Pulmonary Oncocytic Carcinoid: 1 Case report / 대한흉부외과학회지

Oncocytic carcinoid is a very rare tumor and only few cases have been reported in the literatures. We have experienced one case of pulmonary oncocytic carcinoid occuring at the left upper lobe. The patient was a 56 years old female with no spedific symptoms. Chest Computed tomography showed about 3X3.5cm sized homogenous mass at the left upper lobe. After the evaluation, surgical resection was performed. Gross finding showed a well-defined and well-encapsulated mass of 3X4cm in size, and yellowish-gray in color. Pathohistologically, the tumor was abundant granular eosinophilic cytoplasm. Immunohistochemical stain showed positive cytokeratin and was focal positive reaction in EMA and chromograin. It was confirmed as pulmonary oncocytic carcinoid. Postoperative course was uneventful and the patient has been followed up with no problem.

Intrapulmonary and gastric teratoma : report of two cases

The lung and stomach are very unusual sites for teratoma. The histologic findings of intrapulmonary and gastric teratomas are not different from those arising in usual sites, such as the ovary or testis. However, preoperative diagnosis is sometimes difficult to make partly because of unusual location. We report here two cases of teratoma, one intrapulmonary teratoma and the other gastric. The intrapulmonary teratoma in our study had an endobronchial tumor growth, which rules out mediastinal teratoma. Meanwhile gastric teratomas usually present as a submucosal tumor and most cases are reported in infancy and childhood. Gastric teratoma in this study occurred in a 27-year-old man. To the best of our knowledge, this case of intrapulmonary teratoma is the eighth and the gastric teratoma is the first to be reported in Korea.

A Case of Somatostatinoma which Manifested as Insulinoma when Metastasized to the Liver / 대한내분비학회지

We report a case of somatostatinoma, which manifested as insulinoma after liver metastasis. A 74-year-old man suffered from diabetes mellitus and jaundice. The abdominal CT scan of this patient showed a mass in the pancreas head, which obstructed biliary duct. He underwent Whipples procedure. Immunohistochemical staining of postoperative specimen disclosed that this tumor was strongly positive for somatostatin. After 4 months, follow up CT scan showed multiple metastatic lesions in the liver. We performed transarterial chemoinfusion two times, but the response was disappointing. After 2 months, he suffered from altered mentality, which was relieved by intake of sugar. Biochemical laboratory findings and immunohistochemical staining of liver biopsy disclosed that the metastatic lesion in this patient was insulinoma. We performed embolization of hepatic artery with gelform. The biochemical response was dramatic, but he died of septic shock, which was caused by gas forming liver abscess. In summary, we report a case of somatostatinoma which manifested as insulinoma after metastasis to the liver.

Flow Cytometric DNA Analysis in Papillary Carcinoma of Thyroid Gland: comparison with Ki-67 immunohistochemical staining

Nuclear DNA content was measured using a flow cytometric method to analyze 36 paraffin- embedded and 7 fresh tissues of 43 papillary carcinomas of thyroid gland. DNA aneuploidy was found in 3 cases(6.9%) and diploidy in 40 cases(93.1%). But there were no suggestive findings in clinical history, and cytological and morphological features for aneuploidy. In 40 diploid cases, S-phase fraction(SPF) were analyzed with regard to sex, age, tumor size, presence or absence of capsular invasion, lymph node involvement and ground glass nuclei. Among the multiple factors, only the tumor size, especially the larger sized-group(above 2cm in tumor diameter) was found to have a statistically significant higher SPF than the smaller sized-group (p<0.05). And high SPF groups relatively well corresponded to the high risk group. Thirty nine cases of papillary carcinoma have also been evaluated for proliferative activity with Ki-67 monoclonal antibody. The average Ki-67 labeling index was 0.36% in total cases, and that of the aneuploid cases was 0.73%, which was higher than that of the diploid cases(0.33%). So. We think that the low aneuploid rate and low Ki-67 labeling index relatively well represent the usual good clinical course of this tumor and the high SPF is a suggestive finding for a high risk group.

