Journal of Pathology and Translational Medicine

Volume 14(2); July 1980

Etcs

Systemic Mycosis in Korea: Yoo Bock Lee; Korean J Pathol. 1980;14(2):1-8.

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Abstract: 1877年 actinomycosis가 처음 報告된 이후 1882年에서 1908年 사이에 나머지 深部眞菌性疾患이 거의다 發見되었으나 그後半世紀 동안은 眞菌疾患에 對한 硏究가 등한시되었다. 그 까닭은 첫째로 眞菌性疾患은 稀貴하며 둘째로는 臨床的으로 眞菌症은 表在性皮膚疾患으로 看做되어 왔기 때문이다. 그러던 中 1949年 Gross가 penicillin 投與後에 合倂症으로 口腔內 monilliasis가 發生한 것을 報告한 것을 爲始로 Harris(1950), Hewitt와 Williams(1950) 및 Woods와 Manning(1956) 등이 연달아 化學療法이나 抗生劑投與가 眞菌性疾患을 誘發한다는 것을 主張하게 됨으로서 眞菌症에 對한 證例報告가 急增하였으며 特히 深部組織의 侵犯 및 全身播種의 傾向을 보임에 따라 眞菌性疾患에 對한 關心이 提高되었고 臨床的, 微生物學的 또 病理組織學的意義가 增大되었다(Connant et al. 1954; Lewis et al. 1958, Wilson, 1959; Moss와 MeQuown 1960; Emmons et al. 1977). 眞菌症의 發生頻度가 增加하게 된 理由의 一部는 眞菌症에 對한 認識이 增進된 데 起因한 表面上의 增加를 들 수 있으나 그보다는 細菌性疾患癌腫 및 各種慢性疾患의 治療에 使用하는 抗生物質, 抗癌物質 혹은 steroid 및 免疫抑制劑와 같은 現代醫療에 不可缺한 藥物의 長期間大量投與後에 招來되는 合倂症 또는 交替性感梁으로 因한 絶對的增加인 것으로 보이며 따라서 臨床的 의의가 한층 더 크게 되었다(Hrris 1950; Woods와 Manning 1951; Brown et al. 1953; Craig와 Farber, 1953; Rankin 1953; Bratlund와 Holten, 1954; Levy와 Cohn, 1955; Carpenter, 1955; Schaberg와 Hildes, 1955; Keye와 Magee, 1956; Torack 1952; Steinberg, 1958; O'Donavan, 1957; Hutter, 1959; McBride et al. 1960; Roberts, 1962; Gruhn Sanson, 1963; Emmons et al. 1977). 이러한 事實에 刺戟되어 眞菌疾患에 對한 臨床的實驗的 혹은 病理組織學的硏究가 多角度로 進行되었고 難治病으로 生角되던 眞菌疾患의 治療도 可能한 段階에 이르게 되었다(Palmrose와 Hosli, 1956; Reiman, 1959; Willson, 1959; Emmons 1977).

Changing Pattern and Prospect of Serological Tests for Syphilis: Samuel Y. Lee; Korean J Pathol. 1980;14(2):9-14.

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Abstract: 오늘날 우리나라에서 실시되고 있는 종목만 꼽아도 다섯 손가락이 모자라는 것이 이 매독 혈청 반응이다. 또한 환자에 따라 그중에서 골라써야 할 종목이 달라지고, 같은 결과를 가지고도 그 해석이 달라지는 것이 이 매독검사다. 먼저 우리나라에서 현재 쓰이는 종목만 꼽아 보기로 하자. 가장 흔히 쓰는 reagin test에 VDRL slide test가 있다. 이것도 단순히 Reactive와 Non-Reactive로만 구별하는 定性검사와 그 titer까지 결정하는 定性검사가 있다. 비슷한 검사이기는 하나 集團검사에 편리하도록 만든 RPR card test가 있다. 이것도 定性, 定量 모두 할 수 있으나 값이 비싸서 定量에는 쓰기 어렵다. treponemal test로는 FTA-ABS가 수년전부터 연세의료원을 비롯한 몇몇 곳에서 쓰이기 시작하였고 근자에 TPHA가 가톨릭의료원 등에서 새로 시작되었다. 혈청검사는 아니지만 매독진단에 빼지 못할 것이 darkfield microscopy로 treponema 자체를 檢出하는 검사가 있다. 이것까지 합하면 다섯여섯까지 검사를 적절히 取捨선택하여 써야하는 것이 오늘의 현실이다. 本稿에서는 오늘에 이르기까지의 과거도 돌이켜보고 또한 앞으로의 方向도 점쳐 보면서 과연 오늘 우리가 취할 태도가 어떠하여야 할지 매독혈청검사 전반에 대한 검토를 하여 보기로 한다.

