Journal of Pathology and Translational Medicine

Volume 19(4); December 1985

Original Articles

Morphological Observation on the Prenatal Development of Human Femur: Analysis of 146 embryos and fetuses.: Yeon Lim Suh, Je G Chi; Korean J Cytopathol. 1985;19(4):377-390.

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Abstract PDF: To evaluate the prenatal development of human femur, a histologic study was made based on normal femora of 24 embryos and 122 fetuses ranging in age from 5 to 41 weeks of gestation. Following observations were made. 1) The femur starts to be formed as mesenchymal condensation in the lower limb bud at 5 weeks of gestation. 2) By the end of the embryonic period (8 weeks), most of the skeleton of lower limb bud consisted of cartilage model defined by perichondrium. 3) At 9 weeks of gestation, endochondral ossification and primary bony trabeculae were prominent in the central portion of cartilage model. 4) At 11 weeks of gestation, along with pregression of endochondral ossification proximally endochondral growth zone was established near the proximal chondro-osseous junction. 5) At 12 weeks of gestation, most centrally located trabeculae were removed, and the marrow cavity and hematopoietic cells were recognized. The cartilage canal was also recognized at this time in the proximal epiphyseal cartilage. 6) In the middle of prenatal life (15-30 weeks), the shape of the femur was reconstructed by remodeling process. 7) The lamellar bone began to form by 31 weeks of gestation. 8) At 15 weeks of gestation, proximal end of ossified shaft showed convexity, and at 29 weeks this convexity was altered to form a rather distinct angulation. 9) As the femoral shaft elongated, primary bony collar continued to develop near the growth plate and remained at the level of the hypertrophied cartilage.

Immunohistochemical Studies on the Serotonin, Somatostatin and Gastrin-Positive Cells in the Gastric Adenocarcinoma.: Chan Choi, Joo Yong Yoo; Korean J Cytopathol. 1985;19(4):391-401.

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Abstract PDF: In order to study the histogenesis of gastric carcinoma, and to find the correlationship between the gastric carcinoma and endocrine tumor of digestive tract, we performed immunoperoxidase staining for serotonin, somatostatin and gastrin respectively in the 34 cases of surgically resected gastric carcinoma. The results were as follows; 1) Endocrine cells were found in 26.5% (9/34) of the gastric adenocarcinoma, but in 58.6% (17/29) in the normal gastric mucosa near the cancer area. The occurrence of endocrine cells was less frequent in cancer than in the normal gastric mucosa. 2) Among the 15 cases of intestinal type adenocarcinoma, serotonin-positive cells were found in 2 cases, somatostatin-positive cells in 1 case and gastrin-positive cells in 1 case. Among 16 cases of diffuse type adenocarcinoma, gastrin-positive cells were found in 2 cases, and somatostatin-positive cells were found in 2 cases. 3) We concluded that, the endocrine cells are more frequently observed in the well differentiated gastric carcinoma than poorly differentiated carcinoma tissue. In summary, gastric carcinomas are supposed to arise from the totipotent stem cells of endoderm origin, and they have multidirectional property of differentiation into both endocrine and nonendocrine cells. Most of them differentiate into nonendocrine cells and only a few of them differentiate into endocrine cells.

Immunohistochemical Study on the Tissue Localization of Human Chorionic Gonadotropin (HCG), Human Placental Lactogen (HPL), and Pregnancy Specific beta-1 Glycoprotein (SP-1).: Soon Lee, Sang Soo Park, Sam Im Choi, Sang Ho Kim; Korean J Cytopathol. 1985;19(4):402-412.

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Abstract PDF: An immunohistochemical study on the tissue localization of human chorionic gonadotropin (HCG), human placental lactogen (HPL), and human pregnancy specific bata-1 glycoprotein (SP-1) in the non-neoplastic (5 incomplete abortion, 5 ectopic pregnancy) and neoplastic (hydatidiform mole 3 cases, 5 ectopic pregnancy) and neoplastic (hydatidiform mole 3 cases, choriocarcinoma 2 cases) gestational status, and germ cell tumors of the ovary (dysgerminoma 2 cases, immature teratoma 1 case) and the testis (seminoma 2 cases, endodermal sinus tumor 1 case) by means of sensitive peroxidase-antiperoxidase method. The results were as follows. 1) Cytoplasmic HCG, HPL, and SP-1 were readily identified in syncytiotrophoblasts of chorionic villi of the incomplete abortion and ectopic pregnancy, as moderate to strong positive reactions. In the cytoplasm of the neoplastic syncytiotrophblasts of hydatidiform mole and choriocarcinoma, positive reactions were stronger than in non-neoplastic syncytiotrophblasts. but the cytotrophoblasts and villous stromal cells showed negative reactions to these hormones. 2) All of the tumor cells of dysgerminoma and immature teratoma of the ovary, and seminoma and endodermal sinus tumor of the testis showed negative reactions to HCG, HPL, and SP-1. According to these results, HCG, HPL, and SP-1 are specifically synthesized and secreted by normal or neoplastic syncytiotrophoblasts Malignant tumors originated from other cells or tissues than trophoblastic cells show elevated serum concentration of these hormones are only evident in the presence of syncytiotrophoblastic giant cells among the tumor cells.

