Journal of Pathology and Translational Medicine

Review

A stepwise approach to fine needle aspiration cytology of lymph nodes: Yosep Chong, Gyeongsin Park, Hee Jeong Cha, Hyun-Jung Kim, Chang Suk Kang, Jamshid Abdul-Ghafar, Seung-Sook Lee; J Pathol Transl Med. 2023;57(4):196-207. Published online July 11, 2023; DOI: https://doi.org/10.4132/jptm.2023.06.12

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The cytological diagnosis of lymph node lesions is extremely challenging because of the diverse diseases that cause lymph node enlargement, including both benign and malignant or metastatic lymphoid lesions. Furthermore, the cytological findings of different lesions often resemble one another. A stepwise diagnostic approach is essential for a comprehensive diagnosis that combines: clinical findings, including age, sex, site, multiplicity, and ultrasonography findings; low-power reactive, metastatic, and lymphoma patterns; high-power population patterns, including two populations of continuous range, small monotonous pattern and large monotonous pattern; and disease-specific diagnostic clues including granulomas and lymphoglandular granules. It is also important to remember the histological features of each diagnostic category that are common in lymph node cytology and to compare them with cytological findings. It is also essential to identify a few categories of diagnostic pitfalls that often resemble lymphomas and easily lead to misdiagnosis, particularly in malignant small round cell tumors, poorly differentiated squamous cell carcinomas, and nasopharyngeal undifferentiated carcinoma. Herein, we review a stepwise approach for fine needle aspiration cytology of lymphoid diseases and suggest a diagnostic algorithm that uses this approach and the Sydney classification system.

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Ming Xu, Yubiao Yue, Zhenzhang Li, Yinhong Li, Guoying Li, Haihua Liang, Di Liu, Xiaohong Xu, Mohamadreza (Mohammad) Khosravi
International Journal of Intelligent Systems.2025;[Epub] CrossRef
Application of the Sydney system for classification and reporting lymph node cytopathology: a retrospective analysis at a tertiary centre
Ashok Teja Kummari, Pramod Kumar Pamu, Krishna Kiran Ganna, Param Jyothi, Sadashivudu
International Journal of Research in Medical Sciences.2025;[Epub] CrossRef
Diagnostic approach to FNA biopsy of cystic lesions of the head and neck
Stefen Andrianus, Olivia Leung, Zubair Baloch
Cancer Cytopathology.2025;[Epub] CrossRef
Applicability of Fine-Needle Aspiration Biopsy of Lymph Nodes Using WHO Reporting System: Comparison between Pediatric and Adult Brazilian Populations
Leonardo Fávaro Ficoto, Deolino João Camilo Júnior, Gustavo Resende Nora, Vitor Bonetti Valente, Daniel Galera Bernabé, José Cândido Caldeira Xavier-Júnior
Acta Cytologica.2025; : 1. CrossRef
Intraoperative cytological assessment of sentinel lymph nodes in gynecologic cancer: diagnostic accuracy and limitations
O. V. Pankova, S. V. Vtorushin, M. V. Klimova, D. S. Pismenny, M. O. Ochirov, L. A. Kolomiets, V. M. Perelmuter
Siberian journal of oncology.2025; 24(5): 72. CrossRef
From smear to diagnosis: the impact of ancillary techniques in lymph node fine-needle cytology
Elisabetta Maffei, Giuseppe Di Motta, Angela D’Ardia, Riccardo Ruotolo, Valentina Giudice, Alessandro Caputo, Pio Zeppa
Journal of the American Society of Cytopathology.2025;[Epub] CrossRef
Immunocytochemical markers, molecular testing and digital cytopathology for aspiration cytology of metastatic breast carcinoma
Joshua J. X. Li, Gary M. Tse
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Response to comment on “A stepwise approach to fine needle aspiration cytology of lymph nodes”
Yosep Chong, Gyeongsin Park, Hee Jeong Cha, Hyun-Jung Kim, Chang Suk Kang, Jamshid Abdul-Ghafar, Seung-Sook Lee
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Efficiency of Fine-Needle Aspiration (FNA) in Relation to Tru-Cut Biopsy of Lateral Neck Swellings
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Original Articles

Clinicopathologic characterization of cervical metastasis from an unknown primary tumor: a multicenter study in Korea: Miseon Lee, Uiree Jo, Joon Seon Song, Youn Soo Lee, Chang Gok Woo, Dong-Hoon Kim, Jung Yeon Kim, Sun Och Yoon, Kyung-Ja Cho; J Pathol Transl Med. 2023;57(3):166-177. Published online May 10, 2023; DOI: https://doi.org/10.4132/jptm.2023.04.12

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Abstract PDF Supplementary Material

Background
Research regarding cervical metastasis from an unknown primary tumor (CUP) according to human papillomavirus (HPV) and Epstein-Barr virus (EBV) status in Korea has been sporadic and small-scale. This study aims to analyze and understand the characteristics of CUP in Korea according to viral and p16 and p53 status through a multicenter study.
Methods
Ninety-five cases of CUP retrieved from six hospitals in Korea between January 2006 and December 2016 were subjected to high-risk HPV detection (DNA in situ hybridization [ISH] or real-time polymerase chain reaction), EBV detection (ISH), and immunohistochemistry for p16 and p53.
Results
CUP was HPV-related in 37 cases (38.9%), EBV-related in five cases (5.3%), and unrelated to HPV or EBV in 46 cases (48.4%). HPV-related CUP cases had the best overall survival (OS) (p = .004). According to the multivariate analysis, virus-unrelated disease (p = .023) and longer smoking duration (p < .005) were prognostic factors for poor OS. Cystic change (p = .016) and basaloid pattern (p < .001) were more frequent in HPV-related cases, and lymphoepithelial lesion was frequent in EBV-related cases (p = .010). There was no significant association between viral status and p53 positivity (p = .341), smoking status (p = .728), or smoking duration (p = .187). Korean data differ from Western data in the absence of an association among HPV, p53 positivity, and smoking history.
Conclusions
Virus-unrelated CUP in Korea had the highest frequency among all CUP cases. HPV-related CUP is similar to HPV-mediated oropharyngeal cancer and EBVrelated CUP is similar to nasopharyngeal cancer in terms of characteristics, respectively.

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Differenzierung von benignen und malignen Halszysten – eine diagnostische Herausforderung
Christina Sauter, Matthias Sand, Karim Plath, Michaela Maria Plath
Laryngo-Rhino-Otologie.2025; 104(05): 296. CrossRef
Unlocking the Hidden: Advancing Imaging Techniques in Diagnosing Cancers of Unknown Primary in the Head and Neck Region
Daniela Messineo, Filippo Valentini, Giovanni Francesco Niccolini, Federica Zoccali, Francesca Ripari, Enrico Marotta, Marcello Caratozzolo, Pasquale Frisina
Applied Sciences.2025; 15(4): 2194. CrossRef
Characterization of undifferentiated carcinoma of the salivary gland: clinicopathological and immunohistochemical analyses in comparison with lymphoepithelial carcinoma
Sangjoon Choi, Gyuheon Choi, Hee Jin Lee, Joon Seon Song, Yoon Se Lee, Seung-Ho Choi, Kyung-Ja Cho
Journal of Pathology and Translational Medicine.2025; 59(6): 361. CrossRef
Management of squamous cell carcinoma of unknown primary in the head and neck: current evidence-based diagnostic and treatment strategies
Marcel Kloppenburg, Matthias Santer, Lukas Schmutzler, Felix Johnson, Benedikt Hofauer, Teresa Steinbichler
memo - Magazine of European Medical Oncology.2025;[Epub] CrossRef
Expansion of tumor-infiltrating lymphocytes from head and neck squamous cell carcinoma to assess the potential of adoptive cell therapy
Sangjoon Choi, Mofazzal Hossain, Hyun Lee, Jina Baek, Hye Seon Park, Chae-Lyul Lim, DoYeon Han, Taehyun Park, Jong Hyeok Kim, Gyungyub Gong, Mi-Na Kweon, Hee Jin Lee
Cancer Immunology, Immunotherapy.2024;[Epub] 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; J Pathol Transl Med. 2022;56(4):199-204. Published online May 11, 2022; DOI: https://doi.org/10.4132/jptm.2022.03.19

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Abstract PDF: Background
Myoferlin is a multifunctional protein expressed in various normal and cancer cells, with novel oncogenic roles being newly discovered. Recently, correlations have been found between myoferlin expression and unfavorable prognosis in various carcinomas. This study investigated the prognostic role of myoferlin expression in papillary thyroid carcinoma (PTC), specifically that associated with nodal metastasis.
Methods
We collected clinicopathological data and PTC tissues from 116 patients who had been admitted to Gyeongsang National University Hospital in 2010. Immunohistochemical analysis was performed on surgical specimen-derived tissue microarray blocks. Myoferlin expression was graded, and the relationship between expression level and pathological features of tumors based on the American Joint Committee on Cancer staging system was evaluated.
Results
Of the 116 patient samples, 100 cases exhibited positive myoferlin expression. Higher grade of myoferlin expression was correlated with lower T category group (p = .010). Presence of lymph node metastasis was determined to be significantly correlated with low-grade myoferlin expression (p = .019), with no significant difference between pN1a and pN1b tumors.
Conclusions
Our study revealed an adverse correlation between myoferlin expression and pathological features of PTC, evidence of the potential prognostic role of myoferlin in PTC lymph node metastasis.

Expression of prostate-specific membrane antigen in the neovasculature of primary tumors and lymph node metastasis of laryngeal squamous cell carcinomas: Gamze Erkılınç, Hasan Yasan, Yusuf Çağda Kumbul, Mehmet Emre Sivrice, Meltem Durgun; J Pathol Transl Med. 2022;56(3):134-143. Published online May 3, 2022; DOI: https://doi.org/10.4132/jptm.2022.02.22

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Abstract PDF

Background
Prostate-specific membrane antigen (PSMA) expression is encountered in tumor-associated neovascularization.
Methods
PSMA-antibody was applied to the paraffin blocks of 51 patients who were diagnosed with squamous cell carcinoma of the larynx and underwent laryngectomy and one who underwent lymph node dissection. The percentage of vascular expression in tumoral and extratumoral stroma and lymph nodes and intensity score in tumoral epithelium were evaluated and divided into groups according to the level of PSMA expression. Final PSMA expression was determined by multiplying intensity and percentage scores.
Results
The mean age was 61±10 years. Patients with perineural invasion, cartilage invasion, and local invasion exhibited higher PSMA expression scores. Age, tumor differentiation, tumor diameter, perineural invasion, tumor localization, capsular invasion, depth of invasion, surgical margin status, local invasion, nodal metastasis, TNM classification, and stage were similar in high and low PSMA expression groups. There was no PSMA expression in extratumoral vascular stroma. Significantly higher PSMA expression was observed in the vascular endothelium of metastatic lymph nodes compared with reactive lymph nodes. Patients with advanced-stage disease exhibited higher PSMA vascular expression scores compared to those with earlier stages (p<.001). PSMA expression was not correlated with overall survival, disease-specific survival, or disease-free survival (p>.05).
Conclusions
Our study suggests that higher PSMA expression is associated with cartilage invasion, local invasion, and advanced-stage of disease. PSMA expression can be utilized for detection of lymph node metastasis and has some predictive role in cases of neck metastasis.

