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Volume 47(5); October 2013
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Letter to the Editor
Perineural Involvement in Benign Mixed Tumor
Se Jin Jung, Jong Cheol Lee, Hye Jeong Choi, Hee Jeong Cha, Young Min Kim, Young Wha Koh, Jae Hee Suh
Korean J Pathol. 2013;47(5):403-404.   Published online October 25, 2013
DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.5.403
  • 4,679 View
  • 36 Download
  • 2 Citations
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Review & Perspective
Cytotechnologists and On-Site Evaluation of Adequacy
Jennifer A. Collins, Anna Novak, Syed Z. Ali, Matthew T. Olson
Korean J Pathol. 2013;47(5):405-410.   Published online October 25, 2013
DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.5.405
  • 8,985 View
  • 60 Download
  • 22 Citations
AbstractAbstract PDF

While fine needle aspiration (FNA) is certainly not a new biopsy technique, recent developments in advanced imaging techniques, molecular testing, and targeted therapies have coincided with a rapid increase in the number of FNA procedures being performed. Concurrently, the demand for on-site evaluation of adequacy (OSEA) has also increased, outstripping the capacity of available cytopathologists at some institutions. Among the several alternatives to cytopathologist-performed OSEA, cytotechnologist-attended OSEA stands out because it preserves the representation of the pathology service at the time of the procedure. Herein, we review the current literature about OSEA and the necessity of cytotechnologists to expand access of this useful pathology service to a broader patient population. We also examine how cytotechnologists are likely to fit into the emerging practice of telecytology.

Original Articles
Clinicopathological Analysis of Hepatocellular Adenoma According to New Bordeaux Classification: Report of Eight Korean Cases
Hyunchul Kim, Ja-June Jang, Dong-Sik Kim, Beom Woo Yeom, Nam Hee Won
Korean J Pathol. 2013;47(5):411-417.   Published online October 25, 2013
DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.5.411
  • 6,963 View
  • 36 Download
  • 6 Citations
AbstractAbstract PDF
Background

Hepatocellular adenoma (HCA) is a rare benign tumor of the liver. A subtype classification of HCA (hepatocyte nuclear factor 1α [HNF1α]-mutated, β-catenin-mutated HCA, inflammatory HCA, and unclassified HCA) has recently been established based on a single institutional review of a HCA series by the Bordeaux group.

Methods

We used histologic and immunohistochemical parameters to classify and evaluate eight cases from our institution. We evaluated the new classification method and analyzed correlations between our results and those of other reports.

Results

Seven of our eight cases showed histologic and immunohistochemical results consistent with previous reports. However, one case showed overlapping histologic features, as previously described by the Bordeaux group. Four cases showed glutamine synthetase immunohistochemical staining inconsistent with their classification, indicating that glutamine synthetase staining may not be diagnostic for β-catenin-mutated HCA. HNF1α-mutated HCA may be indicated by the absence of liver fatty acid binding protein expression. Detection of amyloid A may indicate inflammatory HCA. HCA with no mutation in the HNF1α or β-catenin genes and no inflammatory protein expression is categorized as unclassified HCA.

Conclusions

Although the new classification is now generally accepted, validation through follow-up studies is necessary.

MAD2 Expression in Ovarian Carcinoma: Different Expression Patterns and Levels among Various Types of Ovarian Carcinoma and Its Prognostic Significance in High-Grade Serous Carcinoma
Po Eun Park, Ji Yun Jeong, Sun Zoo Kim, Ji Young Park
Korean J Pathol. 2013;47(5):418-425.   Published online October 25, 2013
DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.5.418
  • 5,260 View
  • 31 Download
  • 5 Citations
AbstractAbstract PDF
Background

Mitotic arrest deficiency protein 2 (MAD2) is a key component of spindle assembly checkpoint function, which mediates cell apoptosis through microtubule kinetics. Aberrant expression of MAD2 is believed to be associated with the development of chromosome instability. MAD2 also has a signihicant role in cellular drug resistance to taxane chemotherapeutic agents.

