Journal of Pathology and Translational Medicine

Volume 12(2); July 1978

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Cellular Response of Chemically-induced Hepatoma Cells 1. Effect of Pattial Hepatectomy on the Formation of Chemically-induced Hyperplastic Nodules: Sung Keun Chang, Soo Young Lee, Young Che Kim; J Pathol Transl Med. 1978;12(2):109-115.

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Abstract: Cancer of the liver is the fourth most prevalent (4.75%) of all malignant tumors among Koreans, whereas in the United States and Europe, the prevalence is about 0.2 to 0.7%. Both aflatoxin and dimethylaminoazobenzene are widely used as the hepatoma- inducing agents in laboratory animals. Epidemiologic studies show correlation between the incidence of hepatoma in specific locales and the apparent content of aflatoxin in diet (Alpert et al., 1968, 1969). Kim et al. detected aflatoxin B1 B2 G1 and G2 in Meju and Doenjang, both of which are Korean-style foodstuffs, the former is a naturally inoculated soybean substrate for soy sauce and paste fermentation, and the latter is a Korean style fermented soybean paste. We made an attempt to observe the difference between the incidence of hyperplastic nodules and the mode of tumor growth in the liver of rats, which were administered aflatoxin B1(APB1) and p-dimethylaminoazobenzene (DAB) by means of intubation into the stomach, and the effect of partial hepatectomy on them. Male Sprague-Dawley rats, 180 to 220 gm. in weight were used exclusively. Each animal received 37.5㎍ of aflatoxin B1 or 5 ㎎ of p-dimethylaminoazo- benzene in 40 doses over 8 weeks. Partial hepatectomy was performed after feeding for 6 weeks and consisted of the anterior median lobe. The increase of body weight, the incidence and site of hyperplastic nodules, and the rates of liver regeneration after partial hepatectomy, were observed 2, 4, 6, 8, 10, 12, 14 and 18 weeks after the initiation of carcinogen-feeding. The result were as follows: 1. The increase of body weight of the rats which received carcinogens (AFB1 and DAB) was delayed in comparison with that of normal rats and that of the partially hepatectomized rats which received carcinogens was also delayed for the first 2 weeks and thereafter accelerated in comparison with that of the rats which received only carcinogens. 2. Carcinogens (AFB1 and DAB) inhibited the regeneration of the liver following partial hepatectomy. 3. The incidence of hyperplastic nodule of the liver in rats which received AFB1 was higher than that of the rats which received DAB, and partial hepatectomy seemed to be the cause of the formation of hyperplastic nodules in AFB1 group.

The Study on Cytopathologic Diagnosis in Benign and Malignant lesions of the Stomach: Dae Yung Kang; J Pathol Transl Med. 1978;12(2):117-126.

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Abstract: In order to evaluate cytologic diagnosis in benign and malignant lesions in the stomach, 91 unfixed gastrectomized specimen were studied, which were submitted to department of pathology, Chungnam National University School of Medicine from January 1976 to September 1976. The cytologic smears were taken from central portions and margins of the ulcer of the lesions, and compared with that of histologic pattern, with clinical consideration. The results obtained were as follows ; 1) 91 cases were consisted of 40 carcinomas (44.O%), 39 benign peptic ulcers (42.9%) and 12 gastritis with other diseases (13.1%). 2) Among gastric carcinomas, there were noted 4 early gastric cancers originated from primary chronic peptic ulcers, which were not detected clinically. 3) Sex distribution of stomach cancer was 26 males (65%), and 14 females (35%) having 1.9 : 1 ratio. Age distribution of stomach cancer was showing the highest in 6th decade ; 23 cases (57.5%). 5th decade ; 10 cases (25.0%), and more than 80% were noted from 40 year to 60 year-old age groups. 4) Sex distribution of chronic peptic ulcer was consisted mainly of male cases showing 37 cases of a total 39 patients(94.9%). Age distribution was the highest in both 4th decade 12 cases (30.8%), and 12 cases (30.8%) in 5th decade. 5) The average diameter of malignant ulcers was 3.0-3.9cm in 14 cases(35.0%), and 6 cases were more than 5.0cm in diameter. In benign peptic ulcer, most frequent average size was 1.0-1.9cm in 16 cases (4l.0%) and there was no case measuring over 5.0cm in diameter. 6) The most malignant ulcers were located along the lesser curvature of the greater curvature of the stomach. The peptic ulcer, also, were located most frequently along the lesser curvature of the anturm in 32 cases (82.1%). 7) Cytologic diagnosis smeared from center and margins of the malignant ulcers was positive in 85%, but that smeared from peripheral portions of the lesion was positive only in 27.5% of cases. 8) The positive diagnosis in well differentiated and moderately differentiated type of the stomach cancer was 100%, and showed one case of pseudonegative in 18 cases of poorly differentiated type. 9) The doubtful cytologic diagnosis in chronic peptic ulcers was 16 cases (4l.0%), and those were associated with chronic gastritis or with marked intestinal metaplasia with atypical glandular hyperplasia.

