Journal of Pathology and Translational Medicine

Volume 20(1); March 1986

Original Articles

Immunohistochemistry of Fibrohistiocytic Tumor and Malignant Soft Tissue Tumor Simulating Malignant Fibrous Histiocytoma.: Young Bae Kim, Hyeon Joo Jeong, In Joon Choi; Korean J Pathol. 1986;20(1):1-11.

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Abstract PDF: Soft tissue tumor is defined as a tumor occurring in voluntary muscles, fat, fibrous tissue, along with the vessels serving these tissue and peripheral nervous system. It is difficult to make a diagnosis by conventional microscopic observation because of their pleuripotentiality and similar growth characteristics. Although their morphological findings of tumors are similar to one another, their clinical courses, treatment and prognosis are different. So early, correct diagnosis and proper treatment are neccessary. The present study is aimed to evaluate a value of immunoperoxidase staining to make definite diagnosis of soft tissue tumors and its application to surgical pathology. The material consisted of 106 cases of fibrohistiocytic tumors and malignant soft tissue tumors which are morphologically similar to malignant fibrohistiocytic tumors for 5 years period lasting from 1980 to 1984 at the Department of Pathology, Yonsei University College of Medicine. After the classificationof fibrohistiocytic tumors by the Enzinger (1983), clinical finndings were reviewed and peroxidase antiperoxidase(PAP) method with alpha1-antichymotrypsin was done in 15 cases of all fibrohistiocytic tumors. Other soft tissue tumors which were difficult to differentiate from MFH by light microscopic observation were liposarcoma, rhabdomyosarcoma, fibrosarcoma and malignant schwannoma. These 21 cases of tumors including MFH were stained with PAP method for alpha1-antichymotrypsin, S-100 protein and myoglobin.
Results
obtained were as follows: 1) The cases on study consisted of 19 cases of malignant fibrous histiocytoma, 2 dermatofibrosarcoma protuberans, 45 fibrohistiocytic tumors and 11 other benign fibrohistiocytic tumors. 2) The male to female ratio was 1 : 1.8 in benign and intermediate group of fibrohistiocytic tumor, but 2.2 : 1 in malignant histiocytic tumor. 3) Most cases of benign fibrohistiocytic tumors were occurred in 4th and 5th decade of life. Intermediate and malignant fibrohistiocytic tumors were mostly found in late adult life and their mean age was 43.6 year. 4) The most common sites were trunk and both extrimities in benign fibrohistiocytic tumors(88.9%), but head, neck and lower extremities in MFH (78.9%). Two cases of dermatofibrosarcoma protuberans were occurred in turnk and upper extremity. 5) The PAP stain for alpha1-antichymotrypsin was done in 15 cases of 77 fibrohistiocytic tumors which included MFH, dermatofibrosarcoma protuberans, xanthoma, xanthofibroma, dermatofibroma showed variable degree of positivity to alpha1-antichymotrypsin. The positivity of alpha1-antichymotrypsin revealed no significant difference according to differentiation of the tumors, such as benign, intermediate and malignant. 6) The PAP stain for alpha1-antichymotrypsin revealed diffuse positivity in all cases of MFH and also in a case of malignant schwannoma, fibrosarcoma, liposarcoma and rhabdomyosarcoma, but myoglobin and S-100 protein were negative. In three cases of leiomyosarcoma, two of rhabdomyosarcoma and three of malignant schwannoma, alpha1-antichymotrypsin, S-100 protein and myoglobin were negative, although a few positive tumor cells were present, which may the considered as metatypci differentiation. Another possibility of this discordance was loss of antigenicity by improper procedure of paraffin embedding and poor differentiation of tumor cells. In summary, PAP method for specific tumor marker is important for proper diagnosis of soft tissue tumors, and application to surgical pathology.

Studies on Placentas among Koreans: Gross and microscopic examination of 4,000 consecutive placentas.: Tae Dong Park, Je G Chi, Sang Kook Lee, Syng Wook Kim; Korean J Pathol. 1986;20(1):12-25.

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Abstract PDF: 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.

Clinical and Histopathological Studies on Salivary Gland Epithelial Tumors.: Soon Yol Hwang, Kang Suek Suh; Korean J Pathol. 1986;20(1):26-34.

