Journal of Pathology and Translational Medicine

Volume 34(1); January 2000

Original Articles

Gender Differences in Expression of Apoptosis, p53, and Bcl-2 in Delayed Focal Cerebral Infarction in Rats.: Hee Suk Jung, Seung Won Park, Sung Nam Hwang, Young Bak Kim, Mi Kyung Kim, Byung Kuk Min, Jung Taik Kwon, Duck Young Choi, Jong Sik Suk; Korean J Pathol. 2000;34(1):1-10.

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Abstract PDF: Apoptosis is a normal physiological process. Morphological studies have shown that cells die by physiological mechanisms after undergoing characteristic changes termed 'apoptosis' or 'programmed cell death'. Several genes were known to participate in the apoptotic process including p53 as a proapoptic gene and Bcl-2 as an antiapoptic gene. It was also known that there are certain gender differences in the cerebrovascular accidents and their effect on tissue damage. The purpose of this study is to evaluate how the apoptotic genes are expressed in delayed focal cerebral infarction and peri-infarct area in male and female adult rats by comparing the immunoexpression of p53 and Bcl-2 and p53:Bcl-2 ratio at delayed focal cerebral infarction between both sexes. In sixteen adult Spraugue-Dawley rats (nine males and seven females), the right MCA and both CCA were ligated for thirty minutes to make a delayed focal cerebral infarction in right frontal lobe. Their brains were taken at seventy two hours after the operation. And then the brains were prepared for immunohistochemical stains for apoptosis, p53 and Bcl-2 proteins. The infarction volume of male rats (11.3 mm3) was larger than that of female rats (7.3 mm3) (p<0.01). In male group, the width (micrometer2) of the apoptotic area (46.4 micrometer2) was significantly larger than those in female group (38.9 micrometer2) (p<0.005). The p53 : Bcl-2 ratio was significantly higher in male group (3.23) compared with female group (2.18) (p<0.01). As a result, the p53:Bcl-2 ratio seemed to be related to the gender differences in neuronal apoptosis after delayed focal cerebral infarction.

The Effects of CD11c/CD18 and CD14 Blocking on Lipopolysaccharide-induced Endotoxemia.: O Jun Kwon, Jong Kuk Kim, Jyung Sik Kwak; Korean J Pathol. 2000;34(1):11-19.

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Abstract PDF: We studied the morphologic changes and the expression of cytokines of major organs by blocking CD14 and CD11c/CD18, which are known to be receptors of lipopolysaccharide (LPS), in the LPS induced endotoxemic mice. In 2 and 8 hours after initial intraperitoneal injection of 10 mg/kg of LPS into the mice, 500 microgram/kg of anti-CD14 antibody (Ab) and/or the same dosage of the anti-CD11c/CD18 Ab were administered intravenously, respectively or concomitantly. Under the light microscope, the LPS only and the LPS with the anti-CD14 Ab injected groups (group 1 and 2) showed marked acute inflammation in the organs, especially in the lung and liver, but the LPS with the anti-CD11c/CD18 Ab only or with both anti-CD14 and anti-CD11c Abs injected groups (group 3 and 4) revealed only mild acute inflammation. Under the electron microscope, there was marked inflammation in the group 1 and 2 such as marked infiltration of neutrophils, monocytes/ macrophages, lymphocytes, aggregation of platelets, and marked edematous change of endothelial cells with separation from the basement membrane. However in the group 3 and 4, there was only mild inflammation such as mild infiltration of neutrophils in the tissue or aggregation of neutrophils in the capillaries and sinusoids with mild endothelial swelling. The expressions of tumor necrosis factor-alpha (TNF-alpha) and interleukin-1alpha (IL-1alpha), detected by RT-PCR method, was remarkable in the group 2, but minimal in the group 3 and 4. We conclude that blocking the CD11c/CD18 with anti-CD11C/CD18 Ab is effective for the prohibition of biologic reactions and diminution of the inflammation induced by the LPS, even in the LPS induced endotoxemia.

