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Volume 7(2); December 1996
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Etcs
Histopathological Classification of Nephrotic Syndrome in Korean Adults
Hyun Soon Lee, Yong Il Kim, Sang Kook Lee
Korean J Cytopathol. 1973;7(2):81-88.
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AbstractAbstract
A light microscopic study of renal biopsy specimens from forty six cases of adult nephrotic syndrome, during a period of 1967 to 1973 at Seoul National University Hospital, was carried out and correlated to the response to corticosteroid therapy. These were classified into minimal change (8 cases), focal glomerulosclerosis (2 cases), mesangial proliferative glomerulonephritis (9 cases), membranoproliferative glomerulonephritis (14 cases), (epi)membranous nephropathy (4 cases), diabetes mellitus (5 cases), and chronic glomerulonephritis (4 cases). The frequency distribution of the three main histological groups was ‘membranoproliferative glomerulonephritis’ 30.4% ’mesangial proliferative glomerulonephritis’ 19.6% and ’minimal change’ 17.4% The much lower incidence of membranous nephropathy was assumed to reflect the use of stricter histological criteria and/or geographical difference. Among 8 cases with minimal changes, who were mostly males, 6 cases revealed complete remission by corticosteroid therapy. Though total 3 cases of focal glomerulosclerosis and membranoproliferative glomerulonephritis responded completely to steroid therapy, most cases with various structural glomerular alterations rather exhibited poor remission by treatment.
A Study on Malignant Lymphoma and Lymphoid Leukemia -It’s Differential Diagnosis from the Hematological Cytological and Histopathological Aspects-
Yeong Hi Choi, Sang In Kim
Korean J Cytopathol. 1973;7(2):91-101.
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AbstractAbstract
As it has been experienced that the differential diagnosis of malignant lymphoma and lymphoid leukemia is a quite frequent problem to the hematologists and surgical pathologists, we made an attempt to clarify it from the hematological, cytological and histopathological aspects with the accumulated materials at the Section of Hematology and Surgical Pathology, Clinical Laboratories, College of Medicine, Seoul National University. The materials consisted of 153 cases of malignant lymphoid and 3 cases of lymphoid leukemia diagnosed by lymph node biopsy, and 101 cases of lymphoid leukemia and 36 cases of malignant lymphoma diagnosed by peripheral blood and bone marrow examinations during the period of January 1969 to September 1973. Original diagnosis were re-evaluated and the results were summerized as follows : 1. Among 153 cases of malignant lymphoma were 73 cases of lymphocytic type, 44 histiocytic type, 8 mixed type, 14 Hodgkin’s disease 14 undifferentiated and unclassified type. While in lymphoid leukemia, 99 were acute type and only 2 cases were chronic type. 2. Leukemic manifestations in the peripheral blood were observed in 25% out of 153 cases of malignant lymphoma. 3. Male to female sex ratio was 2.0 : 1 in malignant lymphoma, while it was 1.8 : 1 in acute lymphoid leukemia. 4. The peak age incidence was 30 to 45 years of age in malignant lymphoma but in acute lymphoid leukemia it ranged from 1 to 15 years of age. 5. The hemoglobin and Hct. in initial stage of diagnosis revealed normal or slightly decreased values in majority cases of malignant lymphoma while it revealed moderate to marked decrease in acute lymphoid leukemia. 6. WBC counts at the initial stage of malignant lymphoma were normal or moderately decreased in majority of cases, but majority of acute lymphoid leukemia case revealed either marked leukocytosis or marked leukopenia. 7. In differential counts, the malignant lymphoma cases without leukemic manifestations revealed marked lymphopenia while those cases of lymphoma with leukemic manifestations revealed considerable increase in number of lymphoid cells but far less than that of acute lymphoid leukemia. Presence of immature granulocytes and eosinophils in peripheral blood was a frequent association of the malignant lymphoma. 8. Lymphosarcoma cells in peripheral blood was a prominent feature of the malignant Iymphoma, however differential diagnosis between each type of lymphoma was extremely difficult by cytological characteristics. 9. Of bone marrow differential count, the mean value of lymphoid cells was 27.4% in total cases of malignant lymphoma and there appeared relatively more lymphoid cells in those cases with leukemic manifestations in peripheral blood while it was 76.6% in acute lymphoid leukemia. Normoblasts, megakaryocytes and granulocytes were relatively high in number in the malignant lymphoma while they were markedly depressed in acute lymphoid leukemia. 10. Histo-pathological findings of lymph node biopsy of the acute lymphoid leukemias comparing to those of lymphoma illustrated monotonous and uniform cellular pattern, less mitosis, more fibrosis, diffuse invasion of capsules and evidences of extramedulary hemopoiesis in subcapsular spaces.
