Journal of Pathology and Translational Medicine

Eun Kyung Hong

42 Articles

Mucinous Tubular and Spindle Cell Carcinoma of Kidney Occurring in a Patient with Pulmonary Adenocarcinoma.: Seog Yun Park, Gyeong Hoon Kang, Jae Y Ro, Jennifer Black, Jinsoo Chung, Kang Hyun Lee, Eun Kyung Hong, Weon Seo Park; Korean J Pathol. 2008;42(1):54-59.

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Abstract PDF: Mucinous tubular and spindle cell carcinoma (MTSCC) is a rare type of kidney tumor that has only been recently described. Furthermore, a case of MTSCC associated with a simultaneous lung cancer in the same patient has never been reported in the literature. In this paper, we describe a kidney tumor that was detected during staging work-up in a 72-year-old lung cancer patient. The kidney tumor was removed and shown to exhibit histological and immunophenotypic features of MTSCC, completely distinct from the pulmonary adenocarcinoma. In addition, this case was unique because it was characterized by neuroendocrine differentiation as well as p53 and Ki-67 overexpression in tumor cells. Therefore, we report a case of MTSCC diagnosed in a patient with pulmonary adenocarcinoma and describe the detailed histologic and immunohistochemical features of MTSCC.

The Cytopathology of Body Cavity Fluid.: Eun Kyung Hong; Korean J Cytopathol. 2008;19(2):72-85.; DOI: https://doi.org/10.3338/kjc.2008.19.2.72

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1 Crossref

Cytologic examination of the body cavity fluid is very important because the specimens represent a significant percentage of nongynecologic samples and this cytologic examination may be the first, best or only chance for making the diagnosis of an underlying malignancy. The purposes of body cavity fluid examination are to correctly identify cancer cells and if possible, to identify the tumor types and primary sites when presented with unknown primary tumor sites. The most important basic differential diagnosis is that of benign and reactive disease vs malignant disease. Reactive mesothelial cells are a consistent population in body cavity fluid, and these are the most versatile cells in the body. Due to the specific environment of the body cavity, the exfoliated reactive mesothelial cells may show significant morphologic overlap with the morphology of cancer cells. With a focus on the differential points between reactive mesothelial cells and metastatic adenocarcinoma cells, the practical diagnostic approaches, the diagnostic clues and the pitfalls to achieve a correct diagnosis are presented in this review.

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A cytological observation of the fluid in the primo-nodes and vessels on the surfaces of mammalian internal organs
Baeckkyoung Sung, Min Su Kim, Byung-Cheon Lee, Seong-Hun Ahn, Sung-Yeoun Hwang, Kwang-Sup Soh
Biologia.2010; 65(5): 914. 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.

Adrenocortical Carcinoma, Myxoid Variant: A Case Report.: Bomi Kim, Sun Och Yoon, Dong Il Kim, Myung Cherl Kook, Eun Kyung Hong; Korean J Pathol. 2007;41(6):430-435.

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Abstract PDF: Myxoid variant of adrenal cortical carcinoma is extremely rare and there have been only 16 such cases reported in the medical literature. Here we report on a case of 43-year-old woman with a left adrenal mass that was detected during the evaluation for Cushing's syndrome. Left adrenalectomy was performed and the tumor weighed 347 g. The cut surface was predominantly myxoid and gelatinous with central hemorrhage and necrosis. Histologically, the tumor cells were rather small, uniform and polygonal with mild pleomorphism. It showed diverse morphologic patterns according to the amount of the myxoid stromal component. Making the diagnosis was not easy because the tumor was without areas of conventional adrenocortical carcinoma. Immunohistochemically, the tumor cells were positive for alpha-inhibin, synaptophysin and vimentin, but the tumor cells were negative for pan-cytokeratin and CAM 5.2. The immunophenotypes were identical to those of conventional adrenal cortical neoplasms. During the evaluation of a cytokeratin-negative and vimentin-positive retroperitoneal neoplasm with a myxoid component, the possibility of adrenal cortical tumor should be considered in spite that this is a very rare entity.

Pathologic Features of Korean Prostate Adenocarcinoma: Mapping Analysis of 83 Cases.: You Jeong Lee, Dong Il Kim, Hee Eun Lee, Jae Kyung Won, Eun Kyung Hong, Geon Kook Lee, Kang Hyun Lee, Weon Seo Park; Korean J Pathol. 2006;40(3):204-209.

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Abstract PDF: BACKGROUND
:Prostatic adenocarcinoma makes up about 2% of the total cancer incidence and cancer death in Korean men, but the incidence of this malady is continuously increasing. So far, there have been only a few studies describing the pathologic characteristics of the prostatic adenocarcinoma in Korean patients. In this study, we analyzed 83 radical prostatectomy specimens by using mapping analysis to discover the clinico pathologic characteristics of Korean prostatic adenocarcinoma.
METHODS
The resected prostates were serially sectioned and embedded for histologic mapping. The clinico pathologic findings, including the Gleason score, tumor size, prostate intraepithelial neoplasia (PIN) and tumor invasion to the surrounding tissues, were examined.
RESULTS
The mean values were as follows: age, 64.1+/-6.6 years; serum prostate specific antigen (sPSA), 16.6+/-16.2 ng/mL; tumor volume, 22.3+/-22.4%; tumor size, 2.2+/-1.2 cm; and Gleason score, 6.9+/-0.9. The rate of high grade PIN was 79.7%. The Gleason score, tumor extent and T stage were statistically correlated (p<0.05).
CONCLUSIONS
Some prognostic factors such as sPSA and the Gleason scores showed significantly lower levels compared with those of the previous studies on Korean prostate adenocarcinoma (16-36 ng/mL vs 16.6 ng/mL and 7.3-7.7 vs 6.9, respectively). Although these values are still higher than those of the western studies, this study implies that the early detection of prostate adenocarcinoma is increasing in Korea.

Cytopathology of Urinary Tract Neoplasms.: Eun Kyung Hong; Korean J Cytopathol. 2006;17(1):1-17.

