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Volume 29(4); September 1995
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Original Articles
Application of Gene Rearrangement Analysis for Diagnosis of Malignant Lymphoma.
Kyung Soo Kim, Chan Choi
Korean J Pathol. 1995;29(4):415-422.
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AbstractAbstract PDF
To evaluate the utility of gene rearrangement analysis, eight cases of malignant lymphoma, one case of Hodgkin's disease, two cases of angioiminunoblastic lymphadenopathy (AILD) and two cases of non-specific lymphadenitis were studied by immunohistochemical and genetic analysis. Southern blot analysis was perfon-ned by a using vacuum transfer system and a biotin labelled probe. This method was faster, safer, and more convenient than conventional methods. Gene rearrangement study showed rearranged novel bands in five of six cases of B cell lymphoma, in all cases of T cell lymphoma, and in all cases of AILD. No rearrangement of the B cell receptor(BCR) or of the T cell receptor(TCR) was seen in Hodgkin's disease or in nonspecific lymphadenitis. These results suggest that gene rearrangement analysis of BCR and TCR is a recommended method for the diagnosis of clonality in lymphoproliferative disorders. It would allow pathologists to differentiate lymphoma from polyclonal lymphoid proliferation and to provide information for cell lineage.
Glomerular Hypertrophy in Focal Segmental Glomerulosclerosis.
So Dug Lim, Tae Sook Kim, Hyun Soon Lee
Korean J Pathol. 1995;29(4):423-430.
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It is not clear whether glomerular hypertrophy is related to the pathogenesis of focal segmental glomerulosclerosis (FSGS). We analyzed renal biopsies from 20 adults with FSGS by morphometry, and the data were compared with those from age- and sex-matched patients with minimal lesion. Mean glomerular volume in the FSGS group was significantly larger than that in the minimal lesion group[(3.4 + 1.1 vs 2.5 0.5)x10(6) micrometer3, P<0.01]. The percentage of glomeruli with global and segmental sclerosis in FSGS group was significantly correlated with the mean glomerular volume (r=+0.66, P<0.001). Relative interstitial volume of renal cortex in the FSGS group was correlated with the serum creatinine concentration(r=+0.5, P<0.05). These results suggest that glomerular hypertrophy observed in our patients with FSGS was related to nephron loss caused by glomerulosclerosis. The interstitial fibrosis may lead to obliteration of postglomerular interstitial capillary network with secondary elevation of glomerular capillary pressure resulting in progressive loss of renal function.
Pathological Analysis of Post-Transplantation Endomyocardial Biopsies.
Jaegul Chung, Soonae Oak, Gheeyoung Choe, Gyungyub Gong, Jooryung Huh, Eunsil Yu, Inchul Lee, Meong Gun Song, Kwang Hyun Sohn, Jae Joong Kim, Jong Goo Lee
Korean J Pathol. 1995;29(4):431-441.
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AbstractAbstract PDF
Heart transplantation was first performed in 1967. It is now regarded as a well-established treatment modality for end-stage cardiac diseases. Once the transplantation is performed, endomyocardial biopsy(EMB) is the examination of choice in monitoring the transplanted heart. We analyzed the pathological findings of follow-up EMB of 6 heart transplant patients. All patients have been suffered from severe heart failure. Four patients were adult male and two were adult females. All the hearts, except for one, displayed characteristic features of dilated cardiomyopathy. The remaining heart was diagnosed as having giant cell myocarditis. Post-transplantion EMBs were performed according to the protocol and standard cardiac biopsy grading of ISHT (1990). The standards were applied for grading of cellular rejection. In five patients, there were one or two episodes of biopsy proven acute rejection, grade II or IIIA without any clinical symptoms of rejection. Immediate "pulse therapy" was performed and follow-up biopsies were done. All episodes of rejection were cleared in subsequent biopsies. All patients are doing well without evidence of cardiac problem. The postoperative monitoring of acute rejection is critical since clinical signs of rejection are usually absent. At present, EMB is regarded as the most reliable method for diagnosis and grading of acute rejection and is an efficient guide to the monitoring of the cardiac recipients. Our experience of post-transplantation EMB corresponds with previously published reports.
Gastric Lymphoid Follicles in Helicobacter Pylori Infection: Frequency, Distribution and Relationship to Inflammation in 331 Gastric Biopsy Material.
