Journal of Pathology and Translational Medicine

Volume 6(2); December 1995

Original Articles

The Bethesda System(TBS): A New Reporting System of Cervicovaginal Smear.: Hy Sook Kim; Korean J Cytopathol. 1995;6(2):85-98.

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Abstract PDF: In 1989, the Bethesda System(TBS) was introduced as an attempt to standardize cervical/vaginal reporting systems. TBS nomenclature was created for reporting cytologic diagnoses to replace the currently used Cervical Intraepithelial Neoplasia(CIN) and Papanicolaou Class System which are deemed less reproducible. The name for preinvasive squamous lesions was changed to squamous intraepithelial lesion(SIL), subdivided into low-grade and high-grade type. TBS recommends a specific format for cytologic report, starting with explicit statement on the adequacy of the specimen, followed by general categorization and descriptive diagnosis. Pathologic and epidemiologic studies performed over last 10 years have provided evidence that human, papillomavirus(HPV) plays a significant role in the development of cervical neoplasia. TBS corresponds not only to currently held views of the behavior of preinvasive lesions and their HPV distribution, but also to the current guidelines for clinical management.

Morphometry of Nuclei in Adenocarcinoma of Prostate.: Hye Rim Park, Seung Wan Char, Jin Hee Sohn, Young Euy Park; Korean J Cytopathol. 1995;6(2):99-105.

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Abstract PDF: Morphometry of nuclei of the benign and malignant prostatic lesions was performed to study the relationship between nuclear size and shape and the prognosis of prostatic adenocarcinoma. Fifty one cases of prostatic adenocarcinoma and 13 cases of benign prostatic hyperplasia were included to evaluate area, perimeter, Dmax, Dmin, and 5 form factors of the nuclei by image analyzer(Zeiss Ibas 2000) using hematoxylineosin stained slides. All analytic factors of nuclear size and shape were significantly different between benign lesions and adenocarcinomas. Increased nuclear size was associated with nuclear irregularity, presence of metastasis, advanced clinical stage, and high Gleason's grade and score of prostatic adenocarcinoma. On Kaplan-Meier method, survival was decreased with older age, no hormonal treatment, stage D, high Gleason}s grade and stage as well as with larger size and irregular shape of the nuclei. In conclusion, morphometry of nuclei of the prostate can be a helpful tool to differentiate between benign and malignant lesions. Nuclear morphology is thought to be associated with prognosis of prostatic adenocarcinoma.

Immunocytochemical Characteristics of the Short-term cultured Mesothelial Cells.: Ho Jong Jeon, Mi Ja Lee, Mi Sook Lee, Yu Kyung Jeong, Young Mi Lee, Hyung Ho Choi; Korean J Cytopathol. 1995;6(2):106-115.

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Abstract PDF: Reactive human mesothelial cells were examined by immunocytochemical stain with intermediate filaments(cytokeratin [CK1, CK7, CK8, CK18, CD19/, vimentin, desmin, actin), epithelial membrane antigen, carcinoembryonic antigen(CEA), MHC class II antigen(HLA-DR), LeuM-1(CD15), alpha1-antitrypsin(ACT), alpha1-antichymotrypsin (ACHT), CD68(KP-1) and FcgammaRIII(CD16). The mesothelial cells were isolated from patients with liver cirrhosis and pleural effusion, and short-term cultured in RPMI 1640 media containing 10% heat inactivated fetal calf serum and 1% identical supernatant fluid of the patients' transudates. The results obtained are as follows. 1. The cultured-reactive mesothelial cells were positive for the protein of cytoskeleton such as cytokeratin and vimentin, but negative for desmin and actin. The resting mesothelial cells showed positive reactions for cytokeratin, but negative for vimentin, desmin and actin. 2. The primary antibodies to the cytokeratin were strongly reactive for CK1, CK8 and CK18 but negative for CK7 and CK19 in both reactive and resting mesothelial cells. 3. Resting mesothelial cells showed negative reactions for CEA, but strong positive reactions in cultured-reactive mesothelial cells. 4. The markers for the monocytes\histiocytes (CD11b, CD14, CD16, CD68, lysozyme and alpha1-antitrypsin and alpha1-antichymotrypsin) were nonreactive in resting mesothelial cells, but lysozyme and alpha1-antitrypsin were weakly reactive in reactive and proliferative mesothelial cells. 5. MHC Class II molecule(HLA-DR antigen) was negative in both resting and reactive mesothelial cells. These results suggest that the short-term cultured, reactive mesothelial cells show a newly aberrant expression of the vimentin and carcino-embryonic antigen. The reason of the aberrant expression of the intermediate filament and oncofetal antigen in reactive and proliferative mesothelial cells should be further evaluated.