Methods

Expression of MAD2 and p53 was investigated using immunohistochemistry in 85 cases of ovarian carcinomas. Clinicopathological data including progression-free survival were analyzed.

Results

A significant (p=.035) association was observed between the grade of serous carcinoma and the expression level of MAD2. While low-grade serous carcinoma showed a low-level expression of MAD2, high-grade serous carcinoma showed a high-level expression of MAD2. We also determined that low-level expression of MAD2 was associated with reduced progression-free survival (PFS) (p=.016) in high-grade serous carcinoma.

Conclusions

MAD2 expression in ovarian carcinoma is related to the grade of serous carcinoma and PFS of high-grade serous carcinoma. Expression level of MAD2 detected by immunohistochemistry may serve as an indicator in predicting the response of microtubule-interfering chemotherapeutic agents.

Histologic Variations and Immunohistochemical Features of Metastatic Clear Cell Renal Cell Carcinoma
Cheol Lee, Jeong-Whan Park, Ja Hee Suh, Kyung Han Nam, Kyung Chul Moon
Korean J Pathol. 2013;47(5):426-432.   Published online October 25, 2013
DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.5.426
  • 7,712 View
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  • 15 Citations
AbstractAbstract PDF
Background

Due to advancements in treatment of metastatic and advanced renal cell carcinoma (RCC), it has become increasingly important to diagnose metastatic RCC and the specific subtype. In this study, we investigated the diverse histologic features of metastatic clear cell renal cell carcinoma (CCRCC) cases in comparison with corresponding primary lesions.

Methods

We identified 119 metastatic CCRCC cases from 81 corresponding primary lesions diagnosed between 1995 and 2010 and evaluated the diverse histologic and immunohistochemical features of these lesions.

Results

A total of 44 primary lesions (54.3%) had a non-clear cell component in addition to a typical clear cell component. Of the 119 metastatic lesions, 63 lesions (52.9%) contained a non-clear cell component, and 29 metastatic lesions were composed of a non-clear cell component only. Rhabdoid features were the most frequent non-clear cell histology among the metastatic lesions. Metastatic CCRCCs mainly showed positive CD10 and epithelial membrane antigen staining and negative cytokeratin 7 staining.

Conclusions

Metastatic CCRCC commonly showed a variety of histologic features. If there is a difficulty to diagnose metastatic CCRCC due to a variety of histologic features or small biopsy specimen, histologic review of the primary lesion and immunohistochemical analysis can help determine the correct diagnosis.

Morphologic Alteration of Metastatic Neuroblastic Tumor in Bone Marrow after Chemotherapy
Go Eun Bae, Yeon-Lim Suh, Ki Woong Sung, Jung-Sun Kim
Korean J Pathol. 2013;47(5):433-442.   Published online October 25, 2013
DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.5.433
  • 5,520 View
  • 35 Download
  • 1 Citations
AbstractAbstract PDF
Background

The aim of this study is to evaluate the histologic features of metastatic neuroblastic tumors (NTs) in bone marrow (BM) before and after chemotherapy in comparison with those of primary NTs.

Methods

A total of 294 biopsies from 48 children diagnosed with NTs with BM metastasis were examined. There were 48 primary neoplasm biopsies, 48 BM biopsies before chemotherapy, 36 primary neoplasm excisional biopsies after chemotherapy, and 162 BM biopsies after chemotherapy.

Results

Metastatic NTs in BM before chemotherapy were composed of undifferentiated and/or differentiating neuroblasts, but had neither ganglion cells nor Schwannian stroma. Metastatic foci of BM after chemotherapy were found to have differentiated into ganglion cells or Schwannian stroma, which became more prominent after further cycles of chemotherapy. Persistence of NTs or tumor cell types in BM after treatment did not show statistically significant correlation to patients' outcome. However, three out of five patients who newly developed poorly differentiated neuroblasts in BM after treatment expired due to disease progression.

