Journal of Pathology and Translational Medicine

Volume 12(2); December 2001

Original Articles

Detection of Epstein-Barr virus in the inflammatory and neoplastic uterine cervical lesions.: Hye Jin Jeong, Eung Seok Lee, Zhen Hua Lin, Seol Hee Park, In Sun Kim, Jae Sung Kang; Korean J Cytopathol. 2001;12(2):73-80.

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Abstract PDF: The prevalence of Epstein-Barr virus(EBV) in the uterine cervix was investigated to define the possible etiologic role in cervical carcinogenesis. The viral genotyping and LMP-1 30bp deletion were also studied. The materials included 169 uterine cervical swabs(152 within normal limits, 12 atypical squamous cells of uncertain significance, 3 low grade intraepithelial lesions, and 2 high grade squamous intraepithelial lesion) and 104 uterine cervical tissues obtained from hysterectomy specimens(32 carcinoma in situ, 9 microinvasive squamous cell carcinomas, 37 invasive squamous cell carcinomas, 7 adenocarcinomas, 7 adenosquamous carcinomas, and 12 cervicitis). EBV detected by PCR for EBNA-1 was positive in 52(56.5%) of 92 invasive and noninvasive cervical carcinomas, and 80(48.8%) of 164 inflammatory or normal cervices. The viruses detected in carcinomas were all type A, and LMP-1 30bp deletion form was more frequent in premalignant and malignant cervical lesions than in nonneoplastic cervices. From the above results, it may be concluded that EBV is one of common viruses detected in uterine cervix of Korean women, and type A virus and LMP-1 30bp deletion form may have a role in cervical carcinogenesis.

Immunocytochemical Expression of E-cadherin in Cell Blocks of Serous Effusions.: Byung Heon Kim, O Jun Kwon; Korean J Cytopathol. 2001;12(2):81-88.

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Abstract PDF: The differentiation between reactive mesothelial and carcinoma cells in serous effusion cytology can be a diagnostic challenge based on morphology alone. The expression of some cell adhesion molecules may be helpful in the differential diagnosis. This study evaluated the usefulness of E-cadherin immunocytochemistry for discrimination of carcinoma cells from reactive mesothelial cells. Alcohol fixed, paraffin embedded cell blocks taken from 42 reactive and 102 malignant serous effusions with histologically confirmed diagnoses were immunostained with monoclonal antibody to E-cadherin by LSAB method. E-cadherin expression was identified in only 2 benign reactive serous effusions(5%) whereas 91 malignant serous effusions(89%) expressed E-cadherin. The differences in immunostaining for E-cadherin between reactive and malignant serous effusions were statistically significant(p<0.001). The sensitivity and specificity of the E-cadherin immunostaining for carcinoma cells were 89% and 95%, respectively. In conclusion, E-cadherin is a useful diagnostic adjunct for differentiation between reactive mesothelial and carcinoma cells in serous effusions.

Utility of Calretinin in Distinction between Benign Reactive Mesothelial and Carcinoma Cells in Serous Effusions.: Byung Heon Kim; Korean J Cytopathol. 2001;12(2):89-96.

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Abstract PDF: The cytological distinction of carcinoma cells from reactive mesothelial cells in serous effusions may be difficult or impossible based on morphology alone, especially in specimens containing reactive mesothelial cells which form glandular or ball- or papillary-shaped conglomerates or which mimic malignant nuclear features. Calretinin is a newly reported immunocytochemical marker for mesothelial cells, which can potentially be utilized for facilitating this distinction. This study evaluated the usefulness of calretinin for the discrimination between reactive mesothelial and metastatic carcinoma cells in serous effusion. Immunocytochemical staining was undertaken on 33 benign reactive and 87 malignant serous effusion specimens with histologically confirmed diagnoses. The specimens including smears and cell blocks were stained with polyclonal antibody to calretinin by labelled streptavidin-biotin method. The positive expression of calretinin was noted in 32(97.0%) of 33 benign reactive effusions and 9(10.3%) of 87 malignant effusions. The sensitivity and specificity of the calretinin immunostaining for reactive mesothelial cells was 97.0% and 89.7%, respectively. In conclusion, calretinin is a useful marker for distinguishing between reactive mesothelial cells and carcinoma cells in serous effusions.

