Recommendations for pathologic practice using digital pathology: consensus report of the Korean Society of Pathologists

Digital pathology (DP) using whole slide imaging (WSI) is becoming a fundamental issue in pathology with recent advances and the rapid development of associated technologies. However, the available evidence on its diagnostic uses and practical advice for pathologists on implementing DP remains insufficient, particularly in light of the exponential growth of this industry. To inform DP implementation in Korea, we developed relevant and timely recommendations. We first performed a literature review of DP guidelines, recommendations, and position papers from major countries, as well as a review of relevant studies validating WSI. Based on that information, we prepared a draft. After several revisions, we released this draft to the public and the members of the Korean Society of Pathologists through our homepage and held an open forum for interested parties. Through that process, this final manuscript has been prepared. This recommendation contains an overview describing the background, objectives, scope of application, and basic terminology; guidelines and considerations for the hardware and software used in DP systems and the validation required for DP implementation; conclusions; and references and appendices, including literature on DP from major countries and WSI validation studies.

Recommendations for pathologic practice using digital pathology: consensus report of the Korean Society of Pathologists

Digital pathology (DP) using whole slide imaging (WSI) is becoming a fundamental issue in pathology with recent advances and the rapid development of associated technologies. However, the available evidence on its diagnostic uses and practical advice for pathologists on implementing DP remains insufficient, particularly in light of the exponential growth of this industry. To inform DP implementation in Korea, we developed relevant and timely recommendations. We first performed a literature review of DP guidelines, recommendations, and position papers from major countries, as well as a review of relevant studies validating WSI. Based on that information, we prepared a draft. After several revisions, we released this draft to the public and the members of the Korean Society of Pathologists through our homepage and held an open forum for interested parties. Through that process, this final manuscript has been prepared. This recommendation contains an overview describing the background, objectives, scope of application, and basic terminology; guidelines and considerations for the hardware and software used in DP systems and the validation required for DP implementation; conclusions; and references and appendices, including literature on DP from major countries and WSI validation studies.

Chest Pain in a Renal Transplant Recipient due to Concomitant Cytomegalovirus and Herpes Simplex Virus Esophagitis

Chest pain in kidney transplant patients is usually caused by cardiac or pulmonary problems. However, it may be rarely caused by opportunistic esophageal infections. A 66-year-old female kidney transplant recipient was admitted because of chest pain. She had been treated with high-dose steroid and immunosuppressants for acute T-cell-mediated rejection. Cardiologic and pulmonary evaluations had normal results. Endoscopic examination revealed three clear ulcerative lesions in the esophagus. Histological and immunohistochemical staining of the endoscopic biopsy specimens revealed coinfection of herpes simplex virus and cytomegalovirus. The patient was treated with intravenous ganciclovir for 2 weeks. Her symptoms completely resolved, and follow-up endoscopy revealed complete healing of the previous ulcers. Viral esophagitis should be considered in the differential diagnosis in kidney transplant recipients presenting with chest pain.

A Case of Peritoneal Sarcomatoid Mesothelioma with Absence of Occupationl Exposure to Asbestos / 고신대학교의과대학학술지

Sarcomatoid mesothelioma is not very common, mesothelioma is directly attributable to occupational asbestos exposure, with 90% of cases showing a history of exposure. A 66-year-old male was admitted with an abdominal pain that persisted for 3 weeks. He had no abdominal mass. Computed tomography showed soft tissue thickening in perihepatic space and nodularities in omentum and peritoneum with ascites. There was no absolute diagnosis evidence in ascites analysis. Although the pathology of ascites was free for malignancy, the patient underwent omentum biopsy for definitive diagnosis. In laproscopic exploration, there was omental cake, peritoneal nodular seeding. It was suspected cancer carcinomatosis. Immunohistochemical findings suggested that it was sarcomatoid masothelioma. This is the rare case of a peritoneal sarcomatoid mesothelioma, without any exposure to asbestos.

