Journal of Pathology and Translational Medicine

Volume 20(2); June 1986

Original Articles

Experimental Induction of Pancreatic Hyperplastic Nodules by Administration of 4-hydroxyaminoquinoline-1-oxide in Rats.: Hyung Sik Shin, Yong Il Kim; Korean J Pathol. 1986;20(2):133-146.

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Abstract PDF: Pancreatic hyperplastic nodules were experimentally produced in male Sprague-Dawley rats by single doses of intravenous injection of 4-hydroxyaminoquinoline-1-oxide(4-HAQO), 5 mg, 10 mg, 20 mg and 30 mg per 1kg of body weight. Every ten rats were sacrificed after 1 day, 1 week and monthly until 6 months. Within the first week, pancreatic acini and islets were severely affected with necrosis and the adjacent acinar cells underwent vacuolization. But, pancreatic ductules remained relatively unaffected. The degrees of acinar cell degeneration were proportionally increased as with the increased doses of 4-HAQO administration. The levels of blood glucose and serum amylase were closely corresponding to the light microscopic features of the pancreas. Two months after administration of 4-HAQO, the nongranular acinar cells started to proliferate and their proportion of total acinar cells was 35%, whereas that of control group was 15%, after 3 months the proportion of nongranular cells was decreased. After 6 months, multiple hyperplastic nodules were discovered within the pancreatic acini of all 12 rats, and the largest one measured 500 micro in diameter. Each hyperplastic nodule was uniformly composed of larger cells in two folds of normal cells with hyperchromatic muclei and prominent nucleoli together with a few zymogen granules in their cytoplasms. Ultrastructurally, the cells contained abundant dilated endoplasmic reticulum and markedly decreased zymogen granules. Nuclear heterochromatin became finely dispersed with loss of marginal clumping. During the regeneration process, admixture of islet cells with membrance-bounded granules was identified among the clusters of regenerating acinar cells. On the basis of above findings, the induction of hyperplastic nodules in rat pancreas by 4-HAQO was confirmed, and its histogenesis may reflect a nodular hyperplasia of non-granular acinar cells with potential progress as a neoplastic lesion. And the evidence of the hypothesis that the pancreatic exocrine cells and endocrine cells are in same origin, was presented.

Study on the Anti-Smooth Muscle Antibody and Anti-Nuclear Antibody of Chronic Active Hepatitis, Chronic Persistant Heratitis and Liver Cirrhosis in Korea.: Kap No Lee, Seung Yong Paik, Sang Kook Lee; Korean J Pathol. 1986;20(2):147-156.

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Abstract PDF: In Korea chronic liver diseases are the important medical issues because of their high incidence, poor prognosis and no available therapeutic resume. It is believed that the etiologic agent of most of chronic liver diseases in Korea is hepatitis B virus. To find out the incidence of positivity and to understand the autoantibodies in some of the chronic liver diseases in Korea, anti-smooth muscle antibody and anti-nuclear antibody tests were performed on 43 patient serum with chronic active hepatitis, 13 patient serum with chronic persistant hepatitis and 20 patient serum with liver cirrhosis, who diagnosed by liver biopsies. The results of the study are summarized as follows: 1) The positivity of anti-smooth muscle antibody in chronic active hepatitis was 93.0%, that in chronic persistant hepatitis 60.0% and that in liver cirrhosis 80.0%. 2) The positivity of anti-nuclear antibody in chronic active hepatitis was 18.6%, that in chronic persistant hepatitis 15.4%, that in liver cirrhosis 5.0%. 3) The test efficiency of anti-smooth muscle antibody to differentiate chronic active hepatitis from chronic persistant hepatitis and liver cirrhosis was 48.7%. The above results suggest that the antismooth muscle antibody may be related to the "necrosis of liver cells", and further studies are needed to fine out any relationship between the autoantibody and the disturbance of immune regulatory function if there is, as this study suggested.

Classification of Gallstones and their Characteristics.: Sang Sook Lee, Eun Sook Chang, Chai Hong Chung; Korean J Pathol. 1986;20(2):157-164.

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Abstract PDF: Total 481 cases of gallstones from Korean patients operated at Keimyung University Dongsan Hospital during the last 6 years were classified by macroscopic view according to the classification of Sato, et al and reviewed with a special reference to age, sex, and kinds and sites of gallstones. Gallstrones were present predominatly in the age of 50-60 years, the average 52. Sex ratio (M:F) was nearly equal, being 1:1.05. Gallbladder was the most frequent site, comprising 53.2%, followed by common bile duct, 23.3% and intrahepatic location, 3.7%. Macroscopic classification revealed pigment gallstones in 53.0% (calcium bilirubinate, 41.8%; black, 11.2%); cholesterol gallstones in 36.2%, of which mixed stone being 33.1%. Cholesterol gallstones occurred predominantly in 50-60 years of age with a prediletion to females. On the contrary, elderly persons more than 60 years of age had calciu bilirubinate stones. No sex difference was found in the calcium bilirubinate stones. Eightly-six percent of cholesterol gallstones were present in the gallbladder only. Common bile duct stones were mostly composed of pigment gallstones in 80.4%.

