A case of papillary adenoma of the gallbladder in a sixty seven-year-old female with varietise of epithelial components in metaplastic nature is presented. This adenoma was bordered by hyperplastic epithelium with intervening Paneth cells and enterochromaffin cells, but goblet cells were rarely participated, as with focal epithelial change resembling gastric foveolar epithelium and aggregation of antral type mucous glands. Based on its morphologically distinct type of gallbladder adenoma and histogenetic point of view, we propose this neoplasm to be designated as a metaplastic adenoma or polyp, and the relationship of various metaplastic changes to adenoma or carcinoma is discussed.
Female ; Humans ; Adenoma

Various clinical and pathologic parameters in order to determine the prognosis of gastric carcinoma have been proposed. Among them "carcinoma with lymphoid stroma" has been proven to show good prognosis. But the criteria of lymphoid stroma in this condition remain vague and not clear. A total of 7 cases of gastric carcinoma with heavy lymphoid stromal response out of 947 surgically resected gastric carcinomas was reviwed with histotopographic analysis. They were all advanced carcinoma, Borrmann type I and II. Histologically, the lymphoid stromal response could be divided into three patterns; nodular (3 cases), diffuse (3 cases) and mixed (1 case). The nodular pattern was characterized by massive lymphoid cell infiltration with many follicle formation and little desmoplastic reaction, while the diffuse pattern showed diffuse permeative type of inflammatory cell infiltration with scarce lymphoid follicle formation and mild desmoplasia. Regional lymph node metastasis was found in 2 cases; one in diffused and another one in mixed pattern. The stromal reaction was not directly related with the depth of tumor invasion. We propoose that the term GCLS should be used in the cases of nodular pattern with complete follicle formation of lymphoid stroma.
Neoplasm Metastasis

Fifty three surgically resected gallbladders(49 cases of chronic cholecystitis with or without cholelithiasis, 4 cases of incidentally resected gallbladders) and 14 autopsy cases were subjected to the histotopographic analysis to identify the nature and distribution of metaplastic mucosal changes, and to determine the possible histogenesis of these mucosal lesions and diagnostic implication as a parameter of chronic cholecystitis. 1) Antral type glands were demonstrated in 47(88.7%), goblet cells in 19(35.8%) and surface epithelial changes in 27(50.9%) of total surgical specimens, indicating the benign metaplastic changes of the gallbladder mucosa toward the gastric or intestinal type. 2) Topographic distribution illustrated the extension of antral type gland to the middle and upper one third portions of the gallbladder mucosa in 37 cases, each. Goblet cells in the middle and upper one third of the mucosa were demonstrable in 13 cases(68%) an 8 cases(42%), respectively. 3) Average age by degree of extension was 50.0 years in Grade O-I, 50.1 years in Grade II and 56.4 years in Grade III. 4) Among 53 surgically resected gallbladders, gallstone was found in 31 cases, in which was a significant correlation between the distribution of metaplastic changes by degree of extent and cholelithiasis. 5) There was no statistical significance between incidence of metaplastic changes of the gallbladder and degree of inflammatory reaction by means of chronic and/or acute inflammatory cell infiltration and Rokitansky-Aschoff sinus formation. 6) Only two out of fourteen autopsy cases demonstrated focal and spotty presence of goblect cells. It is of authors assumption that the lining epithelium of the gallbladder undergos various types of metaplastic changes in the diseased conditions, in which cholelithiasis is included as one of preceding factor. And also, the diagnostic implication of epithelial metaplasia as an expression of chronic cholecystitis is discussed.
Incidence

The ARS(Acute Radiation Syndrome) develops, within 60 days after exposure to ionising radiation with typical clinical signs and symptoms as a function of time. The interactions and combined effects of radiation-induced damage to different organ systems are diverse and not yet fully understood. Therefore, when accidental exposure to ionising radiation is documented or suspected, guidance for immediate diagnostic procedures and specialised care are required to handle the complexity of the ARS. The following four organ systems, Neurovascular system (N), Hematopoietic system (H), Cutaneous system (C) and Gastrointestinal system (G) are considered to be of critical significance for the development of ARS and should therefore receive special attention in the medical management of radiation accident cases. The Assessment of the severity of damage, Decision on the kind of hospitalisation, Provision of appropriate therapeutic interventions and Evaluation of the patient's prognosis must be considered in the management of a patient after a radiation accident. When significant levels of radioactive materials are incorporated, pathological consequences may ensue, making emergent treatment particularly important. However, this should not take priority over treatment of life threatening conditions and of acute injuries. Following medical stabilization, careful radiological assessment can be performed to determine the presence of both external and internal contamination. It is important to note that 1) contaminated patients do not represent a direct hazard to health care providers and 2) lifesaving procedures should not be delayed regardless of the level of contamination.
Acute Radiation Syndrome* ; Health Personnel ; Hematopoietic System ; Humans ; Prognosis ; Radioactive Hazard Release

No abstract available.
Humans ; Nitroblue Tetrazolium* ; Skin* ; Tuberculosis, Cutaneous*

This report presents a case with gastric ulcer whose gastric mucosal biopsy revealed heavy aggregations of Russell body containing plasma cells in the lamina propria and in peptic detritus. A sixty four year old female received an endoscopic examination for currently aggravated peptic ulcer symytoms, It revealed a small round ulcer with nodular margin along the greater curvature of high body, suggesting of early gastric carcinoma. Endoscopic biopsies (two times) confirmed heavy collections of Russell body-containing plasma cells which were once misinterpreted as signet ring cell carcinoma. Immonohistochemically they were strongly positive to both kappa and lambda light chains by pgtroxidase-antiperoxidase method. Each infiltrated cell contained one or more refractile intracytoplasmic eosinophilic globules, bcing associated with extracellular ones and heavy matare lympho-plasma cell infiltration. Differential diagnosis from neoplastic signet ring cells in endoscopic biopsy was diseussed.
Biopsy ; Carcinoma, Signet Ring Cell* ; Diagnosis, Differential ; Eosinophils ; Female ; Humans ; Mucous Membrane ; Peptic Ulcer ; Plasma Cells* ; Plasma* ; Stomach Ulcer ; Stomach* ; Ulcer