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Abstract PDF: Urine cytology is the most useful technique for detecting either primary or recurrent neoplasms in the urinary tract. Although urine cytology is the traditional method of detecting these neoplasms, its diagnostic accuracy has been underevaluated because of low sensitivity. The cytologic interpretation of urinary samples is not an easy task, even with some expertise in this area, for many reasons. In low-grade urothelial carcinoma, no reliable or reproducible diagnostic cytologic criteria can be provided because of the lack of obvious cytologic features of malignancy, which is one of the main factors lowering its diagnostic accuracy. Many diagnostic markers have been developed recently to enhance its diagnostic yield, but the results have not been satisfactory. However, urine cytology plays a role in detecting high-grade urothelial carcinoma or its precursor lesions. It still shows higher specificity than any of the newly developed urine markers. Understanding the nature of urine samples and the nature of neoplasms of the urinary tract, recognizing their cytologic features fully, and using cytologic findings under appropriate conditions in conjunction with a detailed clinical history would make urine cytology a very valuable diagnostic tool.

The Bethedsa System 2001 Workshop Report.: Eun Kyung Hong, Jong Hee Nam, Moon Hyang Park; Korean J Cytopathol. 2001;12(1):1-15.

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Abstract PDF: The Bethesda System (TBS) was first developed in 1988 for the need to enhance the communication of the cytopathologic findings to the referring physician in unambiguous diagnostic terms. The terminology used in this reporting system should reflect current understanding of the pathogenesis of cervical/vaginal disease, so the framework of the reporting system should be flexible enough to accommodate advances in medicine, including virology, molecular biology, and pathology. Three years after the introduction of TBS, the second Bethesda workshop was held to set or amend diagnostic criteria for each categories of TBS. TBS 1991 is now widely used. The third Bethesda workshop, The Bethesda System 2001 Workshop, was held in National Cancer Institute, Bethesda, Maryland from April 30 to May 2, 2001. Again, the goals of this workshop were to promote effective communication and to clarify in reporting cervical cytopathology results to clinicians and to provide with the information to make appropriate decisions about diagnosis and treatment. Nine forum groups were made and there were Web-based bulletin board discussions between October, 2000 and the first week of April, 2001. On the basis of bulletin board comments and discussions, the forum moderators recommended revised terminologies in the Workshop. Hot discussions were followed after the presentation by forum moderators during the workshop. Terminologies confusing clinicians and providing no additional informations regarding patient management were deleted in the workshop to clarify the cervicovaginal cytology results. Any informations related to the patient management were encouraged to add. So 'Satisfactory for evaluation but limited by' of 'Specimen Adequacy' catergory was deleted. Terminology of 'Unsatisfactory' was further specified as 'Specimen rejected' and 'Specimen processed and examined, but unsatisfactory'. Terminologies of 'Benign Cellular Change' and 'Within Normal Limits' were combined and terminology was changed to 'Negative for intraepithelial lesion

Pigmented Mediastinal Paraganglioma: A case report.: Seong Ho Kim, Yoon Hee Jin, Eun Kyung Hong, Moon Hyang Park; Korean J Pathol. 2000;34(8):597-600.

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Abstract PDF: Pigmented extraadrenal paraganglioma is an unusual neoplasm that has rarely been reported in the literature. Based on histochemical staining or electron microscopy, pigment has been classified as lipofuscin, neuromelanin or true melanin. We report a case of pigmented extraadrenal paraganglioma in the posterior mediastinum of a 70-year-old woman. Histologically, the tumor had a characteristic organoid architecture of "zellballen" pattern with rich delicate microvasculature. Tumor cells contained numerous coarse brown-black pigment granules. Ultrastructurally, the tumor showed abundant large electron-dense pigment granules that vary in size and shape and smaller membrane-bound neurosecretory granules. The larger granules were consistent with neuromelanin or lipofuscin. Histochemically, the pigment is most likely neuromelanin, which is a waste product of catecholamine metabolism.

Subcutaneous Neuromuscular Hamartoma: A case report.: Dong Hoon Kim, Eun Kyung Hong, Jung Dal Lee; Korean J Pathol. 1999;33(1):62-64.

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Abstract PDF: Subcutaneous form of neuromuscular hamartoma is extremely rare and histologically different from the conventional neuromuscular hamartoma of the peripheral nerve or benign Triton tumor by an indistinct nodular growth with ill-defined margin and marked collagen interposition. It is usually not associated with a major nerve. We report a case of subcutaneous neuromuscular hamartoma developed in the forehead of 24-year-old man. The tumor showed proliferation of dense, hyalinized fibrous tissue, in which single or group of mature skeletal muscle fibers and nerve fibers were haphazardly intermixed. Recognition of abnormally arranged muscle and nerve fibers is important not to miss this lesion.

Fine Needle Aspiration Cytology of Inflammatory Pseudotumor of the Lung: Report of A Case Misdiagnosed as Adenocarcinoma .: Wan Seop Kim, Eun Kyung Hong, Moon Hyang Park; Korean J Cytopathol. 1999;10(2):145-149.

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Abstract PDF: Cytologic features of inflammatory pseudotumor of the lung have not been described frequently. We report fine needle aspiration cytologic(FNAC) finding of a case of inflammatory pseudotumor misdiagnosed as adenocarcinoma in a 63-year-old man. The FNAC displayed a mixture of histiocytes, myofibroblasts, pneumocytes, and plasma cells. Some histiocytes and myofibroblasts had large nuclei with irregular nuclear membrane and prominent nucleoli, which mislead the diagnosis of adenocarcinoma on FNAC. The heterogeneous cell population is the unique cytologic features of inflammatory pseudotumor, which are helpful to distinguish it from other circumscribed benign and malignant lesions. Familiarity with these features is essential to avoid misdiagnosis and possible overtreatment.

Primary Hepatic Leiomyosarcoma.: Won Mi Lee, Chan Kum Park, Eun Kyung Hong, Moon Hyang Park, Jung Dal Lee; Korean J Pathol. 1998;32(12):1092-1094.

