Journal of Pathology and Translational Medicine

Volume 24(2); June 1990

Original Articles

Detection of Human Papillomavirus 16/18, 31/33/35 in Verrucous Carcinoma of the Larynx by In Situ Hybridization with Human Papillomavirus DNA Probes.: Ki Kwon Kim, Sang Sook Lee, June Sik Park, Seung Won Jin, U Ik Sohn; Korean J Pathol. 1990;24(2):95-102.

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Abstract PDF: Verrucous carcinoma of the larynx is a distinct and uncommon variant of well-differentiated squamous cell-carcinoma. The authors hybridized in situ a case of laryngeal verrucous carcinoma with DNA prebes to humman papillomavirus (HPV) 6, 11, 16, 18, 31, 33 and 35. The DNAs from the verrucous carcinoma of larynx hybridized with mixed DNA probes HPV-16/18 and 31/33/35. In addition, there was an evidence of HPV infection based on hybridization with mixed DNA probe HPV-6/11 in the adjacent papilloma tissue. By in situ DNA hybridization techniques, we clearly demonstrated human papillomavirus (HPV-16/18, and 31/33/35) related sequences in this neoplasm. These findings suggest the role of HPV-6/11 in the development of laryngeal papilloma ad HPV-16/18 and 31/33/35 probably on the progression to verrucous carcinoma.

Morphological Observation on the Prenatal Development of the Human Gastrointestinal Tract.: Yeon Lim Suh, Je G Chi; Korean J Pathol. 1990;24(2):103-119.

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Abstract PDF: A total of 322 fetuses and 29 embryos were examined light microscopically to evaluate the morphological development of the human gastrointestinal tract with increasing gestational age. The human embryos were analysed by reconstruction of serial section slides. One hundred and forty fetuses ranging from 15 to 41 weeks of gestation were used for correlating the gestational age and the body weight with the measurement of the small and large intestines. 1) The esophagus develps from the distal part of the foregut through a partition of the tracheoesophageal septum. Initially the esophagus is short, but it elongates rapidly and reaches its final relative length and position by the seventh week. The epithelium of the esophagus proliferates and completely obliterates the lumen by the seventh week, but recanalization occurs by the ninth week. The esophageal epithelia consist of three different groups of cells; stratified squamoid cells, ciliated columnar cells and tall columnar cells by the 21th week. 2) The stomach appears as a fusiform enlargement of the caudal part of the esophagus at the fourth week. During next two weeks the stomach acquires its adult shape and final position. The primordial gastric pits and the parietal cells appear at the eighth and eleventh weeks, respectively. 3) As the midgut elongates, it forms a ventral U-shaped loop, called primitive intestinal loop by the fifth week. At this stage the cecum appears as a swelling from the caudal limb of the intestinal loop. By the seventh week the bulks of the caudal limb of the intestine herniate into the umbilical cord, in which the loop rotates 90 degrees counterclockwise around the axis of the superior mesenteric artery. During the tenth week, the intestine returns to the abdomen and undergoes a further 180 degrees counterclockwise rotatation. 4) The cloaca is divided into two parts by a urorectal septum at the fifth week. By the seventh week the urorectal septum has fused with the cloacal membrane, dividing it into a dorsal anal membrane and ventral urogenital membrane. The anal membrane ruptures at the eighth week. 5) During the sixth week the duodenal lumen becomes completely filled with proliferating epithelium. The villi project from the mucosa of the small and large intestines at the eighth and eleventh weeks, respectively. The villi of large intestine become resorbed again after the 21th week. At the fifth week Paneth cells appear through the entire length of the intestine including the rectum, but disappear in the colon and the rectum after the 36th week. 6) The developing Auerbach's plexuses are well recognized along the outside of muscle coat throughout the gastrointestinal tract, but demonstrate no immunoreactivity for the anti-neuron specific enolase antibody. The neuroblasts in the myenteric plexus reveal strong positivity for the anti-neuron specific enolase antibody at the eleventh week, but the ganglion cells differentiate by the fourteenth week. 7) Differentiation of the gastrointestinal wall and development of the myenteric plexus begin form the esophagus and progress caudally down to the colon. But the anorectal wall is differentiated from the cloaca more earlier than the esophagus, stomach and colon are. 8) The small and the large intestines elongate progressively with the increasing gestational age and body weight and increase approximately 5.6 and 5.4 folds, respectively during the 25 weeks from the 15th to 41th week of gestation. At the 40th gestational week the small intestine is 5.68 times the length of the colon. 9) The correlation between the body weight (BW), crown-rump length (CR) and intestianl length (small intestine (SI), large itestine (LI) is presented as: SI (cm)= -33.67 + 4.14CR + 11.62 (BW)(1/3), LI (cm)= 5.56 + 0.76CR + 0.007BW (gm), CR (cm)= 7.82 + 0.015 SI + 0.41 (BW)(1/2).

