Journal of Pathology and Translational Medicine

Volume 14(4); December 1980

Etcs

A Histopathological Study on the Uterine Cervix Cancer: Ju Hie Lee, Moon Ho Yang; Korean J Cytopathol. 1980;14(4):1-15.

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Abstract: A histopathological study has been performed on 319 cases of the uterine cervix cancers which were submitted to the Dept. of Pathology, KyungHee University Hospital, during the period of 7 years and 10 months from October, 1971 to August. 1979. The results were summerized as follows: 1) The uterine cervical tumors were 8.4% of all surgical specimens which were submitted from the Dept. of Gynecology during the same periods. And among cervical pathologic lessons, the uterine cervix cancers were 21.73%. 2) According toeir growth pattern, exophytic growth were 66.18%, endophytic growth, 29.41%, and mixed type were 4.41%. 3) Among 319 cases of the uterine cervix cancers, epidermoid carcinomas were 94.04%(300 cases), adenocarcinomas, 3.76%, and adenosquamous carcinomas were 1.57%. 4) Among 300 cases with epidermoid carcinoma, 44 cases(13.79%) were carcinoma in situ, 28 cases(8.78%), microinvasive carcinoma, and 228 cases(71.48%) were invasive carcima. 5) The histologic subtypes of the invasive epidermoid carcinoma were as follows: large cell keratinizing type(18.86%), large cell non-keratinizing type(74.56%), and small cell non-keratinizing type(6.14%). 6) The most prevalent age groups of the uterine cervix cancers were 40∼49 years (35.74%) and 50∼59 years(29.78%). 7) The most prevalent age group of the carcinoma in situ was 40∼49 years group with the average age of 44.05 years, and that of the invasive epidermoid carcinoma was 50∼59 years group with the average age of 49.54 years. 8) The most prevalent age group of the adenocarcinoma was 40∼49 years and the average age was 48.67 years old. 9) The uterine cervix cancers showed inflammatory reaction of moderate to severe degree in 59.24% in which epidermoid carcinoma in 42.85%∼66.66% according to the cell types, and adenocarcinoma in 16.66%. 10) The uterine cervix cancers revealed moderate to severe eosinophilic infiltration in 31.93%, in which carcinoma in situ in 14.81%, microinvasive carcinoma in 15%, and invasive carcinoma in 35.25%∼42.85% according to the cell types. 11) The most frequent clinical symptoms of the uterine cervix cancers are irregular vaginal bleeding(52.7%) and contacting bleeding(15.36%).

Strumal Carcinoid of the Ovary : Histological and Histochemical Studies: Myung Hee Kang, Jung Dal Lee; Korean J Cytopathol. 1980;14(4):16-22.

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Abstract: A case of strumal carcinoid arising in the wall of a mucinous cystadenoma of the left ovary was studied by histological and histochemical techniques. Histologically the tumor was characterized by the presence of carcinoid element of trabecular type merged imperceptibly with thyroid follicle-like structure filled with colloidal materials. Both tumor cells of the carcinoid component and lining cell of the thyroid follicular structure showed intracytoplasmic granules with argentaffin as well as argyrophilic reactions. The stroma of the tumor failed to reveal amyloid on crystal violet and Congo red stains. Histogenesis of a strumal carcinoid was discussed in details with emphasis on monophyletic development of both carcinoid and follicular structures.

Infantile Carcinoma of Pancreas in Korea -A case report: Hye Jae Cho, Jong Eun Joo, Hyuk Sang Lee, Ill Hyang Ko, Nak Whan Paik; Korean J Cytopathol. 1980;14(4):23-26.

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Abstract: A case primary carcinoma of the pancreas in a 4 years o14 Korean male is presented. A large mass, 11×9×8, in the tail with direct invasion to the splenic parenchyma and metastasis to the regional surgery, the patient developed liver metastasis 15 month later and eventually death ensued at 22 months postoperatively. Despite the radical surgery, the patient developed liver metastasis 15 months later and eventually death ensured at 22 months postoperatively. On light microscopic examination, most areas simulated an well differentiated acinar carcinoma with occasional foci of islet like configuration and squamous metaplasia. This was supported by electron microscopy which revealed zymogen granules of acinar cells in the tumor cells. These features, common to other reported cases in one way or the other, have been suggested as a peculiarity of childhood pancreatic carcinoma. Carcinoma of the pancreas, infantile type, is one of the very rare malignant tumor and less than 50 cases are reported in English literatures. To our knowledge this probable is the first reported case in Korea.

