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Volume 19(1); March 2008
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Review
Cytological Diagnosis of Lung Cancer: The Diagnostic Accuracy and Pitfalls.
Hyun Sook Chi, Je Geun Chi
Korean J Cytopathol. 2008;19(1):1-8.
DOI: https://doi.org/10.3338/kjc.2008.19.1.1
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AbstractAbstract PDF
The role of respiratory cytology is to detect and classify pulmonary disease, with an emphasis of neoplastic disease, so that proper therapy can be instituted. As in many branches of cytology, the recognition of malignancy in the cells obtained from the respiratory tract is more straightforward than identifying the type of tumor cell. It is important to accurately determine the true cytopathological cell type in cases of primary lung cancer and to know the accuracy of the diagnosis achieved by the cytological procedures. The well differentiated tumors have characteristic cytoplasmic and nuclear abnormalities that enable physicians to firmly categorize these lesions, as in squamous cell or adenocarcinoma, but some moderately and most poorly differentiated tumors show few distinctive features. This article reviews the malignant and reactive pulmonary cytologic findings and we also report on some of their pitfalls and the cytologic criteria.
Original Article
Studies on Morphology and Fibrinolytic Activity of Ganglionic Eminence.
Hyun Sook Chi, Je Geun Chi
Korean J Cytopathol. 1985;19(1):1-12.
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AbstractAbstract PDF
Ganglionic eminence initially appears as a slight swelling in the floor of the cerebral vesicle during the 5th fetal week and attains maximum prominence late in the 4th fetal month; it then declines in relative size, and nearly disappears after birth. The ganglionic eminence constitutes a collection of the proliferating cells throughout most of span of gestation and supply neuroblasts and spongioblasts to basal ganglia and pulvinar region of thalamus and cerebral cortex. Nowadays intraventricular hemorrhage predominantly occurs in preterm infants of less than 32 weeks gestational age, and the intraventricular hemorrhage arises most frequently from rupture of a ganglionic eminence hemorrhage is equally frequent in both hemispheres and is associated with an extensive destruction of the capillary bed without arterial or venous rupture. Although fibrin thrombi are seen within veins in relation to ruptures at the capillary vein junction, the other study reveals little or no fibrin is to be seen within the ganglionic eminence hemorrhage presumably due to the high fibrinolytic activity within this region of the immature brain. Accordingly this study was planned to evaluate the ganglionic eminence of fetal brain in two aspects, i.e., morphological development of ganglionic eminence during gestation and functional maturation by measuring fibrinolytic activity of various portions of developing brains. To evaluate the development of ganglionic eminence a total of 97 brains of Korean fetuses of gestational ages ranging from 16 to 37 weeks, was studied; 62 for morphological study and 35 for functional study. The fetuses were products of therapeutic abortions, and were proved to be normal after complete examination of fetuses and placentas. The brains were removed as soon as possible after delivery, and were fixed in 10% formalin for 1 to 2 weeks before being examined. Representative blocks containing white matte around lateral ventricle, ganglionic eminence, caudate nucleus and thalamus on the serial coronal sections. Through routine histological procedure, slides were made and stained with hematoxylin and eosin for microscopical examination of the ganglionic eminence and striatum. The fibrionlytic activity of the tissue was measured by fibrin plate method of Astrup and Albrechtsen and the amount of lysis expressed as area/mg of wet tissues. As controls comparable aliquots of 2M potassium thiocyanate or saline alone had no fibrinolytic activity. To detect the in vivo fibrinolysis, fibrin and/or fibrinogen degradation product, staphylococcal clumping tests for the tissue extracts were performed. Following results were obtained. 1) The ganglionic eminence was well formed and located at the lateral side of terminal vein and over the caudate nucleus and protruded into the lateral ventricle. 2) The thickness of the ganglionic eminence is reached to maximum width by 20th week of gestation and is shown a progressive reduction till 30th week, and revealed sharp reduction after 31th week of gestation and became no longer recognizable after 37th week of gestation. 3) The ependymal layer was most thickened at 16~19th week of gestation, showing 6~8 layers with numerous mitoses and declined to 2~3 layers at 28~31th week of gestation and no more mitosis was found. 4) The distribution of capillary beds were most pronounced at 16~19th week of gestation and the permeation of the capillaries to the ependymal zone and decreased in number after 20th week of gestation. The medium sized, well developed veins were demonstrable at the junction of ganglionic eminence and caudate nucleus from 24th week of gestation. 5) The fibrinolytic activity of the choroid plexus and leptomeninges were significantly increased than the other areas(p<0.005) and there was no evidence of gestational changes. 6) The fibrinolytic activity of the ganglionic eminence was no more pronounced than those of cerebral cortex, periventricular white matter, cerebellum and spinal cord.