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Abstract: Primary hepatic sarcoma is a rare tumor, with fewer than 60 previously reported cases. It is thought to arise from hepatic connective tissue or vascular channels. The tumor is located usually in the intrahepatic area. Pedunculated or bulging lesion is also reported. We report a case of primary leiomyosarcoma of the liver occuring in a 62-year-old Korean woman. A pedunculated, 21 16 cm sized mass is located in the left lateral segment of the liver. Microscopically, the tumor is hypercellular and composed of elongated, partly pleomorphic spindle cells with blunt-ended nuclei, which are focally reactive for muscle specific actin. Mitotic figures are 5/10 high power fields (HPFs). No other primary site is recognized on clinical study.

Prognostic Significance of the Tall Cell Variant of Papillary Thyroid Carcinoma: Expression of p53, bcl-2 & Leu-M1 proteins.: Won Mi Lee, Joo Seob Keum, Eun Kyung Hong, Moon Hyang Park, Jung Dal Lee; Korean J Pathol. 1998;32(11):1000-1007.

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Abstract: Papillary carcinoma of the thyroid is a well differentiated neoplasm and usually has a good prognosis. However, a subset of morphologically distinct papillary carcinoma has bad prognoses. The tall cell variant of papillary carcinoma (TCPC), characterized by tall columnar cells with a height at least twice the width, is the one of these. In order to differentiate TCPC from usual papillary carcinoma (UPC) in terms of prognosis, we performed immunohistochemical studies for the expression of p53, bcl-2 and Leu-M1 proteins in 25 cases of TCPC, 26 cases of UPC and 14 cases of poorly differentiated, solid type papillary carcinoma (SPC) with an analysis of clinical parameters. The nuclear expression of p53 was noted in one case each of UPC and TCPC. The cytoplasmic p53 expression of TCPC, UPC, and SPC was observed in 17/25 cases (68%), 14/26 cases (54%), 3/14 cases (21%), respectively. bcl-2 expression was 19/25 cases (76%), 18/26 cases (69%), 5/14 cases (36%), and that of Leu-M1 was 21/25 cases (84%), 18/26 cases (69%), 4/14 cases(29%), respectively. There were no statistical significance in the expression of those immunoproteins among these three groups (p>0.05). The p53 protein was consistently expressed in the cytoplasm rather than nucleus in this study and was very well correlated to bcl-2 positivity (p<0.01). There were no statistical significance in any clinical parameters examined among these three groups (p>0.05). In conclusion, TCPC can not be separated from UPC as a distinct entity in this study and the cytoplasmic expression of p53 protein provides another mechanism of p53 inactivation in tumorigenesis of the thyroid papillary carcinoma, possibly by bcl-2 related mechanism.

Extrapulmonary Silicosis: A case report.: Won Mi Lee, Se Jin Jang, Eun Kyung Hong, Jung Dal Lee; Korean J Pathol. 1998;32(7):540-542.

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Abstract: A case of extrapulmonary silicosis involving abdominal lymph nodes in a 62-year-old man is presented. The patient underwent subtotal gastrectomy and regional lymph nodes dissection for gastric adenocarcinoma of clinical stage III. On gross examination, two separate gastric adenocarcinomas and multiple enlarged lymph nodes mimicking metastatic lesion were noted. Microscopic examination of the enlaged lymph nodes revealed characteristic sclerohyaline silicotic nodules without metastatic adenocarcinoma. Chest roentgenogram showed diffusely scattered multiple tiny nodular lesions in the entire lung fields, particularly the posterior side of both upper lung fields. He had worked in a mine for 18 years and had been exposed to silica for 5 of those years. We report incidentally found, unusual case of extrapulmonary silicosis.

Gastrointestinal Polyposis in Koreans: A Nationwide Survey of Clinicopathologic Analysis of 112 Surgically Resected Cases.: Mee Soo Chang, Hoguen Kim, Woo Ho Kim, Chan Il Park, Eun Kyung Hong, Han Kyeom Kim, In Soo Suh, Byung Kee Kim, Ja June Jang, Woon Sub Han, Hyung Sik Shin, So Young Jin, Dae Young Kang, Yong Il Kim; Korean J Pathol. 1998;32(6):404-412.

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Abstract: Gastrointestinal polyposis (GIP) is a rare disease characterized by formation of the numerous polyps in the gastrointestinal tract and presenting several extraintestinal manifestations. Most of the diseases are transmitted in an autosomal dominant pattern. In Korea, the epidemiological study as well as the pathological analysis of the GIP is not well established. We therefore analysed 38 items of GIP using surgically resected specimens. The materials in this study were collected from the 12 institutions and case reports in Korean literature between 1980 and 1991. The clinicopathologic findings were reevaluated by several members of the study group for gastrointestinal pathology. The results are as follows: (1) A total of 112 cases were included in this study: 83 cases were collected from 12 institutions and 29 cases were collected from Korean literature. The cases were classified as familial adenomatous polyposis (FAP), 59 cases; Gardner's syndrome, 3 cases; juvenile polyposis, 12 cases; Peutz-Jeghers syndrome, 35 cases; multiple colonic adenomas, 3 cases. (2) Among 59 cases of FAP, the range of age at operation was 14 to 61 years, and a family history was positive in 25 cases. The number of polyps in colorectum was 100~8,000. Of the 37 cases in which the examination of polyp density was available, 16 cases (43%) showed the highest density in the rectum and the sigmoid colon. The carcinomatous change within polyp(s) was present in 18 cases (31%), and associated advanced single or multiple colonic carcinomas existed in 37 cases (63%). Twenty-six (45%) tumors out of total 58 carcinomas were in the rectum. Twenty-five patients were evaluated for the upper gastrointestinal lesions, and 11 patients (44%) had pathologic lesions; multiple fundic gland polyps in 3 cases (12%), gastric and duodenal adenomas in 2 cases (8%), gastric adenomas in 2 cases (8%), duodenal adenomas in 2 cases (8%), gastric carcinoma and adenoma in 1 case (4%), gastric carcinoma in 1 case (4%). (3) Among 3 cases of Gardner's syndrome, the range of age at operation was 25 to 31 years, a family history was identified in 2 cases. One case was associated with an advanced colonic carcinoma and carcinomatous change within polyp. Extra gastrointestinal lesions were sebaceous cyst, epidermal cyst, osteoma and desmoid tumor. (4) Among 12 juvenile polyposis, the range of age at operation was 8 to 51 years and 5 patients had a family history. The carcinomatous change within polyp was found in 2 cases (17%) and associated advanced colonic carcinoma was in 4 cases (33%). The associated different type of polyps was tubular adenomas in 9 cases (75%), hyperplastic polyps in 4 cases (33%) and villous adenomas in 2 cases (17%). (5) Among 35 Peutz-Jeghers syndrome, the range of age at first operation was 6 to 42 years, family history was positive in 11 cases. The carcinomatous change within polyp was found in 1 case (3%), and associated advanced colonic carcinoma in 1 case (3%). The epithelial misplacement was observed in 4 cases (11%), and tubular or villous adenomatous feature in 4 cases (11%). In summary, the most frequent GIP for the surgical resection in Korea is FAP and the FAP is associated with high incidence of coexisting advanced and intramucosal carcinomas. Hamartomatous polyposis syndromes, such as juvenile polyposis and Peutz-Jeghers syndrome are another frequent disease for the surgical resection and are also associated with an increased risk of cancer.

