Journal of Pathology and Translational Medicine

Volume 11(2); December 2000

Original Articles

Cytologic Features and Distribution of Primary Sites of Malignant Cells in Cerebrospinal Fluid .: Yeon Mee Kim, Mi Yeong Jeon, Je Geun Chi; Korean J Cytopathol. 2000;11(2):65-73.

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Abstract PDF: Cytologic evaluation of cerebrospinal fluid(CSF) is an effective mean for diagnosing many disorders involving the central nervous systems(CNS). One of the most important reasons for cytologic examination of CSF is to detect metastatic or primary neoplasms of the CNS. We did a retrospective study of 1,438 CSF specimens obtained between 1992 and 1996. A total of 1,205 adult and 233 pediatric CSF specimens from 947 patients were accessed at the Department of Pathology of Seoul National University Hospital and Children's Hospital, respectively. Among 1,438 CSF cytology specimens, 169 cases(11.8%, 77 patients) including 135 adult cases(59 patients) and 34 pediatric cases(18 patients) were positive for malignant cells. Diagnoses included 60 metastatic carcinomas(adult, 60; pediatric, 0); 46 malignant lymphomas(adult, 44; pediatric, 2); 21 leukemias(adult, 20; pediatric, 1); 4 retinoblastomas(adult, 0; pediatric 4); 2 rhabdomyosarcomas(adult, 0; pediatric, 2); 1 multiple myeloma(adult, 1; pediatric, 0), and 35 primary CNS neoplasms(adult, 10; pediatric, 25). The most commonly identified metastatic carcinomas in adults were adenocarcinoma. Their primary sites were the lung, gastrointestinal tract, and breast in order of frequency. The most common primary CNS neoplasm in children was medulloblastoma.

Immunocytochemical Assay of Cathepsin D in Fine Needle Aspiration Cytology of Breast Carcinoma and Benign Breast Diseases .: Kyeongmee Park, Illhyang Ko; Korean J Cytopathol. 2000;11(2):75-81.

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Abstract PDF: Cathepsin D is a protease which is known to facilitate invasion and metastasis of breast carcinoma. Overexpression of cathepsin D is associated with poor clinical outcome and biologic aggressiveness of the breast cancer. We underwent immunocytochemical assay(ICA) for cathepsin D in fine needle aspiration cytology(FNAC) specimens from the breast carcinoma and benign breast diseases. In FNAC specimens cathepsin D was expressed in 21(42.9%) out of 49 cases of invasive ductal carcinoma, whereas negative result was observed in all 15 cases of benign breast diseases including 7 fibroadenomas, 6 fibrocystic diseases, and 2 benign ductal hyperplasias. Among the 11 FNAC specimens from ductal carcinoma in situ(DCIS), cathepsin D was expressed in 3 cases(27.3%). In FNAC specimens immunocytochemistry for cathepsin D showed positive result in 24 out of 60 carcinomas(sensitivity, 40%) and negative result in 15 out of all 15 benign breast diseases(specificity, 100%). No significant correlation was noted between cathepsin D expression in FNAC specimen and clinicohistological characteristics of the breast carcinoma, such as hormone receptors and cell differentiation. In conclusion, ICA of cathepsin D in FNAC specimens thought to be a good adjunct to differentiate malignancy from benign breast diseases.

Differential Diagnosis of Ovarian Mucinous, Serous, and Endometrioid Adenocarcinoma in Peritoneal Washing Cytology .: Shi Nae Lee, In Ae Park; Korean J Cytopathol. 2000;11(2):83-88.

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Abstract PDF: This study presents the cytologic features of peritoneal washings, with particular emphasis on the cytologic discrimination among serous, mucinous, and endometrioid adenocarcinoma of the ovary. We selected histologically confirmed 27 cases of peritoneal washing : 8 cases of serous cystadenocarcinomas, 5 cases of mucinous cystadenocarcinomas, and 14 cases of endometrioid adenocarcinomas. The most frequent cytologic pattern of three tumors was clusters. Ball pattern was found in serous cystadenocarcinoma(36%) and acinar pattern in endometrioid adenocarcinoma (36%). Mucinous adenocarcinoma showed mucoid background(100%) and endometrioid adenocarcinoma revealed inflammatory background(43%). The cytoplasmic vacuoles were noted in 80%, 13%, and 43% of mucinous, serous, and endometrioid adenocarcinoma, respectively. The endometrioid adenocarcinoma showed prominent nucleoli(64%). In conclusion, the cytologic findings of mucinous cystadenocarcinoma were different from that of serous and endometrioid carcinomas, such as mucoid background, abundant cytoplasm with vacuolated cytoplasm, and peripherally located cytoplasm. Although endometrioid carcinoma showed acinar pattern and prominent nucleoli, the differential diagnosis between serous cystadenocarcinoma and endometrioid adenocarcinoma in peritoneal washing cytology was not always possible.

