Quantitative Nuclear Characteristics of Lung Cancer Cells Using Image Analysis

BACKGROUND: The usefulness of quantitative nuclear image analysis in the classification of lung carcinoma is widely investigated and published. In this study, we tried to measure the nuclear characteristics of primary lung carcinomas by image analysis and to find the possibility of differential diagnoses. METHODS: Seventeen cases of adenocarcinomas (not including bronchioloalveolar carcinoma), seven of bronchioloalveolar carcinomas, eight of large cell neuroendocrine carcinomas, five of small cell carcinamas, and 26 of squamous cell carcinomas were analysed. Three different images of each case were captured by digital camera, and we analyzed the nuclear area, perimeter, circularity, and density using the Optimas 6.5 Image Analyser software package. Statistical analyses were done using the statistical program STATISTICA kernel release 5.5. RESULTS: The mean nuclear area was 0.52+/-0.25micrometer2 in the adenocarcinomas, 0.50+/-1.82micrometer2 in the squamous cell carcinomas, 0.45+/-0.20micrometer2 in the large cell neuroendocrine carcinomas, 0.42+/-0.16micrometer2 in the bronchioloalveolar carcinomas, and 0.31+/-0.12micrometer2 in the small cell carcinamas. The nuclear area was significantly different between the small cell carcinomas and the non-small cell carcinomas (p<0.01) and between the adenocarcinomas and the bronchioloalveolar carcinomas (p=0.02). The mean nuclear perimeter was 3.36+/-0.92micrometer2 in the adenocarcinomas, 3.24+/-0.67micrometer2 in the squamous cell carcinomas, 3.16+/-0.82micrometer2 in the large cell neuroendocrine carcinomas, 3.05+/-0.80micrometer2 in the bronchioloalveolar carcinomas, and 2.54+/-0.62micrometer2 in the small cell carcinamas. The nuclear perimeter was significantly different between the small cell carcinomas and the non-small cell carcinomas (p<0.04). The nuclear circularity showed no statistical difference. Nuclear density was the highest in the squamous cell carcinomas, and the lowest in the small cell carcinomas. The large cell neuroendocrine carcinomas showed the lowest standard deviation in nuclear density. CONCLUSION: The analysis of nuclear characteristics using an image analyser can be used as an objective method in the classification of lung carcinoma.

Plexogenic Pulmonary Arteriopathy in Congenital Heart Disease: A Report of Two Cases

Hypertensive pulmonary vascular disease can develop in those cases of congenital cardiac shunt in which critical levels of pulmonary artery pressure and flow are reached and exceeded. We have experienced two cases of plexogenic arteriopathy in complex congenital heart disease and tried to evaluate of distribution of arterial lesions by total mapping of the explanted lung. Case 1 and 2 were 12-year-old boy and 36 year-old man. They were treated with combined heart-lung transplantation. Mapping of the both lungs was done, and graded according to Heath and Edward's grading scheme. The elastic pulmonary artery was tortuous, dilated and aortic configuration. Both lungs showed mostly grade 3. Plexiform lesion or veinlike branches of hypertrophied muscular arteries arosed in a lateral branch of a muscular artery that might be proximal to an area of occlusion. Comprising the right and left lung, the right was more severe than the left. By getting closer to the distal part, the grade tended to increase to 4 to 5. By analyzing the pulmonary lobe, severe pulmonary hypertension of grade 4 or 5 was comparatively disseminated throughout the right lung. On the other hand, in the left lung, the grade of the lower lobe was higher than that of the upper lobe, and within the upper lobe, there was a tendency for the grade of inferior segment to be higher than that of the corresponding apical segment.

