Journal of Pathology and Translational Medicine

Volume 38(3); June 2004

Original Articles

Genomic Imbalances in Ependymoma by Degenerate Oligonucleotide Primed PCR-Comparative Genomic Hybridization.: Sung Hye Park, Gi Jin Kim, Min Kyung Kim, Hanseong Kim, Yoen Lim Suh, Sun Hwa Park; Korean J Pathol. 2004;38(3):133-137.

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Abstract PDF: BACKGROUND
The most consistent chromosomal abnormality in ependymomas, is loss of 22q (17-75%) and gain of 1q (0-50%). However, significance of this abnormality is uncertain.
METHODS
Genomic imbalances in 27 Korean ependymomas, including 21 low grade ependymomas, 4 anaplastic and 2 myxopapillary ependymomas, were analyzed by degenerate oligonucleotide primed-PCR-comparative genomic hybridization.
RESULTS
Common gains were found in 17 (63%), 20q (59%), 9q34 (41%), 15q24-qter (33%), 11q13 (30%), 12q23 (26%), 7q23-qter (26%), 16q23-qter (30%), 19 (26%), and 1q32-qter (22%). DNA amplification was identified in 12 tumors (44%). Chromosomal loss was a less common occurrence in our study, but was found in 13q (26%), 6q (19%), and 3 (11%).
CONCLUSION
The recurrent gains or losses of the chromosomal regions which were identified in this study provide candidate regions that may be involved in the development and progression of ependymomas.

Clinicopathologic Features of Early Hepatocellular Carcinoma.: Chang Ohk Sung, Suk Jin Choi, Cheol Keun Park; Korean J Pathol. 2004;38(3):138-144.

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Abstract PDF: BACKGROUND
Early hepatocellular carcinoma (HCC) is an early stage HCC, and it is sometimes difficult to identify the margins of the cancer nodules in the resected specimens.
METHODS
We studied 22 cases of early HCC to investigate the clinicopathologic features of early stage HCC.
RESULTS
Seven of 22 cases were single HCC, and 15 were multicentric HCC. The average tumor size was 1.34 cm (0.4-2.7 cm). Early HCCs didn't destroy the basic architecture of the liver lobules or pseudolobules and the lesions had an indistinct margin. Most tumors were uniformly composed of well-differentiated cancer tissue that was characterized by an increased cell density and an irregular thin-trabecular pattern. The tumor retained a varying number of portal tracts. There was a replacing growth pattern at the tumor-nontumor boundary without tumor capsule. Three of 22 cases had a "nodule-in-nodule" lesion, and the inner nodules consisted of moderately differentiated HCC without portal tracts. All 22 cases showed no vascular invasion. All 7 patients with single early HCC have survived for the past 11-54 months without any local recurrence. But in one patient with single early HCC, multicentric HCC developed 20 months after surgery.
CONCLUSION
The clinicopathologic features of early HCCs are quite different from those of advanced HCCs. The increased recognition of early HCC during routine clinical practice will contribute to improved patient survival.

Reducing Effect of Angiotensin-1 Converting Enzyme Inhibitor (Captopril) in Fibrosis of Radiation Induced Lung Injury.: Kun Young Kwon, Hae Ra Jung, Sun Young Kwon, Jin Hee Kim, Ok Bae Kim; Korean J Pathol. 2004;38(3):145-156.

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Abstract PDF: BACKGROUND
The captopril reduces radiation induced lung injury and fibrosis. We designed a study to evaluate the antifibrogenic effect of Captopril in radiation induced lung injury.
METHODS
Fifty Sprague-Dawley rats were divided into radiation group (I) (n=30) and radiation plus captopril group (II) (n=15). The rats were sacrificed at 12 hours and 11 weeks after radiation. We examined light microscopic, immunohistochemical and electron microscopic features in each groups.
RESULTS
In Group I, the lungs showed acute lung injury at 12 h. The lungs showed patchy fibrosis with collagen deposits at 11 weeks. The severity of the alveolar injury and fibrosis was correlated with radiation doses. The Group II showed less severe lung fibrosis than Group I. The mean numbers of mast cells and myofibroblasts of Group II were lower than Group I (p< 0.05). The TNF-alpha and TGF-beta were higher expressed according to radiation doses in Group I, and less prominent in Group II. Ultrastructurally, the alveolar cell injury and fibrosis were less severe in Group II. The TUNEL stains showed higher expressions according to radiation doses in Group I, and expressed in Group II.
CONCLUSIONS
The captopril decreases the number of mast cells and myofibroblasts, reduces collagen deposition and apoptosis of alveolar cells in rat lungs after radiation, and so reduces the degree of pulmonary injury and fibrosis.

