Two Cases of Hyperparathyroidism Presenting as Acute Pancreatitis / 대한내분비학회지

The relationship between hypercalcemic crisis and pancreatitis, first described in patients with hyperparathyroidism, still remains controversial. Acute pancreatitis may complicate the clinical course of hyperparathyroidism, particularly when the degree of hypercalcemia is severe. The incidence of hyperparathyroidism presenting as acute pancreatitis appears to be steadily decreasing, possibly reflecting the earlier diagnosis of asymptomatic hyperparaparathyroidism due to widespread application of screening methods. Here, we report two patients with primary hyperparathyroidism manifesting clinically as acute pancreatitis. One patient died of progessive pancreatitis and uncontrolled sepsis. The other patient was fullly recovered by emergent parathyroidectomy followed by medical management of hypercalcemia.

A Morphological Study of the Pulmonary Endothelium and Neuroendocrine Cells in Monocrotaline-Induced Pulmonary Arterial Hypertension

To investigate the mechanism of monocrotaline-induced pulmonary arterial hypertension, authors performed immunohistochemical study using antibody to von Willebrand factor(vWF), cell kinetic study using 5-bromodeoxyuridine and ultrastructural study after single subcutaneous injection of monocrotaline(MCT) to Wistar rats. The results of this study demonstrated that the expression of vWF by pulmonary endothelial cells was markedly increased from day 3 until 2 months after MCT injection. The labeling index of pulmonary microvessel endothelium began to increase after six days and was maximal on the third weeks, and thereafter it remained slightly increased above basal level. Electron microscopic study revealed attachment of inflammatory cells an platelets to endothelium from 6 hours and degranulation of attached platelets 24 hours after MCT injection. Evidences of endothelial injury began to appear from 12 hours after MCT injection. Evidences of endothelial injury began to appear from 12 hours and was maximal after 48 hours. From the third day, ultrastructural change of cell regeneration and hypertrophy began to appear and was continuosly observed until 2 months. In addition, we evaluated the changes in the number of pulmonary neuroendocrine cells using antibody to gastrin releasing peptide but it demonstrated no change until 2 months suggesting no role of neuroendocrine cells in the development of pulmonary hypertension of Wistar rats at early stage. In conclusion, the results indicate that pulmonary hypertension by MCT injection is due to increased vascular resistance caused by vasoconstriction and hyperplasia of endothelium with musculariz ation of the pulmonary arterioles induced by endothelial dysfunction and some biologic substances released form endothelium and platelets.

Pathological Predictor for Prognosis in Gastrointestinal Mesenchymal Neoplasms

To evaluate the prognostic predictor and clinicopathologic characteristics of the gastrointestinal (GI) mesenchymal neoplasm, we examined 75 cases of GI mesenchymal tumors surgically resected during 8 years from 1983 to 1990. Various histological parameters referrable to the prognosis, including the Ag-NORs count, were analysed. Fifty cases were followed-up for 1 to 7 years. Sixteen out of these fifty cases died during this period. The location of tumor was the stomach in 33 cases, the small intestine in 31 cases and the large intestine in 11 cases, and the tumor size was variable from 2 to 35 cm in diameter. The GI mesenchymal neoplasm appeared as an extraluminal mass in 50 cases, an intramural mass in 17 cases, and an intraluminal mass in 8 cases. Each tumor was composed of spindle or epithelioid cells, the former cell type being more common than the latter (45 vs 30 cases). Mitotic count of the tumor showed the best correlationship with the survival of patients(p0.05). These results indicate that the mitotic count is the most valuable pathological predictor for the prognosis in GI mesenchymal neoplasms.

