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Volume 43(2); April 2009
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Review Article
Liquid-Based Cytology in Fine-Needle Aspirates of the Thyroid and Breast.
Ji Young Kim
Korean J Pathol. 2009;43(2):99-106.
DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.2.99
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  • 5 Citations
AbstractAbstract PDF
Liquid-based cytology (LBC) is becoming more widely used in analyzing the fine-needle aspirates (FNAs) from various organs, including the thyroid and breast. Compared to the conventional smear, LBC can achieve more consistent cellularity and evenly distributed mono-layered cell preparations and it can diminish the obscuring background, thus lower the rate of 'unsatisfactory' specimens. The cytomorphological details are better preserved with LBC, and it also provides the opportunity to perform ancillary tests such as immunocytochemical or molecular studies. It requires less time and manpower for screening, too. Yet there are drawbacks for the liquid-based technique. The cell clusters tend to be more fragmented and they often lose their typical structural characteristics that may have helped in making a diagnosis. Some useful background material such as colloid and mucin is diminished. However, LBC still retains many of the cytological features of a conventional smear and possesses unique characteristics as well. Here, some of the typical cytological findings of the liquid-based technique for FNA of the thyroid and breast are reviewed. Experience and awareness of the cytomorphological characteristics of liquid-based technique in non-gynecological aspirates is crucial for correct interpretation.
Original Articles
The Overexpression of Histone Deacetylase 1 and Its Relationship with p16INK4a Gene Hypermethylation in Pulmonary Squamous Cell Carcinoma and Adenocarcinoma.
Jong Hyeok Park, Young Seoub Hong, Phil Jo Choi, Na Young Kim, Kyung Eun Lee, Mee Sook Roh
Korean J Pathol. 2009;43(2):107-112.
DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.2.107
  • 2,777 View
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  • 3 Citations
AbstractAbstract PDF
BACKGROUND
DNA methylation and histone modification are dynamically linked in the epigenetic control of gene silencing and they play an important role in tumorigenesis.
METHODS
To evaluate the role of histone deacetylase 1 (HDAC1) in the development of lung cancer and the relationship between a HDAC1 overexpression and p16INK4a hypermethylation, we performed immunohistochemical staining for HDAC1 in 76 lung cancer specimens (39 squamous cell carcinomas and 37 adenocarcinomas) that had been previously evaluated for their p16INK4a methylation status by real-time quantitative polymerase chain reaction.
RESULTS
A HDAC1 overexpression (>50% of HDAC1 immunoreactive cells) was detected in 65 (85.5%) out of the 76 cases and it was more frequently seen in the squamous cell carcinomas (97.4%) than in the adenocarcinomas (73.0%) (p=0.002). The incidence of HDAC1 overexpression tended to be higher in the heavy smokers with more than 20 pack-years (p=0.067). Although there was no statistical significance, the frequency of p16INK4a hypermethylation in the cases with a HDAC1 overexpression (27.7%) tended to be higher than that in the cases without a HDAC1 overexpression (9.0%) (p=0.175).
CONCLUSIONS
A HDAC1 overexpression might be involved in lung carcinogenesis, and especially in a subgroup of smoking and squamous cell carcinoma patients, and a HDAC1 overexpression may be associated with p16INK4a hypermethylation.
Pathological Characteristics of 20 Cases of Langerhans Cell Histiocytosis and Specificity of Immunohistochemical Stain of Langerin (CD207).
Youngjoon Ryu, Hyunjoo Lee, Sangho Lee, Hoiseon Jeong, Bongkyung Shin, Aeree Kim, Hankyeom Kim, Insun Kim
Korean J Pathol. 2009;43(2):113-119.
DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.2.113
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  • 1 Citations
AbstractAbstract PDF
BACKGROUND
Langerhans cell histiocytosis (LCH) is a well-known neoplastic disorder of Langerhans cells which has characteristic findings, however, LCH has not been adequately studied in Korea.
