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Volume 44(1); February 2010
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Review Article
Basaloid Squamous Cell Carcinoma of the Upper Aerodigestive Tract.
Kyung Ja Cho
Korean J Pathol. 2010;44(1):1-8.
DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.1.1
  • 3,308 View
  • 31 Download
  • 2 Citations
AbstractAbstract PDF
Basaloid squamous cell carcinoma (BSCC) is an uncommon variant of squamous cell carcinoma (SCC), usually occurring in the larynx, hypopharynx, oropharynx and esophagus. BSCCs have been reported from various geographic areas, but esophageal BSCCs are more prevalent in Asia. The morphology of BSCC is quite characteristic, but BSCC occasionally needs to be differentiated from neuroendocrine carcinoma or adenoid cystic carcinoma. Human papillomavirus16-associated oropharyngeal SCC with poorly differentiated or basaloid features has recently been recognized as a new clinical entity with a different etiology and prognosis. Nonoropharyngeal BSCC appears to share etiologic factors, genetic alterations and an immunoprofile with conventional SCC of the upper aerodigestive tract. However, the divergent differentiation of BSCC into various non-basaloid, epithelial or mesenchymal elements suggests the participation of more mulipotential cells than in SCC. The biologic behavior of BSCC has been reported to be worse than or equal to that of SCC, yet the data including the increasing numbers of human papillomavirus-associated cases now require reanalysis. It is presently uncertain whether BSCC is a histogenetically or clinically unique disease entity.
Original Articles
The Prognostic Significance of the Tumor-Infiltrating FoxP3-Positive Regulatory T Cells in Gastric Carcinoma.
Sang Jae Noh, Shin Young Park, Kyung Ryoul Kim, Chan Young Kim, Keun Sang Kwon, Ho Sung Park, Ho Lee, Myoung Ja Chung, Woo Sung Moon, Kyu Yun Jang
Korean J Pathol. 2010;44(1):9-15.
DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.1.9
  • 2,865 View
  • 21 Download
  • 2 Citations
AbstractAbstract PDF
BACKGROUND
Regulatory T cells (Tregs) are known to be key regulators of immune responses in patients with autoimmune disease and infection and also for attenuating antitumor immunity by the host. It has been reported that high numbers of tumor-infiltrating Tregs might be associated with poor clinical outcomes for several malignant tumors. Therefore, this study aimed to examine the impact of tumor-infiltrating Tregs on the prognosis of gastric carcinoma patients.
METHODS
The immunohistochemical staining for anti-fork head Box P3 (FoxP3) antibody was performed by using a 3 mm core from the tumor specimens of each of the 173 gastric cancer patients for constructing a tissue microarray. FoxP3-positive Tregs were quantified by calculating the numbers of positive cells per 5 high-power fields on light microscopy. Thereafter, the 173 patients were subdivided into the low Tregs group (< or = 3/5 high power fields [HPF], n = 41) and the high Tregs group (> 3/5 HPF, n = 132).
RESULTS
The high Tregs group was significantly associated with a higher stage, more invasion depth and lymph node metastasis (p = 0.009, p = 0.036, p = 0.006, respectively). The high Tregs group showed significantly poorer overall survival and event-free survival (p = 0.004, p = 0.017, respectively) on the univariate analysis. The Tregs group and the tumor, node and metastasis stage were also independent prognostic factors that were significantly associated with overall survival (p = 0.025, p < 0.001, respectively) by multivariate analysis.
CONCLUSIONS
Our results indicated that a high number of tumor-infiltrating FoxP3-positive Tregs could be an indicator of poor long term survival for gastric carcinoma patients.
Clinicopathologic Significances of EGFR Expression at Invasive Front of Colorectal Cancer.
Yeo Ju Kang, Chan Kwon Jung, Yeong Jin Choi, Kyo Young Lee, Hyung Jin Kim, Won Kyung Kang, Seong Taek Oh
Korean J Pathol. 2010;44(1):16-21.
DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.1.16
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AbstractAbstract PDF
BACKGROUND
Epidermal growth factor receptor (EGFR) is frequently expressed in the invasive front of colorectal cancer (CRC), but its clinicopathologic significance remains unclear. We investigated the clinical value of the EGFR expression at the invasive front of CRC.
METHODS
We performed an immunohistochemical analysis in order to examine the expression and distribution of EGFR in 214 cases of CRC. The EGFR status was considered positive when > or =1% of the tumor cells had membranous staining.
RESULTS
Overall, an EGFR expression was observed in 144 (67%) cases and it had no significant relationship with the clinicopathologic parameters. However, an EGFR expression at the invasive front was correlated with lymphatic invasion, lymph node metastasis and a high level of serum carcinoembryonic antigen (p = 0.028, p = 0.043, and p = 0.045, respectively). For the budding-positive CRCs liver metastases were found in the cases with an EGFR expression at the budding, but no liver metastasis occurred in the EGFR negative cases at the budding (p = 0.030).
CONCLUSIONS
An EGFR expression at the invasive front has clinicopathologic significances in patients with CRC. An EGFR expression at tumor cell budding is a pathologic marker that suggests the high potential for liver metastasis in CRC.
The Prognostic Subgroups as Defined by the Patterns of Epstein-Barr Virus Infection in Patients with Hodgkin Lymphoma.
Ji Hyeon Roh, Seok Jin Kim, Won Seog Kim, Young Hyeh Ko
Korean J Pathol. 2010;44(1):22-27.
DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.1.22
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AbstractAbstract PDF
BACKGROUND
The purpose of this study was to investigate the prognostic significance of the Epstein-Barr virus (EBV) infected non-neoplastic lymphocytes in patients with Hodgkin lymphoma (HL).
METHODS
Seventy-seven cases of HL were evaluated by immunohistochemical analysis and EBV-encoded RNA in situ hybridization. The cases were divided into three groups according to the EBV status. EBV was negative in 48 cases (group 1), EBV was located in the Hodgkin/Reed-Sternberg (HRS) cells, but not in the non-neoplastic lymphocytes in 20 cases (26%) (group 2) and EBV was located in both the HRS cells and the non-neoplastic lymphocytes in 9 cases (12%) (group 3).
RESULTS
The groups differed with respect to the age distribution, the clinical presentation and the prognosis. The median ages were 30 (group 1), 47.5 (group 2) and 23 years (group 3) (p = 0.011). B symptoms (p = 0.007) and the histologic subtype of mixed cellularity classical HL (p = 0.001) were more common in the EBV-positive patients than in their EBV-negative counterparts. Two patients from group 3 had associated chronic EBV infection syndrome. The five-year survival rate was 97.56% in group 1, 75.76% in group 2 and 100% in group 3 (p = 0.0178).
CONCLUSIONS
HL with EBV located in both the HRS cells and the non-neoplastic lymphocytes is a distinct prognostic subgroup that has better survival than the HL with EBV located in only the HRS cells.
Automated Silver-enhanced In Situ Hybridization for Evaluation of HER2 Gene Status in Breast Carcinoma: Comparison with Fluorescence In Situ Hybridization and Immunohistochemistry.
Woo Jung Sung, Seok Ju Park, Mi Jin Gu, Young Kyung Bae
Korean J Pathol. 2010;44(1):28-34.
DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.1.28
  • 2,974 View
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  • 10 Citations
AbstractAbstract PDF
BACKGROUND
The human epidermal growth factor receptor 2 (HER2) is amplified in 20-25% of breast cancers. HER2 overexpression or amplification is associated with a worse clinical outcome and it can predict the benefit from anthracycline and anti-HER2 therapies. The HER2 status has usually been assessed by immunohistochemistry (IHC) or fluorescence in situ hybridization (FISH) in clinical samples. A new silver-enhanced in situ hybridization (SISH) technique was recently introduced. Therefore we evaluated the usefulness of SISH for detecting HER2 amplification.