We reviewed a total of 15 cases of heterotopic pancreatic tissue within the gastrointestinal wall(intramural type), and compared with 3 extramural ones. Intramural heterotopic pancreatic lesions were located in the antrum(33%), pylorus(20%), and body of stomach(7%), and the remainders in the duodenum(40%). Only two cases presented with chinical symptoms by their existence. Two of them were situated within the submucosa, 3 in the muscularis, 6 in submucosa-muscularis, 2 in the muscularis-subserosa, and 1 in the susbmucosa-subserosa. Intramural type was featured with their structural heterogeneity compared to the extramural ones; 10 cases showed participation of gastrointestinal mucosal elements, and some accompanied tissue elements that were indistinguishable from submucosal epithelial heterotopia or microduplication cyst of the stomach. Langerhans islets were found in 67%, and one developed islet cell tumor. The above results suggest that the initially engrafted heterotopic pancreatic tissue becomes modified and presents with heterogeneity of endodermal and mesodermal tissue-derived components by its intramural growth during the gastrointestinal organogenesis; failure of opening of its drainage system into the gastrointestinal lumen may result in the increase of intraductal pressure with subsequent atrophy of the acinar tissue and various metaplastic changes of ductal epithelium, aside from induction of smooth muscle coat around the heterotopic tissue.
Cysts

No abstract available.
Twins, Conjoined*

Eight cases of combine hepatocellular-cholangiocarcinoma(HCC-CC) of the liver were analysed along with their growth patterns and histologic subtypes to draw a possible implication in understanding of their histogenesis. The relative incidence of combined HCC-CC among the surgically resected primary carcinomas of the liver(485 cases) was 1.6%. The combination patterns varied and were classified as follows; the multinodular tumor, each consisting of HCC or CC element(type 1) was found in 1 case, the single tumor mass with two distinct compartments of HCC and CC(type 2) in 3, and the single tumor with random mixture of two elements(type 3) comprised the remaining 4 cases. Of the 7 cases of single tumor mass(type 2 and 3) HCC and CC comprised the major component in 5 and 2 cases, respectively. The histologic features of both HCC and CC elements were not different from those of isolated HCC and CC, except for two of CC element in type 3 which disclosed the intermediated differentiation or socalled cholangiolocellular carcinoma in part. We conclude that there is no significant difference in the relative incidence of combined HCC-CC among primary carcinomas of the liver and their subtypes compared to that in other countries, regardless of high incidence of both HCC and CC in Korea. Also, we discussed a possible histogenisis along a hypothesis that some of the combined HCC-CC be the consequence of interposition of different cell type from a new subclone into the growth of an initial single cell type of primary carcinoma of the liver.
Incidence ; Carcinoma, Hepatocellular

BACKGROUND/AIMS: Although the mechanism of hepatocellular carcinogenesis still remains to be clarified, it has been suggested that persistent hepatic necrosis and resultant irregular regeneration might cause genetic mutations, such as activation of protooncogenes, inactivation of tumor suppressor genes and modulation of apoptosis-related genes, finally leading to hepatocellular carcinoma (HCC). To elucidate the role of cell proliferative activity and apoptosis, a major mechanism of cell death, in hepatocellular carcinogenesis, we analyzed expression of proliferation cell nuclear antigen (PCNA), p53 protein and apoptotic cells in HCC and surrounding nonneoplastic hepatic parenchyma. METHODS: We performed immunohistochemical staining to detect P CAN, p53 protein, and terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labelling (TUNEL) method for the detection of apoptosis in 52 hepatocellular carcinomas and their adjacent nonneoplastic liver. We scored the expression of PCNA and p53, and apoptotic index by a 5 point scale' 0, 0%,1, 1-25%', 2, 25-50%, 3, 50-75%', 4, >76%, and analyzed the results with other clinicopathologic characteristics. RESULTS: p53 protein was expressed in 42.3% of the HCC, but was not evident in nonneoplstic liver. P53 overexpression was correlated with the histologic grade of HCC (p<0.05). PCNA labelling indices (LI) of HCC were correlated with those of liver cell dysplasia and normal liver (p<0.05). Leading edges of HCCs showed higher proliferative activity than the central part of HCC. Four cases of HCCs with high TUNEL also showed high proliferative activity. There was no difference of the TUNEL between HCC and surrounding nonneoplastic liver. Expression of p53, PCNA LI and TUNEL had no relationship with clinicopathologic parameters including viral markers, aFP elevation, tumor size and underlying cirrhosis. CONCLUSION: p53 overexpression in HCC and absence of p53 mutation in nonneoplastic liver indicates the active participation of p53 in hepatocellular carcinogenesis. Invasiveness and metastatic potential appear to be related with the strong expression of PCNA, but apoptosis in HCC has no direct implication in hepatocellular carinogensis.
Apoptosis* ; Biomarkers ; Carcinogenesis ; Carcinoma, Hepatocellular* ; Cell Death ; Fibrosis ; Genes, Tumor Suppressor ; In Situ Nick-End Labeling ; Liver* ; Necrosis ; Proliferating Cell Nuclear Antigen ; Regeneration