Journal of Pathology and Translational Medicine

Review

Trouble-makers in cytologic interpretation of the uterine cervix: Eunah Shin, Jaeeun Yu, Soon Won Hong; J Pathol Transl Med. 2023;57(3):139-146. Published online May 15, 2023; DOI: https://doi.org/10.4132/jptm.2023.04.25

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The development and standardization of cytologic screening of the uterine cervix has dramatically decreased the prevalence of squamous cell carcinoma of the uterine cervix. Advances in the understanding of biology of human papillomavirus have contributed to upgrading the histologic diagnosis of the uterine cervix; however, cytologic screening that should triage those that need further management still poses several difficulties in interpretation. Cytologic features of high grade intraepithelial squamous lesion (HSIL) mimics including atrophy, immature metaplasia, and transitional metaplasia, and glandular lesion masquerades including tubal metaplasia and HSIL with glandular involvement are described with accentuation mainly on the differential points. When the cytologic features lie in a gray zone between the differentials, the most important key to the more accurate interpretation is sticking to the very basics of cytology; screening the background and cellular architecture, and then scrutinizing the nuclear and cytoplasmic details.

Citations

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Cytological features of human papillomavirus‐infected immature squamous metaplastic cells from cervical intraepithelial neoplasia grade 2
Mitsuaki Okodo, Kaori Okayama, Koji Teruya, Ruku Shinohara, Shuichi Mizuno, Rei Settsu, Yasuyoshi Ishii, Masahiko Fujii, Hirokazu Kimura, Mizue Oda
Journal of Medical Virology.2023;[Epub] CrossRef

Brief Case Report

A Ciliated Cyst with Müllerian Differentiation Arising in the Posterior Mediastinum: So Jung Lee, Chung Su Hwang, Do Youn Park, Gi Young Huh, Chang Hun Lee; Korean J Pathol. 2014;48(5):401-404. Published online October 27, 2014; DOI: https://doi.org/10.4132/KoreanJPathol.2014.48.5.401

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A large retroperitoneal Mullerian cyst: case report and review of the literature
Elena Parmentier, Jody Valk, Paul Willemsen, Caroline Mattelaer
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M. Kawaguchi, H. Kato, A. Hara, N. Suzui, H. Tomita, T. Miyazaki, H. Iwata, M. Matsuo
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A case of Mullerian cyst arising in the posterior mediastinum
Masahiro Adachi, Isao Sano, Shintaro Hashimoto, Ryoichiro Doi, Hideki Taniguchi, Kazuto Shigematsu
The Journal of the Japanese Association for Chest Surgery.2018; 32(6): 713. CrossRef
Two resected cases of Mullerian cyst in the posterior mediastinum
Shotaro Hashimoto, Masato Hisano, Masato Morimoto
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Posterior mediastinal Müllerian cyst: a rare cause of pain in a young woman
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Original Articles

The Utility of p16INK4a and Ki-67 as a Conjunctive Tool in Uterine Cervical Lesions: Sangho Lee, Hyunchul Kim, Hyesun Kim, Chulhwan Kim, Insun Kim; Korean J Pathol. 2012;46(3):253-260. Published online June 22, 2012; DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.3.253

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Abstract PDF

Background

Immunohistochemical staining for p16INK4a and Ki-67 has been used to improve the accuracy in making a diagnosis of the uterine cervix cancer on biopsy. This study was conducted to examine the usefulness of these markers in the pathological diagnosis based on cervical biopsy.

Methods

We selected a consecutive series of 111 colposcopically directed cervical punch biopsies. Using these biopsy samples, we performed an immunohistochemical staining for p16INK4a and Ki-67 to establish a diagnosis. The slides were circulated among four pathologists in a sequential order: the hematoxylin and eosin (H&E) slide, H&E slide and p16INK4a-stained slide, and H&E slide, p16INK4a- and Ki-67-stained slides.

Results

The overall rates of the concordance in the first, the second, and the third diagnoses were 77.5%, 82.0%, and 82.0%, respectively. The rate of the concordance in the diagnosis of cervical intraepithelial neoplasm (CIN) 2/3 was increased from 62.2% to 73.0%. But there was a variability in the rate of the revision of the diagnosis between the pathologists. With the application of criteria for interpreting the expressions of p16INK4a and Ki-67, benign and CIN 1 lesions showed a p16INK4a expression score of 0 or 1. But CIN 2 and CIN 3 lesions showed a p16INK4a expression score of 2 and 3, respectively.

