Journal of Pathology and Translational Medicine

Volume 10(1); June 1999

Original Article

Comparison of Qualified Diagnosis of "Atypical Squamous Cells of Undetermined Significance" with Subsequent Biopsy .: Jae Soo Koh, Jin Haeng Chung, Seung Sook Lee, Kyung Ja Cho; Korean J Cytopathol. 1999;10(1):1-5.

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Abstract PDF: To evaluate whether different qualifications of a cytologic diagnosis of "atypical squamous cells of undetermined significance(ASCUS)" predict a greater or lesser likelihood of tissue diagnosis of uterine cervix, we compared different cytologic qualifications of ASCUS with the tissue diagnosis. One hundred twenty-two con secutive Papanicolaou smears showing ASCUS in women who had undergone cervical biopsy within nearest 30 days were collected. The 122 smears were qualified as "favor reactive"(25%), "favor low grade squamous intraepithelial lesion (LSIL)"(24%), "favor squamous intraepithelial lesion(SIL)"(16%), "favor high grade squa mous intraepithelial lesion(HSIL)"(16%), and "not otherwise specified"(19%). Squamous intraepithelial or invasive lesion was pathologically confirmed by cervical biopsy in 13% of the "favor reactive", 27% in "favor LSIL", 70% in "favor SIL", 75% in "favor HSIL", and 35% in "not otherwise specified" smears. There were significant asso ciations between the favor reactive smear and the benign biopsy finding and between the favor SIL smear and the biopsy showing a squamous intraepithelial or more severe lesion. Nevertheless, most of favor LSIL smears exhibit reactive process in tissue biopsy. Conclusively, qualified ASCUS stratifies women into different risk groups for SIL. The cytopathologist should make the cytologic diagnosis of "ASCUS, favor LSIL" circumspectly.

Etc

The Effects of Prednisolone Administration on the Ultrastructures Lymph Node Cells: In Soo Suh, Jong Gu Chung, Byung Hun Kim; Korean J Cytopathol. 1976;10(1):1-6.

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Abstract: It is well known that the glucocorticoids have a suppressive activity to the immune responses through various mechanisms. Among others, one of well explained suppression mechanisms is that through lympholytic effects of the drugs on the lymphoid tissue throughout the body. But the precise processes of lympholytic actions and the ultrastructural changes during the cytolytic responses are largely remained in questions. In the efforts of clarifying the morphologic changes of the lymphoid tissue after glucorticoid administration, the author studied the ultrastructural changes of the mesenteric lymph nodes of rabbits after the injections of varying doses of prednisolone. Animals were injected 5mg, 10mg and 20mg of prednisolone for three consecutive days, repectively. On the fourth day, the animals were sacrificed and observed. The results were summarized as follow : 1. Light microscopically, the germinal center showed severe loss of large lymphocytes and prominent increase of reticulum cells. Marked decrease of small lymphocytes were also noted in TDA, while large lymphocytes were evidently increased in number in the mdeulla. 2. Electron microscopically, the nuclei showed increased tendency of heterochromatin, dilatation of perinuclear cisternae and condensation of chromatin to the degree of pyknosis. Mitochondria were markedly atrophied, accompanying with increase of matrix density and decrease of cristae. Increased number of pseudopodia with swelling was also prominent. Other changes were decrease of ribosomes and dilatation of ER. These changes were mostly confined to the small lymphocytes, and the other cellular components did not show such changes. The changes of small lymphocytes were progressively more severe with increasing the doses of the drug. The destructed cellular debris were phagocytized within macrophages and reticulum cells. 3. These results suggest that the main cytolytic actions of prednisolone are exerted to the small lymphocytes, preserving other cellular components, and the destucted cellular debris are caught to the surrounding macrophages and reticulum cells.

Original Article

Availability of Toluidine Blue Stain in Body Fluid.: Hye Kyung Lee, Myung Jin Joo, Kwang Min Lee, Eun Hee Lee, Sang In Sim; Korean J Cytopathol. 1999;10(1):7-11.

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Abstract PDF: We evaluated the availability of toluidine blue stain in body fluids, such as peritoneal and pleural fluid and urine. Nine hundreds specimens, i.e., 400 pleural and 400 peritoneal fluids and 100 urine samples, respectively, from Jan. 1995 to May 1996 were included. We obtained the result of high sensitivity and high specificity in toluidine blue stained body fluid in comparison with Papanicolaou stained result. Additionally, we found the diagnostically important crystals in chylothorax and some urine samples, which can not be seen in routine Papanicolaou stain. We thought the toluidine blue stain in body fluid is one of very useful diagnostic methods.

Etc

Histopathology of Early Gastric Cancer: Kim Ok Kyung; Korean J Cytopathol. 1976;10(1):9-21.

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Abstract: Objectives of the study; In the past few years, the diagnosis of early gastric cancer of stomach has been improved. The clinical symptoms and statistics of early gastric cancer have been reported at several occasions, in which histopathology has been rather lightly presented. The purpose of this study is to analysis some reasons that incidence of early gastric cancer is lower than the incidence of advanced gastric cancer in Korea. This study also aims to examine the gross and microscopic findings in order to strengthen the bases of diagnosis of early gastric cancer in the process of biopsy and gastrectomy specimen. Methods and materials; It is the author's intention to describe in details about histopathology of eleven cases of early gastric cancer with gastrectomy specimens, which were operated at Okinawa Central Hospital, Okinawa, Japan During 18 months from March 1973 to August 1974, according to age, sex, classification, size, depth of invasion, lymph node metastasis and histopathology. The author's also intents to compare 40 cases of gastric cancer at O.C.H. with 29 cases of gastric cancer operated at Ewha Womans University Hospital, Seoul, Korea, during 11 years from 1964 to 1975. The comparison and analysis will be made in terms of age, sex, duration, location, lymph node metastasis, depth of invasion, incidence of early cancer. Results and summary; The highest incidence of early cancer among the 11 cases at O.C.H. revealed in the age groups of 60's and average age was 58. M F ratio was 2.7 to 1 with male predominance. The classification of early gastric cancer revealed 2 cases of Type I, 3 cases of Type IIa, 3 cases of Type IIa, 3 cases of Type IIc, 2 cases of Type III, 1 case of Combined Type (IIc+III) with slightly predominance of Type IIc, and its combined type. The size of early gastric cancer measured from 0.3cm. to 3.0cm. With average of 1.2cm. in greatest diameter. The depth of invasion was within mucosa in 8 cases and within submucosa in 3 cases. Most common sites were the lesser curvature of angulus and antrum. All cases were negative for metastatic lymph nodes. The histopathology of early cancer revealed: Papillary type (1), Polypoid type (1), Signet ring cell type (3), Small tubular type (2), Small tubular type (2), Well differenciated type (3), Undiff. Small cell type (1). In comparison of 29 cases gastric cancer at E.W.U.H. with 40 cases gastric cancer at O.C.H., M F ratio was 1.5 to 1 with a slight higher incidence over male at E.W.U.H. and 2.5 to 1 at O.C.H. Number of metastatic lymph nodes was higher at E.W.U.H with 70% than O.C.H. with 57%. The incidence of early gastric cancer was considerable lower at E.W.U.H. with 3.8% in all cases of gastric cancer than O.C.H. with 27%. In conclusion, the Korean people generally visit to hospital at the fairly advanced stage of gastric cancer, resulting a poor prognosis after surgical treatment. The main reasons of such a phenomenon in Korea are considered to be (1) inadequacy of health insurance, (2) insufficient understanding on early gastric cancer, and (3) a short of availability of diagnostic facilities.

