Journal of Pathology and Translational Medicine

Volume 18(1); March 2007

Review

Cervical Cancer Prevention for the Future: the Complimentary Roles of Cytology Screening and HPV Vaccination.: Euphemia McGoogan; Korean J Cytopathol. 2007;18(1):1-12.

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Abstract PDF: Approximately 70% of cervical cancers are caused by HPV types 16/18 and thus the implementation of vaccination programmes ith vaccines against HPV types 16/18 will have a major impact on the incidence of cervical cancer worldwide. However, this reduction will not be seen until several decades after full implementation of such vaccination programmes since the vaccines must be given to young adolescents before exposure to the virus and women who are already sexually active are not likely to be protected. Both GSK and Merck insist that even vaccinated women must continue to participate in regular cervical screening by the most sensitive method available since the vaccine can only give protection against up to 70% of cervical cancers. It is unlikely that the current vaccines will be modified to include additional high risk HPV types in the foreseeable future. While HPV testing is highly sensitive, it is not recommended for women under 30 years of age nor for vaccinated women. Additionally, HPV testing has poor specificity. The Digene Hybrid Capture 2 test is licensed for use only in conjunction with a cytology test, not as a stand-alone test, and the high risk panel has recognised cross reactivity with low risk HPV types. None of the other HPV test methods currently commercially available are FDA approved and all must be internally validated before use. This makes comparison of test results between laboratories difficult. The most sensitive and specific screening test currently available for women of all ages is the Cytyc ThinPrep(R) System consisting of the ThinPrep(R) Pap Test (TPPT) and the ThinPrep(R) Imaging System (Imager). The TPPT was the first LBC system approved by the US FDA in 1996 and there are about 4,000 processors in use worldwide. The Imager was FDA approved in 2003 and over 350 systems are in routine use, mainly in the US. 40% of TPPT in the US are processed on Imager. There is clear evidence in peer reviewed literature that the Imager increases laboratory productivity by 100% and growing evidence that Imager detects more high grade SIL than the conventional smear or manual evaluation of TPPT. This aspect is particularly important since the number of cytological abnormalities will decrease as vaccination programmes are implemented. Cytotechnologists will see fewer and fewer abnormal smears and their skills will be put at risk. By doubling throughput, Imager will allow cytotechnologists to maintain their skills.

Etcs

Application of Case Study-Oriented Small Group Teaching Method for the Strengthening of Pathology Laboratory Course: Yong Il Kim; Korean J Cytopathol. 1984;18(1):1-7.

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Abstract: Traditional teaching method of pathology laboratory course during the preclinical year has been one of the major concerns by its less active student participation, overemphasis of morphological details with little opportunity on clinical correlation and poor integration with lecture in most of undergraduate programs. Furthermore, increased number of student enrollment and shortage of faculty have accelerated the reduction of existing limited efficiency by means of achieving the course objective. The author introduced an easily accessible format by application of case-oriented small group teaching method based on the policy of no additional curricular revision or crucial modification of present didactic pathology instruction. Carefully selected cases of 5 to 6 with clinical summary and well controlled questionnaires were supplied with microslide sets for small group discussion, and each student group was assigned to answer a series of questions on the case at the whole class plenary session. Development of appropriate questionnaires was crucially critical to determine the group activity so that the best answer should be possible only after careful observation of microslides and with close referring to available handout or textbook in the areas not only of morphological alterations but also no etiology, pathogenesis, correlation with clinical features and interpretation of laboratory data. plenary discussion was scheduled at the end of each course, during which faculty's comment on the cases with Kodachrome transparency (of microphotography) was supplemented. Immediate feedback on two occasions of experiment supported the active student interaction in learding process, and enhanced the synchronization of cognitive content in lecture-laboratory courses along with confidence on self-directed learning. It also stressed the necessity of further improvement in faculty's questioning and answering skill. The program was also less expensive, saved faculty time, and enabled to promote the bridging effort between the basic and clinical sciences as expected.

Cryoglobulinemia: Young Joo Cha, Myoung Hee Park, Hyun Chan Cho, Han Ik Cho; Korean J Cytopathol. 1984;18(1):8-15.

