Journal of Pathology and Translational Medicine

Volume 23(1); March 1989

Original Articles

Weekly Development and Growth of Tooth Germ in Korean Fetuses.: Suk Keun Lee, Chang Yun Lim, Je G Chi; Korean J Pathol. 1989;23(1):1-19.

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Abstract PDF: In order to elucidate the developmental stages of human tooth germ during prenatal period, we examined 254 normal fetuses ranging in gestational age from six weeks to fourty weeks old histologically. Lim's developmental pattern of prenatal tooth germ was divided into three groups, the first group consisting of five grades (I, II, III, IV, V) was for the development of enamel epithelium the second group of three grades was for the deposition of dentin matrix and enamel matrix, and the third group of three grades (A, B, C) was for the growth of perifollicular bone. Some developmental progress between enamel epithelium and dental papilla could be identified by observation of the sequential development of deciduous and permanent tooth germs histologically. The following results were made. 1) The prenatal development of tooth germ showed similar weekly stages in both the maxilla and the mandible. The initial deposition of dentin matrix and enamel matrix (III-1 stage) started at 12-14 weeks of gestational age in the deciduous incisor and canine, and at 16-20 weeks of gestational age in the deciduous molars. And the initial deposition of dentin matrix and enamel matrix in the permanent first molar was at 20-22 weeks of gestational age, and that of the permanent incisor was at 34-36 weeks, and that of the permanent canine was 36-38 weeks, and of the permanent premolar was at 38-40 weeks. 2) The S-shaped curvature was characteristically found where the reciprocal induction of odontoblast and amelobast occurred actively in the developing tooth germ. Primarily pre-ameloblasts which abutted on the dental papilla differentiate the condensed mesenchymal cells into odontoblasts, and secondarily matured odontoblasts which bulged into enamel epithelium produced dentin matrix and differentiated the shrunken pre-ameloblasts into ameloblasts. 3) The mandible grew more rapidly than the maxilla during the early prenatal period. The trabecular bone from both jaws proliferated initially into labial side of developing tooth follicle and gradually circumscribed the tooth follicle lingually and mesio-distally, to form perifollicular bone resultantly.

A Pathological and Immunohistochemical Study of 9 Cases of Inflammatory Fibroid Polyp.: Nam Hoon Cho, Hyeon Joo Jeong, Ho Guen Kim; Korean J Pathol. 1989;23(1):20-28.

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Abstract PDF: We aimed to study the clinicopathologic features of inflammatory fibroid polyp by histological and immunohistochemical methods. The materials used in this study consisted of 9 cases of inflammatory fibroid polyp: 4 in the stomach, 4 in the small intestine and 1 in the cecum. The results were as follows: Females were affected more frequently than males and the average age was 45 years(range:27-61). In cases of gastric lesion, the size tended to be smaller, the mass was mainly located along the greater curvature side of antrum, and confined to the submucosa. However inflammatory fibroid polyp of the small intestine was over 2.5 cm in size, located along the antemesenteric border, and involved the proper muscle layer. In addition, intussusception was accompanied by polyp in 2 cases of small intestinal lesions. Histologically inflammatory fibroid polyps of the stomach were characterized by prominent lymphocytic infiltration and occasional onion-skinning of stromal cells, whereas plasmocytic infiltration was prominent in those of the small intestine. Main component cells comprising this lesion were confirmed to be fibroblasts by immunohistochemistry which revealed strong reactivity to vimentin in the cytoplasm of slindle cells.

A Study on the Cell Kinetics of the Dysplastic Epithelium in the Stomach.: Jong Hee Nahm, Kyu Hyuk Cho; Korean J Pathol. 1989;23(1):29-35.

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Abstract PDF: This study was designed to evaluate the biological behavior of the dysplastic lesion of the stomach by applying immunohistochemical method for bromodeoxyuridine (BrdUrd). The results obtained were as follows. 1) In most hyperplastic and dysplastic lesions, the proliferative cell zones, loci of BrdUrd-labelled cells, were found in the upper later of the mucosa, whereas they were confined to the neck zone in the normal gastric mucosa. 2) The labelling indices (LIs), percentages of BrdUrd-labelled cells, were 11.0% to 13.6% in the normal gastric mucosa, and were 14.3% to 17.9%, 16.4% to 19.2% and 17.4% to 20.7% in the simple hyperplasia, in the atypical hyperplasia and in the dysplasia, respectively. These findings suggested that proliferative potential in hyperplasia and dysplasia were greater than that in normal gastric mucosa, the higher the grade of dysplasia being, the greater the proliferative potentials.

