Journal of Pathology and Translational Medicine

Brief Case Report

A Case of Epithelioid Blue Nevus: Chung Hun Lee, Hye Sook Min, Eon Sub Park, Kye Yong Song; Korean J Pathol. 2014;48(6):434-437. Published online December 31, 2014; DOI: https://doi.org/10.4132/KoreanJPathol.2014.48.6.434

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Dilshad Sachedina, Marisa Taylor
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Original Article

Calcifying Synovial Sarcoma.: Nam Bok Cho, Tae Jin Lee, Mi Kyung Kim, Yong Wook Park, Kye Yong Song; Korean J Pathol. 1995;29(4):536-539.

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Abstract PDF: A case of calcifying synovial sarcoma, occuring in the deep muscle fascia of the left thigh is reported. The presence of extensive calcification in synovial sarcoma is a favorable sign for prognosis. The patient was a 31-year-old female. The tumor mass had been present for 3 years, accompanying local tenderness. X-ray revealed a soft tissue tumor with central calcification, which was located between the adductor magnus and brevis of the left thigh. The tumor size was 7 x 5.5 cm. There was no connection with the knee joint or the femur. Grossly, the tumor was a relatively well circumscribed hard tumor with massive calcification. Microscopically, the tumor was composed of predominantly spindle cells with accompanying hyalinization, numerous spherical concretions and ossification. The epithelial component was not clearly noted. Mitotic figures were rarely noted in the densely cellular area. Immunohistochemical staining for EMA, S-100, vimentin, and carcinoembryonic antigen was negative while vimentin and cytokeratin were weakly and focally positive. EM study revealed multiple desmosome-like calcification intercellular junctions with a slit-like lumen and an incomplete basal lamina, which suggest that tumor show these cells were undergoing epithelia] differentiation. Above evidence suggest that this tumor is a synovial sarcoma associated with a large area of calcification, a so called calcifying synovial sarcoma. No recurrence was noted in one and half years of follow up.

Case Reports

Large-Cell Acanthoma: A case report.: Yu Hoon Kim, Seong Jin Cho, Ae ree Kim, Nam Hee Won, Kye Yong Song; Korean J Pathol. 1996;30(2):161-163.

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Abstract PDF: Large-cell acanthoma is a generally hyperkeratotic, sharply demarcated patch on sun-exposed skin with the outstanding pathologic feature being composed of large, relatively uniform keratinocytes. We describe a case of large-cell acanthoma that involved the skin of the nasal bridge. Patient was a 56-year-old women with a tannish brown patch, 2 cm in size and of 5 years' duration. Controversial issues about nosologic entity of large cell acanthoma are discussed.

Trichogerminoma: A case report.: Sung Suk Paeng, Jin Hee Sohn, Duck Hwan Kim, Hee Jin Chang, Jung Il Suh, Kye Yong Song; Korean J Pathol. 1996;30(4):340-343.

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Abstract PDF: Though trichogenic tumors were classified as trichoblastoma, trichoblastic fibroma, trichogenic trichoblastoma and trichogenic myxoma by Headington(1970), their true classification depends upon the epithelial and mesodermal component as well as evidence of their induction. Because of the rarity of hair germ cell tumors their classification is still controversial. In this report, we describe a case of trichogerminoma which is not included in the above classification. The trichogerminoma was first described by Sau et al. in 1992 and characterized by its morphologic pattern of germinal centers and lymphoid follicle-like structures in the nests of trichoblasts. Herein we reporte a tumor which arose on the skin on the back of a 51-year-old man and presented as a sharply circumscribed mass(4.5x2.0x1.5 cm) involving both the dermal and subcutaneous tissues without any epidermal connection. The tumor had many germinal center-like structures in the basaloid trichoblasts. Lobular cell nests were separated by variable amounts of stroma, but no horn cyst were noted. The germinal center-like cells showed early differentiation of hairs, resembling early hair bulbs. Trichogerminoma is considered to be a type of tumor located between trichoblastoma and trichoblastic fibroma.

