Journal of Pathology and Translational Medicine

Original Articles

The Prognostic Significance of p53 Protein and PCNA in Advanced Gastric Carcinoma.: Ho Won Hwang, Hyung Bae Moon; Korean J Pathol. 1995;29(4):450-458.

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Abstract PDF: The 5 year-survival rates were examined to evaluate the prognositic significance of the expression of the p53 protein and the positivity of the PCNA in 108 cases of advanced gastric carcinoma. The p53 protein and PCNA were stained by immunohistochemistry in the tissue of the gastrectomized specimen. The results were as follows. 1) The overall 5 year-survival rate of advanced gastric carcinoma was 42.3 % and the significant prognostic factors were a pathologic stage and p53 protein(p<0.005). 2) The expanding or infiltrating type by Ming's classification and the intestinal or difftise type by Lauren's classification had similar prognosis. 514_ @@l %R-t 3) The 5 year-survival rate of the p53-positive group was 25.1% and that of p53-negative group was 56.1%(p<0.005). 4) The 5 year-survival rate of the PCNA low-grade tumors by PCNA stain(<50%)was 48.7% and that of the high-grade tumor(>=50%)was 29.9%(p>0.1). 5) There was a tendency to have a good prognosis in the p53-negative group and low grade tumors in the stage 11, III, and IV. There was a significant difference between p53 protein positive and negative groups in the stage III(p<0.005), but no significant differences were found in the other groups. The above results indicate that the p53 protein is an another useful tool for prediction of the prognosis in advanced gastric carcinoma.

Expression Pattern of Tumor Progression and Metastasis-related Gene Proteins - CD44H, CD44v6, erbB-2, and p53 -in Gastric Carcinoma.: Sung Woo Joo, Young Jhoon Chin, Dae Cheol Kim, Gi Yeoung Huh, Sook Hee Hong; Korean J Pathol. 1996;30(9):751-763.

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Abstract PDF: Immunohistochemical studies of the molecules associated with gastric tumor progression and metastasis were done to evaluate their relationship with known prognostic factors and their usefulness in assessment of the progression of gastric carcinoma in 127 gastric carcinoma tissues. The 4 antibodies used in this study were CD44H, CD44v6, erbB-2, and p53. The CD44H expression was detected in 76 (59.8%), CD44v6 in 63 (49.6%), erbB-2 in 18 (14.2%), and mutant p53 in 98 (77.2%) out of 127 cases of gastric carcinomas. There was no significant correlation between the expression rates of each four proteins. The expression rates of all 4 proteins were not significantly correlated with age and sex of the patients and lymph node metastasis, but the correlation between CD44v6 expression and the depth of tumor invasion and tumor stage was significant (p<0.05). These results suggest that CD44v6 is closely associated with tumor invasion, and high levels of CD44H, erbB-2 and p53 are associated with tumorigenesis of the stomach as they are highly expressed in early as well as in advanced gastric carcinomas. The findings also support the conclusion that the loss of control of alternative CD44 mRNA splicing resulted in production of CD44v6 splicing variant in tumor cell facilitates tissue invasion by increased adherence of the tumor cell to an extracellular matrix or by tumor cell migration. It can be expected that CD44v6 overexpression in tumor cells appears to be an important prognostic indicator for gastric tumor progression.

The Correlation between the Proliferative Activity in Biopsied Specimen of Gastric Adenocarcinoma and the Pathologic Findings of Resected Specimen.: Hye Sun Kim, Jae Bok Lee, Se Min Kim, Jong Sang Choi, Han Kyeom Kim; Korean J Pathol. 1997;31(3):211-218.

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Abstract PDF: Studies on the correlation between proliferative activity of biopsied specimen and pathologic findings of resected specimen have been carried out to find the prognostic factors. To estimate the proliferative activity, 100 cases of biopsied specimen of gastric adenocarcinoma were tested for the PCNA (proliferating cell nuclear antigen) and the AgNOR (argyrophilic nucleolar organizer region) by the immunohistochemical and histochemical stainings, respectively. The resected tumors classified by histologic type, differentiation, depth of invasion, and nodal metastatic status were followed by cell cycle analysis using flow cytometry. The PCNA LI (labelling index) were higher in well or moderately differentiated tumors (P<0.01) than the poorly differentiated ones and the aneuploid tumors (P<0.05) more than in diploid ones. However, there were no correlations among histologic types, depth of invasion, nodal metastatic status and PCNA LI. The AgNOR counts were higher in advanced tumor than in the EGC (early gastric cancer) (P<0.01). In cases with nodal metastasis, most of them showed the AgNOR counts higher than those without nodal metastasis. There were no correlations between the AgNOR counts and the DNA ploidy, histologic type, or differentiation. High PCNA LI and high AgNOR counts were shown in cases with advanced tumors (P=0.000) and nodal metastasis (P<0.05). No correlation was shown with the histologic type or differentiation. The results show that proliferative activity of the biopsied specimen of gastric adenocarcinoma is correlated with the differentiation and the invasion depth of resected specimen. Especially, better correlation is obtained by analyzing both the PCNA LI and the AgNOR counts than by analyzing each.

