Journal of Pathology and Translational Medicine

Original Article

Prognostic Implication of Semi-quantitative Immunohistochemical Assessment of CD20 Expression in Diffuse Large B-Cell Lymphoma: Chang Hwan Choi, Young Hoon Park, Joo Han Lim, Suk Jin Choi, Lucia Kim, In Suh Park, Jee Young Han, Joon Mee Kim, Young Chae Chu; J Pathol Transl Med. 2016;50(2):96-103. Published online February 15, 2016; DOI: https://doi.org/10.4132/jptm.2016.01.12

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Background
Immunohistochemical demonstration of CD20 in diffuse large B-cell lymphoma (DLBCL) is prerequisite not only for the diagnosis but also for assigning patients to rituximab-containing chemotherapy. However, little is known about the impact of abundance of CD20 expression assessed by immunohistochemistry on the clinical outcome of DLBCL. We performed a semi-quantitative immunohistochemical analysis of CD20 expression in DLBCL to examine the prognostic implication of the level of CD20 expression. Methods: Pre-treatment diagnostic tissue samples from 48 DLBCL patients who were treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) regimen were represented in a tissue microarray and immunostained for CD20. The relative abundance of CD20 expression was semi-quantitatively scored using a web-based ImmunoMembrane plug-in. Receiver operating characteristic curve analysis was used to determine a prognostically relevant cut-off score in order to dichotomize the patients into CD20-high versus CD20-low groups. Results: The levels of CD20 expression were heterogeneous among the patients, with a wide and linear distribution of scores. Patients in CD20-low group showed significantly poor clinical outcome. Conclusions: The levels of CD20 expression in DLBCL are heterogeneous among the patients with DLBCL. A subgroup of the patients with CD20 expression levels below the cut-off score showed poor clinical outcome.

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Induced CD20 Expression on B-Cell Malignant Cells Heightened the Cytotoxic Activity of Chimeric Antigen Receptor Engineered T Cells
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Brief Case Report

Myoepithelial Carcinoma of Soft Tissue: A Case Report and Review of the Literature: Chang Hwan Choi, Young Chae Chu, Lucia Kim, Suk Jin Choi, In Suh Park, Jee Young Han, Joon Mee Kim; Korean J Pathol. 2014;48(6):413-417. Published online December 31, 2014; DOI: https://doi.org/10.4132/KoreanJPathol.2014.48.6.413

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Original Articles

Preparation of Compact Agarose Cell Blocks from the Residues of Liquid-Based Cytology Samples: Suk Jin Choi, Yeon Il Choi, Lucia Kim, In Suh Park, Jee Young Han, Joon Mee Kim, Young Chae Chu; Korean J Pathol. 2014;48(5):351-360. Published online October 27, 2014; DOI: https://doi.org/10.4132/KoreanJPathol.2014.48.5.351

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Abstract PDF

Background: Inevitable loss of diagnostic material should be minimized during cell block preparation. We introduce a modified agarose cell block technique that enables the synthesis of compact cell blocks by using the entirety of a cell pellet without the loss of diagnostic material during cell block preparations. The feasibility of this technique is illustrated by high-throughput immunocytochemistry using high-density cell block microarray (CMA). Methods: The cell pellets of Sure- Path residues were pre-embedded in ultra-low gelling temperature agarose gel and re-embedded in standard agarose gel. They were fixed, processed, and embedded in paraffin using the same method as tissue sample processing. The resulting agarose cell blocks were trimmed and represented on a CMA for high-throughput analysis using immunocytochemical staining. Results: The SurePath residues were effectively and entirely incorporated into compact agarose cell buttons and embedded in paraffin. Sections of the agarose cell blocks revealed cellularities that correlated well with corresponding SurePath smears and had immunocytochemical features that were sufficient for diagnosis of difficult cases. Conclusions: This agarose-based compact cell block technique enables preparation of high-quality cell blocks by using up the residual SurePath samples without loss of diagnostic material during cell block preparation.

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The Clinicopathological Significance of Epithelial Mesenchymal Transition Associated Protein Expression in Head and Neck Squamous Cell Carcinoma: Kyu Ho Kim, Lucia Kim, Suk Jin Choi, Jee Young Han, Joon Mee Kim, Young Chae Chu, Young-Mo Kim, In Suh Park, Joo Han Lim; Korean J Pathol. 2014;48(4):263-269. Published online August 26, 2014; DOI: https://doi.org/10.4132/KoreanJPathol.2014.48.4.263

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Abstract PDF

Background

Epithelial mesenchymal transition (EMT) has an important role in invasion and metastasis of tumor cells. The purpose of this study was to evaluate the roles of EMT-associated proteins on progression and metastasis as a prognostic/predictive factor in curatively-resected (R0) head and neck squamous cell carcinoma (HNSCC).

Methods

A total of 118 patients who received curative surgery for HNSCC at Inha University Hospital between January 1996 and December 2011 were included. We used protein immunohistochemistry to evaluate the expression of E-cadherin, vimentin, and EZH2 on tissue microarrays. Also, we reviewed all medical records and analyzed the relationship between the expression of EMT-associated proteins and prognosis.

Results

The E-cadherin-negative group showed more moderate/poor differentiation of cancer cell type than the higher E-cadherin-expressing group (p=.016) and high EZH2 expression was significantly correlated with nodal metastasis (p=.012). Our results demonstrate a significant association between high expression of EZH2 and vimentin and presence of distant progression (p=.026). However, expression of E-cadherin, vimentin, and EZH2 was not significantly associated with overall survival.

Conclusions

These findings suggest that an EMT-associated protein expression profile is correlated with aggressiveness of disease and prognosis, and could be a useful marker for determination of additional treatment in curatively-resected HNSCC patients.

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Correlation of EZH2 expression and response to chemoradiation in patients with locally advanced inoperable oral cavity and oropharyngeal squamous cell cancers
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In-house Manual Construction of High-Density and High-Quality Tissue Microarrays by Using Homemade Recipient Agarose-Paraffin Blocks: Kyu Ho Kim, Suk Jin Choi, Yeon Il Choi, Lucia Kim, In Suh Park, Jee Young Han, Joon Mee Kim, Young Chae Chu; Korean J Pathol. 2013;47(3):238-244. Published online June 25, 2013; DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.3.238

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Abstract PDF

Background

Self-made tissue punches can be effectively used to punch holes in blank recipient paraffin blocks and extract tissue cores from the donor paraffin blocks for the low-cost construction of tissue microarrays (TMAs). However, variable degrees of section distortion and loss of the tissue cores can occurs during cutting of the TMAs, posing technical problems for in-house manual construction of high-density TMAs. We aimed to update the method for in-house manual TMA construction to improve the quality of high-density TMAs.

Methods

Blocks of agarose gel were subjected to the standard tissue processing and embedding procedure to prepare recipient agarose-paraffin blocks. The self-made tissue punches and recipient agarose-paraffin blocks were used to construct TMAs, which were completely melted and re-embedded in paraffin to make finished TMA blocks.

Results

The donor tissue cores were completely integrated into the surrounding paraffin of the recipient blocks. This method enabled us to construct high-density TMAs with significantly less section distortion or loss of tissue cores during microtomy.

Conclusions

Simple and inexpensive construction of high-density and high-quality TMAs can be warranted by using paraffinized agarose gels as recipient blocks.

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Prognostic Implication of Semi-quantitative Immunohistochemical Assessment of CD20 Expression in Diffuse Large B-Cell Lymphoma
Chang Hwan Choi, Young Hoon Park, Joo Han Lim, Suk Jin Choi, Lucia Kim, In Suh Park, Jee Young Han, Joon Mee Kim, Young Chae Chu
Journal of Pathology and Translational Medicine.2016; 50(2): 96. CrossRef
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Case Study

Peripheral Primitive Neuroectodermal Tumor with Osseous Component of the Small Bowel Mesentery: A Case Study: Joon Mee Kim, Young Chae Chu, Chang Hwan Choi, Lucia Kim, Suk Jin Choi, In Suh Park, Jee Young Han, Kyung Rae Kim, Yoon-La Choi, Taeeun Kim; Korean J Pathol. 2013;47(1):77-81. Published online February 25, 2013; DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.1.77

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Abstract PDF

A case of peripheral primitive neuroectodermal tumor of the small bowel mesentery with osseous component is reported. A 23-year-old man was admitted to our hospital because of acute severe abdominal pain. Abdominal computed tomography revealed a large solid and cystic, oval shaped mass, measuring 11.0×6.0 cm in the pelvic cavity. Histologically the resected lesion consisted of sheets of undifferentiated small round cells forming Homer-Wright rosettes and perivascular pseudorosettes, and showed areas of osteoid and bone formation. Immunohistochemical studies revealed that tumor cells expressed positivity against CD99 (MIC2), CD57, neuron-specific enolase, and vimentin. Fluorescence in situ hybridization study revealed Ewing sarcoma breakpoint region 1 (EWSR1) gene rearrangement on chromosome 22q12. To the authors' knowledge this is the first documentation of a peripheral neuroectodermal tumor with osteoid and bone formation of the small bowel mesentery.

