Journal of Pathology and Translational Medicine

An Evaluation of Modified Method (one tube direct method) for the Determination of ALA-U and it's Hospital Normal Range: Sook Joe Hue, Young Hoe Moon; Korean J Pathol. 1982;16(4):655-659.

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Abstract: The method applied is a direct one tube micromethod that measures rapidly and reliably d-ALA in a urine sample of 100ul. And also shows good linearity between absorbance and added ALA over a wide range of concentration. The test was performed in 79 urine samples, randomly selected in this hospital. 1) The mean value of ALA-U in all the samples is 3.94±2.22(1.72～6.16 ㎎/L.) with variation in according to age group, ie. 4.5±2.8㎎/L. in the group under the age of 10, 4.1±2.2 ㎎/L. in 10～19yrs group and 3.28±1.36㎎/L. in the group of 20～39 years old. 2) The peak frequency of specimen allocated depend on the concentration of ALA-U is in range of 2～2.9 ㎎/L with 32.6%(29 cases). 3) The effect of reaction time(boiling time of reactant) to the recovery rate of ALA added to samples shows at Table 1. ie., the peak recovery rate(98%) found at 15-minutes reaction time. 4) A good linearity (relationship) between the ALA value and its absorbance is noted at Fig. III. ie., Absorbance 0.1 equivalent to 6㎎/L. of ALA concentration(Factor is 60).

Antimicrobial Susceptibility of Bacteria Isolated from Clinical Specimens in 1981: Dong Seok Jeon, Kyung Sun Kim, Jay Sik Kim, Jung Myung Kim; Korean J Pathol. 1982;16(4):660-667.

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Abstract: Susceptibility of 128 strains of bacteria isolated from clinical materials at Kyungpook National University Hospital in 1981 were determined by disc diffusion and plate dilution methods. A total of 128 isolates consisting of 49 Staphylococcus aureus, 29 Serratis marcescens and 50 Escherichia coli were tested. 19 strains of S. aureus were isolated from pus, and 20 strains of S. marcescens and 31 strains E, coli were isolated from urine specimens. Susceptible isolates of S. aureus by disc diffusion method and plate dilution method and plate dilution method were 95.9% and 87.8% to amikacin, 98.0% and 87.8% to cephalothin. 51.0% and 42.9% to chloramphenicol, 53.1% and 49.0% to gentamicin, 14.3% and 57.1% to penicillin G, and 20.4% and 20.4% to tetracycline respectively. Susceptible isolates of S. marcescens were 55.2% and 41.4% to amikacin, 37.9% and 27.6% to gentamicin, 31.0% and 13.4% to tobramycin, 3.4% and 0% to ampicillin, 24.1% and 0% to chloramphenicol. To cephalothin and to tetracycline all of the isolates showed resistance by both methods. Susceptible isolates of E. coli were 96.0% and 100% to amikacin, 87.0% and 78.0% to cephalothin 72.0% and 72.0% to tobramycin, 24.0% and 26.0% to ampicillin, 28.0% and 26.0% to chloramphenicol, 18.0% and 8.0% to tetracycline respectively. Comparison of the results of susceptibility by disc diffusion method and plate dilution method showed a tendency of slightly higher rate of susceptibility by the former method. Minimum inhibitory concentration of amikacin was 1～32㎍/㎖ against E. coli, but in other antibiotics remarkable difference was noted in minimum inhibitory concentrations. Some difference was noted in susceptibility of the same species depending on the source of isolation of organisms.

Comparison of Capillary Precipitation Method with Slide Agglutination Method in CRP Test: Jay Ryong Kim, Jay Sik Kim, Jung Myung Kim; Korean J Pathol. 1982;16(4):668-674.

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Abstract: An investigation to evaluate the CRP test was performed as well as ESR with 77 cases of patient sera and 17 cases of normal controlsera. In CRP test, the capillary precipitation and slide agglutination methods were used. The positivity rate of capillary method and slide agglutination method were 50.6% and 39.0% respectively and the former appears to be more sensitive than the later. In 17 normal control sera, the capillary method revealed one case(5.9%) as positive while all cases were negative by slide agglutination method. Using another two-fold dilutions of 2+ reactive sera, the slide agglutination method showed reactivity up-to 1 : 128 and the capillary method up-to 1 : 4. In tuberculosis and malignancy, the results from the slide agglutination, capillary precipitation and ESR methods paralleled each other but not in other various diseases.

Time and Temperature Effect on Samples for Blood Gas Analysis: Hea Ran Park, Jung Hee Um, Kyung Eun Cheong, Myong Joon Cho; Korean J Pathol. 1982;16(4):675-680.

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Abstract: The effect of temperature, time of storage for arterial blood gas analysis was studied. The results were: 1) Those samples kept at 25℃ for 2 hours showed decreased pH and increased PCO2(P<0.05), but no considerable clinical meanings are recognized. Those samples kept at 4℃ or 0℃ showed no significant changes in pH and PCO2. 2) A significant change, decreasing the PO2 values, during the period, storage, was found and the decreasing rate of PO2 was greater in group, initial value high, than it low one, and such changes could lead to a clinically considerable error, stored at 25℃, beyond 15 minutes. 3) The changes of pH, PCO2 and PO2 during the first one hour of the experimental period were higher than that of the latter one hour. The effect of time delay on blood gas analysis can causes significant errors, especially in PO2 values. The results of these experiments suggest that unless the arterial blood samples are analyzed immediately after experiments suggest that unless the arterial blood samples are analyzed immediately after shedding, prompt icing of samples are optimal to minimize possible error in laboratory results.

A Comparative Study in Routine Urine for Visual and Chemical Testing Compared with Microscopic Examination: Ock Hwa Kim, Ok Kyung Kim; Korean J Pathol. 1982;16(4):681-685.

