Journal of Pathology and Translational Medicine

Volume 26(4); August 1992

Original Articles

The effects of Broad Spectrum Antibiotics and Endotoxin to the Carbon Tetrachloride-induced Liver Injury.: Hyun Ho Shin, O Joon Kwon, Yoon Kyung Sohn, In Soo Suh, Tae Joong Sohn; Korean J Pathol. 1992;26(4):329-337.

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Abstract PDF: This study was performed to investigate the effect of endotoxin to the CCl4-induced liver injury. Twelve Sprague-Dawley rats were intraperitoneally injected 1.6 g/kg CCl4 as control group. Another 24 rats were orally administrated 300 mg/kg of neomycin at 16 and 3 hours prior to CCl4 injection as experimental group. Twelve among them were intraperitoneally infected 1.0 mg/kg of endotoxin(E-Coli, 0111:B4, No L-2630, lipopolysaccharide, Sigma, USA) and CCl4 simultaneously for offsetting neomycin effect. The rats were sacrificed at 1, 4, 10, and 24 hours after CCl4 injection. The liver tissues from all experimental groups were observed by light and electron microscopy. The results obtained were summarized as follows: In the CCl4 only group, the hepatocytes revealed sweling of ER and mitochondria with many lipid droplet in the cytoplasm. Focal cellular necrosis was seen at the later phase. The Kupffer cells were activated and showed many cytoplasmic processes, secondary lysosomes, and vaculoles. The endothelial cells were edematous. Several neutrophils, platelets, and microthrombi were scattered in the sinusoid. In the neomycin-CCl4-endotoxin administrated group, both hepatocytic destruction and intrasinusoidal microthrombi formation were more pronounced. In the neomycin pretreated group, the hepatocytes revealed mild cellular destruction without necrosis. There is no intrasinusoidal microthrombi. According to these results, it would be concluded that the small dosage of gastrointestinal tract-derived endotoxin affects to the liver injury caused by CCl4. The synergistic effects of CCl4 and gastrointestinal tract-derived endotoxin which can not be detoxified by damaged Kupffer cells, may be more important in the pathogenesis of CCl4-induced liver injury.

Liver Cell Dysplasia: Analysis of 141 cases with reference to histopathologic Characterization and proliferative activity.: Sang Yong Song, Yong Il Kim; Korean J Pathol. 1992;26(4):338-347.

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Abstract PDF: Liver cell dysplasia of Anthony(LCD) is a common association in hepatocellular carcinoma(HCC)-bearing liver and has been regarded as a premalignant condition with strong linkage to hepatitis B virus infection and cirrhosis. A total of 189 surgically resected livers [HCC(168 cases), cholangiocarcinoma(3 cases), metastatic carcinoma(3 cases), and non-neoplastic lesions(15 cases)] were reviewed to elucidate the nature of LCD by means of light microscopic examination, in situ hybridization method for HBV DNA and expression of proliferatin cell nuclear antigen(PCNA) using immunohistochemical technique. LCD was present in 141 cases(74.6%), and its prevalence rate was independently significant in HCCs with or without cirrhosis than other groups. There was no difference in mean age, although LCD-positive group was younger than its negative counterpart. Association rate of LCD in HCC-cirrhosis group was statistically significant than the non-cirrhotic group, and higher histological grading of LCD was correlated well with wider distribution pattern and clustering. Seropositivity of HBsAg was not correlated with presence of LCD or with histological grading. In situ hybridization techique using HBV DNA probe demonstrated fine granular stainable particles even in LCD cells. Immunohistochemical study for PCNA revealed that the proliferative activity of LCD was lower than that of the cirrhotic cell. With the above results it is concluded that LCD reflects neither a regenerating condition nor a premalignant lesion but suggest a reactive change.

