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Case Study
Squamous Cell Carcinoma of the Extrahepatic Common Hepatic Duct
Myunghee Kang, Na Rae Kim, Dong Hae Chung, Hyun Yee Cho, Yeon Ho Park
J Pathol Transl Med. 2019;53(2):112-118.   Published online October 1, 2018
DOI: https://doi.org/10.4132/jptm.2018.09.03
  • 6,853 View
  • 170 Download
  • 8 Web of Science
  • 9 Crossref
AbstractAbstract PDF
We report a rare case of hilar squamous cell carcinoma. A 62-year-old Korean woman complaining of nausea was referred to our hospital. Her biliary computed tomography revealed a 28 mm-sized protruding solid mass in the proximal common bile duct. The patient underwent left hemihepatectomy with S1 segmentectomy and segmental excision of the common bile duct. Microscopically, the tumor was a moderately differentiated squamous cell carcinoma of the extrahepatic bile duct, without any component of adenocarcinoma or metaplastic portion in the biliary epithelium. Immunohistochemically, the tumor was positive for cytokeratin (CK) 5/6, CK19, p40, and p63. Squamous cell carcinoma of the extrahepatic bile duct is rare. To date, only 24 cases of biliary squamous cell carcinomas have been reported. Here, we provide a clinicopathologic review of previously reported extrahepatic bile duct squamous cell carcinomas.

Citations

Citations to this article as recorded by  
  • Cholangiocarcinoma With Liver Metastasis in Squamous Cell Carcinoma Type: A Case Report
    Jane Chiang
    Journal of Diagnostic Medical Sonography.2024; 40(6): 609.     CrossRef
  • A Rare Case of Squamous Cell Carcinoma of the Bile Duct
    Julianna Tantum, Rachael Schneider, Stefanie Gallagher, Kyley Leroy, Jared Lander, Patricia Wong
    ACG Case Reports Journal.2023; 10(8): e01119.     CrossRef
  • Metastatic Anal Squamous Cell Carcinoma Presenting as an Indeterminate Biliary Stricture Diagnosed By Cholangioscopy
    Ritu Nahar, Ian Holmes, Jeffrey Baliff, Austin Chiang, Thomas Kowalski
    ACG Case Reports Journal.2022; 9(6): e00785.     CrossRef
  • Temporal Changes in Cholangiocarcinoma Incidence and Mortality in the United States from 2001 to 2017
    Milind Javle, Sunyoung Lee, Nilofer S Azad, Mitesh J Borad, Robin Kate Kelley, Smitha Sivaraman, Anna Teschemaker, Ishveen Chopra, Nora Janjan, Shreekant Parasuraman, Tanios S Bekaii-Saab
    The Oncologist.2022; 27(10): 874.     CrossRef
  • PRIMARY SQUAMOUS CELL CARCINOMA OF THE COMMON BILE DUCT WITH LIVER METASTASES
    Dhouha BACHA, Mohamed HAJRI, Wael FERJAOUI, Ghofrane TALBI, Lasaad GHARBI, Mohamed Taher KHALFALLAH, Sana ben SLAMA, Ahlem LAHMAR
    ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo).2021;[Epub]     CrossRef
  • S1510 A Rare Case of Squamous Cell Carcinoma of the Bile Duct
    Stefanie Gallagher, Kyley Leroy, Julianna Tantum, Babak Etemad
    American Journal of Gastroenterology.2021; 116(1): S688.     CrossRef
  • Heparin

