Journal of Pathology and Translational Medicine

Volume 10(1); June 1999

Original Article

Comparison of Qualified Diagnosis of "Atypical Squamous Cells of Undetermined Significance" with Subsequent Biopsy .: Jae Soo Koh, Jin Haeng Chung, Seung Sook Lee, Kyung Ja Cho; Korean J Cytopathol. 1999;10(1):1-5.

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Abstract PDF: To evaluate whether different qualifications of a cytologic diagnosis of "atypical squamous cells of undetermined significance(ASCUS)" predict a greater or lesser likelihood of tissue diagnosis of uterine cervix, we compared different cytologic qualifications of ASCUS with the tissue diagnosis. One hundred twenty-two con secutive Papanicolaou smears showing ASCUS in women who had undergone cervical biopsy within nearest 30 days were collected. The 122 smears were qualified as "favor reactive"(25%), "favor low grade squamous intraepithelial lesion (LSIL)"(24%), "favor squamous intraepithelial lesion(SIL)"(16%), "favor high grade squa mous intraepithelial lesion(HSIL)"(16%), and "not otherwise specified"(19%). Squamous intraepithelial or invasive lesion was pathologically confirmed by cervical biopsy in 13% of the "favor reactive", 27% in "favor LSIL", 70% in "favor SIL", 75% in "favor HSIL", and 35% in "not otherwise specified" smears. There were significant asso ciations between the favor reactive smear and the benign biopsy finding and between the favor SIL smear and the biopsy showing a squamous intraepithelial or more severe lesion. Nevertheless, most of favor LSIL smears exhibit reactive process in tissue biopsy. Conclusively, qualified ASCUS stratifies women into different risk groups for SIL. The cytopathologist should make the cytologic diagnosis of "ASCUS, favor LSIL" circumspectly.

Etc

The Effects of Prednisolone Administration on the Ultrastructures Lymph Node Cells: In Soo Suh, Jong Gu Chung, Byung Hun Kim; Korean J Cytopathol. 1976;10(1):1-6.

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Abstract: It is well known that the glucocorticoids have a suppressive activity to the immune responses through various mechanisms. Among others, one of well explained suppression mechanisms is that through lympholytic effects of the drugs on the lymphoid tissue throughout the body. But the precise processes of lympholytic actions and the ultrastructural changes during the cytolytic responses are largely remained in questions. In the efforts of clarifying the morphologic changes of the lymphoid tissue after glucorticoid administration, the author studied the ultrastructural changes of the mesenteric lymph nodes of rabbits after the injections of varying doses of prednisolone. Animals were injected 5mg, 10mg and 20mg of prednisolone for three consecutive days, repectively. On the fourth day, the animals were sacrificed and observed. The results were summarized as follow : 1. Light microscopically, the germinal center showed severe loss of large lymphocytes and prominent increase of reticulum cells. Marked decrease of small lymphocytes were also noted in TDA, while large lymphocytes were evidently increased in number in the mdeulla. 2. Electron microscopically, the nuclei showed increased tendency of heterochromatin, dilatation of perinuclear cisternae and condensation of chromatin to the degree of pyknosis. Mitochondria were markedly atrophied, accompanying with increase of matrix density and decrease of cristae. Increased number of pseudopodia with swelling was also prominent. Other changes were decrease of ribosomes and dilatation of ER. These changes were mostly confined to the small lymphocytes, and the other cellular components did not show such changes. The changes of small lymphocytes were progressively more severe with increasing the doses of the drug. The destructed cellular debris were phagocytized within macrophages and reticulum cells. 3. These results suggest that the main cytolytic actions of prednisolone are exerted to the small lymphocytes, preserving other cellular components, and the destucted cellular debris are caught to the surrounding macrophages and reticulum cells.

Original Article

Availability of Toluidine Blue Stain in Body Fluid.: Hye Kyung Lee, Myung Jin Joo, Kwang Min Lee, Eun Hee Lee, Sang In Sim; Korean J Cytopathol. 1999;10(1):7-11.

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Abstract PDF: We evaluated the availability of toluidine blue stain in body fluids, such as peritoneal and pleural fluid and urine. Nine hundreds specimens, i.e., 400 pleural and 400 peritoneal fluids and 100 urine samples, respectively, from Jan. 1995 to May 1996 were included. We obtained the result of high sensitivity and high specificity in toluidine blue stained body fluid in comparison with Papanicolaou stained result. Additionally, we found the diagnostically important crystals in chylothorax and some urine samples, which can not be seen in routine Papanicolaou stain. We thought the toluidine blue stain in body fluid is one of very useful diagnostic methods.