Conclusions

The immunostain for p16INK4a and Ki-67 might be useful in reducing an inter-observer variability. But criteria for interpreting both markers should be strictly applied.

Citations

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Possible role of negative human papillomavirus E6/E7 mRNA as a predictor of regression of cervical intraepithelial neoplasia 2 lesions in hr-HPV positive women
Maria Teresa Bruno, Nazario Cassaro, Salvatore Giovanni Vitale, Arianna Guaita, Sara Boemi
Virology Journal.2022;[Epub] CrossRef
Evaluation of p16, human papillomavirus capsid protein L1 and Ki-67 in cervical intraepithelial lesions: Potential utility in diagnosis and prognosis
Hanan AlSaeid Alshenawy
Pathology - Research and Practice.2014; 210(12): 916. CrossRef
Distribution of Human Papillomavirus 52 and 58 Genotypes, and Their Expression of p16 and p53 in Cervical Neoplasia
Tae Eun Kim, Hwal Woong Kim, Kyung Eun Lee
Korean Journal of Pathology.2014; 48(1): 24. CrossRef
Detection and pathological value of papillomavirus DNA and p16INK4A and p53 protein expression in cervical intraepithelial neoplasia
JINGBO WU, XIAO-JING LI, WEI ZHU, XIU-PING LIU
Oncology Letters.2014; 7(3): 738. CrossRef
p16INK4a Immunohistochemistry in Cervical Biopsy Specimens
Miriam Reuschenbach, Nicolas Wentzensen, Maaike G. Dijkstra, Magnus von Knebel Doeberitz, Marc Arbyn
American Journal of Clinical Pathology.2014; 142(6): 767. CrossRef

Composite Tumor of Adenocarcinoma and Small Cell Neuroendocrine Carcinoma of the Uterine Cervix: A Case Report.: Hye Rim Park, Yong Woo Lee, Young Euy Park; Korean J Cytopathol. 1990;1(1):111-120.

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Abstract PDF: Small cell neuroendocrine carcinoma of the uterine cervix is a distinct subtype of cervical cancer that appears analogous to oat cell carcinoma and carcinoid tumors of the lung. It has been assumed to be derived from the neural crest via argyrophilic cells in the normal endocervix. We have recently encountered a case of small cell neuroendocrine carcinoma of the uterine cervix coexisting with adenocarcinoma which was argyrophil negative. A 66-year-old multiparous woman was admitted because of vaginal bleeding for 2 months. Cervicovaginal smear revealed several scattered clusters and sheets of monotonous small cells with some peripheral palisading in the background of hemorrhage and necrosis. Radical hysterectomy specimen revealed and ulcerofungating tumor on endocervical canal which was composed of two components. Major component of the tumor was made up of monomorphic population of small oval-shaped tumor cells arranged in sheets and partly in acinar structeres or trabecular fashion. Other component was adenocarcinoma, endocervical well-differentiated type. Argyropilia was present on the Grimelius stain and immunohistochemical studies revealed diffuse positivity to neuron-specific enolase and carcinoembryonic antigen. Electron microscopic examination showed clusters of small round to oval cells, which had a few well-formed desmosomes and several membrane-bound, dense-core neurosectetory granules.

Prevalence and Genotype Distribution of Cervical Human Papillomavirus DNA in Korean Women: A Multicenter Study.: Sung Ran Hong, In Sun Kim, Dong Won Kim, Mi Jin Kim, Ae Ree Kim, Young Ok Kim, Hye Sun Kim, Seo Hee Rha, Gyeong Sin Park, Yong Koo Park, Yong Wook Park, Ho Sung Park, Kwang Sun Suh, Jin Hee Sohn, Mi Kyung Shin, Hoon Kyu Oh, Ki Jung Yun, Hye Kyoung Yoon, Shi Nae Lee, Ah Won Lee, Hyo Jin Lee, Hyun Yee Cho, Chan Choi, Woon Won Jung; Korean J Pathol. 2009;43(4):342-350.; DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.4.342

