Journal of Pathology and Translational Medicine

Volume 22(3); September 1988

Original Articles

Immunohistochemical Application of Leukocyte Common Antigen and Epithelial Membrane Antigen in the Diagnosis of Large Cell Undifferentiated Tumors.: Chan Hwan Kim, Sang Sook Lee, Chai Hong Chung; Korean J Pathol. 1988;22(3):215-221.

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Abstract PDF: A total of 42 cases undifferentiated large cell tumors were stained by immunoperoxidase techniques using antibodies against leukocyte common antigen (LCA) and epithelial membrane antigen (EMA). In 18 of the 21 cases studied, initially diagnosed as malignant lymphoma or Hodgkin's disease, reactivity with monoclonal anti-LCA (and noreactivity with monoclonal anti-EMA)indicated that the tumor was a lymphomas. The remaining 3 cases gave the reverse reaction pattern and therefore were classified as carcinoma. One out of 16 cases diagnosed as undifferentiated carcinoma proved to be a case of mialignant lymphoma in 5 patients in whom the original diagnosis was uncertain, a definite diagnosis was possible in all cases and 3 of these proved to be large cell lymphoma; the remainders, undifferentiated carcinoma. It is suggested that the staining of undifferentiated human neoplasms using combinations of antibodies reactive with epithelial and lymphoid cells may result in much greater diagnostic accuracy.

Histopathological Studies of 300 Cases of Non-Hodgkin's Lymphoma in Korean Patients.: Hee Jeong Ahn, Soon Hee Jung, Hyen Joo Jeong, Dong Hwan Shin, Kwang Gil Lee, In Joon Choi; Korean J Pathol. 1988;22(3):222-231.

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Abstract PDF: Non-Hodgkin's malignant lymphoma is a relatively frequent lymphoreticular malignancy, and has been reported to constitute up to 5.2% of all malignant tumors in Korean patients. Various morphologic classifications of non-Hodgkin's lymphoma have been proposed, and among them, the Rappaport's classification has been most widely accepted. In 1982, a National Cancer Institute sponsored study on classification led to the creation of the Working Formulation in an attempt to resolve the controversy anddebate regarding the various classifications of non-Hodgkin's lymphoma. Angioimmunoblastic lymphadenopathy with dysproteinemia and polymorphic reticulosis are lymphoreticular proliferative disorders which have reported to transform to malignant lymphoma. The purpose of the present study is to reclassify non-Hodgkin's lymphomas according to the Working Formulation and to investigate the histopathological and immunocytochemical characteristics of angioimmunoblastic lymphadenopathy with dysproteinemia and polymorphic reticulosis. This study reviewed 300 cases of nodal and extranodal non-Hodgkin's lymphoma, 26 cases of polymorphic reticulosis, and 7 cases of angioimmunoblastic lymphadenopathy with dysproteinemia examined in the Departments of Pathology, Yonsei University College of Medicine, Youngdong Severance Hospital and Yonsei University Wonju College of Medicine from January 1977 to December 1986. In non-Hodgkin's lymphoma, each case was classified according to the Working Formulation and the Rappaport classification. All angioimmunoblastic lymphadenopathy with dysproteinemia and polymorphic reticulosis cases were subjected to histopathological analysis and a review of the clinical records. Immunocytochemical studies were done using kappa and lambda chains for B-cell markers and alpha-1-antichymotrypsin for histiocytic marker. The results obtained were as follows; 1) Among 300 cases of non-Hodgkin's lymphoma, the primarily involved tumor sites were the lymph nodes (141 cases), the gastrointestinal tract (67 cases), and the tonsils (32 cases) in descending order of frequency. 2) Using the Working Formulation, intermediategrade lymphomas occurred in 66.4% of the patients, and the most common subtype was "diffuse, large cell" (32.7%). By the Rappaport classification, 3 patients had nodular lymphomas, and "diffuse, histiocytic" was the most common subtype. 3) Infarction was present in 32 cases in which the "diffuse, lagre cell" type was most frequently associated. 4) In immunoperoxidase stains of 7 cases of angioimmunoblastic lymphadenopathy with dysproteinemia, proliferating immunoblasts revealed a polyclonal positivity for kappa and lambda chains. Atypical reticulocytes present in 26 cases of polymorphic reticulosis revealed a negativity for kappa, lambda and alpha-1-antichymotrypsin.

