Journal of Pathology and Translational Medicine

A Study on Clinical Diagnostic Value of Serum Gamma-Glutamyl Transpeptidase Activity: Yong Mo Ahn, Kui Nyung Yi, Samuel Y. Lee; Korean J Cytopathol. 1979;13(3):179-186.

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Abstract: The enzyme Gamma-Glutamyl Transpeptidase (γ-GT, EC 2.3.2.2.) is distributed widely throughout the body, highest activities being present in the kidney, followed by pancreas, liver, spleen, and brain. It catalyses transfer of the gamma-glutamyl group from gama glutamyl peptides to other peptides or any of the common amino acids except proline. Since a group of Polish investigators first reported elevated γ-GT activity in sere of Patients with hepatic disease, a number of reports have appeared describing the conditions in which there is an elevated serum γ-GT activity. The level of γ-GT has been shown to be raised mainly in patients with hepato-biliary disease and to a lesser extent in a number of other conditions as Pancreatic, heart, neurologic, and renal diseases. As the Department of Clinical Pathology, Yonsei University Medical College, has recently purchased the autoanalyzer System 5 (Gilford Instrument Laboratories, Inc.), the rapid and_accurate determination of serum γ-GT activity has ben made possible. The author measured he activity in sera from the patients with a variety of diseases and 30 normal controls comprised of healthy medical students by using System 5. The results are as follows. 1. The average values of γ-GT for normal controls were 19.2 IU/L (range 8-33 IU/L) in male, and 16.5 IU/L (range 6-28 IV/L) in female, respectively. 2. Patients with all forms of hepato-biliary diseases had elevated serum γ-GT level. The highest activity was noted in patients with cholecystits or cholelithiasis. 3. Patients with primary hepatocellular and metastatic carcinomas had significantly elevated serum γ-GT level and higher increase rate than those of. any other enzyme tests. This may suggest the value of γ-GT as a screening test for neoplastic diseases of the liver. 4. Of all the patients studied, patients with carcinoma of pancreas revealed highest γ-GT values. 5. Patients with carcinomas except hepatocellular and pancreatic carcinomas did not reveal significant elevation of serum γ-GT activity. 6. In patients with bone diseases, γ-GT levels were within normal range in contrast to elevated alkaline phosphatase activities. 7. A portion of patients with neurologic diseases showed slightly elevated γ-GT level No significant change of γ-GT activity was noted in patients with renal failure. 8. In spite of the lack of specificity, it appears that the determination of γ-GT can indicate hepato-biliary dysfunction, especially used with other tests. 9. When the level of γ-GT is increased abruptly during the follow-up of a liver cirrhosis patient, the measurement of γ-GT may indicate the progress of liver cirrhosis or complication of hematoma, especially in a country like Korea which has a high incidence of liver.

A Study on Penicillinasse-producing Staphylococci Isolated from Clinical Specimen: Kyung Ho Shin, Won Kil Lee, Jae Sik Kim, Jyung Myung Kim; Korean J Cytopathol. 1979;13(3):187-190.

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Abstract: Several tests for detection of penicillinase have been devised to the present time but most of them are too cumbersome or too time consuming for routine hospital use. Recently, Rosenblatt et al. developed a rapid slide test which is a modification of the iodometric method. The authors examined 130 strains of S.aureus and 70 strains of S. epidermidis isolated from clinical specimens using this slide method and compared these results with those of Workman and Farrar's agar plate method and disk diffusion susceptibility test against penicillin G. All of the penicillinase-positive staphylococci were resistant to penicillin G. However peincillinase-negative staphylococci were not always sensitive to penicillin G. Therefore the susceptibility test were needed in this cases.

Survey for the Laboratory Methods of Chemical Tests in Korea: E.S. Kim, S.Y. Choi, H.I. Cho, S.I. Kim; Korean J Cytopathol. 1979;13(3):191-198.

