Journal of Pathology and Translational Medicine

Volume 33(1); January 1999

Original Articles

Relation of Heart Weight to Body Weight, Body Surface Area, Height, and Age in Normal Korean Men and Women.: Hee Soo Yoon, Hea Soo Koo, Joong Seok Seo, Sang Yong Lee, Jung Duck Park, Moo Yeol Lee, Sang Ho Cho; Korean J Pathol. 1999;33(1):1-8.

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Abstract PDF: Cardiovascular diseases have been the most serious threat to life and health. The socioeconomic ramifications of heart disease have long been a source of vexing legal as well as medical problems with no easy resolution as yet in hand. Heart weight, one of the important factors for the diagnosis of cardiomegaly and various heart diseases, shows extreme variability according to the height, weight, age, sex, nutritional status of individuals as well as other various factors. The purpose of this investigation was to find a practical method for calculating expected normal range of heart weight in a given individual. The study was performed on 259 autopsy cases of normal Korean men and women, consisting of 123 men and 136 women in age from newborn to 77 years old. Height, body weight, and heart weight were measured and the body surface area was calculated by height (cm)0.725 x weight (kg)0.425 x 71.84 and height (cm)0.7763 x weight (kg)0.4081 x 71.84 in men and women, respectively. The results showed that the mean heart weight of men and women older than 20 years old were 316.20 +/- 51.15 g (n=96) and 275.87 +/- 44.69 g (n=108), respectively. Heart weight was gradually increased according to the age. The body weight (men: r=0.81, women: r=0.84) and body surface area (men: r=0.83, women: r=0.83) were better univariate predictors of normal heart weight than body height (men: r=0.78, women: r=0.75) and age (men: r=0.42, women: r=0.57). No significant difference was found in predictive precision between body weight and body surface area. Since the body surface area was calculated from body weight and height, measuring the body weight was essential for calculating expected normal range of heart weight in a given individual, and calculation of expected normal range of heart weight using body weight was simpler method than using body surface area.

Loss of Heterozygosity at VHL, FHIT, and p16 Loci in Nonpapillary Renal Cell Carcinoma.: Won Sang Park, Seung Myung Dong, Yong Hyun Cho, Tae Gon Hwang, Su Young Kim, Min Sun Shin, Jae Ho Pi, Suk Hyung Lee, Nam Jin Yoo, Jung Young Lee; Korean J Pathol. 1999;33(1):8-14.

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Abstract PDF: The objectives of this study were to characterize the alterations of 3p and 9p in sporadic renal cell carcinomas (RCC) and to assess the relationship between the clinical stages or tumor size and the alteration of these chromosomes. Thirty eight archival, paraffin embedded tissue sections from 38 patients with RCC were analyzed for loss of heterozygosity (LOH) at 3p and 9p with 11 microsatellite markers. LOH was detected in 81.6% (31/38) and 37.8% (14/37) at 3p and 9p, respectively. The frequencies of LOH at VHL and FHIT locus were 75.6% and 72.2%, respectively. Twelve cases out of 38 showed LOH at both 9p21 and 3p. The loss of 3p in the samples tested was not related to clinical stages and tumor size, but that of 9p21 was significantly associated with advanced stage and larger tumor size. These results support that 3p deletion, including VHL and FHIT gene, play a critical role in the tumorigenesis of sporadic RCC, especially at early stage, and that 9p21 may contribute to the progression of sporadic RCC.

Alterations of the Mucin Glycoprotein Expression and Their Relationship with the Pathologic Prognostic Factors in Gastric Carcinoma.: Mee Sook Roh, Gi Yeong Huh, Sook Hee Hong; Korean J Pathol. 1999;33(1):15-24.

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Abstract: Alterations of the mucin-type glycoproteins may contribute to changes in cancer cell growth regulation, immune regulation, and cellular adhesion, which in turn may influence the invasive and metastatic capabilities of the cancer. Many of the cancer-associated antigens such as mucin antigens have been identified recently and alterations in the glycosylation of the mucins have been described in the cancer. Immunohistochemical studies of 3 antigens associated with alteration of the mucin glycoprotein (MUC1, MUC2, STn) were done to evaluate their relationship with known pathologic prognostic factors and their usefulness in assessment of the progression of gastric carcinoma in 127 gastric carcinoma tissues. The MUC1 was detected in 57 (44.9%), MUC2 in 76 (59.8%) and STn antigen in 77 (60.6%) out of 127 cases of gastric carcinomas. The expression rate of MUC1 was significantly correlated with depth of tumor invasion, lymph node and distant metastases, and advanced tumor stage (p=0.001). The expression rate of MUC2 was not significantly correlated with pathologic findings and known prognostic factors. The STn antigen was significantly associated with incidence of lymph node metastasis (p=0.02). The coexpression of both MUC1 and MUC2 or MUC1 and STn was more frequent in tumors with deep invasion, lymph node metastasis and advanced tumor stage than one or none expression (p<0.05). These results suggest that the alterations of expression of the mucin proteins, especially MUC1 and carbohydrate antigen (STn) are associated with poor biological behavior of the gastric carcinoma.

