Primary Squamous Cell and Adenosquamous Carcinomas of the Stomach: Clinico-pathologic analysis of 6 cases

Squamous cell carcinomas and adenosquamous carcinomas are rarely originated from the stomach, thus the limited and sporadic informations about their clinico-pathologic characteristics as well as histogenesis have been elucidated. Six cases of primary squamous cell carcinoma (3 cases) and adenosquamous carcinoma(3 cases) in the stomach were examined during a period of 4 years from 1981 to 1984. After pertinent review of both clinical data and morphology through extended histotopographic study performed on 4 cases, their clinicopathologic characteristics were described. Male to female sex ratio was 4 : 2 and average age was 58.6 years. Clinical presentations or physical findings were not different from those of adenocarcinoma. Tumor masses of all cases were located in the body or phloric antrum. In all cases except for the early gastric carcinoma, each tumor was larger than 8 cm in long axis, and showed expansile and intraluminal endophytic growing tendencies with sharp margin. Simple Borrmann's macroscopic classification was applicable to none of 6 cases because of irregular and multicentric ulceration pattern and occasional submucosal growth which were reminiscent of those in submucosal tumors such as malignant lymphoma and leiomyosarcoma. Virtually four out of all six cases were diagnosed as submucosal tumor at the time of radiological examination. Microscopically three cases were composed of pure squamous cell carcinoma and remaining three contained both adeno and squamous components. Metastatic regional lymph nodes revealed only squamous element in case of pure squamous cell carcinoam, while both components were identified in adenosquamous carcinomas. Surrounding non-tumors mucosa exhibited moderate to severe degree of intestinal metaplasia accompanied by multifocal mucin pool formation. Growth pattern and surrounding mucosal changes as with older age prevalence of these tumors might express the biological behavior of intestinal type of gastric carcinoma.

Atypical Thymic Carcinoid Associated with Ectopic ACTH Syndrome: Demonstration of ACTH secretion with ultrastructural and immunohistochemical studies

We reported a case of atypical thymic carcinoid tumor with ectopic ACTH syndrome which was proved by the presence of intracytoplasmic ACTH in the tumor cells using PAP method and electron microscopy. The patient was a 43-year-old housewife who was referred with Cushing's syndrome of unknown origin, and subsequantly followed by many disabling symptoms including, diabetes mellitus and electrolyte imbalance for which bilateral adrenalectomy was carried out. Thereafter, rapid rise in serum ACTH level and hyperpigmentation were followed. Pituitary irradiation was done under the impression of Nelson's syndrome despite of lacking evidence of pituitary tumor, but high serum ACTH persisted. Seven months after pituitary irradiation, two anterior mediastinal masses were first noticed and removed. Immunohistochemical and ultrastructural studies confirmed this neoplasm as a ACTH producing spindle cell variant of atypical thymic carcinoid tumor. When dealing with a patient who developed Nelson's syndrome-like phenomenon without apparent pituitary tumor, the possibility of ectopic ACTH syndrome caused by thymic carcinoid should be considered.

Hamartoma of the Lung: An autopsy case

The so-called chondromatous hamartoma of the lung is an uncommon(0.25% of autopsies) benign tumor consisting of mixture of cartilage, fat, undifferentiated mesenchymal cells and cleft-like spaces lined by a simple cuboidal or ciliated epithelium.) This lesion is now thought to be a true neoplasm rather than a developmental abnormality as the term originally implied. It is generally agreed that it arises in the connective tissue in relation to bronchial walls. We report an autopsy case of lung hamartoma which is associated with advanced tubular bronchiectasis and diffuse interstitial fibrosis. This single case casts some interesting points about its pathogenesis. The patient was a 47 year old woman and had a 2 cm sized well circumscribed pulmonary mass which was located in the subpleural portion of right upper lobe near the minor fissure. On the basis of observations on the tumor and background lesion, we speculated that the multifocal lesions originating from submucosal immature connective tissue coalesce to become a large single mass. So the tumor possesses entrapped alveoli which exhibit the same changes as those of surrounding parenchyme. We also pressure that the inflammatory change may play a role in the initiation of neoplastic proliferating process in this kind of lesion.

Urachal anomaly: Two Cases Report

Two cases of urachal anomaly (1 urachal cyst and 1 patent urachus) are reported in a neonate and an eleven-year old boy, respectively. In case 1, the patient was born after an uncomplicated pregnancy to a mother who had taken progesterone during the first trimester. Because of breech presentation, cesarian section was elected to deliver a male baby weighing 2.3 kg who showed abdominal distension. The patient died of respiratory difficulty several minutes after birth. At autopsy, there was a large cyst in the midpoint of the abdominal and pelvic cavity. This round cyst was composed of two components, urachus and urinary bladder. No area of umbilicocystic fistula was present. The lining epithelium was chiefly of transitional type. Assocaited anomalies were segmental stenosis of posterior urethra, absence of abdominal musculature, bilateral polycystic kidney of Potter type IV, hydroureter, and hypoplasia of lungs. Low set ears, micrognathia and club foot were also present. In case 2 the patient was 11-year old boy. He had suffered from intermittent urinary dribbling from umbilicus since early infancy, whenever the abdominal pressure was increased. The patency of urachus was confirmed by fistulography. And the urachal anomaly was surgically removed. Histopathologically the resected patent urachus consisted of pseudostratified columnar to transitional epithelium resting on fibrous stroma mixed with well formed smooth muscle bundles.