A Study on the Mechanism of Generalized Shwartzman Reaction: Soo Young Lee, Won Il Kim, Sung Keun Chang, Choo Soung Kim; Korean J Pathol. 1980;14(2):15-20.

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Abstract: The anti-rabbit plasma coagulation factor XIII goat immunoglobulin infusion, prevents the generalized Shwartzman reaction of rabbits elicited by two 24 hours interval intravenous injections of bacterial endotoxin. Measurements of circulating platelets, fibrinogen and factor ?I activities were done after either the first or second injection of endotoxin in both antibody-treated and non-treated rabbits. Twenty four hours after the first injection of endotoxin, a marked increase of platelet was occurred in antibody-treated rabbits, however an increase in fibrinogen was appeared in non-treated ones and forty eight hours after the injection an increase in fibrinogen was greater in antibody-treated group than in non-treated group. Forty eight hours after the first injection of endotoxin, plasma factor ?I activities were decreased in non-treated rabbits. The occurrence of bilateral cortical necrosis was confirmed in four out of five rabbits in non-treated group, whereas no bilateral cortical necrosis was occurred in antibody-treated group.

Cytologic Study on Microinvasive Squamous Cell Carcinoma of the Uterine Cervix: Myoung Hee Kang, Woon Sup Han, Jung Dal Lee; Korean J Pathol. 1980;14(2):21-30.

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Abstract: Cervico-vaginal smears from 10 patients with microinvasive squamous cell carcinoma of the cervix confirmed on the histologic examination of the conization or hysterectomy specimen were retrospectively investigated. 1) The degree of stromal penetration on the histologic examination was estimated as upper (1 case), middle (4 cases) and lower 1/3 (5 cases) of the mucosa equivalent to the length of the cervical mucous glands. The cervico-vaginal smears of the 10 patients obtained prior to the surgical interventions were originally diagnosed as severe dysplasia (3 cases), microinvasive carcinoma (2 cases) and invasive carcinoma (5 cases). 2) On the histological examination the covering epithelium of the microinvasive carcinoma showed a variety of intraepithelial neoplastic changes including dysplasia of variable degrees and in situ carcinoma in some extend. 3) A cytologic analysis on the smears revealed the cells indicating microinvasion in 9.5%(upper 1/3), 26.4% (middle 1/3) and 17.8% (lower 1/3 stromal invasion) as a prevalence among the cells screened. 4) The microinvasive carcinoma cells contained cellular abnormalities which varied somewhat in relation to the depth of penetration. The deeper penetrated the abnormal cells the more smeared in aggregates. A tumor diathesis was evident in 9 of 10 ases. The cells with the deepest penetration (lower 1/3) had an irregularly distributed coarse chromatin and prominent nucleoli, while the abnormal cells with upper 1/3 stromal penetration had a regularly distributed fine chromatin and no prominent nucleoli.

Plasmacytosis in the Bone Marrow: K.S. Hahn, I.K. Paik, M.H. Park, H.I. Cho, S.I. Kim; Korean J Pathol. 1980;14(2):31-38.

