Journal of Pathology and Translational Medicine

Case Studies

Gastric crystal-storing histiocytosis with concomitant mucosa-associated lymphoid tissue lymphoma: Mee Joo, Nam-Hoon Kim; J Pathol Transl Med. 2020;54(4):332-335. Published online May 22, 2020; DOI: https://doi.org/10.4132/jptm.2020.04.20

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Crystal-storing histiocytosis (CSH) is a rare entity that is characterized by intrahistiocytic accumulation of crystallized immunoglobulins. CSH is not a malignant process per se, but the majority of CSH cases are associated with underlying lymphoproliferative disorder. Although CSH can occur in a variety of organs, gastric CSH is very rare. We present a localized gastric CSH with concomitant mucosaassociated lymphoid tissue (MALT) lymphoma, manifesting as an ulcer bleeding in a 56-year-old man. Histologically, the biopsied gastric mucosa demonstrated expansion of the lamina propria by prominent collections of large eosinophilic mononuclear cells containing fibrillary crystalloid inclusions. Immunohistochemical studies revealed that the crystal-storing cells were histiocytes harboring kappa light chain-restricted immunoglobulin crystals. Within the lesion, atypical centrocyte-like cells forming lymphoepithelial lesions were seen, consistent with MALT lymphoma. Since this entity is rare and unfamiliar, difficulties in diagnosis may arise. Particularly, in this case, the lymphomatous area was obscured by florid CSH, making the diagnosis more challenging.

Citations

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Crystal-storing histiocytosis in the stomach: A case report and review of the literature
Linghong Kong, Liyan Xue, Yanfeng Zhong, Shenglan Wang, Danfeng Zheng, Lining Wang, Yang Jiao, Xinpeng Zhang, Huizhong Xue, Xiaogang Liu
Frontiers in Oncology.2022;[Epub] CrossRef
Lambda-Restricted Crystal-Storing Histiocytosis of Stomach: A Case Report and Review of Literature
Nalini Bansal, Pankaj Puri, Nishant Nagpal, Rahul Naithani, Rahul Gupta
Cureus.2021;[Epub] CrossRef
Immunoglobulin-Storing Histiocytosis: A Case Based Systemic Review
Hanne Wiese-Hansen, Friedemann Leh, Anette Lodvir Hemsing, Håkon Reikvam
Journal of Clinical Medicine.2021; 10(9): 1834. CrossRef

Diffuse Involvement of Primary Colorectal Lymphoma Simulating Ulcerative Colitis: Ji-Ye Kim, Sun Hee Chang, Han Seong Kim, Mee Joo; J Pathol Transl Med. 2019;53(5):332-336. Published online August 2, 2019; DOI: https://doi.org/10.4132/jptm.2019.07.12

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Abstract PDF: Diffuse involvement of colorectal lymphoma masquerading as colitis is a very rare presentation of primary colorectal lymphoma. Detecting occult lymphoma is difficult in the setting of diffuse colonic involvement with no definite mass and inflammatory mucosal changes. We encountered a case of diffuse-type primary colorectal lymphoma simulating ulcerative colitis in a previously healthy 31-year-old woman. Despite multiple mucosal biopsies, the biopsy diagnosis was not made due to unawareness of atypical lymphocytes admixed with dense lymphoplasmacytic infiltration. The present case emphasizes the importance of being aware of this rare presentation of primary colorectal lymphoma in order to avoid misdiagnosis.

Review

Rare Gastric Lesions Associated with Helicobacter pylori Infection: A Histopathological Review: Mee Joo; J Pathol Transl Med. 2017;51(4):341-351. Published online June 5, 2017; DOI: https://doi.org/10.4132/jptm.2017.04.03

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Abstract PDF

Helicobacter pylori infection is associated with chronic gastritis, peptic ulcer disease, gastric adenocarcinoma, and mucosa-associated lymphoid tissue lymphoma. However, some rare gastric lesions exhibiting distinctive histological features may also be associated with H. pylori infection, including lymphocytic gastritis, granulomatous gastritis, Russell body gastritis, or crystal-storing histiocytosis. Although diverse factors can contribute to their development, there is convincing evidence that H. pylori infection may play a pathogenic role. These findings are mainly based on studies in patients with these lesions who exhibited clinical and histological improvements after H. pylori eradication therapy. Thus, H. pylori eradication therapy might be indicated in patients with no other underlying disease, particularly in countries with a high prevalence of H. pylori infection. This review describes the characteristic histological features of these rare lesions and evaluates the evidence regarding a causative role for H. pylori infection in their pathogenesis.

