Journal of Pathology and Translational Medicine

Volume 16(2); November 2005

Reviews

Cytologic Diagnosis of Basaloid Neoplasms of Salivary Gland.: Kyung Ja Cho; Korean J Cytopathol. 2005;16(2):67-74.

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Abstract PDF: Although fine needle aspiration cytology (FNAC) has become one of the primary tools for diagnosing salivary gland lesions, some of these methods continue to confuse pathologists. The most common problems occur so-called basaloid neoplasms. Basal cell adenomas are frequently misdiagnosed as pleomorphic adenomas, and in worse cases, as adenoid cystic carcinomas. The cytologic diagnostic accuracy of basaloid neoplasms could be increased by a better understanding of the histology and the nature of the tumor cells. These are displayed well in aspiration smears. A consideration of differential points on the basis of the epithelial-stromal relationship is offered in this paper.

Fine Needle Aspiration Cytology of High Grade Neoplasm and Spindle Cell Lesion of Salivary Gland.: Young Lyun Oh; Korean J Cytopathol. 2005;16(2):75-87.

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Abstract PDF: Fine needle aspiration cytology (FNAC) is a very useful tool in the preoperative diagnosis of lesions of the salivary gland. Surgical therapy of high-grade malignancies (salivary duct carcinoma, mucoepidermoid carcinoma, squamous cellcarcinoma, carcinoma ex pleomorphic adenoma, small cell carcinoma, and sebaceous carcinoma) is different from that of benign lesions or low-grade malignancies. Therefore, the recognition of high-grade malignancies is important in salivary gland FNAC. Although recognition of high-grade malignancies of the salivary gland by FNAC is not difficult, precise classification of these malignancies is often impossible. Additionally, because of its rarity, FNAC of spindle cells and mesenchymal lesions of the salivary glands is a tool that is not familiar to many cytopathologists. The characteristic cytomorphologic features of these lesions are reviewed here with a discussion of specific diagnostic problems.

Case Reports

Fine Needle Aspiration Cytology of Mucinous Cystic Carcinoma of the Pancreas: A Case Report.: Kyungji Lee, Ahwon Lee, Kyo Young Lee, Chang Suk Kang, Sang In Shim; Korean J Cytopathol. 2005;16(2):88-92.

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Abstract PDF: Mucious cystic neoplasm of pancreas is a cystic neoplasm composed of columnar, mucin-producing epithelium and is supported by ovarian-type stroma. The key to the cytologic evaluation of pancreatic cystic lesions is to recognize the cytologic components as being diagnostic of a mucin-producing cystic neoplasm, as all of these neoplasms need to be resected. We report the use of fine needle aspiration cytology in the diagnosis of an invasive mucinous cystic carcinoma confirmed by partial pancreatectomy. The cytologic specimen showed a abundant mucin background and sheets or papillae of neoplastic cells. There are mucin-containing columnar cells that show a variable degree of cytologic atypia.

Touch Imprint Cytology of Merkel Cell Carcinoma: A Case Report.: Suk Jin Choi, Lucia Kim, In Suh Park, Jee Young Han, Joon Mee Kim, Young Che Chu; Korean J Cytopathol. 2005;16(2):93-97.

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Fine Needle Aspiration Cytology of Eccrine Spiradenoma: Report of a Case.: Dong Ja KIM; Korean J Cytopathol. 2005;16(2):98-101.

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Abstract PDF: Eccrine spiradenoma is a rare adnexal tumor of the skin and its cytomorphology has seldom been described in literature. To evaluate the cytologic features and diagnostic pitfalls of eccrine spiradenoma, we report a case of 33-year-old male whose clinical presentation was a painful subcutaneous mass at the right preauricular area. Fine needle aspirates revealed tight clusters of multilayered, uniform, cuboidal cells arranged around hyalinized perivascular spaces. Some epithelial cells showed tubules or rosette formations. The background showed scattered, naked nuclei. The histologic findings confirmed the eccrine spiradenoma. The recognition of peculiar cytologic features and clinical correlation could be helpful in the diagnosis of skin adnexal tumors.

Fine Needle Aspiration Cytology of Chronic Sclerosing Sialadenitis with Mucinous Metaplasia in Parotid Gland: A Case Report.: Jae Yeon Seok, Woo Hee Jung, Xu Xiang Fan, Jin Kim, Soon Won Hong; Korean J Cytopathol. 2005;16(2):102-105.

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Abstract PDF: Chronic sclerosing sialadenitis, also known as Kuttner tumor, is a benign chronic inflammatory lesion of the salivary gland. Here, we describe a case of chronic sclerosing sialadenitis with mucinous ductal metaplasia in a parotid gland, which was confused with low-grade mucoepidermoid carcinoma on aspiration cytology.

