Journal of Pathology and Translational Medicine

Volume 18(1); January 1984

Etcs

Application of Case Study-Oriented Small Group Teaching Method for the Strengthening of Pathology Laboratory Course: Yong Il Kim; J Pathol Transl Med. 1984;18(1):1-7.

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Abstract: Traditional teaching method of pathology laboratory course during the preclinical year has been one of the major concerns by its less active student participation, overemphasis of morphological details with little opportunity on clinical correlation and poor integration with lecture in most of undergraduate programs. Furthermore, increased number of student enrollment and shortage of faculty have accelerated the reduction of existing limited efficiency by means of achieving the course objective. The author introduced an easily accessible format by application of case-oriented small group teaching method based on the policy of no additional curricular revision or crucial modification of present didactic pathology instruction. Carefully selected cases of 5 to 6 with clinical summary and well controlled questionnaires were supplied with microslide sets for small group discussion, and each student group was assigned to answer a series of questions on the case at the whole class plenary session. Development of appropriate questionnaires was crucially critical to determine the group activity so that the best answer should be possible only after careful observation of microslides and with close referring to available handout or textbook in the areas not only of morphological alterations but also no etiology, pathogenesis, correlation with clinical features and interpretation of laboratory data. plenary discussion was scheduled at the end of each course, during which faculty's comment on the cases with Kodachrome transparency (of microphotography) was supplemented. Immediate feedback on two occasions of experiment supported the active student interaction in learding process, and enhanced the synchronization of cognitive content in lecture-laboratory courses along with confidence on self-directed learning. It also stressed the necessity of further improvement in faculty's questioning and answering skill. The program was also less expensive, saved faculty time, and enabled to promote the bridging effort between the basic and clinical sciences as expected.

Cryoglobulinemia: Young Joo Cha, Myoung Hee Park, Hyun Chan Cho, Han Ik Cho; J Pathol Transl Med. 1984;18(1):8-15.

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Abstract: Seventy cases of cryoglobulinemia detected at the Department of Clinical Pathology, Seoul National University Hospital, during the period from January 1977 to September 1982 were analysed for sex and age distribution, associated disease, laboratory findings, and physicochemical propertie of cryoglobulins. The results were as follows. 1) Among 70 cases, 38 cases were male and the remaining 32 cases were female. Age was widely distributed form 4 to 60 years. 2) Diseases associated with cryoglobulinemia were various renal diseases (32 cases), autoimmune diseases (16 cases including 11 cases of systemic lupus erythematosus), chronic active hepatitis (6 cases), infections (4 cases including 2 cases of subacute bacterial endocarditis) and malignant lymphoma (1 case) in decreasing order of frequency. Eleven cases were considered idiopathic and associated diseases could not be found. 3) Serum rheumatoid factor was positive in 32% of patients, serum complement level was decreased in about 30%, and HBsAg was positive in 18%, HBsAb in 38% and HBcAb in 81%. 4) In systemic lupus erythematosus, serum rheumatoid factor was positive in 33% of patients, serum complement level was decreased in about 90%, and findings of renal involvement were observed in all cases by urinalysis and renal biopsy. 5) In two cases of subacute bacterial endocarditis, serum rheumatoid factor was positive in one and decreased serum complement level and impairment of renal function were observed in both cases. 6) Precipitation of cryoglobulins were observed for 3 days. After one day of incubation, only 26% of cases showed precipitation and 43% showed precipition after 3 days. 7) In 4 cases, cryoglobulins could be isolated and test for rheumatoid factor and immunoelectroesis were done. In all cases, rheumatoid factor was positive. By immunoelectrophoresis, 2 cases were identified as IgM-IgG mixed cryoglobulins and one case as IgG-IgG mixed cryoglobulins. On the basis of these findings, cryoglobulinemia was found in disease associated with rheumatoid factor formation and characterized by prolonged stimulation of the immune system. And we thought it important to detect the presence of even small amount of cryoglobulins because it has important clinical relevance such as association with renal involvement and prognosis.

Ultrastructural Study on Streptozotocin -induced Pancreatic Acinar Injury in Rats: Hyung Sik Shin, Seong Hoe Park, Yong Il Kim; J Pathol Transl Med. 1984;18(1):16-22.

