Journal of Pathology and Translational Medicine

Volume 27(2); April 1993

Original Articles

Primary Ciliary Dyskinesia(Immotile Cilia Syndrome): Clinical and electron microscopic analysis of 17 cases.: Je G Chi, Chul Jong Yoon; Korean J Pathol. 1993;27(2):99-107.

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Abstract PDF: Immotile cilia syndrome is a genetically determined disorder characterized by immotility or poor motility of the cilia in the airways and elsewhere. Since its first description in 1976 determination of a ciliary abnormality has now clarified its variable expression and pleiotropism. Certain specific defects in the ciliary axoneme can be found and are pathognmoic of the syndrome. These defects include missing dynein arms, abnormally short dynein, arms, spokes with no central sheath, missing central microtubules, and displacement of one of the nine peripheral doublets. We have studied 80 cases of bronchial or nasal mucosal biopsies that were performed with the suspicion of immotile cilia syndrome. Of 80 cases only 17 cases were sampled optimally to be able to observe under transmission and scanning electron microscopes. All 17 cases had certain abnormality of the cilia. They consisted of Ia(3 cases), Ib(3 cases), Id only(3 cases) and Id+other types(6 cases) a according to Sturgess classification. Seven cases consisted of 1 solitary and 6 combined form; II+Id(1 case) and II+Id+III(5 case). All 5 cases of type III were combined with Id and II. Clinically most pronounced manifestations were cough(82%), sputum(59%), rhinorrhea(41%) and nasal stuffiness(35%), All the patients were below the age of 15 years, and there were 6 boys and 11 girls.

Discriminant Analysis of Tumor Cell Subpopulation Based on Morphometric and Photometric Features: Observations on tumor cells of the uterine cervix carcinoma.: Chang Soo Park, Dae Yong Choi, Min Cheol Lee, Sang Woo Juhng; Korean J Pathol. 1993;27(2):108-114.

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Abstract PDF: DNA aneuploid cells are poorly characterized in both biochemical and morphological terms. This study was performed to see the relationship between DNA ploidy and morphometric and photometric nuclear features. DNA contents of tumor cells were measured by image cytometry in 46 cases of micro- or early invasive squamous cell carcinoma of the uterine cervix. Also measured were nuclear area, perimeter, maximum diameter, chromatin pattern index, and staining intensity. Among the 46 cases, 20 cases which had both DNA diploid and aneuploid cell subpopulations were selected, and the two subpopulations were discriminated statistically. Multivariate discriminant analysis seperated clearly the two subpopulations, whereas univariate analysis failed. For canonical discriminant function, nuclear area was selected first, followed by staining intensity in each case. Other variables selected afterwards were nuclear perimeter, maximum diameter, and/or chromatin pattern index in random fashion. Correlation coefficient between the canoncial discriminant function and the variables were 0.20~0.40 for nuclear area and 0.25 or less for the others. The above results suggest that DNA ploidy is a parameter more or less independent on individual morphometric and photometric parameters.

Neonatal Necrotizing Enterocolitis: Pathologic analysis of 14 cases.: Yeon Lim Suh, Je G Chi; Korean J Pathol. 1993;27(2):115-124.

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Abstract PDF: We reviewed surgical or autopsy specimens of the gastrointestinal tract from 14 patients with necrotizing enterocolitis(NEC) to define the specific pathologic findings and the pathologic changes of the bowel in the premature and fullterm infants, and then to see how these findings are related each other and to clinical features. In two-thirds of patients two or more continuous segments of the gastrointestinal tract were affected, and the ileum and colon were by far the most common sites of involvement. Pathologically, coagulation necrosis, inflammatory reaction, ulceration, microthrombi, overgrowth of microorganism, and perforation were the leading changes of NEC. On the basis of these histopathologic findings of the involving intestine, we could classify the pathology of NEC into two different histologic types. Type 1 and II are thought to represent pathologic changes of the intestine in acute and chronic stages of disease process. The symptom duration of the patients was significantly different between two types. The pathologic changes of the involved bowel were similar in both premature and fullterm infants, although the premature tended to have type 1 and the fullterm babies had more cases of type II. These pathologic changes could be associated with various clinical manifestation of NEC.

