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Volume 15(2); November 2004
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Original Articles
Usefulness of Sputum Cytology as a Diagnostic Tool of Lung Cancer.
Eun Yoon Cho, Hee Dae Park, Sun Hee Kim, Woon Sun Park, Seoung Wan Chae, Eo Jin Kim, Jin Hee Sohn
Korean J Cytopathol. 2004;15(2):75-80.
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AbstractAbstract PDF
To analyze the accuracy and usefulness of sputum cytology as a screening method, 103 cases of histologically proven lung cancer registered from 1998 to 2000 at Kangbuk Samsung Hospital were retrospectively examined. We reviewed the original cytologic and surgical diagnoses for the cases, and the cytology slides of all cytologically negative cases. The overall sensitivity of sputum cytology was 0.83 ; the sensitivity of prebronchoscopy sputum cytology for bronchogenic carcinoma was 0.87. Central tumor location (P=0.002), tumor size (>2.4 cm), (P=0.027) and the number of sputum samples (> or =3) (P=0.001) were associated with a positive cytologic diagnosis. Of the 18 cytologically negative cases, 9 cases (38% of smears) were determined to be insufficient for diagnosis, due strictly to low cellularity and saliva. After a review of the cytology slides of cytologically negative cases, we identified several atypical clusters in one case of bronchioloalveolar carcinoma. This negativity was thus attributed to an interpretation error (1/18, 5.6%). Our results suggest that its sensitivity is more strongly related to the specimen adequacy and the times of sampling than to interpretation error. In terms of sensitivity, specificity, accessibility, cost, and morbidity associated with the screening tests, sputum cytology was found to be an accurate effective screening method for lung cancer.
Correlation Of Human Papillomavirus Infection and Postmenopausal Squamous Atypia in Cervical Cytology.
Yi Kyeong Chun, In Gul Moon, Sung Ran Hong, Hye Sun Kim, Jong Sun Choi, Ji Young Park, Jong Sook Park, Tae Jin Kim, Hy Sook Kim
Korean J Cytopathol. 2004;15(2):81-85.
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AbstractAbstract PDF
Postmenopausal squamous atypia (PSA) is a phenomenon characterized by cellular alterations mimicking condyloma in the uterine cervix of postmenopausal women. It is not associated with human papillomavirus (HPV) infection. The aim of this study is to correlate findings with HPV infection and the cytohistologic findings of PSA. Eighty-three smears from postmenopausal women, initially interpreted as ASCUS and low-grade squamous intraepithelial lesions(LSIL), were reviewed according to the criteria of PSA. Fifty-eight cases were subsequently reclassified as PSA. Forty cases categorized as PSA were available for HPV-DNA detection by a nested polymerase chain reaction. Eight of these 40 cases(20%) showed biopsy-proven LSIL lesions. The HPV-DNA was detected in 42.5%(17/40), compared to 25%(5/20) of control cases. The HPV-DNA detection rate of biopsy-proven LSIL was 62.5%(5/8). It has been concluded that cytologic differential diagnosis of PSA from LSIL is difficult due to because of poor histologic and viral correlation.
Evaluation of the Manual Method of Liquid-Based Uterine Cervicovaginal Cytology - By The Manual Method Based on SurePathTM Methodology.
Jong Myoung Park, Jin Wook Jang, So Yeo Lim, Jong Gi Lee, In Soo Suh
Korean J Cytopathol. 2004;15(2):86-91.