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Abstract: Seventy cases of cryoglobulinemia detected at the Department of Clinical Pathology, Seoul National University Hospital, during the period from January 1977 to September 1982 were analysed for sex and age distribution, associated disease, laboratory findings, and physicochemical propertie of cryoglobulins. The results were as follows. 1) Among 70 cases, 38 cases were male and the remaining 32 cases were female. Age was widely distributed form 4 to 60 years. 2) Diseases associated with cryoglobulinemia were various renal diseases (32 cases), autoimmune diseases (16 cases including 11 cases of systemic lupus erythematosus), chronic active hepatitis (6 cases), infections (4 cases including 2 cases of subacute bacterial endocarditis) and malignant lymphoma (1 case) in decreasing order of frequency. Eleven cases were considered idiopathic and associated diseases could not be found. 3) Serum rheumatoid factor was positive in 32% of patients, serum complement level was decreased in about 30%, and HBsAg was positive in 18%, HBsAb in 38% and HBcAb in 81%. 4) In systemic lupus erythematosus, serum rheumatoid factor was positive in 33% of patients, serum complement level was decreased in about 90%, and findings of renal involvement were observed in all cases by urinalysis and renal biopsy. 5) In two cases of subacute bacterial endocarditis, serum rheumatoid factor was positive in one and decreased serum complement level and impairment of renal function were observed in both cases. 6) Precipitation of cryoglobulins were observed for 3 days. After one day of incubation, only 26% of cases showed precipitation and 43% showed precipition after 3 days. 7) In 4 cases, cryoglobulins could be isolated and test for rheumatoid factor and immunoelectroesis were done. In all cases, rheumatoid factor was positive. By immunoelectrophoresis, 2 cases were identified as IgM-IgG mixed cryoglobulins and one case as IgG-IgG mixed cryoglobulins. On the basis of these findings, cryoglobulinemia was found in disease associated with rheumatoid factor formation and characterized by prolonged stimulation of the immune system. And we thought it important to detect the presence of even small amount of cryoglobulins because it has important clinical relevance such as association with renal involvement and prognosis.

Original Article

Misinterpretation of Pregnancy Related Changes: Effect on the Postpartum Regression Rate of Abnormal Cervical Smears in Pregnancy.: Hye Sun Kim; Korean J Cytopathol. 2007;18(1):13-19.

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Abstract PDF: An aim of this study was to evaluate an effect of misinterpretation of pregnancy related cellular changes on the postpartum regression rate of abnormal cervical smears in pregnancy. A series of 265 cases with abnormal cervical smears in pregnancy were selected from a database of cervical smear results. The selected cases were classified as regression, persistence, and progression based on the results of postpartum cervical smears and histology. Of the selected cases, 162 cases were classified as regression and the postpartum regression rate was 61.1% (162/265). We reviewed abnormal cervical smears in pregnancy these cases. The primary cytologic diagnoses of these cases were ASCUS (118 cases), AGUS (2 cases), ASCUS/AGUS (1 case), LSIL (25 cases), LSIL R/O HSIL (2 cases), and HSIL (14 cases). With information of the pregnacy, we identified decidual cells in 24 cases, but cells identified by the Arias-Stella reaction and trophoblasts were not found. Sixteen cases out of 162 cases were reclassified as a pregnancy related change rather than an abnormal. Desidual cells were considered as ASCUS in 15 cases and as LSIL in one case. The revised postpartum regression rate was 55.5%(147/265) and was lower than the original. Consequently, misinterpretation of the pregnancy related cellular changes has an effect on a rise of the postpartum regression rate of the abnormal cervical smear in pregnancy. Pathologists may diagnose pregnancy related cellular changes as abnormal findings if they do not have information regarding the pregnancy. Therefore, clinical information of pregnancy and knowledge about the pregnancy related cellular changes are essential to prevent misinterpretation.

Etc

Ultrastructural Study on Streptozotocin -induced Pancreatic Acinar Injury in Rats: Hyung Sik Shin, Seong Hoe Park, Yong Il Kim; Korean J Cytopathol. 1984;18(1):16-22.

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Abstract: Experimental diabetes was produced in Sprague-Dawley rats by single dose of intraperitoneal injection of streptozotocin, 50㎎/kg and sacrificed on the 15th, 45th, and 90th day. Blood glucose levels were 400㎎/㎗ in all groups (normal control: 120㎎/㎗) and serum amylase level of a group after 45 days was 621.1 IU of average, whereas 750.5 IU in normal control group. The cytoplasms of pancreatic acinar cells were closely packed withh minute hydropic vacuoles and numerous fat globules, measuring 0.5～1.0μ in diameter. Electron microscopic findings represented mitochondrial swelling with loss of cristae and indistinct outlines. Populations of free ribosome were increased, but the zymogen granules were reduced than those of control group. The above findings support that streptozotocin induces acinar cell injury in part through the direct chemical toxicity on mitochondria.