METHODS
We analyzed the clinicopathologic features of 20 patients with LCH who were diagnosed between 1997 and 2006 at the Korea University Guro and Anam Hospitals.
RESULTS
The M:F ratio was 3:1 and the age ranged from 2-60 years (mean, 23.8 years [4 in 1st decade, 6 in 2nd decade, 2 in 3rd decade, 5 in 4th decade and 3> or =40 years of age). The cases were classified as unifocal unisystemic in 13 patients, multifocal unisystemic in 4 patients, and multifocal multisystemic in 3 patients. The bone was the most commonly involved organ (14), followed by lymph node (5), lung (2), skin (2) and ureter (1). The Langerhans cells were immunohistochemically stained with Langerin, CD1a, S-100 protein, and CD68. Langerin and CD1a were specific for Langerhans cells.
CONCLUSIONS
The distribution of the involved organs in patients with LCH was similar to the distribution in Western countries, but lymph node involvement was more frequent, whereas lung involvement was less common. Langerin is considered to be a specific marker for Langerhans cells.
Intestinal Endometriosis: Clinicopathologic Analysis of 15 Cases Including a Case of Endometrioid Adenocarcinoma.
Heejin Lee, Kyu Rae Kim
Korean J Pathol. 2009;43(2):120-125.
DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.2.120
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AbstractAbstract PDF
BACKGROUND
Since many patients with intestinal endometriosis present with gastrointestinal symptoms without a history of endometriosis, endoscopic examination of the intestinal tract is initially performed, often leading to a misdiagnosis.
METHODS
We reviewed the clinicopathologic findings of 18 samples from 15 patients with intestinal endometriosis who underwent endoscopic biopsy and/or surgical resection to identify diagnostically helpful findings.
RESULTS
All 7 biopsy specimens displayed relatively well-defined submucosal lesions, with non-mucinous glands lined by ciliated epithelium and surrounding cellular stroma containing spiral arteriole-like blood vessels. The stroma was immunopositive for CD10 in all cases. All but one specimen exhibited immunopositivity for ER and PR in both glandular and stromal components. In contrast to the overlying normal colonic mucosa, glandular epithelium with endometriosis was immunopositive for cytokeratin (CK) 7, but immunonegative for CK20 in all cases. Three cases were associated with adenocarcinoma in the same or different segments; specifically, two primary rectal adenocarcinomas and one endometrioid adenocarcinoma arising from endometriosis.
CONCLUSIONS
The characteristic features of endometrial glands and stroma, including non-mucinous glands without goblet cells, ciliated columnar epithelium, and cellular stroma with spiral arterioles, facilitate the accurate diagnosis of intestinal endometriosis, which can be confirmed by immunohistochemical staining.
Immunohistochemical Study about the Origin of Bile Ductules Proliferation in Obstructive Liver Disease.
Hyun Jung Sung, Byung Chul Ann, Jae Tae Lee, Yoon Seup Kum, Jae Bok Park, Kwan Kyu Park
Korean J Pathol. 2009;43(2):126-132.
DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.2.126
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AbstractAbstract PDF
BACKGROUND
The relationship between bile duct proliferation and portal fibrosis in obstructive liver diseases remains unclear. The purpose of this study is to analyze the relationship between hepatic stellate cells (HSC), hepatocytes and bile ductule proliferation in obstructive liver disease using immunoreactivity for alpha-SMA (alpha-smooth muscle actin), CK7, and CK19.
METHODS
We used 20 human tissue samples with hepatic fibrosis due to intrahepatic stones and liver cirrhosis. Immunohistochemical staining was performed using the streptavidin-biotin method.
