Journal of Pathology and Translational Medicine

Volume 30(7); July 1996

Original Articles

Immunohistochemical Analysis of TGF-beta Expression and Angiogenesis in Infiltrating Duct Carcinoma of the Breast.: Tae Jin Lee, Nam Bok Cho, Eun Sub Park, Jae Hyung Yoo, Sung Jun Park; Korean J Pathol. 1996;30(7):557-569.

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Abstract PDF: Forty cases of infiltrating duct carcinoma of the breast were examined immunohistochemically for expression of TGF-beta and angiogenesis in order to analyze significant correlation with prognostic parameters including tumor size, axillary lymph node metastasis, clinical stage, histologic grade, estrogen receptor and progesterone receptor status. The TGF-beta expression was observed in tumors center and advancing edges of tumors. To determine microvessel density for angiogenesis, we stained endothelial cells for Factor VIII related antigen and counted microvessel within tumor. The results were as follows: 1) The strong immunohistochemical expression of TGF-beta and higher counts of microvessels were observed in advancing edges of tumors (p<0.05). 2) The TGF-beta expression in the advancing edges of tumors was closely related to clinical stage and presence of axillary lymph node metastasis (p<0.05). 3) The mean microvessel counts were significantly higher in tumors from patients with axillary lymph node metastasis and increased with increasing clinical stage (p<0.05). 4) The TGF-beta expression was not related to histologic grade, estrogen receptor and progesterone receptor status(p>0.05). Therefore, the results suggested that the TGF-beta expression and angiogenesis in infiltrating duct carcinoma of the breast may play an important part in prognostic factors, closely related to the lymph node metastasis and clinical stage.

Melanosis Coli: Relation to Apoptosis in Pathogenesis.: Sun Hee Sung, Hea Soo Koo, Woon Sup Han; Korean J Pathol. 1996;30(7):570-575.

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Abstract PDF: Melanosis coli is characterized by a dark brownish discoloration of the colonic mucosa. Its pathogenesis is still unknown. Recently it was proposed that the apoptosis of mucosal epithelium due to habitual use of laxatives play an important role for induction of melanosis coli. We studied clinicopathologic aspects of 12 cases of melanosis coli and analysed the histochemical and immunohistochemical characteristics of them. Results are as follows. : Mean patient's age was 53.5, and the male:female ratio was 4:8. Nine patients had a history of constipation, and all of these had administrated various kinds of laxatives. The severity of discoloration was correlated with the duration of constipation and age. There was no difference of anatomical distribution in colon. Other remarkable mucosal lesions were not accompanied. On pathologic examination, all cases showed frequent yellow-brown pigment laden cells in lamina propria. These pigments were positive for periodic acid Schiff stains, Fontana Masson stains, and Victoria blue stains, however they were negative for prussian blue stain. On immunohistochemical stainings pigmented cells were positive for CD68, and negative for S-100 protein and neuron specific enolase. These results indicate that they are macrophages. On ultrastructural examination pigmented cytoplasms were filled with variable sized electron dense granules including irregulary round deformed membranous structures, lipid vacuoles. Apoptosis of mucosal epithelium was noted in 5 cases. These findings suggest that apoptosis is the significant pathologic process in the progression of some cases of melanosis coli.

p53 Expression in the Head and Neck Tumor.: Chae Hong Suh, Mi Sook Lee, Sin Eui Yoon; Korean J Pathol. 1996;30(7):576-586.

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Abstract PDF: Mutations in the p53 gene seem to be the most common genetic changes in human malignancies. Mutation or altered p53 expression is a common occurrence in many solid neoplasms, including head and neck carcinomas. Recent studies have also shown p53 alterations in several premalignant conditions of the colon, esophagus, lung, and brain. Preliminary data have suggested that p53 mutations may be involved in tumor progression. This study was performed to determine the incidence of p53 mutations in histologically 27 squamous cell carcinomas, 19 basal cell carcinomas, 18 Schneiderian papillomas, 3 Schneiderian papillomas with malignant transformation, and 15 pleomorphic adenomas of the head and neck region. The degree of p53 gene overexpression was also evaluated according to differentiation, histologic type of tumor, and tumor progression in the head and neck carcinomas. The results were as follows; 1) Eighteen of 27 squamous cell carcinomas, and 4 of 27 dysplasias adjacent to the squamous cell carcinoma of the head and neck expressed p53 protein, but none of the normal control specimens expressed detectable p53 protein. There was no relationship between differentiation of squamous cell carcinoma and p53 protein expression. 2) Twelve of 19 basal cell carcinomas expressed p53 protein; the adenoid type especially overexpressed p53 protein. 3) Nine of 15 pleomorphic adenomas expressed p53 protein especially in the epithelial components. 4) Thirteen of 18 Schneiderian papillomas and all Schneiderian papillomas with malignant transformation expressed p53 protein. The above results indicate that the p53 protein expression is a useful tool for the prediction of tumor progression in the head and neck tumor, but there was no relationship between the differentiation of the tumor and p53 protein expression.

