Journal of Pathology and Translational Medicine

Volume 25(2); April 1991

Original Articles

Gross Anatomical Typing of Hepatocellular Carcinoma: Classification of 49 lobectomized hepatocellular carcinomas.: Young Nyun Park, Eun Kyung Han, Chan Il Park; Korean J Pathol. 1991;25(2):83-92.

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Abstract PDF: Forty-nine lobectomized hepatocellular carcinomas(HCC) were classified according to the gross anatomical features. Because the presence of cirrhosis in the remaining liver has a good clinico-pathological implication, cases of HCC were divided into non-cirrhotic(non-LC) and cirrhotic(LC) groups. In both groups, the tumors themselves belonged to either expanding, focal spreading, spreading or mixed type. Another special type, which has been called a "diffuse type" is added in the LC group with the name of "cirrhotomimetic type" Among 49 cases, 21 belonged to the non-LC group and 28 to the LC group. Most common was expanding type(20 cases, 40.8%), which was followed by spreading(32.7%), focal spreading(16.3%), mixed(6.1%) and cirrhotomimetic(4.1%) types. Expanding type of the LC group was the single most common type(13 cases, 26.5%). The accordance rate of gross typing was 0.94. Tumor masses of the LC group showed a greater tendency of having a fibrous capsule(60.7%) and a lobulated cut surface(82.1%), in contrast to those of the non-LC group (28.6% and 42.9% respectively). The patient's age and the HBsAg seropositivity were not different between the groups and between the types. Increased serum level of AFP was particularly frequent in the spreading type(81.3%) of both groups and in the cirrhotomimetic type(100%).

Immunohistochemical Study of Gastrointestinal Stromal Tumors.: Jung Weon Shim, Hye Jae Cho, Ill Hyang Ko, Ok Kyung Kim; Korean J Pathol. 1991;25(2):93-103.

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Abstract PDF: Historically, gastrointestinal stroma tumors (GIST) have been considered as smooth muscle tumors, but the controversy over this histogenesis is provoked due to various results with utilizing immunohistochemical methods. In andeffort to further clarify the histogenesis of GIST, we performed the immunohistochemical study, as well as histopathologic reexamination, of 24 cases, all diagnosed as smooth muscle tumors of gastrointestinal tract, from Seoul Paik Hospital and Ewha University Hospital between 1980 and 1989, and the main results were as follows; 1) In the histopathologic features by light microscopic study, 11 benign and 13 malignant lesions (including one high grade malignancy and 12 low-grade malignant lesions) were disclosed. 2) In the immunohistochemical study, all tumors showed Vimentin positivity (100%), but no tumor showed S-100 protein positivity (0%), and 7 cases (29.1%) showed Desmin positivity. Positive reaction for Desmin made it possible to suggest that the histogenesis of GIST be in smooth muscle, and neurogenic origin would be excluded by all negativity for S-100 protein. In summary, we would like to conclude that GIST would be smooth muscle tumors on account of their morphological characteristics and their intramural location, but most of them appear poorly differentiated by immunohistochemical method.

A Study on the Precancerous Lesion of Breast Carcinoma in 9, 10-Dimethyl-1, 2-Benzanthracene-treated Rats.: Cheon Sik Choi, Soo Min Kang, Hye Jung Lee, Gyung Hyuck Ko, Cheol Keun Park; Korean J Pathol. 1991;25(2):104-113.

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Abstract PDF: Following results were obtained from the light microscopic and stereomicroscopic observations of the breasts of rats treated with 9, 10-Dimethyl-1,2-Benzanthracene(DMBA). 1) Adenocarcinomas developed in 17 rats (24%) among 70 DMBA-treated rats. 2) Terminal and buds (TEB) were observed longer in DMBA-treated rats than in control group, but they finally disppeared 4 monthes after treatment. 3) Many hyperplastic alveolar nodules (HAN) developed in DMBA-treated rats. 4) There were no transitional lesions between TEB and adenocarcinoma or HAN and adenocarcinoma. 5) The number of lobules was decreased in DMBA-treated rats. On the other hand, terminal ducts were increased in number. These findings suggest that DMBA stimulate the regression of lobules and induce to form terminal ducts from which adenocarcinomas and HAN develop independently.

