Journal of Pathology and Translational Medicine

Moon Hyang Park

84 Articles

Cytologic Features and BRAF Mutation of Hyalinizing Trabecular Adenoma of the Thyroid: A Case Report with Review of the Literature.: Se Min Jang, Young Ha Oh, Yoon Kyung Jeon, Yong Wook Park, Moon Hyang Park; Korean J Pathol. 2011;45(4):428-433.; DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.4.428

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A hyalinizing trabecular adenoma (HTA) is a rare benign thyroid tumor of follicular epithelial cell origin with a trabecular-alveolar growth pattern and marked intratrabecular hyalinization. The cytological and histological features of HTA are very similar to those of papillary and medullary carcinomas of the thyroid. Therefore, an accurate diagnosis of HTA is important to avoid unnecessary and potentially harmful management of patients. However, the results of BRAF gene mutation analysis shown by many studies are distinctly different between HTAs and papillary thyroid carcinomas. Herein, we describe a rare case of HTA of the thyroid in a 49-year-old female and consider its characteristic cytological features and BRAF gene mutation analysis results with a brief review of the literature.

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Hyalinizing trabecular tumor, a rare histologically unique tumor of the thyroid, coexisting with papillary thyroid carcinoma
Chiu-Hsuan Cheng
Tzu Chi Medical Journal.2021; 33(2): 198. CrossRef
A Case of Hyalinizing Trabecular Tumor of the Thyroid Gland
Kun Woo Kim, Sang Joon Lee, Phil-Sang Chung, Junghwan Moon
Korean Journal of Otorhinolaryngology-Head and Neck Surgery.2012; 55(12): 795. CrossRef

Practical Standardization in Renal Biopsy Reporting.: So Young Jin, Hyeon Joo Jeong, Sun Hee Sung, Beom Jin Lim, Jee Young Han, Soon Won Hong, Hyun Ee Yim, Yeong Jin Choi, Yong Mee Cho, Myoung Jae Kang, Kyung Chul Moon, Hee Jeong Cha, Seung Yeon Ha, Mi Seon Kang, Mee Young So, Kwang Sun Suh, Jong Eun Joo, Yong Jin Kim, Nam Hee Won, Moon Hyang Park; Korean J Pathol. 2010;44(6):613-622.; DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.6.613

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Abstract PDF

BACKGROUND
To standardize renal biopsy reporting and diagnosis, The Renal Pathology Study Group of the Korean Society of Pathologists (RPSKSP) has developed a renal pathology reporting format for the native and allograft kidney.
METHODS
A consensus checklist of a provisional renal biopsy format was sent to all members of the RPSKSP. Feed back opinions regarding the practical application of the checklist to the diagnostic work were received.
RESULTS
Kidney biopsies require three essential examinations: by light microscopy, immunofluorescence (IF), and electron microscopy (EM). A final report of a renal biopsy should include information on specimen adequacy and a description of the morphologic change using a systematic semiquantitative method for each of the compartments, with optional separate IF and EM reports.
CONCLUSIONS
A standard renal biopsy report format is important in establishing clinicopathologic correlations, making reliable prognostic considerations, comparing the findings in sequential biopsies and evaluating the effects of therapy.

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Additional antihypertensive effect of magnesium supplementation with an angiotensin II receptor blocker in hypomagnesemic rats
Kyubok Jin, Tae Hee Kim, Yeong Hoon Kim, Yang Wook Kim
The Korean Journal of Internal Medicine.2013; 28(2): 197. CrossRef
Clinicopathologic Features of IgA-Dominant Postinfectious Glomerulonephritis
Tai Yeon Koo, Gheun-Ho Kim, Hyang Park
Korean Journal of Pathology.2012; 46(2): 105. CrossRef

The Morphologic Patterns of Diabetic Nephropathy in Koreans.: Si Hyong Jang, Moon Hyang Park; Korean J Pathol. 2009;43(1):36-42.; DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.1.36

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Abstract PDF

BACKGROUND
Diabetic nephropathy is the most common cause of end-stage renal disease and it has various pathologic features. We investigated the clinicopathologic differences between the histologic classes of diabetic nephropathy.
METHODS
A total of 46 patients with diabetic nephropathy were evaluated. Morphologically, the renal lesions were divided into three categories: class 1, diffuse or nodular glomerulosclerosis: class 2, vascular change without evidence of glomerulosclerosis: and class 3, non-diabetic renal disease superimposed on diabetic glomerulosclerosis. We evaluated the laboratory findings and the histologic findings, including mesangial expansion, interstitial fibrosis and inflammation, arteriolar hyalinosis and tubular atrophy.
RESULTS
The proportion of each class was 32 cases (70%), 4 cases (9%) and 10 cases (21%), respectively. The clinical and laboratory data showed no significant difference among the classes. For the groups of class 1, the group with nodular sclerosis showed a higher serum creatinine level than did the diffuse group (p=0.003). IgA nephropathy was the most common non-diabetic renal disease superimposed on diabetic glomerulosclerosis in our study.
CONCLUSIONS
The patients with nodular glomerulosclerosis presented with a more progressed clinicopathological features than did the patients with class 1 diffuse glomerulosclerosis. We also found 21% of all the patients with diabetic nephropathy had superimposed non-diabetic renal disease in a Korean population.

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Renal biopsy pattern in diabetes mellitus patients and their correlation with clinical parameters
G. Singh, B. Naik, U. Singh, A. Modi, R. Dave
Nephrology (Saint-Petersburg).2023; 27(3): 53. CrossRef
Non-diabetic renal disease in Croatian patients with type 2 diabetes mellitus
Ivica Horvatic, Miroslav Tisljar, Patricia Kacinari, Ivana Matesic, Stela Bulimbasic, Danica Galesic Ljubanovic, Tina Katic, Darko Kristovic, Kresimir Galesic
Diabetes Research and Clinical Practice.2014; 104(3): 443. CrossRef
Clinical versus histological diagnosis of diabetic nephropathy--is renal biopsy required in type 2 diabetic patients with renal disease?
G. Biesenbach, G. Bodlaj, H. Pieringer, M. Sedlak
QJM.2011; 104(9): 771. CrossRef

Cytohistologic Correlation of Phyllodes Tumors of the Breast: A Study on 17 Cases.: Young Ha Oh, Moon Hyang Park; Korean J Pathol. 2009;43(1):68-74.; DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.1.68

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Abstract PDF: Phyllodes tumor (PT) is a rare fibroepithelial tumor of the breast, and these tumors are subdivided into benign, borderline, and malignant tumors. The criteria for their histologic diagnosis have been relatively well-described. However, the cytologic diagnosis presents more difficulties and only a few cytologic studies concerned with their subclassification have been published. The objective of the current study is to describe the cytologic features of benign, borderline and malignant PTs in an attempt to distinguish one from the others. Cytohistologic correlation for 11 benign, 3 borderline and 3 malignant PTs was performed. For all these cases, the preoperative fine needle aspiration (FNA) findings were available for review. The features we examined were a necrotic background, cellularity, stromal tissue fragments, stromal pleomorphism and atypism, dissociated stromal cells and mitosis. The overall diagnostic accuracy of FNA for the PT grading was 88.2% (15/17). Two benign PTs were cytologically misinterpreted as "atypical epithelial and stromal cells" and "highly suspicious for ductal carcinoma". Nevertheless, the cytologic diagnosis and the grading of PTs on FNA were relatively reliable. Semiquantitative analysis for the cellular stromal tissue fragments, stromal pleomorphism and atypism, dissociated stromal cells and mitosis might be helpful for subclassifing PTs on FNA. In the case of encountering a markedly necrotic background, special concern about degenerative change such as infarction is needed.

The Expression of C4d and HLA-DR in Renal Allografts with the Histologic Features of Antibody-Mediated Rejection.: Young Soo Song, Moon Hyang Park; Korean J Pathol. 2008;42(5):260-269.

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Abstract PDF: BACKGROUND
Deposition of C4d along the peritubular capillaries is generally associated with an antibody-mediated response. We evaluated, with performing C4d immunostaining, the diagnostic accuracy of the cases that were previously diagnosed as antibody-mediated rejection (ABMR) when based only on the histologic findings, and we examined possible correlation of C4d with HLA-DR.
METHODS
Forty-five renal transplantation biopsies, which showed ABMR-like histology, were obtained. The expressions of C4d and HLA-DR in the transplant rejection cases were investigated using immunofluorescent and/or immunohistochemical staining. RESULTS: There were 14 discordant cases among a total of 45 cases when C4d was used as a diagnostic marker and the original slides were reviewed. These total cases consisted of the C4d negative cases in two cases of hyperacute rejection and all the cases of ABMR and ABMR with chronic/sclerosing allograft nephropathy (CAN) and two C4d positive cases (one each of acute cellular rejection (ACR) and CAN according to their original diagnosis) and all these cases were then revised according to Banff 07. The expression of HLA-DR tended to be correlated with the log-transformed duration of grafts until three years after the transplantation. CONCLUSION: This study demonstrates that C4d together with the histologic findings should be used for making the diagnosis of ABMR. The tubular HLA-DR expression over time should be studied to further understand the mechanism of graft rejection.

A Multiinstitutional Consensus Study on the Pathologic Diagnosis of Endometrial Hyperplasia and Carcinoma.: Kwang Sun Suh, Insun Kim, Moon Hyang Park, Geung Hwan Ahn, Jin Hee Sohn, In Ae Park, Hye Kyoung Yoon, Kyu Rae Kim, Hee Jung An, Dong Won Kim, Mi Jin Kim, Hee Jae Joo, Eun Kyung Kim, Young Hee Choi, Chong Woo Yoo, Kyung Un Choi, Sang Yeop Yi, Hye Sun Kim, Sung Ran Hong, Hee Jeong Lee, Sun Lee; Korean J Pathol. 2008;42(2):87-93.

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Abstract PDF: BACKGROUND
The purpose of this study was to examine the reproducibility of both the diagnosis of endometrial hyperplasia (EH) or adenocarcinoma, and the histologic grading (HG) of endometrioid adenocarcinoma (EC).
METHODS
Ninety-three cases of EH or adenocarcinomas were reviewed independently by 21 pathologists of the Gynecologic Pathology Study Group. A consensus diagnosis was defined as agreement among more than two thirds of the 21 pathologists.
RESULTS
There was no agreement on the diagnosis in 13 cases (14.0%). According to the consensus review, six of the 11 EH cases (54.5%) were diagnosed as EH, 48 of the 57 EC cases (84.2%) were EC, and 5 of the 6 serous carcinomas (SC) (83.3%) were SC. There was no consensus for the 6 atypical EH (AEH) cases. On the HG of EC, there was no agreement in 2 cases (3.5%). According to the consensus review, 30 of the 33 G1 cases (90.9%) were G1, 11 of the 18 G2 cases (61.1%) were G2, and 4 of the 4 G3 cases (100.0%) were G3.
CONCLUSIONS
The consensus study showed high agreement for both EC and SC, but there was no consensus for AEH. The reproducibility for the HG of G2 was poor. We suggest that simplification of the classification of EH and a two-tiered grading system for EC will be necessary.

The Expression of c-erbB-2, EGFR, p53 and Ki-67 in Ovarian Borderline Tumors and Carcinomas of the Ovary.: Kyueng Whan Min, Moon Hyang Park; Korean J Pathol. 2007;41(5):296-306.

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Abstract PDF: BACKGROUND
An ovarian surface epithelial tumor is a heterogenous disease, and various biological and molecular factors are important for its development and progression. Several findings support EGFR or c-erbB-2 as adverse prognostic indicators for an ovarian carcinoma.
METHODS
We reviewed the histological and clinical findings of 52 carcinomas (17 endometrioid, 16 serous, 13 mucinous and 6 clear cell tumors), and 26 borderline (10 serous and 16 mucinous) tumors. Expression of c-erbB-2, EGFR, p53, and Ki-67 was evaluated on paraffinembedded tissue from a primary ovarian tumor by immunohistochemical methods.
RESULTS
Expression of c-erbB-2 was found in 7.6% of tumors and expression of EGFR was found in 9.6% of tumors by immunohistochemical analysis. No significance was found between cerbB- 2 and EGFR expression as indicators of a poor prognosis. The expression of p53 and Ki-67 (>50%) correlated with the grade and type of tumor in the ovarian cancers. p53 and Ki- 67 overexpression (>50%) was absent in the borderline ovarian tumors, whereas ovarian carcinomas showed expression of both p53 and Ki-67.
CONCLUSION
Expression of c-erbB- 2, EGFR, p53, and Ki-67 as determined by immunohistochemical analysis did not correlate with prognostic significance. However, p53 and Ki-67 expression may be used as markers to predict aggressive behavior, and to differentiate between malignant and borderline epithelial ovarian tumors. Further large-scale studies are required to clarify the significance of c-erbB-2 and EGFR expression in ovarian tumors.

International Society of Nephrology/Renal Pathology Society 2003 Classification of Lupus Nephritis.: Moon Hyang Park; Korean J Pathol. 2006;40(3):165-175.

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Abstract PDF: The new revised classification of glomerulonephritis in systemic lupus erythematosus under the auspice of the International Society of Nephrology and the Renal Pathology Society (ISN/ RPS) was proposed in 2003. The revised classification preserves the simplicity of the original WHO classification, incorporates selective refinements concerning activity and chronicity from the 1982 and 1995 revisions, and adds a number of new modifications. Overall, it bears a strong similarity to the 1974 classification, but introduces several important modifications concerning quantitative and qualitative differences between class III and IV lesions. The new classification provides a clear and unequivocal description of the various lesions and classes of lupus nephritis as well as definitions for diagnostic terms. This review is introduced the ISN/RPS 2003 classification which will facilitates accurate communication between pathologists and clinicians.

Primary Leptomeningeal Glioblastomatosis Detected in Cerebrospinal Fluid Cytology: A Case Report.: Ki Seok Jang, Si Hyong Jang, Young Soo Song, Moon Hyang Park; Korean J Cytopathol. 2005;16(2):110-114.

