Journal of Pathology and Translational Medicine

Volume 42(4); August 2008

Original Articles

Predictive Factors of Epstein-Barr Virus Association in Gastric Adenocarcinoma.: Young Su Kim, Sang Chul Nam, Man Hoon Han, Ji Yun Jeong, Sun Kyun Park, In Soo Suh, Han Ik Bae; Korean J Pathol. 2008;42(4):193-197.

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Abstract PDF: BACKGROUND
It is important to detect Epstein-Barr virus (EBV) in the setting of gastric cancer so that early viral targeted therapy and prevention can be undertaken. The aim of this study was to investigate the predictive clinicopathologic factors for EBV-related gastric cancer.
METHODS
The archival tumor tissues from 335 patients with gastric cancer were examined using tissue microarray. The detection of EBV was performed using EBV mRNA in situ hybridization (EBV-ISH), and the results were compared against clinicopathologic factors.
RESULTS
EBV-related gastric cancers were identified in 21 of 335 investigated cases (6.27%). The anatomical predisposition of EBV-related cancers to manifest in the upper stomach was statistically significant (p<0.001). EBV-related cancers were almost always (20/21) accompanied by lymphoid stroma. No differences in age, sex, histologic differentiation, or T or N stage were noted between EBV-positive and EBV-negative gastric carcinomas.
CONCLUSIONS
The association of EBV with gastric adenocarcinomas could be predicted when tumors with lymphoid stroma occurred in the upper stomach.

Birefringent Particles as an Effective Factor in Usual Interstitial Pneumonia.: Min Jung Kim, Seung Yeon Ha, Sung Hwan Jeong, Bongkyung Shin; Korean J Pathol. 2008;42(4):198-201.

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Abstract PDF: BACKGROUND
It has long been recognized that birefringent paticles (BP) are associated with pulmonary disease. And there is increasing evidence that BP cause fibrotic reaction within the lung depending on both particle size and composition.
METHODS
We collected 41 cases of usual interstitial pneumonia (UIP) and 101 cases of normal lung tissue from control group including squamous cell carcinoma, adenocarcinoma and bullae. BPs in the 0.1 to 10 micrometer size range under polarizing microscope was measured and counted by image analyzer.
RESULTS
BP counts are mean 244.05/10 HPF in UIP and 71.4/10 HPF in control group. BPs in UIP is three times more than control (p=0.000). It increased significantly by the age of patients (p=0.000).
CONCLUSIONS
BPs in lung might be important cause of inflammation and fibrosis in UIP.

Microsatellite Instability in Endometrial Adenocarcinomas of Young Women.: Hyang Im Lee, Ga Won Choi, Jene Choi, Kyu Rae Kim; Korean J Pathol. 2008;42(4):202-207.

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Abstract PDF: BACKGROUND
The correlation between microsatellite instability (MSI) and the prognosis of patients with endometrial carcinomas is controversial. The endometrial carcinomas in the young adult group usually have an excellent prognosis, and these tumors might have a different frequency of MSI compared with those in old women. Further, the pathogenetic mechanisms of the two groups might be different. We investigated the frequency of MSI in the endometrial cancers of patients who were under the age of 40 and we correlated the frequency with other prognostic factors.
METHODS
MSI analyses were performed using 5 primers (BAT25, BAT26, D2S123, D5S346 and D17S250) and with using the genomic DNA obtained from the paraffin embedded tumor and the paired normal tissues.
RESULTS
All 23 cases we examined exhibited endometrioid adenocarcinomas, and most of them were of the low international federation of gynecologists and obstetricians (FIGO) stage (stage I: 22, IIB: 1); 78% were microsatellite stable and 22% were MSI-low; an abnormal peak was present at only one marker, and any case of MSI-high was not identified. The FIGO stages of the 5 MSI-low cases were variable.
CONCLUSIONS
The frequency of MSI in the endometrial cancers of young patients is not significantly different from the frequencies reported for all age groups in the previous studies, MSI-low does not seem to be related to the other poor prognostic parameters, although the number of cases we studied is insufficient to draw any firm conclusion.