Fine Needle Aspiration Cytologic Findings of Gastric Inflammatory Myofibroblastic Tumor: A case report / 대한세포병리학회지

Inflammatory myofibroblastic tumor, histologically characterized by the presence of bland-looking spindle cells and infiltration of chronic inflammatory cells, is extremely rare in the gastric wall. We report a case of gastric inflammatory myofibroblastic tumor in a 27-month-old boy. The fine needle aspiration biopsy from the mass showed loose clusters or scattered spindle cells and inflammatory cells, predominantly of lymphocytes and plasma cells. The spindle cells resembled fibroblasts or myofibroblasts. Differential diagnosis from benign and malignant diseases involving abdominal cavity was discussed.

In Vitro of MR Imaging of the Resected Normal Gastric Wall: Radiologic-Histologic Correlation

PURPOSE: To evaluate normal human gastric wall layers in vitro using magnetic resonance*(MR) imaging, to correlate the results with the histologic findings, and to determine the optimal technique for evaluation of the gastric wall. MATERIALS AND METHODS: Forty-one normal resected gastric specimens obtained from 25 patients were dissected and placed in a polyethylene tube filled with normal saline. MR imaging with four MR sequences, T1-weighted FLASH*(T1FLASH), fat-saturated T1-weighted FLASH, T2-weighted TSE*(T2TSE), and True-FISP, was performed. The number of gastric wall layers and signal intensity of each layer were determined, and after correlating MR images with the histologic findings, the conspicuity of each layer*(mucosa, submucosa, and muscle), the distinction between each layer, and overall image quality were assessed. RESULTS: The gastric wall was shown by TIFLASH to have two (n=6, 14-6%), three (n=31, 75.6%) and four layers (n=4, 9.8%); by fat-saturated TIFLASH to have two (n=6, 14.6%) and three (n=35, 85.4%) ; by T2TSE to have three (n=24, 58.5%), four (n=11, 26.8%), and five (n=6, 14.6%); and by True-FISP to have one (n=2, 4.9%), two (n=8, 19.5%), three (n=23, 56%), four (n=4, 9.8%), and five (n=4, 9.8%) . The signal intensity of each layer at T1FLASH and fat-saturated T1FLASH was high-intermediate from the lumen in two-layer cases, high-low-high/intermediate in three-layer cases, and high-low-high-intermediate in four-layer cases. The signal intensity of each layer at T2TSE was intermediate/high-low-intermediate in three-layer cases, intermediate low-high-intermediate/low in four-layer cases, and low-high-low-high-low in five-layer cases. Three-layered gastric wall corresponded mostly to mucosa, submucosa, and muscle from the inner to outer layers, respectively. T1FLASH, fat-saturated T1FLASH, and T2TSE were superior to True-FISP in evaluating the gastric wall. T1FLASH and fat-saturated T1FLASH were the best sequences for demonstrating mucosa (p<0.05), and T2TSE was the best for submucosa and the distinction between this and muscle (p<0.05). Both T1FLASH and T2TSE provided the best overall image quality (p<0.05). CONCLUSION: In-vitro MR imaging is an excellent technique for the evaluation of layers of normal gastric wall. T2TSE is the sequence which best demonstrates the conspicuity of submucosa, the distinction between submucosa and muscle, and overall image quality.

The Effect of Nonspecific Endothelin-1 Receptor Blocker (Bosentan®) on Paraquat Induced Pulmonary Fibrosis in Rat / 결핵

