Journal of Pathology and Translational Medicine

Original Articles

A scoring system for the diagnosis of non-alcoholic steatohepatitis from liver biopsy: Kyoungbun Lee, Eun Sun Jung, Eunsil Yu, Yun Kyung Kang, Mee-Yon Cho, Joon Mee Kim, Woo Sung Moon, Jin Sook Jeong, Cheol Keun Park, Jae-Bok Park, Dae Young Kang, Jin Hee Sohn, So-Young Jin; J Pathol Transl Med. 2020;54(3):228-236. Published online April 15, 2020; DOI: https://doi.org/10.4132/jptm.2020.03.07

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Background
Liver biopsy is the essential method to diagnose non-alcoholic steatohepatitis (NASH), but histological features of NASH are too subjective to achieve reproducible diagnoses in early stages of disease. We aimed to identify the key histological features of NASH and devise a scoring model for diagnosis.
Methods
Thirteen pathologists blindly assessed 12 histological factors and final histological diagnoses (‘not-NASH,’ ‘borderline,’ and ‘NASH’) of 31 liver biopsies that were diagnosed as non-alcoholic fatty liver disease (NAFLD) or NASH before and after consensus. The main histological parameters to diagnose NASH were selected based on histological diagnoses and the diagnostic accuracy and agreement of 12 scoring models were compared for final diagnosis and the NAFLD Activity Score (NAS) system.
Results
Inter-observer agreement of final diagnosis was fair (κ = 0.25) before consensus and slightly improved after consensus (κ = 0.33). Steatosis at more than 5% was the essential parameter for diagnosis. Major diagnostic factors for diagnosis were fibrosis except 1C grade and presence of ballooned cells. Minor diagnostic factors were lobular inflammation ( ≥ 2 foci/ × 200 field), microgranuloma, and glycogenated nuclei. All 12 models showed higher inter-observer agreement rates than NAS and post-consensus diagnosis (κ = 0.52–0.69 vs. 0.33). Considering the reproducibility of factors and practicability of the model, summation of the scores of major (× 2) and minor factors may be used for the practical diagnosis of NASH.
Conclusions
A scoring system for the diagnosis of NAFLD would be helpful as guidelines for pathologists and clinicians by improving the reproducibility of histological diagnosis of NAFLD.

Citations

Citations to this article as recorded by

Changes in indications for outpatient percutaneous liver biopsy over 5 years: from hepatitis C to fatty liver disease
Marlone Cunha-Silva, Luíza D. Torres, Mariana F. Fernandes, Tirzah de M. Lopes Secundo, Marina C.G. Moreira, Ademar Yamanaka, Leonardo T. Monici, Larissa B. Eloy da Costa, Daniel F. Mazo, Tiago Sevá-Pereira
Gastroenterología y Hepatología.2022; 45(8): 579. CrossRef
Changes in indications for outpatient percutaneous liver biopsy over 5 years: from hepatitis C to fatty liver disease
Marlone Cunha-Silva, Luíza D. Torres, Mariana F. Fernandes, Tirzah de M. Lopes Secundo, Marina C.G. Moreira, Ademar Yamanaka, Leonardo T. Monici, Larissa B. Eloy da Costa, Daniel F. Mazo, Tiago Sevá-Pereira
Gastroenterología y Hepatología (English Edition).2022; 45(8): 579. CrossRef

Interobserver Agreement on Pathologic Features of Liver Biopsy Tissue in Patients with Nonalcoholic Fatty Liver Disease: Eun Sun Jung, Kyoungbun Lee, Eunsil Yu, Yun Kyung Kang, Mee-Yon Cho, Joon Mee Kim, Woo Sung Moon, Jin Sook Jeong, Cheol Keun Park, Jae-Bok Park, Dae Young Kang, Jin Hee Sohn, So-Young Jin; J Pathol Transl Med. 2016;50(3):190-196. Published online April 18, 2016; DOI: https://doi.org/10.4132/jptm.2016.03.01

