- Bilateral Frontal Polymicrogyria: An Autopsy Case Report.
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Yi Kyeong Chun, Jong Sun Choi, Je G Chi
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Korean J Pathol. 2011;45:S62-S65.
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DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.S1.S62
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- Bilateral frontal polymicrogyria is a recently recognized syndrome characterized by symmetric polymicrogyria of both frontal lobes that presents with delayed motor and language development, spastic quadriparesis, and variable mental retardation. However, the postmortem findings of this syndrome are not fully elaborated. Here we describe an autopsy case of bilateral frontal polymicrogyria in a male fetus delivered at 22 weeks gestation due to extensive chorioamnionitis. The microscopic findings included a thinned cortical plate with fair neuronal maturation. There were no signs of neuronal damage and the white matter was unremarkable.
- A Case Report of Cutaneous Coccidioidomycosis.
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Sunhee Chang, Sang Hwa Shim, Ji Eun Kwak, Mee Joo, Hanseong Kim, Hai Jin Park, Yee Gyung Kwak, Je G Chi
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Korean J Pathol. 2008;42(4):223-225.
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- Coccidioidomycosis, which results from inhaling the spores of Coccidioides species, is endemic in the southwestern United States. The primary infection site is the lung, and dissemination of the disease can occur. We report a case of cutaneous coccidioidomycosis in a 79-year-old Korean woman who presented with purpura on both lower extremities, but no pulmonary symptoms and no history of visiting an endemic area. Microscopically, skin biopsy showed multiple aggregates of granulomas in the dermis. Numerous multinucleated giant cells were associated with the granulomas. Mature and immature fungal spherules, which were 20 to 30 micrometer in diameter, were present inside and outside the multinucleated giant cells.
- Fibrovascular Polyp of the Hypopharynx: A Case Report.
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Sunhee Chang, Sang Hwa Shim, Ji Eun Kwak, Mee Joo, Hanseong Kim, Bum Jo Jung, Joong Wook Shin, See Young Park, Kyung Ja Cho, Je G Chi
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Korean J Pathol. 2008;42(4):226-228.
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- We report here on a case of fibrovascular polyp arising in the hypopharynx of a 62-year-old man. Laryngomicroscopic surgery with laser ablation was performed to excise the mass. Histopathologically, the surface of the polyp was covered with mature squamous epithelium. The polyp showed a characteristic lobular proliferation of mature adipose tissue that was separated by myxoid or collagenous connective tissue. Some scattered skeletal muscle bundles were seen in the central portions of the polyp and these bundles were surrounded by a concentric proliferation of the spindle cells; this was reminiscent of Pacinian corpuscles.
Regarding their location and the intermingled pattern of proliferating tissues, it is more plausible that the skeletal muscle is a hamartomatous component rather than entrapped, preexisting tissue.
- A Diagnostically Challenging Case of an Infarcted Adenomatoid Tumor of the Epididymis.
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Sunhee Chang, Sang Hwa Shim, Ji Eun Kwak, Mee Joo, Hanseong Kim, Je G Chi, Keon cheol Lee
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Korean J Pathol. 2008;42(4):229-231.
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- We describe a case of an infarcted adenomatoid tumor of the epididymis that was challenging to diagnose. A 20-year-old man presented with acute left scrotal pain. He was found to have a 2x1.5x1 cm tumor that was relatively well circumscribed on gross examination. There was a central necrotic area that exhibited gaping spaces and ghost outlines of epithelial cells. The periphery of the necrotic lesion showed focally viable adenomatoid tumor. The majority of the tissue adjacent to the necrosis consisted of granulation tissue, fibroblastic and myofibroblastic proliferation, and neutrophils. The fibroblasts and myofibroblasts showed plump nuclei, often with small nucleoli. No mitotic activity was present. The differential diagnosis for an infarcted adenomatoid tumor includes malignant mesothelioma, inflammatory myofibroblastic tumor, and inflammatory conditions. The key to diagnosing an infarcted adenomatoid tumor is to consider it in the differential diagnosis of any spindle cell tumor with necrosis occurring in the genital tract.
- Florid von Brunn Nests of the Urinary Bladder: A Case Report.
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Han Seong Kim, Ji Eun Kwak, Sang Hwa Shim, Mee Joo, Sun Hee Chang, Je G Chi, In Rae Cho
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Korean J Pathol. 2008;42(3):169-171.
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- Among benign proliferations of the urinary bladder, von Brunn nests and cystitis cystica et glandularis are common.
Sometimes florid proliferation of von Brunn nests makes an intravesical mass, which mimics tumorous lesions. We report here on a case of florid von Brunn nests, occurred in the 34-year-old man with hematuria. Radiological and cystoscopic examinations reveal a polypoid-papillary lesion and transurethral resection was then performed. Pathologically, prominent proliferations of urothelial cell nests were found deep in the lamina propria. Neither significant cytologic atypia nor muscle invasion was noted. Florid von Brunn nests should be considered both clinically and pathologically in the differential diagnosis of a intravesical mass.
- Synchronous Development of Gastrointestinal Stromal Tumor and Arteriovenous Malformation in the Jejunum: A Case Report.
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Sang Hwa Shim, Yoon Hee Han, Ji Eun Kwak, Sun Hee Chang, Hanseong Kim, Je G Chi, Mee Joo
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Korean J Pathol. 2008;42(3):185-188.
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- Vascular malformations associated with neoplasms are extremely rare. Herein we report an extraordinary coincidence of arteriovenous malformation (AVM) and gastrointestinal stromal tumor (GIST) in the jejunum. A 44-year-old woman presented with melena and anemia.
Abdominal computed tomography revealed a highly vascularized, strong early arterial enhancing soft tissue mass in the jejunum, which was confirmed by angiography to be an AVM supplied by the distal jejunal branch of the superior mesenteric artery. An emergency operation was performed due to active gastrointestinal (GI) bleeding. The resected jejunum showed a protruding, mostly solid subserosal mass. The mass was confirmed to be a spindle cell type GIST and was intermingled with the AVM located in the overlying submucosa and muscularis propria. To our knowledge, this is the first reported case of an AVM associated with a GIST. This case masqueraded radiologically as an AVM alone and presented clinically with GI bleeding.
- Combined Xanthogranulomatous Urachitis and Bullous Cystitis: A Case Report.
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Ji Eun Kwak, Han Seong Kim, Mee Joo, Sun Hee Chang, Sang Hwa Shim, Je G Chi, In Rae Cho
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Korean J Pathol. 2008;42(1):41-44.
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- Xanthogranulomatous inflammation of the urachus is a very rare benign chronic inflammatory disease of an unknown etiology. Herein we report a case of a 31-year-old woman who complained of lower abdominal pain and dysuria. Cystoscopy revealed a bullous change at the dome of the urinary bladder. MRI revealed a cystic mass above the bladder dome that extended to the umbilicus. A partial cystectomy with urachal resection was performed. Pathological examination revealed xanthogranulomatous urachitis combined with bullous cystitis.
- Lipomatous Hypertrophy of the Interatrial Septum: A Case Report.
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Ji Eun Kwak, Han Seong Kim, Mee Joo, Sun Hee Chang, Sang Hwa Shim, Je G Chi, Wook Sung Kim
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Korean J Pathol. 2007;41(3):213-215.
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- Lipomatous hypertrophy of the interatrial septum is a benign cardiac mass that is characterized by excessive deposition of fat in the interatrial septum. It typically occurs in elderly, obese patients and may cause arrhythmia. We report a case of lipomatous hypertrophy of the interatrial septum.
A 45-year-old man was admitted for evaluation of chest discomfort. Transthoracic echocardiography revealed a cardiac mass, which was suspected as a myxoma. A resection of the tumor was performed. Grossly, the mass was 1.3x1.2x0.8 cm, and showed yellow soft consistency and good demarcation. Microscopically, the mass consisted of mature adipose tissue, intermixed cardiac muscle fibers, entrapped nerve fibers and ganglion cells. Lipomatous hypertrophy of the interatrial septum should be differentiated pathologically from tumorous cardiac mass such as lipoma and myxoma.
- Causes of Hydrops Fetalis: Analysis of 149 Autopsy Cases.
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Ho chang Lee, Je G Chi, Sung Hye Park
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Korean J Pathol. 2007;41(2):103-108.
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- BACKGROUND
Hydrops fetalis is defined as abnormal accumulation of serous fluid in two or more fetal compartments, and this malady is known to be associated with various pathologic conditions.
METHODS
We collected 149 cases of hydrops fetalis out of 2,312 autopsies, and we tried to elaborate the underlying causes of hydrops fetalis. The diagnosis was based on the material from either antenatal termination or intrauterine death.
RESULTS
The relative incidence of hydrops fetalis was 6.44% of all the pediatric autopsies we performed. The gestational age was evenly distributed from 18 to 33 weeks, except for 30 to 31 weeks. There was no sex difference in the incidence of hydrops fetalis. The main causes were cardiovascular diseases (30.9%), cystic hygroma (13.4%), chromosomal anomaly (8.05%), thoracic conditions (7.38%), followed by urinary tract malformation (4.03%), infection (4.03%) and anemia (3.36%). The most common chromosomal anomaly was Turner syndrome and the second one was Down syndrome.
CONCLUSION
Since various conditions can be the cause of hydrops fetalis, pathologists should pay attention to elaborate the underlying causes in every single autopsy.
- Propylthiouracil-induced Hepatic Injury: A Case Report.
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Ji Eun Kwak, Han Seong Kim, Sun Hee Chang, Mee Joo, Je G Chi, Jin Soo Moon, Jong Guk Lee
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Korean J Pathol. 2006;40(4):289-291.
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- Propylthiouracil (PTU) is one of the most widely used drugs for the treatment of the hyperthyroidism. However the liver damage is a rare adverse effect, which can be fatal. We present a case of PTU-induced hepatitis. A 13-year-old girl was diagnosed as having Graves' disease, for which PTU was administered. Three months after commencing PTU, she developed jaundice accompanied with elevated serum transaminases and total bilirubin levels. The viral markers were all negative. The pathologic findings of the liver biopsy included necrosis of hepatocytes predominantly around the central veins (i.e., zone 3 necrosis) and moderate to severe infiltration of lymphocytes in portal areas. After withdrawal of the PTU, clinical symptoms and liver function test results were improved gradually.
- Hydrops Fetalis Due to Parvovirus B19 Infection: Report of Two Autopsy Cases.
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Ho Chang Lee, Hee Eun Lee, Pil Gyu Hwang, Je G Chi, Sung Hye Park
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Korean J Pathol. 2006;40(3):245-249.
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- Hydrops fetalis (HF) is a disease characterized by generalized subcutaneous edema and cavity effusion in the fetal stage. We report here on two autopsy cases of HF that were caused by parvovirus B19 (PVB19) infection. The human PVB19 is an erythrovirus that cause diverse clinical manifestations ranging from an asymptomatic or mild presentation to more severe effects such as hydrops fetalis, and this is the only known human pathogenic parvovirus. The gestational ages of the two fetuses were 21 weeks and 23 weeks, respectively. Both fetuses were hydropic and anemic.
Hepatic tissues of both fetuses demonstrated erythroblasts with eosinophilic intranuclear inclusions, the so called "lantern cells". PVB19 was confirmed by electron microscopy and immunohistochemical staining. For the diagnosis of this disease, recognition of parvovirus infection as a cause of hydrops fetalis and careful examination of red blood cells with a high-power view are required.
- Why and How to Use Surgical Pathology Terminology in Korean?.
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Je G Chi
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Korean J Pathol. 2005;39(6):442-444.
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- The great majority of the terms that are used in describing the pathological findings are in English. These English terms became very familiar to most surgical pathologists in non-English speaking countries including Korea. Considering the situation of global importance of diagnostic pathology for the better international communication. It is acceptable to our Korean pathologists to be competent in English and English terminology. However, it is equally important to be competent and fluent in Korean terminology as well.
Therefore, instead of mixing or combining two languages in describing pathological changes, it should be encouraged to be competent in both Korea and English. The author proposes a list of Korean terms that could best fit for the corresponding English terms that are frequently used in describing gross and microscopic findings in routine surgical pathology. It is hoped that these proposed terms could be standardized through the process of feedback from the members of our Society, and be used routinely in everyday practice.
- Urachal Adenocarcinoma with a Concomitant Urachal Remnant: A Case Report.
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Tae Hoon Kim, Mee Joo, Min Kyung Kim, Hanseong Kim, Je G Chi, Jae Y Ro
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Korean J Pathol. 2004;38(4):280-283.
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- Urachal adenocarcinoma is a rare tumor, and it has similarities with nonurachal adenocarcinoma; therefore, it is sometimes difficult to make a diagnosis. We present a typical case of urachal adenocarcinoma that had all the diagnostic criteria including the presence of an urachal remnant. A 65-year-old woman presented with complaints of a painless gross hematuria. Pelvic CT and cystoscopy showed an intraluminal protruding mass centered in the bladder wall.
When diagnosed as adenocarcinoma with a signet ring cell component being noted by frozen biopsy, partial cystectomy with resection of the median umbilical ligament and peritoneum was carried out for a suspected urachal adenocarcinoma. The tumor morphology showed as typical mucinous adenocarcinoma. Characteristic tubular structures showing the typical histology of an urachal remnant was found in the perivesical fat. On immunohistochemical staining, the urachal adenocarcinoma showed a pattern similar to colonic adenocarcinoma, while the urachal remnant showed strong positivity for CK7 and Chromogranin A.
- Odontogenic Gingival Epithelial Hamartoma; with Reference to the Expression of Ameloblastin Gene by in situ Hybridization and Immunohistochemistry.
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Na Rae Kim, Yeon Lim Suh, Je G Chi, Young Joon Lee, Suk Keun Lee, Jae Il Lee, Chang Yun Lim, Ji Young Park
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Korean J Pathol. 2004;38(2):116-120.
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- Odontogenic gingival epithelial hamartoma (OGEH) is an extremely rare lesion characterized by an abnormal proliferation of odontogenic epithelium. This lesion is thought to arise from the rest of the dental lamina lying dormant in the gingival tissue after odontogenesis.
Distinguishing OGEH from the granular cell variant of ameloblastoma and central odontogenic fibroma is important.
To date, only eleven cases have been reported, and its pathogenesis remains unclear. We report here on a case of OGEH, where the epithelial strands in the lesion were conspicuously positive for the antisera of cytokeratin 19 and ameloblastin. Tumor cells intensely expressed ameloblastin mRNA by in situ hybridization. To the best of our knowledge, this is the first case of OGEH to which ameloblastin immunohistochemical stain and in situ hybridization were applied. Although our study is limited to a single case, the coexpression of cytokeratin 19 and ameloblastin might indicate the origin and specific cytodifferentiation of OGEH is quite different and unique, when contrasted to other odontogenic tumors.
- Central Core Disease: A Case Report.
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Ji Hoon Kim, Young S Park, Sung Hye Park, Je G Chi
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Korean J Pathol. 2004;38(1):68-71.
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- Central core disease is a rare autosomal dominantly inherited non-progressive congenital myopathy, which is pathologically characterized by the formation of a "core".
We report a 28-year-old female with non-progressive muscle weakness, who had a hypotonic posture at birth. The developmental milestones were delayed with her first walking at 18 months of age. She could not run or walk a long distance and weight-bearing tasks were almost impossible.
None of her family members showed motor symptoms. An investigation of the electromyography and nerve conduction velocity showed non-specific results. A gastrocnemius muscle biopsy revealed central cores in approximately 70% of myofibers with a type 1 myofiber predominance and deranged sarcolemmal structures. To the best of our knowledge, this is the fifth report of central core disease in the Korean literature.
- Undifferentiated Sarcoma of the Liver: Clinical and Pathologic Study of 9 Cases.
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Kyung Chul Moon, Chong Jai Kim, Je G Chi, Gyeong Hoon Kang
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Korean J Pathol. 2003;37(1):50-57.
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- BACKGROUND
Undifferentiated sarcoma of the liver (USL) is a rare malignant tumor that is found in children and young adults.
METHODS
We performed a clinicopathologic analysis of 9 cases (M:F=4:5) of USL using immunohistochemical staining for vimentin, desmin, -smooth muscle actin (SMA), CD68, CD117, S-100, cytokeratin, epithelial membrane antigen (EMA), and p53.
RESULTS
Grossly, the tumors were large, single, and well demarcated with areas of hemorrhage and necrosis.
Microscopically, the tumors were composed of spindle to stellate cells and variable numbers of multinucleated giant cells with a myxoid background. The tumors had eosinophilic globules, small cystic spaces and fibrous pseudocapsule.
Under immunohistochemical study, the tumor cells were positive for vimentin, CD68 and desmin, but negative for S-100 protein. p53 overexpression was noted in most cases, and four cases showed immunoreactivity for CD117. All patients received chemotherapy before or after the excision of the tumors. Two patients died during chemotherapy, but six patients survived without recurrence for 18, 35, 53, 57, 65 and 126 months after the initial diagnosis. The remaining one patient survived with recurrence for 20 months after the initial diagnosis.
CONCLUSION
Our cases showed unique pathological and immunohistochemical features similar to the cases of previous reports. In contrast to the previous reports, the outcome of our cases were not poor.
Modern multimodal treatment including surgical resection combined with multiagent chemotherapy may contribute to the better prognoses.
- Prenatal Development of Human Lip with Immunohistochemical Study.
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Su Jung Hong, Young Joon Lee, Yeon Sook Kim, Suk Keun Lee, Je G Chi
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Korean J Pathol. 2002;36(4):212-221.
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- BACKGROUND
This study is aimed to elucidate the developmental pattern of human fetal lip by histological and immunohistochemical examinations.
METHODS
Totally 231 normal human lip tissues obtained from autopsied fetuses were fixed with 10% buffered formalin, sectioned in cross and longitudinal directions, routinely stained for H&E and performed for immunohistochemistry with antibodies of S-100 protein, proliferating cell nuclear antigen (PCNA), transglutaminase C (TGase-C), metalloproteinase (MMP)-3, MMP-10, tenascin, KL1, K8.12, E-cadherin, tissue inhibitors of matrix metalloproteinase (TIMP)-1, TIMP-2 and total keratin (TK).
RESULTS
The lip structure first appeared as an orifice of stomodeum around the 7-8th week of gestation, and a major structure of the midface was observed by the 11-12th week.
As the squamous epithelium of the lip became thick and was keratinized, the vermilion border became distinguished in the 15-16th week, and the lip structure was almost completed with the presence of orbicularis oris muscle in the lingual side of vermilion border by the 17-18th week.
Immunohistochemically, the vermilion border showed strong reactions for tenascin, E-cadherin and MMP-3 and increased positivity for PCNA, cytokeratins (TK, KL1, K8.12), and TGase-C.
CONCLUSIONS
With the above findings we suppose that the cytodifferentiation of vermilion border epithelium plays an important role for the development of human fetal lip.
- Bronchoalveolar Lavage (BAL) Cytology and Ultrastructural Findings in a Patient with Amiodarone-Induced Pulmonary Toxicity: A Case Report.
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Sun Lee, Min A Kim, Young Soo Shim, Chun Taek Lee, Je G Chi, Doo Hyun Chung
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Korean J Pathol. 2002;36(3):175-178.
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- Amiodarone is a potent antiarrhythmic agent and can cause potentially life-threatening pulmonary fibrosis. Of the numerous side effects associated with amiodarone therapy, lugn toxicity is one of the most serious adverse reactions.
Recently, we experienced a case of amiodarone-induced pulmonary toxicity (APT), which induced severe dyspnea and productive coughing, confirmed by cytologic and electron microscopic examination of the bronchoalveolar lavage (BAL).
The symptoms and abnormalities in the chest X-ray were improved after the withdrawal of amiodarone. Cytologic examination of the BAL revealed numerous foam cells with cytoplasmic vacuoles or small particles. Ultrastructurally, the foam cells demonstrated characteristic lysosomal inclusions, which were electron-dense multilamellated bodies, crystalloid bodies, and mixed forms with small lipid vacuoles. It is strongly suggested that only cytologic and electron microscopic examination of the BAL without open lung biopsy is enough for diagnosis of APT, when APT is clinically suspected in a patient who has a history or ingestation of amiodarone.
- Expression of Cytokeratin 1, 10 and 14 in Fetal Skin.
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Kye Yong Song, Sun Lee, Dong Hye Suh, Mi Kyung Kim, Hye Jung Min, Je G Chi
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Korean J Pathol. 2001;35(3):226-231.
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- BACKGROUND
During the fetal stage, the epidermis and adnexal epithelium might express different types of cytokeratin (CK) by developmental stages. The objective of this study is to observe the expressions of CK1, CK10 and CK14 in the skin of human fetuses.
METHODS
Immunohistochemical stains were applied to the skin of 42 fetuses ranging from 10 to 36 gestation weeks. Three different portions of the body (i.e., scalp, chest and sole) were sampled. Immunohistochemical staining with monoclonal antibodies against CK1, 10, 14 were done.
