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Volume 41(4); August 2007
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Original Articles
Relationship of Gastric Metaplasia of the Duodenum with Age, Duodenal Ulcer and Helicobacter pylori Infection.
Dae Hyun Song, Dong Chul Kim, Jong Sil Lee, Jeong Hee Lee, Hyun Jin Kim, Hee Shang Youn, Gyung Hyuck Ko
Korean J Pathol. 2007;41(4):217-223.
  • 1,753 View
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AbstractAbstract PDF
BACKGROUND
Gastric metaplasia of the duodenum is thought to be associated with the pathogenesis of duodenal ulcer. We investigated the pathological features of gastric metaplasia and their relation to age, gender, duodenal ulcer and H. pylori infection.
METHODS
We reviewed the duodenal endoscopic findings of 535 patients (age range: 0 to 87) and the microscopic slides of the duodenal biopsy specimens.
RESULTS
Gastric metaplasia was first noted at the age of 4 and the prevalence increased thereafter until the patients' mean age reached about 30. The prevalence of gastric metaplasia was 53.7% after 30 years of age. As the metaplasia became severer, it became more polypoid in appearance and it more often contained parietal cells. Gastric metaplasia was more frequently observed or severe in duodenal ulcer patients, in males and in the first portion of the duodenum than in patients without duodenal ulcer, in females and in the second portion, respectively. There was a lack of correlation between gastric metaplasia and H. pylori infection.
CONCLUSIONS
The prevalence and/or severity of gastric metaplasia of the duodenum increases with age, and it is thought that most duodenal ulcers develop in the areas of gastric metaplasia.
Genetic and Epigenetic Alterations of the Wnt/beta-catenin Signaling Pathway in Cancer of the Ampulla of Vater.
Gwang Il Kim, Jeong Boon Kim, Sang Bum Park, Young Sik Kim, Han Kyeom Kim, Bom Woo Yeom, Yang Seok Chae
Korean J Pathol. 2007;41(4):224-231.
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AbstractAbstract PDF
BACKGROUND
Carcinoma of the ampulla of Vater is rare and its pathogenesis is unclear. The role of epigenetic changes in the APC or CDH1, in the Wnt pathway, has not been reported in ampullary carcinomas.
METHODS
We performed immunohistochemistry on 73 sporadic ampullary carcinomas to identify Wnt-related molecules (APC, beta-catenin, E-cadherin, c-erbB2, cyclin D1) and examined mutations in the CTNNB1, loss of heterozygosity of 5q21, and the methylation status of the CpG island of APC and CDH1.
RESULTS
Thirteen tumors (17.8%) showed abnormal nuclear localization of beta-catenin; this was more prominent in the intestinal type than in the pancreaticobiliary type (p=0.01). The loss of APC correlated with the loss of beta-catenin or c-erb B2 (p<0.01). The prognosis was worse in the group with APC loss than when APC was maintained (p<0.05). There was no mutation identified in CTNNB1. Six (24%) out of 25 informative cases had 5q21 allelic loss. CpG island methylation in APC and CDH1 was detected in 33 (45.2%) and 29 (31.5%) cases, respectively.
CONCLUSIONS
The absence of mutations in CTNNB1 and the epigenetic alteration of APC and CDH1, might be characteristic changes in the Wnt/beta-catenin signaling pathway during the carcinogenesis of ampullary carcinomas.
Expression of Claudin-1 and -4 in Benign Lesions and Invasive Ductal Carcinomas of the Breast.
Hyun Joo Choi, Ji Han Jung, Jinyoung Yoo, Seok Jin Kang, Kyo Young Lee
Korean J Pathol. 2007;41(4):232-237.
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AbstractAbstract PDF
BACKGROUND
The claudins are a family of transmembrane proteins associated with tight junctions and they are critical for maintaining cell-to-cell adhesion in sheets of epithelial cells. However, their role in the progression of cancer remains largely unexplored. The aims of this study were to evaluate the expression patterns of claudin-1 and -4 in benign lesions and invasive ductal carcinomas (IDC) of the breast, and relationships between the expression of these markers and the clinicopathological characteristics in IDC patients.
METHODS
We examined the claudin-1 and -4 protein expressions by performing immunohistochemical stainings in 54 benign lesions and 120 IDCs via the tissue microarray method. We evaluated the correlation between the expression of these markers and the clinicopathological characteristics of IDC.
