Journal of Pathology and Translational Medicine

Volume 24(4); December 1990

Original Articles

Ultrastructural Studies of Aortic Endothelial Injury and Regeneration.: Gium Mi Jang, Dong Hoon Kim, Jyung Sik Kwak, Tae Joong Sohn; Korean J Pathol. 1990;24(4):337-348.

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Abstract PDF: Author performed this experiment to define the most important factor preventing the intimal thickening. An endothelium of abdominal aorta in the rat was denuded by two different wires having same caliver. The degree of injury was limited to the endothelial cells in one, and extended to the internal elastic lamina in another. The results showed that at 72 hours, in the case of superficial injury, the entire injury site was covered by new regenerating cells, but in the case of disruption of the internal elastic lamina, the migrating smooth muscle cell completely reached into the intima and resulted in intemal thickening. Similar findings persisted to 1 week later. Above results suggest the most important factor preventing the intimal thickening in endothelial injury is the depth of the injury which limited within the endothelial cells without extending into the internal elastic lamina and medial smooth muscle cells.

Deep-seated Fungal Infections in Biopsy Specimens.: Kyung Ae Yoon, Je G Chi; Korean J Pathol. 1990;24(4):349-357.

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Abstract PDF: 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.: Suk Keun Lee, Chang Yun Lim, Je G Chi; Korean J Pathol. 1990;24(4):358-374.

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Abstract PDF: 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.

Pathological and Epidemiological Analysis of Gastric Carcinoma among Koreans in Pusan Area.: Sook Nyo Lee, Dongsoo Suk, Yeon Jae Cheong, Sun Kyung Lee; Korean J Pathol. 1990;24(4):375-385.

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Abstract PDF: Epidemiology, pathology, diagnosis and treatment of gastric carcinoma has been revised recently. The authors analysed 3,170 cases of gastric carcinoma which were diagosed with fiberoptic biopsy or resected specimens from 1968 to 1988 in Pusan area. The specimen were collected from Pusan National University Hospital, Pusan Paik Hospital and other general hospitals in Pusan city. The results obtained were summarized as follows; 1) The time trend indicated that difference in the annual fluctuation of requency of gastric carcinoma during last 21 years was not statistically significant. But it was noticed that by comparing the following the two decades (1970~1979 and 1980~1988) the frequency of gastric carcinoma decreased in male, in middle age and in intestinal type. 2) Morbidity of gastric carcinoma increased in both sexes by aging, and this tendency was more marked in male and in intestinal type in female and in diffuse type. 3) In general the gastric carcinoma involved more frequently distal portion than proximal portion of the stomach was characterized predominantly by male, older patients and intestinal type. 4) Carcinoma with Borrmann type I and II were characterized predominantly by male, older patients and intestinal type. With Borrmann type III and IV, female, young patients and diffuse type were found more frequently. From the above results, the authors concluded that the pathological and epidemiological findings of gastric carcinoma among Koreans in Pusan area showed a transition moving from high risk to low risk area of gastric carcinoma.

Plasma prostaglandin E2 Levels in Patients wth Gastric Carcinoma.: Gyeong Yeob Gong, Sun Kyung Lee; Korean J Pathol. 1990;24(4):386-392.

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Abstract PDF: This study was performed for the purpose of evaluation of plasma PGE2, levels in patients with gastric carcinomas. To carry out this study twenty-one gastrectomy patients with gastric carcinoma were selected. Serial plasma PGE2 levels were measured before and after operation by radioimmunoassay. Plasma PGE2 was also measured in five normal healthy volunteers or of patients with gastric ulcer. The conclusion drawn therefrom were as followed: 1) In normal healthy volunteers, plasma PGE2 level was 50.2+/-16.5 pg/ml which ws higher than that of parients with gastric ulcer, 20.7+/-15.4 pg/ml, (p<0.001). 2) In patients with diffuse type of gastric carcinoma, preoperative and postoperative plasma PGE2 levels were 25.7+/-12.1 pg/ml, and 23.1+/-8.7 pg/ml, rewpectively. In parients with intestinal type of gastric carcinoma, preoperative and postoperastive plasma PGE2 levels were 26.2+/-8.9 pg/ml and 24.1+/-11.2 pg/ml, respectively. In both types of gastric carcinoma, plasma PGE2 levels were lower than that of normal healthy volunteers and there was no significant difference compaired with the levels in patients with gastric ulcer. 3) In diffuse and intestinal types of gastric carcinoma, postoperative PGE2 levels were lower that those of preoperative state but it was not significant. 4) In early and advanced gastric carcinoma, preoperative PGE2 levels were 29.0+/-11.7 pg/ml and 24.8+/-9.9 pg/ml, respectively. There was no significant difference by the depth of invasion. From the result as mentioned above, it is concluded that plasma PGE2 levels of patients with gastric carcinoma and it is presumable that there is a factor decreasing plasma PGE2 levels in patients with gastric carcinoma or ulcer.

