The Risk Factors Influencing between the Early and Late Recurrence in Systemic Recurrent Breast Cancer / 한국유방암학회지

PURPOSE: Patients with recurrent breast cancer usually die of their disease, even after radical surgery and adjuvant therapies which could reduce the odds of dying. Many studies analyzed and compared patients who died of recurrent disease with those that died without recurrent disease. However, less attention has been paid to evaluating factors associated with the timing of recurrence. Thus, the objective of this study is to investigate the correlation between various factors and the timing of recurrence. METHODS: We retrospectively reviewed the data of 95 recurrent breast cancer patients who underwent curative surgery to determine the prognostic factors such as menopausal status, operation method, stage, nodal status, histologic grade, nuclear grade, extensive intraductal carcinoma component, hormone receptor, p53, c-erbB-2, Ki-67, and molecular subtype. We had attempted to compare the recurrent patients within 2 years after operation and adjuvant chemotherapies as the early recurrence with those over 2 years as the late recurrence. RESULTS: Histologic grade (p=0.005), nuclear grade (p<0.001), p53 (p=0.022), and Ki-67 (p<0.001) were significant different factors that influenced the systemic recurrence between early recurrence and late recurrence. In stage I/II, histologic grade (p=0.001), nuclear grade (p<0.001), and Ki-67 (p=0.005) were significant factors that influenced the systemic early recurrence. In stage III, nuclear grade (p=0.024), and Ki-67 (p=0.001) were significant factors that influenced the systemic early recurrence. But subtypes (p=0.189, p=0.132, p=0.593, p=0.083) are not associated with the timing of recur rence. CONCLUSION: In systemic recurrent breast cancer patients, the risk factors such as histologic grade, nuclear grade, p53 and Ki-67 are also associated with the timing of recurrence. We sug gest that these patients should be proper treated and be closely followed up.

Type and Incidence of Soft Tissue Sarcomas in Korea: 2001-2007

BACKGROUND: The Korean Bone and Soft Tissue Pathology Study Group of the Korean Society of Pathologists conducted a nationwide retrospective analysis of soft tissue sarcoma (STS) to provide the clinicopathologic characteristics of STS within the population of the Republic of Korea. METHODS: The cases of STS were collected during a 7-year period (2001-2007) from 19 institutes in Korea. All cases were classified according to the histologic criteria proposed by the World Health Organization. Clinicopathologic data were reviewed. RESULTS: Data from 722 patients (median age, 50 years) were collected. Data showed a slight male predominance. The most frequent types of STS in decreasing order were liposarcoma, malignant fibrous histiocytoma, leiomyosarcoma, and synovial sarcoma. STS occurred throughout the body, although approximately half (47.8%) were located in the extremities. The majority of STS was histologically classified as high grade with a large tumor size (>5 cm). The overall survival rate for the patients was 76.3% (median follow-up time, 26 months; range, 1 to 89 months). Histologic grade, tumor size, American Joint Committee on Cancer stage, tumor site, and resection status were prognostic. Significant independent adverse prognostic factors were large tumor size (>5 cm) and tumor site other than extremities. CONCLUSIONS: We reported the distribution and characteristics of STS in the Republic of Korea.

The Difference between Clinical and Pathophysiologic Recovery according to Recovery Periods in Experimental Maxillary Sinusitis of Rabbit / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study was designed to investigate the difference between clinical and pathophysiologic recovery by comparing the recovery periods in the rabbit sinusitis model. MATERIALS AND METHOD: A synthetic sponge was inserted into the right-side nasal cavities of 15 rabbits. After 2 weeks, the maxillary sinusitis was induced and confirmed by computed tomography (CT) scan. The opacification in CT scan was graded, and the mucosa was harvested from the maxillary sinus. Ciliary beat frequency (CBF) was measured for evaluating mucosal function. Light microscopic, scanning and transmission electron microscopic (SEM & TEM) examinations were performed. Histopathologic findings in microscopic examinations were scored in a semiquantitative measure. Each examination was performed at the time of re-opening of maxillary sinus ostium, 4 weeks and 8 weeks after re-opening of maxillary sinus ostium. RESULTS: The sinus opacification in CT scan and ciliary regeneration in SEM showed significant improvement 8 weeks after re-opening of maxillary sinus ostium. But CBF, tissue inflammation score and ciliary wave disorder were not improved significantly 8 weeks after re-opening of maxillary sinus ostium. CONCLUSION: Clinical, functional and histopathologic recoveries from sinusitis require different periods of time. Incomplete functional and histopathologic recoveries can be the cause of relapse or recurrence of sinusitis. Therefore, close follow-up will be necessary after clinical resolution of sinusitis.

