Journal of Pathology and Translational Medicine

Case Study

An Intrarenal Adrenocortical Carcinoma Arising in an Adrenal Rest: Ji Hee Lee, Young Deuk Choi, Nam Hoon Cho; J Pathol Transl Med. 2018;52(6):416-419. Published online October 1, 2018; DOI: https://doi.org/10.4132/jptm.2018.07.20

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We describe a case of a 61-year-old Korean man who was diagnosed with renal cell carcinoma that was discovered on abdominopelvic computed tomography obtained after the patient complained of back pain. A radical nephrectomy was performed, and the surgical specimen showed a relatively well-circumscribed and yellowish lobulated hard mass. Microscopically, the tumor showed sheets and nests of hypercellular pleomorphic cells with thick fibrous septation, frequent mitoses, and areas of adrenal cortical-like tissue. Immunohistochemical staining revealed that the tumor cells were positive for inhibin-α, vimentin, synaptophysin, and melan A. It also revealed that the tumor cells were negative for pan-cytokeratin, epithelial membrane antigen, paired box 8, α-methylacyl-coenzyme A racemase, CD10, cytokeratin 7, carbonic anhydrase 9, c-Kit, renal cell carcinoma, transcription factor E3, human melanoma black 45, desmin, smooth muscle actin, S-100, chromogranin A, CD34, anaplastic lymphoma kinase, and integrase interactor 1. Based on these histopathological and immunohistochemical findings, we diagnosed the tumor as intrarenal adrenocortical carcinoma arising in an adrenal rest. Several cases of intrarenal adrenocortical carcinoma have been reported, although they are very rare. Due to its poor prognosis and common recurrence or metastasis, clinicians and pathologists must be aware of this entity.

Citations

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Non-functional Adrenocortical Carcinoma in the Wall of the Small Bowel
Shu-Juan Lin, Yan Gao, Chun-Juan Sun
Current Medical Imaging Formerly Current Medical Imaging Reviews.2023;[Epub] CrossRef
Ectopic adrenal tissue in the kidney: A systematic review
Davide De Marchi, Alessandro Tafuri, Guglielmo Mantica, Aliasger Shakir, Federico Scarfò, Giovanni Passaretti, Salvatore Smelzo, Silvia Proietti, Lorenzo Rigatti, Roberta Luciano, Alessandro Antonelli, Vincenzo Pagliarulo, Rosario Leonardi, Gu
Archivio Italiano di Urologia e Andrologia.2021; 93(4): 481. CrossRef
Extra-adrenal, non-functional adrenocortical carcinoma presenting with acute abdomen: a case report
Alireza Mirsharifi, Mohammad Vasei, Ehsan Sadeghian, Ali Ghorbani-Abdehgah, Sara Naybandi Atashi
Journal of Medical Case Reports.2020;[Epub] CrossRef
Testicular Adrenal Rest Tumors: Current Insights on Prevalence, Characteristics, Origin, and Treatment
Manon Engels, Paul N Span, Antonius E van Herwaarden, Fred C G J Sweep, Nike M M L Stikkelbroeck, Hedi L Claahsen-van der Grinten
Endocrine Reviews.2019; 40(4): 973. CrossRef

Original Article

The Expression of Hypoxia Inducible Factor-1alpha and Its Correlation with the Expressions of Cyclin A1 and Cyclin B1 and the Clinicopathologic Factors of Uterine Cervical Carcinoma.: Ju Yeon Pyo, Jae Ho Cho, Hyunki Kim, Jong Pil Park, Young Tae Kim, Nam Hoon Cho; Korean J Pathol. 2009;43(1):13-19.; DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.1.13