Plasminogen Activator Inhibitor-1, c-erbB2, and p53 Protein Overexpression and Prognosis in Gastric Adenocarcinoma.: Ayoung Park, So Young Jin, Dong Won Kim, Dong Wha Lee; Korean J Pathol. 2000;34(8):559-566.

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Abstract PDF: Despite its fall in incidence, gastric adenocarcinoma remains a common disease with dismal prognosis worldwide. A better understanding of its tumorigenesis and biologic properties of tumor cells related to invasion and metastasis is crucial to improving diagnosis and treatment. Conflicting results concerning the relationships between overexpression of PAI-1, c-erbB2, and p53 protein and biologic behavior of gastric carcinoma have been noted. The aim of this study was to evaluate the value of overexpression of PAI-1, c-erbB2, and p53 protein as prognostic factors in gastric adenocarcinoma. Overexpression of PAI-1, c-erbB2, and p53 protein by immunohistochemistry was correlated with variable clinicopathological parameters and patients' survival in 80 cases of gastric adenocarcinoma. Overall PAI-1 expression rate was 63.7% (51/80) and higher in advanced cancer (p=0.0003) and nodal metastasis (p=0.003) groups. Overall c-erbB2 expression rate was 43.8% (35/80) and higher in antral (p=0.03), differentiated (p=0.001), intestinal (p=0.0007), and expanding (0.03) groups. The p53 protein overexpression was 37.5% (30/80) and higher in early cancer (p=0.02), differentiated (p=0.006) and intestinal groups (p=0.009). Patients with PAI-1, c-erbB2, and p53 protein positive tumors tended to have poorer survival rates than patients with PAI-1, c-erbB2, and p53 protein negative tumors, but the difference was not statistically significant (p=0.25, 0.37, 0.52). Our data indicated that PAI-1 overexpression is one of the poor prognostic factors in gastric adenocarcinoma and c-erbB2 and p53 protein seem to be involved in the early stage of carcinogenesis of intestinal type-gastric adenocarcinoma.

Prognostic Significance of Thymosin- 4 in Gastric Adenocarcinoma Patients.: Lucia Kim, Ye Ji Kim, Suk Jin Choi, In Suh Park, Jee Young Han, Young Chae Chu, Joon Mee Kim; Korean J Pathol. 2007;41(3):176-182.

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Abstract PDF: Background
: Thymosin- 4 is an actin-sequestering protein that regulates actin polymerization. It is known to be associated with cell migration, angiogenesis and wound healing, as well as with tumor metastasis.
Methods
: We immunohistochemically evaluated the thymosin- 4 expression in gastric adenocarcinoma specimens, the relationship between this protein and the pathologic features and other tumor-related proteins, and its influence on the patient outcome.
Results
: We demonstrated that 40 specimens (26.3%) of 152 gastric adenocarcinomas showed positivity for thymosin- 4. The thymosin- 4 expression was statistically associated with advanced tumor stage (p=0.010), the nodal stage (p=0.029), the TNM stage (p=0.008), and the presence of lymphovascular invasion (p=0.009). The thymosin- 4 protein expression was closely related to the positivity for VEGF (p=0.000), c-Myc (p=0.007), and cyclin D1 (p=0.005), but it was not associated with the E-cadherin (p=0.861) or -catenin (p=0.640) expressions. The median survival and disease relapse time of patients showing thymosin-4 immunoreactivity were statistically shorter than those of patients without expression. Multivariate analysis showed that the tumor stage (p=0.003), nodal stage (p=0.005), thymosin- 4 expression (p=0.019) and Lauren's classification (p=0.037) were statistically important prognostic factors for gastric adenocarcinomas.
Conclusions
: The thymosin- 4 expression might be associated with disease progression of gastric adenocarcinomas and it should be regarded as an important prognostic factor for estimating patient survival.

Case Report

Signet Ring Cell Carcinoma of Stomach in Child: Report of a case.: Kyeong Mee Park, Ill Hyang Ko; Korean J Pathol. 1994;28(1):102-105.