Immunohistochemical Studies on Localization of Carcinoembryonic Antigen and Epithelial Membrane Antigen in Adenoma and Well-differentiated Adenocarcinoma of the Stomach.: Hye Soog Kim, Man Ha Huh, Sun Kyung Lee; Korean J Pathol. 1989;23(1):36-42.

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Abstract PDF: This study was performed with the purpose of histochemical comparison of CEA and EMA localization between adenoma and well-differentiated adenocarcinoma of the stomach. The specimen was 12 lesions of adenoma and 15 foci of well-differentiated adenocarcinoma of the stomach. The markers in neoplastic tissue and neighbouring mucosa of the tumors were examined in paraffin sections using peroxidase-antiperoxidase method. The data obtained were evaluated statistically. The results were summarized as follows: 1) In 12 lesions of stomach adenoma, the positive reaction to CEA was seen in 3 lesions (20.0%), and to EMA in 10 lesions (83.3%). The positive rate of CEA in adenoma was lower than that of the neighbouring normal mucosa, but the positive rate of EMA was similar between the two. 2) In 15 foci of well-differentiated adenocarcinoma of the stomach, the positive reaction to CEA was seen in 13 foci (86.7%), and to EMA in 12 foci (80.0%). The positive rate of CEA in well-differentiated adenocarcinoma was higher than that of the neighbouring normal mucosa, while the positive rate of EMA was similar to each other. 3) Immunoreactivity to CEA in adenocarcinoma showed good positive correlation with the development of cuticular border of the neoplastic glands, while reactivity to EMA in adenocarcinoma was not related with the development of cuticular border. 4) The positive rate and intensity of CEA reaction in adenocarcinoma were higher than those in adenoma, but the positive rate and reactiveity of EMA were similar to those of adenoma. 5) The positive rate of CEA or EMA in the neighbouring mucosa of adenoma was not different compared with those in the neighbouring mucosa of adenocarcinoma. With the above results, it is concluded that adenoma and adenocarcinoma of the stomach may be different each other, biologically, and further more, it is presumable that adenoma may not be a premalignant lesions. It is considered that examination of CEA immunoreactivity may be helpful in differentiated of adenoma from well-differentiated adenocarcinoma, in most cases.

Development of Endocrine Cells of Human Pancreases: A Morphologic and Immunohistochemical Study.: Jung Hee Cho, Je Geun Chi; Korean J Pathol. 1989;23(1):43-50.

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Abstract PDF: Pancreases from 123 human embryos and fetuses ranging from 3 weeks to 40 weeks of gestation age were studied. Thirty four cases were examined by immunohistochemical preparations to investigate the temporal development of the pancreatic islet particularly with reference of its origin, time of appearance and interrelation of various types of islet cells. Following results were made. 1) The endocrine cells and the acinar cells both originated from the primitive pancreatic duct cells. 2) Alpha, beta and delta cells began to appear almost simultaneously at 10 weeks og gestation. A, B and D cells, in decreasing order of frequency, were all found in the entire areas of the pancreas. 3) Four types of fetal islets i.e., preimtive, "homologous", bipolar and mantle, could be recognized during development. The latter 3 types first appeared simultaneously at 17 weeks of gestation. They continued to increase in sized and number throughout the fetal life and constituted permanent islets. 4) Two types of islet cells could be distinguished with routine H&E staining after the second trimester. 5) The size of fetal pancreatic islets were rapidly increased between early (64 micrometer) and mid-term (113 micrometer) (p<0.05). 6) The primitive islets were composed of 37.3% of alpha cells, 41.3% of beta cells and 13.4% of delta cells. At mid-term the mantle islets were composed of 36.4% of alpha cell, 42.7% of beta cell and 25.6% of delta cell. At term beta cell was higher value (52.6%) than alpha cell (29.3%) and delta cell (17.6%) (p<0.05).

