Journal of Pathology and Translational Medicine

Volume 14(1); May 2003

Case Report

Cytologic Findings of Parathyroid Carcinoma: Report of Two Cases.: Yun Hee Jin, Yong Wook Park, Mi Sheon Jin, Seung Sam Paik, Se Jin Jang, Moon Hyang Park; Korean J Cytopathol. 2003;14(1):1-6.

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Abstract PDF: Parathyroid carcinoma is a rare disorder accounting for 0.5% to 5% of parathyroid neoplasia. Diagnosis of parathyroid carcinoma in fine needle aspiration cytology(FNAC) is difficult because all characteristic features of parathyroid carcinoma can be recognized in parathyroid adenoma or hyperplasia. Cellular atypism cannot be used for the diagnostic criteria of parathyroid carcinoma as malignancies of most other organs. We experienced two cases of cytologic features of parathyroid carcinoma confirmed by histologic examination. The majority of tumor cells formed large cohesive clusters, although individual tumor cells were also present. The tumor cells displayed rather pleomorphic round to oval nuclei, occasional prominent nucleoli, and distinct cytoplasmic margin. Occasionally karyolysis, anuclear cells, and nonepithelial cell clusters were noted. The histologic findings showed a partially lobulated architecture, with admixture of sheets of chief cells, oxyphil cells, and occasional water clear cells. The tumor infiltrated into the thyroid parenchyme and perithyroidal soft tissue. The electron microscopic study of case 1 disclosed typical findings of parathyroid neoplasm; clusters of secretory chief cells with centrally located round to ovoid nuclei, moderately clumped heterochromatins and one or two nucleoli. The tumor cells showed conspicous interdigitation of contiguous cell membrane and intercellular microvilli.

Etc

Clinico-Pathologic Studies on Testicular Tumors among Koreans: Myoung Hee Park; Korean J Cytopathol. 1980;14(1):1-11.

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Abstract: Though the tumors of the testis comprises only a small percentages of all human malignancy, they unfortunately strike the young and productive men with greatest frequency. No other organs, except the ovary, manifest the wide structural range of neoplasia and the broad spectrum of clinical behavior as these encountered in the testis. There have been very little comprehensive studies on the testicular tumors among Koreans. The present study is, therefore, intended to establish a basic pathologic and clinical aspect of the testicular tumors among Koreans. The author collected sixty Veight cases from sixty six patients in four medical centers to get a wider statistical study. The majority were 50 cases from Yonsei University Hospital and 9 from Ewha Womans University Hospital during the twenty years from July, 1959 to June, 1979. Five cases from Korea General Hospital during the eleven years from July, 1968 to June, 1979, and 4 cases from Paik Hospital during the five years from July, 1974 to June, 1979 were added. The microscopic observations were made on the routine hematoxylin and eosin stained sections. Age, laterality, chief complaints and symptom duration were investigated when clinical informations were available. The results were as follow: 1. According to the histologic types, embryonal carcinoma was 17 cases (25.0%), seminoma, 15(22.1%), teratoma, 12(17.6%), yolk sac tumor and mixed germ cell tumor, 7(10.3%), respectively, and gonadoblastoma, 1(1.5%). Malignant lymphoma was 7cases (10.3%) and rhabdomyosarcoma, 2(2.9%). Among 15 cases of seminoma, classical type was 13 and anaplastic type, 2. Among 12 cases of teratoma, 9 were mature and 3 were immature. 2. Among symptoms, a painless palpable scrotal mass was most frequent which were 13 out of 34 cases. The duration of the symptom was less than 6 months in 12 cases (36.3%) and over 2 years in 7 cases (21.2%). 3. The tumors were developed almost equally in each testis. Four patients had bilateral tumors and among them, two had two different histologic types. Six cases were occurred in the undescended testes. 4. Twenty-four patients (35.3%) were in the first decade and the mean was 22 years, while it was 35.6 years in seminoma, 15.4 years in embryonal carcinoma, 12.7 years in teratoma, 2.4 years in yolk sac tumor and 42.7 years in malignant lymphoma. 5. Twenty four patients (73.0%) out of 33 cases whose clinical records about treatment were known, received orchidectomy only.

