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Volume 26(6); December 1992
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Original Articles
The Pathology Specialty System in Korea: Past, Present and Future Prospects.
Je G Chi
Korean J Pathol. 1992;26(6):537-542.
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AbstractAbstract PDF
The specialist system of hospital pathology in Korea has adopted the American system in its start, and divided its categories into anatomical pathology(AP), clinical pathology(CP), and combind anatomic and clinical pathology(AP +CP). Since 1975 the society eliminated the category of combined AP and CP specialist. The first qualifying examination took place in 1963. It started out as a written examination and later changed to have two parts, written and practical. One year of internship and 4 years of anatomic pathology were required for AP specialist. CP required the same period of training in CP to be eligible for the specialist qualifying examination. The training period was shortened to 3 years from 4 years, 1981~1990 and then returned to 4 years in 1991. There has been considerable confusion during the adoption period of the pathologist specialist system in Korea, mainly because of an incorrect concept of the term "clinical pathology" in the modern hospital. Many people understood "clinical pathology" to mean "hospital pathology" as an opposing concept of "basic or experimental pathology" at medical school. The misconception arose from the fact that Pathology Department in a Hospital has not been realized under Japanese hospital system that prevailed Korean hospital system until 1950. In old Japanese style, the laboratory examinations including some histopathological examination had been conduced in corresponding clinical departments. And Pathology Department in medical school was responsible only for autopsy and not for making diagnosis of biopsy or operative specimen necessarily. Therefore, there has been a conflict between traditional Pathologists(most of them anatomic pathologists) at medical school and so-called "clinical pathologists" in the hospital, as the Korean medical delivery system adopted American system particularly after the Korean war. Now in Korean, in the great majority of hospitals, clinical pathology is clearly defined from anatomic pathology, and the two-services are at work in separate programs. However, there are still a few university hospitals, where histopathological examination and reporting are done in the Clinical Pathology Department. It is hoped that a combined AP and CP program can be started again in near future for the pathologists who work in community hospitals or most smaller general hospitals where the pathologists with adequate knowledge on both AP and CP at work supervising clinical laboratory technicians and technologists. However, it is fully realized the specialists in subspecialty field such as neuropathology, dermatopathology, hematopathology, clinical microbiology, clinical chemistry, etc. are also needed. For future prospect both the Korean Society of Pathologists and Korean Society of Clinical Pathologists should collaborate with each other in full scale in spite of painful past experiences.
Expression of Cellular Oncogenes in Gastric Carcinoma Related with Its Histologic Subtype: Southern blot analysis and immunohistochemistry.
Jin Sook Jeong, In Hoo Kim
Korean J Pathol. 1992;26(6):543-551.
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AbstractAbstract PDF
To search biologic characteristics of gastric carcinoma, one of the most common cancer in Korea, the author examined the alterations in DNA level and the expression of Ha-ras gene and c-myc gene in 20 primary tumors. Amplification of c-Ha-ras DNA was detected in 4(40%) of 10 patients who showed histologic subtype of relatively differentiated adenocarcinoma, but rearrangement of c-Ha-ras DNA was absent. Neither augumentation nor deletion of the c-myc DNA was observed. Higher expression of the ras p21 in tumor cells was noted in more differentiated tumor cells rather than poorly differentiated cases. One mucinous carcinoma, two signet ring cell carcinomas and one papillary carcinoma did not disclose expression of p21. The expressions of c-myc oncogene product were variable and were not correspond to the expressions of ras p21. A tendency that poorly differentiated tumor cells had higher expression of c-myc oncogene was suggested.
A Study on Immunohistochemical Stain for S-100 Protein, HMB 45 and Proliferating Cell Nuclear Antigen(PCNA) of Spitz Nevus Compared with Benign Nevus and Malignant Melanoma.
Mee Yon Cho, Kwang Gil Lee, Myung Wook Kim
Korean J Pathol. 1992;26(6):552-560.
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AbstractAbstract PDF
The differential diagnosis between Spitz nevus and malignant melanoma is difficult due to similar histologic findings. To obtain the useful aids for the differential diagnosis between two diseases, we studied 13 cases of Spitz nevus, 8 benign nevi of compound and intradermal, and 9 melanomas of primary and metastatic, using the immunohistochemical stain for S-100 protein, HMB.45 and proliferating cell nuclear antigen(PCNA). The staining pattern and intensity of S-100 protein showed homogenously strong positive reactivity in all cases. The frequency of HMB.45 positive cell in Spitz nevus was significantly lower than that in melanoma. When compared with the usual compound and intradermal nevi, Spitz nevi showed more significantly positive reaction in the dermal component of nevus cells. The expression of PCNA was higher in melanoma than in Spitz nevus. The immunohistochemical stains for HMB.45 and PCNA are considered as a useful methods for differentiation between Spitz nevus and melanoma, while stain for S-100 protein is not helpful.
