Journal of Pathology and Translational Medicine

Volume 7(1); June 1973

Etcs

A Pathologic Study on Tropical Malaria in South Vietnam -Analysis of Cause of Death in 7 Autopsy Cases-: Yong Il Kim, Ki Hong Kim; J Pathol Transl Med. 1973;7(1):1-12.

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Abstract: The pathologic lesions in seven consecutive autopsy cases among 555 Korean army personnel of falciparum malaria, during a period of November 1965 to July 1966, performed at the Oth Evacuation Hospital, ROKA in South Vietnam, were presented and correlated with cause of death. 1. All of the cases were heavily infected with P. falciparum, but one combined with P. malariae as well. Their duration of illness ranged from 7 to 11 days. 2. Basic Pathologic changes in each organ and tissue were related with presence of parasitized red blood cells and malaria pigments with subsequent development of tissue hypoxia and advanced proliferative changes of reticuloendothelial system. 3. Direct cause of death in all of fatal cases was considered to be cerebral. malaria, although cerebral lesions varied and presented no intimate relationship to clinical manifestations ; their findings strongly indicated cerebral hypoxia secondary to capillary blood stasis and plugging of parisitized red blood cells. None of cases demonstrated actual thrombosis or Durck’s glial nodes. 4. Renal lesions, both blackwater fever and malarial nephrosis, were inconspicuous, and did not considered as a direct cause of death ; one case was featured with mild hemoglobinuric nephrosis but giving no significant histologic differences from others. Mesangial changes of renal glomeruli encountered in the others accompanied moderate accentuation of glomerular lobulation, but evidence of malarial nephrosis remained unclarified. 5. Myocardial changes occurred with relative frequency, revealing focal necrosis together with interstitial edema, to result in acute myocardial insufficiency and pulmonary edema in one. 6. Presence of fibrin thrombi, though rarely manifest, raised possibility of intravascular coagulation as one of hemorrhagic diathetic mechanisms in fatal malarial infection.

Clinical, Histopathological and Studies on Malignant Lymphomas among Koreans: Kwang Kil Lee, Yoo Bock Lee, Dong Sik Kim; J Pathol Transl Med. 1973;7(1):13-28.