Mechanisms of Acinar Cell Deletion in Rat Pancreas Following Experimental Duct Ligation.: Sang Pyo Kim, Kun Young Kwon, Sang Sook Lee, Chai Hong Chung; Korean J Pathol. 1989;23(1):51-64.

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Abstract PDF: This study was carried out to investigate the mechanisms of acinar cell deletion, leading to the pancreatic atrophy of rat pancreas after experimental duct ligation. Fifty-seven male Sprague-Dawley rats, maintained on a stock diet, weighing 200 gm, in average, were divided into 2 experimental groups. Group 1. Control group. Six rats. Abdominal cavity was opened and closed without further treatment. Group 2. Fifty-one rats. Animals were treated with partial ligation of the pancratic ducts according to the procedure developed by Hultquist followed by sequential sacrifices at: 1 hour (3 rats), 3 hours (3 rats), 6 hours (6 rast), 12 hours (3 rats) and 24 hours (8 rats); 2 days (8 rats), 3 days (3 rats), 4 days (3 rats) and 5 days (5 rats); 1 week (3 rats), 2 weeks (3 rats) and 8 weeks (3 rats); after partial ligation was extirpated and examined by both light and electron microscopy. The results obtained were as follows: Light microscopically, noted were an interstitial edema and focal necrosis of the pancreatic tissue along with fine vacuolization and depletion of the zymogen granules in the acinar cell cytoplasms and condensation of the acinar cell nucleus. These changes were observed by 2 days after ligation. At about the same time, one can observe the dense body, identified to be apoptotic body, in the acinar cell which were found to be decreased in quantity. By 5 days after ligation, no recognizable acinar cells left in the collagenous stroma except intercalated ducts. Conspicuous stroma except intercalated ducts. Conspicuous stromal hyalinization, thereafter. Electron microscopically (TEM and SEM), nuclear condensation and margination toward the nuclear membrane was noted by 6 hours after duct ligation. By 24 hors sporadic membrane-bounded apoptotic bodies appeared in the acinar cells, the number of which reaching to the peak by 3 days after ligation. These apoptotic bodies were found to be phagocytosed by either intraepithelial mononuclear phagocytes or adjoining acinar cells. It can be concluded, therefore: That orderly remodeling of pancreatic exocrine tissue during atrophy is effected by rapid deletion of acinar cells by apoptosis.

Clinicopathologic Study of the Endometrium of Dysfunctional Uterine Bleeding.: Nam Hoon Cho, Chan Il Park, In Joon Choi; Korean J Pathol. 1989;23(1):65-74.

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Abstract PDF: One of the most common symptoms in gynecologic disorders is an abnormal utirine bleeding, of which dysfuncyional uterine bleeding (DUB) is frequently encountered. DUB is defined as an endocrinologic imbalance of the axis of hypothalamus-pituitary-ovary-endometrium without organic diseases such as a neoplasm, and inflammation, a pregnancy, a trauma, Although the correct diagnosis of DUB depends on various assessements such as a menstrual cycle, basal body temperature, endocrine assay, vaginal cytology and endometrial histology, in many circumstances pathologist have only the endometrial histology with trivial clinical information to make a diagnosis. Therefore, the present study was aimed at assessing the pattern of the endometrium as precisely as possible. The histologic pattern was classified according to the Handrickson and kempson classification (1980). The authors also attempted to correlate the non-neoplastic metaplasia with the endometrial histology. The material consisted of 447 cases of endometrial curettage specimens diagnosed clinically as DUB during recent 4 years. The histologic examination was carried out through the routine formalin fixed-paraffin embedding method, followed by hematoxylin-eosin staining in routine and other special staining as required. The following results were obtained; 1) The pattern of the endometrium in DUB was predominently the proliferative type (239 cases, 65.55%). Of these 293 cases, 144 were of the abnormal proliferatrive phase, and particulary most were the disordered proliferative phase. The remaining 154 cases (34.45%) were found to have secretory endometrium, of which 50 cases belonged to the abnormal secretory type. Most of the cases shewing abnormal secretory patterns appeared dyssynchronous or underdeveloped. 2) Of the 361 patients with DUB for whom the clinical records were available, 197 (54.57%) were non-ovulatory and 118 (32.69%) were ovulatory. 3) Non-neoplasic metaplasia was found in 87 cases, of which ciliiated and papillary types were most common. The endometrium was of the proliferative phase in 73.56% of the cases with metaplasia, and the disordered proliferative pattern showed a particular correlation with the metaplasia (44 cases). 4) Among 63 postmenopausal DUB patients, 52 (82.53%) appeared to have the proliferative endometrium, and in particular 23 (36.51%) had the disordered proliferative endometrium.