Etc

The Study on Cytopathological Diagnosis of Carcinoma of the Lung: Dong Wha Lee, In Joon Choi, Yoo Bock Lee, Dong Sik Kim; Korean J Cytopathol. 1977;11(2):87-95.

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Abstract: No report on cytopathology of the lung cancer is published in Korea. For this reason, the present study is to describe the positivity of cytologic examination and accuracy of cytologic cell typing for cancer of the lung with the cases histologically diagnosed. Cytopathological evaluation of a total of 89 cases of cancer of the lung, both cytopathologically and histologically examined, was Performed, from January 1973 to June 1975 at the department of pathology, Severance Hospital, Yonsei University, College of Medicine, Seoul, Korea. 1. Among 89 crises, the frequency was as fellows: epidermoid carcinoma, 61.8% : undifferentiated small cell carcinoma, 20.22%: bronchogenic adenocarcinoma and metastatic carcinoma, 4.5%. 2. Age and sex incidences were 82.01% distribution over the age of 40 and male preponderance. 3. Both sputum and bronchial washing show positive cytology in 68 (76.4%) of 89 cases and negative cytology in 21 cases(23.6%). The rate of cytopathologic diagnosis higher in epidermoid carcinoma, 87. 2%, and alveolar cell carcinoma, 100%, but was lessor in bronchogenic adenocarcinoma, 62. 5%, and undifferentiated small cell carcinoma, 61. 1%. 4. The positivity in sputum only was 58(67.44%) of 86 crises examined, and in bronchial washing only was 46 (69.70%) of 66 cases examined. 5. Of the 58 positive sputum cytology cases, positivity in first sputum was 32 crises(55.2%) and in three successive sputum samples was increased to 94.9%. So, three successive sputum examination was recommended for minimum requirement in routine procedure to obtain higher diagnostic rate. 6. Consistent rate of cytopathologic diagnosis with histologic diagnosis was differ in cell type as fellows; epidermoid carcinoma, 44(91.67%) of 48 cases; undifferentiated small cell carcinoma, 10(90.91%) of 11 cases examined; bronchogenic adenocarcinoma, 4 of 5 cased (85%); alveolar cell carcinoma, 4 of 4 cases (100%). In summary, the positivity of the sputum and bronchial washings was about 70% and almost same. Cytopathological diagnosis, for cell type of cancer of the lung was apparently quite accurate. There, however, was no significant difference and meaning in raising positivity over 3 Successive Sputum Samples.

Case Reports

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 Metastatic Epithelial-Myoepithelial Carcinoma of the Scalp: A Case Report .: Mi Seon Kwon, Seung Sook Lee, Jae Soo Koh, Jin Haeng Chung; Korean J Cytopathol. 2000;11(2):93-97.

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Abstract PDF: Epithelial-myoepithelial carcinoma is an uncommon, low grade malignant epithelial neoplasm and metastasis is exceedingly rare. This article highlights the fine needle aspiration cytology(FNAC) of a case of metastatic epithelial-myoepithelial carcinoma of the scalp. A 51-year-old female presented with the left parietotemporal scalp mass two months after the left parotidectomy for epithelial-myoepithelial carcinoma. FNAC from the scalp mass showed a biphasic population of ductal epithelial and myoepithelial origin. These epithelial aggregates were numerous and formed a distinct three dimensional architecture in the background of numerous naked nuclei. The three dimensional architectures were predominantly composed of tightly cohesive eosinophilic ductular epithelial cells which tended to aggregate, overlap, and form tubules. Clear myoepithelial cells in three dimensional tissue fragment were inapparent and a few were attached to the periphery of the fragments. A few myoepithelial cells with clear abundant vaculoated cytoplasm were found in the foamy background. The cytological diagnosis was metastatic epithelial-myoepithelial carcinoma. The histologic findings of the scalp mass were those of typical epithelial-myoepithelial carcinoma. Cytologic distinction of epithelial-myoepithleial carcinoma, pleomorphic adenoma, and adenoid cystic carcinoma may be very difficult but careful attention to clinical features and cellualr details can classify these neoplasms correctly.

