Journal of Pathology and Translational Medicine

Volume 27(4); August 1993

Original Articles

Histopathologic Studies of Muscle and Peripheral Nerve Following Ingestion of L-tryptophan in Rats.: Tae Sik Yoon, Tai Seung Kim, In Joon Choi, Jung Soon Shin; Korean J Pathol. 1993;27(4):318-327.

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Abstract PDF: The eosinophilia-myalgia syndrome associated with ingestion of L-tryptophan in man is defined by the CDC(1989) as follows: 1) eosinophil count more than 1,000 cells per microliter; 2) generalized myaligia(at some point during the course of illness) of severity sufficient to affect a patient's ability to pursue his or her usual daily activities; 3) no evidence of any infection(e.g., trichinosis) or neoplasm that would explain either the eosinophila or the myalgia. The pathologic findings of the eosinophilia-myalgia syndrome varies according to the degree of severity and types of inflammatory cells in the skeletal muscle. In order to simulate this syndrome in animals and further determine its histopathogenesis, L-tryptophan was administered to rats in the laboratory at various doses(25 mg/kg, 50 mg/kg, 150 mg/kg) over a set period of time. In this study, positive histopathologic findings were designated according to the inflammatory cell infiltration of the epimysium and epineurium. Most of the pathologic findings in the positive group were that of inflammatory cell infiltration composed mainly of eosinophils in the epimysial, epineurial connective and surrounding adipose tissues. Only a few necrotic muscle fibers were seen, and there was absence of any evidence of inflammatory cell inflitration in endoneurium or axonal degenerations. Of 59 rats which were given L-tryptophan, 27 rats(45.8%) met the criteria and were designated as belongintg to the positive group. Only 2 rats ingested with L-tryptophan(150 mg/kg) for 2 months and 4 months showed an eosinophil count more than 1,000 cells/microliter. The eosinophil count in the positive group showed significantly different levels when compared to the the negative group and control group. On the other hand, there were no significant differences in the electrodiagnostic study and serum CK, SGOT, SGPT level between the positive, negative and control groups. In summary, histopathologic findings similar to the eosinophilia-myalgia syndrome were inducible in rats followign the administration of L-tryptophan.

The Ultrastructural Study of Intermediate Filaments in Epithelial and Mesenchymal Tumors.: Chae Hong Suh, Keun Hong Kee; Korean J Pathol. 1993;27(4):328-338.

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Abstract PDF: The immunohistochemical results are compared with ultrastructural features of neoplastic epithelial cells and mesenchymal cells to assess whether immunohistochemistry is useful in the differential diagnosis of epithelial tumors and mesenchymal tumors. Squamous cell carcinoma and transitional cell carcinoma exhibited positive reaction for keratin, but adenocarcinoma was weakly positive reaction for keratin. Ultrastructurally, heavy bundles of tonofilaments were more frequently encountered in squamous cell carcinoma. In adenocarcinomas, the intermediate filaments were arranged randomly as nonaggregated, short filaments spread throughout the cytoplasm. Fibroblastic and fibrohistiocytic tumors, schwannomas, and neurofibromas exhibited positive reaction for vimentin and alpha-smooth muscle actin. Vimentin consisted of large aggregates of gently curved filaments that often displace other cytoplasmic constituents was noted. Fibroblastic cells with features of smooth muscle differentiation were found in granulation tissue of healing wounds, hypertrophic scars, fibromatosis, fibroma, neurofibroma and malignant fibrous histiocytoma. Smooth muscle tumors showed abundant bundles of thin filaments with dense bodies, pinocytotic vesicles and dense attachment plaques along the cell membrane. Skeletal muscle tumors showed bundles of disorganized thick and thin filaments, remnants of sarcomeres and Z-bands. From the above result, ultrastructural and immunohistochemical studies on epithelial and mesenchymal tumors were useful in tumor diagnosis sand classification.

Histopathological and Immunohistochemical Features of Wilms' Tumor.: Yoon Jung Choi, Woo Hee Jung, Dong Whan Shin, Chan Il Park, Chuhl Joo Lyu; Korean J Pathol. 1993;27(4):339-348.

