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Volume 46(4); August 2012
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Original Articles
HDAC1 Expression in Invasive Ductal Carcinoma of the Breast and Its Value as a Good Prognostic Factor
Minseob Eom, Sung Soo Oh, Sayamaa Lkhagvadorj, Airi Han, Kwang Hwa Park
Korean J Pathol. 2012;46(4):311-317.   Published online August 23, 2012
DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.4.311
  • 5,682 View
  • 48 Download
  • 6 Citations
AbstractAbstract PDF
Background

Histone deacetylase 1 (HDAC1) is associated with the expression and function of estrogen receptors and the proliferation of tumor cells, and has been considered a very important factor in breast tumor progression and prognosis. Several studies have reported an association between HDAC1 expression and poorer prognosis in cancers including breast cancer, with a few exceptions. However, because of the dearth of studies on HDAC1 expression in breast cancer, its significance for breast cancer prognosis has not been well defined. Therefore, we examined HDAC1 expression in invasive ductal carcinoma (IDC), the most common breast cancer, and investigated its potential prognostic significance.

Methods

We used 203 IDC tissue samples. Immunohistochemical stains for HDAC1 and real-time polymerase chain reaction for HDAC1 mRNA were performed and the results were compared to generally well-established prognostic factors in breast cancer and patient survival rates.

Results

HDAC1 expression was significantly reduced in proportion to higher histologic grade, higher nuclear pleomorphism score, and higher mitotic counts, and with lower estrogen receptor expression. Furthermore, it was significantly associated with the survival rate.

Conclusions

HDAC1 expression is a good prognostic indicator in IDC.

Clinicopathologic Implications of PIWIL2 Expression in Colorectal Cancer
Sun-Ju Oh, Su-Mi Kim, Young-Ok Kim, Hee-Kyung Chang
Korean J Pathol. 2012;46(4):318-323.   Published online August 23, 2012
DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.4.318
  • 5,490 View
  • 41 Download
  • 28 Citations
AbstractAbstract PDF
Background

There are no established reports about the expression of the Piwil gene, a subfamily of the Piwi gene involved in RNA silencing and self-renewal, in colorectal carcinomas. It is known that the degree of PIWIL2 expression is higher in colorectal carcinomas. But its clinicopathologic significance remains undetermined. This study reassessed the relationship between PIWIL2 expression and the clinicopathologic parameters in colorectal carcinomas.

Methods

An immunohistochemistry of PIWIL2 expression was done in 60 cases of colorectal carcinoma. This was followed by an analysis of the correlation between PIWIL2 expression and clinicopathologic features and a survival analysis.

Results

There were 44 cases (73.3%) where the degree of PIWIL2 expression was relatively higher. The high degree of PIWIL2 expression was significantly correlated with the lower degree of differentiation (p=0.039), deep invasion (p=0.019) and perineural invasion (p=0.027). The overall survival was longer in patients with the lower degree of PIWIL2 expression than in those with the higher degree of PIWIL2 expression.

Conclusions

Our results showed that the degree of PIWIL2 expression was relatively higher in colorectal carcinomas and it was significantly correlated with variable clinicopathologic indicators for a poor prognosis. This indicates that PIWIL2-positive cells contribute to the progression of colorectal cancer.

Expressional Difference of RHEB, HDAC1, and WEE1 Proteins in the Stromal Tumors of the Breast and Their Significance in Tumorigenesis
Minseob Eom, Airi Han, Mi Jeong Lee, Kwang Hwa Park
Korean J Pathol. 2012;46(4):324-330.   Published online August 23, 2012
DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.4.324
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  • 6 Citations
AbstractAbstract PDF
Background

Fibroadenoma (FA) and phyllodes tumor (PT) are stromal tumors of breast and are histologically similar. There are no established differences in tumorigenesis and oncogene expression among them. Ras homolog enriched in brain (RHEB) plays an important role in cell growth and cell-cycle control, histone deacetylase 1 (HDAC1) is an important factor in breast tumor progression and prognosis, and WEE1 homolog (WEE1) functions as a tumor suppressor. No studies on the expressional differences of these proteins in FA and PT have been reported to date.

Methods

The expression of these proteins in FA, PT, and normal breast was compared. We used 102 cases of FA and 25 cases of benign PT.

