Journal of Pathology and Translational Medicine

Yong Il Kim

85 Articles

Mucinous Tubular and Spindle Cell Carcinoma of the Kidney: Touch Imprint Cytologic and Histologic Findings: A Case Report.: Woo Ho Kim, Yong Il Kim, Seong Hoe Park, Jae Gahb Park; Korean J Cytopathol. 2008;19(2):194-199.; DOI: https://doi.org/10.3338/kjc.2008.19.2.194

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The recent WHO classification has recognized mucinous tubular and spindle cell carcinoma (MTSCC) as a distinct entity of renal cell carcinoma, exhibiting a mixed pattern of tubules and a surrounding spindle cell proliferation within a myxoid stroma, with low-grade nuclear features. A 51-year-old woman had an incidentally discovered renal mass. Radiologic examination revealed a large, well defined mass in the lower pole of the right kidney; a right radical nephrectomy was performed. Imprint cytologic smears from fresh surgical specimens showed cellular, cohesive clusters with thick, broad trabecular arrangements and branching structures. On high power fields, the tumor was composed of round-to-oval low-grade nuclei with vesicular chromatin and small nucleoli. The tumor cells had indistinct borders and pale, eosinophilic cytoplasm. In some areas, round-to-elongated tubular structures and spindle cell patterns were noted. Chronic inflammatory cell infiltration was noted, along with a mucinous background and occasional psammoma bodies. Neither significant cytologic atypia nor mitosis was seen.

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Mucinous Tubular and Spindle Cell Carcinoma of the Kidney with Aggressive Behavior: An Unusual Renal Epithelial Neoplasm - A Case Report -
Ji-Hye Lee, Mee-Hye Oh, Hyun Deuk Cho, Young-Sik Kim
The Korean Journal of Pathology.2010; 44(2): 211. CrossRef

Gastrointestinal Stromal Tumors associated with Neurofibromatosis Type I: A Report of Two Cases.: Joo Heon Kim, Ock Seong In, Seong Kyu Lee, Haing Woon Baik, Seong Ho Kim, Dong Wook Kang, Kyung Hee Kim, Mee Ja Park, Yong Il Kim; Korean J Pathol. 2006;40(2):137-141.

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Abstract PDF: Gastrointestinal stromal tumor (GIST) is the most common non-epithelial neoplasm arising in the gastrointestinal tract, but this tumor is rarely seen in association with type 1 neurofibromatosis (NF-1). We report here on two cases of multiple GISTs of the small intestine that occurred in NF-1 patients. We also analyzed the mutations of c-kit exons 9, 11, 13 and 17 and the plateletderived growth factor receptor-alpha (PDGFRA) exons 12 and 18 in two GIST patients. Histologically, the NF-1-associated GISTs were similar to those of non-the NF-1 GISTs, but they characteristically revealed hyperplastic interstitial cells of Cajal around the GISTs. Immunohistochemically, these tumors showed strong co-expressions of CD117 and CD34. The molecular genetic analysis of the GISTs showed that all of the c-kit and PDGFRA exons that were analyzed in the GISTs of the two patients were the wild-type, suggesting a limited role for the c-kit and PDGFRA mutations in the tumorigenesis of NF-1-associated GISTs.

Pathology Teaching for the Undergraduate Students in Korean Medical Schools: Current Debates and Future Program Design.: Yong Il Kim; Korean J Pathol. 2005;39(3):145-150.

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Abstract PDF: This article aimed to summarize the current critiques or debates on the pathology teaching for the undergraduate medical students in Korean medical schools and to rationalize the curricular approaches for renovation and instructional strategies which are under the hot discussion. Of 41 medical schools in Korea, most pathology programs have been criticized along the line of their traditional discipline-oriented, teacher-centered curriculum and morphologydirected instruction by their limited emphasis of developing either the reasoning abilities or the effort for the systematic understanding of disease mechanism, while any measures of compensatory strategies against the declining participation to the autopsy remain unqualified. The formal instruction of the pathology course was also under the strong debates in regard to the driving effort in teaching every corners of the textbook contents aside from the overemphasis of rather monotonous and less dynamic microscopic observation equipped with the sketch-based laboratory works. Also, student's loss of interest on pathology and other concerns neglected during the undergraduate pathology course was discussed. The author stressed the leadership of the pathology course among other biomedical disciplines especially in development of the appropriate educational curricula such as the horizontal vs. vertical integrated teachinglearning process and tutorials. Alternative emphasis was made on more experimental experiences as a part of upgrading the reasoning power together with the simulated case studies prior to the senior class to meet the school objectives.

Multiple Pancreatic Islet Cell Tumors with Diverse Hormonal Expression in a Multiple Endocrine Neoplasia Type I Patient: A Case Report.: Jang Han Kim, Kuhn Uk Lee, Woo Ho Kim, Yong Il Kim; Korean J Pathol. 2002;36(3):184-186.

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Abstract PDF: Multiple endocrine neoplasia type I is characterized by multiple tumors, particularly in the parathyroid glands, the pituitary gland and the pancreatic islet. We observed multiple pancreatic islet cell tumors with diverse hormonal expression in a MEN-I patient. The patient suffered from protracted diarrhea and multiple gastrododuodenal ulcers for 10 years. In abdominal computed tomography, space occupying lesions were detected in the distal pancreas. Distal pancreatectomy was done. Three tumors that measured 2.0 X 1.0 cm (A), 1.0 X 1.0 cm (B), and 1.0 X 0.5 cm (C) were discovered. Microscopic examination revealed another tumor, 1.0 X 0.5 cm (D). Microadenomas, less than 0.5 cm, were also found throughout the pancreas. Immunohistochemical stainings for insulin, pancreatic polypeptide, gastrin, glucagon, somatostain, and chromogranin were performed. Tumor A was trabecular and acinar in form and showed weak cytoplasmic reactivity to insulin. Tumor B was a gyriform and a few cells showed cytoplasmic reactivity to pancreatic polypeptide. Tumor C was trabecular in form and showed cytoplasmic reactivity to chromogranin. Direct invasion and distant metastasis were not found.

Does the Colorectal Cancer Among Koreans Share the Same Pathological Features by Geographical Distribution: A Nationwide Survey of Surgically Resected 1,676 Cancers from 1,602 Patients.: Mee Soo Chang, Jin Hee Sohn, Dae Young Kang, Gyeong Hoon Kang, Myung Sook Kim, Woo Ho Kim, Jong Hee Nam, Woo Sung Moon, Sun Hoo Park, Cheol Jeun Park, Ro hyun Sung, Young Lyun Oh, Eun Sook Chang, Hee Kyung Chang, Mee Yon Cho, Kyung Ja Cho, Yong Il Kim; Korean J Pathol. 2001;35(1):14-19.

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Abstract PDF: BACKGROUND
This nationwide survey was undertaken to characterize the general pathological features of colorectal cancer in Korea, and especially to elucidate the geographical characteristics by means of their anatomical distribution.
METHODS
We analysed 1,676 colorectal cancers (from 1,602 patients) surgically resected in 1998 at 15 institutions from nine geographical sites in Korea.
RESULTS
The topographic incidence of colorectal cancer in seven out of the total nine geographical sites, was the highest in the rectum (32-54%); and those from Wonju and Cheongju were in the sigmoid colon (28% for both). The right colon cancer incidence was 42% in Wonju and 36% in Cheongju, while it was 17-22% in the other areas. The cecal cancer incidences in Wonju and in Taegu were 7% and 8%, respectively, but 0-4% in the other areas. As for histology, moderately differentiated adenocarcinoma was the most frequent (46-84%), except for in Wonju and Chonju, where the most predominant type was well differentiated (63% and 52%, respectively).
CONCLUSION
The incidence of right colon cancer was higher in Wonju and Cheongju, than in the other geographical sites. The cecal predilection was prominent in Taegu and Wonju. The Elucidation of geographical differences in degree of differentiation for tubular adenocarcinoma seems to require further cumulative study with strict guidelines.

Heterotopic Enchondral Ossification in Metastatic Colonic Adenocarcinoma: A case report .: So Yeon Park, Yong Il Kim, Woo Ho Kim; Korean J Pathol. 2000;34(7):531-533.

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Abstract PDF: Calcification and ossification of colon cancer is frequently encountered, especially in the mucinous carcinoma. However, cartilage formation or enchondral ossification has rarely been described in human colon cancer. This report describes a case of a 59-year-old man with retroperitoneal metastasis of mucinous adenocarcinoma of colon, which showed a widespread heterotopic ossification through membranous or enchondral ossification. The ossification appeared in apposition to tumor cell nests and in the organized mucin pool. In our knowledge, this is the first case showing enchondral ossification in gastrointestinal carcinoma in Korea.

Pathologic Analysis of 2159 Cases of Appendix.: Chan Sik Park, Mee Soo Chang, In Ae Park, Yong Il Kim, Gheeyoung Choe; Korean J Pathol. 2000;34(1):39-49.

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Abstract PDF: We reviewed 2159 consecutive cases of surgically resected appendices. The appendectomy specimen consisted of 91 cases of acute focal appendicitis (5.4%), 926 cases of acute suppurative appendicitis (55.1%), 228 cases of acute gangrenous appendicitis (13.6%), 63 cases of periappendicitis (3.8%), 13 cases of pure fibrous obliteration of the lumen (FOL; 0.8%), 18 cases of other diseases (7 mucoceles, 2 mucinous cystic neoplasms, 4 carcinoids, 2 metastatic carcinomas, 2 tuberculous appendicitides, and 1 eosinophilic appendicitis; 1%), and 342 cases with no diagnostic abnormality (20.3%). Patients having acute appendicitis ranged from 3 to 84 years of age, and patients in their 10's and 20's occupied over half of 2159 cases. Diagnostic accuracy of the acute appendicitis was 79.7%. Incidence of the acute appendicitis was suspected to be 7.2/100,000/year. Twenty eight cases of acute appendicitis were associated with diverticula. In the former acute primary diverticulitis led to acute appendicitis in 14 of 28 cases. Among 478 incidental appendectomy cases, there were 3 acute focal appendicitides, 1 acute suppurative appendicitis, 1 eosinophilic appendicitis, 32 periappendicitides, 1 mucocele, 40 pure FOLs, 1 deciduosis, 1 endometriosis, and 1 diverticulosis without inflammation. There were 69 cases of FOL (32 complete forms and 37 incomplete forms), among which 13 cases were associated with acute appendicitis. FOL was more frequent in female patients as well as patients over 40 years of age. Incomplete FOL was considered to progress to complete form with age. The incidence of appendiceal diverticula was higher, whereas the incidences of carcinoid tumor and FOL were lower compared with that in the western report. In 14 of 28 cases the appendiceal diverticulum was the site in which acute appendicitis began.

Histological Grading and Staging of Chronic Hepatitis Standardized Guideline Proposed by the Korean Study Group for the Pathology of Digestive Diseases .: 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; Korean J Pathol. 1999;33(5):337-346.

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Abstract PDF: 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.

Melanosis Duodeni.: Sun Hoo Park, So Yeon Park, Yong Il Kim, Woo Ho Kim; Korean J Pathol. 1998;32(12):1089-1091.

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Abstract: Melanosis duodeni is an uncommon pathologic condition characterized by diffuse small black spots on the first and second portions of the duodenum. It occurs predominantly in elderly patients and is linked to chronic renal failure, use of antihypertensive drug and oral iron supplementation, and/or presence of gastric hemorrhage. We report a case of melanosis duodeni in a 60-year-old woman diagnosed with hypertension 20 years ago and chronic renal failure 6 years ago. She has taken antihypertensive drugs for many years. On endoscopy, speckled black pigmentation of duodenal mucosa was detected. Microscopically, this duodenal lesions showed numerous coarse pigments in macrophages confined within the lamina propria. By ultrastructural study, macrophages contained electron-dense granules admixed with lipofuscin-like material in residual bodies.

Gastrointestinal Polyposis in Koreans: A Nationwide Survey of Clinicopathologic Analysis of 112 Surgically Resected Cases.: 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; 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.

The Current Practice of the Autopsy Services and the Autopsy Records at the Seoul National University Hospital.: Jeong Wook Seo, Yoon Sung Lee, Je Geun Chi, Ghee Young Choe, Soong Deok Lee, Chong Jai Kim, In Ae Park, Woo Ho Kim, Ja June Jang, Chul Woo Kim, Seong Hoe Park, Jung Bin Lee, Hyun Soon Lee, Yong Il Kim, Eui Keun Ham, Sang Kook Lee; Korean J Pathol. 1998;32(6):453-459.