Embryogensis of Human Liver.: Woong Kim, Je G Chi; Korean J Pathol. 1990;24(4):393-401.

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Abstract PDF: 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.

The Effect of Common Bile Duct Ligation on Liver Morphology and Coper Metabolism in Rat.: Kyoung Sook Kim, Chanil Park, Jang Whan Cho, In Joon Choi, Yoo Bock Lee; Korean J Pathol. 1990;24(4):402-411.

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Abstract PDF: To clarity the effect of biliary obliteration on copper metabolism of rat liver and on the hepatic morphology, 0.5% cuppuric sulfate was administered intraperitoneally for 42 days following ligation of the common bile duct (CBD) of Sprague-Dawley rats. The blood copper concentration, the hepatic copper content and the accumulation patterns of copper and copper binding protein in the liver were examined and compared with those of the simple CBD ligation group and the simple copper over loaded group. CBD ligation induced marked proliferation of bile ductular structures which, after expanding the portal tracts, invaded and divided the hepatic lobules. There was, however, no excess fibosis beyond what needed to support the new ductules. The blood copper concentration and the hepatic copper content were increased by copper overload with or without CBD ligation, particularly incases with CBD ligation. Liver cell necrosis did not occur by the overloaded copper alone in rats. The hepatic copper and copper binding protein were accumulated at periportal liver cells in the group of coppe overload after CBD ligatio, whereas they began to appear at perivenular hepatocytes in the simple copper overloaded group. In conclusion, it is suggested that CBD ligation does not induce excess fibrosis or liver cirrhosis in rat as far as during our experimental period, but affect significantly on copper metabolism by intrahepatic redistribution of the copper and the copper binding proteins.

Liver Cirrhosis: Etiological diagnosis and morphological characteristics of 369 biopsy-proven cases.: Eun Kyung Han, Chanil Park, Sang In Lee; Korean J Pathol. 1990;24(4):412-422.

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Abstract PDF: To pursue a desirable format for the pathological diagnosis of liver cirrhosis, the authors attempted to classify 369 biopsy-proven cirrhosis on the basis of etiology and made effort to find out the morphological characteristics of each category. About 735 of total cases were HBsAg seropositive postnecrotic cirrhosis. Alcholic cirrhosis ws the second most frequent type, although accounted only 6.8%. In about 15%, the etiology was not known. Excluding the congenital biliary atresia, chronic biliary obstruction appeared to be a rare cause of cirrhosis among these biopsied cases. Of the HBsAg positive postnecrotic cirrhosis, the eAg seropositive cases tended to be micronodular and to show a higher necroinflammatory activity, in contrast to eAg seronegative cases and those complicated by hepatocellular carcinoma (HCC), suggesting that the loss of eAg is followed by a decrease of the destructive activity, active regeneration of hepatocytes and finally the development of HCC. alcoholic cirrhosis was micronodular in 64% and revealed histologic evidences of alcoholic liver disease in most cases. The results indicate that etiological diagnosis can be made in most cases of cirrhosis by the morphological characteristics and the precise clinical informations, including those on the NANB virus and the inborn error of metabolism, and that the pathological diagnosis should be more comprehensive, implicating the etiology, the nodular size and the necroinflammatory activity.

Cyclosporine Toxicity on Cultured Human Renal Proximal Tubular Cells.: Jung Young Lee; Korean J Pathol. 1990;24(4):423-429.