Histopathological Differences between Silicone Granuloma and Paraffinoma

During the past two decades, silicone (polydimethylsiloxane) has become one of the most extensively applied biomaterials. Although pure silicone is relatively inert and usually causes only minimal tissue reactions, it has been reported to evoke a definite foreign body reaction. We studied five cases of silicone-induced granulomas in various sites; two in the breast, one in the breast and axillary lymph nodes, one in the subcutis of the abdomen, back and extremities and one in the eyeball, to illustrate the salient histopathologic features of reactions to silicone with particular emphasis to its differences from paraffin granuloma. For this, 17 paraffinomas were also studied. Tissue reaction to silicone liquid and gel was characterized by numerous round to oval empty cystic vacuoles, mild to moderate fat necrosis, foreign body reaction, a variable degree of mononuclear inflammatory cell infiltration and mild focal fibrosis. The cystic spaces were relatively uniform and showed a snow-man like appearance. In contrast to the silicone granulomas, the paraffinomas, also refered to as sclerosing lipogranulomas showed diffuse sclerosis and frequent calcification around the cystic vacuoles. The cystic spaces in paraffinomas were swiss cheese-like configuration, and the content of the cystic spaces was dirty and frequently calcified. However, there were certain similarities between these two types of granulomas particularly in the early phases of the reaction, therefore, the history of silicone injection or implant, is sometimes critical to the diagnosis of silicone granuloma. Despite great technologic advances in the manufacturing of prostheses and medical equipment, droplets and/or particles of silicone still escape into the body tissues in a variety of ways; therefores, the pathologist should always wonder whether the histologic reaction observed is due to silicone or to some other foreign material including paraffin.

Fine Needle Aspiration Cytology of Metastatic Cell Carcinoma of Lymph Nodes: Comparison to Non-Hodgkin's Lymphoma on 5 Cases / 대한세포병리학회지

Small cell carcinoma of the lung is characterized by cells with finely stippled chromatin and scanty cytoplasm as well as a particularly aggressive clinical course and favorable response to the chemotherapy. Recently percutaneous fine needle aspiration(FNA) biopsy has become both widely established and highly respected for the diagnosis of lung cancer. However metastatic small cell carcinoma of lymph node should be cytologically differentiated from the small round cell tumor of particular sites, especially malignant lymphoma, because small cell carcinoma of classic oat cell type may simulate small cell non-Hodgkin's lymphoma. We report five cases of metastatic small cell carcinoma of intermediate cell type diagnosed by FNA of the enlarged lymph nodes of the neck and axilla. The cytologic smears contained diffuse small neoplastic cells larger than lymphocytes with dense, pyknotic nuclei and extremely scanty cytoplasm. Apparently viable large tumor cells have vesicular nuclei with granular, sometimes very coarse chromatin. The characteristic cytologic features of small cell carcinoma as compared to malignant lymphoma were as follows.: 1) small cells with dense pyknotic nuclei are evenly distributed in the background of apparently viable larger tumor cells, admixed with mature lymphocytes and phagocytic macrophages. 2) small loose aggregates of cells with nuclear molding are indicative of small cell carcinoma rather than non-Hodgkin's lymphoma. 3) the cytoplasmic and nuclear fragments of tumor necrosis are more dominant in the smears of small cell carcinoma. 4) nuclear membrane and nucleoli are generally indistinct in small cell carcinoma due to condensation of chromatin.

Cytologic Analysis of Metastatic Malignant Tumor in Pleural and Ascitic Fluid / 대한세포병리학회지

Cytodiagnosis of pleural and ascitic fluid is a commonly performed laboratory examination. Especially, positivity for malignant cells in effusion cytology is very effective and also presents the first sign of malignancy in unknown primary site of the tumor. We examined each 34 cases of pleural and ascitic fluid cytologic specimen diagnosed as metastatic tumor, which was selected among 964 pleural fluid cytology cases and 662 ascitic fluid cytology cases from September 1989 to June 1995. Among the ascitic fluid cytology specimens examined, 34 specimens were positive in 29 patients. The most common primary neoplasms were carcinomas of ovary (32%), stomach (32%), colon (6%), breast (3%), pancreas (3%), and lung (3%) and lymphoreticular neoplasms (3%). The metastatic tumor was predominantly adenocarcinoma type in both pleural (82%) and ascitic (91%) fluid. The study of metastatic adenocarcinoma in effusion from lung, ovary, and stomach was undertaken to find distinctive features for the identification of the primary site. The smears of metastatic pulmonary adenocarcinoma had a tendency to show high grade pleomorphism and many large tight cell clusters, whereas that of the ovarian adenocarcinoma showed low grade pleomorphism with abundant intracytoplasmic vacuoles in relatively clear background. That of the stomach revealed the intermediate features.

Urinary Cytologic Findings of Transitional Cell Carcinoma: Analysis of 83 Cases / 대한세포병리학회지

Urinary cytology has become an essential element in the diagnosis and management of transitional cell carcinoma(TCC) of the urinary tract. It has the advantage of being noninvasive, inexpensive, and easily accessible. Besides that it can even detect malignancy when unsuspected at cystoscopy. We report a retrospective review of urine cytology in the diagnosis of 83 TCC cases that underwent 295 cytologic evaluation. All patients had biopsy-proven TCC of the bladder, ureter and renal pelvis. The overall incidence of the positive cytology cases was 66.2%. To define the cytologic features of tumor cells, we tried to use three cytologic gradings such as "grade 1", "grade 2", and "grade 3" according to the cytologic degree of anaplastic neoplastic cells. These cytologic gades of TCC were relatively well correlated with the histologic grade and tumor invasiveness. This result suggests that the recognition of characteristic cellular features of TCC can suspect the histologic grade and tumor stage. The false negative TCC cases were 78.9%. They showed severe inflammatory or bloody background and a few neoplastic cells. Therefore, a cautious approach for accurate interpretation, personal experience, and proper fixation and processing could expand the role of urinary cytology.