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Abstract: This study outlines the current status of the autopsy practice and the medical records for autopsies at the Department of Pathology, Seoul National University Hospital. Total number of autopsy cases from 1954 to 1995 was 3,131. Adults aged over 17 were 371 cases and children were 2,515 cases. The demographic data in 245 cases was not available. The number of adult autopsies and its proportion among total number of autopsies during 10-year periods decreased from 144 cases (40%) during the 10-year-period from 1956 to 52 cases (3%) during the 10-year-period from 1986. The number of children cases during the same period groups increased slightly from 210 cases (58%) to 393 cases (25%). But the number of fetal cases increased rapidly from 7 cases (2%) to 1,146 cases (72%). Among fetal autopsies the proportion of fetuses died earlier than 24 weeks of gestation increased and this figure exceeds that of fetuses that died later than 24 weeks of gestation from 1992. Forty percent of the cases were submitted from the clinical departments of the Seoul National University Hospital but the remainders were referred from 73 hospitals. Final autopsy diagnoses were analysed according to the Korean Standard Classification of Disease (KCD)-3 coding system and by searching key words for all cases. Common diagnoses as coded among cases from 1990 were P9, P0, P2, Q2 and Q0. Common diseases by key words for adult cases were liver disease, tuberculosis and pneumonia. Common diseases for children cases were pneumonia, hyaline membrane disease, meningitis and tuberculosis. Through this study we could show the importance of autopsy services for fetuses. We could also establish a regular registration system for autopsies at general hospitals.

Correlation between Helicobacter pylori Infection and Lymphoid Follicle Formation in Gastrectomy Specimens.: Won Ae Lee, Hye Sung Hahn, Woo Ho Kim, Yong Il Kim; Korean J Pathol. 1998;32(3):162-168.

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Abstract PDF: Histopathologic studies for Helicobacter pylori (H. pylori)-associated chronic gastritis have been mostly undertaken with endoscopic biopsy specimens, often leading to an inappropriate evaluation of the gastric mucosal alterations. The purpose of this paper was designed to investigate the actual prevalence of lymphoid follicle formation by H. pylori infection using the resected stomachs. A total of 16 fresh gastrectomy specimens bearing gastric carcinoma were examined under the quick and gentle procedure, with which H. pylori was detected in 12 cases (75%) and lymphoid follicles in 14 cases (87.5%), while the detection rate of H. pylori remained 56.3% in the control group which comprised the same 16 resected stomachs and were examined by routine tissue preparation procedure without any special care. There was a significant correlation between the presence of H. pylori and lymphoid follicle formation (p=0.05), but no correlation was found between the grades of H. pylori and lymphoid follicles. The topographical distribution of H. pylori or lymphoid follicles in antrum and body gave no statistical difference. Similarly, there was no correlation between H. pylori infection and intestinal metaplasia, activity of chronic gastritis or histologic types of accompanying adenocarcinoma. We conclude that studies of the gastric mucosal change by H. pylori infection using the gastrectomy specimens provide a useful information for analysis of lymphoid follicle formation which is a consistent morphological characteristic of H. pylori infection.

Cytomegalovirus Infection in Idiopathic Inflammatory Bowel Disease: Clinicopathologic Analysis of 6 Cases.: Won Ae Lee, Hye Sung Hahn, Woo Ho Kim, Yong Il Kim; Korean J Pathol. 1998;32(2):125-130.

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Abstract PDF: Cytomegalovirus (CMV) infection is an uncommon association with idiopathic inflammatory bowel disease (IBD) often leading to a variety of serious complications. A total of 41 resected cases of IBD were examined to elucidate the pathologic features of intestinal CMV infection which was assessed by histologic examination and confirmed by immunohistochemistry with CMV antibody. Six cases were positve for CMV antibody; five cases in 19 ulcerative colitis (UC, 26.3%) and one case in 22 Crohn's disease (CD, 4.5%). Of 7 cases of the steroid-treated UC group, five cases were superinfected with CMV (71.4%) but none in 12 cases of the steroid-untreated UC group. All of the five CMV-positive cases in UC showed deep ulceration and transmural inflammation, while none of 10 UC cases without above features were CMV positive. Fibrinoid necrosis and thrombi were found in 83.3% of the CMV infected group, while none in the CMV-negative group of UC cases (p=0.01). We conclude that IBD, particularly UC, is susceptible to the CMV infection when steroid hormone is administered, and that deep colonic ulceration, transmural inflammation and fibrinoid necrosis of vasculature may suggest superinfection of CMV in UC patients. It seems that deep colonic ulceration may be the consequence of an ischemic change following vascular luminal occlusion or vasculitis by CMV infection.

Grading System for Gastric Epithelial Proliferative Diseases Standardized Guidelines proposed by Korean Study Group for Pathology of Digestive Diseases.: 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; Korean J Pathol. 1997;31(5):389-400.

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Abstract PDF: 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.

Antibiotics-associated Pseudomembranous Colitis: A Clinico-Pathologic Analysis with Special Reference to Non-pseudomembranous Mucosal Change.: Jin Haeng Chung, Yong Il Kim; Korean J Pathol. 1997;31(4):308-313.

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Abstract PDF: The presence of volcano-shaped pseudomembrane(PM) formations above the inflamed mucosa has been referred to as the unique biopsy criterion of the pseudomembranous colitis, but PM might be lost during the bowel preparation, and such loss leads pathologists to erroneous interpretations of the endoscopic biopsy specimens. The purpose of this paper is to identify the additional diagnostic clue other than PM among various histologic features in pseudomembranous colitis. We reviewed sigmoidoscopic biopsy specimens from 13 cases of antibiotics-associated pseudomembranous colitis which was confirmed to reveal characteristic PM by endoscopy aside from the clinical history of antibiotics administration. The cases were divided into two groups: the presence of PM (n=7) and its absence (n=6). Both groups showed basically identical histology, which included features of glandular distension, epithelial necrosis, crypt abscess, regenerative glands and mucous plug within the necrotic/dilated glands. Mucous plugs within the necrotic/ dilated glands were found in all cases and seemed to be the most characteristic microscopic feature. Ten cases of resected chronic ulcerative colitis in the active stage were compared for a differential diagnosis of crypt abscess-associated mucosal change. None of them revealed necrotic gland with mucous plugs, although crypt abscess formation was common in both conditions. We conclude that presence of mucous plugs in the dilated/necrotic glands is a useful diagnostic clue even though the biopsy specimens fail to demonstrate PM.

Primary Necrotizing Granulomatous Vasculitis of the Stomach.: Myeong Cherl Kook, Sang Yong Song, Yong Il Kim, In Sung Song, Keun Wook Lee; Korean J Pathol. 1997;31(1):68-74.

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Abstract PDF: A 55-year-old woman suffered from upper abdominal pain for two months and remained refractile against the anti-ulcer regimen. The palliative gastrectomy specimen revealed multiple shallow ulcerations on the thickened mucosal folds mainly in the antrum and body along the greater curvature where multiple, whitish nodules were found in the submucosa. Microscopically, individual submucosal nodules clearly corresponded to the necrotizing granulomatous vasculitis which were featured with diffuse fibrinoid necrosis of arterial walls accompanying granuloma formation and heavy infiltration of neutrophils, eosinophils, histiocytes and giant cells. Similar vasculitic lesions involved venules and arterioles. There were scattered vasculitic changes in the liver biopsy specimens and omentum. There were no clinical presentations or serological support of systemic involvement including systemic lupus erythematosus, Henoch-Schoenlein purpura, cryoglobulinemia or Churg-Strauss granulomatous vasculitis. We conclude that this is a hitherto undescribed primary necrotizing granulomatous vasculitis predominantly involving the stomach.

Obstructive Colitis: A Clinicopathologic Analysis of 7 Cases.: Jung Sun Kim, Yong Il Kim; Korean J Pathol. 1996;30(12):1116-1122.

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Abstract PDF: Obstructive colitis is an ulceroinflammatory lesion of the large intestine at a distance proximal to the obstructing or potentially obstructing lesion of any etiology. It has been suggested that a rise in the intraluminal pressure related to the obstruction results in a fall in the intramural blood flow with subsequent ischemic necrosis. We examined 7 cases of surgically resected obstructive colitis associated with distal constrictive adenocarcinoma of the large intestine. Two cases of the obstructive colitis were radiologically suspected prior to surgery either as a separate tumor mass or diverticulosis, and another case was suggested to be a tumor seeding by colonoscopy. Grossly, five cases presented with single or multiple, shallow, well-demarcated ulcerative lesions, and the remaining two were featured with a segmental ulcerative lesion the with pseudopolypoid area. The ulceroinflammatory lesions were separated from the distal obstructive carcinoma by a skipped zone of relatively normal mucosa measuring 4-43 cm. The proximal colon to the obstructive lesions were obviously dilated except in one case. Microscopically, mucosa and submucosa were replaced by granulation tissue, and showed inflammatory cell infiltration and fibrin exudates. Muscle coat often accompanied ischemic contraction. Fissuring was noted in one case. The recognition of these lesions prior to or during surgery is stressed based on the morphological features corresponding to an ischemic change in the proximal mucosa to the primary obstructive lesion.

Decubitoma: A Pseudosarcoma in Decubitus: Report of a case.: Hye Seung Han, Yong Il Kim, Jeong Wook Seo; Korean J Pathol. 1996;30(11):1060-1064.

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Abstract PDF: Decubitus ulcer is often seen in the skin and underlying tissue of debilitated or immobilized patients as the result of prolonged pressure and impaired circulation. It manifests chiefly as an ulcer over bony prominences, but tumefaction is an extremely unusual presentation. A 53-year old male, a paralytic of the lower extremity for 18 years, developed a recurrent decubital ulcer despite repeated surgical repair, from which a rapidly growing, large fungating mass grew within a month. The last resected mass was bosselated and measured 15x9x3 cm with a major area of cicatrix-like induration, interdigitated with skeletal muscle bundles at the central area. Microscopically, the mass was composed of an upper half of active granulation tissue layer and a deeper half of dense, poorly cellular, fibrocollagenous bundles admixed with florid proliferation of atypical fibroblasts, but the absence of mitosis and the multifocal admixture of active inflammatory process-granulation tissue formation seemed to help exclude genuine fibromatosis, nodular fasciitis or proliferative myositis. We assume that this rapidly growing pseudofibromatosis is an additional manifestation of a prolonged decubitus ulcer, possibly related to the modified reparative process of decubitus ulcer following repeated excisions, for which we propose a term of decubitoma.

Intraductal Papillary-Mucinous Neoplasm of the Pancreas: A case report.: Ji Eun Kim, Young Hyeh Ko, Howe Jung Ree, Yong Il Kim, Poong Ryul Lee; Korean J Pathol. 1996;30(8):726-732.

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Abstract PDF: Intraductal papillary mucinous neoplasm (IPMN) is a recently recognized clinicopathologic entity characterized by dilatation of pancreatic duct filled with copious mucin and papillary ductal epithelial proliferation ranging from simple hyperplasia to invasive carcinoma. The exact clinicopathologic identification of this tumor is important because of favorable prognosis contrast to that of conventional ductal adenocarcinoma. Herein we report a case of surgically resected typical IPMN. A 59-year-old man had a long history of diabetes mellitus with epigastric pain of 4 months duration. Ultrasonography and computed tomographic examination revealed cystic dilatations of main pancreatic duct in the head. The patient underwent total pancreatectomy. The gross appearance showed diffuse dilatation of main pancreatic duct associated with cystic dilatation of subbranches in the uncinate process. Histologic examination revealed diffuse papillary proliferations lined by mucinous epithelium with mild atypism within ectatic ducts. No invasive carcinoma was noted. Histochemically, the papillary epithelium contained mostly neutral and acid sialomucin.

Application of the Revised Case Matrix Format to Tutorial in Pathology Teaching: An Interim Approach toward Problem-Based Learning under Traditional Curricular Structure.: Yong Il Kim, Chong Jai Kim, Gee Young Kim, Chul Woo Kim, Woo Ho Kim, Ja June Jang, Je Geun Chi, Gyeong Hoon Kang, Myeong Cherl Kook, Jung Sun Kim, Tae Sook Kim, Gee Young Kwon, So Dug Lim; Korean J Pathol. 1996;30(8):570-661.

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Abstract: This paper describes a student-centered case study program concerning the tumor pathology course for first year students in medical school under the traditional curricular structure. A traditional, discipline-oriented, lecture-laboratory approach was partly modified by introducing a tutuorial session using a modified case matrix format during the laboratory hours without altering the general scheme of the existing system. Small group tutorial sessions were set with the development of learning objectives emphasizing clinicopathologic reasoning and early exposure to future practical presentation which was followed by the large class session; each tutorial was supplied with a short clinical history, gross kodachrome slides, and microslides. The session for problem identification was replaced by proving a series of instructor-designed questions for both pathology and interdisciplinary correlation during which pedagogical implication was stressed the most. Student's active participation, development of self learning skill and vigorous teaching-learning process among students, and motivation/relevance for forthcoming pathology study were among the benefits conferred by this modification. We conclude that this approach is an interim step to meet the advantages of problem-based learning even in a traditional curricular structure.

