Journal of Pathology and Translational Medicine

Volume 28(4); August 1994

Comparative Study

Interpretation of DNA Histogram in Flow Cytometry: A Comparative Study of DNA Ploidy in Fresh and Paraffin-embedded Tissues of Colorectal Adenocarcinomas.: Eun Sook Nam, Soon Hee Jung, Yeon Lim Suh, Woo Hee Jung, Keung Min Kim, In Sun Kim; Korean J Pathol. 1994;28(4):341-349.

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Abstract PDF: As flow cytometric analysis using paraffin-embedded tissue was developed by Hedley et al in 1983, retrospective study with large amount of archival material was possible. Many literatures reported that the result of paraffin embedded tissue was compatible with that of fresh tissue. We compared the DNA histograms of 26 cases of colorectal adenocarcinoma in which the analysis was done in both fresh and paraffin-embedded tissues. Aneuploidy in fresh and paraffin-embed-ded tissues was 73.0% and 50.0%, respectively. The concordance rate of fresh and paraffin-em-bedded tissues was 76.8% and six interpreters were agreed in 73.0% of the cases. Because flow cytometric DNA analysis using fresh tissues can detect more aneuploid population than in paraffin-embedded tissue, the former is strongly recommeded in DNA ploidy study. Also careful observation using standard criteria may improve the interpretation of DNA histogram.

Original Articles

The Study of Proliferating Cell Nuclear Antigen (PCNA) Reactivity in Fibrohistiocytic Tumors.: Jae Hyuk Lee, Yong Han Park, Hyang Mi Ko, Ji Shin Lee, Chang Soo Park; Korean J Pathol. 1994;28(4):350-357.

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Abstract PDF: Fibrohistiocytic tumors are a diverse group of benign and malignant soft tissue lesions, including dermatofibroma, dermatofibrosarcomaprotuberans, and malignant fibrous histiocytoma. On the clinical point of view, the distinction between benign and malignant lesions and malignancy grading is far more important. Therefore, we investigated 23 fibrohistiocytic tumors, using PCNA (PC10) which was a useful marker of proliferating activity, to differentiate the benign lesions from the malignant and correlate with other prognostic factors including tumor necrosis. cellularity, histologic grade, and mitotic counts. The results obtained were as follows 1) Positive tumor cells were clearly identified by the characteristic diffuse or granular nuclear staining. 2) The number of PCNA-positive tumor cells were 2.16+/-2.39% in dermatofibroma, 16.12+/-7.38% in dermatofibrosacoma protuberans, and 28.02+/-17.47% in the malignant fibrous histiocytoma. The numbers of PCNA-positive tumor cells in the malignant lesions higher than in the benign (p<0.001). 3) Deep seated, large size (>5 cm) and recurred or metastatic cases of MFH were more the high PCNA index (more than 20%) than the low index (less than 20%) groups. 4) PCNA index in MFHs had positive correlation with the number of mitotic counts (r=0.7582, p<0.001), cellularity (r=0.5908, p<0.05) and histologic grade (r=0.4164, p<0.05). These results suggested that reactivity on PCNA might assist in the distinction between benign and malignant lesions in fibrohistiocytic tumors, and could be a useful prognostic factor in the patients with malignant fibrous histiocytoma.

Pulmonary Lymphangioleiomyomatosis: Pathologic Analysis of Eight Korean Cases.: Seung Sook Lee, Jeong Wook Seo, Eul Keun Ham, Yong Il Kim, Nam Hee Won, Jung Gi Im, Young Soo Shim; Korean J Pathol. 1994;28(4):358-367.

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Abstract PDF: Histopathology of pulmonary lymphangioleiomyomatosis(LAM) is studied using four new cases and six previously reported cases, which include two cases without definite evidence of LAM. The important diagnostic features of this lesion were nodular proliferation of immature smooth muscle and cleft or cyst formation within the nodules of smooth muscle cells. The nuclei of the smooth muscle cells were bigger than those of blood vessels or fibrotic lung, and the direction of nuclei was irregular. The lung parenchyma showed little inflammatory change but there were multiple air cysts with smooth muscle nodules at their margin. There were two cases with exuberant proliferation of smooth muscle nodules and two cases with papilliferous projections of the cells into lymphatic lumen. Whereas, three cases had only a few small slender nodules of smooth muscle cells at the margin of air cyst. The lymphatic lumen with smooth muscle nodules is dilated in four cases but other four cases show collapsed lumen. Pulmonary hemorrhage and hemosiderosis were prominent in three cases. There were variety of histology in terms of the cellularity of smooth muscle nodules, the size of the lymphatic lumen and the degree of pulmonary destruction, which may have significance on the clinical presentation and prognostication.