Experimental Studies on Relationship between Hyperplastic Hepatic Nodule and Hepatic Megalocytosis of the Liver
Chong Man Kim, Yong Il Kim, Chae Koo Lee
Korean J Cytopathol. 1973;7(2):103-109.
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AbstractAbstract
Experimental induction of hyperplastic hepatic nodules was carried out by administration of p-dimethylaminoazobenzene in rats, to correlate with hepatic megalocytosis and to clarify sequence of precancerous lesion. Hyperplastic hepatic nodules and megalocytosis were induced in most of rats following administration of p-DAB : megalocytosis developed during the initial phase (before the 12th wk) of carcinogenesis, and showed a tendency to spread panlobularly from periportal distribution. Those paralleled with increase of compensatory mitotic index following hepatic cell damages by ingestion of p-DAB. Megalocytic index diminished during the phase of hyperplastic nodules and hepatocellular carcinomas, and illustrated no direct relationship with carcinogenesis. Number of hyperplastic nodules regressed with prolongation of experimental duration after cessation of administrating p-DAB. There was a strong evidence to indicate that megalocytosis and compensatory proliferation of hepatocytes would preceed in the p-DAB induced hepatic carcinogenesis and the latter only undergoes into precancerous phase of hyperplastic hepatic nodule.
Original Article
A Study of Usefulness of Fine Needle Aspiration Cytology of the Thyroid Lesions.
Kye Hyun Kwon, So Young Jin, Dong Wha Lee
Korean J Cytopathol. 1996;7(2):111-121.
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AbstractAbstract PDF
Fine needle aspiration cytology(FNAC) is preferred because of simplicity, safety, and reliability in the evaluation of patients with thyroid nodule or hyperplasia. However, there are a few limitations such as false-negative or false-positive cases and nondiagnostic material. To evaluate the usefulness of FNAC in thyroid lesions, we reviewed 704 FNAC cases of thyroid nodules from 1988 to 1994 at Soonchunhyang University Hospital. The results are as follows. 1. Among 704 FNAC cases of thyroid gland, 571(81.1%) cases were benign, 12 (1.7%0) were suspicious, 71(10.1%0) were malignancy, and 50(7.1%)-were material insufficiency. The cytologic diagnoses of the benign lesions included 168 cases of follicular neoplasm, 139 cases of adenomatous goiter, 162 cases of follicular lesion such as follicular neoplasm or adenomatous goiter, 61 cases of Hashimoto's thyroiditis, 13 cases of subacute thyroiditis, and 28 cases of colloidal nodule or benign nodule. The malignant lesions included 68 cases of papillary carcinoma, two medullary carcinomas and a case of metastatic colon cancer. 2. The average number of cytologic smear slides was 4.12+/-1.81 in material insufficiency and 5.63+/-1.79 in diagnostic cases. This difference was statistically significant(p<0.00001). 3. Histological assessment of 150 cases revealed 2 false negative and 1 false positive cases. The false negative cases were a case of marked sclerosis in papillary carcinoma and an occult case of papillary, carcinoma. The false positive case resulted from pseudo-ground glass nuclei due to marked dry artifact. 4. Comparison between the FNAC and the histologic diagnosis revealed that INAC had a sensitivity of 93.5%, a specificity of 99.2%, a false negative rate of 64%, a false positive rate of 0.8%, and an overall diagnostic accuracy of 98.0%. Therefore, FNAC of thyroid gland is a very reliable diagnostic method with excellent accuracy rate.