Fine Needle Aspiration Cytology of the Warthin's Tumor Misinterpretated as Squamous Cell Carcinoma: A Case Report.: Kyungji Lee, Chan Kwon Jung, Ahwon Lee, Kyo Young Lee, Chang Suk Kang; Korean J Cytopathol. 2005;16(2):106-109.

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Abstract PDF: We report a case of Warthin's tumor of the parotid gland in a 53?year?old man, which is incorrectly diagnosed as squamous cell carcinoma. Fine needle aspiration cytology(FNAC) smear obtained from the right parotid gland revealed scattered epithelial cell clusters or nests in a diffuse inflammatory and necrotic background. Some epithelial cells had squamoid appearance showing variable sized bizarre shaped nuclei. They had abundant of dense eosinophilic keratinized cytoplasm. Occasionally, parakeratotic cells were also present. These cytologic findings with significant atypia and necrotic background made diagnosis as squamous cell carcinoma. But, the resection specimen from this patient showed classic Warthin's tumor in addition to abundant areas of inflammation and squamous metaplasia. Metaplastic or infarcted Warthin's tumor in the salivary gland may be confused with false positive diagnosis of malignancy on FNAC. Therefore, cytopathologist should have adequate awareness of potential of erroneous diagnosis in FNAC of Warthin's tumor.

Primary Leptomeningeal Glioblastomatosis Detected in Cerebrospinal Fluid Cytology: A Case Report.: Ki Seok Jang, Si Hyong Jang, Young Soo Song, Moon Hyang Park; Korean J Cytopathol. 2005;16(2):110-114.

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Abstract PDF: Primary leptomeningeal glioblastomatosis is a rare and fatal tumor of the central nervous system, the condition is characterized by diffuse infiltration of the tumor in the meninges without evidence of primary tumor within the brain or spinal cord. We reported an unusual case of leptomengial glioblastomatosis, which was detected by the consecutive cerebrospinal fluid (CSF) cytology with application of immunohistochemistry, in addition to its cytologic findings. A healthy 21 year old man, who was enlisted in the army, presented with a stuporous mental state and diffuse enhancement of meninges without evidence of primary mass lesion in the brain and spinal cord on magnetic resonance imaging(MRI). CSF cytology showed small loose clusters of tumor cells with single cells and lymphocytes. The tumor showed variable pleomorphism with coarse chromatin, irregular nuclear membranes and multi lobated nuclei. On immunohistochemical staining, the tumor cells were founded to be positive for GFAP. In conjunction with radiologic findings, brain biopsy confirmed the diagnosis of leptomenigeal glioblastomatosis. The use of immunohistochemistry is helpful in confirming CSF cytologic diagnosis in patients with primary leptomeningeal glioblastomatosis.

Etcs

Serum Antitrypsin Levels in Gastric Ulcer Patients and Gastric Cancer Patients: In Sun Jun, Man Ha Huh; Korean J Cytopathol. 1982;16(2):119-123.

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Abstract: Alpha1-antitrypsin(AAT) is an alpha-1-globulin with a molecular weight of approximately 54,100. This glycoprotein inhibits trypisn, elastase, collagenase and proteolytic enzymes from human leukocytes. Increased AAT levels have been found in patients who have various neoplastic diseases; however, association of the enzyme with adenocarcinoma of the stomach and chronic peptic ulcer of the stomach has been studied to a very limited extent. To determine if a significant association exists with peptic ulcer and stomach cancer, serum AAT levels were measured in 30 patients with peptic ulcer and 30 patients with stomach cancer, as well as in 40(20 males and 20 females) healthy adults as control. Authors determined the serum levels of AAT by single radial immunodiffusion method. The results obtained are as follows: 1) The mean value of serum AAT concentration of the normal Korean adult group(from 20 to 60 years old) is 227±42.3㎎/㎗ and no significant difference between males(229±47㎎/㎗) and females (225±36㎎/㎗) is observed(p>0.05). 2) The mean value of serum AAT concentration in total patients with peptic ulcer(320±108.7㎎/㎗) is slightly increased(p<0.05) and the mean value in patients with peptic ulcer with perforation is significantly increased(p<0.05), as much as twice compared with that of normal value. And the value in patients with peptic ulcer without perforation is not significantly increased(p>0.05). 3) The mean value of serum AAT concentration in total patients with stomach cancer (405±122.4㎎/㎗) is significantly increased(p<0.05), as much as 1.8 times compared with that of normal value, but no significant difference between stomach cancer with metastasis and stomach cancer without metastasis is observed(p>0.05).

An Observation on the Leukocyte Transfusion: Kyung Won Lee, Oh Hun Kwon, Kyung Soon Song, Samuel Y. Lee, Yun Woong Ko*; Korean J Cytopathol. 1982;16(2):124-136.