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Abstract PDF

Background
The histomorphologic criteria for the pathological features of liver tissue from patients with non-alcoholic fatty liver disease (NAFLD) remain subjective, causing confusion among pathologists and clinicians. In this report, we studied interobserver agreement of NAFLD pathologic features and analyzed causes of disagreement.
Methods
Thirty-one cases of clinicopathologically diagnosed NAFLD from 10 hospitals were selected. One hematoxylin and eosin and one Masson’s trichrome-stained virtual slide from each case were blindly reviewed with regard to 12 histological parameters by 13 pathologists in a gastrointestinal study group of the Korean Society of Pathologists. After the first review, we analyzed the causes of disagreement and defined detailed morphological criteria. The glass slides from each case were reviewed a second time after a consensus meeting. The degree of interobserver agreement was determined by multi-rater kappa statistics.
Results
Kappa values of the first review ranged from 0.0091–0.7618. Acidophilic bodies (k = 0.7618) and portal inflammation (k = 0.5914) showed high levels of agreement, whereas microgranuloma (k = 0.0984) and microvesicular fatty change (k = 0.0091) showed low levels of agreement. After the second review, the kappa values of the four major pathological features increased from 0.3830 to 0.5638 for steatosis grade, from 0.1398 to 0.2815 for lobular inflammation, from 0.1923 to 0.3362 for ballooning degeneration, and from 0.3303 to 0.4664 for fibrosis.
Conclusions
More detailed histomorphological criteria must be defined for correct diagnosis and high interobserver agreement of NAFLD.

