Chondrolipoma in the Pelvic Cavity: a Case Report

A chondrolipoma is an extremely rare form of a benign mesenchymal tumor containing mature cartilage and fatty tissue. Chondrolipomas may be found in almost any part of the body, particularly in the connective tissue of the breast, head and neck area, as well as in the skeletal muscle. However, to the best of our knowledge, chondrolipomas located in the pelvic cavity have not been reported. In this case report, we describe a case of a chondrolipoma in the pelvis, and show that it has its own characteristic imaging findings, which included the composition of fatty tissue and calcification in most parts, as well as some focal areas of chondroid tissue based on the CT and MR findings.

The Expression of G1-S Cell Cycle Inhibitors in Normal Placenta and Gestational Trophoblastic Diseases

BACKGROUND: The objective of this study is to determine the expression pattern of G1-S inhibitor molecules in normal trophoblasts and gestational trophoblastic diseases, including hydatidiform moles and choriocarcinoma. METHODS: A total of 157 cases comprising 47 normal placentas and 110 gestational trophoblastic diseases such as choriocarcinoma (19 cases) and hydatidiform moles (91 cases of which 58 were complete, 12 were partial and 21 were invasive mole) were immunohistochemically analyzed on paraffin blocks using anti-p21, antip27, anti-p16, anti-p53, anti-pRb antibodies. RESULTS: The results revealed that in the normal placenta, all the G1-S cell cycle inhibitors were maximally expressed by the first-trimester trophoblasts and these levels decreased with gestational age. The expression of p21 and p53 was greatly enhanced in the gestational trophoblastic diseases, particularly in invasive mole and choriocarcinoma, whereas the p27 expression was significantly downregulated in choriocarcinoma. Especially, Rb expression was typically enhanced in the invasive mole, but not in choriocarcinoma. The expression level of p16 was low in all the cases, and particularly in choriocarcinoma. CONCLUSIONS: In conclusion, we demonstrated that the expression of G1/S cell cycle inhibitors correlates well with normal trophoblast differentiation, and these expressions are considerably altered in the gestational trophoblastic diseases, including complete/partial/ invasive hydatidiform mole and choriocarcinoma.

A Multiinstitutional Consensus Study on the Pathologic Diagnosis of Endometrial Hyperplasia and Carcinoma

BACKGROUND: The purpose of this study was to examine the reproducibility of both the diagnosis of endometrial hyperplasia (EH) or adenocarcinoma, and the histologic grading (HG) of endometrioid adenocarcinoma (EC). METHODS: Ninety-three cases of EH or adenocarcinomas were reviewed independently by 21 pathologists of the Gynecologic Pathology Study Group. A consensus diagnosis was defined as agreement among more than two thirds of the 21 pathologists. RESULTS: There was no agreement on the diagnosis in 13 cases (14.0%). According to the consensus review, six of the 11 EH cases (54.5%) were diagnosed as EH, 48 of the 57 EC cases (84.2%) were EC, and 5 of the 6 serous carcinomas (SC) (83.3%) were SC. There was no consensus for the 6 atypical EH (AEH) cases. On the HG of EC, there was no agreement in 2 cases (3.5%). According to the consensus review, 30 of the 33 G1 cases (90.9%) were G1, 11 of the 18 G2 cases (61.1%) were G2, and 4 of the 4 G3 cases (100.0%) were G3. CONCLUSIONS: The consensus study showed high agreement for both EC and SC, but there was no consensus for AEH. The reproducibility for the HG of G2 was poor. We suggest that simplification of the classification of EH and a two-tiered grading system for EC will be necessary.

Nasal Chondromesenchymal Hamartoma: A Case Report

We report a case of nasal chondromesenchymal hamartoma. A 14-year-old boy presented with a 5 cm sized mass in the left maxillary sinus, facial swelling and a loose tooth. A subtotal left maxillectomy with a bone graft was performed. The excised mass was composed of partly encapsulated, solid and cystic fragments of soft tissues. The mass contained chondroid and myxoid areas consisting of mesenchymal tissues including hyaline cartilage, osteoid and spindle cells in various proportions. The hyaline cartilage component was the most prominent. The spindle cell component had a fibrous matrix with variable myxoid or sclerotic changes. Thick hyalinized eosinophilic osteoid-like trabeculae were focally present. Immunohistochemically, all the mesenchymal cells tested positive for vimentin. The chondrocytes tested positive for the S-100 protein, and the spindle cell component showed focal immunoreactivity for smooth muscle actin and desmin. However, the cells were negative to pan-cytokeratin and p63.

