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Volume 33(3); March 1999
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Original Articles
Loss of Heterozygosity of Chromosome 3p in Squamous Cell Carcinomas and Adenocarcinomas of the Lung.
Gyeong Shin Park, Young Shin Kim, Kyo Young Lee, Chang Suk Kang, Sang In Shim, Byung Kee Kim
Korean J Pathol. 1999;33(3):151-157.
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We evaluated the frequency of genetic alteration of chromosome 3p in lung cancer, and analyzed the patterns of genetic alterations between two distinct histologic types, squamous cell carcinomas (SCC) and adenocarcinomas (AC). PCR-LOH analysis for 40 Korean non-small cell lung cancer including 20 SCC and 20 AC was performed using microsatellite markers, D3S1300, D3S1029 and D3S1038. These markers represented the loci of FHIT gene (3p14), mismatch repair gene hMLH1 (3p21) and VHL gene (3p25), respectively. For SCC, the frequency of LOH at D3S1300, D3S1029 and D3S1038 was 78.6%, 61.5% and 64.3%, and for AC, was 62.5%, 62.5% and 46.7%, and for total 40 cases of SCC and AC, was 70.0%, 62.1% and 55.2%, respectively. Among 27 cases showing heterozygosity at three examined loci, 7 cases (25.9%) revealed LOH at only one locus and 16 cases (59.3%) revealed LOH at two or three loci. The differences of incidence of LOH and the patterns of genetic alterations at chromosome 3p between two distinct histologic types of lung cancer were not significant. The genetic deletion of relatively broad area, including more than two loci, was more frequent than that of small area, including only one locus.
A Study of the Relationship between p53 Mutation and Proliferating Activities in Astrocytic Tumors.
Geun Ho Lee, Jong Sang Choi
Korean J Pathol. 1999;33(3):158-168.
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To evaluate the relationship between p53 protein expression and proliferating activity in astrocytic tumors, we performed a study using 37 cases of astrocytic tumors; 13 cases of low-grade astrocytoma (LGA), 9 cases of anaplastic astrocytoma (ANA), and 15 cases of glioblastoma multiforme (GM). The p53 protein expression was studied by immunohistochemical staining (IHC) with DO-7 monoclonal antibody in 37 cases and p53 mutation was detected by single strand conformational polymorphism (SSCP) using PCR products of 31 cases. Proliferating activities were detected by Ki-67 (MIB-1) and proliferating cell nuclear antigen (PCNA). Immunohistochemically, 24.3% (9/37) of astrocytic neoplasms showed p53 expression, which consisted of 7.7% (1/13) of LGA, 44.4% (4/9) of ANA, and 26.7% (4/15) of GM. The p53 expression was statistically significant between the tumor grades. p53 mutations on exon 5 were noted in 6 (19.4%) out of 31 cases of astrocytic tumors. Average indices of MIB-1 and PCNA were 1.5 2.6% and 7.0 10.1% in LGA, 10.0 12.7% and 23.7 23.2% in ANA, and 30.9 22.4% and 69.9 26.7% in GM, respectively. p53 positive group by IHC showed significantly higher average MIB-1 (26.2 23.5%) and PCNA index (56.7 30.3%) than those (12.1 18.3%, 27.6 29.6%) of p53 negative group (p<0.05). p53 mutation group also showed significantly higher MIB-1 (30.7 26.0%) and PCNA index (55.5 32.6%) than those without p53 mutation (10.8 16.5%, 24.2 28.7% respectively). These results showed that about one-fifth of astrocytic tumors have p53 abnormalities, which were related with higher proliferating activities than those without p53 abnormalities.
A Clinicopathological Study of Posttransplant Liver Biopsy.
Na Rae Kim, Dae Su Kim, Young Lyun Oh, Mi Kyung Kim, Young Hyeh Ko
Korean J Pathol. 1999;33(3):169-178.
