Journal of Pathology and Translational Medicine

Volume 42(5); October 2008

Original Articles

Expression Pattern of the Cortical Immature Thymocyte Specific Antigen JL1 in Thymomas; a New Adjunctive Diagnostic Marker.: Young Soo Park, Youngji Kim, Yun Hee Lee, Joo Ryung Huh, Chan Sik Park; Korean J Pathol. 2008;42(5):251-259.

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Abstract PDF: BACKGROUND
JL1 is a novel antigen that has been reported to be expressed exclusively in immature CD4 CD8 double positive T-cells in the thymic cortex. Thymomas are often infiltrated with lymphocytes that are mostly immature T-cells. METHODS: We evaluated 67 cases of surgically resected thymomas and reviewed their histological, surgical, and clinical findings. Representative sections were immunostained using anti-JL1 monoclonal antibody and the immunostaining score was evaluated in each case. RESULTS: JL1 was strongly positive in immature T cells infiltrated in various subtypes of thymomas. The mean value of the immunostaining score was 0 for type A, 0.24 for the A areas of type AB, 2.71 for the B areas of type AB, 3 for type B1, 1.87 for type B2, 0.67 for type B3, and 0.13 for type C. The immunostaining score correlated with the histological subtypes according to the WHO classification, and stages according to the modified Masaoka system. CONCLUSION: JL1 was specifically detected in immature thymocytes in thymomas. Therefore, JL1 immunostaining can be useful for subtyping thymomas. JL1 can also serve as an adjunctive marker to diagnose thymomas in small biopsy specimens.

The Expression of C4d and HLA-DR in Renal Allografts with the Histologic Features of Antibody-Mediated Rejection.: Young Soo Song, Moon Hyang Park; Korean J Pathol. 2008;42(5):260-269.

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Abstract PDF: BACKGROUND
Deposition of C4d along the peritubular capillaries is generally associated with an antibody-mediated response. We evaluated, with performing C4d immunostaining, the diagnostic accuracy of the cases that were previously diagnosed as antibody-mediated rejection (ABMR) when based only on the histologic findings, and we examined possible correlation of C4d with HLA-DR.
METHODS
Forty-five renal transplantation biopsies, which showed ABMR-like histology, were obtained. The expressions of C4d and HLA-DR in the transplant rejection cases were investigated using immunofluorescent and/or immunohistochemical staining. RESULTS: There were 14 discordant cases among a total of 45 cases when C4d was used as a diagnostic marker and the original slides were reviewed. These total cases consisted of the C4d negative cases in two cases of hyperacute rejection and all the cases of ABMR and ABMR with chronic/sclerosing allograft nephropathy (CAN) and two C4d positive cases (one each of acute cellular rejection (ACR) and CAN according to their original diagnosis) and all these cases were then revised according to Banff 07. The expression of HLA-DR tended to be correlated with the log-transformed duration of grafts until three years after the transplantation. CONCLUSION: This study demonstrates that C4d together with the histologic findings should be used for making the diagnosis of ABMR. The tubular HLA-DR expression over time should be studied to further understand the mechanism of graft rejection.

Clinical Trial

Prognostic Significance of Ezrin Expression in Liposarcoma.: Jae Seok Lee, Min Sun Jin, Jung Eun Lee, Min Suk Kim, Dae Geun Jeon, Jae Soo Koh; Korean J Pathol. 2008;42(5):270-276.

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Abstract PDF: BACKGROUND
Ezrin has been reported to be involved in the metastasis of solid tumors in both an animal model and clinical trials. However, questions remains as to whether an ezrin expression is an independent predictor of the event-free survival of liposarcoma patients. METHODS: We analyzed 85 liposarcoma patients without metastasis at the time of presentation. We performed immunohistochemistry with anti-ezrin antibody, and we analyzed the association of an ezrin expression with the clinicopathological variables and event-free survival. RESULTS: Twenty-nine patients (34.1%) showed an ezrin expression. Among the 30 low-grade liposarcoma patients, only one patient showed ezrin positivity. The patients who had an ezrin expression were found to be at a significantly increased risk for metastasis compared with the patients who had no ezrin expression (risk ratio: 3.4, 95% confidence interval: 1.3-9.1). The 10-year metastasis-free survival rate was 26.9% for the patients with an ezrin expression and 86.7% for the patients without an ezrin expression. The ezrin expression rate increased with an advanced tumor grade and stage. CONCLUSION: An ezrin expression is an independent predictor of distant metastasis for liposarcoma. Thus, ezrin has the potential to provide additional prognostic information and to be a novel target for the development of new adjuvant therapies for treating the patients who suffer from liposarcoma.

