- Expression of Anaphase Promoting Complex (APC) and APC Regulatory Proteins in Invasive Ductal Carcinoma Associated with Paget's Disease.
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Kwang Hwa Park, Sang Yeop Yi, Woo Ick Yang, Yup Kang, Kwang Gil Lee
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Korean J Pathol. 2004;38(5):319-323.
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- BACKGROUND
Oncogene expression in Paget's disease of the breast is not well known. To characterize invasive ductal carcinoma associated with Paget's disease, we studied expression of anaphase promoting complex (APC) with its regulatory proteins.
METHODS
Immunohistochemical stainings were done with 10 cases of invasive ductal carcinoma associated with Paget's disease for APC, pituitary tumor transforming gene (PTTG), cyclin B1, p53, cyclin D1, and c-erbB-2. The expressions of these markers in Paget's disease were compared with those in the associated with carcinoma.
RESULTS
APC, PTTG, cyclin B1, and c-erbB-2 were positive in all of the cases with both Paget's disease and underlying carcinoma. p53 was expressed in Paget's disease of 6 cases (60%) and in carcinoma of 7 cases (70%). Cyclin D1 was positive in Paget's disease of 8 cases (80%) and in carcinoma of 9 cases (90%).
CONCLUSIONS
Breast carcinomas with Paget's disease seem to be distinguished by the high expression of APC, cyclin B1, PTTG, c-erbB2, and cyclin D1 in contrast to breast cancers without Paget's disease. Furthermore, the similar expression patterns of APC and APC regulatory proteins in both Paget's disease and underlying breast cancer support the epidermotropic theory as its pathogenetic mechanism.
- Cytologic Features of Secretory Meningioma in Squash Preparation: A Case Report.
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Se Hoon Kim, Kwang Gil Lee, Tai Seung Kim
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Korean J Cytopathol. 2004;15(1):52-55.
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- Secretory meningioma is a distinct subtype of meningioma. We describe the cytologic features of a secretory meningioma on squash preparations, in comparision with other cytologic mimickers. A 54-year-old woman presented with hearing loss, vertigo, tinnitus, and headache for seven years. A brain MRI study revealed a 4.5 cm sized mass in the cerebellopontine angle, which showed homogenous signal intensity in T2-weighted image. The intraoperative squash smear showed some well-defined, thin rimmed intracytoplasmic inclusions, containing a finely granular eosinophilic core among less cohesive meningiomatous cells. Histologic sections revealed a meningothelial meningioma with scattered inclusions, with periodic acid-Schiff, carcinoembryonic antigen, and cytokeratin positivity. Identification of characteristic intracytoplasmic inclusions is helpful for diagnosing secretory meningiomas. On squash preparations, differential diagnoses included tumors with inclusions or cytoplasmic vacuolizations, such as metastatic mammary infiltrating ductal carcinoma, gastric adenocarcinoma, hepatocellular carcinoma, and clear cell ependymoma, oligodendroglioma, hemangioblastoma, chordoma, and other variants of meningiomas (clear cell, xanthomatous, microcytic, and chordoid variants). In addition, the possibilities of glioma with eosinophilic granular body, and metastatic tumors from mammary infiltrating ductal carcinoma, gastric adenocarcinoma, and hepatocellular carcinoma in meningioma should be considered.
- Macrofollicular Variant of Papillary Thyroid Carcinoma with Extensive Hemorrhage.
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Haeryoung Kim, SoonWon Hong, Kwang Gil Lee, Eun Kyung Kim, Cheong Soo Park, Woung Youn Chung, Woo Ick Yang
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Korean J Cytopathol. 2004;15(1):60-64.
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Abstract
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- BACKGROUND
The macrofollicular variant of papillary thyroid carcinoma (MVPC) is characterized by macrofollicles occupying more than half of the tumor and demonstrating nuclear features of classic papillary carcinoma. It is difficult to recognize on fine needle aspiration (FNA) cytology due to the paucity of aspirated neoplastic cell clusters, especially when the tumor is associated with extensive areas of hemorrhage.
CASE
A 34-year-old female presented with a well-demarcated nodule in the thyroid gland, diagnosed as a benign nodule on ultrasonography and computed tomography. FNA cytology smear revealed a few small aggregates of follicular cells with morphological features suspicious for papillary carcinoma, set in a background of hemorrhage, inflammatory cells, and hemosiderin-laden macrophages. Intraoperative frozen section revealed macrofollicular nests filled with hemorrhage and composed of follicular cells demonstrating nuclear clearing and grooves.
CONCLUSION
MVPC is a rare but distinctive variant of papillary carcinoma, which is easily mistaken for adenomatous goiter or benign macrofollicular neoplasm on radiologic findings. The cytopathologist should alert oneself on encountering benign radiologic findings and any smear composed of scant numbers of follicular cells with nuclear features suspicious for papillary carcinoma despite the bland-looking background of hemorrhage and hemosiderin-laden macrophages, and recommend intraoperative frozen sections for a definite diagnosis.
- Inflammatory Myofibroblastic Tumor (InflammatoryFibrosarcoma) of the Lung: A Case Report.
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Minseob Eom, Tae Heon Kim, Jin Kyu Park, Kwang Hwa Park, Soon Hee Jung, Kwang Gil Lee
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Korean J Pathol. 2003;37(4):291-295.
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- Inflammatory myofibroblastic tumor, also known as inflammatory fibrosarcoma, has been frequently diagnosed as inflammatory pseudotumor. Although there are six cases reported as inflammatory pseudotumors or inflammatory myofibroblastic tumors in the lung, no cases of pulmonary inflammatory myofibroblastic tumor with features of inflammatory fibrosarcoma have been reported in Korea. We experienced a case of inflammatory myofibroblastic tumor (inflammatory fibrosarcoma)characterized by high cellularity, severe nuclear pleomorphism, necrosis, or increased mitoticcounts. A 31-year-old male patient with a solitary pulmonary nodule on the routine chest x-rayreceived a right lower lobectomy. The tumor was an ovoid solid mass with multifocal necrosis, showing diffuse irregular proliferation of spindle cells with high cellularity and focal nuclear pleomorphism, admixed with dense lymphoplasmacytic cells. Although spindle cells are focally immunoreactivefor smooth muscle actin, the ultrastructural examination failed to demonstrate smooth muscledifferentiation. In cases of inflammatory myofibroblastic tumor (inflammatory fibrosarcoma), a completeexcision and close follow-up without radical surgery, radiation, or chemotherapy are needed.
- Relationship between Expression of Anaphase-promoting Complex and Prognostic Factors in Invasive Ductal Carcinoma of Breast.
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Minseob Eom, Kwang Hwa Park, Kwang Gil Lee, Sang Yeop Yi, Yup Kang, Soon Hee Jung
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Korean J Pathol. 2003;37(1):19-25.
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- BACKGROUND
The role of the anaphase-promoting complex (APC) is to promote the degradation of mitotic cyclins and other substrates involved in sister chromatid adhesions. The APC appears to be responsible for the degradation of cyclin B and may have a potential role in the loss of control concerning cell proliferation in mammalian cells. However, a direct link between the defects in the APC components and oncogenesis has not been estabilished. This study investigates the relationship between APC expression and variable prognostic factors in invasive ductal carcinoma of the breast.
METHODS
We evaluated 108 cases of invasive ductal carcinoma surgically resected from January, 1996 to May, 2000 at Wonju Christian Hospital, Wonju College of Medicine, Yonsei University. Immunohistochemical stains for APC, estrogen receptor, and Ki-67 were done in paraffin sections using the avidin-biotin complex method. The results were compared with clinical and pathologic parameters and flow cytometric DNA analysis factors.
RESULTS
Forty cases (37.0%) showed immunopositive reactions for APC. The APC positivity in histologic grades 1, 2, and 3 were 28 cases (84.4%), 33 cases (60.0%), and 7 cases (35.0%), respectively (p=0.0011). The APC expressions in cases with the number of mitosis of less than 10, 10-19, and more than 20 per 10 high power fields, were noted in 37 cases (75.5%), 26 cases (63.4%), and 5 cases (27.8%), respectively (p=0.0016). The mean value of the Ki-67 labeling index was 221.7 in the APC-positive group and 317.9 in the APC-negative group (p= 0.0091). DNA flow cytometric analysis revealed higher APC expressions in cases with diploid patterns (p=0.0095). The APC expression rate increased significantly with decreasing histologic grade, with decreasing mitotic activity, in cases with a low Ki-67 labeling index, and those in the diploid group (p<0.05). The APC expression was not statistically correlated with clinical stage, tumor size, and estrogen receptor status.
CONCLUSIONS
These findings suggest that positive APC expression may be considered as a good prognostic factor of invasive ductal carcinoma, and loss of APC expression may be related with the progression of breast cancer.
- The Fine Needle Aspiration Cytologic Features of Apocrine Carcinoma of the Breast: A Case Report.
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Minseob Eom, Jin Kyu Park, Soon Hee Jung, Kwang Gil Lee
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Korean J Cytopathol. 2003;14(2):76-81.
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- Apocrine carcinoma of the breast is a very rare subtype.
Although it has no clinical differences from usual ductal carcinoma of the breast, it should be categorized as a subtype of breast carcinoma because the cells of apocrine carcinoma reveal characteristic abundant eosinophillic cytoplasms with intraductal apical snouting as well as round or oval nuclei and central macronucleoli. On fine needle aspiration cytology, the cells of apocrine carcinoma have a lot of similarity to benign or reactive apocrine cells of the breast. Therefore, it is difficult to make a differential diagnosis of apocrine carcinoma from mammary neoplasms with similar cytologic findings unless the subtle cytologic differences are recognized. We report the cytologic and histologic findings of a case of apocrine carcinoma in the breast of a 40-year-old female patient.
