Continuous quality improvement program and its results of Korean Society for Cytopathology

Since 1995, the Korean Society for Cytopathology has overseen the Continuous Quality Improvement program for cytopathology laboratories. The Committee of Quality Improvement has carried out an annual survey of cytology data for each laboratory and set standards for proficiency tests. Methods: Evaluations were conducted four times per year from 2008 to 2018 and comprised statistics regarding cytology diagnoses of previous years, proficiency tests using cytology slides provided by the committee, assessment of adequacy of gynecology (GYN) cytology slides, and submission of cytology slides for proficiency tests. Results: A total of 206 institutes participated in 2017, and the results were as follows. The number of cytology tests increased from year to year. The ratio of liquid-based cytology in GYN gradually decreased, as most of the GYN cytology had been performed at commercial laboratories. The distribution of GYN diagnoses demonstrated nearly 3.0% as atypical squamous cells. The rate for squamous cell carcinoma was less than 0.02%. The atypical squamous cell/squamous intraepithelial lesion ratio was about 3:1 and showed an upward trend. The major discordant rate of cytology-histology in GYN cytology was less than 1%. The proficiency test maintained a major discordant rate less than 2%. The rate of inappropriate specimens for GYN cytology slides gradually decreased. Conclusions: The Continuous Quality Improvement program should be included in quality assurance programs. Moreover, these data can contribute to development of national cancer examination guidelines and facilitate cancer prevention and treatment.

Histological Differences between Vascular and Mucosal Hemorrhoids

PURPOSE: The aim of this study is to compare and analyze the histological differences between vascular and mucosal hemorrhoids, two structurally different types of hemorrhoids. METHODS: Internal hemorrhoidal tissue samples were fixed in 10% Formalin solution, and coronal sections included 10-mm proximal and 5-mm distal of the dentate line. Routine Masson-Trichrome and H&E were performed to evaluate the thickness of the mucosa and changes in the structure and the densities of submucosal vessels, connective tissue, and muscle. RESULTS: Compared with the corresponding tissues of mucosal hemorrhoids, the submucosal connective tissue and perivascular connective tissue of vascular hemorrhoids showed a loosened density, severe fragmentation, and an irregular arrangement. The submucosal vascular dilatation was more frequent and more severe in vascular hemorrhoids, but the number of vessels between both types of hemorrhoids did not show much difference. Hypertrophy and regular arrangement of the submucosal muscles were observed more frequently in the mucosal than in the vascular hemorrhoids. CONCLUSION: Compared to mucosal hemorrhoids, vascular hemorrhoids showed augmented damage in submucosal connective tissue and intense dilatation of vessels with a thinner mucosa. On the other hand, compared to vascular hemorrhoids, mucosal hemorrhoids showed hypertrophy of submucosal muscle and relatively minor alterations in vessels with a thicker mucosa. These histological differences may provide the basis for different etiologies between vascular and mucosal hemorrhoids.

Subperiosteal Ganglion Cyst of the Tibia Communicationg with the Knee: A Case Report

Subperiosteal ganglion is a rare lesion. It is reported that the lesion is developed at femur, radius, ilium and tibia. 64-year-old male visited our hospital complaining of exudate on leg. He had been treated at private clinic about soft tissue mass on anteromedial aspect of the leg. After MRI study, we performed arthroscopic examination. It is comfirmed that a communication is present between subperiosteal ganglion cyst and knee joint. Arthroscopic synovectomy and meniscectomy were performed. The cyst was excised. The clinical result was satisfactory.

A Clinical and Histopathologic Study of Ovarian Hemorrhagic Lesions / 대한산부인과학회잡지

No abstract available.

Three cases of pancreas allograft dysfunction

We present dincopathologic features of three cases of biopsy-proven pancreas allograft dysfunction in Korea. All patients had advanced insulin-dependent diabetes mellitus (IDDM). Case 1 was a 30-year-old woman who underwent a simultaneous pancreas-kidney transplantation. Urinary infection developed 6 days after the operation, which remitted and reappeared, when urine amylase level was normal. Since the 55th day after the operation, intermittent hematuria has persisted. Cytomegalovirus inclusions were detected on the urinary bladder and grafted duodenal mucosa. The graft was removed due to perforation of the grafted duodenum and panperitonitis. Case 2 was a 27-year-old man undergoing pancreas transplantation alone (PTA). Ten days after the transplatation, the level of 24 urine amylase decreased and the graft was not delineated by 99mTc DTPA scintigraphy. Allograft needle biopsy revealed multiple acinar cell necrosis and mild lymphocytic infiltration which were compatible with mild acute rejection. Case 3 was a 25-year-old man undergoing cadevaric PTA. Three months after the transplantation, graft was removed due to gastric perforation associated with cytomegalovirus and angiodestructive fungal infection. Various causes of pancreas allograft dysfunction can be diagnosed by needle biopsy, thus appropriate biopsy specimen should be taken using improved biopsy technique.