Hydatidiform Mole with a Coexisting Fetus: Report of three cases with nuclear DNA ploidy analysis by flow cytometry or chromosomal analysis.: Kyu Rae Kim, Dong Hee Choi, Woo Hee Jung, Yong Hyun Park, Myong Ock Ahn, Seon Hee Cha; Korean J Pathol. 1992;26(4):348-354.

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Abstract PDF: Three cases of hydatidiform mole with a coexisting fetus are described. In two cases, flow cytometric analysis of nuclear DNA content from paraffin-embedded, molar tissues and normal-appearing placental tissues showed diploid pattern. One case had karyotypes of 46, XX both in fetal skin fibroblasts and in molar tissues. Microscopically, the villi showed diffuse hydropic swelling with circumferential trophoblastic proliferations and consistent with the diagnosis of complete mole. Two patient had persistent gestational trophoblastic neoplasia on the follow-up. Therefore, in cases of hydatidiform mole with a coexisting fetus, dizygotic twin pregnancies composed of a normal pregnancy from one ovum and a complete mole pregnancy from the other ovum must be considered and the patients should be followed with serum beta-hCG measurements.

Biologic Significance of Hepatocyte Hepatitis B Core Antigen Expression in Chronic Hepatitis B Virus Infection II.: Hye Kyung Lee, Kwang Min Lee, Dong Kyu Chung; Korean J Pathol. 1992;26(4):355-359.

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Abstract PDF: Routine use of commercially available antisera against hepatitis B core antigen(HBcAg) has permitted a reevaluation of the histochemical distribution of the antigen in liver tissue. HBcAg, classically described almost exclusively in the nucleus, was found with a very high frequency in the cytoplasm of liver cells as well. To elucidate the biologic significance of HBcAg expression and its relation to the natural course of hepatitis B virus(HBV) infection, the patterns of activity in 33 needle liver biopsies of HBsAg carriers were analysed. A good correlation of liver HBcAg with disease activity was demonstrated. HBcAg was present in the hepatocyte nuclei(nHBcAg) or cytoplasm(cHBcAg), or in both(mixed). Pure nHBcAg was seen mainly in non-aggressive reactive liver tissue and cHBcAg was predominantly associated with chronic active hepatitis(95%). The results suggest that expression of HBcAg correlates with the liver pathology and the possibility of HBcAg to be an immunological target for T cell mediated hepatocyte damage.

The Effect of Copper on 3'-Methyl-4-dimethylaminoazobenzene Induced hepatic Carcinogenesis.: Jung Sook Moon, Young Nyun Park, Chan Il Park; Korean J Pathol. 1992;26(4):360-371.

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Abstract PDF: To elucidate the effect of copper on the 3'-methyl-4-dimethylaminoazobenzene(3'-MeDAB) induced hepatic carcinogenesis, Sprague-Dawley rats were divided into 4 groups according to 3'-MeDAB and copper administration: I. noraml control, II. copper only, III. 3'-MeDAB only, IV. 3'-MeDAB plus copper. The animals of groups III and IV were fed experimental diet containing 0.06% 3'-MeDAB. Copper was administrated intraperitoneally in a dose of 0.5 mg, twice a weak. Animals were sacrificed at different intervals. Liver weight, hepatic copper content and gross and microscopical changes of the liver were examined and the cell kinetics of various lesions in the hepatic carcinogenesis was studied by applying the immunohistochemical method for bromodeoxyuridine(BrdU). The hepatic copper content was significantly increased in animals given copper but returned to the normal value after cessation of adminstration. 3'-MeDAB administration caused oval cell proliferation and produced hyperplastic nodules, cholangiofibrosis and carcinoma of the liver. Simultaneous administration of copper did not alter the incidence of 3'-MeDAB induced lesions, except for carcinoma. The liver weight and the size of hepatic nodules and masses were smaller in group IV than in group III. The liver weight as well as the nodularity and the mass formation continued to increase affect cessation of 3'-MeDAB administration. Copper did not affect the BrdU labelling indices of the hepatic lesions induced by 3'-MeDAB. The oval cell proliferation and the BrdU labelling indices of the oval cell and the hyperplastic nodule were decreased, but the incidence of cholangiofibrosis and its BrdU labelling index were still elevated after cessation of 3'MeDAB administration. These findings indicate that copper could delay the developement of 3'-MeDAB induced hepatic lesions, but not suppress, since copper does not stay long enough to accumulate in the rat liver, and that copper could not affect the proliferation of 3'-MeDAB induced hepatic lesions once developed.