An Effective Role Pulsed Unipolar Magnetic Field for Bony Decalcification.: Suk Keum Lee, Eun Young Chung, Gi Jin Kim, Dae Beom Song, Jo Ho Kim, Je G Chi; Korean J Pathol. 1993;27(2):125-133.

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Abstract PDF: To achieve optimal decalcification in tissue and tissue preservation, we have tried magnetic field method and made some promising results. We used pulsed unipolar magnetic field obtained by rectification of 250 V-60 cycle, A.C. As a new method of bony decalcification, using 5% nitric acid, 10% formic acid and 10% formic acid+3% hydrochloric acid solutions, experimental groups were decalcified in the center of the magnetic field. The concentration of calcium ion in the decalcifying solution was measured by calcium-oxalate turbidity test by photometry method, and direct visualization of calcium radiopacity was obtained by soft X-ray view during the decalcification process. The pH change during decalcification was continuously checked and needle penetration method was also used. All the decalcification solution used in this study showed accelerated effect of bony decalcification in the strong magnetic field. Among them 5% nitric acid produced complete decalcification for the medium size bony specimen (less than 10x10x10 mm) within 24 hours, and the histologic feature was almost free of acid-chemical degeneration. The pH of all the decalcification solutions decreased in the strong magnetic field, maximum within 4~6 hours, and kept strong acidity throughout the decalcification procedure. After removal of the magnetic field the pH of all the decalcification solution returned to their original values after 24 hours. It was presumed that the cause of the accelerated decalcification in the magnetic field was due to combined effects of the rapid increase of acidity and the increased molecular resonance to stimulate the ionization of mineral elements.

An Immunohistochemical Study of CA 125, CA 19-9, and CA 15-3 in Ovarian Epithelial Tumors.: Hye Rim Park, Hye Kyung Ahn, Young Euy Park, Joo Hyun Nam; Korean J Pathol. 1993;27(2):134-142.

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Abstract PDF: To evaluate the relationship between the expression of CA 125, CA 19-9, and CA 15-3 and ovarian epithelial tumors, immunohistochemical stainings were performed and analyzed to the types of tumor, and the degree o malignancy and differentiation in the total 42 cases. The results were summarized as follows: 1) The expression of CA 19-9 and CA 15-3 was demonstrated in most cases of benign, borderline and malignant mucinous tumors. All types tumors were negative for CA 125. 2) All types of serous tumors including benign, borderline and malignant revealed strong positive reaction for CA 125 and CA 15-3 in contrast to some weak positivity for CA 19-9. Expression of CA 125 was significantly increased in high grade serous adenocarcinomas compared with low of grade. 3) Endometrioid carcinomas revealed strong positive reaction for CA 15-3 in contrast to some positivity for CA 125 and CA 19-9. One case of Brenner tumor expressed CA 19-9 and CA 15-3 without expression of CA 125. 4) Serum CA 125 levels were elevated in 80% and CA 15-3 levels in 100% of ovarian epithelial malignancy. The correlation between serum levels and staining intensities was moderate.

In Vitro

Ovarian Serous Borderline Tumors with Peritoneal Implants: A clinicopathologic and flow cytometric DNA analysis of 5 cases.: Kyu Rae Kim, Kwang Yul Cha, Soon Hee Jung, Woo Hee Jung, Dong Hee Choi, Jong Wook Kim; Korean J Pathol. 1993;27(2):143-151.

