Journal of Pathology and Translational Medicine

Volume 28(5); October 1994

Original Articles

Histological, Enzyme Histochemical, and Electron Microscopic studies of the Rat Kidney Following Administration of Folic Acid.: Myoung Jae Kang, Woo Sung Moon, Dong Geun Lee, Ho Yeul Choi, Sang Ho Kim, Kyu Hyuk Cho; Korean J Pathol. 1994;28(5):449-459.

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Abstract PDF: To investigate the morphologic evidence of acute renal failure by folate, histological, histochemical (PAS), enzyme histochemical (Na-K-ATPase, G6PD, and ALP), and ultrastructural studies were performed. The results are as follows: l) Oliguria was most severe 3 hours after folate and the urine volume was 24.8% that of the control group. 2) Histologically, dilatation of tubules, degeneration and focal necrosis of the cortical tubules, and PAS(+) droplets in the tubular lumen were noted. And also frequent mitoses, mild interstital connective tissue proliferation, and neutrophilic infiltrates were observed in the late stage. 3) On enzyme histochemical examination, the activities of Na-K-ATPase and ALP were decreased, but G6PD activity was increased in comparison with the control group. 4) The ultrastructural studies revealed cytoplasmic vacuoles, apical cytoplasmic blebbing, dense bodies, mildly swollen mitochondria, dilated endoplasmic reticulum, loss bf brush border of the proximal tubules, and loss of microvilli of the thin limb of Henle's loop. Later, marked attenuation or loss of infoldings of basal plasma membrane of the cortical tubules was recognized. According to above results, the cause of acute renal failure by late is thought to be the injuries of tubular epithelial cells including sodium pump secondary to tubular obstruction.

A Histopathological Analysis on 73 Cases of Enucleated Eyeballs.: Kyoung Chan Choi, Joon Hyuk Choi, Won Hee Choi, Tae Sook Lee, Myung Mi Kim; Korean J Pathol. 1994;28(5):460-468.

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Abstract PDF: A total of 73 enucleated eyeballs is reviewed and analyzed clinicopthologically. These eyeballs were selected among the enucleated spceimens that had been removed at the Yeungnam University Hospital during a period of 10 years beginning from 1983 to 1992. Following results were obtained. 1) When the eyeballs were classified according to me direct cause of removal, the neoplasm was the most common single cause accounting for 26 cases(35.6%) out of 73 cases, followed by phthisis bulbi l6 cases(21.9%), trauma 10 cases(13.7%), glaucoma 8 cases(10.9%), inflammation 5 cases(6.8%), staphyloma 4 cases(5.5%), retinal detachment 1 cases(1.4%), Coat's disease 1 cases(1.4%), corneal disease 1 cases(1.4%) and choroidal hemorrhage 1 cases(1.4%). 2) 39 cases(53.4%) were male and 34(46.6%) were female. 23 cases(31.5%) were below 10 years of age, which was the highest rate. 3) The neoplastic lesion included retinoblastoma 20 cases(76.9%) in 26 neoplasms, malignant melanoma 4 cases(15.3%), hemagioblastoma of optic disc 1 cases(3.9%), adenocarcinoma of Meibomian gland 1 cases(3.9%). 4) Retinoblastoma was the commonest intraocular tumor accounting for 20 out of 26 cases, In growth pattern, 80.0% of the tumor grew endophtytically. True rosette were seen 60% of the retinoblastoma.

PCNA Labelling index and AgNORs of Transitional Cell Carcinoma of the Urinary Bladder.: Byung Gon Park, Sang Yong Lee, Mee Sook Roh, Seo Hee Rha, Sook Hee Hong; Korean J Pathol. 1994;28(5):469-477.

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Abstract PDF: Proliferating cell nuclear antigen (PCNA, PC10), an auxillary protein of DNA polymerase, plays a main role in the early stage of DNA Synthesis and is synthesized from Gl phase to s phase of the cell cycle. Nucleolar organizer region (NORs) are DNA loops encoding RNA proteins(AgNORs). To evaluate correlation with PCNA labelling index (LI)and AgNORs according to histological grades and clinical stages of transitional cell carcinoma of the urinary bladder, the authors analysed 54 transitional cell carcinoma using immunohistochemical stain for PCNA and silver stain for AgNORs in paraffin sections. The comparison of PCNA (PC10) LI and clinical stage showed a significant correlation (p<0.05), where as PCNA (PC10) LI according to histologic grade showed no significant correlation. High grade tumors showed increase PCNA LI. Superficial tumors (Ta-Tl) showed significantly lower PCNA LI than muscle invasive tumors (T2-T4)(p<0.05). There was no significant correlation between AgNORs and clinical stage, bur higher stage and higher grade tumors showed increased noubers of AgNORs. These results suggest that PCNA LI has a significant correlation with clinical stages of transitional cell carcinoma of the urinary bladder.

