Journal of Pathology and Translational Medicine

Volume 28(3); June 1994

Original Articles

Congenital Cystic Adenomatoid Malformation of the Lung: Clinicopathologic analysis of 22 cases.: Young Lyun Oh, Yeon Lim Suh, Je G Chi; Korean J Pathol. 1994;28(3):219-227.

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Abstract: Congenital cystic adenomatoid malformation of the lung(CCAML) is a rare developmental anomaly characterized by an "adenomatoid" hyperplasia of terminal respiratory structures with formation of the cysts of varying sizes. CCAML is separated into three major types based on the gross and microscopic findings. We have analyzed 22 cases of CCAML, those consisted of 6 autopsy cases and 16 surgical specimens. Out of 22 cases, 5 cases were composed of large cysts(type I) and 9 cases had multiple small cysts(type II). Remaining one case revealed features of solid type(type III), and 7 cases were mixed form. There were 16 boys and 6 girls. All cases were below the age of 14 years. There was no clear-cut age difference between different types of CCAML. However, inflammation, fibrosis and pseudostratification of epithelium were often found in older age. All fetal autopsy cases of CCAML had hydrops fetalis and were associated with maternal hydramnios. One case of type III showed definite mucinogenic cells in the cysts unexpectedly, and one case of the mixed form(typeI+II+III) was found in a fetus of 22 weeks of gestational age. Above findings contradicted the classical description of the CCAML, and suggested that arbitrary classification into three types may not be the best way in understanding this condition.

Histopathological Analysis of Posterior Fossa Tumor.: Yoon Jung Choi, Tai Seung Kim; Korean J Pathol. 1994;28(3):228-234.

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Abstract: The posterior fossa, containing roughly 6ne fourth of the intracranial contents, is the site of about 30-35% of the intracranial tumors. The incidence of primary tumors in the posterior fossa is quite different from that of the cerebivm. We analysed 124 cases of posterior fossa tumor, over a 10 year period, to understand the status of posterior fossa tumor and its histologic characteristics. Medulloblastoma was most common(37cases, 29.8%), followed by astrocytoma, hemangiobla-stoma, ependymoma, meningioma, metastatic tumor, arteriovenous malformation and choroid plexus papilloma in descending order of frequency. Tumors were found most frequently between the ages of two and ten years(28.2%) and sixty seven(54.0%) cases were diagnosed before the age of fifteen. The ratio of male to female was 60 : 64. Astrocytoma revealed a characteristic juvenile pilocytic type and a microcystic change. Hemangioblastoma showed higher frequency(17.7%) than previous reports and the origin of tumor cells is still equivocal. Other tumors revealed the same histologic features as other intracranial tumors.

Effect of Eicosapentaenioc acid and Butyrated hydroxyanisole on Hypercholestrolemic Diet Induced Atherogenesis in Rabbit.: Choong Sik Lee, Jeung Mok Choi, Sung Ki Min, Kyu Sang Song, Dae Young Kang, Kyu Lym; Korean J Pathol. 1994;28(3):235-245.

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Abstract: It has been suggested that the fish oil can reduce atherogenesis in humans and animals, and that peroxidation of lipoproteins may be a major factor causing atherosclerotic lesions. We tested these posibilities in rabbits fed an atherogenic diet by comparing the effect of a eicosapentaenoic acid(EPA: a major component of fish oil)supplement and a butyrated hydroxyanisole(BHA: antioxidant)diet supplement. Tweenty-eight young male New Zealand White rabbits were used in this study. The animals were divided by control, cholesterol fed only, cholesterol + EPA, and cholesterol + BHA groups. The experimental course lasted 12 weeks and animals were sacrificed periodically(2, 5, 8, 12weeks)for quantitative studies of aortic atherosclerosis using light and electron microscopy. Plasma cholesterol levels were determined and lipopreteins were separated periodically. The cholesterol fed only group showed an increased serum cholseterol level and atherosclerotic lesions from 5 weeks of experiments. The EPA supplement resulted in similiar serum cholesterol levels with cholesterol fed only group, but greater lesion than cholesterol fed only group. The BHA supplement resulted in higher serum cholesterol levels except VLDL-cholesterol than EPA supplement group. However, the atherosclerotic lesion was not increased. Our studies support the theory that oxidative modification of lipoproteins is important for the atherogenesis and antioxidant may have a protective effect. However, it failed to show antiatherogenesis effect of fish oil.

Assessment of DNA Ploidy, Estrogen and Progesterone Recetor Status and Her-2/neu Oneoprotein Expression in Breast Carcinoma by Image Analysis.: Ae Ree Kim, In Sun Kim, Kap No Lee; Korean J Pathol. 1994;28(3):246-259.

