Journal of Pathology and Translational Medicine

Volume 25(5); October 1991

Original Articles

Evaluation of DNA Ploidy and Other Morphometric Parameters of Ovarian Mucinous Tumors.: Yun Mee Kim, Sang Woo Juhng, Joo Yong Yoo, Kyu Hyuk Cho; Korean J Pathol. 1991;25(5):397-406.

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Abstract: Biological behavior of malignant tumors has been assessed by morphological grading, clinical staging, and estimating other tumor markers. Recently DNA ploidy measured by flow cytometry and image analyser has been suggested as an additional useful indicator of the tumor behavior. In order to extract useful tumor cell-specific information in ovarian mucinous tumors, DNA contents and other morphologic parameters were measured by image analysis and DNA ploidy was also measured by flow cytometry. In all cases of cystadenoma, DNA diploidies were observed. In borderline malignancy, DNA diploidies were chiefly observed except one case of polyploidy. In true malignancy, DNA aneuploidies were observed except one case of polyploidy and two cases of diploidies by image analysis, and except four cases of diploides and one cas of polyploidy by flow cytometry. The statistical significance were observed in DNA ploidy pattern by image analysis. In nuclear areas, perimeters and major axis, statistical significance were not observed. These results suggest that DNA ploidy pattern are more or less independent parameter as an additional useful indicator of the histological grade of malignancy and that image analysis are better than flow cytometry in detecting DNA aneuploidy.

Immunopathologic Study and Clinical Correlation of Non-Hodgkin's Lymphoma.: Mi Seon Lee, Jin Man Kim, Kwang Sun Suh, Dae Young Kang; Korean J Pathol. 1991;25(5):407-417.

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Abstract: In Korea, the proportion of B-cell and T-cell lymphomas has not yet been clearly estimated. In the present study, we analysed clinicopathologic and immunophenotypic findings in 60 cases of non-Hodgkin's lymphomas(NHL) and in 17 cases of polymorphic reticulosis. Immunohistochemical studies for monoclonal antibodies, such as MB2, UCHL-1, Kappa/Lambda light chains, and IgG/IgM/IgD heavy chains were performed on formaldehyde-fixed paraffin embedded tissue sections. Among 60 cases of NHL, 28 cases(46.7%) expressed B-cell markers, 29 cases(48.3%) T-cell markers, and 3 cases(5.0%) lacked detectable markers, whereas 16 of 17 cases(94.2%) of polymorphic reticulosis reacted with T-cell markers. The mean survival of the 16 cases of T-cell lymphoma group was shorter than that of the lymphoma group positive for B-cell markers.

Smooth Muscle Tumors of the Stomach : A clinicopathologic analysis of 46 cases.: Mee Soo Chagn, Yong Il Kim, Woo Ho Kim; Korean J Pathol. 1991;25(5):418-426.

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Abstract: This study was undertaken to characterize the clinicopathologic features of smooth muscle tumors of the stomach with additional regard to recent controversy over the gastrointestinal smooth mscle tumors. A total of 46 consecutive cases(47 tumors) of surgically resected or excised gastric smooth muscle tumors, were assessed for review. The criteria for malignancy applied in this study were one of the followings; (1) 5 or more mitoses/10 HPF or (2) 1-4 mitoses/10 HPF with tumor cell necrosis and 5 cm or greater in tumor size. The tumors were classified as ordinary leiomyoma in 24 cases(25 tumors), epithelioid leiomyoma in 3, cellular leiomyoma in 6, ordinary leiomyosarcoma in 10, myxoid leiomyosarcoma in 2, and epithelioid leiomyosarcoma in 1. Of the 46 cases, 13 cases(28%) were categorized as malignant smooth muscle tumor. But immunohistochemical study for S-100 protein, desmin and vimentin(5 cases), and ultrastructural study(2 cases) support that myogenic or neurogenic differentiation is evident simultaneously within the same tumor, regardless of malignancy, and that even the differentiated tumor cells seem to express such direction toward immature smooth muscle cell or nerve cell.

A Histopathological Analysis of 69 Cases of Adenocarcinoma of the Uterine Cervix.: Na Hye Myong, Chang Won Ha, Kyung Ja Cho, Ja June Jang; Korean J Pathol. 1991;25(5):427-435.

