Journal of Pathology and Translational Medicine

Volume 15(4); December 1981

Etcs

Titers and Fluorescence Patterns of Antinuclear Antibody(ANA) in Autoimmune Diseases: Chong Soon Rhee, Kyung Won Lee, Kyung Soon Song, Samuel Y. Lee; Korean J Cytopathol. 1981;15(4):393-400.

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Abstract: Immunologic evaluation of patients for autoimmune diseases begins with the search for humoral or cellular immune components that is directed against the patient's oven tissues. In Korea no study has been made on the clinical significance of ANA titer and nuclear staning pattern which are shown by the specimens tested by indirect immunofluorescent technique. From January to December, 1980, 471 serum specimens were obtained from patients who were supected to have autoimmune diseases. The specimens were tested by indirect immunofluorescent technique. The following results were obtained. 1) There were 52 ANA positive specimens. Among these, 28 were low, 7 intermediate and 17 high titers. 2) All SLE patients, scleroderma Patients and the majority of rheumatoid arthritis patients showed high titers, while other diseases (Table 2) showed low titers. 3) The majority of SLE patients stowed homogenous pattern. 4) The ANA test was a more sensitive indicator than LE cell test or anti DNA test in the detection of SLE. From this study it is concluded that the ANA test is a very sensitive test in the detection of autoimmune diseases, SLE in particular, but the specificity is relatively low. In this connection, the titers and patterns of ANA test are quite helpful to increase its specificity.

A Study on Thirteen Cases of Erythroleukemia in Korea: In Sook Chung, Sang In Shim, Sun Moo Kim, Chong Moo Lee; Korean J Cytopathol. 1981;15(4):401-408.

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Abstract: Since the description of acute erythremic myelosis by Di Gug1ielmo in 1928, several different and overlapping terms including erythroleukemia, erythremic myelosis, Di Guglielmo's disease and Di Guglielmo's syndrome have been used to encompass this entity. During the past ten years from January 1971 to December 1980, we have experienced 13 cases of erythroleukemia which were diagnosed in the course of the routine tone marrow studies at the Catholic Medical Center in Seoul. This 13 cases occupied 3.4% of all leukemia diagnosed by the routine bone marrow studies during the same 10 year period. Of the 13 cases, there were 9 males and 4 females Cases were distributed in all age groups from the first to the fifth decade and 5 of the 13 cases were found in the first decade. The chief complaints at the time of first admission were pallor (77%), general weakness(39%), fever(39%), dyspnea(32%), and bleeding tendency(31%). There were hepatomegaly in 10 cases(77%), splenomegaly 6 cases(46%) and petechia or ecchymosis 5 cases (39% ). The peripheral blood findings are summarized in Table 6. In the majority of the cases, the type of the anemia was of normocytic and normochromic type. However, mild to moderate degree of reticulocytosis was found in the majority of the cases suggestingan excessive hemolytic process. Nucleated red blood cells were found in all of 13 cases. The leukocyte count varies from subnormal count to moderately increased number, and leukemic cells, mostly leukemic myeloblasts and occasionally leukemic progranulocytes were found in all but one cases in our series. Platelets were decreased in number in 9 of the 13 crises. The bone marrow findings showed about 100% cellularity of the tissue section particles and showed marrow cell hyperplasia virtually in all of our crises. The relative number of the erythroblasts stowed a marked variation, in some cases occupying more than 90% of all nucleated elements. In other cases, the erythrocytic hyperplasia was of a less marked degree. And in still other cases, leukemic cells outnumbered the erythrocytic precursors. The megalotlastoid pictures of the erythrocytic precursors were found in all of the cases. The leukemic myeloblasts were found in almost all cases, though the relative number and the degree of anaplasia varied according to the individual cases. In one case, the morphology of the leukemic cells showed rather distinct myelomonocytic appearance. And one patient showed myelofibrosis in the course of the disease.

Salmonella Isolated from Purulent Specimens: Chang Hyun Rhim, Young Sook Choi, Yunsop Chong, Samuel Y. Lee, Younghat Ryu; Korean J Cytopathol. 1981;15(4):409-414.

