- Gonadoblastoma Overgrown by Dysgerminoma in Women with 46,XX Karyotype: A Report of Two Cases.
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Mi Jung Kim, Hee Jeong Ahn, Ji Young Kim, Kyu Rae Kim
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Korean J Pathol. 2003;37(1):66-70.
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- Gonadoblastoma is a neoplasm containing an intimate mixture of germ cells and elements resembling immature granulosa or Sertoli cells. It has been considered as in situ germ cell malignancy that can be overgrown by more malignant germ cell neoplasms. The tumor has been reported to almost exclusively develop in various types of gonadal maldevelopment syndromes containing the Y chromosome, such as in pure or mixed gonadal dysgenesis and, less commonly, in male hermaphroditism. However, occurrences in phenotypically and chromosomally normal, menstruating women are exceptionally rare. We report two cases of gonadoblastoma overgrown by dysgerminoma occurring in the ovaries of phenotypically and cytogenetically normal menstruating women. One of the two cases showed an area composed of granulosa cell tumor-like elements. This type of combination has been very rarely described, and exemplified that gonadoblastoma may progress to sex cord-stromal tumors as well as to the malignant germ cell tumors.
- Expression of CD44 in Epithelial Ovarian Tumors.
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Kye Weon Kwon, Hee Jeong Ahn, Yoon Jeong Choi, Hee Jae Joo, Nam Hoon Cho
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Korean J Pathol. 1998;32(8):596-602.
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Abstract
- CD44 is a hyaluronic acid receptor that exists as a standard 90-kd form (CD44H) as well as several CD44 variants isoforms are produced through alternative splicing. Alternatively spliced variants of the CD44 molecule have been found to be associated with invasive and metastatic potential of cancer cells and poor prognosis in several types of carcinoma. The purpose of the present study is to define the expression of CD44H and CD44v6 in ovarian tumors and to investigate whether the expression of these molecules is associated with adverse prognosis. We evaluated the expression of CD44 isoforms in 58 ovarian tumors by means of immunohistochemistry, and correlated between CD44 expression and the histologic types, tumor grade, peritoneal implants, pseudomyxoma peritonei and FIGO stage. While the CD44H was commonly expressed in ovarian tumors, the CD44v6 was expressed in a minor proportion of serous tumors in comparison with frequent expression of v6 isoform in mucinous tumors. The CD44H expression was significantly higher in stage I/II than in stage III. However, there was no correlation between the expression of CD44 and the presence of peritoneal implants or pseudomyxoma peritonei.
These results suggest that CD44H could play an important role in the adhesive function in the lower stage of the ovarian tumor and reduced expression in the higher stage might be related to the metastasis and widespread invasion of ovarian carcinoma cells.
- Wegener's Granulomatosis Involving Lung and Middle Ear: A case report.
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Kye Weon Kwon, Yoon Jung Choi, Hee Jeong Ahn, Min Soo Han, Dong Hwan Shin
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Korean J Pathol. 1998;32(6):470-473.
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- A case of Wegener's granulomatosis is described, with special attention focused on the typical histologic findings and involvement of both middle ear and lung. The patient is a 37-year-old man presented with four-month history of cough and sputum. He had a past history of surgery of both ears because of otitis media followed by left facial palsy. Chest radiographs showed variable sized ill defined nodules in both lower lobes with internal airspace consolidation.
Histologic preparations of the open lung biopsy specimens demonstrated a diffusely scattered palisading micro and macrogranulomas with central focus of neutrophils and necrotic collagen surrounded by histiocytes, histiocytic giant cells. Fibrinoid necrosis involved blood vessels and lung parenchyma. Chronic inflammation, diffuse granulation tissue formation and irregular fibrosis are also found in the lung parenchyma. The histologic findings of middle ear which was previously biopsied showed scattered palisading ill defined microgranulomas mixed with fibrotic tissue.
- Congenital Sialoblastoma: A case report and review.
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Jong In Yook, Hee Jeong Ahn, Jin Kim
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Korean J Pathol. 1997;31(11):1227-1232.
