Journal of Pathology and Translational Medicine

Case Study

Renal intravascular large B cell lymphoma: the first case report in Korea and a review of the literature: Moonsik Kim, Haerim Chung, Woo Ick Yang, Hyeon Joo Jeong; J Pathol Transl Med. 2020;54(5):426-431. Published online August 13, 2020; DOI: https://doi.org/10.4132/jptm.2020.06.18

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Herein, we describe the first case of renal intravascular large B cell lymphoma in Korea occurring in a 66-year-old female. She presented with mild fever and dyspnea. On physical and laboratory evaluations, hemophagocytic lymphohistiocytosis was suspected, but the bone marrow biopsy results were unremarkable. During the work-up, massive proteinuria developed, which led to a renal biopsy. The renal architecture was relatively well-preserved, but the glomeruli were hypercellular with the infiltration of atypical, large lymphoid cells with increased nucleus-cytoplasm ratio and clumped chromatin. Similar cells were also present in the peritubular capillaries. The tumor cells exhibited membranous staining for CD20 and CD79a. After the diagnosis of intravascular large B cell lymphoma, the patient received rituximab-based chemotherapy under close follow-up.

Citations

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EBV-Positive Intravascular Large B-Cell Lymphoma of the Small Intestine: A Case Report and Literature Review
Chenglong Pan, Xiaoling Ma, Yanfei Yao, Chunyan Wang
International Journal of Surgical Pathology.2024; 32(3): 586. CrossRef
Intravascular large B‐cell lymphoma in renal cell carcinoma incidentally detected by robot‐assisted partial nephrectomy
Michio Noda, Yutaka Enomoto, Yukari Shirasugi, Sumiyo Ando, Yukimasa Matsuzawa, Haruki Kume
IJU Case Reports.2022; 5(3): 191. CrossRef
Case Report: Intravascular Large B-Cell Lymphoma: A Clinicopathologic Study of Four Cases With Review of Additional 331 Cases in the Literature
Yingying Han, Qingjiao Li, Dan Wang, Lushan Peng, Tao Huang, Chunlin Ou, Keda Yang, Junpu Wang
Frontiers in Oncology.2022;[Epub] CrossRef
Renal Involvement of CD20-Negative Intravascular Large B Cell Lymphoma with Neurological Manifestations
Faten Aqeel, Serena M. Bagnasco, Duvuru Geetha, Yoshihide Fujigaki
Case Reports in Nephrology.2022; 2022: 1. CrossRef

Original Article

Aberrant Blood Vessel Formation Connecting the Glomerular Capillary Tuft and the Interstitium Is a Characteristic Feature of Focal Segmental Glomerulosclerosis-like IgA Nephropathy: Beom Jin Lim, Min Ju Kim, Soon Won Hong, Hyeon Joo Jeong; J Pathol Transl Med. 2016;50(3):211-216. Published online April 11, 2016; DOI: https://doi.org/10.4132/jptm.2016.02.01

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Abstract PDF

Background
Segmental glomerulosclerosis without significant mesangial or endocapillary proliferation is rarely seen in IgA nephropathy (IgAN), which simulates idiopathic focal segmental glomerulosclerosis (FSGS). We recently recognized aberrant blood vessels running through the adhesion sites of sclerosed tufts and Bowman’s capsule in IgAN cases with mild glomerular histologic change.
Methods
To characterize aberrant blood vessels in relation to segmental sclerosis, we retrospectively reviewed the clinical and histologic features of 51 cases of FSGS-like IgAN and compared them with 51 age and gender-matched idiopathic FSGS cases.
Results
In FSGS-like IgAN, aberrant blood vessel formation was observed in 15.7% of cases, 1.0% of the total glomeruli, and 7.3% of the segmentally sclerosed glomeruli, significantly more frequently than in the idiopathic FSGS cases (p = .009). Aberrant blood vessels occasionally accompanied mild cellular proliferation surrounding penetrating neovessels. Clinically, all FSGS-like IgAN cases had hematuria; however, nephrotic range proteinuria was significantly less frequent than idiopathic FSGS.
Conclusions
Aberrant blood vessels in IgAN are related to glomerular capillary injury and may indicate abnormal repair processes in IgAN.