Conclusions

Metastatic NTs in BM initially consist of undifferentiated or differentiating neuroblasts regardless of the primary tumor subtype, and become differentiated after chemotherapy. Newly appearing poorly differentiated neuroblasts after treatment might be an indicator for poor prognosis.

Progressive Increase of Regulatory T Cells and Decrease of CD8+ T Cells and CD8+ T Cells/Regulatory T Cells Ratio during Colorectal Cancer Development
Tae Jung Jang
Korean J Pathol. 2013;47(5):443-451.   Published online October 25, 2013
DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.5.443
  • 6,977 View
  • 46 Download
  • 20 Citations
AbstractAbstract PDF
Background

We examined the distribution of CD8+ T cells and regulatory T cells (Tregs), measured the CD8+ T cell/Tregs ratio, investigated the relationship between Tregs and cyclooxygenase-2 (COX-2) expression during colorectal cancer (CRC) development.

Methods

We performed immunohistochemical staining for CD8, forkhead box P3, E-cadherin, and COX-2 in 32 cases of invasive CRC, 10 cases of intramucosal CRC, 27 cases of high-grade tubular adenoma, 22 cases of low-grade tubular adenoma, and 32 cases of non-neoplastic conditions.

Results

We observed a progressive increase in Tregs, and a decrease in CD8+ T cells and the CD8+ T cells/Tregs ratio during CRC development. The alterations were most severe in high-grade tubular adenoma and CRC. COX-2 expression was positively associated with Tregs infiltration. The degree of T cell infiltration differed among tumor compartment and the ratio in the tumor center was the lowest of all areas. The ratio and number of CD8+ T cells in the tumor center and the invasive front of invasive CRC were associated with gender, differentiation, node metastasis and tumor budding.

Conclusions

Alteration in the distribution of both CD8+T cells and Tregs may contribute to the generation of an immune environment suitable for the development and progression of CRC.

ALK-Positive Renal Cell Carcinoma in a Large Series of Consecutively Resected Korean Renal Cell Carcinoma Patients
Cheol Lee, Jeong Whan Park, Ja Hee Suh, Kyung Han Nam, Kyung Chul Moon
Korean J Pathol. 2013;47(5):452-457.   Published online October 25, 2013
DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.5.452
  • 6,456 View
  • 52 Download
  • 27 Citations
AbstractAbstract PDF
Background

Recently, there have been a few reports of renal cell carcinoma (RCC) cases with anaplastic lymphoma kinase (ALK) gene fusion. In this study, we screened consecutively resected RCCs from a single institution for ALK protein expression by immunohistochemistry, and then we performed fluorescence in situ hybridization to confirm the ALK gene alteration in ALK immunohistochemistry-positive cases.

Methods

We screened 829 RCCs by ALK immunohistochemistry, and performed fluorescence in situ hybridization analysis using ALK dual-color break-apart rearrangement probe. Histological review and additional immunohistochemistry analyses were done in positive cases.

Results

One ALK-positive case was found. Initial diagnosis of this case was papillary RCC type 2. This comprises 0.12% of all RCCs (1/829) and 1.9% of papillary RCCs (1/53). This patient was a 44-year-old male with RCC found during routine health check-up. He was alive without evidence of disease 12 years after surgery. The tumor showed a papillary and tubular pattern, and showed positivity for CD10 (focal), epithelial membrane antigen, cytokeratin 7, pan-cytokeratin, PAX-2, and vimentin.

Conclusions

We found the first RCC case with ALK gene rearrangement in Korean patients by ALK immunohistochemistry among 829 RCCs. This case showed similar histological and immunohistochemical features to those of previous adult cases with ALK rearrangement, and showed relatively good prognosis.