Etc

Histopathology of Early Gastric Cancer: Kim Ok Kyung; Korean J Cytopathol. 1976;10(1):9-21.

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Abstract: Objectives of the study; In the past few years, the diagnosis of early gastric cancer of stomach has been improved. The clinical symptoms and statistics of early gastric cancer have been reported at several occasions, in which histopathology has been rather lightly presented. The purpose of this study is to analysis some reasons that incidence of early gastric cancer is lower than the incidence of advanced gastric cancer in Korea. This study also aims to examine the gross and microscopic findings in order to strengthen the bases of diagnosis of early gastric cancer in the process of biopsy and gastrectomy specimen. Methods and materials; It is the author's intention to describe in details about histopathology of eleven cases of early gastric cancer with gastrectomy specimens, which were operated at Okinawa Central Hospital, Okinawa, Japan During 18 months from March 1973 to August 1974, according to age, sex, classification, size, depth of invasion, lymph node metastasis and histopathology. The author's also intents to compare 40 cases of gastric cancer at O.C.H. with 29 cases of gastric cancer operated at Ewha Womans University Hospital, Seoul, Korea, during 11 years from 1964 to 1975. The comparison and analysis will be made in terms of age, sex, duration, location, lymph node metastasis, depth of invasion, incidence of early cancer. Results and summary; The highest incidence of early cancer among the 11 cases at O.C.H. revealed in the age groups of 60's and average age was 58. M F ratio was 2.7 to 1 with male predominance. The classification of early gastric cancer revealed 2 cases of Type I, 3 cases of Type IIa, 3 cases of Type IIa, 3 cases of Type IIc, 2 cases of Type III, 1 case of Combined Type (IIc+III) with slightly predominance of Type IIc, and its combined type. The size of early gastric cancer measured from 0.3cm. to 3.0cm. With average of 1.2cm. in greatest diameter. The depth of invasion was within mucosa in 8 cases and within submucosa in 3 cases. Most common sites were the lesser curvature of angulus and antrum. All cases were negative for metastatic lymph nodes. The histopathology of early cancer revealed: Papillary type (1), Polypoid type (1), Signet ring cell type (3), Small tubular type (2), Small tubular type (2), Well differenciated type (3), Undiff. Small cell type (1). In comparison of 29 cases gastric cancer at E.W.U.H. with 40 cases gastric cancer at O.C.H., M F ratio was 1.5 to 1 with a slight higher incidence over male at E.W.U.H. and 2.5 to 1 at O.C.H. Number of metastatic lymph nodes was higher at E.W.U.H with 70% than O.C.H. with 57%. The incidence of early gastric cancer was considerable lower at E.W.U.H. with 3.8% in all cases of gastric cancer than O.C.H. with 27%. In conclusion, the Korean people generally visit to hospital at the fairly advanced stage of gastric cancer, resulting a poor prognosis after surgical treatment. The main reasons of such a phenomenon in Korea are considered to be (1) inadequacy of health insurance, (2) insufficient understanding on early gastric cancer, and (3) a short of availability of diagnostic facilities.

Original Articles

Transthoracic Fine Needle Aspiration Cytology of the Lung .: Min Suk Kim, In Ae Park, Sun Hoo Park, Sung Shin Park, Hwal Wong Kim, Kyung Chul Moon, Young Ah Kim, Hye Seung Lee, Ki Wha Park, Jeong wook Seo, Hyun Soon Lee, Eui Keun Ham; Korean J Cytopathol. 1999;10(1):13-19.

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Abstract PDF: The authors analysed 2,653 cases of transthoracic fine needle aspiration cytology of the lung to evaluate the diagnostic accuracy and its limitation. A comparison was made between the original cytologic and the final histologic diagnoses on 1,149 cases from 1,074 patients. A diagnosis of malignancy was established in 38.3% benign in 48.1%, atypical lesion in 2.3%, and inadequate one in 11.9% of the cases. Statistical data on cytologic diagnoses were as follows; specificity 98.9%: sensitivity of procedure, 76.8%: sensitivity of diagnosis, 95.5%: false positive 5 cases: false negative 18 cases: predictive value for malignancy, 98.8%: predictive value for benign lesion, 79.5%: overall diagnostic efficiency, 87.5%: typing accuracy in malignant tumor, 80%.

The Significance of Nuclear Size in Nuclear Grade of Invasive Ductal Carcinoma of the Breast.: Young Kyung Bae, Dong Sug Kim, Hye Jung Choi, Mi Jin Gu, Soo Jung Lee, Jea Young Lee; Korean J Cytopathol. 1999;10(1):21-26.

