Journal of Pathology and Translational Medicine

Letter To The Editor

Response to comment on “A stepwise approach to fine needle aspiration cytology of lymph nodes”: Yosep Chong, Gyeongsin Park, Hee Jeong Cha, Hyun-Jung Kim, Chang Suk Kang, Jamshid Abdul-Ghafar, Seung-Sook Lee; J Pathol Transl Med. 2024;58(1):43-44. Published online January 10, 2024; DOI: https://doi.org/10.4132/jptm.2023.12.04

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Review

A stepwise approach to fine needle aspiration cytology of lymph nodes: Yosep Chong, Gyeongsin Park, Hee Jeong Cha, Hyun-Jung Kim, Chang Suk Kang, Jamshid Abdul-Ghafar, Seung-Sook Lee; J Pathol Transl Med. 2023;57(4):196-207. Published online July 11, 2023; DOI: https://doi.org/10.4132/jptm.2023.06.12

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The cytological diagnosis of lymph node lesions is extremely challenging because of the diverse diseases that cause lymph node enlargement, including both benign and malignant or metastatic lymphoid lesions. Furthermore, the cytological findings of different lesions often resemble one another. A stepwise diagnostic approach is essential for a comprehensive diagnosis that combines: clinical findings, including age, sex, site, multiplicity, and ultrasonography findings; low-power reactive, metastatic, and lymphoma patterns; high-power population patterns, including two populations of continuous range, small monotonous pattern and large monotonous pattern; and disease-specific diagnostic clues including granulomas and lymphoglandular granules. It is also important to remember the histological features of each diagnostic category that are common in lymph node cytology and to compare them with cytological findings. It is also essential to identify a few categories of diagnostic pitfalls that often resemble lymphomas and easily lead to misdiagnosis, particularly in malignant small round cell tumors, poorly differentiated squamous cell carcinomas, and nasopharyngeal undifferentiated carcinoma. Herein, we review a stepwise approach for fine needle aspiration cytology of lymphoid diseases and suggest a diagnostic algorithm that uses this approach and the Sydney classification system.

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Response to comment on “A stepwise approach to fine needle aspiration cytology of lymph nodes”
Yosep Chong, Gyeongsin Park, Hee Jeong Cha, Hyun-Jung Kim, Chang Suk Kang, Jamshid Abdul-Ghafar, Seung-Sook Lee
Journal of Pathology and Translational Medicine.2024; 58(1): 43. CrossRef
Comment on “A stepwise approach to fine needle aspiration cytology of lymph nodes”
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Journal of Pathology and Translational Medicine.2024; 58(1): 40. CrossRef
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Original Article

A machine-learning expert-supporting system for diagnosis prediction of lymphoid neoplasms using a probabilistic decision-tree algorithm and immunohistochemistry profile database: Yosep Chong, Ji Young Lee, Yejin Kim, Jingyun Choi, Hwanjo Yu, Gyeongsin Park, Mee Yon Cho, Nishant Thakur; J Pathol Transl Med. 2020;54(6):462-470. Published online August 31, 2020; DOI: https://doi.org/10.4132/jptm.2020.07.11

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Abstract PDF Supplementary Material

Background
Immunohistochemistry (IHC) has played an essential role in the diagnosis of hematolymphoid neoplasms. However, IHC interpretations can be challenging in daily practice, and exponentially expanding volumes of IHC data are making the task increasingly difficult. We therefore developed a machine-learning expert-supporting system for diagnosing lymphoid neoplasms.
Methods
A probabilistic decision-tree algorithm based on the Bayesian theorem was used to develop mobile application software for iOS and Android platforms. We tested the software with real data from 602 training and 392 validation cases of lymphoid neoplasms and compared the precision hit rates between the training and validation datasets.
Results
IHC expression data for 150 lymphoid neoplasms and 584 antibodies was gathered. The precision hit rates of 94.7% in the training data and 95.7% in the validation data for lymphomas were not statistically significant. Results in most B-cell lymphomas were excellent, and generally equivalent performance was seen in T-cell lymphomas. The primary reasons for lack of precision were atypical IHC profiles for certain cases (e.g., CD15-negative Hodgkin lymphoma), a lack of disease-specific markers, and overlapping IHC profiles of similar diseases.
Conclusions
Application of the machine-learning algorithm to diagnosis precision produced acceptable hit rates in training and validation datasets. Because of the lack of origin- or disease- specific markers in differential diagnosis, contextual information such as clinical and histological features should be taken into account to make proper use of this system in the pathologic decision-making process.