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Abstract PDF: Primary leptomeningeal glioblastomatosis is a rare and fatal tumor of the central nervous system, the condition is characterized by diffuse infiltration of the tumor in the meninges without evidence of primary tumor within the brain or spinal cord. We reported an unusual case of leptomengial glioblastomatosis, which was detected by the consecutive cerebrospinal fluid (CSF) cytology with application of immunohistochemistry, in addition to its cytologic findings. A healthy 21 year old man, who was enlisted in the army, presented with a stuporous mental state and diffuse enhancement of meninges without evidence of primary mass lesion in the brain and spinal cord on magnetic resonance imaging(MRI). CSF cytology showed small loose clusters of tumor cells with single cells and lymphocytes. The tumor showed variable pleomorphism with coarse chromatin, irregular nuclear membranes and multi lobated nuclei. On immunohistochemical staining, the tumor cells were founded to be positive for GFAP. In conjunction with radiologic findings, brain biopsy confirmed the diagnosis of leptomenigeal glioblastomatosis. The use of immunohistochemistry is helpful in confirming CSF cytologic diagnosis in patients with primary leptomeningeal glioblastomatosis.

Fine Needle Aspiration Cytology of a Thymic Carcinoid Tumor: A Case Report.: Young Ha Oh, Ki Seok Jang, Young Soo Song, Chul Burm Lee, Choong Ki Park, Moon Hyang Park, Yong Wook Park; Korean J Cytopathol. 2005;16(1):41-46.

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Abstract PDF: Carcinoid tumors of the thymus are vanishingly rare, and the characteristic cytologic findings of this condition have never before been reported in Korea. Recently, we encountered a 58-year-old woman who had been suffering from general weakness and weight loss for several months. Radiological imaging revealed a large anterior mediastinal mass. A fine needle aspiration biopsy (FNAB) of the mass showed predominantly scattered single cells, as well as some loose clusters of small cells with scanty cytoplasm. Some of these small cells exhibited plasmacytoid features, with moderately granular cytoplasm. We also discuss the cytological differential diagnosis between thymic carcinoid and other mediastinal tumors.

Macrocystic Form of Serous Cystadenoma of the Pancreas: Two Cases Report.: Ki Seok Jang, Hyo Jin Lee, Moon Hyang Park; Korean J Pathol. 2004;38(6):423-426.

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Abstract PDF: The macrocystic form of serous cystadenoma of the pancreas is an uncommon benign neoplasm composed of few, relatively large cysts that are lined by uniform, glycogen-rich, cuboidal epithelial cells. We report here on two cases of pathologically proven macrocystic serous cystadenoma of the pancreas in a 45-year-old female patient and a 53-year-old female patient. Both these cysts were lined by low cuboidal epithelia without any evidence of mucin production. There was also no evidence of pancreatitis. These tumors were radiologically suspected as being mucinous cystic neoplasm or pseudocysts. Although the microscopic and immunohistochemical studies of the macrocystic variant are not different from the conventional serous microcystic cystadenoma, their unusual macroscopic features can lead to confusion for the clinicians and radiologists.

Expression of Urokinase-type Plasminogen Activator (uPA) and Plasminogen Activator Inhibitor-1 (PAI-1) in Gallbladder Carcinoma.: Kee Hyung Lee, Haeng Ji Kang, Seung Yeoun Lee, Moon Hyang Park; Korean J Pathol. 2003;37(6):384-392.

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Abstract PDF: BACKGROUND
There are evidences that uPA and its inhibitor play a key role in tumor spread. We studied whether uPA and PAI-1 expressions could serve as prognostic parameters along with clinical, gross and microscopic findings in gallbladder carcinomas.
METHODS
We analyzed 42 cases of gallbladder carcinomas by immunohistochemical staining and clinicopathologic parameters.
RESULTS
uPA and PAI-1 were more frequently expressed in the adenocarcinoma than in the normal or benign gallbladder tissue. The uPA expression in the glands of low grade adenocarcinoma was significantly correlated with both distant and lymph node metastases. The uPA expression in the stroma around the low grade adenocarcinoma was significantly correlated with either distant or lymph node metastasis. The PAI-1 expression was significantly correlated with lymph node metastasis only for both distant and lymph node metastases. In multivariate analysis, the lymphatic invasion was significantly related to poor survival (p= 0.0115). In univariate analysis, the cases without lymphatic invasion had prolonged survival. Positive expression of uPA in the glands of low-grade adenocarcinoma was significantly correlated with poor survival (p=0.0391).
CONCLUSION
In conjunction with clinicopathologic findings, expressions of uPA and PAI-1 may be useful prognostic markers in gallbladder carcinomas.

Analysis of Expression of p63 in Cervical Neoplasia Comparing with Other Immunohistochemical Markers .: Min Yeong Kim, Sam Hyun Cho, Moon Hyang Park; Korean J Pathol. 2003;37(5):333-341.

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Abstract PDF: BACKGROUND
The reproducibility in grading a cervical intraepithelial neoplasia (CIN) are not perfect. The aim of this study was to assess the value of the immunohistochemical expression of p63 and the other biomarkers for grading a CIN (dysplasia and in situ carcinoma), and diagnosing invasive carcinomas.
METHODS
Sixty six cervical specimens were immunostained with the monoclonal antibodies against p63, Ki-67, p27Kip1, and p53 to determine the localization.
RESULTS
The p63 positive cells are well linked with squamous cell maturation and the degree of dysplasia. In mild dysplasia, the p63 positive cells were localized to the basal and parabasal cells, which gradually extended into the middle and upper layers in moderate and severe dysplasia. p63 expression was strong in immature squamous epithelium and invasive squamous cells, but was constantly absent in an adenocarcinoma. The Ki-67 positive cells were scattered from the parabasal cells to the superficial cells in accordance with the degree of dysplasia. p27Kip1 expression was noted in the intermediate cells in the normal cervix. In CIN, the p27Kip1 positive nuclei tended to extend to the basal cells, but it showed no diagnostic consistency in an invasive carcinoma. p53 expression was also variable.
CONCLUSION
p63 is a useful diagnostic adjunct for grading CIN as well as for detecting microinvasion and squamous differentiation in invasive carcinoma. However, immunohistochemical expressions for the p27Kip1 and p53 have no correlation with the grade of CIN and squamous cell carcinoma.

Apoptosis and Cell Proliferation in Experimental Acute Tubular Necrosis Induced by Intramuscular Glycerol Injection.: Wan Seop Kim, Jung Woo Noh, Moon Hyang Park; Korean J Pathol. 2003;37(1):41-49.

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Abstract PDF: BACKGROUND
Acute tubular necrosis (ATN) is the most common cause of acute renal failure. It is characterized by the destruction of tubular epithelial cells. To examine apoptosis and proliferative activity of tubular cells in the course of acute tubular necrosis, we induced acute renal failure by intramuscular hypertonic glycerol injection to New Zealand White rabbits.
METHODS
The immunohistochemistry was done for Ki-67 and tissue-transglutaminase (tTG), and the terminal deoxynucleotidyl transferase mediated nick end labeling (TUNEL) method was performed using a total of 77 renal specimens including 29 gun biopsies and 48 nephrectomiy specimens.
RESULTS
Widespread tubular injury with pigment casts and interstitial hemorrhage were noted. The tubular proliferation index was increased at 2 hours after glycerol injection, and the index peaked at 3 hours. The second cell proliferation peak was noted at 3 days. Apoptotic cells were identified by TUNEL and tTG staining. The apoptotic index was significantly increased, and it peaked at 24 hours after glycerol injection. There was a significant correlation between the proliferation index (MIB-1) the and the apototic index (TUNEL)(p= 0.001). A DNA ladder pattern was observed at 6 to 8 hours.
CONCLUSIONS
Tubular cell proliferation and apoptosis occur in the early phase after the induction of acute tubular necrosis, and the excess hyperplastic epithelial cells appear to be eliminated by apoptosis.

Uterine Leiomyoma with Massive Lymphocytic Infiltration.: Won Mi Lee, Moon Hyang Park; Korean J Pathol. 2003;37(1):71-73.

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Abstract PDF: Uterine leiomyoma with massive lymphocytic infiltration is known to be associated with Gona-dotropin releasing hormone (GnRH) agonist treatment. The lymphocytic cells in those cases were composed predominantly of T-lymphocytes. We report an unusual case of uterine leiomyoma with massive lymphocytic infiltration, composed predominantly of B-lymphocytes, without a history of GnRH agonist treatment. A 59-year-old woman underwent a transvaginal hysterectomy for uterine leiomyomas. Microscopically, the leiomyoma showed a massive infiltration of the lymphocytes, histiocytes, and also showed scattered plasma cells and many lymphoid follicles. The lymphocytic infiltrates were confined to the leiomyoma. These lymphocytic cells mainly represented the B-cell phenotype. She had no history of GnRH agonist treatment. To the best of our knowledge, This is the first reported case in Korea.

Cervical Cancer Screening in Korea.: Moon Hyang Park; Korean J Cytopathol. 2003;14(2):43-52.

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Abstract PDF: The incidence of cervical cancer has been gradually decreased since 1990, now it ranks the fourth most common carcinoma among Korean women in 2001. If squamous cell carcinomas in situ are included, the cervical cancer is still the most frequent tumor in Korean women. However, cervical cancer mortality in Korea has been decreased over the last 10 years in large part attributable to the introduction of the Papanicolaou test (Pap. test). The guidelines for the early detection of cervical cancer recommend women aged 30 and more to take biennial screening with Pap. test. According to the screening data of National Health Insurance Corporation (NHIC), 4,425 women (0.94%) showed an abnormal Pap among 473,395 cases tested in 2001; dysplasia was in 3,953 (0.84%) women, in situ carcinoma in 357 (0.075%) women, and invasive carcinoma in 115 (0.024%) women. The detection rates of abnormal Pap. were 4.21% in Korean Society for Cytopathology (KSC-2001), 1.37% (ASCUS : 0.26%, AGUS : 0.03%, LSIL : 0.45%, HSIL : 0.55%, Carcinoma : 0.09%) in health check-up and 5.41% (ASCUS : 1.89%, AGUS : 0.69%, LSIL : 1.39%, HSIL : 0.84%, Carcinoma : 0.64%) of patients in out-patient clinic without having history of cervical neoplasia at Hanyang University Hospital in 2002. Low rate of cervical cancer screening (34%) in Korea is mainly due to the lack of information for the low income people regarding national cancer screening program. More adequate budget by government and more man-power for precise screening, new guideline and system for management of the cervical cancer patients are required.

Cytologic Findings of Parathyroid Carcinoma: Report of Two Cases.: Yun Hee Jin, Yong Wook Park, Mi Sheon Jin, Seung Sam Paik, Se Jin Jang, Moon Hyang Park; Korean J Cytopathol. 2003;14(1):1-6.

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Abstract PDF: Parathyroid carcinoma is a rare disorder accounting for 0.5% to 5% of parathyroid neoplasia. Diagnosis of parathyroid carcinoma in fine needle aspiration cytology(FNAC) is difficult because all characteristic features of parathyroid carcinoma can be recognized in parathyroid adenoma or hyperplasia. Cellular atypism cannot be used for the diagnostic criteria of parathyroid carcinoma as malignancies of most other organs. We experienced two cases of cytologic features of parathyroid carcinoma confirmed by histologic examination. The majority of tumor cells formed large cohesive clusters, although individual tumor cells were also present. The tumor cells displayed rather pleomorphic round to oval nuclei, occasional prominent nucleoli, and distinct cytoplasmic margin. Occasionally karyolysis, anuclear cells, and nonepithelial cell clusters were noted. The histologic findings showed a partially lobulated architecture, with admixture of sheets of chief cells, oxyphil cells, and occasional water clear cells. The tumor infiltrated into the thyroid parenchyme and perithyroidal soft tissue. The electron microscopic study of case 1 disclosed typical findings of parathyroid neoplasm; clusters of secretory chief cells with centrally located round to ovoid nuclei, moderately clumped heterochromatins and one or two nucleoli. The tumor cells showed conspicous interdigitation of contiguous cell membrane and intercellular microvilli.

Composite Epithelioid Hemangioendothelioma in Pleural Effusion Mimicking Metastatic Adenocarcinoma: Cytologic and Immunocytochemical Findings.: Ki Seok Jang, Hong Xiu Han, Moon Hyang Park; Korean J Cytopathol. 2003;14(1):36-41.

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Abstract PDF: Epithelioid hemangioendothelioma is a rare vascular tumor of borderline malignancy which is characterized by the presence of "epithelioid" or "histiocytoid" endothelial cells. Superficial and deep tumors have been recognized in the extremities, head, neck, chest, and mediastinum of adult patients. It may also occur as a primary tumor of liver, bone, and other visceral organs. Few effusion cytologic findings of epithelioid hemangioendothelioma have been reported. We report a case of composite epithelioid hemangioendothelioma with focal epithelioid angiosarcomatous areas of the iliac bone and adjacent soft tissue in a 38-year-old female, which, during its metastatic course, was presented as a pleural effusion. The effusion was cellular with epithelioid cells presenting both singly and in clusters. The tumor cells were round to ovoid showing cytoplasmic vacuolization, variability in cell size, and prominent nucleoli. The effusion smears and cell block sections revealed strong positive staining for CD31 and vimentin, weak positive for CD34 and Factor VIII-related antigen, and negative for cytokeratin, CEA, and calretinin. The cytologic findings in this case were similar to that of metastatic adenocarcinoma or malignant mesothelioma. Therefore, immunocytochemical staining in smear and cell block is a helpful tool to differentiate malignant "epithelioid" cells in effusion.

Apoptosis in Renal Hypertrophy after Uninephrectomy in the Rats.: Chan Pil Park, Jung Woo Noh, Joo Seob keum, Myung Sook Kim, Moon Hyang Park; Korean J Pathol. 2001;35(6):513-523.