A Histopathological Study of IgM Nephropathy.: Youn Wha Kim, Moon Ho Yang, Myung Jae Kim, Byoung Soo Cho; Korean J Pathol. 1986;20(2):165-177.

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Abstract PDF: 461 cases of renal biopsy specimens were summerized correlated with their light microscopic and immunofluorescence findings, which obtained from Jan. 1981 to Jul. 1986 at Department of Pathology, Kyung Hee School of Medicine, The results were as follws: 1) The incidence of IgM nephropathy was about 5.8% of the primary glomerulopathy. 2) Sex distribution showed male preponderance with male: female ratio of 1.7:1. 3) Age distribution were 0-9 years 7.4%, 10-19 years 29.6%, 20-29 years 37.0%, 30-39 years 7.4%, 40-49 years 7.4% and 50-59 years 11.1%. 4) The clinical symptoms were gross hematuria 7.4%, microscopic hematuria 59.2%, proteinuria (nonnephrotic) 37.0%, nephrotic syndrome 55.5%, hypertension 7.8% and edema 59.2%. 5) 9 cases (33.3%) had past histories of upper respiratory infections. 6) The distributions of the light microscopic deagnosis were minimal histologic change 11 cases (40.7%), focal glomerulonephritis 7 cases (25.9%), measangial proliferative glomerulonephritis 5 cases (18.5%), focal and segmental glomerulosclerosis 1 case (3.7%) and poststreptococla glomerulonephritis 1 case (3.7%). 7) Immunofluorescence study showed significant diffuse mesangial granular deposits of IgM and C3 in all of the 27 cases. 8) It was demonstrated that in the patients with nephrotic syndrome, the prognosis for the patients with IgM deposition were less favorable than those without IgM deposition.

Metastatic Ovarian Carcinoma: Clinicopathologic analysis of 33 cases.: Dong Suck Kim, Sang Sook Lee, Jong Min Chae, Eun Sook Chang, Chai Hong Chung; Korean J Pathol. 1986;20(2):178-183.

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Abstract PDF: Thirty three cases of metastatic ovarian carcinoma were analysed cilincopathologically. The patient's age ranged from 20 to 68 years, the average being 44.3. Most ovarian tumors were bilateral and asymmertically enlarged, firm and occsaionally multicystic. Histologic examination revealed adenocarcinoma in 31 cases, of which Krukenberg tumors in 14; squamous cell carcinoma in 2. The most common primary site was gasrtointestinal(75.8%), followed by genital, breast and gallbaldder. Most Krukenberg tumors were originated from poorly differentiated adenocarcinoma of stomach. The ovarian and primary carcinomas were synchronously diagnosed in 15 cases, while in 3 cases the primary carcinoma was not round until the ovarian tumor had been removed.

A Simple Storage and Retrieval System for Pathologic Diagnoses Using the Apple II(R) Computer.: Sang Sook Lee, Chi Hwan Lee, June Sik Park; Korean J Pathol. 1986;20(2):184-186.

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Abstract PDF: The coding and filing of pathologic diagnoses have been heavy tasks; however with the availability of inexpensive microcomputer, a system may be developed that permits storage and retrieval to be performed efficiently. With Apple II(R) computer system and SNOP coding, a simple program using dBASE-II and QUICKCODE computer program can be created to include the following informations: accession number, chart number, sex and age of patients and 2 diagnosis codes. Once SNOP coding is carried out by medical staff, a secretary or clerk can enter the informations into the microcomputer. Data may be searched on any combination of the above parameters.

Case Reports

Congenital Immature Teratoma arising from the Tongue: Report of an autopsy case.: Jung Hoon Yoon, Kyi Beom Lee, Chan Il Park; Korean J Pathol. 1986;20(2):187-190.

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Abstract PDF: Congenital immature teratoma of the tongue is a exceedingly rare form of epignathus. We report here an autopsy case of a huge immature teratoma protruding from the tongue of a newborn female infant. The mass obstructed the mouth and caused hydramnios. The mother's serum level of alpha-fetoprotein was elevated, and the tumor was identified by a ultrasonogram subsequently done. Discussion on the histogenesis of epignathus was made through a review of literatures.