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AbstractAbstract PDF
Liquid-Based Uterine Cervicovaginal Cytology is known to be a sensitive and effective screening method for cervical neoplasm. MonoPrepTM, ThinPrepTM, and SurePathTM methods have been recently used as Liquid- Based Uterine Cervicovaginal Cytology techniques, and the SurePathTM method has been used in Sung-Yoon Reference Laboratory since 2003. The goal of Liquid-Based Uterine Cervicovaginal Cytology is to separate cervical epithelial cells from non-target cells, red blood cells and neutrophils. This report describes a study which evaluated cellularity, stainability, and cellular changes of epithelial cells in samples processed using a manual technique as compared to samples processed using SurePathTM automated method. The samples processed by means of a manual technique contained a cellularity of epithelial cells similar to that of the samples processed using the SurePathTM automated method. In addition, we compared variable density gradient reagents, including dextran, dextrose, and sucrose, to SurePathTM gradient media in order to evaluate cell fractionation and cellularity of epithelial cells. 10% dextran of gradient media shows good fractionation. The samples processed with 10% dextran demonstrated sufficient cellularity of epithelial cells and shows the fewest cellular changes. In conclusion, using a manual technique on these samples is easier to read than those results obtained using the SurePathTM automated method.
Etc
A Study on the Infection Due to Group B, C and G β-hemolytic Streptococci
Young SookChoi, Yunsop Chong, Samuel Y. Lee
Korean J Cytopathol. 1981;15(2):91-99.
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AbstractAbstract
Streptococci, pathogenic to human subjects, are mostly β-hemolytic and generally belong to groups A and D. Besides group A and D, organisms belonging to B, C, and G have long been known to cause infections, but their clinical importance has not been recognized until quite recently. The incidence of fatal neonatal infections of group B has been increasing particularly during the last decade. However, there has been only a few reports on group B, C, and G infection in Korea. This study was made to determine serological group of clinical isolates of β-hemolytic streptococci by coagglutination method and to clarify the B, C, and G infection in Korea. β-hemolytic streptococci isolated from Yonsei Medical Center specimen during August 1979 October 1980 were studied and the following results were obtained. 1) A total of 414 isolates were obtained and their groups were: A 19.1%, B 6.3%, C 11.4%, G 13.7%, and nongroupable 49.5%, 2) Groups B, C, and G were most frequently isolated from the respiratory tract specimens. Excluding respiratory sources, group B was mainly isolated from the urogenital tract, and group G from various wounds. 3) Among the 126 patients, who were categorized as having definite infections, 12 yielded group B, 3 group C and 27 group G organisms. There were 8 cases each of the respiratory and urogenital tract infections, and 26 infections on various other sites. 4) From patients under 10 years of age, 50.7% of B, C, and G organisms were isolated. 8.0% of the cultures were isolated from patients 60 years and over. There was a fatal neonatal meningitis and septicemia due to group B organism. The organisms were isolated more frequently from male patients. 5) Majority of the patients who yielded the organisms were found to have underlying diseases such as tissue injury, neoplasm, tuberculosis and diabetes mellitus. It is concluded that group B, C and G streptococci cause respiratory infection not frequently, but they often invade otter sited. Patients with underlying diseases are prone to be infected by the organisms and some of them can be fatal. Therefore it is important to identify not only group A but also 5, C and G organisms.
Original Article
Pregnancy-Related Cytologic Changes In Cervicovaginal Smears.
Yi Kyeong Chun, Hoi Sook Jang, Hye Sun Kim, Sung Ran Hong, Jong Sun Choi, Ji Young Park, Jung Sook Cho, Seok Ju Seong, Jae Hyug Yang, Hy Sook Kim
Korean J Cytopathol. 2004;15(2):92-100.
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AbstractAbstract PDF
Due to insufficient clinical information, most cervicovaginal smears from pregnant or postpartum women have been screened without regard to pregnancy-related cytological changes. Here, we have reviewed 116 abnormal cervicovaginal smears from 103 pregnant and postpartum women. Initial cytological diagnoses revealed the following: 9 cases of high-grade squamous intraepithelial lesions (HSIL), 8 cases of low-grade squamous intraepithelial lesions (LSIL), 85 cases of atypical squamous cells of undetermined significance (ASCUS), and 14 cases involving atypical glandular cells of undetermined significance (AGUS). 31 cases, upon review, involved pregnancy-related cytological changes, comprising 25 cases of decidua cells, 4 cases of Arias-Stella reaction, and 2 cases of decidual cells coupled with Arias-Stella reaction. Interpretation errors were detected in 14 cases: 13 cases of decidual cells interpreted as either ASCUS favor reactive or ASCUS ruled out HSIL, and one case of Arias-Stella reaction was interpreted as ASCUS ruled out HSIL. Decidual cells and degenerated glandular cells with Arias-Stella reaction can result in diagnostic mistakes. In order to avoid misdiagnosis and unnecessary surgeries, both clinicians and pathologists must be aware of the pregnancy-related cytological changes. The clinician should also always inform the pathologist on the pregnancy status of the patient.