A case of ectopic parathyroid carcinoma presenting with renal failure and anemia / 대한내과학회지

Parathyroid carcinoma is an uncommon cause of PTH-related hypercalcemia with a reported incidence of 0.4% to 5% of all cases of primary hyperparathyroidism. Even though the clinical manifestations of hyperparathyroidism are more severe in patients with parathyroid carcinoma than in those with parathyroid adenoma, it is difficult to differentiate carcinoma from adenoma preoperatively. Parathyroid carcinomas are usually larger and firmer than parathyroid adenomas and patients with parathyroid carcinoma have a higher incidence of renal dysfunction, bone disease and gastrointestinal symptoms. Anemia is an uncommon clinical feature of parathyroid carcinoma. There have been no prior cases of ectopic parathyroid carcinomas reported to date. In this article, we report the case of a 26-year-old man who developed severe anemia and acute renal failure due to an ectopic parathyroid tumor and was diagnosed with parathyroid carcinoma postoperatively. His serum calcium levels returned to normal and the anemia resolved postoperatively.

Cytological Features of Low Grade Fibromyxoid Sarcoma : Report of a Case with a Review of the Literature / 대한세포병리학회지

Low-grade fibromyxoid sarcoma (LGFMS) is a rare soft tissue tumor. There have been only a few prior fine-needle aspiration (FNA) cytological reports. Recognition of this tumor is important because of its potential for metastasis despite its indolent nature and its deceptively bland cytologic appearance. A 60-year-old male presented with a slowly growing mass in the left calf detected 10 years ago. The patient underwent surgical excision. FNA cytology was performed directly on the mass. The smears showed low cellularity composed of hypercellular tissue fragments, hypocellular loose aggregates, and stripped nuclei. The cytoplasm was seen as either collagenous material or very thin fibrillary collagen strands. Tumor cells had spindle, ovoid, or irregular nuclei, fine chromatin, and small nucleoli. Focally slight degree of nuclear pleomorphism is noted. There were no mitotic figures. Blood vessels were frequently seen. Immunocytochemically, tumor cells were negative for S-100 protein, desmin, smooth muscle actin, and CD34. The diagnosis of LGFMS is rarely possible by cytology alone; however, LGFMS should be included in the differential diagnosis of spindle-cell tumors consisting of hypercellular and hypocellular components with some capillary-sized vessels arising in the deep soft tissue of the lower extremities, particularly the thigh. The immunocytochemical findings are of help in the differential diagnosis.

A Case of Sarcoidosis with Cavitation / 결핵및호흡기질환

Sarcoidosis is a rare systemic disorder with unknown cause that is characterized pathologically by non-caseating granuloma. The lung and mediastinal lymph nodes are almost always involved, and most patients experience acute or insidious respiratory symptom. Because sarcoidosis is an interstitial lung disorder involving the alveoli and bronchioles, the most common radiological finding is a reticularnodular lesion with lymphatic distribution. However, cavitation is quite rare. Sarcoidosis is also a major cause of hepatic granuloma in Western countries, accounting for 12% to 30% of cases. In most patients, the course of hepatic sarcoidosis is benign. However, chronic intrahepatic cholestasis or portal hypertension may develop in some patients. We report a case of sarcoidosis with cavitation and hepatic involvement.

A Case of Low-grade Papillary Adenocarcinoma of the Nasopharynx / 대한이비인후과학회지

Low-grade nasopharyngeal papillary adenocarcinoma is a very rare nasopharyngeal, surface epithelium-derived malignant tumor characterized with adenocarcinomatous differentiation and an indolent biological behavior. We report a case of 36-year old female presenting a papillary adenocarcinoma of the nasopharynx. The tumor was of a 0.5 cm sized exophytic mass located on the nasopharyngeal mucosa near the posterior choanal septum. Because of the histologic similarities with thyroid papillary carcinoma, it was necessary to rule out metastasis from thyroid by immunohistochemical staining for thyroglobulin. Surgical excision was done via transpalatal approach; mass was removed with a clear resection margin.