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Review

Epstein-Barr Virus–Associated Lymphoproliferative Disorders: Review and Update on 2016 WHO Classification: Hyun-Jung Kim, Young Hyeh Ko, Ji Eun Kim, Seung-Sook Lee, Hyekyung Lee, Gyeongsin Park, Jin Ho Paik, Hee Jeong Cha, Yoo-Duk Choi, Jae Ho Han, Jooryung Huh; J Pathol Transl Med. 2017;51(4):352-358. Published online June 5, 2017; DOI: https://doi.org/10.4132/jptm.2017.03.15

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Abstract PDF

Epstein-Barr virus (human herpesvirus-4) is very common virus that can be detected in more than 95% of the human population. Most people are asymptomatic and live their entire lives in a chronically infected state (IgG positive). However, in some populations, the Epstein-Barr virus (EBV) has been involved in the occurrence of a wide range of B-cell lymphoproliferative disorders (LPDs), including Burkitt lymphoma, classic Hodgkin’s lymphoma, and immune–deficiency associated LPDs (post-transplant and human immunodeficiency virus–associated LPDs). T-cell LPDs have been reported to be associated with EBV with a subset of peripheral T-cell lymphomas, angioimmunoblastic T-cell lymphomas, extranodal nasal natural killer/T-cell lymphomas, and other rare histotypes. This article reviews the current evidence covering EBV-associated LPDs based on the 2016 classification of the World Health Organization. These LPD entities often pose diagnostic challenges, both clinically and pathologically, so it is important to understand their unique pathophysiology for correct diagnoses and optimal management.