Thymoma: A clinicopathologic analysis of 66 cases.: Weon Seo Park, Seong Hoe Park, Yong Il Kim; Korean J Pathol. 1992;26(4):372-380.

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Abstract PDF: A total of 66 cases of thymoma(57 surgically resected cases and 9 incisional biopsy cases) were reviewed with an attempt to correlate pathomorphologic features and clinical presentations. Criteria of benign or invasive thymoma were primarily determined by operative clinical and pathologic findings. Of them, 21 cases were invasive thymomas. The mean age of patients at the time of surgery was 47 years and it occurred largely in the sixth decade. Myasthenia gravis was accompanied in 29 cases(43%). One patient died during folow-up period, and five of the remainder suffered from recurrence. Microscopically, mixed type was the most common one(33 cases), being followed by predominantly epithelial type(17 cases) and predominantly lymphocytic type(16 cases). Thirty four cases of thymomas were cortical type, 29 mixed type, and the remaining 3 medullary type. None of the histologic type were significantly correlated with tumor invasiveness, Myasthenia gravis was more frequently associated with mixed and cortical type, respectively.

Case Reports

Amelobastic Fibrosarcoma of the Mandible: A case report.: O Joon Kwon, Hyun Ho Shin, Hee Kyung Park, Jong Min Chae, Chin Soo Kim; Korean J Pathol. 1992;26(4):381-388.

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Abstract PDF: Ameloblastic fibrosarcoma is an extremely rare variety of odontogenic tumor. It has not previously been reported in Korea. The tumor is composed of benign odontogenic epithelium with a mesenchymal part which exhibits the histologic features of fibrosarcoma. We have reported a case of amloblastic fibrosarcoma of the mandible in a 26-year-old man with swelling of right mandible for 2 weeks. The tumor showed yellowish ill-demarcated ulcerating mass involving right premolar and molar area. Light microscopy revealed irregularly arranged strands and islands of odontogenic epithelium surrounded by abundant mesenchymal tissue with the feature of fibrosarcoma. The fibrosarcoma cells were strong positive on immunostain for vimentin and ameloblastic cells were weakly positive for cytokeratin. S-100 and CEA were negative in both epithelial and sarcoma cells. The sarcoma cells were corresponding to fibroblasts on the electron microscopy with abundancy of RER and mitochondria and covering of basal lamina. Two types of virus like particles were distributed in the cytoplasm and nuclei of sarcoma cells. We treated the patient with surgery and chemotherapy. The recovery was uneventful and the prognosis is under observation.

Primary Angiosarcoma of the Spleen associated with Kasabach-Merritt Syndrome: Report of a case.: Mee Soo Chang, Yun Kyung Kang, Yong Il Kim, Kun Wook Lee; Korean J Pathol. 1992;26(4):389-393.

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Abstract PDF: A 46-year-old woman presented with multiple purpuric skin rashes together with splenomegaly and thrombocytopenia. The resected spleen weighed 720 gm, and contained multiple, discrete, dark red, bulging nodules throughout the entire splenic parenchyma. Microscopically, the nodules revealed various range of endothelial cell proliferation which included cavernous vasculature, anastomosing vascular channels, papillary intravascular growth and solid pattern. Intrasinusoidal sequestration of platelets along with extramedullary hematopoiesis was present in the neoplastic vascular spacws. Neither exposure to thorotrast nor vinyl chloride was nonfirmed. Ultrastructurally, the tumor cells demonstrated a row of pinocytotic vesicles, occasional intercellular junctional structures, and the paucity/absence of filamentous structures or Weibel-Palade bodies supports origin of sinus lining type cells. After splenectomy, the thrombocyte count returned to normal. We conclude this is the first case of primary splenic angiosarcoma with Kasabach-Merritt syndrome in Korean literature.

