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.
Incidence ; Neoplasm Metastasis

The rapid frozen section method is a means of intraoperative pathological diagnosis, first introduced by Welch in 1891 and developed as a diagnostic tool by Cullen, Wilson, MacCarty et al. This method serves useful purposes, such as determining the malignancy or benignancy of a suspected lesion, determining the adequacy of a biopsy of a suspected lesion, confirming the presence or absence of metatasis, and identifying small structures. But it bears many disadvantages, the most of which is the danger of incorrect diagnosis. We studied the indications, the limitations and the accuracy of the frozen section method and the materials studied was total cases of frozen section during recent 5 years. The ovarall accuracy of the frozen section diagnosis of 1,603 cases was 96.2% with 0.3% of false positive, 3.5% of false negative and 2.8% of incorrect histological diagnoses or grading errors the tissues submitted for frozen section were lymph node, breast, gastrointestinal tract and soft tissue in decreasing order of frequency. The false positive cases were four in number, while the false negative cases were 53, one third of which were the misdiagnoses of the presence of ganglion cells in Hirschsprung's disease.
Biopsy

Mediastinum is bounded by sternum, vertebra, 1st rib, and diaphragm externally, and by pleural cavity internally and includes important structures such as great vessels, nerves, thymus and many lymph nodes. Primary and metastatic cancers, cysts and inflammatory lesions can develop in this region, and the tumor developing in the mediastinum has a tendency to developed in a specific area of mediastinum depending on the histologic type. Therefore the developing site of tumor and the clinical findings are very important in diagnosing the tumor of the mediastinum. We studied not only the characteristics of mediastinal tumor and tumorlike conditions but the histologic classification and frequency of mass to a specific area and then observed if there is any information that could help in diagnosis of the lesion of the mediastinum. Results obtained were as follows: 1) Of the 95 cases of mediastinal lesion which excludes inflammatory process, there were 70 cases (73.5%) of primary tumors, 13 cases (13.1%) of metastatic tumors and 12 cases (12.6%) of tumor-like conditions. 2) Of the 70 cases of primary tumor, 54 cases (76.8%) were benign, 13 cases (20%) were malignant and 3 cases were unclassified or unidentified tumor with the overall 3.8:1 prevalence rate of benign tumor compared to malignancy. 3) Histologic classification of the 70 cases of primary tumor showed 27 cases (28.4%) of germ cell tumor, 22 cases (23.2%) of neurogenic tumor, 7 cases (7.4%) of thymoma, 6 cases (6.3%) of lymphoma and 5 cases (5.3%) of soft tissue tumors with the highest frequency of germ cell tumor. Germ cell tumor and neurogenic tumor exceeded to 50% of total primary mediastinal tumor. 4) Male to female prevalence rate showed that benigh tumor had a high frequency in female with the the ratio of 1:1.4. But malignant tumor showed much higher frequency in male with the ratio of 4.2:1. 5) Anterior mediastinum had germ cell tumor, thymoma and lymphoma in order of frequency. Metastatic tumor was the most common in superior mediastinum. Superior mediastinum had germ cell tumor and neurogenic tumor with about the equal number, and soft tissue tumor was also developed. Middle mediastinal tumor was less common in number compared to other portions of mediastinum but the majority of tumors developed was developmental cysts and metastatic tumors. And the majority of neurogenic tumors occured at the posterior mediastinum. 6) Mass sized 5-10 cm in diameter were about 55.7% of all tumor, 2.5-5 cm and 10-15 cm were 20% respectively. But the mass sized smaller than 2.5 cm and larger than 15 cm were about 5% respectively. And the malignant tumors have more larger size than benign tumors. 7) Patient with benigh tumor had no symptoms at all or some complaints of chest tightness, dyspnea, chest pain, shoulder pain and dysphagia. In addition to above symptoms, patient with malignant tumor complained of systemic symptoms such as weight loss and fever.
Female ; Male ; Humans ; Cysts ; Neoplasm Metastasis