Clinical and Histopathological Studies on Soft Tissue Tumors: Tae Jung Kwon, Jae Yun Ro, Yoo Bock Lee, Dong Sik Kim; J Pathol Transl Med. 1978;12(2):127-147.

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Abstract: Soft tissues which are most widespread in body have common mesenchymal derivation and comprise a variety of more differentiated specific and undifferentiated nonspecific types. In general the cell types of the tumors of the soft tissue tend to closely resemble to a variable degree their prototype tissues. However, often, because of their pleuripotentiality and common mesenchymal derivation they show wide morphological range and may present similar growth characteristics lacking in morphologic individuality. Therefore classification of soft tissue tumors on a histogenetic basis is not easily accomplished and controversy concerning the classification has existed for years. Stout (1966), Enzinger (1969), Shuman (1971), Ackerman (1974) erall have made valuable contribution to the understanding of many of the soft tissue tumors by a variety of the special diagnostic techniques which brought about great advances in the classification and more accurate microscopic diagnosis of soft tissue tumors. However, there is no comprehensive report on soft tissue tumors among Koreans based on clinical and histopathological aspects. The present study is an attempt to refine classification of the soft tissue tumors, to investigate Clinico-histopathological characteristics and diagnostic values of selective special stains which seem to be helpful in differential diagnosis. Material and Method : The materials used in this study consisted of 502 cases of benign and malignant tumors of soft tissue origin for 6.5 years period lasting from 1971 to 1977. The histopathological study was attempted by microscopic examination following gross inspection, and tinctorial characteristics of selective special stains uire investigated. For all cases of soft tissue tumors whose clinical records were available, age, sex, location, chief complaints, duration, size, multiplicity, therapeutic modality, recurrence were investigated.
Results
and Summary : Based on clinical and histopathological studies of 502 cases of benign and malignant tumors, which were submitted to the Department of Pathology, Yonsei University, College of Medicine during the period of 6 years and 5 months from Jan., 1971 to May, 1977, following results are obtained. 1. Among 502 cases, 431 cases (85.9%) were benign and 71 cases (14.1%) were malignant, with ratio of approximately 6 : 1. 2. Lipoma was the most common benign soft tissue tumor, followed by hemangioma Iymphangioma, and neurilemoma. Among the malignant tumors fitrosarcoma was the ’most common, followed by liposarcoma, and Rhabdomyosarcoma. 3. The sex distribution of benign tumors showed slight female preponderance (1.3 : 1), but that of the malignant tumors was about 3 times more common in males than in females. 4. The age of benign tumors was rather evenly distributed from childhood to advanced age, while the majority of malignant tumors developed in adult age group. 5. The predilections for the benign tumors were head, neck and trunk, while those of the malignant tumors were lower extremity and trunk. But the specific predilection sites differed according to the histological types. 6. The clinical course of malignant tumors was rapid compared to benign ones. 7. Most of the benign tumors were fairly well controlled by local excision, but for the malignant tumors therapeutic modalities such as wide excision, chemotherapy and radiotherapy were used. 8. The special stains provided great diagnostic aid, but other specific diagnostic techniques such as electron microscopy, tissue culture and enzyme study were desired to accomplish more accurate microscopic diagnosis.

A Morphological Study of Endodermal Sinus Tumor: Jae Yun Ro, Chan Il Park, Chung Sook Kim, In Joon Choi, Yoo Bock Lee, Dong Sik Kim; J Pathol Transl Med. 1978;12(2):149-157.