Cytologic Analysis of Malignant Effusion.: Sang Pyo Kim, Ji Yeon Bae, Kwan Kyu Park, Kun Young Kwon, Sang Sook Lee, Eun Sook Chang, Chung Sook Kim; Korean J Cytopathol. 1995;6(2):116-124.

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Abstract PDF: Eighty cases of malignant effusion were cytologically studied to elucidate the incidence of primary tumor site and cytologic characteristics of each tumor types. Eighty fluid specimens were composed of 43 ascitic, 35 pleural, and 2 pericardial effusion and primary tumor site had been confirmed by histology. The frequent primary sites were stomach (22 cases, 28%), lung (21 cases, 26%), ovary (11 cases, 14%), liver (7 cases, 9%), and breast (4 cases, 5%). The principal malignant tumors were adenocarcinoma (56 cases, 70%), squamous cell carcinoma (7 cases, 9%), liver cell carcinoma (7 cases, 9%), small cell carcinoma (4 cases, 5%), and non-Hodgkin}s lymphoma (4 cases, 5%). The distinctive cytologic findings according to primary tumor types were as follows ; the gastric adenocarcinomas were mainly characterized by isolated cells and irregular clusters sometimes with signet ring cells. Papillary serous cystadenocarcinoma of ovary showed frequently papillary clusters and occasional psammoma bodies. Breast carcinoma of ductal type showed cell balls with smooth margins. Colonic adenocarcinoma showed rather irregular clusters or palisading pattern of cylindrical cells. Metastatic squamous cell carcinoma, liver cell carcinoma, small cell carcinoma, and non-Hodgkin}s lymphoma showed also characteristic features. These findings indicate that the cytological features observed in the great majority of malignant effusion are similar to those of primary tumor types, which are very helpful to indentify the primary tumor site.

Cytologic Analysis of Metastatic Malignant Tumor in Pleural and Ascitic Fluid.: Mee Joo, Hye Je Cho; Korean J Cytopathol. 1995;6(2):125-132.

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Abstract PDF: Cytodiagnosis of pleural and ascitic fluid is a commonly performed laboratory examination. Especially, positivity for malignant cells in effusion cytology is very effective and also presents the first sign of malignancy in unknown primary site of the tumor. We examined each 34 cases of pleural and ascitic fluid cytologic specimen diagnosed as metastatic tumor, which was selected among 964 pleural fluid cytology cases and 662 ascitic fluid cytology cases from September 1989 to June 1995. Among the ascitic fluid cytology specimens examined, 34 specimens were positive in 29 patients. The most common primary neoplasms were carcinomas of ovary (32%), stomach (32%), colon (6%), breast (3%), pancreas (3%), and lung (3%) and lymphoreticular neoplasms (3%). The metastatic tumor was predominantly adenocarcinoma type in both pleural (82%) and ascitic (91%) fluid. The study of metastatic adenocarcinoma in effusion from lung, ovary, and stomach was undertaken to find distinctive features for the identification of the primary site. The smears of metastatic pulmonary adenocarcinoma had a tendency to show high grade pleomorphism and many large tight cell clusters, whereas that of the ovarian adenocarcinoma showed low grade pleomorphism with abundant intracytoplasmic vacuoles in relatively clear background. That of the stomach revealed the intermediate features.