The tuberculosis of the stomach is very rare disease and its association with gastric carcinoma is more so. The diagnosis of gastric tuberculosis is usually made on the histological basis not clinical findings. This case of gastric tuberculosis was found incidentally after the subtotal gastrectomy performed under the impression of stomach cancer. There was an ill-defined ulcerative lesion at the lesser curvature. Microscopically, poorly differentiated adenocarcinoma extended to the serosa and typical tuberculous granulomas were found in the lesion of stomach and regional lymph nodes. Acid-fast bacilli were demonstrated by Ziehl-Neelsen stain in the granuloms of the regional lymph nodes, and a case of gastric carcinoma is presented here and briefly reviewed with the literature.
Adenocarcinoma ; Stomach Neoplasms

No abstract available.
Knee*

Following is a case report of giant cell tumor of the metacarpal bone of rlght thumb treated with surgical method. The metacarpal bone except both articular surfaces was excised and replaced with an autogenous iliac bone graft. The graft bone was fixed with 3 Kirschner's wires and the thumb was immobilized with plaster cast. There has been no evidence fo recurrence during the 6 years following and function of the hand is normal.
Casts, Surgical ; Giant Cell Tumors ; Giant Cells ; Hand ; Methods ; Recurrence ; Thumb ; Transplants

In spite of numerous clinical and patho-anatomical studies made in the past, there are still different opinions concerning the machanism of low back pain. We have focused attention on the posterior structures as an alternative source of low back pain with leg radiation, so we have studied and analyzed the effect of the injection of mixture methylprednisolone acetate suspension (20-40 mg) and local anesthetic (1% procaine, 1cc) into the posterior facet joint. In this paper, the records of 41 in-patients who have chiefly compalned of low back pain wlth leg radiation and have been treated at the Departmnt of Orthopedics, Han Yang University Hospital from May, 1979 to April, 1980 were studied. The following results are recognized by observing and analyzing their chief complalnts, physical examination, x-ray findings, the effect of facet block and the follow-up studies after facet block. 1. Low back pain with sciatica was 1.9 times more common in female than male, and frequently occured In 4th to 6th decades (75.7%). 2. The abnormal findings of plain x-rays were osteophyte (35.6%), marginal sclerosis (27.1%), narrowing of disc spce (18.6%), lumbarization (11.9%), spina bifida (3.4%), and tropism (3.4%). 3. The most frequent site of abnormal posterior facet joints was at the level between 4th and 5th lumbar vertebra (42.9%), and all were on lower lumber region. 4. The range of lumbar motion was decreased in the cases of abnormal posterior facet jolnt or degenerative changes, and it was especially more decreased in the combined cases. 5. The effect of facet block was as follows; In initial assessment, 29 of 41 cases (70.7%) showed complete rellef and one month later, 16 of 29 cases (55.2%) showed continuous rolief, 4 of 18 cases (22.2%) which were followed for 3 more months showed complete relief. 6. The effect of facet block according to pain character was as follows: 20 of 26 cases (76.9%) of numbness, 5 of 6 cases (83.3%) of dull pain and 4 of 8 cases (50.0%) of radlating pain were completely relleved and a case of burning pain was partially relleved.
Burns ; Female ; Follow-Up Studies ; Humans ; Hypesthesia ; Leg ; Low Back Pain ; Male ; Methylprednisolone ; Orthopedics ; Osteophyte ; Physical Examination ; Procaine ; Sciatica ; Sclerosis ; Spinal Dysraphism ; Spine ; Tropism ; Zygapophyseal Joint