Rhabdomyosarcoma of the Prostate: Two cases report.: Kyoung Mee Kim, Ki Hwa Yang, Seok Jin Kang, Byoung Kee Kim, Sun Moo Kim; Korean J Pathol. 1992;26(4):394-398.

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Abstract PDF: The rhabdomyosarcoma of the prostate is very rarely encountered in the western literature, and only a few reports have been published in Korea. The authours recently experienced two cases of rhabdomyosarcomas of the prostate in 35-year-old and 51-year-old males who had suffered from gross hematuria and difficulty of urination. Microscopic studies showed embryonal type of rhabdomyosarcoma in two cases. The clinical and pathological features of the distinctive prostatic rhabdomyosarcoma are described, and a brief review of the literature is made.

Small Cell Carcinoma of the Ovary: A case report.: Young Bae Kim, Sook Hee Hong, Kyu Rae Kim; Korean J Pathol. 1992;26(4):399-404.

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Abstract PDF: Small cell carcinoma of the ovary is rare malignancy occurring in women under 40 years of age(average, 23 years), which is associated with hypercalcemia in two thirds of cases. Its histogenesis is uncertain, but the possibilities of common epithelial, neuroendocrine, sex cord stromal and germ cell origin are suggested. All reported cases were proved to have rapid fatal course despite various therapy and 5 years suvival rate was only 10%. We report one case of a 20-year old woman with primary small cell carcinoma of the left ovary. The ovary was markedly enlarged and completely replaced by a mass, measuring 21x16x8 cm. Microscopic examination revealed dimorphic population of small and large malignant cell producing immature follicle-like structure which is characteristic of small cell carcinoma of the ovary. These pathological findings were similar to those of granulosa cell tumor, which is required to make differential diagnosis from small cell carcinoma. Immunohistochemical stains for cytokeratin and vimentin were positive, but those for S-100 protein and NSE were negative. One month after the initial operation, the tumor has recurred and the second and the second palliative operation followed by 3 cycles of chemotherapy was done. The patient showed disseminated metastasis at present time.

Original Article

Gastric Choriocarcinoma and Endodermal Sinus Tumor in Collision Tumor.: Eun Kyung Kim, Eun Kyung Hong, Kwang Soo Lee, Jung Dal Lee; Korean J Pathol. 1992;26(4):405-410.

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Abstract PDF: Both primary choriocarcinoma and endodermal sinus tumor of the stomach are very rare entities. Combination of these two tumors is even rarer, and only a single such case has been reported in English literature. The case had gastric adenocarcinoma in addition to these tumors. We experienced a case of combined, pure choriocarcinoma and endodermal sinus tumor in the stomach of a 74 year-old man. He had no gonadal or any other primary tumor. Huge exophytic tumor was located in the lesser curvature of the body. Two components of the tumor was separated and clearly defined. Human chorionic gonadotropin(HCG) was demonstrated in serum and in tissue sections. Alpha-fetoprotein(alpha-FP) was also demonstrated in serum and in tissue sections. Alpha-fetoprotein(alpha-FP) was also elevated in the serum. Possible tumor origin was speculated.

Case Reports

Fibrocalcific Nodule in the Liver Capsule Caused by Ascaris Eggs: A case report.: Yeon Lim Suh, So Young Park, Je G Chi; Korean J Pathol. 1992;26(4):411-413.