Etc
Histopathological Study of the Jaw Cysts
Jin Kim
Korean J Cytopathol. 1981;15(2):100-109.
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AbstractAbstract
Due to the facts that epithelial rests are frequently found in jaw bones and the jaw bones are vulnerable to trauma and infection which would stimulate to proliferate epithelial rest, occurrence of various types of cysts in jaw bones is not infrequently found. However, confusion exists in classification and terminology of the jaw cysts because of uncertainty of histogenesis of the cysts. Present study is, therefore, aimed to find the most rational classification of the jaw cysts with consideration of histopathologic features, clinical characteristics, and review of literatures. The material used in this stuffy consist of 70 cases of the jaw cysts examine at the Department of Pathology Yonsei University College of Medicine for ten year period from 1970 to 1980. All specimens were fixed in 10% neutral formalin. For histologic examination, paraffin embedded blocks were cut in 6 micron thickness and sections were stained by routine Hematoxylin-Eosin method. Classification recommended by World Health Organization in 1971 and description of Robinson in 1975 was applied. Each cases were analysed with clinical, radiological and histopathological findings. 1) Of the total 70 cases, 52(74.3%) were inflammatory periodontal cyst, and 18(25.7%) were developmental cysts. The developmental cyst consisted of 13 cases of dentigerous cysts (18.6%), 3 cases of odontogenic keratocyst, one case of Primordial cyst, and one case of nasopalatine cyst. 2) The peak age incidence of periodontal cysts was in the fourth decade of life with a wide age range, and developmental cysts were usually found in the second and third decades. There was a slight male predominance with the male to female ratio being 4:3. 3) The most common location of periodontal cysts was on the anterior aspects of the maxilla, and the majority of dentigerous cysts occurred in association with impacted supernumerary teeth in the maxilla. Multiple cysts were found in 2 cases of odontogenic keratocysts. 4) The most common complaints were swelling and pain. Other symptoms included pus discharge, trismus and delayed eruption of tooth. 5) Histologic type of epithlium lining cysts showed mainly stratified squamous epithelium, and ciliated cells were found only in the nasopalatine cyst. Inflamed fibrous wall was found predominantly in inflammatory periodontal cysts. 6) Heterogenous histological features of dentigerous cysts showed keratinization in 3 cases, hyaline bodies and calcification in 2 cases and adenoameloblastoma in one case. Metaplastic mucous cells were found focally on the lining epithelium in 2 cases of dentigerous and one case of periodontal cysts. 7) One case of odontogenic keratocysts showed microcyst formation in the fibrous wall. It is considered that this finding is the histologic evidence of high recurrence rate of odontogenic keratocyst.
Case Reports
Well Differentiated Adenosquamous Carcinoma of Lung Mimicking Benign Lesions in Fine Needle Aspiration Cytology: Report of a Case .
Jong Yup Bae, Hoon Kyu Oh, Jae Bok Park
Korean J Cytopathol. 2004;15(2):101-105.