Citations

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IgA nephropathy
Maria F. Soares, Ian S.D. Roberts
Current Opinion in Nephrology and Hypertension.2017; 26(3): 165. CrossRef

Review

Overview of IgG4-Related Tubulointerstitial Nephritis and Its Mimickers: Hyeon Joo Jeong, Su-Jin Shin, Beom Jin Lim; J Pathol Transl Med. 2016;50(1):26-36. Published online December 14, 2015; DOI: https://doi.org/10.4132/jptm.2015.11.09

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Abstract PDF

Tubulointerstitial nephritis (TIN) is the most common form of renal involvement in IgG4-related disease. It is characterized by a dominant infiltrate of IgG4-positive plasma cells in the interstitium and storiform fibrosis. Demonstration of IgG4-positive plasma cells is essential for diagnosis, but the number of IgG4-positive cells and the ratio of IgG4-positive/IgG-positive plasma cells may vary from case to case and depending on the methods of tissue sampling even in the same case. IgG4-positive plasma cells can be seen in TIN associated with systemic lupus erythematosus, Sjögren syndrome, or anti-neutrophil cytoplasmic antibody–associated vasculitis, which further add diagnostic confusion and difficulties. To have a more clear view of IgG4-TIN and to delineate differential points from other TIN with IgG4-positive plasma cell infiltrates, clinical and histological features of IgG4-TIN and its mimickers were reviewed. In the rear part, cases suggesting overlap of IgG4-TIN and its mimickers and glomerulonephritis associated with IgG4-TIN were briefly described.

Citations

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IgG4-related kidney disease: Clinicopathologic features, differential diagnosis, and mimics
Sarwat I. Gilani, Alessia Buglioni, Lynn D. Cornell
Seminars in Diagnostic Pathology.2024; 41(2): 88. CrossRef
Utilizing Immunoglobulin G4 Immunohistochemistry for Risk Stratification in Patients with Papillary Thyroid Carcinoma Associated with Hashimoto Thyroiditis
Faridul Haq, Gyeongsin Park, Sora Jeon, Mitsuyoshi Hirokawa, Chan Kwon Jung
Endocrinology and Metabolism.2024; 39(3): 468. CrossRef
IgG4-assoziierte Nierenerkrankungen
Christina Thompson, Frank O. Henes, Oliver M. Steinmetz, Simon Melderis
Die Nephrologie.2023; 18(4): 249. CrossRef
Concurrent anti-neutrophil cytoplasmic antibody-associated glomerulonephritis and IgG4-associated tubulointerstitial nephritis with C3 glomerulonephritis
Jianan Feng, Jinyu Yu, Xueyao Wang, Yue Wang, Yang Liu, Zhonggao Xu, Weixia Sun
Medicine.2020; 99(5): e18857. CrossRef
A case of eosinophilic granulomatosis with polyangiitis as a mimicker of IgG4-related disease
Ryuichiro Kanda, Satoshi Kubo, Kazuhisa Nakano, Akio Kawabe, Aya Nawata, Kentaro Hanami, Shingo Nakayamada, Yoshiya Tanaka
Modern Rheumatology Case Reports.2020; 4(2): 278. CrossRef
Renal tubular acidosis as the initial presentation of Sjögren’s syndrome
Karen Ho, Pouneh Dokouhaki, Mark McIsaac, Bhanu Prasad
BMJ Case Reports.2019; 12(8): e230402. CrossRef
Immunoglobulin G4-related kidney diseases: An updated review
Maurizio Salvadori, Aris Tsalouchos
World Journal of Nephrology.2018; 7(1): 29. CrossRef
Systemic lupus erythematosus in a patient with an organic lesion of the central nervous system: practicaldifferential diagnosis
E. V. Lebedeva, M. V. Novoseltsev, A. N. Lvov, I. V. Khamaganova
Klinicheskaya dermatologiya i venerologiya.2018; 17(6): 21. CrossRef
Concurrent IgG4-related tubulointerstitial nephritis and IgG4 myeloperoxidase-anti-neutrophil cytoplasmic antibody positive crescentic glomerulonephritis
Tao Su, Li Yang, Zhao Cui, Su-xia Wang, Ming-hui Zhao
Medicine.2017; 96(20): e6707. CrossRef
IgG4-Related Kidney Disease: Report of a Case Presenting as a Renal Mass
Daniele Bianchi, Luca Topazio, Gabriele Gaziev, Valerio Iacovelli, Pierluigi Bove, Alessandro Mauriello, Enrico Finazzi Agrò
Case Reports in Surgery.2017; 2017: 1. CrossRef