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Concomitant laryngeal squamous cell carcinoma and prostate cancer on 18F-FDG PET/CT and 18F-PSMA-1007 PET/CT
Yongzhu Pu, Ran Xie, Zhiyong Deng, Long Chen
European Journal of Nuclear Medicine and Molecular Imaging.2025; 52(9): 3051. CrossRef
A Practical Guide to the Pearls and Pitfalls of PSMA PET Imaging
Andrew F. Voter, Rudolf A. Werner, Hatice Savas, Andrei Gafita, Ashley E. Ross, Michael A. Gorin, Lilja B. Solnes, Martin G. Pomper, Steven P. Rowe, Sara Sheikhbahaei
Seminars in Nuclear Medicine.2024; 54(1): 119. CrossRef
p53 and PTEN expression evaluation with molecular evident recent criteria in laryngeal carcinoma
Ayca Tan, Gorkem Eskiizmir, Ugur Kamiloglu, Sulen Sarioglu
Medicine.2023; 102(19): e33676. CrossRef
Diagnostic, Prognostic, and Therapeutic Role for Angiogenesis Markers in Head and Neck Squamous Cell Carcinoma: A Narrative Review
Lara Alessandrini, Laura Astolfi, Antonio Daloiso, Marta Sbaraglia, Tiziana Mondello, Elisabetta Zanoletti, Leonardo Franz, Gino Marioni
International Journal of Molecular Sciences.2023; 24(13): 10733. CrossRef

Causes of necrotic features in fine-needle aspirates from cervical lymph nodes: Young Jin Seo, Hyeongchan Shin, Hye Won Lee, Hye Ra Jung; J Pathol Transl Med. 2021;55(1):60-67. Published online November 27, 2020; DOI: https://doi.org/10.4132/jptm.2020.09.28

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Abstract PDF

Background
Lymph node fine-needle aspiration (LN FNA) cytology indicates necrosis in various diseases. Dominant necrotic features make the diagnosis of underlying conditions very difficult.
Methods
We retrospectively reviewed 460 patients who underwent cervical LN aspiration cytology that revealed necrotic findings at Keimyung University Dongsan Hospital in Daegu, Korea, from 2003–2017. Each specimen was evaluated and analyzed in association with the clinical findings, biopsy findings, and/or other ancillary tests, including acid-fast bacilli staining and molecular testing for Mycobacterium tuberculosis.
Results
When necrotic features were noted upon cervical LN FNA cytology, the most common pathologic LN FNA category was necrosis alone (31.5%). The second most common category was granulomatous inflammation (31.3%), followed by Kikuchi disease (20.0%) and malignant neoplasm (8.7%). In cases where the cervical LN FNA revealed necrosis alone, the most common final diagnosis was tuberculosis. In young patients, Kikuchi disease should be considered as one cervical LN FNA category, while metastatic carcinoma should be suspected in older patients.
Conclusions
Even when necrosis alone is observed in LN FNA cytology, it is important to determine the cause through further evaluation.

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Hayelom Berhe, Mahesh Kumar Cinthakunta Sridhar, Mulate Zerihun, Nir Qvit
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Does the Necrotic Portion of Metastatic Lymphadenopathy from Squamous Cell Carcinoma Still Have Tumoral Oncologic Information? Differential Diagnosis of Benign Necrotic Lymphadenopathy Using microRNA
Eun Shin, Seung Hoon Han, Il-Seok Park, Jee Hye Wee, Joong Seob Lee, Heejin Kim
Biomedicines.2023; 11(9): 2407. CrossRef
Impact of HPV status in T1–2 oropharyngeal squamous cell carcinoma with bulky N3 nodes: a multicenter GETTEC study
Charles Hurel, Florent Carsuzaa, Julia Salleron, Philippe Gorphe, Christian Righini, Maximilien Rogé, Erwan de Mones, Sylvain Morinière, Sébastien Vergez, Juliette Thariat, Xavier Dufour
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Lymph node size and its association with nodal metastasis in ductal adenocarcinoma of the pancreas: Jaehoon Shin, Seungbeom Shin, Jae Hoon Lee, Ki Byung Song, Dae Wook Hwang, Hyoung Jung Kim, Jae Ho Byun, HyungJun Cho, Song Cheol Kim, Seung-Mo Hong; J Pathol Transl Med. 2020;54(5):387-395. Published online July 21, 2020; DOI: https://doi.org/10.4132/jptm.2020.06.23

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Abstract PDF

Background
Although lymph node metastasis is a poor prognostic factor in patients with pancreatic ductal adenocarcinoma (PDAC), our understanding of lymph node size in association with PDAC is limited. Increased nodal size in preoperative imaging has been used to detect node metastasis. We evaluated whether lymph node size can be used as a surrogate preoperative marker of lymph node metastasis.
Methods
We assessed nodal size and compared it to the nodal metastatic status of 200 patients with surgically resected PDAC. The size of all lymph nodes and metastatic nodal foci were measured along the long and short axis, and the relationships between nodal size and metastatic status were compared at six cutoff points.
Results
A total of 4,525 lymph nodes were examined, 9.1% of which were metastatic. The mean size of the metastatic nodes (long axis, 6.9±5.0 mm; short axis, 4.3±3.1 mm) was significantly larger than that of the non-metastatic nodes (long axis, 5.0±4.0 mm; short axis, 3.0±2.0 mm; all p<.001). Using a 10 mm cutoff, the sensitivity, specificity, positive predictive value, overall accuracy, and area under curve was 24.8%, 88.0%, 17.1%, 82.3%, and 0.60 for the long axis and 7.0%, 99.0%, 40.3%, 90.6%, and 0.61 for the short axis, respectively.
Conclusions
The metastatic nodes are larger than the non-metastatic nodes in PDAC patients. However, the difference in nodal size was too small to be identified with preoperative imaging. The performance of preoperative radiologic imaging to predict lymph nodal metastasis was not good. Therefore, nodal size cannot be used a surrogate preoperative marker of lymph node metastasis.

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Advances in Radiomics for the Diagnosis and Treatment of Pancreatic Ductal Adenocarcinoma
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Qiying Tang, Lei Li, Zhiwei Pan, Jianbo Li, Xiaolan Huang, Mengsu Zeng, Haitao Sun, Jianjun Zhou
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Prognostic Role of Metastatic Lymph Node Ratio in Papillary Thyroid Carcinoma: Jung-Soo Pyo, Jin Hee Sohn, Kyungseek Chang; J Pathol Transl Med. 2018;52(5):331-338. Published online August 30, 2018; DOI: https://doi.org/10.4132/jptm.2018.08.07

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Abstract PDF

Background
The aim of this study is to elucidate the clinicopathological significances, including the prognostic role, of metastatic lymph node ratio (mLNR) and tumor deposit diameter in papillary thyroid carcinoma (PTC) through a retrospective review and meta-analysis.
Methods
We categorized the cases into high (≥ 0.44) and low mLNR (< 0.44) and investigated the correlations with clinicopathological parameters in 64 PTCs with neck level VI lymph node (LN) metastasis. In addition, meta-analysis of seven eligible studies was used to investigate the correlation between mLNR and survival.
Results
Among 64 PTCs with neck level VI LN metastasis, high mLNR was found in 34 PTCs (53.1%). High mLNR was significantly correlated with macrometastasis (tumor deposit diameter ≥ 0.2 cm), extracapsular spread, and number of metastatic LNs. Based on linear regression test, mLNR was significantly increased by the largest LN size but not the largest metastatic LN (mLN) size. High mLNR was not correlated with nuclear factor κB or cyclin D1 immunohistochemical expression, Ki-67 labeling index, or other pathological parameters of primary tumor. Based on meta-analysis, high mLNR significantly correlated with worse disease-free survival at the 5-year and 10-year follow-up (hazard ratio [HR], 4.866; 95% confidence interval [CI], 3.527 to 6.714 and HR, 5.769; 95% CI, 2.951 to 11.275, respectively).
Conclusions
Our data showed that high mLNR significantly correlated with worse survival, macrometastasis, and extracapsular spread of mLNs. Further cumulative studies for more detailed criteria of mLNR are needed before application in daily practice.

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Case Study

Erdheim-Chester Disease Involving Lymph Nodes and Liver Clinically Mimicking Lymphoma: A Case Report: Yeoun Eun Sung, Yoon Seo Lee, Jieun Lee, Kyo Young Lee; J Pathol Transl Med. 2018;52(3):183-190. Published online December 27, 2017; DOI: https://doi.org/10.4132/jptm.2017.10.16

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Abstract PDF

Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis and multisystem disease. First described in 1930, there are no more than 750 cases reported. The etiology remains unknown, but a majority of cases of ECD and Langerhans cell histiocytosis were found to have clonal mutations involving genes of the mitogen-activated protein kinase pathway. We recently encountered a 53-year-old male patient with extensive ECD involving the systemic lymph nodes, pleura, liver, and long bones clinically mimicking malignant lymphoma. Biopsies were performed at multiple sites, including a pleural mass, an external iliac lymph node, bone marrow, and the liver. Based on histopathological and immunohistochemical findings of positivity for CD68 and negativity for CD1a and S-100, the patient was diagnosed with ECD. Interferon-α was administered as the first-line treatment, but the patient rapidly progressed to hepatic failure after 2 months of treatment. We report this rare case of ECD clinically mimicking malignant lymphoma and diagnosed by careful pathological review.

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Original Article

Programmed Death-Ligand 1 Expression and Its Correlation with Lymph Node Metastasis in Papillary Thyroid Carcinoma: Hyo Jung An, Gyung Hyuck Ko, Jeong-Hee Lee, Jong Sil Lee, Dong Chul Kim, Jung Wook Yang, Min Hye Kim, Jin Pyeong Kim, Eun Jung Jung, Dae Hyun Song; J Pathol Transl Med. 2018;52(1):9-13. Published online October 3, 2017; DOI: https://doi.org/10.4132/jptm.2017.07.26

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Abstract PDF

Background
The immunotherapeutic role of programmed death-ligand 1 (PD-L1) in life expectancy in many cancers has been highlighted. However, data regarding PD-L1 expression in papillary thyroid carcinoma (PTC) are limited. In this study, we describe the PD-L1 and programmed cell death protein 1 (PD-1) expressions in PTC and analyze their correlation with lymph node (LN) metastasis.
Methods
Clinicopathological data were obtained from 116 patients with PTC who were treated in Gyeongsang National University Hospital, Jinju, Korea in 2009. Tissue microarray blocks were made using representative paraffin blocks of classical PTCs excluding follicular variants. Two pathologists graded the proportion and intensity of PD-L1 and PD-1 expression in both tumor and inflammatory cells. According to their proportions, positive PTC cells were scored as negative (0%), grade 1 (1%–50%), and grade 2 (51%–100%). Similarly, positive inflammatory cells were graded as negative (0%), grade 1 (1%–10%), and grade 2 (11%–20%). The intensity of each protein expression was simplified as positive or negative.
Results
A statistically significant correlation exists between the proportions of PD-1 and PD-L1 expression both in papillary carcinoma (p=.001) and peritumoral lymphoid cells in the thyroid (p<.001). In addition, the proportion of PD-L1 expression in PTC cells was closely related to metastatic LNs (p=.036).
Conclusions
PD-L1 is a valuable predictive marker for LN metastasis in PTC. Immunomodulating therapies that inhibit PD-L1 might be an option for patients with LN metastasis.

