Journal of Pathology and Translational Medicine

Volume 20(3); September 1986

Original Articles

Human Papillomavirus infection in Cervical Intraepithelial Neoplasia: A Comparative Histopathological and Immunohistochemical Study.: Chan Kum Park, Moon Hyang Park, Jung Dal Lee; Korean J Pathol. 1986;20(3):255-262.

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Abstract PDF: One hundred twelve cases of cervical intraepithelial neoplasia (CIN) were reviewed to detect the condylomatous lesion characterized by koilocytotic cells. Condylomatous lesions were present in 12 cases (30.8%) of 39 cases with mild dysplasia, 3 cases (15.0%) of 20 moderate dysplasia, 2 cases (13.3%) of 15 severe dysplasia and 4 cases (10.5%) of 38 cases with carcinoma in situ. These 21 cases with condylomatous lesions were subjected to the study on demonstration of human papillomavirus (HPV) antigen with peroxidase antiperoxidase reaction and 6 simple condylomatous lesions of the uterine cervix were included for control. Twenty seven cases with simple cervical condyloma and condylomatous lesions associated revealed 22 cases of flat type, 3 cases of exophytic type, 1 spiked type, and 1 inverted type. Cells showing a positive reaction for HPV antigen were identified in 5 cases (55.6%) of 27 cases with condylomatous lesions. HPV antigen positive nuclei were found chiefly in koilocytotic cells. The prevalence of HPV antigen positive cells was well correlated with the extent and intraepithelial level of the koilocytotic changes. The results of this study provide a confirmation of the presence of HPV antigens in CIN, and suggest that the HPV may be an important factor in the etiology of CIN.

Study for the Effects of the Polyvalent Pseudomonas Vaccine of the Experimental Pseudomonas sepsis.: Sook Jo Hur, Moon Ho Yang; Korean J Pathol. 1986;20(3):263-276.

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Abstract PDF: Recently there is increasing tendency of the nosocomial infection, and Pseudomonas aeruginosa is one of the most important and common pathogens causing hospital opportunistic infections with rapid emergence of resistant strain especially in immunologically compromised patients. An experimental study for the effects of polyvalent Pseudomonas vaccine was performed in an animal model of Pseudomonas sepsis on a survival rates and histopathological points of view-using ICR inbred mice. The vaccine was prepared with heat killed whole cells of the 10 representative serotypes of Pseudomonas aeruginosa, which were isolated from the Department of Microbiology, College of Medicine, Kyung Hee University and Seoul National University, and they were devided into two polyvalent vaccine groups. The animal model of the Pseudomonas sepsis was deveoped by intravenous inoculation of Pseudomonas aeruginosa (serotype F, inoculum size 100 microliter, 109 cells/ml), immediately after cutaneous burns. The results were as follows. 1) The survival rate of the immune mice was 100% and that of non-immune mice was 60%. 2) The histologic findings of lung of the non-immune mice were severe congestion (18/18 mice), hemorrhage (18/18 mice), emphysematous change (18/18 mice), thrombosis (9/18 mice), infarction (9/18 mice) and inflammation (6/18 mice) and those of the immune mice were only congestion (6/20 mice) and focal emphysematous change (2/20) from the 3 day experimental group. 3) The histologic findings of the liver in the non-immune mice were severe congestion, Kupffer cell mobilization, focal necrosis, & portal inflammation in most of them, and from 7 day experimental group there were noted infiltrations of lagre histiocytic cells in sinusoids, and those in the immune mice were only reactive change of varying degree. 4) The histologic findings of the spleen in the non-immune mice were severe reactive hyperplasia in all and ischemic necrosis in about half of them, and those in the immune mice were only reactive change. 5) The histologic findings of the heart in the non-immune mice were severe congestion and inflammation in most and in the immune mice were only occasional nonspecific congestion. 6) The histologic findings of the kidney in the non-immune mice were severe congestion in all, interstitial inflammation, acute tubular necrosis and cortical necrosis in about half of them, and those in the immune mice were only mild congestion. With the above results, we can suspect there is a significant protective effects of the polyvalent pseudomonas vaccine on the pseudomonas sepsis in ICR mice.

