CD4+CD56+CD68+Hematopoietic Tumor of Probable Plasmacytoid Monocyte Derivation with Weak Expression of Cytoplasmic CD3

Hematopoietic neoplasm coexpressing CD4 and CD56 includes a subset of acute myeloid leukemia with myelomonocytic differentiation, plasmacytoid monocyte tumor, and other immature hematopoietic neoplasms of undefined origin. Herein, we report a CD4+CD56+CD68+ hematopoietic tumor that was thought to be a tumor of plasmacytoid monocytes. This case is unique in the absence of accompanying myelomonocytic leukemia and the faint expression of cCD3 on the tumor cells. The patient was a 22-yr old man presented with multiple lymphadenopathy and an involvement of the bone marrow. Tumor cells were large and monomorphic with an angulated eosinophilic cytoplasm of moderate amount. Nuclei of most tumor cells were eccentric and round with one or two prominent nucleoli. Rough endoplasmic reticulum was prominent in electron microscopic examination. Tumor cells expressed CD4, CD7, CD10, CD45RB, CD56, CD68, and HLA-DR and were negative for CD1a, CD2, sCD3, CD5, CD13, CD14, CD20, CD33, CD34, CD43, CD45RA, TIA-1, S-100, and TdT. cCD3 was not detected in the immunostaining using paraffin tissue, but was faintly expressed in flow cytometry and immunostaining using a touch imprint slide. T-cell receptor gene rearrangement analysis and EBV in situ hybridization showed negative results. Cytochemically, myeloperoxidase, Sudan black B, and alpha naphthyl butyrate esterase were all negative.

Clinical Application of Sentinel Node Biopsy in T1 or Less Breast Cancers. Is it Effective or Feasible?

BACKGROUND: Sentinel node biopsy has emerged recently as an alternative to routine axillary node dissection in predicting axillary nodal metastasis, and various studies have shown its effectiveness in patients with breast cancer. However, there have been some controversies in clinical application because of its high false negative rate. METHODS: One hundred forty patients with breast cancer underwent operative management in consideration of the results of sentinel node biopsies at the department of surgery, Samsung Medical Center, between Sep. 1995 and Jul. 1998. Sixty-three patients with tumor sizes of T1 or less were retrospectively evaluated. Intraoperative lymphatic mappings using vital blue dye and using a combination of vital dye and a 99mTc-antimony sulphide colloid were performed for 53 patients and 10 patients, respectively. RESULTS: Patient's ages were in the third decade for 2 patients (3.2%), in the fourth decade for 18 (28.6%), in the fifth decade for 18 (28.6%), in the sixth decade for 13 (20.6%) and in the seventh decade for 12 (19.0%). An infiltrating ductal carcinoma was observed in 51 patients (81.0%), an intraductal carcinoma in 8 (12.6%), a medullary carcinoma in 2 (3.2%), an infiltrating lobular carcinoma in 1 (1.6%) and a mucinous carcinoma in 1 (1.6%). Sentinel node was detected in 42 of the 53 patients (79.2%) evaluated with vital blue dye only and in 10 of the 10 patients (100%) evaluated with a combination of vital dye and a 99mTc-antimony sulphide colloid. Among the group of T1 or less, the sensitivity rates of vital dye and the combination were 81.8% and 100% and their accuracies of them were 95.2% and 100%, respectively. The false negative rates for all cases were 12.2% and 8.3%, respectively, but they were decreased to 6.1% and even 0% for the group of T1 or less. CONCLUSIONS: The detection rate and the accuracy of sentinel node biopsy were enhanced in patients with T1 or less breast cancer. If a combination of vital dye and a radioisotope is used, sentinel node biopsy may be applied clinically in limited patients such as those with T1 or less breast cancer.

