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Volume 22(1); March 1988
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Original Articles
An Application of Immunohistochemical Study of Cytokeratin in Tumor Diagnosis.
Hye Rim Park, In Sun Kim, Seung Yong Paik
Korean J Pathol. 1988;22(1):1-12.
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AbstractAbstract PDF
Cytokeratins are a family of polypeptides of intermediate filaments which in diverse epithelia are expressed in diffeent, yet specific combinations. To evaluate the diagnostic value of keratin, immunohistochemical staining was done in formalin-fixed, paraffin-embedded normal and neoplastic tissues by PAP and StreptABC methods. The antiserum for cytokeratin in monoclonal antibody which gives the specificity for 40, 46, 50, 52, 56, 58, and 65-67 Kd keratin classes. The results are as follows: 1) The staining was positive for cytokeratin in all of the squamous epithelium, ductular epithelial cells of various glands, respiratory and urinary tract epithelium, and mesothelial cells. 2) No staining for cytokeratin was ovserved in respiratory alveolar epithelium, acinar cells of various glands, renal glomeruli, hepatocytes, and many mesoderm-derived tissues such as muscle, hematopoieitc and lymphoid tissues, nerve, bone, cartilage, and fibroblasts. 3) Squamous cell carcinomas, transitional cell carcinomas, mesotheliomas, and some of the adenocarcinomas (stomach, colon, uterine cervix, biliary tract and breast) exhibited positive staining for cytokeratin. Epithelial cells of thymoma, adenomatoid tumor, plemorphic adenoma of salivary gland, papillary carcinoma of thyroid, lymphoepithelioma, and craniopharyngioma were also positive. 4) Some of the adenocarcinomas (prostate and pancreas), renal cell carcinoma, ovarian stromal and germ cell tumors, hepatocellular carcinoma, malignant melanoma, and mesoderm-derived tumors including malignant lymphoma were uniformly negative for staining. 5) From the above results, the immunohistochemical study in paraffin-embedded tissues using monoclonal antibody for cyto keratin may be useful to differentiate various tumors, especially in differential of hepatocellular carcinoma from bile duct adenocarcinoma, lymphoepithelioma and other undifferentiated carcinomas from lymphoma, thymoma from lymphoma, and squamous cell carcinoma from melanoma. It will be helpful in the diagnosis of transitional cell carcinoma in which the differentiation from renal cell carcinoma and prostatic adenocarcinoma be difficult.
Effect of Intra-and Extrahepatic Cholestasis on the Function and Morphology of the Rat Liver.
Ho Jong Chun, Chae Hong Suh
Korean J Pathol. 1988;22(1):13-30.
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The cholestasis are defined as blockade or secretory distrubance of bile and appearance of bile in hepatocytes, Kupffer cells and biliary passages, usually associated with dilated bile canaliculi. Intra-and extraheptic cholestasis were induced by 17-ethinyl estradiol, or chlorpromazine hydrochloride and by ligation of bile duct to investigate the mechanism of the hepatic injury, ultrastructural changes of liver and alterations of liver function. The results obtained were as follows. 1) Functional and histological changes of intra-and extrahepatic cholestasis differed in various experimental groups. The liver weight is increased in 17-ethinyl estradiol treated group and ligation of bile duct group (5.6+/-0.15, P<0.001, 5.3+/-0.19 gm/100 gm body weight, P<0.001). The common features of intra-and extrahepatic cholestasis were double membrane bounded amorphous vesicular material infiltrations in the cytoplasm of hepatocyte, partial loss of microvilli of bile canaliculi, anf focal thickening of pericanalicular ectoplasm on electron microscopy. 