Original Articles

A Serous Papillary Cystadenoma of Low Malignant Potential in Paratesticular Tissue.: Keum Min Park, Nam Bok Cho, Kye Yong Song; Korean J Pathol. 1996;30(5):463-465.

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Abstract PDF: The serous papillary cystadenoma of low malignant potential in the paratesticular tissue is a tumor characterized by its resemblance to ovarian serous papillary tumor of low malignant potential. Several possible origins have been proposed but it is thought to originate from the Mullerian-type epithelium just like ovarian serous tumor of low grade malignancy. Because of the rarity of this tumor, the natural history and treatment have not been established. Herein we report on a serous papillary cystadenoma arising in the paratesticular tissue of a 12 year old . To our knowledge, this is the first reported case in the Korean literature. The size of this cystic tumor in this patient was 0.9x0.9x0.8 cm and had a sponge-like cut surface. The papillary structure was lined by both ciliated and nonciliated secretory cells, the same cellular structure as the salpinx. Areas with just a few mitoses and stratification of epithelial cells were noted, but invasion into the paratesticular tissue was absent, suggesting borderline malignancy. He is doing well after 5 months follow up. Prognosis of this scrotal tumor is thought to be better than the ovarian tumor of similar histology due to a better possibility of early detection.

Cutaneous Infection of Larval strongyloides stercoralis Manifesting Pseudolymphomatous Reactions.: Jin Hee Sohn, Hye Rim Park, Kye Yong Song, Seung Yull Cho; Korean J Pathol. 1996;30(5):466-469.

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Abstract PDF: Larval nematodes belonging to genera Ancylostoma, Strongyloides, Rhabditis, Gnathostoma or microfilariae (Onchocerca volvulus)/adult filaria (Loa loa) can invade human skin, each making different lesion. In a 71-year old immunocompetent Koreanman with 23% eosinophilia and elevated serum IgG (2530 mg/dl), a skin biopsy was undertaken for a nodular lesion at abdominal wall. A longitudinal section of a larval nematode was recognized in mid-dermal tunnel surrounded by pseudolymphomatous diffuse lymphoreticular cell infiltration. The larval nematode, 15 um in maximum diameter, had outermost cuticular layer and pale intestinal cells. The nematode section was identified as a filariform larva of Strongyloides stercoralis mainly based on its maximum diameter. In Korea, this is the first description of a cutaneous larval nematode infection. This case did not show quick migration of lesion which is a typical manifestation of classical cutaneous larva migrans.

Morphological and Biochemical Study on the Processes of Apoptosis Induced by Radiation.: Kye Yong Song, Seong Man Kang, Seong Hwan Ha, Sang Chul Park; Korean J Pathol. 1996;30(9):819-829.

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Abstract PDF: Transglutaminase(TGase) is a calcium dependent enzyme that catalyse and acyl transfer reaction forming epsilon-(gamma-glutamyl)-lysine cross linkage. the major known effect of TGase is its important role in the programmed cell death manifested in the granular layer of the skin and acidophilic bodies in the viral hepatitis and neoplastic processes. The enzyme activity, immunohistochemical reaction using polyclonal antibodies against cytosolic TGase C, light and electron microscopic studies and TdT staining of the transplanted fibrosarcoma cells in C3H mouse with radiation therapy were done. The presence of TGase was detected immunohistochemically by avidin-biotin peroxidase complex (ABC) method Apoptosis were significantly induced after irradiation dependent with time factors and irradiation doses, resulted in marked and confluent tumor cell loss. Highest activity of the cytosolic form of TGase was noted at 24 hours and decrease after then while membrane bounded form of the TGase showed no significant changes. Immunohistochemical staining revealed strong positive reaction in the sarcoma cells in diffuse fasion and around the necrotic foci in the cytoplasm. Terminal dideoxynucleotidyl transferase(TdT) staining revealed increasing numbers of apotptic cells from two hours after irradiation. In the mechanism of decreasing tumor size and cell death in radiation therapy, apoptosis plays an important role and during that process transglutaminse might do some irreversible cross-linking effects of cytoplasmic proteins causing cell death in part.