Kyoung Mee Kim, Anhi Lee, Sang In Shim, Hyun Suk Chae
Korean J Pathol. 1995;29(4):442-449.
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Helicobacter pylori(H. pylori) infection is considered the most important cause of chronic active gastritis and peptic ulcer. To determine the prevalence, distribution and it's relationship to degree of inflammation, gastric biopsy specimens were obtained from 331 nonulcer dyspepsia(NUD) patients consisting of 52 H. pylori negative normal volunteers and 279 H. pylori infected patients. Lymphoid follicles, degree of acute and chronic inflammation(Grade 0 to 3), and degree of H. pylori(Grade 0 to 4) were observed. The prevalence of H. pylori in NUD was 84.29%. The lymphoid follicles were found in 138 patients(41.7%) and only 5 patients(l.5%) without H. pylori showed lymphoid follicles. There was strong a relationship between lymphoid follicles and degree of acute and chronic inflammation and intensity of H. pylori infection(P<0.001). Acute and chronic inflammation were more serious in the antrum than body in H. pylori infected patients. There was no relationship between lymphoid follicles and the site in the stomach of H. pylori infection(P<0.078), but the body portion had an increased frequency of lymphoid follicles compared to the in antrum. Our results indicate that the prevalence of H. pylori infection in Korea is higher than in Western people and the degree of acute and chronic inflammation are strongly correlated with the presence of lymphoid follicles. The lymphoid follicles are believed to be absent from the normal stomach and their presence is strongly associated with H. pylori infection. The fact there is an that increased frequency of lymphoid follicles in H. pylori infected patients, and that they are more prevalent in the body of the antrum, support the concept that H. pylori may be a precursor in the development of primary gastric lymphoma.
The Prognostic Significance of p53 Protein and PCNA in Advanced Gastric Carcinoma.
Ho Won Hwang, Hyung Bae Moon
Korean J Pathol. 1995;29(4):450-458.
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AbstractAbstract PDF
The 5 year-survival rates were examined to evaluate the prognositic significance of the expression of the p53 protein and the positivity of the PCNA in 108 cases of advanced gastric carcinoma. The p53 protein and PCNA were stained by immunohistochemistry in the tissue of the gastrectomized specimen. The results were as follows. 1) The overall 5 year-survival rate of advanced gastric carcinoma was 42.3 % and the significant prognostic factors were a pathologic stage and p53 protein(p<0.005). 2) The expanding or infiltrating type by Ming's classification and the intestinal or difftise type by Lauren's classification had similar prognosis. 514_ @@l %R-t 3) The 5 year-survival rate of the p53-positive group was 25.1% and that of p53-negative group was 56.1%(p<0.005). 4) The 5 year-survival rate of the PCNA low-grade tumors by PCNA stain(<50%)was 48.7% and that of the high-grade tumor(>=50%)was 29.9%(p>0.1). 5) There was a tendency to have a good prognosis in the p53-negative group and low grade tumors in the stage 11, III, and IV. There was a significant difference between p53 protein positive and negative groups in the stage III(p<0.005), but no significant differences were found in the other groups. The above results indicate that the p53 protein is an another useful tool for prediction of the prognosis in advanced gastric carcinoma.
An Immunohistochemical Study on the Expression of the Bauhinia Purpurea in the Reed-Sternberg Cells.
Yun Sin Kim, Mi Sook Lee, Ho Jong Jeon, Bong Nam Choi, Jong Hoon Jung, Choon Hae Chung, Chul Woo Kim
Korean J Pathol. 1995;29(4):459-468.