Etcs
Atypical Fibroadenomas of Breast in Women Receiving Oral Contraceptives -A Histological Reappraisal-
Jung Bin Lee, Yong Il Kim, Chae Koo Lee
Korean J Cytopathol. 1973;7(2):111-119.
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AbstractAbstract
Histopathological features of 4 atypical fibroadenomas of breast in women receiving oral contraceptives were compared with those of fibroadenomas in lactating and pregnant period and common fibroadenomas, to specify morphological characteristics of these atypical neoplastic growths and to correlate with administration of oral contraceptives. Fibroadenomas found among women taking contraceptive pills were able to divide into 2 types ; atypical glandular and ductal hyperplasia with secretory activity (epithelial type), and stromal cell hyperplasia with more prominent cleft formation of ducts with or without multinucleated cells (stromal type). They appeared partly similar to those seen in 5 fibroadenomas in lactating and pregnant period. It was highly suggestive that atypicality of fibroadenomas of the women receiving oral contraceptives may be related to high hormonal millieu. However, at present, it is hard to determine definite cause-and-result relationship between the atypical features and administration of oral contraceptives.
Studies on the Normal Values of Clinical Chemistry among Koreans
Chang-Se Kim, Man-Hee Cho, Jong-Hee Cha, Choon-Nam Koh, Je-Yoon Park
Korean J Cytopathol. 1973;7(2):121-126.
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AbstractAbstract
The normal values of clinical chemistry among Koreans were calculated based on the laboratory records, and were obtained by means of N.E.D. and probability graph. The probability graph was more superior than N.E.D. in comparison with those two methods. The values calculated by authors among Koreans were lower than western countries in view of normal value (mid-point of normal range) and were wider than those in normal range.
Original Article
Diagnostic Accuracy of Fine Needle Aspiration Cytology in Thyroid Lesions: Analysis of Histologically Confirmed 153 Cases.
Kyeong Mee Park, Ill Hyang Ko
Korean J Cytopathol. 1996;7(2):122-133.
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AbstractAbstract PDF
This is a retrospective review of fine-needle aspiration cytology(FNAC) smears of 153 cases of thyroid disease performed during August 1989 to July 1995, which were confirmed histologically following surgical operations. FNAC results showed 63 cases(41.2%) of adenomatous goiter, 45 cases(29.4%) of papillary carcinoma, 29 cases(19.0%) of follicular neoplasm, 4 cases(2.6%) of follicular variant of papillary carcinoma, 4 cases(2.6%) of Hashimoto's thyroiditis, 4 cases(2.6%) of Hurthle cell neoplasm, 2 cases(1.3%) of medullary carcinoma and one case(O.7%) each of subacute thyroiditis and of anaplastic carcinoma. The overall accuracy of cytological diagnosis was 83.7%. These data strongly suggest thyroid FNAC is a reliable preoperative diagnostic tool, but FNAC has been less valuable in the diagnosis of follicular lesions than any other disease of the thyroid. Adenomatous goiter was not infrequently interpreted as follicular neoplasia that requires surgery for diagnostic .conformation and vice versa. The following findings are considered to be compatible with follicular neoplasm: 1) microfolticles, 2) nuclear grooving, 3) irregularity of nuclear membrane, and 4) irregular arrangement or crowding of follicular cells in groups. The FNAC criteria of adenomatous goiter are as follows: 1) atrophic follicular cells, 2) presence of macrophages, 3) abundant colloid, and 4) large follicles. It is recommended that aspiration of thyroid lesions in order to analyse with critical clinico pathological approach and surgery is considered only for nodules that are clinically suspicious or unresponsive to hormone therapy or when a diagnosis of follicular neoplasm is made.