Case Reports

Exfoliation of endometrial cells on cervicovaginal smears.: Miseon Kang, Hye Kyoung Yoon; Korean J Cytopathol. 2001;12(2):97-103.

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Abstract PDF: The significance of endometrial cells on cervicovaginal smears is underestimated. The aim of this study is to evaluate the detection rate of endometrial cells on cervicovaginal smears. The materials consisted of two groups. Group I was 701 cervicovaginal smears from patients with no gynecological problems. Group II was 208 cervicovaginal smears from patients with abnormal uterine bleeding followed by endometrial curettage; 31 cases of endometrial adenocarcinoma(CA), 19 cases of endometrial hyperplasia(HP), 83 cases of dysfunctional uterine bleeding(DUB), and 75 cases of normal endometrium. Cervicovaginal smears was reviewed according to the criteria of The Bethesda System. Endometrial cells were identified in 15 of 701 cases(2.1%) in group I and 64 of 208 cases(30.8%) in group II. Among group II, detection rate of endometrial cells was the highest in CA (51.6%) compared to HP(26.3%), DUB(41.0%), and normal endometrium(12.0%) (p<0.05). Cytologic atypia of endometrial cells was not found in group I, but was more frequently identified in CA(87.5%) than in HP(10.5%) or DUB(14.7%) (p<0.05). Exfoliation of endometrial cells might be related to abnormal endometrial lesion, and reporting of endometrial cells in the cervicovaginal smear may increase a chance to detect endometrial lesions especially in patients with abnormal uterine bleeding.

Cytologic Features of the Chordoma: Report of five cases.: Dong Hoon Kim, Shin Kwang Khang, Gyun Gyub Gong; Korean J Cytopathol. 2001;12(2):105-110.

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Abstract PDF: Chordoma is a rare, clinically and morphologically well characterized tumor, which arises from remnants of the notochord. The majority(60%) occurs in the sacrococcygeal region, with 25% in the clival region, and 15% in the spine. Although most chordomas do not develop metastasis, the long term prognosis is very poor due to local progressive tumor growth and tendency to recur if incompletely excised. The chordoma has characteristic cytologic features which make a preoperative diagnosis possible. We reviewed the cytologic findings of five patients with chordoma(one oropharynx, two clivus, and two sacrum). The patients were three male and two female, aged from 29 to 77 years(mean 60). Of five chordomas, there were local recurrences in two cases and metastasis of lymph node in one case. Four were FNA smears and one was squash smear taken from intraoperative consultation. All five cases show similar cytologic features. The dominating tumor cells were large with round nuclei and pale-stained vacuolated cytoplasm. The small round uniform cells and short spindle- shaped cells were frequently noted. The cells were surrounded by myxoid or mucoid matrix. The chordoma has characteristic cytologic features which make a preoperative diagnosis possible.

Etc

Cellular Response of Chemically-induced Hepatoma Cells 1. Effect of Pattial Hepatectomy on the Formation of Chemically-induced Hyperplastic Nodules: Sung Keun Chang, Soo Young Lee, Young Che Kim; Korean J Cytopathol. 1978;12(2):109-115.