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Abstract: BACKGROUND
Glomerular compensatory hypertrophy maintains decreased renal function after uninephrectomy (UNX). Proliferation and apoptosis of renal cells may be involved in hypertrophy.
METHODS
In small and large male Sprague-Dawley rats, contralateral kidneys were harvested 1, 7, 14 and 30 days after UNX. Apoptosis was assessed by the Tdt-mediated dUTP-digoxigenin nick end labelling method. Proliferating cell nuclear antigen and Fas ligand (FasL) expression was determined by immunohistochemically.
RESULTS
Morphometrically, glomerular hypertrophy was observed in both small and large rats after UNX, and it was more significant in the small rats. The glomerular proliferation index (PI) was gradually increased from day 7 but decreased on day 30 in the small rats. Glomerular PI was significantly increased from day 7 in large rats and peaked at day 14. Apoptotic cells in the glomeruli were slightly increased on day 1 and on day 7 in both groups of rats. The expression of FasL was gradually increased in the distal tubular epithelium in both groups.
CONCLUSIONS
These results demonstrate different profiles regarding the compensatory growth of the kidney, cell proliferation, and apoptosis during the period of compensatory hypertrophy in uninephrectomized rats of different weight and age. Apoptosis may play a role in regressing a number of proliferated cells during renal compensatory hypertrophy.

A Case of Solitary Cutaneous Myofibroma of the Thigh in An Adult.: Jung Hwan Park, Chang Woo Lee, Young Chae Chu, Moon Hyang Park; Korean J Pathol. 2001;35(4):354-356.

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Abstract PDF: Adult solitary cutaneous myofibroma is a recently described benign neoplasm of the skin or subcutis, representing the adult counterpart of infantile myofibroblastoma. The histologic and immunohistochemical features of a 21-year-old woman with a solitary brownish, mildly tender nodule on her right thigh are reported here. The nodule had been present for a duration of 3 years. It showed a nodular dermal mass with an irregular margin. The lesion consisted of interlacing bundles of spindle cells which were positive for smooth muscle actin, muscle specific actin and vimentin. Immunohistochemical stainings for desmin, S-100 protein, CD 34 and CD 68 were negative. Cutaneous myofibroma in an adult is a distinct entity of benign neoplasm.

Cytologic diagnosis of a chordoma without physaliferous cells: A case report.: Yun Hee Jin, Chan Kum Park, Won Mi Lee, Moon Hyang Park; Korean J Cytopathol. 2001;12(2):131-134.

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Abstract PDF: Cytologic features of conventional chordoma have been described and most reports emphasize the presence of large cells with numerous well defined cytoplasmic vacuoles or physaliferous cells. We report fine needle aspiration cytologic (FNAC) findings of a case of chordoma without physaliferous cells. The smear was cellular and composed of large cohesive clusters or individually scattered cells in mucinous background. The round or cuboidal cells had centrally located nuclei with fine granular chromatin, inconspicuous nucleoli, and occasional vacuolated cytoplasm. Mild to moderate pleomorphism was noted. Physaliferous cells are extremely helpful when present in cytologic material, but they are not necessary for diagnosis. Thus clinical history, roentgenographic appearance, and exact location of the lesion are required for the successful interpretation of presacral aspirates together with cytologic findings.

The Bethedsa System 2001 Workshop Report.: Eun Kyung Hong, Jong Hee Nam, Moon Hyang Park; Korean J Cytopathol. 2001;12(1):1-15.

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Abstract PDF: The Bethesda System (TBS) was first developed in 1988 for the need to enhance the communication of the cytopathologic findings to the referring physician in unambiguous diagnostic terms. The terminology used in this reporting system should reflect current understanding of the pathogenesis of cervical/vaginal disease, so the framework of the reporting system should be flexible enough to accommodate advances in medicine, including virology, molecular biology, and pathology. Three years after the introduction of TBS, the second Bethesda workshop was held to set or amend diagnostic criteria for each categories of TBS. TBS 1991 is now widely used. The third Bethesda workshop, The Bethesda System 2001 Workshop, was held in National Cancer Institute, Bethesda, Maryland from April 30 to May 2, 2001. Again, the goals of this workshop were to promote effective communication and to clarify in reporting cervical cytopathology results to clinicians and to provide with the information to make appropriate decisions about diagnosis and treatment. Nine forum groups were made and there were Web-based bulletin board discussions between October, 2000 and the first week of April, 2001. On the basis of bulletin board comments and discussions, the forum moderators recommended revised terminologies in the Workshop. Hot discussions were followed after the presentation by forum moderators during the workshop. Terminologies confusing clinicians and providing no additional informations regarding patient management were deleted in the workshop to clarify the cervicovaginal cytology results. Any informations related to the patient management were encouraged to add. So 'Satisfactory for evaluation but limited by' of 'Specimen Adequacy' catergory was deleted. Terminology of 'Unsatisfactory' was further specified as 'Specimen rejected' and 'Specimen processed and examined, but unsatisfactory'. Terminologies of 'Benign Cellular Change' and 'Within Normal Limits' were combined and terminology was changed to 'Negative for intraepithelial lesion

Pigmented Mediastinal Paraganglioma: A case report.: Seong Ho Kim, Yoon Hee Jin, Eun Kyung Hong, Moon Hyang Park; Korean J Pathol. 2000;34(8):597-600.

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Abstract PDF: Pigmented extraadrenal paraganglioma is an unusual neoplasm that has rarely been reported in the literature. Based on histochemical staining or electron microscopy, pigment has been classified as lipofuscin, neuromelanin or true melanin. We report a case of pigmented extraadrenal paraganglioma in the posterior mediastinum of a 70-year-old woman. Histologically, the tumor had a characteristic organoid architecture of "zellballen" pattern with rich delicate microvasculature. Tumor cells contained numerous coarse brown-black pigment granules. Ultrastructurally, the tumor showed abundant large electron-dense pigment granules that vary in size and shape and smaller membrane-bound neurosecretory granules. The larger granules were consistent with neuromelanin or lipofuscin. Histochemically, the pigment is most likely neuromelanin, which is a waste product of catecholamine metabolism.

The Role of MIB-1 Expression and Apoptosis in Experimental Crescentic Glomerulonephritis.: Nam Hoon Kim, Wan Seop Kim, Jung Woo Noh, Moon Hyang Park; Korean J Pathol. 1999;33(4):231-242.

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Abstract PDF: It has been postulated that programmed cell death via apoptosis may be critical for remodelling of glomeruli after inflammatory injury. To understand the regulatory mechanism of apoptosis in experimental crescentic glomerulonephritis (CGN), we examined the MIB-1 score (proliferation index, PI) and apoptotic index during the progression of experimental CGN to end-stage renal failure. CGN was induced in New Zealand White rabbits by administration of guinea pig anti-GBM IgG after sensitization with guinea pig IgG and their kidneys were analyzed for the development of crescents through sequential renal biopsies. Serum creatinine levels progressively increased in a time course until day 45. The PI in glomeruli, tubular epithelial cells, and interstitium progressively increased during the progression of experimental CGN. The mean numbers of MIB-1 positive intraglomerular nuclei (PI) were significantly correlated with degrees of crescent formation and the numbers of apoptotic cells in the glomeruli, tubules, and interstitium. Significant apoptosis was present from day 1 (15.8 10.16 cells/glomerular cross section) and increased in number with the proliferative lesions as glomerular inflammation continued. Moreover, apoptosis increased during the resolution of the glomerular inflammation, and many apoptotic cells were present in the sclerotic lesions in day 17 (18.6 12.99 cells/glomerular cross section). As glomerular inflammation subsided, cellular crescents progressed to fibrous crescents with a reduction of cellularity by day 45. On day 45, the glomerular PI and the numbers of apoptotic cells were markedly decreased. The correlations found in CGN between the creatinine level and the percentage of crescents, between the percentage of crescent and PI, and between the PI and number of apoptotic cells support the hypothesis that there is a change in the glomerular and tubulo-interstitial apoptosis under pathologic conditions. These findings indicate that apoptosis plays an essential role in the resolution of intra- and extraglomerular inflammation and in the elimination of glomerular cells within the sclerotic regions for progressive CGN. The regulation of the apoptotic phenomenon and increased PI during CGN may be important in the progression of glomerular inflammation and the development of pathologic glomerular sclerosis.

Localized Cystic Disease of the Kidney: A case report.: Wan Seop Kim, Moon Hyang Park; Korean J Pathol. 1999;33(3):210-213.

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Abstract PDF: Localized cystic disease of the kidney is a rare entity with the gross and microscopic features of autosomal dominant polycystic kidney disease localized to only a portion of a kidney, and negative family history. We report a case of localized cystic disease of the kidney in a 38-year-old woman who complained of intermittent right flank pain for 1 year. The resected kidney showed multiple cysts measuring up to 4.0 3.5 3.0 cm, which were scattered throughout the mid- and lower poles of the kidney. Microscopically, the cystic lesion was composed of numerous cysts of variable size, lined by flattened epithelium. The intervening septa of the cysts contained normal or compressed renal tubules and glomeruli. Neither dysgenetic tissue such as immature cartilage or primitive mesenchymal tissue nor malignant cells was identified. Localized cystic disease should be included in the differential diagnosis of cystic lesions in the kidney.

Liesegang Structure in Simple Hemorrhagic Cyst Incidentally Found in Donor Kidney: A case report.: Dong Hoon Kim, Moon Hyang Park; Korean J Pathol. 1999;33(2):133-136.

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Abstract: Liesegang rings (LRs) are peculiar structure of periodic precipitation zones from supersaturated solution in colloidal system. LRs are formed by a process referred to as "the Liesegang phenomenon". Here we describe LRs in renal hemorrhagic cyst from the donor kidney of a 59-year-old man. His general condition was good. Abdominal ultrasonography revealed a simple cyst in the left kidney. After donor nephrectomy for renal transplantation, a 3x2 cm sized cyst containing the brownish necrotic fluid was noted in the upper pole of left kidney. Frozen section from the relatively thickened cystic wall was performed. During frozen section examination, round concentric rings with double-layered outer wall, striations and amorphous central nidus admixed with the foamy macrophages were found and the lesion was originally interpreted as xanthogranulomatous inflammation with unusual crystalline structures in the cytoplasm of macrophages or freely in the interstitium. Macrophages with calcium crystals or malakoplakia were also considered at that time. Additional specimen for the permanent sections showed a simple hemorrhagic renal cyst with areas of small or large aggregates of LRs along the cyst wall. Multiple round ring-like structures ranging from 11 to 42 micrometer in diameter had uniform, pale eosinophilic, radially striated double wall. Histochemical and immunohistochemical stainings for iron, calcium, mucopolysaccharide, amyloid, cytokeratin were negative in these structures. They were highlighted by CD68 immunostaining as well as PAS and Masson's trichrome stainings. Awareness of Liesegang phenomenon in cystic lesions will decrease the possibility of erroneous diagnosis as another type of pathologic process, such as parasitic worms or eggs.

Fine Needle Aspiration Cytology of Inflammatory Pseudotumor of the Lung: Report of A Case Misdiagnosed as Adenocarcinoma .: Wan Seop Kim, Eun Kyung Hong, Moon Hyang Park; Korean J Cytopathol. 1999;10(2):145-149.

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Abstract PDF: Cytologic features of inflammatory pseudotumor of the lung have not been described frequently. We report fine needle aspiration cytologic(FNAC) finding of a case of inflammatory pseudotumor misdiagnosed as adenocarcinoma in a 63-year-old man. The FNAC displayed a mixture of histiocytes, myofibroblasts, pneumocytes, and plasma cells. Some histiocytes and myofibroblasts had large nuclei with irregular nuclear membrane and prominent nucleoli, which mislead the diagnosis of adenocarcinoma on FNAC. The heterogeneous cell population is the unique cytologic features of inflammatory pseudotumor, which are helpful to distinguish it from other circumscribed benign and malignant lesions. Familiarity with these features is essential to avoid misdiagnosis and possible overtreatment.

Fine Needle Aspiration Cytology of the Hyalinizing Trabecular Adenoma of the Thyroid Gland: A Case Report .: Seong Ho Kim, Seung Sam Paik, Moon Hyang Park; Korean J Cytopathol. 1999;10(2):175-178.

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Abstract PDF: Hyalinizing trabecular adenoma is an uncommon benign thyroid tumor that is recently described in the literature. This tumor is easily confused with medullary carcinoma on surgical specimens and with papillay carcinoma on cytologic specimens. Herein we report the cytologic characteristics of a case of histologically proven hyalinizing trabecular adenoma of the thyroid gland. Cytologically, the aspirate showed trabecular or individually dispersed polygonal cells with finely stippled chromatin pattern, nuclear grooves, and eosinophilic nuclear pseudoinclusions. No colloid materials were noted in the background.

Primary Hepatic Leiomyosarcoma.: Won Mi Lee, Chan Kum Park, Eun Kyung Hong, Moon Hyang Park, Jung Dal Lee; Korean J Pathol. 1998;32(12):1092-1094.

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Abstract: Primary hepatic sarcoma is a rare tumor, with fewer than 60 previously reported cases. It is thought to arise from hepatic connective tissue or vascular channels. The tumor is located usually in the intrahepatic area. Pedunculated or bulging lesion is also reported. We report a case of primary leiomyosarcoma of the liver occuring in a 62-year-old Korean woman. A pedunculated, 21 16 cm sized mass is located in the left lateral segment of the liver. Microscopically, the tumor is hypercellular and composed of elongated, partly pleomorphic spindle cells with blunt-ended nuclei, which are focally reactive for muscle specific actin. Mitotic figures are 5/10 high power fields (HPFs). No other primary site is recognized on clinical study.

