Journal of Pathology and Translational Medicine

Volume 24(3); September 1990

Original Articles

Autopsy Findings of Neonatal Tetanus.: Je G Chi, Sang Woon Choi; Korean J Pathol. 1990;24(3):183-189.

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Abstract PDF: During last 28 years since 1962 we experienced 11 cases of neonatal tetanus that was clinically diagnosed and autopsied at the Department of Pathology, Seoul National University Hospital. All these case were encountered before the year 1980, and was caused by cutting the umbilical cord with unsterilized scissors. All the patients had onset of characteristic symptoms of seizure in first few days and died within a week in most cases. Postmortem findings could be summarized as follows: 1) The most impressive pathological finding was found in lungs, which was multifocal intraalveolar hemorrhage. In 3 cases, only fresh hemorrhage and edema were found. 2) Fatty changes of hepatocytes, focal degenerations of cardiac and skeletal muscles, vacuolar change of proximal tubules were found. 3) The changes of other organs seemed to be the secondary changes due to hypoxia.

Immunohistochemical Observation of Placental Form of Glutathione S-Transferase in Squamous Cell Carcinoma.: Mi Kyung Kim, Jin Seok Seo, Kye Yong Song, Ja June Jang, Sang Chul Park; Korean J Pathol. 1990;24(3):190-196.

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Abstract PDF: Glutathione S-Transferase (GST) is a conjugation enzyme in the metabolism of exogenous and endogenous lipophilic compounds for their excretion and detoxification. Acidic isozyme of GST, GST-Pi, has been recognized as a preneoplastic marker in the experimental hyperplastic nodules of liver in rats, and GST-Pi is abundant in the squamous cells of the skin, also. This histochemical study was carried out to evaluate the distribution and the relationship between the differentiation status of squamous cells in dysplastic or neoplastic epithelium in various organs. The human placental form of glutathione S-transferase (GST-Pi) were stained immunohistochemically with specific anti GST-Pi rabbit antibody in 23 cases of human squamous cell carcinomas. The patients consisted of 14 cases from the uterine cervix, 3 cases from the esopahgus, 3 cases from the lung and 3 cases from the larynx. The results obtained were as follows; 1. Basal cells in normal mucosa were stained negative for GST-Pi while superficial keratinocytes were stained moderately positive. Basal dysplastic cells were stained negatively or weakly positive. Carcinoma cells especially large cells either keratinizing or nonkeratinizing were stained moderately to strongly. Carcinoma cells surrounding keratin pearl were strongly reacted with GST-Pi than other carcinoma cells. 2. Differentiated cells of squamous cell carcinoma showed moderate to strong positive reaction to GST-Pi staining irrespective of its site of origin. 3. Therefore, Immunohistochemical staining pattern of GST-Pi in various squamous carcinoma cells showed similar immunohistochemical reaction to the GST-pi, which is closely correlated to the degree of differentiation, keratinigation and also suggested that squamous carcinoma cells had abundant GST-Pi related detoxifying system.

Cytologic Study of Sputum and Bronchial Secretions in Endobronchial Tuberculosis.: Suek Yul Choi, Gu Kong, Jung Dal Lee; Korean J Pathol. 1990;24(3):197-203.

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Abstract PDF: Endobronchial tuberculosis is granulomatous inflammation of the bronchial mucosa characterized by bronchial ulceration due to caseous necrosis. There is a good chance to expectorate cellular components of granulomas in the sputum. The author studied a cytologic series from 46 patients with endo-bronchial tuberculosis confirmed on fiberoptic bronchoscopic biopsy. The cytologic series consisted of 32 sputa, 41 washings, and 17 bronchial brushings, and were carefully screened for elongated epithelioid cells, Langhan's type giant cells, other multinucleated giant cells and caseous material. Elongated epithelioid cells were demonstrated in 9 sputa (28.1%), 30 bronchial washings (73.2%) and 11 brushing smears (64.7%). Langhans' giant cells were observed in two of 32 sputa (6.2%), six of 41 bronchial washings (14.6%) and four of 17 bronchial brushings (23.5%). The caseous materials were noted in 19 of 32 sputa (59.4%), 32 of 41 bronchial washings (78.0%), and 14 of 17 bronchial burshings (82.4%). It appeared that the pertinent cellular components of granulomas in sputa or bronchial secretions indicated a strong evidence of endobronchial tuberculosis of the lung.