Case Reports

Cytologic Features of Fine Needle Aspirates of Hyalinizing Trabecular Adenoma with Occult Papillary Carcinoma of the Thyroid.: Kyung Un Choi, Jee Yeon Kim, Jin Sook Lee, Do Youn Park, Chang Hoon Lee, Mee Young So, Kang Suek Suh; Korean J Cytopathol. 2003;14(1):7-11.

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Abstract PDF: Hyalinizing trabecular adenoma of the thyroid gland is a rare benign neoplasm predominantly diagnosed in middle-aged women. Carney et al. first described this entity that may mimic paraganglioma, medullary carcinoma and papillary carcinoma in 1987. We describe cytologic and histopathologic features of a case of hyalinizing trabecular adenoma combined with occult papillary carcinoma in the opposite lobe. A 55-year-old woman presented with nontender palpable mass of the right neck for 6 months. The aspirate was cellular and contained small clusters and sheets of epithelial cells with abundant filamentous, vacuolated, and ill-defined cytoplasm. The nuclei were slightly pleomorphic and showed nuclear overlapping, nuclear grooves, and intranuclear cytoplasmic inclusions. Histologic examination showed hyalinizing trabecular adenoma in the right lobe and occult papillary carcinoma in the left lobe.

Fine Needle Aspiration Cytology of Ganglioneuroma: A Case Report.: Hee Kyung Kim, Dong Wha Lee, So Young Jin; Korean J Cytopathol. 2003;14(1):12-16.

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Abstract PDF: Ganglioneuroma is a well-differentiated, benign tumor of the sympathetic nervous system. These tumors belong to a family of neoplasm that exhibit a wide range of differentiation, with neuroblastoma at one end and ganglioneuroma at the other. Because it share morphologic features with other both benign and malignant neural tumors, accurate preoperative diagnosis is often difficult. Nonetheless, it is critical for proper management. Fine needle aspiration cytology(FNAC) in the diagnosis of the ganglioneuroma has been a little documented. We describe a case of mediastinal ganglioneuroma in a 33-month-old girl. The diagnosis was suggested on FNAC and was confirmed by histopathologic examination later.

Etc

Studies on Serum Immunoglobulin Patterns in Liver Diseases: Ae Ja Park, Suh Hae Kim, Kyung Soon Song, Kyi Nyong Yi, Samuel Y. Lee; Korean J Cytopathol. 1980;14(1):13-24.

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Abstract: The recent development in immunology have facilitated the study of the immunological aspects of acute and chronic liver disease which are frequently associated with changes in serum immunoglobulin levels. After thatemphasized values of serum immuno globulin assay in the diagnosis of primary disease of the liver by Hobbs (1967), these changes, are often characteristic of the individual disease and may therefore help in their differentiation and provide evidences as to the pathogenesis. At the department of clinical pathology, Yonsei University Medical College, using the Laser-Nephelometry (Model PDQ, Hyland Labolatories, Costa Mesa, calif.) the rapid and accurate measurement of serum immunoglobulin has been made. 101 cases of acute and chronic liver disease were observed. Control sera were obtained from 51 healthy adult Korean. Serum immunoglobulin levels were measured by the Laser-Nophelometry, using monospecific antisera obtained from Hyland manufacture. The results are as the follows. 1) The mean±2S.D. values of Ig G, Ig A, Ig M in adult healthy Korean were 1364± 362mg%, 378±145mg%, and 127±54mg %, respectively. The more age, the higher the levels of immunolobulin in sera, except third decade of female. 2) In the case of the acute hepatitis, the levels of Ig M were significantly increased in the both HBs Ag negative and HBs Ag positive group, while the levels of Ig G were increased in the cases of the HBs Ag positive group, which provided the valuable differential point between the 2 types of the acute hepatitis. 3) In the case of HBs Ag negative group, Ig M were significantly in creasedon the first week, Ig G and Ig A on the second week and to the normal levels on the 8th week after the onset of the symptoms. In contrast in the cases of HBs Ag positive group, IgM is increased on the second week and then decreased to the normal level at the 12th week-persisting longer than HBs Ag negative group-lt is important test that the measurement of different Classes of serum immunoglobulin to observe the course of acute viral hepatitis. 4) Serum Ig G levels are higher than control group in all cases, but not cases of acute HBs Ag negative hepatitis and metastatic cancer. Especially Ig G is increased in 90.5% of postnecrotic cirrhosis, and 78.6% of primary hepatocellutar carcinoma. 5) Serum Ig A levels are higher than control group in all cases, but not in cases of primary biliary cirrhosis. Especially Ig A levels are increases more two times than the control, in cases of liver abscess and metastatic carcinoma of the liver. 6) Serum Is M levels are higher in all liver diseases except in cases of hepatic carcinoma. Especially Ig M levels are increased in cases of primary biliary cirrhosis. No single test can answer the many complex questions that beset the clinician confronted with problems in liver diseases, but the importance of IgA in the diagnosis of amebic abscess, of IgM in the diagnosis of primary biliary cirrhosis is supported by the present data.

