Journal of Pathology and Translational Medicine

Volume 17(3); January 1983

Etcs

Subacute Necrotizing Lymphadenitis: I. Histopathologic Study: Young Hyeh Koh, In Joon Choi, Yoo Bock Lee; Korean J Cytopathol. 1983;17(3):257-262.

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Abstract: Since 1972, a unique lymphadenitis called as subacute necrotizing lymphadenitis has been described in many Japanese literature and a few English articles. This condition is accepted as a new entity in Japan, but not yet in other countries. We have occasionally encountered lymph node biopsies which showed histologic picture of subacute necrotizing lymphadenitis with clinical impression of malignant lymphoma. As an initial step to investigate the etiology of this disease, we studied the common clinicopathologic features in 24 cases of subacute necrotizing lymphadenitis. The lesion frequently developed in the cervical lymph node of young women, causing simple enlargement of lymph node and was accompanied by fever or pain occasionally. The duration of symptoms was within one month and seasonal distribution was not remarkable. In laboratory tests, WBC was below 4000/㎣ in 8 cases and Widal test was negative in all of 4 cases examined. Microscopically, the characteristic finding was the wide area of patch or confluent necrosis associated with numerous karyorrhectic nuclear dusts and surrounded by diffuse infiltration of immunoblastic or activated histiocytoid cells. No appreciable plasma cell or neutrophilic infiltration were noted.

Changes on Levels of Serum Lipoproteins, Fractions Total Cholesterol and Triglycerides in Liver Diseases: Byung Chang Kim, Soon Ho Kim; Korean J Cytopathol. 1983;17(3):263-270.

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Abstract: The author investigated changes of serum lipoprotein fractions, total cholesterol and triglyceride levels and some liver function tests in 46 cases of patients with various liver diseases who had visited or been admitted to the Department of Internal Medicine, Busan National University Hospital and 5 cases of healthy control subjects from January, 1983 to August, 1983. The 46 cases of liver disease were consisted of 11 cases of acute hepatitis, 11 cases of chronic hepatitis, 13 cases of liver cirrhosis and 11 cases of hepatocellular carcinoma. Diagnosis was confirmed clinically and histopathologically in all the patients. Serum total protein was measured by Biuret method and transaminase was measured by modified Henry method. The cholesterol and trigoycerides were measured by cholesterol oxidase and enzymatic methods, respectively. The protein and lipoprotein fractions were analyzed by cellulose actate electrophoresis. The results obtained were summerized as follows: 1) Serum pre-beta-lipoprotein level was significantly decreased in various liver diseases compared with controls and was more significantly lower in liver cirrhosis than in chronic hepatitis and hepatocellular carcinoma. And serum betalipoprotein level was significantly increased in various liver disease compared with controls. 2) Serum total cholesterol level was significantly decreased in liver cirrhosis and was significantly lower in liver cirrhosis than in chronic hepatitis and hepatocellular carcinoma. And serum triglyceride level was significantly decreased in liver cirrhosis and hepatocellular carcinoma but increased in chronic hepatitis. 3) There was posititive correlation between serum alpha-lipoprotein and alph-2-globulin in control and chronic heptitis, and negative correlation between pre-beta-lipoprotein and alpha-2-globulin and between alpha-lipoprotein and AST in control. And there was also negative correlation between pre-beta-lipoprotein and gamma-globulin in liver cirrhosis.

Total Serum Hemolytic Complement (CH50) Activity in Normal Korean Adults: Kyung Dong Kim, Myoung Hee Park, Jin Q Kim; Korean J Cytopathol. 1983;17(3):271-274.

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Abstract: The measurement of total serum hemolytic complement activity is a useful screening test for the integrity of the complete complement system of the classical pathway and hemolytic titration (CH50) assay is most commonly used. The purpose of this study was to examine serum values for total hemolytic complement (CH50) activity by the method of Mayor in 100 normal Korean adults in the age range from 18 through 57 years. The values showed Gaussian distribution, and we obtained reference range of 18-35 CH50 units/ml with tolence limits set for 95% of the general population.

Monitoring of Heparin Treatment -Comparison of TT, ACT, APTT and Plasma Heparin Concentration-: Mi Young Park, Kyung Soon Song, Samuel Y Lee; Korean J Cytopathol. 1983;17(3):275-281.