Original Article

Renal Histologic Parameters Influencing Postoperative Renal Function in Renal Cell Carcinoma Patients: Myoung Ju Koh, Beom Jin Lim, Kyu Hun Choi, Yon Hee Kim, Hyeon Joo Jeong; Korean J Pathol. 2013;47(6):557-562. Published online December 24, 2013; DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.6.557

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Abstract PDF

Background

Pre-existing non-neoplastic renal diseases or lesions may influence patient renal function after tumor removal. However, its description is often neglected or omitted in pathologic reports. To determine the incidence and clinical significance of non-neoplastic lesions, we retrospectively examined renal tissues obtained during 85 radical nephrectomies for renal cell carcinoma.

Methods

One paraffin-embedded tissue block from each case containing a sufficient amount of non-tumorous renal parenchyma was cut and processed with hematoxylin and eosin and periodic acid-Schiff methods. Non-neoplastic lesions of each histological compartment were semi-quantitatively and quantitatively evaluated.

Results

Among the various histologic lesions found, tubular atrophy, arterial intimal thickening, and glomerulosclerosis were the most common (94.1%, 91.8%, and 88.2%, respectively). Glomerulosclerosis correlated with estimated glomerular filtration rate at the time of surgery, as well as at 1- and 5-years post-surgery (p=.0071), but tubulointerstitial fibrosis or arterial fibrous intimal thickening did not. Post-hoc analysis revealed that glomerulosclerosis of more than 20% predicted post-operative renal function. However, its significance disappeared when gender and age were considered.

Conclusions

In conclusion, non-neoplastic lesions, especially with regard to glomerulosclerosis percentage, should be described in pathology reports to provide additional information on renal function decline.

Citations

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Role of intravoxel incoherent motion diffusion-weighted MRI in differentiation of renal cell carcinoma subtypes
Amira R. Mahmoud, Nehad Fouda, Eman Mohamed Helmy, Ali Elsorougy
Egyptian Journal of Radiology and Nuclear Medicine.2024;[Epub] CrossRef
Chronic kidney damage pathology score for systematic assessment of the non-neoplastic kidney tissue and prediction of post-operative renal function outcomes
Yong Jia, Seyed M.M. Poor, Brenden Dufault, Vivian Lu, Jasmir G. Nayak, Deepak K. Pruthi, Ian W. Gibson
Human Pathology.2022; 124: 76. CrossRef
Value of intravoxel incoherent motion for differential diagnosis of renal tumors
Qingqiang Zhu, Wenrong Zhu, Jing Ye, Jingtao Wu, Wenxin Chen, Zhihua Hao
Acta Radiologica.2019; 60(3): 382. CrossRef
Conventional and Papillary Renal Cell Carcinomas and Focal Segmental Glomerulosclerosis in a Nephrectomy
Firas Al-Delfi, Guillermo A. Herrera
Pathology Case Reviews.2015; 20(6): 263. CrossRef

Case Report

Cytologic Features of Giant Cell Ependymoma: A Case Report and Review of the Literature: Myoung Ju Koh, Sun Och Yoon, Hyae Min Jeon, Hyeon Joo Jeong, Soon Won Hong, Se Hoon Kim; Korean J Pathol. 2012;46(5):507-513. Published online October 25, 2012; DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.5.507