Original Articles

Transthoracic Fine Needle Aspiration Cytology of the Lung .: Min Suk Kim, In Ae Park, Sun Hoo Park, Sung Shin Park, Hwal Wong Kim, Kyung Chul Moon, Young Ah Kim, Hye Seung Lee, Ki Wha Park, Jeong wook Seo, Hyun Soon Lee, Eui Keun Ham; Korean J Cytopathol. 1999;10(1):13-19.

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Abstract PDF: The authors analysed 2,653 cases of transthoracic fine needle aspiration cytology of the lung to evaluate the diagnostic accuracy and its limitation. A comparison was made between the original cytologic and the final histologic diagnoses on 1,149 cases from 1,074 patients. A diagnosis of malignancy was established in 38.3% benign in 48.1%, atypical lesion in 2.3%, and inadequate one in 11.9% of the cases. Statistical data on cytologic diagnoses were as follows; specificity 98.9%: sensitivity of procedure, 76.8%: sensitivity of diagnosis, 95.5%: false positive 5 cases: false negative 18 cases: predictive value for malignancy, 98.8%: predictive value for benign lesion, 79.5%: overall diagnostic efficiency, 87.5%: typing accuracy in malignant tumor, 80%.

The Significance of Nuclear Size in Nuclear Grade of Invasive Ductal Carcinoma of the Breast.: Young Kyung Bae, Dong Sug Kim, Hye Jung Choi, Mi Jin Gu, Soo Jung Lee, Jea Young Lee; Korean J Cytopathol. 1999;10(1):21-26.

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Abstract PDF: To make the objective standard of nuclear size in grading nuclear pleomorphism of invasive ductal carcinoma of the breast, we measured maximal nuclear diameter of tumor cells on imprint cytology slides and histologic sections from 65 cases by using computer-based image analysis system(Optimas 6.0). The maximal diameter of red blood cells were also measured to evaluate the ratio of maximal nuclear diameter of tumor cells to maximal diameter of red blood cells. The mean values of maximal nuclear diameter of tumor cells on imprint cytology slides and histologic sections were 7.56 micrometer, 7.53 micrometer in nuclear grade 1, 8.92+/-0.98 micrometer, 9.02+/-0.74 micrometer in nuclear grade 2, and 12.90+/-1.47 micrometer, 12.44+/-1.41 micrometer in nuclear grade 3, respectively. There were no significant differences between values of imprint cytology and histologic section. The ratio of maximal nuclear diameter of tumor cells to maximal diameter of red blood cells were 1.3-1.4:1 in nuclear grade 1, 1.6-1.7:1 in nuclear grade 2, and 2.2-2.3:1 in nuclear grade 3. These values would be guidelines for grading nuclear pleomorphism of invasive ductal carcinoma of the breast on routine surgical pathology work.

Etc

A Histochemical Study on HBsAg in Liver Diseases in Korea: Soon Ho Kim; Korean J Cytopathol. 1976;10(1):23-32.

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Abstract: The author observed HBsAg in the liver tissues histochemically with Shikata’s orcein method in 11 cases of chronic hepatitis, 22 cases of liver cirrhosis and 32 cases of primary liver cell carcinoma. The liver tissues were collected by biopsy or operation in Busan University Hospital and Busan Gospel Hospital during the year of 1975. The results obtained were discussed and were summarized as follows : 1. HBsAg was identified in the liver cells in 4 out of the 11 cases of chronic hepatitis (36.4%) and in 7 out of the 22 cases of liver cirrhosis (31.8%). 2. HBsAg was identified in neoplastic and/or non-neoplastic liver cells in 13 out of the 32 cases of primary liver cell carcinoma (40.6%). In 11 cases it was found in both neoplastic and non-neoplastic liver cells and in 2 cases only in non-neoplastic liver cells. 3. There was no significant difference in positive rate of HBsAg among the chronic hepatitis, liver cirrhosis and primary liver cell carcinoma. 4. It was suggested that hepatitis virus B might play an important role in the etiology of liver cirrhosis and primary liver cell carcinoma.

Original Article

A Cytomorphologic Study of Benign and Malignant Papillary Neoplasms of the Breast.: Ho Jung Lee, Gyungyub Gong, Bohng Hee Kim, Sei Hyun Ahn, Jeong Mi Park, Jooryung Huh, Shin Kwang Khang, Jae Y Ro; Korean J Cytopathol. 1999;10(1):27-34.