Giatn Lymph Node Hyperplasia : Analysis of 17 Cases with Special Reference to 5 Cases of Plasma Cell Type.: Jeong Hee Cho, Seong Hoe Park, Yong Il Kim; Korean J Pathol. 1990;24(3):204-214.

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Abstract PDF: This report describes the pathologic features of 17 cases of Castleman's disease, examined at the Department of Pathology, Seoul National University Hospital during a period from 1973 to 1989. The lesions in 12 cases were hyaline-vascular type and the remainders plasma cell type. The pathologic features favoring the plasma cell type over the hyaline vascular type included a sufficient number to large-sized follicles. However, a histologic overlapping between two types was present. In the hyaline vascular type the age of the patients ranged from 7 to 76 years and they appeared to be no particular sex predominence. The majority of the lesions occurred in the neck and within the chest. Almost all cases presented with a solitary mass except three cases. Neither conventional symptoms nor systemic manifestations were associated. The plasma cell type was characterized by presentation of constitutional symptoms, involvement of intra abdominal and inguinal lymphnodes, in association with unusual clinicopathologic features including IgA nephropathy, diabetes mellitus, systemic progressive sclerosis, peripheral neuropathy, and anemia. Immunohistochemical study was performed in three cases of the plasma cell type. Two cases revealed poly-clonal plasma cell infiltration. In a patient with IgA nephropathy, however, serum IgA was increase and a strong immunoreactivity to IgA heavy chain was found. Another case, associated with systemic progressive sclerosis and neuropathy, revealed monoclonal plasma cell infiltration (IgG and lambda light chain). The above results support a possibility that in some of the plasma cell type an altered immune mechanism is involved in its pathogenesis.

IgA Nephropathy Associated with Pulmonary Tuberculosis.: Mi Kyung Kim, Hyun Soon Lee; Korean J Pathol. 1990;24(3):215-226.

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Abstract PDF: There have been a few reports suggesting that the imune response to pulmonary tuberculosis provides the appropriate setting for the development of IgA nephropathy (IgAN). To define better the relation between pulmonary tuberculosis and IgAN, we evaluated the prevalence of pulmonary tuberculosis among 386 Korean patients with IgAN. Seventeen cases (4.4%) showed abnormal chest X-ray findings suggestive of pulmonary tuberculosis. Ten patients were male and seven were female. Only one case was a child. Urinary abnormalities were detected during the course of antituberculous medication in 11 patients, and after completion of chemotherapy in 2. Chest abnormalities were noted in the remaining 4 patient after IgAN had been diagnosed. Clinical diagnosis of tuberculosis was made mainly based on the chest X-ray findings, but sputum Acid-Fast Bacilli were detected in one patient and pulmonary granulomo was noted in 2. The patients presented various clinical manifestations such as gross hematuris (5 cases), nephrotic syndrome (5 cases), asymptomatic urinary abnormalities (4 cases) and pyuris (1 case) at time of biopsy. Histologic grading of the glomerular lesions was made with modified Meadow classification (1972): one had grade I lesion, 8 grade II, 5 GRADE III and 3 showed grade IV. Follow-up studies were made in 7 patients. Six showed resolution of urinary abnormalities after completion f antituberculous medication, while one pursued chronic renal failure 20 days after the onset. The above clinical and morphologic features suggest that pulmonary tuberculosis may be partly related to the occurrence of IgAN in some Korean patients.

An Immunohistochemical Study of PNA (peaunt agglutinin) Binding in Transitional Cell Carcinomas of the Urinary Bladder.: Chul Hwan Kim, Nam Hee Won, Kap No Lee; Korean J Pathol. 1990;24(3):227-235.