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Abstract PDF: BACKGROUND
Hypoxia inducible factor-1alpha(HIF-1alpha) is a transcription factor for various target genes that are involved in adapting cells to hypoxia. It promotes cell proliferation and survival via modulation of such cell cycle regulators such as cyclin A1 and cyclin B1 in response to hypoxia. This is associated with local failure of radiotherapy, which renders a poor prognosis for cervical carcinoma.
METHODS
Using the tissue histologic sections and a tissue microarray of the archived biopsy and surgical specimens of uterine cervical carcinoma from 57 patients who were treated with radiation therapy alone, we performed immunohistochemical staining for HIF-1alpha and cyclin A1 and B1 to evaluate the correlations between the expressions of these proteins in tumors and the clinicopathologic parameters associated with the prognosis.
RESULTS
The large tumor cell nests and invasive front margins of the tumors showed comparatively intense immunoreactivity of HIF-1alpha. There was no significant correlation between the HIF-1alpha, cyclin A1 and cyclin B1 expressions and the clinicopathologic factors.
CONCLUSIONS
The HIF-1alpha expression showed marked intra-tumoral heterogeneity. The HIF-1alpha expression is neither a powerful predictor of resistance to radiotherapy nor is it a poor prognostic marker in cervical carcinoma patients who are treated with radiotherapy. The expressions of cyclin A1 and cyclin B1 are neither independently associated with the response of radiation therapy nor are they associated with the prognostic parameters of uterine cervical carcinoma.

Case Report

Female Urethral Adenocarcinoma Possibly Arising in Paraurethral Gland: A case report.: Hyun Hee Lee, Hyun Ee Yim, Nam Hoon Cho, Chanil Park; Korean J Pathol. 1995;29(3):399-401.

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Abstract PDF: Female urethral adenocarcinoma is one of the rare tumors. It has been thought to arise in the paraurethral Skene's gland, the transitional epithelium of proximal urethra or the urethral diverticulum. This is to report a urethral adenocarcinoma developed in a 51 year-old patient who had a past history of suburethral abscess 7 years ago, and to discuss its possible histogenetic origin. The tumor was located in the urethral wall and revealed a centrifugal growth pattern toward the anterior wall of uterus and vagina and an upward extension to the bladder neck. The tumor was composed mostly of well differentiated adenocarcinoma and partly of signet ring cell carcinoma. The urethral and bladder epithelia were well preserved without cancerous or precancerous changes, and there was no urethritis glandularis nor cystitis glandularis. The secretary material of the neoplastic glands was weakly positive for prostate specific antigen (PSA) and prostate specific acid phosphatase (PSAP). Although the tumor cells themselves were not reactive to PSA and PSAP, the histologic findings suggest that the urethral adenocarcinoma arises in the paraurethral Skene's gland which had probably been the site of abscess in this patient.

Original Articles

Correlation between Transforming Growth Factor-beta and Procollagen III with Regenerative Activity in Acute Liver Injury, and the Effect of Prostaglandin E2.: Nam Hoon Cho, Chan Il Park; Korean J Pathol. 1996;30(5):367-387.

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Abstract PDF: Transforming growth factor-beta (TGF-beta) plays an important role in hepatic fibrogenesis. It is thought to inhibit regeneration of the hepatocytes. The aim of this present study was to clarify the correlation of TGF-beta, collagen type III (PIIINP) and the regenerating activity of hepatocytes, and the effect of prostaglandin E2 (PgE2) on them in acute liver injury. Two hundred and sixteen male Sprague-Dawley rats, weighing 200g on average, were divided into six experimental groups and two control groups; group I-CCl4 only administration, group II-partial hepatectomy(PH) only, group III-PH following CCl4 administration, group IV-olive oil only administration, group V-sham operation, group VI-CCl4 administration with pretreatment of PgE2, group VII- PH with pretreatment of PgE2, and group VIII- PH following CCl4 administration with pretreatment of PgE2. Five rats were sacrificed at 12, 24, 36, 48, 96 and 168 hours after the administration of CCl4 or PH in each experimental group. The liver was tested with immunohistochemical stain for proliferating cell nuclear antigen (PCNA) and in situ hybridization for TGF-beta. Radioimmunoassay for serum PIIINP was also performed. The results were as follows: TGF-beta was expressed mainly in the perisinusoidal cells and periportal mesenchymal cells. The TGF-beta positive cells were most numerous in the combined group of CCl4 plus PH. TGF-beta expression tended to have an inverse relation, with the PCNA index in all experimental groups. The PCNA index was highest in the CCl4 only group and lowest in the combined group of CCl4 plus PH. The PH only group showed a peak PCNA index at 48 hours. In the CCl4 only group and the combined group of CCl4 plus PH, serum PIIINP appeared to increase at 12 hours or more after the expression of hepatic TGF-beta. Pretreatment of PgE2 revealed that TGF-beta precipitously disappeared at 48-96 hours after insult. PgE2 influenced the vanishing period, not the emerging time of TGF-beta and had a remarkable effect on the amount of TGF-beta especially in the PH following CCl4 administration group, which resulted in significant accentuation of PCNA indices. In conclusion, PH of the prior injured liver induces a marked increase of TGF-beta followed by a significant suppression of regeneration of the remaining liver, and PgE2 overtly suppresses the expression of TGF-beta.

