Journal of Pathology and Translational Medicine

Volume 13(1); June 2002

Original Article

Exfoliation of Endometrial Cells on Cervicovaginal Smears.: Miseon Kang, Hye Kyoung Yoon; Korean J Cytopathol. 2002;13(1):1-7.

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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 were 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.

Etc

Malignant Tumors Among Koreans -Relative Frequency Study on 7,363 Cancers during 1968 to 1977-: Sang Kook Lee, Je G Chi. Sang In Kim, Eui Keun Ham, Yong Il Kim, Han Ik Cho, Geung Hwan Ahn; Korean J Cytopathol. 1979;13(1):3-19.

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Abstract: In 1968 The Korean Society of Pathology (authored by Chae Koo Lee, Sang Kook Lee. Sang In Kim and Je G. Chi et al) presented the first nationwide data on cancer prevalence among Koreans, based on 22,208 biopsy and autospy cases during a 10 year period of 1958 to 1967. Since that time there has been a multitude of factors that might have influenced on the cancer prevalence among Koreans. In this study, an analysis was made on 7,363 consecutive cases of primary malignant tumors, all diagnosed microscopically at the Department of Pathology, College of Medicine. Seoul National University, Seoul, Korea, during a 10 year period from January 1968 to December 1977. The great majority of the cases of this study were specimens from in-patients and out-patients of Seoul National University Hospital, and some were from outside hospitals sent for the confirmative diagnosis. Hematological diagnoses were made by staffs of Department of Clinical Pathology Seoul National University Hospital. Metastatic tumors were excluded from the statistics. The description of tumor of each case was made in a punch card. These cards were classified according to the World Health Organization code numbers of diseases and other items including those of each calender year, sex and the age distributions. And the results were tabulated. The following analyses were male. 1. The total number of malignant tumors included in this study was 7,363. There were 3,662 cases of male (49.7%) and 3,663 cases of female (49.7％). 2. The mean age of the patients with cancer was 46.6 years; 47.1 years in male and 45.6 years in female. 3. The frequency ranks of malignant tumors in male, female and both sexes are listed in Table 1. Among all malignant tumors in both sexes together, the relative frequency in percentage is cancer of the stomach (16.65％), uterine cervix cancer (15.08％), leukemia (6.51％), liver cancer (5.62％), breast cancer (5.53％), skin cancer (4.29％), thyroid cancer (4.13％), malignant lymphoma (4.03％), rectal cancer (3.92%) and larynx cancer (3.72%) in decreasing order of frequency. 4. Among all malignant tumors in male the relative frequency in percentage is stomach cancer (22.23%), liver cancer (8.98％), leukemia (8.36%), laryngeal cancer (6.19%), skin cancer (5.65%), malignant lymphoma (5.19%), lung cancer (4.4％), urinary bladder cancer (4.23%) and bone cancer (3.25%) in decrasing order of frequency. 5. Among all malignant tumors in female the relative frequency in percentage is uterine cervix cancer (39.3%), stomach cancer (11.0%), breast cancer (10.89%), thyroid cancer (6. 67％), leukemia (4.72%), rectal cancer (3.41%), malignant lymphoma (2.89%), skin cancer (2.87%), ovary cancer (2.6%) and uterine body cancer (2.46%) in decreasing order of frequency. 6. The age distribution of the malignant tumors shows the highest frequency in the sixth decade in male and the fifth decade in female. 7. Generally, the annual identification of total malignant tumors shows a tendency of gradual increase since the first year of the study. An increasing trend appears definite in breast cancer, thyriod cancer, liver cancer particularly in female, and a decreasing trend is suggestive in cancer of uterine cervix and malignant lymphoma.

Original Articles

A Comparision of AutoCyte PREP with Matched Conventional Smear in Cervicovaginal Cytology.: Jaejung Jang, Jungsun Kim, Kyung Ja Cho, Shin Kwang Khang, Joo Hyun Nam, Gyungyub Gong; Korean J Cytopathol. 2002;13(1):8-13.

