Journal of Pathology and Translational Medicine

Volume 25(1); February 1991

Original Articles

Phospholipidosis of Liver Induced by Amiodarone.: Dong Hoon Kim, Gium Mi Jang, In Soo Suh, Tae Joong Sohn; Korean J Pathol. 1991;25(1):1-10.

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Abstract PDF: Ultrastructural study of the effects of amiodarone on the liver tissue was performed. Rats were fed with amiodarone containing diet and were sacrificerd at 1st, 3rd, 4th, 5th and 8th weeks of experiment. Charateristic lisosomal inclusion bodies were appeared form first week, which were more prominent and increased in size at the 5th and 8th week of experiment. These inclusion bodies were found in hepatocytes, Kupffer cells, bile duct epithelial cells and fibroblasts but most prominent in hepatocytes. The lysosomal inclusion bodies could be divided into four types; those characterized by (1) dense bodies with packed crystaloid contents, (2) multilamellated bodies, (3) irregular shaped bodies with varying electron density and 4. dense bodies containing stacks of fine membranous structures. All types were found in all experimental groups. But the type 1 and 2 were predominent at early stage, while type 3 and 4 were more prominent at later stage According to these findings, the formation of the lysosmal inclusion body was a characteristic change in derangement of phospholipid metabolism. And amiodarone could induce disturbance of phospholipid metabolism in all kinds of cells in liver tissue.

Immunohistochemical Staining of Ovarian Tumors.: Young Seak Kim, Yang Seok Chae, In Sun Kim, Seung Yong Paik; Korean J Pathol. 1991;25(1):11-20.

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Abstract PDF: Forty-four ovairan tumors were immunohistochemically studied for the presence of broad-spectrum keratin, vimentin, desin, carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP), and alpha 1-antitrypsin (AAT) in formalin-fixed, paraffin-embedded tissues. 1) Among the common epithelial tumors, all the serous carcinomas (4) expressed keratin and AAT, and one additionally CEA. Six mucinous carcinomas exhibited keratin-positivity in two. One endometrioid carcinoma coexpressed keratin and vimentin as well as AAT, but one clear cell carcinoma expressed only keratin. Keratin-and CEA-positivity in epithelial cell nests and vimentin-positivity in stromal cells were observed in two Brenner tumors. Two undifferentiated carcinomas showed keratin-positivity in one and focal CEA positivity in the other. 2) In sex cord-stromal tumors, four out of six granulsa cell tumors, all four thecomas and three fibromas expressed vimentin, and two granulosa cell tumors and two thecomas showed AAT-positivity. The others were negative. 3) Among germ cell tumors, four dysgerminomas showed focal vimentin-positive cells in two and diffuse staining for AAT. Seven endodermal sinus tumors expressed AAT in all. Additionally, AFP were positive in two and CEA in three out of them. One embryonal carcinoma expressed CEA, AAT and AFP. 4) In four metastatic carcinomas, three exhibited keratin-and CEA-positivity, whereas one exhibited keartin-and vimentin-positivity. All showed AAT-positivity. 5) There was no positive case for desmin among ovarian tumors.

The Effect of Ethanol on 3'-Methyl-4-dimethylaminoazobenzene Induced Carcinogenesis in Rat Liver.: Chan Il Park, Ho Guen Kim, So Young Jin, Woo Ick Yang, Yoo Bock Lee; Korean J Pathol. 1991;25(1):21-29.

