Journal of Pathology and Translational Medicine

Original Articles

The proteomic landscape shows oncologic relevance in cystitis glandularis: Jun Yong Kim, Dohyun Han, Hyeyoon Kim, Minsun Jung, Han Suk Ryu; J Pathol Transl Med. 2023;57(1):67-74. Published online December 22, 2022; DOI: https://doi.org/10.4132/jptm.2022.10.24

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Abstract PDF: Background
The relationship between cystitis glandularis (CG) and bladder malignancy remains unclear.
Methods
We identified the oncologic significance of CG at the molecular level using liquid chromatography-tandem mass spectrometry-based proteomic analysis of 10 CG, 12 urothelial carcinoma (UC), and nine normal urothelium (NU) specimens. Differentially expressed proteins (DEPs) were identified based on an analysis of variance false discovery rate < 0.05, and their functional enrichment was analyzed using a network model, Gene Set Enrichment Analysis, and Gene Ontology annotation.
Results
We identified 9,890 proteins across all samples and 1,139 DEPs among the three entities. A substantial number of DEPs overlapped in CG/NU, distinct from UC. Interestingly, we found that a subset of DEP clusters (n = 53, 5%) was differentially expressed in NU but similarly between CG and UC. This “UC-like signature” was enriched for reactive oxygen species (ROS) and energy metabolism, growth and DNA repair, transport, motility, epithelial-mesenchymal transition, and cell survival. Using the top 10 shortlisted DEPs, including SOD2, PRKCD, CYCS, and HCLS1, we identified functional elements related to ROS metabolism, development, and transport using network analysis. The abundance of these four molecules in UC/CG than in NU was consistent with the oncologic functions in CG.
Conclusions
Using a proteomic approach, we identified a predominantly non-neoplastic landscape of CG, which was closer to NU than to UC. We also confirmed a small subset of common DEPs in UC and CG, suggesting that altered ROS metabolism might imply potential cancerous risks in CG.

Ultrastructural Changes in Human Gallbladder Epithelium in Acalculous and Calculous Cholecystitis.: Sung Chul Lim, Chae Hong Suh; Korean J Pathol. 1995;29(6):714-726.

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Abstract PDF: Cholelithiasis is defined as the presence of stones within the lumen of the gallbladder or in the extrahepatic biliary tree. Cholecystitis, secondary to gallstones, is a common surgical disorder in Korea. Detailed microscopic descriptions, particularly the ultrastructural changes, of these diseases were not available. The goal of this study was to identify the ultrastructural alterations of gallbladder epithelium in cholecystitis with and without a stone, according to the degree of severity of inflammation, and the nature of the stone. The gallbladders of the control group, and cholecystitis cases without stone and with stone were fixed and examined with routine stain, special stain, immunohistochemical stain and trans-mission electron microscopy. The number and the volume density of the mucin containing secretary granules were not significantly increased in the calculous cholecystitis cases compared with those of the acalculous cholecystitis cases. Major findings were that the calculous cholecystitis cases showed a markedly reduced total lysosome area and volume density of the lysosome compared with those of the acalculous chole-cystitis cases. The differences between the mucin secretary granules and lysosomes, according to the degree of severity of cholecystitis and the natures of gallstones, were statistically not significant.

Case Reports

Cytologic Findings of Polyomavirus Infection in the Urine: A Case Report.: Mi Seon Kwon, Young Shin Kim, Kyo Young Lee, Yeong Jin Choi, Chang Suk Kang, Sang In Shim; Korean J Cytopathol. 1996;7(2):192-196.

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Abstract PDF: The principal significance of the urothelial changes caused by polyomavirus activation is in an erroneous diagnosis of urothelial cancer; however, the clue to their benign nature is the smooth structureless nuclear configuration and the relative paucity of affected cells. Though virologic studies and electron microscopy are usually needed to firmly establish the diagnosis, cytology is the most readily available and rapid means of establishing a presumptive diagnosis of human polyomavirus infection. A urine specimen of a 24-year-old man with hemorrhagic cystitis beginning two months after bone marrow transplantation for acute myeloblastic leukemia(M2) was submitted for cytologic evaluation. Cytologic findings revealed a few inclusion-bearing epithelial cells intermingled with erythrocytes, neutrophils, lymphocytes, and macrophages. Most of the inclusion-bearing -cells had large, round to ovoid nuclei almost completely filed with homogeneous dark, basophilic inclusion. The chromatin was clumped along the periphery and the cytoplasm was mostly degenerated. The other cells exhibited irregular inclusions attached to the nuclear membrane surrounded by an indistinct halo. These findings were consistent with polyomavirus infection.

