- p21 Protein Expression and Cell Proliferation Activity in Human Multistep Hepatocarcinogenesis.
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Kye Weon Kwon, Young Nyun Park, Chan Il Park
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Korean J Pathol. 2000;34(5):325-330.
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- p21 is a universal inhibitor of cyclin-dependent kinase (cdk) and of cell-cycle progression.
p21 expression is variable according to the type of tissue and the pathologic condition. To study the role of p21 in the multistep hepatocarcinogenesis, the expression of p21, p53 and Ki-67 was investigated in 53 cases of inactive liver cirrhosis, 4 cases of low grade dysplastic nodules, 3 cases of high grade dysplastic nodules, 7 cases of early hepatocellular carcinomas (HCCs), 27 cases of small HCCs (< or =3 cm), and 52 cases of advanced HCCs (>3 cm). p21 expression was not detected in liver cirrhosis, low grade dysplastic nodules, high grade dysplastic nodules and early HCCs which were mitotically inactive. p21 expression was significantly increased in small HCCs and advanced HCCs which were mitotically active. p21 expression was significantly correlated with Ki-67 labelling indices. p53 protein was not expressed in liver cirrhosis, dysplastic nodules, and early HCCs. The expression of p53 protein was, however, significantly increased in small and advanced HCCs. The p21 expression was not correlated with p53 expression. Therefore, p21 is suggested to play a role in the mitotically active small and advanced HCCs, but not in the mitotically inactive lesion of dysplastic nodules and early HCC in multistep hepatocarcinogenesis.
These findings suggest that homeostatic mechanism of growth control is not totally destroyed in HCC.
- Histological Grading and Staging of Chronic Hepatitis Standardized Guideline Proposed by the Korean Study Group for the Pathology of Digestive Diseases .
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Young Nyun Park, Ho guen Kim, Chae Yoon Chon, Jae Bok Park, Jin Hee Sohn, Seung Ha Yang, Eun Sil Yu, Mi Seon Lee, Ja June Jang, Hee Kyung Chang, Jong Jae Jeong, Dae Young Kang, Yong Il Kim, Chan Il Park
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Korean J Pathol. 1999;33(5):337-346.
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- The terms chronic active hepatitis (CAH), chronic persistent hepatitis (CPH), and chronic lobular hepatitis (CLH) should be discontinued in favor of etiologic terminology.
The activity of necro-inflammation and the degree of fibrosis should be evaluated for grading the severity and for the stage of disease. Members of the Korean Study Group for the Pathology of Digestive Diseases reviewed 30 cases of chronic hepatitis and reached the following consensus: 1) The pathology report of the biopsy samples with features of chronic hepatitis should include the etiology, grade and stage. 2) Grade and stage should be semiquantitatively evaluated as none, minimal, mild, moderate and severe. 3) For grading, lobular activity and periportal activity should be evaluated, separately. 4) To avoid confusion with other grading systems, simple report using descriptive terms rather than numerical records is recommended in daily practice.
Criteria for each grade and stage should be presented and discussed. Histologic grading and staging of chronic hepatitis by new standardized guidelines will give more information about the prognosis as well as the present status of hepatitis. The terms CAH, CPH and CLH may be used in parentheses to facilitate relearning.
- Gastrointestinal Polyposis in Koreans: A Nationwide Survey of Clinicopathologic Analysis of 112 Surgically Resected Cases.
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Mee Soo Chang, Hoguen Kim, Woo Ho Kim, Chan Il Park, Eun Kyung Hong, Han Kyeom Kim, In Soo Suh, Byung Kee Kim, Ja June Jang, Woon Sub Han, Hyung Sik Shin, So Young Jin, Dae Young Kang, Yong Il Kim
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Korean J Pathol. 1998;32(6):404-412.
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Abstract
- Gastrointestinal polyposis (GIP) is a rare disease characterized by formation of the numerous polyps in the gastrointestinal tract and presenting several extraintestinal manifestations. Most of the diseases are transmitted in an autosomal dominant pattern. In Korea, the epidemiological study as well as the pathological analysis of the GIP is not well established. We therefore analysed 38 items of GIP using surgically resected specimens. The materials in this study were collected from the 12 institutions and case reports in Korean literature between 1980 and 1991. The clinicopathologic findings were reevaluated by several members of the study group for gastrointestinal pathology. The results are as follows: (1) A total of 112 cases were included in this study: 83 cases were collected from 12 institutions and 29 cases were collected from Korean literature. The cases were classified as familial adenomatous polyposis (FAP), 59 cases; Gardner's syndrome, 3 cases; juvenile polyposis, 12 cases; Peutz-Jeghers syndrome, 35 cases; multiple colonic adenomas, 3 cases. (2) Among 59 cases of FAP, the range of age at operation was 14 to 61 years, and a family history was positive in 25 cases. The number of polyps in colorectum was 100~8,000. Of the 37 cases in which the examination of polyp density was available, 16 cases (43%) showed the highest density in the rectum and the sigmoid colon. The carcinomatous change within polyp(s) was present in 18 cases (31%), and associated advanced single or multiple colonic carcinomas existed in 37 cases (63%). Twenty-six (45%) tumors out of total 58 carcinomas were in the rectum.
Twenty-five patients were evaluated for the upper gastrointestinal lesions, and 11 patients (44%) had pathologic lesions; multiple fundic gland polyps in 3 cases (12%), gastric and duodenal adenomas in 2 cases (8%), gastric adenomas in 2 cases (8%), duodenal adenomas in 2 cases (8%), gastric carcinoma and adenoma in 1 case (4%), gastric carcinoma in 1 case (4%). (3) Among 3 cases of Gardner's syndrome, the range of age at operation was 25 to 31 years, a family history was identified in 2 cases. One case was associated with an advanced colonic carcinoma and carcinomatous change within polyp. Extra gastrointestinal lesions were sebaceous cyst, epidermal cyst, osteoma and desmoid tumor. (4) Among 12 juvenile polyposis, the range of age at operation was 8 to 51 years and 5 patients had a family history. The carcinomatous change within polyp was found in 2 cases (17%) and associated advanced colonic carcinoma was in 4 cases (33%). The associated different type of polyps was tubular adenomas in 9 cases (75%), hyperplastic polyps in 4 cases (33%) and villous adenomas in 2 cases (17%). (5) Among 35 Peutz-Jeghers syndrome, the range of age at first operation was 6 to 42 years, family history was positive in 11 cases. The carcinomatous change within polyp was found in 1 case (3%), and associated advanced colonic carcinoma in 1 case (3%). The epithelial misplacement was observed in 4 cases (11%), and tubular or villous adenomatous feature in 4 cases (11%). In summary, the most frequent GIP for the surgical resection in Korea is FAP and the FAP is associated with high incidence of coexisting advanced and intramucosal carcinomas.
Hamartomatous polyposis syndromes, such as juvenile polyposis and Peutz-Jeghers syndrome are another frequent disease for the surgical resection and are also associated with an increased risk of cancer.
- Adreno-Hepatic Fusion: A case report.
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Kyung Moo Yang, Young Nyun Park, Chan Il Park
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Korean J Pathol. 1998;32(5):385-387.
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- Adreno-hepatic fusion is rare condition defined as adhesion of the liver and right adrenal cortex with close intermingling of the respective parenchyme. It is suggested to be an aging phenomenon, because its incidence is much higher in older age group. Clinically it may pose a problem of operability of the organ involved. We report a case of incidentally found adreno-hepatic fusion in a 49 year old female patient with adenocarcinoma of the sigmoid colon. The segementectomy of VIII segement of the liver was done due to a 6 4 cm sized metastatic nodule of adenocarcioma.
Pathological examination of the liver revealed an ovoid shaped, 1 0.5 cm sized adrenal cortical tissue. It was subcapsularly located and about 1cm apart from the metastatic adenocarcinoma with an intervening normal hepatic tissue. The adrenal tissue was mainly composed of zona fasciculata without medullary tissue. In the interphase, the adrenal tissue and liver tissue were admixed closely and partially septated by thin fibrous tissue. There was no inflammatory response to the heterotropically located adrenal tissue and there was no symptom related to the adrenal gland.
- Relationship between Proliferative Activity and Expression of HBcAg and p53 Protein in Hepatocellular Carcinoma and Surrounding Nontumorous Liver.
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So Ya Paik, Ho Guen Kim, Chan Il Park
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Korean J Pathol. 1997;31(8):773-781.