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Abstract: Cervical adenocarcinoma represents approximately 3-6% of the uterine cervical neoplasms. Recently, its relative incidence tends to be increased in contrast to squamous cell carcinoma. Sixty nine cases from 1985 to 1990 diagonsed as adenocarcinoma of the cervix by radical or total hysterectomy were analyzed to know their histopathological characteristics and related prognostic factors. The results wer as follows. (1) The age distribution ranged from 24 to 60 years and the mean age was 44 years and 47 years in adenocarcinoma in situ and invasive adenocarcinoma, respectively. Staging by FIGO classification showed the range from stage 0 to IIb, of which 63.8% was stage Ib. (2) Cases were composed of 7 cases of adenocarcinoma in situ(10%) and 62 cases of invasive adenocarcinomas(90%). The latter included 16 cases of adenosquamous carcinoma and 46 cases of pure adenocarcinoma which showed endocervical, endometrioid, clear cell, minimal deviation adenocarcinoma subtypes. The most frequent subtype was endocervical adenocarcinoma(51%) and the endometrioid subtype showed slightly higher incidence rate(13%) in comparison to the previous studies. (3) Coexistent squamous lesions ranging from mild dysplasia to invasive carcinoma were found in 4 out of 7 cases(57%) of adenocarcinoma in situ and 18 out of 62 cases(29%) of invasive adenocarcinoma. Severe dysplasia and carcinoma in situ comprised most(77%) of them. (4) Analyses of histopathological and clinical characteristics of adenocarcinoma of the uterine cervix revealed positive correlations between tumor size or mucin leakage and depth of invasion. The prognostic factors in relation to lymph node metastasis were considered to be th stage of disease, the size of tumor, mucin leakage in the stroma, and histologic subtypes.

A Study of beta 2-Microglobulin Expression in Uterine Cervical Epithelial Lesion.: Na Hye Myong, Eui Keun Ham; Korean J Pathol. 1991;25(5):436-445.

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Abstract: Beta-2-microglubulin(beta 2m), the invariable light chain of the histocompatibility antigen is present on the surfaces of most human nucleated cells. It has proved to be reduced or disappeared on the cell surfaces of variable skin cancers. Patterns of beta 2m stainability in normal uterus and of the loss in several cervical epithelial lesions were examined by immunohistochemical staining using rat monoclonal and rabbit polyclonal anti-beta 2m, repectively on fresh tissues of 13 cases and formalin-fixed paraffin-embedded tissues of 23 cases. To know patterns of loss of beta 2m stainability and measure its extent and degree, only fixed tissues were examined. Fresh uterine tissue showed beta 2m stainability present on the cell membranes of squamous epithelium, endocervical gland, and capillary endothelium. Of these, squamous epithelium of uterine cervix revealed most characteristic lace-like staining along the cell outlines. Paraffin-embedded 23 cases were classified as group I (6 normal conrol and metaplasia), II (5 mild and moderate dysplasia), III (6 severe dysplasia and carcinome in situ), and IV ( 6 microinvasive and invasive squamous cell carcinoma). Group 2-4 showed reduced beta 2m stainability when compared to group 1 that exhibited the similar stainability as fresh normal cervical epithelium. The reduction or less proved to be statistically significant(p-value<0.001) in group 3 and 4 except for group 2. In spite of being invasive cases, a few disclosed beta 2m positive cells mainly in well-differentiated areas. In sum, ABC immunohistochemical staining of beta 2m showed the tendency tend to decrease or disappear in uterine cervical epithelial lesions with premalignant or malignant change and rather to appear in some well-differentiated areas of malignant lesions.

Neonatal Hepatitis and Extrahepatic Biliary Atresia : A Comparison by Scoring the Histological Parameters.: Sun Hee Sung, Woo Hee Jung, Ho guen Kim, Ki Sup Jeong, Chanil Park; Korean J Pathol. 1991;25(5):446-456.