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Abstract: The authors made an analysis on 582 cases of bone marrow Plasmacytosis out of 2,896 cases performed during the last 13 years from 1966 to 1978 at the Department of Laboratory Medicine, Seoul National University Hospital. Cases having 2% or more of plasma cells in differential count were selected, and the results were as follows : 1) The older patients showed the more bone marrow plasmacytosis in general, and this tendency was more prominent in 299 cases of aplastic anemia and 54 cases of Korean hemorrhagic fever. 2) Diseases with prominent bone marrow plasmacytosis other than multiple myeloma in decreasing order of degree were ; aplastic anemia, typhoid fever, hemolytic anemia, Korean hemorrhagic fever, tuberculosis, malignancies with or without bone marrow metastasis, collagen diseases, leukemias (especially acute monocytic and granulocytic), iron deficiency and other types of anemias, liver cirrhosis and idiopathic thrombo- cytopenic purpura. 3) In cases of Korean hemorrhagic fever, the patients in oliguric stage showed more prominent bone marrow plasmacytosis than those in diuretic stage. 4) In aplastic anemia, the patients with bone marrow plasmacytosis showed more prominent hyperglobulinemia than those without plasmacytosis. 5) The incidence of plasmacytic satellitosis was significantly higher in cases having both bone marrow plasmacytosis and serum hyperglobulinemia compared to cases having neither of them. This finding was more Prominent in cases of Korean hemorrhagic fever.

A Study on the Influences of Acid-base Imbalance on the Hematological Pictures of the Peripheral Blood, Bone Marrow and Spleen: Eui Chong Kim, Sang-in Kim; Korean J Pathol. 1980;14(2):39-44.

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Abstract: The influences of acid-base imbalance on the hematological aspects of peripheral blood, bone marrow and spleen were studied in albino rats under the controlled environments including room temperature, diet, fluid supply etc. Acidosis and alkalosis were induced by intragastric ingestion of ammonium chloride and sodium bicarbonate, and was confirmed by blood gas analysis including pH and base excess. The results are summerized as follows : 1) The peripheral blood of the acidosis group showed an increasing tendency in RBC, Hb, Hct and reticulocyte count comparing to that of control & alkalosis groups. The WBC total counts were also increased in acidosis group with relative neutrophilia and lymphopenia while the alkalosis group showed marked relative neutropenia and lymphocytosis comparing that of acidosis group. 2) In the bone marrow, the acidosis group showed a decreased erythroid series with increased myeloid series and eosinophilia comparing to the control group. The alkalosis group showed a marked decrease in erythroid series and a marked increase in lymphoid cells comparing to those of control and acidosis groups. 3) In the spleen, the acidosis group showed a marked increase in nucleated red blood cells.

A Study on Serum Ferritin Level in Iron Deficiency Anemia: Yoon Chung Kim, Kui Nyung Yi, Samuel Y. Lee; Korean J Pathol. 1980;14(2):45-51.

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Abstract: The recently developed method of measuring serum ferritin by using radioisotope has assumed a very important role in the diagnosis of iron deficiency anemia. The serum ferritin level of a patient with iron deficiency anemia (I.D.A.) is very low, compared to that of normal person. While, the patients with anemias other than I.D.A. and some kinds of diseases may reveal elevated serum ferritin level. Author measured serum ferritin level by using two-site immunoradiometric assay, serum iron, total iron binding capacity from which the transferrin saturation is determined by using modified Goodwin method on 24 patients confirmed to have I.D.A. and normal controls comprised of healthy 66 males and 60 females. The results are summarized as follows. 1) The average serum ferritin, iron level, and transferrin saturation of male controls were 63.8ng/ml, 103.2㎍/100ml, 32.8%, and those of female controls were 20.3ng/ml, 68.3㎍/100ml, 24.2%, respectively. 2) The average serum ferritin, iron level, and transferrin saturation of patients with I.D.A. were 9.1ng/ml, 97.3㎍/100m1, 16.2% and these values were lower than those of normal healthy controls. 3) The finding of bone marrow iron was closely correlated with serum ferritin level and transferrin saturation, but not so well with serum iron level. 4) Serum ferritin level and transferrin saturation of the patients with I.D.A. were significantly lower than those of normal controls (p<0.05), but the serum iron level did not show a significant difference from that of normal controls (p>0.05). From above results, it can be said that single measurements of serum iron or T.I.B.C. could hardly help the diagnosis of I.D.A. So the two factors should be measured at the same time for the determination of transferrin saturation. But, the transferrin saturation can hardly indicate the presence of I.D.A. in some cases. The measurement of serum ferritin is relatively simple and often useful for the diagnosis and follow-up of treatment of I.D.A. When some I.D.A. patients show normal serum ferritin levels, bone marrow examination should be indicated for the exact diagnosis.