After the fine needle aspiration cytology, she received the lumpectomy and lymph node dissection. The cellularity was moderate to high. The cytoplasmic borders of tumor cells of three-dimensional clusters were relatively distinctive, and the cytoplasm was abundant, eosinophilic, and granular.
Although the nuclear/cytoplasmic ratio was low, the nuclei of the cells were variable in size and shape with prominent macronucleoli. Histologically, it was a typical invasive apocrine carcinoma, showing numerous cytoplasmic lysosomes and mitochondriae on electron microscopy.
- Fine Needle Aspiration Cytology of Kimura's Disease of Parotid Gland: Report of A Case Cytologically Failed to Diagnose as Kimura's Disease.
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Se Hoon Kim, Haeryoung Kim, Sung Eun Kim, Woo Ick Yang, Soon Won Hong, Kwang Gil Lee
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Korean J Cytopathol. 2003;14(2):86-90.
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- Kimura's disease is a chronic inflammatory disorder of unknown cause and is most prevalent among Asians. The cytologic findings of Kimura's disease are significant numbers of eosinophils in a background of lymphoid cells, occasional fragments of collagenous tissue, proliferation of vessels, and Warthin-Finkeldey polykaryocytes. Among these features, the most important cytologic feature of Kimura's disease is a significant numbers of eosinophils. We experienced a case of Kimura's disease in the parotid gland which we failed to recognize on cytology due to the apparent paucity of eosinophils. On careful retrograde reviewing of the cytologic findings, a few scattered leukocytes, previously interpreted as polymorphous leukocytes, had bilobed nuclei and coarse green but granular cytoplasm on Papanicolaou preparation. These leukocytes showed obvious orange-red intracytoplasmic granules as in eosionophils on Giemsa stain. The paucity of eosinophils may be due to the thick fibrosis around lymphoid follicles or any technical error during aspiration. Whereas the Warthin-Finkeldey type giant cell is not a sensitive cytologic marker of Kimura's disease, it may be a helpful cytologic feature. To reach a correct cytologic diagnosis of Kimura's disease, it is important to keep in mind that searching for Warthin-Finkeldey type giant cells and evaluation of Giemsa stain for detection of eosinophils would be helpful.
- Nevus Cell Inclusions in the Lymph Node: A Report of Two Cases.
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Ji Sun Song, Tae Woong Noh, Yoon Mee Kim, Sang Ho Cho, Kwang Gil Lee
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Korean J Pathol. 2001;35(3):245-247.
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- Nevus cell inclusion in the lymph node is an uncommon histologic finding and usually is an incidental finding in the capsule, fibrous trabeculae, perinodal adipose tissue, and parenchyma of the axillary, inguinal, or cervical lymph nodes which are removed as part of cancer diagnostic or therapeutic procedures. The aggregated pigmented nevus cells in the lymph node resemble the cells of the cutaneous nevi. It is important to differentiate them from metastatic carcinoma or malignant melanoma. The characteristic features of nevus cell inclusions are presence of nevus cells within the capsule and supporting stroma, without presence in the marginal sinus of the lymph node, and the absence of cytological atypia or mitosis of nevus cells. We report two cases of nevus cell inclusions, in the axillary lymph nodes in a patient with breast carcinoma and in an enlarged inguinal lymph node in a patient without a malignant tumor.
- Expression of E-cadherin, Matrix Metalloproteinase, and Vascular Endothelial Growth Factor in Squamous Cell Carcinoma and Adenocarcinoma of the Lung.
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Ji Sun Song, Mee Yon Cho, Kwang Hwa Park, Soon Hee Jung, Kwang Gil Lee
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Korean J Pathol. 2000;34(12):972-981.
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- E-cadherin is a calcium-dependent epithelial adhesion molecule which plays a role in the initial step of invasion of cancer cells. The step that follows the migration of separated tumor cells is a proteolytic lysis of basement membrane and extracellular matrix by protease of epithelial and endothelial cells such as matrix metalloproteinase (MMP). Vascular endothelial growth factor (VEGF) is known to be an endothelial cell-specific powerful mitogen as well as a vascular permeability factor. This study is aimed to evaluate the correlation between expression of these factors and pathologic or clinical variables and the roles and prognostic significance of those factors in squmous cell carcinoma and adenocarcinoma of the lung.
Immunohistochemical stains were performed for E-cadherin, MMP-2, and VEGF in surgically resected specimens from 90 patients with squmous cell carcinoma and adenocarcinoma of the lung. Mean age of the patients was 59.7 years. Histologic type was categorized into 56 cases of squamous cell carcinoma and 34 cases of adenocarcinoma. Mean survival period of the 35 patients was 54 months. The immunohistochemical stains for E-cadherin, MMP-2, and VEGF revealed positive reaction in 67 cases (74.4%), 43 cases (47.8%), and 34 cases (37.8%), respectively. The expression of E-cadherin was higher in adenocarcinoma (82.4%) than in squamous cell carcinoma (69.6%). MMP-2 was expressed in the tumor cells, especially those invading into the surrounding stroma. The expression of MMP-2 was significantly correlated with the survival rate (p<0.05).
The expression of VEGF in the tumor cells was significantly higher in cases with lymph node metastasis (p<0.05). In conclusion, these findings suggest that the expression of MMP-2 and VEGF predict poor prognosis of patients with squmous cell carcinoma and adenocarcinoma of the lung and that VEGF may play a role in tumor metastasis.
- Expression of Matrix Metalloproteinase and Tissue Inhibitor of Metallproteinase in Breast Carcinoma Related to Angiogenesis and Invasion.
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Yoon Jung Choi, Woo Hee Jung, Hy De Lee, Kwang Gil Lee
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Korean J Pathol. 2000;34(9):652-664.
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- Among the enzymes which are responsible for basement membrane breakdown, matrix metalloproteinases (MMP) form a family of neutral proteases that are regulated at the levels of gene transcription, proenzyme activation by the cleavage of protein, and the inhibition of the active enzyme by tissue inhibitors of matrix metalloproteinases (TIMP). Recent reports have demonstrated that the expression of these proteolytic enzymes are elevated in several solid tumors and that it can be associated with invasiveness and poor prognosis. We examined the expression of MMP-2, MMP-9, TIMP-1 and TIMP-2 by immunohistochemistry in 160 cases of infiltrating ductal carcinoma. And we compared these data with the established prognostic parameters - tumor size, nodal status, clinical stage, hormonal receptor status, microvessel density, and TGF-beta1 expression in order to evaluate how MMP and TIMP expression are associated with breast cancer progression and prognosis.
Microvessel density in invasive breast carcinoma was significantly correlated with tumor size and recurrence (p<0.05).
The immunohistochemical expression of TGF-beta1 was significantly associated with tumor size, lymph node metastasis, and clinical stage (p<0.05).
The microvessel density was significantly correlated with TGF-beta1 expression in more than 50% of tumor cells. The immunohistochemical expression of MMP-2 and MMP-9 were significantly correlated with nodal metastasis and absence of immunoreactivity for estrogen and progesterone receptors. The immunohistochemical expression of TIMP-1 was inversely correlated with clinical stage and microvessel density while that of TIMP-2 was inversely correlated with clinical stage (p<0.05). Small size of tumor, presence of progesterone receptor, highly differentiated histologic grade, and absence of immunoreactivity for MMP-9 were significantly associated with higher survival rate, but in multivariate analysis only tumor size and MMP-9 expression appeared to affect survival independently.
- Histological and Immunohistochemical Characteristics of Keratoacanthoma and Well Differentiated Squamous Cell Carcinoma.
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Lucia Kim, Seung Kyung Hann, Kwang Gil Lee
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Korean J Pathol. 2000;34(2):145-153.
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- Keratoacanthoma (KA) is a rapidly growing cutaneous tumor and is difficult to distinguish from squamous cell carcinoma (SCC) on histomorphology alone. In the present study, we compared the clinicopathological and immunohistochemical findings using antibodies for p21 (WAF-1/CIP1), p53, laminin, and Ki-67 proteins in 27 cases of KA and 31 cases of well differentiated SCC. KA was characterized by occurrence in sun-exposed skin, shorter duration, and smaller size.
Expression of p21 protein was increased according to the maturation and involution of KA, but there was no statistical significance. Expression of Ki-67 was decreased in the involutional stage of KA than in SCC (p<0.05). But p53 protein and Ki-67 were expressed in the cells at the periphery of both KA and SCC. The immunoexpression pattern of p53 and Ki-67 suggests that proliferative activities of the two lesions are similar.
Laminin was present in the infiltrative cell nests of fully developed and involutional stages of KA, and it may be related to the healing process of KA. In conclusion, it is suggested that the degree of proliferative activity in the proliferative and fully developed stages of KA is similar to that of SCC and that p21 gene expression represents the differentiation property of KA and may be associated with its regression.
- Correlation of Heregulin mRNA and Her-2/neu Protein Expression with Node Metastasis and DNA Ploidy Pattern in Human Invasive Breast Carcinoma.
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Yee Jeong Kim, Woo Hee Jung, Hyde Lee, Sung Kong Lee, In Gul Moon, Kwang Gil Lee
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Korean J Pathol. 1998;32(8):563-573.