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Abstract PDF: Five cases of ovarian serous borderline tumor associated with multiple peritoneal implants were analysed. The age of 5 patients ranged from 34 to 45(mean: 39) years at the time of diagnosis. Two patients presented with secondary infertility underwent hyperstimulation of the ovary under the in vitro fertilization program. One patient was presented with abdominal pain and the remaining two with lower abdominal mass accompanied by abdominal pain. Serous surface papilloma of borderline malignancy, involving one or both ovaries, was present in all 5 cases and papillary serous cystic tumor of borderline malignancy was associated simultaneously in one or both ovaries in all cases. Marked adhesions between the pelvic organs, and multiple granularities and nodularities of the omentum and peritoneum were noted. Microscopically, the peritoneal lesions were composed of noninvasive implants of tumor cells and pasmmoma bodies on the surface of entire pelvic and abdominal organs. Flow cytometric analysis of nuclear DNA content from paraffin-embedded tissue fo primary ovarian tumor classified as aneuploidy in 3 cases and as diploidy in 2 cases. The DNA index of the aneuploid tumors ranged from 1.21 to 1.37. Four patients underwent hysterectomy, bilateral salpingo-oophorectomy and partial omentectomy in which two were followed by chemotherapy and one case underwent bilateral salpingo-oophorectomy.

Original Article

Lymphoproliferativ Lesions of the Orbit and Conjunctiva: Histopathologic Study on 20 cases including 5 cases analyzed by Immunophenotyping.: Chul Woo Kim, Na Hye Myong, Je G Chi; Korean J Pathol. 1993;27(2):152-163.

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Abstract PDF: Lymphoid lesions of the orbit and conjunctiva may be divided histologically into three groups: monomorphous and cytologically atypical malignant lymphomas, benign reactive follicular hyperplasia or inflammatory pseudotumor, and borderline lymphoid lesions mainly composed of small, non-atypical lymphocytes with or without evidence of plasmacytic differentiation or germinal centers which are difficult to clarify its nature by histologic criteria alone. From 1984 to 1992 at Seoul National University Hospital, 20 cases of orbital lymphoid infiltrates were reviewed to find out histopathologic characteristics of malignant lymphomas and try to classify them properly. Also, we sought histologic findings helpful for differential diagnosis between malignant and borderline cases. Histologic examination of malignant lesions usually revealed the features of low-grade B cell lymphomas of mucosa-associated lymphoid tissue(MALT) origin, which predominantly consist of centrocyte-like(CCL) cells. Among 13 primary orbital lymphomas, six cases were classified as MALT lymphomas of Isaacson, six were more apt to be the type of immunocytoma by kiel classification, and remaining one showed mixed pattern of both types in areas. The one case of malignant lymphoma with diffuse large cell type was confirmed by secondary involvement of intestinal lymphoma. Five cases were confirmed by immunoglobulin k-light chain monoclonality on flow cytometry and immunofluorescence study. The histologic findings such as Dutcher bodies, hemosiderin, deposits and polykaryocytes tended to be more frequently encountered in malignant lymphoma rather than indeterminate lesions and were thought to be helpful ones in making differential diagnosis between malignant and benign lesions. With above findings, we assume that the principal neoplastic cells in the low grade lymphoma arising in the orbit and conjunctiva are CCL cells, which might be originated from the localized memory B cells, and also several kinds of B lymphocytes in on-going differentiation stages such as medium-sized monocytoid B cell, lymphoplasmacytoid cell, plasma cell, and mature small lymphocyte also contribute to the tumor progression.

Case Reports

Inflammatory Pseudotumor of the Lymph Node: A case report.: Yee Jeong Kim, Kun Chang Song, Woo Hee Jung, Woon Sup Han; Korean J Pathol. 1993;27(2):164-168.

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Abstract PDF: A 21-year-old man presented with a 7 days history of fever. Careful clinical examination led to the discovery of left supraclavicular lymphadenopathy without hepatosplenomegaly. Serologic tests for Ebstein-Barr virus, HIV, hepatitis type B & C, syphilis and typhoid fever were negative. Blood, urine, and stool cultures yielded no growth. Histologically, the process mainly involved the connective tissue framework of the lymph node, sharing the features of inflammatory pseudotmor(IPT) of other organs: a storiform growth pattern, increased vascularity with associated vascular lesions, and a polymorphous inflammatory infiltrate in a collagen-rich stroma. Immunohistochemical study for spindle cells showed positive reaction for actin and vimentin but not for desmin, and lymphoid cells revealed polyclonality. Characteristics of mass formation, and the inflammatory nautre of the process enabled us adopt the term IPT which should be differentiated from hematolymphoid proliferative disorder or mesenchymal neoplasia.