2) Intrahepatic cholestasis induced by 17-ethinyl estradiol show significantly increased serum level of alkaline phosphatase and total bile aicd (134.0+/-16.82 IU/L, 29.5+/-4.68 umol/l). Kupffer cell proliferation and focal cytoplasmic degradation with myelin figures are characteristic features on electron microscopy. Chlorpromazine hydrochloride induced intrahepatic cholestasis show increased serum level of AST, ALT, Cholesterol and bilirubin (156.9+/-11.32, 49.0+/-2.83 IU/L, 59.3+/-6.73 mg/dl, 1.8+/-.043 mg/dl). Inflammatory cell infiltration, chiefly lymphocytes and esoinophils are seen in periportal area. Prominent vesiculation and vacuolations of smooth endoplasmic reticulum are characteristic feature on electron microscopy. 3) Extrahepatic cholestasis induced by ligation of bile duct show increase serum level of AST, ALT, GGT, cholesterol, total bile acid, and bilirubin (290.2+/-50.24, 171.5+/-47.17, 159.3+/-24.54, 33.7+/-1.47 IU/L, 86.6+/-9.18 mg/dl, 246.6+/-27.34 umol/l, 13.9+/-0.83 mg/dl). Light microscopically, morphologic alterations are feathery degeneration of hepatocytes, proliferation of bile ducts, bile infarct and prominent intracytoplasmic lipid droplets. Electron microscopically, electron dense acidophilic body, bile casts and complete loss of microvilli are seen in dilated bile canaliculi. Also noted are hypertrophy of cannalicular ectoplasm. Finely granular materials are infiltrated in degenerative cytoplasm.
Immunohistochemical Study on the Blood Group A, B and H in Colonic Adenocarcinomas.
Seoung Hye Park, Kap No Lee, Seung Yong Paik
Korean J Pathol. 1988;22(1):31-41.
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AbstractAbstract PDF
Blood group isoantigens (BGS) A, B and H comprise a group of carbohydrate cell surface markers found not only on the erythrocytes but in wide variety of epithelial cells and body fluid on 80% of the human population. There has been increasing interest in the changes in blood group A, B and H antigen expression in various epithelial malignancies. These changes included deletion of A, B determinants, accumulation of precursor substances, increment or neosynthesis of imcomplete blood group antigens and synthesis of sialylated substances bearing blood group carbohydrate chains. Also these changes have been explained as an evidence of immunologic dedifferentiation analogous to the morphologic dedifferenctiation of anaplasia. isoantigens may be altered in epithelial tissues that show repair and regeneration, metaplastic changes and dysplasia. We studied that the changes of blood group isoantigens A, B and H in 30 cases of adenocarcinoma of the colon, 27 cases of adjacent mucosa and 19 cases of metastatic lymph nodes by immunohistochemical study. In ascending, transverse and rectosigmoid colon, the blood group isoantigens A, B and H are positive in 57.1%, 0% and 57.1% of adenocarcinomas and 100%, 50% and 0% in adjacent mucosae, respectively. In ascending colon,the frequency of the metastasis and recurrences in Blood group isoantigen positive and negative cases are 75% and 66.6% and in rectosigmoid colon, those are 50.5% and 90.0%, respectively. In tumors of the ascending colon, there was no significant correlation between antigen content and frequency of metastasis. However, the cancer of the rectosigmoid colon with bloodgroup isoantigen positive were associated with a lower frequency of metastasis than those without blood group isoantigen. (p=0.045). The data suggests that the immunohistochemical studies of blood group isoantigen may be of value in estimating the clinical behavior of certain colon carcinoma.
Morphologic Changes of the Parenchymal-Stromal Junction in Infiltrating Duct Carcinoma of the Breast: Immunohistochemical and Ultrastructural Features of Myoepithelial Cell, Basement Membrane.
Min Cheol Lee
Korean J Pathol. 1988;22(1):42-56.