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Abstract: The examination of urine is the most common screening laboratory procedure utilized for the early detection of renal or urinary tract disease in asymtomatic subjects. The authors studied 1755 routine urine specimens for visual and chemical testing and then compared the results of groups with or without microscopic examination. The results of this study are summarized as follows: 1) The most fregent positive finding in chemical testing is blood in urine with proteinuria, 79.9% of total. 2) Causes of the urinary turbidity under the microscope are due to pyuria, bacteriuria, and hematuria in order. 3) 3.97% of diagnostic yield is aquired when the urine sediment is examined under the microscope among negative groups for visual and chemical test of urines. In summary, routine microscopic examination of sediment results considerable low positivity among negative patients by routine visual and chemical test, and also the visual turbidity yield high positivity of microscopic examination.

Malignant Lymphomas in Ho-Nam Area: Kwang Min Lee, Dong Kyu Chung; Korean J Pathol. 1982;16(4):686-698.

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Abstract: A statistical analysis of Hodgkin's diseases and non-Hodgkin's lymphomas was carried out on the basis of histopathologic and clinical records of Presbyterian Medical Center during 17 years form 1964 to 1980. The total number of Hodgkin's diseases was 59 and that of non-Hodgkin's lymphomas was 282. 1) The ratio of non-Hodgkin's lymphoma to Hodgkin's disease was 4.8:1. And the ratio of diffuse non-Hodgkin's lymphoma to nodular non-Hodgkin's lymphoma was 11:1. 2) The most frequent subclass of Hodgkin's disease was mixed cellularity type(35.6%). The most frequent subclass of nodular non Hodgkin's lymphoma was poorly differentiated lymphcytic type(41.7%), and that of diffuse non-Hodgkin's lymphoma was mixed type(34.9%). 3) Over one half of Hodgkin's lymphomas were distributed in 4th, 5th and 7th decades. 4) The male to female ratio was 2.3:1. in Hodgkin's diseases and 2.2:1 in non-Hodgkin's lymphomas. 5) In Hodgkin's disease, the frequently involved organs were cervical lymph nodes(81.4%), axillary lymph nodes(40.7%) and inguinal lymph nodes(27.1%) in order. But in non-Hodgkin's lymphoma, those were cervical lymph nodes(75.5%), inguinal lymph nodes(33.7%) and axillary lymph nodes(27.7%). 6) Frequent chief complaints were palpable mass(86.4%) and gastrointestinal symptoms(20.0%) in Hodgkin's diseases, and palpable mass(78.0%), symptoms of ENT and eye(13.5%), gastrointestinal symptoms(12.1%) and pain(11.7%), in non-Hodgkin's lymphomas.

Experiences in U.K. National Q.C. Sheme for General Hematology: Hae Ran Moon, Kyou Sup Han, Myung Hee Lee, Myoung Hee Park, Han Ik Cho, Sang In Kim; Korean J Pathol. 1982;16(4):699-707.

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Abstract: Our hematology laboratory has taken a part in U.K. National Quality Control Scheme for general hematology since 1978. We have participated in 20 trials, 22 trials, 2 trials, 8 trials in years of 1978, 1979, 1980 and 1981, respectively for full blood count. The blood specimen 2 of 20 in 1978, 7 of 22 in 1979 and 3 of 8 in 1981 were partly hemolysed. The mean /R/ value of hemoglobin was below two, which could be classified into a good to satisfactory results. There was no significant difference between data obtained from both routine and stat laboratories. In platelet count, the automated methods provided a better results than the manual technique. The reticulocyted count and iron, TIBC, transferrin determinations and WBC differential count provided excellent to satisfactory /R/ value. The most common cause of deviated results was hemolysis of the specimens.

A Cell-Mediated Hypersensitivity Model of Gastric Ulcer in Rabbit: Woo Ho Kim, Yong Il Kim; Korean J Pathol. 1982;16(4):708-715.

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Abstract: An experimental model of gastric peptic ulcer by means of cell-mediated hypersensitivity induced with low dose gastric application of 2, 4-dinitrochlorobenzene(DNCB) in the previously sensitized New Zealand white rabbit is presented. Animals were divided into 4 groups; 2 non-sensitized animals with gastric application of DNCB(group I), 7 sensitized animals with gastric application of DNCB(group II and III), and 1 sensitized animal with colonic application of DNCB(group IV). In group I were only superficial and mild erosive changes of gastric mucosa, wherease in group II and III, 2 animals developed typical peptic ulcer in association with features of chronic gastritis and stereotypic area gastricae. The latter gastritic changes with early superficial peptic digestion were also demonstrable in the rests. No gastric mucosal changes were seen in group IV. It is assumed that type IV hypersensitivity reaction(Cell-mediated hypersensitivity) on gastric mucosa is responsible for the development of gastric ulcer and chronic gastritis, being useful as an experimental model of gastric ulcer. The applicability of this model to human stomach and reasons for the limited development of peptic ulcer were discussed.

The Diagnostic Value of Serum GGT Activity in Hepatobiliary Disease: Dong Seok Jeon, Kyung Sun Kim, Jay Silk Kim, Jyung Myung Kim; Korean J Pathol. 1982;16(4):716-723.

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Abstract: The diagnostic value of GGT was evaluated in patients with various hepatobiliary diseases. The sensitivity of serum GGT in suspected hepatobiliary diseases was 81.5%. ALP, AST, and ALT were elevated in 60.0%, 84.2% and 69.7% respectively. 69.7% in GGT, 46.7% in ALP, 69.8% in AST, and 66.0% in ALT were above twice of normal range. Each one case of acute hepatitis and cirrhosis showed only GGT elevation without elevations of other three enzymes. The number of cases with only AST or ALT elevation was one in each, but there was no case with ALP elevation alone. The mean values of normal control and hepatobiliary disease group were 21.2 U/L and 198.8 U/L. The highest level of serum GGT was found in fatty liver with a mean of 376.0 U/L, and in alcoholism with 188.0 U/L. The mean values of GGT in acute and chronic hepatitis, cirrhosis, obstructive jaudnice and metastatic carcinoma were 149.2, 140.4, 132.8, 160.4 and 134.5 U/L respectively. The values of above 5 groups were uncontributory in distinguishing between different types of hepatobiliary disease. The mean value of GGT was compared with other enzymes. GGT was markedly elevated in hepatoma, metastatic carcinoma, fatty liver, and alcoholism and was frequently elevated in chronic hepatitis, hepatoma, fatty liver, and alcoholism. In cirrhosis and hepatoma GGT was significantly correlated with AST but with ALP and ALT.