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Quercetin Interrupts the Positive Feedback Loop Between STAT3 and IL-6, Promotes Autophagy, and Reduces ROS, Preventing EBV-Driven B Cell Immortalization
Marisa Granato, Maria Saveria Gilardini Montani, Claudia Zompetta, Roberta Santarelli, Roberta Gonnella, Maria Anele Romeo, Gabriella D’Orazi, Alberto Faggioni, Mara Cirone
Biomolecules.2019; 9(9): 482. CrossRef
Diffuse Large B-Cell Lymphoma Arising within Ileal Neobladder: An Expanding Spectrum of Diffuse Large B-Cell Lymphoma Associated with Chronic Inflammation
Hyekyung Lee, Hyunbin Shin, Nae Yu Kim, Hyun Sik Park, Jinsung Park
Cancer Research and Treatment.2019; 51(4): 1666. CrossRef
EBV-associated lymphoproliferative disorder involving the gastrointestinal tract which mimic IBD in immunocompetent patients: case reports and literature review
Yanhua Zhou, Yanlin Zhang, Haiying Zhao, Xuan Cui, Yongqiu Wei, Yongdong Wu, Shutian Zhang, Ye Zong
International Journal of Colorectal Disease.2019; 34(11): 1989. CrossRef
Mechanistic Insights into Chemoresistance Mediated by Oncogenic Viruses in Lymphomas
Jungang Chen, Samantha Kendrick, Zhiqiang Qin
Viruses.2019; 11(12): 1161. CrossRef
Rapidly Fatal Encephalitis Associated with Atypical Lymphoid Proliferations of the Basal Ganglia Subsequent to Aneurysmal Subarachnoid Hemorrhage
Ayesha Kar, Evin L. Guilliams, Joshua A. Cuoco, Eric A. Marvin
Clinics and Practice.2019; 9(4): 1187. CrossRef
Clinicopathologic features of adult EBV-associated B-cell lymphoproliferative disease
Sonja Wörner, Hans-Konrad Mueller-Hermelink, Hans-Ullrich Voelker
Pathology - Research and Practice.2018; 214(2): 207. CrossRef
Primary Intestinal Epstein–Barr Virus-associated Natural Killer/T-cell Lymphoproliferative Disorder: A Disease Mimicking Inflammatory Bowel Disease
Zhujun Wang, Wenyan Zhang, Chengxin Luo, Min Zhu, Yu Zhen, Jingxi Mu, Yan Zhang, Renwei Hu, Yufang Wang, Zhonghui Wen, Qin Ouyang, Shuyuan Xiao, Hu Zhang
Journal of Crohn's and Colitis.2018; 12(8): 896. CrossRef
Downregulation of CD5 and dysregulated CD8+ T‐cell activation
Taizo Wada
Pediatrics International.2018; 60(9): 776. CrossRef
Chronic active Epstein-Barr virus infection of T-cell type, systemic form in an African migrant: case report and review of the literature on diagnostics standards and therapeutic options
Maxi Wass, Marcus Bauer, Roald Pfannes, Kerstin Lorenz, Andreas Odparlik, Lutz P Müller, Claudia Wickenhauser
BMC Cancer.2018;[Epub] CrossRef
Aggressive B-cell lymphomas in patients with myelofibrosis receiving JAK1/2 inhibitor therapy
Edit Porpaczy, Sabrina Tripolt, Andrea Hoelbl-Kovacic, Bettina Gisslinger, Zsuzsanna Bago-Horvath, Emilio Casanova-Hevia, Emmanuelle Clappier, Thomas Decker, Sabine Fajmann, Daniela A. Fux, Georg Greiner, Sinan Gueltekin, Gerwin Heller, Harald Herkner, Gr
Blood.2018; 132(7): 694. CrossRef
Gammaherpesviral infections in patients with immunological disorders
Anna Żuk-Wasek, Maciej Przybylski, Natalia Żeber, Grażyna Młynarczyk, Tomasz Dzieciątkowski
Postępy Mikrobiologii - Advancements of Microbiology.2018; 57(2): 145. CrossRef
COMPARATIVE ANALYSIS OF SEROLOGICAL MARKERS OF HERPES VIRUSES AND QUANTITATIVE IMMUNOGLOBULINOPATHIES IN PRIMARY PATIENTS WITH ANGIOIMMUNOBLASTIC T-CELL LYMPHOMA
N. G. Chernova, D. S. Tihomirov, N. P. Soboleva, S. A. Mariina, Y. V. Sidorova, M. N. Sinitsyna, V. N. Dvirnyk, S. M. Kulikov, T. A. Tupoleva, E. E. Zvonkov
Problems of Virology.2018; 63(4): 171. CrossRef

Original Articles

Histologic Disorderliness in the Arrangement of Tumor Cells as an Objective Measure of Tumor Differentiation: Sungwook Suh, Gyeongsin Park, Young Sub Lee, Yosep Chong, Youn Soo Lee, Yeong Jin Choi; Korean J Pathol. 2014;48(5):339-345. Published online October 27, 2014; DOI: https://doi.org/10.4132/KoreanJPathol.2014.48.5.339

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Abstract PDF: Background: Inter-observer and intra-observer variation in histologic tumor grading are well documented. To determine whether histologic disorderliness in the arrangement of tumor cells may serve as an objective criterion for grading, we tested the hypothesis the degree of disorderliness is related to the degree of tumor differentiation on which tumor grading is primarily based. Methods: Borrowing from the statistical thermodynamic definition of entropy, we defined a novel mathematical formula to compute the relative degree of histologic disorderliness of tumor cells. We then analyzed a total of 51 photomicrographs of normal colorectal mucosa and colorectal adenocarcinoma with varying degrees of differentiation using our formula. Results: A one-way analysis of variance followed by post hoc pairwise comparisons using Bonferroni correction indicated that the mean disorderliness score was the lowest for the normal colorectal mucosa and increased with decreasing tumor differentiation. Conclusions: Disorderliness, a pathologic feature of malignant tumors that originate from highly organized structures is useful as an objective tumor grading proxy in the field of digital pathology.