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Abstract: Though the use of appropriate antibiotics in granulocytopenic patients, the mortality from infection is high. Therefore, an analysis of the clinical effects of leukocyte transfusions was made on granulocytopenic patients at Yonsei University Medical Center from September 1980 to October 1981. Following results were obtained; 1) As a result of 113 leukapheresis on 100 donors, they showed 7% decrease of Hot by alternative bag method and 6.4% by simple bag method. There was no significant difference between these two methods(p>0.1). In both methods, they showed a considerable increase of WBC counts after leukapheresis. 2) Out of 120 times of leukapheresis on 105 donors, there developed a transient paresthesia and chill on 19 occasions(15.8%) as the major complications, but no further serious problems were observed. As to these complications, there was no significant difference between forementioned two methods(p>0.05). 3) In alternative bag method, 1.374×10 Leukocytes were yielded, among which 70.3% were granulocytes. In simple bag method, 0.957×10 leukocytes were yielded, among which granulocytes were 55.3%. As to the granulocytes yields, the former method was definitely superior than the latter method((p<0.05). 4) The average body temperature of pre-transfusion in 29 patients was 38.1±1.0℃, which was reduced to 37.7±0.9℃ after the transfusion. The difference was statistically significant(p<0.01). The average circulating granulocyte counts of pre-transfusion was 215.8±257.3/㎕, which was elevated to 346.4±374.4/㎕ after 30 leukocyte transfusions in 17 patients. But the difference was statistically insignificant(p>0.05), an actual increments of circulating granulocyte was achieved in 19 occasions (63.3%). Throughout the experiment, 21 patients survived and 14 died. 5) Among the infectious organisms in granulocytopenic patients, the most common one was E. coli(6 cases), and the most common type of infection was septicemia(9 cases). 6) Following the transfusions, some of the patients developed alloimmunizations. Namely, out of 11 patients 5 were positive in lymphocytotoxicity test and the rest negative. Between these two group, there was no difference in clinical pictures.

Hemostatic Abnormalities in Patients with Chronic Liver Diseases: Myung Hee Lee; Korean J Cytopathol. 1982;16(2):137-144.

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Abstract: Five coagulation tests were performed in 79 randomly selected patients with chronic liver disease to evaluate the overall incidence and types of hemostatic abnormalities. The results were as follows: 1) Majority of the patients(89%) showed one or more abnormal coagulation tests. Most common abnormality was prolonged prothrombin time(80%) followed by decreased platet count(71%), decreased antithrombin III level(66%), hypofibrinogenemia(52%) and porlonged thrombin time(32%) in decreasing order of frequency. 2) The level of antithrombin III(54.0±28.8%), fibrinogen(207.2±145.4㎎/㎗), and platelets(11.9±10.6×104/㎣) were significantly decreased and prothrombin time(18.4±3.2 sec) was significantly prolonged compared to those of normal control. 3) Albumin level was significantly correlated to antithrombin III, fibrinogen, and prothrombin time. Among the coagulation tests, prothrombin time and antithrombin III level seemed to reflect hepatic synthetic function. 4) Frequency of abnormally prolonged prothrombin time was much higher with Behring Thromborel reagent compared to Dade thromboplastin C reagent.

A Study on Diagnostic Significance of Plasma CEA in Various Carcinomas and Non-neoplastic Diseases: Chae Won Lee, Sun Kyung Lee; Korean J Cytopathol. 1982;16(2):145-156.

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Abstract: This study was performed in order to clarify the diagnostic significance of plasma CEA level in various carcinomas and non-neoplastic diseases. The material used were 184 cases of the patients with carcinomas and 148 cases of the patients with non-neoplastic diseases. The patients were valued the plasma CEA level when the surgical specimens were submitted for evaluation of pathological diagnosis to our department of pathology, from Feb. 1979 to Jan. 1981. The frequencies of abnormal elevation of plasma CEA level were compared statistically with each other. The results obtained were summarized as follows: 1) In the non-neoplastic diseases, the rate of abnormal elevation of plasma CEA level of the patients with liver cirrhosis was 44%, the patients with inflammatory disease of hepatobiliary system 26.9%, patient with inflammatory diseases of G-I tract 18.9%, and the patients with inflammatory diseases of other organs 20.0%, respectively. The rate of abnormal elevation of plasma CEA level of the patients with liver cirrhosis was significantly higher than that of various systems. 2) In the carcinomas, the rate of abnormal elevation of plasma CEA level of the patients with colorectal carcinoma was 34.6%, the patients with stomach carcinoma 39.3%, the patient with primary carcinoma of liver 57.5%, the patient with pulmonary carcinoma 40.0%, and the patients with pancreatic carcinoma 41.0% respectively. In the rate of abnormal elevation of plasma CEA level, there was no distinct difference among the cases of carcinomas. 3) The average rate of abnormal elevation of plasma CEA level, there was no distinct difference among the cases of carcinomas. 3) The average rate abnormal elevation of plasma CEA level in the patients with carcinomas was 42.9%, the patients with liver cirrhosis 44.0%, and the patients with inflammatory diseases 21.4%, respectively. The rate of abnormal elevation of plasms CEA level of the patients with carcinomas or liver cirrhosis was higher than that of the patients with inflammatory diseases. 4) The rate of abnormal elevation of plasma CEA level in patients observed were increased with age, but not differ by sex. On the basis of the above findings, it was suggested that plasma CEA is not specific in certain carcinoma and that it may have some significance to differentiate carcinomas and inflammatory diseases.