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Abstract PDF: Benign and malignant papillary neoplasms of the breast may be difficult to distinguish in both cytologic and histologic preparations. To define the cytologic features of benign and malignant papillary lesions, we retrospectively reviewed 18 cases of fine needle aspirates from histologically confirmed cases of papilloma or papillary carcinoma of the breast. This study included 3 intraductal papillary carci nomas, 3 invasive papillary carcinomas, and 12 intraductal papillomas. All cases were evaluated for presence or absence of papillary fragments, bloody background, apocrine metaplasia, macrophages, and degree of cellularity, atypia, and single isolated columnar epithelial cells. Papillary fragments were present in all cases. The background of the smear was bloody in all 6 carcinomas, but in only 7 out of 12 papillomas. Markedly increased cellularity was present in 4 carcinomas(67%) and 7 papillomas(58%). Single cells were present in 5 carcinomas(83%) and 8 papil lomas(67%). The majority of papillomas and papillary carcinomas had mild to moderate atypia, and severe atypia was noted in one case of intraductal papillary carcinoma and one case of invasive papillary carcinoma. Apocrine metaplasia was absent in all cases of papillary carcinomas, but present in 8 papillomas(67%). Macrophages were noted in 4 carcinomas and were present in all cases of papillomas. The constellation of severe atypia, bloody background, absence of apocrine metaplasia and/or macrophages were features to favor carcinoma. Malignant lesions tended to show higher cellularity and more single isolated cells. The cytologic features mentioned above would be helpful to distinguish benign from malignant papillary lesions of the breast. However, because of overlapping of cytologic features, surgical excision should be warranted in all cases of papillary lesions of the breast to further characterize the tumor.

Etc

An Epidemiological Study of Primary Liver Carcinomas in Busan Area with Special Reference to Clonorchiasis: Chang Soo Chung, Sun Kyung Lee; Korean J Cytopathol. 1976;10(1):33-46.

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Abstract: This study was undertaken to investigate the relationship of primary liver carcinoma and clonorchiasis in Busan area, one of the areas most heavily infested with Clonorchis sinensis in the southern part of Korea. A series of consecutive 368 cases of primary liver carcinoma which were subjected to pathological evaluation in our department of pathology during the years from 1963 to 1974. The cases were mostly derived from Busan National University Hospital and Busan Gospel Hospital. The diagnosis was established by gross observation at operation table and morphological examination of the biopsied livers. The cases were analyzed statistically from an epidemiological view of point and obtained following results : 1. The relative risk of Clonorchis sinensis infestation in cholangiocarcinoma compared to hepatocarcinoma is about 5. The prevalence rate of clonorchaisis sinensis is much higher in cholangiocarcinoma than in cases without primary liver carcinoma, but it is not so with hepatocarcinomas. 2. The average age of the cases with cholangiocarcinoma and with hepatocarcinoma is 52 and 47, correspondingly, the difference being 5 years. No such marked difference between the average ages of both types of primary liver carcinomas is found in the reports by foreign authors. The average age of the cases with primary liver carcinomas is not associated with Clonorchis infestation and sex, but with its histological type. The average age of primary liver carcinoma is 48 and is much younger than those of Japanese and American white cases. 3. The ratio of primary liver carcinoma of male to female is 3.7, almost equal to those in Japanese and American white. 4. The frequency ratio of the hepatocarcinomas to the cholangiocarcinomas in cases with clonor. Chiasis was 1.5 and that in cases without clonorchiasis 8.4. On the basis of the above it seems to be of importance to consider clonorchiasis sinensis in epidemiological studies of liver cancer in Korea where this parasitic disease prevails widely.

Original Articles

Diagnostic Usefulness and Limitation of Fine Needle Aspiration Cytology of Lymph Node: Analysis of 176 Cases Confirmed by Biopsy .: Hee Sung Kim, Dae Soo Kim, Young Lyun Oh, Young Hyeh Ko, Howe J Ree; Korean J Cytopathol. 1999;10(1):35-42.

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Abstract PDF: The accuracy of fine needle aspiration cytology(FNAC) of the lymph node was investigated through a review of 176 FNAC cases and the corresponding biopsies. We chose 157 FNAC cases after the exclusion of 19 inadequate ones. Sensitivity of malignancy was 94.0%, specificity 100%, false negativity 6.0%, and false positivity 0.0%. The overall diagnostic accuracy was 96.8%. Sensitivity of metastatic carcinoma was 98.0% and that of malignant lymphoma was 87.9%. False negative cases included one metastatic carcinoma and four malignant lymphomas. The aspirates of metastatic carcinoma with false negativity exhibited a diffuse smear of keratin debris without viable cells, which led to the difficulty in differentiation from benign epithelial cyst. The cases of malignant lymphoma with false negative diagnosis were two Hodgkin diseases, one Lennert's lymphoma, and one peripheral T cell lymphoma in the histologic sections. On the analysis of 39 cases of tuberculosis, 17 cases(43.6%) were diagnosed as tuberculosis, 4(10.3%) as granulomatous lymphadenitis, 3(7.7%) as necrotizing lymphadenitis, and 15(38.5%) as reactive hyperplasia or pyogenic inflammation. Sensitivity of tuberculosis was 53.9%. In conclusion, lymph node FNAC is an excellent non-invasive diagnostic tool for the diagnosis of metastatic carcinoma. The diagnostic accuracy of malignant lymphoma could be improved with flow cytometry or polymerase chain reaction for antigen receptor genes. For the FNAC diagnosis of tuberculosis, AFB stain, culture, and PCR would be helpful as adjuvant techniques.

Fine Needle Aspiration Cytology of Thyroid Nodules: Assessment of diagnostic accuracy and evaluation of each cytologic diagnosis .: In Ae Park, Eui Keun Ham; Korean J Cytopathol. 1999;10(1):43-53.

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Abstract PDF: We retrospectively reviewed the results of 1,850 fine needle aspiration cytology (FNAC) of thyroid nodules performed from 1990 to 1991 in the Department of Pathology, Seoul National University Hospital. Among 1,528 cases and 322 cases aspirated by clinicians and a pathologist, 465 cases(30.4%) and 13 cases(4.0%) of the aspirates were inadequate, respectively. In 227 cases, correlation of the FNAC diagnosis and histologic diagnosis was done. Excluding the inadequate cases, the sensitivity for the detection of neoplasm(malignancy together with follicular adenoma) was 86.4% and the specificity was 70.7%. The overall diagnostic accuracy was 79.0%. There were 16 false-positive cases(7.0%), and 19 false-negative cases(8.4%). The predictive value of each cytologic diagnosis was 92% in papillary carcinoma, and 100% in Hashimoto's thyroiditis. The expectancy of malignancy was 52.8% in "suspicious malignancy" and 26.7% in "atypical lesion".

Etcs

Cantharidin-induced Hepatic Injury -Part Ⅰ : Reappraisal of Tissue Reaction Based on Hepatic Injury-: Chae Koo Lee, Yong Il Kim, Jung Bin Lee; Korean J Cytopathol. 1976;10(1):47-51.