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Abstract PDF: Ascariasis is probably the most common helminthic infestation of man, but it seldom causes severe illness. Pathologic conditions of Ascaris may be caused by adult worms, eggs or larvae. We describe a case of Ascaris egg granulomas that were found incidentally on the surface of the liver in a 75-year-old woman who had undergone a segmentectomy for an intrahepatic stone. Grossly, there were several yellowish calcific nodules of 0.4 cm in diameter on the lateral surface of the left lobe of the liver. Microscopically, the lesions were located in the hepatic capsule and consisted of fibrocalific nodules with many eggs. The eggs were round to oval, thick-shelled and measured 50~75x30~50 um. Most of the morphologically preserved eggs were fertilized eggs, but they had smooth shells without external protein coats. This case is of interest for the unusual location of the lesion, the presence of eggs without mammillation, and the association with the intrahepatic stone.

Intestinal Spargnanosis Presenting as an Inflammatory Mass: A case report.: Weon Seo Park, Seung Sook Lee, Yong Il Kim, Seon Hee Kim; Korean J Pathol. 1992;26(4):414-416.

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Abstract PDF: A 39-year-old male patient presented with chronic abdominal pain and intermittent diarrhea for 8 months. Colon study showed an annular stricture at the ileocecal value. He underwent ileocecectomy with clinica impression of intestinal tuberculosis. The resected intestinal wall along the lieocecal junction demonstrated a localized, annular constriction and intramural nodular inflammatory growth in which were clusters of multiple microabscesses as well as acute and chronic inflammatory cell infiltration including eosinophils and fibrosis. Encountered were a few resolving phase of parasitic granulomatous tunnels in which fragments of degenerated sparganum with foreign body reaction were found in one focus. He had history of ingesting uncooked frogs 2 years ago. The above case suggests that differential diagnosis of inflammatory tumorous lesions in the intestine should include sparganosis in Korea.

Pregnancy Luteoma of the Ovary in a Primiparous Woman: A case report.: Chul Hwan Kim, Han Kyeom Kim; Korean J Pathol. 1992;26(4):417-419.

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Abstract PDF: Pregnancy luteoma is composed of a single or multiple nodules of large lutenized cells that develop during pregnancy but involute during the puerperium. This lesion is usually an incidental finding at the time of cesarean section or postpartum tubal ligation. Microscopically, this tumor is difficult to be differentiated from various types of sex-cord stromal tumors including Leydig cell tumor, luteinized thecoma, adult or juvenile granulosa cell tumors with luteinization, and lipoid cell tumor. We report a case of pregnancy luteoma in a 34-year-old primipara without virilizing symptoms at the time of cesarean section in the right ovary. The mass measured 5x4.5x3.5 cm and 60 gm in weight. The cut surface was homogeneously yellow-orange with mulitple hemorrhagic spots. Microscopically, the tumor revealed solid, trabecular, or microcystic pattern of large granular eosinophilic luteinized cells and somewhat large nuclei with prominent nucleoli. Differentiation from Leydig cell tumor and juvenile granulosa cell tumor was difficult in this case.

Original Article

Elastofibroma.: Sang Yong Song, In Ae Park, Yong Il Kim; Korean J Pathol. 1992;26(4):420-422.

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Abstract PDF: Elastofibroma is a rare benign tumorous growth presenting as a slowly growing ill-defined mass of fibroblastic tissue occurring in elderly persons and arising mainly form the connective tissue between the lower portion of the scapula and the chest wall. Its pathogenesis is not well established but it may be the result of nonneoplastic reactive hyperplasia taking place with constitutional predisposition in the background. A case of elastofibroma occurring in the subscapular area of a 65-year-old female cook is presented. The mass, 6x5x3 cm in maximum dimensions, was poorly circumscribed, solid, hard, pale fleshy and pray-white fibrous tumor. Microscopically, it was composed of numerous small globular and linear elastic fibers embedded in collagenous matrix. To our knowledge, it is the first case of elastofibroma in Korea.

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