Journal of Pathology and Translational Medicine

Volume 26(5); October 1992

Original Articles

Cytologic Heterogeneity of Signet Ring Cell Carcinoma of the Stomach: Histochemical and electron microscopic observations.: Yun Kyung Kang, Yong Il Kim; Korean J Pathol. 1992;26(5):427-435.

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Abstract PDF: The cytologic heterogeneity of the tumor cells in gastric signet ring cell carcinoma was studied with 13 surgically early gastric carcinoma specimens by means of histochemical stainings on mucin(periodic acid Schiff-alcian blue at pH 2.5, paradoxical concanavalin A, high iron diamine) and electron microscopy. Of the 13 cases of early gastric cell carcinomas, 6 were mucosal type and 7 were submucosal type. Eleven cases consisted of mixture of gastric and intestinal type signet ring cells and the remaining 2 of the mucosal type were entirely made of gastric type. The colonic goblet cell type was found in 4 of the submucosal type. Within the mucosa the tumor cells showed a layering phenomenon; type A signet ring cells were distributed at the central zone and type B and C at the superficial or deeper zone. Each type of signet ring cell showed variable mucin histochemical stainability of gastric and/or intestinal nature. Above finding strongly suggest that the variable phenotypes of signet ring cells result from a heterogeneity of cytoplasmic mucin as well as different stages of differentiation of signet ring carcinoma cells.

Characterization of Human Papillomavirus Types in Cervical Epithelial Neoplasia by in Situ Hybridization.: Chan Kum Park, Moon Hyang Park; Korean J Pathol. 1992;26(5):436-444.

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Abstract PDF: An in situ DNA hybridization technique was applied to detect human papillomavirus(HPV) DNA, HPV types 6/11 and 16/18, on paraffin sections of 36 cervical condylomatous lesions associated with cervical intraepithelial neoplasia and invasive squamous cell carcinoma. 1) HPV DNA sequences were identified in 14 of 36 cervical condylomatous lesions(39.0%); HPV 6/11 in 7 cases(19.0%) and HPV 16/18 in 7 cases(19.0%). 2) With the use of biotinylated HPV 6/11 DNA probes, 5 of 5 condyloma acuminata(100%), 1 of 5 flat condylomata(20%), and 1 of 7 mild dysplasias(14.3%) were positive. 3) With the use of HPV 16/18 DNA probes, 1 of 7 mild dysplasias(14.3%), 2 of 5 moderate dysplasias(40%), 2 of 4 severe dysplasias(50%), and 2 of 5 invasive squamous cell carcinomas(40%) were positive. 4) The positive stainings to HPV DNA probes were primarily detected in koilocytotic nuclei of the superficial epithelium. No positive signals were found in the normal, dysplastic or carcinoma cells. 5) The numbers positively stained cells were decreased with increasing severity of the lesions from benign condylomas to invasive squamous cell carcinomas. In conclusion, HPV types 6/11 were more commonly identified in benign condylomatous and low grade intraepithelial lesions than high grade lesions. However, HPV types 16/18 were identified in high grade CIN and invasive squamous cell carcinomas. The present results while supporting the concept on HPV 16/18 as the high risk of HPV types in cerivical carcinogenesis also emphasize the applicability of the situ DNA hybridization as a tool in analysis of the specific HPV DNA sequences in routine biopsies of these lesions.

Liver in Systemic Lupus Erythematous: Clinicopathological analysis of 8 cases.: Young Nyun Park, Chan Il Park, Yoon Sok Chung, Si Young Song, Chein Soo Hong; Korean J Pathol. 1992;26(5):445-450.

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Abstract PDF: Hepatic changes in eight cases of systemic lupus erythematosus(SLE), were studied to evaluate the nature of hepatic injury of SLE and its relation to lupoid hepatitis. Common histologic changes of the liver in SLE included intralobular necro-inflammatory activities, fatty change, canalicular bile stasis and mild perivenular and Disse space fibrosis. The fatty change and intralobular fibrosis were thought not to be due to SLE itself but associated with steroid administration or chronic alcoholic consumption. The necro-inflammatory changes were usually mild and features of chronic active hepatitis with periportal destruction occured in one case. Symptoms related to the involvement of many other organs than the liver appeared much frequently in patients with SLE than lupoid hepatitis, suggesting that the SLE involving liver and the lupoid hepatitis are different diseases.

A Study of Nucleolar Organizer Regions in Normal and Neoplastic Epithelial Cells of Stomach.: Hee Jin Chang, Kyung Ha Kang, Jung Hee Park, Jin Hee Sohn, Jung Il Suh; Korean J Pathol. 1992;26(5):451-458.