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Abstract PDF: Cancer of the alimentary tract in children is an extremely rare occurence, and it accounts for no more than 5% of all pediatric neoplasms. Malignant neoplasms of the stomach are particularly uncommon in childhood. The majority of such lesions are malignant lymphomas or soft tissue sarcomas, with less than 5% identified as carcinomas. We report a case of signet ring cell carcinoma of stomach in 15-year-old girl. This patient had a clinical manifestation of cough with sputum, fever, abdominal distension due to ascites, hepatomegaly, and cervical lymphadenopathy for 40 days. There was no known gastrointestinal symptoms. Metastatic signet ring cell carcinoma was suspected by aspiration biopsy cytology of cervical lymph node, and confirmed later by excisional biopsy. Endoscopy confirmed a small mucosal erosion in the anterior wall of the antrum and histopathology confirmed the diagnosis of signet ring cell carcinoma.

Original Articles

Guidelines for Pathologic Study of Gastric Cancer.: Korean J Pathol. 1992;26(2):154-163.

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Abstract PDF: Gastric cancer is the most common malignant neoplasm among Koreans, and the pathologists's daily diagnostic competency on gastric cancer at any hospital setting plays a critical implication not only in the quality of clinical service but also to the determination of patient's prognosis. Thus, adoption of a unified assessment system based on comprehensive understanding of pathologic features together with their active participation has been crucially demanded. Nevertheless, a considerable difference in handling procedures and diagnostic approach on gastric cancer among institutions apparently resulted in an extreme difficulty in exchange of clinicopathologic informations and in the nationwide survey. It is, therefore, essential and be the first step to develop a practical but scientific and reproducible classification of gastric cancer with its diverse gross and histologic findings. Based on the following basic principles, the Subcommittee on Gastric Cancer under the Gastrointestinal Study Group of the Korean Society of Pathologists has been requested to develop the guidelines of future pathologic study of gastric cancer to meet the above needs and be efficiently used with ease among the society members. 1) The prerequisite for pathologic classification of gastric cancer starts with consistency in handling of the resected stomach before its further examination. Thus, the guideline shall limits its scope only with the minimum agreement. 2) The classification should be simple and practical so that all pathologists can use with ease and with high reproducibility. 3) All the gross and microscopic findings which have been considered to be the prognosis-related factors should be included in every pathologic procedures to help future information exchange among pathologists and clinicians and to provide a meaningful role in determination of patient's prognosis. 4) The classification should be interchangeable and stand with compatibility among WHO and other internationally accepted classifications. 5) The guideline accepts in part the staging system of American Joint Commitee on Cancer, classification of early gastric cancer proposed by the Japanese Society of Gastrointestinal Endoscopy, and the General Rules of Stomach Cancer Study by Japanese Research Society of Gastric Cancer, until otherwise developed and accepted by the Korean Society of Pathologists. 6) The guideline should not interfere with each institution-based special study. The details of the handling procedures of the resected stomach cancer, its gross and histologic classifications and descriptive methods of prognostic factors are supplemented with illustrations.

Carcinomatous Meningitis as the Initial Manifestation of Primary Stomach Cancer.: Gui Ohk Yoon, Ill Hyang Ko; Korean J Pathol. 1988;22(2):208-210.

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Abstract PDF: Meningeal carcinomatosis as the initial clinical manifestation of a tumor is a very rare event and difficult to make diagnosis. Lumbar puncture is a single and useful diagnostic method, and meticulous cytologic study of cerebrospinal fluid specimen is needed for correct diagnosis. A case of meningeal carcinomatosis diagnosed by cytologic study of CSF and later confirmed primary carcinoma of the stomach by, fiberscopic biopsy is briefly presented. Meningeal signs and symptoms were the primary clinical manifestation in case.

Case Report

Exceptionally Good Lymphocytic Infiltration with Histiocytes and Multinucleated Giant Cells of Stomach Cancer: A case report.: Dongsoo Suk, Sook Hee Hong, Hye Kyung Yoon, Hyung Gin Kang; Korean J Pathol. 1986;20(1):112-115.

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Abstract PDF: Stomach of 34 year old man showed an early stage of the cancer with slight involvement of the superficial part of the inner muscle layer and accompanied with one metastatic lymph node. The cancer is that of medium differentiated adenocarcinoma. There is an heavy infiltration of lymphocytes mixed with histiocytic mononuclear cells and multinucleated giant cells. Some giant cells appear as Langhans' type suggesting phagocytic cells of their origin containing PAS positive materials in the cytoplasma. In other places, they appear as atrophic cancer nests suggesting that these tumor nests were arrested and undergone to regressive cellular process because of the over-whelming immunological pressure by the host.

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