Citations

Citations to this article as recorded by

Non-alcoholic fatty liver disease: the pathologist’s perspective
Wei-Qiang Leow, Anthony Wing-Hung Chan, Paulo Giovanni L. Mendoza, Regina Lo, Kihan Yap, Haeryoung Kim
Clinical and Molecular Hepatology.2023; 29(Suppl): S302. CrossRef
CT-based Hounsfield unit values reflect the degree of steatohepatitis in patients with low-grade fatty liver disease
Ha Neul Kim, Hong Jae Jeon, Hei Gwon Choi, In Sun Kwon, Woo Sun Rou, Jeong Eun Lee, Tae Hee Lee, Seok Hyun Kim, Byung Seok Lee, Kyung Sook Shin, Hyun Jung Lee, Hyuk Soo Eun
BMC Gastroenterology.2023;[Epub] CrossRef
Artificial intelligence and deep learning: New tools for histopathological diagnosis of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis
Yoshihisa Takahashi, Erdenetsogt Dungubat, Hiroyuki Kusano, Toshio Fukusato
Computational and Structural Biotechnology Journal.2023; 21: 2495. CrossRef
An integrated gene-to-outcome multimodal database for metabolic dysfunction-associated steatotic liver disease
Timothy J. Kendall, Maria Jimenez-Ramos, Frances Turner, Prakash Ramachandran, Jessica Minnier, Michael D. McColgan, Masood Alam, Harriet Ellis, Donald R. Dunbar, Gabriele Kohnen, Prakash Konanahalli, Karin A. Oien, Lucia Bandiera, Filippo Menolascina, An
Nature Medicine.2023; 29(11): 2939. CrossRef
Artificial intelligence scoring of liver biopsies in a phase II trial of semaglutide in nonalcoholic steatohepatitis
Vlad Ratziu, Sven Francque, Cynthia A. Behling, Vanja Cejvanovic, Helena Cortez-Pinto, Janani S. Iyer, Niels Krarup, Quang Le, Anne-Sophie Sejling, Dina Tiniakos, Stephen A. Harrison
Hepatology.2023;[Epub] CrossRef
Improved pathology reporting in NAFLD/NASH for clinical trials
Caitlin Rose Langford, Marc H Goldinger, Darren Treanor, Clare McGenity, Jonathan R Dillman, Daniela S Allende, Robert Goldin, Elizabeth M Brunt, Kurt Zatloukal, Helmut Denk, Kenneth A Fleming
Journal of Clinical Pathology.2022; 75(2): 73. CrossRef
Standardizing the histological assessment of late posttransplantation biopsies from pediatric liver allograft recipients
Stefan G. Hübscher, Sandy Feng, Annette S. H. Gouw, Hironori Haga, Hyo Jeong Kang, Deirdre A. Kelly, Mina Komuta, Andrew Lesniak, Benjamin A. Popp, Henkjan J. Verkade, Eunsil Yu, Anthony J. Demetris
Liver Transplantation.2022; 28(9): 1475. CrossRef
Discordant pathological diagnosis of non‐alcoholic fatty liver disease: A prospective multicenter study
Takuya Kuwashiro, Hirokazu Takahashi, Hideyuki Hyogo, Yuji Ogawa, Kento Imajo, Masato Yoneda, Takashi Nakahara, Satoshi Oeda, Kenichi Tanaka, Yuichiro Amano, Shinji Ogawa, Atsushi Kawaguchi, Shinichi Aishima, Masayoshi Kage, Kazuaki Chayama, Atsushi Nakaj
JGH Open.2020; 4(3): 497. CrossRef
Obeticholic acid for the treatment of nonalcoholic steatohepatitis: Expectations and concerns
Stergios A. Polyzos, Jannis Kountouras, Christos S. Mantzoros
Metabolism.2020; 104: 154144. CrossRef
A scoring system for the diagnosis of non-alcoholic steatohepatitis from liver biopsy
Kyoungbun Lee, Eun Sun Jung, Eunsil Yu, Yun Kyung Kang, Mee-Yon Cho, Joon Mee Kim, Woo Sung Moon, Jin Sook Jeong, Cheol Keun Park, Jae-Bok Park, Dae Young Kang, Jin Hee Sohn, So-Young Jin
Journal of Pathology and Translational Medicine.2020; 54(3): 228. CrossRef
An Improved qFibrosis Algorithm for Precise Screening and Enrollment into Non-Alcoholic Steatohepatitis (NASH) Clinical Trials
Wei-Qiang Leow, Pierre Bedossa, Feng Liu, Lai Wei, Kiat-Hon Lim, Wei-Keat Wan, Yayun Ren, Jason Pik-Eu Chang, Chee-Kiat Tan, Aileen Wee, George Boon-Bee Goh
Diagnostics.2020; 10(9): 643. CrossRef
Deep learning quantification of percent steatosis in donor liver biopsy frozen sections
Lulu Sun, Jon N. Marsh, Matthew K. Matlock, Ling Chen, Joseph P. Gaut, Elizabeth M. Brunt, S. Joshua Swamidass, Ta-Chiang Liu
EBioMedicine.2020; 60: 103029. CrossRef
Magnetic resonance elastography SE-EPI vs GRE sequences at 3T in a pediatric population with liver disease
Juan S. Calle-Toro, Suraj D. Serai, Erum A. Hartung, David J. Goldberg, Bradley D. Bolster, Kassa Darge, Sudha A. Anupindi
Abdominal Radiology.2019; 44(3): 894. CrossRef
R2 relaxometry based MR imaging for estimation of liver iron content: A comparison between two methods
Juan S. Calle-Toro, Christian A. Barrera, Dmitry Khrichenko, Hansel J. Otero, Suraj D. Serai
Abdominal Radiology.2019; 44(9): 3058. CrossRef
Inhibition of mitochondrial fatty acid oxidation in drug-induced hepatic steatosis
Bernard Fromenty
Liver Research.2019; 3(3-4): 157. CrossRef
Standardising the interpretation of liver biopsies in non‐alcoholic fatty liver disease clinical trials
Rish K. Pai, David E. Kleiner, John Hart, Oyedele A. Adeyi, Andrew D. Clouston, Cynthia A. Behling, Dhanpat Jain, Sanjay Kakar, Mayur Brahmania, Lawrence Burgart, Kenneth P. Batts, Mark A. Valasek, Michael S. Torbenson, Maha Guindi, Hanlin L. Wang, Veeral
Alimentary Pharmacology & Therapeutics.2019; 50(10): 1100. CrossRef
NAFLD Histology: a Critical Review and Comparison of Scoring Systems
Rish K. Pai
Current Hepatology Reports.2019; 18(4): 473. CrossRef
Hepatic sonic hedgehog protein expression measured by computer assisted morphometry significantly correlates with features of non-alcoholic steatohepatitis
Michael Estep, Rohini Mehta, Gary Bratthauer, Lakshmi Alaparthi, Fanny Monge, Simon Ali, Dinan Abdelatif, Zahra Younoszai, Maria Stepanova, Zachary D. Goodman, Zobair M. Younossi
BMC Gastroenterology.2019;[Epub] CrossRef
Validation of intimate correlation between visceral fat and hepatic steatosis: Quantitative measurement techniques using CT for area of fat and MR for hepatic steatosis
Moon Hyung Choi, Joon-Il Choi, Michael Yong Park, Sung Eun Rha, Soon Nam Oh, Seung Eun Jung, Jae Young Byun, Stephan Kannengiesser, Yohan Son
Clinical Nutrition.2018; 37(1): 214. CrossRef
Ultrasound or MR elastography of liver: which one shall I use?
Meng Yin, Sudhakar K. Venkatesh
Abdominal Radiology.2018; 43(7): 1546. CrossRef
Feasibility and agreement of stiffness measurements using gradient-echo and spin-echo MR elastography sequences in unselected patients undergoing liver MRI
Guilherme Moura Cunha, Kevin J Glaser, Anke Bergman, Rodrigo P Luz, Eduardo H de Figueiredo, Flavia Paiva Proença Lobo Lopes
The British Journal of Radiology.2018; : 20180126. CrossRef
Second harmonic generation microscopy provides accurate automated staging of liver fibrosis in patients with non-alcoholic fatty liver disease
Pik Eu Chang, George Boon Bee Goh, Wei Qiang Leow, Liang Shen, Kiat Hon Lim, Chee Kiat Tan, Manlio Vinciguerra
PLOS ONE.2018; 13(6): e0199166. CrossRef

