Journal of Pathology and Translational Medicine

Volume 12(4); December 1978

Etcs

Gastric Carcinoma among Koreans: An Analysis of 1122 Cases: Chang Soo Chung; Korean J Cytopathol. 1978;12(4):337-353.

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Abstract: The author investigated 1122 consecutive cases of gastric carcinoma which were subjected to the Department of Pathology, College of Medicine, Busan National University for pathological evaluation during the last 10 years from 1968 to 1977. All the specimens obtained either by subtotal or total gastrectomy were referred by the Busan University Hospital and the Busan Gospel Hospital. The author analyzed them statistically in epidemiological and pathological points of view and obtained the following
results
1. No information about the incidence of gastric carcinoma among Koreans during the period could be acquired from the materials studied. 2. The male-to-female ratio was 1.94 to 1. The youngest and the oldest cases were 19 and 78 years of age, respectively. The model age group was 5th decade in both sexes. There was some difference in form and center between the age distributions of gastric carcinoma in male and female. The former was slightly asymmetrical and negatively skewed, while the later was symmetrical and normal in form. The average age of male cases was 51.15 year and that of female cases, 49.37 year. 3. The mortality or morbidity rate increased in both sexes as the age increases and this tendency was more marked in male than in female. 4. There was no significant difference between the gross findings of gastric carcinoma in male and female. The location of the carcinoma was as follows: pylorus and antrum was in 69%, body 9%, cardia 7%, and fundus 1%. Most of the carcinomas were found in the low part of the stomach, especially at the lesser curvature. The sizes of the carcinomas varied greatly. The 1st, 2nd, and 3rd quartiles were 4.3cm, 6.0cm, and 8.4cm, respectively. The gross types of the carcinomas were classified, after Stout, and their relative frequencies were as follows: ulcerative type 66%, diffuse infiltrating 26%, fungating 6%, and early spreading 2%. There was no significant difference between the age distributions by the gross types in male and female, and no significant association between gross types and age. The histological types were classified after Kubo, and their relative frequencies were as follows: adenocarcinoma was in 61%, diffuse carcinoma 36%, and mucoid adenocarcinoma 3%. The distribution of histological types of the series under study did not differ from that of the Kubo’s Kyushu (Japan) series, but did differ from that of the Kubo’s Minnesota (U.S.A.) series. The ratio of adenocarcinoma to diffuse carcinoma increased in both sexes as the age increases. There was a significant association between sex and age in the distribution of adenocarcinorma and diffuse carcinoma. There was no significant difference between the male and female age distributions in both adenocarcinoma and mucoid adenocarcinoma, but a significant difference was found between the male and female age distributions in diffuse carcinoma. The average ages of the patients, if indicated to male and female separatedly, were as fellows: adenocarcinoma 52.6 and 51.7, mucoid Ca 52.5 and 47. 1, diffuse 52.3, and 48.7. There was a significant association between gross and histologic types. On the basis of the results described above, it was suggested that the characteristic features of gastric carcinoma among Koreans might be expressed by the phenomena due to the low average age of the patients. One of the phenomena is, for instance, the relatively high incidence of the histologic type of diffuse carcinoma in younger age.

Electrophoretic Patterns of Serum Alkaline Phosphatase Isoenzyme in Liver Diseases: Su Ja Chu, Jung Ok Kee, Myung Joon Cho; Korean J Cytopathol. 1978;12(4):355-362.

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Abstract: Serum alkaline phosphatase isoenzyme pattern of liver disease in adult age have been studied using cellulose acetate electrophoresis on New Dry Titan IV I.E plate and compared with the serum electrophoretic mobility of each protein components. The results were: 1) Seperated were six fractions corresponding to albumin band, alpha 1 (fast liver), alpha 2 (liver), between alpha 2 and beta (bone), between beta and gamma (intestine), and diffuse band between gamma and application point of the electrophoresis(Pa). 2) Liver band corresponding to alpha 2 appeared in all normal control group and diseases. And it have been suggested that alkaline phosphatase may be originated from liver in adult age. 3) Characteristic band corresponding to albumin fraction appeared in hepatocellular carcinoma (13/19), and obstructive jaundice (9/18) due to cholelithiasis and pancreatic carcinoma. 4) Fast liver corresponding to alpha 1 have been demonstrated in the same diseased group that showed albumin band, particularly all of six cases of pancreatic carcinoma. 5) Bone (α2/β) and intestine (β/r) fractions were less often demonstrated in this study. 6) Pa (gamma to application point) band have been demonstrated in two out of six cases of the pancreatic carcinoma. It is therefore, summarized that further studies are required to make use of alkaline phosphatase isoenzyme pattern in a routine clinical tests differentiating liver disease.