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Abstract PDF: Nucleolar organizer regions are DNA loops encoding rihbosomal RNA production and detectable by the argyrophilia of their associated proteins(AgNORs). AgNOR numbers correlate with cellular proliferating activity. Many studies have shown a significnt difference in AgNOR counts between benign and malignant tumors. AgNOR counts were also helpful in differential diagnosis. For the evaluation of its diagnostic utility in gastric lesions, a silver staining technique was carried out in paraffin sections of 5 control cases, 5 benign peptic ulcers, 7 hyperplastic polyps, 10 tubular adenomas, 16 early gastric adenocarcinomas and 15 advanced gastric adenocarcinomas. The results were as follows. The mean numbers of AgNORs in early and advanced gastric adenocarcinomas(1.94 and 2.16) were significantly higher than those of normal foveolar epithelium(1.43) and epithelia of benign gastric ulcers(1.54), hyperplastic polyps(1.64) and tubular adenomas(1.79). In malignancy, there was increased variability in size and shape of AgNORs. There was little differences in mean AgNOR numbers between early and advanced gastric adenocarcinomas. Differentiation of the tumor made no difference in AgNOR numbers. From the above results, the AgNORs count, if its morphologic change are taken into consideration, is helpful in differentiation between malignant and non-malignant lesions.

Immunohistochemical Study of Cytokeratin in Human Trophoblastic Tissue.: Jeong Hee Kang, Kang Suek Suh; Korean J Pathol. 1992;26(5):459-465.

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Abstract PDF: The use of human chorionic gonadotropin(hCG), human placental lactogen(hPL) as markers for trophoblastic tissue has been well documented in the literature. However, it is not widely recognized that cytokeratin is a very sensitive and reliable marker for various types of trophoblastic tissue. The authors have studied 15 cases of human placental tissue ranging in age from first to third trimesters. Unlike hCG and hPL, which stain only the syncytiotrophoblast and intermediate trophoblast, cytokeratin(low molecular weight) stains all three types trophoblastic tissue. The staining of placental tissue for cytokeratin is marked and very consistent throughout pregnancy. Because of its high sensitivity and ability to stain cytotrophoblast, it is believed that it could be very useful in detecting trophoblasts of early pregnancy and in the study of the pathologic process of trophoblastic diseases.

A Histopathological Study on the Estrogen-induced Breast Lesion in Rats.: Gyung Hyuck Ko, Cheol Keun Park, Myoung Keun Shin, Soo Min Kang, Hye Jung Lee, Jeong Hee Lee; Korean J Pathol. 1992;26(5):466-475.

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Abstract PDF: Forty eight female Sprague-Dawley rats received a subcutaneous implant containing 12.5 mg estradiol ant the age of 3 weeks. Three rats were killed in 1, 2, 3, 4, 6 weeks and in every month during 2~12 months after implantation, and the breasts were examined by light microscope. In all rats, enlargement of terminal end buds was obseved in 1~2 weeks, maximum development of hyperplastic alveolar nodules in 3 weeks, and marked dilatation and secretion of alveoli or ducts in 1~12 months after implantation. Ductal epithelial hyperplasia was observed in 27 rats and carcinomas developed in 23 rats in 2~12 months after implantation. It was thought that the changes induced by estradiol are more similar to the human breast lesions, compared with changes induced by chemical carcinogens such as dimethylbenzanthracene(DMBA), because breast carcinomas developed in close relationship with ductal epithelial hyperplasia in both estradiol-treated rats and humans, but not in DMBA-treated rats.

Histologic and Immunopathologic Study of Central Nervous System Lymphoma.: Yee Jeong Kim, Tae Seung Kim, Woo Ick Yang, Kyu Rae Kim; Korean J Pathol. 1992;26(5):476-483.

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Abstract PDF: Twelve cases of primary malignant lymphoma of the central nervous system experienced between 1980 and 1990 were investigated by histological and immunohistochemical findings correlated with clinical observation. Of the 12 patients, 6 were male and 6 were female. Their ages ranged from 31 to 58 years(mean, 45.8 years). All Tumors were supratentorial except 1 case which was found in the spinal cord. The fronto-parietal lobe was the most common site, which accounted for 66.7%. Histologically, all the tumors showed unfavorable histology. Diffuse large cell type was the most frequent(66.7%). Immunohistochemical studies using monoclonal antibodies revealed predominance of B-cell phenotype. Although most cases were treated with a combination of surgery and irradiation, the outcome was poor in all.

