Positive Expression of Insulin-Like Growth Factor-1 Receptor Is Associated with a Positive Hormone Receptor Status and a Favorable Prognosis in Breast Cancer / 한국유방암학회지

PURPOSE: Insulin-like growth factor 1 receptor (IGF-1R) is commonly expressed in primary breast cancers. Understanding the role of IGF-1R signaling in the different subtypes of breast cancer is important because each subtype has a different outcome and requires different treatment modalities. However, the precise biological significance of IGF-1R expression in cancer cells is still unclear. In this study, we examined the expression of IGF-1R in the different molecular subtypes of breast cancer. The effects of IGF-1R expression on the survival rates and outcomes of breast cancer were also examined. METHODS: IGF-1R expression was evaluated immunohistochemically in tissue microarray blocks constructed from 1,198 invasive breast cancer samples collected from six medical institutions. IGF-1R expression was interpreted according to the human epidermal growth factor receptor 2 (HER2)/neu immunohistochemistry scoring system. Scores of 2+ and 3+ were considered positive. RESULTS: Positive IGF-1R expression was observed in 65.4% of invasive breast cancer samples. IGF-1R expression was detected in all cancer subtypes (luminal A, 84.4%; luminal B, 75.9%; HER2, 21.2%; triple-negative, 46.6%) and was found to be associated with a positive hormone receptor status and the absence of HER2 amplification (p<0.001). Positive IGF-1R expression was significantly associated with high survival rates (p=0.014). However, a multivariate analysis revealed that the expression levels of IGF-1R did not achieve statistical significance. In the triple-negative cancer subtype, IGF-1R expression was found to be associated with a lower disease-free survival rate (p=0.031). CONCLUSION: Positive IGF-1R expression is associated with a favorable prognosis in breast cancer. IGF-1R is frequently expressed in the luminal A/B subtypes of breast cancer, and its expression is related to the hormone receptor status.

Isolated Bowel Endometriosis Resembling a Myogenic Tumor on Endoscopic Ultrasonography

No abstract available.

HER2 Status by Standardized Immunohistochemistry and Silver-Enhanced In Situ Hybridization in Korean Breast Cancer / 한국유방암학회지

PURPOSE: Amplification of the human epidermal growth factor receptor 2 (HER2) gene occurs in 18% to 20% of breast cancers, and it is recognized as a prognostic and predictive marker. We investigated the HER2 status in Korean breast cancer by immunohistochemistry (IHC) and silver-enhanced in situ hybridization (SISH), as the first step toward building a nationwide quality assurance program for HER2 testing. METHODS: A total of 1,198 breast carcinoma samples were collected from six institutions and IHC and SISH were performed using tissue microarrays in central laboratories. The results were compared to those of local laboratories. RESULTS: Available data were obtained from 959 samples. Central IHC results were negative, equivocal, and positive for 756 (78.8%; range among institutions, 76.8-81.8%), 37 (3.9%; 1.9-6.2%), and 166 (17.3%; 13.6-20%), respectively. SISH results were negative, equivocal, and positive for 756 (78.8%; 77.4-79.9%), 2 (0.2%; 0-0.7%), and 201 (21%; 20.1-22.2%), respectively. HER2 gene amplification was observed in 4.4%, 19%, and 73.9% of the negative, equivocal and positive groups stratified by local IHC results, respectively. When central SISH was considered to be the gold standard method for measuring HER2 status, the false-negative and false-positive rates of local IHC were 14.4% (29/201) and 7.1% (54/756). The concordance rate between central IHC and SISH was 98.4%. CONCLUSION: Central IHC and SISH markedly decreased the interlaboratory variability of HER2 status and the results of the two were highly concordant. The quality control program for HER2 testing must be focused on decreasing both the false negativity and positivity of IHC in local laboratories.

A Case of Tuberculous Prostatitis with Abscess

We present a case of acute prostatitis with abscess. The patient had undergone intravesical bacillus Calmette-Guerin (BCG) immunotherapy for bladder cancer. A prostate biopsy demonstrated tuberculous prostatitis with abscess. This case illustrates that when bladder cancer is treated with BCG, a tuberculous prostate abscess can develop.

