Journal of Pathology and Translational Medicine

Byung Kee Kim

66 Articles

Alteration of Bile Acid Transporter Expression in Patients with Early Cholestasis Following Living Donor Liver Transplantation.: Eun Sun Jung, Byung Kee Kim, So Youn Kim, Youn Soo Lee, Si Hyun Bae, Seung Kew Yoon, Jong Young Choi, Young Min Park, Dong Goo Kim; Korean J Pathol. 2009;43(1):48-55.; DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.1.48

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Abstract PDF: BACKGROUND
Intrahepatic cholestasis can occur early after living donor liver transplantation (LDLT). We investigated the changes in the expressions of the bile acid transporters and the liver histology in the patients who suffered with early cholestasis (EC) following LDLT.
METHODS
The histological differences between 15 graft livers with EC after LDLT and 5 graft livers with biliary stricture following LDLT were evaluated. The hepatic mRNA levels of the bile canaliculi transporters (BSEP, MRP2, MRP3, MDR1, MDR3, NTCP) in 40 (20 graft livers, 20 matched donor livers) liver biopsy tissues were analyzed by performing real-time reverse-transcription polymerase chain reaction (RT-PCR).
RESULTS
Microscopic examination revealed hepatocellular and/or bile canalicular cholestasis around acinar zone 3 in the livers of the patients with EC. In the livers with biliary stricture, the cholestasis was dominantly observed in the hepatocytic cytoplasm and in the bile ductules around the portal area rather than around acinar zone 3. The BSEP and MRP2 mRNA levels in the EC livers were significantly reduced by 44% and 23%, respectively (p=0.000), compared to the matched donor livers. The levels of MDR3 and NTCP mRNA in the EC livers increased by 738% (p=0.000) and 281% (p<0.01), respectively. The change of the expressions of the bile acid transporters in the patients with biliary stricture was less significant than that in the EC group.
CONCLUSIONS
These results suggest that the altered expressions of the bile acid transporters may play a role in the pathogenesis of EC following LDLT.

Ameloblastoma Associated with Dentinogenic Ghost Cell Tumor: A Case Report.: Tae Jung Kim, Youn Soo Lee, Byung Kee Kim, Kyo Young Lee; Korean J Pathol. 2006;40(4):297-302.

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Abstract PDF: Dentinogenic ghost cell tumor (DGCT) is an uncommon odontogenic tumor. It is characterized by islands of odontogenic epithelial cells that contain numerous ghost cells and dysplastic dentin. Occasionally, DGCT combines with other odontogenic tumors, such as ameloblastoma. We report here on a 21-year-old female who complained of a tender solid mass in the left maxilla for the 7 month previous to her admission. MRI revealed a relatively well demarcated mass in the left maxilla with heterogenous signal intensity, measuring 3.2 x 2.8 cm, and this mass had invaded the left palate. Microscopically, the tumor was composed of nests of odontogenic epithelium that contained ghost cells and calcification with dysplastic dentin, which is all consistent with DGCT. Localized area showed odontogenic epithelial follicles that had peripheral palisading and satellite reticulum without ghost cells and dentin, and this is consistent with ame- loblastoma. The immunohistochemistry revealed cytokeratins, EMA, S100 and Bcl-2 positivity in areas of the DGCT and ameloblastoma. In the ameloblastoma, Bcl-2 positivity was noted in the palisading basal cells. We concluded that the tumor was an ameloblastoma associated with DGCT.

Ependymoma Arising from the Pelvis: A Case Report.: Kyungji Lee, Jihan Jung, Youn Soo Lee, Kyo Young Lee, Byung Kee Kim, Chang Suk Kang; Korean J Pathol. 2005;39(2):120-124.

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Abstract PDF: We report here on a case of an ependymoma arising from the pelvis in a 25-year-old woman. She had no evidence of abnormality in her brain and bilateral ovaries. The diagnosis was based on light microscopic, immunohistochemical, and ultrastructural features of a typical ependymoma, including the patterns of pseudorosette or true ependymal rosette, the strong immunopositivity for glial fibrillary acid protein and intermediate filaments, and cilia of tumor cells. The mass was over 20 cm in maximum diameter, and it was located between the uterus and rectum without any connection to bilateral ovaries. There were many metastatic nodules in the pelvis and omentum. In addition, the proliferation index in the most active area was 10% by immunohistochemistry using monoclonal antibody MIB-1. Although the prognosis of the pelvic ependymoma is known to be difficult to evaluate, this case may serve to illustrate the poor prognostic course, according to the size of the tumor, the evidence of metastasis, and the MIB-1 labelling index.

Invasive Ductal Carcinoma Arising in a Recurrent Malignant Phyllodes Tumor: A Case Report.: Ahwon Lee, Gyeongsin Park, Kyo Young Lee, Chang Suk Kang, Byung Kee Kim, Sang In Shim; Korean J Pathol. 2005;39(2):134-136.

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Abstract PDF: We report here on a case of invasive ductal carcinoma arising in a recurrent malignant phyllodes tumor. The patient was a 33-year-old woman who presented with a left breast mass, and an excision was then performed. The mass, measuring 7.0 x 4.0 cm in size, was relatively well demarcated with a nodular contour and showed pale gray and solid cut surface with clefts on it. Histologically, the mass mainly consisted of stromal components that were characterized by high cellularity, marked nuclear atypism and brisk mitosis. The sparse glandular components were leaf-like in shape and lined by bland ductal epithelium without any nuclear atypism. Sixteen months later, the patient revisited our hospital with a recurrent mass, and underwent total mastectomy. The recurrent mass contained foci of definite invasive ductal carcinoma in the background of malignant phyllodes tumor, which was identical to the primary mass. This case demonstrates that it is possible that an invasive ductal carcinoma might arise within, at least with, a recurrent malignant phyllodes tumor.

Expression of FHIT and p21 in Gastric Adenocarcinoma.: Hyun Joo Choi, Byung Kee Kim, Jinyoung Yoo, Seok Jin Kang, Chang Suk Kang; Korean J Pathol. 2004;38(1):35-41.

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Abstract PDF: BACKGROUND
The fragile histidine triad (FHIT) gene, located on the human chromosome 3p14.2, is frequently inactivated by its deletion in a number of human tumors, including gastric carcinomas. Its protein product, FHIT is presumed to have a tumor suppressor function. p21, one of the tumor markers acts as a regulator of the cell cycle, and inhibits cell proliferation.
METHODS
The association of the expressions of FHIT and p21 protein, with clinicopathological features, such as age, gender, tumor size, histological type, depth of invasion, lymph node metastasis, lymphatic and vascular invasion, grade and stage were investigated, and correlation of their expressions with p21 expression in 82 gastric adenocarcinomas attempted by immunohistochemical staining.
RESULTS
Of the 82 tumors analyzed, 58 (70.7%) were markedly reduced, or completely negative, for FHIT protein expression. The loss of FHIT expression was correlated with the depth of invasion (p=0.000), lymph node metastasis (p=0.001), lymphatic invasion (p=0.000), histological grade (p=0.000) and tumor stage (p=0.000). The loss of p21 expression was correlated with lymph node metastasis (p=0.026) and lymphatic invasion (p= 0.017), but not with the histological grade and tumor stage. The comparison of the FHIT and p21 protein expressions showed significant correlation (p=0.035).
CONCLUSIONS
The loss of FHIT and p21 expressions may be a useful indicator of the post diagnostic prognosis. Also, FHIT could be related to cell cycle arrest.

Eccrine Syringofibroadenoma: A Case Report.: Hee Jeong Lee, Jinyoung Yoo, Seok Jin Kang, Byung Kee Kim, Chang Suk Kang; Korean J Pathol. 2003;37(4):298-299.

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Abstract PDF: Eccrine syringofibroadenoma is an uncommon benign eccrine tumor, which was first described by Mascaro in 1963. It usually develops on the extremeties of elderly persons. Recently we experienceda case of eccrine syringofibroadenoma that occured in a 38-year-old woman. She presentedus an asymptomatic solitary reddish nodular plaque with a verrucous surface, whichshe'd had on her right arm for three months. Histologically, slender anastomosing epithelial cellcords with focal luminal differentiation resembling duct structures were embedded in a fibrovascularstroma. The net-like pattern of epithelial cells resembled that seen in fibroepithelioma.

Metastasizing Atypical Chondroid Lesion: A Case Report.: Heejeong Lee, Jinyoung Yoo, Seok Jin Kang, Byung Kee Kim; Korean J Pathol. 2003;37(1):62-65.

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Abstract PDF: We recently experienced an atypical chondroid lesion metastatic to the lung. Examined under the microscope, the excised nodules displayed abundant amounts of chondroid tissue and necrosis with dystrophic calcification. The calcification had a characteristic "chicken wire" pattern. The chondroblasts contained one or two round to oval, focally indented nuclei with inconspicuous nucleoli. Although some enlarged nuclei with mild to moderate pleomorphism were present, significant nuclear atypia was lacking. Mitotic figures were scarce (1/10 high power field). Scattered multinucleated osteoclast-type giant cells were observed among the chondroblasts. Thus, the possibility of chondroblastoma was considered first. Metastasis of histologically benign chondroblastoma is a rare event, but well documented. The pulmonary metastatic nodules were described as ceasing to grow in some cases; and a significant number of patients were free of tumors following removal of the metastatic nodules. These findings suggest that the metastasis may represent a simple transport phenomenon. However, there are, as yet, no histologic parameters that help determine whether these metastases are to cease their growth or will progress to kill the host.

Primary Leiomyosarcoma of Adrenal Gland: A Case Report.: Heejeong Lee, Jinyoung Yoo, Seok Jin Kang, Byung Kee Kim; Korean J Pathol. 2002;36(3):191-194.

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Abstract PDF: Primary mesenchymal neoplasm of the adrenal gland is very rare. Recently we experienced a case of leiomyosarcoma of the adrenal gland in a 47-year-old female patient. The resected adrenal gland showed a large lobulated mass, which replaced the entire gland. The cut surface was firm and whitish gray with foci that showed hemorrhage and necrosis. Histologically, the tumor was composed of intersecting fascicles of pleomorphic spindle cells with numerous giant cells and mitotic figures. Some of the tumor cells showed elongated nuclei. Immunohistochemical studies were strongly positive for vimentin and smooth muscle actin. Cytokeratin, desmin, alpha-1-antitrypsin and lysozyme were all negative. To the best of our knowledge, this is the first case reported in Korea.

