Journal of Pathology and Translational Medicine

Sang In Shim

99 Articles

Lipofibromatosis: A Case Report.: Tae Eun Kim, Tae Jung Kim, Youn Soo Lee, Chang Suk Kang, Sang In Shim, Kyo Young Lee; Korean J Pathol. 2011;45(1):106-110.; DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.1.106

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Abstract PDF: Lipofibromatosis is a recently described rare benign fibrofatty tumor of childhood. It typically forms as an ill defined, slowly growing, painless mass. We present here the case of lipofibromatosis that occurred in a 21-year-old male who had complained of a bulging enlarged mass involving the right thigh and prepatella area for the previous 1 year. Magnetic resonance imaging showed an ill-defined reticular infiltration in the subcutaneous layer with subtle linear enhancement and high T2 signal intensity. The mass was surgically excised and it displayed an 11.0x5.5x1.5 cm-sized adipose appearance without encapsulation. Microscopically, the tumor was composed of alternating streaks of mature adipose tissue and a fibroblastic component that mainly involved the septa of adipose tissue. On immunohistochemical study, the fibroblastic component was positive for S-100, CD99, CD34, actin and bcl-2. He has shown an eventful recovery for 6 months after surgery.

Distribution of Dendritic Cells and Regulatory T-Cells in Cutaneous Lymphomas.: Changyoung Yoo, Young Seon Hong, Baik Kee Cho, Sang Ho Kim, Sang In Shim, Chang Suk Kang; Korean J Pathol. 2010;44(6):581-588.; DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.6.581

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Abstract PDF: BACKGROUND
Dendritic cells (DCs) play an important role in immune reactions. This study was designed to identify the distribution patterns of DCs and regulatory T-cells (Tregs) in cutaneous lymphomas.
METHODS
Immunohistochemistry was used to determine langerin expression on Langerhans cells, CD11b on inflammatory DCs, CD209 and CD11c on dermal DCs, CD303 on plasmacytic DCs, and Foxp3 on Tregs in 81 cases of cutaneous lymphomas.
RESULTS
Various DCs and Tregs were identified in most cutaneous lymphomas. Plasmacytic DCs, inflammatory DCs and Tregs were identified mainly in tumor areas, whereas dermal DCs were distributed both in the tumor and stromal areas. Among DCs, dermal DCs were most prominently identified in the cutaneous lymphomas not only in the tumor area but also in the stroma. The intense stromal infiltration of dermal DCs was consistent finding in T-cell lymphomas. Diffuse large B-cell lymphoma (DLBCL), not otherwise specified also showed intense stromal infiltration of dermal DCs, but stromal infiltration in DLBCL, leg type was relatively scant.
CONCLUSIONS
The results suggest that all types of DCs and Tregs are involved in cutaneous lymphoma tumor immunity. Among them dermal DCs may play a dominant role.

C1q Nephropathy: A Distinct Pathologic Entity.: Jung Ha Shin, Tae Eun Kim, Kyo Young Lee, Sang In Shim, Yeong Jin Choi; Korean J Pathol. 2009;43(4):335-341.; DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.4.335

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Abstract PDF: BACKGROUND
C1q nephropathy (C1qN) is a controversial diagnostic entity defined by Jennette and Hipp in 1985. The prevalence is very low and a few large scale studies have been reported. Application of the criteria for clinical diagnostics of C1qN may cause confusion with other glomerulonephropathies, such as minimal change disease (MCD) or focal segmental glomerulosclerosis (FSGS). In order to clarify the confusion with glomerulonephropathies, we did this study to identify the clinicopathological characteristics and the exact disease entity of C1qN.
METHODS
A total of 5,258 kidney biopsies at Kangnam St Mary's Hospital were reviewed. Twenty three cases (0.44%) met the criteria of C1qN. Twenty eight cases showing dominant C1q deposits without electron dense depostis (EDD) grouped as C1q+EDD-, and previously diagnosed typical cases of MCD and FSGS were selected for this study. Four groups were compared to each other with regard to the clinical and pathological aspects of the disease. RESULTS: C1qN patients had an average age of 30.4 years. Eighteen were males and 5 were females. Eighty seven percent had proteinuria and 18% had hematuria. By electron microscopy analysis, 100% had mesangial EDD and 47.8% showed foot process effacement. C1qN had some significant differences compared with C1q+EDD-, MCD and FSGS. CONCLUSIONS: C1qN is clinically and morphologically different from MCD and FSGS. However, additional long term studies are needed to fully define C1qN from other glomerulonephritis with C1q deposits.

IgA Nephropathy: Correlation of WHO Classification and Morphologic Semi-quantitative Scoring System.: Kyung Jin Seo, Tae Jung Kim, Kyo Young Lee, Sang In Shim, Yeong Jin Choi; Korean J Pathol. 2009;43(3):244-249.; DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.3.244

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Abstract PDF

BACKGROUND
IgA nephropathy (IgAN) is the most common glomerulonephritis worldwide, and the clinical course of IgAN shows marked variability. Many efforts have made to histologically predict the clinical outcome. There are two methods to classify IgAN. One is mainly based on the glomerular changes, such as the WHO and the Lee and Haas classification systems. The other is a morphologic semi-quantitative scoring system, which counts the changes of the glomerular, tubulointerstitial and vascular structures, respectively. The purpose of this study is to determine whether the WHO classification properly reflects the various morphologic findings of IgAN.
METHODS
We analyzed 354 cases of IgAN by both the WHO classification system and the semiquantitative scoring system and evaluated the correlations of these two methods.
RESULTS
The severity of the glomerular lesions (glomerulosclerosis, capsular adhesion and mesangial matrix expansion) and the tubulointerstitial lesions (interstitial fibrosis, tubular atrophy and interstitial lymphocytic infiltration) are strongly correlated with the increase of the WHO classes of IgAN (Spearman's rho [R] > or =0.5, p<0.05). There is a weak correlation between crescent formation and the increase of the WHO classes (R=0.3, p<0.05).
CONCLUSIONS
This study shows that the WHO classification well reflects the severity of various morphologic findings and this suggests a complementary role for the semi-quantitative scoring system in classifying IgAN.

Citations

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The Oxford classification as a predictor of prognosis in patients with IgA nephropathy
S. H. Kang, S. R. Choi, H. S. Park, J. Y. Lee, I. O. Sun, H. S. Hwang, B. H. Chung, C. W. Park, C. W. Yang, Y. S. Kim, Y. J. Choi, B. S. Choi
Nephrology Dialysis Transplantation.2012; 27(1): 252. CrossRef

The Cytology for Leukemic Cells in Cerebrospinal Fluid; Comparison of Conventional Cytology with Liquid-Based Cytology.: Changyoung Yoo, Youn Soo Lee, Chang Suk Kang, Sang In Shim, Kyo Young Lee; Korean J Pathol. 2009;43(2):164-170.; DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.2.164

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Abstract PDF: BACKGROUND
The cytological examination of cerebrospinal fluid (CSF) using conventional cytology with a cytocentrifuge (cytospin) is an important method for evaluating the involvement of leukemia in the CNS. Liquid-based cytology (LBC) is now a widely used cytological method not only for gynecological and non-gynecological specimens, but its application to CSF for the identification of leukemic cell has not yet been reported. In this study, we tried to compare conventional cytology with using a cytospin with LBC and Papanicolaou (Pap) staining. We also examined the modified LBC with Wright staining to assess whether this modified method can be useful for diagnosing Leukemia.
METHODS
We studied 30 cases of CSF that were obtained from 16 patients, including 17 cases of acute myeloid leukemia, 12 cases of acute lymphoblastic leukemia and 1 case of diffuse large B cell lymphoma. We applied conventional cytology with a cytocentrifuge (cytospin), LBC with Pap staining and modified LBC with Wright staining.
RESULTS
The morphological features of the LBC with Pap staining showed difficulty for interpretation when compared with conventional cytology with a cytospin, and mainly because of cellular shrinkage. The modified LBC with Wright staining showed good morphological features.
CONCLUSIONS
We suggest that modified LBC with Wright staining may be useful for examining CSF.

Evaluation for Cytopreservability of Manual Liquid-Based Cytology Liqui-PREP(TM) and its Application to Cerebrospinal Fluid Cytology: Comparative Study with Cytospin.: Gyeongsin Park, Kyungji Lee, Chan Kwon Jung, Dae Hyoung Lee, Bin Cho, Youn Soo Lee, Sang In Shim, Kyo Young Lee, Chang Suk Kang; Korean J Cytopathol. 2007;18(1):46-54.

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Abstract PDF: Cerebrospinal fluid (CSF) cytology is an effective tool for evaluating diseases involving the central nervous system, but his technique is usually limited by its low cellularity and poor cellular preservation. Here we compared the manual liquid-base Liqui-PREPTM (LP) to the cytospin (CS) with using a mononuclear cell suspension and we applied both methods to the CSFs of pediatric leukemia patients. The cytopresevability, in terms of cell yield and cell size, and the clinical efficacy were evaluated. When 2000 and 4000 mononuclear cells were applied, LP was superior to CS for the cell yield, 16.8% vs 1.7% (P=0.001) and 26.2% vs 3.5% (P=0.002), respectively. The mean size of the smeared cells was 10.60 micrometer in the CS, 5.01 micrometer in the LP and 6.50 micrometer in the direct smear (DS), and the size ratio was 1.7 (CS to DS), 0.8(LP to DS) and 2.1 (CS to LP), respectively. As compared to the cells in the DS, the cells in the CS were significantly enlarged, but those in the LP were slightly shrunken. Upon application to 109 CSF samples, 4 were diagnosed as positive for leukemia (positive), 4 had atypical cells and 101 were negative by CS; 6 were positive, one had atypical cells and 102 were negative by LP. For six cases, in which 4 were positive for leukemia and 2 of 4 had atypical cells by CS, they were positive by LP and they were also confirmed as positive according to the follow-up study. Three cases diagnosed as atypical cells (two by CS and one by LP), were confirmed as negative. In conclusion, these results suggest that LP is superior to CS for the cytopresevability and for rendering a definite diagnosis of cerebrospinal fluid.

Clinicopathologic Analysis of the Micropapillary Variant of Urothelial Carcinoma in Urinary.: Kyungji Lee, Ahwon Lee, Yeong Jin Choi, Kyo Young Lee, Chang Suk Kang, Sang In Shim; Korean J Pathol. 2006;40(4):263-268.

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Abstract PDF: BACKGROUND
Micropapillary urothelial carcinoma of urinary bladder is a rare and aggressive subtype of urothelial carcinoma (UC).
METHODS
AND RESULTS: Seven UCs with a micropapillary component (MPC) were identified by reviewing 135 cystectomy specimens of UC (5.2% in incidence). MPC was associated with conventional UC in 6 cases and the plasmacytoid variant of UC in 1 case. Lymph node metastasis, that characteristically contained MPC was present in 60% (3 out of 5 cases of regional lymph node dissection). Three patients with extensive MPC showed laminar propria invasion (pT1; 33%) and perivesical fat invasion (pT3; 67%). Two out of 3 patients with extensive MPC showed distant metastasis into the colon after cystectomy. The colonic lesions showed exclusively micropapillary differentiation. Four patients with focal or moderate MPC (pT2, 25%; pT3, 75%) were alive without disease at the time of writing this article. All 3 cases with extensive MPC had surface and/or invasive MPC on the prior TURB specimen. Immunohistochemically, the tumor cells were positive for cytokeratin 7, cytokeratin 20, EMA and E-cadherin and tissue retraction spaces that simulate lymphatic spaces were negative for CD34 in all 7 cases.
CONCLUSIONS
This study suggests that the micropapillary growth pattern in UC is a manifestation of aggressive behavior and UC with MPC must be included as part of the differential diagnosis when dealing with a metastatic lesion with a micropaillary structure.

