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Volume 18(2); September 2007
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Reviews
Diagnostic Approach to Fine Needle Aspiration in a Breast Lesion.
Gyungyub Gong
Korean J Cytopathol. 2007;18(2):93-99.
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AbstractAbstract PDF
Fine needle aspiration has been widely used to diagnose of breast lesions whether they are malignant or not. When applied by experienced and well-trained practitioners, its accuracy can approach that of histopathology, In order to make optimal use of FNAB in breast lesions, this article has reviewed the criteria for sample adequacy, the diagnostic terminology and the cytomorphologic approach to making a diagnosis and avoiding diagnostic pitfalls.
General Cytological Characters of Malignant Breast Lesions.
Jee Yeon Kim
Korean J Cytopathol. 2007;18(2):100-111.
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AbstractAbstract PDF
Fine needle aspiration (FNA) cytology of breast disease is recognized to be highly accurate and cost effective, especially when this is used in combination with clinical examination and imaging as part of a triple approach. A probabilistic/categorical approach is used for the classification of breast FNA specimens. Criteria are defined from the perspective of the likelihood of making a definitive diagnosis of cancer on excision. This approach is an accurate way of classifying breast FNA specimens, and this can be reliably applied regardless of the level of experience of the pathologist for interpreting the case. When a definitive diagnosis of malignancy is made, the next step is to determining the specific histologic types of the malignancy according to their cytological features. In order to make an accurate diagnosis of carcinoma and for correct typing a tumor, an adequate, correctly sampled aspirate without any other artifacts is required.
Diagnostic Pitfalls in Breast Fine Needle Aspiration Cytology: False Positive and False Negative.
Kyeongmee Park
Korean J Cytopathol. 2007;18(2):112-118.
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AbstractAbstract PDF
Fine needle aspiration cytology (FNAC) has become a highly preferred, minimally invasive diagnostic tool of choice in the diagnosis of a palpable breast mass owing to its sensitivity, specificity, cost-effectiveness, and expediency. Although breast needle biopsies have been widely employed recently due to the increased detection rate of nonpalpable early lesions, the importance of the use of FNAC cannot be underestimated. It comprises part of the diagnostic triad for the breast along with a physical examination and mammography, which together contribute to an increasing diagnostic accuracy. The differential diagnosis of a benign and malignant lesion is of the utmost importance in the diagnosis of breast lesions, and therefore the understanding of the possible diagnostic pitfalls is of great importance.
Etc
Pathological Study on Wilms' Tumor
Jeong Wook Seo, Je Geun Chi, Sang Kook Lee, Hyo Seop Ahn
Korean J Cytopathol. 1984;18(2):113-121.
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AbstractAbstract
Twenty-nine Wilms' tumors of 144 resected renal neoplasms during the period 1968 ti 1982, are reviewed. Twenty-six cases are analyzed clinically and 25 cases are reexamined microscopically. Classification of the tumor and clinical staging are based on the National Wilms' Tumor Study. The clinical group Ⅰ, Ⅱ, Ⅲ were 13, 6, 7 cases, respectively. The epithelial predominent, mixed, blastemal predominent and stromal predominent types were 3, 8, 5 and 9 cases, respectively. Eleven cases showed diffuse anaplasia. Four of them were stromal, diffuse anaplasia and the types of malignancy were rhabdomyosarcoma(3 cases) and clear cell sarcoma(1 case). Gross findings of the tumors were greatly variable, however, those matched well to the microscopic findings. So classification based on gross as well as microscopic findings was thought to be superior to that based on simple collection of microscopic slides. Five cases showing no evidence of recurrence or metastasis during the period of follow-up more than one year and two cases with metastasis but survival over 2 years are classified into good prognostic group. Four of them were stromal, no anaplasia type and clinical group 1. Six cases showing widespread metastasis or rapid recurrence of tumor resulting in death or giving up the treatment were classified into poor prognostic group. Factors related to their poor prognosis were older age, high clinical stage and histologic features of anaplasia. All the cases with poor prognosis showed evidences of recurrence or metastasis within one year. The resected kidneys of the cases with good prognosis was heavier than those of the cases with poor prognosis. Six cases showed significant rhabdoid differentiation. Three cases were associated with renal dysplasia. Two cases were adult Wilms' tumor.