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Abstract: Aside from the usual intestinal infections of salmonella, suppurative infections of different anatomic sites have been increasingly reported. During the period of 1977 to 1980, the authors isolated salmonella from 12 specimens obtained from unusual anatomic sites of patients at Yonsei Medical Center. The specimens or sources of isolation and diagnosis or underlying conditions were CSF with subdural abscess. CSF with meningitis, abscess of right neck with mediastinal teratoma, throat with patent ductus arteriosus, chest wall abscess with septic arthritis, rib abscess with tuberculous chondritis, osteomyelitis of humerus, osteomyelitis of tibia, psoas abscess, tubo-ovarian abscess, placenta with incomplete abortion, and retroperitoneal abscess with diabetes mellitus. Isolated salmonella were S. typhi 4, S.paratyphi-A 4, S.hirschfeldii(S. paratyphi-C) 2, and Salmonella group D 2. It can be said that salmonella abscess are not different clinically from other suppurative lesions, and the correct etiological diagnosis can be made solely on the basis of bacterial culture.

Infections with Acinetobacter calcoaceticus: Eui Chong Kim, Young Joo Cha, Jong Sung Suck, Myoung Hee Park, Sang In Kim; Korean J Cytopathol. 1981;15(4):415-421.

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Abstract: Acinetobacter calcoaceticus is widely prevalent in nature and frequently is a commensal in humans. In recent years, however, infections due to this organism are considered to occur more frequently than commonly appreciated, especially among seriously ill hospitalize patients. A spectrum of clinical infections due to A. calcoaceticus seen in 119 patients at Seoul National University Hospital over a one-year period is presented through at retrospective review of 242 patients with Positive culture for A. calcoaceticus. The results are as follows. 1) Most frequent type of specimens from which A. calcoaceticus was isolated was sputum(37%) followed by pus(30%), urine(24%), and blood(9%) in decreasing order of frequency. 2) Other organisms were isolated in combination with A. calcoaceticus in 40% of the infoctions. 3) According to Glew's diagnostic criteria, 119(49%) out of 242 patients were diagnosed as significant clinical infection due to A. calcoaceticus. Most frequent type of significant acinetobacter infection was pulmonary(35%) and urinary(35%) followed by wound infection(27%) and septicelaia(3%). 4) Virtually all of the patients had one of more underlying diseases or predisposing factors; prior antibiotic therapy(79%), instrumentation(11%), local trauma and disease(53%) and surgery (49%). 5) Mortality rate ascribed to A. calcoaceticug infection was 7% and especially high mortality was encountered in patients with pneumonia (l7%). 6) Antibiotic sensitivity test revealed relatively high susceptibility of A. calcoaceticus to gentamicin and claforan (HR 756), however the sensitivity pattern was quite variable among different strains of A. calcoaceticus.

Results of blood cultures at Seoul National University Hospital in 1980: Kyu Man Lee, Myoung Hee Park, Sang In Kim; Korean J Cytopathol. 1981;15(4):422-428.

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Abstract: Total 3,808 blood specimens from 1,891 patients were cultured at Seoul National University Hospital in 1980. Laboratory data were analyzed and the following results were obtained. 1) Average number of specimens requested per one patient was 2. 2) 328 patients (17.4%) of the total 1,891 patients had at least 1 positive blood culture. Of these patients with bacteriologically established bacteremia, 6.7% had multiple isolates from a single specimen (poly-microbial bacteremia), and 2.1% had different isolates in additional blood culture (bacteremic superinfection). 3) Distribution of organisms (single isolate) involved in patients with bacteriologically proven bacteremia were gram-negative bacilli 71.3%, gram-positive cocci 27. 1% and anaerobes 1.6%. Frequently isolated organisms in decreasing order were Enterobacterieae (31%), Salmonella spp. (17.4%), Psendomonas spp. (10.5%), Staph. aureus (9.2%) and alpha hemolytic streptococcus(7.5%). 4) Salmonella typhi was susceptable to commonly used antimicrobial agents but many of the isolates of Staph. aureus, E. coli and Ps. aerugiuosa were resistant to routinely tested antimicrobial agents

Yersinia enterocolitica Gastroenteritis: A case report: Kyoung Sook Kim, Yunsop Chong, Samuel Y. Lee, Younghat Ryu, Jun Hee Sul*; Korean J Cytopathol. 1981;15(4):429-434.

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Abstract: Yersinia enterocolitica was isolated from a stool specimen of a 11-year-old male patient with gastroenteritis, admitted to Yonsei Medical Center in July 1981. This was the fifth isolate at the Center. From the patient, other enteropathogenic bacteria was not isolated, The isolate showed typical cultural and biochemical characteristics of Y. enterocolitica. The Wauter's biotype was determined to be 3. The isolate was resistant to ampicillin, carbenicillin, cefoxitin and cephalothin, and susceptible to other antimicrobials determined by Kirby-Bauer disc diffusion method. The patient recovered after receiving fluid therapy together with antidiarrheal agent and ampicillin.