Ras Gene Mutations and Expression of ERK1 and ERK2 Proteins in Stomach Cancer.: Jinyoung Yoo, Seok Jin Kang, Byung Kee Kim, Chang Suk Kang; Korean J Pathol. 2002;36(2):77-83.

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Abstract PDF: BACKGROUND
We investigated stomach cancers for ras abnormalities and expression of ERK1 and ERK2 to determine their significance in the tumor development and/or progression and to evaluate their potential correlation with clinicopathologic parameters.
METHODS
Seventy gastric adenocarcinomas were studied immunohistochemically in paraffin-embedded tissue sections for the expression of ERK1 and ERK2 proteins. All tumors were further analyzed with the use of a polymerase chain reaction technique and a direct sequence analysis procedure for the presence of the mutated ras gene.
RESULTS
ERK1 and/or ERK2 was expressed in 65.7% (46/70) of the tumors; overexpression of ERK1 was observed in 38 (54.3%) tumors, whereas ERK2 was detected in 29 (41.4%). Nine (12.8%) samples demonstrated multations in the ras gene: 4 in H-ras and 5 in K-ras. Seven of the 9 (77.8%) mutated tumors were of the intestinal type. No association was established between the ras abnormalities and the overexpression of ERK1 and/or ERK2. However, the correlation between ERK2 and progression (early vs. advanced) was statistically significant (p<0.05).
CONCLUSIONS
These data indicate that ras abnormalities are uncommon events in gastric adenocarcinomas. The majority of ras mutations, however, occurred in intestinal-type tumors, supporting the notion of different molecular mechanisms involved between the intestinal-and diffuse-type lesions. Enhanced ERK2 activity may provide assistance in the determination of tumor penetration in these tumors.

Primary Choriocarcinoma of the Stomach: A Case Report.: Eun Joo Seo, Hi Jeong Kwon, Ki Ouk Min, Keun Woo Lim, Seong Lee, Byung Kee Kim; Korean J Pathol. 2002;36(1):55-58.

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Abstract PDF: A case of primary gastric choriocarcinoma with multiple liver metastases is described. A 54-year-old man underwent gastrectomy for an advanced cancer. An ulcerofungating tumor with extensive hemorrhagic necrosis was found in the anterior wall of the prepyloric antrum. The histologic examination revealed a biphasic pattern composed of uninucleated cyto or intermediate trophoblasts and syncytiotrophoblasts. A small area of the adenocarcinoma forming glandular structures and poorly differentiated solid sheets was also noted on the superficial portion of the tumor. Immunohistochemical staining for the beta human chorionic gonadotropin (-hCG) and the human placental lactogen (hPL) showed strong immunoreactivity, particularly in the cytoplasms of the syncytiotrophoblasts and intermediate trophoblasts, respectively. A diagnosis of the choriocarcinoma was made. Multiple hepatic nodules consistent with metastases were noted on the abdominal sonogram. The serum -hCG level of the patient was significantly increased.

Fine Needle Aspiration Cytology of Ameloblastoma: A Case Report.: Hee Jeong Lee, Eun Sun Jung, Byung Kee Kim, Chang Suk Kang; Korean J Cytopathol. 2002;13(2):70-73.

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Abstract PDF: Utilization of fine needle aspiration cytology(FNAC) in the diagnosis of odontogenic tumors seems to have little attention. Ameloblastoma is the most common epithelial odontogenic tumor. However, the cytologic findings of ameloblastoma are described recently. We report a case of ameloblastoma diagnosed by FNAC. The aspirated blood-tinged mucoid fluid from maxillary mass showed a few clusters of tumor cells with distinct two-cell population: basaloid cells with palisading arrangement and squamous cells with more abundant and eosinophilic cytoplasm. Nuclear atypism, pleomorphism or mitosis were absent. A few keratinized bodies in the tumor cell clusters and the third component, stellate cells were also characteristic.

Loss of Heterozygosity on Chromosome 9p21, 17p13 and 3p in Human Astrocytic Tumor.: Youn Soo Lee, Chang Suk Kang, Seung Myung Dong, Jung Yong Lee, Sang In Shim, Byung Kee Kim; Korean J Pathol. 2001;35(4):330-337.

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Abstract PDF: BACKGROUND
The purpose of this study was to determine the genetic abnormalities of chromosomes 9p21, 17p13.1, 3p25 and 3p14.2 in the development and progression of astrocytic tumors.
METHODS
We performed loss of heterozygosity (LOH) analysis in 41 astrocytic tumors, including 20 astrocytomas, 11 anaplastic astrocytomas and 10 glioblastomas, and correlated the results of LOH at different histopathologic grades. LOH was determined by multiplex polymerase chain reaction analysis of the DNA, which was extracted by microdissection.
RESULTS
LOH of 9p21 was found in 55.6% of astrocytomas, 54.6% of anaplastic astrocytomas and 100.0% of glioblastomas. LOH of 17p13.1 was found in 21.4% of astrocytomas, 28.6% of anaplastic astrocytomas, and 66.7% of glioblastomas. LOH of 3p25 was found in 37.5% of astrocytomas, 16.7% of anaplastic astrocytomas, and 14.3% of glioblastomas. LOH of 3p14.2 was found in 16.7% of astrocytomas, 40.0% of anaplastic astrocytomas, and 42.9% of glioblastomas. LOH on chromosome 9p21 and 17p13.1 was closely related with the histopathologic grades.
CONCLUSIONS
These results may suggest that LOH of 9p21, 17p13.1, 3p25 and 3p14.2 involves an early event of astrocytoma development and accumulates during progression. LOH of 3p25 may be involved in the tumorigenesis of astrocytoma. Identification of these LOH may illuminate the stepwise pathogenesis of astrocytic tumors and predict the possibility of malignant transformation.

ras Gene Mutations in Malignant Fibrous Histiocytoma.: Jinyoung Yoo, Ah Won Lee, Seok Jin Kang, Byung Kee Kim; Korean J Pathol. 2001;35(3):232-237.

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Abstract PDF: BACKGROUND
ras gene mutations have been described in various human malignancies, suggesting that their activation may play a role in oncogenesis. However, there are few reports concerning ras gene alterations in malignant fibrous histiocytomas. We therefore designed a study to determine the prevalence and type of mutations in the first exons of H-ras and K-ras genes in these tumors.
METHODS
Twenty-seven malignant fibrous histiocytomas were investigated by direct sequencing analysis with the automated DNA sequencing of polymerase chain reaction-amplified ras sequences.
RESULTS
Twenty-four mutations were found in 18 (67%) of the tumors: GGC to GAC transition mutations at codon 13 of K-ras (coding for aspartic acid instead of glycine) in 18 of the samples and GGC to GTC transversions at codon 12 of H-ras (coding for valine instead of glycine) in six of the lesions.
CONCLUSIONS
Our data suggest an involvement of the ras gene mutation in conjunction with other yet unknown events in the tumorigenesis and/or progression of malignant fibrous histiocytomas. The K-ras gene activation predominated in these tumors by a mutation at codon 13. It is noteworthy that H-ras mutations were detected only in association with the lesions containing K-ras mutated genes, the significance of which remains to be determined.

Expression of Cyclin D1, CDK4, p16 and Rb Proteins in Human Soft Tissue Sarcomas.: Jinyoung Yoo, Ah Won Lee, Seok Jin Kang, Byung Kee Kim; Korean J Pathol. 2001;35(3):238-244.

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Abstract PDF: BACKGROUND
Altered cell cycle regulation may underlie the development and/or progression of human malignancies. The purpose of this study is to determine if the oncogenesis of soft tissue sarcomas could be better explained by examining the components involved in G1 phase progression.
METHODS
Sixty-seven soft tissue sarcomas were studied for the immunohistochemical expression of cdk4, cyclin D1, retinoblastoma (Rb) and p16 proteins. For Rb and p16, samples showing either negative or heterogeneous (<80% of tumor cells) staining were considered to be altered.
RESULTS
The cdk4 protein was observed in 64 cases (95.5%). Cyclin D1 was expressed in 14 cases (20.9%). The Rb expression was altered in 48 (71.6%). Sixty-three (94%) sarcomas demonstrated altered p16 expressions. All of the samples displayed altered expressions of either Rb or p16. A high percentage of the tumors with altered Rb were observed in relapsed patients (p<0.05).
CONCLUSIONS
Disturbance in the cell cycle regulatory system involving the Rb/p16/cdk4/cyclin D1 pathway appears to be relatively frequent in soft tissue sarcomas and may play an important role in the tumorigenesis of these tumors. It is noteworthy that the reduced Rb expression correlates with tumor relapse, suggesting its prognostic significance.

Pulmonary Aspergillus niger Fungus Ball Associated with Calcium Oxalate Crystal: A Case Report.: Eunhee Lee, Heejung Kim, Eundeok Chang, Kyo Young Lee, Byung Kee Kim; Korean J Pathol. 2001;35(2):165-167.

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Abstract PDF: Pulmonary aspergillomas are considered to represent saprophytic growth of hyphae within the preexisting lung cavity. Causative Aspergillus species are mostly composed of A. fumigatus and A. flavus and, occasionally, A. niger. It is difficult to identify these species using histopathologic evaluation without a culture of sputum and bronchoalveolar lavage. We recently experienced a case of pulmonary Aspergillus niger infection associated with characteristic calcium oxalate crystal formation. A large cavity contained hyphae with a typical conidial head, conidiophore, and conidia. Characteristic birefrigent calcium oxalate crystals were demonstrated in the cavity wall.

Primary Extramedullary Plasmacytoma of the Colon: A Case Report.: Ok Ran Shin, Gyeong Shin Park, Youn Soo Lee, Eun Sun Jung, Sun Moo Kim, Byung Kee Kim; Korean J Pathol. 2001;35(1):80-82.