Original Article
Diagnostic Value of Urine Cytology in 236 cases; a Comparison of Liquid-Based Preparation and Conventional Cytospin Method.
Sun Lee, Jung Hee Park, Sung Im Do, Youn Wha Kim, Juhie Lee, Sung Gu Chang, Yong Koo Park
Korean J Cytopathol. 2007;18(2):119-125.
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AbstractAbstract PDF
Urine cytology is an important screening tool for urinary tract neoplasms. Liquid-based preparation methods, such as ThinPrep(R), have been introduced for non-gynecological samples. We aimed to assess the diagnostic accuracy of liquid-based preparations in urine cytology by comparing the results of the conventional Cytospin preparation method for the same samples. A total of 236 cases subject to urine cytology were enrolled in this study from January 2005 to December 2005. All cases were subjected to cystoscopy and if a malignancy was suspected, a biopsy was performed. Urine cytology slides were made using the ThinPrep(R) preparation method and the conventional Cytospin and/or direct smear method from the individual samples. The results of urine cytology were compared with the final cystoscopic or histological diagnoses. We analyzed the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of both cytology preparation methods. A total of 236 slides made using the liquid based method were satisfactory for slide quality, whereas 5 slides (2.1%) prepared by conventional methods were unsatisfactory because of air-drying, a thick smear, or a bloody or inflammatory background. The ThinPrep(R) method showed 53.1% sensitivity, 92.6% specificity, a 92.6% positive predictive value, a 94.1% negative predictive value and 85.6% accuracy, while the conventional method showed 51% sensitivity, 98.4% specificity, a 92.6% positive predictive value, a 98.4% negative predictive value and 88.6% accuracy. Although the diagnostic values were equivalent between the use of the two methods, the quality of the cytology slides and the time consumed during the microscopic examination for a diagnosis were superior for the ThinPrep(R) method than for the conventional method. In conclusion, our limited studies have shown that the use of the liquid based preparation method is beneficial to improve the quality of slides and reduce the duration for a microscopic examination, but did not show better sensitivity, accuracy and predictive values.
Etc
Effect of the Nitrofen on Diaphragmatic Development of Rat
Wha Soon Chung, Je Geun Chi*
Korean J Cytopathol. 1984;18(2):122-135.
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AbstractAbstract
Enormous increase of use of herbicide was brought to problem with adverse effect on environment and its inhabitant. And the refatogenic effects of a few herbivides were reported. Nitrofen, 2,3-dichlorphenyl-p-nitrophenyl ether is an organic chemical placed in nitrophenol/aniline group. This chemical has been one of most widely used herbicides in Korea. Initial toxicity study of nitrofen was done by Ambrose with lung toxicity. Respiratory distress and cyanosis of neonatal rats following nitrofen exposure in uterus was descibed by Kimbrough et al and suggested that nitrofen might be affecting surfactant production. Later, it was reported that cardiac naomaly accounted for the neomatal distress and death. This experiment was attempted to produce diaphragmatic defect in offsprings of rats by nitrofen administration orally in early developmental stage and to find characteristics of diaphragmatic defect. Following results and conclusions were made. 1) Nitrofen was a potent teratogenic agent in rats in dose of 350 mg/kg at 10th day of gestation. It was fairly selective in producing diaphragmatic defect. The overall frequency of diaphragmatic defect was 66.3%. 2) Diaphragm was the primary target organ in nitrofen induced neonatal death, and pulmonary hypoplasia due to diaphramatic defect was major contributor of direct cause of neonatal death. 3) In majority the defect was in the posterolateral(Bochdalek) portion of the ddiaphragm and in some cases, diaphragmatic defect was due to attenuation of central tendon. 4) The difference in the sidedness of the defect was obviously noted; in group of administration of 250 mg/ kg at gestation 11th day, the great majority were right sided(92%), while in group of administration of 350 mg/kg at gestation 10th day no difference was observed. 5) Pathogenesis of nitrofen induced diaphragmatic defect was thought probable due to delay or arrest of development of pleuroperitoneal fold.
