Journal of Pathology and Translational Medicine

Volume 8(2); December 1997

Original Articles

Effectiveness of Transbronchial Fine Needle Aspiration in Diagnosing Lung Cancers.: Tae Yub Kim, Gyung Yub Gong, Won Dong Kim, On Ja Kim; Korean J Cytopathol. 1997;8(2):109-114.

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Abstract PDF: Transbronchial fine needle aspiration(TBNA) is one of the cytologic methods in diagnosing lung cancers. TBNA can be used in cases of hilar, mediastinal or lung masses adjacent to the bronchi. We analyzed and compaired the findings of 27 cases of TBNA and bronchial washing and brushing(BW/BB) in lung cancers confirmed by either biopsy or surgical resection between Jun, 1996 and May, 1997 in Asan Medical Center. They were 18 cases of non-small cell carcinomas(eight squamous cell carcinomas, nine adenocarcinomas, and one large cell undifferentiated carcinoma), eight cases of small cell carcinomas, and one case of metastatic hepatocellular carcinoma. The sensitivity of TBNA was 37%(10/27) and false negative was 63%(17/27). Although the sensitivity of BW/BB was 56%(15/27), it was not different statistically from that of TBNA(Chi square, p=0.38). Overall sensitivity of TBNA and BW/BB in this series was 70%(19/27). Forty-seven percent of false negative TBNA(8/17) were positive in BW/BB. The findings suggest that the addition of TBNA to the standard BW/BB increases diagnostic yield in cytologic diagnosis of lung cancer.

PLC-gamma1 for Differentiating Adenocarcinoma from Reactive Mesothelial Cells in Effusions.: Woo Yeong Ju, Sung Sook Kim; Korean J Cytopathol. 1997;8(2):115-119.

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Abstract PDF: Cytologic diagnosis of reactive or malignant effusion is sometimes difficult. Espe- cially, differentiation of benign reactive mesothelial cells from malignant cells in body effusion is more difficult. Recently, immunohistochemistry has been used to diagnose difficult cases. Phospholipase C(PLC)-gamma 1 is one of the isoenzyme of the PLC which plays central role in signal transduction involving cellular growth, differentiation and transformation by phosphorylating many protein component. Increased expression of PLC-gamma 1 in human breast carcinoma, colorectal carcinoma and stomach cancers are reported. To evaluate the efficacy of positive PLC-gamma 1 immunostaining in the diagnosis of malignancy in effusions, paraffin-embedded cell blocks of pleural fluid and ascites from 10 patients(5 metastatic adenocarcinomas, and 5 reactive mesothelial cells) were immunostained with a monoclonal antibody to PLC-gamma 1. PLC-gamma 1 immuostained all the adenocarcinomas in cell block(5/5) with intense membrane pattern, however, none of the reactive mesothelial proliferations stained with the diagnostic membrane pattern. Thus, our study strongly supports the conclusion that PLC-gamma 1 immunopositivity is likely to become a useful adjunct for the diagnosis of malignancy in effusions.

Comparison of Fine Needle Aspiration Cytologic Diagnoses and Histologic Diagnoses in 256 Breast Lesions.: Mi Sun Kang, Soo Jin Jung, Hye Kyoung Yoon; Korean J Cytopathol. 1997;8(2):120-128.

