Renal Pathology: Retrospect and Prospect / 대한신장학회잡지

No abstract available.

Ameloblastoma Arising in Odontogenic Cysts: Report of 5 Cases and its Histologic Characteristics

Five cases of ameloblastoma considered to be originated from the wall of the odontogenic cysts are reported. Histologic characteristics and diagnostic criteria are aimed to study in differentiation of ameloblastoma arising in odontogenic cysts from odontogenic cysts accompanying with reactive epithelial proliferation, and the literature is reviewed. This study can propose that the ameloblastic change and downward growth of epithelial cells lining the cysts are the most important and characteristic findings of the ameloblastoma derived from odontogenic cysts. In addition, the intraluminal proliferation of epithelial cells in plexiform pattern is also significant.

Basaloid-Squamous Carcinoma of the Esophagus: A case report

Basaloid-squamous carcinoma of the esophagus is rare and similiar to the solid type of adenoid cystic carcinoma of the salivary gland. The origin of this tumor is unknown. The tumor was located in the lower third of the esophagus. The case of basaloid-squamous carcinoma consisted of submucosal tumor showing carcinoma with a basaloid pattern and focal squamous differentiation associated with squamous cell carcinoma or carcinoma in situ of the esophageal mucosa. A few submucosal tumor cells were positive for cytokeratin.

Adenoacanthoma of Pyloric Antrum of the Stomach: Report of a Case

In view of rarity and its unsolved histogenesis, a case of adenoacanthoma at the pyloric antrum of the stomach is reported. The patient was a 43 years old Korean male teacher who had onset of symptoms referable to present illness three months prior to the admission, although he had ulcer symptoms 7 years previously and subsequently free from the symptoms during last 4 years following 3 years, anti-ulcer regimen. Histopathologic studies of the stomach revealed a large ulcerated lesion at the pyloric antrum, and it was predominantly a well differentiated squamous cell carcinoma occupying the central and superficial part and surrounded by a narrow rim of adenocarcinoma at the periphery. Multiple regional nodes examinations disclosed metastases of only adenocarcinoma in 5 nodes and no metastasis of squamous element was found. A brief review of the literature and a discussion concerning clinical, histopathologic and especially histogenetic aspects is made. It was interesting to note that all squamous cell nests are surrounded by multi-layers of small indifferent basal type of cells, and it was thought that this might possibly be a supportive evidence of direct stimulation to basal cells to differentiate into squamous element.

Wilms Tumor of the Kidney Among Koreans: A Clinicopathologic Study of 12 Proved Cases

Twelve cases of Wilms tumor proved by histological examination are recorded and the literature is reviewed because of the paucity of the reports on this neoplasm occurring in Koreans. The average age incidence was 4.2 years; the youngest patient was 9 months of age and the oldest one was 23 years of age. Three fourths of the patients were children under three years of age. Seven were males and five were females. The incidence of Wilms tumor among all renal cancers was 57 per cent and this is much higher than that reported in the foreign literature. This high incidence may be attributed to a much higher incidence of this neoplasm among Korean infants and children. The most prominent clinical finding was abdominal swelling and a palpable mass, but fever, hypertension, irritability, hematuria and cough were other common symptoms. Hypertension was encountered in 89 per cent of the cases. The common laboratory findings were anemia, leukocytosis, increased erythrocyte sedimentation rate and proteinuria. Gross and microscopic findings are described. All specimens were much 1arger than the normal kidney. The largest specimen, kidney plus tumor, weighed 1,800 gm. The tumors were composed of well formed tubules. solid islands of dark staining undifferentiated cells presumably of mesoblastic origin and various elements of stromal cells. The proportion of each element varied markedly from case to case and also in different parts of the same tumor. Nests of squamous cells, some of them forming pearls, and cystic structures identical with epidermal cysts were observed in three of our 12 cases, but unequivocal striated muscle cells as well as bone or cartilage were found in none of our cases. Some nests of squamous cells observed in tubules suggested that they were derived from metaplasia of the lining epithelium.

