Journal of Pathology and Translational Medicine

Volume 12(1); March 1978

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A Pathologic Study on Tumors of the Kidney: Sang Kook Lee, Shin Kwang Khang, Geung Hwan Ahn; J Pathol Transl Med. 1978;12(1):3-8.

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Abstract: A pathologic study of 24 cases of primary malignant renal tumors that were examined at the Department of Pathology, Seoul National University Hospital, during period of 5 years from January, 1970 to December, 1974, was made. The results were as follows : 1. The malignant tumors of the kidney constituted 0.9 percent of 2,757 cases of all primary malignant tumors, that were examined during the same period. The mean age of total renal malignant tumors was 38 years : adenocarcinoma 50 years : Wilms’ tumor 6 years : and tumors of renal pelvis 50 years. The renal adenocarcinoma and tumors of renal pelvis were most prevalent after the age of 40 years, while Wilms’ tumor was prevalent before the age of 10 years. The renal tumors affected more males than females with a male to female ratio of 1.4 to 1. Even a single case of benign renal tumor was not noted during the same period. 2. The cardinal symptoms included hematuria, flank pain or discomfort, and palpable abdominal mass. Palpable abdominal mass was the most important and frequent complaints in patients with Wilms’ tumor. Systemic manifestations were observed in 4 cases : hypertension in 1 case. unexplained fever in 2 cases, and polycythemia in 1 case. 3. Twenty-four cases of primary malignant renal tumors were classified histologically into 11 adenocarcinomas(45.8 %), 6 Wilms’ tumors(25.0 %), and 7 carcinomas of renal pelvis (29.2 %). Eleven cases of renal adenocarcinoma included 8 cases of clear cell type(72.7 %), 1 case of granular cell type(9.1 %), and 2 cases of mixed variety(18.2 %). Renal vein invasion was noted in 4 out of 11 cases of renal adenocarcinoma. Epithelial components were observed in all 6 cases of Wilms’ tumor, while striated muscle was observed in only one case.

Pathologic Study on Tumors of Breast: Sang Kook Lee, Geung Hwan Ahn; J Pathol Transl Med. 1978;12(1):9-13.

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Abstract: A histopathologic study was made on 268 cases of tumors of the breast, which were obtained during a period of 5 years, from 1970 to 1974, at the Department of Pathology, College of Medicine, Seoul National University, and the result were as follow; 1. Two hundred and sixty-eight tumors of the breast examined consist of 155 benign tumors and 113 malignant tumors. 2. Among benign tumors, fibroadenoma is the most prevalent (95.5%) and shows highest incidence in the age group of 20 ~ 29. 3. The mean age of female breast carcinoma is 45.1 years. 4. Site incidence of female breast carcinoma is highest in outer upper quadrant of breast and frequent clinical symptoms include lump (89%), nipple discharge (12%), pain in breast (7%) and nipple retraction (6%) in order of frequency. 5. Among various histopathologic types of breast carcinoma, infiltrating duct carcinoma with productive fibrosis is most prevalent (66.4%) and shows the highest rate of node involvement (80.8%).

Estimation of Normal Ranges of ESR from Routine laboratory Data: Chang Soo Chung; J Pathol Transl Med. 1978;12(1):15-22.

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Abstract: The main purpose of this study was to introduce the two methods by the present author and the maximum likelihood estimate method applicable to the determination of normal ranges of ESR from the routine laboratory data. At first the basic principles of the three methods were explained, and then their application to practice were illustrated by estimating normal ranges of ESR from complete and artificially truncated gambles obtained from 309 normal Korean adult women. At last an attempt was made to estimate normal ranges of ESR from the laboratory data of Pusan National University Hospital, and values of upper limit of 95% range were gained, ranging between 16 and 21mm/hour in women and between 14 and 18mm/hour in man.

Serratia marcescens Isolation and the Patients' Clinical Status: Ae Ja Park, Yunsop Chong, Samuel Y. Lee; J Pathol Transl Med. 1978;12(1):23-29.

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Abstract: Awareness of the importance of Serratia marcescens as an opportunistic pathogen causing nosocomial infections lead us to use deoxyribonuclease and tween 80 hydrolysis tests to identify this organism from our clinical specimens. From 56 patients Serratia marcescens were isolated during the period of February to October, 1977. Among these 56 cases, 43 were reviewed and the following results were obtained. 1. Serratia marcescens were frequently isolated from patients with age groups of both 40-49, and 60 or over. The male to female ratio was 3 : 1. 2. The isolation was frequently from respiratory, woulld and urine specimens. There were two serious patients; one yielded the organism from blood and the other from spinal fluid. 3. The patients yielding the organisms were found to have predisposing factors such as various debilitating disorders, surgical procedures and urinary catheterizations. 4. Thirty eight out of the 43 were hospitalized patients and remaining 5 were outpatients with previous hospitalizations. This fact is highly suggestive of the nosocomial nature of the infections. 5. At the time of bacterial culture, 34 patients had been receiving single or multip!e antibiotics, suggesting the relationship of the infections an4 the antibioic administrations. 6. In 10 patients, the organisms were solely isolated indicating their etiological significance. From the rest of the patients other organisms were also isolated together with Serratia marcescens. Serrtia infections were thought to be rare previously, but it was obviously wrong and perhaps it was due to the difficulty of their correct identification. The infections are frequent among long standing inpatients particulary in aged persons with various underlying disorders. A correct identification and a proper susceptibility testing should be considered imperative for both prevention of new infections and adequate treatment of the patients.