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Original Article

Construction of High-Density Tissue Microarrays at Low Cost by Using Self-Made Manual Microarray Kits and Recipient Paraffin Blocks: Chang Hwan Choi, Kyu Ho Kim, Ju Young Song, Suk Jin Choi, Lucia Kim, In Suh Park, Jee Young Han, Joon Mee Kim, Young Chae Chu; Korean J Pathol. 2012;46(6):562-568. Published online December 26, 2012; DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.6.562

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Abstract PDF

Background

Advances of tissue microarray (TMA) technology have enabled simultaneous in situ analysis of biomarker expression in a large number of archived pathology specimens. However, the relatively high cost of TMA construction may hamper many researchers from using this essential tool of modern pathology research. We discuss methods for making TMA kits and recipient blocks for manual construction of high-density TMAs at low cost.

Methods

Ordinary cannula piercing needles, hypodermic needles, bone marrow biopsy needles, metallic ink cartridges of ballpoint pens, and disposable skin biopsy punches were used to construct self-made manual TMA kits. The recipient blocks were manufactured by boring holes in the conventional bare paraffin blocks. A mini electric hand drill and a microcompound table assembled on a drill stand were used to maximize the capacity of the recipient blocks.

Results

By using TMA kits made from cannula piercing needles (16- and 18-gauge), it was possible to construct TMAs with 1 mm×140 cores, 0.6 mm×320 cores, 2 mm×70 cores, 3 mm×35 cores, and 5 mm×12 cores. The capacity of the recipient blocks could be dramatically increased by drilling holes.

Conclusions

Construction of TMAs using self-made TMA kits is an inexpensive alternative to construction of TMAs using commercial devices.

Citations

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Ljubiša Jovanović, Branka Šošić-Jurjević, Anđa Ćirković, Sandra Dragičević, Branko Filipović, Svetlana Milenković, Stefan Dugalić, Miroslava Gojnić-Dugalić, Aleksandra Nikolić
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Case Reports

Granular Cell Astrocytoma: Report of a Case: Kyu Ho Kim, Ju Young Song, Chang Hwan Choi, Lucia Kim, Suk Jin Choi, Jee Young Han, Joon Mee Kim, Young Chae Chu, In Suh Park; Korean J Pathol. 2012;46(4):370-372. Published online August 23, 2012; DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.4.370

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Abstract PDF

We report here a rare case of granular cell astrocytoma. A 75-year-old man was admitted to Inha University Hospital with a three-month history of language deterioration. In a magnetic resonance imaging, a 6.5 cm-sized heterogeneous enhancing mass was seen in both the frontal lobes and the anterior genu of the corpus callosum. A stereotactic biopsy was performed. The tumor was composed of large and small round cells with abundant intracytoplasmic granules. The nuclei were bland, round to oval, and often eccentrically located. The cytoplasm of the tumor cells was positive for glial fibrillary acidic protein and S-100 protein.

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Granular cell tumor of the brain: case report and review of literature
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Granular cell astrocytoma: Case report
Rohan Gupta, Supriya Gupta, Nathaniel Shapiro, Scott Rahimi, Suash Sharma
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Unusual presentation of a granular cell astrocytoma
Alan A George, Gregory N Fuller, Lauren A Langford, Clayton D Simon, Amy A Zingalis, Derek A Mathis
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Adenocarcinoma with Intraductal Papillary Mucinous Neoplasm Arising in Jejunal Heterotopic Pancreas: Ju Young Song, Jee Young Han, Sun Keun Choi, Lucia Kim, Suk Jin Choi, In Suh Park, Young Chae Chu, Kyu Ho Kim, Joon Mee Kim; Korean J Pathol. 2012;46(1):96-100. Published online February 23, 2012; DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.1.96

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Abstract PDF

A 74-year-old man suffered from jejunal perforation and adhesion to sigmoid colon due to adenocarcinoma associated with intraductal papillary mucinous neoplasm (IPMN) arising in a jejunal heterotopic pancreas. The jejunal lesion showed direct extension to the sigmoid colon, which was mistaken as sigmoid colon cancer by surgeons. Malignant transformation is a rare complication of a heterotopic pancreas. About half of malignancies in reported cases were ductal adenocarcinoma arising in the stomach, and the jejunal location is extremely rare. Furthermore, IPMN is also uncommon finding in a heterotopic pancreas.

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Primary adenocarcinoma from a gastric heterotopic pancreas: A case report
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Pancreatic Intraductal Papillary Mucinous Neoplasm Arising Within Heterotopic Pancreas Tissue of the Stomach
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Clinicopathological Features of Intraductal Papillary Mucinous Neoplasm Derived from Ectopic Pancreas: A Systematic Review
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Malignant Transformation of Ectopic Pancreas
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Intraductal papillary mucinous neoplasm originating from a heterotopic pancreas within the jejunum: a case report
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Heterotopic Pancreas of the Gastrointestinal Tract and Associated Precursor and Cancerous Lesions
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Original Article

Type and Incidence of Soft Tissue Sarcomas in Korea: 2001-2007.: Kyung Un Choi, Hae Youn Kang, Heasoo Koo, Mi Seon Kwon, Dong Hoon Kim, Mi Jung Kim, Su Jin Kim, Young Sill Kim, Chul Hwan Kim, Yong Koo Park, Hye Rim Park, Seung Sam Paik, Jin Young Yoo, Anhi Lee, Jae Hyuk Lee, Hyekyung Lee, Kyu Yun Jang, Young Chae Chu, Joon Hyuk Choi; Korean J Pathol. 2011;45(6):557-563.; DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.6.557

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Abstract PDF

BACKGROUND
The Korean Bone and Soft Tissue Pathology Study Group of the Korean Society of Pathologists conducted a nationwide retrospective analysis of soft tissue sarcoma (STS) to provide the clinicopathologic characteristics of STS within the population of the Republic of Korea.
METHODS
The cases of STS were collected during a 7-year period (2001-2007) from 19 institutes in Korea. All cases were classified according to the histologic criteria proposed by the World Health Organization. Clinicopathologic data were reviewed.
RESULTS
Data from 722 patients (median age, 50 years) were collected. Data showed a slight male predominance. The most frequent types of STS in decreasing order were liposarcoma, malignant fibrous histiocytoma, leiomyosarcoma, and synovial sarcoma. STS occurred throughout the body, although approximately half (47.8%) were located in the extremities. The majority of STS was histologically classified as high grade with a large tumor size (>5 cm). The overall survival rate for the patients was 76.3% (median follow-up time, 26 months; range, 1 to 89 months). Histologic grade, tumor size, American Joint Committee on Cancer stage, tumor site, and resection status were prognostic. Significant independent adverse prognostic factors were large tumor size (>5 cm) and tumor site other than extremities.
CONCLUSIONS
We reported the distribution and characteristics of STS in the Republic of Korea.

Citations

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Distribution and survival of primary sarcoma in Korea: A single center analysis of 2017 cases
Sung Jun Jo, Kyeong Sik Kim, Kyo Won Lee, Jae Berm Park, Yoon-La Choi, Jeong Il Yu, Su Jin Lee, Dong Il Choi, Sung Joo Kim
Korean Journal of Clinical Oncology.2018; 14(1): 30. CrossRef

Case Report

Fine Needle Aspiration Cytologic Findings of Angiosarcoma: Report of Two Cases.: Jin Xian Ji, Young Chae Chu, Lucia Kim, Suk Jin Choi, In Suh Park, Jee Young Han, Joon Mee Kim, Kyu Ho Kim, Ju Young Song; Korean J Pathol. 2011;45(2):217-222.; DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.2.217

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Abstract PDF

Angiosarcoma is a rare malignant vascular neoplasm which can arise in any part of the body. Specific recognition of this neoplasm in cytological specimens is difficult in the absence of an ancillary method. Herein, we present the cytologic findings of two cases of angiosarcomas diagnosed on fine needle aspiration cytology. One case is a recurred angiosarcoma in the left chest wall and the other case is a lymphedema-associated angiosarcoma in the left lower leg. The cytologic findings of both cases are similar. Cytologic features that identified this neoplasm as an angiosarcoma included arborizing microtissue fragments, irregular anastomosing vascular spaces lined by atypical cells, microacini, intracytoplasmic lumen, and intracellular red blood cells, marked cell discohesiveness, spindle to ovoid, irregular, hyperchromatic nuclei, and elongated cytoplasmic processes with indistinct borders. This report emphasizes that when aspiration smears show vasoformative features in a bloody background, angiosarcoma should be included in the differential diagnosis.

