Basic and applied pathology最新文献

Background and aim: Breast cancer is the second most common malignancy in Korean women. Fine needle aspiration cytology (FNAC) has been used as the first-line pathological modality; however, use of core needle biopsy (CNB) is on the increase. FNAC is a cost effective, less invasive and rapid method for evaluation of breast lesions. The limitations of FNAC, such as high false negative rates and equivocal results restrict its use. The aim of this study is to evaluate FNAC as a diagnostic tool in comparison with CNB by matching corresponding excision specimens. Methods: From May, 2003 to April, 2008, 753 cases of FNAC, 331 cases of CNB, and 98 cases of combined FNAC and CNB were collected. Diagnoses with FNAC and CNB were compared with excision. Results: Sensitivity, specificity, and diagnostic accuracy of FNAC were 93.8%, 80.8%, and 90.1%, respectively. Those of CNB were 92.1%, 90.9%, and 92.3%, and combined FNAC and CNB, 100%, 77.8%, and 98.0%. There were no false positive cases in either the FNAC or the CNB group. False negative rates were 6.2% in FNAC and 9.9% in CNB. Sampling error was the cause of error or a false negative result in all FNAC samples, and all but one CNB sample. Diagnostic accuracy of FNAC was superior to that of CNB for lesions between 1 cm and 2 cm. Conclusions: Our data suggest that FNAC is an accurate and reliable first line diagnostic tool for evaluation of breast lesions when compared with core biopsy.

Background and aim: The activated phosphorylated form of signal transducer and activator of transcription 3 (pSTAT3) up-regulates multiple downstream targets, including Survivin, which is an inhibitor of apoptosis, and has been implicated as an important process in malignant progression. The purpose of this study was to investigate the expression of pSTAT3 and Survivin in diffuse large B cell lymphomas (DLBCL) for their clinicopathological significance. Methods: Using tissue microarrays constructed from 102 DLBCLs, immunohistochemistry was done for pSTAT3 and Survivin. Results: Immunoreactivity for pSTAT3 and Survivin was seen in 41% and 46% of 102 patients of DLBCL. Patients who expressed pSTAT3 were more likely to have Survivin (p < 0.001) and p53 expressions (p= 0.002). According to the sub-groups of DLBCL, non-germinal center B cell (non-GCB) group was more likely to express pSTAT3 and Survivin. Both the pSTAT3 and Survivin expression were significantly associated with short overall survival by Kaplan–Meier survival curves and log-rank tests in both overall (p= 0.021 and p= 0.002) and non-GCB group of DLBCL (p= 0.023 and p= 0.006). Multivariate analysis confirmed that Survivin was an independent prognostic factor in both overall DLBCL (p= 0.014) and non-GCB group (p= 0.032). Conclusions: pSTAT3 and Survivin expression appear to be important prognostic factors for DLBCL patients.

Background and aims: The expression pattern of high affinity neurotrophin receptors dichotomizes the clinicopathologic characteristics of neuroblastoma (NB). The effects mediated by trkA have been documented in many experimental systems, whereas the effects mediated by trkB have only been investigated in limited studies. Methods: We established a new cell line of NB, “SNU-NB1”, by primary culture and the effects mediated by trkB were addressed in this cell line. Results: NB cells in primary culture showed amplification of N-myc and expression of trkB. Activation of trkB in primary culture by brain-derived neurotrophic factor (BDNF) was followed by activation of extracellular signal-regulated kinase1/2 (ERK1/2), growth inhibition, neuronal differentiation, and N-myc down-regulation. However, fully transformed SNU-NB1 cells lost BDNF sensitivity while being tumorigenic in vivo. Restoration of trkB expression in SNU-NB1 cells, by retroviral infection of trkB, induced differentiation and inhibition of growth in the cells following BDNF treatment. Although the prognosis of neuroblastomas is different according to the status of trkA and trkB mRNA expressions, the cytologic effects mediated by trkB per se are similar to those by trkA in NB. Conclusion: The patterns of trkA and trkB mRNA expression were markers for different lineages of transformed cells but were inconsistent with the clinical behavior.

Colorectal adenocarcinoma with rhabdoid features is extremely rare and only three cases have been previously reported. We report a 62-year-old man who presented with general weakness and poor oral intake for 6 months, and showed multiple masses at the duodenum, jejunum, ileum and the ascending colon. The patient underwent right hemicolectomy with small bowel segmental resection. Microscopically, the tumor masses were characterized by incohesive sheet of neoplastic cells with vesicular nuclei, large nucleoli, and abundant eosinophilic cytoplasm. Immunohistochemical studies showed strong reactivity of the tumor cells for pan-cytokeratin, anti-endomysial antibodies (EMA) and vimentin. This was a case of undifferentiated carcinoma with prominent rhabdoid feautures arising in the ascending colon with multiple gastrointestinal metastases.

