Journal of Pathology and Translational Medicine

Volume 8(1); June 1997

Original Article

Cytologic Features of Well Differentiated Hepatocellular Carcinoma .: Shin Kwang Khang, Seung Sook Lee, Kyung Ja Cho, Hwa Jeong Ha; Korean J Cytopathol. 1997;8(1):1-10.

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Abstract PDF: The fine needle aspiration biopsy(FNAB) has become a popular method to diagnose mass lesions of the liver. Although many reports have listed FNAB criteria to be used to diagnose hepatocellular carcinoma(HCC), a diagnostic dilemma still exists at the extreme ends of the spectrum, particularly for well differentiated HCC. The authors reviewed a series of FNAB specimens of the liver to distinguish well differentiated HCC from nonneoplastic liver. Fifteen cytologic features were examined in this study: high cellularity, large sheet formation, trabecular pattern, acinar pattern, dispersed pattern, irregular arrangement, increased nuclear/cytoplasmic ratio, naked nuclei, irregular chromatin, irregular nuclear contour, multinucleation, uniform macronucleoli, multiple nuclei, uniform small cytoplasm and monotony of atypia. These features were examined in a series of 76 FNAB specimens. Fifty two specimens were from patients with HCC and 24 specimens were from patients with nonneoplastic lesion or tumors other than HCC containg adequate amount of nonneoplastic hepatocytes in smear. All specimens were coded as to the presence or absence of the above cytologic features. With the use of stepwise logistic regression analysis, three features were identified as the key cytologic features predictive of HCC: irregular chromatin, monotony of atypia and absence of large sheet formation. When these criteria were used, the sensitivity diagnosing HCC by FNAB was 94.2%, specificity 100%, positive predictive value 100% and negative predictive value was 88.9%.

Etc

Clinico-Pathologic Studies on Ovarian Tumors Among Koreans: Jung Sil Cho, Yoo Bock Lee, Dong Sik Kim; Korean J Cytopathol. 1974;8(1):1-14.

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Abstract: The ovary is a complex structure from an embryologic, anatomic, and functional stand-point. Therefore, it is not surprising that tumors originating in this organ are diverse, complicated, and often histogenetically poorly understood. As a corollary, many ovarian tumors are difficult to diagnose. The complexity of ovarian tumors becomes more understandable when it is realized that there is not yet universal agreement as to the origin of such essential structures as germinal epithelium, primordial germ cell, or graafian follicle wall. Tumors are the most common type of lesion encountered in the ovary, and they are a common form of neoplasia in women. Ovarian cancer ranks below only carcinoma of the breast, colon, cervix, endometrium and stomach in the list of common malignancies in the female. With respect to the reproductive tract alone, ovarian cancer accounts for about one-fifth of malignant tumors that occur in this system. The classification of these lesions presents a problem on which there is no unaminity of opinion. The classification differ, depending upon whether the criteria employed are based upon the macroscopic appearance, microscopic architecture, clinical behavior or histogenesis of the tumors. It is not, however, fundamentally different from classifications in recent studies on this subject. Pathologist is expected not only to make a correct microscopic diagnosis using modern terminology but also to supply accurate information about the natural history of a given tumor, thereby guaranteeing the possibility of optimal treatment. This collective review will emphasize current treads in the classification of ovarian tumors, their incidence among Koreans, and comparative incidence in other reports. Materials and Method: Primary and metastatic ovarian tumors were collected that occurred in 454 cases of all age during the period of 12 years from 1961 to 1972. All specimens were fixed in 10% formalin. Gross observations were focused on the size of tumors, cystic or solid in consistency, and capillary growth and locularity of epithelial tumors. For histologic examination, paraffin embedded blocks were cut in 6 M thickness and sections were stained by routine hematoxylin-eosin method. The classification of ovarian tumors was based largely on current concepts and criteria for diagnosis. It includes recognition of the relatively new category of borderline tumors in the serous and mutinous categories. Frequency of psammoma bodies in serous and mucinous tumors were examined for comparison. Age, chief complaints, duration of symptoms and laterality were analysed by means of clinical charts. Also ovarian tumors associated with pregnancy and other lesions were accessioned.
Results
and Summary: Clinical and histopathological studies were made on 454 cases of primary and metastatic ovarian tumors, that were submitted to the Department of Pathology, Yonsei University, College of Medicine, during the period of 12 years, from 1961 to 1972. 1. Among 454 cases, 358(78.991) were benign and 96(21.1%) wire malignant. Metastatic tumors were 19 cases(4.2%). 2. In histologic types, cystic teratomas(175, 38.5%) ranked first followed by mucinous cystadenoma (93cases) and serious cystadenoma and serous cystadengcarcinoma in order of frequency. 3. Benign ovarian tumors showed mean size of 11.0cm in maximum diameter, and malignant tumors was 12.4cm. 4. No site predilection was identified with bilaterality in 22 cases(6.4%) of benign and 14 cases(31.3%) of malignant tumors. 5. Psammoma bodies and papillary growth were more frequently found in serous types than in mucinous types. 6. Mean age of benign ovarian tumors was 35.2 years and malignant one was 41.9 years. 7. Clinical symptoms were abdominal pain, abdominal mass & menstrual disturbance, in order of frequency. 8. There were 31 intrauterine & 4 ectopic pregnancies which were associated with ovarian tumors. Among them, cystic teratomas were 26 cases. In Summary, these findings are comparable to other reports both in Korea and in other countries, except that most frequent histologic type of all ovarian tumors in this review, cystic teratoma(38.5%), ranks 3rd or 4th in other reports, and mean age of malignant of brian tumors, 41.9 years, is much younger than that of other reports(50 years).

