Journal of Pathology and Translational Medicine

Volume 10(2); December 1999

Original Articles

Usefulness of E-Cadherin Expression in Malignant Effusion .: Sung Jig Lim, Gou Young Kim, Youn Wha Kim, Yong Koo Park, Juhie Lee, Moon Ho Yang, Nam Hee Won; Korean J Cytopathol. 1999;10(2):121-126.

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Abstract PDF: The usefulness of E-cadherin immunostaining as a marker of malignancy in the body fluids was investigated in the present study. Thirty-three histologically proven cases of cell blocks from the pleural, peritoneal, and pericardial fluids were studied by immunocytochemistry for E-cadherin antibody using LSAB method. These cases were cytologically diagnosed as adenocarcinoma (25 cases) and atypical cells (8 cases). Tumor cells showed strong positive membranous staining for E-cadherin antibody in 21 out of 25 cases (84%) of adenocarcinoma. E-cadherin staining was not found in 6 of 8 cases of suspicious maligancy. The sensitivity and specificity were 84% and 75%, respectively. Reactive mesothelial cells and inflammatory cells scattered were all negative. In conclusion, E-cadherin is an useful adjunctive marker to distinguish reactive mesothelial cells from the carcinoma cells in the body fluids.

Cytologic Analysis of Fibroadenomas of Breast Overdiagnosed as High Risk Group in Fine Needle Aspiration Cytology .: Sung Hye Park, Gil Sook Yoon, Misun Choi, Shin Kwang Khang; Korean J Cytopathol. 1999;10(2):127-127.

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Abstract PDF: Among total 108 cases of biopsy-proven fibroadenomas of the breast, which obtained from the files of the Asan Medical Center during one year period from October 1998 to September 1999, 23 cases cytologically diagnosed as high risk group were reviewed to retrieve the mis-leading factors. Initial cytologic diagnoses of 23 cases were proliferative breast lesion with atypia(high risk) in 21 cases(91.3%) and papillary neoplasm in 2 cases(8.7%). When we reanalysed 23 cases by Masood scoring system, they were classified as one non-proliferative breast lesion(4.3%), 16 proliferative breast lesions without atypia (69.6%), and 6 proliferative breast lesions with atypia(26.1%). None were subject to the category of carcinoma. Cytologic features leading to the overdiagnosis of high grade epithelial lesions were as follows; cellular dissociation without nuclear atypia, nuclear pleomorphism, anisonucleosis, and occasional macronucleoli without nuclear enlargement, lack of myxoid stroma, and few naked stromal cells. To avoid cytologic overdiagnosis of fibroadenoma, mild to moderate nuclear pleomorphism without nuclear enlargement, and cellular dissociation without nuclear atypia should not be regarded as criteria of high risk group.

Fine Needle Aspiration Cytology of the Salivary Gland: An analysis of 221 cases .: Ayoung Park, Hee Kyoung Kim, Dong Won Kim, So Young Jin, Dong Wha Lee; Korean J Cytopathol. 1999;10(2):133-143.

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Abstract PDF: Fine needle aspiration cytology of the salivary lesions was performed on 221 patients at Soonchunhyang University Hospital for 10 years. Of 221 aspirates, 6 aspirates(2.7%) were inadequate, 116 cases(52.5%) were non-neoplastic lesions, 76(34.4%) cases were benign neoplasms and 23 cases(10.4%) were malignant neoplasms. The cytologic diagnoses could be correlated with histologic findings in 58 cases. FNAC correctly discriminated between neoplastic and nonneoplastic lesions in fifty-seven lesions and failed in a case, and overall accuracy, sensitivity, and specificity were 98.3%, 98.0%, and 100.0%. FNAC correctly discriminated malignant neoplasms from benign neoplastic/non- neoplastic lesions in fifty-three cases and failed in five cases, and overall accuracy, sensitivity, and specificity were 91.3%, 72.7%, and 95.7%. Among three false negative cases, two mucoepidermoid carcinomas were misdiagnosed as mucocele and benign neoplasm, and an acinic cell carcinoma were misdiagnosed as Warthin's tumor. Two false positive cases were a Warthin's tumor misdiagnosed as squamous cell carcinoma and a pleomorphic adenoma misinterpretated as suggestive of malignancy. In conclusion, diagnostic accuracy of FNAC of salivary lesions is high, and the possibilities of low grade mucoepidermoid carcinoma and acinic cell carcinoma should be considered on hypocellular smears with mucoid or fluidy background.