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Abstract PDF: Wilms' tumor is one of the most common primary malignant tumors of the kidney during infancy and childhood and is known to be originated from the primitive cells of metanephric blastema. It presents difficulties when encountered in deciding the presence of anaplasia or in differentiating it from other renal tumors of childhood with different biologic behavior because of its diverse histologic patterns and varying degrees of differentiation. Evaluation of clinical and histopathologic features in terms of prognostication was done of 32 cases of Wilms' tumor which were surgically resected and diagnosed in the period from January 1979 through June 1992. Immunohistochemical reaction for cytokeratin, vimentin, actin and desmin was also analysed on all cases of Wilms' tumor in conjunction with clear cell sarcoma of the kidney(CCSK), malignant rhabdoid tumor of the kidney(MRTK) and congenital mesoblastic nephroma(CMN) to assess the validity of immunohistochemistry in differentiating Wilms' tumor from these renal tumors. Twenty four(75%) cases were diagnosed before the age of 5 and 40.7% were under 2 years old. Mixed type was most common(62.5%), followed by epithelial, blastemal and stromal predominant type in descending order of frequency. Anaplasia was observed in 3 cases(9.4%), two of which were epithelial predominant type and one blastemal predominant type. Treatment modality and presence of anaplasia were significantly correlated with 5 year survival rate of patients. Immunohistochemical stain revealed that all epithelial component of Wilms' tumor were positive for cytokeratin and 56.3% of Wilms' tumor had blastemal component which were positive for both cytokeratin and vimentin. Twenty cases(62.5%) of Wilms' tumor had blastemal component which were positive for cytokeratin with a proportion of more than 5% of reactive cells. Stromal component of Wilms' tumor generally did not show differentiation into the specialized type of tissue and all revealed positive reactions for vimentin among which some revealed positive reactions for actin. Only 3 out of 6 cases with rhabdomyoblastic differentiation were positive for desmin. CCSK, MRTK and CMN which have different biologic behavior and treatment modality compared to Wilm's tumor showed positivity only for vimentin and/or actin. In summary, treatment modality and presence of anaplasia are significantly correlated with patients' survival and the immunohistochemical stain for cytokeratin is very helpful in confirming the presence of blastemal component and useful in the differential diagnosis of Wilms' tumor from other kinds of pediatric renal tumors.

A Morphologic Study of the Structural Changes of Normal Aging Facial Skin.: Joong Won Song, Dae Young Kang; Korean J Pathol. 1993;27(4):349-361.

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Abstract PDF: In an attempt to elucidate the morphologic changes of normal aging skin, the present study was undertaken in human facial and chest well skin of individuals aged from 4 months to 76 years old. Biopsied skin was studied with light microscope, scanning electron microscope, and transmission electron microscope, using both conventional and tannic acid staining. The morphologic changes in the skin were noted as follow: 1. Structurally, the aged epidermis gradually became somewhat thinner, with flattening of the dermoepidermal interface. The number of melanocytes also decreased. 2. Abnormalities of elastic fibers such as loss of oxytalan fibers were observed from age 30. It was the initial sign of the aging process of elastic fibers, followed by abnormal changes in elaunin and mature elastic fibers. The degree of facial skin abnormality was rather more severe than that of the chest wall skin. 3. In individuals more than 50 years old, the age related changes in mature elastic fibers were more severe. Transmission electron microscopically, the electron density in elastin was irregular. The elastic fibers also showed pores and irregular splitting with fragmentation. Fine granular materials were scattered near the elastin. 4. Scanning electron microscopically, the elastic fibers in young adult skin showd ribbon-like fibers aligned in the same direction. They were either cylindrical or elliptical, having smooth surface. In old skin, the elastic fibers ran in various directions, forming complicated networks. These were larger, more elliptical and more branched than those in young adult skin. In summary, histologic changes of aging are much more prominent in sun-exposed skin(facial skin) than in sun protected skin(chest wall skin). A completely different spectrum of elastic fiber abnormalities was found in individuals more than 30 years old. The result indicates that elastic fiber abnormalities are related to aging skin.

Ultrastructural Study of Alcohol-Induced Gastric Mucosal Change of Rat.: Kam Rae Cho, Kun Young Kwon, Eun Sook Chang; Korean J Pathol. 1993;27(4):362-370.