A Pathologic Study of Renal Cell Carcinoma: Correlation between clinical and morphologic parameters and prognosis.
Hye Seon Ahn, Moon Hyang Park
Korean J Pathol. 1992;26(6):561-572.
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AbstractAbstract PDF
The prognostic significance of morphologic parameters was evaluated in 36 cases of renal cell carcinoma diagnosed during five years(1986~1990). We reviewed and classified on the basis of pathologic stage, tumor size, histologic pattern, cell type and nuclear grade. Mean age was 51 years old. Average tumor size was 7.3 cm in diameter. Six of 35 patients died of disease. Overall mean survival was 43.3+/-7.3 months. An increasing nuclear grade was generally correlated with a decrease in cummlative survival rate. Similarly, a higher stage at the time of diagnosis could predicated a low survival rate only for high nuclear grade carcinoma. There was an apparent positive correlation between grade and age, grade and size, grade and cell type, cell type and histologic pattern as well as stage and age. This positive correlations are in part a function of nuclear grade; only 20% of grade 3 & 4 tumor consisted of clear cells whereass 71% of grade 1 & 2 consisted of clear cell type. All 6 cases of granular cell types and 50% of mixed cell type were grade 3 & 4. The tumor size of the primary was well correlated with the nuclear grade. Nuclear grade was the most significant factor among the morphologic parameters studied.
Rhabdomyosarcoma in Children: Histologic Subtypes and Prognosis.
Woo Hee Jung, Yee Jeong Kim, Soon Hee Jung, Hyunee Yim, Cheol Joo Yoo
Korean J Pathol. 1992;26(6):573-581.
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AbstractAbstract PDF
Thirty cases of rhabdomyosarcoma in patients under the age of 15 years were reviewed retrospectively to find out characteristics of histologic subtypes related to prognosis. Histologic diagnosis were embryonal in 21(70%), alveolar in 7(23%) and mixed type in 2(7%). Cellular anaplasia was noted in 6 cases. Round to polygonal cells with abundant eosinophilic cytoplasmic rim or globules were most characteristic cytologic feature or rhabdomyosarcomas, being followed by myofibrils. Myxoid and edematous stroma in embryonal type and alveolar pattern in alveolar type wee nost characteristic growth pattern. Immunohistochemically, tumors were positive for desmin, actin and myoglobin in 97%, 27%, and 40%, respectively. Consequently, characteristic cytologic features are important to differentiate rhabdomyosarcomas form other kinds of small round cell tumor and growth pattern is more critical in categorizing histologic subtypes. Desmin is far more useful than actin or myoglobin in the diagnosis of rhabdomyosarcoma.
A Morphological Study of the Pulmonary Endothelium and Neuroendocrine Cells in Monocrotaline-Induced Pulmonary Arterial Hypertension.
Woo Ick Yang, Sang Ho Cho, In Joon Choi, Yoo Bock Lee
Korean J Pathol. 1992;26(6):582-592.
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AbstractAbstract PDF
To investigate the mechanism of monocrotaline-induced pulmonary arterial hypertension, authors performed immunohistochemical study using antibody to von Willebrand factor(vWF), cell kinetic study using 5-bromodeoxyuridine and ultrastructural study after single subcutaneous injection of monocrotaline(MCT) to Wistar rats. The results of this study demonstrated that the expression of vWF by pulmonary endothelial cells was markedly increased from day 3 until 2 months after MCT injection. The labeling index of pulmonary microvessel endothelium began to increase after six days and was maximal on the third weeks, and thereafter it remained slightly increased above basal level. Electron microscopic study revealed attachment of inflammatory cells an platelets to endothelium from 6 hours and degranulation of attached platelets 24 hours after MCT injection. Evidences of endothelial injury began to appear from 12 hours after MCT injection. Evidences of endothelial injury began to appear from 12 hours and was maximal after 48 hours. From the third day, ultrastructural change of cell regeneration and hypertrophy began to appear and was continuosly observed until 2 months. In addition, we evaluated the changes in the number of pulmonary neuroendocrine cells using antibody to gastrin releasing peptide but it demonstrated no change until 2 months suggesting no role of neuroendocrine cells in the development of pulmonary hypertension of Wistar rats at early stage. In conclusion, the results indicate that pulmonary hypertension by MCT injection is due to increased vascular resistance caused by vasoconstriction and hyperplasia of endothelium with musculariz ation of the pulmonary arterioles induced by endothelial dysfunction and some biologic substances released form endothelium and platelets.