Carcinoid Tumors of the Gastrointestinal Tract: Analysis of 36 Cases.: Kyeong Cheon Jung, Hee Sung Kim, Sang Yong Song, Ghee Young Choe, Yong Il Kim; Korean J Pathol. 1996;30(5):396-407.

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Abstract PDF: We reviewed a total of 36 cases of gastrointestinal carcinoid tumors during a period of ten and a half years at Seoul National University Hospital, looking at their histologic and ultrastructural features, as well as immunohistochemical results, then we correlated these with location. The primary sites of carcinoid tumors were rectum(39%), stomach(25%), appendix(22%), small intestine(8%) and colon(6%), in order of frequency. The predominant histologic types by organ were mixed and solid(A) types in all location, the solid type(type A) in the stomach, and tubular type(type C) in the rectum. Six out of 8 cases of appendiceal carcinoid were type A and the other two cases were mucinous carcinoid. Tubular adenoma or adenocarcinoma was associated with 36% of the rectal carcinoids, with one case of carcinoid in the small intestine, and one(11%) of the gastric carcinoids was found near an adenocarcinoma. Metastasis was found in one case of ileal carcinoid(100%), one case of cecal carcinoid, 3 of gastric carcinoid(33%) and 2 of rectal carcinoid(14%). Primary tumor size ranged from 1 to 7 cm. Tumor necrosis and endolymphatic tumor emboli were found in 57% and 43% of the metastatic carcinoids, respectively. PCNA index showed a borderline significant difference between metastatic and nonmetastatic groups(P value=0.063). The low prevalence of appendiceal carcinoid and the relatively high prevalence of gastric-rectal carcinoid may reflect a low chance of incidental appendectomy and frequent detection of gastrointestinal endoscopy.

Alpha-Fetoprotein-Producing Carcinoma of the Gallbladder.: Young Ha Oh, Haeng Ji Kang, Hyoung Guen Lee, Eun Kyung Hong, Yong Il Kim, Jung Dal Lee; Korean J Pathol. 1996;30(5):453-456.

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Abstract PDF: Alpha-fetoprotein (AFP) is a well-known tumor marker for hepatocellular carcinoma, hepatoblastoma, and yolk sac tumors. There are several studies on AFP-producing tumors that arose from the gastrointestinal tract, pancreas, lung, kidney, and urachal tract. AFP-producing carcinoma of the gallbladder is extremely rare. We report a case of AFP-producing carcinoma of the gallbladder without liver involvement in a 58-year-old man with a gallstone, on which clinical, morphologic, and immunohistochemical studies were performed.

Yellowish Degeneration of Uterine Leiomyomas: Light Microscopic and Ultrastructural Observations.: So Dug Lim, Joo Ryung Huh, Yong Il Kim; Korean J Pathol. 1995;29(2):221-227.

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Abstract PDF: We reviewed five cases of Uterine leiomyomas, each with a conspicuously, yellow cut surface, among 198 consecutive cases of surgically removed uterine leiomyomas. Their gross findings were not significantly different from ordinary leiomyomas except for their pale to bright Yellowish cut surface. Microscopically, multiple small clusters of clear cells were widely scattered in otherwise hypercellular leiomyornas in 4 of the 5 cases. Of those, one case gave a positive reaction of Oil-Red O stain. Ultrastructurally, clear cells corresponded to the degenerating smooth muscle cells with intracytoplasmic lipid vacuoles. The rest of cells showed myofibers undergoing varying degrees of degeneration. Focal accumulation of foamy histiocytes was associated with carneous degeneration in one case. We conclude that the yellowish leiomyoma of the uterus seems, in part, to reflect accumulation of a lipid substance in degenerating hypercellular leiornyoma, or possibly collections of xanthoma cells in secondary degeneration.

Expression of BrdU and C-Ha-ras in Experimentally Induced Enzyme Altered Foci of the Liver and Hepatocellular Carcinoma.: Myung Sook Kim, Woo Ho Kim, Yong Il Kim; Korean J Pathol. 1994;28(6):584-595.

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Abstract PDF: For sequential phenotypic changes including enzyme altered hepatocytic foci, hyperplastic nodules, hepatocellular adenomas and carcinomas were produced in Sprague-Dawley rats by Solt-Farber method (administration of diethylnitrosamine and acetylaminofluorene (AAF), and partial hepatectomy). The immunohistochemical expressions of glutathione S transferase P (GST-P) and bromodeoxyuridine (BrdU) were assessed for selective proliferative activity in the enzyme altered foci and the subsequently developed lesions by double immunohistochemical staining technique. Immunoreactive areas against GSTP gradually increase from early period of carciogenesis. BrdU labeling in such areas remained high during the first week. but decreased thereafter. BrdU labeling index remained low in the GSTP negative area throughout the experimental period. This suggests that cells in the enzyme altered foci keep away from the suppressor effect of AAF in contrast to the normal cells in which their growth are inhibited by AAF. BrdU labeling index remained very low in both hyperplastic nodule and adenoma which were prevalent during the mid-experimental period, but increase markedly in carcinoma. The long period of low BrdU labeling index seems to correspond to the "slowly growing step of persistent nodule" during hepatocarcinogenesis. The differentiation index, a ratio of S phase fraction between GSTP positive and negative areas, was low in adenoma-developing period and high in carcinoma-developing period. C-Ha-ras p21 was not expressed in foci of enzyme altered hepatocyte and hyperplasia, but highly positive in carcinoma. This indicates that the c-Ha-ras may involve the late step of hepatocarcinogenesis.

Hepatoid Adenocarcinoma of the Stomach: A Pathologic Analysis of 14 cases.: Gyeong Hoon Kang, Yong Il Kim; Korean J Pathol. 1994;28(6):620-628.

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Abstract PDF: Hepatoid adenocarcinoma of the stomach has been designated to a primary gastric adenocarcinoma with minimum criteria of elevated serum alpha-fetoprotein and its histological resemblance to neoplastic liver cells. Of the 1,500 consecutive cases of surgically resected gastric carcinomas during a period of 4 years, we retrieved 14 cases of adenocarcinoma which met the histologic features of hepatoid growth and compared them histologically with 400 consecutive cases of non-hepatoid gastric adenocarcinomas. The patient's age ragned from 32 to 80 years(non-hepatoid group: 25 to 81 years) and their male to female ratio was 3.7 : 1(non-hepatoid group: 1.8 : 1). Grossly, five case were Borrmann type II and another five cases type III. All three cases of early gastric carcinomas were the submucosal type IIc. The remaining one was an advanced gastric carcinoma mimicking early gastric carcinoma. Microscopically, the hepatoid portions varied in growing patterns and arranged in either compact, trabecular or pseudoglandular pattern and gave an immunoreactivity to alpha-fetoprotein and alpha-1-antichymotrypsin. Regardless of the tumor stage, the hepatoid areas were located in the deeper portion of the tumor mass and grew in an expanding/nodular pattern. The associated adenocarcinomatous areas were mostly papillotubular, moderately to well differentiated, and frequently revealed clear PAS-negative cytoplasm reminiscent of the differentiated embryonal carcinoma. Tumor emboli and nodal metastasis were the frequent associations. We assume that the hepatoid adenocarcinoma may develop from gastric'adenocarcinoma through embryonal carcinomatous growth.

Primary Malignant Lymphoma of the Gallbladder: A case of report.: Jung Sun Kim, Chul Woo Kim, Yong Il Kim, Yong Bum Yoon, Yung Jue Bang; Korean J Pathol. 1994;28(5):538-540.

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Abstract PDF: Lymphomatous involvement of the gallbladder is rarely identified and manifests mostly as a local involvement of disseminated disease. There have been reported only about 20 primary malignant lymphomas of the gallbladder without involvement of other sites. A 63-year-old woman presented with jaundice, epigastric pain, and weight olss of two months duration. There was no systemic lymphadenopathy elsewhere. Abdominal computed tomograph revealed a focal thickening of the gallbladder wall. The removed gallbladder contained a well circumscribed, 5x3 cm-sized, slightly elevated firm area with accentuated mucosal papillary excrescences near the neck protion. The lesion involved whole thickness of the wall, and was made up of diffuse atypical lymphoid cell infiltrates of variable size accompanying plasmacytoid differentiation in areas. Some large tumor cells were pleomorphic and contained prominent nucleoli. To our knowledge, this is the first case of primary malignant lymphoma of the gallbladder in Korean literature.

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

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

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

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

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

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

Gastrointestinal Cytomegalovirus Infection: A clinicopathologic analysis of 8 cases.: Yun Kyung Kang, Sang Yong Song, Woo Ho Kim, Yong Il Kim; Korean J Pathol. 1994;28(1):22-29.

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Abstract PDF: We analysed 8 cases of gastrointestinal cytomegalovirus(CMV) infection including one autopsy, three surgically resected and four endoscopic biopsy cases. Involved sites were colon in four,stomach in three and small intestine in one. Three of them were associated with immu-nosuppressed condition but others had no clinical evidence of immune deficiency. Multiple aphthous mucosal ulceration was a common presentation, but one revealed a mucosal ulcer with segmental narrowing and thickening of wall. Microscopically, six showed cytomegalic inclusions in endothelial cells and fibroblasts, one in mucosal epithelial cells and the remaining one in both endothelial cells and mucosal epithelial cells. Immunohistochemical staining using monoclonal antibody against CMV confirmed postive result in seven cases. Serum IgM anti-CMV antibody was elevated in one case. We conclude that gastrointestinal CMV infection is currently not a rare condition and frequently associated with non-immunosuppressed condition, and thus a thorough histologic examination is required especially in the gastrointestinal ulcerative lesion. Once cytomegalic inclusion is suspected, immunohistochemical identification of CMV seems essential for specific diagnosis.

Flow Cytometric DNA Analysis of Hepatocellular Carcinoma.: Young Lyun Oh, Yong Il Kim; Korean J Pathol. 1993;27(6):581-589.

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Abstract PDF: A flow cytometric analysis of the nuclear DNA content of solid tumors using paraffin-embedded tissues has become available since 1983, and its ploidy pattern has been designated as an important prognostic parameter in many human tumors. Hepatocellular carcinoma(HCC) is one of the most common malignant tumors among Koreans, but little information is consolidated about the significance of ploidy pattern. We measured the nuclear DNA content of 62 surgically resected HCCs and 45 non-neoplastic tissues from the surrounding parenchyma by flow cytometry. Aneuploid was detected in 18 cases(29.0%) in HCCs and 2 cases(4.4%) in nonneoplastic hepatic parenchyma(p<0.005). Correlations between the DNA ploidy pattern and various clinicopathologic findings of HCCs were analized. The mean tumor size was significantly different(p<0.05) between the aneuploid group(8.8 cm) and the diploid group(6.1 cm). Mean age of the aneuploid group was younger(47 year) than the diploid group(51 years), but the difference was not statistically significant(p=0.052). The DNA pattern did not show any meaningful correlation with the gross and microscopic features of HCC except for the presence of capsule. These results suggest that DNA ploidy correlates with growth rate of the tumor and it may be a possibly useful prognostic factor in HCCs.

Squamous Metaplasia in Tubular Adenoma of Sigmoid Colon: A case report.: Soo Min Kang, Weon Seo Park, Woo Ho Kim, Yong Il Kim; Korean J Pathol. 1993;27(6):663-665.

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Abstract PDF: The occurrence of squamous metaplasia(morule) in colorectal mucosa and adenocarcinoma, althrough rare, has been well documented. In contrast, very little mention has been given to mature squamous cells seen in colorectal polyps or adenomas. A 42-year-old woman presented with a 2-month history of diarrhea and melena. Proctosigmoidoscopy revealed a 4 cm-sized polypoid tumor 20 cm above the anal verge. Colonoscopic biopsy showed tubular adenoma, and a segmental resection of sigmoid colon was done. Microscopically, the tumor was c classical tubular adenoma containing multiple solid nests of squamous cells scattered only in the neoplasm; the squamous nests were generally small, and some showed direct continuity with adenomatous glands. The squamous cells were keratinizing and had regular nuclei with no mitotic activity. The importance of this phenomenon lies in its pathologic recognition, and the findings suggest that awareness of this rare occurrence in colorectal polyps should avert such overdiagnosis, and consequently prevents unnecessary radical surgery.

Dedifferentiated Chordoma: Report of a case.: Sang Yong Song, Mi Kyung Kim, Yong Il Kim; Korean J Pathol. 1993;27(3):256-262.