Original Article

Diagnostic Usefulness of Fine Needle Aspiration Cytology on Lymphadenopathy: An analysis of 1,216 Cases .: Dong Won Kim, So Young Jin, Dong Wha Lee, Chan Soo Lee; Korean J Cytopathol. 1997;8(1):11-19.

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Abstract PDF: Clinical lymphadenopathies are subjected to fine needle aspiration cytology(FNAC) for diagnosing not only benign lesions but also malignant ones, as the first diagnostic procedure. While the diagnostic reliability in metastatic carcinoma is high, it is difficult to differentiate malignant lymphoma from reactive conditions. We evaluated the diagnostic reliability of FNAC in lymphadenopathy, and discuss the diagnostic limitation and its place in clinical practice in this study. Over 8 years from January 1988, FNAC of 1,216 lymphadenopathies were analyzed and among them 170 cases were compared with histopathology. The results are as follows. 1. Of all the cases, 890 cases(73.2%) were diagnosed cytologically as benign, 312 cases(25.7%) as malignant, and 14 cases(1.1%) as unsatisfactory material. Reactive hyperplasia was diagnosed in 585 cases(65.7%) of the benign lesions, and among the malignant diseases, metastatic carcinoma was diagnosed in 248 cases(79.5%), and malignant lymphoma in 62 cases(19.9%). 2. The overall diagnostic accuracy was 89.2%, and no false positive case and 9 false negative results were observed among 170 cases which were proven by histopathology. Six cases of sampling error of false negative diagnoses included 3 of metastatic carcinomas and 3 of malignant lymphomas. The causes were difference between aspiration and biopsy site, poor fixation, or scanty cellularity with bloody smear. All 3 cases of misinterpretation error were malignant lymphomas, one of mixed type on biopsy which was diagnosed as reactive hyperplasia cytologically. In summary, FNAC technique is thought to be useful in the initial diagnosis of lymphadenopathies as well as in the follow-up of patients with known malignancy. Although the results of malignant lymphoma was less accurate than other malignant lesions, the application of strict cytologic criteria or lymphoid marker studies of aspiration material will reduce the false negative rate.