Cytomorphologic Features According to HPV DNA Type in Histologically Proven Cases of the Uterine Cervix

BACKGROUND: This study investigated whether human papillomavirus (HPV) genotype is related to koilocytic changes in cervical cytology and histology, and what factors cause discrepancies among cytology, HPV DNA chip tests, and biopsies. METHODS: We examined 174 of 949 cases histologically confirmed by both cytology and HPV DNA chip testing. We analyzed koilocytic changes in cytology and biopsies according to HPV genotype. RESULTS: HPV-16 significantly coincided with nuclear size variation and hyperchromasia, although the cytomorphologic features correlated with other HPV genotypes were not statistically significant. By analyzing 68 cases in which there were discrepancies between the HPV DNA chip test and histological results, we confirmed that artifacts or glycogen acanthosis resulted in the over-diagnoses of four HPV-negative cases with normal cytology. Four diagnostic errors and four sampling errors were present in eight HPV-positive cases. The degree of nuclear size variation significantly influenced the cytologically under-diagnosed cases (p=0.006). CONCLUSIONS: Other than HPV-16, HPV genotype exhibited no cytological or histological differences. The discrepancy between the results of HPV DNA chip test and histology was created by glycogen acanthosis, immature squamous metaplasia, artifacts, and sampling errors.

WHO Classification of Malignant Lymphomas in Korea: Report of the Third Nationwide Study

BACKGROUND: The aim of study was to determine the relative frequency of malignant lymphoma according to World Health Organization (WHO) classification in Korea. METHODS: A total of 3,998 cases diagnosed at 31 institutes between 2005 and 2006 were enrolled. Information including age, gender, pathologic diagnosis, site of involvement and immunophenotypes were obtained. RESULTS: The relative frequency of non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL) was 95.4% and 4.6%, respectively. B-cell lymphomas accounted for 77.6% of all NHL, while T/natural killer (T/NK)-cell lymphomas accounted for 22.4%. The most frequent subtypes of NHL were diffuse large B-cell lymphoma (42.7%), extranodal marginal zone B-cell lymphoma (MZBCL) of mucosa-associated lymphoid tissue (19.0%), NK/T-cell lymphoma (6.3%) and peripheral T-cell lymphoma (PTCL), unspecified (6.3%), in decreasing order. The relative frequency of HL was nodular sclerosis (47.4%), mixed cellularity (30.6%), and nodular lymphocyte predominant (12.1%) subtypes. Compared with a previous study in 1998, increase in gastric MZBCL and nodular sclerosis HL, and slight decrease of follicular lymphoma, PTCL, and NK/T-cell lymphoma were observed. CONCLUSIONS: Korea had lower rates of HL and follicular lymphoma, and higher rates of extranodal NHL, extranodal MZBCL, and NK/T-cell lymphoma of nasal type compared with Western countries. Changes in the relative frequency of lymphoma subtypes are likely ascribed to refined diagnostic criteria and a change in national health care policy.

A Case of Bladder Cancer Found during a Workup for Urge Incontinence / 대한배뇨장애요실금학회지

Irritative urinary symptoms may suggest the possibility of bladder cancer. We report a case of metastatic bladder cancer that was discovered during a workup for urge incontinence in a 65-year-old woman with a history of stomach cancer. She had a medical history of gastrectomy due to stomach cancer 4 years previously. The patient complained of urgency unresponsive to anticholinergic therapy. Cystoscopy revealed the presence of suspicious bladder mucosal lesions that were biopsied. The pathology was consistent with metastatic signet-ring cell adenocarcinoma. This case suggests that irritative urinary symptoms can be the first clinical manifestation in patients with bladder cancer.

A Multi-institutional Study of Interlaboratory Variance in the Estrogen and Progesterone Receptor Assays / 한국유방암학회지