Clinicopathologic Analysis of Gastrointestinal Polyps.: Hye Rim Park, In Sun Kim, Seung Yong Paik; Korean J Pathol. 1988;22(3):232-243.

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Abstract PDF: Pathologists play an important role in proper evaluation of endoscopically removed polyps of the gastrointestinal tract. This study is purposed to reclassify the polyps and review the clinicopathologic features of each histologic subtypes and their malignant potential. Our material consists of total 345 gastrointestinal polyps obtained from Jan. 1986 to Dec. 1987. The results are as follows: 1) A total of 345 gastrointestinal polyps was removed from stomach is 151 cases, from colon in 180 cases, and from small intestine in 14 cases. 2) Hyperplastic polyps were the most common type of polyps I stomach (53.6%) whereas neoplastic polyps were the most common in colon (56.1%). 3) Hyperplastic polyps of the stomach occur in any age after the 3rd decade of life and neoplastic polyps predominantly developed between the 5th and 8th decades. Juvenile retention polyps were frequently noted before the 3rd decade of age. 4) Approximately 267 cases (77.4%) of patients had a single polyp and the remainders had multiple polyps. The gastric polyps were usually located at the antrum and the colonic polyps were at the sigmoid colon and rectum. 5) Epithelial atypia was exclusively noted in the neoplastic polyps of stomach (72.7%) and colon (72.3%). Malignancy in the polyp was observed in the neoplastic polyps only (13 cases). 6) Different types of polyp may occur in the same organ.

An Ultrastructural Cytochemical Study on the Mechanism in the Development of Fatty Liver Induced by the Orotic Acid.: Jae Bok Park, In Soo Suh, Tae Joong Sohn; Korean J Pathol. 1988;22(3):244-258.

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Abstract PDF: For the elucidation of a possible pathogenetic mechanism of fatty accumulation by the orotic acid in the liver, male Sprague-Dawley rats were fed on semisynthetic diet containing 1 per cent orotic for a week, and followed by the morphological examination on the rat livers. The experimental animals were sacrificed on the 1st, 2nd, 3rd, and the 7th days of orotic acid feeding and daily sacrifice was performed after conversion to normal diet feeding during the performed after conversion to normal diet feeding during the period of successive 7 days. The control group animals were fed on normal regular diet, or semisynthetic diet without orotic acid. The liver tissues were examined by the light ad electron microscopy, together with electron microscopic cytochemical study for glucose-6-phosphatase and thiamine pyrophosphatase. On the light microscopy, the lipid droplets began to appear in the 3rd day of orotic acid feeding and then occupy through the all hepatic lobules in the 7th day of orotic acid feeding. On the electron microscopy in the 3rd day of orotic acid administraion, the endoplasmic rdticulum were fragmented and vesiculated, and vesicles containing VLDL particles were demonstrated closely around the Golgi complex. In the 7th day, Golgi complex were increased in numbers. The limiting membrances of lipid vacuoles were regarded to originated from rough-surfaced endoplasmic reticulum of account of demonstration of glucose-6-phospatase in them. In the Golgi complex the activity of thyamine pyprophosphatase were markedly decreased in the 1st day of orotic acid feeding, and then the activity of this enzyme is failed to present afterthat. On the above findings it is assumed that orotic acid depresses the function of trans aspect of Golgi stack and the VLDL is interrupted and followed by the retrograde accumulation of VLDL. The cis aspect of Golgi stack and rough-surfaced endoplasmic reticulum were accumulated with VLDL particles, and eventually coalesced vesicles of VLDL with become lipid vacuole. The sequential alteration of endoplasmic reticulum and Golgi complex is supporting the concept of conformational change of membranes in cytocavitary net-work.

Histochemical and Immunohistochemical Properties of Endometrial and Endocervical Adenocarcinoma.: Kyu Rae Kim, In Joon Choi; Korean J Pathol. 1988;22(3):259-267.

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Abstract PDF: The histologic differentiation of endometrial and endocervical adenocarcinomas is a common diagnostic problum of clinical importance, because the staging, treatment and prognosis of these lesions are quite different. First, we examined the distribution of acid mucin in endometrial and endocervical adenocarcinoma (23 cases and 25 cases repectively), but distinguishing differences between endometrial and endocervical adenocarcinoma, especially of endometrioid type, were not observed. Secondly, the distribution of low-molecular weight cytokeratin, vimentin and carcino-embryonic antigen (CEA) by immunohistochemistry were examined in formalin-fixed tissues. CEA was present in 88% of endocervical adenocarcinomas and 34.8% of endometrial adenocarcinoma. vimentin was found in 91.3% of endometrial adenocarcinomas, in contrast with only in 16% of endocervical adenocarcinomas. This study showed that the presence of vimentin in neoplastic glands, in which CEA is negative, may be helpful in the differential diagnosis of endometrial from endocervical adenocarcinomas.