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- In an attempt to discover the factors contributing to the increased proliferative activity in hepatocytes and subsequent development of HCC, the proliferative activity of hepatocytes was compared with the size of regenerative nodules and HBcAg expression status in the surrounding nontumorous liver of 45 surgically resected hepatocellular carcinomas, including 34 HBV related ones. In the tumor, the difference in proliferative activity and the histological grade was analyzed in terms of p53 gene alteration. The proliferative activity was assessed by immunohistochemical methods using Ki-67 monoclonal antibody. HBcAg expression in the surrounding nontumorous liver correlated with both the inflammatory and proliferative activity of hepatocytes (p<0.05). p53 overexpression was associated with high proliferative activity and aggressive phenotype of tumor. No correlation was observed between the proliferative activity of hepatocytes and the size of regenerative nodules in cirrhosis (p>0.05). p53 overexpression was not evident in surrounding nontumorous liver including cirrhosis. In conclusion, the above results are in line with the view that hepatic carcinogenesis is a mutistep, progressive process.
In the initial stage, chronic cellular injury incurred by immumologic reaction against HBcAg seems to play a pivotal role in increased cellular regeneration. However, once transformation of hepatocytes occur the major contributor to tumor growth seems to be alteration in p53 tumor suppresor gene.
- Grading System for Gastric Epithelial Proliferative Diseases Standardized Guidelines proposed by Korean Study Group for Pathology of Digestive Diseases.
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Hoguen Kim, So Young Jin, Ja June Jang, Woo Ho Kim, Sang Yong Song, Kyu Rae Kim, Eun Sil Yu, Hyung Sik Shin, Han Kyeom Kim, Jin Hee Sohn, Eun Kyung Hong, Youn Wha Kim, Jin Sook Jeong, Chang Jin Kim, Shin Eun Choi, In Suh Park, Chan Il Park, Yong Il Kim
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Korean J Pathol. 1997;31(5):389-400.
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- The assessment of epithelial changes in gastric mucosal biopsies has been one of the major problems caused by inconsistencies in and disagreements about nomenclature and interpretation. To resolve these issues, members of the Study Group for Pathology of Digestive Diseases reviewed microslides of 50 gastric lesions showing varying degrees of mucosal abnormality and reached the following consensus; 1) the proliferating gastric epithelium can be divided into hyperplastic and neoplastic; 2) the term "dysplasia" is reserved for the microscopic epithelial changes that are unequivocally neoplastic; 3) Biopsy specimens can be categorized as regenerative(negative for dysplasia), indefinite(questionable dysplasia), positive(positive for dysplasia) and overt carcinoma; 4) The positive category can be divided into two subgroups, high grade dysplasia and low grade dysplasia. Criteria for each grade are presented and discussed. We offer these guidelines for establishing the correct diagnosis of the gastric mucosal biopsy specimens and for prospective studies.
- Histopathologic Re-evaluation of Thymoma with Immunonhistochemical Study for bcl-2 and MIC-2 Protein.
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Kyung Moo Yang, Mee Yon Cho, Soon Won Hong, Tae Seung Kim, Chan Il Park, Woo Ick Yang
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Korean J Pathol. 1997;31(5):446-461.
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- We reviewed 86 thymic epithelial tumors and reclassified them according to the Kirchner and Muller- Hermelink classification. They were subtyped as medullary, mixed, predominantly cortical (organoid), cortical, well differentiated thymic carcinoma, and poorly differentiated thymic carcinoma. The frequency of each subtype was determined and histologic findings were related to stage and myasthenia gravis. Immunohistochemical stains for bcl-2 protein as a marker for medullary thymocytes and MIC-2 protein as a marker for cortical thymocytes were performed in each case. The stages and association of myasthenia gravis was significantly different in each subtypes. The results of this study demonstrate that this histogenetic classification is clinically applicable. The bcl-2 protein was specifically demonstrated in lymphocytes within areas of medullary differentiation and MIC-2 protein in cortical differentiation. The expression of bcl-2 and MIC-2 proteins lend histogenetic support for this new classification of thymoma. Bcl-2 protein is strongly expressed in tumor epithelial cells of every case of poorly differentiated thymic carcinoma whereas the other types of thymic epithelial tumors do not show epithelial expression of this protein. The strong expression of bcl-2 protein in tumor epithelium may be considered as a predictor of aggressive behavior in thymic epithelial tumors.
- Hepatic Fascioliasis Mimicking Metastatic Tumor.
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Jong Yup Bae, Chan Il Park
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Korean J Pathol. 1996;30(10):928-932.
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- A case of hepatic fascioliasis misdiagnosed as metastatic carcinoma was reported. The patient was a 22-year-old woman who had had rectal adenocarcinoma (Duke stage C2), and had been treated by Mile'operation 8 months ago. A computed tomogram(CT) demonstrated multiple low density nodules in the liver suggesting a metastatic tumor. A partial liver lobectomy was performed. The resected liver showed multiple necrotic nodules, which appeared to be abscesses containing eggs of the Fasciola species. Parasitic infection should be considered as one of the possible etiologies of hepatic nodules which mimic metastatic carcinoma either clinically or radiologically.
- Correlation between Transforming Growth Factor-beta and Procollagen III with Regenerative Activity in Acute Liver Injury, and the Effect of Prostaglandin E2.
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Nam Hoon Cho, Chan Il Park
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Korean J Pathol. 1996;30(5):367-387.
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- Transforming growth factor-beta (TGF-beta) plays an important role in hepatic fibrogenesis. It is thought to inhibit regeneration of the hepatocytes. The aim of this present study was to clarify the correlation of TGF-beta, collagen type III (PIIINP) and the regenerating activity of hepatocytes, and the effect of prostaglandin E2 (PgE2) on them in acute liver injury. Two hundred and sixteen male Sprague-Dawley rats, weighing 200g on average, were divided into six experimental groups and two control groups; group I-CCl4 only administration, group II-partial hepatectomy(PH) only, group III-PH following CCl4 administration, group IV-olive oil only administration, group V-sham operation, group VI-CCl4 administration with pretreatment of PgE2, group VII- PH with pretreatment of PgE2, and group VIII- PH following CCl4 administration with pretreatment of PgE2.
Five rats were sacrificed at 12, 24, 36, 48, 96 and 168 hours after the administration of CCl4 or PH in each experimental group. The liver was tested with immunohistochemical stain for proliferating cell nuclear antigen (PCNA) and in situ hybridization for TGF-beta.
Radioimmunoassay for serum PIIINP was also performed. The results were as follows: TGF-beta was expressed mainly in the perisinusoidal cells and periportal mesenchymal cells.
The TGF-beta positive cells were most numerous in the combined group of CCl4 plus PH. TGF-beta expression tended to have an inverse relation, with the PCNA index in all experimental groups. The PCNA index was highest in the CCl4 only group and lowest in the combined group of CCl4 plus PH.
The PH only group showed a peak PCNA index at 48 hours. In the CCl4 only group and the combined group of CCl4 plus PH, serum PIIINP appeared to increase at 12 hours or more after the expression of hepatic TGF-beta. Pretreatment of PgE2 revealed that TGF-beta precipitously disappeared at 48-96 hours after insult. PgE2 influenced the vanishing period, not the emerging time of TGF-beta and had a remarkable effect on the amount of TGF-beta especially in the PH following CCl4 administration group, which resulted in significant accentuation of PCNA indices. In conclusion, PH of the prior injured liver induces a marked increase of TGF-beta followed by a significant suppression of regeneration of the remaining liver, and PgE2 overtly suppresses the expression of TGF-beta.
- Papillary Neoplasm of the Endolymphatic Sac: A report of two cases.
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Jai Hyang Go, Yoon Jung Choi, Tae Seung Kim, Chan Il Park
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Korean J Pathol. 1996;30(2):150-154.
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- Papillary tumor of the temporal bone or middle ear has been recognized as an aggressive neoplasm because of its invasive growth pattern. The site of origin is controversial so that most cases have been reported under various diagnostic terms. Recently, Heffner(1989) suggested that the endolymphatic sac is a possible site of origin, because the tumor resembles the endolymphatic sac in several aspects. We report two such cases. One patient was a 34-year-old female presenting with tinnitus and hearing difficulty for 1 year.
Temporal bone CT revealed extensive bone destruction by the tumor which was located in the posterolateral aspect of temporal bone. The other patient was a 56-year-old female who complained of tinnitus, dizziness and otalgia for 2 years. Cranial MR imaging showed an irregularly marginated mass in the left jugular fossa with extension to the petrous bone. Histologically, both cases showed a papillary pattern and locally destructive growth that are typical of papillary tumor of the endolymphatic sac. The papillae were lined by a single layer of bland-looking cuboidal to low columnar cells. Immunohistochemically the lining cells expressed cytokeratin, epithelial membrane antigen, neuron specific antigen and in one case, S-100 protein, supporting the thesis that these neoplasms might be of endolymphatic sac origin.