Citations

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Crystal-Storing Histiocytosis: The Iceberg of More Serious Conditions
Mousa Mobarki, Alexandra Papoudou-Bai, Jean Marc Dumollard, Abdulaziz H. Alhazmi, Shaqraa Musawi, Mohammed Ali Madkhali, Khalid Y. Muqri, Michel Péoc’h, Georgia Karpathiou
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Elizaveta Flerova, Susan Inniss, Nneamaka Nwaoduah, Richard P. Denicola, Jialing Huang
Human Pathology Reports.2023; 31: 300696. CrossRef
Infectious Gastric Diseases Other than Helicobacter
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H. pylori Infection and Virulence Factors cagA and vacA (s and m Regions) in Gastric Adenocarcinoma from Pará State, Brazil
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Crystal-storing histiocytosis in the stomach: A case report and review of the literature
Linghong Kong, Liyan Xue, Yanfeng Zhong, Shenglan Wang, Danfeng Zheng, Lining Wang, Yang Jiao, Xinpeng Zhang, Huizhong Xue, Xiaogang Liu
Frontiers in Oncology.2022;[Epub] CrossRef
Dynamics of inflammatory changes of the gastric mucosa in children with duodenal ulcer
T.V. Sorokman, P.M. Moldovan, L.Yu. Khlunovska, I.Ya. Lozyuk
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Clinicopathological characteristics and aetiological factors of granulomatous gastritis
Yuanxin Liang, Shengjie Cui, Alexandros D Polydorides
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A case of Russell body gastritis with multifocal lesions
Michinobu Umakoshi, Ken Miyabe, Hajime Ishii, Yukitsugu Kudo-Asabe, Yukinobu Ito, Makoto Yoshida, Daichi Maeda, Masato Sageshima, Akiteru Goto
SAGE Open Medical Case Reports.2020; 8: 2050313X2092384. CrossRef
Gastric crystal-storing histiocytosis with concomitant mucosa-associated lymphoid tissue lymphoma
Mee Joo, Nam-Hoon Kim
Journal of Pathology and Translational Medicine.2020; 54(4): 332. CrossRef
Nonimmunoglobulin Crystal-Storing Histiocytosis (CSH): Case Report and Literature Review
Manuel Beltran, Sharad Khurana, Yennifer Gil, Jason T. Lewis, Rohit Kumar, James M. Foran, Masayuki Nagasawa
Case Reports in Hematology.2020; 2020: 1. CrossRef
Benign and malignant gastroduodenal diseases associated with Helicobacter pylori: a narrative review and personal remarks in 2018
György M. Buzás
Minerva Gastroenterologica e Dietologica.2018;[Epub] CrossRef
Crystal-storing Histiocytosis in the Stomach
Christina A. Arnold, Wendy L. Frankel, Ling Guo, Chandra Krishnan, Sheryl Pfeil, Melinda Schumacher, Lysandra Voltaggio, Martha M. Yearsley, Wei Chen
American Journal of Surgical Pathology.2018; 42(10): 1317. CrossRef

Original Article

Mesothelin Expression in Gastric Adenocarcinoma and Its Relation to Clinical Outcomes: Song-Hee Han, Mee Joo, Hanseong Kim, Sunhee Chang; J Pathol Transl Med. 2017;51(2):122-128. Published online February 15, 2017; DOI: https://doi.org/10.4132/jptm.2016.11.18

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Abstract PDF

Background
Although surgical resection with chemotherapy is considered effective for patients with advanced gastric cancer, it remains the third leading cause of cancer-related death in South Korea. Several studies have reported that mesothelial markers including mesothelin, calretinin, and Wilms tumor protein 1 (WT1) were positive in variable carcinomas, associated with prognosis, and were evaluated as potential markers for targeted therapy. The aim of this study was to assess the immunohistochemical expression of mesothelial markers (mesothelin, calretinin, and WT1) in gastric adenocarcinoma and their relations to clinocopathological features and prognosis. Methods: We evaluated calretinin, WT1, and mesothelin expression by immunohistochemical staining in 117 gastric adenocarcinomas. Results: Mesothelin was positively stained in 30 cases (25.6%). Mesothelin expression was related to increased depth of invasion (p = .002), lymph node metastasis (p = .013), and presence of lymphovascular (p = .015) and perineural invasion (p = .004). Patients with mesothelin expression had significantly worse disease-free survival rate compared with that of nonmesothelin expression group (p = .024). Univariate analysis showed that mesothelin expression is related to short-term survival. None of the 117 gastric adenocarcinomas stained for calretinin or WT1. Conclusions: Mesothelin expression was associated with poor prognosis. Our results suggest that mesothelin-targeted therapy should be considered as an important therapeutic alternative for gastric adenocarcinoma patients with mesothelin expression.