Original Article

A Comparision of Surepath(TM) Liquid-Based Smear with a Conventional Smear for Cervicovaginal Cytology-with Reference to a Histological Diagnosis.: Kyung Chul Lee, Chan Kwon Jung, Ahwon Lee, Eun Sun Jung, Yeong Jin Choi, Jong Sup Park, Kyo Young Lee; Korean J Cytopathol. 2007;18(1):20-28.

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Abstract PDF: This study was performed to compare Surepath(TM) liquid-based smear and a conventional cervicovaginal smear with reference to a histological diagnosis. A hybrid capture test (HCII) was also performed and analyzed. We collected matched cases for cervicovaginal cytology- histology: 207 cases for conventional cytology (CC) and 199 cases for liquid-based cytology (LBC). HCII was performed in 254 patients. When a cytological diagnosis of ASCUS or above (ASCUS+) is classified as positive and a histological diagnosis of LSIL+ is classified as positive, the sensitivity and specificity for LBC was 91.7% and 75.9%, respectively and the sensitivity and specificity for CC was 62.6% and 96.1%, respectively. When a cytological and histological diagnosis of LSIL+ is classified as positive, the sensitivity and specificity for LBC was 77.5 and 96.6%, respectively and the sensitivity and specificity for CC was 49.7% and 100%, respectively. When a histological diagnosis of LSIL+ is classified as positive, the sensitivity and specificity for HCII was 78.9% and 78.1%, respectively. The concordance ratio between the cytological and histological diagnosis was 80.4% (kappa=76.0) for LBC and 56.5% (kappa=55.1) for CC. LBC is more sensitive and less specific then CC, as a cytological cutoff level of ASCUS, but more sensitive and equally specific, as a cytological cutoff level LSIL or HSIL. LBC is more reliable with a high concordance ratio between the cytological and histological diagnosis.

Etc

Electron Microscopical Study on the Rat Myocardium in Acute Neurogenic Cardiovascular Death: Hyung Bae Moon; Korean J Cytopathol. 1984;18(1):23-31.

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Abstract: Death resulting from acute neurogenic cardiovascular failure have been divided into primary shock caused by parasymphathetic stimulation and ventricular fibrillation caused by symphatheticoadrenal stimulation. Morphological characteristics have not been established in gross and microscopical finding in either cases. Hence this experiment was designed to provide some positive findings in differentiating these two cause of death. Primary shock or ventricular fibrillation was induced by electrical stimulation of the vagus nerve (5 volt, 50 Hz, 1.0 msec.) and of the chest wall (120 volt, 50 Hz, A.C.) respectively and rat myocardium were observed with electron microscope. 1) The heart of the rat which died from primary shock revealed relatively normal pattern of ultrastructural architectures in the myofilaments, myofibrils, sarcomeres, Z lines, mitochondria and other sarcoplasmic organelles. 2) The heart of the rat which died from ventricular fibrillation revealed shortening and scalloping of the sarcomeres, fragmentation of the Z lines, distortion of the myofilaments around the intercalted disc and displacement of the mitochondria away from the intercalated disc, appear to be similar to those of zonal lesion seen in the hemorrhagic shock. Furthermore, marked changes were noted in mitochondria. These changes consisted of swelling, destruction of the cristae, and abnormal cystic space formation with or without amorphous materials stic depression of glycogen particles were present. From these results, it might be suggested that the ultrastructural findings of the heart could provide the morphological differences between death from primary shock and ventricular fibrillation.

Original Article

Cytologic Evaluation of CellPrep(R) Liquid-based Cytology in Cervicovaginal, Body Fluid, and Urine Specimens: Comparison with ThinPrep(R).: Jae Soo Koh, Soo Yeon Cho, Hwa Jeong Ha, Jung Soon Kim, Myung Soon Shin; Korean J Cytopathol. 2007;18(1):29-35.