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Abstract PDF

Background
DNA prevalence and type distribution of human papillomavirus (HPV) varies geographically. We investigated HPV prevalence and type distribution in Korean women using the MyHPV DNA chip testing. Methods: A total of 2,368 women from five regions of the country underwent Pap smear examination and MyHPV chip testing. Results: Overall HPV positivity was 15.8% and 78.4% in women with normal and abnormal cytology, respectively. High-risk HPV infection was strongly correlated with cytological atypia. In women with abnormal cytology, the five most common HPV types were 16, 58, 18, 52, and 56/53, and HPV16 was significantly the most common type in most geographical regions. After HPV16, HPV58, and 52 were the next most frequently detected types. Women with normal cytology, in contrast, showed heterogeneity in HPV type distribution. High-grade intraepithelial lesions infected with HPV16, 18, 31 or 45 are more likely to progress to carcinoma. Conclusions: The HPV chip test can provide useful data regarding HPV positivity and type. The most common HPV type in Korean women with abnormal cytology is HPV16, with HPV58 and 52 being frequently present. Our data may have important implications for vaccination programs and the development of cervical screening.

Citations

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HPV genotyping by L1 amplicon sequencing of archived invasive cervical cancer samples: a pilot study
Charles D. Warden, Preetam Cholli, Hanjun Qin, Chao Guo, Yafan Wang, Chetan Kancharla, Angelique M. Russell, Sylvana Salvatierra, Lorraine Z. Mutsvunguma, Kerin K. Higa, Xiwei Wu, Sharon Wilczynski, Raju Pillai, Javier Gordon Ogembo
Infectious Agents and Cancer.2022;[Epub] CrossRef
Enhanced disease progression due to persistent HPV-16/58 infections in Korean women: a systematic review and the Korea HPV cohort study
Jaehyun Seong, Sangmi Ryou, JeongGyu Lee, Myeongsu Yoo, Sooyoung Hur, Byeong-Sun Choi
Virology Journal.2021;[Epub] CrossRef
Comparison of FFPE histological versus LBP cytological samples for HPV detection and typing in cervical cancer
Geehyuk Kim, Hyemi Cho, Dongsup Lee, Sunyoung Park, Jiyoung Lee, Hye-young Wang, Sunghyun Kim, Kwang Hwa Park, Hyeyoung Lee
Experimental and Molecular Pathology.2017; 102(2): 321. CrossRef
Distribution of Oncogenic Human Papillomavirus Genotypes at High Grade Cervical Lesions above CIN 2 Grade with Histological Diagnosis
Geehyuk Kim, Sungyoung Park, Hye-young Wang, Sunghyun Kim, Sangjung Park, Kwangmin Yu, Boohyung Lee, Seung-Ju Ahn, Eun-Joong Kim, Dongsup Lee
Biomedical Science Letters.2016; 22(2): 37. CrossRef
Human Papillomavirus Prevalence and Genotype Distribution in Normal and ASCUS Specimens: Comparison of a Reverse Blot Hybridization Assay with a DNA Chip Test
Sunghyun Kim, In-soo Lee, Dongsup Lee
Biomedical Science Letters.2015; 21(1): 32. CrossRef
Genotype Analysis of Human Papilloma Virus Infection in Accordance with Cytological Diagnoses
Mi-Suk Park, Hyun-Wook Cho, Jin-Gak Kim, Nan-Young Bae, Dong-Sun Oh, Ho-Hyun Park
Korean Journal of Clinical Laboratory Science.2015; 47(1): 39. CrossRef
Comparison of the Cobas 4800 HPV and HPV 9G DNA Chip Tests for Detection of High-Risk Human Papillomavirus in Cervical Specimens of Women with Consecutive Positive HPV Tests But Negative Pap Smears
Sun-Young Jun, Eun Su Park, Jiyoung Kim, Jun Kang, Jae Jun Lee, Yoonjin Bae, Sang-Il Kim, Lee-So Maeng, Magdalena Grce
PLOS ONE.2015; 10(10): e0140336. CrossRef
Uncommon and Rare Human Papillomavirus Genotypes Relating to Cervical Carcinomas
Na Rae Kim, Myunghee Kang, Soon Pyo Lee, Hyunchul Kim, Jungsuk An, Dong Hae Chung, Seung Yeon Ha, Hyun Yee Cho
Korean Journal of Pathology.2014; 48(1): 43. CrossRef
Evaluation of Human Papillomavirus Genotyping from Formalin-fixed Paraffin-embedded Specimens in Cervical Cancers
Hyunwoo Jin
Journal of Life Science.2014; 24(9): 1025. CrossRef
Comparative Evaluation of the HPV28 Detection and HPV DNA Chip Test for Detecting and Genotyping Human Papillomaviruses
Eunsim Shin, Heojin Bae, Wan-Keun Song, Sun-Kyung Jung, Yoo-Sung Hwang
Laboratory Medicine Online.2013; 3(4): 234. CrossRef
Significance of HPV-58 Infection in Women Who Are HPV-Positive, Cytology-Negative and Living in a Country with a High Prevalence of HPV-58 Infection
Joon Seon Song, Eun Ju Kim, Jene Choi, Gyungyub Gong, Chang Ohk Sung, Robert D. Burk
PLoS ONE.2013; 8(3): e58678. CrossRef
REBA HPV‐ID® for efficient genotyping of human papillomavirus in clinical samples from Korean patients
Sunghyun Kim, Dongsup Lee, Sangjung Park, Tae Ue Kim, Bo‐Young Jeon, Kwang Hwa Park, Hyeyoung Lee
Journal of Medical Virology.2012; 84(8): 1248. CrossRef
Dynamin 2 expression as a biomarker in grading of cervical intraepithelial neoplasia
Yoo-Young Lee, Sang Yong Song, In-Gu Do, Tae-Joong Kim, Byoung-Gie Kim, Jeong-Won Lee, Duk-Soo Bae
European Journal of Obstetrics & Gynecology and Reproductive Biology.2012; 164(2): 180. CrossRef
Cytomorphologic Features According to HPV DNA Type in Histologically Proven Cases of the Uterine Cervix
In Ho Choi, So-Young Jin, Dong Wha Lee, Dong Won Kim, Yoon Mi Jeen
The Korean Journal of Pathology.2011; 45(6): 612. CrossRef
Human Papillomavirus Prevalence in Gangwon Province Using Reverse Blot Hybridization Assay
Dongsup Lee, Sunghyun Kim, Sangjung Park, Hyunwoo Jin, Tae Ue Kim, Kwang Hwa Park, Hyeyoung Lee
The Korean Journal of Pathology.2011; 45(4): 348. CrossRef
Pediatric vulvar squamous cell carcinoma in a liver transplantation recipient: a case report
Na-Rae Kim, Soyi Lim, Hyun Yee Cho
Journal of Gynecologic Oncology.2011; 22(3): 207. CrossRef