Intraductal Variant of Peripheral Cholangiocarcinoma of the Liver A report of three cases.: Won Mi Lee, Seok Hoon Jeon, Eun Kyung Hong, Moon Hyang Park, Jung Dal Lee; Korean J Pathol. 1998;32(3):222-225.

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Abstract PDF: Intraductal variant of peripheral cholangiocarcinoma is extremely rare. This variant shows intraductal growth and intraluminal extension without any infiltrative growth. The mode of intraductal growth is not known. The prognosis of this variant is better than that of usual cholangiocarcinoma. We report three cases, one of which is associated with Clonorchis sinensis (CS) infection. The tumors were entirely confined within the dilated peripheral tributaries of the intrahepatic bile duct. Microscopically, the tumors were well to moderately well differentiated, with a papillary or a micropapillary growth pattern. Focal clear cytoplasmic change and mucin production were noted. The tumors showed intraductal spreading without any invasion to the liver parenchyme. Mucosal hyperplasia and dysplasia were noted in the adjacent ducts. The authors assume that intraductal cholangiocarcinoma is a distinct subtype, and persistent irritation, such as, CS infection may undergo a malignant transformation through mucosal dysplasia.

Granular Cell Tumor of the Thyroid.: Haeng Ji Kang, Eun Kyung Hong, Moon Hyang Park, Jung Dal Lee; Korean J Pathol. 1998;32(1):63-67.

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Abstract PDF: Granular cell tumor is not uncommon and is a well recognized entity which may arise at virtually any site of the body. However, occurrence in the thyroid is extremely rare and has not been described well. Only three cases could be found in the English literatures. We report a case of granular cell tumor of the thyroid in a 30 year-old woman. The tumor was illdefined, infiltrative and was composed of diffuse sheets of polygonal to fusiform cells with abundant eosinophilic granular cytoplasm. The tumor showed evidence of Schwann cell differentiation in immunohistochemical and ultrastructural examinations. Differentiation from more common thyroid tumors having oncocytic granular cytoplasm should be made by immunohistochemistry or electron microscopy.

Fine Needle Aspiraton Cytology of Polymorphous Low Grade Adenocarcinoma in the Hard Palate: A Case Report .: Wan Seop Kim, Seok Hoon Jeon, Eun Kyung Hong, Moon Hyang Park, Jung Dal Lee; Korean J Cytopathol. 1998;9(2):181-186.

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Abstract PDF: Polymorphous low grade adenocarcinoma(PLGA) is a rare malignant tumor of the salivary gland. It is characterized by diverse histology, bland-looking cytology, indolent behavior and favorable prognosis. The fine needle aspiration cytologic features of PLGA are described. The aspirates from the hard palate in a 33-year-old woman showed cellular smear composed of monotonous small round to oval cells with scanty cytoplasm. Papillary, tubular and cell ball arrangements with characteristic dense stromal spheres were recognized. PLGA could be suggested by fine needle aspiration cytology, if one encountered cellular smear with various architectures and uniform bland-looking cytologic feature.

Fine Needle Aspiration Cytology of Glycogen-Rich Clear Cell Carcinoma of the Breast: A Report of Two Cases .: Wan Seop Kim, Won Mi Lee, Eun Kyung Hong, Moon Hyang Park, Jung Dal Lee; Korean J Cytopathol. 1998;9(2):213-219.

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Abstract PDF: Glycogen-rich clear cell carcinoma of the breast is an unusual variant of carcinoma with a recorded incidence of 1.4-3% of breast carcinomas. The cytologic characteristics have not been well described. We report two cases of glycogen-rich clear cell carcinoma with corresponding fine needle aspiration(FNA) cytologic findings and compare them to infiltrating ductal carcinoma and other clear cell malignancies with a review of literature. One was a 62-year-old woman exhibiting a palpable mass of the right breast. The smears showed atypical tight cell clusters and individually scattered single cells containing foamy or clear abundant cytoplasm with well defined cytoplasmic margins. Mild to moderate nuclear pleomorphism and a prominent nucleolus were present. The other was a 42-year-old woman who was admitted with a right breast mass. The smears showed moderately cellular, tightly cohesive tumor cells. The cytoplasmic outline was generally well demarcated. The tumor cells contained foamy to clear abundant cytoplasm with large and small vacuoles. The nuclear pleomorphism was marked. Both tumors resected by modified radical mastectomy, were diagnosed as glycogen-rich clear cell carcinoma. Histologically, the clear cell nature of tumor cells were not characteristic enough to predict this type of the tumor. Some cytologic features can be distinguished other clear cell breast cancer from glycogen-rich carcinoma. Recognition of these unusual patterns in a breast FNAC should raise the suspicion of a clear cell carcinoma including glycogen-rich subtype. Cytological localization of glycogen using PAS and D-PAS staining may permit the correct identification and differential diagnosis of this tumor.