Histopathologic Features of Gastric Mucosa Colonized by Helicobacter pylori.: Tae Jung Jang, Dong Haeng Lee, Sang Kun Sim; Korean J Pathol. 1994;28(4):368-375.

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Abstract PDF: TO evaluate the histopathologic features of gastric mucosa by Helicobacter pylori (HP), we reviewed 70 endoscopically biopsied chronic gastritis and peptic ulcer. The results are as fonows. l. HP was detected in 923% (48/52) of active gastritis, 8l8% (9/l l) of peptic ulcer and l43% (1/7) of chronic gastritis. The prevalence of HP infection was significantly higher in active gastritis and peptic ulcer than chronic gastritis (P<0005). 2. The infiltration of intraepithelial neutrophil of the 58 HP-positive cases was significantly more than of the l2 HP-negative cases (P<0005). 3. The infiltration of neutrophil and chronic inflammatory cells in the lamina propria of the 58 HP positive cases were significantly more than of 12 HP-negative cases (P<0.005, P<0.01) 4. The gastric epithelium of 58 HP positive case showed characteristic degenerative change, such as epithelial pits (93.l%), irregular surface (84.4%), individua1 cell drop-out (46.5%) and microerosion (27.6%). The similiar changes were not seen in l2 HP-negative cases. In summary, HP is significantly correlated with inflammatory reaction of the gastric mucosa. It is also significantly correlated with the epithelial degenerative changes that is considered to the precursor of peptic ulcer.

Overexpression of Mutant p53 in Human Anaplastic Astrocytoma and Glioblastoma Multiforme.: Sang Sook Lee, Kam Rae Cho, Cheoul Hee Yun, Sang Pyo Kim, Kwan Kyu Park, Eun Sook Chang, Eun Ik Sohn; Korean J Pathol. 1994;28(4):376-380.

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Abstract PDF: A total of 30 cases of cerebral gliomas, including 6 cases of low grade astrocytomas, 6 anaplasticastrocytoomas and l8 glioblastomas multiforme, was examined immunohistochemically to demonstrate the overexpression of mutant forms of p53 protein and to evaluate their relationships with histological subtypes. A p53 monoclonal antibody was applied to the routine formalin fixed, paraffin-embedded tissues for this study using microwave-assisted avidin-biotin method. Overexpression of p53 protein was identified in 4 out of 6 anaplastic astrocytomas (66.7%) and in l3 out of l8 glioblastomas multiforme (72.2%). No immunohistochemical positivity of p53 was found in adjacent normal brain tissue, gliosis and 6 cases of astrocytoma. These results suggest that overexpression of mutant p53 may be an important step in the development and progression of malignant astrocytoma, especially of the aggressive subtypes of glioma, including glioblastoma multiforme.

CD30 (Ber H2) Distribution in Hodgkin's Disease and non-Hodgkin's Lymphoma.: Bong Hee Kim, Young Hee Maeng, Ju Hie Lee, Moon Ho Yang; Korean J Pathol. 1994;28(4):381-388.

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Abstract PDF: Forty one cases of Hodgkin's disease and non-Hodgkin's lymphomas were immunohisto-chemi-cally studied for the presence of CD30 antigen on the paraffin embedded formaldehyde fixed tissue by using Ber H2(CD30) monoclonal antibody (Dakopatts, diluted l : 20) and avidin biotin peroxidase complex technique seventy five %(6/8) of Hodgkin's lymphoma and 27% (9/33) of non-Hodgkin's lymphomas were CD30 positive. Five of l7 diffuse large cell and immunoblastic lymphoma and one large cell anaplastic lymphoma showed large numbers of CD30 positive cells. Occasional CD30 positive cells were found in one of 2 angiommunoblastic lymphadenopathy-like T cell lymphoma, one of 4 small lymphocytic lymphoma and one unclassified lymphoma. Immunophenotypically l6% of B cell lymphoma and 42% of T cell lymphoma showed CD30 positivity. six cases of Hodgkin's disease except lymphocyte predominance showed positive tumor cells. Our results show that CD30 is more widespread in histologic subtypes of lymphomas and is not specific for the diagnosis of Hodgkin's disease.

Promoting Effect of Aflatoxin B1 and D-Galactosamine on Development of Glutathione S-Transferase Positive Foci in Diethylnitrosamine-initiated Rat Liver.: Hye Kyung Lee, Yong Il Kim; Korean J Pathol. 1994;28(4):389-398.