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Abstract PDF: In an attempt ultrastructural study of alcohol-induced gastric mucosal change, we selected sixty Sprague-Dawley rats. The rats were administrated with 4 ml of 10% and 40% ethanol enterically and examined by light and electron microscopy. Light microscopically, the thickness of the mucus layer of both 10% and 40% ethanol groups was decreased. The antral mucosa revealed focal inflammatory infiltrates, disturbed glandular arrangements, and significant decrease of mucosal thichness and proper glands. On scanning electron microscopy, flattened or swollen mucosal epithelium and irregularly distributed gastric pits were seen in both experimental groups, and these changes were more severe in the groups of higher concentration and longer duration. On transmission electron microscopy, mitochondrial abnormalities with myelin-like materials and dilatation of endoplasmic reticulum and cytoplasmic blebs were observed. Also the mucus cells show significantly decreased mucus globules, increased fat vacuoles, and large autophagic vacuoles. These alterations were similar to those produced by ethanol in the liver and small intestine. This study indicates that, prolonged administration of ethanol induced chronic gastritis, especially chronic atrophic gastritis.

The Tissue Expression of HBsAg and HBcAg in Hepatocellular Carcinoma and Peritumoral Liver.: Jee Young Han, Woo Hee Jung, Chae Yoon Chon, Chan Il Park; Korean J Pathol. 1993;27(4):371-378.

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Abstract PDF: To evaluate the tissue expression rate and pattenr of HBsAg and HBcAg in tumors and peritumoral livers, an immunohistochemical study was undertaken on 47 surgically resected hepatocellular carcinomas(HCCs). The results are as follows. 1. Patient's sera were positive for HBsAg in 40 cases(85.1%). In the remaining 7 cases, the tumor and peritumoral liver expressed neither HBcAg nor HbSaG, suggesting that they were caused by other etiologies than hepatitis B virus. 2. The peritumoral liver had HBsAg and HBcAg in 95.0% and 27.5% among the 40 cases, respectively. But the tumor expressed HBsAg in 50.0% and HBcAg in none. 3. The expression of HBsAg within the tumor and both HBsAg and HBcAg in the peritumoral liver tended to be more frequent in the pretreated cases before surgery. 4. Edmondson-Steiner grade IV tumors revealed a lower expression rate of HBsAg than the low grade tumors(p<0.05). Incases with cirrhosis at peritumoral tissues, HBcAg was less frequently found than in those without cirrhosis. The majority of tissue HBsAg and HBcAg was represented as groups of positive cells. These results suggest that, during the development and progression of HCCs, the HBcAg containing cells are repeatedly removed and the HBcAg negative cells are selected, because cellular expression of HBcAg is the target of host immune response.

Histologic and Clinical Characteristics of Skin Warts According to the Human Papillomavirus Antigen Expression.: Kun Chang Song, Kwang Gil Lee; Korean J Pathol. 1993;27(4):379-386.

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Abstract PDF: Skin wart is an infectious disease of human papillomavirus(HPV). Its clinical and histopathologic characteristics are largely determined by lesion sties, viral type and host immunity. The infected basal cells and keratinocytes of the epidermis are induced to proliferate by the viral genome. It is, however, not well known how htose factors give rise to histopathologic alterations in the infected basal cells and keratinocytes. So, evaluation of correlation between HPV antigen expression in the wart tissues and clinical and histopathologic charateristics was done on 83 cases of skin warts. The age of patients ranged from 2 to 83 years. Thirty six(43.3%) cases were diagnosed before the age of third decade. The sex ratio was nearly same. Verruca vulgaris was most common(46 cases), followed by verruca plana(26 cases) and verruca palmoplantaris(11 cases). HPV antigen expression was observed in 43 out of total 83(51.8%). It was noted in 47.8%(22/46) of verruca vulgaris, in 46.2%(12/26) of verruca plana and in 81.8%(9/11) of verruca palmoplantaris. HPV antigen-positive groups included more younger patient's age and more higher PCNA than those of HPV negative groups. HPV positive groups also tend to have shorter duration of disease and more numerous mitoses than HPV negative groups. HPV antigen-positive groups showed lower inflammation grade than that of HPV negative groups(p<0.05). The higher the inflammaton grade is, the lower the HPV antigen expression rate. In summary, HPV antigen expression in cutaneous wart tissue is significantly correlated with the proliferative activity of the lesion. It is also significantly correlated with the inflammation that is considered to be the result of cell-mediated immune reaction.

Case Reports

Adenomatoid Mesothelioma of the Epididymis: A case report.: Youn Mee Kim, Yi Kyeong Chun, Hy Jae Cho, Il Hyang Ko; Korean J Pathol. 1993;27(4):387-391.