RESULTS
We found that CK14 was expressed in the basal layer of the epidermis and adnexae of fetuses beween 10 to 36 gestation weeks. However, stronger expression in the middle than the basal layer was noted in the soles of 15-week fetuses followed by exclusive basal expression. The sebaceous gland, the outer root sheath of the hair follicle and the eccrine duct epithelium also showed CK14 expressions, while CK14 was negative in hair germ and acini.
Both CK1 and CK10 were expressed in the epidermis of fetuses ranging between 10 to 36 gestation weeks at the suprabasal layer of the scalp, chest and sole; while they were negative in the basal layer and skin adnexae including sebaceous, hair and eccrine gland.
CONCLUSIONS
Expression of cytokeratins in the fetal skin were noted at 10 weeks throughout the entire gestation period and were similar in the three different sites, except in the early stage of the sole. The main expression sites of K14 were the basal layer of the epidermis, the eccrine ducts and the outer root sheath cells of hair, suggesting the same origin, while those of K1 and K10 were in the suprabasal layer of epidermis.
- Polyomavirus Renal Infection Confirmed by Electron Microscopy in a Patient with Acquired Immunodeficiency Syndrome: An Autopsy Case Report.
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Na Rae Kim, Byoung Kwon Kim, Je G Chi
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Korean J Pathol. 2001;35(2):168-171.
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- Polyomavirus infection commonly occurs in childhood and adolescence, remaining in a latent status and reactivated in an immunocompromised status. We report herein an autopsy case of HIV-positive 41-year-old male, who succumbed to disseminated Kaposi sarcoma and cytomegalovirus infection involving the gastrointestinal tract, lung and brain. The involved kidney showed minimal inflammatory infiltrates and tubular injury: the nuclei of tubular epithelial cells were markedly enlarged with central clearing and peripheral chromatin margination or bore basophilic nuclear inclusions.
Inclusion-bearing tubular epithelial cells were negative for the viral immunostains including herpes simplex virus, Epstein-Barr virus and adenovirus. Electron microscopy disclosed 42 nm intranuclear viral particles compatible with the BK polyomavirus. The viral particles were icosahedral in paracrystalline array and nonenveloped.
- Molecular Cloning of Novel Genes Related to the Craniofacial Development of Human Embryo.
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Young Jun Lee, Tak Soo Go, Hyung Wook Han, Sang Shin Lee, Eun Cheol Kim, Yeon Sook Kim, Suk Keun Lee, Je G Chi
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Korean J Pathol. 2000;34(12):961-971.
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- In order to obtain novel genes for craniofacial development of human, molecular cloning and sequencing were performed and followed by in situ hybridization in tissue sections. Subtracted cDNA library of craniofacial tissue from 8 weeks old human embryo was made by the subtraction with cDNA of RHEK cells.
A total of 231 clones were obtained and their partial sequence data disclosed that 214 clones were nonredundant in Genebank search. We have done in situ hybridization screening on the craniofacial sections of a 10 weeks old human fetus, and found significant positive reaction in 30 clones. Depending on the cell type of similar developmental origin, the positive reactions could be divided into four groups: first group showed an intense positive reaction in neural tube, ganglion, and a part of peripheral nerve tissue, second group relatively diffuse positive reaction in neural tube, cartilage, epithelium, and muscle, third group localized positive reaction in nerve, and muscle, and fourth group positive reaction in almost all kinds of cells of craniofacial tissues. Although every clone showed different expression patterns in the craniofacial development, some of them showed intense mRNA expressions in the characteristic cell type.
Because this study also aimed to test a screening methods to find out novel genes related to craniofacial development by the subtracted cDNA library and in situ hybridization, the intense positive reaction of a certain clone by in situ hybridization may indicate its role in the developmental processes. We presumed that 30 clones selected in this study are possibly important new genes for the development of human craniofacial structure.
- Gene Expressions of Mouse Submandibular Gland during the Developmental Stage and Their Antisense Inhibition in Organ Culture.
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Yeon Sook Kim, Suk Keun Lee, Je G Chi
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Korean J Pathol. 2000;34(6):395-412.
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- This study is aimed to observe the expressions of different genes, including the extracellular matrix proteins, growth factors, and transcription factors during different developmental stages of mouse submandibular gland. Reverse transcription-polymerase chain reaction (RT-PCR) and the antisense inhibition in organ culture system were performed using mouse embryos and newborns. Total 140 mouse embryos (E14(80), E15(20), E16(20), E18(20)) and 30 newborn mice (D2(10), D3(10), D6(10)) obtained from 60 pregnant mice and 3 adult mice (3 weeks old) were used for the cDNA production and the salivary gland organ culture. Syndecan, perlecan, laminin alpha1 chain, TGF beta1, beta 3, and sonic hedgehog mRNAs were expressed in the early stage (E14~E16) of the submandibular gland development, whereas transglutaminase C (TGase C), E-cadherin, epimorphin, laminin beta2 and gamma1 chains, and HGF mRNAs were expressed in the middle and late stages (E16~E18, D2~D6). Antisense inhibition of different genes in the organ culture of E14 mouse embryos of submandibular gland showed specific growth retardation in the development of ductal and acinar cells.
Especially, the antisense inhibition of perlecan, E-cadherin, laminin alpha1 chain, laminin beta2 chain, and syndecan mRNA arrested the growth of ductal and acinar cells. While the antisense inhibition of integrin beta5 greatly affected the acinar cell differentiation and also produced cystic dilatation of salivary ducts, the antisense inhibition of fibronectin showed aberrant growth of ectomesenchymal tissues of the mouse submandibular gland.
- Pulsating Magnetic Field Effects on in vitro Culture of Human Osteogenic Sarcoma Cell Lines.
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Hyo Sook Shin, Jin Young Lee, Suk Keun Lee, Sang Chul Park, Je G Chi
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Korean J Pathol. 2000;34(3):169-180.
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- In order to elucidate the biological effects of pulsating magnetic field in in vitro culture system we designed a pulsating magnetic apparatus using 120 Hertz, 24 Volt direct current. It can generate 63~225 Gauss in the experimental area of 90 mm petri dish, and has little thermal effect on the culture media in 37.5oC, 5% CO2. Human osteogenic sarcoma (HOS) cells were cultured in the pulsating magnetic field and the nuclear changes of cultured cells were observed routinely by hematoxylin staining, and apoptotic change was detected by ApopTag staining using both peroxidase and fluorescein labelings. Compared to the control group which formed well organized whorling pattern of HOS cell line in 3 days culture, the HOS cells cultured in the pulsating magnetic field for 12 hours or 24 hours grew irregularly and showed increased number of apoptotic cells. When the flow of pulsating magnetic field was interrupted by insertion of strong permanent magnetic bar (1000 Gauss, 5530 mm) beneath the petri dish during in vitro culture, the area of sparse pulsating magnetic field showed active proliferation and aggregation of HOS cells even in 24 hour exposure group. These data suggest that the pulsating magnetic field may play a role in inducing growth retardation and apoptosis of HOS cells. Furthermore, the hazardous effects of pulsating magnetic field can be lessened or nullified by the interruption of pulsating magnetic field with a strong permanent magnetic bar.
- Juvenile Hyaline Fibromatosis in an Adult.
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Young A Kim, Seoung Wan Chae, Chong Jai Kim, Je G Chi
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Korean J Pathol. 2000;34(3):239-242.
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- Juvenile hyaline fibromatosis is a rare disorder probably inherited as an autosomal recessive trait. It is characterized by multiple slowly growing subcutaneous nodules, hypertrophy of gingiva, flexion contracture, and radiolucent bone destruction.
The histological features of the tumor-like lesions are characterized by the deposition of amorphous hyaline material in which spindle shaped cells are embedded. We report a case of juvenile hyaline fibromatosis in a 26 year-old-woman. She had multiple subcutaneous nodules in scalp, ear, forearms, right knee, and back. Surgical excision of the tumors in the scalp and ear was done. The largest one measured 13 9 6 cm, and had homogeneous, grayish yellow cut surface with calcification. Light microscopic examination showed abundant eosinophilic hyaline material with extensive calcification and metaplastic bone formation. Spindle cells were rarely observed at the periphery of the tumor. Hyaline matrix was PAS positive, diastase resistant, and alcian blue negative.
Scattered spindle cells were positive for vimentin but negative for S-100 protein and smooth muscle actin. There were many reports regarding early lesions of juvenile hyaline fibromatosis; however in this patient, tumor existed for more than 20 years and the histology was somewhat different from the early lesions reported in the literature.
- Cryptosporidium Infection of Human Intestine: An Electron Microscopic Observation.
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Min Suk Kim, Yun Kyung Kang, Chul Jong Yoon, Mee Joo, Hye Kyung Lee, Jeong Gi Seo, Je G Chi
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Korean J Pathol. 1999;33(2):121-127.
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- Protozoa of the genus Cryptosporidium are small coccidian parasite known to infect the mucosal epithelium of a variety of animals including human, causing fatal course in immunodeficient patients as well as self-limited illness in healthy individuals. Various life cycle stages including trophozoite, meront, merozoite, gametocyte and oocyst in infected mucosa are a diagnostic feature. Electron microscopy (EM) provides sufficient findings for genus and species identification of this parasitic organism. The authors presented scanning and transmission EM findings of Cryptosporidium parvum infection in two children: one with acute lymphoblastic leukemia and the other without any evidence of immune compromise.
- Osteochondrodysplasia Pathologic study of 29 autopsy cases.
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Yi Kyeong Chun, Yee Jeong Kim, Sung Ran Hong, Min Suk Kim, Je G Chi
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Korean J Pathol. 1999;33(1):32-41.
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- Osteochondrodysplasia is a heterogeneous group of disorders appearing short limbed dwarfism. Because many of these entities are lethal and hereditary, an accurate diagnosis is mandatory. The purpose of this study is to define the clinicopathologic features and radiologic findings of osteochondrodysplasia. We reviewed 29 autopsy cases of congenital short limbed dwarfism, consisting of thanatophoric dysplasia (TD) (12 cases), osteogenesis imperfecta (OI) (12 cases), asphyxiating thoracic dysplasia (ATD) (3 cases), short-rib-polydactyly syndrome (SRPS) (1 case) and hypochondrogenesis (1 case). The gestational age ranged from 16 to 41 weeks. Of 6 fetuses that were born alive, 3 were ATD, 2 were TD and 1 was hypochondrogenesis.
TD was frequently complicated by hydramnios. Of 8 cases studied chromosomally, only 1 showed chromosomal abnormality -46XY, inv 9. Intrauterine growth retardation was frequently associated with OI. Pulmonary hypoplasia was present in 23 cases (79%), including all cases of ATD, SRPS and hypochondrogenesis, 11 in TD and 7 in OI. Other associated anomalies were present in 17 cases (59%).
- Perspective of The Korean Society of Pathologists.
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Je G Chi
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Korean J Pathol. 1997;31(10):902-908.
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- Only since the introduction of western medicine by Japanese officials and American missionaries in the late 1890's, has the Pathology in its modern concept been considered a major part of basic science in medical schools in Korea, after its role as a hospital service had long been ignored. Limited service of tissue diagnosis on surgical material was the only service performed. Professor Inamoto was the first Japanese pathologist to come to Korea and set up a Pathology Department at the Chosun Chongdogbu Hospital in 1913, and Dr. Mills appears to be the first American hospital pathologist who worked at Severance Hospital in 1913 practicing bacteriology and parasitology as well as lecturing pathology at the medical school. Korea was annexed by Japan from 1910 to 1945. The Korean Society of Pathologists (The former Chosun Society of Pathology) was founded on October 1, 1946, during the turmoil after the end of the Second World War and liberation from Japanese occupation. Only a handful of pathologists gathered for the delivery of the Society. The purpose of the Society was to study, research and exchange information and knowledge in the field of Pathology among its members. Since 1947 the Society had held regular annual academic meetings. In 1950 the Korean War occurred and the Korean Society of Pathologists (KSP) had to restart after the war. The still existing Monthly Slide Conference started in 1959, and the Pathology specialist system was adopted in 1963. There had been a considerable confusion during the adoption period of the pathology specialist system in this country, mainly because of the confused concept of the term "clinical pathology". In its start three categories, i.e., anatomic pathology, clinical pathology, and combined anatomic and clinical pathology were opened. However, the combined training program was eliminated in 1975, which eventually resulted in the separation of clinical pathologists from the KSP to found a new society of Clinical Pathology in 1980 against the advice of the KSP. The first official Journal of the Society, The Korean Journal of Pathology was launched in 1967, marking the 20th anniversary of the Society. It started as a biannual Journal and became a quarterly in 1977. In 1991 the Journal became a bimonthly periodical, and since 1996 the Society issues 12 volumes a year. From 1976, academic activity of the Society was expanded by opening its Spring Meeting in addition to the conventional annual Fall Meeting. In 1992 the Society adopted board of trustee system, providing a fresh blood transfusion. In 1996, the Society commemorated its 50th Anniversary, and published a record book, "The First Fifty Years of The Korean Society of Pathologists". As of December 1996, the Society has a total membership of 500 and 7 special study groups The Society holds 2 annual meetings, monthly slide conferences, several long and short courses, and workshops every year.
Approximately 400 papers have been presented each year at the annual meetings. Approximately 350 anatomic pathologists work at hospitals, and a additional 50 pathologists are engaged in full time research at the Department of Pathology in medical schools and other research institutes. As we turn the first half century of founding the Korean Society of Pathologists we realize that we have to be well prepared for various expected and unexpected situations in the future.
Enforcement of research pathology at medical schools appears to be the most urgent and important issue. For this purpose, the concept of basic pathology, research pathology, and hospital pathology (surgical pathology) should be clearly established. We also have to clearly define the differnece between anatomic pathology and clinical pathology in this country. At present, the clinical pathology stands alone without any collaboration with the KSP in terms of training program, specialty qualification and hospital practice.
Undergraduate pathology education is another issue that we have to pay special attention. The number of full time research pathologists should be increased, and their active and dominant participation in the Society are needed. As the demand for the knowledge and promotions of special field of pathology increases, establishment of additional study group should be encouraged. And if the requirements are met, founding a new Special Pathology Society could also be encouraged. However, the basic skeleton and executive power of the KSP in training residents, qualifying specialty or subspecialty, and in representing the entire pathology field should be maintained and strictly enforced. Hospital pathology has been a dominant drive of the KSP for the last 35 years since the adoption of specialty system. The term, "Diagnostic Pathology" appears to be a term that can replace "Anatomic Pathology", "Surgical Pathology", or "Tissue Pathology" in this country. In future the demand of diagnostic pathology particularly endoscopy biopsy diagnosis, cytological diagnosis and evaluation of surgical operation would be greatly increased. Therefore, we have to be ready for the requirements of professional diagnostician in various fields of pathology as well as overall general diagnostic pathologist. Subspecialty qualification could be expected around the year 2005, when the membership of the Society is expected to be 700. The Korean Journal of Pathology has yet to be improved. It should contain more basic research articles produced by full-time basic pathology researchers. Papers related to hospital pathology (diagnostic pathology) including cytopathology should pursure not only originality but also its practical importance in our situation in this country. The Korean Journal of Pathology should aim for its acception and inclusion in international indexing system in near future.
- Congenital Anomalies Observed by Autopsies at the Seoul National University Children's Hospital.
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Jin Haeng Chung, Jeong Wook Seo, Chong Jai Kim, Chul Woo Kim, Je G Chi
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Korean J Pathol. 1997;31(2):93-99.
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- A retrospective analysis was performed on the 968 cases of fetal or pediatric autopsies over five year period (1990-1994), at the Seoul National University Children's Hospital. Age/mode distribution of cases were artificial abortus(30.6%), spontaneous abortus(12.0%), stillbirth(21.9%), neonates(29%), infants(2.8%) and children(0.9%). Male/female ratio was 1.21. Overall incidence of congenital anomalies was 60.8% and 34.0% of all cases had anomalies involving multiple organ systems.
Percentage of cases with any anomaly was 71.6% in artificial abortus, 35.3% in spontaneous abortus, 59% in still births, 65.5% in neonates and 38.9% in infant and children. Common organ systems involved were the cardiovascular system (39.0%), musculoskeletal system (23.6%), nervous system (22.6%), gastrointestinal system (19.9%), and urinary system (14.6%). From these results, we found that the congenital anomalies were most significant diseases of the perinatal period and the cardiovascular anomalies were the most common anomalies of them.
- Prenatal Development of Eccrine Sweat Gland: Morphologic and Morphometric Analysis.
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Nam Bok Cho, Tae Jin Lee, Je G Chi, Kye Yong Song
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Korean J Pathol. 1997;31(2):121-134.
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- To elucidate the developmental sequence of the eccrine sweat gland, a morphologic and a morphometric observation were done using developing human embryos and fetuses. Five embryos and sixty four fetuses from the 9th to the 38th week of the gestational age were studied. The skin was sampled in eight different areas, i.e., scalp, forehead, face, chest, abdomen, back, palm and sole. Routine histological sections were made for histological evaluation and morphometric analysis. The results obtained were as follows : The primordia of the eccrine sweat glands appeared first as regular undulation of the basal cells in the palm and the sole in the 13th week of getation. Subsequently, elongation and coiling of the cell cords were noted from the 16th to the 18th weeks. Intraductal lumen formation was first noted in the 20th week. Secretory segment of the eccrine sweat glands were noted from the distal part of the coiling intradermal sweat duct in the 22nd week of the gestational age. The eccrine sweat glands became fully developed by the 28th week of gestation and this included the clear cell, the dark cell and the myoepithelial cell. In the morphometric analysis, the number of eccrine epithelial buddings were decreased with aging and the highest were in the palm and the sole. The diameter of the eccrine sweat duct showed no significant change by gestational age or in the different sites observed. Straight and coiled eccrine sweat ducts or glands were lengthened into the deep reticular dermis and upper portion of the subcutaneous adipose tissue with an increase of the gestational age. The above results suggest that developmental stage and the number of eccrine glands of the skin in the fetal stage is different from other areas of the body, especially in the palm and the sole.
- Morphological Study on the Mechanism of the Central Nervous System Dysfunction Induced by Unipolar Pulsating Magnetic Field in Mice.
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Ro Hyun Sung, Gyeong Hoon Kang, Chong Heon Lee, Suk Keun Lee, Young Hae Chung, Yoo Hurn Suh, Jeong Wook Seo, Je G Chi
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Korean J Pathol. 1996;30(12):1073-1082.
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- The morphologic change of the mouse brain after exposure to magnetic field is studied. Our magnetic field model was a pulsed unipolar magnetic field with the flux density of 0.2 - 0.3 tesla and the frequency of 60 hertz. Twelve adult male mice were exposed to the magnetic field for 2, 4, 8, 12, 18 and 24 hours. After the exposure to the magnetic field mice were anesthetized with chloral hydrate, and paraformaldehyde was infused through the left ventricle for fixation. During exposure to the magnetic field, behavioral and weight changes of mice were observed. Mice became irritable and restless, especially during first 2 hours of the exposure.
Microscopic and ultrastructural examination on the brain revealed nuclear chromatin clumping of the neuron in mice exposed to the magnetic field for more than four hours. The change was proportional to the exposed time and more prominent in the cerebral cortex. An immunohistochemical study for amyloid precursor protein (APP) was also performed. There was an increased expression of APP in the neuronal cytoplasm of the mouse brain exposed to the magnetic field for 4 hours or more. But the reaction was not proportional to the exposure time and reactive neuron was diffusely distributed through the whole brain. Anti-APP antibody reactivity was not correlated with the chromatin clumping. The mechanism of APP induction was postulated as stress-induced APP-gene induction, and the role of APP was presumed to protect the neuron against hazardous environment.
- Adenoma of Retinal Pigment Epithelium: A case report.
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Jae Soo Koh, Je G Chi
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Korean J Pathol. 1996;30(11):1053-1056.
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- A retinal pigment epithelium tumor is extremely rare, and the distinction from malignant melanoma or reactive hyperplasia of pigment epithelium is mandatory, clinically or pathologically. We report a case of adenoma of retinal pigment epithelium. A 21 year-old female presented with a sudden decrease of visual acuity. She had no previous inflammatory ocular disease. Fundic examination revealed an elevated mass at the temporal side of the right eye. With the suspicion of choroidal malignant melanoma, a right eye enucleation was done. Grossly there was a 0.7x0.5 cm dark soft broad-based elevated lesion in the temporal side. The anterior border was the ora serrata, and the posterior border reached the equatorial area. The tumor was confined to the intraocular portion. Histologically, the tumor mass was composed of the cuboidal or columnar cells arranged in papillary, trabecular, or solid pattern with fine fibrovascular stroma. The tumor cells were heavily pigmented. The cytoplasmic border of the tumor cell was indistinct and there was a finely granular brown pigment diffusely scattered in the cytoplasm. Mild anisokaryosis noted, but hyperchromatism or pleomorphism were negligible.