Ultrastructural Observation on Maturation Process of Cytomegalovirus in Human Cells.: Chul Jong Yoon, Je Geun Chi; Korean J Pathol. 1994;28(5):478-484.

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Abstract PDF: Cytomegalovirus(CMV) infection can be diagnosed by finding characteristic intranuclear inclusion body and enlargement of the cell size congenital CMV infection can be associated with various types of anomalies seen in different gestational age. These anomalies are probable due to direct virus infection of the parenchymal cell m early gestation. Based on four autopsy cases of congenital CMV infection we have studied maturation process of virus particles in parenchymal cells, with special reference to me mode of replication and transmission. Virus particles in CMV-infected cells in brain and kidney showed nucleocapsids with characteristic concentric core, that were enclosed around fibrillar network in nucleus. During replication process virions showed various morphogenic mutation that was rather consistent in different tissues and individuals. There were virions without core or with eccentric core. Occasional cores were divided into 2~5 fragments. The virus particles reached the cytoplasm through the nuclear membrane, and here the virions increased twice in size. After virions were fully matured in the cytop1asm. they showed exocytosis phenomenon through the cellular membrane to reach extracellular portion.

Expression of Alpha Fetoprotein, Transforming Growth Factor, Epidermal Growth Factor and Alpha-1-Antitrypsin in Gastric Cancer.: Sook Guem Jeong, Hwan Jun Choi, Ja Young Koo, Man Ha Huh; Korean J Pathol. 1994;28(5):485-492.

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Abstract PDF: The immunohistochemical expression of transforming growth factor-beta(TGF-beta), epidermal growth factor(EGF) and alpha-1-antitrypsin(AAT) was studied in 47cases of endoscopic biopsy matearials of gastric carcinoma to determine me correlation to the expression of alpha fetoprotein(AFP). And immunoreactivity of the antigens was correlated to me degree of tumor infiltrating lymphocytes and histologic differentiation of the tumors. And the results were analyzed to elucidate pathological AFP-producing gastric cancer. The results were summarized as follows. AFP immunoreactivity was demonstrated in 30 cases(63.8%) of the tumors, TGF-beta in 26 cases(55.3%), EGF in l4 cases(29.8%) and AAT in l0 cases(21.3%). The incidence of expression of the antigens was significantly higher in the cases of elevated serum AFP(>2ng/ml) than that of the cases with normal serum AFP(p<0.05). There was no relation between the expression of antigens and histological differentiation of gastric cancer. The expression of AFP and TGF-beta revealed good correlation(k=0.72). The relation between expression of TGF-beta and AAT and the degree of tumor infiltrating lymphocytes disclosed negative correlation(p<0.05). These results suggest that TGF-beta and AAT prodution contribute to the worse prognosis of AFP-producting gastric cancer. Possible immunosuppressive action of TGF-beta and AAT in the cancer tissue is discussed.

An Ultrastructural Morphometric study of Follicular Center Lymphocytes of the palatine Tonsil: Reinvestigation of the Lukes-Collins' Classification of Malignant lymphoma.: Min Cheol Lee, Jong Han Shin; Korean J Pathol. 1994;28(5):493-505.

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Abstract PDF: The model of lymphocyte differentiation described for Lukes-Collins' classification of non-Hodgkin's lymphoma is related particularly to morphological alterations of nuclei of follicular center lymphocytes by antigenic stimulation. The authors carried out ultrastructural and morphometric studies to investigate morphological alterations during lymphocyte transformation on the nuclear profiles of follicular center, parafollicular and mantle zone lymphocytes in ten tonsillectomy cases of chronic hypertrophic tonsillitis. The nuclear parameters measured included nuclear area, contour index, frequency invagination and cleft, depth of invagination and nuclear diameters. Follicular centers contained a mixed population of lymphocytes consisting of untransformed (type 1), partially transformed (type 2) and fully transformed (type 3) lymphocytes. During lymphocyte transformation in both follicular, and parafollicular and mantle zones, the nuclei had a gradual and progressive increase in size. The nuclear contour index of type 2 nuclei of both follicular and parafollicular and mantle zones tended to be higher than those of type 1 and 3, indicating a greater degree of irregularity and variability of nuclear profiles. Invaginated and cleaved lymphocytes were not confined to me transformed lymphocytes. A considerable portion of lymphocytes had invaginations and clefts in parafollicular and mantle zone as well as follicular center. No difference on the depth of invagination was noted in type 1, type 2 and type 3 lymphocytes. The results indicate that some promise of the Lukes-Collins conepts of follicular center cells and the process of lymphocyte transformation in follicular centers may be necessary to revise

Interstitial Mononuclear Cell Infiltration and its Phenotypes in IgA Nephropathy.: Hyeon Joo Jeong, Hyunee Yim, Sun Hee Sung, In Joon Choi; Korean J Pathol. 1994;28(5):506-510.