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Abstract PDF: This study is aimed to elucidate the biological nature of the precancerous lesions and to evaluate whether the ethanol alters 3'-Methyl-4-dimethylaminoazobenzene (3'-Me-DAB) induced experimental hepatocarcinogenesis. A total of 108 Sprague-Dawley male rats were used for the experiment and divided into 6 groups according to 3'-Me-DAB and ethanol administration. Administration of the drugs were carried out daily by nasogastric tube insertion and the animals were sacrificed at different interval. A part of right lateral lobe was prepared for the histological examination. Cell kinetics of the immunohistochemical method for bromodeoxyuridine (BrdU). The administration of 3'-Me-DAB induced oval cell proliferation, hyperplastic nodule, cholangiofibrosis and carcinoma in the liver. The mean labelling indices, the percentages of BrdU labelled cells, of hepatocytes were increased by administration of 3'-Me-DAB, only to reverse after cessation of the drug (2.58 vs 0.61). The labelling indices of the oval cells were also affected by the administration and cessation of 3'-Me-DAB (11.41 vs 4.48). In contrast, the cholangiofibrosis did not decrease but were still increasing following cessation of 3'-Me-DAB administration (4.37 vs 5.17 and 8.25 vs 11.29). These finding that the hyperplastic nodule and particularly the cholangiofibrosis have an autonomous proliferative potential and are definite precancerous lesions in the experimental hepatocarcinogenesis. Short term administration of ethanol decreased the incidence of development of the precancerous lesions, but did not affect the labelling indices in all the pathologic lesions of hepatocarcinogenesis.

Cantrell's Syndrome: It's relationship to ectopia cordis.: Je G Chi; Korean J Pathol. 1991;25(1):30-36.

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Abstract PDF: A syndrome featuring defects of the heart, sternum, diaphragm, and anterior abdominal wall has been designated as Cantrell's syndrome. Since Cantrell described this syndrome as one type of ectopia cordis there has been debate and confusion in the literature on its entity particularly in relationship to ectopia cordis. Since ectopia cordis is defined as "the heart is completely or incompletely located outside the mediastinum" and every case Cantrell's syndrome is associated with pericardial and diaphragmatic defects as well as low sternal defect, these two seemingly different entities should be closely related or may even be in the spectrum of same anomaly complex. With above speculation in mind we have reviewed two cases of typical Cantrell's syndrome, two cases of typical ectopia cordis and a case of bifid sternum from autopsy file of Seoul National University Children's Hospital. Findings pertinent to the differential diagnosis are tabulated. Based on postmortem findings on these 5 cases it was concluded that these three anomaly complexes are essentially same, being only different in severity and probably of time of occurrence during developmental period. Therefore it was suggested that the definition of Cantrell's syndrome should be extended to include all cases of ectopia cordis. Or the whole syndrome could be redesignated as midline defect syndrome because it involves the midline of the body and is always multiple and complex anomaly.

Case Reports

Cardiac Fibroma of the Ventricular Septum: A case report.: Byung Tae Park, Se Jin Jang, Moon Hyang Park, Jung Dal Lee, Hyo Jin Lee; Korean J Pathol. 1991;25(1):37-41.

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Abstract PDF: This is an autopsy case of a 6 month old girl who suddenly died of respiratory distress during sleep. She had suffered from mild but frequent episodes of common cold and was treated for eczema for several days. At autopsy, the heart was enlarged and weighed 100 gm. A firm and gray-white tumor, measuring 4.5 x 3.8 x 2.8 cm, was located in the interventricular septum and encroached upon the wall of left ventricle. The mass was well demarcated but was not encapsulated. Neither necrosis nor calcification was present. Microscopically the tumor was composed of haphazardly arranged bundles of collagen fibers and fibroblasts. Myocardial cells are intermingled with the fibroblasts at the margin of the tumor. Massive edema of the lung and congestion of the liver and spleen were pronounced.

Xanthogranulomatous Cholecystitis: 3 cases report.: Jae Hoon Park, Youn Wha Kim, Yong Koo Park, Ju Hie Lee, Moon Ho Yang; Korean J Pathol. 1991;25(1):41-44.

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Abstract PDF: Xanthogranulomatous cholecystitis is a rare form of inflammatory disease of the gall bladder and was first described in 1970 by Christensen and Ishak as fibroxanthogranulomatous inflammation of the gall bladder. Recently authors experienced three cases of xanthogranulomatous cholecystitis, two of which were erroneously diagnosed as malignant tumor in preoperative clinical and radiological examinations. Grossly, the gallbladders were enlarged and the walls were thickened with yellowish granular necrotic areas ranging from a few millimeters to 1.0 cm in diameter. Microscopically, all of three cases showed diffuse infiltration of the foamy histiocytes containing bile pigments and mononuclear leukocytes associated with fibroblastic proliferation and foreign body reactions. The pathogenesis of the xanthogranulomatous cholecystitis is uncertain, but opinion favours an inflammatory response to extravasated bile probably, from ruptured Rokitanky-Aschoff sinuses. Three cases of xanthogranulomatous cholecystitis with brief review of literature are presented.