Expression pattern of Hepatitis B Viral Core Antigen (HBcAg) and Surface Antigen (HBsAg) in Liver of the Inactive HBsAg Carriers.: Hee Jeong Ahn, Kyoung Ho Kim, Young Nyun Park, Ho Guen Kim, Chan Il Park; Korean J Pathol. 1990;24(2):120-127.

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Abstract PDF: To understand better the complex natural course of HBV infection, the expression patterns of HBcAg and HBsAg in the liver of 51 inactive serum HBsAg carriers (24 CPH and 27 NPD) were studied by immunohistochemical methods. The inactive serum HBsAg carriers were devided into 3 groups by the following expression patterns of serum HBeAg/anti-HBe status and tissue HBcAg and HBsAg. Pattern A (18 cases) : HBeAg+, cHBcAg+ (94.4%), mHBsAg+ (61.1%), pATTERN B (14 cases) : anti-HBe+, nHBcAg+, cHBsAg+, Pattern C (19 cases) : anti-HBe+, HBcAg-, cHBsAg+ (89.5%). There were no significant differences between CPH and NPD, lthough the core free pattern was more common in the latter. The cHBcAg was expressed in 17 of 18 (94.4%) HBeAg seropositive cases but only one of 33 cases with serum anti-HBe, suggesting that the cHBcAg is intimately related to HBeAg. Since the inactive HBsAg carriers also expressed cHBcAg and/or mHBsAg, the necro-inflammatory activity of HBV infected liver is assumed to depend on the host immune response rather than their presence alone

Morphometric Analysis of Malignant Lymphoma.: In Sook Kim, Eun Kyung Hong, Jong Dal Lee; Korean J Pathol. 1990;24(2):128-136.

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Abstract PDF: Nuclear morphology and size are important in the diagnosis and classification of non-Hodgkin's lymphoma. The recognition of morphologic features of the lymphoma cells and their interpretation are somewhat subjective and often difficult. We apply the morphometric study in touch imprints from 22 cases of non-Hodgkin's lymphoma classified by Working formulation. Determination of the exact size of the tumor cells and substantial diagnostic value of this method compared with histology are proposed. Morphometric parameters, including nuclear area, perimeter, maximal diameter (D-max), diameter of an equivalent circle for a measured area (D-circle), circularity factor (From PE) and regularity factor (Form AR) are measured, using Kontron, user-controlled image analyser (IBAS-1). The correlation between morphometric and histologic diagnosis is relatively good, except for 2 cases of Burkitt's lymphoma, measured as large cell and 2 cases of large cell lymphoma measured as medium cell. The most reliable parameter of the nuclear size is D-circle. The parameters for the nuclear shape, Form PE and Form AR, also reflect the nuclear cleavage and polymorphous pattern. The large cell group shows more wide standard deviation than small and medium cell groups, reflecting heterogeneity and variability in unclear size of large cell group. We suggests the morphometric analysis using touch imprints is complementary diagnostic tool for more accurate and reproducible diagnosis.

Malignant Lymphoma in Children.: Sung Hye Park, Sung Sik Shin, Chul Woo Kim, Je G Chi; Korean J Pathol. 1990;24(2):137-147.

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Abstract PDF: We have reviewed malignant lymphomas in children (15 years and less) that were diagnosed at the Department of Pathology, Seoul National University Hospital and Seoul National University Children's Hospital over the last 10 years, 1979~1989, trying to find any significant histological difference between childhood and adult lymphomas. After critical review by 3 pathologists, the lymphomas are classified according to Rappaport, Lukes-Collins and NCI (working formulation) classifications for non-Hodgkin's lymphomas and Reye classification for Hodgkin's disease. Fifty mine non-Hodgkin's lymphoma (NHL) and 18 Hodgkin's disease (HD) was the material that this study was based. NHL vs HD was 3 : 1, this HD being 23.4% of all malignant lymphomas in children.

Alcoholic Type Cirrhosis Following Side to Side Ileo-Transverse Colon Anastomosis.: Kwang Hwa Park, Kwang Hyup Han, Chan Il Park; Korean J Pathol. 1990;24(2):148-152.

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Abstract PDF: A case of micronodular cirrhosis of the alcoholic type developed following an intestianl bypass surgery in a 47 year-old nonalcoholic male patient is presented. The patient denied any drug use of a long duration and had no diabetes mellitus. Five years before, a side to side ileo-transverse colon anastomosis had been performed for perforated intestinal tuberculosis at 1 m proximal to the ileocecal valve, bypassing a short segment of ileum (about 1.5 m) and transverse colon. The ileum distal to the perforated site had been found completely stenosed. He was severely lean with evidences of nutritional deficiency such as low serum levels of the albumin and vitamin B12. The liver biopsy showed a fatty change, Mallory bodies and perihepatocellular collagenosis within the cirrhotic nodules. The present case suggests that, when there are blind loop formation and nutritional deficiency, hepatic changes identical to those following jejunoileal bypass could develop even by reduction of a shore segment of the small intestine.

