- Analysis of Estrogen and Progesterone Receptors in Breast Carcinoma: Comparison of immunocytochemical assay with biochemical dextran-coated charcoal assay.
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Ill Hyang Ko, Kyeong Mee Park
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Korean J Pathol. 1996;30(3):228-237.
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- Estrogen receptor(ER) is a soluble form of hormone receptor protein which is located in the nucleus and cytoplasm of a cell is found in 60% of cases of the cells of breast carcinoma. Fifty to sixty percent of ER positive breast carcinoma responds to antihormone therapy wheres the response rate is only 5% in ER negative tumors. Currently, the ER assay has become a standard index in the management and prediction of the prognosis of advanced breast carcinoma. Semiquantitative biochemical assay, dextran-coated charcol(DCC) assay, to measure ER from fresh tissue was first developed by Korenman in 1970 using isotope-labled ertradiol, has been widely utilized. In 1978, Kurzon newly developed immunocytochemical assay(ICA) employing monoclonal antibody against those hormone receptors to detect intracellular localization of ER and progesterone receptor (PR). The results of the assay have been reported by many investigators thereafter. The purpose of this study was to evaluate the hormonal receptors with a monoclonal antibody using an immunoperoxidase procedure to detect both estrogen and progesterone receptors (ER-immunocytochemical assay:ER-ICA and PR-immunocytochemical assay:PR-ICA) in 59 cases of paraffin embedded sections from formalin-fixed and routinely processed breast carcinoma tissue. Concomitantly, fine-needle aspiration biopsy cytology of the breast cancer from 29 women were assayed for ER/PR receptors. Results were compared with quantitative biochemical values determined from dextran-coated charcoal(DCC) assay on the fresh tumor tissue obtained subsequently from the surgery. ER-ICA showed positive result in 22 out of 36 DCC-positive cases(sensitivity, 61.1%) and negative in 23 out of 23 DCC-negative cases (specificity, 100.0%). PR-ICA was positive in 33 out of 35 DCC-positive cases(sensitivity, 94.3%) and negative in 16 out of 24 DCC-negative cases(specificity, 66.7%). The value of ER-ICA or PR-ICA positivity were roughly correlated with the concentration of ER/PR receptors analyzed by DCC method. The results of both methods were correlated with the nuclear grade of the tumor(ICA:p=0.002, DCC: p=0.015) but were not correlated with histologic grade(ICA: p=0.323, DCC: p=0.0164). ER-ICA positivity was correlated with lower incidence of axillary node metastasis (p=0.021) but no significant correlation between PR-ICA positivity and node metastasis(p=0.171). Both ER/PR-ICA positivity were not correlated with age(p=0.924) and tumor size(p=0.663). The score of ICA particularly ER was proportional to DCC level(ER: r=0.5, p=0.000, PR: r=0.2, p=0.000). ICA concordance with DCC of ER and PR were 76.3% and 83.1%, respectively. The concordance of PR-ICA and DCC was proportional but was statistically less significant. In aspiration biopsy cytology the concordance of ER/PR-ICA and DCC were 72.4% and 65.5%, respectively. Immunocytochemical staining to identify ER/PR receptors from the tissue of breast carcinoma would be tested as a mean to substitute for the conventional DCC method.
- Diagnostic Accuracy of Fine Needle Aspiration Cytology in Thyroid Lesions: Analysis of Histologically Confirmed 153 Cases.
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Kyeong Mee Park, Ill Hyang Ko
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Korean J Cytopathol. 1996;7(2):122-133.
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- This is a retrospective review of fine-needle aspiration cytology(FNAC) smears of 153 cases of thyroid disease performed during August 1989 to July 1995, which were confirmed histologically following surgical operations. FNAC results showed 63 cases(41.2%) of adenomatous goiter, 45 cases(29.4%) of papillary carcinoma, 29 cases(19.0%) of follicular neoplasm, 4 cases(2.6%) of follicular variant of papillary carcinoma, 4 cases(2.6%) of Hashimoto's thyroiditis, 4 cases(2.6%) of Hurthle cell neoplasm, 2 cases(1.3%) of medullary carcinoma and one case(O.7%) each of subacute thyroiditis and of anaplastic carcinoma. The overall accuracy of cytological diagnosis was 83.7%. These data strongly suggest thyroid FNAC is a reliable preoperative diagnostic tool, but FNAC has been less valuable in the diagnosis of follicular lesions than any other disease of the thyroid. Adenomatous goiter was not infrequently interpreted as follicular neoplasia that requires surgery for diagnostic .conformation and vice versa. The following findings are considered to be compatible with follicular neoplasm: 1) microfolticles, 2) nuclear grooving, 3) irregularity of nuclear membrane, and 4) irregular arrangement or crowding of follicular cells in groups. The FNAC criteria of adenomatous goiter are as follows: 1) atrophic follicular cells, 2) presence of macrophages, 3) abundant colloid, and 4) large follicles. It is recommended that aspiration of thyroid lesions in order to analyse with critical clinico pathological approach and surgery is considered only for nodules that are clinically suspicious or unresponsive to hormone therapy or when a diagnosis of follicular neoplasm is made.