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Abstract
- The Her-2/neu protooncogene encodes a transmembrane tyrosine kinase that is structurally homologous to the receptor for epidermal growth factor. Its amplification and overexpression are associated with poor prognosis in breast cancer patients. Neu differentiation factor is a ligand for Her-2/neu protooncogene and was detected in ras-transformed rat fibroblasts. Heregulin (human homologue of neu differentiation factor) is a 44-kilodalton glycoprotein that stimulates tyrosine phosphorylation and induces growth arrest or stimulation and differentiation in human breast cancer cell lines. In this study we examined the expression of heregulin mRNA by nested reverse transcription (RT) PCR with fresh tissue, Her-2/neu protein, ICAM-1 and steroid receptors by immunohistochemistry, and DNA ploidy pattern by flow cytometry with paraffin-embedded tissue in invasive breast carcinoma. We compared the data with nodal status, lymphovascular invasion, steroid receptor status and DNA ploidy pattern. For RT-PCR to heregulin mRNA, 38 cases of fresh breast cancer tissue were obtained. Total 68 cases of invasive breast carcinoma tissue were fixed in formalin, which were used for routine histology, immunohistochemistry and flow cytometry. The results are as follows; 1) Heregulin mRNA was expressed in 86.1% of patients with invasive breast carcinoma and 100% of patients with benign breast lesion using nested RT-PCR analysis. 2) Her-2/neu protein was overexpressed in 50.0% of tumors using immunohistochemistry.
The expression of Her-2/neu protein was significantly correlated with high counts of lymph nodes with metastasis (p<0.05), and high nuclear grade (p<0.05). 3) Her-2/neu protein overexpression was significantly correlated with a high DNA index(p<0.05). All of the tumors showing Her-2/neu protein overexpression and no heregulin mRNA expression revealed near tetraploid DNA content. However, both Her-2/neu overexpression and heregulin mRNA expressing tumors revealed near tetraploidy in 38.9% and diploidy in 50.0%. Based on these results, heregulin mRNA expression rate was 86.1% in human invasive breast carcinoma. Her-2/neu protein overexpression is associated with high positive lymph node number and DNA index. Statistically significant reverse correlation with lymph node metastasis is not present.
- The Relation between Cell Proliferation and Apoptosis According to the Histologic Types in Chemically Induced Rat Mammary Tumorigenesis.
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Tae Jung Jang, Woo Hee Jung, Kwang Gil Lee
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Korean J Pathol. 1998;32(3):174-185.
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- Balancing the rates of cell proliferation and cell death is important in maintaining normal tissue homeostasis. The relationship among apoptosis, cell proliferation and factors influencing apoptosis according to the histologic types in chemically induced mammary tumorigenesis appears important in understanding the pathogenesis of breast carcinoma. In this study, we investigated alterations in the kinetics of cell proliferation and apoptosis during rat mammary tumorigenesis induced by 7, 12-dimethylbenzanthracene (DMBA) and we related these changes to the expressions of bcl-2, p53, and TGF-beta. Seven-week-old female Sprague-Dawley rats were divided into an experimental group (20 mg/ml DMBA by oral intubation) and a control group. The results were as follows. 1. In the experimental group, breast tumors occurred in twenty two of fifty nine rats(37.3%, 22/59), and the total number of tumors was 100 (4.5 2.0/rat). The histological classification was infiltrating ductal carcinomas (n=5), ductal carcinomas with focal invasion (n=10), intraductal carcinomas (n=36), adenomas accompanied with intraductal proliferation (n=35), intraductal proliferation (n=9), and adenomas (n=5); 2. The differentiation of terminal end bud into alveolar bud (AB) in the experimental group was significantly lower than that of the control group (p<0.05); 3. BrdU labeled tumor cells were mainly located at the peripheral portion of tumor cell nests. BrdU labeling indices were highest in ductal carcinomas, less pronounced in intraductal proliferation, and lowest in adenomas, whereas apoptosis levels were highest in adenomas, less pronounced in intraductal proliferation, and lowest in ductal carcinomas (p<0.05); 4.
p53 protein was not expressed in any breast tumors. Although the expression of bcl-2 protein was highest in infiltrating and focal infiltrative ductal carcinomas (58.3%), compared with adenomas, intraductal proliferation, and intraductal carcinomas (p<0.05), the extent of its expression was less than 1% of all tumor cells; 5. TGF-beta was mainly expressed in the central portion of tumor cell nests rather than in peripheral portion, and TGF-beta immunoreactive tumor cells displayed good differentiation and did not reveal BrdU immunoreactivity. TGF-beta labeling index of infiltrating and focal infiltrative ductal carcinomas was significantly higher than that of intraductal carcinomas, intraductal proliferation, and adenomas (p<0.05). Based on these results, it is thought that high cell proliferation and the suppression of apoptosis are closely associated with DMBA-induced rat mammary carcinogenesis. However, the suppression of apoptosis is not related to p53 mutation, bcl-2, and TGF-beta. TGF-beta seems to be reversely related to tumor cell proliferation but closely associated with the progression of the tumor, especially an invasion of breast carcinomas.
- Fine Needle Aspiration Cytology of the Sclerosing Hemangioma of the Lung: A Report of Five Cases.
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Ji Young Kim, Yong Hee Lee, Kwang Gil Lee
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Korean J Cytopathol. 1998;9(2):193-200.
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- Sclerosing hemangioma is a rare, benign neoplasm of the lung, usually presented as a solitary pulmonary nodule in an otherwise asymptomatic middle-aged woman.
Cytologically it shows papillary, sheet, and cyst-like arrangements representing three main histologic patterns of papillary, solid, and angiomatous ones, respectively. Herein, we report the fine needle aspiration cytology of 5 cases of sclerosing hemangioma of the lung. The most characteristic finding is cyst-like spaces intimately related to the papillary or solid cell nests. The tumor cells are relatively monotonous, round to oval, small to medium in size. They have small amount of eosinophilic cytoplasm.
The nuclei are uniform, round and have small but conspicuous nucleoli. The tumor cells in one of the presenting cases are large with abundant cytoplasm and show moderate nuclear pleomorphism. The nuclear chromatin, however, is fine and even without exception, even in the case showing nuclear pleomorphism. Major differential diagnoses based on the cytologic findings are well-differentiated papillary adenocarcinoma, bronchioloalveolar carcinoma, and carcinoid tumor.
- The Effect of Tamoxifen and Pentosan Polysulfate on the Microvessel Density and Cell Proliferation of Dimethylbenzanthracene-Induced Rat Mammary Carcinoma.
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Chan Heun Park, Zhe Piao, Kwang Gil Lee
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Korean J Pathol. 1996;30(2):94-105.
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- Antiestrogen tamoxifen (TMX) is thought to elicit its therapeutic effect by competing with endogenous estrogens for the estrogen receptor. Several more recent studies asserted that the antitumor effect of TMX is not due solely to the inhibition of estrogen receptor-mediated action, but due partly to its capacity to inhibit angiogenesis and impair neovascularization. Despite extensive research and clinical experience with this drug, its exact mode of action in inducing tumor regression is still not clear. The present study is aimed toward the investigation of the effects of TMX on dimethylbenzanthracene- induced rat mammary carcinomas with respect to the tumor response to the drugs, histological changes, cell proliferative acitivity and angiogenesis inhibition, and if TMX has antiangiogenic action, to compare it with that of pentosan polysulfate (PPS), an already known antiangiogenic substance. Female Sprague-Dawley rats, aged 50 days, were divided into normal control, test control (tumor induction by dimethylbenzanthracene), TMX (TMX administration after tumor induction), and PPS (PPS administration after tumor induction) groups. Tumor response to the drug administration was classified according to changes of tumor volume as follows; complete response (CR), partial response (PR), no response (NR), and progressive disease (PD). The response rate of rat mammary carcinomas to the drug administration was significantly higher (p<0.05) in the TMX and PPS groups as compared with the test control group. There was, however, no statistical significance between the TMX and PPS groups.
Necrosis was considerably frequent in tumors of the TMX and PPS groups. Hyaline change of the stroma was strikingly more common and marked in the TMX group and it was associated with atrophy of epithelial cells of the tumor glands.
Proliferating cell nuclear antigen (PCNA)- labeling index of the tumors was significantly higher (p<0.05) in the tumors with NR and PD of the TMX group when compared with those with PR of the same group, which suggested a higher cell proliferative activity in these response groups. In the PPS group, however, there was no significant difference in PCNA index according to response. Microvessel density of the tumors was significantly lower (p<0.05) in the PPS group as compared with the test control and TMX groups and it was not related with response. The TMX group, however, did not show any significant difference in microvessel density when compared with the test control group. Microvessel density was significantly higher (p<0.05) in tumors with PD than those with PR in all 3 groups, which suggested a positive relation of increase in tumor size and angiogenesis. Based on these results it is thought that TMX and PPS inhibit growth of chemically-induced rat mammary carcinomas. It seems that the antitumor action of PPS is related with its antiangiogenic capability, but that of TMX does not have a relationship with angiogenenesis inhibition.
- Subcutaneous Fat Necrosis Associated with Pancreatic Adenocarcinoma: A case report.
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Hee Jung Kim, Kwang Gil Lee
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Korean J Pathol. 1996;30(2):155-160.