    Reactions Weekly.2019; 1752(1): 184.     CrossRef
  • Carcinoma primario de células escamosas del conducto hepático común: a propósito de un caso
    Ana Delgado Maroto, Andrés Barrientos Delgado, Marta Lázaro Sáez, Samia Hallouch Toutouh, Enrique Práxedes González
    Gastroenterología y Hepatología.2019; 42(7): 436.     CrossRef
  • Primary squamous cell carcinoma of the extrahepatic bile duct: A case report
    Ana Delgado Maroto, Andrés Barrientos Delgado, Marta Lázaro Sáez, Samia Hallouch Toutouh, Enrique Práxedes González
    Gastroenterología y Hepatología (English Edition).2019; 42(7): 436.     CrossRef
Original Articles
Myoferlin Expression and Its Correlation with FIGO Histologic Grading in Early-Stage Endometrioid Carcinoma
Min Hye Kim, Dae Hyun Song, Gyung Hyuck Ko, Jeong Hee Lee, Dong Chul Kim, Jung Wook Yang, Hyang Im Lee, Hyo Jung An, Jong Sil Lee
J Pathol Transl Med. 2018;52(2):93-97.   Published online March 14, 2018
DOI: https://doi.org/10.4132/jptm.2017.11.29
  • 6,271 View
  • 117 Download
  • 11 Web of Science
  • 9 Crossref
AbstractAbstract PDF
Background
For endometrioid carcinoma patients, International Federation of Gynecologists and Obstetricians (FIGO) histologic grading is very important for identifying the appropriate treatment method. However, the interobserver discrepancy with this three-tiered grading system is a serious potential problem. In this study, we used immunohistochemistry to analyze the relationship between FIGO histologic grading score and myoferlin expression.
Methods
We studied the endometrioid carcinoma tissues of 60 patients from Gyeongsang National University Hospital between January 2002 and December 2009. Immunohistochemical analysis of myoferlin was performed on tissue microarray blocks from surgical specimens.
Results
Myoferlin expression was observed in 58 of 60 patients. Moderate and strong myoferlin expression was observed in low-grade endometrioid carcinoma, while there was a tendency toward loss of myoferlin expression in high-grade endometrioid carcinoma (p<.001).
Conclusions
Our study revealed that myoferlin loss is significantly correlated with high FIGO grade of endometrioid carcinoma.