Fibrosing cholestatic hepatitis: a report of three cases

Fibrosing cholestatic hepatitis is an aggressive and usually fatal form of viral hepatitis in immunosuppressed patients. We report three cases of fibrosing cholestatic hepatitis in various clinical situations. Case 1 was a 50-year-old man who underwent a liver transplant for hepatitis B virus (HBV)-associated liver cirrhosis. Two and a half years after the transplant, he complained of fever and jaundice, and liver enzymes were slightly elevated. Serum HBsAg was positive. Case 2 was a 30-year-old man in an immunosuppressed state after chemotherapy for acute lymphoblastic leukemia. He was a HBV carrier. Liver enzymes and total bilirubin were markedly elevated. Case 3 was a 50-year-old man who underwent renal transplantation as a known HBV carrier. One year after the transplant, jaundice developed abruptly, but liver enzymes were not significantly elevated. Microscopically lobules were markedly disarrayed, showing ballooning degeneration of hepatocytes, prominent pericellular fibrosis, and marked canalicular or intracytoplasmic cholestasis. Portal inflammation was mild, but interphase activity was definite and cholangiolar proliferation was prominent. Hepatocytes were diffusely positive for HBsAg and HBcAg in various patterns. Patients died of liver failure within 1 to 3 months after liver biopsy in spite of anti-viral treatment.

Digital Mucous Cyst: Unusual Loeation and Characteristic Histopathologic Findings / 대한피부과학회지

Digital mucous cysts encompass two pathogenetically distinct entities, the cutaneous myxomatous type and ganglion type. We describe an 8-year-old boy with a digital mucous cyst on the ventral side of the proximal phalanx of the right fifth finger. The case shows characteristic histopathological findings, but in an unusual location.

A Case of Blastomycosis-like Pyoderma / 대한피부과학회지

Blastomycosis-like pyoderma is a rare reaction pattern to a superficial bacterial infection in persons with a variety of underlying coniditions, including inflammatory and neoplastic pathologic conditions, and in associaton with a primary immunodeficiency state. We describe a clinically recurrent blastomycosis-like pyoderma on the right ankle area in an otherwise healthy man.

A Prospective Endoscopic Blind Trial Comparing Precolonoscopy Bowel Cleansing Methods / 대한소화기내시경학회지

BACKGROUND AND AIMS: Although some authors have suggested that sodium phosphate (NaP) is more effective than polyethylene glycol (PEG) in bowel cleansing, there has been no crossover study proving the superiority of NaP over PEG in bowel cleansing and patients' compliance. The aim of this study was to compare the two solutions for colonoscopy, PEG and NaP, through crossover design with regard to patients' compliance, cleansing ability and side effects. METHODS: Thirty patients underwent two separate colonoscopies for colonic polyp(s) with PEG and NaP, respectively. Before and after bowel preparation, blood pressure, body weight, and serum biochemical parameters were measured in all patients. In addition, a detailed questionnaire was used to assess side effects and the patients' preference. The presence of bubbles, types of residual stool, and overall quality of colon cleansing were assessed by one endoscopist blinded to the type of preparation used. In each colonoscopy, two biopsy specimens were taken at rectum. RESULTS: In the NaP group, but not in the PEG group, there were significant changes in several biochemical parameters including sodium ( +3.0 +/- 3.0 mEq/L), potassium ( -0.3 +/- 0.3mEq/L), calcium ( -0.5 +/- 0.5 mg/dL), phosphorus ( +3.9 +/- 2.2 mg/dL) and osmolarity ( +10.1 +/- 9.3 mOsm/kg) after bowel preparation. In addition, the degree of body weight change was greater with NaP ( -2.2 +/- 2.3 kg) than with PEG ( -1.2 +/- 2.0 kg) (p=0.06) and the formation of bubbles that disturb luminal observation was more frequently found in the NaP group (p<0.01). There was no difference, however, in the type of residual stool and the overall quality of bowel preparation between the two groups and no significant mucosal change was noted after bowel preparation in both groups. Moreover, PEG was found to be more difficult to take than NaP (p<0.05) and among the 30 patients, 26 (87%) preferred NaP, while only two favored PEG (p<0.01). CONCLUSIONS: We conclude that NaP can replace PEG at least in patients with good general condition. Further studies to decrease the incidence of bubbles and to establish subgroups suitable for NaP are needed.