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Abstract: Surveys for laboratory methods of 20 chemical test items were performed in 1978 and 1979. 57 and 34 laboratories of general hospitals participated in 1978 and 1979 respectively. The most popular methods were as follows; Items Method 1978 1979 Total Bilirubin Evelyn-Malloy meth. 74.5(%) 75.8(%) Cholesterol Lieberman-Burchard meth 87.2 72.7 Triglyceride Enzyme-Colorimetry 56.3 78.9 Glucose Orthotoluidine meth 52.0 47.1 Calcium Cresolphthlein complexone meth 71.5 83.4 Phosphorus Fiske-Subbarow meth. 75.7 51.7 Sodium Flame photometry 100.0 100.0 Potassium Flame photometry 100.0 100.0 Chloride Schales-Schales meth. 93.0 81.3 Protein Biuret meth. 94.1 91.2 Albumin Bromcresol green meth. 78.3 58.8 Protein Electrophoresis Cellulose Acetate meth. 89.5 Urea Nitrogen Urease Indophenol 56.9 64.7 Uric acid Phosphotungstate meth. 89.5 96.8 Creatinine Jaffe reaction meth. 100.0 100.0 SGOT Reitman-Frankel meth. 100.0 100.0 SGPT Reitman-Frankel meth. 100.0 100.0 LDH (P-L) NADH Colorimetry 96.8 82.6 AlK. Phosphatase Bessey-Lowry Brock meth. 40.4 52.9 Kind-King meth. 48.1 29.4 Amylase Amyloclastic meth. 100.0 88.2

A Study on Determination of Triglyceride. -Comparision of enzymatic and acetylacetone method-: Jong Woo Park, Han Ik Cho*; Korean J Cytopathol. 1979;13(3):199-202.

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Abstract: A comparision of analytical methods for the determination of serum triglyceride was made between enzymatic and acetylacetone methods. The authors evaluated intra- and inter-assay variation as well as correlation between two methods. The results are as follows. 1. The mean values of triglyceride of one commercial control serum (Monitrol I) were 98. 02mg/dl by enzymatic method and 68.54mg/dl by acetylacetone method: enzymatic method shown higher value compared to acetylacetone method by 30mg/dl. 2. Intra and inter-assay variation (n=12) represented by coefficient of variation was 3.1% and 5.05% by enzymatic method, and 7.7% and 15.86 enzymatic method shorts lower inter-and inter assay variation. 3. A correlation between two methods (n=30) was made: correlation coefficient r=0.982, and linear regression y= 1.22x+9.32 4. Enzymatic method has the advantage of simplicity, rapidity and specificity.

On the Histological Observation of the Development of Granulomatous Changes in Silicotic Lung. -Report on six autopsy cases-: Eun Joo Seo, Choo Soung Kim, Im Goung Yun; Korean J Cytopathol. 1979;13(3):203-213.

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Abstract: Six cases of silicosis were autopsied and the postmortem changes were compared with clinical manifestations. Gross and microscopic findings of pneumosilicosis were described and three distinct morbid morphological units, namely, early silicotic nongranulomatous changes, silicotic granulomatous changes, silicotic granulomatous nodules and conglomerated silicotic nodular masses, were presented. These three changes proceded in the order successively in progress and in parallel. However, the last change was self-limited within the lobar dimension. The details, of each unit were as follows: Early silicotic non-granulomatous changes. The earliest chief finding was the accumulation of dust cells laden with silica in the alveolar spaces and in the alveolar walls. The next stage finding of the earliest change was composed of many foci with silica laden macrophages and the nearby fibroblasts proliferation around the small vessels and bronchioles. Silicotic granulomatous nodules. The nodules consisted of centrally located layers of concentric hyalinized collagenous tissue lacking macrophages and anthracotic pigments. In the peripheral area of this nodule. many macrorhages laden with anttracotic pigments and silica and proliferation of fibrotlasts inter-mingled with anthracotic pigments were found. Conglomerated silicotic nodular masses. Grossly many nodules, 1∼5mm in size, were conglomerated into a large compact mass occupying almost the entire lobe. The main changes appeared chiefly in the apex of the lung and near the hilum. Fibrous tissue between the nodules showed no concentric arrangement and became partially hyalinized. Combined changes were as follows: bronchitis, bronchiectasis, tuberculosis, lobar pneumonia, emphysema and congestion and edema. Among these changes, lobar pneumonia, marked congestion and edema and corpulmonale seemed to be lethal complications.