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Abstract PDF: Extramedullary plasmacytoma is a relatively rare tumor, occuring in a wide variety of organs and tissues, and is most frequently seen in the oral cavity and upper respiratory tract. Solitary extramedullary plasmacytoma located in the gastrointestinal tract is rare, especially the in colon. We report a case of solitary extramedullary plasmacytoma in the cecum of a 58-year-old man which simulated a carcinoma both endoscopically and radiologically. But histopathologic evaluation demonstrated a sheet-like proliferation of pure plasma cells with monoclonality for IgM and lamda chain which confirmed the diagnosis of plasmacytoma.

Fine Needle Aspiration Cytology of Papillary-Cystic Variant of Acinic Cell Carcinoma of Salivary Gland: A Case Report .: Ah Won Lee, Jin Young Yoo, Seok Jin Kang, Byung Kee Kim; Korean J Cytopathol. 2001;12(1):45-48.

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Abstract PDF: Acinic cell carcinoma(ACC) is the third common malignancy in major salivary gland. Fine needle aspiration cytology is a useful tool for the diagnosis of salivary gland lesions. However, some low grade malignancies, such as ACC and mucoepidermoid carcinoma show relatively high false negative rate, mainly due to deceptively benign cytomorphologic appearance. We experienced a papillary-cystic variant of ACC, having different cytopathologic features compared with those of classic ACC. Our case showed monolayered sheets and papillary clusters without any acinic structures or naked nuclei of the tumor cells. Foamy proteinaceous material was seen in the background. The tumor cells had a large amount of granular cytoplasm and eccentric nuclei. Many vacuolated or clear cells were also noted.

Epidermoid Cyst of the Sole: A report of two cases positive for human papillomavirus.: Eun Joo Seo, Hi Jeong Kwon, Ki Ouk Min, Hyun Jeong Lee, Byung Kee Kim; Korean J Pathol. 2000;34(12):1025-1028.

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Abstract PDF: Epidermoid cysts occur rarely on the palms and soles, where hair is not present. These cysts have long been assumed to arise from traumatic implantation of epidermal fragment, but the pathogenesis is still controversial. Recently, with microscopic findings, immunohistochemical features, and molecular studies, the epidermoid cysts of the sole may be induced by the human papillomavirus. We report two cases of epidermoid cysts of the sole with the discussion of the pathogenesis.

Dendriform Pulmonary Ossification: A case report.: Chan Kwon Jung, Kyo Young Lee, Chang Suk Kang, Sang In Shim, Byung Kee Kim; Korean J Pathol. 2000;34(11):950-952.

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Abstract PDF: The dendriform pulmonary ossification (DPO) is a rare condition of unknown origin in which branching mature bony spicules, usually containing marrow, are found within the alveolar septa. DPO manifests slow progression over many years or may remain unchanged; spontaneous regression has not been recorded. Most patients have no symptoms directly attributed to the ossification, although they may have symptoms due to the underlying fibrotic process. We experienced a case of DPO in 38 year-old-man who presented with cough and sputum for a month. The chest X-ray showed marked coarsened interstitial lung markings in both lungs, especially in the lower lobes. Open lung biopsy was done. Grossly, there were significant dendriform osseous structures. Histologically, branching arrays of mature bone were found in the interstitium and occasionally in alveolar spaces. Some bony trabeculae contained fatty or cellular marrow. The alveolar septa showed fibrous thickening with chronic inflammation. The transition between fibrosis and bone tissue was observed. Our case suggests that dendriform pulmonary ossification may be a rare special manifestation of chronic fibrosing interstitial inflammation of the lung. Osseous structures seem to derive from metaplastic bone formation in the vicinity of undergoing fibrous process.

Trichofolliculoma in Korean Patients: A report of six cases.: Kyoung Mee Kim, Jai Kyung Ko, Anhi Lee, Chang Suck Kang, Byung Kee Kim, Seok Jin Kang; Korean J Pathol. 2000;34(11):957-960.

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Abstract PDF: Trichogenic tumors are a very rare group of primary cutaneous neoplasms and a few tumors have been recognized. Trichofolliculoma is a benign, papular, organoid adnexal tumor of the skin and presents as a solitary skin-colored nodule. We report six cases of trichofolliculoma occurred in Korean patients consisting of three male and three female patients. The duration of disease was variable from 3 months to 5 years. The site of tumor was limited to the face and included eyelid in two cases, nose in two cases, cheek and posterior aspect of ear in each one case. The size of the mass varied from 4 to 8 mm in diameter. Microscopically, all the cases showed large central cystic hair follicle with numerous secondary follicular buds, producing a radiating pattern. The stroma was fibrotic and well demarcated from the adjacent dermis.

Expression of CD44v6 Protein in the Progression of Colorectal Carcinomas.: Eunhee Lee, Kyoung Mee Kim, Anhi Lee, Byung Kee Kim; Korean J Pathol. 2000;34(9):636-641.

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Abstract PDF: During tumor progression, a subset of cells acquires metastatic properties, presumably through a series of genetic alterations. CD44 variant glycoproteins containing sequences encoded by exon v6 are related to tumor progression of human colorectal cancer. But their expression in normal colonic epithelium is controversial and studies of CD44 on each step of colorectal carcinogenesis are scanty. We studied CD44v6 expression in the normal colonic mucosa, adenoma, carcinoma in situ, and invasive colorectal carcinomas of different Astler-Coller stages. Endoscopically or surgically resected 36 normal colonic mucosa, 19 adenomas, 8 cases of carcinoma in situ, and 25 cases of carcinoma were selected. After immunohistochemical stain with CD44v6 antibody, positivity was graded as 0 to 4 based on the estimated percentage of positively stained tumor cells. The intensity of positive staining cells was also graded as 0 to 3. In all but one cases (97.2%), normal colorectal mucosa was negative for CD44v6. Positive rates in adenoma, carcinoma in situ, Astler-Coller stage A/B and C/D carcinoma were 73.6%, 88.9% and 87.5%, respectively. There was no statistically significant difference in the positivity between these groups. The staining intensity was significantly higher in the cases of stage C/D carcinoma group than those of adenomas (p<0.05). The percentage of positivity for CD44v6 was higher in stage C/D carcinoma group than adenoma, carcinoma in situ, and stage A/B carcinoma group (p<0.05). Expression of CD44v6 in the normal colonic mucosa was extremely rare and the positivity was increased according to the progression of colorectal tumors. Furthermore, it is more important to interpret the CD44v6 positivity according to the estimated percentage of positively stained tumor cells.

Complex Conjunctival Choristoma in Linear Nevus Sebaceous Syndrome: A case report.: Jinyoung Yoo, Jae Kyung Koh, Seok Jin Kang, Byung Kee Kim; Korean J Pathol. 2000;34(9):680-684.

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Abstract PDF: Linear nevus sebaceous syndrome is an uncommon neurocutaneous disorder characterized by nevus sebaceus, seizures, and mental retardation, and is often accompanied by ocular anormalies. We recently experienced a case of conjunctival choristoma associated with linear nevus sebaceous syndrome in a 17-month-old boy. The child was the product of a full-term uncomplicated pregnancy and normal delivery with normal karyotype of 46, XY. He was noted at birth to have a conjunctival mass on the right eye and linear nevi over the midline facial region and right temporoparietal scalp. Ophthalmologic examination revealed optic atrophy, peripapillary staphyloma, macular hypogenesis, and osseous choristoma of the choroid. A computed tomography scan demonstrated widening of the subarachnoid space and moderate atrophy of the cerebral and cerebellar hemispheres. He has been followed by ophthalmology and completely free of seizures since birth. The patient underwent excision of the conjunctival mass and biopsies of the skin lesion at 17 months of age. Histologic examination of the skin biopsies was characteristic for the linear sebaceous nevus of Jadassohn. Histologic findings of the conjunctival lesion showed a complex choristoma that contained lacrimal gland tissue and cartilage.

Trichoblastic Fibroma: A Pathologic Analysis of 4 Cases.: Ah Won Lee, Ji Han Jung, Jin Young Yoo, Seok Jin Kang, Byung Kee Kim; Korean J Pathol. 2000;34(8):574-580.

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Abstract PDF: Trichoblastic fibroma is a benign trichogenic tumor that has both epithelial and mesenchymal components and exhibits partial follicular induction. We studied 4 cases of trichoblastic fibroma and reviewed their clinical and histologic features. Two tumors were present in the face. The remaining two were in the vulva and perianal area, respectively. The age of the patients ranged from 53 to 68 years, with an average age of 62. All were female. Histologically, the lesions showed a well circumscribed mass, located at dermo-subcutaneous junction in three patients and subcutaneous in one. They demonstrated mesenchymal induction evidenced by hair germ-like structure and perifollicular sheath. There was no connection between the tumor and epidermis. Differentiation toward hair structure led to the formation of the infundibulum through inner root sheath. Trichoblastic fibroma may be confused clinically and/or histologically with basal cell carcinoma. Identification of the mixed epithelial and mesenchymal components, and the absence of epidermal connection and cleft within the stroma are important in differentiating this benign neoplasm from basal cell carcinoma.

Effects of Active Hexose Correlated Compounds on Drug Induced Liver Injury in Mice.: Ki Ouk Min, Hi Jeong Kwon, Eun Joo Seo, Jeana Kim, Seok Jin Kang, Byung Kee Kim; Korean J Pathol. 2000;34(7):509-515.

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Abstract PDF: AHCC (Active Hexose Correlated Compounds), which was at first extracted from cultured broth of Basidiomycotina, is known to be one of the Biological Response Modifiers (BRM). We examined the protective effects of AHCC on carbon tetrachloride (CCl4) and thioacetamide (TAA)-induced liver injury in mice. The AHCC pretreatment prevented the suppression of several physiological and biochemical parameters in the mice injected with CCl4 or TAA for 5 days. The liver weights and serum ALT and AST levels were increased by CCl4 or TAA, the degree of which was significantly reduced with the AHCC pretreatment. The AHCC pretreatment induced increasing activity of GST (glutathione s-transferase) and showed an increasing tendency of P450 and EROD (ethoxyresorufin o-dealkylation). The AHCC pretreatment also showed negative effects against the suppression of drug metabolizing enzymes, such as P450, EROD, and GST induced by CCl4 or TAA. AHCC pretreatment showed protective effects with significant inhibition of fatty change, inflammation, and necrosis in CCl4 and TAA intoxicated mice liver. The present study suggests that the protective effect of AHCC pretreatment might be related to the protection of liver from the drug induced liver injury in mice model.

