Clinicopathologic Study for 10 Cases of Cutaneous Angiosarcoma / 대한피부과학회지

BACKGROUND: Cutaneous angiosarcoma (CAS) is occasionally difficult to differentiate with other benign dermatoses, clinically, because of various clinical manifestations. OBJECTIVE: The aim of this study is to examine the clinical and histopathologic findings of CAS, and investigate specific clinicopathologic features to aid in the early diagnosis. METHODS: We reviewed photographs, medical records and biopsy specimen of 10 cases diagnosed as CAS for 5 years at our clinic. RESULTS: The male and female numbers were 7 and 3, and the mean onset age was 69.7 years old. The mean duration of disease was 5.7 months. The site of involvement was scalp or face in all patients. The most common clinical feature was erythematous or purpuric nodule, with surrounding erythematous or purpuric patch, without symptoms. Initial impressions based on clinical findings on the first visit of our clinic were CAS (n=6), squamous cell carcinoma (n=2), basal cell carcinoma (n=1), and erysipelas (n=1). Histopathologically, irregular vascular channels lined by atypical endothelial cell dissect between the collagen bundles were seen in 6 cases, malignant endothelial cells forming continuous sheets with epithelioid morphology in 3 cases, and mild vascular hyperplasia in 1 case. CD31 was positive on atypical endothelial cells in all patients. CONCLUSION: CAS should be included in differential diagnosis when cutaneous lesions show erythematous to purpuric nodule or patch with rapid progression on scalp or face of elderly patients. Histopathologically, CAS had wide spectrum from mild vascular hyperplasia to spindle cell tumors. As such, immunohistochemical stain, using endothelial markers, is valuable to diagnosis of CAS.

Histopathologic Changes of Articular Cartilage and Subchondral Bone in Cylindrical Biopsy Specimen from Talar Osteochondral Lesions / 대한족부족관절학회지

PURPOSE: This study was aimed at elucidating the pathogenesis of talar osteochondral lesion by analyzing the histopathological findings. MATERIALS AND METHODS: Twenty specimens from 20 patients who underwent surgical treatment for talus osteochondral lesions were studied. Preoperative MRI images including T1, T2, and stir images were taken and cases were classified according to modification of the Anderson's classification. There were 5 cases of MRI group 1, 6 cases of group 2, 7 cases of group 3 and 2 cases of group 4. A full thickness osteochondral plug including the osteochondral lesion of the talus was harvested from each patient and reviewed histopathologic changes of osteochondral fragment using H-E staining. Mean diameter of specimens was 8.5 mm and mean depth was 10.3 mm. Pathologic changes of articular cartilage and subchondral bone were observed. Subchondral bone was divided into superficial, middle and deep zones according to depth. Cartilage formation, trabecular thickening and marrow fibrosis were observed in each zone. RESULTS: There were detachment of the joint cartilage at the tidemark in 16 cases of 20 cases and the separated cartilages were almost necrotic on the histopathologic findings. Cartilage formation within subchondral bone was discovered beneath the tidemark in 12 cases. Trabeculae were increased and thickened in 17 cases. These pathologic changes were similar to fracture healing process and these findings were more conspicuous near the tidemark and showed transition to normal bone marrow tissue with depth. No correlation between the pathological progression and MRI stages was found. A large cyst shown on MRI's was microscopically turned out to be multiple micro-cysts accompanied by fibrovascular structure and newly formed cartilage tissue. CONCLUSION: The histopathologic findings of osteochondral lesions are detachment of overlying cartilage at the tidemark and subsequent changes of subchondral bone. Subchondral bone changes are summarized as cartilage formation, marrow fibrosis and trabecular thickening that mean healing process following repeated micro fractures of trabecular. These osteochondral lesions should have differed from osteochondral fractures.