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Abstract: Heparin is used prophylactically in low doses mainly for patients undergoing surgery, and therapeutically in large doses for patients with acute venous or arterial thrombosis of pulmonary embolism. It is generally agreed that it is advantageous to monitor heparin therapy, but no such general agreement exists as to which tests are the most reliable. The activated partial thromboplastin time has gained popularity as an effective assay for following patients on heparin, and some investigators have used the thrombin time to monitor heparin. A new method for measuring the plasma heparin concentration using a chromogenic substrate has recently been made available. We therefore measured thrombin time(TT), activated partial thromboplastin time(APTT), activated coagulation time(ACT), and heparin concentration in 34 samples from 15 patients being treated with various heparin doses. Statistical correlation was evaluated between these coagulation tests and plasma heparin concentration. The results are as follows: 1) Heparin concentrations in 34 samples were 0.2-0.4 U/㎖ therapeutic range in 9 samples (27%), lower than 0.2 U/㎖ in 19 samples (56%), and higher than 0.4 U/㎖ in 6 samples (17%). 2) Statistical correlation coefficient between plasma heparin level and coagulation assays such as TT, APTT, ACT were 0.812, 0.780 and 0.715, respectively. 3) APTT was relatively well correlated with ACT, but correlations between other coagulation tests (APTT and TT, ACT and TT, ACT and CT) were less satisfactory. As a conclusion, TT, APTT and ACT were sensitive enough to heparin effect for use in monitoring of patients and the determination of heparin level in plasma can be practical method for therapeutic monitoring

Extraintestinal Infection with Shigella: Yong Ho Chung, Sook Jin Jang, Wha Soon Chung, Choon Won Kim, Ki Hong Kim; Korean J Cytopathol. 1983;17(3):282-287.

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Abstract: Shigellosis has continuously posed considerable clinical problems in Korea. Shigella infections are practically always limited to the gastrointestinal tract but occasional infections, although rare, are documented. The authors have isolated 17 strains of shigella from various unusual infection sites at Han Yang University Hospital from Jan. 1983. They are as follows. Eight strains of shigella were isolated from vaginal swab, one of which was S. dysentery and the remainders were S. genitalia. The chief complaints of these patients were vaginal discharge and only one patient showed vaginal spotting. Three of them showed hyperemic external genitalia. All strains were isolated from children under 10 years of age and in winter. Four strains of S. flexneri were isolated from urine and the chief complaints were variable depending upon the underlying diseases. One strain of S. flexneri and one strain of S. sonnei were isolated from bloods and the chief complaints were abdominal pain and hepatosplenomegaly. The remained three strains were S. flexneri and were isolated from throat, umbilical discharge and eye discharge, respectively. There strains were highly susceptible to dibekacin, sisomycin, tobramycin and gentamicin but resistant to penicillin, chloramphenicol, streptomycin and carbenicillin.

A Comparative Study of Bacterial Flora in Normal and Vaginitis Women: Ock Hwa Kim; Korean J Cytopathol. 1983;17(3):288-296.

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Abstract: There are many reports on the distribution of normal flora in the vagina and the causative agents of vaginal inflammatory disease. The most commonly encountered organisms are known to be doderlein bacillus which plays a major role in the cleanliness of the vagina. The other organisms frequently found in healthy as well as inflammatory vagina are staphylococci, streptococci, hemophilus species, diphtheroid bacilli, coliforms, fungi, and others. However the incidences of lactobacilli on the cultures show some differences between several authors. Also it is considered to be significant relationship of lactobacilli to the vaginal acidity as well as to vaginitis. Therefore this study is aimed to observe the distribution of bacterial flora in normal group and vaginal cleanliness and pH, were analysed. The results of the study were as follows; 1) The flora on direct vaginal smear in normal and vaginitis was graded according to the presence of doderlein bacilli. Cases of normal group reveals mostly grade I (38%), while vaginitis group reveals mostly grade II (42%). 2) 88% of the cases isolate on the culture of the vaginal flora in normal group and 90% of the cases isolate on the culture of the vaginal flora in vaginitis group. 3) The incidence of staphylococci, coliform group, hemophilus species and monilia in vaginitis group are higher than that of normal group, while the incidence of lactobacilli and diphtheroid bacilli in vaginitis group are lower than that of normal group. 4) 56% in normal group and 43% in vaginitis group grew on general culture media with 5-10% Co2. But 79% in normal group and 58% in vaginitis group of lactobacilli grew on selective media with 5-10% Co2, Also cultivation of vaginal lactobacilli on selective media gives satisfactory yield. 5) The distribution of vaginal pH values in vaginitis group reveals higher pH values than that of normal group. In the normal, vaginal pH values were distributed 4-5 predominantly, and vaginal pH values of vaginitis were distributed 5-6 predominantly. 6) Lower the pH value of vagina, lower the grading of direct vaginal smear, and also increase the positivity of lactobacilli on selective media.