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Abstract: Experimental diabetes was produced in Sprague-Dawley rats by single dose of intraperitoneal injection of streptozotocin, 50㎎/kg and sacrificed on the 15th, 45th, and 90th day. Blood glucose levels were 400㎎/㎗ in all groups (normal control: 120㎎/㎗) and serum amylase level of a group after 45 days was 621.1 IU of average, whereas 750.5 IU in normal control group. The cytoplasms of pancreatic acinar cells were closely packed withh minute hydropic vacuoles and numerous fat globules, measuring 0.5～1.0μ in diameter. Electron microscopic findings represented mitochondrial swelling with loss of cristae and indistinct outlines. Populations of free ribosome were increased, but the zymogen granules were reduced than those of control group. The above findings support that streptozotocin induces acinar cell injury in part through the direct chemical toxicity on mitochondria.

Electron Microscopical Study on the Rat Myocardium in Acute Neurogenic Cardiovascular Death: Hyung Bae Moon; J Pathol Transl Med. 1984;18(1):23-31.

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Abstract: Death resulting from acute neurogenic cardiovascular failure have been divided into primary shock caused by parasymphathetic stimulation and ventricular fibrillation caused by symphatheticoadrenal stimulation. Morphological characteristics have not been established in gross and microscopical finding in either cases. Hence this experiment was designed to provide some positive findings in differentiating these two cause of death. Primary shock or ventricular fibrillation was induced by electrical stimulation of the vagus nerve (5 volt, 50 Hz, 1.0 msec.) and of the chest wall (120 volt, 50 Hz, A.C.) respectively and rat myocardium were observed with electron microscope. 1) The heart of the rat which died from primary shock revealed relatively normal pattern of ultrastructural architectures in the myofilaments, myofibrils, sarcomeres, Z lines, mitochondria and other sarcoplasmic organelles. 2) The heart of the rat which died from ventricular fibrillation revealed shortening and scalloping of the sarcomeres, fragmentation of the Z lines, distortion of the myofilaments around the intercalted disc and displacement of the mitochondria away from the intercalated disc, appear to be similar to those of zonal lesion seen in the hemorrhagic shock. Furthermore, marked changes were noted in mitochondria. These changes consisted of swelling, destruction of the cristae, and abnormal cystic space formation with or without amorphous materials stic depression of glycogen particles were present. From these results, it might be suggested that the ultrastructural findings of the heart could provide the morphological differences between death from primary shock and ventricular fibrillation.

A Morphological Observation on Human Pineal Glands -80 cases analysis of fetal and postnatal pineals: Jung Ran Kim, Je G. Chi; J Pathol Transl Med. 1984;18(1):32-38.

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Abstract: To evaluate the histological appearance of the human pineals, a morphologic study was made based on 80 normal human pineals. The material consisted of 44 pineals from fetuses ranging in age from 16 to 40 gestational weeks and 36 pineals of children and adults ranging in age from 1 day to 58 years. Following observation were made: 1) The pineals show a distinctive pattern of evolution in the morphology through the entire life as judged by morphological features, such as glandular, alveolar, mosaic and locular pattern. 2) At 16 weeks of gestation are proliferated and become ependymal cells transformed into glial and primitive pineal parenchymal cells, that later become pinealoblasts by before 28 weeks of gestation. The pineals of newborn show the pattern of adult type by 10 months of age. 3) Melanin pigment deposits in the pineals is noted in 66 percent of the cases examined. The pigment is first seen in glandular structure at early gestational period and becomes visible in undifferented parenchymal cells or glial cells. Although pigment density varies intensity it is generally prominent through the gradually less prominent starting from 8 months of age and is minimal over the age 50 years.

Histopathological Study of Partial Hydatichiform Mole: Hee Kyung Chang, Tae Lee, Sun Kyung Lee; J Pathol Transl Med. 1984;18(1):40-46.