Review
Fine Needle Aspiration Cytologic Findings of Pulmonary Neuroendocrine Tumors.
Jae Soo Koh
Korean J Cytopathol. 2008;19(1):9-15.
DOI: https://doi.org/10.3338/kjc.2008.19.1.9
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AbstractAbstract PDF
The major categories of neuroendocrine tumors of lung are typical carcinoid, atypical carcinoid, large cell neuroendocrine carcinoma, and small cell carcinoma. The histologic classification criteria of neuroendocrine tumors are well documented in the "WHO Classification of Tumors" based on mitotic figures and necrosis. Cytologic characteristics of neuroendocrine tumors are trabecular, acinar, and solid arrangement of tumor cells and occasional rosette formation. Nuclear chromatin patterns are characteristically described as "salt and pepper chromatin pattern". Many of cytologic classifications documented in the literature are before the "WHO Classification". In this review, the cytologic features of pulmonary neuroendocrine tumors are documented according to the WHO classification, and recent concepts of neuroendocrine tumors of lung are discussed.
Original Article
Ultrastructure of Adenocarcinoma of the Stomach by Scanning Electron Microscope.
Kyung Rak Sohn, Jyung Sik Kwak, Tae Joong Sohn
Korean J Cytopathol. 1985;19(1):13-26.
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AbstractAbstract PDF
The author studied 11-cases of adenocarcinoma of the stomach confirmed by gastrofiberscopic biopsy before in order to differentiate between differentiated and undifferentiated adenocarcinoma by scanning electron microscope. Light and transmission electron microscopie examination were done, too. Seven of them are differentiated accompanied by severe intestinal metaplasia and four of them are undifferentiated with rearly focal intestinal metaplasia. Two of the undifferentiated cases shows focal tubular differentiation on the superficial region of the mucosa. Microvilli on the free border are long, regular on the differentiated type but in state of variable loss of microvilli under the transmission electron microscope. Number and density of the mucous granules are variable. Scanning electron microscopic examination shows prominent disorganization of the folds, cellular pleomorphism and pleomorphic microvilli are suggestive of early marker of neoplastic transformation. The size of them are 0.6 micrometer and 1.2 micrometer on the differentiated type respectively. Disorganization of the folds is an important differential point between differentiated and undifferentiated type on the lower power examination. Development of folds, furrow, and hemispheric colliculi are more porminent on the differentiated adenocarcinoma. Presence of striated border, partial or complete loss of microvilli and intestinal metaplasia on the undifferentiated and differentiated adenocarcinomas are consisent with origin from common precursor cells.
Review
Cytologic Features of Cancers Metastatic to the Lung and Diagnostic Usefulness of Immunohistochemistry: Distinction Between Primary and Secondary Lung Tumors.
Young Lyun Oh
Korean J Cytopathol. 2008;19(1):16-26.
DOI: https://doi.org/10.3338/kjc.2008.19.1.16
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AbstractAbstract PDF
The lungs are one of the most common visceral sites for metastatic disease. The identification of a metastasis from a second primary lung tumor is clinically important for patients with pulmonary metastases of an extrathoracic origin. Although the cytologic features of metastatic tumors involving the lung have been extensively described, making the cytologic diagnosis is usually not easy in the absence of clinical information. However, the immunohistochemical staining for many tumor markers and the different expressions of cytokeratin 7 and 20 are very useful in the diagnosis. This review presents the cytomorphological spectrum of metastatic tumors along with the immunohistochemical findings.