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A Case Series and Literature Review of Angiosarcoma With Malignant Effusion—A Challenging Cytologic Diagnosis With Dire Prognostic Implications
Jamie C. Y. Lam, Iris Y. H. Liu, Joanna K. M. Ng, Joshua J. X. Li
Diagnostic Cytopathology.2025;[Epub] CrossRef
Four newly reported ophichthid leptocephali species revealed by mitochondrial 12S rDNA, with implications of their occurrence in Korea
Hwan Sung Ji, Hae Won Lee, Byung Kyu Hong, Jin Koo Kim
Animal Cells and Systems.2012; 16(5): 415. CrossRef

Original Article

Cytologic Features of Prostatic Adenocarcinoma in Urine: Comparison with Urothelial Carcinoma.: Lucia Kim, Joo Young Song, Suk Jin Choi, In Suh Park, Jee Young Han, Joon Mee Kim, Young Chae Chu; Korean J Pathol. 2011;45(1):79-86.; DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.1.79

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Abstract PDF

BACKGROUND
Prostate adenocarcinoma (PACa) cells are rarely identified in urine cytology specimens and might be easily overlooked or misdiagnosed as urothelial neoplasm when clinically unsuspected.
METHODS
We reviewed 19 urine cytology specimens obtained from 13 patients with PACa and evaluated the characteristic features discriminating PACa from urothelial carcinoma (UCa). For comparison, 27 cases of high-grade UCa (HGUCa) and 10 cases of urothelial carcinoma in situ (UCis) were also evaluated.
RESULTS
The urine cytologic evaluation of PACa revealed clustered cells forming 3-dimensional syncytial fragments with occasional microacinar grouping in a clean background. Most tumor cells were small and uniform with a high nuclear-to-cytoplasmic ratio and indistinct cell borders. The nuclei were round-to-oval and the cytoplasm was scanty and thin. One or more centrally-located prominent nucleoli were characteristically noted in one half of the cases. The nucleoli had a well-defined, large, round and eosinophilic appearance. In four high-grade cases, large tumor cells were encountered and had relatively monotonous cells with smooth-outlined cell clusters, well-defined and thin cytoplasm, and round nuclei with characteristic prominent nucleoli.
CONCLUSIONS
Combining the information of prostate cancer and the recognition of cytomorphologic features of PACa will help differentiate PACa from HGUCa and UCis.

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Cas no 8. Infiltration de la paroi vésicale par un adénocarcinome prostatique
Monique Courtade-Saïdi
Annales de Pathologie.2025; 45(2): 147. CrossRef
Bladder Washing Cytology in the Detection of High-Grade Prostatic Adenocarcinoma: A Case Report
Gabriel Pastrana, Camille L Santiago Negron, Suheidy Cardona, Juan C Santa Rosario, María D Rivera Rolón
Cureus.2025;[Epub] CrossRef
The diagnostic challenge of suspicious or positive malignant urine cytology findings when cystoscopy findings are normal: an outpatient blue-light flexible cystoscopy may solve the problem
Marie Andersson, Marthe Berger, Karsten Zieger, Per-Uno Malmström, Mats Bläckberg
Scandinavian Journal of Urology.2021; 55(4): 263. CrossRef
Sensitive Time-Gated Immunoluminescence Detection of Prostate Cancer Cells Using a TEGylated Europium Ligand
Nima Sayyadi, Irene Justiniano, Russell E. Connally, Run Zhang, Bingyang Shi, Liisa Kautto, Arun V. Everest-Dass, Jingli Yuan, Bradley J. Walsh, Dayong Jin, Robert D. Willows, James A. Piper, Nicolle H. Packer
Analytical Chemistry.2016; 88(19): 9564. CrossRef

Case Reports

Aspiration Cytology of Cervical Thymoma: A Case Report.: Xian Ji Jin, Ju Young Song, Suk Jin Choi, Lucia Kim, In Suh Park, Jee Young Han, Joon Mee Kim, Young Chae Chu; Korean J Pathol. 2010;44(4):444-447.; DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.4.444

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Abstract PDF

An ectopic cervical thymoma is an uncommon tumor of the neck displaying the same histologic features as a mediastinal thymoma. Because of its unusual location, this mass is often confused as originating from the thyroid. In this report we describe a case of cervical type AB thymoma. Aspiration cytologic smears were highly cellular and revealed irregular tissue fragments, cohesive sheets, and clusters of crowded epithelial cells intermingled with many small lymphocytes. The epithelial cells had oval and spindle shaped bland-looking nuclei and scant cytoplasm with indistinct cell borders. Mitosis, nuclear atypia, and necrosis were not observed. The cells were focally arranged in a nesting pattern. Many small lymphocytes, a few activated lymphocytes, and lymphoid tangles were seen in the background. A cytologic misdiagnosis of "possible carcinoma" was rendered. Therefore, ectopic thymoma should also be considered in fine needle aspiration cytology of a neck mass when the smear shows epithelial and lymphoid components.

Citations

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Aspiration cytology of an ectopic cervical thymoma misinterpreted as a lymphoproliferative lesion of the thyroid: A case report
YI-YING LEE, WEN-CHING WANG, CHIEN-FENG LI
Oncology Letters.2015; 10(3): 1255. CrossRef

Cytology of Follicular Dendritic Cell Sarcoma on Intraoperative Touch Imprint Smears: A Case Report.: Ju Young Song, Xian Ji Jin, Jee Young Han, Lucia Kim, In Suh Park, Joon Mee Kim, Young Chae Chu, Suk Jin Choi; Korean J Pathol. 2009;43(6):589-593.; DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.6.589

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Abstract PDF

Follicular dendritic cell (FDC) sarcoma is a neoplastic proliferation of FDCs. Because its cytologic findings can vary widely, both the cytomorphology and histopathology of FDC sarcoma can impose a significant diagnostic dilemma. We present cytologic features of FDC sarcoma assessed by intraoperative touch imprint. Intra-abdominal lymphadenopathies were noted in 54-year-old male with hepatitis B-virus associated liver cirrhosis. In contrast to cytologic features of classical FDC sarcoma, the tumor cells featured a large epithelioid or Reed-Sternberg cell-like shape scattered in a background with abundant inflammatory cells, which led to a mistaken diagnosis of malignant lymphoma. However, in accordance with cytologic features previously described in the literature, the tumor cells were characterized by a fragile cytoplasm with cytoplasmic processes in dendritic or reticulated patterns reminiscent of the ultrastructural features of FDC. Cytoplasmic features rendering nuclei with a tendency to form clusters or syncytial aggregates associated with reactive lymphocytes appear to be the most valuable finding in diagnosis of FDC sarcoma.

Citations

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Cytomorphology of follicular dendritic cell sarcoma: a report of 7 cases with an emphasis on the diagnostic challenges
Cody Weimholt, Jalal B. Jalaly, Cedric Bailey
Journal of the American Society of Cytopathology.2023; 12(3): 229. CrossRef
A Cytological Review of Follicular Dendritic Cell-Derived Tumors with Emphasis on Follicular Dendritic Cell Sarcoma and Unicentric Castleman Disease
José A. Jiménez-Heffernan, Cristina Díaz del Arco, Magdalena Adrados
Diagnostics.2022; 12(2): 406. CrossRef
Cytological diagnosis of follicular dendritic cell sarcoma: A case report and review of literature
A. Dutta, P. Arun, P. Roy, I. Arun
Cytopathology.2018; 29(5): 461. CrossRef

Endoscopic Ultrasound-Guided Fine Needle Aspiration Cytology in the Diagnosis of a Gastrointestinal Stromal Tumor of the Stomach: A Case Report.: Lucia Kim, Hyung Gil Kim, Young Chae Chu, In Suh Park, Suk Jin Choi, Jee Young Han, Sun Hee Kim, Don Haeng Lee, Joon Mee Kim; J Pathol Transl Med. 2008;19(2):178-182.; DOI: https://doi.org/10.3338/kjc.2008.19.2.178

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Abstract PDF: We report here a case of a gastrointestinal stromal tumor (GIST) in the stomach that was diagnosed by endoscopic ultrasound-guided fine needle aspiration cytology (EUS-FNA). A 67 year old male patient underwent regular check-ups for five years due to the presence of a submucosal tumor that was found in the fundus of the stomach incidentally. EUS-FNA was performed to evaluate the tumor, which had increased in size from 1cm to 2.8cm. A cytologic smear revealed cohesive sheets or clusters of spindle cells with elongated nuclei. Immunohistochemical staining revealed a strong positive reaction for c-kit and CD34, without any reaction for smooth muscle actin and Ki-67. Therefore, a diagnosis of GIST was made.