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Summary and Analysis of Molecular Biological Changes, PD-L1 Immune Status and Clinicopathological Features of 78 Cases of Papillary Thyroid Carcinoma (<1 cm in Diameter) Combined With Lateral Cervical Lymph Node Metastasis
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Applied Immunohistochemistry & Molecular Morphology.2026;[Epub] CrossRef
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Ilaria Girolami, Liron Pantanowitz, Ozgur Mete, Matteo Brunelli, Stefano Marletta, Chiara Colato, Pierpaolo Trimboli, Anna Crescenzi, Massimo Bongiovanni, Mattia Barbareschi, Albino Eccher
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Review

Sentinel Lymph Node in Breast Cancer: Review Article from a Pathologist’s Point of View: Sophia K. Apple; J Pathol Transl Med. 2016;50(2):83-95. Published online January 12, 2016; DOI: https://doi.org/10.4132/jptm.2015.11.23

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Abstract PDF

Breast cancer staging, in particular N-stage changed most significantly due to the advanced technique of sentinel lymph node biopsy two decades ago. Pathologists have more thoroughly examined and scrutinized sentinel lymph node and found increased number of small volume metastases. While pathologists use the strict criteria from the Tumor Lymph Node Metastasis (TNM) Classification, studies have shown poor reproducibility in the application of American Joint Committee on Cancer and International Union Against Cancer/TNM guidelines for sentinel lymph node classification in breast cancer. In this review article, a brief history of TNM with a focus on N-stage is described, followed by innate problems with the guidelines, and why pathologists may have difficulties in assessing lymph node metastases uniformly. Finally, clinical significance of isolated tumor cells, micrometastasis, and macrometastasis is described by reviewing historical retrospective data and significant prospective clinical trials.

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Brief Case Report

Peritoneal Carcinosarcoma and Ovarian Papillary Serous Carcinoma Are the Same Origin: Analysis of TP53 Mutation and Microsatellite Suggests a Monoclonal Origin: Chang Gok Woo, Dae Shik Suh, Joo Young Kim, Chang Ohk Sung, Jene Choi, Kyu-Rae Kim; Korean J Pathol. 2014;48(6):449-453. Published online December 31, 2014; DOI: https://doi.org/10.4132/KoreanJPathol.2014.48.6.449

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Original Articles

Extrapulmonary Lymphangioleiomyoma: Clinicopathological Analysis of 4 Cases: Dae Hyun Song, In Ho Choi, Sang Yun Ha, Kang Min Han, Jae Jun Lee, Min Eui Hong, Yoon-La Choi, Kee-Taek Jang, Sang Yong Song, Chin A Yi, Joungho Han; Korean J Pathol. 2014;48(3):188-192. Published online June 26, 2014; DOI: https://doi.org/10.4132/KoreanJPathol.2014.48.3.188

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Abstract PDF

Background

Lymphangioleiomyomatosis (LAM) is a slowly progressive neoplastic disease that predominantly affects females. Usually, LAM affects the lung; it can also affect extrapulmonary sites, such as the mediastinum, the retroperitoneum, or the lymph nodes, although these locations are rare. A localized form of LAM can manifest as extrapulmonary lesions; this form is referred to as extrapulmonary lymphangioleiomyoma (E-LAM). Due to the rare occurrence of E-LAM and its variable, atypical location, E-LAM is often difficult to diagnose. Herein, we report the clinicopathological information from four E-LAM cases, and also review previous articles investigating this disease.

Methods

Four patients with E-LAM were identified at the Samsung Medical Center (Seoul, Korea) from 1995 to 2012. All E-LAM lesions underwent surgical excision.

Results

All patients were females within the age range of 43 to 47 years. Two patients had para-aortic retroperitoneal masses, while the other two patients had pelvic lesions; two out of the four patients also had accompanying pulmonary LAM. In addition, no patient displayed any evidence of tuberous sclerosis. Histologically, two patients exhibited nuclear atypism with cytologic degeneration.

Conclusions

E-LAM should be considered in the differential diagnosis of patients presenting with pelvic or para-aortic masses. We also conclude that further clinical and pathological evaluation is needed in patients with E-LAM and nuclear atypism.

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Weiwei Fu, Yujun Li, Hong Li, Ping Yang, Xiaoming Xing
Experimental and Therapeutic Medicine.2016; 12(3): 1499. CrossRef
Incidental Pelvic and Para-aortic Lymph Node Lymphangioleiomyomatosis Detected During Surgical Staging of Pelvic Cancer in Women Without Symptomatic Pulmonary Lymphangioleiomyomatosis or Tuberous Sclerosis Complex
Joseph T. Rabban, Brandie Firetag, Ankur R. Sangoi, Miriam D. Post, Charles J. Zaloudek
American Journal of Surgical Pathology.2015; 39(8): 1015. CrossRef

Tumor Sprouting in Papillary Thyroid Carcinoma Is Correlated with Lymph Node Metastasis and Recurrence: Eunjung Lee, Wonkyung Jung, Jeong-Soo Woo, Jae Bok Lee, Bong Kyung Shin, Han Kyeom Kim, Aeree Kim, Baek-hui Kim; Korean J Pathol. 2014;48(2):117-125. Published online April 28, 2014; DOI: https://doi.org/10.4132/KoreanJPathol.2014.48.2.117

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Abstract PDF

Background

Identification of poor prognostic factors in papillary thyroid carcinoma (PTC) patients is important for the patients' care and follow-up. We can sometimes see small tumor clusters without desmoplasia and no evidence of lymphatic emboli around the main tumor mass of PTC. We termed this form of tumor clustering, 'tumor sprouting,' and determined whether these tumors correlate with lymphovascular invasion, lymph node metastasis, and recurrence.

Methods

We analyzed a total of 204 cases of papillary thyroid macrocarcinoma. Number, size and distance from the main tumor of the tumor sprouting were observed and analyzed with clinicopathologic characteristics.

Results

Tumor sprouting was observed in 101 patients. Presence of tumor sprouting was significantly associated with positive resection margin (p=.002), lymphovascular invasion (p=.001), lymph node metastasis (p<.001), and recurrence (p=.004). Univariate analysis of recurrence-free survival revealed that tumor multiplicity (p=.037), positive resection margin (p=.007), lymphovascular invasion (p=.004), lymph node metastasis (p<.001), and tumor sprouting (p=.004) were poor prognostic factors. In multivariate analysis, positive resection margin was an independent poor prognostic factor of recurrence.

Conclusions

In conclusion, tumor sprouting is significantly correlated with lymph node metastasis and recurrence. Evaluation of tumor sprouting in PTC patients could be helpful in predicting tumor recurrence or lymph node metastasis.

Citations

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The Initial Risk Stratification System for Differentiated Thyroid Cancer: Key Updates in the 2024 Korean Thyroid Association Guideline
Shinje Moon, Young Shin Song, Kyong Yeun Jung, Eun Kyung Lee, Jeongmin Lee, Dong-Jun Lim, Chan Kwon Jung, Young Joo Park
Endocrinology and Metabolism.2025; 40(3): 357. CrossRef
Korean Thyroid Association Guidelines on the Management of Differentiated Thyroid Cancers; Part I. Initial Management of Differentiated Thyroid Cancers - Chapter 5. Evaluation of Recurrence Risk Postoperatively and Initial Risk Stratification in Different
Eun Kyung Lee, Young Shin Song, Ho-Cheol Kang, Sun Wook Kim, Dong Gyu Na, Shin Je Moon, Dong-Jun Lim, Kyong Yeun Jung, Yun Jae Chung, Chan Kwon Jung, Young Joo Park
International Journal of Thyroidology.2024; 17(1): 68. CrossRef
Significance of Lymphovascular Invasion as a Prognostic Factor in Patients with Papillary Thyroid Cancer: a Systematic Review and Meta-Analysis
Ho-Ryun Won, Bon Seok Koo
International Journal of Thyroidology.2023; 16(2): 157. CrossRef
Peripheral Versus Intraparenchymal Papillary Thyroid Microcarcinoma: Different Morphologies and PD-L1 Expression
Bozidar Kovacevic, Dragana Vucevic, Snezana Cerovic, Catarina Eloy
Head and Neck Pathology.2022; 16(1): 200. CrossRef
Lymphovascular invasion and risk of recurrence in papillary thyroid carcinoma
Katy Wagner, Earl Abraham, Bryan Tran, David Roshan, James Wykes, Peter Campbell, Ardalan Ebrahimi
ANZ Journal of Surgery.2020; 90(9): 1727. CrossRef
The Predictors of Multicentricity in Well-Differentiated Thyroid Cancer
Mohamed Hegazi, Waleed El Nahas, Mohamed Elmetwally, Amr Hassan, Waleed Gado , Islam Abdou, Ahmed Senbel, Mohamed Samir Abou-Sheishaa
Journal of Analytical Oncology.2018; 7(4): 65. CrossRef
Prognostic impact of vascular invasion in differentiated thyroid carcinoma: a systematic review and meta-analysis
Huy Gia Vuong, Tetsuo Kondo, Uyen N P Duong, Thong Quang Pham, Naoki Oishi, Kunio Mochizuki, Tadao Nakazawa, Lewis Hassell, Ryohei Katoh
European Journal of Endocrinology.2017; 177(2): 207. CrossRef
Detection of Tumor Multifocality Is Important for Prediction of Tumor Recurrence in Papillary Thyroid Microcarcinoma: A Retrospective Study and Meta-Analysis
Jung-Soo Pyo, Jin Hee Sohn, Guhyun Kang
Journal of Pathology and Translational Medicine.2016; 50(4): 278. CrossRef

Case Study

Peritoneal and Nodal Gliomatosis with Endometriosis, Accompanied with Ovarian Immature Teratoma: A Case Study and Literature Review: Na Rae Kim, Soyi Lim, Juhyeon Jeong, Hyun Yee Cho; Korean J Pathol. 2013;47(6):587-591. Published online December 24, 2013; DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.6.587

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Abstract PDF

Gliomatosis peritonei (GP) indicates the peritoneal implantation of mature neuroglial tissue and is usually accompanied by ovarian mature or immature teratoma. Here, we report a case of ovarian immature teratoma associated with gliomatosis involving the peritoneum, lymph nodes and Douglas' pouch, where gliomatosis coexisted with endometriosis. As far as we know, only seven cases of GP have been reported as coexisting with endometriosis. Eight cases with mature glial tissue in the lymph nodes, i.e., nodal gliomatosis, have been published either in association with GP or in its absence. Metaplasia of pluripotent coelomic stem cells has been suggested to be responsible for the pathogenesis of endometriosis and GP rather than implantation metastases of ovarian teratomatous tumor with varying maturation. This theory is also applied to GP independently of ovarian teratomatous tumors. To the best of our knowledge, nodal gliomatosis coexisting with GP and also involving endometriosis has not yet been reported.