Malignant Histiocytosis with Cutaneous Lesions and Eosinophilia -A case report with light and electron microscopic study-: Hea Soo Koo, Moon Hyang Park, Hyo Sook Park, Jin Hyuk Kim*, Sook Ja Son*, Shil Shin*; Korean J Cytopathol. 1978;12(4):365-374.

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Abstract: A 70 year-old Korean male was admitted to Dept. of Dermatology, because of generalized erythematous match head sized papules with itching sensation for 45 days. Physical examination revealed palpable axillary, inguinal and left subclavicu1ar lymph nodes, and slight hepatomegaly. Peripheral blood findings showed marked eosinophilia (up to 41%) and a few atypical monocytoid cells. Multiple skin biopsies revealed malignant histiocytosis with cutaneous involvement. He was treated with oncovin and prednisolone, and skin lesions and hematologic abnormalities were considerably improved. But the patient was died on 38th hospital day. On autopsy, the lesions were systemic, showing diffuse proliferation of atypical histiocytes with atypical giant cell formation in spleen, lymph nodes, lung, bone marrow and skin. However, erythrophagocytosis of these atypical histiocytes was not seen.

Histopathologic Study of 2 Separate Dysplastic Lesions in one Stomach and its Malignant Change -Papillary adenoma and Atypical epithelial lesion-: Hyo Sook Park, Hae Soo Koo, Byung Doo Lee; Korean J Cytopathol. 1978;12(4):375-381.

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Abstract: A subtotally removed stomach of a 47 year old male patient which has two separate protruded lesions, papillary adenoma and atypical epithelial lesion, was examined with histotopographic reconstruction method. Both lesions were associated similarly with diffuse dysplastic epithelial changes, and the former, papillary adenoma, demonstrated focal malignant change with submucosal invasion. Dysplasia or cellular atypism accompanied by the papillary adenoma or atypical epithelial lesions (often called as borderline lesion, tubular adenorna, or adenomatous polyp) has the evidence of malignant potential and must be carefully examined for coexisting carcinoma or indepencent carcinoma in neighboring gastric mucosa. A more radical surgical approach than other benign gastric polyps is required for these lesions.

Eosinophilc Infiltration in Cervical Carcinoma: Nam Hee Won, Dale Lee, Seung Young Paik; Korean J Cytopathol. 1978;12(4):383-389.

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Abstract: Eosinophilia has been known to appear in patients with certain parasitic infections, allergies. dermatoses, hypereosinophilic syndrome and malignancies. In recent years. there is growing evidence that actual mechanism of eosinophilia in peripheral blood and tissue may be largely mediated by immune processes. But pathogenesis of eosinophilia in tumor tissue is still debated. In an attempt to understand the immune mechanism in cervical carcinoma, we observed the degree and frequency of eosinophilic infiltration in 180 cases of cervical carcinoma and 118 cases of chronic cervicitis as a control group. The results obtained are as followings. 1. Eosinophilic infiltration in the lesion was noted in 13 cases among 118 cases of cervicitis (11%) and 93 cases among 180 cases of cervical cancer(51.7%). 2. Eosinophilic infiltration in each histologic type of cervical cancer revealed 39% in keratinizing type, 61.2% in non-keratinizing large cell type, 46.2% in non-keratinizing small cell type, showing more frequent infiltration in undifferentiated type. 3. Eosinophilic infiltration cervical cancer revealed no significant difference in frequency or degree by age group of patients. 4. Above findings suggest that eosinophilic infiltration of cervical cancer is cancer specific finding in half of cases and closely related with degree of cancer cell differentiation

A Clinical and Laboratory Evaluation of 73 Cases of Leukemia: Heum Rea Park, Dale Lee, Seung Young Paik; Korean J Cytopathol. 1978;12(4):391-397.

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Abstract: Seventy three cases of leukemia admitted to the Korea University Hospital during the last 8 years, from January 1971 to July 1978, were analyzed on the basis of age and sex distribution, type, initial symptoms, initial physical findings and laboratory findings. The results are as followings. 1. The most frequent age group of leukemia was under 10 year group and difference of sex ratio was not found. 2. The ratio of acute to chronic in overall cases was 12 : 1 and the most common type among overall cases was acute myelocytic type. 3. The distribution of each type of crises by age group revealed that the lymphocytic type being most common in under 10 year group. Acute and chronic myelocytic type show even distribution in each age group from under 10 year group to 6th decade group. 4. Chief complaints were bleeding tendency, pain, fever, fatigue and pale face in order of frequency. 5. The most frequent finding in initial physical examination was bleeding tendency(58.6%) in acute myelocytic type and hepatomegaly(81.5%) in acute lymphocytic type. 6. In initial laboratory examination, hemoglobin level under l0gm % was noted in 89.7% of acute myelocytic leukemia, 96.3% of acute lymphocytic leukemia and 80% of chronic myelocytic leukemia cases. Leukocytosis over 10,000/mm3 was seen in 55.2% in acute myelocytic leukemia, 63% in acute lymphocytic leukemia and 100% in chronic myelocytic leukemia. And thrombocytopenia under 100,000/mm3 was observed in 73.9% of acute myelocytic leukemia and 65.2% of acute lymphocytic leukemia.

