Journal of Pathology and Translational Medicine

Volume 14(2); November 2003

Editorial

Cervical Cancer Screening in Korea.: Moon Hyang Park; Korean J Cytopathol. 2003;14(2):43-52.

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Abstract PDF: The incidence of cervical cancer has been gradually decreased since 1990, now it ranks the fourth most common carcinoma among Korean women in 2001. If squamous cell carcinomas in situ are included, the cervical cancer is still the most frequent tumor in Korean women. However, cervical cancer mortality in Korea has been decreased over the last 10 years in large part attributable to the introduction of the Papanicolaou test (Pap. test). The guidelines for the early detection of cervical cancer recommend women aged 30 and more to take biennial screening with Pap. test. According to the screening data of National Health Insurance Corporation (NHIC), 4,425 women (0.94%) showed an abnormal Pap among 473,395 cases tested in 2001; dysplasia was in 3,953 (0.84%) women, in situ carcinoma in 357 (0.075%) women, and invasive carcinoma in 115 (0.024%) women. The detection rates of abnormal Pap. were 4.21% in Korean Society for Cytopathology (KSC-2001), 1.37% (ASCUS : 0.26%, AGUS : 0.03%, LSIL : 0.45%, HSIL : 0.55%, Carcinoma : 0.09%) in health check-up and 5.41% (ASCUS : 1.89%, AGUS : 0.69%, LSIL : 1.39%, HSIL : 0.84%, Carcinoma : 0.64%) of patients in out-patient clinic without having history of cervical neoplasia at Hanyang University Hospital in 2002. Low rate of cervical cancer screening (34%) in Korea is mainly due to the lack of information for the low income people regarding national cancer screening program. More adequate budget by government and more man-power for precise screening, new guideline and system for management of the cervical cancer patients are required.

Original Articles

Diagnostic Correlation and Accuracy Between Fine Needle Aspiration Cytology and Histopathologic Examination.: Jin Hee Sohn, Seoung Wan Chae, Eun Yoon Cho, Eo Jin Kim; Korean J Cytopathol. 2003;14(2):53-59.

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Abstract PDF: Fine needle aspiration cytology (FNAC) has been known as a very sensitive and effective method for preoperative diagnosis. We studied cases preoperatively diagnosed by FNAC and confirmed by the histopathologic examination to define the effectiveness of FNAC. A total of 567 cases including breast, thyroid gland, lymph node, and soft tissue confirmed histologically after FNAC were enrolled, among 2,844 FNAC cases from January 1996 to March 2000. Overall sensitivity and specificity of FNAC were 93% and 100%, respectively. Sensitivity and specificity of FNAC by sites or organs were 91% and 100% in breast, 100% and 100% in thyroid, 97% and 100% in lymph node, and 71% and 100% in soft tissue, respectively. Nine cases showed diagnostic discrepancy; eight cases of sampling error and one case of interpretation error. Five cases, diagnosed as fibrocystic change at FNAC but invasive ductal carcinoma after the histopathologic examination, were categorized as sampling error due to the presence of diffuse fibrosis or deep seated location. One case of breast, diagnosed descriptively as atypical ductal and stromal cells suggesting invasive ductal carcinoma at FNAC but malignant phyllodes tumor histologically, was categorized as interpretation error. Other cases of sampling errors were two cases of soft tissue, a case of lymph node, and a case of salivary gland.

Sensitivity of AutoPap Primary Screening System with Location-Guided Screening in Uterine Cervical Cytology.: Jong Sun Choi, Hoi Sook Jang, Hy Sook Kim, Yi Kyeong Chun, Hye Sun Kim, Ji Young Park, In Sou Park, Sung Ran Hong; Korean J Cytopathol. 2003;14(2):60-65.

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Abstract PDF: OBJECTIVE: The sensitivity of the AutoPap Primary Screening System with Location-Guided Screening (AutoPap LGS) for identifying atypical cells in cervicovaginal smears was evaluated. METHODS: Two hundred forty one slides with atypical cervical cytology randomly sampled were rescreened both manually and by the AutoPap LGS. The AutoPap LGS localized the atypical cells as 15 fields of view(FOVs), which were reexamined by manual review. The sensitivity was also evaluated in accordance with the cellularity of the smears. RESULTS: The AutoPap LGS successfully processed 232 out of 241 slides. The sensitivity of the AutoPap LGS identifying the atypical cells in successfully processed slides was 97.4%(226/232). The false negative rate was 2.6%(6/232). There was no false negative case in high grade squamous intraepithelial lesion (HSIL) or squamous cell carcinoma(SCC) smears in the AutoPap LGS. The FOVs localized the diagnostic-atypical cells in 97.8%(221/226). The number of diagnostic-atypical FOVs was increased in higher-degree of atypical cytology. The AutoPap LGS localized the atypical cells in 100% of adequately cellular smears and in 92.5% even in low cellular smears. CONCLUSION: The AutoPap LGS showed relatively good sensitivity to detect atypical cells. It can be a valuable system to localize atypical cells, especially in HSIL or cancer slides, even in smears with low cellularity.