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B. Lawson, I. Rajendran, J. Smith, A. Shakur, V. Sadler, T.J. Sadler, H.C. Addley, S. Freeman
Clinical Radiology.2024; 79(10): 736. CrossRef
Ovarian Immature Teratoma With Nodal Gliomatosis: A Case Report and Literature Review
Marwa Alna’irat, W. Glenn McCluggage, Maysa Al-Hussaini
International Journal of Gynecological Pathology.2023; 42(6): 627. CrossRef
Germ Cell Tumors of the Ovary: A Review
Preetha Ramalingam
Seminars in Diagnostic Pathology.2023; 40(1): 22. CrossRef
Immature Teratoma with Gliomatosis Peritonei Arising in a Young Girl: Report of a Rare Case and Review of Literature
Isheeta Ahuja, Ruchi Rathore, Neerja Bhatla, Sandeep R. Mathur
Indian Journal of Gynecologic Oncology.2023;[Epub] CrossRef
Growing Teratoma Syndrome with Synchronous Gliomatosis Peritonei during Chemotherapy in Ovarian Immature Teratoma: A Case Report and Literature Review
Sijian Li, Na Su, Congwei Jia, Xinyue Zhang, Min Yin, Jiaxin Yang
Current Oncology.2022; 29(9): 6364. CrossRef
Extratesticular gliomatosis peritonei after mesenteric teratoma: a case report and literature review
Jiaqiang Li, Shoulin Li, Dong Xiao, Jiaming Song, Jianxiong Mao, Jianchun Yin
Journal of International Medical Research.2021;[Epub] CrossRef
Germ Cell Tumors of the Female Genital Tract
Elizabeth D. Euscher
Surgical Pathology Clinics.2019; 12(2): 621. CrossRef
Gliomatosis peritonei: a series of eight cases and review of the literature
Dan Wang, Cong-wei Jia, Rui-e Feng, Hong-hui Shi, Juan Sun
Journal of Ovarian Research.2016;[Epub] CrossRef

Original Article

Histopathologic Predictors of Lymph Node Metastasis and Prognosis in Tonsillar Squamous Cell Carcinoma: Dong Jin Lee, Mi Jung Kwon, Eun Sook Nam, Ji Hyun Kwon, Jin Hwan Kim, Young-Soo Rho, Hyung Sik Shin, Seong Jin Cho; Korean J Pathol. 2013;47(3):203-210. Published online June 25, 2013; DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.3.203

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Abstract PDF

Background

Risk factors for lymph node metastasis in tonsillar squamous cell carcinoma (TSCC) need to be established to determine the degree of surgery required to achieve high curative rates. However, little is known currently about the histopathological features predicting prognosis, specifically in TSCC.

Methods

This study included 53 patients who underwent surgical resection with neck dissection. Clinicopathological factors investigated included age, gender, alcohol use, tobacco consumption, tumor stage, adjacent structure involvement, cell differentiation, squamous dysplasia, in situ carcinoma associated with primary invasive cancer, carcinoma in situ skip lesions, necrosis, invasive front, depth of invasion, and lymphatic, muscle, or perineural invasion.

Results

Contralateral cervical metastasis was associated with higher T stages and soft palate invasion. Lymphatic and muscle invasion were associated with ipsilateral cervical metastasis. Advanced T stage, invasion to the base of tongue, and skip lesions were associated with decreased disease-free survival. Advanced T stage and skip lesions were associated with worse overall survival.

Conclusions

Advanced T stage and soft palate invasion may predict a high risk of contralateral nodal metastasis. T stage and skip lesion are worse prognostic factors in TSCC and should be commented in pathology reports.

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Comprehensive Transcriptome Analysis Reveals the Distinct Gene Expression Patterns of Tumor Microenvironment in HPV-Associated and HPV-Non Associated Tonsillar Squamous Cell Carcinoma
Reham M. Alahmadi, Najat Marraiki, Mohammed Alswayyed, Hatim A. Khoja, Abdullah E. Al-Anazi, Rawan M. Alahmadi, Meshael M. Alkusayer, Bandar Alosaimi, Maaweya Awadalla
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Masanari G. Kato, Mark A. Ellis, Shaun A. Nguyen, Terry A. Day
Head & Neck.2018; 40(2): 338. CrossRef
Clinical implication of programmed cell death-1 ligand-1 expression in tonsillar squamous cell carcinoma in association with intratumoral heterogeneity, human papillomavirus, and epithelial-to-mesenchymal transition
Mi Jung Kwon, Young-Soo Rho, Eun Sook Nam, Seong Jin Cho, Hye-Rim Park, Soo Kee Min, Jinwon Seo, Ji-Young Choe, Eun Soo Kim, Bumjung Park, Mineui Hong, Kyueng-Whan Min
Human Pathology.2018; 80: 28. CrossRef
Comparison of the eighth version of the American Joint Committee on Cancer manual to the seventh version for colorectal cancer: A retrospective review of our data
Guo-Jun Tong, Gui-Yang Zhang, Jian Liu, Zhao-Zheng Zheng, Yan Chen, Ping-Ping Niu, Xu-Ting Xu
World Journal of Clinical Oncology.2018; 9(7): 148. CrossRef
HIPK2 Overexpression and Its Prognostic Role in Human Papillomavirus-Positive Tonsillar Squamous Cell Carcinoma
Mi Jung Kwon, So Young Kang, Eun Sook Nam, Seong Jin Cho, Young-Soo Rho
BioMed Research International.2017; 2017: 1. CrossRef
Frequent hepatocyte growth factor overexpression and low frequency of c-Met gene amplification in human papillomavirus–negative tonsillar squamous cell carcinoma and their prognostic significances
Mi Jung Kwon, Dong Hoon Kim, Hye-Rim Park, Hyung Sik Shin, Ji Hyun Kwon, Dong Jin Lee, Jin Hwan Kim, Seong Jin Cho, Eun Sook Nam
Human Pathology.2014; 45(7): 1327. CrossRef
CT and MR imaging findings of palatal tumors
Hiroki Kato, Masayuki Kanematsu, Hiroki Makita, Keizo Kato, Daijiro Hatakeyama, Toshiyuki Shibata, Keisuke Mizuta, Mitsuhiro Aoki
European Journal of Radiology.2014; 83(3): e137. CrossRef

Case Reports

Castleman's Disease of the Renal Sinus Presenting as a Urothelial Malignancy: A Brief Case Report: Se Min Jang, Hulin Han, Ki-Seok Jang, Young Jin Jun, Tchun Yong Lee, Seung Sam Paik; Korean J Pathol. 2012;46(5):503-506. Published online October 25, 2012; DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.5.503

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Abstract PDF

Castleman's disease is a rare benign lymphoproliferative disorder that frequently affects lymph nodes of the mediastinal thorax and the neck. It very rarely affects the renal sinus. We report a case of Castleman's disease arising in the renal sinus in a 64-year-old man. The patient visited the hospital with the chief complaint of hematuria. Abdominal computed tomography revealed a homogeneous mass in the sinus of the left kidney, radiologically interpreted as a malignant urothelial tumor. Subsequently, nephroureterectomy was performed, after which microscopic examination of the specimen revealed a diffuse lymphoproliferative lesion with reactive lymphoid follicles of various sizes and prominent plasma cell infiltration of interfollicular spaces, highlighted by immunohistochemical staining for CD138. The lesion was diagnosed as Castleman's disease of the plasma cell type. Although preoperative diagnosis of Castleman's disease is difficult and the incidence is exceedingly rare, it should be considered in the differential diagnosis of renal sinus tumors.

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Misdiagnosis of renal pelvic unicentric Castleman disease: a case report
Dian Fu, Bo Yang, Ming Yang, Zhenyu Xu, Wen Cheng, Zhijia Liu, Liming Zhang, Zhiguo Mao, Cheng Xue
Frontiers in Surgery.2023;[Epub] CrossRef
Case report: Castleman’s disease involving the renal sinus resembling renal cell carcinoma
Enlong Zhang, Yuan Li, Ning Lang
Frontiers in Surgery.2022;[Epub] CrossRef
Radiologic features of Castleman’s disease involving the renal sinus: A case report and review of the literature
Xiao-Wan Guo, Xu-Dong Jia, Shan-Shan Shen, Hong Ji, Ying-Min Chen, Qian Du, Shu-Qian Zhang
World Journal of Clinical Cases.2019; 7(8): 1001. CrossRef
Castleman’s Disease: a Suprarenal Surprise!
Praveen Sundar, Priyank Bijalwan, Ginil Kumar Pooleri
Indian Journal of Surgical Oncology.2018; 9(2): 254. CrossRef

Hyaline Vascular Castleman Disease Involving Renal Parenchyma and a Lymph Node: A Case Report: Ji Hyun Kwon, Soo Kee Min, Mi Kyung Shin, Yong Seong Lee, Young-Goo Lee, Young Hyeh Ko; Korean J Pathol. 2012;46(1):79-82. Published online February 23, 2012; DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.1.79

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Abstract PDF

Castleman disease is a rare lymphoproliferative lesion that is predominantly found in the mediastinum. Retroperitoneal and pararenal localizations are very rare. We describe a 36-year-old man with a hyaline vascular type of Castleman disease involving renal parenchyma and a paraaortic lymph node. Most reported renal Castleman disease was plasma cell type with systemic symptoms. Herein, we report the first Korean case of the hyaline vascular type of Castleman disease involving the renal parenchyma and the paraaortic lymph node simultaneously.

Citations

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Hiding in the kidney: a series of 13 lymphoid proliferations clinically mimicking renal carcinoma
Jihoon William Lee, Marie E. Perrone, Daniel E. Sabath, Daniel W. Lin, George R. Schade, Funda Vakar-Lopez, Maria Tretiakova
Virchows Archiv.2025;[Epub] CrossRef
Primary hyaline vascular Castleman disease in the kidney: a report and brief literature review
Ibrahim Elsharawi, Sorin Selegean
Journal of Hematopathology.2025;[Epub] CrossRef
Castleman Disease of the Kidney in Computed Tomography Urography
Kai Wang, Fengjuan Xing, Heng Ma, Wenjuan Li
Current Medical Imaging Formerly Current Medical Imaging Reviews.2022; 18(1): 74. CrossRef
Primary hyaline vascular Castleman disease of the kidney: case report and literature review
Yunzhu Li, Haixia Zhao, Bingyin Su, Chan Yang, Shurong Li, Wanlei Fu
Diagnostic Pathology.2019;[Epub] CrossRef
Castleman’s Disease of the Kidney Mimicking Renal Cell Carcinoma on FDG PET/CT
Yang Wang, Aisheng Dong, Bo Yang, Jianping Lu
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Unicentric hyaline vascular type of castleman disease of the renal hilum with diagnostic dilemma: A case report and review of literature
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Original Article

Cytologic findings of Hodgkin's disease with special emphasis on Reed-Sternberg cells and their variants.: Young Hyeh Ko, Chan Pil Park, Jung Dal Lee; J Pathol Transl Med. 1991;2(1):1-7.