Case Reports

Fine Needle Aspiration Cytology of Inflammatory Pseudotumor of the Lung: Report of A Case Misdiagnosed as Adenocarcinoma .: Wan Seop Kim, Eun Kyung Hong, Moon Hyang Park; Korean J Cytopathol. 1999;10(2):145-149.

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Abstract PDF: Cytologic features of inflammatory pseudotumor of the lung have not been described frequently. We report fine needle aspiration cytologic(FNAC) finding of a case of inflammatory pseudotumor misdiagnosed as adenocarcinoma in a 63-year-old man. The FNAC displayed a mixture of histiocytes, myofibroblasts, pneumocytes, and plasma cells. Some histiocytes and myofibroblasts had large nuclei with irregular nuclear membrane and prominent nucleoli, which mislead the diagnosis of adenocarcinoma on FNAC. The heterogeneous cell population is the unique cytologic features of inflammatory pseudotumor, which are helpful to distinguish it from other circumscribed benign and malignant lesions. Familiarity with these features is essential to avoid misdiagnosis and possible overtreatment.

Bronchial Brushing and Bronchial Washing Cytologic Features of Primary Malignant Fibrous Histiocytoma of the Lung: A Case Report .: Mi Ok Park, Wook Su Ahn; Korean J Cytopathol. 1999;10(2):151-155.

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Abstract PDF: A case of primary malignant fibrous histiocytoma(MFH) of the lung occurring in a 62-year-old man is presented. After preoperative bronchial brushing and washing cytologic diagnosis of poorly differentiated carcinoma, surgical resection and lymph nodes dissection were performed. Subsequent histologic examination revealed a primary MFH. The diagnosis was confirmed by electron microscopic and immunohistochemical examinations. The review of the bronchial brushing and washing cytologic features disclosed many bipolar and a few unipolar spindle tumor cells with a "comet" configuration, mainly single cells, but also forming loose clusters. The nuclei were elongated and hyperchromatic and contained one or more irregular nucleoli. Scattered bizarre, multinucleated tumor giant cells were also present.

Fine Needle Aspiration Cytology of Peripheral T Cell Lymphoma of the Lung: A Case Report .: Ok Ran Shin, Eun Sun Jung, Youn Soo Lee, Chang Suk Kang, Byung Kee Kim, Sang In Shim; Korean J Cytopathol. 1999;10(2):157-162.

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Abstract PDF: Primary non-Hodgkin's lymphoma of the lung is rare among extranodal lymphomas. The most common form is low grade B-cell type originated from the mucosa-associated lymphoid tissue (MALT) of the lung and primary peripheral T cell lymphoma of the lung is extremely rare. We recently experienced a case of fine needle aspiration cytology of primary peripheral T cell lymphoma of the lung in a 39-year-old male patient. The cytologic smears revealed some sheets of reactive epithelial cells, epithelioid histiocytes, and numerous polymorphous population of lymphoid cells composed of small and intermediate sized lymphoid cells and mature lymphocytes. Lymphoid cells were slightly larger than normal mature lymphocytes and showed significant irregularity of nuclear membrane. The internal nuclear structure was marked by chromatin clumping, clear parachromatin areas, and inconspicuous nucleoli. Histopathologically, atypical small lymphocytes infiltrated in the interstitium and alveolar sac. By the immunohistochemical study and molecular biologic study of gene rearrangement, the T cell clonality of atypical lymphoid cells was confirmed.

Fine Needle Aspiration Cytology of Small Cell Carcinoma of the Parotid Gland: A Case Report .: Chan Kwon Jung, Eun Sun Jung, Youn Soo Lee, Sun Moo Kim, Byung Kee Kim; Korean J Cytopathol. 1999;10(2):163-167.