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Abstract PDF: PURPOSE: Henoch-Schonlein purpura nephritis(HSPN) accompanied by nephrotic syndrome(NS) is known to have a poor prognosis and effective treatment is still controversial, even though both corticosteroids and immunosuppresant have been used for therapy. Cyclosporine A(CsA) is a well known immunosuppresant and widely used in renal transplantation and glomerular diseases especially steroid resistant. The aims of this study was to evaluate the therapeutic effect of CsA and to compare CsA with previously reported our data of rifampin(RFP) and azathioprine(AZA) in children with HSPN accompanied by NS.
METHODS
37 HSPN patients with NS confirmed by renal biopsy were selected. Of these, 17 patients were treated with CsA(5 mg/kg/day) for 6-8 months, 7 children were treated with RFP(10-20 mg/kg/day) for 9-12 months and 13 patients were treated with AZA(2 mg/kg/day) for 8 months. Along with these regimens, low dose oral prednisolone(0.5-1 mg/kg, qod) was also used. Sequential renal biopsy was done in all patients 1 month after termination of treatment. RESULTS: Complete remission rate of nephrotic syndrome was 5S.8% in CsA, 57.1% in RFP and 38.4% in AZA group after 17, 22, 11 months of mean follow-up period. Overall remission rate including partial remission was 88.2% in CsA, 85.7% in RFP and 84.6% in AZA group. Disappearance rate of hematuria was 58.8% in CsA, 57.1% in RFP and 46.2% in AZA group. Improvement of grade of clinical status was observed in 17 out of 17 CsA, 7 out of 7 RFP and 10 out of 13 AZA group. Improvement of pathologic class on sequencial renal biopsy was shown in 5 CsA(29.4%), none RFP(0%) and 2 AZA group(12.4%). Improvement on histologic immune-deposition was seen in 15 CsA(88.2%), 6 RFP(85.9%) and 4 AZA group(30.8%). CONCLUSION: In conclusion, Both CsA and RFP treated groups showed better result in complete remission rate of nephrotic syndrome and significant inprovement of histologic immune-deposition compared with AZA treated group(p=0.004). So, we recommend CsA and RFP rather than AZA for immunosuppresant treatment in HSPN with nephrotic syndrome.

The Significance of AgNOR Count in Body Fluid: Differential between reactive mesothelial cells & malignant cells.: Seung Sam Paik, Eun Kyung Hong, Se Jin Jang, Moon Hyang Park, Jung Dal Lee; Korean J Cytopathol. 1997;8(2):129-134.

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Abstract PDF: To distinguish reactive mesothelial cells from malignant cells in body fluid, we applied silver staining of nucleolar organizer regions(AgNORs) to ethanol fixed cytologic preparations. Fifty aspirated samples of benign(22 cases) and malignant(26 cases) body fluids were studied using the one step silver staining method. Two cytologically atypical samples were also included in the study. In malignant cases the mean AgNOR count was 3.56+/-0.81, while in benign cases the mean AgNOR count was 2.02+/-0.33. The difference of AgNOR counts between these two groups were statistically significant(p<0.001). The mean of atypical cases was 2.91. Both were diagnosed as malignant in follow-up cytology. In malignant effusions, there is statistically significant difference in AgNOR counts between cells forming complex papillae or clusters and singly scattered cells(p<0.05), 3.29+/-0.95 and 3.83+/-0.55, respectively. We concluded that AgNOR count appears to be useful as a diagnostic tool especially when the cytologic differentiation is difficult.

Fine Needle Aspiration Cytology of Mucoepidermoid Carcinoma of the Salivary Gland.: Jeong Seok Moon, Hwa Eun Oh, Joo Han Lee, Aee Ree Kim, Chul Hwan Kim, Han Kyeom Kim, Mee Ja Park, Nam Hee Won; Korean J Cytopathol. 1997;8(2):135-142.

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Abstract PDF: PURPOSE: There is no specific treatment guidelines for Henoch-Schonlein (HS) nephritis. Therefore we performed this study to observe the effect of long term steroid therapy combined with azathioprine METHODS: Treatment protocols; 1) Steroid pulse therapy: methylprednisolon 30 mg/kg/dose, maximum 1 gm, intravenously 6 times for alternate day. 2) Oral steroid was given 2 mg/kg/day for 1 month, 1 mg/kg/day for following I month and alternate day oral steroid combined with azathioprine 2 mg/kg/day for 2 years. RESULTS: Time period from HSP to onset of HS nephritis was between 2 weeks to 5 months with mean 7.4+/-7.4 weeks. Clinical remission were seen in 4 cases out of 5 (80%). Mean time period with disappearance of proteinuria and microscopic hematuria were 5+/-2.4 month and 13.3+/-2.9 month respectively. On pathologic findings by ISKDC, 3 cases were grade IIIb, 2 cases were grade IV in first kidney biopsies and showed pathologic improvement in follow up kidney biopsies after 2 years treatment. CONCLUSION: As there no definitive treatment for HS nephritis so far, our study of long term oral steroid therapy with azathioprine was effective in clinical and histologic aspect. Therefore further study in HS nephritis with in a large group will be needed in the future.