Urine Cytology of Prostatic Adenocarcinoma: A Case Report / 대한세포병리학회지

Prostatic adenocarcinoma cells can be detected in urine cytology specimens when the tumor extends to the bladder mucosa. We report a case of prostatic adenocarcinoma diagnosed by urine cytology. A 70-year-old man presented with urinary frequency and low back pain. On rectal examination, a nodular mass was palpated in the left side of prostate. Bone scan revealed multifocal hot lesions suggesting metastasis. Urine cytology revealed hypocellular smear on clean or bloody background. Tumor cells were mainly arranged in syncytial or papillary clusters which occasionally contained foci of luminal formation. The cytoplasm of tumor cells was finely granular. The nuclei of tumor cells revealed evenly distributed fine chromatin and large prominent nucleoli without nuclear pleomorphism. In needle biopsy specimen of prostate, tumor cells were detected in entire prostatic tissue with extension to pericapsular soft tissue. The tumor cells infiltrated individually or in a cord-like fashion with foci of cribriform pattern. Inconspicuous nuclear pleomorphism and prominent nucleoli were also noted.

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.

Striatocapsular Infarct and Aphasia

BACKGROUND: Determining the mechanism for aphasia following a subcortical infarct involving the striatum and internal capsule has been controversial. The aim of this study was to determine the underlying mechanism, which might clarify the relationship between the severity of aphasia and the cortical hypoperfusion in a striatocapsular infarct. METHODS: We included 33 patients with striatocapsular infarcts in the dominant hemisphere on precontrast CT/MRI. A MR angiography (MRA) was done in all patients. Contrast enhanced MRI and/or triphasic perfusion CT (TPCT) were performed in 26 patients to identify slow collateral blood flows. The regional cerebral blood flow was evaluated in 14 out of 33 patients by perfusion SPECT. The index of aphasia severity was the aphasia quotient, measured by the Korean version-Western Aphasia Battery. RESULTS: Twenty-five of 33 patients (75.7%) showed aphasia with different degrees of severity. The four aphasic subgroups were mild (n=9), mild-to-moderate (n=8), moderate-to-severe (n=3), and severe (n=3) groups. Six patients with moderate-to-severe or severe degree of aphasia showed larger infarcts, occlusions of the middle cerebral artery (MCA) stem or internal carotid artery (ICA) on MRA, and abnormal delayed cortical vascular enhancements on MRI and/or TPCT. The severity of aphasia correlated strongly with the degree of perisylvian cortical hypoperfusion on SPECT. Focal perisylvian cortical atrophy on follow-up MRI was found in two patients with greater than moderate-to-severe aphasia. CONCLUSIONS: Aphasia of greater than moderate-to-severe degree following a striato-capsular infarct may be explained by selective neuronal loss of the perisylvian cortex due to the occlusion of the MCA stem or ICA and insufficient collateral blood flow. (J Korean Neurol Assoc 19(1):10~18, 2001

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.

Fine Needle Aspiration Cytology of Primary Malignant Lymphoma of the Thyroid Gland: A Case Report / 대한세포병리학회지

Primary malignant lymphoma of the thyroid gland is uncommon malignancies. Its fine needle aspiration cytology (FNAC) findings are rarely described in the literature. This article highlights the FNAC diagnosis of primary malignant lymphoma of the thyroid gland. A 70-year-old female presented with a rapidly enlarging thyroid mass of five months' duration. FNAC smears showed low cellularity consisting of predominantly atypical enlarged lymphoid cells admixed with a few small lymphocytes, plasma cells, and oncocytic cells. Some disrupted lymphoid cells were also present. The tumor cells infiltrated into the thyroid follicular epithelium forming lymphoepithelial lesion. The cytologic appearance showed a diffuse mixture of cell types with only a few small, mature lymphocytes and many enlarged lymphoid cells. The enlarged lymphoid cells were atypical and pleomorphic with nuclear clefting and irregularities. Grossly, the left lobe of the thyroid was nearly replaced by a diffuse firm to soft solid mass with smooth tan fish-flesh homogeneous cut surface. Histological diagnosis was diffuse large B-cell lymphoma with areas of marginal zone B-cell lymphoma of MALT type.