Prognostic Significance of the Tall Cell Variant of Papillary Thyroid Carcinoma: Expression of p53, bcl-2 & Leu-M1 proteins.: Won Mi Lee, Joo Seob Keum, Eun Kyung Hong, Moon Hyang Park, Jung Dal Lee; Korean J Pathol. 1998;32(11):1000-1007.

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Abstract: Papillary carcinoma of the thyroid is a well differentiated neoplasm and usually has a good prognosis. However, a subset of morphologically distinct papillary carcinoma has bad prognoses. The tall cell variant of papillary carcinoma (TCPC), characterized by tall columnar cells with a height at least twice the width, is the one of these. In order to differentiate TCPC from usual papillary carcinoma (UPC) in terms of prognosis, we performed immunohistochemical studies for the expression of p53, bcl-2 and Leu-M1 proteins in 25 cases of TCPC, 26 cases of UPC and 14 cases of poorly differentiated, solid type papillary carcinoma (SPC) with an analysis of clinical parameters. The nuclear expression of p53 was noted in one case each of UPC and TCPC. The cytoplasmic p53 expression of TCPC, UPC, and SPC was observed in 17/25 cases (68%), 14/26 cases (54%), 3/14 cases (21%), respectively. bcl-2 expression was 19/25 cases (76%), 18/26 cases (69%), 5/14 cases (36%), and that of Leu-M1 was 21/25 cases (84%), 18/26 cases (69%), 4/14 cases(29%), respectively. There were no statistical significance in the expression of those immunoproteins among these three groups (p>0.05). The p53 protein was consistently expressed in the cytoplasm rather than nucleus in this study and was very well correlated to bcl-2 positivity (p<0.01). There were no statistical significance in any clinical parameters examined among these three groups (p>0.05). In conclusion, TCPC can not be separated from UPC as a distinct entity in this study and the cytoplasmic expression of p53 protein provides another mechanism of p53 inactivation in tumorigenesis of the thyroid papillary carcinoma, possibly by bcl-2 related mechanism.

Sequential Changes of Extracellular Matrix mRNA in Anti-GBM Antibody Induced Crescentic Glomerulonephritis in the Rabbit.: Moon Hyang Park, Unn Wha Lee, In Sup Han, Rho Won Chun, Jung Woo Noh; Korean J Pathol. 1998;32(9):627-637.

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Abstract: Progressive renal fibrosis is considered to be the final common pathway leading to chronic renal insufficiency, however, the mechanism regarding renal fibrosis in renal injury is not well understood. Recently, several kinds of cytokines have been known to be related to fibrosis after renal injury. The interaction between elements regulating fibrogenesis would be better understood by looking at the effect of TGF-beta1 on the synthesis and accumulation of extracellular matrix, especially collagenous proteins. Crescentic glomerulonephritis (CGN) was induced in New Zealand White rabbits by administration of guinea pig anti-GBM IgG after sensitization with guinea pig IgG; and their kidneys were analyzed for the development of crescents and fibrosis through sequential renal biopsies. Serum creatinine levels in a time course progressively increased until day 15. We semi-quantitatively assayed the levels of the expression of alpha1(I) collagen mRNA and TGF-beta1 mRNA factored for GAPDH mRNA using RT-PCR. We observed a progressive interstitial fibrosis and the expression of collagen I both in the cortex and medulla. The effect of repeated renal biopsy itself on pathology and on the expression of alpha1(I) collagen mRNA and TGF-beta1 mRNA in a time course were not significant, but a very mild increase of the expression of alpha1(I) collagen mRNA was noted at day 15. Histology showed a progressive crescent formation and interstitial fibrosis in a time course that roughly paralleled the expression of alpha1(I) collagen mRNA in both cortex and medulla. TGF-beta1 mRNA was hardly expressed at day 0 in cortex as well as in medulla. It was elevated from day 1, peaked at day 7, and then decreased. In medulla, TGF-beta1 mRNA was noticeably expressed at day 1, peaked at day 4, and then decreased. The expression of alpha1(I) collagen mRNA was seen even before inducing CGN. It was gradually and continuously increased until day 15 both in cortex and medulla. These results suggest that the expression of TGF-beta1 mRNA precedes that of alpha1(I) collagen mRNA in the early stage of CGN and has a central role for provoking the accumulation the collagen I, the most representative interstitial extracellular matrix, in the rabbit model CGN induced by anti-GBM antibody. We conclude that the measurement of the expression of TGF-beta1 mRNA and/or alpha1(I) collagen mRNA in a biopsy sample can be a useful predictor for renal outcome.

Prognostic Significance of PCNA Index and AgNORs Score in Transitional Cell Carcinoma of the Renal Pelvis.: Wan Seop Kim, Seung Sam Paik, Nam Hoon Kim, Moon Hyang Park, Jung Dal Lee; Korean J Pathol. 1998;32(7):521-530.

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Abstract: Proliferative activity of a malignant tumor is known to reflect its biological aggressiveness. Proliferating cell nuclear antigen (PCNA) is a marker of cellular proliferation, and silver-stained nucleolar organizer regions (AgNORs) have been shown to correlate with ploidy and proliferative activity of cells. In transitional cell carcinoma of the renal pelvis, the prognostic value of these markers has not been well defined. We studied PCNA expression and the AgNORs count in 22 transitional cell carcinoma of the renal pelvis to assess their prognostic significance compared with their cumulative survival rate, the stage of disease and histopathologic features of the tumors. An immunohistochemical method and a standard colloidal silver staining were used. The mean percentage of PCNA positivity (PCNA index) and the mean number of AgNORs per nucleus (AgNORs score) were determined. In a multivariable analysis, PCNA indexes were significantly associated with tumor stage (p=0.024), whereas AgNORs scores were not significantly associated with the stage or histopatholgic features of the tumors. Histologic grade was correlated to disease stage at a significant level (p=0.000). But there was a trend of low tumor PCNA-indices or AgNORs counts with survival advantage for patients, but this did not reach statistical significance. The results suggest that the fraction of PCNA positive nuclei would be useful for investigating the malignant potential of renal pelvic cancers, although their clinical use as markers of biologic behavior may be limited.

Clinicopathologic Analysis of Membranous Glomerulonephropathy.: Seok Hoon Jeon, Moon Hyang Park; Korean J Pathol. 1998;32(6):420-430.

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Abstract: Membranous glomerulonephropathy (MGN) is the most common primary cause of the nephrotic syndrome in adults, accounting for about 20% of the cases in most series. MGN is idiopathic in the majority of cases, however approximately 25% of adults have identifiable causes (secondary MGN). To evaluate the clinical and pathologic characteristics of MGN, we reviewed the clinical data and renal biopsies from 141 cases of MGN. The mean age of the patients at biopsy was 43 years old, but patients of all age were seen (range from 3 to 76 years of age). There were 88 males and 53 females. There were 99 idiopathic MGN cases and 42 secondary MGN cases. The associated causes of secondary MGN included hepatitis B infection (18 cases), SLE (10 cases), drugs (4 cases), post-transplantation MGN (5 cases), diabetes mellitus (4 cases), syphilis (1 case) and hepatitis B infection associated with rheumatoid arthritis. The prevalence of histologic stages by Ehrenreich and Churg was as follows. Stage I was 24 cases, stage II was 72 cases, stage III was 35 cases, and stage IV was 9 cases. All patients had proteinuria. Nephrotic syndrome was observed in 39%, edema in 73%, microscopic hematuria in 49%, gross hematuria in 28%, hypertension in 13%, and the serum creatinine level above 1.5 mg/dl was in 13%. Cases with glomerulosclerosis was observed in 45 cases with an increased percentage of glomerulosclerosis in the higher grade. Immunofluorescence (IF) examination showed predominantly granular IgG (118 cases) and C3 (84 cases) stainings along the glomerular capillary wall. In idiopathic MGN, sparse mesangial IF staining was noted up to 10% of the cases. However, mesangial IF staining in SLE was observed in 33%, hepatitis B infection in 28% and diabetes mellitus in 50%. An electron microscopic examination revealed subepithelial electron dense deposits of immune complex in all cases. The prevalence of mesangial and subendothelial electron dense deposit in idiopathic MGN was present in 19% and 6%, respectively. In SLE cases, mesangial and subendothelial deposits were observed in 78% and 56%, respectively. In hepatitis B infection, mesangial and subendothelial deposits were observed in 54% and 69%, respectively. In conclusion, immune deposits in the mesangium are scanty in idiopathic MGN, and if pronounced this should increase suspicion of underlying systemic diseases, such as SLE or other infectious diseases.

Carcinosarcoma of the Female Genital Tract: Immunohistochemical study on transitional area further supports the metaplastic origin.: Chan Pil Park, Joo Seob Keum, Gu Kong, Moon Hyang Park, Jung Dal Lee; Korean J Pathol. 1998;32(5):370-377.

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Abstract: Carcinosarcoma of the female genital tract, also called malignant mixed mullerian tumor (MMMT), is a rare and relatively aggressive tumor with various homologous and heterologous components. There have been various studies to find prognostic factors and to investigate the histogenesis, including tissue culture, electron microscopy, and immunohistochemical studies. We investigated carcinomatous, sarcomatous, and transitional areas of 6 cases of carcinosarcoma of the uterus and ovary by using epithelial and mesenchymal markers. Immunohistochemical profiles of the transitional areas were significantly different from those of carcinomatous and sarcomatous areas. Immunoreactivities for cytokeratin and epithelial membrane antigen (50% and 22.2%) were weaker than those of carcinomatous areas (95.2% and 100%), but stronger than those of sarcomatous areas (11.1% and 5.6%)(p<0.01). In transitional areas, vimentin, smooth muscle actin and S-100 protein were more strongly expressed than in carcinomatous areas, but more weakly expressed than in sarcomatous areas (p<0.01, p<0.01, and p=0.018, respectively). Myoglobin was entirely negative in carcinomatous areas and immunoreactive in minor portions of transitional and sarcomatous areas (22.2% and 16.7%, respectively). These results suggest that the transitional areas are between the carcinomatous and sarcomatous nature in differentiation, further supporting that the carcinosarcomas of the female genital tract may arise, through metaplastic change, from a type of carcinoma.

Intraductal Variant of Peripheral Cholangiocarcinoma of the Liver A report of three cases.: Won Mi Lee, Seok Hoon Jeon, Eun Kyung Hong, Moon Hyang Park, Jung Dal Lee; Korean J Pathol. 1998;32(3):222-225.

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Abstract PDF: Intraductal variant of peripheral cholangiocarcinoma is extremely rare. This variant shows intraductal growth and intraluminal extension without any infiltrative growth. The mode of intraductal growth is not known. The prognosis of this variant is better than that of usual cholangiocarcinoma. We report three cases, one of which is associated with Clonorchis sinensis (CS) infection. The tumors were entirely confined within the dilated peripheral tributaries of the intrahepatic bile duct. Microscopically, the tumors were well to moderately well differentiated, with a papillary or a micropapillary growth pattern. Focal clear cytoplasmic change and mucin production were noted. The tumors showed intraductal spreading without any invasion to the liver parenchyme. Mucosal hyperplasia and dysplasia were noted in the adjacent ducts. The authors assume that intraductal cholangiocarcinoma is a distinct subtype, and persistent irritation, such as, CS infection may undergo a malignant transformation through mucosal dysplasia.

Alteration in Extracellular Matrix Components in Preeclamptic Nephropathy.: Moon Hyang Park, Seung Sam Paik; Korean J Pathol. 1998;32(3):186-192.

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Abstract PDF: The preeclamptic nephropathy is characterized by swelling of endothelial cells, interposition of mesangial cells and matrix, subendothelial deposits of incompletely defined material, and thickening of the capillary walls. To determine the distribution of extracellular matrix (ECM) components in preeclamptic nephropathy, the immunohistochemical study was performed in ten renal biopsy cases using antisera to human type I, III, IV, and VI collagens, fibronectin, and laminin. In preeclamptic nephropathy, the accumulation of type IV and VI collagens, fibronectin was observed in moderate amount in the mesangium and, to some extent, in the thickened capillary walls, particularly in the subendothelial layer. In segmentally sclerotic lesions seen in six cases, the amount of type IV collagen was partly decreased, whereas those of type VI collagen and fibronectin were slightly increased. Type I collagen was expressed to a mild degree in the expanded mesangium and segmentally sclerotic lesions. The results suggest that the expression of ECM in the mesangium is increased in preeclamptic nephropathy, and the deposition of ECM components may be involved in the development and the reparative process of the characteristic glomerular lesions. The formation of sclerotic lesions may be linked to the alternative accumulation of ECM components.

Granular Cell Tumor of the Thyroid.: Haeng Ji Kang, Eun Kyung Hong, Moon Hyang Park, Jung Dal Lee; Korean J Pathol. 1998;32(1):63-67.

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Abstract PDF: Granular cell tumor is not uncommon and is a well recognized entity which may arise at virtually any site of the body. However, occurrence in the thyroid is extremely rare and has not been described well. Only three cases could be found in the English literatures. We report a case of granular cell tumor of the thyroid in a 30 year-old woman. The tumor was illdefined, infiltrative and was composed of diffuse sheets of polygonal to fusiform cells with abundant eosinophilic granular cytoplasm. The tumor showed evidence of Schwann cell differentiation in immunohistochemical and ultrastructural examinations. Differentiation from more common thyroid tumors having oncocytic granular cytoplasm should be made by immunohistochemistry or electron microscopy.

Cytopathologic Analysis on Fine Needle Aspiration Cytologic Misdiagnoses of the Thyroid .: Chan Pil Park, Joo Seob Keum, Won Mi Lee, Moon Hyang Park, Jung Dal Lee; Korean J Cytopathol. 1998;9(2):169-180.