Correlation of the Nuclear beta-catenin Expression with the Clinicopathological Parameters of Hepatocellular Carcinoma.: Hyoung Jong Kwak, Ha Na Choi, Sung Ho Hwang, Keum Ha Choi, Ho Sung Park, Kyu Yun Jang, Myoung Ja Chung, Myoung Jae Kang, Dong Geun Lee, Woo Sung Moon; Korean J Pathol. 2008;42(4):208-214.

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Abstract PDF: BACKGROUND
Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the human liver. However, the molecular changes and mechanisms that regulate the development and progression of HCC remain unclear. Beta-catenin is known as a multi-functional protein that acts as a regulator of the cadherin-mediated cell-cell adhesion system and also in the Wingless/Wnt signal transduction pathway. The aim of this study was to investigate the expression of beta-catenin and its possible role in HCC.
METHODS
We investigated the expression of beta-catenin, Ki-67, TP53, alpha-smooth muscle actin and CD34 by performing immunohistochemical staining for 61 specimens of HCC and their adjacent non-tumorous tissue. We also examined the relationship between the nuclear expression of beta-catenin and the clinicopathologic parameters.
RESULTS
The altered expression of beta-catenin was not detected in the nontumorous liver tissue. The nuclear expression of beta-catenin was observed in approximately 16% (10/61) of the HCC specimens. Double immunohistochemical staining for beta-catenin and E-cadherin showed a close relationship between nuclear translocation of beta-catenin and the loss of the membranous E-cadherin expression. Significant correlation was found between the nuclear translocation of beta-catenin and the tumor size, tumor necrosis and the presence of microvessel invasion and intrahepatic metastasis (p<0.05).
CONCLUSIONS
This data indicates that nuclear translocation of beta-catenin could play a role in the growth and progression of HCC.

The Prognostic Implications of the Histologic Subtype and the Expression of Phosphorylated ERK 1/2 in Papillary Renal Cell Carcinoma.: Bo Sung Kim, Dong Il Kim, Tae Hoon Kang, Eun Shin, Kyung Chul Moon; Korean J Pathol. 2008;42(4):215-222.

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Abstract PDF: BACKGROUND
The authors of this study wanted to confirm the prognostic implication of the histologic subtype; further, we wanted to explore the expression of phosphorylated extracellular signal-regulated kinase 1/2 (pERK) in papillary renal cell carcinoma (PRCC) and determine its clinicopathologic and prognostic significance.
METHODS
A total of 45 patients who underwent nephrectomy for PRCC were enrolled in this study. The hematoxylin and eosin slides were reviewed and pERK immunohistochemistry was performed.
RESULTS
Type 2 PRCC was significantly correlated with a larger tumor size (p=0.030), a higher nuclear grade (p<0.001), a more advanced tumor stage (p=0.041) and more frequent distant metastasis (p=0.019). The tumors were pERK-low (0 and 1+) in 30 cases (66.7%) and pERK-high (2+) in 15 cases (33.3%). The pERK-high PRCC was significantly associated with a smaller tumor size (p=0.001) and an earlier tumor stage (p=0.004). On the univariate analysis, the histologic subtype, the TNM stage and the pERK status were significantly associated with progression-free survival (PFS). Multivariate analysis showed that the histologic subtype (hazard ratio 22.81, p=0.042) and the TNM stage (hazard ratio 23.48, p=0.009) were independent prognostic factors for PFS.
CONCLUSIONS
Type 2 PRCC, together with the TNM stage, was identified as one of independent poor prognostic factors for PFS. The pERK status was a prognostic factor for PFS on the univariate analysis, but not on the multivariate analysis.