The Efficacy of Endorectal Ultrasonography in the Preoperative Staging of Rectal Cancer / 대한소화기내시경학회지

BACKGROUND AND AIMS: The precise preoperative staging of rectal cancer is of great im-portance for the selection of an appropriate treatment. Endorectal ultrasonography (EUS) has been proven as an efficient tool for staging in rectal cancer. Moreover, its technical advancement has been enhancing resolution and applications. We evaluated the accuracy of preoperative staging using EUS in rectal cancer and examined whether staging by EUS was an efficient procedure. METHODS: EUS was performed in 79 patients with rectal cancer diagnosed by colonoscopic biopsy from January to December, 1996. Endoscopic examina-tion was used with Olympus, GF-UM20 and Br?l and Kjaer type 2001 Scanner. The staging by EUS was based on UICC classification. RESULTS: Preoperative staging by EUS was equal to pathologic staging in 70.9% (56/79) of cases. Overstaging was found in 17.7% (14/79) and downstaging in 11.4% (9/79). The prediction of lymph node metastases was accurate in 50 of 79 cases (63.3%). CONCLUSION: EUS seems to be an efficient diagnostic method to assess rectal cancer staging. More accurate imaging and further experience in the interpretation is needed to improve the efficacy of EUS.

A Case of Acute Hepatitis related to the Chinese Medicine Ho-Shou-Wu / 대한내과학회지

There are few reports of hepatitis related to the Chinese Medicine in Korea. Because herbal medicine contains many ingredients, it is confused what ingredient causes the hepatitis. We experienced a case of acute hepatitis developed after consumption of Chinese herbal medicine, Ho-Shou-Wu, for 75 days which contains only one component, Polygonum multiflorum, in a 55 year-old woman. And gradual recovery from hepatitis was observed after stopping the medication. Drug-induced hepatitis was diagnosed with typical clinical course and exclusion of all the possible causes of acute hepatocellular injury. We report this case with review of literature.

Prostatic Tissue in Ovarian Mature Cystic Teratoma: A case report

Ovarian mature cystic teratoma containing benign prostatic tissue is rare and only 11 cases have been reported in the literature to date. We report a case of mature cystic teratoma of the ovary containing prostatic tissue. A 23-year-old female patient came to our hospital complaining of irregular menstruation for 3 months. Her menarche had occurred when she was 13 years old. The patient showed no evidence of virilization nor of endocrinopathy. A goose-egg-sized mass was palpable in the left lower abdomen on physical examination. Ultrasonography revealed a cystic ovarian mass with internal echogenecity. Microscopic finding was consistent with that of usual mature cystic teratoma except for a 1.5 cm focus of prostatic and bladder tissues. Prostatic tissue demonstrated strong immunoreactivity for prostatic specific antigen (PSA), prostatic alkaline phosphatase (PAP) and cytokeratin 7. Basal cells of the prostate glands were positive for high molecular weight cytokeratin (34betaE12). Although ovarian mature cystic teratoma containing prostatic tissue has been reported as a rare occurrence, a careful examination with immunohistochemical staining may increase the detection of prostatic tissue in mature cystic teratoma of the ovary.

Carcinosarcom a of the Skin: A New Combination of Squamous Cell Carcinoma and Chondrosarcoma

Carcinosarcoma is a rare malignant tumor composed of a mixture of neoplastic epithelial and mesenchymal elements, which has been reported in many organ systems, but its occurrence is very rare in the skin. An 81-year-old female patient presented with aml-year-history of a painful exophytic mass on the tip of the middle finger of the right hand involving the distal part of the nail bed. The mass was 1 × 1 × 0.6 cm in size, hard, flesh colored, ulcerated and easily bleeding. Microscopically, the epidermis at the margin of the tumor showed the characteristic findings of squamous cell carcinoma and the carcinomatous component was mixed with malignant mesenchymal components focally differentiating into chondrosarcoma. This combination of squamous cell carcinoma and chondrosarcoma has not been reported yet in the skin. She had a distal interphalanx amputation and no recurrence appeared for 1 year on follow-up.

