Journal of Pathology and Translational Medicine

Volume 17(2); September 2006

Reviews

Fine Needle Aspiration Cytology of Lymph Node : Reactive Hyperplasia vs Malignant Lymphoma.: Chan Hwan Kim; Korean J Cytopathol. 2006;17(2):75-78.

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Abstract PDF: No Abstract available.

Fine Needle Aspiration Cytology of Medium to Large Cell Lymphomas of Lymph Node.: Jinman Kim; Korean J Cytopathol. 2006;17(2):79-86.

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Abstract PDF: No Abstract available.

Fine Needle Aspiration Cytology of Non-Hodgkin Lymphomas predominating Small Lymphoid Cells : Differential Diagnosis of Small Lymphoid Cell Neoplasm.: Seung Sook Lee; Korean J Cytopathol. 2006;17(2):87-98.

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Abstract PDF: No Abstract available.

Etc

Morphometric and Histochemical Studies on the Mucosa adjacent to Primary Carcinomas of the Colon and Rectum: Chan Il Park, Tae Seung Kim, Dong Sik Kim; Korean J Cytopathol. 1983;17(2):95-104.

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Abstract: 원발성 대장선암의 조직발생기원을 추구하기 위하여 지난 10여년 간 암병변 주위점막의 변화에 관한 연구가 진행되어 왔으며, 현재까지 기술된 변화들은 crypt에 구조적 변화가 초래된다는 것과 대장점액이 sulfomucin에서 sialomucin으로 바뀐다는 것으로 요약할 수 있다. 실험동물에 DMH를 투여하면 인체 대장암 주위점막에서 볼 수 있는 변화와 유사한 과정을 거쳐서 암이 발생하며, 특히 점액성분의 변화는 일정시기의 태아에서와 같다는 보고들로 미루어 볼 때 이러한 주위점막 변화는 대장암의 전암병변일 가능성이 매우 짙으나 아직도 대장암에 의한 2차적 변화일 가능성이 완전히 배제되지 않고 있다. 이에 저자들은 원발성 대장선암 66예의 주위점막에 대하여 광학현미경적 조직계측과 aldehyde fuchsinalcian blue(pH 2.5) 및 high iron diamine(HID)-alcian blue(pH 2.5)를 이용한 조직점액성분변화를 조사하고 이를 cloacogenic carcinoma, anorectal squamous cell carcinoma, 자궁경부로부터의 전이암, 육종 및 장결핵을 포함한 양성병변들과 비교하였던 바 다음과 같은 결과를 얻었다. 병변으로부터 4㎝ 상부의 점막을 대조점막으로 할 때 원발성 대장선암과 cloacogenic careinoma에서는 주위점막(TM)의 crypt 깊이가 대조점막(CM)보다 각각 1.71배 및 2.12배, crypt 직경이 각각 2.17배 및 2.99배 증가하였으나 기타 질환에서는 TM과 CM간에 뚜렷한 차이를 보이지 않았다. Crypt의 분지도 원발성 선암 66예 중 62예와 cloacogenic carcinoma 2예 모두에서 관찰되었으나 그 외의 병변에서는 이러한 점액성분의 변화를 볼 수 없었다. 이상의 결과로 보아 대장선암 TM의 crypt 구조 및 점액성분 변화는 원발성 대장상피암의 전암병변으로 사료되었으며 원발성 대장암의 조직기원에 있어서 가장 먼저 초래되는 변화는 sialomucin을 함유한 goblet cell 증식이고 이로 인하여 crypt의 구조적 변화가 야기되며, 세포학적 이형성 및 점액의 감소는 그 후에 초래되는 암형성의 과정이라고 추측되었다.

Review

Differential Diagnosis of Fine Needle Aspiration Cytology of Benign Lymphadenopathy.: Eun Mee Han, Dong Eun Song, Dae Un Eom, Hye Jeong Choi, Hee Jeong Cha, Jooryung Huh; Korean J Cytopathol. 2006;17(2):99-107.