Etc
Alveolar Cell Carcinoma of the Lung -An Electron Microscopic Study-
Geung Hwan Ahn, Jae Yun Ro, Won Ha Yoo, Sun Ho Kim, Hyun Pil Shin, Sang Bin Park, Chung Kil Kim*, Jung Suk Kim**, Chan Il Park**, Yoo Bock Lee**, Sang Kook Lee***, Eui Keun Ham***, Yong Il Kim***
Korean J Cytopathol. 1973;7(2):127-134.
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AbstractAbstract
Alveolar cell carcinoma constitutes only 1 to 8% of all primary lung malignancies but it has occasioned considerable controversy about its histogenesis, morphology and prognostic implication. Authors experienced recently a case of alveolar cell carcinoma of the lung occurring in a 64-year-old male. He was admitted for the evaluation of coughing and expectoration of sputum for 3 months. X-ray film of chest showed diffuse radio-opacity of the left lower lobe of lung. Bronchoscopy was unrevealing. Exploratory thoracotomy and left lower lobectomy was performed to show diffuse consolidation involving entire left lower lobe of the lung. Grossly, cut surface exhibited diffusely yellow white or pale grayish firm lobar consolidation, which resembled lobar pneumonia in the stage of gray hepatization or lipoid pneumonia. Microscopically, proliferating columnar epithelia were supported by thin or slightly thickened alveolar septa, presenting an alveolar pattern of growth. Electron microscopically, the tumor cells lining the alveolar basement membrane had ultrastructural features resembling pneumonocyte type B. It was concluded that the tumor cells in this alveolar cell carcinoma were derived from pneumonocyte type B.
Original Articles
Demonstration of TCM-9 Monoclonal Antibody in Follicular Neoplasm of Thyroid.
Yun Jung Kim, Jung Weon Shim, Hye Kyung Ahn, Young Euy Park
Korean J Cytopathol. 1996;7(2):134-137.
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AbstractAbstract PDF
Monoclonal antibody(TCM-9) against human thyroid cancers have been studied by screening with human thyroid cancers, normal and benign thyroid tissue, and normal human serum protein. A monoclonal antibody(TCM-9) that is known to have strong specificity for human thyroid cancer but not for Graves' disease, adenoma or normal thyroid does not bind to native or mature human thyroglobulin(Tg). We used to TCM-9 antibody by immunohistochemical staining on 5 follicular cancer, 2 follicular adenoma, 1 follicular neoplasm with suspicious invasion, 2 papillary cancer to ascer- tain being of help in differentiation between follicular carcinoma and adenoma. Reactivity of TCM-9 was observed in follicular carcinoma and papillary carcinoma but not observed in follicular adenoma. Thus TCM-9 is a novel monoclonal antibody against the thyroid cancer.
Diagnostic Value of p53 Expression in the Evaluation of Effusions.
Jin Shin Lee, Chang Soo Park
Korean J Cytopathol. 1996;7(2):138-143.
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AbstractAbstract PDF
The diagnostic accuracy of routine cytological preparations from effusions ranges from 60% to 70%. Immunohistochemical markers, especially tumor-associated antigens, have been successfully employed to increase diagnostic sensitivity in effusion cytology. However, more than two different antibodies in diagnosis of effusions are needed. In the view of prevalence of abnormalities of p53 gene in human malignancies, we investigated the diagnostic usefulness of demonstration of p53 protein immunoreactivity in distinguishing benign changes versus malignant processes in effusions. p53 protein expression was studied immunohistochemically in 76 effusions(28 malignant and 48 benign) using anti-human p53 antibody. p53 immunoreactivity was identified in 19 of 28(67.9%) malignant effusions. In contrast, no p53 immunoreactivity was!, observed in all benign effusions. A specificity of 100% and a sensitivity of 67.9% Were observed. These results suggest that immunohistochemical detection of p53 protein seems to be helpful in distinguishing benign changes versus malignant processes in effusions, although its principal limitation is-its relatively low sensitivity.