Case Reports

Cytologic Features of Signet Ring Cell Carcinoma of the Uterine Cervix: A Report of Two Cases.: Hyun Yee Cho, Seung Yeon Ha, Jaegul Chung, Young Ha Oh, Dong Hae Chung, Na Rae Kim, Jong Min Lee, Eui Don Lee; Korean J Cytopathol. 2003;14(2):66-70.

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Abstract PDF: Signet ring cell carcinoma is a rare type of mucinous adenocarcinoma of the uterine cervix. To the best of our knowledge, there is no report on cytologic findings of primary signet ring cell carcinoma of the uterine cervix in the literature. Recently, we experienced two cases of signet ring cell carcinoma of the uterine cervix. The finding of characteristic signet ring cells on cervicovaginal smear led to the diagnosis of signet ring cell carcinoma. However, primary signet ring cell carcinoma could not be cytologically distinguished from more common metastatic tumor. Therefore, diagnosis rests upon the recognition of signet ring cells and the absence of signet ring cell carcinoma elsewhere.

Uterine Tumor Resembling Ovarian Sex-Cord Tumor: A Case Report of the Cytologic Finding.: Insun Kim, Eun Mee Han, Woon Yong Jung, Ju Han Lee, Bum Woo Yeom; Korean J Cytopathol. 2003;14(2):71-75.

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Abstract PDF: Uterine stromal tumors with features of ovarian sex-cord differentiation are relatively rare. The neoplasms composed of sex cord-like components in more than 50% of the tumor are classified as group II. We report the cytologic findings of a case of uterine tumor resembling ovarian sex-cord tumor. The cervical smears of a 62-year-old woman with submucosal tumor showed loose aggregates of spindle cells as well as glandular or tubular structures of round cells with a distinct cell membrane and a prominent small nucleolus. Because uterine stromal tumor can have sex cord differentiation, its possibility should be considered in the interpretation of cervical smears.

The Fine Needle Aspiration Cytologic Features of Apocrine Carcinoma of the Breast: A Case Report.: Minseob Eom, Jin Kyu Park, Soon Hee Jung, Kwang Gil Lee; Korean J Cytopathol. 2003;14(2):76-81.

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Abstract PDF: Apocrine carcinoma of the breast is a very rare subtype. Although it has no clinical differences from usual ductal carcinoma of the breast, it should be categorized as a subtype of breast carcinoma because the cells of apocrine carcinoma reveal characteristic abundant eosinophillic cytoplasms with intraductal apical snouting as well as round or oval nuclei and central macronucleoli. On fine needle aspiration cytology, the cells of apocrine carcinoma have a lot of similarity to benign or reactive apocrine cells of the breast. Therefore, it is difficult to make a differential diagnosis of apocrine carcinoma from mammary neoplasms with similar cytologic findings unless the subtle cytologic differences are recognized. We report the cytologic and histologic findings of a case of apocrine carcinoma in the breast of a 40-year-old female patient. After the fine needle aspiration cytology, she received the lumpectomy and lymph node dissection. The cellularity was moderate to high. The cytoplasmic borders of tumor cells of three-dimensional clusters were relatively distinctive, and the cytoplasm was abundant, eosinophilic, and granular. Although the nuclear/cytoplasmic ratio was low, the nuclei of the cells were variable in size and shape with prominent macronucleoli. Histologically, it was a typical invasive apocrine carcinoma, showing numerous cytoplasmic lysosomes and mitochondriae on electron microscopy.

Urine Cytology of Prostatic Adenocarcinoma: A Case Report.: Won Ae Lee, Mi Seon Kwon, Jai Hyang Ko, Na Hye Myong; Korean J Cytopathol. 2003;14(2):82-85.