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Abstract PDF: This study was designed to compare the performance of liquid-based preparation from the AutoCyte PREP with the conventional cervicovaginal smear in masked split-samples. In randomly selected 840 cases, the conventional smear was always prepared first, and the AutoCyte PREP used the residual cells on the collecting device. Parallel AutoCyte PREP slides and matched conventional smears were screened in a blind fashion. All abnormals and 10% random normal cases were reviewed by two pathologists in a blind fashion. The Bethesda System was used for reporting the diagnosis and specimen adequacy. The diagnoses from the two methods were agreed exactly in 767(91.3%) of 840 cases. The AutoCyte PREP demonstrated a 25% overall improvement in the detection of squamous intraepithelial lesion(SIL). The ratio of ASCUS to SIL was decreased as 0.45 compared with 1.00 of conventional smear. The AutoCyte PREP produced excellent cellular preservation and superior sensitivity for detection of atypical cells as compared to the conventional smear. It makes us to be able to subclassify ASCUS into from WNL to HSIL. We thought that the AutoCyte PREP method might contribute to increase the detection rate of abnormal cells than conventional methods.

Qualification of Atypical Squamous Cells of Undetermined Significance - "ASCUS, R/O HSIL": Cytologic Features and Histologic Correlation.: Hye Sun Kim, Bock Man Kim, Yee Jung Kim, Hy Sook Kim; Korean J Cytopathol. 2002;13(1):14-20.

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Abstract PDF: Cytologic and histopathologic features and human papillomavirus (HPV) DNA detection associated with 101 cervicovaginal smears which are classified as 'atypical squamous cells of undetermined significance, rule out high grade squamous intraepithelial lesion(ASCUS, R/O HSIL)' were reviewed and compared to 89 smears of 'ASCUS, not otherwise specified(NOS)' . Cytologic fieatures of ASCUS, R/O HSIL included atypical single small cells(36.6%), hyperchromatic tissue fragments(35.6%), atypical metaplastic cells(18.8%), endometrial cell-like clusters(5.9%), and atypical parakeratotic cells(3.0%). A final diagnosis of HSIL on biopsy was assigned to 47(54.0%) of 87 women with ASCUS, R/O HSIL and to 13(14.6%) of 89 women with ASCUS, NOS ( p=0.000). There was no difference in HPV DNA detection rate between ASCUS, R/O HSIL and ASCUS, NOS smears. These data suggest that subclassification of ASCUS is helpful to manage patients because ASCUS, R/O HSIL is more often associated with an underlying HSIL on biopsy. Therefore, women with ASCUS, rule out HSIL should be actively managed with colposcopic examination.

Cytologic Features of Papillary Immature Metaplasia of Uterine Cervix.: Hye Sun Kim, Mee Im Seon, Yee Jung Kim, Hy Sook Kim; Korean J Cytopathol. 2002;13(1):21-27.

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Abstract PDF: Papillary immature metaplasia (PIM) of the uterine cervix (immature condyloma) is a subset of low grade squamous intraepithelial lesion (LSIL) which is frequently associated with human papilloma virus (HPV) types 6 and 11. The histologic features of PIM include filiform papillae lined by evenly spaced immature metaplastic-type cells with frequent nucleoli, mild anisokaryosis, and a low mitotic index. To characterize the cytologic changes associated with PIM, we analyzed 14 cases of PIM from our file. We reviewed biopsy slides and the cervicovaginal smears taken proximate to the time of biopsy. Histologically, nine cases had either flat condyloma (7 cases) or high grade squamous intraepithelial lesion (HSIL) (2 cases). Cytologic changes included cells in various stages of maturation with karyomegaly (14 cases), cells with irregularities in the nuclear membrane (13 cases), intermediate cells with karyomegaly(13 cases), cells with binucleation (13 cases), and aborted koilocytes (11 cases). Cervicovaginal smears from all cases were interpreted as atypical squamous cells of undetermined significance (ASCUS), NOS or ASCUS, rule out squamous intraepithelial lesion (SIL) or LSIL in two cases with flat condyloma or HSIL in a case with severe dysplasia. PIM is a distinct histologic entity that can present with a spectrum of cytologic findings, but cytologic findings may resemble variable reactive conditions and immature HSIL. Therefore, it is difficult to diagnose PIM by cytology alone. However, the meticulous efforts for making the cytologic diagnoses which can induce active management of patients are recommended because PIM is a variant of LSIL and frequently has a flat condyloma or HSIL.