Original Article

Prognostic Significance of Thymosin- 4 in Gastric Adenocarcinoma Patients.: Lucia Kim, Ye Ji Kim, Suk Jin Choi, In Suh Park, Jee Young Han, Young Chae Chu, Joon Mee Kim; Korean J Pathol. 2007;41(3):176-182.

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Abstract PDF: Background
: Thymosin- 4 is an actin-sequestering protein that regulates actin polymerization. It is known to be associated with cell migration, angiogenesis and wound healing, as well as with tumor metastasis.
Methods
: We immunohistochemically evaluated the thymosin- 4 expression in gastric adenocarcinoma specimens, the relationship between this protein and the pathologic features and other tumor-related proteins, and its influence on the patient outcome.
Results
: We demonstrated that 40 specimens (26.3%) of 152 gastric adenocarcinomas showed positivity for thymosin- 4. The thymosin- 4 expression was statistically associated with advanced tumor stage (p=0.010), the nodal stage (p=0.029), the TNM stage (p=0.008), and the presence of lymphovascular invasion (p=0.009). The thymosin- 4 protein expression was closely related to the positivity for VEGF (p=0.000), c-Myc (p=0.007), and cyclin D1 (p=0.005), but it was not associated with the E-cadherin (p=0.861) or -catenin (p=0.640) expressions. The median survival and disease relapse time of patients showing thymosin-4 immunoreactivity were statistically shorter than those of patients without expression. Multivariate analysis showed that the tumor stage (p=0.003), nodal stage (p=0.005), thymosin- 4 expression (p=0.019) and Lauren's classification (p=0.037) were statistically important prognostic factors for gastric adenocarcinomas.
Conclusions
: The thymosin- 4 expression might be associated with disease progression of gastric adenocarcinomas and it should be regarded as an important prognostic factor for estimating patient survival.

Case Reports

Pulmonary Blastoma with Rhabdomyoblastic Differentiation: A case report with immunohistochemical and electron microscopic examination.: Joon Mee Kim, Young Chae Chu; Korean J Pathol. 1992;26(6):620-626.

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Abstract PDF: Pulmonary blastoma is a rare lung tumor composed of epithelial and mesenchymal element : the latter element may show various pattern of differentiation toward mature tissue, such as cartilage, smooth muscle, and bone. Rhabdomyoblastic differentiation in pulmonary blastoma is quire rare. In th literature, only seven cases have been reported. We report a case of pulmonary blastoma with rhabdomyoblastic differentiation which occured in a 3 year old girl. Microscopically, cytoplasmic cross-striation was present. Immunohistochemically, strong positivity for vimentin and desmin was observed. Electron microscopy demonstrated A and I bands which documented rhabdomyoblastic differentiation.

Cytologic Features of an Angiosarcoma in Pleural Fluid: A Case Report .: Young Chae Chu, In Seo Park, Yoon Ju Kim, Hye Seung Han, Jee Young Han; J Pathol Transl Med. 1999;10(1):61-66.

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Abstract PDF: Angiosarcomas are rare tumors, seen most commonly in the skin and soft tissue of head and neck region. But it has been described in numerous body sites including thyroid, breast, liver, spleen, bone, etc.. Their biological behaviors depend on the microscopic grade, site of origin, and multifocality. We report the unique cytological features of an angiosarcoma in pleural fluid. A 61-year-old woman presented with a 6 month history of dyspnea on exertion and chest pain. Chest computerized tomography(CT) revealed multiple subpleural small nodules in the right lung and widespread air space consolidation and pleural effusion in the left lung. CT of liver revealed multiple small low attenuated lesion. The smears obtained from pleural fluid showed hypocellularity with a hemorrhagic background. The tumor cells were highly pleomorphic oval or spindle in shape and presented singly, in loose groups, in knitted syncytial aggregates, and in acinar pattern. Their nuclei had vesicular chromatin with delineated, thick nuclear membranes and occasionally a large eosinophilic, prominent nucleolus. The cytoplasm was plump, thin or projected in spindly fashion. Almost all tumor cells showed variable sized intracytoplasmic vacuoles and their nuclei were sometimes crescentic by a huge vacuole. Occasional binucleated tumor cells and mitotic figures were present. Cellular debris and streaky materials were identified. Needle biopsy specimen from the pleura revealed anastomosing slit-like spaces lined by pleomorphic tumor cells. The tumor cells showed a strong reactivity for CD31 and vimentin and focal weak reactivity for factor VIII-related antigen.

Original Articles

Immunohistochemical Expression of p53, p21, and mdm2 Proteins in Human Papillomavirus Positive and Negative Invasive Uterine Cervical Carcinomas.: In Seo Park, Hye Seung Han, Tae Sook Kim, Jee Young Han, Joon Mee Kim, Young Chae Chu, Tae Sook Hwang; Korean J Pathol. 2001;35(3):212-219.

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Abstract PDF: BACKGROUND
In the uterine cervical carcinoma, the inactivation of p53 protein by human papillomavirus(HPV) E6 protein has been reported to play a greater role in carcinogenesis than the mutation of the p53 gene. Therefore, the mutation of the p53 gene is rare. p21 and mdm2 proteins are induced by wild-type p53 protein and are involved in the cell cycle regulatory mechanism.
METHODS
Immunohistochemical staining for p53, p21 and mdm2 proteins was performed in 26 HPV-positive and 13 HPV-negative invasive cervical carcinomas together with 5 non-neoplastic cervical tissues.
RESULTS
The frequencies of the expression of p53, p21 and mdm2 proteins were 82.1%, 84.6% and 66.7%, respectively. The expression of p53 protein was less frequently demonstrated in HPV-positive cases than HPV-negative cases, which was statistically a negative correlation(p=0.018). The expression of p53 and p21 proteins was statistically significant(p=0.000).
CONCLUSIONS
p53, p21 and mdm2 proteins were highly expressed in both HPV-positive and HPV-negative cervical carcinomas. Significantly higher expression of p53 protain in HPV-negative cases necessitate a further study for investigating the role of p53 protein accumulation in carcinogenesis of HPV-negative cervical carcinomas. The relationship between the expression of p53 protein and p21/mdm2 proteins may indicate that p21 and mdm2 proteins also have a role in carcinogenesis, where p53 protein plays a fundamental role.

Fine needle aspiration cytology of medullary carcinoma of the thyroid gland: a case report.: Young Chae Chu, Tae Sook Hwang; J Pathol Transl Med. 1991;2(2):119-126.

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Abstract PDF: No abstract available.

Fine Needle Aspiration Cytology of Diffuse Sclerosing Variant of Papillary Carcinoma of the Thyroid: A Case Report.: Joon Mee Kim, Soo Kee Min, Young Chae Chu, Mi Rim Kim, Kyung Rae Kim; J Pathol Transl Med. 2000;11(1):47-52.

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Abstract PDF: Diffuse sclerosing papillary carcinoma(DSPC), a variant of papillary carcinoma of the thyroid, is characterized by diffuse involvement of one or both thyroid lobes, and histologic features such as prominent sclerosis, intense lymphocytic infiltrate, num erous psammoma bodies, and squamous metaplasia together with the charac teristic cytoarchitectural pattern of classical papillary carcinoma. We experienced a case of fine needle aspiration cytologic(FNAC) findings of DSPC, which was con firmed by histologic examination of the thyroidectomy specimens. The patient was 26 years old female who presented with diffuse firm enlargement of the thyroid gland with enlargement of many cervical lymph nodes. FNAC smears showed numerous psammoma bodies, many lymphocytes, metaplastic squamous cells, absence of stringy colloid, and epithelial cells showing classical features of papillary carcinoma, such as nuclear grooves, intranuclear inclusions, and ground glass chromatin pattern.

Case Report

Achondrogenesis Type 2: An autopsy case.: Joon Mee Kim, Young Chae Chu, Soo Kee Min, Hee Jeung Cha, Je Geun Chi; Korean J Pathol. 1997;31(5):482-488.

