Journal of Pathology and Translational Medicine

Volume 17(2); January 1983

Etcs

Morphometric and Histochemical Studies on the Mucosa adjacent to Primary Carcinomas of the Colon and Rectum: Chan Il Park, Tae Seung Kim, Dong Sik Kim; J Pathol Transl Med. 1983;17(2):95-104.

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Abstract: 원발성 대장선암의 조직발생기원을 추구하기 위하여 지난 10여년 간 암병변 주위점막의 변화에 관한 연구가 진행되어 왔으며, 현재까지 기술된 변화들은 crypt에 구조적 변화가 초래된다는 것과 대장점액이 sulfomucin에서 sialomucin으로 바뀐다는 것으로 요약할 수 있다. 실험동물에 DMH를 투여하면 인체 대장암 주위점막에서 볼 수 있는 변화와 유사한 과정을 거쳐서 암이 발생하며, 특히 점액성분의 변화는 일정시기의 태아에서와 같다는 보고들로 미루어 볼 때 이러한 주위점막 변화는 대장암의 전암병변일 가능성이 매우 짙으나 아직도 대장암에 의한 2차적 변화일 가능성이 완전히 배제되지 않고 있다. 이에 저자들은 원발성 대장선암 66예의 주위점막에 대하여 광학현미경적 조직계측과 aldehyde fuchsinalcian blue(pH 2.5) 및 high iron diamine(HID)-alcian blue(pH 2.5)를 이용한 조직점액성분변화를 조사하고 이를 cloacogenic carcinoma, anorectal squamous cell carcinoma, 자궁경부로부터의 전이암, 육종 및 장결핵을 포함한 양성병변들과 비교하였던 바 다음과 같은 결과를 얻었다. 병변으로부터 4㎝ 상부의 점막을 대조점막으로 할 때 원발성 대장선암과 cloacogenic careinoma에서는 주위점막(TM)의 crypt 깊이가 대조점막(CM)보다 각각 1.71배 및 2.12배, crypt 직경이 각각 2.17배 및 2.99배 증가하였으나 기타 질환에서는 TM과 CM간에 뚜렷한 차이를 보이지 않았다. Crypt의 분지도 원발성 선암 66예 중 62예와 cloacogenic carcinoma 2예 모두에서 관찰되었으나 그 외의 병변에서는 이러한 점액성분의 변화를 볼 수 없었다. 이상의 결과로 보아 대장선암 TM의 crypt 구조 및 점액성분 변화는 원발성 대장상피암의 전암병변으로 사료되었으며 원발성 대장암의 조직기원에 있어서 가장 먼저 초래되는 변화는 sialomucin을 함유한 goblet cell 증식이고 이로 인하여 crypt의 구조적 변화가 야기되며, 세포학적 이형성 및 점액의 감소는 그 후에 초래되는 암형성의 과정이라고 추측되었다.

Antiplatelet Antibodies Detected in Thrombocytopenia with Indirect Platelet Suspension Immunofluorescence Test: Young Joo Cha, Hang Ik Cho, Sang In Kim; J Pathol Transl Med. 1983;17(2):105-111.

