Journal of Pathology and Translational Medicine

Volume 7(1); June 1996

Original Articles

Recent Advances in Cancer Diagnosis: On an Overview of Diagnostic Cytopathologic Modalities and Ancillary Techniques.: Kital Kim, Eui Keun; Korean J Cytopathol. 1996;7(1):1-11.

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Abstract PDF: Form the concepts of cellular pathology and of exfoliative cytology, as elucidated by Virchow and Papanicolaou respectively in the late 19th and early 20th century, have evolved the primary methods for the diagnosis of cancer today. From Papanicolaou's concept of exfoliative cytology developed fine needle aspiration biopsy in the early 1960's ; this has become a major diagnostic procedure and has contributed to a significant reduction in open biopsies and, therefore, to medical cost-effectiveness. Immunobiochemical techniques provided us with a supplement to cancer diagnosis in the 1980's. The immunoperoxidase method, using monoclonal antibodies, is applied primarily as an ancillary measure to elucidate the nature of cancers. The evailability of specific monoclonal antibodies has greatly facilitated the identification of cell products or surface markers. For example, antibodies directed against intermediate filaments have proved to be of value in determining the histogenesis of poorly differentiated neoplasms. Tumor markers may serve as biochemical indicators of the presence of a neoplasm. They can be detected in plasma and other body fluids. Their concentration can be applied as a diagnostic test, for monitoring the clinical course of known cancer, and as a screening measure to detect certain cancers in a population at risk. Flow cytometry is a useful tool for distinguishing several cell characteristics. such as the immunophenotype of leukemia-lymphoma cells, the DNA content of neoplastic cells, and cell proliferation rate. Molecular biologic techniques provided a giant step for the management of cancer patients encompassing diagnosis, prognostic evaluation, and therapy. Nucleic acid hybridization techniques are utilized as Southern, Northern, and dot blots and in situ hybridization. Molecular biology and its techniques may bring a bright new horizon for understanding cancer biology and in designing therapy on the basis of gene manipulation

Role of Cytologic Scoring System in Minimizing "Gray Zone" in Breast Aspiration Cytology.: Jung Yeon Kim, Kyung Ja Cho, Seung Sook Lee, Shin Kwang Khang; Korean J Cytopathol. 1996;7(1):12-22.

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Abstract PDF: Fine needle aspiration(FNA) has been quite successful in identifying benign and malignant breast lesions, but a "gray zone" exists. A total of 697 FNAs of breast were performed at Korea Cancer Center Hospital for a period of one year. One hundred and eleven of the 697 FNAs were diagnosed as atypical or suspicious for malignancy. Among them, we reviewed 74 FNAs, in which histologic diagnoses were made, and applied cytologic grading system proposed by masood et al.(1990) to evaluate the usefulness of this system in minimizing the size of gray zone. Technical problem was responsible for equivocal diagnoses in 19 FNAs. Of the remaining 55 FNAs, 18 were benign and 37 were mali. Among benign conditions, fibroadenoma(5 cases) and fibrocystic disease with fibroadenomatous feature(3 cases) constituted the largest groups. The majority of malignant conditions were infiltrating ductal carcinoma(29 cases); however, those low grade carcinomas including tubular carcinoma(3 cases), cribriform carcinoma(2 cases), and mucinous carcinoma(2 cases) occupied a relatively large proportion Cytologic grading system was quite useful in minimizing the size of gray zone. The scores of 27 out of 29 usual infiltrating ductal carcinomas belonged to the group of cytologic malignancy, however, only 2 out of 7 low grade carcinomas got scores of malignancy. FNA from fibroadenoma or fibrocystic disease with fibroadenomatous features showed a tendency toward high scores. Experience of the cytopathologist and famillarity with cytologic alteration in breast disease cannot be overemphalized.

A study of Digital Image Analysis of Chromatin Texture for Discrimination of Thyroid Neoplastic Cells.: Sang Woo Juhng, Jae Hyuk Lee, Eun Kyung Bum, Chang Won Kim; Korean J Cytopathol. 1996;7(1):23-30.

