Journal of Pathology and Translational Medicine

Volume 28(2); April 1994

Original Articles

The Establishment of Hospital Pathology in Korea.: Je G Chi; Korean J Pathol. 1994;28(2):109-117.

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Abstract PDF: A brief historical review of the Pathology Service in the western hospital system in Korea is made. Only since the introduction of western medicine by Japanese officials and American missionaries in the late 1890 has Pathology been considered a major part of basic science in medical schools, and its role as a hospital "Service had previously long been ignored. A limited service of tissue diagnosis of surgical material and autopsy had been performed. Professor Inamato was the first Japanese pathologist to come to Korea and set up a Pathology Department at the Chosun Chongdogbu Hospital in 1913. And Dr Mills appears to be the first American hospital pathologist who worked at Severance Hospital in 1913 doing bacteriology and parasitology as well as lecturing on patology at the medical school. After the Korean war most university hospitals adopted the Central Laboratory system which is equivalent to Pathology Service in the American hospital system. The need for hospital pathologists, therefore increased greatly. To meet this need the Korean Society of Pathologists that was founded in 1946, established a pathology specialty system in 1963, and began to produce hospital pathologists in both anatomic and clinical pathology. Unfortunately in the midst of changing a hospital laboratory system the term Clinical Pathology was erroneously used by some pathologists to measn Hospital Pathology as a whole. They claimed and advocated that Surgical Pathology should also be a part of Clinical Pathology. They made no distinction between anatomic pathology and clinical pathology. Although their claims proved to be erroneous later, the discord between anatomic pathologists and clinical pathologists resulted in a complete separation of the anatomic pathology(AP) and clinical pathology(CP) programs in residency training and in the specialty board system. As of now there is no access to train combined AP and CP specialists who are greatly needed for a great majority of hospitals in Korea. Presently there are almost equal number of anatomic pathology and clinical pathology specialists. M.D. clinical pathologists in Korea have no knowledge of tissue pathology examination, and conversely anatomic pathologists have no access to a clinical laboratory during their training periods. Furthermore there are only a handful specialists in the clinical pathology field. There is an increased chance to have clinical microbiologists, clinical biochemists and other experts in clinical pathology fields, who are not M.D.s but Ph.D.s, in the near future, because M.D. microbiologists and biochemists working at Departments of Microbilogy or Biochemistry at medical schools are doing research of their own. Therefore general clinical pathologists with a con-temporary training background as in Korea would have difficulty in finding a ro as a physician and not as an administrator or supervisor of a clinical laboratory. It is hoped that a balanced system involving Pathology(anatomic pathology) and Laboratory Medicine(clinical pathology) in modern Korean hospitals will be established in the coming years.

Histopathologic Study of Primary Gastrointestinal Lymphoma: Gross and immunohistochemical analysis of 30 cases.: Hye Jae Cho, Jeong Eun Joo, Ill Hyang Ko; Korean J Pathol. 1994;28(2):118-125.

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Abstract PDF: A histopathologic study including iramunohistochemical stains was made in 30 patients who were presented with gastrointestinal lymphoma. The occurrence was 13 in the stomach, 8 in the ileocecum, 7 in the small intestine and 2 in the colon. The disease more frequently affected males than females and the average ages were 53 years in the patients of gastric lymphoma and 44 years in the patients of intestinal lymphoma. Gastric lymphomas were usually presented with a single lesion, and the antrum and/or body were the most common sites. But intestinal lymphomas were presented with a single or multiple lesion, and the ileocecum was the most common site. The most common gross type of gastrointestinal lymphomas was the ulceroinfiltrating type and most are of the diffuse large noncleaved cell type of B-cell lymphoma, histologically. There were 2 cases of T-cell lymphoma presented in the intestine as the superficially ulcerative gross pattern and diffuse immunoblastic cell type. The distinct MALToma was seen in only one case of stomach but the feature was partially remained in each two cases of stomach and intestine. Their coexistent findings may suggest that diffuse large of immunoblastic component arises through blastic transformation of the low-grade M ALToma component.