Primary Linitis Plastica of the Rectum: A Clinico-Pathologic Analysis of Five Cases with Special Reference to Comparison with Gastric Form.: Mee Soo Chang, Yong Il Kim, Woo Ho Kim, In Ae Park; Korean J Pathol. 1991;25(2):114-122.

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Abstract PDF: Colorectal cancer can have a gross appearance similar to linitis plastica of the stomach. However, most of these cases are not primary colorectal lesions but are, indeed, metastases from other sites. This study was designed to answer the following questions; (1) Why is the linitis plastica of the large intestine so rare compared to that of te stomach? (2) Which part of the large intestine is predominantly affected by linitis plastical form? (3) Is the histogenesis of linitis plastica involving the lagre intestine similar to that involving the stomach? Of the 911 cases of the resected colorectal primary cancer, we found only 4 cases of primary linitis plastica of the intestine (0.4%) and another one case referred from other hospital. All involved the rectum; they were of encircling carcinoma with diffuse transmural infiltration of signet ring cell carcinoma accompanied by marked desmoplasia as in the gastric form. Signet ring cell carcinoma of the large intestine comprised 1.8%(n=16) of the total colorectal cancer(n=911), and predominantly occurred in the rectum(n=8). There was no histologic difference between the linitis plastica in both stomach and colon in terms of desmoplastic reaction, once the tumor infiltrated into the submucosa. We conclude that rarity of signet ring cell carcinoma in the large intestine together with its predominant occurrence in the rectum can explain low incidence of primary colorectal linitis plastica and high preference in the rectum.

An Experimental Study of Vibrio vulnificus Infection in Mice.: Moon Ho Yang; Korean J Pathol. 1991;25(2):123-146.

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Abstract PDF: An experimental of Vibrio vulnificus infection has been performed with the intravenous, subcutaneous and oral inoculation of Vibrio vulnificus into ICR mice. The results are as follows: 1) The LD50 of the intravenous, subcutaneous and oral inoculation of Vibrio vulnificus were 1.6x10(7) cells/ml, 4.0x10(7) cells/ml, and 2.5x10(9) cells/ml, respectively. 2) In the experimental group without treatment with CC14, the survival rates for intravenous inoculation were 100% (1/2 LD50), 39.1% (LD50), and 8.3% (2 LD50). The survival rates for subcutaneous inoculation groups were 100% (1/2 LD50), 46.9% (LD50), and 18.8% (2 LD50). And the survival rates for oral inoculation groups were 100% (1/2 LD50), 53.1% (LD50), and 43.8% (2 LD50). 3) In those treated with CC14 0.05 ml, the survival rates for intravenous inoculation groups were 43.8% (1/2 LD50), 29.1% (LD50), 0% (2 LD50). The survival rates for subcutaneous inoculation groups were 59.4% (1/2 LD50), 40.6% (LD50), and 9.4% (2 LD50). The survival rates for oral inoculation groups were 68.8% (1/2 LD50), 46.9% (LD50), and 18.8% (2 LD50). In those treated with CC14 0.1 ml, the survival rates for intravenous inoculation groups were 25.0% (1/2 LD50), 10.4% (LD50), and 0% (2 LD50). The survival rates for subcutaneous inoculation groups were 43.8% (1/2 LD50), 21.9% (LD50), 0% (2 LD50). The survival rates for oral inoculation groups were 50.0% (1/2 LD50), 37.5% (LD50), and 0% (2 LD50). 4) Liver, lungs, meninges and brain, kidneys, heart, gastrointestinal tract and spleen showed septic inflammatory findings. Their degree of inflammation were different according to the severity of hepatic damage and the inoculum size.