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Abstract PDF

Here, we present a case of anaplastic giant cell ependymoma (GCE) occurring in a 15-year-old woman. Squash smear slides for intraoperative frozen section diagnosis revealed oval to round cell clusters with a papillary structure in a fibrillary background. This was occasionally accompanied by the presence of bizarre pleomorphic giant cells with hyperchromatic nuclei and prominent intranuclear inclusions. These intranuclear inclusions were a key clue to diagnosis of ependymoma. Histologic analysis revealed features of a high-grade tumor with perivascular pseudorosettes and bizarre pleomorphic giant cells, which established the diagnosis of GCE. We performed a review of literatures about the cytologic features of GCE, including our case, thus proposing that intraoperative frozen diagnosis of GCE would be established by squash smear preparations featuring the mitosis and necrosis, as well as the high cellularity, and the presence of giant cells showing hyperchromatic nuclei with eosinophilic cytoplasm and intranuclear inclusions/pseudoinclusions.

Citations

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A case of myxopapillary ependymoma with predominant giant cell morphology: A rare entity with comprehensive genomic profiling and review of literature
Bryan Morales‐Vargas, Hassan Saad, Daniel Refai, Matthew Schniederjan, Zied Abdullaev, Kenneth Aldape, Malak Abedalthagafi
Neuropathology.2024;[Epub] CrossRef
Report of a case of giant cell ependymoma with unusual clinical and pathological presentation
Mónica B. Mezmezian, Victor Del Caño, Liliana G. Olvi
Neuropathology.2019; 39(4): 313. CrossRef
Giant Cell Ependymoma of Cervicomedullary Junction: A Case Report of a Long-Term Survivor and Literature Review
Martina Cappelletti, Andrea G. Ruggeri, Giorgia Iacopino, Roberto Delfini
World Neurosurgery.2018; 116: 121. CrossRef
Immunohistochemical features of giant cell ependymoma of the filum terminale with unusual clinical and radiological presentation
Fernando Candanedo-Gonzalez, Cindy Sharon Ortiz-Arce, Samuel Rosales-Perez, Ana Lilia Remirez-Castellanos, Candelaria Cordova-Uscanga, Armando Gamboa-Dominguez
Diagnostic Pathology.2017;[Epub] CrossRef
Giant Cell Ependymoma of Lateral Ventricle: Case Report, Literature Review, and Analysis of Prognostic Factors and Genetic Profile
Hirokazu Takami, Christopher S. Graffeo, Avital Perry, Aditya Raghunathan, Robert B. Jenkins, Caterina Giannini, Terry C. Burns
World Neurosurgery.2017; 108: 997.e9. CrossRef

Original Articles

Urinary Decoy Cell Grading and Its Clinical Implications: Myoung Ju Koh, Beom Jin Lim, Songmi Noh, Yon Hee Kim, Hyeon Joo Jeong; Korean J Pathol. 2012;46(3):233-236. Published online June 22, 2012; DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.3.233

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Abstract PDF

Background

Examination of urine for decoy cells (DCs) is a useful screening test for polyomavirus (PV) activation. We explored the significance of the amount of DCs in persistent shedding, PV nephropathy and acute rejection.

Methods

A case-controlled study was performed in 88 renal allograft patients who had DCs detected at least once in four or more urine samples.

Results

Fifty one patients were classified into the high-grade shedding group (HG) and 37 patients into the low-grade shedding group (LG) according to DC shedding (≥10 or <10 DCs/10 high power field [HPF]). DC shedding of more than three consecutive months was significantly more prevalent in the HG as compared with their LG counterparts (p<0.0001). Urinary DCs were present for more than one year in 29.4% of the HG and 8.1% of the LG. Real-time polymerase chain reaction for PV was higher in both urine (51.4% vs. 11.1%) and plasma (9.1% vs. 0%) of the HG than the LG. The prevalence of PV nephropathy was higher in the HG than the LG (p=0.019). However, there was no significant difference in the prevalence of acute rejection.