Nesidioblastosis of the Pancreas.: Young Bae Kim, Jin Sook Jeong, Ahn Hong Choi; Korean J Pathol. 1992;26(5):484-489.

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Abstract PDF: The morphologic abnormalities of the endocrine pancreas that underlie persistent neonatal hyperinsulinemic hypoglycemia and are included under the heading "nesidioblastosis" appears to be heterogeneous. This characteristic morphologic finding is ductuloinsular complexes showing endocrine cells budding off the ductoepithelium and merging with adjacent endocrine cell clusters. A case of nesidioblastosis associated with hyperinsulinemic hypoglycemia occurred in a 6/365 year-old male neonate. Microscopic finding of near totally resected pancreas revealed irregular sized islets and ductuloinsular complexes, both of which contained hypertrophied B cells with a few mitosis. Because of persistent hypoglycemia after first operation, he received second operation 8 days after. This histologic finding was more severe comparative to that of first operation. According to these findings, the pathogenesis of nesidioblastosis may be congenital or developmental defect of a kind of compensatory mechanism by unknown stimuli to acquire persistent hypoglycemia.

Case Reports

Malanotic Neuroectodermal Tumor of Infancy: A case report.: Young Chae Chu, Joon Mee Kim, Tae Sook Hwang, Il Kyu Kim; Korean J Pathol. 1992;26(5):490-495.

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Abstract PDF: The melanotic neuroectodermal tumor of infancy(MNTl) is a rare, usually benign, pigmented lesion which most frequently involves the maxilla. Skull, brain, and mandible are other craniofacial sites; this anatomic region accounts for 87% of all cases. The vast majority of MNTl, nearly 95%, present in infants of both sexes within the first year of life. Most cases of MNTl follow a benign course, with a 15% propensity for local recurrence. MNTl is regarded as a primitive neuroectodermal tumor with polyphenotypic differentiation. We report a classical MNTl which occurred in left lower maxilla in 6-month old female infant. She developed an ill defined, firm swelling on the left alveolar ridge and gum during 3 weeks. Mass excision reveals ill defined, grayish-tan hard mass, measuring 2.0x1.6 cm. Microscopically, the tumor reveals irregular alveolar pattern of melanin-containing cuboidal cells and nests of small round cells. The immunohistochemical staining for melanoma-associated antigen, neuron-specific enolase and cytokeratin show positive reactions. Ultrastructural examination showed intracytoplasmic melanosome, tonofilament and desmosome.

Cavernous Hemangioma of Lymph node: A case report with the review of literature.: Seong Nam Kim, Sang Yong Song, Yong Il Kim; Korean J Pathol. 1992;26(5):496-499.

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Abstract PDF: Primary hemangioma of the lymph node is an extremely rare vascular neoplasm, and only four cases on the subject have been reported in the literature. We describe a case of cavernous hemangioma in an axillary lymph node that was incidentally found in 70-year-old woman who underwent a modified radical mastectomy for infiltrating duct carcinoma of the left breast. Brief review of the literature regarding vasoformative lesions occupying lymph node is made with special regard to differential diagnosis from reactive-proliferative processes and other true neoplasms.

Oxyphilic Clear Cell Carcinoma of the Ovary: A case report.: Chang Won Ha, Jae Soo Koh, Na Hye Myoung, Kyung Ja Cho, Sang Yoon Park, Mi Kyung Kim, Ja June Jang; Korean J Pathol. 1992;26(5):500-503.

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Abstract PDF: Oxyphilic clear cell carcinoma of the ovary is a variant of clear cell carcinoma with abundant eosinophilic cytoplasm described by Young & Scully in 1987. Thorough samplin is needed to identify typical foci of clear cell carcinoma for the differential diagnoses from a variety of ovarian tumors with oxyphilic cells. We report a case of oxyphilic clear cell carcinoma in a 65-year-old female patient who presented with vaginal spotting and lower abdominal discomfort. The excised mass was a 10x8x7cm sized, well circumscribe yellowish white solid ovarian tumor. Microscopically, the tumor showed glandular, papillary and alveolar growth patterns composed of cuboidal or hobnail-shaped oxyphilic cells.

Embryonal Sarcoma of the Liver with Chondrosarcomatous Differentiation: A case report.: Woo Hee Jung, Hyunee Yim, Ho Guen Kim, Chan Il Park, Ki Keun Oh, Seung Hoon Choi; Korean J Pathol. 1992;26(5):504-509.