Immunohistopathologic Changes in Experimental Allergic Encephalomyelitis.: Woo Ho Kim, Je G Chi, Sang Kook Lee; Korean J Pathol. 1986;20(3):277-287.

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Abstract PDF: Experimental allergic encephalomyelitis (EAE) has been a well established animal model of postvaccinatal demyelinating diseases occurring in humans. Therefore elucidation of its pathogenesis would be very critical for the understanding of various human demyelinating diseases including multiple sclerosis. This study was performed to characterize the infiltrating cells in inflammatory sites and analyze the nature of the damage of blood brain barrier in experimental allergic encephalomyelitis. Experimental allergic encephalomyelitis was produced by administering homologous spinal cord homogenate together with complete Freund's adjuvant in guinea pigs. Immunostainings on guinea pig IgG, IgM, IgA and muramidase were performed by peroxidase-antiperoxidase or indirect immunofluorescent methods. The blood-brain barrier change was assessed by administering fluorescent Evans blue. Following results were made. In juvenile animals, both clinical findings and histopathologic changes were first noted by 3 weeks after injection and progressed during the whole experimental period. However, these findings were delayed in onset and low in incidence in adult animals. The clinical and pathologic changes started from the caudal portions and extended rostrally. The blood-brain barrier (BBB) was damaged and progressed starting also from the caudal portion of the spinal cord. The BBB changes were more severe in young animal than adult animals. Those changes preceded th histologic alterations. It is suggested that the BBB susceptibility is responsible for the caudal onset of histologic changes. Although the lesion has been thought to be induced by T-cell mediated hypersensitivity, infiltrating cells consisted mainly of muramidase positive histiocytes. A few immunoglobulin positive B cells or plasma cells could also be demonstrated in the lesion. The former usually infiltrated the parenchyme and the latter remained around the small or medium-sized vessels.

The Formation of Giant Mitochondria in the Liver Cells Induced by Hydrazine.: Il Hoon Kwon, Jong Gi Lee, Yoon Kyung Sohn, Tae Joong Sohn; Korean J Pathol. 1986;20(3):288-294.

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Abstract PDF: The authors studied the formation of giant mitochondria in liver cell. The Sprague Dawley rats were sacrificed following intervals; 5, 10, 20, 30, and 60 minutes after intraperitoneal injection of hydrazine in the amount of 200 microliter/kg. And the extracted liver tissues were examined with light and electron microscopes. The results obtained were summarized as follow; Light microscopically, there is little difference between control and experimental groups. Electron microscopically, elongated, bizzare shaped mitochondria are appears 5 minutes after hydrazine injection. Those show attenuated portion, Y, U, or C shaped feature suggesting fusion or budding mitochondria. The number of giant mitochondria is decreased after 10 minutes group and rarely present in 60 minutes group. The results suggest in this experiment that the formation of giant mitochondria is kind of reversible change and it is different from the mitochondrial swelling of cellular injury. Intermitochondrial fusion and mitochondrial budding may be related with the formation of giant mitochondria.

Clinical and Pathological Analysis of Germ cell Tumors.: You Bong Song, Kyu Rae Kim, In Joon Choi; Korean J Pathol. 1986;20(3):295-304.