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Abstract: In 41 cases of breast cancers, the aneuploidy measured by Image Analyzer was compared with that of flow cytometric analysis, and estrogen and progesterone receptor(ER/PR) and Her-2/neu oncoprotein were immunohistochemically stained and measured by Image Analyzer. In ER/PR, the positive nuclear area(PNA, %) was measured, and in Her-2/neu, the content of oncoprotein was expressed as pg/cell. To assess the usefulness of these parameters as a prognostic factor, the author evaluated the results in relation with tumor size, nuclear grade and lymph node metastasis. The obtained results are summarized as follows: 1) The detection rate (90%) of aneuploidy by image analysis was higher than that (70%) of flow cytometric analysis. The concordance rate of both method was 80%. 2) The positivity of ER was 73% and PR was 34%, and the high PNA of ER and PR was related with high nuclear grade. There was an inverse correlation of the ER PNA with tumor size and PR PNA with negative lymph node. 3) Her-2/neu oncoprotein overexpression was found in only 2 cases and another two showed borderline overexpression. All four cases had DNA tetraploidy. From the above results, it was concluded that the image analyzer could be used in DNA analysis and in quantitation of immunostained ER/PR and Her-2/neu oncoprotein, providing the important information in the management of the breast cancer patients.

An Immunohistochemical Study on the Distribution of Endotoxin.: Tae In Park, Jung Ja Park, Jyung Sik Kwak, In Soo Suh; Korean J Pathol. 1994;28(3):260-271.

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Abstract: This study was performed to investigate the distribution of endotoxin in various organs after intraperitoneal injection of E. coli homogenator(0111:B4, 3X10(9)cells/200g of body weight). Sprague-Dawley rats were intraperitoneally injected with E. coli homogenator and sacrificed 1 and 3 hours after injection. The lung, liver, and kidney were immunohistochemically stained with avidin-biotin complex method and observed by light and electron microscopy. On the light microscopy, granular deposits of reaction products of immunohistochemical stain were found on the cytoplasmic membrane of endothelial cells and some of parenchymal cells of all organs observed. Electron microscopic study revealed finely granular reaction products on the surface of endothelial cells and some of parenchymal cells. The pinocytotic vesicles of endothelial cells demonstrated reaction products in the early phase of experiment. The distribution of reaction products were prominent in the liver among three organs. The Kupffer cells showed the most sensitive and strongest positive reaction. The hepatocytes and endothelial cells revealed weak positive reaction 3 hours later. The alveolar macrophages of the lung were also positive from the early phase of endotoxemia, while the pneumocytes and alveolar septa demonstrated weakly positive reaction in the later phase. The capillary endothelium of the kidney revealed positive reaction from the early phase. According to above results, it is concluded that the endotoxin entered into the systemic circulation was captured in the liver and lung. And both mononuclear phagocytic system and endothelial cells could be activated or damaged by endotoxin.

Immunohistochemical Analysis of Transforming Growth Factor-beta Expression in Gastric Adenocarcinoma.: Young Hee Choi, Seoung Wan Chae, Min Chul Lee, Jung Weon Shim, Hye Kyung Ahn, Hye Rim Park, Gu Kang, Hyung Sik Shin, Young Euy Park; Korean J Pathol. 1994;28(3):272-281.

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Abstract: Thirty cases of gastric adenocarcinoma were examined immunohistochemically for expression of transforming growth factor-beta(TGF-beta) in order to analyze significant correlation with clinical stage and pathologic grade of gastric adenocarcinoma. Specific immunostaining was clearly detected in the cytoplasm of the neoplastic cells. The TGF-,6 expression in the gastric adenocarcinoma is closely related to the depth of invasion, the degree of invasiveness and the presence of metastasis. Thus, we observed the stronger immunohistochemical. expression of TGF-beta in the deeper portion of invasion and in the invasive gastric adenocarcinomas with the lymph nodal metastasis than in the superficial portion of invasion and in those without the lymph nodal metastasis. There results suggest that the transforming growth factors expression in carcinoma cells may play an important role in the carcinomatous invasion resulting in metastasis.

Prognostic Value of the PCNA Index in Transitional Cell Carcinoma of the Urinary Bladder.: Sang Yeop Yi, Young Nyun Park, Chan Il Park; Korean J Pathol. 1994;28(3):282-287.

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Abstract: It is well known that histologic grade and tumor stage are important prognostic factors, and that the monoclonal antibody to proliferating cell nuclear antigen(PCNA) can recognize S-phase cells. The PCNA index of 53 transitional cell carcinomas(TCCs) of the urinary bladder was studied to evaluate its prognostic validity. The PCNA indices of TCCs ranged from 38 to 92, whih were quite different from that of normal transitional epithelium(9.4). The PCNA indices were significantly higher in tumors of the higher histologic grade and/or tumor stage(correlation coefficient 0.64 and 0.43; P=0.00). The PCNA index was particularly valuable in discriminating the superficial TCCs from the deeply invasive TCCs(67.1+/-15.46 and 79.9+/-9.70; P=0.000). Among TCCs of the same tumor stage, the histologic grade affected the PCNA index. However, TCCs of the same histologic grade revealed similar PCNA indices regardless of tumor stage. These results indicate that the PCNA index is an objective and reliable prognostic factor in TCCs, which is superior to the conventional histologic grade.