Case Report

Fine Needle Aspiration Cytology of Salivary Duct Carcinoma: A Case Report.: A Young Park, Hyun Jung Kim, Dong Won Kim, Dong Wha Lee; Korean J Cytopathol. 1997;8(2):143-149.

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Abstract PDF: PURPOSE: To investigate renal toxicity of high-dose intravenous immunoglobulin(IVIG) in children with Kawasaki disease and idiopathic thrombocytopenic purpura. METHODS: 23 children with Kawasaki disease and 7 children with idiopathic thrombocytopenic purpura who were treated with high-dose IVIG(2 g/kg) were evaluated for the change of urine output, blood urea nitrogen(BUN), serum creatinine(Scr), creatinine clearance(Ccr), tubular reabsorption of phosphorus(TRP), fractional excretion of sodium(FENa), 24hour urine b2-microg1obuin/creatinine(b2MG/cr) ratio and urine microalbumin/creatinine(MA/cr) ratio at post-IVIG 1 and 3 day. RESULTS: There was no significant change of urine output, BUN, Scr, Ccr, TRP, 24hour urine b2MG/cr and MA/cr ratio after high-dose IVIG treatment. Transient increase of FENa at post-IVIG 1 day was the only significant change.
CONCLUSION
There was no significant renal toxicity of high-dose IVIG in children with Kawasaki disease and idiopathic thrombocytopenic purpura who had normal renal function.

Original Articles

Lymphocyte Rich Papillary Oxyphilic Carcinoma of Thyroid.: Soon Ran Kim, Jin Hee Sohn; Korean J Cytopathol. 1997;8(2):150-154.

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Abstract PDF: Lymphoid infiltration can be seen in some lesions such as Hashimoto's thyroiditis, subacute thyroiditis and several neoplasm of the thyroid. In case of malignancy, there are a few reports of lymphoid infiltration in the diffuse sclerosing variant of papillary carcinoma. But heavy lymphoid infiltraton without evidence of sclerosis is uncommon. We experienced a case of papillary oxyphilic carcinoma with massive lymphoid infiltration, which looks like Warthin tumor of salivary gland. However cytological feature of epithelial cells exhibit that of papillary carcinoma.

Fine Needle Aspiration Cytology of Pilomatrixoma.: Seung Sam Paik, Dong Hoon Kim, How Jin Lee, Se Jin Jang, Moon Hyang Park, Jung Dal Lee; Korean J Cytopathol. 1997;8(2):155-159.

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Abstract PDF: Pilomatrixoma is a benign skin appendage tumor of hair matrix cell origin. The cytological appearance of this tumor may cause problems when attempting to establish a differential diagnosis with other neoplasms. Herein we report the aspiration cytology findings of two cases of pilomatrixoma. One case was diagnosed as atypical cell clusters initially and the other was diagnosed as pilomatrixoma. On cytologic examination, both cases showed clusters of tightly arranged basaloid cells with an uniform appearance, scanty cytoplasm and round hyperchromatic nuclei. There were histiocytes and multinucleated foreign body giant cells merged with the amorphous opaque orangeophilic materials of "ghost cells". The differential diagnosis with other neoplasms is discussed.

Fine Needle Aspiration Cytologic Findings of Proliferating Trichilemmal Tumor.: Seok Jin Kang, Kyoung Mee Kim, Byung Ki Kim, Sun Moo Kim, Sang In Shim; Korean J Cytopathol. 1997;8(2):160-163.