Grading System for Gastric Epithelial Proliferative Diseases Standardized Guidelines proposed by Korean Study Group for Pathology of Digestive Diseases.: Hoguen Kim, So Young Jin, Ja June Jang, Woo Ho Kim, Sang Yong Song, Kyu Rae Kim, Eun Sil Yu, Hyung Sik Shin, Han Kyeom Kim, Jin Hee Sohn, Eun Kyung Hong, Youn Wha Kim, Jin Sook Jeong, Chang Jin Kim, Shin Eun Choi, In Suh Park, Chan Il Park, Yong Il Kim; Korean J Pathol. 1997;31(5):389-400.

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Abstract PDF: The assessment of epithelial changes in gastric mucosal biopsies has been one of the major problems caused by inconsistencies in and disagreements about nomenclature and interpretation. To resolve these issues, members of the Study Group for Pathology of Digestive Diseases reviewed microslides of 50 gastric lesions showing varying degrees of mucosal abnormality and reached the following consensus; 1) the proliferating gastric epithelium can be divided into hyperplastic and neoplastic; 2) the term "dysplasia" is reserved for the microscopic epithelial changes that are unequivocally neoplastic; 3) Biopsy specimens can be categorized as regenerative(negative for dysplasia), indefinite(questionable dysplasia), positive(positive for dysplasia) and overt carcinoma; 4) The positive category can be divided into two subgroups, high grade dysplasia and low grade dysplasia. Criteria for each grade are presented and discussed. We offer these guidelines for establishing the correct diagnosis of the gastric mucosal biopsy specimens and for prospective studies.

Clear Cell Islet Cell Tumor of the Pancreas: An Immunohistochemical and Ultrastructural study.: Seung Sam Paik, Young Ha Oh, Eun Kyung Hong, Moon Hyang Park, Jung Dal Lee; Korean J Pathol. 1997;31(2):162-166.

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Abstract PDF: A clear cell islet cell tumor of the pancreas is extremely rare and characterized by extensive clear cell components. Electron microscopic and immunohistochemical findings are essential to prove that the mass with clear cells is an unusual manifestation of an islet cell tumor. Herein, we report a case of clear cell islet cell tumor of a 54-year-old woman with abdominal pain. The tumor was composed of polygonal clear cells arranged in nests, trabeculae, and ribbon pattern with the extensively fibrous stroma. These tumor cells showed strong reactivity for chromogranin and weak reactivity for somatostatin and glucagon. An electron microscope revealed that the important contributing factor of the clear cytoplasmic change was mainly due to an accumulation of lipid droplets, coupled with cytoplasmic swelling in some areas. Some tumor cells showed many endosecretory granules ranging from 111 to 297nm in diameter. In the clinical and immunohistochemical findings these granules were consistent with somatostatin granules in morphology and size.

Ossifying Fibromyxoid Tumor of Soft Parts.: Seok Hoon Jeon, Seung Sam Paik, Eun Kyung Hong, Moon Hyang Park, Jung Dal Lee; Korean J Pathol. 1997;31(2):174-178.

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Abstract PDF: An ossifying fibromyxoid tumor of soft parts is a rare, recently described, fibro-osseous neoplasm of uncertain histogenesis. It occurs most frequently within the subcutis or skeletal muscle of the extremities. Its biologic behavior is generally regarded as benign with at worst a locally aggressive clinical course. But, atypical and malignant variants have been recently reported. Herein we report a case of a benign ossifying fibromyxoid tumor which occurred in the left upper back of 41-year-old man. The tumor is composed of uniformly round or polygonal cells arranged in cords or nests which are separated by myxoid and hyalinzed fibrous matrix and associated with irregular bony trabeculae. The tumor cells are strong positive for vimentin. Ultrastructural findings and a review of literatures are added.

The Significance of AgNOR Count in Body Fluid: Differential between reactive mesothelial cells & malignant cells.: Seung Sam Paik, Eun Kyung Hong, Se Jin Jang, Moon Hyang Park, Jung Dal Lee; Korean J Cytopathol. 1997;8(2):129-134.

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Abstract PDF: To distinguish reactive mesothelial cells from malignant cells in body fluid, we applied silver staining of nucleolar organizer regions(AgNORs) to ethanol fixed cytologic preparations. Fifty aspirated samples of benign(22 cases) and malignant(26 cases) body fluids were studied using the one step silver staining method. Two cytologically atypical samples were also included in the study. In malignant cases the mean AgNOR count was 3.56+/-0.81, while in benign cases the mean AgNOR count was 2.02+/-0.33. The difference of AgNOR counts between these two groups were statistically significant(p<0.001). The mean of atypical cases was 2.91. Both were diagnosed as malignant in follow-up cytology. In malignant effusions, there is statistically significant difference in AgNOR counts between cells forming complex papillae or clusters and singly scattered cells(p<0.05), 3.29+/-0.95 and 3.83+/-0.55, respectively. We concluded that AgNOR count appears to be useful as a diagnostic tool especially when the cytologic differentiation is difficult.

Polymerase Chain Reaction Analysis of Human Papillomavirus in Esophageal Squamous Cell Carcinoma with its Correlation to p53 mutation.: Wan Seop Kim, Eun Kyung Hong, In Kyu Kim, Moon Hyang Park, Jung Dal Lee; Korean J Pathol. 1996;30(11):1018-1026.

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Abstract PDF: HPV infection has been implicated strongly in the pathogenesis of human squamous cell carcinoma(SCC). We analysed a series of 28 surgically removed, invasive squamous cell carcinoma of the esophagus by polymerase chain reaction to detect HPV DNA using consensus primers and 8 type-specific primers of HPV (6, 11, 16, 18, 31, 33, 35, 51). HPV 6, 31, 35 or 51 DNA were detected in 20 out of 28 cases (71.4%) of the esophageal SCCs. HPV 51 was the most frequently detected type, occuring in 13 out of 28 cases (46.4%). p53 immunohistochemical staining was also performed to demonstrate any relationship to HPV DNA positivity. It showed positivity in 16 out of 28(57.1%) esophageal SCCs, and HPV DNA and p53 positivity were concurrently detected in 11 out of 28 cases of SCCs. There was no significant inverse relation between HPV DNA positivity and p53 expression(p>0.05). Our results supported HPV involvement in esophageal squamous cell carcinoma, and suggested there may be another pathway not related to the p53-binding pathway in the carcinogenesis of esophageal SCCs by HPV.