RESULTS
Proliferations of bile ductules at the periphery of the hepatic lobules, and diffuse HSC activation in the perisinusoidal spaces were observed in all cases. Immunoreactivity of the hepatocytes for CK7 and CK19 suggested a possible phenotypic transformation into bile duct epithelium during fibrogenesis. Immunohistochemical-analyses of alpha-SMA expression profiles showed that intralobular HSCs and some hepatocytes underwent early phenotypic changes, and that the accumulation of collagen coincides with that of alpha-SMA-labeled myofibroblasts around portal/septal ductular structures.
CONCLUSIONS
Our results showed the possibility of a phenotypic transformation of hepatocytes into bile ductular epithelium. It is suggested that hepatocytes might play a role in bile ductule proliferation in obstructive liver disease.
Microscopic Colitis: The Pathologic Features of 24 Korean Patients.
Sun Ah Lee, Min Jung Kang, Sung Ae Jung, Heasoo Koo
Korean J Pathol. 2009;43(2):133-138.
DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.2.133
  • 2,629 View
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  • 1 Citations
AbstractAbstract PDF
BACKGROUND
The clinical presentation of microscopic colitis (MC) consists of chronic non-bloody watery diarrhea for weeks or months at a time, abdominal pain, and changes in bowel habits with a normal mucosal appearance upon performing colonoscopy. MC includes two relatively well established histopathologic entities: collagenous colitis (CC) and lymphocytic colitis (LC) as well as atypical forms. The recognition of the microscopic findings of this heterogeneous entity is very important for making the correct diagnosis and providing proper treatment.
METHODS
We studied the colonoscopic biopsy specimens that were obtained from 26 patients who had clinical findings that were suggestive of MC.
RESULTS
Fifteen patients (M:F=9:6) and 9 patients (M:F=5:4) showed the microscopic features of LC and MC, not otherwise specified, respectively.
CONCLUSIONS
The clinicopathologic findings (the incidence of the subtypes, the patients' ages and the male/female ratio) of the 24 cases of MC in this study showed differences from the previously reported findings from other countries. Further studies with a sufficient number of patients from multi-centers would be necessary to confirm the regional or ethnic influence.
The Relationship between Prognostic Factors and the Expression Pattern of Fascin and E-cadherin in Renal Cell Carcinoma.
Sung Hee Kang, Seoung Wan Chae, Kyoung Bun Lee, Dong Hoon Kim, Min Kyoung Kim, Jin Hee Sohn
Korean J Pathol. 2009;43(2):139-144.
DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.2.139
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AbstractAbstract PDF
BACKGROUND
Fascin is associated with motility in various transformed cells. Overexpression of fascin is known to aid in the progression of some cancers and is associated with a poor prognosis. E-cadherin is a major protein of epithelial cells and its expression is involved in the regulation of cell proliferation and differentiation. The aim of this study was to determine the expression pattern for fascin and E-cadherin and how it is related to the prognostic factors for renal cell carcinoma (RCC).
METHODS
The expression of fascin and E-cadherin was evaluated in 208 RCCs including 175 clear cell, 20 papillary, and 9 chromophobe types using tissue array analysis.
RESULTS
The expression of fascin increased as the tumor stage (p=0.00) and Fuhrman grade (p=0.00) increased. A high positive rate of expression for fascin was observed in cases with sarcomatoid changes (p=0.27). E-cadherin expression was seen in the distal tubules and collecting ducts of normal kidneys with a membranous pattern. The positive rate of expression for E-cadherin increased as the Fuhrman grade increased (1, 0%; 2, 23.2%; 3, 34.9%; and 4, 53.8%, p=0.00). An inverse correlation in RCCs was observed in the expression of fascin and E-cadherin (p=0.026, r=-0.158).
CONCLUSIONS
In patients with RCC, the increased expression of fascin and E-cadherin was positively correlated to poor prognostic factors such as a higher Fuhrman nuclear grade and advanced pTNM stage.
The Expressions of Nerve Growth Factor and Its Receptor p75NGFR in Hepatocellular Carcinoma: Their Relation with the Clinicopathologic Factors.