Etc

Micro Serum Glucose Determinations with Neocuproine Hydrochloride: B.S. Tchai, Kyong Hwan Cho; Korean J Cytopathol. 1974;8(1):15-20.

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Abstract: A simple and micro method for the determination of the blood sugar was studied. serum glucose was estimated by neocuproine hydrochloride method previously described by M.E. Brown. Neocuproine method was compared with a classical Somogyi-Nelson method and also two filtrates namely Somogyi and Folin-Wu were used for the determination of glucose according to the neocuproine method. The values of glucose in serum of thirty seven healthy person by classical Somogyi-Nelson method were 8.60 ±7.5mg/100m1, by Somogyi filtrate-neocuproine method, 85.8±12.4mg/100ml and by Folin-Wu filtrate-neocuproine method, 102 ± 7.4mg/100m1 respectively. The estimation of glucose by a Somogyi-Nelson procedure and by the neocuproine is affected by the protein-free filtrate, and intraprocedual differences are small. However, consistantly lower values are obtained by the Somogyi-Nelson and Somogyi-neocuproine methods and probably represent a mere valid index of true serum glucose than the Folin-Wu neocuproine procedure.

Original Article

Diagnostic Value of Flow Cytometric DNA Analysis in the Evaluation of Effusions .: Ji Shin Lee, Sang Woo Juhng; Korean J Cytopathol. 1997;8(1):20-26.

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Abstract PDF: The specificity of cytologic examination in effusions is high but the sensitivity is low. Therefore, various ancillary methods for the detection of malignant cells in effusions have been proposed. The presence of an aneuploid cell population is generally considered diagnostic of malignancy. The purpose of this study is to determine whether the routine use of flow cytometry adds to standard cytologic evaluation in effusions. We did flow cytometric DNA analysis in 76 effusions(28 malignant and 48 benign fluids). All the 48 benign effusions were diploid. There were 12(42.9%) aneuploid and 16(67.1%) diploid malignant effusions. Based on these results flow cytometric DNA analysis had a sensitivity of 42.9% and a specificity of 100%. These results suggest that flow cytometric DNA analysis may be a useful adjunct to conventional cytology, but its principal limitation is its relatively low sensitivity.

Etc

Histiocytic Medullary Reticulosis -Report of Five Cases-: Sang In Kim, Hyun Sook Chi, Bo Ryun Kim, Young Hee Choi, Yong Il Kim; Korean J Cytopathol. 1974;8(1):21-27.

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Abstract: Five cases of histiocytic medullary reticulosis diagnosed by authors at the Seoul National University Hospital during 1971 to 1973 are presented with clinical summary, laboratory results and hematological findings of peripheral blood and bone marrow. The results are summerized as follows: 1. Four out of five cases were male with average age of 20, and male to female ratio was 4 : 1. 2. Four patients died during hospitalization and their mean survival from the onset of disease to the death was 121 days. 3. All case disclosed clinical manifestation of high fever, hepatosplenomegaly and/or lymphadenopathy and bleeding tendency or icterus. 4. Peripheral blood showed severe anemia, thrombocytopenia (4 cases showed less than 40,000/mm3 of platelets at the end-stage), leukopenia (mean WBC total count was 1,700/mm3 at the end-stage) and prolonged bleeding & prothrombin time. 5. All cases had atypical monocytes in peripheral blood smears with erythrophagocytosis(3 case)or phagocytosis of platelets or other cell debris. 6. Bone marrow showed hypoplasia and increased number of atypical monocytes with slightly increased proportion of lymphocytes, plasma cells and normoblasts, Careful examination of bone marrow disclosed an erythrophagocytosis in monocytic cells even in those cases with little monocytic hyperplasia. 7. Though the histocytic medullary reticulosis is a rare disease, an attention and careful study will find more cases in Korea.