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Abstract: The malignant lymphoma is a malignant proliferation of the reticuloendothelial and lymphoid elements that are found in lymphnodes and other lymphoid tissues of spleen, tonsil, small intestine, etc. The clinical picture of this malignant disorder is sometimes so variable, and causes of lymphnode enlargement are so many that the lymphoma has been taken a much importance both clinically and pathologically. Many authors have reported and discussed about the so-called pseudolymphomatous lymphadenitis (Saltzstein, 1958 ; Canale and Smith, 1967 ; Hartsock, 1968 ; Rosai and Dorfman, 1969), viral lymphadenitis (Salvador et at., 1971) and marked follicular hyperplasia of lymphnodes (Evans, 1944 ; Motulsky et al., 1952 : Stansfeld, 1961) which resemble the malignant lymphoma histopathologically, and in fact, early lymphocytic lymphomas, early Hodgkin’s disease, mild inflammatory reactions and reticular hyperplasias may be difficult or impossible to distinguish from one another (Willis, 1967) in spite of diligent research of pathologists in that field. The classification of the lymphomas has undergone a series of changes over the years, and now the one proposed by Rappaport et al. (1956) is widely used as the classification of Lukes et al. (1966) for Hodgkin’s disease. There are several reports on lymphoma among Koreans based on clinical aspects but there are very little reports on lymphomas based on pathological aspects, especially the ones which are classified by the Rappaport et al.’s and Lukes et al.’s. The present study is an attempt to investigate mainly histopathological characteristics, such as classification of malignant lymphoma, relationship between histological types of lymphoma, sex, age and location, and to research differential criteria to distinguish the benign lesions from lymphoma of lymphnodes by way of special staining. Materials and Methods ; The materials used in this study consist of 286 cases of malignant lymphoma for 12 years and 8 months from January, 1960 to August, 1972, and 37 cases of benign lesions of the lymphnode. All specimens were fixed in 10% neutral formalin, paraffin embedded blocks were cut in 5 micron thickness, and sections were stained by hematoxylin-eosin methods, and according to the classification of Rappaport et al, (1956) and Lukes et al. (1966), histopathological studies were done on all cases of lymphoma. In addition, methyl-green pyronin and Gomori’s silver impregnation methods were performed on the 37 cases of benign lesion and 81 cases of lymphoma of lymphnodes to observe the number of plasms cells and the amount and distributed pattern of reticulin fibers in them. For all cases of malignant lymphoma whose clinical records were available, sex, age, chief complaints, duration of disease and hematologic data were reviewed.
Results
and Summary ; Clinical and histopathological studies were made on 286 cases of lymphoma, and histochemical studies were performed on 118 cases of excised lymphnodes (benign lesions, 37 ; malignant lymphomas, 81) that were submitted to the Department of Pathology, Yonsei University College of Medicine, during the period of 12 years and 8 months from January, 1960 to August, 1972. 1. The histological types in order of frequency were as follows : reticulum cell sarcoma (53.9%), lymphocytic lymphoma (20.3%), lymphoma, mixed cell type (13.6%), Hodgkin’s disease (10.1%) and undetermined (2.1%). 2. The histological types of Hodgkin’s disease in order of frequency were as follows : reticular (48.3%), mixed cellularity (27.6%), lymphocytic and/or histiocytic (13.8%), diffuse fibrosis (6.9%) and nodular sclerosis (3.4%). 3. Among 286 cases, 195 cases (68.2%) were male and 91 cases (31.8%) were female. The average age was 37.1 year-old (male : 33.9 years, female 44.9 years). 4. Clinical symptoms in order of frequency were as follows : enlargement of the lymphnode or palpable mass (75.2%), local pain (34.3%), gastrointestinal symptoms (21. 2%) and ENT symptoms (14.6%). The duration of chief complaints was mostly within 6 months (78.2%). 5. The locations of malignant lymphomas were as follows : nodal, 143 cases (50.5%) and extranodal, 124 cases (43.4%). Among the nodal group, cervical area was the most common (81.1%), and the next, axillary (21.7%) and inguinal (10,3%). Among the extra-nodal group, nasopharynx was the most common (27.4%), and the next, tonsil (25.8%) and small intestine (16.9% ) 6. Hodgkin’s disease showed somewhat bimodal curve in age distribution, was more common in male than other types of lymphoma, and involved gastrointestinal tract most commonly when extranodal in its origin. 7 Except cases of Hodgkin’s disease, the more the number of plasma cells in lymphnodes, the more likely the lesion was benign but this was not an absolute criterion in deciding the nature of lesions. 8. The amount and distribution pattern of reticulin fibers in lymphnodes gave a considerable aid in some cases to distinguish between benign and malignant but these did not have a great significance in deciding the nature of lesions. In conclusion based on these findings, it can be stated that reticulum cell sarcomas are more common and Hodgkin’s disease are less common in this country than in western countries. The existing number of plasma cells and the amount and distribution of reticulin fibers could be considerable aid in deciding the nature of lesions of lymphnodes, but could not be the decisive factor.

Clinical and Histopathological Studies on Surgical Thyroid Diseases Among Koreans: Sung Chong Yim, Chi Whan Kim, Yoo Bock Lee, Dong Sik Kim; J Pathol Transl Med. 1973;7(1):31-46.