Prenatal Development of Eccrine Sweat Gland: Morphologic and Morphometric Analysis.: Nam Bok Cho, Tae Jin Lee, Je G Chi, Kye Yong Song; Korean J Pathol. 1997;31(2):121-134.

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Abstract PDF: To elucidate the developmental sequence of the eccrine sweat gland, a morphologic and a morphometric observation were done using developing human embryos and fetuses. Five embryos and sixty four fetuses from the 9th to the 38th week of the gestational age were studied. The skin was sampled in eight different areas, i.e., scalp, forehead, face, chest, abdomen, back, palm and sole. Routine histological sections were made for histological evaluation and morphometric analysis. The results obtained were as follows : The primordia of the eccrine sweat glands appeared first as regular undulation of the basal cells in the palm and the sole in the 13th week of getation. Subsequently, elongation and coiling of the cell cords were noted from the 16th to the 18th weeks. Intraductal lumen formation was first noted in the 20th week. Secretory segment of the eccrine sweat glands were noted from the distal part of the coiling intradermal sweat duct in the 22nd week of the gestational age. The eccrine sweat glands became fully developed by the 28th week of gestation and this included the clear cell, the dark cell and the myoepithelial cell. In the morphometric analysis, the number of eccrine epithelial buddings were decreased with aging and the highest were in the palm and the sole. The diameter of the eccrine sweat duct showed no significant change by gestational age or in the different sites observed. Straight and coiled eccrine sweat ducts or glands were lengthened into the deep reticular dermis and upper portion of the subcutaneous adipose tissue with an increase of the gestational age. The above results suggest that developmental stage and the number of eccrine glands of the skin in the fetal stage is different from other areas of the body, especially in the palm and the sole.

Case Report

A Cystic Mesothelioma in the Inguinal Area.: Im Joong Yoon, Nam Bok Cho, Tae Jin Lee, Mee Kyung Kim, Se Chul Kim, Kye Yong Song; Korean J Pathol. 1997;31(3):284-287.

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Abstract PDF: The cystic mesothelioma is a very rare tumor which has a clinically and histologically benign nature. Here in reported is the case of a cystic mesothelioma presented as a palpable mass of the inguinal area in a 28-year-old male. Ultrasound showed a cystic tumor at the inguinal canal, and the other physical and laboratory examinations were within normal limits. Grossly, the tumor consisted of cysts containing clear serous fluid and focally solid areas. Microscopically, the tumor was encapsulated with fibrocollagenous wall, and the tumor cells were cuboidal or polygonal epithelial cells with single or multiple layers and had clear cytoplasm. Some areas showed thyroid follicle-like structures. The content of follicle-like structures showed eosinophilia in the H&E section, but positive in mucin stain. Neither cytologic atypia nor mitoses were present. Immunohistochemical staining revealed positive reaction for keratins of low molecular weight, while negative for the thyroglobulin and CEA. These findings suggested mesothelial in origin. We concluded that this tumor was primary rather than metastatic, because he had no evidence of a tumor in gastrointestinal, genitourinary tracts and scrotum.

Original Articles

Clinicopathological Analysis on the 104 Cases of Malignant Melanoma.: Kye Yong Song, Kyeong Cheon Jung, Kwang Hyun Cho, Je Geun Chi, Eui Geun Ham; Korean J Pathol. 1997;31(6):566-573.

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Abstract PDF: The cliniopathological analysis was done on the 104 cases of malignant melanoma diagnosed at the Seoul National University Hospital (SNUH) from 1984 to 1993. The basic clinical data and the pathological items were based on the New Mexico Melanoma Registry Worksheet. The results were as follows. The male to female ratio was 1 : 0.79. Primary cutaneous melanoma was more common in the male (M : F=1 : 0.56) but primary extracutaneous melanoma with slight female dominancy (M : F=1 : 1.25). The peak age was the 6th decade in both cutaneous and extracutaneous malignant melanoma. In 66% (35 cases) of primary cutaneous malignant melanoma, the primary site was located in the acral area (including cases of acral lentiginous and nodular type), of which 63% (41% of total cutaneous melanoma) was acral lentiginous type. Major components of tumor cells were epithelioid. Clark's level of tumor was III or more at the time of the first visit in the majority of the cases (85%). The incidence rate of extracutaneous melanoma was 34.6% (36 cases) among the primary melanoma, and the eyeball (17.3%) was the most prevalent organ. All these features suggest that the racial difference between the Korean and the Caucasian is evident and also that etiologic role of sun damage is not quite marked in the Korean. We also suggest that an early detection program is very important to cure this malignant tumor.