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Abstract PDF: The author has studied the 111 cases of salivary gland epithelial tumors which confirmed clinically and pathologically during the period of 11 years and 7 months from 1973 to 1984 at Pusan National University Hospital. The results of the study were summarized as follows: 1) Among 111 cases of salivary gland epithelial tumors, benign tumors were 72 cases (64.9%) and malignant tumors 39 cases (35.1%). The male to female ratio of overall salivary gland epithelial tumors was 1 to 1.6. Mean age of benign tumors was 39.6 years old and that of malignant tumors 44.6. 2) The analysis of the salivary gland epithelial tumors in histologic type revealed 63 cases (56.8%) of pleomorphic adenoma, 14 cases (12.6%) of the mucoepidermoid carcinoma, 11 cases (9.9%) of adenoid cystic carcinoma, 4 cases (3.6%) of adenolymphoma and adenocarcinoma, respectively. 3) The incidence of salivary gland epithelial tumors was found to be in the major salivary gland in 62 cases (56.9%), in the major salivary gland in 47 cases (43.1%), preferably involving parotid gland in 38 cases (34.9%), palate in 29 cases (26.6%), submandibular gland in 20 cases (18.3%) in order of frequency. 4) The mean size of benign salivary gland epithelial tumors was 3.5 cm in diameter and that of malignant 3.6 cm. Therefore, that size of both benign and malignant tumors was not significantly different. The mean duration of chief complaints of salivary gland epithelial tumors was 5 years and 3 months in benign type, 2 years and 4 months in malignant type, approximately half of the benign tumors. 5) The most frequent manifestation in malignant tumors was palpable mass 89.7%(benign : 97.2%), pain 23.1%, ulcer and hemorrhage 15.4%, respectively, et al., whereas, that of benign tumors was exophthalmos 5.6%, ulcer 4.2%, et al. In order of frequency. 6) Among the 67 cases of pleomorphic adenoma, 4 cases (6.0%) of them were malignant type.

A Pathologic Study on Microinvasive Squamous Cell Carcinoma of Uterine Cervix.: Eun Sil Yu, Geung Hwan Ahn, Hyun Soon Lee, Eui Keun Ham; Korean J Pathol. 1986;20(1):35-41.

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Abstract PDF: Seventy five cases of squamous cell carcinoma of the uterine cervix, invasion depth of which was less than 5 mm from the basement membrane, were reviewed during a period of 9 years from 1975 to 1983 at SNUH and investigated clinicopathologically by the following items; 1) lymphnode metastasis 2) vascular invasion 3) recurrence 4) pattern of invasion 5) cell type. Following results were obtained. 1) Lmyphnode metastasis was demonstrated in 4 out of 75 cases (5.3%). One of them had stromal invasion to 1.3 mm and the other three to a depth of 3.1 to 5.0 mm. 2) Vascular invasion was seen in 5 among the cases (6.7%) and well related to the depth of invasion. Vascular invasion did not occur in tumors with 3 mm depth of stromal invasion. 3) Three patients were with recurrence, treated by postoperative radiation. The depth of stromal invasion was over 2 mm in all of them. 4) The pattern of invasion was confluent in 26 out of 28 cases (92%) whose stromal invasion were over 2 mm depth, while only 3 confluency of 27 cases (11%) invaded less than 1 mm depth. 5) There was no good relationship between the tumor cell type and the depth of stromal invasion. Based on the above results, it is concluded that diagnostic criteria of microinvasive squamous cell carcinoma of the uterine cervix is stromal invasion not exceeding a depth of 3 mm from basement membrane of surface or glandular epithelium.

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

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

The Frequency of Enterochromaffin Cells in Stomach and Intestinal Carcinoma.: Han Young Lee, Kwang Gil Lee, Yoo Bock Lee; Korean J Pathol. 1986;20(1):49-59.