Backgroud and aim: Peroxisome proliferator-activated receptor γ (PPARγ) is one of the ligand-activated transcription factors belonging to the nuclear hormone receptor family. The protein is expressed in various kinds of tumor and has been implicated as a tumor suppressor in most cancers. We aimed to understand the role of PPARγ in breast cancer. Methods: The expression of PPARγ in 288 cases of invasive ductal carcinoma was examined using tissue microarray and immunohistochemistry. Results: PPARγ immunoreactivity was detected in 21.5% of cases and significantly associated with expression of EGFR and ki-67 (P= 0.008; P= 0.046). PPARγ expression was correlated with high histological grade and basal type (P≤ 0.001; P= 0.009). Conclusions: PPARγ expression is related to poor prognostic factors of breast cancer. It is considered that PPARγ has evident tumor promoting properties in vivo, but receptor-independent effects of PPARγ ligands may compound its biologic effects in cancer. A better understanding of action mechanisms of the activated PPARγ is required.

Background and aim: The objective of this paper is to evaluate the workload of staff in anatomic pathology (AP) laboratories in Korea. Methods: A survey was conducted at 197 AP laboratories in South Korea, these were categorized as 37 free standing laboratories, 14 laboratories in non-training hospitals (without residents), 79 in training hospitals (with residents), and 67 in university hospitals. The workloads of the staff were analyzed using the mean and standard deviation of the number of cases. Results: In total, there were 512 pathologists, 806 technicians and 205 cytopathology screeners. In a year, they processed a total of 3,150,261 histopathology cases and 4,115,420 cytopathology cases. The numbers of histopathology cases per pathologist or technician in one laboratory were 6,950 ± 6,748 and 4,074 ± 3,630, respectively. There were 109 laboratories that employed 205 cytoscreeners in addition to the 308 pathologists, where a cytoscreener read 14,780 ± 13,110 cases of cytopathology. However, in 88 laboratories, there were 132 pathologists who were not assisted by cytoscreeners, where a pathologist was reading 4,277 ± 3,033 cases of cytopathology. Conclusion: We propose a mean plus a standard deviation as a recommended guideline for staff workload at each laboratory setting to be used for a quality assurance program.

Background and aims: There are a number of different commercially available demineralized bone matrix (DBM) products with significant differences between products with regard to the osteoinductive effect in bone defects. We aimed to evaluate the cellular response for the osteoinductive effect of the DBM graft materials by immunohistochemistry. Methods: Among five cases of sinus mucosa biopsy from the implant placement into the sinus floor elevation using DBM allograft, one case showed an intact sinus mucosa containing DBM inserted 4 months ago, while the others were severely infected and unable to be compared with each other for the osteoinductive effect of DBM. Immunohistochemistry investigations were undertaken. Results: The multinucleated giant cells were strongly positive for RANKL, cathepsin K, and HSP-90, and consistently positive for lysozyme, TNF-α, CD31, CD68, MMP-2, and MMP-9. The stromal cells were strongly positive for osteonectin and osteocalcin, but weak for BMP-2, BMP-4, RUNX2, TGF-β1, CTGF, and TGase-2. Conclusions: For sinus floor elevation the autogenic bone graft or osteogenic stem cell replacement is necessary, whereas DBM allograft only being insufficient.

Gastrinoma is one of the most symptomatic pancreatic endocrine tumors and is associated with recurrent gastric or duodenal ulcer and an induction of chronic gastric acid hypersecretion. This tumor is commonly involved within the gastrinoma triangle. Herein we report a peripancreatic lymph node gastrinoma in a 56-year-old man who was suffered from a recurrent duodenal or jejunal ulcer perforation. Octreotide scan detected a peripancreatic or periduodenal mass and the serum gastrin level was set in upper normal range (107.73 pg/mL). Whipple's procedure was performed. The resected specimen showed multiple duodenal ulcers, hypertrophic gastric body mucosa and an enlarged peripancreatic node, measured 1.5 × 1.0 cm in cross diameter. Microscopic examination revealed a single enlarged lymph node replaced by tumor cell nests with pale eosinophilic cytoplasm and ‘salt-and-pepper’ chromatin pattern. On immunohistochemical staining, the tumor cells were diffusely positive for chromogranin, synaptophysin, gastrin and focally positive for CD56. He was finally diagnosed as a primary lymph node gastrinoma. After operation, the patient revisited our hospital due to severe esophageal stricture and he underwent endoscopic esophagoplasty.

Background and aims: Nod2 is an intracellular pathogen sensor found to be associated with susceptibility to Crohn's disease (CD) in Western countries. However, the results from Asian population including Koreans showed discordant findings. Meanwhile, a recent study demonstrated significant associations between NOD2 polymorphisms and tuberculosis (TB). However, in Korea, no studies on NOD2 mutations in TB patients have been conducted as of yet. Methods: We collected the surgically resected intestines confirmed as TB with more than one positivity among TB-polymerase chain reaction, Ziehl-Neelsen stain, and culture for Mycobacterium tuberculosis. CD was confirmed on the basis of usual clinico-pathological criteria with all negativity for aforementioned tests and without other infectious causes. DNA extracted from the formalin-fixed, paraffin-embedded tissues of patients with intestinal TB (14), CD (19), and controls (18) were amplified by PCR using five primers for Ala140Thr, Pro268Ser, Arg702Trp, Arg708His, Ala725Gly, Gly908Arg, and Leu1007fs. DNA sequencing was then performed. Results: Histologically, well-defined granulomas with caseous necrosis were found in all TB but not in any CD. We found no mutations related to CD as well as TB in DNA sequencing. Conclusions: This result reconfirmed that the molecular changes associated with CD in Asian populations might differ from Western populations. Furthermore, the genetic change associated with TB in Korea is still remains to be clarified.