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Abstract PDF: Prostatic adenocarcinoma cells can be detected in urine cytology specimens when the tumor extends to the bladder mucosa. We report a case of prostatic adenocarcinoma diagnosed by urine cytology. A 70-year-old man presented with urinary frequency and low back pain. On rectal examination, a nodular mass was palpated in the left side of prostate. Bone scan revealed multifocal hot lesions suggesting metastasis. Urine cytology revealed hypocellular smear on clean or bloody background. Tumor cells were mainly arranged in syncytial or papillary clusters which occasionally contained foci of luminal formation. The cytoplasm of tumor cells was finely granular. The nuclei of tumor cells revealed evenly distributed fine chromatin and large prominent nucleoli without nuclear pleomorphism. In needle biopsy specimen of prostate, tumor cells were detected in entire prostatic tissue with extension to pericapsular soft tissue. The tumor cells infiltrated individually or in a cord-like fashion with foci of cribriform pattern. Inconspicuous nuclear pleomorphism and prominent nucleoli were also noted.

Fine Needle Aspiration Cytology of Kimura's Disease of Parotid Gland: Report of A Case Cytologically Failed to Diagnose as Kimura's Disease.: Se Hoon Kim, Haeryoung Kim, Sung Eun Kim, Woo Ick Yang, Soon Won Hong, Kwang Gil Lee; Korean J Cytopathol. 2003;14(2):86-90.

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Abstract PDF: Kimura's disease is a chronic inflammatory disorder of unknown cause and is most prevalent among Asians. The cytologic findings of Kimura's disease are significant numbers of eosinophils in a background of lymphoid cells, occasional fragments of collagenous tissue, proliferation of vessels, and Warthin-Finkeldey polykaryocytes. Among these features, the most important cytologic feature of Kimura's disease is a significant numbers of eosinophils. We experienced a case of Kimura's disease in the parotid gland which we failed to recognize on cytology due to the apparent paucity of eosinophils. On careful retrograde reviewing of the cytologic findings, a few scattered leukocytes, previously interpreted as polymorphous leukocytes, had bilobed nuclei and coarse green but granular cytoplasm on Papanicolaou preparation. These leukocytes showed obvious orange-red intracytoplasmic granules as in eosionophils on Giemsa stain. The paucity of eosinophils may be due to the thick fibrosis around lymphoid follicles or any technical error during aspiration. Whereas the Warthin-Finkeldey type giant cell is not a sensitive cytologic marker of Kimura's disease, it may be a helpful cytologic feature. To reach a correct cytologic diagnosis of Kimura's disease, it is important to keep in mind that searching for Warthin-Finkeldey type giant cells and evaluation of Giemsa stain for detection of eosinophils would be helpful.

Fine Needle Aspiration Cytology of the Intraductal Papillary Mucinous Tumor of the Pancreas: A Case Report.: In Gu Do, Jae Hoon Park, Youn Wha Kim, Ju Hie Lee, Moon Ho Yang, Sung Wha Hong, Yong Koo Park; Korean J Cytopathol. 2003;14(2):91-95.

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Abstract PDF: Intraductal papillary mucinous tumor of the pancreas is characterized by intraductal papillary proliferation of mucin-producing epithelial cells with or without excessive mucin secretion. According to the degree of epithelial dysplasia, intraductal papillary mucinous tumor is classified into adenoma, borderline tumor, and carcinoma. We recently experienced a case of fine needle aspiration cytology of the intraductal papillary mucinous adenoma in a 69-year-old male. The fine needle aspiration cytology yielded flat sheets of columnar, mucin containing epithelial cells in the background of dense mucin containing degenerated cellular material and histiocytes.

Fine Needle Aspiration Cytology of Biphasic Synovial Sarcoma: A Case Report.: Hee Kyung Kim, So Young Jin, Dong Wha Lee; Korean J Cytopathol. 2003;14(2):96-101.

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Abstract: Synovial sarcoma is a rare soft tissue tumor accounting for 5-10% of soft tissue sarcomas. Most arise in the extremities and trunk, and a small proportion occur in the abdominal wall, head and neck region, and mediastinum. It manifests different phenotypic subtypes that render their cytologic evaluation challenging. Moreover, cytomorphologic description of the epithelial component of synovial sarcoma is rare in Korea. We report a case of biphasic synovial sarcoma on the right lower extremity in a 49-year-old woman diagnosed by fine needle aspiration cytology. The aspirate was moderately cellular and composed of a mixture of tissue fragments and dissociated cells with bland chromatin, inconspicuous nucleoli, and oval to spindle-shaped cytoplasm. Mitosis was rare. A monolayer sheet of epithelial component was seen. The cells in this monolayer sheet had more abundant distinct cytoplasm, round nuclei, and prominent micronucleoli. Histologic examination showed a biphasic pattern consisting of mostly sarcomatous stroma and a few small glandular areas at the periphery of the tumor.

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