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- A congenital salivary gland tumor, sialoblastoma, is extremely rare. A sialoblastoma of the parotid gland, occurring in a 28-week old fetus, is described. The histologic, immunohistochemical, and ultrastructural features of this tumor were studied. The tumor was characterized by solid nests or sheets of tumor cells intermingled with ductal structures lined by a columnar cells. Some of the tumor cells showed squamous differentiation. Immunohistochemically, these epidermoid cells reacted positively with anti-cytokeratin. But anti-S-100, anti- vimentin, anti-smooth muscle actin, anti-GFAP positive cells were not found. The ultrastructure was characterized by primitive epithelial cells. Although various names have been proposed, we favored the term "sialoblastoma". The histogenesis of this tumor is also discussed.
- Analysis of Histological Findings and Estrogen and Progesterone Receptor Status in Luteal Phase Defect Caused by Delayed Ovulation and Clomiphen Treatment.
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Kyu Rae Kim, Hee Jeong Ahn, Jai Hyang Go, Dong Hee Choi, Byoung Goo Yoon
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Korean J Pathol. 1996;30(12):1106-1115.
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- Luteal phase defect (LPD) is an ovulatory disorder of considerable clinical importance that leads to delayed endometrial maturation and inadequate endometrium for blastocyst implantation. This disorder is implicated in infertility and recurrent spontaneous abortion. We analyzed the endometrial histological maturation, and the estrogen receptor(ER) and progesterone receptor(PR) status in patients with unexplained delayed ovulation, and in patients with ovulation induction by clomiphen citrate. The purpose of this study was to determine whether the length of the follicular phase influences the endometrial histological maturation and the hormonal receptor status, and to know the effect of clomiphen citrate on the endometrium. In the delayed ovulation group, the endometrium was characterized by an irregular outpouching and dilated lumina of the glands, a decreased secretory activity and predecidualization, and a decreased number of granulocytes in the stroma. In the clomiphen citrate-ovulation induction group, glandular proliferation was markedly diminished with poorly convoluted and narrow glands, secretory activity was decreased, stroma was undecidualized, and there was an absence of granulocytes. ER expression was increased in the glandular epithelium in the delayed ovulation group, and both ER and PR expressions were markedly decreased in the glandular epithelium and stromal cells in the ovulation induction group. Endometrial maturation and differentiation may be diminished by increased estrogenic and relatively deficient progesterone effects in patients with delayed ovulation. The hormonal receptor status might also be influenced by hormonal changes. Clomiphen citrate successfully induced ovulation in patients with delayed ovulation, however, endometrial proliferation and maturation were markedly suppressed. This might be related to the lower pregnancy rate and higher abortion rate in patients with clomiphen citrate induced ovulation.
- Atypical Polypoid Adenomyomas of the Endometrium: 2 case reports.
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Hee Jeong Ahn, Kyu Rae Kim, Yoon Jung Choi, Bok Soo Kim
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Korean J Pathol. 1996;30(11):1034-1039.
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- Atypical polypoid adenomyoma(APA) is a rare benign polypoid tumor arising in the uterine endometrium which was first designated by Mazur in 1981. Microscopic examination reveals architecturally and cytologically atypical endometrial glands separated by intersecting fascicles of smooth muscle cells. The tumor can be misdiagnosed as endometrial adenocarcinoma with myometrial invasion, especially on microscopic examination of a curettage specimen. However a granulation tissue-like stromal response is absent and the smooth muscle in APA is more cellular than that of normal myometrium. We are reporting 2 cases of APA of the uterine endometrium which are 1.5 cm and 1.7 cm in size, respectively, in a 30 and a 22 year-old women. This is the first report in Korean literature using the immunohistochemical staining for smooth muscle actin and desmin.
- Metastatic Gestational Trophoblastic Disease in the Lung Occuring with Hydatidiform-mole in Tubal Pregnancy: A case report.
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Hee Jeong Ahn, Kyu Rae Kim, Chang Jo Chung
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Korean J Pathol. 1996;30(9):851-853.