The nucleoli were small. A transition between normal retinal pigment epithelium and tumor mass was noted. Reactive gliosis was noted at the periphery of the tumor.
- Beckwith-Wiedemann Syndrome with Unusual Sialoadenomegaly.
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Hye Seung Han, Seung Sook Lee, Suk Keun Lee, Je G Chi
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Korean J Pathol. 1996;30(10):939-942.
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- Beckwith-Wiedemann syndrome is a rare clinical entity characterized by exomphalos, macroglossia, macrosomia, and renal hyperplasia/dysplasia. Although its entity is established, its etiology and obligatory features have not been settled. We report an autopsy case with the unusual involvement of the salivary gland. This infant was born to a 37-year-old mother as a normal full-term spontaneous delivery. At 11 days of age she developed with purulent eye discharge and weak sucking, and died suddenly. At autopsy the baby weighed 2,630 gm and the head circumference was 35 cm. She showed thick and prominent skin folds, bilateral aural fissures, macroglossia, hepatomegaly, cardiomegaly, dysmorphic kidneys, and nesidioblastosis. Both kidneys showed dysplastic tubules and hyperplastic cortical tissue enclosing the medulla. In this case there were characteristic findings in major and minor salivary glands with both acinar and ductal hyperplasia, and hypertrophy of mammary glands. Besides, she had generalized depletion of subcutaneous fat, immature buccal fat, patent ductus arteriosus, hyperlobation of the right lung, two accessory spleens, and hyperplasia of basophils and chromophobes in the pituitary gland. The lungs showed diffuse interstitial pneumonia and multiple fibrin thrombi. There were no adrenal cytomegaly, umbilical hernia and exophthalmos.
- Somatostatin Secreting Islet Cell Adenoma: A case report.
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Tae Sook Kim, Je G Chi
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Korean J Pathol. 1996;30(7):630-634.
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- Somatostatin secreting islet cell adenoma(somatostatinoma) of the pancreas is a rare entity. Less than 30 cases of pancreatic somatostatinoma could be searched in the world literature. We present a case of somatostatinoma of the pancreas in a 64-year-old woman. This patient had suffered from diabetes, cholelithiasis and intermittent diarrhea.
Laboratory examination revealed steatorrhea, blood somatostatin level of 30 pg/ml, and fasting blood glucose level of 116 mg/dl. Subtotal pancreatectomy was done after radiological demonstrations of a round tumor mass in the pancreas. It was a 2 cm-sized well demarcated yellowish brown round solid mass located in the proximal pancreas. A retention cyst was seen just distal to the tumor.
Histologically, tumor masses consisted of polygonal cells with distinct cell border, having granular eosinophilic cytoplasm and small bland looking nuclei. The tumor cells were arranged in small solid islands and trabeculae, separated by fibrovascular stroma. Immunohistochemical stain for somatostatin was positive in the cytoplasm of the individual tumor cell, and ultrastructurally variable sized membrane bound electron dense granules of 200 nm in average diameter were found in tumor cells.
- Benign Lymphoepithelial Cyst: A case report.
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Jin Haeng Chung, Gyeong Hoon Kang, Je G Chi
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Korean J Pathol. 1996;30(6):551-553.
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- An intraparotid benign lymphoepithelial cyst is a rare disease characterized by unilateral painless swelling of parotid region. The histogenesis is controversial. Surgical excision is recommended for diagnosis and curative treatment. We present a case of benign lymphoepithelial cyst arising in a patient with neurofibromatosis. A 46-year-old woman presented with a slowly growing multilocular cystic mass in the left cheek. The cystic mass measured 4 cm in maximal outer diameter and the cystic wall was thick and yellowish pale to gray, soft with well circumscribed margin.
Microscopically, the multilocular cyst was lined by stratified squamous epithelium for the most part and underlying lymphoid tissue aggregates with follicles and sharply demarcated from adjacent salivary parenchyma which is of normal appearance and without lymphoid aggregates.
Since this lesion is absolutely benign, it is important to separate this benign cyst from cystic salivary gland tumors.
- VATER Association: Three autopsy case reports with imusual defects.
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Mi Ja Lee, Myeong Cherl Kook, Je G Chi
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Korean J Pathol. 1995;29(5):678-683.
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- VATER association represents vertebral defects, anal atresia, tracheo-esophageal fistula with without esophageal atresia, renal defects and radial limb dysplasia. The probability of the simultaneous occurrence of any three of these defects is so unlikely that it suggests a sporadic non-random association. This non-random association appears to be related to some chromosomal anomalies, the caudal regression syndrome, mesodermal defects in early developmental period or the matemal use of sex hormones during embryogenesis. We report three autopsy cases of the VATER association that showed most of the known major and minor defects as well as an unusual concurrence of other defects, i.e., scoliosis, talipes varus, absent penis, urethral agenesis and stenosis, rectourethral fistula, rib anomaly, single umbilical artery, Meckel's diverticulum, diaphragmatic hemia, absent rectum, short neck, simian crease, low set ear, and hypoplastic lung.
- Expression of nm23 Protein in Breast Carcinoma: An immunohistochemical study.
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Sang Yong Song, Je G Chi, Se Hwan Han, Kuk Jin Choe
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Korean J Pathol. 1995;29(4):469-477.
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- To elucidate a possible prognostic factor, we studied 91 cases of breast carcinoma for the expression of n-tn23 protein using an immunohistochemical method, and compared these results with the known prognostic parameters of the breast carcinoma. The mn23 protein was intensely stained in the cytoplasm and/or the nucleus of carcinoma cells in 82 cases(90.1%). There were two patterns of cytoplasmic staining; heterogeneous pattern and homogeneous pattern.
Among the positive cases, 43 cases(47.2%) were heterogeneous while 39 cases(42.8%) were homogeneous. Axillary lymph node metastases(p<0.005) was found more frequently in the heterogeneous pattern group(79.0%) than in the homogeneous pattern group(41.0%). There was no significant correlation between nm23 protein expression and other parameters such as patient age, tumor size, estrogen receptor, histopathologic grade, and p53 overexpression. Although axillary lymph node metastasis was correlated with the disease free status(p<0.0005) and patient survival (p<0.05), they showed no correlation with nin23 expression. Multivariate analysis showed that axillary lymph node metastasis was the only prognostic indicator(p<0.05), and the expression of nm23 protein was of borderline significance. The results suggest that the homogeneous and/or granular cytoplasmic expression of mn23 protein plays a role in the suppression of nodal metastasis in breast carcinoma and might contribute in predicting patient survival.
- Nasal Cerebral Heterotopia-so called Nasal Glioma: A case report.
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Tae Sook Kim, Je G Chi
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Korean J Pathol. 1995;29(4):517-520.
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- Encephalocele and nasal glioma are rare, benign congenital neuroectodennal tumors which result from a failure of embryologic sepearation of neuroectodermal and ectodemlal tissues. Nasal glioma should be differentiated from a true glioma, and from a primary encephalocele, which is a herniation of the cranial contents through a bony defect in the skull. For this reason, nasal cerebral heterotopia is a preferred term. We report an unusual case of a nasal mass that was histologically indistinguishable from nasal cerebral heterotopia but proved to be connected to the skull base by fibrotic cord. The patient was a 2 year old girl who had had a slow growing palpable mass in the left epicanthal area for three months.
- Selective Neuronal Damage Produced by beta-fluoroethylacetate Intoxication in Rat Brain.
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Ki Hyeong Lee, Beom Seok Jeon, Duk Lyul Na, Seong Ho Park, Je G Chi
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Korean J Pathol. 1995;29(3):277-285.
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- Beta-fluoroethylacetate has been extensively used as the rodenticide in Korea. In some patients with acute poisoning, beta-fluoroethylacetate caused cerebellar dysfunction as a single and persistent neurologic sequela after a period of an acute neurological disorder which is characterized by mental deterioration, seizures, and respiratory failure. But there has been no report of pathological findings to explain neurological deficit. We tried to verify the histologic changes of the central nervous systems in beta-fluoroethylacetate poisoned rats. Silver staining(Gallyas) was used to evaluate the histology. In acute intoxication experiment with LD50(7mg/Kg), beta-fluoroethylacetate elicited acute onset of consciousness deterioration, generalized tonic-clonic seizures and large amplitude tremulous activity involving whole body with full recovery after 24 hours. There was no discernible pathologic change in CNS in acutely poisoned rats. However, when poisoned with sublethal dose(5mg/Kg) daily for five days, a moderate degree of nerve cell degeneration was found selectively in dentate nucleus, Purkinie cell layer, vestibulo-cochlear nucleus and striatum. This change was not seen in hippocampus, cerebral cortex or cerebellar cortex. These findings were well correlated with the previous reports of selective pathology in human 5-FU intoxication cases. Our preliminary results suggest that beta-fluoroethylacetate, a kind of cellular metabolism inhibitor may induce selective neuropathology mainly involving cerebellar output pathway in rats.
- Ultrastructural Feature of Molluscum Contagiosum Virus.
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Chul Jong Yoon, Je G Chi
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Korean J Pathol. 1995;29(3):321-326.
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- Molluscum contagiosum virus(MCV) infection occurs in both sporadic and epidemic forms, and affects children more frequently. The skin lesions are small, pinkish and wartlike tumor. MCV has not been transmitted to animals and nQt propagated in cell culture. Therefore the viruses in human lesions can only be demonstrated by electron microscopy.
Histologically, characteristic intracytoplasmic inclusion bodies (called molluscum bodies) are formed in infected epithelial cells. They gradually enlarge and eventually fill the cell. Ultrastructure of molluscum bodies in infected cells showed a large number of MCV particles that are variable-sized, spherical, ellipsoidal and brick-shaped.
Early viral replication stage shows small dense bodies in the nucleus and then reveal immature MCV that consist of homogeneous rounded core and separated capsidal membrane from the cytoplasm matrix In advanced stage, shrinked nucleus with irregular membrane moves into marginal area of the cell. The spherical fon-ns represented immature viruses in cytoplasm matrix, whereas the brick-sphaped forms represented mature viruses in the inclusion of cytoplasm.
- Pathology in Korea during the Period 1945~1957.
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Je G Chi
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Korean J Pathol. 1995;29(3):352-360.
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- The pathology in Korea was introduced by Japanese and American missionaries in early 1920. Since that time, pathology teaching, service and research in Korea had been under strong influence of Japan. There was no indendent disciplines of Korean Pathology until the time of Liberation from Japan in 1945. Pathology activity during early period of Korean Pathology, 1945 to 1957, was reviewed in this paper, based on the literature available. The first half of this period (1945 to Korean War), was a transition period from the Pathology. Only 8 papers related to pathology were Japanese-German Pathology to Korean published during this time in Korean literature. However, papers that were orally presented at annual meetings were 12 in 1947, 23 in 1948 and 13 in 1949, respectively. The Korean Society of Pathologists was founded in 1947. And the annual meeting was started from 1947 under the auspiece of Korean Medical Association. The annual meeting could not be held in the year of 1950, when the Korean war started. Virtually no public academic activity was present during 1950 to 1952. The second half of this period(Korean war to 1957) represented reconstruction of Pathology. In fact it was a restart of the Korean Pathology in Korea. During this period less than 10 papers were published in the Korean medical journals. Oral presentation titles at the annual meetings were 6 in 1953, 18 in 1954, 14 in 1955, 15 in 1956 and 31 in 1957, respectively. In summary, the period of the first 12 years since the liberation from Japan, 1945 to 1957, appears to be the dark age of Korean Pathology. No significant academic activity could be found during this period. The slow start of Korean Pathology during the first half of this period was further delayed by the Korean War. Despite all these facts, spirit and effort of early Korean pathologists should be highly appreciated. It seems that the Korean Pathology actually restarted after the Korean war under the influence of American Pathology. It seems only after 1958 that the Korean Pathology took a firm position for promotion.
- Ultrastructural and Immunohistochemical Investigations of Exocrine and Endocrine Cells in Fetal Human Pancreas.
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Jung Ran Kim, Je G Chi, Jung Hee Cho
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Korean J Pathol. 1995;29(3):286-295.
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- The pancreas consists of two types of tissue arising from same primitive cells, but with entirely different functions.
Although the adult human pancreas and fetal islet tissue have been the subject of numerous electron microscopic studies, little is known of the ultrastructure of the developing human exocrine pancreas. The purpose of the current study is to investigate development of endo and exocrine of pancreas, especially during the middle trimester of human fetal life, which is the period of acinar cell maturation. Fresh autopsy specimens of pancreas, taken from 15 human fetuses at the 12th (n=2), 13-16th (n=5), 17-20th (n=4), 21-24th (n=2) and 25-28th (n=2) weeks of gestation, were studied electron microscopically, and immunohistochemically. Antisera against insulin, somatostatin, glucagon, pancreatic polypeptide and gastrin, were used for immunohistochemistry. By the 12th week, primitive exocrine acini were identified and these were matured rapidly in the next 6 weeks. At the 17th week stage, ultrastructural examination revealed atypical zymogen granules in the acinar cells. These became progressively less numerous in the 21-28 week period when classical zymogen granules increased upto the level of adult stage.
All the endocrine cells were found at the 12th week, forming primitive or mature islets. The relative ratio of endocrine cells at the 12th week was about 35.4%, 24.9%, 39.8%, 0.5% for A, B, D & PP cell, respectively. But at the 25th to 28th week of development, the relative numbers of A and D cells decreased somewhat, whereas those of the B cells increased.
The PP cells were constant. The G cells were found at the 12th week of fetal period, which appeared through out the on period.
- Fetal Death Secondary to Constriction and Torsion of Umbilical Cord: An autopsy case.
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Yeon Mee Kim, Je G Chi
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Korean J Pathol. 1995;29(2):238-240.
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- Localized constriction and torsion of the umbilical cord are rare cord abnormalities. The seg- mental absence of Whartion's jelly in the involved area of the cord is believed to be an etiologic factor of the constriction and subsequent torsion. In the past, constriction and torsion were thought to occur after the death of the fetus as a result of maceration. However, recently it has been suggested that the torsion of the constricted area might cause fetal death. We report an autopsy case of a localized constriction and torsion of the umbilical cord in a stillborn baby. The baby was delivered to a 27-year-old primiparous woman after 28 weeks gestation. The fetus was of 24 gestational weeks in size and weight. And the placenta weight was 259 gm. A grossly macerated fetus showed a cystic hygroma in the posterior neck. There were two areas of constriction in the umbilical cord, one at the squamoamniotic junction and the other, 15 cm from the fetal end. Torsions were noted in both constricted areas, more severe than in the mid portion of the cord. Microscopically, the Whartion's jelly was deficient and partly replaced by fibrosis in the constricted areas. It is believed that these two areas of constrictions and torsion are causally related to the intrauterine fetal death in this case.
- Clinico-Pathological Characteristics of Congenital Megacolon.
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Soon Young Kim, Jeong Kee Seo, Kwi Won Park, Woo Ki Kim, Je G Chi
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Korean J Pathol. 1995;29(1):40-51.
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- This study is based on 155 patients of congenital me colon.
For the diagnosis, 93 cases were histologically proven and the remaining 63 cases were diagnosed on clinical basis including barium enema or surgical gross findings. On histologic examination, 80 cases(86%) showed typical features of absence of ganglion cell in the myenteric plexus and the 13 cases(14%) had atypical features which were segmental absence Of ganglion cell in one case. There we 127 males(82%) and 28 females(18%). The age at diagnosis was younger than 30 days in 87 cases(56%), I month to 1 year in 39 cases(25%) and older than I year in 29 cases(18%). The levels of aganglionosis were variable: short segment (rectosigmoid) in 134 cases(86%), intermediate segment (more proximal colon) in 14 cases(100%). and 6 cases(4%) had total aganglionosis. Common clinical presentations were abdominal distention, delayed meconium passage or bilious vomiting in neonate, and chronic constipation in infancy or childhood.
Following initial colostomy or ileostomy, a definitive procedure was performed in 151 cases(Duhamel type in 150 cases; Soave type in 2 cases; Swenson type in 3 cases).
Frequently associated problems after definitive procedure were persistent constipation(ll%) due to septum formation, fecaloma, remnant aganglionic segment and rectal stenosis.
Overall mortality rate was 4%, and increased mortality was associated with enterocolitis(14%) which was the most frequent cause of death. The follow-up study longer than 3 months was available in 138 patients who underwent a definitive procedure(mean 2 year 11 months). Seventy-three cases(53%) had normal bowel function, 38cases(27.5%) had occasionally used enema or stool softners, and 27 cases(19.5%) had severe constipation or soiling. The bowel habit improved with time, and were considered normal in 60% of patients after follow-up more than 3 years. The results of definitive procedures for congenital megacolon including Duhamel operation was satisfactory, and long-term follow-up appeared an important and critical component of patients'care.
- Craniofacial Morphogenesis of Mouse with Trisomy 16.
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Jung Sun Kim, Jeong Wook Seo, Suk Wha Kim, Je G Chi
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Korean J Pathol. 1994;28(6):596-604.
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- Based on the genetic homology between mouse chromosome 16 and human chromosome 21, experimentally induced trisomy 16 mouse has been considered to serve as a suitable model for human Down syndrome. Mice with trisomy 16 express several phenotypic characteristics of human trisomy 21 syndrome; i.e., intrauterine growth retardation, anarsarca, congenital heart disease, brain abnormality, etc. To elucidate morphogenesis of characteristic craniofacial malformation in human Down syndrome, we studied trisomy 16 mouse fetuses that were produced by crossing karyotypically normal C57BL/6 female ice with males carrying the two Robertsonian translocation chromosome Rb(16.17)/Rb(11.16). We examined a series of trisomy 16 conecptuses and their normal littermate controls from day 14 to day 18 of gestation by gross observation and serial microscopic sections. In addition to smaller size and generalized edema, we observed variable, but definite delay in brain and craniofacial development in trisomy 16 mice. The brain revealed less stratified telencephalon, underdeveloped thalamus and hypothalmus with relatively wide third ventricle, and small rhombencephalon.
Craniofacial underdevelopment was characterized by persistent open eye, cochlea with fewer turns, delayed closure of the palate, more simple nasal cavity, etc. The tongue was shorter and convex upward, that were especially prominent at 14 days of gestation. The convex tongue and underdeveloped brain made the cranial base convex upward, and the angle between the cranial base an vertebral axis more obtuse. Small head with increase cephalic index and midfacial hypoplasia appeared to account for brain underdevelopment.
- Extracranial Meningioma in Parotid Area: A case report.
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Kyeong Cheon Jung, Je G Chi, Eui Keun Ham
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Korean J Pathol. 1994;28(6):673-674.
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- Meningioma is one of the most common intracranial tumor in adult. The tumor, however, occurs very rarely outside the central neuraxis, such as orbit, nasal cavity of parotid area. We report a case of extracranial meningioma in the parotid area. A 38-year-old man was presented with a round mass in the left parotid area. Magnetic resonance imaging revealed a round mass attached to anterior pole of the left parotid. The mass was easily separated from facial nerve.
Microscopically, the mass was composed of ovoid or spindle cells. The tumor cells tended to show bundle formation, lobular arrangement and occasionally whorling appearance.
This case is important at the means that meningioma should be included in differential diagnosis of mass in the parotid area.
- Aqueductal Atresia with Forking Anomaly: Report of 3 cases.
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Na Hye Myong, Mi Kyung Kim, Je G Chi
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Korean J Pathol. 1994;28(5):514-521.
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- Aqueductal forking was first described by Russell (l949) as a cause of aqueductal obstruction and a form of congenital malformation with simple stenosis, it is a relatively common cause of congenital hydrocephalus not associated with spina bifida or meningomyelocele. Pathologically it is characterized by two distinct channels separated by non-gliotic brain tissue. We describe variable clinicopathologic findings of 3 autopsy cases showing hydrocephaly due to aqueductal atresia with forking case 1 was a 35-week-old female showing Potter's syndrome, dextrocardia, and skeletal anomaly. case 2 was a 29-week-old male abortus with micrognathia, simian crease, club feet, and minor defects of visceral organs. Case 3 was a 32-week-old female abortus with associated anomalies such as a low-set ear, ectopic thymus and thyroid, and Meckel's diverticulum. On serial sections of brain stems of all 3 cases, were seen variably shaped and atretic lumina of aqueducts with distinct two channe1s and intervening brain tissues of normal cellularity.
- Ceruminous Gland Tumors: 5 cases report.
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Yun Kyung Kang, Je G Chi
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Korean J Pathol. 1994;28(4):414-419.
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- Tumors of the ceruminous gland are rare. However, careful histologic evaluation and classification are necessary for the proper treatment and ultimate prognosis. We present 5 cases of ceruminous gland tumors. Case l (73/M) and case 2 (52/M) were adenoid cystic carcinoma. They presented with protuding masses in the left external auditory canal for several months. Case 3 (76/M) was a mucoepidermoid carcinoma of auditory canal, who presented with right ear swelling.
