- Polymerase Chain Reaction Detection of Mycobacterium tuberculosis and Fine Needle Aspiration Cytology for the Diagnosis of Tuberculous Lymphadenitis .
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Joo Heon Kim, Nam Hoon Kim, Dong Wook Kang, Mee Ja Park, Sang Kyoung Moon, Tae Cho Yu, Eun Ju Jang
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Korean J Cytopathol. 2001;12(1):25-30.
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- Tuberculous lymphadenitis is not uncommon in Korea.
Therefore, an inexpensive, safe and rapid method is needed to diagnose the tuberculous lymphadenitis. Fine needle aspiration cytology is a good method for this purpose, but has several limitations in the diagnosis of tuberculous lymphadenitis, especially when the presence of acid-fast bacilli is not proved.
To evaluate the usefulness of the polymerase chain reaction with enzyme immunoassay technique in the detection of Mycobacterium tuberculosis (M. tuberculosis) in the cervical lymph node aspirates, the authors performed fine needle aspiration cytology and M.
tuberculosis PCR with enzyme immunoassay for mycobacterial DNA sequences from 15 cases of the fine needle aspirates.
Cytomorphologically, the cases were categorized into three types: predominantly necrotic materials; typical epithelioid cell granulomas with or without giant cells and caseous necrosis; and non-tuberculous lesions, such as reactive lymphadenitis, abscess, metastatic carcinoma and malignant lymphoma. M. tuberculosis DNA was found in 8 of 15 cases by PCR with enzyme immunoassay.
Negative findings on PCR were achieved in 7 cases, which revealed non-tuberculous lymphadenopathy. In conclusion, we suggest that M. tuberculosis PCR with enzyme immunoassay using the fine needle aspirates is a very useful tool for the diagnosis of tuberculous lymphadenitis.
- The Role of MIB-1 Expression and Apoptosis in Experimental Crescentic Glomerulonephritis.
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Nam Hoon Kim, Wan Seop Kim, Jung Woo Noh, Moon Hyang Park
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Korean J Pathol. 1999;33(4):231-242.
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- It has been postulated that programmed cell death via apoptosis may be critical for remodelling of glomeruli after inflammatory injury. To understand the regulatory mechanism of apoptosis in experimental crescentic glomerulonephritis (CGN), we examined the MIB-1 score (proliferation index, PI) and apoptotic index during the progression of experimental CGN to end-stage renal failure. CGN was induced in New Zealand White rabbits by administration of guinea pig anti-GBM IgG after sensitization with guinea pig IgG and their kidneys were analyzed for the development of crescents through sequential renal biopsies. Serum creatinine levels progressively increased in a time course until day 45. The PI in glomeruli, tubular epithelial cells, and interstitium progressively increased during the progression of experimental CGN. The mean numbers of MIB-1 positive intraglomerular nuclei (PI) were significantly correlated with degrees of crescent formation and the numbers of apoptotic cells in the glomeruli, tubules, and interstitium.
Significant apoptosis was present from day 1 (15.8 10.16 cells/glomerular cross section) and increased in number with the proliferative lesions as glomerular inflammation continued. Moreover, apoptosis increased during the resolution of the glomerular inflammation, and many apoptotic cells were present in the sclerotic lesions in day 17 (18.6 12.99 cells/glomerular cross section). As glomerular inflammation subsided, cellular crescents progressed to fibrous crescents with a reduction of cellularity by day 45. On day 45, the glomerular PI and the numbers of apoptotic cells were markedly decreased. The correlations found in CGN between the creatinine level and the percentage of crescents, between the percentage of crescent and PI, and between the PI and number of apoptotic cells support the hypothesis that there is a change in the glomerular and tubulo-interstitial apoptosis under pathologic conditions. These findings indicate that apoptosis plays an essential role in the resolution of intra- and extraglomerular inflammation and in the elimination of glomerular cells within the sclerotic regions for progressive CGN. The regulation of the apoptotic phenomenon and increased PI during CGN may be important in the progression of glomerular inflammation and the development of pathologic glomerular sclerosis.
- Prognostic Significance of PCNA Index and AgNORs Score in Transitional Cell Carcinoma of the Renal Pelvis.
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Wan Seop Kim, Seung Sam Paik, Nam Hoon Kim, Moon Hyang Park, Jung Dal Lee
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Korean J Pathol. 1998;32(7):521-530.
