Journal of Pathology and Translational Medicine

Volume 11(1); June 2000

Original Article

Cytologic Features of Endometrial Hyperplasia: Comparison with Normal Endometrium and Endometrial Adenocarcinoma.: Sung Ran Hong, Mee Im Seon, Yee Jeong Kim, Yi Kyeong Chun, Hye Sun Kim, Hy Sook Kim; Korean J Cytopathol. 2000;11(1):1-10.

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Abstract PDF: The purpose of this study is to describe the cellular characteristics of endometrial hyperplasia without/with atypia in cervical smears. These cellular features were compared with those of normal endometrium and endometrial carcinoma. We reviewed 265 cervical smears : 64 normal proliferative endometrium, 118 endometrial hyperplasia without atypia, 21 endometrial hyperplasia with atypia, and 62 endometrial adenocarcinoma. Of these smears, 72(27.2%) smears which had diagnostic endometrial epithelial cells were selected for this study. The cytologic abnormalities about cellularity, background, changes in cellular architecture, alterations in nuclear size, anisokaryosis, chromatin pattern, nucleoli, cytoplasmic vacuoles, and mitosis were observed. Nuclear enlargement(1.6 to 2 times of the nucleus in the intermediate squamous cell) and anisokaryosis(> OR =2 fold in size variation) were highly suggestive of endometrial hyperplasia without/with atypia. The nuclei from endometrial hyperplasia with atypia were more coarsely granular in chromatin patterns than hyperplasia without atypia(33.3% vs 3.4%). Micronucleoli were observed in all endometrial conditions, but the presence of macronucleoli were more suggestive of hyperplasia with atypia(22.2%) and adenocarcinoma(55%). The changes in cellular architecture(loss of polarity, uneven internuclear distance, overlapping and loose

Etcs

A Clinico-Pathologic Study in Adenomyosis and Endometriosis: Eu Han Kim, Dale Lee, Seung Yong Paik; Korean J Cytopathol. 1977;11(1):1-6.

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Abstract: The author performed clinico-pathologic study of adenomyosis and endometriosis from 446 cases of hysterectomized uterus which were operated during January 1971- December 1975. The results are summarized as following. 1. Adenomyosis was noted in 74 cases (16.6%) among 446 cases of hysterectomized uterus. 2. The most frequent age group of the adenomyosis was 41-45 showing 24 cases (32.4%) and that of endometriosis was noted on age group 31-35 revealing 6 cases (30%) among total 20 cases. 3. The most frequent chief complaints among 74 cases of adenomyosis and 20 cases of endometriosis were irregular uterine bleeding (31 cases) and lower abdominal pain(29 cases) 4. Most cases of adenomyosis and endometriosis were operated under the preoperative diagnosis as uterine myoma (43 cases, 45.7%) and only 2 cases were diagnosed, preoperatively, as adenomyosis. 5. Most of cases were noted among multipara and the ratio of multipara to nullipara was 8 : 1. 6. Histologic picture of the endometrium of hysterectomized uterus was mostly in proliferative phase (24 cases, 32.4%) and cystic hyperplasia was infrequently (7 cases, 9.5%) noted. Histologic picture of the adenomyosis revealed cystic hyperplasia in 52.7% (39 cases), proliferative phase in 28.4% (21 cases) and secrectory phase in 12.2% (9 cases). That of endometriosis disclosed secretory phase in 45% (9 cases), endometrial hyperplasia in 25% (5 cases) and proliferative phase in 15% (3 cases). 7. Among 74 cases of adenomyosis, oophorectomy was performed in 63 cases and histologic picture of the ovaries revealed follicular cyst in 27 cases (42.9%) and hyperplasia of cortical stroma in 23 cases (36.5%). 8. About half cases of edometriosis were located in ovaries (11 cases) and other sites such as pelvic peritoneum, uterine cervix, oviduct, regional lymphnode, abdominal wall, operative scar, appendix, mesentery were infrequently noted.

The Effects of Cortisone and Estrogen on the Functional and Morphological Modification of the Reticuloendothelial System of the Rats Treated with Methylcellulose: Kang Hyuk Yoon; Korean J Cytopathol. 1977;11(1):9-22.

