Columnar Cell Lesions in Fibrocystic Change of the Breast: The Incidence and Relationship with Microcalcifications

BACKGROUND: Columnar cell lesions (CCLs) are characterized by the presence of columnar epithelial cells lining the terminal duct lobular units of the breast and frequently found in biopsies for microcalcifications. Their incidence and relationship with other lesions and the locations of microcalcifications have not been established. METHODS: We reviewed 1,038 cases of fibrocystic change (FCC) for the degrees of CCLs and ductal proliferative change (PC) and the locations of microcalcifications. RESULTS: Among 1,038 FCC cases, CCLs were found in 18.9%, columnar cell change (CCC) in 12.5%, columnar cell hyperplasia (CCH) in 5.3% and flat epithelial atypia (FEA) in 1.1%. CCLs were found in 14.2%, 28.8%, and 40.0% of non-PC (NPC), proliferative disease (PD) without atypia and PD with atypia, respectively. Microcalcifications were found in 33.5%, 56.2%, 61.8%, and 81.8% of caese without CCLs, with CCC, CCH and FEA, respectively. Their locations were in NPC in 66.3% of the cases, PD in 14.8% of the cases or both areas in 18.8% of FCC. CONCLUSIONS: The incidence of CCLs increased according to the degree of PD without positive correlation between the degree of CCLs and PD. The frequency of microcalcifications increased according to the degree of CCLs but was statistically insignificant. There is a possibility that a needle biopsy targeting a microcalcification area might leave additional PD around the targeted area because microcalcifications were found more frequently in NPC than PD area.

Spontaneous Disappearance of Microcalcifications in Breast Papillary Carcinoma: Case Report

Spontaneous disappearance of breast calcification has rarely been reported. The majority of cases of spontaneously resolving calcifications have been concerned with benign processes. We report here on breast papillary carcinoma that showed spontaneously resolving microcalcifications without newly developed parenchymal changes on the follow-up mammogram.

Collision Tumor in the Gastric Stump after Radical Subtotal Gastrectomy

Collision tumors is rare entities in which two distinct primary tumors develop in contiguity. They may arise as independent tumors in the same organ or in adjacent organs. The occurrence of a collision tumor in the stomach, consisting of adenocarcinoma and neuroendocrine tumor, is extremely rare. We report a case of a patient, who had undergone a radical subtotal gastrectomy for gastric cancer 3 year earlier, and an ulcerating tumor of the gastric stump had developed. A total resection of the remnant stomach was performed, and the pathological examination revealed a collision tumor consisting of an adenocarcinoma and a neuroendocrine tumor. The coexistence of both adenocarcinoma and neuroendocrine tumor of the gastric stump has never been reported. The authors present this case and a review of the relevant literature.

A Case of Polypoid Esophageal Carcinosarcoma with Spontaneous Resected Stalk / 대한소화기내시경학회지

Carcinosarcomas of the esophagus are rare malignant neoplasms that consist of both carcinomatous and sarcomatous components, which comprise approximately 1~2% of all esophageal neoplasms. Usually, esophageal carcinosarcomas are the polypoid type, and patients with esophageal carcinosarcoma have progressive dysphagia. The multiplicity in terminology appears to be related to the uncertain histogenesis of these tumors. We report a case of a polypoid esophageal carcinosarcoma with a spontaneous resected stalk in a 45 year-old male patient who presented with progressive dysphagia and weight loss.

Expression of cytokeratin subtypes and vimentin in ameloblastoma

Ameloblastoma is the most common odontogenic tumor of the jawbones, but the origin of this tumor has been remained to be unproven. Cytokeratins (CKs) are specific intermediate filament of epithelial cells, and vimentin is expressed in mesenchymal cells. The immunohistochemical detection of different CKs and vimentin has made it easier to know the origin of tumor. Paraffin-embedded tissue sections from 15 ameloblastomas and 1 ameloblastic carcinoma were used for immunohistochemical evaluation of CK 7, 8, 13, 14, 19 and vimentin. Their expression is evaluated in different tumor cells, which are observed in different type of tumors. In the follicular and reticular subtype, central stellate cells of tumor nests expressed CK 8, 14, 19 and peripheral columnar cells expressed CK 14. CK 7, and 13 were not expressed. Vimentin was detected in fibrous stroma around tumor nest, not in tumor cells. The tumor cells of ameloblastic carcinoma expressed CK 7, 14 and 19, but CK 8 was more weakly stained than that in ameloblastoma. Central stellate cells and peripheral columnar cells of acanthomatous subtype showed same expression pattern with others. Meta plastic squamous cells expressed CK 8, 14, 19 and keratinizing squamous cells expressed CK 13, 19. CK 7 and vimentin were not detected in tumor cells and vimentin was expressed in fibrous stroma. Most of the tumor cells of ameloblastoma showed CK 14 and CK 19 and did not express CK 7 and vimentin. These findings were similar to the immunophenotype of dental lamina. And these results will be beneficial to differential diagnosis of odontogenic tumors and other kind of tumors arising at the oral cavity.