- Galactocele in a Male Child: A case report.
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Yoon Mi Jeen, Yoon Jeong Choi, Dong Wha Lee, Chan Il Park
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Korean J Pathol. 1996;30(2):164-165.
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- We investigated a unilocular mammary cyst occurring in a two and a half year old male baby. The cyst was lined by simple columnar epithelium and filled with a milky secretory material. These histologic features were consistent with galactocele. The child had enlarged left breast since birth, but it seemed to be noncontributory as the child had neither endocrine abnormalities nor perinatal disorders. Galactocele is an uncommon breast lesion usually occuring in females following lactation. It is rarely a cause of breast enlargement.
- Short-term Effect of Iron on the Hyperplastic Lesions of Chemical Hepatocarcinogenesis.
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Young Nyun Park, Woo Hee Jung, Soon Hee Jung, Chan Il Park
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Korean J Pathol. 1994;28(6):569-583.
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- This study was undertaken to elucidate the short-term effect of iron on the hyperplastic lesions of experimental hepatocarcinogenesis. The Solt-Farber's resistant hepatocyte model was chosen for the experiment, and Sprague-Dawley rats wee divided into six groups: normal control, iron-rich diet administration with or without hydroxyquinoline. The iron content, microscopic changes, bromodeoxyuridine(BrdU) labelling index and the DNA polidy were studied. In the carcinogen administered group, oval cell proliferation and consecutive hyperplastic lesions of hepatocyte developed regardless of iron administration. The hepatic iron content was increased rimarkably by iron administration, but gradually decreased as the hyperplastic lesions developed in carcinogen administered groups. Although the administration of iron without carcinogen induced hepatic accumulation of stainable iron, the hyperplastic lesions appeared to be lack of it. BrdU labelling indices of the oval cells and the hyperplastic lesions of hepatocyte were very high and were not significantly altered by iron administration. Most liver cells had diploid or tetraploid DNA content, but there was an increase of diploidy as the development of hyperplastic lesions regardless of iron administration. The results indicate that the chemical carcinogen-induced hyperplastic lesions of hepatocyte do not accumulate iron, and that short-term iron administration does not affect the development of hyperplastic lesions and their proliferative activity and DNA ploidy.
- Immunohistochemical Profile of Sclerosing Hepatic Carcinoma.
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Chan Il Park, Young Nyun Park
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Korean J Pathol. 1994;28(6):636-642.
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- Sclerosing hepatic carcinoma (SHC) is composed of slender cords or small nests of tumor cells with peripheral palisading, and abundant intervening sclerosis. The tumor seems to have the histologic features of both hepatocellular carcinoma (HCC) and cholangiocarcinoma. To evaluate the phenotypic expression of SHC and to investigate its cellular origin, immunohistochemical studies on three cases of SHC were performed. In all cases, the tumor cells showed positive staining for cytokeratins AE1, AE3 and 19, carcinoembryonic antigen (CEA) and epithelial membrane antigen (EMA). The expressions of cytokeratins AE1 and 19 were stronger in the palisading cells than the interior of the cords and nests. Conversely, CEA and EMA were expressed mainly in the inner portion. Alpha-fetoprotein was expressed in only one case, mainly in the palisading cells. In summary, SHC has the histological as well as the immunohistochemical profiles intermediate between HCC and cholangiocarcinoma, and the immunohistochemical profile suggests that SHC arises from primitive hepatoblast with a tendency of differentiation to the bile duct epithelium.
- The Effect of Preoperative Treatment on Cell Kinetics and Patients Survival in Hepatocellular Carcinoma.
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Yoon Jung Choi, Ho Guen Kim, Chan Il Park, Woo Hee Jung
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Korean J Pathol. 1994;28(6):605-611.
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- To evaluate the effect of preoperative treatment on proliferative activity and prognosis of the hepatocellular carcinomas(HCCs), fifty-three surgically resected HCCs were studied. Twenty cases were treated preoperatively and thirty-three were not treated before surgery. The proliferation index(PI, % of proliferating cell nuclear antigen positive cells) of the remaining cancer cases(35.41). Although PI was similar among gross types and among histologic grades, tumors of the expanding type and of the histologic grade I revealed distinctly low PI in pretreated cases. Two-year survival rate was not significantly different between pretreated and not-pretreated cases(67.4 vs 52.7). But the differences between gross types(p<0.05) and between histologic grades(p<0.01) were significant. Total necrosis of tumor occurred in five pretreated patients, all of whom were alive during two-year follow-up. Smaller HCCs showed better prognosis(p<0.01). Although PI appeared not correlated well with the two tear survival rate, the pretreated HCCs preoperative modalities induce tumor necrosis, but do not reduce the proliferative activity of tumor cells significantly, and that pretreatment does not affect the long-term prognosis of HCCs except for the accasions of total necrosis of tumor.
- Idiopathic Intestinal Lymphangiectasia.
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Kun Chang Song, Chan Il Park
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Korean J Pathol. 1994;28(3):319-321.
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- This is a case report of idiopathic intestinal lymphangiectasia occurring in a 3-year-old boy. Idiopathic intestinal lymphangiectasia is believed to be a part of the generalized congenital disorder of lymphatic system. The present case revealed markedly ectatic lymphatics in the lamina propria of duodenal villi with lymphorrhagia.
Clinical features were typical of the protein-losing enteropathy; hypoalbuminemia, hypocalcemia, chylous ascites, edema of the lower extremities and mild lymphocytopenia.
This case indicates that serious protein loss may ensue, even in cases of intestinal lymphangiectasia without abnormalities of extraintestinal lymphatics.
- roded Polypoid Hyperplasia of the Rectosigmoid Colon: Report of 2 cases with special reference to its relation to mucosal prolapse syndrome.
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Nam Hoon Cho, Hee Jeong Ahn, Chan Il Park
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Korean J Pathol. 1994;28(3):297-301.
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- Polypoid prolapse of mucosal folds can occur at various sites and in various conditions predominantly associated with strain during defecation. There are two well known types of mucosal prolapse syndrome(MPS), the inflammatory cloacogenic polyp(ICP) and the mucosal redundant polyp associated with diverticular disease(N4RPD). ICP is a mucosal prolapse of the anorectal junction and MRPD is a proximal analogue involving the sigmoid colon. We experienced two cases of eroded polypoid hyperplasia(EPH) of the rectosigmoid colon which manifested as a huge gyriform mass simulating the gross features of gastrointestinal lymphomas or other malignant tumors. The EPH consisted of confluent polypoid mucosal folds with rolled-up submucosa to form stalk, The polypoid lesion represented hyperplastic epithelium, erosion of the mucosal surface and congestive vascular ectasia of lamina propria and submucosa. To explain the whole morphologic features, the initial phenomenon should be the mucosal prolapse. Vascular stretching with ischemic erosion of the mucosal surface and compensatory epithelial hyperplasia ensue as the result. The ominous endoscopic and gross features of EPH should be kept in mind to avoid erroneous radical surgery.
- Prognostic Value of the PCNA Index in Transitional Cell Carcinoma of the Urinary Bladder.
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Sang Yeop Yi, Young Nyun Park, Chan Il Park
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Korean J Pathol. 1994;28(3):282-287.
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- It is well known that histologic grade and tumor stage are important prognostic factors, and that the monoclonal antibody to proliferating cell nuclear antigen(PCNA) can recognize S-phase cells. The PCNA index of 53 transitional cell carcinomas(TCCs) of the urinary bladder was studied to evaluate its prognostic validity. The PCNA indices of TCCs ranged from 38 to 92, whih were quite different from that of normal transitional epithelium(9.4). The PCNA indices were significantly higher in tumors of the higher histologic grade and/or tumor stage(correlation coefficient 0.64 and 0.43; P=0.00). The PCNA index was particularly valuable in discriminating the superficial TCCs from the deeply invasive TCCs(67.1+/-15.46 and 79.9+/-9.70; P=0.000). Among TCCs of the same tumor stage, the histologic grade affected the PCNA index. However, TCCs of the same histologic grade revealed similar PCNA indices regardless of tumor stage. These results indicate that the PCNA index is an objective and reliable prognostic factor in TCCs, which is superior to the conventional histologic grade.
- Methotrexate Induced Chronic Active Hepatitis: A report of two cases.