Proteinuria : Comparison of Dipstick Assays and Sulfosalicylic Acid Method: Kyung Eun Cheong, Hae Ran Park, Jung Hee Um, Myong Joon Cho; Korean J Pathol. 1982;16(4):724-729.

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Abstract: We studied and compared results of three types of urine dipsticks and the sulfosalicylic acid method using samples supplemented with various proteins. Dipsticks yield accurate results when the protein under consideration is stricted to albumin: the sulfosaliylic acid method responds to the total amount of urine protein. The sensitivities of the three types of dipsticks toward albumin are similar and are very close to the values indicated by the manufactures. The changes of urinary pH affect each of methods, but changes in slat concentration only affect results by dipstick assays. Addition of preservatives to urine samples were produced erroneous results both dipstick assays and sulfosalicylic acid method, but the refrigerated urine samples were not affected by each methods.

Antibiotic Susceptibility of Gram-negative Bacilli Isolated from Clinical Materials in 1981: Jae Ryong Kim, Kyung Sun Kim, Jay Sik Kim, Jyung Myung Kim; Korean J Pathol. 1982;16(4):730-740.

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Abstract: The authors performed the antibiotic susceptibility test against randomly selected 13 gram negative bacilli isolated from various specimens at clinical pathology laboratory. Fifty strains of K. pneumoniae, thirty strains of P. aeruginosa and twenty-five strains of Salmonella group A and Shigella subgroup B in each, totally 130 strains were tested. Sixty percent of K. pneumoniae, were isolated from urine, forty-three point three percent of P. aeruginosa were from pus, fifty six percent of Salmonella group A were from blood and one hundred percent of Shigella subgroup B were from stool. By disc diffusion method, the K. pneumoniae and P. aeruginosa were sensitive to Amikacin(AMK), the Salmonella group A were sensitive to the Amikacin(AMK), Ampkicillin(AMP), Cephalothin(CEP), Chloramphenicol(CAM), Gentamicin(GAM) and Tobramycin(TOB), the Shigella subgroup B were sensitive to Amikacin(AMK), Cephalothin(CEP), Gentamicin(GAM) and Tobramycin(TOB). By agar dilution method, the K. pneumoniae and P. Salmonella group A were sensitive to Amikacin(AMK), Ampicillin(AMP), Cephalothin(CEP), Gentamicin(GAM) and Tobramycin(TOB) and the Shigella subgroup were sensitive to Amikacin(AMK), Gentamicin(GAM) and Tobramycin(TOB). By agar dilution method, the most of cases of antibiotic susceptibility to pathogens except some Salmonella group A and Shigella subgroup B show tendency of wide range of MIC from 1.0㎍/㎖ to over 256㎍/㎖. On comparison of numbers of sensitive species strains by disc diffusion and agar dilution methods, most of the antibiotics except Tetracycline(TET) show relative linearity in sensitivity but in general, the disc diffusion appeared to be showing more numbers of sensitive strains than the agar dilution methods. On correlation of sensitivity between isolated bacteria from various specimen and antibiotics, the strains of K. pneumoniae isolated from urine showed a tendency of resitancy to Ampickllin(AMP), Chloramphenicol(CAM) and Tetracycline(TET), the strains of P. aeruginosa isolated from pus and ear discharge showed a tendency of sensitivity to Ampikacin(AMK), the most strains of Salmonella group A and Shigella subgroup B isolated from various clinical materials were sensitive to all antibiotics except Tetracycline(TET) in Salmonella group A and Amplicillin(AMP), Chloramphenical(CAM) and Tetracycline(TET) in Shigella subgroup B.

A Light and Electron Microscopic Study on Effect of Korean Blended Alcohol upon the Small Intestines: Chan Kum Park, Kook Hwae Koo; Korean J Pathol. 1982;16(4):741-744.

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Abstract: With an increase of alcohol consumption, the occurrence of corresponding alimentary disorder has been steadily increased. Some investigators reported that alcohol is a calorie substitute predisposing malnutrition, while others have described alcohol as a gastroenteric toxin. Thus, the pathogenesis of alcoholic alimentary tract injury has not been settled yet. This study was conducted anatopathologically to evaluate the effect of alcohol upon the jejunum. Sixty healthy Spraque-Dawley rats weighing about 200gm were used for this experiment and divided into the following two groups. 1) Control group fed basic diet for 20 days. 2) Alcohol administered group given 40% of alcohol for 20 days. The basic diet was nutritionally composed of adequate solid diet, and each rat was administered orally 20～25gm of basic diet per day. Control group was administered basic diet with 20㎖ of normal saline. Alcohol administered group was given orally 20㎖ of alcohol instead of normal saline in addition to basic diet. The results obtained from this experiment were as follows; Light microscopically, jejunal villi were mildy atrophied in alcohol administered group. Electron microscopic study revealed a number of ultrastructural alterations such as mitochondrial abnormalities, vesiculation of Golgi apparatus, and increased fuzzy material above the micro villi. Disruption of Cristae, formation of clear spaces and myelin figures or increased cytoplasmic lipid droplets were also observed in the jejunal villi.

The Distrubution of Histochemical Fiber Types in the Extensor Digitorum Longus Muscles of the Rat: Chang Soo Park, Soon Pal Suh, Joo Yong Yoo; Korean J Pathol. 1982;16(4):745-752.

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Abstract: This study was designed to investigate regional histochemical fiber composition of the rat skeletal muscle. The stains for sections of the Extensor Digitorum Longus muscle are H&E, trichrome, PAS, SDH and myosin-ATPase. Regional proportions of the fiber types were classified along the superficial to deep and medial to lateral axis. The results obtained are as follows. 1) Distribution of three fiber types(S, I and W fibers) classified by periodic acid Schiff reaction showed little or no difference. 2) Extensor Digitorum Longus muscle was composed of three fiber types (Type I, IIA and IIB fibers) which can be differentiated by staining for myosin-ATPase and SDH. Type IIA fibers were increased in the deep and medial area. Type IIB and I fibers were abundant in the superficial and lateral area.