A Comparative Study on Total Lipid, Cholesterol and Lipoprotein Level in Normal and Various Disease: Boem Woo Yeom, Dale Lee, Seung Young Paik; Korean J Cytopathol. 1978;12(4):399-406.

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Abstract: The authors studied serum levels of total lipid, cholesterol and lipoprotein in 118 healthy person, 6 cases of hypertension in 6th decade, 5 cases of cardiovascular accident in 7th decade, 10 cases of diabetes mellitus in 6th decade, 6 cases of stomach cancer in 6th decade, 5 cases of drug intoxication in 3rd decade and 15 cases of liver cirrhosis in 6th decade. Above serum levels in each disease group were compared with those of normal healthy persons in same age group. The results obtained are as followings. 1. In normal control groups, total lipid, cholesterol and each fraction of lipoprotein were determined and presented by age group. 2. Patients with diabetes mellitus revealed significant decrease(p<0.01) only in pre β -fraction of lipoprotein. 3. Patients with drug intoxication disclosed significant decrease(p<0.01) only in pre β -fraction of lipoprotein. 4. Patients with cirrhosis of the liver showed significant decrease both in total lipid and pre β -fraction of lipoprotein(p<0.05, p<0.01). 5. Patients with hypertension, C.V.A. and stomach cancer revealed no significant change(p>0. 05) in total lipid, cholesterol and each fraction of lipoprotein.

A Computer Diagnostic System Based on Automated Multiphasic Screening by SMA 12/60 on Korean: Oh Hun Kwon, Kui Nyung Yi, Samuel Y. Lee; Korean J Cytopathol. 1978;12(4):407-412.

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Abstract: Since the report of Bayes’ theorem in 1763, many studies have been made to set various discase patterns using a mathematical probability. However, most of those were too convenient for practical use. Fortunately the recent development of computer system solved some of these problems. Reece and Hobbie(1971) developed the System of Organizing Relevant Tests(SORT). SORT is a kind of approach to find out the most probable disease pattern, delived from 12 different biochemical data of SMA 12/60 interpreted in regard to the sex and age. This study is conducted to apply the SORT on Korean. First, the Korean normal values in regard to the sex & age were calculated by Hoffmann’s method. Then a random selection of 100 patients with various discharge diagnosis were selected. On these patients, the SORT was applied. 1. The normal values was obtained by the Hoffmann’s method. 2. The normal values of 12 biochemical tests reveal the following characteristics, in general compared with those of the white population. ⅰ) Calcium, phosphorus, BUN, uric acid and cholesterol are relatively low. ⅱ) Alkaline phosphatase and LDH tend to be high. ⅲ) Total protein, albumein and bilirubin are almost the same. ⅳ) SGOT is almost same in upper limit and low in lower limit. 3. When only 5 possible disease entities were taken in consideration, the SORT was in consistent with the discharge diagnosis in a rate of 24%, If 10 were taken, the consistency rate becomes 47%. 4. It was discussed that the consistency rate will be raised if the inherited disadvantages of Hoffmann’s method were supplemented and if the sample sizes were expanded. 5. The SORT expences per patient were about 20 Won, after the computer Programming was completed. It was considered Quite inexpensive for a practical use. 6. The routine application of SORT was considered to be beneficial for both the patient and doctor to make an early diagnosis otherwise might be overlooked.

Eikenella corrodens Isolation from an Aspirate of Empyema Developed Following a Stomach Cancer Surgery: Oh Hun Kwon, Young Sook Choi, Yunsop Chong, Samuel Y. Lee; Korean J Cytopathol. 1978;12(4):413-417.