An Autopsy Case of Dissecting Aneurysm (De Bakey Type I) of the Aorta Associated with Diffuse Atherosclerosis: Ki Hwa Yang, Byoung Kee Kim, Sun Moo Kim, Chong Moo Lee; Korean J Cytopathol. 1983;17(3):297-301.

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Abstract: Dissecting aneurysm was described by Morgagni in 1761. Although the cystic medial necrosis has been thought as the major cause of dissecting aneurysm, diffuse atherosclerotic change of the aortic intima may contribute the medical degeneration. Recently, the authors experienced a case of dissecting aneurysm associated with diffuse atherosclerotic change in the intima, in an autopsy case. A 60 years old male patient was admitted to the hospital because of indigestion and chilling sensation for 7 days. Three days prior to this entry, he experienced a sudden crushing chest pain, that was spontaneously releaved several hours later. He denied any past history of coronary heart disease, valvular hear disease or syphilitic infection. On admission, physical examinations revealed slightly puffy face, distended jugular veins, and palpable liver. Chest x0ray film revealed elongation and distortion of the greater vessels accompanied by cardiomegaly. Laboratory findings including complete blood count, blood chemistry, urinalysis, and VDRL were within normal limits. During admission, he was observed with supportive therapy. On the 8th hospital day, 18 days after first symptoms developed, he suddenly fell into unconscious state during defecation, and died soon after. The autopsy was limited to the cardiovascular system. The heart weighed 670gm, and about 1,500 cc of blood and clots were noted in the pericardial cavity. There was a rupture, 2.5×1.7㎝, in the ascending aorta near the aortic value, on the point 5㎝ distal from the aortic valve. The wall of the aorta was dissected near the aortic valve to the lower abdominal aorta (De Bakey Type I). Diffuse atherosclerotic change of the aortic intima was observed, but atheromatous ulcer was not observed. Microscopic findings revealed diffuse hyalin degeneration of the aortic media, intimal thickening and subintimal aggregations of foam cells with focal calcification.

Congenital Jejunal Diverticulum: Kye Yong, Jae Hyung Yoo, Youn Baik Choi*; Korean J Cytopathol. 1983;17(3):302-305.

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Abstract: 공장의 게실(憩室)은 1807년 Cooper에 의해 처음 기술되었으며 0.01-0.32%의 빈도를 나타내고 있다고 보고되어 있어서 극히 드문 질환중의 하나이다. 저자들은 4세의 남아에서 발생한 공장의 선천성게실 1예를 경험하고 문헌고찰과 함께 보고하는 바이다. 본 증례는 4세의 남아로서 심한 복통과 양측 견갑부 동통을 주소로 내원하였으며 당시 복부 X-ray 단순촬영상 양측 횡경막하부에 유리공기음영이 나타나 장천공을 의심하여 수술을 시행하였다. 수술소견상 Treitz 인대하방 70㎝ 부위 공장의 장간막반대부에 직경 1.5㎝ 정도의 천공의 발견되었고 그 주위에는 섬유소성 삼출액이 관찰되었다. 다른 부위는 정상이었으며 또 다른 게실은 발견되지 않았다. 수술은 게실을 포함한 공장의 부분절제술 및 충수돌기 절제술을 시행하였다. 육안적소견상 직경 4.5㎝의 게실이 장간막 반대부에서 발견되었으며 정상 공장내강과의 연결부위는 직경이 3㎝이었다. 천공부위는 게실의 정점에 위치하고 있었으며 섬유소성삼출액이 장표면을 덮고 있었고 활면상장벽의 출혈이 관찰되었다. 현미경소견상 게실은 잘 발육된 소장점막으로 피복되어 있었으며 림프절도 관찰되었고, 장벽은 근육층이 얇아져 있었으며 내측근은 얇게 구성되어 있었고 외측근은 불완전하게 발육되었으며 근육속으로 지방조직이 산재하고 있었다. 천공부위 점막에는 울혈, 출혈, 섬유소성삼출액이 관찰되었을 뿐만 아니라 섬유소성삼출액이 장막밖에서도 관찰되었으며 이러한 소견들을 종합하여 저자들은 공장에 선천성으로 발생된 게실이라 진단하였고 게실의 장천공으로 인한 합병증이 생겨 수술하게 되었다고 생각되었다. 또 이 증례를 통하여 선천성게실의 병인은 근육층의 이상발육과 장중복이 다 관여되리라 추측되었다.