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AbstractAbstract PDF
The morphologic study of noninfiltrating and infiltrating duct carcinoma of the breast disclosed profound alterations along the parenchymal-stromal junction. But fate of myoepithelial cell, changes of basement membrane and the relationship of fibroblast to myofibroblast remain uncertain. To study the morphologic changes of myoepithelial cell, basement membane and stromal fibroblast, a series of 32 not otherwise specified (NOS) type of infiltrating duct carcinoma of the breast with regional lymph node metastases was examined light microscopically after S-100 protein immunoperoxidase staining by biotinavidin system (BAS) and ultrastructurally. The results were as follows. 1) In 18 out of 32 cases, S-100 protein positive myoepithelial cells were observed individually in the parenchyma at the periphery of some carcinomatous duct-like structures or cancer cell nests. The cells were noted in 7 cases of metastatic regional lymph nodes. In 5 cases contained with 2 cases of infiltrating duct carcinoma with focal sarcomatous metaplasia, S-100 protein positive cells were seen in fibroblast-like spindle cells in stroma adjacent to cancer nests. 2) Ultrastructural features of myoepithelial cells showed significant loss of fine microfilament and hemides-mosomes and relative imcrease of coarse large filaments. Morphologic transformation of myoepithelial cells to neoplastic epithelial cells or stromal fibroblast-like spindle cells were suggested in 3 NOR type and 2 metaplastic type carcinomas. 3) The ultrastructural changes of basement membrane disclosed some variations from case to case and even within a single tumor if large number of blocks were studied. Focal destruction, splitting, segmentation and extensive loss of basement membrane arround cancer nests were noted. On the other hand, basement membrane material surrounded cancer nests or individual cancer cells irregularly. 4) Most stromal fibroblasts in infiltrating duct carcinoma had abundant rough endoplasmic reticulum with enlarged plump cytoplasm. Some of them were transformed to myofibroblasts which had perinuclear rough endoplasmic reticulum and peripheral microfilaments with dense bodies in their cytoplasm.
A ClinicoPathological Study of Lipomatous Tumors.
Tae Sook Hwang, Eui Keun Ham
Korean J Pathol. 1988;22(1):57-62.
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Lipomatous tumors represent a common group of neoplasm in adult life usually presented as a mass. Authors reviewed 872 benign liopmatous tumors and 39 liposarcomas in the Department of pathology, SNUH during last 10 years (1978-1987). Among the benign lipomatous tumors, the ordinary lipomas consisted of 80.8%, followed by angiolipomas (11.4%), fibrolipomas (2.3%), intramuscular lipomas (1.8%), and angiomyolipomas (1.4%). Most of the benign lipomatous tumors occurred at adult life and were rare in infancy and childhood except for lipoblastoma. In our series, the peak age of liposarcoma at the time presentation was 50 to 60 years, and the youngest age was 17 years. The myxoid type was the most common and it accounted for 38.5% of the cases. The two major sites were the extremities and retroperitoneum. Thirteen cases out of 39 liposarcomas had recurred and 2 cases had lymph node metastases at the time of presentation.
An Immunohistochemical Study of Alpha-1-antichymotrypsin and Lysozyme in the Hofbauer Cells of Human Placentas.
Ho Won Hwang, Ho Jong Chun, Chae Hong Suh
Korean J Pathol. 1988;22(1):63-69.
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The present study has shown that immunohistochemical staining of the human placentas (5 first trimester and 20 full term placentas) for confirmation of the monocytic linease of its macrophage function. We used two macrophage associated glycoprotein; alpha-1-antichymotrypsin (A1Ac) and lysozyme (LSZ). The results from presence or absence of A1Ac & LSZ by immunohistochemical methods can be helpful to deceide the degree of differentiation of macrophage. In al the placentas examined a strong cytoplasmic reaction for A1Ac was seen in the Hofbauer cells, and the same cells of serial sections didn't stain for LSZ. The strong cytoplasmic reaction for A1Ac supports that Hofbauer cells are macrophage, but they didn't stain for LSZ, a bactericidal enzyme, we propose that these cells are not fully differentiated macrophage. The lack of LSZ may have some relevance to the pathogenesis of certain placental infections.
Four Cases of Intrapulmonary Hamartoma: An ultrastructural study.
Ho Jong Chun, Keun Hong Kee, Chae Hong Suh, Jang Sihn Sohn, Chung Hee Chi
Korean J Pathol. 1988;22(1):70-81.