Citations

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Mesothelin-Targeted Recombinant Immunotoxins for Solid Tumors
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Mesothelin as a target for cervical cancer therapy
Korinna Jöhrens, Lea Lazzerini, Jana Barinoff, Jalid Sehouli, Guenter Cichon
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Experimental and Therapeutic Medicine.2018;[Epub] CrossRef

Case Study

Gastric-Type Extremely Well-Differentiated Adenocarcinoma of the Stomach: A Challenge for Preoperative Diagnosis: Mee Joo, Song Hee Han; J Pathol Transl Med. 2016;50(1):71-74. Published online September 30, 2015; DOI: https://doi.org/10.4132/jptm.2015.07.14

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Abstract PDF

Gastric-type extremely well-differentiated adenocarcinoma (EWDA) is a rare type of gastric adenocarcinoma characterized by infiltration of well-formed mucinous glands with little or no nuclear atypia, which resemble foveolar epithelium or pyloric glands. Because of its high degree of differentiation, preoperative biopsy diagnosis of gastric-type EWDA is very difficult. We encountered a case of gastric-type EWDA, manifesting as a Borrmann type 4 lesion, in a 47-year-old man. Despite four repeated biopsies, the preoperative biopsy diagnosis was not conclusive due to the scarcity of diagnostic tumor cells and lack of knowledge regarding the unusual histologic findings of gastric-type EWDA. We herein describe the histologic findings of gastric-type EWDA in detail, with the aim of facilitating a preoperative biopsy diagnosis and understanding of this rare type of gastric adenocarcinoma.

Citations

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Unusual or Uncommon Histology of Gastric Cancer
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Clinicopathological features of gastric adenocarcinoma of fundic gland type
Bao-Zhen Guo, Zhen-Zhen Liu, Gao-Fei Shen, Fei Zhu, Hui-Fen Lian, Xin Li, Jun-Yi Zheng, Jin-Peng Li, Shui-Miao Deng, Rui Huang
World Chinese Journal of Digestology.2023; 31(6): 244. CrossRef
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Extremely well-differentiated adenocarcinoma of the stomach: diagnostic pitfalls in endoscopic biopsy
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Helicobacter pylori-negative Gastric Cancer
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The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2021; 21(1): 10. CrossRef
Preoperative diagnosis of a gastric extremely well-differentiated adenocarcinoma: A case report
Katsushi Suenaga, Shiro Matsumoto, Alan Kawarai Lefor, Yoshimasa Miura, Yoshinori Hosoya, Daigo Kuboki, Hidenori Haruta, Kentaro Kurashina, Atsushi Kihara, Daisuke Matsubara, Yasunari Sakuma, Joji Kitayama, Naohiro Sata
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Gastric adenocarcinoma of the fundic gland type: clinicopathological features of eight patients treated with endoscopic submucosal dissection
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Diagnostic Pathology.2020;[Epub] CrossRef
Gastric Adenocarcinoma of the Fundic Gland Type
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American Journal of Clinical Pathology.2018; 149(6): 461. CrossRef

Brief Case Report

Malakoplakia Affecting the Umbilical Cord: Song-Hee Han, Mee Joo, Sunhee Chang, Han-Seong Kim; J Pathol Transl Med. 2015;49(2):177-179. Published online March 12, 2015; DOI: https://doi.org/10.4132/jptm.2015.02.04

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PDF

Citations

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Cecal malakoplakia: A case report
Jin Woon Jeong, Ji Hyun Noh, Jeong Hyun Kang, Ji Hyun Park, Joo Hyung Lee
Korean Journal of Clinical Oncology.2021; 17(1): 44. CrossRef
Rectal malakoplakia
Ted George Achufusi, Kegan Jessamy, Philip Chebaya, Sekou Rawlins
Baylor University Medical Center Proceedings.2020; 33(3): 389. CrossRef
Colonic Malakoplakia: A Rare Finding in a Healthy Male
Rawad A. Yared, Hussein A. Badran, Mohammed Hussein Kamareddine, Youssef Ghosn, Roula Bou Khalil, Khaled El Ajamy, Camil Chouairy, Said G. Farhat
Case Reports in Gastroenterology.2018; 12(2): 453. CrossRef

