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Volume 12(1); June 2001
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Editorial
The Bethedsa System 2001 Workshop Report.
Eun Kyung Hong, Jong Hee Nam, Moon Hyang Park
Korean J Cytopathol. 2001;12(1):1-15.
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AbstractAbstract PDF
The Bethesda System (TBS) was first developed in 1988 for the need to enhance the communication of the cytopathologic findings to the referring physician in unambiguous diagnostic terms. The terminology used in this reporting system should reflect current understanding of the pathogenesis of cervical/vaginal disease, so the framework of the reporting system should be flexible enough to accommodate advances in medicine, including virology, molecular biology, and pathology. Three years after the introduction of TBS, the second Bethesda workshop was held to set or amend diagnostic criteria for each categories of TBS. TBS 1991 is now widely used. The third Bethesda workshop, The Bethesda System 2001 Workshop, was held in National Cancer Institute, Bethesda, Maryland from April 30 to May 2, 2001. Again, the goals of this workshop were to promote effective communication and to clarify in reporting cervical cytopathology results to clinicians and to provide with the information to make appropriate decisions about diagnosis and treatment. Nine forum groups were made and there were Web-based bulletin board discussions between October, 2000 and the first week of April, 2001. On the basis of bulletin board comments and discussions, the forum moderators recommended revised terminologies in the Workshop. Hot discussions were followed after the presentation by forum moderators during the workshop. Terminologies confusing clinicians and providing no additional informations regarding patient management were deleted in the workshop to clarify the cervicovaginal cytology results. Any informations related to the patient management were encouraged to add. So 'Satisfactory for evaluation but limited by' of 'Specimen Adequacy' catergory was deleted. Terminology of 'Unsatisfactory' was further specified as 'Specimen rejected' and 'Specimen processed and examined, but unsatisfactory'. Terminologies of 'Benign Cellular Change' and 'Within Normal Limits' were combined and terminology was changed to 'Negative for intraepithelial lesion
Etcs
A Pathologic Study on Tumors of the Kidney
Sang Kook Lee, Shin Kwang Khang, Geung Hwan Ahn
Korean J Cytopathol. 1978;12(1):3-8.
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AbstractAbstract
A pathologic study of 24 cases of primary malignant renal tumors that were examined at the Department of Pathology, Seoul National University Hospital, during period of 5 years from January, 1970 to December, 1974, was made. The results were as follows : 1. The malignant tumors of the kidney constituted 0.9 percent of 2,757 cases of all primary malignant tumors, that were examined during the same period. The mean age of total renal malignant tumors was 38 years : adenocarcinoma 50 years : Wilms’ tumor 6 years : and tumors of renal pelvis 50 years. The renal adenocarcinoma and tumors of renal pelvis were most prevalent after the age of 40 years, while Wilms’ tumor was prevalent before the age of 10 years. The renal tumors affected more males than females with a male to female ratio of 1.4 to 1. Even a single case of benign renal tumor was not noted during the same period. 2. The cardinal symptoms included hematuria, flank pain or discomfort, and palpable abdominal mass. Palpable abdominal mass was the most important and frequent complaints in patients with Wilms’ tumor. Systemic manifestations were observed in 4 cases : hypertension in 1 case. unexplained fever in 2 cases, and polycythemia in 1 case. 3. Twenty-four cases of primary malignant renal tumors were classified histologically into 11 adenocarcinomas(45.8 %), 6 Wilms’ tumors(25.0 %), and 7 carcinomas of renal pelvis (29.2 %). Eleven cases of renal adenocarcinoma included 8 cases of clear cell type(72.7 %), 1 case of granular cell type(9.1 %), and 2 cases of mixed variety(18.2 %). Renal vein invasion was noted in 4 out of 11 cases of renal adenocarcinoma. Epithelial components were observed in all 6 cases of Wilms’ tumor, while striated muscle was observed in only one case.
Pathologic Study on Tumors of Breast
Sang Kook Lee, Geung Hwan Ahn
Korean J Cytopathol. 1978;12(1):9-13.
