We report a case of extraskeletal osteosarcoma in view of rarity, and a brief review of the literature related to this type of tumor is presented. The patient was a 31-year-old Korean woman, who had noticed a bean-sized hard mass in the right thigh progressively enlarged to become egg-size during about 7 months, followed by pain and tenderness. There was neither recognizable previous lesion nor causable agent about the mass on history taking. Physical examination revealed another palpable mass on the inguinal area. The right thigh and inguinal masses were simply excised and histologically confirmed to be an extraskeletal osteosarcoma and metastatic one, respectively.
Female ; Humans ; Neoplasm Metastasis

This study was undertaken to evaluate the significant diagnostic points of chronic alcoholic hepatitis (CALH) among clinicopathologic findings observed. The specimens used in this study were 20 cases of CALH and 28 cases of chronic active viral hepatitis (CAVH), which were diagnosed at our University Hospital during 9 years period from 1978 to 1987. In these cases, comparative analysis of age and sex distribution, major clinical manifestations, and laboratory and histopathologic findings was performed. The results obained were summarized as follows: Among 20 cases of CALH, the sex distribution was 15 in male and 15 in female with a ratio of 3:1. The range of age distribution was wide from third to seventh decade. There was no recognizable special point about the age and sex distribution of CALH, compared with cases of CAVH. Major clinical manifestations of CALH were hepatomegaly (85%), jaundice (75%) and abdominal pain (50%). Also there was no recognizable special point about the major clinical manifestations of CALH, compared with cases of CAVH. Abnormal values of major laboratory items in CALH were observed in activities of serum r-GTP (100%), SGOT (95%), SGPT (75%) and serum alkaline phosphatase (60%), and total serum bilirubin (60%). Compared with CAVH in major laboratory findings, the significant diagnostic items of CALH were the activities of serum r-GTP and alkaline phosphatase. The characteristic histopathologic findings of CALH, which were compared with CAVH and observed in liver parenchyma, were fatty change (100%), cytoplasmic ballooning and coagulation (100%), delicate fibrosis (85%), bile stagnation (35%), and Mallory bodies (20%), and that observed blurring of limiting plate (60%) in portal and periportal areas.
Female ; Male ; Humans

We present here a brief literature review and a case study of postpartum pulmonary arterial hypertension, a rare and progressive disease with a high maternal mortality rate. The patient, a 32-year-old woman, presented with dyspnea and shivering immediately following an uncomplicated vaginal delivery. The patient had no remarkable individual or familial history. She died 4 hours after her delivery, and an autopsy revealed atherosclerosis of the main pulmonary arteries and characteristic plexiform lesions on the lung. The remaining organs showed no remarkable pathology. We reported pulmonary arterial hypertension associated with pregnancy as the cause of death.
Adult ; Atherosclerosis ; Autopsy ; Cause of Death ; Death, Sudden ; Dyspnea ; Female ; Humans ; Hypertension* ; Lung ; Maternal Mortality ; Pathology ; Postpartum Period* ; Pregnancy ; Pulmonary Artery ; Shivering

Alterations of the mucin-type glycoproteins may contribute to changes in cancer cell growth regulation, immune regulation, and cellular adhesion, which in turn may influence the invasive and metastatic capabilities of the cancer. Many of the cancer-associated antigens such as mucin antigens have been identified recently and alterations in the glycosylation of the mucins have been described in the cancer. Immunohistochemical studies of 3 antigens associated with alteration of the mucin glycoprotein (MUC1, MUC2, STn) were done to evaluate their relationship with known pathologic prognostic factors and their usefulness in assessment of the progression of gastric carcinoma in 127 gastric carcinoma tissues. The MUC1 was detected in 57 (44.9%), MUC2 in 76 (59.8%) and STn antigen in 77 (60.6%) out of 127 cases of gastric carcinomas. The expression rate of MUC1 was significantly correlated with depth of tumor invasion, lymph node and distant metastases, and advanced tumor stage (p=0.001). The expression rate of MUC2 was not significantly correlated with pathologic findings and known prognostic factors. The STn antigen was significantly associated with incidence of lymph node metastasis (p=0.02). The coexpression of both MUC1 and MUC2 or MUC1 and STn was more frequent in tumors with deep invasion, lymph node metastasis and advanced tumor stage than one or none expression (p<0.05). These results suggest that the alterations of expression of the mucin proteins, especially MUC1 and carbohydrate antigen (STn) are associated with poor biological behavior of the gastric carcinoma.
Glycoproteins* ; Glycosylation ; Immunohistochemistry ; Incidence ; Lymph Nodes ; Mucins* ; Neoplasm Metastasis

Medico-legal investigations in Korea depend mostly on postmortem inspection without autopsy. Both untrained physicians and experienced forensic pathologists may not be able to determine the cause and manner of death only by postmortem inspection. The aim of our study was to show the limitations of postmortem inspection by evaluating the discrepancy between the results of postmortem inspection and autopsy after natural death. The manner of death by postmortem inspection changed to unnatural death in 9.4% of the cases (12 cases/127 cases) after autopsy. The cause of death in most cases was consumption of alcohol, agricultural chemicals, and antipsychotic intoxication. The cause of death by postmortem inspection changed in 24.3% of the cases (26 cases/107 cases) among cases of confirmed natural death after autopsy. The positive predictive value of cause of death by postmortem inspection was higher for cardiovascular disease (79.0%) and lower for chronic alcoholism and/or chronic liver disease (28.6%). This study shows that forensic pathologists could make considerable errors in determining the cause and manner of death without autopsy and emphasizes the necessity to refine medico-legal investigations in Korea by introducing the limited autopsy with toxicologic study and supportive postmortem imaging.
Agrochemicals ; Alcoholism ; Autopsy ; Cardiovascular Diseases ; Cause of Death ; Korea ; Liver Diseases

