Journal of Pathology and Translational Medicine

Volume 6(2); December 1972

Etcs

Histopathological study on chronic congestive splenomegaly: Chung Hee Chi; J Pathol Transl Med. 1972;6(2):115-122.

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Abstract: The spleen consisted of mesenchymal tissue mainly with splenic cord is specific organ on the circulatory point of view that communicating to the portal system and bearing quite characteristic structure different from ordinary capillaries playing a role as terminal route of end circulation where arteriovenovs shunt exists. And changes in splenic cord is sensitively occur under variable conditions. It is quite natural that circulatory disturbance in portal system giving rise considerable influence to the splenic histologic architecture. A number of previous reports for normal anatomical and structural studies on splenic cord (1, 3, 4, 5) are rather limited to cellular component in splenic cord and not extended to the changes of lattice fiber in process of demolishing or reconstructing pattern in congestive splenopathy. Koboth’s study on splenic cord by reconstruction of tissue sections revealed regular arrangement of lattice fiber that contributed to basic ideal pattern to be investigated to understand pathological changes in chronic congestive splenopathy (splenomegaly). Material and Method: Among 98 autopsy cases (male-72, female-26) associated with underlying cause of hepatic diseases, examined at the National Medical Center during the period of last 10 years from 1958 to 1968, 50 cases (male-39, female-11) of chronic congestive splenomegaly were selected and classified by sex, age and in disease group. Also statistical study on correlation between liver and spleen in weight was made. For histopathologic findings ordinary paraffin section of Hematoxylin Eosin(H-E) staining, Masson’s Trichrom(collagen), Weigret Elastic Van Gieson (Elastic fiber), and Grocott Methenamine-Silver (Lattice fiber) staining were performed to observe the changes of lattice fiber in splenic cord during the course of hepatic diseases with splenomegaly.
Result
1. Age on motality showed no significant difference in sex. Age distribution in disease group reveal hepatic abscess 5-29y, hepatoma 35-55y, cirrhosis 9-59y, and average 24.5, 34.2 and 44.5 year respectively. 2. No remarkable sex difference is noted in frequency of hepatic abscess. But cirrhosis group showed ratio of 25 : 8 (male: female) and hepatoma group 13 : 1 with dominant incidence in male. 3. In cirrhotic group average of liver and spleen with standard deviation are as follows 933.34±268.74g., 470.83g±225.42g. and reveals moderate atrophy or shrinkage of liver and splenomegaly. Correlation coefficient between liver and spleen is r= -0.25 indicating slight reverse correlation. Regression line quotent spleen(χ) to liver(y) and liver to spleen is χ= 668.23-0, 12ｙ, and ｙ= 1074.87-0.30χ respectively. 4. In hepatoma group average weight of liver and spleen with standard deviation are as follows 2354.56g±688.04g, 265.91g±87.43g. and reveal pronounced hepatomegaly associated with mild splenomegaly. Correlation coefficient between liver and spleen is r= -0.41 presenting slight reverse correlation. Regression line quotent spleen to liver and liver to spleen is χ= 658.23-0.21y, and ｙ=1074.87-0.30y respectively. 5. Hematoxylin-Eosin stain revealed no definite structural alteration except sinusoidal distension, endothelial proliferation, widening of splenic cord and periarterial fibrosis in Malpighian corpuscles. 6. Alteration of lattice fiber is quite characteristic with dissociation of GF (Grenzfaser), fine network formation, nextly forming small sinuses dividing in to splenic cord, from which histologic architectural changing process in splenomegaly due to portal hypertension is partly explainable. 7. Senile spleen with ordinary hematoxylin-Eosin (H-E) stain showed no much difference from mild degree of splenomegaly. However, silver staining for lattice fiber reveals further complicating findings than splenomegaly with atrophy or destruction of cord bearing fragmentation of R.F. and demolishing of Mgm, and Mmf. No evidence of newly forming sinuses is noted. 8. Special staining employed for collagen and elastic fiber had not given much contribution on the histological study of splenomegaly.

A Study on H.A.A. and Liver Function Tests in Professional Donors and Viral Hepatitis Patients: Moon Hyang Park, Sung Yong Paik; J Pathol Transl Med. 1972;6(2):125-133.

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Abstract: The author has performed H.A.A. and liver function tests with sera from 200 Korean male professional donors and 41 viral hepatitis patients to understand the frequency of H.A.A. in both group and relation between H.A.A. and liver function test. The results were as following: 1. H.A.A. was detected in 10% of Korean professional blood donors. 2. The incidence of H.A.A. positivity was 14.6% in the adult viral hepatitis. 3. In H.A.A. positive donor group, significant increase in mean value and frequency of abnormal value than H.A.A. negative donor group was noted in T.T test. 4. In H.A.A. positive viral hepatitis group, increase in mean value and frequency of abnormal value than H.A.A. negative hepatitis group was noted both in alkaline phosphatase activities and γ-globulin content.