Case Report

Cytologic Findings of Thyroid Carcinoma Showing Thymus-like Differentiation: A Case Report: Sunhee Chang, Mee Joo, Hanseong Kim; Korean J Pathol. 2012;46(3):302-305. Published online June 22, 2012; DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.3.302

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Abstract PDF

Carcinoma showing thymus-like differentiation (CASTLE) is a rare carcinoma of the thyroid or adjacent soft tissue of the neck with a histologic resemblance to thymic epithelial tumors. Although the fine-needle aspiration (FNA) plays a central role in the initial evaluation of thyroid nodules, few reports about the cytologic findings of CASTLE have been found according to a review of literatures. We report cytologic findings of a case of CASTLE. A 34-year-old woman presented with a 2-month history of sore throat. The FNA showed that the smear was composed of three dimensional clusters and sheets. The tumor cells were round to ovoid with high nuclear : cytoplasmic ratios. The nuclei were vesicular with small nucleoli. There were some tumor cells showing keratinization. Some lymphocytes were found on the background and within clusters. The presence of poorly-differentiated tumor cells with a focal keratinization and a lymphocytic background on the FNA is suggestive of CASTLE.

Citations

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Intrathyroidal Thymic Carcinoma: A Retrospective Case Series Study
Jinhui Liang, Mei Huang, Helang Huang, Li Li, Hailin Luo, Weidong Mao, Shan Gao, Haoxiang Xu
Ear, Nose & Throat Journal.2023; 102(9): 584. CrossRef
Carcinoma showing thymus‐like differentiation of the parotid gland: The brief report of cytomorphology and review of the literature
Tomoko Uchiyama, Chiyoko Terada, Yuma Tachibana, Hirokazu Nishiura, Maiko Takeda, Tomomi Fujii, Takahiro Kimura, Masahiro Tsutsumi, Chiho Ohbayashi
Diagnostic Cytopathology.2023;[Epub] CrossRef
A case of concurrent occurrence of carcinoma showing thymus-like differentiation and follicular variant of papillary thyroid cancer in the same thyroid
Takahito Kimura, Keisuke Enomoto, Masamitsu Kono, Masanobu Hiraoka, Saori Takeda, Naoko Kumashiro, Shun Hirayama, Eri Kimura, Shunji Tamagawa, Makiko Ohtani, Shin-Ichi Murata, Muneki Hotomi
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Ultrasonographic Features of Intrathyroidal Thymic Carcinoma: Review and Analysis of 10 Cases
Wang, MD Yanhai, Yang, MD Hua, Liu, MD Hanqing, Luo, MD Xiaoli, Liu, BS Luying, Zhou, BS Pingting
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Thyroid carcinoma with thymus-like differentiation (CASTLE) tumor: а сase report
A. A. Ilyin, V. V. Polkin, P. A. Isaev, F. E. Sevrukov, N. Yu. Dvinskych, M. I. Ryzhenkova, S. A. Ivanov, A. D. Kaprin
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Maria-Rosa Bella-Cueto, Mireia Pascua-Solé, Albert Cano-Palomares, M. Àngels Cabezuelo-Hernandez, Maria-Rosa Escoda-Giralt, Santiago Barcons-Vilaplana, Paula Serret-Miralles, Carmen Caral-Vanaclocha, Xavier Guirao-Garriga, Joan Prats-Lopez, Meritxell Meda
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Intrathyroidal thymic carcinoma exhibiting neuroendocrine differentiation: Case report with cytomorphology, immunocytochemistry, and review of the literature focusing on cytology
Wen‐hao Ren, Kun Dong, Xiao‐zheng Huang, Yan‐li Zhu
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Management and Prognostic Factors for Thyroid Carcinoma Showing Thymus-Like Elements (CASTLE): A Case Series Study
Rui Gao, Xi Jia, Ting Ji, Jinteng Feng, Aimin Yang, Guangjian Zhang
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Heather Gage, Elizabeth Hubbard, Laurentia Nodit
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Clinical analysis of 82 cases of carcinoma showing thymus-like differentiation of the thyroid
WEI GE, YONG-ZHONG YAO, GANG CHEN, YI-TAO DING
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Carcinoma Showing Thymus-Like Differentiation (CASTLE): Cytopathological Features and Differential Diagnosis
Jennifer A. Collins, Bo Ping, Justin A. Bishop, Syed Z. Ali
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Carcinoma Showing Thymus-Like Elements of the Thyroid Gland: Report of Three Cases Including One Case with Breast Cancer History
Guanjun Zhang, Xi Liu, Wei Huang, Xiaofeng Li, Marianne Johnstone, Yuan Deng, Yongqiang Ke, Quentin M. Nunes, Hongyan Wang, Yili Wang, Xuebin Zhang
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Potential Role of Adjuvant Radiation Therapy in Cervical Thymic Neoplasm Involving Thyroid Gland or Neck
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Original Article