ISUP/WHO Classification of Papillary Urothelial Neoplasms of Urinary Bladder: Consensus Study Conducted by Korean Society of Urogenital Pathology.: Jung Weon Shim, Jae Y Ro, Nam Hoon Cho, Young Sik Kim, Yong Wook Park, Sang In Shim, Dong Wha Lee, Yeong Jin Choi, Woon Sup Han; Korean J Pathol. 2006;40(4):282-288.

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Abstract PDF: BACKGROUND
Pathologic grading, one of the most important prognostic factors of papillary urothelial neoplasia (PUN) of the urinary bladder, has been revised continuously. The current study focused on the analysis of interobserver agreement on PUN of the urinary bladder bet- ween 1973 WHO classification (WHO 1973) and 1998 WHO/ISUP classification.
METHODS
Seventy five cases from 15 institutions were collected, and after review by Korean Society of Urogenital Pathology (KSUP), 30 cases were selected as follows; group I, WHO grade 1 and papillary urothelial neoplasm of low malignant potential by ISUP (7 cases), group II, WHO grade 2 and low-grade papillary urothelial carcinoma (16 cases), and group III, WHO grade 3 and high-grade papillary urothelial carcinoma (7 cases). Seventy five general surgical pathologists who participated in this study were asked to grade the tumors based on WHO/ISUP classification. Interobserver agreement between the participants' diagnosis and KSUP consensus diagnosis was analyzed by kappa value.
RESULTS
Interobserver agreement assessed by kappa value for all diagnostic groups was very low; for group I, kappa value was -0.900893722; for group II, -0.944650025, and for group III, -0.876728996. The overall kappa value of pathology residents was better than that of practicing pathologists.
CONCLUSIONS
The 1998 WHO/ ISUP classification could not be easily translated from the 1973 WHO classification and because of poor interobserver agreement, it appears that further work would be needed before it can be practically applied.

Expressions of Cyclin E-pathway Proteins (cyclinE, cdk2, p21, p27, p57) and Their Prognostic Significance in Non-small Cell Lung Carcinomas.: Ji Han Jung, Gyeongsin Park, Myung Ah Lee, Jae Ho Byun, Chan Kwon Jung, Heejeong Lee, Kyo Young Lee, Sang In Shim, Chang Suk Kang; Korean J Pathol. 2006;40(1):24-31.

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Abstract PDF: BACKGROUND
The aberrant expression of cyclins, cdk and cdk inhibitor has been shown to be involved in oncogenic transformation. The aim of this study was to investigate the expression of the cyclin E-pathway proteins (cyclin E, cdk2, p21, p27, p57) in human non-small cell lung carcinomas (NSCLC) and also to evaluate the clinical significance of these expressions.
METHODS
A total of 203 consecutive patients with completely resected pathological stage I-III NSCLC were retrospectively reviewed. The expressions of cyclin E, cdk2, p21, p27 and, p57 was examined by performing immunohistochemistry with using the tissue microarray method.
RESULTS
In the total cases, the expression levels of cyclin E, cdk2, p21, p27 and p57 were 39.9% (81/203), 48.3% (98/203), 68.0% (138/203), 32.5% (66/203) and 2.7% (5/203), respectively. The overexpression of cyclin E and cdk2 was significantly and inversely correlated with the histologic differentiation in the adenocarcinoma (p<0.05), but not in the squamous cell carcinoma. Among the clinicopathologic factors, the stage and lymph node metastasis were associated with overall survival (p<0.05). Among these proteins, the negative expression of p21 was significantly correlated with a shortened survival rate (p<0.05).
CONCLUSIONS
These data suggest that the overexpression of cyclin E and cdk2 and the loss of p21 and p27 are associated with tumor progression in NSCLC. The aberrant expression of p21 is correlated with a poor prognosis. Therefore the immunohistochemical analysis of this protein as well as the clinical stage and, lymph node metastasis may be useful tools for evaluating the prognosis of NSCLC patients.

Touch Imprint Cytology Contributed to the Frozen Section Diagnosis of Merkel Cell Carcinoma : A Case Report.: Changyoung Yoo, Youn Soo Lee, Joo Wan Park, Suk Kang Chang, Sang In Shim, Gyeong Sin Park, Kyo Young Lee; Korean J Cytopathol. 2006;17(2):143-147.

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Abstract PDF: Merkel cell carcinoma (MCC), a rare primary cutaneous small cell neuroendocrine carcinoma, is a tumor with distinct cytological features. In many cases, immunohistochemical staining (IHC) is required for the differentiation from other small round cell malignancies. Here we describe the cytological findings of Merkel cell carcinoma; these findings contributed to the diagnosis prior to performing IHC. A lower eyelid mass was excised and submitted for frozen section diagnosis. The frozen section diagnosis was consistent with a malignancy, but the more specific diagnosis was limited by the lack of specific histological features. Touch imprint cytology revealed a high cellularity with loosely cohesive small to large sized cells. The tumor cells showed hyperchromatic nuclei with fine chromatin and inconspicuous nucleoli, and thin-rimmed-cytoplasm including the characteristic eosinophilic button-like paranuclear inclusion, previously described as a pathognomonic cytological finding of MCC; this was not found in the H&E frozen section. In conclusion, we suggest that the touch imprint cytology may help in the differential diagnosis of small round cell neoplasms prior to performing IHC especially in frozen section diagnosis.

Fine Needle Aspiration Cytology of Inflammatory Myofibroblastic Tumor of Lung: A Case Report.: Gyeongsin Park, Kyungji Lee, Sun Mi Lee, Kyo Young Lee, Sang In Shim, Chang Suk Kang, Youn Soo Lee; Korean J Cytopathol. 2006;17(1):63-68.

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Abstract PDF: Inflammatory myofibroblastic tumor (IMT), normally referred to as inflammatory pseudotumor, is a fairly rare condition. Fine needle aspiration cytology (FNAC) of IMT has only rarely been reported. Here, we describe one such case of pulmonary inflammatory myofibroblastic tumor. A 30-year-old man presented with a 2.8cm-sized mass in his lung. Chest CT revealed a well defined, poorly enhancing mass. FNAC showed some fascicular or swirled clusters of spindle cells, admixed with occasional inflammatory cells and foamy histiocytes. The majority of the tumor cells evidenced bland, elongated nuclei, but infrequent pleomorphic nuclei. Some of the tumor cells evidenced nuclear grooves and intranuclear inclusions. Although the cytological differentiation of IMT from malignant lesions is not immensely problematic, due to the general paucity of cytological and nuclear atypia, a definite cytological diagnosis of IMT cannot be rendered simply by FNAC. Therefore, a diagnosis of IMT may be suggested via exclusive diagnosis.

The Expression of Matrix Metalloproteinase-9 and Tumor Angiogenesis in Human Osteosarcoma.: Jinyoung Yoo, Ji Han Jung, Hyun Joo Choi, Seok Jin Kang, Anhi Lee, Eun Joo Seo, Sang In Shim, Chang Suk Kang; Korean J Pathol. 2005;39(6):418-423.

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Abstract PDF: BACKGROUND
Matrix metalloproteinase-9 (MMP-9) is a matrix-degrading enzyme that's believed to play a crucial role not only for tumor invasion and metastasis, but also for a variety of stromal reactions, including neovascularization. The aim of this study was to investigate the expression of MMP-9 and to compare its expression with the angiogenesis activity in human osteosarcoma.
METHODS
Archival tumor tissue samples from 20 patients with osteosarcoma were analyzed by performing immunohistochemistry for the expression of MMP-9 and CD34. The vascularity was measured as the average microvascular density (MVD) of the CD34-positive vessels. The clinical information was obtained through searching the computerized retrospective database from the tumor registry.
RESULTS
MMP-9 was expressed in 90% (18/20) of the tumors we examined. The MVD ranged from 10.5 to 179.7 with a mean of 64.9. There was no significant correlation between the MMP-9 expression and the MVD (p=.613). The MMP-9 expression was not associated with any of the clinicopathologic variables, whereas the MVD showed an increasing tendency according to the metastasis status (p=.073).
CONCLUSIONS
We demonstrated that MMP-9 activation is likely to occur in human osteosarcoma. However, there was no direct involvement of MMP-9 with tumor angiogenesis. It is noteworthy that MVD may aid physicians to predict the presence of distant metastasis in osteosarcoma patients.

Epidermoid Cyst in the Kidney with Nephrolithiasis: A Case Report.: Changyoung Yoo, Yeong Jin Choi, Kyoyoung Lee, Sang In Shim, Chang Suk Kang; Korean J Pathol. 2005;39(5):348-350.

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Abstract PDF: Epidermoid cysts in the kidney have rarely been reported, and in most cases its pathogenesis has not been well understood. We report a case of an epidermoid cyst in a kidney with nephrolithiasis in a 61-year-old man. A pyelonephrolithotomy was performed on the patient four years ago to treat nephrolithiasis of the left kidney. During the follow-up, a newly developed mass was discovered three years ago and the mass has recently increased in size. A unilateral nephrectomy was performed under the clinical impression of renal cell carcinoma. Gross examination revealed a well encapsulated cystic mass measuring 3.0 x 2.0 x 2.0 cm and containing lumps of soft whitish material, in the upper pole of the left kidney. This location was the same as that of previous nephrolithiasis. Microscopic examination revealed typical findings of an epidermoid cyst. We suspect that the chronic irritation induced by renal stones may be associated with the development of the epidermoid cyst in this case.

Combined IgA Nephropathy and Membranous Glomerulonephritis : A Report of Six Cases.: Ji Han Jung, Yeong Jin Choi, Yong Soo Kim, Yoon Sik Chang, Byung Kee Bang, Sang In Shim, Chang Suk Kang; Korean J Pathol. 2005;39(4):278-283.

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Abstract PDF: IgA nephropathy (IgAN) and membranous glomerulonephritis (MGN) are common in adults. However, it is unlikely that these two distinct glomerulonephrites coexist in a renal biopsy. Here, we report clinical and pathological data of six patients with concomitant existence of IgAN and MGN in renal biopsy specimens from 1990 to 2004. Five patients were male and one was female, and their ages ranged from 29 to 71 years. Four patients had microscopic hematuria, five had nephrotic range proteinuria, three had hepatitis B virus infections, three had rheumatoid factors, one had antinuclear antibodies. Two cases were developed after kidney transplant. Immunofluorescence microscopy showed characteristic findings of mesangial IgA deposits and granular IgG deposits on the capillary walls. These were confirmed by electron microscopic findings of immune-type electron-dense deposits in the mesangium and subepithelial capillary basement membranes. The pathogenesis and prognosis of the patients are discussed in this report.

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

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

Fine Needle Aspiration Cytology of Mucinous Cystic Carcinoma of the Pancreas: A Case Report.: Kyungji Lee, Ahwon Lee, Kyo Young Lee, Chang Suk Kang, Sang In Shim; Korean J Cytopathol. 2005;16(2):88-92.