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Abstract PDF: Dedifferentiated chordoma is a rare pathologic entity presenting an additional sarcomatous component in otherwise classical chordoma. It has been also emphasized that this neoplasm is classified as a distinct entity because of its different clinical settings and aggressive behavior. Dedifferentiation is a peculiar phenomenon but its histogenesis has remained controversial. A 50-yera-old man developed a huge tumor mass in the retrorectal, presacral area, featured with two histological components. The one was a typical chordoma accounted for approximately 60% of the mass and the other was made up of highly cellular, plemorphic, undifferentiated tumor cells, reminiscent partly to the cells of plemorphic malignant fibrous histiocytoma. Ultrastructural features and immunoreactivity against cytokeratin, S-100 protein and alpha-1-antichymotrypsin in both portions support that histologically different components of this neoplasm derive from the same origin. To our knowledge, this is the first case of dedifferentiated chordoma in Korea.

Gastroduodenal Adenomas and Carcinoma in Patients with Familial Polyposis Coli.: Seung Sook Lee, Woo Ho Kim, Yong Il Kim; Korean J Pathol. 1993;27(3):263-267.

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Abstract PDF: Gastric lesion in familial polyposis coli is commonly presented with fundic gland hyperplastic polyps, but duodenal and gastric adenomas together with their carcinomatous transformation have been rarely described in familial polyposis coli mostly by case reports. We present three cases of gastric adenomas in familial polyposis coli with one in synchronous development of gastric adenocarcinoma in Korea. All three cases had the family history related to familial polyosis coli and received proctocolectomy because of synchronous development of colonic adenocarcinoma. One patient developed gastric polyposis and adenocarcinoma 8 years after colectomy, and the remaining two presented with multiple polyps either in the stomach or duodenum synchronously at the time of the diagnosis of familial polyposis coli with colonic adenocarcinoma. None disclosed any evidence of Gardner's syndrome. We conclude that association of gastric adenomas in familial oplyposis coli is not uncommon and gastric adenoma-carcinoma sequence is an another important participating mechanism to understand the histogenesis of gastric carcinoma in Korea.

Inflammatory Gastric Adenocarcinoma with Neutrophil Leukcytosis.: Eon Sub Park, Yong Il Kim; Korean J Pathol. 1993;27(2):195-197.

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Abstract PDF: A 36-year-old man received a subtotal gastrectomy for Borrmann type 2 advanced carcinoma in the antrum of the posterior well. Preoperatively, peripheral white blood cell count was 16,400/mn3 with 80% of neutrophils. Microscopically, the tumor was of a poorly differentiated adeocarcinoma with intense eutrophilic infiltration which was totally confined within the neoplastic portion and in the metastatic focus in the regional lympho nodes. Repeated postoperative whits blood cell counts dropped down to the normal level. Neither infectious nor knowledge, this is the first case of gastric carcinoma with massive neutrophilic stromal reaction(inflammatory carcinoma) and leukocytosis in the literature in the korea.

Pseudosarcomatous Variant of Transitional Cell Carcinoma of the Renal Pelvis.: Yun Kyung Kang, Ta Jin Kim, Yong Il Kim, Si Whang Kim; Korean J Pathol. 1992;26(6):610-614.

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Abstract PDF: We report a case of pseudosarcomatous variant of transitional cell carcinoma of the renal pelvis which showed grossly and microscopically the distinct biphasic growth patterns. Grossly, most part of the tumor showed solid growth protruding into the renal pelvic cavity as well as infiltrating into the parenchyma of lower pole. The overlying pelvic mucosa was replaced by a diffuse, papillary transitional cell carcinoma, and the solid mass was composed of pleomorphic spindle cell sarcomatoid component with frequent myxoid change and a few foci of osteoid deposit. Ultrastructural study of the spindle cells revealed epithelial differentiation featured with rich cytoplasmic organelles, basal lamina and basement membrane-like structures, although immunohistochemistry failed to detect epithelial differentiation.

Cytologic Heterogeneity of Signet Ring Cell Carcinoma of the Stomach: Histochemical and electron microscopic observations.: Yun Kyung Kang, Yong Il Kim; Korean J Pathol. 1992;26(5):427-435.

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Abstract PDF: The cytologic heterogeneity of the tumor cells in gastric signet ring cell carcinoma was studied with 13 surgically early gastric carcinoma specimens by means of histochemical stainings on mucin(periodic acid Schiff-alcian blue at pH 2.5, paradoxical concanavalin A, high iron diamine) and electron microscopy. Of the 13 cases of early gastric cell carcinomas, 6 were mucosal type and 7 were submucosal type. Eleven cases consisted of mixture of gastric and intestinal type signet ring cells and the remaining 2 of the mucosal type were entirely made of gastric type. The colonic goblet cell type was found in 4 of the submucosal type. Within the mucosa the tumor cells showed a layering phenomenon; type A signet ring cells were distributed at the central zone and type B and C at the superficial or deeper zone. Each type of signet ring cell showed variable mucin histochemical stainability of gastric and/or intestinal nature. Above finding strongly suggest that the variable phenotypes of signet ring cells result from a heterogeneity of cytoplasmic mucin as well as different stages of differentiation of signet ring carcinoma cells.

Cavernous Hemangioma of Lymph node: A case report with the review of literature.: Seong Nam Kim, Sang Yong Song, Yong Il Kim; Korean J Pathol. 1992;26(5):496-499.

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Abstract PDF: Primary hemangioma of the lymph node is an extremely rare vascular neoplasm, and only four cases on the subject have been reported in the literature. We describe a case of cavernous hemangioma in an axillary lymph node that was incidentally found in 70-year-old woman who underwent a modified radical mastectomy for infiltrating duct carcinoma of the left breast. Brief review of the literature regarding vasoformative lesions occupying lymph node is made with special regard to differential diagnosis from reactive-proliferative processes and other true neoplasms.

Liver Cell Dysplasia: Analysis of 141 cases with reference to histopathologic Characterization and proliferative activity.: Sang Yong Song, Yong Il Kim; Korean J Pathol. 1992;26(4):338-347.

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Abstract PDF: Liver cell dysplasia of Anthony(LCD) is a common association in hepatocellular carcinoma(HCC)-bearing liver and has been regarded as a premalignant condition with strong linkage to hepatitis B virus infection and cirrhosis. A total of 189 surgically resected livers [HCC(168 cases), cholangiocarcinoma(3 cases), metastatic carcinoma(3 cases), and non-neoplastic lesions(15 cases)] were reviewed to elucidate the nature of LCD by means of light microscopic examination, in situ hybridization method for HBV DNA and expression of proliferatin cell nuclear antigen(PCNA) using immunohistochemical technique. LCD was present in 141 cases(74.6%), and its prevalence rate was independently significant in HCCs with or without cirrhosis than other groups. There was no difference in mean age, although LCD-positive group was younger than its negative counterpart. Association rate of LCD in HCC-cirrhosis group was statistically significant than the non-cirrhotic group, and higher histological grading of LCD was correlated well with wider distribution pattern and clustering. Seropositivity of HBsAg was not correlated with presence of LCD or with histological grading. In situ hybridization techique using HBV DNA probe demonstrated fine granular stainable particles even in LCD cells. Immunohistochemical study for PCNA revealed that the proliferative activity of LCD was lower than that of the cirrhotic cell. With the above results it is concluded that LCD reflects neither a regenerating condition nor a premalignant lesion but suggest a reactive change.

Thymoma: A clinicopathologic analysis of 66 cases.: Weon Seo Park, Seong Hoe Park, Yong Il Kim; Korean J Pathol. 1992;26(4):372-380.

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Abstract PDF: A total of 66 cases of thymoma(57 surgically resected cases and 9 incisional biopsy cases) were reviewed with an attempt to correlate pathomorphologic features and clinical presentations. Criteria of benign or invasive thymoma were primarily determined by operative clinical and pathologic findings. Of them, 21 cases were invasive thymomas. The mean age of patients at the time of surgery was 47 years and it occurred largely in the sixth decade. Myasthenia gravis was accompanied in 29 cases(43%). One patient died during folow-up period, and five of the remainder suffered from recurrence. Microscopically, mixed type was the most common one(33 cases), being followed by predominantly epithelial type(17 cases) and predominantly lymphocytic type(16 cases). Thirty four cases of thymomas were cortical type, 29 mixed type, and the remaining 3 medullary type. None of the histologic type were significantly correlated with tumor invasiveness, Myasthenia gravis was more frequently associated with mixed and cortical type, respectively.

Elastofibroma.: Sang Yong Song, In Ae Park, Yong Il Kim; Korean J Pathol. 1992;26(4):420-422.

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Abstract PDF: Elastofibroma is a rare benign tumorous growth presenting as a slowly growing ill-defined mass of fibroblastic tissue occurring in elderly persons and arising mainly form the connective tissue between the lower portion of the scapula and the chest wall. Its pathogenesis is not well established but it may be the result of nonneoplastic reactive hyperplasia taking place with constitutional predisposition in the background. A case of elastofibroma occurring in the subscapular area of a 65-year-old female cook is presented. The mass, 6x5x3 cm in maximum dimensions, was poorly circumscribed, solid, hard, pale fleshy and pray-white fibrous tumor. Microscopically, it was composed of numerous small globular and linear elastic fibers embedded in collagenous matrix. To our knowledge, it is the first case of elastofibroma in Korea.

Intestinal Spargnanosis Presenting as an Inflammatory Mass: A case report.: Weon Seo Park, Seung Sook Lee, Yong Il Kim, Seon Hee Kim; Korean J Pathol. 1992;26(4):414-416.

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Abstract PDF: A 39-year-old male patient presented with chronic abdominal pain and intermittent diarrhea for 8 months. Colon study showed an annular stricture at the ileocecal value. He underwent ileocecectomy with clinica impression of intestinal tuberculosis. The resected intestinal wall along the lieocecal junction demonstrated a localized, annular constriction and intramural nodular inflammatory growth in which were clusters of multiple microabscesses as well as acute and chronic inflammatory cell infiltration including eosinophils and fibrosis. Encountered were a few resolving phase of parasitic granulomatous tunnels in which fragments of degenerated sparganum with foreign body reaction were found in one focus. He had history of ingesting uncooked frogs 2 years ago. The above case suggests that differential diagnosis of inflammatory tumorous lesions in the intestine should include sparganosis in Korea.

Primary Angiosarcoma of the Spleen associated with Kasabach-Merritt Syndrome: Report of a case.: Mee Soo Chang, Yun Kyung Kang, Yong Il Kim, Kun Wook Lee; Korean J Pathol. 1992;26(4):389-393.

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Abstract PDF: A 46-year-old woman presented with multiple purpuric skin rashes together with splenomegaly and thrombocytopenia. The resected spleen weighed 720 gm, and contained multiple, discrete, dark red, bulging nodules throughout the entire splenic parenchyma. Microscopically, the nodules revealed various range of endothelial cell proliferation which included cavernous vasculature, anastomosing vascular channels, papillary intravascular growth and solid pattern. Intrasinusoidal sequestration of platelets along with extramedullary hematopoiesis was present in the neoplastic vascular spacws. Neither exposure to thorotrast nor vinyl chloride was nonfirmed. Ultrastructurally, the tumor cells demonstrated a row of pinocytotic vesicles, occasional intercellular junctional structures, and the paucity/absence of filamentous structures or Weibel-Palade bodies supports origin of sinus lining type cells. After splenectomy, the thrombocyte count returned to normal. We conclude this is the first case of primary splenic angiosarcoma with Kasabach-Merritt syndrome in Korean literature.

Gastric Metaplasia in Duodenum.: Young Lyun Oh, Mi Kyung Kim, Woo Ho Kim, Yong Il Kim; Korean J Pathol. 1992;26(3):242-246.

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Abstract PDF: The partial replacement of the human duodenal mucosa by epithelial cells containing gastric-type mucus(gastric metaplasia) is not an uncommon finding, and an emphasis on its etiological role in duodenal ulcerogenesis has been proposed. It is unclear, Furthermore, all the previous studies were done with endoscopic biopsy specimens. We reviewed a total of 118 surgically resected stomachs with attached duodenal stumps(24 cases of gastric ulcer, 15 duodenal ulcer and 79 advanced gastric cancer). The gastric-type mucous cells were homogeneously stained red with PAS in contrast to the intestinal cells which gave a strong PAS stainability only along the the brush border. The gastric metaplasia was seen near the tips or on the sides of the villi and occasionally in the crypts. It was observed in 8 cases(53%) in duodenal ulcer, 12 cases(50%) in gastric ulcer and 29 cases(37%) in gastric cancer. There were no significant statistical differences in incidence among the groups. Nevertheless, diffuse form of gastric metaplasia was more prevalent in patients with duodenal ulcer(p<0.05).