A Study on the Possibility for the Replacement of the Conventional Carbohydrate Fermentation by the Disk paper Method: Hyun Sook Lee, In Sun Kim, Sun Chul Whang, Seung Yong Paik; J Pathol Transl Med. 1978;12(1):31-38.

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Abstract: The use of carbohydrate fermentation tests has teen widely employed in the identification and the classification of various species of micro-organisms. The characteristics of the bacterial metabolism differ even within the same species depending upon its energy requirement a digestive patterns. The majority types of carbohydrate fermentation tests have been based on the fact that a certain micro-organism uses carbohydrates as an energy supply source and yields some metabolites by action of type specific enzymes. The study had been concentrated on the possibility whether the conventional fermentation tests could be replaced by the disk paper method, and concluded as following: 1. Between the data obtained by the test tube and the disk parer methods of carbohydrate fermentation, there was practically little discrepancy as for the fermentation pattern. 2. The most acceptable concentration of carbohydrates preparing the disk paper was 5 percent while 10 and 20 percents showed the zone of inhibition to the high acidity produced around the disks. 3. Generally, the acidification of the media can be read between 6 and 8 hours of incubation followed by the inoculation, therefore preliminary or complete identification can be cut at least one day. Consequently the laboratory data can reach at the physician’s hand a day earlier. 4. The disk paper method is proved to be much economic in the aspects of reagent, media, man power, and most of all, the time of identification still exhibiting the accuracy and the reliability.

The Antagonistic Effect of Ps. aeruginosa against some Enteric Bacteria: Kwang Gab Sim, In Sun Kim, Sun Chul Whang, Seung Yong Paik; J Pathol Transl Med. 1978;12(1):39-45.

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Abstract: Some genera of micro-organisms produce bacterial metabolites that have antibiotic effect against same species and to other genera of bacteria as well. The known bacteria which can affect the intact cells of other bacteria are mostly gram negative bacilli such as E. coli, Ps. aeruginosa, V. cholerae and Y. pestis. The most responsible substances inhibiting the bacterial growth are known grossly as bacteriocin, and subsequently named as colicin, pyocin, vibriocin and pesticin according to the bacteria from which these metabolites are derived. The study had been conducted to see the antagonistic effect of Ps. aeruginosa against some enteric bacteria, both pathogenes and normal flora, and gram positive cocci. The experiment yielded the following results: 1. The antagonistic effect of Ps. aeruginosa against the testing strains was confirmed, but the degree of the effect varied not only depending upon the age of the strains, but also to the organisms. 2. Dilution of the Ps. aerugionsa bacterial suspension decreased the potency of the effect, however, rendered the quantitative estimation of the inhibitory effect. 3. The quantitative analysis showed that the antagonistic effect of Ps. aeruginosa proved weaker against the other genera of bacteria than against the same species. This definite difference in degree of inhibitory action indicated the possibility of its application in the identification of the clinical bacteriology employing the principle of the type specificity. 4. It was also interesting that the antagonistic effect of Ps. aeruginosa was not only inhibitory against gram negative bacilli, but also against the highly resistant gram-positive cocci, Staphylococcus aureus.

Incidence of HBsAg Positivity and Liver Function Tests in Leprosy Patients: S.W. Juhng, D.W. Ryang, J.Y. Yoo, S.H Kim, K.H. Cho; J Pathol Transl Med. 1978;12(1):47-53.

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Abstract: Hepatitis B surface antigen and liver function tests were carried out to evaluate the degree of hepatic damage in 147 leprosy patients admitted in Sorok National Leprosarium. In 147 leprosy patients, 118 were of a lepromatous type, 16 were of a tuberculoid type and 13 were of a borderline group. The results were obtained as follows; 1. In leprosy patients, HBsAg positivity was observed in 4(2.7%) lepers, which was lower than 4(4%) positivity in normal control group. 2. The abnormal elevations of serum alkaline phosphatase, SGOT, SGPT and 777 were observed in 37(25.2%), 24(16.3%), 12(8.2%) and 20(13.5%) lepers respectively. Inverted A/G ratio was noticed in 28(19.0%) lepers. These data of various liver function tests except for SGPT tests in leprosy patients were statistically significant. 3. The abnormal elevations of serum alkaline phoshatase were chiefly observed in the lepers below age of 20 years, in borderline group and in the group of treatment with rifampin. The abnormal elevations of SGOT and inverted A/G ratio seemed to be increased with duration of illness and treatment.