PURPOSE: The expression of hormone receptors is the most reliable factor for predicting the responsiveness to hormonal therapy. At present, immunohistochemistry (IHC) is considered as a practically reliable method. This study was designed to examine the interlaboratory variance in immunohistochemical assays for estrogen receptor (ER) and progesterone receptor (PR) in Korea. METHODS: The Korean Study Group for Breast Pathology (KSGBP) made a questionnaire to know the current situation in HR assay in Korea. The questionnaire was sent to the members of KSGBP by e-mail, which were included eight questions relating to tissue handling, ER/PR IHC procedure and interpretation method. Forty laboratories replied with the completed questionnaire. RESULTS: All 40 laboratories were using formalin as a fixative. Pretreatment was performed using six different methods including autoclave (25%), microwave (30%) and full autostainer (15%). Primary antibodies for ER were SP1 in 40%, 6F11 in 27.5% and 1D5 in 32.5%. Primary antibodies for PR were more variable (seven clones) than those for ER. Interpretation method used was Allred system in 20%, modified Allred system in 15%, report the % of positive tumor cells in 45%, positive/ negative in 15% and others in 5%. The expression rate of ER was ranged from 45.6% to 93% (mean 63.5%) and the expression rate of PR was ranged from 27% to 90% (mean 59.1%). The differences according to the numbers of breast cancer in each institute, primary antibodies, detection systems and interpretation methods did not influence to the expression rate of ER/PR, statistically (p>0.05). CONCLUSION: In Korea, the interlaboratory variance in ER/PR IHC procedure was too huge to make a standardized method. We suggest the proper quality control program such as ER/PR staining with positive internal and external controls and negative control might be better to aim at getting similar results among the different laboratories rather than trying to standardize the procedure.

A Multi-institutional Study of Interlaboratory Variance in the Estrogen and Progesterone Receptor Assays / 한국유방암학회지

PURPOSE: The expression of hormone receptors is the most reliable factor for predicting the responsiveness to hormonal therapy. At present, immunohistochemistry (IHC) is considered as a practically reliable method. This study was designed to examine the interlaboratory variance in immunohistochemical assays for estrogen receptor (ER) and progesterone receptor (PR) in Korea. METHODS: The Korean Study Group for Breast Pathology (KSGBP) made a questionnaire to know the current situation in HR assay in Korea. The questionnaire was sent to the members of KSGBP by e-mail, which were included eight questions relating to tissue handling, ER/PR IHC procedure and interpretation method. Forty laboratories replied with the completed questionnaire. RESULTS: All 40 laboratories were using formalin as a fixative. Pretreatment was performed using six different methods including autoclave (25%), microwave (30%) and full autostainer (15%). Primary antibodies for ER were SP1 in 40%, 6F11 in 27.5% and 1D5 in 32.5%. Primary antibodies for PR were more variable (seven clones) than those for ER. Interpretation method used was Allred system in 20%, modified Allred system in 15%, report the % of positive tumor cells in 45%, positive/ negative in 15% and others in 5%. The expression rate of ER was ranged from 45.6% to 93% (mean 63.5%) and the expression rate of PR was ranged from 27% to 90% (mean 59.1%). The differences according to the numbers of breast cancer in each institute, primary antibodies, detection systems and interpretation methods did not influence to the expression rate of ER/PR, statistically (p>0.05). CONCLUSION: In Korea, the interlaboratory variance in ER/PR IHC procedure was too huge to make a standardized method. We suggest the proper quality control program such as ER/PR staining with positive internal and external controls and negative control might be better to aim at getting similar results among the different laboratories rather than trying to standardize the procedure.

Korean Pediatric/Adolescent Lymphoma: Incidence and Pathologic Characteristics

BACKGROUND: The Hematopathology Study Group of the Korean Society of Pathologists conducted a nation-wide retrospective analysis of Korean pediatric lymphoma, to provide pathologic data on pediatric/adolescent lymphoma subtypes and features. METHODS: All lymphoma cases of all age groups were collected during a recent 2 year-period (2005-2006) from 32 institutes in Korea. Among 3,686 lymphoma patients, 142 who were age 18 or less were classified according to the World Health Organization (WHO) classification. RESULTS: Among 142 pediatric/adolescent lymphoma patients, Hodgkin lymphoma accounted for 21 (14.8%) and non-Hodgkin lymphoma (NHL) for 121 (85.2%). Hodgkin lymphoma appears to be more common in the pediatric/adolescent age group than in the all-ages group (14.8% vs 4.4%). T- and natural killer cell-NHL was more common in the pediatric/adolescent age group than in the all ages group (46.3% vs 22%). The majority of Korean pediatric/adolescent NHL cases was composed of Burkitt lymphoma, T- or B-lymphoblastic lymphoma, anaplastic large-cell lymphoma, and diffuse large B-cell lymphoma. For lymphoma patients under the age of 6 years, most had B-lymphoblastic or Burkitt lymphoma, which commonly presented at extranodal sites. CONCLUSIONS: The distribution of lymphoma subtypes in the pediatric/adolescent age group is quite different from the distribution of adults, but it was quite similar to distribution in Western countries.