RESULTS
The expressions of claudin-1 (p=0.099) and -4 (p=0.000) were up-regulated in IDCs as compared with benign lesions. The claudin-1 expression correlated with the loss of estrogen receptor (p=0.036) and progesterone receptor (p=0.011). The claudin-4 expression correlated with lymph node metastasis (p=0.043), the nuclear grade (p=0.030), the histologic grade (p=0.007), and the loss of estrogen receptor (p=0.001) and progesterone receptor (p= 0.029).
CONCLUSIONS
These results suggest that claudin-1 and -4 may play a significant role in the carcinogenesis of IDC of the breast and these may represent novel markers for this disease.
Expression of Survivin According to Malignant Progression of Breast Lesions.
Hyun Joo Choi, Ji Han Jung, Chan Kwon Jung, Jinyoung Yoo, Eun Jung Lee, Chang Suk Kang, Seok Jin Kang, Kyo Young Lee
Korean J Pathol. 2007;41(4):238-243.
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AbstractAbstract PDF
BACKGROUND
The aim of this study was to examine the survivin expression pattern in benign lesions, atypical ductal hyperplasias (ADH), ductal carcinomas in situ (DCIS) and in invasive carcinomas of the breast and to evaluate the effect of expression of this marker on the malignant progression of breast cancers. In addition, the relationship between the expression of the marker and the clinicopathological characteristics for invasive carcinomas were investigated.
METHODS
Immunohistochemical staining using a tissue microarray method for survivin was performed for 103 benign lesions, 30 ADHs, 26 DCISs and 116 invasive carcinomas.
RESULTS
The expression of cytoplasmic survivin was higher for invasive carcinomas than for ADHs and DCISs (p<0.05). For breast invasive carcinomas, expression of cytoplasmic survivin significantly correlated with tumor size, lymph node metastasis and stage (p<0.05).
CONCLUSIONS
These results suggest that overexpression of cytoplasmic survivin may be involved in the development of the late stage of breast malignancy, especially invasiveness. In breast invasive carcinomas, expression of survivin may be a useful indicator for the evaluation of patient prognosis.
Study on the Function of NAG-1 in Hepatocellular and Gastric Carcinoma Cells.
Tae Jung Jang
Korean J Pathol. 2007;41(4):244-251.
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AbstractAbstract PDF
BACKGROUND
Nonsteroidal anti-inflammatory drug activated gene (NAG-1) has proapoptotic activities in the colon and also in gastric cancer cells that lack any endogenous COX-2 expression. Recent studies have suggested that the proa- poptotic activity of NAG-1 is cell type specific. I investigated the cell proliferation, invasiveness and apoptosis in Hep3B cells and SNU719 cells by determining the different expression levels of NAG-1. In addition, I examined the gene profile in the Hep3B cells that have a stable expression of NAG-1.
METHODS
SNU719 cells and several clones of Hep3B cells with a stable expression of NAG-1 were used. I reduced the expression level of NAG-1 via the RNAi method. An Agilent Human 22k microarray was used for studying the gene profile in Hep3B cells that had a stable expression of NAG-1.
RESULTS
The expression level of NAG-1 did not influence apoptosis, cell proliferation and invasiveness in Hep3B cells. There was no correlation between the reduction of the endogenous NAG-1 expression and cell proliferation, including invasiveness, in the SNU719 cells. However, a knocked-down NAG-1 expression protected against apoptosis in the SNU719 cells. The microarray analysis results showed that 0.25% (58/22,575) of the genes were induced or repressed more than three fold in the Hep3B cells that had a stable expression of NAG-1.
CONCLUSIONS
Proapoptotic activity of NAG-1 is found in gastric cancer cells, but not in hepatocellular cancer cells.
An Immunohistochemical Study of Angiogenesis in Tumor Emboli.
Jo Heon Kim, Chan Choi, Jae Hyuk Lee, Ji Shin Lee, Sung Sun Kim, Chang Woo Han, Sang Woo Juhng
Korean J Pathol. 2007;41(4):252-257.
  • 1,626 View
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AbstractAbstract PDF
BACKGROUND
Angiogenesis, which is essential for tumor growth, is known to occur in the extravascular stroma. However, vascular structures were noted in intravascular tumor emboli in surgical specimens. This prompted our investigation of the frequency and morphology of angiogenesis in tumor emboli.