Multiple Osteochondritis Dissecans of Knee Joint in a Patient with Wilson Disease, Focusing on Magnetic Resonance Findings

A 17-year-old man was admitted with a complaint of knee pain. He was diagnosed with Wilson disease by ophthalmologic and laboratory studies during hospitalization. Initial plain radiography of both knees showed multiple osteochondritis dissecans (OCD) on the medial and lateral femoral condyles of both knees. Subsequent magnetic resonance imaging showed multiple OCDs, which were symmetric on both knees. Subchondral cysts on the medial condyle and trochlear dysplasia were additionally evident on both femurs. We report this case with a focus on the imaging findings.

Human Cutaneous Protothecosis: Report of a Case and Literature Review

The Prototheca species is achlorophyllic algae and rarely causes human infection. Human protothecosis presents clinically as a cutaneous infection, olecranon bursitis, and disseminated systemic disease. We report a case of human cutaneous protothecosis involving the left wrist. A 68-year-old man presented with an ill-defined erythematous lesion with crust at the dorsal aspect of his left wrist. A punch biopsy was performed to reveal the histologic features of granulomatous inflammation with necrosis at the upper dermis, containing Prototheca organisms, of which, the characteristic features were highlighted by special staining. Through a molecular study, the Prototheca zopfii species was identified.

Reply: Multiple Large Cysts Arising from Nevus Comedonicus

No abstract available.

Multiple Large Cysts Arising from Nevus Comedonicus

Nevus comedonicus is a type of hamartoma that arises from a developmental anomaly of the mesodermal part of the pilosebaceous gland. In most cases of nevus comedonicus, an acne-like skin condition develops. Repeated inflammation can cause a morphological change to the cyst, papule, to abscess. We experienced a case of congenital nevus comedonicus, which led to the formation of large multiple cysts. A 50-year-old man was referred with a 12.5x10 cm lobulated mass on the posterior neck and upper back. The patient had a widespread presence of nevus comedonicus in the region ranging from the right superior chest to the posterior neck. The patient had a 30-year history of six prior excisions. A magnetic resonance imaging review led to a diagnosis of nevus comedonicus. Surgical treatment consisted of excision of the mass and wide excision for the patch type of nevus comedonicus around the neck. On histopathology, multiple masses were diagnosed as typical cysts containing keratinized tissue. The diffuse comedone lesions were diagnosed as nevus comedonicus. This case shows that large, multiple cysts can occur as a long-term complication of nevus comedonicus, and also highlights the importance of radical resection to prevent its further invagination.

Linear Psoriasis Localized on Unilateral Arm - A Rare Variant of Psoriasis / 대한피부과학회지

Psoriasis vulgaris is one of the most common skin diseases in the world, which is recognized as an autoimmune disease that is caused by genetic and environmental factors. Plaque, guttate, pustular form, and psoriatic erythroderma are known as classical feature of psoriasis with tendency as generalized or sporadic appearance. There are some cases of uncommon forms in the shape and distribution, as nevoid and linear psoriasis. Linear psoriasis is a rare entity and thought as a variant of psoriasis, but its existence is still in debate. Herein, we report an interesting case of 19-year old Korean man with psoriasis, occurring on the right arm, following the line of Blaschko in a linear form.

Basal Cell Nevus Syndrome Showing Several Histologic Types of Basal Cell Carcinoma

Basal cell nevus syndrome (BCNS), or Gorlin Syndrome, is an autosomal dominant disorder, characterized by multiple developmental abnormalities and associated with germline mutations in the PTCH gene. Patients show multiple and early onset basal cell carcinomas (BCCs) in skin, odontogeniccysts in the jaw, pits on palms and soles, medulloblastoma, hypertelorism, and calcification of the falx cerebri. Clinical features of BCCs in these patients are indistinguishable from ordinary BCCs. However, some patients show variable histologic findings in subtypes of BCCs, and only one case associated with several histologic types of BCCs in the syndrome has been reported in Korea. We present a case of BCNS characterized by multiple BCCs, odontogenic keratocysts, multiple palmar pits, and calcified falx cerebri. Histopathologic findings of BCCs showed several patterns, which were nodular, superficial, and pigmented types.

Comments to "Pr imary Cutaneous CD30+ Anaplastic Large Cell Lymphoma That Developed after Lymphomatoid Papulosis" / 대한피부과학회지

No abstract available.