Citations

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  • Myoferlin: A Potential Marker of Response to Radiation Therapy and Survival in Locally Advanced Rectal Cancer
    Hayley Fowler, Rachael E. Clifford, David Bowden, Paul A. Sutton, Naren Govindarajah, Matthew Fok, Mark Glenn, Michael Wall, Carlos Rubbi, Simon J.A. Buczacki, Amit Mandal, Hayley Francies, Jonathan Hughes, Jason L. Parsons, Dale Vimalachandran
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  • Neoexpression of JUNO in Oral Tumors Is Accompanied with the Complete Suppression of Four Other Genes and Suggests the Application of New Biomarker Tools
    Dominik Kraus, Simone Weider, Rainer Probstmeier, Jochen Winter
    Journal of Personalized Medicine.2022; 12(3): 494.     CrossRef
  • Correlation between myoferlin expression and lymph node metastasis in papillary thyroid carcinoma
    Ji Min Na, Dong Chul Kim, Dae Hyun Song, Hyo Jung An, Hyun Min Koh, Jeong-Hee Lee, Jong Sil Lee, Jung Wook Yang, Min Hye Kim
    Journal of Pathology and Translational Medicine.2022; 56(4): 199.     CrossRef
  • PINCH-1 interacts with myoferlin to promote breast cancer progression and metastasis
    Tao Qian, Chengmin Liu, Yanyan Ding, Chen Guo, Renwei Cai, Xiaoxia Wang, Rong Wang, Kuo Zhang, Li Zhou, Yi Deng, Chuanyue Wu, Ying Sun
    Oncogene.2020; 39(10): 2069.     CrossRef
  • Human colon cancer cells highly express myoferlin to maintain a fit mitochondrial network and escape p53-driven apoptosis
    Gilles Rademaker, Brunella Costanza, Justine Bellier, Michael Herfs, Raphaël Peiffer, Ferman Agirman, Naïma Maloujahmoum, Yvette Habraken, Philippe Delvenne, Akeila Bellahcène, Vincent Castronovo, Olivier Peulen
    Oncogenesis.2019;[Epub]     CrossRef
  • Prognostic significance of immunohistochemical staining for myoferlin in clear cell renal cell carcinoma and its association with epidermal growth factor receptor expression
    Minsun Jung, Cheol Lee, Jeong Hwan Park, Kyung Chul Moon
    Urologic Oncology: Seminars and Original Investigations.2019; 37(11): 812.e9.     CrossRef
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    Olivier Peulen, Gilles Rademaker, Sandy Anania, Andrei Turtoi, Akeila Bellahcène, Vincent Castronovo
    Cells.2019; 8(9): 954.     CrossRef
  • Myoferlin, a multifunctional protein in normal cells, has novel and key roles in various cancers
    Wei Zhu, Bolun Zhou, Chenxuan Zhao, Zhengqing Ba, Hongjuan Xu, Xuejun Yan, Weidong Liu, Bin Zhu, Lei Wang, Caiping Ren
    Journal of Cellular and Molecular Medicine.2019; 23(11): 7180.     CrossRef
  • Myoferlin, a Membrane Protein with Emerging Oncogenic Roles
    Yimin Dong, Honglei Kang, Huiyong Liu, Jia Wang, Qian Guo, Chao Song, Yunlong Sun, Ya Zhang, Honghua Zhang, Zheng Zhang, Hanfeng Guan, Zhong Fang, Feng Li
    BioMed Research International.2019; 2019: 1.     CrossRef
Evaluation of Pathologic Complete Response in Breast Cancer Patients Treated with Neoadjuvant Chemotherapy: Experience in a Single Institution over a 10-Year Period
Misun Choi, Yeon Hee Park, Jin Seok Ahn, Young-Hyuck Im, Seok Jin Nam, Soo Youn Cho, Eun Yoon Cho
J Pathol Transl Med. 2017;51(1):69-78.   Published online December 25, 2016
DOI: https://doi.org/10.4132/jptm.2016.10.05
  • 10,615 View
  • 266 Download
  • 21 Web of Science
  • 20 Crossref
AbstractAbstract PDF
Background
Pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) has been associated with favorable clinical outcome in breast cancer patients. However, the possibility that the prognostic significance of pCR differs among various definitions has not been established. Methods: We retrospectively evaluated the pathologic response after NAC in 353 breast cancer patients and compared the prognoses after applying the following different definitions of pCR: ypT0/is, ypT0, ypT0/is ypN0, and ypT0 ypN0. Results: pCR was significantly associated with improved distant disease-free survival (DDFS) regardless of the definition (ypT0/is, p = .002; ypT0, p = .008; ypT0/is ypN0, p < .001; ypT0 ypN0, p = .003). Presence of tumor deposits of any size in the lymph nodes (LNs; ypN ≥ 0(i+)) was associated with worse DDFS (ypT0 ypN0 vs ypT0 ypN ≥ 0(i+), p = .036 and ypT0/is ypN0 vs ypT0/is ypN ≥ 0(i+), p = .015), and presence of isolated tumor cells was associated with decreased overall survival (OS; ypT0/is ypN0 vs ypT0/is ypN0(i+), p = .013). Residual ductal carcinoma in situ regardless of LN status showed no significant difference in DDFS or OS (DDFS: ypT0 vs ypTis, p = .373 and ypT0 ypN0 vs ypTis ypN0, p = .462; OS: ypT0 vs ypTis, p = .441 and ypT0 ypN0 vs ypTis ypN0, p = .758). In subsequent analysis using ypT0/is ypN0, pCR was associated with improved DDFS and OS in triple-negative tumors (p < .001 and p = .003, respectively). Conclusions: Based on our study results, the prognosis and rate of pCR differ according to the definition of pCR and ypT0/is ypN0 might be considered a more preferable definition of pCR.