Case Reports

Fine Needle Aspiration Cytology of Insular Carcinoma of the Thyroid.: Kyung Un Choi, Jee Yeon Kim, Jin Sook Lee, Chang Hun Lee; Korean J Cytopathol. 2003;14(1):17-21.

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Abstract PDF: Insular carcinoma of the thyroid(ICT) is an uncommon thyroglobulin-producing neoplasm, intermediate between well differentiated and anaplastic carcinoma. Only a few publications have addressed the fine needle aspiration cytologic(FNAC) findings from ICT. We experienced a case histologically diagnosed as ICT and with preoperative FNAC in a 52-year-old woman. The FNAC displayed scanty colloid and abundant monomorphic follicular cells presented singly, in small loose aggregates, and in cohesive trabecular or acinar clusters. Intact insulae of tumor cells were also identified. Necrosis and mitosis were rare. Tumor cells showed round and monomorphic nuclei, finely granular chromatin, and inconspicuous nucleoli. When insular structure is identified in thyroid FNAC specimen, ICT should be included in the differential diagnosis. Herein we discuss and review the cytologic criteria for separation of ICT from other thyroid neoplasms.

Fine Needle Aspiration Cytology of Cystic Hypersecretory Intraductal Carcinoma of the Breast: Report of Two Cases.: Hee Jeong Cha, Dae Woon Eom, Jae Hee Suh; Korean J Cytopathol. 2003;14(1):22-26.

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Abstract: Cystic hypersecretory carcinoma of the breast is a rare variant of ductal carcinoma of breast, first described in 1984 by Rosen and Scott. Histologically, it is characterized by the formation of dilated ducts and cysts containing an eosinophilic secretory product resembling thyroid colloid. Cytologic findings show a few clusters of atypical ductal epithelial cells in amorphous proteinaceous material with cracking artifact. Differential diagnosis include mucinous carcinoma and benign mucocele-like tumor. We present two cases of fine needle aspiration cytology of cystic hypersecretory intraductal carcinoma of the breast with a review of the literature.

Etc

A Comparative Study of Frozen, Permanent Sections of Gastroscopic Biopsy and Gastrectomized Specimen: Jong Eun Joo, Il Hyang Ko; Korean J Cytopathol. 1980;14(1):25-30.

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Abstract: This study was carried out to estimate reliability of frozen section against permanent preparation in gastric biopsies and all biopsies and all biopsies against gastrectomized specimnse. From July, 1977 to June, 1979, 667 cases were biopsied at Seoul Paik Hospital, In Je Medical College. Out of 667 cases, frozen section was performed in 575 cases in addition to permanent tissue preparation. From each biopsied material, one to four sections were made either for frozen or permanent preparations. In this series, 107 cases were gastrectomized of which 80 cases were proven to be carcinoma and 27 cases were non-malignant lesions. The correspondence of frozen section with permanent preparation of gastric biopsy was 85.7%, while 77.6% of permanent preparation of gastric biopsy corresponded with final diagnosis of gastrectomized specimens. 12 out of 107 gastrectomized patients revealed early carcinoma, of which 11 cases were detected by the biopsies, only one missed. The detect-ability will increase if endoscopist can properly select the biopsy site. The authors also wish to stress secondary benefit of making both frozen and permanent sections because of chances of studying sections at different layers of the tissue at different directious.

