Journal of Pathology and Translational Medicine

Volume 28(1); February 1994

Original Articles

c-erbB-2 Oncoprotein Overexpression in Breast Cancer.: Tae Sook Hwang, Kyung Ja Cho, Young Bae Kim, Joo Ryung Huh, Ja June Jang; Korean J Pathol. 1994;28(1):1-7.

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Abstract PDF: c-erbB-2 oncogene is a normal cellular proto-oncogene coding transmembrane glycoprotein structurally similar to the epidermal growth factor receptor. Amplification of this oncogene in a variety of human adenocarcinomas has been reported and is particularly well documented in breast carcinoma. It has been suggested that amplification of this oncogene is indicative of poor prognosis and is valuable only second to the lymph node status. Using immunohistochemical staining for the c-erbB-2 protein, overexpression of this protein was analysed in 228 primary breast cancer specimens and the frequency of overexpression and the relationship between overexpression and the other established prognostic variables are evaluated. Ninty three cases out of 228 cases(40.8%) show postive oncoprotein overexpression and using the chi-squared test for a trend, a significant correlation was found between c-erbB-2 protein staining and the histological grade, lymph node status, and estrogen receptor status(P<0.05). No significant association was found between staining and the patient's age and tumor size. Most of the tumors with histological types known to have good prognosis showed negative expression. Above findings strongly suggest that expression of c-erbB-2 oncogene is another independent indicator of poor prognosis in breast carcinoma.

Development of Intrahepatic Bile Duct in Human Embryos and Fetuses; Histologic and Immunohfstochemical Observations.: Yeon Lim Suh, Je G Chi; Korean J Pathol. 1994;28(1):8-21.

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Abstract PDF: Sequential development pattern of the intrahepatic bile ducts is analyzed histologically and immunohistochemically using 50 embryonal and fetal liver specimens. Serial sections are made to reconstruct the intrahepatic biliary system, and monoclonal antibodies were used for differential antigenic expression of the biliary system. By 9 weeks of gestation a layer of small round cells, namely plate cells, became first noticed around large portal vein branches close to the hepatic hilum. These plate cells extended subsequently to more distal branches. The ductal plates became duplicated to contain cleft-like spaces and tubular structures. These tubules gradually became incorporated into surrounding connective tissue around the protal vein, and gave the appearance of the individualized bile duct. At term(40 weeks of gestation) the smallest branches of the portal vein were still surrounded by a discontinuous ductal plate. The ductal plate cells showed strong positive reaction for CAM 5.2 and AE1/AE3. They also expressed CK 19 and AE1 from 9 weeks of gestation on. The immunoreactivity of bile duct cells for cytokeratins persisted throughout the whole gestational period. Carcinoembryonic antigen was expressed along the luminal border of the bile duct, duplicated ductal plate and intrahepatic bile canaliculi. Laminin was demonstrated along the basement membrane of the bile duct cells from 9 weeks of gestation. Few duplicated ductal plates were composed of two different types of cells, duct-like cells and hepatocyte-like cells. The duct-like cells and hepatocyte-like cells showed same imrhunoreactivity with the hepatocytes and the bile duct cells, respectively, suggesting that the intrahepatic bile duct cells are actually coming from the hepatocytes around the branches of the portal vein.

Gastrointestinal Cytomegalovirus Infection: A clinicopathologic analysis of 8 cases.: Yun Kyung Kang, Sang Yong Song, Woo Ho Kim, Yong Il Kim; Korean J Pathol. 1994;28(1):22-29.

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Abstract PDF: We analysed 8 cases of gastrointestinal cytomegalovirus(CMV) infection including one autopsy, three surgically resected and four endoscopic biopsy cases. Involved sites were colon in four,stomach in three and small intestine in one. Three of them were associated with immu-nosuppressed condition but others had no clinical evidence of immune deficiency. Multiple aphthous mucosal ulceration was a common presentation, but one revealed a mucosal ulcer with segmental narrowing and thickening of wall. Microscopically, six showed cytomegalic inclusions in endothelial cells and fibroblasts, one in mucosal epithelial cells and the remaining one in both endothelial cells and mucosal epithelial cells. Immunohistochemical staining using monoclonal antibody against CMV confirmed postive result in seven cases. Serum IgM anti-CMV antibody was elevated in one case. We conclude that gastrointestinal CMV infection is currently not a rare condition and frequently associated with non-immunosuppressed condition, and thus a thorough histologic examination is required especially in the gastrointestinal ulcerative lesion. Once cytomegalic inclusion is suspected, immunohistochemical identification of CMV seems essential for specific diagnosis.