Histopathologic Analysis of Malignant Lymphoma Involving the Skin and Its Relationship with the Epstein-Barr Virus.: Yun Hee Jin, Seong Ho Kim, Chan Kum Park; Korean J Pathol. 2000;34(1):20-28.

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Abstract PDF: The author classified 38 cases of malignant lymphoma involving the skin primarily or secondarily by the new WHO classification with minor modifications and carried out RNA in situ hybridization and/or polymerase chain reaction (PCR) to investigate the role of Epstein-Barr virus (EBV). A case was follicular lymphoma of B cell origin and 37 cases were malignant lymphomas of T cell origin, including 15 cases of Mycosis fungoides/Sezary syndrome, five cases of subcutaneous panniculitis-like T cell lymphomas, a case of anaplastic large cell lymphoma, and four cases of primary cutaneous CD30 T cell lymphoproliferative disorders. There were eight cases of unspecified peripheral T cell lymphomas, in which four cases were composed of medium-sized cells, three cases of large cells, and a case of lymphoepithelioid cells. Four cases of nasal and nasal type NK/T cell lymphomas and three cases of unspecified peripheral T cell lymphomas showed EBV genome. The nasal and nasal type NK/T cell lymphomas, especially those involving the nasal cavity, showed close association with the EBV infection.

Topographic Difference of Inflammatory Reactions in Gastric Mucosa in Various Helicobacter pylori-Associated Diseases.: Suk Jin Choi, Tae Jung Jang; Korean J Pathol. 2000;34(1):29-33.

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Abstract PDF: Gastric biopsy specimens from 140 patients (66 chronic gastritis, 33 gastric ulcers, 26 duodenal ulcers, 15 gastric cancers) were examined to investigate the topographic difference of inflammation, glandular atrophy, intestinal metaplasia, and Helicobacter pylori (H. pylori) colonization by the updated Sydney system. Density of H. pylori of the antrum was significantly higher in duodenal ulcers than in chronic gastritis, gastric ulcers, and gastric cancers. Inflammation of duodenal ulcers was predominantly antral and glandular atrophy and intestinal metaplasia of duodenal ulcer were significantly less than those of gastric ulcers and gastric cancers. Chronic inflammation of gastric ulcers and gastric cancers was higher in antrum than in corpus. Increasing atrophy of the antrum was associated with decreasing density of H. pylori of antrum itself, but increasing colonization of the corpus. This study reveals the inflammatory reactions of gastric mucosa differ in chronic gastritis, gastric ulcers, gastric cancers, and duodenal ulcers and suggests that antral atrophy fosters the colonization of oxyntic mucosa by H. pylori.

Expression of Cytokeratin 7 and 20 in Periampullary Carcinomas.: Jong Sun Choi, Na Rae Kim, Geung Hwan Ahn, Cheol Keun Park; Korean J Pathol. 2000;34(1):34-38.

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Abstract PDF: The distinction of carcinomas involving periampullary region is often difficult, even in the surgically resected specimens. To examine the differences in the expressions of cytokeratin (CK) 7 and 20 in the periampullary carcinomas, we performed immunohistochemical studies on surgically resected 20 pancreatic duct adenocarcinomas (PDA), 13 distal bile duct adenocarcinomas (DBA), 10 duodenal adenocarcinomas (DA), and 18 ampulla of Vater adenocarcinomas (AVA). We analyzed the relationships between CK 7/CK 20 immunoprofile, and tumor cell differentiation and tumor size. We interpreted diffuse cytoplasmic reactivity found in > or =5% of tumor cells as positive. In the majority of cases, PDA were CK 7 /20 (95%), DBA CK 7 /20 (92.3%), DA either CK 7 /20 (40%) or CK 7 /20 (30%), AVA either CK 7 /20 (50%) or CK 7 /20 (44.4%). In DA, there was an increased CK 20 negativity in less differentiated (moderately or poorly differentiated) cases (p<0.05) and in larger (> or =5 cm) tumor size (p=0.049). In AVA, there was a tendency of increased CK 20 positivity in less differentiated cases (p=0.10). In conclusion, the CK 7/CK 20 immunophenotype is useful in the differentiation of periampullary carcinomas: the CK 7 /CK 20 immunophenotype strongly suggests DA or AVA, whereas the CK 7 /CK 20 immunophenotype suggests PDA or DBA.

