Cholelithiasis is defined as the presence of stones within the lumen of the gallbladder or in the extrahepatic biliary tree. Cholecystitis, secondary to gallstones, is a common surgical disorder in Korea. Detailed microscopic descriptions, particularly the ultrastructural changes, of these diseases were not available. The goal of this study was to identify the ultrastructural alterations of gallbladder epithelium in cholecystitis with and without a stone, according to the degree of severity of inflammation, and the nature of the stone. The gallbladders of the control group, and cholecystitis cases without stone and with stone were fixed and examined with routine stain, special stain, immunohistochemical stain and trans-mission electron microscopy. The number and the volume density of the mucin containing secretary granules were not significantly increased in the calculous cholecystitis cases compared with those of the acalculous cholecystitis cases. Major findings were that the calculous cholecystitis cases showed a markedly reduced total lysosome area and volume density of the lysosome compared with those of the acalculous chole-cystitis cases. The differences between the mucin secretary granules and lysosomes, according to the degree of severity of cholecystitis and the natures of gallstones, were statistically not significant.
Humans

The aims of this study were to assess the role of p53 overexpression in colorectal tumorigenesis and the association with clinicopathological features. The immunohistochemical results were semiquantitatively assessed. Expression of aberrant p53, tumor-suppressor gene product, was studied immunohistochemically using a monoclonal antibody in 11 nonneoplastic polyps, 19 tubular adenomas, 9 villous adenomas, and 48 colorectal carcinomas. Five out of 11 nonneoplastic polyps, 14 out of 19 tubular adenomas and one out of 9 villous adenomas expressed p53 protein. Seven out of 24 colorectal carcinomas without lymph node metastasis and 14 out of 24 colorectal carcinomas with lymph node metastsis expressed p53 protein. The case of more than 75% positivity of p53 in colorectal carcinoma with lymph node metastasis was seven out of 24, but that in lymph node negative group was two out of 24. In the colorectal carcinoma with lymph node metastasis group; metastatic intranodal neoplastic cells were expressed positively for p53 in 10 out of 14 cases and zero out of 10 cases in group of positive and negative expression of primary lesions, respectively. p53 protein expression was not significantly correlated with variable clinicopathologic features such as age, sex, tumor location, tumor size, differentiation and Dukes' stage. It is suggested that p53 protein overexpression could be a early event in pathogenesis of colon cancer but is not involved in progression of villous adenoma to adenocarcinoma. p53 overexpression seems to be involved in metastatic ability of colorectal carcinomas.
Adenoma ; Neoplasm Metastasis ; Cell Transformation, Neoplastic

Small round cell tumors such as neuroblastoma, rhabdomyosarcoma, Ewing's tumor, malignant lymphoma and small cell carcinoma are often confused clinically and histologically. To clarify the similarites and differences and to get more information on the histogenesis among the small round cell tumors, we examined histological, immunohistochemical and ultrastructural features of ten cases of neuroblastomas, twenty Ewing's tumors, ten embryonal rhabdomyosarcomas and twelve small cell carcinomas in children and young adults. Antibodies against desmin, vimentin, cytokeratin, neuron-specific enolase, synaptophysin, neurofilament, S-100 protein, chromogranin and HBA 71 were used in biotin streptavidin procedures. The results of the immunohistochemical and electron microscopical examinations yielded virtually identical findings in each group as followings. 1) Among the twenty cases of Ewing's tumors, eighteen cases were positive in staining for HBA-71. The staining for HBA-71 was negative in neuroblastoma, embryonal rhabdomyosarcoma and small cell carcinoma. 2) Neuroblastomas had marked interdigitating cytoplasmic processes containing many microtubules and dense-core secretory granules, however, they were sparse and rare in Ewing's tumor. 3) Embryonal rhabdomyosarcoma showed actin-myosin bundles. According to differentiation, well differentiated rhabdomyosarcoma exhibited Z-band materials and external lamina. 4) Neuroblastoma showed ultrastructural evidence of a neuronal differentiation, but neuronal differentration is a sparse and rare in Ewing's tumor. This ultrastructural feature strengthens the hypothesis that Ewing's tumor is derived not only from an undifferentiated neuroectodermal stem cell but from primitive cell of neuroectodermal origin.
Antibodies ; Biotin ; Carcinoma, Small Cell ; Child ; Cytoplasm ; Desmin ; Humans ; Immunohistochemistry ; Keratins ; Lymphoma ; Microtubules ; Neural Plate ; Neuroblastoma ; Neurons ; Phosphopyruvate Hydratase ; Rhabdomyosarcoma ; Rhabdomyosarcoma, Embryonal ; S100 Proteins ; Sarcoma, Ewing ; Secretory Vesicles ; Stem Cells ; Streptavidin ; Synaptophysin ; Vimentin ; Young Adult