Histopathologic Study of the Mediastinal Tumors and Tumor-like Condition.: Kyu Rae Kim, Kwang Kil Lee, In Joon Choi; Korean J Cytopathol. 1985;19(4):413-419.

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Abstract PDF: Mediastinum is bounded by sternum, vertebra, 1st rib, and diaphragm externally, and by pleural cavity internally and includes important structures such as great vessels, nerves, thymus and many lymph nodes. Primary and metastatic cancers, cysts and inflammatory lesions can develop in this region, and the tumor developing in the mediastinum has a tendency to developed in a specific area of mediastinum depending on the histologic type. Therefore the developing site of tumor and the clinical findings are very important in diagnosing the tumor of the mediastinum. We studied not only the characteristics of mediastinal tumor and tumorlike conditions but the histologic classification and frequency of mass to a specific area and then observed if there is any information that could help in diagnosis of the lesion of the mediastinum. Results obtained were as follows: 1) Of the 95 cases of mediastinal lesion which excludes inflammatory process, there were 70 cases (73.5%) of primary tumors, 13 cases (13.1%) of metastatic tumors and 12 cases (12.6%) of tumor-like conditions. 2) Of the 70 cases of primary tumor, 54 cases (76.8%) were benign, 13 cases (20%) were malignant and 3 cases were unclassified or unidentified tumor with the overall 3.8:1 prevalence rate of benign tumor compared to malignancy. 3) Histologic classification of the 70 cases of primary tumor showed 27 cases (28.4%) of germ cell tumor, 22 cases (23.2%) of neurogenic tumor, 7 cases (7.4%) of thymoma, 6 cases (6.3%) of lymphoma and 5 cases (5.3%) of soft tissue tumors with the highest frequency of germ cell tumor. Germ cell tumor and neurogenic tumor exceeded to 50% of total primary mediastinal tumor. 4) Male to female prevalence rate showed that benigh tumor had a high frequency in female with the the ratio of 1:1.4. But malignant tumor showed much higher frequency in male with the ratio of 4.2:1. 5) Anterior mediastinum had germ cell tumor, thymoma and lymphoma in order of frequency. Metastatic tumor was the most common in superior mediastinum. Superior mediastinum had germ cell tumor and neurogenic tumor with about the equal number, and soft tissue tumor was also developed. Middle mediastinal tumor was less common in number compared to other portions of mediastinum but the majority of tumors developed was developmental cysts and metastatic tumors. And the majority of neurogenic tumors occured at the posterior mediastinum. 6) Mass sized 5-10 cm in diameter were about 55.7% of all tumor, 2.5-5 cm and 10-15 cm were 20% respectively. But the mass sized smaller than 2.5 cm and larger than 15 cm were about 5% respectively. And the malignant tumors have more larger size than benign tumors. 7) Patient with benigh tumor had no symptoms at all or some complaints of chest tightness, dyspnea, chest pain, shoulder pain and dysphagia. In addition to above symptoms, patient with malignant tumor complained of systemic symptoms such as weight loss and fever.

Morphologic and Etiologic Classification of Liver Cirrhosis in Korea.: J S Keum, K Kong, E K Hong, Y H Ko, C K Park, M H Park, C M Kim, J D Lee; Korean J Cytopathol. 1985;19(4):420-426.

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Abstract PDF: Of 951 consecutive cases of liver biopsies reviewed, 162 cases were satisfied with criteria of liver cirrhosis. Clinical records of the cirrhosis patients were summarized, and morphologic as well as etiologic classifications on liver cirrhosis were attempted. The morphologic and etiologic patterns characteristics in Korean were discussed in details. The following were results obtained. 1) Posthepatitic cirrhosis was the most prevalent type in Korean classified as 120 cases of 162 cirrhosis patients (74.1%). Their morphologic types consisted of micronodular (37 cases), mixed micro-and macronodular (48 cases), and macronodular (34 cases) cirrhosis. 2) Alcoholic cirrhosis was presented as 11 cases of 162 cirrhosis (6.8%), and micronodular was the predominant type (9 cases) in alcoholic cirrhosis. 3) Secondary biliary cirrhosis due to congenital biliary atresia was presented in 5 children. The large duct obstruction with secondary biliary cirrhosis occurred in 14 cases. Causes of the large duct obstruction in adults were biliary stones, clonorchiasis and inflammatory fibrosis of the bile ducts. 4) Cirrhosis of unpredictable etiology was noted in 12 cases, of which 10 cases were classified as macronodular cirrhosis. 5) Patients with posthepatitic and alcoholic cirrhosis were diagnosed mainly on needle biopsy materials while those with secondary biliary cirrhosis were confirmed on the wedge biopsy tissues obtained during a laparotomy.