Original Article

Immunocytochemical Detection of Pneumocystis Carinii in Bronchoalveolar Lavage .: Kun Young Kwon, Seung Che Cho, Sang Pyo Kim, Kwan Kyu Park, Eun Sook Chang, Chung Sook Kim; Korean J Cytopathol. 1997;8(1):27-34.

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Abstract PDF: Pneumocystis carinii is an established cause of pulmonary infections in immuno- compromised hosts. Several cytological stains, such as Papanicolaou, Gomori methenamine silver(GMS) and Diff-Quik have been used for detection of the organism, but occasionally can be laborious and, due to a degree of nonspecificity, may be misleading. We evaluated the diagnostic utility of immunocytochemical stains that recognize P. carinii in bronchoalveolar lavage from experimentally induced P. carinii pneumonia rats(n=15). In addition to routine stains for diagnosis by morphologic recognition of P. carinii on Papanicolaou, GMS and Diff-Quik stains, bronchoalveolar lavage samples were reacted with immunocytochemical stains using monoclonal antibodies(MAB) 092 and 902. In bronchoalveolar lavage P. carinii organisms were detected in 9 of 10 cases (90%) using each MAB 092 and 902, whereas GMS and Diff-Quik stains demonstrated P. carinii in 13(86%) and 11(73%) of 15 cases respectively. In lung tissue specimens(n=15) P. carinii organisms were well identified on GMS stain and immunohistochemical stains using MAB 092 and 902 in all cases. We believe that the immunocytochemical staining using MAB 092 and/or 902 is a very useful and diagnostic tool in addition to GMS and Diff-Quik stain to detect P. carinii organisms in bronchoalveolar lavage.

Etc

Acute Hepatic Alterations Induced by Aflatoxin B₁ -Correlation of Histopathologic Findings with ³H-thymidine Uptake by Autoradiography and Mitotic Index-: Moon Ho Yang, Chae Koo Lee; Korean J Cytopathol. 1974;8(1):29-40.

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Abstract: Acute hepatic alterations was induced in young male rats by a single intraperitoneal injection of aflatoxin B₁ dissolved within diaethylsulfoxide, and their histopathologic characteristics were correlated with mitotic activity and incooperation of 3H-thymidine uptake into hepatocytes and Kupffer cells using microautoradiography. 1. Major morphological changes in the earl phase included little periportal necrosis but accompanied features of much significant hepatocellular degeneration and unrest as well as kupffer cell reaction and minimal ductular cell proliferation; Evidences of hepatocellular injuries started to appear within 24 hours after exposure, but became regressed 72 hours later to restore normal hepatic architectures and cellular details after the 7th day. 2. Indices of both 3H-thymidine uptake and mitosis of the hepatocytes was lowest at the 24 hour-group, being followed by rather rapid increase up to the levels of 2∼3 times higher than those in the control group at the 5th day, and thereafter both returned to the normal status. 3. Those transient increases of both indices were assumed to be resulted by compersatory proliferation for hepatic injuries. 4. Hepatic megalocytosis during morphological architectural restore supported that abnormal increase of metabolism was involved against antimetabolic effect of aflatoxin. 5. Kupffer cells were also similarly but less severely affected by aflatoxin in terms of both 3H-thymidine uptake and mitotic indices. The above features during the early phase of hepatic alterations suggested that administration of aflatoxin B₁ results in impairment or blockage of DNA synthesis and antimetabolic effect within 24 hours on both hetpatocytes and kupffer cells, after which both of 3H-thymidine uptake and mitotic indices return to the normal as with morphologic restorement.

Original Article

Cytologic Features and Distribution of Primary Sites of Malignant Cells in Body Cavity Fluids .: Kang Suek Suh, Chang Hun Lee, Hyun Ok Kim; Korean J Cytopathol. 1997;8(1):35-46.