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AbstractAbstract
A histopathologic study was made on 268 cases of tumors of the breast, which were obtained during a period of 5 years, from 1970 to 1974, at the Department of Pathology, College of Medicine, Seoul National University, and the result were as follow; 1. Two hundred and sixty-eight tumors of the breast examined consist of 155 benign tumors and 113 malignant tumors. 2. Among benign tumors, fibroadenoma is the most prevalent (95.5%) and shows highest incidence in the age group of 20 ~ 29. 3. The mean age of female breast carcinoma is 45.1 years. 4. Site incidence of female breast carcinoma is highest in outer upper quadrant of breast and frequent clinical symptoms include lump (89%), nipple discharge (12%), pain in breast (7%) and nipple retraction (6%) in order of frequency. 5. Among various histopathologic types of breast carcinoma, infiltrating duct carcinoma with productive fibrosis is most prevalent (66.4%) and shows the highest rate of node involvement (80.8%).
Estimation of Normal Ranges of ESR from Routine laboratory Data
Chang Soo Chung
Korean J Cytopathol. 1978;12(1):15-22.
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AbstractAbstract
The main purpose of this study was to introduce the two methods by the present author and the maximum likelihood estimate method applicable to the determination of normal ranges of ESR from the routine laboratory data. At first the basic principles of the three methods were explained, and then their application to practice were illustrated by estimating normal ranges of ESR from complete and artificially truncated gambles obtained from 309 normal Korean adult women. At last an attempt was made to estimate normal ranges of ESR from the laboratory data of Pusan National University Hospital, and values of upper limit of 95% range were gained, ranging between 16 and 21mm/hour in women and between 14 and 18mm/hour in man.
Original Article
Diagnostic Sensitivity of Sputum and Bronchial Washing Cytology in Bronchogenic Carcinomas Confirmed by Bronchoscopic Biopsy .
Joon Mee Kim, Soo Kee Min, Young Chae Chu, Chul Ho Cho
Korean J Cytopathol. 2001;12(1):17-23.
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AbstractAbstract PDF
To evaluate the role of sputum and bronchial washing for the diagnosis of lung carcinoma, we studied the sensitivity of both cytologic techniques using the biopsy confirmed cases from 228 patients. Among them, 123 cases were squamous cell carcinomas, 42 cases were adenocarcinomas, 48 cases were small cell carcinomas, one case was large cell carcinoma, and 14 cases were other types of carcinoma including poorly differentiated carcinomas. Three hundreds and ninety two sputa and 173 sputa were obtained in the pre- and post- bronchoscopic periods. Bronchial washing had been taken once in each patient. The overall sensitivity of the sputum cytology was 0.52 and that of the bronchial washing 0.63, while it increased to 0.83 when a combination of both techniques. Squamous cell carcinomas were diagnosed to the great extent in which sensitivities were 0.59 and 0.74, in sputum and bronchial washing, respectively. The post-bronchoscopic sputa showed higher sensitivity (0.44) than pre-bronchoscopic sputa (0.30). The sensitivity of sputa increased from 0.34 to 0.49 when three samples were examined compared to the single examination. The accuracy of cell typing was 94.0% in sputa and 93.8% in bronchial washing. Repeated sputum examination including post- bronchoscopic sputa is warranted to improve sensitivity and a complementary role of both cytologic techniques can be postulated by these data.
Etc
Serratia marcescens Isolation and the Patients' Clinical Status
Ae Ja Park, Yunsop Chong, Samuel Y. Lee
Korean J Cytopathol. 1978;12(1):23-29.
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AbstractAbstract
Awareness of the importance of Serratia marcescens as an opportunistic pathogen causing nosocomial infections lead us to use deoxyribonuclease and tween 80 hydrolysis tests to identify this organism from our clinical specimens. From 56 patients Serratia marcescens were isolated during the period of February to October, 1977. Among these 56 cases, 43 were reviewed and the following results were obtained. 1. Serratia marcescens were frequently isolated from patients with age groups of both 40-49, and 60 or over. The male to female ratio was 3 : 1. 2. The isolation was frequently from respiratory, woulld and urine specimens. There were two serious patients; one yielded the organism from blood and the other from spinal fluid. 3. The patients yielding the organisms were found to have predisposing factors such as various debilitating disorders, surgical procedures and urinary catheterizations. 4. Thirty eight out of the 43 were hospitalized patients and remaining 5 were outpatients with previous hospitalizations. This fact is highly suggestive of the nosocomial nature of the infections. 5. At the time of bacterial culture, 34 patients had been receiving single or multip!e antibiotics, suggesting the relationship of the infections an4 the antibioic administrations. 6. In 10 patients, the organisms were solely isolated indicating their etiological significance. From the rest of the patients other organisms were also isolated together with Serratia marcescens. Serrtia infections were thought to be rare previously, but it was obviously wrong and perhaps it was due to the difficulty of their correct identification. The infections are frequent among long standing inpatients particulary in aged persons with various underlying disorders. A correct identification and a proper susceptibility testing should be considered imperative for both prevention of new infections and adequate treatment of the patients.