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Abstract: Cancer of the liver is the fourth most prevalent (4.75%) of all malignant tumors among Koreans, whereas in the United States and Europe, the prevalence is about 0.2 to 0.7%. Both aflatoxin and dimethylaminoazobenzene are widely used as the hepatoma- inducing agents in laboratory animals. Epidemiologic studies show correlation between the incidence of hepatoma in specific locales and the apparent content of aflatoxin in diet (Alpert et al., 1968, 1969). Kim et al. detected aflatoxin B1 B2 G1 and G2 in Meju and Doenjang, both of which are Korean-style foodstuffs, the former is a naturally inoculated soybean substrate for soy sauce and paste fermentation, and the latter is a Korean style fermented soybean paste. We made an attempt to observe the difference between the incidence of hyperplastic nodules and the mode of tumor growth in the liver of rats, which were administered aflatoxin B1(APB1) and p-dimethylaminoazobenzene (DAB) by means of intubation into the stomach, and the effect of partial hepatectomy on them. Male Sprague-Dawley rats, 180 to 220 gm. in weight were used exclusively. Each animal received 37.5㎍ of aflatoxin B1 or 5 ㎎ of p-dimethylaminoazo- benzene in 40 doses over 8 weeks. Partial hepatectomy was performed after feeding for 6 weeks and consisted of the anterior median lobe. The increase of body weight, the incidence and site of hyperplastic nodules, and the rates of liver regeneration after partial hepatectomy, were observed 2, 4, 6, 8, 10, 12, 14 and 18 weeks after the initiation of carcinogen-feeding. The result were as follows: 1. The increase of body weight of the rats which received carcinogens (AFB1 and DAB) was delayed in comparison with that of normal rats and that of the partially hepatectomized rats which received carcinogens was also delayed for the first 2 weeks and thereafter accelerated in comparison with that of the rats which received only carcinogens. 2. Carcinogens (AFB1 and DAB) inhibited the regeneration of the liver following partial hepatectomy. 3. The incidence of hyperplastic nodule of the liver in rats which received AFB1 was higher than that of the rats which received DAB, and partial hepatectomy seemed to be the cause of the formation of hyperplastic nodules in AFB1 group.

Case Reports

Fine Needle Aspiration Cytology of Solitary Fibrous Tumor of the Pleura: Report of a case misdiagnosed as denocarcinoma of lung.: Yoon La Choi, Young Lyun Oh, Mee Sook Lee, Jung Ho Han, Geung Hwan Ahn; Korean J Cytopathol. 2001;12(2):111-115.

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Abstract PDF: Solitary fibrous tumor of the pleura is rare but should be included in the differential diagnosis of a peripheral pulmonary nodule. Cytologic features of solitary fibrous tumor of the pleura is not familar to the pathologist and may be misdiagnosed as malignancy. We report fine needle aspiration cytologic(FNAC) findings of a case of solitary fibrous tumor misdiagnosed as adenocarcinoma in a 48-year-old woman. The FNAC displayed a mixture of bland-looking spindle cells and clusters of epithelioid cells, which have hyperchromatic nuclei with prominent nucleoli. The helpful finding to distinguish it from other circumscribed benign and malignant lesions is the presence of fibromyxoid matrix admixed with blood vessels and thin collagen fibers. Familiarity with these features is essential to avoid misdiagnosis and overtreatment.

Fine Needle Aspiration Cytologic Findings of Gastric Inflammatory Myofibroblastic Tumor: A case report.: Ji Hye Lee, Bong Kyung Shin, Chung Yeul Kim, Seong Jin Cho, Han Kyeom Kim, In Sun Kim; Korean J Cytopathol. 2001;12(2):117-120.

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Abstract PDF: Inflammatory myofibroblastic tumor, histologically characterized by the presence of bland-looking spindle cells and infiltration of chronic inflammatory cells, is extremely rare in the gastric wall. We report a case of gastric inflammatory myofibroblastic tumor in a 27-month-old boy. The fine needle aspiration biopsy from the mass showed loose clusters or scattered spindle cells and inflammatory cells, predominantly of lymphocytes and plasma cells. The spindle cells resembled fibroblasts or myofibroblasts. Differential diagnosis from benign and malignant diseases involving abdominal cavity was discussed.

Etc

The Study on Cytopathologic Diagnosis in Benign and Malignant lesions of the Stomach: Dae Yung Kang; Korean J Cytopathol. 1978;12(2):117-126.