A Histological Analysis of the Polyps in a Familial Juvenile Colonic Polyposis: Kwang Min Lee, Soon Pal Suh*, Chang Soo Park*, Sang Woo Juhng*, Joo Yong Yoo*; Korean J Pathol. 1982;16(4):753-762.

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Abstract: A histopathologic analysis of the 294 polyps in a proctocolectomy specimen from a 21-year-old male patient was performed. Evaluating the locations, sizes, growth patterns and neoplastic changes of the polyps, the following results were obtained. 1) Of the total 294 polyps, 79(26.9%) were hyperplastic ones and 215(73.1%) were juvenile ones. The juvenile polyps were mixed focally with hyperplastic component, adenomatous component, or villous component. The polyps mixed with neoplastic components(adenomatous or villous component) were 28 of 215 juvenile polyps. 2) The most of polyps(206;70.1%) were crowded in the rectosigmoid region, but a considerable number of polyps(44;15.0%) were identified in the cecum. Others were scattered in the ascending colon(25;8.5%), descending colon(12;4.1), and the transverse colon(7;2.4%). 3) The average size of the juvenile polyps was larger than that of hyperplastic ones. The neoplastic changes in the juvenile polyps were seen more frequently in the larger polyps and in the pedunculated and multilobulated ones. 4) In consideration of the neoplastic changes, the juvenile polyps were regarded as preneoplastic lesions which could evolve adenomatous or villous polyps.

Acute Myeloid Leukemia in Twin -Case report-: Hye Soo Lee, Ho Yeul Choi, Sook Ja Park*; Korean J Pathol. 1982;16(4):763-768.

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Abstract: The mechanism of leukemogenesis in man is unknown, but inciting agents as well established. The strongest evidence for a genetic predisposition to acute leukemia is the occurrence of disease in paris of identical twin. The authors report the cases of acute myeloid leukemia in a pair of male twin, the first at 21-month-old and the second at 23-month-old, with the review of the literatures.

Segmental Renal Dysplasia -Two cases report-: Young Chun Moon, Doo Hwa Yoon, Moon Hyang Park, Hyo Sook Park; Korean J Pathol. 1982;16(4):769-775.

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Abstract: Two 11 year and 14 year old girls presented with urinary incontinence form birth. In the former, IVP and renogram revealed adult thumb tip sized left kidney located at L2～3 level. Cystoscopically ureteral olifice of left side was not identified and ureteral orifice like fold was observed at 12 o'clock direction by vaginoscopy. The latter, right kidney was not visualized in IVP. After nephrectomized incontinence was disappeared and they discharged without any complication. The removed kidneys weighed 3.8g and 2.7gm respectively, and pathologic diagnosis of both was segmental dysplsia. A brief review of literature is added.

Inflammatory Fibrous Histiocytoma in Mediastinum -Report of a Case with Special Emphasis on the Chemotactic Effect of Tumor Tissue upon Circulating Leukocytes-: Chul Woo Kim, Yong Il Kim, Hyun Soon Lee; Korean J Pathol. 1982;16(4):776-781.

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Abstract: Inflammatory fibrous histiocytoma, known as an unusual variant of malignant fibrous histiocytoma, is characterized by diffuse and at times intense neutrophlic infiltration unassociated with tissue necrosis in the background of bidirectional proliferation of neoplastic histiocytes, morphologically. This report presents a case of inflammatory fibrous histiocytoma, arising in the posterior mediastinum of 45-year-old female patient. Preoperative leukocytosis aside from diffuse neutrophilic infiltration within the non-necrotic tumor tissue has been corrected after operation, but develops again with recurrence of metastatic lesion. The possible suggestions about the chemotactic effect of this neoplasm upon blood leukocytes of the host are discussed.

A Clinical Study on 5 Cases of Erythroleukemia: Kun Ju Hahm, Wha Soon Chung, Choon Woon Kim, Seung Hahm Park, Ki Hong Kim; Korean J Pathol. 1982;16(4):782-789.

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Abstract: Discussion of a curious disease of the blood was begun by Copelli in 1912 and continued by di Guglielmo. Dameshek and Gunz called it the "di Guglielmo syndrome" and defined it as a "myeloproliferative disorder". This syndrome is a condition characterized principally by neoplastic proliferation of the cells of the erythroid series, which is frequently, if not invariable, associated with leukemic proliferation of the cells of the granulocytic series. Many studies and clinical observations had been reported in the western and Korean(38 cases) literature. About 10 cases of the 38 cases are complete regarded to develop a final stage of acute leukemia. This report describes 5 cases of di Guglielmo's syndrome.

Pheochromocytoma: Jung Hi Kim, Eun Sook Chang; Korean J Pathol. 1982;16(4):790-795.

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Abstract: Pheochromocytoma is a catecholamine-producing tumor which may arise at the same locations in the body where chromaffin tissue has been found to occur. This potentially lethal neoplasm originates in approximately 60% in the adrenal medulla and less frequently 10% are malignant. Pheochromocytoma continues to evoke interest because clinically it is capable of mimiking a variety of syndromes or remaining silent. The clinical manifestations are those which result from the release of catecholamines secreted by the tumor. Epinephrine and norepinephrine are both usually present in adrenal medullary tumors and norepinephrine alone more commonly is secreted by extra-adrenal tumors. Since norepinephrine is a relatively pure alpha adrenergic stimulator and epinephrine has both strong alpha and strong beta adrenergic stimulant effects, clinical manifestations range from hypertension alone to various combinations of tachyarrythmias and hypermetabolism syndromes associated with hypertension. The diagnosis of pheochromocytoma can be confirmed by demonstrating increases in catecholamine or their metabolites. The three most common determinations used for diagnosis are urinary VMA, metanephrine and catecholamines. Radiologic tests included roentgenograms of chest and abdomens, intravenous pyelography, nephrotomogram, arteriography and CT are helpful in diagnosis. Recently scintigrams using a new radiopharmaceutical agent, [131I] metaiodobenzylguanidine([131I] MIBG) is appealing because they not only locate the anatomic position of the disease but also shed light on the nature of the disturbance by providing evidence of function, this procedures are safe. The treatment of pheochromocytoma is only surgical excision. The surgical mortality is approximately 2.9% and 5 years survival subsequent to treatment of the benign tumors was 96%. The purpose of this paper is to report two cases of pheochromocytoma with characteristic clinical manifestations and teated at Presbyterian Medical Center, Taegu during last tow years and review briefly the literatures.