Diagnostic Accuracy of Cervicovaginal Cytology in the Detection of Squamous Epithelial Lesions of the Uterine Cervix; Cytologic/Histologic Correlation of 481 Cases / 대한세포병리학회지

BACKGROUND: Cervicovaginal cytology is a screening test of uterine cervical cancer. The sensitivity of cervicovaginal cytology is less than 50%, but studies of cytologic/histologic correlation are limited. We analyzed the diagnostic accuracy of cervicovaginal cytology in the detection of the squamous epithelial lesions of the uterine cervix and investigate the cause of diagnostic discordance. MATERIALS AND METHODS: We collected a total of 481 sets of cervicovaginal cytology and biopsies over 5 years. The cytologic diagnoses were categorized based on The Bethesda System and the histologic diagnoses were classified as negative, flat condyloma, cervical intraepithelial neoplasia (CIN) I, CIN II, CIN III, or squamous cell carcinoma. Cytohistologic discrepancies were reviewed. RESULTS: The concordance rate between the cytological and the histological diagnosis was 79.0%. The sensitivity and specificity of cervicovaginal cytology were 80.6% and 92.6%, respectively. Its positive predictive value and negative predictive value were 93.7% and 77.7%, respectively. The false negative rate was 19.4%. Among 54 false negative cytology cases, they were confirmed by histology as 50 flat condylomas, 2 CIN I, 1 CIN III, and 1 squamous cell carcinoma. The causes of false negative cytology were sampling errors in 75.6% and interpretation errors in 24.4%. The false positive rate was 7.4%. Among 15 false positive cytology cases, they were confirmed by histology as 12 atypical squamous cells of undetermined significance (ASCUS) and 3 low grade squamous intraepithelial lesions (LSIL). The cause of error was interpretation error in all cases. The overall diagnostic accuracy of cervicovaginal cytology was 85.7%. CONCLUSIONS: Cervicovaginal cytology shows high overall diagnostic accuracy and is a useful primary screen of uterine cervical cancer.

The Role of Immunohistochemical Biomarkers as Prognostic Factorsby the Use of a Tissue Microarray in Breast Cancer PatientsUnder 45-years-old / 대한방사선종양학회지

PURPOSE: This study evaluates the association of estrogen receptor (ER), progesterone receptor (PR), Her-2, COX-2, and survivin with the clinicopathological features and outcomes in young Korean women with breast cancer using recently developed tissue microarray (TMA) technology. MATERIALS AND METHODS: A cohort of 212 young patients with breast cancer diagnosed at the age of 45 years or younger from March 1994 to August 2005, were enrolled in this study. The age range of patients was 23~45 years (median age, 39 years). The minimum and median follow-up periods were 24 months and 60 months, respectively. Serial sections of primary tumors were processed by the use of a TMA for immunohistochemical staining for five biomarkers. The correlation of these five biomarkers and the clinicopathological features and outcomes were analyzed by statistical methods. RESULTS: The majority of the patients were stage T1 (90 patients) or T2 (101 patients), and 105 patients (49.5%) had an axillary node metastasis. The 5-year overall and relapse free survival rates for all of the patients were 90.4% and 82.3%, respectively, and 36 patients had a locoregional or distant metastasis as a first event. Positive expression of ER, PR, Her-2, COX-2, and survivin was determined in 38.2%, 45.3%, 25.9%, 41.5%, and 43.4%, of the tumor samples, respectively. Tumor stage, nodal status, age, as well as expression of ER, PR, and HER-2 status were significantly associated with the disease free survival rate. Tumor stage, nodal status, as well as expression of ER, PR, and HER-2 were significantly related with the overall survival rate. Expression of COX-2 and survivin were not single independent prognostic factors for the disease free and overall survival rate although co-expression of HER-2 and COX-2 had a tendency as a poor prognostic factor. By multivariate analysis, only T stage and lymph node status were significant prognostic factors, and ER status was a marginally significant prognostic factor (p=0.075). CONCLUSION: Expression of ER, PR and HER-2 were significant prognostic factors for the relapse free and overall survival rate. Expression of COX-2 and survivin were not prognostic factors for young women with breast cancer.