Results

In epithelial cells, the expression of RHEB, HDAC1, and WEE1 was lowest in PT, higher in FA, and most enhanced in normal breast. In addition, the expression of RHEB and HDAC1 was higher in the stromal cells of PT than in FA and normal breast.

Conclusions

Both epithelial and stromal cells of FA and PT express these proteins, which indicates that epithelial cells play an important role in the development of stromal tumors. In addition, the expressional differences of these proteins may be associated with the tumorigenesis of breast stromal tumors.

Expressions of E-cadherin, Cortactin and MMP-9 in Pseudoepitheliomatous Hyperplasia and Squamous Cell Carcinoma of the Head and Neck: Their Relationships with Clinicopathologic Factors and Prognostic Implication
Tack Kune You, Kyoung Min Kim, Sang Jae Noh, Jun Sang Bae, Kyu Yun Jang, Myoung Ja Chung, Woo Sung Moon, Myoung Jae Kang, Dong Geun Lee, Ho Sung Park
Korean J Pathol. 2012;46(4):331-340.   Published online August 23, 2012
DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.4.331
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  • 13 Citations
AbstractAbstract PDF
Background

E-cadherin, cortactin, and matrix metalloproteinase (MMP)-9 have roles in tumor development or progression, but their expression has not been fully investigated in pseudoepitheliomatous hyperplasia (PEH) and squamous cell carcinoma (SCC) of the head and neck.

Methods

We evaluated the immunohistochemical expression of E-cadherin, cortactin, and MMP-9 in 29 cases of PEH and 97 cases of SCC. Additionally, we evaluated their relationship with clinicopathologic factors and prognostic implications in SCC.

Results

Thirty-five cases of SCC showed reduced expression of E-cadherin, whereas none of the PEH did. A total of 20 cases and 11 cases of SCC were immunoreactive for cortactin and MMP-9, respectively, whereas none of the PEH did. In SCC, reduced expression of E-cadherin was correlated with cortactin expression and invasion depth. Cortactin expression was correlated with differentiation, T classification, and recurrence and/or metastasis. MMP-9 expression was correlated with invasion depth. Cortactin expression was correlated with poor overall survival and relapse-free survival and it was an independent prognostic factor.

Conclusions

The reduced expression of E-cadherin and the expression of cortactin may be helpful for the differential diagnosis of PEH and SCC. Furthermore, cortactin expression in association with reduced E-cadherin expression is correlated with poor prognosis in SCC.

Loss of E-cadherin and Acquisition of Vimentin in Epithelial-Mesenchymal Transition are Noble Indicators of Uterine Cervix Cancer Progression
Na-Hye Myong
Korean J Pathol. 2012;46(4):341-348.   Published online August 23, 2012
DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.4.341
  • 7,412 View
  • 67 Download
  • 52 Citations
AbstractAbstract PDF
Background

Epithelial-mesenchymal transition (EMT) has been known to play a key role in the stromal invasion of carcinoma in situ (CIS) lesion. Loss of E-cadherin and acquisition of vimentin are two critical steps in EMT, that are induced by Snail-1 upregulation associated with overexpression of epidermal growth factor receptor (EGFR). However, roles of EMT-related proteins in human cervical tissues have not been fully elucidated. In this study, we investigated the immunoexpressions of EMT-related proteins in CIS, microinvasive squamous cell carcinoma (SCC), and invasive SCC to demonstrate their key roles in tumor progression.

Methods

Eighty one CIS, 17 microinvasive, and 21 invasive SCC cases were immunostained with primary antibodies for Snail-1, EGFR, E-cadherin, and vimentin on paraffin-embedded tissue microarray blocks.

Results

EGFR and Snail-1 proteins were highly expressed but the levels were not significantly different between the three groups. However, loss of E-cadherin and acquisition of vimentin were proven to occur significantly higher in microinvasive and invasive SCC cases than in CIS.

Conclusions

E-cadherin and vimentin were found to be two useful indicators of EMT in evaluating stromal invasion of CIS. However, it was not demonstrated for Snail-1 and EGFR proteins to play any key role in the progression of cervix cancer.