Immunohistochemical Study of p53 and nm23-H1 Protein in Gastric Carcinoma.: Duck Hwan Kim, Yoen Ju Kim, Seon Eun Yang, Sung Suk Paeng, Hee Jin Chang, Jung Il Suh, Hyo Sook Park; Korean J Pathol. 1996;30(7):587-594.

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Abstract PDF: The p53 gene, which resides on the short arm of chromosome 17, has been described as a tumor suppressor gene playing a role of G1 checkpoint monitering DNA damage, but mutation of this gene has been shown in numerous types of human cancers. The nm23-H1 gene encodes human NDP(nucleotide diphosphate) kinase. The expression of nm23-H1 gene was postulated to inversely correlate with metastatic potential of malignant tumors. We examined immunohistochemical expression in 30 cases of stomach cancers including 10 cases each of early gastric cancers(EGC), advanced gastric cancers without lymph node involvement, and advanced gastric cancers with lymph node involvement, which were stained with mouse monoclonal antibody of p53(PB53-12) and nm23-H1. Positive nuclear staining of p53 was frequently found in advanced gastric cancers with lymph node involvement (80%). The lymph node positive group showed high expression of p53(80%), and low expression of nm23-Hl(30%) than lymph node negative group. There was no significant correlation of p53 and nm23-H1 expression with tumor size, invasion depth, TNM stages, distant metastasis and histologic differentiation. Based on the present study, the expression of p53 and down regulation of nm23-H1 are thought to be correlated with tumor progression and lymph node involvement, and may be a useful prognostic factor in gastric cancers.

Immunohistochemical Study of p53 Protein Expression in Colorectal Tumors.: Mi Sook Lee, Chae Hong Suh, Sung Chul Lim; Korean J Pathol. 1996;30(7):595-603.

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Abstract PDF: The aims of this study were to assess the role of p53 overexpression in colorectal tumorigenesis and the association with clinicopathological features. The immunohistochemical results were semiquantitatively assessed. Expression of aberrant p53, tumor-suppressor gene product, was studied immunohistochemically using a monoclonal antibody in 11 nonneoplastic polyps, 19 tubular adenomas, 9 villous adenomas, and 48 colorectal carcinomas. Five out of 11 nonneoplastic polyps, 14 out of 19 tubular adenomas and one out of 9 villous adenomas expressed p53 protein. Seven out of 24 colorectal carcinomas without lymph node metastasis and 14 out of 24 colorectal carcinomas with lymph node metastsis expressed p53 protein. The case of more than 75% positivity of p53 in colorectal carcinoma with lymph node metastasis was seven out of 24, but that in lymph node negative group was two out of 24. In the colorectal carcinoma with lymph node metastasis group; metastatic intranodal neoplastic cells were expressed positively for p53 in 10 out of 14 cases and zero out of 10 cases in group of positive and negative expression of primary lesions, respectively. p53 protein expression was not significantly correlated with variable clinicopathologic features such as age, sex, tumor location, tumor size, differentiation and Dukes' stage. It is suggested that p53 protein overexpression could be a early event in pathogenesis of colon cancer but is not involved in progression of villous adenoma to adenocarcinoma. p53 overexpression seems to be involved in metastatic ability of colorectal carcinomas.

The Morphologic Changes of the Sinusoidal Endothelial Cells in N-diethylnitrosamine Induced Cirrhotic Rat Liver.: Ok Ji Paik, Hee Kyung Park, Jong Min Chae, Jyung Sik Kwak, Tae Joong Sohn; Korean J Pathol. 1996;30(7):604-615.