A Case of Strangulated Intussusception Caused by the Small Intestinal Lipoma in Adult / 대한소화기내시경학회지

An intussusception in adulthood is an unusual cause of bowel obstruction. It accounts for up to 5% of all intussusception. Approximately 90% of cases are secondary to a definite lesion such as malignancy or lipoma. Most patients are asymptomatic and the lesion is often detected incidentally at colonoscopy, operation and autopsy. Strangulated intussuscetion is a rare case and also requires emergency operation. A 32-year-old woman visited our emergency room because of severe epigastric pain. Abdominal CT revealed a low density mass in bowel loop and distended small bowel loops filled with fluid. Colonoscopic finding showed huge purple-colored coil-spring lesion in the ascending colon. From this findings, we diagnosed a strangulated intussusception. Surgically removed specimen revealed a small intestinal lipoma.

Extracellular Matrix and Astrocytic Response during Regeneration following Cryogenic Injury in Adult Rat Cerebral Cortex

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.

A Case of Nasal Glioma

No abstract available.

A Case of Lipomatous Meningioma

A case of lipomatous meningioma is described. On pre-enhanced CT study the lesion was radioluscent but after enhancement almost half of the lesion was strongly enhanced and the other half was still radioluscent. A review of the literatures showed few similar reported cases.

Epidermal nevus: a clinical and histopathological study / 대한피부과학회지

We reviewed 48 skin bicpsies obtained from 48 patients with epidermal nevus during a 10 year period from January 1981 to December 1990. The results are summarized as follows : 1) Of our 48 patients, 23 were male and 25 were female, and male to female ratio was 1 to 1.1. 2) The average of the patients was 19.8 years at the time of diagnois. 3) Lesions were present at birth in 45.7 percent of patients, and most of the remainder de veloped in childhood. The mean age of onset was 7.7 years. 4) The clinical varieties of the nevi in 48 patients were classified according to caicegories of nevus verrucosus, including systematized epidermal nevus, nevu, unius lateris, ichthyosis hystrix, epidermal nevus syndrome and inflammatory linear veirucous epidermal nevus. The most common type was nevus verrucosus(88.6%). 5) A large variety of histopathologic changes can be seen in epidermal nevi. The most common histopathologic .ype was nonspecific(31.3%), follows by common(12.5%), epidermolytic hyperkertosis(12.5%), and acanthosis nigricans(10.4%). 6) The most commonly affected area was head and neck(48.5%) followed by trunk(28.6%), upper limb(11.4%) and lower limb(2.9%).

Fine Needle Aspiration Cytology of hepatocellular Carcinoma: A Study on 247 Cases / 대한세포병리학회지