Conclusions

Shedding of ≥10 DCs/10 HPF is associated with sustained shedding, polymerase chain reaction positivity and PV nephropathy, but not a predictor of acute rejection.

Citations

Citations to this article as recorded by

Polyomavirus nephropathy: diagnosis, histologic features, and differentiation from acute rejection
Cynthia C. Nast
Clinical Transplantation and Research.2024; 38(2): 71. CrossRef
Challenges and opportunities in research on BK virus infection after renal transplantation
Yukun Tang, Zipei Wang, Dunfeng Du
International Immunopharmacology.2024; 141: 112793. CrossRef
BK Virus-Associated Nephropathy after Renal Transplantation
Yasuhito Funahashi
Pathogens.2021; 10(2): 150. CrossRef
Diagnostic utility of urine cytology in detection of decoy cells in renal transplant patients: Report of five cases and review of literature
Santosh Tummidi, Kanchan Kothari, Mona Agnihotri, Leena Naik, Amey Rojekar
Diagnostic Cytopathology.2020; 48(3): 222. CrossRef
Association of Pretransplant BK Polyomavirus Antibody Status with BK Polyomavirus Infection After Kidney Transplantation: A Prospective Cohort Pilot Study of 47 Transplant Recipients
Yu Hisadome, Hiroshi Noguchi, Yuki Nakafusa, Kukiko Sakihama, Takanori Mei, Keizo Kaku, Yasuhiro Okabe, Kosuke Masutani, Yuki Ohara, Kazuyuki Ikeda, Yoshinao Oda, Masafumi Nakamura
Transplantation Proceedings.2020; 52(6): 1762. CrossRef
Association Between the Polyomaviruses Titers and Decoy Cell Positivity Rates After Renal Transplantation
Y. Funahashi, M. Kato, T. Fujita, S. Ishida, A. Mori, M. Gotoh
Transplantation Proceedings.2016; 48(3): 921. CrossRef

Practical Standardization in Renal Biopsy Reporting.: So Young Jin, Hyeon Joo Jeong, Sun Hee Sung, Beom Jin Lim, Jee Young Han, Soon Won Hong, Hyun Ee Yim, Yeong Jin Choi, Yong Mee Cho, Myoung Jae Kang, Kyung Chul Moon, Hee Jeong Cha, Seung Yeon Ha, Mi Seon Kang, Mee Young So, Kwang Sun Suh, Jong Eun Joo, Yong Jin Kim, Nam Hee Won, Moon Hyang Park; Korean J Pathol. 2010;44(6):613-622.; DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.6.613

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Abstract PDF

BACKGROUND
To standardize renal biopsy reporting and diagnosis, The Renal Pathology Study Group of the Korean Society of Pathologists (RPSKSP) has developed a renal pathology reporting format for the native and allograft kidney.
METHODS
A consensus checklist of a provisional renal biopsy format was sent to all members of the RPSKSP. Feed back opinions regarding the practical application of the checklist to the diagnostic work were received.
RESULTS
Kidney biopsies require three essential examinations: by light microscopy, immunofluorescence (IF), and electron microscopy (EM). A final report of a renal biopsy should include information on specimen adequacy and a description of the morphologic change using a systematic semiquantitative method for each of the compartments, with optional separate IF and EM reports.
CONCLUSIONS
A standard renal biopsy report format is important in establishing clinicopathologic correlations, making reliable prognostic considerations, comparing the findings in sequential biopsies and evaluating the effects of therapy.

Citations

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Additional antihypertensive effect of magnesium supplementation with an angiotensin II receptor blocker in hypomagnesemic rats
Kyubok Jin, Tae Hee Kim, Yeong Hoon Kim, Yang Wook Kim
The Korean Journal of Internal Medicine.2013; 28(2): 197. CrossRef
Clinicopathologic Features of IgA-Dominant Postinfectious Glomerulonephritis
Tai Yeon Koo, Gheun-Ho Kim, Hyang Park
Korean Journal of Pathology.2012; 46(2): 105. CrossRef