A Pathologic and Immunopathologic Study of Behcet's Syndrome

The pathologic and immunopathologic findings of 15 skin biopsies of Behcet's syndrome were studied to investigate the pathogenetic mechanism of this syndrome. The age range was 28 to 50 years; male to female ratio was 1 : 1.2. Ulceration with acute necrotizing and chronic nonspecific inflammation was present in most cases with leukocytoclastic vasculitis and perivascular lymphohistiocytic, plasmocytic infiltrations. Eight of 15 cases showed C3 deposit in the walls of venules and capillaries, one of them was associated with IgM and fibrinogen deposits. With these findings humoral factor seemed to play a main role in the pathogenesis of vasculitis observed in Behcet's syndrome, but the possibility of other mechanisms operative in complex pattern was also considered.

The effects of lovastatin on puromycin aminonucleoside-induced focal segmental glomerulosclerosis in rats / 대한신장학회잡지

No abstract available.

Immunohistochemical Study on Expression of Extracellular Matrix Components in Glomerular Diseases

Most glomerular lesions are associated with qualitative and quantitative alterations of the extracellular matrix components, having relation to progressive glomerular sclerosis. We aimed to investigate the characteristic alteraltions in distribution of extracellular matrix components, such as fibronectin, laminin, collagen type III and IV in human glomerular diseases by immunohistochemical method. The materials included are 3 nephrectomy as normal control, 51 renal biopsies and I autopsy; 3 normal, 5 minimal change disease, 5 minimal change disease with minimal mesangial lgA deposit, 5 benign recurrent hematuria, 10 focal segmental glomerulosclerosis, 15 lgA nephropathy, 10 membranoproliferative glomerulonephritis, 2 diffuse mesangial sclerosis of infancy. Type IV collagen and laminin were present normally in the mesangium, GBM, TBM and interstitial vessels, and were increased at the portion of increased mesangial matrix, of sclerosis and thickened GBM in cases of lgA nephropathy, membranoproliferative glomerulonephritis, focal segmental glomrulosclerosis and diffuse mesangial sclerosis in the proportion to the glomerular damage. Type III collagen was absent in the normal glomeruli, but was detectable focally and segmentally in cases of membranoproliferative glomerulonephritis, IgA nephropathy and focal segmental glomerulosclerosis at the sclerotic portion. Fibronectin was normally detectable mainly in the mesangium, and partly and incompletely in GBM, and was increased at the portion of increased mesangial matrix, sclerosis and thickened GBM in cases of focal segmental glomerulosclerosis, membranoproliferative glomerulonephritis, IgA nephropathy and diffuse mesangial sclerosis, but was diminshed at the old slcerotic portion or global sclerosis. The expression of these antibodies in cases of minimal change disease, minimal change disease with minimal mesangial IgA deposit, benign recurrent hematuria was not different, quantitatively and qualitatively, from that of normal glomeruli. These findings suggest that progressive glomerular sclerosis was due to the increase of extraceuular matrix components such as type IV collagen, laminin, fibronectin and new appearance of type III collagen, and the expression was in proportion to the degree of sclerosis, but had no relation to the disease entity.

The effect of sodium cromoglycate on the induction of experimental IgA nephropathy

Mesangial IgA nephropathy was experimentally induced in ddY mice by oral and parenteral administration of the poliomyelitis vaccine (POLIO), and we then tried to investigate if IgA deposition could be prevented by the concurrent use of sodium cromoglycate (SCG), which is known to inhibit the local mucosal immune reaction. Mucosal and systemic immunity could be induced by the administration of POLIO; proteinuria, increased serum IgA levels, mesangial cell proliferation, mesangial matrix widening, mesangial deposits of IgA, and large electron dense deposits in the mesangium were observed. Concurrent administration of SCG and POLIO resulted in a significant decrease in the serum IgA level and mesangial IgA deposits. The later addition or abstinence of SCG after the 70th day did not influence the glomerular mesangial IgA deposition. But the serum IgA level was still decreased by the continuous treatment of SCG even after the 70th day. Thus, mesangial IgA nephropathy simulating IgA nephropathy in humans could be induced in ddY mice using POLIO and its induction could largely be prevented by the concurrent use of SCG. However mesangial IgA deposits already present could not be cleared by the late administration of SCG.