Application of Immunohistochemical Stain for Granulocytic Sarcoma.: Yeong Ju Woo, Chan Hwan Kim, Jong Eun Joo; Korean J Pathol. 1994;28(1):30-37.

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Abstract PDF: Granulocytic sarcoma is a rare localized tumor composed of granulocytic precusor cells. Granu-locytic sarcoma occurs in a variety of clinical conditions and it is often misdiagnosed histologically. Differential diagnosis frorh lymphoma or nonhematopoietic malignancies such as undifferentiated carcinoma or sarcoma is difficult in the routing histologic examination. An evaluation of clinical and histopathologic features was done on 4 cases of granulocytic sarcoma which were diagnosed at Pusan Paik Hospital from 1988 to 1992. During the period, 282 cases of myelogenous leukemia were diagnosed. Immunohistochemical reaction for lysozyme, myelopero-xidase, leukocyte common antigen, epthelial membrane antigen and cytokeratin was assessed comparing to lymphoma and undifferentiated carcinoma. The histologic features of the granulocytic sarcoma revealed thin nuclear membrane, fine chromatin pattern and one or two small nucleoli. It also often involved the vascular wall and infiltrated the native structures without destruction. Immunohistochemical stain revealed that all(4 cases) of granulocytic sarcoma showed diffuse and strong positivity for myeloperoxidase, and partial but strong positivity for lysozyme. One case of granulocytic sarcoma was negative and 3 cases revealed focal positive reaction for LCA, and all 4 cases was negative for cytokeratin and EMA. In summary, careful observation under light microscopy with immunohistochemical stain for myeloperoxidase, lysozyme, and LCA is helpful in the differential diagnosis of granulocytic sarcoma from malignant lymphoma and cytokeratin and EMA is useful for differential diagnosis from undifferentiated carcinoma.

Immunohistochemical Study of the Multidrug Resistant(MDR) Gene Expression in Gastric Carcinoma.: Jung Hee Han, Byung Gon Park, Mi Sook Roh, Sook Hee Hong; Korean J Pathol. 1994;28(1):38-48.

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Abstract PDF: We performed immunohistochemical stain of p-glycoprotein using JSB-1 monoclonal antibody to study multidrug resistant(MDR) gene expression in 137 gastric tumor tissues obtained from 87gastric carcinoma patients. The incidence of p-glycoprotein expression was 60 of 87 cases(69%) and it was not correlated with age, sex, depth of tumor invasion, and lymph node metastasis, but was correlated with histologic type of gastric adenocarcinoma. The distribution of p-glycoprotein positive cells in the tumor tissue was diffuse in 34 cases(73.9%) and focal in 12 cases(26.1%), and the dominant staining patterns of p-glycoprotein in the tumor cells were cytoplasmic and golgi staining in 20 cases(43.5%) and 19 cases(41.3%), respectively, and 7 cases(15.2%) showed fine granules in the cytoplasm. The incidence of p-glyco-protein expression in the tumor tissue was higher in A and AB blood type patients who have A antigen than in 0 and B blood type patients. Cytoplasmic staining pattern was dominant in O and B blood types and golgi staining in A and AB blood type patients. Among 27 patients 'who received chemotherapy, partial remission was noted in 9 of 11 p-glyco-protein negative patients(81.8%) and no remission or progression of the tumor was seen in 9 of 16 p-glycoprotein positive patient(56.3%). The p-glycoprotein expression in gastric carcinoma had no direct correlation with known several prognostic factors of the gastric tumor except for histologic type, and it is supposed that p-glycoprotein detection in gastric tumor tissue by immunohisto-chemical stain is a good method for predicting the response of chemotherapy, especially in p-gly-coprotein negative cases.

Histologic Grading of Astrocytic Neoplasms in Conjunction with Evaluation of Proliferative Activity Using Ag-NORs Count PCNA Expression, and Flow CYtometric DNA Analysis.: Mee Yon Cho, Soon Hee Jung, Tal Seung Kim, Yong Pyo Han; Korean J Pathol. 1994;28(1):49-55.

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Abstract PDF: Although the histologic grade of astrocytic neoplasms of the brain have been used as a prognostic factor, the lack of an objective criteria is possible to create the disagreement of classification. We evaluated 25 cases of astrocytic neoplasms of brain to document the usefulness of prolifera-tive potential of tumor as a prognostic indicator and the correlation with histologic grade by Nils Ringertz. The Ringertz's classification was relatively simple in an application among the variable systems and easy to define the differentiate from grade to grade. The examined cases were com-prised of 7 astrocytomas, 9 anaplastic astrocytomas and 9 glioblastoma multif6rmes. The prolife-rative potential of tumors were measured by Ag-NORs count, PCNA labeling index and flow cytometric analysis. The mean numbers of Ag-NORs per cell and PCNA labeling index were sig-nificantly differ among each histologic grade. In addition, abnormal DNA content and high prolif-erative index were frequently identified in anaplastic astrocytoma and glioblastoma multiforme. Therefore, the Ag-NORs counts, PCNA labeling index, DNA index and proliferative index were well correlated with the histologic grade.