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Abstract PDF: Recently, extensive uses of lectins as cytochemical markers have made of studies for various epithelial and nonepithelial neoplasia, however, investigations of epithelial cell surface of transitional cell carcinomas of the urinary bladder have been few. Thus, the atuhors performed a study of PNA binding in the authors performed a study of PNA binding in transitional cell carcinomas with comparision with that in normal mucosa of the urinary bladder to allow more accurate diagnosis and histological grade or degree of differentiation. The results of this study are as follows: 1) PNA shows negative reactions on all ten normal mucosae of the urinary bladder but positive staining at the glycocalyx of umbrellar cells in two cases. 2) PNA shows negative reactions on all four cases of von Brun'n nests and cystitis cystica. 3) PNA shows positive reactions on thirty (50%) of total sixty-one cases of transitional cell carcinomas and reveals two (20%), nine (41%), eleven (55%) and eight (88%) cases in grade I, II, III and IV, respectively. 4) PNA shows positive reactions on the intracytoplasm and/or degree of PNA binding activity in grade I to IV transitional cell carcinomas is not statistically significantly different (p>0.05). In summary, PNA did not react with normal nucosa and metaplastic lesions such as von Brunn's nests and cystitis cystica, however, it reacted with 50% (30/61 cases) of transitional cell carcinoma and its positivity is significantly increased with gradings of transitional cell carcinomas (p<0.05).

Histological Grade of Prostatic Adenocarcinoma.: Kyong Ho Kim, Soon Hee Jung, Chan Il Park; Korean J Pathol. 1990;24(3):236-242.

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Abstract PDF: The authors attempted to choose what has the best reproducibility and predictability for prognosis of the prostatic adenocarcinoma among four most widely used gradings methods; the Gleason's Mostofi's, Bocking and MD Anderson hospital systems. According to these gradings systems, each of two pathologists made histologic gradings of 40 consecutive prostatic adenocarcinomas which had been diagnosed with the surgically resected specimens. Correlation between the histological grades and the clinical stages was studied and a comparison was made among each system. For the comparison, the Gleason's and MDAH systems were revised as 3 grades and adjusted to the other gradings systems. In this study, MDAH grading system yielded the highest reproducibility as represented by 90% agreement, as compared with the other systems which showed 82.5~87.5% agreement. By the Gleason's, Mostofi's and Bocking's systems, 46.2%, 23.1% and 46.2% of grade 3 tumors respectively fell under the clinical stage A. On the contrary, there were no cases of grade 3 in stage A and no cases of grade 1 in stage D, by MDAH gradings system. These results suggest that MDAH gradings system is superior to the other systems in reproducibility and for predicting the biological behavior.

Correlation between Histologic Differentiation and Prognosis of Prostate Adenocarcinoma.: Se Jin Jang, Jung Dal Lee; Korean J Pathol. 1990;24(3):243-253.

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Abstract PDF: The authors reviewed clinical data and 50 pathologic specimens from 41 patients of prostate adenocarcinoma filed in the Department of Pathology, Hanyang University school of Medicine, in order to evaluate correlation between clinical stages and histopathologic grades of prostate adenocarcinoma. Each of five currently used grading systems were compared with clinical stages of prostate adenocarcinomas. The followings results were obtained: All of the grading systems were relatively well correlated with clinical progression of the tumon. Histologic grading systems including Gleason's grading system, Gleasons scoring system and M.D. Anderson system showed better correlation than cytologic grading system of Mostofi. Gaeta gradings system regarding both histologic and cytologic aspects of the carcinoma showed good correlation to clinical stage with correlation coefficient of 0.654. Combined scoring system of cytologic and histologic grades (Mostofi-M.D. Anderson combined scoring system) showed better correlation to the clinical stage than single individual grading s system. The author conclued that Gleasons histologic grading system with cytologic characteristics of tumor cells would represent best parameter of clinical progression of the prostate adenocarcinoma.

The Spontaneously Occurred Apoptosis in Squamous Carcinoams of the Uterine Cervix.: Chan Hwan Kim, Kwan Kyu Park, Kun Young Kwon, Sang Sook Lee, Eun Sook Chang; Korean J Pathol. 1990;24(3):254-266.

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Abstract PDF: The apoptosis, a distinctive type of individual cell necrosis, has been considered to play a complementary but opposite role to mitosis in the regulation of animal cell populations. It can be initiated or inhibited by a variety of environmental stimuli, physiologically and pathologically. Apoptosis seems to appear in either non-neoplastic or neoplastic tissues, even malignant tumors in the state of untreatment or irradiation. This study was carried out to investigate the spontaneous occurrence of apoptosis in squamous carcinomas of the uterine cervix and its mechanisms. Light microscopically, noted were the condensation and fragmentation of individual tumor cells with formation of apoptotic bodies that were frequently phagocytosed by nearby intact tumor cells. They were commonly seen in the neighbourhood of coagulative necrosis. Electron microscopically (TEM and SEM), noted were nuclear condensation, margination toward the nuclear membrane and fragmentation of membrane-bounded apoptotic bodies that were well preserved. The intracellular apoptotic bodies were phagosomes and reduced to electron-dense lysosomal residual bodies. The conclusion obtained was as follow: Apoptosis was found in all cases of squamous carcinoma of the uterine cervix, of which the frequency was higher in tumors of poor differentiation than those of well to moderate differentiation. The process of the apoptosis is considered to pass through the step of formation of the apoptotic bodies, phagocytosis by adjoining tumor cells or histiocytes, and then degradation as lysosmal residual bodies.