Citations

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    Discover Oncology.2024;[Epub]     CrossRef
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    The Breast.2022; 62: S25.     CrossRef
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Pathologic Factors Associated with Prognosis after Adjuvant Chemotherapy in Stage II/III Microsatellite-Unstable Colorectal Cancers
Jung Ho Kim, Jeong Mo Bae, Hyeon Jeong Oh, Hye Seung Lee, Gyeong Hoon Kang
J Pathol Transl Med. 2015;49(2):118-128.   Published online March 12, 2015
DOI: https://doi.org/10.4132/jptm.2015.02.05
  • 10,909 View
  • 119 Download
  • 19 Web of Science
  • 16 Crossref
AbstractAbstract PDF
Background
Although there are controversies regarding the benefit of fluoropyrimidine-based adjuvant chemotherapy in patients with microsatellite instability–high (MSI-H) colorectal cancer (CRC), the pathologic features affecting postchemotherapeutic prognosis in these patients have not been fully identified yet. Methods: A total of 26 histopathologic and immunohistochemical factors were comprehensively evaluated in 125 stage II or III MSI-H CRC patients who underwent curative resection followed by fluoropyrimidine-based adjuvant chemotherapy. We statistically analyzed the associations of these factors with disease-free survival (DFS). Results: Using a Kaplan- Meier analysis with log-rank test, we determined that ulceroinfiltrative gross type (p=.003), pT4 (p<.001), pN2 (p=.002), perineural invasion (p=.001), absence of peritumoral lymphoid reaction (p=.041), signet ring cell component (p=.006), and cribriform comedo component (p=.004) were significantly associated with worse DFS in patients receiving oxaliplatin-based adjuvant chemotherapy (n=45). By contrast, pT4 (p<.001) and tumor budding-positivity (p=.032) were significant predictors of poor survival in patients receiving non-oxaliplatin–based adjuvant chemotherapy (n=80). In Cox proportional hazards regression model-based univariate and multivariate analyses, pT category (pT1-3 vs pT4) was the only significant prognostic factor in patients receiving non-oxaliplatin–based adjuvant chemotherapy, whereas pT category, signet ring cell histology and cribriform comedo histology remained independent prognostic factors in patients receiving oxaliplatin-based adjuvant chemotherapy. Conclusions: pT4 status is the most significant pathologic determinant of poor outcome after fluoropyrimidine-based adjuvant chemotherapy in patients with stage II/III MSI-H CRC.

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Case Report
Maxillo-facial Extraskeletal Myxoid Chondrosarcoma: A Case Report and Discussion.
Ratnadeep Ganguly, Abhishek Mukherjee
Korean J Pathol. 2011;45(6):639-643.
DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.6.639
  • 3,166 View
  • 24 Download
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AbstractAbstract PDF
In this report, we share our experience of a case of maxillo-facial extraskeletal myxoid chondrosarcoma, a very rare location for this neoplasm. In addition, a literature review is provided. The patient, a 61-year-old male, had a maxillary mass encroaching on the nasal cavity. After debulking, the tumor recurred, attaining its pre-surgical proportion in two months. The patient improved clinically with radiation and remained stable for about one year. However, he ultimately developed metastases in his lung which were treated with palliative chemotherapy with a good outcome lasting three months. We could find only eight reported cases of this tumor in the head region of which two are in the maxilla; hence, ruling out other primary sites is mandatory for a patient presenting with a primary head and neck mass. Surgical removal may be complicated because of the location. A combination of surgery and radiation is the management of choice, with palliative chemotherapy in metastasis.