Fine Needle Aspiration Cytology of Metastatic Epithelial-Myoepithelial Carcinoma of the Scalp: A Case Report / 대한세포병리학회지

Epithelial-myoepithelial carcinoma is an uncommon, low grade malignant epithelial neoplasm and metastasis is exceedingly rare. This article highlights the fine needle aspiration cytology(FNAC) of a case of metastatic epithelial-myoepithelial carcinoma of the scalp. A 51-year-old female presented with the left parietotemporal scalp mass two months after the left parotidectomy for epithelial-myoepithelial carcinoma. FNAC from the scalp mass showed a biphasic population of ductal epithelial and myoepithelial origin. These epithelial aggregates were numerous and formed a distinct three dimensional architecture in the background of numerous naked nuclei. The three dimensional architectures were predominantly composed of tightly cohesive eosinophilic ductular epithelial cells which tended to aggregate, overlap, and form tubules. Clear myoepithelial cells in three dimensional tissue fragment were inapparent and a few were attached to the periphery of the fragments. A few myoepithelial cells with clear abundant vaculoated cytoplasm were found in the foamy background. The cytological diagnosis was metastatic epithelial-myoepithelial carcinoma. The histologic findings of the scalp mass were those of typical epithelial-myoepithelial carcinoma. Cytologic distinction of epithelial-myoepithleial carcinoma, pleomorphic adenoma, and adenoid cystic carcinoma may be very difficult but careful attention to clinical features and cellualr details can classify these neoplasms correctly.

Sarcomatoid Transitional Cell Carcinoma of the Renal Pelvis A report of two cases

Sarcomatoid carcinomas are malignant epithelial neoplasms in which the tumor cells assume a partial or complete spindle cell pattern of growth, leading to the erroneous classification of some true carcinomas as sarcomas. These spindle cells are malignant and manifest various amount of both vimentin and cytokeratin. Positive reaction of some of the spindle cells for cytokeratin antibodies is confirmatory. Clinical features do not differ significantly from those of patients with high-grade transitional cell carcinoma. So far, 13 cases of sarcomatoid transitional cell carcinoma of the renal pelvis have been reported in English and Korean literature. In this report, we describe clinicopathologic features of recently observed two cases of sarcomatoid transitional cell carcinoma of the renal pelvis and summarize the pathologic findings of previously reported cases with review of the literature.

Primary Pulmonary Hodgkin's Lymphoma: A case report

Primary pulmonary Hodgkin's lymphoma is a rare but distinct entity to be distinguished from nodal Hodgkin's lymphoma and from lymphomas involving lung secondarily. This lymphoma affects women more frequently than men, and typically involves superior portions of the lung. This case is reported to illustrate the clinical, radiographic and anatomic characteristics of the primary pulmonary Hodgkin's lymphoma. A 34-year-old woman presented for the evaluation of hemoptysis. A chest CT revealed a large poorly defined mass in the medial aspect of the right upper lobe, extending to the right mediastinum and trachea. The microscopic examination of the biopsied lesion revealed fibroblastic stroma infiltrated by a mixture of lymphocytes, histiocytes, and eosinophils. The clinical impression was inflammatory pseudotumor, presumably due to slightly favorable response to corticosteroid therapy. Two months later the patient's symptoms worsened despite the steroid therapy and a lobectomy was done. The specimen showed a soft to firm, pale yellow, ill defined mass, 10.0 8.0 cm, involving the visceral pleura. A few satellite nodules around the main mass were noted. The histologic findings were consistent with Hodgkin's lymphoma, nodular sclerosis type.

Mucous Gland Adenoma of the Bronchus; Light Microscopic and Ultrastructural Features

We present a case of mucous gland adenoma arising from the main bronchus of the lower lobe of the left lung in terms of clinicopathologic, immunohistochemical, and ultrastructural aspects as well as review of related literatures. The patient, a 31-year-old female, was admitted to Catholic University Medical College Hospital with complaints of coughing and purulent sputum for about seven years. The chest CT showed a severely calcified tumor in the left lower lobe of the lung. Grossly, the calcified tumor arising from the main bronchus protruded into the lumen and showed bronchiectasis of the lower lobe and atelectasis of the upper lobe of the lung. The tumor was pale brown-gray and sharply circumscribed and showed some small cystic spaces filled with mucoid material. Microscopically, most of the tumor showed dystrophic calcification. The growth pattern of the tumor is composed of cysts, tubules, and glands lined by cytologically bland columnar, cuboidal, or flattened mucus secreting cells. Electron micrograph of tumor cells showed some round or oval mucous granules measuring 0.5-1.8 micrometer.