Original Articles
Fine Needle Aspiration Cytology of Palpable Lymph Nodes: A Single Institutional Experience of 1,346 Cases.
Dong Hoon Shin, Kyung Un Choi, Jee Yeon Kim, Hyun Jeong Kang, Ick Doo Kim, Mee Young Sol
Korean J Cytopathol. 2007;18(2):126-132.
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AbstractAbstract PDF
The aim of this study was to evaluate the diagnostic value of fine needle aspiration cytology (FNAC) for the assessment of palpable enlarged lymph nodes. The authors reviewed the results of 1,346 FNACs of palpable enlarged lymph nodes performed at Pusan National University Hospital from 1998 to 2004. Of the 1,346 cases, 1,265 (94.0%) were satisfactory and 81 (6.0%) unsatisfactory. Cytologic diagnoses were judged in 488 cases, based on subsequent histologic diagnoses, clinical follow up, or both. Global results for all malignancies (lymphoid and non-lymphoid neoplasms) based on cases with final diagnoses, showed a sensitivity of 87.4% and a specificity of 98.7%. The overall diagnostic accuracy was 93.2%, and the false negative rate reduced from 12.6% to 7.3% when lymphomatous cases were excluded. The annual data for this period showed that the number of diagnostic lymph node biopsies and the rate of inadequately sampled material markedly decreased. Gene rearrangement studies for IgH and TCR gamma were helful in 30 cases. FNAC is a useful initial diagnostic procedure for the evaluation of palpable enlarged lymph nodes. However, the technique should be assisted by the appropriate ancillary studies and by proper interpretation by a cytopathologist.
Analysis of Fine Needle Aspiration Cytology and Ultrasonography of Metastatic Tumors to the Thyroid.
Eun Yoon Cho, Young Lyun Oh
Korean J Cytopathol. 2007;18(2):133-142.
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AbstractAbstract PDF
Cytologic diagnosis of the metastatic tumors to the thyroid is important in the management of the patients. There have been rare reports analyzing fine-needle aspiration (FNA) cytology of metastatic tumors to the thyroid. This study examines comprehensive cytologic findings of metastatic tumors to the thyroid with radiologic findings. The FNA cytology slides obtained from 12 cases with metastatic tumors of the thyroid; lung cancer (n=5), tongue and tonsil cancer (n=3), esophageal cancer (n=2), and breast cancer (n=2) were reviewed. Radiological study showed single mass with heterogeneous texture or multiple masses without calcification. Metastatic tumor was easily considered in a differential diagnosis of FNA cytology because they had peculiar cytological features which were not seen in primary thyroid tumor. The smear background varied from predominantly necrotic, bloody, and inflammatory to colloid. The aspirates exhibited a mixture of benign follicular cells and malignant cells in 6 cases. The characteristic cytoplasmic features of the tumor cells, such as keratin, mucin and melanin, were found in 9 cases. Although some cases mimic primary thyroid neoplasm, a careful examination of the cytological characteristics may help cytopathologists to recognize a metastatic tumor in the thyroid by FNA, and may help the clinicians to establish a proper treatment plan.
Etc
Benign Glandular Inclusions in Pelvic Lymph Nodes -Histopathologic Observation with special reference to histogenesis-
Yong Il Kim, Hae Jae Cho
Korean J Cytopathol. 1984;18(2):136-143.
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AbstractAbstract
Benign glandular inclusions(BGI) are nonneoplastic glandular structures which are not infrequent in pelvic lymph nodes, and the chance of finding these structures is dependent on the intensity with which one searches. We examined the pelvic lymph nodes from total 189 consecutive cases of radical hysterectomy for uterine malignancies performed at Seoul National University Hospital over a period of two years from January, 1979 to June, 1981. These lymph nodes revealed glandular inclusions in fifteen(7.9%) of the 189 cases. Over 50 of BGI were located either in the capsule or subcapsular portion of lymph nodes. These were reflected by simple microcysts of tubes with a single layer of cilliated cuboidal or columnar epithelium whichresembled the epithelial cells lining the endosalpinx, endocervical and endometrial glands. In serial sections of lymph nodes with benign gladular inclusions, the following characteristic findings were observed. First, these structures were extending from nodal capsular tissue to the adjacent subcapsular portion of cortex and often invaginated into the medullar along the fibrous trabevulae ; secondly BGIs were not identifiable within the peripheral sinuses; thirdly these were often racemous and communicating ; and fourthly, admixture of both serous and mucinous linings in a same lymph nodes were present. Bu these findings we propose that the benign glandular inclusions may be due to localized metaplasic proliferation of the peritoneal mesothelium which is derivative of coelomic epithelium from which the Mullerian system originates.