Case Reports

Arthrogryppsis Multiplex Congenita: Pathologic examination of three autopsy cases.: Seung Sook Lee, Je G Chi; Korean J Pathol. 1994;28(1):56-64.

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Abstract PDF: Three autopsy cases of arthrogryposis multiplex congenita are studied. They were two deadborns and one neonatal death. All of them had characteristic abnormalities involving multiple joints. Neither primary myopathy nor abnormalities of anterior horn cells of the spinal cord were detected in our cases. However, two cases had minor central nervous system anomalies. All four cases showed pulmonary hypoplasia of varying degree. Two of three cases showed facial dysmorphism such as micrognathia and low set ears, and one showed cleft lip and palate. Ventricular septal defect, umbilical hernia and ureteral anomalies were also associated.

A Case of Heterophyid Trematode Infection with Intestinal Obstruction.: Jin Young Yoo, Sang In Shim; Korean J Pathol. 1994;28(1):65-67.

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Abstract PDF: This report describes a case of ileal obstruction in a 31-year-old male with acute abdominal pain. A plain film of the abdomen showed segmental obstruction of small intestine. The patient underwent laparoscopic resection of the segment. Microscopic examination demonstrated foci of ulceration, submucosal edema, transmural inflammation, mural and neural hyperplasia and noncaseating granulomas, mimicking Crohn's disease. However, there were microabscesses predominantly composed of eosinophils. Furthermore, a section of an adult heterophyid trematode was identified in the crypt. Heterophydiasis usually causes diffuse enteritis. Therefore, this case with intestinal obstruction seems to be a rare manifestation of intestinal heterophydiasis.

Congenital Choroid Plexus Papilloma: Report of a case.: Jee Young Han, Jai Hyang Go, Tai Seung Kim; Korean J Pathol. 1994;28(1):68-72.

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Abstract PDF: The choroid plexus papilloma is a rare tumor. Its incidence is 0.4-0.6% of all intracranial tumors. Most cases of this tumor are found in the young subject, especially infant and childhood but its congenital form is very rare. The clinical and pathologic findings of congenital choroid plexus papilloma are similar to that of any age. But the cilia on the cell surface are common in the former and very rare in the latter. We present a case of congenital choroid plexus papilloma of the lateral ventricle in a 2 month-old male baby. He had suffered from a sudden onset of convulsions and a drowsy mental state for 2 days. The CT scan revealed a large intraventricular tumor in the left lateral ventricle with hydrocephalus. After ventriculo-peritoneal shunt(V-P shunt), his symptoms were improved. But the hydrocephalus was aggravated due to malfunction of V-P shunt, and he recieved the operation after 4 months. The gross examination revealed a large ovoid papillary tumor(4x3x3cm). On light microscopic examination, the tumor showed papillary structure lined by columnar eosinophilic cells. Some cells had cilia. The electron microscopic finding showed intercellular junction, microvilli and cilia. The tumor cells were positive for cytokeratin, vimentin and S-100 protein.

Lhermitte-Duclos Disease in a Sudden Death: An autopsy case.: Tae Jung Kwon, Tae Seung Kim, Han Young Lee, Shin Mong Kang; Korean J Pathol. 1994;28(1):73-78.

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Abstract PDF: Lhermitte-Duclos disease of the cerebellum manifests itself as a slowly growing mass formed by abnormal neurons that appear more malformative than tumoral. Although most cases show satisfactory clinical evolution, several cases, not recognized in life, died abruptly, usually from respiratory arrest. We recently experienced a 19 year old male, who died suddenly during alcohol drinking. At autopsy, the cerebellum revealed thickening of the folia over two limited areas. Microscopically, the lesion was characterized by proliferation of abnormal neuronal cells with excessive myelination of their axons, disappearance of Purkinie cells and greatly reduced white mater. Theories regarding the pathogenesis of Lhermitte-Duclos disease were reviewed and discussed.

Trichofolliculoma: A case report.: Su Kyeong Yeon, Ki Hwa Yang, Seok Jin Kang, Sun Moo Kim; Korean J Pathol. 1994;28(1):79-81.

