A multicenter study of interobserver variability in pathologic diagnosis of papillary breast lesions on core needle biopsy with WHO classification

Background@#Papillary breast lesions (PBLs) comprise diverse entities from benign and atypical lesions to malignant tumors. Although PBLs are characterized by a papillary growth pattern, it is challenging to achieve high diagnostic accuracy and reproducibility. Thus, we investigated the diagnostic reproducibility of PBLs in core needle biopsy (CNB) specimens with World Health Organization (WHO) classification. @*Methods@#Diagnostic reproducibility was assessed using interobserver variability (kappa value, κ) and agreement rate in the pathologic diagnosis of 60 PBL cases on CNB among 20 breast pathologists affiliated with 20 medical institutions in Korea. This analysis was performed using hematoxylin and eosin (H&E) staining and immunohistochemical (IHC) staining for cytokeratin 5 (CK5) and p63. The pathologic diagnosis of PBLs was based on WHO classification, which was used to establish simple classifications (4-tier, 3-tier, and 2-tier). @*Results@#On WHO classification, H&E staining exhibited ‘fair agreement’ (κ = 0.21) with a 47.0% agreement rate. Simple classifications presented improvement in interobserver variability and agreement rate. IHC staining increased the kappa value and agreement rate in all the classifications. Despite IHC staining, the encapsulated/solid papillary carcinoma (EPC/SPC) subgroup (κ = 0.16) exhibited lower agreement compared to the non-EPC/SPC subgroup (κ = 0.35) with WHO classification, which was similar to the results of any other classification systems. @*Conclusions@#Although the use of IHC staining for CK5 and p63 increased the diagnostic agreement of PBLs in CNB specimens, WHO classification exhibited a higher discordance rate compared to any other classifications. Therefore, this result warrants further intensive consensus studies to improve the diagnostic reproducibility of PBLs with WHO classification.

PLAG1, SOX10, and Myb Expression in Benign and Malignant Salivary Gland Neoplasms

BACKGROUND: Recent findings in molecular pathology suggest that genetic translocation and/or overexpression of oncoproteins is important in salivary gland tumorigenesis and diagnosis. We investigated PLAG1, SOX10, and Myb protein expression in various salivary gland neoplasm tissues. METHODS: A total of 113 cases of surgically resected salivary gland neoplasms at the National Cancer Center from January 2007 to March 2017 were identified. Immunohistochemical staining of PLAG1, SOX10, and Myb in tissue samples was performed using tissue microarrays. RESULTS: Among the 113 cases, 82 (72.6%) were benign and 31 (27.4%) were malignant. PLAG1 showed nuclear staining and normal parotid gland was not stained. Among 48 cases of pleomorphic adenoma, 29 (60.4%) were positive for PLAG1. All other benign and malignant salivary gland neoplasms were PLAG1-negative. SOX10 showed nuclear staining. In normal salivary gland tissues SOX10 was expressed in cells of acinus and intercalated ducts. In benign tumors, SOX10 expression was observed in all pleomorphic adenoma (48/48), and basal cell adenoma (3/3), but not in other benign tumors. SOX10 positivity was observed in nine of 31 (29.0%) malignant tumors. Myb showed nuclear staining but was not detected in normal parotid glands. Four of 31 (12.9%) malignant tumors showed Myb positivity: three adenoid cystic carcinomas (AdCC) and one myoepithelial carcinoma with focal AdCC-like histology. CONCLUSIONS: PLAG1 expression is specific to pleomorphic adenoma. SOX10 expression is helpful to rule out excretory duct origin tumor, but its diagnostic value is relatively low. Myb is useful for diagnosing AdCC when histology is unclear in the surgical specimen.

