Journal of Pathology and Translational Medicine

Volume 30(6); June 1996

Original Articles

Extracellular Matrix and Astrocytic Response during Regeneration following Cryogenic Injury in Adult Rat Cerebral Cortex.: Soo Im Choi, Woo Ick Yang, Tae Seung Kim; Korean J Pathol. 1996;30(6):473-486.

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Abstract PDF: Astrocytes are the most numerous cellular elements in the cerebrum, and they normally have a very slow turnover rate. But during regeneration after injury, they proliferate markedly resulting in astrogliosis. The extracellular matrix in the central nervous system is present in the vessel walls and in the external glia limitans as a basal lamina. The presence of an intact extracellular matrix framework is important in regeneration after injury. Understanding the properties of astrocytic proliferation will be helpful to find out new treatment for functional recovery in the central nervous system. In this study, after cryogenic injury was performed on the cerebral cortex in rats, changes in astrocytes and the extracellular matrix were observed using light microscopy, immunohistochemical stain for glial fibrillary acidic protein(GFAP), proliferating cell nuclear antigen(PCNA), fibronectin, laminin, and type IV collagen, autoradiography and electron microscopy. The results were as follows; 1) The coagulative necrosis, which followed cryogenic injury on the cerebral cortex was healed, forming a new pia mater above the lesion. 2) Some of the PCNA positive cells were astrocytes and some of the GFAP positive cells showed a positive reaction to PCNA. 3) Proliferating astrocytes labelled by autoradiography or immunohistochemical stain for PCNA reached maximal numbers 3days after the injury and they were no longer found 2 weeks after injury. 4) In autoradiography with immunohistochemical stain for GFAP, about 1% of GFAP positive astrocytes were labelled by autoradiography and in double immunohistochemical stain for PCNA and GFAP, about 8-16% of GFAP positive astrocytes were also stained by PCNA. 5) In immunohistochemical stain for fibronectin, laminin and type IV collagen, laminin and type IV collagen were present in the newly formed blood vessel walls and fibronectin showed a diffuse positive reaction within the lesion. The new pia mater was formed within 2 weeks after the injury. 6) On electron microscopic examination, basal lamina material was found in the vessel wall 1 week after the injury and at 2 weeks, a nearly complete and continuous basal lamina was formed although the thickness was uneven. According to these findings, astrocytes in the cerebral cortex of adult rats proliferate very early in the regenerative period after cryogenic injury. At 2 weeks after the injury, this regeneration ceases and the damaged basal lamina of pia mater and vessel wall were reconstituted.

Expression of nm23 Protein in Human Gastric Carcinoma: correlation between nm23 expression with the development and metastasis of gastric carcinoma.: Jin Hee Sohn, Hye Rym Park, Young Oui Park; Korean J Pathol. 1996;30(6):487-494.

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Abstract PDF: Gene expression of nm23 has been investigated in many kinds of tumors, including breast cancers, colon cancers, hepatocellular carcinomas, papillary carcinomas of the thyroid and malignant melanomas since the nm23 was dislovered by Dr. Steeg as a tumor metastatic suppressor gene. Reduced expression of nm23 gene implicated in high metastatic potential in a variety of malignancies. However, there have been only a few reports on genetic alteration and expression of nm23 in human gastric carcinomas even though gastric carcinoma is a leading malignancy in Korea. In this study, we examined the expression of nm23 protein by immunohistochemistry in advanced and early gastric carcinomas, adenomas, matching normal mucosa to elucidate the role of nm23 in the development, progression and metastasis of human gastric carcinomas. The results are as follows; 1) Nm23 was expressed in 39 cases(69.6%) of 56 advanced gastric carcinomas. Among them, strong positive cases(grade 3) were 26(46.4%) and weak positive cases(grade 2) were 13(23.2%). 2) Nm23 expression was significantly different (P<0.05) depending on the site of the neoplasm. Antral carcinomas showed grade3 positivity in the 22/37 cases(60%), but carcinomas of the body showed negative (grade 1) result in about half(42.1%). 3) Nm23 expression was more intense in the neoplasm than normal mucosa.(67.9%) 4) Nm23 expression was not significantly related to the lymph node metastasis, invasion of lymphatics or veins and depth of invasion. 5) In the well differentiated carcinomas, grade3 were more common(64.0%). But in cases of signet ring cell carcinoma, many cases were negative(50.0%). 6) Nm23 expression rate and intensity was significantly increased from the normal mucosa to the gastric adenomas, early gastric carcinomas and advanced gastric carcinomas.