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Abstract PDF: Nephrotoxicity is the most common dose-limiting factor of cyclosporine A (CSA) in clinical usage. But the mechanism of CSA-induced nephrotoxicity still remains unresolved. Many authors insisted that CSA induced renal proximal tubular cell injury is due to the secondary effects following hemodynamic changes or endothelial cell damage, instead of direct toxicity by CSA. To find out that CSA has a direct toxicity to the proximal tubular cells, the author used primary cultures of human proximal tubular cells to eliminate the hemodynamic or endothelial influences that could be produced in in vivo model. In the present study, the viability against CSA was tested by the neutral red assay method with modulation of Ca2+ amount in incubating media and observed electron microscopically. The viability test showed direct toxic effect of CSA on human proximal tubular cells and this was enhanced by Ca2+ depletion in incubating media. Morphologically noted are accumulation of lipid droplets and polyribosomal dispersion, which may be association with inhibition of cellular synthetic activity. These results suggest the toxixity is a direct effect of cyclosporine and that toxic mechanism may be due to inhibition of cellular synthetic activity. And this experiment also showed that primary cultures of human renal proximal tubular cells can be a good in in vivo model for investigating CSA nephrotoxicity.

Kinetics of Cyclosporine uptake on Cultured Human Proximal Tubular Cells.: Jung Young Lee; Korean J Pathol. 1990;24(4):430-435.

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Abstract PDF: Cyclosporine A (CSA), a lipophilic cyclic undecapeptide, is not accumulated evently in all tissues and has a high affinity to several tissues such as lymphoid organs, liver, and kidneys. From this point of view, it is reasonable to assume that the amount of CSA uptake would be correlated with the extent of cell injury. On the other hand, verapamil, a Ca2+ channel blocker, bas been shown to ameliorate CSA nephrotoxicity. Since proximal tubule is the major site of drug transport and CSA uptake and its interaction with verapamil in isolated human renal proximal tubular cells. The CSA uptake rapidly increased over the first 5 min and then achieved almost steady-state after 10 min at all concentrations (0.5-10 uM). Kinetic analysis yielded that the Km and Vmax values of CSA were 5.6 uM and 86.2 p mol/mg cell protein/min, respectively. And Ca2+ depletion in media enhanced CSA uptake significantly but verapamil reduced it. These results suggest that the Ca2+ channels and CSA transporting sites on cell membrane are closely associated and that Ca2+ and CSA might be taken up competitively by proximal tubular cells.

Nevus Sebaceous with Special Reference on Its Aging Effect.: Jin Seok Seo, Mi Kyung Kim, Mikyung Kim, Kye Yong Song, Yun Lim Seo, Je G Chi; Korean J Pathol. 1990;24(4):436-445.

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Abstract PDF: 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.

Histopathologic and Immunohistochemical observation on Malignant Schwannoma.: Tae Sook Hwang, Seong Hoe Park, Eui Keun Ham; Korean J Pathol. 1990;24(4):446-455.

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Abstract PDF: Histopathologic and immunohistochemical analysis using antibodies for S-100 protein and keratin has been conducted on 21 cases of malignant schwannomas. The 21 cases were divided into the following three groups Group A: tumors originating from the nerve trunk or neurofibroma; Group B: tumors related to von Recklinghausen's disease; and Group C: other tumors not belonging to the above groups but histologically diagnosed as malignant schwannoma. The commonest histological pattern consisted of either closely packed or loosely arranged interlacing fascicles of slender spindle cells with wavy fibrillar cytoplasm, followed by myxoid change, perithelial pattern, hyaline change of the blood vessels, and hyalinlzed cords or nodules. Nine out of 12 cases of malignant schwannomas in group A and B, and 7 out of 9 cases of group C were positive for S-100 protein. None of the above cases showed positive staining reaction for keratin. Since 7 of 9 malignant schwannomas in Group C stained with S-100 protein, we can conclude that careful histological analysis supplemented by immunohistichemical study can make a conclusive diagnosis in most of the cases of malignant schwannomas even in cases that do not fulfil the traditional strict criteria.

Cytologic Features and Distribution of Primary site of Malignant Cells in Body Fluids.: Kyoung Ho Kim, Kwang Gil Lee; Korean J Pathol. 1990;24(4):456-464.