Prenatal Development of Sebaceous Gland: Morphologic and Morphometric Observation.: Im Joong Yoon, Je Geun Chi, Kye Yong Song; Korean J Pathol. 1998;32(4):273-282.

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Abstract PDF: This study was conducted to illustrate the histological and morphometric features of the sebaceous gland of human fetal skin. For this purpose, we studied 12 human embryos and 60 fetuses from the 4 th to 38 th week of gestation. In each case, we sampled eight different areas of skin, i.e., scalp, forehead, face, chest, abdomen, back, extremity, and palm and sole. Through routine tissue processing, hematoxylin and eosin preparations were made for morphology and morphometric analysis. The sebaceous gland anlagen is noted in the face and scalp by the 14th week of gestation, being subsequently generalized in other parts of the body, namely by 16th week of gestation. The lobation of the sebaceous gland subsequently differentiated into multilobular appearance in the face and scalp by the 17th week of gestation and in the chest and abdomen by the 26th week of gestation. The sebaceous ducts were seen by the 21th week of gestation in face and scalp, and in the chest and abdomen by the 27th week of gestation. In morphometric observation, the number and diameter of sebaceous gland were reached its peak during the 21st to 24th week of gestation, and then decreased gradually until it became constant in later days of the gestational period. In general, cephalic portion of the body had more sebaceous glands and also was larger in diameter. This difference became negligible as fetuses reached the term.

Case Reports

Cutaneous Lymphadenoma: A case report and Review of Literature.: Im Joong Yoon, Mee Kyung Kim, Kye Yong Song; Korean J Pathol. 1998;32(4):309-311.

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Abstract PDF: The cutaneous lymphadenoma is a recently described tumor with a distinctive histologic picture representing a basaloid epithelial proliferation and intraepithelial lymphocytic infiltration; it seems to be a benign adnexal neoplasm of uncertain histogenesis. We documented one example of cutaneous lymphadenoma showing typical histologic features. The tumor typically presented as a well circumscribed nodule with scant or no epidermal connections. The proliferating one consisted of multiple rounded lobules of basaloid cells with some degree of peripheral palisading. There was an intense infiltrate of small lymphocytes within the lobules but few in the stroma. No clear adnexal differentiation is noted. Immunohistochemically, the basaloid cells show weak immunoreactivity for high molecular weight keratin and carcinoembryonic antigen, small lymphocytes for T-cell marker and some dendritic cells for S-100 protein. After surgical resection, we found no evidence of local recurrence or distant metastasis for four years, so we considered this tumor as a benign one and diagnosed as cutaneous lymphadenoma by typical histologic features.

Epithelioid Leiomyosarcoma of Skin: A case report.: Han Seong Kim, Nam Bok Cho, Hyun Soon Lee, Kye Yong Song; Korean J Pathol. 1998;32(9):700-703.

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Abstract: This report concerns a rare malignant smooth muscle neoplasm of the skin and the subcutaneous tissue, which was examined immunohistochemically and ultrastructurally. It occured in a 48-year-old female patient who had suffered from painful nodules on the left shoulder. The nodules were removed and diagnosed as a benign fibrohistiocytic tumor. One year after local excision, multiple nodules were detected by physical examination at the previous operation site. Grossly, thirteen well-defined small nodules had spread in the dermis and the subcutaneous tissue, of which nine were located from lower dermis to the subcutaneous tissue and four were in the subcutaneous tissue. Histologically, each nodule consisted mainly of epithelioid tumor cells having eosinophilic or clear plump cytoplasm and round to oval nuclei with small nucleoli, and some peripheral spindle tumor cells. The tumor cells were negative for PAS reaction with and without diastase digestion or alcian blue. Immunohistochemically, tumor cells were positive for smooth muscle actin and vimentin. Ultrastructurally, the tumor cells showed actin filaments and dense bodies in cytoplasm. This case was diagnosed as an epithelioid leiomyosarcoma of the skin and the subcutaneous tissue with local metastasis one year after local excision.