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Abstract: Neonatal hepatitis(NH) and congenital extrahepatic biliary atresia(BA) are two major causes of neonatal cholestasis. The method of therapeutic trials for each disease is essentially different. Nonetheless it is very difficult to differentiate these diseases histologically, since most of the hepatic changes are mutual in both of them. This study is to aimed to find out major differences between the two by scoring various histological parameters. A total of 63 consecutive liver biopsies taken from 54 patients with suggested NH and BA were examined by applying morphometric scoring system. The detailed clinical histories, laboratory data including serology for HBsAg and TORCH infection and radiologic operative findings were reviewed. Among 54 patients, 27 were diagnosed as NH and 20 as BA. In two cases, features of both diseases were coexistent. The pathological diagnosis was not compatible with the final diagnosis in 5 cases(10.7%). In all of these 5 cases, biopsy had been performed at the age of one to two months. The seropositivity for TORCH was 59.3%(16.27) in NH, but 25.0%(5/20) in BA. Serum AST, ALT and alpha-fetoprotein values were higher in NH, and total bilirubin in BA. Of various histological parameters, scores of portal fibrosis, bile duct and ductular proliferation and bile thrombi were much higher in BA, and at the age of less than 2 months, extramedullary hemopoiesis(EMH) was found much more frequently in NH. Giant cell transformation of hepatocytes(GCT) was more commonly observed in NH. The numbers of GCT and EMH were particulary plentiful when the patients' sera were positive for HBsAg or TORCH. These results indicate that portal fibrosis, biliary proliferation and bile thrombi are the three major histologic features of BA, and therefore erroneous histological diagnosis may ensue when scores of those features are low as in some early BA.

Heterotopic Glial Nodule in the Lung of an Anencephaly Patient : An autopsy case.: Hye Joung Lee, Soo Min Kang, Gyung Hyuck Ko; Korean J Pathol. 1991;25(5):457-461.

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Abstract: The heterotopic and tissues may be divided into two categories: those that are found in the head and neck region, and those that arise elsewhere. The latter type is rare and most cases are found in the lungs of patients with neural tube defect, particularly anencephaly. Our report descrives anencephalic male infant with heterotopic glial nodules in both lungs. The largest nodule is 2x1.5x1 cm, locates in the lower lobe of the left lung, and has a round gray-white cut surface with cystic spaces. Microscopically, the nodules consist of irregularly arranged astrocytes and glial fibers, in which are embedded gland-like or cystically dilated bronchioles. The astrocytes and glial fibers are strongly positive for glial fibrillary acidic protein and show astrocytic filaments on electron microscopy. This will be an additional case supporting the amniotic fluid aspiration/implantation theory of pathogenetic mechanism of distal heerotopic glial tissue.

Squamous Cell Carcinoma and Struma Ovarii Arising in Benign Cystic Teratoma.: Eun Sook Nam, Young Seek Kim, Yang Seok Chae, Kap No Lee, Seung Yong Paik; Korean J Pathol. 1991;25(5):462-466.

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Abstract: Malignant tumor is found in 1-2% of ovarian benign cystic teratomas. Among these malignant neoplasms, squamous cell carcinoma is by far the most common malignancy, whereas the incidence of struma ovarii is less than 5% in mature teratoma. As far as concerned the struma ovarii, a very small percentage is associated with carcinoid, mucinous or serous cystadenoma, or Brenner tumor. However, any reports of struma ovarii associated with squamous cell carcinoma in the same ovary could not be found in English literature. Recently we have experienced a case of squamous cell carcinoma and struma ovarii arising in an ovarian benign cystic teratoma in 72 year old female patient.

Case Reports

A Case Report of Pedunculated Hepatocellular Carcinomas.: Jae Bok Park, Sae Kwang Moon; Korean J Pathol. 1991;25(5):467-470.

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Abstract: Pedunculated hepatocellular carcinoma was first described by Roux in 1987, and Goldberg and Wallerstein presented a case with pathological description in 1934. Since then 37 cases have been reported in the world literature. A pedunculated hepatocellular carcinoma, occurred in a 69-year-old woman, was encountered. It was attached to the Glission's capsule of the right lobe of liver inferiorly, and was connected to the porta hepatis bt a mesenteric pedicle containing arteries, veins, bile ducts and nerve bundles. The tumor mass was completely encapsulated, and measured 8.5x8x6 cm and 255 gm. It was composed of hepatocellular carcinoma of a well-differentiated, acinar type. Tumor cells were positive for HBsAg, but negative for alpha-fetoprotein on peroxidase-antiperoxidase staining. The liver exhibited macronodular cirrhosis on gross examination. This tumor is thought to have on in the supernumerary lobe of liver.

Blue Nevus of the Uterine Endocervix : Report of three cases.: Moon Hyang Park, Eun Kyung Hong; Korean J Pathol. 1991;25(5):471-475.