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Abstract: Because cortisone has a depressive effect on the RES, while estrogen has stimulating effect on it, it was thought to be of interest to compare the two hormones with regard to the effect on modification of the reticuloendothelial organs of the rats treated with methylcellulose. The phagocytotic activity was assessed by carbon clearance method, and the morphological investigation was carried out on the reticuloendothelial organs, liver and spleen. The results obtained were as follows. 1. In the methylcellulose-treated group, the phagocytotic activity was shown, to be decreased as compared with that of the normal rats. There was marked proliferation of macrophages phagocytosed methylcellulose, but no increase in acid phosphatase activity, PAS positive granules and hemosiderin granules was noted. 2. In the methylcellulose plus cortisone-treated group, the phagocytotic activity was shown to be more decreased than that of methylcellulose or cortisone-treated group. The liver stowed slight fatty metamorphosis and more markedly increased activity of phosphatase, but relatively normal architecture was maintained. The spleen showed conspicuous regressive changes such as atrophy of the follicles, necrosis and marked reduction in hemosiderin granules. 3. In the methylcellulose plus estrogen-treated group, cellular and functional alterations of the reticuloendothelial organs seemed to be similar to those of methylcellulose-treated group. From these results, it may be concluded that cortisone influences markedly the functional and cellular modification of the reticuloendothelial organs of the rats treated with methylcellulose. On the contrary, however, estrogen dose not.

Original Articles

Usefulness of Brushing Cytology in the Diagnosis of the Patients with the Stricture of Biliary Tree.: Mi Ok Park; Korean J Cytopathol. 2000;11(1):11-18.

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Abstract PDF: Pancreaticobiliary tract strictures are frequent indications for endoscopic retrograde cholangiopancreatography(ERCP). We have investigated the brushing cytology in order to determine its efficacy for diagnosis of pancreaticobiliary malignancies. Brushing cytology during ERCP was evaluated in 56 patients with biliary tract stricture presenting to the Catholic Hospital of Taegu-Hyosung from April 1997 to August 1999. A comparison was made between the cytologic and histologic diagnoses on 32 cases from 30 patients. A diagnosis of malignancy was establishied in 78.1%, benign in 15.6%, and inadequate in 6.3% of the cases. Statistical data on cytologic diagnoses in strictures of the bile duct were as follows; specificity and sensitivity of brushing procedure was 100% & 83.3%, respectively: sensitivity of interpretation was 89.3%: with no false positive cases and 3 false negative cases: predictive value for malignancy was 100% & 100%, respectively: predictive value for benign was 28.6% & 40%, respectively: overall diagnostic efficiency was 84.4%. It is concluded that brush cytology is a diagnostically reliable, highly specific technique for malignant lesions encounted at ERCP, although a negative result does not rule out the diagnosis of malignancy.

Fine Needle Aspiration Cytology of Pulmonary Hamartoma.: Tae Jin Lee, Jin Sook Lee, Gyung Yub Gong, Shin Kwang Khang, Jae Y Ro; Korean J Cytopathol. 2000;11(1):19-24.

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Abstract PDF: Pulmonary hamartomas are uncommon benign tumors, usually discovered radiologically as a solitary coin lesion in asymptomatic individual. The approach to the patient with a peripheral lung nodule has changed with the increasing acceptance of fine needle aspiration cytology(FNAC) as a rapid, safe, inexpensive, and highly accurate diagnostic tool. However, a few reports describing the FNAC findings of pulmonary hamartoma have appeared in the cytologic literature and the experience of FNAC is limited. We reviewed all 9 cases of pulmonary hamartoma with histologic confirmation after FNAC seen at Asan Medical Center since 1995 to evaluate cytologic findings and to determine the value of FNAC in identifying that lesion. Originally, seven of nine patients were diagnosed as pulmonary hamartoma, while two patients were diagnosed as inflammatory lesion and adenocarcinoma of each. On review, eight of nine patients were considered as diagnostic of pulmonary hamartoma. The diagnostic findings in FNAC of pulmonary hamartoma were the presence of fibrillary myxoid tissue with spindle cells as well as hyaline cartilage.

Etc

The Precision of Normal Ranges Determined by Means of Random Samples from Normal Populations: Chang Soo Chung; Korean J Cytopathol. 1977;11(1):23-48.

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Abstract: This study was undertaken to lay down some definite criterion for the evaluation of the precision of abnormal range determined by means of a random sample form a normal population. There are two types of abnormal range. In the first type an abnormal range is set up unilaterally and in the second type bilaterally in a normal distribution. In the first type an abnormal range sized 100α% is assumed to be set up on the right side in a normal distribution N(μ, δ²). In the parametric method to determine the normal range is to estimate the lower limit of the abnormal range sized 100α% by

were and s are the mean and standard deviation of a n-sized random sample from a normal population N(μ, δ²) and K_α is the value defined as follows:

where Φ(u) is the standardized normal distribution N(0.1²). Y₁is a random variable which varies from sample to sample and is distributed normally with mean

and variance

since and s are stochastically independent and the former is distributed normally with parameters (μ, δ²/n) and the latter with parameters (c₁δ, (c₂δ)²), where c₁=1-1/4n and c₂=1/. Then, the upper and lower limits of the middle 100p%-range of Y₁denoted by Y₁₍₊₎(Χ_p) and Y_1(-)(Χ_p) are easily obtained by the following formulas:

where Χ_p is the square root of 100p%-fractile of Χ²-distribution with d.f.1, that is, Χ_p²(1) and . Now, let us estimate the 100α%-size of the abnormal range by u₁₍₊₎(Χ_p) and u_1(-)(Χ_p) which are obtained by the following transformation,