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Abstract PDF: The germ cells first appear from the primitive streak, the splanchnopleure and the allantoic membrane of the embry and they migrate toward the gonadal ridge. It can happen, however, that some of these germ cells may not migrate to the gonadal ridge and may remain at ectopic sites such as the mediastium, the central nervous system, the sacrococcygeal region and the retroperitoneum. Therefore, germ cell tumors can arise from these ectopic sites and according to their totipotentiality of differentiating into embryonic and extraembryonic tissues, such as chorionic tissues and yolk sac, they can develop into various tumors. Generally, the sites in which these tumors are frequently found are the gonads, the sacrococcygeal region, the mediastinum, the retroperitoneum and the intracranial region. The aim of this study was to organize and report the data found on these tumors in the records of 412 patients whose tumor specimens were examined in the Department of Pathology of the Yonsei University, college of Medicine within the 10 year period, 1976~1985. The findings are as follows: 1) In total 412 cases, the ratio of benign to malignant tumors was 5.8:1. 2) Germ cell tumors occur commonly in the ovary (326 cases: 78.6%). It's incidence was followed by the descending order, in the mediastinum (26 cases: 6.3%), testis (23 cases: 5.6%), central nervous system (15 cases: 3.6%), sacrococcygeal region (11 cases: 2.7%) and retroperitoneal space (7 cases: 1.7%). Also, 2 were found in the intraorbital region and 1 each in the pericardium and the kidney. 3) In extragonadal sites, female were much more common and the sex ratio (M:F) showed 1:10 in sacrococcygeal region. 1:2.5 in retroperitoneum and 1:2.3 in mediastinum. 4) Mature teratoma was found most commonly (85.4%). It's incidence was followed by in descending order, seminoma (including dysgerminoma and germinoma) (6.8%), embryonal carcinoma (2.9%), endodermal sinus tumor (2.0%), immature teratoma (1.7%) and mixed forms (1.2%). 5) Benign teratoma takes up mostly at ovary, retroperitoneal space, sacrococcygeal region and mediastinum by 93.3%, 100.0%, 81.8%, 80.9%, respectively. But in testis and intracranial region, malignancy were more common. 6) Embryonal carcinoma and endodermal sinus tumor occured at similar aged group and each was distributed 41.7% and 62.5% respectively at first decade. 87.5% of dysgerminoma occured at 11~30 aged group, 91.7% of germinoma at 11~20 aged group, 67% mature teratoma at 20~40 aged group, 75% of seminoma at 31~50 aged group, so age distribution showed embryonal carcinoma, endodermal sinus tumor, dysgerminoma/germinoma, mature teratoma and seminoma, in increasing order. 7) In 352 cases of mature teratoma, 347 cases (98.6%) were cystic type and 5 cases (1.4%) were solid type. In 7 cases of immature teratoma, 5 cases (71.4%) were solid and 2 cases (28.6%) were cystic. 8) The incidence of bilaterality were 10.2% in mature teratoma, 12.5% in dysgerminoma and 16.7% in seminoma. 9) When the corredation of the tumor markers, alphafetoprotein and human chorionic gonadotropin, with malignancy was checked in 12 out of 28 cases of tumor of the testis. Either alpha fetoprotein of human chorionic gonadotropin was found to be elevated in 3 cases (75%) in which metastasis was already present at the time of diagnosis, where in 8 cases in which neither marker was elevated, metastasis was found to be present in only 1 (12.8%).

Morphological Changes of Coronary Arteries in Childhood.: Jeong Wook Seo, Je Geun Chi, Chang Yee Hong; Korean J Pathol. 1986;20(3):305-312.

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Abstract PDF: The coronary arteries of young individuals are histologically studied. Fourteen cases in pediatric age group and three adult hearts were used. No case had clinical and pathological evidences of heart disease. Inner circumference, thickness of tunicae intima, media and adventitia were measured at eight different sites of coronary arteries. The thickness of tunica media was used as a standard scale of cardiac growth, and the heart weight, body weight, height and age were compared with the medial thickness. The morphological changes were assessed in five groups by the heart weights. Group I ( less than 10 gm) showed single endothelial lining with cytoplasmic vacuolization or endothelial denudation. Group II (more than 10 but less than 20 gm) consisted of full term babies and showed first stigma of focal intimal thickening and intimal collagen fibers. Diffuse intimal thickening more than 1/1 of medial thickness was first seen in a case with 46 gm of heart weight. Elastic fiber was not seen in internal elastic laminae of groups I and II. Fragmentation of internal elastic lamina and smooth muscle proliferation as a form of musculoelastic layer were the major findings of intimal thickening in childhood and no case showed complicated atherosclerotic lesions.

Pathological Study of Malignant Tumors of Larynx.: Sang Yoon Kim, Eui Keun Ham; Korean J Pathol. 1986;20(3):313-321.