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Abstract PDF: Achondrogenesis type 2 is a lethal form of congenital skeletal dysplasia characterized by severe short-limbed dwarfism, decreased vertebral ossification and normal ossification of the skull. We report an autopsy case of achondrogenesis type 2 in a female fetus terminated at 29 weeks of gestation. External morphology revealed a relatively large head, short upper and lower extremities, short neck, and distended abdomen. The x-ray finding showed normal calvarial ossification, hypoplastic ilium and unossified ischium, and metaphyseal flares of the femur and tibia. Histologically, chondrocytes were large and irregular with increased vascularity.

Original Article

Correlation between Tumor Angiogenesis (Microvessel Density), Metastasis and Tumor Cell Proliferation in Colorectal Carcinomas.: Young Chae Chu, Joon Mee Kim; Korean J Pathol. 1997;31(6):517-526.

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Abstract PDF: Tumor angiogenesis has been shown to be associated with metastatic potentials in breast, lung and prostatic carcinomas. The relation between tumor angiogenesis and metastatic potentials in colorectal cancer has not been established to date. We analysed 66 selected patients with colorectal carcinomas (37 with and 29 without nodal metastases) for the microvessel density, tumor proliferation activity, and the clinicopathologic parameters including size, stage, histologic grade, growth pattern, presence of angioinvasion, perineural invasion and lymph node metastasis. For evaluation of microvessel density and tumor proliferative activity, the primary tumors were immunohistochemically stained for CD31 and PCNA. The mean microvessel counts (MVC) per 200X field were 99.27+/-23.28 and 131.35+/-31.48 in node-negative and node-positive patients, respectively. The PCNA index was 39.41+/-5.63% and 56.60+/-7.09% in node-negative and node-positive patients, respectively. MVC and PCNA index were higher in tumors with nodal metastasis (p=0.002, p<0.001), and also correlated each other (sr=0.33, p=0.007). Higher microvessel counts were seen in tumors with advanced stage (p=0.016). Tumor proliferation activity assessed by PCNA immunostaining was significantly higher in tumors with advanced stage, perineural invasion, angioinvasion, poor differentiation and larger size. From these results, MVC and PCNA index in colorectal carcinomas are assumed to be valuable prognostic parameters. Thus assessment of tumor angiogenesis and tumor cell proliferation in colorectal carcinomas may be helpful for the patients in need of aggressive therapy.

Case Report

Fine Needle Aspiration Cytology of Alveolar Soft Part Sarcoma: A Case Report .: Hye Seung Han, In Seo Park, Jee Young Han, Joon Mee Kim, Young Bae Kim, Tae Sook Hwang, Young Chae Chu; J Pathol Transl Med. 2000;11(2):115-119.

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Abstract PDF: Alveolar soft part sarcoma is a rare soft tissue tumor. Few cases of fine needle aspiration cytology have been reported in the literature. We experienced a case of recurrent alveolar soft part sarcoma of the right thigh diagnosed by fine needle aspiration cytology in a 47-year-old man. Cytologic findings showed single cells and clusters associated with thin walled vasculature in a distinct pseudo-alveolar pattern. The tumor cells exhibited round or ovoid abundant granular cytoplasm and large pleomorphic nuclei with prominent central nucleoli.

Original Article

Diagnostic Sensitivity of Sputum and Bronchial Washing Cytology in Bronchogenic Carcinomas Confirmed by Bronchoscopic Biopsy .: Joon Mee Kim, Soo Kee Min, Young Chae Chu, Chul Ho Cho; J Pathol Transl Med. 2001;12(1):17-23.

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Abstract PDF: To evaluate the role of sputum and bronchial washing for the diagnosis of lung carcinoma, we studied the sensitivity of both cytologic techniques using the biopsy confirmed cases from 228 patients. Among them, 123 cases were squamous cell carcinomas, 42 cases were adenocarcinomas, 48 cases were small cell carcinomas, one case was large cell carcinoma, and 14 cases were other types of carcinoma including poorly differentiated carcinomas. Three hundreds and ninety two sputa and 173 sputa were obtained in the pre- and post- bronchoscopic periods. Bronchial washing had been taken once in each patient. The overall sensitivity of the sputum cytology was 0.52 and that of the bronchial washing 0.63, while it increased to 0.83 when a combination of both techniques. Squamous cell carcinomas were diagnosed to the great extent in which sensitivities were 0.59 and 0.74, in sputum and bronchial washing, respectively. The post-bronchoscopic sputa showed higher sensitivity (0.44) than pre-bronchoscopic sputa (0.30). The sensitivity of sputa increased from 0.34 to 0.49 when three samples were examined compared to the single examination. The accuracy of cell typing was 94.0% in sputa and 93.8% in bronchial washing. Repeated sputum examination including post- bronchoscopic sputa is warranted to improve sensitivity and a complementary role of both cytologic techniques can be postulated by these data.

Case Report

A Case of Solitary Cutaneous Myofibroma of the Thigh in An Adult.: Jung Hwan Park, Chang Woo Lee, Young Chae Chu, Moon Hyang Park; Korean J Pathol. 2001;35(4):354-356.

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Abstract PDF: Adult solitary cutaneous myofibroma is a recently described benign neoplasm of the skin or subcutis, representing the adult counterpart of infantile myofibroblastoma. The histologic and immunohistochemical features of a 21-year-old woman with a solitary brownish, mildly tender nodule on her right thigh are reported here. The nodule had been present for a duration of 3 years. It showed a nodular dermal mass with an irregular margin. The lesion consisted of interlacing bundles of spindle cells which were positive for smooth muscle actin, muscle specific actin and vimentin. Immunohistochemical stainings for desmin, S-100 protein, CD 34 and CD 68 were negative. Cutaneous myofibroma in an adult is a distinct entity of benign neoplasm.

Original Articles

Peripheral neuroblastoma of the ulnar nerve:diagnosis by fine needle aspiration cytology.: Young Chae Chu, Joon Mee Kim; J Pathol Transl Med. 1993;4(1):45-51.

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Abstract PDF: No abstract available.

Fine needle aspiration cytology of carotid body paraganglioma-a case report.: Joon Mee Kim, Young Chae Chu; J Pathol Transl Med. 1993;4(1):77-80.

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Abstract PDF: No abstract available.

Case Reports

Clear Cell Meningioma.: Hee Jeung Cha, Soo Kee Min, Joon Mee Kim, Young Chae Chu; Korean J Pathol. 1997;31(8):782-787.

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Abstract PDF: Clear cell meningioma is a recently recognized morphologically unique entity. It shows no sex predilection, affects primarily the lumbar region, and the cerebellopontine angle. Despite its benign appearance, it may be aggressive, particularly in intracranial cases. All lesions are moderately cellular, with the exception of stromal hyalinization. The tumor consists largely of a sheet- like or somewhat lobular pattern of polygonal cells, the cytoplasm of which is clear. No close association is noted between the recurrence or the clinical outcome and factors such as mitotic activity, the PCNA index, and the DNA ploidy status. But the MIB-1 proliferation index is appreciably higher in recurrent tumors. We experienced a case of clear-cell meningioma showing a characteristic histologic finding. A 39-year-old man was admitted due to the recent onset of right-sided, facial-nerve palsy, left hemiparesis and general weakness. A CT scan of the head showed a well defined mass in the petroclival area. After surgical resection, the patient was in good condition, but 1 year later symptoms recurred. A CT scan of the head showed a huge, recurrent petroclival tumor with adhesion to the surrounding brain parenchyme.

Fibro-osseous Pseudotumor of the Digits: A case report .: In Seo Park, Jee Young Han, Hye Seung Han, Young Bae Kim, Young Chae Chu; Korean J Pathol. 1999;33(7):540-543.

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Abstract PDF: Fibro-osseous pseudotumor of the digits is a heterotopic ossification closely related to myositis ossificans and occurs in the subcutaneous tissue of the digits. This lesion is considered a reactive fibroblastic proliferation with metaplastic bone formation. We report a case of fibro-osseous pseudotumor of left index finger in a 28-year-old woman. She had had an ovoid smooth subcutaneous mass with tenderness on the left index finger for one month. In gross, the specimen consisted of a relatively circumscribed, rubbery soft mass with grayish white cut surface measuring 2.0 1.7 1.5 cm. Upon microscopic examination the lesion showed irregular multinodular growth with considerably variable cellularity. Because of the focal hypercellularity, cellular atypia, and increased mitotic activity this lesion may be confused with extraskeletal osteosarcoma or parosteal osteosarcoma. This rare lesion is curable by complete local excision.

Original Article

Expression of Maspin Protein in Ductal Hyperplasia, Intraductal Carcinoma and Invasive Ductal Carcinoma of the Breast.: Young Chae Chu, In Seo Park, Yoon Ju Kim, Joon Mee Kim, Hye Seung Han, Jee Young Han, Young Bae Kim; Korean J Pathol. 1999;33(8):614-619.

