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Volume 32(11); November 1998
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Original Articles
Flush Perfusion, Preservation and Reperfusion Effects in Lung Transplantation: Light Microscopic and Ultrastructural Study.
Kun Young Kwon, Young Keun Lim, Jae Hoon Bae, Chang Kwon Park
Korean J Pathol. 1998;32(11):967-977.
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AbstractAbstract
This study was undertaken to investigate the morphologic changes following flushing, preservation and reperfusion procedures in a canine lung allotransplantation model. Donor lungs were flushed with modified Euro-Collins (MEC) solution, low potassium dextran glucose (LPDG) solution or University of Wisconsin (UW) solution, then stored at 10oC for 20 hours. Light microscopic and electron microscopic features of the lungs were examined after flushing, preservation and 2 hours after reperfusion. After flushing light microscopy showed focal mild alveolar collapse and interstitial edema. After preservation the lung tissue showed multiple foci of alveolar collapse, consolidation, and alveolar epithelial cell damage. After reperfusion the lung tissue showed diffuse alveolar collapse, consolidation and many destroyed cellular debris in the alveolar lumina. After flushing electron microscopy showed focal alveolar collapse and mild swelling of type I epithelial cells. After preservation both type I epithelial cells and endothelial cells were swollen and destroyed focally. Some type I epithelial cells were detached from the basal lamina. The endothelial cells showed luminal protrusion of tactile-like structure and vacuoles of the cytoplasm. After reperfusion the lung tissue showed fibrin material in the alveoli, prominent type I epithelial cell swelling with fragmented cytoplasmic debris and marked endothelial cell swelling with vacuoles or tactile-like projections. The alveolar macrophages showed active phagocytosis. After preservation scanning electron microscopic examination of the pulmonary arteries showed multiple patchy areas of swelling or conglomerated lesions in the inner surface of the pulmonary arteries. In conclusion, the ultrastructural changes associated with flushing were mild in severity, the donor lungs were injured during the preservation, and further damage occurred during the reperfusion.
Expression of bcl-2 and p53 Protein in Primary Gastric Lymphomas.
Young Rok Cho, Yu Na Kang, Sang Sook Lee, Hong Suk Song, Soo Sang Sohn, Dong Sug Kim
Korean J Pathol. 1998;32(11):978-984.
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AbstractAbstract
The bcl-2 gene is a proto-oncogene which extends cell survival by blocking apoptosis. Bcl-2 expression has been detected in many types of nodal and MALT lymphoma. The p53 gene is a tumor suppressor gene and p53 mutation is the most common genetic alteration in human malignancies. The relationship between the expression of bcl-2 and p53 protein in primary gastric lymphoma has been rarely reported. The authors investigated the expression of bcl-2 and p53 protein in 37 cases of primary gastric lymphoma by immunohistochemical method using bcl-2 and p53 monoclonal antibodies. There were five cases of low grade B-cell MALT lymphomas and thirty two cases of high grade B-cell lymphomas. Fifteen of 37 cases (41%) showed bcl-2 protein expression in the cytoplasm of tumor cells and 26 cases (70%) showed p53 protein expression in the nucleus of tumor cells. Bcl-2 protein was detected in 4 of 5 (80%) low grade MALT lymphomas, and in 11 of 32 (34%) high grade lymphomas. There was no significant correlation between bcl-2 expression and histologic grade of primary gastric lymphomas (p>0.05). p53 protein was positive in 25 of 32 (78%) high grade lymphomas, and in 1 of 5 (20%) low grade MALT lymphomas. The expression of p53 protein is significantly higher in high grade lymphoma than in low grade MALT lymphoma (p<0.05). The p53 expression in the bcl-2 negative cases (86%) was significantly higher than in the bcl-2 positive cases (47%). There was an inverse relationship between bcl-2 and p53 expression in primary gastric lymphoma. These results suggest that bcl-2 and p53 expression in primary gastric lymphoma may be involved in the transition from low grade MALT lymphoma to high grade lymphoma.
Immunohistochemical Characteristics of Biliary Tract Carcinoma and Its Precancerous Lesions.
Jiyoung Kim, Youngnyun Park, Hogeun Kim
Korean J Pathol. 1998;32(11):985-992.