A Study on Serum Enzyme Activities in HBsAg Positive and HBsAg Negative Liver Diseases: Jung Man Kim, Eun Yup Lee, Soon Ho Kim; Korean J Cytopathol. 1982;16(2):157-164.

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Abstract: The authors investigated the activities of some serum enzymes in 66 cases of patients with HBsAg positive liver diseases and in 52 cases of patients with HBsAg negative ones and 25 cases of adult healthy controls. The patients with HBsAg positive liver diseases were consisted of 14 cases of acute hepatitis, 8 cases of chronic hepatitis, 29 cases of liver cirrhosis and 15 cases of hepatocellular carcinoma. And the patients with HBsAg negative liver diseases comprised 9 cases of acute hepatitis, 11 cases of chronic hepatitis, 20 cases of liver cirrhosis and 12 cases of hepatocellular carcinoma. Diagnosis was confirmed clinically and pathologically in all the patients. Serum HBsAg was detected by reverse passive hemagglutination test. Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) activities were measured by Reitman-Frankel method. And serum alkaline phosphatase (AP) activity was estimated by Kind-King method and serum gamma-glutamyl transpeptidase (r-GTP) activity by Orlowski method. The results obtained were summarized as follows: 1) The activities of serum AST and ALT were significantly higher in HBsAg positive liver cirrhosis than those in HBsAg negative one. 2) The activity of serum r-GTP was significantly higher in HBsAg positive chronic hepatitis and liver cirrhosis than that in HBsAg negative ones. 3) In HBsAg positive liver cirrhosis, a significant positive correlation was found between AST and AP activity and between ALT and AP activity, in HBsAg negative acute hepatitis between ALT and AP activity and in HBsAg positive hepatocellular carcinoma between AP and r-GPT activity, respectively. 4) In the HBsAg positive chronic hepatitis, a significant negative correlation was also observed between serum ALT and r-GTP activity On the basis of the results mentioned above, it is suggested that estimation of some serum enzyme activities may be somewhat helpful for differentiation between HBsAg positive and HBsAg negative liver diseases.

The Relation between Serum Proteins and Lactic Dehydrogenase Isoenzyme Activity in Liver Diseases: Woo Young Suh, Eun Yup Lee, Soon Ho Kim; Korean J Cytopathol. 1982;16(2):165-172.

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Abstract: The author investigated the relation between serum protein fraction and lactic dehydrogenase (LD) isoenzyme activity in 28 cases of patients with various liver diseases who had visited or admitted to the Department of Internal Medicine, Busan National University Hospital and 34 cases of adult healthy control subjects from June, 1978 to July, 1979. The 28 cases of the liver disease were consisted of 8 cases of chronic hepatitis, 9 cases of liver cirrhosis and 11 cases of hepatocellular carcinoma. Total serum protein was measured by Biuret method and total serum LD activity was estimated by Caboud-Wr?blewski method. Serum protein fraction and LD isoenzyme activity were analyzed by cellulose acetate electrophoresis. The results obtained were summarized as follow 1) In the healthy control, there was no significant correlation between serum protein fractions and LD isoenzyme activities 2) In the chronic hepatitis, there was negative correlation between serum albumin and LD5 activity 3) In the liver cirrhosis, there was positive correlation between serum globulin and LD5 activity 4) In the hepatocellular carcinoma, there was negative correlation between LD5 activity and a1-, a2- and β-globulin, and also positive correlation between serum γ-globulin and LD4 & LD5 activity On the basis of above results, it was suggested that in differential diagnosis and evaluating clinical course and the effect of treatment of various liver diseases, evaluating the relation between serum protein fractions and LD isoenzyme activity might be more significant than that of each one of both separately.

Evaluation of Lipid Screening Methods for Hyperlipoproteinemia: Sook Joe Hur, Young Hoe Moon; Korean J Cytopathol. 1982;16(2):173-179.

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Abstract: Combination of rapid and reliable methods for the recognition of most common types of hyperlipoproteinemia according to D.S. Fredeickson seen in routine clinical laboratory are described. 4 Determination include for this kind of phenotyiping, determination of cholesterol, triglycerides, total lipids and an electrophoretic analysis of lipoprotein use agarose-gel as a medium with good differentiation obtained.

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