An Analysis of Focal Segmental Glomerulosclerosis according to Morphologic Subtypes.: Min Ju Kim, Dokyung Kim, Beom Jin Lim, Hyeon Joo Jeong; Korean J Pathol. 2010;44(6):589-596.; DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.6.589

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Abstract PDF

BACKGROUND
The histological subtypes of focal segmental glomerulosclerosis (FSGS) have different significance and influence clinical presentations and outcomes in patients with FSGS. However, no such data has been reported in Korea.
METHODS
We reviewed renal biopsy specimens of 69 adult patients who were diagnosed with idiopathic FSGS between 2000 and 2008, subclassified them according to the Columbia classification and correlated the results with clinical findings.
RESULTS
The frequencies of the FSGS subtypes were not otherwise specified (NOS) (n = 28), tip (n = 21), perihilar (n = 11), collapsing (n = 5) and cellular types (n = 4) in descending order. Nephrotic syndrome was more common in patients with the tip and collapsing types than the perihilar type. The prevalence of chronic kidney disease stage 4/5 at the time of renal biopsy was significantly higher in patients with the cellular type than the NOS or the tip type. The remission rate after treatment tended to be higher in patients with the NOS type (22.0%) and the tip type (15.2%) than the perihilar (6.8%) and collapsing types (3.4%).
CONCLUSIONS
Classifying FSGS subtypes may be helpful to predict of clinical features and renal outcomes.

Citations

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Podocytopathy and Morphologic Changes in Focal Segmental Glomerulosclerosis
Hyeon Joo Jeong
Journal of the Korean Society of Pediatric Nephrology.2013; 17(1): 13. CrossRef
Pathology and Classification of Focal Segmental Glomerulosclerosis
Yong-Jin Kim
Journal of the Korean Society of Pediatric Nephrology.2012; 16(1): 21. CrossRef

Cell Mediated Immunity in Tubulointerstitial Nephritis of Rats.: Hyeon Joo Jeong; Korean J Pathol. 1995;29(5):634-643.

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Abstract: To investigate the tubular major histocompatibility complex(MHC) expression and inflammatory phenotypes in tubulointerstitial nephritis, Lewis rats were inununized with azobenzen-earsonate-tyrosine in complete Freund adjuvant and challenged either foot pad or kidney, either by subcapsular injection or by ex vivo perfusion. The rats were sacrificed 2, 3, 5, 10 and 15 days after antigenic challenge. Foot pad swelling was significant at the antigenic challenge site (151.8 vs 6.8 x 10(-2) mm) at 24 hours. Tubulointerstitial nephritis was induced by both methods and the inflammatory infiltrate which first appeared on day 2, became prominent at day 5, then gradually subsided in ex vivo perfused rats, while inflannnation started on day 3 in subcapsular injected rats. The major site of inflammation was in the cortex and outer stripe of the outer medulla, with predominance of mononuclear cells throughout the course. The inflammatory cells showed mainly OX8 and ED1 positivity with OX19, W3/25 and CD5 positivity in minority. RT1B expression was diffuse in the cytoplasm of proximal tubules at day 2 and 5. These results suggest the involvement of cell mediated immunity in this experimental model, and the possibility that tubular epidielial cells process antigen and then become targets in immune injury.

Case Reports

Acute Renal Failure Associated with Gross Hematuria in a Patient with Focal Glomerulonephritis.: Hee Jung Kim, Hyeon Joo Jeong, Dae Suk Han; Korean J Pathol. 1997;31(3):263-268.

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Abstract PDF: A 58-year-old female with an episode of gross hematuria two months before and fever and chill for the past three days presented oliguric acute renal failure. She has taken NSAID intermittently for 18 years due to rheumatoid arthritis, and herb medicine for one week two months ago when gross hematuria developed. Physical examination revealed mild tenderness on costovertebral angles. Her blood pressure was 170/100 mmHg, the urinalysis showed >300 mg protein with many RBCs and 10-20 WBCs and the serum creatinine was 5.8 mg/dl. A renal biopsy performed on the 4th hospital day showed that it was overwhelmed by severe tubular lesions which reveal intratubular obstruction by massive erythrocyte casts and tubular necrosis. The glomeruli showed focal minimal crescents with many red blood cells entrapped in the crescents and in the capillaries. Immune deposits were not present. A renal failure resolved spontaneously and the patient was discharged three weeks later with creatinine of 2.4 mg/dl. In this patient, acute renal failure was considered to be due to a tubular lesion related to the glomerular bleeding from focal glomerulonephritis revealing minimal crescents.