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Abstract PDF: Fine needle aspiration cytology(FNAC) has been used effectively as the initial modality in evaluating various thyroid lesions. We correlated cytologic and histopathologic features to investigate the diagnostic pitfalls of FNAC of the thyroid. A total of 1,593 FNACs of the thyroid were diagnosed at the Department of Pathology, Hanyang University Hospital, from January 1993 to December 1997. There were 963 cytologically benign cases(60.5%), 97 suspicious cases(6.1%), and 75 malignant cases(4.71%). The remaining 458 cases(28.8%) were unsatisfactory. Subsequent surgical resection was done in 192 cases. Seventy-two cases(37.5%) were cytologi cally diagnosed as benign, 45 cases(23.4%) suspicious, 56 cases(29.2%) malignant, and 19 cases(9.9%) unsatisfactory. Histopathologically, 101 cases were benign(11 thyroidites, 52 adenomatous hyperplasias, 34 follicular adenomas, and four Hurthle cell adenomas), and 91 cases malignant(72 papillary carcinomas, 16 follicular carcinomas, one medullary carcinoma, one anaplastic carcinoma, and one granular cell tumor). After excluding 19 unsatisfactory cases, 63 were misdiagnosed. They included 17 benign(three thyroidites and 14 adenomatous hyperplasias), 27 suspi cious(16 follicular adenomas, four Hurthle cell adenomas, and seven follicular carcinomas), and 19 malignant(16 papillary carcinoma, one medullary carcinoma, one anaplastic carcinoma, and one granular cell tumor) lesions. The accuracy rates in the benign, suspicious, and malignant categories were 54.9%, 49.8%, & 92.8%, respectively. The cytological pitfalls were as follows: (1) bloody background, (2) crowded follicular cell clusters indistinguishable between follicular neoplasia and adenomatous hyperplasia, (3) papillary structure, irregular nuclear membrane and pleomorphism mimicking those of papillary carcinoma, (4) indistinct eosinophilia in follicular epithelial cells, (5) unusual cellular components not commonly seen in FNACs of the thyroid.

Fine Needle Aspiraton Cytology of Polymorphous Low Grade Adenocarcinoma in the Hard Palate: A Case Report .: Wan Seop Kim, Seok Hoon Jeon, Eun Kyung Hong, Moon Hyang Park, Jung Dal Lee; Korean J Cytopathol. 1998;9(2):181-186.

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Abstract PDF: Polymorphous low grade adenocarcinoma(PLGA) is a rare malignant tumor of the salivary gland. It is characterized by diverse histology, bland-looking cytology, indolent behavior and favorable prognosis. The fine needle aspiration cytologic features of PLGA are described. The aspirates from the hard palate in a 33-year-old woman showed cellular smear composed of monotonous small round to oval cells with scanty cytoplasm. Papillary, tubular and cell ball arrangements with characteristic dense stromal spheres were recognized. PLGA could be suggested by fine needle aspiration cytology, if one encountered cellular smear with various architectures and uniform bland-looking cytologic feature.

Fine Needle Aspiration Cytology of Glycogen-Rich Clear Cell Carcinoma of the Breast: A Report of Two Cases .: Wan Seop Kim, Won Mi Lee, Eun Kyung Hong, Moon Hyang Park, Jung Dal Lee; Korean J Cytopathol. 1998;9(2):213-219.

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Abstract PDF: Glycogen-rich clear cell carcinoma of the breast is an unusual variant of carcinoma with a recorded incidence of 1.4-3% of breast carcinomas. The cytologic characteristics have not been well described. We report two cases of glycogen-rich clear cell carcinoma with corresponding fine needle aspiration(FNA) cytologic findings and compare them to infiltrating ductal carcinoma and other clear cell malignancies with a review of literature. One was a 62-year-old woman exhibiting a palpable mass of the right breast. The smears showed atypical tight cell clusters and individually scattered single cells containing foamy or clear abundant cytoplasm with well defined cytoplasmic margins. Mild to moderate nuclear pleomorphism and a prominent nucleolus were present. The other was a 42-year-old woman who was admitted with a right breast mass. The smears showed moderately cellular, tightly cohesive tumor cells. The cytoplasmic outline was generally well demarcated. The tumor cells contained foamy to clear abundant cytoplasm with large and small vacuoles. The nuclear pleomorphism was marked. Both tumors resected by modified radical mastectomy, were diagnosed as glycogen-rich clear cell carcinoma. Histologically, the clear cell nature of tumor cells were not characteristic enough to predict this type of the tumor. Some cytologic features can be distinguished other clear cell breast cancer from glycogen-rich carcinoma. Recognition of these unusual patterns in a breast FNAC should raise the suspicion of a clear cell carcinoma including glycogen-rich subtype. Cytological localization of glycogen using PAS and D-PAS staining may permit the correct identification and differential diagnosis of this tumor.

Composite Adenocarcinoma and Choriocarcinoma of the Sigmoid Colon with Hepatic Metastasis of the Choriocarcinomatous Component.: Young Ha Oh, Won Mee Lee, Kyung Sook Kim, Moon Hyang Park, Jung Dal Lee; Korean J Pathol. 1997;31(8):788-793.

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Abstract PDF: A rare case of hepatic metastasis with a choriocarcinomatous component from a composite adenocarcinoma and choriocarcinoma of the sigmoid colon in a 60-year-old man is reported. The hepatic metastasis displayed choriocarcinoma with extensive hemorrhagic necrosis. The tumor cells were poorly differentiated with scattered foci of bizzare syncytiotrophoblastic cells. Retrospective examination of the previous colonic carcinoma proved that the tumor was composed of two distinctive elements. One was a moderately well differentiated adenocarcinoma located in mucosa and submucosa. The other was a deep seated and undifferentiated carcinoma which was made up of hyperchromatic bizzare cells with syncytiotrophoblastic cells. There were transitional foci from adenocarcinoma to undifferentiated carcinoma with trophoblastic cells. Immunohistochemical staining showed beta-hCG expression in the undifferentiated cells of both the primary and the metastatic tumors. Implications for the possible origin and cause of tumor cell heterogeneity are briefly discussed.

Alteration of p53 Tumor Suppressor Gene in Hyperplastic Lesions and Adenocarcinomas of Uterine Endometrium - Immunohistochemistry and PCR-SSCP.: Eun Kyung Kim, Chan Kum Park, Gu Kong, Moon Hyang Park, Jung Dal Lee; Korean J Pathol. 1997;31(7):662-671.

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Abstract PDF: To investigate the role of the p53 gene in the development of endometrial adenocarcinoma and to study the relation between alteration of the p53 gene and histologic grade, the author studied the alteration of thep53 gene in hyperplastic lesions and adenocarcinomas of the uterine endometrium. The study was carried out with immunohistochemical stain and PCR-SSCP. The materials included ten cases of endometrial hyperplasia (five simple and five atypical complex) and 18 cases of endometrial adenocarcinoma. Overexpression of the p53 protein were found in one of five atypical complex hyperplasias (20%) and 11 of 18 adenocarcinomas (61.1%). The intensity of p53 overexpression appeared to have increasing tendency with higher histologic grade of adenocarcinomas. Among the II cases of adenocarcinoma that overexpressed p53 protien, five cases (45.5%) were found to have mutations by PCR-SSCP. One was grade 1 (20%), two were grade 11 (25%), and two were grade III (40%). The sites of mutation were three exon 8, one exon 5, and one exon 6. In conclusion, alteration of the p53 gene may paly a role in the development of endometrial adenocarcinoma and appears to occur as a late event in carcinogenesis.HHowever, inactivation of the p53 gene in early stage of tumor development cannot be excluded.

Immunohistochemical Localization of Extracellular Matrix Components in Diabetic Nephropathy.: Seung Sam Paik, Moon Hyang Park; Korean J Pathol. 1997;31(5):427-435.

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Abstract PDF: Normal human glomerular basement membrane (GBM) and mesangial matrix (MM) contain several different basement membrane components in varying degrees. The characteristic morphological and ultrastructural changes in patients with diabetic nephropathy are the thickening of the GBM and the expansion of the MM. In order to investigate the changes of extracellular matrix components in diabetes, the immunohistochemical localization was performed in 17 cases with different degrees using antisera to human collagen types I, III, IV, VI, fibronectin, and laminin. The following results were obtained: 1. The reactivity for collagen IV was increased in expanded MM in the diffuse glomerulosclerosis (GS). With the progression to the nodule formation, collagen IV was prominently decreased in the peripheral area of the nodules. 2. Collagen VI was increased in GBM and MM in the diffuse GS, it was especially prominent in the expanded MM. With the progression to nodule formation, collagen VI was prominently increased in the periphery of the nodules. 3. Interstitial collagen I and III were not stained in many of the cases with the diffuse GS. With the progression to nodule formation, these were slightly expressed. A lamellar pattern of positive reaction was noted at the periphery of the late nodular lesions. 4. Fibronectin was increased in GBM & MM in the diffuse GS, it was especially intense in the MM. With the progression to the nodule formation, the reactivity of antibody to the fibronectin was decreased. 5. Laminin was weakly stained along the GBM & trace in the MM, but was not changed in the nodular GS. In summary, the expanded mesangial matrix in the diffuse GS showed a markedly increased staining for collagen IV, fibronectin and collagen VI. Less intense linear staining for collagen VI, fibronectin, laminin, collagen IV and collagen III was noted along the GBM. In the nodular GS, the composition of the early nodules resembled that of the diffuse GS. However, the late nodular lesion of the nodular GS revealed decreased reactivity for collagen IV and fibronectin at the periphery of the nodule, where collagen VI and interstitial collagen I and III were increased in laminated pattern.

Congenital Mesoblastic Nephroma.: Seok Hoon Jeon, Seung Sam Paik, Nam Hoon Kim, Moon Hyang Park, Jung Dal Lee; Korean J Pathol. 1997;31(4):375-378.

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Abstract PDF: Mesoblastic nephroma is an important differential diagnosis of a renal mass occurring in the neonatal period or in early childhood. It is a rare monomorphous congenital renal neoplasm most commonly recognized during the first 3 months of life. With the widespread application of ultrasound imaging, many cases are recognized prior to birth. We report a case of mesoblastic nephroma detected by ultrasonograph at 36 weeks of intrauterine fetal life and removed after birth. It showed a well circumscribed, grayish white, solid mass measuring 4x3x2 cm. The tumor was predominantly a classic type with a focal cellular pattern. Immunohistochemical and electron microscopic studies were done.

Sequential Studies of Glomerular Crescent Formation in Rabbits with Anti-Glomerular Basement Membrane(GBM) Antibody Induced Glomerulonephritis(GN).: Hye Seon Ahn, Jung Woo Noh, Moon Hyang Park; Korean J Pathol. 1997;31(3):219-232.

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Abstract PDF: To investigate the mechanism of crescent formation, sequential pathologic changes from the New Zealand White rabbits with anti-GBM antibody induced GN by administration of guinea pig anti-GBM IgG were studied by light (LM), immunofluorescent (IF) and electron (EM) microscopy. Although no glomerular changes were observed in LM, swelling of the endothelial cells and the epithelial cells were noted in EM by day 2. By day 7, early and cellular crescents were evident. Proteinaceous materials and fibrins were noted in the glomerular capillary lumina (GCL) and Bowman's space (BS) associated with segmental hypercellularity. The GBM damage became progressively severe, followed by focal detachment of the visceral epithelial cells from the GBM. At day 14, fibrin strands, mononuclear cells and collagen fibrils were present between the proliferating extracapillary cells. At day 31, fibrocellular crescents were predominated. Elongated spindle cells, morphologically resembling myofibroblasts, were noted near the Bowman's capsule (BC). A degree of tubular atrophy, interstitial fibrosis, and inflammatory infiltrates increased as it did with fibrous organization of crescent. Intense linear IF staining for IgG and C3 were seen throughout the experiments along the GBM. In conclusion, the progression of crescent from an early "proteinaceous" stage through cellular, fibrocellular and fibrous stages was well documented in this study. Inflammatory cells and coagulation mechanism may activate the initiation of the GBM damage at the early stage. Activated periglomerular mononuclear cells may also cause disruption of BC which facilitates entry of activated periglomerular cells and fibroblasts into BS leading to progressive fibrous crescent formation.

Carcinosarcoma and Multiple Early Gastric Carcinomas of the Stomach.: Won Mee Lee, Young Ha Oh, Moon Hyang Park, Kwang Su Lee, Jung Dal Lee; Korean J Pathol. 1997;31(3):252-256.

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Abstract PDF: We report a rare case of carcinosarcoma arising in the stomach. The tumor is presented in the posterior wall of the gastric lower body and antrum of a 56-year-old man. Grossly the tumor has polypoid appearance with diffuse surface ulceration and measures 5.5 cm in diameter. The tumor is accompanied with three separate well differentiated early gastric adenocarcinomas (two EGC type IIc & IIa). Microscopically, the tumor consists of moderately well differentiated adenocarcinoma in the periphery, and lobulated sarcomatous areas in the center, which shows chondroid differentiation. Transitional areas between adenocarcinoma and chondrosarcoma are evident. Immunohistochemical studies show positivity for cytokeratin and carcinoembryonic antigen in the epithelial component, and for vimentin and S-100 in the sarcomatous component. The transitional areas are positive in carcinoembryonic antigen, vimentin, S-100, and cytokeratin. The tumor extended to the subserosa and showed metastasis of only adenocarcinomatous component in six out of 47 dissected perigastric lymph nodes.

Malignant Glomus Tumor Arising in Benign Glomus Tumor.: Seung Sam Paik, Eun Sun Kim, Young Chun Moon, Chan Kum Park, Moon Hyang Park, Jung Dal Lee; Korean J Pathol. 1997;31(3):280-283.