Analysis of HPV-other Samples by Performing HPV DNA Sequencing.: Yoo Duk Choi, Chang Woo Han, Woon Jae Chung, Woon Won Jung, Ji Shin Lee, Jong Hee Nam, Min Cheol Lee, Sang Woo Juhng, Ho Sun Choi, Chang Soo Park; Korean J Pathol. 2009;43(3):250-253.; DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.3.250

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Abstract PDF

BACKGROUND
HPV-other samples are designated as being positive on HPV-PCR, but negative when using specific HPV hybridization probes. We wanted to determine the types on the HPV-other samples by performing sequencing, and to know the pathologic status of the uterine cervix according to the HPV type detected on sequencing.
METHODS
For HPV genotying, we used the commercially available HPV DNA Chip test, which contains 15 types of high-risk HPV and 9 types of low-risk HPV. The HPV DNA sequencing was performed for the HPV-other samples of 209 patients who subsequently underwent cervical biopsy.
RESULTS
For 204 of the 209 samples, the HPV types detected by sequencing were absent types at used HPV DNA chip. For the remaining 5 samples, sequencing was impossible due to mixed peaks. HPV-81 (19.6%), HPV-61 (18.6%), HPV-62 (16.7%) and HPV-84 (13.9%) were frequently detected. For the HPV-81, -62, -71, and -72 samples, most of the samples displayed normal or LSIL. However, HPV-84 and -61 were more associated with HSIL or worse, as compared to the other types.
Conclusion
HPV-81, -61, -62 and -84 were frequently found on sequencing analysis of the HPV-other samples. The pathologic status was diverse, according to the HPV type detected on sequencing.