Expression of Tumor Necrosis Factor-alpha, Interleukin-1beta and Inducible Nitric Oxide Synthase after Stereotaxic Injection of Lipopolysaccharide in Rat Hippocampus.: Hoon Kyu Oh, Ku Seong Kang, Ji Yeon Kim, Eun Kyoung Kwak, Jung Wan Kim, Ji Young Park, Yoon Kyung Sohn; Korean J Pathol. 2004;38(3):157-164.

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Abstract PDF: BACKGROUND
Brain inducible nitric oxide synthase (iNOS) might be detectable in several pathologic conditions, and it is thought to play an important role in their pathophysiology. Tumor necrosis factor (TNF)-alpha and interleukin (IL)-1beta are believed to be essential factors of iNOS induction of the brain.
METHODS
After intrahippocampal stereotaxic injection of lipopoly-saccharide (LPS), the rat brains were removed at 6, 12 and 24 h. The rat brain tissues were examined to clarify the expression patterns of TNF-alpha, IL-1beta and iNOS.
RESULTS
The inflammatory cells which were stained with anti-TNF-alpha antibody, appeared in 6 h and increased for 24 h after LPS injection. The iNOS positive cells appeared after 12 h of LPS injection. A semiquantitative analysis of reverse transcription-polymerase chain reaction (RT-PCR) revealed that the TNF-alpha and IL-1beta mRNA arose at 1 h, peaked at 6 h and then declined until 48 h after LPS injection. The iNOS mRNA arose after 6 h, peaked at 12 h, and declined until 48 h after LPS injection.
CONCLUSIONS
We conclude that the induction of inflammatory events by intrahippocampal injection of LPS activates TNF-alpha and IL-1beta secretion, and this is followed by an induction of iNOS expression. TNF-alpha and IL-1beta seem to be related with iNOS expression in brain inflammation.

Medical Students' Attitudes Toward Autopsy and the Effect of Their Attitudes Following a Forensic Pathology Course.: Yoon Young Yang, Hee Kyung Park, Cheong Yi Park, Won Kee Lee, Sang Han Lee, Jung Sik Kwak, Jong Min Chae; Korean J Pathol. 2004;38(3):165-173.

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Abstract PDF: BACKGROUND
The autopsy is a special surgical operation on a dead body to discover its cause of death. The autopsy is necessary for forensic uses, and it is also of great importance for educating students regarding medical uncertainty.
METHODS
To evaluate medical studentsO attitudes toward autopsy and the effect of their attitudes following a forensic pathology course, a questionnaire with 25 items that addressed the usefulness of autopsies and discomfort reactions was used. One hundred eighty nine medical students from 3 medical schools in Daegu participated in this study.
RESULTS
The medical students showed a high perception of an autopsy's principles, but the medical students were reluctant to become personally involved, despite being more aware of the necessities of the autopsy in forensic cases. Acceptance for the necessities of the autopsy for medical students who took the forensic pathology course was increased, but most of discomfort reactions were not improved.
CONCLUSIONS
One way to fulfill the role of forensic pathology as an inspector for human rights and to retain the very special source of knowledge that autopsies represent would be to provide medical education that lead to reconciliation of the discomfort feelings.

Morphologic Difference of the Atrial Chambers and Determination of the Atrial Situs in the Normal and Congenitally Malformed Heart.: Eo Jin Kim, Jeong Wook Seo; Korean J Pathol. 2004;38(3):174-180.