Results of VDRL and TPHA Tests in Lepers: Dong Wook Rhang; Korean J Cytopathol. 1979;13(3):215-221.

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Abstract: VDRL (Venereal disease research laboratory) and TPHA(Treponema pallidum hemagglutination) tests were carried out to evaluate the BFP (biological false positives) for non-treponemalantigen tests in leprosy patients admitted in Sorok National Leprosarium. The results were obtained as follows: 1. VDRL qualitative tests: Of 167 leprosy patients, 26 patients (15.6%) gave the positive VDRL reactions, which were graded as weakly reactive in 19 patients(11.4% ), and reactive in 7 patients (4.2%). 2. VDRL quantitative tests: Of the 26 leper's sera which gave the positive VDRL quantitative tests, the titer was 1 : 1 in 18 sera (69.2 4 in 2 sera (7.7%), and 1 : 8 in 2 sere (7.7%). 3. TPHA tests : Of the VDRL-reactive 26 lepers, 12 patients (46.2%) showed positive reactions and the other 14 lepers (53.8%) gave the negative reactions in TPHA tests. TPHA-negative reactions were observed in the patients giving the positive VDRL quantitative reactions in 1 : 1, and 1 : 2. But all of those giving reactivity in 1 : 4 or above gave the positive TPHA tests. TPHA tests revealed that the 53. 8% of VDRL-reactive lepers in qualitative rests gave the positive reactions possibly due to BFP and these BFP might be excluded by concomittant VDRL quantitative tests.

Some Observation on Examination Method of Regional Lymph Nodes of Malignant Neoplasm: Kook Young Maeng, Je G. Chi; Korean J Cytopathol. 1979;13(3):223-231.

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Abstract: Studies of the regional lymph nodes of malignant tumor for search of metastatic lesion has been the most accessible measure to evaluate spreading and metastatic property of maligant tumor. Lymph nodes beating metastatic lesions present some remarkable differences from those without tumor as pointed out by some investigators. This investigation was undertaken to observe on nodal histologic changes and the behavior of metastatic tumor in the regional lymph nodes; e.g. detection rate of metastatic tumor in midsagittal versus parasagittal sections, location of tumor lesions in positive Iymph nodes, and occurrence of tumor emboli in perinodal lymphatics. In this study, 88 lymph nodes from 25 cases of carcinomas (Stomach carcinoma. 11; colon carcinoma, 6; breast carcinoma, 5; cervix carcinoma, 1; thyroid carcinoma. 1) were randomly sampled and examined. Of these, 57 lymph noses showed metastatic involvement. The following observations and conclusions are made; There seemed to be a few cancer-related changes in the regional lymph notes with or without metastases in these given specimens. Sinus histiocytosis was consistently prominent in noses without tumor, and the degree of sinus histiocytosis was inversely proportional to the degree of metastatic tumor involvement These findings might support the view that cellular immunity, especially histiocyte-macrophage system, plays an important role in biologic control of tumor growth. Other findings e.g. enlargement and reactive change of lymphoid follicles, plasma cellular reaction of the pulp, etc. were considered to be nonspecific changes, probably due to concomitant inflammation. All of the metastatic lesions, with the exception of those in two nodes, were presented in the midsagittal section, while parasagittal sections occasionally tailed to show the metastatic lesions. Also noted were pattern of tumor spread within Iymph noses. None of nodes revealed tumor emboli in lymphatics without parenchymal involvement, and notes with subcapsular sinus, no matter where other tumor cell neats may be encountered, thus enabling the speculation that tumor emboli were first lodged in subcapsular sinus, immediately after entering the nods from afferent lymphatics and permeate inward through trabecular and interfollicular sinuses into parenchyme.

Light Chain Disease, Kappa Type -A case report-: Chong Soon Rhee, Kui Nyung Yi, Kyung Soon Song, Samuel Y. Lee; Korean J Cytopathol. 1979;13(3):233-236.