Case Reports

Verrucous Carcinoma of Uterine Cervix: A case report.: Mee Young Sol, Sook Tae Ha, Kang Suek Suh, Sun Kyung Lee; Korean J Cytopathol. 1985;19(4):427-430.

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Abstract PDF: Verrucous carcinoma is a highly differentiated variant of squamous cell carcinoma and is very rare in the uterine cervix. It infiltrates locally but practically never metastasizes. Authors present a case of verrucous carcinoma arising in the uterine cervix of a 48 year-old Korean female and review literatures about the verrucous carcinoma reported.

Congenital Cystic Adenomatoid Malformation of the Lung: A report of 3 cases.: Kyi Beom Lee, Woo Hee Jung, In Joon Choi; Korean J Cytopathol. 1985;19(4):431-437.

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Abstract PDF: Congenital cystic adenomatoid malformation of the lung is a rare form of congenital cystic disease of the lung and associated with developmental arrest of bronchioles in embryonic life. We report 3 cases of congenital cystic adenomatoid malformation which are classified as type I, II and III according to the morphological classification by Stocker et al. The first case was a 6-year-old female with a mass in the lower lobe of the right lung. The mass was composed of several cysts which were filled with inflammatory exudate and lined by ciliated pseudostratified columnar epithelium (type I + II). The second case was a 4-year-old female with a mass in the middle lobe of the right lung. It was composed of numerous small cysts which were uniform sized and contained inflammatory exudate. These were lined by ciliated columnar and pseudostratified columnar epithelium (type II). The third case was a stillborn female at 27 weeks of gestation. There was generalized edema and severe ascites. The left lower lobe consisted of an ill-defined solid area and small cysts. The solid lesion was composed of bronchiole-sized cysts lined by non-ciliated cuboidal epithelium (type II + III).

Juvenile Breast Carcinoma: A case report.: Keum Min Park, Dong Wha Lee, Duk Yong Kang; Korean J Cytopathol. 1985;19(4):438-441.

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Abstract PDF: Breast carcinoma has been infrequently reported in children. About 25 cases have been reported in world literatures since first description in 1913, by Bryan. We present a case of juvenile breast carcinoma in a 17 months old girl with brief review of literatures. Grossly, the submitted specimen is grayish white and measured by 1.3x1.0x0.8 cm in size. It is not encapsulated and its cut surfaces are homogeneous. Microscopic examination showed a neoplastic proliferation of duct cells forming mainly glandular spaces with focal papillary pattern, solid sheets or cribriform pattern. The glandular spaces were filled with collections of PAS-positive eosinophilic secretory materials. The individual cell varied from columnar to polygonal and showed moderate hyperchromatism and variation of nuclear size. Mitoses and necrosis are not found. Tumor cell invasion into the stroma was found.

Original Article

Recurrent Malignant Fibrous Histiocytoma Reminiscent of Clear Cell Sarcoma.: Chan Kum Park, Jung Dal Lee; Korean J Cytopathol. 1985;19(4):442-445.

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Abstract PDF: This is a case of recurrent malignant fibrous histicytoma, histologic features of which are reminiscent of a clear cell carcinoma of soft tissue or myxoid liposarcoma. The tumor recurred 2 years and 10 months after the initial removal of the primary tumors in the lateral aspect of the left tigh. In view of histogenesis of malignant fibrous histiocytoma, possibility of recurrent tumor with a wide range of histologic features including clear cell type is discussed. Pertinent clinical history with review of the initial tumor is mandatory for a definite assessment of histologic feature of recurrent malignant fibrous histiocytoma.

Case Reports

Melanocyte Colonization and Pigmentation of Breast Carcinoma: Report of a case.: Kyu Rae Kim, Hyeon Joo Jeong, Yoo Bock Lee; Korean J Cytopathol. 1985;19(4):446-448.