Original Articles
Fine Needle Aspiration Cytology of Subacute Granulomatous Thyroiditis: A Clinico-Cytological Review of 10 Cases with Immunocytochemical Analysis.
Eun Hee Suh, Seong Hoe Park, Je Geun Chi
Korean J Cytopathol. 2008;19(1):27-33.
DOI: https://doi.org/10.3338/kjc.2008.19.1.27
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AbstractAbstract PDF
Although subacute granulomatous thyroiditis(SGT) is usually diagnosed clinically, papillary carcinoma or other thyroid conditions must be considered in the differential diagnosis. We retrospectively reviewed the clinical and fine-needle aspiration(FNA) cytologic findings seen in 10 SGT cases to decide what are the most reliable cytologic findings and the most helpful molecular tools for reaching a confident cytologic diagnosis. The most representative smear slides were retrieved to perform immunocytochemistry for cytokeratin19(CK19) and Ret protein. Five papillary carcinomas(PTCs) were included as controls. The constant and typical cytologic findings of SGT were multinucleated giant cells(MGCs) (100%), epithelioid granulomas(90%), an inflammatory dirty background(90%) and plump transformed follicular cells(80%) without fire-flare cells, oncocytic cells or transformed lymphocytes. The immunoreactivities for CK19(37.5%) and Ret(10%) of the follicular cells of SGT were less than those(CK19 and Ret:100%) of PTC. CK19 immunoreactivity of the MGCs was seen in only one case of PTC. There was no significant difference between CK19 and Ret immunocytochemical staining for the MGCs of both SGT and PTC. The results of this study demonstrate that the cytological diagnosis of SGT can be improved by employing a combination of the typical and constant diagnostic cytological features and immunocytochemical results.
Histological Observations on Human Thyroids: 100 cases analysis of embryos and fetuses.
Eun Hee Suh, Seong Hoe Park, Je Geun Chi
Korean J Cytopathol. 1985;19(1):27-36.
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AbstractAbstract PDF
To evaluate the morphogenesis of the human thyroid, a histologic study was made based on 100 normal thyroids of human embryos and fetuses ranging in age from 4 to 42 weeks of gestation. The embryos were serially sectioned and fetuses were examinated as an individual organ. 1) The first sign of thyroid primordium was the spherical proliferation of median ventral pharyngeal wall at the 4th week of development. 2) At the 6th week of gestation, the thyroid differentiated into two lobes that were connected by an isthmus, and was on the way of migration to the definite position from the foramen cecum. 3) The developing thyroid consisted of two cell cords, solid nests or interconnecting complex pattern until 14th week of gestation, when the entire portion of thyroid was replaced by follicles of variable size. 4) At the 9th week, the first follicle was recognizable at the periphery of the gland. 5) At the 14th week, follicles were partly filled with faintly eosinophilic colloid. 6) After the 18th week of gestation, lobulation of the thyroid parenchyme was a prominent feature. 7) After the 24th week, large follicles with rich colloid content are distributed through both superificial and deep portions. And after the 34th week, maturation reached the general pattern of adult thyroid. 8) The ability of thyroglobulin synthesis which was confirmed by PAP method, was first recognized at the 10th week of gestation.
Manual Liquid-Based Cytology (Liqui-PREPtrade mark) in Breast Fine Needle Aspiration Cytology: Comparison with the Conventional Smears.
Ji Yun Jeong, Jeong Shik Kim, Young Su Kim, Hye Jung Kim, Ji Young Park
Korean J Cytopathol. 2008;19(1):34-40.
