Journal of Pathology and Translational Medicine

Volume 21(4); December 1987

Original Articles

The Effect of Uremic Plasma on the Proliferative Activity of CFU-GM in in-vitro Culture of Mouse Bone Marrow.: Chang Soo Park, Joo Yong Yoo; Korean J Pathol. 1987;21(4):215-226.

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Abstract PDF: The increased susceptibility in patients of chronic renal failure to infection has been reported to be attributed to defects in granulocyte and lymphocyte function and proliferative activity of hematopoietic cells. The definite cause of the frequent infection in uremic patients, however, is still controversial. The effect of uremic plasma on the aspect of the hematopoietic cells has been scarcely been studied. In the present study, mouse bone marrow was cultured with uremic plasma, to evaluate the effect of uremic plasma on the proliferative activity and morphological features of CFU-GM. The results obtained were as follows. 1) The number of colonies in group co-cultured with uremic plasma was more reduced than that of normal plasma group. 2) There was no difference between the group cultured with predialytic uremic plasma and that of postdialytic plasma in number of colonies, macroclusters and microclusters. 3) The forms of colony were granulocytic and monocytic forms at 5 day of culture. Electron microscopically, granulocytes disclosed electron dense azurophilic granules and electrolucent specific granules in the cytoplasm, and monocyte showed numerous vesicles and vacuoles in the cytoplasm which had finger-like projections. 4) The molecular weight of inhibitory factor in the uremic plasma was supposed to be less than 50,000 daltons.

Schneiderian Papillomas A Clinicopathologic Study of 27 Cases.: Chae Hong Suh, Ho Jong Chun; Korean J Pathol. 1987;21(4):227-232.

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Abstract PDF: Schneiderian papillomas are papillary lesions of the nasal cavity paranasal sinuses that arise from the Schneiderian membrane, a membrane of ectodermal origin embryologically derived from the nasal placodes. This membrane is characterized by transitional type epithelium, similar to bladder urothelium, with admixed microcysts or mucin droplets. It has a tendency to recur after removal and transform into malignancy even though rare. Total 27 cases of Schneiderian papillomas were examined in the Chosun University medical college, which were collected from 1978 to 1986. The results obtained were as follows: 1) There were 19 male and 8 female patients, and mean age at diagnosis was 50.5+/-12.0 (SD) year (27-74 years). 2) Nasal obstruction or perception of nasal mass was the most common presenting symptom; Mean duration of symptoms was 25.8+/-15.0 (SD) month (4-48 months). 3) Numbers of papillomas had predominantly endophytic (inverted, n=17) and predominantly exophytic (fungiofrom n=6) patients, and four had mixed pattern. 4) In 27 patients, recurrences developed in 9, local invasion in one (with an inverted papilloma), and epidermoid carcinoma in one (with an inverted papilloma).

The Expression of ras and myc Oncogene in Transitional Cell Carcinoma of the Urinary Bladder.: Chang Soo Park, Byoung Dong Juhng, Sang Woo Juhng, Kyu Hyuk Cho; Korean J Pathol. 1987;21(4):233-239.

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Abstract PDF: The oncogenes, which have been detected in various human solid tumors, transform culture cells, and the level of m-RNA specific for an oncogene increases in the cellular extract of the tumor cells. These findings suggested that oncogene expression was closely related with carcinogenesis. Recently, oncogen products were considered as tumor markers, but it was not confirmed that the relationship between quantitative change of oncogene product and malignant potential of a neoplasm. To evaluate the relationship between the quantitative change of oncogene product and malignant potential, immunohistochemical staining for the ras and myc oncogene products was performed in the sections of papilloma and transitional cell carcinoma of urinary bladder. 1) Positive reaction of c-ras oncogene product was noted along the cell membrane and in the cytoplasm, and c-myc oncogene product in the nucleus, and along the unclear membrane and cell membrane. 2) Tissue expression of c-ras oncogene was homogeneous and strong in the transitional cell carcinoma rather than in papilloma. 3) The ratio of the positive cells with c-ras oncogene product was 35.1% in the papilloma, 79.4% in the grade I, 81.9% in the grade II, 87.6%, in the grade III of transitional cell carcinoma of the urinary bladder. There was a tendency for the ratio to increase with the degree of histological grading. 4) By the immunoperoxidase staining of c-myc oncogene product, the number of the cells showing positive nuclear staining incrased with the tumor grading.

Light and Electron Microscopical Studies on the Stroma of Hydatidiform Mole.: Jong Tae Park, Sang Woo Juhng, Kyu Hyuk Cho; Korean J Pathol. 1987;21(4):240-248.