Detection of HBV DNA in Needle Biopsied Paraffin Embedded Liver Tissues of Chronic Hepatitis B Patients by PCR: Comparison with Serological and Immunohistochemical Studies.: Hye Soo Lee, Kahng Yeul Oh, Joo Heon Kim, Yoon Jeong Kim, Sam Im Choi, Dong Geun Lee, Sang Ho Kim; Korean J Pathol. 1996;30(6):495-504.

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Abstract PDF: In this study, the prevalence of Hepatitis B virus(HBV) DNA in the needle biopsied paraffin embedded liver tissues of chronic hepatitis B patients by rapid nested PCR was examined. DNA was extracted by NaOH with boiling, and amplified by rapid air thermocycler with glass capillary tubes and nested PCR with two primer sets specific for the surface and the core genes of HBV. The PCR results were compared to that of serum HBeAg, serum HBV DNA by dot blot hybridization with a radioactive DNA probe, and tissue immunohistochemical (HBsAg/ HBcAg) studies. Among 44 patients with chronic hepatitis with serum HBsAg positivity, HBV DNA could be detected by PCR in 43 liver tissues (98%). This results were comparable to the positive rates of 94%(31/33) for serum HBV DNA, 80%(35/44) for serum HBeAg, and 59%(26/44) and 75%(33/44) for tissue HBsAg and HBcAg, respectively. The accordance rate between tissue PCR and serum DNA probe testing was 91%. The results indicate that HBV DNA detection by rapid nested PCR of paraffin embedded liver tissues by needle biopsy is a more sensitive method to detect the HBV DNA carrier than the serum HBeAg or tissue HBsAg/HBcAg status, and is well correlated with the result of serum HBV DNA probe testing. Therefore this method is a practical indicator for the diagnosis and replication status in retrospective analysis.

Clinico-Pathologic Evaluation of 18 Cases of Lymphomatoid Papulosis.: Sug Kyoung Ko, Hye Sook Kim, Kee Suck Suh, Sang Tae Kim, Man Ha Huh; Korean J Pathol. 1996;30(6):505-514.

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Abstract PDF: Lymphomatoid papulosis is an enigmatic disease entity which is clinically benign and histologically malignant. Although sporadic cases have been reported, we could not find any comprehensive report on the combined clinical and histologic features of lymphomatoid papulosis in the literature. Perhaps the most controversial aspect of lymphomatoid papulosis is its pathogenesis and categorization as a benign versus a malignant entity. To date, there are no reports on p53 and bcl-2 protein expression in lymphomatoid papulosis. We analysed the clinico-pathological findings of 18 cases with lymphomatoid papulosis during the 10 year period from 1984 to 1995 and examined the prevalence of immunoreactivity for CD30(DAKO, Ber-H2), p53(DAKO, DO-7), and bcl-2(DAKO, 124) using an immunohistochemical(ABC) method. The results obtained are summarized as follows. 1) Age distribution ranged from 20 to 65, with a mean age of 45 years and a sex distribution which showed a male predominence(8:1). The lesions were located on the trunk and extremities(8cases), extremities (7cases), and trunk(3 cases). The morphology of the lesions were papules or plaques(12 cases), and nodules(6 cases). 2) Histopathologic types were classified into 3 types: type A(4 cases), type B(8 cases) and mixed type (6 cases). 3) Positive immunoreactivity for CD30 was seen in 17%(3 of 18cases): type A(2 of 3) and mixed type(1 of 3). 4) The positive immunoreactivity for p53 and bcl-2 was observed in 29%(5 of 18) and 11%(2 of 18), respectively. 5) Cases showing positive immunoreactivity for P53 were type A(1 of 5), type B(1 of 5), and mixed type(3 of 5). 6) Cases showing positive immunoreactivity for bcl-2 were mixed type(2 of 2). One case developed into Ki-1 lymphoma. These results support the idea that lymphomatoid papulosis and Ki-1 lymphoma represent a continuum. The role of p53 gene mutation and bcl-2 activation in the development of lymphomatoid papulosis is currently unknown. But, our results suggest that p53 gene mutation and bcl-2 activation are not a critical step in the development of lymphomatoid papulosis. Further studies are needed to elucidate the role of p53 gene mutation and bcl-2 activation in the development and progression of lymphomatoid papulosis.