A 46, XY True Hermaphrodite with Endodermal Sinus Tumor -Report of a Case with Cytogenetic Study-: Min Cheol Lee, Joo Yong Yoo, Kyu Hyuk Cho; Korean J Pathol. 1982;16(4):796-803.

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Abstract: Various types of gonadal neoplasia are encountered with unusual frequency in several forms of congenitally abnormal gonads associated with somatosexual maldevelopment. But the incidence of such an association is probably greater than it would seem to be from a review of the available metrical literature. This discrepancy is probably due to followings : 1) In some patients, the genital anomaly was obvious, but the "hidden" neoplasm was missed because physical examination, surgery, or autopsy was not performed. 2) In other patients, though a gonadal neoplasm was found, the sexual ambiguity was overlooked. 3) In still other instances, a gonadal tut was encountered in individuals whose external genitals were consistent with the attributed sex but whose genetic sex may have been contrary Nowadays, a simply method chromosomal analysis enhanced our understanding of this biological phenomenon helped to explain the various morphological aberrations seen in them. 4) Finally, there mayhave been a number of recognized intersexes with gonadal neoplasms who were not reported, because of the bizarre and poorly understood pathological findings. True hermaphroditism is the most uncommon varient of intersexuality in the human being and associated with malignant germ cell tumors of gonads are very rare. Most of them are dysgerminoma, gonadoblastoma and only few cases are endodermal sinus tumor. We describe in this paper an unusual case of true hermaphrodite with 46, XY chromosomal pattern and in whom, on exploration, we defected a huge gonadal mass on right side and an ovotestis on left side.

Hereditary Elliptocytosis with Multiple Myeloma -Report of a case-: In Suck Song, Man Su Song, Jong Woo Park; Korean J Pathol. 1982;16(4):804-808.

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Abstract: Hereditary elliptocytosis with multiple myeloma is very rare in orientals and transmitted as an autosomal dominant trait, and although usually benign, occasionally results in severe hemolytic anemia. The incidence in white populations approaches 0.05%, and it is most frequent in Europeans. A case of hereditary elliptocytosis with multiple myeloma in a 60 years old female was presented. She had mild anemia with anisocytosis due to marked elliptocytosis and normal white blood cell count and platelet in peripheral blood. Hepatosplenomegaly was not noted. Bone marrow revealed massive proliferation of immature plasma cells. The purpose of this paper is to record the first reported case of hereditary elliptocytosis with myeloma in a Korean family.

Insulin Secreting Pancreatic Islet Cell Carcinoma: Histologic, Histochemical and Electron Microscopic Evaluation -Report of a case-: Chang Suck Kang, Sang In Shim, Sun Mo Kimo, Chong Moo Lee; Korean J Pathol. 1982;16(4):809-813.

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Abstract: Histochemical, light and electron microscopic studies of an insulin secreting islet cell carcinoma are presented. A 28-year-old female patient complained of a loss of consciousness, especially at the fasting time, with hypoglycemia below 45 ㎎%. The symptom was relieved after meals. Celiac angiography revealed abnormal proliferation of tumor vessels between the body and tail portion of the pancreas. An operation was performed under he diagnosis of functioning B cell tumor of the pancreatic islet. A histological examination of hematoxylin-eosin stained sections of the surgical specimen revealed gyriform pattern or diffuse growth pattern of the tumor cells with vascular and perineural invasion. Histochemical studies including aldehyde fuchsin, phosphotungstic acid hamatoxylin stain and modified Scott's stain revealed positive reaction with the reagents that recognized normal B cells of the Langerhans islet. An electron microscopic study revealed that this tumor consisted mainly of cells with a few, immature beta granules. Numerous dense granules resembling lysosomes were found in the majority of the cells. Extensive interdigitations of the cell membrane formed the intercellular spaces. She is relatively well without hypoglycemia for 1 year after the operation.

A Case of Acute Monocytic Leukemia with Prominent Erythroleukophagocytosis: Kyou Sup Han, Jung Soon Goo, Hyun Chan Cho, Dae Won Kim, Jin Q Kim, Myoung Hee Park, Han Ik Cho, Sang In Kim; Korean J Pathol. 1982;16(4):814-818.

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Abstract: A case of acute leukemia with prominent erythroleukophagocytosis in a 7-year-old boy is reported. The case was confirmed as acute monocytic leukemia by cytochemical tests including alpha-naphthyl acetate esterase with and without NaF inhibition, immunological marker studies and hemopoietic stem cell culture. Approximately one per cent of leukemic blast forms showed an erythroleukophagocytosis.

Nephrogenic Adenoma -A case report-: Dong Hwan Shin, Woo Ick Yang, Tae Seung Kim, Yoo Bock Lee, Yong Soo Lho*, Seung Choul Yang*, Jin Moo Lee*; Korean J Pathol. 1982;16(4):819-822.

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Abstract: Nephrogenic adenoma is a papillary or polypoid bladder lesion of uncertain pathogenesis, which may easily be mistaken for carcinoma of the bladder on cystocsopy. Microscopically, it consists of numerous epithelial tubules lined by simple cuboidal epithelium, some of which usually shows cystic change containing proteinaceous material in the lamina propria. It is widely accepted that nephrogenic adenoma may be metaplastic process of urothelium rather than true neoplastic process as shown by usual concurrence with chronic inflammatory condition. We have experienced a case of nephrogenic adenoma of urinary bladder in a 24 year old man suffering from pulmonary and renal tuberculosis. The natural history, pathogenesis and managements of patients with nephrogenic adenoma are discussed.

Desmoplastic Fibroma of Femur -A case report-: Yong Wook Park, Kye Sook Lee, Sung Ho Lee, Jae Hyung Yoo*, Kye Yong Song*, Geung Hwan Ahn**; Korean J Pathol. 1982;16(4):823-826.