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- Proliferative activity of a malignant tumor is known to reflect its biological aggressiveness. Proliferating cell nuclear antigen (PCNA) is a marker of cellular proliferation, and silver-stained nucleolar organizer regions (AgNORs) have been shown to correlate with ploidy and proliferative activity of cells. In transitional cell carcinoma of the renal pelvis, the prognostic value of these markers has not been well defined. We studied PCNA expression and the AgNORs count in 22 transitional cell carcinoma of the renal pelvis to assess their prognostic significance compared with their cumulative survival rate, the stage of disease and histopathologic features of the tumors. An immunohistochemical method and a standard colloidal silver staining were used. The mean percentage of PCNA positivity (PCNA index) and the mean number of AgNORs per nucleus (AgNORs score) were determined. In a multivariable analysis, PCNA indexes were significantly associated with tumor stage (p=0.024), whereas AgNORs scores were not significantly associated with the stage or histopatholgic features of the tumors. Histologic grade was correlated to disease stage at a significant level (p=0.000). But there was a trend of low tumor PCNA-indices or AgNORs counts with survival advantage for patients, but this did not reach statistical significance. The results suggest that the fraction of PCNA positive nuclei would be useful for investigating the malignant potential of renal pelvic cancers, although their clinical use as markers of biologic behavior may be limited.
- Congenital Mesoblastic Nephroma.
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Seok Hoon Jeon, Seung Sam Paik, Nam Hoon Kim, Moon Hyang Park, Jung Dal Lee
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Korean J Pathol. 1997;31(4):375-378.
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- Mesoblastic nephroma is an important differential diagnosis of a renal mass occurring in the neonatal period or in early childhood. It is a rare monomorphous congenital renal neoplasm most commonly recognized during the first 3 months of life. With the widespread application of ultrasound imaging, many cases are recognized prior to birth. We report a case of mesoblastic nephroma detected by ultrasonograph at 36 weeks of intrauterine fetal life and removed after birth.
It showed a well circumscribed, grayish white, solid mass measuring 4x3x2 cm. The tumor was predominantly a classic type with a focal cellular pattern. Immunohistochemical and electron microscopic studies were done.
- Intraabdominal Desmoplastic Small Cell Tumors with Divergent Differentiation: Report of two cases with immunohistochemical and ultrastructural studies.
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Young Ha Oh, Nam Hoon Kim, Joo Seob Keum, Moon Hyang Park
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Korean J Pathol. 1996;30(1):40-49.
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- We studied two intraabdominal desmoplastic small cell tumors. The patients were two men, 37 and 23 years old, with jaundice and palpable abdominal masses. On exploratory laparotomy, each patient revealed a huge mass in the greater omentum with disseminated peritoneal seeding, measuring 32 cm and 11 cm in its greatest dimension, respectively. The tumor involved the diaphragm, rectal shelf, and cul de sac in case 1, and it involved the porta hepatis, retroperitoneum, and serosal surface of the ascending and transverse colon in case 2. Omentectomy of the huge mass and satellite masses was performed in each patient. Both tumors showed nearly the same histopathologic features. The histologic pattern was suggestive of a metastatic small cell carcinoma, but there was no specific, single primary site.
The tumors consisted of variably sized, discrete islands of epithelial-like small cells in dense desmoplastic stroma.
The tumor cells revealed divergent epithelial, mesenchymal, and neural differentiation by histologic, immunohistochemical, and electron microscopic observations.
Only one cycle of chemotherapy including cisplatin and VP-16 was given in case 1 because of a subsequent hepatic problem, who, thereafter, showed massive intraabdominal recurrent tumors 6 months after diagnosis. In case 2, the poor condition of the patient had made chemotherapy and radiotherapy impossible. Case 2 died of disseminated intravascular coagulation following progressive cachexia 7 months after diagnosis.
- Fine Needle Aspiration Cytology of Metastatic Wilms' Tumor in the Lung: Report of Two Cases.
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Wan Seop Kim, Nam Hoon Kim, Young Hyeh Koh, Moon Hyang Park, Jung Dal Lee
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Korean J Cytopathol. 1996;7(2):218-224.