Pathologic Analysis of 2159 Cases of Appendix.: Chan Sik Park, Mee Soo Chang, In Ae Park, Yong Il Kim, Gheeyoung Choe; Korean J Pathol. 2000;34(1):39-49.

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Abstract PDF: We reviewed 2159 consecutive cases of surgically resected appendices. The appendectomy specimen consisted of 91 cases of acute focal appendicitis (5.4%), 926 cases of acute suppurative appendicitis (55.1%), 228 cases of acute gangrenous appendicitis (13.6%), 63 cases of periappendicitis (3.8%), 13 cases of pure fibrous obliteration of the lumen (FOL; 0.8%), 18 cases of other diseases (7 mucoceles, 2 mucinous cystic neoplasms, 4 carcinoids, 2 metastatic carcinomas, 2 tuberculous appendicitides, and 1 eosinophilic appendicitis; 1%), and 342 cases with no diagnostic abnormality (20.3%). Patients having acute appendicitis ranged from 3 to 84 years of age, and patients in their 10's and 20's occupied over half of 2159 cases. Diagnostic accuracy of the acute appendicitis was 79.7%. Incidence of the acute appendicitis was suspected to be 7.2/100,000/year. Twenty eight cases of acute appendicitis were associated with diverticula. In the former acute primary diverticulitis led to acute appendicitis in 14 of 28 cases. Among 478 incidental appendectomy cases, there were 3 acute focal appendicitides, 1 acute suppurative appendicitis, 1 eosinophilic appendicitis, 32 periappendicitides, 1 mucocele, 40 pure FOLs, 1 deciduosis, 1 endometriosis, and 1 diverticulosis without inflammation. There were 69 cases of FOL (32 complete forms and 37 incomplete forms), among which 13 cases were associated with acute appendicitis. FOL was more frequent in female patients as well as patients over 40 years of age. Incomplete FOL was considered to progress to complete form with age. The incidence of appendiceal diverticula was higher, whereas the incidences of carcinoid tumor and FOL were lower compared with that in the western report. In 14 of 28 cases the appendiceal diverticulum was the site in which acute appendicitis began.

Aberrant Crypt Foci: Histopathologic Classification and Profiles of Mucin Secretion.: Aeree Kim, Jong Sang Choi, Won Jun Choi, Hong Young Moon; Korean J Pathol. 2000;34(1):50-55.

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Abstract PDF: Aberrant crypt foci (ACF) are grossly unidentifiable lesions of the colon and visible only with low-power microscopic examinations after methylene blue stain. To establish the role of ACF in colorectal carcinogenesis, we evaluated the distribution, frequency, histopathological classification, and patterns of mucin secretion of ACF in the colon. A total of 142 aberrant crypt foci were found in 41 colectomy specimen for adenocarcinoma (36 cases) and benign diseases of colon (5 cases). Ten of 142 ACFs were in the ascending and transverse colon, 39 in the descending and sigmoid colon, and 93 in the rectum. The mean number of ACFs in the rectum (0.13 0.11/cm2) was higher than in the ascending and transverse colons (0.019 0.018/ cm2) and descending and sigmoid colon (0.10 0.14/cm2). ACFs were found only in cancer patients. One hundred and twenty ACFs among 142 ACFs identified by topology, were identified on histological examination. We classified ACFs into simple (48.3%), hyperplastic (42.5%), and dysplastic (9.2%) types. All ACFs were infiltrated by the lymphocytes in the stroma and 18 of these accompanied the lymphoid follicles. ACFs have variable histopathologic features and mucin profiles. Some variants of ACFs are at the early stage of the spectrum between benign and malignant.