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Abstract: In order to evaluate cytologic diagnosis in benign and malignant lesions in the stomach, 91 unfixed gastrectomized specimen were studied, which were submitted to department of pathology, Chungnam National University School of Medicine from January 1976 to September 1976. The cytologic smears were taken from central portions and margins of the ulcer of the lesions, and compared with that of histologic pattern, with clinical consideration. The results obtained were as follows ; 1) 91 cases were consisted of 40 carcinomas (44.O%), 39 benign peptic ulcers (42.9%) and 12 gastritis with other diseases (13.1%). 2) Among gastric carcinomas, there were noted 4 early gastric cancers originated from primary chronic peptic ulcers, which were not detected clinically. 3) Sex distribution of stomach cancer was 26 males (65%), and 14 females (35%) having 1.9 : 1 ratio. Age distribution of stomach cancer was showing the highest in 6th decade ; 23 cases (57.5%). 5th decade ; 10 cases (25.0%), and more than 80% were noted from 40 year to 60 year-old age groups. 4) Sex distribution of chronic peptic ulcer was consisted mainly of male cases showing 37 cases of a total 39 patients(94.9%). Age distribution was the highest in both 4th decade 12 cases (30.8%), and 12 cases (30.8%) in 5th decade. 5) The average diameter of malignant ulcers was 3.0-3.9cm in 14 cases(35.0%), and 6 cases were more than 5.0cm in diameter. In benign peptic ulcer, most frequent average size was 1.0-1.9cm in 16 cases (4l.0%) and there was no case measuring over 5.0cm in diameter. 6) The most malignant ulcers were located along the lesser curvature of the greater curvature of the stomach. The peptic ulcer, also, were located most frequently along the lesser curvature of the anturm in 32 cases (82.1%). 7) Cytologic diagnosis smeared from center and margins of the malignant ulcers was positive in 85%, but that smeared from peripheral portions of the lesion was positive only in 27.5% of cases. 8) The positive diagnosis in well differentiated and moderately differentiated type of the stomach cancer was 100%, and showed one case of pseudonegative in 18 cases of poorly differentiated type. 9) The doubtful cytologic diagnosis in chronic peptic ulcers was 16 cases (4l.0%), and those were associated with chronic gastritis or with marked intestinal metaplasia with atypical glandular hyperplasia.

Case Reports

Cytologic Findings of Primary Small Cell Carcinoma of the Urinary Bladder: A case report.: Mi Seon Kwon, Geung Hwan Ahn, Jin Haeng Chung, Seung Sook Lee, Jae Soo Koh; Korean J Cytopathol. 2001;12(2):121-126.

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Abstract PDF: Primary small cell carcinoma of the urinary bladder is a rare malignant tumor. A more rapidly fatal course may be seen in advanced stages of small cell carcinoma as compared to similar stages of urothelial carcinoma. It is very important to recognize this distinct form of bladder cancer by urinary cytology. The differential diagnosis of small cell carcinoma of the urinary bladder includes metastatic small cell carcinoma, urothelial carcinoma, and primary or secondary malignant lymphoma. This article highlights the urinary cytologic diagnosis of a case of primary small cell carcinoma. A 59-year-old male presented with gross hematuria for five months. Urinary cytology showed high cellularity consisting of tiny monotonous tumor cells in the necrotic background. The tumor cells occurred predominantly singly, but a few in clusters. The cytoplasm was so scanty that only a very narrow rim of it was seen. The nuclei were oval or round and had finely stippled chromatin. Rarely, the nuclei contain visible nucleoli. Frequently cell molding was noted in clusters. Many single cells demonstrated nuclear pyknosis or karyorrhexis. The histologic findings of transurethral resection and partial cystectomy specimen were those of small cell carcinoma. Cytologic distinction may be very difficult but careful attention to clinical features and cellualr details can classify these neoplasms correctly.

Fine Needle Aspiration Cytology of Solid Papillary Carcinoma of the Breast: Report of a case associated with mucinous carcinoma.: Hee Kyung Kim, Dong Won Kim, So Young Jin, Dong Wha Lee; Korean J Cytopathol. 2001;12(2):127-130.

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Abstract PDF: Solid papillary carcinoma of the breast is a distinctive form of intraductal papillary carcinoma frequently associated with both mucinous carcinoma and infiltrating ductal carcinoma, not otherwise specific. To our knowledge, this case is the first description of the cytologic aspects of solid papillary carcinoma of the breast in the Korean literature. We experienced a case of solid papillary carcinoma of the right breast diagnosed by fine needle aspiration cytology(FNAC) in a 70-year-old female. FNAC from the right breast showed high cellularity consisting of mostly tight clusters of tumor cells and a few scattered tumor cells. The nuclei were monotonously round to oval in shape with inconspicuous nucleoli. The cytoplasm was abundant and finely granular. Scant amount of mucinous material was present on the background. The diagnosis was confirmed histologically and immunohistochemically.