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Abstract PDF: Cytologic findings from five cases with variable types of Hodgkin' disease were reviewed with special emphasis on the Reed-Sternberg (R-S) cells and their variants. Typical R-S and Hodgkin's cells were mono- or binucleated, and nuclei had rounded smooth contour. Acidophilic prominent nucleoli with perinucleolar halo were conspicuous. In comparison to typical Reed-Sternberg cells, L & H (lymphocytic and histiocytic) cells in the lymphocyte predominant type tended to show pop-corn like irregular nuclear contour and to lack the prominent nucleoli. Lacunar cells in the nodular sclerosis type had multilobated nuclei with prominent acidophilic nucleoli. There was no prominent perinucleolar halo in L & H and lacunar cells. In conjuction with the number of Reed-Sternberg cells and back ground findings observed on the smears, the characteristic features of R-S cells and their variants allowed to make typing of Hodgkin's disease.

Case Reports

Angiomyomatous Hamartoma of Popliteal Lymph Nodes Occurring in Association with Diffuse Pigmented Villonodular Synovitis of Knee.: Hyun Soo Kim, Ki Yong Na, Jae Hoon Lee, Nam Su Cho, Gou Young Kim, Sung Jig Lim; Korean J Pathol. 2011;45:S58-S61.; DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.S1.S58

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Abstract PDF: We report the first case of an angiomyomatous hamartoma (AH) of the popliteal lymph nodes (LNs) occurring in association with diffuse pigmented villonodular synovitis (PVNS) of the knee. AH is a rare benign vascular disease with a predisposition for the LNs of the inguinal region. Twenty-five cases of AH have been reported to date; however, the precise pathogenesis is still undetermined. In the present case, an open synovectomy revealed two of three popliteal LNs in close proximity to the extra-articular component of diffuse PVNS. These LNs demonstrated irregularly distributed thick-walled blood vessels in the hilum. These vessels extended into the medulla and cortex and were associated with haphazardly arranged smooth muscle cells in the sclerotic stroma. These findings are compatible with an AH. Our observations raise the possibility that AH of the popliteal LNs may represent an abnormal proliferative reaction against the inflammatory process caused by PVNS of the knee.

Systemic Plasmacytosis: A Case Report with a Review of the Literature.: Sung Hak Lee, Chang Young Yoo, Ji Han Jung, Jin Young Yoo, Suk Jin Kang, Chang Suk Kang; Korean J Pathol. 2011;45(6):632-638.; DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.6.632

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Abstract PDF

Systemic plasmacytosis is an uncommon disorder characterized by widely disseminated macular skin eruptions composed of polyclonal lymphoplasmacytic infiltrates associated with variable extracutaneous involvement. An aggressive clinical course has been observed in a small number of patients, but most cases have followed chronic and benign clinical course without spontaneous remission. Previously reported cases of this entity have been described almost exclusively in Japanese patients. We recently experienced a case of systemic plasmacytosis in a 48-year-old Korean female patient. Initial skin biopsy specimen revealed patchy perivascular and periadnexal infiltrates of mature plasma cells. Serum immunoelectrophoresis revealed polyclonal hypergammaglobulinemia, and polyclonal plasmacytosis was noted on the subsequent biopsy specimens of left supraclavicular and axillary lymph nodes. Multiple tiny pulmonary nodules appeared six years after the initial cutaneous presentation and were found to be of the same histologic appearance. We herein report a rare case of systemic plasmacytosis with a review of the literature.

Citations

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Cutaneous plasmacytosis with mast cell infiltration
Sarina Jain, RohitV Hede, UdayS Khopkar
Indian Journal of Dermatology, Venereology and Leprology.2020; 86(1): 91. CrossRef
Plasmocitosis cutánea en un varón de raza blanca
A. López-Gómez, T. Salas-García, A. Ramírez-Andreo, E. Poblet-Martínez
Actas Dermo-Sifiliográficas.2015; 106(6): 520. CrossRef
Cutaneous Plasmacytosis in a White Man
A. López-Gómez, T. Salas-García, A. Ramírez-Andreo, E. Poblet-Martínez
Actas Dermo-Sifiliográficas (English Edition).2015; 106(6): 520. CrossRef

Original Article

Fine-Needle Aspiration Cytology of the Nodal Marginal Zone Lymphoma.: Seung Kyu Choi, Ji Eun Kwon, Young Hyeh Ko; Korean J Pathol. 2011;45(4):406-411.; DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.4.406

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Abstract PDF: BACKGROUND
Nodal marginal zone lymphoma (NMZL) is a rare B-cell neoplasm consisting of heterogeneous cellular components and residual B-cell follicles. Because of such histological features, it is difficult to diagnose NMZL by fine needle aspiration (FNA) cytology. We reviewed FNA cytology of NMZL to identify a cytological clue to avoid misdiagnosing NMZL.
METHODS
Histological, cytological, and clinical findings of seven cases of NMZL were reviewed.
RESULTS
Most cases showed nodular aggregates of lymphohistiocytes derived from the germinal center irrespective of histological pattern. The cellular components were heterogeneous and composed of mature small lymphocytes, intermediate and large lymphocytes, immunoblasts, tingible body macrophages, and follicular dendritic cells. Intermediate-sized neoplastic cells with a pale nucleus were observed but difficult to identify because of admixed non-neoplastic cells, which outnumbered neoplastic cells. Except for one case with a high proportion of intermediate-sized cells, the other six cases were initially diagnosed as reactive hyperplasia. A flow cytometric analysis was performed in two cases and failed to demonstrate a monoclonal B-cell population.
CONCLUSIONS
The FNA showing a reactive hyperplasia-like smear pattern should be carefully observed by experienced cytopathologists to identify intermediate-sized neoplastic cells. Clinical information including the size of the lymph nodes is important to avoid a misdiagnosis.

Case Reports

Langerhans Cell Sarcoma Arising in a Lymph Node: A Case Report and Review of the Literature.: Dong Wook Kang, Hyun Jin Son, Tae Hwa Baek, Hye Kyung Lee, Joo Ryung Huh, Joo Heon Kim, Mee Ja Park; Korean J Pathol. 2011;45(1):101-105.; DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.1.101

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Abstract PDF: We report a case of Langerhans cell sarcoma presented as a solitary mass in the left supraclavicular area in a 31-year-old woman. Computed tomography revealed a relatively well-defined and lightly enhancing mass in the left supraclavicular area, measuring 5.5x4.5x3.2 cm. Excision was subsequently performed. Microscopically, the specimen consisted of an enlarged and partially effaced lymph node. Nests of different size composed of atypical tumor cells were located in the paracortex and the medulla of the lymph node. The tumor cells exhibited abundant eosinophilic or clear cytoplasm and displayed marked nuclear atypia and increased mitotic figures. Infiltration of many eosinophils was identified in the periphery and between the tumor cells. The tumor cells were reactive for CD1a and S100 protein. Ultrastructually, they were found to have Birbeck granules in the cytoplasm.

Metastases from Rectum and Thyroid Cancers in Same Cervical Lymph Node: A Case Report.: Bulent Yildiz, Abdulkadir Reis, Evren Fidan, Feyyaz Ozdemir, Halil Kavgaci, Fazil Aydin; Korean J Pathol. 2010;44(5):551-553.; DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.5.551

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Abstract PDF

An excisional biopsy targeting a cervical lymph node was performed on a 49-year-old female patient with metastatic rectal cancer. The biopsy revealed rectal and papillary thyroid cancer metastasis in the same lymph node. A thin-needle thyroid aspiration biopsy was performed, and the result was papillary thyroid carcinoma. The patient, who received chemotherapy for the metastatic rectal cancer, died due to disease progression about 5 months after a secondary primary tumor was detected. Metastasis of multiple malignancies in the same lymph node is extremely rare. A metastases of rectal and thyroid cancers to the same lymph node has not been reported until now. Our patient is the first case in the literature.

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Michał Kunc, Paulina Skrzypkowska, Rafał Pęksa, Wojciech Biernat
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Cytology of Follicular Dendritic Cell Sarcoma on Intraoperative Touch Imprint Smears: A Case Report.: Ju Young Song, Xian Ji Jin, Jee Young Han, Lucia Kim, In Suh Park, Joon Mee Kim, Young Chae Chu, Suk Jin Choi; Korean J Pathol. 2009;43(6):589-593.; DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.6.589

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Abstract PDF

Follicular dendritic cell (FDC) sarcoma is a neoplastic proliferation of FDCs. Because its cytologic findings can vary widely, both the cytomorphology and histopathology of FDC sarcoma can impose a significant diagnostic dilemma. We present cytologic features of FDC sarcoma assessed by intraoperative touch imprint. Intra-abdominal lymphadenopathies were noted in 54-year-old male with hepatitis B-virus associated liver cirrhosis. In contrast to cytologic features of classical FDC sarcoma, the tumor cells featured a large epithelioid or Reed-Sternberg cell-like shape scattered in a background with abundant inflammatory cells, which led to a mistaken diagnosis of malignant lymphoma. However, in accordance with cytologic features previously described in the literature, the tumor cells were characterized by a fragile cytoplasm with cytoplasmic processes in dendritic or reticulated patterns reminiscent of the ultrastructural features of FDC. Cytoplasmic features rendering nuclei with a tendency to form clusters or syncytial aggregates associated with reactive lymphocytes appear to be the most valuable finding in diagnosis of FDC sarcoma.

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Cody Weimholt, Jalal B. Jalaly, Cedric Bailey
Journal of the American Society of Cytopathology.2023; 12(3): 229. CrossRef
A Cytological Review of Follicular Dendritic Cell-Derived Tumors with Emphasis on Follicular Dendritic Cell Sarcoma and Unicentric Castleman Disease
José A. Jiménez-Heffernan, Cristina Díaz del Arco, Magdalena Adrados
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Cytological diagnosis of follicular dendritic cell sarcoma: A case report and review of literature
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Short Case Reports

Schwannoma Arising in a Lymph Node : A Brief Case Report.: Ji Han Jung, Jinyoung Yoo, Seok Jin Kang, Kyo Young Lee; Korean J Pathol. 2009;43(3):271-273.; DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.3.271

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Abstract PDF

Intranodal schwannomas are extremely rare and only three cases have currently been reported in the English language literature. We report here on a case of a schwannoma that arose in a retroperitoneal lymph node. A 59-year-old male patient had experienced abdominal discomfort for two months. An abdominal CT scan demonstrated a heterogeneous density mass in the retroperitoneum. Histological examination of the mass identified it as a lymph node due to the presence of a peripheral rim of compressed lymphoid tissue that contained a well-demarcated benign spindle cell tumor in its center. The spindle cells were positive for S-100 protein, and they were negative for smooth muscle actin, desmin, and CD 34. Although an intranodal schwannoma is histologically benign, it is important to distinguish this lesion from an intranodal metastasis of a spindle cell tumor and other common benign spindle cell tumors that can arise in a lymph node.