Leiomyoma of the Skin: clinicopathological study of 19 cases.: Seok Jin Kang, Sun Moo Kim; Korean J Pathol. 1996;30(6):515-522.

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Abstract PDF: Nineteen cases of leiomyoma of the skin were examined clinicopathologically. This group included 12 cases of angioleiomyoma, 5 cases of solitary piloleiomyoma, and 2 cases of multiple piloleiomyomas. 1) All twelve angioleiomyomas occured as solitary lesion in the extremities. There was a preponderance in females with a ratio of 2:1. The ages of patients ranged from 24 to 80 years and only one was below the age of 30 years. Six tumors were either painful or tender. Nine tumors in subcutaneous fat were shelled out at surgery. All tumors did not exceed 4cm in diameter. Histologically they could be separated into ten cases of the solid type and two cases of venous type according to Morimoto's classification. Although actin or desmin was easily detected in all tumors, the diagnosis was better made using a combination of hematoxylin-eosin and Masson trichrome stains. 2) Five cases of solitary piloleiomyoma were slow-growing intradermal nodules. The ages of patients ranged from 10 to 77 years. All five cases were female. The lesions were located on the extremities, back and sholuder. Pain or tenderness was present in 3 cases among these tumors. Histologically, all tumors were characterized by subtle poorly circumscribed proliferation of benign smooth muscle in the dermis. 3) Two multiple piloleiomyomas from two female patients, aged 50 and 40 years, were situated on the shoulder and thigh, respectively. Pain was induced by change of temperature in the shoulder lesion. Histologically they were identical to the solitary piloleiomyoma.

Case Report

Giant Cell Myocarditis: A case report.: Ho Jung Lee, Jae Gul Chung, In Chul Lee, Myeong Gun Song, Jae Jung Kim, Jong Goo Lee; Korean J Pathol. 1996;30(6):523-527.

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Abstract PDF: Giant cell myocarditis(GCM) is a rare inflammatory heart disease which is characterized by multinucleated giant cells and a granulomatous reaction. It usually progresses rapidly and results in a fatal course. We report a patient with giant cell myocarditis who was treated by cardiac transplantation. A 35-year-old male was admitted with dyspnea which had developed 4 months before. On echocardiography, the right and left ventricles were markedly dilated and severe global hypokinesia was noted. He was diagosed with dilated cardiomyopathy with secondary severe mitral regurgitation. His cardiac function deteriorated progressively. He underwent orthotopic heart transplantation. Grossly the heart was enlarged, weighing 420gm and round with a blunt apex. Both right and left ventricles were markedly dilated. There were numerous white patches, measuring up to 4cm, throughout the epi- and myocardium. Microscopically, extensive fibrosis and multiple exuberant granulomas with numerous scattered multinucleated giant cells were seen. Lymphocytes and eosinophils were also frequent. Coronary arteries were unremarkable. Neither microorganisms nor foreign materials were found. By serial endomyocardial biopsies of the transplanted heart, only mild perivascular lymphocytic infiltration was occasionally observed without any evidence of rejection or recurrence of giant cell myocarditis. The patient's postoperative course has been uneventful so far(postoperative 21 months). The etiology of GCM remains to be clarified, although various factors are suspected. No matter what the cause, our experience suggests that this grave disease might be treated well by heart transplantation.