Histochemical and Immunohistochemical Properties of Endometrial and Endocervical Adenocarcinoma

The histologic differentiation of endometrial and endocervical adenocarcinomas is a common diagnostic problum of clinical importance, because the staging, treatment and prognosis of these lesions are quite different. First, we examined the distribution of acid mucin in endometrial and endocervical adenocarcinoma (23 cases and 25 cases repectively), but distinguishing differences between endometrial and endocervical adenocarcinoma, especially of endometrioid type, were not observed. Secondly, the distribution of low-molecular weight cytokeratin, vimentin and carcino-embryonic antigen (CEA) by immunohistochemistry were examined in formalin-fixed tissues. CEA was present in 88% of endocervical adenocarcinomas and 34.8% of endometrial adenocarcinoma. vimentin was found in 91.3% of endometrial adenocarcinomas, in contrast with only in 16% of endocervical adenocarcinomas. This study showed that the presence of vimentin in neoplastic glands, in which CEA is negative, may be helpful in the differential diagnosis of endometrial from endocervical adenocarcinomas.

Histochemical and Immunohistochemical Properties of Endometrial and Endocervical Adenocarcinoma

The histologic differentiation of endometrial and endocervical adenocarcinomas is a common diagnostic problum of clinical importance, because the staging, treatment and prognosis of these lesions are quite different. First, we examined the distribution of acid mucin in endometrial and endocervical adenocarcinoma (23 cases and 25 cases repectively), but distinguishing differences between endometrial and endocervical adenocarcinoma, especially of endometrioid type, were not observed. Secondly, the distribution of low-molecular weight cytokeratin, vimentin and carcino-embryonic antigen (CEA) by immunohistochemistry were examined in formalin-fixed tissues. CEA was present in 88% of endocervical adenocarcinomas and 34.8% of endometrial adenocarcinoma. vimentin was found in 91.3% of endometrial adenocarcinomas, in contrast with only in 16% of endocervical adenocarcinomas. This study showed that the presence of vimentin in neoplastic glands, in which CEA is negative, may be helpful in the differential diagnosis of endometrial from endocervical adenocarcinomas.

Massive Hepatic Necrosis Associated with Halothane Anesthesia

Two cases in which postoperative hepatic necrosis followed by halothane(fulthane) anesthesia are presented. Case 1 was 3 dar-old neonate who was performed corrective surgery for jejunal atresia under the halothane anesthesia. He was placed with hyperalimentation just after operation, and was relatively well. He died on postoperative 11 days. Necropsy matrial was obtained from liver. Histologic finding of liver disclosed massive cental hemorrhagic necrosis. Case 2 was a 17 year-old boy who was performed corrective open heart surgery for TOF under the halothane anesthesia, He developed oliguria just after operation. On postoperative 1 day, hepatocellular and renal dysfunction were found, and peritoneal diaysis performed. He died on postoperative 3 day. Necropsy matrials were obtained from liver and kidney-Liver disclosed massive central hemorrhagic necrosis. Kidney showed intact glomeruli and proximal and distal convoluted tubular cells were degenerated. The configuration of tubular basement membrane was not clear. These considered to be acute tubular necrosis, ischemic type.

Electron microscopic study of the cases of minimal change nephrotic syndrome with mesangial IgA deposition

Twenty-five cases of minimal change nephrotic syndrome(minimal change disease, MCD) with mesangial IgA deposition were evaluated electron microscopically. The thickness of the glomerular basement membrane(GBM) was 3875 +/- 1271 A and 3056 +/- 1201 A in adults and children, respectively. Alteration of the GBM was noted in 3 adults and eight children: splitting in 4, focal thinning in one, widening of the lamina rara interna in 10, and widening of the lamina rara externa in 4 cases. Minimal mesangial electron dense deposits were found in all but one adult, and an increase of the mesangial matrix and minimal mesangial proliferation were observed in 8 and 6 cases, respectively. Electron microscopic findings show representative findings of MCD in our cases. A relationship between the GBM alterations in these cases and frequent association of hematuria is suggested and discussed.

Hyperkeratosis of Renal Pelvis and Ureter: A case report

Hyperkeratosis of the renal pelvis and ureter is a rare condition and is explained by the metaplastic change from transitional to cornified squamous epithelium. This lesion is frequently associated with, and perhaps caused by chronic urinary infection, but potentially premalignant, accompaning with carcinoma in about 10 to 20 per cent of the cases at the time of diagnosis. A case of hyperkeratosis of renal pelvis & ureter which was clinically suspected of carcinoma in a 49-year old woman with a long history of chronic pyelonephritis is presented with review of literature.