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Abstract PDF: Mucious cystic neoplasm of pancreas is a cystic neoplasm composed of columnar, mucin-producing epithelium and is supported by ovarian-type stroma. The key to the cytologic evaluation of pancreatic cystic lesions is to recognize the cytologic components as being diagnostic of a mucin-producing cystic neoplasm, as all of these neoplasms need to be resected. We report the use of fine needle aspiration cytology in the diagnosis of an invasive mucinous cystic carcinoma confirmed by partial pancreatectomy. The cytologic specimen showed a abundant mucin background and sheets or papillae of neoplastic cells. There are mucin-containing columnar cells that show a variable degree of cytologic atypia.

Prognostic Significance of P53, BCL-2 and PCNA in Diffuse Large B-Cell Lymphoma: Correlation with International Prognostic Index.: Dong chul Kim, Gyeongsin Park, Ahwon Lee, Kyo Young Lee, Sang In Shim, Chang Suk Kang; Korean J Pathol. 2003;37(6):407-412.

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Abstract PDF: BACKGROUND
Diffuse large B-cell lymphoma (DLBCL) represents a diverse spectrum of clinical presentation, morphology, and genetic and molecular alterations, and shows variable prognoses and responses to therapy. The International Prognosis Index (IPI) is widely used to predict prognosis but is not precise.
METHODS
Thirty-nine cases of DLBCL were classified into low- and high-risk groups according to IPI and were analyzed for their p53, BCL-2, BCL-6 and PCNA expression profile by immunohistochemical staining and overall survival rate.
RESULTS
The mean age of the 39 patients, 23 males and 16 females, was 52.6 years. There were 23 cases (59.0%) in the low-risk group and 16 (41.0%) in the high-risk group. p53, BCL-2, BCL-6 and PCNA expression was higher in the high-risk group than in the low-risk group, but only the differences in p53 and BCL-2 expression were statistically significant (p < 0.05).
CONCLUSION
The p53 and BCL-2 protein expression in DLBCL may supplement IPI in predicting the prognosis of DLBCL patients.

Epithelial-Myoepithelial Carcinoma of the Parotid Gland: Report of a Case Misinterpreted as Pleomorphic denoma on Fine Needle Aspiration Cytology.: Dong Chul Kim, Ahwon Lee, Kyo Young Lee, Cang Suk Kang, Sang In Shim; Korean J Cytopathol. 2002;13(1):42-46.

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Abstract PDF: Epithelial-myoepithelial carcinoma(EMC) is a rare, low grade malignant tumor of the salivary glands. The EMC has a distinctive histological appearance comprising ductal structures with an inner epithelial cell component and an outer layer of myoepithelial cells which show plump clear cytoplasm. The cytologic features of the EMC have been rarely described. A correct cytological diagnosis to this rare tumor is difficult with high false negative rate. We report a case of EMC in which fine needle aspiration cytologic findings were misinterpreted as a pleomorphic adenoma.

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

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

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

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

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

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

Cranial Fasciitis of Childhood: A case report.: Ok Ran Shin, Kyo Young Lee, Young Shin Kim, Chang Suk Kang, Sang In Shim; Korean J Pathol. 2000;34(2):164-166.

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Abstract PDF: Cranial fasciitis is a rare fibroblastic tumor which shows a predilection for the scalp of young children. We present a child with a rapidly growing mass and lytic skull lesion which on pathologic evaluation was diagnosed as cranial fasciitis. Histologically this lesion was identical to nodular fasciitis which was typically found in the trunk and extremities of adults. Cranial fasciitis is unique in that it may present as a lytic lesion in the skull, but this disease entity is not widely known to pathologists and radiologists, and should be included in the differential diagnosis of fibroblastic lesion occurring in the cranium of young children.

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

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

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

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

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

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

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

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

Expression of Matrix Metalloproteinase-1,2,3 and Type IV Collagen in Gastric Adenocarcinoma: Influence on Lymph Node Metastasis and Prognosis.: Eun Sun Jung, Byung Gee Kim, Jo Hyun Park, Sang In Shim; Korean J Pathol. 1999;33(4):251-258.

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Abstract PDF: Matrix metalloproteinases are believed to play an important role in tumor invasion and metastasis. But little is known about the role of them in the gastric adenocarcinoma. We investigated the expression of matrix metalloproteinase-1,2,3 in eighty paraffin blocks of the primary gastric adenocarcinoma tissues with immunohistochemistry and analysed their correlation with lymph node metastasis and survival. MMP-1,2,3 were expressed most intensely in the fibroblasts around the tumor stroma. In our study the increased immunoreactivity of MMP-2 only showed statistically significant correlation with lymph node metastasis (P=0.0517, Odd's ratio=2.274). But MMP-1,2,3 all were correlated with survival. Type IV collagen was observed in the vascular basement membranes and tumor basement membranes and showed statistically significant correlation with lymph node metastasis (P=0.0002, Odd's ratio=0.194) and prognosis (P=0.0001). The immunoreactivity of MMP-2 and type IV collagen was inversely correlated (Kendall's Tau-b correlation = 0.37482, P=0.0001). Our results suggest that in human gastric adenocarcinoma the increased immunoreactivity of MMP-2 and the decreased immunoreactivity of type IV collagen has an important role in lymph node metastasis and prognosis. MMP-1,3 are not correlated with lymph node metastasis but correlated with survival. The mechanism responsible for the production of MMP by the host fibroblasts remains obscure and requires further investigation.

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

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

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

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

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

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

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

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

The Expression of p53, c-erbB-2 and nm23 Proteins in Breast Cancer.: Kyo Young Lee, Yong Goo Kim, Young Shin Kim, Kyung Ja Han, Chang Suk Kang, Jean A Kim, Won Il Kim, Sang In Shim; Korean J Pathol. 1999;33(2):88-95.

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Abstract: Recently, p53, c-erbB-2 and nm23 proteins have been studied in breast cancer. The expression of p53 protein indicates the mutation of p53 gene known as a tumor supressor gene, and c-erbB-2 gene amplification has been considered an indicator of poor prognosis and nm23 a metastsis suppressor gene. In order to elucidate the roles and relations of these proteins in the develpoment, progression and metastasis in breast cancer, we studied 89 cases of invasive breast cancer and 32 cases of lymph node metastasis for the expression of p53, c-erbB-2 and nm23 proteins using an immunohistochemical method. The results were as follows: 1) The expression rates of p53, c-erbB-2, and nm23 proteins in breast cancer were 40.4%, 34.8% and 55.1%, respectively. Co-expression of p53 protein and c-erbB-2 protein was found in 20.2% of cases, showing the highest incidence in poorly differentiated type (40%). 2) p53 protein expression was increased in poorly differentiated type but was not statistically significant. On the other hand, the expression of nm23 protein was decreased in poorly differentiated type, which was statistically significant (p<0.05). 3) The correlation of p53 protein expression with c-erbB-2 protein expression was statistically significant (p<0.05) but that with nm23 protein was not. 4) In the cases with lymph node metastasis, discordant expression of p53, c-erbB-2 and nm23 proteins between primary tumor and the lymph node metastatic tumor was found in 9.4%, 3.1% and 18.8% of cases, respectively. The above results suggest that overexpression of p53 and c-erbB-2 proteins and downregulation of nm23 protein are associated with the tumor progression in the breast cancer.

Sarcomatoid Transitional Cell Carcinoma of the Renal Pelvis A report of two cases.: Kyo Young Lee, Mi seon Kwon, Yeong Jin Choi, Chang Suk Kang, Seok Jin Kang, Baying Kee Kim, Sang In Shim; Korean J Pathol. 1999;33(2):128-132.

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Abstract: Sarcomatoid carcinomas are malignant epithelial neoplasms in which the tumor cells assume a partial or complete spindle cell pattern of growth, leading to the erroneous classification of some true carcinomas as sarcomas. These spindle cells are malignant and manifest various amount of both vimentin and cytokeratin. Positive reaction of some of the spindle cells for cytokeratin antibodies is confirmatory. Clinical features do not differ significantly from those of patients with high-grade transitional cell carcinoma. So far, 13 cases of sarcomatoid transitional cell carcinoma of the renal pelvis have been reported in English and Korean literature. In this report, we describe clinicopathologic features of recently observed two cases of sarcomatoid transitional cell carcinoma of the renal pelvis and summarize the pathologic findings of previously reported cases with review of the literature.

B-cell Prolymphocytic Leukemia Involving Entire Female Genital Tract: A case report.: Hee Jung Lee, Young Shin Kim, Yong Gu Kim, Kyung Ja Han, Kyo Young Lee, Chang Suk Kang, Sang In Shim, Jong Wook Lee, Woong Shick Ahn, Soo Pyung Aim, Seung Il Kim; Korean J Pathol. 1999;33(2):145-148.

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Abstract: Prolymphocytic leukemia is a chronic lymphoproliferative disorder, characterized by prominent splenomegaly, prolymphocytes accounting for more than 55% of circulating lymphocytes, no significant peripheral lymphadenopathy and short term survival with terminal fatal multi-organ failure. We report a case of B-cell prolymphocytic leukemia in a 57-year-old woman who presented with easy bruising and arthritis for 1 year and low abdominal pain for 2 months. Physical examination revealed gingival hypertrophy and mild splenomegaly. On peripheral blood smears the leukocytes were markedly increased in number due to leukemic cells that count about 62% of leukocytes. The bone marrow aspiration smear and biopsy revealed diffuse infiltration of medium to large prolymphocytes having moderate amount of basophilic cytoplasm, round to oval nuclei with coarse chromatin, and prominent nucleoli. Abdominal pain aggravated despite chemotherapy, and pelvic computed tomography (CT) revealed a huge lobular pelvic mass which had increased in size on the follow-up CT. Total hysterectomy with bilateral adnexectomy was performed. Microscopic findings included massive infiltration of prolymphocytic cells in the uterus, upper vaginal wall, bilateral ovaries, and bilateral mesosalpinges. On immunohistochemistry, the leukemic cells showed B cell gamma light chain phenotype.

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

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

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

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

Fine Needle Aspiration Cytology of a Pilomatrixoma Misdiagnosed as Carcinoma: A Case Report.: Ji Han Jung, Young Shin Kim, Kyo Young Lee, Chang Suk Kang, Sang In Shim; Korean J Cytopathol. 1999;10(1):91-96.

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Abstract PDF: Sometimes a pilomatrixoma on upper neck can be misdiagnosed as primary salivary gland tumor, skin adnexal tumor or metastatic carcinoma. On fine needle aspiration cytology(FNAC), characteristic features are ghost cells, basaloid cells, and calcium deposits, among which presence of ghost cells seems to be the key to recognize it. Here we present a cytologically misdiagnosed case of pilomatrixoma. A 32-year-old man presented a subcutaneous mass on the right posterior neck. It has grown slowly for 1 year, and was nontender, well circumscribed, hard, and movable mass. An initial FNAC yielded only monomorphic population of highly mitotic basaloid cells, without anucleated ghost cells, chronic inflammatory cells or foreign-body giant cells, suggestive of a poorly differentiated carcinoma. However, that was inconsistent with patient's clinical findings. For further correct diagnosis, FNAC was repeated, which yielded the basaloid cells and foreign-body giant cells. The diagnosis of pilomatrixoma could be made and the mass was excised. This case demonstrates that the pilomatrixoma should be considered in the differential diagnosis of subcutaneous aspirates containing not ghost cells but a dominant population of basaloid cells.