METHODS
Hematoxylin-eosin stained specimens were reviewed for tumor emboli, in 21 cases of stomach adenocarcinoma and 22 cases of colon adenocarcinoma. The cases were examined with immunohistochemistry using antibodies against epithelial antigen (cytokeratin), endothelial antigens (CD31, CD34), lymphatic endothelial antigen (D2-40), and proliferation-associated antigen (MIB1).
RESULTS
Endothelial cells were observed in 16 tumor emboli among four (19.1%) of the 21 cases of stomach adenocarcinoma and in 32 tumor emboli among four (18.2%) of the 22 cases of colon adenocarcinoma. The endothelial cells in the tumor emboli showed papillary ingrowth from the vessel wall, formation of vascular lumens, scattered distribution, or surface coating of the emboli. Some of the endothelial cells in the tumor emboli were D2-40-positive, and some were MIB1- positive.
CONCLUSIONS
These findings demonstrated that angiogenesis occurs in intravascular tumor emboli as well as in the extravascular stroma. Angiogenesis in the tumor emboli may reflect an active process and may facilitate tumor growth.
Case Reports
Nasal Chondromesenchymal Hamartoma: A Case Report.
Jun Kang, Young Ok Hong, Geung Hwan Ahn, Young Min Kim, Hee Jeong Cha, Hye Jeong Choi
Korean J Pathol. 2007;41(4):258-262.
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AbstractAbstract PDF
We report a case of nasal chondromesenchymal hamartoma. A 14-year-old boy presented with a 5 cm sized mass in the left maxillary sinus, facial swelling and a loose tooth. A subtotal left maxillectomy with a bone graft was performed. The excised mass was composed of partly encapsulated, solid and cystic fragments of soft tissues. The mass contained chondroid and myxoid areas consisting of mesenchymal tissues including hyaline cartilage, osteoid and spindle cells in various proportions. The hyaline cartilage component was the most prominent. The spindle cell component had a fibrous matrix with variable myxoid or sclerotic changes. Thick hyalinized eosinophilic osteoid-like trabeculae were focally present. Immunohistochemically, all the mesenchymal cells tested positive for vimentin. The chondrocytes tested positive for the S-100 protein, and the spindle cell component showed focal immunoreactivity for smooth muscle actin and desmin. However, the cells were negative to pan-cytokeratin and p63.
Meningioma Arising from Meningioangiomatosis Without Neurofibromatosis: A Case Report.
Jae Hong Park, Seung Yeon Ha, Na Rae Kim
Korean J Pathol. 2007;41(4):263-265.
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AbstractAbstract PDF
We report a rare case of meningioma associated with meningioangiomatosis in a 9-year-old male patient who showed none of the stigmata of neurofibromatosis 2. Brain magnetic resonance images showed marked cortical calcification with slight contrast-enhancement in the parieto-occipital lobe. The resected mass showed that the lesion was mainly composed of meningioangiomatosis and a small focus was transformed into meningioma. To date, only 17 cases of such combined lesions have been reported in English medical literature. We report a rare case of meningioma that arose from meningioangiomatosis.
An Unusual Stroma-Rich Variant of Castleman's Disease of the Hyaline-Vascular Type: A Case Report.
Ji Han Jung, Gyeongsin Park, Hyun Joo Choi, Jinyoung Yoo, Seok Jin Kang, Kyo Young Lee
Korean J Pathol. 2007;41(4):266-270.
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AbstractAbstract PDF
The stroma-rich variant of Castleman's disease of the hyaline-vascular type (CDHV) is a rare entity that shows overgrowth of a variety of stromal cells in the widened interfollicular (IF) area. We report here on a case of a stroma-rich variant of CDHV in an 18-year-old man who presented with an asymptomatic solitary neck mass he'd had for 1 year. Histologically, an enlarged lymph node fulfilled the criteria of CDHV, along with vague nodularity of a widened IF area. The nodular lesion consisted of numerous vessels and a proliferation of spindle cells. Immunohistochemically, the spindle cells were positive for vimentin and smooth muscle actin, they were negative for desmin, CD21, CD34, CD68, ALK-1, and S-100 protein. This stromal lesion is typically hyperplastic and clinically benign, and it must be distinguished from neoplastic stromal proliferation associated with Castleman's disease because of its potential for recurrence and metastasis.