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Abstract: Hepatic toxic injuries were induced in young male rats by subcutaneous injection of Cantharidin and their histologic characteristics were summarized as follows ; 1) diffuse swelling of hepatocytes, periportal hepatocullular necrosis with smudging and degranulation of cytoplasms in addition to focal spotty necrosis. 2) portal vein dilatation with swelling of its endothelial cells and leucocytic margination, accompanied by periportal congestion, portal exudation and hemorrhage. With the above histologic features, the main toxic mechanisms of Cantharidin to the liver may be deduced as mixtures of vascular factor and direct toxic effect to the hepatocytes.

Endometrial Biopsy Findings in Female Infertility: Jong Sang Choi, Seung Young Baik, Dale Lee, Gook Jin Moon; Korean J Cytopathol. 1976;10(1):53-57.

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Abstract: Histologic findings of endometrial tissue obtained by means of infertility studies on the first day of menstruation at Woo Sok Hospital Korea University from 1964 to 1973 were presented. Histologic findings which were agreeable with their menstrual cycle were noted in 85.4% of total 525 cases. Remaining cases revealed proliferative phase in 5.9%, endometrial hyperplasia in 0.4%, tuber culous endometritis in 1.7%, nonspecific endometritis in 0.4%, endometrial tissue with placenta in 1.2% and inadequate specimen in 5.2%

Original Article

Fine Needle Aspiration Cytologic Features of Schwannomas .: Sun Young Kim, Hae Joo Nam, Jung Hee Kim, Young Rok Cho, Yu Na Kang, Sang Sook Lee; Korean J Cytopathol. 1999;10(1):55-60.

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Abstract PDF: Schwannoma is a benign encapsulated nerve sheath tumor and is histologically characterized by a mixture of Antoni type A and B tissue. A preoperative diagnosis of schwannoma by fine needle aspiration cytology or by any other means is important to preserve clinically important nerves. Therefore, it is necessary to make a specific cytological diagnosis of nerve sheath tumor. However, there are a few reports regarding cytological features of schwannoma in Korea. We experienced seven cases of solitary schwannoma and here we report their characteristic cytological features with a review of literatures. The characteristic features of schwannoma on cytology were the presence of both Antoni type A and B tissue. The cytologic findings common to all cases of schwannoma generally corresponded to the histologic findings of Antoni type A tissue, consisting of fragments of tightly cohesive fascicles with variable cellularity. Dense fibrillary substances were found, along with palisading nuclei and Verocay bodies. Individual tumor cells consisted of cohesive cells having spindle or oval nuclei, with pointed ends and indistinct cell borders. Variation in nuclear size and shape was also present. The Antoni type B consisted of scattered wavy or short spindle cells and some histiocytes and lymphocytes in the abundant myxoid background with formation of microcysts. Immunohistochemistry for S-100 protein revealed a uniformly strong positive reaction and was helpful to make more accurate diagnosis of schwannoma.

Etc

A Correlated Cytologic and Histopathologic Approach to Uterine Cervical Atypia: Hyo Sook Park; Korean J Cytopathol. 1976;10(1):59-64.

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Abstract: The simplest and broadest application of clinical exfoliative cytology has been in the diagnosis of carcinoma of uterine cervix, and a vast literature has accumulated concerning the value of it especially in unsuspected preclinical stage. As a means of determining the efficacy of the cervicovaginal smear, the results of smears from 166 women were reviewed, compared to the histopathologic studied. Conclusively the diagnostic accuracy of cervical cytology is high (92.7%) in various epithelial lesions such as dysplasia (91-94%), carcinoma in situ (87%), microinvasive (78%) and invasive(95-100%) carcinomas, and it appears to be also useful in the follow-up of patients with cervical dysplasia as well as cervical carcinoma treated by either surgery or irradiation. In addition, the interpretations of sources of cytologic error were made in individual cases.

Case Report

Cytologic Features of an Angiosarcoma in Pleural Fluid: A Case Report .: Young Chae Chu, In Seo Park, Yoon Ju Kim, Hye Seung Han, Jee Young Han; Korean J Cytopathol. 1999;10(1):61-66.

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Abstract PDF: Angiosarcomas are rare tumors, seen most commonly in the skin and soft tissue of head and neck region. But it has been described in numerous body sites including thyroid, breast, liver, spleen, bone, etc.. Their biological behaviors depend on the microscopic grade, site of origin, and multifocality. We report the unique cytological features of an angiosarcoma in pleural fluid. A 61-year-old woman presented with a 6 month history of dyspnea on exertion and chest pain. Chest computerized tomography(CT) revealed multiple subpleural small nodules in the right lung and widespread air space consolidation and pleural effusion in the left lung. CT of liver revealed multiple small low attenuated lesion. The smears obtained from pleural fluid showed hypocellularity with a hemorrhagic background. The tumor cells were highly pleomorphic oval or spindle in shape and presented singly, in loose groups, in knitted syncytial aggregates, and in acinar pattern. Their nuclei had vesicular chromatin with delineated, thick nuclear membranes and occasionally a large eosinophilic, prominent nucleolus. The cytoplasm was plump, thin or projected in spindly fashion. Almost all tumor cells showed variable sized intracytoplasmic vacuoles and their nuclei were sometimes crescentic by a huge vacuole. Occasional binucleated tumor cells and mitotic figures were present. Cellular debris and streaky materials were identified. Needle biopsy specimen from the pleura revealed anastomosing slit-like spaces lined by pleomorphic tumor cells. The tumor cells showed a strong reactivity for CD31 and vimentin and focal weak reactivity for factor VIII-related antigen.

Etc

Breast Cancer and Elastosis: Jung Sil Cho, Dong Sik Kim; Korean J Cytopathol. 1976;10(1):65-70.

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Abstract: 90 cases of simple, radical and modified radical mastectomized breast carcinoma were studied to compare the degree of elastosis in cancer through Verhoeff van Gieson stain with histologic types, tumor border, stromal amount, lymph node metastasis, age and the degree of elastosis in adjacent breast tissue. Elastosis was 77.0% in adjacent normal breast tissue and 82.2% in breast carcinoma. Moderate to marked degree of elastosis were related to the degree of connective tissue stromal amount and tumor border. Breast carcinoma with moderate to marked elastosis showed frequent lymph node metastasis.