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AbstractAbstract PDF
The diagnosis of Hodgkin's disease is based on the morphologic identification of Reed-Sternberg (RS) cells and its variants in paraffin-embedded sections. The origin of RS cells remains a subject of controversy, and cells resembling RS cells are observed in some non-Hodgkin's lymphoma of T-cell lineage. In this study, eighteen cases of Hodgkin's disease (3 nodular sclerosis, 6 diffuse lymphocyte predominance, and 9 mixed cellularity) were studied with peanut agglutinin(PNA), anti-Leu-M1(CD15), LN2(CD74), Ber-H2(CD30) and bauhinia purpurea (BPA) by the avidin-biotin-peroxidase complex(ABC) method in paraffin-embedded sections. RS cells and their variants revealed positive reactions with one or more of the reagents in all examined cases. BPA staining was positive in 17 of 18 cases (94.4%), PNA staining was positive in 9 of 18 cases (50.0%), Leu MI was positive in 7 of 18 cases(38.9%), Ber-H2 was positive in 11 of 18 cases (61.1%), and LN2 was positive in 8 of 18 cases(44.4%). The staining properties of examined markers were recognized as paranuclear, diffuse cytoplasmic and cellular membranous patterns, but LN2 disclosed diffuse cytoplasmic staining in the positive cells. BPA also showed dense cytoplasmic staining reaction with macrophage-histiocytes. BPA reactivity was not affected by fortnalin fixation or paraffm embedding. Thirty six cases of non-Hodgkin's lymphomas(IO T-cell and 26 B-cell type) were also examined. The neoplastic cells of those cases did not stain positive with BPA, PNA, and Leu-Mi, but stained positively with LN2 in 3 cases of T-cell lymphomas and 14 cases of B-cell lymphomas, and BeT-H2 in T-cell lymphomas. In conclusion, to facilitate the detection of RS cells and related variants in paraffm sectionse of Hodgkin's disease, BPA can be used as a useful marker because of its high-detection rate, reproducible staining pattem, and resistance to fixative.
Expression of nm23 Protein in Breast Carcinoma: An immunohistochemical study.
Sang Yong Song, Je G Chi, Se Hwan Han, Kuk Jin Choe
Korean J Pathol. 1995;29(4):469-477.
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To elucidate a possible prognostic factor, we studied 91 cases of breast carcinoma for the expression of n-tn23 protein using an immunohistochemical method, and compared these results with the known prognostic parameters of the breast carcinoma. The mn23 protein was intensely stained in the cytoplasm and/or the nucleus of carcinoma cells in 82 cases(90.1%). There were two patterns of cytoplasmic staining; heterogeneous pattern and homogeneous pattern. Among the positive cases, 43 cases(47.2%) were heterogeneous while 39 cases(42.8%) were homogeneous. Axillary lymph node metastases(p<0.005) was found more frequently in the heterogeneous pattern group(79.0%) than in the homogeneous pattern group(41.0%). There was no significant correlation between nm23 protein expression and other parameters such as patient age, tumor size, estrogen receptor, histopathologic grade, and p53 overexpression. Although axillary lymph node metastasis was correlated with the disease free status(p<0.0005) and patient survival (p<0.05), they showed no correlation with nin23 expression. Multivariate analysis showed that axillary lymph node metastasis was the only prognostic indicator(p<0.05), and the expression of nm23 protein was of borderline significance. The results suggest that the homogeneous and/or granular cytoplasmic expression of mn23 protein plays a role in the suppression of nodal metastasis in breast carcinoma and might contribute in predicting patient survival.
Immunohistochemical Investigation on Expression of Hepatitis B Surface Antigen, Transforming Growth Factor-alpha, and Proliferating Cell Nuclear Antigen in Hepatocellular Carcinoma.
Bang Hur, Man Ha Hur
Korean J Pathol. 1995;29(4):478-491.
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In an attempt to evaluate the expression of hepatitis B surface antigen(HBs Ag), transforming growth factor-ct(TGF-alpha), and proliferating cell nuclear antigen(PCNA) in hepatocellular carcinoma(HCC), an immunohistochemical investigation(ABC method) was performed using 31 surgically resected HCCS. The authors examined the expression rate and patterns, histopathologic correlation, and inter-relationships among these expressions. The results were summarized as follows. 1) Among 25 seropositive HCCS, 15 cases showed tissue expression of HBs Ag(60.0%), being expressed as a predominantly cytoplasmic pattern. Its expression rate in low grade HCC was significantly high(76.9%), in contrast to a low rate in high grade HCC(41.7%)(P<0.05). Adjacent nonenoplatic tissue showed a higher expression rate(82.6%). 2) TGF-alpha was expressed in 23 of 31 cases of HCC(74.3%). The intensity and extent of its expression did not correlate tyros with histopathologic features. Bile duct epithelium, juxtaposed and/or entrapped liver cells, and cirrhotic nodules were variably expressed, of which intense peripheral reaction within the nodules was frequently noted. 3) PCNA was expressed throughout the neoplastic tissue of HCC. Its index was significantly high(34.4 13.6), being compared to low index index(3.5 2. 1) in the nonneoplastic tissue(P<0.005). High grade tumors revealed a higher index than the low grade tumors(P<0.05). Conclusively, this data confirms that PCNA index offers useful information about cell proliferation associated with histologic degrees of malignancy of HCC, albeit TGF-alpha is also involved in cellular proliferation of both liver cell and bile duct epithelium. Changes in incidence and cellular localization of HBs Ag expression between the neoplastic and nonneoplastic tissues suggest that an integrated viral genome could be functionally altered during hepatocarcinogenesis. A significant inter-relationship among these expressions was not observed.