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Abstract PDF: Primary small cell carcinoma of the salivary gland is a rare neoplasm that accounts for approximately 1.8% of all primary major salivary gland malignancies. Because of its rarity, it is difficult to diagnose small cell carcinoma of the parotid gland by fine needle aspiration cytology(FNAC). We experienced a case of primary small cell carcinoma of the parotid gland in a 72-year-old woman who presented with two palpable masses of the left infraauricular and ocular regions of two to three month's duration, respectively. Aspirate smears from the left infraauricular area were highly cellular on necrotic and lymphocytic background and showed individually dispersed cells or three-dimensional clusters of small cells. The tumor cells were round to oval with a very high nucleocytoplasmic ratio. Nuclei were about two times the size of lymphocytes and had uniformly dispersed but hyperchromatic to pyknotic chromatin. Nucleoli were occasionally visible but were generally inconspicuous. Numerous mitotic figures were detected. The clusters of these small tumor cells exhibited angular nuclear molding, irregular nuclear outlines, and occasionally rosette like arrangement. The tumor was confirmed by histology and immunohistochemistry.

Imprint Cytologic Features of Fibroadenoma of the Breast with Extensive Infarction: A Case Report .: Suk Jin Choi, Jong Im Lee, Jung Ran Kim, Tae Jung Jang, Ki Kwon Kim, Dong Hoon Kim, Byoung Ook Jeoung; Korean J Cytopathol. 1999;10(2):169-174.

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Abstract PDF: Spontaneous Infarction of fibroadenoma of the breast is very uncommon and may lead to difficulties in clinical and pathological diagnosis. Most reported cases occured in young women during pregnancy or lactation. This report describes imprint cytologic features of an infarcted fibroadenoma in a 19-year-old young woman without evidence of pregnancy. The smears revealed many individually scattered degenerated or necrotic epithelial or spindle stromal cells and naked nuclei on dirty necrotic background. A few sheets of cohesive uniform epithelial cells and a few fragments of stromal cells were also present. Most of the epithelial cells had pyknotic and hyperchromatic nuclei, however, cellular atypism such as pleomorphism, prominent nucleoli or mitosis were not present. Though the necrotic ductular and glandular outline of this case may bear a superficial resemblance to adenocarcinoma, obvious cytologic atypia or mitosis, even in the necrotic areas, were not present.

Fine Needle Aspiration Cytology of the Hyalinizing Trabecular Adenoma of the Thyroid Gland: A Case Report .: Seong Ho Kim, Seung Sam Paik, Moon Hyang Park; Korean J Cytopathol. 1999;10(2):175-178.

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Abstract PDF: Hyalinizing trabecular adenoma is an uncommon benign thyroid tumor that is recently described in the literature. This tumor is easily confused with medullary carcinoma on surgical specimens and with papillay carcinoma on cytologic specimens. Herein we report the cytologic characteristics of a case of histologically proven hyalinizing trabecular adenoma of the thyroid gland. Cytologically, the aspirate showed trabecular or individually dispersed polygonal cells with finely stippled chromatin pattern, nuclear grooves, and eosinophilic nuclear pseudoinclusions. No colloid materials were noted in the background.

Fine Needle Aspiration Cytology of Columnar Cell Variant of Papillary Carcinoma of the Thyroid: A Case Report .: Ji Han Jung, Kyo Young Lee, Chang Suk Kang, Sang In Shim, Byung Kee Kim; Korean J Cytopathol. 1999;10(2):179-184.

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Abstract PDF: The columnar cell variant of papillary carcinoma is a rare tumor of the thyroid, associated with aggressive behavior, early metastasis, and a rapidly fatal course. We present the fine needle aspiration cytologic(FNAC) findings of columnar cell variant of papillary carcinoma with cytohistologic correlation. In the smears, the tumor fragments showed mainly papillary pattern and a few scattered individual cells were present around the papillary fragments. The tumor cells were columnar or cuboidal and exhibited pseudostratification of the nuclei. The nuclei were oval to elongated with finely stippled chromatin and inconspicous nucleoli. Neither nuclear grooves nor intracytoplasmic inclusion was found. The FNAC diagnosis was consistent with papillary carcinoma. Total thyroidectomy was done and the histologic finding of the mass showed a predominantly papillary and focal solid proliferation of columar cells with marked nuclear pseudostratification. The unique histopathologic features and highly aggressive nature of columnar cell variant of papillary carcinoma require that this variant should be differeniated from common papillary carcinoma of the thyroid.