Original Article
The Usefulness of SurePath(TM) Liquid-Based Smear in Sono-Guided Thyroid Fine Needle Aspiration; a Comparison of a Conventional Smear and SurePath(TM) Liquid-Based Cytology.
Dong Hoon Kim, Min Kyung Kim, Seoung Wan Chae, Kyoung Bun Lee, Eun Mee Han, Sung Hee Kang, Jin Hee Sohn
Korean J Cytopathol. 2007;18(2):143-152.
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AbstractAbstract PDF
Sono-guided fine needle aspiration (FNA) of the thyroid is widely used, but the aspirated samples are typically not well preserved and low cellularity makes diagnosis difficult in many cases. The object of the current study is to evaluate the adequacy and diagnostic accuracy of the use of SurePath(TM) liquid-based cytology (SP-LBC) in the sonoguided fine needle aspiration of the thyroid nodule and to compare its use with that of the use of a conventional smear (CS). A total of 172 sono-guided FNAs of thyroid nodules from April to June, 2006 were prepared by the use of the split method with either SP-LBC or CS; the samples were stained with the use of hematoxylin-eosin (H&E) and Papanicolaou (Pap) stains. A cyto-histological correlation was performed in 69 (30 SP and 39 CS) cases that had been histologically confirmed. The rate of producing unsatisfactory slides by the use of the SP-LBC method (9.3%) was less than that of the use of the CS method (20.9%). The diagnostic accuracy of the SP method (93.3%) was better than that of the CS method (85.3%). The sensitivity and specificity of the SP method (94.4% and 92.3%) was better than that of the CS method (83.3% and 70%), respectively (p<0.05). The CS of sono-guided aspirated specimens had some unavoidable limitations related to inadequate sampling such as a bloody background, low cellularity and an indication that some clinicians smeared many useless slides (averaging four to ten slides), and that most slides showed only blood that included few follicular cells. The SP method resulted in more thinly smeared slides and showed cleaner background and greater cellularity than the use of the CS method. Each follicular cell shows superior nuclear detail, and more distinct cytoplasmic features than with the use of the CS method. SP-LBC appears to be an easy, highly accurate, and reliable cytological method for employ for a diagnostic approach of thyroid disease and thyroid nodules. The SP-LBC method is a suitable alternative to the CS method to overcome diagnostic difficulties.
Etcs
Evaluation of Glycosylated Hemoglobin Level by Hemoglobin Quick Column Method
In Ja Kim, Jay Sik Kim, Jyung Myung Kim
Korean J Cytopathol. 1984;18(2):144-151.
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AbstractAbstract
Glycosylated hemoglobin(G-Hb) measurements were performed in normal adults and adult-onset diabetics, and G-Hb values were compared by age, sex, duration of diabetes mellitus, complications of diabetes mellitus, and types of therapy. Mean value of G-Hb was 5.0±0.92% in normal control and 7.9±2.50% in diabetes mellitus. In diabetics, G-Hb values with blood glucose level at the time of G-Hb measurement and blood glucose level 2~3 weeks before G-Hb measurement were compared. No significant correlation was observed between blood glucose levels and G-Hb. No significant correlation between G-Hb value and sex, age, duration of diabetes mellitus, complications of diabetes mellitus and types of therapy.
A Clinical Study of Human Chorionic Gonadotropin Determined by Enzyme Immunoassay
Chun Hee Lee., Sook Ja Park, Ho Yeul Choi*
Korean J Cytopathol. 1984;18(2):152-157.