Case Reports

Urinary Cytologic Findings of Plasmacytoid Transitional Cell Carcinoma of the Urinary Bladder: A Case Report .: Mi Ok Park, Yong Jin Kim, Jae Bok Park; Korean J Cytopathol. 1999;10(1):67-71.

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Abstract PDF: We report a case of 53-year-old man with plasmacytoid transitional cell carcinoma of the urinary bladder, which may be confused with plasmacytoma. The patient initially presented with gross hematuria and dysuria for two months. Cystoscopy and radiologic studies revealed multiple intraluminal protruding masses on the urinary bladder invading perivesical fat tissue. After urinary cytologic examination and cystoscopic biopsy, radical cystectomy and pelvic lymph node dissections were done. Urine cytology showed single cells and poorly cohesive cells with round eccentric nuclei, bi-or multi-nucleation, indistinct nucleoli, coarse chromatin, and abundant basophilic cytoplasm within relatively clear background. The cytologic findings of tumor cells were similar to the plasma cells seen in plasmacytoma. The tumor of the bladder was composed of discohesive, individual cancer cells with diffuse pattern that simulated lymphoma or plasmacytoma. Immunohistochemical and electron microscopic studies clearly established the epithelial nature of the neoplasm. Recognition of this plasmacytoid type of transitional cell carcinoma of the urinary bladder can avoid the misdiagnosis.

Crush Cytologic Findings of Myxopapillary Ependymoma in Spinal Cord: A Case Report.: Soo Jin Jung, Young Il Yang; Korean J Cytopathol. 1999;10(1):73-78.

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Abstract PDF: Myxopapillary ependymoma generally arise in the conus medullaris and filum terminale of adult spinal cord. These tumors are readily recognized due to unique histopathologic features, however, their cytologic features are not well described. When only a tiny sample is obtained, cytologic examination using crush preparation may be a useful diagnostic tool to help appropriate intraoperative diagnosis. We present the crush cytologic features of myxopapillary ependymoma arising in thoracic and lumbar spinal cord of a 13-year-old boy. The patient had complained of paraparesis and back pain for 1 month. The MRI image revealed a relatively well demarcated intramedullary mass in T11-L1 levels. Crush preparation for cytology were performed by biopsy material. Crush cytologic findings revealed high cellularity and small sized branching papillary clusters on fibrillary or mucinous background. The tumor cells had uniform round or elongated nuclei. The cytoplasmic process of tumor cells were attached to the vascular wall. Between the tumor cells and vascular walls, the perivascular collar of globoid acellular stroma with metachromatic reaction on toluidin blue stain was noted. The crush preparation of myxopapillary ependymoma is considered as a simple and highly accurate diagnostic tool for differentiation from other intramedullary neoplasms of central nervous system.

Etc

Clinico-Pathologic Studies on Tumors and Tumor-like Lesions of Bone and Cartilage among Koreans: Yang Ok Huh; Korean J Cytopathol. 1976;10(1):73-90.

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Abstract: Many of the major advances in present-day understanding of bone tumors have been made in the last two decades. Neoplasms of bone occur sporadically and the management of certain malignant tumors of bone remains among the most perplexing problems of clinical medicine despite all the bold therapeutic measures including ablative surgery, with or without adjunctive radiotherapy and chemotherapy. Much has been written in recent years about diagnostic difficulties and pitfalls for the pathologist. In spite of significant advances in the roentgenologic diagnosis of bone tumors X-ray findings alone are sometimes misleading. The pathologist’s diagnosis is still the crucial determining factor in planning appropriate treatment. It has become a cliche to emphasize the necessity for the close liaison between surgeon, radiologist and pathologist to arrive at a correct diagnosis of a lesion suspected of being a bone tumor. This collective review includes classification of bone tumors, their incidence among Koreans, and also emphasizes the importance of cooperation among pathologist, radiologist and surgeon in diagnosis of bone tumors. Materials and Methods ; A total of 232 cases of tumors and tumor-like lesions of bone observed during the ten years and six months period from January, 1965 to June, 1975 was reviewed clinically, roentgenographically, and pathologically. Age, sex, locations of lesions, chief complaints and duration of symptoms were analysed by clinical records. Correlation of the radiologic appearances and microscopic features has been possible in 109 cases in which X-ray films were available. Histologic preparation was made by the ordinary technique with hematoxylin and eosin and decalcification was done by nitric acid method, if necessary. The classification of bone tumors was based largely on the one advocated by Spjut, et al. (1971).
Results
and summary ; Clinical and histopathological studies were made on 232 cases of benign and malignant tumors and tumor-like lesions, which were submitted to the Department of Pathology, Yonsei University College of Medicine during the period of 10 years and 6 months from Jan., 1965 to June, 1975, and the results were as follows. 1. Among 232 cases, 109 cases(47%) were benign and 123 cases(53%) were malignant. 2. Osteochondroma was the most frequently encountered benign bone tumor(30.4%), followed by giant cell tumor(14%), enchondroma and fibrous dysplasia(12.9%, each). 3. Among the 123 cases of all malignant bone tumors, metastatic carcinoma was most frequent(34.1%), followed by osteogenic sarcoma(28.0%), chondrosarcoma(10.8%), Ewing's sarcoma(7.2%) and multiple myeloma(6.3%). 4. The 78% of all benign tumors developed during the first 3 decades of life, and the peak age incidence of osteogenic sarcoma was second decade and most cases of multiple myeloma and metastatic carcinoma arised above 40 years of age. 5. The sex distribution of benign bone tumor showed slightly male predominence(1.3:1), and males were twice as commonly affected as females in malignant bone tumors. 6. Benign tumors, osteosarcoma and chondrosarcoma arised most commonly in the femur, tibia, humerus and small bones of hand and most cases of multiple myeloma and metastatic carcinoma involved vertebrae, rib and calvarium. 7. Clinical symtoms were mass or local swelling, pain and limitation of motion in order of frequency. 8. Overall accuracy of radiologic diagnosis wes 77% in benign tumors and 85% in the malignant. 9. Diagnostic accuanrcy of bone tumors with only histologic preparation without clinical and radiologic findings was 75% in the benign tumors and 86% in the malignant. In summary, these findings were similar to various reports in other countries except low relative incidence of multiple myeloma among the malignant bone neoplasms among the pathologist, radiologist and surgeon in making a correct diagnosis of the bone tumors has been emphasized again.