Etc

Clinical and Histopathological Studies on Soft Tissue Tumors: Tae Jung Kwon, Jae Yun Ro, Yoo Bock Lee, Dong Sik Kim; Korean J Cytopathol. 1978;12(2):127-147.

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Abstract: Soft tissues which are most widespread in body have common mesenchymal derivation and comprise a variety of more differentiated specific and undifferentiated nonspecific types. In general the cell types of the tumors of the soft tissue tend to closely resemble to a variable degree their prototype tissues. However, often, because of their pleuripotentiality and common mesenchymal derivation they show wide morphological range and may present similar growth characteristics lacking in morphologic individuality. Therefore classification of soft tissue tumors on a histogenetic basis is not easily accomplished and controversy concerning the classification has existed for years. Stout (1966), Enzinger (1969), Shuman (1971), Ackerman (1974) erall have made valuable contribution to the understanding of many of the soft tissue tumors by a variety of the special diagnostic techniques which brought about great advances in the classification and more accurate microscopic diagnosis of soft tissue tumors. However, there is no comprehensive report on soft tissue tumors among Koreans based on clinical and histopathological aspects. The present study is an attempt to refine classification of the soft tissue tumors, to investigate Clinico-histopathological characteristics and diagnostic values of selective special stains which seem to be helpful in differential diagnosis. Material and Method : The materials used in this study consisted of 502 cases of benign and malignant tumors of soft tissue origin for 6.5 years period lasting from 1971 to 1977. The histopathological study was attempted by microscopic examination following gross inspection, and tinctorial characteristics of selective special stains uire investigated. For all cases of soft tissue tumors whose clinical records were available, age, sex, location, chief complaints, duration, size, multiplicity, therapeutic modality, recurrence were investigated.
Results
and Summary : Based on clinical and histopathological studies of 502 cases of benign and malignant tumors, which were submitted to the Department of Pathology, Yonsei University, College of Medicine during the period of 6 years and 5 months from Jan., 1971 to May, 1977, following results are obtained. 1. Among 502 cases, 431 cases (85.9%) were benign and 71 cases (14.1%) were malignant, with ratio of approximately 6 : 1. 2. Lipoma was the most common benign soft tissue tumor, followed by hemangioma Iymphangioma, and neurilemoma. Among the malignant tumors fitrosarcoma was the ’most common, followed by liposarcoma, and Rhabdomyosarcoma. 3. The sex distribution of benign tumors showed slight female preponderance (1.3 : 1), but that of the malignant tumors was about 3 times more common in males than in females. 4. The age of benign tumors was rather evenly distributed from childhood to advanced age, while the majority of malignant tumors developed in adult age group. 5. The predilections for the benign tumors were head, neck and trunk, while those of the malignant tumors were lower extremity and trunk. But the specific predilection sites differed according to the histological types. 6. The clinical course of malignant tumors was rapid compared to benign ones. 7. Most of the benign tumors were fairly well controlled by local excision, but for the malignant tumors therapeutic modalities such as wide excision, chemotherapy and radiotherapy were used. 8. The special stains provided great diagnostic aid, but other specific diagnostic techniques such as electron microscopy, tissue culture and enzyme study were desired to accomplish more accurate microscopic diagnosis.

Case Report

Cytologic diagnosis of a chordoma without physaliferous cells: A case report.: Yun Hee Jin, Chan Kum Park, Won Mi Lee, Moon Hyang Park; Korean J Cytopathol. 2001;12(2):131-134.