Mesenchymal Stromal Cells Promote Tumor Progression in Fibrosarcoma and Gastric Cancer Cells: Byunghoo Song, Bokyung Kim, Se-Ha Choi, Kyo Young Song, Yang-Guk Chung, Youn-Soo Lee, Gyeongsin Park; Korean J Pathol. 2014;48(3):217-224. Published online June 26, 2014; DOI: https://doi.org/10.4132/KoreanJPathol.2014.48.3.217

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Abstract PDF

Background

Extensive evidence has accumulated regarding the role of mesenchymal stromal cells (MSCs) in tumor progression, but the exact effects and mechanisms underlying this role remain unclear. We investigated the effects of MSC-associated tumor progression in MSC-sarcoma models and a gastric cancer metastatic model.

Methods

We conducted an in vitro growth kinetics assay and an in vivo tumor progression assay for sarcoma cells and gastric cancer cells in the presence or absence of MSCs.

Results

MSC-cocultured human fibrosarcoma cells (HT1080) showed accelerated growth compared with HT1080 alone (79- vs 37-fold change, p<.050). For HT1080, human MSC-coinjected tumors showed significantly greater and highly infiltrative growth compared to those of HT1080 alone (p=.035). For mouse fibrosarcoma cells (WEHI164), mouse MSC-coinjected tumors had greater volume than those of WEHI164 alone (p=.141). For rat sarcoma cells (RR1022), rat MSC-coinjected tumors exhibited greater volume and infiltrative growth than those of RR1022 alone (p=.050). For human gastric cancer cells (5FU), tumors of 5FU alone were compact, nodular in shape, and expansile with good demarcation and no definite lung metastatic nodules, whereas tumors grown in the presence of human MSCs showed highly desmoplastic and infiltrative growth and multiple lung metastasis.

Conclusions

We observed morphological evidence for MSC-associated tumor progression of fibrosarcomas and gastric cancer cells.

Citations

Citations to this article as recorded by

Transition between canonical to non-canonical Wnt signaling during interactions between mesenchymal stem cells and osteosarcomas
Asulin Masha, Ghedalia-Peled Noa Ben, Erez Ifat Cohen, Ventura Yvonne, Vago Razi
Open Journal of Orthopedics and Rheumatology.2020; : 037. CrossRef
Mesenchymal stem-cell therapy for perianal fistulas in Crohn’s disease: a systematic review and meta-analysis
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Techniques in Coloproctology.2019; 23(7): 613. CrossRef
Human mesenchymal stromal cells do not promote recurrence of soft tissue sarcomas in mouse xenografts after radiation and surgery
PAOLA A. FILOMENO, KYUNG-PHIL KIM, NARA YOON, IRAN RASHEDI, VICTOR DAYAN, RITA A. KANDEL, XING-HUA WANG, TANIA C. FELIZARDO, ELLIOT BERINSTEIN, SALOMEH JELVEH, ANDREA FILOMENO, JEFFREY A. MEDIN, PETER C. FERGUSON, ARMAND KEATING
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Effect of hGC-MSCs from human gastric cancer tissue on cell proliferation, invasion and epithelial-mesenchymal transition in tumor tissue of gastric cancer tumor-bearing mice
Lin Song, Xin Zhou, Hong-Jun Jia, Mei Du, Jin-Ling Zhang, Liang Li
Asian Pacific Journal of Tropical Medicine.2016; 9(8): 796. CrossRef
BMP9 inhibits the growth and migration of lung adenocarcinoma A549 cells in a bone marrow stromal cell-derived microenvironment through the MAPK/ERK and NF-κB pathways
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Oncology Reports.2016; 36(1): 410. CrossRef
Comparative proteomic analysis of fibrosarcoma and skin fibroblast cell lines
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Involvement of Wnt/β-catenin signaling in the mesenchymal stem cells promote metastatic growth and chemoresistance of cholangiocarcinoma
Weiwei Wang, Wei Zhong, Jiahui Yuan, Congcong Yan, Shaoping Hu, Yinping Tong, Yubin Mao, Tianhui Hu, Bing Zhang, Gang Song
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Detection Limit of Monoclonal B-Cells Using Multiplex PCR and Laser-Induced Fluorescence Capillary Electrophoresis.: Sung Hak Lee, Yeonsook Moon, Byunghoo Song, Hyung Nam Lee, Ahwon Lee, Eun Sun Jung, Yeong Jin Choi, Kyo Young Lee, Chang Suk Kang, Gyeongsin Park; Korean J Pathol. 2011;45(6):582-588.; DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.6.582