Expression of CD44 in Epithelial Ovarian Tumors.: Kye Weon Kwon, Hee Jeong Ahn, Yoon Jeong Choi, Hee Jae Joo, Nam Hoon Cho; Korean J Pathol. 1998;32(8):596-602.

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Abstract: CD44 is a hyaluronic acid receptor that exists as a standard 90-kd form (CD44H) as well as several CD44 variants isoforms are produced through alternative splicing. Alternatively spliced variants of the CD44 molecule have been found to be associated with invasive and metastatic potential of cancer cells and poor prognosis in several types of carcinoma. The purpose of the present study is to define the expression of CD44H and CD44v6 in ovarian tumors and to investigate whether the expression of these molecules is associated with adverse prognosis. We evaluated the expression of CD44 isoforms in 58 ovarian tumors by means of immunohistochemistry, and correlated between CD44 expression and the histologic types, tumor grade, peritoneal implants, pseudomyxoma peritonei and FIGO stage. While the CD44H was commonly expressed in ovarian tumors, the CD44v6 was expressed in a minor proportion of serous tumors in comparison with frequent expression of v6 isoform in mucinous tumors. The CD44H expression was significantly higher in stage I/II than in stage III. However, there was no correlation between the expression of CD44 and the presence of peritoneal implants or pseudomyxoma peritonei. These results suggest that CD44H could play an important role in the adhesive function in the lower stage of the ovarian tumor and reduced expression in the higher stage might be related to the metastasis and widespread invasion of ovarian carcinoma cells.

The Expression of DNA Dependent Protein Kinase Protein in Malignant Lymphoma.: Tae Woong Noh, Nam Hoon Cho, Woo Ick Yang; Korean J Pathol. 2001;35(6):477-485.

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Abstract: BACKGROUND
DNA dependent protein kinase (DNA-PK) composed of Ku70, Ku80 and DNA-PK catalytic subunit (DNA-PKcs), plays an important role in the primary repair of break points of damaged DNA and is involved in the recombination of the V, D, and J genes. Loss of DNA-PK may lead to immunodeficiency and malignant lymphomas. This hypothesis has been supported by animal study in a Ku70 knock-out mouse model. The relationship between DNA-PK and human malignant lymphoma has not yet been studied.
METHODS
We examined the loss of DNA-PK proteins in 85 representative cases of different subtypes of malignant lymphoma. Immunohistochemical stains for DNA-PK subunits were performed on formalin-fixed and paraffin-embedded tissue sections.
RESULTS
Lymphomas demonstrated statistically significant loss of Ku70, Ku80 and DNA-PKcs. T cell lymphomas showed more loss of DNA-PK proteins in comparison with B cell lymphomas. According to the World Health Organization (WHO) classification system, both T cell lymphomas and high-grade subtypes of B cell lymphomas demonstrated similar degree of loss of DNA-PK proteins.
CONCLUSIONS
We confirmed the loss of DNA-PK proteins in malignant lymphomas through the results of our study, and the loss of these proteins seems to be more significant in high-grade lymphomas. These findings support the role of DNA-PK as a tumor suppressor gene.