Citations

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Changes in microbial composition and interaction patterns of female urogenital tract and rectum in response to HPV infection
Yong-Hong Dong, Yu-Hua Luo, Chen-Jian Liu, Wen-Yu Huang, Lin Feng, Xing-Yuan Zou, Jin-Yan Zhou, Xiao-Ran Li
Journal of Translational Medicine.2024;[Epub] CrossRef
Cervical Dysplasia, Infection, and Phylogeny of Human Papillomavirus in HIV-Infected and HIV-Uninfected Women at a Reproductive Health Clinic in Nairobi, Kenya
Agnes Omire, Nancy L. M. Budambula, Leah Kirumbi, Hillary Langat, Danvas Kerosi, Washingtone Ochieng, Raphael Lwembe
BioMed Research International.2020; 2020: 1. CrossRef
Molecular characterisation of genital human papillomavirus among women in Southwestern, Nigeria
Yewande T. Nejo, David O. Olaleye, Georgina N. Odaibo, Jason Blackard
PLOS ONE.2019; 14(11): e0224748. CrossRef
Sequencing analysis of HPV-other type on an HPV DNA chip
Min-Jeong Kim, Jin Ju Kim, Sunmie Kim
Obstetrics & Gynecology Science.2018; 61(2): 235. CrossRef
Molecular epidemiology and genotype distribution of Human Papillomavirus (HPV) among Arab women in the state of Qatar
Devendra Bansal, Asha A Elmi, Sini Skariah, Pascale Haddad, Laith J Abu-Raddad, Aysha H Al Hamadi, Nady Mohamed-Nady, Nahla M Affifi, Randa Ghedira, Elham Hassen, Asma AJ Al-Thani, Afaf AHM Al-Ansari, Ali A Sultan
Journal of Translational Medicine.2014;[Epub] CrossRef
HPV Prevalence and Detection of Rare HPV Genotypes in Hong Kong Women from Southern China with Cytological Abnormalities
Ngai Na Chloe Co, Lai-On Chu, Joseph K. F. Chow, Joseph W. O. Tam, Enders K. O. Ng
ISRN Virology.2013; 2013: 1. CrossRef
Type-specific prevalence of high-risk human papillomavirus by cervical cytology and age: Data from the health check-ups of 7,014 Korean women
Min-Jeong Kim, Jin Ju Kim, Sunmie Kim
Obstetrics & Gynecology Science.2013; 56(2): 110. CrossRef

Case Report

Cytologic Findings of Malakoplakia of the Uterine Cervix and the Vagina: A Case Report.: Yi Kyeong Chun, Sung Ran Hong, Hye Sun Kim, Ji Young Kim, Bok Man Kim, Hy Sook Kim; Korean J Cytopathol. 2008;19(2):164-167.; DOI: https://doi.org/10.3338/kjc.2008.19.2.164

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Abstract PDF: Malakoplakia is an uncommon chronic granulomatous inflammation that usually involves the urinary and gastrointestinal tracts, but rarely affects the female genital tract. We experienced a case of malakoplakia in a cervicovaginal smear in a 54-year-old woman. Colposcopic examination showed a friable, easily bleeding tissue in the uterine cervix and the vaginal fornix. The cervicovaginal smear consisted of numerous isolated histiocytes, polymorphonuclear leukocytes, lymphocytes, and plasma cells. The histiocytes had an abundant, granular, and degenerated cytoplasm with inflammatory cell debris. Michaelis-Gutmann bodies were readily identified.

Original Article

Diagnostic Accuracy of Cervicovaginal Cytology in the Detection of Squamous Epithelial Lesions of the Uterine Cervix; Cytologic/Histologic Correlation of 481 Cases.: So Young Jin, Sang Mo Park, Mee Sun Kim, Yoon Mi Jeen, Dong Won Kim, Dong Wha Lee; Korean J Cytopathol. 2008;19(2):111-118.; DOI: https://doi.org/10.3338/kjc.2008.19.2.111

