Journal of Pathology and Translational Medicine

Case Report

Carcinoid Tumor Arising in a Horseshoe Kidney: A case report.: Yoo Jin Kim, Bang Hur, Man Ha Hur; Korean J Pathol. 1996;30(12):1129-1137.

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Abstract PDF: Primary carcinoid tumor of the kidney is extremely rare ; only 29 previous reports have been described in the world literature, 3 cases of which were known to arise in horseshoe kidneys. Because of the scarcity of primary renal carcinoid tumor, its clinicopathologic features and prognosis are not well characterized, and its histogenesis is unknown. We present a case of primary carcinoid tumor arising in the horseshoe kidney of a 43-year-old man. The lesion is morphologically identical to those of gastrointestinal or respiratory tracts. In addition, this tumor contains clusters of intestinal epithelium with goblet cells and mature bony trabeculae. The cytoplasm of the tumor cells are immunoreactive for keratin, NSE, and synaptophysin, but are negative with Grimelius and Fontana-Masson stains. Membrane-bound cytoplasmic neurosecretory granules are observed by electron microscopic examination. This is the first case of primary renal carcinoid tumor arising in a horseshoe kidney documented in Korea. We describe the gross features, light and electron microscopic, and immunohistochemical findings of renal carcinoid and review the literature, with speculations on the possible histogenesis of this unusual neoplasm.

Original Article

Morphologic Comparisons of Focal Segmental Glomerulo-sclerosis between Human and 5/6 Nephrectomy Rat Model.: Yong Jin Kim, Yong Sun Kim, Chae Hong Suh; Korean J Pathol. 1997;31(2):100-111.

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Abstract PDF: This study was conducted to set up a common mechanism for varying phases of focal segmental glomerulosclerosis(FSGS) by comparing the morphological differences between human FSGS and changes in 5/6 renal ablation animal model, which has been accepted as experimental prototype for hyperfiltration theory as pathogenesis of FSGS. Both the human and the experimental rats showed very similar changes such as segmental glomerulosclerosis, vacuole formations or inclusion of small granules of podocytes, appearance of foamy cells in the capillary lumina, eosinophilic deposits along the mesangial area, and focal atrophy of tubules with associated interstitial fibrosis. The halo, frequently seen in human FSGS, is due to detachment of visceral epithelium from basement membrane, however, did not appear in the experimental rat specimen. On the other hand, the foamy cells and hyalinization were more frequently noted in the rat series and even involved the arterioles. The mesangial proliferation never appeared in the rat series occasionally found in human FSGS. In conclusion, the pathogenesis of FSGS cannot depend solely on the hyperfiltration theory of hemodynamic derangement, but has complex impairment of visceral epithelium and cells forming the constituents of basement membrane.

Case Report

Menetrier's Disease Report of two cases.: Joo Heon Kim, Dong Geun Lee, Sang Woo Juhng; Korean J Pathol. 1998;32(2):142-146.

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Abstract PDF: Menetrier's disease is characterized by enlarged gastric folds with foveolar hyperplasia and cystic dilatation of gastric glands. The additional biochemical features of hypoproteinemia, hypochlorhydria, and increased gastric mucus are often encountered. The pathogenesis and etiologic factors have not been clearly defined. In this report, we present two cases of Menetrier's disease in the stomach, one occurring in a 38-year-old male, associated with massive hematemesis, and the other in a 39-year-old male. Grossly, both cases showed marked giant gastric rugal folds resembling cerebral convolutions, sparing the antral portion. Microscopically, the giant gastric rugal folds consisted of the striking foveolar hyperplasia accompanied by an occasional presence of the smooth muscle fibers from the muscularis mucosa. The immunohistochemical stain revealed an intense positive reaction for transforming growth factor-alpha (TGF-alpha) and epidermal growth factor receptor (EGF-R) in the majority of mucous cells throughout the gastric mucosa and parietal cells, but did not reveal for epidermal growth factor (EGF). We suggested that TGF-alpha and EGF-R might be involved in the pathogenesis of Menetrier's disese.

Original Articles

Expression Pattern of Smad Proteins in Diffuse Large B-cell Lymphomas.: Jai Hyang Go; Korean J Pathol. 2004;38(5):301-305.

