Journal of Pathology and Translational Medicine

Volume 50(2); March 2016

Review

Sentinel Lymph Node in Breast Cancer: Review Article from a Pathologist’s Point of View: Sophia K. Apple; J Pathol Transl Med. 2016;50(2):83-95. Published online January 12, 2016; DOI: https://doi.org/10.4132/jptm.2015.11.23

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Breast cancer staging, in particular N-stage changed most significantly due to the advanced technique of sentinel lymph node biopsy two decades ago. Pathologists have more thoroughly examined and scrutinized sentinel lymph node and found increased number of small volume metastases. While pathologists use the strict criteria from the Tumor Lymph Node Metastasis (TNM) Classification, studies have shown poor reproducibility in the application of American Joint Committee on Cancer and International Union Against Cancer/TNM guidelines for sentinel lymph node classification in breast cancer. In this review article, a brief history of TNM with a focus on N-stage is described, followed by innate problems with the guidelines, and why pathologists may have difficulties in assessing lymph node metastases uniformly. Finally, clinical significance of isolated tumor cells, micrometastasis, and macrometastasis is described by reviewing historical retrospective data and significant prospective clinical trials.

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Original Articles

Prognostic Implication of Semi-quantitative Immunohistochemical Assessment of CD20 Expression in Diffuse Large B-Cell Lymphoma: Chang Hwan Choi, Young Hoon Park, Joo Han Lim, Suk Jin Choi, Lucia Kim, In Suh Park, Jee Young Han, Joon Mee Kim, Young Chae Chu; J Pathol Transl Med. 2016;50(2):96-103. Published online February 15, 2016; DOI: https://doi.org/10.4132/jptm.2016.01.12

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Abstract PDF

Background
Immunohistochemical demonstration of CD20 in diffuse large B-cell lymphoma (DLBCL) is prerequisite not only for the diagnosis but also for assigning patients to rituximab-containing chemotherapy. However, little is known about the impact of abundance of CD20 expression assessed by immunohistochemistry on the clinical outcome of DLBCL. We performed a semi-quantitative immunohistochemical analysis of CD20 expression in DLBCL to examine the prognostic implication of the level of CD20 expression. Methods: Pre-treatment diagnostic tissue samples from 48 DLBCL patients who were treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) regimen were represented in a tissue microarray and immunostained for CD20. The relative abundance of CD20 expression was semi-quantitatively scored using a web-based ImmunoMembrane plug-in. Receiver operating characteristic curve analysis was used to determine a prognostically relevant cut-off score in order to dichotomize the patients into CD20-high versus CD20-low groups. Results: The levels of CD20 expression were heterogeneous among the patients, with a wide and linear distribution of scores. Patients in CD20-low group showed significantly poor clinical outcome. Conclusions: The levels of CD20 expression in DLBCL are heterogeneous among the patients with DLBCL. A subgroup of the patients with CD20 expression levels below the cut-off score showed poor clinical outcome.

Citations

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The Expression Levels of CD20 as a Prognostic Value in Feline B-Cell Nasal Lymphoma: A Pilot Study
Kravee Chaipoca, Theerapol Sirinarumitr, Supreeya Srisampan, Charuwan Wongsali, Attawit Kovitvadhi, Tassanee Jaroensong
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Prognostic molecular biomarkers in diffuse large B-cell lymphoma in the rituximab era and their therapeutic implications
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Qiqi Zhu, Xueqin Deng, Wenqing Yao, Zihang Chen, Yunxia Ye, Limin Gao, Wenyan Zhang, Weiping Liu, Sha Zhao
Annals of Hematology.2021; 100(3): 715. CrossRef
Induced CD20 Expression on B-Cell Malignant Cells Heightened the Cytotoxic Activity of Chimeric Antigen Receptor Engineered T Cells
Yingxi Xu, Saisai Li, Ying Wang, Jia Liu, Xinhe Mao, Haiyan Xing, Zheng Tian, Kejing Tang, Xiaolong Liao, Qing Rao, Dongsheng Xiong, Min Wang, Jianxiang Wang
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J. Han van Krieken
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Bertrand Coiffier, Clémentine Sarkozy
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Upregulated Neuro-oncological Ventral Antigen 1 (NOVA1) Expression Is Specific to Mature and Immature T- and NK-Cell Lymphomas: Eun Kyung Kim, Sun Och Yoon, Soo Hee Kim, Woo Ick Yang, Yoon Ah Cho, Soo Jeong Kim; J Pathol Transl Med. 2016;50(2):104-112. Published online February 29, 2016; DOI: https://doi.org/10.4132/jptm.2016.02.08