The mass recurred 3 years after the surgical resection and combined radiation therapy. Case 4 (60/F) and case 5 (2l/F) were ceruminous adenoma, which showed diffuse or focal areas of glandular structures with one-or two-layer of eosinophilic columnar to cuboidal cells and sometimes with myoepithelial cells. These tumors showed non-infil-trative growth pattern and lack of mitosis, and had no capsule.
- Congenital Cystic Adenomatoid Malformation of the Lung: Clinicopathologic analysis of 22 cases.
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Young Lyun Oh, Yeon Lim Suh, Je G Chi
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Korean J Pathol. 1994;28(3):219-227.
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Abstract
- Congenital cystic adenomatoid malformation of the lung(CCAML) is a rare developmental anomaly characterized by an "adenomatoid" hyperplasia of terminal respiratory structures with formation of the cysts of varying sizes.
CCAML is separated into three major types based on the gross and microscopic findings. We have analyzed 22 cases of CCAML, those consisted of 6 autopsy cases and 16 surgical specimens. Out of 22 cases, 5 cases were composed of large cysts(type I) and 9 cases had multiple small cysts(type II).
Remaining one case revealed features of solid type(type III), and 7 cases were mixed form. There were 16 boys and 6 girls. All cases were below the age of 14 years. There was no clear-cut age difference between different types of CCAML. However, inflammation, fibrosis and pseudostratification of epithelium were often found in older age. All fetal autopsy cases of CCAML had hydrops fetalis and were associated with maternal hydramnios. One case of type III showed definite mucinogenic cells in the cysts unexpectedly, and one case of the mixed form(typeI+II+III) was found in a fetus of 22 weeks of gestational age. Above findings contradicted the classical description of the CCAML, and suggested that arbitrary classification into three types may not be the best way in understanding this condition.
- The Establishment of Hospital Pathology in Korea.
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Je G Chi
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Korean J Pathol. 1994;28(2):109-117.
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- A brief historical review of the Pathology Service in the western hospital system in Korea is made. Only since the introduction of western medicine by Japanese officials and American missionaries in the late 1890 has Pathology been considered a major part of basic science in medical schools, and its role as a hospital "Service had previously long been ignored. A limited service of tissue diagnosis of surgical material and autopsy had been performed. Professor Inamato was the first Japanese pathologist to come to Korea and set up a Pathology Department at the Chosun Chongdogbu Hospital in 1913. And Dr Mills appears to be the first American hospital pathologist who worked at Severance Hospital in 1913 doing bacteriology and parasitology as well as lecturing on patology at the medical school. After the Korean war most university hospitals adopted the Central Laboratory system which is equivalent to Pathology Service in the American hospital system. The need for hospital pathologists, therefore increased greatly. To meet this need the Korean Society of Pathologists that was founded in 1946, established a pathology specialty system in 1963, and began to produce hospital pathologists in both anatomic and clinical pathology. Unfortunately in the midst of changing a hospital laboratory system the term Clinical Pathology was erroneously used by some pathologists to measn Hospital Pathology as a whole. They claimed and advocated that Surgical Pathology should also be a part of Clinical Pathology. They made no distinction between anatomic pathology and clinical pathology. Although their claims proved to be erroneous later, the discord between anatomic pathologists and clinical pathologists resulted in a complete separation of the anatomic pathology(AP) and clinical pathology(CP) programs in residency training and in the specialty board system. As of now there is no access to train combined AP and CP specialists who are greatly needed for a great majority of hospitals in Korea. Presently there are almost equal number of anatomic pathology and clinical pathology specialists. M.D. clinical pathologists in Korea have no knowledge of tissue pathology examination, and conversely anatomic pathologists have no access to a clinical laboratory during their training periods.
Furthermore there are only a handful specialists in the clinical pathology field. There is an increased chance to have clinical microbiologists, clinical biochemists and other experts in clinical pathology fields, who are not M.D.s but Ph.D.s, in the near future, because M.D.
microbiologists and biochemists working at Departments of Microbilogy or Biochemistry at medical schools are doing research of their own. Therefore general clinical pathologists with a con-temporary training background as in Korea would have difficulty in finding a ro as a physician and not as an administrator or supervisor of a clinical laboratory. It is hoped that a balanced system involving Pathology(anatomic pathology) and Laboratory Medicine(clinical pathology) in modern Korean hospitals will be established in the coming years.
- Development of Intrahepatic Bile Duct in Human Embryos and Fetuses; Histologic and Immunohfstochemical Observations.
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Yeon Lim Suh, Je G Chi
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Korean J Pathol. 1994;28(1):8-21.
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- Sequential development pattern of the intrahepatic bile ducts is analyzed histologically and immunohistochemically using 50 embryonal and fetal liver specimens. Serial sections are made to reconstruct the intrahepatic biliary system, and monoclonal antibodies were used for differential antigenic expression of the biliary system. By 9 weeks of gestation a layer of small round cells, namely plate cells, became first noticed around large portal vein branches close to the hepatic hilum. These plate cells extended subsequently to more distal branches. The ductal plates became duplicated to contain cleft-like spaces and tubular structures. These tubules gradually became incorporated into surrounding connective tissue around the protal vein, and gave the appearance of the individualized bile duct. At term(40 weeks of gestation) the smallest branches of the portal vein were still surrounded by a discontinuous ductal plate. The ductal plate cells showed strong positive reaction for CAM 5.2 and AE1/AE3. They also expressed CK 19 and AE1 from 9 weeks of gestation on. The immunoreactivity of bile duct cells for cytokeratins persisted throughout the whole gestational period. Carcinoembryonic antigen was expressed along the luminal border of the bile duct, duplicated ductal plate and intrahepatic bile canaliculi.
Laminin was demonstrated along the basement membrane of the bile duct cells from 9 weeks of gestation. Few duplicated ductal plates were composed of two different types of cells, duct-like cells and hepatocyte-like cells. The duct-like cells and hepatocyte-like cells showed same imrhunoreactivity with the hepatocytes and the bile duct cells, respectively, suggesting that the intrahepatic bile duct cells are actually coming from the hepatocytes around the branches of the portal vein.
- Arthrogryppsis Multiplex Congenita: Pathologic examination of three autopsy cases.
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Seung Sook Lee, Je G Chi
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Korean J Pathol. 1994;28(1):56-64.
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- Three autopsy cases of arthrogryposis multiplex congenita are studied. They were two deadborns and one neonatal death.
All of them had characteristic abnormalities involving multiple joints. Neither primary myopathy nor abnormalities of anterior horn cells of the spinal cord were detected in our cases. However, two cases had minor central nervous system anomalies. All four cases showed pulmonary hypoplasia of varying degree. Two of three cases showed facial dysmorphism such as micrognathia and low set ears, and one showed cleft lip and palate. Ventricular septal defect, umbilical hernia and ureteral anomalies were also associated.
- Malignant Melanoma Arising in Giant Congenital Melanocytic Nevus: A case report.
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Jung Sun Kim, Sang Yong Song, Kye Yong Song, Je G Chi
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Korean J Pathol. 1993;27(6):650-655.
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- Giant congenital melanocytic nevus is found in 0.1% of live born infants. If present, this lesion has a 6.3% chance to develop malignant melanoma. We report such a case in a 22-year-old woman who had multiple pigmented skin lesions since birth. Rapidly growing masses were recently detected in the 19 cm-sized occipital pigmented lesion. Removed scalp lesion revealed yellowish white lobulated soft nodules in the background of pigmented nevus. Microscopically, the nodules consisted of epithelioid cells with prominent nucleoli, and pleomorphic cells including signetring cells.
These cells seldom contained melanin pigment. There were metastatic aggregates of tumor cells in the cervical lymph node, which were reminiscent of germinal centers of lymph nodes. S-100 protein immunostaining was helpful to distinguish them. Incidentally, focally scattered pigmented spindle cells were seen in the capsule of a lymph node
- Congenital Bronchopulmonary Foregut Malformation: Analysis of the surgical and autopsy cases.
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Sung Hye Park, Je G Chi
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Korean J Pathol. 1993;27(5):459-467.
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- Because early embryonic development of the tracheobronchial tree and foregut are closely associated, there is a wide spectrum of congenital anomalies involving either one or both organ systems. We analysed a total of 89 surgical and autopsy cases that are assumed to belong to congenital bronchopulmonary foregut malformation from the files of Seoul National University Hospital and Children's Hospital during the periord of 1961~1990. We also reviewed the serial sections of the embryos and fetuses from 3 weeks to fifteen weeks fertilization age for the observation of tracheobronchial and esophageal trees. Intralobar sequestrations(25 cases) and extralobar pulmonary sequestrations(4 cases) with patent, involuted-partial or complete-communication with the alimentary tract, tracheoesophageal fistula(30 cases) with or without esophageal atresia, esophageal atresia, esophageal stenosis due to tracheobroncheal remnant(4 cases), foregut duplication cysts(3 cases), esophageal or gastric diverticulum(1 cases), and bronchogenic cysts(22 cases) are included in this analysis(Table 1). Through this study, we confirmed the unifying concept of "bronchopulmonary forgut malformations". We believe a common embryologic pathogenesis leads to the formation of a previously described spectrum of malformations.
- Sequential Ultrastructural Change of Chorionic Villi in Human Placenta by Gestational Period.
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Tae Dong Park, Tae Jung Kwon, Je G Chi
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Korean J Pathol. 1993;27(5):468-484.
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- A study was performed to observe the sequential morphological change of the human placental barrier by means of light microscopy, immunohistochemistry, scanning electron microscopy and transmission electron microscopy. The examined placentas ranged in age from 4 weeks gestation to the full-term(40 weeks). Sixty seven placental specimens were obtained immediately after delivery. With the progression of gestation, the microvilli on the surface of syncytinum tended to be fewer, shorter and blunter. The syncytiotrophoblasts were getting thinner with formation of vasculo-syncytial membrane. The cytotrophoblasts formed a continuous layer which progressively disappeared but still present in the mature villi. In view of presence of intermediate cells and remnant of desmosomes, the cytotrophoblasts appeared to form the syncytiotrophoblasts.
In early pregnancy, capillary formation took place by the aggregation and differentiation of the proliferation and aggregation of endothelial cells and pericytes.
Myofibroblasts in villous stroma were examined by desmin immunohistochemical staining, and detected from 19 weeks to the full-term. During last period of pregancy definitive smooth muscle cells could be demonstrated, suggesting that the presence of myofibroblasts or smooth muscle cells are closely related to the placental maturity. Scanning electron microscopy of the early placenta showed numerous syncytial sprouts representing stages in the formation of new villi, but in the late period of gestation syncytial sprouts were diminished. It is concluded that the syncytiotrophoblast is originated from the cytotrophoblast in early pregnancy as the placental barrier is formulated. Moreover, myofibroblasts and smooth muscle cells in villous stroma play important role in placental maturation.
- Laryngeal Atresia with Tracheoesophageal Fistula: 1 case report.
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Eun Kyung Kim, Je G Chi
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Korean J Pathol. 1993;27(5):504-508.
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- Laryngeal atresia is a very rare congenital anomaly requiring immediate tracheotomy. We present a case of laryngeal atresia with tracheoesophageal fistula who showed immediate respiratory difficulty after ligation of umbilical cord and died of aspiration pneumonia at 8 days of age. The atretic portion of larynx is composed of irregulary arranged cartilaginous tissue, bundles of intrinsic muscle and soft tissue without epithelium-lined lumen. The lungs show normal development and evidences of aspiration pneumonia.
- Optic Nerve Glioma with Neurofibromatosis.
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Na Hye Myong, Seung Sook Lee, Yun Lim Shu, Je G Chi
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Korean J Pathol. 1993;27(5):524-530.
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- Optic nerve gliomas manifest either as a solitary form or a component of von Recklinghausen's neurofibromatosis. The reported incidence of coexistence with neurofibromatosis varies from 12% to 70%. Usually there are no significant cytological differences between the gliomas that accomapny the disease and those that are deemed to be solitary manifestations. The only possible difference between them is the apparently more common association, with the former, of extensive arachnoid hyperplasia and of a more florid local gliomatous infiltration into the leptomeninges, altogether resulting in perineural thickening. Our cases were 8 and 6 years old girls, respectively, presented with slowly progressive proptosis for 4 years and visual disturbance for 2.5 months. There were multiple cafe au lait spots on their trunks, and case 2 showed Lisch nodules in the iris. MRI of brain revealed unilateral optic nerve thickening with involvement of chiasm or multiple intracranial lesions.
Resection of optic nerve tumor was performed.
Microscopically, variable degree of tumorous change was seen. Most typically enlarged area was composed of intraneural and perineural portions surrounded by a layer of intact dura. Intraneural tumor revealed proliferation of elongated, spindle-shaped pilocytic astrocytes in intertrabecular spaces and distention of the pial septa with fibrovascular thickening. Another segment had areas with reactive gliosis. Perineural tissue was considerably thickened and, associated with proliferation of meningothelial cells and fibroblasts intermingled with astrocytes and Rosenthal fibers. There were increase of the optic nerve diameter and distention of the overlying dura.
Foci of arachnoid cell hyperplasia were noted in both cases, although differed in degree. Immunohistochemically, the tumor cells expressed glial fibrillary acidic protein in intraneural and perineural portions particularly in case 2.
- Chromomycosis of the Skin: A case report.
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Tae Sook Kim, Kye Yong Song, Je G Chi
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Korean J Pathol. 1993;27(5):531-534.
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- Cutaneous chromomycosis is a slow growing verrucous skin infection caused by five species, identified as Philadophara verruscosa, Fonsecaea dermatitidis, Fonsecaea pedrosoi, Fonsecaea compactum, Cladosporium, carionii. We report a case of chromomycosis of the skin causing by Cladosporium genus, in view of its rarity and unique light microscopic and ultrastructural features. This 65-year-old female had suffered from eczematous and lichenified skin lesion for the last two years since she burned her dorsum of the left hand by boiling oil. The lesion was slowly progressed, and ended up to the brownish hardening of the skin covered with crusts. Skin punch biopsy was done. Histologically, the sections revealed typical features of chronic granulomatous inflammation along with the heavy infiltration of the lymphocytes, plasma cells and histiocytes.
Pseudocarcinomatous downgrowth of the epidermis and microabscesses in the upper dermis were also found. Numerous thick walled fungal organisms were noted within the giant cells and freely in the dermis, which were positive ant PAS stain, and diastase resistant. Thick mucous capsule is not observed. The organisms showed very faint yellowish walls with a few buddings and a few short elongated hyphae were also noted. Ultrastructurally, the fungus wall was multilayered and inner organelles were sparse. There is no evidence of systemic involvement, especially brain.
- Cellular Blue Nevus: A case report.
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Na Hye Myong, Je G Chi, Byung Kyu Cho, Kye Yong Song
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Korean J Pathol. 1993;27(5):542-545.
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- Cellular blue nevus is an benign variant of blue nevus group, characterized by cellular islands composed of closely aggregated spindle cells with little or no melanin. The other variants include atypical and malignant blue nevus which often had the difficulties in the differential diagnosis from the malignant melanoma. A 4-year-old boy presented with hemispheric scalp nodule, which has been slowly grown since birth, measuring 3.5x3x1.5 cm. The surface showed geographic black pigmentation without hairs, hemorrhage, and ulceration. The excised mass disclosed homogeneoulsy dark black, glistening, and muddy cut surface.
Histological examination revealed exuberant melanocytic proliferation with both spindle and dendritic components.
Heavily pigment ed spindle cells, melanophages, focal necrosis, and vacuolated epithelioid cells were unusually noted in our case and diagnosed as cellular blue nevus.
Electron microscopy disclosed largely mature melanosomes in tumor cells and melanophages. During about 16 months since operation, he has been relatively well with no evidence of disease.
- Primary Oxalosis: A case report.
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Sang Yong Song, Je G Chi, Yong Choi, Sang Jun Kim
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Korean J Pathol. 1993;27(5):509-513.
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- Primary oxalosis is a rare genetic disorder caused by a deficiency of the peroxisomal enzyme alanine-glyoxylate aminotransferase(type I) and D-glyceric dehydrogenase(type II). It is characterized by the triad of radiopaque urolithiasis, nephrocalcinosis, and latered renal function.
We report a case of primary oxalosis in a 10-year-old Korean girl. She presented with chronic renal failure at 9 years of age. Ultrasonographic examination revealed bilateral, multiple renal and ureteral stones. Removed stones were chemically analysed to be composed of calcium oxalate. She underwent renal transplantation after prolonged period of dialysis. Removed kidneys were firm and gritty. Cut sections showed numerous tiny yellow sandy stones and a large staghorn stone. Specimen X-ray also exhibited disseminated fine granular and often coalescent radiopaque materials throughout the cortex and medulla. Microscopically numerous varying-sized crystals were noted in the kidney in globular or rhomboid appearance. The crystals were semitranslucent and doubly refractile under the polarized light. Diffuse interstitial fibrosis and chronic inflammation as well as glomerular obsolescence were also noted. The oxalate deposit was diffuse and marked, and was thought to be intimately related to the parenchymal damage and fibrosis.
- Scanning Electron Microscopic Findings of Hair Anomalies.
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Chul Jong Yoon, Je G Chi, Hai Won Chung
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Korean J Pathol. 1993;27(5):491-500.
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- Scanning electron microscopic(SEM) examination of hair is an efficient and definite method for the diagnosis of hair anomaly. The Hair specimen is placed on a stub, gold coated, and directly viewed without prior fixation or treatment for identification. We have analyzed 25 cases of scalp hair and 2 cases of eyebrow that were sampled with the suspicion of hair anomalies at Seoul National University Hospital during the last 7 year period from January 1988 to June 1992. All 27 cases had certain abnormalities of the hair. They consisted of monilethrix(1 case), hair casts(4 cases), pili torti(1 case), uncombable hair syndrome(1 case), trichorrhexis nodosa(5 cases), woolly hair(5 cases) and other anomaly(1 case). Some cases of them were mixed with two or three anomalies in hairs. Their combinations were; hair casts and woolly hair(1 case), hair casts and pili torti and uncombabla hair syndrome(1 case), hair casts and uncombable hair syndrome and trichorrhexis nodosa(1 case), trichorrhexis nodosa and uncombable hair syndrome(3 cases).
Most of these defects included brittleness of scales and distortion of the hair shaft.
- Cystic Adventitial Disease of the Popliteal Artery: A case report.
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Soo Min Kang, Kyeong Cheon Jung, Je G Chi
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Korean J Pathol. 1993;27(4):418-420.
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- Localized cystic degeneration of peripheral arteries represents and unusual cause of arterial insufficiency. It frequently occurs in patient without generalized arteriosclerosis. It has been reported in patients from age 11 to 62 years. Cystic adventitial disease is most common in the popliteal artery. At least 115 cases have been reported worldwide, but none in Korea. We report a case of cystic adventitial disease involving the left popliteal artery.
This 64-year-old man presented with an 18-month history of cramping pain of sudden onset in the left calf and claudication. Angiographic findings showed a 6 cm length of luminal obliteration of the popliteal artery. Segmentally resected popliteal artery showed two longitudinally directed cystic masses measuring 3.5x1.5 cm and 2.5x1.5 cm in the adventitia. Microscopic examination revealed cystic space in the arterial adventitia compressing arterial lumen. There were a number of foamy histiocytes collected along the cystic lumen.
- Iris Cyst: A case report.
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Sang Yong Song, Je G Chi, Jin Hak Lee
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Korean J Pathol. 1993;27(4):427-429.
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- Cysts of the iris may be primary lesions of either epithelial or stromal in origin, or secondary lesions after trauma or surgery. The stromal cyst is usually of primary lesion, although it could be secondary as shown in our case.
We report a case of recurrent iris cyst after trauma. The patient was an 8-year-old girl. She had a penetrating injury of the involved eye three years ago. She had a similar iris cyst removed two years before this surgery. Histologically, the cyst was lined by non-keratinizing stratified squamous epithelia and subjacent fibrovascular tissue. Islands of melanin-containing epithelial cells and acellular basophilic degenerating materials were also seen in the lesion. This case represents a stromal epithelial cyst that by history appears to be of post-traumatic etiology.
- Body Stalk Anomaly: Analysis of 10 Autopsy Cases.
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Seung Sook Lee, Je G Chi
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Korean J Pathol. 1993;27(3):235-242.