Congenital Neuroblastoma of the Adrenal with Metastasis to Liver, Contralateral Adrenal and Pituitary: Report of an autopsy case.: Na Hye Myong, Sang Yong Song, Je G Chi; Korean J Pathol. 1993;27(2):169-174.

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Abstract PDF: Neoplasms presenting at birth or within the first month of life are defined as congenital tumors. The principal components of this congenital tumors are neuroblastoma, leukemia, brain tumors and sarcomas. The neuroblastoma is the most common accounting for 15~50% of all tumors in this group. It most often presents with an abdominal mass due to adrenal-retroperitoneal primary or hepatomegaly resulting from extensive metastasis. Most often the primary site is adrenal but other loci include the retroperitoneum, mediastinum, pelvis, etc. This 2-day-old female presented with hepatomegaly and a left adrenal mass at birth, first detected by ultrasonography. On the first day, she suffered from hematemesis and bradycardia. She died on the second day. Postmortem examination revealed massive metastatic tumor nodules in the liver and a well-demarcated round mass, 4 cm, in the left adrenal, with necrosis and hemorrhage. Microscopic findings revealed largely undifferentiated neuroblastoma with focal neuronal differentiation and areas of necrosis and calcification in the background of fine fibrovascular stroma. Other metastatic foci were detected in the right adrenal and pituitary gland.

Neuroendocrine Differentiation in Adrenal Cortical Tumor of Chidhood: A case report.: Sang Yong Song, Seung Sook Lee, Na Hye Myung, Je G Chi; Korean J Pathol. 1993;27(2):175-180.

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Abstract PDF: Although neuroendocrine differentiation is a characteristic feature of tumors of the adrenal medulla, cortical tumors may also rarely be differentiated into medullary element. Recently we experienced such a case of adrenal cortical tumor having features of both cortical and medullary tumor. The patient was an 11-year-old girl who was incidentally found to have a left adrenal mass. Laboratory results showed elevated serum cortisol, aldosterone, renin, and epinephrine with high excretion of urinary metanephrine. Urine vanillyl mandelic acid and 17-ketosteroid remained within normal limits. Histologic featuresof a 6 cm round yellowish tumor were ambiguous to decide the orgin of this neoplasm. Cortical element predominated in the tumor with minor areas of pheochromocytomatous feature. Immunohistochemically, the tumor cells were positive for vimentin, neuron specific enolase, and epithelial membrane antigen. Ultrastructural examination revealed scattered membrane bound dense core granules in the tumor cells of medullary differentiation, measuring 150~500 nm in average diameter. Cortical tumor element showed corresponding ultrastructural features. These results indicate that this is a case of adrenal cortical tumor with features of neuroendocrine differentiation.

Primary Cutaneous Meningioma arising from the Scalp: A case report.: Sug Hyung Lee, Seok Jin Gang, Sun Moo Kim; Korean J Pathol. 1993;27(2):181-183.

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Abstract PDF: Primary cutaneous meningiomas are extremely rare tumors found in the cutis or subcutis, and generally have a benign course. The tend to be located on the scalp, face, neck. or paravertebral area. The primary cutaneous meningioma bears similarities to developmental defects and probably originates from arachnoid cell rests in the skin, although diverse groups of cutaneous meningiomas seem to arise from several different sources. A case of primary cutaneous meningioma occuring in the scalp of left parietal area of a 27-year-old female is presented. Clinically the lesion appeared as indolent, slow growing cutaneous mass and has no connection with underlying brain tissue, as determined by examination of the roentgenographs. The definite diagnosis was made after pathological examination. Microscopically the tumor is composed of sheets and nests of meningothelial cells. Immunohistochemical and electron microscopic studies reveal the typical findings of meningioma.