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Abstract PDF: Many investigators were interested in the pathogenesis and the relationship between microscopical features and clinical behavior of hydatidiform mole. Trophoblastic cells in the trophoblastic disease were intensively examined histologically, ultrastructurally, immunohistochemically, and with hormone assay method, etc. But ultrastructural study on the stroma of hydatidiform mole was scarcely reported. In this paper, hydatidiform mole was examined at light and electron microscopic levels, with emphasis on the stroma. The results were as follows: 1) Hydropic degeneration of H-mole is more severe in the center of stroma and is not related with the degree of trophoblastic proliferation. Hofbauer cell and vascular structure are extremely rarely observed in the periphery of stroma which has relatively preserved cellular components. 2) Basement membrane is sometimes separated from trophoblastic layer. Degenerated cells in the stroma contain vacuoles, autophagosomes, and lipid droplets. Collagen is abundant in the loose interstitium. Hofbauer cells have no lysosome or phagosome. Vascular lumen is patient and endothelial cells are degenerated. From the above results, H-mole may be produced due to abnormal changes of trophoblasts and stromal changes may be a secondary process, so called autolysis. Hofbauer cells are not engaged in the stromal degeneration and may be different from usual tissue macrophages.

Peanut Agglutinin Binding Activity in Overian Malignant Mucinous Tumors.: Hyung Geun Song, Chul Woo Kim; Korean J Pathol. 1987;21(4):249-256.

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Abstract PDF: The positive binding activity of lectin, peanut agglutinin (PNA), against the mucinous malignancies of the ovary was studied in order to clarify biologic differences among those lesions using immunoperoxidase method (ABC). A total of 23 cases were included in this study and they were classified as 10 cases of mucinous cystadenocarcinoma, 9 mucinous tumors of borderline malignancy and 4 pseudomyxoma peritonei, histologically. Nine of 10 cystadenocarcinomas and all cases of pseuomyxoma peritonei showed more than moderate degree of positive binding activity (>2+) with PNA in the neoplastic epithelial cells. In the cases of borderline malignancy, only 3 of 9 revealed as much similar binding pattern with PNA as cystadenocarcinoma group, in contrast, minimal degree of positivity (1+) was noted in the remainder. These findings may suggest heterogeneity in the biochemical characteristics among the cases of borderline lesion. And it is proposed that the higher PNA binding cases in ovarian mucinous borderline malignancy require extensive sampling by multiple sections and further careful follow-up study.

Pathologic Study of Breast Cancer in Korea.: Sang Kook Lee, Gyung Hyuck Ko; Korean J Pathol. 1987;21(4):257-266.

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Abstract PDF: From a retrospective study of 366 cases of breast cancer, following results are obtained. 1) Relative incidence of breast cancer is increased during recent 7 years as compared with total female cancer. 2) Invasive ductal carcinoma and invasive ductal carcinoma with a predominant intraductal component (ICPI) account for 78% of total breast cancer, and its ratio shows little variance during recent 7 years and as compared with previous studies. 3) The incidence of invasive lobular carcinoma is increased as compared with 10 years ago, but it seems more likely that the increase is due to difference in diagnostic criteria rather than due to real increase in incidence. 4) The average patients' age of five major histologic types of breast cancer is 47.3 year. The patient's age of invasive ductal carcinoma is highest and that of ICPI is lowest. 5) Outer upper quadrant is the most frequent site of breast cancer. Left side is slightly more frequent than right side. There is little variance among the histologic types in tumor location. 6) The average symptom duration of patients of major types of breast cancer is 8.4 month. It is longest in invasive ductal carcinoma and shortest in ICPI. 7) Invasive lobular carcinoma is largest in tumor size and intraductal carcinoma is smallest, among the major histological types. 8) Intraductal carcinoma is most freqnently accompanied by nipple discharge and Paget's disease. 9) The rate of axillary lymph node metastasis is highest in invasive lobular carcinoma, followed by invasive ductal carcinoma, medullary carcinoma, and ICPI, in order of freqnency. 10) Distant metastasis is to the bone, lung, liver and brain, in order of freqnency. Medullary carcinoma shows the highest rate of distant metastasis. 11) The important prognostic factors of breast cancer are histologic types, status of axillary lymph node metastasis, size of tumor and histologic grade of malignancy. But there is little difference in prognosis between invasive ductal carcinoma and medullary carcinoma.

Lectin Binding Activities in Ewing's Sarcoma of the Bone.: Chul Woo Kim, Hyo Min Kim, Eui Keun Ham; Korean J Pathol. 1987;21(4):267-273.