The Relationship of Ki-67, Proliferating Cell Nuclear Antigen, AgNORs and p53 Protein Expression in Astrocytoma.: Dong Ja Kim, Jae Weon Lim, Yoon Kyung Sohn; Korean J Pathol. 1999;33(1):25-31.

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Abstract PDF: The grading of astrocytoma has traditionally relied on histological assessment, but there are some differences in their parameters, application, and reproducibility. Recently, numerous studies have attempted to correlate biological aggresiveness with tumor proliferation index using new immunohistochemical methods. The purpose of this study is to correlate the histopathological grades of astrocytoma with the expression of Ki-67, PCNA, p53 protein and AgNORs. The paraffin sections of 41 consecutive cases of astrocytomas were examined. Histologically the tumors were graded as three groups under the St. Anne-Mayo system and showed 14 cases in grade II, 15 cases in grade III and 12 cases in grade IV (glioblastoma multiforme). As a result, the Ki-67 labelling index and p53 protein expression tended to increase with increasing grade of malignancy. But the univariate analysis showed that there was no significant difference between the tumor grades (p>0.05). The PCNA labelling index and number of AgNORs revealed striking differences between the grade II and grade III astrocytomas (p<0.05). We concluded that the PCNA labelling index and AgNORs counting are useful markers for differentiation between grade II and III astrocytomas.

Osteochondrodysplasia Pathologic study of 29 autopsy cases.: Yi Kyeong Chun, Yee Jeong Kim, Sung Ran Hong, Min Suk Kim, Je G Chi; Korean J Pathol. 1999;33(1):32-41.

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Abstract PDF: Osteochondrodysplasia is a heterogeneous group of disorders appearing short limbed dwarfism. Because many of these entities are lethal and hereditary, an accurate diagnosis is mandatory. The purpose of this study is to define the clinicopathologic features and radiologic findings of osteochondrodysplasia. We reviewed 29 autopsy cases of congenital short limbed dwarfism, consisting of thanatophoric dysplasia (TD) (12 cases), osteogenesis imperfecta (OI) (12 cases), asphyxiating thoracic dysplasia (ATD) (3 cases), short-rib-polydactyly syndrome (SRPS) (1 case) and hypochondrogenesis (1 case). The gestational age ranged from 16 to 41 weeks. Of 6 fetuses that were born alive, 3 were ATD, 2 were TD and 1 was hypochondrogenesis. TD was frequently complicated by hydramnios. Of 8 cases studied chromosomally, only 1 showed chromosomal abnormality -46XY, inv 9. Intrauterine growth retardation was frequently associated with OI. Pulmonary hypoplasia was present in 23 cases (79%), including all cases of ATD, SRPS and hypochondrogenesis, 11 in TD and 7 in OI. Other associated anomalies were present in 17 cases (59%).

Expression of Cytokeratins 7 and 20 in Cholangiocarcinoma and Metastatic Colonic Adenocarcinoma of the Liver.: Cheol Keun Park, Mi Kyung Kim; Korean J Pathol. 1999;33(1):42-47.

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Abstract PDF: The distinction between cholangiocarcinoma (CC) and metastatic colonic adenocarcinoma of the liver (MCA) is often difficult, particularly in needle biopsy and fine-needle aspiration specimens, if histologic features alone are used. To examine the differences in the expressions of the cytokeratin (CK) 7 and 20 in the CCs and MCAs, we performed immunohistochemical studies on surgically resected 19 CCs and 23 MCAs. We used monoclonal antibodies against CK 7 and CK 20, and applied microwave antigen retrieval technique on formalin-fixed, paraffin-embedded tissue. We interpreted diffuse cytoplasmic reactivity found in > or =5% of tumor cells as positive. CCs showed CK 7+/CK 20- immunophenotype in 63%, CK 7+/CK 20+ in 32%, CK 7-/CK 20+ in 5%, and CK 7-/CK 20- in 0%. MCAs exhibited CK 7-/CK 20+ immunophenotype in 87%, CK 7+/CK 20+ in 9%, CK 7-/CK 20- in 4%, and CK 7+/CK 20- in 0%. CK 20-reactive cells in CCs were frequently columnar in shape (p<0.05). In conclusion, the CK 7/CK 20 immunophenotype was useful in the differentiation of CCs from MCAs: the CK 7+/CK 20- immunophenotype strongly suggested CCs, whereas the CK 7-/CK 20+ immunophenotype strongly suggested MCAs.

Case Reports

Primary Malignant Fibrous Histiocytoma of the Liver: A case report.: Bum Kyeong Kim, Kyeong Hee Kim, Hye Jeong Sul, Dae Young Kang; Korean J Pathol. 1999;33(1):48-51.

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Abstract PDF: Malignant fibrous histiocytoma (MFH) of the liver is uncommon, representing less than 1% of the primary malignant lesions of the liver. We report primary MFH of the liver in a 59-year-old woman. The tumor, measuring 9.0 9.0 6.0 cm, was located in the left lobe of the liver. It showed multiple areas of hemorrhage and necrosis. Microscopically, the tumor consisted of plump spindle cells haphazardly arranged in short fascicle and focal storiform pattern. Multiple bizarre giant cells were also noted. Immunohistochemically, many of the tumor cells were positive for vimentin and alpha1-antitrypsin but negative for epithelial markers. Ultrastructurally, the tumor cells showed fibroblastic and histiocytic features.