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Abstract PDF: BACKGROUND
Identification of atrial situs is the initial step in any segmental analysis and classification of congenital heart malformations. To elucidate the differences for both atria of the normal and congenitally malformed heart, we performed morphological studies on the human heart with or without abnormal laterality syndrome.
METHODS
Five normally formed human hearts, five hearts with right isomerism and five hearts with left isomerism were used in this study. The postero-superior walls of the atrial chambers were examined.
RESULTS
Although the division line of the ventral and dorsal compartments was not as conspicuous as was seen in the right atrium of rat embryo previously studied, this division line existed as a well-developed terminal crest and vestigial structure of the antero-lateral extension of the terminal crest. These structures were noted in the right atrial chambers of normal human hearts and in the bilateral atrial chambers of right isomerism. However, they were totally absent in the bilateral atrial chambers in hearts with left isomerism.
CONCLUSIONS
Our study showed that the right atrial chamber in the normally developed human heart has vestigial components of division between the ventral and dorsal compartment, and hearts with right isomerism and left isomerism have differential development of the ventral and the dorsal compartment.

Case Reports

Angioleiomyoma of the Nasal Cavity: A Case Report.: Su Jin Kim, Sook Hee Hong, Mee Sook Roh; Korean J Pathol. 2004;38(3):181-183.

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Abstract PDF: Angioleiomyoma of the sinonasal area is an extremely rare benign neoplasm. To the best of our knowledge, only 26 cases have been described. Here, we report a case of angioleiomyoma arising in the nasal cavity of a 60-year-old woman. Microscopically, the tumor consisted of proliferating smooth muscle cells punctuated with thick-walled vessels with slit-like lumina. The tumor was negative for estrogen and progesterone receptor by immunohistochemical study. Further studies are needed to clarify whether the growth of this tumor is sex steroid-dependent.

Localized Amyloidosis of the Ureter: A Report of Two Cases.: Ho Jung Lee, Dong Eun Song, Jong Eun Joo, Won Mi Lee, Dong Hoon Kim, Eun Kyung Kim, Jae Y Ro; Korean J Pathol. 2004;38(3):184-187.

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Abstract PDF: We report on two cases of localized amyloidosis involving the ureter. The patients were a 64-year-old woman with right upper quadrant pain (case 1) and a 36-year-old woman suffering from left flank pain and intermittent gross hematuria (case 2). An intravenous pyelography of case 1 revealed multiple filling defects in the entire right ureter, whereas retrograde pyelography in case 2 showed diffuse narrowing in the mid and lower portions of the left ureter. Localized amyloidosis of the ureter was diagnosed in the two cases, and both had amyloid deposit in the renal pelvis and the urinary bladder in case 1, and in the contralateral ureter and the renal pelvis in case 2. Right nephroureterectomy was performed in case 1, but a segmental resection of the ureter with preservation of the kidney was administered in case 2. These two cases demonstrate that ureteral amyloidosis can be associated with amyloid deposition in the renal pelvis and the urinary bladder. Although ureteral amyloidosis is a rare occurrence, it should be considered in the differential diagnosis of ureteral obstruction to avoid unnecessary radical surgery.

Intraocular Ossification: A Case Report.: Ho Sung Park, Tae Shik Kong, Kyu Yun Jang, Myoung Ja Chung, Woo Sung Moon, Dong Geun Lee, Myoung Jae Kang; Korean J Pathol. 2004;38(3):188-190.

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Abstract PDF: Heterotopic bone formation in the eyeball is a rare finding. Some etiologic factors, such as trauma, chronic inflammation, and long-standing retinal detachment have been associated with the onset of intraocular ossification. We report here on a case of a 21-year-old woman with a history of blunt trauma fifteen years ago, who complained of right eye blindness. When the right eyeball eviceration was done, a hard, grayish mass was found. On histopathologic examination, the mass showed lamellar bone with fatty marrow and hyalinized tissue with dystrophic calcification. We diagnosed her case as intraocular ossification.

Chronic Intestinal Pseudoobstruction Associated with Inflammatory Visceral Neuropathy: A Case Report.: Young Kyung Bae, Joon Hyuk Choi, Mi Jin Kim, Dong Sug Kim, Won Kyu Park, Jae Hwang Kim; Korean J Pathol. 2004;38(3):191-195.

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Abstract PDF: The pathogenesis of chronic intestinal pseudoobstruction (CIP) presents a broad spectrum of etiologies. Among them, visceral neuropathy and myopathy are two major pathologic conditions. We report here on a very rare case of CIP associated with inflammatory visceral neuropathy involving the terminal ileum, appendix and entire colon in a 64-year-old woman who did not have any detectable neoplasm or family history of this disease. Microscopically, the submucosal and myenteric plexuses showed a severe and diffuse lymphoplasmacytic infiltrate with degenerative changes of the ganglion cells and nerve fibers. The pathogenesis of the inflammatory reaction is unclear for our patient, but we think that this would be a rare example of idiopathic and sporadic visceral neuropathy resulting in chronic intestinal pseudoobstruction.