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Abstract PDF: The enhancing potential of anatoxin a (AFB1) and D-galactosamine (DGA) on development of preneoplastic glutathione S-transferase placental form positive (GST-P+) hepatic foci was examined using an in vivo mid-term assay system based on two-stage concept of hepatocarci-nogenesis. Rats were initially given a single dose (200 mg/kg) of diethylnitrosamine (DEN) intraperi-toneally, and thereafter. with an interval of 2 weeks, AFBl at a graded concentration (0.06, 0.012, 0.0024, 0.00048, and 0.000096 mg/kg i.g.) and DGA (100 mg/kg i.p.) were administered for 6 weeks and then sacrificed. All rats were subjected to a two-thirds partial hepatectomy to induce a potent growth stimulus to DEN-altered hepatocytes at the week 3. The modifying potential was scored by comparing the number and the area (mm2) per cm2 of GST-P+ foci in the liver with those of the corresponding control group given DEN alone. AFBl (at a graded concentration between 96 ng/kg and 60 microgram/kg) exerted a strong promoting effect oil induction of GST-P+ foci with both the number and the area. The logarithmic dose of AFBl and the potency to promote hepatocarcinogenesis were in dose-dependent relationship. DGA, a known necrogenic chemical to cause periportal necrosis and stimulate hepatocellular proliferation. also revealed the increase in the area of GST-P+ foci. although its enhancing potentia1 was 1ess profound than that of AFBl. The results suggest that DGA is also a useful proliferative stimulus m improve the medium-termdetection of unknown carcinogens.

Comparative Study

A Comparative Study of DNA Quantitation by Image Cytometry and Flow Cytometry.: In Sun Kim, Eun Sook Nam; Korean J Pathol. 1994;28(4):399-404.

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Abstract PDF: There are substantial evidences suggesting that DNA content of tumors may provide the prognostic information with independent significances. In this study, the results of DNA ploidy analyzed by image cytometry on touch imprint and by flow cytometry on fresh cell suspension of 78 solid tumors were compared. For 68 cases, there was an excellent correlation between two methods. For 6 cases, an aneuploid population was found by image, but not by flow cytometry one case had an aneuploid peak by flow cytometry. Two methods may use in a complementary fashion m identify as many aneuploid cell population as possible.

Case Reports

Malignant Brenner Tumor: Report of a case.: Kyeong Mee Park, So Young Park, Yeon Lim Suh; Korean J Pathol. 1994;28(4):405-408.

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Abstract PDF: Brenner tumors constitute about l.5~2.5% of all primary ovarian neoplasms and are almost always benign. It appears to derive from the surface epithelium of the ovary which undergoes metap1asia to form the urothelial-like components. we experienced a case of malignant Brenner tumor with adenocarcinoma and squamous cell carcinoma patterns in a 57-year-old woman. It was partly cystic tumor and contained a 4cm-sized gray yellow, lobulated or papillary solid mass, projecting from the cystic wall. Ultrastructurally, the solid mass was composed of malignant urothelial-like cells with focal glandular differentiation.

Gagtric Adenocarcinoma with Choriocarcinomatous and Hepatoid Differentiation: Report of a case.: Kyeong Cheon Jung, Woo Ho Kim, Yong Il Kim, Kook Jin Choe; Korean J Pathol. 1994;28(4):409-413.

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Abstract PDF: Association of the hepatoid and choriocarcinomatous components in adenocarcinoma of the stomach is extremely unusual and raises a possibility of new approach understand the histogenesis of gastric hepatoid adenocarcinoma. This paper describes a Borrmann type III adenocarcinoma of the stomach with both choriocarcinomatous and hepatoid components in composite tumor pattern in a 50-year-old man. Tubular arrangement of differentiated embryonalcarcinoma was encountered in choricarcinomatous and hepatoid areas, which showed strong immunoreactivity to beta-HCG and AFP, respectively. The findings suggest that gastric adenocarcinoma may have a potential of differentiation toward embryonal carcinoma. from which both choriocarcinoma and hepatoid variant of gastric adenocarcinoma may develop by retrodifferentiation.

Ceruminous Gland Tumors: 5 cases report.: Yun Kyung Kang, Je G Chi; Korean J Pathol. 1994;28(4):414-419.

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Abstract PDF: Tumors of the ceruminous gland are rare. However, careful histologic evaluation and classification are necessary for the proper treatment and ultimate prognosis. We present 5 cases of ceruminous gland tumors. Case l (73/M) and case 2 (52/M) were adenoid cystic carcinoma. They presented with protuding masses in the left external auditory canal for several months. Case 3 (76/M) was a mucoepidermoid carcinoma of auditory canal, who presented with right ear swelling. The mass recurred 3 years after the surgical resection and combined radiation therapy. Case 4 (60/F) and case 5 (2l/F) were ceruminous adenoma, which showed diffuse or focal areas of glandular structures with one-or two-layer of eosinophilic columnar to cuboidal cells and sometimes with myoepithelial cells. These tumors showed non-infil-trative growth pattern and lack of mitosis, and had no capsule.

Richer's Syndrome: Report of a case.: Su Kyeong Yeon, Chang Sug Kang, Han Jin Lee, Dong Uk Kim, Chun Chu Kim, Sang In Shim; Korean J Pathol. 1994;28(4):420-426.