Original Article

Spinal Pleomorphic Xanthoastrocytoma.: Tae Jin Kim, Je G Chi; Korean J Pathol. 1993;27(2):184-186.

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Abstract PDF: Pleomorphic xanthoastrocytoma is a rare tumor, presenting superficially over the cerebral hemispheres of young subjects. We report a case of Pleomorphic xanthoastrocytoma of the cervical cord in view of its unusual location. The patient is a 20-year-old female, presenting with left neck pain radiating to the left shoulder one month before the admission. Magnetic resonance imaging revealed a high signal lesion in the upper cervical cord lower brainstem in T2 weighted image. On operation, intramedullary tumor was present and it was relatively well delineated. Near-total removal of the spinal cord mass was done. Microscopically, the tumor was composed of pleomorphic astrocytes, which were spindle-shaped with cytoplasmic processes and hyperchromatic nuclei. Other cells were round with vesicular nuclei and abundant eosinophilic cytoplasm. A few giant cells were seen. Despite the marked pleomorphism, mitosis or necrosis was not encountered. Scattered foamy cells were also seen, which showed negative staining in GFAP immunostaining in contrast to other GFAP-positive tumors cells.

Case Reports

Strumal Carcinoid of the Ovary: Report of a case.: Su Kyeong Yeon, Kyo Yeong Lee, Chang Seog Kang, Sang In Shim, Sun Moo Kim; Korean J Pathol. 1993;27(2):187-190.

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Abstract PDF: Strumal carcinoma of the ovary is rare tumor of germ cell origin characterized by intimate mixture of thyroid tissue and carcinoid. We report a strumal carcinoid tumor associated with ipsilateral follicular cyst and contralateral mature cystic teratoma of the ovary in a 47-year-old woman. Histologically it was composed largely of trabeculae partly of insular carcinoid and focally of individual thyroid follicles. Many cells in the carcinoid areas and even some follicular areas contained abundant argyrophile granules, and they also, in the corresponding areas, demonstrated thyroglobulin. Electron microscopic findings revealed abundant neurosecretory granules and colloid material in the same cell. We agree that this tumor is derived from hybrid showing thyroid and neuroendocrine differenciation.

Orbital Pseudolymphoma: A case report.: Su Kyeong Yeon, Mi Kyung Jee, Seok Jin Kang, Byoung Kee Kim, Sun Moo Kim; Korean J Pathol. 1993;27(2):191-194.

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Abstract PDF: Lymphoid tumors of the orbit are rare, and sometimes it is not possible either clinically or histologically to differentiate between lymphoid tumor and pseudolymphoma. Some authors assert that the degree of cytologic differentiation appears to be the single most important factor for determining the prognosis of patients with orbital lymphoid lesions. However, the cytomorphologic basis is not so helpful to diagnose and classify our case, which shows some discrepancy between pathological findings and clinical and radiological findings. At first we misdiagnosed our case as orbital malignant lymphoma on the basis of cytomorphology and immunohistochemical study. But no responce to local intensive radiotherapy and the follow up study of the patient suggest orbital pseudolymphoma.

Original Article

Inflammatory Gastric Adenocarcinoma with Neutrophil Leukcytosis.: Eon Sub Park, Yong Il Kim; Korean J Pathol. 1993;27(2):195-197.

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Abstract PDF: A 36-year-old man received a subtotal gastrectomy for Borrmann type 2 advanced carcinoma in the antrum of the posterior well. Preoperatively, peripheral white blood cell count was 16,400/mn3 with 80% of neutrophils. Microscopically, the tumor was of a poorly differentiated adeocarcinoma with intense eutrophilic infiltration which was totally confined within the neoplastic portion and in the metastatic focus in the regional lympho nodes. Repeated postoperative whits blood cell counts dropped down to the normal level. Neither infectious nor knowledge, this is the first case of gastric carcinoma with massive neutrophilic stromal reaction(inflammatory carcinoma) and leukocytosis in the literature in the korea.

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