The estimates of the 100α%-size of the abnormal range by Y₁₍₊₎(Χ_p) and Y_1(-)(Χ_p) denoted by â₁(Χ_p) and â_1(-)(Χ_p) correspondingly are

Hence

where

Accordingly, it can be stated that 100p% of the estimated values of the 100α%-size of the right abnormal range are between â₁₍₊₎(Χ_p) and â_1(-)(Χ_p). By the same argument it could easily be varified that 100p% of the estimated values of the same size of a left abnormal range are between the same limits. It is evident that by the formula(1.7.1) we can evaluate the precision of the estimate by a n-sized random sample of the 100α%-size of the abnormal range set up unilaterally in a normal distribution. Now the second type of normal range is considered. This type is assumed to be characterized by bilateral abnormal ranges with equal size of 100α% set up on both the right and the left side in a normal distribution N(μ, δ²). In this case the upper and lower limits of the normal range are estimated

where and s are the mean and standard deviation of a n-sized random sample which are distributed normally with parameters (μ, δ²/n) and (c₁δ, (c₂δ)²), correspondingly. So the point Y(,s) follws a two dimensional normal distribution with correlation coefficient o. If the closed domain which is defined by the contour ellipse, E(Χ_p), corresponding to the probability p determined by Χ_p²(2) in the s-plane is denoted by
A(Χ_p),

where Χ_p is the square root of Χ_p²(2). Now let us standardize the two variable and s by the follwing transformation,

then the point U(u₁, u₂) follows the standardized two dimensional normal distribution with correlation coefficient o. If the closed domain which is defined by the contour ellipse, E’(Χ_p)_γ corresponding to the probability p determined by Χ_p²(2) in the u₁u₂-plane is denoted by A’(Χ_p)_γ again

Here it is worthy of note that there is one to one correspondance between Y∈A(Χ_p) and U∈A’(Χ_p) and that E’(Χ_p) is a circle with radius Χ_p and center (0,0) in the u₁u₂-plane. By the inverse transformation of (2.3)

Substituting these for and s in the equiations (2.1.1) and (2.1.2)

For the estimation of the 100α%-size of each abnormal range set up bilaterally, it is necessary to standardize
Y_(±) by using μ and δ as follows:

where the symbols t_(±)(u₁, u₂) indicate the standardized deviates of Y_(±). If the estimates of the 100α%-size of the abnormal range set up bilaterally by Y∈A(Χ_p) and U∈A’(Χ_p) that corresponds to Y∈A(Χ_p) are denoted by â_(±)(Y∈A(Χ_p) and â_(±)(U∈A’(Χ_p), correspondingly, then

By summing (2.8.1) and (2.8.2) a new function of U(u₁, u₂),

is introduced to estimate the 100(2α)%-size of the abnormal ranges. Since E’(Χ_p) is a circle with radius Χ_p and ceter (0,0) t_(±)(U∈E’(Χ_p))-equivalent to t_(±)((u₁, u₂)∈E’(Χ_p))-can be expressed in terms of polar coordinates by putting u₁=Χ_pcosΘ and u₂=Χ_psinΘ as in the following:

By substituting these for the end values t_(±)(u₁, u₂) in the integrals (2.8.1), (2.8.2) and (2.8.3), these become

and

Examining the variation of the function of Θ, â(U∈E’(Χ_p), it is found that the function has the minimum value at the point (Χ_p, π/2)∈E’(Χ_p) and the maximum value at the point (Χ_p, 3π/2)∈E’(Χ_p) and that

that is,

Now it is evident that by the formula (2.11.1) we are able to evaluate the precision of the estimate by a n-sized random sample of 100(2α)%-size of the abnormal ranges set up bilaterally in a normal distribution. At the end of this paper, tables are provided which are available for the evaluation of the precision of estimates of normal or abnornal ranges by random samples from normal populations.

Original Articles

Fine Needle Aspiration Cytology for Secretory Carcinoma of the Breast in a Female Adult: A Case Report.: Na Rae Kim, Young Hyeh Ko, Young Lyun Oh; Korean J Cytopathol. 2000;11(1):25-30.