An Immunohistochemical Study for the neu and ras Oncoprotein and Epidermal Growth Factor Receptor in the Breast Carcinoma.: Jeong Ja Park, Tae In Park, Tae Joong Sohn, In Soo Suh; Korean J Pathol. 1994;28(2):126-134.

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Abstract PDF: To evaluate correlation between the expression of neu and ras oncoprotein and epidermal growth factor receptor on breast carcinoma and other known prognostic factors, immunohisto-chemical studies were performed. Positive reaction for neu, which appeared as brown granular deposits along cell surface and cytoplasm of the tumor cells, was significantly correlated with the histological grade but not with other prognostic factors such as tumor size, lymph node me-tastasis, local recurrence, and estrogen and progesteron receptor status. Also granular deposits of ras were noted in the carcinoma cells in the cytoplasm, while the epithelaial cells of the normal lobule and duct showed negative reation. But expression of ras was not significantly associated ras with other prognostic factors. The reaction for EGFR was mostly negative on epithelial cells of both the normal lobule and duct, and was not significantly associated with other prognostic factors. The results suggested that expression of the neu oncoprotein is significantly associated with the histological grade of breast carcinoma, while the ras and the EGFR do not show significant prognostic value.

Immunohistochemical Study for Ki-1 and EMA Antigens in Large Cell Lymphoma including Anaplastic Large Cell Lymphoma.: Soon Ae Oak, Young Hyeh Ko, Jung Dal Lee; Korean J Pathol. 1994;28(2):135-143.

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Abstract PDF: To evaluate the frequency of EM A and Ki-I antigen expression in the large cell lymphoma and to define the histologic characteristics of Ki-1 positive anaplastic large cell lymphoma, 40 cases of malignant lymphoma, diffuse large cell type were immunostained by Ki-I and EMA monoclonal antibodies. Eight cases of large cell lymphomas expressed EMA, among which 4 cases were positive for Ki-I antibody as well. The positive rate for EMA was much higher in T cell lymphomas than in B cell lymphomas. Among 4 cases of Ki-I positive lymphomas, 2 cases showing membrane staining of Ki-1 with prototypic histologic feature of anaplastic large cell lymphoma were classified as Ki-1 positive anaplastic large cell lymphoma(ALCL). Ki-I positive ALCL were T-cell in one and non-T, non-B cell type in the other, respectively. The remaining 2 cases of Ki-1 positive lymphomas showing cytoplasmic staining were classified as both B-cell centroblastic/centrocytic lymphoma and T-cell pleomorphic large cell lymphoma.

Immunohistochemical Study of Upper Respiratory Tract Malignant Lymphomas with Features of Polymorphic Reticulosis.: Jeong Ja Park, Tae In Park, Young Hyeh Ko, Jung Dal Lee; Korean J Pathol. 1994;28(2):144-148.

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Abstract PDF: Malignant lymphomas of the upper respiratory tract are relatively common in the Orient including Korea. They have a marked clinicopathologic and immunophenotypic diversity. We retrospectively reviewed 20 cases of malignant lymphomas with features of polymorphic reticulosis in the upper respiratory tract. Histopathologic findings consisted of polymorphism of lymphoid cells in 17 cases(85%), angiocentricity in 14 cases(70%), coagulation necrosis in 12 cases(60%), and epitheliotropism in 8 cases(40%). By Working Formulation, 14 cases(70%) were classified as diffuse large cell type, 4 cases(20%) as diffuse mixed small cleaved and large cell type, one case as immunoblastic type, and one case as anaplastic large cell type. On immunostaining, one showed B-cell phenotype and 19 cases showed T-cell phenotype. The B-cell type was histologically diffuse large cell type. From these results, we concluded that polymorphic reticulosis is a type of peripheral T-cell lymphoma with angiocentricity.