Histopathologic Analysis of Helicobacter pylori-associated Chronic Gastritis between cagA-positive and cagA-negative Strains

Infection with Helicobacter pylori (H. pylori) leads to gastritis, but the majority of infected persons are asymptomatic, and it has been recently described that the ability of H. pylori to cause more severe disease is related to the presence of the cytotoxin-associated gene A (cagA). We investigated the prevalence of cagA-bearing strains in a group of H. pylori-positive gastritis, and compared the morphologic differences between cagA-positive and cagA-negative cases on H&E stained slides. Polymerase chain reaction (PCR) assays for detection of H. pylori and cagA of 62 gastric biopsy specimens were performed. All the slides were analyzed by the updated Sydney system. Forty eight (77.4%) were PCR positive for H. pylori and thirty four (54.8%) were positive for cagA. There were no significant differences in numbers of H. pylori, degree of infiltration of mononuclear cells and degree of atrophy between cagA-positive and cagA-negative groups. The rates of neutrophilic infiltration and intestinal metaplasia were significantly higher in cagA-positive group than in cagA-negative group. In conclusion, the detection of H. pylori by PCR method is more sensitive than that of microscopic examination and H. pylori strains possessing cagA are associated with an enhanced induction of severe gastritis.

The Prognostic Significance of the p53 Overexpession on Complete Response and Survival in Preoperative Chemoradiotherapy Treated Squamous Cell Esophageal Carcinoma / 대한암학회지

PURPOSE: To determine the frequency of p53 overexpression and to analyse the relationship between p53 overexpression and complete response rate, survival in locoregionl squamous cell esophageal cancers treated with preoperative chemoradiation multimodality approaches. MATERIALS AND METHODS: Using a microwave oven heating method, we have detected p53 overexpression by immunohistochemically with a monoclonal antibody(DO-7) in formalin- fixed paraffin-embedded samples of 42 patients with locoregional squamous cell esophageal cancer, who treated with concurrent chemotherapy and radiatian followed by surgery. RESULTS: In 27 of 42 tumors(64.2%), nuclear immunoreactivity for the p53 protein was detected. Complete response rate, evaluated in surgical specimen 3-4 weeks after chemoradiation seemed to be high in p53 positive group compared to p53 negative group, however, there was no statistically significant difference in acquiring better complete response rate, overall survival and progression free survival between p53 positive and p53 negative group(p=0.0546, p=0.0599, p= 0.6832). Complete response group(n=17) survived longer than non-complete response group(n=25)(p=0.0010). CONCLUSION: The results indicate that p53 is not a statistically significant prognostic factor in obtaining better complete response rate, overall survival and progression free survival of the patients with esophageal carcinoma treated with preoperative chemoradiotherapy. Additional studies are warranted for further evaluation.

Primary Signet Ring Cell Carcinoma of the Colon and Rectum / 대한암학회지

PURPOSE: Signet ring cell carcinoma is a rare type of adenocarcinoma in the colon and rectum. We evaluated the differences of clinical features between colorectal signet ring cell carcinoma and ordinary adenocarcinoma. MATERIALS AND METHODS: The clincopathologic data of 13 cases with primary colorectal signet ring cell carcinoma were reviewed. The primary colorectal signet ring cell carcinoma was diagnosed when following criteria were met: 1) the tumor was primary; 2) histologic material was adequate; 3) signet ring cells represented more than 50% of the cancer. RESULTS: Patients ranged in age from 20 to 68 (median, 45) years; 7 were male, and 6 were female. Three tumors were located in the proximal colon, 3 in the distal colon, and 7 in the rectum. There was no case that had family history. Most cases (77%) were stage III, one was stage II, and two were stage IV with peritoneal seeding. There were 9 cases that showed local recurrence or distant metastases during follow-up periods 6 cases with peritoneal seeding, 3 with bone metastases, 2 with brain metastases and 1 with pelvic recurrence (two cases had either bone and brain metastasis, and one case had bone and peritoneal seeding). Prognosis was extremely poor, and overall two years survival rate was 25%. CONCLUSION: Early onset, mode of metastasis and poor prognosis may imply the different biologic behavior of signet ring cell carcinoma, compared with ordinary adenocarcinoma. To improve outcome, early diagnosis and radical operation should be stressed.