Diagnosis and Treatment of Granulomatous Mastitis: A study of 12 cases

PURPOSE: Granulomatous mastitis is a benign inflammatory disease of the breast and its etiology is not clearly defined. In 1972, Kessler and Wolloch described the microscopic features of granulomatous mastitis, but frequently it mimics a carcinoma in a clinical setting. This study was performed to determine the modalities that are important for the diagnosis and the treatment of granulomatous mastitis. METHODS: We studied 12 patients who were diagnosed as having granulomatous mastitis based on pathology. Age, parity, time from last delivery, number of operations, past history of breast feeding and oral contra ceptives, radiologic findings, and cytologic results were retrospectively evaluated. In two recent cases, a polymerase chain reaction (PCR) for mycobacterium tuberculosis was performed to exclude tuberculous mastitis. RESULTS: Among the 12 patients, 8 were in the thirties, 2 in the twenties, 1 in the forties and 1 in the fifties. Of the 12 patients, 9 patients had breast fed and 2 patients had used oral contraceptive pills previously. No patients were suffered from pulmonary tuberculosis. The mean number of deliveries was two. The time from last delivery were varied from 3 weeks to 24 years but most were within 6 years. The location of the lesions were the upper outer quadrant in 6, upper inner quadrant in 3, inner area in 1, lower outer quadrant in 1 and lower inner quadrant in 1 patient. The mean size of the lesions was 3.52 cm. Preoperative mammography was not helpful in finding granulomatous mastitis. Ultra sonographically multiple clustered, contiguous tubular hypochoic lesions suggested the possibility of the disease. Furthermore, fine needle aspiration cytology showed epithelial histiocytes or giant cells and could be used to diagnose granulomatous mastitis. Cultures of microorganisms were sterile, and AFB stainings were all negative. Tuberculous mastitis was excluded by PCR in 2 cases. Surgical resection of the affected tissue was performed in 8 patients and steroid therapy was performed in the remaining 4 who had been surgically treated in other clinics before. All excision cases, except one, were cured. Among the patientsfor whom steroid therapy was used, 1 patient was cured, 1 had a recurrence and the remaining 2 are now under treatment. CONCLUSION: Although rare, granulomatous mastitis could be diagnosed with the aid of ultrasonography and cytology. Surgical excision of the affected tissue and long-term steroid therapy could be used to treat the disease.

ret/PTC-1, -2, and -3 Incogene Rearrangements of Papillary Thyroid Carcinomas in Korea and Its Relevance to Clinical Aggressiveness / 대한내분비학회지

BACKGROUND: The prevalence of ret/PTC rearrangement in papillary thyroid carcinomas has been found to have wide variance in different populations. Recent studies, however, have been reporting no significant geographical difference between Asian and Western countries. In addition, there are some arguments about the correlation of ret/PTC expression with clinical aggressiveness. We have performed this study in order to examine the prevalence of ret/PTC-1, -2 and -3 rearrangements in korean papillary throid carcinomas and to ascertain its clinical relevance. METHODS: Fourteen thyroid tumors histologically confirmed to be papillary carcinomas were included in this study. To find rearrangements, we adopted RT-PCR and automated direct sequencing. Initial and follow-up clinical data were obtained form the patients medical records. The plasmid containing ret/PTC-2, and 3 was kindly provided by Dr. Ahn (Ulsan University, Seoul Choonang Hospital). RESULTS: We identified one tumors containing ret/PTC-1(1/14, 7.1%), and two containing ret/PTC-2 (2/14, 14.2%), and could not find ret/PTC-3 rearrangement in other patients (0/11). There was no significant correlation of ret/PTC with clinical aggressiveness. CONCLUSION: We found that the prevalence of ret/PTC rearrangement (3/14, 21.4%) in papillary thyroid carcinomas from Korea was similar to those recently reported in other nations. ret/PTC rearrangement may not affect biological behaviors of papillary thyroid carcinomas.

Clinical Application of Sentinel Node Biopsy in T1 or less Breast Cancers Is it Effective or Feasible? / 한국유방암학회지