Hepatocellular carcinoma(HCC) is malignant tumor frequently occurring in Koreans. There have been few reports regarding the cytologic findings of fine needle aspiration(FNA) of HCC. Most have suggested a diagnostic problem in the cytology distinguishing HCC from some benign hepatic lesion-for example, a regeneration nodule in cirrhosis and liver cell adenoma. In spite of its high frequency in Korea, no cytologic study has been reported, concerning the FNA of HCC. In an attempt to achieve cytologic criteria for the diagnosis of HCC, the authors studied retrospectively cytopathologic findings of 247 cases of HCC. These cases were confirmed either by histologic examination including lobectomy, biopsy, or cell block material, or, when tissue diagnosis was unavailable, by a high serum alpha-fetoprotein level(over 400 I. U.). All aspiration smears were stained by the Papainicolaou method. In each case, the smears were analyzed for cell patterns and various cytomorphology of the tumor cells. The smear background was assessed for the presence of tumor cell necrosis and inflammatory components and compared to that of metastatic carcinomas. The cell patterns were classified as trabecular, acinar, dispersed, and irregular. The cytologic parameters analyzed included the degree of nuclear atypia and the presence of mitoses, intranuclear cytoplasmic inclusions, nucleolar prominency, endothelial lining, multinucleated giant cells, eosinophilc, globules bile and Mallory body. Most of the FNA of HCC showed markedly cellular smears. The tumor cells were most frequently arranged in a trabecular pattern(80.3%). The irregular(12.6%), the acinar(5.5%), and the dispersed patterns(1.7%) followed in decreasing frequency. Individual hepatoma cells were larger than normal liver cells. However, they had morphologic features characteristic of the hepatic cells : the cells were round or polygonal, their cytoplasm was abundant and granular with eosinophilic or amphophilic stainability, and their nuclei were round to oval, located centrally, and tended to have prominent nucleoli. Anaplasia and pleomorphism of tumor cells were generally mild to moderate. These findings existed even in very well differentiated cases. Mitotic figures were present in about 85% of the cases. Prominent nucleoli were observed only in about half the cases. The frequency of other cytologic features was as follows : intranuclear cytoplasmic inclusion in 86.8% ; endothelial lining in 56.1% ; bile in 19.8% ; and giant cells in 60.1%. Clear cells were often present in 11.7%, Most aspiration smears of HCC displayed clean background without necrosis or inflammatory material in contrast to the dirty, necrotic background of metastatic cancers and cholangiocarcinomas. Based on the above mentioned features, it is suqqested that the cytologic critieria most important for the diagnosis of HCC include a markedly cellular smear, trabecular pattern. hepatocytoid appearance of tumor cells, endothelial lining, the presence of bile, giant cells, intranuclear cytoplasmic inclusions, and prominent nucleoli, Among these, trabecular pattern, endothelial lining, giant cells and clean smear background are points to be considered in differentiating HCC from metastatic and cholangiocellular carcinoma.

A Study on the Histopathologic Features of Bowenoid Papulosis and the Numerical Change in Langerhans Cells

Fourteen cases of bowenoid papulosis were studied both clinically and histologically and were compared with 22 cases of Bowen's disease to find histologic differences between the two diseases. Bowenoid papulosis was prevalent in young, sexually active adults, consisted of multiple erythematous or hyperpigmented papules, and located mostly on the penis and vulva. The main histologic characteristics of bowenoid papulosis were an orderly background of keratinocyte maturation of the epidermis with monotonous pattern, the frequent presence of 'skip area', and the lesser degree of cytologic atypia than seen in lesions of Bowen's disease. In addition, mitotic figures more than 5 per x400 filed, formation of keratin pearl, and spindling of keratinocytes, which have not been described in other articles yet, are considered very important findings for the diagnosis of bowenoid papulosis. It is our opinion that bowenoid papulosis can be reliably distinguished from Bowen's disease by light microscopic features. Paraffin-embedded samples of bowenoid papulosis, Bowen's disease, and normal skin were investigated with antibodies against S 100-protein to relate the number of intraepidermal Langerhans cells and the disease. Langerhans cells were found to be reduced when compared with normal skin. No significant differences between Bowen's disease and bowenoid papulosis were found in density of Langerhans cells.

The Significance of Nesidiodysplasia of the Pancreas

To elucidate the significance of the nesidiodysplasia of pancreas, histological re-evaluation and immunohistochemical studies for insulin, glucagon and somatostatin were done on 16 consecutive cases (5 premature babies, 2 stillborns, 5 infants and 3 adults) in which paraffin blocks of the pancreas were available. Only one infant was hypoglycemic. All 16 pancreases showed changes of nesidiodysplasia which appeared immunohistochemically to have isulin, glucagon and /or somatostatin. The histologic patterns of nesidiodysplasia included ductoendocrine proliferation, endocrine cell dysplasia, adenomatosis, septal islet, islket cell hypertrophy and islet hypertrophy. All the patterns of nesidiodysplasia except for the adenomatosis were seen in premature babies, infants, stillborns and adults with or without hypoglycemia. The adenomatosis was found only in the hypoglycemic infant. The result suggests that all patterns of nesidiodysplasia of other than the adenomatosis does not imply the pathologic basis of hypoglycemia.