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Abstract: Endodermal sinus tumor or yolk sac carcinoma occurs with great frequency in both male and fema1e gonads, but has been described sporadically in extragonadal locations as well. The histologic features of 15 cases of endodermal sinus tumor arising from testis (8 cases), ovary (5 cases) and presacrum (2 cases) were presented, and in an effort to delineate the histogenesis, the light and electron microscopic findings were compared to that of yolk sac obtained from five normal pregnant rats. The two Patients with presacral endodermal sinus tumor were female. The mean age of the patients with endodermal sinus tumor was 13.1 years, 8 being under the age of 5 and only one over 30. The histologic appearances of the 15 tumors were essentially similar showing loose mucinous stroma mimicking the magma reticularis and PAS-positive, diastase-resistant hyaline globules. The pseudo-papillary pattern, in which Schiller-Duval bodies were abundant, and which was considered as the clue for histological diagnosis in the present series, was predominant in 5 cases (33.3%). The reticular pattern was predominant in 6 cases (40.0%), whereas no one showed the polyvesicular vitelline structure or solid pattern as prominent picture. 4 cases (26.7%) of the endodermal sinus tumor showed mixture of the pseudopapillary and reticular patterns. The light microscopical features of normal rat yolk sac were similar to that of human endodermal sinus tumor, except the lack of polyvesicular vitelline structure. The most prominent ultrastructural feature of the tumors was the presence of volum inous basement membrane like material in both intra- and extra-cellular location, corresponding to the PAS-positive hyaline globules seen in these tumors by light microscopy, and the appearance of skein-like nucleolema. Other ultrastructural findings were also similar in human endodermal sinus tumor and normal rat yolk sac. These findings suggest that yolk sac tumor is a peculiar germ cell origin having a property to differentiate to yolk sac.

A Histochemical Study on Acid Mucopolysaccharide of the Uterine Cervix with Carcinoma and Chronic Inflammation: Han Chul Son, Soon Ho Kim; J Pathol Transl Med. 1978;12(2):159-168.

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Abstract: In an attempt to elucidate the state of acid mucopolysaccharide of uterine cervix with carcinoma and chronic inflammation, the author examined histochemically 27 cases of the squamous cell carcinoma and 62 cases of chronic cervicitis with erosion, squamous metaplasia or dysplasia. These were obtained by total hysterectomy and biopsy in Busan National University Hospital during the period of 1975 and 1976. By the examination the following results were obtained : 1. In the mucosa of the chronic cervicitis the surface epithelium did not containe acid mucopolysaccharide. 2. In the mucosa of the chronic cervicitis the metaplastic and dysplastic squamous epithelium contained very small to small amount of acid mucopolysaccharide, but the malignant squamous cells did not contain acid mucopolysaccharide. 3. The surface columnar epithelium in the mucosa of the chronic cervicitis contained more large amount of the acid mucopolysaccharide than that of the non-cancerous tissue of the cervical carcinoma. 4. The acid mucopolysaccharide of the glandular epithelium was not significantly different in amount between the mucosa of the chronic cervicitis and the non-cancerous tissue of the cervical carcinoma. On the basis of mentioned above, it may be somewhat helpful to examine the state of acid mucopolysaccharide of the cervical mucosal epithelium in differentiation between the cervical carcinoma and chronic cervicitis with metaplasia or dysplasia.

Biosynthesis of Plasma Protransglutaminase (Blood Coagulation Factor XIII): Soo Young Lee, Young Che Kim; J Pathol Transl Med. 1978;12(2):171-174.

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Abstract: Transglutaminase from its zymogen, blood coagulation Factor XIII, catalyzes the covalent intermolecular polymerization of fibrin through formation of ε (γ-glutamyl) lysine crosslink. In recent years, considerable progress has been made in understanding the molecular and catalytic Properties of Factor XIII. However, the metabolic aspects of Factor XIII under various physiological conditions are not fully understood. Lee and Chung (1976) elucidated that plasma protransglutaminase is synthesized in hepatocytes. In this report we observed the mode of synthesis and the secretion of plasma pro-transglutaminase in vivo. Rabbits were used as the experimental model. The results were as follows : 1. Both a and b-chains incorporated by [75Se] -L-methionine in the liver showed their maximum values at 30 minutes after [75Se] -L-methionine infusion, then the values continued to decrease up to 2 hours, followed by plateau of 4 hours, whereas those in the plasma rapid1y increased up to 3 hours, and then showed a plateau. Plasma fibrinogen showed the same pattern as that of plasma protransglutaminase. 2. B-chains were formed and secreted at a much larger rate than a-chains. 3. Protransglutaminase was formed and secreted at a much larger rate than fibrinogen.

Syphilis Serology with VDRL and TPHA: Chang Hwan Bae, Kyung Sun Kim, Jae Sik Kim, Jyung Myung Kim; J Pathol Transl Med. 1978;12(2):175-178.

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Abstract: Forty five cases consisting of 42 cases of VDRL positive sera and 3 cases of VDRL negative sera were compared to TPHA test. Thirty four cases (81.0%) of 42 positive VDRL sera were TPHA positive and consider -ed to be syphilis. Eight cases (19.0%) of 42 positive VDRL were TPHA negative and considered to be non-syphitic. However one case of 8 negative TPHA was exception. This case was syphilis on the diagnosis and was receiving antisyphilis therapy showing remarkable lowering of serologic titer in VDRL. Three cases of negative VDRL showed also negative TPHA. The agreement between VDRL and TPHA was 91.8% .