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Abstract PDF: This study purposed to evaluate a CellPrep(R) (CP) of liquid-based cytology (LBC) to search for a less expensive and automated alternative cytologic preparation technique applicable to usually encountered cytologic specimens. Cervicovaginal direct-to-vial split samples from 457 gynecologic patients, 40 body fluid samples, and 34 urine samples were processed with the CP technique and the results were compared with those of currently used ThinPrep(R) (TP) method. Both CP and TP methods provide evenly distributed thin layers of cells with little cellular overlaps or significant obscuring elements in most of cases. Staining quality of both preparations showed a little difference due to the difference of fixative solutions without significant distractions in cytologic interpretation. On the supposition that TP was a gold standard, sensitivity, specificity, positive predictive value, and negative predictive value of CP cytology were 89%, 98%, 86%, and 99% in the cervicovaginal smear, 89%, 82%, 80%, and 90% in body fluid, and all of these values were 100% in urine samples. To testify the availability of immunohistochemistry on CP preparations, cytokeratin, vimentin, and Ki-67 were applied on body fluid specimens, and all of these antibodies were specifically stained on targeted cells. Conclusively, the CP method gave comparable results to those of TP in terms of smear quality and cytologic diagnostic evaluation, and was available on immunohistochemistry. The CP method could offer a cost-effective and automated alternative to the current expensive techniques of liquid- based cytology on popular cytologic materials including cervicovaginal, body fluid, and urine specimens.

Etc

A Morphological Observation on Human Pineal Glands -80 cases analysis of fetal and postnatal pineals: Jung Ran Kim, Je G. Chi; Korean J Cytopathol. 1984;18(1):32-38.

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Abstract: To evaluate the histological appearance of the human pineals, a morphologic study was made based on 80 normal human pineals. The material consisted of 44 pineals from fetuses ranging in age from 16 to 40 gestational weeks and 36 pineals of children and adults ranging in age from 1 day to 58 years. Following observation were made: 1) The pineals show a distinctive pattern of evolution in the morphology through the entire life as judged by morphological features, such as glandular, alveolar, mosaic and locular pattern. 2) At 16 weeks of gestation are proliferated and become ependymal cells transformed into glial and primitive pineal parenchymal cells, that later become pinealoblasts by before 28 weeks of gestation. The pineals of newborn show the pattern of adult type by 10 months of age. 3) Melanin pigment deposits in the pineals is noted in 66 percent of the cases examined. The pigment is first seen in glandular structure at early gestational period and becomes visible in undifferented parenchymal cells or glial cells. Although pigment density varies intensity it is generally prominent through the gradually less prominent starting from 8 months of age and is minimal over the age 50 years.

Original Article

Cytologic Evaluation of Adenocarcinoma and its Mimics in Sputum and Bronchial Washings.: Young Chae Chu, In Suh Park, Suk Jin Choi, Lucia Kim, Jee Young Han, Joon Mee Kim, Jung Ae Park; Korean J Cytopathol. 2007;18(1):36-45.

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Abstract PDF: OBJECTIVE: To identify key cytologic features for diagnosis of adenocarcinoma and morphologic differentiation from reactive/reparative respiratory epithelium. STUDY DESIGN: The cytomorphologic features of 145 pulmonary cytology specimens (sputum and bronchial washing), which included 117 histologically proven adenocarcinomas and 28 non-neoplastic lesions, cytologically diagnosed as atypia and suspicious for malignancy (adenocarcinoma) were reviewed retrospectively. We analyzed 11 morphologic criteria in pulmonary cytologic specimens.
RESULTS
Over 110 of 117 cases of adenocarcinomas revealed nuclear membrane irregularities, non-cohesive cells, single atypical cells, moderate to markedly enlarged nuclei and an increased nuclear/cytoplasmic (N/C) ratio. Chromatin clearing, chromatin heterogeneity and hyperchromasia were seen in 102, 99 and 97 cases, respectively. All 28 cases involving non-neoplastic lesions revealed hyperplastic reactive pneumocytes, hyperplastic reactive bronchial epithelium, or degenerating macrophages. The non-neoplastic lesions revealed a small number of atypical cell clusters and paucity or absence of atypical single cells.
CONCLUSION
The most important morphologic features for diagnosis of adenocarcinoma are nuclear membrane irregularities, non-cohesive cells, single atypical cell, moderate to markedly enlarged nuclei and increased N/C ratio. Chromatin clearing, chromatin heterogeneity and hyperchromasia were also helpful features, while pleomorphism and prominent nucleoli were less valuable.