The Effect of Ethanol on 3'-Methyl-4-dimethylaminoazobenzene Induced Carcinogenesis in Rat Liver

This study is aimed to elucidate the biological nature of the precancerous lesions and to evaluate whether the ethanol alters 3'-Methyl-4-dimethylaminoazobenzene (3'-Me-DAB) induced experimental hepatocarcinogenesis. A total of 108 Sprague-Dawley male rats were used for the experiment and divided into 6 groups according to 3'-Me-DAB and ethanol administration. Administration of the drugs were carried out daily by nasogastric tube insertion and the animals were sacrificed at different interval. A part of right lateral lobe was prepared for the histological examination. Cell kinetics of the immunohistochemical method for bromodeoxyuridine (BrdU). The administration of 3'-Me-DAB induced oval cell proliferation, hyperplastic nodule, cholangiofibrosis and carcinoma in the liver. The mean labelling indices, the percentages of BrdU labelled cells, of hepatocytes were increased by administration of 3'-Me-DAB, only to reverse after cessation of the drug (2.58 vs 0.61). The labelling indices of the oval cells were also affected by the administration and cessation of 3'-Me-DAB (11.41 vs 4.48). In contrast, the cholangiofibrosis did not decrease but were still increasing following cessation of 3'-Me-DAB administration (4.37 vs 5.17 and 8.25 vs 11.29). These finding that the hyperplastic nodule and particularly the cholangiofibrosis have an autonomous proliferative potential and are definite precancerous lesions in the experimental hepatocarcinogenesis. Short term administration of ethanol decreased the incidence of development of the precancerous lesions, but did not affect the labelling indices in all the pathologic lesions of hepatocarcinogenesis.

Effects of iodinated fatty acid ester on human hepatocellular carcinoma cells

The interaction between Lipiodol and cells was studied by treating Lipiodol in a human hepatocellular carcinoma cell line(Hep) and mouse fibroblast cell line (L929). Irregular, sustained radioactivity was released from both cell lines shortly after incubation in the radioiodinated Lipiodol mixed media. Lipiodol droplets were found to be firmly attached to the cells following the incubation and these cells were strongly positive for fat stains. The radioiodinated Lipiodol demonstrated the same behavior of accumulation within the cell and on the cell membrane. Although the amount of Lipiodol attached was almost equal in both of the cell lines, the final amount accumulated in the cells was larger in the Hep cells. The accumulation of Lipiodol within the cell and on the cell membrane may play a significant role for its selective targeting and its prolonged retention in the solid tumor.

The Effect of Common Bile Duct Ligation on Liver Morphology and Coper Metabolism in Rat

To clarity the effect of biliary obliteration on copper metabolism of rat liver and on the hepatic morphology, 0.5% cuppuric sulfate was administered intraperitoneally for 42 days following ligation of the common bile duct (CBD) of Sprague-Dawley rats. The blood copper concentration, the hepatic copper content and the accumulation patterns of copper and copper binding protein in the liver were examined and compared with those of the simple CBD ligation group and the simple copper over loaded group. CBD ligation induced marked proliferation of bile ductular structures which, after expanding the portal tracts, invaded and divided the hepatic lobules. There was, however, no excess fibosis beyond what needed to support the new ductules. The blood copper concentration and the hepatic copper content were increased by copper overload with or without CBD ligation, particularly incases with CBD ligation. Liver cell necrosis did not occur by the overloaded copper alone in rats. The hepatic copper and copper binding protein were accumulated at periportal liver cells in the group of coppe overload after CBD ligatio, whereas they began to appear at perivenular hepatocytes in the simple copper overloaded group. In conclusion, it is suggested that CBD ligation does not induce excess fibrosis or liver cirrhosis in rat as far as during our experimental period, but affect significantly on copper metabolism by intrahepatic redistribution of the copper and the copper binding proteins.

Histologic Pattern of Alcoholic Liver Disease in Korea

To elucidate the histologic pattern of alcoholic liver disease (ALD) in Korea, liver biopsies from 173 chronic alcoholics with clinical liver diseases were classified according to the pathologic parameters. One hundred and seventeen cases, the sum of 91 of 116 serum HBsAg negative and 26 of 57 HBsAg positive patients, had the histologic evidence of ALD. Fatty change(23.9%), alcoholic fibrosis (AF)(23.1%) and cirrhosis (23.1%), comprised the three major ALDs, and only 8.5% of cases fit the criteria of alcoholic hepatitis. Chronic sclerosing hyaline disease (CSHD), chronic active alcoholic hepatitis (CAAH) and AF, where non-cirrhotic fibrosis is the predominant change, comprised 44.5% of ALD. Both features of ALD and HBV liver disease (HBV-LD) were found in 17 cases that included 8 AF and 7 cirrhosis. These 17 patients tended to consume less alcohol than patients with other types of pure ALD except alcoholic heaptitis. Patients with the serum HBsAg positive ALD (37.4years) were about 8 years younger than those with the serum HBsAg negative ALD (45.1years). More or less fatty change and foamy degeneration were seen in 77.4% and 31.6% of ALD respectively. Mallory bodies, megamitochondria, iron deposition and perihepatocellular fibrosis were found in 20.5%, 29.9%, 42.7% and 77.8%, respectively. These findings indicate that non-cirrhotic chronic ALD such as CSHD, CAAH and AF are the important histologic patterns of ALD in Korea, and that chronic alcohol consumption and HBV may act synergistically in developing liver disease.