Clinicopathologic Findings of Metastatic Skin Cancer / 대한피부과학회지

BACKGROUND: The incidence of metastatic skin cancer has been reported to be relatively low. Because the diagnosis is not so difficult, cutaneous metastasis could be an important clue to discover the hidden internal malignancy, if found before recognizing primary cancer, or play a significant role to determine therapeutical plans and prognosis if found after diagnosis of primary cancer. MATERIAL AMD METHODS: This study was made upon the 68 cases of metastatic skin cancer, which had been confirmed histopathologically in the department of dermatology, Kosin University Gospel hospital from January, 1986 to August, 2003. Age and sex distributions, sites of primary cancer, time of detection, localization of the lesions, morphologic and histopathologic findings were examined by the review of medical records, clinical photographs, and pathologic slides. RESULTS: 1. The mean age at the time of diagnosis was 56.6 years and most patients were distributed over 5 decades. The male to female ratio was 1: 1.3. 2. Metastasis from breast carcinoma consisted of 19 cases, this was the most common primary cancer, followed by lung cancer, melanoma, and stomach cancer. In men, lung cancer and stomach cancer were the most common primary neoplasm, while breast cancer was the most frequent in women. 3. 50 of the cases were detected after diagnosis of primary cancer and during therapy. The other 18 cases were detected before the internal malignancy was recognized. 4. The localization of metastatic skin cancer was widespread over the whole body. The majority of cutaneous metastasis was predisposed to the surface near primary cancer, but distant metastases such as alopecia neoplastica on the scalp were also observed. 5. The most common morphologic features were single or multiple nodules, while inflammatory and indurated plaques were also found. 6. Histopathologic examination revealed that adenocarcinoma was the most common pathologic type, followed by squamous cell carcinoma and melanoma. The histopathologic features of cutaneous metastasis generally mimicked that of primary tumors. CONCLUSION: Generally, metastatic skin cancer is detected after the diagnosis of primary cancer showing subsequent treatment failure and poor prognosis. In some cases, however, cutaneous metastasis can be the earliest sign to recognize internal malignancy. Especially in the cases of metastatic skin cancer originating from the kidney, liver and thyroid gland, cutaneous features are the most significant evidences to presume the site of origin without any other findings. Therefore, it is important to recognize the clinical and histopathologic findings of metastatic skin cancer for the most successful diagnostic, therapeutic and prognostic determination.

A Case of Kikuchi's Disease (Histiocytic Necrotizing Lymphadenopathy) Showing Typical Histopathologic Findings in Cutaneous Lesion / 대한피부과학회지

Kikuchi's disease(Histiocytic necrotizing lymphadenitis) is an idiopathic, self-limiting disease typically affecting cervical lymph nodes in young adults. Cutaneous involvement has been reported in 16-40%. We report a case of Kikuchi's disease in 10-year-old female that showed asymptomatic erythematous papules on the face accompanied by cervical lymphadenopathy. The histopathologic examination of the skin revealed diffuse dermal lymphohistiocytic infiltrate, a large amount of nuclear dust with absence of neutrophils, which is characteristic of Kikuchi's disease. In general, histopathologic findings of skin biopsy show a mirror image of that of lymph nodes involved in Kikuchi's disease. Therefore, it is important to recognize cutaneous manifestations of this entity, because we can avoid invasive lymph node biopsy. if skin lesions involved show typical histopathologic findings of Kikuchi's disease.

Association of Membrane Thickness, Histopathologic Findings and Premature Rupture of the Membranes / 대한산부인과학회잡지

OBJECTIVE: The aim of our study was to compare the thickness and histopathologic changes in the fetal membrane between premature rupture of membranes (PROM) and intact membrane after delivery. METHODS: In a prospective study involving 31 patients who were divided into 4 groups such as or=37 weeks without PROM, and >or=37 weeks with PROM, we measured the thickness of membrane and studied the histopathologic findings in vitro by light microscopy of histological sections. RESULTS: The membrane thickness of or=37 weeks with PROM and >or=37 weeks without PROM were similar (25.6 micrometer, 26.0 micrometer). But the membrane thickness of >or=37 weeks with/without PROM was significantly thinner (25.8 micrometer) compared with that (38.9 micrometer) of or=37 weeks was statistically significant. The histopathologic change of PROM positive group was prominent as amnionitis. Further evaluation will be needed about the relationship between membrane thickness and PROM.