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- Subcutaneous fat necrosis is manifested by erythematous tender nodules on the legs, buttock or trunk and is associated with pancreatic disease including acute and chronic pancreatitis, pancreatic carcinoma, pseudocyst, pancreatic stone and other diseases. Its histologic findings are pathognomonic and reveal foci of subcutaneous fat necrosis with "ghost-like" anucleated cells with thick "shadowy wall" and surrounding inflammatory infiltrate consisting of polymorphonuclear cells, eosinophils, lymphocytes, histiocytes, foam cells and foreign body giant cells. We experienced a case of subcutaneous fat necrosis associated with pancreatic adenocarcinoma manifested by subcutaneous nodules in the buttock and lower extremities and by arthralgia of the left knee in a 67-year-old woman.
Therefore, we are reporting to emphasize the importance of the skin findings of the internal disease.
- Fine Needle Aspiration Cytology of Angiosarcoma of the Rib: A Case Report.
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Hee Jung Kim, Mee Yon Cho, Soon Hee Jung, Kwang Gil Lee
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Korean J Cytopathol. 1996;7(2):207-212.
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- Angiosarcoma of the bone is rare with an incidence of 0.13%.
It may be solitary or multiple. Its cytologic findings by FNA have rarely been reported. We report a case of angiosarcoma of the rib in a 66 year-old man. FNA revealed single or clusters of round to oval shaped cells in a hemorrhagic and myxoid background. The large central nuclei had irregular nuclear membrane, chromatin clumping and prominent nucleoli. The cytoplasm was scanty with an eosinophilic distinct cytoplasmic border.
Erythrophagocytosis by malignant cells was also found.
Histopathologic examination confirmed the diagnosis of angiosarcoma revealing irregular and com- plex anastomosing vascular channels lined by malignant round tumor cells, protruding into the lumen. Immunohistochemical staining revealed diffuse strong positive reaction to factor VIII-related antigen and CD31.
- Cytologic Features of Infiltrating Lobular Carcinoma of the Breast in Ascitic Fluid: A Case Report.
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Mi Kyung Lee, Kwang Gil Lee
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Korean J Cytopathol. 1996;7(1):75-78.
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Abstract
- We experienced a case of infiltrating lobular carcinoma of the breast in the ascitic fluid. The patient was a 49 year-old woman who presented with a palable mass of 3 months duration in the left upper quadrant of the abdomen and abdominal distension. Five years ago, she had undergone left radical mastectomy with chemotherapy and radiotherapy for infiltrating lobular carcinoma of the breast.
The ascitic fluid smears revealed singly scattered small round to elliptical cells, many of which were arranged in characteristic indian-file patterns consisting of 3 to 5 cells. The tumor cells had scanty cytoplasm, rare cytoplasmic vacuoles and marked chromatin clumping with small, but prominent nucleoli.
- Cytologic Features of Metastatic Thymoma in the Liver: A Cese Report.
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Ji Young Kim, Kwang Gil Lee
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Korean J Cytopathol. 1996;7(1):92-96.
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- Extrathoracic metastases of thymomas are extremely rare, occurring in less than 2% of cases. We present a case of metastatic thymoma in the liver diagnosed by aspiration biopsy. A fine-needle aspirate from a hepatic mass of a 65-year old man who had a history of malignant thymoma locally invading pericardium was examined. Nests of epithelial cells with few scattered lymphocytes were present. The nuclei of the epithelial cells were round to oval and appeared retatively uniform and regular, with fine chromatin pattern. They had one or two, small but rather conspicuous nucleoli. Unlike previous reports on the findings of the aspiration cytology of thymomas, the charactristic biphasic pattern was not present in this case.
- Histologic and Immunohistochemical Study of Cutaneous Vascular Disorders.
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Jai Hyang Go, Hoon Jin, Dong Hwan Shin, Kwang Gil Lee
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Korean J Pathol. 1995;29(3):327-333.
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Abstract
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- There is a wide array of designation for cutaneous vascular disorders based on clinical characteristics, histology, embryology, cellular biology, and hemodynamics. The cutaneous vascular disorders can be divided into hemangioma and vascular malformation according to the biologic classification based on cell kinetics i.e. endothelial hyperplasia. There are clinical and histologic differences between them. In this study, clinical, histologic and im-munohistochemical evaluations were attempted on 40 cases of cutaneous vascular disorders diagnosed the period between 1985 and 1993. The results are as follows: 1) Twenty-three out of forty cases were immunoreacive for proliferating cell nuclear antigen(PCNA). The lesions composed of capillary-sized blood vessels with endothelial hyperplasia were diffusely reactive, whereas those composed largely of dilated blood vessels with or without focal endothelial hyperplasia were only focally reactive. 2) Each groups of the classic classification contained both reactive and nonreactive cases except nevus flammeus and juvenfle hemangioma. 3) In contrast to the cases nonreactive for PCNA, those reactive for PCNA contained areas of proliferating small vessels, which showed reactivity for PCNA. In conclusion, the cutaneous vascular disorders diagnosed by the classic classification are heterogeneous in the pattern of the endothelial hyperplasia and the PCNA staining. Therefore it should be classified by the clinical and the histologic characteristics.
- Correlation of Histologic Findings of Ovarian Epithelial Tumors with Expression of Proliferating Cell Nuclear Antigen and Flow Cytometric DNA Analysis.
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Sang Yeop Yi, Soon Hee Jung, Kwang Gil Lee
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Korean J Pathol. 1995;29(1):68-76.
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- The prognosis of malignant ovarian tumor is poorer than that of borderline malignant ovarian tumor, Therefore an accurate diagnosis and estimation of the biologic behavior of the tumor are necessary for proper management of the patient.
The histologic investigation of the tumor may provide information on the estimation of the malignant potential of tumor cells, but it may be a questionable method because of the subjective determination of tumor grade. Quantification of proliferative activity of tumor cells may play a role as an objective method to provide an estimation of the malignant potential of tumor cells. An evaluation of histologic findings was done on 84 cases of ovarian mucinous and serous tumors that were surgically resected and diagnosed during the period from January 1981 through July 1992. The proliferating cell nuclear antigen (PCN A) labelling index estimated from the immunohistochemical stain for PCN A and the Sphase fraction and porliferative index obtained from flow cytometric DN A analysis were assessed each other with histologic findings. The results are as follows: The presence of aneuploidy in malignant tumors was statistically significant as compared with benign tumors.
The borderline malignant tumors showed no significant difference between the number of diploidy and aneuploidy.
The PCNA labelling index, S-phase fraction and proliferative index tended to increase as the histologic grade of tumors went up. They were higher in malignant tumors than in others. The PCN A labelling index, S-phase fraction and proliferative index were higher in tumors with aneuploidy than in those with diploidy. In contrast to borderline malignant tumors, the PCNA labelling index in malignant tumors revealed a significant relation with the mitotic index. The S-phase fraction and proliferative index showed, in malignant tumors, a close correlation with the architectural grade and nucleolar grade, but not in borderline malignant tumors. Considering these results, the presence of aneuploidy, PCNA label.
- Relationship between Immunohistochemical Expression of Cathepsin D and Other Prognostic Factors of Breast Carcinoma.
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Kwang Hwa Park, Byeng Woo Park, Kyong Sik Lee, Kwang Gil Lee
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Korean J Pathol. 1994;28(6):612-619.
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- The cathepsin D is a lysosomal protease secreted in excess by breast cancer cells. The function of this enzyme is degradation of the extracellular matrix and proteoglycan. It is induced by estrogens in estrogen receptor positive breast cancer cell lines. On the basis of this, cathepsin D expression in breast cancer cells seems to be correlated with the prognosis. But there is debates in its prognostic significance. Relationship between cathepsin D expression and other prognostic factors of breast cancer was studied.
We investigated 51 cases of invasive ductal cell carcinoma of breast removed by open biopsy or mastectomy. All cases were fixed in formalin and embedded in paraffin. We used 46-KD intermediate form of the enzyme for cathepsin D expression on immunohistochemical stain. We observed no significant correlation with age, stage, histologic grade, lymphatic invasion, and estrogen receptor status. Cathepsin D may be an independent factor which is not related with other prognostic factors, especially estrogen receptor status.
- Urinary Cytologic Findings of Urothelial Lesions.
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Yoon Jung Choi, Kwang Gil Lee
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Korean J Cytopathol. 1994;5(2):130-136.
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- Urinary cytology is increasingly accepted as a diagnostic tool in the detection and follow-up of patients with bladder cancer. However, its value is reduced by several limitations, especially by the tack of cytologic criteria specifically reflecting the morphology of low-grade urothelial neoplasm. We reviewed histologically proven 50 cases of urine cytology with emphasis on cytologic findings of benign atypia and differential findings of urothelial neoplasm according to the grade. The diagnoses included 17 benign lesions (including 5 cases of urine calculi) and 33 malignant lesions(including 28 transitional cell carcinomas.
3 squamous cell carcinomas, 1 adenocarcinoma and 1 prostate adenocarcinoma). Diagnostic accuracy was 92%. Important cytodiagnostic criteria for benign atypia and low grade malignancy were cellularity, number of cell clusters, and morphology and arrangement of urothelial cells. The cytologic findings of urothelial neoplasms according to histologic grade were relatively well correlated with the histologic findings. However, the cytologic criteria were not sufficient to readily distinguish grade I from grade II.
In view of this, we think that cytologic nomenclature "low-grade" and "high-grade" is a more reliable criterion.