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Abstract PDF: Chromatin texture, which partly reflects nuclear organization, is evolving as an important parameter indicating cell activation or transformation. In this study, chromatin pattern was evaluated by image analysis of the electron micrographs of follicular and papillary carcinoma cells of the thyroid gland and tested for discrimination of the two neoplasms. Digital grey images were converted from the electron micrographs; nuclear images, excluding nucleolus and intranuclear cytoplasmic inclusions, were obtained by segmentation; grey levels were standardized; and grey level histograms were generated. The histograms in follicular carcinoma showed Gaussian or near-Gaussian distribution and had a single peak, whereas those in papillary carcinoma had two peaks(bimodal), one at the black zone and the other at the white zone. In papillary carcinoma. the peak in the black zone represented an increased amount of heterochromatin particles and that at the white zone represented decreased electron density of euchromatin or nuclear matrix. These results indicate that the nuclei of follicular and papillary carcinoma cells differ intheir chromatin pattern and the difference may be due to decondensed chromatin and/or matrix substances.

Cytologic Features of Renal Cell Carcinoma: Clear Cell, Granular Cell and Oncocytoma.: Yeong Jin Choi, Youn Soo Lee, Mi Seon Kwon, Kyo Young Lee, Byung Kee Kim, Sang In Shim; Korean J Cytopathol. 1996;7(1):31-37.

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Abstract PDF: It is well known that fine needle aspiration biopsy(FNAB) is very useful and has a high accuracy rate in the diagnosis of renal neoplasms. Although there is some indecision to perform the FNAB for a rare possibility of tumor seeding along the biopsy needle tract, it tends to be used increasingly. As in the cytologic diagnosis of metastatic lesion through out the body, renal cell carcinoma should nearly always be considered in the differential diagnosis, the precise understainding of cytologic features of renal cell carcinoma with various cell types and architectural patterns is necessarily required. In this report, we present three cases of primary renal cell tumors, two of renal cell carcinomas and one of oncocytoma, preponderantly emphasizing the cytologic differential points in the FNAB specimen.

Application of Epstein-Barr Virus Cell Lines (CCL85 EB-3) in Performing the EBER mRNA In Situ Hybridization as a Positive Control.: Sung Sook Kim, Woon Sup Han, Joo Young Suh, Joo Ryung Huh; Korean J Cytopathol. 1996;7(1):38-43.

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Abstract PDF: Epstein-Barr virus(EBV) is associated with a wide spectrum of benign and malignant disorders including leukoplakia, Hodgkin's lymphoma, central nervous system lymphoma, peripheral T cell lymphoma and nasopharyngeal undifferentiated carcinoma. There are several distinctive aspects of biology of the virus that are important in investigation of virus in clinical specimens. The abundant expression of the EBER mRNA transcripts makes possible the sensitive detection of latent expression in EBV-associated tumors. Although there has been a dramatic increased interest in the direct characterization of EBV in clinical specimens, there have been few studies about the effective and reliable positive controls in performing in situ hybridization technique for EBV, especially on paraffin-embedded tissue. We applied Burkitts lymphoma cell line as positive control in EBV in hydridization using Oncor Kit. The cell block of Burkitt lymphoma cell line(CCL85 EB-3) showed strong and specific positivity for EBER in situ in nuclei of EBV infected cells.

Fine Needle Aspiration Cytology of Metastatic Cell Carcinoma of Lymph Nodes: Comparison to Non-Hodgkin's Lymphoma on 5 Cases.: Yeon Mee Kim, Hye Je Cho, Ill Hyang Ko; Korean J Cytopathol. 1996;7(1):44-50.

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Abstract PDF: Small cell carcinoma of the lung is characterized by cells with finely stippled chromatin and scanty cytoplasm as well as a particularly aggressive clinical course and favorable response to the chemotherapy. Recently percutaneous fine needle aspiration(FNA) biopsy has become both widely established and highly respected for the diagnosis of lung cancer. However metastatic small cell carcinoma of lymph node should be cytologically differentiated from the small round cell tumor of particular sites, especially malignant lymphoma, because small cell carcinoma of classic oat cell type may simulate small cell non-Hodgkin's lymphoma. We report five cases of metastatic small cell carcinoma of intermediate cell type diagnosed by FNA of the enlarged lymph nodes of the neck and axilla. The cytologic smears contained diffuse small neoplastic cells larger than lymphocytes with dense, pyknotic nuclei and extremely scanty cytoplasm. Apparently viable large tumor cells have vesicular nuclei with granular, sometimes very coarse chromatin. The characteristic cytologic features of small cell carcinoma as compared to malignant lymphoma were as follows.: 1) small cells with dense pyknotic nuclei are evenly distributed in the background of apparently viable larger tumor cells, admixed with mature lymphocytes and phagocytic macrophages. 2) small loose aggregates of cells with nuclear molding are indicative of small cell carcinoma rather than non-Hodgkin's lymphoma. 3) the cytoplasmic and nuclear fragments of tumor necrosis are more dominant in the smears of small cell carcinoma. 4) nuclear membrane and nucleoli are generally indistinct in small cell carcinoma due to condensation of chromatin.