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AbstractAbstract PDF
Fine needle aspiration (FNA) cytological examination is an appropriate method for the evaluation of pulmonary nodules. In major types of lung cancer, its diagnostic accuracy is quite high. However, it is sometimes difficult, using this technique, to differentiate between some unusual phenotypes including adenosquamous carcinoma, bronchioloalveolar carcinoma (BAC), neuroendocrine tumor, mucoepidermoid carcinoma, and sclerosing hemangioma. Here, we present a case involving extremely well differentiated adenosquamous carcinoma, mimicking benign lesions, such as pulmonary scar and adenomatoid malformation with squamous metaplasia. The patient was a 68-year-old man presenting with a solitary pulmonary nodule (1.6x1.6 cm), which was incidentally found at the periphery of the right lower lobe. FNA revealed some clusters of glandular cells with minimal atypia, in addition to squamous cells at a nearly full maturational state. Histological examination verified the cytological diagnosis on a lobectomy specimen. The tumor exhibited a well differentiated adenocarcinoma component, mimicking the bronchioles in scarred lung tissue, and a well differentiated squamous cell carcinoma component, mimicking the squamous cell nests of adenoacanthoma, in the other organs. In the present case, the possibility of adenosquamous carcinoma should have been considered if squamous cells were seen in the FNA from the peripheral pulmonary nodule, even though they appeared to be benign.
Fine Needle Aspiration Cytology of Invasive Micropapillary Carcinoma of the Breast: Report of four Cases.
Sun Young Kwon, Hae Ra Jung, Yu Na Kang, Sang Pyo Kim, Kun Young Kwon, Sang Sook Lee
Korean J Cytopathol. 2004;15(2):106-111.
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AbstractAbstract PDF
Invasive micropapillary carcinoma (IMPCa) is a rare variant of invasive ductal carcinoma of the breast. This variant is associated with a set of peculiar cytological findings and aggressive biological behaviors. In most reported cases, IMPCa has involved massive axillary lymph node metastases at the time of diagnosis. We experienced four cases of cytological features of IMPCa, all of which were verified by histological examination. Fine needle aspiration cytology (FNAC) revealed malignant epithelial cells, which formed small, oval to angulated papillary clusters, which lacked central fibrovascular cores. The histological findings of the four cases revealed both pure and mixed forms of IMPCa, composed of cohesive malignant epithelial cells, surrounded by distinctive clear spaces and separated by thin fibrous septa. All patients evidenced axillary lymph node metastases at the time of diagnosis. It is important to identify the peculiar cytological findings which would differentiate IMPCa from other diseases.
Etc
Studies on Anaerobe Infection: Use of Gas Liquid Chromatography for Anaerobe Identification
Hee Joo Lee, Ae Ja Park, Yunsop Chong, Samuel Y. Lee
Korean J Cytopathol. 1981;15(2):110-118.
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AbstractAbstract
Anaerobic bacteria are organisms that could grow only in the abscence of free oxygen. Therefore it is very difficult to culture the organisms. Anaerobic infections are often neglected not only because of the difficulty of cultivation but also of identification which require analysis of fattyacids. As the isolates in Korea have not been subjected to fatty acid analysis, our knowledge in anaerobe infections are very limited. This study was conducted to identify clinical isolates of anaerobes accurately with the use of gas liquid chromatography(GLC) and to determine the relationship between anaerobe species and the infection. Clinical specimens obtained at YUMC during the period of September 1979-August 1980 were cultured anaerobically and the anaerobes isolated were identified with GLC if necessary. Clinical conditions were reviewed retrospectively. Following results were obtained. 1) A total of 342 anaerobic organisms were isolated from 282 clinical specimens. Most frequently isolated anaerobes were Pc. asaccharolyticus, Ps. anaerobius, S. intermedius, Cl. perfringens, B. fragilis and B. melaninogenicus. 2) Anaerobes were most frequently isolated from specimens of thorax, abdomen and soft tissue wound. 3) With the review of 118 available patients' records, it was found that most frequent clinical conditions were appendicitis with peritonitis, wound infection following GIT cancer surgery, empyema, lung abscess, and infection of umblicus of new-torn and soft tissues. 4) Only 18.4% of the specimens yielded anaerobes alone, and the remaining 81.6% yielded both anaerobes mixed with aerobes. 5) With the use of GLC, up to 94.4% and 94.1% of isolates unidentifiable by conventional methods, were satisfactorily identified during the periods of September 1979-May 1980 and June 1980-August 1980 respectively.