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Brian D. Hayes, Maureen J. O'Sullivan
Pediatric and Developmental Pathology.2011; 14(4): 313. CrossRef
Intranodal Schwannoma Mimicking a Gastrointestinal Stromal Tumor of the Stomach: A Case Report
Kyung Bum Nam, Sook Namkung, Heung Cheol Kim, Hae Sung Kim, Byoung Yoon Ryu, Young Hee Choi
Journal of the Korean Society of Radiology.2011; 65(4): 395. CrossRef

Intranodal Palisaded Myofibroblastoma with Desmin Expression : A Brief Case Report.: Dong Chul Kim, Tae Hoon Kang, Min A Kim, Yoon Kyung Jeon; Korean J Pathol. 2009;43(3):263-265.; DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.3.263

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Abstract PDF: Intranodal palisaded myofibroblastoma is a rare benign mesenchymal neoplasm of the lymph node. It is characterized by intranodal spindle cell proliferation along with amianthoid fibers and prominent hemorrhage. It has been rarely reported in South Korea. We report here on a case of palisaded myofibroblastoma that arose in the left inguinal lymph node. The tumor mass was well demarcated, and it was composed of a proliferation of benign-looking spindle cells. It showed focal hemorrhage and a fibrous pseudocapsule. The tumor cells displayed little pleomorphism, no mitotic count, and characteristic palisading nuclei and amianthoid fibers. The tumor cells were positive for smooth muscle actin, vimentin, and also for desmin, but they were negative for S-100 protein, supporting the diagnosis of myofibroblastoma.

Case Report

Pseudofungi Associated with a Granulomatous Response in a Lymph Node: A Case Report.: Haeryoung Kim, Ja Seung Koo, Hyosup Shim, Gijong Yi, Sang Ho Cho; Korean J Pathol. 2004;38(1):64-67.

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Abstract PDF: . We present herein a case of pseudofungi incidentally found in the mediastinal lymph nodes of a 31-year-old woman who had a left pneumonectomy for a pulmonary blastoma. The pseudofungi were located in the subcapsular sinuses of the lymph nodes with an associated granulomatous reaction. They revealed yellowish-brown hyphae-like structures with pseudosepta and irregular branching at various angles intermingled with round yeast-like forms. These structures stained positively with periodic acid-Schiff and Gomori methenamine silver, but also stained strongly positive for Prussian blue suggesting that they contain iron. The characteristic morphological features of pseudofungi are discussed with emphasis on the features that distinguish them from true fungal organisms.

Original Article

Diagnostic Usefulness and Limitation of Fine Needle Aspiration Cytology of Lymph Node: Analysis of 176 Cases Confirmed by Biopsy .: Hee Sung Kim, Dae Soo Kim, Young Lyun Oh, Young Hyeh Ko, Howe J Ree; J Pathol Transl Med. 1999;10(1):35-42.

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Abstract PDF: The accuracy of fine needle aspiration cytology(FNAC) of the lymph node was investigated through a review of 176 FNAC cases and the corresponding biopsies. We chose 157 FNAC cases after the exclusion of 19 inadequate ones. Sensitivity of malignancy was 94.0%, specificity 100%, false negativity 6.0%, and false positivity 0.0%. The overall diagnostic accuracy was 96.8%. Sensitivity of metastatic carcinoma was 98.0% and that of malignant lymphoma was 87.9%. False negative cases included one metastatic carcinoma and four malignant lymphomas. The aspirates of metastatic carcinoma with false negativity exhibited a diffuse smear of keratin debris without viable cells, which led to the difficulty in differentiation from benign epithelial cyst. The cases of malignant lymphoma with false negative diagnosis were two Hodgkin diseases, one Lennert's lymphoma, and one peripheral T cell lymphoma in the histologic sections. On the analysis of 39 cases of tuberculosis, 17 cases(43.6%) were diagnosed as tuberculosis, 4(10.3%) as granulomatous lymphadenitis, 3(7.7%) as necrotizing lymphadenitis, and 15(38.5%) as reactive hyperplasia or pyogenic inflammation. Sensitivity of tuberculosis was 53.9%. In conclusion, lymph node FNAC is an excellent non-invasive diagnostic tool for the diagnosis of metastatic carcinoma. The diagnostic accuracy of malignant lymphoma could be improved with flow cytometry or polymerase chain reaction for antigen receptor genes. For the FNAC diagnosis of tuberculosis, AFB stain, culture, and PCR would be helpful as adjuvant techniques.

Case Reports

Three Cases of Giant Lymph Node Hyperplasia in Unusual Location.: Hye Kyung An, Ill Hyang Ko; Korean J Pathol. 1989;23(3):365-370.

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Abstract PDF: Giant lymph node hyperplasia (Castleman's disease) was first described by Castleman and associates. In the first accounts of giant lymph node hyperplasia, the lesions were described as solitary and localized to the mediastinum. Recently, we have experienced three cases of Castleman's disease, first of which is a 54 year old male with plasma cell type in the mesentery, second is 27 year old femal with hyaline vascular type in the inguinal region and third is a 29 year old female with hyaline vascular tye in neck.

Lymph Node Infarction After Fine-Needle Aspiration.: Ho Sung Park, Kyu Yun Jang, Myoung Ja Chung, Woo Sung Moon, Dong Geun Lee, Myoung Jae Kang; Korean J Pathol. 2004;38(3):204-207.

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Abstract PDF: Histologic alterations of lymph nodes following fine-needle aspiration have not been well described. Only two cases of lymph node infarction following fine-needle aspiration have currently been reported. We report here on a case of near total infarction of a lymph node that was detected 16 days after fine-needle aspiration in a 74-year old man. A fine-needle aspiration smear of the right inguinal lymph node showed scattered and clustered cells including lymphocytes, plasma cells, neutrophils that were seen as a reactive nodal hyperplasia in the clean background. There were no malignant cells, granulomas or necrotic debris. In the incisional biopsy of the same lymph node, the sections revealed a thin rim of viable lymphocytes, granular tissue was noted peripherally and extensive necrosis associated with vascular thrombi was noted centrally. There was no evidence of malignancy or granulomatous inflammation.

Fine Needle Aspiration Cytology of Peripheral T Cell Lymphoma, Lymphoepithelioid Cell Type: Report of A Case Mimicking Tuberculous Lymphadenitis .: Ho Sung Park, Jong Myung Hong, Myoung Ja Chung, Woo Sung Moon; J Pathol Transl Med. 1999;10(2):185-189.

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Abstract PDF: The diagnosis of peripheral T cell lymphoma is difficult due to the varying size and shape of the neoplastic lymphoid cells and the frequent admixture of nonneoplastic mature lymphyocytes, histiocytes, eosinophils, and plasma cells. We report a case of peripheral T cell lymphoma, lymphoepithelioid cell type, which was difficult to differentiate from tuberculous lymphadenitis due to the aggregates of epithelioid histiocytes mimicking granuloma and the past history of pulmonary tuberculosis. Fine needle aspiration cytology of the inguinal lymph node in a 63-year-old male was characterized by hypercellular aspirates composed of a mixture of small and intermediate-size lymphoid cells and large lymphoid cells with background of confluent epithelioid histiocytes. The neoplastic lymphocytes demonstrated significant nuclear irregularity with protrusion and indentations of the nuclear membrane, prominent nucleoli, and frequent mitotic figures. The diagnosis of peripheral T cell lymphoma was confirmed by histological and immunohistochemical studies.

Original Article

Expression of Matrix Metalloproteinase-1,2,3 and Type IV Collagen in Gastric Adenocarcinoma: Influence on Lymph Node Metastasis and Prognosis.: Eun Sun Jung, Byung Gee Kim, Jo Hyun Park, Sang In Shim; Korean J Pathol. 1999;33(4):251-258.

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Abstract PDF: Matrix metalloproteinases are believed to play an important role in tumor invasion and metastasis. But little is known about the role of them in the gastric adenocarcinoma. We investigated the expression of matrix metalloproteinase-1,2,3 in eighty paraffin blocks of the primary gastric adenocarcinoma tissues with immunohistochemistry and analysed their correlation with lymph node metastasis and survival. MMP-1,2,3 were expressed most intensely in the fibroblasts around the tumor stroma. In our study the increased immunoreactivity of MMP-2 only showed statistically significant correlation with lymph node metastasis (P=0.0517, Odd's ratio=2.274). But MMP-1,2,3 all were correlated with survival. Type IV collagen was observed in the vascular basement membranes and tumor basement membranes and showed statistically significant correlation with lymph node metastasis (P=0.0002, Odd's ratio=0.194) and prognosis (P=0.0001). The immunoreactivity of MMP-2 and type IV collagen was inversely correlated (Kendall's Tau-b correlation = 0.37482, P=0.0001). Our results suggest that in human gastric adenocarcinoma the increased immunoreactivity of MMP-2 and the decreased immunoreactivity of type IV collagen has an important role in lymph node metastasis and prognosis. MMP-1,3 are not correlated with lymph node metastasis but correlated with survival. The mechanism responsible for the production of MMP by the host fibroblasts remains obscure and requires further investigation.

Case Reports

Inflammatory Pseudotumor of the Lymph Node: A case report.: Yee Jeong Kim, Kun Chang Song, Woo Hee Jung, Woon Sup Han; Korean J Pathol. 1993;27(2):164-168.

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Abstract PDF: A 21-year-old man presented with a 7 days history of fever. Careful clinical examination led to the discovery of left supraclavicular lymphadenopathy without hepatosplenomegaly. Serologic tests for Ebstein-Barr virus, HIV, hepatitis type B & C, syphilis and typhoid fever were negative. Blood, urine, and stool cultures yielded no growth. Histologically, the process mainly involved the connective tissue framework of the lymph node, sharing the features of inflammatory pseudotmor(IPT) of other organs: a storiform growth pattern, increased vascularity with associated vascular lesions, and a polymorphous inflammatory infiltrate in a collagen-rich stroma. Immunohistochemical study for spindle cells showed positive reaction for actin and vimentin but not for desmin, and lymphoid cells revealed polyclonality. Characteristics of mass formation, and the inflammatory nautre of the process enabled us adopt the term IPT which should be differentiated from hematolymphoid proliferative disorder or mesenchymal neoplasia.

Nevus Cell Inclusions in the Lymph Node: A Report of Two Cases.: Ji Sun Song, Tae Woong Noh, Yoon Mee Kim, Sang Ho Cho, Kwang Gil Lee; Korean J Pathol. 2001;35(3):245-247.