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Abstract PDF: To make the objective standard of nuclear size in grading nuclear pleomorphism of invasive ductal carcinoma of the breast, we measured maximal nuclear diameter of tumor cells on imprint cytology slides and histologic sections from 65 cases by using computer-based image analysis system(Optimas 6.0). The maximal diameter of red blood cells were also measured to evaluate the ratio of maximal nuclear diameter of tumor cells to maximal diameter of red blood cells. The mean values of maximal nuclear diameter of tumor cells on imprint cytology slides and histologic sections were 7.56 micrometer, 7.53 micrometer in nuclear grade 1, 8.92+/-0.98 micrometer, 9.02+/-0.74 micrometer in nuclear grade 2, and 12.90+/-1.47 micrometer, 12.44+/-1.41 micrometer in nuclear grade 3, respectively. There were no significant differences between values of imprint cytology and histologic section. The ratio of maximal nuclear diameter of tumor cells to maximal diameter of red blood cells were 1.3-1.4:1 in nuclear grade 1, 1.6-1.7:1 in nuclear grade 2, and 2.2-2.3:1 in nuclear grade 3. These values would be guidelines for grading nuclear pleomorphism of invasive ductal carcinoma of the breast on routine surgical pathology work.

Etc

A Histochemical Study on HBsAg in Liver Diseases in Korea: Soon Ho Kim; Korean J Cytopathol. 1976;10(1):23-32.

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Abstract: The author observed HBsAg in the liver tissues histochemically with Shikata’s orcein method in 11 cases of chronic hepatitis, 22 cases of liver cirrhosis and 32 cases of primary liver cell carcinoma. The liver tissues were collected by biopsy or operation in Busan University Hospital and Busan Gospel Hospital during the year of 1975. The results obtained were discussed and were summarized as follows : 1. HBsAg was identified in the liver cells in 4 out of the 11 cases of chronic hepatitis (36.4%) and in 7 out of the 22 cases of liver cirrhosis (31.8%). 2. HBsAg was identified in neoplastic and/or non-neoplastic liver cells in 13 out of the 32 cases of primary liver cell carcinoma (40.6%). In 11 cases it was found in both neoplastic and non-neoplastic liver cells and in 2 cases only in non-neoplastic liver cells. 3. There was no significant difference in positive rate of HBsAg among the chronic hepatitis, liver cirrhosis and primary liver cell carcinoma. 4. It was suggested that hepatitis virus B might play an important role in the etiology of liver cirrhosis and primary liver cell carcinoma.

Original Article

A Cytomorphologic Study of Benign and Malignant Papillary Neoplasms of the Breast.: Ho Jung Lee, Gyungyub Gong, Bohng Hee Kim, Sei Hyun Ahn, Jeong Mi Park, Jooryung Huh, Shin Kwang Khang, Jae Y Ro; Korean J Cytopathol. 1999;10(1):27-34.

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Abstract PDF: Benign and malignant papillary neoplasms of the breast may be difficult to distinguish in both cytologic and histologic preparations. To define the cytologic features of benign and malignant papillary lesions, we retrospectively reviewed 18 cases of fine needle aspirates from histologically confirmed cases of papilloma or papillary carcinoma of the breast. This study included 3 intraductal papillary carci nomas, 3 invasive papillary carcinomas, and 12 intraductal papillomas. All cases were evaluated for presence or absence of papillary fragments, bloody background, apocrine metaplasia, macrophages, and degree of cellularity, atypia, and single isolated columnar epithelial cells. Papillary fragments were present in all cases. The background of the smear was bloody in all 6 carcinomas, but in only 7 out of 12 papillomas. Markedly increased cellularity was present in 4 carcinomas(67%) and 7 papillomas(58%). Single cells were present in 5 carcinomas(83%) and 8 papil lomas(67%). The majority of papillomas and papillary carcinomas had mild to moderate atypia, and severe atypia was noted in one case of intraductal papillary carcinoma and one case of invasive papillary carcinoma. Apocrine metaplasia was absent in all cases of papillary carcinomas, but present in 8 papillomas(67%). Macrophages were noted in 4 carcinomas and were present in all cases of papillomas. The constellation of severe atypia, bloody background, absence of apocrine metaplasia and/or macrophages were features to favor carcinoma. Malignant lesions tended to show higher cellularity and more single isolated cells. The cytologic features mentioned above would be helpful to distinguish benign from malignant papillary lesions of the breast. However, because of overlapping of cytologic features, surgical excision should be warranted in all cases of papillary lesions of the breast to further characterize the tumor.