A Study on BRCA1/2 Mutations, Hormone Status and HER-2 Status in Korean Women with Early-onset Breast Cancer / 대한방사선종양학회지

PURPOSE: Women with breast cancer diagnosed at an age of 40 years or younger have a greater prevalence of germline BRCA1 and BRCA2 mutations than the prevalence of women with breast cancer diagnosed at older ages. Several immunohistochemical characteristics have been identified in breast cancers from studies of Caucasian women with BRCA1/2 mutations having familial or early-onset breast cancers. The aim of this study is to determine whether early-onset breast cancer in BRCA1 or BRCA2 mutation carriers, who were not selected from a family history, could be distinguished by the use of immunohistochemical methods and could be distinguished from breast cancer in women of a similar age without a germline BRCA1 or BRCA2 mutation. We also analyzed the prognostic difference between BRCA1/2 related and BRCA1/2 non-related patients by the use of univariate and multivariate analysis. MATERIALS AND METHODS: Breast cancer tissue specimens from Korean women with early-onset breast cancers were studied using a tumor tissue microarray. Immunohistochemical staining of estrogen receptor (ER), progesterone receptor (PR) and HER-2, as well as the histology and grade of these specimens, were compared. The prognostic impact of immunohistochemical and histological factors as well as the BRCA1/2 mutation status was investigated separately. RESULTS: There were 14 cases and 16 deleterious BRCA1/2 mutations among 101 patients tested. A family history (4/14) and bilateral breast cancers (3/9) were high risk factors for BRCA1/2 mutations. BRCA1/2- associated cancers demonstrated more expression of ER-negative (19.4% versus 5.1%, p=0.038) and HER-2 negative than BRCA1/2 negative tumors, especially for tumors with BRCA1 tumors The BRCA1/2 mutation rate for patients with triple negative tumors (negative expression of ER, PR and HER-2) was 24.2%. Tumor size, nodal status, and HER-2 expression status were significantly associated with disease free survival, as determined by univariate and multivariate analysis, but the BRCA1/2 status was not a prognostic factor. CONCLUSION: Breast cancer that occurs in women with a germline BRCA1 or BRCA2 mutations have recognizable immunohistochemical features, which may be useful in identifying individuals that are more likely to carry germline mutations. Although the BRCA1/2 mutation status was not a prognostic factor in Korean women with early-onset breast cancer, more cases with a longer follow-up period are needed for further study.

A Case of Gastric Inverted Hyperplastic Polyp Associated with Gastritis Cystica Profunda and Early Gastric Carcinoma

A gastric inverted hyperplastic polyp is characterized by downward growth of the hyperplastic mucosal components into the submucosa. Lesions are composed of hyperplastic foveolar-type glands, and sometimes coexist with gastritis cystica profunda (GCP). Adenocarcinoma frequen- tly can coexist, but the relationship is not clear. A 71-year-old male was admitted to hospital because of dyspepsia for one month. He underwent a wedge resection of the stomach, after endoscopic biopsies. The gross finding showed a slightly elevated papillary lesion with central depression. Microscopically, the elevated lesion was composed of hyperplastic fundic glands and foveolar cells, and the central depressed lesion showed a nodular inverted proliferation of normal appearing gastric epithelium and glands in the submucosa. An additional proximal gastrectomy specimen exhibited marked GCP and a minute adenocarcinoma at the proximal margin with p53 protein overexpression.

A Sertoli-Leydig Cell Tumor in a Patient with Complete Androgen Insensitivity Syndrome: A Case Report

Complete androgen insensitivity syndrome (CAIS) is a rare disorder sometimes referred to as male pseudohermaphroditism. This syndrome is characterized by a 46,XY karyotype with internal bilateral testes, female external genitalia, absence or scantiness of pubic and axillary hair and normal breast development. A variety of gonadal tumors can develop in individuals with CAIS. A 57-year-old patient was admitted to urology with intermittent gross hematuria for one month. CT revealed a left ureteric mass, measuring 2.5 x 2 cm. Ureteroscopic biopsy was performed and the result was a diagnosis of high grade urothelial carcinoma. The patient underwent laparotomy which revealed slightly enlarged gonads in the pelvic cavity. However, a uterus and fallopian tubes were not identified. Left nephroureterectomy and bilateral gonadectomy were performed. The right gonad measured 3.9 x 2.5 x 2 cm and the cut surface showed a well circumscribed, firm, brownish gray colored 2 x 1.8 cm sized nodule. Microscopically, this nodule consisted of uniform and solid tubules containing immature Sertoli cells and Leydig cells which were both positive for alpha-inhibin. The left gonad measured 3.5 x 2 x 1.9 cm and showed atrophic testicular tissue.

