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Volume 36(3); June 2002
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Original Articles
Neoplastic Diseases of the Hematopoietic and Lymphoid Tissues: New World Health Organization Classification.
Woo Ick Yang
Korean J Pathol. 2002;36(3):137-145.
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AbstractAbstract PDF
Encouraged by the success of the Revised European American Classification of Lymphoid Neoplasms (REAL) which was published in 1994 by th International Lymphoma Study Group (ILSG), the European Association of Pathologists and the Society for Hematopathology have started a collaborative classification project in 1995 under the auspices of World Health Organization (WHO). The two collaborators employed the same consensus building process used by ILSG for the REAL to the classification of myeloid, histocytic/dendritic, and mast cell neoplasms and listed real biologic entities defined by morphologic, immunophenotypic, cytogenetic, and and clinical findings. In contrast to the REAL, Clinical Advisory Committee composed of expert hematologists and oncologists evaluated the clinical relevance of the classification scheme proposed by the pathologists before the publication of new WHO classification of hematologic malignancies. While the classification of lymphoid neoplasms contained minor changes compared with the REAL, there were major changes in the classification system of myeloid neoplasms compared with the previously used French-American-British (FAB) classification. The new WHO classification of hematologic malignancies, published last year, is a product of the first true worldwide consensus among leading pathologists and clinicians alike, and it overcomes the drawbacksof old fashioned classification schemes; therefore, we can expect progress in the understanding and treatment of hematologic malignancies.
Expression of Cytokeratin 7 and 20 According to The Anatomical Location of Colon Cancer and The Differential Diagnosis with Cholangiocarcinoma.
Yoon Kyung Jeon, Sun Lee, Byoung Kwon Kim, Woo Ho Kim, Gyeong Hoon Kang
Korean J Pathol. 2002;36(3):146-153.
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AbstractAbstract PDF
BACKGROUND
Colonic adenocarcinoma usually shows CK7 negativity and CK20 positivity, which helps to differentiate it from cholangiocarcinoma usually showing a reverse immunohistochemical profile. We immunohistochemically investigated the pattern of CK7 and 20 expressions according to the anatomical location of colon cancer to refine the usefulness of CK expression in differential diagnosis.
METHODS
Immunohistochemical staining was done on 90 cases of surgically resected colon cancers and 84 cases of cholangiocarcinomas.
RESULTS
When the cases of colon cancer were divided into CATD (from the cecum to the descending colon) (32), sigmoid (26), and rectum (32), the positivity of CK7 was 41%, 15% and 28%, respectively, and the negativity of CK20 was 25%, 0 and 9% (p=0.013), respectively. In sigmoid colon cancers, 22 cases (85%) exhibited CK7-/CK20+ immunophenotype. However, the percentage decreased to 63% in the rectum and 47% in CATD. The CK7+/CK20- immunophenotype was found only in cancers in the cecum and ascending colon. The expression of CK7 was related to histologic differentiation (p=0.017).
CONCLUSIONS
The aberrant expressions of CKs were frequent in cancers of the rectum and ascending colon which are located in the transition site from the anus and small bowel, respectively. If adenocarcinoma in the liver were CK7+/CK20+ or CK7-/CK20-, the possibility of metastatic adenocarcinoma from CATD and rectum should be considered.
Study on Creating A Classifier for Grading of Bladder Carcinoma Based on Computerized Method.
Hyun Ju Choi, Hye Kyoung Yoon, Heung Kook Choi
Korean J Pathol. 2002;36(3):154-162.
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AbstractAbstract PDF
BACKGROUND
We have described an objective and reproducible classification method for grading malignancy in the Feulgen stained bladder carcinoma. To create an optimized classifier for malignancy grading of histological bladder carcinoma cell images, it is necessary to extract the features that accurately describle the order/disorder of the nuclear variation and to evaluate the significance of the features. Above all, features selection considered about the correlation of features is very important, because the performance of the classification method depends on the selected features.
METHODS
First, we acquired 40 representative histological bladder carcinoma cell images from each of four groups (Grade 1, Grade 2A, Grade 2B, Grade 3) and extracted morphology features, texture features and the texture features of wavelet transformed images. Second, we evaluated the significance of the extracted features using variance analysis. Third, we created classifiers for each selected feature and its combination set using discriminant analysis. Finally, we compared and analyzed the correct classification rate of each classifer.
RESULTS
The optimized classifier was created from the combination of morphology features, texture features and the texture features of wavelet transformed images.
CONCLUSIONS
We found that the correlation of features is more important than one feature's great significance in grading the malignancy of bladder carcinoma, and we have confirmed that the correct classification rate is determined by feature extractin, feature evaluation and feature selection.
Usefulness of Frozen Section Examination of Core Needle Biopsy in the Breast Carcinoma.
Yee Jeong Kim, Yi Kyeong Chun, Sung Ran Hong, Hy Sook Kim, Sung Su Kang, Ji Hyun Lee, Sung Kong Lee, Hye Sun Kim
Korean J Pathol. 2002;36(3):163-166.