Emphysematous Pyelonephritis in Diabetic Nephropathy A report of two cases.: Jae Ho Han, Lucia Kim, Sung Eun Kim, Soon Won Hong, Hyeon Joo Jeong; Korean J Pathol. 1999;33(5):367-370.

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Abstract PDF: Diabetic nephropathy is characterized by one or a combination of the following lesions: (1) glomerular involvement with three distinctive patterns: diffuse glomerulosclerosis, nodular glomerulosclerosis, and exudative lesions; (2) arteriolo sclerosis; (3) urinary tract bacterial infection with pyelonephritis and sometimes emphysematous pyelonephritis. Emphysematous pyelonephritis is an uncommon life-threatening and acute suppurative infection of the kidney, and usually occurs in diabetic female patients. It is characterized by the production of intraparenchymal gas. Glucose fermentation has been considered the main cause of the gas formation. We presented two illustrative nephrectomy cases of emphysematous pyelonephritis in addition to the typical pathologic features of diabetic nephropathy.

Original Articles

Expression of Biologic Markers and DNA Ploidy Analysis in Atypical Ductal Hyperplasia and Ductal Carcinoma in Situ of the Breast.: Hee Jung Kim, Woo Hee Jung, Hyeon Joo Jeong, Hy De Lee; Korean J Pathol. 1999;33(11):1076-1089.

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Abstract PDF: Status of margins and the size of the lesion are independent prognostic factors of ductal carcinoma in situ (DCIS). Histologic grading of DCIS and expression of biologic marker also appear to act as prognostic factors. However, DNA ploidy analysis using flow cytometry in the DCIS and atypical ductal hyperplasia (ADH) has been rarely reported, and the biologic behavior of ADH is unknown. We performed immunohistochemical staining and DNA ploidy analysis using flow cytometry on 45 cases of pure DCIS without microinvasion and 34 cases of ADH to compare the expression of biologic markers and DNA ploidy patterns according to the histologic grade of DCIS, to evaluate the usefulness of the Van Nuys classification, and to investigate the biologic behavior of ADH and low grade DCIS. A total of 41.9% of DCIS and 32.1% of ADH were detected mammographically in asymptomatic patients. The most common subtype of the high grade DCIS was comedo type (56.3%), while the low and intermediate grade DCIS were cribriform type. Expression of ER, c-erbB-2 and Ki-67 proliferative index (PI) was significantly associated with nuclear grade and histologic grade of DCIS. Expression of c-erbB-2 was also significantly correlated with presence of necrosis. In low grade DCIS, Ki-67 PI was significantly higher than ADH. A total of 63.6% of DCIS and 70% of ADH were diploidy and 15.9% of DCIS was aneuploidy. There was no aneuploidy in ADH. No significant association was noted between DNA ploidy and histologic grade or nuclear grade. However, in high grade DCIS, the frequency of aneuploidy was high. In conclusion, histologic grading of DCIS employing nuclear grade and necrosis is a useful tool accounting for biologic behavior. High grade DCIS and comedo DCIS impart aggressive biologic behavior and suggest a higher possibility of local recurrence or progression to invasive carcinoma. In the differential diagnosis of ADH and low grade DCIS, the use of Ki-67 PI and DNA ploidy analysis by flow cytometry will be helpful for accurate diagnosis and prediction of biologic behavior.

Glomerular Basement Membrane Thickness in Minimal Change Disease.: Yoon Mee Kim, Soon Hee Jung, Hyeon Joo Jeong; Korean J Pathol. 2000;34(12):994-1000.