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Abstract PDF: Nevus cell inclusion in the lymph node is an uncommon histologic finding and usually is an incidental finding in the capsule, fibrous trabeculae, perinodal adipose tissue, and parenchyma of the axillary, inguinal, or cervical lymph nodes which are removed as part of cancer diagnostic or therapeutic procedures. The aggregated pigmented nevus cells in the lymph node resemble the cells of the cutaneous nevi. It is important to differentiate them from metastatic carcinoma or malignant melanoma. The characteristic features of nevus cell inclusions are presence of nevus cells within the capsule and supporting stroma, without presence in the marginal sinus of the lymph node, and the absence of cytological atypia or mitosis of nevus cells. We report two cases of nevus cell inclusions, in the axillary lymph nodes in a patient with breast carcinoma and in an enlarged inguinal lymph node in a patient without a malignant tumor.

Original Articles

Correlation of Tumor Angiogenesis and nm23-H1 Expression with Lymph Node Metastasis in Proper Muscle Gastric Cancer.: Eun Sook Nam, Gu Kang, Hyung Sik Shin, Young Eui Park; Korean J Pathol. 1997;31(5):410-416.

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Abstract PDF: We studied clinicopathologic features of 44 cases of PM (proper muscle) gastric cancer, correlated the lymph node metastasis and found the result of immunohistochemical staining for tumor angiogenesis using antibodies to Factor VIII-related antigen and nm23-H1, known as meatastasis inhibitory substance. The results were as follows: 1) The average age of these 44 cases of PM gastric cancer was 55.1 years old (range 35-81). The ratio of male to female was 2.2 : 1. The tumor was located at the antrum of stomach in 72.7% of the cases. The average size of the tumor was 4.1 cm (range 0.6-9). The gross features were comprised of Borrmann type I (6.8%), II (29.6%), III (56.8%), IV (6.8%), respectively. The microscopic type was a diffuse type in 70.5% and an intestinal type in 29.5%. There were lymph node metastasis in 25 of the 44 cases (56.8%). 2) The microvessel count was higher in the lymph node positive group (average 69.3) than in the lymph node negative group (average 45.6) (P=0.004). There was a higher microvessel density in diffuse type, over 4 cm of tumor size, proximally located tumor, older than 50 years, Borrmann type II and IV, but there was no statistically significant correlation. 3) The more decreased expression of nm23-H1 was found in the lymph node positive group (56.0%) than in the lymph node negative group (31.6%), but showed no statistical significance (P=0.0142). There was no significant correlation between the expression of nm23-H1 and the other clinicopathologic factors. We suggest that the microvessel count of the tumor angiogenesis may be a prognostic factor for predicting lymph node metastasis and also help to determine the therapeutic modalities of PM gastric cancer.

The Clinicopathologic Analysis of Kikuchi's Lymphadenitis.: Jung Woo Choi, Ji Hye Lee, Ju Han Lee, Yang Seok Chae, Insun Kim; Korean J Pathol. 2004;38(5):289-294.

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Abstract PDF: BACKGROUND
Kikuchi's disease has been known as a self-limiting lymphadenitis mostly affecting the cervical lymph nodes of young women.
METHODS
We retrospectively reviewed the clinical data of 77 cases of Kikuchi's lymphadenitis from 1996 to 2003 at Korea University Medical Center.
RESULTS
Histologically, 69 available cases were classified into three types: proliferative (60.8%), necrotizing (33.3%), and xanthomatous type (5.7%). These three types differed in terms of their clinical features, showing tenderness most predominantly in the necrotizing type. In spite of the insufficient numbers of cases, the data on the duration of the disease well correlated with the possible progression of the three histologic types (Kikuch's disease begins as proliferative type, then progress into necrotizing type and finally resolves into xanthomatous type). During the ten-month period of the mean follow-up, the recurrence rate was 7.0%. Three and two patients developed into pulmonary tuberculosis and systemic lupus erythematosus, respectively, but there were no prognostic differences among the three types.
CONCLUSIONS
Our results confirmed that Kikuchi's lymphadenitis is a self-limiting necrotizing lymphadenitis with a low rate of recurrence. Here, we suggest that the classification of histologic types have some meanings because of their differences in certain clinical aspects and possible sequential disease progression.

Case Report

Pseudometastasis in Sentinel Lymph Nodes with Cytokeratin Debris-containing Histiocytes in Breast Cancer Patient: A Case Report.: Keum Ha Choi, Eun Jung Cha, Ha Na Choi, Woo Sung Moon; Korean J Pathol. 2007;41(6):427-429.

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Abstract PDF: Immunohistochemical staining for cytokeratins can detect false negative nodes in patients with breast carcinoma. We report on a patient with breast carcinoma and pseudometastasis detected by immunohistochemical staining within a negative sentinel lymph node. A 66-year-old woman underwent a simple mastectomy and sentinel lymph node biopsy. Immunohistochemical staining of the sentinel nodes for cytokeratin in permanent sections showed cells with intense cytoplasmic staining in the subcapsular sinus. The cells were negative for epithelial membrane antigen staining, but positive for CD68. In combination with morphologic findings and immunohistochemistry, cytokeratin-positive cells were confirmed as histiocytes with phagocytized cytokeratin debris. Careful correlation with histology and additional IHC could help avoid a misinterpretation of this type of pseudometastasis.

Original Article

Polymerase Chain Reaction Detection of Mycobacterium tuberculosis and Fine Needle Aspiration Cytology for the Diagnosis of Tuberculous Lymphadenitis .: Joo Heon Kim, Nam Hoon Kim, Dong Wook Kang, Mee Ja Park, Sang Kyoung Moon, Tae Cho Yu, Eun Ju Jang; J Pathol Transl Med. 2001;12(1):25-30.

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Abstract PDF: Tuberculous lymphadenitis is not uncommon in Korea. Therefore, an inexpensive, safe and rapid method is needed to diagnose the tuberculous lymphadenitis. Fine needle aspiration cytology is a good method for this purpose, but has several limitations in the diagnosis of tuberculous lymphadenitis, especially when the presence of acid-fast bacilli is not proved. To evaluate the usefulness of the polymerase chain reaction with enzyme immunoassay technique in the detection of Mycobacterium tuberculosis (M. tuberculosis) in the cervical lymph node aspirates, the authors performed fine needle aspiration cytology and M. tuberculosis PCR with enzyme immunoassay for mycobacterial DNA sequences from 15 cases of the fine needle aspirates. Cytomorphologically, the cases were categorized into three types: predominantly necrotic materials; typical epithelioid cell granulomas with or without giant cells and caseous necrosis; and non-tuberculous lesions, such as reactive lymphadenitis, abscess, metastatic carcinoma and malignant lymphoma. M. tuberculosis DNA was found in 8 of 15 cases by PCR with enzyme immunoassay. Negative findings on PCR were achieved in 7 cases, which revealed non-tuberculous lymphadenopathy. In conclusion, we suggest that M. tuberculosis PCR with enzyme immunoassay using the fine needle aspirates is a very useful tool for the diagnosis of tuberculous lymphadenitis.

Case Reports

Intra-abdominal Desmoplastic Small Round Cell Tumor Diagnosed by Lymph Node Biopsy: A case report.: Myung Jin Ju, Kwang Min Lee, Hye Kyung Lee, Dong Kyu Chung; Korean J Pathol. 1995;29(5):698-701.

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Abstract: Intra-abdominal desmoplastic small round cell tumor has been described in the literature since 1989. It is characterized by the occurrence in ages less than 40 with male predominance, an intra-abdominal location, and small round to oval shaped tumor cells with divergent differentiation in the background of the desmoplastic stroma. We recently experienced this tumor in an inguinal lymph node of a 36-year-old man. It is suspected that it metastasized from a lower intra-abdominal tumor. Immunohistochemical stains for keratin, epithelial membrane antigen, vimentin, S-100 protein and neuron specific enolase were positive. This is the first documented case in Korea. Herein, we report on this tumor with a review of literature.

Fine Needle Aspiration Cytology of Mantle Cell Lymphoma: A Case Report .: Han Seong Kim, Sung Hye Park; J Pathol Transl Med. 2001;12(1):53-56.

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Abstract PDF: Cytologic features of a case of mantle cell lymphoma is presented, which was obtained by fine needle aspiration cytoloby and confirmed by excisional biopsy of axillary lymph node. A 67-year-old female alleged palpable masses in both axillae for several months. Additional multiple lymphadenopathies were found in the both neck and inguinal areas. The main cytologic feature was carpeting of monotonous slightly atypical small lymphocytes without heterogeneous components. The nuclei of these lymphocytes are slightly larger than benign small lymphocyte and relatively round with some indentation. Nucleolus was not prominent and no mitosis was found. Their cytoplasm was scanty and cyanophilic in Papanicolaou's stain. The histiocytic cells, which had bland-looking banded nuclei and abundant cytoplasm, corresponding to pink histiocytes were shown. Excisional biopsy of lymph nodes was diagnosed as mantle cell lymphoma, diffuse type.

Fine Needle Aspiration Cytology of Metastatic Seminoma in Cervical Lymph Node: A Case Report .: Kee Taek Jang, Hye Rim Park, Jin Seok Ahn; J Pathol Transl Med. 2001;12(1):57-60.

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Abstract PDF: Fine needle aspiration cytology of the cervical lymph node was performed in a 63-year-old man who had had an orchiectomy for seminoma one year ago. The tumor cells were arranged in loose clusters, occasional sheets, or single cells. The nuclei were round to ovoid with fine or reticular chromatin, and had one or more prominent nucleoli. These cells were intermingled with lymphocytes in a characteristic foamy, lacelike background. Documented reports of the cytologic appearance of the seminoma are rare, especially in the metastatic lesion. The diagnosis of primary gonadal seminoma by fine needle aspiration cytology is probably not indicated since the treatment of primary gonadal tumor requires surgical resection. Because of the characteristic cytologic features, fine needle aspiration cytology may be helpful in evaluation of the extent of tumor spread in the patients with testicular tumors.

Sarcoidosis Associated with Adenocarcinoma of the Lung: A Case Report.: Joon Seon Song, Seungkoo Lee, Yong Hee Kim, Se Jin Jang; Korean J Pathol. 2008;42(2):108-112.

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Abstract PDF: Sarcoidosis and malignant neoplasm are frequently encountered pulmonary diseases, but their combined existence in the same patient is rare. As sarcoidosis usually presents as mediastinal lymphadenopathy, its concurrence in lung cancer patient radiologically mimics mediastinal metastasis and this can be possibly interpreted as unresectable disease. We report here on a case of lung adenocarcinoma associated with sarcoidosis that developed in a 64 year-old male who underwent surgical resection. Radiological examinations revealed 5.7 cm-sized mass in the right upper lobe with an enlargement of the bilateral supraclavicular, highest mediastinal, subcarinal and the upper and lower paratracheal lymph nodes. Histologic examination showed a well differentiated adenocarcinoma with non-caseating epithelioid granulomas in the lung. The enlarged peribronchial and mediastinal lymph nodes also revealed sarcoid granulomas without cancer metastasis. A good prognosis may be expected for those cases of lung cancers with non-caseating granulomas in the regional lymph nodes. The patient presently has no symptoms or signs of tumor, without further treatment since his surgery.