Diagnostic Utility of AMACR and Claudin-7 for the Classification of Renal Cell Carcinoma.: Sang Hwa Shim, Mee Joo, Han Seong Kim, Sun Hee Chang, Ki Young Kwon; Korean J Pathol. 2010;44(2):155-161.; DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.2.155

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Abstract PDF: BACKGROUND
The histologic classification of renal cell carcinoma (RCC) is based on the cytoarchitectural features, yet sometimes this requires correlation with the immunophenotype. Alpha-methylacyl-CoA racemase (AMACR) and claudin-7 have recently been introduced as useful markers that are frequently expressed in papillary RCC (PRCC) and chromophobe RCC (ChRCC), respectively. The aims of this study are to evaluate the expressions of AMACR and claudin-7 in RCCs and to investigate whether they are helpful for making the histological classification of RCCs.
METHODS
Immunohistochemistry for CD10, RCC marker, cytokeratin (CK)7, CD117, AMACR and claudin-7 was performed for 104 RCCs, and these consisted of 54 clear cell RCCs (CCRCC), 26 PRCCs and 24 ChRCCs.
RESULTS
For diagnosing PRCC, the sensitivity and specificity of AMACR were 92.3% and 71.8%, respectively, and using AMACR(+)/CK7(+), the specificity was increased by 23.1% to 94.9%. For diagnosing ChRCC, the sensitivity and specificity of claudin-7 were 91.7% and 78.8%, respectively, and using claudin-7(+)/AMACR(-), the specificity was significantly improved (to 96.3%). For diagnosing CCRCC, CK7(-)/claudin-7(-)/CD117(-) was the most useful immunohistochemical panel (sensitivity, 96.3%; specificity, 98%).
CONCLUSIONS
AMACR and claudin-7 are helpful markers for the histologic classification of RCCs, and their diagnostic utility is strengthened when they are used as an immunohistochemical panel, AMACR(+)/CK7(+) for PRCC, claudin-7(+)/AMACR(-) for ChRCC and CK7(-)/claudin-7(-)/CD117(-) for CCRCC.

Case Reports

A Case of Endocrine Mucin-Producing Sweat Gland Carcinoma Co-existing with Mucinous Carcinoma: A Case Report.: Sunhee Chang, Sang Hwa Shim, Mee Joo, Hanseong Kim, Yong Kyu Kim; Korean J Pathol. 2010;44(1):97-100.; DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.1.97

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Abstract PDF

An endocrine mucin-producing sweat gland carcinoma (EMPSGC) is a rare skin tumor that most commonly occurs on the eyelids of elderly women. This tumor is morphologically analogous to endocrine ductal carcinoma in situ and solid papillary carcinoma of the breast. We describe one case of a 51-year-old male with an EMPSGC co-existing with mucinous carcinoma of the eyelid. The tumor was composed of dilated ducts with a smooth border and was partially filled with a papillary proliferation. Tumor cells were uniform, small-to-medium in size, and oval-to-polygonal with light eosinophilic cytoplasm. Nuclei were bland with diffusely stippled chromatin and inconspicuous nucleoli. Tumor cells expressed chromogranin, synaptophysin, estrogen and progesterone receptors, cytokeratin 7, and epithelial membrane antigen.