A Histopathologic Studies for Endometrium of Early Pregnancy.
Mi Ja Lee, Kenn Hong Kee, Chae Hong Suh, Ho Jong Jeon
Korean J Pathol. 1995;29(4):492-501.
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Endometrium of early pregnancy were compared with nonpregnant endometnum by inimunohistochemical and ultrastructural techniques with respect to glandular and stromal elements of endometrium. The results obtained were as follows: 1. The AS cell in decidua has all the features of actively secreting glandular epithelium and shows the pronounced arrays of glandular endoplasmic reticulum and moderate numbers of ribosomes ultrastructually. Therefore the AS cell indicate considerable protein production, presumably contributing to both cell gowth and the production of secretions. 2. The process of decidualization can be characterized morphologically and immunohistochemically by the accumulation of basement membrane-like materials, such as laminin and type IV collagen which may be related to the hormonal stimulation occuring during pregnancy and trophoblastic attachment. 3. The decidual cells show strong positive for vimentin and some large mature decidual cells show weakly positive for lysozyme and cti- antitrypsin, which might represent more the sequential differentiation of stromal cells into decidual cells than origin of histiocytes. 4. Immunoreactivity with S-100 protein was found in glandular and stromal cells of decidua but negative in endometrium of nonpregnant women. So some humoral factors related to pregnancy stimulate expression of S-100 protein in glandular and stromal cells of decidua.
Detection of Human Papillomavirus DNA 16/18 in Cervical Adenocarcinomas by Polymerase Chain Reaction.
Sang Sook Lee, Nam Jo Park, Chong Guk Yoon
Korean J Pathol. 1995;29(4):502-510.
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AbstractAbstract PDF
Twenty-five paraffin-embedded tumor tissues were analyzed for detection of HPV 16 and 18 in cervical adenocarcinoma by polymerase chain reaction with type specific primers and by non-radioactive Southern blot hybridization for confirmation . The suitability of paraffin-embedded tissue as PCR material was confirmed by successful amplification of 100% of cervical specimens with human -globin specific primer. Eighty four percent of the cervical adenocarcinoma tissues were positive for HPV 16 and/or 18. HPV 16 positive rate was 68%, HPV 18 was 60%. The double infection with HPV 16 and 18 was found in 44%. Three cases of the negative specimen in PCR for each type of HPV DNA 16 and 18 were positive in Southern blot hybridization. The total positive rate was 92% for HPV 16 and/or HPV 18, HPV 16 positive rate was 80%. HPV 18 was 72%. The double infection with HPV 16 and 18 was 60%. These results suggest that the pattern of HPV types 16 and 18 is closely associated with carcinogenesis of cervical cancers. HPV type 18 appears to be preferentially related to cervical adenocarcinoma and the poor prognosis of these patients. Therefore, determination of HPV DNA type in cervical carcinoma patients is important in treatment and prognosis.
Large Cell Neuroendocrine Carcinoma of the Lung: Report of three cases.
Jai Hyang Go, Sun Ree Jung, Dong Hwan Shin, Woo Hee Jung
Korean J Pathol. 1995;29(4):511-516.