DOI: https://doi.org/10.3338/kjc.2008.19.1.34
  • 2,425 View
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AbstractAbstract PDF
Fine needle aspiration (FNA) cytology of the breast is a useful method for diagnosing breast lesions. Yet making the definite diagnosis with performing FNA is limited by some problems, such as the low cellularity, the poor preservation and the obscuring background. Recent studies have found that liquid-based cytology solves such problems, but it is an expensive method and it is limited by the loss of the background information. The purpose of this study is to compare the Liqui-PREP(TM), a new manual liquid-based method of cytology, and the conventional smears for analyzing breast FNA cytology materials. A total of 31 randomized FNA specimens of breast were studied. In each case, both the conventional smears and the Liqui-PREP(TM) method were performed, and the smears were evaluated for cellularity, cellular preservation, the background, the cytologic features and the architectural arrangement. The cellularity and architectural arrangement were equal for both preparations. The Liqui-PREP(TM) specimens showed better cellular preservation, loss of the obscuring background, no overlapping of cells and a smaller area to screen compared with the conventional smears. Moreover, it has the potential advantages of being able to use the remaining specimens for immunohistochemical study and ploidy analysis, and it can reduce the costs for preparation compared with the other liquid-based methods of cytology. But some background information is lost in the Liqui-PREP(TM) specimens, the same as the other liquid-based methods of cytology. In conclusion, the Liqui-PREP(TM) and conventional smears showed good correlation, but they have their respective advantages and disadvantages. These results suggest that Liqui-PREP(TM) can contribute to making the accurate diagnosis with performing breast FNA cytology when it is used along with other methods.
A Study on Serum Total Bile Acid in Patients with Various Liver Diseases.
Mee Young Sol, Jun Yeon Kim, Eun Yup Lee, Soon Ho Kim
Korean J Cytopathol. 1985;19(1):37-44.
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AbstractAbstract PDF
For the purpose to define the clinical usefulness of fasting serum total bile acid, the authors carried out to measure the serum total bile acid in 18 cases of acute hepatitis, 10 cases of chronic active hepatitis, 21 cases of liver cirrhosis, 7 cases of hepatocellular carcinoma and 35 cases of adult healthy control. Diagnosis were confirmed histopathologically in all the patients. Blood samples were obtained usually in the morning before meals from th anterior cubital vein of all the patients and adult healthy control in Pusan National University Hospital during the periods from January to August, 1984. Total bile acid was measured fluorome cally by means of an enzymatic technique. The results obtained were as follows: 1) The mean value of serum total bile acid in adult healthy subject in fasting was 2.6+/-2.3 umol/L. 2) The mean values of serum total bile acid were significantly higher in the patients with various liver diseases, as compared with those in adult healthy subjects. 3) In acute hepatitis and chronic active hepatitis, the percentages of abnormal values were significantly higher or tended to be higher in total bile acid, as compared with those in total bilirubin, ALP, LDH and GGT activity and tended to be lower in total bile acid, as compared with those in AST and ALT activity. 4) In liver cirrhosis and hepatocellular carcinoma, the percentages of abnormal values of total bile acid were significantly higher in the patients with above 100IU/L of AST activity, compared with those in the patients with 50~100IU/L of AST activity. 5) Total bile acid showed a significant correlation with total bilirubin and ALP in acute hepatitis, with total bilirubin in chronic active hepatitis and hepatocellular carcinoma, and with ALP in liver cirrhosis. On the basis of the results obtained, it was suggested the measurement of serum total bile acid is clinically a highly sensitive, useful test in diagnosis of various liver diseases.
Cytologic Findings of Fine Needle Aspiration Biopsy of 23 Schwannomas.
Sunhee Chang, Mee Joo, Hanseong Kim
Korean J Cytopathol. 2008;19(1):41-46.
