A multicenter study of interobserver variability in pathologic diagnosis of papillary breast lesions on core needle biopsy with WHO classification

Background@#Papillary breast lesions (PBLs) comprise diverse entities from benign and atypical lesions to malignant tumors. Although PBLs are characterized by a papillary growth pattern, it is challenging to achieve high diagnostic accuracy and reproducibility. Thus, we investigated the diagnostic reproducibility of PBLs in core needle biopsy (CNB) specimens with World Health Organization (WHO) classification. @*Methods@#Diagnostic reproducibility was assessed using interobserver variability (kappa value, κ) and agreement rate in the pathologic diagnosis of 60 PBL cases on CNB among 20 breast pathologists affiliated with 20 medical institutions in Korea. This analysis was performed using hematoxylin and eosin (H&E) staining and immunohistochemical (IHC) staining for cytokeratin 5 (CK5) and p63. The pathologic diagnosis of PBLs was based on WHO classification, which was used to establish simple classifications (4-tier, 3-tier, and 2-tier). @*Results@#On WHO classification, H&E staining exhibited ‘fair agreement’ (κ = 0.21) with a 47.0% agreement rate. Simple classifications presented improvement in interobserver variability and agreement rate. IHC staining increased the kappa value and agreement rate in all the classifications. Despite IHC staining, the encapsulated/solid papillary carcinoma (EPC/SPC) subgroup (κ = 0.16) exhibited lower agreement compared to the non-EPC/SPC subgroup (κ = 0.35) with WHO classification, which was similar to the results of any other classification systems. @*Conclusions@#Although the use of IHC staining for CK5 and p63 increased the diagnostic agreement of PBLs in CNB specimens, WHO classification exhibited a higher discordance rate compared to any other classifications. Therefore, this result warrants further intensive consensus studies to improve the diagnostic reproducibility of PBLs with WHO classification.

Standardized Pathology Report for Breast Cancer / 한국유방암학회지

Given the recent advances in management and understanding of breast cancer, a standardized pathology report reflecting these changes is critical. To meet this need, the Breast Pathology Study Group of the Korean Society of Pathologists has developed a standardized pathology reporting format for breast cancer, consisting of ‘standard data elements,’ ‘conditional data elements,’ and a biomarker report form. The ‘standard data elements’ consist of the basic pathologic features used for prognostication, while other factors related to prognosis or diagnosis are described in the ‘conditional data elements.’ In addition to standard data elements, all recommended issues are also presented. We expect that this standardized pathology report for breast cancer will improve diagnostic concordance and communication between pathologists and clinicians, as well as between pathologists inter-institutionally.

Standardized Pathology Report for Breast Cancer / 한국유방암학회지

Given the recent advances in management and understanding of breast cancer, a standardized pathology report reflecting these changes is critical. To meet this need, the Breast Pathology Study Group of the Korean Society of Pathologists has developed a standardized pathology reporting format for breast cancer, consisting of ‘standard data elements,’ ‘conditional data elements,’ and a biomarker report form. The ‘standard data elements’ consist of the basic pathologic features used for prognostication, while other factors related to prognosis or diagnosis are described in the ‘conditional data elements.’ In addition to standard data elements, all recommended issues are also presented. We expect that this standardized pathology report for breast cancer will improve diagnostic concordance and communication between pathologists and clinicians, as well as between pathologists inter-institutionally.

Standardized pathology report for breast cancer

Given the recent advances in management and understanding of breast cancer, a standardized pathology report reflecting these changes is critical. To meet this need, the Breast Pathology Study Group of the Korean Society of Pathologists has developed a standardized pathology reporting format for breast cancer, consisting of ‘standard data elements,’ ‘conditional data elements,’ and a biomarker report form. The ‘standard data elements’ consist of the basic pathologic features used for prognostication, while other factors related to prognosis or diagnosis are described in the ‘conditional data elements.’ In addition to standard data elements, all recommended issues are also presented. We expect that this standardized pathology report for breast cancer will improve diagnostic concordance and communication between pathologists and clinicians, as well as between pathologists inter-institutionally.