Three Cases of Neuroblastoma in Adults: Electromicroscopic study.: In Sook Kim, Tae Jung Kwon, Dong Wha Lee; Korean J Pathol. 1990;24(2):153-160.

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Abstract PDF: Because neuroblastoma is predominantly a tumor of childhood, patholgists and clinicians tend to exclude it from differential diagnosis when the patient is an adult. The diagnosis of neuroblastoma by light microscopy can be difficult because of similarities between neuroblasts and cells of other round cell neoplasms. The fine structural features of neuroblastoma is distinctive and is valuable in its diagnosis. We present 2 cases of neuroblastoma and a case of ganglioneuroblastoma arising in adults with their ultrastructural findings.

Case Reports

Postirradiation Malignant Mixed Mesodermal Tumor of the Uterus: A case report.: Na Hye Myong, Kyung Ja Cho, Sang Yoon Park, Ja June Jang; Korean J Pathol. 1990;24(2):161-165.

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Abstract PDF: A case of malignant mixed mesodermal tumor (MMMT) developed after radiation therapy for a uterine cervix cancer is described. The patient was a 62-year-old female at the time of diagnosis of stage Ib squamous cell carcinoma of the cervix and a total of 12,000 rads of x-ray was administered on the pelvic area. Five years later she manifested vaginal spotting and rectal pain. Endometial curettage and biopsy revealed carcinosarcoma. Radical hysterectomy was done and a 5x3x2 cm sized polypoid mass was noted in the uterine cavity. Microscopically, the tumor showed intimate admixture of adenocarcinomatous and sarcomatous areas. The sarcomatous stroma was composed of compactly arranged atypical spindle cells with frequent mitoses, merging into a loosely textured reticular areas and abundant amount of heterologous elements such as skeletal muscle and cartilage. The rhabdomyosarcomatous element was confirmed by PTAH staining and immunohistochemical staining for myoglobin and desmin. Multiple metastases to the liver, lung, and lymph nodes appeared within one year of total abdominal hysterectomy and bilateral salpingo-oophorectomy. In spite of palliative radiotherapy, she expired one month later.

Rhinoscleroma: A case report.: Joung Ho Han, Joon Mee Kim, In Sun Kim, Seung Young Paik; Korean J Pathol. 1990;24(2):166-170.

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Abstract PDF: Rhinoscleroma, or scleroma, is a chronic, slowly progressing granulomatous disease involving the upper respiratory tract, especially the nasal vestibules, choanae, pharynx, and larynx. Almost certainly the causative agent is Klebsiella rhinoscleromatis. The disease occurs frequently in Eastern Europe, the Middle East, and parts of Latin America, but it is hard to find such case in Korea. We prisent a case of rhinoscleroma involving the nasal vestibule in a 18-year-old male who was admitted due to nasal obstruction for 5 years and epistaxis for 2 months. The resected specimen was an irregular polypoid mass with relatively firm consistency and measured 3 cm in the largest diameter. Microscopically, the lesion was characterized by extensive fibrosis and inflammatory cell infiltration. The infiltrates consisted of predominantly lumphocytes, plasma cells, foamy or granular histiocytes which were singly scattered or grouped in clusters. In the cytoplasm of the histiocytes, round slightly basophilic bodies were noted. Warthin-Starry satin showed short positive rods within the cytoplasm of the cell (Mikulicz cell). Electron microscopically, the cytoplasm of Mikulicz cells contained large, round or irregular shaped clear vacuoles in which numerous Klebsiella bacilli attached to the boundaries of the vaculoes were noted. With higher magnifications, the bacilli were seen as roung or rod-shaped organisms.

Proliferating Trichilemmal Tumor: Report of four cases.: Yeong Jin Choi, Mi Kyung Jee, Seok Jin Gang, Byoung Kee Kim, Sun Moo Kim, Soo Il Chung; Korean J Pathol. 1990;24(2):176-182.

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Abstract PDF: Proliferating trichilemmal tumor is relatively rare, and is generally considered to be a benign tumor that can be histologically mistaken for well-differentiated squamous cell carcinoma. The proliferating trichilemmal tumor is thought to be a tumor with differentiation toward the hair structure because the characteristic trichilemmal keratinization in this tumor is analogous to that of the outer root sheath of anagen hair or the trichilemmal sac surrounding catagen hair. We report four cases of proliferating trichilemmal tumor removed by surgical excision.

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