Etc

Studies on Blastogenesis and T-Rostte Formation of Human Peripheral Blood Lymphocyte: Se-Ho Kim, Sang-ln Kim*, Kil-Soo Park; Korean J Cytopathol. 1977;11(2):97-111.

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Abstract: Various techniques to detect the immundozical functions of the lymphocytes has been developed. The authors establishing a stable techniques, performed the quantitations of rosette forming T-Iymphocyte(RP-TL) and phytohemagglutinin(PHA) stimulated Iymphocyte transformation rate(LTR) with 3H-thymidine uptake in in-vitro culture to define the characteristics of cellular immunity of Korean children, adults, and aged persons together with patients in various diseases. To standardize the potency of PHA, the authors used self-made saline extract of phaseolus vulgaris(PV) standardized by commercially available PHA. The results are summarized as follows : 1) The proportion of RF-TL was variable depending on individuality of sheeps ranging from 32±8.1 to 70.1±5.6% in total RF-TL and from 9.8±2.8 to 36.9±6.0% in active RF-TL in normal adnet. The most stable result was obtained by the concentration of 1.0% SRBC. 2) The proportion of total RF-TL in normal Koreans were 68.4±14.6% in adults, 65.6± 12.4% in children and 59.2±18.3% in old ages while the active RF-TL were 30.4±8.9% in children, 25.3±7, 4% in adults and 23.1±10.4% in old ages. 3) By means of our own self-made extract of P.V. the 3H-thymidine uptake of the peripheral blood lymphocytes was about 3% lower than that of foreign-made commercially available PHA but its blastogenesis was almost same with the latter. The PV-LTR were 68.6+17.6% in adult, 61.0+7.5% in old ages and 58.4±12.3% in children. 4) The RF-TL of cancer patients lower than that of normals and it was especially so in patients with extensive metastasis. The acute lymphoid leukemia patients disclosed the lowest RF-TL valves among the stuffy groups. 5) The PV-LTR in cancer patients was lowest in chronic lymphoid leukemia following the stomach cancer, lung cancer, hematoma, lymptoma and acute lymphoid leukemia in decreasing order of transformation rates. The PV-LTR were higher than normal controls in infectious mononucleosis and congenital syphilis while it was similar to normals in aplastic anemias. 6) The PV-LTR and RF-TL performed at the same time disclosed the following features ; a) In normal subjects, the RF-TL was lowest in old ages while the PV-LTR was lowest in children. b) In cancer patients, the PV-LTR was more significantly decreased than RF-TL suggesting more pronounced alteration or impairment of in vitro viability and/or DNA synthetic activity than the natural membrane-bound immune characters in their lymphocytes.

Case Reports

Fine Needle Aspiration Cytology of Primary Pulmonary Amyloidosis: A Case Report .: Hyuni Cho, Seung Yeon Ha, Young Ha Oh, Seong Hwan Jeong; Korean J Cytopathol. 2000;11(2):99-102.

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Abstract PDF: Pulmonary amyloid deposition generally occurs with concurrent primary systemic amyloidosis. Localized forms of pulmonary amyloidosis are rare and appear most frequently as an incidental finding on chest radiographs. We present a case of nodular pulmonary amyloid tumor suggested by fine needle aspiration cytology (FNAC) and confirmed by histologic examination with the polarizing light microscopy. A 41-year-old woman presented with ill-defined nodules in the middle and lower lobes of both lungs. FNAC of the nodules revealed waxy, acellular amorphous fragments. Thoracotomy for diagnosis may be avoided by FNAC diagnosis of this unusual lesion.

Pulmonary Alveolar Proteinosis: A Case Report with Diagnostic Features in Bronchoalveolar Lavage Specimen .: Seung Yeon Ha, Hyuni Cho, Young Ha Oh; Korean J Cytopathol. 2000;11(2):103-108.