Histopathologic Study of Post-irradiation Specimen.
Hye Kyung Lee, Kwang Min Lee, Dong Kyu Chung, Su Gon Kim
Korean J Pathol. 1992;26(6):593-600.
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AbstractAbstract PDF
The number of post-irradiated surgical specimen appears to have risen in recent years due to the increasing utiliz ation of radiotherapy for cancer patients. Radiation therapy damages cells by its effects on the deoxyribonucleic acid and the spectrum of injury ranges from acute self-limited lesion to irreversible chronic lesion. We reviewed 24 cases of post-irradiated specimen and thought that time interval is the main factor influencing the morphologic change. Within six weeks, the individual cytologic changes such as biz arre nuclei, altered nucleus/cytoplasm ratio, amphophilic and vacuolated cytoplasm are noted. Chronic injury resulting from progressive changes in the fibrovascular tissue of the radiated area occur in six months after the initial course of radiation and the vascular changes of intimal thickening and fibrosis, foamy histiocytes within media, periadventital fibrosis and chronic inflammatory cells infiltration are present. Althouhg above mentioned finding are not pathognomonic, we thought them quite constant nd reproducible characteristics of radiation injury.
Case Reports
Epithelioid Hemangioendothelioma of the Left Middle Finger: A case report.
Mi Kyung Kim, Yong Wook Park, Kye Yong Song
Korean J Pathol. 1992;26(6):601-604.
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AbstractAbstract PDF
Epithelioid hemangioendothelioma is a recently described vascular neoplasm characterized by epitheloiod endothelial linings and its borderline biologic behavior. We report a case of epithelioid hemangioendothelioma in a 6-year-old male. The tumor was presented as a non-tender dermal nodule on the left middle finger. The microscopic sections revealed irregular proliferation of vascular channels lined by epithelioid cells with histiocytoid features and frequent intracytoplasmic vacuoles, mimicking so called signet ring cells. Immunohistochemical stainings for factor VIII and vimentin were positive both in epithelioid and vacuolated endothelial cell. Electron microscopic finding reveals abundant intermediate filaments.
Meningeal Melanocytoma Associated with Ota's Nevus: Report of a case.
Woo Sung Moon, Joo Heon Kim, Dong Geun Lee, Ho Yeul Choi, Sang Ho Kim
Korean J Pathol. 1992;26(6):605-609.
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AbstractAbstract PDF
Primary meningeal melanocytoma of the central nervous system is extremely rare. We report a case of meningeal melanocytoma associated with Ota's nevus as a recurrent form in a 53-year old male. The meningeal melanocytoma was removed from right parietooccipital lobe 4 years ago and recurred in right parietal, occipital and left frontal lobes. Ultrastructurally, the tumor cells were characterized by the presence of numerous melanosomes and premelanosomes in their cytoplasm. Moreover, the tumor was lacking in histologic and ultrastructural features of pigmented meningioma, melanotic schwannoma and prolonged clinical course was different from primary meningeal melanoma or metastatic malignant melanoma.
Original Articles
Pseudosarcomatous Variant of Transitional Cell Carcinoma of the Renal Pelvis.
Yun Kyung Kang, Ta Jin Kim, Yong Il Kim, Si Whang Kim
Korean J Pathol. 1992;26(6):610-614.
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AbstractAbstract PDF
We report a case of pseudosarcomatous variant of transitional cell carcinoma of the renal pelvis which showed grossly and microscopically the distinct biphasic growth patterns. Grossly, most part of the tumor showed solid growth protruding into the renal pelvic cavity as well as infiltrating into the parenchyma of lower pole. The overlying pelvic mucosa was replaced by a diffuse, papillary transitional cell carcinoma, and the solid mass was composed of pleomorphic spindle cell sarcomatoid component with frequent myxoid change and a few foci of osteoid deposit. Ultrastructural study of the spindle cells revealed epithelial differentiation featured with rich cytoplasmic organelles, basal lamina and basement membrane-like structures, although immunohistochemistry failed to detect epithelial differentiation.
Negri Bodies in Rabid Dog: Light and Electron Microscopic Findings.
Eon Sub Park, Young Uk Park, Jae Hyung Yoo, Kye Yong Song, Je G Chi
Korean J Pathol. 1992;26(6):615-619.