Ki-67 labeling index as a prognostic marker in advanced stomach cancer

PURPOSE: Proliferation marker Ki-67 is widely used in cancer prognosis prediction. We tried to investigate the role of Ki-67 as a prognostic factor in stomach cancer after surgery in this study. METHODS: We retrospectively evaluated 251 patients who underwent curative resection for gastric cancer from 2010 to 2015. In pathologic examination, Ki-67 labeling index was defined as the percentage of Ki-67 antigen positive cells. Prognostic significance of Ki-67 for gastric cancer was evaluated. Disease-free survival (DFS) was assessed as a primary end-point. RESULTS: The median follow-up period was 28.0 months. Thirty-one patients (12.4%) showed Ki-67 labeling index (LI) lower than 25%. Sixty-eight patients (26.6%) showed recurrence during follow-up period. Recurrence was associated with Ki-67 LI level (≤25%, P = 0.016), and lymph node metastasis status (P = 0.002). High Ki-67 LI level (>25%) was also related to p53 positivity (P < 0.001) and poorly cohesive type (P = 0.002). The 3-year DFS was 69.4%. Low Ki-67 LI level (≤25%) was related with low DFS (47.6% vs. 72.6%, P = 0.016). T stage (P < 0.001), N stage (P = 0.006), lymphovascular invasion (P = 0.010), and neuronal invasion (P = 0.001) also affected the DFS. In addition, T stage (P = 0.03) and Ki-67 LI (P = 0.035) were independent prognostic factors for DFS. In patients treated with adjuvant chemotherapy (n = 239, 93.4%), low Ki-67 (≤25%) was a poor prognostic factor for DFS (P = 0.013). CONCLUSION: Low Ki-67 LI predicts high rate of progression and low DFS of stomach cancer. Ki-67 LI can be a predictive marker in resected stomach cancer treated with surgery and adjuvant chemotherapy.

A Case of Hepatocellular Carcinoma Metastasis to the Dorsal Tongue / 대한이비인후과학회지

Hepatocellular carcinoma (HCC) is a common neoplasm, and its metastasis to the head and neck area is rare. We herein describe a unique case of HCC metastasis to the dorsal tongue. A 54-year-old male who was already diagnosed with HCC visited our hospital complaining of dysphagia and a progressively enlarging dorsal tongue mass. We operated to excise on the mass using CO₂ laser including mucosal margin and deep margin. The diagnosis of HCC metastasis was confirmed immunohistochemically. After 2 weeks of follow-up, the patient did not exhibit any evidence of complication and could eat orally without any problem. Further treatment to the other metastatic lesion was rejected, and the patient was followed up for more than six months. We introduce this first case of metastatic HCC in the dorsal tongue. With the extended life expectancy of HCC patients, the incidence of rare metastasis is expected to increase.

Concomitant Drug Reaction with Eosinophilia and Systemic Symptom Syndrome from Ethambutol and Autoimmune Hepatitis from Isoniazid / 대한소화기학회지

Anti-tuberculosis drugs can produce levels of hepatotoxicity ranging from mild elevation of aminotransferase to severe acute hepatitis. A few cases of drug-induced autoimmune hepatitis or the drug reaction with eosinophilia and systemic symptom (DRESS) syndrome by anti-tuberculosis medications have been reported. However, concomitant occurrence of these two disorders has not been reported. Here, we present a case of severe acute hepatitis with DRESS syndrome and autoimmune hepatitis resulting from primary standard anti-tuberculosis drugs. Both conditions were successfully treated with a systemic steroid regimen.