Case Reports
Fine Needle Aspiration Cytology of Primay Malignant Lymphoma of the Breast: A Case Report.
Hyun Joong Kim, Kyung Hwa Lee, Jo Heon Kim, Min Keun Shim, Ji Shin Lee, Chan Choi
Korean J Cytopathol. 2004;15(2):112-115.
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AbstractAbstract PDF
Lymphoproliferative disorders, manifesting either as a primary lesion or as part of a generalized process, rarely involve the breast. The primary malignant lymphoma of the breast is rare. The cytologic features of this neoplasm have not been reported in Korea thus far. We described a case of primary malignant lymphoma of the breast, as diagnosed by fine needle aspiration cytology (FNAC) in an 84-year-old female. FNAC smears showed high cellularity. The main cytologic feature observed was a carpeting of monotonous, atypical, enlarged lymphoid cells. These lymphocytes showed relatively round elliptical nuclei with some indentation. One or more prominent nucleoli were seen. Biopy from the breast mass revealed diagnostic features of non-Hodgkin's lymphoma, diffuse large B-cell type.
Cytology of the Uterine Cervico-vaginal Smear of Clear Cell Adenocarcinoma in Uterine Cervix: Report of a Case.
Leeso Maeng, Kyoung Mee Kim, Anhi Lee, Chang Suk Kang
Korean J Cytopathol. 2004;15(2):116-119.
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AbstractAbstract PDF
Primary clear cell adenocarcinoma of uterine cervix is rare and cytomorphology in the vaginal smear have not been previously described in Korean literatures. The cytologic characteristics of clear cell adenocarcinoma of the uterine cervix include : malignant cells with abundant, finely vacuolated cytoplasm ; hobnail appearance ; and distinctive basement membrane-like hyaline materials within cellular aggregates. A 36-year-old woman presented with vaginal bleeding. Cytologic examination of vaginal smear and histopathologic examination of a radical hysterectomy specimen allowed the diagnosis of hemorrhagic tumor in the uterine cervix as a clear cell adenocarcinoma. Cytologic findings were very characteristic. The tumor cells had abundant, pale, finely vacuolated cytoplasm with indistinct cytoplasmic membrane. The nuclei were round to oval with finely dispersed chromatin. Extracellular basement membrane-like hyaline substance, which stained a light green color in Papanicolaou's preparation, was frequently observed within the cancer cell clusters.
Etc
Studies on Ornithine Amininotransferase from Human Tissues
Man Soo Song
Korean J Cytopathol. 1981;15(2):119-123.
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AbstractAbstract
The properties of ornithine aminotransferase, which catalyzes the transfer of S-NH2 group of ornithine to α-ketoacids were characterized in the post-mortem human tissues. The enzyme was distributed in all human tissues tested especially high in small intestine and its activity was increasing in liver and kidney but decreasing in small intestine with age. The intestinal enzyme being reactive with α-ketoglutarate, glyoxylate, pyruvate and oxaloacetate in decreasing order was very heat-unstable but its inactivation by heat-treatment was partially prevented by the presence of pyridoxal phosphate. The enzyme was completely inhibited by p-hydroxy-mercuritenzoate, suggesting that SH-group of enzyme protein is essential for catalytic action.
Case Report
Ewing's Sarcoma/PNET of the Talus: Report of a Case.
Sun Young Kim, Hyuck Po Kwon, Jae Su Roh, Hyoun Oh Cho
Korean J Cytopathol. 2004;15(2):120-125.