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Abstract PDF

BACKGROUND
The identification of monoclonality has been widely used for making diagnoses of lymphoproliferative lesions. Awareness of the sensitivity and detection limit of the technique used would be important for the data to be convincing.
METHODS
We investigated the minimum requirement of cells and sensitivity of gel electrophoresis (GE) and laser-induced fluorescence capillary electrophoresis (LFCE) for identifying IgH gene rearrangement using BIOMED-2 protocols. DNA extracted from Raji cells were diluted serially with peripheral blood mononuclear cells (PBMNCs) DNA. DNA from mixtures of diffuse large B-cell lymphoma (DLBCL) and reactive lymph nodes were also serially diluted.
RESULTS
For Raji cells, the detection limit was 62 and 16 cell-equivalents for GE and LFCE, respectively. In the condition with PBMNCs mixture, 2.5% and 1.25% of clonal cells was the minimum requirement for GE and LFCE, respectively. In 23% of DLBCL cells in tissue section, the detection limit was 120 and 12 cell-equivalents for GE and LFCE, respectively. In 3.2% of DLBCL cells, that was 1,200 and 120 cell-equivalents for GE and LFCE, respectively.
CONCLUSIONS
These results show that LFCE method is more sensitive than GE and the sensitivity of clonality detection can be influenced by the amount of admixed normal lymphoid cells.

Citations

Citations to this article as recorded by

Molecular pathology diagnosis of diffuse large B cell lymphoma using BIOMED-2 clonal gene rearrangements
Saeid Ghorbian
Annals of Diagnostic Pathology.2017; 29: 28. CrossRef

The Usefulness of p16INK4a Immunocytochemical Staining in ASC-H Patients.: Kwang Il Yim, Yeo Ju Kang, Tae Eun Kim, Gyeongsin Park, Eun Sun Jung, Yeong Jin Choi, Kyo Young Lee, Chang Seok Kang, Ahwon Lee; Korean J Pathol. 2011;45(3):290-295.; DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.3.290

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Abstract PDF

BACKGROUND
The grey zone of cervical cytology, and in particular atypical squamous cells, cannot exclude HSIL (ASC-H) causes diagnostic difficulties and increases medical expenses. We analyzed p16INK4a expression in ASC-H liquid-based cytology specimens (LBCS) to develop more effective methods for the management of ASC-H patients.
METHODS
We carried out p16INK4a immunostaining with 57 LBCS of ASC-H diagnostic categories, all of which were histologically cofirmed and 43 cases of which were compared with the results of a human papillomavirus (HPV) chip test.
RESULTS
p16INK4a immunostaining with ASC-H LBCS was positive in 20% (3/15) of cervicitis, 25.0% (3/12) of tissue-low-grade squamous intraepithelial lesion, 75.0% (18/24) of tissue-high grade squamous intraepithelial lesion (HSIL), and 100% (6/6) of invasive cancer cases. The positivity of p16INK4a in LBCS was correlated with higher grade of histologic diagnosis (r=0.578, p=0.000). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of p16INK4a immunostaining for the prediction of tissue-HSIL+ were 80.0%, 77.8%, 80.0%, and 77.8%, respectively. The sensitivity, specificity, PPV, and NPV of p16INK4a immunostaining plus HPV chip test for predicting tissue-HSIL+ were 71.2%, 86.4%, 84.2%, and 79.2%.
CONCLUSIONS
p16INK4a immunostaining as well as HPV chip testing with remaining LBCS with ASC-H are useful objective markers for the prediction of tissue-HSIL+.