Etc

Vascular Changes in Congenital and Acquired Heart Diseases, Studied in Lung Biopsies of Koreans: Eui Keun Ham, Hyun Soon Lee; Korean J Cytopathol. 1976;10(2):181-188.

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Abstract: Histopathological investigation of lung biopsies on pulmonary vascular changes from 68 patients with congenital heart diseases and 58 with acquired heart diseases were made. Used specimens were examined at the Department of Pathology, College of Medicine, Seoul National University, during a period of 10 years from 1965 to 1974. The progression of vascular changes in lung biopsies were so stereotyped as to allow a division of structural effects into six grades regarding as Heath and Edwards method. Author observed various gradational changes of pulmonary vascular lesions, ranging from almost normal looking to marked medial hypertrophy with intimal fibrosis and plexiform or angiomatous dilatation lesions. Intimal fibrosis was thought to be based on organization of thrombi. One case of necrotizing angitis was revealed in a patient with patent ductus arteriosus. Severity of pulmonary vascular lesions of lung biopsies from patient with acquired heart diseases was more prominent than those from patient with congenital heart diseases. And no particular relationships to sex was made from both groups of heart diseases, but age had statistically significant relationship to those severity especially inpatient group with congenital heart diseases (r=0.39, p<0. 01).

Case Reports

Fine Needle Aspiration Cytology of Peripheral T Cell Lymphoma, Lymphoepithelioid Cell Type: Report of A Case Mimicking Tuberculous Lymphadenitis .: Ho Sung Park, Jong Myung Hong, Myoung Ja Chung, Woo Sung Moon; Korean J Cytopathol. 1999;10(2):185-189.

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Abstract PDF: The diagnosis of peripheral T cell lymphoma is difficult due to the varying size and shape of the neoplastic lymphoid cells and the frequent admixture of nonneoplastic mature lymphyocytes, histiocytes, eosinophils, and plasma cells. We report a case of peripheral T cell lymphoma, lymphoepithelioid cell type, which was difficult to differentiate from tuberculous lymphadenitis due to the aggregates of epithelioid histiocytes mimicking granuloma and the past history of pulmonary tuberculosis. Fine needle aspiration cytology of the inguinal lymph node in a 63-year-old male was characterized by hypercellular aspirates composed of a mixture of small and intermediate-size lymphoid cells and large lymphoid cells with background of confluent epithelioid histiocytes. The neoplastic lymphocytes demonstrated significant nuclear irregularity with protrusion and indentations of the nuclear membrane, prominent nucleoli, and frequent mitotic figures. The diagnosis of peripheral T cell lymphoma was confirmed by histological and immunohistochemical studies.

Fine Needle Aspiration Cytology of Pigmented Villonodular Synovitis: A Case Report .: Joon Hyuk Choi, Young Kyung Bae, Young Ran Shim, Mi Jin Kim, Won Hee Choi; Korean J Cytopathol. 1999;10(2):191-195.

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Abstract PDF: Pigmented villonodular synovitis is a destructive, fibrohistiocytic proliferation producing innumerable villous and nodular synovial protrusions. Its common locations are knee, ankle, foot, and hip. Although histologic feature of this tumor is well known, there have been few reports on the fine needle aspiration cytology findings. We report the cytologic features of a biopsy-proven case of pigmented villonodular synovitis. The patient was a 21-year-old male with a mass of the right knee for 2 years. On fine needle aspiration cytology, the aspirates was composed of abundant mononuclear histiocytic cells, singly and in clusters, multinucleated giant cells, and hemosiderin pigments.

Etcs

Progressive Multifocal Leukoencephalopathy: Je G. Chi; Korean J Cytopathol. 1976;10(2):191-198.