Multiple Myeloma Associated with Adenocarcinoma of the Stomach: report of a case.: Hye Ju An, Kyung Ja Han, Won Il Kim, Sang In Shim; Korean J Pathol. 1986;20(2):191-194.

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Abstract PDF: A case of multiple myeloma associated with adenocarcinoma of the stomach was review. A 59-year, old Korean man had been abmitted to St. Mary's Hospital in January 1984, with chief complaint of posterior neck pain, and intermittent headache for one year prior to amission. Osteo lytic punched-out lesions were noted on skull and other skeletal x-ray films. Bone marrow aspirates revealed diffuse infiltration of mature and immature plasma cells. Laboratory findings revealed anemia and Bence-Jones proteinuria. Immunoelectrophoresis revealed findings consistent with IgA-lamda type multiple myloma. Alkylating agents and steroids were tried with some clinical improvements. In August 1985, the patient revisited outpatient clinic with chief complaints of epigastric pain and neck mass. Endoscopic biopsy and excision biopsy of the cervical lymph node were performed. By microscopic examination, adenocarcinoma of the stomach and metastasis of multiple myeoma to the supraclavicular lymph nodes were confirmed. Subtotal gastrectomy was performed. By gross and microscopic revealed metastasis to the regional lymph nodes.

Malignant Histiocytic Lymphoma Associated with Celiac Disease: A Case Report.: Bang Hur, Hae Sook Kim, Sung Sook Kim, Man Ha Huh; Korean J Pathol. 1986;20(2):195-198.

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Abstract PDF: The celiac disease is an immunologic disorder, related to dietary gluten and morphologically characterized by a striking loss of villi in the small intestine and, with it, a marked reduction in the absorptive surface area. The authors experienced a rare case of pathologically confirmed malinant histiocytic lymphoma of jejunum, associated with celiac disease which was histologically manifested with ulcerative jejunitis in a 25-year-old Korean female who had suffered from projectile vomiting for 2 months. We report this case with literature review emphasis on the pathogenesis of malignant neoplasm in celiac disease and pathogenetic relationship between ulcerative jejunitis and celiac disease. To our knowledge, this is the first reported case of malignant histiocytic lymphoma complicating celiac disease with ulcerative jejunitis, in Korea.

Original Article

Congenital Absence of Intestinal Musculature Associated with Long Segment Hirschsprung's Disease.: Chan Kum Park, Moon Hyang Park, Jung Dal Lee, Poong Man Jung; Korean J Pathol. 1986;20(2):199-202.

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Abstract PDF: Intestinal obstruction is the commonest cause for emergency surgical intervention in the newborn. An extremely rare cause of intestinal obstruction in the neonate is a congenital abnormality consisting of segmental absence of intestinal musculature with intact serosa and mucosa. This report represents not only the fourth reported case of this anomaly but also the first case associated with long segment Hirschsprung's disease in English-written literatures.

Case Reports

Embryoral Rhabdomyosarcoma of the Biliary Tree: A case report.: Keum Min Park, Dong Wha Lee, Duk Yong Kang; Korean J Pathol. 1986;20(2):203-208.

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Abstract PDF: Although embryonal rhabdomyosarcoma has been frequently reported in genitourinary tract, head and neck, embryonal rhabdomyosarcoma of the biliary tree is an extremely rarte. It must be considered in differential diagnosis of jaundice in childhood. About 35 cases have been reported in world literatures, since first description on 1875, by Moxon and Wilks. We present a case of embryonal rhabdomyosarcoma of the biliary tree in a 25 months old boy with brief review of literatures. Since chief complaints of this case were jaundice and loss of appetite, the first clinical diagnosis was infectious hepatitis. On ultrasound examination, there is a space occupying lesion in right lobe of liver and it was diagnosed as hepatoma. Choledochoduodenostomy with biopsy was done. The operation revealed dilated common bile dut and both hepatic ducts which were filled with light brown jelly like materials and diagnosed as embryonal rhabdomyosarcoma on frozen and permanent senions. In gross and histologic characteristics, this tumor resembles embryonal rhabdomyosarcoma(sarcoma botryoides) in other locations. In spite of chemo-and radiotherapy after operation, the boy was died.

Congenital Laryngeal Atresia: An autopsy case.: Yeon Lim Suh, Sang Yoon Kim, Je G Chi; Korean J Pathol. 1986;20(2):209-214.