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Abstract PDF

Background
Recent studies have revealed that the splicing factor neuro-oncological ventral antigen 1 (NOVA1) is enriched in fibroblasts and accumulated T cells of tertiary lymphoid structures. In the present study, we investigated NOVA1 expression in various subtypes of mature and immature T- and natural killer (NK)-cell lymphomas as well as in various B-cell lymphoma subtypes. Methods: NOVA1 immunoexpression was evaluated in hyperplastic palatine tonsils (n = 20), T- and NK-cell lymphomas (n = 177), diffuse large B-cell lymphomas (n = 151), and other types of B cell lymphomas (n = 31). Nuclear staining intensity and percentage of positive tumor cells were graded. NOVA1 mRNA expression was analyzed in various lymphoma cell lines. Results: Tumor cells of T- and NK-cell lymphomas showed higher expression levels of NOVA1 than did normal paracortical T cells, and 56.5% of T- and NK-cell lymphoma cases showed diffuse and strong expression. The NOVA1 expression level varied according to the subtype; it was higher in angioimmunoblastic T-cell lymphoma, anaplastic lymphoma kinase (ALK)-negative anaplastic large cell lymphoma (ALCL), and T lymphoblastic leukemia/lymphoma (T-LBL), but it was lower in ALK-positive ALCL. In almost all B-cell lymphomas, NOVA1 expression was very low or negative. NOVA1 mRNA was also expressed in Jurkat, a T-LBL cell line. Conclusions: The present findings suggest that NOVA1 upregulation may be involved in certain subtypes of T- and NK-cell lymphomas, but not in B-cell lymphomas. Upregulated NOVA1 expression seems to be a specific biological feature of activated T cells such as T- and NK-cell lymphomas.

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Intraoperative pathologic diagnosis of central nervous system lymphomas: A comparison of frozen and permanent section diagnoses, and the significance of preoperative imaging
Aslı Kahraman, Fikret Dirilenoğlu, İsmail Güzeliş, Kenan Çetinoğlu
Annals of Diagnostic Pathology.2024; 69: 152246. CrossRef
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Lianyue Qu, Yulong Tian, Fan Wang, Zixuan Li
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Meningeal Solitary Fibrous Tumors with Delayed Extracranial Metastasis: Nayoung Han, Hannah Kim, Soo Kee Min, Sun-Ha Paek, Chul-Kee Park, Seung-Hong Choi, U-Ri Chae, Sung-Hye Park; J Pathol Transl Med. 2016;50(2):113-121. Published online December 14, 2015; DOI: https://doi.org/10.4132/jptm.2015.10.30

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Abstract PDF

Background
The term solitary fibrous tumor (SFT) is preferred over meningeal hemangiopericytoma (HPC), because NAB2-STAT6 gene fusion has been observed in both intracranial and extracranial HPCs. HPCs are now considered cellular variants of SFTs. Methods: This study analyzes 19 patients with STAT6-confirmed SFTs, who were followed for over 11 years in a single institution. Ten patients (10/19, 56.2%) had extracranial metastases (metastatic group), while the remainder (9/19) did not (non-metastatic group). These two groups were compared clinicopathologically. Results: In the metastatic group, the primary metastatic sites were the lungs (n = 6), bone (n = 4), and liver (n = 3). There was a mean lag time of 14.2 years between the diagnosis of the initial meningeal tumor to that of systemic metastasis. The median age at initial tumor onset was 37.1 years in the metastatic group and 52.5 in the non-metastatic group. The 10-year survival rates of the metastatic- and non-metastatic groups were 100% and 33%, respectively. The significant prognostic factors for poor outcomes on univariate analysis included advanced age (≥45 years) and large initial tumor size (≥5 cm). In contrast, the patients with higher tumor grade, high mitotic rate (≥5/10 high-power fields), high Ki-67 index (≥5%), and the presence of necrosis or CD34 positivity showed tendency of poor prognosis but these parameters were not statistically significant poor prognostic markers. Conclusions: Among patients with SFTs, younger patients (<45 years) experienced longer survival times and paradoxically had more frequent extracranial metastases after long latent periods than did older patients. Therefore, young patients with SFTs require careful surveillance and follow-up for early detection of systemic metastases.