BACKGROUND: Sentinel node biopsy has emerged recently as an alternative to routine axillary node dissection in predicting the axillary nodal metastasis and various studies habe shown its effectiveness in patients with breast cancer. However there have been some controversies in clinical application because of high false negative rate. MATERIALS AND METHODS: One hundred and forty patients with breast cancer underwent operative management in consideration of the results of patients with breast cancer underwent operative management in consideration of the results of sentinel node biopsy at department of surgery in Samsung Medical Cancer between Sep. 1995 and July 1998. Sixty-three patients with tumor size of T1 or less were retrospectively evaluated. Intra-operative lymphatic mapping using vital blue dye was performed in 53 patients and using combination of vital dye and 99mTc-antimony sulphide colloid in 10 patients. RESULTS: patients ages were in the third decade in 1 patients (3.2%), in the forth decade in 18 (28.6%), in the fifth decade 18 (28.6%), in the sixth decade in 13 (20.6%) and in the seventh decade in 12 (19.0%). The patients had infiltrating ductal carcinoma in 51 patients(81.0%), intraductal carcinoma in 8 (12.6%), medullary carcinoma in 2 (3.2%), infiltrating lobular carcinoma in 1 (1.6%) and mucinous carcinoma in 1 (1.6%). Sentinel node was detected in 42 of 53 patients (79.2%) evaluated with vital blue dye only and 10 of 10 (100%) evaluated with combination of vital dye and 99mTc-antimony sulphide colloid. Among the group of T1 of less, each sensitivity rates of vital dye and combination were 81.8% and 100% and accuracy of them were 95.2% and 100% respectively. Each false negative were 12.2% and 8.3% in total cases but they were decreased to 6.1% and even 0% in the group of T1 or less. CONCLUSION: The detection rate and accuracy of sentinel node biopsy were enhanced in patients with T1 or less breast cancer. If the combination of vital dye and radioisotope is used, sentinel node biopsy may be applied clinically in limited patients such as T1 or less breast cancer.

Secretory Carcinoma of the Breast: 4 Cases

BACKGROUND: A secretory carcinoma is one of the least common carcinomas of the breast. Most studies of this carcinoma have been single case reports or separate analyses of the problem in either children or adults. METHODS: We studied 4 female patients treated in Samsung Medical Center from Nov.1994 to Dec. 1998. All of them were diagnosed as having a secretory carcinoma by using pathologic examination. RESULTS: All patients were female and they were 21, 29, 49, and 69 years of age. The initial symptom in two cases was a palpable mass. One patient presented with nipple discharge, but a palpable mass was found during the physical examination. The other carcinoma was detected on screening mammography. Mammography and ultrasonography suggested malignancy in three cases. One case was preoperatively misinterpreted as an intraductal papilloma. Preoperative ultrasonography-guided core biopsy performed in one case was diagnosed as a secretory carcinoma. All the patients were in a relatively early stage, stages IIb, I, I, and I. Estrogen receptors were negative in three and positive in one, but progesteron receptors were negative in all four cases. Postoperative courses were good, and there have been no recurrence or side effects yet. CONCLUSIONS: A secretory carcinoma is a rare condition of the breast, but the prognosis seems to be favorable with a mortality rate lower than that of the usual breast cancer. Exact diagnosis with preoperative aspiration cytology and biopsy will make it possible to perform more conservative surgery.

Morphohistometric Investigation and bcl-2 Expression in the Placenta of Chromosomally Abnormal Pregnancy

To evaluate the significance of placental histology, a collaborative histological and cytogenetic study was performed on the products of 88 spontaneous abortions, and subsequently bcl-2 immunostaining was performed on 62 cases. The morphometric parameters included were DCIRCLE, FORMSHAPE, CPRATIO, and the expression of bcl-2 immunostainig was graded in four categories (I to IV). The results were as follows: 1) 40% (n=35) were chromosomally abnormal: trisomies predominated (57%, n=20) and was followed by triploidy (14%, n=5), double trisomy (6%, n=2), monosomy X (6%, n=2), inversion (9) (6%, n=2). 2) mean of DCIRCLE in chromosomally abnormal pregnancy was 40 micrometer larger than that in chromosomally normal pregnancy (p=0.012, one side t-test), while no difference was found in FORMSHAPE and CPRATIO between chromosomally abnormal and normal pregnancy. 3) bcl-2 expression was found in syncytiotrophoblast and cytotrophoblast. bcl-2 expression was weaker in chromosomally abnormal pregnancy with intensity I and II of 59% than chromosomally normal pregnancy with intensity I and II of 24%. 4) In comparison bcl-2 expression with DCIRCLE, in chromosomally normal abortion one (10%) in I & II and one (3%) in III & IV showed large DCIRCLE (above 360 micrometer), while 11 (85%) in I & II and 3 (33%) in III & IV in chromosomally abnormal pregnancy. It would mean that bcl-2 protein is necessary in preservation of pregnancy and placental morphology. Abnormal villous diameter and weak bcl-2 expression may be suggestive of chromosomal anomaly. Besides other histologic parameters, application of bcl-2 immunostaining and morphometric analysis probably give more sensitive and specific results in identifying chromosomally abnormal abortion.