Parameter That Predict Nipple Involvement in Breast Cancer / 한국유방암학회지

PURPOSE: Skin-sparing mastectomy (SSM) involves the resection of the nipple-areolar complex (NAC) along with the breast parenchyma, and this improves aesthetic outcome for breast cancer patients. Yet most patients desire preservation of the NAC. The purpose of this study was to determine the associated risk factors of NAC involvement and to identify the value of preoperative breast magnetic resonance imaging (MRI) for measuring the tumor-nipple distance (TND). METHODS: This prospective study was carried out in 92 breast cancer (3 patients with bilateral breast cancer) patients who underwent MRI and they had undergone modified radical mastectomy or SSM at the Department of Surgery in Soonchunhyang University Hospital from November of 2003 to March of 2006. The patients were divided into two groups: nipple-positive for malignancy (group 1; n=9) and nipple-negative for malignancy (group 2; n=86). We analyzed the risk factors of NAC involvement, including tumor size, nuclear grade, lymph node invasion, muticentricity, TND, the hormone recepor status, and lymphovascular invasion. The TND was measured by preoperative breast MRI (the imaging distance) in all patients and by the distance of specimens which were obtained postoperatively (the real distance) in 31 patients. RESULTS: The overall frequency of malignant nipple involvement was 9 of 95 (9.4%). There were no differences in tumor size, nuclear grade, lymph node invasion, muticentricity, the hormone recepor status and lymphovascular invasion between the two groups. The TND was identified as an independent predictor of malignant NAC involvement: the mean TND by breast MRI was 0.7 cm in group 1 and 2.7 cm in group 2 (p=0.01) the mean TND by pathologic measuring the specimen was 0.7 cm in group 1 and 3.2 cm in group 2 (p=0.02). In all the nipple involved cases, the tumor was within 2 cm of the nipple. In measuring the TND, there was no significant difference between the imaging distance of MRI and real distance of the sepcimen (p=0.166). CONCLUSION: The only predictive factor for malignant NAC invasion was TND in our study. NAC preservation would be appropriate for the patients with tumor located more than 2 cm away from the nipple. The TND as determined by preoperative MRI is considered to be helpful when deciding whether to preserve the NAC.

Utility of Bile Duct Brush Cytology in Pancreaticobiliary Diseases: Prospective Comparative Study of Conventional Smear and MonoPrep2(TM) Liquid Based Cytology / 대한세포병리학회지

Bile duct brush cytology has been employed as a diagnostic tool for the evaluation of pancreatic and biliary tract strictures. The specificity of this method is high however, its sensitivity is quite low. A recent study employing liquid based cytology (LBC) reported results comparable to those achieved via conventional cytology. Therefore, we have attempted to prospectively evaluate the diagnostic utility of bile duct brush cytology in pancreaticobiliary diseases. A total of 46 cases with bile duct stricture were enrolled including 11 cases of benign stricture, 29 cases of bile duct carcinoma, 3 cases of gallbladder cancer, and 3 cases of pancreatic cancer. Both conventional smear and LBC using MonoPrep2(TM) system were conducted in each case. The cytological diagnosis of each case was classed into the following categories; benign, suspicious for malignancy, and malignancy. The diagnostic accuracy of both cytologic methods was investigated. LBC evidenced a high rate of material insufficiency (13/46), which was attributed to low cellularity. The kappa index of both cytological methods was 0.508. Cytological and tissue diagnoses were correlated in 25 cases conducted from biopsy or operation. The sensitivity, specificity, positive predictive value, and negative predictive value were 41.2% (7/17), 100% (8/8), 100% (7/7), and 44.4% (10/18) in conventional smear; 58.8% (10/17), 87.5% (7/8), 90.9% (10/11), and 50.0% (7/14) in LBC; and 94.1% (16/17), 87.5% (7/8), 94.1% (16/17), and 87.5% (7/8) in any one of both cytological methods, respectively. Based on these results, the sensitivity of LBC was found to be superior to that of conventional smear and we were able to obtain higher positive predictive value upto 94.1% by simultaneously conducting both cytologic methods.