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- Body stalk anomaly represents an extreme maldevelopment of embryonic body folding and is characterized by absence of the umbilicus and umbilical cord. The failure of complete obliteration of the extraembryonic coelom is responsible for the absence of the umbilical cord formation and the wide-based insertio of the amnioperitoneal membrane onto the placental chorionic plate. We have analyzed 10 autopsy cases of various midline anomalies of the body that could best be classified into body stalk anomaly. All cases were either stillborns or dead immediately after birth. The pregnancy was interrupted due to this anomaly in 6 cases, and their gestational ages varied from 17 weeks to 37 weeks. The affected fetuses were characterized bt absent or vestigial umbilical cord, and ruptured amnion with direct amnioperitoneal connection without the mediation of the umbilical cord. Exomphalos with abdominal wall defect and serve scoliosis were characteristic components of this anomaly, that provided important clues in differentiating other similar anomalies. Other associated anomalies included neural tube defect, intestinal atresia, genitourinary and skeletal defects, pulmonary hypoplasia, single umbilical artery and narrow-spaced chest and abdomen, etc. These findings strongly suggest that anomaly of body stalk represents mechanical teratogenesis due to early amnion repture and subsequent effect, and should be categorized into amniotic band disruption syndrome.
- Nephroblastomatosis Associated with Wilms' Tumor.
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Kyeong Cheon Jung, Sang Yong Song, Yeon Lim Suh, Je G Chi, Hwang Choi
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Korean J Pathol. 1993;27(3):274-278.
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- In contrast to the nodular renal blastema which is defined by nests of primitive metanephric cells after 36 weeks of gestation, the nephroblastomatosis is characterized by neoplastic proliferation of the primitive cells. This lesion is presumed to be closely related to the development of Wilms' tumor. We report a case of bilateral nephroblastomatosis associated with Wilms' tumor in a child.
This 4 1/2 year-old girl was admitted because of a 10 cm-sized round mass in the right kidney, and smaller nodules in the left kidney and the lung. After three cycles of chemotherapy and subsequent disappearance of the nodules in the left kidney and lung, she underwent a right nephrectomy and a wedge resection of the left kidney. A round Wilms' tumor mass was seen in the lower pole of the right kidney.
Remaining right renal cortex showed multiple, slightly depressed gray-white nodules associated with multiple samll cysts. They were comprised of multifocal subcapsular nests of primitive nephrogenic cells with focal tubular or glomerular differentiation. They resembled fetal renal tissue. In the left kidney, similar nests of primitive cells were also noted. These lesions were interpreted as multifocal perilobar type of nephroblastomatosis.
- Neonatal Necrotizing Enterocolitis: Pathologic analysis of 14 cases.
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Yeon Lim Suh, Je G Chi
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Korean J Pathol. 1993;27(2):115-124.
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- We reviewed surgical or autopsy specimens of the gastrointestinal tract from 14 patients with necrotizing enterocolitis(NEC) to define the specific pathologic findings and the pathologic changes of the bowel in the premature and fullterm infants, and then to see how these findings are related each other and to clinical features. In two-thirds of patients two or more continuous segments of the gastrointestinal tract were affected, and the ileum and colon were by far the most common sites of involvement.
Pathologically, coagulation necrosis, inflammatory reaction, ulceration, microthrombi, overgrowth of microorganism, and perforation were the leading changes of NEC. On the basis of these histopathologic findings of the involving intestine, we could classify the pathology of NEC into two different histologic types. Type 1 and II are thought to represent pathologic changes of the intestine in acute and chronic stages of disease process. The symptom duration of the patients was significantly different between two types. The pathologic changes of the involved bowel were similar in both premature and fullterm infants, although the premature tended to have type 1 and the fullterm babies had more cases of type II. These pathologic changes could be associated with various clinical manifestation of NEC.
- An Effective Role Pulsed Unipolar Magnetic Field for Bony Decalcification.
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Suk Keum Lee, Eun Young Chung, Gi Jin Kim, Dae Beom Song, Jo Ho Kim, Je G Chi
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Korean J Pathol. 1993;27(2):125-133.
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- To achieve optimal decalcification in tissue and tissue preservation, we have tried magnetic field method and made some promising results. We used pulsed unipolar magnetic field obtained by rectification of 250 V-60 cycle, A.C. As a new method of bony decalcification, using 5% nitric acid, 10% formic acid and 10% formic acid+3% hydrochloric acid solutions, experimental groups were decalcified in the center of the magnetic field. The concentration of calcium ion in the decalcifying solution was measured by calcium-oxalate turbidity test by photometry method, and direct visualization of calcium radiopacity was obtained by soft X-ray view during the decalcification process. The pH change during decalcification was continuously checked and needle penetration method was also used. All the decalcification solution used in this study showed accelerated effect of bony decalcification in the strong magnetic field. Among them 5% nitric acid produced complete decalcification for the medium size bony specimen (less than 10x10x10 mm) within 24 hours, and the histologic feature was almost free of acid-chemical degeneration. The pH of all the decalcification solutions decreased in the strong magnetic field, maximum within 4~6 hours, and kept strong acidity throughout the decalcification procedure. After removal of the magnetic field the pH of all the decalcification solution returned to their original values after 24 hours.
It was presumed that the cause of the accelerated decalcification in the magnetic field was due to combined effects of the rapid increase of acidity and the increased molecular resonance to stimulate the ionization of mineral elements.
- Lymphoproliferativ Lesions of the Orbit and Conjunctiva: Histopathologic Study on 20 cases including 5 cases analyzed by Immunophenotyping.
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Chul Woo Kim, Na Hye Myong, Je G Chi
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Korean J Pathol. 1993;27(2):152-163.
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- Lymphoid lesions of the orbit and conjunctiva may be divided histologically into three groups: monomorphous and cytologically atypical malignant lymphomas, benign reactive follicular hyperplasia or inflammatory pseudotumor, and borderline lymphoid lesions mainly composed of small, non-atypical lymphocytes with or without evidence of plasmacytic differentiation or germinal centers which are difficult to clarify its nature by histologic criteria alone. From 1984 to 1992 at Seoul National University Hospital, 20 cases of orbital lymphoid infiltrates were reviewed to find out histopathologic characteristics of malignant lymphomas and try to classify them properly. Also, we sought histologic findings helpful for differential diagnosis between malignant and borderline cases. Histologic examination of malignant lesions usually revealed the features of low-grade B cell lymphomas of mucosa-associated lymphoid tissue(MALT) origin, which predominantly consist of centrocyte-like(CCL) cells. Among 13 primary orbital lymphomas, six cases were classified as MALT lymphomas of Isaacson, six were more apt to be the type of immunocytoma by kiel classification, and remaining one showed mixed pattern of both types in areas. The one case of malignant lymphoma with diffuse large cell type was confirmed by secondary involvement of intestinal lymphoma. Five cases were confirmed by immunoglobulin k-light chain monoclonality on flow cytometry and immunofluorescence study. The histologic findings such as Dutcher bodies, hemosiderin, deposits and polykaryocytes tended to be more frequently encountered in malignant lymphoma rather than indeterminate lesions and were thought to be helpful ones in making differential diagnosis between malignant and benign lesions.
With above findings, we assume that the principal neoplastic cells in the low grade lymphoma arising in the orbit and conjunctiva are CCL cells, which might be originated from the localized memory B cells, and also several kinds of B lymphocytes in on-going differentiation stages such as medium-sized monocytoid B cell, lymphoplasmacytoid cell, plasma cell, and mature small lymphocyte also contribute to the tumor progression.
- Congenital Neuroblastoma of the Adrenal with Metastasis to Liver, Contralateral Adrenal and Pituitary: Report of an autopsy case.
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Na Hye Myong, Sang Yong Song, Je G Chi
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Korean J Pathol. 1993;27(2):169-174.
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- Neoplasms presenting at birth or within the first month of life are defined as congenital tumors. The principal components of this congenital tumors are neuroblastoma, leukemia, brain tumors and sarcomas. The neuroblastoma is the most common accounting for 15~50% of all tumors in this group. It most often presents with an abdominal mass due to adrenal-retroperitoneal primary or hepatomegaly resulting from extensive metastasis. Most often the primary site is adrenal but other loci include the retroperitoneum, mediastinum, pelvis, etc. This 2-day-old female presented with hepatomegaly and a left adrenal mass at birth, first detected by ultrasonography. On the first day, she suffered from hematemesis and bradycardia. She died on the second day. Postmortem examination revealed massive metastatic tumor nodules in the liver and a well-demarcated round mass, 4 cm, in the left adrenal, with necrosis and hemorrhage.
Microscopic findings revealed largely undifferentiated neuroblastoma with focal neuronal differentiation and areas of necrosis and calcification in the background of fine fibrovascular stroma. Other metastatic foci were detected in the right adrenal and pituitary gland.
- Neuroendocrine Differentiation in Adrenal Cortical Tumor of Chidhood: A case report.
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Sang Yong Song, Seung Sook Lee, Na Hye Myung, Je G Chi
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Korean J Pathol. 1993;27(2):175-180.
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- Although neuroendocrine differentiation is a characteristic feature of tumors of the adrenal medulla, cortical tumors may also rarely be differentiated into medullary element.
Recently we experienced such a case of adrenal cortical tumor having features of both cortical and medullary tumor.
The patient was an 11-year-old girl who was incidentally found to have a left adrenal mass. Laboratory results showed elevated serum cortisol, aldosterone, renin, and epinephrine with high excretion of urinary metanephrine. Urine vanillyl mandelic acid and 17-ketosteroid remained within normal limits. Histologic featuresof a 6 cm round yellowish tumor were ambiguous to decide the orgin of this neoplasm.
Cortical element predominated in the tumor with minor areas of pheochromocytomatous feature. Immunohistochemically, the tumor cells were positive for vimentin, neuron specific enolase, and epithelial membrane antigen. Ultrastructural examination revealed scattered membrane bound dense core granules in the tumor cells of medullary differentiation, measuring 150~500 nm in average diameter. Cortical tumor element showed corresponding ultrastructural features. These results indicate that this is a case of adrenal cortical tumor with features of neuroendocrine differentiation.
- Spinal Pleomorphic Xanthoastrocytoma.
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Tae Jin Kim, Je G Chi
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Korean J Pathol. 1993;27(2):184-186.
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- Pleomorphic xanthoastrocytoma is a rare tumor, presenting superficially over the cerebral hemispheres of young subjects. We report a case of Pleomorphic xanthoastrocytoma of the cervical cord in view of its unusual location. The patient is a 20-year-old female, presenting with left neck pain radiating to the left shoulder one month before the admission. Magnetic resonance imaging revealed a high signal lesion in the upper cervical cord lower brainstem in T2 weighted image. On operation, intramedullary tumor was present and it was relatively well delineated. Near-total removal of the spinal cord mass was done. Microscopically, the tumor was composed of pleomorphic astrocytes, which were spindle-shaped with cytoplasmic processes and hyperchromatic nuclei. Other cells were round with vesicular nuclei and abundant eosinophilic cytoplasm. A few giant cells were seen. Despite the marked pleomorphism, mitosis or necrosis was not encountered. Scattered foamy cells were also seen, which showed negative staining in GFAP immunostaining in contrast to other GFAP-positive tumors cells.
- Primary Ciliary Dyskinesia(Immotile Cilia Syndrome): Clinical and electron microscopic analysis of 17 cases.
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Je G Chi, Chul Jong Yoon
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Korean J Pathol. 1993;27(2):99-107.
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- Immotile cilia syndrome is a genetically determined disorder characterized by immotility or poor motility of the cilia in the airways and elsewhere. Since its first description in 1976 determination of a ciliary abnormality has now clarified its variable expression and pleiotropism. Certain specific defects in the ciliary axoneme can be found and are pathognmoic of the syndrome. These defects include missing dynein arms, abnormally short dynein, arms, spokes with no central sheath, missing central microtubules, and displacement of one of the nine peripheral doublets. We have studied 80 cases of bronchial or nasal mucosal biopsies that were performed with the suspicion of immotile cilia syndrome. Of 80 cases only 17 cases were sampled optimally to be able to observe under transmission and scanning electron microscopes. All 17 cases had certain abnormality of the cilia. They consisted of Ia(3 cases), Ib(3 cases), Id only(3 cases) and Id+other types(6 cases) a according to Sturgess classification. Seven cases consisted of 1 solitary and 6 combined form; II+Id(1 case) and II+Id+III(5 case).
All 5 cases of type III were combined with Id and II.
Clinically most pronounced manifestations were cough(82%), sputum(59%), rhinorrhea(41%) and nasal stuffiness(35%), All the patients were below the age of 15 years, and there were 6 boys and 11 girls.
- Secretory Meningioma: A case report.
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Na Hye Myung, Je G Chi
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Korean J Pathol. 1993;27(1):64-68.
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- Secretory meningioma is now a distinctive subtype of mostly meningotheliomatous type of meningioma, which was first defined by Alguacil-Garcia et al. It shows characteristic light-microscopic, ultrastructural, and immunohistochemical features of epithelial and secretory differentiation of meningothelial cells with accumulation of secretory material in the from of hyaline inclusions. A 38-year-old female presented with headache for about 5 months. Magnetic resonance imaging revealed a round multilobated mass, measuring 4x4x3 cm, in the right inferior frontal lobe near the skull base, with surrounding brain edema.
Histologically, the tumor basically showed a pattern of meningotheliomatous meningioma but tended to deposit eosinophilic homogeneous material both in the intracellular and extracellular spaces. The shape was globular intracellularly and of variable shape and often conglomerated extracellularly. Histochemical stains revealed the material not of psammomatous but of pseudopsammomatous proteinaceous nature. On electron microscopy, there was no intracellular lumen with secretion but granular electron-dense material of variable size accumulated in the degenerated endoplasmic reticulums, suggestive of proteinaceous secretion.
- Negri Bodies in Rabid Dog: Light and Electron Microscopic Findings.
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Eon Sub Park, Young Uk Park, Jae Hyung Yoo, Kye Yong Song, Je G Chi
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Korean J Pathol. 1992;26(6):615-619.
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- Rabies is a fetal viral encephalitis to which all mammals, including man are susceptible. This virus, the genus of Rhabdovirus, is usually present in the saliva of infected animals and is transmitted by their bite. As a rule the virus enter the CNS by ascending along peripheral nervous system and extremely variable in extent. Negri bodies are appear in about 75% of cases. These bodies are eosinophilic, usually rounded inclusions and is located in the cystoplasm of the neurons, most frequently in the pyramidal neurons of the Hippocampus and the Purkinje cells of the cerebellum. We have experienced a case of canine rabies that showed Negri bodies in the Purkinje cells along with diffuse degenerative encephalitis and perivascular mononuclear cells infiltration. The Negri bodies were best demonstrated by Negri body staining although routine H-E staind was also useful. There inclusion bodies were located exclusively in the cytoplasm, and were found occasionally. Electron microscopic findings of the Negri bodies showed aggregates of bulletshaped nucleocapsids. We report a Negri body found in the brain of rabid dog with the light and electron microscopic findings.
- The Pathology Specialty System in Korea: Past, Present and Future Prospects.
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Je G Chi
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Korean J Pathol. 1992;26(6):537-542.
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- The specialist system of hospital pathology in Korea has adopted the American system in its start, and divided its categories into anatomical pathology(AP), clinical pathology(CP), and combind anatomic and clinical pathology(AP +CP). Since 1975 the society eliminated the category of combined AP and CP specialist. The first qualifying examination took place in 1963. It started out as a written examination and later changed to have two parts, written and practical. One year of internship and 4 years of anatomic pathology were required for AP specialist. CP required the same period of training in CP to be eligible for the specialist qualifying examination. The training period was shortened to 3 years from 4 years, 1981~1990 and then returned to 4 years in 1991. There has been considerable confusion during the adoption period of the pathologist specialist system in Korea, mainly because of an incorrect concept of the term "clinical pathology" in the modern hospital. Many people understood "clinical pathology" to mean "hospital pathology" as an opposing concept of "basic or experimental pathology" at medical school. The misconception arose from the fact that Pathology Department in a Hospital has not been realized under Japanese hospital system that prevailed Korean hospital system until 1950. In old Japanese style, the laboratory examinations including some histopathological examination had been conduced in corresponding clinical departments. And Pathology Department in medical school was responsible only for autopsy and not for making diagnosis of biopsy or operative specimen necessarily. Therefore, there has been a conflict between traditional Pathologists(most of them anatomic pathologists) at medical school and so-called "clinical pathologists" in the hospital, as the Korean medical delivery system adopted American system particularly after the Korean war. Now in Korean, in the great majority of hospitals, clinical pathology is clearly defined from anatomic pathology, and the two-services are at work in separate programs. However, there are still a few university hospitals, where histopathological examination and reporting are done in the Clinical Pathology Department. It is hoped that a combined AP and CP program can be started again in near future for the pathologists who work in community hospitals or most smaller general hospitals where the pathologists with adequate knowledge on both AP and CP at work supervising clinical laboratory technicians and technologists. However, it is fully realized the specialists in subspecialty field such as neuropathology, dermatopathology, hematopathology, clinical microbiology, clinical chemistry, etc. are also needed. For future prospect both the Korean Society of Pathologists and Korean Society of Clinical Pathologists should collaborate with each other in full scale in spite of painful past experiences.
- Fibrocalcific Nodule in the Liver Capsule Caused by Ascaris Eggs: A case report.
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Yeon Lim Suh, So Young Park, Je G Chi
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Korean J Pathol. 1992;26(4):411-413.
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- Ascariasis is probably the most common helminthic infestation of man, but it seldom causes severe illness.
Pathologic conditions of Ascaris may be caused by adult worms, eggs or larvae. We describe a case of Ascaris egg granulomas that were found incidentally on the surface of the liver in a 75-year-old woman who had undergone a segmentectomy for an intrahepatic stone. Grossly, there were several yellowish calcific nodules of 0.4 cm in diameter on the lateral surface of the left lobe of the liver.
Microscopically, the lesions were located in the hepatic capsule and consisted of fibrocalific nodules with many eggs. The eggs were round to oval, thick-shelled and measured 50~75x30~50 um. Most of the morphologically preserved eggs were fertilized eggs, but they had smooth shells without external protein coats. This case is of interest for the unusual location of the lesion, the presence of eggs without mammillation, and the association with the intrahepatic stone.
- Pulmonary Arteriovenous Fistula in Childbood: Report of a case.
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Soo Min Kang, Mi Kyung Kim, Je G Chi
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Korean J Pathol. 1992;26(2):201-203.
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- A case of pulmonary arteriovenous fistula in a 8-year-old boy who presented with easy fatigability and cyanosis for 4 months, is described. Grossly, there was a large vascular anomaly measuring 2x2 cm in the center of the removed right lower lobe. Microscopically, the lesion consisted of dilated arterial and venous structures resembling a cavernous hemangioma. Subintimal fibrosis and attenuated vascular structure lacking elastic fiber and representing A-V shunt were also noted in the lesion.
- Epithelial-Myoepithelial Carcinoma of Intercalated Duct of Parotid Gland.
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Soong Deok Lee, Doo Hyun Chung, Sung Hye Park, Chul Woo Kim, Je G Chi
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Korean J Pathol. 1992;26(1):76-81.
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- Epithelial-myoepithelial carcinoma of intercalated duct(origin) is a recently described tumor characterized by its typical biphasic pattern of central duct like cell and peripheral clear cell. We described a case of epithelial-myoepithelial carcinoma in a 10-year-old boy.
Microscopically, the tumor showed typical biphasic pattern, diffuse proliferation of clear cells and linining epithelial cells of tubular structures. Immunohistochemically, the clear cell showed positive reaction to S-100 protein, and the epithelial cells expressed cytokeratin indicating myoepithelial and epithelial differentiation respectively.
Biphasic differentiation of the tumor cells could be also proved by electronmicroscopic study.
- Spinal Neurenteric Cyst of Foregut Origin.
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Gyeong Hoon Kang, Je G Chi
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Korean J Pathol. 1992;26(1):92-97.
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- The neurenteric cyst with associated anomalies is the result of an ectoentodermal communication that exists during embryogenesis. The variety of lesions include intraspinal cysts, congenital vertebral deformities, thoracic cyst, malformations of the digestive tract, and occasionally, dysrhaphias of the sinodermal or myelomeningocele type. A case of intraspinal neurenteric cyst in a 3-year-old boy is presented. He presented with cyclic abdominal pain, fever and constipation of 30 days' duration. These symptoms progressed rapidly into gait disturbance and left hemiplegia. A single epithelial cyst, located ventral to the spinal cord in the lower thoracic region, traversed the cleft of spina bifida of thoracic vertebrae and connected to retromediastinal cyst. The inner cyst wall was lined with pseudostratified ciliated epithelia and a few squamous cells. The cyst wall contained well-developed muscle coat, myenteric plexuses, and scattered seromucinous glands.
- Epidermolysis Bullosa Simplex Generalisata.
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Kye Yong Song, Joong Seok Seo, Sung Hye Park, Je G Chi, Kwang Hyun Cho
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Korean J Pathol. 1992;26(1):62-65.