METHODS
Tissue microarrays (TMAs) were constructed with 144 invasive breast cancer tissue samples. We performed IHC, FISH and SISH for HER2 on the tissue sections from the TMAs and we interpreted the results according to the American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) guidelines. The concordant rates between the two different tests were calculated.
RESULTS
HER2 was overexpressed and amplified in 16.9%, 16.9%, and 18% of the cases by IHC, FISH and SISH, respectively. The concordant rates between IHC and FISH, IHC and SISH, and FISH and SISH were 95.1%, 95.7%, and 97.8%, respectively.
CONCLUSIONS
SISH can be an alternative test for evaluating HER2 amplification because the 97.8% concordance with FISH satisfies the ASCO/CAP requirement of > 95% concordance with an alternative validated method.
CD44 and MMP14 Expression Associated with WHO Grade of the Astrocytoma and the Prognostic Implications.
Jaekyung Myung, Bogun Jang, Heae Surng Park, Woongjae Yon, Hyun Ju Lee, Sung Hye Park
Korean J Pathol. 2010;44(1):35-41.
DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.1.35
  • 2,521 View
  • 19 Download
AbstractAbstract PDF
BACKGROUND
CD44 is a cell surface receptor that has been implicated in tumor cell invasion and metastasis in a range of tumors of various organs, including breast, ovary, colon, lung, and brain. CD44 stimulates the invasive ability by interacting with matrix metalloproteinase 14 (MMP14). The expression of MMP14 on the cell surface is thought to trigger multiple proteinase cascades and to stimulate cell migration.
METHODS
A total 54 astrocytoma patients were eligible for this study. We performed a retrospective clinicopathological review and CD44 and MMP14 immunohistochemistry.
RESULTS
The expressions of CD44 and MMP14 were significantly correlated with the World Health Organization (WHO) grade. On univariate analysis, the WHO grade and the expression of CD44 were the significant prognostic factors affecting overall survival (OS) and disease progression free survival (DPFS). On the multivariate analysis by the Cox regression model, the only WHO grade was shown to be a significant independent prognostic factor for predicting the DPFS and OS.
CONCLUSIONS
In this study, the CD44 and MMP14 expressions were related to the WHO grade of astrocytoma. The CD44 expression status was a prognostic factor for DPFS and OS on univariate analysis, but it was not an independent prognostic factor on the multivariate analysis.
Expression of Cyclooxygenase-2 and Embryonic Lethal Abnormal Vision-Like Protein HuR in Gallbladder Carcinoma.
Sung Im Do, Gou Young Kim, Sung Jig Lim, Youn Wha Kim
Korean J Pathol. 2010;44(1):42-47.
DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.1.42
  • 2,513 View
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  • 1 Citations
AbstractAbstract PDF
BACKGROUND
Cyclooxygenase-2 (COX-2) is an enzyme that promotes proliferation of tumor cells. HuR is a member of the family of embryonic lethal abnormal vision-like proteins. Recent studies show that cytoplasmic HuR stabilizes the mRNA of COX-2 and regulates the expression of COX-2. Moreover, cytoplasmic HuR expression is associated with a poorer prognosis for patients with some cancers. The aim of this study was to investigate the expression patterns of and the relationship between COX-2 and HuR in gallbladder carcinoma.
METHODS
We analyzed COX-2 and HuR expression by immunohistochemical staining of 108 gallbladder carcinomas.
RESULTS
COX-2 expression and nuclear and cytoplasmic HuR expression were seen in, respectively, 61 (56.5%), 77 (71.3%), and 4 (3.7%) cases. COX-2 and nuclear HuR were simultaneously expressed in 44 of the 108 samples without any quantitative association between the levels of each. COX-2 expression correlated with tumor stage, differentiation (based on histology), lymph node metastasis, perineural invasion, and survival. Nuclear and cytological expression of HuR did not correlate with any clinical parameters.