Metastatic Squamous Cell Carcinoma of the Stomach from the Uterine Cervix: A case report

Secondary tumor of the stomach is rare when metastatic involvement is defined as an extragastric tumor invading the muscularis, submucosa or mucosa and the only serosal implant is excluded. Recently, authors experienced a case of metastatic squamous cell carcinoma of the stomach in the pyloric antrum from the uterine cervix. The patient was a 57-year-old female who received a simplified Wertheim's operation followed by irradiation for squamous cell carcinoma of uterine cervix in stage IIb, and 2-1/2 years later she presented gastric symptoms, for which subtotal gastrectomy was carried out. The gastric lesion simulated primary adenocarcinoma of Borrmann type III, but differed in the following macroscopic characteristics. Firstly, Bormann classification is not applicable; secondly, mucosal ulcerations appear irregular and multicentric; thirdly, flaskshaped ulceration and broad based penetration are evidet; fourthly, submucosal tumor-growth pattern is conspicuous in bulk of areas; and fifthly, circumferential/semicircumferential growth is manifested. The above features should also be differentiated from those of malignant lymphoma and leiomyosarcoma.

Histological Observations on Human Thyroids: 100 cases analysis of embryos and fetuses

To evaluate the morphogenesis of the human thyroid, a histologic study was made based on 100 normal thyroids of human embryos and fetuses ranging in age from 4 to 42 weeks of gestation. The embryos were serially sectioned and fetuses were examinated as an individual organ. 1) The first sign of thyroid primordium was the spherical proliferation of median ventral pharyngeal wall at the 4th week of development. 2) At the 6th week of gestation, the thyroid differentiated into two lobes that were connected by an isthmus, and was on the way of migration to the definite position from the foramen cecum. 3) The developing thyroid consisted of two cell cords, solid nests or interconnecting complex pattern until 14th week of gestation, when the entire portion of thyroid was replaced by follicles of variable size. 4) At the 9th week, the first follicle was recognizable at the periphery of the gland. 5) At the 14th week, follicles were partly filled with faintly eosinophilic colloid. 6) After the 18th week of gestation, lobulation of the thyroid parenchyme was a prominent feature. 7) After the 24th week, large follicles with rich colloid content are distributed through both superificial and deep portions. And after the 34th week, maturation reached the general pattern of adult thyroid. 8) The ability of thyroglobulin synthesis which was confirmed by PAP method, was first recognized at the 10th week of gestation.

Radiotherapy Results of the Non-odgkin's Lymphoma in the Head and Neckt / 대한치료방사선과학회지

This is a retrospecitve analysis of 54 patients with stage I or II Non-odgkin's lymphoma involving the head and neck region treated with curative radiotherapy in the Department of Therapeutic Radiology, Seoul National University Hospital during the period of February 1979 through September 1982. The minimum follow-p period was 24 months. The review of histologic slides was available in 36 cases. Waldeyer's ring was the most common extranodal sites (46%). 41% of patients were in the stage I and 59% in the stage II by Ann Arbor classification. Of the 44 patients who responded after radiotherapy, 24 patients (54.5%) subsequently relapsed. Regional recurrence rate was 29%, distant metastasis was 54% and simultaneous regional recurrence and distant metastasis was 17%. The survival rate and disease free survival at 2 years were 57% and 45% respectively. Those patients with a large primary lesion (over 6cm in diameter), multiple conglomerated. extranodal site and diffuse cell type, experienced a high rate of distant metastasis. Therefore it seems desirable to study the use of adjuvant chemotherapy in those patients with a high probability of distant metastasis.

Fibrous Hamartoma of Infancy: Report of three cases

Fibrous hamartoma of infancy is a distinct clinicopathologic entity with unique microscopic findings and benign clinical course. This tumor is composed of intervening dense fibrocollagenous trabeculae, well defined mucoid areas and varying amounts of mature fat, which are arranged in organoid growth pattern. We report three typical cases of this tumor which were experienced during the recent two years at the Seoul National University Hospital. It is the first description on this tumor in Korean literature. Case 1 was a 10 month old boy who was admitted due to a mass in the right infra clavicular area for 6 months. The mass showed irregular and poorly circumscribed outer surface. Case 2 was a one month old girl who was presented with a diffuse ill defined hairy mass in the left buttock since birth. Case 3 was a 15 month old boy who was brought to the hospital due to well circumscribed scrotal mass fot 8 months. Microscopically all three cases showed very similar histological features. And all 3 cases are well after the removal of the tumors.