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

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

Serratia marcescens Skin Abscess.: Chan Kwon Jung, Young Shin Kim, Kyo Young Lee, Kyungja Han, Chang Suk Kang, Sang In Shim, Jun Young Lee, Baik Kee Cho; Korean J Pathol. 1998;32(11):1032-1034.

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Abstract: Serratia marcescens is the most important member of the genus Serratia and causes opportunistic infections, particularly pneumonia and septicemia in patients with malignancy, renal failure (acute and chronic), and diabetes mellitus. The most common portals of entry are known to be, in descending order, lung, genitourinary tract, intravenous line, gastrointestinal tract, and skin. S. marcescens rarely causes skin infection because it does not normally colonize human skin. Only six cases of S. marcescens cellulitis were reported. Five of them were immunocompromised patients. We have experienced a case of skin abscess caused by S. marcescens, which was found in a 59-year-old woman. She was undergoing prior antibiotic treatment after insulinoma surgery. S. marcescens was isolated from the skin abscess as a sole organism. She was treated with appropriate antibiotics that exhibited sensitivities for the organism and cured without any complication. The authors report a case of S. marcescens infection on the skin of a 59-year-old woman and review the literature concerning this organism as a causative agent.

Heterotopic Brain Tissue in the Soft Palate.: Hyun Joo Choi, Youn Soo Lee, Young Shin Kim, Kyo Young Kim, Chang Suk Kang, Sang In Shim; Korean J Pathol. 1998;32(11):1039-1041.

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Abstract: Heterotopic brain tissue is a developmental anomaly of neurogenic origin with no malignant potential, and is usually present around the nose of children and infants. So it has been called nasal glioma. But, even more rarely, heterotopic glial tissue may be found in various sites other than nasal cavity, such as the ethmoidal sinus, palate, tonsillar area, pharynx, ear, subcutaneous tissue, lung, and female genital tract. We experienced a more unusual case of a polypoid heterotopic brain tissue in the soft palate in a 3-year-old boy. The mass was microscopically reminiscent of "gliosis" of the central nervous system and interestingly contained choroid plexus focally. The glial nature of the lesion was confirmed by glial fibrillary acidic protein immunostain.

Primary Malignant Melanoma of the Esophagus: A case report.: Lee So Maeng, Kyoung Mee Kim, Eun Jung Lee, Anhi Lee, Sang In Shim; Korean J Pathol. 1998;32(9):694-696.

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Abstract: This report presents an unusual case of primary malignant melanoma in the midesophagus. The patient was a 36-year-old woman presenting with dysphagia and odynophagia. The resected esophagus and proximal stomach showed a dark purple large polypoid mass, measuring 6.0 3.3 2.0 cm, with a diffuse tan pigmentation of surrounding mucosa in the mid-esophagus and two small daughter nodules, up to 1.2 0.3 cm, in the lower esophagus near the gastro-esophageal junction. A microscopic examination revealed a malignant melanoma of epithelioid cell type confined to mucosa and submucosa with a diffuse melanosis. Cytoplasmic immunoreactivity for HMB 45 and S-100 protein were noted. An electron microscopic examination revealed large, loosely cohesive variable shaped cells with a few cytoplasmic premelanosomes.

Paneth Cell-rich Carcinoma of the Stomach: A case report .: Ah Won Lee, Young Shin Kim, Kyo Young Lee, Chang Suk Kang, Sang In Shim; Korean J Pathol. 1998;32(8):613-615.

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Abstract: Paneth cell-rich carcinoma is essentially an adenocarcinoma with a predominance of Paneth cells. A 60-year-old male patient was admitted with a history of abdominal distension for several months. Endoscopic examination revealed a large ulceroinfiltrative tumor involving most of the areas of the stomach. The biopsy of the lesion confirmed poorly differentiated adenocarcinoma and total gastrectomy was followed. The submitted total stomach contained a diffuse infiltrative Borrmann type IV mass with ulceration, 8.0 3.5 cm, at the body along the lesser curvature. Microscopically, it was composed of Paneth cell differentiated cancer cells and poorly differentiated tubular adenocarcinoma cells. The Paneth cell differentiation was characterized by cytoplasmic coarse eosinophilic granules, which were PAS-positive and positive reaction for lysozyme. Electron microscopic examination showed numerous, spherical, electron-dense, homogeneous granules corresponding to those in Paneth cells as well as mucin granules in the signet-ring cells, and various intermediate forms in some cancer cells, which might be immature in the Paneth cell lineage.

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

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

Hemorrhagic Pseudocyst of the Adrenal Gland: A case report.: Kyoung Mee Kim, Anhi Lee, Kyung Myung Sohn, Seung Man Park, Sang In Shim; Korean J Pathol. 1998;32(7):543-545.

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Abstract: Adrenal pseudocysts are rare benign cystic lesions resulting from a hemorrhage into a normal parenchyme of the adrenal gland. Although the frequency of adrenal cysts are increasing due to improved radiologic imaging techniques, only two cases have been reported in Korean literatures. A 63-year-old man was presented with a 10-year history of a mass in the right abdomen. Abdominal computed tomogram and a magnetic resonance image study showed a 9 cm sized well defined heterogeneous low attenuated mass in the right suprarenal area. Gross examination revealed an ovoid rubbery mass measuring 10 9 8 cm and weighing 355 gm. The content of this lesion was tan to deep brown, necrotic, and creamy with myxoid areas. Histologic examination revealed compressed, thin layers of adrenal cortex embedded in the fibrous tissue, and the cystic contents were eosinophilic fibrinoid materials with a few dilated cavernous vascular spaces lined by endothelial cells.

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

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

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

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

Detection of Minimal Lesion and Identification of Clonality in Malignant Lymphoma.: Young Shin Kim, Chang Suk Kang, Kyun gja Han, Kyo Young Lee, Yong Goo Kim, Won Il Kim, Sang In Shim; Korean J Pathol. 1998;32(4):298-308.

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Abstract PDF: The bone marrow biopsy is an integral part of the staging process in patients with malignant lymphomas. Bone marrow(BM) involvement indicates stage IV disease, but there are always a lot of cases in which clear separation is not possible when based on morphology alone. Additional difficulties are caused by morphologic discordance between the BM and the primary lymphoma. Immunohistochemical stain, mRNA in situ hybridization (ISH) for light chain restriction and polymerase chain reaction (PCR) for IgH CDR3 and TCRgamma were performed to find a minimal lesion and the clonality in formalin fixed paraffin embedded tissues of 39 primary lymphomas and corresponding BM biopsy specimens. As a result, nine morphologically negative bone marrows of 18 lymphomas were positive by PCR (Group I). Among the 6 lymphoma cases with morphologically suspicious BM involvement (Group II), one was confirmed to be positive for marrow involvement by both mRNA ISH and PCR and the other four by PCR alone. The positive bone marrows of Group I and II revealed gene rearrangement at the same site as the primary lesion, suggesting the same clonality. Thirteen of 15 lymphomas with morphologically positive BM (Group III) had the same clonality in the primary lymphomas and the BM lesion. Three cases among the Group III with morphologic discordance also revealed the same clonality by PCR. This study shows that a combination of mRNA ISH and PCR in addition to an immunohistochemical stain improves the diagnostic sensitivity in the detection of BM involvement and identification of clonality. Among the three different methods used, PCR is the most sensitive in detecting a minimal lesion.

Histopathologic Findings & Expression of bcl-2 of the Endometrium Analysis of 1,000 consecutive biopsies of uterine bleeding .: Hye Kyung Lee, Dong Geun Lee, Ho Lee, Sang In Shim; Korean J Pathol. 1998;32(3):208-214.

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Abstract PDF: We evaluated 1,000 consecutive endometrial curettage samples obtained over a 30 month period. The clinico-pathologic correlation was analysed according to Hendrickson's five criteria based on the practical view. The causes of uterine bleeding in decreasing order of occurrence were as follows: 1) hormonal imbalance lesions (49.2%) encompassing glandular and stromal breakdown suggesting anovulatory bleeding, proliferative phase endometrium, and disordered proliferative endometrium, 2) pregnancy associated lesions (24.2%), 3) organic lesions (13.5%), 4) endometrial hyperplasia (6.9%), and 5) inadequate specimen (6.2%). According to age, pregnancy related lesions were most frequent in the third decade. In the fourth, fifth, and sixth decades, hormonal imbalance lesions were the most common cause. In approximately 30% of the samples, there were two or three morphologic patterns such as anovulatory bleeding with an endometrial polyp, postabortal bleeding with inflammation, and glandular-stromal dissociation with a polyp, which suggested there was a variable histologic morphology in the same disease spectrum. Using immunohistochemical techniques we studied the hormonal dependency of bcl-2 oncoprotein in anovulatory bleeding, endometrial hyperplasia, and proliferative endometrium. 70% of anovulatory bleeding specimens showed weak positivity in the epithelial cytoplasm, and all cases of endometrial hyperplasia and carcinoma showed a strong positivity. These results suggest that there is a estrogenic hormonal dependency of apoptosis in the endometrium.

Immunohistochemical Study of p53 and E-cadherin Proteins in Prostate Carcinoma.: Lee So Maeng, Won Il Kim, Kyo Young Lee, Young Shin Kim, Chang Suk Kang, Sang In Shim; Korean J Pathol. 1998;32(3):215-221.

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Abstract PDF: Considerable controversy exists concerning the value of histomorphological data in the assessment of the malignant potential of prostate carcinomas. Mutations in the p53 gene resulting in the accumulation of altered p53 proteins with prolonged half-life have been found in a large variety of human malignancies. E-Cadherin is a specific epithelial cell-to- cell adhesion molecule which has previously been found to be expressed in well-differentiated non-invasive carcinoma cell lines, but it is lost in many poorly differentiated invasive cell lines. We performed immunohistochemical staining of p53 and E-cadherin in formalin fixed paraffin embedded tissues of 58 primary prostatic carcinomas. The expression rates of p53 and E-cadherin proteins in prostate carcinoma were positive in 15.5% and 44.8% of the cases, respectively. Histologically high-grade prostate carcinoma shows an increased expression of the p53 protein and a decreased one of the E-cadherin protein (P<0.05). The expression rates of the E-cadherin protein in prostate carcinoma decreased significantly according to the higher clinical stages and PSA levels (P<0.05). There was no accordance between the expression rate of p53 and E-cadherin. There were no significant correlation between each of the clinical stages and the expression rate of p53 protein or the PSA levels and the expression rates of p53 protein (P<0.05). Based on the present study, the expression of p53 and down regulation of E-cadherin are correlated with tumor progression and metastasis, and may be a useful prognostic factor in prostate carcinoma.

Pulmonary Pseudallescheriasis: A case report and Histopathologic Comparision with Pulmonary Aspergillosis.: Young Sill Kim, Chang Suk Kang, Kyung Ja Han, Kyo Young Lee, Sang In Shim, Young Shin Kim; Korean J Pathol. 1998;32(2):147-149.