Radiation-Induced Changes in Cervico-vagical Smears of Uterine Cervical Cancer Patients.: Sung Hye Park, In Sun Kim, Seung Yong Paik, Hyo Sook Park, No Won Park; Korean J Pathol. 1988;22(3):268-276.

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Abstract PDF: Nowday, ionizing radiation is one of the methods eradicating the uterine cervical malignancy. However radiation alone or in combination with surgery have an effect on normal tissue as well as the malignant cells, and their changes have been well described in other countries. Unfortunately, the history of radiation modality for cancer treatment is relatively short and the reports about radiation induced changes are limited in our country. We evaluated the radiation-induced changes in cervico-vaginal smears of 107 uterine cervical cancer patients obtained from March, 1985 to October, 1987. Most patients had been received 5,400 Rads of external radiation and intracavitary radiation. Patient's age ranged from 30 to 67 years old. Of 107 cases, 24 cases were normal, 72 cases showed benign radiation changes, 7 cases revealed radiation dysplasia, and residual and recurrent carcinomas found in one and 3 cases, respectively. Cytoplasmic and nuclear enlargement were the most common and noted in 57 and 38 cases, respectively. Vacuolization and polychromasia of the cytoplasm were identified in 43 and 30 cases, respectively. The most common histiocytic change was multinucleation, which was found in about one third. The radiation changes of the cytoplasm and nuclear enlargement persisted for a long time after completion of radiation, however, nuclear degeneration and multinucleation gradually disappeared after 6 months. The inflammation in background prolonged for a long time but degeneration disappeared after 6 months. The biologic significance of post-radiation dysplasia could not evaluated because of short follow up period.

Malignant Meningioma: Clinical, Radiologic and Pathologic Characteristics.: Hye Rim Park, Yang Seok Chae, Kap No Lee, Seung Yong Paik; Korean J Pathol. 1988;22(3):277-284.

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Abstract PDF: This is a report of the clinico-pathologic findings in six cases of histologically verified malignant meningiomas-three hemangiopericytic and three anaplastic types. They were three males and three females and two of them were reoperated for recurrence. The hemangiopericytic types had similar angiographic and macroscopic features and malignant characteristics such as increased mitoses. The anaplastic types lacked typical arrangement, but had a large number of mitoses, increased cellularity, focal necrosis, pleomorphism, anaplasia, and the adjacent normal parenchymal infiltration. However the metastasis was not yet proven in these cases.

Pathologic Diagnoses Management System "Pathology Slide Bank" Using IBM-PC Microcomputer.: Yong Koo Park, Moon Ho Yang, Won Tae Lee, Joo Young Park; Korean J Pathol. 1988;22(3):285-288.

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Abstract PDF: A simple and convenient management system in coding and storage of the pathologic diagnoses was developed by generating the dBASE III with IBM-PC microcomputer. The program named "Pathology Slide Bank" can store about 3,600 data according to the SNOP coding in a standard 51/4 inch floppy disk and retrieve the data within two minutes.

Case Report

Fabry's Disease: A case report of electronmicroscopy and enzyme studies.: Joon Mee Kim, Joung Ho Han, Nam Hee Won, Seung Yong Paik; Korean J Pathol. 1988;22(3):289-294.

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Abstract PDF: Fabry's disease is a rare hereditary metabolic disease caused by alpha-galactosidase deficiency, resulting in abnormal accumulation of galactosyl galactosyl galactosyl ceramide (ceramide trihexoside) in various organs. Articles in English reported approximately one hundred cases but only two cases in Korea. Recently the authors experienced a case of Fabry's disease of a male patient and studied the electronmicroscopy on skin biopsied tissue and enzyme assay of alpha -galactosidase activity in his peripheral blood leukocytes. The male patient was a 21-year-old soldier who suffered from anhidrosis with heat intolerance and generalized telangietatic papules (Angiokeratoma corporis diffusum) since childhood. Other clinical findings were ocular change, paroxysmal pain of lower extremities and proteinuria with oval fat bodies on urinalysis. The ultrastructural study of skin demonstrated abnormal lysosomal deposits of finger-prints or "zebra" body configuration in the endothelial cells, pericytes, perineural cells and intercalated ductal epithelium of sweat glands. Enzyme activity of alpha-galactosidase was markedly decreased in the peripheral blood leukocytes comparing to the normal control, which was conclusive to make a diagnosis of Fabry's disease.