Extrinsic Indentation at Gastric Fundus by Splenic Lymphangioma / 대한소화기내시경학회지

Splenic lymphangioma is a very rare benign condition, and it is classified as one of the cystic proliferations of the spleen. This is considered to result from developmental malformation of the lymphatic system. Splenic lymphangioma is usually seen in children and it is often found incidentally. Herein, we report on an unusual case of splenic lymphangioma in an adult. A 66-year-old woman presented with abdominal pain. On esophagogastroduodenoscopy, the gastric fundus was externally compressed by an extrinsic mass. Computed tomography revealed multiple cystic masses in the spleen. Laparoscopic splenectomy was then performed. The histology revealed multiple splenic lymphangiomas. This case showed an unusual presentation of splenic lymphangioma as gastric extrinsic compression, and this should be examined by imaging studies.

Telomerase Activity in Urethane-Induced Mouse Lung Tumorigenesis

BACKGROUND: Telomerase activity in precancerous conditions of lung adenocarcinomas has not been well studied. This study is designed to investigate the role of telomerase in premalignant lesions of urethane-induced mouse lung adenocarcinoma. METHODS: We harvested A/J mouse lung tissues at 3, 6, 9, 12, 28, 41, and 48 weeks after intraperitoneal urethane treatment, and classified each lesion in terms of histologic findings. We examined telomerase activity using a modified version of the telomeric repeat amplification protocol assay using both gel-based and enzyme linked immunosorbent assay methods. An immunohistochemical analysis of proliferating cell nuclear antigen (PCNA) was performed. RESULTS: In urethane-induced mouse lung tissues, it was sequentially developed from hyperplasia, adenoma, and eventually to adenocarcinoma. Telomerase activity began to show a positive level in tissues with no histologically visible nodule after urethane administration. It revealed a statistically significant increase in hyperplasia compared to the "control" lung tissue (p<0.05), which was proportionally elevated relative to adenoma and adenocarcinoma. There was a direct correlation between telomerase activity and the PCNA labeling index (p<0.05). CONCLUSIONS: The elevation of telomerase activity in normal-appearing lung lesions is thought to be a possible marker of early detection of pulmonary adenocarcinoma.

Primary Cutaneous CD30+ Anaplastic Large Cell Lymphoma That Developed after Lymphomatoid Papulosis / 대한피부과학회지

Lymphomatoid papulosis (LyP) and primary cutaneous anaplastic large cell lymphoma (ALCL) are grouped under the category of cutaneous T-cell lymphomas as CD30+ lymphoproliferative disorders. Though LyP is clinically characterized by chronic recurrent papulonodular cutaneous lesions, it shows malignant features on the histologic findings. LyP is associated with lymphomas, including primary cutaneous ALCL, mycosis fungoides and other lymphoproliferative disorders. A few cases of LyP related to ALCL have been reported in Korea. We report here on an interesting case of primary cutaneous ALCL that developed in succession after LyP in a 38-year-old female.

A Case of Ectopic Sebaceous Glands in the Esophagus / 대한소화기내시경학회지

A 42-year-old man without any signs or symptoms of illness underwent esophagogastroduodenoscopy (EGD) for a routine health check up. On esophagogastroduodenoscopy, multiple small and yellowish mucosal plaques were detected in the mid to distal esophagus. These plagues proved to be ectopic sebaceous glands of the esophagus according to the histologic examination. On the immunohistochemical staining with anti-Keratin 14, the basal cells and the heterotopic sebaceous glands were immunoreactive for keratin 14. The histogenesis of this extremely rare lesion is not completely clear. There have been some reports on ectopic esophagus sebaceous glands combined with esophageal cancer or gastric cancer. However, malignant transformation of the ectopic sebaceous gland itself has not yet been reported on. This case was regularly followed up for 12 months, and no interval change or malignant transformation was found both endoscopically and histologically.

Calcification of the Lateral Collateral Ligament of the Knee: A Case Report

Calcification most frequently occurs in the rotator cuff insertion of the shoulder. However, calcification is known to develop in any joint, including the hip, knee, wrist and elbow. Around the knee joint, it usually occurs in the areas such as the quadriceps femoris muscle, the popliteus muscle and the medial collateral ligament with a history of trauma. But the occurrence of calcification in the lateral collateral ligament is very rare. We herein report on one case of the calcification that developed in the lateral collateral ligament, and this was treated by excision of the calcified materials and repair of the ligament. We also present the magnetic resonance imaging findings of this case.