Clinico-pathologic Studies of the Liver Biopsies among Koreans: Chan Il Park, Yoo Bock Lee, Dong Sik Kim; J Pathol Transl Med. 1972;6(2):135-148.

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Abstract: Liver is, of course, a most important organ biochemically and physiologically, and if we consider the wide range of diseases involving the liver, the importance must be emphasized again in pathological field. But still the etiology and/or pathogenesis of some hepatic lesions especially cirrhosis have not been clearly understood, and so classification of liver cirrhosis has not hither to been solved. Furthermore, in the clinical aspect, the performance of needle biopsy has been rising for the physicians’needs to confirm the provisional impression by tissue diagnosis. Therefore difficulty in the diagnosis of the needle biopsied liver tissues has become a problem to the pathologists. Meanwhile, in Korea, in spite of the high incidence of liver diseases probably due to the average low protein diet which would result in decreased states of the liver function, results of other races who were different in cultural and environmental back ground have frequently been cited because of the rarity of exact records on the whole liver diseases among Koreans. Considering the above subjects, this study is to provide the incidence of liver diseases and to ensure the frequent occurrence of primary liver carcinoma in Korea, on morphological basis Materials and Methods ; The materials used in this study consisted of 951 liver biopsies obtained during the period from Jan., 1960 to Jun., 1971. For histologic studies, the specimens filed with 10% formalin were followed by paraffin embedding and were cut in 6 μ thickness. Sections were stained with hematoxylin-eosin for routine examination, and the biopsies obtained since May, 1970 were all stained with in addition to hematoxylin-eosin, Gomori’s silver impregnation for lobular architecture and reticulin pattern and Masson’s trichrome for connective tissue. Stains for bile or iron were also done in cases of needs. Histopathological classification was made as follows for convenience, 1. diffuse hepatitis, 2. liver cirrhosis, 3. neoplasm and 4. miscellaneous diseases. Diffuse hepatitis included acute hepatitis, chronic active and inactive hepatitis, cholangiolitis neonatal hepatitis and nonspecific reactive hepatitis of Schaffner and Popper (1957, 1959) Liver cirrhosis was subclassified as macronodular, micronodular cirrhosis and biliary cirrhosis by the size and shape of the cirrhotic nodules(Popper and Schaffner, 1968; Scheuer, 1970). On the macronodular cirrhosis, the degree of differentiation was made according chiefly to the evidence of parenchymal collapse or not, whether the cirrhotic nodules revealed resemblance of lobular pattern, and to whether the portal tracts and efferent veins could be identified or not. Based on the criteria of Popper et al. (1965), activity of the macro- and micronodular cirrhosis was also examined, which was then closely compared with serum transaminase level. Hepatoblastoma was inc]used to the primary carcinoma of the liver and was subclassified as epithelial type and mixed type (Ishak and Grunz, 1967 ; Ito and Johnson, 1969). Combined or associated pathology of the primary liver carcinoma was also examined. Congenital liver diseases, including intra- or extrahepatic biliary atresia, passive congestion, fatty metamorphosis, clonorchiasis and granulomatous diseases were all comprised in the misce]laneous category, because of their rarity. Clinical records and laboratory data were reviewed and compared with the tissue findings.
Results
and Summary ; Histopathological and clinical studies were made on 951 liver biopsies submitted to the Department of Pathology, Yonsei University College of Medicine, during the period from Jan., 1960 to Jun., 1971, and the results were as follows. 1. Among 951 liver biopsies, 827 (87%) cases were available for the study, excluding insufficient tissues. And big three hepatic diseases in Korea based on biopsy were diffuse hepatitis, liver cirrhosis and neoplasm, marking 33.0%, 27.9% and 24.8% respectively with the sum of 85.7%. 2. Diffuse hepatitis was encountered in 273 cases with the sex ratio of 2.5 : 1 and the average age of 41.5 year-old. More than half (141 cases) of the diffuse inflammatory lesions were chronic inactive and nonspecific reactive hepatitis. In contrast, acute hepatitis diagnosed by the tissue pathology was far less common (28 cases) and it was likely the cause that acute viral hepatitis was somewhat conventional clinically and the biopsy was frequently contraindicated when the patient was in icteric state. 3. Neonatal hepatitis was found in 13 cases and of them only 8 showed giant cell transformation of the liver cells. 4. Cirrhosis was encountered in 231 cases with the sect ratio of 5.2 : 1 and the average age of 48.8 year-old. 149 cases(64.9%) were regarded as macronodular and 45(19.5%) as micronodular cirrhosis. 5. 74 cases of macro-and 30 cases of micronodular cirrhosis were histologically active and the active one tended to show-more frequently the serum transaminase level of higher than 40 unit/cc. But the degree of increment in serum transaminase was not so remarkable even in the active form of cirrhosis, suggesting that piece-meal necrosis might be progressed slowly and step by step. 6. Neoplasm of the liver was diagnosed in 206 cases, 134 (65.0%) being primary carcinoma and most of the remainders metastatic tumor and anaplastic carcinoma. In primary carcinoma. male was far more commonly affected than female with the ratio of 5.1 : 1 and the mean age was 48.4 year old. Histopathologically 12.5 cases (60.7%) were hepatocellular and only 7 were bile duct type of carcinoma. 7. 24 cases of primary hepatocellular carcinoma showed, as associated pathological findings, cirrhotic changes which were mostly regarded as macronodular well differentiated. Although none of the seven cholangiocarcinoma was combined with cirrhosis, three of them were associated with histologic changes usually found in clonorchiasis. 8. Of the miscellaneous liver diseases, abscess ranked the first, most of which were regarded as nonspecific. And granulation tissue, pus, or collagenous wall was the only finding frequently observable in the needle biopsied tissue from abscess. In conclusion, it can be stated that in comparison to liver diseases of Europeans and Americans, those among Koreans examined on biopsied specimens exhibited quite different incidence, which may be the result of unusually high occurence of primary carcinoula of the liver, and that clonorchiasis, a common disease among Koreans, is closely related to the cholangiocarcinoma, and that the elevation of serum transaminase may be used for the clinical activity of liver cirrhosis.