Diagnostic Utility of a Clonality Test for Lymphoproliferative Diseases in Koreans Using the BIOMED-2 PCR Assay
Young Kim, Yoo Duk Choi, Chan Choi, Jong-Hee Nam
Korean J Pathol. 2013;47(5):458-465.   Published online October 25, 2013
DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.5.458
  • 7,477 View
  • 73 Download
  • 12 Citations
AbstractAbstract PDF
Background

A clonality test for immunoglobulin (IG) and T cell receptor (TCR) is a useful adjunctive method for the diagnosis of lymphoproliferative diseases (LPDs). Recently, the BIOMED-2 multiplex polymerase chain reaction (PCR) assay has been established as a standard method for assessing the clonality of LPDs. We tested clonality in LPDs in Koreans using the BIOMED-2 multiplex PCR and compared the results with those obtained in European, Taiwanese, and Thai participants. We also evaluated the usefulness of the test as an ancillary method for diagnosing LPDs.

Methods

Two hundred and nineteen specimens embedded in paraffin, including 78 B cell lymphomas, 80 T cell lymphomas and 61 cases of reactive lymphadenitis, were used for the clonality test.

Results

Mature B cell malignancies showed 95.7% clonality for IG, 2.9% co-existing clonality, and 4.3% polyclonality. Mature T cell malignancies exhibited 83.8% clonality for TCR, 8.1% co-existing clonality, and 16.2% polyclonality. Reactive lymphadenitis showed 93.4% polyclonality for IG and TCR. The majority of our results were similar to those obtained in Europeans. However, the clonality for IGK of B cell malignancies and TCRG of T cell malignancies was lower in Koreans than Europeans.

Conclusions

The BIOMED-2 multiplex PCR assay was a useful adjunctive method for diagnosing LPDs.

Fine Needle Aspiration Cytology of Parathyroid Lesions
Ilyeong Heo, Sunhoo Park, Chang Won Jung, Jae Soo Koh, Seung-Sook Lee, Hyesil Seol, Hee Seung Choi, Soo Youn Cho
Korean J Pathol. 2013;47(5):466-471.   Published online October 25, 2013
DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.5.466
  • 7,482 View
  • 68 Download
  • 23 Citations
AbstractAbstract PDF
Background

There has been an increase in the use of fine needle aspiration cytology (FNAC) for the diagnosis of parathyroid lesions (PLs). Differentiation between a thyroid lesion and a PL is not easy because of their similar features. We reviewed parathyroid aspirates in our institution and aimed to uncover trends in diagnostic criteria.

Methods

We selected 25 parathyroid aspirates (from 6 men and 19 women) confirmed surgically or immunohistochemically from 2006 to 2011.

Results

Major architectural findings of PLs include scattered naked nuclei, loose clusters, a papillary pattern with a fibrovascular core, tight clusters, and a follicular pattern. These architectures were commonly admixed with one another. Cytological features included anisokaryosis, stippled chromatin, a well-defined cell border, and oxyphilic cytoplasm. Eighteen of the 25 patients were diagnosed with PL using FNAC. Seven patients had been misdiagnosed with atypical cells (n=2), benign follicular cells (n=2), adenomatous goiter (n=2) and metastatic carcinoma (n=1) in FNAC. Using clinicoradiologic data, the sensitivity of the cytological diagnosis was 86.7%. The cytological sensitivity decreased to 50% without this information.

Conclusions

FNAC of PL is easily confused with thyroid lesions. A combination of cytological parameters and clinical data will be required to improve the diagnostic sensitivity of PLs.

Case Studies
Abdominal Fibromatosis in a Young Child: A Case Study and Review of the Literature
Hyun Hee Chu, Pyoung Han Hwang, Yeon Jun Jeong, Myoung Ja Chung
Korean J Pathol. 2013;47(5):472-476.   Published online October 25, 2013
DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.5.472
  • 6,314 View
  • 28 Download
  • 3 Citations
AbstractAbstract PDF

Fibromatoses comprise many different entities of well-differentiated fibroblastic proliferation with variable collagen production and form a firm nodular mass. Abdominal fibromatosis is distinguishable from other forms of fibromatosis because of its location and its tendency to occur in women of childbearing age during or following pregnancy. Abdominal fibromatosis in children is an extremely rare condition. A 15-month-old boy presented with an abdominal wall mass that had recently increased in size. Mass excision was perfomed. The tumor was 4.3×4.1 cm and partly circumscribed. Histologically, the tumor was composed of parallel long fascicles of spindle-cells with a uniform appearance. The edges of the resected mass were infiltrative, and the surgical margins were positive. Mitotic figures were <1/10 high power fields. No cellular atypia or necrosis was present. The tumor cells were positive for vimentin and nuclear β-catenin staining.