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Abstract PDF: In the investigation of superficial lymphadenopathy of unknown cause, fine needle aspiration (FNA) cytology plays an invaluable role. It enables the differentiation of benign lymphadenopathy from lymphoid and non-lymphoid malignancies, obviating the need for open biopsy, and allowing the triage of patients. Cytopathologists should be familiar with the typical FNA patterns of benign lymphadenopathy, and recognize and differentiate among categories. In a minority of cases of benign lymphadenopathy, FNA can render a specific diagnosis. Benign lymphadenopathies are generally categorized into reactive lymphoid hyperplasia (RLH), inflammatory or infectious processes, and benign lymphoproliferative disorders. RLH characteristically presents with a heterogeneous and polymorphous smear composed of normal cellular constituents of lymph nodes, in contrast with the homogeneous or monomorphic smear of most lymphomas. The caveat is that various malignant disorders may also present with polymorphous populations. It is also important to recognize thatbenign lymphoid smears may sometimes contain atypical cells that raise the suspicion of malignancy. Clinical information should always be the integral part of the diagnostic criteria in FNA of lymphadenopathy. If there is any doubt about the benign nature of the smear, it is prudent to suggest biopsy and ancillary studies.

Etc

Antiplatelet Antibodies Detected in Thrombocytopenia with Indirect Platelet Suspension Immunofluorescence Test: Young Joo Cha, Hang Ik Cho, Sang In Kim; Korean J Cytopathol. 1983;17(2):105-111.

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Abstract: Indirect platelet suspension immunofluorescence test was performed in sixty-seven patients with thrombocytopenia. Clinical diagnoses were idiopathic thrombocytopenic purpura (ITP) in 17, multiple transfusion in 16, systemic lupus erythematosus in 8, rheumatoid arthritis in 2, autoimmune hemolytic anemia in 1, malignant lymphoma in 1, multiple myeloma in 1, neonatal thrombocytopenia in 1, and non-immune thrombocytopenia in 20. The results are as follows: 1) Antiplatelet antibodies were positive in 2 of 17 cases with ITP (12%) 2) Of 13 cases with autoimmune thrombocytopenia other than ITP, antiplatelet antibodies could be detected in 4 cases (31%). 3) Antiplatelet antibodies were detected in 5 out of 16 cases with multiple transfusions. HLA antibodies were detected in 3 and platelet-specific antibodies in 2 among 5 cases with positive antinlatelet antibodies. 4) Among 11 cases with positive antiplatelet antibodies, IgG antibodies were detected in 8 (73%), IgM antibodies in (18%), and IgG puls IgM in (9%). 5) In one case of SLE with positive antiplatelet antibody, an increase in platelet count was observed, being antiplatelet antibody negative during therapy with prednisolone. 6) Of 20 cases with non-immune thrombocytopenia, all were negative in indirect platelet suspension immunofluorescence test. On the basis of these findings, it was considered that the indirect platelet suspension immunofluorescence test would be a useful method for detection of platelet autoantibodies and alloantibodies. IgM agglutinins, IgG non-agglutinating antibodies, platelet-specific antibodies, and HLA antibodies were also detectable with this method.

Original Article

The Diagnostic Utility of Mesothelial Markers in Distinguishing between Reactive Mesothelial Cell and Adenocarcinoma Cells in Serous Effusions with Cytospin Preparation.: Sooim Choi, Mi Sun Kang; Korean J Cytopathol. 2006;17(2):108-115.

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Abstract PDF: Evaluation of serous effusions can include immunocytochemical stains that differentiate reactive mesothelial cell from adenocarcinoma cell. Among several positive mesothelial cell markers, we used desmin, CK5/6, WT1 and calretinin all known to have high sensitivity and specificity as selective mesothelial cell markers. We studied smears obtained with cytospin from 15 malignant and eight benign effusions. The mesothelial cells were positively stained by desmin, CK5/6, WT1 and calretinin in 60.9%, 29.1%, 26.7% and 56.5%, respectively among 8 benign and 15 malignant effusions; the adenocarcinoma cells were positively stained 6.7%, 13.3%, 1.0% and 0.0%, respectively among 15 malignant effusions. The percentage of positively stained mesothelial cells were somewhat lower for all antibodies compared to the results of previous studies. This was likely due to the differences in preparation methods and fixatives among studies. In conclusion, the use of desmin and calretinin were more valuable than CK5/6 and WT1 for distinguishing between reactive mesothelial cell and adenocarcinoma cells in serous effusion; however, choice of the proper preparation methods and fixatives are also important

Etc

Koilocytotic Atypia and Cervical Neoplasia: Hye Yeon Kim, In Sun Kim, Seung Yong Paik; Korean J Cytopathol. 1983;17(2):112-118.