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Abstract PDF

BACKGROUND
Cervicovaginal cytology is a screening test of uterine cervical cancer. The sensitivity of cervicovaginal cytology is less than 50%, but studies of cytologic/histologic correlation are limited. We analyzed the diagnostic accuracy of cervicovaginal cytology in the detection of the squamous epithelial lesions of the uterine cervix and investigate the cause of diagnostic discordance. MATERIALS AND METHODS: We collected a total of 481 sets of cervicovaginal cytology and biopsies over 5 years. The cytologic diagnoses were categorized based on The Bethesda System and the histologic diagnoses were classified as negative, flat condyloma, cervical intraepithelial neoplasia (CIN) I, CIN II, CIN III, or squamous cell carcinoma. Cytohistologic discrepancies were reviewed.
RESULTS
The concordance rate between the cytological and the histological diagnosis was 79.0%. The sensitivity and specificity of cervicovaginal cytology were 80.6% and 92.6%, respectively. Its positive predictive value and negative predictive value were 93.7% and 77.7%, respectively. The false negative rate was 19.4%. Among 54 false negative cytology cases, they were confirmed by histology as 50 flat condylomas, 2 CIN I, 1 CIN III, and 1 squamous cell carcinoma. The causes of false negative cytology were sampling errors in 75.6% and interpretation errors in 24.4%. The false positive rate was 7.4%. Among 15 false positive cytology cases, they were confirmed by histology as 12 atypical squamous cells of undetermined significance (ASCUS) and 3 low grade squamous intraepithelial lesions (LSIL). The cause of error was interpretation error in all cases. The overall diagnostic accuracy of cervicovaginal cytology was 85.7%.
CONCLUSIONS
Cervicovaginal cytology shows high overall diagnostic accuracy and is a useful primary screen of uterine cervical cancer.

Citations

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Overall accuracy of cervical cytology and clinicopathological significance of LSIL cells in ASC‐H cytology
S. H. Kim, J. M. Lee, H. G. Yun, U. S. Park, S. U. Hwang, J.‐S. Pyo, J. H. Sohn
Cytopathology.2017; 28(1): 16. CrossRef
Correlation Analysis Between Cervicovaginal Cytologic and Histopathologic Diagnoses in Cervical Squamous Cell Neoplasm
Kyoung Bun Lee, Woon Sun Park, Jin Hee Sohn, Min Kyung Kim, Dong Hoon Kim, Hee Sung Kim, Seoung Wan Chae, Sung Hee Kang, Young Hye Cho, Hee Dae Pak, Sun Hee Kim
The Korean Journal of Pathology.2009; 43(2): 157. CrossRef

Case Report

Adenoid Basal Carcinoma Associated with Invasive Squamous Cell Carcinoma of Uterine Cervix: A case report.: Hyun Jung Kim, Dong Won Kim, So Young Jin, Dong Wha Lee; Korean J Pathol. 1996;30(8):739-741.

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Abstract PDF: Adenoid basal carcinoma of the uterine cervix is a rare neoplasm that accounts for less than 1% of cervical adenocarcinomas. Though it has been confused with adenoid cystic carcinoma, it is now distinctly recognized by better prognosis and different histologic and immunohistochemical findings. We have experienced a case of adenoid basal carcinoma associated with invasive squamous cell carcinoma of the uterine cervix in a 52-year-old woman. The tumor was composed of small, round to oval nests of basaloid cells with peripheral palisading. Some of the nests showed central cystic spaces, or cribriform pattern, and central squamous differentiation with cytological atypia. Invasive squamous cell carcinoma was located adjacent to the adenoid basal carcinoma without any transition between these two lesions. Immunohistochemically, the tumor cells disclosed positive staining for cytokeratin, but negative reaction for CEA, EMA, and S-100 protein.

Original Articles

Endocervical Glandular Lesions in Invasive and Intraepithelial Squamous Neoplasms of the Uterine Cervix.: Hye Kyoung Yoon, Mi Sun Kang, Young Ju Kim; Korean J Pathol. 1996;30(10):912-919.