This study was performed to fine out the possible causes of primary infertility in female and to provide some diagnostic and therapeutic modalities. A total of 104 cases of endometrium in primary infertility was obtained from the pathology files of Chosun University Hospital and Kwang-ju Christian Hospital during the period of 5 years and 10 months from January, 1984 to October, 1989. The endometrial biopsies were taken on the first of menstruation and classified according to Noyes, Hertig and Rock's criteria. Histologic findings which were compatible with their normal menstrual cycle (premenstrual of late secretory phase and bleeding phase) were noted in 52 cases (50%). Abnormal 52 cases (50%) revealed deficient secretory phase in 36 case (34.6%), proliferative phase in 5 cases (4.8%), irregular proliferation and chronic nonspecific endometritis in 4 cases (3.8%), respectively, endometrial hyperplasia in 3 cases (2.9%), tuberculous endometritis in 2 cases (1.9%), and asynchronous cycle in 1 case (1%). Among the case of dissociated delay was 21 cases (20.2%) and coordinated delay was 15 cases (14.4%). Therefore, deficient secretory phase with dissociate delay was most common abnormal endometrial finding in cases of female primary infertility. The peak age distribution of the female primary infertility in this study revealed 73 cases (63.8%) in patients between the age of 25 and 29. This finding indicated that there was no significant relationship between the age distributions and the endometrial histopathologic findings.
Female ; Humans ; Biopsy

Liposarcoma of the male breast is rare. In English literature, nearly 90 tumors of this type can be found, but the majority of citation is female without detail descriptions of gross or microscopic features. Recently, we experienced a case with pleomorphic liposarcoma of the breast. This 62-year-old male patient presented with tumorous mass of right breast for 3 months ago. He underwent radical mastectomy under the impression of breast cancer. Received specimen was a breast and attached nodular bulging mass. The serial section reveal a relatively defined nodular mass consists of yellowish and glistened bulging tumorous lesion, measuring 5x4.5x5cm. Microscopically, there were multiple pleomorphic giant cells composed of plump esoinophilic or microvesiculated cytoplasm and bizarre nuclei with prominent nucleoli. These cells were positive staining for oil-red O. Ultrastructurally, variable sized numerous fatty vacuoles in the cytoplasm were seen.
Female ; Male ; Humans ; Breast Neoplasms

Lipid cell tumors of the ovary are among the rarest of the functional ovarian neoplasms. Recently, authors experienced a case of lipid cell tumor of the left ovary in a 19 year old female, who presented with amenorrhea and hirsutism for 4 years. Grossly, the ovary was well encapsulated, and measured 6.5x6x4.5 cm. Cut surface show homogenous yellowish bulging neoplastic tissue and peritheral displaced normal ovarian tissue. Microscopically, neoplastic cells were composed of rounded and polyhedral cells, arranged in nests seperated by rich vascular networks. On the basis of the author's findings and the evidence available in the literature, we determined this case as ovarian lipid cell tumor.
Female ; Humans

A 55 year old male complain right shoulder pain and right upper quadrant pain about three months. He was a heavy alcoholism. Highly selective angiography, CT scan and operation findings suggest primary malignant neoplasm of the liver. Right hepatic lobectomy and partial diaphragmectomy was done under impression of heaptocellular carcinoma. The specimen measured 15x11x9 cm and disclose relatively hard and nodular mass devoid of cirrhotic changes. Cut surface show unilobar large mass measuring 11x8x6 cm and bearing brightly yellow discoloration and multifocal hemorrhagic necrosis. Histological characteristics were diffuse proliferation of large neoplastic cells with ample cytoplasm, containing granular materials, erythrophagocytosis, neutrophagocytosis and hemosiderin pigments. Atypical and bizarre mitosis and multinucleated giant cells bearing abundant erythro and neutrophagocytosis were frequently seen. The large or vesicular nuclei were irregular, with occasional deep indentations and revealed sharply defined nuclear membrane, coarse chromatin and conspicious nucleoli. Ultrastructurally the cytoplasm of neoplasltic cells had lysosomal granule, phagolysosome, phagocytized material and residual bodies. Immunohistochemical stains for alpha 1-antitrypsin, alpha 1-antichymotrypsin, vimentin and lysozyme showed positive reactions, but, alpha fetoprotein, cytokeratin, S-100 protein, factor VIII, complement 3 receptor and carcinoembryonic antigen were negative. Alpha-naphtyl acetate esterase activity in paraffin embedded tissue ribbon showed negative reaction. These findings show compatible with primary malignant lymphoma, true histiocytic type, (histiocytic sarcoma, Kupffer cell carcinoma) of the liver.
Male ; Humans