Classification of Gastrointestinal B-cell Lymphoma and Expression of Cyclin D1, bcl-2, bcl-6, p53 Protein and PCNA.: Ji Han Jung, An Hee Lee, Chang Suk Kang, Byung Kee Kim; Korean J Pathol. 2000;34(6):437-445.

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Abstract PDF: Until recently, the gastrointestinal lymphomas were classified according to the criteria developed for the node-based lymphomas. In recent years, the REAL classification provided a new category of MALT lymphoma and Mantle cell lymphoma in B-cell lymphomas. Low-grade MALT lymphomas have been well characterized clinically, histologically, and immunophenotypically. We retrospectively recategorized 41 cases of the primary gastrointestinal B-cell lymphoma and investigated the expression of cyclin D1, bcl-2, bcl-6, p53 protein, and PCNA by immunohistochemical method. The cases were categorized in 5 groups, low grade MALToma, low/high grade MALToma, high grade MALToma, diffuse large cell lymphoma, and mantle cell lymphoma according to the morphological findings. The expression of cyclin D1 protein was restricted to the cases of mantle cell lymphoma. The bcl-2 protein expression was higher in the low grade MALT lymphoma than in the high grade lymphoma (P=0.006). The bcl-2 protein expression was higher in the low grade area than in the high grade area in the low/high grade MALT lymphoma (P=0.005). The bcl-6 and p53 protein expression was higher in the high grade MALT lymphoma than in the low grade lymphoma (P=0.022, P<0.018). However, the bcl-6 protein expression of the tumor cells was higher in high grade area than in low grade area in the low/high grade MALT lymphoma (P=0.004). The degree of the PCNA expression was positively correlated with the grade of the malignant lymphoma (P=0.003). The above results suggest that the cellular proliferation assessed by PCNA index correlates with the histologic grade. And the bcl-2, bcl-6, p53 protein may be effective in the transition from the low grade MALT lymphoma to the high grade lymphoma. Therefore, we can differentiate the low grade lymphoma from the high grade lymphoma by the immunohistochemical staining for cyclin D1, bcl-2, bcl-6, p53 protein and can predict the prognosis of the patients in accordance with the grade of the tumor.

Expression of Matrix Metalloproteinase and Tissue Inhibitors of Matrix Metalloproteinase in Malignant Lymphoma.: Ah Won Lee, An Hi Lee, Chang Suk Kang, Byung Kee Kim; Korean J Pathol. 2000;34(4):249-256.

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Abstract PDF: Matrix metalloproteinases (MMPs) and their inhibitors (tissue inhibitors of matrix metalloproteinases, TIMPs) play essential roles in the remodelling of the extracellular matrix. The balance between MMPs and TIMPs is altered in neoplasia, contributing to the invasive and metastatic properties of malignant tumors. Although MMP and TIMP are believed to play an important role in invasion and metastasis in malignant solid tumors, little is known about their involvement in malignant lymphoma. Immunohistochemical stains for MMP-1, MMP-2, MMP-9, TIMP-1 and TIMP-2 were performed using 56 paraffin blocks of the malignant lymphoma and the results were analyzed by using the tumor grade by Working Formulation. The expression of MMP-9 was noted in 45.5% of low grade, 86.1% of intermediate grade, and 100% of high grade malignant lymphoma. The incidence of MMP-9 expression in tumor cells was positively correlated with the grade of the malignant lymphoma (P<0.025). In nodal lymphomas, the incidence of the MMP-9 expression of the tumor cells was higher in malignant lymphoma with extracapsular invasion than those without extracapsular invasion (P=0.008). The incidence of TIMP-1 expression in the tumor cells and fibroblasts was positively correlated with the grade of the malignant lymphoma (P<0.025). In nodal lymphoma, the incidence of the TIMP-1 expression of the tumor cells was higher in malignant lymphoma with extracapsular invasion than those without extracapsular invasion (P=0.009). The incidences of the MMP-1, MMP-2, and TIMP-2 expression in malignant lymphoma were neither increased in the malignant lymphoma with extracapsular tumor invasion nor correlated with the grade by working formulation. There was no significant difference in the expression rate of MMP-1, MMP-2, MMP-9, TIMP-1, and TIMP-2 in nodal- and extra-nodal malignant lymphoma. The above results suggest that the expressions of MMP-9 and TIMP-1 are positively correlated with the grade and the presence of extranodal tumor invasion in malignant lymphomas.

Argyrophilic Nucleolar Organizer Region and Expression of Ki-67 in Malignant Lymphoma.: Hee Jung Lee, An Hi Lee, Kyo Young Lee, Chang Suk Kang, Sang In Shim, Byung Kee Kim; Korean J Pathol. 2000;34(4):257-263.

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Abstract PDF: Nucleolar organizer regions (NORs) are loops of DNA which occur in the nucleoli of cells which possess ribosomal RNA genes. The numbers and areas of NORs have been thought to be related to cellular activities. We aimed to investigate the direct relationship between the parameters of AgNORs and cellular proliferative activity using immunohistochemical method with the monoclonal antibody Ki-67, which demonstrates proliferating nuclei. The sequential technique for the simultaneous Ki-67 immunostaining and NOR staining was applied to the same slides of a series of non-Hodgkin's lymphomas (NHL) of the low, intermediate, and high grade type. The number of AgNOR per cell was counted and mean NOR percentage nuclear area (NPNA) was measured by morphometry in both the Ki-67 positive and Ki-67 negative nuclei. The increased immunoreactivity for Ki-67 was found in the high grade than in the low grade non-Hodgkin's lymphoma. This was reflected in the two areas of the palatine tonsils and lymph nodes, the positive cell counts being higher in the follicle center nuclei than in those in the interfollicular compartment. In general the numbers and NPNA of AgNORs were higher in the Ki-67 positive nuclei than in those lacking the antigen in malignant lymphomas as well as in control. The AgNORs numbers and NPNA in controls were the highest in the Ki-67 positive cells in the follicular area and the lowest in the Ki-67 negative cells in the perifollicular area. In malignant lymphomas the numbers and NPNA of AgNORs tended to increase in proportion to their grade in both the Ki-67 positive and negative cells. The numbers of AgNORs of the high grade and the NPNA of the intermediate and the high grade were significantly higher in Ki-67 positive cells than in Ki-67 negative ones. With this double staining method it was now possible to confirm that numbers and NPNA of AgNORs were directly related to the cellular proliferative activity. In maligant lymphoma, among the several parameters of the AgNORs, NPNA in Ki-67 positive cells is proposed to be the most useful marker in determining the prognosis of the patient.

Hemimegalencephaly: A case report.: Youn Soo Lee, Eun Sun Jung, Sun Moo Kim, Byung Kee Kim; Korean J Pathol. 2000;34(3):243-247.

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Abstract PDF: Hemimegalencephaly is an uncommon sporadic congenital malformation of the central nervous system characterized by enlargement of one cerebral hemisphere with cranial asymmetry, hemiparesis, epilepsy, and mental retardation. This report deals with a 12-month-old girl with intractable seizure and developmental delay, who revealed hemispheric asymmetry and enlarged right cerebral hemisphere. MRI scan revealed asymmetric enlargement of right cerebral hemisphere with lissencephaly and multifocal calcification. She underwent right frontal lobectomy and parietal cortical resection, but died of complication of surgery. Histological features included loss of cortical lamination, large atypical neurons, neuronal heterotopia, and astrocytosis with dystrophic calcification. The heterotopic neurons in the white matter were suggestive of aberrant neuronal migration.

Expression of CD44 Splicing Variants v4/5 and v6 in Gastric Adenocarcinoma and Its Relationship with Prognostic Factors.: Lee So Maeng, Hae Kyung Lee, Byung Kee Kim, Eun Jung Lee; Korean J Pathol. 2000;34(2):119-124.

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Abstract PDF: CD44, an integral membrane glycoprotein expressed by many cell types, serves as the principal transmembrane hyaluronate receptor and may be a determinant of metastatic and invasive behavior in carcinomas. This study was performed to investigate the relationship between CD44 splicing variants v4/5 and v6 expression and histopathologic prognostic factors (depth of tumor invasion, histologic classification, vascular and lymphatic invasion, and lymph node metastasis) in 107 gastric adenocarcinomas. In 107 cases of gastric carcinoma, the immunohistochemical stainining for CD44 v4/5 and CD44 v6 gave the following results. CD44 v4/5 was expressed in 40.2% and CD44 v6 in 67.3% of gastric carcinomas. The expression of CD44 v4/5 was correlated with histologic classification by Lauren (p<0.05), lymphatic invasion (p<0.05), and lymph node metastasis (p<0.004). In contrast, expression of CD44 v6 had no impact on prognostic markers. This study suggests the role of CD44 v4/5 in invasion, metastasis, and its prognostic significance in gastric adenocarcinoma.

Myofibrosarcoma of the Breast: A case report .: Chan Kwon Jung, Kyo Young Lee, Chang Suk Kang, Sang In Shim, Byung Kee Kim; Korean J Pathol. 2000;34(1):96-98.

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Abstract PDF: Myofibrosarcoma of the breast is a rare malignant mesenchymal tumor that has been reported in only four well documented cases so far. We report a case of myofibrosarcoma of the breast in an 88-year-old man who complained of a palpable mass for 1 year. Microscopically, the tumor consisted mainly of spindled cells, arranged in irregular fascicles and embedded in broad bands of dense hyalinized collagen. It showed ill-defined border infiltrating the adjacent adipose tissue, moderate cellular pleomorphism, and high mitotic rate (8~9/10 HPF). Immunohistochemical study confirmed myofibroblastic differentiation of the tumor cells with diffuse strong reaction for vimentin, smooth muscle actin, and fibronectin.