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Abstract PDF: Embryonal sarcomas of the liver, often called undifferentiated sarcomas or malignant mesenchymomas, are extremely rare tumors that occur chiefly in children with poor prognosis and uncertain histogenesis. Histologically, tumor cells are stellate or spindle shaped, loosely arranged in edematous or myxoid pattern alternating with highly cellular zones and do not show evidence of differentiation. Ultrastructural and immunohistochemical studies by previous investigators indicate that the neoplastic cells are mostly primitive mesenchymal cell which occasionally differentiate to fibroblasts, lipoblasts, histiocytes and smooth muscle cells via intermediate cell types. The authors experienced a case of 6-year old boy who presented with an enlarging abdominal mass of the liver which revealed typical histological and ultrastructural features of embryonal sarcoma with focal areas of unusual chondrosarcomatous differentiation.

Intracerebral Metastasis of Alveolar Soft Part Sarcoma: A case report and study on its histogenesis.: Young Chae Chu, Joon Mee Kim, Young Bae Kim, Tae Sook Hwang; Korean J Pathol. 1992;26(5):510-516.

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Abstract PDF: We describe a case metastatic alveolar soft part sarcoma of the brain in a 20-year old man. Alveolar soft part sarcoma is slowly growing tumor which almost shows conspicuous vascular invasion and have a high incidence of blood-borne metastasis. The principal metastatic sites are the lungs, followed by the skeleton and brain. Cerebral metastases may be the first manifestation of the disease and are more common with alveolar soft part sarcoma than with any other type of soft tissue sarcoma. The light-and electron-microscopic and immunohistochemical findings are described. Periodic acid-Schiff-positive, diastase resistant, intracytoplasmic crystals, pathognomonic for alveolar soft part sarcoma, are present. The cells expressed immunoreactivity for vimentin, desmin, neuron-specific enolase, S-100 protein and renin. The results of our own immunohistochemical examinations is suggestive of myoendocrine origin.

Sex Cord Tumor with Annular Tubules Associated with Turner's Syndrome: Report of a case.: Woo Sung Moon, Soo Hun Kim, Dong Geun Lee, Sang Ho Kim, Sung Nam Cho, So Ja Jin; Korean J Pathol. 1992;26(5):517-523.

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Abstract PDF: An ovarian sex cord tumor with annular tubules(SCTAT) in an 18-year-old woman who had secondary amenorrhea but not Peutz-Jeghers syndrome was studied by light and electron microscopy. Her clinical features were consistent with those of Turner's syndrome, i.e, shortness of stature, webbing of the neck, scanty or absent axillary and pubic hairs, lower hair line with streak gonad. Chromosomal analysis revealed 45, X/46, XX karyotype. The patient has been well and disease free for a period of 2 years after surgical removal of tumor. Histologically, the tumor was composed of nests of cells arranged in simple and complex annular tubules with central acidophilic hyaline bodies. Ultrastructurally, the cells had deeply indented nuclei and the cells were joined by specialized intercellular junctions along their lateral adjacent borders. Central acidophilic hyaline body consisted of concentric lamellae of basal lamina, but Charcot-Boettcher filaments were not observed.

Giant Chorioangioma of the Placenta as a Cause of Fetal Hydrops and Neonatal Death: A case report.: Kyu Rae Kim, Kyu Hyung Lee, Tae Ki Yoon, In Kyu Kim, Kyung Sub Cha; Korean J Pathol. 1992;26(5):524-529.

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Abstract PDF: We described a giant chroioangioma of the placenta that caused premature rupture of membranes at 31 weeks of gestation in a 31-year-old primiparous woman and a subsequent neonatal death of the baby. The placental mass, weighing 820 gm and measuring 21.5x15x4.5 cm, was easily shelled out from a edematous 1280 gm-placenta. The mass had a thin fibrous capsule and a solid fibromatous appearance. The infant, weighed 2175 gm, appeared edematous oon the whole body and had Apgar scores of 4 and 5 at 1 and 5 minutes respectively. The baby expired 4 days after birth due to high output cardiac failure and respiratory failure. Postmortem examination revealed markedly dilatated umbilical vein, inferior vena cava and right atrium with patent froamen ovale, congestive hepatosplenomegaly, pulmonary hemorrhages, and meconium aspiration pneumonia. Microscopically, the mass revealed a variety of histologic patterns, reflecting entire spectrums of villous vasculogenesis from loose myxomatous connective tissue and undifferentiated hemangioblastic cell nests to well-developed capillaries with hematopoietic cells in the lumen.

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