Etc

An Epidemiological Study of Primary Liver Carcinomas in Busan Area with Special Reference to Clonorchiasis: Chang Soo Chung, Sun Kyung Lee; Korean J Cytopathol. 1976;10(1):33-46.

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Abstract: This study was undertaken to investigate the relationship of primary liver carcinoma and clonorchiasis in Busan area, one of the areas most heavily infested with Clonorchis sinensis in the southern part of Korea. A series of consecutive 368 cases of primary liver carcinoma which were subjected to pathological evaluation in our department of pathology during the years from 1963 to 1974. The cases were mostly derived from Busan National University Hospital and Busan Gospel Hospital. The diagnosis was established by gross observation at operation table and morphological examination of the biopsied livers. The cases were analyzed statistically from an epidemiological view of point and obtained following results : 1. The relative risk of Clonorchis sinensis infestation in cholangiocarcinoma compared to hepatocarcinoma is about 5. The prevalence rate of clonorchaisis sinensis is much higher in cholangiocarcinoma than in cases without primary liver carcinoma, but it is not so with hepatocarcinomas. 2. The average age of the cases with cholangiocarcinoma and with hepatocarcinoma is 52 and 47, correspondingly, the difference being 5 years. No such marked difference between the average ages of both types of primary liver carcinomas is found in the reports by foreign authors. The average age of the cases with primary liver carcinomas is not associated with Clonorchis infestation and sex, but with its histological type. The average age of primary liver carcinoma is 48 and is much younger than those of Japanese and American white cases. 3. The ratio of primary liver carcinoma of male to female is 3.7, almost equal to those in Japanese and American white. 4. The frequency ratio of the hepatocarcinomas to the cholangiocarcinomas in cases with clonor. Chiasis was 1.5 and that in cases without clonorchiasis 8.4. On the basis of the above it seems to be of importance to consider clonorchiasis sinensis in epidemiological studies of liver cancer in Korea where this parasitic disease prevails widely.

Original Articles

Diagnostic Usefulness and Limitation of Fine Needle Aspiration Cytology of Lymph Node: Analysis of 176 Cases Confirmed by Biopsy .: Hee Sung Kim, Dae Soo Kim, Young Lyun Oh, Young Hyeh Ko, Howe J Ree; Korean J Cytopathol. 1999;10(1):35-42.

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Abstract PDF: The accuracy of fine needle aspiration cytology(FNAC) of the lymph node was investigated through a review of 176 FNAC cases and the corresponding biopsies. We chose 157 FNAC cases after the exclusion of 19 inadequate ones. Sensitivity of malignancy was 94.0%, specificity 100%, false negativity 6.0%, and false positivity 0.0%. The overall diagnostic accuracy was 96.8%. Sensitivity of metastatic carcinoma was 98.0% and that of malignant lymphoma was 87.9%. False negative cases included one metastatic carcinoma and four malignant lymphomas. The aspirates of metastatic carcinoma with false negativity exhibited a diffuse smear of keratin debris without viable cells, which led to the difficulty in differentiation from benign epithelial cyst. The cases of malignant lymphoma with false negative diagnosis were two Hodgkin diseases, one Lennert's lymphoma, and one peripheral T cell lymphoma in the histologic sections. On the analysis of 39 cases of tuberculosis, 17 cases(43.6%) were diagnosed as tuberculosis, 4(10.3%) as granulomatous lymphadenitis, 3(7.7%) as necrotizing lymphadenitis, and 15(38.5%) as reactive hyperplasia or pyogenic inflammation. Sensitivity of tuberculosis was 53.9%. In conclusion, lymph node FNAC is an excellent non-invasive diagnostic tool for the diagnosis of metastatic carcinoma. The diagnostic accuracy of malignant lymphoma could be improved with flow cytometry or polymerase chain reaction for antigen receptor genes. For the FNAC diagnosis of tuberculosis, AFB stain, culture, and PCR would be helpful as adjuvant techniques.

Fine Needle Aspiration Cytology of Thyroid Nodules: Assessment of diagnostic accuracy and evaluation of each cytologic diagnosis .: In Ae Park, Eui Keun Ham; Korean J Cytopathol. 1999;10(1):43-53.

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Abstract PDF: We retrospectively reviewed the results of 1,850 fine needle aspiration cytology (FNAC) of thyroid nodules performed from 1990 to 1991 in the Department of Pathology, Seoul National University Hospital. Among 1,528 cases and 322 cases aspirated by clinicians and a pathologist, 465 cases(30.4%) and 13 cases(4.0%) of the aspirates were inadequate, respectively. In 227 cases, correlation of the FNAC diagnosis and histologic diagnosis was done. Excluding the inadequate cases, the sensitivity for the detection of neoplasm(malignancy together with follicular adenoma) was 86.4% and the specificity was 70.7%. The overall diagnostic accuracy was 79.0%. There were 16 false-positive cases(7.0%), and 19 false-negative cases(8.4%). The predictive value of each cytologic diagnosis was 92% in papillary carcinoma, and 100% in Hashimoto's thyroiditis. The expectancy of malignancy was 52.8% in "suspicious malignancy" and 26.7% in "atypical lesion".

