelial Cells in the Pleomorphic Adenoma.: Jong Boum Choi, Sung Churl Lim, Ho Jong Jeon, Chae Hong Suh; Korean J Pathol. 1992;26(2):125-136.

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Abstract PDF: A total of 51 cases of pleomorphic adenoma was obtained from the pathologic files of Chosun University hospital from january, 1980 December, 1989. The studies of clinical, microscopic, immunohistochemical, and electronmicroscopic examination showed the following results. The peak age incidence of the pleomorphic adenoma in this study was in the 5th decade and no significant difference in the incidence between male and female patients was observed. The most common histologic type of myoepithelial data showed positive reactions of the myoepithelial cells to cytokeratin and S-100 protein in the solid, myxoid, and chondroid area. The electronmicroscopic examination of the myoepithelial cells revealed myofilaments, dense bodies, desmosomes, and basement membrane suggesting epithelial origin of these cells. In conclusion, the pleomorphic adenoma seems to be derived from epithelial component and the variable stromal change may be derived from modified myoepithelial cells considering the results of immunohistochemical and electron microscopic study.

Histopathologic Appearance of Cytomegaloviral Liver Diseases in Neonates and Infants.: Sun Hee Sung, Chan Il Park, Ho Guen Kim, Woo Hee Jung, Ki Sep Chung; Korean J Pathol. 1992;26(2):137-145.

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Abstract PDF: To provide ideas for the recognition of neonatal and infantile liver diseases caused by cytomegalovirus(CMV) infection, histopathological examinations were made on hepatic tissues obtained by biopsy or autopsy from 23 patients. All patients were sero-positive for IgM anti CMV and had no other known or suggested etiologic factors for their liver disease. There were five different types of liver diseases: 8 cases of giant cell hepatitis(34.8%), 4 cases of biliary atresia(17.4%), 5 cases of biliary atresia with changes of neonatal hepatitis(21.7%), 4 cases of diffuse hepatic fibrosis(17.4%) and 2 cases of hepatic necrosis with CMV inclusion(8.7%). The diffuse hepatic fibrosis involved both the hepatic lobules and portal areas without evidences of regeneration. This type of liver disease appeared to be a chronic progressive illness that began during the first week of life, and in 3 of 4 cases, the liver biopsy was dong at 5 to 9 months after birth. The two patients showing CMV inclusion in their liver were premature of debilitated, and died within I month after birth. Diffuse hepatic necrosis as well as the cytomegalic change of bile duct epithelium was characteristic. The findings suggest that the pattern of CMV liver disease depends on the major site of hepatic injury, the status of status of patient's defense mechanism and the chronicity of illness.

Computerization of Surgical Pathology Reporting by Personal Computer.: Dong Sug Kim, Young Ran Shim, Mee Jin Kim, Hae Joo Nam, Won Hee Choi, Tae Sook Lee; Korean J Pathol. 1992;26(2):146-153.

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Abstract PDF: The authors have been developed a menu-driven FoxBASE system for surgical pathology reporting and automatic encoding in Systematized Nomenclature of Medicine. The system requires no prior knowledge of FoxBASE and is readily installed on any IBM or it's compatible personal computer. Working sheet generation is automatically accompanied by data from previous cases on the same patient. Important data which include patient name, age, sex, surgical number, hospital unit number and encoded diagnoses, are stored on the hard disk permanently; complete reports are saved on floppy diskettes. Cases can be retrieved by patient name, surgical number, hospital unit number and SNOMED codes within 0.1 second. Daily work lists and listings of incomplete cases are easily obtained. This FoxBASE system has been in use for 1 year and 6 months and resulted in increased efficiency of retrieval and gathering of basic information for specific study, cost effectiveness, markedly diminished workload of typist and very short wasting time during complete restoration of data file for hard disk failure.

Guidelines for Pathologic Study of Gastric Cancer.: Korean J Pathol. 1992;26(2):154-163.