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Abstract PDF: Maspin is a recently described gene with tumor suppressor activity. The gene product is a 42 kD protein with homology to the serpin family of protease inhibitors and may play a role as an inhibitor of tumor cell invasion. The prior observation that invasive breast cancers and their metastases showed decreased maspin protein expression by immunostaining supports this speculation. However, the role of maspin in breast cancer progression has not been studied in detail. We, therefore, studied maspin protein expression in a series of hyperplasia, atypical ductal hyperplasia, intraductal carcinoma and invasive carcinomas. Immunohistochemical staining (IHC) for maspin was performed on paraffin sections of 136 breast specimens using a commercially available monoclonal antibody. Among the 106 cases studied were 36 moderate/florid ductal hyperplasia, 11 atypical ductal hyperplasia (ADH), 29 intraductal carcinoma (IDC) (4 low grade, 13 intermediate grade, 12 high grade) and 30 invasive ductal carcinomas. Thirty cases of normal breast were also studied as control group. IHC stains were scored using a semiquantitative scoring system. The mean IHC scores for maspin for normal, moderate/florid hyperplasia, atypical ductal hyperplasia, intraductal carcinoma, and invasive carcinoma were 5.51 1.30, 7.36 0.72, 3.82 1.60, 4.48 2.69, 3.97 3.30, respectively. These scores for each category were statistically significant (p<0.05), except between ADH and IDC. Maspin protein expression was increased in most cases of moderate/florid hyperplasia, while maspin expression was more heterogeneous in ADH and IDC. In high grade IDC, maspin protein expression was stronger than low and intermediate grade IDC, and this suggests the possibility of a compensatory cellular response against the forces driving further tumor progression. Two thirds of invasive ductal carcinomas expressed maspin protein weakly and focally. All metastatic carcinomas of lymph nodes were negative for maspin. It is possible that high grade IDC with strong maspin expression may represent a subset less likely to progress to invasive cancer. This speculation merits investigation in clinical outcome studies.

Case Reports

Angiodysplasia Arising in the Bowels: Two cases report.: Soo Kee Min, Hee Jeung Cha, Joon Mee Kim, Young Chae Chu; Korean J Pathol. 1997;31(12):1308-1313.

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Abstract PDF: Gastrointestinal angiodysplasia is a distinct disease entity which causes frequent gastrointestinal bleeding. It predominantly arises at the stomach and duodenum in the upper gastrointestinal tract and cecum and ascending colon in the lower gastrointestinal tract. The general histological finding of the angiodysplasia is a submucosal vascular ectasia and tortuosity. We have experienced two cases of the intestinal angiodysplasia. The first case occurred on a jejunum in a 22-year-old woman who had anemia. The second case occurred on a sigmoid colon in a 59-year-old man who had constipation. In addition to the general histologic finding of the angiodysplasia, the microscopic findings of the first case revealed some capillary hemangioma-like areas; and in the second case, there was a marked ischemic change and the thickening of the wall.

Undifferentiated Sarcoma of the Liver in an Adult: A case report.: Young Chae Chu, Yong Hwa Moon, In Sun Kim; Korean J Pathol. 1987;21(1):34-39.

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Abstract PDF: Undifferentiated sarcoma of the liver is a highly malignant neoplasm that occurs almost exclusively in children. We present a case of adult undifferentiated sarcoma in a 33-year-old man. The neoplasm was typically hypovascular on hepatic angiography and a globular, cystic and mucoid mass separated from the adjacent liver by a psedocapsule was removed from the left lobe of the liver. Necrosis and hemorrhage were found. Microscopically the neoplasm consisted of myxoid and cellular areas and the basic neoplastic cells were stellate cells showing variable degree of anaplasia and pleomorphism. Eosinophilic globules were PAS-positive and immunohistochemically negative for alpha-fetoprotein. Extramedullary hematopoiesis was present and normal-appearing bile ducts and hepatic cell cords were noted.

Pleomorphic Hyalinizing Angiectatic Tumor of Soft Parts: A Case Report.: Young Chae Chu, Sun Keun Choi, In Suh Park, Hye Seung Han, Jee Young Han, Joon Mee Kim; Korean J Pathol. 2002;36(3):195-198.

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Abstract PDF: A case of rare pleomorphic hyalinizing angiectatic tumor (PHAT) of soft parts is reported. A 35-year-old woman presented with a subcutaneous solid mass in the left inguinal area, which had been present for 3 months, was presented to us. The tumor was histologically characterized by sheets of mitotically inactive oval and pleomorphic cells, mono-and multinucleated giant cells, intranuclear cytoplasmic inclusions, and prominent clusters of thinwalled ectatic vessels with perivascular hyalinization. A focal hemangiopericytoma-like vascular pattern, pseudovascular spaces, stromal collagen with degenerative change and abundant mast cells were observed. The tumor cells were reactive for vimentin and CD34. This tumor shared several features with malignant fibrous histiocytoma, ancient schwannoma, giant cell angiofibroma, giant cell fibroblastoma and solitary fibrous tumor. The patient was well with no evidence of disease for 10 months.

Fine Needle Aspiration Cytologic Findings of Fibromatosis Colli: A Report of Three Cases.: In Suh Park, Lucia Kim, Suk Jin Choi, Jee Young Han, Joon Mee Kim, Young Chae Chu, Sun Geun Choi; J Pathol Transl Med. 2005;16(1):61-65.

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Abstract PDF: Fibromatosis colli is a benign fibrous tissue proliferation of sternocleidomastoid muscle, which is usually observed during the first month of life, often associated with congenital torticollis. It should be differentiated from other neck masses in infants because the usual initial treatment of fibromatosis colli is conservative management and invasive therapy should be avoided. Fine needle aspiration cytology provides an excellent minimally invasive diagnostic way for evaluation of infantile neck masses. We describe three cases of fibromatosis colli diagnosed by fine needle aspiration cytology. All of them were younger than one month and presented as a neck mass. Clinical impressions were malignant tumors in two cases and fibromatosis colli in one case. Fine needle aspiration cytology revealed benign and mature fibroblasts and atrophic striated muscle fibers. The cytologic diagnosis was fibromatosis colli or benign fibous lesion.

Original Articles

Gangliocytic Paraganglioma.: Joon Mee Kim, Suk Jin Choi, Lucia Kim, In Suh Park, Jee Young Han, Young Chae Chu, Hyung Gil Kim, Sun Geun Choi; Korean J Pathol. 2005;39(6):428-432.

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Abstract PDF: Gangliocytic paraganglioma (GP) is a rare benign tumor that is usually seen in the duodenum. It shows unique histologic features that are composed of a carcinoid or paraganglioma-like appearance, ganglion cells, and Schwann cells. The common presenting symptoms are abdominal pain, gastrointestinal bleeding and obstruction. The lesion can sometimes be asymptomatic and they are discovered incidentally. We experienced a case of incidentally found GP in a 73 year-old-man who had a colon cancer with liver metastasis. During the preoperative workup, a submucosal tumor was found in the duodenal papilla. The frozen diagnosis of the duodenal mass was GP, which was confirmed by the permanent sections and immunohistochemical staining. Pathologists should be alert to recognize and diagnose this rare, but benign disease, especially in the patient suffering with gastrointestinal cancer.

Expression of Nitric Oxide Synthase Isotypes in Advanced Gastric Carcinoma.: Kyong Mee Kwon, Young Chae Chu, Tae Sook Hwang; Korean J Pathol. 2002;36(6):374-371.

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Abstract PDF: BACKGROUND
Increased expression of nitric oxide synthase (NOS) isotypes is present in human tumor cell lines and solid tumor tissues. Hypoxia upregulates NOS expression, and nitric oxide (NO) induces mitogenesis among endothelial cells. NO has been known to induce vascular endothelial growth factor (VEGF) expression in carcinoma cells and to induce neovascularization in tumors.
METHODS
The expression and cellular localization of 3 isotypes of NOS was detected by immunohistochemistry in 73 advanced gastric carcinoma tissues along with adjacent normal gastric mucosa; and the relationship to known clinicopathologic parameters, microvascular density, and VEGF expression was analysed.
RESULTS
Forty-four (60.3%), 56 (76.7%), and 52 (71.2%) of the 73 cases revealed eNOS, nNOS, and iNOS expression, respectively. Intestinal type adenocarcinomas tended to have higher activity of eNOS (p=0.000) and nNOS (p=0.001) activities than did the diffuse type adenocarcinomas. All isotypes of NOS (eNOS, p=0.001; nNOS, p=0.005; iNOS, p=0.044) tended to be highly expressed when the tumor was differentiated. There was no significant relationship between any of the 3 NOS isotypes and microvascular density, whereas VEGF was closely related with microvascular density (p=0.000). The expression of VEGF was not related to with any of the NOS isotype expressions.
CONCLUSIONS
From the above results, we speculated that NO may be implicated in the early stage of the gastric carcinogenesis rather than the growth and progression stages, and NO does not appear to affect angiogenesis or VEGF expression in the advanced gastric carcinoma.