Fine Needle Aspiration Cytology of Kimura's Lymphadenitis with Characteristic Warthin-Finkeldey Type Polykaryocytes: A Case Report / 대한세포병리학회지

Kimura's disease is a chronic inflammatory disorder of unknown etiology, presenting usually as a painless subcutaneous swelling in the head and neck region or in the lymph nodes. We experienced a case of Kimura's lymphadenitis with characteristic Warthin-Finkeldey type polykaryocytes by fine needle aspiration cytology. The patient was a 10 - year old male, with two enlarged lymph nodes in the postauricular area. Fine needle aspiration cytology from the lymph nodes disclosed hypercellular smears with some scattered eosinophils and polykaryocytes in a polymorphous lymphoid background. There were also fragmented vessel walls and activated endothelial cell clusters in the slightly necrotic background. The Warthin-Finkeldey type polykaryocytes had three to thirty nuclei and prominent nucleoli with ill defined cytoplasmic borders. Their nuclei were arranged in grapevine or ring shaped clusters. As these polykaryocytes could also be found in lymph nodes and extranodal tissues of both reactive and neoplastic lymphoid disorders, polykaryocytes themselves are clinically nonspecific. However, the morphologic features of the Warthin-Finkeldey type giant cells are quite different from the foreign body type or Langhans' type giant cells. When the characteristic cytologic features of Kimura's disease such as significant number of eosinophils in a background of lymphoid cells asd proliferation of vessels and endothelial cells are also observed in the smear, it is possible to suggest this diagnosis in the appropriate clinical setting.

Splenic lymphoid change in abdominal neoplasmic patients: analysis of 121 cases

Because the spleen is likely to play a specific role in immunity, we have tried to observe the influence of the abdominal neoplasms on splenic lymphoid tissue as well as the distribution and localization of immunoregulatory cells with a special attention to the marginal zone, using splenectomy specimens in the various kinds of 121 abdominal neoplasm patients. As a control group, twenty-six splenectomy specimens from patients with traumatic rupture were used. In splenic size and weight, there was a statistically meaningful increase in the patients with abdominal neoplasms. Among those patients, the evolving activated immune reaction (EVA) was 60.2%, the early activated immune-reaction (EAA) 39.0%, the mixed evolving activated and granulomatous reaction (MIX) 0.8%, unlike EVA 30.8%, EAA 69.2%, and MIX 0% in the normal control group. The reason for this change may be explained by activated lymphoid tissue in the form of EVA type. In conclusion, the splenic lymphoid tissue in the various kinds of abdominal neoplasms, mostly malignant, revealed the chronic immune activated state characterized by the increased number of prominent germinal centers and distinct marginal zones, the latter of which revealed the positive reaction for L26, IgM and IgG, and negative for IgD, as well as showing increased natural killer and dentritic reticulum cells identified by Leu7 and S-100 protein respectively. Therefore, we could at least find the significance of the immunologic role of the spleen in the case of abdominal neoplasms, mostly from malignancy.

Fine Needle Aspiration Cytologic Findings of Kikuchi's Lymphadenitis: Analysis of 30 cases / 대한세포병리학회지

Thirty cases of kikuchi's lymphadenitis, diagnosed by fine needle aspiration cytology, were reviewed to determine the main cytologic features helpful in reaching a diagnosis. The patients(mean age 26.6 years. male: female=1:3.8) presented with lymphadenopathy(cervical 24, submandibular 3, and axillary 1) with or without fever and local tenderness. Excisional biopsy was done for confirmation in 5 cases and the remaining 25 cases showed the similar cytologic and clinical features. In the aspiration smears of all cases. there was a heterogenous cellular mixture including frequent extracellular karyorrhectic nuclear debris, phagocytic histiocytes, plasmacy toid monocytes, and a variable number of polymorphous lymphocytes such as immunoblasts. activated large lymphocytes, and small mature lymphocytes, The characteristic cytologic features of kikuchi's lymphadenitis were the following: (1) frequent extracelluar karyorrhectic nuclear debris in the background: (2) phagocytic histiocytes with eccentrically placed crescentic nuclei and abundant pale cytoplasm containing phagocytized karyorrhectic debris: (3) plasmacytoid monocytes, which were medium-sized cells with eccentrically placed round nuclei and amphophilic cytoplasm: (4) no neutrophilic background.