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Prognostic Significance of Aquaporin 5 Expression in Non-small Cell Lung Cancer: Young Min Jo, Tae In Park, Hwa Young Lee, Ji Yun Jeong, Won Kee Lee; J Pathol Transl Med. 2016;50(2):122-128. Published online February 8, 2016; DOI: https://doi.org/10.4132/jptm.2015.10.31

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Abstract PDF

Background
Aquaporins are water channel proteins that play a major role in the movement of water in various human tissues. Recently, it has been found that aquaporins have influence in the carcinogenesis of human malignancies. We analyzed the prognostic impact of aquaporin 5 (AQP5) in non-small lung cancer (NSCLC). Methods: Seventy-six cases of NSCLC were studied, including 44 cases of adenocarcinoma (ADC) and 32 cases of squamous cell carcinoma (SQCC). Tissue microarray was constructed and immunohistochemical staining for AQP5 was performed. Results: AQP5 was positive in 59.2% of the total enrolled NSCLCs (63.7% in ADC and 53.1% in SQCC). The difference in expression of AQP5 according to the histologic grade of the tumor was significant (p<.047), but not in a serial order. When ADC and SQCC were separately evaluated, no significant difference was observed according to the histologic grade of the tumor (p=.076 in ADC and p=.631 in SQCC). No difference was observed between AQP5 expression and other demographic data and tumor characteristics. Disease-free survival (DFS) was higher in AQP5 negative cases than positive cases in ADC (p=.047), but no significance was found in SQCC (p=.068). We were unable to find a significance between AQP5 overexpression and overall survival in either ADC (p=.210) or SQCC (p=.533). Conclusions: AQP5 expression is associated with DFS in ADC of the lung and tumor grade of NSCLC. The present study suggests that AQP5 can be a prognostic factor of NSCLC.

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AQP5 promotes epithelial-mesenchymal transition and tumor growth through activating the Wnt/β-catenin pathway in triple-negative breast cancer
Zhengcai Zhu, Tao Li, Honggang Wang, Lianghe Jiao
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Aquaporin-mediated dysregulation of cell migration in disease states
Ian M. Smith, Shohini Banerjee, Allison K. Moses, Kimberly M. Stroka
Cellular and Molecular Life Sciences.2023;[Epub] CrossRef
The Role of Aquaporin 5 (AQP5) in Lung Adenocarcinoma: A Review Article
Lukasz Jaskiewicz, Anna Romaszko-Wojtowicz, Anna Doboszynska, Agnieszka Skowronska
Cells.2023; 12(3): 468. CrossRef
Aquaporins 1, 3 and 5 in Different Tumors, their Expression, Prognosis Value and Role as New Therapeutic Targets
Mahdieh-Sadat Moosavi, Yalda Elham
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Aquaporins in lung health and disease: Emerging roles, regulation, and clinical implications
Ekta Yadav, Niket Yadav, Ariel Hus, Jagjit S. Yadav
Respiratory Medicine.2020; 174: 106193. CrossRef
Combined Systematic Review and Transcriptomic Analyses of Mammalian Aquaporin Classes 1 to 10 as Biomarkers and Prognostic Indicators in Diverse Cancers
Pak Hin Chow, Joanne Bowen, Andrea J Yool
Cancers.2020; 12(7): 1911. CrossRef
Prognostic Role of S100A8 and S100A9 Protein Expressions in Non-small Cell Carcinoma of the Lung
Hyun Min Koh, Hyo Jung An, Gyung Hyuck Ko, Jeong Hee Lee, Jong Sil Lee, Dong Chul Kim, Jung Wook Yang, Min Hye Kim, Sung Hwan Kim, Kyung Nyeo Jeon, Gyeong-Won Lee, Se Min Jang, Dae Hyun Song
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Effect of FGF/FGFR pathway blocking on lung adenocarcinoma and its cancer‐associated fibroblasts
Ahmed E Hegab, Mari Ozaki, Naofumi Kameyama, Jingtao Gao, Shizuko Kagawa, Hiroyuki Yasuda, Kenzo Soejima, Yongjun Yin, Robert D Guzy, Yoshikazu Nakamura, David M Ornitz, Tomoko Betsuyaku
The Journal of Pathology.2019; 249(2): 193. CrossRef
Anti-cancer effect of Aquaporin 5 silencing in colorectal cancer cells in association with inhibition of Wnt/β-catenin pathway
Wei Wang, Qing Li, Tao Yang, Dongsheng Li, Feng Ding, Hongzhi Sun, Guang Bai
Cytotechnology.2018; 70(2): 615. CrossRef
Knockdown of aquaporin-5 sensitizes colorectal cancer cells to 5-fluorouracil via inhibition of the Wnt–β-catenin signaling pathway
Qing Li, Tao Yang, Dongsheng Li, Feng Ding, Guang Bai, Wei Wang, Hongzhi Sun
Biochemistry and Cell Biology.2018; 96(5): 572. CrossRef
Implications of KRAS mutations in acquired resistance to treatment in NSCLC
Marzia Del Re, Eleonora Rofi, Giuliana Restante, Stefania Crucitta, Elena Arrigoni, Stefano Fogli, Massimo Di Maio, Iacopo Petrini, Romano Danesi
Oncotarget.2018; 9(5): 6630. CrossRef