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AbstractAbstract PDF
BACKGROUND
Core needle biopsy (CNB) is widely used as the initial sampling method for breast cancer. And because frozen section (FS) diagnosis is rapid and reliable, we studied the diagnostic agreement between the diagnosis of FS of CNB and final diagnosis after surgery to evaluate the diagnostic accuracy of the FS of CNB.
METHODS
Of 409 patients who were preoperatively diagnosed by FS of CNB and who underwent final surgery from 1996 through 2000, 24 cases were found to be ductal carcinoma in situ (DCIS) and 385 cases invasive carcinoma (IC). The diagnoses of FS of CNB were compared with final diagnoses.
RESULTS
The diagnostic accuracy of carcinoma is 63.6% for DCIS and 86.9% for invasive carcinoma. Five cases (1.2%) could not be diagnosed because of material insufficiency for diagnosis. Twenty two cases (5.4%) were diagnosed as benign on FS, among which 20 (90.9%) were misdiagnosed by sampling error. Twenty seven cases (6.7%) were deferred on FS, 4 of these cases were DCIS, 5 were invasive lobular carcinoma (ILC), the rest displayed low nuclear grades or marked freezing artifacts.
CONCLUSIONS
The diagnostic accuracy of FS of CNB is very high except for cases of ILC and low grade DCIS. Considering the advantage of rapid evaluation, more definitive diagnosis, familiarity by pathologists and availability of ancillary study, FS of CNB is very useful method as the preoperative evaluation.
Ganglion Cell Tumors.
Sung Hye Park, Harry V Vinters
Korean J Pathol. 2002;36(3):167-174.
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AbstractAbstract PDF
BACKGROUND
In ganglion cell tumos, immunohistochemical characteristics and malignant changes of neuronal cells and the usefulness of the MIB-1 (Ki67) indices for granding ganglion cell tumors and abnormalities of the adjacent nonneoplastic cortex have been issued.
METHODS
The clinicopathologic features of 34 surgically resected ganglion cell tumors (32 gangliogliomas and 2 gangliocytomas) were retrospectively analysed, and immunohistochemical characteristics and malignant changes of neuronal cells and the usefulness of the MIB-1 (Ki67) indices for grading ganglion cell tumors and abnormalities of the adjacent normal cortex were investigated using various immunohistochemical studies.
RESULTS
According to the Daumas-Duport grading system, there were 24 (70.6%) grade II, 8 (23.5%) grade III, and two (5.9%) grade IV cases. Malignant transformation was present only in the glial (7 cases) or both glial and neuronal (3 cases) components. The MIB-1 indices were statistically significant (p<0.001): grade II was 0.0-1.05% (0.27+/-0.3%), grade III was 0.8-8.02% (2.8+/-3.2%), and grade IV was 3.0-4.99% (3.99+/-1.0). Anaplasia and MIB-1 positivity was observed among the neurons in the three cases. Perikaryal cytoplasmic expression or surface punctate accentuation of synaptophysin were noted only in the neoplastic neurons in some cases. Fifteen out of 20 cases, which included the nonneoplastic cerebral cortex, displayed mild cortical dysplasia (microdysgenesis).
CONCLUSIONS
The neuronal component also showed malignant transformations with proliferating activity. In our study, synaptophysin-immunoreactive patterns of neoplastic neurons were unique. The MIB-1 indices were helpful for grading ganglion cell tumos. Only mild cortical dysplasia was present in the normal cortex adjacent to the tumor.
Case Reports
Bronchoalveolar Lavage (BAL) Cytology and Ultrastructural Findings in a Patient with Amiodarone-Induced Pulmonary Toxicity: A Case Report.
Sun Lee, Min A Kim, Young Soo Shim, Chun Taek Lee, Je G Chi, Doo Hyun Chung
Korean J Pathol. 2002;36(3):175-178.
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AbstractAbstract PDF
Amiodarone is a potent antiarrhythmic agent and can cause potentially life-threatening pulmonary fibrosis. Of the numerous side effects associated with amiodarone therapy, lugn toxicity is one of the most serious adverse reactions. Recently, we experienced a case of amiodarone-induced pulmonary toxicity (APT), which induced severe dyspnea and productive coughing, confirmed by cytologic and electron microscopic examination of the bronchoalveolar lavage (BAL). The symptoms and abnormalities in the chest X-ray were improved after the withdrawal of amiodarone. Cytologic examination of the BAL revealed numerous foam cells with cytoplasmic vacuoles or small particles. Ultrastructurally, the foam cells demonstrated characteristic lysosomal inclusions, which were electron-dense multilamellated bodies, crystalloid bodies, and mixed forms with small lipid vacuoles. It is strongly suggested that only cytologic and electron microscopic examination of the BAL without open lung biopsy is enough for diagnosis of APT, when APT is clinically suspected in a patient who has a history or ingestation of amiodarone.
Malignant Peripheral Nerve Sheath Tumor in Descending Colon: A Case Report.
Young S Park, Sung Jing Lim, Woo Ho Kim, Eui Keun Ham
Korean J Pathol. 2002;36(3):179-183.