Fine Needle Aspiration Cytology of Ovarian Cysts.: In Ae Park, Eui Keun Ham; Korean J Cytopathol. 1996;7(1):51-58.

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Abstract PDF: The cytologic samples of 26 ovarian cystic lesions from 25 women, aspirated under guide by trans-vaginal ultrasound, were evaluated for clinicopathologic correlation. Clinically 20 women were seeking medical assistance for infertility problems, and trans-vaginal cyst aspiration was done during follow-up of ovulation induction. Among them seven cases were histologically confirmed. Twenty cases of "benign cyst" in cytologic diagnosis were follicullar cyst and two cases of "endometriotic cyst" in cytology were histologically also proven in one case. One false positive diagnosis was given to corpus luteum cyst. It is emphasized that because the cysts are aspirated transvaginally and mature squamous epithelial cells occasionally could be mixed in the asmple, attention should be given not to diagnose such cases as mature cystic teratoma. According to this study, ovarian aspiration cytology is useful in the management of cystic ovarian lesions, particularly in young women.

Fine Needle Aspiration Cytology of Sparganosis.: Sung Suk Paeng, Yoon Ju Kim, Seong Eun Yang, Hee Jin Chang, Jung Il Suh, Young Chun Moon; Korean J Cytopathol. 1996;7(1):59-63.

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Abstract PDF: Human sparganosis is a rare parasitic disease in which the larval cestode proliferates in the various organs in the body. It usually presents as a subcutaneous or soft- tissue mass. By fine needle aspiration this lesion can be diagnosed with its characteristic cytologic findings. We experienced 3 cases of sparganosis diagnosed by the fine needle aspiration. Aspirates were taken from subcutaneous mass in the abdomen and both thighs respectively. The aspirates showed a portion of body of sparganum with numerous calcospherules, smooth muscles and tegmentat cells. They also revealed granulomas with various inflammatory infiltration of eosinophils, neutrophils, lymphocytes and plasma cells.

Case Reports

Cytologic Findings of Epithelial-Myoepithelial Carcinoma of the Salivary Gland: A Case Report.: Eun Sook Nam, Gu Kang, Hyung Sik Shin; Korean J Cytopathol. 1996;7(1):64-68.

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Abstract PDF: The report of aspiration cytologic findings of epithelial-myoepithelial carcinoma(EMC) in the salivary gland is extremely rare. We present a case of fine needle aspiration cytology(FNAC) from EMC in the right submandibular gland of a 46 years old male patient. Neck CT scan revealed a confined lesion in the submandibular gland without enlargement of the regional lymph node. FNAC from the tumor showed several three-dimensional cellular clusters with admixed normal acinar cells. They frequently formed branching tubular structures composed of two type of cells; darker cells having eosinophilic scanty cytoplasm with round dense nuclei and clear cells having abudant pale cytoplasm with vesicular nuclei at the periphery of clusters. The tumor cells of both types did not show pleomorphism or mitoses. The resected submandibular gland showed an ill-defined whitish firm tumor, measuring 2 X1.5X2cm. The histology revealed an infiltrative tumor showing characteristic two cell types in a duct-like arrangement surrounded by thin basement menbrane. An inner layer of darker cells and outer layer of clear cells were postive for cytokeratin in the former and S-100 protein in the latter on the immunohistochemical stain.

Extrarenal Malignant Rhabdoid tumor: A Case Report.: Sang Yong Lee, Dae Cheol Kim, Seo Hee Rha, Sook Hee Hong, Tae Hun Kang, Young Ho Lee, Kyoung Jin Nam, Jin Sook Jeong; Korean J Cytopathol. 1996;7(1):69-74.

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Abstract PDF: Malignant rhabdoid tumor is a distinct renal tumor in the pediatric age group. It was originally described as a rhabdomyosarcomatoid variant of Wilms tumor. However, subsequent studies failed to confirm myogenous differentiation, so it is now considered to be a distinct and unique type of highly malignant tumor, histogenetically unrelated. Although extrarenal forms of this tumor are rare, several examples have been described in other sites, especially the liver, prostate, paravertebral area, urinary bladder and soft tissue. We experienced a case of malignant rhabdiod tumor located in the intraabdominal cavity in a 10 month-old boy. Smear of peritoneal fluid showed round, polygonal and irregular shaped cells with large nuclei, ample cytoplasm containing Jight pink "to purple cytoplasmic inclusions, and one or a few prominent nucleoli. Immunocytochemistry revealed positivity to cytokeratin, epithelial membrane antigen and vimentin, and negativity to desmin and neuron-specific enolase. These distinct cytologic appearance and immunophenotypes were most consistent with a diagnosis of extrarenal malignant rhabdoid tumor. The cytoplasmic inclusions were correlated with eosinophilic inclusions seen in histologic section and electron microscopy confirmed this interpretation, showing filamentous aggregations in the cytoplasms of the tumor cells.

