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Case Study
Mucinous Carcinoma with Extensive Signet Ring Cell Differentiation: A Case Report
Hye Min Kim, Eun Kyung Kim, Ja Seung Koo
J Pathol Transl Med. 2017;51(2):176-179.   Published online December 5, 2016
DOI: https://doi.org/10.4132/jptm.2016.08.17
  • 9,214 View
  • 159 Download
  • 3 Web of Science
  • 3 Crossref
AbstractAbstract PDF
Breast cancers that present with mucin include mucinous carcinoma and carcinoma with signet ring cell differentiation. The former shows extracellular mucin and the latter shows abundant intracellular mucin. Here, we report a case of breast cancer showing both extracellular mucin and extensive signet ring cell differentiation due to abundant intracellular mucin. Unlike mucinous carcinoma, this case had the features of high-grade nuclear pleomorphism, high mitotic index, estrogen receptor negativity, progesterone receptor negativity, human epidermal growth factor receptor-2 positivity, and ductal type with positivity for E-cadherin. In a case with signet ring cell differentiation, differential diagnosis with metastatic signet ring cell carcinoma of the stomach and colon is essential. In this case, the presence of accompanied ductal carcinoma in situ component and mammaglobin and gross cystic disease fluid protein-15 positivity were findings that suggested the breast as the origin.

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Citations to this article as recorded by  
  • Research on the Histological Features and Pathological Types of Gastric Adenocarcinoma With Mucinous Differentiation
    Nian-Long Meng, Yang-kun Wang, Hai-Li Wang, Jun-Ling Zhou, Su-nan Wang
    Frontiers in Medicine.2022;[Epub]     CrossRef
  • Clinicopathologic characteristics of HER2-positive pure mucinous carcinoma of the breast
    Yunjeong Jang, Hera Jung, Han-Na Kim, Youjeong Seo, Emad Alsharif, Seok Jin Nam, Seok Won Kim, Jeong Eon Lee, Yeon Hee Park, Eun Yoon Cho, Soo Youn Cho
    Journal of Pathology and Translational Medicine.2020; 54(1): 95.     CrossRef
  • Human Epidermal Growth Factor Receptor 2-positive Mucinous Carcinoma with Signet Ring Cell Differentiation, Which Showed Complete Response after Neoadjuvant Chemotherapy
    Yunjeong Jang, Eun Yoon Cho, Soo Youn Cho
    Journal of Breast Cancer.2019; 22(2): 336.     CrossRef
Review
Pathologic Evaluation of Breast Cancer after Neoadjuvant Therapy
Cheol Keun Park, Woo-Hee Jung, Ja Seung Koo
J Pathol Transl Med. 2016;50(3):173-180.   Published online April 11, 2016
DOI: https://doi.org/10.4132/jptm.2016.02.02
  • 12,973 View
  • 440 Download
  • 32 Web of Science
  • 30 Crossref
AbstractAbstract PDF
Breast cancer, one of the most common cancers in women, has various treatment modalities. Neoadjuvant therapy (NAT) has been used in many clinical trials because it is easy to evaluate the treatment response to therapeutic agents in a short time period; consequently, NAT is currently a standard treatment modality for large-sized and locally advanced breast cancers, and its use in early-stage breast cancer is becoming more common. Thus, chances to encounter breast tissue from patients treated with NAT is increasing. However, systems for handling and evaluating such specimens have not been established. Several evaluation systems emphasize a multidisciplinary approach to increase the accuracy of breast cancer assessment. Thus, detailed and systematic evaluation of clinical, radiologic, and pathologic findings is important. In this review, we compare the major problems of each evaluation system and discuss important points for handling and evaluating NAT-treated breast specimens.