Florid von Brunn Nests of the Urinary Bladder: A Case Report.: Han Seong Kim, Ji Eun Kwak, Sang Hwa Shim, Mee Joo, Sun Hee Chang, Je G Chi, In Rae Cho; Korean J Pathol. 2008;42(3):169-171.

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Abstract PDF: Among benign proliferations of the urinary bladder, von Brunn nests and cystitis cystica et glandularis are common. Sometimes florid proliferation of von Brunn nests makes an intravesical mass, which mimics tumorous lesions. We report here on a case of florid von Brunn nests, occurred in the 34-year-old man with hematuria. Radiological and cystoscopic examinations reveal a polypoid-papillary lesion and transurethral resection was then performed. Pathologically, prominent proliferations of urothelial cell nests were found deep in the lamina propria. Neither significant cytologic atypia nor muscle invasion was noted. Florid von Brunn nests should be considered both clinically and pathologically in the differential diagnosis of a intravesical mass.

Chronic Sclerosing Dacryoadenitis: Report of 2 Cases.: Ji Eun Kwon, Sang Kyum Kim, Sang Ryul Lee, Woo Ick Yang, Haeryoung Kim; Korean J Pathol. 2008;42(2):118-122.

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Abstract PDF: Chronic sclerosing dacryoadenitis is a rare and under-recognized chronic inflammatory disease of the lacrimal gland. We describe 2 patients with a localized type of chronic sclerosing dacryoadenitis. Both patients presented with a slowly growing painless mass of the eyelid mimicking a tumorous lesion. The morphologic findings of the masses excised under the clinical diagnosis of lymphoma closely recapitulate those of chronic sclerosing sialadenitis (Kuttner tumor). Immunohistochemical staining demonstrated an increased population of IgG4-positive plasma cells confirming that this disease also belongs to the spectrum of a recently described IgG4-related sclerosing disease.

Combined Xanthogranulomatous Urachitis and Bullous Cystitis: A Case Report.: Ji Eun Kwak, Han Seong Kim, Mee Joo, Sun Hee Chang, Sang Hwa Shim, Je G Chi, In Rae Cho; Korean J Pathol. 2008;42(1):41-44.

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Abstract PDF: Xanthogranulomatous inflammation of the urachus is a very rare benign chronic inflammatory disease of an unknown etiology. Herein we report a case of a 31-year-old woman who complained of lower abdominal pain and dysuria. Cystoscopy revealed a bullous change at the dome of the urinary bladder. MRI revealed a cystic mass above the bladder dome that extended to the umbilicus. A partial cystectomy with urachal resection was performed. Pathological examination revealed xanthogranulomatous urachitis combined with bullous cystitis.

The Intestinal Type of Florid Cystitis Glandularis Mimics Bladder Tumor: A Case Report.: Young Soo Song, Ki Seok Jang, Si Hyong Jang, Kyueng Whan Min, Woong Na, Soon Young Song, Hong Sang Moon, Tchun Yong Lee, Seung Sam Paik; Korean J Pathol. 2007;41(2):116-118.

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Abstract PDF: Cystitis glandularis is a benign metaplastic proliferative lesion of the urinary bladder which usually occurs in the setting of chronic irritation and infection or in some cases as a congenital process. Sometimes it presents as a tumor mass-like florid lesion, grossly mimicking malignancy. We report a case of 59-year-old man with multiple mass lesions around the trigone and the neck portion, which suggested the possibility of malignancy in clinical and radiological evaluations. Final diagnosis was confirmed by transurethral resection. The surface urothelial lining was intact. The submucosa showed von Brunn's nests, cystitis glandularis and cystitis cystica in the edematous lamina propria. There were numerous glands lined by tall columnar, mucin producing epithelium without atypia, conforming to the appearance of the intestinal variant of cystitis glandularis. The cystitis glandularis may mimic a neoplasm on gross evaluation. The intestinal variant of cystitis glandularis is particularly likely to be problematic when florid.