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Liver biopsies are used routinely in the assessment of graft dysfunction following liver transplantation and generally considered to be the most reliable method for the diagnosis of posttransplant complications with overlapping clinical and laboratory findings. To investigate posttransplant complications causing graft dysfunction and usefulness of liver biopsy, we analysed clinicopathologic features of 65 posttransplant liver biopsies, 2 autopsies and an explanted liver, taken from 20 patients. The frequencies of posttransplant complications were acute cellular rejection in 9 patients (45%), postoperative infection in 11 patients (55%), of which cytomegalovirus (CMV) infection and systemic invasive aspergillosis with candidiasis occured in 10 patients (50%) and 1 patient (5%), respectively. Remainders were hepatic arterial thrombosis in two (10%), primary graft dysfunction due to fatty donor liver in one (5%), and posttransplant lymphoproliferative disorder (PTLD) in two (10%). There were no chronic rejection or recurrent disease. Postoperative mortality was 25%. Histologic grade by Banff schema was well correlated with clinical parameters associated with unfavorable short term prognosis. CMV infection was associated with acute cellular rejection in 6 out of 10 patients (60%). Immunohistochemical staining for CMV was more sensitive method than CMV in situ hybridization or histologic detection of viral inclusion on tissue section. It was unique that one case of PTLD developed under the circumstances of the lowest dosage of immunosuppression and took grave outcome. Based on these results, we concluded that clinicopathologic correlation with integration of all the clinical and laboratory findings is necessary in the interpretation of accurate and early diagnosis of posttransplant liver biopsies. The interrelationship between chronic rejection and CMV infection as well as pathogenetic factors of PTLD remains to be clarified through further ongoing observation.
bcl-2 and p53 Protein Expression in Multiple Myeloma and Non-tumorous Plasma Cells A study related to survival.
Yu Na Kang, Kwan Kyu Park, Kun Young Kwon, Sang Sook Lee, Eun Sook Chang, Young Jae Lee
Korean J Pathol. 1999;33(3):179-186.
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AbstractAbstract PDF
The gene product of bcl-2 (B-cell leukemia/lymphoma-2) was suggested to suppress programmed cell death (apoptosis) of tumor cells and be involved in the development of multiple myeloma. However, the normal plasma cells also express the protein. It is unclear whether the expression of bcl-2 in multiple myeloma is of normal character or of regulatory adaptation in association with neoplastic transformation. p53 was also suggested to be involved in tumor progression since mutations on p53 were found in multiple myeloma. In order to find the relationship between the expression patterns of bcl-2 and p53 in tumor cells of multiple myeloma and non-neoplastic plasma cells, we examined 38 cases of multiple myeloma and 10 cases of nasal polyp immunohistochemically. Furthermore, expression of bcl-2 and p53, mitosis, clinical stage and infiltrative pattern of tumor cells in bone marrow were also evaluated in association with the survival of patients. By immunostaining with anti-bcl-2 and p53 monoclonal antibody, 37 out of 38 cases of multiple myeloma and all of 10 cases of nasal polyp were positive for bcl-2 but only 7 cases of multiple myeloma were positive for p53. Marked dysplasia, low percentage of bcl-2 expression, and increased mitoses were correlated with poor prognosis. Based on these observations, we suggest that bcl-2 and p53 are involved in tumorigenesis of multiple myeloma and the survival of patients would be influenced by dysplastic change, mitosis and degree of bcl-2 expression.
Expression of p21 and p53 Proteins in Gastric Adenocarcinoma.
Yun Jung Kim, Young Hee Choi, Kyoung Chan Choi, Young Euy Park
Korean J Pathol. 1999;33(3):187-192.
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Fifty-four adenocarcinomas of stomach were investigated to assess the expression of p21 and p53 using an immunohistochemical method. The relationship between p21 and p53 expression and the clinicopathologic parameters were analysed. The staining pattern of p21/p53 were: p21+/p53+, p21-/p53+, p21+/p53-, and p21-/p53- in 30, 12, 8, and 4 cases, respectively. Loss of p21 expression was observed in 16 of 54 tumor tissues (29%). p21 expression, however, had an inverse correlation with vascular invasion and depth of tumor invasion. The p21 and p53 protein expression showed intratumoral heterogeneity. In 63% of the adenocarcinoma, a proportional relationship was found between p21 and p53 immunostaining. The present results suggest that p53 independent induction of p21 expression may be involved in the molecular mechanism of these tumors, and expression of p21 protein may be related to a favorable prognosis in gastric adenocarcinomas.
Pseudoangiomatous Stromal Hyperplasia of the Breast A clinicopathological study of 8 cases.
Hye Sun Kim, Yi Kyeong Chun, Yee Jung Kim, Sung Ran Hong, Hy Sook Kim
Korean J Pathol. 1999;33(3):193-198.