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AbstractAbstract PDF
Rabies is a fetal viral encephalitis to which all mammals, including man are susceptible. This virus, the genus of Rhabdovirus, is usually present in the saliva of infected animals and is transmitted by their bite. As a rule the virus enter the CNS by ascending along peripheral nervous system and extremely variable in extent. Negri bodies are appear in about 75% of cases. These bodies are eosinophilic, usually rounded inclusions and is located in the cystoplasm of the neurons, most frequently in the pyramidal neurons of the Hippocampus and the Purkinje cells of the cerebellum. We have experienced a case of canine rabies that showed Negri bodies in the Purkinje cells along with diffuse degenerative encephalitis and perivascular mononuclear cells infiltration. The Negri bodies were best demonstrated by Negri body staining although routine H-E staind was also useful. There inclusion bodies were located exclusively in the cytoplasm, and were found occasionally. Electron microscopic findings of the Negri bodies showed aggregates of bulletshaped nucleocapsids. We report a Negri body found in the brain of rabid dog with the light and electron microscopic findings.
Case Reports
Pulmonary Blastoma with Rhabdomyoblastic Differentiation: A case report with immunohistochemical and electron microscopic examination.
Joon Mee Kim, Young Chae Chu
Korean J Pathol. 1992;26(6):620-626.
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AbstractAbstract PDF
Pulmonary blastoma is a rare lung tumor composed of epithelial and mesenchymal element : the latter element may show various pattern of differentiation toward mature tissue, such as cartilage, smooth muscle, and bone. Rhabdomyoblastic differentiation in pulmonary blastoma is quire rare. In th literature, only seven cases have been reported. We report a case of pulmonary blastoma with rhabdomyoblastic differentiation which occured in a 3 year old girl. Microscopically, cytoplasmic cross-striation was present. Immunohistochemically, strong positivity for vimentin and desmin was observed. Electron microscopy demonstrated A and I bands which documented rhabdomyoblastic differentiation.
Intraosseous Well Differentiated Osteosarcoma: A case report.
Mee Hye Oh, So Young Park, Yeon Lim Suh, Shin Khang Kang
Korean J Pathol. 1992;26(6):627-631.
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AbstractAbstract PDF
Well differentiated osteosarcomas are variants of osteosarcoma composed mainly of fibrous and osseous tissue with minimal cystologic atypia. This tumor may be misinterpretated as a benign lesion if the radiologic and clinical features are not taken into account. We report a typical case of intraosseous well differentiated osteosarcoma occuring in the left distal femur of a 58-year-old woman. Radiologically, it appered as an ill-defined lesion with a mixture of sclerotic and osteolytic ares. But there was a lack of highly destructive appearance of conventional osteosarcoma. Grossly, the mass occupied a metaphysis of the distal femur with extension into the diaphysis and epiphysis. Multifocal cortical destruction and sclerosis were also associated. Histologically, the mass showed typical features of intraosseous well differentiated osteosarcoma. There were various patterns of osteoid deposits and bone formation mimicking those of fibrous dysplasia, nonossifying fibroma or parosteal osteosarcoma.
Retroperitoneal Mucinous Tumor: Report of two Cases.
Eun Kyung Kim, Seong Ran Hong, Hy Sook Kim, Young Hyeh Ko, Jung Dal Lee
Korean J Pathol. 1992;26(6):632-634.
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AbstractAbstract PDF
Primary retroperitoneal mucinous tumor is very rare. In the worldwide literature, only 14 cases have been reported. Herein, we report two cases of retroperitoneal mucinous tumor found at laparotomy. The patients were females, aged 24 and 21 years, respectively. They had bilateral normal ovaries. Histologically, one was mucinous cystadenoma and the other showed borderline histology. The connective tissue wall resembling ovarian stroma was noted in one case. The pathogenesis was discussed.
Elastofibroma: Report of a case.
Hye Kyung Lee, Kwang Min Lee, Dong Kyu Chung, Eul Sam Chung
Korean J Pathol. 1992;26(6):635-637.
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AbstractAbstract PDF
Elastofibroma is a rare entity of slowly-growing, solid, ill-defined fibroblastic mass occurring almost exclusively in elderly persons and arising mainly from the connective tissue between the lower portion of the scapula and the chest wall. This entity has been considered to be a degenerative pseudo-neoplastic process caused by mechanical friction. We report an additional case of elastofibroma removed from the subscapular region of a 58-year-old woman. Microscopically the tumor was made up of a mixture of swollen eosinophilic collagen and elastic fibers occasionally associated with fibroblasts and mature fat cells. The elastic fibers showed a degenerated beaded appearance or were fragmented into small globules or droplets in a linear pattern.

JPTM : Journal of Pathology and Translational Medicine