Recognition of subtle cellular morphologic features specific for urothelial lesions(including benign or malignancy) and proper fixation, processing and staining of specimen can expand the role of urinary cytology in detection and follow-up of patients.
- Fine Needle Aspiration Cytology of Collecting Duct Carcinoma of the Kidney: A Case Report.
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Sang Yeop Yi, Kwang Gil Lee
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Korean J Cytopathol. 1994;5(2):160-166.
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- Collecting duct carcinoma of the kidney is an unusual variety of renal carcinoma considered to arise from the epithelium of the collecting ducts. We recently experienced an case of fine needle aspiration cytology of collecting duct carcinoma of the kidney in a 17 year-old girl. The smear revealed many cellular clusters of ordinary papillary pattern, characterized by clumping of cells with nuclear overlapping, in a slightly necrotic background. The tumor cells had abundant delicate granular cytoplasm with some having vacuolation. The nuclei were only slightly pleomorphic with somethat coarse chromatin and one or more small nucleoli. Some nuclei showed irregular nuclear membrane and nuclear groove. A few polmorphs were also present.
- Fine Needle Aspiration Cytology of Atypical Proliferative Lesion of the Breast.
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Kun Chang Song, Kwang Gil Lee
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Korean J Cytopathol. 1994;5(1):52-56.
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- We experienced a case of fine-needle aspiration(FNA) cytology of breast which showed atypical proliferative lesion. It was very difficult to differentiate this case from malignancy, because of hypercellular smear and many clusters composed of large, atypical ductal cells. However, it showed other features favoring benignancy, such as tendency of cellular cohesiveness, only slightly increased nucleus/cytoplasm ratio and most importantly presence of myoepithelial cells. It's histologic diagnosis was intraductal hyperplasia with atypia. This case indicates that all atypical breast FNA specimen should lead to the suggestion of surgical biopsy for avoiding over- or under-diagnosis.
- Fine Needle Aspiration Cytology of the Renal Angiomyolipoma.
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Yong Hee Lee, Dong Won Min, Hyeon Joo Jeong, Kwang Gil Lee
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Korean J Cytopathol. 1994;5(1):65-70.
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- We describe a case of fine needle aspiration cytologyof renal angiomyolipoma which was not associated with the clinical complex of tuberous sclerosis and was incidentally found. It was a solitary lesion and the clinical impression before needle aspiration was renal cell carcinoma. The aspirated specimen showed mature fat cells, clusters of renal tubular epithelial cells and sheets of pleomorphic smooth muscle cells with fibrillary cytoplasm. The nuclei of smooth muscle cells varied in size and shape. Since the treatment of renal angiomyolipoma differs from that of renal cell carcinoma, the preoperative cytological diagnosis is of great value.
- The Epidermal Proliferation and the Number of Langerhans Cells in 7, 12-dimethylbenzanthracene Induced Epidermal Changes.
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Chang Soon Han, Young Nyun Park, Kwang Gil Lee, In Joon Choi
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Korean J Pathol. 1993;27(6):590-604.
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- Chemically induced epiderml carcinogenesis is usually divided into two stages, the initiation and promotion. The initiation involves conversion of some epidermal cells into latent neoplastic cells and the promotion is proliferation of the transformed cells. As immunosurveillence is thought to be a host defense against tumors, Langerhans cells, being essential in initiation of local cutaneous immunologic reaction, is suggested to be important in the carcingenesis of the epidermis. This study is attempted to investigate the epidermal proliferative changes in mice induced by application of 12-0-tetradecanoy1-phorbol-13-acetate(TPA) on the skin initiated with 7, 12-dimethylbenzanthracene(DMBA) and its relationship with Langerhans cell. Ninty five male inbred BALB/c mice weighing 20~25 g were divided into five groups; the 33 week-group, the 21 week-group, the 12 week-group and the 4 week-group according to the duration of carcinogen application, and the control group. The carcingen was applied with a brush on the dorsal skin of mice after depilation. Ten days after application of 800 nmole DMBA in 0.4 cc acetone, 20 nmole TPA in 0.4 cc acetone was applied twice per week and the control group was applied with the same amount of acetone for 4 weeks. Animals were sacrificed 3 days after the last application of TPA. One hour before sacrifice, bromodeoxyuridine(BrdU) (1 mg/g) was injected via the tail artert for BrdU stain of S phase cells. A strip of dorsal skin was used for hematoxylineosin stain, immunohistochemical stain for BrdU and la antigen of Langerhans cell, and flow cytometry. The results are as follows: 1. Cellular proliferation, hyperkeratosis and dysplasia of the epidermis were increased in relation to duration of carcingen application. Papillomas were developed 12 weeks after application of the carcingen. 2. BrdU labelling and proliferative indices of the 20 weeks' application group were significantly higher than those of the 12 weeks' application group. The number of Langerhans cell was decreased markedly ater 4 week' application of the carcinogen. 3. All epiedrmal lesions including a case of squamous cell carcinoma were diploidy in flow cytometry. It is thought that disturbance of immunosurveillence, caused by depletion of Langerhans cell, may permit proliferation of epidermal cells. Although abnormal quantitative change of nuclear DNA has not occurred even when the epidermal proliferative activity and dysplastic change were increased markedly, it is thought that the occurrence of structural change of chromosome is remained to be clarified.
- Histologic and Clinical Characteristics of Skin Warts According to the Human Papillomavirus Antigen Expression.
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Kun Chang Song, Kwang Gil Lee
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Korean J Pathol. 1993;27(4):379-386.
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- Skin wart is an infectious disease of human papillomavirus(HPV). Its clinical and histopathologic characteristics are largely determined by lesion sties, viral type and host immunity. The infected basal cells and keratinocytes of the epidermis are induced to proliferate by the viral genome. It is, however, not well known how htose factors give rise to histopathologic alterations in the infected basal cells and keratinocytes. So, evaluation of correlation between HPV antigen expression in the wart tissues and clinical and histopathologic charateristics was done on 83 cases of skin warts. The age of patients ranged from 2 to 83 years. Thirty six(43.3%) cases were diagnosed before the age of third decade. The sex ratio was nearly same. Verruca vulgaris was most common(46 cases), followed by verruca plana(26 cases) and verruca palmoplantaris(11 cases). HPV antigen expression was observed in 43 out of total 83(51.8%). It was noted in 47.8%(22/46) of verruca vulgaris, in 46.2%(12/26) of verruca plana and in 81.8%(9/11) of verruca palmoplantaris. HPV antigen-positive groups included more younger patient's age and more higher PCNA than those of HPV negative groups. HPV positive groups also tend to have shorter duration of disease and more numerous mitoses than HPV negative groups. HPV antigen-positive groups showed lower inflammation grade than that of HPV negative groups(p<0.05). The higher the inflammaton grade is, the lower the HPV antigen expression rate. In summary, HPV antigen expression in cutaneous wart tissue is significantly correlated with the proliferative activity of the lesion. It is also significantly correlated with the inflammation that is considered to be the result of cell-mediated immune reaction.
- Fine needle aspiration cytology of Warthin's tumor-report of 3 cases-.
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Jee Young Han, Kwang Gil Lee
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Korean J Cytopathol. 1993;4(2):146-149.
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- No abstract available.
- Usefulness of intraoperative fine needle aspiration of pancreatic lesions.
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Young Byun Park, Myung Wook Kim, Kwang Gil Lee
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Korean J Cytopathol. 1993;4(1):9-15.
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- No abstract available.
- Fine needle aspiration cytology of proliferative fasciitis.
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Yoon Jung Choi, Sang Yeop Yi, Woo Ick Yang, Soon Hee Jung, Kwang Gil Lee
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Korean J Cytopathol. 1993;4(1):52-56.
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- No abstract available.
- A Study on Immunohistochemical Stain for S-100 Protein, HMB 45 and Proliferating Cell Nuclear Antigen(PCNA) of Spitz Nevus Compared with Benign Nevus and Malignant Melanoma.
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Mee Yon Cho, Kwang Gil Lee, Myung Wook Kim
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Korean J Pathol. 1992;26(6):552-560.
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- The differential diagnosis between Spitz nevus and malignant melanoma is difficult due to similar histologic findings. To obtain the useful aids for the differential diagnosis between two diseases, we studied 13 cases of Spitz nevus, 8 benign nevi of compound and intradermal, and 9 melanomas of primary and metastatic, using the immunohistochemical stain for S-100 protein, HMB.45 and proliferating cell nuclear antigen(PCNA). The staining pattern and intensity of S-100 protein showed homogenously strong positive reactivity in all cases. The frequency of HMB.45 positive cell in Spitz nevus was significantly lower than that in melanoma. When compared with the usual compound and intradermal nevi, Spitz nevi showed more significantly positive reaction in the dermal component of nevus cells. The expression of PCNA was higher in melanoma than in Spitz nevus. The immunohistochemical stains for HMB.45 and PCNA are considered as a useful methods for differentiation between Spitz nevus and melanoma, while stain for S-100 protein is not helpful.
- Cytologic findings of pancreatic islet cell tumor with lymph node metastasis.
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Yee Jeong Kim, Yoon Jung Choi, Kyu Rae Kim, Woo Hee Jung, Kwang Gil Lee
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Korean J Cytopathol. 1992;3(2):60-66.
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- No abstract available.
- Fine needle aspiration cytology of meningioma presenting as a neck mass.
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Hyunee Yim, Young Nyun Park, Kwang Gil Lee
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Korean J Cytopathol. 1992;3(2):94-99.
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- No abstract available.
