Uterine Leiomyomas with Perinodular Hydropic Degeneration: A Report of Two Cases

Hydropic degeneration is a frequent degenerative change in otherwise typical uterine leiomyomas. Very rarely, however, a significant amount of edema fluid accumulates around the fascicles of neoplastic smooth muscle bundles and forms the characteristic multinodular growth pattern that is called perinodular hydropic degeneration of leiomyoma (PHDL). The gross findings, showing a vague worm-like appearance and very rarely having an extrauterine extension, and the microscopic features, showing perinodular retraction artifacts forming pseudovascular spaces, make it difficult to differentiate the tumor from intravenous leiomyomatosis or myxoid leiomyosarcoma. We described two cases of leiomyomas showing perinodular hydropic degeneration (PHD), a condition that has rarely been described in English literature, and discussed the mechanism of forming "extrauterine extension" or cotyledonoid features. One of our cases showed the typical features of cotyledonoid dissecting leiomyoma, the other showed those of intramural dissecting leiomyoma. An awareness of the gross and microscopic findings of PHDL is important not to overdiagnose a benign smooth muscle neoplasm as a more aggressive type of tumor. It is thought that intramural dissecting leiomyoma, cotyledonoid dissecting leiomyoma, and PHDL are not distinct, but closely related subtypes showing different phases of evolutionary changes.

A Comparision of AutoCyte PREP with Matched Conventional Smear in Cervicovaginal Cytology / 대한세포병리학회지

This study was designed to compare the performance of liquid-based preparation from the AutoCyte PREP with the conventional cervicovaginal smear in masked split-samples. In randomly selected 840 cases, the conventional smear was always prepared first, and the AutoCyte PREP used the residual cells on the collecting device. Parallel AutoCyte PREP slides and matched conventional smears were screened in a blind fashion. All abnormals and 10% random normal cases were reviewed by two pathologists in a blind fashion. The Bethesda System was used for reporting the diagnosis and specimen adequacy. The diagnoses from the two methods were agreed exactly in 767(91.3%) of 840 cases. The AutoCyte PREP demonstrated a 25% overall improvement in the detection of squamous intraepithelial lesion(SIL). The ratio of ASCUS to SIL was decreased as 0.45 compared with 1.00 of conventional smear. The AutoCyte PREP produced excellent cellular preservation and superior sensitivity for detection of atypical cells as compared to the conventional smear. It makes us to be able to subclassify ASCUS into from WNL to HSIL. We thought that the AutoCyte PREP method might contribute to increase the detection rate of abnormal cells than conventional methods.

Immunohistochemical Study of Calponin, Smooth Muscle Myosin Heavy Chain, Cytokeratin 34E12, and p53 in Papillary Neoplasm of the Breast

BACKGROUND: The most important feature distinguishing intraductal papilloma (IDP) from papillary carcinoma is the presence of uniform myoepithelial cells (MECs) within the lesion. METHODS: Immunohistochemistry (IHC) for calponin, smooth muscle myosin heavy chain (SMMHC), cytokeratin 34E12, and p53 were performed on 37 IDP, 4 intraductal papillary carcinomas (IDPCA), 5 microinvasive papillary carcinomas, and 5 invasive papillary carcinomas (IPCA), respectively. RESULTS: The mean age of the patients was 43 (43.3+/-11.6) years. Cytokeratin 34E12 was expressed in epithelial cells (84%) as well as in MECs (23%) of IDP. The expression of SMMHC was significantly reduced in the intraductal and invasive papillary carcinoma (p=0.001). The expression of calponin was also significantly reduced (P<0.001) as IDP 95%, IDPCA 76%, microinvasive papillary carcinoma 39%, and IPCA 8%, respectively. p53 over-expression was noted in 3 (one IDP and two IPCA) of 51 cases. CONCLUSIONS: Because MECs were significantly reduced with malignant progression, calponin and SMMHC were very useful markers for differentiating between benign and malignancy in the papillary neoplasm. Calponin was more sensitive than SMMHC and was an excellent ancillary test for assessing MECs and for detecting microinvasion.

Cardiac Sarcoidosis Treated by Cardiac Transplantation: A Case Report

Sarcoidosis, in general, has a low mortality rate. But cardiac sarcoidosis (CS) is a serious condition which may lead to death. Here, we report a rare case of CS that was treated by heart transplantation. A 47-year-old male had occasional syncopes and atypical chest pain. Ventricular tachycardia with right bundle branch block was noted by electrocardiogram. Multiple fixed myocardial perfusion defects in the interventricular septum and both the inferior-posterior ventricular walls were observed by thallium scan. Coronary angiography was unremarkable. Neither perihilar nor mediastinal lymphadenopathy was noted. The patient also suffered three times from tonic-clonic generalized seizures in 3 years, but no neurologic abnormalities were detected. The explanted heart displayed multiple white patches on the endomyocardial surface, measuring up to 8x7 cm. On microscopic examination, the lesion consisted of multiple well-formed and confluent granulomas with numerous scattered multinucleated giant cells, CD68-positive epithelioid histiocytes, and T-lymphocytes. Neither microorganisms nor foreign material was identified on special stain and culture study. It has been six months since the heart transplant, and the patient has been doing well.

The first imported case of pulmonary coccidioidomycosis in Korea

Coccidioidomycosis is an endemic disease found in the southwestern part of North America. Travellers who visit the endemic area may carry the infection. We report a case of pulmonary coccidioidomycosis in a 74-year-old woman. She was healthy before visiting Arizona, U.S.A twice. After returning home, she began to complain of intermittent dry coughing. The symptom was mild, however, and she was treated symptomatically. Later a chest radiograph, which was taken 4 years after the onset of the symptom, showed a solitary pulmonary nodule in the right upper lobe. By percutaneous needle aspiration, a few clusters of atypical cells were noted in the necrotic background. A right upper and middle lobectomy was done. A 1.5 x 1.5 x 1.2 cm sized tan nodule was present in otherwise normal lung parenchyma. Microscopically, the nodule consisted of aggregates of multiple solid granulomas inside of which was mostly necrotic. Neutrophils and nuclear debris were scattered along the periphery of the necrotic foci. Numerous multinucleated giant cells were associated with the granulomas. In the necrotic area, mature spherules of Coccidioides immitis, which were 30-100 microm in diameter, were present. They contained numerous endospores which ranged from 5 to 15 microm and were also noted in multinucleated giant cells. The diagnosis of coccidioidomycosis was made. She is doing well after the resection.