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Abstract PDF: Many articles concerning the accuracy of diagnosis of malignant tumor cells in body fluids have appeared in the literature, but few authors have attempted to describe the characteristics of these cells to determine the site of the primary tumor as they relate to tumors of specific primary sites. This paper presents the results of a retrospective study on malignant body cavity effusions of which the primary site was established on the basis of either biopsy or surgical resection of the primary neoplasm during the period of 6 years beginning from January 1983 to December 1988. The results obtained are summarized as follows: 1) The 143 fluid specimens from 129 patients were composed of 51 cases of pleural, 69 of peritoneal, and 9 of pericardial origin. 2) Adenocarcinoma was the most frequent type of malignant effusions (78.3%). The most common primary site was the lung (50%) in pleural fluid and stomach (55.2%) in ascites. 3) The results of this study show that the primary site of tumor cells can be identified in the body fluid of accurate cytomorphologic criteria are used. Identification of the primary site of an effusion would be improved by the consideration of clinical information

A Cytopathologic Study of Fine Needle Aspiration Biopsy of Lung Cancer.: Soon Won Hong, Kwang Gil Lee; Korean J Pathol. 1990;24(4):465-475.

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Abstract PDF: Available conventional pathologic diagnostic tools for lung cancer include sputum cytology, lung biopsy using bronchoscopy, and washing and brushing cytology. In addition, fine needle aspiration (FNA) cytology is now available and has become popular. In this study, an attempt was made to compare the relative sensitivity between conventional cytopathologic methods and FNA cytology, to study the clinical characteristics of lung cancer in which the diagnosis was established by FNA cytology, and to study the cellular findings and diagnostic criteria of lung cencers. Cases included in this study were selected from 105 patients who had been diagnosed an lung cancer at Yonsei University Medical Center during the 5-year period from January 1984 to December 1988. These 105 cases were reviewed with respect to medical records and pathologic slides and then the following conclusions were made. The mean age of cases was 58.5 years, and the sex ratio of males to females was 3.5:1. Tumors were mostly solitary in number and were mainly located at the periphery of the lung. The sensitivity of FNA cytology, sputum, and bronchial washing was as follows: FNA cytology was 0.93, sputum, 0.2, and bronchial washing, 0.14. The coincidence rate of cytopathologic diagnosis with histologic diagnosis was as follows: epidermoid carcinoma was 92%, adenocarcinoma 83%, undifferentiated large cell carcinoma 66%, and undifferentiated small cell carcinoma 100%. The false negativity of FNA cytology was 7%, which was mainly due to material insufficiency. For the differential diagnosis of histologic type, some brief criteria could be summarized. Differential diagnostic points of each histologic type were as follows: epidermoid carcinoma showed a large cellular group with keratinized cytoplasms and hyperchromatic and pyknotic nuclei, adenocarcinoma showed a glandular or ball-like arrangement by monotonous round cells, undifferentiated large cell carcinoma was mainly composed of irregular large cells and showed emperipolesis, and undifferentiated small cell carcinoma showed an Indian file appearance with molding by small, round hyperchromatic cells. In conclusion, FNA cytology is a more efficient, definite, and sensitive method for diagnosing lung cancer than other cytopathologic studies, so that careful selection of patients and experienced technique will improve the diagnostic accuracy of FNA cytology in diagnosing lung cancer.

A Pathological Review of Pleural Effusion by Immunocytochemical Methods.: Dong Hwan Shin, Hee Jeong Ahn, Woo Ick Yang, In Joon Choi; Korean J Pathol. 1990;24(4):476-481.

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Abstract PDF: An unequivocal diagnosis of mesothelioma during life, on the basis of limited biopsy tissue or cytological specimens, is frequently difficult and requires distinction from inflammatory mesothelial hyperplasia on the one hand and secondary neoplasms, especially adenocarcinoma on the other. Although some studies have produced conflicting results, it is generally believed that immunohistochemical methods can aid in this distinction. To obtain comparable and reproducible results, 23 metastatic carcinoma of the pleura and 2 unequivocal malignant epiehtlial mesotheliomas were studied by the peroxidase-antiperoxedase method on paraffin-embedded cell blocks, and commercially available antibodies to carcinoembryonic antigen (CEA), keratin and epithelial membrane antigen (EMA) were used. Nineteen metastaic adenocarcinoma (73%) and two mesotheliomas (100%) reacted with keratin and EMA antibodies. Nineteen matastatic adenocarcinomas (73%) reacted with EMA antibodies. Nineteen metastatic adenocarcinoma (73%) reacted with CEA antibody; no mesotheliomas stained for CEA. Two cases of reactive mesothlial hyperplasia showed positive for keratin, but negative reaction for EMA and CEA. Noen of the antibodies used in this study was specific for mesothelioma, but CEA was found to be the most useful marker for differentiating between mesothelioma and metastatic carcinoma.

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