Prenatal ultrasonic detection of endocardial cushion defect in 1 case / 대한산부인과학회잡지

No abstract available.

A Familial Nemaline Myopathy

Nemaline myopathy is a rare congenital m opathy, characterized by nonprogressive or slowely progressive muscle weakness associated with rod-like structures in muscle fibers and characteristic dysmorphic features. We report the first farnilial nemaline myopathy in two generations of the same family, confirmed by muscle biospy in an 11-year-old boy and his mother. The patients had hypotonia and slowly progressive muscle weakness of the four limbs associated with characteristic facial dysmorphism and skeletal deformities. Light and electron microscopic study of a muscle biopsy showed numerous nemaline rods in both patients.

Histopathologic changes of the spleen in suckling rats inoculated with Hantaan virus

The purpose of this study is to delineate the histopathologic findings of the spleen after Hantaan viral inoculation, which is the largest lymphoid organ in rats, and to identify the viral location by anti-Hantaan virus (HTNV) monoclonal antibody. All the sixty one suckling rats of less than twenty four hours of age were used. Except twenty one rats of control group, twenty-five rats inoculated intracerebrally for the early change and fifteen suckling rats inoculated intramuscularly for the late change were uniformly susceptible to lethal infection with the ROK 84-105-1 strain of seed HTNV. The characteristic histopathologic findings were; appearance of macrophages below the splenic capsule on the 3rd day, small lymphocytes around the periarteriolar sheath on the 5th day increasing in numbers on the 7th day, and a markedly expanded marginal zone with some immunoblasts and plasma cells as well as decreased extramedullary hematopoiesis on the 9th and 14th days. Time of onset of histopathologic changes in spleen thickness, appearance of medium and large lymphocytes and degree of extramedullary hematopoiesis were influenced by inoculation route, whereas expansion of the marginal zone was affected by postnatal age.

Clinicopathologic and immunophenotypic study of non-Hodgkin's lymphoma in Korea

This study sponsored by the Lymphoreticular Study Group of the Korean Society of Pathologists was carried out to provide nationwide data about the histopathologic-immunophenotypic features of malignant lymphomas in Korea. Two hundred and ninety Non-Hodgkin's lymphoma (NHL) among 312 malignant lymphomas collected from three representative areas in Korea were histologically reclassified. Two hundred and fifty three cases were immunohistochemically studied. T-cell lymphoma comprised 35.2% of NHL in this study and showed a quite comparable incidence to that of Japan and China, but it was much higher than in Western countries. A very low prevalence rate of the follicular variety (4.0%) and a higher propensity of primary extranodal involvement (60%) are additional characteristics of NHL in Korea. The most common histologic subtype of B cell lymphoma was diffuse large cell type, whereas the most common subtype of T cell lymphoma was diffuse mixed small and large cell type.

Study on Histopathologic Changes of Suckling Rats Inoculated with Hantaan Virus

Hantaan and related viruses have been implicated as causative agents for a diverse group of human diseases known collectively as "hemorrhagic fevers with renal syndrome" (HFRS). Outbred SD rats obtained within 24 hours after birth were inoculated by intracerebral (the first group) or intramuscular routes (the second group) with 10(9.5)/ml DL50 of Hantaan seed virus suspension in 0.02 ml and 0.1 ml, respectively. Brain, lung, liver, kidney and spleen were used for virus antigen detection by immunofluorecence and histopathologic examination. In the first group, immunofluorescent intensity of virus antigen was increased in all organs (especially brain) and persisted until time of death(day 9). The histopathologic changes were relatively mild in brain and spleen and unremarkable in liver, lung and kidney. In the second group, immunofluorescent intensity of virus antigen was markedly increased in brain until time of death(day 17), but decreased in other organs. The histopathologic findings, such as meningoencephalitis, interstitial pneumonitis with focal hemorrhage, and lymphoid hyperplasia of splenic white pulp were much prominent compared to the first group. However, those of liver and kidney were unremarkable. The chronology of virologic and pathologic findings in Hantaan-infected suckling rats suggests a possible immune-mediated mechanism in disease pathogenesis.

Malignant Transformation in Cystic Teratoma of Ovary: 4 cases report

Development of a malignant tumor within a mature cystic teratoma is a serious event, and occurs in about 1%~4% of cases. The malignant transformation occurs most frequently in the squamous epithelium with the formation of a squamous cell carcinoma. There are 10 cases reported in the literature, in Korea. We report 4 additional cases, which include 3 squamous cell carcinomas and 1 adenosquamous carcinomas, arising in cystic teratoma of the ovary.

A Case of Glycogenosis I

No abstract available.