Journal of Pathology and Translational Medicine

Volume 41(5); October 2007

Original Articles

Clinicopathologic Analysis of Lymphocytic Gastritis.: Jeong Eun Hwang, Young Ok Hong, Dong Eun Song, Se Jin Jang, Eunsil Yu; Korean J Pathol. 2007;41(5):289-295.

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Abstract PDF: BACKGROUND
Lymphocytic gastritis (LG) is defined as an infiltration of more than 25 intraepithelial lymphocytes (IELs) per 100 surface epithelial cells, and the histological differential diagnosis of LG and residual mucosa associated lymphoid tissue (MALT) lymphoma can be difficult. Helicobacter pylori (H. pylori) is regarded as one of the possible causes of LG, but its clinicopathologic features of LG have not been clarified in Korea, which has a much higher prevalence of H. pylori infection than Western countries. We analyzed the clinicopathologic findings of LG in Korean patients and compared the cytologic findings of IELs of LG with those of MALT lymphoma.
METHODS
Sixty six cases of LG and 59 cases of MALT lymphoma were selected and clinicopathologic features were analyzed.
RESULTS
Eighteen cases (27.3%) of LG were found to be associated with H. pylori infection. The IELs in LG were found to diffusely and regularly infiltrate in the epithelium, but MALT lymphoma showed patchy IELs. IELs in LG and MALT lymphoma were CD 8+T lymphocytes and CD20+B lymphocytes, respectively. The mean nuclear size of IELs in LG was 4.37 micrometer, which was significantly smaller than those in MALT lymphoma (5.19 micrometer).
CONCLUSION
LG, a rare variant of chronic gastritis is partly associated with H. pylori infection and more complex unknown causative factors. In addition to the immunophenotyping, the nuclear sizes of IELs can be helpful in the differential diagnosis of LG and residual MALT lymphoma.

The Expression of c-erbB-2, EGFR, p53 and Ki-67 in Ovarian Borderline Tumors and Carcinomas of the Ovary.: Kyueng Whan Min, Moon Hyang Park; Korean J Pathol. 2007;41(5):296-306.

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Abstract PDF: BACKGROUND
An ovarian surface epithelial tumor is a heterogenous disease, and various biological and molecular factors are important for its development and progression. Several findings support EGFR or c-erbB-2 as adverse prognostic indicators for an ovarian carcinoma.
METHODS
We reviewed the histological and clinical findings of 52 carcinomas (17 endometrioid, 16 serous, 13 mucinous and 6 clear cell tumors), and 26 borderline (10 serous and 16 mucinous) tumors. Expression of c-erbB-2, EGFR, p53, and Ki-67 was evaluated on paraffinembedded tissue from a primary ovarian tumor by immunohistochemical methods.
RESULTS
Expression of c-erbB-2 was found in 7.6% of tumors and expression of EGFR was found in 9.6% of tumors by immunohistochemical analysis. No significance was found between cerbB- 2 and EGFR expression as indicators of a poor prognosis. The expression of p53 and Ki-67 (>50%) correlated with the grade and type of tumor in the ovarian cancers. p53 and Ki- 67 overexpression (>50%) was absent in the borderline ovarian tumors, whereas ovarian carcinomas showed expression of both p53 and Ki-67.
CONCLUSION
Expression of c-erbB- 2, EGFR, p53, and Ki-67 as determined by immunohistochemical analysis did not correlate with prognostic significance. However, p53 and Ki-67 expression may be used as markers to predict aggressive behavior, and to differentiate between malignant and borderline epithelial ovarian tumors. Further large-scale studies are required to clarify the significance of c-erbB-2 and EGFR expression in ovarian tumors.

Genetic Expression Pattern of Gastric Carcinomas According to Cellular Mucin Phenotypes.: Won Ae Lee, In Soo Suh, Ying Hua Li, Ji Hyun Eum, Wan Sik Yu, Han Ik Bae; Korean J Pathol. 2007;41(5):307-315.

