Journal of Pathology and Translational Medicine

Original Article

A multicenter study of interobserver variability in pathologic diagnosis of papillary breast lesions on core needle biopsy with WHO classification: Hye Ju Kang, Sun Young Kwon, Ahrong Kim, Woo Gyeong Kim, Eun Kyung Kim, Ae Ree Kim, Chungyeul Kim, Soo Kee Min, So Young Park, Sun Hee Sung, Hye Kyoung Yoon, Ahwon Lee, Ji Shin Lee, Hyang Im Lee, Ho Chang Lee, Sung Chul Lim, Sun Young Jun, Min Jung Jung, Chang Won Jung, Soo Youn Cho, Eun Yoon Cho, Hye Jeong Choi, So Yeon Park, Jee Yeon Kim, In Ae Park, Youngmee Kwon; J Pathol Transl Med. 2021;55(6):380-387. Published online October 6, 2021; DOI: https://doi.org/10.4132/jptm.2021.07.29

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Background
Papillary breast lesions (PBLs) comprise diverse entities from benign and atypical lesions to malignant tumors. Although PBLs are characterized by a papillary growth pattern, it is challenging to achieve high diagnostic accuracy and reproducibility. Thus, we investigated the diagnostic reproducibility of PBLs in core needle biopsy (CNB) specimens with World Health Organization (WHO) classification.
Methods
Diagnostic reproducibility was assessed using interobserver variability (kappa value, κ) and agreement rate in the pathologic diagnosis of 60 PBL cases on CNB among 20 breast pathologists affiliated with 20 medical institutions in Korea. This analysis was performed using hematoxylin and eosin (H&E) staining and immunohistochemical (IHC) staining for cytokeratin 5 (CK5) and p63. The pathologic diagnosis of PBLs was based on WHO classification, which was used to establish simple classifications (4-tier, 3-tier, and 2-tier).
Results
On WHO classification, H&E staining exhibited ‘fair agreement’ (κ = 0.21) with a 47.0% agreement rate. Simple classifications presented improvement in interobserver variability and agreement rate. IHC staining increased the kappa value and agreement rate in all the classifications. Despite IHC staining, the encapsulated/solid papillary carcinoma (EPC/SPC) subgroup (κ = 0.16) exhibited lower agreement compared to the non-EPC/SPC subgroup (κ = 0.35) with WHO classification, which was similar to the results of any other classification systems.
Conclusions
Although the use of IHC staining for CK5 and p63 increased the diagnostic agreement of PBLs in CNB specimens, WHO classification exhibited a higher discordance rate compared to any other classifications. Therefore, this result warrants further intensive consensus studies to improve the diagnostic reproducibility of PBLs with WHO classification.

Citations

Citations to this article as recorded by

Invasive papillary carcinoma of the breast
Shijing Wang, Qingfu Zhang, Xiaoyun Mao
Frontiers in Oncology.2024;[Epub] CrossRef
Encapsulated papillary carcinoma of the breast: A single institution experience
Liang Xu, Qixin Mao, Qiuming Liu, Yufeng Gao, Lihua Luo, Chungen Guo, Wei Qu, Ningning Yan, Yali Cao
Oncology Letters.2023;[Epub] CrossRef
High-risk and selected benign breast lesions diagnosed on core needle biopsy: Evidence for and against immediate surgical excision
Aparna Harbhajanka, Hannah L. Gilmore, Benjamin C. Calhoun
Modern Pathology.2022; 35(11): 1500. CrossRef

Review

Standardized pathology report for breast cancer: Soo Youn Cho, So Yeon Park, Young Kyung Bae, Jee Yeon Kim, Eun Kyung Kim, Woo Gyeong Kim, Youngmee Kwon, Ahwon Lee, Hee Jin Lee, Ji Shin Lee, Jee Young Park, Gyungyub Gong, Hye Kyoung Yoon; J Pathol Transl Med. 2021;55(1):1-15. Published online January 11, 2021; DOI: https://doi.org/10.4132/jptm.2020.11.20

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Abstract PDF Supplementary Material

Given the recent advances in management and understanding of breast cancer, a standardized pathology report reflecting these changes is critical. To meet this need, the Breast Pathology Study Group of the Korean Society of Pathologists has developed a standardized pathology reporting format for breast cancer, consisting of ‘standard data elements,’ ‘conditional data elements,’ and a biomarker report form. The ‘standard data elements’ consist of the basic pathologic features used for prognostication, while other factors related to prognosis or diagnosis are described in the ‘conditional data elements.’ In addition to standard data elements, all recommended issues are also presented. We expect that this standardized pathology report for breast cancer will improve diagnostic concordance and communication between pathologists and clinicians, as well as between pathologists inter-institutionally.