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- Gestational trophoblastic disease associated with the tubal pregnancy is uncommon, and the incidence has been described as 1/5000 tubal pregnancy. We have experienced a case of metastatic gestational trophoblastic disease(GTD) in the lung occuring with complete hydatidiform mole arising in tubal pregnancy. The patient was a 39-year-old, G4P2A2L2 woman with amenorrhea for 5 weeks. Ectopic pregnancy in the right fallopian tube was suspected on transvaginal ultrasonogram. A right adnexectomy was performed. The fallopian tube was markedly dilated and ruptured. The right ovary and a round hematoma had adhered to the external surface of the fallopian tube. On gross examination, no molar tissue was identified. On microscopic examination, the lumen of the dilated fallopian tube was filled with blood clots admixed with several chorionic villi showing hydropic swelling and marked proliferation of atypical trophoblasts.
Proliferating syncytio-and cytotrophoblasts invaded the wall of the blood vessels of the fallopian tube and sheets of trophoblasts and some villi were identified in the lumen of blood vessels. Multiple pulmonary nodules thought to be metastatic nodules were identified in the chest X-ray and serum beta-HCG had increased 2 weeks later. This case indicates that a careful pathological examination in the ectopic pregnancy is mandatory, because tubal GTD is not clinically distinguishable from ordinary tubal pregnancy.
- Effects of Progesterone Treatment on the Squamous or Morular Metaplasia Associated with Endometrial Hyperplasia.
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Kyu Rae Kim, Hee Jeong Ahn
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Korean J Pathol. 1996;30(8):680-686.
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- During evaluation of follow-up curettage of endometrial hyperplasia after progesterone treatment, we have noticed that the foci of squamous or morular metaplasia are persistent or even markedly increased after the hyperplastic glands have all disappeared. These observations have led us to study the histological changes of squamous or morular metaplasia in the hyperplastic endometrium after progesterone treatment and to examine the changes of estrogen receptors(ER) and progesterone receptors(PR) to find out, if there is any pathogenetic role of progesterone administration on the squamous or morular metaplasia.
Squamous or morular metaplasia was associated in 21 cases (13.5 %) out of 156 endometrial hyperplasia during the study periods and all of them were associated with complex hyperplasia, but not associated with simple hyperplasia. At follow-up curettage after progesterone treatment, squamous metaplasia newly appeared in 3 cases(20 %), markedly increased in 4 cases(26.7%), persisted in 4 cases(26.7%) and decreased in 4 cases(26.7%), even after hyperplastic glands have all disappeared or were markedly decreased. On immunohistochemical staining, metaplastic foci showed ER- and PR- in 13 cases (87 %) in contrast to the surrounding endometrium and the remaining 2 cases showed minimal ER+ and PR+ confined to several nuclei. Intensity or staining pattern of ER and PR in metaplastic foci were not changed with progesterone treatment. In the background endometrium, intensity of glandular ER+ and PR + was higher than that of the stroma at the initial curettage, however, progesterone treatment predominantly down-regulated glandular ER+ more than stromal ER+. Increment or persistence of squamous metaplasia along the progesterone treatment seemingly would implicate hormonal influences as playing a significant role in the formation of squamous or morular metaplasia and the absence of cellular receptors for these hormones in the metaplastic foci may suggest qualitative changes in the receptors.
- roded Polypoid Hyperplasia of the Rectosigmoid Colon: Report of 2 cases with special reference to its relation to mucosal prolapse syndrome.
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Nam Hoon Cho, Hee Jeong Ahn, Chan Il Park
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Korean J Pathol. 1994;28(3):297-301.
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- Polypoid prolapse of mucosal folds can occur at various sites and in various conditions predominantly associated with strain during defecation. There are two well known types of mucosal prolapse syndrome(MPS), the inflammatory cloacogenic polyp(ICP) and the mucosal redundant polyp associated with diverticular disease(N4RPD). ICP is a mucosal prolapse of the anorectal junction and MRPD is a proximal analogue involving the sigmoid colon. We experienced two cases of eroded polypoid hyperplasia(EPH) of the rectosigmoid colon which manifested as a huge gyriform mass simulating the gross features of gastrointestinal lymphomas or other malignant tumors. The EPH consisted of confluent polypoid mucosal folds with rolled-up submucosa to form stalk, The polypoid lesion represented hyperplastic epithelium, erosion of the mucosal surface and congestive vascular ectasia of lamina propria and submucosa. To explain the whole morphologic features, the initial phenomenon should be the mucosal prolapse. Vascular stretching with ischemic erosion of the mucosal surface and compensatory epithelial hyperplasia ensue as the result. The ominous endoscopic and gross features of EPH should be kept in mind to avoid erroneous radical surgery.