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Abstract PDF: Secretory carcinoma of the breast is a rare tumor of the ductal origin with a more favorable prognosis than the conventional ductal carcinoma. To the best of our knowledge, there are a few reports on fine needle aspiration cytology (FNAC) of secretory carcinoma in the English literature and one in the Korean literature. Recently, we experienced a case of secretory carcinoma of the breast performed by FNAC. The cytologic smears revealed several clusters and sheets of cohesive neoplastic cells in eosinophilic secretory background. Individually scattered cells were rarely found. Intracytoplasmic vacuolization and occasional signet ring cells with lacy cytoplasm were detected. To make the diagnosis and differentiation of this rare tumor, an identification of the secretory background and microcystic spaces filled with bluish mucin and occasional nuclear atypism of tumor cells is crucial.

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.

Fine Needle Aspiration Cytology of Inflammatory Myofibroblastic Tumor in Mesentery: A Case Report.: Hyun Jin Son, Joo Heon Kim, Woo Sung Moon, Myoung Jae Kang, Ho Yeul Choi; Korean J Cytopathol. 2000;11(1):35-40.

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Abstract PDF: Since inflammatory myofibroblastic tumor was initially recognized in the lung, this tumor has been described in other extrapulmonary sites. In spite of relatively uniform histologic findings in various organs, a rarity in extrapulmonary sites and highly vascular characteristics frequently lead to a misdiagnosis in preoperative radiology and fine needle aspiration cytology. We present a case of inflammatory myofibro blastic tumor occurring in the mesentery of a 4-month-old girl. Fine needle aspira tion cytology smear disclosed characteristic spindle cells intermixed with prominent mature plasma cells and lymphocytes. According to the immunohistochemical staining, we recognized that the intervening spindle cells are myofibroblasts which have reactivity for the both actin and vimentin.

Fine Needle Aspiration Cytologic Diagnosis of Thymoma Presenting as a Thyroid Nodule: A Report of Two Cases.: Dong Ja Kim, Ji Young Park, Yoon Seup Kum, Tae In Park, Yoon Kyung Sohn; Korean J Cytopathol. 2000;11(1):41-46.

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Abstract PDF: Thymoma is the most common anterior mediastinal tumor in adults. Rarely, it is presented as the anterior neck mass, commonly located in the anterolateral aspect of the neck or adjacent to the thyroid. We experienced two cases of fine needle aspiration cytology of thymoma, mimicking thyroid mass. The first case was an ectopoic cervical thymoma in a 31-year-old female. The fine needle aspiration cytology was misinterpreted as reactive hyperplasia of lymph node. But the histologic diagnosis was thymoma, predominantly lymphocytic type. The second case was an invasive thymoma in a 66-year-old female, who complained a large anterior neck mass. The fine needle aspiration cytology revealed biphasic population of some clusters of epithelial cells and scattered lymphocytes. The cytologic diagnosis was thymoma and was confirmed as invasive thymoma after the biopsy. Therefore, when the cytologic feature of anterior neck mass shows the both lymphocyte and epithelial component, the differential diagnosis should include the possibility of thymoma.

Fine Needle Aspiration Cytology of Diffuse Sclerosing Variant of Papillary Carcinoma of the Thyroid: A Case Report.: Joon Mee Kim, Soo Kee Min, Young Chae Chu, Mi Rim Kim, Kyung Rae Kim; Korean J Cytopathol. 2000;11(1):47-52.

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Abstract PDF: Diffuse sclerosing papillary carcinoma(DSPC), a variant of papillary carcinoma of the thyroid, is characterized by diffuse involvement of one or both thyroid lobes, and histologic features such as prominent sclerosis, intense lymphocytic infiltrate, num erous psammoma bodies, and squamous metaplasia together with the charac teristic cytoarchitectural pattern of classical papillary carcinoma. We experienced a case of fine needle aspiration cytologic(FNAC) findings of DSPC, which was con firmed by histologic examination of the thyroidectomy specimens. The patient was 26 years old female who presented with diffuse firm enlargement of the thyroid gland with enlargement of many cervical lymph nodes. FNAC smears showed numerous psammoma bodies, many lymphocytes, metaplastic squamous cells, absence of stringy colloid, and epithelial cells showing classical features of papillary carcinoma, such as nuclear grooves, intranuclear inclusions, and ground glass chromatin pattern.

Etc

Electron Microscopic Study on the Plasmacytogenesis in the Autotransplanted Spleen: Sun Moo Kim; Korean J Cytopathol. 1977;11(1):49-55.

