Basic and applied pathology最新文献

In January 2009, a new classification of pathology services was been launched for the reimbursement by the National Health Insurance system in Korea. Five basic types of surgical pathology services are reclassified into 13 types and their resource based relative value scores are adjusted. In this report, we summarize the history of the classification system for the reimbursement on pathology services and report the impact of the change in January 2009 on the distribution of cases and contribution on the income of the department of pathology from each class at the Seoul National University Hospital.

Background and aim: Survivin, an antiapoptotic protein, is involved in both the control of the cell division and the inhibition of apoptosis. The regulation of apoptotic cell death may have a profound effect on the carcinogenesis and progression of colorectal cancer. This study was designed to evaluate the survivin expression in colorectal tissues and to investigate whether the survivin expression is associated with the clinicopathologic characteristics and the patient survival. Methods: Immunohistochemical analysis of survivin was performed using the tissue microarrays of 622 colorectal tissue samples from 529 colorectal adenocarcinomas, 40 normal mucosa, 34 adenomatous polyps, and 59 metastatic lymph nodes. Results: Normal colorectal mucosa were completely negative for survivin (0/40, 0%), but survivin was expressed in adenomatous polyps (8/34, 23.5%), adenocarcinomas (327/529, 61.8%), and metastatic lymph nodes (27/59, 45.8%). In the analyses between the survivin expression and clinicopathologic parameters, the survivin expression was correlated with tumor location in colon (P= 0.026), lymph node metastasis (P= 0.003) and American Joint Committee on Cancer (AJCC) stage (P= 0.040). The patient survival was significantly associated with age, histologic grade, AJCC stage, and lymphovascular invasion. On stage wise analyses of patient survival, the survivin expression was significantly correlated with overall survival (P < 0.001) and disease free survival (P < 0.001), especially in stage II colorectal adenocarcinomas. Conclusions: The results suggest that the survivin expression is a relatively frequent early event of colorectal carcinogenesis and may play an important role in the adenoma-carcinoma transition sequence. Survivin expression provides important prognostic information and an apoptosis-based therapeutic target in colorectal adenocarcinomas.

Activated charcoal is commonly used in the treatment of patients experiencing an oral overdose of drugs and is considered to be a safe, inert agent. However, various complications associated with the use of activated charcoal have been reported, with acute respiratory failure being a fatal one. In the presenting case, a 29-year-old female arrived at an emergency room having taken an overdose of drugs. When a nasogastric tube was inserted for gastric lavage and charcoal administration, she vomited and respiration ceased. The patient subsequently developed acute respiratory failure and died 19 days after admission. Charcoal deposition in the trachea, bronchi and lungs was observed on the postmortem examination.

Background and aim: Wild-type p53-induced phosphatase (Wip1), a serine/threonine phosphatase encoded by Ppm1d, is a protein, induced by p53 in response to DNA damage. Recently, correlation between Ppm1d amplification and erbB2 expression has been reported in breast cancers. However, in vitro experiments provide evidences suggesting a relationship between Wip1 and hormone receptor (HR) activity. The aim of the current study was to clarify the relationship between Wip1 overexpression and the expression of HR and erbB2, and to investigate the prognostic significance of Wip1 in breast cancer. Methods: Using tissue microarrays that contained 743 cases of primary invasive breast cancers, we analyzed Ppm1d copy number and examined the expression of Wip1, HRs, p53 and erbB2 by immunohistochemistry. Results:Ppm1d was amplified in 4.7% of breast cancer tumors, while Wip1 was overexpressed in 20.8%. Wip1 overexpression was associated with low nuclear grade (P= 0.032), higher expression of progesterone receptor (P= 0.001), and increased nodal metastasis (P= 0.013). No statistically significant correlations were identified among other clinicopathologic parameters. Conclusions: The close correlation between Wip1 overexpression, progesterone receptor expression and nodal metastasis suggest that Wip1 expression is closely associated with HR activity and might heighten the malignant properties of breast cancers through hormone-mediated tumor growth and progression.

Background and aim: The deregulation of transforming growth factor β (TGF-β) action and its signaling function has been a widely accepted concept in carcinogenesis. However, its dual roles, as a tumor suppressor gene and oncogene, have interfered in applying TGF-β signaling to cancer therapeutics. To evaluate its role in the carcinogenesis of oral squamous cell carcinoma (OSCC), we performed mutational analysis of the TGF-β type II receptor (TβRII). Methods: Eighteen cases of OSCC were used for mutational analysis of TβRII. Normal surgical margin, dysplastic lesion, invasive carcinoma and metastatic cancer cells into lymph node tissue were used. Exon-specific spanning primers of exon 1, 2, 3, 4, 5, 6, 7 of TβRII were used for the mutational analysis. Results: A single nucleotide polymorphism (SNP) at the codon 191 was found in 8 cases. The genetic mutations were mainly found in exon 4 through dysplastic areas, carcinoma and metastatic areas, which induced the structural change or the alteration of hydrophobicity of the amino acid. Conclusions:TβRII mutations occur frequently in exon 4 in OSCC and their functional significance should be proven.

