Laser capture microdissection shows HPV11 as both a causal and a coincidental infection in cervical cancer specimens with multiple HPV types.

AIMS: To identify, by laser capture microdissection (LCM), the cellular localization of HPV11 when present with carcinogenic HPV in invasive cervical cancer (ICC) specimens, and to relate this to p16(INK) (4a) expression. METHODS AND RESULTS: Three squamous cell ICC specimens showing coinfection with HPV11 and carcinogenic HPV16 or HPV31 were selected from the Institut Català d'Oncologia international survey of anogenital carcinomas, and coinfection was confirmed by SPF10 -DEIA-LiPA25 analysis. In two cases LCM-PCR identified HPV11 in low-grade and high-grade squamous intraepithelial lesions (SILs) adjacent to the ICC, and HPV16 or HPV31 in the ICC. In one case, HPV11 was the only genotype found in the ICC. P16(INK) (4a) expression was diffuse in ICC associated with carcinogenic HPV, but focal in ICC with HPV11. CONCLUSIONS: Our results confirm that a single cervical, cancerous or precancerous lesion is associated with a single HPV type. Detecting low-risk HPV as a coinfection in whole tissue from ICC does not prove a causal association. HPV11 may be found only in an adjacent SIL with carcinogenic HPV in the ICC. It is also found alone in carcinoma. LCM-PCR and differential P16(INK) (4a) expression can clarify the causal role of each type when multiple HPVs are present in whole tissue from carcinomas.

A Case of Cytomegalovirus Colitis with Nontuberculous Mycobacterium Infection in Immunocompetent Host

Cytomegalovirus(CMV) infections are common in immune compromised situations such as human immunodeficiency virus infection and organ transplantation. However CMV colitis had been rarely found in immunocompetent individuals. We experienced a case of an 83-year-old female patient, initially immune competent, who developed a massive lower gastrointestinal bleeding caused by CMV colitis. Previously, multiple antibiotics were used for nontuberculous Myco- bacterium and other bacterial infections after total knee arthroplasty. Colonoscopy revealed multiple ulcerations and mucosal congestion with hemorrhage. In spite of ganciclovir therapy, our patient did not recover.

Sulindac Prevents Esophageal Adenocarcinomas Induced by Gastroduodenal Reflux in Rats

PURPOSE: It is known that cyclooxygenase (COX)-2 expression is increased in Barrett's esophagus and esophageal adenocarcinomas. We studied COX-2 expression and the effect sulindac has on the genesis of Barrett's esophagus and adenocarcinoma in rats undergoing esophagogastroduodenal anastomosis (EGDA). MATERIALS AND METHODS: Fifty-one rats were divided into a control group (n=27), a 500ppm sulindac-treated group (n=15) and 1000 ppm sulindac-treated group (n=9). Randomly selected rats were killed by diethyl ether inhalation at 20 and 40 weeks after surgery. RESULTS: At 40 weeks, rats treated with 1000 ppm sulindac showed narrower esophageal diameter and milder inflammation than the control rats. At 40 weeks, the incidence of Barrett's esophagus was similar between control and sulindac-treated groups, but the incidence of adenocarcinoma was significantly lower in the 1000ppm sulindac-treated group than either the control or 500 ppm sulindac-treated groups. COX-2 was significantly increased in the lower esophagus of control rats killed at 40 weeks. Cyclin D1 expression was negligible in the sulindac- treated group compared with the control group. CONCLUSION: We suggest that the chemopreventive effect of sulindac is related to decreased COX-2 and cyclin D1 expression, which may be influenced by reduced inflammation.

A Case of Kaposi Sarcoma of the Bronchi and Gastrointestinal Tract in an AIDS Patient

Kaposi sarcoma is a rare tumor originated from skin in patients with immune suppressive illness like as acquired immunodeficiency syndrome (AIDS) or organ transplantation. It may be widely disseminated internally such as digestive or respiratory organ. In Korean patients with AIDS, Kaposi sarcoma is rarely seen rather than western countries. The reason is unknown. Although few cases of Kaposi sarcoma in patients with AIDS had been described in the Korean literatures, multi-organ involved cases were extremely rare. We describe a case of old AIDS patient in whom Kaposi sarcoma had affected multi-organs including esophagus, stomach, duodenum, colon, bronchi and skin.