Effect of Improved Method of Cultivation on the Isolation of Anaerobic Bacteria: Hyon-Suk Kim, Yunsop Chong, Samuel Y. Lee; Korean J Pathol. 1980;14(2):53-59.

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Abstract: In order to improve the isolation of anaerobic bacteria from clinical materials, we have been using Stuart transport medium to hold swab specimens and phenylethanol blood agar to inoculate specimens since 1978. Also, all purulent materials have been cultured anaerobically regardless of the request. To evaluate the effect of such a practice, an analysis was made on the data obtained during the period of September 1978 to August 1979. The following results were obtained. 1) A total of 256 positive cultures of anaerobic bacteria were isolated from 187 patients. Of these 87 were gram-positive cocci and 143 gram-negative bacilli. 2) Anaerobes were most frequently isolated from specimens of abdominal, head and neck, and genital lesions. 3) The percentage of the number of specimens with both anaerobes and aerobes from the same specimen against the total isolation of anaerobes has increased from 41.4% in 1975-77 to 77.5% in 1978-79. 4) The percentage of anaerobe isolations against the total number of bacteriological specimens was 0.48% in 1975-77 and 1.34% in 1978-79. 5) The percentage of Clostridium against the total number of anaerobe isolates was 18% in 1972-73 and 3.1% in 1978-79. These facts clearly indicated that our new measures taken in 1978-79 have resulted in favorable effects in the isolation of non-sporeforming anaerobic bacteria from clinical specimens.

Study on Sex Differention by Leukocytic Nuclear Appendages in Peripheral Blood of Korean: Kyu Man Lee, Eui Keun Ham; Korean J Pathol. 1980;14(2):61-68.

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Abstract: A study on sex difference by nuclear appendages of polymorphonuclear neutrophilic leukocytes was made of one hundred cases in equal numbers of Korean male and female using peripheral blood smears. The nuclear appendages were observed and morphologically classified into type A (drumstick body), type B (sessile nodule, nodule with a thick stalk, drop), type C (rod, hocky, filament) and type D (dome, pyramid, rectangle) and made to differential counting of each type in the 500 neutrophils. Followings are results : 1) The occurrence of nuclear appendage type A was 5±3.8 in female, whereas no one was observed in male at all. It seems type A was the absolute diagnostic criteria for sex differentiation. 2) The occurrence of nuclear appendage type B was 46±18.8 in male, 55±26.3 in female, type C, 77±24.8 in male, 44±19.5 in female and type D, 55±16.2 in male, 47± 19.7 in female. The combined occurrence of type A and B was 46±20 in male and 61± 27.5 in female, All of them revealed no recognizable significance to make sex difference. 3) The ratio of the occurrence of type A and B to that of type C was 0.6±0.1 in male and 1.5±0.6 in female respectively and that was considerably significant to make sex difference. 4) The ratio of the occurrence of type A, B and D to that of type C was 1.4±0.3 in male and 2.7±1.0 in female respectively, and the ratio of the occurrence of type A and B to that of type C and D was 0.4±O.1 in male and 0.7土0.2 in female respectively, those were helpful to make sex differentiation.

Changes on Serum Protein Fraction and Serum Immunoglobulin in Liver Diseases: Bock Hee Park, Soon Ho Kim; Korean J Pathol. 1980;14(2):69-79.