A case of cardiac malignant fibrous histiocytoma treated by cardiac autotransplantation / 대한내과학회지

Primary cardiac tumors are rare findings and they are mostly benign. Malignant primary cardiac tumors make up 25% of the primary cardiac tumors and most of them are sarcomas. Malignant fibrous histiocytoma (MFH) is the most common soft tissue sarcoma in late adulthood, and it is an extremely rare sub-type of cardiac sarcoma. It is known that MFH displays a poor clinical course with complete resection being the most important prognostic factor for survival. We described here the case of a malignant fibrous histiocytoma of the heart in a 54-year-old woman who presented with dyspnea. The tumor was treated by mass excision via cardiac explantation and autotransplantation followed by adjuvant chemotherapy. This is the first report of cardiac autotransplantation in Korea.

Adenosquamous Carcinoma of the Ampulla of Vater: A Report of Two Cases

Primary adenosquamous carcinoma of the ampulla of Vater is extremely rare. We report two cases of adenosquamous carcinoma of the ampulla of Vater in a 48-year-old female and an 80-year-old female patient. The gross appearance was a polypoid mass in both cases. Histologically, the majority of the two tumors was composed of squamous cell carcinoma with some intermingled glandular adenocarcinoma components in both cases. Squamous cell carcinomas showed an abrupt transition from the normal glandular epithelium or glandular adenocarcinoma. Although the two cases revealed duodenal wall invasion and lymph node metastasis was found in case 2, both patients are still alive at 19 and 46 months after surgery, respectively.

Conization by combination of loop electrosurgical excision procedure (LEEP) and cold coagulation for the stage Ia1 squamous cell carcinoma of the uterine cervix / 대한산부인과학회지

OBJECTIVE: This study was performed to evaluate the results of conization by loop electrosurgical excision procedure (LEEP) and cold coagulation as a definitive treatment in the patients with FIGO stage Ia1 squamous cell carcinoma of the cervix. METHODS: One hundred eighty-seven patients were diagnosed as stage Ia1 cervical squamous cell carcinomas from 1995 to 2004 by conization with LEEP and cold coagulation. Fifty-nine patients who wanted to preserve fertility and/or refused further surgical treatment were followed-up without further treatment. Eleven patients of the 59 had involved ectocervical resection margins. All patients were followed-up with cervicovaginal smear and colposcopic examination at a regular interval. Disease recurrence was defined as a histologic diagnosis of dysplasia or more. RESULTS: The median follow-up period was 69.0 months (range 8 to 103). All 59 patients had no lymphvascular space invasion (LVSI). In four patients, the ectocervical margins were involved by dysplasia, in seven patients, by carcinoma in-situ. There were no specific differences in ages, depth of stromal invasion and HPV status between the groups with and without involved margins. All 59 patients did not recur during follow-up period. CONCLUSION: Conization with LEEP and cold coagulation was feasible and could be used as a definitive therapy for the patients with stage Ia1 cervical squamous cell carcinoma. This study suggests that conization might play a role in a patient with positive margins (dysplasia or CIS) when LVSI is not demonstrated.

Adenomyoma of Ampulla of Vater or the Common Bile Duct: A Report of Three Cases

Adenomyoma is a rare non-neoplastic lesion of the biliary tract. Here we report on three cases of adenomyoma; one located in the ampulla of Vater and two located in the common bile duct. Although preoperative endoscopic and radiological evaluations could not determine whether lesions were benign or malignant, intra-operative frozen section histologic examinations aided the differential diagnosis. Microscopic features of a lobular gland architecture with basally located nuclei and the absence of desmoplastic stromal reaction were found to be characteristic in frozen and paraffin sections.