Primary Leiomyosarcoma of the Small Intestine -Report of 2 Cases-: Jung Man Kim, Hwan Joo Choi, Kang Suek Suh, Soon Ho Kim; Korean J Cytopathol. 1983;17(3):306-311.

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Abstract: The incidence of leiomyosarcoma of the small intestine was low, variable reported 1 to 3 per cent of all neoplasms of the gastrointestinal tracts and 10 to 14 per cent of all cancers of the small intestine. We have recently experienced two cases of leiomyosarcoma, one of which is located in the ileum from 63-year old female and the other in the jejunum from 53-year old female. Grossly, the two tumor masses measured 7×6×5㎝ and 10×10×8㎝ in dimensions, respectively. There were areas of mucosal ulceration and hemorrhage over the mucosa. The cut surface of the masses was relatively well-demarcated, grayish white fibrous tissue with a few hemorrhagic necrosis throughout the whole layers except for mucosa. Metastasis was found in the retroperitoneum in one case and the liver in the other. Microscopically, both tumors were composed of interlacing bundles of smooth muscle cells having increased cellularity and atypical features. More than 6 mitoses per ten high power fields were found in both tumors. The metastatic lesions were infiltrated with above neoplastic cells. A brief review of literatures was made.

Cystic Mesenchymal Hamartoma of the Liver -A Case Report-: Je G. Chi, Hye Kyung Lee, Kwi Won Park, Woo Ki Kim; Korean J Cytopathol. 1983;17(3):312-314.

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Abstract: 15개월 남아에서 관찰된 간장의 낭성 간엽성 과오종의 1예를 보고하였다. 환자는 생후 11개월부터 복부팽만으로 시작되어 점차로 심하여졌으며 수술로 간종괴 거의 전부를 절제하였다. 크기는 16×15×8㎝였다. 종괴는 육안적으로 회백색으로 많은 낭성구조를 가지는 큰 종괴였으며 주위와의 경계는 명확하였다. 현미경적으로 간세포의 섬들과 더불어 담관의 증식이 있었고, 이와 함께 점액성 조직 즉 활동성 섬유 모세포증식과 부종 그리고 약간의 맥관조직의 증식이 관찰되었다.

Angiolymphoid Hyperplasia with Eosinophilia -Report of 2 Cases-: Gyu Sang Song, Dae Young Kang; Korean J Cytopathol. 1983;17(3):315-319.

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Abstract: Angiolymphoid hyperplasia with eosinophilia is a distinct clinicopathological entity characterized by proliferation of endothelial cells and lymphoid hyperplasia with germinal centers, associated with varying degrees of lymphocyte, histiocyte, and numerous eosinophil infiltration. The authors experienced two cases of angiolymphoid hyperplasia with eosinophilia. The first case was a 28-year-old female who had a slowly growing mass in the right elbow. The second was a 39-year-old male having a painless soft tumor in the inguinal region for 8 years. Marked eosinophilia (43%, 30%) were noted in both cases. Microscopic examination showed vascular proliferation, many well formed lymphoid follicles, and extensive eosinophil infiltration together with fibrosis. A discussion on its histogenesis and its relationship to Kimura's disease, with literature review, was made.