Gastrointestinal Adenomatous Polyposis Associated with Small Cell Neuroendocrine Carcinoma of the Rectosigmoid: A case report.: Wan Seop Kim, Eun Kyung Hong, Kang Sik Kim, Kwang Soo Lee, Jung Dal Lee; Korean J Pathol. 1996;30(11):1040-1044.

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Abstract PDF: In adenomatous polyposis coli there are many colonic and extracolonic manifestations, and various combinations of these induce different clinical presentations and syndromes. We experienced a unique case of adenomatous polyposis of the large intestine and stomach in a 39-year-old man. In the colon, small cell neuroendocrine carcinoma rather than adenocarcinoma had developed, which did not contain adenomatous or carcinomatous foci. The adenomatous polyps in the colon were all small and sessile with no cancerous or precancerous change two years after the resection of the symptomatic gastric adenomas, even though the gastric adenomas were larger and showed dysplastic change. We think this case is another variant of adenomatous polyposis syndrome.

Mucinous Adenocarcinoma of Anal Ducts.: Young Ha Oh, Wan Seop Kim, Eun Kyung Hong, Moon Hyang Park, Jung Dal Lee; Korean J Pathol. 1996;30(9):843-850.

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Abstract PDF: Anal duct carcinoma is a rare tumor, and accounts for less than 5 percent of all anal cancers, which typically present a long-standing perianal fistulas. Some authors suggest that the fistulous tracts are congenital duplications of the lower end of the hind gut lined by rectal mucosa which is prone to malignant change to mucinous adenocarcinoma. It is usually a well differentiated mucinous (colloid) adenocarcinoma. The prognosis after wide excision of the rectum is relatively good. Since 1985, we have had three cases of anal duct carcinoma with well differentiated mucinous adenocarcinoma involving the posterior wall of the anus. Two patients had a long history of perianal fistula with mucinous discharge. There was no spread to the regional lymph node except one patient who had regional lymph node metastasis, and post-operative chemotherapy and radiation therapy were then given. All patients have no evidence of any recurrent problem at 16 months to 3 years following the surgical treatment. Because of their rarity and the failure of recognition at an early stage, we are presenting three cases to emphasize the characteristic features of this insidious, slow-growing carcinoma.

Ureteral Fibroepithelial Polyp: A report of four cases (One case with nephrogenic adenoma).: Won Mee Lee, Seung Sam Paik, Eun Kyung Hong, Moon Hyang Park, Jung Dal Lee; Korean J Pathol. 1996;30(8):715-720.

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Abstract PDF: Fibroepithelial polyps of the ureter are usually acquired rather than congenital. Most polyps are hamartomatous growths which tend to arise in the proximal portion of the left ureter. Most patients exibit either hematuria or persistent flank pain secondary to partial ureteral obstruction. Because of false positivity of urine cytology, as well as intravenous pyelogram, the correct diagnosis is confused with malignancy. Herein we report four cases of ureteral fibroepithelial polyp, which are associated with stones resulting in partial obstruction of the ureter. One of the four cases is associated with nephrogenic adenoma in the lamina propria of the adjacent ureter. The following report describes clinicopathologic findings of fibroepithelial polyp with review of literatures.

Idiopathic Entero-colic Lymphocytic Phlebitis: A case report.: Seung Sam Paik, Young Ha Oh, Eun Kyung Hong, Jung Dal Lee; Korean J Pathol. 1996;30(6):533-538.

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Abstract PDF: Localized enterocolic lymphocytic phlebitis is characterized by selective phlebitis involving the small to medium-sized veins and venules, infiltration exclusively by lymphocytes, and no other systemic vasculitis or inflammatory bowel disease. This vasculitis can be a rare cause of intestinal ischemia. We experienced a case of enterocolic lymphocytic phlebitis in a 72-year-old woman, who presented with abdominal pain and distension. The resected colon and terminal ileum showed striking lymphocytic phlebitis affecting the veins and venules of the bowel and mesentery which resulted in ischemic injury of the bowel. This vasculopathy was the only demonstrable cause of ischemia. Arteritis and arteriolitis was not found. There is no clinical or laboratory evidence or a history of extraintestinal vasculitis. The etiology of this clinicopathological entity has not been elucidated. Herein, we report the clinicopathological findings in this patient who presented with ischemic intestinal necrosis caused by localized intestinal lymphocytic phlebitis associated with thrombosis.

Alpha-Fetoprotein-Producing Carcinoma of the Gallbladder.: Young Ha Oh, Haeng Ji Kang, Hyoung Guen Lee, Eun Kyung Hong, Yong Il Kim, Jung Dal Lee; Korean J Pathol. 1996;30(5):453-456.

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Abstract PDF: Alpha-fetoprotein (AFP) is a well-known tumor marker for hepatocellular carcinoma, hepatoblastoma, and yolk sac tumors. There are several studies on AFP-producing tumors that arose from the gastrointestinal tract, pancreas, lung, kidney, and urachal tract. AFP-producing carcinoma of the gallbladder is extremely rare. We report a case of AFP-producing carcinoma of the gallbladder without liver involvement in a 58-year-old man with a gallstone, on which clinical, morphologic, and immunohistochemical studies were performed.

Fetal Rhabdomyomatous Nephroblastoma: A case report.: Nam Hoon Kim, Chan Pil Park, Eun Kyung Hong, Poong Man Jung, Moon Hyang Park; Korean J Pathol. 1995;29(1):96-102.

