Journal of Pathology and Translational Medicine

Original Article

Diagnostic proficiency test using digital cytopathology and comparative assessment of whole slide images of cytologic samples for quality assurance program in Korea: Yosep Chong, Soon Auck Hong, Hoon Kyu Oh, Soo Jin Jung, Bo-Sung Kim, Ji Yun Jeong, Ho-Chang Lee, Gyungyub Gong; J Pathol Transl Med. 2023;57(5):251-264. Published online August 24, 2023; DOI: https://doi.org/10.4132/jptm.2023.07.17

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Abstract PDF Supplementary Material: Background
The Korean Society for Cytopathology introduced a digital proficiency test (PT) in 2021. However, many doubtful opinions remain on whether digitally scanned images can satisfactorily present subtle differences in the nuclear features and chromatin patterns of cytological samples.
Methods
We prepared 30 whole-slide images (WSIs) from the conventional PT archive by a selection process for digital PT. Digital and conventional PT were performed in parallel for volunteer institutes, and the results were compared using feedback. To assess the quality of cytological assessment WSIs, 12 slides were collected and scanned using five different scanners, with four cytopathologists evaluating image quality through a questionnaire.
Results
Among the 215 institutes, 108 and 107 participated in glass and digital PT, respectively. No significant difference was noted in category C (major discordance), although the number of discordant cases was slightly higher in the digital PT group. Leica, 3DHistech Pannoramic 250 Flash, and Hamamatsu NanoZoomer 360 systems showed comparable results in terms of image quality, feature presentation, and error rates for most cytological samples. Overall satisfaction was observed with the general convenience and image quality of digital PT.
Conclusions
As three-dimensional clusters are common and nuclear/chromatin features are critical for cytological interpretation, careful selection of scanners and optimal conditions are mandatory for the successful establishment of digital quality assurance programs in cytology.

Case Study

Sebaceous Carcinoma Arising in Mature Cystic Teratoma of Ovary: Hyo Jeong An, Yong Han Jung, Hye Kyoung Yoon, Soo Jin Jung; Korean J Pathol. 2013;47(4):383-387. Published online August 26, 2013; DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.4.383

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Roughly 1% of mature cystic teratomas undergo malignant transformation. In particular, cutaneous-type adnexal neoplasms may occur in mature cystic teratomas. Sebaceous carcinomas, which arise from mature cystic teratomas, have rarely been observed, with only seven cases previously reported. Here, we present a case of a 69-year-old female who had pelvic pain for two weeks and who subsequently underwent bilateral salpingo-oophorectomy and hysterectomy. Her left ovary showed a unilocular cyst, measuring 22.0 cm in diameter, filled with sebaceous material and a few hairs. A luminally-protruding solid mass measuring 4.0 cm in diameter was also noted. Microscopic findings revealed lobular or diffusely arranged basophilic, atypical sebaceous cells connected to a typical mature cystic teratoma. Tumor cells demonstrated positive immunoreactivity for high molecular weight cytokeratin, cytokeratin 7, cytokeratin 19, epithelial membrane antigen, and carcinoembryonic antigen. Here, we present a case of sebaceous carcinoma arising from a mature cystic teratoma along with a review of previously published reports.