A Case Report of Lymph Node Infarction As a Presenting Sign of Malignant Lymphoma: Sook Ja Park, Ho Youl Choi, Sang Ho Kim, Chun Hee Lee*; Korean J Cytopathol. 1983;17(3):320-324.

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Abstract: A case malignant lymphoma accompanied by lymph node infarction is presented and the literatures of the case are briefly reviewed. This 55-year-old female patient was admitted to the Department of Internal Medicine of the Presbyterian Medical Center Because of neck mass. The peripheral blood smears showed moderate anemia and leukopenia with a few immature cells. Bone marrow smears showed 70% cellularity with predominant atypical lymphocytes. Sectioned marrow tissue revealed also 70% cellularity with partial infiltration of lymphoma cells. Bilateral neck mass biopsy tissue revealed complete infarction of lymph nodes. So a case of lymph node infraction as a presenting sign of malignant lymphoma is reported.

A Case of Leukemic Involvement of the Ovary in Acute Lymphoblastic Leukemia: Yong Ho Chung, Sea Yoon Chung, Wha Soon Chung, Choon Won Kim, Ki Hong Kim, Poong Man Jung*, Keun Soo Lee**; Korean J Cytopathol. 1983;17(3):325-330.

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Abstract: Since the advent of combination chemotherapy and central nervous system prophylaxis, more children with acute lymphoblastic leukemia have achieved prolonged remission. Prolonged survival has had result in extramedullary leukemia being recognized more frequently in patients still in bone marrow remission. Central nervous system and the testes have been the most frequently recognized antemortem extramedullary relapse sites. However, leukemic involvement of the ovary has received little attention, and the significance of ovarian-associated relapse in relation to the eventual outcome of the patient has not been ivestigated. Recently, we experienced an 11 year-old girl with acute lymphoblastic leukemia in hematological remission in whom a large ovarian tumor developed due to leukemic infiltration. We report in this case and briefly pertinent review of literature was done.

Urine Lactate Dehydrogenase Electrophoresis Showing Extra Isozyme Band -Report of 4 Cases-: Kyung Dong Kim, Jin Q Kim, Hyoun Chan Cho; Korean J Cytopathol. 1983;17(3):331-336.

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Abstract: Serum lactate dehydrogenase (LD) isozyme studies are widely used in various clinical conditions and there are well documented cases of extra LD bands in patients with various diseases. However, it is only in recent years that urinary LD isozyme patterns have been utilized for differential diagnosis of urinary trace infections and to our best knowledge extra LD bands in urine have not been reported in the literature. In recent two years, we have experienced urinary extra LD bands in 4 patients with clinical and laboratory evidence of urinary tract infections. Two of these patients had spesis and one was in postoperative state of prostatic carcinoma and nother one had recurrent urinary tract infection. These extra LD bands showed similar electrophoretic mobility, moving anodal to LD1 fraction on cellulose acetate electrophoresis. The origin and significance of these extra LD bands in urine is not known, and some of the possibilities are discussed.

Waldenström's Macroglobulinemia -Histopathologic and Electron Microscopic Observation-: Ki Sook Hong, Woon Sup Han, Ok Kyung Kim; Korean J Cytopathol. 1983;17(3):337-343.

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Abstract: We had experienced a case of Waldenström's macroglobulinemia in 45-year-old man, who visited the outpatient department of internal medicine due to bleeding diathesis of nose and gum, multiple lymphadenopathy, and general fatigue. Physical examination revealed mild hepatosplenomegaly and generalized lymphadenopathy. Serum protein electrophoresis shows the monoclonal gammopathy at the late beta-fraction. By the immunoelectrophorsis of serum protein, IgM, lambda-type macroglobulinemia was confirmed. Bone marrow smear and biopsy shows 61% of plasmocytoid lymphocytes atypical lymphocyte and mature and immature plasma cells. Cervical lymph node biopsy shows obliteration of normal structure by diffuse proliferation of plasmacytoid lymphocytes and histiocytes in subcapsular sinus, cortex and medulla. PAS positive intranuclear and intracytoplasmic inclusion bodies were seen in plasmacytoid lymphocytes. By electron microscopic findings of cervical lymph node, dilated rough endoplasmic reticulum which was filled with electron-light density and pale amorphous material. Intracytoplasmic and intranuclear inclusion bodies containing the same density material were seen.

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