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Abstract PDF: A total of 359 cases of malignant tumors of the larynx (including 87 resected cases) obtained from the pathology file of the Department of Pathology, College of Medicine, Seoul National University during a period of 10 years from 1976 to 1985 were studied by histopathologic and gross investigation with analysis of clinical records, with following results. 1) Out of 359 cases, 356 cases were primary and 3 cases were metastatic. The primary malignant tumors consisted of 348 cases (97.8%) of squamous cell carcinoma, each 2 cases of verrucous carcinoma, malignant lymphoma and undifferentiated carcinoma, a case of adenoid cystic carcinoma and a case of unclassified sarcoma. The metastatic malignant tumors were each one case of renal cell carcinoma, malignant schwanoma and esophageal squamous cell carcinoma. 2) In primary squamous cell carcinoma, the ratio of male to female was 7.8:1 and mean age was 58.2 years (35-87 years). The location was in order of the supraglottic (54.1%), the glottic (25.0%), the transglottic (18.0%), and the subglottic (2.9%). The degree of histologic differentiation was in order of well (72.7%), moderate (23.6%) and poor (3.7%). The tumor stage was stage I in 7.8% of cases, stage II 19.7%, stage III 38.5%, and stage IV 34.0%, and the supraglottic tumors were relatively higher grade than the glottic tumors. 3) The chief complaints of the primary squamous cell carcinoma were mostly hoarseness (70.9% in total case, 49.2% in the supraglottic, 90.9% in the transglottic, and 100% in the glottic and the subglottic), and were variable in the supraglottic cases in order of sore throat, neck mass, throat pain, dyspnea, swallowing difficulty, and foreign body sensation. The duration from the time of first symptom to vistiation was average 7.34 months and was less than 3 months in 45.6% of cases, and showed two peaks, major in 1-2 months and minor in 10-12 months. 4) In the 87 resected cases of primary squamous cell carcinoma, the gross pattern was the ulcerofungating type in 49.4% of cases, the ulceroinfiltrative in 47.1% and flat in 3.5%. The size of tumor was up to 1.5 cm in 30% of cases and more than 1.6 cm in 70%. The extent of invasion was to the submucosa in 40.7% of resected cases, to the laryngeal skeletal muscle(s) 16.3%, to the laryngeal cartilage(s) 33.7%, to the perilaryngeal soft tissue 9.3%. In the 65 cases of lymph node dissection out of these 87 cases, 25 cases (38.5%) showed metastatic lesion(s). With relation to tumor location, lymph node metastases were frequent in the supraglottic, the transglottic and the subglottic region (50-60%) and less common in the glottic region (13.8%). With relation to gross pattern, the metastases were most frequent in ulceroinfiltrative type and none in flat type. And the metastasis rate was increased according to the increase of the tumor size and to the decrease of the tumor differentiation. 5) Smoking history in 140 recorded cases revealed only 8 nonsmokers and average 35.39 pack-years of cigarettes in smoker group with peak in 20-40 pack-yeas (57.2%). 6) Distant metastases were found in 8 cases. The organs were the lung in 5 cases, brain 4 cases, liver 1 case (Three cases were positive in two foci, the lung and the brain). The coexistant primary malignant tumors were found in 8 cases which were 5 bronchogenic squamous cell carcinomas, 2 gastric adenocarcinoma, 1 pancreatic head adenocarcinoma and 1 thyroid papillary carcinoma (Triple primary cancers in one case, of the larynx, the lung and the stomach). 7) Follow-up of 6-53 months (mean 25.8 months) in 115 cases resulted in NED in 62 cases (53.9%) and expired or less resulted in NED in 62 cases (53.9%) and expired or loss of follow-up after recurrence or distant metastasis in 53 cases (46.1%). The recurrence was detected in 2-34 months (average 12.0 months) after treatment.

Presence of Beta-2-microglobulin in Cutaneous Epithelial Tumors.: Byung Doo Lee, Eui Keun Ham; Korean J Pathol. 1986;20(3):322-327.