- Fine Needle Aspiration Cytology of Metastatic Cell Carcinoma of Lymph Nodes: Comparison to Non-Hodgkin's Lymphoma on 5 Cases.
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Yeon Mee Kim, Hye Je Cho, Ill Hyang Ko
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Korean J Cytopathol. 1996;7(1):44-50.
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- Small cell carcinoma of the lung is characterized by cells with finely stippled chromatin and scanty cytoplasm as well as a particularly aggressive clinical course and favorable response to the chemotherapy. Recently percutaneous fine needle aspiration(FNA) biopsy has become both widely established and highly respected for the diagnosis of lung cancer. However metastatic small cell carcinoma of lymph node should be cytologically differentiated from the small round cell tumor of particular sites, especially malignant lymphoma, because small cell carcinoma of classic oat cell type may simulate small cell non-Hodgkin's lymphoma. We report five cases of metastatic small cell carcinoma of intermediate cell type diagnosed by FNA of the enlarged lymph nodes of the neck and axilla. The cytologic smears contained diffuse small neoplastic cells larger than lymphocytes with dense, pyknotic nuclei and extremely scanty cytoplasm. Apparently viable large tumor cells have vesicular nuclei with granular, sometimes very coarse chromatin. The characteristic cytologic features of small cell carcinoma as compared to malignant lymphoma were as follows.: 1) small cells with dense pyknotic nuclei are evenly distributed in the background of apparently viable larger tumor cells, admixed with mature lymphocytes and phagocytic macrophages. 2) small loose aggregates of cells with nuclear molding are indicative of small cell carcinoma rather than non-Hodgkin's lymphoma. 3) the cytoplasmic and nuclear fragments of tumor necrosis are more dominant in the smears of small cell carcinoma. 4) nuclear membrane and nucleoli are generally indistinct in small cell carcinoma due to condensation of chromatin.
- Primary Atypical Carcinoid Tumor of Liver: A case report.
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Won Ae Lee, Hong Yong Kim, Ill Hyang Ko
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Korean J Pathol. 1995;29(6):807-810.
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- Primary hepatic carcinoid tumors are extremely rare although the liver is a frequent site of metastases from intestinal carcinoids. Recently we investigated a case of primary hepatic atypical carcinoid in a 47-year-old man who had infested with Clonorchis sinensis for 20 years. The resected right lobe of the liver was almost completely occupied by a huge tumor, measuring 20 x 19 x 12 cm. The cut surfaces of the mass were solid, soft and pale yellow, accompanied by several small satellite nodules, measuring up to 1.5 cm in diameter. Microscopically, the tumor consisted of polygonal to columnar cells with eosinophilic granular cytoplasm forming Lym-numerous small acini and large trabeculae. Their nuclei were round to polygonal with coarse stone chromatin, had obscure to small nucleoli and frequent mitoses. There were multiple necrotic foci of varing sizes. The surrounding dilated bile ducts contained several degenerating worms on in of Clonorchis sinensis. The tumor cells were argyrophil-positive but argentaffin-negative.
Immunohistochemically, the tumor cells were positive for cytokeratin, chromogranin and somatostatin but were negative for CEA, AFP, insulin, glucagon, ACTH, growth hormone and volve-prolactin. Ultrastructually, the tumor cells contained variable-sized numerous electron dense of neurosecretory granules.
- Fine Needle Aspiration Cytology of Parasitic Infestation in Soft Tissue.
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Kyeong Mee Park, Ill Hyang Ko
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Korean J Cytopathol. 1995;6(1):36-40.
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- In the past, parasitic diseases were a major problem in public health in Korea. In recent years, however, nematodiasis that used be prevalent are no longer a serious problem. Instead some cestodiasis, particularly cysticercosis and sparganosis have become comparatively more important in recent years. Parasitic infestation of soft tissue is presented as a subcutaneous nodule or mass with nonspecific clinical manifestations.
- Histopathologic Study of Primary Gastrointestinal Lymphoma: Gross and immunohistochemical analysis of 30 cases.
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Hye Jae Cho, Jeong Eun Joo, Ill Hyang Ko
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Korean J Pathol. 1994;28(2):118-125.