Original Articles
Polymerase Chain Reaction Detection of Mycobacterium tuberculosis and Fine Needle Aspiration Cytology for the Diagnosis of Tuberculous Lymphadenitis .
Joo Heon Kim, Nam Hoon Kim, Dong Wook Kang, Mee Ja Park, Sang Kyoung Moon, Tae Cho Yu, Eun Ju Jang
Korean J Cytopathol. 2001;12(1):25-30.
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AbstractAbstract PDF
Tuberculous lymphadenitis is not uncommon in Korea. Therefore, an inexpensive, safe and rapid method is needed to diagnose the tuberculous lymphadenitis. Fine needle aspiration cytology is a good method for this purpose, but has several limitations in the diagnosis of tuberculous lymphadenitis, especially when the presence of acid-fast bacilli is not proved. To evaluate the usefulness of the polymerase chain reaction with enzyme immunoassay technique in the detection of Mycobacterium tuberculosis (M. tuberculosis) in the cervical lymph node aspirates, the authors performed fine needle aspiration cytology and M. tuberculosis PCR with enzyme immunoassay for mycobacterial DNA sequences from 15 cases of the fine needle aspirates. Cytomorphologically, the cases were categorized into three types: predominantly necrotic materials; typical epithelioid cell granulomas with or without giant cells and caseous necrosis; and non-tuberculous lesions, such as reactive lymphadenitis, abscess, metastatic carcinoma and malignant lymphoma. M. tuberculosis DNA was found in 8 of 15 cases by PCR with enzyme immunoassay. Negative findings on PCR were achieved in 7 cases, which revealed non-tuberculous lymphadenopathy. In conclusion, we suggest that M. tuberculosis PCR with enzyme immunoassay using the fine needle aspirates is a very useful tool for the diagnosis of tuberculous lymphadenitis.
The Cytologic Analysis of Microinvasive Squamous Cell Carcinoma of the Uterine Cervix on Cervical Smear .
Hyun Joo Choi, In Ae Park
Korean J Cytopathol. 2001;12(1):31-37.
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AbstractAbstract PDF
While cytologic characteristics of squamous dysplasia, carcinoma in situ, and invasive squamous cell carcinoma of the uterine cervix are well documented, relatively few studies have dealt with the cellular features of microinvasive carcinoma. In order to describe the cellular characteristics of microinvasive squamous cell carcinoma, we retrospectively reviewed 45 cervovaginal smears(15 carcinoma in situ, 15 microinvasive cancer, 15 invasive cancer) which were confirmed by histologic examination of specimens obtained by hysterectomy at the Seoul National University Hospital during 5 years from 1995 to 1999. The cytologic features about tumor diathesis, inflammatory background, cell arrangement, anisonucleosis, nuclear membrane irregularity, nuclear chromatin pattern, and nucleoli were observed. The cytologic characteristics of microinvasive squamous cell carcinoma of the uterine cervix are syncytial pattern, mild tumor diathesis, the irregularity of nuclear membrane, irregularly distributed nuclear chromatin, and occurrence of micronucleoli. But, correlation between the depth of invasion and the cytologic feature had limited value.
Etc
A Study on the Possibility for the Replacement of the Conventional Carbohydrate Fermentation by the Disk paper Method
Hyun Sook Lee, In Sun Kim, Sun Chul Whang, Seung Yong Paik
Korean J Cytopathol. 1978;12(1):31-38.