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Abstract PDF: A fetal rhabdomyomatous nephroblastoma is considered to be a predominantly monophasic mesenchymal variant of Wilms' tumor, which acts less aggressively than a conventional Wilms' tumor despite its much larger size. Bilaterality of this tumor in a nine month-old girl, however, may negatively affect the overall prognosis. A radical nephrectomy for bulky masses in the left kidney and a partial nephrectomy for right kidney with five small tumor masses was performed at the same time. Two small tumor masses in the upper part of right kidney were left behind because of preserving minimal renal functional capacity. Pathological study revealed a mixed type of nephroblastoma which was composed predominantly of mesenchymal components with fetal rhabdomyomatous differentiation. After post-operative chemotherapy with vincristine, actinomycin D and adriamycin, and radiotherapy(2,130 rad), residual tumor masses became a single tumor 5 cm in diameter and well demarcated, which was resected at 15 months after first operation when the size and renal function of remained right kidney was appropriate to resect out the residual tumor. The tumor resected out at second operation was entirely composed of scattered differentiated fetal skeletal muscle cells in the fibrovascular tissue. Only a few entrapped epithelial components were seen but no blastemal cornponents were present. Follow up abdominal CT and ultrasonographic examinations revealed no evidence of tumor recurrence. The girl has developed normally without disease.

Fine Needle Aspiration Cytology of Bilateral Granulomatous Mastitis: A Cese Report.: Seung Sam Paik, Seok Hoon Jeon, Eun Kyung Hong, Moon Hyang Park; Korean J Cytopathol. 1995;6(2):174-178.

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Abstract PDF: Granulomatous mastitis is a rare inflammatory breast lesion, usually presented with rapidly enlarging palpable mass in young parous women and can simulate carcinoma. Unnecessary surgical procedure can be avoided if the nature of the lesion were defined by fine needle aspiratio(FNA) cytology. We experienced a case of bilateral granulomatous mastitis diagnosed by FNA cytology. The patients was a 31-year-old woman with one month history of a rapidly enlarging mass in the left breast. considered clinically to be malignant. After 4 years. she presented with a palpable mass in the right breast. The FNA cytology smears contained numerous aggregates of epithelioid histiocytes admixed with Langhans' and foreign body giant cells, lymphoytes, neutrophils and apoptotic debris leading to a diagnosis of granulomatous mastitis. The subsequent lumpectomy of the left breast confirmed the diagnosis of granulomatous mastitis. The FNA cytology smears from right breast showed identical cytologic findings.

Clear Cell Meningioma arising from Lumbar Nerve Root in a Child: A case report.: Eun Kyung Hong, Geun Shin Lyu, Moon Hyang Park; Korean J Pathol. 1994;28(2):179-184.

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Abstract PDF: Meningioma of unusual age of onset, location, histogenesis and histologic type is reported. The patient, 4 year-old girl, had an intradural spinal meningioma arising from lumbar nerve root with no dural attachement. The meningioma revealed glycogen-rich, clear cell type with extensive and blocky hyalinization of the stroma. The tumor shared common fibrous sheath with attached lumbar nerve, and nerve fibers were scattered within the tumor. Ultrastructurally, the tumor cells had abundant glycogen particles, intermediate filaments and intercellular desmosomes. Hyalinized material revealed large amianthoid collagen fibers.

Limb-Body Wall Malformation Complex: Two autopsy cases and its pathogenesis.: Geun Shin Lyu, Nam Hoon Kim, Eun Kyung Hong, Jung Dal Lee; Korean J Pathol. 1993;27(6):638-644.

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Abstract PDF: Limb-body wall malformation complex(LBWC), also know as the amniotic band syndrome, is a poorly defined, sporadic group of congenital anomaly characterized by a collection of protean fetal malformation, deformation and disruption. Accurate diagnosis is often difficult because of its variable presentation pattern and the absence of exactly same case. We report two autopsy cases. One revealed body wall, cardiac, and craniofacial anomalies with anencephaly, and amniotic adhesive band attached to craniofacial defect of the fetal part without evidence of amniotic rupture. The other exibited abdominal wall defect with omphalocele, visceral, postural, and limb anomalies together with neural tube defect in the lumbosacral region. The pathogenesis of this syndrome was discussed in detail.

Incidental Glomus Coccygeum Associated with Coccygeal Dimple.: Chan Kum Park, Eun Kyung Hong, Nam Hoon Kim; Korean J Pathol. 1993;27(2):198-199.

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Abstract PDF: The glomus coccygeum is a glomus body located close to the tip of the coccyx. Because of its large size and multiple anastomotic channels, it mimics glomus tumor. It is very unfamiliar to the pathologits. We describe a case of glomus coccygeum incidentally found associated with coccygeal dimple from 5-month-old infant.

Gastric Choriocarcinoma and Endodermal Sinus Tumor in Collision Tumor.: Eun Kyung Kim, Eun Kyung Hong, Kwang Soo Lee, Jung Dal Lee; Korean J Pathol. 1992;26(4):405-410.

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Abstract PDF: Both primary choriocarcinoma and endodermal sinus tumor of the stomach are very rare entities. Combination of these two tumors is even rarer, and only a single such case has been reported in English literature. The case had gastric adenocarcinoma in addition to these tumors. We experienced a case of combined, pure choriocarcinoma and endodermal sinus tumor in the stomach of a 74 year-old man. He had no gonadal or any other primary tumor. Huge exophytic tumor was located in the lesser curvature of the body. Two components of the tumor was separated and clearly defined. Human chorionic gonadotropin(HCG) was demonstrated in serum and in tissue sections. Alpha-fetoprotein(alpha-FP) was also demonstrated in serum and in tissue sections. Alpha-fetoprotein(alpha-FP) was also elevated in the serum. Possible tumor origin was speculated.

Papillary Craniopharyngiona: A report of two cases.: Gu Kong, Eun Kyung Hong, Jung Dal Lee; Korean J Pathol. 1992;26(2):171-174.

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Abstract PDF: Two cases of suprasellar papillary craniopharyngioma are presented. The tumors are exclusively composed of well-formed papillary squamous epithelium and show morphologic homogeneity. There is no palisading basal layer in squamous epithelium. Clinical and radiologic findings, exclusive occurrence in adult and lack of calcification, are much different from conventional craniopharyngioma. Differences between papillary craniopharyngiom and conventional craniopharyngioma are discussed.

Primary Malignant Hemangiopericytoma of the Lung: A case report.: Jung Hee Kang, Eun Kyung Hong, Chan Keum Park, Jung Dal Lee; Korean J Pathol. 1992;26(1):66-70.