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Abstract: Indirect platelet suspension immunofluorescence test was performed in sixty-seven patients with thrombocytopenia. Clinical diagnoses were idiopathic thrombocytopenic purpura (ITP) in 17, multiple transfusion in 16, systemic lupus erythematosus in 8, rheumatoid arthritis in 2, autoimmune hemolytic anemia in 1, malignant lymphoma in 1, multiple myeloma in 1, neonatal thrombocytopenia in 1, and non-immune thrombocytopenia in 20. The results are as follows: 1) Antiplatelet antibodies were positive in 2 of 17 cases with ITP (12%) 2) Of 13 cases with autoimmune thrombocytopenia other than ITP, antiplatelet antibodies could be detected in 4 cases (31%). 3) Antiplatelet antibodies were detected in 5 out of 16 cases with multiple transfusions. HLA antibodies were detected in 3 and platelet-specific antibodies in 2 among 5 cases with positive antinlatelet antibodies. 4) Among 11 cases with positive antiplatelet antibodies, IgG antibodies were detected in 8 (73%), IgM antibodies in (18%), and IgG puls IgM in (9%). 5) In one case of SLE with positive antiplatelet antibody, an increase in platelet count was observed, being antiplatelet antibody negative during therapy with prednisolone. 6) Of 20 cases with non-immune thrombocytopenia, all were negative in indirect platelet suspension immunofluorescence test. On the basis of these findings, it was considered that the indirect platelet suspension immunofluorescence test would be a useful method for detection of platelet autoantibodies and alloantibodies. IgM agglutinins, IgG non-agglutinating antibodies, platelet-specific antibodies, and HLA antibodies were also detectable with this method.

Koilocytotic Atypia and Cervical Neoplasia: Hye Yeon Kim, In Sun Kim, Seung Yong Paik; J Pathol Transl Med. 1983;17(2):112-118.

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Abstract: The concept of koilocytotic atypia of the cervix was defined and developed by Koss although the morphologic alterations were described previously by others. The koilocytotic atypia and squamous cell carcinoma frequently coexist and their histologic features sometimes merge imperceptibly. In the author's study, forty-five hysterectomized specimens were obtained for cervical squamous cell carcinoma to determined the association of the koilocytotic atypia with cervical malignancy. Forty-five controls were selected from patients who were underwent hysterectomy for uterine leiomyomas. According to a blind semiobjective scoring system of the Reid, the results are as follows: 1) The major histologic features of the neoplastic group were koilocytotic cytoplasmic vacuolization (98%), basal cell hyperplasia (98%), binucleation (96%) and dyskeratosis (93%). But stromal changes were not significant. Those of the control group were basal cell hyperplasia (31%), koilocytotic nuclear changes (13%) and acanthosis (13%). 2) Forty-three of 45 women (95.6%) showed histologic evidence of hyman papillomavirus infection. Forty-three of the controls, but none of the neoplastic group, had normal cervical epithelium. As a result, it was evident that there is association of koilocytotic atypia and cervical malignancy.

Studies on β-Glucuronidase Activity in the Rats with Clonorchiasis: Yeon Jae Cheong, Sun Kyung Lee; J Pathol Transl Med. 1983;17(2):119-126.

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Abstract: This study was performed in order to investigate the changes of β-glucuronidase activity in rats with clonorchiansis. The rats were experimentally infested with 200 metacercariae of Clonorchis sinesis. The metacercariae were isolated from the Pseudorasbora parva by digestion technique. The animals were killed by a depletion of blood at 1st, 2nd 3rd and 4th week after infestation; the livers and blood in the heart were obtained and examined immediately for the enzyme activity. The livers were also examined morphologically. The results obtained were summarized as follows; 1) Marked papillary and adenomatous hyperplasia of bile ducts and acute and chronic inflammatory reaction of the portal areas were observed in the liver of rats with clonorchiasis. The hyperplasia of bile ducts was somewhat more severe as the days go by. 2) β-glucuronidase activities in the liver and serum were significantly increased form first to fourth week after infestation compared to the findings of control animals. 3) There was a positive correlation between β-glucuronidase activities in the liver tissue and serum. On the basis of the above findings, it was suggested that Clonorchis sinensis is a continuously increasing factor of β-glucuronidase activity in the liver and serum, and that there is a correlation between increase of β-glucuronidase activity and hyperplasia of intrahepatic bile ducts.

Cardiac Conduction System -Morphologic observations on the autopsy cases-: Jeong Wook Seo, Je GeunChi, Sang Kook Lee; J Pathol Transl Med. 1983;17(2):127-137.