Fine Needle Aspiration Cytology of Solid Type Adenoid Cystic Carcinoma of Buccal Mucosa: A Case Report .: Jeana Kim, Kyoung Mee Kim, Young Sill Kim, Anhi Lee, Sang In Shim, Byung Kee Kim; Korean J Cytopathol. 2000;11(2):89-92.

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Abstract PDF: Adenoid cystic carcinoma constitutes 4 percent of all benign and malignant epithelial salivary gland tumors and is a highly malignant tumor of the salivary glands. The cytologic presentation in aspirates is usually characteristic with spherical clusters(balls) of small tumor cells filled with hyaline material. But in case of the poorly differentiated variety(solid type), it is difficult to differentiate from other tumors because sheets of small, fairly monotonous malignant cells, with somewhat larger and more conspicuous nuclei are only seen. The cytologic findings of fine needle aspiration of solid type adenoid cystic carcinoma of buccal mucosa in a 51-year-old man are presented. On cytologic findings, solid sheets of monotonous tumor cells with focal necrosis was noted on a hemorrhagic background and the characteristic cytologic features of adenoid cystic carcinoma was absent.

Fine Needle Aspiration Cytology of Pulmonary Hamartoma: A Report of Two Cases.: Jeana Kim, Kyoung Mee Kim, Young Sill Kim, An hi Lee, Sang In Shim, Byung Kee Kim; Korean J Cytopathol. 2000;11(1):31-34.

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Abstract PDF: Pulmonary hamartoma is an uncommon benign tumor consisting of a mixture of loose fibromyxoid tissue, cartilage, fat, and cleft-like spaces lined by cuboidal or ciliated epithelium. Cytologically, the presence of a mesenchymal component is essential for the diagnosis of pulmonary hamartoma. We report the fine needle aspiration cytologic findings of two cases of pulmonary hamartoma. Case 1 was a 71-year-old woman with a mass, measuring 1.8X1.5 cm in the upper lobe of the right lung. Case 2 was a 51-year-old woman with a mass, measuring 2.3 x 2.0 cm in the lower lobe of the right lung. Fine needle aspiration cytology of both pulmonary masses revealed several sheets of loose fibromyxoid tissue fragments with focal cartilaginous differentiation and a few clusters of bland cuboidal epithelial cells on the bloody background. The diagnosis was histologically confirmed by needle biopsy.

Multiple Kaposi's Sarcoma in the Renal Transplant Patient: A case report .: Jae Kyung Koh, Eun Sun Jung, Youn Soo Lee, Seok Jin Kang, Byung Kee Kim, Sun Moo Kim; Korean J Pathol. 1999;33(11):1097-1101.

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Abstract PDF: The Kaposi's sarcoma, which was found in an immunosuppressed patient of renal transplantation, may have been developed by long term use of immunosuppressant agent after the renal transplantation. The case was a 29-year-old woman who was diagnosed as chronic renal failure in 1988, and since then, she had been on CAPD until May, 1997. After the renal transplantation in May 1997, the patient has been prescribed cyclosporin and prednisone as immunosuppressant agent. In June 1997, she showed clinical symptom of Kaposi's sarcoma with multiple papules and nodules in the skin and viscera, such as ureter, urinary bladder, stomach, duodenum and subcutaneous tissue of the chest. Multiple excisional biopsies were carried out in the skin, ureter, urinary bladder, stomach and duodenum. All of excisional biopses indicated nodular stages with extensive proliferation of spindle shaped, somewhat pleomorphic cells which have slit-like vascular spaces, proliferation of small vessels, and extravasation of erythrocytes. These lesions nearly diminished after sytemic chemotherpy, excision and discontinuity of immunosuppressive agents.

Primitive Neuroectodermal Tumor of the Ovary: A case report .: Chan Kwon Jung, Eun Sun Jung, Youn Soo Lee, Byung Kee Kim, Sun Moo Kim; Korean J Pathol. 1999;33(8):631-635.

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Abstract PDF: Primitive neuroectodermal tumors (PNET) of the ovary are rare tumors with an exclusive or almost exclusive malignant neuroectodermal composition, and are generally regarded as a monodermal expression of an ovarian teratoma. The tumors are basically identical with the lesions of the same name occuring typically in the central nervous system of children. These tumors consist chiefly of undifferentiated small cells resembling neuroblasts. There are also mature, well- differentiated neuroectodermal cells, such as astrocytes and ependymal cells. We report a case of ovarian PNET with glial and neuroblastic differentiation and focal teratomatous foci of non-neural tissue in a 17-year-old female.

Papillary Serous Cystadenoma of Borderline Malignancy Arising from a Paramesonephric Parovarian Cyst: A case report.: Ji Han Jung, Youn Soo Lee, Seok Jin Kang, Byung Kee Kim, Sang In Shim; Korean J Pathol. 1999;33(6):457-459.

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Abstract PDF: Primary malignant parovarian epithelial tumors are extremely rare, with only 56 cases previously reported in the world literature. Most parovarian epithelial tumors are of paramesonephric (Mullerian) origin. In this article, we report the first case in the Korean literature of papillary serous cystadenoma of borderline malignancy from paramesonephric parovarian cyst. This case presented here is of particular interest since this neoplasm is rare. A 48-year-old female underwent a hysterectomy with bilateral adnexectomy and pelvic lymph node dissection for a cystic tumor of the right parovarian area. The tumor, measuring 13 cm in diameter, was apart from the ovaries, fallopian tubes and uterus. The cyst wall had well-developed smooth muscle layers. The cyst was lined with mildly atypical ciliated and non-ciliated low columnar cells compatible with those of paramesonephric origin. From the inner surface of the cyst several cauliflower-like structures projected into the lumen. They were of a predominantly papillary architecture covered by atypical epithelial cells with piling-up and occasional glandular growth. No destructive stromal invasion was identified.

Chromophobe Renal Cell Carcinoma.: Yeong Jin Choi, Tae Kon Hwang, Youn Soo Lee, Eun Jung Lee, Seok Jin Kang, Byung Kee Kim, Sang In Shim; Korean J Pathol. 1999;33(4):259-266.

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Abstract PDF: We report 13 chromophobe renal cell carcinomas (10.8%) observed among 120 renal cell carcinomas in adults. The average age was 53 (range: 34-72) years old, and 6 were males and 7 females. The mean tumor size was 10 (range: 5-17) cm, mean nuclear grade 2.4, and mean Robson's stage was 1.9. There were two distinct histologic variants; typical variant (n=9) and eosinophilic variant (n=4). Both of them showed typical light microscopic features and positive reaction with Hale's colloidal iron and carbonic anhydrase II, a marker protein of intercalated cells of renal collecting ducts. A strong positive immunoreactivity for epithelial membrane antigen was noted in the cytoplasm in 12 of 13 tumors. Numerous microvesicles, 180~440 nm in diameter, were identified ultrastructurally. DNA aneuploidy was found in 3 out of 10 cases. Neither local recurrence nor metastasis have been identified during the following period of 4~144 (mean 48) months.

Primary Pulmonary Hodgkin's Lymphoma: A case report.: Mi Seon Kwon, Kyo Young Lee, Chang Suk Kang, Byung Kee Kim, Sang In Shim, Myeong Im Ahn, Chi Hong Kim; Korean J Pathol. 1999;33(4):285-287.

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Abstract PDF: Primary pulmonary Hodgkin's lymphoma is a rare but distinct entity to be distinguished from nodal Hodgkin's lymphoma and from lymphomas involving lung secondarily. This lymphoma affects women more frequently than men, and typically involves superior portions of the lung. This case is reported to illustrate the clinical, radiographic and anatomic characteristics of the primary pulmonary Hodgkin's lymphoma. A 34-year-old woman presented for the evaluation of hemoptysis. A chest CT revealed a large poorly defined mass in the medial aspect of the right upper lobe, extending to the right mediastinum and trachea. The microscopic examination of the biopsied lesion revealed fibroblastic stroma infiltrated by a mixture of lymphocytes, histiocytes, and eosinophils. The clinical impression was inflammatory pseudotumor, presumably due to slightly favorable response to corticosteroid therapy. Two months later the patient's symptoms worsened despite the steroid therapy and a lobectomy was done. The specimen showed a soft to firm, pale yellow, ill defined mass, 10.0 8.0 cm, involving the visceral pleura. A few satellite nodules around the main mass were noted. The histologic findings were consistent with Hodgkin's lymphoma, nodular sclerosis type.

Necrotizing Vasculitis of the Gallbladder: A case report.: Ah Won Lee, Youn Soo Lee, Seok Jin Kang, Byung Kee Kim, Sang In Shim; Korean J Pathol. 1999;33(4):292-294.

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Abstract PDF: We report a case of necrotizing arteritis involving the gallbladder. This case was clinically diagnosed as cholelithiasis with cholecystitis, and necrotizing arteritis was found in the surgically resected specimen. Vascular changes were similar to those seen in classic polyarteritis nodosa, involving medium-sized muscular arteries and characterized by fibrinoid necrosis and panarterial and periarterial inflammation varying from active to resolving stages. Acute cholecystitis is a rare initial clinical manifestation of the systemic vasculitis. If acute cholecystitis is found in the absence of obvious cause, careful examination is essential. Since steroid therapy improves the prognosis in the systemic vasculitis, clinicians and pathologists should be aware of this unusual lesion.

Loss of Heterozygosity of Chromosome 3p in Squamous Cell Carcinomas and Adenocarcinomas of the Lung.: Gyeong Shin Park, Young Shin Kim, Kyo Young Lee, Chang Suk Kang, Sang In Shim, Byung Kee Kim; Korean J Pathol. 1999;33(3):151-157.