Radiation-Induced Epithelial Proliferation Mimicking Invasive Carcinoma of the Urinary Bladder: A Report of 2 Cases.: Ok Jun Lee, Kyu Rae Kim, Dae Woon Eom, Hyun Jung Kim, Na Hye Myong, Jae Y Ro; Korean J Pathol. 2004;38(5):341-344.

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Abstract PDF: Radiation-induced epithelial proliferation in the urinary bladder mimicking urothelial carcinoma has received only a little attention in the literature. Herein, we describe two cases of radiation-induced epithelial proliferative changes, which mimicked invasive urothelial carcinoma. Cystoscopy revealed bullous or edematous mucosal changes with multiple hemorrhagic foci. Microscopically, we observed inverted epithelial proliferation, forming nests and cords extending into the lamina propria. The epithelial cells in these nests and cords exhibited enlarged, hyperchromatic and pleomorphic nuclei, closely mimicking the infiltrative growth of urothelial carcinoma. However, the presence of radiation-induced changes was validated by the observation of abundant vacuolated cytoplasm, normal or slightly increased nuclear to cytoplasmic ratios, the absence of mitotic activity, dilated blood vessels containing frequent fibrin thrombi, scattered atypical fibroblasts, and the patients' previous history of radiation treatment. Radiation-induced changes should be always included in differential diagnoses of proliferative epithelial lesions in the urinary bladder and a pertinent clinical history of radiotherapy should be searched.

Hamartoma Arising in the Urinary Bladder: A case report.: Young Bae Kim, Tae Sook Hwang, Byung Gon Park, Jin Sook Jeong, Sook Hee Hong; Korean J Pathol. 1993;27(3):283-286.

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Abstract PDF: Hamartoma of the bladder is quite a rare entity which is composed of a disorderly admixture of mature cellular elements normally present in the urinary bladder. There is a great controversy regarding the pathogenesis of this lesion. Whether it is a true hamartomatous lesion or metaplastic lesion developed secondary to the inflammatory process. Similar or identical lesions has often been given by other names such as florid examples of cystitis glandularis. We prefer to cell florid examples of cystitis glandularis rather than hamartoma when it was occurred in an old age higher then 50th decade. Here we report a case of hamartoma of the urinary bladder in 44 years old man. Cystoscopic examination revealed a papillary polypoid mass which was attached to the fundus of bladder by long stalk. The mass measured 1.5 cm in greatest diameter. It was composed of epithelial nests resembling von Brunn's nest, cystitis glandularis or cystitis cystica dispersed in a stroma rich in smooth muscle and fibrous tissue.

Xanthogranulomatous Cholecystitis: 3 cases report.: Jae Hoon Park, Youn Wha Kim, Yong Koo Park, Ju Hie Lee, Moon Ho Yang; Korean J Pathol. 1991;25(1):41-44.

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Abstract PDF: Xanthogranulomatous cholecystitis is a rare form of inflammatory disease of the gall bladder and was first described in 1970 by Christensen and Ishak as fibroxanthogranulomatous inflammation of the gall bladder. Recently authors experienced three cases of xanthogranulomatous cholecystitis, two of which were erroneously diagnosed as malignant tumor in preoperative clinical and radiological examinations. Grossly, the gallbladders were enlarged and the walls were thickened with yellowish granular necrotic areas ranging from a few millimeters to 1.0 cm in diameter. Microscopically, all of three cases showed diffuse infiltration of the foamy histiocytes containing bile pigments and mononuclear leukocytes associated with fibroblastic proliferation and foreign body reactions. The pathogenesis of the xanthogranulomatous cholecystitis is uncertain, but opinion favours an inflammatory response to extravasated bile probably, from ruptured Rokitanky-Aschoff sinuses. Three cases of xanthogranulomatous cholecystitis with brief review of literature are presented.

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