Analysis of Transthoracic Fine Needle Aspiration Cytologic Diagnoses of Pulmonary Nodules.: Chan Kum Park, Jung Dal Lee; Korean J Cytopathol. 1995;6(2):133-139.

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Abstract PDF: To evaluate the sensitivity and specificity of transthoracic fine needle aspiration cytology(TFNAC) in the preoperative diagnosis of pulmonary nodules, a retrospective analysis was carried out on a consecutive series of 200 TFNACs. They included 186 primary malignant tumors, 66 squamous cell carcinomas, 65 adenocarcinomas, 36 small cell carcinomas, 7 large cell carcinomas, 4 carcinoids, 8 others, 9 metastatic tumors, and 5 benign tumors. On cytohistologic correlation of malignant pulmonary tumors, the procedure had a sensitivity of 97.3% and a specificity of 100%. A 86.6% correct correlation between the cytologic and histologic diagnoses was achieved. Five out of the 7 undifferentiated large cell carcinomas, 10 out of the 65 adenocarcinomas, 2 out of the 36 small cell carcinomas, and 2 out of the 66 squamous cell carcinomas were turned out to be mistyped in cytologic diagnosis. We concluded that TFNAC is a highly sensitive and specific preoperative diagnostic procedure in the investigation of patients with discrete pulmonary nodules in whom the specific cell type of the malignant neoplasm has important implications in treatment modality and prognosis.

A Cytopathologic Analysis of Percutaneous Transthoracic Needle Aspiration Cytology of the Lung: A Six-year Correlation Study in 322 Cases.: Sook Kim, Dong Won Kim, So Young Jin, Dong Wha Lee; Korean J Cytopathol. 1995;6(2):140-147.

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Abstract PDF: In a six-year period (from May 1988 to April 1994), fine needle aspiration cytology (FNAC) of 322 pulmonary lesions from 296 patients were performed at Soonchunhyang University Hospital. Of these 322, malignancy was diagnosed cytologically in 139 (43.2%), suspicious malignancy in 7 (2.2%), negative in 164 (50.8%), and insufficient material in 12 (3.8%). Malignant lesion consisted of 54 cases of adenocarcinoma, 50 cases of squamous cell carcinoma, 18 cases of small cell carcinoma. They were verified by histologic confirmation in 70 cases. There were 2 (0.6%) false positive cases due to florid bronchoalveolar hyperplasia and atypical bronchial epithelial cells associated with granulomatous lesion. Overall accuracy rate was 90%, the sensitivity 84.3% and the specificity 94.7%.

Urinary Cytologic Findings of Transitional Cell Carcinoma: Analysis of 83 Cases.: Yeon Mee Kim, Hye Je Cho; Korean J Cytopathol. 1995;6(2):148-155.

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Abstract PDF: Urinary cytology has become an essential element in the diagnosis and management of transitional cell carcinoma(TCC) of the urinary tract. It has the advantage of being noninvasive, inexpensive, and easily accessible. Besides that it can even detect malignancy when unsuspected at cystoscopy. We report a retrospective review of urine cytology in the diagnosis of 83 TCC cases that underwent 295 cytologic evaluation. All patients had biopsy-proven TCC of the bladder, ureter and renal pelvis. The overall incidence of the positive cytology cases was 66.2%. To define the cytologic features of tumor cells, we tried to use three cytologic gradings such as "grade 1", "grade 2", and "grade 3" according to the cytologic degree of anaplastic neoplastic cells. These cytologic gades of TCC were relatively well correlated with the histologic grade and tumor invasiveness. This result suggests that the recognition of characteristic cellular features of TCC can suspect the histologic grade and tumor stage. The false negative TCC cases were 78.9%. They showed severe inflammatory or bloody background and a few neoplastic cells. Therefore, a cautious approach for accurate interpretation, personal experience, and proper fixation and processing could expand the role of urinary cytology.

Fine Needle Aspiration Cytologic Findings of Inflammatory Breast Diseases.: Hye Kyoung Yoon, Seol Mi Park, Mi Sun Kang, Young Il Yang, Chan Hwan Kim; Korean J Cytopathol. 1995;6(2):156-162.