Citations

Citations to this article as recorded by

Extraocular sebaceous carcinoma arising in a mature cystic teratoma of ovary: A case report and review of literature
Sara Pakbaz, Tanya Chawla, Marcus Q Bernardini, Liat Hogen, Marjan Rouzbahman
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Takashi Minamisaka, Johji Imura, Keitaro Shiraishi, Kohji Takagi, Takahiko Tomia, Sinichi Tanaka, Akira Noguchi, Takuya Akai, Kyo Noguchi, Satoshi Kuroda
Neuropathology.2022; 42(4): 289. CrossRef
Malignant transformation of mature cystic teratoma of the ovary
Doaa Atwi, Maria Kamal, Michael Quinton, Lewis A. Hassell
Journal of Obstetrics and Gynaecology Research.2022; 48(12): 3068. CrossRef
Sebaceous Carcinoma Arising in Ovarian Teratoma: First Report Associated With Germline Mismatch Repair Gene Mutation
Jacinta Murray, Patrick McIlwaine, Patrick J. Morrison, W. Glenn McCluggage
International Journal of Gynecological Pathology.2022; 41(6): 608. CrossRef
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International Journal of Dermatology.2020; 59(4): 494. CrossRef
Mismatch repair deficiency is implicated in carcinoma arising from ovarian teratoma
Alvin Ho-Kwan Cheung, Chit Chow, Mei-Yung Yu, Wendy Wai-Tak Law, Peggy Pui-Ying Law, Paul Cheung-Lung Choi, Wei Kang, Ka-Fai To
Pathology.2019; 51(1): 67. CrossRef
Malignant transformation of an ovary mature cystic teratoma: case report and review of the literature
Elkin Fabián Dorado-Roncancio, Oscar Joel Carrillo-Garibaldi
Obstetrics & Gynecology International Journal.2019;[Epub] CrossRef
A case of ovarian clear cell carcinoma arising from ovarian mature cystic teratoma
Kazuya Maeda, Yoshito Terai, Shinichi Terada, Hiroshi Maruoka, Yuhei Kogata, Keisuke Ashihara, Yoshimichi Tanaka, Tomohito Tanaka, Hiroshi Sasaki, Satoshi Tsunetoh, Takashi Yamada, Masahide Ohmichi
Journal of Ovarian Research.2018;[Epub] CrossRef
Sebaceous carcinoma arising within an ovarian mature cystic teratoma: A case report with discussion of clinical management and genetic evaluation
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Gynecologic Oncology Reports.2018; 26: 37. CrossRef

Case Report

Pulmonary Endometriosis: A case report.: Soo Jin Jung, Young Ju Kim, Hye Kyoung Yoon; Korean J Pathol. 1998;32(5):382-384.

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Abstract: Pulmonary endometriosis is a rare disease which is characterized by hemoptysis during menstruation (catamenial hemoptysis). We report a case of pulmonary endometriosis in a 33-year-old housewife. She has had regular menses with moderate flow and minimal dysmenorrhea. She had undergone curettage in May 1995 for artificial abortion. In July 1995, she experienced the first episode of hemoptysis. A chest CT scan revealed a 2.0 1.0 cm sized ill-defined soft tissue density in the periphery of anterior segment of the left upper lobe with a surrounding irregular ground-glass opacity. A left upper lobectomy was done under the diagnosis of pulmonary endometriosis. Cut section of the resected lung showed a round red-brownish solid lesion, measuring 2.0x1.0cm in cross. Microscopically a focus of the endometrial tissue, which was composed of endometrial glands and stroma, was found in the lung parenchyme and many hemosiderin laden macrophages were seen in the surrounding alveoli. The postoperative course was favorable with no further episodes of hemoptysis.

Original Articles

Immunohistochemical Findings in 10 Cases of Inflammatory Myofibroblastic Tumor.: Soo Jin Jung, Mi Seon Kang, Chang Hoon Lee, Sook Hee Hong, Hye Kyoung Yoon; Korean J Pathol. 1999;33(9):717-722.

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Abstract PDF: A wide range of denomination has been used for inflammatory myofibroblastic tumor (IMT). IMT is not entirely homogeneous, even though it shows some overlapping histologic features such as haphazard proliferation of spindle cell and polymorphic chronic inflammatory cell infiltraion. The spindle cell is considered to be of myofibroblastic origin but follicular dendritic cell origin was reported recently. IMT is known as nonneoplastic, aberrant inflammatory response. However, IMT could show local invasion, recurrence, vascular invasion, and malignant transformation, and clonal characteristics and aneuploidy of IMT support the hypothesis that IMT may be a neoplastic process. In order to define the nature of spindle cell of IMT, immunohistochemical stains for smooth muscle actin (SMA), vimentin (VMT), lysozyme, S-100 protein, cytokeratin, CD21 were done. Additional immunohistochemical stains for MIB-1 for proliferating activity and LMP (latent membrane protein) for Epstein-Barr virus (EBV) were done. IMTs were composed of each 2 cases from lung, liver and lymph node and one case from common bile duct, maxillary sinus, bladder and thigh, and were histologically subclassified according to Coffin et al. Nine cases (90%) were positive for SMA and VMT, but no correlation between SMA and VMT immunoreactivity and histologic types was identified. Five cases (50%) were positive for lysozyme and S-100 protein, and histologic type III was negative for lysozyme and S-100 protein, and immunoreactivity for S-100 protein was different according to the histologic subtypes. All 11 cases were negative for CD21 and EBV LMP. MIB-1 labelling index was less than 1% in all cases. In summary, the spindle cell is regarded as myofibroblastic origin rather than follicular dendritic cell origin. Relationship with EBV is not clear, and negligible MIB-1 reaction suggests that IMT might have a good prognosis.