Proposal for a Standardized Pathology Report of Gastroenteropancreatic Neuroendocrine Tumors: Prognostic Significance of Pathological Parameters: Mee-Yon Cho, Jin Hee Sohn, So Young Jin, Hyunki Kim, Eun Sun Jung, Mi-Jung Kim, Kyoung-Mee Kim, Woo Ho Kim, Joon Mee Kim, Yun Kyung Kang, Joon Hyuk Choi, Dae Young Kang, Youn Wha Kim, Eun Hee Choi; Korean J Pathol. 2013;47(3):227-237. Published online June 25, 2013; DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.3.227

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Abstract PDF

Background

There is confusion in the diagnosis and biological behaviors of gastroenteropancreatic neuroendocrine tumors (GEP-NETs), because of independently proposed nomenclatures and classifications. A standardized form of pathology report is required for the proper management of patients.

Methods

We discussed the proper pathological evaluation of GEP-NET at the consensus conference of the subcommittee meeting for the Gastrointestinal Pathology Study Group of the Korean Society of Pathologists. We then verified the prognostic significance of pathological parameters from our previous nationwide collection of pathological data from 28 hospitals in Korea to determine the essential data set for a pathology report.

Results

Histological classification, grading (mitosis and/or Ki-67 labeling index), T staging (extent, size), lymph node metastasis, and lymphovascular and perineural invasion were significant prognostic factors and essential for the pathology report of GEP-NET, while immunostaining such as synaptophysin and chromogranin may be optional. Furthermore, the staging system, either that of the 2010 American Joint Cancer Committee (AJCC) or the European Neuroendocrine Tumor Society (ENETS), should be specified, especially for pancreatic neuroendocrine neoplasms.

Conclusions

A standardized pathology report is crucial for the proper management and prediction of prognosis of patients with GEP-NET.

Citations

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Analysis of Prognostic Risk Factors of Endoscopic Submucosal Dissection (ESD) and Curative Resection of Gastrointestinal Neuroendocrine Neoplasms
Yuan Si, ChaoKang Huang, JingBin Yuan, XianHui Zhang, QingQiang He, ZhiJin Lin, Ling He, ZhongXin Liu, Yuvaraja Teekaraman
Contrast Media & Molecular Imaging.2022; 2022: 1. CrossRef
Standardization of the pathologic diagnosis of appendiceal mucinous neoplasms
Dong-Wook Kang, Baek-hui Kim, Joon Mee Kim, Jihun Kim, Hee Jin Chang, Mee Soo Chang, Jin-Hee Sohn, Mee-Yon Cho, So-Young Jin, Hee Kyung Chang, Hye Seung Han, Jung Yeon Kim, Hee Sung Kim, Do Youn Park, Ha Young Park, So Jeong Lee, Wonae Lee, Hye Seung Lee,
Journal of Pathology and Translational Medicine.2021; 55(4): 247. CrossRef
Preoperative diagnosis of well‐differentiated neuroendocrine tumor in common hepatic duct by brush cytology: A case report
Jiwoon Choi, Kyong Joo Lee, Sung Hoon Kim, Mee‐Yon Cho
Diagnostic Cytopathology.2019; 47(7): 720. CrossRef
Primary renal well-differentiated neuroendocrine tumors: report of six cases with an emphasis on the Ki-67 index and mitosis
Bohyun Kim, Han-Seong Kim, Kyung Chul Moon
Diagnostic Pathology.2019;[Epub] CrossRef
Primary low‐grade neuroendocrine carcinoma of the skin: An exceedingly rare entity
Tiffany Y. Chen, Annie O. Morrison, Joe Susa, Clay J. Cockerell
Journal of Cutaneous Pathology.2017; 44(11): 978. CrossRef
Prognostic Validity of the American Joint Committee on Cancer and the European Neuroendocrine Tumors Staging Classifications for Pancreatic Neuroendocrine Tumors
Jae Hee Cho, Ji Kon Ryu, Si Young Song, Jin-Hyeok Hwang, Dong Ki Lee, Sang Myung Woo, Young-Eun Joo, Seok Jeong, Seung-Ok Lee, Byung Kyu Park, Young Koog Cheon, Jimin Han, Tae Nyeun Kim, Jun Kyu Lee, Sung-Hoon Moon, Hyunjin Kim, Eun Taek Park, Jae Chul Hw
Pancreas.2016; 45(7): 941. CrossRef
Early diagnosis and treatment of gastrointestinal neuroendocrine tumors
Hong Shen, Zhuo Yu, Jing Zhao, Xiu-Zhen Li, Wen-Sheng Pan
Oncology Letters.2016; 12(5): 3385. CrossRef
Recent Updates on Neuroendocrine Tumors From the Gastrointestinal and Pancreatobiliary Tracts
Joo Young Kim, Seung-Mo Hong
Archives of Pathology & Laboratory Medicine.2016; 140(5): 437. CrossRef
Pancreatic neuroendocrine tumors: Correlation between the contrast-enhanced computed tomography features and the pathological tumor grade
Koji Takumi, Yoshihiko Fukukura, Michiyo Higashi, Junnichi Ideue, Tomokazu Umanodan, Hiroto Hakamada, Ichiro Kanetsuki, Takashi Yoshiura
European Journal of Radiology.2015; 84(8): 1436. CrossRef
Tumeurs neuroendocrines du tube digestif et du pancréas : ce que le pathologiste doit savoir et doit faire en 2014
Jean-Yves Scoazec, Anne Couvelard
Annales de Pathologie.2014; 34(1): 40. CrossRef
Spectrum of Gastroenteropancreatic NENs in Routine Histological Examinations of Bioptic and Surgical Specimen: A Study of 161 Cases Collected from 17 Departments of Pathology in the Czech Republic
Václav Mandys, Tomáš Jirásek
Gastroenterology Research and Practice.2014; 2014: 1. CrossRef
p27 Loss Is Associated with Poor Prognosis in Gastroenteropancreatic Neuroendocrine Tumors
Hee Sung Kim, Hye Seung Lee, Kyung Han Nam, Jiwoon Choi, Woo Ho Kim
Cancer Research and Treatment.2014; 46(4): 383. CrossRef