Immunohistochemical Detection of p53 Gene Mutation in Urine Samples in the Patients with Bladder Cancer.
Sang Sook Lee, Ji Yeon Bae, Yu Na Kang, Young Rok Cho, Nam Jo Park, Seun Young Kim, Jung Hi Kim
Korean J Cytopathol. 1996;7(2):144-150.
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AbstractAbstract PDF
Although bladder cancers are very common, little is known about their molecular pathogenesis. It is known, that p53 alteration is found in about 60%p of muscleinvasive bladder cancer, necessiating aggressive therapy and poor outcome. We examined the nuclear expression of p53 protein, using D07 monoclonal antibody in the urine samples, from 31 patients with transitional cell carcinoma of the bladder to investigate the correlation of p53 overexpression with histologic grades and depth of invasion. The positive rate of p53 protein was 27%o in superficial bladder tumor, but increased up to 71% in the invasive bladder carcinomas. The overexpression of p53 protein increased according to Mostofi grading system from 18% in grade I, 45% in grade Il, and up to 100% in grade ill. The p53 expression tended to be higher in the invasive and high grade bladder cancers than in the superficial and low grade ones(p<0.05). These results suggest that immunohistochemical analysis of the urine specimen in the bladder cancer patients could be a useful method of screening for the presence of p53 mutant protein. The mutant p53 protein expression may be an indicator of bladder cancer with more proliferative potential and/or aggressive biologic behavior.
Cytologic Features of Benign Phyllodes Tumors as Compared to Fibroadenomas of the Breast.
Jae Hee Suh, Gyung Yub Gong, Jeong Mi park, Sei Hyun Ahn, On Ja Kim
Korean J Cytopathol. 1996;7(2):151-156.
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AbstractAbstract PDF
Phyllodes tumor(PT) is a rare distinctive fibroepithelial breast tumor that occasionally shows unpredictable clinical behavior. Wide excision should be the primary treatment of PT and enucleation, the standard procedure for fibroadenoma(FA), is proscribed due to high frequency of local recurrence. Therefore an accurate preoperative diagnosis of PT is essential in order to ensure proper surgical treatment. However, the differentiation between benign PT and FA is often difficult on the basis of cytologic findings. In an attempt to better understand the cytologic features of benign PT and possibly to differentiate PT from FA on the findings of fine needle aspiration(FNA)smears, we reviewed cytologic smears from 22 histologically diagnosed cases each of benign PT and FA, respectively. The cytologic features assessed were cellularity and atypia of both epithelial and stromal components, and shape of epithelial cell clusters. Atypia of stromal cells was more frequent in PT, while blunt branching pattern of epithelial cells was more frequent in FA. The specific cytologic diagnosis of PT is not possible in many cases, but the abundance of stromal cells with moderate nuclear atypia in the correct clinical setting such as older age and larger size(>4cm) allows the diagnosis.
Value of Fine Needle Aspiration Cytology of Mucinous Carcinoma of the Breast.
Yoon Jung Kim, Gyung Yub Gong, Joo Ryung Huh, Jeong Mi Park, Sei Hyun Ahn, On Ja Kim
Korean J Cytopathol. 1996;7(2):157-162.
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AbstractAbstract PDF
Fine needle aspiration(FNA) is an effective tool in diagnosing mammary carcinoma, We experienced 7 cases of histologically confirmed mammary mucinous carcinoma among 3,052 aspirated cases of breast from 1992 to 1996 in Asan Medical Center" The average age of the patient was 48(33-64) years. The mean size of the lesions was 1.6(0.7-3) cm, and they were palpated as well-defined, firm to hard masses. The cytologic features that may be useful in making a FNA diagnosis of mucinous carcinoma of the breast were analysed. Mucinous background and tumor cell, clusters with occasional single cells were observed in all cases. Among them, two, cases showed abundant scattered single cells, whereas only few single cells were seen in the other two cases. Tumor cells exhibited mild pleomorphism in four cases, and moderate pleomorphism in three cases. Nucleoli tended to be not prominen and are observed in three cases, rarely noted in other three cases and not seen in one. There was microcalcification in four cases(57%). In conclusion, mucinous background and clustered tumor cells showing mild td moderate pleomorphism with characteristic clinical findings allow us to diagnose, mucinous carcinoma of the breast.