Expression of Trans forming Growth Factor-a and Proliferating Cell Nuclear Antigen in Human Gliomas.: Gyeong Sin Lee, Byung Hyun Kim, Bong Kwon Chun, Man Ha Huh; Korean J Pathol. 1994;28(2):149-153.

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Abstract PDF: To evaluate the expression of transforming growth factor-alpha(TGF-alpha) and proliferating cell nuclear antigen(PCNA) and its relation to the differentiation of the tumors, immunohistochemical studies were performed in 49 human gliomas. Tumors were graded by a 3-grade-system; grade I=low grade glioma, grade Il=anaplastic glioma, grade III=glioblastoma multiforme. TGF-A and PCNA were predominantly expressed in malignant gliomas compared with benign gliomas. Malignant gliomas revealed 87% TGF-A reactivity, while benign gliomas revealed 26% TGF-A reactivity. The proliferation index with PCNA was 26%+/-7%(mean+/-standard deviation) in malignant gliomas and 5%?% in benign gliomas. A strong positive correlation between tumor grade and extent of TGF-A and PCNA expression was found(P<0.0001, Chi square and P<0.002, T-test). Synchronous expression of TGF-A and PCNA was observed in 16 cases(33%). The results of this study support the suggestion that the expression of TGF-A might be a useful prognostic indicator in human gliomas.

Distribution of Smooth Muscles in Hemorrhoids.: Jae Gul Chung, Ghee Young Choe, Gyung Yub Gong, Eun Sil Yu, Jin Cheon Kim, In Chul Lee; Korean J Pathol. 1994;28(2):154-159.

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Abstract PDF: Hemorrhoids are one of the commonest disorders specific to the human. However, the pathogenesis is not well understood so far. Anal submucosa is largely composed of blood vessels, loose connective tissue and smooth muscles, forming muscular network around the venous plexuses. We analyzed the distribution of smooth muscles in the hemorrhoidal tissues. Immunohistochemical stainings for desmin, vimentin, and Factor VIII related antigen were performed using six freshly frozen hemorrhoidal tissues. All of them were diagnosed as external hemorrhoids. Four anal tissues from Miles' operation specimen without hemorrhoids were used as normal controls. In all six cases, venous plexuses were variably dilated and smooth muscle cells were unevenly distributed. In minimally involved areas, there were relatively sufficient amount of perivascular smooth muscles which were arranged in their bundles. In contrast, only single scattered cells or very small amount of smooth muscle bundles were noted around the dilated vascular plexuses in severely affected areas. In two severe hemorrhoidal tissue samples, vascular plexuses were markedly dilated and only single scattered smooth muscle cells were seen. In conclusion, the total amount of smooth muscles in the submucosa of hemorrhoid tissue was reduced than those of the normal controls. The degree of hemorrhoidal dilation was inversely related to the amount of smooth muscles. However, causal relation between diminution of submucosal smooth muscles and venous dilation remains to be clarified.

Pathological Analysis of the Basal Cell Carcinoma.: Kye Yong Song, Young Hwa Choi, Mi Kyung Kim, Kenn Kook Lee, Eui Kenn Ham; Korean J Pathol. 1994;28(2):160-167.

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Abstract PDF: Though basal cell carcinoma is the most frequent and increasing malignant tumor of the skin in Korea, its pathological analysis has been done only on the small numbers. So, we did a comprehensive pathologic study on the 283 patients with basal cell carcinoma diagnosed in the Department of Pathology, Seoul National(233cases) and Chung-Ang(50cases) University Hospital during 1975-1992. The age distribution was ranged from 15 to 84 years with highest incidence rate in the age group of 5th-8th decades and 83.7% of all patients were over 40 years of age. Sex difference was not noted. The most common site was face occuring in 235 out of 283cases(83.0%) especially in the eyelid(25.5%), nose(17.9%) and cheek(16.6%). The most frequent histopathologic type was solid type(54.0%) followed by mixed(23.9%), adenoid(7.5%), and metatypical(4.7%). Among 51 mixed type, all showed solid components with adenoid(51.0%) followed by morphea(25.5%) and metatypical type(13.7%). And among 14 recurrent cases, solid type is found in 50% of cases. The characteristic clinicopathological findings are solid arrangement of tumor cells with various histological pattern and predominant occurence on the face.