Original Article

Mitral Atresia Associated with Corrected Transposition of Great Arteries.: Dong Heon Yoon, Jeong Wook Seo, Je Geun Chi, Yong Soo Yoon, Jeong Yeon Choi, Yong Jin Kim, In Won Kim; Korean J Pathol. 1988;22(3):295-300.

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Abstract PDF: A case of congenital absence of right atriovntricular (A-V) connection of heart is reported. Patient was 81 day old male infant with chief complaints of dyspnea and irritability. Clinical evaluation revealed increased pulmonary vascularity on chest x-ray, absence of right A-V connection, regurgitation of left A-V valve, right-sided ventricular hypoplasia and L-TGA. Clinical assessment of the case was tricupsid atresia with LTGA and mitral regurgitation. Pulmonary artery banlding and artial septectomy was performed. Parenteral alimentation through the femoral veins resulted in obstruction of IVC and subsequent multiorgan failure. The autopsy findings of the heart were corrected transposition of great arteries with associated anomallies of right-sided mitral atresia, Ebstein's malformation of left-sided tricuspid valve, ventricular septal defect, muscular hypertrophy of right-sided left ventricle with luminal obliteration. Long segment of IVC was completely occluded due to occlusive thrombi with fungal infection. Bilateral kidneys were infarcted and azygos vein was markedly engorged. Microscopic examination revealed candidal colonization in the inferior vena cava and septic embolzation in brain.

Case Reports

Splenic Abscess: Three cases report.: Mi Jin Kim, Hae Joo Nam, Won Hee Choi, Tae Sook Lee; Korean J Pathol. 1988;22(3):301-307.

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Abstract PDF: Splenic abscess is uncommon, but often fatal entity characterized by high mortality rate which ranges from 60 to 100%, due to nonspecific clinical presentation and failure to preoperative definitive diagnosis. Clinical symptom or simple X-ray was not helpful in diagnosing splenic abscess. Perhaps the most useful information was obtained from the scanning and computerized tomography. Emphasis is placed on the necessity for prompt diagnosis and surgical intervention when splenic abscess was suspected. We have experienced three cases of splenic abscess. Case 1 was a 59 year-old male patient; the cause was possibly direct spreading from pancreatitis; The culture demonstrated klebsiella oxytoca.
Case
2 was a 42 year-old female patient; the abscess was produced by preceding infarct. Case 3 was a 64 year-old female; metastatic adenocarcinoma was identified in the soft tissue around spleen, that suggest causative factor. All three cases showed multiple abscesses.

Congenital Acute Myelocytic Leukemia: An autopsy case.: Kyu Rae Kim, Eun Kyoung Han, In Joon Choi, Chang Hyun Yang, Kir Young Kim; Korean J Pathol. 1988;22(3):308-316.

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Abstract PDF: Leukemia is a rare disease in the newborn infant. We have presented an autopsy case of congenital acute myelocytic leukemia in a female neonate and discussecd with review of literature. At birth, she was relatively in good health with 4.2 kg in body weight except a large cephalhematoma on left parietal scalp and multiple subcutaneous nodules with ecchymosis on entire body surface. Hemoglobin concentration was 12.0 gm/, Hct 34.6% and erythrocyte count was 2.24 millions. Of 212,400 leukocytes/mm2, 47% were myeloblast. Biopsy of skin nodules reveal leukemia cutis, which disappear dramatically with anticancer drug. The infant was expired 12 days after admission due to intracerebral hemorrhage and acute renal failure.

Inflammatory Pseudotumor of the Lung: Three cases report.: Hye Soog Kim, Bang Hur, Hee Kyung Chang, Man Ha Hur; Korean J Pathol. 1988;22(3):317-323.