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Abstract: Based on two autopsy materials a brief review on progressive multifocal leukoencephaopathy was made, with special emphasis on its neuropathological findings and pathogenesis. The importance of recognizing this primarily demyelinating illness of viral etiology is emphasized, particularly in view of its potential epidemiological significance.

Effect of DPH(Diphenylhydantoin) to RBC Osmotic Fragility of Normal Person: Yung Heon Lee, Jae Soong Kim, Jae Sik Kim, Jung Myung Kim; Korean J Cytopathol. 1976;10(2):199-202.

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Abstract: The authors investigated the effects of DPH to the RBC osmotic fragility of normal person in vitro and obtained the result as follows : The usual doses, 20 ug of DPH, were added to four persons’ RBC suspension in various concentration of buffered NaCl in orders and divided evenly in half respectively, the one for incubation at 37℃ and the other for control omitting the incubation. There was noted a remarkable decrease in the RBC osmotic fragility with incubation comparing to the decrease in the RBC osmotic fragility without incubation.

Study on Serum Alpha-Fetoprotein and Hepatitis-associated Antigen in Patients with Primary Hepatoma: Yung Heon Lee, Jae Sik Kim, Jyung Myung Kim; Korean J Cytopathol. 1976;10(2):203-209.

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Abstract: Alpha-fetoprotein (AFP) and hepatitis-associated antigen (HAA) have been checked by the method of agarose gel immunodiffusion with 303 Korean patients including 79 patients of primary hepatoma, 169 patients of miscellaneous liver diseases, 25 cases of extrahepatic malignant tumor, and 30 normal persons for the recent two years from July 1974 to June 1976 and the results are as follows. 1. AFP was positive in 46 of 79 cases (58.2%) with primary hepatoma, 2 of 92 cases with liver cirrhosis, and 1 of two neonatal hepatitis. 2. The occurrence of HAA in patients with primary hepatoma is 18 of 76 cases (23.6%) 3. AFP positive cases in hepatomas showed positive HAA in 15 of 51 (29.1%) and AFP negative cases showed 3 of 25 (12.0%) respectively. The frequency of HAA positive in hepatomas seemed to be higher in AFP positive cases than AFP negative. 4. The primary hematoma showed a tendency of higher incidence of AFP positivity in young age group than elderly persons.

Korea Native Phytagglutinin Arisaema amurense Maximowicz induced Agglutinations of Normal and Tumor Cells: Gook Jin Moon, Seung Yong Paik*, Bong Hee Lee, Chul Soo Lee; Korean J Cytopathol. 1976;10(2):211-221.

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Abstract: A previous study demonstrated that animal erythrocytes such as horse, dog, rabbit and rat were agglutinated by the saline extracts of Arisaema amurense Maximowicz (AAM) while human erythrocytes were not by one of authors (Moon). In the present experiments, normal cells such as human erythrocytes, leukocytes, lung, liver, spleen, kidney, heart, stomach, adrenal gland and urinary bladder cells were suspended in 0.1% EDTA solution and tumor cells such as acute & chronic myelocytic leukemia, acute lymphocytic leukemia, lung cancer, urinary bladder cancer, mice leukemia cells and leukocytes of multiple myeloma patients were suspended in 0.1% EDPA solution and performed agglutination test with AAM phytagglutinin which were extracted by various solvents such as saline, ammonium sulfate(AS ; 45%, 75% and 85% solution) and perchloric acid (PA : 0.45M, 0.75M and 1.5M solution). The effects of the saliva and sugars on agglutination inhibition were studied as well in the present paper with the following results. Normal cells were not agglutinated by AAM saline extracts while some of non leukemia patient’s leukocytes were agglutinated by AS an4 PA extracts. Tumor cells used in this experiment were highly susceptible to agglutination by AAM extracts in order PA, AS and saline extracts. AAM saline and AS extracts induced agglutination of tumor cells were inhibited by D-galactose and PA extracts were by L-fucose. All kinds of AAM extracts such as saline AS and PA induced agglutinations of tumor cells were inhibited by some human saliva and some were not and it was not related with secrete form and blood groups of saliva. These results indicate that AAM agglutinability by various extraction emphasizes the importance of examining a wide variety of cells in attempting to understand the interactions of PHA with an cell surface and AAM extracts are more useful than con-A and wheat germ agglutinin to study for cellular surface recept sites of tumor cells.