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Abstract PDF: Cytologic features of conventional chordoma have been described and most reports emphasize the presence of large cells with numerous well defined cytoplasmic vacuoles or physaliferous cells. We report fine needle aspiration cytologic (FNAC) findings of a case of chordoma without physaliferous cells. The smear was cellular and composed of large cohesive clusters or individually scattered cells in mucinous background. The round or cuboidal cells had centrally located nuclei with fine granular chromatin, inconspicuous nucleoli, and occasional vacuolated cytoplasm. Mild to moderate pleomorphism was noted. Physaliferous cells are extremely helpful when present in cytologic material, but they are not necessary for diagnosis. Thus clinical history, roentgenographic appearance, and exact location of the lesion are required for the successful interpretation of presacral aspirates together with cytologic findings.

Etcs

A Morphological Study of Endodermal Sinus Tumor: Jae Yun Ro, Chan Il Park, Chung Sook Kim, In Joon Choi, Yoo Bock Lee, Dong Sik Kim; Korean J Cytopathol. 1978;12(2):149-157.

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Abstract: Endodermal sinus tumor or yolk sac carcinoma occurs with great frequency in both male and fema1e gonads, but has been described sporadically in extragonadal locations as well. The histologic features of 15 cases of endodermal sinus tumor arising from testis (8 cases), ovary (5 cases) and presacrum (2 cases) were presented, and in an effort to delineate the histogenesis, the light and electron microscopic findings were compared to that of yolk sac obtained from five normal pregnant rats. The two Patients with presacral endodermal sinus tumor were female. The mean age of the patients with endodermal sinus tumor was 13.1 years, 8 being under the age of 5 and only one over 30. The histologic appearances of the 15 tumors were essentially similar showing loose mucinous stroma mimicking the magma reticularis and PAS-positive, diastase-resistant hyaline globules. The pseudo-papillary pattern, in which Schiller-Duval bodies were abundant, and which was considered as the clue for histological diagnosis in the present series, was predominant in 5 cases (33.3%). The reticular pattern was predominant in 6 cases (40.0%), whereas no one showed the polyvesicular vitelline structure or solid pattern as prominent picture. 4 cases (26.7%) of the endodermal sinus tumor showed mixture of the pseudopapillary and reticular patterns. The light microscopical features of normal rat yolk sac were similar to that of human endodermal sinus tumor, except the lack of polyvesicular vitelline structure. The most prominent ultrastructural feature of the tumors was the presence of volum inous basement membrane like material in both intra- and extra-cellular location, corresponding to the PAS-positive hyaline globules seen in these tumors by light microscopy, and the appearance of skein-like nucleolema. Other ultrastructural findings were also similar in human endodermal sinus tumor and normal rat yolk sac. These findings suggest that yolk sac tumor is a peculiar germ cell origin having a property to differentiate to yolk sac.

A Histochemical Study on Acid Mucopolysaccharide of the Uterine Cervix with Carcinoma and Chronic Inflammation: Han Chul Son, Soon Ho Kim; Korean J Cytopathol. 1978;12(2):159-168.

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Abstract: In an attempt to elucidate the state of acid mucopolysaccharide of uterine cervix with carcinoma and chronic inflammation, the author examined histochemically 27 cases of the squamous cell carcinoma and 62 cases of chronic cervicitis with erosion, squamous metaplasia or dysplasia. These were obtained by total hysterectomy and biopsy in Busan National University Hospital during the period of 1975 and 1976. By the examination the following results were obtained : 1. In the mucosa of the chronic cervicitis the surface epithelium did not containe acid mucopolysaccharide. 2. In the mucosa of the chronic cervicitis the metaplastic and dysplastic squamous epithelium contained very small to small amount of acid mucopolysaccharide, but the malignant squamous cells did not contain acid mucopolysaccharide. 3. The surface columnar epithelium in the mucosa of the chronic cervicitis contained more large amount of the acid mucopolysaccharide than that of the non-cancerous tissue of the cervical carcinoma. 4. The acid mucopolysaccharide of the glandular epithelium was not significantly different in amount between the mucosa of the chronic cervicitis and the non-cancerous tissue of the cervical carcinoma. On the basis of mentioned above, it may be somewhat helpful to examine the state of acid mucopolysaccharide of the cervical mucosal epithelium in differentiation between the cervical carcinoma and chronic cervicitis with metaplasia or dysplasia.

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