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Abstract: The clinical, gross, light microscopic and immunohistochemical findings of three cases of blue nevus of the uterine endocervix were described. All three cases were incidentally found in hysterectomy specimens from middle-aged women, 45 to 48 years of age. The lesions were small and measured 1 to 4 mm in the greatest diameter. The presence of elongated, somewhat wavy and dendritic melanin-containing cells, in clusters or scattered deep in the subepithelial stroma and between the endocervical glands, was the distinct feature. The cytoplasmic granules appeared black with Grimelius and Fontana-Masson stains. The cells showed strong positive reaction with S-100 protein in perinuclear cytoplasm, in addition to the diffusely dispersed melanin granules. The demonstration of S-100 protein in the blue nevus, along with the histochemical findings, supports combined melanocytic and schwannian differentiation of the blue nevus cells.

Low-grade Uterine Endometrial Stromal Sarcoma Resembling Ovarian Sex-Cord Tumor : A case report.: Mee Yon Cho, Kyu Rae Kim, Woo Hee Jung, Hyeon Joo Jeong, Kyi Beum Lee; Korean J Pathol. 1991;25(5):476-480.

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Abstract: A case of low-grade endometrial stromal sarcoma resembling ovarian sex-cord tumor in the uterus of a 43-year-old woman is described. This tumor belongs to the group II category of uterine tumors resembling ovarian sex-cord tumor described by Clement and Scully, and the epithelial-like elements show prominent smooth muscle differentiation, proved by immunoreactivity for desmin and actin. The patient did not receive any adjuvant therapy; she is alive and well without recurrence 8 months postoperatively.

Ependymoma in Pelvic Cavity : A case report.: Joon Hyuk Choi, Hae Joo Nam, Dong Suk Kim, Won Hee Choi, Tae Sook Lee, Hong Jin Kim; Korean J Pathol. 1991;25(5):481-487.

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Abstract: A case of ependymoma originated in pelvic cavity is reported. Metastasis to regional lymph nodes and abdominal cavity developed. This tumor is thought to arise from heterotopic ependymal rests. The patient was 32 year old woman. A 10.0x7.0x7.0 cm sized mass was located between the uterus and rectum, which was attached to the rectal wall. It was a well circumscribed tumor with massive hemorrhage and necrosis. Histologically, tumor showed variegated appearance. Plump oval or round cells were arranged oval of elongated cells with fibrillary cytoplasmic process. Occasionally perivascular pseudorosette and ependymal rosette were seen. Immunohistochemical staining for GFAP showed intense positivity. Ultrastructural examination showed intracytoplasmic microfilaments, cilia, microvilli, and blepharoplasts.

Mesenteric Cystic Lymphangioma with Sustained Abdominal Pain : Report of a case.: Gyeong Hoon Kang, Yong Il Kim, Woo Ho Kim, In Sung Song, Kyoo Wan Choi; Korean J Pathol. 1991;25(5):488-490.

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Abstract: A case of cystic lymphangioma of the mesentery with severe and persistent abdominal pain in a 22-year-old man is presented. The cyst was filled with chylous fluid. Microscopically, numerous nerve bundles were incorporated within the lymphangiomatous walls, and some protruded into the lumen. The above findings lead to a suggestion that mesenteric lymphangioma may differ from those in the other sites by its abundance of incorporation of nerve bundles into the lymphangiomatous walls, and that increase of tumor size by intracystic accumulation of chylous fluid may subsequently result in increase of intraluminal pressure to compress the nerve bundles with which abdominal pain is much enhanced.

Lymphatic Cyst of the Adrenal : Report A Case.: Soong Deok Lee, Yong Il Kim; Korean J Pathol. 1991;25(5):491-494.

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Abstract: A case of lymphatic cyst of the adrenal gland in a 55-year-old woman is described. The patient presented with vague abdominal pain, and abdominal CT and ultrasonography suggested a pancreatic cyst. The cyst, 10x8x6 cm in size, was found in the left adrenal gland; it was multilocular and septated with thin walls that were lined by a single layer of attenuated cells. The lining cells gave a weak positive immunoreactivity against factor VIII-related antigen and Ulex eurapaeus, and ultrastructural study revealed the lining cells to be of endothelial origin. Together with small tiny proliferative cystic spaces were intermixture of the normal adrenal cortical cells in the transition zone between large cysts and adrenal cortex. No histologic distinction between cystic lymphangioma and lymphangiectatic cyst was obtained; instead, a term of lymphatic cyst seems preferred unless otherwise confirmed. With its classification, the pathogenesis of adrenal lymphatic cysts is reviewed.

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