Interobserver Variability of Ki-67 Measurement in Breast Cancer: Yul Ri Chung, Min Hye Jang, So Yeon Park, Gyungyub Gong, Woo-Hee Jung, The Korean Breast Pathology Ki- Study Group; J Pathol Transl Med. 2016;50(2):129-137. Published online February 15, 2016; DOI: https://doi.org/10.4132/jptm.2015.12.24

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Background
As measurement of Ki-67 proliferation index is an important part of breast cancer diagnostics, we conducted a multicenter study to examine the degree of concordance in Ki-67 counting and to find factors that lead to its variability. Methods: Thirty observers from thirty different institutions reviewed Ki-67–stained slides of 20 different breast cancers on whole sections and tissue microarray (TMA) by online system. Ten of the 20 breast cancers had hot spots of Ki-67 expression. Each observer scored Ki-67 in two different ways: direct counting (average vs. hot spot method) and categorical estimation. Intraclass correlation coefficient (ICC) of Ki-67 index was calculated for comparative analysis. Results: For direct counting, ICC of TMA was slightly higher than that of whole sections using average method (0.895 vs 0.858). The ICC of tumors with hot spots was lower than that of tumors without (0.736 vs 0.874). In tumors with hot spots, observers took an additional counting from the hot spot; the ICC of whole sections using hot spot method was still lower than that of TMA (0.737 vs 0.895). In categorical estimation, Ki-67 index showed a wide distribution in some cases. Nevertheless, in tumors with hot spots, the range of distribution in Ki-67 categories was decreased with hot spot method and in TMA platform. Conclusions: Interobserver variability of Ki-67 index for direct counting and categorical estimation was relatively high. Tumors with hot spots showed greater interobserver variability as opposed to those without, and restricting the measurement area yielded lower interobserver variability.