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AbstractAbstract
Carcinomas of the biliary tract are known to be more common in East Asia than in Western countries, but their exact histopathological characteristics and tumorigenesis are not well elucidated. To examine the histological and immunohistochemical characteristics of the biliary tract carcinomas according to their anatomical sites and to elucidate their tumorigenesis, we performed histological review and immunohistochemical study in a total of 135 cases of biliary tract carcinomas; 24 intrahepatic bile duct, 34 gallbladder, 51 common bile duct, and 26 periampullary carcinomas. Precancerous lesions were associated with 5 (20.8%) cases of intrahepatic duct carcinomas (dysplasia 5), 7 (20.6%) cases of gallbladder carcinomas (adenoma 5, dysplasia 2), 10 (19.6%) cases of common bile duct carcinomas (adenoma 7, dysplasia 3), and 2(7.7%)cases of periampullary carcinomas (adenoma 2). Immunohistochemically, c-erbB-2 expression in gallbladder carcinoma (21/34, 62%) was significantly higher than that of intrahepatic (8/24, 33%). Ki-67 indices were higher in common bile duct carcinomas (19%) than those of intrahepatic bile duct (14%) or periampullary carcinomas (12%). Overexpression of p53 gene product in the periampullary carcinomas (20/22, 77%) was higher than that of intrahepatic (12/24, 50%) or common bile duct carcinoma (26/51, 51%). In the precancerous lesions the c-erbB-2 expression was present in 29% of the gallbladder, 20% of the intrahepatic, 10% of the common bile duct precancerous lesions and none of the 2 cases of adenomas in the periampullary region. The p53 overexpression in the precancerous lesions was frequent, ranging from 43% to 60%. These results suggest that a mechanism involving p53 gene mutation and c-erbB-2 gene activation is present in the tumorigenesis in a significant number of the biliary tract carcinomas and they may be the early events in the tumorigenesis of the biliary tract carcinomas.
Flow Cytometric DNA Content Analysis in Breast Cancer Comparison study of fresh and paraffin-embedded tissues.
Jin Ye Yoo, Hye Jae Cho
Korean J Pathol. 1998;32(11):993-999.
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AbstractAbstract
DNA content of 25 cases of breast carcinoma was analyzed by flow cytometry in both fresh and formalin-fixed, paraffin-embedded tissue. Aneuploidy in fresh tissue and paraffin-embedded tissues was 72% and 32%, respectively. There was a 52% agreement in analysis of DNA ploidy between fresh and paraffin-embedded tissues. Most of the discrepancies resulted from loss of aneuploid peaks on the histograms of paraffin-embedded tissue. Mean S-phase fraction was slightly higher in a paraffin-embedded tissue than that in the fresh tissue; 19.2 9.1% versus 16.1 8.8% and there was no significant correlation between the S-phase fractions. In statistical analysis, the histologic and nuclear grades were not correlated with ploidy or mean S-phase fraction. Therefore it is strongly recommended to use the fresh tissue in flow cytometric DNA content analysis of breast cancer.
Prognostic Significance of the Tall Cell Variant of Papillary Thyroid Carcinoma: Expression of p53, bcl-2 & Leu-M1 proteins.
Won Mi Lee, Joo Seob Keum, Eun Kyung Hong, Moon Hyang Park, Jung Dal Lee
Korean J Pathol. 1998;32(11):1000-1007.
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AbstractAbstract
Papillary carcinoma of the thyroid is a well differentiated neoplasm and usually has a good prognosis. However, a subset of morphologically distinct papillary carcinoma has bad prognoses. The tall cell variant of papillary carcinoma (TCPC), characterized by tall columnar cells with a height at least twice the width, is the one of these. In order to differentiate TCPC from usual papillary carcinoma (UPC) in terms of prognosis, we performed immunohistochemical studies for the expression of p53, bcl-2 and Leu-M1 proteins in 25 cases of TCPC, 26 cases of UPC and 14 cases of poorly differentiated, solid type papillary carcinoma (SPC) with an analysis of clinical parameters. The nuclear expression of p53 was noted in one case each of UPC and TCPC. The cytoplasmic p53 expression of TCPC, UPC, and SPC was observed in 17/25 cases (68%), 14/26 cases (54%), 3/14 cases (21%), respectively. bcl-2 expression was 19/25 cases (76%), 18/26 cases (69%), 5/14 cases (36%), and that of Leu-M1 was 21/25 cases (84%), 18/26 cases (69%), 4/14 cases(29%), respectively. There were no statistical significance in the expression of those immunoproteins among these three groups (p>0.05). The p53 protein was consistently expressed in the cytoplasm rather than nucleus in this study and was very well correlated to bcl-2 positivity (p<0.01). There were no statistical significance in any clinical parameters examined among these three groups (p>0.05). In conclusion, TCPC can not be separated from UPC as a distinct entity in this study and the cytoplasmic expression of p53 protein provides another mechanism of p53 inactivation in tumorigenesis of the thyroid papillary carcinoma, possibly by bcl-2 related mechanism.