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- A histopathologic study including iramunohistochemical stains was made in 30 patients who were presented with gastrointestinal lymphoma. The occurrence was 13 in the stomach, 8 in the ileocecum, 7 in the small intestine and 2 in the colon. The disease more frequently affected males than females and the average ages were 53 years in the patients of gastric lymphoma and 44 years in the patients of intestinal lymphoma. Gastric lymphomas were usually presented with a single lesion, and the antrum and/or body were the most common sites. But intestinal lymphomas were presented with a single or multiple lesion, and the ileocecum was the most common site. The most common gross type of gastrointestinal lymphomas was the ulceroinfiltrating type and most are of the diffuse large noncleaved cell type of B-cell lymphoma, histologically.
There were 2 cases of T-cell lymphoma presented in the intestine as the superficially ulcerative gross pattern and diffuse immunoblastic cell type. The distinct MALToma was seen in only one case of stomach but the feature was partially remained in each two cases of stomach and intestine. Their coexistent findings may suggest that diffuse large of immunoblastic component arises through blastic transformation of the low-grade M ALToma component.
- Signet Ring Cell Carcinoma of Stomach in Child: Report of a case.
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Kyeong Mee Park, Ill Hyang Ko
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Korean J Pathol. 1994;28(1):102-105.
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- Cancer of the alimentary tract in children is an extremely rare occurence, and it accounts for no more than 5% of all pediatric neoplasms. Malignant neoplasms of the stomach are particularly uncommon in childhood. The majority of such lesions are malignant lymphomas or soft tissue sarcomas, with less than 5% identified as carcinomas. We report a case of signet ring cell carcinoma of stomach in 15-year-old girl. This patient had a clinical manifestation of cough with sputum, fever, abdominal distension due to ascites, hepatomegaly, and cervical lymphadenopathy for 40 days.
There was no known gastrointestinal symptoms. Metastatic signet ring cell carcinoma was suspected by aspiration biopsy cytology of cervical lymph node, and confirmed later by excisional biopsy. Endoscopy confirmed a small mucosal erosion in the anterior wall of the antrum and histopathology confirmed the diagnosis of signet ring cell carcinoma.
- Fine Needle Aspiration Cytologic Findings of Kikuchi's Lymphadenitis: Analysis of 30 cases.
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Hyun Ju Yoo, Hye Je Cho, Ill Hyang Ko
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Korean J Cytopathol. 1994;5(2):113-119.
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- Thirty cases of kikuchi's lymphadenitis, diagnosed by fine needle aspiration cytology, were reviewed to determine the main cytologic features helpful in reaching a diagnosis. The patients(mean age 26.6 years. male: female=1:3.8) presented with lymphadenopathy(cervical 24, submandibular 3, and axillary 1) with or without fever and local tenderness.
Excisional biopsy was done for confirmation in 5 cases and the remaining 25 cases showed the similar cytologic and clinical features. In the aspiration smears of all cases.
there was a heterogenous cellular mixture including frequent extracellular karyorrhectic nuclear debris, phagocytic histiocytes, plasmacy toid monocytes, and a variable number of polymorphous lymphocytes such as immunoblasts. activated large lymphocytes, and small mature lymphocytes, The characteristic cytologic features of kikuchi's lymphadenitis were the following: (1) frequent extracelluar karyorrhectic nuclear debris in the background: (2) phagocytic histiocytes with eccentrically placed crescentic nuclei and abundant pale cytoplasm containing phagocytized karyorrhectic debris: (3) plasmacytoid monocytes, which were medium-sized cells with eccentrically placed round nuclei and amphophilic cytoplasm: (4) no neutrophilic background.
- Urine Cytology of Renal Cell Carcinoma: Analysis of 11 cases.
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Yi Kyeong Chun, Hye Jae Cho, Ill Hyang Ko
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Korean J Cytopathol. 1994;5(2):137-142.
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- Urine cytology is of limited value in the diagnosis of renal cell carcinoma with reported detection rates of 0~80%. The aim of this study is to demonstrate the usefulness of urine cytology in renal cell carcinoma, In the eleven histologically proven cases of renal cell carcinoma, urinary smears were reevaluated. The cytologic results were as follows; positive for malignant cells in 3 cases (27%), suspicious in 2 cases (18%) and negative in 6 cases (55%).
The average diameter of the tumor of the 5 cases reported as positive or suspicious for malignant cells was 9.7cm and 3 had invaded the renal pelvis. The other 6 tumors, reported as negative, were 5.7cm in average diameter and one of them showed involvement of the renal pelvis. These results suggest that urine cytology is considered unsatisfactory in the early detection of renal cell carcinoma. However.
careful examination of urinary smear could improye the detection rate especially in more advanced cases involving the renal pelvis as well as those of larger tumors.