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Abstract: The concept of koilocytotic atypia of the cervix was defined and developed by Koss although the morphologic alterations were described previously by others. The koilocytotic atypia and squamous cell carcinoma frequently coexist and their histologic features sometimes merge imperceptibly. In the author's study, forty-five hysterectomized specimens were obtained for cervical squamous cell carcinoma to determined the association of the koilocytotic atypia with cervical malignancy. Forty-five controls were selected from patients who were underwent hysterectomy for uterine leiomyomas. According to a blind semiobjective scoring system of the Reid, the results are as follows: 1) The major histologic features of the neoplastic group were koilocytotic cytoplasmic vacuolization (98%), basal cell hyperplasia (98%), binucleation (96%) and dyskeratosis (93%). But stromal changes were not significant. Those of the control group were basal cell hyperplasia (31%), koilocytotic nuclear changes (13%) and acanthosis (13%). 2) Forty-three of 45 women (95.6%) showed histologic evidence of hyman papillomavirus infection. Forty-three of the controls, but none of the neoplastic group, had normal cervical epithelium. As a result, it was evident that there is association of koilocytotic atypia and cervical malignancy.

Original Article

Morphometric Analysis for Cytological Diagnosis of Thyroid Papillary Carcinoma.: Jong Ok Kim, Bo Seong Yang, Hye Soo Kim, Jong Min Lee, Dong Ho Lee, So Young Shin, Chang Suk Kang, Hye Kyung Lee; Korean J Cytopathol. 2006;17(2):116-119.

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Abstract PDF: The diagnosis of papillary thyroid cancer is generally based on the findings of intranuclear cytoplasmic inclusions and nuclear grooves. Although anisokaryosis and poikilokaryosis, in papillary thyroid cancer, are not distinct when compared to other cancers, cytological examination can provide useful preoperative information. Our study evaluated the diagnostic role of computer-assisted image analysis for the pre-surgical assessment of papillary thyroid carcinoma. Thyroid aspirates from twenty female patients who were histologically confirmed to have both papillary carcinoma and benign nodules were studied. Different populations of 50 benign cells and 50 malignant cells were analyzed. Five morphometric parameters were selected for analysis: nuclear area, perimeter, maximum length, maximum width and intensity standard variation. The values obtained for papillary carcinomas were higher than the surrounding benign nodules as follows: nuclear area 63.5 vs. 36.1 (p=0.000), nuclear perimeter were 29.4 vs. 22.0 (p=0.000), maximum length 9.6 vs. 7.1 (p=0.000), maximum width 8.2 vs. 6.3 (p=0.000), the ratio between maximal length and maximal width 1.16 vs. 1.13 (p=0.000), the standard variation of intensity 14.9 vs. 15.9 (p=0.101) respectively. Therefore, morphometric information can be helpful for the differential cytological diagnosis of papillary thyroid carcinoma.

Etc

Studies on β-Glucuronidase Activity in the Rats with Clonorchiasis: Yeon Jae Cheong, Sun Kyung Lee; Korean J Cytopathol. 1983;17(2):119-126.

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Abstract: This study was performed in order to investigate the changes of β-glucuronidase activity in rats with clonorchiansis. The rats were experimentally infested with 200 metacercariae of Clonorchis sinesis. The metacercariae were isolated from the Pseudorasbora parva by digestion technique. The animals were killed by a depletion of blood at 1st, 2nd 3rd and 4th week after infestation; the livers and blood in the heart were obtained and examined immediately for the enzyme activity. The livers were also examined morphologically. The results obtained were summarized as follows; 1) Marked papillary and adenomatous hyperplasia of bile ducts and acute and chronic inflammatory reaction of the portal areas were observed in the liver of rats with clonorchiasis. The hyperplasia of bile ducts was somewhat more severe as the days go by. 2) β-glucuronidase activities in the liver and serum were significantly increased form first to fourth week after infestation compared to the findings of control animals. 3) There was a positive correlation between β-glucuronidase activities in the liver tissue and serum. On the basis of the above findings, it was suggested that Clonorchis sinensis is a continuously increasing factor of β-glucuronidase activity in the liver and serum, and that there is a correlation between increase of β-glucuronidase activity and hyperplasia of intrahepatic bile ducts.