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Abstract: Sinoatrial (S-A) nodes and atrioventricular (A-V) nodes of 13 human hearts were examined by regular step sections and morphometry. Eleven cases were from fetuses, infants and children, and the others were from adult cases. S-A nodes were examined in 3 ways. The first one was resection, horizontal trisection and regular step sections by 100 micrometers. The second one was resection, longitudinal bisection and regular step sections, and the third one was regular step section in toto. Fifty sections were obtained from each node, and length of tissue in paraffin block was calculated from the total count of sections. Location, area and volume of S-A nodes were measured and corrected. The major sources of errors were contraction during formalin fixation, contraction during dehydration and paraffin embedding, and irregular change of length during microtoming. The latter two were corrected by use of total section count and measurement of length of paraffin on slide. The following results were obtained. 1) S-A node is located at one fourth (26.8/100) of the length of sulcus terminalis, below the summit of atrial auricle. S-A node is located at subepicardium of sulcus terminalis. (Crista terminalis is at some distance.) 2) Relative range of S-A node is 16.8/100 of the length of sulcus terminalis. And it decreases as cardiac weight increases. Relative volume of S-A node is 1/20,000 of the volume of heart. And it decreases as cardiac weight increases. 3) S-A node is located at the right atrial subendocardium, at some distance above the center of tricuspid septal leaflet. The node runs antero-inferiorly to the His bundle and pierces the cardiac skeleton.

Histopathologic Study on Hodgkin's Disease: Sung Sik Shin, Je G Chi, Sang Kook Lee; J Pathol Transl Med. 1983;17(2):138-143.

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Abstract: A total of 42 cases of Hodgkin's disease was obtained from the file of Department of Pathology, College of Medicine, Seoul National University during a period of 7 years from 1976 to 1982. These cases were critically reviewed microscopically and classified according to Rye modification of Lukes-Butler classification. In 42 cases of Hodgkin's disease the patients ranged in age from 5 to 75 years, with an average of 35.1 years. Male to female ratio was 5:1. Histological types consisted of 17(40.5%) mixed cellularity, 12 (28.6%) lymphocyte depletion, 7 (16.6%) lymphocyte predominance and 6 (14.3%) nodular sclerosis. Biopsy sites were lymph nodes in 36 cases, spleen in 2 and gastrointestinal tract in 4. Comparing with previously reported material on non-Hodgkin's lymphoma in our department, there were 25 cases of Hodgkin's disease and 160 cases of non-Hodgkin's disease comprised 13.5% of all malignant lymphoms. In conclusion, Hodgkin's disease in Korea seems to be characterized by relatively low incidence comparing with non-Hodgkin's lymphoma, and low relative frequency of nodular sclerosis type, while lymphocyte depletion type is relatively high.

Sézary Syndrome: Hyung Sik Shin, Chang Sik Shin*, Seong Hoe Park, Eil Soo Lee*; J Pathol Transl Med. 1983;17(2):144-152.

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Abstract: Sézary syndrome was first described in 1983, by Sézary and Bouvrain. The classical description of this syndrome consist of generalized pruritus, exfoliative dermtitis with edema and thickening of the skin, ectropion, leonine facies, alopecia, dystrophic nails, keratoderma of the palms and soles, and lymphadenopathy associated with leukocytosis and abnormal mononuclear cells. We present a case of Sézary syndrome, in a 50-year-old male farmer with generalized exfoliative erythroderma, keratoderma of palms and soles, generalized lymphadenopathy, hepatomegaly, and pruritus, as clinical features, and severe leukocytosis (W.B.C.: 66.000㎣ of blood) with increased atypical mononuclear cells (21,120/㎣ of blood) in the peripheral blood, of which most were identified as cerebriform mononuclear cells with electromicroscopy as hematologic features. Histopathologic findings of the skin lesions revealed hyperkeratosis with parakeratosis and slight acanthosis of epidermis, moderate to marked mononuclear cells mixed with a few atypical cells in the papillary and upper dermis with epidermotropism. Axillary lymph node biopsy findings showed loss of normal architecture and marked infiltration of mononuclear cells with many atypical cells. Chemotherapy with vincristine, cyclophosphamide, adriamycin, bleomycin, and prednisolone, was done. Two weeks later, the exfoliative erythrodermic lesion and pruritus were nearly subsided and a few atypical lymphocytes (504/㎣) were observed in peripheral blood smear.