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Abstract PDF: The cytologic finding of proliferating trichilemmal tumor is not well documented and have difficulties in the cytological analysis of the fine needle aspirates. This rare dermatopathologic entity may be encountered during aspiration biopsy of subcutaneous masses, and is, occasionally, confused with other neoplasm, particulary squamous carcinoma owing to its close cytological resemblance. We report a case of proliferating trichilemmal tumor in the left breast. The patient is a woman and had a lump in the breast for 20 years. Fine needle aspiration revealed a few small clusters of squamoid cells in the background of amorphous and calcified material. After excisional biopsy, the mass was confirmed as proliferating trichilemmal tumor. The main cytologic features discriminating squamous cell carcinoma were bland nature of epithelial cells, absence of atypical dyskeratotic cells, and rich amount of amorphous material.

Cytologic Features of Plasmacytoma of the Ovary and Breast Occurred in a Patient with Solitary Plasmacytoma of Vertebra .: Mi OK Park, Hoon Kyu Oh, Yong Jin Kim, Jae Bok Park; Korean J Cytopathol. 1997;8(2):164-169.

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Abstract PDF: A case of plasmacytoma of the ovary and breast, which developed in a patient with a solitary plasmacytoma in the lumbar vertebra for nine months, was diagnosed cytologically and histologically. Enlargement of the right ovary and multiple palpable masses in the right and left breast were already present at six months after the diagnosis of vertebral solitary plasmacytoma. At eight months, plasma cell leukemia developed, and nine months the enlarged both ovaries, replaced by yellowish-gray solid tumors showed infiltration of immature plasma cells. The cytologic features of the ovarian tumors were same with those of the breast tumor. The tumor cells were of predominantly immature plasma cells with one or more nuclei. Some mature plasma cell had an eccentric nucleus with single nucleolus and peripherally clumped chromatin. Binucleated or multinucleated giant cells were often present. Histologically, sheets of poorly differentiated plasmacytoid tumor cells were separated by strands of hyaline fibrous tissue. On immunohistochemical stains, the tumor cells showed strong reactivity for lambda-light chain but no reaction for kappa-light chain, cytokeratin, or leukocyte common antigen.

Fine Needle Aspiration Cytology of Langerhans' Cell Histiocytosis in the Lymph Node.: Eun Kyung Kim, Jong Eun Joo; Korean J Cytopathol. 1997;8(2):170-173.

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Abstract PDF: Langerhans' cell histiocytosis is a relatively rare disorder of children, characterized by abnormal proliferation of Langerhans' cells. It usually presents as multiple osteolytic lesion with lymphadenopathy or cutaneous manifestations. We experienced a case of Langerhans' cell histiocytosis involving bone and lymph node, diagnosed by fine needle aspiration cytology of the lymph node. The patient was a 10-year old girl with left inguinal lymphadenopathy. Fine needle aspiration cytology from the lymph node disclosed very cellular smear consisted of Langerhans' cells, eosinophils and lymphocytes. The Langerhans' cells had eccentric oval to reniform shape nuclei with grooving and abundant pale cytoplasm. The diagnosis was confirmed later by histologic study of bone lesion.

Fine Needle Aspiration Cytology of Matrix Producing Carcinoma of the Breast.: Hyun Jung Kim, Ayoung Park, Dong Won Kim, Dong Wha Lee, Kui Hyang Kwon; Korean J Cytopathol. 1997;8(2):174-178.

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Abstract PDF: Matrix producing carcinoma of the breast is a variant of heterologous metaplastic carcinoma which is defined as "overt carcinoma with direct transition to a cartilagenous and/or osseous stromal matrix without an intervening spindle cell zone or osteoclastic cells". This tumor is very rare, occuring in less than 0.2% of total breast carcinoma, but the prognosis is better than other metaplastic carcinoma. We experienced a case of fine needle aspiration(FNA) cytologic finding of matrix producing carcinoma of the breast. A 75-year old woman, who presented a right huge breast mass(9x8cm) during 10months, was examined. Mammography reveals right lateral mass with even density without calcification. Breast ultrasonography shows multifocal hypoechogenic cystic change in the huge mass, suggesting resolving hematoma or carcinoma or sarcoma with necrosis. On cytologic finding of FNA, myxoid matrix was the dominant feature and the rest of the material was composed of scanty isolated atypical cells with large irregular nuclei. The histologic finding was moderately differentiated adenocarcinoma with abundant cartilagenous matrix and focal squamous metaplasia.