Citations

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  • Extraskeletal Myxoid Chondrosarcoma of Floor of Mouth—A Rare Case Report and Review of Literature
    Surendra K Dabas, Nandini N Menon, Reetesh Ranjan, Bikas Gurung, Sukirti Tiwari, Bharat Bhushan Bassan, Himanshu Shukla, Sunil Pasricha, Ajit Sinha, Rahul Kapoor, Vinay Kumar Verma, Devesh Verma, Saurabh Arora, Ashwani Sharma, Sourabh Mukharjee, Rishu Sin
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Original Articles
ERCC1 Predicts a Poorer Platinum-based Chemotherapy Outcome but a Better Outcome for Uracil-Tegafur in the Resected Stage I-II NSCLC.
Han Suk Ryu, Xianhua Xu, Hyojin Kim, Jong Suk Lee, Sanghoon Jheon, Jin Haeng Chung
Korean J Pathol. 2011;45(1):45-52.
DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.1.45
  • 2,708 View
  • 18 Download
AbstractAbstract PDF
BACKGROUND
The role of excision repair cross-complementation group 1 (ERCC1) has been controversial in non-small cell lung cancer (NSCLC) patients who received adjuvant chemotherapy with a platinum agent. We investigated ERCC1 expression in stage I-II NSCLC to clarify its significance for adjuvant chemotherapy.
METHODS
The ERCC1 expression profile was evaluated by immunohistochemistry and compared according to adjuvant chemotherapeutic agents in 146 patients who underwent surgical resection for stage I-II NSCLC. The patients were divided into 3 groups; adjuvant chemotherapy with a platinum based agent (18.5%, 27/146); adjuvant chemotherapy with uracil-tegafur (UFT) (40.4%, 59/146); surgery-alone (41.1%, 60/146).
RESULTS
Nuclear ERCC1 expression was detected in 71.9% (105/146) of NSCLC and was significantly associated with a shortened survival period in the group 1 patients who received the platinum based regimen after surgery. The group 2 patients who received UFT showed the longest survival period, followed by the surgery-alone group (overall survival, p=0.049; disease-free survival [DFS], p<0.001).
CONCLUSIONS
These results suggest that stage I-II NSCLC patients with ERCC1 expression experience a shorter DFS period with adjuvant chemotherapy with a platinum based regimen and may benefit from adjuvant chemotherapy with UFT, instead of platinum after surgery.
Predictive Significance of KRAS and Tau for Chemoresponse in Advanced Non-Small-Cell Lung Cancer.
Jinyoung Yoo, Byoung Yong Shim, Chang Young Yoo, Seok Jin Kang, Kyo Young Lee
Korean J Pathol. 2009;43(5):435-440.
DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.5.435
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AbstractAbstract PDF
BACKGROUND
Taxane-platinum combinations are often used as first-line treatments for patients with advanced non-small cell lung cancer (NSCLC). Response to chemotherapy for these patients is still poor. The aim of our study was to investigate, for this disease, whether KRAS and Tau proteins affect responses to taxane-platinum combinations.
METHODS
Expression of KRAS and Tau was examined immunohistochemically in 71 tumor samples obtained from patients with stage IIIB or IV NSCLC prior to combination therapy. Expression was correlated with tumor responses.
RESULTS
The response rate was 55% (39 of 71). KRAS and Tau were expressed in seven (10%) and 31 (44%) patients, respectively. All seven KRAS-positive patients were non-responders (p=0.014). Among Tau-positive patients, 35% (11 of 31) responded to therapy, whereas a partial response was observed in 70% (28 of 40) of Tau-negatives (p=0.045). Two were positive for both, and they were non-responders. In patients negative for both, the response rate was 71% (25 of 35) (p=0.012).
CONCLUSIONS
Expression of KRAS and Tau are significantly correlated with poor responses to this combination therapy in advanced NSCLC patients, and may be a useful marker for chemoresistance.