CONCLUSIONS
COX-2 expression but not HuR may play an important role in the prognosis of patients with gallbladder carcinoma.
Availability of Immunohistochemistry in the Diagnosis of Follicular Variant of Papillary Thyroid Carcinoma.
Ji Yun Jeong, Jung Sik Jang, Yoon Kyung Sohn, Jin Hyang Jung, Yi Kyeong Chun, Ji Young Park
Korean J Pathol. 2010;44(1):48-55.
DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.1.48
  • 3,829 View
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  • 1 Citations
AbstractAbstract PDF
BACKGROUND
Making the diagnosis of the follicular variant of papillary thyroid carcinoma (FVPTC) is often difficult, and there are no accurate immunohistochemical or molecular markers. The purpose of this study is to evaluate performing immunohistochemistry to make the diagnosis of FVPTC.
METHODS
A total of 249 thyroid lesions were studied. We made the tissue microarray, and we assessed the expression of HBME-1, galectin-3, CD56, and p63.
RESULTS
Galectin-3, HBME-1, and p63 were positive in 79.7%, 79.7%, and 15.9% of the FVPTC, respectively. These immunohistochemical features of FVPTC were between those of classic papillary thyroid carcinoma (CPTC) and those of non-PTC. The CD56 expression was positive in 75.4% of the FVPTC, which is much higher than that of the CPTC (28.3%), and even higher than that of the non-PTC lesions (60%). Comparing FVPTC with CPTC, the expression of galectin-3 was significantly higher and the expression of CD56 was significantly lower in the CPTCs. Comparing the FVPTC with follicular carcinoma (FC), the expression of all the markers was significantly higher in the FVPTC. Comparing PTC with FC, the expression of CD56 was lower and the expressions of the other markers were higher in the PTCs.
CONCLUSIONS
Galectin-3, HBME-1, and p63 can help make the diagnosis of FVPTC, and a cocktail of these markers can be even more useful. But CD56 is not thought to be useful to make the diagnosis of FVPTC.
Pathologic Findings of Surgically Resected Nontuberculous Mycobacterial Pulmonary Infection.
Hye Jong Song, Jung Suk An, Joungho Han, Won Jung Koh, Hong Kwang Kim, Yong Soo Choi
Korean J Pathol. 2010;44(1):56-62.
DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.1.56
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AbstractAbstract PDF
BACKGROUND
Surgical resection of the involved lung for nontuberculous mycobacteria (NTM) has become an important curative therapy. However, there is limited information on the histopathological features of NTM pulmonary disease in Korean patients with NTM infection.
METHODS
We evaluated 51 specimens from 49 patients who were treated at our referral center from 2002 to 2009.
RESULTS
Almost all the cases showed bronchiectasis with lymphocytic infiltration. Variable features of granulomatous inflammation were found; well-defined granulomas in the parenchyma (68.6%), pneumonia-like granulomatous lesions (49.0%) and granulomatous inflammation in the bronchial wall (41.2%) were identified. The microscopic findings of cavitary lesions (37.3%) showed that these lesions were composed of granulomas and necrosis.
CONCLUSIONS
The differentiation of tuberculosis from NTM could not be accurately made based solely on the histological features. However, the airway centered tendency of NTM reflected an airborn etiology, and this could be correlated with the classification according to the radiological findings. In addition, coexisting constitutional lung diseases, and especially bronchiectasis, were suspected to be predisposing conditions for NTM organisms to colonize and progress to true NTM pulmonary disease.
Histological and Immunohistochemical Findings of the Intermediate Trophoblasts in Normal Full Term and Pre-eclamptic Placentas.
Sang Hak Han, Kyu Rae Kim, Yonghee Lee, Jae Y Ro
Korean J Pathol. 2010;44(1):63-69.
DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.1.63
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AbstractAbstract PDF
BACKGROUND
Recent studies have suggested that implantation site intermediate trophoblasts (ISITs) and chorionic type intermediate trophoblasts (CTITs) show different immunohistochemical findings, and that each type has specific location in placentas. However, we observed that both subtypes are intimately admixed in many areas of the placentas and both types are proliferated around the infarcts.
METHODS
In order to examine the site specificity in their distribution and the changes of intermediate trophoblasts (ITs), if any, in the pre-eclamptic placentas, quantitative analyses of ISITs and CTITs using p63, CD146, placental alkaline phosphatase, human placental lactogen, and alpha-inhibin were performed in normal and pre-eclamptic placentas containing infarcts.
RESULTS
In the fetal membranes of both normal and pre-eclamptic placentas, CTITs and ISITs were equally identified, forming distinct layers. ISITs were predominant in the intervillous septum and basal plate, while CTITs were predominant in the subchorionic area. At the margin of infarcts in pre-eclamptic placentas, both subtypes were increased in number, forming distinct layers.
CONCLUSIONS
The subtypes of ITs do not have site specificity in placentas. Increased number of ITs and zonal distribution around infarcts suggest that CTITs and ISITs have differentiation associated relationship, and the differentiation might be related to the microenvironment of placenta, such as intraplacental oxygen concentration.
Metastatic Tumors to the Breast from Extramammary Malignancies.
Bong Hee Park, Yonghee Lee, Sei Hyun Ahn, Hak Hee Kim, Sung Bae Kim, Gyungyub Gong
Korean J Pathol. 2010;44(1):70-76.
DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.1.70
  • 2,558 View
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  • 1 Citations
AbstractAbstract PDF
BACKGROUND
Metastases to the breast from extramammary malignancies are very rare. We describe here the clinicopathologic features of the metastatic breast tumors that were identified in Korean patients at a single institute.
METHODS
We analyzed the clinicopathologic data of the patients who were diagnosed between January 1989 and April 2009 at Asan Medical Center.
RESULTS
Only 31 (0.21%) patients with metastases to the breast from extramammary malignancies were diagnosed over a 20-year period, and 29 of them had available data. The mean time to the diagnosis of metastasis after the diagnosis of the primary malignancy was 21 months (range, 0 to 102 months). The most common primary site was the stomach, followed by the uterus and lung. The most common histologic type was adenocarcinoma. A common clinical presentation was a unilateral palpable mass. Most metastatic tumors had morphological features that were similar to those of their respective primary tumors. However, in situ carcinoma, microcalcification and desmoplastic reactions were rarely observed.
CONCLUSIONS
Metastatic breast lesions from extramammary sites are extremely rare, and the stomach, uterus and lung could be considered as the common primary sites in Korean patients. The clinical history and comparing the morphology of the primary tumor with the morphology of the metastatic tumor are important for achieving the proper diagnosis.
The Analysis and Clinical Usefulness of HPV DNA Chip Test in the Uterine Cervix.
Joo hyeon Jeong, Hyun Yee Cho, Na Rae Kim, Dong Hae Chung, Sanghui Park, Seung Yeon Ha
Korean J Pathol. 2010;44(1):77-82.
DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.1.77
  • 2,746 View
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  • 3 Citations
AbstractAbstract PDF
BACKGROUND
The genotypes of human papillomavirus (HPV) are important in carcinogenesis in uterine cervical cancer and may be different in geographic distribution.
METHODS
In 2,086 women, we analyzed the prevalence of HPV and HPV genotypes in uterine cervix by HPV-DNA chip test (n = 2,086), cytology (PAP smear, n = 1997) and biopsy (n = 546).
RESULTS
Of the 2,086 cases, 1,019 cases (48.8%) were HPV-positive and 1,067 cases (51.2%) were negative for HPV. Single infection occurred most commonly (72.1% of women). HPV genotypes in the high-risk and low-risk groups, respectively were HPV-16/-58/-18/-52/-53 and HPV-70/-6/-11. The detection rates of HPV-70 in subjects older than 50 years increased significantly (p < 0.05). Infection in high risk subjects was detected in high grade lesions compared with infection in low risk subjects (p < 0.05).