A Primary Duodenal Angiosarcoma with Lung and Bone Metastases: A Case Report and Literature Review / 대한내과학회지

An angiosarcoma is a rare soft-tissue neoplasm that develops anywhere in the body, and most commonly presents cutaneously in elderly white males, involving the head and neck, particularly the scalp. The neoplasm occurs only very rarely in the gastrointestinal tract. A patient was initially admitted to our hospital for treatment of dyspnea and hemoptysis. Both lungs contained multiple nodules, and a computed tomography (CT)-guided lung biopsy was performed. Endogastroduodenoscopy used to evaluate the anemia revealed a duodenal polypoid tumor. Microscopic examination showed that the tumor was a primary angiosarcoma of the duodenum with metastasis to the lung. In addition, positron emission tomography/CT revealed metastasis to the femur and the pelvic bone. Thus, we report a case of primary duodenal angiosarcoma with metastases to the lung and bone.

Primary Myoepithelioma of the Testis: A Case Report

Myoepitheliomas are well-established to occur in the salivary glands, but they have also been described in the breast, upper aerodigestive tract, skin, and soft tissues. We report here on a unique case of primary myoepithelioma that occurred in the right testis of a 28-year-old man. The tumor was entirely confined to the testis and it was clearly separated from the epididymis. Histopathology revealed mixed architectural patterns in which the reticular areas merged into the chondromyxoid stroma. The tumor cells, which were focally immunoreactive to pancytokeratin and S-100 protein, were round to ovoid and spindly arranged in cords, strands, and fascicles. They showed mild nuclear pleomorphism, sparse mitotic figures and a low Ki-67 proliferative index. There was no ductal differentiation in the tumor. To the best of our knowledge, there has been only one case report of a primary testicular myoepithelioma in the English medical literature.

A Case of Huge Primary Intracardiac Tumor Diagnosed by Prenatal Ultrasonography / 대한주산의학회잡지

No abstract available.

A Case of Milk Allergy with Positive Contact Challenge Test / 소아알레르기및호흡기학회지

Food allergy is a state of immunologic reaction resulting from the exposure to food or food additive. The clinical symptoms and signs varied from localized symptoms at the site of direct contact such as contact urticaria, localized gastrointestinal symptoms with nausea, pain, vomiting and diarrhea to systemic symptoms occurring in remote organs, such as skin, respiratory system, cardiovascular system. We reported a case of 8 month-old girl with milk allergy who presented skin symptoms after cutaneous contact with milk protein. Developed after 15 minutes of milk contact challenge on forearm and followed by erythematous papules and wheals distributed throughout the face and neck area accompanied by edema and itching. The symptoms were continued for 2 hours and disappeared after an injection of pheniramine maleate.

Twa Cases of Sacrococcygeal Teratoma Doagnosed by prenatal Ultrasosography / 대한주산의학회잡지

No abstract available.

Two Cases of Retroperitioneal Schwannoma / 대한산부인과학회잡지

Schwannomas are benign nerve sheath tumors that can originate at any anatomic sites. These tumors are usually soitary, benign, and slow-growing masses attached to large nerve trunks. These tumors have been described as arising in the pelvic retroperitoneum. We present two cases of pelvic retroperitoneal Schwannomas with a brief review of literatures.

A Study of p53 Overexpression in Endometrial Disorder, Endometrial Hyperplasia, and Endometrial Carcinoma / 대한부인종양콜포스코피학회잡지