Carcinoid Tumor Arising from A Normal Kidney: A Case Report.: Seo Young Sohn, Han seong Kim, Mee Joo, Min Kyung Kim, Sung Hye Park; Korean J Pathol. 2004;38(3):196-199.

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Abstract PDF: Primary carcinoid tumor of the kidney is a very rare disease. Until now, only 41 cases have been reported worldwide, and nine of these arose in a horseshoe kidney. In Korea, 3 cases have been reported to date, and all of these arose in a horseshoe kidney. We present a case of primary carcinoid tumor occurring in a normal kidney of a 45 year old man. A tumor was incidentally found close to the hilum of the left kidney. Histologically, the tumor exhibited trabecular and ribbon-like pattern of cuboidal or columnar cells. Mitotic activity was rarely seen. The tumor cells were positive for synaptophysin and chromogranin A. Numerous dense-core neurosecretary granules were observed by the electron microscopic examination. To our knowledge, the present case is the first report of primary renal carcinoid tumor arising in a normal kidney in Korea.

Warthin-like Tumor Variant of Papillary Thyroid Carcinoma: A Case Report.: Sun Hee Chang, Chang Sig Choi, Yoon Suk Kim; Korean J Pathol. 2004;38(3):200-203.

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Abstract PDF: An unusual oncocytic papillary thyroid carcinoma with abundant lymphoid stroma bearing a resemblance to Warthin? tumor of salivary gland is described. We report a rare case of a Warthin-like tumor variant of papillary thyroid carcinoma in a 41-year-old-woman. Histologically, the tumor was characterized by oncocytic follicular cells showing nuclear features reminiscent of papillary carcinoma and lymphoid rich stroma. The surrounding non-neoplastic thyroid parenchyma showed focal peritumoral lymphocytic thyroiditis.

Lymph Node Infarction After Fine-Needle Aspiration.: Ho Sung Park, Kyu Yun Jang, Myoung Ja Chung, Woo Sung Moon, Dong Geun Lee, Myoung Jae Kang; Korean J Pathol. 2004;38(3):204-207.

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Abstract PDF: Histologic alterations of lymph nodes following fine-needle aspiration have not been well described. Only two cases of lymph node infarction following fine-needle aspiration have currently been reported. We report here on a case of near total infarction of a lymph node that was detected 16 days after fine-needle aspiration in a 74-year old man. A fine-needle aspiration smear of the right inguinal lymph node showed scattered and clustered cells including lymphocytes, plasma cells, neutrophils that were seen as a reactive nodal hyperplasia in the clean background. There were no malignant cells, granulomas or necrotic debris. In the incisional biopsy of the same lymph node, the sections revealed a thin rim of viable lymphocytes, granular tissue was noted peripherally and extensive necrosis associated with vascular thrombi was noted centrally. There was no evidence of malignancy or granulomatous inflammation.

Inflammatory Pseudotumor of the Paratesticular Area: A Case Report.: Na Rae Kim, Seung Yeon Ha, Jae Gul Chung, Joungho Han; Korean J Pathol. 2004;38(3):208-211.

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Abstract PDF: Inflammatory pseudotumors of the paratesticular area are rare, and are often reported in the literature by various terms, e.g., proliferative funiculitis, inflammatory myofibroblastic tumor, pseudosarcomatous myofibroblastic proliferation and fibrous pseudotumor. This is one of the most common lesions of that region, and typically presents as a longstanding, painless scrotal mass. Here, we describe a 34 year-old man who has had a palpable scrotal mass for the past 10 years. The excised mass was composed of multiple conglomerated nodules, which had homogeneous rubbery cut surfaces. Histologically, each was a well circumscribed, but unencapsulated mass of hyalinized collagenous tissue interspersed with lymphoplasmacytic cells and lymphoid follicle formation. A small fraction of paucicellular spindle cells was positive for vimentin, smooth muscle actin and CD68. Ultrastructurally, abundant collagen fibrils were mixed with paucicellular spindle cells and inflammatory cells. These spindle cells had abundant rough endoplasmic reticula and myofilaments with focal densities, indicating myofibroblastic differentiation.

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