Studies on Eosinophils : Bone Marrow Eosinophilia: K. Y. Maeng, H. I. Cho, S. I. Kim; Korean J Cytopathol. 1976;10(2):223-229.

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Abstract: 39 bone marrow eosinophilia cases which showed more than 10% of eosinophils in marrow differential counts were analyzed according to etiology. Mean valuers of eosinophils in differential count of these cases were 17.5±9.5% in bone marrow and 23.7±16.4% in peripheral blood. Mean of absolute eosinophil counts of peripheral blood was 5,788/cmm. Other hematologic values were not so significant except moderate anemia (mean Hb value, 10.7gm/dl) and leucocytosis (18,700/cmm). Clinical diagnosis and bone marrow findings were parasitic infestations in 12 cases (31%), lymphoma in 4 cases(10%), other blood dyscrasias in 6 crises(15%), eosinophilia associated with liver diseases in 4 cases(10%), dermatologic diseases in 2 cases(5%), allergic conditions in 2 cases(5%), malignant diseases in 3 cases(8%), undetermined etiology in 2 eases(5%), varicose vein in 1 case, Raynaud disease in 1 case, dwarfism in 1 case and cryptococcosis in 1 case. Degrees of eosinophilia in marrow differential count were 10∼19% in 26 cases, 20∼ 29% in 8 cases, 30∼39% in 3 cases, and more than 40% in 2 cases, while absolute eosinophil counts in peripheral blood were less than 500/cmm in 3 cases, 500∼2000/cmm in 11 cases, 2000∼5000/cmm in 7 cases, 5000∼10000/cmm in 6 cases and more than 10000/cmm in 6 cases. In cases of parasitic infestations, there were clonorchiasis in 3 cases, ascariasis in 3 cases, hook worm disease in 3 cases, trichocephaliasis in 2 cases and combined infestation of hook worm, trichuris trichura, clonorchis sinensis and paragonimus westermani in 1 case. In cases of blood dyscrasias, there were malignant lymphoma in 4 cases. In comparison with our previous report, cases of portal hypertension are decreased, while parasitic infestations and 1ymphoma cases are markedly increased.

Analysis of Technical Errors in Clinical Chemistry: Jae Sik Kim, Jyung Myung Kim, Han Ik Cho*, Sang In Kim*, Yong Hee Choi**, Kye Neung Lee***, Samuel Lee***; Korean J Cytopathol. 1976;10(2):231-240.

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Abstract: At present, the demand of clinical biochemisty has increased because the highly developed clinical medicine requires a very strong scientific basis to establish correct diagnosis, treatment and evaluation of the progress of patient. Clinical Chemistry lab seems to be the most important nucleus of laboratory functions in accordance with the tremendous increases in both bulk and kinds of the test requested. However it is still difficult to perform satisfactory biochemical tests with accuracy and precision due to the errors during daily procedures. With the world wide quality control system applies to clinical biochemistry, it is still not so satisfactory in Korea. There might be a number of factors bringing errors in biochemical determination including sample process, glassware and instrument, reagent, standard solution, and personal technic etc. We made, a rough survey, to detect the causes of errors, mainly with pipet, photometer, densitometer and personal technic and the followings are the findings with tables and figures accompanying.

A Study on Pseudomonas Aeruginosa: Jin Tae Suh, Sang In Kim, Han Ik Cho, Jung Ik Suh; Korean J Cytopathol. 1976;10(2):241-245.