Etcs

Cantharidin-induced Hepatic Injury -Part Ⅰ : Reappraisal of Tissue Reaction Based on Hepatic Injury-: Chae Koo Lee, Yong Il Kim, Jung Bin Lee; Korean J Cytopathol. 1976;10(1):47-51.

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Abstract: Hepatic toxic injuries were induced in young male rats by subcutaneous injection of Cantharidin and their histologic characteristics were summarized as follows ; 1) diffuse swelling of hepatocytes, periportal hepatocullular necrosis with smudging and degranulation of cytoplasms in addition to focal spotty necrosis. 2) portal vein dilatation with swelling of its endothelial cells and leucocytic margination, accompanied by periportal congestion, portal exudation and hemorrhage. With the above histologic features, the main toxic mechanisms of Cantharidin to the liver may be deduced as mixtures of vascular factor and direct toxic effect to the hepatocytes.

Endometrial Biopsy Findings in Female Infertility: Jong Sang Choi, Seung Young Baik, Dale Lee, Gook Jin Moon; Korean J Cytopathol. 1976;10(1):53-57.

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Abstract: Histologic findings of endometrial tissue obtained by means of infertility studies on the first day of menstruation at Woo Sok Hospital Korea University from 1964 to 1973 were presented. Histologic findings which were agreeable with their menstrual cycle were noted in 85.4% of total 525 cases. Remaining cases revealed proliferative phase in 5.9%, endometrial hyperplasia in 0.4%, tuber culous endometritis in 1.7%, nonspecific endometritis in 0.4%, endometrial tissue with placenta in 1.2% and inadequate specimen in 5.2%

Original Article

Fine Needle Aspiration Cytologic Features of Schwannomas .: Sun Young Kim, Hae Joo Nam, Jung Hee Kim, Young Rok Cho, Yu Na Kang, Sang Sook Lee; Korean J Cytopathol. 1999;10(1):55-60.

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Abstract PDF: Schwannoma is a benign encapsulated nerve sheath tumor and is histologically characterized by a mixture of Antoni type A and B tissue. A preoperative diagnosis of schwannoma by fine needle aspiration cytology or by any other means is important to preserve clinically important nerves. Therefore, it is necessary to make a specific cytological diagnosis of nerve sheath tumor. However, there are a few reports regarding cytological features of schwannoma in Korea. We experienced seven cases of solitary schwannoma and here we report their characteristic cytological features with a review of literatures. The characteristic features of schwannoma on cytology were the presence of both Antoni type A and B tissue. The cytologic findings common to all cases of schwannoma generally corresponded to the histologic findings of Antoni type A tissue, consisting of fragments of tightly cohesive fascicles with variable cellularity. Dense fibrillary substances were found, along with palisading nuclei and Verocay bodies. Individual tumor cells consisted of cohesive cells having spindle or oval nuclei, with pointed ends and indistinct cell borders. Variation in nuclear size and shape was also present. The Antoni type B consisted of scattered wavy or short spindle cells and some histiocytes and lymphocytes in the abundant myxoid background with formation of microcysts. Immunohistochemistry for S-100 protein revealed a uniformly strong positive reaction and was helpful to make more accurate diagnosis of schwannoma.

Etc

A Correlated Cytologic and Histopathologic Approach to Uterine Cervical Atypia: Hyo Sook Park; Korean J Cytopathol. 1976;10(1):59-64.

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Abstract: The simplest and broadest application of clinical exfoliative cytology has been in the diagnosis of carcinoma of uterine cervix, and a vast literature has accumulated concerning the value of it especially in unsuspected preclinical stage. As a means of determining the efficacy of the cervicovaginal smear, the results of smears from 166 women were reviewed, compared to the histopathologic studied. Conclusively the diagnostic accuracy of cervical cytology is high (92.7%) in various epithelial lesions such as dysplasia (91-94%), carcinoma in situ (87%), microinvasive (78%) and invasive(95-100%) carcinomas, and it appears to be also useful in the follow-up of patients with cervical dysplasia as well as cervical carcinoma treated by either surgery or irradiation. In addition, the interpretations of sources of cytologic error were made in individual cases.

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