Case Report

Imprint Cytologic Features of Poorly Differentiated Synovial Sarcoma: A Case Report.: Mi Jin Gu, Joon Hyuk Choi, Young Kyung Bae; Korean J Cytopathol. 2003;14(1):27-31.

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Abstract PDF: Poorly differentiated synovial sarcoma is a variant of synovial sarcoma. We report a case of poorly differentiated synovial sarcoma imprinted after resection. The patient was a 47-year-old woman with a right shoulder pain for 6 months. The cytologic features showed malignant round to oval, monotonous tumor cells with high nuclear to cytoplasmic ratio. Some tumor cells showed perivascular distribution and nuclear molding. Vague rosette-like structures were seen. On immunohistchemical stains, tumor cells were diffusely positive for CD99 and focally positive for epithelial membrane antigen. Ultrastructural examination showed desmosomes and microvilli.

Etc

A Comparative Study on the Detection Rate of HBsAg according to Various Methods: Woo Sung Ahn, In Ki Paik, Sang In Kim; Korean J Cytopathol. 1980;14(1):31-37.

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Abstract: A comparative study on the detection rate of HBsAg according to various methods; enzyme immunoassay, indirect hemagglutination, reverse passive hemagglutination and counterelectrophoresis methods. Study subjects consist of 289 hospital patient samples requested for HBsAg tests, 146 hospital personnel Seoul National University Hospital and 397 pupils from an elementary school in Kangwondo. The sensitivity and specificity of these methods were also evaluated using 100 HBsAg positive samples confirmed by radioimmunoassay. The results are summarized as follows; 1) The HBsAg positive cases in 289 patients were 64 (22.1%) by EIA, 63 (21.8%) by IHA, 61 (21.1%) by RPHA, 12 (4.2%) by CEP. 2) Of the 146 hospital personnel of SNUH, only 2 persons were HBsAg positive by four methods. 3) The HBsAg positive cases in 397 pupils of an elementary schcol were 46 (11.6%) by IHA, 42 (10.6%) by RPHA. 4) Of the 100 HBsAg positive samples confirmed by RIA, 100 by EIA, 99 by IHA, 96 by RPHA and 25 by CEP were positive. 5) Of the 200 HBsAg negative samples confirmed by RIA, none were positive by the four methods.

Case Reports

Fine Needle Aspiration Cytology of Anaplastic Carcinoma of the Thyroid with Osteoclast-like Giant Cells : A Case Report.: Leeso Maeng, Jehoon Lee, Kyoung Mee Kim, Anhi Lee, Chang Suk Kang; Korean J Cytopathol. 2003;14(1):32-35.

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Abstract PDF: Multinucleated giant cells of osteoclast-like appearance can be seen in a type of anaplastic carcinoma of thyroid and only a few case reports for fine needle aspiration cytologic findings are found in the literatures. Recently, we experienced a case of anaplastic carcinoma of thyroid with many osteoclast-like giant cells in a 72-year-old woman. The cytologic features and immunohistochemical results are described with special emphasis on differential diagnosis.

Composite Epithelioid Hemangioendothelioma in Pleural Effusion Mimicking Metastatic Adenocarcinoma: Cytologic and Immunocytochemical Findings.: Ki Seok Jang, Hong Xiu Han, Moon Hyang Park; Korean J Cytopathol. 2003;14(1):36-41.

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Abstract PDF: Epithelioid hemangioendothelioma is a rare vascular tumor of borderline malignancy which is characterized by the presence of "epithelioid" or "histiocytoid" endothelial cells. Superficial and deep tumors have been recognized in the extremities, head, neck, chest, and mediastinum of adult patients. It may also occur as a primary tumor of liver, bone, and other visceral organs. Few effusion cytologic findings of epithelioid hemangioendothelioma have been reported. We report a case of composite epithelioid hemangioendothelioma with focal epithelioid angiosarcomatous areas of the iliac bone and adjacent soft tissue in a 38-year-old female, which, during its metastatic course, was presented as a pleural effusion. The effusion was cellular with epithelioid cells presenting both singly and in clusters. The tumor cells were round to ovoid showing cytoplasmic vacuolization, variability in cell size, and prominent nucleoli. The effusion smears and cell block sections revealed strong positive staining for CD31 and vimentin, weak positive for CD34 and Factor VIII-related antigen, and negative for cytokeratin, CEA, and calretinin. The cytologic findings in this case were similar to that of metastatic adenocarcinoma or malignant mesothelioma. Therefore, immunocytochemical staining in smear and cell block is a helpful tool to differentiate malignant "epithelioid" cells in effusion.