Hyperinfection Syndrome with Strongyloides Stercoralis: Report of a case

Strongyloides stercoralis is a nematodes and is prevalent in the tropical regions. In Korea, 6 cases have been reported in which the parasites were identified in feces. We report a case of hyperinfection syndrome with Strongyloides stercoralis confirmed in the tissue sections. A 52-year-old woman was admitted to the hospital because of generalized edema and weakness. She received steroid therapy for 30 years because of rheumatoid arthritis. One year ago, generalized edema and dyspnea were developed and she was diagnosed as minimal change nephrotic syndrome for which she received cyclosporin. On admission, she complained of generalized weakness and edema, multiple arthralgia and abdominal discomfort with nausea. The white-cell count was 14,600 without eosinophilia. A stool specimen was negative for occult blood, ova or parasites. Right lower quadrant abdominal pain and tenderness were developed, and the exploratory laparotomy was done under the impression of the acute appendicitis. An appendectomy with a biopsy of mesenteric lymph nodes was performed. From the 5th day after operation, the patient began to complain of the abdominal pain and constipation. Under the impression of adhesion bad formation, the laparotomy was done and disclosed that the proximal ileum was markedly dilated. On jejunotomy, a great amount of formed stool and barium was noticed in the proximal portion of small bowel. The jejunal tissue was biopsied. Grossly, the appendix was unremarkable. Microscopically, the inflammatory reaction was nearly absent, but in serosa, minute granulomas were found which contain a part of the parasite. Same feature was noted in the mesenteric lymph node. The biopsied jejunum contains numerous adult female, filariform and rhabdidiform larvae and eggs in the mucosa, submucosa and muscle wall. Their morphology was compatible with Strongyloides stercoralis. The patient died 5 days later in the state of multiple organ failure.

Buerger's Disease of Paratesticular Tissue: A case report

We report a case of Buerger's disease manifested by a scrotal mass, in view of its rarity. A tender bean sized mass was palpated in the left scrotum of a 34 year-old male heavy smoker, who had a history of right pain two years ago which subsided spontaneously. The left testis with the paratesticular tissue was excised. Vessels of the spermatic cord and epididymis showed microscopic changes of Buerger's disease. The involved arteries and veins revealed a predominantly subacute pattern with granulomatous inflammation and Langhans' type giant cells within the thrombi.

Histopathologic and Immunocytochemical Study of Hodgkin's Disease

Hodgkin's disease primarily involves the lymphoreticular system with characteristic tumor cells and infiltration of reactive lymphocytes, eosinophils and plasma cells. The present study investigates the incidence of the disease by subtypes and by geographic differences, its clinicopathologic features and properties of the tumor cells. Fifty-eight cases were retrospectively reviewed, and the results were as follows; 1) Histopathologic classification by the Rye modification were; lymphocyte predominance(LP) 4 cases, nodular sclerosis (NS) 12 cases, mixed cellularity (MC) 26 cases and lymphocyte depletion(LD) 16 cases 2) The geographic difference in the distribution of subtypes of Hodgkin's disease between the Seoul and Wonju areas was noted and in Seoul, the ratio of NS was higher than in Wonju, and the ratio of LD was higher in Wonju than in Seoul 3) Age distribution was between 6 and 7O years with a mean age of 37 years. The peak incidence was seen between the 3rd and 5th decades. The male to female ratio was 2.9:1 with 43 male patients and 15 female 4) Utilizing the Ann Arbor staging method, 75-87.5% of LP, MC and NS were classified as stage I or II and 81.3% of LD were stage III or IV 5) The initial biopsy sites most commonly seen were in the peripheral lymph nodes (54 cases) and one case each in the mediastinal lymph node, thymus, tonsil and stomach 6) The most frequent initial chief complaint was a palpable mass (60.3%), other complaints included fever, cough, dyspnea, anorexia general weakness and hematemesis 7) Among 58 cases, 32 cases were studied using an immunoperoxidase stain. The Reed-Stemberg (R-S) cells and/or Hodgkin's cells were positive for Kappa and Lambda light chains, simultaneously. One case was positive for lysozyme and all were negative for S-100 protein. For the (C)u-antichymotrypsin, 13 cases exhibited a positive reaction. These findings suggest that R-S cells might be the histiocytic origin.

Intrauterine Testicular Torsion / 대한비뇨기과학회지

We report 2 cases of intrauterine unilateral testicular torsion This experience reemphasizes the necessity of a careful and complete examination of the newborn immediate after delivery. The presence of a scrotal mass in a newborn that does not transilluminate represent trosion of the spermatic cord until proved otherwise, and demands immediate surgical intervention through an inguinal approach for accurate diagnosis and appropriate therapy.

Hepatic Changes Resembling the Indian Childhood Cirrhosis in an IgM anti-CMV Positive Infant

This is to describe a neonatal hepatitis with pericellular hepatic fibrosis and Mallory bodies in a sero-positive infant for IgM anti-CMV. A necropsy of the liver revealed severe heaptocellular swelling with many intracytoplasmic hyaline bodies, pronounced fibrosis of a creeping type, bile stasis with ductular proliferation, and the lack of parenchymal regeneration. These microscopical changes of the liver resembled those of Indian Childhood Cirrhosis (ICC). In the present case the patient's serum IgM anti-CMV is the only clue for the etiological diagnosis.