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Abstract PDF: The binding activities of 6 plant lectins were studied in a total of 6 cases of Ewing's sarcoma of the bone, using the avidin-biotin-peroxidase complex (ABC) method on paraffin embedded material. The lectins used in this study were Ricinus communis agglutinin I (RCA I), Concanavalin A (Con-A), Peanut agglutinin (PNA), Wheat germ agglutinin (WGA), Ulex europeus I (UEA I), and Soybean agglutinin (SBA). However, no specific lectin, which showed consistent binding activity in the majority of Ewing's sarcoma cells was identified, in 5 of 6 cases, intracytoplasmic RCA I binding cells were occasionally observed, at somewhat regular intervals, among the neoplastic cell nests. Con-A stains were also positive in 4 cases, but the numbers of Cona-A binding cell were fewer than that of positive cell with RCA I, With PNA, WGA, UEA I, and SBA virtually no tumor cells were stained. These findings suggest that all Con-A positive cells and a part of RCA I binding cells are probably stromal macrophage-histiocytes, which are incorperated in neoplastic cells. And remaining RCA I positive cells seem to be either a kind of differentiating neoplastic cells or supporting cells having close correlation with the neoplastic cells.

Case Reports

Pedunculated Gallbladder Encircled by Accessory Liver: A case report.: Woo Ho Kim, Cheol Keun Park, Kyung Hyuck Ko; Korean J Pathol. 1987;21(4):274-277.

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Abstract PDF: The authors presented a case of gastroschisis with a pedunculated gallbladder embedded in hepatic tissue. The patient was born after fullterm gestation. Due to extensive abdominal wall defect, she succumbed 3 days after birth. There was a pedunculated mass measuring 2.5x1.5x1.5 cm between the liver and distended stomach without any attachment to the liver. The pedicle of the mass was connected to the common bile duct. Cut surface revealed that the mass was an accessory hepatic lobe encircling the gallbladder. The histologic feature of both accessory liver and gallbladder was markedly altered probably due to vascular obstruction. We could find only a single similar case in literlature. That case was associated with Beckwith syndrome and ours was associated with large atrial spetal defect, large patent ductus arteriosus, accessory spleen as well as gastroschisis. The common feature of abdominal wall defect might be a predisposing factor.

Wilson's Disease: Report of a Case with Comprehensive Review of the Previously Reported Cases in Korean Literature.: Mi Kyung Lee, Chan Il Park; Korean J Pathol. 1987;21(4):278-284.

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Abstract PDF: We reported a case of Wilson's disease, which was histologically confirmed by liver biopsy in a 15 year-old boy and made a comprehensive analysis on the sum of 22 cases reported in Korean literature. Although Wilson's disease is still rare, it should be included in the differential diagnosis of chronic liver diseases particularly in children of 5 to 15 years old. For the clinical diagnosis of Wilson's disease, changes in serum ceruloplasmin, plasma copper and urine copper values are most important as well as Kayser-Fleischer ring and family hestory. The serum level of GOT, when elevated, were always higher than GPT. This atypical transaminase profile may be a clue for diagnosis of hepatic diseases by a metabolic derangement. Among various histologic changes of the liver in Wilson's disease, what have diagnostic importance are anisonucleosis, nuclear glycogenosis and Mallory body, all of which may appear in any stages of the disease. In 3 cases only neurologic symptoms such as dysarthria and athetosis were found. Hemolytic anemia was another rare complication.

Primary Malignant Lymphoma of the Liver: Report of a case.: Soo Kyong Chung, Chang Suck Kang, Won Il Kim, Sang In Shim, Sun Moo Kim; Korean J Pathol. 1987;21(4):285-290.

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Abstract PDF: Primary extranodal lymphoma of the liver is very rare, approximately thirty-one cases having been reported in the literature. We report one case of primary malignant lymphoma of the liver in a 26-year-old female, who was presented with palpable abdominal mass on the epigastrium for about 40 days. Laboratory findings revealed no specific abnormalities. Peripheral lymph nodes or spleen were not palpable. An abdominal ultrasonogram revealed a huge mass involving the entire left lobe of the liver. Left lateral segmentectomy of the liver was done. The resected lateral portion of left lobe of the liver showed a large solitary mass, 12 cm in the greatest dimension, with a yellowish gray fleshy solid cut surface. Though light microscopic feature was compatible with primary malignant lymphoma, diffuse large cell type, intermediate grade by the working formulation, undifferentiated carcinomas including hepatocellular carcinoma, plasmacytoma, and pleomorphic sarcomas could not be completely ruled out. Thus, marker studies and electron microscopic examination were performed. Immunoperoxidase stains for common leukocyte antigen was positive, and the Leder stain for myeloid granule was negative. Electron microscopic stuids revealed findings of neoplastic lymphoid cells, consistent with malignant lymphoma. Primary lymphoma of the liver has only rarely been reported, and its natural history is unclear. Many of the reported cases have been large cell lymphomas, as in this case.