Fibromatosis Involving Abdominal Cavity -Report of a Case-: Mi Kyung Hur, Sun Moo Kim, Chong Moo Lee; J Pathol Transl Med. 1978;12(1):55-59.

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Abstract: Fibromatosis is a low grade malignant proliferation of fibrous tissues which is thought to be arising primarily from fascial sheaths and musculoaponeurotic structures in various parts of the body. However, fibromatosis involving abdominal viscera is only rarely encountered, and in our knowledge only about 47 cases have been reported in literature of the western world, and so far no case report has been published in korea. In January 1975, we experienced a case of fibromatosis involving abdominal viscera occurring in a 18 years old you female. The chief complaints are constipation, abdominal discomfortness and large palpable mass on the left lower quadrant for several months. On a exploratory laparatomy, abdominal cavity showed a large tumor mass which was adhered to the outer surface of sigmoid colon, and another tumor mass which was densely adhered to the splenic capsule and tail of pancreas. Lumpectomy, sigmoid colectomy, splenectomy and removal of tail of pancreas was done under the clinical impression of leiomyoma or teratoma. Grossly, a tumor mass which was firmly attached to the sigmoid colon measured 11.3×9.5×7.5cm. and weighed 1180 grams altogether. The mass had white gray smooth external surface and fish-flesh like solid and moderately firm cut surface. Another tumor mass which was tightly adhered to splenic capsule and tail of pancreas was 7×4×3cm. On cut section, the mass was tightly adhered to the portion of splenic capsule and infiltrated into pancreatic tissue. Microscopically, a mass attached to the outer surface of colon and another tumor mass attached to the splenic capsule and tail of pancreas showed proliferation of relatively mature fibrous tissue with a moderately rich amount of collagen fibers. Occasional mitoses were noted. These proliferating fibrous tissue were found to be deeply infiltrating to the pancreas tissue, and firmly adherent to the serosa of colon and splenic capsule. A brief review of the literature on fibromatosis was done.

Malignant Strums Ovarii -Report of a Case-: Mi Kyung Hur, Chong Moo Lee; J Pathol Transl Med. 1978;12(1):61-65.

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Abstract: Struma ovarii is a neoplastic disease of the ovary occasionally encountered associated with dermoid cyst, or mucinous cystadenoma or rarely as an exclusive neoplastic tissue. However, malignant struma ovarii is only rarely encountered, and in our knowledge only 37 cases have been reported in the literature of the western world, and no case report has been published in Korea. In April 1975, we experienced a case of malignant strums ovarii occurring 54 years o1d menopausal woman. On Physical examination, a huge lower abdominal palpable mass was noted. A total hysterectomy and bilateral salpingo-oophorectomy was done under the diagnosis of the right ovarian tumor. The pathological examination of the present case showed menopausal uterus with inactive endometrium and chronic cervicitis. The right ovary was enlarged, weighing 1,400 grams, and had tan gray rather smooth external surface. Microscopically, the right ovary showed a struma ovarii, 17×14×8cm, with indistinct demarcation of the mass with clear follicular pattern and with undisputably malignant cellula details showing distinct vascular invasions. Though search for, other neoplastic component was not found. The left ovary showed a dermoid cyst, 7×5×5cm, of benign morphology. Findings of both fallopian tubes were not remarkable. A brief review of the literature on the malignant strums ovarii was done.

A Case of Adenomatoid Tumor of the Ovary: T.J. Kwon, J.Y. Ro, Y.B. Lee; J Pathol Transl Med. 1978;12(1):67-71.

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Abstract: The adenomatoid tumor is a rare and interesting neoplasm which is usually a small, circumscrited benign lesion of the female and male genital tract characterized by somewhat adenomatcus structure and is of uncertain derivation. The ovary apparently is the least frequent site of the adenomatoid tumor, therefore only 8 cases were reported in the literature. We experienced recently a case of adenonlatoid tumor of the ovary in a G6P4L4A2P0 38 years old housewife. Grossly the tumor was firm. solid and well circumscribed. The diameter of the tumor is 1cm and the cut surface showed grayish white homogenous appearance. Microscopically the tumor consisted of irregular glands or vessel like spaces which were lined by cells, designated by various authors as endothelial, mesothelial, or epithelial within a fibrous background. A brief review of literature pertinent to the case is also made.

Recurrent Neurilemmoma in Mesentery -A Case Report-: S.W. Juhng, D.W. Ryang; J Pathol Transl Med. 1978;12(1):73-77.