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Abstract PDF: The inflammatory pseudotumor of the lung is a non-neoplastic pulmonary mass lesion, composed of a variey of inflammatory cells including plasma cells, histiocytes(often xanthomatous), mast cells, lymphocytes, and spindle shaped mesenchymal cells. Although the pathogenetic etiology of this lesion is not estabilished, it has been claimed that it is associated with local inflammatory reaction. From 1984 to 1986, we experienced three cases of pathologically confirmed inflammatory pseudotumor of the lung. All three cases revealed similar gross and microscopic features, with only minor differences in components on microscopic level. All specimens were products of lobectomy. They showed a relatively well defined, yellowish white and solid mass, measuring about 5.0 cm in diameter. Histologically, the lesions, which were well demarcated from the uninvolved region, were characterized by dense infiltration of plasma cells and xanthomatous histiocytes admixed with lymphocytes, spindle shaped mesenchymal cells and polymorphonuclear leukocytes. At periphery, bronchi and bronchioles were entrapped by these cells. In focal areas, spindle shaped mesenchymal cells were aggregated, resulting in formation of thick bundles in which plasma cells were infiltrated. In case 1 and 2, myxoid change of stromal tissue was noted. Also noted were foci of osteoid metaplasia of the stromal layer in case 1. The authors report three cases of inflammatory pseudotumor of the lung, with comparative observation of each case, associated with literature review, with emphasis on the pathogenesis of this rather infrequent lesion. And some reviews were made on differential diagnosis between inflammatory pseudotumor and non-neoplastic or neoplastic lung mass including so called sclerosing hemangioma.

Plasmacytoid Myoepithelioma of the Parotid Gland: A Case Report with Ultrastructural and Immunohistochemical Findings.: Chae Hong Suh, Ho Jong Chun; Korean J Pathol. 1988;22(3):324-330.

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Abstract PDF: The myoepithelioma is a rare salivary gland tumor composed nearly exclusively of myoepithelial cells. A case occuring on the parotid gland of a 51 year-old female is reported. Light microscopy finding revealed plasmacytoid cells. Ultrastructurally, the most of the neoplastic cells had polygonal outlines and showed eccentric, round to ovoid nuclei with even contours, peripherally distributed heterochromatin and to three small nuceoli. Their cytoplasms were almost completly filled with thin filaments, arranged in parallel strains and exhibiting "dense bodies". The neoplastic cells showed positive immunostaining for S-100 protein and cytokeratin.

Original Article

Multicystic Renal Dysplasia associated with Ectopic Ureteral Orifice.: Shin Mong Kang, Yong Koo Park, Ju Hie Lee, Soo Eung Chai, Moon Ho Yang; Korean J Pathol. 1988;22(3):331-335.

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Abstract PDF: A case of unilateral multicystic renal dysplasia was reported in view of rarity, and a review of literature 23-year-old female was admitted to Kyung Hee University Hospital with a complaint of urinary incontinence. An excretory urogram revealed non-visualization of the right kidney. The right ureter had opening at the 2 cm above the vaginal introitus. The resected right kidney revelaed multilobulated outer surface with multiloculated cystic struture on cut surface. The associated anomaly was uterine didelphy. The condition was treated by nephroureterectomy.

Case Reports

Ovarian Paragonimiasis: A case report.: Shin Mong Kang, Yong Koo Park, Ju Hie Lee, Jung Eun Mok, Moon Ho Yang; Korean J Pathol. 1988;22(3):336-339.

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Abstract PDF: The authors report a case of ectopic paragonimiasis in a 33 year old Korean housewife who came to the hospital because of lower abdominal discomfortness and palpable mass. Parasitic granulomas involved the ovary and posterior wall of the uterine body. This report deals with the rare occurrence of a parasitic infestation in the ovary.

A Case of Desmoplastic Fibroma of the Mandible.: Dong Won Kim, Tae Jung Kwon, Dong Wha Lee; Korean J Pathol. 1988;22(3):340-347.

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Abstract PDF: A case of desmoplastic fibroma of mandible in a 18 years old woman is presented. She had complained progressive swelling of right mandible for 4 years. Radiographically, a multilocular radiolucent of right hemimandibulectomy showed multinodular external surface without cortical destruction. Cut surfaces revealed grayish white, fibrous homogeneous appearance with firm consistency, sparing head portion. The maximum diameter of the tumor was 13 cm. Microscopically, the tumor was composed of interlacing bundles of monomorphic spindle-shaped cells with abundant intercellular collagen. Ultrastructurally, most tumor cells were fibroblastic-like cells with abundant RER and cytoplasmic fibrils, but a few disclosed transition to myofibroblasts. However, no fully developed myofibroblasts were seen.