Cytologic Features of Gaucher's Disease in the Spleen: A case Report / 대한세포병리학회지

Gaucher's disease is an autosomal recessive disorder resulting fror i mutation at the glucocerebrosidase locus on chromosome 1q21. As a result, glucocerebroside accumulates principally in the phagocytic cells known as Gaucher ce Is. In our case, a five-year old girl was admitted with seven days history of fever and abdominal distension. At physical examination the patient had hepatosplenomegaly. Laboratory tests revealed a hemoglobin concentration of 2.8g/L: platelet counts of 23,0001?l: normal range of white cell and differential counts, and negative Coombs' test. Liver enzymes were normal. For the evaluation of hepatosplenomegaly, fine needle aspiration was aerformed blindly against the palpable spleen. Wet-fixed hematoxylin and eosin-stained smears are made. The smears from the spleen showed predominantly macrophages with abundant cytoplasm and rather small, uniform, often eccentric nuclei with small nucleoli. The multinucleated cells were often found. The cytoplasm was pale, with more or less distinct fibrillarity. The cells had the characteristic appearance of Gaucher cells. Gaucher cells were also found it the tissue section from the liver, spleen and lymph node and the bone marrow aspirate. The diagnosis was later confirmed by determination of beta-glucosidase activity in peripheral blood leucocytes. Fine needle aspiration of the spleen is considered as a convenient procedure with a low complication rate for the diagnosis of lysosomal storage disease.

Solitary Fibrofolliculoma: A case report

The clinical and pathological features of solitary fibrofolliculoma are presented. Solitary fibrofolliculoma is very rarely encountered and to our knowledge, only 7 cases have been reported in the Western literature and no cases have been published in Korea. We experienced a case of solitary fibrofolliculoma occurring in a 56-year-old female, who had a 1.0 cm-sized and slowly growing nodule on her chin. A brief review of the literature, was made especially in relation to the pathological findings and histogenesis of solitary fibrofolliculoma.

Deletions of 9p21 and TP53 in bladder cancer

The objective of this study was to characterize the alterations of 9p21 and TP53 in Korean transitional bladder cancer and to assess the relationship between the histopathologic parameter and the alteration of these genes. Allele loss in 29 surgically resected transitional cell carcinoma was examined by using the multiplex PCR with 7 and 1 microsatellite markers for 9p21 and TP53, respectively. Twenty-one (72%) demonstrated allele loss at 9p21 and/or TP53. Deletion at the 9p21 region was detected in 17(61%) of 28 informative cases at one or more loci, and LOH at TP53 was found in 12(55%) of 22 informative cases. Of 7 microsatellite markers for 9p21, allele loss occurred the most frequently at locus D9S162(69%) and D9S104(69%). Additionally, hemizygous deletion was slightly more common than homozygous deletion. Deletion at 9p21 and TP53 was not related with increased grade. These results suggest that the alteration of 9p21 may be an early event in the development of Korean bladder cancer, while p53 gene may be involved in early event of some bladder cancers as well as in their late events.

Well-Differentiated Thymic Carcinoma, Spindle Cell Type, Arising from Anterior Mediastinum: A case report

Well differentiated thymic carcinoma(WDTC) was recently separated from cortical thymoma. It is characterized by a predominance of epithelial cells with usually low mitotic rate, an epidermoid differentiation with slight to moderate cytologic atypia and lobular growth pattern. In recent reports, an uncommon spindle cell variant of WDTC, which is composed of spindle shaped epithelial cells, has been described. We investigated an unusual case of WDTC consisted of purely spindle shaped epithelial cells in a 66-year-old female. Radiologically, the well demarcated mass was located in the anterior mediastinum with focal invasion into the surrounding left upper lung. The tumor, 10 x 8 x 5 cm, was encapsulated with thin fibrous tissue and showed a pale yellow solid and lobulated cut surface. Microscopically, it consisted of solid sheets of purely spindle shaped epithelial cells with mild atypism, a low mitotic rate and focal epidennoid differentiation.