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Abstract PDF: BACKGROUND
Gastric carcinomas (GCs) have recently been reclassified according to the mucin phenotypes. We aimed to characterize the relationship between the mucin phenotypes and the genetic alterations or the clinicopathologic parameters of GCs.
METHODS
Immunohistochemistry was performed for MUC1, MUC5AC, MUC6, MUC2, CD10, p53, hMLH1, CerbB2 and E-cadherin in 150 GCs. The mucin phenotypes of the GCs were classified as 4 phenotypes: gastric, intestinal, mixed and unclassified.
RESULTS
MUC1, MUC5AC, MUC6, MUC2 and CD10 were expressed in 63.3%, 42.7%, 14.0%, 24.7% and 14.0% of the GCs, respectively. The mucin phenotypes of the GCs corresponded to the gastric type in 31.3%, the intestinal type in 20.0%, the mixed type in 15.3% and the unclassified type in 33.3%. The incidence of a p53 overexpression was higher in the gastric or mixed phenotype than in the intestinal or unclassified phenotype. MUC5AC expression, p53 overexpression and the gastric or mixed phenotype were associated with poor patient survival by multivariate analysis.
CONCLUSION
This study suggests the gastric or mixed mucin phenotype may more likely go through the p53 pathway in carcinogenesis and the mucin phenotype may be considered as a prognostic indicator.

Epidermal Growth Factor Receptor Overexpression and the Tumor Response to Preoperative Radiochemotherapy for Patients with Advanced Rectal Cancer.: Jinyoung Yoo, Ju Won Chyung, Ji Han Jung, Hyun Joo Choi, Seok Jin Kang, Kyo Young Lee; Korean J Pathol. 2007;41(5):316-323.

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Abstract PDF: BACKGROUND
An association between the epidermal growth factor receptor (EGFR) signaling pathway and the response of cancer cells to ionizing radiation has been previously described. Preoperative radiochemotherapy (PRCT) has been administered for treating locally advanced rectal cancer to improve the outcomes, and to preserve the sphincter from lowlying tumor. However, the responses of tumors to PRCT are variable and there are currently no reliable markers that predict the therapeutic benefits. We studied the association between EGFR overexpression and the tumor response to PRCT in rectal cancer.
METHODS
The EGFR protein expression, as determined by immunohistochemistry, was analyzed in the pretreatment biopsy specimens from 120 patients with advanced rectal cancer. The tumor response was graded in the surgically resected specimens by using a three-scale grading system: no response (NR), partial remission (PR) and complete remission (CR).
RESULTS
NR was identified in 70 cases (58.3%). Fifty patients (41.7%) responded to PRCT; 27 (22.5%) achieved a PR and 23 (19.2%) achieved a CR. EGFR overexpression was detected in 78 (65%) cases. Seventy-eight percent (39/50) of the tumors with a CR/PR revealed EGFR reactivity, whereas 55.7% (39/70) of the tumors with NR showed an EGFR expression (p=0.048).
CONCLUSIONS
The EGFR protein expression might be a valuable marker for identifying those patients who are most likely to benefit from PRCT.

Twist Expression in Upper Urinary Tract Urothelial Carcinoma Affects Patients Disease Free Survival and is Associated with Tumor Grade.: Dong Il Kim, Sun Och Yoon, Seog Yun Park, Bomi Kim, Gyeong Hoon Kang, Kyung Chul Moon; Korean J Pathol. 2007;41(5):324-328.

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Abstract PDF: BACKGROUND
Epithelial-mesenchymal transition (EMT) is critical for morphogenesis during embryonic development and is also implicated in the conversion of early-stage tumors into invasive malignancies. Recently, Twist has been identified to play an important role in EMTmediated metastatic progression of several types of human cancer. The present study examined the expression of Twist and evaluated its clinicopathologic significance in urothelial carcinoma of upper urinary tract.
METHODS
Immunohistochemical staining for Twist expression was performed on 70 upper urinary tract urothelial carcinomas (UUT-UCs) using tissue microarray.
RESULTS
Immunohistochemical staining for Twist was positive in 31/70 cases (44.3%) of UUT-UCs. Twist expression was associated with high-grade and advanced-stage (ISUP grade, p<0.01; stage, p=0.045). The patients with Twist positive-tumors revealed lower disease free survival rate than those with Twist negative-tumors (p<0.01). The overall survival for patients with Twist positive-tumors was slightly worse than the patients with Twist negative- tumors, but the difference was not statistically significant (p=0.12).
CONCLUSION
Our results suggest that Twist is a novel marker for advanced UUT-UC.