ISUP/WHO Classification of Papillary Urothelial Neoplasms of Urinary Bladder: Consensus Study Conducted by Korean Society of Urogenital Pathology

BACKGROUND: Pathologic grading, one of the most important prognostic factors of papillary urothelial neoplasia (PUN) of the urinary bladder, has been revised continuously. The current study focused on the analysis of interobserver agreement on PUN of the urinary bladder bet- ween 1973 WHO classification (WHO 1973) and 1998 WHO/ISUP classification. METHODS: Seventy five cases from 15 institutions were collected, and after review by Korean Society of Urogenital Pathology (KSUP), 30 cases were selected as follows; group I, WHO grade 1 and papillary urothelial neoplasm of low malignant potential by ISUP (7 cases), group II, WHO grade 2 and low-grade papillary urothelial carcinoma (16 cases), and group III, WHO grade 3 and high-grade papillary urothelial carcinoma (7 cases). Seventy five general surgical pathologists who participated in this study were asked to grade the tumors based on WHO/ISUP classification. Interobserver agreement between the participants' diagnosis and KSUP consensus diagnosis was analyzed by kappa value. RESULTS: Interobserver agreement assessed by kappa value for all diagnostic groups was very low; for group I, kappa value was -0.900893722; for group II, -0.944650025, and for group III, -0.876728996. The overall kappa value of pathology residents was better than that of practicing pathologists. CONCLUSIONS: The 1998 WHO/ ISUP classification could not be easily translated from the 1973 WHO classification and because of poor interobserver agreement, it appears that further work would be needed before it can be practically applied.

Differentiation of Benign and Malignant Cystic Lesions of the Breast according to Sonographic Findings

PURPOSE: To classify the ultrasonographic findings of cystic lesions of the breast and correlated them with the pathology, to evaluate the characteristic features of cystic masses in benign and malignant tumors, and to determine the appropriate level of patient management according to the ultrasonographic findings. MATERIALS AND METHODS: From June 2002 through to June 2004, the ultrasonographic findings of 113 pathological proven cystic breast lesions were reviewed retrospectively. The cystic lesions were classified as simple acysts, clustered cysts, cysts with thin septa, complicated cysts, cystic masses with a thick wall/ septa or nodules, and complex solid and cystic masses. The ultrasonographic findings of each type of cystic lesion of the breast were compared with the pathology and evaluated according to whether they were benign or malignant. RESULTS: Of the 113 lesions, there were 17 simple cysts, 10 clustered cysts and 19 cysts with thin septa. Twenty four cases of complicated cysts were found to be benign. Five (31.3%) of the 16 cases of cystic masses with a thick wall / septa or nodules and 17 (63%) of the 27 cases of complex solid and cystic masses were found to be malignant. The shape and margin of the 43 cases of cystic masses with a solid component were analyzed. Seventeen out of 36 sonographical round or oval shaped masses and 10 out of 27 sonographical circumscribed margins were found to be malignant. CONCLUSION: The simple cysts, clustered cysts, cyst with thin septa and non-symptomatic complicated cysts detected by sonography were all benign. Symptomatic complicated cysts should be aspirated and treated appropriately. Cystic masses with a solid component should be examined by a biopsy with a pathological confirmation.

A Case of Goodpasture's Syndrome Combined with Crohn's Disease / 결핵및호흡기질환

A 29-year-old male patient was admitted due to his general weakness and poor oral intake for several months. He was diagnosed as having Crohn disease 16 years ago and total colectomy was performed 10 years ago. On the 3rd day after admission, gross hematuria and sudden hemoptysis combined with diffuse infiltration were noted on chest X-ray. His symptoms and the diffusely increased lung opacities improved with administering high-dose steroid therapy. Later, anti-GBM antibody was found to be positive on the laboratory findings. We report here on a rare case of Goodpsture syndrome combined with prolonged Crohn disease along with a review of literature.