Woo Sung Moon, Kyu Yun Jang, Myoung Ja Chung, Myoung Jae Kang, Dong Geun Lee, Ho Lee, Ho Sung Park
Korean J Pathol. 2009;43(2):145-151.
DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.2.145
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  • 1 Citations
AbstractAbstract PDF
BACKGROUND
Nerve growth factor (NGF) has been suggested to participate in tumor progression and it can interact with its receptor p75NGFR. In the present study, we investigated the expressions of NGF and p75NGFR in hepatocellular carcinoma (HCC).
METHODS
We performed immunohistochemistry for NGF, p75NGFR and PCNA in 45 cases of HCCs, and examined the relationships between the clinicopathologic factors and the immunohistochemical results.
RESULTS
NGF was detected in 84.4% (38/45) of the tumor cells and in 64.4% (29/45) of the non-tumorous hepatocytes. Furthermore, a NGF expression was present in 28.9% (13/45) of the endothelial cells in the HCCs, but in 80% (36/45) of the endothelial cells in the non-tumor liver tissue. The tumor cells were negative for p75NGFR in all the HCCs. Although a p75NGFR expression was present in all the nerve fibers in the non-tumor liver tissues, it was markedly reduced (42.2%; 19/45) in the HCCs and a p75NGFR expression was observed at the sinusoids or around the large vessels. The HCCs expressing NGF, either in the tumor cells or the endothelial cells, showed a larger size than those HCCs that didn't express NGF. The NGF positive tumors showed a tendency toward a higher PCNA-labeling index than did the negative tumors.
CONCLUSIONS
The changed localization of the NGF expression and the decreased expression of p75NGFR are associated with hepatic carcinogenesis. We suggest that a NGF expression may contribute to the progression of HCC.
The Expression of Transforming Growth Factor-beta1 and alpha-Smooth Muscle Actin is Increased in the Human Myxomatous Valve.
Jeong Hwan Park, Ho Joong Youn, Jung Sook Yoon, Chul Soo Park, Soo Sung Oh, Woo Baek Chung, Jong Won Chung, Yun Seok Choi, Dong Hyun Lee, Yong Seog Oh, Wook Sung Chung, Soon Jo Hong, Youn Soo Lee, Sung Bo Sim, Sun Hee Lee
Korean J Pathol. 2009;43(2):152-156.
DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.2.152
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  • 2 Citations
AbstractAbstract PDF
BACKGROUND
In vitro experimental studies have reported that transforming growth factor-beta1 (TGF-beta1) stimulates the production of alpha-smooth muscle actin (alpha-SMA) in porcine valves. However, the relation between TGF-beta1 and alpha-SMA in myxomatous valves has not been elucidated.
METHODS
We classified 27 subjects into two groups: 1) myxomatous group (M:F=11:12, mean age=55+/-15 years) and 2) rheumatic group (M:F=3:1, mean age=41+/-17 years) according to preoperative echocardiographic and postoperative histologic findings. Twenty-seven valve specimens from the patients who underwent valve replacement were obtained. Tissue samples were analyzed by immunohistochemistry for TGF-beta1 and alpha-SMA. The positively stained areas were measured using an image analysis program (Image Pro-Plus 4.5), and then the TGF-beta1 volume fraction (TGF-VF) and alpha-SMA volume fraction (alpha-SMA-VF) were calculated.
RESULTS
TGF-VF in myxomatous valves was higher than in rheumatic valves (2,759+/-2,294 vs 864+/-276, p=0.04). alpha-SMA-VF in myxomatous valves was higher than in rheumatic valves (4,122+/-2,275 vs 2,421+/-844, p=0.002). There was a significant correlation between TGF-beta1 and alpha-SMA in myxomatous valves (r=0.38, p=0.04). There was no significant correlation between TGF-beta1 and alpha-SMA in rheumatic valves (r=-0.50, p=0.67).