Primary Appendiceal Papillary Adenocarcinoma of Colonic Type: Report of a case.: Yun Kyung Kang, Ghee Young Choe, Yong Il Kim, Kuk Jin Choe; Korean J Pathol. 1992;26(3):306-309.

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Abstract PDF: We report a case of colonic type-papillary adenocarcinoma of appendiceal origin in a 73-year-old male patient. The patient presented with right lower quadrant mass and was operated for a preoperative diagnosis of inflammatory small bowel mass. The mid one-third of the appendix showed a 3.5x3.3 cm sized, broad-based, intraluminal papillary mass. Microscopically, it was a well differentiated papillary adenocarcinoma and revealed a strong immunoreactivity to carcinoembryonic antigen. Tumor desmoplasia and acute inflammatory change were prominent.

Multiple Fibromuscular Dysplasia of Arteries with Aneurysm Formation: A case report.: Soo Min Kang, Sang Yong Song, Yong Il Kim, Sung Kwon Kim, Jung Sang Lee, Sang Joon Kim; Korean J Pathol. 1992;26(3):288-292.

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Abstract PDF: Multiple involvement of arterial fibromuscular dysplasia is unusal and such a case is quite limited in the literature. We present a case of multiple arterial fibromuscular dysplasia with aneurysm formation in a 38-year-old non-hypertensive man. Angiographic study showed multiple aneurysmal dilatations of the right renal, superior mesenteric, celiac axis, and left colic arteries. The resected right kidney demonstrated an aneurysm of the main renal artery and extensive infarction in the midportion of the renal parenchyma. The segmentally resected superior mesenteric artery disclosed a similar nature of aneurysm occluded by recent thrombi. Microscopically, all the resected arterial walls showed both intimal and medial fibroplasia together with periadventitial fibrosis resulting in marked narrowing of the lumen and subsequent thrombus formation.

Combined Hepatocellular-Cholangiocarcinoma: Analysis of 8 cases with special reference to their growth patterns.: Yong Il Kim, Geun Kook Lee, Woo Ho Kim, Eun Sil Yu, Ghee Young Choe; Korean J Pathol. 1992;26(3):229-241.

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Abstract PDF: Eight cases of combine hepatocellular-cholangiocarcinoma(HCC-CC) of the liver were analysed along with their growth patterns and histologic subtypes to draw a possible implication in understanding of their histogenesis. The relative incidence of combined HCC-CC among the surgically resected primary carcinomas of the liver(485 cases) was 1.6%. The combination patterns varied and were classified as follows; the multinodular tumor, each consisting of HCC or CC element(type 1) was found in 1 case, the single tumor mass with two distinct compartments of HCC and CC(type 2) in 3, and the single tumor with random mixture of two elements(type 3) comprised the remaining 4 cases. Of the 7 cases of single tumor mass(type 2 and 3) HCC and CC comprised the major component in 5 and 2 cases, respectively. The histologic features of both HCC and CC elements were not different from those of isolated HCC and CC, except for two of CC element in type 3 which disclosed the intermediated differentiation or socalled cholangiolocellular carcinoma in part. We conclude that there is no significant difference in the relative incidence of combined HCC-CC among primary carcinomas of the liver and their subtypes compared to that in other countries, regardless of high incidence of both HCC and CC in Korea. Also, we discussed a possible histogenisis along a hypothesis that some of the combined HCC-CC be the consequence of interposition of different cell type from a new subclone into the growth of an initial single cell type of primary carcinoma of the liver.

Small Hepatocellular Carcinoma: Pathologic Features of 39 Cases A Comparison with Large Hepatocellular Carcinoma.: Yong Il Kim, Geon Kook Lee, Sang Yong Song; Korean J Pathol. 1992;26(2):103-116.

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Abstract PDF: With advance of diagnostic imaging technics, the detection rate of small hepatocellular carcinoma (HCC) has become much increased, but the questions whether the growth pattern and histologic nature of the HCC keep maintain the original gross and microscopic features with its advancement of tumor size remain still unclear. We reviewed 39 surgically resected hepatocellular carcinomas(HCCs) with a tumor size less than or equal to 3 cm in diameter(s-HCC), and their gross and microscopic features were compared with the HCCs bigger than 3 cm (i-HCC, 199 cases). Single nodular type(SN) was the most common gross type(60%) in s-HCCs, and was followed by single nodular type with perinodular extension(SNPE; 15.4%), multinodular-discrete type(10.3%) and multinodular-confluent type(5.1%). These figures contrasted to SNPE(42.2%) and SN(20.6%) in the i-HCCs. Of the 39 s-HCCs, 25 cases(64.1%) were encapsulated, and 14 cases(36%) demonstrated intratumoral fibrous septations, being contrasted to the i-HCCs in which fibrous septa formation was mord prominent but complete capsule formation was found only in 40.2% of the larger ones. Microscopically, the trabecular type was the most frequent one(53.9%), and increased with their size while the compact type transformed into trabecular one. Thirty three cases(84.6%) were associated with macronodular cirrhosis. Seropositivity for HBsAg was found in 26 cases(66.6%), and high serum alpha-fetoprotein level over 500 IU/L was found in 15 s-HCC cases(38.4%), while 53.3% in i-HCC. The above results suggest that HCCs change their pathologic features by increase of their size, and a comparison of the details with regard to the possible mechanisms involved is discussed.

Pseudolipomatosis of the Gastrointestinal Mucosa: Report of 6 cases with analysis of possible factors involved during endoscopic procedure.: Ghee Young Choe, Yong Il Kim, Kyoo Wan Choi, Kee Suk Hong; Korean J Pathol. 1992;26(1):10-16.

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Abstract PDF: Pseudolipomatosis of the colonic mucosa has been recognized as a lesion featured with aggregations of gaseous spaces in the lamina propria, but its pathogenesis remains still unclear. This paper describes 6 cases of pseudolipomatosis occurring in the mucosa of stomach and large intestine, and the possible factors involved in gastrointestinal endoscopic procedure to produce gaseous entrapment in the lamina propria were analysed. All cases received either gastroscopy or colonoscpy before endoscopic biopsy. Mucosal tissues from both stomach and recto-sigmoid colon revealed multiple aggregations of small air-spaces resembling fatty infiltration in the lamina propria. Rarely were similar infiltrations within the muscularis mucosae and adjacent lymphoid follicles. Evidence for pneumatosis cystoides intestinalis or ulcerative colonic lesion was not associated, although one showed a small gastric ulcer nearby. Repeated inflations and deflations of the stomach or colon during the endoscopic procedure with miner mechanical trauma by instrument to the mucosa seem to contribute to its pathogenesis.

Early Gastric Carcinoma with Hepatoid Differentiation: Report of a case with histotopographic analysis.: Gyeong Hoon Kang, Chong Jai Kim, Yong Il Kim; Korean J Pathol. 1991;25(6):594-600.

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Abstract PDF: A 56-year-old man received subtotal gastrectomy for an early gastric carcinoma type IIa+IIc with submucosal invasion. The tumor was made up of mixed papillo-tubular adenocarcinoma and solid carcinomatous portion, the latter comprising approximately four-fifths of the total tumor mass. The solid portion was confined within the submucosa and revealed a mixture of trabecular, compact and pelioid patterns of large polyhedra cells, resembling hepatocellular carcinoma of the liver(Edmondson-Steiner grade 2). Sinusoid-like vascular stroma of classical trabecular hepatocellular carcinoma intervened the tumor cell nests but was not associated with endothelial-cell lining. Immunohistochemical stainings with alpha-fetoprotein and alpha1-antitrypsin gave a strong reactivity in those areas of hepatoid differentiation and in the adjacent minute portion of adenocarcinoma. The findings suggest that a portion of gastric carcinoma may transdifferentiate into cells with hepatoid features along the line of endodermal lineage.

Epithelioid Hemangioendothelioma of the Lung: Report of a case.: Gyeong Hoon Kang, Yong Il Kim, Sung Koo Han, Young Soo Shim, Eui Keun Ham, Sang Kook Lee, Sang Sook Lee; Korean J Pathol. 1991;25(6):563-569.

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Abstract PDF: Intravascular bronchioloaveolar tumor is now recognized as a pulmonary form of epithelioid hemangioendothelioma, being manifested with bilateral multiple pulmonary nodules in young women. This 34-year-old woman received two occasions of open lung biopsies with interval of 1 year for diffuse nodular infiltrations in both lung fields. Repeated radiographic study 3 year later showed no significant progression of the pulmonary nodular lesions except for pleural effusion. Two occasions of open lung biopsies disclosed similar multiple discrete nodules which consisted of central acellular areas with lacuna-like ghosts and peripheral cellular zone. The tumor cells grew in micropolypoid fashion with preservation of background alveolar frame-works. Ultrastructure disclosed most of neoplastic cells presenting with the features suggestive of endothelial differentiation, and immunohistochemical study revealed the presence of cellular areas which gave positive reaction to factor VIII-related antigen. We support that this is an additional case of epithelioid hemangioendothelioma of the lung that is manifested with a multicetric intrapulmonary vascular endothelial cell growth featuring a vasoformative tendency and participation of topography-specific histologic modification.

Histologic Variations of Intramural Heterotopic Pancreas in Gastrointestinal Tract Analysis of 15 Cases.: Seung Sook Lee, Yong Il Kim, Woo Ho Kim, Eun Sil Yu; Korean J Pathol. 1991;25(6):520-527.

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Abstract PDF: We reviewed a total of 15 cases of heterotopic pancreatic tissue within the gastrointestinal wall(intramural type), and compared with 3 extramural ones. Intramural heterotopic pancreatic lesions were located in the antrum(33%), pylorus(20%), and body of stomach(7%), and the remainders in the duodenum(40%). Only two cases presented with chinical symptoms by their existence. Two of them were situated within the submucosa, 3 in the muscularis, 6 in submucosa-muscularis, 2 in the muscularis-subserosa, and 1 in the susbmucosa-subserosa. Intramural type was featured with their structural heterogeneity compared to the extramural ones; 10 cases showed participation of gastrointestinal mucosal elements, and some accompanied tissue elements that were indistinguishable from submucosal epithelial heterotopia or microduplication cyst of the stomach. Langerhans islets were found in 67%, and one developed islet cell tumor. The above results suggest that the initially engrafted heterotopic pancreatic tissue becomes modified and presents with heterogeneity of endodermal and mesodermal tissue-derived components by its intramural growth during the gastrointestinal organogenesis; failure of opening of its drainage system into the gastrointestinal lumen may result in the increase of intraductal pressure with subsequent atrophy of the acinar tissue and various metaplastic changes of ductal epithelium, aside from induction of smooth muscle coat around the heterotopic tissue.

Lymphatic Cyst of the Adrenal : Report A Case.: Soong Deok Lee, Yong Il Kim; Korean J Pathol. 1991;25(5):491-494.

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Abstract: A case of lymphatic cyst of the adrenal gland in a 55-year-old woman is described. The patient presented with vague abdominal pain, and abdominal CT and ultrasonography suggested a pancreatic cyst. The cyst, 10x8x6 cm in size, was found in the left adrenal gland; it was multilocular and septated with thin walls that were lined by a single layer of attenuated cells. The lining cells gave a weak positive immunoreactivity against factor VIII-related antigen and Ulex eurapaeus, and ultrastructural study revealed the lining cells to be of endothelial origin. Together with small tiny proliferative cystic spaces were intermixture of the normal adrenal cortical cells in the transition zone between large cysts and adrenal cortex. No histologic distinction between cystic lymphangioma and lymphangiectatic cyst was obtained; instead, a term of lymphatic cyst seems preferred unless otherwise confirmed. With its classification, the pathogenesis of adrenal lymphatic cysts is reviewed.

Mesenteric Cystic Lymphangioma with Sustained Abdominal Pain : Report of a case.: Gyeong Hoon Kang, Yong Il Kim, Woo Ho Kim, In Sung Song, Kyoo Wan Choi; Korean J Pathol. 1991;25(5):488-490.

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Abstract: A case of cystic lymphangioma of the mesentery with severe and persistent abdominal pain in a 22-year-old man is presented. The cyst was filled with chylous fluid. Microscopically, numerous nerve bundles were incorporated within the lymphangiomatous walls, and some protruded into the lumen. The above findings lead to a suggestion that mesenteric lymphangioma may differ from those in the other sites by its abundance of incorporation of nerve bundles into the lymphangiomatous walls, and that increase of tumor size by intracystic accumulation of chylous fluid may subsequently result in increase of intraluminal pressure to compress the nerve bundles with which abdominal pain is much enhanced.