Etc

Studies on Peripheral Blood Eosinophilia and Liver Function Test in Clonorchiasis: Eun Suk Kim, Sang In Kim; Korean J Cytopathol. 1979;13(1):21-27.

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Abstract: A field study to investigate the correlation between the Clonorchis sinensis infestation and the peripheral blood eosinophilia and liver functioning was performed examining the presenece of parasite eggs in stool, EPG for Clonorchis sinensis, total WBC count and eosinophils in peripheral blood, serum alkaline phosphatase and SGOT with the subjects of 607 women in Kim Hae, the endemic area of C.S. infestation, and 74 women in Choon Sung as a control group. The results were as follows; 1. The infestation rate of Clonorchis sinensis in Kim Hae area was 52% (316/607 cases). 2. In the clonorchiasis group, the mean values ±2 S.D. were, WBC total count 5527± 2069/mm3 eosinophil percentage 13.64±12.52%, SGOT 27.82±11.07 unit, and serum alkaline phosphatase 58.42±33.43mIU/m1 respectively. These results were significantly high comparing with the results of the group without any parasitic infestation in Kim Hae area except serum alkaline phosphatase value. 3. In the control group without clonorchiasis in Choon Sung area, the mean values ±2 S.D. were, WBC total count 4633±1280/mm3, eosinophil percentage 4.77± 4.14%, SGOT 25.77±11.08 unit, and serum alkaline phosphatase 51.47±13.72mIU/m1 respectively, These results were significantly low comparing with the clonochiasis group in Kim Hae area except SGOT value. 4. In the clonorchiasis group in Kim Hae area, the mean values of WBC total count and eosinophil percentage were significantly high comparing with the group of other parasitic infestation in Kim Hae area and the control group in Choon Sung area. The serum alkaline phosphatase was significantly high in the clonorchiasis group in Kim Hae area comparing with the control group in Choon Sung area, however no significant difference was observed between the former and the group of other parasitic infestation in Kim Hae area. 5. There was no correlation between eosinophil percentage of peripheral blood and EPG of C1onorchis sinensis. Summerizing the overall results, in clonochiasis, we observed significantly increased peripheral blood eosinoptil, WBC total count and serum alkaline phosphatase except SGOT.

Case Report

Fine Needle Aspiration Cytology of Malignant Myoepithelioma of the Salivary Gland: A Case Report.: Jae Hwa Lee, Jean Kyung Park, Bang Hur; Korean J Cytopathol. 2002;13(1):28-32.

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Abstract PDF: Malignant myoepithelioma (myoepithelial carcinoma), is a very rare malignant epithelial neoplasm accounting for less than 1% of all salivary gland tumors and has an intermediate malignant potential. We report a case of malignant myoepithelioma arising in the left parotid gland in a 54-year-old man, which was difficult to differentiate from pleomorphic adenoma and other malignant salivary gland neoplasms. Fine needle aspiration cytology of the parotid gland showed cellular smear, composed of overlapped sheets and clusters or individually scattered tumor cells without any acinic or ductal structures. The tumor cells were rather uniform, with distinct cell borders and moderate amount of cytoplasm. The eccentrically located nuclei were oval to round and pleomorphic and showed prominent nucleoli. A few clear cells were noted in the cellular aggregates. Metachromatic matrix was seen between individual tumor cells in a lacelike fashion, resembling pleomorphic adenoma. According to the immunohistochemical staining, we recognized that the component cells are myoepithelial in nature, showing reactivity for the S-100 protein, vimentin, and actin.