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Abstract PDF: Fine needle aspiration of the breast is an important diagnostic tool in malignant lesions, but is also useful in differentiation of inflammatory breast diseases mimicking carcinoma clinically and radiologically. Recently. the authors have experienced eight biopsy-proven cases of chronic inflammatory diseases of the breast, which consisted of 4 cases of duct ectasia, 2 cases of fat necrosis, and a case of tuberculous mastitis and granulomatous mastitis respectively, Their cytologic features mainly based on the components and the relative frequency of inflammatory cells were evaluated for differential diagnosis of chronic inflammatory breast diseases. The results are as follows: 1. In cases of duct ectasia, varying amount of neutrophils, mononuclear leukocytes, histiocytes and multinucleated giant cells were intermixed with benign epithelial cell clusters. 2. Abundant fat tissue fragments were diagnostic for fat necrosis. Histiocytes and mononuclear cells were main components but not rich, and neutrophils and giant cells were infrequently observed. 3. Characteristic granulomas composed of epithelioid cells, mononuclear leukocytes and Langhans} type giant cells and lymphocytic infiltrates were conspicuous in tuberculous mastitis, and occasionally neutrophils, necrotic materials and epithelial cell clusters were found. 4. In granulomatous mastitis, epithelioid cell granulomas were also noted but numerous neutrophils and histiocytes were intermingled within or outside the granulomas.

Case Reports

Effusion Cytology of Ki - 1 Positive Anaplastic Large Cell Lymphoma: A Case Report.: Mi Sook Lee, Mi Ja Lee, Yu Kyung Jeong, Sung Chul Lim, Keun Hong Kee, Ho Jong Jeon; Korean J Cytopathol. 1995;6(2):163-168.

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Abstract PDF: Ki-1 positive anaplastic large cell lymphoma is a newly described high-grade lymphoma and is defined by histopathological and immunologic criteria. We experienced a case of systemically involving Ki-1 positive anaplastic large cell lymphoma in a 44 year-old female which initially manifested as pleural effusion. Abdominopelvic CT scan showed the evidence of marked lymphadenopathy in retroperitoneal and both external and inguinal lymph nodes. On cytologic examination of pleural fluid tumor cells revealed pleomorphic large isolated cells with prominent nucleoli and abundant cytoplasms. The nuclei were large with irregular profiles including some deep invaginations. Also. occasional multilobed/multinucleated and binucleated nuclei were seen. Immunohistochemical examination was performed to differentiate from the undifferentiated adenocarcinoma. Hodgkin's disease, non-Hodgkin's lymphoma and malignant histiocytosis. The neoplastic cells were positive for leukocyte common antigen. CD3 CD30(ki-1) but negative for cytokeratin. epithelial membrane antigen. and CD15. A histologic diagnosis of Ki-1 positive anaplastic lymphoma was made by biopsies of the inguinal lymph node, polypoid lesion of the stomach and cecum.

Pulmonary Nocardiosis Diagnosed by Fine Needle Aspiration: A Case Report.: Hyunee Yim, Kwang Hwa Park; Korean J Cytopathol. 1995;6(2):169-173.

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Abstract PDF: Nocardia, aerobic members of the order of Actinomycetaceae, produces infections in human lung. Nocardial infection is associated with underlying diseases of immuno-suppression or treatment with corticosteroid. It is difficult to detect Nocardia by sputum examination or histologic sections and it has rarely been diagnosed by fine needle aspiration of the lung. We describe a case of pulmonary nocardiosis in a 72 year-old man. diagnosed by fine needle aspiration, which was confirmed by culture of aspirates. The aspirates showed neutrophil-predominant inflammatory cells with microoganisms demonstrated by Gomori methenamine silver and Gram stain. The organisms had characteristic long branching filamentous strucutres. The lesions on chest x-ray were in resolution with antimicrobial therapy.

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.