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Abstract PDF: Adenomatoid tumors are well-recognized neoplasms generally to be of mesothelial derivation. We experienced a case of an adenomatoid tumor of the tail of the epididymis in a 56-year-old male. Grossly the tumor was firm and whitish gray, and microscopically it consisted of glandular, cord-like, microcystic structures which were lined by flattened endothelial like to plump cuboidal cells. Immunohistochemical stains whowed positivity for keratin and negativity for facter VIII related antigen and carcinoembryonic antigen. Ultrastructually, there was many long microvilli projecting into the glandular lumina and intracytoplasmic luminal spaces, desmosomes, and prominent cytoplasmic tonofilaments. Those findings strongly support the mesothelial origin of the adenomatoid tumor especially in the glandular type. It also lead us to suggest that the term adenomatoid tumor should be remain in use for light microscopic diagnosis, and that the term adenomatoid mesothelioma should be applied when the mesothelial nature of an adenomatoid tumor is proven by electron microscopy and immunohistochemical stains.

Wilms' Tumor in an Adult: Report of a case.: Kyoung Me Kim, Kyo Young Lee, Chang Suk Kan, Sang In Shim, Sun Moo Kim; Korean J Pathol. 1993;27(4):392-396.

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Abstract PDF: Wilm's tumor, which is the most mommon renal tumor in childhood, has rarely been reported in adult. Diagnosis of Wilm's tumor in an adult is more apt to be accidental and is almost never suspected in the adult until discovered at operation or necropsy. Recently, we experienced a caseof Wilm's tumor in 20-year-old female patient with chief complaints of right flank pain and he maturia for two months. Renal angiogram revealed a huge renal mass replacing the upper portion of the right kidney. Nephrectomy was done under the impression of renal tumor. Grossly, the tumor was rather soft and relatively well circumscribed, measuring 13 x 8.3 cm in dimension with adhesion to renal capsule and perirenal adipose tissue. The cut surfaces revealed grayish brown in color with areas of multifocal necrosis and hemorrhage. Histologically, the tumor was composed of mainly ovoid or polygonal shaped undifferentiated blastemal cells with large areas of necrosis.

Primary Cardiac Angiosarcoma: A case report and rewiew of literture.: Mee Yon Cho, Soon Hee Jung, Woo Ick Yang, Kyung Hoon Choe, Chong Kook Lee; Korean J Pathol. 1993;27(4):397-401.

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Abstract PDF: We report a case of primary cardiac angiosarcoma in a 35 year-old woman. She presented with dyspnea, facial edema and neck vein distension during 1 month. The oval round large mass(8x4 cm) filling the right atrium infiltrated into the entire thickness of the lateral wall and extended to the vena cava and ventricle. The interatrial septum and pericardium seemed to be intact. Despite the surgical excision and adjuvant chemo-and radiotherapy, the patient died 8 months later due to tumor recurrence. The histologic findings of tumor varied from benign looking capillary proliferation mimicking granulation tissue to sarcoma composed of spindle cells. But anastomosing vascular channels lined by anaplastic polygonal cells and intracytoplasmic lumen containing red blood cells were characteristic findings. These tumor cells showed positive reaction to endothelial cell antigen and factor VIII-related antigen. The intercellular junctional complex and vascular channels formed by cytoplasmic process of tumor cells were identified by the ultrastructural study.

Eccrine spiradenoma: A report of two cases.: Woo Sung Moon, Dong Geun Lee, Myoung Ja Jeong, Myoung Jae Kang, Ho Yeul Choi, Sang Ho Kim; Korean J Pathol. 1993;27(4):402-406.

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Abstract PDF: Eccrine spiradenomas are clinically characterized by a solitary, tender mass and they are situated on the upper parts of the body, predominantly on the ventral aspect. We herein report two cases of eccrine spiradenoma in 35-year-old man and 53-year-old woman, which located on upper extremity and inguinal region. The masses are round, well circumscribed and measuring 0.7x0.5x0.5 cm, 5x4.5x3 cm in size, respectively. Histopathologically, the tumor consists of masses of two types of cells, intensely staining cells and pale staining cells, usually arranged in chains, cords and pseudoglands. Immunostainings for low molecular cytokeratin, high molecular cytokeratin, carcinoembryonic antigen, and S-100 protein show positivity in neoplastic cells. Electron microscopically, the tumor was composed of three types of cells, i. e. 1) round or ovoid tumor cells in shape with scanty cytoplasm and poorly developed intracytoplasmic orgenelles, 2) spindle shaped dark cells interconnected by desmosomes, 3) large epithelial cells with abundant cytoplasm and cytoplasmic intermediate filaments which formed glandular structures. The large epithelial cells joint each other by desmosomal attachments and luminal cells featured small numbers of microvilli, but either secretory granules nor ductal type granules were noticed.