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Abstract PDF: Infection by pseudallescheria boydii is an occasional cause of mycetoma, corneal ulcers, endophthalitis, sinusitis, pneumonia, endocarditis, meningitis, arthritis, and osteomyelitis. But, it also causes serious disseminated or localized infection in immunocompromised patients. We report a case of pulmonary pseudallescheriasis developed in a 32-year-old man who has been a sofa manufacturer for several years. He presented with a cystic mass in the lung, 5cm in the largest dimension. Dark green necrotic material was evacuated from the cavity. Microscopically, the cystic wall and adjacent lung parenchyme were infiltrated by histiocytes rather than eosinophils and there was little fibrosis in the wall. The P. boydii was isolated from the cystic contents, which revealed white floccose colonies in Sabouraud dextrose agar and revealed single or multiple-celled oval conidia being produced on short hyalinated hyphae and on the elongated annellides in the slide culture. The differential findings with aspergillosis are discussed.

Expression of the nm23 and E-cadherin Proteins in Breast Carcinoma.: Jean a Kim, Won Il Kim, Sang In Shim, Chang Suck Kang, Kyo Young Lee, Young Shin Kim; Korean J Pathol. 1998;32(1):29-34.

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Abstract PDF: Expression of the nm23 and E-cadherin proteins has been studied in a number of tumors. Reduced expression of the nm23 and E-cadherin proteins seems to be associated with metastasis or disease progression in some tumors, including breast carcinoma. To assess the role of nm23 and E-cadherin in tumor differentiation and metastasis of breast carcinoma, immunohistochemical staining for the nm23 and E-cadherin proteins was performed in paraffin embedded tumor samples from 86 breast carcinomas. The results were as follows: 1) Expression of the nm23 protein in breast carcinoma was strong positive in 32 cases (37.2%), weak positive in 26 cases (30.2%), and negative in 28 cases (32.6%) of the cases. Expression of the nm23 protein in breast carcinoma decreased according to histological grade and lymph node metastasis, but was not statistically significant. 2) Expression of the E-cadherin protein in breast carcinoma was strong positive in 50 cases (58.1%), weak positive in 24 cases (27.9%), and negative in 12 cases (14%) of the cases. Expression of the E-cadherin protein in breast carcinoma decreased according to histological grade and lymph node metastasis, but was not statistically significant. 3) There was a statistically significant correlation between the expression of the nm23 protein and the E-cadherin protein in breast carcinoma (p<0.05). These results suggest that the expression of the nm23 and E-cadherin proteins is related to tumor differentiation, and may also be an useful prognostic factor in breast carcinoma.

Normoblasts and Lymphocytes Carry the Fused Bcr-Abl Gene in Chronic Myelogenous Leukemia: Two Color Fluorescence in Situ Hybridization(FISH) Analysis on the Blood Smears.: Chang Suk Kang, Eun Jung Lee, Won bae Lee, Yong goo Kim, Kyung Ja Han, Kyung Soo Lee, Sang In Shim; Korean J Pathol. 1998;32(1):58-62.

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Abstract PDF: We performed dual color fluorescence in situ hybridization (FISH) for the bcr/abl fusion in CML using the peripheral blood smears without destruction of cell morphology to determine the bcr/abl fusion. Two patients of CML, one patient in accelerated phase and one patient in chronic phase, were selected. The blood smears were fixed in absolute methanol. FISH was performed with the Mbcr/abl translocation DNA probe mixture and the slides were stained with Wright's stain after FISH. The blood smears of both cases revealed distinct signals without destruction of cellular morphology. The normoblasts and lymphocytes revealed beautiful fused bcr/abl signals as well as granulocytes in both cases. The results provide a novel finding that the normoblasts and lymphocytes in CML are also neoplastic clonal cells which has not been demonstrated with a single-cell approach before.

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

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

Cytologic Features of Adenoma Malignum of the Uterine Cervix: A Case Report.: Hyun Joo Choi, Young Shin Kim, Kyo Young Lee, Chang Suk Kang, Sang In Shim; Korean J Cytopathol. 1998;9(2):201-206.

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Abstract PDF: Adenoma malignum is an extremely well-differentiated variant of cervical adeno carcinoma in which the cells composing the tumor lack the typical cytological features of malignancy. The prognosis of this rare tumor is poor in spite of high degree of differentiation. The cytologic characteristics are extremely bland, so frequently make a confusion of adenoma malignum with endocervical glandular hyperplasia. We report a case of adenoma malignum in a 36-year-old woman who complained of mucoid vaginal discharge and vaginal bleeding. The cervicovaginal smear showed endocervical cells exhibiting a spectrum of atypical changes. The cells were arranged in multilayered strips and monolayered sheets. Individual cells ranged from cuboidal to columnar; typically the columnar cells had abundant lacy or vacuolated cytoplasm. The smear showed the majority of only atypical cells and small numbers of frankly malignant cells.

Fine Needle Aspiration Cytoloy of Poorly Differentiated "Insular" Carcinoma of the Thyroid: A Case Report.: Hee Jung Lee, Kyung Shin Park, Young Shin Kim, Kyo Young Lee, Chang Suck Kang, Sang In Shim; Korean J Cytopathol. 1998;9(1):117-122.

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Abstract PDF: Cytologic features of a poorly differentiated "insular" carcinoma of the thyroid are presented. In fine needle aspiration cytology, the aspirates were highly cellular and tumor cells were arranged in loose clusters or singly dispersed on focally necrotic background. Occasional microfollicles were evident. The tumor cells had poorly defined, scanty cytoplasm and most of the nuclei were fairly uniform with coarse chromatin pattern. A few large pleomorphic cells were also noted. The cytologic findings of the present case were correlated well with the histologic findings, which showed typical insular pattern and the presence of uniform cells with occasional pleomorphism.

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

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

Mucous Gland Adenoma of the Bronchus; Light Microscopic and Ultrastructural Features.: Mi Seon Kwon, Kyo Young Lee, Young Shin Kim, Chang Suk Kang, Sang In Shim; Korean J Pathol. 1997;31(9):898-901.

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Abstract PDF: We present a case of mucous gland adenoma arising from the main bronchus of the lower lobe of the left lung in terms of clinicopathologic, immunohistochemical, and ultrastructural aspects as well as review of related literatures. The patient, a 31-year-old female, was admitted to Catholic University Medical College Hospital with complaints of coughing and purulent sputum for about seven years. The chest CT showed a severely calcified tumor in the left lower lobe of the lung. Grossly, the calcified tumor arising from the main bronchus protruded into the lumen and showed bronchiectasis of the lower lobe and atelectasis of the upper lobe of the lung. The tumor was pale brown-gray and sharply circumscribed and showed some small cystic spaces filled with mucoid material. Microscopically, most of the tumor showed dystrophic calcification. The growth pattern of the tumor is composed of cysts, tubules, and glands lined by cytologically bland columnar, cuboidal, or flattened mucus secreting cells. Electron micrograph of tumor cells showed some round or oval mucous granules measuring 0.5-1.8 micrometer.

Pathologic Diagnosis of Intestinal Tuberculosis in Endoscopic Biopsied Material.: Kyoung Mee Kim, An Hi Lee, Kyu Yong Choi, Se Jeong Oh, Sang In Shim; Korean J Pathol. 1997;31(8):754-764.

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Abstract PDF: The clinicopathologic features and the comparative analysis of diagnostic methods in 42 patients having intestinal tuberculosis were studied. In all the cases, clinical and colonoscopic diagnosis was confirmed by histological examination. Abdominal pain was the most common symptom (54%). Twenty nine patients had active pulmonary tuberculosis which was confirmed by a chest X-ray, or an AFB smear and a culture of sputum. A transverse ulcer with surrounding hypertrophic mucosa and multiple erosion was the usual colonoscopic findings. The granulomas were usually located in the just upper and lower portion of muscularis mucosa. The direct smear and culture of the fresh biopsy material showed AFB in 11 (32.4%) and 12 cases (36.4%) respectively. Ziehl-Neelsen staining in serially sectioned slides from formalin-fixed, paraffin- embedded tissue revealed AFB in 15 cases (35.7%). An immunohistochemical stain for Mycobacterium bovis was done in all cases and 13 cases were positive (31%). A polymerase chain reaction (PCR) was done and showed positivity in 4 out of 20 cases of fresh biospy material and 12 out of 40 cases in paraffin embedded tissue. For the conclusive diagnosis of intestinal tuberculosis, a Ziehl-Neelsen stain is the most sensitive, fast, and cost-effective method. The diagnostic accuracy will be increased when other diagnostic methods such as tissue culture and PCR are coupled with this simple staining method.

Expression of p53 and nm23 Proteins in Non-Small Cell Lung Cancer.: Mi Seon Kwon, Won Il Kim, Kyo Young Lee, Young Shin Kim, Chang Suk Kang, Sang In Shim; Korean J Pathol. 1997;31(6):499-507.

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Abstract PDF: To elucidate the role of p53 and nm23 in the development, progression, and metastasis of non-small cell lung cancer, we studied 91 paraffin sections of the primary non-small-cell lung cancers and the 34 paraffin sections of their metastatic lymph nodes using the immunohistochemical method. The results are as follows: 1) The incidence of p53 protein expression was positively correlated with the staging of lung cancers (p<0.025). 2) The incidence of p53 protein expression was higher in the lung cancers with lymph node metastasis than in those without lymph node metastasis (p=0.009). 3) The incidence of nm23 protein expression was lower in the adenocacinomas than in the squamous cell carcinomas (p=0.032). 4) The incidence of nm23 protein expression was lower in the lung cancers with lymph node metastasis than in those without lymph node metastasis (p=0.026). The expression of nm23 protein between the primary lung cancers and corresponding metastatic lymph nodes showed positive correlation (Kendall's Tau-b correlation coefficient=0.47140, p=0.0068). 5) The expression of p53 was not correlated with the expression of nm23 protein (Kendall's Tau-b correlation coefficient=0.11387, p=0.2800). The above results suggest that an overexpression of p53 protein and a downregulation of nm23 protein are associated with tumor progression and metastasis in non-small-cell lung cancer.

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

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

Fine Needle Aspiration Cytologic Findings of Proliferating Trichilemmal Tumor.: Seok Jin Kang, Kyoung Mee Kim, Byung Ki Kim, Sun Moo Kim, Sang In Shim; Korean J Cytopathol. 1997;8(2):160-163.

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Abstract PDF: The cytologic finding of proliferating trichilemmal tumor is not well documented and have difficulties in the cytological analysis of the fine needle aspirates. This rare dermatopathologic entity may be encountered during aspiration biopsy of subcutaneous masses, and is, occasionally, confused with other neoplasm, particulary squamous carcinoma owing to its close cytological resemblance. We report a case of proliferating trichilemmal tumor in the left breast. The patient is a woman and had a lump in the breast for 20 years. Fine needle aspiration revealed a few small clusters of squamoid cells in the background of amorphous and calcified material. After excisional biopsy, the mass was confirmed as proliferating trichilemmal tumor. The main cytologic features discriminating squamous cell carcinoma were bland nature of epithelial cells, absence of atypical dyskeratotic cells, and rich amount of amorphous material.

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

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

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

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

Sarcomatoid Carcinoma with Heterologous Osteosarcomatous Component of the Prostate: A case report.: Eun Sun Jung, Young Jin Choi, Seok Jin Kang, Byung Gee Kim, Sun Moo Kim, Sang In Shim; Korean J Pathol. 1996;30(12):1144-1149.