Diagnostic Application of p53 IMMUNOSTAINING in Bronchial Brush Specimens.
Sang Sook Lee, Ji Yeon Bae, Yu Na Kang, Young Rok Cho, Si Nam Kim, Nam Jo Park, Seun Young Kim, Jung Hi Kim
Korean J Cytopathol. 1996;7(2):163-168.
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AbstractAbstract PDF
Abnormalities of p53 gene are common in lung cancers and are associated with immunologically detectable p53 protein. p53 immunoreactivity is uncommon in normal cells but is frequently seen in neoplasia. Therefore, assessment of p53 expression may assist in the cytological diagnosis of malignancy. The usefulness of p53 immunostaining as a marker of malignancy in the cytological analysis of bronchial brush specimens from the patients with lung cancers was investigated in this study. A total of 71 bronchial brush samples submitted for cytologic diagnosis were immunostained with D07, a monoclonal antibody to recombinant p53 protein.
Result
ant p53 data were correlated with cytologic diagnosis and clinical information. Of the 17 smears with a benign cytodiagnosis, all were p53 negative. Of the 40 cases with a malignant cytodiagnosis(histologically confirmed), 35 were p53 positive and 5 were negative. Of the 14 cases that were cytologically suspicious but nondiagnostic for malignancy, 11 were p53 positive, 9 of which were subsequently proved to be malignant by histologic examination, and the remaining 2 cases were tuberculosis clinically. Forty four of 51 histologically confirmed lung carcinomas were p53 positive, including 25 of 28 squamous cell carcinomas, 13 of 17 small cell carcinomas, 3 of 3 adeno- carcinomas, and 3 of 3 large cell undifferentiated carcinomas. These results suggest that p53 immunostaining could be of value as a marker of malignancy in the cytologic examination of bronchial brush specimens. Furthermore, we have shown the possible clinical utility of p53 immunostaining in cytopathological diagnosis, that is, as a valuable adjunct to morphological assessment in the analysis of cytopathologically suspicious cases.
Crush Cytology Features and Differential Diagnosis of Meningiomas and Schwannomas in Central Nervous System.
Young Ju Kim, Mi Yeong Jeon, Young Il Yang, Chan Hwan Kim, Hae Kyoung Yoon, Shin Kwang Khang
Korean J Cytopathol. 1996;7(2):169-176.
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AbstractAbstract PDF
This study was performed in order to evaluate the usefulness of the crush cytologic features and differential diagnosis between meningiomas and schwannomas in the central nervous system. Deeply seated and unusually located meningiomas and schwannomas with equivocal or erroneous frozen section diagnosis can be correctly diagnosed cytologically in crush preparations. Twenty-four meningiomas and nine schwannomas were studied by frozen section and crush preparation technique. These tumors displayed distinctive cytologic features. In meningiomas, the tumor tissue fragments were easy to crush, and the tumor cells were arranged in small clusters, flat sheets, papilla-like, whorling pattern or singly. Individual tumor cells displayed round or oval nuclei with finely granular chromatin pattern and inconspicuous small nucleoli. Occasionally psammoma bodies, nuclear pseudoinclusion or nuclear grooves were found. In schwannomas, tissue fragments were hard in consistency and difficult to crush. The crushed tissue presented as thick, irregular fragments with sharp borders. The cells showed ill-defined cytoplasm and round, oval, cigar-shaped or curved nuclei. It is important to emphasize that the smear pattern under low-power view and cytologic features are helpful in discriminating between these two tumors.

JPTM : Journal of Pathology and Translational Medicine