Original Article

Sinusoidal Involvement of Malinant Lymphoma in Lymph Nodes Simulating Metastatic Carcinoma.: Young Seak Kim, Mi Kyung Shin, In Sun Kim; Korean J Pathol. 1991;25(1):45-49.

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Abstract PDF: We present a case of this distinctive variety of malignant lymphoma, which was diagnosed in the axillary lymph nodes of a 66-year-old woman. The patient was admitted to the GS department due to palpable mass on the right axillary area for two months. A 2 x 1 cm sized mass was also palpated on the cervical area. The laboratory and radiologic findings were unremarkable. Axillary dissection was done under the impression of metastatic carcinoma from breast. Received lymph nodes were multiple and variable in size, ranging from 0.5 cm to 5.0 cm in diameter. Histologically, the lymph nodes were partly effaced and involved by nodular and diffuse infiltrations of large lymphoid cells in the subcapsular and medullary sinuses. In diffuse areas, typical starry-sky pattern was seen. Immunohistochemically, the tumor cells were negative for broad-spectrum keratin, but positive for leukocyte antigen, ML, and B cell markers, L26, and 4KB5. T cell marker. UCHL1 was negative. On staining with histiocytic marker, Mac387 antibody, the tingible-body macrophages were only positive. Interstitial plasma cells and some of the tumor cells were positive for lambda light chain. Electron microscopic study, which was done on paraffin embedded tissue showed lymphoid-type of nuclei without cellular junction suggestive for carcinoma.

Case Reports

Congenital Hepatic Fibrosis: A case report.: Weon Young Choi, Sun Hee Yoon, In Sook Lim, Ha Jin Choi; Korean J Pathol. 1991;25(1):50-53.

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Abstract PDF: Congenital hepatic fibrosis is an uncommon disease of children and young adults with two major risks: gastrointestinal hemorrhage caused by portal hypertension, and cholangitis related to bacterial infection of dilated intrahepatic bile ducts. It is characterizeed by stony hard hepatomegaly and portal hypertension with rather well preserved hepatic function and architecture, and frequent association of the renal lesions. We have recently experienced a case of congenital hepatic fibrosis in a 24 year-old Korean male. The chief complaint was hematemesis from esophageal varices. There were marked hepatosplenomegaly, mild pancytopenia and the liver function test was within normal engorgement and dilatation of portal and splenic veins and multiple cysts of both kidneys.

Adenoid Squamous Cell Carcinoma of the Vulva: Report of a case.: Chang Ok Kim, Ki Hwa Yang, Seok Jin Gang, Ahn Hee Lee, Byoung Kee Kim, Sun Moo Kim; Korean J Pathol. 1991;25(1):54-58.

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Abstract PDF: In 1947, Liver described adenoid squamous cell carcinoma under the title of "adenoacanthoma of sweat gland". This tumor is not rare, but reported cases in literatures were relatively few. The tumor were frequently found in the sun-exposed skin; such as face, ear, neck etc.. The cases involving non-sun-exposed area, such as oral and labial mucosa, nosopharynx and vulva etc., were also reported. Therefore, the relation between the pathogenesis of adenoid squamous cell carcinoma and sun damage has been still debated. Immunohistochemical studies have recently suggested that this tumor is squamous cell carcinoma undergoing acantholysis. The authors experienced a case of adenoid squamous cell carcinoma of the vulva in a seventy-one year old female patient. She had suffered from itching sensation on vulva for 10 years, and palpable mass on vulva for 1 month. On gross examination, a pale gray pigmentation and erosion, was noted at the right labia major, the minor extending left labia major and minor. On microscopic examination, nests of atypical epithelial cells extending into the cornium showed an adenoid architecture. These were composed of a peripheral layers of cuboidal cell in a lacy pattern. And the glandular spaces contained dyskeratotic acantholytic tumor cells in central portion. Therefore we diagnosed this case as adenoid squamous cell carcinoma of the vulva.