Gastric Duplication Associated with Marked Atypism: A case report.: Hae Joo Nam; Korean J Pathol. 1999;33(1):52-54.

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Abstract PDF: A case of gastric duplication associated with marked atypism in an adult is reported. The patient was a 62-year-old woman presenting a mass in left upper quadrant of abdomen. The mass was a closed gastric cyst located in the greater curvature, measuring 11 9 cm in diameter. The cyst had common muscular layer with stomach. It showed gray-white firm cystic wall with yellowish brown soft necrotic tissue. Microscopically, the cyst was lined by columnar mucin-secreting epithelium having marked cellular atypism. The cyst wall was supported by layers of smooth muscle, accompanied with severe fibrosis and chronic inflammation.

Chondroblastoma-like Extraskeletal Chondroma: A case report.: Jung Won Lee, Dae Su Kim, Mi Kyung Kim, Yeon Lim Suh; Korean J Pathol. 1999;33(1):55-58.

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Abstract PDF: Extraskeletal chondromas are relatively uncommon benign cartilaginous tumors of the soft tissue and well known to pose a considerable diagnostic problem because of histological variations including the immature appearance of their tumor cells. Recently, we have experienced a case of extraskeletal chondroma mimicking benign chondroblastoma. The patient was a 47-year-old woman who complained of a painful subcutaneous swelling on the radial aspect of 4th proximal interphalangeal (PIP) joint in the left hand for 6 months. Radiologic examination of the 4th finger revealed a 1cm-sized soft tissue mass. Histologically, the tumor was characterized by a lobulated mass which was composed of dense proliferation of chondroblast-like cells admixed with a few multinucleated giant cells of osteoclastic type. However, there were focal areas of typical chondroma which showed lace-like intense calcification around the differentiated chondrocytes.

Aggressive Angiomyxoma of the Scrotum: A case report.: Jong Eun Joo, Eun Kyoung Kim, Hong Sun Uh; Korean J Pathol. 1999;33(1):59-61.

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Abstract PDF: Aggressive angiomyxoma is a rare, locally aggressive tumor and occurs exclusively in the pelvic and perineal regions of women. But this tumor can occur in men, and the ratio of man to woman is about 1:6. We report a case of aggressive angiomyxoma of the scrotum in a 75-year-old man. The resected mass measured 23 21 10 cm and weighed 1,150 g, and was covered with thick but intact scrotal skin. The cut surface of the mass showed pale yellow to grayish white loose and edematous fibrous tissue with focal cystic degeneration. Microscopically, the mass was composed of loosely arranged bland-looking spindle or stellate cells and variable sized blood vessels with thickened and hyalinized wall. The spindle cells were strong positive for vimentin, focal, weak positive for desmin and smooth muscle actin but negative for S-100 protein. The spindle cells were also positive for estrogen and progesterone receptors.

Subcutaneous Neuromuscular Hamartoma: A case report.: Dong Hoon Kim, Eun Kyung Hong, Jung Dal Lee; Korean J Pathol. 1999;33(1):62-64.

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Abstract PDF: Subcutaneous form of neuromuscular hamartoma is extremely rare and histologically different from the conventional neuromuscular hamartoma of the peripheral nerve or benign Triton tumor by an indistinct nodular growth with ill-defined margin and marked collagen interposition. It is usually not associated with a major nerve. We report a case of subcutaneous neuromuscular hamartoma developed in the forehead of 24-year-old man. The tumor showed proliferation of dense, hyalinized fibrous tissue, in which single or group of mature skeletal muscle fibers and nerve fibers were haphazardly intermixed. Recognition of abnormally arranged muscle and nerve fibers is important not to miss this lesion.

Original Article

Primary Squamous Cell Carcinoma of the Endometrium Covering Submucosal Leiomyoma.: Myoung Ja Chung, Dong Geun Lee; Korean J Pathol. 1999;33(1):65-67.

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Abstract PDF: Primary squamous cell carcinoma of the endometrium is exceedingly rare. To be accepted as a primary carcinoma of the endometrium, the tumor must satisfy the criteria estalished by Fluhmann: There must be; 1) no coexisting endometrial adenocarcinoma, 2) no connection between the endometrial tumor and the squamous epithelium of the cervix, and 3) no squamous cell carcinoma of the cervix. We recently experienced a case of primary squamous cell carcinoma of the endometrium covering the submucosal leiomyoma in a 68-year-old female patient. On gross examination a submucosal leiomyoma covered by an irregular, dirty endometrium was found. On histologic examination the endometrium covering the leiomyoma revealed invasive, well differentiated squamous cell carcinoma. The uterine cervix showed no evidence of malignancy. In situ PCR using a probe for HPV 16/18 was negative in the carcinoma tissue.

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