Etc

Detection of Serum HBsAg by Reserved Passive Hemoagglutination and Serum Anti-HBsAg by Passive Hemoagglutination: Eun Yup Lee, Bock Hee Park, Soon Ho Kim; Korean J Cytopathol. 1979;13(1):29-37.

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Abstract: The authors investigated serum HBsAg and anti-HBsAg by methods of counterimmunoelectrophoresis(CIEP) and reverses passive hemagglutination(r-PHA) and passive hemagglutination(PHA) The sera were obtained from 1502 cases of healthy control, 530 cases of acute liver damage and 480 cases of chronic liver damage in Busan National University Hospital during the year of 1977. We compared serum HBsAg and anti-HBsAg positive rates between two methods and the following results were obtained. 1. In the healthy control, acute and chronic liver damage, serum HBsAg positive rates 4.5, 17.1 and 22.9% by R-PHA were significantly higher than those 2.3, 5.3 and 9.2% by CIEP, respectively. 2. In the healthy control, acute and chronic liver damage, serum anti-HBsAg positive rates 13.8, 14.9 and 17.5% by PHA were significantly higher than those 0.3, 0.4 and 1.5% by CIEP, respectively. On the basis of above mentioned results, R-PHA and PHA tests proved to be more sensitive than CIEP in detection of serum HBsAg and anti-HBsAg.

Case Reports

Fine Needle Aspiration Cytologic Findings of Thyroid Lymphoma: Report of Two Cases.: Hye Kyung Lee, Jong Min Lee, Chang Suk Kang; Korean J Cytopathol. 2002;13(1):33-37.

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Abstract PDF: We report two different types of thyroid lymphoma associated with Hashimoto's thyroiditis. Both showed autoantibodies and were compatible with Hashimoto's thyroiditis according to their clinical backgrounds. A 76-year-old female noted a painless, rapidly growing mass in her neck which was diagnosed as diffuse non-Hodgkin's lymphoma, large cell type, after the fine needle aspiration cytology of the thyroid. She underwent chemo-radiotherapy and is free of the disease 10 months after diagnosis. The other patient, a 73-year-old female with a diffuse goiter, was diagnosed on fine needle aspiration cytology as having Hashimoto's thyroiditis. Three years later she developed a hard nodular growth in the both lobes of the thyroid. This was subjected to fine needle aspiration cytology and needle biopsy and was diagnosed as a MALT lymphoma. She refused any treatment and died 12 months after the diagnosis.

Ureteral Washing Cytology of Localized Ureteral Amyloidosis: A Case Report.: Won Ae Lee, Jeong Hae Kie, Yoon Mi Jeen, Mi Kyung Lee; Korean J Cytopathol. 2002;13(1):38-41.

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Abstract PDF: Localized amyloidosis of the ureter is rare and clinically confused with neoplasm. We describe a case of localized amyloidosis of the ureter in which the presence of amyloid was detected in ureteral washing cytology. A 75-year-old female presented with gross hematuria. Abdominal CT and retrograde pyelography revealed hydronephrosis and hydroureter on the left side with abrupt narrowing of the distal ureter. Ureteral washing cytology yielded a hypocellular smear with many irregular clumps of amorphous, extracellar, waxy material. Biopsy sections demonstrated submucosal deposits of eosinophilic amorphous material which gave characteristic apple green birefringence with Congo-red stain under the polarized light. Familarity with the cytologic features of amyloid is helpful for preoperative diagnosis and proper treatment.

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A Collective Survey on Idiopathic Thrombocytopenic Purpura in Korea: Mi Kyung Hu, Chin Hee Cho, Chong Moo Lee; Korean J Cytopathol. 1979;13(1):39-44.