The Diagnostic Significance of AgNORs and MIB-1 Labelling Index in Atypical Meningioma.
Dae Hong Suh, Dong Sug Kim, Oh Lyong Kim
Korean J Pathol. 1998;32(11):1008-1014.
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AbstractAbstract
There is no definite histological criteria which can predict the biologic behavior of meningiomas, although resectability is the most important factor in terms of recurrence. For grading meningiomas, various factors have been studied, such as hypercellularity, nuclear pleomorphism, small cells with high N/C ratio, prominent nucleoli (PN), frequent mitosis, loss of architecture, focal necrosis (FN). We investigated 116 meningiomas to evaluate the correlation between the factors and the proliferative activity using AgNORs and MIB-1 labelling index (LI). They were divided into 3 groups: Group A includes meningiomas with none of the factors; group B with one of the factors; group C with two or more factors. MIB-1 LI was correlated with each factor, but AgNORs was not. There was a statistical difference among group A (<1.28%), B (2.7%) and C (5.1%) (p<0.05) using MIB-1 LI. FN was the most frequently associated with other factors, and it had the highest MIB-1 LI (6.31%). MIB-1 LI of group B was 5.1 2.3%. In group B, the most frequent combination was FN and PN, and it showed the highest MIB-1 LI (5.74%). This study indicates that FN and PN are important for diagnosis of atypical meningioma, and MIB-1 LI appears to be a useful method for estimating the proliferative activity of meningiomas, and 5% or more of MIB-1 LI could help in making a diagnosis of atypical meningioma.
Immunohistochemical Expression of p53 Protein, Estrogen and Progesterone Receptor in Soft Tissue Leiomyosarcoma and Its Significance.
Byung Heon Kim
Korean J Pathol. 1998;32(11):1015-1024.
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AbstractAbstract
This study was carried out to evaluate the expressions of the p53 protein, the estrogen receptor (ER) and the progesterone receptor (PR), as well as the relationship between their expressions and clinicopathologic prognostic factors with storage duration of a paraffin block, and correlation between the p53 protein, the ER and the PR expressions in 29 cases of leiomyosarcoma of soft tissue. The expressions of the p53 protein, the ER and the PR were semiquantiatively analyzed in paraffin sections by the immunohistochemical method out of 29 cases the p53 protein, ER and PR were expressed in 9 (31.0%), 2 (6.9%) and 5 (17.2%), respectively. The expression of the p53 protein was not significantly associated with sex, age, anatomic site, tumor size, tumor depth, histological differentiation or mitotic rate (p>0.05), but statistically correlated to storage duration of a paraffin block (p=0.028). There was no significant relationship between the expression of the ER and all the clinocopathological prognostic factors with storage duration of a paraffin block (p>0.05). The expression of the PR was related to the histological differentiation (p=0.02), but not related to other clinicopathological prognostic parameters and storage duration of a paraffin block (p>0.05). The expression of the p53 protein and the PR had a significant relationship (p=0.022), but the expression of the p53 protein and the ER had no significant correlation. In conclusion, these results suggest that the expression of the p53 protein and the PR may play a role in development and growth of soft tissue leiomyosarcoma. Further studies of large numbers are needed to clarify the exact relationship between tumorigenesis and the p53 and the PR expressions in leiomyosarcoma of soft tissue.
Case Reports
A Pancreatic Cyst of the Anterior Mediastinum.
Kye Weon Kwon, Kyung Young Jung, Woo Ick Yang
Korean J Pathol. 1998;32(11):1025-1027.
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AbstractAbstract
Although heterotopia of pancreatic tissue is a developmental anomaly found in approximately 2% of all autopsies, pancreatic tissue within the thorax and mediastinum is uncommon. In most of these instances, the pancreatic tissue is a component of gastroenteric duplication cysts, intralobar pulmonary sequestrations or teratomas. We describe an anterior mediastinal cyst consisting entirely of pancreatic tissue. A previously healthy 27-year-old woman was admitted due to chest pain during deep inspiration. The computed tomographic scan of the thorax showed a large cyst occupying the right anterior mediastinum. The excised multilocular cystic lesion measured 12 cm in maximum diameter and contained a brown, turbid fluid. The wall was fibrotic and showed a haphazard mixture of ducts and exocrine acini without islets. The histogenesis of this lesion is unclear.
Soft Tissue Perineurioma.