No abstract available.
Humans ; Osteosarcoma*

Chemically induced epiderml carcinogenesis is usually divided into two stages, the initiation and promotion. The initiation involves conversion of some epidermal cells into latent neoplastic cells and the promotion is proliferation of the transformed cells. As immunosurveillence is thought to be a host defense against tumors, Langerhans cells, being essential in initiation of local cutaneous immunologic reaction, is suggested to be important in the carcingenesis of the epidermis. This study is attempted to investigate the epidermal proliferative changes in mice induced by application of 12-0-tetradecanoy1-phorbol-13-acetate(TPA) on the skin initiated with 7, 12-dimethylbenzanthracene(DMBA) and its relationship with Langerhans cell. Ninty five male inbred BALB/c mice weighing 20~25 g were divided into five groups; the 33 week-group, the 21 week-group, the 12 week-group and the 4 week-group according to the duration of carcinogen application, and the control group. The carcingen was applied with a brush on the dorsal skin of mice after depilation. Ten days after application of 800 nmole DMBA in 0.4 cc acetone, 20 nmole TPA in 0.4 cc acetone was applied twice per week and the control group was applied with the same amount of acetone for 4 weeks. Animals were sacrificed 3 days after the last application of TPA. One hour before sacrifice, bromodeoxyuridine(BrdU) (1 mg/g) was injected via the tail artert for BrdU stain of S phase cells. A strip of dorsal skin was used for hematoxylineosin stain, immunohistochemical stain for BrdU and la antigen of Langerhans cell, and flow cytometry. The results are as follows: 1. Cellular proliferation, hyperkeratosis and dysplasia of the epidermis were increased in relation to duration of carcingen application. Papillomas were developed 12 weeks after application of the carcingen. 2. BrdU labelling and proliferative indices of the 20 weeks' application group were significantly higher than those of the 12 weeks' application group. The number of Langerhans cell was decreased markedly ater 4 week' application of the carcinogen. 3. All epiedrmal lesions including a case of squamous cell carcinoma were diploidy in flow cytometry. It is thought that disturbance of immunosurveillence, caused by depletion of Langerhans cell, may permit proliferation of epidermal cells. Although abnormal quantitative change of nuclear DNA has not occurred even when the epidermal proliferative activity and dysplastic change were increased markedly, it is thought that the occurrence of structural change of chromosome is remained to be clarified.
Male ; Humans ; Mice ; Animals ; Carcinogens

Various immunologic studies were performed for the investigation of humoral immunity in 30 patients with Behcet's syndrome who had been registered in Behcet Special Clinic of Severance Hospital: direct immunofluorescent staining, quantitation of serurn Ig, complement by immunoelectrophoresis and B-cell by EAC-rosette method. The results can be summerized as follows: 1. Direct immunofluorescent staining occurs in biopsies from patients with Behcets syndrome: 11 of the 30 patients(36. 7%). Among them, vascular fluorescene with C3 was noted in 10 of 11 patients (90. 9%), in addition of IgG, IgA, IgM, and fibrinogen on dermoepidermal junction or vessel. 2. The results of direct immunofluorescence staining showed different tendency according to biopsy sites and clinical types: 5 of 10(50%,) in the specimens from oral mucosa, 5 of 13(38.5%) from leg, 1 of 3(33.3%,) from genitalia, and 0 of 7(0%) from other sites: higher in complete and incomplete types than in suspected and possible types. 3. Immunofluorescent staining rates were statistically not significant according to sex, age and Lehner's classification. 4. Serum IgG, IgA, IgM, C3, C4 and B-cell were statistically not significant between DIF positive and negative groups. Therefore it is considered that vascular deposits of immune complexes and activation of complements by immune omplexes may be a role of pathogenetic mechanisms of Behcet's syndrorne.
Antigen-Antibody Complex ; B-Lymphocytes ; Behcet Syndrome* ; Biopsy ; Classification ; Complement System Proteins ; Fibrinogen ; Fluorescent Antibody Technique, Direct ; Genitalia ; Humans ; Immunity, Humoral* ; Immunoelectrophoresis ; Immunoglobulin A ; Immunoglobulin G ; Immunoglobulin M ; Leg ; Mouth Mucosa