Citations

Citations to this article as recorded by

Usefulness of p16INK4a Immunocytochemical staining for the Differentiation between Atrophy and ASCUS in Diagnosis of Uterine Cervical Cancer
Hye Ryoung Shin, Taekil Eom, Wan-Su Choi
Biomedical Science Letters.2023; 29(3): 144. CrossRef

Case Reports

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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Abstract 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.

Invasive Ductal Carcinoma Arising in a Recurrent Malignant Phyllodes Tumor: A Case Report.: Ahwon Lee, Gyeongsin Park, Kyo Young Lee, Chang Suk Kang, Byung Kee Kim, Sang In Shim; Korean J Pathol. 2005;39(2):134-136.

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Abstract PDF: We report here on a case of invasive ductal carcinoma arising in a recurrent malignant phyllodes tumor. The patient was a 33-year-old woman who presented with a left breast mass, and an excision was then performed. The mass, measuring 7.0 x 4.0 cm in size, was relatively well demarcated with a nodular contour and showed pale gray and solid cut surface with clefts on it. Histologically, the mass mainly consisted of stromal components that were characterized by high cellularity, marked nuclear atypism and brisk mitosis. The sparse glandular components were leaf-like in shape and lined by bland ductal epithelium without any nuclear atypism. Sixteen months later, the patient revisited our hospital with a recurrent mass, and underwent total mastectomy. The recurrent mass contained foci of definite invasive ductal carcinoma in the background of malignant phyllodes tumor, which was identical to the primary mass. This case demonstrates that it is possible that an invasive ductal carcinoma might arise within, at least with, a recurrent malignant phyllodes tumor.

Original Article

Expressions of Cyclin E-pathway Proteins (cyclinE, cdk2, p21, p27, p57) and Their Prognostic Significance in Non-small Cell Lung Carcinomas.: Ji Han Jung, Gyeongsin Park, Myung Ah Lee, Jae Ho Byun, Chan Kwon Jung, Heejeong Lee, Kyo Young Lee, Sang In Shim, Chang Suk Kang; Korean J Pathol. 2006;40(1):24-31.

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Abstract PDF: BACKGROUND
The aberrant expression of cyclins, cdk and cdk inhibitor has been shown to be involved in oncogenic transformation. The aim of this study was to investigate the expression of the cyclin E-pathway proteins (cyclin E, cdk2, p21, p27, p57) in human non-small cell lung carcinomas (NSCLC) and also to evaluate the clinical significance of these expressions.
METHODS
A total of 203 consecutive patients with completely resected pathological stage I-III NSCLC were retrospectively reviewed. The expressions of cyclin E, cdk2, p21, p27 and, p57 was examined by performing immunohistochemistry with using the tissue microarray method.
RESULTS
In the total cases, the expression levels of cyclin E, cdk2, p21, p27 and p57 were 39.9% (81/203), 48.3% (98/203), 68.0% (138/203), 32.5% (66/203) and 2.7% (5/203), respectively. The overexpression of cyclin E and cdk2 was significantly and inversely correlated with the histologic differentiation in the adenocarcinoma (p<0.05), but not in the squamous cell carcinoma. Among the clinicopathologic factors, the stage and lymph node metastasis were associated with overall survival (p<0.05). Among these proteins, the negative expression of p21 was significantly correlated with a shortened survival rate (p<0.05).
CONCLUSIONS
These data suggest that the overexpression of cyclin E and cdk2 and the loss of p21 and p27 are associated with tumor progression in NSCLC. The aberrant expression of p21 is correlated with a poor prognosis. Therefore the immunohistochemical analysis of this protein as well as the clinical stage and, lymph node metastasis may be useful tools for evaluating the prognosis of NSCLC patients.

Case Report

Fine Needle Aspiration Cytology of Inflammatory Myofibroblastic Tumor of Lung: A Case Report.: Gyeongsin Park, Kyungji Lee, Sun Mi Lee, Kyo Young Lee, Sang In Shim, Chang Suk Kang, Youn Soo Lee; J Pathol Transl Med. 2006;17(1):63-68.