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Therese Bocklage, Virgilius Cornea, Caylin Hickey, Justin Miller, Jessica Moss, Mara Chambers, S. Emily Bachert
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Assessment of the Predictive Role of Ki-67 in Breast Cancer Patients’ Responses to Neoadjuvant Chemotherapy
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European Journal of Breast Health.2024; : 199. CrossRef
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Surgery.2023; 173(2): 365. CrossRef
Automated Molecular Subtyping of Breast Carcinoma Using Deep Learning Techniques
S. Niyas, Ramya Bygari, Rachita Naik, Bhavishya Viswanath, Dhananjay Ugwekar, Tojo Mathew, J Kavya, Jyoti R Kini, Jeny Rajan
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Diana Grace Varghese, Jaydira Del Rivero, Emily Bergsland
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Diagnostic Role and Prognostic Impact of PSAP Immunohistochemistry: A Tissue Microarray Study on 31,358 Cancer Tissues
Laura Sophie Tribian, Maximilian Lennartz, Doris Höflmayer, Noémi de Wispelaere, Sebastian Dwertmann Rico, Clara von Bargen, Simon Kind, Viktor Reiswich, Florian Viehweger, Florian Lutz, Veit Bertram, Christoph Fraune, Natalia Gorbokon, Sören Weidemann, C
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Yiqing Liu, Tiantian Zhen, Yuqiu Fu, Yizhi Wang, Yonghong He, Anjia Han, Huijuan Shi
Cancers.2023; 16(1): 167. CrossRef
Expression of estrogen and progesterone receptors, HER2 protein and Ki-67 proliferation index in breast carcinoma in both tumor tissue and tissue microarray
UP Hacısalihoğlu, MA Dogan
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Diffusive Ki67 and vimentin are associated with worse recurrence-free survival of upper tract urothelial carcinoma: A retrospective cohort study from bench to bedside
Che Hsueh Yang, Wei Chun Weng, Yen Chuan Ou, Yi Sheng Lin, Li Hua Huang, Chin Heng Lu, Tang Yi Tsao, Chao Yu Hsu, Min Che Tung
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Should Ki-67 be adopted to select breast cancer patients for treatment with adjuvant abemaciclib?
P. Tarantino, H.J. Burstein, N.U. Lin, I.E. Krop, E.P. Winer, S.J. Schnitt, E.P. Hamilton, S.A. Hurvitz, H.S. Rugo, G. Curigliano, S.M. Tolaney
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Tojo Mathew, S. Niyas, C.I. Johnpaul, Jyoti R. Kini, Jeny Rajan
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Deep learning for the standardized classification of Ki-67 in vulva carcinoma: A feasibility study
Matthias Choschzick, Mariam Alyahiaoui, Alexander Ciritsis, Cristina Rossi, André Gut, Patryk Hejduk, Andreas Boss
Heliyon.2021; 7(7): e07577. CrossRef
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Fabio Marazzi, Roberto Barone, Valeria Masiello, Valentina Magri, Antonino Mulè, Angela Santoro, Federica Cacciatori, Luca Boldrini, Gianluca Franceschini, Francesca Moschella, Giuseppe Naso, Silverio Tomao, Maria Antonietta Gambacorta, Giovanna Mantini,
Clinical Breast Cancer.2020; 20(5): e600. CrossRef
Study of Ki-67 index in the molecular subtypes of breast cancer: Inter-observer variability and automated scoring
Divya Meermira, Meenakshi Swain, Swarnalata Gowrishankar
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Darshana Govind, Kuang-Yu Jen, Karen Matsukuma, Guofeng Gao, Kristin A. Olson, Dorina Gui, Gregory. E. Wilding, Samuel P. Border, Pinaki Sarder
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Practical approaches to automated digital image analysis of Ki-67 labeling index in 997 breast carcinomas and causes of discordance with visual assessment
Ah-Young Kwon, Ha Young Park, Jiyeon Hyeon, Seok Jin Nam, Seok Won Kim, Jeong Eon Lee, Jong-Han Yu, Se Kyung Lee, Soo Youn Cho, Eun Yoon Cho, Irina V. Lebedeva
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Evaluation of Ki-67 Index in Core Needle Biopsies and Matched Breast Cancer Surgical Specimens
Soomin Ahn, Junghye Lee, Min-Sun Cho, Sanghui Park, Sun Hee Sung
Archives of Pathology & Laboratory Medicine.2018; 142(3): 364. CrossRef
Assessment of Ki-67 for Predicting Effective Prognosis in Breast Cancer Subtypes
Sangjung Park, Sunyoung Park, Jungho Kim, Sungwoo Ahn, Kwang Hwa Park, Hyeyoung Lee
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Anne‐Sofie Wessel Lindberg, Knut Conradsen, Rasmus Larsen, Michael Friis Lippert, Rasmus Røge, Mogens Vyberg
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Min Hye Jang, Hyun Jung Kim, Yul Ri Chung, Yangkyu Lee, So Yeon Park, William B. Coleman
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Yi Zhang, Brock E. Schroeder, Piiha-Lotta Jerevall, Amy Ly, Hannah Nolan, Catherine A. Schnabel, Dennis C. Sgroi
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Comparison of Analytical and Clinical Performance of HPV 9G DNA Chip, PANArray HPV Genotyping Chip, and Hybrid-Capture II Assay in Cervicovaginal Swabs: Ho Young Jung, Hye Seung Han, Hyo Bin Kim, Seo Young Oh, Sun-Joo Lee, Wook Youn Kim; J Pathol Transl Med. 2016;50(2):138-146. Published online January 13, 2016; DOI: https://doi.org/10.4132/jptm.2015.10.21