Case Reports

ISUP/WHO Classification of Papillary Urothelial Neoplasms of Urinary Bladder: Consensus Study Conducted by Korean Society of Urogenital Pathology.: Jung Weon Shim, Jae Y Ro, Nam Hoon Cho, Young Sik Kim, Yong Wook Park, Sang In Shim, Dong Wha Lee, Yeong Jin Choi, Woon Sup Han; Korean J Pathol. 2006;40(4):282-288.

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Abstract PDF: BACKGROUND
Pathologic grading, one of the most important prognostic factors of papillary urothelial neoplasia (PUN) of the urinary bladder, has been revised continuously. The current study focused on the analysis of interobserver agreement on PUN of the urinary bladder bet- ween 1973 WHO classification (WHO 1973) and 1998 WHO/ISUP classification.
METHODS
Seventy five cases from 15 institutions were collected, and after review by Korean Society of Urogenital Pathology (KSUP), 30 cases were selected as follows; group I, WHO grade 1 and papillary urothelial neoplasm of low malignant potential by ISUP (7 cases), group II, WHO grade 2 and low-grade papillary urothelial carcinoma (16 cases), and group III, WHO grade 3 and high-grade papillary urothelial carcinoma (7 cases). Seventy five general surgical pathologists who participated in this study were asked to grade the tumors based on WHO/ISUP classification. Interobserver agreement between the participants' diagnosis and KSUP consensus diagnosis was analyzed by kappa value.
RESULTS
Interobserver agreement assessed by kappa value for all diagnostic groups was very low; for group I, kappa value was -0.900893722; for group II, -0.944650025, and for group III, -0.876728996. The overall kappa value of pathology residents was better than that of practicing pathologists.
CONCLUSIONS
The 1998 WHO/ ISUP classification could not be easily translated from the 1973 WHO classification and because of poor interobserver agreement, it appears that further work would be needed before it can be practically applied.

Malignant Mixed Mullerian Tumor of Fallopian Tube with Multiple Distinct Heterologous Components.: Beom Jin Lim, Jae Wook Kim, Woo Ick Yang, Nam Hoon Cho; Korean J Pathol. 2003;37(6):429-431.

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Abstract PDF: We experienced a case of primary malignant mixed mullerian tumors (MMMT) of the fallopian tube of FIGO stage I. In addition to endometrioid adenocarcinomas, multiple apparent heterologous elements encompassing myxoid chondrosarcoma, osteosarcoma, myxoid liposarcoma and well differentiated angiosarcoma were recognized as separate nodules. These findings have not been described previously in MMMTs of the female genital tract.

Collision Tumor Composed of Papillary Transitional Cell Carcinoma, and Osteosarcoma in Urinary Bladder: A cases report.: Nam Hoon Cho, Chanil Park; Korean J Pathol. 1995;29(3):374-377.

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Abstract PDF: This is to report a case of collision tumor of the urinary bladder, which was composed of papillary transitional cell carcinoma(PTCC) and osteosarcoma. Grossly the tumor was located at left antero-lateral wall and was a fungating, gray yellow, bony hard mass with papillary configuration of the luminal surface. Histologically the tumor was composed of PTCC confined to the mucosa and sarcomatous component not intermixed with the overlying PTCC. The sarcomatous area had features of classic osteosarcoma with anaplastic tumor cells and haphazardly arranged osteoid matrix, and was positive for osteonectin but entirely negative for cytokeratin or epithelial membrane antigen. Ultrastructural study demonstrated the tumor cells to be osteoblast which had rich rERs and a few lipid vesicles in plump cytoplasm without any evidence of epithelial ongin. The case is thought to be an example of collision tumor because there was no evidence of transition between PTCC and osteosarcoma.

Original Articles

roded Polypoid Hyperplasia of the Rectosigmoid Colon: Report of 2 cases with special reference to its relation to mucosal prolapse syndrome.: Nam Hoon Cho, Hee Jeong Ahn, Chan Il Park; Korean J Pathol. 1994;28(3):297-301.