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Abstract PDF: The authors reviewed 167 malignant effusions from 110 patients, of which the primary site was established on the basis of either biopsy or surgical resection of the primary neoplasm. Main factors analysed were the distribution of primary organs and the cytohistologic correlation of body cavity effusions. The 167 fluid specimens from 110 patients consisted of 90 cases(53.9%) of pleural, 68(40.7%) of peritoneal, and 9(5.4%) of pericardial origins. Histologically they consisted of 82 cases(74.5%) of adenocarcinoma, 8(7.3%) of malignant lymphoma, 6(5.5%) of squamous cell carcinoma, and 3(2.7%) of small cell carcinoma. The most common site among the primary lesions was the stomach in 25 cases(22.7%) followed by the lung in 21 (19.1%), ovary in 17(15.5%), and breast in 7(6.4%). As for the distribution of primary tumors in adenocarcinoma, the most common site was lung in 16 cases (48.5%) in pleural fluid and stomach in 22(48.9%) in peritoneal fluid. In pericardial effusions, all 5 cases were from the lung. As a whole, the cytologic findings of malignant effusion were fairly representative of histologic characteristics of primary lesions. Thus, when the primary lesion is unknown, careful evaluation of effusion cytology is presumed to be a helpful tool for tracing the primary tumor.

Etc

Intrahepatic Colloid Deposit in Kupffer Cell: Yong Il Kim, Jin Soo Lee, Jae Hoon Koo; Korean J Cytopathol. 1974;8(1):43-47.

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Abstract: A histologic and histochemical study on ten cases of the liver needle biopsy specimens disclosing smudgy, pale basophilic, globular, aggregations mainly localized within the hepatic Kupffer cells, was made to clarify the nature of substance and tissue reaction. 1. The material lay mainly with in Kupffer cells freely in the hepatic sinusoids or in the portal spaces. 2. Hematoxylin-eosin stained sections revealed aggregations of pale to deep blue globular substance measuring 10-100 μ in diameter, and accompanied a mild lymphocytic and histiocytic reaction except in one which was characterized by foreign body type granulomas. 3. Histochemical reaction of the material to PAS, mucicarmine and alcian blue stains gave all negative reactions. 4. Two cases presented histories of receiving either periston and/or dextran as plasma expander. 5, These all of cases revealed no hepatic dysfunction in regard to the deposit. 6. Nature and pathogenesis of the colloidal material were not identified but it is suggested that deposit of certain exogenous nonmucinous substances as with polyvinyl pyrrolidone would participate on to the intrahepatic colloidal deposit.

Case Report

Cytologic Findings of Rheumatoid Pleuritis in Pleural Effusion: A Case Report .: Hee Jeung Cha, Soo Kee Min, Joon Mee Kim, Young Chae Chu; Korean J Cytopathol. 1997;8(1):47-51.

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Abstract PDF: Patients with rheumatoid arthritis of any degree of severity or duration may develop necrotizing granulomatous pleuritis, a morphologic replica of the inflammatory reaction characteristic of rheumatoid synovitis and rheumatoid nodules. The principal feature is the background composed of granular, amorphous, particulate material or debris of various hues. The material is sometimes eosinophilic, sometimes more cyanophilic, or even green in the Papanicolaou stain. Within this background are elongated, fibroblast-like epithelioid cells, numerous multinucleated giant cells and degenerating leukocytes. The combination of the debris, spindle epithelioid cells, and multinucleated giant cells in fluid is pathognomonic for rheumatoid pleuritis. We experienced a hcase of rheumatoid pleuritis showing these characteristic cytologic findings. The patient was a 63 year-old man with positive rheumatoid factor. The pleual fluid specimen revealed elongated epithelioid cells and multinucleated giant cells in a background of amorphous granular material.

Etc

Histopathologic and Clinical Studied of the Salivary Gland Tumors among Koreans: Kwang Kil Lee, Jin Kook Choe, Chi Whan Kim, Chung Sook Kim, In Joon Choi, Yoo Bock Lee, Dong Sik Kim; Korean J Cytopathol. 1974;8(1):49-59.