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Catharine A. Dhaliwal, Antonia Torgersen, Jonathan J. Ross, James W. Ironside, Asok Biswas
The American Journal of Dermatopathology.2013; 35(1): 117. CrossRef

Giant Cell Tumor-like Proliferation Associated with Renal Staghorn Calculi: A Case Report.: Han Seong Kim, Mee Joo, Sun Hee Chang, Ji Eun Kwak, Sang Hwa Shim, Sung Yong Cho; Korean J Pathol. 2009;43(2):182-184.; DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.2.182

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Abstract PDF

A 62-year-old man with left flank pain and hematuria was shown to have a staghorn stone in left renal pelvis. Grossly, renal pelvis and calyces were markedly dilated with cystic and hemorrhagic degeneration and renal parenchyma was atrophied. A tumor-like mass was located in a hemorrhagic cyst of the renal upper pole. This mass consisted of giant cells and stromal cells mimicking a giant cell tumor of bone. This giant cell tumor-like proliferation may represent a response to hemorrhage into a cystic cavity. Recognition of this finding is important to avoid the over-diagnosis of neoplastic lesions.

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Imaged guided surgery during arteriovenous malformation of gastrointestinal stromal tumor using hyperspectral and indocyanine green visualization techniques: A case report
Tristan Wagner, Onur Mustafov, Marielle Hummels, Anders Grabenkamp, Michael N Thomas, Lars Mortimer Schiffmann, Christiane J Bruns, Dirk L Stippel, Roger Wahba
World Journal of Clinical Cases.2023; 11(23): 5530. CrossRef

Original Articles

Cytologic Findings of Fine Needle Aspiration Biopsy of 23 Schwannomas.: Sunhee Chang, Mee Joo, Hanseong Kim; Korean J Cytopathol. 2008;19(1):41-46.; DOI: https://doi.org/10.3338/kjc.2008.19.1.41

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In an attempt to better define the cytologic characteristics of schwannomas, we have reviewed aspirates and corresponding histologic sections from 23 schwannomas. Of this number, the original cytologic diagnoses were: schwannoma in 14 cases (61%), benign soft tissue tumor in 2 cases (9%), and insufficient specimen in 7 cases (30%). The cytologic findings common to all cases of schwannoma included fragments of tightly cohesive fascicles with variable cellularity and corresponding Antoni type A area. The Antoni type B area, consisting of scattered spindle cells and some histiocytes and lymphocytes against a myxoid background, was seen in 14 cases. Fibrillary stroma was seen in 12 cases. The tumor cells had spindle- or oval-shaped nuclei, with pointed ends and indistinct cell borders. Nuclear palisading was seen in 10 cases, and distinctive Verocay bodies were seen in 5 cases. In ancient schwannomas, there were no Verocay bodies. Most schwannomas have distinct cytomorphologic features that allow correct diagnosis. The major problem with fine needle aspiration cytology of these tumors is the high frequency of poor cellularity, particularly in lesions with cystic degeneration. Of 7 cases with insufficient specimen, 4 showed marked cystic changes and 1 showed marked hyaline changes on histologic sections. In conclusion, we believe that if cytopathologist reminds the situation such as cystic degeneration or hyaline degeneration, the correct diagnosis of the schwannoma will be easily made.

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Multiple Cervical Schwannomas Mimicking Metastatic Lymph Nodes from Papillary Thyroid Cancer
Ji-Sun Kim, Chang-Young Yoo, Rae-Hyung Kim, Jung-Hae Cho
Journal of Korean Thyroid Association.2014; 7(1): 102. CrossRef

Flow Cytometric DNA Analysis in Papillary Carcinoma of Thyroid Gland: comparison with Ki-67 immunohistochemical staining.: Mee Joo, Hye Je Cho; Korean J Pathol. 1996;30(11):959-965.

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Abstract PDF: Nuclear DNA content was measured using a flow cytometric method to analyze 36 paraffin- embedded and 7 fresh tissues of 43 papillary carcinomas of thyroid gland. DNA aneuploidy was found in 3 cases(6.9%) and diploidy in 40 cases(93.1%). But there were no suggestive findings in clinical history, and cytological and morphological features for aneuploidy. In 40 diploid cases, S-phase fraction(SPF) were analyzed with regard to sex, age, tumor size, presence or absence of capsular invasion, lymph node involvement and ground glass nuclei. Among the multiple factors, only the tumor size, especially the larger sized-group(above 2cm in tumor diameter) was found to have a statistically significant higher SPF than the smaller sized-group (p<0.05). And high SPF groups relatively well corresponded to the high risk group. Thirty nine cases of papillary carcinoma have also been evaluated for proliferative activity with Ki-67 monoclonal antibody. The average Ki-67 labeling index was 0.36% in total cases, and that of the aneuploid cases was 0.73%, which was higher than that of the diploid cases(0.33%). So. We think that the low aneuploid rate and low Ki-67 labeling index relatively well represent the usual good clinical course of this tumor and the high SPF is a suggestive finding for a high risk group.