Malignant Mixed Mullerian Tumor Arising from Adenomyosis of Uterus

Malignant mixed mullerian tumor (MMMT) is an unusual tumor composed of malignant epithelial and nonepithelial components in the same lesion and is subdivided into homologous and heterologous types. Epidemiologically, these tumors are associated with prior pelvic irradiation, functioning ovarian lesions, exogenous estrogen therapy and rarely endometriosis. We experienced a case of uterine MMMT which arose from adenomyosis in a 47-year-old woman who had no specific past medical history. The posterior uterine corpus showed a 3.5x3.0x2.0 cm sized, relatively well defined tumor mass within the background of the adenomyosis. The tumor was composed of well differentiated endometrial adenocarcinoma and sarcomatous stroma with foci of rhabdomyosarcomatous differentiation confirmed by immunohistochemical and electron microscopic studies. Through the immunohistochemical study, both the epithelial and nonepithelial components were positive for cytokeratin and it suggested that the sarcomatous area originated from metaplasia of the adenocarcinoma component. From the overall findings, it is regarded as an uterine heterologous MMMT which arose from adenomyosis.

Adult Wilms' Tumor: Monomorphous Epithelial, Tubular, Variant

Adult Wilms' tumor, unlike that of childhood, is a rare disease. Microscopically, the tumor is fundamentally characterized by triplastic embryonal renal tumor composed of variable amounts of metanephric blastema and its epithelial and stromal derivatives but rarely a small group of tumors composed virtually entirely of differentiated epithelial derivatives, the abundance of tubular structures. These monomorphous epithelial type of Wilms' tumor tended to have an early onset and benign course. Grossly, classic Wilms' tumor is a solid tumor, but very rarely shows cystic change and may lead to misinterpretation as a polycystic kidney or multicystic nephroma. Here, we reports a case of primary renal tumor, grossly very similar to a multicystic kidney but histologically represent a tubular monomorphous epithelial variant of Wilms' tumor occured in 63 year old male adult.

Hyperplasia, Metaplasia, and Dysplasia of the Gallbladder Correlation to Gallbladder Adenocarcinoma

The correlation of metaplasia to dysplasia and carcinoma in the gallbladder has attracted the attention of many investigators. We mapped and examined a total of 263 cholecystectomized gallbladders to analyze the mucosal changes in the carcinogenesis of the gallbladder. Stones were present in 59.7%, hyperplasia in 28.5%, metaplasia in 55.5% (gastric 37.6%, intestinal 17.9%), dysplasia in 17.1% (low grade 9.1%, high grade 8%) and carcinoma in 7.6%. Metaplasia was more frequently identified in the stone-positive group (62.4%) than in the stone-negative group (45.3%) (P<0.05). Especially, the incidence of intestinal metaplasia was significantly higher in the stone-positive group. Dysplasia and carcinoma were more frequent in the metaplasia-positive group (dysplasia 26.7%, carcinoma 11%) than in the metaplasia-negative group (dysplasia 5.1%, carcinoma 3.4%) (P<0.05). Their incidences were significantly higher in the intestinal metaplasia than in the gastric metaplasia. Forty four percent of the dysplasia-positive cases were associated with carcinoma in the adjacent mucosa but carcinoma was absent in the dysplasia-negative cases. Hyperplasia did not reveal any significant correlation with metaplasia, dysplasia and carcinoma. These results suggest that gallstone is causally related to the metaplasia in the gallbladder and the metaplasia-dysplasia- carcinoma sequence exists in the gallbladder.

Pathologic Analysis of Gallbladder Cancer by the Stage and Intestinal Metaplasia with the Diagnostic Significance of CEA and p53