Immunohistochemical Demonstration of Neuron-Specific Enolase and Chromogranin and Ultrastructural Studies on Endocrine Carcinoma of the Uterine Cervix.: H J Chun, K H Kee, S C Lim, Hae Sook Song, M W Kim, S J Han, C H Suh; Korean J Pathol. 1989;23(1):75-84.

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Abstract PDF: Three cases of endocrine carcinoma, well differentiated type of the uterine cervix, were found in a study of 201 cases listed in the files of the Chosun University medical college as malignant tumors in the uterine cervix based on light microscopic pattern, three cases were divided into pure endocrine carcinoma (2 cases) and endocrine carcinoma mixed with large cell nonkeratinizing squamous cell carcinoma (1 case). The histologic picture of these lesions varied from solid sheets to glandular patterns and show monotonous and intermediate size of neclei. Argyrophilic granules were demonstrated in two pure forms by Grimelius stain, and Masson-Hamperl (argentaffin) stain were negative in all three cases. Immunohistochemical studies demonstrated positive reactions for neuron specific enolase and chromogranin in all three cases. Although endocrine symptoms were not found, ACTH were demonstrated in two pure forms. Ultrastructural studies disclose distinct membrane bounded neurosecretory granules and well defined Golgi complex.

The Expression of ras Oncogene in Benign and Malignant Lesions of Breast.: Jong Hee Nahm, Jong Hyun Lee, Chang Soo Park, Kyu Hyuk Cho; Korean J Pathol. 1989;23(1):85-93.

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Abstract PDF: To evaluate correlation between the amount of oncogene products in tumor cell extracts and malignant potentiality in breast tumor, immunohistochemical staining for the ras Oncogene products was performed in the sections of benign and malignant lesions of the breast. The results obtained were as follows: 1) The positive reaction to ras Oncogene products was usually observed in the cytoplasm and cell membrane. 2) The ratio of positive reaction was 30.4% in epithelial hyperplasia of fibrocystic disease, 26.5% in fibroadenoma. 49.5% in intraductal carcinoma 71.6% in infiltrating ductal carcinoma, 85.2% in metastatic infiltrating ductal carcinoma, and 89.7% in relatively preserved neighboring lobules of infiltrating ductal carcinoma. In conclusion, the ras oncogene products are found by a significantly higher ratio in the more aggressive lesions, and the infiltrating ductal carcinoma might represent its potential of malignant transformation. 3) The expression of ras oncogene was heterogeneous in primary as well as metastatic mammary carcinomas.

Effect of Lysodren(R) on the Ultrastructural Changes in the Rat Adrenal Corex: Immunohistochemical staining for anti-ACTH antibody on the adenohypophysis.: Ho Jong Chun, Hae Chang Cho, Hae Sook Song, Kyu Ho Park; Korean J Pathol. 1989;23(1):94-110.