Backgroud and aim: We investigated the incidence of codon 249 mutation of p53 in hepatocelluar carcinoma (HCC) and the relation between cyclooxygenase-2 (COX-2) expression in HCC and survival of the patients. Methods: Forty-one cases of HCC from 1988 to 2007 were retrieved from the files of department of pathology, Chungnam National University Hospital. We performed single strand confirmation polymorphism (SSCP) and direct DNA sequencing for detection of p53 mutation and immunohistochemical staining using monoclonal antibody to COX-2. Results: SSCP and direct DNA sequencing revealed a p53 mutation at exon 7 in one of 41 cases (2.4%). The mutation was observed at codon 249 and consisted of a G–T transversion in the third position of this codon, resulting in an amino acid change from arginine to serine (missense mutation). Positive COX-2 staining (score ≥ 100) was observed in thirty-three of 41 cases (80.5%) and high score (score ≥ 200) in 15 of 41 (36.6%). The high-score group showed a worse survival than the low-score group (score < 200) in Fisher's exact test with confidence level at 90%. Conclusion: This is the first report on the existence of p53 codon 249 mutation of HCC in Korea.

Background and aims: Precise pathological diagnosis is essential for optimal treatment of thyroid tumors. Ancillary diagnostic markers may be helpful in some cases. The purpose of this study was to compare and evaluate the diagnostic value of CD56, cytokeratin 19 (CK19), and galectin-3 immunohistochemical stainings in distinguishing between papillary carcinoma (PC) and other thyroid malignancies and benign lesions. Methods: The expressions of the three markers were evaluated in PC (n= 67), follicular carcinoma (FC, n= 23), medullary carcinoma (MC, n= 18), anaplastic carcinoma (AC, n= 4), follicular adenoma (FA, n= 15), and nodular hyperplasia (NH, n= 21). Results: Statistical analysis showed significantly different expressions of CD56, galectin-3, and CK19 in PC versus other lesions of the thyroid gland, with the exception of AC. Especially, the sensitivity and specificity of CD56 for diagnosing PC were 92.5% and 86.4%, respectively. The diagnostic specificity of CD56 was higher than that of galectin-3 or CK19 in differentiating PC from other lesions of the thyroid gland. However, its sensitivity was lower than that of galectin-3 or CK19. Conclusion: CD56 turns out to be a good negative marker for diagnosing PC. We suggest that immunohistochemical panels directed at the diagnosis of PC should include CD56 together with galectin-3 and CK19.

Sclerosing hemangioma (SH) of the lung is a rare primary pulmonary neoplasm and is thought to be benign. Although SH was originally considered to be a variant of a hemangioma and was suggested to be of mesenchymal, mesothelial, endothelial, and neuroendocrine origin, there is now consensus that SH is derived from primitive respiratory epithelium. Pulmonary neuroendocrine cell (PNEC) hyperplasia is considered to be a reactive process associated with regeneration of chronically injured airways or alveoli, such as in lung abscesses, bronchiectasis, cystic fibrosis, and chronic obstructive pulmonary disease. We report a rare case of SH combined with PNEC hyperplasia and tumorlets in a 62-year-old woman. Further studies on the relationship between the histogenesis of SH and PNEC hyperplasia or tumorlets are needed.

Background and aims: To determine the role of parvovirus B19 (PVB19) in Kikuchi's lymphadenitis of Korean patients. Methods: We detected PVB19 DNA by polymerase chain reaction, and confirmed by DNA sequencing, and immunohistochemical stain in 67 histologically confirmed cases. Results: Male to female ratio was 1:3 and the mean age was 24.6 years. The cases were classified into proliferative type (60.8%), necrotizing type (33.3%), and xanthomatous type (5.7%) and the duration of the disease was well correlated with progression from proliferative, necrotizing and xanthomatous types. PVB19 was detected in only one patient, who was a 33-year old woman and did not show any specific clinicopathologic characteristics from other patients. Conclusions: Although parvovirus may not play an important role in Kikuchi's lymphadenitis in Korean patients, PVB19 may be still considered one of the agents, relating with Kikuchi's lymphadenitis in Korea. In contrast to the previous studies, we concluded that the association of PVB19 in Kikuchi's lymphadenitis may be an incidental finding rather than a constant features of this disease.