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Abstract: Recently serial experimental studies on the transformations of reticular cells into plasma cells were reported by co-workers in our department. They confirmed histologically the transformation in the thymus from irradiated rats; in the spleen and lymph node from adrenalectomized rats and treated with cortisone or DOCA; in the transplanted spleen; and also autoradiographically in the spleen and the lymph node from the rats treated with cortisone, DOCA or from adrenalectomized rats. It is a well known fact that the plasma cell is most easily differentiated from the lymphocyte by the characteristic feature that is richness of rER in the cytoplasm. Thus the author applied electron microscopy to this study. Materials find Methods ; Albino male rats, weighing approximately 200 gms, were used. The transplantation of the spleen were performed by the Cameron and de Saram method. The experimental rats were divided into 10 groups. The transplanted spleen were histologically (H & E, methyl green pyronin, van Gisson) and electron-microscopically observed.
Results
; Within 3 days implanted spleen fragments became almost completely necrotic but splenic capsule, trabecauae and reticular tissues were remained. The beginning of regeneration usually started subcapsularly. At the 4th day the invasion of newly formed capillary accompanied with fibrous tissue appeared extracepsularly, and then appeared subcapsularly. The regenerative cells appeared at first in the subcapsular reticular tissue and they were characterized by round oval vesicular nuclei with abundant cytopiasm. These cells were localized in the subcapsular area forming cell clusters and were strong1y pyroninophilic and quite separated topographically from other leukocytes such as and small lymphocytes, neutrophils which were found around capillaries. These colonized cells had many mitochondria and rER in their cytoplasm, and were strongly indicative of young plasma cells. Such colonization was numerous and, with progress of regeneration, the same colonization of young plasma cells appeared in the newly formed splenic cord. In parallel with progress of regeneration, most cells became mature plasma cells. The cells in the colonization showed electron-microscopically successive transitional pattern from the reticular cells to young or mature plasma cells.
Conclusion
; In the autotransplanted spleen, it was confirmed light and electron-microscopically that the plasma cell arises from the reticular cell in the regenerative spleen.

Original Article

Fine Needle Aspiration Cytology of Pilomatrixoma: A Report of Five Cases.: Ho Sung Park, Myoung Ja Chung, Myoung Jae Kang, Dong Geun Lee; Korean J Cytopathol. 2000;11(1):53-58.

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Abstract PDF: Pilomatrixoma is a benign tumor which usually occur as a solitary, firm nodule in the head and neck, and upper extremities of young people. This tumor is occasionally encountered during aspiration biopsy of subcutaneous masses, but only a small number of cases are correctly diagnosed prior to excision. We report five cases of pilomatrixoma. Four cases occurred in the neck and one case in the back. The characteristic fine needle aspiration cytologic features are shadow cells and basaloid cells in the background of inflammatory cells, including some multinucleated giant cells. The shadow cells were recognized in all five cases. These cells were pale, anucleated cells with relatively distinct cell borders. May-Gr nbald-Giemsa stain is useful for the identification of shadow cells. The recognition of shadow cells appears to be essential for accurate diagnosis of pilomatrixoma.

Etc

Hashimoto’s Thyroiditis with Massive Ossification (A case report): Hee Kyung Kim, Hyun Sook Chi, Moon Ho Yang, Hoong Zai Joo, Chae Koo Lee; Korean J Cytopathol. 1977;11(1):57-60.

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Abstract: A case of Hashimoto’s thyroiditis occuring in a 58 year old female is presented, and its pathologic and clinical characteristics are briefly summarized. Severe ossification is an unusual histologic picture, and its pathogenesis is also briefly discussed.

Original Article

Imprint Cytologic Feature of Extraskeletal Osteosarcoma: A Case Report.: Mi Jin Gu, Young Kyung Bae, Mi Jin Kim, Joon Hyuk Choi, Won Hee Choi; Korean J Cytopathol. 2000;11(1):59-63.

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Abstract PDF: Extraskeletal osteosarcoma is an uncommon tumor originated from soft tissue without evidence of skeletal involvement. It usually affects adults and its common locations are extremity, buttock, and retroperitoneum. Although the histologic feature of this tumor is well known, there have been few reports on the fine needle aspiration cytologic findings. We report the imprint cytologic feature of extraskeletal osteosarcoma. The patient was a 49-year-old man with a mass of the left anterior chest for 2 years. On the imprint preparation, the smears showed malignant round, polygonal or spindle cells with coarsely clumped chromatin and occasionally prominent nucleoli. The malignant cells occur singly, in clusters, or associated with amorphous eosinophilic osteoid. Mitotic figures are also seen.

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