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Abstract PDF: In 1927, Hamperl carried out histochemical studies on gastric cancer and found one case which contained many Fontana reactive argentaffin cells. Thereafter the gastric and intestinal adenocarcinomas which contain enterochromaffin cells such as argentaffin cell and argyrophil cell have been reported by several investigators. As the results, many reports revealed that 1.7 to 8% of gastric carcinomas and about 3% of intestinal carcinomas contained argentaffin cells, and 13 to 20% of gastric carcinomas and 12 to 15% of intestinal carcinomas contained argyrophil cells. The present study is aimed to evaluate the frequency of argentaffin and argyrophil cells in gastric and intestinal carcinoma in relation to the histopathological patterns. The material consisted of 282 cases of gastric adenocarcinoma and 83 cases of intestinal carcinoma which were diagnosed at the Department of Pathology, Yonsei University College of Medicine from January 1982 through December 1983. All cases were stained with hematoxylin-eosin for histological classification and with silver impregnation techniques for argentaffin and argyrophil granules. Staining for mucin was also performed using PAS stain. The results obtained were as follows: 1) Among 282 cases of gastric carcinomas, Grimelius positive argyrophil cells are noted in 43 cases (15.2%) and Fontana-Masson positive argentaffin cells are noted in 5 cases (1.8%). 2) Among 83 cases of intestinal carcinomas, Grimelius positive argyrophil cells are noted in 15 cases (18.2%) and Fontana-Masson positive argentaffin cells are noted in 1 cases (1.2%). 3) In gastric carcinoma, argyrophil cells are present in 31 cases (17.5%) among 176 male patients and and in 12 cases (11.3%) among 106 female patients. 4) In intestinal carcinoma, argyrophil cells are present in 9 cases (20.4%) amogn 44 male patients, and in 6 cases (15.4%) among 39 female patients. 5) According to classification by Willis, argyrophil cells are present in 12 cases (11.1%) among 108 well to moderately well differentiated adenocarcinoma, 14 cases (14.4%) among 99 poorly differentiated adenocarcinoma, 6 cases (30%) among 20 mucinous carcinoma, and 11 cases (21.1%) among 52 undifferentiated carcinoma. There is no significant difference in the frequency of argyrophil cells in relation to the histological type. 6) According to general classification of intestinal carcinoma, argyrophil cells are present in 9 cases (21.4%) among 42 well to moderately well differentiated adenocarcinoma, 3 cases (15%) among 25 poorly differentiated adrcinom adenocarcinoma and and cases (18.7%) among 16 mucinous carcinoma. The argentaffin cells were noted only in one case, which was the case of well to moderately well differentiated adenocarcinoma. In summary, the results of this study indicates that the frequency of enterochromaffin cells was 15.2% in stomach carcinoma and 18.2% in intestinal carcinoma. According to histological type, the Grimelius positivity was higher in mucinous and undifferentiated type, and higher frequency was noted in male than female.

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

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

Normal Sizes and Weights of Internal Organs of the Korean Young Male Adults.: Chae Won Lee, Han Kyeom Kim; Korean J Pathol. 1986;20(1):71-76.

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Abstract PDF: In autopsy, the evaluation of the size and weight of th internal organs is very important for the understanding of the pathologic conditions. The normal data of the internal organs must have regard to size, weight, sex, age and body weight. There are many reports on the normal value of human organs in Japan and other Western countries. But there are some variations in normal value according to race, geographics and living standard. In Korea, Lee & Roh had reported on weights of various organs of Korean and their proportional weights to body weights in 1957, based upon autopsy records from 1929 to 1941. But, there has been many improvement in socioeconomic status during past half-century in this country. And the Korean body conditions have much improved. Upon the base of above consideration, normal data fit for present Korean is mandatory. We have analysed records of 45 cases of Korean young adults's autopsy cases which were performed from Jan. 1984 to Dec. 1985, and obtained following data. The results obtained are as follows: Heart : left ventricle thickness; 1.76+/-0.3 cm right ventricle thickness; 0.5+/-0.1 cm Aorta circumference; 6.1+/-0.5 cm Pulmonary a. circumference; 7.0+/-0.7 cm Weight : 338+/-54 gm Lung : size: left; length 23.3+/-2.78 cm, width 12.3+/-2.28 cm, thickness 6.4+/-1.55 cm right; length 24.1+/-2.65 cm, width 14.7+/-2.95 cm, thickness 6.6+/-1.31 cm Weight : left; 541+/-117 gm, right; 634+/-118 gm Liver : size: greatest transverse measurement; 28.5+/-2.7 cm vertical measurement; 16.6+/-1.74 cm great anterior-posterior diameter; 8.8+/-1.51 cm weight: 1,559+/-267 gm Spleen : length: 12.7+/-2.1 cm, breadth: 8.4+/-1.5 cm, thickness: 3.4+/-1.1 cm, weight: 155+/- 69.3 gm Pancreas : length; 16.7+/-2.8 cm, weight: 111+/-34.5 gm Kidney : size: left; length; 11.2+/-0.7 cm, width; 5.9+/-0.7 cm, thickness; 3.8+/-0.8 cm, thickness; 3.6+/-0.7 cm weight: left; 150+/-25 gm, right; 138+/-29 gm Brain : weight: 1,498+/-132 gm