Smooth Muscle Tumors of the Stomach : A clinicopathologic analysis of 46 cases.: Mee Soo Chagn, Yong Il Kim, Woo Ho Kim; Korean J Pathol. 1991;25(5):418-426.

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Abstract: This study was undertaken to characterize the clinicopathologic features of smooth muscle tumors of the stomach with additional regard to recent controversy over the gastrointestinal smooth mscle tumors. A total of 46 consecutive cases(47 tumors) of surgically resected or excised gastric smooth muscle tumors, were assessed for review. The criteria for malignancy applied in this study were one of the followings; (1) 5 or more mitoses/10 HPF or (2) 1-4 mitoses/10 HPF with tumor cell necrosis and 5 cm or greater in tumor size. The tumors were classified as ordinary leiomyoma in 24 cases(25 tumors), epithelioid leiomyoma in 3, cellular leiomyoma in 6, ordinary leiomyosarcoma in 10, myxoid leiomyosarcoma in 2, and epithelioid leiomyosarcoma in 1. Of the 46 cases, 13 cases(28%) were categorized as malignant smooth muscle tumor. But immunohistochemical study for S-100 protein, desmin and vimentin(5 cases), and ultrastructural study(2 cases) support that myogenic or neurogenic differentiation is evident simultaneously within the same tumor, regardless of malignancy, and that even the differentiated tumor cells seem to express such direction toward immature smooth muscle cell or nerve cell.

Immunohistochemical Expression of Neuron Specific Enolase-Positive Cells in Gastric Adenocarcinomas.: Ghee Young Choe, Yong Il Kim; Korean J Pathol. 1991;25(4):291-304.

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Abstract PDF: In order to correlate the frequency of neuroendocrine cells with pathologic parameters in gastric adenocarcinomas, immunoperoxidase staining for neuron specific enolase was performed on 250 consecutive cases of surgically resected gastric adenocarcinomas(201 advanced gastric carcinomas[AGCs], 49 early gastric carcinomas[EGCs] and 2 cases of gastric carcinoid tumors. Of the 252 cases of gastric carcinomas, pure exocrine carcinomas were 174 cases(69%), pure neuroendocrine(NE) carcinomas 2 cases(0.8%), mixed exocrine and NE carcinomas 32 cases(12.7%), and exocrine carcinomas with occasional NE cells 44 cases(17.5%). The frequency of gastric carcinomas with NSE-positive cells increased with age proportionally. NSE positivity was higher in polypoid or fungating tumors(AGC Borrmann type I, II, EGC I and IIa) than ulcerative or scirrhous tumors. There was no significant difference in frequency of NSE-positive cells by histologic type and differentiation of gastric adenocarcinomas. The above findings reflect that most gastric carcinomas are heterogeneous in their constituents and suggest that both exocrine and neuroendocrine carcinomas are the expression of the extreme ends of the exocrine-endocrine differentiation spectrum based on the assumption that they develop from the pluripotent stem cells differentiating into both exocrine endocrine carcinomas.

Morphometric Analysis of Cirrhotic Nodules in Hepatocellular Carcinoma-bearing Livers.: Gyeong Hoon Kang, Yong Il Kim; Korean J Pathol. 1991;25(4):338-345.

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Abstract PDF: It has been well known that liver cirrhosis, regardless of its etiology, is an important predisposing factor in hepatocarcinogenesis. However, the type of cirrhosis in hepatocellular carcinoma(HCC)-bearing liver varies not only by geographic areas but also with the cirteria applied for morphological classification of cirrhosis. To elucidate the relationship between the nodule size of HCC-bearing cirrhotic liver and clinicopathologic features, we measured cirrhotic nodule areas of 49 surgically resected HCC cases using image analyzer. The morphological type of cirrhosis was predominantly macronodular(49%), and followed by mixed(37%) and micronodular(14%). Seventy percent of the cases showed seropositivity for HBsAg. The average area of cirrhotic nodules was significantly larger in HBsAg-positive cases(mean: 6.14 mm2) than that of HBsAg-negative cases(mean: 2.5 mm2)(p<0.05), and their size was bigger in cases with grossly expansile pattern of HCC than those cases with infiltrative ones(p<0.05). Based on the above findings, we assume that seropositivity of HBsAg may influence on the regenerative activity of cirrhotic nodules and also subsequent increase of risk for further development of HCC. The presence of cirrhohsis and nodule size seem to be the important contributing factors to determine the growing patterns of HCC.

Primary Biliary Cirrhosis: A Clinicopathologic Analysis of Four Cases.: Mi Kyung Kim, Yong Il Kim, Hyo Suck Lee, Chung Yong Kim; Korean J Pathol. 1991;25(4):318-326.

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Abstract PDF: Primary biliary cirrhosis, a chronic, progressive, and often fatal cholestatic liver disease, is characterized by destruction of intrahepatic bile ducts, portal inflammation and scarring, and the eventual development of cirrhosis and liver failure. We reviewed four cases of primary biliary cirrhosis primarily suspected with peritoneoscopic liver biopsy specimens. All patients were female and their age ranged from 29 to 50 years(median age: 43.8 years). Presenting symptoms were typically pruritus and/or upper abdominal discomfort. On physical examination, interus was presented in 3; hepatomegaly in 3; chronic liver disease stigmata in one. Co-existing autoimmune diseases such as Hashimoto' thyroiditis and Sjoegren' syndrome were found in 2 cases. Biochemical tests of liver function revealed a cholestatic pattern. An antimitochondrial-antibody test was positive in 2 out of 3 patients(75%). Increase levels of serum immunoglobulins, especially of IgM, were evident in 3 cases. Histologic staging(Ludwig et al.) disclosed stage I lesion in one, stage III in two, and stage IV in the remaining one.

Ciliated Foregut Cyst of the Liver: Report of a case.: Yun Kyung Kang, Yong Il Kim, Hyun Soon Lee, Soong Duk Lee, Kuk Jin Choe; Korean J Pathol. 1991;25(3):278-280.

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Abstract PDF: We report a case of ciliated hepatic foregut cyst which was incidentally found in a 64 year-old man. The cyst, 6 cm in diameter, was unilocular, solitary and was located in the medial segment of left lobe, just below the Glisson's capsule. Microscopically, the cyst wall consisted of 4 layers; pseudostratified ciliated columnar epithelium, subepithelial loose connective tissue, smooth muscle bundles and an outermost fibrous capsule. Although cartilage or subepithelial sero-mucous glands were absent, the morphologic features of the cyst correspond with those of an incomplete form of brochogenic cyst.

Primary Linitis Plastica of the Rectum: A Clinico-Pathologic Analysis of Five Cases with Special Reference to Comparison with Gastric Form.: Mee Soo Chang, Yong Il Kim, Woo Ho Kim, In Ae Park; Korean J Pathol. 1991;25(2):114-122.

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Abstract PDF: Colorectal cancer can have a gross appearance similar to linitis plastica of the stomach. However, most of these cases are not primary colorectal lesions but are, indeed, metastases from other sites. This study was designed to answer the following questions; (1) Why is the linitis plastica of the large intestine so rare compared to that of te stomach? (2) Which part of the large intestine is predominantly affected by linitis plastical form? (3) Is the histogenesis of linitis plastica involving the lagre intestine similar to that involving the stomach? Of the 911 cases of the resected colorectal primary cancer, we found only 4 cases of primary linitis plastica of the intestine (0.4%) and another one case referred from other hospital. All involved the rectum; they were of encircling carcinoma with diffuse transmural infiltration of signet ring cell carcinoma accompanied by marked desmoplasia as in the gastric form. Signet ring cell carcinoma of the large intestine comprised 1.8%(n=16) of the total colorectal cancer(n=911), and predominantly occurred in the rectum(n=8). There was no histologic difference between the linitis plastica in both stomach and colon in terms of desmoplastic reaction, once the tumor infiltrated into the submucosa. We conclude that rarity of signet ring cell carcinoma in the large intestine together with its predominant occurrence in the rectum can explain low incidence of primary colorectal linitis plastica and high preference in the rectum.

Computerization of 100,000 cases of Surgical Pathology Data at SNUH by Automatic Coding System using Personal Computer.: Woo Ho Kim, Ghee Young Choe, Jeong Wook Seo, Yong Il Kim; Korean J Pathol. 1990;24(4):509-512.

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Abstract PDF: A computer program using automatic coding of the diagnosis has been used for report printing as well as data storage and retrieval system at the Department of Pathology, Seoul National University Hospital. Previous surgical pathology files were also computerized by the automatic coding system using personal computer, and 100,000 cases of surgical pathology data during 7 years were computerized at present. The cpmputerized surgical files were counted and listed according to topograph and morphologic diagnosis. It is available to print out the list of a specific diagnosis or to copy the records to a floppy diskette. Collection of cases in surgical pathology files using cpmputerized automatic coding system becomes much convenient and accurate than using stored file cards or log books. In addition, previous biopsy records of the patient are automatically searched during the routine work so that understanding of a patient as a whole is possible through the informations about previous pathologic diagnosis. We confirm that automatic coding methods is the most practical and economic method for computerization of the surgical pathology records.

Giatn Lymph Node Hyperplasia : Analysis of 17 Cases with Special Reference to 5 Cases of Plasma Cell Type.: Jeong Hee Cho, Seong Hoe Park, Yong Il Kim; Korean J Pathol. 1990;24(3):204-214.

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Abstract PDF: This report describes the pathologic features of 17 cases of Castleman's disease, examined at the Department of Pathology, Seoul National University Hospital during a period from 1973 to 1989. The lesions in 12 cases were hyaline-vascular type and the remainders plasma cell type. The pathologic features favoring the plasma cell type over the hyaline vascular type included a sufficient number to large-sized follicles. However, a histologic overlapping between two types was present. In the hyaline vascular type the age of the patients ranged from 7 to 76 years and they appeared to be no particular sex predominence. The majority of the lesions occurred in the neck and within the chest. Almost all cases presented with a solitary mass except three cases. Neither conventional symptoms nor systemic manifestations were associated. The plasma cell type was characterized by presentation of constitutional symptoms, involvement of intra abdominal and inguinal lymphnodes, in association with unusual clinicopathologic features including IgA nephropathy, diabetes mellitus, systemic progressive sclerosis, peripheral neuropathy, and anemia. Immunohistochemical study was performed in three cases of the plasma cell type. Two cases revealed poly-clonal plasma cell infiltration. In a patient with IgA nephropathy, however, serum IgA was increase and a strong immunoreactivity to IgA heavy chain was found. Another case, associated with systemic progressive sclerosis and neuropathy, revealed monoclonal plasma cell infiltration (IgG and lambda light chain). The above results support a possibility that in some of the plasma cell type an altered immune mechanism is involved in its pathogenesis.

Acute Corrosive Esophago-Gastritis: A Case of Drain-cleansing Liquid-induced Transmural Inflammation.: Tae Jin Kim, Jeong Wook Seo, Yong Il Kim; Korean J Pathol. 1990;24(3):294-298.

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Abstract PDF: The pathologic features of acute corrosive esophago-gastritis by ingestion of "Trapunc", a common commercial drain cleansing liquid, is presented. A 37-year-old woman ingested abut 30 ml of Trapunc (3 gm NaOH/100 ml) to commit suicide and received piecemeal esophagectomy and total gastrectomy 9 days after the episode. The esophagus and stomach were extremely friable and necrotic. The most part of the stomach showed acute toxic necrotizing gastritis which was manifested by extensive greenish brown discoloration due to liquefaction necrosis of the mucosa except for a few rugae along the greater curvature. The antrum and distal body revealed severe mucosal detachment and even transmural necrosis. The tissue reaction was basically the same as those of NaOH-induced corrosive esophago-gastritis of acute stage, although it appeared to be severer probably due to sodium hypochlorite, and additive constituent of the ingested cleanser. A unique distribution pattenr of mucosal involvement is discussed.

Development of Desmoid and Mesenteric Fibromas following Total Colectomy for Adenomatous Polyposis Coli in Gardner's syndrome.: Jung Hee Cho, Yong Il Kim; Korean J Pathol. 1989;23(4):465-469.

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Abstract PDF: We describe a case of polyposis coli, which was followed by development of desmoid in the rectus adbominis muscle and fibromas in the mesentery during an interval of two years. This case supports the hypothesis that, in Garder's syndrome, the traumatic injury by colectomy triggers an unusual fibrous proliferation in the peritoneal cavity and incision site under the possible genetic basis.

Computerization of Surgical Pathology Reporting and Data Storage by Automatic Coding System using Personal Computer.: Woo Ho Kim, Jeong Wook Seo, Yong Il Kim; Korean J Pathol. 1989;23(4):410-415.