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- We report a case of epidermolysis bullosa simplex occurred in a 12-year-old girl, who presented with intractable bullous lesions of the hands and feet after minor traumas ever since her early neonatal period. The bullous lesions were noted on the 2nd and 4th webs of the fingers and dorsum of the hands as well as on the skin of the ankle. The lesions were healed without scar formation. Family history was not contributary and seasonal pattern was not noted.
Histologic sections revealed intraepidermal bullae just above the well preserved basement membrane. Electron microscopic findings revealed cytolysis of basal cells with preservation of the basement membrane, indicating the epidermal type of epidermolysis bullosa simplex.
- Brain Stem Glioma (An autopsy case).
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Doo Hyun Chung, Soong Deok Lee, Hee Jin Yang, Dae Hee Han, Je G Chi
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Korean J Pathol. 1991;25(6):607-610.
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- We report an autopsy case of the brain stem glioma that extended extensively in the brain stem itself and cephalad.
This 18-year-old boy first presented with dizziness, vomiting and left side weakness with left facial palsy.
Brain MRI revealed a diffusely infiltrative tumor involving whole medulla, pons and lower midbrain. A total of 4000 R was given with some alleviation of respiratory difficulty.
He died one year after the onset. Autopsy revealed the tumor involving pons, a portion of medulla oblongata, and cerebellum. The tumor showed diffusely infiltrative pattern and extended along the periventricular area to the thalamus and corpus callosum. The cut surface was grayish white and solid. It also showed areas of myxoid degeneration and necrosis probably related to radiation therapy.
Microscopically the tumor was a cellular and pleomorphic glioma that showed some astrocytic differentiation. It was diffuse without geographic necrosis.
- The Korean Journal of Pathology: A Review of the First 25 Years.
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Je G Chi
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Korean J Pathol. 1991;25(6):497-508.
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- The Korean Journal of Pathology was first launched in 1967, marking the 20th anniversary of the founding of the Korean Society of Pathologists in 1946. The first publisher was Professor Chae Koo Lee and the first editor was Professor Sang In Kim. What began as a semi-annual journal became a quarterly beginning in 1977. Now, in 1991, it is a bimonthly journal with an average of 14 articles per issue. A total of 1,075 articles consisting of 8,624 pages have been published through this journal with more than 537 persons having joined authorship. Papers related to diagnostic pathology took a majority, and accordingly, articles of animal experiment and basic research were the minor. Because of low autopsy rate among Koreans papers on systemic and special pathology have not developed harmoniously, with particular deficit of cardiovascular pathology and special sense organs. Papers on gastrointestinal tract and hepatobiliary system predominate since early years of publication, indicative of prevalence of diseases related to those organ systems. Relative dominance of papers on pediatric pathology and teratology represents availability of postmortem materials of fetuses and infants in many hospitals, despite the extremely low adult autopsy rate. Papers using electron microscopy appeared first in 1972 and the first paper on cytopathology was published in 1977. During the last 25 years of the Korean Journal of Pathology two new related journals were born. The first journal was the Korean Journal of Clinical Pathology in 1981, and the second journal was the Korean Journal of Cytopathology in 1990. Two journal supplements, one of nationwide cancer statistics and the other of an accumulated total index, were accompanied. One issue in memory of the late Professor Yun Il-Sun was published in 1975. The Korean Journal of Pathology is now a periodical registered as a quarterly journal to the Ministry of Culture(MA-1664), and its international standardized serial number is 0379-1149. It is indexed in Excerpta Medica since 1990. It is hoped that the Korean Journal of Pathology will become an internationally referenced periodical approved by eminent international indexing systems such as Index Medicus and Science Citation Index in the nearest future.
- Neonatal Giant Cell Hepatitis: An autopsy case.
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Sung Churl Lim, Moo Young Song, Un Jun Hyung, Je G Chi
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Korean J Pathol. 1991;25(2):147-152.
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- We report an autopsy case of neonatal giant cell hepatitis that was presumed to be related to bacterial sepsis, endotoxemia and to the subsequent parenteral alimentation and antibiotics treatment. The patient died of candidal endocarditis and multiple brain infarcts. This female baby was born by a normal full term spontaneous delivery. Six days after delivery she developed fever and lethargy as she suffered from Cheyne-Stokes respiration with severe grunting. Blood culture grew Enterobacter and Acinetobacter.
After management of the sepsis her general condition improved. On the 23rd day of admission she was found to have deep jaundice and hepatosplenomegaly. The liver became larger progressively and the edge was palpable at the umbilical level. Grade II systolic murmur was heard along the left lower sternal border. She died on the 31st day of hospitalization. Postmortem examination showed severe jaundice, hepatosplenomegaly, a large vegetation on the mitral valve and multiple petechial hemorrhages of the viscera. Microscopically the liver showed features of massive giant cell transformation, mild fibrosis and inflammatory cells, suggestive of giant cell hepatitis.
Numerous yeasts and candidal pseudohyphae were seen in the cardiac vegetation, focally extending into the myocardium.
There was a focus of candidal vasculitis in the bowel wall.
In addition there were multiple bilateral organizing infarcts in the cerebral hemisphere as well as diffuse white matter damage associated with septicemia.
- Sebaceous Adenoma in Medial Caruncle of the Eye: A case report.
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Geon Kook Lee, Joong Seok Seo, Kye Yong Song, Je G Chi
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Korean J Pathol. 1991;25(2):174-177.
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- Sebaceous adenoma is a rare solitary or multiple yellow, circumscribed neoplasm consisting of sharply demarcated, proliferating lobules or irregular size and shape that are composed of three cell bypes: basal cells, mature and transitional sebaceous cells. We reported a case of extremely rare sebaceous adenoma arising in caruncle of the left eye in a 78-year-old female. A polypoid tumor nodule, measuring 0.6x0.5 cm, was noticed 6 months before resection.
It was grayish white with granular surface. There is no evidence of associated visceral neoplasm.
Histopathologically, it revealed a lobulated tumor, composed of equal amount of highly differentiated sebaceous and intermediate transitional epithelium with minor participation of basaloid cells. This tumor is thought to be the neoplasm of the sebaceous gland normaly present in the caruncle of the eye rather than ectopic origin.
- Subcutaneous Granuloma Annulare of the Scalp: A case report.
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Geon Kook Lee, Joong Seok Seo, Kye Yong Song, Seong Hye Park, Je G Chi, Kyoung Chan Park
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Korean J Pathol. 1991;25(2):178-182.
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- Subcutaneous granuloma annulare (SGA) is a rare, benign noninfectious histiocytic disease of unknown cause, characterized by necrobiosis of the connective tissue surrounded by infiltrates of histiocytes and lymphocytes. We report a case of SGA in a 49/12-year-old boy. The lesions were five nontender subcutaneous nodules in the parieto-occipital scalp, measuring 1.0 cm to 2.0 cm in diameter. Microscopical examination revealed variable stages of multiple necrobiotic areas, which showed central necrobiosis with palisading histiocytes, involving both the lower dermis and subcutaneous fatty tissue. Electron microscopic findings revealed many histiocytes in the necrobiotic areas with degenerating and necrotic collagen fibers as well as regenerating fibroblasts.
- Cantrell's Syndrome: It's relationship to ectopia cordis.
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Je G Chi
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Korean J Pathol. 1991;25(1):30-36.
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- A syndrome featuring defects of the heart, sternum, diaphragm, and anterior abdominal wall has been designated as Cantrell's syndrome. Since Cantrell described this syndrome as one type of ectopia cordis there has been debate and confusion in the literature on its entity particularly in relationship to ectopia cordis. Since ectopia cordis is defined as "the heart is completely or incompletely located outside the mediastinum" and every case Cantrell's syndrome is associated with pericardial and diaphragmatic defects as well as low sternal defect, these two seemingly different entities should be closely related or may even be in the spectrum of same anomaly complex. With above speculation in mind we have reviewed two cases of typical Cantrell's syndrome, two cases of typical ectopia cordis and a case of bifid sternum from autopsy file of Seoul National University Children's Hospital. Findings pertinent to the differential diagnosis are tabulated. Based on postmortem findings on these 5 cases it was concluded that these three anomaly complexes are essentially same, being only different in severity and probably of time of occurrence during developmental period. Therefore it was suggested that the definition of Cantrell's syndrome should be extended to include all cases of ectopia cordis. Or the whole syndrome could be redesignated as midline defect syndrome because it involves the midline of the body and is always multiple and complex anomaly.
- Deep-seated Fungal Infections in Biopsy Specimens.
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Kyung Ae Yoon, Je G Chi
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Korean J Pathol. 1990;24(4):349-357.
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- A total of 197 cases of fungal infections in biopsy specimens obtained from the pathology file of the Department of Pathology, Seoul National University Hospital, for a period of 28 years from 1960 to 1987 were studied by histopathologic investigations with analysis of clinical records. The following results are obtained; 1) While most fungal infections increased in number, annual relative frequency of them were between 0.1% and 0.2%. 2) Among 197 cases of fungal infections, deep-seated mycosis was 175 cases (88.8%). Aspergillosis was the most common mycosis, accounting for 29.4 percent. 3) The age and sex distribution of fungal infection was even throughout the ages, but it was more common in age group over fifty, and the male was more frequently affected than the female. 4) Aspergillosis was encountered in 58 cases (29.4%) and the preferred localization was the lung. The candidiasis was seen in 48 cases (24.4%) and the preferred localization of cryptococcosis was lymph node and skin.
- Development and Growth of Tongue in Korean Fetuses.
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Suk Keun Lee, Chang Yun Lim, Je G Chi
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Korean J Pathol. 1990;24(4):358-374.
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- We examined sixty-three human embryos ranged from three weeks to eight weeks of fertilization age and 117 human fetuses from eleven weeks to fourty weeks of gestational age. Anatomical structure of developing tongue could be classified into eight developmental stages. The first is the sgage of mesial swelling of tongue primordium in the fertilization age of 28~40 days (Streeter stage 13~16), the second is the stage of lateral swelling of tongue primordium in the fertilization age of 41~46 days (Streeter stage 17~18), the third is the sgage of vertical positioning of tongue in the fertilization age of 47~53 days (Streeter stage 19~21), the fourth is the transitional stage of tongue from vertical position to horizontal position in the fertilization age of 54~56 days (Streeter stage 22~23), the fifth is the stage horizontal positioning of tongue in the gestational age of 11 weeks, the sixth is the stage of protrusion of tongue in the gestational age of 12 weeks, the seventh is the stage of maturation of tongue muscle in the gestational age of 7-10 months. The development of tongue papilla characteristically progresses into three stages. The first stage is the epithelial ingrowth for the crypt formation, the second stage is the anatomical formation of vallate, fungiform and filiform papillae, and the third stage is the differentiation of taste buds in the vallate and fungiform papillae or the formation of thick spike-like keratinization at the tip of filiform papilla. We observed that the tongue primordium mainly derived from occipital myotome developed more repidly than other oro-facial structures, so it transitionally occuied the spaces of the pharynx and the posterior nasal cavity, and directly affected the formation of palate and the growth of maxilla and mandible. Whereas the tongue papilla development showed continuous developmental sequences during the fetal period.
- Embryogensis of Human Liver.
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Woong Kim, Je G Chi
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Korean J Pathol. 1990;24(4):393-401.
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- The morphologic development of the liver in the embryonic period is described in serial sections of 18 human embryos representative of Horizons 12 to 23 . In the earliest specimen of horizon 12, the liver is seen as branching cord of endodermal cells originating from the hepatic diverticulum and invading into the loose stroma of septum transversum, transforming the surrounding stromal cells into primitive blood spaces and blood cells. Thereafter, the parenchymal cells rapidly proliferated so that the size of the organ was reaching a fifth of the CR length in horizon 23. The vascular system of the liver was in a symmetric configuration in horizon 12, which is composed of umbilical and vitelline veins and hepatocardiac channels on both sides. The evolution of the vascular system includes intergration of the vitelline veins into the portal vein, obliteration of the right umbilical vein and left hepatocardiac channel, and creation of the ductus venosus.
The intrahepatic biliary tract is found to be formed by the "in situ transformation" mechanism, which involves transformation of the parenchymal cells, adjacent to the fibrous tissue surrounding the portal and umbilical veins, to networks of cuboidal epithelial cells lining the ductal lumen. These intrahepatic duct systems were found to communicate with the extrahepatic system at the porta hepatis.
- Nevus Sebaceous with Special Reference on Its Aging Effect.
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Jin Seok Seo, Mi Kyung Kim, Mikyung Kim, Kye Yong Song, Yun Lim Seo, Je G Chi
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Korean J Pathol. 1990;24(4):436-445.
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- A histopathological study was performed on nevus sebaceus to observe its aging effect based on 75 cases of neuvs sebaceus those were collected during the past 10 years from three university hospitals in Seoul. The results are as follows: 1) Clinical findings The incidence was most frequent in the teenage group. The 75 cases consisted of 41 males and 34 females with a sex ratio of 1.2:1. Most of cases developed in the head and neck areas with 62.7% on the scalp and 29.3% on the face. 2) Histopathologic findings. The epidermal changes such as acanthosis(40%), papillomatosis(73%), hypergranulosis(44%) were most remarkable in the second decade and gradually decreased with aging. The apparent proliferation of sebaceous gland was observed in 73% and it was most prominent in the second decade. Apocrine glands were absent before the first decade but apparently increased after then. Proliferation of eccrine gland was not significant in all the age groups. Mild increase of immature hair follicles were noted in 49% of our cases with gradually decreasing tendency in the older age. The dermal inflammatory infiltrates were noted from the 2nd decade(28%) and thereafter gradually increased. Associated neoplasms were one apocrine adenoma, one sebaceous adenoma, two trichilemmomas and two arteriovenous hemangiomas. The majority of tumors occured in the third decade. Therefore, it is observed that neuvs sebaceous undergoes dynamic histopathologic changes according to the age of patient and later develop various secondary neoplastic changes. The pathogenesis of the nevus sebaceus is suggested to be closely related with developmental anomalies of primitive hair germ units in fetal stage.
- Juvenile Granulosa Cell Tumor of the Ovary: Report of a Case of Malignant Form with Unusual Pleomorphism.
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Chong Jai Kim, Jin Suk Suh, Sung Hye Park, Je G Chi
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Korean J Pathol. 1990;24(3):316-320.
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- A case of Juvenile Granulosa Cell Tumor (JGCT) of the ovary with unusual pleomorphic histologic and malignant biologic behaviour is described. The tumor occurred in a 10-year-old girl and was associated with clinical features of isosexual pseudoprecosity and a marked elevation of serum estradiol.
The mass manifested initially in the right ovary and subsequently involved the contralateral ovary. A multi-organ metastasis developed during a 6-month-interval despite chemotherapy. She received two operations at 6-month interval, and tissues were obtained from the tumor mass. A marked histologic difference was observed between these two samples. The second biopsy showed profound cellular pleomorphism with numerous multinucleated tumor giant cell formation and hyaline bodies. The differential diagnosis from germ cell tumor and the possible factors for the pleomorphism are discussed.
- Autopsy Findings of Neonatal Tetanus.
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Je G Chi, Sang Woon Choi
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Korean J Pathol. 1990;24(3):183-189.
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- During last 28 years since 1962 we experienced 11 cases of neonatal tetanus that was clinically diagnosed and autopsied at the Department of Pathology, Seoul National University Hospital. All these case were encountered before the year 1980, and was caused by cutting the umbilical cord with unsterilized scissors. All the patients had onset of characteristic symptoms of seizure in first few days and died within a week in most cases. Postmortem findings could be summarized as follows: 1) The most impressive pathological finding was found in lungs, which was multifocal intraalveolar hemorrhage. In 3 cases, only fresh hemorrhage and edema were found. 2) Fatty changes of hepatocytes, focal degenerations of cardiac and skeletal muscles, vacuolar change of proximal tubules were found. 3) The changes of other organs seemed to be the secondary changes due to hypoxia.
- Morphological Observation on the Prenatal Development of the Human Gastrointestinal Tract.
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Yeon Lim Suh, Je G Chi
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Korean J Pathol. 1990;24(2):103-119.
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- A total of 322 fetuses and 29 embryos were examined light microscopically to evaluate the morphological development of the human gastrointestinal tract with increasing gestational age. The human embryos were analysed by reconstruction of serial section slides. One hundred and forty fetuses ranging from 15 to 41 weeks of gestation were used for correlating the gestational age and the body weight with the measurement of the small and large intestines. 1) The esophagus develps from the distal part of the foregut through a partition of the tracheoesophageal septum. Initially the esophagus is short, but it elongates rapidly and reaches its final relative length and position by the seventh week. The epithelium of the esophagus proliferates and completely obliterates the lumen by the seventh week, but recanalization occurs by the ninth week. The esophageal epithelia consist of three different groups of cells; stratified squamoid cells, ciliated columnar cells and tall columnar cells by the 21th week. 2) The stomach appears as a fusiform enlargement of the caudal part of the esophagus at the fourth week. During next two weeks the stomach acquires its adult shape and final position. The primordial gastric pits and the parietal cells appear at the eighth and eleventh weeks, respectively. 3) As the midgut elongates, it forms a ventral U-shaped loop, called primitive intestinal loop by the fifth week. At this stage the cecum appears as a swelling from the caudal limb of the intestinal loop. By the seventh week the bulks of the caudal limb of the intestine herniate into the umbilical cord, in which the loop rotates 90 degrees counterclockwise around the axis of the superior mesenteric artery. During the tenth week, the intestine returns to the abdomen and undergoes a further 180 degrees counterclockwise rotatation. 4) The cloaca is divided into two parts by a urorectal septum at the fifth week. By the seventh week the urorectal septum has fused with the cloacal membrane, dividing it into a dorsal anal membrane and ventral urogenital membrane. The anal membrane ruptures at the eighth week. 5) During the sixth week the duodenal lumen becomes completely filled with proliferating epithelium. The villi project from the mucosa of the small and large intestines at the eighth and eleventh weeks, respectively.
The villi of large intestine become resorbed again after the 21th week. At the fifth week Paneth cells appear through the entire length of the intestine including the rectum, but disappear in the colon and the rectum after the 36th week.
6) The developing Auerbach's plexuses are well recognized along the outside of muscle coat throughout the gastrointestinal tract, but demonstrate no immunoreactivity for the anti-neuron specific enolase antibody. The neuroblasts in the myenteric plexus reveal strong positivity for the anti-neuron specific enolase antibody at the eleventh week, but the ganglion cells differentiate by the fourteenth week. 7) Differentiation of the gastrointestinal wall and development of the myenteric plexus begin form the esophagus and progress caudally down to the colon. But the anorectal wall is differentiated from the cloaca more earlier than the esophagus, stomach and colon are. 8) The small and the large intestines elongate progressively with the increasing gestational age and body weight and increase approximately 5.6 and 5.4 folds, respectively during the 25 weeks from the 15th to 41th week of gestation. At the 40th gestational week the small intestine is 5.68 times the length of the colon. 9) The correlation between the body weight (BW), crown-rump length (CR) and intestianl length (small intestine (SI), large itestine (LI) is presented as: SI (cm)= -33.67 + 4.14CR + 11.62 (BW)(1/3), LI (cm)= 5.56 + 0.76CR + 0.007BW (gm), CR (cm)= 7.82 + 0.015 SI + 0.41 (BW)(1/2).
- Malignant Lymphoma in Children.
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Sung Hye Park, Sung Sik Shin, Chul Woo Kim, Je G Chi
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Korean J Pathol. 1990;24(2):137-147.
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- We have reviewed malignant lymphomas in children (15 years and less) that were diagnosed at the Department of Pathology, Seoul National University Hospital and Seoul National University Children's Hospital over the last 10 years, 1979~1989, trying to find any significant histological difference between childhood and adult lymphomas. After critical review by 3 pathologists, the lymphomas are classified according to Rappaport, Lukes-Collins and NCI (working formulation) classifications for non-Hodgkin's lymphomas and Reye classification for Hodgkin's disease. Fifty mine non-Hodgkin's lymphoma (NHL) and 18 Hodgkin's disease (HD) was the material that this study was based. NHL vs HD was 3 : 1, this HD being 23.4% of all malignant lymphomas in children.
- Morphological Observations on the Epidermal Development of Human Fetal Skin.
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Joong Seok Seo, Kye Yong Song, Je G Chi
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Korean J Pathol. 1990;24(1):27-38.
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- To observe developing process of human fetal skin during intrauterine life, morphological studies in light microscopic level were made based on 27 human embryos and 76 fetuses ranging from 4 to 40 gestation weeks. The fetuses were the products of induced abortion and were found to have no associated diseases of congenital anomalies at the autopsy. Ten different portions of the body were sampled and examined. They were scalp, forehead, face, chest, abdomen, back, palm, sole, finger and toe. In embryos two different portions; cephalic and caudal portions were examined: The following results were obtained: 1) A single layer of undifferentiated cell was the primitive epidermis at the 4th week and it was followed by two layered epidermis consisting of periderm and primitive basal cell layer. Epidermal ridges started to develop along with primitive eccrine and hair germs as clustering of basal cells at the llth week. Stratum inter-medium was formed at the 12th week, and primitive granular cell layers and keratin formation in association with hair follicles at the 19th week forming earliest adult type epidermis, followed by progressive maturation. 2) The thickness of the fetal epidermis and keratin layer increased as the fetal age approached to the term with its slightly different developmental pattern by the site of body.