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AbstractAbstract
Human chorionic gonadotropin is a glycoprotein secreted by trophoblast. It has been determined by several methods, but resectly enzyme immunoassy is developed. The authors investigated serum levels of β-HCG determined by enzyme immunoassay in normal controls and patients with diseases of the reproductive organs. The results were as follows : 1) In hydatidiform mole, serum β-HCG levels were significantly increased(11.9×10³ mlU/Ml), but the elevated levels were returned to normal in 12 weeks after operation. 2) In choriocarcinoma, serum β-HCG levels were also markedly increased. 3) In ectopic pregnangy, serum β-HCG levels were increased moderately. 3) In chronic cervicitis and other diseases of the reproductive organs, serum β-HCG showed normal levels. According to the above results, enzyme immunoassay is a simple, rapid, highly specific, and sensititive method for determination of serum β-HCG. Evaluation of serum β-HCG levels is very important in diagnosis of trophoblastic disease and ectopic pregnancies.
Case Reports
Voided Urine Cytology of Small Cell Carcinoma of the Urinary Bladder: A Case Report.
Won Ae Lee, Seung Ha Lee
Korean J Cytopathol. 2007;18(2):153-156.
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AbstractAbstract PDF
Primary small cell carcinoma of the urinary bladder is an extremely rare but important entity. We experienced a case of small cell carcinoma of the urinary bladder diagnosed by urine cytology. A 59-year-old man presented with gross hematuria and dysuria, and a calcified mass was detected at the left ureterovesical junction by cystoscopy. Abdominal ultrasonography revealed focal wall thickening at the left lateral side of the urinary bladder, and urine cytology findings were of an inflammatory background and atypical small round cells with minute hyperchromatic or pyknotic nuclei, scant cytoplasm, and rare nucleoli. In addition, atypical cells were scattered in an isolated single cell pattern or in small loose clusters with prominent nuclear molding. Subsequent histological and immunohistochemical examinations confirmed a diagnosis of small cell carcinoma.
Fine Needle Aspiration Cytology of Granular Cell Tumor in Breast: A Case Report.
Soo Young Chung, Wo Chul Noh, Min Sun Jin, Seung Sook Lee, Jae Soo Koh
Korean J Cytopathol. 2007;18(2):157-160.
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AbstractAbstract PDF
Granular cell tumor (GCT) of the breast is a rare clinical entity, and is believed to be of schwannian origin and to follow a benign clinical course. A 50-year-old woman presented with a slowly growing mass in the right breast. Fine needle aspiration cytology revealed a cellular smear containing isolated or clustered cells showing round to oval nuclei with abundant oncocytic granular cytoplasm. Nuclei showed a fine granular chromatin pattern and occasional small single nucleoli. Cell boundaries were poorly defined, and naked nuclei were frequently found. Histologically, the tumor showed features of typical GCT, and immunohistochemical staining findings strongly supported the diagnosis. The present study demonstrates that GCT of the breast can mimic malignant lesions of breast both clinically and radiologically. The recognition of its cytologic features and suspicion of this lesion would undoubtedly aid the correct diagnosis of mammary GCT.
Etc
An Experimental Study on the Effect of the Blastocyst to the Endometrial Stroma
Kyo Suck Woo, Ki Tae Keum, Chong Man Kim, Kook Hwae Koo
Korean J Cytopathol. 1984;18(2):158-163.
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AbstractAbstract
The present study was undertaken to investigate the developing mechanism and its biological significance of the decidua. Unilateral salpingeal ligation was performed on mature female Sprogue-Dawley rats. Mating was proceeded. On the 3rd, 5th, 7th, and 9th days of the pregnancy, morphological changes of both ligated (non-pregnant horn) and non-ligated (pregnant horn) salpinges were observed. Gradual change of the decidualization was observed already by the 5th day of the pregnancy in the non-ligated horn, but was not in ligated. Marked change of the decidualization was observed by the 7th and 9th days of pregnancy in the non-ligated horn, but little change was in the ligated. The results suggest that decidualization is contributed not only by endocrinological factors but also obviously by some factors of the blastocyst.

JPTM : Journal of Pathology and Translational Medicine