Enterogenous Cyst of the Testis.
Sang Chul Nam, Man Hoon Han, Seok Jun Ye, Tae Gyun Kwon, Bup Wan Kim, Ghil Suk Yoon
Korean J Pathol. 2007;41(4):271-273.
  • 1,616 View
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AbstractAbstract PDF
We present a rare case of an enterogenous cyst of the testis in a 21-year-old man. On ultrasonography, an ovoid hypoechoic solid mass (2x2x1.5 cm) was confined to the right testis. The left testis and bilateral epididymis were within normal limits. Grossly, the tumor was a unilocular cystic mass, without a solid component. Microscopically, the cystic mass was composed of mucin-secreting simple columnar epithelial lining cells, lamina propria and a well-differentiated muscularis propria. There was no evidence of any germ cell derivatives or neoplasia in the cystic mass and in the surrounding testicular parenchyma. Immunohistochemistry showed a positive reaction for cytokeratin and the epithelial membrane antigen in the epithelial lining; in addition, it was positive for smooth muscle actin in the well-differentiated muscularis propria.
Trichoblastic Carcinoma arising in Trichoblastoma: A Case Report.
Kyung Jin Seo, Jinyoung Yoo, Seok Jin Kang, Ji Han Jung, Hye Kyung Lee, Kyo Young Lee
Korean J Pathol. 2007;41(4):274-277.
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AbstractAbstract PDF
Trichoblastic carcinoma is a rare malignant neoplasm of follicular germ cell origin; to the best of our knowledge, only six trichoblastic carcinomas arising in trichoblastomas have appeared on the literature. We recently experienced a trichoblastic carcinoma arising in a long standing trichoblastoma. A 68-year old woman came to the hospital with a chief complaint of an ulcerated nodule on her face. The nodule, 1.1x0.9 cm with an asymmetrical configuration, had been present and unchanged for more than 20 years, however, it grew suddenly with painful burning sensation. An excisional biopsy was performed and disclosed a deeply invasive, highgrade carcinoma, which consisted of cohesive epithelial cells arranged in irregular plump or germinative cell nests of various sizes. However, at the periphery of the tumor was a benign trichoblastoma surrounded by perifollicular sheath. We believe that the present case is a trichoblastic carcinoma developed via malignant transformation of pre-existing trichoblastoma.
Ki-1 Positive Extranodal NK/T Cell Lymphoma, Nasal Type, Mistaken as Dermatomyositis: A Case Report and Literature Review.
Hyun Jung Kim, Eunah Shin, Jung Yeon Kim, Kyeongmee Park, Young Jin Yoo, Seung Sook Lee
Korean J Pathol. 2007;41(4):278-283.
  • 1,464 View
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AbstractAbstract PDF
We report a case of a 38-year-old male with extranodal NK/T-cell lymphoma, nasal type, showing unusual clinical and pathological features. The patient was admitted for soft tissue swelling and tenderness in both legs. The patient had been treated intermittently 8 months prior for repeated muco-cutaneous ulcers. A muscle biopsy showed medium-sized atypical lymphoid cells with bizarre nuclei and plump cytoplasm, infiltrating to the skeletal muscle fibers with angiocentricity. The immunoresults were Ki-1+, CD56+, cytoplasmic CD3+, with EBV-in situ hybridization +. The patient rapidly deteriorated and died of sepsis and respiratory failure shortly after initiation of low-dose chemotherapy. A careful review of previous biopsies revealed scarce atypical lymphoid cells around vessels with similar immunoprofiles without the presence of Ki-1 positive cells. This case emphasizes that an extranodal NK/T-cell lymphoma may have a dermatomyositis-like diffuse presentation. Ki-1 co-expression can be an unexpected event in a process of the disease course; however, this should be validated with future studies.
Granular Cell Tumors of the Larynx: Report of Three Cases.
Ilseon Hwang, Jeong Eun Hwang, Seung Ho Choi, Soon Yuhl Nam, Kyung Ja Cho
Korean J Pathol. 2007;41(4):284-287.
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AbstractAbstract PDF
Granular cell tumors are rare and usually benign neoplasms that can occur in various parts of the body. We recently encountered three cases of granular cell tumor of the larynx; here, we present their clinicopathologic features, along with a review of reported Korean cases.

J Pathol Transl Med : Journal of Pathology and Translational Medicine