Case Reports

Methotrexate Induced Chronic Active Hepatitis: A report of two cases.: Jee Young Han, Young Nyun Park, Chan Il Park, Chae Yoon Chon; Korean J Pathol. 1994;28(2):168-172.

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Abstract PDF: Although methotrexate(MTX) has been known to have many side effects, especially toxicity on the hemopoietic cells and the liver, it has been used as a potent anticancer drug and for the treatment of psoriasis or rheumatoid arthritis. The severity of hepatotoxicity varies from mild fatty change to chronic active hepatitis(CAH) and cirrhosis. We experienced two cases of MTXinduced CAH in patients with psoriasis, which prompted us to report in view of the absence of biopsy proven MTX hepatotoxicity in the Korean literature. Microscopically, the liver showed a distorted lobular architecture with portal fibrous expansion, piecemeal necrosis and bridging necrosis/fibrosis. The hepatic lobules revealed fatty changes of hepatocyte, focal hepatocytolysis, delicate collagen deposits along the space of Disse and the characteristically marked polyploid nuclear change of hepatocytes.

Metastatic Adenocarcinoma of Colon in Meningioma: A case report.: Yung Suk Lee, Hyun I Cho, Jong Sang Choi, In Sun Kim; Korean J Pathol. 1994;28(2):173-178.

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Abstract PDF: Cases of metastases from extracranial tumor to intracranial tumor are very rare. The world wide review of the literatures until 1992 revealed 44 cases of primary intracranial tumors containing metastatic tumors which are unrelated extracranial primary malignant tumors; the intracranial recipient tumor is a meningioma in 35 cases among them. Carcinomas of the lung and the breast are the most common extracranial donor tumors. Metastases from colon cancer to meningioma are extremely rare. A 74 year-old-female presented with headache for 2 weeks. CT revealed a round mass with high signal intensity, measuring 4 cm in diameter, which is located in the left parietal lobe. The patient had colon cancer 2 years ago and lymphoma I year ago. On operation, the tumor is relatively well delineated and attached to the meninx. Microscopically, the tumor is composed of fascicles of long slender, fibroblast-like spindle cells with indistinct cytoplasmic border, variable amount of collagen deposit and many psammoma bodies. A few scattered glands are present in periphery of the meningioma. The tumor glands are composed of columnar cells with basally located hyperchromatic nuclei and similiar to the glands of the adenocarcinoma of the colon.

Clear Cell Meningioma arising from Lumbar Nerve Root in a Child: A case report.: Eun Kyung Hong, Geun Shin Lyu, Moon Hyang Park; Korean J Pathol. 1994;28(2):179-184.

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Abstract PDF: Meningioma of unusual age of onset, location, histogenesis and histologic type is reported. The patient, 4 year-old girl, had an intradural spinal meningioma arising from lumbar nerve root with no dural attachement. The meningioma revealed glycogen-rich, clear cell type with extensive and blocky hyalinization of the stroma. The tumor shared common fibrous sheath with attached lumbar nerve, and nerve fibers were scattered within the tumor. Ultrastructurally, the tumor cells had abundant glycogen particles, intermediate filaments and intercellular desmosomes. Hyalinized material revealed large amianthoid collagen fibers.

Microcystic Meningioma: A case report.: Gyeong Sin Lee, Il Seon Lee, Bang Hur, Man Ha Hur; Korean J Pathol. 1994;28(2):185-190.

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Abstract PDF: Microcystic meningioma, a distinct morphological variant of meningiomas, is histologically characterized by a vacuolated appearance with multiple cystic spaces lined by vacuolated or stellate-shaped tumor cells. We report a case of microcystic meningioma occuring in right frontoparietal area of 42-year-old woman, with emphasis on differential diagnosis, along with a review of literatures. Immunohistochemically, most of the tumor cells demonstrated positive immunoreactivity for both epithelial membrane antigen and vimentin. Electron microscopy showed that the extracellular space was extensive, where eletron-lucent material was occasionally seen. The tumor cells had long cytoplasmic processes showing complex interdigitation and a large number of desmosomes.