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Abstract: The author investigated changes of serum protein fractions and immunoglobulins in 46t cases of patients with various liver diseases who had been visited or admitted to he Department of Insternal Medicine, Busan National University Hospital and 20 cases of control subjects from May, 1979 to March, Jul 1980. The 46 cases of liver diseases were consisted of 13 cases of acute hepatitis. 13 cases of chronic hepatitis, 13 cases of liver cirrhosis and 7 cases of hepatocellular carcinoma, Diagnosis was confirmed clinically and histopathologically in all the patients. Serum protein fractions were measured by cellulose acetate electrophoresis and serum immunoglobulins were measured by radial single immunodiffusion method. The results obtained were summerized as follows : 1) In the acute hepatitis, the levels of alpha globulin, gamma-globulin, IgG and IgM were significantly increased than those of control. 2) In the chronic hepatitis, the levels of serum albumin was significantly decreased than that of control and acute hepatitis. The levels of gamma-globulin, IgG and IgM were significantly increased than those of the control. The level of IgA was significantly increased than that of the control and acute hapatitis. 3) In the liver cirrhosis, the level of albumin were significantly decreased than that of the control, acute hepatitis and chronic hepatitis. The level of gamma-globulin, IgG and IgM were significantly increased than those of the control. The level of IgA was significantly increased than that of the control and acute hepatitis. 4) In the hapatocellular carcinoma, the level of albumin was significantly decreased than that of the control and acute hepatitis. The level of alpha-globulin was significantly increased than that of the control, chronic hepatitis and liver cirrhosis. The levels of gamma-globulin and IgM significantly increased than those of the control and level of IgA was also significantly increased than that of the control and acute hepatitis.

Pilar Tumor of the Scalp -Report of a Case-: Mi Kyung Hur, Chong Moo Lee; Korean J Pathol. 1980;14(2):81-84.

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Abstract: A pilar tumor of the scalp is a rare tumor of the squamous epithelium occurring in the scalp area. We have experienced a case of 12 year old female who had a small, but slowly growing tumor mass of 1 cm in diameter in the scalp of the mid-parietal region. Under the clinical impression of a sebaceous cyst, an excisional biopsy of the mass was done. Crossly the cut surface of lesion was an indistinctly defined, gray tan, solid and rubbery mass of 1cm dimension showing friable, soft material. Microscopically the lesion was composed of irregularly shaped lobules of squamous epithelium, in many areas undergoing rather abrupt change into amorphous eosinophilic keratin material. A moderate irregularity in the nuclear morphology was found. However, mitoses were infrequent, and obvious microscopic findings of malignancy were not found. On the basis of these findings, a diagnosis of pilar tumor of the scalp wag made. A brief review of his entity particularly on the current opinions about the histogenesis and the biological behavior of this neoplasm was made.

An Autopsy Case of Dandy-Walker Syndrome: In Sun Kim, Heum Rye Park, Min Chul Lee, Seung Yong Paik; Korean J Pathol. 1980;14(2):85-88.

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Abstract: Hydrocephalus associated with a posterior fossacyst and hypoplasia of the cerebellar vermis constitute a traid of Dandy-Walker syndrome. This syndrome was first described by Sutton in 1887. In 1914 Dandy & Blackfan described a case of 13 year old child and thought that these finding were due to atresia of the foramina of Luschka and Magendie. Taggart and Walker, D'Agostino, Giebson and others supported the concept of congenital atresia of the foramina of Luschka and Magendie. However many other authors rejected this concept, and especially Brodal and Hauglie Hanssen pointed out the cerebellar anlage is fused before the foramina normally become patent and thus there was no cause-result relationship between foramina atresia and vermal hypoplasia. They and Gardner thought that this abnormality was the result of preexisting and persistent hydrocephalus and Benda concluded that the entity is a complex developmental abnormaly. There were not a few literature-reported cases in other countries, but in Korea the literature is scarce. We describe an autopsy case of Dandy-Walker syndrome associated with malformations of the brain and additional systemic anomalies, which may be related to acute carbon monoxide poisoning during the early pregnancy period.

A Case of Multiple Congenital Malformations: Gue Tae Chae, Choo Soung Kim; Korean J Pathol. 1980;14(2):89-94.