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Jee Young Han, Young Nyun Park, Chan Il Park, Chae Yoon Chon
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Korean J Pathol. 1994;28(2):168-172.
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- Although methotrexate(MTX) has been known to have many side effects, especially toxicity on the hemopoietic cells and the liver, it has been used as a potent anticancer drug and for the treatment of psoriasis or rheumatoid arthritis. The severity of hepatotoxicity varies from mild fatty change to chronic active hepatitis(CAH) and cirrhosis. We experienced two cases of MTXinduced CAH in patients with psoriasis, which prompted us to report in view of the absence of biopsy proven MTX hepatotoxicity in the Korean literature.
Microscopically, the liver showed a distorted lobular architecture with portal fibrous expansion, piecemeal necrosis and bridging necrosis/fibrosis. The hepatic lobules revealed fatty changes of hepatocyte, focal hepatocytolysis, delicate collagen deposits along the space of Disse and the characteristically marked polyploid nuclear change of hepatocytes.
- The Tissue Expression of HBsAg and HBcAg in Hepatocellular Carcinoma and Peritumoral Liver.
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Jee Young Han, Woo Hee Jung, Chae Yoon Chon, Chan Il Park
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Korean J Pathol. 1993;27(4):371-378.
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- To evaluate the tissue expression rate and pattenr of HBsAg and HBcAg in tumors and peritumoral livers, an immunohistochemical study was undertaken on 47 surgically resected hepatocellular carcinomas(HCCs). The results are as follows. 1. Patient's sera were positive for HBsAg in 40 cases(85.1%). In the remaining 7 cases, the tumor and peritumoral liver expressed neither HBcAg nor HbSaG, suggesting that they were caused by other etiologies than hepatitis B virus. 2. The peritumoral liver had HBsAg and HBcAg in 95.0% and 27.5% among the 40 cases, respectively.
But the tumor expressed HBsAg in 50.0% and HBcAg in none. 3.
The expression of HBsAg within the tumor and both HBsAg and HBcAg in the peritumoral liver tended to be more frequent in the pretreated cases before surgery. 4. Edmondson-Steiner grade IV tumors revealed a lower expression rate of HBsAg than the low grade tumors(p<0.05). Incases with cirrhosis at peritumoral tissues, HBcAg was less frequently found than in those without cirrhosis. The majority of tissue HBsAg and HBcAg was represented as groups of positive cells. These results suggest that, during the development and progression of HCCs, the HBcAg containing cells are repeatedly removed and the HBcAg negative cells are selected, because cellular expression of HBcAg is the target of host immune response.
- Schwannoma of the Adrenal Gland: A case report.
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Yong Chan Chun, Sun Hee Sung, Chan Il Park
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Korean J Pathol. 1993;27(4):424-426.
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- Retroperitoneum is often the site of occurrence of schwannoma, but reports on schwanoma of the adrenal gland is exceptional and only 4 cases have been documented in the literature. This report is to add one such case occurred in a 53 year-old male who had anorexia, nausea and indigestion for one month. Whole body bone scan and abdominal CT scan revealed a 10 cm sized solid mass at upper pole of the left kidney. Under the impression of renal cell carcinoma, an operation was performed. The tumor was well encapsulated and appeared not to involve the kidney. The cut surfaces were light yellow and seemed to be composed of several hard lobules with areas of mucoid, cystic and calcific changes.
No adrenal gland was identified grossly. But microscopically, the tumor was found to be partly surrounded by a small portion of adrenal cortical tissue.
Histologically the tumor was a typical schwannoma with Verocay bodies, although modified in some extents by mucoid degeneration, cystic change, hyaline change and focal calcification. It is worthwhile to remember that the retroperitoneal schwannoma commonly had a huge size, sometimes involving the adjacent structures.
- Chronic Sclerosing Hyaline Change and Fatty Metamorphosis Resembling Alcoholic Liver Diseas in Prader-Willi Syndrome.
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Sun Hee Sung, Dong Won Min, Chan Il Park, Ki Sup Chung
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Korean J Pathol. 1993;27(4):407-410.
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- A complex syndrome, later called as Prader-Willi syndrome, was first described in 1956 by Prader et al, and Zellweger and Schneider characterized this syndrome as hypogonadism, hypotonia, hypomentia and boesty. It is not rare in western countries and more than 400 cases have been reported until 1983. But our interest arose because of our recent experience of diffuse noncirrhotic fibrosis of the liver in a 6 year-old boy who had the clinical features of Prader-Willi syndrome. The core of liver showed destruction of most of the hepatic lobules, particularly of the acinar zone 3, and replacement bt diffuse fibrosis. The remaining liver cells underwent fatty change, and the overall changes resembled chronic sclerosing hyaline disease of the alcoholic type. Inflammation was negligible. This particular case suggests that the severe fatty change of liver could result in irreversible damage to the hepatocytes and progressive fibrosis.
- Histopathological and Immunohistochemical Features of Wilms' Tumor.
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Yoon Jung Choi, Woo Hee Jung, Dong Whan Shin, Chan Il Park, Chuhl Joo Lyu
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Korean J Pathol. 1993;27(4):339-348.
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- Wilms' tumor is one of the most common primary malignant tumors of the kidney during infancy and childhood and is known to be originated from the primitive cells of metanephric blastema. It presents difficulties when encountered in deciding the presence of anaplasia or in differentiating it from other renal tumors of childhood with different biologic behavior because of its diverse histologic patterns and varying degrees of differentiation.
Evaluation of clinical and histopathologic features in terms of prognostication was done of 32 cases of Wilms' tumor which were surgically resected and diagnosed in the period from January 1979 through June 1992. Immunohistochemical reaction for cytokeratin, vimentin, actin and desmin was also analysed on all cases of Wilms' tumor in conjunction with clear cell sarcoma of the kidney(CCSK), malignant rhabdoid tumor of the kidney(MRTK) and congenital mesoblastic nephroma(CMN) to assess the validity of immunohistochemistry in differentiating Wilms' tumor from these renal tumors. Twenty four(75%) cases were diagnosed before the age of 5 and 40.7% were under 2 years old. Mixed type was most common(62.5%), followed by epithelial, blastemal and stromal predominant type in descending order of frequency. Anaplasia was observed in 3 cases(9.4%), two of which were epithelial predominant type and one blastemal predominant type. Treatment modality and presence of anaplasia were significantly correlated with 5 year survival rate of patients. Immunohistochemical stain revealed that all epithelial component of Wilms' tumor were positive for cytokeratin and 56.3% of Wilms' tumor had blastemal component which were positive for both cytokeratin and vimentin. Twenty cases(62.5%) of Wilms' tumor had blastemal component which were positive for cytokeratin with a proportion of more than 5% of reactive cells. Stromal component of Wilms' tumor generally did not show differentiation into the specialized type of tissue and all revealed positive reactions for vimentin among which some revealed positive reactions for actin. Only 3 out of 6 cases with rhabdomyoblastic differentiation were positive for desmin. CCSK, MRTK and CMN which have different biologic behavior and treatment modality compared to Wilm's tumor showed positivity only for vimentin and/or actin. In summary, treatment modality and presence of anaplasia are significantly correlated with patients' survival and the immunohistochemical stain for cytokeratin is very helpful in confirming the presence of blastemal component and useful in the differential diagnosis of Wilms' tumor from other kinds of pediatric renal tumors.
- Eosinophilic Liver Abscess in Patients with Gastric Carcinoma.
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Soon Won Hong, Ho Guen Kim, Chan Il Park, Sang In Lee
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Korean J Pathol. 1993;27(1):27-33.
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- Sixteen cases of heavy eosinophil infiltration or eosinophilic abscess of the liver in patients with gastric carcinoma were analyzed to draw attention to this interesting combination and to persue the pathogenetic mechanism. Peripheral blood eosinophilia and hepatic granuloma were found in only 5 and 4 cases, respectively.
Neither the patients' stool nor the hepatic tissues disclosed any parasitic worms or eggs, although the skin tests for Clonorchis sinensis and Paragonimus westermani were positive in 2 cases. Among stomach carcinomas, early gastric cancer tended to have more eosinophils than advanced carcinoma, but was less frequently associated with the infiltration of mast cells. In the regional lymph nodes, there was no infiltration of eosinophils even in the presence of tumor metastasis. In the liver, none of the 16 cases had metastatic gastric carcinoma and mast cells were found in only 2 cases. The results suggest that heavy hepatic infiltration of eosinophils in gastric carcinoma patients is not of the parasitic or allergic cause, but of certain eosinophil chemotactic factor which may gain access to accumulate in the liver following released from the gastric carcinoma and transfered through the portal vein.