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Abstract PDF: The purpose of this study is to investigate the morphologic changes of the sinusoidal endothelial cells and the associated structures of the cirrhotic rat liver induced by repeat intraperitoneal injections of N-diethylnitrosamine (DEN) (100 mg/kg/week). One day to 6 weeks later, rat livers were observed under the light, transmission and scanning electron microscopy, and immunostained with laminin antibody. Two weeks after DEN treatment, the fibrillar material in Disse's space was noted, and then a basement membrane-like structure was found at 4 weeks after treatment. Laminin was detected in perisinusoidal areas after 4 weeks. Laminin was strongly positive on the fibrous septum and in the sinusoidal wall of cirrhotic nodules after 6 weeks of treatment. The diameters and numbers of sinusoidal endothelial fenestrations did not change significantly until 2 weeks. They decreased within 4 weeks, and then the sinusoidal endothelium was poorly fenestrated at 6 weeks after DEN treatment. These results suggest that as fibrosis develops in cirrhosis, the deposit of extracellular matrix such as laminin within Disse's space is a major contributing factor in the structural alteration of sinusoidal endothelial cells, and the capillarization of the sinusoidal endothelial cells may be a contributor to impairment of the hepatic function in cirrhosis.

Case Reports

Chromophobe Cell Renal Carcinoma: A report of 3 cases.: Me Sook Roh, Gi Yeong Huh, Seo Hee Rha, Heon Young Kwon, Sook Hee Hong; Korean J Pathol. 1996;30(7):616-622.

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Abstract PDF: Chromophobe cell renal carcinoma is an uncommon variety of renal cell carcinoma first described in humans in 1985 by Thoenes and his colleagues. It is a distinct type of renal cancer presumably derived from the intercalated cells of the collecting duct system and exhibiting a better prognosis than other types of renal cell carcinoma. This type of renal cell carcinoma has not been reported in Korean literature. We experienced three cases of chromophobe cell renal carcinoma from surgical pathology files of Dong-A medical center. The patients were a 65-year-old female, a 54-year-old female, and a 50-year-old male who had 8.2x6 cm, 4x2.5 cm and 4.3x3.2 cm sized, yellowish gray, beige to tan colored masses in the kidneys, respectively. Microscopically, the tumor cells were arranged in sheets or nests with delicate intervening vasculature. The cells were voluminous, uniform in appearance and contained finely reticulated cytoplasms delineated by prominent cell borders. With Hale's iron colloid staining the cytoplasm showed positive reaction; with PAS staining the result was negative. Immunohistochemically, the tumor cells showed positive reaction for cytokeratin but negative for vimentin. Electron microscopy showed numerous small, round to oval cytoplasmic vesicles, 150-300nm in size. All the patients received only radical nephrectomy and survived without evidence of recurrence or metastasis during follow-up intervals ranging from 4 months to 5 years.

Myofibroblastoma of the Male Breast: Report of a case.: Ji Eun Kim, Yeon Lim Suh, Howe Jung Ree; Korean J Pathol. 1996;30(7):623-629.

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Abstract: A case of myofibroblastoma of the breast in a 55-year-old man is described. Myofibroblastoma is a relatively recently recognized benign stromal tumor, and predominantly occurs in middle aged men. The pateint presented with a nontender firm mass in his right breast. Fine needle aspiration biopsy revealed bland looking stromal cell clusters without epithelial cells. Simple excision was done and the patient discharged uneventfully. The mass was well demarcated, lobulated and sligtly myxoid. Microscopically bipolar elongated spindle cell fascicles with interspersing broad collagen bands are so characteristic. Ultrastructurally the tumor cell show features of fibroblast as well as smooth muscle cell.

Somatostatin Secreting Islet Cell Adenoma: A case report.: Tae Sook Kim, Je G Chi; Korean J Pathol. 1996;30(7):630-634.

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Abstract PDF: Somatostatin secreting islet cell adenoma(somatostatinoma) of the pancreas is a rare entity. Less than 30 cases of pancreatic somatostatinoma could be searched in the world literature. We present a case of somatostatinoma of the pancreas in a 64-year-old woman. This patient had suffered from diabetes, cholelithiasis and intermittent diarrhea. Laboratory examination revealed steatorrhea, blood somatostatin level of 30 pg/ml, and fasting blood glucose level of 116 mg/dl. Subtotal pancreatectomy was done after radiological demonstrations of a round tumor mass in the pancreas. It was a 2 cm-sized well demarcated yellowish brown round solid mass located in the proximal pancreas. A retention cyst was seen just distal to the tumor. Histologically, tumor masses consisted of polygonal cells with distinct cell border, having granular eosinophilic cytoplasm and small bland looking nuclei. The tumor cells were arranged in small solid islands and trabeculae, separated by fibrovascular stroma. Immunohistochemical stain for somatostatin was positive in the cytoplasm of the individual tumor cell, and ultrastructurally variable sized membrane bound electron dense granules of 200 nm in average diameter were found in tumor cells.