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Abstract PDF: Pulmonary alveolar proteinosis(PAP) is a rare disease in which the alveolar spaces are filled with an eosinophilic, PAS-positive material, whereas the interstitial architecture of the lung usually remains unaffected. Although a definitive diagnosis is usually made by an open lung biopsy, bronchoalveolar lavage(BAL) cytology may play a decisive role in the diagnosis and therapy of these patients and may spare a patient a more invasive diagnostic procedure. The author presents a patient in whom BAL cytology specimen contained the characteristic globules of amorphous proteinaceous PAS-positive material accompanied by background of rare macrophages and inflammatory cells. Ultrastructural study using BAL specimen can confirm the diagnosis of PAP.

Fine Needle Aspiration Cytology of Amyloid Goiter: A Case Report .: Seoung Wan Chae, Jin Hee Sohn, Eun Sook Nam, Duck Hwan Kim, Hyung Sik Shin; Korean J Cytopathol. 2000;11(2):109-114.

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Abstract PDF: Amyloid goiter is a rare disease entity that is defined as a symptomatic mass or clinically detectable thyroid enlargement because of amyloid deposition. We present a case of amyloid goiter diagnosed in the fine needle aspiration cytology(FNAC) in a 73-year-old Korean woman presented with nephrotic syndrome and thyroid enlargement. The thyroid function was in normal range. Thyroid scan showed a nodule, 4x2 cm in the right lobe with underlying diffuse goiter. Aspirates revealed benign looking follicular cells and scattered eosinophilic material. The sections of the cell block showed nodular deposit of eosinophilic hyalinized material in the interfollicular area. It showed apple-green birefringence under polarization with Congo red stain. The renal biopsy also exhibited deposition of eosinophilic materials in the glomeruli and interstitial vascular wall, which were confirmed as amyloidosis. This material was morphologically distinct from the colloid.

Etc

A Comparative Study of Lee-White Coagulation Time and Activated Coagulation Time (ACT) in Heparinized Rabbits: Kook Young Maeng; Korean J Cytopathol. 1977;11(2):113-118.

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Abstract: A comparative study of Lee-White coagulation time and activated coagulation time (ACT) using celite in heparinized rabbits was carried out. Initially, baseline values of both tests were measured before heparin administration. Then, heparin of varying dose (200unit/kg b.w. in one and 1000unit/kg b.w. in the other) were injected. Exactly after one hour, coagulation time and ACT were measured simultaneously using three syringe technic. Since then, coagulation time and ACT were measured at an hour interval every hour after heparin injection through 9 hour thereafter. Lee-White method was observed to be unstable and fluctuating, and to be poor measure for heparin monitoring. Values of ACT plotted on semilogarithmic graph, however, revealed linear drop reflecting semilogarithmic decay of anticoagulant effect of heparin injected. These observations were consistent with those observations of Hattersley, Bull and others, who said that ACT Precisely reflected semilogarithmic decay of heparin injected and preferred ACT to conventional Lee-White coagulation time in many clinical use including control of heparin therapy in various conditions.

Case Report

Fine Needle Aspiration Cytology of Alveolar Soft Part Sarcoma: A Case Report .: Hye Seung Han, In Seo Park, Jee Young Han, Joon Mee Kim, Young Bae Kim, Tae Sook Hwang, Young Chae Chu; Korean J Cytopathol. 2000;11(2):115-119.

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Abstract PDF: Alveolar soft part sarcoma is a rare soft tissue tumor. Few cases of fine needle aspiration cytology have been reported in the literature. We experienced a case of recurrent alveolar soft part sarcoma of the right thigh diagnosed by fine needle aspiration cytology in a 47-year-old man. Cytologic findings showed single cells and clusters associated with thin walled vasculature in a distinct pseudo-alveolar pattern. The tumor cells exhibited round or ovoid abundant granular cytoplasm and large pleomorphic nuclei with prominent central nucleoli.

Etcs

Antibiotic Susceptibility of Clinical Isolates of Bacteria: Sook Ja Park, Yunsop Chong, Samuel Y. Lee; Korean J Cytopathol. 1977;11(2):119-125.