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Abstract PDF: The incidence of adenocarcinoma of the uterine cervix had shown an increasing tendency, and which is related to the increased use of oral contraceptives or prevalent in human papillomavirus infection. Endocervical glandular dysplasia or adenocarcinoma in situ are occasionally associated with squamous neoplasms of the uterine cervix. This study was aimed to evaluate the histologic features and the incidence of endocervical glandular lesions associated with squamous neoplasms, the presence of human papillomavirus infection-suggesting histologic findings in adjacent squamous neoplasms and the immmunohistochemical findings of endocervical glandular lesions for carcinoembryonic antigen. The materials used were 105 cases of microinvasive and invasive squamous cell carcinoma, and 83 cases of squamous intraepithelial lesions which are consisted of 142 radical or total hystrectomy products and 46 conization or loop excision products. The results are as follows; 1. Among 188 cases, six cases(3.2%) had shown foci of high grade glandular dyaplasia, and 19 cases(10.1%) revealed the areas of low grade glandular dysplasia. There was no adenocarcinoma in situ case. 2. In four of six high grade glandular dysplasia cases, microinvasive or invasive squamous cell carcinomas were associated. In low grade glandular dysplasias, sqaumous intraepithelial lesions were occcupying 68.4%. 3. HPV infection-suggesting histologic findings had accompanied all high grade glandular dysplasia cases and in 17 cases(89.5%) of 19 low grade glandular dysplasias. 4. In 2 of 5 high grade glandular dysplasias and in 1 of 19 low grade glandular dysplasias, the immunohistochemical reaction for carcinoembryonic antigen was similar to that of adenocarcinoma. In conclusion, the clinicopathologic importance of endocervical glandular lesions associated with squamous neoplasms of the uterine cervix should be kept in mind, and further study for the relationship between endocervical glandular lesions and human papillomavirus infection or hormonal influence will be continued.

Alveolar Soft Part Sarcoma of the Uterine Cervix: A case report.: Ghee Young Kwon, Yeon Lim Suh; Korean J Pathol. 1996;30(10):933-938.

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Abstract PDF: We report a case of alveolar soft part sarcoma(ASPS) of the uterine cervix in a 57-year-old female. She was presented with vaginal bleeding and underwent total hysterectomy. A 1.1cm-sized, polypoid mass was found at the uterine cervix. Microscopically, it had shown an alveolar arrangement of tumor cells and characteristic Periodic acid-Schiff-positive, diastase-resistant, intracytoplasmic granules. Distinct cytoplasmic crystals were found on the ultrastructural examination and tumor cells showed immunoreactivity for smooth muscle actin, myoglobin and neuron-specific enolase, while nonreactive for desmin, vimentin and S-100 protein. Myogenic origin can be suggested with these immunohistochemical results.

Detection of Human Papillomavirus in Lesions of Uterine Cervix Immunohistochemistry and in situ Hybridization.: Chang Soo Park, Jong Hee Nam, Jae Hyuk Lee, Jong Soon Kim, Seung Jin Oh; Korean J Pathol. 1997;31(4):289-297.

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Abstract PDF: To evaluate the detection of HPV DNA according to subtype of lesions of uterine cervix and its clinical applicability, in situ hybridization (ISH) and immunohistochemistry for HPV were performed in 189 cases of uterine cervical lesion, including 23 cases of low grade squamous intraepithelial lesion (SIL), 115 cases of high grade SIL and 51 cases of invasive carcinoma. Positive immunostaining, brown precipitate, was mainly noted in the nucleus of koilocytes in the superficial and intermediate layer. Positivity of immunostaining was 21.7% in low grade SIL, 13.0% in high grade SIL and 9.8% in invasive carcinoma. Positive reaction in ISH, red precipitate, was noted in the nucleus of not only koilocytes but also non-koilocytes in the superficial and intermediate layer, and dot precipitate was rarely identified in the nest of squamous cell carcinoma. Based on HPV subtype, 6/11 was 21.7% in low grade SIL, 16/18 was 32.2% and 39.2% in high grade SIL and invasive carcinoma, respectively. With regard to their associated HPV types, low grade SILs were heterogeneous and high grade SILs and invasive carcinomas were related with the high oncogenic risk group only. The correlation of HPV subtypes with panHPV was 91.3% in low grade SIL, 91.3% in high grade SIL and 98.0% in invasive carcinoma. These results suggest that detection of HPV infection by ISH may be a more useful method than immunohistochemistry and application of the HPV subtype probe with the panHPV probe could improve the sensitivity of ISH.

E-Cadherin Expression and DNA Ploidy Analysis in Invasive Squamous Cell Carcinoma of the Uterine Cervix Comparison with those of CIN.: Yoo Jin Kim, Mee Young Sol, Man Ha Huh, Sun Kyung Lee; Korean J Pathol. 1997;31(6):557-565.