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Abstract PDF: Sarcomatoid carcinoma of prostate has been rarely reported and occasionally difficult to distinguish from a true sarcoma or carcinosarcoma. A case of sarcomatoid carcinoma of the prostate, which has been occured in 61-year-old male patient is presented. The tumor consists of carcinomatous areas with epithelioid cells, sarcomatoid areas with spindle cells and foci of heterologous osteosarcoma component. The phenotypic nature of the tumor was confirmed immunohistochemically by positive reaction for cytokeratin, epithelial membrane antigen, vimentin and prostate specific acid phosphatase in both sarcomatous and carcinomatous components.

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

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

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

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

Pathologically Diagnosed Giardia Lamblia Enteritis: A case report.: An Hi Lee, Kyoung Mee Kim, Se Hyun Cho, Sang In Shim; Korean J Pathol. 1996;30(4):361-363.

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Abstract PDF: Giardiasis is one of the most common causes of infectious diarrhea and it has a worldwide distribution. Although it is a relatively common disorder, histologically confirmed Giardiasis is a rare occurrence and there have been no previous reports in Korea. A 34-year-old man presented with a 2-year history of epigastric discomfort and left flank pain. On stool examination, many cystic forms of Giardia lamblia were noted. In biopsy specimens of the small intestine, there was moderate chronic inflammatory cell infiltration and several trophozoites of Giardia were observed in the intervillous space and luminal surface. The trophozoites were pear shaped symmetrical organisms with two nuclei, and measured 9~10 micrometer in length.

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

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

Ovarian Sertoli-Leydig Cell Tumors with Heterologous Gastrointestinal Type Epithelium or with Striated Skeletal Muscle: report of two cases.: Ki Ouk Min, Eun Joo Seo, Young Shin Kim, Kyo Young Lee, Sang In Shim; Korean J Pathol. 1996;30(1):50-56.

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Abstract PDF: Sertoli-Leydig cell tumors of the ovary are rare, accounting for no more than 0.5% of all ovarian neoplasms. These tumors occur predominantly in women 10 to 30 years of age. Heterologous elements are found in over 20% of the moderately and poorly differentiated Sertoli- Leydig cell tumors. The most common element is gastrointestinal mucin-secreting epithelium, found in approximately 20% of all cases. Approximately 4% of Sertoli-Leydig cell tumors contain immature skeletal muscle and/or cartilaginous elements. The origin of these neoplasms is regarded as neometaplasia of the mesodermal neoplastic element. While the degree of differentiation of Sertoli-Leydig cell tumors is probably of greater importance in determining prognosis than the presence of heterologous components, recent evidence does point to an unfavorable effect on clinical outcome when heterologous mesenchymal components such as cartilage and striated muscle are present. We experienced two cases of ovarian heterologous Sertoli-Leydig cell tumors with gastrointestinal type epithelium and striated skeletal muscle in 20 and 21 year-old females, respectively. One case involved a patient who had complained of amenorrhea for 3 years while the other case involved a patient who had complained of left lower abdominal tenderness and amenorrhea for one and one half years. It was determined by ultrasonography of the pelvis that the two patients suffered from right and left ovarian masses. Both patients underwent adnexectomy. These tumors were large with partly solid and partly cystic areas. Based on light microscopic examination one case was classified as an intermediate Sertoli-Leydig cell tumor with heterologous gastrointestinal type epithelium, while the other case was classified as a poorly differentiated Sertoli-Leydig cell tumor with heterologous striated skeletal muscle.

Cytologic Findings of Polyomavirus Infection in the Urine: A Case Report.: Mi Seon Kwon, Young Shin Kim, Kyo Young Lee, Yeong Jin Choi, Chang Suk Kang, Sang In Shim; Korean J Cytopathol. 1996;7(2):192-196.

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Abstract PDF: The principal significance of the urothelial changes caused by polyomavirus activation is in an erroneous diagnosis of urothelial cancer; however, the clue to their benign nature is the smooth structureless nuclear configuration and the relative paucity of affected cells. Though virologic studies and electron microscopy are usually needed to firmly establish the diagnosis, cytology is the most readily available and rapid means of establishing a presumptive diagnosis of human polyomavirus infection. A urine specimen of a 24-year-old man with hemorrhagic cystitis beginning two months after bone marrow transplantation for acute myeloblastic leukemia(M2) was submitted for cytologic evaluation. Cytologic findings revealed a few inclusion-bearing epithelial cells intermingled with erythrocytes, neutrophils, lymphocytes, and macrophages. Most of the inclusion-bearing -cells had large, round to ovoid nuclei almost completely filed with homogeneous dark, basophilic inclusion. The chromatin was clumped along the periphery and the cytoplasm was mostly degenerated. The other cells exhibited irregular inclusions attached to the nuclear membrane surrounded by an indistinct halo. These findings were consistent with polyomavirus infection.

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

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

Cytologic Features of Gaucher's Disease in the Spleen: A case Report.: Hun Kyung Lee, Gyeong Shin Park, Young Shin Kim, Kyo Young Lee, Chang Suk Kang, Sang In Shim; Korean J Cytopathol. 1996;7(1):79-83.

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Abstract PDF: Gaucher's disease is an autosomal recessive disorder resulting fror i mutation at the glucocerebrosidase locus on chromosome 1q21. As a result, glucocerebroside accumulates principally in the phagocytic cells known as Gaucher ce Is. In our case, a five-year old girl was admitted with seven days history of fever and abdominal distension. At physical examination the patient had hepatosplenomegaly. Laboratory tests revealed a hemoglobin concentration of 2.8g/L: platelet counts of 23,0001?l: normal range of white cell and differential counts, and negative Coombs' test. Liver enzymes were normal. For the evaluation of hepatosplenomegaly, fine needle aspiration was aerformed blindly against the palpable spleen. Wet-fixed hematoxylin and eosin-stained smears are made. The smears from the spleen showed predominantly macrophages with abundant cytoplasm and rather small, uniform, often eccentric nuclei with small nucleoli. The multinucleated cells were often found. The cytoplasm was pale, with more or less distinct fibrillarity. The cells had the characteristic appearance of Gaucher cells. Gaucher cells were also found it the tissue section from the liver, spleen and lymph node and the bone marrow aspirate. The diagnosis was later confirmed by determination of beta-glucosidase activity in peripheral blood leucocytes. Fine needle aspiration of the spleen is considered as a convenient procedure with a low complication rate for the diagnosis of lysosomal storage disease.

Fine Needle Aspiration Cytology of Squamous Cell Carcinoma of the Breast: Report of A Case.: Kyoung Mee Kim, An Hi Lee, Kyo Young Lee, Eun Joo Seo, Sang In Shim, Han Lym Moon; Korean J Cytopathol. 1996;7(1):88-91.

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Abstract PDF: A primary squamous cell carcinoma of the breast was evaluated by fine needle aspiration cytology in a 60 year-old female. Squamous cell carcinoma is a rarely encountered lesion in the breast and nine cases of cytologic findings of mammary squamous cell carcinomahave been reported in the world literature. Our case appears to be one of these rare pure squamous cell tumors. The cytologic diagnosis was possible because of the well defined characteristics of the malignant squamous cells, similar to those found in other locations. Thorough examination of the patient did not reveal squamous cell carcinoma elsewhere.

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

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

Interfollicular Hodgkin's Lymphoma: A case report.: Lee So Maeng, Kyung Mee Kim, You Mee Kang, Chang Seok Kang, Sang In Shim; Korean J Pathol. 1995;29(6):804-806.

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Abstract PDF: An unusual pattern of focal involvement of lymph nodes by Hodgkin's disease is described using the name Interfollicular Hodgkin's Disease. It is characterized by florid reactive follicular hyperplasia which overshadows involvement of the interfollicular zones by Hodgkin's desease. The importance of interfollicular Hodgkin's disease rests on its misdiagnosis as a benign lesion. We report a case of interfollicular Hodgkin's disease in a 34-year-old female patient in the inguinal area. The lymph nodes showed reactive follicular hyperplasia. The focal interfollicular spaces were invaded by Hodgkin's disease. The Reed-Stemberg cells stained positively with CD15 and CD30 antibody in the immunohistochemical stain. An in situ hybridization study looking for EBV was negative in these R-S cells.

Leiomyoma of the Female Urethra: A case report.: Kyoung Mee Kim, Anhi Lee, Sang In Shim; Korean J Pathol. 1995;29(5):684-686.

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Abstract: Leiomyomas are benign tumors of smooth muscle origin and are very rare in the female genital tract. To date, approximately 35 cases of urethral leiomyoma have been reported in the literature. A 34-year-old woman presented with a 3-year history of a mass at the urethral meatus. Physical examination showed 2 x 1.5 cm lump at the urethral meatus, posterior lip. Histologically the tumor was mainly composed of benign cigar shaped smooth muscle izells which were arranged in interlacing fascicles without cellular atypia or mitosis. Immunohistochemistry confirmed leiomyoma with positive staining for vimentin, desmin and muscle specific actin.

Gastric Lymphoid Follicles in Helicobacter Pylori Infection: Frequency, Distribution and Relationship to Inflammation in 331 Gastric Biopsy Material.: Kyoung Mee Kim, Anhi Lee, Sang In Shim, Hyun Suk Chae; Korean J Pathol. 1995;29(4):442-449.

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Abstract PDF: Helicobacter pylori(H. pylori) infection is considered the most important cause of chronic active gastritis and peptic ulcer. To determine the prevalence, distribution and it's relationship to degree of inflammation, gastric biopsy specimens were obtained from 331 nonulcer dyspepsia(NUD) patients consisting of 52 H. pylori negative normal volunteers and 279 H. pylori infected patients. Lymphoid follicles, degree of acute and chronic inflammation(Grade 0 to 3), and degree of H. pylori(Grade 0 to 4) were observed. The prevalence of H. pylori in NUD was 84.29%. The lymphoid follicles were found in 138 patients(41.7%) and only 5 patients(l.5%) without H. pylori showed lymphoid follicles. There was strong a relationship between lymphoid follicles and degree of acute and chronic inflammation and intensity of H. pylori infection(P<0.001). Acute and chronic inflammation were more serious in the antrum than body in H. pylori infected patients. There was no relationship between lymphoid follicles and the site in the stomach of H. pylori infection(P<0.078), but the body portion had an increased frequency of lymphoid follicles compared to the in antrum. Our results indicate that the prevalence of H. pylori infection in Korea is higher than in Western people and the degree of acute and chronic inflammation are strongly correlated with the presence of lymphoid follicles. The lymphoid follicles are believed to be absent from the normal stomach and their presence is strongly associated with H. pylori infection. The fact there is an that increased frequency of lymphoid follicles in H. pylori infected patients, and that they are more prevalent in the body of the antrum, support the concept that H. pylori may be a precursor in the development of primary gastric lymphoma.

Primary Teratocarcinoma of the Pineal Gland: A case report.: Kyoung Mee Kim, Eun Jung Lee, Ki Wha Yang, Anhi Lee, Sang In Shim, Sun Moo Kim; Korean J Pathol. 1995;29(4):527-529.