Original Articles

Differential Diagnosis between Small Cell Carcinoma and Adenocarcinoma of Lung in Fine Needle Aspiration Cytology.: Young Hee Choi, Jae Soo Koh, Sunhoo Park, Min Suk Kim, Soo Youn Cho, Jung Soon Kim, Hwa Jung Ha, Seung Sook Lee; Korean J Cytopathol. 2006;17(2):120-125.

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Abstract PDF: Distinguishing small cell carcinoma from other lung malignancies is of great clinico-therapeutic significance. Small cell carcinoma is an aggressive tumor with a tendency to metastasize early. Survival time if untreated is low but this tumor is highly responsive to chemotherapy. We have occasionally experienced difficulties in differentiation between adenocarcinoma and small cell carcinoma of the lung in fine needle aspiration cytology (FNAC). The aim of this study was to investigate the possibility of distinguishing small cell carcinoma from adenocarcinoma of the lung in FNAC. We evaluated cytomorphological features of FNAC specimens from 62 small cell carcinomas and 57 adenocarcinomas from the lung that were confirmed by biopsy and/or immunohistochemistry on cell block. Cytomorphological details of the two tumors were compared. Nuclear smearing and nearly absent cytoplasm were the most distinct findings in small cell carcinoma compared to adenocarcinoma (p<0.05). Necrotic background, architecture and chromatin pattern, nuclear molding and nucleoli were significantly different (p<0.05). Nuclear size, nuclear membrane nature and nuclear size variation however were not helpful in distinguishing the two tumors. Combining several features described above, small cell carcinoma can be properly differentiated from adenocarcinoma on FNAC. FNAC is proposed as a diagnostic tool of small cell carcinoma of the lung in the case of inaccessibility to biopsy, and so may allow the proper therapeutic strategies to be determined in such cases.

Cytomorphologic Comparison of Hodgkin Lymphoma and Anaplastic Large cell Lymphoma in Fine Needle Aspiration Cytology.: Seung Sook Lee, Jae Soo Koh, Sunhoo Park, Min Suk Kim, Soo Youn Cho, Soo Young Chung, Han Suk Ryu, Jung Soon Kim, Hwa Jung Ha, Baek Youl Ryoo; Korean J Cytopathol. 2006;17(2):126-135.

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Abstract PDF: To study the differentiating cytomorphological features of Hodgkin lymphoma (HL) and anaplastic large cell lymphoma (ALCL) using fine needle aspiration cytology (FNAC), cytomorphological features of 16 patients with HL (n=8) or ALCL (n=8) were analyzed. In the initial cytological diagnosis prior to biopsy, HLs were properly diagnosed in 4 out of 8 cases (4 HL, 2 atypical, 2 benign), whereas all ALCL were diagnosed as malignancies. However, correct diagnosis of non-Hodgkin lymphoma (NHL) was made in only two ALCL patients (2 NHL, 1 HL, 1 sarcoma, 4 malignancy without specific type). Overall, the percentage of large abnormal cells ranged from 30% to 90% in ALCL except for one case, whereas it was less than 5% in all 8 HL. A spectrum of atypical cells was more characteristic of ALCL. In contrast, HL showed an sharp difference between reactive lymphoid cells and neoplastic ones (bimorphic pattern). Moreover, the emergence of kidney-shaped abnormal cells or wreath-like multinucleated cells was helpful in diagnosing ALCL. The combination of thesefeatures would be useful in differentiating HL and ALCL. Nevertheless, these two types of lymphomas cannot be definitely distinguished based on cytomorphological features alone. Therefore, the aim of FNAC would be to suggest a specific diagnosis and indicate the need for a biopsy.