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Abstract PDF: Inflammatory myofibroblastic tumor (IMT), normally referred to as inflammatory pseudotumor, is a fairly rare condition. Fine needle aspiration cytology (FNAC) of IMT has only rarely been reported. Here, we describe one such case of pulmonary inflammatory myofibroblastic tumor. A 30-year-old man presented with a 2.8cm-sized mass in his lung. Chest CT revealed a well defined, poorly enhancing mass. FNAC showed some fascicular or swirled clusters of spindle cells, admixed with occasional inflammatory cells and foamy histiocytes. The majority of the tumor cells evidenced bland, elongated nuclei, but infrequent pleomorphic nuclei. Some of the tumor cells evidenced nuclear grooves and intranuclear inclusions. Although the cytological differentiation of IMT from malignant lesions is not immensely problematic, due to the general paucity of cytological and nuclear atypia, a definite cytological diagnosis of IMT cannot be rendered simply by FNAC. Therefore, a diagnosis of IMT may be suggested via exclusive diagnosis.

Original Articles

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; J Pathol Transl Med. 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.

Prognostic Significance of P53, BCL-2 and PCNA in Diffuse Large B-Cell Lymphoma: Correlation with International Prognostic Index.: Dong chul Kim, Gyeongsin Park, Ahwon Lee, Kyo Young Lee, Sang In Shim, Chang Suk Kang; Korean J Pathol. 2003;37(6):407-412.

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Abstract PDF: BACKGROUND
Diffuse large B-cell lymphoma (DLBCL) represents a diverse spectrum of clinical presentation, morphology, and genetic and molecular alterations, and shows variable prognoses and responses to therapy. The International Prognosis Index (IPI) is widely used to predict prognosis but is not precise.
METHODS
Thirty-nine cases of DLBCL were classified into low- and high-risk groups according to IPI and were analyzed for their p53, BCL-2, BCL-6 and PCNA expression profile by immunohistochemical staining and overall survival rate.
RESULTS
The mean age of the 39 patients, 23 males and 16 females, was 52.6 years. There were 23 cases (59.0%) in the low-risk group and 16 (41.0%) in the high-risk group. p53, BCL-2, BCL-6 and PCNA expression was higher in the high-risk group than in the low-risk group, but only the differences in p53 and BCL-2 expression were statistically significant (p < 0.05).
CONCLUSION
The p53 and BCL-2 protein expression in DLBCL may supplement IPI in predicting the prognosis of DLBCL patients.

Case Report

Primary Diffuse Large B-cell Lymphoma of the Prostate: A Case Report.: Dong chul Kim, Gyeongsin Park, Ahwon Lee, Kyungja Han, Chang Suk Kang; Korean J Pathol. 2003;37(6):432-434.

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Abstract PDF: Primary lymphomas of the prostate are extremely rare and can mimic other more common prostatic lesions clinically. We report a case of primary diffuse large B-cell lymphoma of the prostate in an 81-year-old man. The patient presented with voiding difficulty as an initial symptom and enlargement of the prostate on rectal digital examination. Transurethral prostatic resection was performed. On microscopic examination, atypical lymphoid cells infiltrated and replaced the prostatic parenchyma. The tumor cells had large nuclei with irregular nuclear membrane and vesicular clumped chromatin. Nucleoli were not distinct and the cells had scanty cytoplasm. Immunohistochemically, the tumor cells were immunoreactive for CD20 and CD79a but not reactive for CD5, BCL-2 and BCL-6. Histopathological diagnosis was diffuse large B-cell lymphoma of the prostate. The patient received 5 cycles of chemotherapy after histologic diagnosis but died from pulmonary and scrotal metastases 6 months later.

Original Articles

The Expression of Telomerase Reverse Transcriptase Protein is an Independent Prognostic Marker in Early Stage Non-Small Cell Lung Carcinomas.: Ji Han Jung, Chan Kwon Jung, Ahwon Lee, Gyeongsin Park, Jinyoung Yoo, Kyo Young Lee; Korean J Pathol. 2007;41(2):95-102.