Comparative Study

Lymphocytic Hypophysitis Presenting with Diabetes Insipidus in a Man: Report of a case.: Woo Sung Moon, Myoung Jae Kang, Dong Geun Lee, Hyung Il Kim, Ho Yeul Choi, Sang Ho Kim; Korean J Pathol. 1996;30(6):528-532.

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Abstract PDF: Lymphocytic hypophysitis is an autoimmune disorder of the pituitary gland which usually occurs in a woman in the postpartum period. Diabetes insipidus is not a major clinical feature of this disorder. We report a case of a 22-year-old man with lymphocytic hypophysitis which presented with diabetes insipidus and also involved his cavernous sinus. This represents the seventh reported and the youngest case of a man with lymphocytic hypophysitis. A comparative study of all six male patients is also presented. We suggest diabetes insipidus should be added to the spectrum of clinical manifestations of this disorder.

Case Reports

Idiopathic Entero-colic Lymphocytic Phlebitis: A case report.: Seung Sam Paik, Young Ha Oh, Eun Kyung Hong, Jung Dal Lee; Korean J Pathol. 1996;30(6):533-538.

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Abstract PDF: Localized enterocolic lymphocytic phlebitis is characterized by selective phlebitis involving the small to medium-sized veins and venules, infiltration exclusively by lymphocytes, and no other systemic vasculitis or inflammatory bowel disease. This vasculitis can be a rare cause of intestinal ischemia. We experienced a case of enterocolic lymphocytic phlebitis in a 72-year-old woman, who presented with abdominal pain and distension. The resected colon and terminal ileum showed striking lymphocytic phlebitis affecting the veins and venules of the bowel and mesentery which resulted in ischemic injury of the bowel. This vasculopathy was the only demonstrable cause of ischemia. Arteritis and arteriolitis was not found. There is no clinical or laboratory evidence or a history of extraintestinal vasculitis. The etiology of this clinicopathological entity has not been elucidated. Herein, we report the clinicopathological findings in this patient who presented with ischemic intestinal necrosis caused by localized intestinal lymphocytic phlebitis associated with thrombosis.

Malignant Rhabdoid Tumor of the Kidney in an Adult: A case report.: Sang Yong Lee, Dae Cheol Kim, Seo Hee Rha, Sook Hee Hong; Korean J Pathol. 1996;30(6):539-543.

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Abstract PDF: Malignant rhabdoid tumor is a distinct renal tumor in pediatric age group and extremely rare in adults. It was originally described as a rhabdomyosarcomatoid variant of Wilms' tumor. But subsequent studies failed to confirm myogenous differentiation, so the rhabdoid tumor is now considered to be a distinct and unique disease type of highly malignant renal tumor, histogenetically unrelated to Wilms' tumor. However the histogenesis have not been clearly defined until now. We report a case of malignant rhabdoid tumor of the kidney in a 34-year-old man who represented with a left abdominal mass. Grossly, a large mass occupying most of the left kidney except for a part of upper pole was invading beyond renal capsule and the perirenal soft tissue. It measured 18x14 cm in dimension and was soft, lobulated and yellowish gray with large areas of hemorrhage and necroses. Microscopically, the tumor mass was composed of sheets of round or polygonal neoplastic cells growing in a solid pattern. These tumor cells were medium to large in size with ample cytoplasm containing recognizable eosinophilic inclusion and had an eccentrically located, large nucleus with one or a few prominent nucleoli. Mitotic figures were frequently observed. Ultrastructurally, the tumor cells contained whorled filamentous inclusions corresponding to vimentin, epithelial membrane antigen and cytokeratin in immunostaining.