Original Article

Interdigitating Reticulum Cell Sarcoma of Lymph Node.: Sung Suk Paeng, Yoon Ju Kim, Seong Eun Yang, Duck Hwan Kim, Hee Jin Chang, Jung Il Suh, Chu Woo Kim; Korean J Pathol. 1996;30(7):635-642.

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Abstract PDF: We report a case of reticulum cell sarcoma in the right cervical lymph node of a 42-year-old male. It was a slowly growing, non-tender movable mass of 8 months duration. Microscopically, the lymph node was effaced by proliferating spindle cells arranged in broad sheets, bands, or fascicular patterns in paracortical area sparing of B-cell region. The tumor component was divided by fibrous band. The individual cells had oval to round or elongated nuclei, with inconspicuous nucleoli and moderate amounts of cytoplasms with indistinct cell borders. Pleomorphic large cells with binucleated, or multinucleated bizarre nuclei with prominent nucleoli, were partly admixed. In immunohistochemical stain, the tumor cell was strong positive for S-100 protein, HLA-DR, Mac387 and weakly positive for Leukocyte common antigen and equivocal for Vimentin. But it was negative for CD21, Ki-1, Desmin, Epithelial membrane antigen and Cytokeratin. These immunohistochemical findings suggested that the neoplastic cell was originated from the interdigitating reticulum cell of lymph node. The patient was treated by radiation therapy, and alive well at 37 months of follow-up.

Case Reports

Tailgut Cyst with Glomus Coccygeum: Report of a case.: Mi Jung Kim, Shi Nae Lee, Sung Sook Kim, Hea Soo Koo, Ok Kyung Kim; Korean J Pathol. 1996;30(7):643-645.

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Abstract PDF: Tailgut cyst of retrorectal space is uncommon and its classification and prognosis are unclear. The lesion usually consists of a multiloculated cyst lined by squamous, transitional, and glandular epithelium. Disorganized fascicles of smooth muscle may be seen in the wall. Glomus coccygeum, normally located at the tip of coccyx, is incidentally discovered in the presacral mass including tailgut cyst. We report a case of tailgut cyst in a 35 year old female who had internal hemorrhoid and intermittent anal pain for 3 years. Pelvic computerized tomography revealed a 3x2 cm sized mass in the presacral area. The mass was multicystic and lined by squamous, transitional, and peudostratified ciliated columnar epithelium with inflammatory cells and scattered smooth muscle in the wall. Dermal adnexal structures were not present, which excluded dermoid cyst. A glomus body was identified in the surrounding soft tissue.

Well-Differentiated Papillary Mesothelioma of the Peritoneum: Report of a case.: Ji Eun Kim, So Duk Lim, Kyu Rae Kim, Han Young Choi; Korean J Pathol. 1996;30(7):646-648.

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Abstract PDF: We described a case of well differentiated papillary mesothelioma (WDPM) of the peritoneum in a 68-year-old man because of its rarity. It was incidentally found during operation for renal cell carcinoma. Grossly, the tumor appeared as multiple small granules or nodules on the entire peritoneal surface, including serosa of the intestine, omentum and mesentery. Microscopically, characteristic features are papillary, tubulopapillary or solid architecture lined by single layer of uniform, cytologically bland, cuboidal or polygonal mesothelial cells. The tumor cells were positive for EMA, cytokeratin and vimentin, but negative for CEA on immunohistochemical staining. Ultrastructural study showed characteristic long slender microvilli on the surface and intercellular junctions.

Suprasellar Rathke Cleft Cyst: A case report.: Mi Sook Lee, Yu Kyeong Jeong, Mi Ja Lee, Keun Hong Kee; Korean J Pathol. 1996;30(7):649-651.

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Abstract PDF: We report a case of a large asymptomatic Rathke cleft cyst in a 14-year-old boy. This cyst was of considerable size, measuring 2x1.8x1.8 cm, but did not produce any symptoms and was confined to the suprasellar area. The cyst wall was lined by pseudostratified ciliated columnar epithelium with goblet cells. The lining epithelium of the Rathke cleft cyst was immnoreactive for cytokeratin, EMA and CEA.

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