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Abstract: The 294 cases of Pseudomonas aeruginosa isolated at S.N.U.H. during a period of 18 months from January 1975 to June 1976 were analyzed on the age and sex of patients, sources of specimens, species and frequency of mixed micro-organisms, and the results of antibiotic sensitivity test. The following results and conclusions were made. 1) Ratio of male to female patients was 7.1 ; 2.9, average age of patient is 39 year-old. There were 9 patients over 70 year-old and 4 patients less than one year old. 2) Source of specimens were ; 113 cases of pus (38%), 68 cased of urine(23%), 48 cases of sputum (16%), 35 cases of bronchial aspiration(12%), 9 cases of blood cultures (3%), and others 14 cases (5%). 3) Frequencies of mixed microorganisms were ; 40 cases of coliform bacilli, 28 cases of non-sugar fermenting microorganism (5 groups in TSI reaction), 27 cases of Klebsiella, 16 cases of Coagulase (+)Staphylococcus, 15 cases of paracolon bacilli, 11 cases of Proteus species, 9 cases of E coli, and 25 cases other microorganisms. 4) Frequencies of single or mixed microorganism isolation were ; Pseudomonas aeruginosa alone : 159 cases, one species mixed : 113 cases, two species mixed : 18 cases, and three species mixed : 4 cases. 5) Monthly or seasonal frequency in isolation rate was not demonstrated. 6) In the antibiotic sensitivity test, Pseudomonas aeruginosa was sensitive to only gentamicin.

Histiocytic Medullary Reticulosis (Report of Two Cases): O. J. Paik, C. C. Cho, S. K. Moon; Korean J Cytopathol. 1976;10(2):247-254.

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Abstract: Two cases of histiocytic medullary reticulosis occurring in an 18 years old male and a 14 years old female were presented with discussion of their clinicopathologic characteristics and brief literature review, and the latter was verified with autopsy. Although the cutaneous lesions were much more prominent in our cases, the clinical symptoms and signs, rapid fatal course, and hematological features were basically identical to those of previously documented histiocytic medullary reticulosis. On autopsy, the lesions were found to be systemic and showed diffuse proliferation of the atypical hitiocytes engaged in active phagocytosis. Liver, spleen, Iymph nodes, and bone marrow were mainly involved, but the other tissues, such as skin, lungs, brain, kidneys, thyroid, adrenal capsule, pericardium, and thoracic wall, were considerably affected as well.

A Case of Sacrococcygeal Endodermal Sinus Tumor: Ok Sun Rhee, Yoo Bock Lee, Bong Yong Lee*, Eui Ho Whang*, Kyu Chul Whang*; Korean J Cytopathol. 1976;10(2):255-259.

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Abstract: Endodermal sinus tumor is a rare neoplasm and microscopically characterized by a glomerulus-like structures. It was first described by Schiller in 1939 under the designation of mesonephroma because of microscopic structures resembling mesonephric glomeruli. Kazancigil et al.(1940), however, considered the glomerulus-like structures to be papillary and endothelial in nature and do not represent attempted formations of true glomeruli. Teilum(1952, 1965) observed similarity between papillary formations in the rat placenta and this tumor of human ovary. These papillary structures in the rat had been called endodermal sinuses by Duval (1891) because he considered them to represent diverticula of the yolk sac growing into extraembrynoic mesenchyme. Endodermal sinus tumor hag generally been reported to be in the ovary and testis and often in association with teratomatous areas. Very few cases of endodermal sinus tumor originating from extragonadal sites such as anterior mediastinum, pelvis, pineal gland have been described. In 1964, Rao et al. first reported the endodermal sinus tumor of sacrococcygeal area from a 3 years old girl under the title of sacrococcygeal mesonephroma. Our case is a 4 year old girl and complained pain and slow glowing mass of sacrococcygeal area for 2 months. Except for a palpable mass at sacrococcyx, all other physical examinations were negative including pelvic organs. Barium enema showed soft increased mass shadow in the buttock and somewhat increased presacral or retrorectal space. No evidence of bone destruction in the sacrum is noted. Excision of the mass was performed. Histologic examination revealed the typical picture of sinus tumor without the evidence of teratomatous component. Since there was no evidence of ovarian involvement, the lesion was regarded as a primary sacrococcygeal endodermal sinus tumor.