Expression of Insulin-like Growth Factor-I-Receptor in Colorectal Adenomas and Carcinomas.: Young Chae Chu, Hye Seung Han, Jee Young Han, Joon Mee Kim, Young Bae Kim, Tae Sook Hwang; Korean J Pathol. 2000;34(3):199-207.

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Abstract PDF: The activation of the insulin-like growth factor-I-receptor system (IGF-IR) has recently emerged as critical events in transformation and tumorigenicity of several human tumors. In this study we investigated the expression of IGF-IR in 33 colorectal adenomas, 88 primary colorectal carcinomas, and 30 normal colonic mucosa adjacent to the carcinoma. Immunohistochemical staining (IHC) for IGF-IR was performed on paraffin embedded sections using an anti-IGF-IR rabbit polyclonal antibody. IHC stains for IGF-IR were scored using a semiquantitative scoring system. The relationship of IGF-IR staining to clinicopathologic variables and proliferating cell nuclear antigen (PCNA) staining was also analysed. The mean IHC scores for IGF-IR of normal glands, adenoma, intramucosal carcinoma, node-negative carcinoma, and node-positive carcinoma were 0.41 0.96, 0.76 1.23, 2.0 1.48, 2.83 2.0 and 5.93 1.58, respectively. These scores for each category were statistically significant except between normal glands and adenoma and between intramucosal carcinoma and node-negative carcinomas. The mean PCNA indexes of normal glands, adenoma, intramucosal carcinoma, node-negative carcinoma, and node-positive carcinoma were 2.48 2.60, 6.94 11.03, 27.21 11.42, 43.36 9.9 and 57.60 10.01, respectively. The PCNA index for each category was statistically significant except between normal and adenoma. IGF-IR scores and PCNA indexes were higher with tumor progression and also correlated each other (sr=0.65, p=0.0001). Higher IGF-IR scores and PCNA indexes were seen in tumors with advanced stage, infiltrative growth pattern, poor differentiation, nerve invasion, lymphovascular invasion, and moderate fibrosis. Our results suggest that IGF-IR plays an important role in tumorigenicity and tumor progression.

Case Reports

Composite Hemangioendothelioma: A Case Report.: Young Chae Chu, Suk Jin Choi, In Suh Park, Lucia Kim, Jee Young Han, Joon Mee Kim; Korean J Pathol. 2006;40(2):142-147.

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Abstract PDF: Composite hemangioendothelioma (CHE) is a recently described vascular tumor of low-grade malignancy. We report a case of CHE in an 18-year-old woman who presented with a 2-month history of an enlarging palpable mass in the left axilla. Grossly, the excised tumor was relatively circumscribed, nodular, firm, and soft. It measured 6.0 x 4.5 x 4.0 cm. The cut surface revealed a whitish gray solid area and a dark red to tan cystic area containing necrotic material. Histologically, the tumor demonstrated variably intermixed benign and malignant vascular components. The benign components showed features of an arteriovenous malformation, capillary hemangioma, spindle cell hemangioma and cavernous hemangioma. The malignant components were composed of areas resembling retiform hemangioendothelioma, epithelioid hemangioendothelioma, Kaposiform hemangioendothelioma, and angiosarcoma. The angiosarcoma component showed a mixed epithelioid and spindle shaped cell morphology with moderate differentiation. A nearly imperceptible transition between the benign and malignant components was noted.

Inflammatory Myofibroblastic Tumor of the Stomach: A Case Report.: Joon Mee Kim, In Suh Park, Lucia Kim, Suk Jin Choi, Jee young Han, Young Chae Chu, Kyoung Rae Kim; Korean J Pathol. 2006;40(2):148-150.

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Abstract PDF: Inflammatory myofibroblastic tumor of the stomach is a rare tumor-like, benign disease with an uncertain pathogenesis. A 15-year-old male presented with epigastric pain. Endoscopic ultrasonography revealed a 2.3 cm sized ovoid intramuscular mass in the lower body of the stomach at the lesser curvature. Histologically, the tumor was composed of smooth muscle actin positive- and vimentin positive spindle cells and there were a large number of lymphocytes, plasma cells and histiocytes in the fibrotic background. The spindle cells were also positive for ALK1, but negative for EBV in situ hybridization.

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; J Pathol Transl Med. 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.

Case Reports

Fine Needle Aspiration Cytology of Parathyroid Neoplasms: A Review of Three Cases.: Lucia Kim, Jee Young Han, In Suh Park, Suk Jin Choi, Joon Mee Kim, Young Chae Chu; J Pathol Transl Med. 2007;18(1):74-80.

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Abstract PDF: Parathyroid tumors may be difficult to distinguish from thyroid follicular lesions, especially when a tumor is nonfunctioning. We report here two cases of asymptomatic parathyroid carcinoma preoperatively misdiagnosed as thyroid follicular lesions, and one case of parathyroid adenoma showing hyperparathyroidism, and review the cytologic features favoring the diagnosis of parathyroid neoplasm. The cytologic findings that are characterized by clean background, monomorphic small cells, cohesive three-dimensional papillary clusters, small tight clusters with scattered naked nuclei, and well-defined clear cytoplasm favor a diagnosis for the parathyroid lesions. Cytologic findings such as macrofollicular structure, presence of colloid and macrophages, and presence of perivacuolar cytoplasmic granules on May-Grunwald-Giemsa stain support a diagnosis of a thyroid follicular lesion. The cytomorphology of parathyroid tumors is so variable that the distinction from a thyroid lesion cannot be based on the presence or absence of a single feature only but on the cytologic features as a whole.

Cerebellar Pleomorphic Xanthoastrocytoma: A Case Report.: Seung Baik Han, Suk Jin Choi, Lucia Kim, Jee Young Han, Joon Mee Kim, Young Chae Chu, In Suh Park; Korean J Pathol. 2006;40(3):231-234.

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Abstract PDF: Cerebellar pleomorphic xanthoastrocytoma (PXA) is a rare tumor. The most common manifestation of PXA is a seizure, as opposed to the headache and dizziness that were present in our reported case; these atypical symptoms were related to the development of tumor in cerebellum. We describe here a case of PXA in the cerebellum of a 49-year-old female and we discuss the radiological, histological and immunohistochemical findings of PXA that occurred in the cerebellum.

Original Articles

Prostatic Intraepithelial Neoplasia in Transurethral Resection Specimens On serum PSA and histologic findings.: Joon Mee Kim, Soo Kee Min, Young Chae Chu, Tae Sook Hwang, Young Bae Kim, Jee Young Han, Tae Sook Kim, Hye Seung Han; Korean J Pathol. 2000;34(5):349-357.

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Abstract PDF: Prostatic intraepithelial neoplasia (PIN), which is divided into low and high grade, has different clinicopathologic significance. We reviewed 158 prostatic tissues, which consisted of 144 cases of nodular hyperplasias and 14 cases of adenocarcinomas, to evaluate incidence of PIN, its histologic finding, and its clinical significance. Ten cases of PIN, 4 low grade and 6 high grade, were found. Four cases of low grade PIN (LPIN) and five cases of high grade PIN (HPIN) were associated with nodular hyperplasia. Only one case of HPIN occurred in carcinoma. The constant histologic findings of LPIN were nuclear stratification and nucleomegaly. The most prominent characteristics of HPIN were hyperchromasia and prominent nucleoli. Anisonucleosis was not so helpful for differential diagnosis between LPIN and HPIN. Basal layer disruption was present in one case of high grade PIN associated with adenocarcinoma, and important for the differentiatial diagnosis of cribriform HPIN from the cribriform adenocarcinoma. There was no significant difference in age incidence between the two groups with the mean age of 70.9 years in nodular hyperplasia and 69.4 years in adenocarcinoma. Serum PSA level was significantly different between the two group with the mean PSA value of 11.03 ng/ml in nodular hyperplasia and that of 73.76 ng/ml in carcinoma (p=0.000). However, PSA values between "nodular hyperplasia only" group and "PIN associated nodular hyperplasia" group were not significantly different. PIN association changed neither age distribution nor serum PSA level. During the follow up period, no adenocacinoma has occurred in the cases having PIN although serum PSA level has elevated in some cases. One case of adenocarcinoma associated with HPIN developed in the nodular hyperplasia patient. Although PIN did not increase the possibility of subsequent prostatic adenocarcinoma in transurethral resection specimens, it could not be excluded that PIN was a precursor of prostatic adenocarcinoma.