Fine Needle Aspiration Cytology of Parapharyngeal Ganglioneuroma: A Case Report.: Ji Shin Lee, Hyang Jeong Cho, Ki Jung Yun, Hyung Bae Moon; Korean J Cytopathol. 1995;6(2):179-182.

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Abstract PDF: Ganglioneuromas are a fully differentiated tumor that contains no immature elements. The majority of ganglioneuromas are diagnosed in patients older than 10 years and are most often located in the posterior mediastinum, followed by the retroperitoneum. The location of these tumors in the parapharyngeal region is extremely uncommon and there are only a few reports on the cytologic appearance of the tumor. We report a case of ganglioneuroma presenting in a parapharyngeal location in a 4 year-old boy, diagnosed by fine needle aspiration cytology. The smears revealed scattered large oval to polygonal cells with voluminous, granular cytoplasms. The nuclei were one to two in number and had a prominent nucleolus. Clusters of benign spindie-shaped cells were also present.

Neuroblastoma of Mediastinum Diagnosed by Fine Needle Aspiration: A Cese Report.: Eun Joo Seo, An Hee Lee; Korean J Cytopathol. 1995;6(2):183-186.

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Abstract PDF: Fine needle aspiration has been effectively being applided to pediatric tumors since it renders a rapid diagnosis with minimal intervention. This measure is especially required for the large pediatric mass, which needs preoperative chemotherapy or radiotherapy to shrink the tumor to an operable size. A case of neuroblastoma of mediastinum, stage IV diagnosed by CT-guided FNA is described.

Cytology of Anaplastic Thyroid Carcinoma with Varied Histologic Patterns Arising in Preexisting Goiter: Report of A Cese.: Mi Ja Lee, Mi Sook Lee, You Kyung Jeong, Sung Chul Lim, Keun Hong Kee, Ho Jong Jeon; Korean J Cytopathol. 1995;6(2):187-192.

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Abstract PDF: Anaplastic carcinoma of the thyroid(ACT0 is a rare subtype of thyroid neoplasm. This tumor represents approximately 5-10% of all thyroid malignancies and has poor prognosis. ACT often arises in a long-standing thyroid nodule and has been documented to be associated with a variety of more with a variety of more well-differentiated thyroid carcinomas. We experienced a case of anaplastic thyroid carcinoma who had had about a year history of thyroid goiter. The patients had been injected with sclerosing agents in treatment of preexisting goiter. The ACT in this case had varied cytologic and histologic appearances pleomorphic, giant cells, spindle and squamoid. Immunohistochemically, strong cytoplasmic positivity for cytokeratin was seen in all kinds of tumor cells. Ultrastructurally. the evidences of epithelial differentiation were seen such as intercellular junctions and tonofibrils.

Cytopathology of Hurthle Cell Adenoma: A Cese Report by Fine Needle Aspiration.: Bohng Hee Kim, Myoung Suk Kang, Jae Hoon Park, Youn Wha Kim, Yong Ku Park, Ju Hie Lee, Moon Ho Yang; Korean J Cytopathol. 1995;6(2):193-198.

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Abstract PDF: The increased use of thyroid fine needle aspiration (FNA) has refocused on Hurthle cell lesions. The cytologic diagnosis of Hurthle cell tumor is a challenge due to the presence of Hurthle cells in non-neoplastic lesions and the inability to differentiate between benign and malignant Hurthle cell tumor. We report a case of Hurthle cell adenoma(HCA) in a 68-year old woman, with reivew of the cytopathologic findings. FNA revealed losely cohesive or sheets of sheets of large oval to polygonal Hurthle cells containing bundant granular cytoplasm. The histopathologic examination confirmed the diagnosis of HCA with follicular growth pattern, Ultrastructurally, the cytoplasm was packed with variable sized mitochondria.

Cytohistologic Features of Chordoma Arising in Thoracic Spine: A Case Report.: Seung Yeon Ha, Insun Kim, Sung Hye Park, Heum Rye Park; Korean J Cytopathol. 1995;6(2):199-203.