Mycosis Fungoides in Children: Clinical Feature of 14 Patients / 대한피부과학회지

BACKGROUND: Mycosis fungoides(MF) is a representative of cutaneous T cell lymphoma and progresses through clinical stages, such as initial pre-mycotic(macule or patch), plaque, and tumor stage. MF is usually thought of as a disease of old adults, but it can develop at any age, including childhood. Despite the recognition that MF may occur in pediatric patients, there is scant literature regarding clinical feature, histopathologic finding and prognosis specially related to childhood onset. The purpose of this study was to examine the clinical, histopathologic and follow up observation of MF in children. METHODS:This study has been reviewed in the clinicopathologic findings of 14 MF patients who visited the Kosin University Gospel Hospital during about 10 years from January, 1991 to June, 2000. RESULTS: 1.Duration of cutaneous lesions was from 6 months to 10 years, with mean duration of 3.6 years. 2.The morphology of skin lesions showed various features(pityriasis lichenoides-like, hypopigmented, hyperpigmented, ichthyosis-like, inflammatory linear verrucous epidermal nevus-like). 3. Histopathologic features revealed epidermotropism, a perivascular infiltrate in all cases, haloed lymphocytes, lymphocytes aligned in the basal layer, and coarse collagen in the papillary dermis in most cases. Pautrier's microabscess was shown in 3 cases(23%). 4. In T cell receptor gamma gene arrangement using PCR(polymerase chain reaction), monoclonality was detected in 13 out of 14(93%). 5. Treatment including PUVA(psoralen and UVA), UVB, topical steroid agents and calcipotriol had good a response. 6. No patients had progressed to a more advanced disease. CONCLUSION: MF in children of this study showed a wide variety of skin lesions. Although no case of MF in this study progressed to a more aggressive status, MF in children should be carefully followed for development of more advanced cutaneous lesions and visceral involvement.

Mycosis Fungoides in Children: Clinical Feature of 14 Patients / 대한피부과학회지

BACKGROUND: Mycosis fungoides(MF) is a representative of cutaneous T cell lymphoma and progresses through clinical stages, such as initial pre-mycotic(macule or patch), plaque, and tumor stage. MF is usually thought of as a disease of old adults, but it can develop at any age, including childhood. Despite the recognition that MF may occur in pediatric patients, there is scant literature regarding clinical feature, histopathologic finding and prognosis specially related to childhood onset. The purpose of this study was to examine the clinical, histopathologic and follow up observation of MF in children. METHODS:This study has been reviewed in the clinicopathologic findings of 14 MF patients who visited the Kosin University Gospel Hospital during about 10 years from January, 1991 to June, 2000. RESULTS: 1.Duration of cutaneous lesions was from 6 months to 10 years, with mean duration of 3.6 years. 2.The morphology of skin lesions showed various features(pityriasis lichenoides-like, hypopigmented, hyperpigmented, ichthyosis-like, inflammatory linear verrucous epidermal nevus-like). 3. Histopathologic features revealed epidermotropism, a perivascular infiltrate in all cases, haloed lymphocytes, lymphocytes aligned in the basal layer, and coarse collagen in the papillary dermis in most cases. Pautrier's microabscess was shown in 3 cases(23%). 4. In T cell receptor gamma gene arrangement using PCR(polymerase chain reaction), monoclonality was detected in 13 out of 14(93%). 5. Treatment including PUVA(psoralen and UVA), UVB, topical steroid agents and calcipotriol had good a response. 6. No patients had progressed to a more advanced disease. CONCLUSION: MF in children of this study showed a wide variety of skin lesions. Although no case of MF in this study progressed to a more aggressive status, MF in children should be carefully followed for development of more advanced cutaneous lesions and visceral involvement.

Clinical and Histopathologic Findings on the Abnormal Liver Function Complicated with Kawasaki Disease / 대한소아소화기영양학회지

PURPOSE: The aim of this research is to examine the abnormal liver function complicated with Kawasaki disease (KD) and to analyze its clinical characteristics and complications. METHODS: Ninty eight cases were diagnosed as having KD, among which thirty four cases had abnormal alanine aminotransferase (ALT) (>30 IU/L). These abnormal ALT cases were evaluated in terms of age and sex distribution, major symptoms, complications, laboratory and histopathologic findings. RESULTS: Male to female ratio was 2.4 : 1 and most patients (91.2%) were under 5 years of age. Cervical lymphadenopathy was observed in 3 cases (8.8%); and recurred cases were two (5.8%). Average fever duration was 8 days: average length of hospitalization was 9 days; and average recovery period was 13 days. Immediately after admission, positive CRP was observed in 31 cases (91.2%), leukocytosis (>10,000/mm(3)) in 26 cases (76.0%), thrombocytosis (>450,000/mm(3)) in 7 cases (20.6%), and anemia (<10 gm/dl) in 7 cases (20.6%), respectively. GB hydrops or cholecystitis were noted in 3 cases (8.8%) abnormal ECG finding in 1 case (2.9%), coronary dilatation or aneurysm in 2 cases (5.9%). Liver biopsy was done in four cases and revealed mild infiltration of lymphocytes on the portal area and mild bile duct proliferations. CONCLUSION: The abnormal liver function was noted in 34.7% of KD patients, and subsided all within one month. But the liver function test should be checked closely in patients of the abnormal liver function test complicated with KD despite of its good prognosis.