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Abstract PDF: The trichofolliculoma is a rare tumor of the hair follicle occuring most often on the head and neck. We have experienced a case of 24-year-old female who had a small, dome-shaped, tan brown firm nodule on the nose. Under the clinical impression of a granuloma, an excisional biopsy of the nodule was done. Microscopically the lesion was composed of a large central cystic hair follicle with many srhall but well differenciated secondary hair follicles branching from the wall. Well developed secondary hair follicles were often grouped and were surrounded by a prominent stroma.

Localized Pseudopolyposis of the Ascending Colon Associated with Granulomatous Colitis: A case report.: Jeong Ja Kwak, Kye Hyun Kwon, So Young Jin, Dong Wha Lee; Korean J Pathol. 1994;28(1):82-85.

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Abstract PDF: Pseudopolyps represent discrete areas of mucosal inflammation and regeneration that are seen in a variety of inflammatory bowel disease including ulcerative colitis and Crohn's disease. These polyps are typically short, measuring less than 1.5 cm in height. Rarely, localized giant pseudopolyposis can occur, i.e., a collection of larger inflammatory pseudopolyps giving rise to a mass lesion within the colon. The most serious problem concerned with pseudopolyposis is a confusion with carcinoma. We experienced a case of localized giant pseudopolyposis causing partial large bowel obstruction. Right hemicolectomy was done for a preoperative diagnosis of ascending colon carcinoma. The resected specimen contained a circumferential lesion, which was composed of numerous interconnecting cylindrical villi, measuring 12 cm in length and 3 cm in height. Microscopically, these polypoid lesions were inflammatory pseudopolyps. Several deep fissure-like ulcerations were noted with multifocal microabscess, lymphoid hyperplasia and an area of noncaseating granuloma.

Muscular Hamartoma of the Breast: A case report.: Dong Won Min, Sun Hee Sung, In Joon Choi; Korean J Pathol. 1994;28(1):86-89.

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Abstract PDF: Hamartoma of the breast is relatively rare benign tumor, which is a well-circumscribed mass mainly composed of fibrous stroma, a(tipose tissue, ducts and acini. Muscular hamartoma of the breast is mainly composed of smooth muscle, and is extremely rare because proper smooth muscle is normaly absent in the breast except in the nipple. We describe a rare case of muscular hamartoma of the breast in a 38-year-old woman. This tumor was located in the upper outer quadrant and a 3 x 2.5 x 2 cm sized, well-demarcated but not encapsulated mass, The mass consisted mainly of irregularly arranged smooth muscle bundles in the fibrous stroma with lobular units and admixed fat cells. The origin of smooth muscle in hamartoma is not well known.

Inflammatory Pseudotumor of the Liver: A case report.: Young Hee Maeng, Jae Hoon Park, Youn Wha Kim, Yong Koo Park, Ju Hie Lee, Moon Ho Yang; Korean J Pathol. 1994;28(1):90-92.

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Abstract PDF: Inflammatory pseudotumor of the Aver is a rare benign lesion that usually has been discovered at laparotomy. This lesion is inflamrhatory and reactive, but the etiology remains unknown. In-flammatory pseudotumor of the liver is of the interest not only because of its rarity also because it needs to be clinically differentiated from hepatocellular carcinoma and other malignant tu-mors. In this report, we describe a case of inflammatory pseudotumor of the liver with fever and weight loss in a 46-year-old male. Grossly, the lesion showed a rather well demarcated, gray white to pale yellowish nodular mass mesuring 7 x 5.5 x 5 cm in dimensions. M icroscqpically, the tumor was composed of diffuse infiltration of predominantly plasma cells, lymphocytes and histocytes associated with fibroblastic proliferation.

Inflammatory Pseud0tumor of the Liver: A case report.: Young Ju Woo, Rye Kyoung Yoon, Jong Eun Joo; Korean J Pathol. 1994;28(1):93-95.

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Abstract PDF: Inflammatory pseudotumor of the liver is a relatively rare entity, and frequently misdiagnosed as a malignant tumor. We report a case of inflammatory pseudotumor involving the liver in a 53year-old man. The liver function test and serum alpha-fetoprotein level were within normal range. His preoperative diagnosis was as hepatocellular carcinoma by radiologic studies, and ultrasonography guided fine needle aspiration cytology and biopsy were done but confirmative diagnosis of malignancy or pseudotumor was not given. Grossly a relatively well marginated reddish brown soft mass with focal hemorrhage, measuring 5.0 cm in the largest diameter, was noted in the left lobe of liver. Surrounding hepatic parenchyma was yellowish brown in color without cirrhosis. Microscopically the mass showed typical findings of inflammatory pseudotumor and the ing liver tissue revealed diffuse fatty change and moderate chronic inflammatory cell on in the portal areas.

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