Association between the Expresson of MMP-2 and TIMP-2, and Growth Pattern of Tumor Border, Lymph Node Metastasis, and Estrogen Receptor in the Invasive Ductal Carcinoma of the Breast.: Soo Kee Min, Joon Mee Kim, Young Chae Chu, Young Up Cho, Bom Woo Yeom; Korean J Pathol. 2000;34(5):366-373.

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Abstract PDF: The most important prognostic factor of breast cancer is the status of lymph node or distant metastasis, which is resisted by basement membrane and stromal matrix. MMP (matrix metalloproteinase)-2 is a 72-kilodalton type IV collagenase/ gelatinase and degrades the type IV collagen which is a main component of the basement membrane. Therefore, MMP-2 is believed to be one of the key molecule for cancer invasion and metastasis. Enzymatic activity of MMP is inhibited by TIMPs (tissue inhibitors of metalloproteinase). TIMP-2 forms a complex with latent pro-MMP-2 and inhibits the active forms of MMP-2. The balance of MMPs and TIMPs is suspected as the important factor of invasion and metastasis of the tumor cells. We studied the association between the expression of MMP-2/TIMP-2 and growth pattern of tumor border, lymph node metastasis, and estrogen receptor expression in the 57 cases of invasive ductal carcinoma of the breast using immunohistochemical staining methods. The results revealed increased expression of MMP-2 in the infiltrating tumor border and tumors with positive lymph node metastasis and negative estrogen receptor with no statistical significance (p>0.05). But the expression of TIMP-2 was increased in expanding tumor border and tumors with positive lymph node metastasis and negative estrogen receptor without statistical significance (p>0.05).

Case Reports

Splenic Lymphangioma: A case report.: Young Chae Chu, Ho Suk Lee; Korean J Pathol. 1994;28(5):533-535.

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Abstract PDF: Lymphangioma of the spleen is a rare neoplasm and approximately 100 cases have been reported in the world literature. This lesion may involve the spleen alone or may be a part of a syndrome of multivisceral involvement. The pathogenesis is unclear whether this is a true neoplasm of a developmental defect. We report a case of a 87-year-old woman with solitary splenic lymphangioma. The cut surface mass is not encapsulated and located at the subcapsular area in the mid portion of spleen. It is composed of variable sized cystic spaces containing myxoid tissue. Microscopic finding reveals dilated lymphatic spaces lined by endothelial cells and the content is proteinaceous eosinophilic fluid.

Fine Needle Aspiration Cytologic Findings of Metaplastic Carcinoma of the Breast: A Case Report.: Soo Kee Min, Hee Jeung Cha, Joon Mee Kim, Young Chae Chu; J Pathol Transl Med. 1996;7(2):202-206.

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Abstract PDF: Metaplastic carcinoma of the breast is a morphologically heterogenous group of neoplasms characterized by ductal adenocarcinoma with extensive squamous differentiation, a spindle-cell pattern of growth, and/or heterologous mesenchymal elements. We experienced a case of metaplastic carcinoma diagnosed by fine needle aspiration(FNA) and confirmed by radical mastectomy in a 46 year-old woman. The FNA cytologic findings included atypical squamous cells with kertinization lying singly and in clusters in a necrotic background. In addition, scattered spindle cells with pleomorphic large nuclei and prominent nucleoli were present in a hemorrhagic and necrotic background. The histopathologic findings showed moderately differentiated squamous cell carcinoma and highly pleomorphic sarcoma with chondroid component. The immunohistochemical stain revealed focal positive reaction for cytokeratin as well as diffuse reactivity for vimentin in the sarcomatous area.

Endobronchial Actinomycosis: A report of two cases.: Hye Seung Han, Kwang Ho Kim, In Seo Park, Jee Young Han, Young Bae Kim, Tae Sook Hwang, Young Chae Chu; Korean J Pathol. 2000;34(6):465-470.

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Abstract PDF: Actinomycosis causes a chronic suppurative infection most commonly involving the cervico-facial region, thorax, and the abdomen. Thoracic infection results from an aspiration of contaminated material from mouth or oropharynx. Actinomyces was known to have a predilection for the periphery of the lung and the endobronchial lesion is extremely rare. We report two cases of actinomycosis presenting as an endobronchial mass which arose in 53-year-old and 44-year-old women. The first case presented with cough, sputum, weight loss and had a history of pulmonary tuberculosis 24 years ago. Chest CT revealed a right lobe collapse simulating mass and suggested carcinoma. The second case presented with hemoptysis for 2 years. Chest CT revealed cystic bronchiectasis of both lungs and intracystic soft tissue mass in the anterior segment of the right upper lobe which suggested aspergilloma. The gross features of them were similar to those of aspergilloma. Characteristic sulphur granules consisting of a granular basophilic center surrounded by a radiating zone of eosinophilic, hyaline, club-shaped projection were histologically confirmed in both cases. Granulomas containing P. westermani eggs were present in the second case. Staphylococcus, true fungal organism, nocardia, and streptomyces shoud be distinguished by analysing their morphologic characteristics in the appropriate stains. Actinomycosis should be included in the differential diagnoses of an endobronchial mass.

Cytologic Findings of Rheumatoid Pleuritis in Pleural Effusion: A Case Report .: Hee Jeung Cha, Soo Kee Min, Joon Mee Kim, Young Chae Chu; J Pathol Transl Med. 1997;8(1):47-51.

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Abstract PDF: Patients with rheumatoid arthritis of any degree of severity or duration may develop necrotizing granulomatous pleuritis, a morphologic replica of the inflammatory reaction characteristic of rheumatoid synovitis and rheumatoid nodules. The principal feature is the background composed of granular, amorphous, particulate material or debris of various hues. The material is sometimes eosinophilic, sometimes more cyanophilic, or even green in the Papanicolaou stain. Within this background are elongated, fibroblast-like epithelioid cells, numerous multinucleated giant cells and degenerating leukocytes. The combination of the debris, spindle epithelioid cells, and multinucleated giant cells in fluid is pathognomonic for rheumatoid pleuritis. We experienced a hcase of rheumatoid pleuritis showing these characteristic cytologic findings. The patient was a 63 year-old man with positive rheumatoid factor. The pleual fluid specimen revealed elongated epithelioid cells and multinucleated giant cells in a background of amorphous granular material.

Original Article

Morphometric Study on Fine Needle Aspirates from Follicular Adenoma and Follicular Carcinoma of the Thyroid.: Young Chae Chu, Hee Jung Cha, Soo Kee Min, Joon Mee Kim, Tae Sook Hwang; J Pathol Transl Med. 1998;9(1):63-68.

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Abstract PDF: Fine needle aspiration cytology of "cold" nodules of the thyroid has proved to be of great value in their preoperative diagnosis. Most types of thyroid tumors are readily recognizable from characteristic cellular patterns in the smears of needle aspirates. But follicular neoplasms present some problems because the cytomorphology of the adenomas frequently is same as in carcinoma. For differentiation of benign from malignant follicular neoplasms of the thyroid we tested the usefulness of two objective parameters - nuclear area and perimeter - by morphometry. This study was made on fine needle aspirates from 30 cases with cytologic diagnosis of follicular neoplasm of thyroid. The histologic classification was follicular adenoma in 22 cases and follicular carcinoma in 8 cases. As a reference group we used seven caes with nodular hyperplasia. The smears of aspirates were stained by Papanicolaou method. On each slide 200 randomly selected cells with intact nuclei were measured. The mean value of nuclear area are 25.32+/-5.50 micrometer2, 34.08+/-7.50 micrometer2 and 39.97+/-6.63 micrometer2 in nodular hyperplasia, follicular adenoma, and follicular carcinoma, respectively. The mean value of perimeter are 19.48+/-2.26 micrometer, 22.95+/-2.65 micrometer and 24.78+/-2.23 micrometer in nodular hyperplasia, follicular adenoma and follicular carcinoma, respectively. The mean nuclear areas and perimeters of cells from follicular adenoma were significantly larger than those from nodular hyperplasia (p<0.05). The mean nuclear areas and perimeters of cells from follicular carcinoma were larger than those from follicular adenoma but the differences are not significant statistically(p<0.05). Therefore, morphometric assessment alone is inadequate to predict malignancy in thyroid aspirates.

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