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AbstractAbstract PDF
Pseudoangiomatous stromal hyperplasia (PASH) of the breast occurs in premenopausal women and is characterized by anastomosing channels lined by spindle cells. It has been suggested to be of hormonal origin. This unusual condition may also be mistaken for a vascular tumor. We analyzed eight cases of PASH of the breast in Samsung Cheil Hospital from 1992 through 1998. All patients were premenopausal and had painless breast lump. Clinical diagnoses were fibroadenomas. Grossly, the masses were well circumscribed, nonhemorrhagic and measure 2.2 to 5 cm. Histologically, they consisted of complex interanastomosing channels lined by slender spindle cells, which resembled low grade angiosarcoma. Cells that line the interanastomosing channels showed no immunoreactivity for Factor VIII and electron microscopic findings consistent with fibroblast. All patients were treated with surgical excision and none of them had recurrence for 1 to 69 months (mean: 19 months) postoperatively. Pathologic diagnosis of PASH may be difficult unless the pathologists are aware of the presence of a mass lesion and appreciate the characteristic stromal changes. PASH should be included in the differential diagnosis of a circumscribed mass, especially in the premenopausal women.
Case Reports
Hamartoma of the Breast A report of two cases.
Sung Suk Paeng, In Ae Park, Woo Kyoung Moon, Dong Young Noh, Eui Keun Ham
Korean J Pathol. 1999;33(3):199-203.
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Hamartoma of the breast is a rare benign lesion presenting as palpable mass. They are, however, sometimes misdiagnosed by pathologist due to their resemblance to other benign or physiologic conditions of the breast. We report two cases of hamartomas of the breast. The clinical diagnosis was fibroadenoma in both cases. One patient was a 49-year-old woman presented with palpable mass for the duration of 5 months. Mammography showed a well demarcated round mass with homogeneous density which is slightly greater than the surrounding glandular tissue. Grossly it was a 3.5 3.0 2.0 cm sized round firm mass covered by thin fibrous tissue. Microscopically it was a well defined mass composed of variable amount of breast lobules, dilated ducts and adipose tissue surrounded by dense hyalinized connective tissue. The adipose tissue accounted for 30% of the entire lesion. Cellular atypism was not found. The other patient was a 18-year-old woman presented with palpable mass of the duration of 3 years, which was increased in size recently. Mammography demonstratesd a well delimited lobulated mass with lucent halo. Ultrasonography showed a well encapsulated low echoic mass admixed with high echoic areas. Grossly, it was a 4.0 4.0 2.0 cm sized well demarcated oval-shaped firm mass with translucent thin fibrous capsule.. Microscopic findings were similar to the former. The amount of adipose tissue was 20%.
Small Cell Osteosarcoma Similar to Ewing's Sarcoma in Histologic Findings and MIC2 Expression: A case report.
Yoon Mee Kim, Suk Woo Yang, Mee Yon Cho, Soon Won Hong, Byung Ho Choi
Korean J Pathol. 1999;33(3):204-209.
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Small cell osteosarcoma is a rare form of osteosarcoma and the histological differential diagnosis from other small round cell tumors (SRCTs) is difficult. The immunohistochemical stain for MIC2 has been considered an useful diagnostic marker for Ewing's sarcoma and primitive neuroectodermal tumors but recently, other SRCTs such as malignant lymphoma and embryonal rhabdomyosarcoma also showed positive reaction. Therefore, the usefulness of MIC2 must still be proven. We experienced a case of small cell osteosarcoma of the mandible in a 25-year-old man. Histologically, the tumor consisted of small round cells that resembled those of Ewing's sarcoma. Immunohistochemically, the tumor cells expressed diffuse strong positive reaction for MIC2 gene products. However, the scanty foci of lacy osteoid material between the tumor cells seemed to be diagnostic of osteosarcoma. The histologic and immunohistochemical findings of this case suggest close relationship between small cell osteosarcoma and Ewing's sarcoma.
Localized Cystic Disease of the Kidney: A case report.
Wan Seop Kim, Moon Hyang Park
Korean J Pathol. 1999;33(3):210-213.