Morphometric Study on Cervical Intraepithelial Neoplasia.: Jae Dong Cho, Byung Tae Park, Jung Dal Lee; Korean J Pathol. 1990;24(3):267-274.

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Abstract PDF: Cervical intraepithelial neoplasia in human consist of dysplasia of various developmental stages and squamous cell carcinoma in situ of various types. These lesions can be diagnosed cytologically on cervico-vaginal smears, although the diagnostic reproducibility is limited. To obtain the objects morphologic distinction between normal squamous epithelial cell in different maturation, different stages of dysplastic cells and varieties of in situ carcinoma cells, Kontron IBAS-1 imaging analyzer was applied for the measurement of nuclear and cytoplasmic areas of each categorised cells. The followings are results obtained: 1) Nuclear and cytoplasmic areas of superfical (36.9 micrometer2, 2319.9 micrometer2) intermedicate (45.7 micrometer2, 2989.7 micrometer2) and parabasal cells (50.8 micrometer2, 432.7 micrometer2) of normal squamous epithelium origin are mostly distinctive between cell types. However, cytoplasmic areas of both superficial and intermediate cells and nuclear areas of both intermediate and parabasal cells are not significantly different. 2) Normal squamous cells and various dysplastic cells show obvious difference in their nuclear and cytoplasmic areas, while difference between cytoplasmic areas of both parabasal (432.7 micrometer2) and severe dysplastic cells (409.7 micrometer2) are not statistically significant. 3) No statistical difference is observed in between nuclear areas of both moderate dysplastic (112.3 micrometer2) and severe dysplastic cell (117.6 micrometer2). 4) Varieties of carcinoma in situ cells and severe dysplastic cells are in difference in their nuclear and cytoplastic areas, whereas nuclear areas from both in situ carcinoma cells (95.3 micrometer2) of large cell type and severe dysplasia (117.6 micrometer2) are not distinctive. The results lead the author to consider that the morphometric analysis for various parameters of cell constituents are of value in making objective distinction between cells from cervical intraepithelial neoplasia in human.

A Study on the Histopathologic Features of Bowenoid Papulosis and the Numerical Change in Langerhans Cells.: Kwang Gil Lee, Soo Im Choi; Korean J Pathol. 1990;24(3):275-286.

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Abstract PDF: Fourteen cases of bowenoid papulosis were studied both clinically and histologically and were compared with 22 cases of Bowen's disease to find histologic differences between the two diseases. Bowenoid papulosis was prevalent in young, sexually active adults, consisted of multiple erythematous or hyperpigmented papules, and located mostly on the penis and vulva. The main histologic characteristics of bowenoid papulosis were an orderly background of keratinocyte maturation of the epidermis with monotonous pattern, the frequent presence of 'skip area', and the lesser degree of cytologic atypia than seen in lesions of Bowen's disease. In addition, mitotic figures more than 5 per x400 filed, formation of keratin pearl, and spindling of keratinocytes, which have not been described in other articles yet, are considered very important findings for the diagnosis of bowenoid papulosis. It is our opinion that bowenoid papulosis can be reliably distinguished from Bowen's disease by light microscopic features. Paraffin-embedded samples of bowenoid papulosis, Bowen's disease, and normal skin were investigated with antibodies against S 100-protein to relate the number of intraepidermal Langerhans cells and the disease. Langerhans cells were found to be reduced when compared with normal skin. No significant differences between Bowen's disease and bowenoid papulosis were found in density of Langerhans cells.

Case Reports

Pulmonary Adenocarcinoma of Fetal Type: Report of a case.: Nam Hoon Cho, Kwang Gil Lee; Korean J Pathol. 1990;24(3):287-293.