Case Report

Mediastinal Hemangioma: Report of a case.: Jong Ok Kim, Bum Kyeong Kim, Kyoung Hee Kim, Dae Young Kang, Kwang Sun Suh; Korean J Pathol. 1997;31(9):891-894.

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Abstract PDF: Benign hemangioma of the mediastinum is rare. This slowly growing tumor is described as well circumscribed, cystic, hemorrhagic tumor. Histologically it can be differentiated into capillary or cavernous form. We present a case of mediastinal hemangioma. A 20-year-old-man was presented with a slowly growing posterior mediastinal mass of 6 years duration, 8x6 cm in size. The mass was relatively well defined but focally invasive. Microscopically, it was differentiated into vessels of capillary, cavernous, and venous patterns. A solid cellular proliferation with inconspicuous capillary lumens was focally seen. The stroma between variable-sized vessels showed marked myxoid change associated with some smooth muscle bundles and adipose tissue. Ultrastructurally, areas of solid cellular proliferation showed formation of lumens. These lumens were lined by active endothelial cells showing plasmalemmal vesicles and Weibel-Palade bodies on the abluminal surface.

Original Article

Gastrointestinal Polyposis in Koreans: A Nationwide Survey of Clinicopathologic Analysis of 112 Surgically Resected Cases.: Mee Soo Chang, Hoguen Kim, Woo Ho Kim, Chan Il Park, Eun Kyung Hong, Han Kyeom Kim, In Soo Suh, Byung Kee Kim, Ja June Jang, Woon Sub Han, Hyung Sik Shin, So Young Jin, Dae Young Kang, Yong Il Kim; Korean J Pathol. 1998;32(6):404-412.