- Fine Needle Aspiration Cytology of Medullary Carcinoma of the Breast: A Case Report.
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Yi Kyeong Chun, Ill Hyang Ko
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Korean J Cytopathol. 1994;5(1):57-60.
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- Medullary carcinoma(MC) of the breast is an uncommon histologic form of infiltrating ductal carcinoma and the cytologic features of MC are not well delineated.
- Duodenal Somatostatinoma: A case report.
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Mee Hye Oh, Yi Kyeong Chun, Hye Jae Cho, Jin Ho Lee, Hong Yong Kim, Ill Hyang Ko
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Korean J Pathol. 1993;27(6):645-649.
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- Somatostatinoma is rare endocrine tumor that was first described in 1977 by Ganda et al. and Larsson et al.
simultaneously. It seems nonfunctioning at clinical level.
But it may present with diabetes, diarrhea, cholelithiasis, steatorrhea, indigestion, hypochlorhydria, and anemia. In contrast with pancreatic somatostatinoma, duodenal somatostatinoma, in general, is clinically silent. Duodenal endocrine tumors show similar histologic pattern. Therefore, the definite diagnosis is performed by immunohistochemistry and electron microscopic examination. We have experienced a case of somatostatinoma of duodenum in a 62-year-old male.
He has complained generalized pruritus for one year and jaundice for 2 weeks. Grossly, the mass was a intraluminary protruding, polypoid lesion with focal mucosal erosion at immediately distal to Ampulla of Vater. Histologically, it showed tall, cylindrical cells with distinct cell membranes, having granular cytoplasm and small innocent looking nuclei.
No mitosis was seen. The tumor cells were arraged in small solid groups and trabeculae, separated by fibrovascular stroma. Immunohistochemically, the tumor cells were strongly positive with somatostatin and negative with several other hormonal and neuroendocrine markers. Ultrastructurally, the cytoplasm contains numerous, homogeneous low electron dense secretory granules, which are essentially similar to those seen in normal delta cells.
- Immunohistochemical Study of Gastrointestinal Stromal Tumors.
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Jung Weon Shim, Hye Jae Cho, Ill Hyang Ko, Ok Kyung Kim
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Korean J Pathol. 1991;25(2):93-103.
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- Historically, gastrointestinal stroma tumors (GIST) have been considered as smooth muscle tumors, but the controversy over this histogenesis is provoked due to various results with utilizing immunohistochemical methods. In andeffort to further clarify the histogenesis of GIST, we performed the immunohistochemical study, as well as histopathologic reexamination, of 24 cases, all diagnosed as smooth muscle tumors of gastrointestinal tract, from Seoul Paik Hospital and Ewha University Hospital between 1980 and 1989, and the main results were as follows; 1) In the histopathologic features by light microscopic study, 11 benign and 13 malignant lesions (including one high grade malignancy and 12 low-grade malignant lesions) were disclosed. 2) In the immunohistochemical study, all tumors showed Vimentin positivity (100%), but no tumor showed S-100 protein positivity (0%), and 7 cases (29.1%) showed Desmin positivity. Positive reaction for Desmin made it possible to suggest that the histogenesis of GIST be in smooth muscle, and neurogenic origin would be excluded by all negativity for S-100 protein. In summary, we would like to conclude that GIST would be smooth muscle tumors on account of their morphological characteristics and their intramural location, but most of them appear poorly differentiated by immunohistochemical method.
- Sebaceous Carcinoma of the Eye Lid.
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Hye Kyung Ahn, Gui Ok Yoon, Ill Hyang Ko
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Korean J Pathol. 1989;23(3):387-391.
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- Sebaceous carcinoma is uncommon and usually presents in the ocular adnexa as a cancer of the meibomian glands. They are frequently mistaken for chalazion. Considerable time often elapses before a diagnosis is made. We present a case of sebaceous carcinoma of the left eye lid in 59 year old female who had a history of 3 repeated surgical resections clinically diagnosed as chalazion during last 3 years.
- Three Cases of Giant Lymph Node Hyperplasia in Unusual Location.
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Hye Kyung An, Ill Hyang Ko
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Korean J Pathol. 1989;23(3):365-370.
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- Giant lymph node hyperplasia (Castleman's disease) was first described by Castleman and associates. In the first accounts of giant lymph node hyperplasia, the lesions were described as solitary and localized to the mediastinum. Recently, we have experienced three cases of Castleman's disease, first of which is a 54 year old male with plasma cell type in the mesentery, second is 27 year old femal with hyaline vascular type in the inguinal region and third is a 29 year old female with hyaline vascular tye in neck.