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Abstract PDF: The glomus tumor is a distinct neoplasm composed of modified perivascular smooth-muscle cells identical to those described in the glomus body. Malignant glomus tumor, also referred to as glomangiosarcoma, is exceedingly rare. It has been subdivided into locally infiltrative glomus tumor, glomangiosarcoma arising in a benign glomus tumor, and glomangiosarcoma arising in de novo. A few cases of malignant glomus tumor arising in a benign glomus tumor have been reported. A 55-year-old man underwent resection of a solitary nodule in the right shoulder area. The tumor was biphasic with a typical benign glomus tumor at the periphery and the central sarcomatous area composed of oval to elongated pleomorphic cells with a single prominent nucleolus and occasional mitotic figures. Both tumor components showed intense staining for vimentin, smooth muscle actin, and muscle specific actin. Herein, we report a case of a malignant glomus tumor arising in a benign glomus tumor with an immunohistochemical study and a review of literatures.

Clear Cell Islet Cell Tumor of the Pancreas: An Immunohistochemical and Ultrastructural study.: Seung Sam Paik, Young Ha Oh, Eun Kyung Hong, Moon Hyang Park, Jung Dal Lee; Korean J Pathol. 1997;31(2):162-166.

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Abstract PDF: A clear cell islet cell tumor of the pancreas is extremely rare and characterized by extensive clear cell components. Electron microscopic and immunohistochemical findings are essential to prove that the mass with clear cells is an unusual manifestation of an islet cell tumor. Herein, we report a case of clear cell islet cell tumor of a 54-year-old woman with abdominal pain. The tumor was composed of polygonal clear cells arranged in nests, trabeculae, and ribbon pattern with the extensively fibrous stroma. These tumor cells showed strong reactivity for chromogranin and weak reactivity for somatostatin and glucagon. An electron microscope revealed that the important contributing factor of the clear cytoplasmic change was mainly due to an accumulation of lipid droplets, coupled with cytoplasmic swelling in some areas. Some tumor cells showed many endosecretory granules ranging from 111 to 297nm in diameter. In the clinical and immunohistochemical findings these granules were consistent with somatostatin granules in morphology and size.

Ossifying Fibromyxoid Tumor of Soft Parts.: Seok Hoon Jeon, Seung Sam Paik, Eun Kyung Hong, Moon Hyang Park, Jung Dal Lee; Korean J Pathol. 1997;31(2):174-178.

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Abstract PDF: An ossifying fibromyxoid tumor of soft parts is a rare, recently described, fibro-osseous neoplasm of uncertain histogenesis. It occurs most frequently within the subcutis or skeletal muscle of the extremities. Its biologic behavior is generally regarded as benign with at worst a locally aggressive clinical course. But, atypical and malignant variants have been recently reported. Herein we report a case of a benign ossifying fibromyxoid tumor which occurred in the left upper back of 41-year-old man. The tumor is composed of uniformly round or polygonal cells arranged in cords or nests which are separated by myxoid and hyalinzed fibrous matrix and associated with irregular bony trabeculae. The tumor cells are strong positive for vimentin. Ultrastructural findings and a review of literatures are added.

Signet Ring Cell Variant of Invasive Lobular Carcinoma of Male Breast.: Seung Sam Paik, Seok Hoon Jeon, Moon Hyang Park, Pa Jong Jung, Jung Dal Lee; Korean J Pathol. 1997;31(2):179-181.

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Abstract PDF: Lobular carcinoma of the male breast is very rare, because of the absence of lobules in the normal male breast. Herein, a case of lobular carcinoma of the male breast with cellular features of signet ring cells is described. A 57-year-old man presented with a left breast mass. Histologic examination showed classic invasive lobular carcinoma with in situ component. Most infiltrating tumor cells had a prominent signet ring cell appearance. The patient was phenotypically male and had fathered children. There was no history of predisposing factors to breast lesion, such as hormone use or gynecomastia.

The prognostic significance of tumor angiogenesis, proliferating cell nuclear antigen(PCNA), and the Ki-67 index in carcinoma of the uterine cervix.: Chan Pil Park, Seung Yon Lee, Moon Hyang Park; Korean J Pathol. 1997;31(1):1-14.

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Abstract PDF: Angiogenesis, the induction of new capillaries and venules, is associated with tumor growth. This study was designed to determine whether cervical carcinomas are angiogenic, and to investigate whether tumor angiogenesis can serve as a prognostic factor in cervical carcinoma. Surgical specimens of 47 cervical carcinomas were immunohistochemically stained specifically for endothelial cells with factor VIII-related antigen to identify all vessels. Microvessels were counted from photographs of 200x microscopic fields. In addition, thirty-seven cases were studied by immunohistochemical means using the monoclonal antibodies for PCNA and for Ki-67 to determine tumor cell proliferation rates in cervical carcinomas. The microvessel count(MVC), the PCNA labelling index, and the Ki-67 index were calculated and compared with known prognostic factors and disease free survival rates in cervical carcinomas. A wide range in the MVC count(range 12-100 mean=38.2+/-19.2), the PCNA labeling index(8-69% mean=33.6+/-15.2%), and in the extent of Ki-67 staining(0-43% mean=10.3+/-10.5%) was observed, indicating considerable variation of tumor angiogenic activity and tumor growth rates. This study showed statistically significant correlations in disease free survival rates with both lymph node status and the microvessel count. However, there was no significant difference in disease free survival rates between tumor stage, age, the PCNA labelling index, and the Ki-67 index.

Inflammatory Myofibroblastic Tumor in Posterior Mediastinum.: Seung Sam Paik, Seok Hoon Jeon, Se Jin Jang, Moon Hyang Park, Jung Dal Lee; Korean J Pathol. 1997;31(1):63-67.

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Abstract PDF: Inflammatory myofibroblastic tumor(IMT) or inflammatory pseudotumor is a rare, solid tumor that most often affects children. This tumor is characterized by a spindle cell proliferation admixed with a variety of inflammatory cells. Although it has disputed nosology, a distinctive fibroinflammatory and even pseudosarcomatous appearance have been well appreciated. Herein, we report a case of IMT in the posterior mediastinum in a 19-year-old girl with clinical findings. The immunohistochemical and ultrastructural studies on the tumor cells are reported, and their distinctive characteristics are discussed in details.

The Significance of AgNOR Count in Body Fluid: Differential between reactive mesothelial cells & malignant cells.: Seung Sam Paik, Eun Kyung Hong, Se Jin Jang, Moon Hyang Park, Jung Dal Lee; Korean J Cytopathol. 1997;8(2):129-134.

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Abstract PDF: To distinguish reactive mesothelial cells from malignant cells in body fluid, we applied silver staining of nucleolar organizer regions(AgNORs) to ethanol fixed cytologic preparations. Fifty aspirated samples of benign(22 cases) and malignant(26 cases) body fluids were studied using the one step silver staining method. Two cytologically atypical samples were also included in the study. In malignant cases the mean AgNOR count was 3.56+/-0.81, while in benign cases the mean AgNOR count was 2.02+/-0.33. The difference of AgNOR counts between these two groups were statistically significant(p<0.001). The mean of atypical cases was 2.91. Both were diagnosed as malignant in follow-up cytology. In malignant effusions, there is statistically significant difference in AgNOR counts between cells forming complex papillae or clusters and singly scattered cells(p<0.05), 3.29+/-0.95 and 3.83+/-0.55, respectively. We concluded that AgNOR count appears to be useful as a diagnostic tool especially when the cytologic differentiation is difficult.

Fine Needle Aspiration Cytology of Pilomatrixoma.: Seung Sam Paik, Dong Hoon Kim, How Jin Lee, Se Jin Jang, Moon Hyang Park, Jung Dal Lee; Korean J Cytopathol. 1997;8(2):155-159.

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Abstract PDF: Pilomatrixoma is a benign skin appendage tumor of hair matrix cell origin. The cytological appearance of this tumor may cause problems when attempting to establish a differential diagnosis with other neoplasms. Herein we report the aspiration cytology findings of two cases of pilomatrixoma. One case was diagnosed as atypical cell clusters initially and the other was diagnosed as pilomatrixoma. On cytologic examination, both cases showed clusters of tightly arranged basaloid cells with an uniform appearance, scanty cytoplasm and round hyperchromatic nuclei. There were histiocytes and multinucleated foreign body giant cells merged with the amorphous opaque orangeophilic materials of "ghost cells". The differential diagnosis with other neoplasms is discussed.

Polymerase Chain Reaction Analysis of Human Papillomavirus in Esophageal Squamous Cell Carcinoma with its Correlation to p53 mutation.: Wan Seop Kim, Eun Kyung Hong, In Kyu Kim, Moon Hyang Park, Jung Dal Lee; Korean J Pathol. 1996;30(11):1018-1026.

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Abstract PDF: HPV infection has been implicated strongly in the pathogenesis of human squamous cell carcinoma(SCC). We analysed a series of 28 surgically removed, invasive squamous cell carcinoma of the esophagus by polymerase chain reaction to detect HPV DNA using consensus primers and 8 type-specific primers of HPV (6, 11, 16, 18, 31, 33, 35, 51). HPV 6, 31, 35 or 51 DNA were detected in 20 out of 28 cases (71.4%) of the esophageal SCCs. HPV 51 was the most frequently detected type, occuring in 13 out of 28 cases (46.4%). p53 immunohistochemical staining was also performed to demonstrate any relationship to HPV DNA positivity. It showed positivity in 16 out of 28(57.1%) esophageal SCCs, and HPV DNA and p53 positivity were concurrently detected in 11 out of 28 cases of SCCs. There was no significant inverse relation between HPV DNA positivity and p53 expression(p>0.05). Our results supported HPV involvement in esophageal squamous cell carcinoma, and suggested there may be another pathway not related to the p53-binding pathway in the carcinogenesis of esophageal SCCs by HPV.

Mucinous Adenocarcinoma of Anal Ducts.: Young Ha Oh, Wan Seop Kim, Eun Kyung Hong, Moon Hyang Park, Jung Dal Lee; Korean J Pathol. 1996;30(9):843-850.

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Abstract PDF: Anal duct carcinoma is a rare tumor, and accounts for less than 5 percent of all anal cancers, which typically present a long-standing perianal fistulas. Some authors suggest that the fistulous tracts are congenital duplications of the lower end of the hind gut lined by rectal mucosa which is prone to malignant change to mucinous adenocarcinoma. It is usually a well differentiated mucinous (colloid) adenocarcinoma. The prognosis after wide excision of the rectum is relatively good. Since 1985, we have had three cases of anal duct carcinoma with well differentiated mucinous adenocarcinoma involving the posterior wall of the anus. Two patients had a long history of perianal fistula with mucinous discharge. There was no spread to the regional lymph node except one patient who had regional lymph node metastasis, and post-operative chemotherapy and radiation therapy were then given. All patients have no evidence of any recurrent problem at 16 months to 3 years following the surgical treatment. Because of their rarity and the failure of recognition at an early stage, we are presenting three cases to emphasize the characteristic features of this insidious, slow-growing carcinoma.

Malignant Rhabdoid Tumor of the Kidney: A report of two cases: An immunohistochemical and ultrastructural study.: Seung Sam Paik, Moon Hyang Park; Korean J Pathol. 1996;30(8):706-714.

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Abstract PDF: Malignant rhabdoid tumor of the kidney(MRTK), an uncommon renal tumor found in children, is one of the most lethal neoplasms of early life. It was first recognized during a review of the first National Wilms' Tumor Study(NWTS) as an extremely aggressive neoplasm whose appearance often mimicks those of skeletal muscle tumors, but without histological, immunohistochemical, and ultrastructural markers of rhabdomyogenesis. Herein we present two cases of malignant rhabdoid tumor of the kidney, one occurring in a 6-month-old male baby, and the other in a 123-month-old girl. They presented a huge tender mass on the left upper quadrant of the abdomen. Microscopically, each case was very cellular and composed of sheets of round or polygonal cells with ample cytoplasm often containing eosinophilic filamentous inclusions and round vesicular nuclei with prominent nucleoli. Case 1 showed lymphomatoid pattern, but case 2 showed foci of several variant patterns associated with classic appearances. The tumor cells showed a strong reactivity for vimentin in both cases. Unusually, case 2 showed focal reactivity for epithelial membrane antigen(EMA), muscle specific actin, and smooth muscle actin. Ultrastructural study confirmed the presence of whorled bundles of intermediate filaments in paranuclear position, and a prominent nucleolus.

Ureteral Fibroepithelial Polyp: A report of four cases (One case with nephrogenic adenoma).: Won Mee Lee, Seung Sam Paik, Eun Kyung Hong, Moon Hyang Park, Jung Dal Lee; Korean J Pathol. 1996;30(8):715-720.

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Abstract PDF: Fibroepithelial polyps of the ureter are usually acquired rather than congenital. Most polyps are hamartomatous growths which tend to arise in the proximal portion of the left ureter. Most patients exibit either hematuria or persistent flank pain secondary to partial ureteral obstruction. Because of false positivity of urine cytology, as well as intravenous pyelogram, the correct diagnosis is confused with malignancy. Herein we report four cases of ureteral fibroepithelial polyp, which are associated with stones resulting in partial obstruction of the ureter. One of the four cases is associated with nephrogenic adenoma in the lamina propria of the adjacent ureter. The following report describes clinicopathologic findings of fibroepithelial polyp with review of literatures.

Inflammatory Pseudotumor of the Urinary Bladder: An Immunohistochemical and Ultrastructural Study.: Seung Sam Paik, Joo Seob Keum, Moon Hyang Park, Jung Dal Park; Korean J Pathol. 1996;30(5):447-452.

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Abstract PDF: Inflammatory pseudotumor of the urinary bladder is an unusual, benign mesenchymal proliferative lesion of the submucosal stroma easily mistaken for a malignant neoplasm clinically and histologically. We present a case and describe the clinical presentation and radiologic, histologic, histochemical, immunohistochemical, and ultrastructural findings. A 23-year old patient presented with sudden onset of gross painless hematuria for 3 months. There was no previous instrumentation or surgery involving the genitourinary tract. Cystoscopy revealed a large polypoid and ulcerated bladder mass. The lesion consisted of plump spindle shaped, fibroblast-like cells embedded in a myxoid stroma. Mitotic figures were negligible and the lesion showed encroachment on the superficial muscle bundles. The spindle cells were immunoreactive for vimentin and muscle specific actin. Immunohistochemical and ultrastructural findings revealed the fibroblastic-myofibroblastic nature of this lesion. Complete surgical excision by partial cystectomy was successful in eradicating the lesion. The findings are described with a discussion of the pathogenesis and review of the literature.