- Embryonal Sarcoma of the Liver with Chondrosarcomatous Differentiation: A case report.
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Woo Hee Jung, Hyunee Yim, Ho Guen Kim, Chan Il Park, Ki Keun Oh, Seung Hoon Choi
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Korean J Pathol. 1992;26(5):504-509.
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- Embryonal sarcomas of the liver, often called undifferentiated sarcomas or malignant mesenchymomas, are extremely rare tumors that occur chiefly in children with poor prognosis and uncertain histogenesis. Histologically, tumor cells are stellate or spindle shaped, loosely arranged in edematous or myxoid pattern alternating with highly cellular zones and do not show evidence of differentiation.
Ultrastructural and immunohistochemical studies by previous investigators indicate that the neoplastic cells are mostly primitive mesenchymal cell which occasionally differentiate to fibroblasts, lipoblasts, histiocytes and smooth muscle cells via intermediate cell types. The authors experienced a case of 6-year old boy who presented with an enlarging abdominal mass of the liver which revealed typical histological and ultrastructural features of embryonal sarcoma with focal areas of unusual chondrosarcomatous differentiation.
- Liver in Systemic Lupus Erythematous: Clinicopathological analysis of 8 cases.
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Young Nyun Park, Chan Il Park, Yoon Sok Chung, Si Young Song, Chein Soo Hong
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Korean J Pathol. 1992;26(5):445-450.
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- Hepatic changes in eight cases of systemic lupus erythematosus(SLE), were studied to evaluate the nature of hepatic injury of SLE and its relation to lupoid hepatitis.
Common histologic changes of the liver in SLE included intralobular necro-inflammatory activities, fatty change, canalicular bile stasis and mild perivenular and Disse space fibrosis. The fatty change and intralobular fibrosis were thought not to be due to SLE itself but associated with steroid administration or chronic alcoholic consumption. The necro-inflammatory changes were usually mild and features of chronic active hepatitis with periportal destruction occured in one case. Symptoms related to the involvement of many other organs than the liver appeared much frequently in patients with SLE than lupoid hepatitis, suggesting that the SLE involving liver and the lupoid hepatitis are different diseases.
- The Effect of Copper on 3'-Methyl-4-dimethylaminoazobenzene Induced hepatic Carcinogenesis.
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Jung Sook Moon, Young Nyun Park, Chan Il Park
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Korean J Pathol. 1992;26(4):360-371.
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- To elucidate the effect of copper on the 3'-methyl-4-dimethylaminoazobenzene(3'-MeDAB) induced hepatic carcinogenesis, Sprague-Dawley rats were divided into 4 groups according to 3'-MeDAB and copper administration: I. noraml control, II. copper only, III.
3'-MeDAB only, IV. 3'-MeDAB plus copper. The animals of groups III and IV were fed experimental diet containing 0.06% 3'-MeDAB. Copper was administrated intraperitoneally in a dose of 0.5 mg, twice a weak. Animals were sacrificed at different intervals. Liver weight, hepatic copper content and gross and microscopical changes of the liver were examined and the cell kinetics of various lesions in the hepatic carcinogenesis was studied by applying the immunohistochemical method for bromodeoxyuridine(BrdU). The hepatic copper content was significantly increased in animals given copper but returned to the normal value after cessation of adminstration. 3'-MeDAB administration caused oval cell proliferation and produced hyperplastic nodules, cholangiofibrosis and carcinoma of the liver. Simultaneous administration of copper did not alter the incidence of 3'-MeDAB induced lesions, except for carcinoma. The liver weight and the size of hepatic nodules and masses were smaller in group IV than in group III. The liver weight as well as the nodularity and the mass formation continued to increase affect cessation of 3'-MeDAB administration. Copper did not affect the BrdU labelling indices of the hepatic lesions induced by 3'-MeDAB. The oval cell proliferation and the BrdU labelling indices of the oval cell and the hyperplastic nodule were decreased, but the incidence of cholangiofibrosis and its BrdU labelling index were still elevated after cessation of 3'MeDAB administration. These findings indicate that copper could delay the developement of 3'-MeDAB induced hepatic lesions, but not suppress, since copper does not stay long enough to accumulate in the rat liver, and that copper could not affect the proliferation of 3'-MeDAB induced hepatic lesions once developed.
- Changes of the Kupffer Cell Number in the Course of Metastasis of Hepatocellular Carcinoma.
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Chan Il Park, Yee Jeong Kim, Young Nyun Park, Sun Hee Sung
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Korean J Pathol. 1992;26(3):247-252.
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- The number of Kupffer cells was evaluated in hepatocellular carcinomas, including 18 primary lesions, 3 tumor emboli within the portal vein radicles and 4 metastatic lesions and in non-neoplastic liver adjacent to the primary lesions, to persue the origin of Kupffer cells dwelling in hepatocellular carcinoma. Hepatocellular carcinomas of the sinusoidal(trabecular) type were carefully selected, and excluded were those carcinomas which showed inflammation or other changes evoking inflammation. The immunohistochemical stains for CD 68 and lysozyme were done to identify Kupffer cells and to draw the mean Kupffer cell number per high power microscopic field of each lesion. Kupffer cell was most numerous in primary lesions followed by tumor emboli and still fewer in metastatic lesions. The Kupffer cell number in the primary lesions of hepatocellular carcinoma was in turn smaller than that of the adjacent non-neoplastic liver. The results suggest that, during the early neoplastic transformation, sinusoids of the non-neoplastic liver could creep into the carcinomatous tissue accompanying Kupffer cells.
- Histopathologic Appearance of Cytomegaloviral Liver Diseases in Neonates and Infants.
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Sun Hee Sung, Chan Il Park, Ho Guen Kim, Woo Hee Jung, Ki Sep Chung
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Korean J Pathol. 1992;26(2):137-145.
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- To provide ideas for the recognition of neonatal and infantile liver diseases caused by cytomegalovirus(CMV) infection, histopathological examinations were made on hepatic tissues obtained by biopsy or autopsy from 23 patients. All patients were sero-positive for IgM anti CMV and had no other known or suggested etiologic factors for their liver disease. There were five different types of liver diseases: 8 cases of giant cell hepatitis(34.8%), 4 cases of biliary atresia(17.4%), 5 cases of biliary atresia with changes of neonatal hepatitis(21.7%), 4 cases of diffuse hepatic fibrosis(17.4%) and 2 cases of hepatic necrosis with CMV inclusion(8.7%). The diffuse hepatic fibrosis involved both the hepatic lobules and portal areas without evidences of regeneration. This type of liver disease appeared to be a chronic progressive illness that began during the first week of life, and in 3 of 4 cases, the liver biopsy was dong at 5 to 9 months after birth. The two patients showing CMV inclusion in their liver were premature of debilitated, and died within I month after birth. Diffuse hepatic necrosis as well as the cytomegalic change of bile duct epithelium was characteristic. The findings suggest that the pattern of CMV liver disease depends on the major site of hepatic injury, the status of status of patient's defense mechanism and the chronicity of illness.
- Pathological Predictor for Prognosis in Gastrointestinal Mesenchymal Neoplasms.
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Mee Yon Cho, Ho Guen Kim, Chan Il Park, Yoo Bock Lee
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Korean J Pathol. 1991;25(6):528-538.
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- To evaluate the prognostic predictor and clinicopathologic characteristics of the gastrointestinal (GI) mesenchymal neoplasm, we examined 75 cases of GI mesenchymal tumors surgically resected during 8 years from 1983 to 1990.
Various histological parameters referrable to the prognosis, including the Ag-NORs count, were analysed. Fifty cases were followed-up for 1 to 7 years. Sixteen out of these fifty cases died during this period. The location of tumor was the stomach in 33 cases, the small intestine in 31 cases and the large intestine in 11 cases, and the tumor size was variable from 2 to 35 cm in diameter. The GI mesenchymal neoplasm appeared as an extraluminal mass in 50 cases, an intramural mass in 17 cases, and an intraluminal mass in 8 cases. Each tumor was composed of spindle or epithelioid cells, the former cell type being more common than the latter (45 vs 30 cases). Mitotic count of the tumor showed the best correlationship with the survival of patients(p<0.05), although the tumor size and necrosis appeared to have some values. The Ag-NORs count was variable and was not significantly correlated with the patient's prognosis(p>0.05). These results indicate that the mitotic count is the most valuable pathological predictor for the prognosis in GI mesenchymal neoplasms.
- Distribution of S-100 Protein Positive Dendritic Cell and its Correlation with Degree of Malignancy in Gastric Carcinoma.