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Abstract PDF: To know the correlation between glomerular and tubulointerstitial lesion and to define the characteristics of interstitial inflammatory cell in IgA nephropathy and classified according to WHO classification and graded tubulointerstitial lesion as mild, moderate and severe. Paraffin-embedded 5u sections were stained with UCHL-l, L26 and CD68 antibodies. More than 20 fields were examined in each case under the high power microscopy and the number of positive cells were counted. There was positive correlation between the severity of glomerular and that of tubulointerstitial lesion. The mostcommoninflammatory cells in the interstitiuin were UCHL-l positive cells followed by CD68 and L26 positive cells. As the WHO grade or tubulointerstitial lesion increased, the numbers of positive cells were increased in all three groups. The proportion of UCHL-1 Positive cells were increased in cases with high WHO grade whereas that of L26 positive cells incases with severe tubulointerstitial lesion Proteinuria was correlated with the degree of inflammatory cell infiltration, especially with that of L26 positive cells.

A Study of Umbilical Cord Length According to the Gestational Age.: Eun Kyung Kim, Je Geun Chi; Korean J Pathol. 1994;28(5):511-513.

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Abstract PDF: The umbilical cord length may be a reliable indicator of fetal activity during gestation because it grows in response to tensile forces related to fetal movement. But there has been little attention to normal range of the umbilical cord length. We analyzed the umbilical cord length of 2342 cases de1ivered in Seoul National University Hospital to determine mean values according to the gestational age. The umbilical cord length increased linearly from 15.5cm of 13 week to 50.6 cm of 44 week. After 42 week, the growth was nearly stopped. There was no difference by fetal sex. The length of umbilical cord was variable even within same gestational age.

Case Report

Aqueductal Atresia with Forking Anomaly: Report of 3 cases.: Na Hye Myong, Mi Kyung Kim, Je G Chi; Korean J Pathol. 1994;28(5):514-521.

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Abstract PDF: Aqueductal forking was first described by Russell (l949) as a cause of aqueductal obstruction and a form of congenital malformation with simple stenosis, it is a relatively common cause of congenital hydrocephalus not associated with spina bifida or meningomyelocele. Pathologically it is characterized by two distinct channels separated by non-gliotic brain tissue. We describe variable clinicopathologic findings of 3 autopsy cases showing hydrocephaly due to aqueductal atresia with forking case 1 was a 35-week-old female showing Potter's syndrome, dextrocardia, and skeletal anomaly. case 2 was a 29-week-old male abortus with micrognathia, simian crease, club feet, and minor defects of visceral organs. Case 3 was a 32-week-old female abortus with associated anomalies such as a low-set ear, ectopic thymus and thyroid, and Meckel's diverticulum. On serial sections of brain stems of all 3 cases, were seen variably shaped and atretic lumina of aqueducts with distinct two channe1s and intervening brain tissues of normal cellularity.

Original Article

Serous Cystadenoma of the Pancreas.: Young Mee Cho, Gyung Yub Gong, Ghee Young Choe, Eun Sil Yu, In Chul Lee; Korean J Pathol. 1994;28(5):522-527.

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Abstract PDF: Pathologists and others have been calling the serous cystadenoma of the pancreas "microcystic cystadenoma", following Compagno and Oertel's proposal in l978 because it usually consists of innumerable small cysts (less than 2cm). However, unilocular or predominantly macrocystic types of serous cystadenoma have been occasionally reported. Therefore, they present a difficulty in precise preoperative and intraoperative diagnosis for their simi1ar gross appearance to other cystic lesions of the pancreas. We discovered two cases of macrocystic and unilocular serous cystadenomas of the pancreas which were lined by cuboidal to flattened epithelial cells. They contained PAS positive and D-PAS negative intracytoplasmic glycogen granules. The unilocular, macrocystic and microcystic patterns may represent a morphologic spectrum of a pancreatic neoplasm. So we propose to use the term "serous cystadenoma" rather than microcystic cystadenoma.

Case Reports

Paraganglioma of Cauda Equina: A case report.: Ji Hwa Kim, Sang Han Lee, Yoon Kyung Shon, Jyung Sik Kwak, Tae Joong Shon; Korean J Pathol. 1994;28(5):528-532.