- Fine needle aspiration cytology of paraganglioma of the retroperitoneum.
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Jee Young Han, Kwang Gil Lee
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Korean J Cytopathol. 1992;3(1):19-24.
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- No abstract available.
- Fine needle aspiration cytology of pulmonary hamartoma: report of a case.
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Dongwon Min, Kwang Gil Lee
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Korean J Cytopathol. 1992;3(1):30-36.
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- No abstract available.
- Necrobiotic Xanthogranuloma with Paraproteinemia: A case report.
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Yee Jeong Kim, Kwang Gil Lee, Soo Il Chun, Hyung Soon Lee
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Korean J Pathol. 1991;25(6):589-593.
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- Necrobiotic xanthogranuloma(NXG) is a characteristic cutaneous manifestation associated with paraproteinemia. A case of NXG associated with an IgG (lambda) monoclonal gammopathy occurred in a 48-year-old man. Skin lesions were dome-shaped, hard palpable nodules, 2x3 cm to 4x4 cm sized, on both arms and forearms. They were arranged in a linear pattern. Also, hard palpable tumors, 1x2 cm to 2x3 cm in size, were present on the left leg and the dorsum of the left foot. They were violaceous, slightly protruded, and hard on palpation. Histologically, the lesion was characterized by inflammatory xanthogranuloma with broad hands of hyaline necrobiosis. Many foreign body type of bizarre giant cells, Touton type of giant cells and foamy histiocytes were infiltrated into the dermis and subcutaneous fat tissue. Three days after medication with ledercort and immuran, the cutaneous masses decreased in size and became soft.
- A Pathologic Study of Lymphoproliferative Disorders of the Skin.
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Yee Jeong Kim, Kwang Gil Lee, Soo Il Chun, Yun Woong Ko
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Korean J Pathol. 1991;25(6):551-562.
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- Forty eight skin biopsies obtained from 24 patients were reviewed, and clinical, histological and immunohistochemical findings were analyzed. Results obtained are as follows: 1) Skin manifestation was plaque, erythroderma, scale and hyperpigmentation in mycosis fungoides, and subcutaneous nodule, mass and ulcerated patch in cutaneous lymphoma. The skin of lymphomatoid papulosis revealed hemorrhagic ulcerated and erythematous papules which healed spontaneously. 2) Histologically, mycosis fungoides showed epidermotropism in most cases. Pautrier's micro-abscesses were present in one-fourth of the cases. Malignant lymphoma was different in histology from mycosis fungoides. As compared with mycosis fungoides, it showed less frequent epidermotropism, more compact and diffuse infiltration of atypical lymphocytes, more often association with ulcer and necrosis, and more frequent mitotic figures. Lymphomatoid papulosis showed striking hemorrhage and edema of the papillary dermis. 3) Based on the results of immunohistochemical study, mycosis fungoides and lymphomatoid papulosis were considered as a T cell proliferative disorder of the skin. According to these findings, lymphoproliferative disorders of the skin occurred predominantly in the elderly and males. Clinical and histopathologic findings overlapped and were similar each other. It was difficult to make a definite diagnosis in early lesions, and a sequential follow up biopsy was required. It is concluded that strict criteria such as marked atypia and clustering of atypical cells are necessary for a histologic diagnosis of malignant lymphoproliferative disorder of the skin.
- Fine needle aspiration cytology of tumors metastatic to the liver: a study on 110 cases-.
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Young Nyun Park, Soon Won Hong, Kwang Gil Lee
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Korean J Cytopathol. 1991;2(2):79-89.
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- No abstract available.
- Fine needle aspiration cytology of mediastinal goiter.
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Yee Jeong Kim, Kwang Gil Lee
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Korean J Cytopathol. 1991;2(2):148-152.
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- No abstract available.
- A Cytopathologic Study of Fine Needle Aspiration Biopsy of Lung Cancer.
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Soon Won Hong, Kwang Gil Lee
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Korean J Pathol. 1990;24(4):465-475.
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- Available conventional pathologic diagnostic tools for lung cancer include sputum cytology, lung biopsy using bronchoscopy, and washing and brushing cytology. In addition, fine needle aspiration (FNA) cytology is now available and has become popular. In this study, an attempt was made to compare the relative sensitivity between conventional cytopathologic methods and FNA cytology, to study the clinical characteristics of lung cancer in which the diagnosis was established by FNA cytology, and to study the cellular findings and diagnostic criteria of lung cencers. Cases included in this study were selected from 105 patients who had been diagnosed an lung cancer at Yonsei University Medical Center during the 5-year period from January 1984 to December 1988. These 105 cases were reviewed with respect to medical records and pathologic slides and then the following conclusions were made. The mean age of cases was 58.5 years, and the sex ratio of males to females was 3.5:1. Tumors were mostly solitary in number and were mainly located at the periphery of the lung. The sensitivity of FNA cytology, sputum, and bronchial washing was as follows: FNA cytology was 0.93, sputum, 0.2, and bronchial washing, 0.14. The coincidence rate of cytopathologic diagnosis with histologic diagnosis was as follows: epidermoid carcinoma was 92%, adenocarcinoma 83%, undifferentiated large cell carcinoma 66%, and undifferentiated small cell carcinoma 100%. The false negativity of FNA cytology was 7%, which was mainly due to material insufficiency. For the differential diagnosis of histologic type, some brief criteria could be summarized.
Differential diagnostic points of each histologic type were as follows: epidermoid carcinoma showed a large cellular group with keratinized cytoplasms and hyperchromatic and pyknotic nuclei, adenocarcinoma showed a glandular or ball-like arrangement by monotonous round cells, undifferentiated large cell carcinoma was mainly composed of irregular large cells and showed emperipolesis, and undifferentiated small cell carcinoma showed an Indian file appearance with molding by small, round hyperchromatic cells. In conclusion, FNA cytology is a more efficient, definite, and sensitive method for diagnosing lung cancer than other cytopathologic studies, so that careful selection of patients and experienced technique will improve the diagnostic accuracy of FNA cytology in diagnosing lung cancer.
- Cytologic Features and Distribution of Primary site of Malignant Cells in Body Fluids.
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Kyoung Ho Kim, Kwang Gil Lee
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Korean J Pathol. 1990;24(4):456-464.
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- Many articles concerning the accuracy of diagnosis of malignant tumor cells in body fluids have appeared in the literature, but few authors have attempted to describe the characteristics of these cells to determine the site of the primary tumor as they relate to tumors of specific primary sites. This paper presents the results of a retrospective study on malignant body cavity effusions of which the primary site was established on the basis of either biopsy or surgical resection of the primary neoplasm during the period of 6 years beginning from January 1983 to December 1988. The results obtained are summarized as follows: 1) The 143 fluid specimens from 129 patients were composed of 51 cases of pleural, 69 of peritoneal, and 9 of pericardial origin. 2) Adenocarcinoma was the most frequent type of malignant effusions (78.3%). The most common primary site was the lung (50%) in pleural fluid and stomach (55.2%) in ascites. 3) The results of this study show that the primary site of tumor cells can be identified in the body fluid of accurate cytomorphologic criteria are used. Identification of the primary site of an effusion would be improved by the consideration of clinical information
- Pulmonary Adenocarcinoma of Fetal Type: Report of a case.
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Nam Hoon Cho, Kwang Gil Lee
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Korean J Pathol. 1990;24(3):287-293.
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- Pulmonary adenocarcinoma of fetal type is a very uncommon tumor of the lung which simulates an early stage of lung differentiation. This is a primitive appearing epithelial tumor similar to the epithelial component of pulmonary blastoma but lacking the sarcomatous features. Since the report of Kradin et al, 8 more cases have been reported by a variety of name. These tumors are composed of glycogen-rich, non-ciliated tubular epithelial cells forming irregularly shaped tubules or arranged in a papillary pattern. A very remarkable findings of this tumor is the presence of endocrine cells which is confirmed by argyrophilia, immunohistochemistry or electron microscopy. We experienced a case of this tumor which showed hepatocytoid differentiation in addition to the characteristic histologic findings. Immunohistochemical studies performed on a resected tumor tissue showed immunoreactivity for alpha-fetoprotein, neuron-specific enolase and somatostatin, and endocrine type granules were found ultrastructurally.
Although this tumor seems to have a relation with pulmonary blastoma in its histology, immunohistochemistry and ontogeny, a distinction between these should be attained because the average survival of the former group is longer as 23 months, while that of the latter is only 4 months.
- A Study on the Histopathologic Features of Bowenoid Papulosis and the Numerical Change in Langerhans Cells.
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Kwang Gil Lee, Soo Im Choi
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Korean J Pathol. 1990;24(3):275-286.
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- Fourteen cases of bowenoid papulosis were studied both clinically and histologically and were compared with 22 cases of Bowen's disease to find histologic differences between the two diseases. Bowenoid papulosis was prevalent in young, sexually active adults, consisted of multiple erythematous or hyperpigmented papules, and located mostly on the penis and vulva. The main histologic characteristics of bowenoid papulosis were an orderly background of keratinocyte maturation of the epidermis with monotonous pattern, the frequent presence of 'skip area', and the lesser degree of cytologic atypia than seen in lesions of Bowen's disease. In addition, mitotic figures more than 5 per x400 filed, formation of keratin pearl, and spindling of keratinocytes, which have not been described in other articles yet, are considered very important findings for the diagnosis of bowenoid papulosis. It is our opinion that bowenoid papulosis can be reliably distinguished from Bowen's disease by light microscopic features.