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Tae Jung Jang, Woo Ick Yang, Chan Il Park, In Joon Choi
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Korean J Pathol. 1991;25(4):327-337.
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- The present study was performed in order to investigate the correlation among the number of T zone histiocytes, the clinicopathologic parameters and the patient's survival. The subjects in this study were 131 advanced gastric carcinomas including 86 follow-up cases and 41 early gastric carcinomas. The infiltration of T zone histiocytes into tumor tissues was investigated using the immunohistochemical method with andti s-100 protein, nd the data obtained were evaluated statistically. T zone histiocytes were scattered among the cancer cells and in areas formed clusters within the cancer stroma. These cells were abundantly present in tumor tissues and around lymphoid follicles but were rarely seen in surrounding normal stomach tissue. Analysis of the number of T zone histiocytes showed no correlation between the number of T zone histiocytes and the clinicopathologic features except the degree of lymphocytic infiltration within the advanced and the early gastric carcinomas.
Survival of the patients with a marked infiltration of T zone histiocytes in stage III was longer than that with mild infiltration of T zone histiocytes, but there was no statistical significance(P value=0.084). Multivariate regressio analysis revealed that the depth of invasion(P value=0.0074) and the lymphocytic infiltration(P value=0.0152) were the important prognostic factors. The results indicate that good prognosis is expected in cases with less deep invasion and high lymphocytic infiltration, and that the number of T zone histiocytes is in proportio to the degree of lymphocyte infiltration within the tumor, although not directly correlated with the patient's survival.
- Hepatic Candidiasis: A case occurred in a patient with leukemia.
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Chan Il Park, Sun Hee Sung, Eun Kyung Han, Ho Guen Kim
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Korean J Pathol. 1991;25(3):275-277.
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- In view of the possible role of portal circulation in hematogenous spread of Candida species, a case of hepatic candidiasis occurred in an eight-year-old child with acute lymphoblastic leukemia (ALL) treated by chemotherapy is presented. Symptoms and signs referable to the hepatic disease in this patient included hepatomegaly, icteric sclera and abdominal pain. There were no particular manifestations suggestive of deep mycotic involvement of any sepcific organs or tissues other than the liver. Culture of the blood was negative for one month. On the 24th hospital day the patient died with the presumptive diagnosis of ALL, disseminated intravascular coagulation, acute renal failure, pulmonary edema, cholecystitis and oral thrush. A needle necropsy was performed and revealed fungal aggregates replacing the large foci of hepatic cell loss. It is suggested that, when the gastrointestinal tract serves as the portal of entry, the liver could be the visceral organ involved first in the course of disseminated candidiasis.
- Gross Anatomical Typing of Hepatocellular Carcinoma: Classification of 49 lobectomized hepatocellular carcinomas.
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Young Nyun Park, Eun Kyung Han, Chan Il Park
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Korean J Pathol. 1991;25(2):83-92.
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- Forty-nine lobectomized hepatocellular carcinomas(HCC) were classified according to the gross anatomical features.
Because the presence of cirrhosis in the remaining liver has a good clinico-pathological implication, cases of HCC were divided into non-cirrhotic(non-LC) and cirrhotic(LC) groups.
In both groups, the tumors themselves belonged to either expanding, focal spreading, spreading or mixed type. Another special type, which has been called a "diffuse type" is added in the LC group with the name of "cirrhotomimetic type" Among 49 cases, 21 belonged to the non-LC group and 28 to the LC group. Most common was expanding type(20 cases, 40.8%), which was followed by spreading(32.7%), focal spreading(16.3%), mixed(6.1%) and cirrhotomimetic(4.1%) types. Expanding type of the LC group was the single most common type(13 cases, 26.5%). The accordance rate of gross typing was 0.94. Tumor masses of the LC group showed a greater tendency of having a fibrous capsule(60.7%) and a lobulated cut surface(82.1%), in contrast to those of the non-LC group (28.6% and 42.9% respectively). The patient's age and the HBsAg seropositivity were not different between the groups and between the types. Increased serum level of AFP was particularly frequent in the spreading type(81.3%) of both groups and in the cirrhotomimetic type(100%).
- Hepatic Anthracosis: A case report.
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Hee Jae Joo, Eun Kyung Han, Ho Guen Kim, Chan Il Park
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Korean J Pathol. 1991;25(2):172-173.
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- The authors report a case of hepatic anthracosis, which was found incidentally during cholecystectomy in a 73 year-old woman with acute cholecystitis. Hepatic anthracosis is a very rare condition among pigmentary lesions of the liver.
Light microscopic examination revealed black granular pigments within Kupffer cells, particularly adjacent to the terminal hepatic venules, and macrophages at the portal tracts. The pigments did not show birefringence under the polarizing microscope and did fade out following pretreatment with alcoholic picric acid, confirming themselves anthracotic pigments.
- The Effect of Ethanol on 3'-Methyl-4-dimethylaminoazobenzene Induced Carcinogenesis in Rat Liver.
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Chan Il Park, Ho Guen Kim, So Young Jin, Woo Ick Yang, Yoo Bock Lee
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Korean J Pathol. 1991;25(1):21-29.
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- 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.
- Histological Grade of Prostatic Adenocarcinoma.
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Kyong Ho Kim, Soon Hee Jung, Chan Il Park
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Korean J Pathol. 1990;24(3):236-242.
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- The authors attempted to choose what has the best reproducibility and predictability for prognosis of the prostatic adenocarcinoma among four most widely used gradings methods; the Gleason's Mostofi's, Bocking and MD Anderson hospital systems. According to these gradings systems, each of two pathologists made histologic gradings of 40 consecutive prostatic adenocarcinomas which had been diagnosed with the surgically resected specimens.
Correlation between the histological grades and the clinical stages was studied and a comparison was made among each system. For the comparison, the Gleason's and MDAH systems were revised as 3 grades and adjusted to the other gradings systems. In this study, MDAH grading system yielded the highest reproducibility as represented by 90% agreement, as compared with the other systems which showed 82.5~87.5% agreement. By the Gleason's, Mostofi's and Bocking's systems, 46.2%, 23.1% and 46.2% of grade 3 tumors respectively fell under the clinical stage A. On the contrary, there were no cases of grade 3 in stage A and no cases of grade 1 in stage D, by MDAH gradings system. These results suggest that MDAH gradings system is superior to the other systems in reproducibility and for predicting the biological behavior.
- Expression pattern of Hepatitis B Viral Core Antigen (HBcAg) and Surface Antigen (HBsAg) in Liver of the Inactive HBsAg Carriers.
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Hee Jeong Ahn, Kyoung Ho Kim, Young Nyun Park, Ho Guen Kim, Chan Il Park
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Korean J Pathol. 1990;24(2):120-127.
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- To understand better the complex natural course of HBV infection, the expression patterns of HBcAg and HBsAg in the liver of 51 inactive serum HBsAg carriers (24 CPH and 27 NPD) were studied by immunohistochemical methods. The inactive serum HBsAg carriers were devided into 3 groups by the following expression patterns of serum HBeAg/anti-HBe status and tissue HBcAg and HBsAg. Pattern A (18 cases) : HBeAg+, cHBcAg+ (94.4%), mHBsAg+ (61.1%), pATTERN B (14 cases) : anti-HBe+, nHBcAg+, cHBsAg+, Pattern C (19 cases) : anti-HBe+, HBcAg-, cHBsAg+ (89.5%). There were no significant differences between CPH and NPD, lthough the core free pattern was more common in the latter. The cHBcAg was expressed in 17 of 18 (94.4%) HBeAg seropositive cases but only one of 33 cases with serum anti-HBe, suggesting that the cHBcAg is intimately related to HBeAg. Since the inactive HBsAg carriers also expressed cHBcAg and/or mHBsAg, the necro-inflammatory activity of HBV infected liver is assumed to depend on the host immune response rather than their presence alone
- Alcoholic Type Cirrhosis Following Side to Side Ileo-Transverse Colon Anastomosis.
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Kwang Hwa Park, Kwang Hyup Han, Chan Il Park
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Korean J Pathol. 1990;24(2):148-152.
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- A case of micronodular cirrhosis of the alcoholic type developed following an intestianl bypass surgery in a 47 year-old nonalcoholic male patient is presented. The patient denied any drug use of a long duration and had no diabetes mellitus. Five years before, a side to side ileo-transverse colon anastomosis had been performed for perforated intestinal tuberculosis at 1 m proximal to the ileocecal valve, bypassing a short segment of ileum (about 1.5 m) and transverse colon. The ileum distal to the perforated site had been found completely stenosed. He was severely lean with evidences of nutritional deficiency such as low serum levels of the albumin and vitamin B12. The liver biopsy showed a fatty change, Mallory bodies and perihepatocellular collagenosis within the cirrhotic nodules. The present case suggests that, when there are blind loop formation and nutritional deficiency, hepatic changes identical to those following jejunoileal bypass could develop even by reduction of a shore segment of the small intestine.