Expression of Actin-bundling Protein Fascin and its Relationship with Altered E-cadherin and beta-catenin Expressions in Ovarian Serous Neoplasms

Background : Fascin, an actin-bundling protein, has been found in specialized normal cells, including the neuronal, endothelial and dendritic cells, and its expression is known to be greatly increased in various human neoplasms. Methods : Immunohistochemical stainings for fascin, betacatenin, and E-cadherin were performed in normal ovary tissue (n=13), and in benign (n=14), borderline (n=32), and malignant (n=74) ovarian serous neoplasms. We evaluated the fascin expression, and its relationship with the betacatenin and E-cadherin expressions, as well as the clinicopathologic factors. Results : Fascin expression was detected in the majority of the borderline (100%, 32/32) and malignant tumors (90.5%, 67/74), but it was not seen in the normal ovarian surface epithelial cells and the benign tumors (p<0.001). Fascin expression was significantly correlated with the occurrence of peritoneal metastases in the carcinomas (p=0.043). A significant relationship between the expressions of fascin and betacatenin (p=0.046), as well as E-cadherin (p=0.035) was noted. There was no significant correlation with the tumor grade of carcinoma, the FIGO stage, tumor recurrence, tumor-related death and the survival rate. Conclusions : In ovarian serous neoplasms, the fascin expression may be closely linked with tumor progression and metastasis, and it was associated with the up-regulation of betacatenin and E-cadherin.

Surgery for Primary Pulmonary Liposarcoma / 대한흉부외과학회지

Primary pulmonary liposarcoma is extremely rare disease. It has poor prognosis with early multiple metastases and frequent local recurrences. Surgery is the choice of treatment for liposarcoma. Incomplete resection would result in rapid and aggressive growing of the tumor. We report a case of primary pulmonary liposarcoma which was successfully treated with complete resection without local recurrence and distant metastasis for 10 months.

An Intravenous leiomyoma with cardiac involvement in a patient with uterine leiomyoma / 대한내과학회지

A case of intravenous leiomyomatosis (IVL) invading the vena cava and extending to the right atrium, a rare benign smooth-muscle tumor, is described. Despite their histological benignity, these lesions have a tendency to metastasize and are closely related to the condition called "benign metastasizing leiomyoma" and "intracaval mass and cardiac extension". A 50-year old woman was admitted to the hospital with dyspnea beginning 6 months ago and previous history of hysterectomy due to uterine myoma. Echocardiography revealed severe tricuspid valve insufficiency and a mobile elongated mass which occupied the inferior vena cava and was extending into the right ventricular cavity. Pelvic ultrasonography and pelvic MRI identified suspicious metastasis to both ovaries and peritoneum. She underwent resection of the cardiac tumor, concomitant tricuspid annuloplasty with a closure of the foramen ovale and both salphyngo-oophorectomy with vaginal stump mass biopsy. All of them could be histologically identified as IVL.

Clinical profiles of 10 cases of ovarian malignant mixed mullerian tumor / 대한산부인과학회잡지

Malignant mixed mullerian tumors (MMMT) of the ovary are rare, constituting less than 1% of all primary ovarian tumors. Histologically, tumors include malignant epithelial and sarcomatous elements. MMMT of the ovary is a highly aggressive and rapidly progressive tumor with a poor long-term prognosis. The survival rate is very low inspite of surgery, chemotherapy and radiotherapy. The prognostic factors and optimal treatments for this tumor are still controversial because of its rarity. We experienced ten cases of malignant mixed mullerian tumors of the ovary and report our experiences with a brief review of literature.

Cyclin E, p27 and Mutant p53 do not Predict the Prognosis in AJCC Stage II Colorectal Carcinomas / 대한소화기학회지

BACKGROUND/AIMS: Carcinogenesis is characterized by the abnormal regulation of cell cycle. The abnormal expression of the regulators of cell cycle may be related to the prognosis. Since the clinical significance of the expression of the three proteins in colorectal carcinomas is still controversial, we evaluated the prognostic value of the expression of cyclin E, p27 and mutant p53 in stage II colorectal cancer. METHODS: The expression levels of cyclin E, p27 and mutant p53 proteins in 41 patients with stage II colorectal carcinomas were analyzed by immunohistochemistry. RESULTS: In the univariate analysis, the level of CEA at diagnosis was associated with disease relapse. In the multivariate analysis, the clinicopathological variables such as age, gender, site of primary tumor, tumor size, state of tumor differentiation and preoperative plasma CEA level were not associated with disease relapse. When Kaplan-Meier survival curves were constructed to determine the prognosis, cyclin E, p27 and mutant p53 expressions did not predict poor prognosis. CONCLUSIONS: Our results suggested that the expression of cyclin E, p27 and mutant p53 proteins did not predict the clinical outcome in the stage II colorectal carcinomas.