Case Reports

Neonatal Giant Cell Hepatitis: An autopsy case.: Sung Churl Lim, Moo Young Song, Un Jun Hyung, Je G Chi; Korean J Pathol. 1991;25(2):147-152.

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Abstract PDF: We report an autopsy case of neonatal giant cell hepatitis that was presumed to be related to bacterial sepsis, endotoxemia and to the subsequent parenteral alimentation and antibiotics treatment. The patient died of candidal endocarditis and multiple brain infarcts. This female baby was born by a normal full term spontaneous delivery. Six days after delivery she developed fever and lethargy as she suffered from Cheyne-Stokes respiration with severe grunting. Blood culture grew Enterobacter and Acinetobacter. After management of the sepsis her general condition improved. On the 23rd day of admission she was found to have deep jaundice and hepatosplenomegaly. The liver became larger progressively and the edge was palpable at the umbilical level. Grade II systolic murmur was heard along the left lower sternal border. She died on the 31st day of hospitalization. Postmortem examination showed severe jaundice, hepatosplenomegaly, a large vegetation on the mitral valve and multiple petechial hemorrhages of the viscera. Microscopically the liver showed features of massive giant cell transformation, mild fibrosis and inflammatory cells, suggestive of giant cell hepatitis. Numerous yeasts and candidal pseudohyphae were seen in the cardiac vegetation, focally extending into the myocardium. There was a focus of candidal vasculitis in the bowel wall. In addition there were multiple bilateral organizing infarcts in the cerebral hemisphere as well as diffuse white matter damage associated with septicemia.

Cystic Meningioma: A case report.: Jae Hoon Park, So Yeon Yu, Youn Wha Kim, Yong Koo Park, Moon Ho Yang; Korean J Pathol. 1991;25(2):153-157.

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Abstract PDF: Meningiomas are usually thought of as firm solid tumors and most standard references make no mention of cystic meningiomas. Although several cases of cystic meningioma have been reported in the literature and their neuroradiological features discussed, the rarity of this entity makes its preoperative diagnosis difficult. Recently, the authors encountered a case of cystic meningioma, which was thought as ependymal cyst or infarction, preoperatively. In this report the authors discussed its clinical, neuroradiological and pathological characteristics with brief reviews of the literature.

Original Article

Sarcoidosis Involving the Spinal Dura.: Young Shin Kim, Ki Hwa Yang, Byoung Kee Kim, Sun Moo Kim; Korean J Pathol. 1991;25(2):158-163.

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Abstract PDF: Neurosarcoidosis without systemic manifestation is vary unusual condition. Solitary lesion in the spinal dura is exceptional. The diagnosis of the neurosarcoidosis is very difficult, because the efficacy of Kveim test is low in neurosarcoidosis. The histologic examination is considered as confirmative diagnostic tool. The authors reported a case of neurosarcoidosis involving the dura of the cervical spine, in a fifty-nine year old female who had suffered from mid-back pain for six months and paraparesis for two weeks. There was a dumbbell shaped mass in the D4-5 dura. It showed tan gray color with rubbery consistency. With histological examination, it revealed diffuse non-caseating granuloma. Occasionally asteroid bodies were observed within the cytoplasm of the multinucleated giant cells. After operation, she was treated with steroid, and she has been well about nine month period.

Case Reports

Merkel Cell Carcinoma: A case report associated with squamous cell carcinoma.: Chang Hun Lee, Gyeong Yeob Gong, Kang Suek Suh, Sun Kyung Lee; Korean J Pathol. 1991;25(2):164-171.