DOI: https://doi.org/10.3338/kjc.2008.19.1.41
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AbstractAbstract PDF
In an attempt to better define the cytologic characteristics of schwannomas, we have reviewed aspirates and corresponding histologic sections from 23 schwannomas. Of this number, the original cytologic diagnoses were: schwannoma in 14 cases (61%), benign soft tissue tumor in 2 cases (9%), and insufficient specimen in 7 cases (30%). The cytologic findings common to all cases of schwannoma included fragments of tightly cohesive fascicles with variable cellularity and corresponding Antoni type A area. The Antoni type B area, consisting of scattered spindle cells and some histiocytes and lymphocytes against a myxoid background, was seen in 14 cases. Fibrillary stroma was seen in 12 cases. The tumor cells had spindle- or oval-shaped nuclei, with pointed ends and indistinct cell borders. Nuclear palisading was seen in 10 cases, and distinctive Verocay bodies were seen in 5 cases. In ancient schwannomas, there were no Verocay bodies. Most schwannomas have distinct cytomorphologic features that allow correct diagnosis. The major problem with fine needle aspiration cytology of these tumors is the high frequency of poor cellularity, particularly in lesions with cystic degeneration. Of 7 cases with insufficient specimen, 4 showed marked cystic changes and 1 showed marked hyaline changes on histologic sections. In conclusion, we believe that if cytopathologist reminds the situation such as cystic degeneration or hyaline degeneration, the correct diagnosis of the schwannoma will be easily made.
Frozen Section: Indications, limitations, and accuracy.
Hyeon Joo Jeong, Kwang Kil Lee, In Joon Choi
Korean J Cytopathol. 1985;19(1):45-50.
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AbstractAbstract PDF
The rapid frozen section method is a means of intraoperative pathological diagnosis, first introduced by Welch in 1891 and developed as a diagnostic tool by Cullen, Wilson, MacCarty et al. This method serves useful purposes, such as determining the malignancy or benignancy of a suspected lesion, determining the adequacy of a biopsy of a suspected lesion, confirming the presence or absence of metatasis, and identifying small structures. But it bears many disadvantages, the most of which is the danger of incorrect diagnosis. We studied the indications, the limitations and the accuracy of the frozen section method and the materials studied was total cases of frozen section during recent 5 years. The ovarall accuracy of the frozen section diagnosis of 1,603 cases was 96.2% with 0.3% of false positive, 3.5% of false negative and 2.8% of incorrect histological diagnoses or grading errors the tissues submitted for frozen section were lymph node, breast, gastrointestinal tract and soft tissue in decreasing order of frequency. The false positive cases were four in number, while the false negative cases were 53, one third of which were the misdiagnoses of the presence of ganglion cells in Hirschsprung's disease.
Case Report
Touch Imprint Cytology of Adenomatoid Tumor of the Tunica Albuginea: A Case Report.
Jong Im Lee
Korean J Cytopathol. 2008;19(1):47-51.
DOI: https://doi.org/10.3338/kjc.2008.19.1.47
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AbstractAbstract PDF
Adenomatoid tumor is a benign neoplasm of a mesothelial origin, and it usually occurs in the reproductive organs, especially in the epididymis. The author experienced a case of adenomatoid tumor involving the tunica albuginea and testicular parenchyme without any evidence of epididymis involvement. The patient was a 36-year-old man with a painless scrotal mass that he had experienced for 2 months, and this mimicked testicular neoplasia, including metastatic carcinoma, or other benign lesions. The imprint cytology of the tumor showed a hypocellular smear with mainly arranged cells in cohesive monolayered clusters along with occasional singly dispersed cells and naked nuclei in a clean background. The cellular clusters formed vague glandular and cord-like structures. The tumor cells were large polygonal to columnar cells with a relatively monomorphic appearance. The nuclei were oval to round shape and they showed vesicular, fine chromatin and inconspicuous nucleoli. The cytoplasm was moderate to abundant, and it contained fine vacuoles in some tumor cells. Mitoses and cellular pleomorphism were not present. Awareness of the cytologic finding of this lesion is necessary to screen or differentiate a testicular or paratesticular mass before and/or during surgery because the cytology may be useful as a diagnostic tool. Pathologists should be aware of the cytologic features of common lesions in this anatomic region so as to avoid performing aggressive and unnecessary surgical procedures.
Original Article
Study on the Natural History of Hepatitis B Virus-infected Rats, and its Relationship with Chemical and Physical Injury of the Liver.
Dong Soo Suk
Korean J Cytopathol. 1985;19(1):51-57.