Citations

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Residual pure intralymphatic carcinoma component only (lymphovascular tumor emboli without invasive carcinoma) after neoadjuvant chemotherapy is associated with poor outcome: Not pathologic complete response
Hyunwoo Lee, Yunjeong Jang, Yoon Ah Cho, Eun Yoon Cho
Human Pathology.2024; 145: 1. CrossRef
Sentinel lymph node biopsy in patients with ductal carcinomain situ: systematic review and meta-analysis
Matthew G. Davey, Colm O’Flaherty, Eoin F. Cleere, Aoife Nohilly, James Phelan, Evan Ronane, Aoife J. Lowery, Michael J. Kerin
BJS Open.2022;[Epub] CrossRef

Case Study

Primary Malignant Melanoma of the Breast: A Report of Two Cases: Jiwon Koh, Jihyeon Lee, So Youn Jung, Han Sung Kang, Tak Yun, Youngmee Kwon; J Pathol Transl Med. 2019;53(2):119-124. Published online November 26, 2018; DOI: https://doi.org/10.4132/jptm.2018.10.18

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Abstract PDF Supplementary Material

Primary malignant melanoma of the breast (PMMB) is a rare tumor with only a few case reports available in the literature. We report two cases of PMMB, one derived from the breast parenchyma and the other from the breast skin. The first case consisted of atypical epithelioid cells without overt melanocytic differentiation like melanin pigments. The tumor cells showed diffuse positivity for S100 protein, tyrosinase, and BRAF V600E. However, the tumor cells were negative for cytokeratin, epithelial membrane antigen, and HMB-45. The second case showed atypical melanocytic proliferation with heavy melanin pigmentation. The tumor cells were positive for S100 protein, HMB-45, tyrosinase, and BRAF V600E. These two cases represent two distinct presentations of PMMB in terms of skin involvement, melanin pigmentation, and HMB-45 positivity. Although PMMB is very rare, the possibility of this entity should be considered in malignant epithelioid neoplasms in the breast parenchyma.

Citations

Citations to this article as recorded by

Primary Malignant Melanoma of the Breast Presenting as a Breast Abscess: A Case Report
Hyung In Choi, You Me Kim, Junwon Min, Yong Moon Lee, Hee Jeong Kim
Journal of the Korean Society of Radiology.2023; 84(3): 763. CrossRef
Case Report: Care Report: Primary malignant melanoma of the breast
Juee Meghe, Yeshwant Lamture, Varsha Gajhbhiye, Pankaj Gharde, Akash Inamdar
F1000Research.2023; 12: 1323. CrossRef
Series of rare cases of breast tumour: 8-year review at mankweng Breast Oncology clinic, Limpopo, South Africa
Mirza M. Z. U. Bhuiyan
EUREKA: Health Sciences.2023; (4): 3. CrossRef
Malignant melanoma of the breast: controversies in the diagnosis and therapeutic management of a rare nosologic entity
Aikaterini Mastoraki, Dimitrios Schizas, Ilias Giannakodimos, Athanasios Rebakos, Ioannis Margaris, Ioannis Katsaros, Ilias Vagios, Pantelis Vassiliu, Emmanouil Pikoulis
International Journal of Dermatology.2020; 59(9): 1057. CrossRef
Uncommon Subtypes of Malignant Melanomas: A Review Based on Clinical and Molecular Perspectives
Matías Chacón, Yanina Pfluger, Martín Angel, Federico Waisberg, Diego Enrico
Cancers.2020; 12(9): 2362. CrossRef
Primary Melanoma of the Breast Parenchyma: An Oncoplastic Approach
Emma Snashall, Tamara Kiernan, Aenone Harper-Machin, Rieka Taghizadeh
Plastic and Reconstructive Surgery - Global Open.2020; 8(12): e3276. CrossRef

Case Reports

Endoscopic Ultrasound-Guided Fine Needle Aspiration Cytology Diagnosis of Solid Pseudopapillary Neoplasm: Three Case Reports with Review of Literature: Joon Seon Song, Chong Woo Yoo, Youngmee Kwon, Eun Kyung Hong; Korean J Pathol. 2012;46(4):399-406. Published online August 23, 2012; DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.4.399

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Abstract PDF

Solid pseudopapillary neoplasm of the pancreas (SPN) is relatively rare and it occurs almost exclusively in women. We recently experienced three cases of SPN diagnosed by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). These three cases were two male and one female patient whose age was 29, 37, and 44 years old. Radiological diagnosis was pancreatic endocrine tumor (PEN) showing solid with a heterogenous echogenicity. EUS-FNA cytology specimens consisted of single cells and aggregates of uniform cells, forming microadenoid structures, branching, papillary clusters with delicate fibrovascular cores. In conclusion, a single diagnosis of SPN based on clinical and radiological findings would be risky because there is a possibility of it being misdiagnosed as PEN or other malignancies. An EUS-FNA is therefore essential for establishing the diagnosis. In addition, the pathologists should recognize the characteristic cytologic findings with immunoprofiles of SPN to prevent misdiagnosis of SPN.