Original Articles

p53 Protein Expression in Infiltrating Ductal Carcinoma of the Breast.: Soon Hee Jung, Mee Yon Cho, Soo Yong Kim; Korean J Pathol. 1996;30(1):7-14.

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Abstract PDF: Overexpression of the nuclear phosphoprotein p53 is the most common genetic anomaly found in primary human cancer and mutation of the tumor suppressor gene p53 has been identified in breast cancer cell lines. In this study, we evaluated the prognostic significance of p53 protein expression in patients with mammary infiltrating ductal carcinoma and its correlation with histopathologic grade, lymph node status, tumor size, p53 protein expression and survival. Among 53 cases, p53 protein expression was detected in 26(49.1%) cases by immunohistochemistry. There was no correlation between p53 protein overexpression and histopathologic grade(p=0.09) or lymph node status(p=0.38) and between survival and histopathologic grade (p=0.68) or lymph node status(p=0.52). However, p53 protein expression was significantly correlated with survival(p=0.01) and patients with p53 protein-positive tumors showed poorer survival times. But Cox multivariate analysis showed the lymph node status is significant(p=0.01). The authors conclude that the presence of mutant p53 protein and lymph node status may serve a prognostic role, in a subset of mammary infiltrating ductal carcinoma cases.

Histopathologic Study of the Regional Lymph Nodes Reactivity in Gastric Carcinomas.: Hae Joo Nam, Won Hee Choi, Tae Sook Lee, Suk Jae Hong; Korean J Pathol. 1987;21(1):1-11.

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Abstract PDF: This study represents the immune reaction pattern of gastric carcinoma, based on the morphologic characteristics of regional lymph nodes in the cases of stomach carcinomas. The materials were obtained from the resected specimens from 100 carcinoma patients. We chose Tsakraklides' method in classification of the structure of lymph node, which are as follows: lymphocyte predominance, germinal center predominance, unstimulated and lymphocyte depletion. The incidence was as follows: lymphocyte predominance 45, germinal center predominance 32, unstimulated 21 and lymphocyte depletion 2. In the lymph nodes of peptic ulcer, lymphocyte predominance pattern was most common. The reactivity of lymph nodes is suppressed proportionally to the severity of cancers, thus the advanced case of cancer exhibited lymphocyte depletion pattern which suggests exhaustion of immune reaction. The lymphocyte predominance pattern was frequent in superficial type and expanding type of gastric carcinoma. The cancer metastasis of lymph node in lymphocyte predominance was smaller than the other type of lymph nodes, while metastasis increased progressively higher with the orders as following: lymphocyte predominance, germinal center predominance, unstimulated and lymphocyte depletion.

Case Reports

Secretory Carcinoma of the Breast: A case report.: Kyu Rae Kim, Jung Hyun Yang, Yeon Lim Seo, Howe Jung Ree; Korean J Pathol. 1996;30(4):347-350.

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Abstract PDF: We report a case of secretory carcinoma with axillary lymph node metastasis in a 21-year old woman. She was aware of a mass in her breast for 10 years and noticed a rapid growth of the preexisting mass during the last years. Histologically, the tumor was composed of micropapillary and microcystic or cribriform glandular structures which contained eosinophilic, mucinous, intraluminal secretions. The center had a dense hyalinized strama with a solid infiltrative growth of tumor cells with intracytoplasmic secretory vacuoles at the periphery. In addition, marked intraductal papillary epithelial proliferations were present at the superficial portions of the tumor near the nipple. Prognostic factors and their relationship to juvenile papillomatosis are discussed with a review of the literature.

A Human Case of Hepatic Fascioliasis Accompanied by Egg Granulomas in Common Bile Duct Lymph Node.: Jun Hyuk Choi, Dogn Sug Kim, Won Hee Choi, Tae Sook Lee, Dong Il Chung, Dong Wik Choi; Korean J Pathol. 1991;25(3):250-255.

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Abstract PDF: A 32-year-old housewife who resides in Taegu was admitted in Yeungman University Hospital due to right upper quadrant abdminal pain of 2 mounths'duration. An abdomical CT and ultrasonography revealed a relatively well demarcated low density mass in the right lobe of liver. Right hepatic lobectomy was performed on the clinical impression of hepatoma. On the light microscopic study, the lobulated liver mass showed extensive central necrosis and fibrosis, with large numbers of pseudotubercles therein. The pseudotubercles have distorted helminthic eggs frequently. The submitted common bile duct lymph node also showed a few pseudotubercles. The eggs recovered from the tissue homogenate measured 140~152 micrometer by 75~85 micrometer in size and were unembryonated and light yellow to brown. The eggs were determined as those of Fasciola species. We reported the present case as 11th one of human fascioliasis in korea.

Original Article

Metastatic Carcinoma in Lymph Nodes of Neck: Analysis of 221 Cases Diagnosed by Fine Needle Aspiration Cytology.: Duck Hwan Kim, Youn Ju Kim, Seung Eun Yang, Sung Suk Paeng, Hee Jin Chang, Jin Hee Sohn, Jung Il Suh; J Pathol Transl Med. 1995;6(1):41-47.

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Abstract PDF: Two hundreds and twenty one consecutive patients with enlarged lymph nodes of neck areas were diagnosed as metastatic carcinoma by fine needle aspiration. The metastatic carcinomas were most frequent in the supraclavicular lymph nodes(p<0.05). As a primary site, lung, stomach, upper respiratory tract and breast were common sites in descending order of frequency. In overall cytologic types, squamous cell carcinoma was the most common in males(43%) while adenocarcinoma was the most common in females(72%) (p<0.05). While carcinomas of the esophagogastro -intestinal tract showed a tendency to metastasis to the left supraclavicular lymph nodes, the metastatic carcinomas of lung and breast usually metastasized to the same side primary cancers with predilection for the supraclavicular lymph nodes. The submandibular lymph nodes were frequently involved by the carcinoma of upper and lower respiratory tract, in which squamous cell carcinoma is the most prevalent cytologic type. diagnosis by fine needle aspiration cytology is the first step in the workup of patients with nodal enlargement suspicious for malignancy, particularly in metastatic carcinoma.

Case Report

Effusion Cytology of Ki - 1 Positive Anaplastic Large Cell Lymphoma: A Case Report.: Mi Sook Lee, Mi Ja Lee, Yu Kyung Jeong, Sung Chul Lim, Keun Hong Kee, Ho Jong Jeon; J Pathol Transl Med. 1995;6(2):163-168.

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Abstract PDF: Ki-1 positive anaplastic large cell lymphoma is a newly described high-grade lymphoma and is defined by histopathological and immunologic criteria. We experienced a case of systemically involving Ki-1 positive anaplastic large cell lymphoma in a 44 year-old female which initially manifested as pleural effusion. Abdominopelvic CT scan showed the evidence of marked lymphadenopathy in retroperitoneal and both external and inguinal lymph nodes. On cytologic examination of pleural fluid tumor cells revealed pleomorphic large isolated cells with prominent nucleoli and abundant cytoplasms. The nuclei were large with irregular profiles including some deep invaginations. Also. occasional multilobed/multinucleated and binucleated nuclei were seen. Immunohistochemical examination was performed to differentiate from the undifferentiated adenocarcinoma. Hodgkin's disease, non-Hodgkin's lymphoma and malignant histiocytosis. The neoplastic cells were positive for leukocyte common antigen. CD3 CD30(ki-1) but negative for cytokeratin. epithelial membrane antigen. and CD15. A histologic diagnosis of Ki-1 positive anaplastic lymphoma was made by biopsies of the inguinal lymph node, polypoid lesion of the stomach and cecum.

Original Article

Immunohistochemical Study of p53 and nm23-H1 Protein in Gastric Carcinoma.: Duck Hwan Kim, Yoen Ju Kim, Seon Eun Yang, Sung Suk Paeng, Hee Jin Chang, Jung Il Suh, Hyo Sook Park; Korean J Pathol. 1996;30(7):587-594.

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Abstract PDF: The p53 gene, which resides on the short arm of chromosome 17, has been described as a tumor suppressor gene playing a role of G1 checkpoint monitering DNA damage, but mutation of this gene has been shown in numerous types of human cancers. The nm23-H1 gene encodes human NDP(nucleotide diphosphate) kinase. The expression of nm23-H1 gene was postulated to inversely correlate with metastatic potential of malignant tumors. We examined immunohistochemical expression in 30 cases of stomach cancers including 10 cases each of early gastric cancers(EGC), advanced gastric cancers without lymph node involvement, and advanced gastric cancers with lymph node involvement, which were stained with mouse monoclonal antibody of p53(PB53-12) and nm23-H1. Positive nuclear staining of p53 was frequently found in advanced gastric cancers with lymph node involvement (80%). The lymph node positive group showed high expression of p53(80%), and low expression of nm23-Hl(30%) than lymph node negative group. There was no significant correlation of p53 and nm23-H1 expression with tumor size, invasion depth, TNM stages, distant metastasis and histologic differentiation. Based on the present study, the expression of p53 and down regulation of nm23-H1 are thought to be correlated with tumor progression and lymph node involvement, and may be a useful prognostic factor in gastric cancers.

Review

Differential Diagnosis of Fine Needle Aspiration Cytology of Benign Lymphadenopathy.: Eun Mee Han, Dong Eun Song, Dae Un Eom, Hye Jeong Choi, Hee Jeong Cha, Jooryung Huh; J Pathol Transl Med. 2006;17(2):99-107.

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Abstract PDF: In the investigation of superficial lymphadenopathy of unknown cause, fine needle aspiration (FNA) cytology plays an invaluable role. It enables the differentiation of benign lymphadenopathy from lymphoid and non-lymphoid malignancies, obviating the need for open biopsy, and allowing the triage of patients. Cytopathologists should be familiar with the typical FNA patterns of benign lymphadenopathy, and recognize and differentiate among categories. In a minority of cases of benign lymphadenopathy, FNA can render a specific diagnosis. Benign lymphadenopathies are generally categorized into reactive lymphoid hyperplasia (RLH), inflammatory or infectious processes, and benign lymphoproliferative disorders. RLH characteristically presents with a heterogeneous and polymorphous smear composed of normal cellular constituents of lymph nodes, in contrast with the homogeneous or monomorphic smear of most lymphomas. The caveat is that various malignant disorders may also present with polymorphous populations. It is also important to recognize thatbenign lymphoid smears may sometimes contain atypical cells that raise the suspicion of malignancy. Clinical information should always be the integral part of the diagnostic criteria in FNA of lymphadenopathy. If there is any doubt about the benign nature of the smear, it is prudent to suggest biopsy and ancillary studies.

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