Citations

Citations to this article as recorded by  
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    Cancers.2022; 14(21): 5467.     CrossRef
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    Cancers.2021; 13(16): 4233.     CrossRef
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    Revista de Senología y Patología Mamaria.2021; 34: S25.     CrossRef
  • Neoadjuvant chemotherapy in non‐metastatic breast cancer: a study on practice trends in a regional cancer treatment service
    Edmond Ang, Navin Wewala, Rebecca Carroll, Garry Forgeson, Malcolm Anderson, Jennifer Fernando, Jody Jordan, Richard Isaacs
    Internal Medicine Journal.2020; 50(3): 315.     CrossRef
  • Examination of Tumor Regression Grading Systems in Breast Cancer Patients Who Received Neoadjuvant Therapy
    Anita Sejben, Renáta Kószó, Zsuzsanna Kahán, Gábor Cserni, Tamás Zombori
    Pathology & Oncology Research.2020; 26(4): 2747.     CrossRef
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    Robert A. Gatenby, Joel S. Brown
    Nature Reviews Clinical Oncology.2020; 17(11): 675.     CrossRef
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    The Breast Journal.2020; 26(11): 2151.     CrossRef
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    Tamás Zombori, Gábor Cserni
    Pathology & Oncology Research.2019; 25(3): 1153.     CrossRef
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    Hee Yeon Kim, Tae Hyun Kim, Hye Kyoung Yoon, Anbok Lee
    Journal of Breast Cancer.2019; 22(3): 425.     CrossRef
  • Higher underestimation of tumour size post-neoadjuvant chemotherapy with breast magnetic resonance imaging (MRI)—A concordance comparison cohort analysis
    Wen-Pei Wu, Hwa-Koon Wu, Chih-Jung Chen, Chih-Wie Lee, Shou-Tung Chen, Dar-Ren Chen, Chen-Te Chou, Chi Wei Mok, Hung-Wen Lai, Pascal A. T. Baltzer
    PLOS ONE.2019; 14(10): e0222917.     CrossRef
  • Multimodal image-guided surgery of HER2-positive breast cancer using [111In]In-DTPA-trastuzumab-IRDye800CW in an orthotopic breast tumor model
    Marion M. Deken, Desirée L. Bos, Willemieke S. F. J. Tummers, Taryn L. March, Cornelis J. H. van de Velde, Mark Rijpkema, Alexander L. Vahrmeijer
    EJNMMI Research.2019;[Epub]     CrossRef
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    BMC Cancer.2019;[Epub]     CrossRef
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  • Automatic cellularity assessment from post‐treated breast surgical specimens
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Case Studies
Low-Grade Adenosquamous Carcinoma of the Breast with Diverse Expression Patterns of Myoepithelial Cell Markers on Immunohistochemistry: A Case Study
Yoon Jin Cha, Gi Jeong Kim, Byeong-Woo Park, Ja Seung Koo
Korean J Pathol. 2014;48(3):229-233.   Published online June 26, 2014
DOI: https://doi.org/10.4132/KoreanJPathol.2014.48.3.229
  • 6,359 View
  • 58 Download
  • 6 Crossref
AbstractAbstract PDF

This paper reports a case of low-grade adenosquamous carcinoma (LGASC) arising in a 69-year-old woman, who presented with a 1-cm palpable mass on her right breast. Core needle biopsy diagnosed the mass as a fibroadenoma. After six months, the mass increased in size, and the patient received subsequent mammotome excision. On microscopic examination, bland-looking small glands were infiltrating into the fibrotic stroma with lymphocytic infiltrates at the periphery. Hematoxylin and eosin staining revealed relatively easily detectable myoepithelial cells along the outside in each of the glandular structures with variable degrees of squamous metaplasia. Based on histologic features, the patient was diagnosed with LGASC. LGASC is a rare variant of metaplastic carcinoma, which is characterized by a favorable prognosis. Due to the bland cytology and presence of myoepithelial cells, LGASC can be misdiagnosed as benign lesion. Additionally, inconsistent expression of myoepithelial markers could aid the diagnosis of LGASC.

Citations

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Cytomorphological Findings and Histological Correlation of Low-Grade Cribriform Cystadenocarcinoma of Salivary Gland in Fine-Needle Aspiration: A Case Study
Young Sin Ko, Ja Seung Koo
Korean J Pathol. 2013;47(6):592-595.   Published online December 24, 2013
DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.6.592
  • 7,164 View
  • 56 Download
  • 13 Crossref
AbstractAbstract PDF

Low-grade cribriform cystadenocarcinoma (LGCCC) of the salivary gland is a rare tumor. We report the cytologic features and histologic correlation of a patient with LGCCC. A 57-year-old man had a hardly palpable, nontender mass in the right cheek area followed over nine months. Radiologic analysis revealed a 1.2 cm multiseptated, cystic, solid nodule in an anterior superficial lobe of the right parotid gland. Fine-needle aspiration cytology revealed many irregular overlapping sheets or clusters of ductal epithelial cells forming solid, pseudopapillary, and cribriform architectures. Nuclei of the tumor cells revealed inconspicuous atypia with minimal size variation. On the basis of these findings, we confirmed a diagnosis of ductal epithelial proliferative lesion, favoring neoplasm, with uncertain malignant potential. Tumor excision was performed, revealing a tiny multicystic nodule (0.7 cm). Histopathologically, this tumor showed the characteristic morphology of LGCCC. This is the first report of cytomorphological findings of LGCCC in Korea.