Citations

Citations to this article as recorded by

Laparoscopic parenchyma-sparing resections for solid pseudopapillary tumors located in the head of pancreas
Zhengdong Zou, Lu Feng, Bing Peng, Jianhua Liu, Yunqiang Cai
BMC Surgery.2023;[Epub] CrossRef
Solid pancreatic masses in children: A review of current evidence and clinical challenges
Kelli N. Patterson, Andrew T. Trout, Archana Shenoy, Maisam Abu-El-Haija, Jaimie D. Nathan
Frontiers in Pediatrics.2022;[Epub] CrossRef
Pancreatic solid pseudopapillary neoplasm in male patients: systematic review with three new cases
Anna Caterina Milanetto, Anna-Lea Gais Zürcher, Lorenzo Macchi, Alina David, Claudio Pasquali
Updates in Surgery.2021; 73(4): 1285. CrossRef
Silencing c-Myc Enhances the Antitumor Activity of Bufalin by Suppressing the HIF-1α/SDF-1/CXCR4 Pathway in Pancreatic Cancer Cells
Xia Liu, Yayun Zhou, Jiamin Peng, Bei Xie, Qiyang Shou, Jianchao Wang
Frontiers in Pharmacology.2020;[Epub] CrossRef
Simultaneous colorectal and parenchymal-sparing liver resection for advanced colorectal carcinoma with synchronous liver metastases: Between conventional and mini-invasive approaches
Emilio De Raffele, Mariateresa Mirarchi, Dajana Cuicchi, Ferdinando Lecce, Riccardo Casadei, Claudio Ricci, Saverio Selva, Francesco Minni
World Journal of Gastroenterology.2020; 26(42): 6529. CrossRef
Solid pseudopapillary neoplasm of the pancreas showing marked distal atrophy: A case report
Masanori Tsujie, Tomoko Wakasa, Shigeto Mizuno, Hajime Ishikawa, Hironobu Manabe, Taichi Koyama, Kotaro Kitani, Shumpei Satoi, Keisuke Inoue, Shuichi Fukuda, Toshihiko Kawasaki, Masao Yukawa, Yoshio Ohta, Masatoshi Inoue
International Journal of Surgery Case Reports.2019; 55: 136. CrossRef
Solid pseudopapillary neoplasm of the pancreas in pediatric patients: A case report and institutional case series
Justin B. Mahida, Rajan K. Thakkar, Jon Walker, Rulong Shen, Brian D. Kenney, Vinay Prasad, Jennifer H. Aldrink
Journal of Pediatric Surgery Case Reports.2015; 3(4): 149. CrossRef
Onsite cytopathology evaluation and ancillary studies beneficial in EUS‐FNA of pancreatic, mediastinal, intra‐abdominal, and submucosal lesions
Shafqat Mehmood, Amna Jahan, Asif Loya, Muhammed Aasim Yusuf
Diagnostic Cytopathology.2015; 43(4): 278. CrossRef
Multicentric solid pseudopapillary neoplasms of the pancreas diagnosed by endoscopic ultrasound-guided fine needle aspiration: a case report
Megumi Yamaguchi, Toshikatsu Fukuda, Masahiro Nakahara, Mio Amano, Daisuke Takei, Masumi Kawashima, Yusuke Sumi, Hironobu Amano, Shuji Yonehara, Keiji Hanada, Toshio Noriyuki
Surgical Case Reports.2015;[Epub] CrossRef
A solid pseudopapillary neoplasm without cysts that occurred in a patient diagnosed by endoscopic ultrasound-guided fine-needle aspiration: a case report
Masakuni Fujii, Masao Yoshioka, Takefumi Niguma, Hiroaki Saito, Toru Kojima, Soichiro Nose, Junji Shiode
Journal of Medical Case Reports.2014;[Epub] CrossRef
Surgical Management and Long-Term Follow-Up of Solid Pseudopapillary Tumor of Pancreas: A Large Series from a Single Institution
Yunqiang Cai, Xun Ran, Siming Xie, Xin Wang, Bing Peng, Gang Mai, Xubao Liu
Journal of Gastrointestinal Surgery.2014; 18(5): 935. CrossRef
A case of solid-pseudopapillary neoplasm in a middle-aged male preoperatively diagnosed by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA)
Shin KATO, Takuya HONBU, Moriya ZAKIMI, Kenji CHINEN, Tomiaki KUBOTA, Masayuki ARASHIRO, Kaoru KIKUCHI, Takahiro MURAKAMI, Fumihito KUNISHIMA
Suizo.2014; 29(2): 263. CrossRef
Endoscopic ultrasound-guided fine needle aspiration improves the pre-operative diagnostic yield of solid-pseudopapillary neoplasm of the pancreas: an international multicenter case series (with video)
Joanna K. Law, Alina Stoita, Wallia Weaver, Ferga C. Gleeson, Andrew M. Dries, Amanda Blackford, Vandhana Kiswani, Eun Ji Shin, Mouen A. Khashab, Marcia Irene Canto, Vikesh K. Singh, Anne Marie Lennon
Surgical Endoscopy.2014; 28(9): 2592. CrossRef
Multiple Diagnostic Imaging of a Patient with Solid Pseudopapillary Tumour of the Pancreas: EUS, CT and FDG PET/CT
Ari Chong, Jung-Min Ha, Seong Young Kwon
Nuclear Medicine and Molecular Imaging.2014; 48(1): 82. CrossRef