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Abstract PDF: Merkel cell carcinoma is a relatively uncommon, cutaneous, neuroendocrine neoplasm that was first recognized by Toker in 1972. Occasionally it is found concurrent with squamous cell carcinoma or basal cell carcinoma and in them cases, the coexistence of them is suggesive of presenting the effect of a common carcinogenic influence on two distinct precursor cells. Now the authors report a case of Merkel cell carcinoma associated with squamous cell carcinoma arising in the overlying epidermis, and a brief review of literatures is introduced. The patient was a 75-year-old female, who had noticed a reddish brown, ulcerated mass on the right buttock. It had progressively enlarged to become lemon-size during last 4 months. The right buttock mass excised measured 10x8x3 cm and was gray white, solid, with an ill-defined marigin. Histologically the tumor was located in the dermis and was lacking in connection with the epidermis in which invasive squamous cell carcinoma developed. The neoplastic cells were arranged in a diffuse, lymphoma-like pattern or trabecular arrangement and their cytologic details were reminiscent of small cell carcinoma of the lung, On electron microscopy the cells displayed many neurosecretory granules averaging about 100nm in diameter, intermediate filaments and desmosomes. Immunohistochemically a ball-like immunostaining for keratin, resembling an inclusion body, was seen, but other markers, including neuron-specific enolase, vimentin, S-100 protein and leukocyte common antigen, were unrewarded.

Hepatic Anthracosis: A case report.: Hee Jae Joo, Eun Kyung Han, Ho Guen Kim, Chan Il Park; Korean J Pathol. 1991;25(2):172-173.

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Abstract PDF: The authors report a case of hepatic anthracosis, which was found incidentally during cholecystectomy in a 73 year-old woman with acute cholecystitis. Hepatic anthracosis is a very rare condition among pigmentary lesions of the liver. Light microscopic examination revealed black granular pigments within Kupffer cells, particularly adjacent to the terminal hepatic venules, and macrophages at the portal tracts. The pigments did not show birefringence under the polarizing microscope and did fade out following pretreatment with alcoholic picric acid, confirming themselves anthracotic pigments.

Sebaceous Adenoma in Medial Caruncle of the Eye: A case report.: Geon Kook Lee, Joong Seok Seo, Kye Yong Song, Je G Chi; Korean J Pathol. 1991;25(2):174-177.

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Abstract PDF: Sebaceous adenoma is a rare solitary or multiple yellow, circumscribed neoplasm consisting of sharply demarcated, proliferating lobules or irregular size and shape that are composed of three cell bypes: basal cells, mature and transitional sebaceous cells. We reported a case of extremely rare sebaceous adenoma arising in caruncle of the left eye in a 78-year-old female. A polypoid tumor nodule, measuring 0.6x0.5 cm, was noticed 6 months before resection. It was grayish white with granular surface. There is no evidence of associated visceral neoplasm. Histopathologically, it revealed a lobulated tumor, composed of equal amount of highly differentiated sebaceous and intermediate transitional epithelium with minor participation of basaloid cells. This tumor is thought to be the neoplasm of the sebaceous gland normaly present in the caruncle of the eye rather than ectopic origin.

Subcutaneous Granuloma Annulare of the Scalp: A case report.: Geon Kook Lee, Joong Seok Seo, Kye Yong Song, Seong Hye Park, Je G Chi, Kyoung Chan Park; Korean J Pathol. 1991;25(2):178-182.

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Abstract PDF: Subcutaneous granuloma annulare (SGA) is a rare, benign noninfectious histiocytic disease of unknown cause, characterized by necrobiosis of the connective tissue surrounded by infiltrates of histiocytes and lymphocytes. We report a case of SGA in a 49/12-year-old boy. The lesions were five nontender subcutaneous nodules in the parieto-occipital scalp, measuring 1.0 cm to 2.0 cm in diameter. Microscopical examination revealed variable stages of multiple necrobiotic areas, which showed central necrobiosis with palisading histiocytes, involving both the lower dermis and subcutaneous fatty tissue. Electron microscopic findings revealed many histiocytes in the necrobiotic areas with degenerating and necrotic collagen fibers as well as regenerating fibroblasts.

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