Case Reports

Fine Needle Aspiration Cytology of Osteoclast-like Giant Cell Tumor of the Liver: A Case Report .: Chan Sik Park, Ji Eun Kim, Mee Soo Chang; Korean J Cytopathol. 1999;10(1):79-84.

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Abstract PDF: Osteoclast-like giant cell tumor of the liver is an extremely rare malignancy with poor prognosis. To our knowledge, 5 cases have been reported in English literatures, but there was no report about fine needle aspiration cytologic(FNAC) features. We experienced a case of osteoclast-like giant cell tumor of the liver obtained by computed tomography(CT)-guided FNAC and needle biopsy. The cytologic findings mimicked giant cell tumor of the bone. A large hepatic mass of the left lobe with abdominal wall invasion was found by CT in a 46-year-old female complaining of epigastric pain. The FNAC showed moderately cellular smears consisting of osteoclast-like giant cells and mononuclear cells, which were individually scattered or intermingled in clusters. The osteoclast-like giant cells had abundant cytoplasms and multiple small round nuclei with fine chromatin and distinct nucleoli. The mononuclear cells had moderate amount of cytoplasm and relatively bland-looking oval nuclei with single small nucleoli. All of the cytologic features recapitulated the histologic findings of bland-looking osteoclast-like multinucleated giant cells evenly dispersed throughout the background of mononuclear cell. The immunohistochemical study showed positive reaction for CD68 and vimentin, but negative for cytokeratin in both osteoclast-like giant cells and mononuclear cells.

Fine Needle Aspiration Cytology of Unusual Epidermoid Cyst with Diffuse Parakeratosis and Aggressive Growth: A Case Report.: Hae Joo Nam; Korean J Cytopathol. 1999;10(1):85-89.

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Abstract PDF: An extremely unusual case of epidermoid cyst showing diffuse parakeratosis and aggressive clinical behavior is presented. A destructive bone lesion with surrounding ill-defined soft tissue lesion was found by computed tomography in a 63 year-old man complaining of painful swelling of the right buttock. He had a history of surgical excision twice for epidermoid cysts of soft tissue of the right hip during recent one year. On aspiration cytology, the aspirate was highly cellular and mostly composed of desquamated nucleated squamous cells. Operation finding revealed that the iliac bone was irregularly destroyed and filled with gray-white cheesy material and necrotic bone debris. Adjacent gluteus muscle showed scattered gray-white lesions. The curettage specimen showed bone necrosis and desquamated squamous cells filling the marrow spaces. The lesion within muscle revealed epidermoid cyst with diffuse parakeratosis.

Fine Needle Aspiration Cytology of a Pilomatrixoma Misdiagnosed as Carcinoma: A Case Report.: Ji Han Jung, Young Shin Kim, Kyo Young Lee, Chang Suk Kang, Sang In Shim; Korean J Cytopathol. 1999;10(1):91-96.

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Abstract PDF: Sometimes a pilomatrixoma on upper neck can be misdiagnosed as primary salivary gland tumor, skin adnexal tumor or metastatic carcinoma. On fine needle aspiration cytology(FNAC), characteristic features are ghost cells, basaloid cells, and calcium deposits, among which presence of ghost cells seems to be the key to recognize it. Here we present a cytologically misdiagnosed case of pilomatrixoma. A 32-year-old man presented a subcutaneous mass on the right posterior neck. It has grown slowly for 1 year, and was nontender, well circumscribed, hard, and movable mass. An initial FNAC yielded only monomorphic population of highly mitotic basaloid cells, without anucleated ghost cells, chronic inflammatory cells or foreign-body giant cells, suggestive of a poorly differentiated carcinoma. However, that was inconsistent with patient's clinical findings. For further correct diagnosis, FNAC was repeated, which yielded the basaloid cells and foreign-body giant cells. The diagnosis of pilomatrixoma could be made and the mass was excised. This case demonstrates that the pilomatrixoma should be considered in the differential diagnosis of subcutaneous aspirates containing not ghost cells but a dominant population of basaloid cells.

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Tuberous Sclerosis: Je G. Chi; Korean J Cytopathol. 1976;10(1):91-102.

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Abstract: Based on six autopsy and fifteen biopsy materials gross and microscopic findings of tuberous sclerosis (Bourneville’s disease) are presented and discussed along with the descriptions already available in the literature. Immature or dysgenetic Schwann’s cells appear to be one of the basic abnormalities in this syndrome, particularly in the kidneys, the skin and the central nervous system. Neoplastic changes in the kidney lesions and from the subependymal nodules of the brain are discussed together with the literature review on this subject. Histological features that would help to differentiate between simple hamartomas and true neoplasms are listed.

Sturge-Weber Syndrome: Je. G. Chi; Korean J Cytopathol. 1976;10(1):103-112.

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Abstract: Based on two autopsy and six lobectomy materials gross and microscopic findings of Sturge-weber syndrome(Encephalofacial angiomatosis) are presented and discussed along with the descriptions already available in the literature. Focal glial scar often seen in the outer layers of the involved cortex appears to be progressive together with neuronal loss. These changes are seen even in the younger age group (9 months and 1 9/12 years). Involvement of the skull bone over the leptomeningeal angioma was present in one case, and there were two cases that had angiomatous involvement of the choroid plexi of the lateral ventricles of the affected sides. These findings were interpreted to support the view that the basic malformation in the encephalotrigeminal angiomatosis might be related to a persistence of the primordial vascular plexus, described by Streeter in the human embryo.

Clinico-Pathologic Study of Tumors of the Nervous System among Koreans: Tai Seung Kim; Korean J Cytopathol. 1976;10(1):113-122.