Etc

Histopathological Study of Partial Hydatichiform Mole: Hee Kyung Chang, Tae Lee, Sun Kyung Lee; Korean J Cytopathol. 1984;18(1):40-46.

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Abstract: The study was undertaken to investigate the clinical and histopathological characteristics of partial hydatidiform mole. The subjects were a series of consecutive 54 cases of partial hydatidiform mole and 212 cases of classic hydatidiform mole, which were diagnosed pathologically at the department of pathology during the 11 years period from 1970 to 1980. The cases were analyzed morphologically and statistically. The results obtained were summerized as follows: 1) The age distributions of the patients with partial and classic moles were from third to sixth decade with a peak incidence of third decade with a peak incidence of third decade. There was no significant difference in the age distribution between partial and classic moles. 2) In the patients with partial mole, 90% of the cases were multipara and 32% of cases had history of spontaneous or artificial abortion. In the patients with classic mole, 78% of cases were multipara and 36% of cases had history of abortion. There was no significant difference in obstetric history of the both types. 3) Histopathologic findings of the classic mole were hydropic change and central cisterns of the storma (100%), maze-like cisterns of the stroma (4.3%), blood vessels with/without red cells (0.9%), and considerable hyperplasia of trophoblasts (65.6%). 4) Histopathologic findings of the partial mole consisted of hydropic villi admixed with normal villi (100%), hydropic change of the stroma (100%), central cisterns of the stroma (90.4%), maze-like cisterns of the stroma (83.3%), blood vessels with mature and immature red cells (98.1%), and considerable hyperplasia of trophoblasts (22.2%). On the basis of the above results, characteristic findings of partial mole, which might be distinguished from classic type, were maze-like cisterns of the stroma, mixture of normal and hydropic villi, and blood vessels with mature or immature red cells in the stroma.

Original Article

Evaluation for Cytopreservability of Manual Liquid-Based Cytology Liqui-PREP(TM) and its Application to Cerebrospinal Fluid Cytology: Comparative Study with Cytospin.: Gyeongsin Park, Kyungji Lee, Chan Kwon Jung, Dae Hyoung Lee, Bin Cho, Youn Soo Lee, Sang In Shim, Kyo Young Lee, Chang Suk Kang; Korean J Cytopathol. 2007;18(1):46-54.

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Abstract PDF: Cerebrospinal fluid (CSF) cytology is an effective tool for evaluating diseases involving the central nervous system, but his technique is usually limited by its low cellularity and poor cellular preservation. Here we compared the manual liquid-base Liqui-PREPTM (LP) to the cytospin (CS) with using a mononuclear cell suspension and we applied both methods to the CSFs of pediatric leukemia patients. The cytopresevability, in terms of cell yield and cell size, and the clinical efficacy were evaluated. When 2000 and 4000 mononuclear cells were applied, LP was superior to CS for the cell yield, 16.8% vs 1.7% (P=0.001) and 26.2% vs 3.5% (P=0.002), respectively. The mean size of the smeared cells was 10.60 micrometer in the CS, 5.01 micrometer in the LP and 6.50 micrometer in the direct smear (DS), and the size ratio was 1.7 (CS to DS), 0.8(LP to DS) and 2.1 (CS to LP), respectively. As compared to the cells in the DS, the cells in the CS were significantly enlarged, but those in the LP were slightly shrunken. Upon application to 109 CSF samples, 4 were diagnosed as positive for leukemia (positive), 4 had atypical cells and 101 were negative by CS; 6 were positive, one had atypical cells and 102 were negative by LP. For six cases, in which 4 were positive for leukemia and 2 of 4 had atypical cells by CS, they were positive by LP and they were also confirmed as positive according to the follow-up study. Three cases diagnosed as atypical cells (two by CS and one by LP), were confirmed as negative. In conclusion, these results suggest that LP is superior to CS for the cytopresevability and for rendering a definite diagnosis of cerebrospinal fluid.

Etc

Estimation of Several Normal Values of Peripheral Blood from Clinical Laboratory Data by Various Statistical Methods: Mee Young Sol, Eun Yup Lee, Soon Ho Kim; Korean J Cytopathol. 1984;18(1):47-56.