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Abstract PDF: The authors developed a computer program for use in report printing as well as data storage and retrieval system at the surgical pathology and its efficacy was evaluated at the Department of Pathology, Seoul National University Hospital. This program used IBM PC XT and was written in DBASE III plus language. The main features of the program included an automatic coding and decoding of the diagnosis, automatic searching of the previous biopsy during gross dictation, powerful word processing function and flexibility of the program. The data storage was carried out during the typewriting of the report, so that the typist's workload became markedly reduced. Two kinds of data files wer stored in the hard disk ; the temporary file contained full informations and the permanent file contained the core data only. Searching of a specific case was performed by pathology accession number, chart number, patient's name or by SNOMED code within a second. All the cases were arranged by copied to the diskette during the daily service automatically, with which data were easily restored in case of hard disk failure. The advantages of this program using a persosnal computer were discussed with comparison to those of larger computer system. Based on the experience of 8 months usage in Seoul National University, we assume that this program gives a sufficient solution to the surgical pathology service of many institutes where a large computer system with well designed software is not available yet.

Multiple Localized Hyperplastic Gastropathy: Report of A Case with A Special Reference to its Growth Pattern.: Jung Ran Kim, Yong Il Kim; Korean J Pathol. 1989;23(1):154-159.

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Abstract PDF: We present a case of localized mucosal hyperplasia of the stomach. The resected stomach contained four large, short stalked polyps, three of which were located in the anterior wall of body and the other in the posterior wall. In addition, numerous small sessile polyps were also scattered in the anterior and posterior fundic walls. Microscopically, the abnormally thick mucosa, carrying with it the muscularis mucosae and a thin core of loose fibrous tissue comprised the polyps by intraluminal infolding of widening of mucosal area. Abundant vasculature of the rugal pattern was prominent in the submucosa. The above findings suggest that the histogenesis of the polyps is related to both hyperplastic thickening and widening of mucosal areas in rugal pattern in the background of inverted distribution pattern of intestinal metaplasia.

Two Patterns of Gastric Carcinoma with Lymphoid Stroma.: Gu Kang, Eun Sil Yu, Yong Il Kim; Korean J Pathol. 1988;22(4):375-382.

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Abstract PDF: Various clinical and pathologic parameters in order to determine the prognosis of gastric carcinoma have been proposed. Among them "carcinoma with lymphoid stroma" has been proven to show good prognosis. But the criteria of lymphoid stroma in this condition remain vague and not clear. A total of 7 cases of gastric carcinoma with heavy lymphoid stromal response out of 947 surgically resected gastric carcinomas was reviwed with histotopographic analysis. They were all advanced carcinoma, Borrmann type I and II. Histologically, the lymphoid stromal response could be divided into three patterns; nodular (3 cases), diffuse (3 cases) and mixed (1 case). The nodular pattern was characterized by massive lymphoid cell infiltration with many follicle formation and little desmoplastic reaction, while the diffuse pattern showed diffuse permeative type of inflammatory cell infiltration with scarce lymphoid follicle formation and mild desmoplasia. Regional lymph node metastasis was found in 2 cases; one in diffused and another one in mixed pattern. The stromal reaction was not directly related with the depth of tumor invasion. We propoose that the term GCLS should be used in the cases of nodular pattern with complete follicle formation of lymphoid stroma.

Gastric Phycomycosis Presenting as an Ulcerative Lesion within the Early Gastric Carcinoma.: Myung Sook Kim, Kwang Yun Kim, Yong Il Kim; Korean J Pathol. 1987;21(3):176-184.

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Abstract PDF: Primary phycomycosis of the stomach within the ulcerative portion of early gastric carcinoma is presented in a sixty one year old male alcoholics. In the center of IIc type submucosal adenocarcinoma was a large deep ulcer (UL-IV) which was the only seat of phycomycetes infection accompanied with angioinvasion and exudative endovasculitis aside from unusual granuloma formation with Splendore Hoeppli phenomenon and eosinophilic response as in allergic granulomatous aspergillosis. The above features were reconstructed to indicate that the phycomycetes infection was confined to the type III area of IIc + III early gastric carcinoma, and that the local ulcerogenic lesion seems more contributory in its development than systemic factors including gastric carcinoma per se or alcoholic consumption.

Two Histologic Variants of Giant Cell Carcinoma of the Pancreas.: Hyung Geun Song, Yong Il Kim, Eun Sil Yu, Hyun Soon Lee; Korean J Pathol. 1987;21(3):192-198.

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Abstract PDF: Two cases of unusual giant carcinoma of the pancreas are presented. Each presented with a large tumor mass with or without cystic change, either in the head or tail portion of the pancreas. A pleomorphic gaint cell carcinoma variant (case 1) differed from an epulis type (case 2) with nuclear atypism of giant cells, but widespread metastasis in both cases reflected the accountability of spindle cell element as an important parameter for the determination of their biological behavior.

Secondary Biliary Cirrhosis in A Case with Intraductal Growth of Hepatocellular Carcinoma.: Hyung Geun Song, Yong Il Kim, Chung Yong Kim, Soo Tae Kim; Korean J Pathol. 1987;21(3):185-191.

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Abstract PDF: A case of hepatocellular carcinoma (HCC) complicating with secondary biliary cirrhosis due to intrahepatic bile duct growth of the tumor is presented. The patient was 34 years-old male who had been suffered from right upper quadrant pain with intermittent fluctuating jaundice for 4 months. Left lobectomy specimen contained a single, 4 cm sized, relatively well circumscribed and partly protruding nodular HCC in the medial seqment of left lobe. It compressed the left hepatic duct, and the intra and extra-hepatic ducts were completely plugged with tumor casts (extending to the common bile duct at the operating table). Remaining hepatic parenclyma was the seat of advanced secondary biliary cirrhosis in which were abundance of HBsAg-containing hepatocytes possibily representing a HBsAg carrier status. Biliary cirrhosis in HCC is an extremely rare manifestation, reflecting the delayed adequate clinical procedure by unusual pattern of obstructive jaundice. In such a case presenting as persisting and fluctuating obstructive jaundice in HCC, an intrabile duct tumor growth should be suspected.

A Dedifferentiated Liposarcoma of Soft Tissue with Features of Fibrosarcomatous Redifferentiation.: Kyung Ja Cho, Yong Il Kim, Hyun Soon Lee, Se Il Suk; Korean J Pathol. 1987;21(2):102-107.

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Abstract PDF: A case of dedifferentiated liposarcoma in a fifty-one year old man is presented. The patient received a wide extirpation for a relatively rapidly growing mass in his right gluteal region. The mass was multinodular and consisted of two clearly distinct elements; well differentiated liposarcoma and non-lipogenic spindle cell sarcoma (fibrosarcoma). This is first proven case of dedifferentiated liposarcoma of the soft tissue in Korean literature, and its histogenesis is discussed along the dedifferentiation-redifferentiation pathway of fibrohistiocytic differentiation.

Postirradiation Extraskeletal Osteosarcoma (A case associated with aggressive fibromatosis).: Hy Min Kim, Je Geun Chi, Yong Il Kim, Eui Keun Ham; Korean J Pathol. 1987;21(2):98-101.

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Abstract PDF: A case of postirradiation extraskeletal osteosarcoma with aggressive fibromatosis of the overlying soft tissue of radiation field is reported in a 57 year old house wife who was treated with operation and radiation therapy for cervix carcinoma of the uterus 23 years ago. The overlying aggressive fibromatosis showed characteristic radiation angiitis and atrophic vascular changes such as hyaline degeneration and obliteration of the capillaries which were highly campatible with radiation changes. She also had multiple osteogenic sarcoma in pelvic cavity, occurring in the mesentery bed. As for the histogenesis in this case, we thought the possiblity that fibroblasts went through a process of differentiation into osteoblasts that were responsible for bone formation in the process of malignant change of the aggressive fibromatosis.

Ultrastructural Observations on Human Primary Hepatocellular Carcinomas: Analysis of 35 Lobectomy Specimens.: Hye Kyung Lee, Yong Il Kim; Korean J Pathol. 1986;20(4):442-452.

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Abstract PDF: The etiologic impacts in primary hepatocellular carcinoma among Koreans seem different from those in other countries with its high incidence and close association of hepatitis B virus infection and liver cirrhosis. A series of 35 lobectomy specimens of hepatocellular carcinoma (HCC) was examined by means of electron microscopy to elucidate the general ultrastructural characteristics and to understand the morphogenesis of various histological growth patterns and cytologic features of HCC. 1) General cytological details of HCC were similar to those of non-neoplastic hepatocytes, but characterized by scantiness of subcellular organelles. Degree of cellular differentiation was not correlated with ultrastructural features of HCC. 2) Acinar pattern of HCC seemed to develop by either dilatation of central bile canaliculus or central cystic degeneration of microtrabecular growth, and clear cell group of HCC was expressed in abundance of glycogen particles and lipid droplets. 3) Intranuclear inclusions of HCC proved to be cytoplasmic herniations of tumor cells, and intracytoplasmic tubular arrays appeared to originate from the endoplasmic reticulum. 4) Hyaline globules seen in HCC corresponded to clumps of microfilamentous structures similar or identical to Mallory's hyalin.

Pilomatrix Carcinoma of the Skin: Report of a Case with Clinical Evidence of Distant Metastasis.: Ro Hyun Sung, Yong Il Kim; Korean J Pathol. 1986;20(4):491-495.

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Abstract PDF: Pilomatrix carcinoma is an extremely rare tumor of hair matrix origin and its definite biological behavior of malignancy has remained inconclusive. We report a case of a huge pilomatrix carcinoma arising in the lateral neck skin from an elderly woman, who eventually

Experimental Induction of Pancreatic Hyperplastic Nodules by Administration of 4-hydroxyaminoquinoline-1-oxide in Rats.: Hyung Sik Shin, Yong Il Kim; Korean J Pathol. 1986;20(2):133-146.

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Abstract PDF: Pancreatic hyperplastic nodules were experimentally produced in male Sprague-Dawley rats by single doses of intravenous injection of 4-hydroxyaminoquinoline-1-oxide(4-HAQO), 5 mg, 10 mg, 20 mg and 30 mg per 1kg of body weight. Every ten rats were sacrificed after 1 day, 1 week and monthly until 6 months. Within the first week, pancreatic acini and islets were severely affected with necrosis and the adjacent acinar cells underwent vacuolization. But, pancreatic ductules remained relatively unaffected. The degrees of acinar cell degeneration were proportionally increased as with the increased doses of 4-HAQO administration. The levels of blood glucose and serum amylase were closely corresponding to the light microscopic features of the pancreas. Two months after administration of 4-HAQO, the nongranular acinar cells started to proliferate and their proportion of total acinar cells was 35%, whereas that of control group was 15%, after 3 months the proportion of nongranular cells was decreased. After 6 months, multiple hyperplastic nodules were discovered within the pancreatic acini of all 12 rats, and the largest one measured 500 micro in diameter. Each hyperplastic nodule was uniformly composed of larger cells in two folds of normal cells with hyperchromatic muclei and prominent nucleoli together with a few zymogen granules in their cytoplasms. Ultrastructurally, the cells contained abundant dilated endoplasmic reticulum and markedly decreased zymogen granules. Nuclear heterochromatin became finely dispersed with loss of marginal clumping. During the regeneration process, admixture of islet cells with membrance-bounded granules was identified among the clusters of regenerating acinar cells. On the basis of above findings, the induction of hyperplastic nodules in rat pancreas by 4-HAQO was confirmed, and its histogenesis may reflect a nodular hyperplasia of non-granular acinar cells with potential progress as a neoplastic lesion. And the evidence of the hypothesis that the pancreatic exocrine cells and endocrine cells are in same origin, was presented.

Atypical Thymic Carcinoid Associated with Ectopic ACTH Syndrome: Demonstration of ACTH secretion with ultrastructural and immunohistochemical studies.: Eun Hee Suh, Yong Il Kim, Sung Yeon Kim, Young Soo Shim; Korean J Pathol. 1986;20(1):91-96.

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Abstract PDF: We reported a case of atypical thymic carcinoid tumor with ectopic ACTH syndrome which was proved by the presence of intracytoplasmic ACTH in the tumor cells using PAP method and electron microscopy. The patient was a 43-year-old housewife who was referred with Cushing's syndrome of unknown origin, and subsequantly followed by many disabling symptoms including, diabetes mellitus and electrolyte imbalance for which bilateral adrenalectomy was carried out. Thereafter, rapid rise in serum ACTH level and hyperpigmentation were followed. Pituitary irradiation was done under the impression of Nelson's syndrome despite of lacking evidence of pituitary tumor, but high serum ACTH persisted. Seven months after pituitary irradiation, two anterior mediastinal masses were first noticed and removed. Immunohistochemical and ultrastructural studies confirmed this neoplasm as a ACTH producing spindle cell variant of atypical thymic carcinoid tumor. When dealing with a patient who developed Nelson's syndrome-like phenomenon without apparent pituitary tumor, the possibility of ectopic ACTH syndrome caused by thymic carcinoid should be considered.