Meningioma, Hemangiopericytic Type, with Bone Metastasis: A report of a case.: Ki Hwa Yang, Byoung Kee Kim, Sun Moo Kim; Korean J Pathol. 1991;25(1):59-67.

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Abstract PDF: Since Lebert stated, in 1851, that fibroblastic and sarcomatous tumors of the intracranial cavity had different survival times, many neuropathologists tried to set up histopathological grading system predicting the prognosis of the tumor of the nervous system. Especially, the histological assessment of the aggressiveness of meningiomas has not always been useful in conforming the biological characteristics of these tumors, and the definition of malignancy is still subject to controversy. However, metastases from meningioma to remote sites have always been considered rarities. The authors experienced a case of metastatic meningioma, hemangiopericytic type, with a history of recurrence. A forty years old male patient received a craniotomy to remove a mass in right parasagittal region, in June 1981. He had suffered from Jacksonian type of seizure started from left foot throuth leg, thigh, and arm to face. During operation, a well defined mass was noted in left parasagittal region with cleavage plane. The tumor was completely removed with cauterization of invasion site. In microscopic examination, the mass had typical findings of hemangiopericytic type of meningioma. In September 1987, he received a repeat operation to remove a recurred tumor mass in vertex, at age of forty-six. The removed tumor revealed same histologic features as those seen in primary tumor. In January 1990, at age of forty-nine, he noted pain and tenderness on the right iliac crest and the left iliac tuberosity, Plain pelvis AP x-ray ad Pelvis CT scan revealed osteolytic expansile mass lesions involving both iliac bones, the body of second sacral vertebra, and the right superior ramus of the pelvic bone. An open biopsy of the iliac bone was performed. The microscopic findings of the bone lesion were same as reccruent lesion of the brain.

Primary Cerebral B Cell Lymphoma: A "ghost tumor" case report.: Hye Jae Cho, Jung Won Shim, Sang Keun Park, Joon Suk Song, Gham Hur, Hyun Sook Seo; Korean J Pathol. 1991;25(1):68-75.

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Abstract PDF: Primary non-Hodgkin's lymphoma of the brain is a rare malignancy and there are known to occur almost exclusively in brain parenchyme. Recent immunological advances and immunohistochemical techniques have provided new insights into the pathogenesis and diagnosis of the malignant lymphoma even in the small biopsied tissue and the majority of these CNS tumors is thought to be derived from B lymphocytes. A 22-year old man was admitted due to headack, dizziness and walking difficulty for 2 months. On the initial CT scan, there were two enhancing lesion in the suprasellar area and pineal gland which were completely disappeared with steroid therapy and three new lesions appeared on the follow-up CT and MRI studies in corpus callosum, third ventricle and left cerebral peduncle. The serial cytologic smears of cerebrospinal fluid and a stereotaxic biopsy tissue from the corpus callosum mass showed diffusely homogenous infiltration of neoplastic large noncleaved lymphocytes with focal perivascular arrangement. On the immunocytochemical stains, the reaction was negative for GFAP, positive for LCA and MB2, and negative for MT1. After radiation therapy, the masses completely disappeared on the follow-up CT scan and the patient was discharged free of all the clinical symptoms.

Keratinizing Desquamative Squamous Metaplasia of the Upper Urinary Tract: A case report.: Soo Min Kang, Sun Young Kim; Korean J Pathol. 1991;25(1):76-80.

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Abstract PDF: Keratinizing desquamative squamous metaplasia of the transitional epithelium occurs rarely in the upper urinary tract, especially in the ureter. It is associated in most cases with long-standing chronic inflammation but the exact pathogenesis is unknown, and the relationship to cancer has continued to be controversial. More cases should be accumulated for a better assessmnt of this lesion. Recently, we experienced a case of keratinizing desquamative squamous metaplasia in the renal pelvis, adjacent calyces and ureter following acute and chronic pyelonephritis. Herein, we are presenting our case with a review of literatures.

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