The Histologic Cut-off Point for Adjacent and Remote Non-neoplastic Liver Parenchyma of Hepatocellular Carcinoma in Chronic Hepatitis B Patients
Hae Yoen Jung, Soo Hee Kim, Jin Jing, Jae Moon Gwak, Chul Ju Han, Ja-June Jang, Kyoung-Bun Lee
Korean J Pathol. 2012;46(4):349-358.   Published online August 23, 2012
DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.4.349
  • 5,927 View
  • 32 Download
  • 5 Citations
AbstractAbstract PDF
Background

The molecular profile of peritumoral non-neoplastic liver parenchyma (PNLP) has recently been suggested as predictive factor of early and late recurrence of hepatocellular carcinoma (HCC). However, there is no definite cut-off point for tumor-free PNLP in terms of either histological or molecular changes. Therefore, our aim is to determine the numerical cut-off point for separating adjacent PNLP and remote PNLP in histopathologic perspective.

Methods

Peritumoral tissues from 20 resected HCC patients were sampled from 0 to 40 mm distance from the tumor border (divided into 5-mm columns). Histopathologic parameters such as necroinflammatory activity, fibrosis, bile ductular reaction, hepatic venulitis, peliosis, and steatosis were compared between each column.

Results

The morphologic changes just adjacent to the tumor were notably severe and faded with distance. The parenchyma within 10 mm of the tumor showed significantly severe inflammation, fibrosis, peliosis and hepatic venulitis compared with those from farther areas. The histopathologic changes of the parenchyma became stable beyond 20 mm.

Conclusions

Results of this study revealed that the parenchyma within 10 mm distance from the tumor, or adjacent PNLP, has histopathologic changes that are directly affected by the tumor, and the parenchyma beyond 20 mm as the remote PNLP without tumor effect.

Outcome of "Atypical Squamous Cells" in Cervical Cytology: Follow-up Assessment by Loop Electrical Excision Procedure
Joon Seon Song, Ilseon Hwang, Gyungyub Gong
Korean J Pathol. 2012;46(4):359-364.   Published online August 23, 2012
DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.4.359
  • 5,642 View
  • 55 Download
  • 1 Citations
AbstractAbstract PDF
Background

We have retrospectively assessed the incidence and outcome of women diagnosed during a hospital-based cytology screening program with "atypical squamous cells (ASC)" and followed-up with loop electrical excision procedure (LEEP).

Methods

We analyzed 173,947 cases of cervical smears' follow-up cytology and histology findings. Previous or archival cytology with LEEP results were retrieved for 390 women with ASC of undetermined significance (ASC-US) and 112 with ASC, cannot exclude high-grade squamous intraepithelial lesion (ASC-H).

Results

On the follow-up cytology, of the 390 women initially diagnosed with ASC-US, 130 (33.3%) had no follow-up records of smears before LEEP; smears of 18 (4.6%) were negative for cytologic abnormalities, 193 (49.5%) were ASC-US, 24 (6.2%) were ASC-H, 111 (28.5%) were low grade squamous intraepithelial lesion (SIL), and 44 (11.4%) were high grade SIL. LEEP findings in these 390 women showed that 183 (46.9%) were negative, 73 (18.7%) were graded as cervical intraepithelial neoplasia (CIN) 1, 25 (6.4%) as CIN 2, 102 (26.2%) as CIN 3, and 7 (1.8%) had carcinoma. LEEP was performed in 112 women initially diagnosed with ASC-H; 36 (32.1%) were negative, 4 (3.6%) were graded as CIN 1, 7 (6.3%) as CIN 2, 60 (53.6%) as CIN 3, and 5 (4.5%) with carcinoma.

Conclusions

Patients with ASC-H smears were at increased risk of SIL or carcnoma compared with patients with ASC-US. Careful follow-up is required in ASC patients.

Comparison of Diagnostic Cytomorphology of Atypical Squamous Cells in Liquid-Based Preparations and Conventional Smears
Jung Dal Lee, Young-Ha Oh, Seong Ok Lee, Jong Yull Kim
Korean J Pathol. 2012;46(4):365-369.   Published online August 23, 2012
DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.4.365
  • 8,810 View
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  • 3 Citations
AbstractAbstract PDF
Background

The aims of this study were to compare the cytomorphologic features diagnostic of atypical squamous cells (ASC) in liquid-based preparations (LBPs) and conventional Pap (CP) smears and to cytomorphologically assess the performance of the Cell Scan 1500™ in cervical cytology practice.

