Journal of Pathology and Translational Medicine

Volume 12(2); December 2001

Original Articles

Detection of Epstein-Barr virus in the inflammatory and neoplastic uterine cervical lesions.: Hye Jin Jeong, Eung Seok Lee, Zhen Hua Lin, Seol Hee Park, In Sun Kim, Jae Sung Kang; Korean J Cytopathol. 2001;12(2):73-80.

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Abstract PDF: The prevalence of Epstein-Barr virus(EBV) in the uterine cervix was investigated to define the possible etiologic role in cervical carcinogenesis. The viral genotyping and LMP-1 30bp deletion were also studied. The materials included 169 uterine cervical swabs(152 within normal limits, 12 atypical squamous cells of uncertain significance, 3 low grade intraepithelial lesions, and 2 high grade squamous intraepithelial lesion) and 104 uterine cervical tissues obtained from hysterectomy specimens(32 carcinoma in situ, 9 microinvasive squamous cell carcinomas, 37 invasive squamous cell carcinomas, 7 adenocarcinomas, 7 adenosquamous carcinomas, and 12 cervicitis). EBV detected by PCR for EBNA-1 was positive in 52(56.5%) of 92 invasive and noninvasive cervical carcinomas, and 80(48.8%) of 164 inflammatory or normal cervices. The viruses detected in carcinomas were all type A, and LMP-1 30bp deletion form was more frequent in premalignant and malignant cervical lesions than in nonneoplastic cervices. From the above results, it may be concluded that EBV is one of common viruses detected in uterine cervix of Korean women, and type A virus and LMP-1 30bp deletion form may have a role in cervical carcinogenesis.

Immunocytochemical Expression of E-cadherin in Cell Blocks of Serous Effusions.: Byung Heon Kim, O Jun Kwon; Korean J Cytopathol. 2001;12(2):81-88.

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Abstract PDF: The differentiation between reactive mesothelial and carcinoma cells in serous effusion cytology can be a diagnostic challenge based on morphology alone. The expression of some cell adhesion molecules may be helpful in the differential diagnosis. This study evaluated the usefulness of E-cadherin immunocytochemistry for discrimination of carcinoma cells from reactive mesothelial cells. Alcohol fixed, paraffin embedded cell blocks taken from 42 reactive and 102 malignant serous effusions with histologically confirmed diagnoses were immunostained with monoclonal antibody to E-cadherin by LSAB method. E-cadherin expression was identified in only 2 benign reactive serous effusions(5%) whereas 91 malignant serous effusions(89%) expressed E-cadherin. The differences in immunostaining for E-cadherin between reactive and malignant serous effusions were statistically significant(p<0.001). The sensitivity and specificity of the E-cadherin immunostaining for carcinoma cells were 89% and 95%, respectively. In conclusion, E-cadherin is a useful diagnostic adjunct for differentiation between reactive mesothelial and carcinoma cells in serous effusions.

Utility of Calretinin in Distinction between Benign Reactive Mesothelial and Carcinoma Cells in Serous Effusions.: Byung Heon Kim; Korean J Cytopathol. 2001;12(2):89-96.

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Abstract PDF: The cytological distinction of carcinoma cells from reactive mesothelial cells in serous effusions may be difficult or impossible based on morphology alone, especially in specimens containing reactive mesothelial cells which form glandular or ball- or papillary-shaped conglomerates or which mimic malignant nuclear features. Calretinin is a newly reported immunocytochemical marker for mesothelial cells, which can potentially be utilized for facilitating this distinction. This study evaluated the usefulness of calretinin for the discrimination between reactive mesothelial and metastatic carcinoma cells in serous effusion. Immunocytochemical staining was undertaken on 33 benign reactive and 87 malignant serous effusion specimens with histologically confirmed diagnoses. The specimens including smears and cell blocks were stained with polyclonal antibody to calretinin by labelled streptavidin-biotin method. The positive expression of calretinin was noted in 32(97.0%) of 33 benign reactive effusions and 9(10.3%) of 87 malignant effusions. The sensitivity and specificity of the calretinin immunostaining for reactive mesothelial cells was 97.0% and 89.7%, respectively. In conclusion, calretinin is a useful marker for distinguishing between reactive mesothelial cells and carcinoma cells in serous effusions.