A Case of Vulvar Carcinoma: Squamous Cell Carcinoma with Sarcomatoid Features / 대한산부인과학회잡지

An extremely rare case of squamous cell carcinoma with sarcomatoid features of the vulva in a 43- year-old woman is reported. Squamous cell carcinoma with sarcomatoid features of the vulva is known as a rapidly growing tumor with poorer clinical outcomes than squamous cell carcinoma. To date only 15 cases of squamous cell carcinoma with sarcomatoid features of the vulva have been reported in the world literature, none in our country. We report a case of a squamous cell carcinoma with sarcomatoid features that we have experienced recently with a brief review of the literature.

Comparative Analysis of Serum Mannose-Binding Lectin in Normal Population and Patients with Different Types of Cancer

BACKGROUND: Mannose-binding lectin (MBL) is a serum protein of innate immunity. Its genetic mutations lead to deficiency of serum MBL and recurrent pyogenic infection in childhood. However, little is known about the frequency of its gene mutations or serum levels in Korean population and patients with cancers. METHODS: We studied the mutational genotypes of MBL exon 1 codon 52, 54, and 57 or serum MBL levels from 102 normal adults and 228 cases of breast, stomach, colon, uterine cervical, and lung cancers by allele-specific PCR and enzyme-linked immunosorbent assay. RESULTS: MBL gene mutations were found in 32 of 102 normal adults (31.4%), and were restricted only to exon 1 codon 54 showing homozygous (n=5, 4.9%) or heterozygous mutations (n=27, 26.5%). Mean and median serum MBL in the patients with cancers were increased (2,647+/-1,742 and 2,915 ng/mL, mean+/-S.D. and median) than those of normal adults (1,906+/-1,359 and 1,758 ng/mL). Serum MBL level was significantly increased in the patients with stomach, uterine cervical, colon, and lung cancers. CONCLUSION: Our results indicate that the frequency and pattern of MBL gene mutations and its serum level is very similar among northeastern Asian populations. In addition, MBL might be involved in an immunologic response against common cancers, although further studies are needed.

Solitary Intraosseous Neurofibroma of the Femur Neck: A Case Report / 대한정형외과학회잡지

Whereas neurofibroma is a fairly common soft tissue tumor, solitary intraosseous neurofibroma is a very rare type of bone tumor, and there relatively few cases have been reported worldwide, which were localized to the maxilla and mandible. We experienced a solitary intraosseous neurofibroma and treated it by curettage and bone graft through trochanter osteotomy of the femur. We report a rare case of solitary intraosseous neurofibroma and provide a review of reported cases.

Fine Needle Aspiration Cytology (FNAC) of Gastrointestinal Stromal Tumor: An Emphasis on Diagnostic Role of FNAC, Cell Block, and Immunohistochemistry

Recently the origin of gastrointestinal stromal tumors (GISTs) is thought be the interstitial cells of Cajal or primitive stem cells. This study was performed to evaluate the roles of fine needle aspiration cytology (FNAC), cell block preparation, and immunohistochemistry in the diagnosis of GISTs. Nine cases of GIST in which FNAC was performed were included in this study. Cytologically, the tumor cells characteristically occurred in closely packed cohesive tissue fragments with high cellular density often in bloody background. The tumor cells often formed fascicles with parallel, side-by-side arrangements of the nuclei. Histologically, GISTs were highly cellular spindle or epithelioid tumor with basophilic appearance. Immunohistochemically, GISTs were c-kit positive in all of nine cases, CD34 positive in seven, focally SMA positive in two, and S-100 and GFAP negative in all. Both histologic and cell block sections showed the same histologic and immunohistochemical features. Cytomorphologically GISTs show a broad morphologic spectrum but rarely a significant nuclear pleomorphism and the assessment of malignant potential is difficult based on cytology alone. However, in the appropriate clinical and radiologic setting, a confident diagnosis of primary or metastatic GIST can be established by FNAC, cell block, and immunohistochemistry.