- The Significance of Nesidiodysplasia of the Pancreas.
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Soo Im Choi, Woo Hee Jeong, Chan Il Park
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Korean J Pathol. 1990;24(1):10-15.
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- To elucidate the significance of the nesidiodysplasia of pancreas, histological re-evaluation and immunohistochemical studies for insulin, glucagon and somatostatin were done on 16 consecutive cases (5 premature babies, 2 stillborns, 5 infants and 3 adults) in which paraffin blocks of the pancreas were available. Only one infant was hypoglycemic.
All 16 pancreases showed changes of nesidiodysplasia which appeared immunohistochemically to have isulin, glucagon and /or somatostatin. The histologic patterns of nesidiodysplasia included ductoendocrine proliferation, endocrine cell dysplasia, adenomatosis, septal islet, islket cell hypertrophy and islet hypertrophy. All the patterns of nesidiodysplasia except for the adenomatosis were seen in premature babies, infants, stillborns and adults with or without hypoglycemia. The adenomatosis was found only in the hypoglycemic infant. The result suggests that all patterns of nesidiodysplasia of other than the adenomatosis does not imply the pathologic basis of hypoglycemia.
- Kupffer Cells in Hepatocellular Carcinoma.
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Young Nyun Park, Soon Hee Jung, Chan Il Park
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Korean J Pathol. 1989;23(3):305-310.
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- Kupffer cells are tissue macrophages (histiocytes) fixed in hepatie sinusoids. Since malignant hepatocytes are the only tumor parencymal cells of the hepatocellular carcinoma, theoretically there are no Kupffer cells within the hepatocellular carcinoma. To clarify whether it is true or not, 12 cases of hepatocellular carcinoma of the trabecular type with some extents of the non-neoplastic surrounding liver were subjected to immunoperoxidase staining for lysozyme and S-100 protein and the results are as follows.
1) Kupffer cells were stained positively by the immunoperoxidase staining for lysozyme but not for S-100 protein, indicating that they are monocyte derived macrophages. 2) Kupffer cells were also present within the hepatocellular carcinoma, but were 2-7 times fewer within the hepatocellular carcinoma than in the non-neoplastic areas (p<0.05). 3) The non-neoplastic hepatic tissue of patients with serum HBsAg shows a tendency to have more kupffer cells than those without HBsAg.
- Histologic Pattern of Alcoholic Liver Disease in Korea.
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Chan Il Park, Ho Guen Kim, So Young Jin, Mi Kyung Lee, Yoo Bock Lee
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Korean J Pathol. 1989;23(3):292-304.
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- To elucidate the histologic pattern of alcoholic liver disease (ALD) in Korea, liver biopsies from 173 chronic alcoholics with clinical liver diseases were classified according to the pathologic parameters. One hundred and seventeen cases, the sum of 91 of 116 serum HBsAg negative and 26 of 57 HBsAg positive patients, had the histologic evidence of ALD. Fatty change(23.9%), alcoholic fibrosis (AF)(23.1%) and cirrhosis (23.1%), comprised the three major ALDs, and only 8.5% of cases fit the criteria of alcoholic hepatitis. Chronic sclerosing hyaline disease (CSHD), chronic active alcoholic hepatitis (CAAH) and AF, where non-cirrhotic fibrosis is the predominant change, comprised 44.5% of ALD. Both features of ALD and HBV liver disease (HBV-LD) were found in 17 cases that included 8 AF and 7 cirrhosis. These 17 patients tended to consume less alcohol than patients with other types of pure ALD except alcoholic heaptitis. Patients with the serum HBsAg positive ALD (37.4years) were about 8 years younger than those with the serum HBsAg negative ALD (45.1years). More or less fatty change and foamy degeneration were seen in 77.4% and 31.6% of ALD respectively. Mallory bodies, megamitochondria, iron deposition and perihepatocellular fibrosis were found in 20.5%, 29.9%, 42.7% and 77.8%, respectively. These findings indicate that non-cirrhotic chronic ALD such as CSHD, CAAH and AF are the important histologic patterns of ALD in Korea, and that chronic alcohol consumption and HBV may act synergistically in developing liver disease.
- Cystandenoma and Primary Cystadenocarcinoma of the Liver.
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Kyoung Ho Kim, Chan Il Park
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Korean J Pathol. 1989;23(2):263-268.
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- Primary cystic neoplasia of the liver is rare. We report a cystadenoma with mesenchymal stroma (CMS) and a cystadenocarcinoma, and make a review of literature with particular reference to their histogenesis. The CMS has many similarities to the ovarian mucinous cystadenoma; occurring almost exlusively in female, being lined by mucus-secreting epithelial cells, and containing dense ovarian-like stroma.
These features suggest that CMS may arise from the ectopic ovarian tissue within the liver. Cystadenocarcinoma may have its origin in CMS or cystadenoma without mesenchymal stroma of CMS. Cholangiocarcinoma arising from the congenital hepatic cysts can be differentiated only when it contains benign epithelia.
- Clinicopathologic Study of the Endometrium of Dysfunctional Uterine Bleeding.
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Nam Hoon Cho, Chan Il Park, In Joon Choi
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Korean J Pathol. 1989;23(1):65-74.
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- One of the most common symptoms in gynecologic disorders is an abnormal utirine bleeding, of which dysfuncyional uterine bleeding (DUB) is frequently encountered. DUB is defined as an endocrinologic imbalance of the axis of hypothalamus-pituitary-ovary-endometrium without organic diseases such as a neoplasm, and inflammation, a pregnancy, a trauma, Although the correct diagnosis of DUB depends on various assessements such as a menstrual cycle, basal body temperature, endocrine assay, vaginal cytology and endometrial histology, in many circumstances pathologist have only the endometrial histology with trivial clinical information to make a diagnosis. Therefore, the present study was aimed at assessing the pattern of the endometrium as precisely as possible. The histologic pattern was classified according to the Handrickson and kempson classification (1980). The authors also attempted to correlate the non-neoplastic metaplasia with the endometrial histology. The material consisted of 447 cases of endometrial curettage specimens diagnosed clinically as DUB during recent 4 years. The histologic examination was carried out through the routine formalin fixed-paraffin embedding method, followed by hematoxylin-eosin staining in routine and other special staining as required. The following results were obtained; 1) The pattern of the endometrium in DUB was predominently the proliferative type (239 cases, 65.55%). Of these 293 cases, 144 were of the abnormal proliferatrive phase, and particulary most were the disordered proliferative phase. The remaining 154 cases (34.45%) were found to have secretory endometrium, of which 50 cases belonged to the abnormal secretory type. Most of the cases shewing abnormal secretory patterns appeared dyssynchronous or underdeveloped. 2) Of the 361 patients with DUB for whom the clinical records were available, 197 (54.57%) were non-ovulatory and 118 (32.69%) were ovulatory.
3) Non-neoplasic metaplasia was found in 87 cases, of which ciliiated and papillary types were most common. The endometrium was of the proliferative phase in 73.56% of the cases with metaplasia, and the disordered proliferative pattern showed a particular correlation with the metaplasia (44 cases). 4) Among 63 postmenopausal DUB patients, 52 (82.53%) appeared to have the proliferative endometrium, and in particular 23 (36.51%) had the disordered proliferative endometrium.
- Medullary Carcinoma of Thyroid Gland with Co-existing Papillary Carcinoma.
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Jeong Hee Ahn, So Yong Jin, Ho Guen Kim, Chan Il Park
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Korean J Pathol. 1988;22(4):443-447.
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- We report a medullary carcinoma of the thyroid gland with a coexisting occult sclerosing papillary carcinoma. This rare case, in that the two types of carcinoma are completely separated and not intermixed together, is different from the previously reported mixed follicular and parafollicular cell carcinomas of the thyroid gland, so-called "differentiated thyroid carcinoma, intermediate type". The two separate tumors of the present case are undoubtedly of coincidental double primaries, and it can be a assumed that at least some of the mixed follicular and parafollicular cell carcinomas are results of collision of carcinomas derived from two embryogenetically different cell types.
- Simple Cyst Occurred in an Accessory Ovary.
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Soon Won Hong, Kyu Rae Kim, Chan Il Park
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Korean J Pathol. 1988;22(4):467-470.