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Abstract: The study was undertaken to investigate the clinical and histopathological characteristics of partial hydatidiform mole. The subjects were a series of consecutive 54 cases of partial hydatidiform mole and 212 cases of classic hydatidiform mole, which were diagnosed pathologically at the department of pathology during the 11 years period from 1970 to 1980. The cases were analyzed morphologically and statistically. The results obtained were summerized as follows: 1) The age distributions of the patients with partial and classic moles were from third to sixth decade with a peak incidence of third decade with a peak incidence of third decade. There was no significant difference in the age distribution between partial and classic moles. 2) In the patients with partial mole, 90% of the cases were multipara and 32% of cases had history of spontaneous or artificial abortion. In the patients with classic mole, 78% of cases were multipara and 36% of cases had history of abortion. There was no significant difference in obstetric history of the both types. 3) Histopathologic findings of the classic mole were hydropic change and central cisterns of the storma (100%), maze-like cisterns of the stroma (4.3%), blood vessels with/without red cells (0.9%), and considerable hyperplasia of trophoblasts (65.6%). 4) Histopathologic findings of the partial mole consisted of hydropic villi admixed with normal villi (100%), hydropic change of the stroma (100%), central cisterns of the stroma (90.4%), maze-like cisterns of the stroma (83.3%), blood vessels with mature and immature red cells (98.1%), and considerable hyperplasia of trophoblasts (22.2%). On the basis of the above results, characteristic findings of partial mole, which might be distinguished from classic type, were maze-like cisterns of the stroma, mixture of normal and hydropic villi, and blood vessels with mature or immature red cells in the stroma.

Estimation of Several Normal Values of Peripheral Blood from Clinical Laboratory Data by Various Statistical Methods: Mee Young Sol, Eun Yup Lee, Soon Ho Kim; J Pathol Transl Med. 1984;18(1):47-56.

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Abstract: It is desirable for each clinical laboratory to have its own normal values. The easy way to obtain them was to utilize the routine laboratory test results. Among the various statistical methods proposed for above purpose, the authors chose three statistical methods, such as Hoffmann, Neumann and Chung's methods. And by applying these methods, the authors estimated normal ranges from the laboratory data of Korean adult on hematological items measured by the Coulter Counter Model S-plus II furnished by the clinical laboratory of the Busan National University Hospital from Jan. 1983, to August, 1983. The 95% normal ranges established by the authors were summerized as follows: 1) Total mean RBC count of male was 350×10⁴/㎣, and that of female was 330×10⁴/㎣. 2) The hemoglobin of male was 13～16gm/㎗, and that of female was 11～14gm/㎗. 3) The hematocrit of male was 31～49%, and that of female was 29～43%. 4) The MCV of male was 84～98μ㎥, and that 81～97μ㎥. The MCH of male and female was 27～33pg, and the MCHC of both male and female were 32～35gm/㎗. 5) The total WBC count of male was 4,000～10,000/㎣, and that of female was 4,000～9,000/μ㎥. 6) The total platelet count of male was 17×104/㎣, and that of female was 4,000～9,000/μ㎥. 7) The red cell distribution width of male and female was 11.5～14%.

Normal Values of Liver Function Test in Korean Adults Indirectly Estimated by Analysis of the Values of Patients's Blood Samples: Sung Ryul Kim, Han Chul Son, Soon Ho Kim; J Pathol Transl Med. 1984;18(1):57-65.

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Abstract: It was desirable for each clinical laboratory to have its own normal ranges, though it may be cumbersome and cost-bearing. Patients' laboratory data of each test had recently been attempted by statistical analysis in an effort to obtain indirect estimates of the normal ranges. For this purposes the authors have tried to estimate normal values in our laboratory from routine clinical laboratory test items, using three statistical methods proposed by Hoffmann, Neumann and Chung. The laboratory studies were carried out by Abbott-VP biochemical analyzer at clinical laboratory, Busan National University Hospital from January, 1983 to August, 1983. The normal ranges estimated by the authors are as follows: 1) Normal ranges of serum total protein, album in and globulin are 5.8～5.0 and 2.0～3.6 gm/㎗, respectively. 2) Normal ranges of serum aspartate aminotansferase(AST) and alanine aminotransferase(ALT) are 9～30 and 9～34 IU/L. 3) Normal range of serum alkaline phosphotase(ALP) is 30～90 IU/L. 4) Normal range of serum lactate dehydrogenase(LD) is 95～200 IU/L. 5) Normal rage of serum gamma-glutamyl transpeptidase(GGT) is 10～43 IU/L.

Normal Values of Peripheral Blood in Korean -20～30 year-old healthy adults-: Jin Sook Jeong*, Mee Yeong Seol, Soon Ho Kim; J Pathol Transl Med. 1984;18(1):66-73.