Intraabdominal Desmoplastic Small Cell Tumors with Divergent Differentiation: Report of two cases with immunohistochemical and ultrastructural studies.: Young Ha Oh, Nam Hoon Kim, Joo Seob Keum, Moon Hyang Park; Korean J Pathol. 1996;30(1):40-49.

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Abstract PDF: We studied two intraabdominal desmoplastic small cell tumors. The patients were two men, 37 and 23 years old, with jaundice and palpable abdominal masses. On exploratory laparotomy, each patient revealed a huge mass in the greater omentum with disseminated peritoneal seeding, measuring 32 cm and 11 cm in its greatest dimension, respectively. The tumor involved the diaphragm, rectal shelf, and cul de sac in case 1, and it involved the porta hepatis, retroperitoneum, and serosal surface of the ascending and transverse colon in case 2. Omentectomy of the huge mass and satellite masses was performed in each patient. Both tumors showed nearly the same histopathologic features. The histologic pattern was suggestive of a metastatic small cell carcinoma, but there was no specific, single primary site. The tumors consisted of variably sized, discrete islands of epithelial-like small cells in dense desmoplastic stroma. The tumor cells revealed divergent epithelial, mesenchymal, and neural differentiation by histologic, immunohistochemical, and electron microscopic observations. Only one cycle of chemotherapy including cisplatin and VP-16 was given in case 1 because of a subsequent hepatic problem, who, thereafter, showed massive intraabdominal recurrent tumors 6 months after diagnosis. In case 2, the poor condition of the patient had made chemotherapy and radiotherapy impossible. Case 2 died of disseminated intravascular coagulation following progressive cachexia 7 months after diagnosis.

Cytologic Features of Glassy Cell Carcinoma of the Uterine Cervix: Three Cases Report.: Seok Hoon Jeon, Seung Sam Paik, Won Mi Lee, Se Jin Jang, Yong Wook Park, Moon Hyang Park, Jung Dal Lee; Korean J Cytopathol. 1996;7(2):197-201.

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Abstract PDF: Glassy cell carcinoma is an unusual neoplasm of the uterine cervix that accounts for 1~2% of all cervical malignancy. It is a rapidly progressive and biologically aggressive disease with poor response to therapy. This tumor is considered to be a poorly differentiated mixed adenosquamous carcinoma. The cytologic findings are characterized by tumor cells arranged predominantly in syncytial like aggregates and an inflammatory background. The tumor cells have moderate amounts of eosinophilic or amphophilic cytoplasm, which is often finely granular. The nuclei are relatively large and have fine chromatin with prominent eosinophilic nucleoli. Cytologically, glassy cell carcinoma is most likely to be confused with large cell nonkeratinizing squamous cell carcinoma and with atypical reparative cells. Herein, we report three cases of glassy cell carcinoma of the uterine cervix diagnosed by cervicovaginal smear and confirmed by histologic section with review of literatures.

Fine Needle Aspiration Cytology of Metastatic Wilms' Tumor in the Lung: Report of Two Cases.: Wan Seop Kim, Nam Hoon Kim, Young Hyeh Koh, Moon Hyang Park, Jung Dal Lee; Korean J Cytopathol. 1996;7(2):218-224.

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Abstract PDF: We describe two cases of metastatic Wilms' tumor in the lung with emphasis on the cytologic features of specimens obtained by needle aspiration. One of them was extrarenal Wilms' tumor. The findings were correlated with the histopathologic fea- tures of the primary lesion. Cellular components in the fine needle aspiration cytology (FNAC) slides included blastemal, epithelial, stromal and inflammatory cells with immature tubular differentiation and rosette formation. Recognition of these cellular components in FNAC smears help in establishing FNAC diagnosis of Wilms' tumor. The blastemal cells were represented by small to medium sized cells with scanty cytoplasm having ill-defined borders and round to slightly oval nuclei with evenly dispersed chromatin and small marginated nucleoli. They were seen in our two cases. The differential diagnosis includes neuroblastoma, malignant lymphoma, malignant rhabdoid tumor, clear cell sarcoma, Ewing's sarcoma and embryonal rhabdo-myosarcoma. In conclusion, making a definite cytologic diagnosis of metastatic Wilms' tumor may be possible by light and electron microscopy and immunohi-stochemical staining. The above findings may contribute to the diagnosis of FNAC of metastatic Wilms' tumor.

Fine Needle Aspiration Cytology of Acinic Cell Carcinoma of the Parotid Gland: A Case Report.: Seok Hoon Jeon, Seung Sam Paik, Won Mi Lee, Moon Hyang Park, Jung Dal Lee; Korean J Cytopathol. 1996;7(2):225-229.

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Abstract PDF: We experienced a case of well-differentiated acinic cell carcinoma of the parotid gland in a 65 year-old woman, which was correctly diagnosed preoperatively by fine needle aspiration(FNA) cytology. FNA cytology smears showed clusters or sheets of monomorphic acinic cells having reticulated or finely vacuolated basophilic or acidophilic cytoplasm. The cellular population was homogeneous or slightly polymorphic, having centrally located, round nuclei with finely reticular chromatin and incon- spicuous nucleoli. Herein we report this case with its histologic features and review of literatures.

Correlation between Tumor Angiogenesis and Metastasis in Invasive Breast Carcinoma.: Nam Hoon Kim, Moon Hyang Park; Korean J Pathol. 1995;29(6):740-745.

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Abstract PDF: Tumor angiogenesis(TA) refers to the growth of new vessels toward and within a tumor. TA is necessary both at the beginning and at the end of the metastatic cascade of events. Recently, experimental evidence suggests that the growth of a tumor beyond a certain size requires angiogenesis. To investigate how tumor angiogenesis correlates with metastases in breast carcinoma, the microvessels were counted (per 200 / field) in the most active areas of neovas-cularization by two investigators. The microvessels within breast carcinoma were highlighted by in imunohistochemical staining for factor VIII-related antigen. Microvessel count(MVC) in node-positive carcinoma(59.66=35) was significantly higher than in node-negative carcinoma(44.76=17)(p=0.009). MVC was also statistically correlated with tumor size and stage, but not with histologic grading, DNA ploidy, or hormonal receptors(estro-gen and progesterone). MVC in invasive breast carcinoma may be one of many prognostic predictors of node-positive breast carcinoma. Assessment of tumor angiogenesis may therefore be valuable in selecting patients with early breast carcinoma for aggressive therapy.

Cholesteatoma of the Renal Pelvis: A case report.: Nam Hoon Kim, Young Chun Moon, Moon Hyang Park; Korean J Pathol. 1995;29(5):691-693.

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Abstract: Cholesteatoma in the kidney and ureter are accumulations of waxy, gray flakes of keratin materials, secondary to squamous metaplasia of the transitional epithelium. Herein, we describe a case of cholesteatoma in the renal pelvis of a 69-year-old woman, and give a brief review of the literature. In the upper pole of the left kidney was a 6 cm cystic lesion filled with a thick, flaky, grayish, comified material. Microscopically, the cystic area showed calyceal and pelvic structures being replaced by keratinizing stratified squamous epithelium. The surrounding renal parenchyma was atrophic with features of chronic pyelonephritis.

Fibrous Pseudotumor of the Testicular Tunics: Two case reports.: Seung Sam Paik, Nam Hoon Kim, Young Hyeh Ko, Moon Hyang Park; Korean J Pathol. 1995;29(4):533-535.

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Abstract PDF: Fibrous pseudotumor of the testicular tunics is a rare benign fibrous proliferative disorder, but it is the second most common mass-forining lesion of the testicular tunics. While these lesions are not strict neoplasms, they do form nodules and are often mistaken for neoplasms. Herein, we report 2 cases of fibrous pseudotumor with characteristic histologic findings. Both cases had been incidentally found as slow growing scrotal masses and underwent excision. There were several nodules along the testicular tunics which had bulging whitish-gray cut surface with focal myxoid change and a whorling appearance. These two cases showed the histologic spectrum seen in fibrous pseudotumor from a haphazard arrangement of fibroblastic type cells with intervening collagen and focal lymphocytic infiltrates in case 1, to a densely collagenized lesion in case 2.

Fetal Rhabdomyomatous Nephroblastoma: A case report.: Nam Hoon Kim, Chan Pil Park, Eun Kyung Hong, Poong Man Jung, Moon Hyang Park; Korean J Pathol. 1995;29(1):96-102.

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Abstract PDF: A fetal rhabdomyomatous nephroblastoma is considered to be a predominantly monophasic mesenchymal variant of Wilms' tumor, which acts less aggressively than a conventional Wilms' tumor despite its much larger size. Bilaterality of this tumor in a nine month-old girl, however, may negatively affect the overall prognosis. A radical nephrectomy for bulky masses in the left kidney and a partial nephrectomy for right kidney with five small tumor masses was performed at the same time. Two small tumor masses in the upper part of right kidney were left behind because of preserving minimal renal functional capacity. Pathological study revealed a mixed type of nephroblastoma which was composed predominantly of mesenchymal components with fetal rhabdomyomatous differentiation. After post-operative chemotherapy with vincristine, actinomycin D and adriamycin, and radiotherapy(2,130 rad), residual tumor masses became a single tumor 5 cm in diameter and well demarcated, which was resected at 15 months after first operation when the size and renal function of remained right kidney was appropriate to resect out the residual tumor. The tumor resected out at second operation was entirely composed of scattered differentiated fetal skeletal muscle cells in the fibrovascular tissue. Only a few entrapped epithelial components were seen but no blastemal cornponents were present. Follow up abdominal CT and ultrasonographic examinations revealed no evidence of tumor recurrence. The girl has developed normally without disease.

Fine Needle Aspiration Cytology of Bilateral Granulomatous Mastitis: A Cese Report.: Seung Sam Paik, Seok Hoon Jeon, Eun Kyung Hong, Moon Hyang Park; Korean J Cytopathol. 1995;6(2):174-178.

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Abstract PDF: Granulomatous mastitis is a rare inflammatory breast lesion, usually presented with rapidly enlarging palpable mass in young parous women and can simulate carcinoma. Unnecessary surgical procedure can be avoided if the nature of the lesion were defined by fine needle aspiratio(FNA) cytology. We experienced a case of bilateral granulomatous mastitis diagnosed by FNA cytology. The patients was a 31-year-old woman with one month history of a rapidly enlarging mass in the left breast. considered clinically to be malignant. After 4 years. she presented with a palpable mass in the right breast. The FNA cytology smears contained numerous aggregates of epithelioid histiocytes admixed with Langhans' and foreign body giant cells, lymphoytes, neutrophils and apoptotic debris leading to a diagnosis of granulomatous mastitis. The subsequent lumpectomy of the left breast confirmed the diagnosis of granulomatous mastitis. The FNA cytology smears from right breast showed identical cytologic findings.

Cytologic Features of Malignant Lymphoma of the Uterine Cervix: A case report.: Nam Hoon Kim, Chan Kum Park, Young Hyeh Ko, Moon Hyang Park, Jung Dal Lee; Korean J Cytopathol. 1995;6(1):76-79.

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Abstract PDF: The uterine cervix is an uncommon site of primary non-Hodgkin's lymphoma (NHL). Although the cytologic findings of NHLs are well known, most cervicovaginal smear of uterine NHLs give lower diagnostic yield than common epithelial malignancy because abnormal cells do not appear in the sample in the absence of surface ulceration. Herein, we describe cytologic findings of a case of uterine cervical NHL which was initially diagnosed by cervicovaginal smear. The tumor cells were relatively uniform, isolated, large-sized with scanty cytoplasm and round or indented nuclei. The nuclei had stippled chromatin and small nucleoli. Histologically and immunohistochemically the tumor was proven to be large cell lymphoma of T-cell lineage.

Clear Cell Meningioma arising from Lumbar Nerve Root in a Child: A case report.: Eun Kyung Hong, Geun Shin Lyu, Moon Hyang Park; Korean J Pathol. 1994;28(2):179-184.

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Abstract PDF: Meningioma of unusual age of onset, location, histogenesis and histologic type is reported. The patient, 4 year-old girl, had an intradural spinal meningioma arising from lumbar nerve root with no dural attachement. The meningioma revealed glycogen-rich, clear cell type with extensive and blocky hyalinization of the stroma. The tumor shared common fibrous sheath with attached lumbar nerve, and nerve fibers were scattered within the tumor. Ultrastructurally, the tumor cells had abundant glycogen particles, intermediate filaments and intercellular desmosomes. Hyalinized material revealed large amianthoid collagen fibers.

A Pathologic Study of Renal Cell Carcinoma: Correlation between clinical and morphologic parameters and prognosis.: Hye Seon Ahn, Moon Hyang Park; Korean J Pathol. 1992;26(6):561-572.

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Abstract PDF: The prognostic significance of morphologic parameters was evaluated in 36 cases of renal cell carcinoma diagnosed during five years(1986~1990). We reviewed and classified on the basis of pathologic stage, tumor size, histologic pattern, cell type and nuclear grade. Mean age was 51 years old. Average tumor size was 7.3 cm in diameter. Six of 35 patients died of disease. Overall mean survival was 43.3+/-7.3 months. An increasing nuclear grade was generally correlated with a decrease in cummlative survival rate. Similarly, a higher stage at the time of diagnosis could predicated a low survival rate only for high nuclear grade carcinoma. There was an apparent positive correlation between grade and age, grade and size, grade and cell type, cell type and histologic pattern as well as stage and age. This positive correlations are in part a function of nuclear grade; only 20% of grade 3 & 4 tumor consisted of clear cells whereass 71% of grade 1 & 2 consisted of clear cell type. All 6 cases of granular cell types and 50% of mixed cell type were grade 3 & 4. The tumor size of the primary was well correlated with the nuclear grade. Nuclear grade was the most significant factor among the morphologic parameters studied.