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Abstract: Diseases of the thyroid gland are manifested by either increase in gland size, alterations in hormonal secretion, or both. Changes in gland size and weight are associated with toxic or nontoxic goiter, adenomas, thyroiditis, or malignancies. Most of thyroid disease are manifested by mass, local compression in the neck and symptoms arising from disturbances in hormonogenesis resulting in hypothyroidism or hyperthyroidism. Also thyroid cancer has nodule and therefore is easily confused as to how to differenciate from other thyroid disease. So that, the thyroid cancer is one of the most debated of all neoplasms in terms of biology, the course and growth, precancerous lesions, surgical treatment and prognosis related to histopathological type. Multiple reports can be found to support almost any thyroid diseases related to malignancy, frequency, etiological factors, age distribution, prognosis and surgical treatment, etc. There are several reports on thyroid disease including cancer among Koreans based on clinical and statistical aspects, but there is no report of thyroid disease based on histopathological aspects in Korea. The present studies have surveyed the records of patients with thyroid disorders seen at Severance Hospital from 1960 to 1971. The incidence and pathological classification of all thyroid diseases among Koreans were investigated, and comparison with pathological diagnosis and clinical diagnosis, the incidence of malignancy in cold nodules of scanning, relationship between the malignancy and lymphocytic infiltration and calcification were observed. Materials and Methods ; The materials used in this study consist of surgically resected thyroid tissues for 12 years from 1960 to 1971. All specimens were fixed in 10% formalin. Grossly, the location and size of the tumor were examined. For histologic examinations, paraffin embedded blocks were cut in 5-6u thickness and sections were stained by hematoxylin eosin method. Histopathological studies on all thyroid diseases are performed as follows : 1. Histopathological classification of Thyroiditis by Hazard (1955). Goiter by Robbins (1967). Adenoma by Meissner and McManus (1953). Carcinoma by Hare and Salzman (1950). 2. Functional status. 3. Lymphocytic infiltration and calcification. For the all cases of thyroid diseases whose clinical records were available, sex, age, chief complaints, duration, location and size of lump, clinical diagnosis. type of treatment were reviewed.
Results
and Summary ; Clinical and histopathological studies were made on 446 surgically removed tissues of thyroid lesions, that were submitted to the department of pathology, Yonsei University College of Medicine, during the period of 12 years from 1960 to 1971. The following results were obtained. 1. Among 446 cases, 397 cases were female and the ratio of male and female thyroid disease was 1 : 8.1. In all cases observed, 199 cases (43.3%) adenoma, 130 cases (29.1%) goiter, 193 cases (20.9%) carcinoma, 24 cases (5.4%) thyroiditis were included. 2. The average age of adenoma was 34.2 year-old, nontoxic goiter 37.2, toxic goiter 37.8, carcinoma 41.2, thyroiditis 44.6. 3. The most common complaints of thyroid diseases was a mass(94.2%). The other clinical symptoms in order of frequency were palpitation, dyspnea and cough etc. 4. The average duration of chief complaint of thyroid carcinoma was 4.0 years, adenoma 3.5 years, goiter 1.9 years and thyroiditis 3. 1 years. 5. The comparison of the size of adenoma with that of carcinoma was not significantly different. The average size of adenoma was 4.6 cm and carcinoma 4.7 cm. 6. Among 28 cases of scanning, 18 cases (64.3%) were cold nodule in which 11 cases were adenoma in pathological diagnosis. 7. Some of clinical diagnosis was different from pathological diagnosis. Correct diagnosis of carcinoma was 35.1%, adenoma 31.9%, goiter 80.0% and thyroiditis 6.7%. 8. Histopathologically all of thyroiditis were chronic thyroiditis except one case that was acute suppurative thyroiditis. Hashimoto’s thyroiditis was 50% of all chronic thyroiditis. 9. Histopathologically nontoxic goiter comprises about 76.2% of all goiters. Nontoxic nodular goiter is 70.8% of all goiters. 10. Histologically follicular type comprises about 93% of adenoma. Most of follicular type consist of fetal type (37.8%) and colloid type (37.3%). 11. Histologically, papillary carcinoma is 60.2% of all carcinoma. There is no relation between type of thyroid carcinoma and lymphocytic infiltration. Among 76 cases with papillary growth carcinoma, calcification was observed in 38 cases (50%).

Clinical and Histopathological Studies on Tumors of the Small and Large Intestine among Koreans: Woon Sup Han, Yoo Bock Lee, Dong Sik Kim; J Pathol Transl Med. 1973;7(1):47-62.