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Abstract PDF: Epithelial cadherin (E-cadherin) is a Ca2+ -dependent cell-cell adhesion molecule that connects cells via homotypic interactions. Its function is critical in the induction and maintenance of cell polarity and differentiation, and its loss is associated with an invasive and poorly differentiated phenotype in a wide range of tumors. Formalin-fixed, paraffin-embedded tissue sections from 36 cases of cervical intraepithelial neoplasia (CIN) and 14 cervical squamous cell carcinomas were investigated for the expression of E-cadherin immunohistochemically. While E-cadherin expression was usually restricted on the cell membrane of basal and parabasal cells in normal cervix, the presence of cytoplasmic E-cadherin was found to be associated with its grade in CIN lesions. Also, marked cytoplasmic staining was commonly revealed in poorly differentiated ones than well-differentiated squamous cell carcinomas. More intense reactivity of cytoplasmic E-cadherin was frequently seen in the foci of invasion than adjacent carcinoma in situ, and in its periphery than the center of tumor islands. In addition, DNA ploidy and S-phase fraction of squamous cell carcinomas were analyzed and compared with those of CIN lesion. We found that invasive squamous cell carcinomas more frequently disclosed DNA aneuploidy than CIN lesions, and there was correlation between cytoplasmic E-cadherin expression and DNA aneuploidy. Also, cytoplasmic E-cadherin-reactive cervical neoplasms had a higher rate of cell proliferation than that of membranous E-cadherin-reactive cases. These data suggest that the increased cytoplasmic E-cadherin expression may represent one of the abnormalities underlying the loss of polarity and invasiveness of cancer cells, and the abnormal E-cadherin expression combined with/without DNA ploidy or S-phase fraction may serve as a prognostic indicator.

A Study of Correlation between Stage and Angiogenesis f Uterine Cervical Squamous Cell Carcinoma.: Eung Seok Lee, In Sun Kim; Korean J Pathol. 1998;32(4):283-289.

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Abstract PDF: A variety of malignant neoplasms have been shown to induce neovascularization, and in some cases the degree of vascularization appears to correlate with an aggressive behavior and risk of metastasis. We compared the degree of vascularization in 11 benign and 33 cancerous lesions of the cervix. The microvessels were identified by immunohistochemistry using antibody to Factor VIII-related antigen in 44 hystrectomy specimens. Three highly vascularized microscopic fields were selected and counted the number of microvessels in 400 magnification. The proportion of the endothelial cell area was also quantified by using the CAS 200 image analysis system. All 33 cases of carcinomas demonstrated a significantly higher microvessel count and an endothelial cell area than those of the benign lesions (p<0.01). There were no significant difference in microvessel count and endothelial cell area among carcinoma in situ, microinvasive carcinoma and invasive carcinoma (p>0.05). Microvessel count and an endothelial cell area in invasive cancers were not correlated with tumor size, depth of invasion, or histologic type (p>0.05).This study showed cervical cancer induces neovascularization in an early stage but it is difficult to predict prognosis and metastasis with microvessel count and an endothelial cell area.

Relationship between Vimentin Expression and Progression of Uterine Cervix Epithelial Neoplasms.: Sung Chul Lim, Keun Hong Kee, Hyun Jong Park; Korean J Pathol. 1998;32(9):663-669.

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Abstract: Vimentin is an intermediate filament protein normally expressed in mesenchymal cells, but the evidence of the aberrant expression of vimentin in epithelial cancer cells suggests that the vimentin expression might be related to local invasiveness and metastatic potential. There have been a few previous studies on the vimentin expression in human cervical carcinogenesis using in vivo and in vitro models. We examined the immunohistochemical vimentin expression in various squamous epithelial neoplasms of the uterine cervix, including the cervical intraepithelial neoplasia group (n=25), the microinvasive squamous cell carcinoma group (n=15), the invasive squamous cell carcinoma group (n=15) and the metastatic squamous cell carcinoma group (n=8). Vimentin positivity was significantly higher in the invasive than in the intraepithelial group, and in the cases with lymph node metastasis than in those without metastasis, suggesting a relationship between the vimentin expression and progression of the uterine cervical epithelial tumors.

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