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Abstract: Antibiotic susceptibility test is an essential part of clinical bacteriology because many of the clinical isolates are resistant to various chemotherapeutic agents, and one can hardly predict the susceptibility without an appropriate laboratory procedure. According to the recommendation of WHO, Yonsei Medical Center Clinical Pathology has been using the Kirby-Bauer method. As a quality control, tests have been done using S. aureus ATCC 25923, E. coli ATCC 25922 and p. aerugosa ATCC 27853. This study was carried out to investigate the current susceptibility of clinical isolates to those antibiotics used most widely. The bacteria tested were isolated from the clinical specimens of Yonsei Medical Center between January to July of 1976. The following results were obtained. 1. Only 15% of S. aureus isolates were susceptible to penicillin. 92% were susceptible to cloxacillin, 97% to cephaloridine and 98% to minocycline. 2. Thirty eight per cent of enterococcus were susceptible to cephaloridine and to chloramphenicol. 3. Ninety three per cent of E. coli were susceptible to gentamicin. But the rates to chloramphenicol, streptomycin and tetracycline were very low. 4. The susceptibility rate of Klebsiella to gentamicin was 73%. To ampicillin, only 4% were susceptible. The rate of enterobactor to gentamicin was 74% and to ampicillin 9%. 5. Sixty seven Per cent of Citrobactr were susceptible to gentamicin. All of the serratia were susceptible to chloramphenicol, gentamicin and kanamycin. 6. The susceptibility rate of p. vulgaris was 88% to gentamicin an4 84% to kanamycin. The rates to gentamicin were p. mirabilis 76%, P. morganii 67% and P. rettgeri 60%. 7. All of the isolates of S. typhy were susceptible to ampicillin, chloramphenicol, gentamicin and kanamycin. 8. All of the Shigella isolates were susceptible to ampicillin, gentamicin and kanamycin. 9. Eighty one per cent of P. aeruginosa were susceptible to gentamicin and 80% of Alcaligens to minocycline. 10. The susceptibility rates of A. calcoaceticus were 75% to minocycline and 74% to gentamicin. 11. Minocycline showed higher rate of susceptibility than tetracycline in S. aureus, E. coli and A. calcoaceticus.

Isolation of β-hemolytic Streptococcus from Clinical Specimens: Kyung Soon Song, Yunsop Chong, Samuel Y. Lee; Korean J Cytopathol. 1977;11(2):127-131.

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Abstract: The streptococcal infections have become less frequent and less potent compared to those in the era of preantibiotics, but they still remain to be important in our clinical medicine as some of them result in rheumatic fever or acute glomerulonephritis. Appropriate bacterioogical studies would be of great value to aid the diagnosis, to guide the therapy and to prevent the sequelae. This paper will present some of the bacteriological studies related to streptococcal strains isolated from clinical materials at Yonsei Medical Center during the period of January 1976 to February 1977. 1. A total of 102 strains of group A was isolated. Specimens most frequently yielded group A streptococcus were pub, 43 or 42.2%, and throat culture, 24 or 23.5%. Blood culture yielded 8 or 7.8% and spinal fluid 2 or 2%. 2. As to the age group there were no particular relationship except for a decreasing frequency after the age of 40. 3. Isolation by month showed that group A streptococcus were most frequently isolated during the months of January to March, and August to November. 4. Excluding enterococci, there were a total of 117 bacitracin resistant strains; and these were presumptively identified as other than group A. Among these, 42 isolates were tested by capillary precipitation method to identify 6 of group A, 1 of B, 2 of C and 2 of G. 5. Some of the patients who yielded streptococcus other than group A had underlying diseases which were assumed to be the cause of the infections. 6. When streptococcus other than group A were isolated from either throat or sputum, only in a few patients those streptococci were predominant organisms; and it was hard to assume them as the causative organisms in rest of the patients.

A von Recklinghausen’s Disease with Association of Malignant Schwannoma of the Jejunum: C.C. Cho, O.J. Paik, S.K. Moon; Korean J Cytopathol. 1977;11(2):133-138.

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Abstract: This 39-year-old Korean woman has shown typical features of the von Recklinghausen’s neurofibromatosis, which is associated with a malignant schwannoma on the anti-mesenteric border of the jejunum. The presented case is characterized by the progressive generalized brown-pigment deposits over the skin and multiple cutaneous varying indurative masses, which have started to develop since about 10 years. Additionally, considerable deformities and changes in the skeletal system were demonstrated. The discussion about the clinicopathologic characteristics of the case, with literature review is described.

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