Cardiac Fibroma: A surgically excised case.: Ho Jung Lee, Gyung Ub Gong, Jay Won Lee, Jae Gon Go, In Chul Lee; Korean J Pathol. 1996;30(6):544-547.

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Abstract PDF: Primary cardiac tumors in infancy and childhood are rare, with fibromas being the second most common tumor after rhabdomyomas. Although cardiac fibromas are characteristically benign intramural tumors, they may exhibit exhibit expansile growth resulting in obstruction, valvular dysfunction, as well as other problems so early diagnosis and successful surgical excision are important. We report a case of cardiac fibroma in a 2 month-old male infant. He presented with generalized cyanosis from birth. Echocardiography showed oval round large mass filing the right atrium and ventricle which infiltrated into the lateral wall of the ventricle. Partial excision of the tumor was done after another echocardiogram showed a pericardial effusion and restriction of blood flow to the right ventricle due to the tumor. The resected tumor was ovoid, gray-tan, slightly firm and measuring 5x3x2.5 cm. Histologically, the tumor was composed of spindle-shaped fibroblasts and hyalinized fibrous tissue interdigitating with the surrounding myocardium.

Primary Ovarian Leiomyosarcoma: A case report.: Won Sang Park, Seong Beom Lee, Jung Yong Lee, Sang Ho Kim, Choo Soung Kim; Korean J Pathol. 1996;30(6):548-550.

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Abstract PDF: Primary leiomyosarcoma is a rare tumor of the ovary. We experienced a case of primary ovarian leiomyosarcoma in a 68 year old woman. Microscopically, the tumor was characterized by interlacing bundles of plump spindle cells that showed immunoreactivity for alpha-smooth muscle actin, pleomorphic multinucleated giant cells and an increased mitotic rate. Ultrastructural features included abundant smooth muscle type filaments and irregular bodies. Consequently, this case has led us to propose ultrastructural and immunohistochemical criteria for primary ovarian leiomyosarcoma.

Benign Lymphoepithelial Cyst: A case report.: Jin Haeng Chung, Gyeong Hoon Kang, Je G Chi; Korean J Pathol. 1996;30(6):551-553.

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Abstract PDF: An intraparotid benign lymphoepithelial cyst is a rare disease characterized by unilateral painless swelling of parotid region. The histogenesis is controversial. Surgical excision is recommended for diagnosis and curative treatment. We present a case of benign lymphoepithelial cyst arising in a patient with neurofibromatosis. A 46-year-old woman presented with a slowly growing multilocular cystic mass in the left cheek. The cystic mass measured 4 cm in maximal outer diameter and the cystic wall was thick and yellowish pale to gray, soft with well circumscribed margin. Microscopically, the multilocular cyst was lined by stratified squamous epithelium for the most part and underlying lymphoid tissue aggregates with follicles and sharply demarcated from adjacent salivary parenchyma which is of normal appearance and without lymphoid aggregates. Since this lesion is absolutely benign, it is important to separate this benign cyst from cystic salivary gland tumors.

Original Article

Cavernous Hemangioma of the Ovary.: Jin Hee Sohn, Hye Rim Park, Young Euy Park, Young Woo Lee; Korean J Pathol. 1996;30(6):554-556.

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Abstract PDF: Hemangioma of the ovary is a very rare lesion, although the ovary itself is a highly vascularized organ. In the literature review, about 40 cases were reported all of which were small in size and they were usually identified incidentally. The age range spanned from 4 months to 81 years. Cavernous hemangioma was the most common histologic type. We experienced a case of cavernous hemangioma of the left ovary in a 26 year-old pregnant woman. The lesion was 8x6x2cm in size with well demarcated margin. The cut surface was purple to bluish red in color and had a spongy-like appearance. Microscopically, it was composed of dilated vascular spaces with a common wall.

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