A Histopathologic, Histochemical and Immunocytochemical Study of Cardiac Myxoma

The immunoreactivities of surgically removed 16 cardiac myxomas were studies for factor VIII-related Ag (F VIII-RA), Ulex europaeus agglutinin I (UEA-I) and desmin alpha1-antichymotrypsin, and this study was accompained by a clinicopathologic review. More than 50% of the patients with cardiac myxomas were in their fourth and fifth decades, and cardiac myxomas were much more common in women than in men. All but on occurred in the left atrium, and the majority were attached to the atrial septum, usually in the region corresponding to the fossa ovalis. In one case, an atrial myxoma recurred 37 months after the initial excision. Microscopically, the myxomas contained a myxoid matrix composed of acid mucopolysaccharides within which were embedded polygonal cells. The cells forming both the surface and complicated vascular like channels throuhout the myxoid stroma tested positive for F VIII-RA and UEA-I. The outer cell layers of the complex vascular structures demonstrated variable staining for F VIII-RA, while isolated bundles of smooth muscle cells were present and stained for desmin. A small number of the so-called myxoma cells, immunoreactive for alpha1-antichymotrypsin which were not laden with hemosiderin pigment but were similar to histiocytes, were present particularly around the areas of hemorrhage. These findings support the current view that cellular and histologic heterogeneity arose from the divergent differentiation of multipotential mesenchymal cells. In particular, it remains to be confirmed by further study whether or not true histiocytic differentiation occurs.

Non-Hodgkin's lymphoma: a histopathologic and immunohistochemical study of 79 cases

Recently immunophenotyping has become a valuable tool in the diagnostic workup of malignant lymphoma. We classified 79 consecutive cases of non-Hodgkin's lymphoma experienced at our hospital during the last two years according to the Working Formulation and immunologically using MT1, UCHL1 and MB2 monoclonal antibodies. The results of this study are as follows: 1) four cases (5.1%) were low grade, 54 cases (68.4%) were intermediate grade, and 21 cases (23.3%) were high grade. The most common subtype was 'diffuse, mixed' type, 2) fifty cases (63.3%) showed T-cell phenotype and 14 cases (17.7%) showed B-cell phenotype. Immunophenotyping was impossible in 15 cases due to either double staining or negative staining. 3) the incidence of extranodal presentation was high (65.8%) and the most common extranodal site was the upper aerodigestive tract (29.1%) followed by the gastrointestinal tract (16.4%), and 4) MT1, UCHL1 and MB2 monoclonal antibodies are valuable markers of T- and B-cells in paraffin embedded tissue, enabling retrospective study. However, because these antibodies are not lineage specific, the results of immunostaining should be interpreted with caution.

A Pathological Study of Renal Cell Carcinoma

The most common malignant renal neoplasm is renal cell carcinoma. It is estimated that renal cell carcinoma accounts for 1% of all primary malignancies in Korea. Rell cell carcinoma presents diverse clinical courses with gross, histopathologic features. It has been known to be very difficult tumor to predict its clinical prognosis. In Korea, many studies have been reported concerning the clinical aspects of renal cell carcinoma. However, pathological studies of renal cell carcinoma are very few even though studies of nuclear grade have been attempted recently. We reviewed 93 cases of renal cell carcinoma examined in the period from 1978 to 1987 in the department of pathology, Yonsei university college of medicine, Yongdong Severance hospital, Wonju college of medicine and analyzed the histopathologic classification, including nuclear grade according to the Fuhrman's method. We abtained the following results by studying the relationship of the factors which had been known as correlated with the prognosis. 1) The ages of patients ranged from 9 to 74 years with a peak in the 6th decade. 2) The most common symptoms of the patients were hematuria, mass and pain, in that oder, and 7 patients complained to specific symptoms. The incidentally found cases characterized stage I, nuclear grade 2 small tumor size (not more than 4 cm) and clear cell type. 3) The renal cell carcinoma was more frequently located in the left kidney than the right by a ratio of 1.25 : 1. The incidence of intrarenal location was divided to the upper pole, 40% : mid portion, 29% : lower pole, 23% : diffuse involvement, 8%. The tumor shoing diffuse growth pattern had a large size, high nuclear grade and mixed cells. 4) The tumor size averaged 8 cm and there was no significant relationship between the size and stage. Seven cases of neoplasms not more than 3 cm were seen, of which 2 cases revealed an outcome of distant metastasis. 5) The histological pattern showed major solid, 53% : tubular, 11% : mixed, 18% : papillary, 9% and sarcomatoid type 9%. The sarcomatoid type was characterized by grade 4, a larger size(more than 10 cm), advanced stage. 6) There was no special relationship between the stage and grade but mostly grade 2 occupied the stage I. 7) The clear cell type was predominantly noted at grade 2 (65%), at the stage I (63%), granular or mixed cell type at grade 3 (87%), 4 (70%). According to these results, the tumors showing a sarcomatoid histologic pattern, diffuse growth pattern had unfavorable prognostic factors, and are thus estimated to have a poor prognosis. But the case which were incidentally found have favorable prognostic factors and probably a better prognosis. The tumor size alone can not exactly predict the metastasis and is not correlated with the stage. Small renal cell neoplasm (not more than 3 cm) generally has unfavorable prognostic factors and should be considered potentially malignant. The high grade frequently has granular cytoplasm. This represents the relationship between grade and cytoplasm, poor prognosis in the granular cell than the clear. The renal cell carcinoma shows variable prognosis and thus the prognosis should be estimated by all the factors. Nuclear grade can be used as one of the useful prognostic factors.