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Abstract: Eikenella corrodens, an aerobic gram-negative bacilli found as a normal inhabitant of upper respiratory tract, has been known to cause various infections. This organism was isolated from pleural fluid of a 62-year-old male who developed empyema following stomach cancer surgery. The bacteriological findings and the clinical conditions of the patient are presented. 1. The isolate was found to have fastidious cultural and unique biochemical characteristics of E. corrodens. 2. Predominance of this organism, although Streptococcus intermedius and Bacteroides species were also isolated, indicated etiologic role in the infection. 3. The operation of the stomach was considered predisposed the infection by this opportunistic pathogen. 4. The isolate was found susceptible to many antibiotics by a disk diffusion method, and the patient was cured after receiving kanamycin, gentamicin, ampicillin, erythromycin, & tetracycline together with incision and drainage. It is concluded that this organism may be difficult to culture because of its fastidiousness, but easy to identify due to its unique cultural and biochemical characteristics. Isolation an4 identification of this organism should be important not only to establish etiologic diagnosis but alto help choose proper antibiotics for treatment in severe infections.

Study on Serum Alpha-fetoprotein and Hepatitis B Surface Antigen in Primary Liver Cell Carcinoma in Busan Area: Han Chul Son, Soon Ho Kim; Korean J Cytopathol. 1978;12(4):419-425.

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Abstract: The authors investigated the frequency of alpha-fetoprotein(AFP) and hepatitis B surface antigen(HBsAg) in 135 cases of the primary hepatocellular carcinoma, clinically and pathologically diagnosed in Busan National University Hospital and affiliated hospitals in Busan during a period of 28 months from June 1976 to September 1978. Serum AFP was detected by Ouchterlony microimmunodiffusion method and serum HBsAg was detected by counterimmuno-electrophoresis. The results obtained were as follow: 1. Serum AFP was detected in 81(60%) out of 135 cases of primary hepatocellular carcinoma but were not detected in all cases out of 331 of healthy person and 108 of other liver diseases. 2. Serum HBsAg was detected in 16(11.9%) out of 135 cases of primary hepatocellular carcinoma and in 15(4.5%) out of 351 cases of healthy control. The HBsAg postive rate of the primary hepatocellular carcinoma was significantly higher than that of the healthy control. 3. The serum HBsAg positive rates between the AFP positive and negative hepatocellular carcinoma was not significantly different. 4. No influence of sex and age was found between AFP positive and negative hepatocellular carcinoma and between HBsAg positive and negative hepatocellular carcinoma between HBsAg positive and negative hepatobellular carcinoma. On the basis mentioned above, it is suggested that there is no correlation between serum AFP and HBsAg in primary hepatocellular carcinoma.

Anaerobic Bacterial Species Isolated from Clinical Specimens and Clinical Conditions of the Patients: Yoon Chung Kim, Yunsop Chong, Samuel Y. Lee; Korean J Cytopathol. 1978;12(4):427-432.

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Abstract: Anaerobic bacteria, known to be a normal flora on mucous membrane and skin surface, has now become a well accepted opportunistic pathogen. It causes various infections when the host’s defense mechanism is impaired. In recent years, with the increasing number of major surgery, chemotherapy of radiation and steroid therapy, such opportunities are ever increasing. Consequently, varieties of anaerobic infections have been reported, and their importance in the modern clinical medicine can not be over emphasized in these days. The authors reviewed the outcome of their routine anaerobic cultures at Yonsei Medical Center during the period of May 1975 to May 1977. They tried to analyse and correlate the patients’ clinical conditions with the yielding anaerobic bacteria. The following results were obtained. 1. A total number of 148 anaerobic organisms was isolated out of 103 clinical specimens. Those which yielded anaerobes most frequently were specimens from pleuropulmonary, abdominal, and female genital sources. 2. The more frequently isolated species were Peptococcus asaccharolyticus, Peptostreptococcus anaerobius, Ps. intermedius, Clostridium perfringens, Bacteroides fragilis and B. melaninogenicus. 3. Out of the 99 specimens of knows sources, 58.6% yielded anaerobes alone, but the remaining 41. 4% yielded both anaerobes and aerobes together. 4. With the review of 73 available patiens’ records, it was found that the serious clinical conditions included epidural abscess, lung abscess, empyema, liver abscess, intraabdominal infections and endometritis. 5. Many patients had some kind of underlying conditions, such as viceral rupture, various operations, open wound and burn etc. These conditions are thought to be one of the predisposing factors in their infections. 6. Some of the patients with thoracic and abdominal infections ended up with septicemia of anaerobes. These examples demonstrated eloquently the grave nature of some of the anaerobe infections.

Teratoma of the Thyroid Gland -A case report and literature review-: Sook Hee Hong, Song Ja Chin, Choon Won Kim, Chi Kyeu Won, Ki Hong Kim; Korean J Cytopathol. 1978;12(4):433-440.