Methods

Cervicovaginal smears were obtained from 938 women. Two smears were obtained simultaneously from each individual, one for an LBP and the other for a CP smear; the smears were independently examined. ASC was diagnosed in 24 patients, and their samples were cytomorphologically and semiquantitatively analyzed.

Results

A total of 24 of the 938 women (2.6%) were diagnosed with ASC by one or both methods. Results from LBPs and CP smears were in agreement in 13 of 24 cases of ASC diagnosis (absolute direct agreement, 54.2%; k<0.20; p-value from chi-square test=0.085). Diagnostic features of ASC in the LBPs included squamous cell atypia and atypical squamous metaplasia.

Conclusions

The cellular features diagnostic of ASC present in one preparation can manifest themselves differently in the other. Changes in individual cells, particularly nuclear changes, are the most reliable features for diagnosing ASC. The Cell Scan 1500™ processor is more effective at detecting ASC than are CP smears.

Case Reports
Granular Cell Astrocytoma: Report of a Case
Kyu Ho Kim, Ju Young Song, Chang Hwan Choi, Lucia Kim, Suk Jin Choi, Jee Young Han, Joon Mee Kim, Young Chae Chu, In Suh Park
Korean J Pathol. 2012;46(4):370-372.   Published online August 23, 2012
DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.4.370
  • 5,507 View
  • 40 Download
  • 2 Citations
AbstractAbstract PDF

We report here a rare case of granular cell astrocytoma. A 75-year-old man was admitted to Inha University Hospital with a three-month history of language deterioration. In a magnetic resonance imaging, a 6.5 cm-sized heterogeneous enhancing mass was seen in both the frontal lobes and the anterior genu of the corpus callosum. A stereotactic biopsy was performed. The tumor was composed of large and small round cells with abundant intracytoplasmic granules. The nuclei were bland, round to oval, and often eccentrically located. The cytoplasm of the tumor cells was positive for glial fibrillary acidic protein and S-100 protein.

Collision of Adenocarcinoma and Schwannoma of the Stomach: A Case Report
Jai Hyang Go
Korean J Pathol. 2012;46(4):373-376.   Published online August 23, 2012
DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.4.373
  • 5,676 View
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  • 4 Citations
AbstractAbstract PDF

The simultaneous occurrence of an adenocarcinoma and schwannoma is extremely rare in the stomach, and only one such case has been previously reported, which presented as two separate masses. Indeed, the collision of these tumors has never been reported. We report the case of a 61-year-old male patient who was diagnosed with the synchronous development of a schwannoma and advanced mucinous adenocarcinoma of the stomach, in which the carcinoma cells focally invaded the schwannoma.

Primary Thymic Mucinous Adenocarcinoma: A Case Report
Jamshid Abdul-Ghafar, Suk-Joong Yong, Woocheol Kwon, Il Hwan Park, Soon-Hee Jung
Korean J Pathol. 2012;46(4):377-381.   Published online August 23, 2012
DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.4.377
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  • 17 Citations
AbstractAbstract PDF

Primary thymic mucinous adenocarcinoma is an extremely rare aggressive subtype of thymic carcinoma. With a review of literatures, only nine cases have been reported up to present. A 36-year-old woman was admitted for further evaluation and treatment of a mediastinal mass. The patient had no medical history of cancer. The clinicoradiological examination disclosed no tumor elsewhere. After the surgical excision of mediastinal mass, it was grossly a round semi-solid mass with mucin-filled cystic areas. Microscopically solid areas showed cords, small nests and dilated glands infiltrating the fibrotic parenchyma, while the cystic areas were lined by mucinous epithelium with tumor cells floating in extracellular-mucin pools. Some cystic walls underwent malignant transformation of the benign thymic epithelium. Immunohistochemically, the tumor cells were positive for cytokeratin (CK) 7, CK20, CD5, and CDX-2, and negative for thyroid transcription factor-1. In conclusion, the mucinous thymic adenocarcinoma should be recognized as a separate histopathological entity and considered in the differential diagnosis of mediastinal carcinomas.