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Abstract: Desmoplastic fibroma of bone is rare benign tumor of fibrous tissue origin, resembling desmoid tumor in soft tissue histologically. Jaffe (1958) first named and reported the desmoplastic fibroma in bone. Authors experienced a case of desmoplastic fibroma in proximal shaft of femur. A desmoplastic fibroma occurred in rib was first reported by Ahn et al, therefore, this case was to be the second case in Korea. A 42 years o1d woman was admitted to the Department of Orthopedic Surgery in Han Gang Sung Sim Hospital complaining the painful swelling of right thigh after slipping down at mountain. She noted a painful swelling of right thigh without limitation of motion one year ago. C.B.C and blood chemistry were all within normal limits except slightly increased alkaline phosphatase(6.0 B.U.). Urinalysis was within normal limits. Roentgenography of right femur revealed fracture in the proximal shaft with osteolytic and trabecular appearance of soft tissue tumor around the fracture site. Popliteal angiogram revealed slight increase of vascularity in tumor masts. Bone scanning with Tc99m revealed increased uptake in tumor mass. Operative finding revealed bone fracture and large grayish white firm tumor mass in proximal shaft of femur beneath the Vastus lateralis. The submitted specimen consisted of a hip disarticulated lower extremity showing large eccentrically located grayish white firm tumor mass in proximal shaft of femur, measuring 10×9.5×4㎝. in maximum dimension. Cut surface exhibited homogenously grayish white and fibrous appearance. Neither hemorrhage nor necrosis was noted. Microscopically the tumor was moderately cellular, composed of interfasciculating spindle shaped fibrous tissue with rather uniform nuclei, separates by collagenous stroma of varying amount and slit like vascular channels. Mitotic figure was not noted. Neither osteoid nor chondroid matrix was seen even in multiple section.

Epithelial Retention Cyst of the Adrenal Gland -Report of a case-: Chang Suck Kang, Byung Kee Kim, Sang In Shim, Sun Moo Kim; Korean J Pathol. 1982;16(4):826-831.

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Abstract: Because adrenal casts are rare condition, they are often misinterpreted and misdiagonosed. Here we report one case of epithelial retention cyst of the adrenal gland. This 63-year-old male patient was admitted due to abdominal distension and retroperitoneal huge cystic mass for 2 months. Gross examination revealed a huge unilocular cyst, measuring 18×16×12 cm in dimension. Within the wall, compresses adrenal gland was noted. Histologically, fibrous wall surrounded the adrenal parenchyme and cuboidal to low columnar cells lined the inner surface of the cyst. On the oasis of these findings, a diagnosis of adrenal cyst, epithelial retention cyst, was made. We reviewed literature of the adrenal cyst and discussed on the incidence, classification, pathogenesis, and pathologic findings.

Hepatoblastoma: Gang Young Lee, Wha Soon Chung, Choon Won Kim, Seung Hahm Park, Ki Hong Kim; Korean J Pathol. 1982;16(4):832-835.

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Abstract: Hepatoblastoma is the most common primary malignant hepatic tumor except leukemia in infant and childhood. Some degree of confusion still exist because of the considerable variation in histologic structure and complexity. Recently, we experienced a case of hepatoblastoma in a seven wonts old female patient with chief complaints of palpable mass on abdomen and night sweating for 3 days. Positive findings are reveled as follows : a) Hemoglobin 6.9㎎/dl, T-bilirubin 4.5㎎/dl, LDH 720 μ/㎖ b) Alpha-fetoprotein 400 ng/㎖(↑) c) Simple abdomen: mass crossing midline in upper abdomen I.V.P. : Large Mass in upper abdomen and enlarged liver d) Ultrasono : Semisolid marts in liver parenchyme So left hepatectomy was done. Grossly, the tumor is rather firm, lobulated and well circumscribed measuring 11×10×7㎝ in dimension and 520 gm in weight. Cut surface stows pale grayish in color with areas of multifocal hemorrhagic areas. Microscopically, the tumor composed of m mainly solid cord of dark stained hepatocytes, pale stained cells, osteiod components and intermingled with extramedullary hematopoiesis. So was diagnosed as mixed type of hepatoblastoma according to Ishak and Glunz classification. Brief review of literature to this case was done.

Intrarenal Teratoma -Report of a Case Occurring in an Infant-: Chan Il Park, Nai In Lim, Yoo Bock Lee; Korean J Pathol. 1982;16(4):836-840.

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Abstract: 영유아기에 발생한 신장 기형종은 Wilms씨 종야과의 임상적감별이 대단히 어려울 뿐아니라 발생빈도가 매우 드물기 때문에 영유아기 신장종양의 대부분을 차지하는 Wilms씨 종양으로 간주하기 쉽다. 본 증례는 3개월된 여아에서 방사선과적소견과 수술시의 임상적 진단이 Wilms씨 종양으로 조직학적 확진 이전에 actinomycin D 화학요법이 시작되었던 신장기형종의 1례이다. 발생빈도는 드물지만 영유아기에 신장의 종괴가 발견되면 반드시 동결절편을 시행하여 신장기형종을 비롯한 양성종양의 가능성을 배제하여야 할 것이다.

A Case of Carotid Body Paraganglioma: Kun Ju Hahm, Wha Soon Chung, Choon Won Kim, Seung Hahm Park, Ki Hong Kim; Korean J Pathol. 1982;16(4):841-844.

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Abstract: A case of carotid body paraganglioma in toe left cervical region of 33-year-old woman is reported with review of the literatures. Clinically, she complained of a palpable neck mass and otherwise is within normal limits. Crossly, child fist sifted sass located around the bifurcation of the common carotid artery and become closely adherent to it. Microscopic appearance shows well defined nests of cuboidal cells which separated by fibrous septa and sinusoids. The individual cells have a abundant cytoplasm and vesicular nucleus. Reticulin stein reveals that nests of tumor cells are encircled by reticulin fibers.

Lipid Rich Carcinoma of the Breasts -Report of a case and review of literature -: Won Hee Choi, Yoo Bock Lee; Korean J Pathol. 1982;16(4):845-847.