A Case of Weak Blood Group B Expression: Mi Young Park, Kyung Soon Song, Samuel Y. Lee; J Pathol Transl Med. 1983;17(2):153-155.

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Abstract: Weakened forms of the B antigen was first discovered by Moullec in 1955. Common causes for these findings are due to rare alleles at the ABO locus, action of other genes on normal ABO genes, or environmental variations such as weakening of A and B antigens in leukemia & acquired antigens as a result of infection. Weak B activity due to acquired B antigen phenomenon is known to be found only in A1 person. These acquired variations of B are manifested secondary to the bacterial infection, malignancy, and aging. A 43-yr-old female patient who was once blood typed as O, had weak B antigen with cold reacting anti-B in her sera. It was thought to be as rare B type subgroup although some other possibilities of acquired B antigen could not be ruled out.

Light Chain Disease, Lamda Type -A case report-: Kyung Ja Han, Won Il Kim, Sun Moo Kim, Chong Moo Lee; J Pathol Transl Med. 1983;17(2):156-159.

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Abstract: Light chain disease is a type of multiple myeloma. Its clinical manifestation and bone marrow features are similar to those of other myelomas, but its prognosis is poorer than others. The authors have experienced a case of light chain disease by the electrophoresis and immunoelectrophoresis of the serum and urine and bone marrow biopsy with immunoperoxidase staining. This is a report of the case with clinical history and laboratory studies. A brief review of literature is added.

A Case Report of Myxoid Leiomyosarcoma of the Uterus: Han Kyeom Kim, Jong Sang Choi, Seung Yong Paik, Myung Seo Kim*; J Pathol Transl Med. 1983;17(2):160-164.

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Abstract: Although myxoid change is known to occur in smooth muscle tumors of benign or unspecified nature, leiomyosarcomas have rarely been mentioned in differential diagnosis of sarcomas with myxoid features. To date about six cases have been reported in the literature. This case report is of a 51-year-old woman whose uterus was found to contain a submucosal polypoid mass of myxoid leiomyosarcoma. It is believed to be the first recorded case of myxoid leiomyosarcoma of the uterus in Korea. Grossly, the uterine cavity was filled with a large polypoid mass originating from right lateral wall of fundus. The mass was 5×2.5m in cross and characterized by a gelatinous appearance and an apparently circumscribed border. On microscopical examination, However, it was observed to invade adjacent myometrium and contained copious amounts of myxomatous stroma. Although it was difficult to establish the nature of the neoplastic cells in some areas of these tumor, both light microscopial and histochemical examination showed characteristic features of smooth muscle cells in other areas. The mitotic count was 9/10 high-power-fields. The reported cases of myxoid leiomyosarcoma were those of recurrent lesions within 6 months to 10 years after surgical resection and had average mitotic numbers of 0-2/10HPF. To diagnose this case, mitotic count of 9/10HPF was helpful.

Double Outlet Right Ventricle, Taussing-Bing Type -An autopsy case-: Jeong wook Seo, Je G. Chi, In Aee Park, Sang Kook Lee, Yong Soo Yoon*, Sei Woen Yang*; J Pathol Transl Med. 1983;17(2):165-170.