Characterization of Human Papillomavirus Types in Cervical Epithelial Neoplasia by in Situ Hybridization.: Chan Kum Park, Moon Hyang Park; Korean J Pathol. 1992;26(5):436-444.

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Abstract PDF: An in situ DNA hybridization technique was applied to detect human papillomavirus(HPV) DNA, HPV types 6/11 and 16/18, on paraffin sections of 36 cervical condylomatous lesions associated with cervical intraepithelial neoplasia and invasive squamous cell carcinoma. 1) HPV DNA sequences were identified in 14 of 36 cervical condylomatous lesions(39.0%); HPV 6/11 in 7 cases(19.0%) and HPV 16/18 in 7 cases(19.0%). 2) With the use of biotinylated HPV 6/11 DNA probes, 5 of 5 condyloma acuminata(100%), 1 of 5 flat condylomata(20%), and 1 of 7 mild dysplasias(14.3%) were positive. 3) With the use of HPV 16/18 DNA probes, 1 of 7 mild dysplasias(14.3%), 2 of 5 moderate dysplasias(40%), 2 of 4 severe dysplasias(50%), and 2 of 5 invasive squamous cell carcinomas(40%) were positive. 4) The positive stainings to HPV DNA probes were primarily detected in koilocytotic nuclei of the superficial epithelium. No positive signals were found in the normal, dysplastic or carcinoma cells. 5) The numbers positively stained cells were decreased with increasing severity of the lesions from benign condylomas to invasive squamous cell carcinomas. In conclusion, HPV types 6/11 were more commonly identified in benign condylomatous and low grade intraepithelial lesions than high grade lesions. However, HPV types 16/18 were identified in high grade CIN and invasive squamous cell carcinomas. The present results while supporting the concept on HPV 16/18 as the high risk of HPV types in cerivical carcinogenesis also emphasize the applicability of the situ DNA hybridization as a tool in analysis of the specific HPV DNA sequences in routine biopsies of these lesions.

Clinico-pathological Study on Hepatitis B virus-Associated Nephropathy.: Moon Hyang Park, Hae Sun Ahn; Korean J Pathol. 1992;26(3):215-228.

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Abstract PDF: To clarify the characteristics of HBV-associated renal lesions, renal biopsies obtained from 22 HBsAg seropositive patients(M:F=32:1) were studied. Other than two(age 4 and 12), all were adults(17-77 y.o.). Twelve of the patients had nephrotic syndrome(NS), 5 NS and hematuria(H), 10 proteinuria and H, one gross H, one microscopic H, and 4 normal urinalysis at the time of biopsy. Light microscopy showed minimal change lesion(MCL) in 9 cases, mesangial proliferative glomerulonephritis(MSPGN) in 6, MPGN type I in 7, MPGN type III in 6, and mebranous nephropathy(MGN) in 5 cases. There were variable immunofluorescent(IF) findings of 25 cases studied; IF staining were predominant with IgG in 10 cases, with IgA in 5 and with IgM in 2 cases. Complements tended to be more strong for C1 &/or C4 than C3. In electron microscopic(EM) studies of MCL group, rare mesangial deposits were noted(3/5). In MSPGN, aside from mesangial deposits, there were occasional subendothelia(2/4) or subepithelial(1/4) deposits. In MPGN type I, in addition to the usual EM features of MPGN, some subepithelial deposits were also observed in 5 cases. In MGN, 3 out of 4 showed subendothelial deposits. Among 7 cases stained for HBsAg all were negative with IF and 2 were positive with PAP method. It is concluded that clinico-pathological findings of HBV-associated nephropathy are variable and partly show lupus-like features, different from primary glomerulopathy.

Blue Nevus of the Uterine Endocervix : Report of three cases.: Moon Hyang Park, Eun Kyung Hong; Korean J Pathol. 1991;25(5):471-475.

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Abstract: The clinical, gross, light microscopic and immunohistochemical findings of three cases of blue nevus of the uterine endocervix were described. All three cases were incidentally found in hysterectomy specimens from middle-aged women, 45 to 48 years of age. The lesions were small and measured 1 to 4 mm in the greatest diameter. The presence of elongated, somewhat wavy and dendritic melanin-containing cells, in clusters or scattered deep in the subepithelial stroma and between the endocervical glands, was the distinct feature. The cytoplasmic granules appeared black with Grimelius and Fontana-Masson stains. The cells showed strong positive reaction with S-100 protein in perinuclear cytoplasm, in addition to the diffusely dispersed melanin granules. The demonstration of S-100 protein in the blue nevus, along with the histochemical findings, supports combined melanocytic and schwannian differentiation of the blue nevus cells.

Cardiac Fibroma of the Ventricular Septum: A case report.: Byung Tae Park, Se Jin Jang, Moon Hyang Park, Jung Dal Lee, Hyo Jin Lee; Korean J Pathol. 1991;25(1):37-41.

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Abstract PDF: This is an autopsy case of a 6 month old girl who suddenly died of respiratory distress during sleep. She had suffered from mild but frequent episodes of common cold and was treated for eczema for several days. At autopsy, the heart was enlarged and weighed 100 gm. A firm and gray-white tumor, measuring 4.5 x 3.8 x 2.8 cm, was located in the interventricular septum and encroached upon the wall of left ventricle. The mass was well demarcated but was not encapsulated. Neither necrosis nor calcification was present. Microscopically the tumor was composed of haphazardly arranged bundles of collagen fibers and fibroblasts. Myocardial cells are intermingled with the fibroblasts at the margin of the tumor. Massive edema of the lung and congestion of the liver and spleen were pronounced.

Cytologic features of Langerhan's cell histiocytosis.: Geun Shin Lyu, Young Hyeh Ko, Moon Hyang Park, Jung Dal Lee; Korean J Cytopathol. 1991;2(2):153-159.

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Abstract PDF: No abstract available.

Carcinoid Tumor of the Uterine Cercix: A light and electron microscopic study of two cases.: Moon Hyang Park, Jung Dal Lee, Yoon Young Hwang; Korean J Pathol. 1990;24(1):70-76.

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Abstract PDF: Two cases of carcinoid tumor of the uterine cervix were reported with emphasis on the histologic, cytologic, histochemical and electron microscopic appearance of tumor cells. Based on the light microscopic findings, one case was a well differentiated carcinoid with acinus formation, and the other was a poorly differentiated anaplastic type, being composed of small cells similar to those of oat cell carcinoma of the lung. Both tumors demonstrated scattered argyrophilic cells on Grimelius stain, and contained neurosecretory granules on electron microscopy. They were in stages II b and IV, respectively, at the time of presentation. The latter patient was treated with vinblastin, platinol and bleomycin, but died in 9 months after the initial diagnosis. The former was lost to follow-up study. Importance of distinction between this highly malignant tumor and other varieties of cervical cancer was emphasized.

Disseminated Deciduosis Peritonei.: Moon Hyang Park, Chan Kum Park, Jung Dal Lee; Korean J Pathol. 1988;22(2):159-163.

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Abstract PDF: Gross deciduosis in pregnancy is rare. A case of disseminated deciduosis peritonei studied by light and transmission electron microscopy is reported. The pathogenesis of deciduosis peritonei and relationship with leiomyomatosis peritonealis disseminata are discussed in view of the present findings and those previously reported.

Aspiration Biopsy Cytology of Malignant Fibrous Histiocytoma.: Moon Hyang Park, Eun Kyung Hong, Jung Dal Lee; Korean J Pathol. 1986;20(3):332-335.

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Abstract PDF: Cytologic findings of malignant cells obtained by fine needle aspiration from a huge retroperitoneal malignant fibrous histiocytoma were described. The smears contained numerous malignant cells, isolated or in clusters, in a bloody background. The malignant cells had abundant pleomorphic foamy or acidophilic cytoplasm with occasional multilobated vesicular nuclei and prominent nucleoli. Dual differentiation, both histiocytic and fibroblastic types, and neutrophilic inflammatory background were diagnostic of this neoplasm. The report indicated that study of aspiration cytology specimen from a soft tissue tumor was a valuable adjunct to histologic examination.

Human Papillomavirus infection in Cervical Intraepithelial Neoplasia: A Comparative Histopathological and Immunohistochemical Study.: Chan Kum Park, Moon Hyang Park, Jung Dal Lee; Korean J Pathol. 1986;20(3):255-262.

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Abstract PDF: One hundred twelve cases of cervical intraepithelial neoplasia (CIN) were reviewed to detect the condylomatous lesion characterized by koilocytotic cells. Condylomatous lesions were present in 12 cases (30.8%) of 39 cases with mild dysplasia, 3 cases (15.0%) of 20 moderate dysplasia, 2 cases (13.3%) of 15 severe dysplasia and 4 cases (10.5%) of 38 cases with carcinoma in situ. These 21 cases with condylomatous lesions were subjected to the study on demonstration of human papillomavirus (HPV) antigen with peroxidase antiperoxidase reaction and 6 simple condylomatous lesions of the uterine cervix were included for control. Twenty seven cases with simple cervical condyloma and condylomatous lesions associated revealed 22 cases of flat type, 3 cases of exophytic type, 1 spiked type, and 1 inverted type. Cells showing a positive reaction for HPV antigen were identified in 5 cases (55.6%) of 27 cases with condylomatous lesions. HPV antigen positive nuclei were found chiefly in koilocytotic cells. The prevalence of HPV antigen positive cells was well correlated with the extent and intraepithelial level of the koilocytotic changes. The results of this study provide a confirmation of the presence of HPV antigens in CIN, and suggest that the HPV may be an important factor in the etiology of CIN.

Congenital Absence of Intestinal Musculature Associated with Long Segment Hirschsprung's Disease.: Chan Kum Park, Moon Hyang Park, Jung Dal Lee, Poong Man Jung; Korean J Pathol. 1986;20(2):199-202.

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Abstract PDF: Intestinal obstruction is the commonest cause for emergency surgical intervention in the newborn. An extremely rare cause of intestinal obstruction in the neonate is a congenital abnormality consisting of segmental absence of intestinal musculature with intact serosa and mucosa. This report represents not only the fourth reported case of this anomaly but also the first case associated with long segment Hirschsprung's disease in English-written literatures.

Adult Wilms' Tumor: Monomorphous Epithelial, Tubular, Variant.: Moon Hyang Park, Jung Il Suh; Korean J Cytopathol. 1985;19(4):473-477.

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Abstract PDF: Adult Wilms' tumor, unlike that of childhood, is a rare disease. Microscopically, the tumor is fundamentally characterized by triplastic embryonal renal tumor composed of variable amounts of metanephric blastema and its epithelial and stromal derivatives but rarely a small group of tumors composed virtually entirely of differentiated epithelial derivatives, the abundance of tubular structures. These monomorphous epithelial type of Wilms' tumor tended to have an early onset and benign course. Grossly, classic Wilms' tumor is a solid tumor, but very rarely shows cystic change and may lead to misinterpretation as a polycystic kidney or multicystic nephroma. Here, we reports a case of primary renal tumor, grossly very similar to a multicystic kidney but histologically represent a tubular monomorphous epithelial variant of Wilms' tumor occured in 63 year old male adult.

Fetus-in-fetu: Report of a case.: Young Hyeh Ko, Moon Hyang Park, Doo Pyo Hong, Poong Man Jung; Korean J Cytopathol. 1985;19(2):223-225.

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Abstract PDF: A case of Fetus-in-fetu is reported. The patient was a 8 month-old-boy with a tumor in the left upper retroperitoneum. The characteristic feature of the specimen consisted of vertebral column including pelvis, both upper and lower extremities, neural canal and brain tissue, and well formed large intestine.

A Pathologic Study on the Common "Epithelial" Tumor of Ovary.: Moon Hyang Park, Jae Chul Shim, Jung Il Suh, Hyo Sook Park; Korean J Cytopathol. 1985;19(1):76-83.

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Abstract PDF: One hundred eighty-six cases of ovarian common "epithelial" tumor including 28 endometriosis were reviewed, from the pathology file of the department of pathology of the National Medical Center during a period of 8 years and 6 months from January 1976 to June 1984. The study consisted of 14 cases(77.4%) of benign tumor including 28 cases of ovarian endometriosis, and 21 cases(11.3%) of borderline malignancy and 21 cases(11.3%) of invasive malignant tumors. Among benign common "epithelial" tumors, mucinous cystadenoma(69 cases) was the most frequent tumor, followed by serous cystadenoma (42 cases) and Brenner tumor (5 cases). Of borderline tumor, borderline mucinous tumor (18 cases) was more frequent than serous tumor (3 cases). Serous cystadenocarcinoma(9 cases) was the most frequent malignant tumor, followed by mucinous cystadenocarcinoma(6 cases), endometrioid carcinoma(3 cases) and undifferentiated carcinoma(3 cases). Most ovarian common "epithelial" tumors were prevalent during the reproductive age, but malignant tumors were more prevalent after the age of 40. Although right side was more frequently found (85 vs. 67) there is no significant site predilection. Bilaterality was the most common in undifferentiated carcinoma(66.7%), followed by serous cystadenocarcinoma(44.4%) and Brenner tumor(40%). The size of tumor tended to be larger in malignant tumor than benign. Mucinous tumor were usually larger than serous tumor. There were 7 intrauterine and 1 ectopic tubal prognancy which were associated with ovarian common "epithelial" tumors. Three cases of tumors were excised during Cesarian section. In summary these findings are comparable to other reports in Korea and English literatures. Histologic analysis of borderline and malignant epithelial tumor was done to emphasize their biologic behavor. Further study is required to compare their histological grading and clinical staging with thier survival rate.

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