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Abstract PDF: Atresia of larynx is a rare fatal anomaly that should bring an immediate medical attention for proper managenent. We reported a case who died in neonatal period because of respiratory difficulty. His first problem was difficulty of inserting tracheal tube through the larynx. It was of interest in this case that he was presented with generalized edema and also massive lung edema. The lung was characterized by total absence of squamous and amniotic debris in the alveolar spaces and massive inflation of the alveoli by clear fluid that was thought to be amniotic fouid produced by the lung per se. Because there was no connection between oral cavity and the lungs, there would be no way the amniotic fluid outside the fetus. The laryngeal atresia was of infraglottic type and was complete with dispalced cricoid cartilage. Associated anomalies were left persistent supperior vena cava, perimembranous ventricular septal defect, spina bifida and focal cerebellar heterotopia.

Original Article

Congenital Cystic Disease of the Lung.: Jin Hee Sohn, Je Geun Chi; Korean J Pathol. 1986;20(2):215-221.

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Abstract PDF: Congenital cyst of the lung is a type of rare pulmonary disease. This lesion was initially introduced by Morgagni in 1769. Thereafter many other cases were reported. Etiology or developemental pathogenesis of this lesion is not certain, but abnormal developement of embryonic lung bud during the embryonal period is highly suspected. This lesion is two times more frequently located at the left lung, but both sides of the lung may be involved. This lesion is largely asymptomatic and found incidentally but can be evoked respiratory symptoms and also can be died due to only this lesion. So accurate diagnosis and treatment in the early period are very important. Therefore, 32 cases of congenital cyst of the lung reported at the department of pathology, seoul national university hospital from 1. 1986 to 12. 1984 were reviewed and classified with clinical, gross and microscopic findings based on the Buntain's classification. Among 32 cases of congenital cyst of the lung, 16 cases were bronchogenic cysts and were largest in number, 8 cases were pulmonary sequestration, 6 cases were congenital cystic adenomatoid malformation (CCAM) and 2 cases were pulmonary emphysema. In cases of bronchogenic cyst, involved age was variable from 7 months to 51 years and large cases were asymptomatic. Grossly, 15 cases were solitary cyst and only one case was multiple. Size was also variable from 3 cm to 11.5 cm. Microscopically, cyst wall was lined by pseudostratified ciliated columnar epithelium with gobet cells, mucous secreting glands, smooth muscle fibers and fibrous interstitial tissue. Three cases were also exhibit cartilage at the wall. In cases of CCAM, there were involved below the 7 months old boys and girls. Four cases were confirmed at the autopsy, other 2 cases were confirmed at the surgical specimens which were found incidentally or due to generalized cyanosis. Microscopic findings were similar in all cases showing relatively well demarcated multiple small cysts with adenomatous proliferation. Lining epithelial cells were tall columnar, pseudostratified ciliated columnar epithelium with occasional mucous secretion. Stroma also exhibit adenomatous proliferation lined by simple columnar or cuboidal epithelium. In cases of pulmonary sequestration, 7 cases were intrapulmonary, other one case was extrapulmonary sequestration. In five cases, systemic large vessel were confirmed. Microscopically it was composed of irregularly dilated bronchiolar structures lined by pseudostratified ciliated columnar epithelium.

Case Reports

A Case of Carcinosarcoma of the Lung.: B Hur, J J Hwang, M H Huh; Korean J Pathol. 1986;20(2):222-225.

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Abstract: A pathologically proved case of carcinosarcoma of the left lung(mixed form), in a 58-year-old, is reported, with discussion of the histopathological features of this case, along with a review on histogenesis of the carcinosarcoma of the lung. The carcinosarcoma is composed of squamous epithelial and mesenchymal components, both of which revealed malignant histological evidence. The stromal components are unique in that disclosed cartwheel whorl pattern, along with the resemblance to the malignant fibrous histiocytoma. The stroma also showed oteoid matrix, in areas. This is the second case of the carcinosarcoma reported in Korea.

Mucous Gland Adenoma of the Bronchus: A case report.: Sook Tae Ha, Kang Suek Suh, Sun Kyung Lee; Korean J Pathol. 1986;20(2):226-228.

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Abstract: A case of mucous gland adenoma arising from the main bronchus of the middle lobe of the right lung is reported, with review of related literatures. The patient, a 12 year-old Korean male, was admitted to Pusan National University Hospital with complaints of progressive coughing and dyspnea. Roentgenographic studies revealed a well defined mass involving the right middle lobe of the lung. With the impression of benign tumor, right middle lobectomy was performed. The gross specimen revealed a polypoid mass involving the main bronchus, measuring 4.5x 3.7 x 2.5cm. The cut surface of the mass revealed yellow-gray myxoid tissue. Histologically, the mass consisted of glandular structures filled with mucus, which proved to be acid one on histochemical study. The glandular lining was made up of a single layer of berign mucous cells, many of them being flattened.

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