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Abstract PDF: The toxicity and adrenostatic effect of o,p'-DDD, a derivative of the insecticidal DDT, on the adrenal cortex were well known. It known that the toxicity was based on the blocking of steroid biopsynthesis when cholesterol was converted to pregnenolone. Lysodren(R) was also known to be capable of producing a regression of adrenocortical carcinoma and its metastases, and this drug became one of useful choice for the treatment of unoperable adrenocortical carcinomas. Recently, fine structural effect of o,p'-DDD on the adrenocortical carcinoma show that the mitochondria is the primary target organelle. o,p'-DDD was dissolved in corn oil and it was orally administered for 28 days to investigate the ultrastructural effects of zona fasciculata of rat adrenal cortex. The results obtained were as follow: 1) The body weight was decreased after feeding o,p'-DDD. 2) Light microscopic examination showed no remarkable change except increased fine lipid droplets of zona fasciculata in group I (o,p'-DDD 75 mg/kg feeding). Moderately increased intracytoplasmic lipid droplets and pyknotic nuclei bearing membrane indentations were seen in group II (o,p'-DDD 150 mg/kg feeding). Large sized lipid droplet aggregates, pyknotic nuclei with severe nuclear membrane indentations and karyorrhexis in focal area were evident in group III. 3) Immunohistochemical staining for ACTH in pituitary gland showed increasing number of ACTH secretory cell and increasing intensity of staining property according to the dosage of o,p'-DDD. 4) Ultrastructural examination showed increased intracytoplasmic lipid droplets and mild increased peroxisome. There was no remarkable ultrastructural changes in mitochondria in group I. Moderately increased lipid droplets and clusters formation, compressed mitochondria, partial disappearance of mitochondrial cristae, increased peroxisome and nuclear membrane indentations were seen in group II. In group III, nuclear membrane showed prominent indentation. Numberous cytoplasmic vacuolation, double membrane ring in mitochondria, disappearance of mitochondrial cristae, myelin figure formation in mitochondrial matrix, and fatty changes in mitochondrial matrix were seen. These findings showed that the primary target organelle of attack by o,p'-DDD on zona fasciculata of adrenal gland in rat is mitochondria and it was developed from double ring formation in mitochondrial matrix.

Clinico-pathological Study on the Skin Appendage Tumors.: Kye Yong Song, Dong Hun Yoon, Eui Keun Ham, Yoo Shin Lee; Korean J Pathol. 1989;23(1):111-121.

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Abstract PDF: A clinico-pathological study on the true skin appendage tumors was carried on the accumulated cases during pat 11 years from 1976 to 1986 years in the Department of Pathology, Seoul National University Hospital. The results was as follows; 1) Among various benign skin appendage tumors pilomatricoma was the most common benign tumor consisting of 72 out of 244 cases (30.1%), followed by dermoid cyst 48 cases (20.0%), steatocystoma multiplex 37 cases (15.5%), syringoma 33 cases (13.8%) and trichilemmal cyst 19 cases (0.8%). Other benign skin appendage tumors were rarely noted under 3%. Sebaceous carcinoma was most common among malignant skin appendage tumors and no malignant tumor of sweat gland origin was noted. 2) The sex ratio of male to female of the pilomatricoma was 1 : 2.6 and on the face, neck, and extremeties in 1st and 2nd decades. The sex ratio of dermoid cyst was 1 : 1.2 on the face in 1st decade. The sex ratio of steatocystoma multiplex was 1 : 1.9 and on the trunk in 3rd decade. The sex ratio of syringoma was 1 : 7 and on the face in 5th decade. The sex ratio of trichilemmoma was 1 : 1.6 and on the trunk in 5th decade. Other tumors were not avaiable for analysis because of small number. The sex ratio of sebaceous carcinoma was 1 : 2 and on the eyelid in 6th decade

The Effects of Localized X-ray Irradiation on the Peripheral Nerve.: Jong Gi Lee, Chong Ryong Lee, In Soo Suh; Korean J Pathol. 1989;23(1):122-131.

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Abstract PDF: The authors studied the early morphologic changes of peripheral nerve, which is known as relatively radioresistant tissue to the X-ray irradiation, but recently clamied by several clinician through development of neuropathies after radiotherapy of the malignacy. Rabbits were received 1,000 or 2,000 cGy of X-ray on the knee joint areas. Sciatic nerves were extracted out 30 minutes, 1, 2, 4, 24 hours, and 3 and 7 days after irradiation. The morphologic changes were observed by light and electron microscopes. The results were summarized as follows: Light microscopically, only mild edema is noted. Electron microscopically, irregular separation and folding of myelin sheath with spherical body formation are noted. Above features were more prominent at later stages and aggregated nests of fragmented myelin were scattered 16 hours after irradiation. Schwann cell necrosis is noted after 24 hours. But above degenerative changes were scarcely present 7 days after irradiation. There is no remarkable axonal changes. The interstitial tissue revealed swelling and irregularity of surface of endothelial cells, and edema. On the basis of the results, it may be concluded that the peripheral nerve is injured by irradiation in early stages, and the main target of irradiation injury is thought to be myelin sheath and Schwann cells, which would be reversible and could be recovered promptly.