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Abstract PDF: Teratocarcinoma is a form of mixed germ cell tumor composed of a mixture of teratoma and embryonal carcinoma. It is rarely found in the brain, but when present it is most commonly found in the pineal region. We investigated a case of primary teratocarcinoma in the pineal region. The patient was a 10 year old boy who had suffered from a bitemporal headache for one month. Brain CT and MRI revealed a rather well defined ovoid heterogenous mass in the pineal gland region, measuring 4.3 x 3.8 x 3.0 cm in size. Microscopically the tumor contained areas of immature teratoma and embryonal carcinoma. Immunohistochemical staining revealed positive reactions for cytokeratin, epithelial membrane antigen, carcinoembryonic antigen, and alpha-fetoprotein in the embryonal carcinoma component.

Crescentic Glomerulonephritis in a Patient with Rheumatoid Arthritis: A case report.: Ki Ouk Min, Yeong Jin Choi, Byoung Kee Kim, Sun Moo Kim, Sang In Shim; Korean J Pathol. 1995;29(1):116-118.

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Abstract PDF: Crescentic glomerulonephritis in rheumatoid arthritis is described recently with increasing frequency. It can occur directly as a manifestation of rheumatoid arthritis or may be a reaction to drugs such as D-penicillamine and bucillamine. We report a case of crescentic glomerulonephritis in a 46-year-old woman with rheumatoid arthritis for 20 years who had been treated intermittently with herb medicine or nonsteroidal anti-inflammatory drugs (NSAIDS). Light microscopic examination showed severe focal segmental and global necrotizing glomerulonephritis with crescent formation in 50% of the glomeruli. Immunofluorescent study revealed scanty amount of mesangial granular deposits of IgA, IgM, C3 and fibrinogen in a diffuse pattern.

Cytologic Features of Endodermal Sinus Tumor of Ovary in the Ascitic Fluid: Report of a Cases.: Eun Sun Jeong, Young Shin Kim, Chang Suk Kang, Sang In Shim; Korean J Cytopathol. 1995;6(2):204-208.

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Abstract PDF: The cytologic findings of endodermal sinus tumor of the ovary are reported. The cytologic preperations were obtained from ascitic specimens. The findings on Papanicolaou-stained smears included a clean background and poorly preserved atypical cells loosely arranged in irregular or papillary groups. At high magnification, the cells had ill-defined and microvacuolated cytoplasms, with an increased nuclear-cytoplasmic ratio and prominent nucleoli. Hyaline globules characteristic of the alpha-fetoprotein (AFP)-synthesizing cells of endodermal sinus tumor were observed within the cells with periodic-acid-Schiff (PAS) stain. The presence of PAS - positive hyaline globules can be regarded, therefore, as a diagnostic clue to endodermal sinus tumor in an appropriate clinical setting and in the presence of AFP production. The cytologic findings in a cell block is important, in addition to smears, to obtain more diagnostic clues. A preliminary cytomorphologic diagnosis of this highly malignant tumor is valuable as a guide in planning further immunocytochemical and serologic studies.

Cytologic Features of Metastatic Retroperitoneal Seminoma: A Case Report.: Mi Seon Kwon, Eun Joo Seo, Young Shin Kim, Chang Suk Kang, Sang In Shim; Korean J Cytopathol. 1995;6(1):71-75.

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Abstract PDF: A fine needle aspiration biopsy specimen of a retroperitoneal mass in a 26-year-old man who had had an orchiectomy for seminoma was submitted for cytologic evaluation. Cytologic features of the specimen included uniform neoplastic cells found singly or in groups of several cells intermingled with lymphocytes in a characteristic foamy, lacelike background. These cells varied from 10 to 20 m in diameter. The nuclei were round to ovoid with fine or reticular chromatin and one or more prominent nucleoli. The poorly defined cytoplasm stained pale-blue or blue with cytoplasmic vacuoles. The cytologic appearance was consistent with seminoma. Documented reports of the cytological appearance of seminoma are rare. The diagnosis of primary gonadal seminoma by fine needle aspiration biopsy is probably not indicated since the treatment of a primary gonadal tumor, regardless of its histogenesis, requires surgical resection. However, fine needle aspiration biopsy is extremely valuable in the diagnosis of extragonadal as well as metastic and recurrent seminoma.

Richer's Syndrome: Report of a case.: Su Kyeong Yeon, Chang Sug Kang, Han Jin Lee, Dong Uk Kim, Chun Chu Kim, Sang In Shim; Korean J Pathol. 1994;28(4):420-426.

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Abstract PDF: Richer's syndrome is a development of a high grade malignant lymphoma in a patient with preexisting chronic 1ymphocytic leukemia, small lymphocytic lymphoma or Waldenstrom's macroglobulinemia. A rare case of Richer's syndrome arising in the spleen of a 35-year-old-man was studied by morphology, immunohistochemistry and gene rearrangement study. He has had weight loss and night sweat for last 6 months. Hepatosplenomegaly and abdominal lymphadenopathy were noted on CT scanning. Especially an ovoid radiolucent mass was found within the image of splenomegaly. Lymph nodes and liver biopsy, bone marrow aspiration and splenectomy were done. In the lymph nodes, liver and bone marrow, well differentiated small lymphocytic infiltrations were found but, in the spleen, pleomorphic, large cells with occasional multinucleated giant cells formed a nodular mass surrounded by diffuse, extensive infiltration of small well differentiated lymphocytes. The two distinctive areas in the spleen had positive staining for B-cell marker (HLA-DR and L26), negative staining for T-cell marker (UCLH1), and positive staining for IgM heavy chain and kappa light chain by immuohistochemical study. so this case was diagnosed as a diffuse large cell 1ymphoma transformed from small lymphocytic lymphoma. We made an another effort to clarify their clonality. Gene rearrangement method usingcomplementarity.determining region 3(CDR3) of immunoglobulin heavy chain (IgH) gene and T-cell receptor gamma (TCRgamma) gene by polymerase chain reaction (PCR) technique was done. The two lymphomas in the spleen demonstrated the same rearrangement pattern in both IgH and TCRgamma gene. We think these findings strongly suggest that the large cell lymphoma has the same clonality with that of the small lymphocytic lymphoma.

Low-grade Immature Teratoma of the Ovary with Gliomatosis Peritonei: A case report.: Jin Young Yoo, Sang In Shim; Korean J Pathol. 1994;28(3):322-324.

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Abstract: Immature teratoma accounts for less than I percent of all ovarian teratomas and occurs commonly in young individuals, the peak incidence being in the second decade. It contains a variable mixture of mature and immature tissues in which neuroectodermal elements almost always predominate. Gliomatosis peritonei, miliary implants of mature glial tissues on the peritoneum or omentum, is an infrequently reported complication of mature or immature ovarian teratomas. We describe the first case in Korea of a 12-year-old girl with an immature teratoma and numerous glial peritoneal implants.

A Case of Heterophyid Trematode Infection with Intestinal Obstruction.: Jin Young Yoo, Sang In Shim; Korean J Pathol. 1994;28(1):65-67.

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Abstract PDF: This report describes a case of ileal obstruction in a 31-year-old male with acute abdominal pain. A plain film of the abdomen showed segmental obstruction of small intestine. The patient underwent laparoscopic resection of the segment. Microscopic examination demonstrated foci of ulceration, submucosal edema, transmural inflammation, mural and neural hyperplasia and noncaseating granulomas, mimicking Crohn's disease. However, there were microabscesses predominantly composed of eosinophils. Furthermore, a section of an adult heterophyid trematode was identified in the crypt. Heterophydiasis usually causes diffuse enteritis. Therefore, this case with intestinal obstruction seems to be a rare manifestation of intestinal heterophydiasis.

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

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

Extraskeletal Chondroma Arising from Tongue and Tonsils: Three cases report.: Ki Ouk Min, Kyo Young Lee, Chang Suk Kang, Sang In Shim, Sun Moo Kim; Korean J Pathol. 1993;27(4):421-423.

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Abstract PDF: Three rare tumors of the oral cavity are presented. Lingual chondromas, approximately twenty to thirty cases appear to have been reported since the lesion was first described by Berry in 1892, which are usually seen on the lateral borders in the anterior two thirds of the tongue, while the ventral surface and the posterior third are rarely involved. Chondromas of the tonsil are of very rare occurrence, which are thought to arise as a result of metaplasia, rather than from embryonic rests, with chronic fibrosing inflammation being the inciting factor. Because of its rarity, the following cases of chondroma of the tongue and tonsil are being added to small list of such case reported in the literature.

Five Korean Cases of Dysplastic Melanocytic Neves.: Kyoung Me Kim, Seok Jin Kang, Sang In Shim, Sun Moo Kim, Baik Kee Cho; Korean J Pathol. 1993;27(4):411-417.

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Abstract PDF: The dysplastic nevus is a rare form of melanocytic nevus in Korean people. During the past 5 years the authors experienced 5 cases in the St. Mary's Hospital and Kang Nam St. Mary's Hospital. The criteria and the histologic findings of dysplastic nevi are debated in the western literature. Clinically, all cases were greater than 5 mm in size with ill defined irregular borders and irregularly distributed pigmentation. Histopathologically, all cases showed numerous discrete individual nests of melanocytes located in the dermoepidermal junction and the papillary dermis and were characterized by extension of dermoepidermal component of the nevus at the "shoulder" beyond the dermal component of the nevus. There was no cytologic atypia of nevus cells in all cases. Our cases lacked personal or family history of malignant melanoma. Therefore, we believe our cases are nonfamilial, sporadic and benign nevi with no prognostic significance. A brief review of the literature and a discussion on the term "dysplastic" and clinicopathologic correlation are made.

Wilms' Tumor in an Adult: Report of a case.: Kyoung Me Kim, Kyo Young Lee, Chang Suk Kan, Sang In Shim, Sun Moo Kim; Korean J Pathol. 1993;27(4):392-396.

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Abstract PDF: Wilm's tumor, which is the most mommon renal tumor in childhood, has rarely been reported in adult. Diagnosis of Wilm's tumor in an adult is more apt to be accidental and is almost never suspected in the adult until discovered at operation or necropsy. Recently, we experienced a caseof Wilm's tumor in 20-year-old female patient with chief complaints of right flank pain and he maturia for two months. Renal angiogram revealed a huge renal mass replacing the upper portion of the right kidney. Nephrectomy was done under the impression of renal tumor. Grossly, the tumor was rather soft and relatively well circumscribed, measuring 13 x 8.3 cm in dimension with adhesion to renal capsule and perirenal adipose tissue. The cut surfaces revealed grayish brown in color with areas of multifocal necrosis and hemorrhage. Histologically, the tumor was composed of mainly ovoid or polygonal shaped undifferentiated blastemal cells with large areas of necrosis.

Strumal Carcinoid of the Ovary: Report of a case.: Su Kyeong Yeon, Kyo Yeong Lee, Chang Seog Kang, Sang In Shim, Sun Moo Kim; Korean J Pathol. 1993;27(2):187-190.

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Abstract PDF: Strumal carcinoma of the ovary is rare tumor of germ cell origin characterized by intimate mixture of thyroid tissue and carcinoid. We report a strumal carcinoid tumor associated with ipsilateral follicular cyst and contralateral mature cystic teratoma of the ovary in a 47-year-old woman. Histologically it was composed largely of trabeculae partly of insular carcinoid and focally of individual thyroid follicles. Many cells in the carcinoid areas and even some follicular areas contained abundant argyrophile granules, and they also, in the corresponding areas, demonstrated thyroglobulin. Electron microscopic findings revealed abundant neurosecretory granules and colloid material in the same cell. We agree that this tumor is derived from hybrid showing thyroid and neuroendocrine differenciation.