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Abstract: The tumors of the nervous system have been investigated by many workers in other countries about incidence, classification and pathogenesis. However only one report dealing just incidence of the tumors of central nervous system is available in this country. Therefore, a comprehensive study is needed to understand the status of tumors of nervous system among Koreans. Material and Methods; The materials used in this study consisted of 511 cases during period from 1959 to 1974. For histologic studies, the specimens fixed with 10% neutral formalin were followed by Paraffin embedding and were cut in 5μ thickness. Sections were stained with Hematoxylin-Eosin for routine examination and histologic classification was made. The intracranial tumors were classified by Escourolle and Poirier (1973), intraspinal tumors by Rubinstein (1972), and tumors of the peripheral nervous system by Abell (1970).
Result
and Summary; Histological and clinical studies were made on 511 tumors of nervous system submitted to the Department of Pathology, Yonsei University College of Medicine during the period from 1959 to 1974, and the results were as follows. 1. In the 511 tumors of the nervous system, the central nervous system tumors were 281 cases and the tumors of peripheral nervous system were 230 cases. 2. In the 281 central nervous system tumors, the tumors, arising from intracranial cavity were 72.2% and tumors of the intraspinal cavity were 27.8%. 3. In the 203 intracranial tumors, glial tumors were 44.6%, meningiomas 17.8%, Schwannomas 11.8%, pituitary adenomas 10.4%, metastatic tumors 4.9%, craniopharyngiomas 3.5%, pinealomas 1.5%, ectopic pinealoma 0.5%, and teratoma 0.5%. 4. In the 90 gliomas, glioblastoma multiforme were 43.3%, astrocytomas 33.3%, medulloblastomas 11.1%, ependymomas 6.7%, oligodendrogliomas 3.3%, and choroid plexus papilloma 2.3%. 5. In the 24 children gliomas, astrocytomas were 36,5%, medulloblastomas 34.0%, ependymomas 12.6%, and oligodendrogliomas 8.4% . 6. In the 36 intracranial meningiomas, the meningotheliomatous type were 61.2%, angioblastic type 13.9%, fibroblastic type 11.1%, psammomatous type 5.6%, transitional type 2.3%, and low grade malignancy 2.3%. 7. In the 11 intracranial metastatic tumors, the primary sites were most common in lungs. 8. In the 78 intraspinal tumors, the neurilemmomas were 64.1%, sarcomas 11.5%, metastatic tumors 10.3%, meningiomas 8.9%, gliomas 3.9% and vascular tumor 1.3%. 9. In the Peripheral nervous system, the tumors of peripheral nerve were 183 cases, tumors of sympathetic nervous system 15 cases, pheochromocytomas 2 cases, and retinoblastomas 31 cases. In summary, the overall features of the intracranial tumors are similar to reports in other countries, but the incidence of neurilemmoma among intraspinal tumors is higher than those of other countries.

Blood Sugar Determinations Using Auto Analyzer Ⅱ and Dextrostix-Reflectance Meter Methods: B. S. Tchai, Y. K. Nam, Y. J. Chung*; Korean J Cytopathol. 1976;10(1):123-125.

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Abstract: Recently the utility of the Dextrostix blood sugar estimation method has been greatly increased by the use of the reflectance meter which was devided for quantitative reading of color change in Dextrostix. A comparison study of 300 blood sugar determinations were done using blood serum from in patient and patients attanding diabetic clinic. The Dextrostix-Reflectance meter method was used and the results were compared to an Auto Analyzer Ⅱ method. The correlation of these blood sugar results with those obtained with an Auto Analyzer Ⅱ method was very high (r=0.996) and the replication of the Dextrostix-Refectance meter method by the different experimenters was also satisfactory. These results indicate that Dextrostix-Reflectance meter is a simple and reliable for estimating the blood sugar level if procedure are accurately performed.

A Statistical and Hematological Study on 258 Cases of Acute Granulocytic Leukemia Variants: Dong Heon Yoon, Sang In Kim; Korean J Cytopathol. 1976;10(1):127-135.

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Abstract: This is an analysis and review of 258 cases of acute granulocytic leukemia variants diagnosed by this laboratory during the last 10 years from 1966 to 1975. The results of the study are summarized as follows. 1. The frequency ratios of the various types among the 459 cases of acute leukemia are 40.1%(184 cases) in acute myeloblastic leukemia (AML), 43.8% (201 cases) in acute Iymphocytic leukemia (ALL), 2.8% (13 cases) in acute promyelocytic leukemia (APmL), 8.3% (38 cases) in acute myelomonocytic leukemia of Naegeli type (AMML), 2.6% (12 cases) in acute monocytic leukemia of Schilling type (AMoL) and 2.4% (11 cases) in erythroleukemia including erythremic myelosis, respectively. 2. Among the 258 cases of acute granulocytic leukemia(AGL) the AML is the major type comprising 71.3% of total AGL cases and the other rare variants are AMML (14.7%), APmL(5.0%), AMoL(4.7%) and erythroleukemia including erythremic myelosis, in decreasing order of frequency. 3. Male to female sex ratios in the rare AGL variants (1.1-1.4 : 1)are similar to that of AML (1.65 ; 1) except that of the AMoL in which male is predominant (3 : 1). 4. Age incidences in the rare AGL variants are widely scattered from infancy to old age, however that of AMML is very similar to the AML showing a preponderance in childhood and young age. 5. The onset is acute in APmL so that 82% of them is diagnosed within a month. 6. For the chief complaints, the APmL cass exhibit characteristically sudden massive hemorrhagic tendencies in 92% of the cases, while gum hypertrophics are observed in 11% of the AMML cases and skin nodules with leukemic infitration in 33% of the AMoL cases, in addition to the leukemic symptoms and signs. 7. Auer’s rods are observed in 33.7% of the AML cases, 53.8% of the APmL cases, 55.3% of the AMML cases, 16.7% of the AMoL cases and 11.1% of the erythroleukemia cases. 8. There are some atypical cases or remarkable hematologic findings in AGL variants as follows ; (1) A.M.L. : One case of congenital type (about 0.5%) and one case of micromyloblastic form(about 0.5%) are found among the 184 cases. (2) A.Pm.L. : The leukemic promyelocytoid cells are observed in average of 43% and 64% in peripheral and bone marrow differential counts, respectively. (3) A.M.M.L. : The myelomonocytoid cells are observed in average of 44% and 56% in peripheral and bone marrow differential counts, respectively. The five cases of them discloses extraordinarily coarse and heavy azurophilic granulations like those of APmL in their cytoplasms, but none of them exhibited any D.I.C. finding as in APmL. (4) A,Mo.L. : The monocytoid cells are encountered in average of 56% and 77% in peripheral and bone marrow differential counts, showing more immaturity in nuclei and cytoplasms than those of AMML. (5) Erythroleukemia including erythremic myelosis : All the 11 cases revealed normoblastemia in average of l19/ 100WBC in peripheral blood. The 9 cases of erythroleukemia disclosed myeloblasts and promyelocytes in average of 11% and 5% in peripheral blood, and of 10% and 5% in bone marrow differential counts, respectively. The 3 cases of erythremic myelosis (one of the 9 erythroleukemia cases had been diagnosed as erythremic myelosis 4 months before) revealed malignant erythroid hyperplasia, erythroid series comprising in average of 81% in bone marrow differential counts, while the 9 cases of erythroleukemia 59%, and both of them showed variable degree of megaloblastoid changes with atypical mitoses in erythroid series.