Original Articles

The Immunoexpression of Ki-67, Bcl-2, p53, and Tyrosine Kinase Receptors in Thymic Epithelial Tumors; Their Correlation with the WHO Histologic Subtypes and the Prognostic Value.: Mi Jin Kim; Korean J Pathol. 2008;42(5):277-286.

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Abstract PDF: BACKGROUND
The clinicopathologic features of thymic epithelial tumors are inadequate as predictors of the progression of these tumors because of their heterogeneous histology and varied biological behavior. We attempted to detect the expression of tyrosine kinase receptors and oncogenic markers to determine the correlation between these markers and the WHO classification of the tumors. METHODS: Forty-three surgically resected thymic epithelial tumors (37 thymomas and 6 thymic carcinomas) were immunohistochemically assessed on tissue arrays for c-KIT, her-2/neu, epidermal growth factor receptor (EGFR), p53. bcl-2 and Ki-67.
RESULTS
The Ki-67 labeling index was significantly increased in thymic carcinoma (p<0.05). The overexpression of p53 protein was observed exclusively in type B3 thymoma (67%) and thymic carcinoma (83%). Bcl-2 was expressed in type A and AB thymomas as well as in thymic carcinoma. C-KIT was only present in thymic carcinoma (p<0.05), whereas the EGFR expression was significantly high in all types of thymomas, except for thymic carcinomas. Her-2/neu was not identified in any type of thymoma. CONCLUSION: This study suggests that the Ki-67 LI, bcl-2, p53, c-KIT, and EGFR protein expression may be useful markers for the subclassification of thymic epithelial tumors according to WHO schema and WHO classification correlated with the tumor staging. The overexpression of c-KIT in thymic carcinoma reveals that these patients would likely benefit from an anti-c-KIT treatment.

Expression of Claudin-1, p53 and E-cadherin in Pseudoepitheliomatous Hyperplasia and Squamous Cell Carcinoma of the Head and Neck.: Keum Ha Choi, Jae Hong Lim, Ju Hyung Lee, Keun Sang Kwon, Ho Lee, Ho Sung Park, Myoung Ja Chung, Woo Sung Moon, Jae Soon Eun, Dong Geun Lee, Kyu Yun Jang; Korean J Pathol. 2008;42(5):287-293.

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Abstract PDF: BACKGROUND
Pseudoepitheliomatous hyperplasia (PEH) is a reactive proliferation of surface epithelium and can be confused with invasive squamous cell carcinoma (SCC) in head and neck biopsy specimens. To distinguish PEH from invasive SCC, immunohistochemical staining for claudin-1, E-cadherin and p53 was performed. METHODS: Eighteen cases of PEH and 29 invasive SCC from head and neck lesions were immunostained and examined. RESULTS: The invasive SCC showed increased staining of claudin-1 (p<0.001) and p53 (p<0.001) and decreased staining of E-cadherin (p=0.005) compared to the PEH specimens. The combined score calculated by adding the positive sum of claudin-1 and p53 and subtracting E-cadherin was useful for the differentiation of SCC from PEH (89.7% sensitivity and 88.9% specificity, p<0.001). CONCLUSION: The combined immunostaining for claudin-1, p53 and E-cadherin may help differentiate PEH from invasive SCC. The results of this study suggest that the increased expression of claudin-1 and p53 and the decreased expression of E-cadherin maybe markers for the aggressive growth of invasive SCC.

Expression of p16, Rb and FHIT Proteins in Urothelial Carcinoma of the Urinary Bladder.: Sun Hee Han, Ju Han Lee, Seo Hee Kim, Jungsuk An, Eung Seok Lee, Young Sik Kim; Korean J Pathol. 2008;42(5):294-298.