A case of Rhabdomyosarcoma(Sarcoma botryoides) of Bladder in a Child: Myoung Hee Ahn, Choon Won Kim, Seung Hahm Park, Ki Hong Kim; Korean J Cytopathol. 1980;14(4):27-30.

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Abstract: Sarcoma botryoides, which is a variant of embryonal type of rhabdomyosarcoma, is rare tumor. The embryonal rhabdomyosarcoma arise histogenetically from the tissue derived from the mesenchyme of the urogenital ridge. Grossly, they assume a lobulated or grapelike appearance whence comes the name "botryoid" sarcoma. We have recently experienced a case of sarcoma botryoides of the bladder and prostate in a 6-year-old toy who was admitted to Han Yang University Hospital on September 19, 1979. The bladder was filled with multiple, soft, polypoid, gray nodules. On section, the cut surface of the tumor mass has shown translucent and gelatinous appearance. Microscopically, the tumor mass has shown a loose textured area and compactness. The transitional epithelium on the bladder was intact and a cambium layer of Nicholson was present just beneath the mucous membrane. The neoplastic cells were spindled, oval and rarely multinucleated. No striation was found on the Phosphotungustic acid hematoxylin stain.

Inflammatony Fibroid Polyps of Small Intestine -Report of Two Cases-: Hy Sook Kim, Tae Soo Park; Korean J Cytopathol. 1980;14(4):31-33.

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Abstract: Histologically, an inflammatory fibroid polyp is characterized by a non-neoplastic polyp showing characteristic patterns of fibroblasts ana blood vessels with massive eosinophilic infiltration. This lesion must be differentiated from eosinophilic granuloma (eosinophilic infiltration) of G-I tract. Although there are world wide reports and reports of 3 cases of stomach in Korea, we experienced 2 cases of inflammatory fibroid polyp originated from small intestine, which were not reported yet in this country.

A Case of Aberrant Pyloric Glands in Tuberculous Enteritis -accompanying with multiple stenosis of small intestine-: Kie Sook Yoo, Dong Wha Lee, Duk Yong Kang; Korean J Cytopathol. 1980;14(4):34-37.

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Abstract: Heterotopic gastric mucosa in small intestine, other than in Meckel's diverticulum or other congenital anomalous conditions, is exceedingly rare. The origin of ectopic gastric mucosa in small intestine is open to conjecture. Two concepts have been presented in the literature that these lesions represent. Congenital anomalies or that they arise by metaplasia from existing or neoplastic intestinal epithelium. We experienced a case of aberrant pyloric glands and gastric mucosa in tuberculous enteritis accompanying with multiple stensis of small intestine. A 23 year old female who admitted to Dept. of internal medicine, because of generalized abdominal pain and tenderness for 2 months. Grossly, segmentally resected small intestine, consisted of jejunum and ileum measuring 150 cm in length which showed 11 stenotic areas. The length of stenotic segments measured from 1 cm to 5 cm. Opening the intestine, the mucosa is relatively intact except above mentioned areas which revealed flattening of Kerckring's valves and smooth mucosal surface accompaning with irregular shaped or pin point sized ulcers. Microscopically, the stenotic areas reveal chronic granulomatous inflammation with caseous in the mucosa, submucosal Iymphoid follicles, muscular layer, subserosa and mesenteric lymph nodes. The overlying small intestinal mucosa of those areas partly or totally replaced gastric mucosa and pyloric glands. Acute nonspecific ulceration of the mucosa was also found. Mesenteric lymph nodes revealed a few number of acid fast organisms on Ziehl-Neelson stain. A brief review of the interature was done.

Low-grade Endometrial Stromal Sarcoma -A cast report-: Jung Sik Kwak, Jong Min Chae, Dong Koo Lee, Tae Joong Sohn; Korean J Cytopathol. 1980;14(4):38-43.