Effects of Hypertension Induced by Norepinephrine and Sodium Chloride upon the Arteries and Various Organs of Rats

Histopathological effects due to elevation of blood pressure induced by norepinephrine and sodium chloride, and due to high cholesterol feeding were studied upon the arteries and various organs of rats for the evaluation of relationship between arteriosclerosis and hypertension. Blood pressure was generally elevated in all groups, but rose significantly, particularly in the groups receiving sodium chloride. This was especially abrupt at the end of 3 months. No particular gross nor histopathologic changes were found in the aorta, but variable alterations in the coronary and renal arteries including hypertrophic and proliferative changes were characteristically identified. Variable interesting changes of myocardium, kidneys and adrenal glands were also observed. The hypertrophic changes were especially due to hyalinosis in the vascular wall, and the proliferative changes in several cases were similiar to that noted in malignant hypertension. Induction of hypertension by norepinephrine and sodium chloride caused arterial changes such as hypertrophic changes, mainly hyalinosis, and proliferative and necrotizing changes especially in the renal and coronary arteries of rats.

Muscular Hamartoma of the Breast: A case report

Hamartoma of the breast is relatively rare benign tumor, which is a well-circumscribed mass mainly composed of fibrous stroma, a(tipose tissue, ducts and acini. Muscular hamartoma of the breast is mainly composed of smooth muscle, and is extremely rare because proper smooth muscle is normaly absent in the breast except in the nipple. We describe a rare case of muscular hamartoma of the breast in a 38-year-old woman. This tumor was located in the upper outer quadrant and a 3 x 2.5 x 2 cm sized, well-demarcated but not encapsulated mass, The mass consisted mainly of irregularly arranged smooth muscle bundles in the fibrous stroma with lobular units and admixed fat cells. The origin of smooth muscle in hamartoma is not well known.

The Effect of Corticosteroid on the Fetal Pulmonary Maturation of Rats with Streptozotocin-Induced Diabetes

The effect of dexamethasone of the maturation of the fetal lungs of rats with streptozotocin-induced diabetes was studied morphologically and biochemically. By light and electron microscopy there was little difference in fetal pulmonary maturation between the untreated control group and the untreated diabetic group, but when both groups were treated with dexamethasone the fetuses showed accelerated pulmonary maturation, approximately one day earlier with an increase of air spaces per unit area and an earlier appearance of type II pneumocytes. The number of osmiophilic inclusion bodies per alveolus and per type II pneumocyte, and the lecithin/sphingomyelin ratio in amniotic fluid increased markedly and they were statistically significant in both groups injected with dexamethasone, but were decreased in the untreated diabetic group, though only the L/S ratio of the animals of the 19th day gestation was statistically significant. Phosphatidylglycerol was present in the amniotic fluid of the groups injected with dexamethasone one day earlier than the untreated control and the untreated diabetic groups. However, the intensity of phosphatidylglycerol tended to be lower in the untreated diabetic group. It is concluded that the prenatal administration of dexamethasone to the diabetic pregnant rats will accelerate fetal pulmonary maturation morphologically and promote the synthesis of surfactant biochemically.