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AbstractAbstract
The use of carbohydrate fermentation tests has teen widely employed in the identification and the classification of various species of micro-organisms. The characteristics of the bacterial metabolism differ even within the same species depending upon its energy requirement a digestive patterns. The majority types of carbohydrate fermentation tests have been based on the fact that a certain micro-organism uses carbohydrates as an energy supply source and yields some metabolites by action of type specific enzymes. The study had been concentrated on the possibility whether the conventional fermentation tests could be replaced by the disk paper method, and concluded as following: 1. Between the data obtained by the test tube and the disk parer methods of carbohydrate fermentation, there was practically little discrepancy as for the fermentation pattern. 2. The most acceptable concentration of carbohydrates preparing the disk paper was 5 percent while 10 and 20 percents showed the zone of inhibition to the high acidity produced around the disks. 3. Generally, the acidification of the media can be read between 6 and 8 hours of incubation followed by the inoculation, therefore preliminary or complete identification can be cut at least one day. Consequently the laboratory data can reach at the physician’s hand a day earlier. 4. The disk paper method is proved to be much economic in the aspects of reagent, media, man power, and most of all, the time of identification still exhibiting the accuracy and the reliability.
Case Report
Imprint Cytologic Feature of Pleuropulmonary Blastoma: A Case Report .
Mee Sook Roh, Ji Young Seo, Gi Yeong Huh, Pill Jo Choi, Sook Hee Hong, Jin Sook Jeong
Korean J Cytopathol. 2001;12(1):39-43.
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AbstractAbstract PDF
Pleuropulmonary blastoma (PPB) is an unusual intrathoracic blastoma presenting in childhood and characterized by a biphasic neoplastic population of undifferentiated, small round blastemal cells and larger spindle-shaped sarcomatous cells with entrapped benign epithelial-lined structures. We experienced the cytologic features of PPB in imprint smear from the pleural-based huge mass of the middle lobe of the right lung in a 4-year-old boy. The smears showed high cellularity composed of small ovoid blastemal elements and scattered spindle mesenchymal tumor cells. Lobectomy and pathologic investigation confirmed the diagnosis. PPB seems to be a tumor in which accurate diagnosis may be achieved by cytology if appropriate clinical information were given. Timely and accurate diagnosis of PPB by cytology paves the way for attempting preoperative treatment in future cases.
Etc
The Antagonistic Effect of Ps. aeruginosa against some Enteric Bacteria
Kwang Gab Sim, In Sun Kim, Sun Chul Whang, Seung Yong Paik
Korean J Cytopathol. 1978;12(1):39-45.
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AbstractAbstract
Some genera of micro-organisms produce bacterial metabolites that have antibiotic effect against same species and to other genera of bacteria as well. The known bacteria which can affect the intact cells of other bacteria are mostly gram negative bacilli such as E. coli, Ps. aeruginosa, V. cholerae and Y. pestis. The most responsible substances inhibiting the bacterial growth are known grossly as bacteriocin, and subsequently named as colicin, pyocin, vibriocin and pesticin according to the bacteria from which these metabolites are derived. The study had been conducted to see the antagonistic effect of Ps. aeruginosa against some enteric bacteria, both pathogenes and normal flora, and gram positive cocci. The experiment yielded the following results: 1. The antagonistic effect of Ps. aeruginosa against the testing strains was confirmed, but the degree of the effect varied not only depending upon the age of the strains, but also to the organisms. 2. Dilution of the Ps. aerugionsa bacterial suspension decreased the potency of the effect, however, rendered the quantitative estimation of the inhibitory effect. 3. The quantitative analysis showed that the antagonistic effect of Ps. aeruginosa proved weaker against the other genera of bacteria than against the same species. This definite difference in degree of inhibitory action indicated the possibility of its application in the identification of the clinical bacteriology employing the principle of the type specificity. 4. It was also interesting that the antagonistic effect of Ps. aeruginosa was not only inhibitory against gram negative bacilli, but also against the highly resistant gram-positive cocci, Staphylococcus aureus.
Case Report
Fine Needle Aspiration Cytology of Papillary-Cystic Variant of Acinic Cell Carcinoma of Salivary Gland: A Case Report .
Ah Won Lee, Jin Young Yoo, Seok Jin Kang, Byung Kee Kim
Korean J Cytopathol. 2001;12(1):45-48.