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Localized cystic disease of the kidney is a rare entity with the gross and microscopic features of autosomal dominant polycystic kidney disease localized to only a portion of a kidney, and negative family history. We report a case of localized cystic disease of the kidney in a 38-year-old woman who complained of intermittent right flank pain for 1 year. The resected kidney showed multiple cysts measuring up to 4.0 3.5 3.0 cm, which were scattered throughout the mid- and lower poles of the kidney. Microscopically, the cystic lesion was composed of numerous cysts of variable size, lined by flattened epithelium. The intervening septa of the cysts contained normal or compressed renal tubules and glomeruli. Neither dysgenetic tissue such as immature cartilage or primitive mesenchymal tissue nor malignant cells was identified. Localized cystic disease should be included in the differential diagnosis of cystic lesions in the kidney.
Placental Metastais of Maternal Gastric Adenocarcinoma: A case report.
Hye Seung Lee, Young Ah Kim, Chong Jai Kim, Je Geun Chi
Korean J Pathol. 1999;33(3):214-216.
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Metastasis of a maternal neoplasm to the products of conception is extremely rare. About 50% of the reported cases were not examined grossly or had no grossly visible tumor deposit. A case of placental micrometastasis of gastric adenocarcinoma in a 28-year-old woman is presented. Artificial termination was performed in 22 weeks of gestation and a female fetus weighing 440 gm was delivered. The placenta weighed 220 gm and was grossly normal. Microscopic examination revealed a small number of micrometastasis scattered in the intervillous space.
Ovarian Mucinous Cystadenocarcinoma with Mural Nodules of Anaplastic Carcinoma: A case report.
Kyu Yun Jang, Woo Sung Moon, Dong Geun Lee
Korean J Pathol. 1999;33(3):217-220.
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A case of an ovarian mucinous cystadenocarcinoma with mural nodules of anaplastic carcinoma is reported. The patient was a 46-year-old female with a right ovarian cystic mass and underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy. The patient died of the disease in five months. Macroscopically, the right ovarian cyst wall contained numerous well-demarcated mural nodules. Histologically, the cysts were mucinous cystadenocarcinoma, and the nodules were composed of sarcoma-like spindle and polygonal cells with atypia and numerous mitoses. Spindle cells in the mural nodule showed epithelial characteristics by electron microscopy and immunohistochemistry. This case supports an epithelial origin of the mural nodule of anaplastic carcinoma in ovarian mucinous tumors.
Carcinosarcoma in Recurrent Lesion of Serous Cystadenocarcinoma of the Ovary: A case report.
Kyu Yun Jang, Woo Sung Moon, Dong Geun Lee
Korean J Pathol. 1999;33(3):221-224.
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Neoplasms showing both carcinomatous and sarcomatous features are well established, and have been reported in practically every organ where carcinoma can occur. But the difference in terminology and difficulties in histopathologic interpretation have hampered adequate understanding of these neoplasms. We report a case of carcinosarcoma in the recurrent form of serous cystadenocarcinoma of the ovary. The patient was a 64-year-old female who underwent total hysterectomy and bilateral salpingoophorectomy three years ago, due to perforated papillary serous cysta denocarcinoma of the right ovary. Recurrent pelvic masses contained both carcinomatous and sarcomatous components. Morphological transition between carcinomatous and sarcomatous components, and epithelial characteristics in the sarcomatous component by immunohistochemistry were recognized. We postulate the histopathogenetic mechanism based on the phenotypic conversion of carcinoma into sarcoma in the carcinosarcoma.
Nasal Chondromesenchymal Hamartoma: A case report.
Hyo Jeong Chae, Ji Hye Suk, Sun Kyung Lee
Korean J Pathol. 1999;33(3):225-227.
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Nasal chondromesenchymal hamartoma is a distinctive mixed mesenchymal lesion of sinonasal region with a complex histologic appearance and benign clinical course and clinicopathologically similar to those of the mesenchymal hamartoma of the chest wall of infancy. We report a case of nasal chondromesenchymal hamartoma occurred in the right nasal cavity in a 3-month-old female. She was admitted with a history of profuse nasal bleeding and obstruction. CT revealed complex solid and cystic mass, measuring 3.5x2.5x2.5 cm in dimensions which filled the right nasal cavity and extended into ethmoid sinus and cribriform plate. The received piecemeal fragments of tissue were brown tan-colored firm semitranslucent tissue with a cartilaginous appearance. Microscopically, the basic morphologic elements were irregular islands of hyaline cartilage and myxoid to spindle cell stroma with various cellularity.

JPTM : Journal of Pathology and Translational Medicine