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Abstract PDF: The Beta-2-microglobulin is the part of light chain of human histocompatibility antigen (HLA). This protein can be observed in most of the human nucleated cells. Some of reports indicated that the Beta-2-microglobulin was lost completely or partially in the malignant or premalignant lesions. Observations on presence of Beta-2-microglobulin were made on 24 cases of malignant, premalignant and benign epithelial umors and 6 cases of normal or non-neoplastic epithelial lesions in the skin, using PAP method. The PAP method. 1) Normal epidermis and no-neoplastic cutaneous lesions (chronic non-specific dematitis, actinic change of skin with pseudoepitheliomatous hyperplasia) showed strong positive staining along the cutaneous epithelial cytoplasmic surface for Beta-2-microglobuin in all 6 cases. 2) Benign cutaneous tumors (keratoacanthoma, squamous cell papilloma and pigmented nevus) showed similar strong positive staining for Beta-2-microglobulin along the epithelial cell surface in 4 out 6 cases. Remaining 2 cases were out of 4 pigmented nevus, which showed weakly or pretty weakly staining. 3) Premalignant cutaneous lesions as solar keratosis showed generally weak positive staining along the epithelial cytoplasmic surface in all 4 cases. 4) Malignant cutaneous tumors (basal cell carcinoma, squamous cell carcinoma, Bowen's disease and malignant melanoma) showed mostly negative staining along the surface of epithelial cells for Beta-2-microglobulin, in 8 out of 14 cases. Remaining 6 cases showed slightly weak or patchy positive staining. As above observation, the presence of Beta-2-microglobulin in cutaneous epithelial lesions using PAP method could be indicated as one of good differential tool for histopathologic diagnosis in cutaneous malignant lesions.

Case Report

Myotubular myopathy: A case report.: Je G Chi; Korean J Pathol. 1986;20(3):328-331.

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Abstract PDF: A case of a myotubular myopathy in a 5 year old boy is described. This was the first and the only boy to a 30 year old mother who had no prenatal or perinatal problems. No family history of muscle disease was present. His muscle weakness started from neonatal period but was very slowly progressive. The developmental milestones were generally delayed. He had repeated episodes of pneumonia. Muscle biopsy revealed characteristic cental nuclei in 68% of myofibers, and this findings was associated with generally small and round fibers and minimal interstitial change. No inflammatory reaction was present.

Original Article

Aspiration Biopsy Cytology of Malignant Fibrous Histiocytoma.: Moon Hyang Park, Eun Kyung Hong, Jung Dal Lee; Korean J Pathol. 1986;20(3):332-335.

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Abstract PDF: Cytologic findings of malignant cells obtained by fine needle aspiration from a huge retroperitoneal malignant fibrous histiocytoma were described. The smears contained numerous malignant cells, isolated or in clusters, in a bloody background. The malignant cells had abundant pleomorphic foamy or acidophilic cytoplasm with occasional multilobated vesicular nuclei and prominent nucleoli. Dual differentiation, both histiocytic and fibroblastic types, and neutrophilic inflammatory background were diagnostic of this neoplasm. The report indicated that study of aspiration cytology specimen from a soft tissue tumor was a valuable adjunct to histologic examination.

Case Reports

Potter Syndrome in a Fetus with Trisomy-8 mosaicism: Report of a Case.: Kyu Rae Kim, Han Young Lee, Chan Il Park, Chang Kyu Kim, Myeong Seon Lee, Young Won Park, Young Ho Yang, Tchan Kyu Park; Korean J Pathol. 1986;20(3):336-342.

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Abstract PDF: Since the identification of the C-group chromosome has been made possible by the introduction of banding technique, the features of the trisomy-8 syndrome have been defined. Most of them have been mosaics and have had similar clinical findings. A case of Trisomy-8 mosaicism confirmed by G-banding analysis by skin fibroblast and heart blood in a dead female fetus of 35 weeks of gestation is described.

Edwards Syndrome: an autopsy case.: So Young Jin, Woo Hee Jung, Chang Ho Hong; Korean J Pathol. 1986;20(3):343-348.