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AbstractAbstract PDF
Acinic cell carcinoma(ACC) is the third common malignancy in major salivary gland. Fine needle aspiration cytology is a useful tool for the diagnosis of salivary gland lesions. However, some low grade malignancies, such as ACC and mucoepidermoid carcinoma show relatively high false negative rate, mainly due to deceptively benign cytomorphologic appearance. We experienced a papillary-cystic variant of ACC, having different cytopathologic features compared with those of classic ACC. Our case showed monolayered sheets and papillary clusters without any acinic structures or naked nuclei of the tumor cells. Foamy proteinaceous material was seen in the background. The tumor cells had a large amount of granular cytoplasm and eccentric nuclei. Many vacuolated or clear cells were also noted.
Etc
Incidence of HBsAg Positivity and Liver Function Tests in Leprosy Patients
S.W. Juhng, D.W. Ryang, J.Y. Yoo, S.H Kim, K.H. Cho
Korean J Cytopathol. 1978;12(1):47-53.
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AbstractAbstract
Hepatitis B surface antigen and liver function tests were carried out to evaluate the degree of hepatic damage in 147 leprosy patients admitted in Sorok National Leprosarium. In 147 leprosy patients, 118 were of a lepromatous type, 16 were of a tuberculoid type and 13 were of a borderline group. The results were obtained as follows; 1. In leprosy patients, HBsAg positivity was observed in 4(2.7%) lepers, which was lower than 4(4%) positivity in normal control group. 2. The abnormal elevations of serum alkaline phosphatase, SGOT, SGPT and 777 were observed in 37(25.2%), 24(16.3%), 12(8.2%) and 20(13.5%) lepers respectively. Inverted A/G ratio was noticed in 28(19.0%) lepers. These data of various liver function tests except for SGPT tests in leprosy patients were statistically significant. 3. The abnormal elevations of serum alkaline phoshatase were chiefly observed in the lepers below age of 20 years, in borderline group and in the group of treatment with rifampin. The abnormal elevations of SGOT and inverted A/G ratio seemed to be increased with duration of illness and treatment.
Case Reports
Fine Needle Aspiration Cytology of Salivary Duct Carcinoma with Calcification in Submandibular Gland: A Case Report .
Ki Jung Yun, Weon Cheol Han, Hyang Jeong Jo, Kwang Man Lee
Korean J Cytopathol. 2001;12(1):49-52.
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AbstractAbstract PDF
Salivary duct carcinoma is an uncommon aggressive malignant epithelial neoplasm with similarity to intraductal carcinoma of the breast. This neoplasm occurs most often in the parotid gland of middle-aged and older males. About 7% of reported tumors occured in the submandibular gland. The report of salivary duct carcinoma with calcification is rare. We report a case of salivary duct carcinoma with calcification in the submandibular gland. The patient was a 73-year-old male with a mass of the right submandibular gland for 1 year. On the fine needle aspiration cytology, the aspirate showed scant cellularity, small clusters of tumor cells, and scattered small calcifications. Nuclei of the tumor cells showed mild pleomorphism and round to oval in shape, and cytoplasm was abundant and finely granular. Nucleoli were indistinct and necrosis was not noted. There were no cribriform or papillary arrangements of tumor cells. Cytologic findings of salivary duct carcinoma are variable depending on histologic findings, and calcifications could be an additional cytologic finding.
Fine Needle Aspiration Cytology of Mantle Cell Lymphoma: A Case Report .
Han Seong Kim, Sung Hye Park
Korean J Cytopathol. 2001;12(1):53-56.
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AbstractAbstract PDF
Cytologic features of a case of mantle cell lymphoma is presented, which was obtained by fine needle aspiration cytoloby and confirmed by excisional biopsy of axillary lymph node. A 67-year-old female alleged palpable masses in both axillae for several months. Additional multiple lymphadenopathies were found in the both neck and inguinal areas. The main cytologic feature was carpeting of monotonous slightly atypical small lymphocytes without heterogeneous components. The nuclei of these lymphocytes are slightly larger than benign small lymphocyte and relatively round with some indentation. Nucleolus was not prominent and no mitosis was found. Their cytoplasm was scanty and cyanophilic in Papanicolaou's stain. The histiocytic cells, which had bland-looking banded nuclei and abundant cytoplasm, corresponding to pink histiocytes were shown. Excisional biopsy of lymph nodes was diagnosed as mantle cell lymphoma, diffuse type.

JPTM : Journal of Pathology and Translational Medicine