Comparison of Fine Needle Aspiration Cytologic Diagnoses and Histologic Diagnoses in 256 Breast Lesions.: Mi Sun Kang, Soo Jin Jung, Hye Kyoung Yoon; Korean J Cytopathol. 1997;8(2):120-128.

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Abstract PDF: PURPOSE: Henoch-Schonlein purpura nephritis(HSPN) accompanied by nephrotic syndrome(NS) is known to have a poor prognosis and effective treatment is still controversial, even though both corticosteroids and immunosuppresant have been used for therapy. Cyclosporine A(CsA) is a well known immunosuppresant and widely used in renal transplantation and glomerular diseases especially steroid resistant. The aims of this study was to evaluate the therapeutic effect of CsA and to compare CsA with previously reported our data of rifampin(RFP) and azathioprine(AZA) in children with HSPN accompanied by NS.
METHODS
37 HSPN patients with NS confirmed by renal biopsy were selected. Of these, 17 patients were treated with CsA(5 mg/kg/day) for 6-8 months, 7 children were treated with RFP(10-20 mg/kg/day) for 9-12 months and 13 patients were treated with AZA(2 mg/kg/day) for 8 months. Along with these regimens, low dose oral prednisolone(0.5-1 mg/kg, qod) was also used. Sequential renal biopsy was done in all patients 1 month after termination of treatment. RESULTS: Complete remission rate of nephrotic syndrome was 5S.8% in CsA, 57.1% in RFP and 38.4% in AZA group after 17, 22, 11 months of mean follow-up period. Overall remission rate including partial remission was 88.2% in CsA, 85.7% in RFP and 84.6% in AZA group. Disappearance rate of hematuria was 58.8% in CsA, 57.1% in RFP and 46.2% in AZA group. Improvement of grade of clinical status was observed in 17 out of 17 CsA, 7 out of 7 RFP and 10 out of 13 AZA group. Improvement of pathologic class on sequencial renal biopsy was shown in 5 CsA(29.4%), none RFP(0%) and 2 AZA group(12.4%). Improvement on histologic immune-deposition was seen in 15 CsA(88.2%), 6 RFP(85.9%) and 4 AZA group(30.8%). CONCLUSION: In conclusion, Both CsA and RFP treated groups showed better result in complete remission rate of nephrotic syndrome and significant inprovement of histologic immune-deposition compared with AZA treated group(p=0.004). So, we recommend CsA and RFP rather than AZA for immunosuppresant treatment in HSPN with nephrotic syndrome.

Fine Needle Aspiration Cytology of Adenomyoepithelioma of the Breast: Comparison with Typical Fibroadenoma.: Hye Kyoung Yoon, Soo Jin Jung, Mi Seon Kang; Korean J Cytopathol. 1998;9(1):105-110.

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Abstract PDF: Adenomyoepithelioma is an uncommon benign tumor of the breast. We present the fine needle aspiration cytologic features of adenomyoepithelioma in a 23 year-old Korean women, initially diagnosed as fibroadenoma. Aspiration cytologic findings of the left breast mass revealed high cellularity, small to medium sized, less cohesive epithelial clusters, rich naked cells and amorphous materials on background. The epithelial cells were round and uniform with no cytologic atypia or mitosis. Myoepithelial cells were conspicuous with peripheral rimming along the epithelial clusters. Small amount of fibrotic stromal tissues were observed. Distinguishing features from typical fibroadenoma are less tight epithelial clusters, dyscohesive epithelial cell aggregates, more abundant naked cells and scant stromal tissue fragments.

Case Reports

Crush Cytologic Findings of Myxopapillary Ependymoma in Spinal Cord: A Case Report.: Soo Jin Jung, Young Il Yang; Korean J Cytopathol. 1999;10(1):73-78.