Distribution of lymphocytic subpopulations infiltrated in thyroid glands of Graves' disease

We studied ninety cases of thyroid glands both histopathologically and by immunohistochemical methods in patients with Graves' disease using B and T cell markers to evaluate the role of lymphocytic subpopulation. Females were affected more frequently than males with a ratio of 6.5:1, and usually the females were younger than the males at the time of surgery. The heavier the lymphocytic infiltration, the higher was the percentage of germinal center formation or fibrosis. The degree of lymphocytic infiltration was also related to the titers of antithyroglobulin or antimicrosomal antibodies. T cells were mostly scattered individually or in small groups between the follicles; however, in the severely infiltrated group, the major pattern was in clusters. T8 positive cells were more abundant than T4 positive cells, and their distribution pattern was accordant with T11 positive cells. Immunoglobulin synthesizing B cells were positively stained in 47 of 94 cases tested and IgG was the most predominant. In the mild and moderate lymphocytic infiltration groups, IgM was mostly stained at the mantle zone or in the lymphoid cluster of the interfollicular stroma, whereas IgM positive cells were present exclusively in the germinal center of the severely infiltrated group. The results of our study indicate that the major lymphocyte subpopulation in Graves' disease is B lymphocytes, and the degree of T lymphocytic infiltration correlated better with titers of antimicrosomal antibody than antithyroglobulin.

A Case of Corrosive Gastritis Caused by Hydrochloric Acid / 대한소화기내시경학회지

Recently the use of hydrochloric acid as a toilet disinfectant has become more common, and the risk of its ingestion is though to be increasing. We experienced a case of 67 year-old man who accidentally ingested hydrochloric acid and as a result developed a postprandial epigastric fullness end pain 3 weeks thereafter, The patient underwent an UGI series, fiberoptic gastroscope and abdominal ultrasonography and was found to have a gastric midbody stricture. A total gastreetomy and Roux-en- Y esophagojejunostomy was performed. We report this case with brief review of the literature.

The Frequency of Enterochromaffin Cells in Stomach and Intestinal Carcinoma

In 1927, Hamperl carried out histochemical studies on gastric cancer and found one case which contained many Fontana reactive argentaffin cells. Thereafter the gastric and intestinal adenocarcinomas which contain enterochromaffin cells such as argentaffin cell and argyrophil cell have been reported by several investigators. As the results, many reports revealed that 1.7 to 8% of gastric carcinomas and about 3% of intestinal carcinomas contained argentaffin cells, and 13 to 20% of gastric carcinomas and 12 to 15% of intestinal carcinomas contained argyrophil cells. The present study is aimed to evaluate the frequency of argentaffin and argyrophil cells in gastric and intestinal carcinoma in relation to the histopathological patterns. The material consisted of 282 cases of gastric adenocarcinoma and 83 cases of intestinal carcinoma which were diagnosed at the Department of Pathology, Yonsei University College of Medicine from January 1982 through December 1983. All cases were stained with hematoxylin-eosin for histological classification and with silver impregnation techniques for argentaffin and argyrophil granules. Staining for mucin was also performed using PAS stain. The results obtained were as follows: 1) Among 282 cases of gastric carcinomas, Grimelius positive argyrophil cells are noted in 43 cases (15.2%) and Fontana-Masson positive argentaffin cells are noted in 5 cases (1.8%). 2) Among 83 cases of intestinal carcinomas, Grimelius positive argyrophil cells are noted in 15 cases (18.2%) and Fontana-Masson positive argentaffin cells are noted in 1 cases (1.2%). 3) In gastric carcinoma, argyrophil cells are present in 31 cases (17.5%) among 176 male patients and and in 12 cases (11.3%) among 106 female patients. 4) In intestinal carcinoma, argyrophil cells are present in 9 cases (20.4%) amogn 44 male patients, and in 6 cases (15.4%) among 39 female patients. 5) According to classification by Willis, argyrophil cells are present in 12 cases (11.1%) among 108 well to moderately well differentiated adenocarcinoma, 14 cases (14.4%) among 99 poorly differentiated adenocarcinoma, 6 cases (30%) among 20 mucinous carcinoma, and 11 cases (21.1%) among 52 undifferentiated carcinoma. There is no significant difference in the frequency of argyrophil cells in relation to the histological type. 6) According to general classification of intestinal carcinoma, argyrophil cells are present in 9 cases (21.4%) among 42 well to moderately well differentiated adenocarcinoma, 3 cases (15%) among 25 poorly differentiated adrcinom adenocarcinoma and and cases (18.7%) among 16 mucinous carcinoma. The argentaffin cells were noted only in one case, which was the case of well to moderately well differentiated adenocarcinoma. In summary, the results of this study indicates that the frequency of enterochromaffin cells was 15.2% in stomach carcinoma and 18.2% in intestinal carcinoma. According to histological type, the Grimelius positivity was higher in mucinous and undifferentiated type, and higher frequency was noted in male than female.