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Abstract: Lipid rich carcinoma is a rare subtype recently separated from the usual types of breast carcinoma by its morphologic characteristics and rather poor prognosis than the letters. We have experienced a case of lipid rich carcinoma in a 46 year old woman who had a slowly growing palpable mass in her right breast without nipple retraction. Grossly, the tumor was 3cm in diameter and poorly demarcated. The cut surfaces were uniformly firm but not as hard, and grayish white colored. Microscopically, the mass consisted of sheens and strands of malignant cells, having infiltrative borders throughout a fibrous matrix. The tumor cells were large and had faintly eosinophilic cytoplasms which were somewhat bubbly or vacuolated. The nuclei were fairly regular, although in some areas thor were pleomorphic and hyperchromatic. Large amount of lipid wag demonstrated within the cytoplasm by oil red-O stain applied to frozen sections. It is interest that both the peripheral portion of the breast mass and the metastatic lesion of the axillary node contained areas of typical infiltrating ductal cell carcinoma.

Light and Electron Microscopic Observation of an Extraskeletal Ewing's Sarcoma: Sam Im Choi, Kang Hyuk Yoon; Korean J Pathol. 1982;16(4):848-851.

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Abstract: A soft tissue tumor of a 17-year-old Korean girl was observed light and electron microscopically, which revealed the featured compatible with extraskeletal Ewing's sarcoma. The identity to Ewing's sarcoma of osseous origin was extended to the ultrastructural level. The tumor was composed of two types of cells, namely, principal cells and secondary cells. Although multiple sections of the tumor were examined, there was no definite evidence to indicate the cell of origin on the ultrastructural study.

Two Cases of Clear Cell Sarcoma of Tendons and Aponeuroses: Young Chae Chu, In Sun Kim, Seung Yong Paik; Korean J Pathol. 1982;16(4):852-855.

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Abstract: Malignant tumors arising from tendons are rare. Among those reported most knave been interpreted as synovial sarcoma or fibrosarcoma until Enzinger in 1965 described a new type which he called "Clear cell sarcoma of tendons and aponeuroses. Enzinger used the term as a descriptive term for a clinicopathologic entity to reflect the uncertainty of histogensis. Thereafter the tumor histogenesis was confirmed by electron microscopy as synovial and mela no cytic origin. Moat of the tumor were located in the lower extremities, the feet being the most common site. The tumor rarely causes pain and exceptionally long preoperative duration of symptoms but relentless progression with frequent local recurrence and eventually-metastases to regional lymph notre and lung. This tumor is roughly spherical, firm, usually well-defined and consists of compact nest and fascicles of pale-staining round or fusiform cells of epithelioid appearance. The cellular aggregates are enclosed or delicate fibrous septa emerging with tendinous or aponeurotic tissue. We experienced two cased of clear cell sarcoma of tendons and aponeuroses of foot in a 50-year-old woman and knee in a 37-year-old man. Those cases are presented because of their rarity. Histopathologic findings and a brief review of the literature were done.

Pancreatoblastoma -A case report with electron microscopic examination-: Woo Hee Jung, Chan Il Park, In Joon Choi; Korean J Pathol. 1982;16(4):856-859.

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Abstract: A ease of infantile carcinoma of the head of pancreas specifically diagnosed as pancreatoblastoma was presented in a 4-year-old Korean boy. A well encapsulates intra-abdominal mass was found which was attached to the ventral aspect of the pancreatic head, covered by the lesser omentum anteriorly, and was predominantly cystic. Histologic examination revealed that the tumor was made up largely of cuboidal to low columnar epithelial cello arranged in acinar or tubular structures and solid sheets, and of a few islands of squamoid cells with elongated nuclei arranged in a parallel fasciculating pattern (squamoid corpuscles). Ultrastructural examination of the acinar or tubular strictures stowed microvilli on the luminal surface, well developed granular endoplasmic reticulum, and electron dense zymogen-like granules especially at the apical portion of the cytoplasm. The tumor cells of squamoid corpuscles had tonofilaments and few zymogen-like granules. These findings strongly support the view that pancreatoblastoma arises from cells which might ultimately differentiate into exocrine acinar cells of the pancreas.

A Korean Family Showing Weak B Blood Group in Two Generation: Won Bae Kim, Dong Wha Lee, Duk Yong Kang; Korean J Pathol. 1982;16(4):860-864.

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Abstract: The propositus was 25 year old primigravida who was admitted to this hospital in March, 1982 for full term delivery. In routine blood typing, her cells were herr weakly agglutinated by anti-B serum, whereas revealed strong reaction by anti-A, anti-AB, and anti-H serum. Her serum didn't react with A,B, and 0 cells. Under the impression of A weak B, adsorption and elution studies of the cells, and neutralization studs of saliva and serum were performed. As a result, her blood type was proven to be A weak B and classified into second category of Race and Sanger, that is "no anti-B in serum(or very weak cold anti-B) : B in saliva" Her father and an elder roister were proven to have weak B in the family studs. (weak B in the father and A weak B in an elder sister).

Primary Splenic Lymphoma -A case report-: Byung Doo Lee, Je G. Chi, Sang Kook Lee, Jin Pok Kim*; Korean J Pathol. 1982;16(4):865-869.

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Abstract: Primary malignant lymphoma of the spleen is uncommon neoplasm, approximately 100 substantiated cases having been reported in the literature. We report one case of primary malignant lymphoma of the spleen in a 45-Fear-old man, who was presented with pain in the left upper abdomen together with weight loss and hepatosplenomegaly. Laboratory findings revealed no specific abnormalities. Abdominal computed tomography revealed a huge splenic mass. A splenectomy was done. Removed spleen weighed 1,045 gm and 18 ㎝ in maximum cross. Cut sections showed a large solitary mass replacing almost entire spleen. Multiple irregular areas of necrosis were present. Light microscopic feature was compatible with primary malignant lymphoma of histiocytic type(Rappaport), and large non-cleaved(Lukes-Collins). Electron microscopic findings revealed plump cytoplasm, smooth and regular nuclear margin, heterochromatin aggregates along the nuclear membrane, and prominent nucleoli. There was no evidence of lysosome, phagosomes or erythrophagocytosis. These features were thought to be compatible with B-cell lymphoma.

Cutaneous Leishmaniasis -Report of three cases-: Jae Rhan Hyun, Woon Sup Han, Ok Kyung Kim; Korean J Pathol. 1982;16(4):870-874.