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Abstract PDF: Gastric cancer is the most common malignant neoplasm among Koreans, and the pathologists's daily diagnostic competency on gastric cancer at any hospital setting plays a critical implication not only in the quality of clinical service but also to the determination of patient's prognosis. Thus, adoption of a unified assessment system based on comprehensive understanding of pathologic features together with their active participation has been crucially demanded. Nevertheless, a considerable difference in handling procedures and diagnostic approach on gastric cancer among institutions apparently resulted in an extreme difficulty in exchange of clinicopathologic informations and in the nationwide survey. It is, therefore, essential and be the first step to develop a practical but scientific and reproducible classification of gastric cancer with its diverse gross and histologic findings. Based on the following basic principles, the Subcommittee on Gastric Cancer under the Gastrointestinal Study Group of the Korean Society of Pathologists has been requested to develop the guidelines of future pathologic study of gastric cancer to meet the above needs and be efficiently used with ease among the society members. 1) The prerequisite for pathologic classification of gastric cancer starts with consistency in handling of the resected stomach before its further examination. Thus, the guideline shall limits its scope only with the minimum agreement. 2) The classification should be simple and practical so that all pathologists can use with ease and with high reproducibility. 3) All the gross and microscopic findings which have been considered to be the prognosis-related factors should be included in every pathologic procedures to help future information exchange among pathologists and clinicians and to provide a meaningful role in determination of patient's prognosis. 4) The classification should be interchangeable and stand with compatibility among WHO and other internationally accepted classifications. 5) The guideline accepts in part the staging system of American Joint Commitee on Cancer, classification of early gastric cancer proposed by the Japanese Society of Gastrointestinal Endoscopy, and the General Rules of Stomach Cancer Study by Japanese Research Society of Gastric Cancer, until otherwise developed and accepted by the Korean Society of Pathologists. 6) The guideline should not interfere with each institution-based special study. The details of the handling procedures of the resected stomach cancer, its gross and histologic classifications and descriptive methods of prognostic factors are supplemented with illustrations.

Case Reports

Mullerian Adenosarcoma of the Ovary with Sex Cord-Stromal Differentiation: A case report.: Sun Hee Sung, Soon Won Hong, Kyu Rae Kim, Woo Ick Yang; Korean J Pathol. 1992;26(2):164-170.

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Abstract PDF: Mullerian adenosarcoma is a tumor composed of a mixture of glandular and stromal elements in which the glandular component appear to be neoplastic but, histologically, benign with the stromal component showing varying degrees of malingancy. We report a case of ovarian m llerian adenosarcoma with sex cord stroma differentiation in the stromal components. A 57 year-old female who presented with palpable mass in the right lower abdomen had undergone through salingo-oophorectomy. Grossly, the ovary was multicystic, and partly showed a solid appearance with multiple polypoid projections into the dilated cystic spaces. On microscopic examination, the tumor consisted of benign to borderline epithelial glands that were lined by variety of mullerian epithelia and sarcomatous component with sex cord-stromal elements, which include sertoliform tubules, Leydig cell like clusters, and granulosa cells.

Papillary Craniopharyngiona: A report of two cases.: Gu Kong, Eun Kyung Hong, Jung Dal Lee; Korean J Pathol. 1992;26(2):171-174.

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Abstract PDF: Two cases of suprasellar papillary craniopharyngioma are presented. The tumors are exclusively composed of well-formed papillary squamous epithelium and show morphologic homogeneity. There is no palisading basal layer in squamous epithelium. Clinical and radiologic findings, exclusive occurrence in adult and lack of calcification, are much different from conventional craniopharyngioma. Differences between papillary craniopharyngiom and conventional craniopharyngioma are discussed.

Adenoid Cystic Carcinoma of the Lung: Report of 2 cases.: Jae Soo Koh, Chang Won Ha, Na Hye Myong, Kyung Ja Cho, Mi Kyung Kim, Ja June Jang; Korean J Pathol. 1992;26(2):175-179.

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Abstract PDF: Adenoid cystic carcinoma of the lung is histologically and ultrastructurally identical to the salivary gland tumor of the same name and is characterized by infiltrative growth, local recurrence, and usually a prolonged clinical course. We have recently experienced two cases of adenoid cystic carcinoma arising in the lung. Case 1 was a 59 year-old male who presented with cough, fever, and chill of 1.5 months' duration, and case 2 was a 61 year-old male who was incidentally found to have a 3 to 4 cm sized lobulated mass in the right upper lobe. After being worked up, both patients underwent right pneumonectomy. In case 1, a 3x2 cm sized tumor was located in the lower bronchus, partly elevating toward the lumen and partly infiltrating into regional lymph nodes and lung parenchyma showing grayish-white and solid cut surface. Case 2 was a 3.5x3.5 cm sized upper bronchial tumor resembling the former in appearance. Histologically, the tumors were composed of small round hyperchromatic cells, forming solid, cribriform, acinar, or tubular structures. Luminal spaces in tumor cell nests contained PAS-positive mucinous or hyaline material. Among the tumor cells, scattered islands of normal submucosal gland were noticed.