Case Reports

Exfoliation of endometrial cells on cervicovaginal smears.: Miseon Kang, Hye Kyoung Yoon; Korean J Cytopathol. 2001;12(2):97-103.

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Abstract PDF: The significance of endometrial cells on cervicovaginal smears is underestimated. The aim of this study is to evaluate the detection rate of endometrial cells on cervicovaginal smears. The materials consisted of two groups. Group I was 701 cervicovaginal smears from patients with no gynecological problems. Group II was 208 cervicovaginal smears from patients with abnormal uterine bleeding followed by endometrial curettage; 31 cases of endometrial adenocarcinoma(CA), 19 cases of endometrial hyperplasia(HP), 83 cases of dysfunctional uterine bleeding(DUB), and 75 cases of normal endometrium. Cervicovaginal smears was reviewed according to the criteria of The Bethesda System. Endometrial cells were identified in 15 of 701 cases(2.1%) in group I and 64 of 208 cases(30.8%) in group II. Among group II, detection rate of endometrial cells was the highest in CA (51.6%) compared to HP(26.3%), DUB(41.0%), and normal endometrium(12.0%) (p<0.05). Cytologic atypia of endometrial cells was not found in group I, but was more frequently identified in CA(87.5%) than in HP(10.5%) or DUB(14.7%) (p<0.05). Exfoliation of endometrial cells might be related to abnormal endometrial lesion, and reporting of endometrial cells in the cervicovaginal smear may increase a chance to detect endometrial lesions especially in patients with abnormal uterine bleeding.

Cytologic Features of the Chordoma: Report of five cases.: Dong Hoon Kim, Shin Kwang Khang, Gyun Gyub Gong; Korean J Cytopathol. 2001;12(2):105-110.

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Abstract PDF: Chordoma is a rare, clinically and morphologically well characterized tumor, which arises from remnants of the notochord. The majority(60%) occurs in the sacrococcygeal region, with 25% in the clival region, and 15% in the spine. Although most chordomas do not develop metastasis, the long term prognosis is very poor due to local progressive tumor growth and tendency to recur if incompletely excised. The chordoma has characteristic cytologic features which make a preoperative diagnosis possible. We reviewed the cytologic findings of five patients with chordoma(one oropharynx, two clivus, and two sacrum). The patients were three male and two female, aged from 29 to 77 years(mean 60). Of five chordomas, there were local recurrences in two cases and metastasis of lymph node in one case. Four were FNA smears and one was squash smear taken from intraoperative consultation. All five cases show similar cytologic features. The dominating tumor cells were large with round nuclei and pale-stained vacuolated cytoplasm. The small round uniform cells and short spindle- shaped cells were frequently noted. The cells were surrounded by myxoid or mucoid matrix. The chordoma has characteristic cytologic features which make a preoperative diagnosis possible.

Fine Needle Aspiration Cytology of Solitary Fibrous Tumor of the Pleura: Report of a case misdiagnosed as denocarcinoma of lung.: Yoon La Choi, Young Lyun Oh, Mee Sook Lee, Jung Ho Han, Geung Hwan Ahn; Korean J Cytopathol. 2001;12(2):111-115.

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Abstract PDF: Solitary fibrous tumor of the pleura is rare but should be included in the differential diagnosis of a peripheral pulmonary nodule. Cytologic features of solitary fibrous tumor of the pleura is not familar to the pathologist and may be misdiagnosed as malignancy. We report fine needle aspiration cytologic(FNAC) findings of a case of solitary fibrous tumor misdiagnosed as adenocarcinoma in a 48-year-old woman. The FNAC displayed a mixture of bland-looking spindle cells and clusters of epithelioid cells, which have hyperchromatic nuclei with prominent nucleoli. The helpful finding to distinguish it from other circumscribed benign and malignant lesions is the presence of fibromyxoid matrix admixed with blood vessels and thin collagen fibers. Familiarity with these features is essential to avoid misdiagnosis and overtreatment.

Fine Needle Aspiration Cytologic Findings of Gastric Inflammatory Myofibroblastic Tumor: A case report.: Ji Hye Lee, Bong Kyung Shin, Chung Yeul Kim, Seong Jin Cho, Han Kyeom Kim, In Sun Kim; Korean J Cytopathol. 2001;12(2):117-120.