Cephalic protions developed slightly earlier than the other parts. 3) The developmental pattern of various portions of epidermis could be categorized into three groups; (1) scalp, forehead and face; (2) chest, abdomen and back; (3) palm, sole, finger and toe.
- Morphological Observations on the Hair Development of Human Fetal Skin.
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Kil Seo Kim, Joong Seok Seo, Key Yong Song, Je G Chi
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Korean J Pathol. 1990;24(1):39-49.
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- The developing process of the hair of the fetal skin was studied. The ages of 103 human embryos and fetuses ranged from 4 to 40 gestation weeks. Ten different sites were selected, i.e., scalp, forehead, cheek, chest, abdomen, back, palm, sole, finger and toe. For the embryos 3 sites were studied, i.e., cephalic, trunk, and caudal portions.
Following results were made: 1) The primitive hair germ was first noted the 10th week in the face skin as nubbins of mesenchymal cells beneath discrete foci of crowdes, elongated germinative epithelial cells. The developing hair germs and hair pegs were observes at the cephalic portion by 11 weeks. At 15 weeks the hair pegs including hair germs were noted in the trunk skin. The bulbous hair peg stage started at the 16th week in the cephalic portion and at the 18th week in the trunk. 2) Relative number of fetal hairs progressively increase up to 20 weeks of gestation but, thereafter decreased although it was different by the site of the body. 3) The diameter of fetal hair follicles increased with fetal age to the term with slight difference by the portion of body. 4) The developmental process of hair was more rapid in the cephalic portion than the trunk in views of morphologic changes of the hair structures, number and diameter of hair follicles.
- Holoacardius Hemisomus Acephalus: A case report.
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Tae Jin Kim, Chong Jai Kim, Sung Hye Park, Suk Keun Lee, Je G Chi
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Korean J Pathol. 1989;23(4):487-489.
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- An autopsy case of holoacardius hemisomus acephalus is reported. She weighed 2,190 gm and the height was 38 cm. The head and upper extremities were absent, while the vertebrae and lower extremities were relatively well developed, but severely edematous. The heart, lungs, stomach, liver, spleen, and pancreas were missing, but the lower abdominal organs including kidneys, adrenal, urinary bladder, and genital organs were present. The intestine was blind-ended at jejunal level but opened into a normal anus. The umbilical cord had two arteries and one vein.
- Monthy Slide Conference of the Korean Society of Pathologists: A Historical Review on it's 30-year Anniversary.
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Je G Chi
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Korean J Pathol. 1989;23(4):403-409.
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- A brief historical review of our monthly slide conference (MSC) was made. These conferences were begun by several pathologists in Seoul in 1959 under the name of "Monthly Meeting of Seoul Pathologists" acting on a proposal of Dr.
Kristen Arnesen. Dr. Arnesen, a Scandinavian pathologist, was the first head of the Department of Pathology of the National Medical Center (NMC), which had been established in 1958 by the joint efforts of the U.N.Korean Reconstruction Agency, the goverments of the three Scandinavian countries and the goverment of the Republic of Korea. Seoul National University, Yonsei University, National Medical Center and Holy Ghost Medical College (now Catholic Medical College) were the first 4 participants who joined the conference from the beginning, and the conferences were held at Seoul National University or at the NMC. This conference was incorporated into the official academic activity of the Korean Society of Pathologists by 1965. The history of MSC was arbitrarily divided into five developmental stages: the first stage (1959-1960), second stage (1961-1963), third stage (1964-1970), fourth stage (1971-1983) and the fifth stage (1984-1988). The number of participating institutions increased to 11 by the end of 1973, 24 by the end of 1983 and 41 by the end of 1988. The total number of cases discussed at the MSC was 1,805 by the end of 1988. An average 100 members have participated each month in the meeting since 1980, and a total of 65 slide sets have been distributed since 1986. This conference has contributed enormously in training resident pathologists and refining diagnostic skills of specialist pathologists. It has become one of the most interesting and eagerly-awaited meeting of the Korean Society of Pathologists. It is author's hope that this brief overview may convey some inspiration to our young pathologist collegues and instigate increased efforts to refine their diagnostic skills and also to explore the vast and, as yet, unsolved problems in the pathology field in this country.
- Pathologic Study of Primitive Neuroectodermal Tumor: Report of 5 cases.
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Sook Nyo Lee, Jong Eun Joo, Dong Soo Suk, Hyung Dong Kim, Soo Hyu Kim, Jae Hong Sim, Je G Chi
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Korean J Pathol. 1989;23(3):331-341.
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- Primitive neuroectodermal tumor (PNET) occuring in the brain (especially in the cereburm) of young individuals is a rare and highly malignant neoplasm. The authors analyzed 5 cases of primitive neuroectodermal tumor, operated from January 1986 to September 1987. They had characteristic clinical, radiologic and pathologic features. Patient's age ranged from 2 years to 14 years old (mean 8.2 years old) and there were 3 boys and 2 girls. They were rapidly growing tumor, with a brief duration of symptoms taking a rapidly progessive course. Computerized tomographic findings were characteristic, revealing the large, irregular, typically iso-to hyper-dense mass lesions with calcification and cystic or necrotic areas, and showing dense heterogeneous contrast enhancement of the mass in the cerebral hemisphere.
Grossly all of the 5 cases showed hemorrhage and necrosis with sharp border and 2 cases showed calcification and cystic change grossly. Microscopically, they were predominantly composed of undifferentiated small dark cells with evidence of focal differentiation along glial and or neuronal lines. Four cases showed glial differentiation and three cases showed neuronal differentiation. Mesenchymal components were predominant in 3 cases.
- Morphological Observation on the Prenatal Development of the Human Heart (I): Study on the Early Cardiac Development using Human and Chick Embryos.
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Jeong Wook Seo, Je G Chi
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Korean J Pathol. 1989;23(2):187-197.
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- Normal embryonic development of human heart is studied with special emphasis to the formation of atrioventricular and ventriculoarterial connections and their significance in congenital heart disease. Twenty nine human embryos and 8 chick embryos are used in this study. Human embryos are analyzed by reconstruction of serial section slides and chick embryos are microdissected and examined by scanning electron microscopy. In the early cardiac development (Streeter horizon 12), bulbo-ventricular fold divided two ventricles first. The atrioventricular canal is incompletely divided and the canal was in contact neither with septum primum nor with ventricular septal crest. Infundibular and truncal septa were not seen. The division of A-V canal was observed during the stages 14-15. Septation of truncus arteriosus (Streeter horizon 15-17) was followed by septation of bulbus cordis (Streeter horizon 16-17). The shortening of mitral-aortic distance and downward left shift of aortic valve occured after the trunco-infundibular septation and finally the secondary interventricular formen closed at the end of seventh week (Streeter horizon 20-21).
- Supernumerary Tooth Germs in the Incistive Canal of Five Fetal Maxillas.
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Suk Keun Lee, Chang Yun Lim, Je G Chi
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Korean J Pathol. 1989;23(2):235-239.
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- Five fetal maxillas were obtained from the autopsy file of fetal postmortem examination, and were examined by serial micro-sections of frontal plane and horizontal plane.
Especially the area around the incisive canal of the maxilla was carefully observed. The results are as follows. 1) In 5 fetal maxillas extra-dental laminas and supernumerary tooth germs which are severely malformed in shape are found in the dilated incisive canal, where prominent vessels and nerves are distributed. 2) The supernumerary tooth germs disclose almost normal histo-differentiation of odontoblast and ameloblast, and there shows relatively abundant perifollicular fibrosis in the place of perifollicular bone.
3) It is observed that the over-growth of the extradental lamina from the dental ridge of deciduous central incisor frequently tends to direct toward the incisive canal that includes prominent vessels and nerves.
- Juvenile Cellular Adenofibroma of Breast: A case report.
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Je G Chi, Yeon Lim Suh
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Korean J Pathol. 1989;23(2):269-272.
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- Juvenile cellular adenofibroma of the breast is a unique neoplasm of the breast that should be differentiated from other important benign and malignant lesions of the juvenile breasts. We report a case with it's characteristic clinical, gross and histological features. The tumor was in the right breast with the size of 20 cm in maximum extent. This patient was also associated with hemihypertrophy of the right side. Microscopically the masses were characterized by prominent stromal cellularity associated with pericanalicular duct proliferation.
- Morphological Observation on the Prenatal Development of the Human Heart (II): Analysis of Cardiac Skeleton with Special Emphasis to Their Relation to the Bulboventricular Malformation.
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Jeong Wook Seo, Je G Chi, Kyung Phill Suh
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Korean J Pathol. 1989;23(2):198-207.
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- Two dimensional alignment of valves in the cardiac skeleton is studied using 49 fetal hearts. They are standardized with fixed length between the centers of mitral and tricuspid valves. The relations among the parameters and of wall thichness ratio are studied, especially by the change of gestational age, mitral aortic distance and pulmonary-aortic distance, the angles between the two lines and mitral-tricuspid line. Anterior shift of great vessels was seen in heart with gestational age less than 20 weeks. Long mitral-aortic distance showed anterior shift of the great arteries and left ventricle was relatively thicker than right ventricle. Narrow aortomitral-tricuspid angle denoted posterior shift of great vessels and thich right ventricle.
Short pulmonary-aortic distance denoted antero-posterior alignment and posterior shift of the vessels and thick left ventricle. Left-right alignment of vessels was not associated with right-ward shift but only with pulmonic displacement to the left. By these observation abnormal alignment of valves in cardiac skeleton would be a basic defect in bulboventricular malformation and we could find basic difference of cardiac skeleton, between normal variation and abnormal heart.
- Weekly Development and Growth of Tooth Germ in Korean Fetuses.
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Suk Keun Lee, Chang Yun Lim, Je G Chi
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Korean J Pathol. 1989;23(1):1-19.
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- In order to elucidate the developmental stages of human tooth germ during prenatal period, we examined 254 normal fetuses ranging in gestational age from six weeks to fourty weeks old histologically. Lim's developmental pattern of prenatal tooth germ was divided into three groups, the first group consisting of five grades (I, II, III, IV, V) was for the development of enamel epithelium the second group of three grades was for the deposition of dentin matrix and enamel matrix, and the third group of three grades (A, B, C) was for the growth of perifollicular bone. Some developmental progress between enamel epithelium and dental papilla could be identified by observation of the sequential development of deciduous and permanent tooth germs histologically. The following results were made. 1) The prenatal development of tooth germ showed similar weekly stages in both the maxilla and the mandible. The initial deposition of dentin matrix and enamel matrix (III-1 stage) started at 12-14 weeks of gestational age in the deciduous incisor and canine, and at 16-20 weeks of gestational age in the deciduous molars. And the initial deposition of dentin matrix and enamel matrix in the permanent first molar was at 20-22 weeks of gestational age, and that of the permanent incisor was at 34-36 weeks, and that of the permanent canine was 36-38 weeks, and of the permanent premolar was at 38-40 weeks. 2) The S-shaped curvature was characteristically found where the reciprocal induction of odontoblast and amelobast occurred actively in the developing tooth germ.
Primarily pre-ameloblasts which abutted on the dental papilla differentiate the condensed mesenchymal cells into odontoblasts, and secondarily matured odontoblasts which bulged into enamel epithelium produced dentin matrix and differentiated the shrunken pre-ameloblasts into ameloblasts. 3) The mandible grew more rapidly than the maxilla during the early prenatal period. The trabecular bone from both jaws proliferated initially into labial side of developing tooth follicle and gradually circumscribed the tooth follicle lingually and mesio-distally, to form perifollicular bone resultantly.
- Fatty Hamartoma of Epicardium.
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Hyun Wook Kang, Jung Ran Kim, Jeong Wook Seo, Je G Chi
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Korean J Pathol. 1989;23(1):132-135.
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- The fatty hamartoma of pericardium is characterized by abnormal accumulations of adipose tissue forming a recognizable mass. We reported a case that could best be put into "fatty hamartoma" group. This 66 year old male presented with atrial fibrillation came in for a anterior mediastinal mass. He received an operation for adenocarcinoma of ascending colon several months ago. The chest CT revealed an inhomogeneous mass in the right anterior mediastinal area, which was not clearly demarcated from the right cardiac border. The heart was deviated to the left side due to the mass. Surgical excision was performed under the impression of cardiac teratoma. The large mass was well encapsulated, and was bright yellow and partly pink, and measured 12x8 cm. Microscopically, the mass consisted predominantly of mature fat cells and abundant fibrous tissue with scattered nests of primitive cardiac muscle cells. Reviewing the literature we found the term "fatty hamartoma" could also refer to rhabdomyolipoma or fibrolipoma. Since it contains entrapped cardiac muscle cells, abundant fibrous tissue, multiple blood vessels and fetal fat cells, it could best the categorized into "hamartoma". The term "fatty" represents it's main component. Therefore we propose the term "fatty hamartoma" that could to be used further.
- Congenital Omental Cyst Associated with Hydrops Fetalis: An autopsy case.
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Mi Kyung Kim, Je G Chi
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Korean J Pathol. 1989;23(1):160-164.
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- Omental cyst is benign unilocular or multilocular endothelium-lined cyst that contains either chyle or serous fluid. They are uncommon yet interesting intraabdominal masses that may be difficult to diagnose clinically and often are missed on abdominal palpation. The etiology of this lesion has been subject to much discussion in the literature over the years with the principal debate centering around the question of whether or not this lesion is congenital. It is now recongnized that there is no single etiologic mechanism involved in the development of this lesion. Recently we have experienced an autopsy case of omental cyst occurring in a male fetus. Pregnancy was artificially interrupted at 28 weeks gestation due to suspicious mesenteric cyst or fetal ascites on ultrasonography. Postmortem examination showed hydrops fetalis, hypoplasia of the lungs, ad multifocal calcifications of myocardium. There was an omental cyst in the greater omentum which was 7x3 cm in size, unilocular and containing clear, straw-colored fluid and proteinacious core without evidence of bleeding or calcifications. Microscopic examination of this cyst showed cuboidal or flattened mesothelial lining cells and underlying loose fibrovascular connective tissue with discrete lymphocytic collections.
Rarity and interest on the pathogenesis made us redport this case.
- Phycomycosis Involving Ankle Joint: Report of a case.
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Eui U Park, Jung Ran Kim, Je G Chi
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Korean J Pathol. 1988;22(4):495-499.
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- Phycomycosis is an uncommon opportunistic fungal infection, involving several organs, such as brain, lungs, gastrointestinal tract and skin. Invasion of joint cavity by phycomycetes, however, has never been reported. We report a case of 33-year-old male who had had prehallux with congenital equinovarus and underwent correction operation on the right ankle joint. There after, joint pain and edema had developed on that site. He received reoperation and underwent excisional biopsy from there. Operation showed hypertrophied yellowish synovium. On microscopic examination, the tissue showed several foci of fibrinoid necrosis and suppurative and granulomatuous inflammation.
Periodic acid Schiff stain demonstrated broad. Aseptate hyphae that were wrinkled and folded.
- Intracranial Encephalocele: an autopsy case of anterior basal type.
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Hyun Wook Kang, Je G Chi, Tae Dong Park, Hum Rae Park
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Korean J Pathol. 1988;22(4):500-504.
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- Encephalocele is a relatively rare congenital anomaly which is classified into occipital, parietal, anterior syncipital and anterior basal type regarding to the protrusion site through the bony defect of the skull. Anterior basal type of encephalocele is important in view of it's pathogenesis as well as diagnostic difficulty because of invisibility on external appearance. We have experienced a case which could be best fit to anterior basal encephalocele. This type of encephalocele is extremely rare. This report deals with a case of deadborn of 34 weeks of gestation with body weight of 2400gm and head circumference of 32 cm. There was no evidence of protrusion of brain on external examination. On autopsy the normal brain structure was compressed by abnormal mass of brain with normal consistency which was found in the petrous portion of the parietal area and covered partly by the dura. In this case, there were another associated anomalies, such as atrophy of the left optic nerve, hemihypoplasia of the left mandible, patent ductus arteriosus, bilateral hydrocele, and Meckel's diverticulum.
- Delayed Radionecrosis of the Brain: A case simulating recurrent glioma.
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Shin Kwang Khang, Jun Ho Song, Kyu Ho Lee, In Wook Choo, Je G Chi
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Korean J Pathol. 1988;22(3):360-366.
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- An appreciation of the radiation changes in the brain adjacent to radiated glioma is of considerable importance from both clinical and pathological standpoint because the alteration in the brain parenchyma may result in a picture that mimics recurrence of the neoplasm. A 35 years old woman was admitted because of deterioration of consciousness which has started about 20 days ago. Past history revealed removal of left frontal brain tumor 4 years earlier and the diagnosis was grade II astroma. Postoperative radiation was done at that time. Sine then, she has been doing well.
Computerized tomogram showed an ill defined huge low density mass at right frontal and left posterior parietal areas, which was irregularly enhanced in postcontrast study.
Unlikely to the usual brain tumors, there was no mass effect on adjacent structures. Histologically acellular necrotic zone was alternating with hypercellular zone and most striking changes were vascular and glial reaction. Most of the vessels showed acellular hyliane thickening of their wall and some vessels were almost completely occluded. There was marked glial proliferation with considerable cellular and nuclear irregularities. Gemistocytic astrocytes were frequently seen and some were multinucleated.
- Nodular fasciitis (13 cases analysis).
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Jung Ran Kim, Je G Chi
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Korean J Pathol. 1988;22(2):190-194.
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- Nodular fasciitis is a rare and benign soft tissue tumor that can easily confused microscopically to spindle cell sarcoma. Therefore it is very important disease to the surgical pathologists. However, this lesion has been seldom reported or described in Korean literature. This paper deals with 13 Korean cases of nodular fasciitis diagnosed microscopically. It's pertinent clinicopathologic findings are described. The youngest patients among 13 cases was 18 years and the oldest was 63 years with the mean of 34 years.
Nine were males and 4 were females. Pathologically, the size of the lesion at the time of diagnosis ranged from 0.7 cm to 4.0 cm in the maximum extent. Two were smaller than 1.0 cm and 8 cases were between 1.0~3.0 cm. The site distibution was; trunk(5) upper extremitiy (4), lower extremity (2) and head (2). All the lesions were located in the subcutaneous tissue. The history of recent rapid growth was noted in nearly half of the cases. Mass and tenderness were two common manifestations. In one case, multiple nodules were found in the right breast and in flank. All of the lesions except one were managed by local excision. In one case, a wide excision was done under the impression of malignant fibrous histiocytoma of frozen section. Follow up observation of all cases did not show any evidence of recurrence in all.
- Subglottic Laryngeal Atresia: Associated with Tracheoesophageal Fistula.
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Gu Kang, Je G Chi
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Korean J Pathol. 1988;22(2):145-147.
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- A case of congenital laryngeal atresia of infraglottic type in a newborn infant is described for is rarity and importance of early diagnosis. This case was associated with tracheoesophageal fistula, and died in 5 minutes of life due to asphxia. Failure to intubate in the neonate should raise the possibility of laryngeal atresia and emergency management should be provided. The lung tissue was normally developing despite the complete obstruction of the outlet of the air and possible amniotic fluid passage.
- A Histopathologic Study of Mammary Dysplasia.
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Je G Chi, Chul Woo Kim, Yeon Lim Suh
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Korean J Pathol. 1988;22(2):123-130.
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- "Mammary dysplasia" and "fibroadenoma" represent almost all benign breast disease presenting with breast lumps. Mammary dysplasia comprises variable non-specific changes of stroma and epithelium, but fibroadenoma has been classified as a benign neoplasm, although both features not uncommonly coexist. Authors performed a blind microscopic review of 660 cases of benign breast lesions and the results are as followings. 1. Only 27.9% of all cases consisted of pure fibroadenoma in contrast to 57.5% in the original diagnosis.
2. Fibrocystic disease frequently contained foci of fibroadenoma showing varied stages (68.3%), and the younger age group presented more wide areas of fibroadenoma. 3. The most common feature of the fibrocystic disease was fibrosis, followed by cystic change, adenosis and epithelial hyperplasia in order of frequency. 4. Fibroadenoma may be a form of a spectrum produced by hormonal imbalance, and better classified as a nonneoplastic lesion.
- Spinal Fluid Cytology of Retinoblastoma.
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Je G Chi, Chul Woo Kim, Yeon Lim Suh
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Korean J Pathol. 1988;22(2):123-130.