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Abstract: Ninety five cases of salivary gland tumors were reviewed in histopathlogic and clinical aspects. The results were as follows: The average age of patients was 37.9 years. Overall cases showed female predominance with 1.7 : 1 of male to female ratio, but malignant mixed tumors were more frequent 1.3 times in males. The chief complaints were palpable mass (87.3%), pain(14.5%: facial nerve paralysis (9.1%) and swelling(7.3%) in order of frequency and the duration of the disease was over one year in most of the patients(88.5%). As the location, 49.4% occurred in the major salivary glands and 40.0% in the minor. The parotid gland was the most frequent site with 35.8% of the total, and the next were palate (18.9%), submaxillary gland(11.6%) and nasal cavity and maxillary sinus(10.6%). The tumors were benign in 57.9% and malignant in 42.1%. The most frequent histological type was benign mixed tumors (57.9%) and the next were adenoid cystic carcinoma (21.6%) and mucoepidermoid carcinomas(9.5%). Most of mixed tumors in the minor salivary glands occurred in the palate and all of thens were benign in character. Adenoid cystic carcinoma was most frequent in the basal cavity and maxillary sinus and the next was in the tongue. It seems that both the epithlial and myoepithelial cells take part in the formation of the mixed tumor favoring the opinion of Yates and Paget(1952), Azzopardi and Smith(1959) and Hubner et al. (1971).

Original Article

Oxyphilic Papillary Carcinoma of the Thyroid in Fine Needle Aspiration .: Young Min Kim, Gyung Yub Gong, On Ja Kim; Korean J Cytopathol. 1997;8(1):52-56.

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Abstract PDF: Oxyphilic (H rthle) cells have abundant eosinophilic granular cytoplasms and occur in both benign and malignant neoplasms of the thyroid gland. Most published studies described mainly oxyphilic tumors of follicular type, and reports on oxyphilic papillary thyroid carcinomas are rare. The oxyphilic variant of papillary carcinoma differs from the classic papillary carcinoma in its more aggressive biological behavior. We report a case of oxyphilic papillary carcinoma exhibiting exclusively oxyphilic cells in a follicular pattern without papillary structures. The pattern of papillary carcinoma was confirmed by fine needle aspiration material and lymph nodal metastasis, both of which revealed typicaled papillary structures with characteristic nuclear features, psammoma bodies, and oxyphilic cytoplasm.

Case Report

Fine Needle Aspiration Cytology of Squamous Cell Carcinoma of the Thyroid: Report of A Case .: Im Joong Yoon, Eun Sub Park, Jae Hyung Yoo; Korean J Cytopathol. 1997;8(1):57-61.

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Abstract PDF: A primary squamous cell carcinoma of the thyroid is extremely rare disease. We evaluated this disease by fine needle aspiration cytology in a 43 year-old female. On physical examination, the thyroid was moderately enlarged and palpated with hard consistency. The cytologic aspirate revealed nests of squamous cells, malignant squame and thyroid follicular cells in the necrotic background. We diagnosed this tumor as squamous cell carcinoma with cytologic evidence. Surgically resected thyroid revealed well differentiated squamous cell carcinoma. Immunohistochemical staining for antithyroglobulin proved that this tumor was primary in origin and clinical study confirmed this lesion to be of primary thyroid origin rather than metastasis or direct invasion from contiguous structures.

Etc

Bilateral Ovarian Luteomas of Pregnancy -Report of a Case-: Sang In Shim, Chong Moo Lee; Korean J Cytopathol. 1974;8(1):61-64.

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Abstract: A case of luteoma of pregnancy occurring in a 31 years old multiparous woman, and found incidentally during a cesarean section for placenta previa and transverse position of the fetus, was reported. The gross and microscopic findings of the present case strongly supported that this lesion is a benign, generally non-functioning, lutenized stromal cell hyperplasia, probably due to an overactive physiologic response of the ovary to chorionic gonadotropins. A brief review of the literature was made.

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