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Abstract PDF: We evaluated the frequency of genetic alteration of chromosome 3p in lung cancer, and analyzed the patterns of genetic alterations between two distinct histologic types, squamous cell carcinomas (SCC) and adenocarcinomas (AC). PCR-LOH analysis for 40 Korean non-small cell lung cancer including 20 SCC and 20 AC was performed using microsatellite markers, D3S1300, D3S1029 and D3S1038. These markers represented the loci of FHIT gene (3p14), mismatch repair gene hMLH1 (3p21) and VHL gene (3p25), respectively. For SCC, the frequency of LOH at D3S1300, D3S1029 and D3S1038 was 78.6%, 61.5% and 64.3%, and for AC, was 62.5%, 62.5% and 46.7%, and for total 40 cases of SCC and AC, was 70.0%, 62.1% and 55.2%, respectively. Among 27 cases showing heterozygosity at three examined loci, 7 cases (25.9%) revealed LOH at only one locus and 16 cases (59.3%) revealed LOH at two or three loci. The differences of incidence of LOH and the patterns of genetic alterations at chromosome 3p between two distinct histologic types of lung cancer were not significant. The genetic deletion of relatively broad area, including more than two loci, was more frequent than that of small area, including only one locus.

Fine Needle Aspiration Cytology of Peripheral T Cell Lymphoma of the Lung: A Case Report .: Ok Ran Shin, Eun Sun Jung, Youn Soo Lee, Chang Suk Kang, Byung Kee Kim, Sang In Shim; Korean J Cytopathol. 1999;10(2):157-162.

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Abstract PDF: Primary non-Hodgkin's lymphoma of the lung is rare among extranodal lymphomas. The most common form is low grade B-cell type originated from the mucosa-associated lymphoid tissue (MALT) of the lung and primary peripheral T cell lymphoma of the lung is extremely rare. We recently experienced a case of fine needle aspiration cytology of primary peripheral T cell lymphoma of the lung in a 39-year-old male patient. The cytologic smears revealed some sheets of reactive epithelial cells, epithelioid histiocytes, and numerous polymorphous population of lymphoid cells composed of small and intermediate sized lymphoid cells and mature lymphocytes. Lymphoid cells were slightly larger than normal mature lymphocytes and showed significant irregularity of nuclear membrane. The internal nuclear structure was marked by chromatin clumping, clear parachromatin areas, and inconspicuous nucleoli. Histopathologically, atypical small lymphocytes infiltrated in the interstitium and alveolar sac. By the immunohistochemical study and molecular biologic study of gene rearrangement, the T cell clonality of atypical lymphoid cells was confirmed.

Fine Needle Aspiration Cytology of Small Cell Carcinoma of the Parotid Gland: A Case Report .: Chan Kwon Jung, Eun Sun Jung, Youn Soo Lee, Sun Moo Kim, Byung Kee Kim; Korean J Cytopathol. 1999;10(2):163-167.

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Abstract PDF: Primary small cell carcinoma of the salivary gland is a rare neoplasm that accounts for approximately 1.8% of all primary major salivary gland malignancies. Because of its rarity, it is difficult to diagnose small cell carcinoma of the parotid gland by fine needle aspiration cytology(FNAC). We experienced a case of primary small cell carcinoma of the parotid gland in a 72-year-old woman who presented with two palpable masses of the left infraauricular and ocular regions of two to three month's duration, respectively. Aspirate smears from the left infraauricular area were highly cellular on necrotic and lymphocytic background and showed individually dispersed cells or three-dimensional clusters of small cells. The tumor cells were round to oval with a very high nucleocytoplasmic ratio. Nuclei were about two times the size of lymphocytes and had uniformly dispersed but hyperchromatic to pyknotic chromatin. Nucleoli were occasionally visible but were generally inconspicuous. Numerous mitotic figures were detected. The clusters of these small tumor cells exhibited angular nuclear molding, irregular nuclear outlines, and occasionally rosette like arrangement. The tumor was confirmed by histology and immunohistochemistry.

Fine Needle Aspiration Cytology of Columnar Cell Variant of Papillary Carcinoma of the Thyroid: A Case Report .: Ji Han Jung, Kyo Young Lee, Chang Suk Kang, Sang In Shim, Byung Kee Kim; Korean J Cytopathol. 1999;10(2):179-184.

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Abstract PDF: The columnar cell variant of papillary carcinoma is a rare tumor of the thyroid, associated with aggressive behavior, early metastasis, and a rapidly fatal course. We present the fine needle aspiration cytologic(FNAC) findings of columnar cell variant of papillary carcinoma with cytohistologic correlation. In the smears, the tumor fragments showed mainly papillary pattern and a few scattered individual cells were present around the papillary fragments. The tumor cells were columnar or cuboidal and exhibited pseudostratification of the nuclei. The nuclei were oval to elongated with finely stippled chromatin and inconspicous nucleoli. Neither nuclear grooves nor intracytoplasmic inclusion was found. The FNAC diagnosis was consistent with papillary carcinoma. Total thyroidectomy was done and the histologic finding of the mass showed a predominantly papillary and focal solid proliferation of columar cells with marked nuclear pseudostratification. The unique histopathologic features and highly aggressive nature of columnar cell variant of papillary carcinoma require that this variant should be differeniated from common papillary carcinoma of the thyroid.

Papillary Adenocarcinoma of Nonpigmented Ciliary Epithelium of the Eye.: Hyun Joo Choi, Yeong Jin Choi, Youn Soo Lee, Eun Jung Lee, Seok Jin Kang, Byung Kee Kim, Sang In Shim; Korean J Pathol. 1998;32(12):1104-1107.

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Abstract: Adenocarcinoma of the ciliary epithelium is a rare tumor, usually occuring in elderly patients who have a history of severe ocular trauma or chronic inflammation. We report an adenocarcinoma of the nonpigmented ciliary epithelium found within the phthisical globe of a 36-year-old female whose eye had been loss of vision since infancy. The mass, measured 4.0 x 4.0 cm, was relatively limited by sclera but had invasion to posterior portion. Histologically, the tumor was a compact mass which consisted of tubular and papillary structures with foci of the pleomorphic area. Strands of cells and individual cells were invested with thick basement membrane that have positivity for periodic acid-Schiff stain. Immunohistochemical staining showed strong reactivity for cytokeratin and epithelial membrane antigen, and focal for neuron-specific enolase and S-100 protein.

Warty Dyskeratoma with a Cutaneous Horn: Report of a case.: Ah Won Lee, Hyun Joo Choi, Youn Soo Lee, Seok Jin Kang, Byung Kee Kim, Sun Moo Kim; Korean J Pathol. 1998;32(8):616-618.

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Abstract: The clinical and pathological features of warty dyskeratoma are presented. Warty dyskeratoma is a rarely encountered, solitary, benign cutaneous tumor occurring most often on the head and neck and to our knowledge, no cases associated with cutaneous horn have been published in western literature. We experienced a case of warty dyskeratoma with a cutaneous horn occurring in a 70-year-old male, who had a 1.3 cm-sized and slowly growing nodule on his neck. A brief review of the literature, was made especially in relation to the pathological findings and histogenesis of warty dyskeratoma.

Histopathology and Mainz Classification of Renal Cell Tumors: A Histogenetic Study and DNA Content Analysis.: Yeong Jin Choi, Tae Kon Hwang, Youn Soo Lee, Byung Kee Kim, Sun Moo Kim, Sang In Shim; Korean J Pathol. 1998;32(7):511-520.

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Abstract: The Mainz classification for renal cell tumors was introduced in 1986 and it's utility has been reported in several histogenetic and genetic studies of renal cell tumors. We present a study of 127 cases of renal cell tumors with clinicopathologic correlation, DNA content analysis, and histogenesis studied by histochemical and immunohistochemical staining. The 127 renal cell tumors classified by the Mainz classification were 87 clear cell, 17 chromophilic, 13 chromophobe and 3 sarcomatoid renal cell carcinomas, 5 oncocytomas and 2 adenomas. These subtypes showed significant correlation not with age, sex, Robson's stage, DNA ploidy or tumor recurrence but with nuclear grade (p=0.001) and tumor size (p=0.001). Hall's colloidal iron (p=0.002) and carbonic anhydrase II (p=0.013) stains, representing the origin of distal nephron especially of collecting duct, were significantly correlated with specific subtypes of renal cell tumors, especially chromophobe cell renal carcinoma. This study demonstrates that the Mainz classification suggests several morphologically different subtypes and variants of renal cell tumors and that some of them may have originated from the distal nephron, particularly from the collecting duct.

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.

Acanthamoeba Keratitis: Microscopic and Ultrastructural Findings: A case report.: Hee Jung Lee, Yeong Jin Choi, Tae Won Hahn, Seok Jin Kang, Byung Kee Kim, Sang In Shim; Korean J Pathol. 1998;32(6):466-469.

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Abstract: Acanthamoeba keratitis is uncommon and rarely reported in Korea. It has been reported in world literature as a very severe, progressive necrotizing stromal keratitis due to a non-parasitic free-living amoeba. It is frequently associated with minimal corneal trauma especially from contact lens but sometimes occurs in patients without any past history. We report a case of acanthamoeba keratitis without a specific past history in a 42-year-old man. Light and electron microscopy demonstrated severe stromal keratitis with numerous thick-walled cysts, 10~15 m in diameter, scattered in the superficial and deep stroma. Because this keratitis is most often mistaken for fungal, bacterial or herpetic keratitis, early confirmatory diagnosis by direct smear, biopsy or culture is essentially required for the prevention of visual loss or devastating eyeball loss.

Expression of bcl-2 Protein in Gastric Adenoma and Adenocarcinoma.: Young Sill Kim, Byung Kee Kim, Sang In Shim; Korean J Pathol. 1998;32(4):248-254.

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Abstract PDF: The bcl-2 oncoprotein confers a survival advantage to cells by blocking programmed cell death. Overexpression of bcl-2 probably plays a role in tumorigenesis, and the expression of the bcl-2 protein has been investigated in many kinds of tumors. However, there have been only a few reports on expression of bcl-2 in human gastric adenocarcinoma. The aim of this study was to investigate the relationship between the expression of bcl-2 protein and several clinical and pathological parameters such as age, tumor site, size, histological type, depth of invasion, Lauren's classification, and grade. Immunohistochemical staining using monoclonal bcl-2 protein antibody, clone 124, was performed on paraffin embedded specimens from 23 gastric adenomas and from 45 gastric adenocarcinomas. The results are as follows. 1. Variable intensity of epithelial staining was noted from case to case, although the lymphocytic component showed similar intensity in all examples. The staining was located at the gland and mucous neck region of non-neoplastic epithelium. 2. The more differentiated type of gastric adenocarcinoma showed the higher expression rate and intensity. 3. The relationship between the expression rates of bcl-2 protein and tumor grade (adenoma early gastric adenocarcinoma advanced gastric adenocarcinoma) was statistically significant. The reactivity in adenoma was somewhat stronger with a uniform pattern, while in adenocarcinoma it was much weaker with a heterogenous pattern. 4. Intestinal type carcinomas by Lauren's criteria showed a higher expression rate and intensity than diffuse type. These results suggest that the bcl-2 expression would be found in the early phase of gastric tumorigenesis, and the expression rate and intensity would decrease according to the tumor progression.