Ultrastructural Changes in Glomerular Anionic Sites in Puromycin Aminonucleoside Nephropathy.: Hyun Chul Kim, Chan Oh Choi, Young Ho Kim, Kwan Kyu Park; Korean J Pathol. 2000;34(1):56-67.

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Abstract PDF: An ultrastructural study was done on puromycin aminonucleoside (PAN) nephropathy which was induced in a group of Sprague-Dawley rats by a single intraperitoneally injected dose. To study the ultrastructural alteration of glomerular anionic sites renal tissue was stained with polyethyleneimine (PEI) as a cationic probe. The PEI method seemed to selectively stain heparan sulfate proteoglycan in the basement membrane and has been widely used to evaluate the changes of the basement membrane in human diseases as well as in experimental work. The experimental rats developed proteinuria three days after the PAN injection. Electron microscopic studies of glomeruli showed the loss of epithelial foot processes, formation of cytoplasmic vacuoles, microvillous formation, and increased numbers of lysosomes in the cytoplasm of podocytes. The anionic sites on the basement membrane with foot process fusion were mostly indistinguishable from those seen in control rats, but focal areas of loss or disarray of anionic sites were noted. The anionic sites were not seen on the basement membrane where the overlying epithelium was detached. The results suggest that proteinuria in PAN nephrosis may be primarily due to a glomerular epithelial lesion, leading to focal disarray of anionic sites or focal defects in the epithelial covering of the basement membrane. The loss of anionic sites in the basement membrane may result partially from the foot process fusion, but mostly from the epithelial detachment.

Immunohistochemical Study on Tenascin Expression in IgA Nephropathy.: Ho Jung Kim, Hye Jin Park, Ok Kyung Kim, Sun Hee Sung; Korean J Pathol. 2000;34(1):68-76.

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Abstract PDF: Glomerulosclerosis is a common outcome in various progressive glomerular diseases, and results from accumulation of extracellular matrices. Depending on the disease progression the extracellular matrices show quantitative and qualitative alterations. Tenascin is a significant extracellular matrix glycoprotein that expresses in normal and pathologic tissue of varying organs including kidney. We performed immunohistochemical staining for tenascin using 30 cases of renal biopsy specimens diagnosed as IgA nephropathy to study the alteration of tenascin expression in IgA nephropathy according to the histologic grading. The results were as follows; 1. The more high histologic grade, the more increase of tenascin was found in the glomerulus. 2. Tenascin was increased in proportion to the mesangial matrix. 3. The staining of tenascin was more intense in glomerular sclerotic area and was increased in proportion to the progression of sclerosis. 4. Cellular crescents showed strong positivity for tenascin. 5. Tenascin was increased in proportion to the degree of interstitial fibrosis in renal cortex. In conclusion, tenascin is an important extracellular matrix component which is significantly increased in both glomerulus and cortical interstitium according to the progress of the disease in IgA nephropathy.

Pathologic Findings of Mitochondrial Myopathy.: Lucia Kim, Tai Seung Kim; Korean J Pathol. 2000;34(1):77-84.

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Abstract PDF: Mitochondrial myopathy (MM) has been applied to muscle disease in which mitochondria have abnormal structure, function or both. To characterize the pathologic findings of MM, we examined the ultrastructural and histochemical findings of 24 cases of MM. The ultrastructures of the MM were characterized by abnormal mitochondria in number (pleoconia) and size (megaconia), and showed predominant accumulation of mitochondria in the subsarcolemmal space of myofibers in all cases. Mitochondria contained abnormally shaped cristae (concentric form and gyriform) in 79% of cases. Paracrystalline inclusion which was known to be a characteristics of MM were seen only in 7 cases (29%). Electron dense deposits were more frequently found (77%) in abnormal mitochondria of chronic progressive external opthalmoplegia and Kearn-Sayre syndrome. But, other findings were not specific for the specific clinical entities. On succinate dehydrogenase (SDH) stain, ragged red fibers (RRF) showed more intense positivity than modified Gomori-trichrome stain and definite strong reactive products were present along the periphery of myofibers which showed normal findings on modified Gomori-trichrome stain. In conclusion, ultrastructural findings such as mitochondria showing pleoconia with megaconia, and bizarre shaped cristae may be helpful for the diagnosis of MM and SDH stain is more useful for identification of RRF than modified Gomori-trichrome stains.