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Abstract: The tumors of the small and large intestine have been investigated by many workers in both clinical and pathological aspects. It is of interest that although the small bowel comprises the longest portion of the alimentary canal primary tumors in the small bowel are rare (Botsford and Seibel, 1947 ; Darling and Welch, 1959). However, among the tumors of the small bowel, malignancy is more common than benign tumor, and the former consists of adenocarcinoma, lymphosarcoma, carcinoids, etc. The carcinoma of the large intestine in the most frequent malignant tumor throughout the gastrointestinal tract in the U.S.A. But the incidence of this tumor was preceded by the carcinoma of the stomach in Korea(Lee et al., 1965 ; Kim, et al., 1967). The incidence of carcinoma of the colon and rectum in the Asian and African countries is less high than that of the Europe and America(Burkitt, 1971). Carcinoma of the large bowel occures mostly in the 5th and 6th decade of life. In the right colon carcinoma grows as fungating mass, while the distal colon shows "napkin-ring" configuration. The prognosis of a patient with cancer of the large bowel is dependent upon the progess made by that lesion up to the time of operation. The spread may occur through the lymphatics, by direct extension and by the blood stream. Dukes (1932) devided his cases of carcinoma of the rectum into three groups : Type A ; limited to the rectal wall without nodal involvement Type B ; penetrating through bowel wall into adjacent tissue without nodal involvement. Type C ; penetrating through bowel wall with nodal involvement. This classification by Dukes has been adopted as a useful prognostic guide in dealing with carcinoma of the large bowel, and its modifications were also reported. The polypoid lesions of the large bowel can be identified to be adenomatous polyp, villous adenoma, etc. The adenomatous polyp is almost always benign, the incidence of malignancy being less than 1 per cent. Villous adenoma is premalignant, the incidence of malignancy varying from 5 to ,50 per cent, depending upon the series quoted. But some investigators suggested that these two lesions were growth variants of the same tumor (Hellurg, 1963 ; Hertz, et al., ; Ross and Ferrara) There are several reports on carcinoma of the colon and rectum in Korea, which based on clinical and statistical aspects. The present study is attempt to investigate mainly histopathological characteristics and to compare with reports of other countries, and extent to tumors of the small bowel as well as those of the large intestine. Material and Methods ; The material used in this study consists of 408 surgically resected or biopsied tissue from tumors of the large and small bowel for 12 years from 1960 to 1971. At first gross examination was made to observe size, location and growing characteristics of tumors. Regional lymphnodes were dissected and obtained as possible as we could. All specimens were fixed in 10% formalin. For histological examinations, paraffin embedded blocks were cut in 6 micron thickness and sections were stained by routine hematoxylin-eosin method. Histopathological studies on the cases available for microscopic examination are performed as follows : 1. histopathological grading of carcinoma of the large bowel according to the Broders grade (1925) except the mucoid carcinoma was made ; 2. The grades were compared with metastasis to regional lymphnodes of carcinoma of the large intestine and also with venous or lymphatic invasion by carcinoma of the large bowel. ; 3. The carcinoma of the large bowel were classified as the Dukes’classification and stagings by Smith’s method were also made, and then they were made a comparison in relation to each grade of carcinoma. ; 4. The influences of size of carcinoma of the colon and rectum on metastasis to the regional lymphnodes ; 5. The influences of the growing pattern of the tumor margin, infiltrating or pushing, on metastasis to the regional lymphnodes ; 6. The tumors of the small bowel devided into benign and malignant tumors with location of the tumor. At the duodenum carcinomas arising from the ampullar of Vater were included in this study ; 7. The benign tumors of the large bowel also were classified in histopathological findings and associated malignant change was considered in the polyp. For the all cases which clinical redords were available, sex, age, chief complaints, duration of symptom and value of the serum hemoglobin were reviewed. The duration of recurrent carcinoma, of the large bowel was studied in relation to the staging in which readmissions for the treatment of 5-F. U. were not included.
Results
and Summary ; Clinical and histopathological studies were made on 408 surgically removed cases of tumors of the small and large intestine that were submitted to the Department of Pathology, Yonsei University College of Medicine, during the period of 12 years from 1960 to 1971. 1. Among 41 cases of tumors of the small intestine, 37 cases were malignant tumors and the ratio of malignancy and benignancy was 9.5 : 1. 2. Peutz-Jeghers syndrome was found in benign tumors of the small bowel. The malignant tumors of the small intestine consisted of 11 cases of adenocarcinoma, 16 cases of lymphoma, 2 cases of carcinoid, 1 case of undifferentiated carcinoma and 7 cases of metastatic malignant tumors. 3. The lymphoma occurred at the ileum in total 10 cases. The carcinoids throughout the large and small intestine had its origin in extraappendiceal areas, and it showed difference from the reports of the foreign countries. 4. The ratio of the benign tumors and malignant tumors in the large intestine was 1 : 4.8. And also the ratio of the malignant tumors of the large bowel and those of the small bowel was 8.3 : 1. 5. The adenomatous polyps occupied 85.9% of the benign tumors of the large intestine and 93.7% of them occurred at the rectum. The 34 cases of the benign polypoid lesions of the large intestine were less than that of 1.5cm in its diameter. 6. The malignant tumors of the large intestine were 4.3% of the total malignancy of surgical specimens for the same period. 7. Carcinoma of the large intestine showed different clinical symptoms according to the location. 8. The size of carcinoma of the large bowel had no much influence on the metastasis of the regional lymphnodes. 9. The grade of carcinoma of the large intestine had much effects on the venous or lymphatic invasion by carcinoma and also metastasis of the regional lymphnodes. 10. Stage 0 was not identified in the cases examined and the higher the stage of carcinoma of the large intestine was, the higher the grade was. 11. The characteristics of local spread of carcinoma, infiltrating margin or pushing margin, gave much effects on the metastasis to the regional lymphnodes. 12. The tendency was seen that the recurrent period in less advanced stage of carcinoma was a little short, compared with more advanced atage. In conclusions. based on above findings it can be stated that it is important to observe venous or lymphatic invasion by carcinoma, metastasis of the regional lymphnodes and to make stage of the patient of carcinoma in the large bowel. In this study the carcinoma of the large bowel showed relatively advanced stage, and among the tumors of the small intestine the carcinoid had different location from that reported at foreign countries.