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Abstract PDF: Edwards syndrome is first introduced by Edwards and characterized by facial anomalies, multiple cardiovascular, gastrointestinal, urogenital, and skeletal malformations. It results from triplication of part or all of chromosome 18 in some or all of the patient's cells. It has an incidence of 1 in 4,500 live births or less and short life expectancy. Recently we experienced a case of 3-day-old female new born infant with this syndrome. Post mortem examination showed progeric face with prominent occiput, large flabby ears, microphthalmia, and micrognathia, bilateral clenched hands with flexion contraction of middle fingers, and bilateral rockerbottom feet. Internal examination revealed horseshoe kidney, esophageal atresia with tracheoesophageal fistula, two accessory spleens, and multiple cardiac anomalies. A trisomy 18 was confirmed by the cytogenetic study.

Urachal anomaly: Two Cases Report.: Jung Ran Kim, Eun Hee Suh, Je G Chi, Hyung Soo Kim, Choong Hee Kim; Korean J Pathol. 1986;20(3):349-354.

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Abstract: Two cases of urachal anomaly (1 urachal cyst and 1 patent urachus) are reported in a neonate and an eleven-year old boy, respectively. In case 1, the patient was born after an uncomplicated pregnancy to a mother who had taken progesterone during the first trimester. Because of breech presentation, cesarian section was elected to deliver a male baby weighing 2.3 kg who showed abdominal distension. The patient died of respiratory difficulty several minutes after birth. At autopsy, there was a large cyst in the midpoint of the abdominal and pelvic cavity. This round cyst was composed of two components, urachus and urinary bladder. No area of umbilicocystic fistula was present. The lining epithelium was chiefly of transitional type. Assocaited anomalies were segmental stenosis of posterior urethra, absence of abdominal musculature, bilateral polycystic kidney of Potter type IV, hydroureter, and hypoplasia of lungs. Low set ears, micrognathia and club foot were also present. In case 2 the patient was 11-year old boy. He had suffered from intermittent urinary dribbling from umbilicus since early infancy, whenever the abdominal pressure was increased. The patency of urachus was confirmed by fistulography. And the urachal anomaly was surgically removed. Histopathologically the resected patent urachus consisted of pseudostratified columnar to transitional epithelium resting on fibrous stroma mixed with well formed smooth muscle bundles.

Richter's Syndrome: A Case report.: Han Young Lee, Kyu Rae Kim, I J Choi; Korean J Pathol. 1986;20(3):355-358.

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Abstract: Richter's syndrome is generally accepted taht lymphoma or leukemia of low grade malignancy, during their course, may alter both their morphologic and clinical appearance and evolve into highly malignant neoplasia. The pathogenesis is not clear, however, dedifferentiation by the emergence of a new clone of cells of higher maligancy similar to the blastic transformation in chronic myelocytic leukemia is suggested as possible mechanism. A case of Richter's syndrome is described. This 45 year old female had been diagnosed as chronic lymphocytic leukemia by absolute peripheral lymphocytosis 5 months before, developed sudden severe abdominal pain and was received segmental resection of ileum under the clinical impression of intestinal perforation with peritonitis. Histologically, the ulcer margin was diffusely infiltrated by polymorphic cells composed of large atypical cells having vesicular nuclei, multinucleated giant cells and Reed-Sternberg like cells admixed with mature lymphocytes. These atypical and multinucleated cells of the paraffin section showed strong monoclonal immunoreactivity for IgG and lambda light chain by PAP method and was interpreted as malignant lymphoma, diffuse, large cell, immunoblastic, polymorphous.

Occult Hepatocellular Carcinoma Metastasized to Heart: A case report.: Nam Jin Yoo, Jung Yong Lee, Seok Jin Gang, Byung Kee Kim, Sun Moo Kim; Korean J Pathol. 1986;20(3):359-361.

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Abstract: We have experienced a case of occult hepatocellular carcinoma metastasized to the heart in a 41 year old female. The hepatocellular carcinoma invaded the hepatic vein, grew in a snakelike fashion up the inferior vena cava and reached the right atrium. Ultrastural examination in this case confirmed the hepatocellular origin of the tumor.

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