CONCLUSIONS
TGF-beta1 and alpha-SMA may be related to the pathogenesis of myxomatous valves. The activation of TGF-beta1 might increase the expression of alpha-SMA in human myxomatous valves.
Correlation Analysis Between Cervicovaginal Cytologic and Histopathologic Diagnoses in Cervical Squamous Cell Neoplasm.
Kyoung Bun Lee, Woon Sun Park, Jin Hee Sohn, Min Kyung Kim, Dong Hoon Kim, Hee Sung Kim, Seoung Wan Chae, Sung Hee Kang, Young Hye Cho, Hee Dae Pak, Sun Hee Kim
Korean J Pathol. 2009;43(2):157-163.
DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.2.157
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  • 3 Citations
AbstractAbstract PDF
BACKGROUND
The aim of this study was to confirm the usefulness of cervicovaginal smears in the screening of squamous cell neoplasms of the uterine cervix by comparative analysis between the cytologic diagnosis of cervicovaginal smears and the histologic diagnosis of tissue specimens.
METHODS
We selected 743 patients who had both cervicovaginal smears and histologic evaluations of the uterine cervix by colposcopic biopsy, conization, or hysterectomy at the Kangbuk Samsung Medical Center between January 2005 and December 2007.
RESULTS
The accuracy rate of cervicovaginal smears and histologic diagnoses was 93.0% (691/743) and showed a high correspondence (kappa value, 0.770, p-value, 0.000). The false-negative and false-positive rates were 0.5% (6/484) and 17.8% (46/259), respectively. The sampling and interpretation errors were identified in four and two cases of six false-negative cases and 29 and 17 cases of 46 false-positive cases, respectively. In screening high grade squamous cell neoplasms, there were no false-negative cases and only one false-positive case which resulted from sampling error. The false-negative rate of cervicovaginal smears and the false-positive rate in high-grade squamous cell neoplsams were very low.
CONCLUSIONS
The cervicovaginal smear is a powerful tool for screening of cervical squamous cell neoplasms.
The Cytology for Leukemic Cells in Cerebrospinal Fluid; Comparison of Conventional Cytology with Liquid-Based Cytology.
Changyoung Yoo, Youn Soo Lee, Chang Suk Kang, Sang In Shim, Kyo Young Lee
Korean J Pathol. 2009;43(2):164-170.
DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.2.164
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AbstractAbstract PDF
BACKGROUND
The cytological examination of cerebrospinal fluid (CSF) using conventional cytology with a cytocentrifuge (cytospin) is an important method for evaluating the involvement of leukemia in the CNS. Liquid-based cytology (LBC) is now a widely used cytological method not only for gynecological and non-gynecological specimens, but its application to CSF for the identification of leukemic cell has not yet been reported. In this study, we tried to compare conventional cytology with using a cytospin with LBC and Papanicolaou (Pap) staining. We also examined the modified LBC with Wright staining to assess whether this modified method can be useful for diagnosing Leukemia.
METHODS
We studied 30 cases of CSF that were obtained from 16 patients, including 17 cases of acute myeloid leukemia, 12 cases of acute lymphoblastic leukemia and 1 case of diffuse large B cell lymphoma. We applied conventional cytology with a cytocentrifuge (cytospin), LBC with Pap staining and modified LBC with Wright staining.
RESULTS
The morphological features of the LBC with Pap staining showed difficulty for interpretation when compared with conventional cytology with a cytospin, and mainly because of cellular shrinkage. The modified LBC with Wright staining showed good morphological features.
CONCLUSIONS
We suggest that modified LBC with Wright staining may be useful for examining CSF.
Case Reports
Spindle Cell Lipoma Involving the Larynx and Lateral Neck Space.
Young Ha Kim, Jung Hae Cho, Chan Kwan Jung, Dong Il Sun
Korean J Pathol. 2009;43(2):171-173.
DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.2.171
  • 2,767 View
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  • 1 Citations
AbstractAbstract PDF
Spindle cell lipoma (SCL) is a rare lipoma variant that account for approximately 1.5% of all adipocyte-origin tumors; SCL usually occurs on the posterior neck or shoulder. The histological characteristics of SCL include mature, univacuolar fat cells and fibroblast-like spindle cells in a matrix of collagen and mucoid material. It is important to note that spindle cell lipoma can be mistaken both clinically and histologically for liposarcoma. We report here on a rare case of SCL in a 48-year-old male, and the patient presented with a large right neck mass that involved the lateral neck space and larynx.
Morsicatio Labiorum/Linguarum: Three Cases Report and a Review of the Literature.
Kyueng Whan Min, Chan Kum Park
Korean J Pathol. 2009;43(2):174-176.
DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.2.174
  • 5,064 View
  • 211 Download
  • 3 Citations
AbstractAbstract PDF
Morsicatio is a condition caused by habitual chewing of the lips (labiorum), tongue (linguarum), or buccal mucosa (buccarum). Clinically, it often produces a shaggy white lesion caused by pieces of the oral mucosa torn free from the surface. The condition is generally found among people who are stressed or psychologically impaired. Most patients with this condition are not even aware of their biting habit. Clinically, morsicatio mimics hairy leukoplakia, and sometimes, it may be confused with other dermatologic diseases involving the oral cavity. It is rarely described in pathologic and dermatological textbooks. Histological features are distinctive, however, being careful to make a correct diagnosis can help one avoid providing inappropriate treatment. In this report we describe three cases of morsicatio, one that developed in the lower lip and the others that developed on the side of the tongue.
Smooth Muscle Hyperplasia of the Epididymis: Report of A Case and Review of the Literature.
Hyun Soo Kim, Ji Youn Sung, Gou Young Kim, Sung Jig Lim, Hyun Cheol Kim, Hyung Lae Lee
Korean J Pathol. 2009;43(2):177-181.
DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.2.177
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  • 4 Citations
AbstractAbstract PDF
A 66-year-old man underwent surgery to remove an incidentally discovered non-tender intrascrotal mass. Ultrasonography revealed an irregular-margined, heterogeneous mass-like lesion in the epididymal tail. The mass was relatively well circumscribed but unencapsulated, irregular and firm; it consisted of expansile, increased smooth muscle fascicles originating from the epididymal muscular coat. Its cellular growth pattern lacked the cohesive, well-circumscribed proliferation pattern typical of a leiomyoma. A diagnosis of smooth muscle hyperplasia of the epididymis was made. Although ultrasonography is the imaging modality of choice for evaluating suspected intrascrotal masses, there are times when it cannot reliably identify the character of the masses and distinguish malignant from benign lesions. Ill-defined, solid extratesticular masses, that are ultrasonographically ambiguous, should be excised and confirmed histopathologically and smooth muscle hyperplasia of the epididymis should be included in the differential diagnosis of solid extratesticular masses.
Giant Cell Tumor-like Proliferation Associated with Renal Staghorn Calculi: A Case Report.
Han Seong Kim, Mee Joo, Sun Hee Chang, Ji Eun Kwak, Sang Hwa Shim, Sung Yong Cho
Korean J Pathol. 2009;43(2):182-184.
DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.2.182
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AbstractAbstract PDF
A 62-year-old man with left flank pain and hematuria was shown to have a staghorn stone in left renal pelvis. Grossly, renal pelvis and calyces were markedly dilated with cystic and hemorrhagic degeneration and renal parenchyma was atrophied. A tumor-like mass was located in a hemorrhagic cyst of the renal upper pole. This mass consisted of giant cells and stromal cells mimicking a giant cell tumor of bone. This giant cell tumor-like proliferation may represent a response to hemorrhage into a cystic cavity. Recognition of this finding is important to avoid the over-diagnosis of neoplastic lesions.

JPTM : Journal of Pathology and Translational Medicine