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Abstract: Cutaneous leishmaniasis is one of the tropical diseases in endemic areas of Middle East, Africa, Central Asia, and the Mediterranean. This disease is not naturally acquired in Korea. But according to the increased korean workers and travellers to the Middle East, a few crises of this disease have been encountered and reported in our cuntry. We have experienced three cases of cutaneous leishmaniasis who had been in Saudi arabia as workers in our hospital. A brief review of literature was done.

Glycogenosis -Report of a case-: Won Hee Choi, Tai Jung Kwon, Chan Il Park, Yoo Bock Lee, Myung Jin Kim*, Ki Sup Chung*; Korean J Pathol. 1982;16(4):875-877.

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Abstract: With knowledge of the clinical presentation, the response of blood sugar level to intravenous injection of glucagon or epinephrine, and the light and electron microscopic findings of liver and skeletal muscle, a presumptive diagnosis can be made in most of the glycogenosis. We have experienced a case of type I glycogenosis in a 13-year-old male patient, who presented severe hepatosplenomegly, hypoglycemia, hyperlipidemia and hyperuricemia without any skeletal abnormalities. The hypoglycemia after 24 hour-fasting failed to respond to glucagon or epinephrine tests. The liver cells were swollen apparently due to accumulation of large amount of glycogen which was confirmed by PAS, diastase-PAS and Best's carmine stains, and fatty metamorphosis. Nuclear glycogenation was present in periportal hepatocytes. Portal or septal fibrosis wart not noted. The electron microscopy of the liver clearly demonstrated uniform increase of normal glycogen particles with displacement of other intracellular organelles, numerous lipid droplets and nuclear glycogenation. With these findings one can make a presumptive diagnosis of type I glycogenosis until ultimate chemical proof of glucose-6-phosphatase deficit.

Congenital Hepatic Fibrosis -A case report-: In Sook Lim, Hwan Shik Chang*, Hye Jae Cho, In Ki Paik, Hyuk Sang Lee*, Il Hyang Ko; Korean J Pathol. 1982;16(4):878-883.

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Abstract: Congenital hepatic fibrosis is an unusual congenital disorder of the liver, manifestating a heredofamilial tendency and presenting within the first two decades of life. Congenital hepatic fibrosis is characterized by a generalized portal and interlobular fibrosis of the liver accompanied by bile duct hyperplsia. The intrahepatic portal involvement results in presinusoidal block with signs of portal hypertension and bleeding from esophageal varices. Although the lobular architecture of the liter may appear distorter, the hepatocytes are not affected. Liver function is normal, except in cases in which superimposed liver pathology may causes minor functional abnormalities. In some autosomal recessive manner and it was particularly in these cases that they found evidence of polycystic disease of the kidney. In a study of the pyelographic findings Kerr et al. drew attention to the similarities to medullary sponge kidney. Death has occured in 50 percent of the patients, mainly from uremia or massive variceal bleeding. The survivors have no or minor symptoms. The patients with portal hypertension due to congenital hepatic fibrosis are ideal candidates for portosystemic stunt. We have recently experienced a case of congenital hepatic fibrosis in 14 year old Korean male child. The patient's chief complaint was repeated hematemesis from esophageal varicies in recent years. There are marked hepato-splenomegaly and mild anemia but routine CBC and liver function test were within normal limits. Hassab precedure (castro-esophageal decongestion with splenectomy) and liver wedge biopsy were performed. The spleen weighed 720 ems and showed marked congestion of red pulp. The liver was extremely firm and enlasged. The microscopic findings are characterized by wide and generalized portal and interlobular fibrosis with bile duct hyperplasia, but no evidence of previousliver cell necrosis was observed. The patient was discharged in improved condition and has no recurrent hematemesis.

Juvenile Polyps -A study on the pathogenesis of juvenile polyps and their relationship to colonic adenoma-: Hye Yeon Kim, In Sun Kim, Seung Yong Paik; Korean J Pathol. 1982;16(4):884-889.

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Abstract: Juvenile polyps are relatively common lesions in the gastrointestinal tract as a solitary lesion. The exact nature of juvenile polyps is unclear, but many authors regard these as inflammatory lesions or as hamartomas which become secondarily inflamed. Multiple juvenile polyposis is characterized by a large numbers of these lesions. Although juvenile polyps are not usually considered to be premalignant lesions, recently the neoplastic potential of multiple juvenile polyposis has been emphasized. Two cases of multiple polyposis which have foci of both adenomatous and juvenile features with associated carcinoma are described. Special review about the pathogenesis of juvenile polyposis and their relationship to colonic adenoma and adenocarcinoma will be done.

Ultrastrucrural Changes of Hepatocytes in Reye Syndrome -A Case Report-: Yong Jin Kim, Tae Jung Sohn; Korean J Pathol. 1982;16(4):890-894.

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Abstract: Authors investigated hepatocellular changes in a case of autopsy, 11-month-old female child, dying of Reye syndrome. Light imcroscopically, microvesicular fatty change of the liver was a characteristic finding. The hepatocytes were packed with small fatty droplets without nuclear form and demonstrated by using lipid stains on frozen sections. There was no cholestasis. The portal tracts had mild lymphocytes infiltration. Electron microscopically, mitochondria showed conspicuous abnormalities with reduction in number, pleomorphism, swelling and loss of cristae. Vacuolization and increased electron density of mitoctondrial matrix were observed. RER were decreased in number and had some vesicular change ana SER were dilated. Glycogen particles were rarely seen. nucleus showed some irregular border and clumping of chromatin along the nuclear membrane. Necleoli wert inconspicuous. Fat vacuoles were located in the central portion of cotoplasm and some were closed to nucleus. The size were 1∼2μm in diameter, relatively. Large concealed forms were also present, but were no over 5.5 μm in diameter. All fat vaculoles were rather solid than empty form. Biochemically, the compositions of lipids in liver cells revealed 79.6% of triglyceride, 3.8% of cholesterol, and 16.6% of phospholipid. Conclusively, changes of hepatocytes were thought as reversibleeven in this fatal case and components of fat vacuoles might be triglycerides mostly.

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