Case Reports

Adrenocortical Oncocytoma: A Case Report.: Hun Soo Kim, Dae Young Kang; Korean J Pathol. 2007;41(5):329-333.

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Abstract PDF: Adrenocortical oncocytomas have rarely been reported on in the medical literature, and most of them have been nonfunctional and benign. We report here on a case of a 43-year-old man with a left abdominal mass. The patient showed no signs of hypertension or hormonal imbalance. The abdominal CT scans showed a huge mass that measured 11 cm in diameter, and it was located at the left adrenal area. Grossly, the tumor was well encapsulated and homogenous with central necrosis. Microscopically, the tumor was composed of oncocytes with abundant granular cytoplasm. Immunohistochemically, these cells were diffusely positive for cytokeratin and focally positive for synaptophysin and NSE. The ultrastructural studies showed numerous mitochondria in the cytoplasm. We will discuss the criteria that indicates malignancy as presented by Weiss et al. and we summarize the difference between conventional and oncocytic adrenocortical neoplasm. This case showed some features of malignancy based on the criteria presented by Weiss et al.

Diffuse Ganglioneuromatosis of Appendix associated with Von Recklinghausen;s Disease.: Young Su Kim, Sang Chul Nam, Man Hoon Han, Jeong Shik Kim, Ji Yun Jeong, Han Ik Bae; Korean J Pathol. 2007;41(5):334-336.

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Abstract PDF: Gastrointestinal ganglioneuromatosis is a rare neoplastic condition that can occur in association with von Recklinghausen's disease with multiple endocrine neoplasia type II B. The main locations are the ileum, colon, and appendix. We report a case of diffuse ganglioneuromatosis of the appendix associated with a mesenteric and ileocecal plexiform neurofibroma in von Recklinghausen's disease.

Multiple Glomus Tumors of the Ankle with Prominent Intranuclear Pseudoinclusions.: Jae Yeon Seok, Se Hoon Kim, Tae jung Kwon, Jieun Kwon, Yoon Hee Lee, Kyoo Ho Shin, Woo Ick Yang; Korean J Pathol. 2007;41(5):337-342.

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Abstract PDF: Glomus tumors are neoplasms that are composed of modified smooth muscle cells of the glomus body. Here, we report a case of multiple glomus tumors of the ankle that showed various histologic types, including the solid type (glomus tumor proper) and angiomatous type (glomangioma). The tumor cells observed in this case also showed prominent intranuclear inclusions, which has not yet been reported in glomus tumors. Ultrastructural examination demonstrated that the nuclear inclusions were not true inclusion bodies but were intranuclear cytoplasmic pseudoinclusions formed by cytoplasmic invaginations that formed as a result of the deep and complex nuclear contours.

Two Cases of Strongyloidiasis Diagnosed by Colonoscopic Biopsy.: Sang Chul Nam, Man Hoon Han, Young Su Kim, Yoon Seup Kum, In Soo Suh, Han Ik Bae; Korean J Pathol. 2007;41(5):343-346.

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Abstract PDF: Strongyloides stercoralis is an intestinal nematode that is able to infect the host tissue and persist for many years through autoinfection, and it causes life-threatening hyperinfection in immunocompromised hosts. We report here on two cases of strongyloidiasis that were diagnosed by colonoscopic biopsy. One case was a 73-year-old woman who was hospitalized with complaints of melena. She was being treated with corticosteroid due to her asthma and rheumatoid arthritis. The other case was a 63-year-old man who suffered with abdominal discomfort and severe loss of body weight (18 kg) for 2 months. In both cases, colonoscopic examination revealed polyps and petechiae at the entire colon. Microscopically, a small illdefined granuloma with a longitudinally sectioned parasite was seen on the colonoscopic biopsy. Endoscopic examination was done after suspecting parasitic infestation. The gastric and duodenal mucosa showed numerous cross sections of adult worms, eggs and larvae that were developing in crypts. Even if such a patient is in an asymptomatic state, this illness must be treated due to the potential for fatal autoinfection.