Endometrial carcinoma is the most common female genital organ malignancy in western countries and the incidence is increasing in Korea. Endometrial carcinoma frequently develops under the condition of excessive prolonged estrogenic stimulation in the absence of progesterone but the molecular mechanisms of carcinogenesis remain unknown. Recent advances in molecular biology have led to the concept that carcinoma arise from the accumulation of a series of gene alterations involving activation of proto-oncogenes and inactivation of tumor suppressor genes. The p53, one of tumor suppressor genes, is located on chromosome 17p. Alteration of p53 gene is observed in a wide variety of human cancer. Immunohistochemistry is considered as a simple and useful method to detect p53 overexpression in surgical pathologic specimens and close correlation of p53 expression with the presence of mutations in the gene has been demonstrated. In order to observe the expression of p53 protein, immunohistochemical studies were performed in 28 cases of endometrial carcinoma, 33 cases of endometrial hyperplasia, and 8 cases of disordered proliferative phase endometrium were used as a control group. The results were as follows: 1. The expression rate of p53 protein were 57.1% (16/28) in endometrial carcinoma and 12.1% (4/33) in endometrial hyperplasia but 8 cases of disordered proliferative phase endome-trium revealed negative reaction. 2. The expression rates of p53 protein were 47.4% (9/19) in early stage and 77.8% (7/9) in advanced stage of endometrial carcinoma. 3. According to histologic grade of endometrial carcinoma, the expression rates of p53 protein were 58.4% (10/7) in G1, 62.0% (5/8) in G2, and 33.3% (1/3) in G3. 4. The expression of p53 protein of simple hyperplasia were 12.5% (2/16) and that of complex hyperplasia were 11.8% (2/17). In conclusion, it could be suggested that p53 gene alteration might play a role in carcinogenesis of endometrium and mutation of p53 gene might be a relatively late event in tumor progression. Further study will be required to clarify the role of p53 in the carcinogenesis of the endometrium.

A Study of p53 Overexpression in Endometrial Disorder, Endometrial Hyperplasia, and Endometrial Carcinoma / 대한부인종양콜포스코피학회잡지

Endometrial carcinoma is the most common female genital organ malignancy in western countries and the incidence is increasing in Korea. Endometrial carcinoma frequently develops under the condition of excessive prolonged estrogenic stimulation in the absence of progesterone but the molecular mechanisms of carcinogenesis remain unknown. Recent advances in molecular biology have led to the concept that carcinoma arise from the accumulation of a series of gene alterations involving activation of proto-oncogenes and inactivation of tumor suppressor genes. The p53, one of tumor suppressor genes, is located on chromosome 17p. Alteration of p53 gene is observed in a wide variety of human cancer. Immunohistochemistry is considered as a simple and useful method to detect p53 overexpression in surgical pathologic specimens and close correlation of p53 expression with the presence of mutations in the gene has been demonstrated. In order to observe the expression of p53 protein, immunohistochemical studies were performed in 28 cases of endometrial carcinoma, 33 cases of endometrial hyperplasia, and 8 cases of disordered proliferative phase endometrium were used as a control group. The results were as follows: 1. The expression rate of p53 protein were 57.1% (16/28) in endometrial carcinoma and 12.1% (4/33) in endometrial hyperplasia but 8 cases of disordered proliferative phase endome-trium revealed negative reaction. 2. The expression rates of p53 protein were 47.4% (9/19) in early stage and 77.8% (7/9) in advanced stage of endometrial carcinoma. 3. According to histologic grade of endometrial carcinoma, the expression rates of p53 protein were 58.4% (10/7) in G1, 62.0% (5/8) in G2, and 33.3% (1/3) in G3. 4. The expression of p53 protein of simple hyperplasia were 12.5% (2/16) and that of complex hyperplasia were 11.8% (2/17). In conclusion, it could be suggested that p53 gene alteration might play a role in carcinogenesis of endometrium and mutation of p53 gene might be a relatively late event in tumor progression. Further study will be required to clarify the role of p53 in the carcinogenesis of the endometrium.

A case of endodermal sinus tumor of ovary ; Complete remission & full-term delivery after conservative surgery and BEP therapy / 대한부인종양콜포스코피학회잡지

The endodermal sinus tumor of ovary is a rare, malignant germ cell tumor. It principally affects children and young adults. Earlier reports before combination chemothery described it was fatal and the prognosis was poor. The advances in treatment of endodermal sinus tumor have been achieved with the development of combination chemotherapy with monitoring tumor marker, serum AFP. The authors experienced a case of endodermal sinus tumor of ovary which showed complete remission following primary conservative surgery and three courses of combination chemotherapy(BEP) with normal full-term spontaneous delivery. With the case report, a brief review was made.