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Background
Human papillomavirus (HPV) infection can be detected by using several molecular methods, including Hybrid-Capture II (HC2) assay and variable HPV DNA chip tests, although each method has different sensitivities and specificities. Methods: We performed HPV 9G DNA Chip (9G) and PANArray HPV Genotyping Chip (PANArray) tests on 118 cervicovaginal swabs and compared the results with HC2, cytology, histology, and direct sequencing results. Results: The overall and high-risk HPV (HR-HPV) positivity rates were 62.7% and 44.9% using 9G, and 61.0% and 30.5% using PANArray, respectively. The positivity rates for HR-HPV with these two chips were significantly lower than 55.1% when HC2 was used. The sensitivity of overall HPV positivity in detecting histologically confirmed low-grade cervical squamous intraepithelial lesions or higher was 88.7% for all three tests. The specificity was 58.5% for 9G and 61.5% for PANArray, which was significantly lower than the 72.3% for HC2. With the HR-HPV⁺ genotype threshold, the sensitivity decreased to 75.5% for 9G and 52.8% for PANArray, which was significantly lower than the 88.7% for HC2. Comparison of the two chips showed concordant results in 55.1% of the samples, compatible results in 16.9%, and discordant results in 28.0%, exhibiting poor agreement in detecting certain HPV genotypes. Compared with direct sequencing, 9G yielded no discordant results, whereas PANArray yielded 31 discordant results (26.7%). Conclusions: Compared with HC2, the HPV genotyping tests showed lower sensitivity in histologic correlation. When the two chips were compared, the 9G was more sensitive and accurate for detecting HR-HPV than the PANArray.

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Concordance of Anyplex™ II HPV HR assays with reference HPV assays in cervical cancer screening: Systematic review
Habtamu Biazin
Journal of Virological Methods.2022; 301: 114435. CrossRef
The clinical performance of human papillomavirus genotyping using PANArray HPV chip: Comparison to ThinPrep cytology alone and co-testing
Jiyoung Kim, Sun-Young Jun, Lee-So Maeng
Pathology - Research and Practice.2020; 216(9): 153121. CrossRef
Analytic performance of PANArray HPV and HPV 9G DNA chip tests for genotyping of high-risk human papillomavirus in cervical ThinPrep PreservCyt samples
Jiyoung Kim, Sun-Young Jun, Magdalena Grce
PLOS ONE.2019; 14(10): e0224483. CrossRef

Morphologic Analysis of Cytomegalovirus Infected Cells in Bronchial Washing Cytology: Comparison of Liquid-Based Preparation and Conventional Smear: Jae Yeon Seok, Jungsuk An, Seung Yeon Ha, Dong Hae Chung, Sangho Lee, Hyunchul Kim; J Pathol Transl Med. 2016;50(2):147-154. Published online February 15, 2016; DOI: https://doi.org/10.4132/jptm.2015.12.25