Histopathologic Findings of an Unsuccessful Molteno Implant

We documented the histopathologic findings of an eye with Molteno implant that was nonfunctional at 3 years after implantation.In 1995,a 62-year-old woman developed neovascular glaucoma in her right eye,and installation of a Molteno implant was performed.However,she was lost to follow-up until 1998,when she presented with a blind eye that have to be enucleated with molteno implant because of painful phthisis bulbi.On external examination the implant plate was located in the superotemporal equatorial region of the globe,8 mmposterior to the limbus and 9 mm anterior to the optic nerve.There were adhesions between the plate and surround-ing fibrous tissue.The drainage tube into the anterior chamber left in situ. On microscopic examination the adjacent bleb wall consisted of multilayer, degenerated collagenous connective tissue,maximal 0.7 mmin thickness.Its inner portion mainly consisted of paucicellular,hyalinized and sclerotic col-lagen fibers and outer portion was relatively fibrovascular tissues with a few vascular endothelial cells and fibroblasts.And,there were chronic lym-phocytic infiltrates around a silicone tube insertion site into the anterior chamber.

Experimental Study on Shark Liver Oil-Induced Lipoid Pneumonia in Rats

The purpose of this experiment is to evaluate the histopathologic findings of shark liver oil-induced lipoid pneumonia, and to determine whether shark liver oil is absorbed through lymphatics and the venous system or not. A single intratracheal administration of shark liver oil (0.6 ml/kg of B.W.) was given to Sprague-Dawley rats. They were then sacrificed sequentially from 1 hour to 12 weeks after injection. We investigated the chest radiographic findings, the serum total lipid concentration of blood obtained by cardiac puncture, lipid-laden alveolar macrophage index of the bronchoalveolar lavage fluid, and the histopathology of tracheobronchial lymph nodes and the lung (Oil red O stain & H&E stain). Chest radiographs showed no specific findings; ill-defined hazy, linear, small patch radioopacity, air space consolidation or collapse. Thirty-six percent of the experimental rats revealed normal findings. Within the lung, the shark liver oil appeared either as highly emulsified fine granules in the cytoplasm of the alveolar macrophage or as free, round oil masses. The area of the lung accumulated with lipid material was maximized 1 week after injection, and then decreased thereafter. The tissue reactions were cuboidal metaplasia of the alveolar lining, widening and lymphocytic infiltration of the alveolar septa and granuloma formation (3% of experimental rats) as a reaction to a foreign body. There were also lung abscesses due to superimposed bacterial infection (5% of experimental rats). With time after the injection of the oil, the serum total lipid tended to increase and the intracellular lipid of the alveolar macrophages in the bronchoalveolar lavage fluid tended to decrease. In summary, the histopathologic findings of the lung in the experimental lipoid pneumonia were interstitial chronic inflammation and granulomas with the presence of lipoid material in the lung parenchyma, and shark liver oil appeared to be absorbed in the blood and the lymph, then metabolized.

Tuberculosis of the Breast

Tuberculosis of the breast is a rare disease. Its diagnosis is difficult because clinical and radiological appearances are not specific and because isolation of the tubercle bacillus from the lesion is seldom possible. This disease is more common in women between 20 to 40 years of age, but is rare in male, elderly patients and prepubertal women. Difinite diagnosis rests on bacterilogical proof and histopathological findings -formation of a granuloma and usually caseous necrosis with or without demonstrable acid-fast bacilli. Treatment of the disease requires a combination of surgery and antitubercular drugs. We experienced 10 cases of tuberculosis of the breast and report with on them along a literature review.

Cases of Macular Corneal Dystrophy with a Family History

Macular corneal dystrophy is a heredo-familial disease inherited as an autosomal recessive trait and characterized by corneal opacities due to localized mucopolysaccharidosis. One case of macular corneal dystrophy was reported by Cho et al in Korea in 1976, but it was a case without a family history. We report 3 cases of macular corneal dystrophy with a family history including more specific histopathologic findings and the review of available literatures.