Cytologic Features of Infiltrating Lobular Carcinoma of the Breast in Ascitic Fluid: A Case Report.: Mi Kyung Lee, Kwang Gil Lee; Korean J Cytopathol. 1996;7(1):75-78.

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Abstract: We experienced a case of infiltrating lobular carcinoma of the breast in the ascitic fluid. The patient was a 49 year-old woman who presented with a palable mass of 3 months duration in the left upper quadrant of the abdomen and abdominal distension. Five years ago, she had undergone left radical mastectomy with chemotherapy and radiotherapy for infiltrating lobular carcinoma of the breast. The ascitic fluid smears revealed singly scattered small round to elliptical cells, many of which were arranged in characteristic indian-file patterns consisting of 3 to 5 cells. The tumor cells had scanty cytoplasm, rare cytoplasmic vacuoles and marked chromatin clumping with small, but prominent nucleoli.

Cytologic Features of Gaucher's Disease in the Spleen: A case Report.: Hun Kyung Lee, Gyeong Shin Park, Young Shin Kim, Kyo Young Lee, Chang Suk Kang, Sang In Shim; Korean J Cytopathol. 1996;7(1):79-83.

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Abstract PDF: Gaucher's disease is an autosomal recessive disorder resulting fror i mutation at the glucocerebrosidase locus on chromosome 1q21. As a result, glucocerebroside accumulates principally in the phagocytic cells known as Gaucher ce Is. In our case, a five-year old girl was admitted with seven days history of fever and abdominal distension. At physical examination the patient had hepatosplenomegaly. Laboratory tests revealed a hemoglobin concentration of 2.8g/L: platelet counts of 23,0001?l: normal range of white cell and differential counts, and negative Coombs' test. Liver enzymes were normal. For the evaluation of hepatosplenomegaly, fine needle aspiration was aerformed blindly against the palpable spleen. Wet-fixed hematoxylin and eosin-stained smears are made. The smears from the spleen showed predominantly macrophages with abundant cytoplasm and rather small, uniform, often eccentric nuclei with small nucleoli. The multinucleated cells were often found. The cytoplasm was pale, with more or less distinct fibrillarity. The cells had the characteristic appearance of Gaucher cells. Gaucher cells were also found it the tissue section from the liver, spleen and lymph node and the bone marrow aspirate. The diagnosis was later confirmed by determination of beta-glucosidase activity in peripheral blood leucocytes. Fine needle aspiration of the spleen is considered as a convenient procedure with a low complication rate for the diagnosis of lysosomal storage disease.

Aspiration Cytology of Epithelioid Sarcoma: A Case Report.: Kyung Ja Cho, Jung Youn Kim, Seung Sook Lee, Shin Kwang Khang; Korean J Cytopathol. 1996;7(1):84-87.

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Abstract PDF: Cytologic features of the fine needle aspiration of metastatic epithelioid sarcoma are presente. The patient was a 48 year-old male who had been sufferring from recurrent and metastatic tumors of the right upper extremity for 6 years. The aspirate from the axillary mass cytologically consisted of isolated large polygonal cells with abundant, cyanophilic, slightly granular cytoplasm. Eccentrically located large round nuclei showed finely dispersed chromatin, small nucleoli, occasional convolution and folding of nuclear membrane, and frequent binucleation. Although both histologic and cytologic similarity of epithelioid sarcoma to squamous cell carcinoma is well known, findings of cyanophilic granular cytoplasm, convoluted nuclei, and binucleation appeared to be the differential points.

Fine Needle Aspiration Cytology of Squamous Cell Carcinoma of the Breast: Report of A Case.: Kyoung Mee Kim, An Hi Lee, Kyo Young Lee, Eun Joo Seo, Sang In Shim, Han Lym Moon; Korean J Cytopathol. 1996;7(1):88-91.