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Abstract: Light chain disease is a rare type of plasma cell neoplasm. Its clinical feature is similar to that of other myeloma but its survival time is shorter than others and it secretes different type of M-conponent. The department of Clinical Pathology, Severance hospital, has run immunoelectrophoretic studies for the last 2 years and detected a case of Light chain disease recently. A relative hypogammaglobulinemia was found on the ordinary gerum electrophoresis. On the immunoelectrophoretic study, an antigen excess with deformation on the medical protion of IgG line on polyvalent antiserum and a deformation with partial identity on Kappa antiserum was noticed but the other fractions are of normal pattern. This is to report the case with clinical history and laboratory studies. A brief review of current literature is added.

Fibroma of Stomach -A case report-: Eun Sook Chang; Korean J Cytopathol. 1979;13(3):239-242.

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Abstract: Gastric fibroma is an uncommon tumor of fibrous tissue which may arise in the wall of stomach. The rarity of these neoplasms is attested to by their low prevalence in large series of benign gastric tuners, where they constituted about 0.5 to 5.0% of all benign tumors of stomach. We had a case of fibroma of gastric antrum, referred from An-Dong Presbyterian Hospital Which herein reported and the literatures are reviewed.

Potter's Syndrom (An Autopsy Case Report): Kook Young Maeng, Woo Sung Ahn, J. G. Chi; Korean J Cytopathol. 1979;13(3):245-250.

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Abstract: In 1946, Potter descrived a series of 20 cases of infants in whom bilateral absence of the kidneys was associated with hypoplasia of the lungs and a characteristic face. This combination of abnormal findings has been known as Potter's syndrome after the first describer, E.L. Potter. Since these anomalies are incompatible with life, the diagnosis of this syndrome was seldom made clinically only to be found incidentally at autopsy table. this may be the reason why this anomaly was not reported in this country until very recently by us Chi and Park, in spite of over 160 cases reported in the literature. This case would be the second case of Potter's syndrome in Korean literature.

A Case of Dysgerminoma of the Ovary, Associated with Embryonal Carcinoma: Soo Nam Rhee, Byung Kee Kim, Chong Moo Lee; Korean J Cytopathol. 1979;13(3):253-256.

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Abstract: Dysgerminoma associated with embryonal carcinoma is not common ovarian neoplasm. A 31-year-old normal female was received left salpingo-oophorectomy because of rapidly growing lower abdominal sass. On pathological examination, typical dysgerminoma of the ovary associated with embryonal carcinoma was found. A brief review of literature on this entity was performed.

Infantile Mesenchymal Hamartoma of Liver -A case report-: Dong Wook Ryang, Kang Hyuk Yoon, Joo Yong Yoo; Korean J Cytopathol. 1979;13(3):259-263.

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Abstract: A case of mesenchymal hamartoma of the liver in a Korean infant,12 month old, is reported and relevant literature are briefly reviewed. Abdominal distention and palpable abdominal mass became manifest about 1 month before admission. The tumor was found attached by a pedicle to the inferior margin of the right lobe of the liver, measured 13×12×8cm and weighed 800gm. Successful surgical resection was made. Pathological findings were typical of mesenchymal hamartoma.

Hepathoblastoma and Hepathocellular Carcinoma in Infancy and Childhood: Myoung Hee Park, Yong Il Kim; Korean J Cytopathol. 1979;13(3):265-285.