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Abstract: Endometrial stromal sarcoma is a rare and controversial neoplasm composing of proliferative mesenchymal cells resembling those of the endometrial stroma. There are two types of endometrial stromal sarcoma; a low-grade type known as endolymphatic stromal myosis, and a frankly malignant form known as stromal sarcoma. The former is low-grade, slow-growing sarcoma that may recur locally but rarely metastasizes, whereas the latter has rapid local progression with early distant metastasis. We experienced a case of low-grade endometrial stromal sarcoma in a 39-year-old female with chief complaint of intermittent lower abdominal pain and irregular vaginal bleeding. The uterus of the patient was removed under impression of uterine rnyoma. Grossly, the tumor is a slightly elliptical myometrial mass measuring 6.5cm in larger diameter and is situated mainly in right and posterior wall of the uterus. The free surface of the tumor to the uterine cavity is multiple polypoid. The cut surface is gray to pink, relatively well demarcated but focally infiltrative, firm, and fibrous trabecular. The tumor is not encapsulated and do not compress surrounding myometrium. Microscopically, the tumor is composed of masses of oval or spindle mesenchymal cells closely resembled the endometrial stromal cell in areas between the myometrial muscle bundles and in blood vessels and lymphatics largely dilated. Mitotic figures are rare and cellular atypic is less. A clinicopathologic observation of this case was discussed with a brief review of literature on this entity.

Carcinoma Arising in Pleomorphic Adenoma of Salivary Gland -Report of 4 cases-: Myung Sook Kim, Je G. Chi; Korean J Cytopathol. 1980;14(4):44-50.

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Abstract: The terms "malignant mixed tumor" and "carcinoma arising in pleomorphic adenoma" have been used interchangeably. However, they are theoretically quite different. The term carcinoma arising in pleomorphic adenoma refers to an epithelial malignancy in which remnants of benign pleomorphic adenoma (mixed tumor) matrix can be identified. And metastasis contains only the carcinomatous component. The important microscopic findings are 1) destructive infiltrative growth 2) necrosis and extensive hyalinization 3) frequent mitosis and pleomorphism 4) dystrophic calcification 5) anigo and perineural invasion, and 6) metastasis. Recently we have experienced four cases of major salivary gland carcinomas that showed residual foci of benign pleomorphic adenoma. Detailed histological examination confirmed that these tumors fit the criteria of "carcinoma arising in pleomorphic adenoma". The tumors occurred most commonly in parotid(3 cases), in males(3 cases) and over the age of 60 years(4 cases). The malignant part of the tumors was comprised of poorly differentiated adenocarcinoma in three, and squamous cell carcinoma in one case. One patient died of brain metastasis.

Synovial Sarcoma of the Neck -A Case Showing Unusual Cystic Degeneration-: Hee Sook Kim, Jae Hyung Yoo, Tae Soo Park; Korean J Cytopathol. 1980;14(4):51-55.

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Abstract: Primary synovial sarcoma of the neck is an extremely rare malignant neoplasm. The occurrence of synovial sarcoma in the soft tissue of the neck was first reported in 1954 and thereafter about 50 cases were reported in worldwide. No case was reported in Korea. A case of cervial sarcoma was experienced in the Department of Sung Sim Hospital. It was found in the anterior neck of a 30-years-old male. The patientnoticed a thumb-tip sized mass in the anterior neck and the mass grown up rapidly up to adult's fist size with 4 months duration. Fistulogam of the neck mass revealed a multilocular cystic appearance, which is diagnostic findings of cystic hygroma. On operation there was a lobulated grayish white to partly pinkish adult-fist sized mass, with large area of cystic degeneration, which was filled with reddish brown necrotic material. The mass was partly adhered to the hyoid bone. Radical excision could not be performed due to massive bleeding. Several fragments of biopsy materials were sent to the department of Clinical Pathology and were measured 3×2×0.6 cm in aggregates. Grossspecimen shows grayish white discoloration, and inner surface was coated by focal areas of reddish brown necrotic materials. Microscopically, biopsy materials represented the characteristic biphasic cellular pattern of a synovial sarcoma, with epithelioid and fibrosarcoma-like areas in varying propotions.