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Abstract PDF: Primary pulmonary hemangiopericytoma is a rare, potentially malignant tumor and assumes more malignant course than that originated in the soft tissue. It can be asymtomatic until attaining a large size within the lung. We report a case of malignant hemangiopericytoma of the lung in a 29 year old man. It represented as a sharply demarcated, huge homogeneous opaque mass in the right upper lobe. The cytologic and histologic features were that of malignant hemangiopericytoma.

Blue Nevus of the Uterine Endocervix : Report of three cases.: Moon Hyang Park, Eun Kyung Hong; Korean J Pathol. 1991;25(5):471-475.

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Abstract: The clinical, gross, light microscopic and immunohistochemical findings of three cases of blue nevus of the uterine endocervix were described. All three cases were incidentally found in hysterectomy specimens from middle-aged women, 45 to 48 years of age. The lesions were small and measured 1 to 4 mm in the greatest diameter. The presence of elongated, somewhat wavy and dendritic melanin-containing cells, in clusters or scattered deep in the subepithelial stroma and between the endocervical glands, was the distinct feature. The cytoplasmic granules appeared black with Grimelius and Fontana-Masson stains. The cells showed strong positive reaction with S-100 protein in perinuclear cytoplasm, in addition to the diffusely dispersed melanin granules. The demonstration of S-100 protein in the blue nevus, along with the histochemical findings, supports combined melanocytic and schwannian differentiation of the blue nevus cells.

Cytologic features of glassy cell carcinoma of the uterine cervix.: Gu Kong, Eun Kyung Kim, Eun Kyung Hong, Jung Dal Lee; Korean J Cytopathol. 1991;2(1):62-66.

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Abstract: Glassy cell carcinoma is an unusual neoplasm of the uterine cervix with highly aggressive clinical behavior. On cervico-vaginal smear examination, the tumor has well confused of atypical repair cell of the endocervix. Recently, we have experienced two cases of glassy cell carcinoma of the uterine cervix, diagnosed on cervico-vaginal smears and confirmed on following histologic sections. The cervico-vaginal smears revealed abundant clusters with well defined boarders. The cell clusters were composed of large tumor cells. The tumor cells had distinct granular cytoplasm and eosinophilic macronucleoli. Characteristic cytologic features of this tumor were discussed in view of differential diagnosis.

Morphometric Analysis of Malignant Lymphoma.: In Sook Kim, Eun Kyung Hong, Jong Dal Lee; Korean J Pathol. 1990;24(2):128-136.

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Abstract PDF: Nuclear morphology and size are important in the diagnosis and classification of non-Hodgkin's lymphoma. The recognition of morphologic features of the lymphoma cells and their interpretation are somewhat subjective and often difficult. We apply the morphometric study in touch imprints from 22 cases of non-Hodgkin's lymphoma classified by Working formulation. Determination of the exact size of the tumor cells and substantial diagnostic value of this method compared with histology are proposed. Morphometric parameters, including nuclear area, perimeter, maximal diameter (D-max), diameter of an equivalent circle for a measured area (D-circle), circularity factor (From PE) and regularity factor (Form AR) are measured, using Kontron, user-controlled image analyser (IBAS-1). The correlation between morphometric and histologic diagnosis is relatively good, except for 2 cases of Burkitt's lymphoma, measured as large cell and 2 cases of large cell lymphoma measured as medium cell. The most reliable parameter of the nuclear size is D-circle. The parameters for the nuclear shape, Form PE and Form AR, also reflect the nuclear cleavage and polymorphous pattern. The large cell group shows more wide standard deviation than small and medium cell groups, reflecting heterogeneity and variability in unclear size of large cell group. We suggests the morphometric analysis using touch imprints is complementary diagnostic tool for more accurate and reproducible diagnosis.

Ependymoma Containing Cartilage: A case report.: Eun Kyung Hong, Jung Dal Lee; Korean J Pathol. 1990;24(1):77-81.

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Abstract PDF: The presence of cartilage in a glial tumor is exceptional. It frequently occurs in ependymoma of midline location in young child nuder 5 years of age. The mechanism of cartilage and bone formation in ependymoma is thought to be either metaplastic transformation from mesenchymal tissue or direct transformation from the neoplastic glial cells. A case of ependymoma containing cartilage and bone is reported. The patient is a 4 year-old girl, having calcified mass in the 4the ventricle and cerebellar vermis. The pathogenesis of cartilage formation in this ependymoma is more likely to support the mataplastic theory.

Pathologic Study on Carcinomas of Extrahepatic Biliary Tract.: Byung Tae Park, Eun Kyung Hong, Jung Dal Lee; Korean J Pathol. 1989;23(3):311-321.

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Abstract PDF: The authors reviewed surgical materials from 20 patients with carcinoma of the extrahepatic biliary system, and a correlation between macroscopic appearance of the tumors with various clinical features and histopathologic findings was made. Microscopically, the tumors were classified into four types; Four (21%) patients had polypoid tumors, six (32%) had nodular growths, five (26%) were scirrhous constricting in type, and four (21%) had diffusely infiltrating type. Histologically all the differentiation in two cases. The degree of differentiation of the tumors was classified into 3 types: 11 (55%) patients were well differentiated, 3(15%) were moderately well and 6(30%) were poorly differentiated. All polypoid tumors were well differentiated and had low stage. No correlation in the degree of differentiation of the tumor with the stage was present. No correlation in clinical symptoms, duration of symptoms, laboratory findings with morphologic findings of the tumors was noted.

Aspiration Biopsy Cytology of Malignant Fibrous Histiocytoma.: Moon Hyang Park, Eun Kyung Hong, Jung Dal Lee; Korean J Pathol. 1986;20(3):332-335.

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Abstract PDF: Cytologic findings of malignant cells obtained by fine needle aspiration from a huge retroperitoneal malignant fibrous histiocytoma were described. The smears contained numerous malignant cells, isolated or in clusters, in a bloody background. The malignant cells had abundant pleomorphic foamy or acidophilic cytoplasm with occasional multilobated vesicular nuclei and prominent nucleoli. Dual differentiation, both histiocytic and fibroblastic types, and neutrophilic inflammatory background were diagnostic of this neoplasm. The report indicated that study of aspiration cytology specimen from a soft tissue tumor was a valuable adjunct to histologic examination.

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