Multifocal Renal Cell Carcinoma of Different Histological Subtypes in Autosomal Dominant Polycystic Kidney Disease
Ki Yong Na, Hyun-Soo Kim, Yong-Koo Park, Sung-Goo Chang, Youn Wha Kim
Korean J Pathol. 2012;46(4):382-386.   Published online August 23, 2012
DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.4.382
  • 6,949 View
  • 54 Download
  • 7 Citations
AbstractAbstract PDF

Renal cell carcinoma (RCC) in autosomal dominant polycystic kidney (ADPKD) is rare. To date, 54 cases of RCC in ADPKD have been reported. Among these, only 2 cases have different histologic types of RCC. Here we describe a 45-year-old man who received radical nephrectomy for multifocal RCC with synchronous papillary and clear cell histology in ADPKD and chronic renal failure under regular hemodialysis. The case reported herein is another example of the rare pathological finding of RCC arising in a patient with ADPKD.

Multifocal Adenocarcinomas Arising within a Gastric Inverted Hyperplastic Polyp
Hyun-Soo Kim, Eun-Jung Hwang, Jae-Young Jang, Juhie Lee, Youn Wha Kim
Korean J Pathol. 2012;46(4):387-391.   Published online August 23, 2012
DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.4.387
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  • 8 Citations
AbstractAbstract PDF

We present herein the occurrence of multifocal adenocarcinomas with a minute signet ring cell carcinoma that arose within a gastric inverted hyperplastic polyp (IHP) in a 40-year-old woman. Endoscopic ultrasonography demonstrated a heterogeneous hypoechoic mass in the third layer of the gastric wall. The endoscopic submucosal dissection specimen measuring 3.5×3.2×1.8 cm was a well-circumscribed protruding lesion that had a slit-shaped cavity. Histologically, the lesion consisted mainly of endophytic proliferation of hyperplastic columnar cells resembling normal foveolar epithelium. In addition, six foci of adenocarcinomas and a minute focus of signet ring cell carcinoma were randomly distributed in the superficial and deep regions. The adenocarcinoma was gradually transitioning from dysplasia, while the signet ring cell carcinoma was surrounded by hyperplastic foveolar epithelium. This is the first report of a gastric IHP with multifocal intramucosal adenocarcinomas and a signet ring cell carcinoma, and endoscopic submucosal dissection is used to completely resect it.

Primary Pulmonary Myxoid Liposarcoma with Translocation t(12;16)(q13;p11) in a Young Female Patient: A Brief Case Report
Choonhee Son, Phil Jo Choi, Mee Sook Roh
Korean J Pathol. 2012;46(4):392-394.   Published online August 23, 2012
DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.4.392
  • 4,890 View
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  • 2 Citations
AbstractAbstract PDF

Primary liposarcoma of the lung is an extremely rare disease. To date, only 14 cases have been reported in the literature. We experienced a case of myxoid liposarcoma of the lung treated by surgery. The tumor was well-defined, solid, lobulated mass measuring 3.5×2 cm, involving the bronchus of the left lower lobe. Microscopically, myxoid liposarcoma was identified. The fluorescence in situ hybridization confirmed the presence of a reciprocal translocation involving DNA damage-inducible transcript 3 (DDIT3) and fused in sarcoma (FUS) genes. The patient is still alive with no recurrence or metastasis at the time of writing this report (on 20 months postoperatively). To our knowledge, this is the first cytogenetic case report of pulmonary myxoid liposarcoma.

Primary Endometrial Squamous Cell Carcinoma: A Case Report and Review of Relevant Literature on Korean Women
Sung Jong Lee, Hyun Joo Choi
Korean J Pathol. 2012;46(4):395-398.   Published online August 23, 2012
DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.4.395
  • 5,749 View
  • 48 Download
  • 6 Citations
AbstractAbstract PDF

Primary endometrial squamous cell carcinoma (PESCC) is an extremely rare tumor with unclear pathogenesis. A 54-year-old postmenopausal woman presented with a 6-month history of vaginal bleeding. The patient was provisionally diagnosed with uterine submucosal leiomyoma. This was followed by total hysterectomy with a bilateral salpingo-oophorectomy under the laparoscopic guidance. Histopathologically, the tumor was PESCC which was accompanied by a lack of the tumor in the uterine cervix. The tumor showed positive immunoreactivity for p16INK4a. But there was no evidence of human papillomavirus (HPV) on in situ hybridization and HPV DNA chip analysis. We also present a review of the relevant literature on Korean women.


JPTM : Journal of Pathology and Translational Medicine