A Case of Congenital Acute Lymphocytic Leukemia: Wha Soon Chung, In Pil Kim, Choon Won Kim, Ki Hong Kim; J Pathol Transl Med. 1978;12(2):179-184.

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Abstract: Leukemia is not uncommon disease of infant and children. The incidence in 0- to 4-year old range is estimated at 5 per 100,000 and the over all incidence at 1 per 15,000. However, since acute leukemia in newborn infants extremely rare and also because of its dramatic appearance and the unexpected sudden death, we have presented a case of congenital acute lymphocytic leukemia in an infant of 45 days of age. The infant was apparently well until forty fifth day of life when he suffered from symptom of URI with fever and noticed abdominal huge palpable mass. At this time, total white blood cell count was highly elevated, 198,000 per cu mm(lymphocyte : 72%, segmented neutrophil : 3%, myelocyte : 2%, prolymphocyte: 12%, lymphoblast : 11%). Hemoglobin was 6.3 g/dl, hematocrit was 20%, and bone marrow finding revealed mainly blast form with immature lymphocytes. Finally, we diagnosed the case as congenital acute lymphocytic leukemia. A review of literature briefly was done.

A Case of Paroxysmal Nocturnal Hemoglobinuria: C.H. Bae, K.H. Shin, K.S. Kim, J.S. Kim, J.M. Kim; J Pathol Transl Med. 1978;12(2):187-192.

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Abstract: Clinical and laboratory observation were made in a case of paroxysmal nocturnal hemoglobinuria(PNH). The patient was 20-years old male college student, who was admitted with chief complaint of general weakness with dyspnea on exertion and dark brown urine. The peripheral blood revealed severe anemia with reticulocytosis, moderate increased bilirubin, positive Ham’s test and positive on sucrose hemolysis test. Marked homoglobinuria and hemosiderinuria on urinalysis and the bone marrow aspiration showed normocellular with markedly erythroid hyperplasia. The findings of chest X-ray and ECG were in normal limits. He was treated with packed cell transfusion and dischared with clinical improvement of hemoglobinuria.

Two Cases of Adenocystic Carcinoma from Lacrimal Gland in Orbital Cavity: Tae Teal Choi, Choon Won Kim, Ki Hong Kim; J Pathol Transl Med. 1978;12(2):193-197.

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Abstract: Adenocystic carcinoma of orbit is usually originated from the lacrimal gland, and comprises above than 60% of all malignant tumors found in the lacrimal gland. It is highly invasive and spreads along the nerves and blood vessels. Two cases of adenocystic carcinoma of orbit discovered in the Han Yang University Hospital in January, 1975 and September, 1977 are presented. The first case is found in a 46 year old man who complained of right side exophthalmos, diplopia and impairment of eye movement. The tumor mass including eye ball with optic nerve are removed. The size of tumor mass measures 4×3×2cm in dimension, located on the superior and posterior side of the eye ball and extend along the optic nerve. The tumor mass shows ill defined from normal lacrimal gland, but which is clearly demarcated from eye ball by sclera. The tumor consists of irregularly shaped masses of cells in a rather scanty connective tissue stroma. Numerous cystic or a1veo1ar spaces are presented in the cell mass, giving rise to cribriform effect which is very characteristic feature of this neoplasm. The second case is found in a 29 year old woman whose chief complaints are right sided exophthalmos and a palpable mass. The size of tumor mass is 4×3×2cm, which is covered with thin capsule. Histologic findings are also quite similar to that of case 1

A Case of Coccidioidomycosis: Tae Yeal Choi, Choon Won Kim, Ki Hong Kim; J Pathol Transl Med. 1978;12(2):199-205.

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Abstract: A coccididomycosis is a kind of systemic fungal infection, respiratory in origin, that spreads hematogeneously to skin, subcutaneous tissue, bone, CNS, and other organs. The author here present a case of systemic coccidioidomycosis with skin involvement which has been found in Dec. 1974, for the first time in Korea. The coccidioidomycosis is proved through skin biopsy and mycotic culture from skin lesion. The patient was 57 year old Korean male whose occupation was a cattle breeder. The skin lesion on left extremity showed several skin colored or light brownish papules and surrounding circular erythematous scaly patches with slightly elevated borders. The patient also found to have diabetes mellitus and resultant neuropathy. Histologic picture of skin biopsy showed granuloamatous lesion in the upper dermis and numerous spherules both inside and out side of giant cells. Mycologic culture from grind skin specimen on Sabouraud’s agar showed snow white colony and typical arthrospres.

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