Fine Needle Aspiration Cytology of Intracystic Papillary Carcinoma of the Breast.: Ah Won Lee, Yeong Jin Choi, Kyo Young Lee, Byung Kee Kim, Sun Moo Kim, Sang In Shim; Korean J Cytopathol. 1997;8(2):179-184.

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Abstract PDF: Intracystic papillary carcinoma(IPC) of the breast is a distinctive and very rare variant of intrductal carcinoma. The cytologic features of IPC have been rarely reported, and there are difficulties in distinguishing between benign and malignant papillary breast lesions. Herein we report a IPC of the breast in a 80 year-old female. Fine needle aspiration cytology revealed monotonous cuboidal epithelial cells in small clusters and individually scattered on bloody background. The tumor cells did not show overt cytologic atypia. With the histologic features of this case and review of the literature, the cytologic differential points are discussed.

Fine Needle Aspiration Cytologic Findings of Metastatic Sex Cord Tumor with Annular Tubules to the Neck.: So Yeong Oh, Myoung Jae Kang, Myoung Ja Chung, Woo Sung Moon, Dong Geun Lee; Korean J Cytopathol. 1997;8(2):185-189.

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Abstract PDF: A sex cord tumor with annnular tubules is a relatively rare ovarian neoplasm. The cytologic findings from a fine needle aspiration biopsy of neck metastasis of a sex cord tumor with annnular tubules are described. The origin of the neck metastasis was the right ovary, and the tumor was diagnosed six years ago. The cytologic findings were characterized by tumor cells arranged in solid or follicular patterns. The tumor cells formed rosette-like or complex tubular structures with central rounded or coalesced hyaline materials. It was difficult to distinguish this tumor cytologically from granulosa cell tumor, thyroid follicular neoplasm, Sertoli-Leydig cell tumor, and Brenner tumor, but complex tubular structures were helpful in discriminating between these tumors.

Pleural Effusion Cytology of the Metastatic Sex Cord Tumor With Annular Tubules.: Sun Lee, Ju Hie Lee, Youn Wha Kim, Yong Koo Park, Hak Soon Chang, Moon Ho Yang; Korean J Cytopathol. 1997;8(2):190-193.

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Abstract PDF: The sex cord tumor with annular tubules(SCTAT) is a rare ovarian neoplasm, which charateristically shows simple and complex annular tubules with central acidophilic hyaline bodies. This tumor has been considered as a tumor of low-grade malignancy with late recurrence. We presented a brief case report of metastatic SCTAT of ovary in pleural fluid from ovary with cytopathologic and clinical features. The cytologic features of differential diagnosis are discussed.

Fine Needle Aspiration Cytology of Extraskeletal Mesenchymal Chondrosarcoma.: Myoung Ja Chung, So Yeong Oh, Myoung Jae Kang, Dong Geun Lee, Ho Yeul Choi, Sang Ho Kim; Korean J Cytopathol. 1997;8(2):194-198.

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Abstract PDF: Extraskeletal mesenchymal chondrosarcoma is a relatively rare tumor and its cytologic findings have rarely been reported. We experienced a case of mesenchymal chondrosarcoma of soft tissue of the right lateral neck diagnosed by fine needle aspiration biopsy in a 59 year-old man. Cytologic findings showed two cell components. One was an undifferentiated, small cell component with moderate amount of cytoplasm and spindle nuclei. The second population was a chondroid component. These cytologic findings were diagnostic to mesenchymal chondrosarcoma.

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