Histopathologic study of Dacron Graft following Experimental Fun-thickness Scleral Resection in Rabbits

To evaluate the possibility of Dacron patch for artificial sclera. Dacron(polyethylene terephthalate) which is readily available, biocompatable, safe, and inert synthetic material was implanted in the area of full-thickness scleral defect in rabbits. The histopathologic examinations showed that fibrovascular tissue invested into all interstices of Dacron filaments and fibroconnective tissue encapsulation around Dacron patch had strong connection with collagen fibers of recipient sclera at 4 weeks after graft There were no adverse reactions such as retinal detachment and fibrous proliferation into the vitreous cavity except mild inflammatory response of surrounding tissue at the early postoperative stage. As a result, Dacron graft showed successful firm adhesion to the recipient sclera without serious complications. Thus, We think that Dacron could possibly be used, instead of donor sclera, as artificial scleral graft material for the surgical treatment of perforating scleral diseases.

An Experimental Study of Vibrio vulnificus Infection in Mice

An experimental of Vibrio vulnificus infection has been performed with the intravenous, subcutaneous and oral inoculation of Vibrio vulnificus into ICR mice. The results are as follows: 1) The LD50 of the intravenous, subcutaneous and oral inoculation of Vibrio vulnificus were 1.6x10(7) cells/ml, 4.0x10(7) cells/ml, and 2.5x10(9) cells/ml, respectively. 2) In the experimental group without treatment with CC14, the survival rates for intravenous inoculation were 100% (1/2 LD50), 39.1% (LD50), and 8.3% (2 LD50). The survival rates for subcutaneous inoculation groups were 100% (1/2 LD50), 46.9% (LD50), and 18.8% (2 LD50). And the survival rates for oral inoculation groups were 100% (1/2 LD50), 53.1% (LD50), and 43.8% (2 LD50). 3) In those treated with CC14 0.05 ml, the survival rates for intravenous inoculation groups were 43.8% (1/2 LD50), 29.1% (LD50), 0% (2 LD50). The survival rates for subcutaneous inoculation groups were 59.4% (1/2 LD50), 40.6% (LD50), and 9.4% (2 LD50). The survival rates for oral inoculation groups were 68.8% (1/2 LD50), 46.9% (LD50), and 18.8% (2 LD50). In those treated with CC14 0.1 ml, the survival rates for intravenous inoculation groups were 25.0% (1/2 LD50), 10.4% (LD50), and 0% (2 LD50). The survival rates for subcutaneous inoculation groups were 43.8% (1/2 LD50), 21.9% (LD50), 0% (2 LD50). The survival rates for oral inoculation groups were 50.0% (1/2 LD50), 37.5% (LD50), and 0% (2 LD50). 4) Liver, lungs, meninges and brain, kidneys, heart, gastrointestinal tract and spleen showed septic inflammatory findings. Their degree of inflammation were different according to the severity of hepatic damage and the inoculum size.

Clinical characteristics of the associated histopathological findings in benign prostatic hyperplasia / 대한비뇨기과학회지

We studied on the correlation between the associated histopathological lesions in benign prostatic hyperplasia and the clinical findings in 283 patients. The patients were divided into 5 groups according to the Following associated histopathological lesions : Nonspecific inflammation (274 patients. 96.8%). Granulomatous inflammation (7 patients. 2.4%. including tuberculosis 2 patients). infarction (8 patients, 2.8%). dysplasia (10 patients, 3.5%) and occult cancer (9 patients. 3.2%). There was no significant difference among the groups in age. The duration of symptoms was shorter in the infarction and occult cancer group than the others. The degree of inflammatory lesions were not correlated with preoperative urinalysis findings. Irritative symptom score was high in the patient of severe inflammatory lesion (P<0.05). Acute urinary retention was more common in the infarction group (62.5%) than the non-infarction group (10.9%). Prostatic; dysplasia was more common and higher degree in the occult cancer group (33.3%) than no cancer group(2.5%). So more precise pathological examination are necessary when dysplasia. especially severe dyplasia, is present. In conclusion. most patients of the benign prostatic hyperplasia had some associated histopathologic abnormal lesions, so more careful histopathological examination is needed to understand the progression of the disease.