Immunohistochemical Study on Expression of Extracellular Matrix Components in Glomerular Diseases.: Sun Hee Sung, In Joon Choi; Korean J Pathol. 1994;28(3):288-296.

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Abstract: Most glomerular lesions are associated with qualitative and quantitative alterations of the extracellular matrix components, having relation to progressive glomerular sclerosis. We aimed to investigate the characteristic alteraltions in distribution of extracellular matrix components, such as fibronectin, laminin, collagen type III and IV in human glomerular diseases by immunohistochemical method. The materials included are 3 nephrectomy as normal control, 51 renal biopsies and I autopsy; 3 normal, 5 minimal change disease, 5 minimal change disease with minimal mesangial lgA deposit, 5 benign recurrent hematuria, 10 focal segmental glomerulosclerosis, 15 lgA nephropathy, 10 membranoproliferative glomerulonephritis, 2 diffuse mesangial sclerosis of infancy. Type IV collagen and laminin were present normally in the mesangium, GBM, TBM and interstitial vessels, and were increased at the portion of increased mesangial matrix, of sclerosis and thickened GBM in cases of lgA nephropathy, membranoproliferative glomerulonephritis, focal segmental glomrulosclerosis and diffuse mesangial sclerosis in the proportion to the glomerular damage. Type III collagen was absent in the normal glomeruli, but was detectable focally and segmentally in cases of membranoproliferative glomerulonephritis, IgA nephropathy and focal segmental glomerulosclerosis at the sclerotic portion. Fibronectin was normally detectable mainly in the mesangium, and partly and incompletely in GBM, and was increased at the portion of increased mesangial matrix, sclerosis and thickened GBM in cases of focal segmental glomerulosclerosis, membranoproliferative glomerulonephritis, IgA nephropathy and diffuse mesangial sclerosis, but was diminshed at the old slcerotic portion or global sclerosis. The expression of these antibodies in cases of minimal change disease, minimal change disease with minimal mesangial IgA deposit, benign recurrent hematuria was not different, quantitatively and qualitatively, from that of normal glomeruli. These findings suggest that progressive glomerular sclerosis was due to the increase of extraceuular matrix components such as type IV collagen, laminin, fibronectin and new appearance of type III collagen, and the expression was in proportion to the degree of sclerosis, but had no relation to the disease entity.

roded Polypoid Hyperplasia of the Rectosigmoid Colon: Report of 2 cases with special reference to its relation to mucosal prolapse syndrome.: Nam Hoon Cho, Hee Jeong Ahn, Chan Il Park; Korean J Pathol. 1994;28(3):297-301.

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Abstract: Polypoid prolapse of mucosal folds can occur at various sites and in various conditions predominantly associated with strain during defecation. There are two well known types of mucosal prolapse syndrome(MPS), the inflammatory cloacogenic polyp(ICP) and the mucosal redundant polyp associated with diverticular disease(N4RPD). ICP is a mucosal prolapse of the anorectal junction and MRPD is a proximal analogue involving the sigmoid colon. We experienced two cases of eroded polypoid hyperplasia(EPH) of the rectosigmoid colon which manifested as a huge gyriform mass simulating the gross features of gastrointestinal lymphomas or other malignant tumors. The EPH consisted of confluent polypoid mucosal folds with rolled-up submucosa to form stalk, The polypoid lesion represented hyperplastic epithelium, erosion of the mucosal surface and congestive vascular ectasia of lamina propria and submucosa. To explain the whole morphologic features, the initial phenomenon should be the mucosal prolapse. Vascular stretching with ischemic erosion of the mucosal surface and compensatory epithelial hyperplasia ensue as the result. The ominous endoscopic and gross features of EPH should be kept in mind to avoid erroneous radical surgery.

Case Reports

Microcystic Adnexal Carcinoma: Report of two cases.: Kyoung Mee Kim, Mi Kyung Jee, Ki Wha Yang, Seok Jin Kang; Korean J Pathol. 1994;28(3):302-306.