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We report three cases of neuroendocrine tumors of the lung characterized by large pleomorphic cell with frequent mitosis, which show neuroendocrine differentiation by both light microscopy or electron microscopy and iminunohistochemistry. These tumors have been categorized as large cell neuroendocrine carcinoma by Travis et al.(1991) in contrast with non-small cell lung cancer with neuroendocrine differentiation. In the latter, neuroendocrine differentiation is not evident by light microscopy and must be demonstrated by imunohistochemstry or by electron microscopy. The prognosis of large cell neuroendocrine carcinoma, together with non-small cell lung cancer with neuroendocrine differentiation, appears to be worse than cancer without neuroendocrine differentiation and intermediate between atypical carcinoid and small cell lung cancer. Larger numbers of patients will be needed to demonstrate significant differences in survival.
Case Reports
Nasal Cerebral Heterotopia-so called Nasal Glioma: A case report.
Tae Sook Kim, Je G Chi
Korean J Pathol. 1995;29(4):517-520.
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Encephalocele and nasal glioma are rare, benign congenital neuroectodennal tumors which result from a failure of embryologic sepearation of neuroectodermal and ectodemlal tissues. Nasal glioma should be differentiated from a true glioma, and from a primary encephalocele, which is a herniation of the cranial contents through a bony defect in the skull. For this reason, nasal cerebral heterotopia is a preferred term. We report an unusual case of a nasal mass that was histologically indistinguishable from nasal cerebral heterotopia but proved to be connected to the skull base by fibrotic cord. The patient was a 2 year old girl who had had a slow growing palpable mass in the left epicanthal area for three months.
Coexisting Adenocarcinoma and Epithelioid Leiomyosarcoma of Stomach: A case report.
Jung Youn Kim, Jae Soo Koh, Kyung Ja Cho, Ja June Jang
Korean J Pathol. 1995;29(4):521-523.
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We report a case of malignant tumor of the stomach showing both carcinoma and sarcoma components in a 47 year-old woman. The resected stomach revealed two tumors which were in different location. The one mass was a 2 x I cm, poorly demarcated tumor at the body, along the lesser curvature and the other was a 6 x 7 cm, well demarcated polypoid tumor with a central depression at cardia of the posterior stomach wall. The tumor at the body was a poorly differentiated adenocarcinoma which showed strong reactivity for CEA. The tumor at the cardia was composed of epithelioid or spindle shaped cells with abundant eosinophilic cytoplasm and revealed 5-6 mitoses per ten high power field. The tumor at the cardia was diagnosed as epithelioid leiomyosarcoma and showed reactivity for vimentin but none for actin, desmin,keratin, and CEA. This is different from the usual carcinosarcoma.
Non-Hodgkin's Malignant Lymphoma Arising in the Appendix: A case report.
Yun Sin Kim, Mi Sook Lee, Kwang Seok Lee Lee, Sung Chul Lim, Ho Jong Jeon
Korean J Pathol. 1995;29(4):524-526.
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AbstractAbstract PDF
Primary malignant lymphoma of the appendix is an unconnnon neoplasm although the gastrointestinal tract is the most common extranodal site of malignant lymphoma. We report a case of primary malignant lymphoma of the appendix in a 54-year-old male, who presented with pain in the right lower abdomen. An appendectomy was performed. The appendix measured 9.5 cm in length and 5.5 cm in diameter. Cut sections showed a solitary circumferential mass in the appendiceal lumen. Light microscopic features were compatible with malignant lymphoma of diffuse large cell type(Working Formulation) and the immunophenotype was B cell type.
Primary Teratocarcinoma of the Pineal Gland: A case report.
Kyoung Mee Kim, Eun Jung Lee, Ki Wha Yang, Anhi Lee, Sang In Shim, Sun Moo Kim
Korean J Pathol. 1995;29(4):527-529.
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AbstractAbstract PDF
Teratocarcinoma is a form of mixed germ cell tumor composed of a mixture of teratoma and embryonal carcinoma. It is rarely found in the brain, but when present it is most commonly found in the pineal region. We investigated a case of primary teratocarcinoma in the pineal region. The patient was a 10 year old boy who had suffered from a bitemporal headache for one month. Brain CT and MRI revealed a rather well defined ovoid heterogenous mass in the pineal gland region, measuring 4.3 x 3.8 x 3.0 cm in size. Microscopically the tumor contained areas of immature teratoma and embryonal carcinoma. Immunohistochemical staining revealed positive reactions for cytokeratin, epithelial membrane antigen, carcinoembryonic antigen, and alpha-fetoprotein in the embryonal carcinoma component.

JPTM : Journal of Pathology and Translational Medicine