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Abstract PDF: Colonization of mammary cancers by melanocytes with heavy pigmentation of cancer cells by melanin can occur very rarely. It is not certain which mechanism operates to achieve this transfer. However, the melanocytes might inject melanin through their dendritic processes or alternatively, the cancer cells phagocytose the terminal parts of the dendritic processes with subsequent dispersal of the contained melanin contained melanin granules. We report a case of infiltrating ductal carcinoma of breast with melanocyte colonization and pigmentation in a 59-year old female.

Composite Carcinoma-Carcinoid Tumor of Stomach: Report of a case.: Kyu Rae Kim, Chan Il Park, Tae Seung Kim; Korean J Cytopathol. 1985;19(4):449-452.

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Abstract PDF: The concurrence of typical carcinoid admixed with adenocarcinoma of the gastrointestinal tract is a well known but unusual phenomenom that has been reported in the esophagus, stomach, gall bladder, colon and appendix. The amine precursor uptake and decarboxylation (APUD) concept included the idea that neuroendocrine cells of the gastrointestinal tract were dervied from the neural crest by a process of migration during embryogenesis. However the intimate admixture of cells which have morphologic and immunocytochemical properties of both carcinoid tumors and adenocarcinoma suggests that these tumors are derived from a multipotential stem cell showing bidirectional differentiation rather than from unrelated cell lines. The term composite carcinoma-carcinoid tumor is therefore an appropriate designation for these neoplasms. We report a case of composite carcinoma-carcinoid tumor of the stomach in a 38 year-old female with brief review of literature.

Original Article

Metastasis of Carcinoma to Carcinoma.: Sang Sook Lee, Jae Y Ro; Korean J Cytopathol. 1985;19(4):453-457.

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Abstract PDF: Two unusual cases of metastasis of carcinoma to carcinoma are reported. The initial malignancies, an adenocarcinoma of the rectum and a duct carcinoma of the breast, were found to have metastasis to a clear cell carcinoma of the kidney. The various theories on the peculiar tendency for the renal cell carcinoma to be the most common host tumor for other primary carcinoma are commented upon briefly.

Case Reports

Metastatic Squamous Cell Carcinoma of the Stomach from the Uterine Cervix: A case report.: Eun Hee Suh, Yong Il Kim; Korean J Cytopathol. 1985;19(4):458-462.

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Abstract PDF: Secondary tumor of the stomach is rare when metastatic involvement is defined as an extragastric tumor invading the muscularis, submucosa or mucosa and the only serosal implant is excluded. Recently, authors experienced a case of metastatic squamous cell carcinoma of the stomach in the pyloric antrum from the uterine cervix. The patient was a 57-year-old female who received a simplified Wertheim's operation followed by irradiation for squamous cell carcinoma of uterine cervix in stage IIb, and 2-1/2 years later she presented gastric symptoms, for which subtotal gastrectomy was carried out. The gastric lesion simulated primary adenocarcinoma of Borrmann type III, but differed in the following macroscopic characteristics. Firstly, Bormann classification is not applicable; secondly, mucosal ulcerations appear irregular and multicentric; thirdly, flaskshaped ulceration and broad based penetration are evidet; fourthly, submucosal tumor-growth pattern is conspicuous in bulk of areas; and fifthly, circumferential/semicircumferential growth is manifested. The above features should also be differentiated from those of malignant lymphoma and leiomyosarcoma.

A Case of Human Infection with the Larva of Terranova Type A.: An Hi Lee, Sun Moo Kim, Kyu Yong Choi; Korean J Cytopathol. 1985;19(4):463-467.

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Abstract PDF: Anisakiasis refers to the accidental infection of humans by a marine nematode as a result of eating a raw flsh which contains larval stages of the nematode sub-family Anisakidae. This patient developed acute epigastric pain three days after eating a raw flsh, Astroconcer myriaster. Gastrofiberscopy revealed Anisakis larva invading the stomach wall and the larva could be extracted using a biopsy forceps via gastrofiberscopy. The worm was identified as Terranova type A larva based on their morphologic features such as its length, width, intestinal cecum reaching to anterior one-third level of ventriculus and a mucron at posterior end.

Periphera Neuroepithelioma: A report of 1 case.: An Hi Lee, Jung Young Lee, Sun Moo Kim, Luke S Chung; Korean J Cytopathol. 1985;19(4):468-472.

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Abstract PDF: The peripheral neuroepithelioma is a primitive neuroectodermal tumor arising from peripheral nerve. This tumor is exceedingly rare and various authorities have estimated its incidence as less than 1% of all malignant tumors of peripheral nerve. As far as our knowledge is concerned, no report on the peripheral neuroepithelioma has been published in Korea. In June, 1985, we experienced a case of peripheral neuroepithelioma that arose in scalp in a 56 year old female. Clinical data and histopathological findings with light and electron microscope of the case were discussed and a brief review of the literature on this entity was made.

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