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Abstract: The clincopathologic features of microcystic adnexal carcinoma are presented. Microcystic adnexal carcinoma is a recently described, very rare neoplasm characterized by a locally aggressive growth pattern, and as far as we know, only two reports on the microcystic adnexal carcinoma have been published in the Korean literature. Recently we experienced two cases of microcystic adnexal carcimoma occurred in a 32-year-old male and 27-year-old female patient. They had 2.5 x 2.0 x 2.0 cm and 1.2 x 0.9 x 0.9 cm sized, slowly growing mass in the glabella and below the lower lip, respectively. The immunohistochemical staining for CEA antigen stains the glandular structures but not pilar structures. So we thinked that this tumor would be originated from primitive adnexal cells differentiating into both pilar and eccrine structures.

A Case Report of Strumal Carcinoid of the Ovary.: Young Hee Choi, Seoung Wan Chae, Hye Rim Park, Min Chul Lee, Young Euy Park; Korean J Pathol. 1994;28(3):307-312.

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Abstract: Strumal carcinoid of the ovary is a rare turkor characterized by an intimate mixture of thyroid follicles and carcinoid. Herein is reported an ovarian strumal carcinoid in a serous cystadenoma from a 27-year-old pregnant woman. The thyroid follicular epithelial cells had immunohistochemically thyroglobulin and carcinoid tumor cells contained neuron-specific enolase, chromogranin and carcinoembryonic antigen. In addition, carcinoid cells showed neuroendocrine granules ultrastructurally. Calcitonin and amyloid were not found. This tumor may be originated from pluripotent endodermal germ cells on the basis of morphologic, immunohistochemical and ultrastructural studies.

Infantile Fibrosarcoma: A case report.: Chan Pil Park, Geun Shin Lyu, Chan Kum Park, Jung Dal Lee; Korean J Pathol. 1994;28(3):313-315.

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Abstract: Fibrosarcoma in newborns and infants, designated as congenital, infantile, or juvenile fibrosarcoma is an uncommon soft tissue neoplasm occurring most frequently during the first year of life. Infantile fibrosarcoma is associated with favorable clinical behavior that is markedly different from that of adult fibrosarcoma., We report a case of infantile fibrosarcoma occured in a 3-year-old boy presenting as a palpable mass in the left lower extremity since 3 months of life. Histologic findings of the tumor are similar to those of f ibrosarcomas in adult.

Glycogen-Rich Clear Cell Carcinoma of Breast: A case report.: Nam Hoon Kim, Wan Seop Kim, Young Hyeh Ko, Jung Dal Lee; Korean J Pathol. 1994;28(3):316-318.

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Abstract: Glycogen-rich clear cell carcinoma of the breast is very rare(l -3% of breast cancer). It is defined as a tumor composed of more than 50% of optically clear, neoplastic cells, characterized by centrally located nuclei and abundant cytoplasm, being positive for periodic acid Schiff(PAS) and negative for periodic acid Schiff after diastase(D-PAS) treatment. In the absence of intraductal or in situ lobular carcinoma component, metastatic clear cell carcinomas of other organs should be considered as diagnostic possibilities. We report a case of glycogen-rich clear cell carcinoma arisen in a 62-year-old woman. The tumor revealed both solid and papillary pattern with intraductal component. The neoplastic cells had clear cytoplasm, which were PAS positive, D-PAS negative, mucicarmine negative and oil red 0 negative. More than 90% of tumor cells exhibited moderate staining for anti-estrogen receptor monoclonal antibody. Flow cytometric DNA analysis revealed diploid DNA content.

Original Article

Idiopathic Intestinal Lymphangiectasia.: Kun Chang Song, Chan Il Park; Korean J Pathol. 1994;28(3):319-321.

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Abstract: This is a case report of idiopathic intestinal lymphangiectasia occurring in a 3-year-old boy. Idiopathic intestinal lymphangiectasia is believed to be a part of the generalized congenital disorder of lymphatic system. The present case revealed markedly ectatic lymphatics in the lamina propria of duodenal villi with lymphorrhagia. Clinical features were typical of the protein-losing enteropathy; hypoalbuminemia, hypocalcemia, chylous ascites, edema of the lower extremities and mild lymphocytopenia. This case indicates that serious protein loss may ensue, even in cases of intestinal lymphangiectasia without abnormalities of extraintestinal lymphatics.

Case Report

Low-grade Immature Teratoma of the Ovary with Gliomatosis Peritonei: A case report.: Jin Young Yoo, Sang In Shim; Korean J Pathol. 1994;28(3):322-324.

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Abstract: Immature teratoma accounts for less than I percent of all ovarian teratomas and occurs commonly in young individuals, the peak incidence being in the second decade. It contains a variable mixture of mature and immature tissues in which neuroectodermal elements almost always predominate. Gliomatosis peritonei, miliary implants of mature glial tissues on the peritoneum or omentum, is an infrequently reported complication of mature or immature ovarian teratomas. We describe the first case in Korea of a 12-year-old girl with an immature teratoma and numerous glial peritoneal implants.

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