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Abstract PDF: BACKGROUND
The goal of this study was to investigate the expression of p16, retinoblastoma (Rb) and fragile histidine triad (FHIT) proteins in urothelial carcinomas of the urinary bladder, and to evaluate the relationship between clinicopathlogic parameters and each protein expression level. METHODS: The expression of p16, Rb, and FHIT proteins were studied in 176 patients with urothelial carcinoma of the urinary bladder by immunohistochemistry. RESULTS: The diffuse positive expression of the p16 protein was significantly associated with high grade and advanced tumor depth (p=0.007 and p=0.020). The loss of the Rb protein was significantly associated with old age and disease recurrence (p=0.020 and 0.037). The loss of the FHIT protein was significantly associated with advanced tumor depth (p=0.002). CONCLUSION: Our data suggest that p16 and FHIT proteins may be involved in the progression of urothelial carcinoma. In addition, p16 may be a useful prognostic marker for individual urothelial carcinoma patients.

Age Estimation of Mummies by Dental Attrition: Application of Three-dimensional CT Images.: Kwang Ho Jeong, Han Kyeom Kim, Chang Lyuk Yoon, Seong Jae Lee, Seung Yeon Ha; Korean J Pathol. 2008;42(5):299-305.

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Abstract PDF: BACKGROUND
Because of the rarity of mummies in Korea and the difficulty in obtaining samples from mummies, studies to determine the ages of mummies are uncommon in Korea. This study was performed to determine the ages of mummies using the information obtained by nondestructive methods to minimize damages to the mummies. METHODS: Three mummies excavated between 2002 and 2004 were used. Three-dimensional reconstructed images of the total teeth were obtained by CT scanning. The age at death was determined according to the 'Age Estimation Table of Dental Attrition' as developed by Takei. Three teeth were extracted from each of three mummies and examined grossly and microscopically by serial sections using the Gustafson-Johanson method. RESULTS: The ages at death of the three mummies estimated by the Takei method were 23.57 years (Yoon mummy), 51.01 years (Bong mummy), and 64.45 years (Black mummy). These results were similar to the ages determined by the Gustafson method. CONCLUSION: Age determination method using a CT scan and three-dimensional reconstruction may be a valuable method because it minimizes the damages to valuable mummies and it gives reliable data similar to that obtained by other standard methods.

Case Reports

Myxoma of the Larynx Presenting As a Nodule.: Young Soo Song, Si Hyong Jang, Kyueng Whan Min, Woong Na, Se Min Jang, Young Jin Jun, Seung Sam Paik; Korean J Pathol. 2008;42(5):306-307.

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Abstract PDF: We describe herein a rare case of a laryngeal myxoma presenting as a nodule. Laryngeal myxomas involving the neck region, especially the laryngeal area, are quite rare. A 36-year-old male patient presented with a 2 month history of hoarseness. On laryngoscopic examination, there was a myxoid homogeneous transparent mass on the right vocal cord. On microscopic examination, the lesion was hypocellular and myxoid. The lesion showed stellate or spindle cells which were evenly dispersed in the poorly vascularized myxoid stroma. Although the incidence is extremely rare, a laryngeal myxoma should be considered in the differential diagnosis of laryngeal masses.

Placental Transmogrification of the Lung: A Brief Case Report.: Eun Su Park, Joungho Han, Won Jung Koh, Kyung Soo Lee, Jhingook Kim, Jinwon Seo, Jiyoung Kim; Korean J Pathol. 2008;42(5):308-310.

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Abstract PDF: Placental transmogrification (PT) is an unusual condition in which the alveoli develop a peculiar villous configuration that resembles the placental villi. We report a rare case of pulmonary PT in a 46-year-old man who presented with multiple cystic lesions and nodules on radiography. The patient was treated with a surgical excision. The cut surface of the lung lesion had a villous spongiform manifestation with a partly yellow granular appearance. Microscopically, multiple papillary cores mimicking the villous structures of the placenta were observed within the bullous airspaces. These papillary cores contained many vascular structures, lymphoid aggregates, interstitial clear cells, mature fat and dystrophic calcification. This case was solitary and not associated with other pulmonary or systemic diseases. The etiology is unknown, and further studies will be needed to understand the pathogenesis of the lesion.