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Abstract: Clinical analysis of 42 cases with idiopathic thrombocytopenic purpura, diagnoses by bone marrow examination in department of clinical pathology of the Catholic Medical Center for 10 years, was made and following results were obtained. 1. The sex and age distribution were summarized in Table 12. Of the total 42 cases, the 0-9 years occupied 63.6% in acute form and 10 years or over 67.7% in chronic form. Male to female ratio was 1.8 : 1 in acute form and 1 : 2.1 in chronic form. 2. Clinical manifestations at first examination revealed bleeding tendencies in all crises, in which being petechiae and ecchymosis, nasal bleeding, gum bleeding, vaginal bleeding etc. 3. Among the laboratory findings, the platelets counts revealed below 50,000/mm3 for 77% of cases recorded (Table 4). The bleeding time was prolonged in 61.5% of the cases recorded (Table 8). 4. The analysis of bone marrow findings revealed hypocellularity in 7%, Normocellularity in 71%, and hypercellularity in 22% of the 41 cases recorded (Table 9). The myeloid-erythroid ratio was decreased in 40% because of bleeding tendencies. Megakaryocytes revealed normal or increase in relative number in 95%, and relative increase of immature forms, poor granularity of the cytoplasm and decrease of platelet production in almost all cases.

Case Report

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

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

Etc

A Histopathological Study of 24 Retinoblastomas in Korea: An-Hi Lee, Sun Moo Kim, Chong Moo Lee; Korean J Cytopathol. 1979;13(1):45-50.

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Abstract: The authors made a collective study of 24 cases of retinoblastoma which were diagnosed by the histopathological examination, in the 16 years period between February, 1963 and January 1979. The sex ratio was 1:1, being 12 cases for both male and female. The sex and age incidences were summarized in Table 2. The youngest cases in this series was 9 month old male, and the oldest was 5 years old male. 8 cases involved the left eyes, and 16 cases involved the right eyes. No record of involvement of both eyes was found in this series. The main presenting clinical findings were cat's eye appearance, exophthalmos, intraocular mass, eye pain and visual disturbance and lacrimation (Table 3). Of the 20 cases in which microscopic slides were available for reexamination, 15 cases showed mainly the endoptytic growth and 5 cases showed exophytic growth. 5 cases exhibited a pronounced rosette formation, 5 cases showed a moderate degree of rosette formation and the remaining 10 cases showed either spare or little tendency for rosette formation. Of the 18 cases, in which histopathological examination of optic nerve was possible, 11 cases showed optic nerve invasions.

Case Report

Fine Needle Aspiration Cytology of Proliferative Fasciitis: A Case Report.: Hyang Jeong Jo, Won Cheol Han, Ki Jung Yun, Won Cheol Park; Korean J Cytopathol. 2002;13(1):47-50.

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Abstract PDF: Fine needle aspiration cytology (FNAC) is an easy convenient non-invasive method in the diagnosis of superficial palpable masses. The cytologic findings by FNAC of reactive and neoplastic lesions in various organs including breast, lymph node, thyroid, salivary gland, etc., have been described, but, those of soft tissue lesions including proliferative fasciitis are relatively rare to find. We recently experienced a case of FNAC of proliferative fasciitis in the left back of a 72-year-old male. The FNAC smears were scant in cellularity and contained large cells with abundant basophilic cytoplasm, one to two nuclei lying at the periphery, and prominent nucleoli that resemble ganglion cells.

Etc

A Histopathological Study of Intracardiac Myxoma -A report of 2 cases-: An-Hi Lee, Sung Sim Kim, Chong Moo Lee; Korean J Cytopathol. 1979;13(1):51-56.

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Abstract: Myxoma of the heart is a relatively rare benign growth usually involving the left atrium, but less often involving other chambers of the heart. Though several case reports on this entity have been published in Korea, as far as our knowledge is concerned. virtually all of them were myxoma of the left atrium and no report on the tumor of the right atrium can be found. In July. 1977, we experienced a case of myxoma of the left atrium, in a 23 years old female, and in October of the same year, we experienced a case of right atrial myxoma in a 42 years old male. Clinical data and histopathological findings of each case were discussed and a brief review of the literature on this entity was made.

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