Etcs

Transient Appearance of a Plasmocytogenic Area in the Follicle of Bursa Fabricus After Whole Body Radiation: Sun Moo Kim; Korean J Cytopathol. 1980;14(1):39-46.

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Abstract: The Bursa Fabricus and the thymus so similar that both of them are called central immune organs from the functional view point or lymphoepithelial organs from the morphological view point. Their reponses to various injuries are also similar. Kim and colleagues studied the origin of plasmocytes under various experimental conditions and confirmed that a strong transient plasmocytogensis appeared in the thymus of rats after whole body X-ray radiation. So, the author attempted to confirm whether plasmocytogenesis could be induced in Bursa Fabricus of chickens by whole body radiation or not. As a result, the author confirmed a strong transient plasmocytogenesis in the follicle of Bursa Fabricus 24 hours after 400 R-whole body radiation. In the normal follicle of Bursa Fabricus, there is no plasmocytogensis. However, massive destruction of small lymphocytes took place in the follicle after X-ray radiation, followed by a transient plasmocytogenesis, which preceded regeneration of small lymphocytes.

Histological Distinction between Primary Lymphoma and Leukemic Infiltration of Lymph nodes: Ae Seek Kim, Je G. Chi; Korean J Cytopathol. 1980;14(1):47-54.

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Abstract: The pathologist faced with the necessity for examining the lymph node biopsy needs certain criteria for the differentiation between primary malignant lymphoma and secondary leukemic infiltration into the lymph node. The distinction is not only of academic interest but also has a practical importance because the management of patient with these two diseases is different. Authors conducted a morphological study on 24 lymph nodes that were diagnosed either as lymphnode involvement by lymphogenous leukemia (Group I ). malignant lymphoma of poorly differentiated lymphocytic type (Group II ) or These lymph node specimens were obtained during a period of 10 years from January 1970 to December 1979 at the Department of Pathology of Seoul National University Hospital. The distinction between two groups was made by clinical and hematological findings. To evaluate these lymph nodes ten items were set beforehand, and the results were tabulated (Table I). In summary there was not a single histological feature that would distinguish these two groups of disease. However, combining the various features listed in table I we could reasonably besure of differentiating one from the other. Reviewing the useful histological findings, paucity of mitosis, monotonous tumor cell population in lymph node with involvement of intranodal veins and infiltrating features suggestive of Indian file, were particularly prominent in leukemic infiltration of lymph nodes as compared to lymph nodes involved by primary malignant lymphoma.

A Study of Nosocomial Infection -hospital environment-: Young Kee Kim, Myung Hee Park, Sang In Kim; Korean J Cytopathol. 1980;14(1):55-59.

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Abstract: In recent years the nosocomial infection has been important in hospital administration, preventive medicine and patient's treatment. The author studied several aspects of hospital environment in Seoul National University Hospital from February to September 1979, and the results are as follows: 1) Periodical 3 consecutive examinations of rectal swabs of 63 food service employees were all negative for enteropathogenic organisms including Salmonella and Shigella. 2) HBsAg tests were done for 96 laboratory technicians and 50 central service employees and positive results were observed in 2 laboratory technicians. 3) Periodical biological monitoring of sterilizers was done, using commercial bacterial spore strips. Positive culture was obtained in 2 out of 51 tests for 3 Steam sterilizers and in 4 out of 14 tests for one ethylene oxide gas sterilizer. 4) Product sampling and culture were done for 7 kinds of commercial infusion fluids, 2 kinds of disinfectants and 14 sets of various operation Packages or dressing materials and positive culture was obtained in one disinfectant. 5) Air sampling was done in multiple strategic areas by exposing Standard Petri dishes for 5 minutes. The mean colony count was 8.8±7.8 (1 S.D.) particles/plate/5min.

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