Primary Squamous Cell and Adenosquamous Carcinomas of the Stomach: Clinico-pathologic analysis of 6 cases.: Eun Hee Suh, Woo Ho Kim, Yong Il Kim; Korean J Pathol. 1986;20(1):60-70.

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Abstract PDF: Squamous cell carcinomas and adenosquamous carcinomas are rarely originated from the stomach, thus the limited and sporadic informations about their clinico-pathologic characteristics as well as histogenesis have been elucidated. Six cases of primary squamous cell carcinoma (3 cases) and adenosquamous carcinoma(3 cases) in the stomach were examined during a period of 4 years from 1981 to 1984. After pertinent review of both clinical data and morphology through extended histotopographic study performed on 4 cases, their clinicopathologic characteristics were described. Male to female sex ratio was 4 : 2 and average age was 58.6 years. Clinical presentations or physical findings were not different from those of adenocarcinoma. Tumor masses of all cases were located in the body or phloric antrum. In all cases except for the early gastric carcinoma, each tumor was larger than 8 cm in long axis, and showed expansile and intraluminal endophytic growing tendencies with sharp margin. Simple Borrmann's macroscopic classification was applicable to none of 6 cases because of irregular and multicentric ulceration pattern and occasional submucosal growth which were reminiscent of those in submucosal tumors such as malignant lymphoma and leiomyosarcoma. Virtually four out of all six cases were diagnosed as submucosal tumor at the time of radiological examination. Microscopically three cases were composed of pure squamous cell carcinoma and remaining three contained both adeno and squamous components. Metastatic regional lymph nodes revealed only squamous element in case of pure squamous cell carcinoam, while both components were identified in adenosquamous carcinomas. Surrounding non-tumors mucosa exhibited moderate to severe degree of intestinal metaplasia accompanied by multifocal mucin pool formation. Growth pattern and surrounding mucosal changes as with older age prevalence of these tumors might express the biological behavior of intestinal type of gastric carcinoma.

Pathology of Tuberculous Entercolitis: Analysis of 10 cases in special reference to macroscopic features.: Yeon Lim Suh, Yong Il Kim; Korean J Pathol. 1986;20(1):42-48.

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Abstract PDF: A total of 10 cases of surgically resected intestinal tuberculosis specimens was subjuected for analysis of its macroscopic characteristics. Intestinal tuberculosis was broadley classified into the ulcerative type (4 cases), ulcero-hypertrophic type (3 cases) and mixed type (3 cases) on the basis of its gross features. The ulcerative type was characterized by multiple, segmental lesions of napkin-ring stricture with variable length of uninvolved mucosa, secondary to the circumferential or annular ulceration. Various forms of relatively superficial ulcers were also scattered. Their ulcer beds were rather granular, being covered with a necrotic detritus although the ulcer margins were relatively well defined with areas of some nodularity. The ulcero-hypertrophic type affected the ileocecal region and ascending colon in a tubular form by segmental thickening of the wall. The diseased segment of mucosa appeared cobble-stone, represented by coalescence of irregular ulcers and hemorrhage. There were scattered small ulcers in the separate portions of terminal ileum. The macroscopic distinctions between the intestinal tuberculosis and Crohn's or ischemic enterocolitis were presented in detail.

Metastatic Squamous Cell Carcinoma of the Stomach from the Uterine Cervix: A case report.: Eun Hee Suh, Yong Il Kim; Korean J Cytopathol. 1985;19(4):458-462.

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Abstract PDF: Secondary tumor of the stomach is rare when metastatic involvement is defined as an extragastric tumor invading the muscularis, submucosa or mucosa and the only serosal implant is excluded. Recently, authors experienced a case of metastatic squamous cell carcinoma of the stomach in the pyloric antrum from the uterine cervix. The patient was a 57-year-old female who received a simplified Wertheim's operation followed by irradiation for squamous cell carcinoma of uterine cervix in stage IIb, and 2-1/2 years later she presented gastric symptoms, for which subtotal gastrectomy was carried out. The gastric lesion simulated primary adenocarcinoma of Borrmann type III, but differed in the following macroscopic characteristics. Firstly, Bormann classification is not applicable; secondly, mucosal ulcerations appear irregular and multicentric; thirdly, flaskshaped ulceration and broad based penetration are evidet; fourthly, submucosal tumor-growth pattern is conspicuous in bulk of areas; and fifthly, circumferential/semicircumferential growth is manifested. The above features should also be differentiated from those of malignant lymphoma and leiomyosarcoma.

Metaplastic Variant of the Gallbladder Adenoma: A report of a case.: Eun Sil Yu, Yong Il Kim; Korean J Cytopathol. 1985;19(3):350-354.

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Abstract PDF: A case of papillary adenoma of the gallbladder in a sixty seven-year-old female with varietise of epithelial components in metaplastic nature is presented. This adenoma was bordered by hyperplastic epithelium with intervening Paneth cells and enterochromaffin cells, but goblet cells were rarely participated, as with focal epithelial change resembling gastric foveolar epithelium and aggregation of antral type mucous glands. Based on its morphologically distinct type of gallbladder adenoma and histogenetic point of view, we propose this neoplasm to be designated as a metaplastic adenoma or polyp, and the relationship of various metaplastic changes to adenoma or carcinoma is discussed.

Krukenberg Tumor: Clinico-pathologic analysis of 36 cases.: Yeon Lim Suh, Geung Hwan Ahn, Yong Il Kim, Eui Keun Ham; Korean J Cytopathol. 1985;19(3):305-312.

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Abstract PDF: A total of 36 typical Krukenberg tumors of the ovary was obtained from the pathology file of the Department of Pathology, College of Medicine, Seoul National University during a period of 17 years from January 1968 to December 1984. By definition, all were characterized by the presence of mucin containg signet ring cells within the cellular, nonneoplastic ovarian stroma. The clinico-pathologic characteristics of 36 Krukenberg tumors were as follow: The Krukenberg tumors accounted for 16.3% of all ovarian malignancies. The age of the patient at the time of diagnosis of the Krukenberg tumor ranged from 28 to 69 years with an average of 43 years. A primary carcinoma of stomach (31 cases) of colon (1 case) was found in 32 (88.9%) of 36 patients. The primary carcinomas was not detected in four cases, and autopsy was not performed in any case. In 22 cases the primary carcinomas had been diagnosed before ovarian tumors were found. The ovarian and the primary carcinomas were identified synchronously in 6 cases, while in 8 cases the primary carcinomas were not discovered until after the ovarian tumors had been treated. The gross diameter of the ovarian tumor ranged from 1.5cm to 28cm with an average of 10.3cm. The largest weighed 4,550gm. The Krukenberg tumors typically formed rounded or reniform, solid mass that were coarsely lobulated or bosselated. The cut surface was yellow white and associated frequently with nodular, myxoid or gelatinous area and cystic changes of various size. Both ovaries were involved in 29(80.6%) of the cases and one ovary in 7(19.4%). Krukenberg tumors classified into the three major types on the basis of the characteristic morphologic patterns of signet ring cells. The first type was classic Krukenberg tumor(28 cases) represented by predominent components of typical signet ring cells. The second type was tubular Krukenberg tumor(5 cases) characterized by tubular structures resembling a Sertoli-Leydig cell tumor. The third type was re tiform Krukenberg tumor (3 cases) characterized by an irregular network of elongated, often slitlike tubules and cysts, which resembled the rete testis.

Metastatic Giant Cell Carcinoma of Thyroid Simulating Primary Small Intestinal Tumor: Report of a case with ultrastrucutral and immunohistochemical studies.: Woo Ho Kim, Yong Il Kim, Seong Hoe Park, Jae Gahb Park; Korean J Cytopathol. 1985;19(2):194-201.

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Abstract PDF: We present a case of metastatic giant cell carcinoma of the thyroid in small intestine presenting as an unusual polypoid growth, and its ultrastructure and immunohistochemical reaction to thyroglobulin were investigated. The patient was a 63 years old female who received a segmental resection of ileum for intestinal obstruction, one year after a radical neck dissection and thyroidectomy for anaplastic (giant cell variant) carcinoma with a focus of papillary tumor of the thyroid. In the segmentally resected ileum, there were three conglomerated round intraluminal polypoid tumor masses in close approximation which measured 4.5 cm, 2.5 cm and 2 cm respectively. The histological features were similar to those of thyroid lesion, being predominantly made of anaplastic giant and spindle cells in haphazard arrangement. Ultrastructure of pleomorphic spindle cells and multinucleated giant cells demonstrated numerous mitochondria with tubular cristae, rough endoplasmic reticula and a few membrane-bound dense granules. Peroxidase-antiperoxidase method against thyroglobulin revealed strong positive staining on papillary carcinoma and weak positivity on both giant cells and spindle cells of the anaplastic carcinoma. The above observations confirm that multinucleated giant cells of small intestine originate from metastatic giant cell carcinoma of the thyroid.

Accessory Hepatic Nodules: Histopathologic analysis of three cases.: Hye Kyung Lee, Yong Il Kim; Korean J Cytopathol. 1985;19(1):97-101.

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Abstract PDF: This report deals with three cases of accessory hepatic nodules incidentally noted during operation. Two of them were found on the serosal surface of the gallbladder with no connection to the main body of the liver. The other case was in the greater omentum. All three cases were small oval shaped, measuring less than 1 cm in maximum dimension and were composed of histologically normal hepatic tissue and seemed to receive blood supply from the adjacent tissue through the capsular blood vessels. Presence of the fairly well retained intralobular mesenchymal component may reflect that accessory hepatic nodules develop after conjugation of hepatic diverticulum and septum transversum.

Malignant Lymphoma of Thyroid Associated with Chronic Lymphocytic Thyroiditis and Occult Sclerosing Carcinoma: A case report.: Yeon Lim Suh, Seong Hoe Park, Yong Il Kim; Korean J Cytopathol. 1985;19(1):107-111.

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Abstract PDF: Although the reported number of malignant lymphoma of the thyroid has been increased, primary malignant lymphoma of the thyroid associated with chronic lymphocytic thyroiditis has been sporadically reported since its first description by Graham in 1931. The apparent coexistence of these two conditions has undoubtedly been noted by other observers. And they suggested that malignant lymphoma of the thyroid might arise from the lymphoid tissue ina wide variety of preexisting thyroidal disease. This report was made to record a case of primary thyroid lymphoma recently seen in this department with special emphasis on the associated thyroiditic changes in the uninvolved portion of the gland, which suggest the antecedent presence of chronic lymphocytic thyroiditis.

Histotopographic Observations on Metaplastic Changes of the Gallbladder Mucosa.: Eun Sil Yu, Yong Il Kim, Sang Kook Lee; Korean J Cytopathol. 1985;19(1):58-66.

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Abstract PDF: Fifty three surgically resected gallbladders(49 cases of chronic cholecystitis with or without cholelithiasis, 4 cases of incidentally resected gallbladders) and 14 autopsy cases were subjected to the histotopographic analysis to identify the nature and distribution of metaplastic mucosal changes, and to determine the possible histogenesis of these mucosal lesions and diagnostic implication as a parameter of chronic cholecystitis. 1) Antral type glands were demonstrated in 47(88.7%), goblet cells in 19(35.8%) and surface epithelial changes in 27(50.9%) of total surgical specimens, indicating the benign metaplastic changes of the gallbladder mucosa toward the gastric or intestinal type. 2) Topographic distribution illustrated the extension of antral type gland to the middle and upper one third portions of the gallbladder mucosa in 37 cases, each. Goblet cells in the middle and upper one third of the mucosa were demonstrable in 13 cases(68%) an 8 cases(42%), respectively. 3) Average age by degree of extension was 50.0 years in Grade O-I, 50.1 years in Grade II and 56.4 years in Grade III. 4) Among 53 surgically resected gallbladders, gallstone was found in 31 cases, in which was a significant correlation between the distribution of metaplastic changes by degree of extent and cholelithiasis. 5) There was no statistical significance between incidence of metaplastic changes of the gallbladder and degree of inflammatory reaction by means of chronic and/or acute inflammatory cell infiltration and Rokitansky-Aschoff sinus formation. 6) Only two out of fourteen autopsy cases demonstrated focal and spotty presence of goblect cells. It is of authors assumption that the lining epithelium of the gallbladder undergos various types of metaplastic changes in the diseased conditions, in which cholelithiasis is included as one of preceding factor. And also, the diagnostic implication of epithelial metaplasia as an expression of chronic cholecystitis is discussed.

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