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Abstract: It is desirable for each clinical laboratory to have its own normal values. The easy way to obtain them was to utilize the routine laboratory test results. Among the various statistical methods proposed for above purpose, the authors chose three statistical methods, such as Hoffmann, Neumann and Chung's methods. And by applying these methods, the authors estimated normal ranges from the laboratory data of Korean adult on hematological items measured by the Coulter Counter Model S-plus II furnished by the clinical laboratory of the Busan National University Hospital from Jan. 1983, to August, 1983. The 95% normal ranges established by the authors were summerized as follows: 1) Total mean RBC count of male was 350×10⁴/㎣, and that of female was 330×10⁴/㎣. 2) The hemoglobin of male was 13～16gm/㎗, and that of female was 11～14gm/㎗. 3) The hematocrit of male was 31～49%, and that of female was 29～43%. 4) The MCV of male was 84～98μ㎥, and that 81～97μ㎥. The MCH of male and female was 27～33pg, and the MCHC of both male and female were 32～35gm/㎗. 5) The total WBC count of male was 4,000～10,000/㎣, and that of female was 4,000～9,000/μ㎥. 6) The total platelet count of male was 17×104/㎣, and that of female was 4,000～9,000/μ㎥. 7) The red cell distribution width of male and female was 11.5～14%.

Original Article

Comparision of Effectiveness between the ThinPrep(R) and the Cytospin Preparations of the Repeated Urine Cytology.: Soon Won Hong, Hyun Kyung Kim, Ju Yeon Pyo, Yoonhee Lee, Woo Hee Jung, Se Hoon Kim; Korean J Cytopathol. 2007;18(1):55-61.

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Abstract PDF: Once diagnosed as "cell paucity" or "atypia" by the cytospin (CS) preparation, this CS preparation does not secure a precise diagnosis by repeated testing alone. Although the ThinPrep(R) (TP) preparation is acknowledged to show increased cellularity, performing the screening tests for the cases that have enough cellularity, according to CS, raises issues for the cost-effectiveness. To obtain a more precise diagnosis through increasing the cellularity by performing TP, we selected the cases that were diagnosed as "cell paucity" or "atypia" by CS, but they required a more precise diagnosis, and the samples were processed via both CS and TP to compare the results. 11 patients diagnosed as "cell paucity" and 22 patients diagnosed as "atypia" by CS participated in this study. When the detection rate of atypical cells in both preparations with repeated urine cytology was compared, the overall detection rate of TP (16cases, 48.5%) was superior than that of CS (11cases, 33.3%), with statistical significance. The cellularity of both preparations was compared on repeated urine cytology; the general cellularity of TP (29cases, 87.9%) was higher than that of CS (20cases, 60.6%), but there was no statistical significance. Particularly, we repeated the TP for the 1 case that was diagnosed as "atypia" and we performed polyoma virus immunohistochemical staining, which confirmed polyoma virus. In conclusion, we can avoid obtaining negative diagnosis from cases with uncertain "atypia" or "cell paucity" by performing repeated TP testing.

Etc

Normal Values of Liver Function Test in Korean Adults Indirectly Estimated by Analysis of the Values of Patients's Blood Samples: Sung Ryul Kim, Han Chul Son, Soon Ho Kim; Korean J Cytopathol. 1984;18(1):57-65.

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Abstract: It was desirable for each clinical laboratory to have its own normal ranges, though it may be cumbersome and cost-bearing. Patients' laboratory data of each test had recently been attempted by statistical analysis in an effort to obtain indirect estimates of the normal ranges. For this purposes the authors have tried to estimate normal values in our laboratory from routine clinical laboratory test items, using three statistical methods proposed by Hoffmann, Neumann and Chung. The laboratory studies were carried out by Abbott-VP biochemical analyzer at clinical laboratory, Busan National University Hospital from January, 1983 to August, 1983. The normal ranges estimated by the authors are as follows: 1) Normal ranges of serum total protein, album in and globulin are 5.8～5.0 and 2.0～3.6 gm/㎗, respectively. 2) Normal ranges of serum aspartate aminotansferase(AST) and alanine aminotransferase(ALT) are 9～30 and 9～34 IU/L. 3) Normal range of serum alkaline phosphotase(ALP) is 30～90 IU/L. 4) Normal range of serum lactate dehydrogenase(LD) is 95～200 IU/L. 5) Normal rage of serum gamma-glutamyl transpeptidase(GGT) is 10～43 IU/L.

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