- A Pathological Review of Pleural Effusion by Immunocytochemical Methods.
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Dong Hwan Shin, Hee Jeong Ahn, Woo Ick Yang, In Joon Choi
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Korean J Pathol. 1990;24(4):476-481.
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- An unequivocal diagnosis of mesothelioma during life, on the basis of limited biopsy tissue or cytological specimens, is frequently difficult and requires distinction from inflammatory mesothelial hyperplasia on the one hand and secondary neoplasms, especially adenocarcinoma on the other.
Although some studies have produced conflicting results, it is generally believed that immunohistochemical methods can aid in this distinction. To obtain comparable and reproducible results, 23 metastatic carcinoma of the pleura and 2 unequivocal malignant epiehtlial mesotheliomas were studied by the peroxidase-antiperoxedase method on paraffin-embedded cell blocks, and commercially available antibodies to carcinoembryonic antigen (CEA), keratin and epithelial membrane antigen (EMA) were used. Nineteen metastaic adenocarcinoma (73%) and two mesotheliomas (100%) reacted with keratin and EMA antibodies. Nineteen matastatic adenocarcinomas (73%) reacted with EMA antibodies. Nineteen metastatic adenocarcinoma (73%) reacted with CEA antibody; no mesotheliomas stained for CEA. Two cases of reactive mesothlial hyperplasia showed positive for keratin, but negative reaction for EMA and CEA. Noen of the antibodies used in this study was specific for mesothelioma, but CEA was found to be the most useful marker for differentiating between mesothelioma and metastatic carcinoma.
- Expression pattern of Hepatitis B Viral Core Antigen (HBcAg) and Surface Antigen (HBsAg) in Liver of the Inactive HBsAg Carriers.
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Hee Jeong Ahn, Kyoung Ho Kim, Young Nyun Park, Ho Guen Kim, Chan Il Park
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Korean J Pathol. 1990;24(2):120-127.
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- To understand better the complex natural course of HBV infection, the expression patterns of HBcAg and HBsAg in the liver of 51 inactive serum HBsAg carriers (24 CPH and 27 NPD) were studied by immunohistochemical methods. The inactive serum HBsAg carriers were devided into 3 groups by the following expression patterns of serum HBeAg/anti-HBe status and tissue HBcAg and HBsAg. Pattern A (18 cases) : HBeAg+, cHBcAg+ (94.4%), mHBsAg+ (61.1%), pATTERN B (14 cases) : anti-HBe+, nHBcAg+, cHBsAg+, Pattern C (19 cases) : anti-HBe+, HBcAg-, cHBsAg+ (89.5%). There were no significant differences between CPH and NPD, lthough the core free pattern was more common in the latter. The cHBcAg was expressed in 17 of 18 (94.4%) HBeAg seropositive cases but only one of 33 cases with serum anti-HBe, suggesting that the cHBcAg is intimately related to HBeAg. Since the inactive HBsAg carriers also expressed cHBcAg and/or mHBsAg, the necro-inflammatory activity of HBV infected liver is assumed to depend on the host immune response rather than their presence alone
- Histopathological Studies of 300 Cases of Non-Hodgkin's Lymphoma in Korean Patients.
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Hee Jeong Ahn, Soon Hee Jung, Hyen Joo Jeong, Dong Hwan Shin, Kwang Gil Lee, In Joon Choi
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Korean J Pathol. 1988;22(3):222-231.