Expression of p53 and nm23 Proteins in Non-Small Cell Lung Cancer

To elucidate the role of p53 and nm23 in the development, progression, and metastasis of non-small cell lung cancer, we studied 91 paraffin sections of the primary non-small-cell lung cancers and the 34 paraffin sections of their metastatic lymph nodes using the immunohistochemical method. The results are as follows: 1) The incidence of p53 protein expression was positively correlated with the staging of lung cancers (p<0.025). 2) The incidence of p53 protein expression was higher in the lung cancers with lymph node metastasis than in those without lymph node metastasis (p=0.009). 3) The incidence of nm23 protein expression was lower in the adenocacinomas than in the squamous cell carcinomas (p=0.032). 4) The incidence of nm23 protein expression was lower in the lung cancers with lymph node metastasis than in those without lymph node metastasis (p=0.026). The expression of nm23 protein between the primary lung cancers and corresponding metastatic lymph nodes showed positive correlation (Kendall's Tau-b correlation coefficient=0.47140, p=0.0068). 5) The expression of p53 was not correlated with the expression of nm23 protein (Kendall's Tau-b correlation coefficient=0.11387, p=0.2800). The above results suggest that an overexpression of p53 protein and a downregulation of nm23 protein are associated with tumor progression and metastasis in non-small-cell lung cancer.

Arteriovenous Malformation of the Uterus: A case report

Arteriovenous malformation of the uterus is rarely encountered. It is potentially lethal because of profuse, uncontrollable bleeding at the time of diagnostic dilatation and curettage. To our knowledge, only 38 cases of localized uterine arteriovenous malformation have been reported in English and Korean literature. Recently we experienced a case of uterine arteriovenous malformation in a 28-year-old multiparous woman. Under the clinical impression of uterine tumors or arteriovenous malformation, a total hysterectomy was done. Gross examination demonstrated a vascular nature of the mass in the posterior wall of the fundus. Microscopically, there was an ill-defined mass composed of numerous irregular, anastomosing large vessels with various diameters.

Cytologic Features of Renal Cell Carcinoma: Clear Cell, Granular Cell and Oncocytoma / 대한세포병리학회지

It is well known that fine needle aspiration biopsy(FNAB) is very useful and has a high accuracy rate in the diagnosis of renal neoplasms. Although there is some indecision to perform the FNAB for a rare possibility of tumor seeding along the biopsy needle tract, it tends to be used increasingly. As in the cytologic diagnosis of metastatic lesion through out the body, renal cell carcinoma should nearly always be considered in the differential diagnosis, the precise understainding of cytologic features of renal cell carcinoma with various cell types and architectural patterns is necessarily required. In this report, we present three cases of primary renal cell tumors, two of renal cell carcinomas and one of oncocytoma, preponderantly emphasizing the cytologic differential points in the FNAB specimen.

Cytologic Findings of Polyomavirus Infection in the Urine: A Case Report / 대한세포병리학회지

The principal significance of the urothelial changes caused by polyomavirus activation is in an erroneous diagnosis of urothelial cancer; however, the clue to their benign nature is the smooth structureless nuclear configuration and the relative paucity of affected cells. Though virologic studies and electron microscopy are usually needed to firmly establish the diagnosis, cytology is the most readily available and rapid means of establishing a presumptive diagnosis of human polyomavirus infection. A urine specimen of a 24-year-old man with hemorrhagic cystitis beginning two months after bone marrow transplantation for acute myeloblastic leukemia(M2) was submitted for cytologic evaluation. Cytologic findings revealed a few inclusion-bearing epithelial cells intermingled with erythrocytes, neutrophils, lymphocytes, and macrophages. Most of the inclusion-bearing -cells had large, round to ovoid nuclei almost completely filed with homogeneous dark, basophilic inclusion. The chromatin was clumped along the periphery and the cytoplasm was mostly degenerated. The other cells exhibited irregular inclusions attached to the nuclear membrane surrounded by an indistinct halo. These findings were consistent with polyomavirus infection.