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Abstract: Gastrointestinal polyposis (GIP) is a rare disease characterized by formation of the numerous polyps in the gastrointestinal tract and presenting several extraintestinal manifestations. Most of the diseases are transmitted in an autosomal dominant pattern. In Korea, the epidemiological study as well as the pathological analysis of the GIP is not well established. We therefore analysed 38 items of GIP using surgically resected specimens. The materials in this study were collected from the 12 institutions and case reports in Korean literature between 1980 and 1991. The clinicopathologic findings were reevaluated by several members of the study group for gastrointestinal pathology. The results are as follows: (1) A total of 112 cases were included in this study: 83 cases were collected from 12 institutions and 29 cases were collected from Korean literature. The cases were classified as familial adenomatous polyposis (FAP), 59 cases; Gardner's syndrome, 3 cases; juvenile polyposis, 12 cases; Peutz-Jeghers syndrome, 35 cases; multiple colonic adenomas, 3 cases. (2) Among 59 cases of FAP, the range of age at operation was 14 to 61 years, and a family history was positive in 25 cases. The number of polyps in colorectum was 100~8,000. Of the 37 cases in which the examination of polyp density was available, 16 cases (43%) showed the highest density in the rectum and the sigmoid colon. The carcinomatous change within polyp(s) was present in 18 cases (31%), and associated advanced single or multiple colonic carcinomas existed in 37 cases (63%). Twenty-six (45%) tumors out of total 58 carcinomas were in the rectum. Twenty-five patients were evaluated for the upper gastrointestinal lesions, and 11 patients (44%) had pathologic lesions; multiple fundic gland polyps in 3 cases (12%), gastric and duodenal adenomas in 2 cases (8%), gastric adenomas in 2 cases (8%), duodenal adenomas in 2 cases (8%), gastric carcinoma and adenoma in 1 case (4%), gastric carcinoma in 1 case (4%). (3) Among 3 cases of Gardner's syndrome, the range of age at operation was 25 to 31 years, a family history was identified in 2 cases. One case was associated with an advanced colonic carcinoma and carcinomatous change within polyp. Extra gastrointestinal lesions were sebaceous cyst, epidermal cyst, osteoma and desmoid tumor. (4) Among 12 juvenile polyposis, the range of age at operation was 8 to 51 years and 5 patients had a family history. The carcinomatous change within polyp was found in 2 cases (17%) and associated advanced colonic carcinoma was in 4 cases (33%). The associated different type of polyps was tubular adenomas in 9 cases (75%), hyperplastic polyps in 4 cases (33%) and villous adenomas in 2 cases (17%). (5) Among 35 Peutz-Jeghers syndrome, the range of age at first operation was 6 to 42 years, family history was positive in 11 cases. The carcinomatous change within polyp was found in 1 case (3%), and associated advanced colonic carcinoma in 1 case (3%). The epithelial misplacement was observed in 4 cases (11%), and tubular or villous adenomatous feature in 4 cases (11%). In summary, the most frequent GIP for the surgical resection in Korea is FAP and the FAP is associated with high incidence of coexisting advanced and intramucosal carcinomas. Hamartomatous polyposis syndromes, such as juvenile polyposis and Peutz-Jeghers syndrome are another frequent disease for the surgical resection and are also associated with an increased risk of cancer.

Case Report

Primary Malignant Fibrous Histiocytoma of the Liver: A case report.: Bum Kyeong Kim, Kyeong Hee Kim, Hye Jeong Sul, Dae Young Kang; Korean J Pathol. 1999;33(1):48-51.

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Abstract PDF: Malignant fibrous histiocytoma (MFH) of the liver is uncommon, representing less than 1% of the primary malignant lesions of the liver. We report primary MFH of the liver in a 59-year-old woman. The tumor, measuring 9.0 9.0 6.0 cm, was located in the left lobe of the liver. It showed multiple areas of hemorrhage and necrosis. Microscopically, the tumor consisted of plump spindle cells haphazardly arranged in short fascicle and focal storiform pattern. Multiple bizarre giant cells were also noted. Immunohistochemically, many of the tumor cells were positive for vimentin and alpha1-antitrypsin but negative for epithelial markers. Ultrastructurally, the tumor cells showed fibroblastic and histiocytic features.

Original Article

Histological Grading and Staging of Chronic Hepatitis Standardized Guideline Proposed by the Korean Study Group for the Pathology of Digestive Diseases .: Young Nyun Park, Ho guen Kim, Chae Yoon Chon, Jae Bok Park, Jin Hee Sohn, Seung Ha Yang, Eun Sil Yu, Mi Seon Lee, Ja June Jang, Hee Kyung Chang, Jong Jae Jeong, Dae Young Kang, Yong Il Kim, Chan Il Park; Korean J Pathol. 1999;33(5):337-346.