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Abstract: Most commonly neurilemmomas are found in a subcutaneous tissues on the extremities, heads and neck or in a mediastinum and retroperitoneal soft tissues, but only rarely in the other sites such as mesentery. Malignant degeneration or local recurrence of neurilemmoma is rare event and only a fell cafes have teen reported. We experienced a case of the recurrent neurilemmoma of mesentery in a 29-year-old man, who took the abdominal tumor resection under the diagnosis of neurilemmoma of mesentery about 18 months ago. Grossly the tumor was well encapsulated and excessively large sized (22×20×10cm). Histopathologically, it was composed of two types of tissue, Antoni types A and B. Focally, Hemorragic and necrotic areas were also seen. But malignant evidence was not observed.

Clinicopathological Study of Ulcerative and Necrotizing Lesions of The upper Respiratory Tract: T.S. Kim, J.Y. Ro, I.J. Choi, Y.B. Lee, D.S. Kim; J Pathol Transl Med. 1978;12(1):79-85.

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Abstract: At present lethal midline granuloma falls into 3 distinct and separate clinicopathological entities: (a) malignant lymphoma, (b) midline malignant reticulosis, and (c) Wegener’s granulomatosis. Lethal midline granuloma (LMG) is included in the conditions with ulceration and rapid destruction of upper respiratory tract. Destructive and ulcerative lesions in the upper respiratory tract are frequently met with clinicians and also pathologists, by which diagnostic and therapeutic difficulties may be occasionally followed. For these reasons, this study is aimed to confirm the previous diagnosis, classify the 3 entities, and evaluate the diagnostic problems in inadequate biopsy materials and also evaluate the ulcerative non-specific lesions by repent and/or follow-up biopsies. This study consists of 35 cases of lethal midline granuloma for 10 years period lasting from 1968 to 1977, among them 21 cases being malignant lymphoma and 14 cases midline malignant reticulosis. The differentiation between these 3 entities is emphasized. Lethal midline granuloma should be used only as a clinical term, and early and definite diagnosis is important for these lesions by means of repeated adequate biopsies.

Neck, Facial and Ovarian Actinomycocis: Dae Yung Kang; J Pathol Transl Med. 1978;12(1):87-91.

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Abstract: Actinomycosis is a progressive, suppurative bacterial or granulomatous fungal disease, with local or systemic manifestations, and is thought to be common disease, but is relatively rare in literatures. In these three years, we have experienced three cases of actinomycosis, each of which occurred at neck, facial and ovarian portions. A brief review of literatures and a discussion concerning actinomycosis are presented in this paper.

Cervical Thymic Cyst (A Case Report): Hee Young Shin*, Geung Hwan Ahn, Je G. Chi; J Pathol Transl Med. 1978;12(1):93-96.

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Abstract: The congenital cyst is a rare tumor which can be situated in the neck or the mediastinum. Since Pollosson and Piery published their first case of cervical thymic cyst in 1901, approximately 40 cases have been recorded in the world literature. Correct preoperative diagnosis of this cystic mass has seldom been made. About two-thirds occur in the first decade of life and most of the remainer in the second in contrast to the common branchial cysts that occur after the second decade. Males are affected twice as ofen as females. They are believed to develop in remnants of thymic tissue which have failed to descend from the third branchial pouch into the mediastinum in the 6th to 8th weeks of embryonic life.

Cytomegalic Inclusion Disease - Two Autopsy Cases Report -: Geung Hwan Ahn, Kye Yong Song, Jong Sung Choi*, Je Geun Chi; J Pathol Transl Med. 1978;12(1):99-104.

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Abstract: Depression of host defence mechanisms can be related to old age, underlying debilitating disease, and malnutrition. In recent years the use of immunosuppressive drugs, such as corticosteroids, antimetabolites, and alkylating agents have been attributed to acquired immune deficiency states. This problem is particularly important in patients receiving organ transplants who are maintained on immunosuppressive drugs for long periods of time. In these individuals, opportunistic infections with such uncommon low virulence agents as fungi, cytomegalovirus and pneumocystis carinii have induced fatal disease. Cytomegalic inclusion disease(CID) is encountered mainly in infancy and early childhood, particulary in prematures, who have not yet developed any immunologic resistance, and rarely in vulnerable adults. This viral infection caused by the DNA cytomegalovirus is characterized by the appearance of large(15 microns in diameter) intranuclear and smaller intracytoplasmic inclusion bodies in strikingly enlarged cells (40 microns in diameter) of many viscera. The intranuclear inclusion is characteristically surrounded by a clear halo demarcating it from the nuclear membrane. In this report two cases of CID are described. The first case developed in the course of costeroid therapy for the generalized exfoliative dermatitis, and the second case is that of a malnourished infant, who was associated with pneumocystis carinii pneumonia.

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