Original Article

Fine Needle Aspiration Cytology of Chondrosarcoma.: Kyung Ja Cho, Ja June Jang, Soo Yong Lee; Korean J Pathol. 1988;22(3):348-352.

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Abstract PDF: Fine needle aspiration cytologic findings of four cases of chondrosarcoma were described. The cases consisted of one primary scapular tumor, two recurrent shoulder masses, and right upper quadrant mass which developed after an A-K amputation for an unknown tumor. The aspirates characteristically revealed cell-rich smears containing clusters and isolated cells having abundant cyanophilic cytoplasm and round to oval or elongated vesicular nuclei. The cytoplasm was occasionally foamy. The nuclei were usually small but prominent. Nuclear atypism and pleomorphism were frequently associated. The last case showed epithelioid sheets of polygonal cells, possibly representing chondroblasts, and a well differentiated chondroid element. The fine needle aspiration could be a good diagnostic tool for primary, recurrent, and metastatic chondrosarcomas.

Case Reports

Hibernoma: A case report.: Hee Na Kim, Mi Kyung Jee, Seok Jin Gang, Byung Kee Kim, Sun Moo Kim; Korean J Pathol. 1988;22(3):353-355.

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Abstract PDF: Hibernoma is very rarely encountered and is expressed in the various names including "lipoma of brown fat", "fetal lipoma", and "lipoma of embryonic fat". In our knowledge, only about 50 cases have been reported in the literature of the Western world, and no case reports have been published in Korea. In May 1986, we experienced a case of hibernoma occuring in a 16 old years boy. On physical examination, a relatively well defined nodule was noted on the right scapular region. A total removal of the lesion was done under the clinical diagnosis of epidermal inclusion cyst. On gross examination, the specimen consists of three irregularly shaped portions of yellowish brown soft tissue, measuring up to 0.8 cm in greatest dimension. Microscopically, the tumor showed distinct lobular pattern separated by fibrovascular bands. The lobules were composed of multivacuolated or eosinophilic granular cells showing centrally located small unclei. A brief review of the literature was done.

A Case of Sacrococcygeal Chordoma Diagnosed by Fine Needle Aspiration Biopsy Cytology.: Ja June Jang, Kyung Ja Cho, Soo Yong Lee; Korean J Pathol. 1988;22(3):356-359.

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Abstract PDF: A case of sacrococcygeal chordoma diagnosed by fine needle aspiration is presented. This is a case of a 54-year-old woman who came with coccygeal pain of 5-6 months duration. Aspiration biopsy cytology revealed many nests of cells having abundant bubbly cytoplasm and round to oval variably sized nuclei. The cells had indistinct cytoplasmic borders and many of the cells had cytoplasmic vacuoles. The nuclei had thin regular nuclear membranes, finely granular chromatin and one or two small nucleoli. The cells were generally monotonous, but focally pleomorphic with giant cell formation. Mitotic figures were scanty. The backgroud of the aspirate contained abundant mucinous materal. These findings were typical of those of recorded chordoma cases and the diagnosis was confirmed by a following open biopsy. The patient received 4,000 rads of neutron radiotherapy and has been well till March '88.

Delayed Radionecrosis of the Brain: A case simulating recurrent glioma.: Shin Kwang Khang, Jun Ho Song, Kyu Ho Lee, In Wook Choo, Je G Chi; Korean J Pathol. 1988;22(3):360-366.

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Abstract PDF: An appreciation of the radiation changes in the brain adjacent to radiated glioma is of considerable importance from both clinical and pathological standpoint because the alteration in the brain parenchyma may result in a picture that mimics recurrence of the neoplasm. A 35 years old woman was admitted because of deterioration of consciousness which has started about 20 days ago. Past history revealed removal of left frontal brain tumor 4 years earlier and the diagnosis was grade II astroma. Postoperative radiation was done at that time. Sine then, she has been doing well. Computerized tomogram showed an ill defined huge low density mass at right frontal and left posterior parietal areas, which was irregularly enhanced in postcontrast study. Unlikely to the usual brain tumors, there was no mass effect on adjacent structures. Histologically acellular necrotic zone was alternating with hypercellular zone and most striking changes were vascular and glial reaction. Most of the vessels showed acellular hyliane thickening of their wall and some vessels were almost completely occluded. There was marked glial proliferation with considerable cellular and nuclear irregularities. Gemistocytic astrocytes were frequently seen and some were multinucleated.

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