BACKGROUND: Idiopathic pulmonary fibrosis(IPF) is a devastating illness for which there is little effective treatment. The key cytokines currently implicated in the fibrotic process are the transforming growth factor-β1(TGF-β1), tumor necrosis factor-α(TNF-α), endothelin-1(ET-1) and interferon-γ(IFN-γ). The rat model for paraquat-induced pulmonary fibrosis was chosen to investigate the role of ET-1 in this disease. Both ET-1 and TGF-β1 expression in lung lesions were examined using immunohistochemical staining. After Bosentan® administration, an orally active ET-1A and ET-1B receptor antagonist, the degree of pulmonary fibrosis and ET-1 and TGF-β1 expression were analyzed. METHOD: Sprague-Dawley rats were divided into three groups, the control group, the fibrosis group, and the fibrosis-Bosentan®-treated group. The animals were sacrificed periodically at 1, 3, 5, 7, 10, 14 days after administering saline or paraquat. The effects between groups were compared with the results of light microscopy and immunohistochemical staining for ET-1 and TGF-β1. The degree of fibrosis was evaluated by H&E and Masson's trichrome staining, which were graded by a computerized image analyzer. The degree of immunohistochemical staining was categorized by a semi-quantitative analysis method. RESULTS: The lung collagen content had increased in the paraquat instillated animals by day 3, and continued to increase up to day 14. A daily treatment by gavage with Bosentan®(100mg/kg) did not prevent the increase in collagen deposition on the lung that was induced by paraquat instillation. There were increased imunohistochemical stains of ET-1 on the exudate, macrophages, vascular endothelial cells and pneumocytes in the paraquat instillated group. Furthermore, TGF-β1 expression was higher on the exudate, macrophages, some infalmmatory cells, pneumocytes(type I, and II), vascular endothelium and the respiratory epithelial cells around the fibrotic area. After Bosentan treatment, there were no definite changes in ET-1 and TGF-β1 expression. CONCLUSION: Fibrosis of the Paraquat instillated group was more advanced when compared with the control group. In addition, there was increased ET-1 and TGF-β1 expression around the fibrotic area. ET-1 is associated with lung fibrosis but there was little effect of the ET-1 receptor blocker(Bosentan®) on antifibrosis.

A case of retroperitoneal lipoleiomyoma

We report a case of lipoleiomyoma which arose in retroperitoneum and presented with progressively distended abdomen in a 56-yr-old woman. The tumor was well encapsulated and consisted of two components, benign smooth muscle cells and mature adipose tissue without any atypia. It is likely to be mistaken as extrarenal angiomyolipoma, well-differentiated liposarcoma and leiomyoma with fatty change. We review the histologic characteristics of previously reported myolipoma and describe essential points of differential diagnosis.

SPARC Expression in Thyroid Follicular Adenomas and Carcinomas

SPARC, secreted protein acidic and rich in cysteine, is a extracellular matrix-associated protein implicated in the modulation of cell adhesion, migration, cell cycle regulation, and angiogenesis. SPARC is expressed in fibrocytes and endothelial cells involved in tissue repair and invasive malignant tumors in the gastrointestinal tract, breast, lung, kidney, adrenal cortex, ovary, and brain. This study was aimed to characterize the different expression of SPARC in the thyroid follicular adenomas and follicular carcinomas. Immunohistochemical staining was performed in paraffin-embedded tissues of 25 follicular adenomas and 15 follicular carcinomas of the thyroid gland. Immunohistochemically, SPARC was not expressed in the 19 follicular adenoma and 2 follicular carcinoma but highly expressed in the 6 follicular adenoma and 13 follicular carcinoma. These findings suggest that SPARC is a potential diagnostic marker of follicular carcinoma and is helpful to distinguish follicular carcinoma from follicular adenoma without vascular or capsular invasion.

Metastatic Adenocarcinoma with Mucin Emboli in the Lung: A case report

Lung is known as a vulnerable organ to metastatic tumors. Metastasis occurs mainly through lymphatics but seldom via blood vessels. Adenocarcinoma with mucin emboli is very rare. Primary foci reported in the literature were breast, lung, ovary and pancreas. A lung biopsy from a 60-year-old male patient showed floating mucin associated with metastatic adenocarcinoma to the lung in the blood vessels. The tumor cells spreaded along the vascular endothelium as if they were vascular endothelial cells. The tumor cells and mucin in the vessel were strong positive for PAS staining. Elastic and immunohistochemical staining for smooth muscle actin highlighted the vascular wall in the mucin containing structure with infarction of the lung. The primary focus was identified in the pancreatic head through the abdominal ultra-sonographic and computer-tomographic examination.