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Abstract: We recently experienced a case of teratoma of the thyroid gland in a 20-day-old female infant, who admitted to HYUH on March 6, 1978, due to a hen-egg sized palpable firm mess on left side of the neck from at birth without complaint of any symptoms of respiratory or swallowing difficulties. In microscopic examination of the excised tumor from patient, we found a potion of mature thyroid follicles in subcapsular area of the tumor, which shows pressure atrophy due to underlying growing tumor, and many kinds of tissues derived from three germ layers with predominant neurogenic tissues such as neuroblasts forming rosettes, glial cells, choroid plexus, and retinal anlages. From the findings of anatomic position of the tumor, histologic relation to the thyroid gland, microscopic feature of the tumor, and postoperative thyroid scanning, we diagnosed this tumor as true teratoma of the thyroid gland originated from left lobe of the thyroid gland. This is probable the first case of teratoma of the thyroid gland reporting in Korea. Teratomas of the neck are rare, and slightly more than 100 cases are reported up to date. They occur predominantly under the age of one. Teratomas of the neck arising in infant and child are almost benign except for three cases in the literature. Five cases arising in adult are malignant except for a case of recurrent infant benign teratoma. All varieties of tissues derived from three germ layers with predominance of brain tissue are found in the tumor. There has been disagreement in the classification of cervical teratoma for long time, and it is impossible to say with certainty whether the tumor originates from the thyroid gland or from the adjacent cervical tissue. For clinical evaluation of the tumor, it can be classified as a teratoma of the thyroid gland and a teratoma in the region of the thyroid gland, based on the criteria proposed by Silterman et al. The choice of treatment of cervical teratoma is early surgical removal of the tumor. The prognosis in the immediate postoperative period is excellent, and operative mortality is very low. All cased not received surgical treatment died of respiratory distress. Prolonged follow-up study is needed to establish the long-range prognosis in these patients. We reviewed literature of the teratoma of the neck and discussed on its incidence, classification, pathologic findings, the value of surgical operation, prognosis, and the necessity of long term follow-up Study.

Clostridium perfringens Gas Gangrene -A Case Report-: Dong Wha Lee, Yunsop Chong, Samuel Y. Lee; Korean J Cytopathol. 1978;12(4):443-447.

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Abstract: Gas gangrene is a very rare infection nowadays because of perfection of aseptic surgery, use of varieties of antibiotics and absence of war casualties. Recently we had a
case
of gas gangrene developed following an open fracture, on a 44-year-old male. The authors made bacteriological studies of the case and the result is presented together with the clinical pictures. 1. Inspite of adequate treatment of the open fracture of his right femur and tibia, he developed gas gangrene with typical signs such as severe myonecrosis, subcutaneous vesicles and crepitus, erythematous changes of the skin and with symptoms of toxemia. 2. Gram stained smears of the exudate and tissue fragments from the lesion revealed a large number of gram-positive bacilli. Culture of the specimens yielded Clostridium perfringens which were with typical cultural and biochemical characteristics of the species. Enterobacter and Klebsiella pneumoniae were concomitantly isolated from the specimens. 3. Disk diffusion susceptibility test showed the Clostridium was susceptible to penicillin, chloramphenicol, clindamycin, cephalothin, and tetracycline and resistant to erythromycin. The above-knee amputation and then the hip disarticulation with the massive penicillin and other antibiotics treatment were without effect and the patient expired on the 23rd post operative day. This case demonstrated the severe nature of gas gangrene even in the era of modern medicine.

Seuere Eosinophilia due to Missive Ascariasis: Kye Sook Lee, Sang Yeul Suh, Seung Chull Park, Choon Won Kim, Ki Hong Kim; Korean J Cytopathol. 1978;12(4):449-453.

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Abstract: Eosinophilia occurs in allergic disease in certain skin disease, in parasitic infestation, in a few infectious disease (scarlet fever), in some cases of Hodgkin’s disease and chronic myelogenous leukemia. Parasitic infestation is more likely to produce eosinophilia when the parasites invade the tissue, e.g., trichinosis the larval migratory stage of ascariasis, cysticercosis, visceral larval migrans and ecchinococcosis. Patient with pulmonary ascariasis shows the peak of the eosinophilia from 30 to 70 per cent. But, in intestinal parasitism, eosinophilia is less marked. The presented case was a 64 year-old female who was admitted to medical department of HUH with chief complaints of right upper abdominal & epigastric pain, anorexia, indigestion and constipation. Under the diagnosis of intestinal ascariasis, the patient was medicated with Combantrin for four days. In stool, 152 adult worms were found. At admission time, hematologic finding was revealed with 73% of eosinophils in total leukocyte counts. No evidence of pneumonitis is noted on chest X-ray.

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