Uterine Tumor Resembling Ovarian Sex-Cord Tumor: A case report.: Il Seon Lee, Soon Bong Chung, Bang Hur, Man Ha Huh; Korean J Pathol. 1992;26(2):180-185.

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Abstract PDF: The authors report a case of uterine tumor resembling ovarian sex-cord tumor in a 31-year-old woman with emphasis on immunohistochemistry. Histologically this case showed identical features to a well-recognized endometial stromal tumor except for focal epithelial-like differentiation that resembled sex-cord tumors of the ovary. The sex-cord like differentiation of tumor cells were manifested by trabeculae, plexiform cords, and gland-like pattern. We diagnosed this case, according to the features described by Clement and Scully(1976), as uterine tumor resembling ovarian sex-cord tumor, group I. Although the histogenesis of this tumor is unclarified, most authors believe that this tumor may be originated from multipotent mesenchymal cells of the uterus. On immunohistochemical stains, Desmin was uniformly reactive in epithelial-like cells and in focal areas of endometrial stromal sarcoma-like component. Vimentin was partly reactive in all tumor components, however EMA was non-reactive.

Pulmonary Adenocarcinoma of Fetal Type: Report of a case.: Soon Bong Chung, Il Seon Lee, Hee Kyung Chang, Bang Hur, Man Ha Huh; Korean J Pathol. 1992;26(2):186-190.

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Abstract PDF: Adenocarcionma of fetal type is in lung is a newly recognized malignant tumor sharing morphologic features with the epithelial component of the pulmonary blastoma devoid of sarcomatous component. We present a case of adenocarcinoma of fetal type in a 28-year-old female, consisting of numerous branching tubules or glands and morula-like epithelial complexes. Histologically, the tubules and glands were composed of glycogne-rich nonciliated epithelial cells showing in part argyrophilia. Some of tubular and morula-like epithelial cells revealed immunoreactivity for neuron-specific enolase. We report this case with a review of literatures with special references on the histogenisis. This report is the pathologically confirmed second case of the pulmonary adenocarcinoma of fetal type in Korea, following the report of Cho and Lee, 1990.

Carcinosarcoma of the Esophagus: A report of case.: Sug Hyung Lee, Won Sang Park, Young Jin Choi, An Hee Lee, Sun Moo Kim; Korean J Pathol. 1992;26(2):191-196.

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Abstract PDF: Carcinosarcoma of the esophagus is a rare neoplasm composed of both carcinoma and spindle sarcomatous area. Usually the carcinoma component is a squamous cell carcinoma but rarely adenocarcinoma or undifferentiated carcinoma is found. The histogenesis of the sarcomatous component is still unknown. A case of ulcerated polypoid lesion with a stalk in esophagus was reported. Microscopically it was composed of spindle shaped cells interminled with squamous cell carcinoma and small cell carcinoma nests. No distinct transition between spindle shaped cells and carcinoma are was observed. Immunoreactivity to cytokeratin was observed in both carcinomatous and spindle cell component, but electron microscopic examination failed to demonstrated desmosome or tonofilaments in spindle cells. Undifferentiated small cell nests were reactive to neuron specific enolase and contained membrane bounded secretory granule in electron microscopy.

Vestibular Adenoma of the Vulva: A case report.: Kyu Rae Kim, Sei Yul Han; Korean J Pathol. 1992;26(2):197-200.

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Abstract PDF: A vestibular adenoma arising in mucin-secreting glands of the vulva is described. Grossly, the adenoma was a firm, well-demarcated solid mass with mucoid cut surface, measuring 3.5x3x3 cm, which was associated with an adjacent Bartholin's duct cyst. Microscopically, the solid mass was composed of proliferated mucous acini separted by fibromuscular septa and ducts lined by mucin-secreting columnar epithelium, transitional epithelium or metaplastic squamous epithelium. To our knowledge, less than 20 cases of such cases have been reported in the English literatures. However, whether the nature of proliferation is neoplastic or non-tumorous is still unclear.

Pulmonary Arteriovenous Fistula in Childbood: Report of a case.: Soo Min Kang, Mi Kyung Kim, Je G Chi; Korean J Pathol. 1992;26(2):201-203.

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Abstract PDF: A case of pulmonary arteriovenous fistula in a 8-year-old boy who presented with easy fatigability and cyanosis for 4 months, is described. Grossly, there was a large vascular anomaly measuring 2x2 cm in the center of the removed right lower lobe. Microscopically, the lesion consisted of dilated arterial and venous structures resembling a cavernous hemangioma. Subintimal fibrosis and attenuated vascular structure lacking elastic fiber and representing A-V shunt were also noted in the lesion.

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