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- The accessory ovary can be defined as an extraovarian tissue that is located near the normal ovaries and is connected to the broad ligament, infundibulopelvic ligament or utero-ovarian ligament. It has very rarely been reported.
The majority was found during abdominopelvic surgeries for any other purposes, because they were usually small and less than 1 cm in diameter adn gave no particular symptoms related simply to their presence. We reported a case of accessory ovary in which developed a simple cyst of a largest diameter of 12 cm, and discussed the significance of the accessory ovary in clinical and pathological aspects.
- Buerger's Disease of Paratesticular Tissue: A case report.
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Soo Im Choi, So Young Jin, Chan Il Park
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Korean J Pathol. 1988;22(4):462-466.
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- We report a case of Buerger's disease manifested by a scrotal mass, in view of its rarity. A tender bean sized mass was palpated in the left scrotum of a 34 year-old male heavy smoker, who had a history of right pain two years ago which subsided spontaneously. The left testis with the paratesticular tissue was excised. Vessels of the spermatic cord and epididymis showed microscopic changes of Buerger's disease. The involved arteries and veins revealed a predominantly subacute pattern with granulomatous inflammation and Langhans' type giant cells within the thrombi.
- Wilson's Disease: Report of a Case with Comprehensive Review of the Previously Reported Cases in Korean Literature.
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Mi Kyung Lee, Chan Il Park
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Korean J Pathol. 1987;21(4):278-284.
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- We reported a case of Wilson's disease, which was histologically confirmed by liver biopsy in a 15 year-old boy and made a comprehensive analysis on the sum of 22 cases reported in Korean literature. Although Wilson's disease is still rare, it should be included in the differential diagnosis of chronic liver diseases particularly in children of 5 to 15 years old. For the clinical diagnosis of Wilson's disease, changes in serum ceruloplasmin, plasma copper and urine copper values are most important as well as Kayser-Fleischer ring and family hestory. The serum level of GOT, when elevated, were always higher than GPT. This atypical transaminase profile may be a clue for diagnosis of hepatic diseases by a metabolic derangement. Among various histologic changes of the liver in Wilson's disease, what have diagnostic importance are anisonucleosis, nuclear glycogenosis and Mallory body, all of which may appear in any stages of the disease. In 3 cases only neurologic symptoms such as dysarthria and athetosis were found.
Hemolytic anemia was another rare complication.
- Immunohistochemical Characterization of the Salivary Gland Tumors.
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Jung Hoon Yoon, So Young Jin, Chan Il Park
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Korean J Pathol. 1987;21(3):144-152.
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- It has been clarified that myoepithelial cells contain S-100 protein which is known to be a marker protein of neural tissue. To evaluate the participation of myoepithelial cells in the histogenesis of the salivary gland tumors, normal salivary glands and various salivary gland tumors were stained by immuno-peroxidase method. PAP kits (DAKO Co, USA) for the S-100 protein and the Cytokeratin were used and the following resulting were obtained. Acinic cells of the normal salivery gland were negative for both cytokeratin and S-100 protein. The intercalated duct cells were weakly positive for cytokeratin and S-100 protein. The normal myoepithelial cells scattered around the acini and the intercalated ducts were positive only S-100 protein. In contrast, the striated duct were positive only for cytokeratin. In plemorphic adenoma, the S-100 protein positive cells were found in solid sheets of tumor cells, in chondromyxoid areas and in areas of spindle-cell stroma as well as in the outer layer of the tubular structures. Only the inner lining of the tubules were positive for cytokeratin. In basal cell adenoma, the stromal spindle cells were strongly positive for S-100 protein and the epithelial cells weakly positive. When tubules were present within the epithelial sheets, the inner most lining cells were positive for cytokeratin. The peripheral palisaded tumor cells were negative for both substances. By immunostaining of the adenoid cystic carcinoma, S-100 protein containing cells were found focally scattered independently on the variety of histologies. The lining cells of true cystic structure were positive for cytokeratin. Immunostaining of the mucoepidermoid carcinoma demostrated that the squamous cells and the tubular epithelial cells contained cytokeraitn, whereas only a few intermediate cells were positive for S-100 protein. In Warthin's tumor there were no S-100 protein positive cells, although basally located epithelial cells of the papillae were positive for cytokeratin. These findings suggest that salivary gland tumors other than the Warthin's tumor arise from myoepithelial cells or reserve cells having dual potentiality differentating into myoepithelial and intercalcated duct cells.
- Hepatic Changes Resembling the Indian Childhood Cirrhosis in an IgM anti-CMV Positive Infant.
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Soo Im Choi, Chan Il Park, Ki Sup Chung
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Korean J Pathol. 1987;21(2):90-93.
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- This is to describe a neonatal hepatitis with pericellular hepatic fibrosis and Mallory bodies in a sero-positive infant for IgM anti-CMV. A necropsy of the liver revealed severe heaptocellular swelling with many intracytoplasmic hyaline bodies, pronounced fibrosis of a creeping type, bile stasis with ductular proliferation, and the lack of parenchymal regeneration. These microscopical changes of the liver resembled those of Indian Childhood Cirrhosis (ICC).
In the present case the patient's serum IgM anti-CMV is the only clue for the etiological diagnosis.
- Potter Syndrome in a Fetus with Trisomy-8 mosaicism: Report of a Case.
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Kyu Rae Kim, Han Young Lee, Chan Il Park, Chang Kyu Kim, Myeong Seon Lee, Young Won Park, Young Ho Yang, Tchan Kyu Park
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Korean J Pathol. 1986;20(3):336-342.
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- 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.
- Congenital Immature Teratoma arising from the Tongue: Report of an autopsy case.
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Jung Hoon Yoon, Kyi Beom Lee, Chan Il Park
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Korean J Pathol. 1986;20(2):187-190.
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- Congenital immature teratoma of the tongue is a exceedingly rare form of epignathus. We report here an autopsy case of a huge immature teratoma protruding from the tongue of a newborn female infant. The mass obstructed the mouth and caused hydramnios. The mother's serum level of alpha-fetoprotein was elevated, and the tumor was identified by a ultrasonogram subsequently done. Discussion on the histogenesis of epignathus was made through a review of literatures.
- Apocrine Carcinoma of the Breast: Report of two cases.
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Young Bae Kim, Woo Hee Jung, Chan Il Park
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Korean J Pathol. 1986;20(2):240-242.
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Abstract
- Apocrine carcinoma is a rare type of mammary cancer, which shows partial or total apocrine differentiation in either ductal or lobular carcinoma. The malignant transformation of apocrine epithelium of the breast was first described by Krompecher in 1916. It is well known that their relationship to true apocrine glands of the skin is only a morphological similarity, and this histological difference does not affect the prognosis. The authors experienced two cases of apocrine carcinoma of the breast which involved infiltrating ductal carcinoma of a 64-year old woman and intraductal carcinoma of a 69-year old woman respectively. Electron microscopic examination and brief review of literature was done.
- Composite Carcinoma-Carcinoid Tumor of Stomach: Report of a case.
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Kyu Rae Kim, Chan Il Park, Tae Seung Kim
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Korean J Cytopathol. 1985;19(4):449-452.
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- The concurrence of typical carcinoid admixed with adenocarcinoma of the gastrointestinal tract is a well known but unusual phenomenom that has been reported in the esophagus, stomach, gall bladder, colon and appendix. The amine precursor uptake and decarboxylation (APUD) concept included the idea that neuroendocrine cells of the gastrointestinal tract were dervied from the neural crest by a process of migration during embryogenesis. However the intimate admixture of cells which have morphologic and immunocytochemical properties of both carcinoid tumors and adenocarcinoma suggests that these tumors are derived from a multipotential stem cell showing bidirectional differentiation rather than from unrelated cell lines. The term composite carcinoma-carcinoid tumor is therefore an appropriate designation for these neoplasms. We report a case of composite carcinoma-carcinoid tumor of the stomach in a 38 year-old female with brief review of literature.
- Chromomycosis: A case report.
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So Young Jin, Chan Il Park, Yoo Bock Lee
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Korean J Cytopathol. 1985;19(3):365-367.
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- Chromomycosis is a chronic localized infection of the cutaneous and subcutaneous tissues and characterized by verrucoid, ulcerated and crusted lesions with sclerotic margins. It histologically show confluent granulomatous nodules containing large giant cells of the foreign body type. The organisms are differ from other yeastform fungi by the characteristic chestnut-brown color and by the septate division. A case of 51 year old woman with chromomycosis at submental area is presented.
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