Uterus-Like Mass with Features of an Extrauterine Adenomyoma: A Case Report and Literature Review.: Mi Jin Kim, Sang Hee Seok; Korean J Pathol. 2007;41(5):347-351.

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Abstract PDF: Uterus-like masses, such as cavities lined by endometrium-type mucosa surrounded by bundles of smooth muscle cells, may strikingly resemble the uterus. In this report, we describe a case of a uterus-like mass with features of an extrauterine adenomyoma in a 42-year-old woman. The first uterine-like mass was documented by Cozzutto in 1981 and to date, 13 such cases have been reported. Three theories have been offered to explain their etiology: 1) the uterine/Mullerian duct fusion defect theory, which is based on a developmental abnormality occurring during the formation of the female genital tract, 2) the metaplastic theory, which is based on the fact that a uterus-like mass may arise from subperitoneal mesenchymal cells that retain the ability to duplicate Mullerian duct structures, and 3) the heterotopia theory. We consider that the metaplastic theory best fits with our observations in the present case as both glandular and stromal smooth muscle cells proliferated as a true neoplasm rather than as an anomaly.

Adenocarcinoma with Yolk Sac Tumor of the Stomach: Case Report with Review of the Literature and an Immunohistochemical Study.: Ran Hong, Chae Hong Suh, Mi Ja Lee; Korean J Pathol. 2007;41(5):352-357.

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Abstract PDF: Gastric yolk sac tumors are extremely rare with only a few cases reported in the literature. Here, we present the case of a 50-year-old man with an adenocarcinoma and a yolk sac tumor of the stomach, without metastasis to the lymph nodes. The tumor was an early gastric carcinoma confined to the submucosa. Twelve months post-operation the patient was alive with no complications. The yolk sac tumor showed positive labeling for alpha-fetoprotein (AFP), alpha1-antitrypsin (alpha1-AT), cytokeratin (CK) and carcinoembryonic antigen (CEA), but was negative for human chorionic gonadotrophin (hCG), placental alkaline phosphatase (PLAP), epithelial membrane antigen (EMA) and p53. The adenocarcinoma was positive for alpha1-AT, CK, EMA, and CEA, but was negative for AFP, hCG, PLAP, and p53. These findings suggest that the yolk sac tumor and the adenocarcinoma components are closely related and may represent distinct phenotypes that arise from a common mucosal epithelial cell.

Progressive Multifocal Leukoencephalopathy in the Immunocompromised Patients - 3 Cases Report.: Min Keun Shim, Jo Heon Kim, Chang Soo Park, Hyung Seok Kim, Yoo Duk Choi, Min Cheol Lee; Korean J Pathol. 2007;41(5):358-361.

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Abstract PDF: Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease resulting from infection of oligodendrocytes with JC virus. PML was a rare disease, but nowadays not uncommon as AIDS prevailed. Histopathologic features of the affected lesion shows infiltrations of foamy macrophages and hyperchromatic, pleomorphic, reactive astrocytes that may raise the suspicion of a brain tumor. We recently met with 3 cases of PML. Two of the patients had AIDS and the other had been treated for lymphoma. All cases were diagnosed by histopathologic examination in stereotactic brain biopsies.

Glial Choristoma of the Middle Ear: A Case Report.: Su Jin Kim, Dae Cheol Kim; Korean J Pathol. 2007;41(5):362-365.

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Abstract PDF: Glial choristoma is defined as a mass that is composed of mature, normal brain tissue, isolated from the cranial cavity or spinal canal. The involvement of an extracranial non-midline location, especially the middle ear or mastoid region, is quite exceptional. We report here on a case of glial choristoma of the middle ear in a 2-year-old boy. He presented with otalgia and otorrhea that had lasted for 6 months, and radiological studies revealed a mass-like lesion with soft tissue density in the middle ear cavity. The patient underwent simple mastoidectomy and tympanoplasty. Histologically, the mass was composed of disorganized but mature, normal glial tissue with immunoreactivity for glial fibrillary acidic protein. The patient had no previous history of head trauma or surgery, and no evidence of central nervous system connection was noted on the radiological or operative findings. This mass was regarded as a primary glial heterotopia rather than an acquired encephalocele.

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