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AbstractAbstract PDF
Tumors of the lung and bronchi containing cartilage were known by a variety of names, chondroma, adenochondroma, chondromatous hamartoma and mixed tumor. This variation in nomenclatures explain the difference of illustration on the nature of these tumor. The concept pulmonary harmatomas are benign neoplasm and not developmental malformations, has gained wide acceptance in recent years. We have experienced four cases of intrapulmonary hamartoma which were all discovered during routine chest film check up for certificate of health and evaluation of other disease. One case is added further detailed histologic examination by electron microscopy. The age at time of the detection were 53 (male), 23 (male), 39 (female), and 56 (female) years old. The mean size is 4.3x3.7x3.4 cm. The locations were three left upper lobes and one right upper lobe. Lobectomy and wedge resecions were done. Cut surface showed promiment lobular structures, papillary configuration and multiple cleft like spaces. Predominant cellular components were cartilage but fat tissue in one of the four cases. Microscopic findings showed abundant hyaline cartilages bearing lobular configuration and overlying pseudostratified ciliated columnar and cuboidal epithelium. Fibromyxoid and undifferentiated cells were seen in myxoid and fatty tissue. Electron microscopic findings revealed stellate, undifferentiated mesenchymal cells bearing collagen formation, stellate smooth muscle and transition areas between undifferentiated mesenchymal cells and mature cartilage. Epithelial components were similar to terminal bronchiole and alveolar epithelium. These findings suggest the concept that intrapulmonary hamartoma represent a histologic specturm of benign mesenchymal neoplasms, which originate in peribronchial connective tissue.
Malignant Teratoma in the Mediastinum Associated with Endodermal Sinus Tumor and Squamous Cell Carcinoma.
Keun Hong Kee, Ho Jong Chun, Chae Hong Suh, Hae Sook Song
Korean J Pathol. 1988;22(1):82-87.
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AbstractAbstract PDF
Anterior mediastinal teratoma was removed from the right hemithorax of a 15-year-old male patient presenting initially with right chest discomfort and hemoptysis. He was died following precipitous clinical deterioration, 2 months after open thoracotomy. The true malignant nature of this tumor, that there are endodermal sinus tumor and squamous cell carcinoma, was apparent on resection specimen. The former had metastasized to right supraclavicular lymph node. A similar case has not been reported previously on the review of the pertinent literature on malignant mediastinal teratoma.
Case Reports
Blue Nevus in Uterine Cervix: A case report.
Hyo Min Kim, Eui Keun Ham, Hyo Pyo Lee
Korean J Pathol. 1988;22(1):88-91.
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AbstractAbstract PDF
Blue nevi commonly occur on the skin of head, neck, and arms, and in occasional instances they have been observed in the mucosa of oral cavity, vagina, hard palate, and even breast, and in very rarity observed in the uterine cervix. We have experienced a case of blue nevi on the uterine cervix of a 45 year old famale who was operated under the diagnosis of uterine myoma. In gross findings, besides two well circumscribed uterine myomas measuring 3.5 cm and 0.6 cm in diameter in the anterior myometrium, multiple pin-point sized grayish blue pigments measuring 2-3 mm in diameter aggregated in the submucosa of the uterine cervix. Microscopically the blue nevi showed greatly elongated, slender often slightly wavy melanocytes with long, occasionally branching dendritic processes lie grouped in irregular bundles in the submucosa of the uterine endocervix. The pigments showed positive response to the Fontana-Masson stain in the cytoplasm and the extracellular area.
Malignant Mixed Mullerian Tumor of the Fallopian Tube: Report of a Case.
Eun Deok Chang, Young Hee Jee, Sun Moo Kim
Korean J Pathol. 1988;22(1):92-96.
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AbstractAbstract PDF
Malignant mixed mullerian tumor of the fallopian tube is an extremely rare neoplasm. To date, only 26 cases of primary malignant mixed mullerian tumor of the fallopian tube have been reported, and no report has been published in Korea. This is not surprising, since as a group these meoplasms are least likely to occur in the fallopian tube; the most common sites being the endometrium, vagina, cervix and ovary. We report a case of malignant mixed mullerian tumor of the fallopian tube ina 63-year-old woman with brief review of the literatures.