Primary Central Nervous System Lymphomas; A Clinicopathologic Study of 18 Cases

The incidence of a primary central nervous system (CNS) lymphoma in western countries is about 1% of all the intracranial tumors and has increased 2.2% over the last decade. A similar pattern of increased frequency is observed in Korea. Although most CNS lymphomas in western countries are high grade tumors carrying poor prognosis, the clinicopathologic features of the Korean CNS lymphoma have not been well studied. We report clinicopathological features of 18 cases of histologically proven primary brain lymphoma. The mean age of the patients was 50 years and there was no sex difference. The clinical and radiological characteristics included multiple site of occurrence, infrequent extracranial spread, and frequent seeding via cerebrospinal fluid. No patients were immune-compromised host. Of 18 cases, 15 cases were of B-lineage and 2 cases were of T-lineage. According to REAL classification, there were 12 cases of diffuse large B cell lymphoma, two cases of B cell lymphomas of small lymphoid cell, and two cases of peripheral T cell lymphoma, unspecified. The remaining subtypes were not subclassified because of inadequate material. Pleomorphic cytologic features and necrosis of varying extent were frequent in the cases of diffuse large B-cell lymphoma. These results suggest that overall clinicopathologic features of primary malignant lymphomas of the central nervous system in Korea are similar to those of western countries.

Intraductal Papillary-Mucinous Neoplasm of the Pancreas: A case report

Intraductal papillary mucinous neoplasm (IPMN) is a recently recognized clinicopathologic entity characterized by dilatation of pancreatic duct filled with copious mucin and papillary ductal epithelial proliferation ranging from simple hyperplasia to invasive carcinoma. The exact clinicopathologic identification of this tumor is important because of favorable prognosis contrast to that of conventional ductal adenocarcinoma. Herein we report a case of surgically resected typical IPMN. A 59-year-old man had a long history of diabetes mellitus with epigastric pain of 4 months duration. Ultrasonography and computed tomographic examination revealed cystic dilatations of main pancreatic duct in the head. The patient underwent total pancreatectomy. The gross appearance showed diffuse dilatation of main pancreatic duct associated with cystic dilatation of subbranches in the uncinate process. Histologic examination revealed diffuse papillary proliferations lined by mucinous epithelium with mild atypism within ectatic ducts. No invasive carcinoma was noted. Histochemically, the papillary epithelium contained mostly neutral and acid sialomucin.

Secretory Carcinoma of the Breast: A case report

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.

Myofibroblastoma of the Male Breast: Report of a case

A case of myofibroblastoma of the breast in a 55-year-old man is described. Myofibroblastoma is a relatively recently recognized benign stromal tumor, and predominantly occurs in middle aged men. The pateint presented with a nontender firm mass in his right breast. Fine needle aspiration biopsy revealed bland looking stromal cell clusters without epithelial cells. Simple excision was done and the patient discharged uneventfully. The mass was well demarcated, lobulated and sligtly myxoid. Microscopically bipolar elongated spindle cell fascicles with interspersing broad collagen bands are so characteristic. Ultrastructurally the tumor cell show features of fibroblast as well as smooth muscle cell.

Granulomatous(Lobular) Mastitis in a Pregnant Woman: A case report

Granulomatous(lobular) mastitis is a distinct disease entity of unknown etiology which is characterized by noncaseating granulomatous lobulocentric inflammation. We describe a rare case of granulomatous(lobular) mastitis of a 36 year-old pregnant woman a review of the literature. The mass which was discovered in the third month of her pregnancy, began as a localized, nontender mass on the left breast and persisted during her entire pregnancy. It decreased slightly in size when she began taking post-partum bromocriptine. Clinically and mammographically, the mass was highly suspected as a carcinoma with axillary lymph node metastasis. Fine needle aspiration smears revealed numerous aggregates of granulomas composed of epithelioid histiocytes admixed with multinucleated giant cells of Langhans' and foreign body type, and collections of polymorphonuclear leukocytes. Ziehl-Neelsen, silver methenamine and PAS stain were negative for acid-fast bacilli, fungus, and bacilli on the smear respectively. Histologically, granulomatous inflammation was centered on the breast lobules. Caseation necrosis was absent, instead, numerous microabscesses were formed in the center of the granulomas. Cultures of the fresh tissue for the AFB, aerobic and anaerobic bacteria, and fungus were all negative. Excision of the mass was performed without further treatment and there was no recurrence of the mass 6 months postoperatively. An autoimmune mechanism, infection, and some association with oral contraceptives have been suggested as etiologic factors in the literature.