An Unusual Meningothelial Element in a Hairy Polyp of the Hard Palate.: Si Hyong Jang, Kyueng Whan Min, Woong Na, Se Min Jang, Seung Sam Paik; Korean J Pathol. 2008;42(5):311-313.

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Abstract PDF: Hairy polyps are a rare malformations of bigerminal origin that comprise of both ectodermal and mesodermal elements. Meningothelial elements are an extremely rare pathologic finding in hairy polyps. Here we report a case of a hairy polyp with a meningothelial element, which originated from the hard palate. A 1-year-old boy was evaluated for an intraoral mass accompanied by multiple congenital anomalies. A small polypoid mass was noted at the midline of the hard palate. The lesion had central fibroconnective tissue with an unusual stromal component showing reticulated anastomosing pseudovascular patterns. Immunohistochemical staining of the cells lining the pseudovascular spaces and the interstitial cells revealed vimentin and epithelial membrane antigen positivity.

Bilateral Bartholin's Gland Hyperplasia Associated with Bartholin's Gland Cyst: A Brief Case Report.: Hyun Soo Kim, Gou Young Kim, Sung Jig Lim, Eun Hee You, Youn Wha Kim; Korean J Pathol. 2008;42(5):314-316.

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Abstract PDF: A 40-year-old woman underwent surgery to remove tender bilateral vulvar masses. The masses were gray/brown, well circumscribed, non-encapsulated, and were composed of an increased number of ducts and acini with a normal lobular architecture and a duct-acinar relationship. This appearance was consistent with Bartholin's gland hyperplasia (BGH). Bilateral Bartholin's gland cysts were also associated with BGH. Benign tumors and tumor-like conditions of Bartholin's gland are uncommon, and only a few cases of BGH have been reported in the literature. Hyperplasia is a rare etiology for an enlarged Bartholin's gland, and must be distinguished histologically from adenoma.

Solitary Splenic Metastases from Uterine Cervical Cancer: Case Reports and Review of the Literature.: Jo Heon Kim, Yoo Duk Choi, Jae Hyuk Lee, Jong Hee Nam, Sang Woo Juhng, Yang Seok Koh, Chol Kyoon Cho, Chan Choi; Korean J Pathol. 2008;42(5):317-322.

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Abstract PDF: Splenic metastasis from gynecologic tumors is extremely rare, especially in the absence of apparent disease at other sites. We report two patients that underwent splenectomy for a solitary splenic metastasis from uterine cervical carcinoma. In case 1, a 54-year-old woman with FIGO Stage IIb squamous cell carcinoma of the uterine cervix treated with radiotherapy and chemotherapy developed a solitary splenic metastasis 10 months after initial treatment. In case 2, a 46-year-old woman with FIGO Stage IIb adenocarcinoma of the uterine cervix treated with radiotherapy and chemotherapy was found to have a solitary splenic metastasis 11 months after treatment. Thus all abdominal organs including the spleen must be evaluated for metastases during follow-up of gynecologic tumors.

Hybrid Cyst Coexisting with Glomus Coccygeum.: Hyun Soo Kim, Gou Young Kim, Sung Jig Lim, Youn Wha Kim; Korean J Pathol. 2008;42(5):323-326.

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Abstract PDF: A 36-year-old female patient with a mass in the coccygeal region underwent surgical removal of the mass, and this revealed a hybrid cyst in coexistence with a glomus coccygeum. This unusual cutaneous cyst had an epithelial lining composed of keratinizing, stratified squamous epithelium with an intact granular layer immediately adjacent to apocrine cells, and the apocrine cells showed the characteristic features of "decapitation secretion". The glomus coccygeum, which is a minor finding in specimens from the sacral area and it may represent a diagnostic challenge to the unaware observer, was incidentally identified in the dermis. The glomus coccygeum was located beneath the epithelial transition area of the hybrid cyst. Immunohistochemical analysis revealed that the cytoplasm of the epithelioid glomus cells was positive for smooth muscle actin, and these epithelioid glomus cells were arranged in concentric layers around blood vessels, and the cellular stroma surrounding the glomus bodies were positive for S-100 protein.

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