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Abstract: An autopsy case of multiple congenital malformations was studied. A large posterolateral diaphragmatic defect(6×4cm) with a herniated left lobe of the liver and a herniated half of the stomach without hernia sac was noticed, and also marked hypoplasia of both lungs and a midline displacement of the heart were noticed in the thoracic cavity. A classical complete transposition of the great arteries of the heart and the presense of patent foramen ovale and ductus arteriosus were observed. An imperforated anus with rectovesical fistula, the right renal agenesis and the left renal dysplasia were observed. Absence of the uterus, oviducts and vagina suggesting the congenital absence of Mullerian duct were observed. Malformations of the upper extremities-right amelia, left ulnar agenesia, absence of left carpal bones with oligodactyly-were also observed.

Mucin Producing Carcinoid Tumor of Vermiform Appendix -A case of report-: Young Jin Park, Myung Hee Lee, Ho Jong Chun, Chung Hee Chi; Korean J Pathol. 1980;14(2):95-100.

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Abstract: Because of the presence of infiltrating group of signet ring cells in mucin producing tumor of vermiform appendix, this tumor has often been diagnosed and treated as adenocarcinoma. However, it was recently recognized that this tumor is histologically and biologically similar to a carcinoid tumor. In view of the clinically and morphologically benign course of this tumor, radical surgery beyond appendectomy is questioned. A case of unusual mucoid variant of carcinoid tumor of appendix in a 52 years old male is presented with review of the literature.

An Electron Microscopic Study of Peripheral Nerve Lesion of Lepromatous Leprosy: Gue Tae Chae, Jin Choe; Korean J Pathol. 1980;14(2):101-104.

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Abstract: As a factor of the pathogenesis of neural lesion in LL and the possibility of axonal spread of mycobacterium leprae were studied by means of nerve biopsies. Nerve biopsies were performed with radial cutaneous nerve in one patient and superficial peroneal nerve in the other. Both patients have had a relatively short period of morbid duration and treatment. The results were as follows : 1) The M. leprae bacilli were frequently observed in Schwann cells, macrophages, endothelial cells and perineurial cells. 2) Most of M. leprae were surrounded with electron dense membrane in the cytoplasm of these cells. The multiplication of M. Ieprae induced foamy degeneration of them. 3) Myelin break-down, axonal degeneration and marked fibrosis in nerve lesions were followed by Schwann cell infection. 4) Nerve lesions were conducted by the spread of bacilli via Schwannian passage and vascular dissmination. 5) Intra-axonal presence of the bacilli were not observed in these cases.

Listeriosis : Report of Three Cases and Review of the Infections in Korea: Hee Joo Lee, Yunsop Chong, Samuel Y. Lee, Il Saing Choe, Byung Soo Kim; Korean J Pathol. 1980;14(2):105-111.

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Abstract: Listeria monocytogenes infection, formerly considered a rather rare disease, had been reported increasingly. The infection occurs mostly in patients with underlying diseases, Such as tumor, diabetes mellitus, kidney transplantation and alcoholism, and also in patients with steroides and cytotoxic chemotherapy. In 1978 and 1979, 3 cases of infections of L. monocytogenes were bacteriologically diagnosed at Severance hospital, and the following observations were made. 1) The first patient was a 58-year-old male with malignant lymphoma, the 2nd a 66-year-old female with cervical cancer and the last a 46-year-old female with diabetes mellitus. 2) L. monocytogenes was isolated from blood specimens in all of the patients. From the 3rd patient a CSF specimen was also cultured and yielded the organism. 3) All of the isolates showed the typical cultural and biochemical characteristics of L. monocytogenes and were found to belong to serotype 1b. 4) All of the isolates were susceptible to ampicillin and tetracycline. Erythromycin and penicillin susceptibilities were variable depending on the isolates. Increasing incidence of listeriosis is expected in the future due to the ever increasing number of compromised hosts. It is thought necessary that both clinicians and laboratorians should be familiar with the bacterium and its infection to be able to make accurate diagnosis and to provide proper treatment.

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