Diffuse Neonatal Hemangiomatosis with Association of Massive Osteolysis and Arteriovenous Fistulae: An autopsy case.: Soon Pal Suh, Jong Tae Park, Wan Lee, Young Youn Choi, Chang Soo Park; Korean J Pathol. 1987;21(4):291-297.

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Abstract PDF: Diffuse neonatal hemangiomatosis is an uncommon disease that is characteristed by a diffuse nature of the lesions, and distinguished form a single or few, or superficial or deep, capillary, cavernous, or mixed hemangiomas occuring in early or adult life. We report an autopsy case of multiple hemangiomatosis, which is associated with massive osteolysis of right humerus and arteriovenous fistulae in surrounding soft tissues. The patient is a 23 day old female infant and had a 2.0x1.5 cm sized cystic destructive bony lesion which was located in the proximal shaft of right humerus. Right arm was hypertrophied, compared to the normal looking left. There were multiple hemangiomas in right humerus, lung, cutaneous skeletal muscles and nerves. This case shares clinical characteristics of Gorham's disease.

Hyperkeratosis of Renal Pelvis and Ureter: A case report.: Mi Kyung Lee, Hyeon Joo Jeong, In Joon Choi; Korean J Pathol. 1987;21(4):298-302.

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Abstract PDF: Hyperkeratosis of the renal pelvis and ureter is a rare condition and is explained by the metaplastic change from transitional to cornified squamous epithelium. This lesion is frequently associated with, and perhaps caused by chronic urinary infection, but potentially premalignant, accompaning with carcinoma in about 10 to 20 per cent of the cases at the time of diagnosis. A case of hyperkeratosis of renal pelvis & ureter which was clinically suspected of carcinoma in a 49-year old woman with a long history of chronic pyelonephritis is presented with review of literature.

Malignant Mixed Mullerian Tumor of the Ovary: A case report.: Hae Joo Nam, Won Hee Choi, Tae Sook Lee; Korean J Pathol. 1987;21(4):303-307.

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Abstract PDF: The clinical and pathological features of a case Malignant mixed mullerian tumor of the ovary in 45 year-old female patient with a brief review of the literature are presented. She had both ovarian tumors. The masses are multilocular cystic tumor with interspersed solid component. The cystic component is filled with serous fluid. Microscopically the tumor is composed of epithelial element & intimately related mesenchymal element. The epithelial element shows the findings of adenocarcinoma of solid, glandular and papillary growth. The mesenchymal element is composed of malignant-looking stroma with cartilage formation.

Congenital Melanocytic Schwannoma in Ankle Joint Potentially Malignant: A case report.: Jong Tae Park, Chang Soo Park, Sang Woo Juhng, Kyu Hyuk Cho; Korean J Pathol. 1987;21(4):308-316.

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Abstract PDF: Congenital malignant melanocytic schwannoma in ankle joint was not reported on literature and it was a very interesting case. Light microscopically, melaninladen cells were mixed in abundant wavy spindle cells, some mitotic cells were also observed. Ultrastructurally, melanosomes in variable stages of development were scattered in the cytoplasm which had basal lamina. Collagen bundles were abundant in the intercellular connective tissue. It was histologically malignant tumor and clinically recurred. But in non-congenital potentially malignant melanocytic schwannoma which had been reported, reccurrence or distant metastasis were not noted. So, further clinical survey may be necessary for evaluation of the malignant behavior of this neoplasm.

Spindle and Epithelioid Cell Nevus: Report of four cases.: Hye Ju An, Kyo Young Lee, Sang In Shim, Sun Moo Kim, Jun Young Lee, Baik Kee Cho; Korean J Pathol. 1987;21(4):317-322.

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Abstract PDF: The spindle and epithelioid cell nevus, is known also as Spitz's nevus or benign juvenile melanoma. The histologic picture of the lesion often closely resembles that of a malignant melanoma, but spindle and epithelioid cell nevus hehaves benignly. Criteria for accurate histological diagnosis of this nevus now exist. However, a difficult lesion occasionally brings one to the worrisome situation even now. We experienced four cases (three children and one adult) of spindle and epithelioid cell neveus with nodular or macular skin lesions. In children (7/F, 9/F, 4/M), all of the lesion show a solitary pinkish red or light brown nodular firm masses, 0.7 cm to 1.0 cm in greatest dimension, which are located at the left posterior thigh, posterior neck and right anterior neck region, respectively. In adult (36/F), the lesion shows a light brown, erythematous macule, 0.8 cm in greatest diameter, in the skin of the back. Microscopically, both spindle and epithelioid cells are found in all the four cases, but epithelioid cells predominate in children and spindle cells predominate in adult.

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