Fatty Hamartoma of Epicardium.: Hyun Wook Kang, Jung Ran Kim, Jeong Wook Seo, Je G Chi; Korean J Pathol. 1989;23(1):132-135.

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Abstract PDF: The fatty hamartoma of pericardium is characterized by abnormal accumulations of adipose tissue forming a recognizable mass. We reported a case that could best be put into "fatty hamartoma" group. This 66 year old male presented with atrial fibrillation came in for a anterior mediastinal mass. He received an operation for adenocarcinoma of ascending colon several months ago. The chest CT revealed an inhomogeneous mass in the right anterior mediastinal area, which was not clearly demarcated from the right cardiac border. The heart was deviated to the left side due to the mass. Surgical excision was performed under the impression of cardiac teratoma. The large mass was well encapsulated, and was bright yellow and partly pink, and measured 12x8 cm. Microscopically, the mass consisted predominantly of mature fat cells and abundant fibrous tissue with scattered nests of primitive cardiac muscle cells. Reviewing the literature we found the term "fatty hamartoma" could also refer to rhabdomyolipoma or fibrolipoma. Since it contains entrapped cardiac muscle cells, abundant fibrous tissue, multiple blood vessels and fetal fat cells, it could best the categorized into "hamartoma". The term "fatty" represents it's main component. Therefore we propose the term "fatty hamartoma" that could to be used further.

Case Reports

Pleomorphic Adenoma of the Bronchus: A case report.: Eun Sun Park, Mi Kyung Jee, Seok Jin Gang, Byung Kee Kim, Sun Moo Kim; Korean J Pathol. 1989;23(1):136-140.

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Abstract PDF: Pleomorphic adenoma presenting as primary lesion of the bronchus is very rarely encountered, and in our knowledge only 6 cases have been reported in the literature of the western world, and no case report has been published in Korea. Currently, we experienced a case of bronchial pleomorphic adenoma occuring in a 38 years old woman. On X-ray examination, hazy density in the right upper lobe and emphysematous change in the right lower lobe were noted. A right pneumonectomy was done under bronchoscopic diagnosis of bronchial adeoma. The pathologic examination of the present case showed a polypoid endobronchial tumor, 1.4 x 1.1 cm (with extraluminal portion, 2.2 x 1.7 cm) in the right upper bronchus. The microscopic examination revealed a pleomorphic adenoma showing same morphology as those found in the salivary gland. This case, therefore, was believed to be a genuine example of bronchial pleomorphic adenoma of salivary gland type. We compared this case with 6 cases in the literature.

Tumorlet of Lung Associated with Congenital Bronchogenic Cyst: Report of a case.: Yeong Jin Choi, Mi Kyung Jae, Seok Jin Kang, Byoung Kee Kim, Sun Moo Kim; Korean J Pathol. 1989;23(1):141-144.

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Abstract PDF: Tumorlet is a rare lesion of disputed origin that was first described by whitwell in 1955, and about one-third of the reported cases have been associated with underlying lung disease. Patient was a 60-year-old female who was admitted with a histroy of chest discomfort and dyspnea. Right lower lobe was partially resected under the clinical diagnosis of the bronchogenic cyst. Grossly, lung tissue around round cystic lesion appeared brown firm and somewhat fibrotic, and showed several scattered ill-defined whitish gray nodules. Microscopically, lung tissue around bronchogenic cyst was partially obliterated by dense fibrous scar tissue. Within this areas of fibrosis, and in the wall of alveolar ducts and respiratory bronchioles, innumerable microscopic tumorlets were found and argyrophilic granules were also demonstrated in scattered tumorlets with Grimelius stain.

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