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6 "Lithiasis"
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Original Article
Ultrastructural Changes in Human Gallbladder Epithelium in Acalculous and Calculous Cholecystitis.
Sung Chul Lim, Chae Hong Suh
Korean J Pathol. 1995;29(6):714-726.
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AbstractAbstract PDF
Cholelithiasis is defined as the presence of stones within the lumen of the gallbladder or in the extrahepatic biliary tree. Cholecystitis, secondary to gallstones, is a common surgical disorder in Korea. Detailed microscopic descriptions, particularly the ultrastructural changes, of these diseases were not available. The goal of this study was to identify the ultrastructural alterations of gallbladder epithelium in cholecystitis with and without a stone, according to the degree of severity of inflammation, and the nature of the stone. The gallbladders of the control group, and cholecystitis cases without stone and with stone were fixed and examined with routine stain, special stain, immunohistochemical stain and trans-mission electron microscopy. The number and the volume density of the mucin containing secretary granules were not significantly increased in the calculous cholecystitis cases compared with those of the acalculous cholecystitis cases. Major findings were that the calculous cholecystitis cases showed a markedly reduced total lysosome area and volume density of the lysosome compared with those of the acalculous chole-cystitis cases. The differences between the mucin secretary granules and lysosomes, according to the degree of severity of cholecystitis and the natures of gallstones, were statistically not significant.
Case Report
Ureteral Fibroepithelial Polyp: A report of four cases (One case with nephrogenic adenoma).
Won Mee Lee, Seung Sam Paik, Eun Kyung Hong, Moon Hyang Park, Jung Dal Lee
Korean J Pathol. 1996;30(8):715-720.
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AbstractAbstract PDF
Fibroepithelial polyps of the ureter are usually acquired rather than congenital. Most polyps are hamartomatous growths which tend to arise in the proximal portion of the left ureter. Most patients exibit either hematuria or persistent flank pain secondary to partial ureteral obstruction. Because of false positivity of urine cytology, as well as intravenous pyelogram, the correct diagnosis is confused with malignancy. Herein we report four cases of ureteral fibroepithelial polyp, which are associated with stones resulting in partial obstruction of the ureter. One of the four cases is associated with nephrogenic adenoma in the lamina propria of the adjacent ureter. The following report describes clinicopathologic findings of fibroepithelial polyp with review of literatures.
Original Article
The Observation of Histologic Changes of Major Intrahepatic Bile Duct Epithelium in the Resected Liver Tissue with Hepatolithiasis.
Woon Sup Han, Sae Kyung Choi, Sun Hee Sung
Korean J Pathol. 2001;35(1):20-25.
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AbstractAbstract PDF
BACKGROUND
The relationship between hepatoliths and cholangiocarcinoma is etiologically unclear. However, histogenetic sequencing with hyperplasia, dysplasia and carcinoma can occur in the bile ducts of hepatolithiasis.
METHODS
We studied 55 cases of hepatolithiasis and examined the specimens of resected liver tissue with a microscope. The growth patterns of bile duct epithelium were divided into four types: flat, tufting, micropapillary and papillary. The dysplasia was also divided into low-grade dysplasia (LGD) and high-grade dysplasia (HGD).
RESULTS
Of 55 cases of hepatolithiasis, 30 cases (54.6%) were of the flat pattern, 13 cases (23.6%) the micropapillary pattern, and 11 cases (20%) the tufting pattern. Epithelial hyperplasia was noted in only 36 cases (65.5%) in the large bile ducts, but dysplastic changes were found in 19 cases. Of 19 cases of dysplasia, LGD was present in 14 cases (25.5% of total 55 cases) an HGD in 5 cases (9% of total 55 cases). The epithelial hyperplasia showed histologic growth of the flat pattern in 29 cases out of 36 cases. But LGD (14 cases) had 6 cases of the tufting pattern and 7 cases of the micropapillary pattern. HGD (5 cases) revealed 4 cases of the micropapillary pattern with one case of the tufting pattern.