Fine Needle Aspiration Cytology of Metastatic Prostatic Adenocarcinoma, Pseudohyperplastic Variant.: Youngmee Kwon, Won Seo Park, Geon Kook Lee, Eun Kyung Hong; Korean J Cytopathol. 2008;19(2):183-187.; DOI: https://doi.org/10.3338/kjc.2008.19.2.183

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Abstract PDF: Pseudohyperplastic prostatic adenocarcinoma is a rare histologic variant of prostatic adenocarcinoma that resembles benign nodular hyperplasia. Immunohistochemistry can verify the absence of basal cells, but it is frequently admixed with conventional adenocarcinoma. Because fine needle aspiration cytology is rarely performed in primary prostatic adenocarcinoma, the cytology of the pseudohyperplastic variant has not been described. We experienced a case of metastatic pseudohyperplastic adenocarcinoma in a pulmonary nodule of 75-year-old man. The cytologic smear was mostly composed of large, flat sheets with elongated branching papillae in a clean background. The sheets showed a well-defined honeycomb appearance of tall columnar, regularly arranged monotonous cells with little cytologic atypia. In subsequent prostatic biopsy, pseudohyperplastic variants were identified together with conventional adenocarcinoma of Gleason's grade 3 and 4. The cytologic features of pulmonary nodules were identical to those of pseudohyperplastic components of prostatic adenocarcinoma.

Original Articles

Clinicopathologic Significance of Lymph Node Micrometastasis in Advanced Gastric Carcinoma.: Youngmee Kwon, Jae Y Ro, Gyeong Hoon Kang; Korean J Pathol. 2000;34(2):125-131.

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Abstract PDF: There have been some controversies on prognostic significance of lymph node (LN) micrometastasis (MM) in advanced gastric carcinomas (AGCs). The present study aimed at 1) determination of prognostic significance of MM, 2) evaluation of the relationship between MM and clinicopathological parameters, and 3) determination of LN group where MMs were frequently found. We studied 70 cases of AGC without LN metastasis on initial examination. The tumors were examined for location, size, depth of invasion, differentiation, histologic type, lymphatic invasion, and c-erbB-2 expression. To evaluate MM, pancytokeratin immunohistochemistry was performed in all LNs from 70 cases of AGCs. Among 2,203 dissected LNs from 70 patients, 37 (1.6%) LNs from 19 (27.1%) patients revealed MM. Micrometastases were seen in only group 1 and 2 LNs: none had group 3 and 4 LN involvement. The gender, age, tumor size, location of tumor, histologic type, differentiation, depth of invasion, lymphatic invasion, and c-erbB-2 expression were not significantly associated with MM status. The survival time of the MM-positive group (mean: 62 months) was significantly shorter than that of the MM-negative group (mean: 72 months) (p=0.046). The findings of this study indicate that the presence of MM in LNs is an important prognostic factor in AGC patients.

An Imported Case of Intestinal Capillariasis Presenting as Protein-Losing Enteropathy.: Youngmee Kwon, Hwoon Yong Jung, Hyun Kwon Ha, Inchul Lee; Korean J Pathol. 2000;34(3):235-238.

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Abstract PDF: Intestinal capillariasis is caused by a small trichurid nematode, Capillaria philippinensis, which infects freshwater fish as intermediate hosts and subsequently fish eating birds as definitive hosts. It has occurred in areas such as the Philippines and Thailand where people eat raw fish. We report an imported case of intestinal capillariasis in a 31-year-old Korean man who lived in Saipan for ten years. He suffered from diarrhea with weight loss, abdominal distension, and pitting edema in the lower extremities for two years. He ate raw freshwater fish in the Saipan 2 years ago. The diagnosis was confirmed by jejunal biopsy. Flat mucosal surface without villi contained sections of numerous round worms with stichosome, larvae, and eggs which were identified as Capillaria philippinensis. The patient was successfully treated with albendazole.

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