Mucinous Neoplasm of the Appendix (A re-evaluation of 7 Cases of Appendiceal Mucoceles): Jeong Rae Kim, Hae Soo Koo, Moon Hyang Park, Hyo Sook Park; Korean J Cytopathol. 1976;10(2):261-269.

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Abstract: The designation of mucocele has been traditionally applied to a group of appendiceal lesions characterized by one or more of the following features ; (1) dilatation of the lumen, (2) alterations of the mucosal lining, (3) hypersecretion of mucus, and (4) occasional extension outside the appendix, either as peritoneal implants or exceptionally as distant metastatic spread. The re-evaluation of 7 appenaiceal mucoceles, examined at Department of Pathology, National Medical Center, Seoul, during 17 years from March 1959 to July 1976, was made and showed four distinctive clinicopathologic entities : 1) Secondary mucosal atrophy resulting from proximal luminal obliteration (1 case), accompanied with volvulus. 2) Focal mucosal hyperplasia (1 case), with no epithelial atypia. This case was associated with mucinous adenocarcinoma of cecum. 3) Mucinous cystadenoma (4 cases). Two of these reveal slight degree of cellular atypia and some acellular mucus in peritoneal cavity without adhesion. Remaining two show mucosal ulceration of appendico-cecal junction. 4) Mucinous cystadenocarcinoma (1 case). This case shows focal stromal invasion by atypical glands and/or epithelial cells, also seen in peritoneal implants. On the basis of these findings, most instances of so-called mucocele should be regarded as mucinous neoplasms, analogous in many aspects to the epithelial tumors of the colon, and those diagnostic distinction is justified on practical grounds, since it provides the pathologist and the surgeon with definite criteria on which base prognostic and therapeutic consideration.

A Case of Chromaffin Functional Paraganglioma of the Organs of Zuckerkan이: Jung Bin Lee, Eui Keun Ham, Kook Jin Choi*; Korean J Cytopathol. 1976;10(2):271-275.

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Abstract: A case of chromaffin functional paraganglioma of the organs of Zuckerkandl is reported in a 17-year-old girl, with severe hypertensive retinopathy (K-W grade Ⅳ) and fluctuating hypertension. Laboratory findings revealed increased VMA in urine and positive regitine test with diabetic oral glucose tolerance curve as well. Simple removal of a mass in an area of organs of Zuckerkandl resulted in complete alleviation of clinical symptoms for 2-year -follow-up period.

Hematological Sturdy on Two Cases of Preleukemia: In Ki Paik, Sang In Kim; Korean J Cytopathol. 1976;10(2):277-283.

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Abstract: Two cases of preleukemia diagnosed by authors at the Seoul National University Hospital are presented with clinical summary, laboratory results, hematological findings of peripheral blood and bone marrow as well as literature review. The results are summarized as follows. 1) The patients were 27 year old male and 43 year old female. 2) The duration from the onset of initial symptoms to the final diagnosis of acute leukemia was 10 months and 13 months respectively. 3) Initial clinical manifestations were general malaise, bleeding tendency and fever. Hepatomegaly or lymphadenopathy was not the feature of these two cases. 4) Peripheral blood showed pancytopenia in one case and anemia with leukocytosis in another case. Immature erythroid and myeloid cells were observed in peripheral blood smears of both patients with transient monocytosis. Examination of mean corpuscular volume of red blood cell exhibited normocytic to macrocytic and mild anisocytosis with poikilocytosis was their another feature. 5) Bone marrow examination showed hypocellular marrow in one case and normoceilular marrow in another case. Erythroid hyperplasia with megaloblastoid change was observed in both cases. One case exhibited the pattern of maturation arrest in myeloid series. 6) The initial hematological findings of these preleukemia cases were very similar to those of vitamine B12 or folate deficiency, however the treatment with appropriate anti-anemic preparations was ineffective. 7) Most of the preleukemia cases previously reported were diagnosed retrospectively because of the diagnostic difficulties, however authors believe that a keen attention with the understanding of specific hematological features of the preteukemia will discover more cases of this very important disease entity. Hematological features of these preleukemia cases are suggestive of or similar to those of refractory anemia, sideroblastic anemia, aplastic anemia or hypersplenism.

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