Glanzmann's Thrombasthenia -Report of three patients-: W.S. Ahn, M.H. Park, H.I. Cho, S.I. Kim, E.C. Yang*, E.S. Choi*, J.G. Kim*, H.S. Ahn*, C.Y. Hong*, W.B. Kim**, K.S. Yoo**, D.H. Lee**, D.Y. Kang**, H.K. Park***, Y.M. Song***, M.J. Shin***; Korean J Cytopathol. 1980;14(4):56-61.

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Abstract: Thrombasthenia is a rare disorder, apparently transmitted as an autosomal recessive trait, in which platelet count is normal but bleeding time is greatly prolonged and clot retraction is defective. The chief clinical finding is a tendency to develop purpura and ecchymosis on trivial injury from early childhood but visceral hemorrhage and hemarthroses are rare. Epistaxes are common. The most striking feature, which is pathognomonic of this disease, is a complete failure of the platelets to aggregate in response to any concentration of ADP, epinephrine ana collagen. The three cases, which meet the diagnostic criteria of Glanzmann's thrombasthenia, are reported with review of the literatures.

Serum Creatine Phosphokinase Isoenzymes in Open Heart Patients: Koo Weon Jeong, Byung Yul Kim*, Hoe Sung Yu*, Myong Joon Cho; Korean J Cytopathol. 1980;14(4):62-68.

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Abstract: Total CPK and the heart-specific isoenzyme of creatine phosphokinase(CPK-MB) values have been studied during operative and postoperative periods in 13 patients undergoing open heart surgery, using cellulose acetate electrophoresis. The results were: 1) Total CPK value of normal control group was 29±6.0 U/L (mean±S.D.) and only MM-fraction was observed. 2) Preoperative total CPK value was 49±50.7 U/L(mean±S.D.) and preoperative MB-fraction was not detected in most patients(l1/13), but detected in two patients(2/13). 3) Peak total CPK activity appeared from pump stop to 2nd postoperative day(39∼49 hours from pump stop) and gradually declined to normal activity by 6th postoperative day. 4) CPK-MB was first detectable during the period of cardiopulmonary bypass in about 46% of cases(6/13). 5) Peak MB isoenzyme was demonstrable during the period of pump stop to 1st postoperative day(16∼25 hours from pump stop) in 12 cases out of 13. 6) Duration of sustained CPK-MB showed no correlation with cardiopulmonary bypass and aortic cross-clamping time. 7) In cases showing relatively persistant CPK-MB, the peak total CPK and MB isoenzyme values were higher and remained for longer period of time, than transient CPK-MB group. 8) 2 cases showing preoperative CPK-MB died postoperatively.

Polycythemia in Korea -A collective study of 9 cases-: Young Hee Jee, Jin Hee Cho, Chong Moo Lee; Korean J Cytopathol. 1980;14(4):69-78.

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Abstract: A clinicopathological analysis on nine cases of polycythemias, diagnosed by laboratory data and bone marrow examination in the Department of Clinical Pathology of the Catholic Medical Center from January 1972 to December 1979, was made and the following results were obtained. 1) Of the total 9 cases, six were male and three female. Six cases were between 45 and 55 years of age. The remaining one was 68 years old, the other was 75 years old and 30 years old. 2) The chief clinical manifestations at the time of the first examination was ruddy cyanosis, splenomegaly, hepatomegaly, gastrointestinal symptoms, dyspnea, hemorrhages and thrombosis(Table 1). 3) Among the laboratory findings(Table 2, 3), the hemoglobin was increased in all cases, and 5 cases showed above 19 gm/dl. The hematocrit was also increased above 50% in a1l cases, the highest value was 70%. The morphology of erythrocytes revealed fairly marked poikylocytosis with tear drop and polychromatophilic erythrocytes in 1 case, and relatively normal morphology in the remaining 8 cases. The erythrocyte counts revealed above 7,000,000/cumm in 3 cases and normal limit in 2 cases. The MCH(mean corpuscular hemoglobin) and MCV(mean corpuscular volume) were in normal limit in 4 cases of polythemia vera and 1 case of relative polycythemia, decreased in 2 cases of polycythemia vera and increased in case of secondary polycythemia. The MCHC(mean corpuscular hemoglobin concentration) was slightly decreased in 5 cases and normal in 2 cases of polycythemia vera but normal in both secondary and relative pelycythemia. The leukocyte count of polycythemia vera revealed above 10,000/cumm in 5 cases and normal in 2 cases. The leukocyte counts of the other two cases were normal. The platelet counts revealed above 250,000/cumm in 4 cases of polycythemia vera and normal in all the remaining cases. The serum uric acid showed above 7.8mg/dl in 5 cases and normal in the other 4 cases, and the highest value was 12.5 mg/dl. The urine uric acid of three cases showed increased value and it was not done in the other six cases. 4) The bone marrow findings revealed hypercellularity in 5 cases. The bone marrow morphology, as judged by the Wright stained smears and hematoxylin eosin stained tissue section particles, showed a marked increased of atypical and giant megakaryocytes in 1 case, a marked increase in normal megakaryocytes in 1 case, mild to moderate increase of normal megakaryocytes in the remaining 4 cases, slight increase of immature megakaryocytes in 1 case, and the other relative and secondary polycythemia were in normal number and morphology. The prussian blue reaction of marrow particles revealed a decrease of iron pigment in the 4 cases of polycythemia vera, and normal limit in 1 case of polycythemia vera, 1 case of secondary polycythemia and 1 case of relative polycythemia.