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Abstract: Primary malignant epithelial neoplasms of the liver, namely hepatoblastoma and hepatocarcinoma in infants and children are relatively rare in comparison with those arising in the kidney, adrenal gland, eye, central nervous systems and lymphopoietic system, comprising no more than 0.2 to 5.8 per cent of the total number of malignant tumors, excluding leukemia, in these age groups. In the past, most cases in the literature were form Caucasians, and the strange absence of reports of carcinomas of the liver in infancy and childhood from those parts of the world where adult hepatic neoplasm is prevalent was previously pointed out. This skepticism, however, has been recently effaced by cumulative reports of cases in Asia and the largest series of histopathologic study in the world literature contained 70cases collected in Japan. Since the first document on these neoplasms from our institute, reports of 19 cases have been accumulated in Korean literature until 1978. These comprise around 3 per cent of all malignant tumors excluding leukemia, of pediatric age group in Korea, which is comparable with the figure of 3.9 per cent in Japan. Because of the variety and multiplicity of the histologic composition of hepatoblastomas, they have been reported under various terms, such as embryonal hepatoma, mixed tumor, malignant adenoma, teratoma and teratoid hepatic carcinoma. In recent years, the importance of differential diagnosis of hepatoblastoma form hepatocarcinoma in infancy and childhood has been emphasized, because of comparatively benign character of the former, following radical surgery. It was Wilis, who first contended that the embryonal hepatic neoplasm, hepatoblastoma, of infancy and childhood should be separated from the adult type hepatoma which also occurs in this age group, and later Ishak and Glunz modified his classification with wide acceptance; malignant epithelial neoplasms of infancy and childhood are divided into two categories, hepatoblastoma and hepatocellular carcinoma and the former contains two types, an "epithelial" and "mixed epithelial and mesenchymal" type. However, very limited information is available about the ultrastructure of heptoblastoma and hepatocellular carcinomas of infants and children and two different views have been advanced in the literature. The objectives of this paper are to outline the histopathologic observation of 14 cases of heptic carcinoma in infancy and childhood in Korea and to contribute towards further understanding of their ultrastructural organization.

A Case Report of Adult Nephroblastoma: Wha Soon Chung, Ock Peung Song, Choon Won Kim, Ki Hong Kim; Korean J Cytopathol. 1979;13(3):287-292.

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Abstract: Nephroblastoma, which is the most common renal tumor in childhood, has occasional been reported in adult. Some degree of confusion still exist because of the considerable variation in histologic structure and origin of this tumor. Diagnosis of nephrotlastoma in adult is more apt to be accidental and is almost never suspected in adult until discovered at operation or necropsy. Recently, we experienced a case of nephroblastoma in 61 year old male patient with chief complaints of lower abdominal an6 back pain and urinary difficulty for 20 days. IVP reveals nonfunctioning left kidney and RGP stows marked narrowing of uretero-pelvic junction. So nephrectomy was done under the impression of renal pelvic tumor. Grossly, the tumor is rather firm and well circumscribed, measuring 4×3 cm in dimension and locating renal pelvic portion with adhesion to renal capsule and perirenal fatty tissue. Cut surface shows gray yellow in color with areas of multifocal necrosis and slit-like narrowing of pelvic lumen by surrounding tumor with intact mucosa. microscopically, the tumor consisted of mainly spindle shaped undifferentiated mesenchymal cell and occasionally intermingled with abortive glomeruli and tubules associated with multifocal necrosis. A brief review of literature pertinent to this case was done.

Clear cell Hidradenoma -Three Cases Report-: Song Ja Chin, In Guy Lee, Choon Won Kim, Ki Hong Kim; Korean J Cytopathol. 1979;13(3):295-300.

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Abstract: Clear cell Hidradenoma, benign tumor, is a large variety of sweet gland tumors which have been described, studied and classified in various way because of histological origin in this tumor. Recent progress in this field of investigation, this tumor comparison with the normal structure of the skin appendages using histochemical and electron microscopic methods is originated from eccrine sweat gland. Microscopically, the general configularion of this tumor is composed of epithelial cells of two types ana presence of occasional tubular lumina lined by glandular epithelium. Therefore the most appropriate name for this distinct cutaneous neoplasm is probably Clear cell Hidradenoma. Also, this tumor is important to differential diagnosis with tumor arising in other adnexal structures, metastatic renal cell carcinoma and primary squamous cell carcinoma of the skin. Authors are experienced of three cases of Clear cell Hidradenoma on the skin of scalp, chest wall and thigh, respectively, from may 1973 to July 1979 on the Han Yang University Hospital. Several histogenetic theories and world's literature are reviewed.

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