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- Of all the primary central nervous system tumors, the medulloblastoma, glioblastoma multiforme, ependymoma and pineal germinoma tend to exfoliate in the cerebrospinal space. With all other types of the tumor, abnormal cells may seldom be definitely identified in the cerebrospinal fluid.
Up to now the tumor cells have been rarely found in CSF cases of retinoblastoma. We have experienced a case of advanced retinoblastoma that showed exfoliated cells in spinal fluid.
- Angiosarcoma of the Breast: Three cases report.
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Kyung Ja Cho, Geung Hwan Ahn, Je G Chi, Eui Keun Ham
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Korean J Pathol. 1988;22(1):97-104.
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- Three cases of angiosarcoma of the breast are described. One case in a 66 year old woman was a solid mass and histologically showed poor differentiation leading to a death 14 months after the diagnosis. Another two in 46 and 25 year old females were large vascular masses showing moderate differentiation with endothelial tufting and papillary projections, and abdominal and contralateral mammary, and liver metastasis occurred within postoperative 10 months and 6 months in each case. A radical mastectomy and adjuvant chemotherapy in case 2 were not lifesaving.
Although histologic degree of differentiation seems prognosis-related, angiosarcoma is the most malignant tumor of the breast.
- Fetus Papyraceus Caused by Velamentous Insertion of Cord to Dividing Membrane.
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Je G Chi, Sung Sik Shin, Kie Sook Yoo
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Korean J Pathol. 1987;21(2):108-110.
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- Fetus papyraceus, also called fetus compressus, is a mummified and compressed fetus as a result of fetal death during pregnancy. It is always associated with twin pregnancy, and the other litter is usually alive to compress the dead feuts. The cause of death of the fetus is not always clear. Recently we had a case of fetus papyraceus from a 25-year-old woman, which we thought most probably caused by velamentous insertion of the umbilical cord into the dividing membrane of the placenta, resulting fetal death and subsequently becoming fetus papyraceus.
- Subamniotic Hematoma as a Cause of Neonatal Death.
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Je G Chi, Ro Hyun Sung, Kyung Jae Shin
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Korean J Pathol. 1987;21(2):94-97.
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- An autopsy case of a newborn male who died of exsanguination into the subamniotic space of placenta presumably due to the rupture of the umbilical vein, is reported. This fetus, previously uneventful except for hydramnios and partial breech presentation showed obvious signs of fetal distrees during the first stage of labor that lasted for 6 hours to this 25 year old multigravid mother who came to the hospital because of labor pain at 29 weeks of gestation. Immediately after birth the baby was pale and the Apgar score was 1. He died 30 minutes after birth. Postmortem examination confirmed generalized pallor in this 1380 gm baby, with petechial hemorrhage of viscera and subarachnoid hemorrhage.
No other findings of the cause of death were found. The placenta showed large ellipsoid subamniotic hematoma containing approximately 76 ml of blood, which is 57% of the total circulation blood volume of the fetus.
- A Case of Ocular Neurofibromatosis.
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Je G Chi, In Ae Park
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Korean J Pathol. 1987;21(1):62-65.
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- Neurofibromatosis is one of the neurocristopathies that involve many system or tissues forming various types of lesion. Almost every tissue or organ can be involved by this disease. However, the eyeball itself is very rarely affected by this process. The findings seen in our case indicate the diversity of lesions in neurofibromatosis, and also suggest hamartomatous nature. Heterotopic ganglion cells and glial cells in uveal tract are not easily understood. We reported here a case of intra-occular neurofibromatosis with its characteristic involvement of the uveal tract, in a 21 year old female. Her ocular symptoms began at her age of 11 as poor vision and were slowly progressive together with multiple facial neurofibromas. The involved left eyeball showed many ganglioneuroglial cell nests in iris, ciliary body and retina. Minute plexiform neurofibromas were also seen in small nerve twigs around the eyeball.
- Lipoblastomatosis: A case with evidence of maturation.
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Je G Chi, Hyung Geun Song, Ill Hyang Ko, Hye Che Cho
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Korean J Pathol. 1987;21(1):57-61.
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- A case of lipoblastomatosis occuring in a 1 year and 10 month old boy is described. The tumor was first presented in the left foot at his age of 4 month, and was surgically removed. The tumor was grossly infiltrating skeletal muscle tissue, and was microscopically composed of lobulated fat tissue with prominent myxoid stroma and many immature mesenchymal cells and scattered multivacuolated lipoblasts.
The tumor recurred 11/2 years later and was again removed.
The tumor was equally lobulated and located inbetween skeletal muscle. However, this time lobulated tumor consisted almost entirely of mature fat tissue with scattered lipoblasts.
- Highly Differentiated Nephroblastoma Arising from Peripelvic Region.
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Gyung Hyuck Ko, Chul Woo Kim, Je G Chi
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Korean J Pathol. 1986;20(3):378-382.
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Abstract
- Typical nephroblastoma arise within the renal parenchyme and have pseudocapsules composed of compressed renal tissue, renal capsule and adjacent perirenal tissue. Therefore, it is rarely possible to determine whether the tumor arose from the cortex or medulla. Many authors believe that they are probably cortical in origin and arise from nodular renal blastema just beneath the renal capsule or in the centers of columns of Bertin. We experienced a nephroblastoma supposed to arise from peripelvic region. The patient was a 7 months old male infant with an abdominal mass. Left nephrectomy was done under the impression of nephroblastoma. Received specimen was a diffusely enlarged kidney with preserved normal outline, so it looked like a hydronephrotic kidney.
On section, the pelvis and calyceal system were dilated and totally filled with a gray white soft mass. Most portion of the mass was floating freely in the calyces and pelvis, and only a small portion was attached to the renal parenchyme but without invasion to it. Microscopically the mass was a nephroblastoma containing many well developed glomeruli and tubules. We presumed that the tumor arose from a nodular renal blastema in the peripelvic region, because the tumor had no connection to the renal cortex.
- Urachal anomaly: Two Cases Report.
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Jung Ran Kim, Eun Hee Suh, Je G Chi, Hyung Soo Kim, Choong Hee Kim
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Korean J Pathol. 1986;20(3):349-354.
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Abstract
- Two cases of urachal anomaly (1 urachal cyst and 1 patent urachus) are reported in a neonate and an eleven-year old boy, respectively. In case 1, the patient was born after an uncomplicated pregnancy to a mother who had taken progesterone during the first trimester. Because of breech presentation, cesarian section was elected to deliver a male baby weighing 2.3 kg who showed abdominal distension. The patient died of respiratory difficulty several minutes after birth. At autopsy, there was a large cyst in the midpoint of the abdominal and pelvic cavity. This round cyst was composed of two components, urachus and urinary bladder. No area of umbilicocystic fistula was present. The lining epithelium was chiefly of transitional type. Assocaited anomalies were segmental stenosis of posterior urethra, absence of abdominal musculature, bilateral polycystic kidney of Potter type IV, hydroureter, and hypoplasia of lungs. Low set ears, micrognathia and club foot were also present. In case 2 the patient was 11-year old boy. He had suffered from intermittent urinary dribbling from umbilicus since early infancy, whenever the abdominal pressure was increased. The patency of urachus was confirmed by fistulography. And the urachal anomaly was surgically removed. Histopathologically the resected patent urachus consisted of pseudostratified columnar to transitional epithelium resting on fibrous stroma mixed with well formed smooth muscle bundles.
- Myotubular myopathy: A case report.
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Je G Chi
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Korean J Pathol. 1986;20(3):328-331.
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- A case of a myotubular myopathy in a 5 year old boy is described. This was the first and the only boy to a 30 year old mother who had no prenatal or perinatal problems. No family history of muscle disease was present. His muscle weakness started from neonatal period but was very slowly progressive. The developmental milestones were generally delayed. He had repeated episodes of pneumonia. Muscle biopsy revealed characteristic cental nuclei in 68% of myofibers, and this findings was associated with generally small and round fibers and minimal interstitial change. No inflammatory reaction was present.
- Immunohistopathologic Changes in Experimental Allergic Encephalomyelitis.
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Woo Ho Kim, Je G Chi, Sang Kook Lee
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Korean J Pathol. 1986;20(3):277-287.
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- Experimental allergic encephalomyelitis (EAE) has been a well established animal model of postvaccinatal demyelinating diseases occurring in humans. Therefore elucidation of its pathogenesis would be very critical for the understanding of various human demyelinating diseases including multiple sclerosis. This study was performed to characterize the infiltrating cells in inflammatory sites and analyze the nature of the damage of blood brain barrier in experimental allergic encephalomyelitis. Experimental allergic encephalomyelitis was produced by administering homologous spinal cord homogenate together with complete Freund's adjuvant in guinea pigs. Immunostainings on guinea pig IgG, IgM, IgA and muramidase were performed by peroxidase-antiperoxidase or indirect immunofluorescent methods. The blood-brain barrier change was assessed by administering fluorescent Evans blue. Following results were made. In juvenile animals, both clinical findings and histopathologic changes were first noted by 3 weeks after injection and progressed during the whole experimental period. However, these findings were delayed in onset and low in incidence in adult animals. The clinical and pathologic changes started from the caudal portions and extended rostrally. The blood-brain barrier (BBB) was damaged and progressed starting also from the caudal portion of the spinal cord. The BBB changes were more severe in young animal than adult animals. Those changes preceded th histologic alterations. It is suggested that the BBB susceptibility is responsible for the caudal onset of histologic changes. Although the lesion has been thought to be induced by T-cell mediated hypersensitivity, infiltrating cells consisted mainly of muramidase positive histiocytes. A few immunoglobulin positive B cells or plasma cells could also be demonstrated in the lesion. The former usually infiltrated the parenchyme and the latter remained around the small or medium-sized vessels.
- Congenital Laryngeal Atresia: An autopsy case.
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Yeon Lim Suh, Sang Yoon Kim, Je G Chi
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Korean J Pathol. 1986;20(2):209-214.
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- Atresia of larynx is a rare fatal anomaly that should bring an immediate medical attention for proper managenent. We reported a case who died in neonatal period because of respiratory difficulty. His first problem was difficulty of inserting tracheal tube through the larynx. It was of interest in this case that he was presented with generalized edema and also massive lung edema. The lung was characterized by total absence of squamous and amniotic debris in the alveolar spaces and massive inflation of the alveoli by clear fluid that was thought to be amniotic fouid produced by the lung per se. Because there was no connection between oral cavity and the lungs, there would be no way the amniotic fluid outside the fetus. The laryngeal atresia was of infraglottic type and was complete with dispalced cricoid cartilage. Associated anomalies were left persistent supperior vena cava, perimembranous ventricular septal defect, spina bifida and focal cerebellar heterotopia.
- Teratoid Wilms Tumor: A Case report.
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Yeon Lim Suh, Je G Chi, Sang Eun Lee
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Korean J Pathol. 1986;20(2):229-234.
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- A three year old girl with a left renal teratoid Wilms tumor is reported. The tumor was located both inside and outside the kidney parenchyme, to form a well encapsulated mass containing two lobulated solid and cystic masses. The tumor consists predominantly of otherwise typical Wilms tumor irregularly mixed with teratoid tissue elements such as intestinal tract, mucous glands with argentaffin cells, goblet cells and transitional epithelium. These heterologous elements were regarded as diverse epithelial differentiation of totipotent cells in certain nephrogenetic period, and this tumor was considered to be hest called "teratoid Wilms tumor".
- Sclerosing Hemangioma of the Lung: A report of 2 cases.
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Sung Ran Hong, Hye Jae Cho, In Ki Paik, Ill Hyang Ko, Dong Soon Kim, Je G Chi, Eui Keun Ham
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Korean J Pathol. 1986;20(1):84-90.
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- Sclerosing hemangioma of the lung is uncommon benign neoplasm of uncertain histogenesis, although their radiological appearance is relatively distinct and well-defined. Recently, we experienced 2 cases of sclerosing hemangiomas of the lungs in 61 and 39 years old women. The light microscopic findings of the tissues are similar to the features reported by Liebow and Hubbell(1956). The basic cellular response is thought to be type II pneumonocytes because of findings of multilamellar-like bodies within stromal cells with electron microscopy in case I in addition to other characteristics generally found in epithelial cells.
- Hamartoma of the Lung: An autopsy case.
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Eun Hee Suh, Je G Chi
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Korean J Pathol. 1986;20(1):100-106.
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- The so-called chondromatous hamartoma of the lung is an uncommon(0.25% of autopsies) benign tumor consisting of mixture of cartilage, fat, undifferentiated mesenchymal cells and cleft-like spaces lined by a simple cuboidal or ciliated epithelium.) This lesion is now thought to be a true neoplasm rather than a developmental abnormality as the term originally implied. It is generally agreed that it arises in the connective tissue in relation to bronchial walls. We report an autopsy case of lung hamartoma which is associated with advanced tubular bronchiectasis and diffuse interstitial fibrosis. This single case casts some interesting points about its pathogenesis. The patient was a 47 year old woman and had a 2 cm sized well circumscribed pulmonary mass which was located in the subpleural portion of right upper lobe near the minor fissure. On the basis of observations on the tumor and background lesion, we speculated that the multifocal lesions originating from submucosal immature connective tissue coalesce to become a large single mass. So the tumor possesses entrapped alveoli which exhibit the same changes as those of surrounding parenchyme. We also pressure that the inflammatory change may play a role in the initiation of neoplastic proliferating process in this kind of lesion.
- Rhabdomyoma of the Orbit: A report of a case.
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Kyungja Cho, Hyun Soon Lee, Je G Chi, Hum Chung
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Korean J Pathol. 1986;20(1):125-131.
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- The patient was a 7 months old Korean girl, who was admitted to Department of Ophthalmology of the Seoul National University Hospital, with 6 months history of the left eyelid swelling and exophthalmos. Visual acuity and ocular movement were unaffected. Orbit CT revealed 1.5x.5 cm sized well circumscribed intraconal mass in the left retrobulbar space with pressure erosion of adjacent bone. At surgery, the mass was pinkish gray and firm, and was adherent to adjacent tissue. The whole mass could not be removed, and a local excision was done.
- A Human Embryo of Streeter Age Group XXIII.
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Je G Chi, Chul Won Chung
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Korean J Pathol. 1986;20(1):116-124.
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- A human embryo obtained incidentally from a hysterectomy specimen of a 36 year old woman who was operated for chronic pelvic inflammatory disease, was serially sectioned and reconstructed with 104 section slides. This embryo was characterized by a thick corneal body with well developed Descemet's endothelium, the optic nerve having vascular canal, the cochlear turning a little more than one time, the hypophysis with threadlike stalk, the vomeronasal organ having intermediate long narrow canal, the submandibular gland with deep lumen, the kidney with short secretory tubules and few large glomeruli and a well formed osseous band in the cartilage and bone. From above findings, it was concluded that this embryo belongs to the age group XXIII of Streeter's developmental horizon.
- Studies on Placentas among Koreans: Gross and microscopic examination of 4,000 consecutive placentas.
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Tae Dong Park, Je G Chi, Sang Kook Lee, Syng Wook Kim
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Korean J Pathol. 1986;20(1):12-25.
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- As increasing concern for the fetal aspects of pregnancy, the availability of normal standard of placenta becomes more and more important. because it is very difficult to test the functional capacity of placenta. And for this reason anatnmic studies to determine the normal relationship between the placenta and newborn infant have come to be a considerable importance. A study of morphometric features of 4,000 consecutive placentas delivered at the Seoul National University Hospital during a period of 3 years, from April 1979 to May 1982, in relation to gastational age and weight of newborn was carried out. The findings could be summarized as follows: 1) Among 4,000 consecutive deliveries there were 3,771 liveborns 76 deadborns, and 153 cases of abortion, respectively. 2) The average weight and dimensions of term placenta were 511 gm and 19.94 x17.09 x1.89 cm, respectively. The weight , size and volume of placenta were progressively increased from 20 weeks of gestation till 41 weeks. 3) Morphometric features of placenta such as placenta weight, dimension, fetoplacental ratio and placental co-efficient showed a more significant correlation with birht weight than with gestation age. 4) The average length of umbilical cord was 39.80 cm, with the range of 6 cm to 124 cm. 5) The congenital anomalies of newborn was encountered in 74 cases (1.85%) among 4,000 consecutive deliveries. Anomalies involving musculoskeletal system was the most common oen. 6) The abnormal gross findings among 4,000 consecutive placentas included 6 cases of single umbilical arteries, 4 cases of chorangioma, 545 cases of infarction and 748 cases of calcification.
- Morphological Observation on the Prenatal Development of Human Femur: Analysis of 146 embryos and fetuses.
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Yeon Lim Suh, Je G Chi
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Korean J Cytopathol. 1985;19(4):377-390.
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- To evaluate the prenatal development of human femur, a histologic study was made based on normal femora of 24 embryos and 122 fetuses ranging in age from 5 to 41 weeks of gestation. Following observations were made. 1) The femur starts to be formed as mesenchymal condensation in the lower limb bud at 5 weeks of gestation. 2) By the end of the embryonic period (8 weeks), most of the skeleton of lower limb bud consisted of cartilage model defined by perichondrium. 3) At 9 weeks of gestation, endochondral ossification and primary bony trabeculae were prominent in the central portion of cartilage model. 4) At 11 weeks of gestation, along with pregression of endochondral ossification proximally endochondral growth zone was established near the proximal chondro-osseous junction. 5) At 12 weeks of gestation, most centrally located trabeculae were removed, and the marrow cavity and hematopoietic cells were recognized. The cartilage canal was also recognized at this time in the proximal epiphyseal cartilage. 6) In the middle of prenatal life (15-30 weeks), the shape of the femur was reconstructed by remodeling process. 7) The lamellar bone began to form by 31 weeks of gestation. 8) At 15 weeks of gestation, proximal end of ossified shaft showed convexity, and at 29 weeks this convexity was altered to form a rather distinct angulation. 9) As the femoral shaft elongated, primary bony collar continued to develop near the growth plate and remained at the level of the hypertrophied cartilage.
- Sturge-Weber Syndrome: Report of an incomplete form.
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Hye Yeon Kim, Kap No Lee, Seung Young Paik, Ki Chan Lee, Chang Soo Lim, Suck Ho Nam, Je G Chi
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Korean J Cytopathol. 1985;19(2):226-230.
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- The Sturge Weber syndrome is an uncommon disorder characterized by port-wine nevus of the face with angiomatosis of the ipsilateral cerebral leptomeninges and extensive calcification in the underlying cerebral cortex.
Associated with this syndrome are mental retardation, choroidal angioma, buphthalmus or glaucoma, seizure and hemiplegia. We studied a case of incomplete form of Sturage Weber syndrome in a 12 year-old boy, who had generalized seizure, a homonymous hemianopsia, intracranial calcification and leptomeningeal angiomatosis. There are no characteristic facial nevus, mental retardation, occular changes and hemiplegia.
- Foreign Bodies in Surgical Tissue Section.
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Yoon Seong Lee, Je G Chi
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Korean J Cytopathol. 1985;19(2):187-193.
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- Foreign body reaction of tissues is frequently encountered in routine surgical pathology, whether they contain foreign body or not. Though their presence or identification may be the important clue for the legal problems as in malpractice, and the identification of foreign body will give us the chance for reconstruction of patients' medical history, pathologists often overlook or neglect what they are.
Besides curiosity, the description of individual foreign body and common site for its occurence will be of great help. Therefore, we classify and describe the features of 182 foreign bodies collected in practice of surgical pathology during 1979~82.
- Sacrococcygeal Teratoma: 21 cases analysis and speculation on its pathogenesis.
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Chul Woo Kim, Je G Chi
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Korean J Cytopathol. 1985;19(1):67-75.
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- A total of 21 cases of sacrococcygeal teratomas is reviewed and analyzed histopathologically. They were 15 mature teratomas, one immature teratomas, and five endodermal sinus tumors. All but one neoplasm occurred in infants aged 3 years or younger and had visible masses at birth. Seventeen of these cases occurred in females. In mature teratomas, variable teratoid elements were observed and neuroglial tissue was particularly prominent among them. Also found were gastrointestinal mucosa, respiratory mucosa, pancreas, retinal tissue, and cartilage in order of frequency. Only one case of mature teratoma recurred and turned out to be endodermal sinus tumor with metastasis to the lungs. One immature teratoma showed undifferentiated neuroectodermal tissue in over half of the total area and the remaining portion consisted of mature neuroglial tissue and gastrointestinal mucosa. All endodermal sinus tumors were not combined with germinomatous or choriocarcinomatous elements. Three cases of endodermal sinus tumor contained mature teratoid components adjacent to the carcinomatous area. Based on the findings described above, we discussed some different histopathologic characteristics between the sacrococcygeal teratomas and gonadal teratomas, and speculated the possible origin of sacrococcygeal teratoma from the sequestrated protein in the proximal part of cloacal membrane. And this sequestration might be occurred during the process of cephalo-caudal folding in early embryonal period.
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