Fine needle aspiration cytology of papillary carcinoma of the thyroid with numerous multinucleated giant cells.: Kyung Mi Kim, Kyo Young Lee, Chang Suk Kang, Sang In Shim, Sun Moo Kim; Korean J Cytopathol. 1993;4(1):62-65.

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Abstract PDF: No abstract available.

Congenital Intracranial Teratoma with Extension into Oral Cavity: An autopsy case.: Young Sill Kim, Kyo Young Lee, Chang Suck Kang, Sang In Shim, Sun Moo Kim; Korean J Pathol. 1990;24(3):326-330.

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Abstract PDF: Intracranial teratomas which were first described by Maier in 1861 are uncommon. Those presenting at birth are very rare and in our knowledge no case has been reported in Korea. In November, 1988, we experience a case of congenital intracrainal teratoma which replaced almost all cerebral tissue, filled out the oral cavity, and was protruded from the mouth. A female fetus was artificially delivered by a 25-year-old primigravida at 22 weeks of gestation, because of marked hydramnios and fetal hydrocephalus which were detected by prenatal ultrasonography. Microscopically, tissues from all three germ layers, including a lot of neuroepithelim and primitive mesenchymal tissue, were shown. A brief review of the literature was done.

Espihageal Atresia with Tracheoesophageal Fistula and Other Multiple Congenital Anomalies: An autopsy case.: Mee Soo Chang, Hye Ju An, Kyo Young Lee, Won Il Kim, Sang In Shim, Sun Moo Kim; Korean J Pathol. 1989;23(1):145-148.

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Abstract PDF: We experienced an autopsy case of esophageal atresia with tracheoesophageal fistula and other multiple congenital anomalies in a 4 days old male infant. Esophageal atresia with tracheoesophageal fistula was type C by Gross Classification. Combined anomalies were malrotation of left kidney, one left accessory renal artery form right renal artery and one left accessory renal vein from right renal vein, duodenal atresia and annular pancreas. Until now, the esophageal atresia with tracheoesophageal fistula and other multiple congenital anomalies (7 congenital anomalies) are not reported in the korean literature, except our case. Our autopsy case, it suggests that esophageal atresia with tracheoesophageal fistula has often close relation-ship with other multiple congenital anomalies.

Gastric Duplication.: Hee Na Kim, Chang Seok Kang, Sang In Shim, Sun Moo Kim; Korean J Pathol. 1988;22(2):148-153.

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Abstract PDF: Gatric duplication is a rare congenital anomaly. Thus for about 90 cases of gastric duplication have been recorded in the literature. It is less frequent than small intestinal or eosphageal duplication, and accounts for only 3.8% of all gastrointestinal tract duplication. Most gastric duplications are seen during the first year of life. Palpable abdominal mass and gastric outlet obstruction in infancy are most common presentation. We experienced a case of non-communicating gastric duplication. A 12-year-old girl visited St. Mary's Hospital because of indigestion, intermittent vomiting, and left upper quandrant pain for about 40 days. She have had intemittent abdominal pain with concomitant increased level of amylase since 5 years old. Physical examination showed a hen's egg sized palpable mass on left upper quadrant of the abdomen. Upper GI series and barium enema revealed only indentation of duodenal C-loop, and sonogram and abdominal CT demonstrated isolated cystic mass along the greater curvature of gastric antrum. She had taken an operation under the impression of pancreatic pseudocyst. Operation revealed a cystic mass, located along the greater curvature. There was no pathologic change in the pancreas. Microscopic findings of the cyst wall revealed normal gastric mucosal lining and common muscle layer, shared with gastric antral muscle layer.

Systemic Nocardiosis: An autopsy case.: Eun Sun Park, Kyo Young Lee, Sang In Shim, Sun Moo Kim; Korean J Pathol. 1988;22(2):131-137.

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Abstract PDF: Nocardia species are aerobic, gram-positive, acid-fast, filamentous branching bacilli. Nocardia is a localized or disseminated infection which may involve all tisuses and is produced by members of the genus Nocardia, principally N. asteroides. Other species, notably N. brasiliensis and N. caviae have been implicated, but N. asteroides appears to be the overwhelming predominant pathogen. Nocardial infections are usually opportunistic in the compromised host, at least 15% of the infections occurred in patients without a definable predisposing condition. Recently, we experienced an autopsy case of systemic nocardiosis. The patients was fiffty-three days old female infant, who had suffered from productive cough, dyspnea and fever. The patient was treated under the impression of the miliary tuberculosis, but she died at 34th hosital day. The postmortem examination reveals multiple tan gray colored abscess involving both lungs, both kidneys, and thymus. Microscopically, lung, kidney and thymus reveal multiple abscess, which are composed of necrotic tissue debris admixed with infiltrates of neutrophils, and they are surrounded by fibrosis, ad acute and chronic inflammatory cells. By histologic, microbiologic and biochemical studies, N. asteroides is identified in the lesion of the lung, kidney, thymus, and bronchial washing specimen.

Primary Malignant Lymphoma of the Liver: Report of a case.: Soo Kyong Chung, Chang Suck Kang, Won Il Kim, Sang In Shim, Sun Moo Kim; Korean J Pathol. 1987;21(4):285-290.

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Abstract PDF: Primary extranodal lymphoma of the liver is very rare, approximately thirty-one cases having been reported in the literature. We report one case of primary malignant lymphoma of the liver in a 26-year-old female, who was presented with palpable abdominal mass on the epigastrium for about 40 days. Laboratory findings revealed no specific abnormalities. Peripheral lymph nodes or spleen were not palpable. An abdominal ultrasonogram revealed a huge mass involving the entire left lobe of the liver. Left lateral segmentectomy of the liver was done. The resected lateral portion of left lobe of the liver showed a large solitary mass, 12 cm in the greatest dimension, with a yellowish gray fleshy solid cut surface. Though light microscopic feature was compatible with primary malignant lymphoma, diffuse large cell type, intermediate grade by the working formulation, undifferentiated carcinomas including hepatocellular carcinoma, plasmacytoma, and pleomorphic sarcomas could not be completely ruled out. Thus, marker studies and electron microscopic examination were performed. Immunoperoxidase stains for common leukocyte antigen was positive, and the Leder stain for myeloid granule was negative. Electron microscopic stuids revealed findings of neoplastic lymphoid cells, consistent with malignant lymphoma. Primary lymphoma of the liver has only rarely been reported, and its natural history is unclear. Many of the reported cases have been large cell lymphomas, as in this case.

Spindle and Epithelioid Cell Nevus: Report of four cases.: Hye Ju An, Kyo Young Lee, Sang In Shim, Sun Moo Kim, Jun Young Lee, Baik Kee Cho; Korean J Pathol. 1987;21(4):317-322.

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Abstract PDF: The spindle and epithelioid cell nevus, is known also as Spitz's nevus or benign juvenile melanoma. The histologic picture of the lesion often closely resembles that of a malignant melanoma, but spindle and epithelioid cell nevus hehaves benignly. Criteria for accurate histological diagnosis of this nevus now exist. However, a difficult lesion occasionally brings one to the worrisome situation even now. We experienced four cases (three children and one adult) of spindle and epithelioid cell neveus with nodular or macular skin lesions. In children (7/F, 9/F, 4/M), all of the lesion show a solitary pinkish red or light brown nodular firm masses, 0.7 cm to 1.0 cm in greatest dimension, which are located at the left posterior thigh, posterior neck and right anterior neck region, respectively. In adult (36/F), the lesion shows a light brown, erythematous macule, 0.8 cm in greatest diameter, in the skin of the back. Microscopically, both spindle and epithelioid cells are found in all the four cases, but epithelioid cells predominate in children and spindle cells predominate in adult.

Renal Cell Carcinoma Associated with Rhabdomyosarcomatous Component: Report of a case.: Mee Soo Chang, Mi Kyung Jee, Kyo Young Lee, Sang In Shim, Sun Moo Kim; Korean J Pathol. 1987;21(1):40-44.

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Abstract PDF: Renal cell carcinoma, intimately associated with a sarcomatous component, is a rare malignant renal tumor. There is disagreement whether these represent true sarcomas or are sarcomatoid metaplasia. Therefore, this sarcomatous component is at times still a troublesome problem for pathologists. In March, 1986, we experienced a case of renal cell carcinoma associated with rhabdomyosarcomatous component in 47 year-old woman who had a rapidly enlarged, palpable abdominal mass. Grossly, a spherical renal cell carcinoma, 17x14x10 cm, in upper and middle portions of the right kidney showed extension through the renal capsule into the perirenal fat. Area of myxoid change was evident in the reanl cell carcinoma, with extensive hemorrhagic necrosis. Microscopically, in the myxoid area, there was malignant spindle cell proliferation in which many rhabdomyoblasts showing distinct cross striation could be demonstrated. This rhabdomyosarcomatous component intermixed with renal cell carcinoma of clear cell type could be also identified in the focal area.

Chondroid Syringoma: A report of two case.: Nam Jin Yoo, Ki Hwa Yang, Sang In Shim, Sun Moo Kim; Korean J Pathol. 1986;20(3):369-373.

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Abstract: Chondroid syringoma is a rare primary skin tumor arising from eccrine sweat gland. In 1982, Nasse had found a primary skin tumor having similar morphology as in the mixed tumor of the salivary glands. In 1961, Hirsch and Helwig proposed more descriptive diagnostic term, "Choindroid syringma". The authors experienced two cases of chondroid syringma. The first case was a 47 year old male patient who had had a subcutaneous nodule in the right forehead for two months. It was a well circumscribed mass, that showed tan gray myxoid cut surface with firm consistency. Microscopically, it was a wel diagnosed as chondroid syringoma with tubular, branching lumina. The second case was a 51 year old female patient who had had a subcutaneous nodule in the left forehead for 3 months. It was well circumscribed, ad easily shelled out. It had a typical microscopic features of chondroid syringoma with small, tubular lumina.

Multiple Myeloma Associated with Adenocarcinoma of the Stomach: report of a case.: Hye Ju An, Kyung Ja Han, Won Il Kim, Sang In Shim; Korean J Pathol. 1986;20(2):191-194.

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Abstract PDF: A case of multiple myeloma associated with adenocarcinoma of the stomach was review. A 59-year, old Korean man had been abmitted to St. Mary's Hospital in January 1984, with chief complaint of posterior neck pain, and intermittent headache for one year prior to amission. Osteo lytic punched-out lesions were noted on skull and other skeletal x-ray films. Bone marrow aspirates revealed diffuse infiltration of mature and immature plasma cells. Laboratory findings revealed anemia and Bence-Jones proteinuria. Immunoelectrophoresis revealed findings consistent with IgA-lamda type multiple myloma. Alkylating agents and steroids were tried with some clinical improvements. In August 1985, the patient revisited outpatient clinic with chief complaints of epigastric pain and neck mass. Endoscopic biopsy and excision biopsy of the cervical lymph node were performed. By microscopic examination, adenocarcinoma of the stomach and metastasis of multiple myeoma to the supraclavicular lymph nodes were confirmed. Subtotal gastrectomy was performed. By gross and microscopic revealed metastasis to the regional lymph nodes.

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