Pigmented Squamous Cell Carcinoma Arising from Pigmented Actinic Keratosis.: Hyun Joo Choi, Gyeong Sin Park, Seok Jin Kang, Yeong Jin Choi, Byung Kee Kim, Sun Moo Kim, Sang In Shim; Korean J Pathol. 1998;32(1):76-79.

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Abstract PDF: Pigmented squamous cell carcinoma is a very rare malignant, pigmented, epidermal tumor. The rarity of pigmented squamous cell carcinomas may reflect in part their misdiagnosis as other pigmented neoplasms, particularly malignant melanoma. To our knowledge, only five cases have been reported in literature. We recently experienced a case of pigmented squamous cell carcinoma arising from pigmented actinic keratosis in a 77 years old female. Physical examination showed a 0.8 0.6 cm, smooth, dark brown pigmented patch with irregular but sharply defined borders located on the upper left chest. The biopsy specimen showed histologic findings of pigmented actinic keratosis with abundant melanin pigments, which became pigmented squamous cell carcinoma. Most of pigments in the squamous cell carcinoma were contained within the melanocytes along with the neoplastic squamous cells.

Paraganglioma of Cauda Equina.: Seok Jin Kang, Youn Soo Lee, Byung Kee Kim, Sang In Shim; Korean J Pathol. 1997;31(9):895-897.

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Abstract PDF: This case report describes a paraganglioma of the cauda equina in a 37-year-old man, as documented by light microscopy and immunohistochemistry. The patient experienced low back pain of 3 years duration, with the recent onset of sciatic pain and altered sensation in the right leg. Magnetic resonance imaging of L4 vertebral level revealed an ovoid, solid mass in the cauda equina. The mass was measured 1.5 cm in the greatest diameter. The histologic appearance was characterized by organoid pattern with clusters of chief cells (zellballen). Immunohistochemically, tumor cells are positive for keratin, epithelial membrane antigen, vimentin, neuron specific enolase and chromogranin.

Eccrine Squamous Syringometaplasia.: Gyeong Sin Park, Lee So Maeng, Chang Seok Kang, Seok Jin Kang, Byung Kee Kim; Korean J Pathol. 1997;31(5):489-491.

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Abstract PDF: An eccrine squamous syringometaplasia (ESS) is defined as a mature squamous metaplasia of the eccrine ducts. The clinical and pathological features of an ESS are presented. Syringometaplasia is a rare lesion, mostly occuring in the extremities, and as far as we know, no report on the ESS has been published in Korean literature. We experienced a case of an ESS occured in a 15 year-old male, who had a tender erythematous plaque in the right knee. The histologic examination revealed some scattered nests of metaplastic squamous epithelium in the deep dermis, associated with acute nonspecific panniculitis. The importance of the ESS is that it histologically simulates the well differentiated squamous cell carcinoma. The histopathologic findings were discussed and a brief review of the literature was made.

Loss of Heterozygosity Affecting the APC and p53 Tumor Suppressor Gene Loci in Colorectal Cancers and Its Prognostic Significance.: Eun Deok Chang, Won Sang Park, Byung Kee Kim, Sun Moo Kim, Sang In Shim; Korean J Pathol. 1997;31(3):191-200.

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Abstract PDF: Development of the human colorectal cancer is associated with several distinct genetic abnormalities involving both dominant-acting oncogenes (K-ras, c-src) and tumor suppressor genes (APC, DCC, p53) which undergo inactivation or loss. In colorectal tumors, the common molecular alteration is localized in the 17p13 and 5q21 loci encoding the p53 and the APC gene, respectively. The identification of these genes may help the understanding of the pathogenesis of colorectal neoplasia. In order to determine whether the frequency of the genetic alterations varies with sex, age, tumor size, or site, including pathologic parameters, such as degree of differentiation, tumor stage, mucin component, lymphoid reaction, tumor invasion pattern, vein and nerve invasion, lymph node metastasis, and other parameters, such as disease-free survival, distant metastasis and patient outcome, the authors analyzed the loss of heterozygosity (LOH) of the APC and the p53 genes in paraffin-embedded specimens of 48 colorectal cancers by use of the polymerase chain reaction and restriction fragment length polymorphism. The results were as follows: the LOH affecting the APC was found in 15 out of 31 (48.4%) heterozygous patients, while the LOH of the p53 locus was observed in 11 out of 26 (42.3%) patients. Among 48 patients, the LOH at both the APC and the p53 loci was observed in five (10.4%) patient. No statistically significant associations were found between the LOH of the APC gene and the proposed parameters. The relationship between the LOH of the p53 and the histologic differentiation, lymphoid reaction was significant (P<0.05), but survival was not correlated. Statistically significant associations were found between overall survival of the colorectal cancer patients and distant metastasis, Astler-Coller stage, lymphoid reaction, invasion pattern, nerve invasion, vein invasion, lymph node metastasis, and disease free survival. The above results suggest that the LOH of the p53 genes could be involved in the progression of colorectal cancers. However, neither the LOH of the APC nor that of the p53 have significant association with survival of the colorectal cancer patients.

Fine Needle Aspiration Cytology of Intracystic Papillary Carcinoma of the Breast.: Ah Won Lee, Yeong Jin Choi, Kyo Young Lee, Byung Kee Kim, Sun Moo Kim, Sang In Shim; Korean J Cytopathol. 1997;8(2):179-184.

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Abstract PDF: Intracystic papillary carcinoma(IPC) of the breast is a distinctive and very rare variant of intrductal carcinoma. The cytologic features of IPC have been rarely reported, and there are difficulties in distinguishing between benign and malignant papillary breast lesions. Herein we report a IPC of the breast in a 80 year-old female. Fine needle aspiration cytology revealed monotonous cuboidal epithelial cells in small clusters and individually scattered on bloody background. The tumor cells did not show overt cytologic atypia. With the histologic features of this case and review of the literature, the cytologic differential points are discussed.

Fine Needle Aspiration Cytology of Atypical Carcinoid Tumor of the Lung: 2 Cases Report .: Youn Soo Lee, Gyeong Sin Park, Young Jin Choi, Seok Jin Kang, Byung Kee Kim, Sang In Shim; Korean J Cytopathol. 1997;8(1):76-82.

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Abstract PDF: Two cases of pulmonary atypical carcinoid tumor were diagnosed by fine needle aspiration cytology. Although the cytologic features of atypical carcinoid tumor have been relatively well described, it is easy to confuse atypical carcinoid tumor with typical carcinoid tumor, small cell carcinoma and adenocarcinoma of the lung. Atypical carcinoid tumor has been recognized as a distinct variant of pulmonary neuroendocrine carcinoma, with characteristic histopathologic and clinical features that separate it from both carcinoid and small cell carcinoma. The distinction of atypical carcinoid tumor from small cell carcinoma has important prognostic and therapeutic implications. The cytologic characteristics of atypical carcinoid tumor included polygonal to fusiform cells with a variable amount of lacy cytoplasm, oval nuclei with coarsely dispersed chromatin and frequent nucleoli, and mild pleomorphism. The malignant cells were arranged either in acinus-like clusters or in epithelial sheets.

Arteriovenous Malformation of the Uterus: A case report.: Mi Seon Kwon, Seok Jin Kang, Byung Kee Kim, Sun Moo Kim, Sang In Shim; Korean J Pathol. 1996;30(10):943-946.

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Abstract PDF: Arteriovenous malformation of the uterus is rarely encountered. It is potentially lethal because of profuse, uncontrollable bleeding at the time of diagnostic dilatation and curettage. To our knowledge, only 38 cases of localized uterine arteriovenous malformation have been reported in English and Korean literature. Recently we experienced a case of uterine arteriovenous malformation in a 28-year-old multiparous woman. Under the clinical impression of uterine tumors or arteriovenous malformation, a total hysterectomy was done. Gross examination demonstrated a vascular nature of the mass in the posterior wall of the fundus. Microscopically, there was an ill-defined mass composed of numerous irregular, anastomosing large vessels with various diameters.

Eccrine Spiradenoma: Pathologic Analysis of 9 Cases.: Seok Jin Kang, Lee So Maeng, Chang Suk Kang, Byung Kee Kim, Sang In Shim, Sun Moo Kim; Korean J Pathol. 1996;30(4):301-310.

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Abstract PDF: The clinicopathology of nine cases of eccrine spiradenoma was examined. The ages of the patients ranged from 32 to 65 years, with an average age of 46 years. There were four males and five females. Eight tumors out of the nine presented on the ventral surface of the upper body. The tumors were solitary in seven cases and multiple in two cases(cases 8 and 9). Six tumors were either painful or tender to palpation. Histologically, two cases(cases 1 and 2) were adenomas with well developed tubular structures, while the remaining seven cases were epitheliomas with poor organization and prominent reticular pattern. All tumors were composed of two distinct cell types. Since four cases showed considerable edema with a lot of cystic change, it was difficult in some areas to differentiate these from other adnexal tumors or vascular tumors. Immunohistochemical staining was performed on paraffin-embedded sections of 5 eccrine spiradenomas. CEA and EMA were expressed in the cytoplasm of tumor cells in all cases. Cytokeratin was expressed in 4 out of 5 cases, and S-100 in 3 out of 5 cases. There has been no evidence of recurrence in 8 cases. In one case(case 9) the tumor recurred locally with carcinomatous transformation- characterized by the presence of solid areas of tumor which was composed of large cells with irregularly shaped nuclei and mitotic figures. There were foci of ductal differentiation, extensive areas of tumor necrosis and invasion into surrounding connective tissue. The carcinomatous portion revealed positive reaction for CEA, EMA, S-100 protein and cytokeratin.