  • 1,124 View
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AbstractAbstract PDF
Normal, hepatectomied(partial) or CCI4 injected rats are infected intraperitoneally with human HBV-infected serum, and histopathological examination of major organs, and serologically HBV markers are checked. In the latter groups, the relationship between the regenerating hepatocytes and their infectivity toward HBV are investigated. 1) There are no specific histological changes in the liver which might suggest HBV infection of hepatocytes. 2) There is a tendency to increase basophilic mononuclear cells in the lymphoid organs. At the same time, HBcAb are positive in the rat's serum suggesting that these cells are immunologically oriented effector cells in the defense system. In the groups which received hepatic injury, the number of these cells are decreased. 3) HBcAb are positive in the groups of 5th day, 1 week, and 2 weeks' post-HBV injection. All groups with hepatic injury show trace in the 2 weeks post-HBV injection which corresponds to the concomitant decreased number of basophilic mononuclear cells in the lymphoid organs. 4) Above findings suggest that HBV will promote a proliferative reaction of the mononuclear cells in the lymphoid organs in the early stage of HBV infection. It appears that the infection stops there, and there would be no activation of the mechanism of antibody-dependent cellular cytotoxicity followed by injury of hepatocytes due to the attack of T-lymphocytes manifesting the clinical hepatitis.
Case Reports
Cytologic Features of Epithelial-Myoepithelial Carcinoma Occurring in External Auditory Canal: A Case Report.
Ho chang Lee, Hyung Geun Song, Young Seok Choi, Ok Jun Lee
Korean J Cytopathol. 2008;19(1):52-56.
DOI: https://doi.org/10.3338/kjc.2008.19.1.52
  • 1,774 View
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AbstractAbstract PDF
Epithelial-myoepithelial carcinoma (EMC) is a low grade malignant neoplasm that commonly occurs in the parotid gland. Recently, we investigated a case of EMC that occurred in the external auditory canal (EAC) in a 35-year-old male, and this tumor was initially diagnosed as pleomorphic adenoma. The difficulty associated with diagnosing EMC by aspiration cytology arises from both the rare incidence of this tumor and the overlapping spectrum of cytological features found in various salivary gland tumors, such as pleomorphic adenoma, basal cell adenoma and adenoid cystic carcinoma.
Touch Imprint and Fine Needle Aspiration Cytology of Giant Cell Tumor of Tendon Sheath: A Case Report.
Jong Im Lee
Korean J Cytopathol. 2008;19(1):57-64.
DOI: https://doi.org/10.3338/kjc.2008.19.1.57
  • 1,779 View
  • 15 Download
AbstractAbstract PDF
Giant cell tumor of the tendon sheath (GCTTS) is a slowly growing, benign soft tissue tumor. The tumors occur predominantly on the hands and feet. Although the clinical and histopathologic features are well-defined, only a few reports have described the cytologic appearance of this entity. A 26-year-old woman presented with a gradually developing circumscribed soft tissue mass near the proximal phalanx of her left little finger for one year. Imprint and fine needle aspiration (FNA) smears were obtained from the excisional biopsy specimen. The imprint smears were composed of predominantly singly dispersed bland mononuclear cells and several giant cells. The mononuclear cells were polygonal to round, and they showed a histiocyte-like appearance. Osteoclast-type multinucleated giant cells of various sizes were randomly scattered throughout the smears, and these cells contained 3 to 50 nuclei. Nuclear atypia and pleomorphism were absent in both the single and giant cells. Loose aggregates of hemosiderin-laden macrophages and binuclear stromal cells were also seen. The cytologic features of the FNA smears were similar with those of the imprint. Additionally, the FNA smears contained several clumps of densely collagenous stromal tissue that were seldom noted in previously reported cytologic material. The cytologic features were well-correlated with the concurrent histologic findings and the diagnosis of GCTTS was made. When the clinical and radiologic datas are integrated, the diagnosis of GCTTS can be strongly suggested, based on the pre-operative cytologic specimen.

JPTM : Journal of Pathology and Translational Medicine