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Abstract PDF: BACKGROUND
Smad proteins mediate the cellular signaling from members of transforming growth factor-beta family (TGF-beta s). Smads 2 and 3 transmit signals from TGF-beta and activin, and Smads 1, 5, and 8 transmit signals from the bone morphogenetic protein. Smad4 is known to be a common mediator of both pathways, yet little is known about the expression pattern of Smad proteins in normal lymphoid tissue and malignant lymphoma.
METHODS
Immunohistochemistry was performed for Smad3 and Smad4 on the paraffin-embedded tissue sections from 32 cases of diffuse large B-cell lymphomas.
RESULTS
In reactive lymphoid tissue, nearly all cells of the germinal centers were positive for Smad3 and more than 50% of paracortical cells were positive for Smad3. For Smad4 immunostaining, nearly all cells of the germinal centers showed diffuse cytoplasmic staining, and most of them revealed nuclear positivity as well. Most of the cells in the paracortex regions were positive for Smad4. For the malignant lymphomas, all the cases were positive for Smad3, but 26 cases were positive for Smad4 and 6 cases (19%) were negative for Smad4.
CONCLUSIONS
These results suggest that TGF-beta-specific Smads may be actively involved for signal transduction in lymphoid organs, and the TGF-beta signaling pathway through Smads is operative in malignant lymphoma. The loss of Smad4 expression might be associated with development of some diffuse large B-cell lymphomas.

Clinical and Histopathologic Study of Eosinophilic Cellulitis.: Eun Kyung Kim, Chan Keum Park, Jung Dal Lee; Korean J Pathol. 1995;29(3):334-342.

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Abstract PDF: Eosinophilic cellulitis is a rare dermatosis originally described by Wells as "recurrent granulomatous dermatitis with eosinophilia", then called Wells' syndrome. The etiology is unknown, although a hypersensitivity mechanism is suspected. Flame figures are considered as a characteristic histologic feature of Wells' syndrome. To clarify the nature of eosinophilic cellulitis and its flame figures, the authors have reviewed five cases of eosinophilic cellulitis with its clinical and histopathologic findings. Cutaneous lesions were variable in appearance and was confused with angioedema, urticarial vasculitis, erydiema multiforme, morphea or granuloma annulare. Microscopically, early lesions (2-7 days) showed diffuse dermal eosinophilic infiltration with widespread degranulation, sometimes extended into the underlying muscle. Subepidermal bulla was present in one case. Subsequently, granulomatous features with characteristic "flame figures" became apparent (several months). Collagen alteration by eosinophilic granules resulted in flame figure formation and a granulomatous response. In two patients, there were possible relationships between drug and flare-ups of eosinophilic cellulitis, but the others, no contributory precipitating factors were found. We think that eosinophilic cellulitis represents a severe anaphylactic hypersensitivity reaction to various stimuli showing characteristic histopathology with recurrent episodes and frequent hypereosinophilia in the peripheral blood.

Case Reports

Limb-Body Wall Malformation Complex: Two autopsy cases and its pathogenesis.: Geun Shin Lyu, Nam Hoon Kim, Eun Kyung Hong, Jung Dal Lee; Korean J Pathol. 1993;27(6):638-644.

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Abstract PDF: Limb-body wall malformation complex(LBWC), also know as the amniotic band syndrome, is a poorly defined, sporadic group of congenital anomaly characterized by a collection of protean fetal malformation, deformation and disruption. Accurate diagnosis is often difficult because of its variable presentation pattern and the absence of exactly same case. We report two autopsy cases. One revealed body wall, cardiac, and craniofacial anomalies with anencephaly, and amniotic adhesive band attached to craniofacial defect of the fetal part without evidence of amniotic rupture. The other exibited abdominal wall defect with omphalocele, visceral, postural, and limb anomalies together with neural tube defect in the lumbosacral region. The pathogenesis of this syndrome was discussed in detail.

Hamartoma Arising in the Urinary Bladder: A case report.: Young Bae Kim, Tae Sook Hwang, Byung Gon Park, Jin Sook Jeong, Sook Hee Hong; Korean J Pathol. 1993;27(3):283-286.

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Abstract PDF: Hamartoma of the bladder is quite a rare entity which is composed of a disorderly admixture of mature cellular elements normally present in the urinary bladder. There is a great controversy regarding the pathogenesis of this lesion. Whether it is a true hamartomatous lesion or metaplastic lesion developed secondary to the inflammatory process. Similar or identical lesions has often been given by other names such as florid examples of cystitis glandularis. We prefer to cell florid examples of cystitis glandularis rather than hamartoma when it was occurred in an old age higher then 50th decade. Here we report a case of hamartoma of the urinary bladder in 44 years old man. Cystoscopic examination revealed a papillary polypoid mass which was attached to the fundus of bladder by long stalk. The mass measured 1.5 cm in greatest diameter. It was composed of epithelial nests resembling von Brunn's nest, cystitis glandularis or cystitis cystica dispersed in a stroma rich in smooth muscle and fibrous tissue.