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AbstractAbstract PDF
Ewing's sarcoma (ES)/PNET is common in both axial and appendicular skeletons, but is extremely rare in the talus. Here, we report a case of ES/PNET of the left talus in a 29-year-old male patient diagnosed by fine needle aspiration cytology, and review the literature on similar cases. The cytological smears were composed of individually dispersed small round cells and occasional clusters of loosely cohesive cells. The tumor cells were fragile, frequently exhibiting naked nuclei. Two distinct types of cells were observed. The light (chief) cells displayed round or slightly oval nuclei with frequent indentations, generally inconspicuous nucleoli, and a thin rim of cytoplasm, which sometimes harbored small vacuoles. The dark cells were smaller, displaying scanty cytoplasm with dense hyperchromatic nuclei, intermixed with chief cells, and often manifesting as small molded groups. However, no significant nuclear pleomorphisms or mitoses were noted. Tumor cells in the cell block revealed positive cytoplasmic glycogen, as determined by a PAS stain with diastase control, and also exhibited positive immunoreactivity for CD99.
Etc
Bacteriological Investigation of the Bile and A Review Eleven Cases of Acalculous Cholecystitis
eong Ok Kang, Myoung Hee Ahn, Seung Haham Park, Ki Hong Kim
Korean J Cytopathol. 1981;15(2):124-129.
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AbstractAbstract
Many studies have been reported by various observers on the bacteriology of acute and chronic cholecystitis. But only a few have reported in Korea. The purpose of the present investigation was to analyse the incidence of bacteria in acute and chronic cholecystitis and to define the predisposing factors of acalculous cholecystitis. Bacterial studies of the bile were made in 47 patients with acute and chronic cholecystitis who were operated upon on the Han Yang University Hospital during the 6 year period from 1975 to 1980. The following results were obtained. 1) In 95 cases of bile culture, total 77 strains of bacteria were isolated. The bacterial flora consisted of E. Coli 38 strains, Proteus 7 strains, Enterobacter 5 strains, Pseudomonas 4 strains, Klebsiella pneumoniae 4 strains, Enterococci 4 strains, Gram negactive nonfermentative bacilli 3 strains, Coliform bacilli 3 strains, Serratia 2 strains, and Providencia, Aerotacter, Alkaligenes faecalis, Staphylococcus epidermidis each one strain respectively. 2) In total 47 patients of cholecystitis, 76.6% were culture-pcstive. In 30 cases of chronic cholecystitis, 76.7% were culture-positive and in 17cases of acute cholecystitis, 76.5% were culture-positive, 3) Acalculous cholecystitis was 23.4% (11 cases), and hypochorhydria, cholangitis, liver abscess, pancreatic abscess, Ascaris lumbricoides, Clonerchis sinensis were regarded as predisposing factors.
Case Report
Fine Needle Aspiration Cytology of Granular Cell Tumor of the Lower Leg: Report of a Case.
Sun Young Kim, Jin Seok Hwang, Hyuck Po Kwon, Ju Heon Yang, Jae Su Roh, Wan Suk Yang
Korean J Cytopathol. 2004;15(2):126-130.
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AbstractAbstract PDF
Granular cell tumor is characterized by large eosinophilic cells with granular appearances. These are mostly benign. Approximately 1~2% are malignant, and establishment of reliable criteria for diagnosing malignant granular cell tumor has been difficult to establish because of the rarity. Reports on the cytologic features of this neoplasm are hardly found in Korea. We report a case of rarely-occurring granular cell tumor in the lower leg of a 40-year-old male, diagnosed on fine needle aspiration cytology, together with a review of the literature regarding significant adverse histology and prognostic factors. The aspirates revealed cellular smears of isolated cells, syncytial clusters, and occasionally stripped nuclei in a fine, bluish-purple, granular background. Tumor cells were polygonal, rounded, or slightly spindled, and showed ill-defined granular cytoplasm. Nuclei were small and round or oval, with inconspicuous or small, prominent nucleoli. The nuclei showed rare intranuclear cytoplasmic invagination. Occasionally, there were mild to moderate nuclear pleomorphisms with vesicular nuclei, with large, prominent nucleoi, but no mitosis. The immunocytochemical stain for S-100 was strongly positive in the cytoplasm of tumor cells with occasional nuclei.

JPTM : Journal of Pathology and Translational Medicine