Case Report

Clear Cell Sarcoma of the Kidney: A case in 39 year old man.: Hyun Ju Yoo, Yun Kyung Kang, Mee Joo, Hye Kyung Lee, Dae Woo Kim, Suk San Park; Korean J Pathol. 1996;30(12):1138-1143.

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Abstract PDF: Clear cell sarcoma of kidney(CCSK) is a rare pediatric neoplasm characterized by a predominating component of clear cells, a predilection for metastases to bone, and a poor prognosis. The incidence of CCSK peaks during the 2nd year of life and adult cases are very rare. We report a case of CCSK encountered in the right kidney of a 39-year-old man. Grossly, it was a lobulated mass showing infiltrative margin, measured 7x5.5x5cm and had a homogeneous gray-tan color with a soft, fish-flesh consistency. Microscopically, about half of the tumor revealed the classic pattern of CCSK, having tumor cell cords or nests separated by the characteristic alveolar capillary networks. The tumor cells had clear pale cytoplasm, bland looking round nuclei and inconspicuous nucleoli. The other half showed the epithelioid-trabecular pattern forming pseudorosette or cord-like structures. Immunohistochemically, there was only a focal positive reaction to vimentin. Ultrastructurally, the tumor cells showed the primitive nephrogenic mesenchymal differentiation such as electron lucent cytoplasm, a small amount of organelles, scanty heterochromatin, inconspicuous nucleoli, and a lack of flocculant basal lamina material around the cytoplasmic membrane. We consider that this is a case of CCSK occuring in the oldest patient ever reported, confirmed by both immunohistochemistry and electron microscopy.

Original Article

Congenital Cystic Disease of the Kidney overview and a classification.: Mee Joo, Yeon Mee Kim, Chong Jai Kim, Yeon Lim Suh, Jeong Wook Seo, Je Geun Chi; Korean J Pathol. 1997;31(3):233-243.

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Abstract PDF: The congenital renal cystic disease encompasses a complex group of pathologic and clinical entities. We retrospectively reviewed 42 cases of congenital renal cystic lesions classified into four Potter types in a series of 2,063 consecutive autopsies from 1981 to 1996. According to our study based on morphologic, clinical, genetic features and associated anomalies, type I and III are relatively compatible with Potter's original definition. However, it was reasonable that type II and IV are classified to the same group because of: 1) very similar histologic findings representing dysplastic kidney, 2) many associated anomalies, 3) no evidence of inheritance, and 4) presence of a combined type. Syndrome associated cysts, such as Meckel-Gruber syndrome, were also separately classified. If the dysplastic evidence was insufficient for diagnosis to the dysplastic kidney in type II and IV, then these cases would be better classified into a cystic disease associated with congenital hydronephrosis. We propose a classification of the congenital cystic disease of the kidney to be: 1) dysplastic kidney, 2) cystic disease associated with congenital hydronephrosis, 3) polycystic kidney, and 4) syndromic cystic disease.

Case Report

Cellular Schwannoma Arising in a Facial Nerve.: Mee Joo, Hye Sung Kim, Yun Kyung Kang, Hye Kyung Lee, Jae Young Park; Korean J Pathol. 1997;31(7):688-691.

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Abstract PDF: Cellular schwaninoma is a variant of schwannoma, which is characterized by predominance of cellular Antoni A area, presence of mitotic activity, nuclear hyperchromasia, pleomorphism, and absence of Verocay body. These pathologic features often prompted a misdiagnosis of malignancy. However, the clinical outcome has indicated the benignity of the tumor. We have experienced a case of cellular schwannoma arising from right facial nerve with right hemifacial weakness and erosion of mastoid process. Grossly, it was a 3.5 x 3 cm sized and relatively well encapsulated mass with yellowish, friable cut surface. Microscopically, cellular growth with moderate cellular pleomorphism and some mitotic activity (5/40 HPFS, up to 2/HPF) were noted. Immunostaining for S-100 protein showed diffuse strong positive reaction.

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