Endocardial Fibroelastosis with Aortic and Mitral Valve Atresia: Jung Young Lee, Choo Soung Kim; Korean J Cytopathol. 1980;14(4):79-83.

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Abstract: Endocardial fibroelastosis is a disease of obscure etiology and pathogenesis but its gross and microscopic findings have been well known. We have experienced 8-month-old male infant who is diagnosed clinically transposition of great vessel with atrial septal defect. Postmortem examination was performed 96 hours after death. The heart weighed 130gm(normal 35 gm), and was globular in shape. Left ventricle was completely occuluded by aortric and mitral atresia. Left ventricular endocardial surface was pearly white in color and measured up to 2 mm in thickness. Microscopically, left ventricle showed fibroelastic thickening of endocardium. The left atrium was opened to right atrium through patent formen ovale. Aortic arch is very hypoplastic but its main branches and coronary artery were branched out in normal position, and connected with pulmonary artery by widened ductus arteriosus. The other chambers and valvular morphology of heart were free from remarkable findings.

Cystic Partially Differentiated Nephroblastoma -A case report-: Shin Kwang Khang, Je G. Chi, Eui Keun Ham; Korean J Cytopathol. 1980;14(4):84-89.

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Abstract: Nephroblastoma is one of the most common tumors of childhood being preceded only bv leukemia and neuroblastoma in frequency. This tumor can be associated with cystic change in or around the tumor. The explanation for these cystic lesions associated with nephroblastoma is still in controversy, although the hypothesis that they are resulted from spontaneous differentiation of the nephroblastoma is more prevailing. Recently we encountered a large tumor in a kidney of a 3 years old girl, which would best be designated as "cystic partially differentiated nephroblastoma".

Carcinosarcoma of Kidney -A cases report and literature review-: Seung Ha Yang, In Sun Kim, Sung Kun Koh*, Seung Yong Paik; Korean J Cytopathol. 1980;14(4):90-93.

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Abstract: A carcinosarcoma implies a mixed neoplasm containing epithelial and mesenchymal elements, each of which displays a different morphological criterion of malignancy. These neoplasms are relatively rare and mainly encountered in various organs, such as uterus, breast, esophagus, larynx, lung, urinary bladder, prostate and salpinx. In kidney, malignant neoplasm comprised of epithelial and sarcomatous components are usually, designated as Wilms' tumor or nephroblastoma and commonly occur in children. Although most of authors have thought that carcinosarcoma is an adult Wilms' tumor, there well documented cases of carcinosarcoma in adult kidney. We reported a case of carcinosarcoma arising in 42-year-old male kidney, who had underwent three times of operation because of recurrent transitsonal cell carcinoma of urinary bladder. Histologically the neoplasm was composed of epithelial components of transitional and squamous cell carcinoma, and mesenchymal components of fibrosarcoma, myxosarcoma, myosarcoma, and undifferentiated sarcoma.

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