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Abstract PDF: BACKGROUND
The catalytic subunit of telomerase, hTERT (telomerase reverse transcriptase), is one of the most important components of telomerase, and performs a pivotal role in the mechanism underlying the regulation of telomerase activity in cellular immortalization and carcinogenesis. The principal objective of this study was to investigate hTERT expression in patients with non-small cell lung carcinomas (NSCLCs), and to evaluate its clinical significance and association with the expression of p16 and p53.
METHODS
Using tissue microarray, the protein expression profiles of hTERT, p16 and p53 were investigated via immunohistochemistry in 167 samples of NSCLCs.
RESULTS
Expression was observed in 54.5% (91/167) of the tumors, which were predominantly squamous cell carcinomas. Patients evidencing hTERT expression in their tumors exhibited significantly poorer survival rates than did patients without hTERT expression in early-stage NSCLCs (p=0.0125). According to the results of our Cox regression analysis, hTERT expression proved to be an independent prognostic factor (p=0.006), particularly for squamous cell carcinomas (p=0.019). hTERT expression was not correlated with p16 expression, but was rather associated with the expression of p53 (p=0.002).
CONCLUSIONS
Our results show that hTERT may perform a function in the progression of NSCLC, and that its detection may be useful in predicting the prognosis of NSCLC patients in the early stages of the disease, as well as in the development of a targeted therapy in these tumors.

Expression of p73 in Non-small Cell Lung Carcinomas.: Ji Han Jung, Gyeongsin Park, Chan Kwon Jung, Hyun Joo Choi, Jinyoung Yoo, Seok Jin Kang, Kyo Young Lee; Korean J Pathol. 2007;41(2):109-115.

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Abstract PDF: BACKGROUND
The p73 is a recently identified homologue of the tumor suppressor gene, p53, and it has been found to induce apoptosis and inhibit cell proliferation. However, its role in the development of tumors is unclear. This study examined the expression of p73 in patients with non-small cell lung carcinomas (NSCLCs) to determine its clinical significance and association with the expressions of p53, pRb, and mdm2.
METHODS
A total of 183 NSCLCs were analyzed immunohistochemically using a tissue microarray.
RESULTS
The p73 protein was expressed in the cell nuclei in 156 (85.2%) out of the 183 cases. There was no correlation between the p73 expression and the clinicopathological variables. However, there was a correlation between the p73 expression and the mdm2 and pRb expressions. Multivariate Cox survival analysis identified tumor size and lymph node metastasis to be independent prognostic factors, but the p73 expression was not found to be associated with the patients' survival.
CONCLUSIONS
p73 is commonly expressed in NSCLC and it might, in conjunction with pRb and mdm2, be involved in the development of these tumors.

Mucin Phenotype and CDX2 Expression as Prognostic Factors in Gastric Carcinomas.: Chan Kwon Jung, Kyo Young Song, Gyeongsin Park, Cho Hyun Park, Myeong Gyu Choi, Young Seon Hong, Kyo Young Lee; Korean J Pathol. 2007;41(3):139-148.

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Abstract PDF: Background
: Mucin phenotypic markers and CDX2 are widely expressed in gastric carcinomas, however, recent studies have produced conflicting results regarding whether the expression patterns of these markers have clinicopathologic significance.
Methods
: We examined samples from 217 gastric carcinoma patients immunohistochemically to determine if the expression of mucin phenotypic markers and CDX2 was correlated with postoperative survival and other clinicopathologic factors.
Results
: All tumors were phenotypically classified as gastric (type G, 81 cases), gastric and intestinal mixed (type GI, 55 cases), intestinal (type I, 43 cases), or unclassified (type U, 38 cases). The occurrence of type G and GI tumors was positively correlated with tumor progression whereas that of type U tumors was negatively correlated with tumor progression. CDX2 expression was correlated with type I tumors. Tumors that expressed MUC5AC or MUC6 had a better prognosis than those that did not. When the relationship between phenotype and prognosis was considered, type GI had the best prognosis, followed by type G, then type U.
Conclusions
: The mucin phenotypic markers may be useful for predicting tumor progression and survival in patients with gastric carcinomas. Additionally, CDX2 may play an important role in gastric carcinogenesis of type I tumors.

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