The expression of endothelial nitric oxide synthase in the uterus / 대한산부인과학회지

OBJECTIVE: Nitric oxide has a short half-life and is easily oxidized by nitrite, we can indirectly find out its activity by measuring the nitric oxide synthase in cells. The purpose of this study is to confirm the differences in the expression modes of eNOS in uterine endometrium and myometrium between the patients of uterine leiomyoma and the control group. METHODS: We defined the patient group as perimenopausal women who were diagnosed with uterine leiomyoma and underwent total hysterectomy, and the control group as the women who had no lesions in uterus. All of them were classified into proliferative phase and secretory phase by the Noyes standards and compared by immunohistochemical stain for eNOS. RESULTS: There is no significant differences between the patients of uterine leiomyoma and the control group statistically (endometrium P=0.319, myometrium P=0.264). The expression of eNOS in the vascular endothelial cells of the endometrium did not show significant differences statistically by menstrual cycle (proliferative phage P=0.549, secretory phage P=0.240). The expression of eNOS in the myometrium also did not show significant differences by menstrual cycle or by group statistically (proliferative phage P=0.279, secretory phage P=0.224). CONCLUSIONS: In this study, the expression of endothelial nitric oxide synthase was higher in the patients of uterine leiomyoma than in the control group, and during the secretory phase in menstrual period, but there was no statistical significance. We suppose that we can get statistically significant results if we have many cases of subjects.

Anti-Tuberculosis Agents Induced Pseudomembranous Colitis Treated with Maintaining Anti-Tuberculosis Drugs / 대한소화기내시경학회지

Tuberculosis is one of the main infectious health problems in Korea, and a combination of antibiotics is required to treat this illness. The combination therapy with rifampicin, isoniazid, ethambutol and pyrazinamide has many adverse reactions and there have been several case reports about pseudomembranous colitis (PMC) after anti- tuberculosis treatment. Rifampicin is regarded as a main cause of anti-tuberculosis induced PMC because of its bacteriocidal effect, and interruption of the offending drug, such as rifampicin, is usually necessary to treat the PMC. However, in patents with uncompensated tuberculosis, the discontinuance of anti-tuberculosis medication accentuates the disease severity, and continuance of the anti-tuberculosis medication is necessary to overcome the tuberculosis. We report here on a case in which the anti- tuberculosis agents induced PMC in 32 year old female who was diagnosed with active pulmonary tuberculosis. She was treated with maintenance of the anti-tuberculosis medication and also the addition of both oral metronidazole and probiotics.

A case of hepatitis A and E coinfection in an autoimmune hepatitis patient / 대한내과학회지

In Korea, the number of Hepatitis A virus (HAV) infections has suddenly increased and has become the most common cause of acute viral hepatitis during recent years. A 36-year-old female was diagnosed with acute fulminant hepatitis caused by HAV. Her clinical symptoms and AST/ALT recovered after supportive treatment; however, a re-elevation of AST/ALT was observed. Weperformed another viral marker study, autoimmune marker study and liver biopsy to rule out another hepatic insult. As a result, anti- HEV IgM, an anti-nuclear antibody and anti-smooth muscle antibody were positive and liver histology showed chronic hepatitis. In conclusion, we report a case of hepatitis A and E coinfection in an autoimmune hepatitis patient.

Adult Type Granulosa Cell Tumor of the Testis / 대한비뇨기과학회지

Testicular granulosa cell tumor(GCT) is a rare neoplasm. We report here on an incidentally discovered testicular granulosa cell tumor in a 36-year-old man. The serum tumor markers were within the normal limits. The ultrasonographic findings revealed a mass with a heterogenous hypoechoic echotexture, including multiple variable sized cystic components. The histology on the orchiectomy specimen demonstrated a gonadal stromal tumor with granulosa cell features. Testicular granulosa cell tumor of the adult type is a very rare tumor, and there have been several isolated case reports and small serial studies described in the literature.