Fine Needle Aspiration Cytology of Solitary Fibrous Tumor of the Pleura: Report of a case misdiagnosed as denocarcinoma of lung / 대한세포병리학회지

Solitary fibrous tumor of the pleura is rare but should be included in the differential diagnosis of a peripheral pulmonary nodule. Cytologic features of solitary fibrous tumor of the pleura is not familar to the pathologist and may be misdiagnosed as malignancy. We report fine needle aspiration cytologic(FNAC) findings of a case of solitary fibrous tumor misdiagnosed as adenocarcinoma in a 48-year-old woman. The FNAC displayed a mixture of bland-looking spindle cells and clusters of epithelioid cells, which have hyperchromatic nuclei with prominent nucleoli. The helpful finding to distinguish it from other circumscribed benign and malignant lesions is the presence of fibromyxoid matrix admixed with blood vessels and thin collagen fibers. Familiarity with these features is essential to avoid misdiagnosis and overtreatment.

Cytologic Findings of Primary Small Cell Carcinoma of the Urinary Bladder: A case report / 대한세포병리학회지

Primary small cell carcinoma of the urinary bladder is a rare malignant tumor. A more rapidly fatal course may be seen in advanced stages of small cell carcinoma as compared to similar stages of urothelial carcinoma. It is very important to recognize this distinct form of bladder cancer by urinary cytology. The differential diagnosis of small cell carcinoma of the urinary bladder includes metastatic small cell carcinoma, urothelial carcinoma, and primary or secondary malignant lymphoma. This article highlights the urinary cytologic diagnosis of a case of primary small cell carcinoma. A 59-year-old male presented with gross hematuria for five months. Urinary cytology showed high cellularity consisting of tiny monotonous tumor cells in the necrotic background. The tumor cells occurred predominantly singly, but a few in clusters. The cytoplasm was so scanty that only a very narrow rim of it was seen. The nuclei were oval or round and had finely stippled chromatin. Rarely, the nuclei contain visible nucleoli. Frequently cell molding was noted in clusters. Many single cells demonstrated nuclear pyknosis or karyorrhexis. The histologic findings of transurethral resection and partial cystectomy specimen were those of small cell carcinoma. Cytologic distinction may be very difficult but careful attention to clinical features and cellualr details can classify these neoplasms correctly.

Expression of Cytokeratin 7 and 20 in Periampullary Carcinomas

The distinction of carcinomas involving periampullary region is often difficult, even in the surgically resected specimens. To examine the differences in the expressions of cytokeratin (CK) 7 and 20 in the periampullary carcinomas, we performed immunohistochemical studies on surgically resected 20 pancreatic duct adenocarcinomas (PDA), 13 distal bile duct adenocarcinomas (DBA), 10 duodenal adenocarcinomas (DA), and 18 ampulla of Vater adenocarcinomas (AVA). We analyzed the relationships between CK 7/CK 20 immunoprofile, and tumor cell differentiation and tumor size. We interpreted diffuse cytoplasmic reactivity found in > or =5% of tumor cells as positive. In the majority of cases, PDA were CK 7 /20 (95%), DBA CK 7 /20 (92.3%), DA either CK 7 /20 (40%) or CK 7 /20 (30%), AVA either CK 7 /20 (50%) or CK 7 /20 (44.4%). In DA, there was an increased CK 20 negativity in less differentiated (moderately or poorly differentiated) cases (p or =5 cm) tumor size (p=0.049). In AVA, there was a tendency of increased CK 20 positivity in less differentiated cases (p=0.10). In conclusion, the CK 7/CK 20 immunophenotype is useful in the differentiation of periampullary carcinomas: the CK 7 /CK 20 immunophenotype strongly suggests DA or AVA, whereas the CK 7 /CK 20 immunophenotype suggests PDA or DBA.