Etc

Cardiac Conduction System -Morphologic observations on the autopsy cases-: Jeong Wook Seo, Je GeunChi, Sang Kook Lee; Korean J Cytopathol. 1983;17(2):127-137.

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Abstract: Sinoatrial (S-A) nodes and atrioventricular (A-V) nodes of 13 human hearts were examined by regular step sections and morphometry. Eleven cases were from fetuses, infants and children, and the others were from adult cases. S-A nodes were examined in 3 ways. The first one was resection, horizontal trisection and regular step sections by 100 micrometers. The second one was resection, longitudinal bisection and regular step sections, and the third one was regular step section in toto. Fifty sections were obtained from each node, and length of tissue in paraffin block was calculated from the total count of sections. Location, area and volume of S-A nodes were measured and corrected. The major sources of errors were contraction during formalin fixation, contraction during dehydration and paraffin embedding, and irregular change of length during microtoming. The latter two were corrected by use of total section count and measurement of length of paraffin on slide. The following results were obtained. 1) S-A node is located at one fourth (26.8/100) of the length of sulcus terminalis, below the summit of atrial auricle. S-A node is located at subepicardium of sulcus terminalis. (Crista terminalis is at some distance.) 2) Relative range of S-A node is 16.8/100 of the length of sulcus terminalis. And it decreases as cardiac weight increases. Relative volume of S-A node is 1/20,000 of the volume of heart. And it decreases as cardiac weight increases. 3) S-A node is located at the right atrial subendocardium, at some distance above the center of tricuspid septal leaflet. The node runs antero-inferiorly to the His bundle and pierces the cardiac skeleton.

Case Report

Cytologic Features of Villoglandular Adenocarcinoma of the Uterine Cervix : A Report of Two Cases.: Bohng Hee Kim; Korean J Cytopathol. 2006;17(2):136-142.

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Abstract PDF: Villoglandular adenocarcinoma of uterine cervix has recently been described, and is characterized by good prognosis and occurrence in young women, except a small number of cases. Morphologically, it exclusively shows villoglandular growth and mild to moderate nuclear atypia, the cytologic diagnoses have been frequently missed due to interpretation error. We report here on the cytologic findings of two cases, and both cases were not diagnosed as adenocarcinoma before punch biopsy. One of these cases showed previously described characteristic features such as high cellularity and large tissue fragments with long villous fronds lined by columnar cell with mild nuclear atypia. The other showed moderate cellularity of somewhat smaller clusters without long villous structures. The clusters showed marked nuclear overlapping and the nuclei showed distinct moderate atypia with hyperchromasia and coarse chromatin pattern. The nucleoli were indistinct. Recognition of these features will be helpful to avoid underdiagnosis as a benign lesion, although diagnosis is still difficult in a portion of the cases.

Etc

Histopathologic Study on Hodgkin's Disease: Sung Sik Shin, Je G Chi, Sang Kook Lee; Korean J Cytopathol. 1983;17(2):138-143.

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Abstract: A total of 42 cases of Hodgkin's disease was obtained from the file of Department of Pathology, College of Medicine, Seoul National University during a period of 7 years from 1976 to 1982. These cases were critically reviewed microscopically and classified according to Rye modification of Lukes-Butler classification. In 42 cases of Hodgkin's disease the patients ranged in age from 5 to 75 years, with an average of 35.1 years. Male to female ratio was 5:1. Histological types consisted of 17(40.5%) mixed cellularity, 12 (28.6%) lymphocyte depletion, 7 (16.6%) lymphocyte predominance and 6 (14.3%) nodular sclerosis. Biopsy sites were lymph nodes in 36 cases, spleen in 2 and gastrointestinal tract in 4. Comparing with previously reported material on non-Hodgkin's lymphoma in our department, there were 25 cases of Hodgkin's disease and 160 cases of non-Hodgkin's disease comprised 13.5% of all malignant lymphoms. In conclusion, Hodgkin's disease in Korea seems to be characterized by relatively low incidence comparing with non-Hodgkin's lymphoma, and low relative frequency of nodular sclerosis type, while lymphocyte depletion type is relatively high.

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