Case Reports

A Case Report of Cutaneous Coccidioidomycosis.: Sunhee Chang, Sang Hwa Shim, Ji Eun Kwak, Mee Joo, Hanseong Kim, Hai Jin Park, Yee Gyung Kwak, Je G Chi; Korean J Pathol. 2008;42(4):223-225.

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Abstract PDF: Coccidioidomycosis, which results from inhaling the spores of Coccidioides species, is endemic in the southwestern United States. The primary infection site is the lung, and dissemination of the disease can occur. We report a case of cutaneous coccidioidomycosis in a 79-year-old Korean woman who presented with purpura on both lower extremities, but no pulmonary symptoms and no history of visiting an endemic area. Microscopically, skin biopsy showed multiple aggregates of granulomas in the dermis. Numerous multinucleated giant cells were associated with the granulomas. Mature and immature fungal spherules, which were 20 to 30 micrometer in diameter, were present inside and outside the multinucleated giant cells.

Fibrovascular Polyp of the Hypopharynx: A Case Report.: Sunhee Chang, Sang Hwa Shim, Ji Eun Kwak, Mee Joo, Hanseong Kim, Bum Jo Jung, Joong Wook Shin, See Young Park, Kyung Ja Cho, Je G Chi; Korean J Pathol. 2008;42(4):226-228.

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Abstract PDF: We report here on a case of fibrovascular polyp arising in the hypopharynx of a 62-year-old man. Laryngomicroscopic surgery with laser ablation was performed to excise the mass. Histopathologically, the surface of the polyp was covered with mature squamous epithelium. The polyp showed a characteristic lobular proliferation of mature adipose tissue that was separated by myxoid or collagenous connective tissue. Some scattered skeletal muscle bundles were seen in the central portions of the polyp and these bundles were surrounded by a concentric proliferation of the spindle cells; this was reminiscent of Pacinian corpuscles. Regarding their location and the intermingled pattern of proliferating tissues, it is more plausible that the skeletal muscle is a hamartomatous component rather than entrapped, preexisting tissue.

A Diagnostically Challenging Case of an Infarcted Adenomatoid Tumor of the Epididymis.: Sunhee Chang, Sang Hwa Shim, Ji Eun Kwak, Mee Joo, Hanseong Kim, Je G Chi, Keon cheol Lee; Korean J Pathol. 2008;42(4):229-231.

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Abstract PDF: We describe a case of an infarcted adenomatoid tumor of the epididymis that was challenging to diagnose. A 20-year-old man presented with acute left scrotal pain. He was found to have a 2x1.5x1 cm tumor that was relatively well circumscribed on gross examination. There was a central necrotic area that exhibited gaping spaces and ghost outlines of epithelial cells. The periphery of the necrotic lesion showed focally viable adenomatoid tumor. The majority of the tissue adjacent to the necrosis consisted of granulation tissue, fibroblastic and myofibroblastic proliferation, and neutrophils. The fibroblasts and myofibroblasts showed plump nuclei, often with small nucleoli. No mitotic activity was present. The differential diagnosis for an infarcted adenomatoid tumor includes malignant mesothelioma, inflammatory myofibroblastic tumor, and inflammatory conditions. The key to diagnosing an infarcted adenomatoid tumor is to consider it in the differential diagnosis of any spindle cell tumor with necrosis occurring in the genital tract.

Intravascular Leiomyosarcoma of the Femoral Vein: A Case Report.: Soon Auck Hong, Min Eui Hong, Gui Young Kwon, Tae Jin Lee, Eon Sub Park, Jae Hyung Yoo; Korean J Pathol. 2008;42(4):232-235.

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Abstract PDF: Intravascular leiomyosarcomas of the femoral vein are extremely rare. Our patient was initially diagnosed with a deep vein thrombosis based on ultrasonography and venography. The thrombectomy specimen consisted of typical spindle cells with variable anaplasia arranged in a fasciculating and interlacing pattern. The final diagnosis was proved to be an intravascular leiomyosarcoma confirmed by immunohistochemical studies for smooth muscle actin, desmin, vimentin, CD34 and CD68.