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- We describe two cases of metastatic Wilms' tumor in the lung with emphasis on the cytologic features of specimens obtained by needle aspiration. One of them was extrarenal Wilms' tumor. The findings were correlated with the histopathologic fea- tures of the primary lesion. Cellular components in the fine needle aspiration cytology (FNAC) slides included blastemal, epithelial, stromal and inflammatory cells with immature tubular differentiation and rosette formation. Recognition of these cellular components in FNAC smears help in establishing FNAC diagnosis of Wilms' tumor. The blastemal cells were represented by small to medium sized cells with scanty cytoplasm having ill-defined borders and round to slightly oval nuclei with evenly dispersed chromatin and small marginated nucleoli. They were seen in our two cases. The differential diagnosis includes neuroblastoma, malignant lymphoma, malignant rhabdoid tumor, clear cell sarcoma, Ewing's sarcoma and embryonal rhabdo-myosarcoma. In conclusion, making a definite cytologic diagnosis of metastatic Wilms' tumor may be possible by light and electron microscopy and immunohi-stochemical staining. The above findings may contribute to the diagnosis of FNAC of metastatic Wilms' tumor.
- Correlation between Tumor Angiogenesis and Metastasis in Invasive Breast Carcinoma.
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Nam Hoon Kim, Moon Hyang Park
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Korean J Pathol. 1995;29(6):740-745.
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- Tumor angiogenesis(TA) refers to the growth of new vessels toward and within a tumor. TA is necessary both at the beginning and at the end of the metastatic cascade of events. Recently, experimental evidence suggests that the growth of a tumor beyond a certain size requires angiogenesis. To investigate how tumor angiogenesis correlates with metastases in breast carcinoma, the microvessels were counted (per 200 / field) in the most active areas of neovas-cularization by two investigators.
The microvessels within breast carcinoma were highlighted by in imunohistochemical staining for factor VIII-related antigen. Microvessel count(MVC) in node-positive carcinoma(59.66=35) was significantly higher than in node-negative carcinoma(44.76=17)(p=0.009). MVC was also statistically correlated with tumor size and stage, but not with histologic grading, DNA ploidy, or hormonal receptors(estro-gen and progesterone). MVC in invasive breast carcinoma may be one of many prognostic predictors of node-positive breast carcinoma. Assessment of tumor angiogenesis may therefore be valuable in selecting patients with early breast carcinoma for aggressive therapy.
- Cholesteatoma of the Renal Pelvis: A case report.
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Nam Hoon Kim, Young Chun Moon, Moon Hyang Park
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Korean J Pathol. 1995;29(5):691-693.
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- Cholesteatoma in the kidney and ureter are accumulations of waxy, gray flakes of keratin materials, secondary to squamous metaplasia of the transitional epithelium. Herein, we describe a case of cholesteatoma in the renal pelvis of a 69-year-old woman, and give a brief review of the literature. In the upper pole of the left kidney was a 6 cm cystic lesion filled with a thick, flaky, grayish, comified material. Microscopically, the cystic area showed calyceal and pelvic structures being replaced by keratinizing stratified squamous epithelium. The surrounding renal parenchyma was atrophic with features of chronic pyelonephritis.
- Fibrous Pseudotumor of the Testicular Tunics: Two case reports.
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Seung Sam Paik, Nam Hoon Kim, Young Hyeh Ko, Moon Hyang Park
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Korean J Pathol. 1995;29(4):533-535.
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- Fibrous pseudotumor of the testicular tunics is a rare benign fibrous proliferative disorder, but it is the second most common mass-forining lesion of the testicular tunics.
While these lesions are not strict neoplasms, they do form nodules and are often mistaken for neoplasms. Herein, we report 2 cases of fibrous pseudotumor with characteristic histologic findings. Both cases had been incidentally found as slow growing scrotal masses and underwent excision. There were several nodules along the testicular tunics which had bulging whitish-gray cut surface with focal myxoid change and a whorling appearance. These two cases showed the histologic spectrum seen in fibrous pseudotumor from a haphazard arrangement of fibroblastic type cells with intervening collagen and focal lymphocytic infiltrates in case 1, to a densely collagenized lesion in case 2.
- Fetal Rhabdomyomatous Nephroblastoma: A case report.
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Nam Hoon Kim, Chan Pil Park, Eun Kyung Hong, Poong Man Jung, Moon Hyang Park
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Korean J Pathol. 1995;29(1):96-102.