Report of A Case of Renal Actinomycosis

Actinomycosis, in which the principal causative agent in man is known to Actinomyces israelii, is a chronic, suppurative diseases characterized by extensive fibrosis, multiple abscesses, and formation of sinus tracts that drain suppurative exudates. On the basis of the anatomical sites involved; it can be subclassified into the cervicofacial form, which is the most common form, pulmonary form and abdominal form. Kidneys are rarely affected. Clinically, radiologically, and at operation it is difficult to differentiate the renal actinomycosis from renal tuberculosis and renal carcinoma. The prognosis is excellent after nephrectomy followed by appropriate antibiotic therapy. We presented a case of renal actinomycosis with a brief review of the literatures.

Comparative Cytogenetic and Clinicopathologic Studies on Gestational Trophoblastic Neoplasia, especially Hydatidiform Mole

Hydatidiform mole has been known for its potential for malignant transformation and for its various chromosomal karyotypes. However, the relationship between histologic grading of hydatidiform mole and its future malignant transformation is still controversial. This study was undertaken to determine the cytogentic aspects of gestational trophoblastic neoplasia, especially of hydatidiform mole with respect to its malignant transformation. Cytogenetic studies were performed in 34 cases of hydatidiform mole, 2 cases of invasive mole, and 2 cases of choriocarcinoma. The results were analyzed comparatively using clinical histopathological and endocrinological (human chorionic gonadotropin titer) data. Among the 34 cases of hydatidiform mole studied, 26 cases were complete moles and the remaining 8 were partial moles with karyotypes being diploid (46, XX, 24, 46, XY, 2), and triploid (69, XXY) respectively. Two cases of XX mole among 26 complete hydatidiform moles developed distant metastasis during the follow-ups, suggesting transformation into choriocarcinoma; both cases showed 46, XX in karyotype and Grade III in histologic grading. Not one case of triploid partial hydatidiform mole transformed into malignancy. The karyotypes of the two cases each of invasive mole and choriocarcinoma were from neardiploid to hypotetraploid, and aneuploid cells were predominant in choriocarcinoma.

The Patterns of Invasion and Lymph Node Metastasis of Stomach Cancer by Histopathological Types