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Case Reports
Primary Mucinous Cystadenocarcinoma of the Breast: Cytologic Finding and Expression of MUC5 Are Different from Mucinous Carcinoma
Sung Eun Kim, Ji Hye Park, SoonWon Hong, Ja Seung Koo, Joon Jeong, Woo-Hee Jung
Korean J Pathol. 2012;46(6):611-616.   Published online December 26, 2012
DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.6.611
  • 7,259 View
  • 48 Download
  • 12 Crossref
AbstractAbstract PDF

Mucinous cystadenocarcinoma (MCA) in the breast is a rare neoplasm. There have been 13 cases of primary breast MCA reported. The MCA presents as a large, partially cystic mass in postmenopausal woman with a good prognosis. The microscopic findings resemble those of ovarian, pancreatic, or appendiceal MCA. The aspiration findings showed mucin-containing cell clusters in the background of mucin and necrotic material. The cell clusters had intracytoplasmic mucin displacing atypical nuclei to the periphery. Histologically, the tumor revealed an abundant mucin pool with small floating clusters of mucin-containing tumor cells. There were also small cysts lined by a single layer of tall columnar mucinous cells, resembling those of the uterine endocervix. The cancer cells were positive for mucin (MUC) 5 and negative for MUC2 and MUC6. This mucin profile is different from ordinary mucinous carcinoma and may be a unique characteristic of breast MCA.

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Rosai-Dorfman Disease in the Breast with Increased IgG4 Expressing Plasma Cells: A Case Report
Yoon Jin Cha, Woo Ick Yang, Se Ho Park, Ja Seung Koo
Korean J Pathol. 2012;46(5):489-493.   Published online October 25, 2012
DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.5.489
  • 7,326 View
  • 45 Download
  • 15 Crossref
AbstractAbstract PDF

Rosai-Dorfman disease (RDD) can present in any anatomic site, but breast involvement is rarely reported. Recently, a relationship between RDD and IgG4-related sclerosing disease has been suggested. Here we report another case of RDD with overlapping features of IgG4-related sclerosing disease occurring in a right breast of a 62-year-old female. On microscopic examination, the mass demonstrated a characteristic zonal pattern of proliferation of large polygonal histiocytes and lymphoplasma cells with stromal fibrosis. Emperipolesis was observed in histiocytes with abundant cytoplasm, which showed immunoreactivity for S-100 protein and CD68; the diagnosis of RDD was made. Sheets of plasma cells in the fibrotic stroma demonstrated positive reactions for IgG and IgG4. The mean count of IgG4-positive plasma cells was 100.2/high power field, and the ratio of IgG4/IgG was 56.7%. Additional findings of stromal fibrosis and obliteration of preexisting breast lobules suggested overlapping features with IgG4-related sclerosing disease.

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Original Articles
The Clinicopathologic Features of Molecular Apocrine Breast Cancer
Yoon Jin Cha, Woo-Hee Jung, Ja Seung Koo
Korean J Pathol. 2012;46(2):169-176.   Published online April 25, 2012
DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.2.169
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AbstractAbstract PDF
Background

To elucidate the clinicopathologic features and their implications on the immunohistochemistry in cases of molecular apocrine breast cancer (MABC).

Methods

Immunohistochemical (IHC) staining for estrogen receptor (ER), human epidermal growth factor receptor 2 (HER-2), cytokeratin (CK) 5/6, epidermal growth factor receptor (EGFR), androgen receptor (AR), gamma-glutamyltrasferase 1 (GGT1) and Ki-67 was performed on tissue microarray breast cancer samples from 204 patients. Phenotypes of breast cancer were divided based on the IHC status of ER, AR and GGT1 into the following: luminal type, ER positive and AR and/or GGT1 positive; basal type, ER, AR, and GGT1 negative; non-basal type, ER positive and AR and GGT1 negative; and MABC type, ER negative and AR and/or GGT1 positive.

Results

In our series of patients (n=204), there were 26 cases of MABC. Besides, there were 18, 60, and 100 cases of luminal type, basal type and non-basal type, respectively. The MABC demonstrated apocrine histology and a higher prevalence of HER-2 positivity than other phenotypes. With the basal type, the MABC manifested a more frequent expression of CK5/6 and EGFR and a higher Ki-67 index than other phenotypes (p<0.001). There were no significant differences in patient prognosis between the phenotypes of breast cancer.

Conclusions

MABC are distinguishable from other phenotypes based on the apocrine histology and a higher expression rate of HER-2.