We have recently experienced a clinically atypical case of malignant histiocytosis involving the spleen, ileum and bone marrow, in a 25-year-old Korean male. He was admitted to our hospital because of multiple purpuric lesions of skin which had been appearing since 2 years ago. Physical and laboratory examinations revealed marked splenomegaly with pancytopenia. With clinical impression of hypersplenism, splenectomy was performed. During the operation, the surgeons found a dark red mucosal lesion in the ileum incidentally, to resect the segment. Microscopic findings of the spleen and the ileal lesion showed extensive proliferation of atypical histiocytes, many of them phagocytosing numerous erythrocytes. Bone marrow biopsy was done for follow-up study, which showed increased cellularity with infiltration of atypical histiocytes.
Follow-Up Studies ; Biopsy

Sulfuric acid can cause local or systemic effects after exposure by inhalation, ingestion, or topical application. Direct ingestion is the main exposure route for fatal sulfuric acid injury. Fatal accidents involving the inhalation of toxic sulfuric acid vapors are rare. Inhalation of sulfuric acid fumes causes severe irritation or corrosive damage to the upper respiratory tract. Consequently, severe congestion, edema, and inflammation of the mucous membranes of the upper respiratory passages hinder the entry of air into the lungs, possibly leading to fatalities in victims. A 35-year-old man died at his home after complaining of a severe sore throat. One day earlier, he had worked in a sulfuric acid tank in a copper-smelting plant while wearing an ordinary gas mask that offered no protection against sulfurous acid vapors. Upon autopsy, the larynx and epiglottis showed pronounced edema, congestion, and inflammation that histologically mimicked an acute bacterial suppurative inflammation, accompanied by severe pulmonary edema. A field analysis of the air inside the sulfuric acid tank revealed SO4(2-) positivity and a 40% sulfuric acid concentration.
Adult ; Autopsy ; Eating ; Edema ; Epiglottis ; Estrogens, Conjugated (USP) ; Humans ; Inflammation ; Inhalation* ; Larynx ; Lung ; Mucous Membrane ; Pharyngitis ; Plants ; Pulmonary Edema ; Respiratory Protective Devices ; Respiratory System ; Sulfur* ; Sulfuric Acids

Chromophobe cell renal carcinoma is an uncommon variety of renal cell carcinoma first described in humans in 1985 by Thoenes and his colleagues. It is a distinct type of renal cancer presumably derived from the intercalated cells of the collecting duct system and exhibiting a better prognosis than other types of renal cell carcinoma. This type of renal cell carcinoma has not been reported in Korean literature. We experienced three cases of chromophobe cell renal carcinoma from surgical pathology files of Dong-A medical center. The patients were a 65-year-old female, a 54-year-old female, and a 50-year-old male who had 8.2x6 cm, 4x2.5 cm and 4.3x3.2 cm sized, yellowish gray, beige to tan colored masses in the kidneys, respectively. Microscopically, the tumor cells were arranged in sheets or nests with delicate intervening vasculature. The cells were voluminous, uniform in appearance and contained finely reticulated cytoplasms delineated by prominent cell borders. With Hale's iron colloid staining the cytoplasm showed positive reaction; with PAS staining the result was negative. Immunohistochemically, the tumor cells showed positive reaction for cytokeratin but negative for vimentin. Electron microscopy showed numerous small, round to oval cytoplasmic vesicles, 150-300nm in size. All the patients received only radical nephrectomy and survived without evidence of recurrence or metastasis during follow-up intervals ranging from 4 months to 5 years.
Female ; Male ; Humans ; Neoplasm Metastasis

The forensic significance of the diatom test in diagnosing death due to drowning has been controversial for a long time as diatoms are detected in the non-drowning cases as well. This false positivity may originate from the antemortem as well as postmortem penetration of the diatoms into the bodies.Another problem with the diatom test is the lack of standardization among the different kinds of diatom extraction and identification methods. The author first reviewed the progress in the methods used in the diatom test and then studied the historical arguments in the diagnosis of drowning. Lastly, the research trend in the diatom test since 2000 was evaluated by classifying the manuscripts searched using the keyword “drowning and diatom” on PubMed. Recent studies tend to support the reliability of the diatom test in the diagnosis of drowning when quantitative and qualitative analyses are performed properly with maximum possible reduction in contamination during the preparation of the test samples.

Sepsis-related deaths are occasionally encountered in forensic practice. However, forensic pathologists are reluctant to use the terminology “sepsis” or “septic shock” as a cause of death because of the lack of definite morphological evidence. When sepsis is considered a cause of death, pathologic assessment is essential to identify the foci of infection or consequences of sepsis, such as diffuse alveolar damage (DAD). Pneumonia is known to be a common source of sepsis and can develop into DAD with progression of sepsis. The histology of DAD varies according to the immunologic status. An autopsy of a 55-year-old man who died of septic shock with leukopenia revealed only abundant gram-negative bacilli in the alveoli without typical DAD pathology.