Stomach cancer is the most common malignant neoplasm among Korean men and considered as one of the most important malignant disease in many countries. Thus, many studies have been established about factors affecting prognosis of stomach cancer. These include studies of histopathological pattern which were performed by Mulligan and Rember (1954), Lauren (1965), Ming (1977), and Teglbjerg and Vetner(1977). The present study is aimed to evaluate the useful factors to predict the prognosis of patient of stomach cancer in relation to the histopathological patterns. The material consisted of 284 cases which were diagnosed as gastric carcinoma at the Department of Pathology, Yonsei University, College of Medicine from January, 1981 through December, 1982. After the classification of gastric carcinoma by Ming (1977), Willis (1967), and Mulligan and Rember (1954), age and six of the patients, histopathologic patterns, depth of invasion, degree and major component of inflammatory reaction, lymphatic permeation and metastatic incidence to the regional lymph nodes were investigated, and the results obtained were as follows; 1) The overall male to female ratio was 1.4 : 1 and mean age was 51.6 years old. The mean age of patients with EGC was 46.8 years old, while that of patients with invasive cancer was 52.2 years old, indicating about 5 years difference. 2) The classification of 284 cases by Ming's method showed 36.3% of expanding type and 63.7% of infiltrative one. The incidence of metastasis to regional lymph nodes was 58.3% in expanding type and 72.4% in infiltrative one. 3) The classification of 284 cases by Willis' method showed 45.8% of adenocarcinoma and 23.2% and of signet ring cell carcinoma. Adenocarcinoma anaplastic carcinoma had high degree of desmoplasia. Among them, moderately well differentiated adenocarcinoma and anaplastic carcinoma showed markedly lower metastatic rate to regional lymph nodes than others. 4) The classification of 284 cases by Mulligan and Rember's method showed 15.1% of intestinal cell carcinoma, 21.5% of pyloro-cardiac gland cell carcinoma and 61.6% of mucous cell carcinoma. Highly differentiated intestinal cell and pylorocardiac gland cell carcinomas and desmoplastic mucous cell carcinoma had high degree of desmoplasia. Among them, highly differentiated intestinal cell carcinoma and desmoplastic mucous cell carcinoma showed markedly low metastatic rate to regional lymph nodes. 5) Adenocarcinoma with good differentiation showed higher mean age and male predominancy in comparison to carcinoma with poor differentiation. 6) The degree of inflammatory reaction did not show significant difference in relation to the patterns of gastric carcinoma and the rate of regional node metastasis. However, according to the cell types involved in inflammatory reaction, plasma cell-predominant inflammatory reaction showed low metastatic rate to regional lymph nodes. 7) The more the degree of desmoplasia was observed, the less the rate of metastasis to regional nodes was noted and the difference was statistically significant. 8) The rate of metastasis to regional nodes showed marked difference by the depth of cancer invasion; confined to mucosa, 0% : to submucosa, 15.4%; to muscular layer, 66.7%; and to serosa and perigastric area, 76.5%. In summary, the results of this study indicated several factors suggesting good prognosis, such as; (1) expanding growth pattern, (2) good differentiation, (3) high degree of desmoplasia as stromal reaction, (4) plasma cell-predominant infiltration, and (5) lesser deep invasion. These factors were better evaluated by Mulligan and Rember's classification.

Chromomycosis: A case report

Chromomycosis is a chronic localized infection of the cutaneous and subcutaneous tissues and characterized by verrucoid, ulcerated and crusted lesions with sclerotic margins. It histologically show confluent granulomatous nodules containing large giant cells of the foreign body type. The organisms are differ from other yeastform fungi by the characteristic chestnut-brown color and by the septate division. A case of 51 year old woman with chromomycosis at submental area is presented.

Melanocyte Colonization and Pigmentation of Breast Carcinoma: Report of a case

Colonization of mammary cancers by melanocytes with heavy pigmentation of cancer cells by melanin can occur very rarely. It is not certain which mechanism operates to achieve this transfer. However, the melanocytes might inject melanin through their dendritic processes or alternatively, the cancer cells phagocytose the terminal parts of the dendritic processes with subsequent dispersal of the contained melanin contained melanin granules. We report a case of infiltrating ductal carcinoma of breast with melanocyte colonization and pigmentation in a 59-year old female.

Adjuvant Treatment with Chemotherapeutic Agents and Polyadenylic-Polyuridylic Acid in Operable Stomach Cancers: I. Enhancement of Natural Killer Cell Activity

Natural Killer (NK) cell activity of 47 operable stomach cancer patients was sequentially studied before and after chemotherapy in association with polyadenylic. polyuridylic acid [poly(A).poly(U)]. NK activity was determined by an in vitro 4 h chromium release assay using nonadherent mononuclear cells isolated from peripheral bloods as effectors and human myeloblastic cells (K562) as targets. The following results were obtained: 1) The mean NK activity of the 47 patients tested before chemotherapy was significantly lower than that of 14 healthy controls. 2) The patents who received chemotherapy consisting of 5 FU (12 mg/kg) and adriamycin (40 mg/M2) showed an increase in NK activity 5 days after injection as compared to that of the same patients tested before chemotherapy. 3) In these patients, an additional administration of poly(A) poly(U) (100mg) resulted in a further significant increase of NK activity 2 days later, whereas the control patients who received placebo showed no change of NK activity.