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Abstract PDF: Richer's syndrome is a development of a high grade malignant lymphoma in a patient with preexisting chronic 1ymphocytic leukemia, small lymphocytic lymphoma or Waldenstrom's macroglobulinemia. A rare case of Richer's syndrome arising in the spleen of a 35-year-old-man was studied by morphology, immunohistochemistry and gene rearrangement study. He has had weight loss and night sweat for last 6 months. Hepatosplenomegaly and abdominal lymphadenopathy were noted on CT scanning. Especially an ovoid radiolucent mass was found within the image of splenomegaly. Lymph nodes and liver biopsy, bone marrow aspiration and splenectomy were done. In the lymph nodes, liver and bone marrow, well differentiated small lymphocytic infiltrations were found but, in the spleen, pleomorphic, large cells with occasional multinucleated giant cells formed a nodular mass surrounded by diffuse, extensive infiltration of small well differentiated lymphocytes. The two distinctive areas in the spleen had positive staining for B-cell marker (HLA-DR and L26), negative staining for T-cell marker (UCLH1), and positive staining for IgM heavy chain and kappa light chain by immuohistochemical study. so this case was diagnosed as a diffuse large cell 1ymphoma transformed from small lymphocytic lymphoma. We made an another effort to clarify their clonality. Gene rearrangement method usingcomplementarity.determining region 3(CDR3) of immunoglobulin heavy chain (IgH) gene and T-cell receptor gamma (TCRgamma) gene by polymerase chain reaction (PCR) technique was done. The two lymphomas in the spleen demonstrated the same rearrangement pattern in both IgH and TCRgamma gene. We think these findings strongly suggest that the large cell lymphoma has the same clonality with that of the small lymphocytic lymphoma.

Female Adnexal Tumor of probable Wolffian origin: A case report.: Yee Jeong Kim, Sung Ran Hong, Hy Sook Kim, Hyon U Lee; Korean J Pathol. 1994;28(4):427-429.

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Abstract PDF: We report a case of right broad ligament tumor with features of female adnexal tumor of probable wolffian origin. A 40-year-old woman presented with dysfunctional uterine bleeding. Ultrasonography revealed 1 10cm sized right parovarian solid mass. On microscopic examination, the tumor showed mixed pattern of tightly packed tubular structures and diffuse spindle cell proliferation. Immunohistochemical study demonstrated cytokeratin-and vimentin-positivity and carcino-embryonic antigen-negativity. The ultrastructural study showed prominent tubular structures, continuous basal lamina, definite junctional complex but no secretory granules or glycogen particles, favoring wolffian origin.

Optic Nerve sheath Meningioma: A case report.: Yoon Jung Choi, Yong Hee Lee, Tai Seung Kim; Korean J Pathol. 1994;28(4):430-432.

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Abstract PDF: Optic nerve sheath meningioma arises from the arachnoid cap cell of optic nerve sheath and comprises most of primary orbital meningioma. We experienced a rare case of optic nerve sheath meningioma originating in the left orbit. A 44-year-old woman had suffered from visual disturbance in the left eye for 3 years and had only light perceptibility for the recent 6 months. The right eye was normal. Brain CT scan and MRI revealed a 2x0.8 cm sized fusiform solid mass in the left retrobulbar area. Under the impression of optic nerve tumor. excision of the mass including a small segment of the optic nerve was performed. The tumor was a yellowish firm, relatively well demarcated mass that encircled the optic nerve without infiltrating it. Microscopically it was a typical meningioma, meningothelial type. The recovery of visual acuity was impossible due to resection of optic nerve but there was no evidence of recurrence for u months.

Pineoblastoma with Neuronal Differentiation: A case report.: Sook Guem Jeong, Hee Kyung Chang, Man Ha Huh; Korean J Pathol. 1994;28(4):433-435.

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Abstract PDF: A case of pineoblastoma in a 28-year-old male is reported. A computerized tomography showed hydrocephalus and a mass in the pineal region. Histologically, the tumor is composed of regular, patternless aggregates of small round undifferentiated cells, resembling medulloblastoma-retinoblastoma group. Immunohistochemical reactivity of the neoplastic cells for neuron specific enolase and synaptophysin demonstrates neuronal differentiation. The patient underwent partial resection of the mass followed by radiotherapy. The patient had no cerebrospinal dissemination at 8 month follow-up. The pineoblastoma is a highly malignant neoplasm, one of the class of primitive neuroectodermnal tumors. The tumor is a very rare pineal parenchymal meoplasms, representing an incidence of less than 0.1% of intracranial tumors. This is the first case of pineoblastoma reported in Korea. In this report the divergent differentiation of the tumor is discussed, along with review of literatures.

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