- Carcinomatous Meningitis as the Initial Manifestation of Primary Stomach Cancer.
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Gui Ohk Yoon, Ill Hyang Ko
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Korean J Pathol. 1988;22(2):208-210.
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- Meningeal carcinomatosis as the initial clinical manifestation of a tumor is a very rare event and difficult to make diagnosis. Lumbar puncture is a single and useful diagnostic method, and meticulous cytologic study of cerebrospinal fluid specimen is needed for correct diagnosis. A case of meningeal carcinomatosis diagnosed by cytologic study of CSF and later confirmed primary carcinoma of the stomach by, fiberscopic biopsy is briefly presented.
Meningeal signs and symptoms were the primary clinical manifestation in case.
- Extraskeletal Ewing's Sarcoma.
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Gui Ohk Yoon, Hae Kyung Ahn, Ill Hyang Ko
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Korean J Pathol. 1988;22(2):195-198.
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- A case of extrastkeletal Ewing's sarcoma on lower extremity in a 60-year-old male is reported. Extraskeletal Ewing's sarcoma is a rare malignant neoplasm that shows similar histologic and ultrastructural features to Ewing's sarcoma of bone. Histologically, the neoplasm was composed of small, round to oval cells with scant cytoplasm that were arranged in sheets with large area of necrosis. Electron microscopy of the neoplastic cells revaled scant cytopasm containing glycogen rosettes and a paucity of organelles. There is no ultrastructural evidence to indicate the origin of the cells.
- Lipoblastomatosis: A case with evidence of maturation.
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Je G Chi, Hyung Geun Song, Ill Hyang Ko, Hye Che Cho
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Korean J Pathol. 1987;21(1):57-61.
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- A case of lipoblastomatosis occuring in a 1 year and 10 month old boy is described. The tumor was first presented in the left foot at his age of 4 month, and was surgically removed. The tumor was grossly infiltrating skeletal muscle tissue, and was microscopically composed of lobulated fat tissue with prominent myxoid stroma and many immature mesenchymal cells and scattered multivacuolated lipoblasts.
The tumor recurred 11/2 years later and was again removed.
The tumor was equally lobulated and located inbetween skeletal muscle. However, this time lobulated tumor consisted almost entirely of mature fat tissue with scattered lipoblasts.
- Sclerosing Hemangioma of the Lung: A report of 2 cases.
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Sung Ran Hong, Hye Jae Cho, In Ki Paik, Ill Hyang Ko, Dong Soon Kim, Je G Chi, Eui Keun Ham
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Korean J Pathol. 1986;20(1):84-90.
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- Sclerosing hemangioma of the lung is uncommon benign neoplasm of uncertain histogenesis, although their radiological appearance is relatively distinct and well-defined. Recently, we experienced 2 cases of sclerosing hemangiomas of the lungs in 61 and 39 years old women. The light microscopic findings of the tissues are similar to the features reported by Liebow and Hubbell(1956). The basic cellular response is thought to be type II pneumonocytes because of findings of multilamellar-like bodies within stromal cells with electron microscopy in case I in addition to other characteristics generally found in epithelial cells.
- Malignant Transformation in Cystic Teratoma of Ovary: 4 cases report.
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Seong Sook Kim, Ae Lan Paik, Hye Je Cho, In Ki Paik, Ill Hyang Ko
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Korean J Cytopathol. 1985;19(2):214-219.
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- Development of a malignant tumor within a mature cystic teratoma is a serious event, and occurs in about 1%~4% of cases. The malignant transformation occurs most frequently in the squamous epithelium with the formation of a squamous cell carcinoma. There are 10 cases reported in the literature, in Korea. We report 4 additional cases, which include 3 squamous cell carcinomas and 1 adenosquamous carcinomas, arising in cystic teratoma of the ovary.
- Adenocarcinoma Arising in benign Teratoma of Mediastinum: A case report.
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Seong Sook Kim, Sung Ran Hong, In Ki Paik, Ill Hyang Ko
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Korean J Cytopathol. 1985;19(2):238-243.
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- Although the mediastinum is the second favorite location of primary teratoma in adults, primary malignant teratoma in mediastinum is rare in incidence. Malignant teratoma includes teratocarcinoma, immature teratoma and malignant transformation in benign teratoma. The latter is rarer than others types, and undifferentiated or squamous cell carcinoma are the major incidence. We experience a case of unique adenocarcinoma composed of signet ring cells in mature teratoma of mediastinum and brief review of the literatures are included.
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