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Abstract PDF: Pulmonary adenocarcinoma of fetal type is a very uncommon tumor of the lung which simulates an early stage of lung differentiation. This is a primitive appearing epithelial tumor similar to the epithelial component of pulmonary blastoma but lacking the sarcomatous features. Since the report of Kradin et al, 8 more cases have been reported by a variety of name. These tumors are composed of glycogen-rich, non-ciliated tubular epithelial cells forming irregularly shaped tubules or arranged in a papillary pattern. A very remarkable findings of this tumor is the presence of endocrine cells which is confirmed by argyrophilia, immunohistochemistry or electron microscopy. We experienced a case of this tumor which showed hepatocytoid differentiation in addition to the characteristic histologic findings. Immunohistochemical studies performed on a resected tumor tissue showed immunoreactivity for alpha-fetoprotein, neuron-specific enolase and somatostatin, and endocrine type granules were found ultrastructurally. Although this tumor seems to have a relation with pulmonary blastoma in its histology, immunohistochemistry and ontogeny, a distinction between these should be attained because the average survival of the former group is longer as 23 months, while that of the latter is only 4 months.

Acute Corrosive Esophago-Gastritis: A Case of Drain-cleansing Liquid-induced Transmural Inflammation.: Tae Jin Kim, Jeong Wook Seo, Yong Il Kim; Korean J Pathol. 1990;24(3):294-298.

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Abstract PDF: The pathologic features of acute corrosive esophago-gastritis by ingestion of "Trapunc", a common commercial drain cleansing liquid, is presented. A 37-year-old woman ingested abut 30 ml of Trapunc (3 gm NaOH/100 ml) to commit suicide and received piecemeal esophagectomy and total gastrectomy 9 days after the episode. The esophagus and stomach were extremely friable and necrotic. The most part of the stomach showed acute toxic necrotizing gastritis which was manifested by extensive greenish brown discoloration due to liquefaction necrosis of the mucosa except for a few rugae along the greater curvature. The antrum and distal body revealed severe mucosal detachment and even transmural necrosis. The tissue reaction was basically the same as those of NaOH-induced corrosive esophago-gastritis of acute stage, although it appeared to be severer probably due to sodium hypochlorite, and additive constituent of the ingested cleanser. A unique distribution pattenr of mucosal involvement is discussed.

Original Articles

Neuroendocrine Carcinoma of the Gallbladder Arising as Double Tumor.: Dae Hyun Baek, Seong Ki Min, Jin Man Kim, Kwang Sun Suh, Dae Young Kang; Korean J Pathol. 1990;24(3):299-303.

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Abstract PDF: Pleomorphic (undifferentated) carcinoma is a rare histologic type of carcinomas of the gallbladder and an atypical carcinoid is thought to be an intermediated type between carcinoid tumor and small cell carcinoma. Dense core "neurosecretory" granules can be found in the above mentioned tumors. We experienced a case of a double tumor of the gallbladder in a 51-year old male patient. Grossly, a large solid mass, about 5.0 cm in diameter, was found in the fundic portion and the neck portion also had a small 1.5 cm-sized polypoid mass. Microscopically, these lesions had features of pleomorphic carcinoma and atypical carcinoid, respectively. Immunohistochemically, they manifested reactivity for neuron specific enolase. Ultrastructural study revealed neurosecretory granules in the cytoplasms of tumor cells of the fundic and neck masses. Although light microscopic features of these tumor masses are quite different, we consider that these tumors represent a spectrum of neuroendocrine differentiation.

Solid and Papillary Epithelial Neoplasm of the Pancreas Diagnosed by Percutaneous Fine Needle Aspiration Biopsy.: Chan Kum Park, Jung Dal Lee; Korean J Pathol. 1990;24(3):304-309.

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Abstract PDF: Solid and papillary epithelial neoplasm of the pancreas is a rare, low grade malignant tumor of adolescence. The tumor we described was diagnosed by following preoperative percutaneous fine needle aspiration biopsy and confirmed by tissue examination. Characteristic cytologic findings were monotonous cells arranged in papillary fronds, acinus, and cords in necrotic and hemorrhagic backgrounds. Occasional foamy histiocytes and hyaline globules were present. The cytoplasm of the tumor cells were moderate in amount, pale eosinophilic or vacuolated with distinct borders. The nuclei were centrally located and round. There were one or two small nucleoli and finely granular chromatin throughout the nucleus.

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