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AbstractAbstract PDF
We report a unique case of malignant peripheral nerve sheath tumor (MPNST) of colon, not associated with neurofibromatosis or parasite infection. The tumor presented as an encircling mass in descending colon causing obstruction with nuberous metastatic lesions in a 43-year-old man. The tumor was largely composed of spindle cells which showed strong positivity for vimemtin, S-100 protein and Leu-7. The tumor often exhibited epithelioid feature where tumor cells were weakly positive for cytokeratin.
Multiple Pancreatic Islet Cell Tumors with Diverse Hormonal Expression in a Multiple Endocrine Neoplasia Type I Patient: A Case Report.
Jang Han Kim, Kuhn Uk Lee, Woo Ho Kim, Yong Il Kim
Korean J Pathol. 2002;36(3):184-186.
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AbstractAbstract PDF
Multiple endocrine neoplasia type I is characterized by multiple tumors, particularly in the parathyroid glands, the pituitary gland and the pancreatic islet. We observed multiple pancreatic islet cell tumors with diverse hormonal expression in a MEN-I patient. The patient suffered from protracted diarrhea and multiple gastrododuodenal ulcers for 10 years. In abdominal computed tomography, space occupying lesions were detected in the distal pancreas. Distal pancreatectomy was done. Three tumors that measured 2.0 X 1.0 cm (A), 1.0 X 1.0 cm (B), and 1.0 X 0.5 cm (C) were discovered. Microscopic examination revealed another tumor, 1.0 X 0.5 cm (D). Microadenomas, less than 0.5 cm, were also found throughout the pancreas. Immunohistochemical stainings for insulin, pancreatic polypeptide, gastrin, glucagon, somatostain, and chromogranin were performed. Tumor A was trabecular and acinar in form and showed weak cytoplasmic reactivity to insulin. Tumor B was a gyriform and a few cells showed cytoplasmic reactivity to pancreatic polypeptide. Tumor C was trabecular in form and showed cytoplasmic reactivity to chromogranin. Direct invasion and distant metastasis were not found.
Teratoid Wilms' Tumor: A Case Report.
Seong Rim Kim, Sang Yong Song, Yeon Lim Suh, Ki Woong Sung, Suk Koo Lee
Korean J Pathol. 2002;36(3):187-190.
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AbstractAbstract PDF
Teratoid Wilms' tumor is a rare renal tumor. Fourteen cases have been reported. A 14-month-old girl was presented to us. She had a right renal mass which was diagnosed as a Wilms' tumor in another hospital. She had been treated with chemotherapy but failed to respond to it. The nephrectomy specimen revealed an encapsulated mass of which the cut surface was solid, firm, gray to yellow tan. Microscopically, the stromal elements were predominant, especially comparing with few blastemal element, but the degree of heterologous differentiation was sufficient to warrant the diagnosis of teratoid Wilms' tumor.
Primary Leiomyosarcoma of Adrenal Gland: A Case Report.
Heejeong Lee, Jinyoung Yoo, Seok Jin Kang, Byung Kee Kim
Korean J Pathol. 2002;36(3):191-194.
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AbstractAbstract PDF
Primary mesenchymal neoplasm of the adrenal gland is very rare. Recently we experienced a case of leiomyosarcoma of the adrenal gland in a 47-year-old female patient. The resected adrenal gland showed a large lobulated mass, which replaced the entire gland. The cut surface was firm and whitish gray with foci that showed hemorrhage and necrosis. Histologically, the tumor was composed of intersecting fascicles of pleomorphic spindle cells with numerous giant cells and mitotic figures. Some of the tumor cells showed elongated nuclei. Immunohistochemical studies were strongly positive for vimentin and smooth muscle actin. Cytokeratin, desmin, alpha-1-antitrypsin and lysozyme were all negative. To the best of our knowledge, this is the first case reported in Korea.
Pleomorphic Hyalinizing Angiectatic Tumor of Soft Parts: A Case Report.
Young Chae Chu, Sun Keun Choi, In Suh Park, Hye Seung Han, Jee Young Han, Joon Mee Kim
Korean J Pathol. 2002;36(3):195-198.
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AbstractAbstract PDF
A case of rare pleomorphic hyalinizing angiectatic tumor (PHAT) of soft parts is reported. A 35-year-old woman presented with a subcutaneous solid mass in the left inguinal area, which had been present for 3 months, was presented to us. The tumor was histologically characterized by sheets of mitotically inactive oval and pleomorphic cells, mono-and multinucleated giant cells, intranuclear cytoplasmic inclusions, and prominent clusters of thinwalled ectatic vessels with perivascular hyalinization. A focal hemangiopericytoma-like vascular pattern, pseudovascular spaces, stromal collagen with degenerative change and abundant mast cells were observed. The tumor cells were reactive for vimentin and CD34. This tumor shared several features with malignant fibrous histiocytoma, ancient schwannoma, giant cell angiofibroma, giant cell fibroblastoma and solitary fibrous tumor. The patient was well with no evidence of disease for 10 months.

JPTM : Journal of Pathology and Translational Medicine