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Abstract: The author carried out this study to measure routine hematologic items in 200 cases of healthy Korean adult male and female of 20～30 year-old group using Coulter Count Model S-Plus II. The blood samples were obtained from the antierior cubital veins of the adult persons in Busan National University Hospital and In Je Medical College Pusan Paik Hospital duration of the periods form Jan. To August 1983. The data was analyzed by parametric and non-parametric methods to estimate normal values of the items observed. The reults thus obtained were summerized as follows: 1) The mean and normal ranges of the total RBC count of male were 50×104/㎣ and 40×104～570/㎣ and those of female were 428×104～480×104/㎣, respectively. 2) The mean and normal ranges of hemoglobin of male were 15.2g/㎗ and 13～17g/㎗, and those of female were 12.1g/㎗, and 11～14g/㎗, respectively. 3) The mean and normal ranges of hematocrit of male were 46.3% and 40～52%, and those of female were 38.2% and 34～43%, respectively. 4) The mean and normal ranges of MCV of male were 92.8μ㎥ and 95～98μ㎥ and those of female were 98.4μ㎥ and 85～94μ㎥, respectively. 5) The mean and normal ranges of MCH of male were 30.7 pg and 27～33pg and those of female were 28.4pg and 27～33pg, respectively. 6) The mean and normal ranges of MCHC of male were 33gm/㎗ and 32～43gm/㎗, and those of female were 31.7gm/㎗ and 30～33gm/㎗, respectively. 7) The mean and normal ranges of total WBC count of male were 6,100/㎣ and 4,500～8,000/㎣, and those of female were 6,103/㎣ and 4,500～8,700/㎣, respectively. 8) The mean and normal ranges of total platelet count of male were 31×104/㎣ and 20×104～42×104/㎣, and those of female were 33.6×104 and 18×104～44×104/㎣, respectively. 9) The mean and normal ranges of red cell distribution width of male were 12.7% and 11.5～14%, and those of female were 12.9% and 11.5～15%, respectively.

Adenomatoid Tumor of the Uterus: Jin Hee Sohn, Geung Hwan Ahn, Yong Il Kim, Sang Kook Lee; J Pathol Transl Med. 1984;18(1):74-78.

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Abstract: In 1945 Golden & Ash proposed the term "adenomatoid tumor" for certain distinctive neoplasms of the genital tract. Adenomatoid tumor of the female genital tract occurs frequently in uterus, fallopian tube, ovary and parovariu. Adematoid tumors arising in the uterus are not well-recognized and are sometimes mistaken for other neoplasms. Recently, we experienced 5 cases of adenomatoid tumor of the uterus which are found by chance. They were small nodular lesions (1.5～3.0㎝) with well demarcated margin in the subserosa of the uterus. Microscopically, they show small anastomosing gland-like spaces lined by coboidal or flat cells. Some ara eshows dilated pseudo-vascular channels interspersed among bundles of myometrial smooth muscle.

Four Cases of Plasma Cell Leukemia: Hyoun Chan Cho, Young Joo Cha, Kyoung Dong Kim, Myoung Hee Park, Han Ik Cho, Ro Kyoung Kim; J Pathol Transl Med. 1984;18(1):79-83.

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Abstract: Four cases of plasma cell leukemia are reported. Hematologic, immunologic and biochemical data of the patients were analyzed with the special attention to the diagnostic problems. They showed 42%, 28%, 8% and 31% of plasma cells in peripheral blood, and 97%, 78%, 98% and 92% in none marrow, which were enough for diagnostic criteria of plasma cell leukemia. Their abnormal proteins on serum protein electrophoresis were found on gamma globulin fraction in three and on beta globulin fraction in one of them, and immunoelectrophoresis performed on three of them revealed IgG-Kappa, IgG-lambda and IgA lambda in each patients.

Light Chain Disease, Lamda Type, with Acute Renal Failure: Dong Hee Cho, Won Il Kim, Sang In Shim, Sun Moo Kim, Chong Moo Lee; J Pathol Transl Med. 1984;18(1):84-88.

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Abstract: Light chain disease is a rare type of multiple myeloma. Its clinical manifestation and bone marrow features similar to those of other myelomas, but its prognosis is poorer than others. Recently the authors have experienced a case of light chain disease in the patient with acute renal failure. The renal biopsy revealed the features characteristics of myeloma nephropathy and the case was diagnosed on the basis of the electrophoresis, immunoelectrophoresis of the serum and urine, and bone marrow with immunoperoxidase staining. This is a report of the case with clinical history and laboratory studies. And a brief review of the literature is added.