The expression of FAS-associated factor 1 and heat shock protein 70 in ovarian cancer

OBJECTIVE: In this study, we evaluated the expression of FAS-associated factor 1 (FAF1) and heat shock protein 70 (HSP70) in normal ovary and ovarian cancer, and also analyzed the correlation between FAF1 and HSP70 in ovarian cancer. METHODS: The patient group consisted of 29 unrelated Korean women diagnosed as ovarian cancers and control samples were obtained from 7 patients who underwent oophorectomy for benign disease of uterus, and normal ovary was confirmed histologically from biopsy. We examined FAF1 and HSP70 expression by western blot analysis and immunohistochemical staining in normal ovary and ovarian cancer. Furthermore, we examined a correlation between FAF1 and HSP70 in ovarian cancer. RESULTS: The expression of FAF1 was lower in ovarian cancer than that in normal ovary (P=0.02), and the expression of HSP70 was increased in ovarian cancer in comparison to that in normal ovary (P=0.03). The expression of FAF1 was decreased in advanced stages (stage III or stage IV) as compared with early stages (stage I or stage II) (P=0.01). The expression of HSP70 was not significantly related with ovarian cancer histology (P=0.10), but the expression of HSP70 was most increased with papillary serous carcinomas and undifferentiated ovarian cancer. The expression of FAF1 was inversely correlated with the expression of HSP70 in ovarian cancer (Spearman correlation coefficience=-0.47). CONCLUSION: We concluded that the expression of FAF1 or HSP70 each seems to have a meaning as a biomarker for early detection of ovarian cancer. The expressions of FAF1 and HSP70 seem to be more valuable in predicting ovarian cancer when used together because of their inverse correlation. This is the first study about the expression of FAF1 in ovarian cancer and the correlation between FAF1 and HSP70 expression in ovarian cancer.

Association of the E-cadherin gene polymorphism with cervical intraepithelial neoplasm and cervical cancer in Korean population / 대한산부인과학회지

OBJECTIVE: The aim of this study was to explore the association between E-cadherin promoter -160C>A polymorphism and the risk of cervical cancer and cervical intraepithelial neoplasm (CIN) in a Korean population. METHODS: We investigate 107 patients with histopathologically confirmed cervical cancer, 119 patients with histopathologically confirmed CIN and 112 control group women who were surgically proven to have normal cervices. The genetic distribution of E-cadherin promoter -160C>A polymorphism were analyzed by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) of PCR products. RESULTS: We found no overall association between each individual E-cadherin promoter -160C>A genotype and the risk of cervical cancer and CIN. In the cervical cancer group, the allele frequency of C was 83.6%, in the control group 83.5%, showing no significant difference (p=0.941). Similarly, in the CIN group, the allele frequency of C was 81.9%, in the control group 83.5%, showing no significant difference (p=0.645). A subgroup analysis of the clinical parameters in CC, CA, AA genotype also showed no significant difference suggesting the lack of an association between E-cadherin promoter -160C>A polymorphism and cervix cancer stages (p=0.413), then its polymorphism and HPV infection (p=0.634). CONCLUSION: our results show that Korean women with specific polymorphism in E-cadherin promoter -160C>A are neither more susceptible to develop the cervical cancer or CIN nor more valuable for the cancer progression.

A Case of Adenoma Malignum of the Uterine Cervix / 대한산부인과학회지

Adenoma malignum is a well differentiated form of adenocarcinoma. Despite of benign histologic appearance, this tumor has malignant clinical course. Because of its rarity and subtle histologic changes, it may be missed. Therefore it has poor prognosis. Early diagnosis and early treatment is required by thorough examination. We report one case of adenoma malignum of uterine cervix with a brief review of the literature.

A Clinical Study of Pregnancy and Delivery in The Early Thirties / 대한산부인과학회지

OBJECTIVE: To access the pregnancy and delivery in the early thirties. METHODS: From January 1994 to December 2003, we statistically compared and investigated the 21,744 deliveries in Sung Ae Hospital, considering pregnant women aged 30-34 as study groups, and pregnant women aged 35 or older (elderly gravidas) as control groups. RESULTS: The rate of Cesarean section, preterm delivery, gestational diabetes, pregnancy-induced hypertension, placenta previa, placenta abruptio, low birth weight was low statistically in the study groups. But, the percentage of the pregnant complication in the early thirties were increased than of in pregnant women younger than 30. CONCLUSION: Pregnant women in the early thirties were safer from the maternal complication, and neonatal complication than women aged 35 or older (elderly gravidas), but were exposed to these illnesses more than women aged younger than 30. Therefore, to improve the pregnant outcome of women in the early thirties, it is needed to concern their pregnancy and delivery and to take care of before and after childbirth thorougly.