Yoon La Choi, Dae Soo Kim, Jai Hyang Go, Yeon Lim Suh
Korean J Pathol. 1998;32(11):1028-1031.
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AbstractAbstract
Perineurial cells, which normally surround the nerve fascicles within a nerve, can be distinguished from Schwann cells by their immunoreactivity for epithelial membrane antigen (EMA) and lack of reactivity for S-100 protein. Perineurioma is a form of benign peripheral nerve sheath tumor (PNST) almost exclusively composed of perineurial cells. It is often difficult to differentiate this tumor from the other benign PNSTs or ectopic meningioma by histology alone. Immunohistochemical and electron microscopic studies are helpful for differential diagnosis. We recently experienced a case of soft tissue perineurioma in a 14-year-old girl. This tumor was presented as a 5.6 cm sized subcutaneous movable mass in the elbow. The well encapsulated soft tissue tumor consisted of spindle cells which have whorling and storiform patterns within the collagenous stroma. The spindle cells were stained positive for EMA but negative for S-100 protein, chromogranin, neuron-specific enolase or Leu-7. Ultrastructurally, they possessed long cytoplasmic processes with incomplete basal lamina, primitive intercellular junction and occasional pinocytotic vesicles.
Serratia marcescens Skin Abscess.
Chan Kwon Jung, Young Shin Kim, Kyo Young Lee, Kyungja Han, Chang Suk Kang, Sang In Shim, Jun Young Lee, Baik Kee Cho
Korean J Pathol. 1998;32(11):1032-1034.
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AbstractAbstract
Serratia marcescens is the most important member of the genus Serratia and causes opportunistic infections, particularly pneumonia and septicemia in patients with malignancy, renal failure (acute and chronic), and diabetes mellitus. The most common portals of entry are known to be, in descending order, lung, genitourinary tract, intravenous line, gastrointestinal tract, and skin. S. marcescens rarely causes skin infection because it does not normally colonize human skin. Only six cases of S. marcescens cellulitis were reported. Five of them were immunocompromised patients. We have experienced a case of skin abscess caused by S. marcescens, which was found in a 59-year-old woman. She was undergoing prior antibiotic treatment after insulinoma surgery. S. marcescens was isolated from the skin abscess as a sole organism. She was treated with appropriate antibiotics that exhibited sensitivities for the organism and cured without any complication. The authors report a case of S. marcescens infection on the skin of a 59-year-old woman and review the literature concerning this organism as a causative agent.
Bronchus-Associated Lymphoid Tissue Lymphoma.
Yoon Ju Kim, Sung Sook Paeng, Hee Jin Chang, Jung Il Suh
Korean J Pathol. 1998;32(11):1035-1038.
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AbstractAbstract
Malignant lymphoma arising from mucosa-associated lymphoid tissue (MALT) represents distinct clinicopathologic features and remains localized for prolonged periods. We report a case of low grade B cell lymphoma of bronchus-associated lymphoid tissue (BALT). A 60-year-old female had a long-standing cough, sputum and intermittent fever for 10 years. In 1984, the chest radiography showed increased hazy density in both upper lungs. Although she had been treated by antituberculous medication under clinical diagnosis, there was no improvement. In 1995, open lung biopsy was carried out. Histologically, it showed massive nodular or diffuse infiltration of centrocyte-like cells in bronchus and parenchyme with pleural invasion. On immunohistochemical stain, they were positive for LN-2 and L26 and negative for UCHL-1, LN-1 and LN-3. In polymerase chain reaction (PCR), Ig heavy chain gene rearrangement was detected. The patient was well for 6 months after the biopsy.
Heterotopic Brain Tissue in the Soft Palate.
Hyun Joo Choi, Youn Soo Lee, Young Shin Kim, Kyo Young Kim, Chang Suk Kang, Sang In Shim
Korean J Pathol. 1998;32(11):1039-1041.
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AbstractAbstract
Heterotopic brain tissue is a developmental anomaly of neurogenic origin with no malignant potential, and is usually present around the nose of children and infants. So it has been called nasal glioma. But, even more rarely, heterotopic glial tissue may be found in various sites other than nasal cavity, such as the ethmoidal sinus, palate, tonsillar area, pharynx, ear, subcutaneous tissue, lung, and female genital tract. We experienced a more unusual case of a polypoid heterotopic brain tissue in the soft palate in a 3-year-old boy. The mass was microscopically reminiscent of "gliosis" of the central nervous system and interestingly contained choroid plexus focally. The glial nature of the lesion was confirmed by glial fibrillary acidic protein immunostain.

JPTM : Journal of Pathology and Translational Medicine