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Abstract: 이중 유출로 우심실은 1957년 Witham에 의해 명명된 기형으로 대동맥과 폐동맥이 모두 우심실에서 나가는 심장기형군이다. 이 기형은 대동맥, 폐동맥 및 심실중격결손의 상호관계에서 여러 가지 변형을 보이기 때문에 그에 따라 임상소견도 다양하고 유사 심장기형과의 감별이 어려우며 그 정의 자체도 학자에 따라 이견을 보이고 있다. 저자들은 생후 20개월만에 사망한 남자아기에서 Taussing-Bing 형으로 생각되는 이중유출로 우심실을 부검하여 보고한다. 정상분만으로 태어난 이 아기는 출생시부터 청색증과 호흡곤란이 있었다. 머리가 점점 커져 수두증을 생각하고 뇌압을 낮추기 위한 뇌실-복강 연결관을 시술하였다. 수술에 의한 합병증으로 사망하였다. 흉부 방사선 촬영상 심장종대와 폐혈관 증가가 있었고 심전도상 우심방 및 우심실 비대가 있었다. 부검시 심장은 커져 있었다(119gm). 특히 우심실 비후가 현저하였다. 대동맥은 폐동맥의 우측 전방에 위치하였고 대동맥하 conus가 있어 삼첨판 및 승모판과의 연결이 없었다. 폐동맥은 정상위치에 있었다. 폐동맥하 심실중격결손이 있었고 그 결손을 통하여 폐동맥 판막과 승모판이 섬유성으로 연결되어 있었다. 좌측 관상동맥이 폐동맥 전방으로 주행하였다. 뇌의 부검소견은 연결형 수두증으로 양측 측뇌실과 제3뇌실의 심한 확장이 있었고 화농성 염증이 심하였다. 본례의 심장은 대동맥하 conus는 발달되어 있으나 폐동맥 판막과 승모판이 섬유성 연결을 보이기 때문에 이런 기형을 이중 유출로 우심실에 넣기도 하지만 학자에 따라서는 대동맥 전위증 혹은 그들의 중간형으로 분류하기도 한다. 저자들은 이중 유출로 우심실에서 대동맥과 승모판의 연결은 없어야 하지만 대동맥과 삼첨판 혹은 폐동맥과 승모판의 연결은 있어도 좋다고 생각하였고 아울러 이러한 형태학적 확인이 없이는 진단하기 어려운 기형이라고 생각하였다.

Alveolar Soft Part Sarcoma -A case report-: Chul Woo Kim, Sung Ho Lee, Ik Won Kang*, Je G. Chi**; J Pathol Transl Med. 1983;17(2):171-173.

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Abstract: A case of alveolar soft part sarcoma accurring in the abdominal wall in a 28 year old woman is reported. The mass was slowly growing during past 5 years to become hen egg sized. The lesion was suggested for a sort of malignant vascular neoplasm, clinically, on the basis of preoperative arteriographic findings, showing highly vascularized irregular mass fed by the right deep circumflexiliac artery with subsequent rapid venous drainage of pooled blood. Grossly, the mass was firm and measured 4.5×4.0×2.5㎝. The tumor was relatively well circumscribed except for areas where it blended into surrounding skeletal muscle. Cut surface showed pinkish gray in color with multifocal hemorrhagic microcystic appearances. Microscopically, tumor showed organoid arrangement of lobules separated by numerous delicate vascular septa. Individual tumor cell contained P.A.S. positive crystalline granules in the cytoplasm and prominent nucleolus. Brief comments on the histogenesis of this tumor, especially in relation to the vascular smooth muscle cell are made.

Persistent Hyperplastic Primary Vitreous -A report of a case associated with microphthalmia-: Je G. Chi, In Ae Park; J Pathol Transl Med. 1983;17(2):174-176.

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Abstract: 10개월 남아의 오른쪽 소안구를 검색한 결과 일차성 Vitreous의 잔종증이라고 생각되는 소견이 나타났는데 안구는 13×10×10㎜였고, 각막은 6×5㎜였다. 현미경적으로 렌즈의 석회화와 편위, 전방의 기형과 더불어 전반적 망막박리가 있었다. 한편 Vitreous 내에서는 렌즈뒤로부터 시신경 출구에 이르는 hyaloid 혈관과 함께 이형성 망막조직의 증식이 있었고, 이와 더불어 성숙 지방 조직도 그속에 포함되어 있었다.

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