The Effect of Cortisone on Transformation of Sensitized Allogenic Rabbit Thoracic Lymphocytes in Diffusion Chamber: Bon Young Koo, Sung Kyu Choen, Je Sun Kim; J Pathol Transl Med. 1973;7(1):63-69.

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Abstract: The method of diffusion chamber cultivation was found to be appropriate to observe the potentialities of lymphocytes (Schelton & Rice, 1959 ; Schooley & Berman, 1960 ; Holub, 1958, 1960, 1962), The possibility of separating practically pure suspensions of small thoracic duct lymphocytes enabled us to observe directly the nature of these cells. Holub confirmed that the small lymphocytes from rabbit thoracic duct lymph cells were found capable of being changed to antibody-producing plasmacytoid cells morphologically and functionally when homotransplanted either with or without protein antigen. Bai & Kim (1972) observed the effect of cortisone on the transformation of autologous small lymphocyte of rabbit in diffusion chamber inserted intraperitoneally and confirmed that there was transformation of small lymphocyte into blastic form. Park and Kim (1972) reported allogeneic thoracic lymphocytes in diffusion chamber in cortisone treated rabbits were transformed to blastic form. We made an attempt to observe the effect of cortisone on transformation of eggalbumin sensitized allogeneic rabbit thoracic lymphocyte in diffusion chamber following resensitization. The results were as follows : Sensitized allogeneic thoracic lymphocytes in diffusion chamber were decreased in total number following challenge either by means of intraperitoneal injection or local administration of the same antigen respectively, and/or following those treatment plus injection of cortisone. The transformations into blastic forms were prominent only of the lymphocytes in the challenged group by means of intraperitoneal injection of the same antigen.

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