Citations

Citations to this article as recorded by  
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    Thomas Grellety, Celine Callens, Elodie Richard, Adrien Briaux, Valérie Vélasco, Marina Pulido, Anthony Gonçalves, Pierre Gestraud, Gaetan MacGrogan, Hervé Bonnefoi, Bruno Cardinaud
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Galectin-3 Expression and BRAF Mutation in Cases of Cytologically Suspicious Papillary Thyroid Carcinoma.
Dokyung Kim, Hyunki Kim, Jinyoung Kwak, Minju Kim, Hyung Jae Jung, Ja Seung Koo, Beom Jin Lim, Chankwon Jung, SoonWon Hong
Korean J Pathol. 2010;44(2):191-198.
DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.2.191
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AbstractAbstract PDF
BACKGROUND
Fine needle aspiration, which is known as the most accurate and cost-effective method for diagnosis of thyroid nodule, still may result in indeterminate cases that are pauci-cellular and show minor nuclear atypia, but most cases are associated with suspicion of papillary thyroid carcinoma (PTC). A B-type Raf kinase (BRAF) mutation was found in about half of PTCs and galectin-3 was expressed by malignant tumors, helping us to differentiate malignancies from benign lesions.
METHODS
Cases studied included histologically 44 confirmed PTC cases and 18 benign cases previously diagnosed as suspicious of PTC using cytologic examination. Cases were analyzed for galectin-3 expression by immunohistochemical staining and BRAF mutation by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) with a new restriction enzyme.
RESULTS
All 44 cases of PTC and 8 of 18 benign controls expressed galectin-3. BRAF mutations were found in only 9 of the 44 PTC cases. Assessment of galectin-3 expression demonstrated high sensitivity but low specificity. Evaluation of BRAF mutation revealed high specificity and low sensitivity.
CONCLUSIONS
This study suggests that the combined application of these two methods for PTC of suspicious cytology is complementary.
Cytologic Features of Diffuse Sclerosing Variant of Papillary Carcinoma: Cytohistopathologic Analysis of 16 Cases.
Ja Seung Koo, Woohee Jung, Soonwon Hong, Hyunee Yim
Korean J Pathol. 2009;43(6):557-561.
DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.6.557
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AbstractAbstract PDF
BACKGROUND
The exact preoperative diagnosis of diffuse sclerosing papillary carcinoma (DSPC) is required for aggressive surgical treatment due to its extended involvement with thyroid and neck lymph nodes. The present study investigated the cytomorphologic characteristics of DSPC and identified cytologic features for preoperative diagnosis of DSPC. METHODS: A retrospective review of cytologic and histologic features of 16 patients diagnosed with DSPC after thyroidectomy and underwent preoperative fine needle aspiration cytology (FNAC) was performed.
RESULTS
Prominent psammoma bodies were observed in 16 (100%) and 10 (62.5%) cases of histology and FNAC, respectively. Lymphocytes were observed in nine (56.2%) and four (25.0%) cases, and squamous cells were noted in seven cases (43.7%) and one case (6.2%) on histology and FNAC, respectively. Nuclear grooves and inclusions, which are characteristics of papillary carcinoma, were observed in FNAC and histology slides in all 16 cases. CONCLUSIONS: DSPC displays prominent psammoma bodies and characteristic nuclear features of papillary carcinoma such as nuclear groove and inclusion in FNAC. However, the preoperative diagnosis of DSPC using only FNAC could be difficult due to the absence of other characteristic features such as lymphocytes and metaplastic squamous cells.
Case Reports
An Unusual Type of Acute Renal Failure due to Extensive Crystal Deposition in the Renal Tubular Epithelium and Interstitium: A Case Report.
Ja Seung Koo, Eunah Shin, Shin Woo Kang, Hyeon Joo Jeong
Korean J Pathol. 2004;38(5):337-340.
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AbstractAbstract PDF
Acute tubular necrosis is a major cause of acute renal failure. Acute renal failure that is caused by crystal deposition can result from drug toxicity, lymphoplasmacytic neoplasms, ingestion of industrial organic solvents, or intratubular obstruction due to degenerated red blood cells and red blood cell casts. We herein present an uncommon case of acute renal failure in a 57-year-old woman showing an unusually massive accumulation of variable-sized, round, ellipsoid or rhomboid, pale-pink, refractile bodies in the proximal and distal tubular epithelial cells, interstitial macrophages and Bowman's spaces. These bodies were electron dense with a maximum diameter of 3 micrometer. The information we gathered from the patient history, the laboratory data and the various histochemical and immunohistochemical analyses failed to reveal the exact nature of these crystal-like structures.
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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AbstractAbstract 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.

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