Original Article

Chronic Sclerosing Hyaline Change and Fatty Metamorphosis Resembling Alcoholic Liver Diseas in Prader-Willi Syndrome.: Sun Hee Sung, Dong Won Min, Chan Il Park, Ki Sup Chung; Korean J Pathol. 1993;27(4):407-410.

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Abstract PDF: A complex syndrome, later called as Prader-Willi syndrome, was first described in 1956 by Prader et al, and Zellweger and Schneider characterized this syndrome as hypogonadism, hypotonia, hypomentia and boesty. It is not rare in western countries and more than 400 cases have been reported until 1983. But our interest arose because of our recent experience of diffuse noncirrhotic fibrosis of the liver in a 6 year-old boy who had the clinical features of Prader-Willi syndrome. The core of liver showed destruction of most of the hepatic lobules, particularly of the acinar zone 3, and replacement bt diffuse fibrosis. The remaining liver cells underwent fatty change, and the overall changes resembled chronic sclerosing hyaline disease of the alcoholic type. Inflammation was negligible. This particular case suggests that the severe fatty change of liver could result in irreversible damage to the hepatocytes and progressive fibrosis.

Case Reports

Five Korean Cases of Dysplastic Melanocytic Neves.: Kyoung Me Kim, Seok Jin Kang, Sang In Shim, Sun Moo Kim, Baik Kee Cho; Korean J Pathol. 1993;27(4):411-417.

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Abstract PDF: The dysplastic nevus is a rare form of melanocytic nevus in Korean people. During the past 5 years the authors experienced 5 cases in the St. Mary's Hospital and Kang Nam St. Mary's Hospital. The criteria and the histologic findings of dysplastic nevi are debated in the western literature. Clinically, all cases were greater than 5 mm in size with ill defined irregular borders and irregularly distributed pigmentation. Histopathologically, all cases showed numerous discrete individual nests of melanocytes located in the dermoepidermal junction and the papillary dermis and were characterized by extension of dermoepidermal component of the nevus at the "shoulder" beyond the dermal component of the nevus. There was no cytologic atypia of nevus cells in all cases. Our cases lacked personal or family history of malignant melanoma. Therefore, we believe our cases are nonfamilial, sporadic and benign nevi with no prognostic significance. A brief review of the literature and a discussion on the term "dysplastic" and clinicopathologic correlation are made.

Cystic Adventitial Disease of the Popliteal Artery: A case report.: Soo Min Kang, Kyeong Cheon Jung, Je G Chi; Korean J Pathol. 1993;27(4):418-420.

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Abstract PDF: Localized cystic degeneration of peripheral arteries represents and unusual cause of arterial insufficiency. It frequently occurs in patient without generalized arteriosclerosis. It has been reported in patients from age 11 to 62 years. Cystic adventitial disease is most common in the popliteal artery. At least 115 cases have been reported worldwide, but none in Korea. We report a case of cystic adventitial disease involving the left popliteal artery. This 64-year-old man presented with an 18-month history of cramping pain of sudden onset in the left calf and claudication. Angiographic findings showed a 6 cm length of luminal obliteration of the popliteal artery. Segmentally resected popliteal artery showed two longitudinally directed cystic masses measuring 3.5x1.5 cm and 2.5x1.5 cm in the adventitia. Microscopic examination revealed cystic space in the arterial adventitia compressing arterial lumen. There were a number of foamy histiocytes collected along the cystic lumen.

Extraskeletal Chondroma Arising from Tongue and Tonsils: Three cases report.: Ki Ouk Min, Kyo Young Lee, Chang Suk Kang, Sang In Shim, Sun Moo Kim; Korean J Pathol. 1993;27(4):421-423.

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Abstract PDF: Three rare tumors of the oral cavity are presented. Lingual chondromas, approximately twenty to thirty cases appear to have been reported since the lesion was first described by Berry in 1892, which are usually seen on the lateral borders in the anterior two thirds of the tongue, while the ventral surface and the posterior third are rarely involved. Chondromas of the tonsil are of very rare occurrence, which are thought to arise as a result of metaplasia, rather than from embryonic rests, with chronic fibrosing inflammation being the inciting factor. Because of its rarity, the following cases of chondroma of the tongue and tonsil are being added to small list of such case reported in the literature.

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