Original Articles

Ethnic Differences of the p53 Genetic Alteration in Cutaneous Malignant Melanoma.: Won Sang Park, Eun Young Na, Sang Kyu Lee, Sug Hyung Lee, Su Young Kim, Seok Jin Kang, Kye Yong Song, Suk Woo Nam, Nam Jin Yoo, Jung Young Lee; Korean J Pathol. 2001;35(2):158-164.

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Abstract PDF: BACKGROUND
There are significant differences in the clincopathologic pattern including the incidence, favor site, and histopathologic type between cutaneous malignant melanomas arising from whites, asians and blacks. These differences might suggest that there is a racial difference in the molecular tumorigenesis mechanism of malignant melanoma.
METHODS
To determine the ethnic differences in tumorigenesis of malignant melanoma, we performed loss of heterozygosity (LOH) and sequencing analyses of the p53 gene in cutaneous malignant melanomas arising from 22 white American, 30 Korean and 15 black African patients.
RESULTS
The frequency of LOH of the p53 gene is only 12.5% in white American patients, but the frequency is significantly higher in Korean (42.1%) and black African (61.5%) patients. We also detected 17 mutations (nonsense: 1, missense: 16) of the p53 gene in the cutaneous malignant melanomas of Koreans and black Africans, but none in those of white Americans: among the 16 missense mutations, 10 mutations were C:G to T:A transitional mutations. Of these, we also detected one GG (CC) to AA (TT) tandem mutation at the pyrimidine sequence.
CONCLUSION
These results strongly suggest that there might be a racial difference in molecular carcinogenesis mechanisms among the cutaneous malignant melanomas occurring in white American, Korean and black African patients. But the role of the p53 genetic alteration in the genesis of melanomas in Korean and black African patients is subject to further evaluation.

Expression of Cytokeratin 1, 10 and 14 in Fetal Skin.: Kye Yong Song, Sun Lee, Dong Hye Suh, Mi Kyung Kim, Hye Jung Min, Je G Chi; Korean J Pathol. 2001;35(3):226-231.

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Abstract PDF: BACKGROUND
During the fetal stage, the epidermis and adnexal epithelium might express different types of cytokeratin (CK) by developmental stages. The objective of this study is to observe the expressions of CK1, CK10 and CK14 in the skin of human fetuses.
METHODS
Immunohistochemical stains were applied to the skin of 42 fetuses ranging from 10 to 36 gestation weeks. Three different portions of the body (i.e., scalp, chest and sole) were sampled. Immunohistochemical staining with monoclonal antibodies against CK1, 10, 14 were done.
RESULTS
We found that CK14 was expressed in the basal layer of the epidermis and adnexae of fetuses beween 10 to 36 gestation weeks. However, stronger expression in the middle than the basal layer was noted in the soles of 15-week fetuses followed by exclusive basal expression. The sebaceous gland, the outer root sheath of the hair follicle and the eccrine duct epithelium also showed CK14 expressions, while CK14 was negative in hair germ and acini. Both CK1 and CK10 were expressed in the epidermis of fetuses ranging between 10 to 36 gestation weeks at the suprabasal layer of the scalp, chest and sole; while they were negative in the basal layer and skin adnexae including sebaceous, hair and eccrine gland.
CONCLUSIONS
Expression of cytokeratins in the fetal skin were noted at 10 weeks throughout the entire gestation period and were similar in the three different sites, except in the early stage of the sole. The main expression sites of K14 were the basal layer of the epidermis, the eccrine ducts and the outer root sheath cells of hair, suggesting the same origin, while those of K1 and K10 were in the suprabasal layer of epidermis.

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