Bacterial and Fungal Species Isolated from Cerebrospinal Fluid in the Past Five Years: Sook Ja Park, Yunsop Chong, Samuel Y. Lee; Korean J Cytopathol. 1976;10(1):137-142.

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Abstract: Because of the significant mortality rate and sometimes serious neurological sequelae, pyogenic bacterial meningitis continues to be a serious infection despite of the availability of effective antibiotics. Laboratory diagnosis, on the basis of bacteriological study in particular, is an essential procedure not only for the determination of etiology but also for the selection of proper antibiotics. An analysis of the bacterial and fungal isolations during the years 1970-74 at Yonsei University Medical Center was made to draw the following summaries. 1. Fifty three bacteria and one fungus strains were isolated : of which 60.1% were S. pneumoniae, N. meningitidis and H. influenzae. Isolates include one strain each of B. alvei and C. neoformans. 2. Culture positive patients were most frequently those who belonged to an age group of 1month-1 year. 3. H. influenzae was isolated from Patients upto 2-4 year old group and N. meningitidis upto 20-29 year old group, while S. pneumoniae was isolated from young and from old groups 4. Male to female ratio of culture positive patient was approximately 2 : 1. 5. N. meningitidis was isolated from winter to early summer months and S. pneumoniae and H. influenzae from autumn to spring months. 6. Some of the patients from whom opportunistic pathogens were isolated had injuries or operations on their heads. Some had bacterial infections on other part of their bodies. 7. Few isolates of N. meningitidis, S. pneumoniae and H. influenzae showed in vitro resistance to some of the tested antibiotics.

The Effect of Antibiotics on Salmonella typhi Ingested by Macrophages: Jae Soong Kim, Chang Hwan Bae, Jae Sik Kim, Jyung Myung Kim; Korean J Cytopathol. 1976;10(1):143-148.

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Abstract: The authors studied the effect of antibiotics on Salmonella typhi Ty2 ingested by macrophages, which were obtained from the peritoneal cavities of two male rabbits. The applied antibiotics were ampicillin, chloramphenicol and bactrim. The antibiotic effect was determined with the viable bacterial numbers in the macrophages at 6, 12, 24, 36, 48 and 72 hour-cultivation. The results were summarized as follows : 1. Salmonella typhi Ty2 ingested by macrophages were slightly protected from the killing action of antibiotics than the same organisms not ingested by macrophages. 2. The killing action of ampicillin was slightly decreased, when it combined with other antibiotics. The synergic action of chloramphenicol and bactrim was not observed.

True Hermaphroditism: In Sun Kim, Seung Yong Paik, Dale Lee*, Gook Jin Moon*; Korean J Cytopathol. 1976;10(1):149-155.

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Abstract: The true hermaphroditism is a rare anormaly of sexual differentiation. It is defined as a condition in which ovarian and testicular tissues are identified in one individual. The presented case was 27 year-old Phenotypically male adult with penoscrotal type of hypospadia and absence of scrotal contents on the left side. During left side orchiopexy, the uterus: salpinx, vas deference and epididymis with ovotestis were found near the superficial inguinal canal. On buccal smear, chromatin body was counted in more than 20% suggesting female. The authors assume that this patient belong to Group Ⅳ, unilateral variety of Young’s classification.

A Case of Cutaneous Cryptococcosis: Byung Kee Kim, Soo Nam Rhee, Chong Moo Lee; Korean J Cytopathol. 1976;10(1):157-160.

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Abstract: Cryptococcosis occurs throughout the world. The respiratory tract is the only known Portal of entry into the body. Cryptococcosis often manifest itself as a widespread systemic disease with prominent involvement of the brain and meninges, and the presence of the fungus in the spinal fluid. Cutaneous lesions are found in 10 to 15 percent of the cases of systemic cryptococcosis. A case of cutaneous cryptococcosis found in a 68 years old female patient associated with probable malignant lymphoma. Several small subcutaneous nodules developed about one week before the beginning of the meningeal signs. By repeated cultures and india ink preparation of the cerebrospinal fluid, many Cryptococcus neoformans were identified.

Microglioma -A case report with references on histopathology and histogenesis-: Hyun Soon Lee, Eui Keun Ham, Jung Sik Kim*, Bo Sung Sim*; Korean J Cytopathol. 1976;10(1):163-167.

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Abstract: A primary multiple neoplasm of the brain in a 55-year-old female, diagnosed as microglioma of argyrophilic type is presented. Histopathological diagnosis is based on the presence of transitional mature microglial cells, cytoplasmic metalophilia and of reticulum fibers as well as phagocytic activity of the tumor cells. Histogenesis of this tumor is briefly discussed along the line of histiocytes in the adventitia of the walls of blood vessels.

Four Cases of Hemophilia B: Myoung Hee Park, Han Ik Cho, Sang In Kim; Korean J Cytopathol. 1976;10(1):169-176.

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Abstract: Hemophilia B is a hemorrhagic disease characterized by a deficiency of factor Ⅸ activity and a sex-linked recessive mode of inheritance, and is clinically indistinguishable from hemophilia A. Four cases of proven hemophilia B are presented with a brief review of the literature. The first case (M 1-l/2 yr.) was associated with idiopathic thrombocytopenic purpura, and plasma factor Ⅸ level was 0.3% of normal. The second (M 20yr.) and the third (M 24yr.) cases were siblings, with 1.0% and 0.7% of factor Ⅸ activity. Family study of these second and third cases showed that their father had subhemophilic level of factor Ⅸ activity (35%), and their mother, an obligatory carrier, and their sister, a potential carrier, had reduced factor Ⅸ levels, 48% and 35% respectively. The fourth case (M 18 yr.) had 3.2% of factor Ⅸ activity. The authors believe that this is the first report of factor assay-proven cases of hemophilia B in the Korean literature.

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