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Abstract: Polypoid prolapse of mucosal folds can occur at various sites and in various conditions predominantly associated with strain during defecation. There are two well known types of mucosal prolapse syndrome(MPS), the inflammatory cloacogenic polyp(ICP) and the mucosal redundant polyp associated with diverticular disease(N4RPD). ICP is a mucosal prolapse of the anorectal junction and MRPD is a proximal analogue involving the sigmoid colon. We experienced two cases of eroded polypoid hyperplasia(EPH) of the rectosigmoid colon which manifested as a huge gyriform mass simulating the gross features of gastrointestinal lymphomas or other malignant tumors. The EPH consisted of confluent polypoid mucosal folds with rolled-up submucosa to form stalk, The polypoid lesion represented hyperplastic epithelium, erosion of the mucosal surface and congestive vascular ectasia of lamina propria and submucosa. To explain the whole morphologic features, the initial phenomenon should be the mucosal prolapse. Vascular stretching with ischemic erosion of the mucosal surface and compensatory epithelial hyperplasia ensue as the result. The ominous endoscopic and gross features of EPH should be kept in mind to avoid erroneous radical surgery.

Clear Cell Adenocarcinoma of the Urinary Bladder Accompanied by Vesical Endometriosis.: Eun Kyung Han, So Yeon Park, Nam Hoon Cho, Woo Ik Yang, Chanil Park; Korean J Pathol. 1990;24(4):489-496.

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Abstract PDF: A case of clear cell adenocarcinoma arising in the female urinary bladder, which is accompanied by endometriosis of the urinary bladder and the uterus, is reported. The carcinoma protruded into the vesical lumen as a fungating mass, and had a tubulocyotic pattern. The tumor cell had intracytoplasmic glycogen and electron microscopically short microvilli on their surface, resembling clear cell acenocarcinoma of the female genital tract including ovary. This is the fourth case report of clear cell adenocarcinoma complicating vesical endometriosis, and may support the view that clear cell carcinome arises from endometriosis which, in turn, from the Mullerian remnant.

Case Report

Pulmonary Adenocarcinoma of Fetal Type: Report of a case.: Nam Hoon Cho, Kwang Gil Lee; Korean J Pathol. 1990;24(3):287-293.

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Abstract PDF: Pulmonary adenocarcinoma of fetal type is a very uncommon tumor of the lung which simulates an early stage of lung differentiation. This is a primitive appearing epithelial tumor similar to the epithelial component of pulmonary blastoma but lacking the sarcomatous features. Since the report of Kradin et al, 8 more cases have been reported by a variety of name. These tumors are composed of glycogen-rich, non-ciliated tubular epithelial cells forming irregularly shaped tubules or arranged in a papillary pattern. A very remarkable findings of this tumor is the presence of endocrine cells which is confirmed by argyrophilia, immunohistochemistry or electron microscopy. We experienced a case of this tumor which showed hepatocytoid differentiation in addition to the characteristic histologic findings. Immunohistochemical studies performed on a resected tumor tissue showed immunoreactivity for alpha-fetoprotein, neuron-specific enolase and somatostatin, and endocrine type granules were found ultrastructurally. Although this tumor seems to have a relation with pulmonary blastoma in its histology, immunohistochemistry and ontogeny, a distinction between these should be attained because the average survival of the former group is longer as 23 months, while that of the latter is only 4 months.

Original Articles

Clinicopathologic Study of the Endometrium of Dysfunctional Uterine Bleeding.: Nam Hoon Cho, Chan Il Park, In Joon Choi; Korean J Pathol. 1989;23(1):65-74.