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Abstract PDF: The terms chronic active hepatitis (CAH), chronic persistent hepatitis (CPH), and chronic lobular hepatitis (CLH) should be discontinued in favor of etiologic terminology. The activity of necro-inflammation and the degree of fibrosis should be evaluated for grading the severity and for the stage of disease. Members of the Korean Study Group for the Pathology of Digestive Diseases reviewed 30 cases of chronic hepatitis and reached the following consensus: 1) The pathology report of the biopsy samples with features of chronic hepatitis should include the etiology, grade and stage. 2) Grade and stage should be semiquantitatively evaluated as none, minimal, mild, moderate and severe. 3) For grading, lobular activity and periportal activity should be evaluated, separately. 4) To avoid confusion with other grading systems, simple report using descriptive terms rather than numerical records is recommended in daily practice. Criteria for each grade and stage should be presented and discussed. Histologic grading and staging of chronic hepatitis by new standardized guidelines will give more information about the prognosis as well as the present status of hepatitis. The terms CAH, CPH and CLH may be used in parentheses to facilitate relearning.

Case Report

Chronic Hepatitis in the Idiopathic Hypereosinophilic Syndrome: A case report .: Kyeong Hee Kim, Hae Joung Sul, Sung Chul Jun, Dae Young Kang; Korean J Pathol. 1999;33(8):624-626.

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Abstract PDF: Chronic hepatitis associated with the idiopathic hypereosinophilic syndrome has been very rarely reported worldwide. Recently, we experienced a case of chronic hepatitis with piecemeal necrosis as the clinical feature of the idiopathic hypereosinophilic syndrome. The patient was a 49-year-old woman who complained of a mild fever, nausea, vomiting, and pain in the right upper quadrant. The eosinophil count of peripheral blood increased up to 14,020/microliter (64% of WBC). Liver biopsy specimen showed severe porto-periportal inflammation with marked eosinophilic infiltration and ballooning degeneration of hepatocytes. Corticosteroid therapy significantly normalized the eosinophil count of peripheral blood.

Original Articles

Apoptosis in Rat Thymus after Bolus Intramuscular Injection of 5-Fluorouracil.: Kyung Hee Kim, Hae Joung Sul, Dae Young Kang; Korean J Pathol. 2000;34(6):413-418.

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Abstract PDF: We induced apoptosis in normal rats by intramuscular injection of 5-fluorouracil (5-FU) and immunohistochemically evaluated the thymus for the TdT-mediated dUTP biotin nick end labelling on the 1st, 3rd, 6th, 9th, 15th and 21st days following the bolus intramuscular injection. The injections of 5-FU induced a greater extent of apoptosis in the thymus. In the thymus, a mild increase in apoptosis was observed 24 hours after injection. The greatest number of apoptotic cells were seen at 72 hours. The size of the thymus decreased and the cortex thinned with hypocellularity. The injection of 5-FU caused massive cell loss in the thymus. Most apoptotic cells were scattered in the cortex and lower levels of apoptosis were also observed in the medulla. After 72 hours, the level of apoptosis returned to the control level. Considering the above results, we think that 5-FU induced toxicity may be related to 5-FU induced apoptosis in normal tissue, especially the thymus.

Does the Colorectal Cancer Among Koreans Share the Same Pathological Features by Geographical Distribution: A Nationwide Survey of Surgically Resected 1,676 Cancers from 1,602 Patients.: Mee Soo Chang, Jin Hee Sohn, Dae Young Kang, Gyeong Hoon Kang, Myung Sook Kim, Woo Ho Kim, Jong Hee Nam, Woo Sung Moon, Sun Hoo Park, Cheol Jeun Park, Ro hyun Sung, Young Lyun Oh, Eun Sook Chang, Hee Kyung Chang, Mee Yon Cho, Kyung Ja Cho, Yong Il Kim; Korean J Pathol. 2001;35(1):14-19.

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Abstract PDF: BACKGROUND
This nationwide survey was undertaken to characterize the general pathological features of colorectal cancer in Korea, and especially to elucidate the geographical characteristics by means of their anatomical distribution.
METHODS
We analysed 1,676 colorectal cancers (from 1,602 patients) surgically resected in 1998 at 15 institutions from nine geographical sites in Korea.
RESULTS
The topographic incidence of colorectal cancer in seven out of the total nine geographical sites, was the highest in the rectum (32-54%); and those from Wonju and Cheongju were in the sigmoid colon (28% for both). The right colon cancer incidence was 42% in Wonju and 36% in Cheongju, while it was 17-22% in the other areas. The cecal cancer incidences in Wonju and in Taegu were 7% and 8%, respectively, but 0-4% in the other areas. As for histology, moderately differentiated adenocarcinoma was the most frequent (46-84%), except for in Wonju and Chonju, where the most predominant type was well differentiated (63% and 52%, respectively).
CONCLUSION
The incidence of right colon cancer was higher in Wonju and Cheongju, than in the other geographical sites. The cecal predilection was prominent in Taegu and Wonju. The Elucidation of geographical differences in degree of differentiation for tubular adenocarcinoma seems to require further cumulative study with strict guidelines.