Antibiotic-associated Pseudomembranous Colitis: Jung Dal Lee, Young Il Min*, Hyun Sook Chi; Korean J Cytopathol. 1981;15(4):435-441.

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Abstract: Four cases of pseudomembranous colitis following antibiotic therapy are reported. Special attention is focused on clinical manifestations and histologic features. The clinical manifestation along with history is quite characteristic, if not specific, suggesting the colonic lesions to be post-antibiotic. Colonoscopic examination is diagnostic in four cases studied, and the lesions consist of discrete 0.2 to 2cm raised plaques adherent to an edematous, friable mucosa. The pathologic picture in pseudomembranous colitis is quite distinctive. The diagnostic histological findings include a "mushroom" or "volcano" appearance of the pseudomembrane with sudden transition to normal mucosa adjacent to the lesion.

Angiosarcoma of the Spleen with Spontaneous Rupture: In Sook Chung, Sang In Shim, Chong Moo Lee; Korean J Cytopathol. 1981;15(4):442-444.

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Abstract: An angiosarcoma of the spleen is uncommon and often accompanied by hematologic abnormalities of hemolytic anemia, thromtocytopenia, reticulocytosis, and unusual spontaneous rupture occurs in about one third of the cases. We recently experienced a 65-year-old woman with spontaneous rupture of an angiosarcoma of the spleen. A brief review of the literature was made.

Giant Cell Carcinoma of the Colon -A Case Report-: Jae Hyung Yoo, Kye Yong Song, Tae Soo Park, Jung Hyo Lee*, Sung Il Park*, Sun Taik Chang*; Korean J Cytopathol. 1981;15(4):445-448.

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Abstract: Giant cell carcinoma also called as pleomorptic anaplastic carcinoma is rare and progresses fulminant clinical course. Major diagnostic features are pleomorphic and izarre tumor giant cells with abundant foamy cytoplasm, intense neutrophilic infiltration and leukophagocytosis (emperipolesis) by tumor giant cells. Primary gains cell arcinoma have been reported in lungs, thyroid, pancreas and recently in liver, but this carcinoma in colon has not been described, although giant cell tumor of the bone like neoplasm in colon was reported. It was suggested that this neoplasm was glandular epithelial origin by many authors and confirmed by tissue culture. We have experienced a case of mixed form of primary giant cell carcinoma of colon in a 51 year old male in the Sung-Sim Hospital, Chung-Ang University.

Five Cases of Yersinia Enterocolitica Enteritis in Adults: Sung Hae Ahn, Jin Tae Suh, Hyun Sook Chi, Jung Dal Lee; Korean J Cytopathol. 1981;15(4):449-457.

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Abstract: During the period of 6 months from November 1980 to April 1981, five strains of Yersinia enterocolitica were isolated from fecal materials of adult patients with acute enterocolitis. The followings are summary of our experience on the strains isolated. 1) All of the organisms were isolated from the S-S agar plates after inoculation in 18 hours' selenite F broth. The cultural difficulty was due to both very slow growing rate and sensitivity to the temperature of the organisms. 2) The isolates revealed cultural and biochemical characteristics on the conventional and API-2OE methods. Three isolates were indole negative at room temperature, belonging to Wauter's biotype 3, and two were indole positive, belonging to the biotype 2. 3) The isolates were all susceptible to amik1acin, chloramphenicol, gentamicin, kanamycin, streptomycin, tetracyclin, and three strains of biotype 3 showed resistance to cephalothin, ampicillin and carbenicillin, while biotype 2 strains were resistant to cephalothin. 4) The five patients of Yersiniosis were well controlled by ampicillin, lianamycin and septrin, in single or in combination chemotherapy.

Malignant Sacrococcygeal Teratoma in Fetus: Chung Sik Lee, Tae Sook Lee, Dae Yong Kang*; Korean J Cytopathol. 1981;15(4):458-461.

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Abstract: The most common site of the teratoma in infant and children is sacrococcygeal region, but is rare tumor with incidence of one in 20,000-40,000 birth. It rests anatomically behind the rectum and anterior to the sacrum, and usually has an external portion of variable size. The tumor occurs predominantly in females and appears to be associated frequently with twins, family history of twinning, or malformation. Usually the sacrococcygeal teratoma has a benign fashion in neonate, but there is a definite propensity to undergo malignant change, usually after 4 months of life. We have experienced a case of malignant sacrococcygeal teratoma in 27 weeks old girl who was died in maternal uterus. The mass, 830gm in weight, discloses variable degrees of differentiation of teratoma with malignant foci in histologic examination.

A Case of Intracerebral Menigioma: Bock Hee Park, Han Chul Son, Soon Ho Kim; Korean J Cytopathol. 1981;15(4):462-465.