Case Reports

Non-Salivary Type Adenocarcinoma of the Sinonasal Tract A case report with low and high grade histologies.: Jai Hyang Go, Min Chul Lee; Korean J Pathol. 2000;34(1):85-87.

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Abstract PDF: Non-salivary type adenocarcinoma of the sinonasal tract is a rare entity and includes low grade and high grade adenocarcinomas, which show somewhat different clinical and histological features. We report a case of non-salivary type adenocarcinoma occurring in a 55-year-old man. Computed tomography showed a soft tissue mass in right nasal cavity and ethmoid sinus, which extended to the nasopharynx. Removed mass showed both high grade and low grade adenocarcinomatous areas, which have different histology from usual salivary type tumor. The high grade area mimicked intestinal adenocarcinoma and low grade area was similer to adenoma because of very well differentiated tumor glands.

Acinic Cell Carcinoma in the Nasal Cavity: A case report.: Hyun Jin Son, Myoung Ja Chung, Myoung Jae Kang; Korean J Pathol. 2000;34(1):88-92.

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Abstract PDF: The acinic cell carcinoma (ACC) is very rare in the nasal cavity. A 57-year-old woman suffered from nasal obstruction, postnasal dripping, and hyposmia for 2 months. Rhinoscopic examination revealed a huge polypoid mass in the right inferior and anterior nasal fossa of the nasal cavity and the mass was resected. The tumor showed the classic acinar and trabecular features of ACC on light microscopic examination. The finely granular cytoplasmic granules stained with periodic acid-schiff (PAS) and diastase digested-PAS, but not with alcian blue at pH 2.5 and mucicarmine. On ultrastructural examination, tumor cells contained numerous secretory granules diagnostic of ACC.

Heterotopic Prostatic Tissue with Cystic Change in Retrovesical Space: A case report.: Hyun Jin Son, Myoung Jae Kang, Dong Geun Lee; Korean J Pathol. 2000;34(1):93-95.

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Abstract PDF: Heterotopic prostatic tissue has been reported in a variety of sites within and outside the urinary tract. Extra-urethral ectopic prostatic tissue is a distinct entity and may be more common than previously thought. We report a case of heterotopic prostatic tissue in 71-year-old man. Pelvic CT scan showed a well circumscribed cystic mass in the retrovesical space. Grossly, the tumor was 7.5 7.0 2.8 cm and revealed an ovoid unilocular cyst containing grayish amorphous granular materials. The prostatic origin of the tissue was confirmed by immunohistochemical staining for prostate specific antigen.

Myofibrosarcoma of the Breast: A case report .: Chan Kwon Jung, Kyo Young Lee, Chang Suk Kang, Sang In Shim, Byung Kee Kim; Korean J Pathol. 2000;34(1):96-98.

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Abstract PDF: Myofibrosarcoma of the breast is a rare malignant mesenchymal tumor that has been reported in only four well documented cases so far. We report a case of myofibrosarcoma of the breast in an 88-year-old man who complained of a palpable mass for 1 year. Microscopically, the tumor consisted mainly of spindled cells, arranged in irregular fascicles and embedded in broad bands of dense hyalinized collagen. It showed ill-defined border infiltrating the adjacent adipose tissue, moderate cellular pleomorphism, and high mitotic rate (8~9/10 HPF). Immunohistochemical study confirmed myofibroblastic differentiation of the tumor cells with diffuse strong reaction for vimentin, smooth muscle actin, and fibronectin.

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