Case Reports

Malignant Gastrointestinal Stromal Tumor of the Esophagus: A Case Report.: Hae Joung Sul, Kyeong Hee Kim, Dae Young Kang; Korean J Pathol. 2001;35(3):252-255.

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Abstract PDF: Gastrointestinal stromal tumors (GISTs) predominate in the stomach and small intestine but have rarely been documented in the esophagus. We report a rare case of GIST of the esophagus in a 47-year-old woman. Histologically, the tumors showed a combination of solid, myxoid, and perivascular collar-like patterns, with spindle and epithelioid cells. The tumor cells were positive for CD117, CD34, and S-100 protein and negative for desmin and -smooth muscle actin.

Localized Malignant Mesothelioma of Peritoneum Arising in the Liver Capsule: A Case Report.: Hae Joung Sul, Dae Young Kang; Korean J Pathol. 2003;37(1):74-77.

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Abstract PDF: Mesothelioma originates in several sites including the pleura, peritoneum, pericardium, and tunica vaginalis. The pleura is the most common site of origin, but cases originating in the per- itoneum is relatively rare. Mesothelial lesions of the peritoneum may pose significant diagnostic problems. Yet, the accurate identification of this lesion is important because of its distinctive behavior and treatment modality. We herein report a case of malignant mesothelioma of the peritoneum arising in the capsule of the liver. The accuracy of our diagnosis has been confirmed by the immunohistochemical study and electron microscopic examination.

Fine Needle Aspiration Cytology of Endodermal Sinus Tumor of the Ovary: A Case Report.: Jin Man Kim, Dae Young Kang; Korean J Cytopathol. 1995;6(1):54-57.

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Abstract PDF: We report a case of fine needle aspiration cytology of endodermal sinus tumor of the ovary. A 13-year-old girl complained of abdominal mass and pain. The abdominal sonography revealed a well-demarcated huge mass, which was solid and multiseptated. Percutaneous fine needle aspiration was performed from the mass. The smears revealed moderate cellularity, which was arranged in sheets or clumps of pleomorphic malignant cells on mucoid background. The valuable characteristic features of tumor cells were papillary configuration, vacuolated cytoplasm and intracellular and extracellular hyaline globules. The diagnosis was confirmed later by histologic study of surgical resection of the specimen.

Multicenter Study

Porposal for Creating a Guideline for Cancer Registration of the Gastrointestinal Tumors (I).: Mee Yon Cho, Yun Kyung Kang, Kyoung Mee Kim, Hee Kyung Chang, Hee Jin Chang, Mee Soo Chang, Joon Mee Kim, Dae Young Kang, Chanil Park, Jin Hee Sohn; Korean J Pathol. 2008;42(3):140-150.

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Abstract PDF: BACKGROUND
Cancer registries are fundamental for cancer control and multicenter collaborative research. However, there have been discrepancies among pathologists in classifying cancer and assigning the codes according to the International Classification of Disease Oncology 3 (ICD-O3). To improve the quality of cancer registries as well as to prevent the conflict with medical insurance compensation, a guideline for the coding of cancer is mandatory.
METHODS
AND RESULTS: Funded by the Management Center for Health Promotion, 40 members of the Gastrointestinal Pathology Study Group and the Cancer Registration Committee of the Korean Society of Pathologists participated in the 1st workshop for gastrointestinal tumor registration. The subjects of gastric epithelial tumor, intramucosal carcinoma of the colon, carcinoid tumor, gastrointestinal stromal tumor and appendiceal mucinous tumor were discussed to create a guideline. A survey to obtain consensus for the guideline proposed by the workshop was carried out by the members of the Korean Society of Pathologists and 240 members completed the questionnaire.
CONCLUSION
Although there are some issues to be discussed further, such as coding of high grade dysplasia/adenoma and intramucosal carcinoma of stomach and colon, the members agreed upon most parts of the proposed guideline. Therefore, we suggest using the ICD-O3 coding guideline for gastrointestinal tumor.

Editorial

The Korean Journal of Pathology is Selected for Coverage in Science Citation Index Expanded and Journal Citation Reports by Thomson Reuters.: Jeong Wook Seo, Kyung Ja Cho, Han Kyeom Kim, Dae Young Kang; Korean J Pathol. 2008;42(3):131-133.

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Abstract PDF: No abstract available.

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