CONCLUSIONS
HPV-16/-58/-18/-52/-53/-70/-6/-11 genotypes were common in the patient group similar to findings in East Asia. HPV-70 infection is predominant in those older than 40 years.
Case Reports
Intraductal Papillary Mucinous Tumor Simultaneously Involving the Liver and Pancreas: A Case Report.
Bong Hee Park, Jae Hee Suh, Hee Jeong Cha, Young Min Kim, Hye Jeong Choi
Korean J Pathol. 2010;44(1):83-86.
DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.1.83
  • 2,502 View
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  • 3 Citations
AbstractAbstract PDF
We describe here a 67-year-old man who was diagnosed with a rare case of intraductal papillary mucinous tumors that occurred simultaneously in the liver and pancreas. Abdominal computed tomography showed a tubular and cystic dilatation of the pancreatic duct in the pancreas tail, which suggested an intraductal papillary mucinous tumor (IPMT), and multiple intrahepatic duct stones. The patient underwent a distal pancreatectomy with splenectomy and a lateral segmentectomy of the liver. Microscopic examination showed an intraductal papillary mucinous neoplasms of borderline malignancy in the pancreas and a non-invasive intraductal papillary mucinous tumor with moderate dysplasia of the bile duct. Although several cases of intraductal papillary mucinous neoplasm of the liver (IPNL) without any pancreatic association have been described, the simultaneous presentation of both IPMT of the pancreas and IPNL is very rare. The patient has been doing well for 10 months postoperatively.
A Case of Gastric Carcinosarcoma with Neuroendocrine and Smooth Muscle Differentiation.
Se Min Jang, Si Hyong Jang, Kyueng Whan Min, Woong Na, Young Jin Jun, Seung Sam Paik
Korean J Pathol. 2010;44(1):87-91.
DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.1.87
  • 2,756 View
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  • 4 Citations
AbstractAbstract PDF
Carcinosarcoma of the stomach is a rarely occurring malignant biphasic tumor that consists of both carcinomatous and sarcomatous components simultaneously in a single tumor. The common carcinoma component is tubular or papillary adenocarcinoma and the mesenchymal sarcomatous components are variable and these include leiomyosarcoma, rhabdomyosarcoma, osteosarcoma and chondrosarcoma. However, neuroendocrine carcinomatous differentiation in the carcinomatous component is extremely rare. We present here a rare gastric carcinosarcoma that demonstrated neuroendocrine carcinomatous and leiomyosarcomatous differentiation in a 47-year-old man.
Adnexal Clear Cell Carcinoma with Comedonecrosis: A Case Report.
Seo Hee Kim, Sun Hee Han, Jung Suk An, Ju Han Lee, Eung Seok Lee, Heum Rye Park, Young Sik Kim
Korean J Pathol. 2010;44(1):92-96.
DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.1.92
  • 2,950 View
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AbstractAbstract PDF
Adnexal clear cell carcinoma with comedonecrosis (ACCCC) is a very rare malignancy of the skin with an aggressive clinical course and a predilection for the scalp. This is the first reported case of ACCCC in Korea. A 79-year-old male presented with left abdominal masses that proved to be two subcutaneous nodules. The tumors histologically consisted of epithelial nests that showed a distinctive zonal arrangement. The centrally located clear cell areas with comedonecroses were merged with the peripheral squamoid cells, often exhibiting retraction artifacts and an infiltrating border. Nuclear pleomorphism and frequent mitoses were prominent. The clear cells were immunopositive for carcinoembryonic antigen and epithelial membrane antigen. We report here on a case of ACCCC involving the abdominal skin, and this tumor should be distinguished from the more indolent squamous cell and tricholemmal carcinomas.

JPTM : Journal of Pathology and Translational Medicine