Congenital Acute Myelocytie Leukemia -Report of An Autopsy Case Associated with Mongolism-: Hyun Sook Chi, Jung Bin Lee, Yong Il Kim, Sang In Kim, Hark Jin Chang*, Sang Woo Kim*, Chang Yee Hong*; J Pathol Transl Med. 1972;6(2):149-154.

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Abstract: An autopsy case of congenital acute myelocytic leukemia in a twelve day-old mongoloid male neonate is presented and discussed with brief literature review. It is assumed that this is a first proven and documented case in the Korean literature.

A Histopathological Study on Tumors of Central Nervous System: Hyun Soon Lee, Eui Keun Ham, Jong Man Kim, Sang Kook Lee; J Pathol Transl Med. 1972;6(2):157-167.

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Abstract: A histopathological study on tumors of central nervous system among Koreans was made of one hundred twenty cases of surgical material, obtained during a period of 10 years, 1962-1971, at the Department of Pathology, College of Medicine, Seoul National University, and followings are results; 1. Out of 89 cases, 45 male and 44 female, of intracranial tumors examined, 49 cases of them were benign and 40 malignant. Ages of the cases ranged from 6 months (retinoblastoma) to 65 years (primary intracranial sarcoma). 2. The highest incidence of histological type, out of intracranial tumors, was glioma (33.7%), even including astrocytoma (25.9%) in the high order of frequency in incidence. Average age incidences among the gliomas, were located in 24 years of low grade of astrocytoma, 26.1 years of glioblastoma multiforme and 28.3 years of ependymoma. And also encountered in most of them were no significant sex differences in their incidences, while in cases of glioblastoma multiforme male was more frequently affected with ratio of 8 : 3, than female. 3. Site distribution in various age groups showed anterior and middle fossas of intracranial cavity to be involved by 53 cases of intracranial tumors and 23 tumors in the posterior intracranial fossa, and the others 13 cases. Out of anterior and middle fossa tumors, incidences of histological type of tumors in 0-20 years age group were highest in astrocytomas and highest both 20-40 and over 40 years age groups in meningiomas. And out of posterior fossa tumors were highest incidences of 0-20 years age group both in meduloblastoma and astrocytoma and both 20-40 and over 40 years age groups in intracranial neurilemoma. 4. Out of 31 intraspinal tumors, incidence of histological type were high in neurilemoma (61%), thereafter astrocytoma (16%) and meningioma (13%), in orders of frequency. And out of them, site distribution showed thoracic portion to be involved 48%, in lumbar 19%, cervical 16%, sacral 10% and multiple levels 7%, respectively. 5. In this study on tumors of central nervous system, authors intended to observe retinoblastomas, pituitary tumors and even metastatic tumors, together with usual cerebro-spinal tumors. They were briefly discussed concerning with their onchogenesis in embryological aspect.

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