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Abstract PDF: Myxopapillary ependymoma generally arise in the conus medullaris and filum terminale of adult spinal cord. These tumors are readily recognized due to unique histopathologic features, however, their cytologic features are not well described. When only a tiny sample is obtained, cytologic examination using crush preparation may be a useful diagnostic tool to help appropriate intraoperative diagnosis. We present the crush cytologic features of myxopapillary ependymoma arising in thoracic and lumbar spinal cord of a 13-year-old boy. The patient had complained of paraparesis and back pain for 1 month. The MRI image revealed a relatively well demarcated intramedullary mass in T11-L1 levels. Crush preparation for cytology were performed by biopsy material. Crush cytologic findings revealed high cellularity and small sized branching papillary clusters on fibrillary or mucinous background. The tumor cells had uniform round or elongated nuclei. The cytoplasmic process of tumor cells were attached to the vascular wall. Between the tumor cells and vascular walls, the perivascular collar of globoid acellular stroma with metachromatic reaction on toluidin blue stain was noted. The crush preparation of myxopapillary ependymoma is considered as a simple and highly accurate diagnostic tool for differentiation from other intramedullary neoplasms of central nervous system.

Cytologic Findings of a Plasmacytoid Variant of Urothelial Carcinoma of the Urinary Bladder in Voided Urine.: Soo Jin Jung, Joo Yeon Song, Hye Kyoung Yoon, Sung Hyup Choi; Korean J Cytopathol. 2006;17(1):51-55.

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Abstract PDF: The plasmacytoid variant is an extremely rare form of urothelial carcinoma in which the malignant cells resemble those of plasmacytoma. We report the cytologic features of 3 cases of this disorder. All 3 patients were male and presented with painless macroscopic hematuria. The voided urine cytology revealed a few scattered clusters of tumor cells in a bloody background. Each tumor cell had an abundant amount of cytoplasm that was clear or densely stained and characterized by eccentrically located nuclei. A histological examination of tissue obtained from a radical cystectomy confirmed the cytologic diagnosis in each 3 case, revealing a diffusely infiltrating tumor composed of round, noncohesive tumor cells demonstrating a high nuclear grade. These cells had infiltrated the tunica propria in 2 cases, but were limited to the submucosa in 1 case. The tumor cells were plasmacytoid in appearance, each demonstrating an eccentric nucleus and dense cytoplasm, as seen in the cytologic findings. All of the tumors were immunoreactive for pancytokeratin, CK7, CK20; negative for epithelial membrane antigen (EMA), leukocyte common antigen (LCA), kappa, lambda, and CD79a. Thus, it is important to consider the plasmacytoid variant of urothelial carcinoma in addition to plasmacytoma or lymphoma as a diagnosis when encountering plasmacytoid tumor cells in a voided urine sample.

Original Article

The Difference of Cathepsin D Expression between Invasive Ductal Carcinoma and Ductal Carcinoma In Situ of the Breast.: Hye Kyoung Yoon, Soo Jin Jung; Korean J Pathol. 2004;38(6):408-414.

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Abstract PDF: BACKGROUND
It is known that cathepsin D expression in host stromal cells is associated with a more aggressive tumor behavior in breast cancers.
METHODS
Cathepsin D expression was examined in 222 cases of invasive ductal carcinoma (CA) and 25 cases of ductal carcinoma in situ (DCIS) by the immunohistochemical staining. Cathepsin D expression was evaluated according to the expression site, either in the tumor cells (CD-T) or in the stromal cells (CD-S), and graded according to the immunopositivity. The differences of CD-T and CD-S in each case were evaluated according to the pathologic parameters and estrogen receptor (ER)/progesterone receptor (PR) status.
RESULTS
The rate of CD-S was significantly higher in the CA than in the DCIS (p<0.0001). In the CA, the rate of CD-S was higher than that of CD-T, while in the DCIS, the rate of CD-T was higher than that of CD-S. In the CA, the rate of CD-S and the tumor grade showed a positive relationship (p=0.0281). There were positive correlations between the ER positivity and CD-S (p=0.0236), and between the PR positivity and CD-T (p=0.0246). For the DCIS, no significant relationships were noted between the pathologic parameters including ER/PR status and CD-T/CD-S.
CONCLUSION
Cathepsin D expression in the stromal cells seems to be related to the invasiveness and aggressive biological behavior in breast cancers. In addition, there might be some relationship betweeen the ER positivity and CD-S, and between the PR positivity and CD-T.

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