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  • Emerging Evidences for an Implication of the Neurodegeneration-Associated Protein TAU in Cancer
    Stéphanie Papin, Paolo Paganetti
    Brain Sciences.2020; 10(11): 862.     CrossRef
A High Thymidylate Synthase Expression is Related to Better Outcome for Advanced Gastric Cancer Patients Treated with 5-FU Chemotherapy after Curative Resection.
Mee Yon Cho, Sang Yeop Yi, Min seob Eom, Shu Peng Zhang, Hwan Sik Kim, Jong In Lee, Dae Sung Kim
Korean J Pathol. 2006;40(2):128-136.
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AbstractAbstract PDF
BACKGROUND
The expressions of thymidylate synthase (TS), E2F-1, pRb, and p53 are correlated with DNA synthesis. The significance of their expressions is still controversial for predicting the outcome of 5-fluorouracil (5-FU) therapy in the patients with advanced gastric carcinoma. Furthermore, their prognostic value in the metastatic lesions of gastric carcinoma has not yet been confirmed.
METHODS
To ascertain their prognostic value, we immunohistochemically analyzed the expressions of TS, E2F-1, pRb, and p53 in the primary tumors and the related metastatic lymph nodes, and we then compared the survival between the high and low expression group of each protein. Ninety four patients with advanced gastric carcinoma who were treated by complete resection and adjuvant 5-FU chemotherapy were analyzed.
RESULTS
The TS expression in primary tumors was significantly correlated with that of E2F-1. The expression of these genes showed no significant difference between the primary tumors and the metastatic lymph nodes except for E2F-1, which was significantly higher in the lymph node metastasis than in the primary tumors. After complete resection and 5-FU-based adjuvant chemotherapy, patients with a high TS expression in the primary tumors showed a longer survival than those patients having primary tumors with a low TS expression (p=0.0392).
CONCLUSION
A high TS expression in the primary tumors may be related to a better outcome for advanced gastric cancer patients who were treated with 5-FU chemotherapy after curative resection.
Case Report
Fetal Rhabdomyomatous Nephroblastoma: A case report.
Nam Hoon Kim, Chan Pil Park, Eun Kyung Hong, Poong Man Jung, Moon Hyang Park
Korean J Pathol. 1995;29(1):96-102.
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AbstractAbstract PDF
A fetal rhabdomyomatous nephroblastoma is considered to be a predominantly monophasic mesenchymal variant of Wilms' tumor, which acts less aggressively than a conventional Wilms' tumor despite its much larger size. Bilaterality of this tumor in a nine month-old girl, however, may negatively affect the overall prognosis. A radical nephrectomy for bulky masses in the left kidney and a partial nephrectomy for right kidney with five small tumor masses was performed at the same time. Two small tumor masses in the upper part of right kidney were left behind because of preserving minimal renal functional capacity. Pathological study revealed a mixed type of nephroblastoma which was composed predominantly of mesenchymal components with fetal rhabdomyomatous differentiation. After post-operative chemotherapy with vincristine, actinomycin D and adriamycin, and radiotherapy(2,130 rad), residual tumor masses became a single tumor 5 cm in diameter and well demarcated, which was resected at 15 months after first operation when the size and renal function of remained right kidney was appropriate to resect out the residual tumor. The tumor resected out at second operation was entirely composed of scattered differentiated fetal skeletal muscle cells in the fibrovascular tissue. Only a few entrapped epithelial components were seen but no blastemal cornponents were present. Follow up abdominal CT and ultrasonographic examinations revealed no evidence of tumor recurrence. The girl has developed normally without disease.
Original Article
Immunohistochemical Study of the Multidrug Resistant(MDR) Gene Expression in Gastric Carcinoma.
Jung Hee Han, Byung Gon Park, Mi Sook Roh, Sook Hee Hong
Korean J Pathol. 1994;28(1):38-48.
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AbstractAbstract PDF
We performed immunohistochemical stain of p-glycoprotein using JSB-1 monoclonal antibody to study multidrug resistant(MDR) gene expression in 137 gastric tumor tissues obtained from 87gastric carcinoma patients. The incidence of p-glycoprotein expression was 60 of 87 cases(69%) and it was not correlated with age, sex, depth of tumor invasion, and lymph node metastasis, but was correlated with histologic type of gastric adenocarcinoma. The distribution of p-glycoprotein positive cells in the tumor tissue was diffuse in 34 cases(73.9%) and focal in 12 cases(26.1%), and the dominant staining patterns of p-glycoprotein in the tumor cells were cytoplasmic and golgi staining in 20 cases(43.5%) and 19 cases(41.3%), respectively, and 7 cases(15.2%) showed fine granules in the cytoplasm. The incidence of p-glyco-protein expression in the tumor tissue was higher in A and AB blood type patients who have A antigen than in 0 and B blood type patients. Cytoplasmic staining pattern was dominant in O and B blood types and golgi staining in A and AB blood type patients. Among 27 patients 'who received chemotherapy, partial remission was noted in 9 of 11 p-glyco-protein negative patients(81.8%) and no remission or progression of the tumor was seen in 9 of 16 p-glycoprotein positive patient(56.3%). The p-glycoprotein expression in gastric carcinoma had no direct correlation with known several prognostic factors of the gastric tumor except for histologic type, and it is supposed that p-glycoprotein detection in gastric tumor tissue by immunohisto-chemical stain is a good method for predicting the response of chemotherapy, especially in p-gly-coprotein negative cases.
Case Report
Juvenile Granulosa Cell Tumor of the Ovary: Report of a Case of Malignant Form with Unusual Pleomorphism.
Chong Jai Kim, Jin Suk Suh, Sung Hye Park, Je G Chi
Korean J Pathol. 1990;24(3):316-320.
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AbstractAbstract PDF
A case of Juvenile Granulosa Cell Tumor (JGCT) of the ovary with unusual pleomorphic histologic and malignant biologic behaviour is described. The tumor occurred in a 10-year-old girl and was associated with clinical features of isosexual pseudoprecosity and a marked elevation of serum estradiol. The mass manifested initially in the right ovary and subsequently involved the contralateral ovary. A multi-organ metastasis developed during a 6-month-interval despite chemotherapy. She received two operations at 6-month interval, and tissues were obtained from the tumor mass. A marked histologic difference was observed between these two samples. The second biopsy showed profound cellular pleomorphism with numerous multinucleated tumor giant cell formation and hyaline bodies. The differential diagnosis from germ cell tumor and the possible factors for the pleomorphism are discussed.

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