Angiosarcoma of the Breast: Three cases report.
Kyung Ja Cho, Geung Hwan Ahn, Je G Chi, Eui Keun Ham
Korean J Pathol. 1988;22(1):97-104.
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Three cases of angiosarcoma of the breast are described. One case in a 66 year old woman was a solid mass and histologically showed poor differentiation leading to a death 14 months after the diagnosis. Another two in 46 and 25 year old females were large vascular masses showing moderate differentiation with endothelial tufting and papillary projections, and abdominal and contralateral mammary, and liver metastasis occurred within postoperative 10 months and 6 months in each case. A radical mastectomy and adjuvant chemotherapy in case 2 were not lifesaving. Although histologic degree of differentiation seems prognosis-related, angiosarcoma is the most malignant tumor of the breast.
Original Article
Plexiform Schwannoma.
Kyo Beom Lee, Yang Seok Chae, Nam Hee Won, Seung Yong Paik
Korean J Pathol. 1988;22(1):105-109.
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Three case of plexiform schwannoma displayed multinodular masses and microscopically a multicentric pattern of growth featuring Antoni A cellular component, Verocay bodies and presence of Antoni B areas. Clinically von Recklinghausen's disease was not observed in all cases. The first patient was a 17 year old male who had a protruding nodule of walnut size which was located at the dermis of the left flank for 13 years. The second case, a 25 year old male, had an irregular whitish brown multinodular mass in the choana for 5 years. The last case, a 56 year old woman, had an ovoid yellowish brown mass with multiple nodules in the retroperitoneum.
Case Reports
Giant Cell Glioblastoma: A report of two cases.
Seoung Hyp Park, Kap No Lee, Seung Yong Paik
Korean J Pathol. 1988;22(1):110-117.
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A rare variant of glioblastoma characterized by giant or monster cells is now well recognized. However, this tumor had been remained in controversy on its pathogenesis, and the tumor had been considered to be a sarcoma until 1968, when the electronemicroscopic study demonstrated the presence of filaments mesuring 80 in diameter in the perikarya in giant cells as well as in smaller, better differentiated cells. The peroxidase antiperoxidase stain of glial fibrillary acid protein shows positive glial fibrillary fibers in their cytoplasm, accordingly the giant cells has been recognized as being of astrocytic origin. This concept has been redocumented by light microscopy since PTAH-positive astrocytic fibers are present in large numbers of neoplastic cells. The two cases reported here were frontal and occipital giant cell glioblastomas in 58 years old male and 44 years old women, respectively. On light microscopy, the tumor showed numberous characteristic giant or monster cells as well as the same features seen in the usual glioblastoma. The electron microscopy and special stains, PTAH and GFAP confirmed that the giant cells were in glial origin.
Mixed Germ Cell Tumor in Third Ventricle: A report of case.
Ki Hwa Yang, Sung Dae Jin, Eun Jung Lee, Kyo Young Lee, Seok Jin Gang, Byoung Kee Kim, Sun Moo Kim
Korean J Pathol. 1988;22(1):118-122.
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Primary mixed germ cell tumor is a very rare tumor in the cranial cavity. It is composed of varying combination of germ cell neoplasms, such as germinoma, embryonal carcinoma, choriocarcinoma and teratoma. The authors experienced a case of mixed germ cell tumor developing in the floor of the third ventricle, in a twelve years old boy. He was admitted to the hospital, because of headache, eyeball pain, diplopia and vomiting. Brain CAT scan revealed a round tumor density in the floor of the third ventricle. Tumor marker study, preoperatively checked, revealed beta-HCG, 439.8 mIU/ml and alpha-fetoprotein, under 20 ng/ml. On operation, there was a dark brown firm mass up to 3.0 cm in the third ventricle, that invaded into the foramen Monro. With microscopic examination, this tumor is composed chiefly of germinoma, with embryonal carcinomatous region, choriocarcinomatous region and focal mature teratomatous region. The authors diagnosed this case as mixed germ cell tumor.

JPTM : Journal of Pathology and Translational Medicine