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Abstract PDF: One of the most common symptoms in gynecologic disorders is an abnormal utirine bleeding, of which dysfuncyional uterine bleeding (DUB) is frequently encountered. DUB is defined as an endocrinologic imbalance of the axis of hypothalamus-pituitary-ovary-endometrium without organic diseases such as a neoplasm, and inflammation, a pregnancy, a trauma, Although the correct diagnosis of DUB depends on various assessements such as a menstrual cycle, basal body temperature, endocrine assay, vaginal cytology and endometrial histology, in many circumstances pathologist have only the endometrial histology with trivial clinical information to make a diagnosis. Therefore, the present study was aimed at assessing the pattern of the endometrium as precisely as possible. The histologic pattern was classified according to the Handrickson and kempson classification (1980). The authors also attempted to correlate the non-neoplastic metaplasia with the endometrial histology. The material consisted of 447 cases of endometrial curettage specimens diagnosed clinically as DUB during recent 4 years. The histologic examination was carried out through the routine formalin fixed-paraffin embedding method, followed by hematoxylin-eosin staining in routine and other special staining as required. The following results were obtained; 1) The pattern of the endometrium in DUB was predominently the proliferative type (239 cases, 65.55%). Of these 293 cases, 144 were of the abnormal proliferatrive phase, and particulary most were the disordered proliferative phase. The remaining 154 cases (34.45%) were found to have secretory endometrium, of which 50 cases belonged to the abnormal secretory type. Most of the cases shewing abnormal secretory patterns appeared dyssynchronous or underdeveloped. 2) Of the 361 patients with DUB for whom the clinical records were available, 197 (54.57%) were non-ovulatory and 118 (32.69%) were ovulatory. 3) Non-neoplasic metaplasia was found in 87 cases, of which ciliiated and papillary types were most common. The endometrium was of the proliferative phase in 73.56% of the cases with metaplasia, and the disordered proliferative pattern showed a particular correlation with the metaplasia (44 cases). 4) Among 63 postmenopausal DUB patients, 52 (82.53%) appeared to have the proliferative endometrium, and in particular 23 (36.51%) had the disordered proliferative endometrium.

A Pathological and Immunohistochemical Study of 9 Cases of Inflammatory Fibroid Polyp.: Nam Hoon Cho, Hyeon Joo Jeong, Ho Guen Kim; Korean J Pathol. 1989;23(1):20-28.

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Abstract PDF: We aimed to study the clinicopathologic features of inflammatory fibroid polyp by histological and immunohistochemical methods. The materials used in this study consisted of 9 cases of inflammatory fibroid polyp: 4 in the stomach, 4 in the small intestine and 1 in the cecum. The results were as follows: Females were affected more frequently than males and the average age was 45 years(range:27-61). In cases of gastric lesion, the size tended to be smaller, the mass was mainly located along the greater curvature side of antrum, and confined to the submucosa. However inflammatory fibroid polyp of the small intestine was over 2.5 cm in size, located along the antemesenteric border, and involved the proper muscle layer. In addition, intussusception was accompanied by polyp in 2 cases of small intestinal lesions. Histologically inflammatory fibroid polyps of the stomach were characterized by prominent lymphocytic infiltration and occasional onion-skinning of stromal cells, whereas plasmocytic infiltration was prominent in those of the small intestine. Main component cells comprising this lesion were confirmed to be fibroblasts by immunohistochemistry which revealed strong reactivity to vimentin in the cytoplasm of slindle cells.

Primary Signet Ring Cell Carcinoma with Widespreand Metastasis.: Nam Hoon Cho, Soon Hee Jung, Tae Sung Kim; Korean J Pathol. 1988;22(4):448-455.

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Abstract PDF: We present an autopsy case of signet ring cell carcinoma of urinary bladder which underwent widespread metastsis through nearly entire organ. The patient, 45-year old male, suffered from hematuria, dysuria and flank pain for 6 months. Under the diagnosis of the signet ring cell carcinoma by the cystoscopic biopsy, radical cystectomy and ileocutaneous ureteral division were performed. But he died after 11-months after the diagnosis. The autopsy confirmed the widespread metastasis at the lung, kidney, adrenal gland, parathyroid gland, heart, stomach, ileum, spine, rib and meninges. The preveously resected urinary bladder discolosed the well defined fungating mass at the dome and anterio-lateral portion without apparent evidence of the remnant of the urachus. Histologically, the signet ring cells were predominent and focally mucinous pool floating the signet ring cells was noted. We could find several foci of the well differentiated adenocarcinoma and poorly differentiated adenocarcinomas. The above findings may reflect that the origin of carcinoma may be from the multipotential transitional cell epithelium.

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