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Background
The cytopathic effects of cytomegalovirus (CMV) infection have been well described since the virus was first reported; however, the morphology of CMV infection has not been clearly studied. We examined the difference in detailed cytologic findings in bronchial washing cytology between liquid-based and conventionally prepared smears. Methods: Bronchial washing cytology was processed using either the conventional preparation (CP) or liquid-based preparation (LBP). Sixty-nine cells with typical cytopathic effects of CMV infection were detected on CP slides and 18 cells on LBP slides. Using the image analyzer, area, circumference, major axis, and minor axis of the cytoplasm, nucleus, and intranuclear inclusion were measured in singly scattered CMV-infected cells, and histiocytes were used as a control. Results: The mean cytoplasmic area of CMV-infected cells was 1.47 times larger than that of histiocytes in CP and 2.92 times larger in LBP (p<.05). The mean nuclear area of CMV-infected cells was 2.61 times larger than that of histiocytes in CP and 4.25 times larger in LBP (p<.05). The nucleus to cytoplasm ratio and intranuclear inclusion to cytoplasm ratio of the mean area, circumference, major axis, and minor axis in CP were larger than those in LBP (p<.05). Conclusions: The sizes of cytoplasm, nucleus, and intranuclear inclusion were larger in LBP than in CP, indicating that CMV-infected cells are easily detectable in LBP. However, the nucleus-to-cytoplasm ratio was larger in CP, suggesting that differentiation from malignancy or regenerative atypia requires caution in CP.

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Case Studies

Clear Cell Adenocarcinoma Arising from Adenofibroma in a Patient with Endometriosis of the Ovary: Inju Cho, Sung-Chul Lim; J Pathol Transl Med. 2016;50(2):155-159. Published online October 26, 2015; DOI: https://doi.org/10.4132/jptm.2015.08.07

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Ovarian clear cell adenocarcinomas (CCACs) are frequently associated with endometriosis and, less often with clear cell adenofibromas (CCAFs). We encountered a case of ovarian CCAC arising from benign and borderline adenofibromas of the clear cell and endometrioid types with endometriosis in a 53-year-old woman. Regions of the adenofibromas showed transformation to CCAC and regions of the endometriosis showed atypical endometriotic cysts. This case demonstrates that CCAC can arise from CCAF or endometriosis.

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Zhiwei Yin, Stephen Peters, Ravi Chokshi, Debra Heller
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Thingreila Muinao, Mintu Pal, Hari Prasanna Deka Boruah
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An Adult Case of Bartter Syndrome Type III Presenting with Proteinuria: Eun Jung Cha, Won Min Hwang, Sung-Ro Yun, Moon Hyang Park; J Pathol Transl Med. 2016;50(2):160-164. Published online January 11, 2016; DOI: https://doi.org/10.4132/jptm.2015.08.31

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Bartter syndrome (BS) I–IV is a rare autosomal recessive disorder affecting salt reabsorption in the thick ascending limb of the loop of Henle. This report highlights clinicopathological findings and genetic studies of classic BS in a 22-year-old female patient who presented with persistent mild proteinuria for 2 years. A renal biopsy demonstrated a mild to moderate increase in the mesangial cells and matrix of most glomeruli, along with marked juxtaglomerular cell hyperplasia. These findings suggested BS associated with mild IgA nephropathy. Focal tubular atrophy, interstitial fibrosis, and lymphocytic infiltration were also observed. A genetic study of the patient and her parents revealed a mutation of the CLCNKB genes. The patient was diagnosed with BS, type III. This case represents an atypical presentation of classic BS in an adult patient. Pathologic findings of renal biopsy combined with genetic analysis and clinicolaboratory findings are important in making an accurate diagnosis.

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Brief Case Reports

A Rare Case of Thymic Gangliocytic Paraganglioma: Jung Wook Yang, Joungho Han, Hyun Woo Lee, Soo Youn Cho, Hong Kwan Kim; J Pathol Transl Med. 2016;50(2):165-167. Published online October 8, 2015; DOI: https://doi.org/10.4132/jptm.2015.07.15

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Primary Neurilemmoma of the Thyroid Gland Clinically Mimicking Malignant Thyroid Nodule: Young Sub Lee, Jee Soon Kim, Arthur Minwoo Chung, Woo Chan Park, Tae-Jung Kim; J Pathol Transl Med. 2016;50(2):168-171. Published online October 26, 2015; DOI: https://doi.org/10.4132/jptm.2015.08.26

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