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Abstract: A cases of intracerebral meningioma, arising from the left frontal lobe of the brain was reported. A 14-year-old Korean female was admitted to the department of Neurosurgery, in BNUH, 1981, because of lateral deviation of the left pupil and visual disturbance of the left eye. She had suffered from headache and lateral deviation of the left pupil for one year. On physical examination at admission, there was narrowed visual field, fixed left pupil to upward medial gaze. The cerebrospinal examination reveals within normal limit. On carotid angiography, the anterior cerebral artery was found backward displacement of proximal portion. The brain CT scan showed well circumscribed enhancing tumorous mass of the left frontal lobe, that was surrounded by marked edema and compressed frontal horn with 3-4mm intracranial shifting to right. On left frontal craniotomy dural tension was found to be normal without any evidence of staining. With the dura opened, the gyri were seen to be flattened and the sulci somewhat effaced. Tumor tissue not noticeable at the brain surface. The frontal lobe showed increased consistency. Incision of the cortex produced a sharply demarcated tumor in a depth of 1cm, which was removed totally. Grossly the specimen consisted of several pieces of gray white irregular masses with elastic rubery consistency. The cut surfaces of them disclosed gray white homogenous tissue with no hemorrhage and necrosis. Histologically, the tumorous masses were composed of whorl formations of elongated and crescent-shaped meningioma cells with a central capillary. There was a few psammoma bodies in the whorls. In some place, there was also noted meningiotheliomatous meningioma cells.

A Case of Paroxysmal Nocturnal Hemoglobinuria: Sam-Im Choi, Joo-Yong Yoo; Korean J Cytopathol. 1981;15(4):466-471.

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Abstract: Paroxysmal nocturnal hemoglouinuria(PNH) is a disorder of the hematopoietic stem cell that results in the production of a clone of defective red blood cells in circulating lines. Clinical and laboratory observations were made in a case of PNH admitted to Chonnam University Hospital. The patient was 16-year-old female who complained general weakness and headache. The peripheral blood revealed anemia with reticulocytosis. Whole blood screening test, sucrose hemolysis test and Ham's test were positive. Serum bilirubin was moderately increased. On urinalysis, marked hemoglotinuria and hemosiderinuria were shown. The bone marrow aspiration revealed decreased cellularity with marked erythroid hyperplasia. She was treated with transfusion of packed red cells and discharged with partial alleviation of clinical manifestation.

Cytomegaly of the Adrenal Gland: Jae Hyung Yoo, Kye Yong Song, Je Geun Chi*; Korean J Cytopathol. 1981;15(4):472-476.

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Abstract: Cytomegaly, a unique and interesting morphologic change seen in the fetal zone of human adrenal gland, was first introduced by Kampmeier in 1927 as giant epithelial cells of the human fetal adrenal gland. It has been further described by Craig and Landing, Potter and Morrison, and Potter(1952) termed it "Cytomegaly of the adrenal gland." Although adrenal cytomegaly has coexistent conditions such as several congenital anomalies, erythroblastosis fetalis, congenital syphilis and Beckwith-Wiefemann syndrome, etc., the significance of it is not yet elucidated. We have reported three autopsy cases of adrenal cytomegaly. This three cases represent 0.42% in incidence of total 850 fetal and neonatal autopsies and 0.3% in incidence among 1,000 autopsies including adults. All three cases were found in fetus of 20 weeks of gestational age, still-birth baby of 37 weeks gestational age and newborn infant of 1 day old. One of three cases was associated with congenital syphilis. The other case showed adrenal cytomegaly in heterotopic adrenal nodule found in paratesticular area, and another case revealed in the adrenal gland without other combined disease.

Three Cases of Systemic Cryptococcosis: Dong Kyu Chung; Korean J Cytopathol. 1981;15(4):477-481.

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Abstract: Cryptococcal infection is now not so rare a disease in Far East Asia. The author present three cases of systemic cryptococcosis experienced in pathology, P.M.C. Case I had involvement of the liver, spleen, kidney, lymph-nodes, adrenal glands and train, and case II and case III C.N.S. and liver. Numerous cryptococcus neoformans were found in the affected organs and tissues. The author discuss incidence, diagnostic and pathologic problems and drugs. Routine India ink preparation and repeat of spinal fluid examination were emphasized in the cases of meningitis. In ambiguous cases, urine, sputum, blood, bone marrow and stool examination can help identify a fungus infection. Amphotericin-B is the most effective drug to combat fungal infection upto present. 5-fluorocytocine is a new drug, but more evaluation is required because of little experience with it.

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