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Abstract PDF: Inflammatory myofibroblastic tumor, histologically characterized by the presence of bland-looking spindle cells and infiltration of chronic inflammatory cells, is extremely rare in the gastric wall. We report a case of gastric inflammatory myofibroblastic tumor in a 27-month-old boy. The fine needle aspiration biopsy from the mass showed loose clusters or scattered spindle cells and inflammatory cells, predominantly of lymphocytes and plasma cells. The spindle cells resembled fibroblasts or myofibroblasts. Differential diagnosis from benign and malignant diseases involving abdominal cavity was discussed.

Cytologic Findings of Primary Small Cell Carcinoma of the Urinary Bladder: A case report.: Mi Seon Kwon, Geung Hwan Ahn, Jin Haeng Chung, Seung Sook Lee, Jae Soo Koh; Korean J Cytopathol. 2001;12(2):121-126.

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Abstract PDF: Primary small cell carcinoma of the urinary bladder is a rare malignant tumor. A more rapidly fatal course may be seen in advanced stages of small cell carcinoma as compared to similar stages of urothelial carcinoma. It is very important to recognize this distinct form of bladder cancer by urinary cytology. The differential diagnosis of small cell carcinoma of the urinary bladder includes metastatic small cell carcinoma, urothelial carcinoma, and primary or secondary malignant lymphoma. This article highlights the urinary cytologic diagnosis of a case of primary small cell carcinoma. A 59-year-old male presented with gross hematuria for five months. Urinary cytology showed high cellularity consisting of tiny monotonous tumor cells in the necrotic background. The tumor cells occurred predominantly singly, but a few in clusters. The cytoplasm was so scanty that only a very narrow rim of it was seen. The nuclei were oval or round and had finely stippled chromatin. Rarely, the nuclei contain visible nucleoli. Frequently cell molding was noted in clusters. Many single cells demonstrated nuclear pyknosis or karyorrhexis. The histologic findings of transurethral resection and partial cystectomy specimen were those of small cell carcinoma. Cytologic distinction may be very difficult but careful attention to clinical features and cellualr details can classify these neoplasms correctly.

Fine Needle Aspiration Cytology of Solid Papillary Carcinoma of the Breast: Report of a case associated with mucinous carcinoma.: Hee Kyung Kim, Dong Won Kim, So Young Jin, Dong Wha Lee; Korean J Cytopathol. 2001;12(2):127-130.

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Abstract PDF: Solid papillary carcinoma of the breast is a distinctive form of intraductal papillary carcinoma frequently associated with both mucinous carcinoma and infiltrating ductal carcinoma, not otherwise specific. To our knowledge, this case is the first description of the cytologic aspects of solid papillary carcinoma of the breast in the Korean literature. We experienced a case of solid papillary carcinoma of the right breast diagnosed by fine needle aspiration cytology(FNAC) in a 70-year-old female. FNAC from the right breast showed high cellularity consisting of mostly tight clusters of tumor cells and a few scattered tumor cells. The nuclei were monotonously round to oval in shape with inconspicuous nucleoli. The cytoplasm was abundant and finely granular. Scant amount of mucinous material was present on the background. The diagnosis was confirmed histologically and immunohistochemically.

Cytologic diagnosis of a chordoma without physaliferous cells: A case report.: Yun Hee Jin, Chan Kum Park, Won Mi Lee, Moon Hyang Park; Korean J Cytopathol. 2001;12(2):131-134.

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Abstract PDF: Cytologic features of conventional chordoma have been described and most reports emphasize the presence of large cells with numerous well defined cytoplasmic vacuoles or physaliferous cells. We report fine needle aspiration cytologic (FNAC) findings of a case of chordoma without physaliferous cells. The smear was cellular and composed of large cohesive clusters or individually scattered cells in mucinous background. The round or cuboidal cells had centrally located nuclei with fine granular chromatin, inconspicuous nucleoli, and occasional vacuolated cytoplasm. Mild to moderate pleomorphism was noted. Physaliferous cells are extremely helpful when present in cytologic material, but they are not necessary for diagnosis. Thus clinical history, roentgenographic appearance, and exact location of the lesion are required for the successful interpretation of presacral aspirates together with cytologic findings.

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