Cephalothoracopagus Syncephals -An autopsy case report-: Jeong Rae Kim*, Sun Lee**, Jae Sung Kang**, Hye Kyung Lee, Sung Shik Shin, Je G Chi; J Pathol Transl Med. 1984;18(1):89-93.

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Abstract: Conjoined twins are very rare congenital malformation in which twins have varying degree of anatomical union. They are reported to occur by the incidence of 1/50,000 to 1/100,000 in deliveries and in approximately 1/600 twin births. The conjoined twins are usually associated with anomalies of internal organs, most commonly cardiovascular anomaly leading to immediate postnatal death. A case of conjoined twins (cephalothoracopagus syncephalus) was delivered by Caesarian section from a 23-year-old primiparous woman at OB and GY dept., Veterans Hospital. Gestational period was 30 weeks and both twins died soon after birth. The autopsy was performed and a review of literature on conjoined twins were discussed briefly.

Infantile Polycystic Kidney -A Report of an autopsy case-: Young Jin Kim, Woon Sub Han, Ok Kyung Kim; J Pathol Transl Med. 1984;18(1):94-97.

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Abstract: A great many papers concerned with polycystic kidney have appeared until now, but infantile polycystic kidney rare as compared with other types. We have recently experienced one case of infantile polycystic kidney who was born after 34 weeks of gestation period and died from respiratory failure soon after birth. The discussion about the pathologic characteristics of this case, with literature review was made.

Merkel Cell Tumor -A case report associated with squamous cell carcinoma-: Hyeon Joo Jeong, Hoguen Kim, In Joon Choi; J Pathol Transl Med. 1984;18(1):98-102.

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Abstract: Merkel cell tumor is a primary malignant skin tumor, first reported by Toker in 1972, and has been reported by different names, including trabecular carcinoma, cutaneous APUDoma, primary neuroendocirne carcinoma, and primary small cell carcinoma of the skin. It is characterized by trabecular or anastomosing cord-like arrangement of uniform, round to oval tumor cells with scanty cytoplasm mainly in the dermis and extending in subcutaneous tissue. Ultrastructurally dense core neurosecretory granules 120 to 210nm in diameter are found in the cytoplasm of tumor cells which resemble those found in the Merkel cells. The authors report a case of Merkel Cell tumor arisen in the tip of left index finger associated with squamous carcinoma in the tip of left thumb. The tumor of index finger fulfills the characteristics of Merkel cell tumor including positive argyrophilic stain and that of thumb finger shows typical squamous cell carcinoma. Association between these two skin tumors amy suggest a common carcinogenic influence for squamous and neuroendocrine carcinomas of the skin.

Congenital Bronchogenic Cyst of the Lung Associated with Cytomegalovirus Infection: Doo Hwa Woon, Jung Il Suh, Moon Hyang Park, Hyo Sook Park; J Pathol Transl Med. 1984;18(1):103-107.

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Abstract: We report a case of congenital bronchogenic cyst associated with cytomegalovirus infection in 50 day old female baby. She was admitted under the impression of pyopneumothorax and bronchopleural fistula. Left lower lobectomy was performed due to persistent symptoms despite of conservative treatment. Histopathologic examination of lobectomized left lower lobe reveals congenital bronchogenic cyst with rupture, infected by cytomegalovirus.

Diffuse Eosinophilic Gastritis. A Case with Histotopographic Analysis on Eosinophilic Infiltration: Jin Hee Sohn, Yong Il Kim, Geung Hwan Ahn; J Pathol Transl Med. 1984;18(1):108-111.

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Abstract: A case of diffuse eosinophilic gastritis from a sixty nine years old man with peripheral eosinophilia and increased serum IgE was investigated by means of extended histotopographic approach on population density of eosinophilic infiltration. Localized muscular hypertrophy in the antral portion which corresponded to heavy eosinophilic infiltration with muscular damage resembled the localized from, but the rest of stomach was also the seat of diffuse eosinophilic infiltration, leading into the limited applicability of subtyping under this disease entity. Associated was a concomittant benign chronic peptic ulcer.

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