Paraffin-embedded samples of bowenoid papulosis, Bowen's disease, and normal skin were investigated with antibodies against S 100-protein to relate the number of intraepidermal Langerhans cells and the disease. Langerhans cells were found to be reduced when compared with normal skin. No significant differences between Bowen's disease and bowenoid papulosis were found in density of Langerhans cells.
- Cytologic Findings of Fine Needle Aspiration Biopsy of Ancient Schwannoma.
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Hee Jae Joo, Kwang Gil Lee
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Korean J Cytopathol. 1990;1(2):158-163.
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- Ancient (degenerated) schwannomas are benign tumors that display pronounced degenerative changes including cyst formation, calcification, hemorrhage, and hyalinization. The tumors are usually infiltrated by large numbers of inflammatory cells such as neutrophils, lymphocytes, siderophages, and histiocytes. They are located in deep locations such as the retroperitoneum and must be differentiated from malignant soft tissue tumors because spindle cells with nuclear atypia may be present in the fine needle aspiration biopsy. The cytologic findings of two cases of ancient schwannoma occurring in posterior mediastinum and retroperitoneum, respectively, are described. Computerized tomographic findings of both cases showed changes of cystic degeneration or necrosis. A case occurred in retroperitoneum revealed features of destruction of vertebral body to suggest a malignant soft tussue tumor radiologically. The cytologic findings of aspiration biopsy of both tumors revealed that the tumor cells were spindle in shape with elongated nuclei. Some of tumor cells were arranged in a palisading fashion. Cell structures that resemble the Verocay bodies were observed. Some of the tumor cells showed pleomorphic bizarre nuclei, but no mitotic activity or chromatin clumping was seen. Inflammatory cells, siderophages and histiocytes were scattered in fibrillar material. These cytologic findings are important in the diagnosis of ancient schwannoma and in the differentiation of this tumor from the malignant spindle cell tumor.
- Fine Needle Aspiration Cytology of Pulmonary Carcinosarcoma.
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Tae Jung Jang, Kwang Gil Lee, Soon Won Hong
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Korean J Cytopathol. 1990;1(2):164-169.
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- Carcinosarcoma is an uncommon pulmonary malignancy characterized by carcinomatous parenchyma and sarcomatous stroma. The cytologic, immunohistochemical and ultrastructural features of a case of pulmonary carcinosarcoma suspected by fine needle aspiration cytology is presented.
Only bizarre spindle cells arranged in loose groups, in microtissue fragments and in a dissociate fashion were present in the aspiration smears. They were markedly positive for vimentin. The epithelial component was not found, which was probably due to marked paucity of carcinomatous component that was proved by histologic examination of the resected tumor.
The diagnosis of pulmonary carcinosarcoma should be considered whenever poorly differentiated epithelial cell groups with a malignant mesenchymal component set in a myxoid background are seen in a pulmonary cytology specimen.
- Fine Needle Aspiration Cytology of Mucoepidermoid Carcinoma of the Lung: A Case Report.
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Soon Won Hong, Kwang Gil Lee
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Korean J Cytopathol. 1990;1(2):170-174.
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- The mucoepidermoid carcinoma is a rare tumor in the lung. A case of bronchial mucoepidermoid carcinoma diagnosed by fine needle aspiration cytology is presented. The smear showed many intermediate cells with occasional mucus-secreting cells. Malignant squamous cells were not present. The cellular arrangement of intermediate cells was overlapping and grouped in ball-like fashion. These cytologic features are unique for diagnosis of this tumor.
- Metastatic Adenoid Cystic Carcinoma of the Lung Diagnosed by Fine Needle Aspiration Biopsy.
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So Yeon Park, Kwang Gil Lee
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Korean J Cytopathol. 1990;1(2):175-178.
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- A case of metastatic adenoid cystic carcinoma of the lung, originated from the trachea, was diagnosed by fine needle aspiration. Although the cytologic features of adenoid cystic carcinoma have been well described, it is easy to confuse adenoid cystic carcinoma with more common primary small cell neoplasms of the lung, i.e., small cell carcinoma, well differentiated adenocarcinoma, and carcinoid tumor of the lung. The features distinguishing adenoid cystic carcinoma from these neoplasms include 1) tight, globular, honeycomb pattern of cells, 2) acellular basement membrane material in the lumen, and 3) cells lacking true nuclear molding and having bland chromatin pattern. The morphologic feature of metastatic adenoid cystic carcinoma in this case was so distinctive as to permit a definite diagnosis by aspiration cytology.
- Hyperinfection Syndrome with Strongyloides Stercoralis: Report of a case.
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Soo Im Choi, Soon Won Hong, Kwang Gil Lee
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Korean J Pathol. 1989;23(3):359-364.
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- Strongyloides stercoralis is a nematodes and is prevalent in the tropical regions. In Korea, 6 cases have been reported in which the parasites were identified in feces. We report a case of hyperinfection syndrome with Strongyloides stercoralis confirmed in the tissue sections. A 52-year-old woman was admitted to the hospital because of generalized edema and weakness. She received steroid therapy for 30 years because of rheumatoid arthritis. One year ago, generalized edema and dyspnea were developed and she was diagnosed as minimal change nephrotic syndrome for which she received cyclosporin. On admission, she complained of generalized weakness and edema, multiple arthralgia and abdominal discomfort with nausea. The white-cell count was 14,600 without eosinophilia. A stool specimen was negative for occult blood, ova or parasites. Right lower quadrant abdominal pain and tenderness were developed, and the exploratory laparotomy was done under the impression of the acute appendicitis. An appendectomy with a biopsy of mesenteric lymph nodes was performed. From the 5th day after operation, the patient began to complain of the abdominal pain and constipation. Under the impression of adhesion bad formation, the laparotomy was done and disclosed that the proximal ileum was markedly dilated. On jejunotomy, a great amount of formed stool and barium was noticed in the proximal portion of small bowel. The jejunal tissue was biopsied. Grossly, the appendix was unremarkable.
Microscopically, the inflammatory reaction was nearly absent, but in serosa, minute granulomas were found which contain a part of the parasite. Same feature was noted in the mesenteric lymph node. The biopsied jejunum contains numerous adult female, filariform and rhabdidiform larvae and eggs in the mucosa, submucosa and muscle wall. Their morphology was compatible with Strongyloides stercoralis.
The patient died 5 days later in the state of multiple organ failure.
- Skin Lesions in Secondary Syphilis.
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Sung Ku Ahn, Kwang Gil Lee, Soo Il Chun, Jung Bock Lee
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Korean J Pathol. 1989;23(2):254-262.
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- We reviewed 37 skin biopsies obtained from 35 patients with secondary syphilis during the period of 9 years from January 1980 to June 1988, which had been diagnosed by dark field examination, serologic tests for syphilis, and identification of spirochetes by immunoperoxidase method (avidin-biotin complex) in the skin biopsies. We investigated the histologic features of the skin lesions in secondary syphilis according to the types and patterns of inflammatory cell infiltration in the dermis, vascular reactions and epidermal changes. We matched these histologic findings with the clinical features of the skin lesions. The results were as follows; 1) The histologic patterns of dermal infiltrate in order of frequency were as follows; junctional pattern in 14 biopsies (38%), lichenoid pattern in 10 biopsies (27%), diffuse pattern in 5 biopsies (14%), patchy pattern in 3 biopsies (8%), normal pattern in 3 biopsies (8%) and undertermined in 2 biopsies (5%). 2) The dermal infiltration of plasma cells was found in 24 biopsies (65%). All the biopsies of diffues and lichenoid patterns, 7 biopsies of junctional and one biopsy of patchy pattern showed plasma cells but none in normal pattern. 3) Eosinophils were observed in the dermis in 11 biopsies (30%). There was no difference in incidence of eosinophils in the dermis among morphologic patterns. However, they were frequently seen in the dermis and epidermis of condyloma lata (4 of 7 biopsies). 4) The vascular changes in the dermis included endothelial cell swelling in 23 biopsies (62%), endothelial cell proliferation in 22 biopsies (60%) and vascular dilatation in 10 biopsies (27%). They were most commonly observed in the lichenoid pattern followed by diffuse and junctional patterns. Three cases showed lymphocytic vasculitis. 5) Epidermal changes were seen in all of the biopsies exocytosis, parakeratosis, hydropic change of basal cells, acanthosis, spongiosis, keratinocyte necrosis and hyperkeratosis in the order of frequency. 6) In relation to the clinical manifestations, junctional pattern (14 biopsies) consisted of 6 papulosquamous lesions, 5 macules and 3 papules. Lichenoid pattern (10 biopsies) consisted of 7 papulosquamous lesions and 3 papules. All the biopsies showing diffuse pattern (5 biopsies) appeared in condyloma lata. Patchy pattern (3 biopsies) consisted of 2 macules and 1 papule. All of the normal pattern (3 biopsies) appeared in macules. In conclusion, with dermal and epidermal changes, the acknowlegement of the 5 basic histologic patterns in secondary syphilis seems to be very helpful for the diagnosis of syphilis.
- Histopathological Studies of 300 Cases of Non-Hodgkin's Lymphoma in Korean Patients.
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Hee Jeong Ahn, Soon Hee Jung, Hyen Joo Jeong, Dong Hwan Shin, Kwang Gil Lee, In Joon Choi
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Korean J Pathol. 1988;22(3):222-231.