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Abstract PDF: A primary squamous cell carcinoma of the breast was evaluated by fine needle aspiration cytology in a 60 year-old female. Squamous cell carcinoma is a rarely encountered lesion in the breast and nine cases of cytologic findings of mammary squamous cell carcinomahave been reported in the world literature. Our case appears to be one of these rare pure squamous cell tumors. The cytologic diagnosis was possible because of the well defined characteristics of the malignant squamous cells, similar to those found in other locations. Thorough examination of the patient did not reveal squamous cell carcinoma elsewhere.

Cytologic Features of Metastatic Thymoma in the Liver: A Cese Report.: Ji Young Kim, Kwang Gil Lee; Korean J Cytopathol. 1996;7(1):92-96.

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Abstract PDF: Extrathoracic metastases of thymomas are extremely rare, occurring in less than 2% of cases. We present a case of metastatic thymoma in the liver diagnosed by aspiration biopsy. A fine-needle aspirate from a hepatic mass of a 65-year old man who had a history of malignant thymoma locally invading pericardium was examined. Nests of epithelial cells with few scattered lymphocytes were present. The nuclei of the epithelial cells were round to oval and appeared retatively uniform and regular, with fine chromatin pattern. They had one or two, small but rather conspicuous nucleoli. Unlike previous reports on the findings of the aspiration cytology of thymomas, the charactristic biphasic pattern was not present in this case.

Fine Needle Aspiration Cytology of Metastatic Pulmonary Seminoma: A Cese Report.: Hwa Sook Jeong, Geon Kook Lee, Wun Jae Kim, Jae Ho Earm, Hyung Geun Song; Korean J Cytopathol. 1996;7(1):97-102.

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Abstract PDF: Fine needle aspiration cytologyof a pulmonary mass was performed on a 51-year-old man who had a left testicular mass. Cytologic features were composed of a homogeneous population of malignant cells associated with a background of foamy and lacelike material. The cellular features were characterized by monomorphous cell proliferation of relatively regular large cells, generally isolated or grouped. Occasionally, fine branching stroma with large tumor cells and scanty lymphocytes were noted. The tumor cells had a round, regular nucleus, prominent round nucleoli, and a thin rim of cytoplasm containing large vacuoles or lacunae filled with glycogen. The fine needle aspiration cytologic diagnosis was highly consistent with metastatic seminoma from testis and less likely primary or other metastatic carcinoma. The diagnosis of resected testicular mass was classic seminoma. Despite the fact that cytopathologists were not familiar with diagnosis of seminoma due to clinician's lack of interest in fine needle aspiration cytology of germ cell tumors including seminoma, it appears that a diagnosis of this tumor should not be problematic in cytologic material if specific histologic criteria are applied.

Original Articles

Cytologic Findings of Colon Lavage Fluid in Colon Cancer.: Hye Kyung Lee, Myung Jin Joo, Kwang Min Lee, Dong Kyu Chung, Yong Woo Choi; Korean J Cytopathol. 1996;7(1):103-106.

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Abstract PDF: Although exfoliative colonic cytology for the diagnosis of colorectal cancer has been largely abandoned due to the widespread use of colonoscopy, some authors still insiston the usefulness of colon lavage fluid. We tried evaluating the diagnostic feasibility of colon lavage fluid cytology using an orally administered balanced electrolyte solution. We collected colon lavage fluids in 106 patients prior to colonoscopy and reviewed the slides. Cytologic examination revealed neoplastic cells in 7 of 16(44%) cases of endoscopically proven adenocarcinoma patients. Therefore, we think cytologic study of colon lavage fluid may be considered as one of the noninvasive diagnostic tools in colorectal cancer.

Two Cases of Metastatic Leiomyosarcoma Diagnosed by Fine Needle Aspiration.: Shi Nae Lee, Hee Soo Yoon, Sung Sook Kim, Hae Soo Koo, Jung Su Seo; Korean J Cytopathol. 1996;7(1):107-110.

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Abstract PDF: Cytologic finding of 2 cases of metastatic leiomyosarcoma diagnosed by fine needle aspirtion cytology are reported.
Case
1 is pleomorphic leiomyosarcoma which had metastsized to the liver from the stomach of a 54-year-old male patient. The cytologic features showed highly cellular aspirates with nuclear pleomorphism and interlacing patern. Case 2 is low grade leiomyowsarcoma that occurred in the uterus of a 43-year female patient and metastsized to both lungs. The aspirates were less cellular than that of case 1, and showed spindle cells with minimal pleomorphism, but cell block revealed interlacing patterns of smooth muscle cells with occasional mitosis.

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