CONCLUSION
This study suggests that sequences of hyperplasia, low-grade dysplasia and high-grade dysplasia can play a role in the carcinogenesis of bile duct epithelium in hepatolithiasis with the histologic pattern changing from flat to micropapillary growth.
Case Reports
Epidermoid Cyst in the Kidney with Nephrolithiasis: A Case Report.
Changyoung Yoo, Yeong Jin Choi, Kyoyoung Lee, Sang In Shim, Chang Suk Kang
Korean J Pathol. 2005;39(5):348-350.
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AbstractAbstract PDF
Epidermoid cysts in the kidney have rarely been reported, and in most cases its pathogenesis has not been well understood. We report a case of an epidermoid cyst in a kidney with nephrolithiasis in a 61-year-old man. A pyelonephrolithotomy was performed on the patient four years ago to treat nephrolithiasis of the left kidney. During the follow-up, a newly developed mass was discovered three years ago and the mass has recently increased in size. A unilateral nephrectomy was performed under the clinical impression of renal cell carcinoma. Gross examination revealed a well encapsulated cystic mass measuring 3.0 x 2.0 x 2.0 cm and containing lumps of soft whitish material, in the upper pole of the left kidney. This location was the same as that of previous nephrolithiasis. Microscopic examination revealed typical findings of an epidermoid cyst. We suspect that the chronic irritation induced by renal stones may be associated with the development of the epidermoid cyst in this case.
Actinomycosis of the Intrahepatic Bile Duct, Superimposed on Hepatolithiasis: A Case Report.
Ji Han Jung, Hyun Joo Choi, Jinyoung Yoo, Seok Jin Kang, Chang Suk Kang
Korean J Pathol. 2005;39(2):140-144.
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AbstractAbstract PDF
Actinomycosis is a chronic suppurative infection caused by Actinomyces, a filamentous, grampositive, anaerobic bacterium that is a normal inhabitant of the oral cavity and gastrointestinal tract. Actinomycosis of the biliary duct is very rare and the pathogenesis of this infection is poorly understood. We report here on a case of actinomycosis in the intrahepatic bile duct that was superimposed on hepatolithiasis. A 55-year-old woman presented with epigastric discomfort and episodic upper abdominal pain for 1 year. The radiologic findings revealed multiple hepatolithiasis and cholelithiasis. On performing left lateral segmentectomy of the liver, the markedly dilated intrahepatic bile duct contained several brown pigmented stones, and periductal chronic inflammation with fibrosis and proliferation of the bile ductules were observed. In addition to the intrahepatic stones, there were sulfur granules with neutrophilic infiltration and necrotic debris. The gram stain and methenamine silver stain revealed tangled filamentous and branching bacteria, which were consistent with Actinomyces. Acid-fast staining result was negative and no malignancy was detected.
Primary Oxalosis: A case report.
Sang Yong Song, Je G Chi, Yong Choi, Sang Jun Kim
Korean J Pathol. 1993;27(5):509-513.
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AbstractAbstract PDF
Primary oxalosis is a rare genetic disorder caused by a deficiency of the peroxisomal enzyme alanine-glyoxylate aminotransferase(type I) and D-glyceric dehydrogenase(type II). It is characterized by the triad of radiopaque urolithiasis, nephrocalcinosis, and latered renal function. We report a case of primary oxalosis in a 10-year-old Korean girl. She presented with chronic renal failure at 9 years of age. Ultrasonographic examination revealed bilateral, multiple renal and ureteral stones. Removed stones were chemically analysed to be composed of calcium oxalate. She underwent renal transplantation after prolonged period of dialysis. Removed kidneys were firm and gritty. Cut sections showed numerous tiny yellow sandy stones and a large staghorn stone. Specimen X-ray also exhibited disseminated fine granular and often coalescent radiopaque materials throughout the cortex and medulla. Microscopically numerous varying-sized crystals were noted in the kidney in globular or rhomboid appearance. The crystals were semitranslucent and doubly refractile under the polarized light. Diffuse interstitial fibrosis and chronic inflammation as well as glomerular obsolescence were also noted. The oxalate deposit was diffuse and marked, and was thought to be intimately related to the parenchymal damage and fibrosis.

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