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- Non-Hodgkin's malignant lymphoma is a relatively frequent lymphoreticular malignancy, and has been reported to constitute up to 5.2% of all malignant tumors in Korean patients. Various morphologic classifications of non-Hodgkin's lymphoma have been proposed, and among them, the Rappaport's classification has been most widely accepted. In 1982, a National Cancer Institute sponsored study on classification led to the creation of the Working Formulation in an attempt to resolve the controversy anddebate regarding the various classifications of non-Hodgkin's lymphoma. Angioimmunoblastic lymphadenopathy with dysproteinemia and polymorphic reticulosis are lymphoreticular proliferative disorders which have reported to transform to malignant lymphoma. The purpose of the present study is to reclassify non-Hodgkin's lymphomas according to the Working Formulation and to investigate the histopathological and immunocytochemical characteristics of angioimmunoblastic lymphadenopathy with dysproteinemia and polymorphic reticulosis. This study reviewed 300 cases of nodal and extranodal non-Hodgkin's lymphoma, 26 cases of polymorphic reticulosis, and 7 cases of angioimmunoblastic lymphadenopathy with dysproteinemia examined in the Departments of Pathology, Yonsei University College of Medicine, Youngdong Severance Hospital and Yonsei University Wonju College of Medicine from January 1977 to December 1986. In non-Hodgkin's lymphoma, each case was classified according to the Working Formulation and the Rappaport classification. All angioimmunoblastic lymphadenopathy with dysproteinemia and polymorphic reticulosis cases were subjected to histopathological analysis and a review of the clinical records. Immunocytochemical studies were done using kappa and lambda chains for B-cell markers and alpha-1-antichymotrypsin for histiocytic marker. The results obtained were as follows; 1) Among 300 cases of non-Hodgkin's lymphoma, the primarily involved tumor sites were the lymph nodes (141 cases), the gastrointestinal tract (67 cases), and the tonsils (32 cases) in descending order of frequency. 2) Using the Working Formulation, intermediategrade lymphomas occurred in 66.4% of the patients, and the most common subtype was "diffuse, large cell" (32.7%). By the Rappaport classification, 3 patients had nodular lymphomas, and "diffuse, histiocytic" was the most common subtype. 3) Infarction was present in 32 cases in which the "diffuse, lagre cell" type was most frequently associated. 4) In immunoperoxidase stains of 7 cases of angioimmunoblastic lymphadenopathy with dysproteinemia, proliferating immunoblasts revealed a polyclonal positivity for kappa and lambda chains. Atypical reticulocytes present in 26 cases of polymorphic reticulosis revealed a negativity for kappa, lambda and alpha-1-antichymotrypsin.
- A Histopathologic, Histochemical and Immunocytochemical Study of Cardiac Myxoma.
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Dong Hwan Shin, Hee Jeong Ahn, In Joon Choi
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Korean J Pathol. 1987;21(2):75-81.
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- The immunoreactivities of surgically removed 16 cardiac myxomas were studies for factor VIII-related Ag (F VIII-RA), Ulex europaeus agglutinin I (UEA-I) and desmin alpha1-antichymotrypsin, and this study was accompained by a clinicopathologic review. More than 50% of the patients with cardiac myxomas were in their fourth and fifth decades, and cardiac myxomas were much more common in women than in men.
All but on occurred in the left atrium, and the majority were attached to the atrial septum, usually in the region corresponding to the fossa ovalis. In one case, an atrial myxoma recurred 37 months after the initial excision.
Microscopically, the myxomas contained a myxoid matrix composed of acid mucopolysaccharides within which were embedded polygonal cells. The cells forming both the surface and complicated vascular like channels throuhout the myxoid stroma tested positive for F VIII-RA and UEA-I. The outer cell layers of the complex vascular structures demonstrated variable staining for F VIII-RA, while isolated bundles of smooth muscle cells were present and stained for desmin. A small number of the so-called myxoma cells, immunoreactive for alpha1-antichymotrypsin which were not laden with hemosiderin pigment but were similar to histiocytes, were present particularly around the areas of hemorrhage. These findings support the current view that cellular and histologic heterogeneity arose from the divergent differentiation of multipotential mesenchymal cells. In particular, it remains to be confirmed by further study whether or not true histiocytic differentiation occurs.
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