Original Articles

Nesidioblastosis of the Pancreas.: Young Bae Kim, Jin Sook Jeong, Ahn Hong Choi; Korean J Pathol. 1992;26(5):484-489.

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Abstract PDF: The morphologic abnormalities of the endocrine pancreas that underlie persistent neonatal hyperinsulinemic hypoglycemia and are included under the heading "nesidioblastosis" appears to be heterogeneous. This characteristic morphologic finding is ductuloinsular complexes showing endocrine cells budding off the ductoepithelium and merging with adjacent endocrine cell clusters. A case of nesidioblastosis associated with hyperinsulinemic hypoglycemia occurred in a 6/365 year-old male neonate. Microscopic finding of near totally resected pancreas revealed irregular sized islets and ductuloinsular complexes, both of which contained hypertrophied B cells with a few mitosis. Because of persistent hypoglycemia after first operation, he received second operation 8 days after. This histologic finding was more severe comparative to that of first operation. According to these findings, the pathogenesis of nesidioblastosis may be congenital or developmental defect of a kind of compensatory mechanism by unknown stimuli to acquire persistent hypoglycemia.

Study on Histopathologic Changes of Suckling Rats Inoculated with Hantaan Virus.: Hye Je Cho, Luck Ju Paek, Ho Wang Lee, Eui Keun Ham; Korean J Pathol. 1991;25(3):223-237.

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Abstract PDF: Hantaan and related viruses have been implicated as causative agents for a diverse group of human diseases known collectively as "hemorrhagic fevers with renal syndrome" (HFRS). Outbred SD rats obtained within 24 hours after birth were inoculated by intracerebral (the first group) or intramuscular routes (the second group) with 10(9.5)/ml DL50 of Hantaan seed virus suspension in 0.02 ml and 0.1 ml, respectively. Brain, lung, liver, kidney and spleen were used for virus antigen detection by immunofluorecence and histopathologic examination. In the first group, immunofluorescent intensity of virus antigen was increased in all organs (especially brain) and persisted until time of death(day 9). The histopathologic changes were relatively mild in brain and spleen and unremarkable in liver, lung and kidney. In the second group, immunofluorescent intensity of virus antigen was markedly increased in brain until time of death(day 17), but decreased in other organs. The histopathologic findings, such as meningoencephalitis, interstitial pneumonitis with focal hemorrhage, and lymphoid hyperplasia of splenic white pulp were much prominent compared to the first group. However, those of liver and kidney were unremarkable. The chronology of virologic and pathologic findings in Hantaan-infected suckling rats suggests a possible immune-mediated mechanism in disease pathogenesis.

An Experimental Study of Pathogenesis of Duodenal Ulceration Produced by Mepirizole.: Myung Jae Kang, Jae Ryong Jung, Hye Soo Lee, Sang Ho Kim; Korean J Pathol. 1988;22(4):383-392.

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Abstract PDF: To investigate the pathogenesis of the duodenal ulceration produced by mepirizole (1-(4-methoxy-6-methyl-2-pyrimidinyl)-3-methyl-5-methoxypyrazole) in rat, the effects of various concentraion and sorts of antiulcer drugs and truncal vagotomy on the mepirizole (200 mg/kg of body weight) induced duodenal ulcers were observed morphologically, and after mepirizole administration (200 mg/kg), amount and acidity of gastric jucie were measured sequently. The results were as follows: 1) In the control group of fasting for 24 hours after mepirizole administration only, duodenal ulcers were developed in all animals with 21.5+/-5.8 mm2 of ulcer index, perforation rate was 15%, and mortality rate was 0%. But lesions of the stomach were hemorrhagic and erosive with erosion index of 3.8+/-1.6 mm2. 2) The antiulcer drugs were significantly inhibited duodenal ulceration and gastric erosion produced by mepirizole although the inhibition effects were different. 3) After truncal vagotomy, duodenal ulcer and gastric erosion induced by mepirizole were also significantly inhibited. 4) On the gastric analysis, decrease of amount, increase of acidity, and decrease of concentration of gastric juice were observed after administration of mepirizole compared with nontreated normal group. Above findings suggest that the pathogenesis of the duodenal ulceration by mepirizole is the action of gastric acid on the duodenal mucosa with breakdown of defence mechanisms of the duodenum.

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