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- A fetal rhabdomyomatous nephroblastoma is considered to be a predominantly monophasic mesenchymal variant of Wilms' tumor, which acts less aggressively than a conventional Wilms' tumor despite its much larger size. Bilaterality of this tumor in a nine month-old girl, however, may negatively affect the overall prognosis. A radical nephrectomy for bulky masses in the left kidney and a partial nephrectomy for right kidney with five small tumor masses was performed at the same time. Two small tumor masses in the upper part of right kidney were left behind because of preserving minimal renal functional capacity. Pathological study revealed a mixed type of nephroblastoma which was composed predominantly of mesenchymal components with fetal rhabdomyomatous differentiation. After post-operative chemotherapy with vincristine, actinomycin D and adriamycin, and radiotherapy(2,130 rad), residual tumor masses became a single tumor 5 cm in diameter and well demarcated, which was resected at 15 months after first operation when the size and renal function of remained right kidney was appropriate to resect out the residual tumor. The tumor resected out at second operation was entirely composed of scattered differentiated fetal skeletal muscle cells in the fibrovascular tissue. Only a few entrapped epithelial components were seen but no blastemal cornponents were present. Follow up abdominal CT and ultrasonographic examinations revealed no evidence of tumor recurrence. The girl has developed normally without disease.
- Cytologic Features of Malignant Lymphoma of the Uterine Cervix: A case report.
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Nam Hoon Kim, Chan Kum Park, Young Hyeh Ko, Moon Hyang Park, Jung Dal Lee
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Korean J Cytopathol. 1995;6(1):76-79.
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- The uterine cervix is an uncommon site of primary non-Hodgkin's lymphoma (NHL). Although the cytologic findings of NHLs are well known, most cervicovaginal smear of uterine NHLs give lower diagnostic yield than common epithelial malignancy because abnormal cells do not appear in the sample in the absence of surface ulceration. Herein, we describe cytologic findings of a case of uterine cervical NHL which was initially diagnosed by cervicovaginal smear.
The tumor cells were relatively uniform, isolated, large-sized with scanty cytoplasm and round or indented nuclei. The nuclei had stippled chromatin and small nucleoli. Histologically and immunohistochemically the tumor was proven to be large cell lymphoma of T-cell lineage.
- Glycogen-Rich Clear Cell Carcinoma of Breast: A case report.
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Nam Hoon Kim, Wan Seop Kim, Young Hyeh Ko, Jung Dal Lee
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Korean J Pathol. 1994;28(3):316-318.
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- Glycogen-rich clear cell carcinoma of the breast is very rare(l -3% of breast cancer). It is defined as a tumor composed of more than 50% of optically clear, neoplastic cells, characterized by centrally located nuclei and abundant cytoplasm, being positive for periodic acid Schiff(PAS) and negative for periodic acid Schiff after diastase(D-PAS) treatment. In the absence of intraductal or in situ lobular carcinoma component, metastatic clear cell carcinomas of other organs should be considered as diagnostic possibilities. We report a case of glycogen-rich clear cell carcinoma arisen in a 62-year-old woman. The tumor revealed both solid and papillary pattern with intraductal component. The neoplastic cells had clear cytoplasm, which were PAS positive, D-PAS negative, mucicarmine negative and oil red 0 negative. More than 90% of tumor cells exhibited moderate staining for anti-estrogen receptor monoclonal antibody. Flow cytometric DNA analysis revealed diploid DNA content.
- Limb-Body Wall Malformation Complex: Two autopsy cases and its pathogenesis.
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Geun Shin Lyu, Nam Hoon Kim, Eun Kyung Hong, Jung Dal Lee
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Korean J Pathol. 1993;27(6):638-644.
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- Limb-body wall malformation complex(LBWC), also know as the amniotic band syndrome, is a poorly defined, sporadic group of congenital anomaly characterized by a collection of protean fetal malformation, deformation and disruption.
Accurate diagnosis is often difficult because of its variable presentation pattern and the absence of exactly same case. We report two autopsy cases. One revealed body wall, cardiac, and craniofacial anomalies with anencephaly, and amniotic adhesive band attached to craniofacial defect of the fetal part without evidence of amniotic rupture. The other exibited abdominal wall defect with omphalocele, visceral, postural, and limb anomalies together with neural tube defect in the lumbosacral region. The pathogenesis of this syndrome was discussed in detail.
- Incidental Glomus Coccygeum Associated with Coccygeal Dimple.
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Chan Kum Park, Eun Kyung Hong, Nam Hoon Kim
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Korean J Pathol. 1993;27(2):198-199.
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- The glomus coccygeum is a glomus body located close to the tip of the coccyx. Because of its large size and multiple anastomotic channels, it mimics glomus tumor. It is very unfamiliar to the pathologits. We describe a case of glomus coccygeum incidentally found associated with coccygeal dimple from 5-month-old infant.
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