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- Non-Hodgkin's malignant lymphoma is a relatively frequent lymphoreticular malignancy, and has been reported to constitute up to 5.2% of all malignant tumors in Korean patients. Various morphologic classifications of non-Hodgkin's lymphoma have been proposed, and among them, the Rappaport's classification has been most widely accepted. In 1982, a National Cancer Institute sponsored study on classification led to the creation of the Working Formulation in an attempt to resolve the controversy anddebate regarding the various classifications of non-Hodgkin's lymphoma. Angioimmunoblastic lymphadenopathy with dysproteinemia and polymorphic reticulosis are lymphoreticular proliferative disorders which have reported to transform to malignant lymphoma. The purpose of the present study is to reclassify non-Hodgkin's lymphomas according to the Working Formulation and to investigate the histopathological and immunocytochemical characteristics of angioimmunoblastic lymphadenopathy with dysproteinemia and polymorphic reticulosis. This study reviewed 300 cases of nodal and extranodal non-Hodgkin's lymphoma, 26 cases of polymorphic reticulosis, and 7 cases of angioimmunoblastic lymphadenopathy with dysproteinemia examined in the Departments of Pathology, Yonsei University College of Medicine, Youngdong Severance Hospital and Yonsei University Wonju College of Medicine from January 1977 to December 1986. In non-Hodgkin's lymphoma, each case was classified according to the Working Formulation and the Rappaport classification. All angioimmunoblastic lymphadenopathy with dysproteinemia and polymorphic reticulosis cases were subjected to histopathological analysis and a review of the clinical records. Immunocytochemical studies were done using kappa and lambda chains for B-cell markers and alpha-1-antichymotrypsin for histiocytic marker. The results obtained were as follows; 1) Among 300 cases of non-Hodgkin's lymphoma, the primarily involved tumor sites were the lymph nodes (141 cases), the gastrointestinal tract (67 cases), and the tonsils (32 cases) in descending order of frequency. 2) Using the Working Formulation, intermediategrade lymphomas occurred in 66.4% of the patients, and the most common subtype was "diffuse, large cell" (32.7%). By the Rappaport classification, 3 patients had nodular lymphomas, and "diffuse, histiocytic" was the most common subtype. 3) Infarction was present in 32 cases in which the "diffuse, lagre cell" type was most frequently associated. 4) In immunoperoxidase stains of 7 cases of angioimmunoblastic lymphadenopathy with dysproteinemia, proliferating immunoblasts revealed a polyclonal positivity for kappa and lambda chains. Atypical reticulocytes present in 26 cases of polymorphic reticulosis revealed a negativity for kappa, lambda and alpha-1-antichymotrypsin.
- Seborrheic Keratosis: A Clinical and Histopathological Study.
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Sung Ku Ahn, Dong Hwan Shin, Kwang Gil Lee, In Joon Choi
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Korean J Pathol. 1986;20(4):484-490.
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- A total of 127 cases of seborrheic keratosis examind at the Dept. of Pathology, Yonsei University School of Medicine during 1980~1986 was reviewed. The results were as follow; 1) Sex distribution showed without preponderance with male; Female ratio of 1.05:1. 2) Age distrubution were 10~19 years 0.8%, 20~29 years 4.7%, 30~39 years 14.2%, 40-49 years 25.2%, 50~59 years 29.1%, 60~69 years 17.3%, 70~79 years 6.3% and neck (3.7%). 3) The most common site was face (44.8%), followed by trunk (29.8), lower extremities (10.4%), scalp (6.7%) and neck (3.7%). 4) The clinical diagnoses were sebrorrheic keratosis (47%), nevus (15.4%), verruca (12%), malignant melanoma (7.7%), actinic keratosis (3.4%), pyogenic granuloma (2.6%), mass (2.6%), basal cell epithelioma (0.9%), corn (0.9%), leproy (0.9%), and angiokeratoma (0.9%). 5) The distributions of the light microscopic diagnosis were acanthotic 52 cases (42.9%), hyperkeratotic 33 cases (30%), irritated 17 cases (13.4%), adenoid 15 cases (11.8%), clonal 3 cases (2.4%), melanoacanthoma 1 case (0.8%) and mixed 6 cases (4.7%). 6) The lesions measured from 0.2 cm to 3 cm in maximum diameter and its color was light brown to black with sharply demarcated papule, pladque or nodule.
- A Case of Squamous Cell Carcinoma of the Skin Resembling Atypical Fibroxanthoma.
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So Young Jin, Woo Hee Jung, Kwang Gil Lee, Jung Bok Lee
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Korean J Pathol. 1986;20(2):250-253.
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- Both spindle cell variant of squamous cell carcinoma and atypical fibroxanthoma are most commonly presented as a solitary, often ulcerated nodule, occurring on sun-exposed skin of the elderly. These lesions also share the histologic features of diffuse or indistinct fascicular arrangement of polygonal or pulmp spindle cells. Therefore it is not easy to differentiate immunohistochemistry is done. A case of 73 year old woman with squamous cell carcinoma of the skin resembling atypical fibroxanthoma is presented.
- The Frequency of Enterochromaffin Cells in Stomach and Intestinal Carcinoma.
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Han Young Lee, Kwang Gil Lee, Yoo Bock Lee
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Korean J Pathol. 1986;20(1):49-59.
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- In 1927, Hamperl carried out histochemical studies on gastric cancer and found one case which contained many Fontana reactive argentaffin cells. Thereafter the gastric and intestinal adenocarcinomas which contain enterochromaffin cells such as argentaffin cell and argyrophil cell have been reported by several investigators.
As the results, many reports revealed that 1.7 to 8% of gastric carcinomas and about 3% of intestinal carcinomas contained argentaffin cells, and 13 to 20% of gastric carcinomas and 12 to 15% of intestinal carcinomas contained argyrophil cells. The present study is aimed to evaluate the frequency of argentaffin and argyrophil cells in gastric and intestinal carcinoma in relation to the histopathological patterns. The material consisted of 282 cases of gastric adenocarcinoma and 83 cases of intestinal carcinoma which were diagnosed at the Department of Pathology, Yonsei University College of Medicine from January 1982 through December 1983. All cases were stained with hematoxylin-eosin for histological classification and with silver impregnation techniques for argentaffin and argyrophil granules. Staining for mucin was also performed using PAS stain. The results obtained were as follows: 1) Among 282 cases of gastric carcinomas, Grimelius positive argyrophil cells are noted in 43 cases (15.2%) and Fontana-Masson positive argentaffin cells are noted in 5 cases (1.8%). 2) Among 83 cases of intestinal carcinomas, Grimelius positive argyrophil cells are noted in 15 cases (18.2%) and Fontana-Masson positive argentaffin cells are noted in 1 cases (1.2%). 3) In gastric carcinoma, argyrophil cells are present in 31 cases (17.5%) among 176 male patients and and in 12 cases (11.3%) among 106 female patients. 4) In intestinal carcinoma, argyrophil cells are present in 9 cases (20.4%) amogn 44 male patients, and in 6 cases (15.4%) among 39 female patients. 5) According to classification by Willis, argyrophil cells are present in 12 cases (11.1%) among 108 well to moderately well differentiated adenocarcinoma, 14 cases (14.4%) among 99 poorly differentiated adenocarcinoma, 6 cases (30%) among 20 mucinous carcinoma, and 11 cases (21.1%) among 52 undifferentiated carcinoma. There is no significant difference in the frequency of argyrophil cells in relation to the histological type. 6) According to general classification of intestinal carcinoma, argyrophil cells are present in 9 cases (21.4%) among 42 well to moderately well differentiated adenocarcinoma, 3 cases (15%) among 25 poorly differentiated adrcinom adenocarcinoma and and cases (18.7%) among 16 mucinous carcinoma. The argentaffin cells were noted only in one case, which was the case of well to moderately well differentiated adenocarcinoma. In summary, the results of this study indicates that the frequency of enterochromaffin cells was 15.2% in stomach carcinoma and 18.2% in intestinal carcinoma. According to histological type, the Grimelius positivity was higher in mucinous and undifferentiated type, and higher frequency was noted in male than female.
- Mucous Gland Adenoma of the Bronchus: A case report.
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So Young Jin, Kwang Gil Lee
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Korean J Cytopathol. 1985;19(3):368-373.
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- Mucous gland adenoma, one type of bronchial adenoma, is first introduced by Rosenblum and Klein2) in 1935 and very rare. Only twenty-one cases had been reported in english literature. This tumor must be differentiated from other types of bronchial adenoma because of completely benign clinical course. A case of mucous gland adenoma is presented which showed marked secondary calcification.
- Gastric Tuberculosis Associated with Gastric Carcinoma: A case report.
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Kyoung Sook Kim, Kwang Gil Lee, In Joon Choi
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Korean J Cytopathol. 1985;19(1):92-96.
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- The tuberculosis of the stomach is very rare disease and its association with gastric carcinoma is more so. The diagnosis of gastric tuberculosis is usually made on the histological basis not clinical findings. This case of gastric tuberculosis was found incidentally after the subtotal gastrectomy performed under the impression of stomach cancer. There was an ill-defined ulcerative lesion at the lesser curvature. Microscopically, poorly differentiated adenocarcinoma extended to the serosa and typical tuberculous granulomas were found in the lesion of stomach and regional lymph nodes. Acid-fast bacilli were demonstrated by Ziehl-Neelsen stain in the granuloms of the regional lymph nodes, and a case of gastric carcinoma is presented here and briefly reviewed with the literature.
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