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Abstract PDF: The thickness of the glomerular basement membrane may vary not only in glomerular disease, but also in normal persons according to age and sex. But there has been no data on the normal thickness of the basement membrane in Korea. This study was designed to determine the glomerular basement membrane thickness as a reference value according to age and sex, in 50 cases of minimal change disease obtained from patients aged 2~67 years. Measurement of glomerular basement membrane was made on electron micrograph using an image analyzer. The thickness of each case was estimated by the arithmetic and harmonic mean methods. The mean thickness of the glomerular basement membrane was 291.9 47.9 nm by harmonic mean method and 284.2 43.7 nm by arithmetic mean method. And the harmonic mean thickness of the glomerular basement membrane according to age was 249.1 32.5 nm (1~5 years), 256.6 45.3 nm (6~10 years), 279.2 57.9 nm (11~15 years), 303.2 43.8 nm (16~20 years), 335.3 37.5 nm (21~30 years), and 291.1 22.5 nm (over 30 years), respectively. There was a trend that the thickness of glomerular basement membranes increased with the age till 30 years of age. There was no significant sex-related difference. In conclusion, the mean glomerular basement membrane thickness is comparable to the data from western people and shows a trend of increasing thickness according to the age.

Image Analysis of Glomerular Changes in Patients with Post-transplant IgA Nephropathy.: Kye Won Kwon, Hyeon Joo Jeong; Korean J Pathol. 2001;35(3):206-211.

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Abstract PDF: BACKGROUND
IgA nephropathy after renal transplantation (post-transplant IgAN) may recapitulate the IgAN of native kidneys, however, little has been reported about the histologic characteristics. The aim of this study is to apply glomerular morphometry using an image analyser to examine the histologic characteristics of post-transplant IgAN.
METHODS
The outer margin of the glomerulus (Bowman's area, BA) and glomerular tuft area (GA) were traced manually. The measured area were automatically calculated by KS300 image analysis system (Kontron, Munchen, Germany). The mesangial area (MA) was calculated with a summing each manually traced mesangial area. The total number of glomerular (GC) and mesangial cells (MC) were counted. Eight cases of renal section obtained by nephrectomy due to renal cell carcinoma (normal control: N-CTRL) and nineteen cases of renal section obtained from post-transplantation patients without IgAN (transplantation control: Tx-CTRL) served as controls.
RESULTS
A total of 35 biopsies were finally selected for measurement. BA and GA of post-transplant IgAN were 1.6 and 1.4 times larger than the N-CTRL, respectively, and were not significantly different from Tx-CTRL. MA was 1.4 times significantly larger than that of the Tx-CTRL. As compared to that of the N-CTRL, it was 1.2 times larger, but this difference was not statistically significant. The GC and MC of post-transplant IgAN and the Tx-CTRL were significantly lower than the N-CTRL. There were no significant correlations between glomerular hypertrophy and duration after renal transplantation, mesangial changes, segmental sclerosis, or degree of renal cortical interstitial fibrosis in post-transplant IgAN.
CONCLUSIONS
Prominent glomerular hypertrophy and mesangial expansion suggest a hyperfiltration injury in post-transplant IgAN and a possible way to glomerulosclerosis.

Fine Needle Aspiration Cytology of the Renal Angiomyolipoma.: Yong Hee Lee, Dong Won Min, Hyeon Joo Jeong, Kwang Gil Lee; Korean J Cytopathol. 1994;5(1):65-70.

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Abstract PDF: We describe a case of fine needle aspiration cytologyof renal angiomyolipoma which was not associated with the clinical complex of tuberous sclerosis and was incidentally found. It was a solitary lesion and the clinical impression before needle aspiration was renal cell carcinoma. The aspirated specimen showed mature fat cells, clusters of renal tubular epithelial cells and sheets of pleomorphic smooth muscle cells with fibrillary cytoplasm. The nuclei of smooth muscle cells varied in size and shape. Since the treatment of renal angiomyolipoma differs from that of renal cell carcinoma, the preoperative cytological diagnosis is of great value.

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