Case Reports

Proliferating and Malignant Brenner Tumors of the Overy: Report of 2 cases.: Sang Sook Lee, Eun Sook Chang, Chai Hong Chung; Korean J Pathol. 1986;20(1):77-83.

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Abstract PDF: Two unusual and rare forms of Brenner tumor are reported and the literatures are reviewed. The one, "proliferating" Brenner tumor, morphologically resembling low grade papillary transitional cell carcinoma of urinary bladder and regarded as a third variant intermediate between the benign and malignant forms; the other, malignant Brenner tumor of right ovary, corresponding to grade III transitional cell carcinoma of urinarybladder with areas of invasive squamous cell carcinoma and benign Brenner tumor of left ovary, combined with bilateral cystic teratomas. These tumors give additional support to the concept that Brenner tumors are composted of epithelium of urinary tract(urothelial) type.

Sclerosing Hemangioma of the Lung: A report of 2 cases.: Sung Ran Hong, Hye Jae Cho, In Ki Paik, Ill Hyang Ko, Dong Soon Kim, Je G Chi, Eui Keun Ham; Korean J Pathol. 1986;20(1):84-90.

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Abstract PDF: 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.

Original Article

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

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

Case Reports

Squamous Cell Carcinoma a arising in A Subcutaneous Dermoid Cyst: A case reported.: Dong Sik Kim, Chai Hong Chung; Korean J Pathol. 1986;20(1):97-99.

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Abstract PDF: The development of carcinoma in a subcutaneous dermoid cyst is a rare event. We report a 54-year-old Korean woman in whom excised subcutaneous dermoid cyst showed squamous cell carcinoma in the cyst wall.

Hamartoma of the Lung: An autopsy case.: Eun Hee Suh, Je G Chi; Korean J Pathol. 1986;20(1):100-106.

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Abstract PDF: 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.

Malignant Mesenchymoma of the Right Axillary Area: A case report.: Sung Ran Hong, Gui Ohk Yoon, Seong Sook Kim, Hye Jae Cho, Il Hyang Ko; Korean J Pathol. 1986;20(1):107-111.

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Abstract PDF: The term malignant mesenchymoma has been applied to those tumors of the soft tissue of mesenchymal origin which are composed of tumor cells differentiating into two or more unrelated malignant forms in addition to the fibrosarcomatous element. Recently authors experienced a case of malignant mesenchymoma in the right axillary area. Microscopically the sarcoma revealed multiple pattern of differentiation, including liposarcoma, malignant schwannoma, fibrosarcoma, malignant fibrous histiocytoma and rhabdomyoblastoma. The presence of rhabdomyblastic cells were proved by immunochemical study utilizing desmin. This patient was treated with surgical excision and radiation.

Exceptionally Good Lymphocytic Infiltration with Histiocytes and Multinucleated Giant Cells of Stomach Cancer: A case report.: Dongsoo Suk, Sook Hee Hong, Hye Kyung Yoon, Hyung Gin Kang; Korean J Pathol. 1986;20(1):112-115.

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Abstract PDF: Stomach of 34 year old man showed an early stage of the cancer with slight involvement of the superficial part of the inner muscle layer and accompanied with one metastatic lymph node. The cancer is that of medium differentiated adenocarcinoma. There is an heavy infiltration of lymphocytes mixed with histiocytic mononuclear cells and multinucleated giant cells. Some giant cells appear as Langhans' type suggesting phagocytic cells of their origin containing PAS positive materials in the cytoplasma. In other places, they appear as atrophic cancer nests suggesting that these tumor nests were arrested and undergone to regressive cellular process because of the over-whelming immunological pressure by the host.

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