Malignant Melanoma of the Anus: Report of a case.: Eun Sun Jung, Byung Kee Kim, Sun Moo Kim, Sang In Shim; Korean J Pathol. 1996;30(3):276-278.

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Abstract PDF: This report describes a primary malignant melanoma which developed in the anus, as documented by light microscopy and immunohistochemistry. A 53-year-old woman had a 4 month history of a protruding mass in the anal canal. The mass was located in the squamo-columnar junction of the anal canal, measuring 5.0x4.5 cm. Its cut surface was dark brown and poorly circumscribed. The histologic appearance was characterized by epithelioid or spindle cells with prominant nucleoli and frequent atypical mitosis. Melanin pigments were strongly seen in Fontana-Masson stain. Immunoreactivity revealed that the cytoplasm of tumor cells was strongly positive with antibody directed against S-100 protein, vimentin and it was focally positive with neuron specific enolase.

Cytologic Features of Renal Cell Carcinoma: Clear Cell, Granular Cell and Oncocytoma.: Yeong Jin Choi, Youn Soo Lee, Mi Seon Kwon, Kyo Young Lee, Byung Kee Kim, Sang In Shim; Korean J Cytopathol. 1996;7(1):31-37.

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Abstract PDF: It is well known that fine needle aspiration biopsy(FNAB) is very useful and has a high accuracy rate in the diagnosis of renal neoplasms. Although there is some indecision to perform the FNAB for a rare possibility of tumor seeding along the biopsy needle tract, it tends to be used increasingly. As in the cytologic diagnosis of metastatic lesion through out the body, renal cell carcinoma should nearly always be considered in the differential diagnosis, the precise understainding of cytologic features of renal cell carcinoma with various cell types and architectural patterns is necessarily required. In this report, we present three cases of primary renal cell tumors, two of renal cell carcinomas and one of oncocytoma, preponderantly emphasizing the cytologic differential points in the FNAB specimen.

Well-Differentiated Thymic Carcinoma, Spindle Cell Type, Arising from Anterior Mediastinum: A case report.: Hun Kyung Lee, Yeong Jin Choi, Seok Jin Kang, Byung Kee Kim, Sun Moo Kim, Sang In Shim; Korean J Pathol. 1995;29(6):800-803.

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Abstract PDF: Well differentiated thymic carcinoma(WDTC) was recently separated from cortical thymoma. It is characterized by a predominance of epithelial cells with usually low mitotic rate, an epidermoid differentiation with slight to moderate cytologic atypia and lobular growth pattern. In recent reports, an uncommon spindle cell variant of WDTC, which is composed of spindle shaped epithelial cells, has been described. We investigated an unusual case of WDTC consisted of purely spindle shaped epithelial cells in a 66-year-old female. Radiologically, the well demarcated mass was located in the anterior mediastinum with focal invasion into the surrounding left upper lung. The tumor, 10 x 8 x 5 cm, was encapsulated with thin fibrous tissue and showed a pale yellow solid and lobulated cut surface. Microscopically, it consisted of solid sheets of purely spindle shaped epithelial cells with mild atypism, a low mitotic rate and focal epidennoid differentiation.

Fine Needle Aspiration Cytology of Retroperitoneal Paraganglioma with an Unusual Pattern: A Case Report.: Jean A Kim, Young Shin Kim, Chang Suk Kang, An Hi Lee, Byung Kee Kim, Sang In Shim, Sun Moo Kim; Korean J Cytopathol. 1994;5(1):74-78.

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Abstract PDF: A case of retroperitoneal paraganglioma is presented with fine needle aspiration cytologic features.

Benign Teratomas of the Fallopian Tubes: A report of two cases.: Hee Na Kim, Mi Kyung Jee, Ki Hwa Yang, Seok Jin Gang, Eun Joo Seo, Byung Kee Kim, Sun Moo Kim; Korean J Pathol. 1989;23(3):374-378.

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Abstract PDF: Teratomas of the fallopian tubes are very rarely encountered in the western literature, and not a single case has been documented in Korea. The authors experienced two cases of tubal teratomas. Both patients developed a teratoma in an ampullary portion of the right fallopian tubes. One case occured as an incidental finding, and the other case was presented with a tubal mass. The gross and light microscopic features of these teratomas were described, and a brief review of the literature on the tubal teratomas is made.

Mesenchymal Chondrosarcoma Arising from Orbital Soft Tissue: A case report.: Yu Mee Kang, Mi Kyung Jee, Seok Jin Gang, Byung Kee Kim, Sun Moo Kim; Korean J Pathol. 1989;23(2):273-277.

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Abstract PDF: Orbital mesenchymal chondrosarcoma, first described by Luis et. al in 1971, is a very rare tumor of characteristic histologic features. A 21-year-woman was admitted with a 4-month histoiry of rapidly progressive proptosis and visual disturbance. Right orbital exenteration was performed under the clinical diagnosis of orbital calcifying tumor. Grossly, the tumor presented as a multibloblated, circumscribed mass that measures 5.5 cm in the greatest dimentsion. Cut sections resembled ordinary chonrosarcoma. Microscopically, the tumor was composed of undifferentiated mesenchymal cells, interspersed nodules of well differentated cartilagenous tissue, areas of gradual transition from undifferentiated mesenchymal cells to cartilage, and hemangiopericytoma-like areas. A brief summary of the histopathological aspect of this tumor and a review of literature are presented.

Pleomorphic Adenoma of the Bronchus: A case report.: Eun Sun Park, Mi Kyung Jee, Seok Jin Gang, Byung Kee Kim, Sun Moo Kim; Korean J Pathol. 1989;23(1):136-140.

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Abstract PDF: Pleomorphic adenoma presenting as primary lesion of the bronchus is very rarely encountered, and in our knowledge only 6 cases have been reported in the literature of the western world, and no case report has been published in Korea. Currently, we experienced a case of bronchial pleomorphic adenoma occuring in a 38 years old woman. On X-ray examination, hazy density in the right upper lobe and emphysematous change in the right lower lobe were noted. A right pneumonectomy was done under bronchoscopic diagnosis of bronchial adeoma. The pathologic examination of the present case showed a polypoid endobronchial tumor, 1.4 x 1.1 cm (with extraluminal portion, 2.2 x 1.7 cm) in the right upper bronchus. The microscopic examination revealed a pleomorphic adenoma showing same morphology as those found in the salivary gland. This case, therefore, was believed to be a genuine example of bronchial pleomorphic adenoma of salivary gland type. We compared this case with 6 cases in the literature.

Hibernoma: A case report.: Hee Na Kim, Mi Kyung Jee, Seok Jin Gang, Byung Kee Kim, Sun Moo Kim; Korean J Pathol. 1988;22(3):353-355.

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Abstract PDF: Hibernoma is very rarely encountered and is expressed in the various names including "lipoma of brown fat", "fetal lipoma", and "lipoma of embryonic fat". In our knowledge, only about 50 cases have been reported in the literature of the Western world, and no case reports have been published in Korea. In May 1986, we experienced a case of hibernoma occuring in a 16 old years boy. On physical examination, a relatively well defined nodule was noted on the right scapular region. A total removal of the lesion was done under the clinical diagnosis of epidermal inclusion cyst. On gross examination, the specimen consists of three irregularly shaped portions of yellowish brown soft tissue, measuring up to 0.8 cm in greatest dimension. Microscopically, the tumor showed distinct lobular pattern separated by fibrovascular bands. The lobules were composed of multivacuolated or eosinophilic granular cells showing centrally located small unclei. A brief review of the literature was done.

Clear Cell Hidradenoma: A report of five cases.: Mi Kyung Jee, Seok Jin Gang, Byung Kee Kim, Sun Moo Kim; Korean J Pathol. 1988;22(2):180-189.

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Abstract PDF: The clear hidradenoma, generally regarded as an eccrine sweat gland origin, is an uncommon tumor and occurs as a slowly growing, usually solitary nodule. The histologic patterns varies from one tumor to another and in different parts of the same tumor. The histologically variable patterns, therefore, are expressed in various names, including nodular hidradenoma, eccrine acrospiroma, squamous poroadenoma, and solid cystic hidradenoma. During the past 16 years the authors experienced 5 cases of clear cell hidradenoma which were diagnosed by the histopathological examination of the tumor mass removed by surgical excision. Clinical and pathological features were reviewed and the following results were obtained. 1) The mean age was 34 years with a range from 27 to 45 years. Three were male and two female. 2) The chiefr complaint was intradermal or subcutaneous nodules for a period of several years to 15 years. All cases occured as a solitary nodule without a distinct predilection for certain sites. A nodule which situated in the dermis and was accompanied by superficial ulceration was elevated above the skin surface in one case. 3) Grossly, the tumors were relatively well circumscribed and composed of multiloblated masses in 4 cases. They ranged in size between 1.5 and 3.5 cm. 4) Microscopically, all cases disclosed lobulated solid masses separated by varying amounts of collagenous connective tissue. There were often cystic spaces, which were lined by a single row of cuboidal cells in four cases and were bordered by tumor cells in remaining one case. These cysts contained a faintly eosinophilic homogeneous material. On solid portions of the tumor there were two types of cells (clear cell and polygonal cell), the proportions of which varied from tumor to tumor in three cases. The remaining two cases were predominantly composed of clear cells. Tubular lumina which were lined by cuboidal or columnar ductal cells were found in two cases. Areas of squamous differentiation and squamous eddies were seen in one case. Intracytolasmic PAS-positive materials were shown in all cases, but diastase-resistant PAS materials in two cases.

Occult Hepatocellular Carcinoma Metastasized to Heart: A case report.: Nam Jin Yoo, Jung Yong Lee, Seok Jin Gang, Byung Kee Kim, Sun Moo Kim; Korean J Pathol. 1986;20(3):359-361.

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Abstract: We have experienced a case of occult hepatocellular carcinoma metastasized to the heart in a 41 year old female. The hepatocellular carcinoma invaded the hepatic vein, grew in a snakelike fashion up the inferior vena cava and reached the right atrium. Ultrastural examination in this case confirmed the hepatocellular origin of the tumor.

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