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Abstract PDF: The clinical and pathological features of a paraganglioma arising in the cauda equina is described and compared with previous reports. The right microscopic fetures were similar to those of paragangliomas from other sites, with a 'Zellballen' pattern of cells containing arzyrophil granules. Immunohistocytochemical stains for neurone specific enolase, S-100 protein, cytokeratin were positive, but stains for glial fibrillary acidic protein were negative. Electron microscopy showed densely staining membrane-bound granules, cilia like structures and fibros bodies in the cytoplasm. The last two features only occur in paragangliomas from this site. The pathological findings suggest that paragangliomas in this site arise from pre-existing paraganglia, possibly of the visceral autonomic group.

Splenic Lymphangioma: A case report.: Young Chae Chu, Ho Suk Lee; Korean J Pathol. 1994;28(5):533-535.

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Abstract PDF: Lymphangioma of the spleen is a rare neoplasm and approximately 100 cases have been reported in the world literature. This lesion may involve the spleen alone or may be a part of a syndrome of multivisceral involvement. The pathogenesis is unclear whether this is a true neoplasm of a developmental defect. We report a case of a 87-year-old woman with solitary splenic lymphangioma. The cut surface mass is not encapsulated and located at the subcapsular area in the mid portion of spleen. It is composed of variable sized cystic spaces containing myxoid tissue. Microscopic finding reveals dilated lymphatic spaces lined by endothelial cells and the content is proteinaceous eosinophilic fluid.

Original Article

Squamous Cell Carcinoma Originating from an Epidermal Cyst.: Jung Weon Shim, Seoung Wan Chae, Hye Rim Park, Young Euy Park; Korean J Pathol. 1994;28(5):536-537.

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Abstract PDF: The occurrence of sqamous cell carcinoma arising from epidermal cyst is unusual. A 54-year-old man with soft tissue mass on the back for 25 years presented an infiltrating squamous cell carcinoma within the wall of epidermal cyst. All tissue excised deserved to be examined to be axamined carefully in longterm epidermal cyst.

Case Reports

Primary Malignant Lymphoma of the Gallbladder: A case of report.: Jung Sun Kim, Chul Woo Kim, Yong Il Kim, Yong Bum Yoon, Yung Jue Bang; Korean J Pathol. 1994;28(5):538-540.

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Abstract PDF: Lymphomatous involvement of the gallbladder is rarely identified and manifests mostly as a local involvement of disseminated disease. There have been reported only about 20 primary malignant lymphomas of the gallbladder without involvement of other sites. A 63-year-old woman presented with jaundice, epigastric pain, and weight olss of two months duration. There was no systemic lymphadenopathy elsewhere. Abdominal computed tomograph revealed a focal thickening of the gallbladder wall. The removed gallbladder contained a well circumscribed, 5x3 cm-sized, slightly elevated firm area with accentuated mucosal papillary excrescences near the neck protion. The lesion involved whole thickness of the wall, and was made up of diffuse atypical lymphoid cell infiltrates of variable size accompanying plasmacytoid differentiation in areas. Some large tumor cells were pleomorphic and contained prominent nucleoli. To our knowledge, this is the first case of primary malignant lymphoma of the gallbladder in Korean literature.

Nesal T-cell Lymphoma associated with Hemophagocytic Syndrome: A case report.: Mee Sook Roh, Jin Sook Jeong, Sook Hee Hong; Korean J Pathol. 1994;28(5):541-543.

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Abstract PDF: Peripheral T-cell lymphoma is the generic group given to a family of tumors composed of neoplastic lymphocytes with phenotypic features of peripheral T-cells. Certain peripheral T-cell lymphomas develop a hemophagocytic syndrome that mimics malignant histiocytosis, both clinically and pathologically. We experienced a case of nasal T-cell lymphoma, histologically mimicking malignant histiocytosis in a 40-year-old male. The chief complaints were nasal obstruction and intermittent mild fever. Mild anemia, elevated SGOT and SGPT, polyclonal gammophthy, and moderate hepatomegaly were present. Two weeks later was present an enlarged cervical lymph node. The biopsied nasal mass showed angiocentric and angiodestructive peripheral T-cell lymphoma withextensive necrosis and marked erythrophagocytosis by non-neoplastic histiocytes. Subsequently, cervical lymph node was biopsied, which showed peripheral T-cell ltmphoma with extensive necrosis and erythrophagocytosis as well. The atypical lymphoid cells revealed pan-T(+), but CD4(-) and CD8(-), whereas the reactive histiocytes showed lysozyme(+), immunohistochemistry.

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