Leukemic Infiltration of Acute Hybrid Leukemia with CD7 CD13+ and CD19+ Immunophenotype in the Lymph Node: A case report.: Mi Ja Lee, Ho Jong Jeok, Sang Woo Juhng; Korean J Pathol. 1994;28(2):191-199.

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Abstract PDF: Acute hybrid leukemia is an uncommon disease that demonstrates malignant transformation expressing lymphoid and myeloid cell lineage. We experienced a case of 25-year-old man with acute leukemia with unusual characteristics: unclassifiable morphology and undifferentiated cytochemistry by French-American-British (FAB) criteria. Microscopically, it disclosed monotonous tumor cell population in lymph node with vascular plugging and perivascular infiltration, and indian file appearance in capsule and surroun ng adipose tissue. Results of flow cytometry and immunohistochemical studies of frozen sections, cytospins, and formalin fixed lymphoid tissues disclosed hybrid form characterized by myeloid and lymphoid cell lineage. The immunophenotype analysis showed both anti-T cell, anti-B cell and anti-myeloid cell monoclonal antibody reactivity; blast cells were consistently CD7+(94.6%), CD13+(97.1%), and CD19+(85.22%). The normal hematopoietic cells were almost replaced by tumor cells in PB and bone marrow. In preparation of cytospin of peripheral blood(PB) cells separated by a Ficoll-hypaque gradients, blast cells were negative for Sudan black B, myeloperoxidase, periodic acid Schiff, and nonspecific esterase.

Meckel-Gruber Syndrome: An autopsy case report.: Kyung Ha Kang, Duck Hwan Kim, Hee Jin Chang, In Sook Kim, Jin Hee Sohn, Jung Il Suh; Korean J Pathol. 1994;28(2):200-202.

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Abstract PDF: Meckel-Gruber syndrome is a quite rare congenital disorder, characterized by posterior encepalocele, cleft palate and lip, polycystic kidneys, hepatic fibrosis with bile duct proliferation, and postaxial polydactyly and syndactyly. We experienced an autopsy case of M eckel-Gruber syndrome in a second baby of 28 year-old woman. At 26 weeks of gestation, congenital anomaly was detected on ultrasonographic examination and the pregnancy was terminated. Familial history was not noted.

Pulmonary Cavernous Hemangioma: A case report.: Seung Yeon Ha, Sang Ae Yoon, Yang Seok Chae; Korean J Pathol. 1994;28(2):203-205.

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Abstract PDF: The pulmonary cavernous hemangioma is usually from birth and there may be without symptoms until adulthood. Larger or multiple pulmonary angiomata with considerable pulmonary arteriovenous shunts may cause cyanosis, finger clubbing, dyspnea and frequently accompanyingbruit. Recently, we experienced a case of cavernous hemangioma of the lung. A 34-year-old woman was admitted to our hospital for surgical evaluation of a 4 cm solitary, round nodule in the right upper lobe on the chest X-ray and CT scan. She had no symptoms. Laboratory findings are within normal limits except for elevated glucose levels. At surgery, the mass was well encapsulated and easily excised from the peripheral portion of the posterior segment of the right upper lobe. Grossly, it consisted of a 4 cm in diameter, round, soft, sponge-like, hemorrhagic, slightly lobulated mass with a smooth external surface. Microscopically, the mass was composed of vessels, which were thin walled, dilated and filled with blood. The wall of the abnormal vessels was thin and composed of endothelium and fibrous connective tissue with only a little smooth muscle. Immunohistochemically, the wall of the dilated abnormal vessesls showed negative reaction for cytokeratin(low and high) and epithelial membrane antigen but weakly positive reaction for UEA-1 in focal areas.

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