Cotyledonoid Dissecting Leiomyoma of the Uterus with Intravascular Luminal Growth: A Case Study
Na Rae Kim, Chan Yong Park, Hyun Yee Cho
Korean J Pathol. 2013;47(5):477-480.   Published online October 25, 2013
DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.5.477
  • 8,544 View
  • 55 Download
  • 4 Citations
AbstractAbstract PDF

Here, we report the case of a 43-year-old female who was diagnosed with a cotyledonoid dissecting leiomyoma (CDL) of the uterus. CDL is a recently described and extremely rare variant of a benign leiomyoma that can grossly masquerade as a malignancy. The 13-cm sized tumor was located primarily on the extrauterine surface as an intrauterine continuity, which showed dark red, congested, bulbous protuberances. It was multinodular appearance, encasing the bilateral adnexae and the left iliac vein. Microscopically, the nodules were separated by extensive hydropic degeneration. The nodules were composed of cigar-shaped spindle cells with no mitosis, cellular pleomorphism or coagulation necrosis. They also showed an intravascular luminal growth pattern. CDL with intravascular growth was diagnosed after excluding intravascular leiomyomatosis, disseminated peritoneal leiomyomatosis, and benign metastasizing leiomyoma. The present case is the second reported case of CDL in Korea. Recognition of this rare and bizarre, malignancy-mimicking leiomyoma is crucial to prevent inappropriate treatment.

Fine-Needle Aspiration Cytology of Low-Grade Cribriform Cystadenocarcinoma with Many Psammoma Bodies of the Salivary Gland
Ji Yun Jeong, Dongbin Ahn, Ji Young Park
Korean J Pathol. 2013;47(5):481-485.   Published online October 25, 2013
DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.5.481
  • 5,553 View
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  • 9 Citations
AbstractAbstract PDF

Low-grade cribriform cystadenocarcinoma (LGCCC) is a rare salivary gland tumor that was recently defined as a variant of cystadenocarcinoma by the 2005 World Health Orgazniation (WHO) classification system. We report cytologic findings of an unusual case of LGCCC with many psammoma bodies. A 90-year-old man presented a palpable mass on his left parotid gland. Fine-needle aspiration (FNA) cytology showed tumor cells that were arranged in clusters and dispersed individually. The tumor cells showed mild atypia and had clear or dense cytoplasm with some vacuoles. Numerous psammoma bodies were noted. After surgical resection, the histologic examination revealed a mixed solid and cystic mass showing intraductal growth with focal stromal invasion. The S-100 protein expressed in the tumor cells, but smooth muscle actin and p63 were positive only in myoepithelial cells. Although LGCCCs resemble other salivary gland tumors, differentiating LGCCC during preoperative FNA is important to avoid unnecessary overtreatment.

Brief Case Reports
A Primary Malignant Rhabdoid Tumor in Adult Liver
Yu Na Kang, Sang Pyo Kim, Byoung Kuk Jang
Korean J Pathol. 2013;47(5):486-488.   Published online October 25, 2013
DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.5.486
  • 5,656 View
  • 37 Download
  • 4 Citations
PDF
Nesidioblastosis and Pancreatic Non-functioning Islet Cell Tumor in an Adult with Type 2 Diabetes Mellitus
Ji Eun Choi, Sang Jae Noh, Jong Jin Sung, Woo Sung Moon
Korean J Pathol. 2013;47(5):489-491.   Published online October 25, 2013
DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.5.489
  • 6,438 View
  • 58 Download
  • 8 Citations
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JPTM : Journal of Pathology and Translational Medicine