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Abstract PDF: Chordoma is relatively uncommon tumor comprising 1~4% of primary malignant bone tumors, and believed to arise from the remnants of notochordal tissue. Because of its occurrence in the thoracic spine, we report a case of chordoma in volving the thoracic spine. A 45-year-old male was suffered from chest pain radiating to the back. Chest CT showed a well marginated, round huge mass with multiseptated enhancement at the thoracic spine from T5 to T8 level, After percutaneous needle aspiration, piecemeal resection of the tumor was done. On cytologic smears. two types of neoplastic cells were arranged in sheets and cords in mucinous background. One type of cells consisted of medium sized cells with pink cytoplasm and round nuclei. The other type had voluminous bubbly or clear cytoplasm divided by intracytoplasmic septae imparting a feathery or basket-like appearance. Histologically, the tumor showed lobulated feature divided by fibrous septae and the tumor cells were pink eosinophilic or physaliphorous in morphology. Immunohistochemically, the tumor cells revealed strong positivity for low(AE1) and high (AE3) molecular weight cytokeratins.

Cytologic Features of Endodermal Sinus Tumor of Ovary in the Ascitic Fluid: Report of a Cases.: Eun Sun Jeong, Young Shin Kim, Chang Suk Kang, Sang In Shim; Korean J Cytopathol. 1995;6(2):204-208.

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Abstract PDF: The cytologic findings of endodermal sinus tumor of the ovary are reported. The cytologic preperations were obtained from ascitic specimens. The findings on Papanicolaou-stained smears included a clean background and poorly preserved atypical cells loosely arranged in irregular or papillary groups. At high magnification, the cells had ill-defined and microvacuolated cytoplasms, with an increased nuclear-cytoplasmic ratio and prominent nucleoli. Hyaline globules characteristic of the alpha-fetoprotein (AFP)-synthesizing cells of endodermal sinus tumor were observed within the cells with periodic-acid-Schiff (PAS) stain. The presence of PAS - positive hyaline globules can be regarded, therefore, as a diagnostic clue to endodermal sinus tumor in an appropriate clinical setting and in the presence of AFP production. The cytologic findings in a cell block is important, in addition to smears, to obtain more diagnostic clues. A preliminary cytomorphologic diagnosis of this highly malignant tumor is valuable as a guide in planning further immunocytochemical and serologic studies.

Cytologic Features of Papnicolaou Smears of Malignant Melanoma Arising in Vagina: A Cese Report.: Myung Suk Kang, Bohng Hee Kim, Jae Hoon Park, Youn Wha Kim, Yong Koo Park, Ju Hie Lee, Moon Ho Yang; Korean J Cytopathol. 1995;6(2):209-214.

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Abstract PDF: Primary malignant melanoma of vagina is a rare tumor which is easily misinterpretated in routine cytologic examination. We lately experienced a case of primary malignant melanoma of the vagina with direct cervical extension diagnosed by Pap smear. The cervicovaginal smear showed variable sized clusters of epithelial cells or singly scattered abnormal epithelial cells. Most of the tumor cells had round hyperchromatic nuclei with prominent nucleoli and brownish pigments in cytoplasm. The cytologic findings are compared with histologic features of resected specimen.

Cytopathologic Features of Adenoid Cystic of Trachea Carcinoma: Report of 2 Cases.: Young Mee Cho, So Young Park, In Chul Lee; Korean J Cytopathol. 1995;6(2):214-218.

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Abstract PDF: Cytopathologic findings of two cases of adenoid cystic carcinoma of the trachea are reported. The carcinomas grew as a intratracheal mass. By bronchial washing, brushing and/ or post-bronchoscopic sputum cytology, large cohesive sheets, lobulated clusters, or three dimensional ball-like structures were obtained. They had numerous cyst-like spaces containing characteristic globular basophilic material. The tumor cells were uniform and had a small amount of cytoplasm. Nuclei were small and hyperchromatic. Nucleoli were occasionally observed. The cytological diagnosis was confirmed by bronchoscopic biopsies.

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