Massive Perivillous Fibrin Deposition in Placenta.: Dae Woon Eom, Gil Hyun Kang, Chung Hyun Cho, Sang Wook Yi, Han Moie Park, Sang Su Lee, U Seog Son; Korean J Pathol. 2008;42(4):236-239.

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Abstract PDF: Massive perivillous fibrin deposition (MFD) is a rare condition characterized by heavy accumulation of fibrin in intervillous or perivillous spaces encasing villi throughout the placenta. This condition may cause varying degrees of placental insufficiency, leading to a significantly increased risk of intrauterine growth retardation, intrauterine death, and pre-term delivery. However, the objective criteria for the diagnosis of MFD have not been clearly established. We report a case of MFD associated with intrauterine growth retardation and preterm premature rupture of membranes.

Minimal Deviation Endometrioid Adenocarcinoma of the Uterine Cervix: A Case Report.: Kye Won Kwon, Susie Chin, Hee Kyung Kim, Eun Seok Koh, Kyu Rae Kim, Kye Hyun Nam; Korean J Pathol. 2008;42(4):240-243.

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Abstract PDF: We describe here a case of minimal deviation endometrioid adenocarcinoma (MDEA) of the uterine cervix that was initially suspected according to the abnormal cytologic findings in a 39-year-old woman. The Papanicolaou (pap) smear showed many neoplastic glandular cells in monolayered sheets, rosettes, and clusters with palisading and feathering borders. The tumor cells had oval, hyperchromatic nuclei, with chromatin clumping and small nucleoli. Histologic examination disclosed endometrial-type glands with a bland, isolated, mainly rounded appearance and these glands were widely scattered deep into the cervical stroma with only scant stromal reaction. An association of MDEA with tubo-endometrioid metaplasia or cervical endometriosis has been suggested by identifying the tubo-endometrioid glands in the vicinity of the MDEA.

Cystic Lymphangioma of the Breast in an Adult Woman.: Kyueng Whan Min, Si Hyong Jang, Woong Na, Se Min Jang, Young Jin Jun, Ki Seok Jang, Seung Sam Paik; Korean J Pathol. 2008;42(4):244-246.

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Abstract PDF: Cystic lymphangioma is also known as cystic hygroma, and this is a congenital malformation of the lymphatic system. Most lymphangiomas are present at birth and they are diagnosed by the age of 2. They are mostly located in the neck or axillary region. The breast as a site of origin is an extremely unusual location, and especially in adults. We report here on a case of cystic lymphangioma in a 36-year-old woman. Physical examination revealed a tender cystic mass in the upper outer quadrant of the right breast. Ultrasonography revealed an irregular hypoechoic mass lesion that was associated with irregular duct dilatation and several enlarged axillary lymph nodes. After the operation, the mass was revealed to be a cystic lymphangioma. Although it is very rare, cystic lymphangioma should be considered in the differential diagnosis of a breast mass in adults.

A Well-Differentiated Extraskeletal Osteosarcoma: A Case Report.: Jung Wook Yang, Dae Hyun Song, Dong Hee Kim, Gyung Hyuck Ko; Korean J Pathol. 2008;42(4):247-250.

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Abstract PDF: A well-differentiated extraskeletal osteosarcoma is very rare, and only seven cases have been reported in the English language clinical literature. We report an additional case of this rare tumor. A 71-year-old man had noticed a mass in the left pubic area for ten years. A CT scan demonstrated the presence of a lobulated calcified mass within the soft tissue. A 5 cm-sized well-circumscribed mass was excised. Histologically the tumor was composed of mature collagenous tissue and bony trabeculae rimmed by osteoblasts. After 43 months, the tumor recurred at the same site and was re-excised. The re-excised tumor contained focal areas of higher cellularity and atypism. We believe that this is the first case of well-differentiated extraskeletal osteosarcoma reported in Korea.

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