Subacute Necrotizing Lymphadenitis: I. Histopathologic Study

Since 1972, a unique lymphadenitis called "subacute necrotizing lymphadenitis" has been described in much Japanese literatures and in a few English articles. Although this condition is accepted as a new entity in Japan, it is not yet accepted other countries. Occasionally, we have encountered lymph node biopsies which showed histologic pictures of subacute necrotizing lymphadenitis with clinical impressions of malignant lymphoma. As an initial step to investigating the etiology of this disease, the common clinicopathologic features in 24 cases of subacute necrotizing lymphadenitis were studied. The lesion frequently developed in the cervical lymph node of young women, causing simple enlargement of the lymph node and was accompanied occasionally by fever or pain. The duration of symptoms was within one month and seasonal distribution was not remarkable. In laboratory tests, WBC count was below 4000/mm3 in 8 cases and Widal test was negative in all 4 cases examined. Microscopically, the characteristic finding was the wide area of patch or confluent necrosis associated with numerous karyorrhectic nuclear dust and surrounded by diffuse infiltration of immunoblastic or activated histiocytoid cells. No appreciable increase in plasma cells or neutrophilic infiltration was noted.

An Experimental Study on the Immune Complex Induced Chronic Arthritis in Rabbits: Reference to Macrophophages and M-type Cells of Synovium / 대한정형외과학회잡지

No abstract available in English.

An Experimental Study on Immune Complex Induced Athritis in Rabbits: Reference to Macrophages and M-type Cells of the Synovium

This study evaluates the pathogenesis of rheumatoid arthritis by producing immune complex induced arthritis with an intra-articular injection of BSA in immunized rabbits, and the effect of systemic administration of cyclophosphamide and local administration of anti-macrophage serum. The reduction of inflammatory reaction by cyclophosphamide administration appears to be caused mainly by selective depletion of the neutrophils, and partly by immune suppression. It appears that the rabbit abdominal macrophage has the common morphologic, functional and antigenic patterns with the M-type synovial lining cells. There is another possibility that the cross-reacting antigens between macrophage and the M-type cell of the synovial lining may exist. It is concluded that in this experimental immune complex arthritis, the site of localization of immune complexes seems to be the synovial, M-type cell, and the tissue injury of synovium is largely mediated not only by neutrophils and complement, but also by macrophages.

Sea Blue Histiocytosis Associated with Hyperlipoproteinemia Type IIb

Sea-blue or ceroid histiocytosis is a storage phenomena associated with a variety of conditions especially abnormal lipid metabolism and particularly hyperlipoproteinemia. It is characterized by histiocytic proliferation in the bone marrow and spleen, contain-ing sea-blue inclusions by Romanovsky stain. The present case is a 1 1/2 year-old Korean boy who had marked enlargement of the spleen which was eventually removed. Aspirates of the bone marrow and histology of the spleen disclosed an enormous proliferation of histiocytes containing numerous cytoplasmic inclusions which stained sea-blue with Wright stain, was strongly positive to PAS and weakly positive to oil red-O and Sudan black B in frozen and in paraffin embedded section. Ultrastructually histiocytes were marked1y hypertrophic and contained numerous cytoplasmic inclusions which showed three distinct types and conglomeration of all three types, presumably representing age or maturation steps of the inclusions. The ear1y type consisted of a high electron dense core or deposits within a low electron dense matrix, evolving into homogeneous moderately electron dense inclusion and finally a well developed finger print-like internal structure. Analysis of the plasma lipid disclosed type IIb hyperlipoproteinemia. Types of hyperlipoproteinemia previously reported in association with sea-blue histiocytosis were type-I, III, IV and V, and this is the first case of type IIb hyperlipoproteinemia.