BACKGROUND: Many physicians hesitate to discuss do-not-resuscitate (DNR) orders with patients or family members in critical situations. In the intensive care unit (ICU), delayed DNR decisions could cause unintentional cardiopulmonary resuscitation, patient distress, and substantial cost. We investigated whether the timing of DNR designation affects patient outcome in the medical ICU. METHODS: We enrolled retrospective patients with written DNR orders in a medical ICU (13 bed) from June 1, 2014 to May 31, 2015. The patients were divided into two groups: early DNR patients for whom DNR orders were implemented within 48 h of ICU admission, and late DNR patients for whom DNR orders were implemented more than 48 h after ICU admission. RESULTS: Herein, 354 patients were admitted to the medical ICU and among them, 80 (22.6%) patients had requested DNR orders. Of these patients, 37 (46.3%) had designated DNR orders within 48 hours of ICU admission and 43 (53.7%) patients had designated DNR orders more than 48 hours after ICU admission. Compared with early DNR patients, late DNR patients tended to withhold or withdraw life-sustaining management (18.9% vs. 37.2%, p = 0.072). DNR consent forms were signed by family members instead of the patients. Septic shock was the most common cause of medical ICU admission in both the early and late DNR patients (54.1% vs. 37.2%, p = 0.131). There was no difference in in-hospital mortality (83.8% vs. 81.4%, p = 0.779). Late DNR patients had longer ICU stays than early DNR patients (7.4 ± 8.1 vs. 19.7 ± 19.2, p < 0.001). CONCLUSIONS: Clinical outcomes are not influenced by the time of DNR designation in the medical ICU. The late DNR group is associated with a longer length of ICU stay and a tendency of withholding or withdrawing life-sustaining treatment. However, further studies are needed to clarify the guideline for end-of-life care in critically ill patients.
Advance Directives ; Cardiopulmonary Resuscitation ; Consent Forms ; Critical Illness* ; Hospital Mortality ; Humans ; Intensive Care Units ; Resuscitation Orders* ; Retrospective Studies ; Shock, Septic

PURPOSE: We evaluated the correlation between the carcinogenesis of gallbladder and the expression of lysozyme, p53, c-erbB2 and CEA in gallbladder lesions. MATERIALS AND METHODS: Thirty cases of gallbladder lesions (containing 17 cases of GB carcinoma) were examined. We analyzed the clinicopathologic findings of the early (stage I & II) and advanced carcinoma (stage III, IV & V) and those of carcinoma with or without metaplasia in the tumor. We performed p53, c-erbB2 and CEA immunohistochemical staining and compared their findings with those of normal mucosa and preneoplastic lesions. We also performed lysozyme immunohistochemical staining and compared its finding with metaplastic and non-metaplastic lesions. RESULTS: There are two distinct genetic pathways in gallbladder cacinogenesis and metaplastic carcinoma was more frequent than non-metaplastic carcinoma. Metaplasia of gallbladder did not reveal any difference of the clinicopathologic findings and depth of invasion (Nevin stage). Lysozyme expression was found in all metaplastic lesions but non-expression did not indicate non-metaplastic lesions. p53 mutations and c-erbB2 alterations may have a role in the carcinogenesis of gallbladder carcinomas, especially, in a late event, and in an early and late events, respectively. The correlation of p53 and c-erbB2 expressions was found but which did not indicate that the co-expression was needed in the carcinogenesis. CEA immunohistochemical staining may be helpful in the differential diagnosis of benign lesions and precancerous and cancerous lesions of the gallbladder. CONCLUSION: These results suggest that p53 mutations and c-erbB2 alterations may have a role in the carcinogenesis of gallbladder carcinomas, especially, in a late event, and in an early and late events, respectively.
Carcinogenesis ; Diagnosis, Differential ; Gallbladder* ; Metaplasia* ; Mucous Membrane ; Muramidase

A total of 51 cases of pleomorphic adenoma was obtained from the pathologic files of Chosun University hospital from january, 1980 December, 1989. The studies of clinical, microscopic, immunohistochemical, and electronmicroscopic examination showed the following results. The peak age incidence of the pleomorphic adenoma in this study was in the 5th decade and no significant difference in the incidence between male and female patients was observed. The most common histologic type of myoepithelial data showed positive reactions of the myoepithelial cells to cytokeratin and S-100 protein in the solid, myxoid, and chondroid area. The electronmicroscopic examination of the myoepithelial cells revealed myofilaments, dense bodies, desmosomes, and basement membrane suggesting epithelial origin of these cells. In conclusion, the pleomorphic adenoma seems to be derived from epithelial component and the variable stromal change may be derived from modified myoepithelial cells considering the results of immunohistochemical and electron microscopic study.
Female ; Male ; Humans ; Incidence ; Adenoma