Evaluation of Ovarian Tumors by RMI(risk of malignancy index); -Based on Serum CA-125, Ultrasound Findings and Menopausal Status / 대한산부인과학회잡지

The purpose of this clinical study was to evaluate the efficacy of RMI(risk of malignancy index) as a preoperative predictive screening method in ovarian tumors. The RMI was calculated by the following formula; -RMI=The ultrasonographic score(0, 1, or 3) x serum CA-125 level x menopausal status score(1 or 3). The preoperative RMI was obtained from 69 cases of ovarian tumors operated from July 1993 to March 1996 at the Dept. of Obstetrics and Gynecology, Pusan Paik Hosp. Reviewing the histopathological diagnosis of surgical specimen, using RMI cut-off value of 200, the sensitivity, specificity, positive and negative predictive value of RMI was obtained and compared with CA-125 value and sonographic scores, respectively. The results obtained were as follows; 1. The sensitivity of RMI was 67.7%, it was lower than that of serum CA-125 value(74.0%) and ultrasonographic score(80.6%)(P=0.535). 2. The specificity of RMI was 100%, it was higher than that of serum CA-125 value(81.6 %) and ultrasonographic score(84.2%)(P=0.006). 3. The positive predictive value of RMI was 100%, it was higher than that of serum CA-125 value(76.7%) and ultrasonographic score(80.6%)(P=0.047). 4. The negative predictive value of RMI was 79.2%, it was lower than that of CA-125 value(79.5%) and ultraconographic score(84.2%)(P=0.83). In conclusion, the RMI could be a useful screening method to discriminate a benign from malignant ovarian tumors prior to operation.

A comparative Study for morbidity and Compilication in Total AbdominalHysterectomy ; -Open Versus Closed Vaginal Cuff / 대한산부인과학회잡지

Post-operative morbidity and complication, focused on open versus closed vaginal cuff, were compared. The patients were divided into two groups according to the method of cuff management(open cuff : n=53, closed cuff : n=52). From Jan, 1990 to Dec. 1994 one hundred five cases of total abdominal hysterectomy on the benign uterine disease were carried out by the same operator at the Dept. of Ob/Gyn. Pusan Paik Hospital. The vaginal cuff was opened during the first half periods(1990. 1~1993.3), and it was closed during the later peroids(1993.4 ~ 1994.12). As to the postoperative morbidity and complication(closed : open), urinary tract infection(9.4% : 5.8%), vaginal cuff infection(7.5% : 3.8%), febrile morbidity(3.8% : 3.8%), wound infection(1.9% : 3.8%), pelvic hematoma(0: 1.9%) developed but there were no statistical differences between the two groups. Granulation tissue formation on the vaginal cuff was found in 26 cases(49.1%) of the open cuff and in 18 cases(34.6%) of the closed cuff(p=0.134, X(2) test ) within 6 months after operation. Post operative increased vaginal discharge developed in 7 cases(13.2%) of the open cuff and in 10 cases (19.2%) of the closed cuff group(p=0.516, Fisher's Exact test).

Two Cases of Glassy Cell Carcionma of the Cervix, Treated by Neoadjuvant Chemotherapy and Radical Hysterectomy / 대한부인종양콜포스코피학회잡지

Glassy cell carcinoma is a histologic subtype of cervical cancer with distinct pathologic features and it has an aggressive biologic course. It was first described by Glucksmann and Cherry in 1956 as a poorly differentiated adenoquamous carcinoma and commented on its poor prognosis, unresponsiveness to traditional modes of therapy, and often associated with pregnancy. The characteristic histologic features are defined as follows: 1) cells with a moderate amount of cytoplasm resembling ground glass, 2) a fairly distinct cell membrane that stains with eosin or PAS, 3) large nuclei with prominent nucleoli. We present two cases of glassy cell carcinoma of the cervix successfullyl treated by neoadjuvant chemotherapy and radical hyterectorny, with a brief review of literatures.