Twenty cases of gallbladder cancers were examined using 5 mm stepwise tissue sections. We analyzed the clinicopathologic findings of the early (stage 1, II) and advanced carcinoma (stage III, IV, V) and those of carcinoma with or without metaplasia in the tumor. We also performed CEA and p53 immunohistochemical staining and compared their findings with those of normal mucosa and preneoplastic lesions. The results were as follow: 1) All of the early carcinomas (n=5) were incidentally diagnosed after the resection for the gallstone. They were compared to advanced carcinoma (n=15) in the absence of the lymphatic or angioinvasion, recurrence, metastasis and death. 2) Metaplastic and non-metaplastic carcinoma did not reveal any difference of the clinicopathologic findings except age distribution. 3) CEA and p53 were positive in preneoplastic and malignant lesions. The extent of staining was related to the degree of the atypia. From the above results, an early detection of gallbladder cancer is very important for the prognosis of the patients. Since preoperative diagnosis is difficult, thorough pathologic examination of routinely resected gallbladder is necessary for the early diagnosis. CEA and p53 immunohistochemical staining may be helpful in the differential diagnosis of non-neoplastic and neoplastic lesion of the gallbladder.

The Significance of the Expression of p53, E-cadherin, nm23, CD44, and Tumor Angiogenesis in Colorectal Adenocarcinoma

Many oncogenes and tumor supressor genes have been identified and studied in colorectal carcinoma. Among them, p53 is a tumor supressor gene and its mutation is frequently noted in human tumors. E-cadherin is a cell adhesion molecule and associated with tumor differentiation. CD44 is a cell surface glycoprotein that plays a role in cell migration and metastasis. nm23 is a gene known to lower metastatic potential of tumors and has been proposed to be a metastasis supressor gene. Tumor angiogenesis is required for the expansion of the primary tumor and metastasis and its degree is related to the potential of malignancy. We studied the expression of p53, E-cadherin, nm23, CD44 and tumor angiogenesis in 36 cases of colorectal adenocarcinomas. They were compared with previously known prognostic factors such as the stage, tumor size, depth of invasion, differentiation, presence of lymphatic or venous invasion, the lymph node and distant metastasis. The results were as follows. 1) The expression of p53 was not significantly associated with any prognostic factors. 2) The expression of E-cadherin was significantly associated with tumor differentiation. In the well differentiated adenocarcinomas, its expression was higher than in the poorly differentiated adenocarcinoma. 3) The expression of nm23 was also significantly associated with tumor differentiation. In carcinoma with lymph node metastasis, the expression of nm23 was reduced, but statistically it was not significant. 4) The expression of CD44 was higher in tumors with lymph node metastasis than in tumors without lymph node metastasis, but it was not statistically significant. 5) The degree of microvessel density was significantly associated with lymphatic invasion. According to the above results, the expression of E-cadherin and nm23 are related to the differentiation of the tumor and tumor angiogenesis is related to the lymphatic invasion of the colorectal adenocarcinoma.

Gallstone formation and gallbladder mucosal changes in mice fed a lithogenic diet

To investigate the pathologic change of gallbladder mucosa related to gallstone formation, 52 mice were fed a lithogenic diet containing 1% cholesterol and 0.5% cholic acid and we evaluated the sequential morphologic changes in the gallbladder from two days to 40 weeks. Cholesterol gallstones began to appear after two weeks and all the mice had gallstones after eight weeks. At two days, the mitotic index was at its highest. The gallbladder mucosa showed progressive hyperplastic change with earlier papillary projection of the folds and later inward proliferation. At the same time of stone formation, mucous cells forming glands appeared. Their histochemical profile of mucin was different from that of normal epithelium. Numbers of mucous cells increased gradually until 24 weeks but slightly decreased afterward. These results suggest hyperplasia and metaplasia are closely related to the gallstone formation. Hyperplasia is probably reactive to irritating effect of lithogenic bile or stone. Metaplasia and cholesterol gallstone may develop simultaneously, and act synergistically.

Bronchus-Associated Lymphoid Tissue Lymphoma

Malignant lymphoma arising from mucosa-associated lymphoid tissue (MALT) represents distinct clinicopathologic features and remains localized for prolonged periods. We report a case of low grade B cell lymphoma of bronchus-associated lymphoid tissue (BALT). A 60-year-old female had a long-standing cough, sputum and intermittent fever for 10 years. In 1984, the chest radiography showed increased hazy density in both upper lungs. Although she had been treated by antituberculous medication under clinical diagnosis, there was no improvement. In 1995, open lung biopsy was carried out. Histologically, it showed massive nodular or diffuse infiltration of centrocyte-like cells in bronchus and parenchyme with pleural invasion. On immunohistochemical stain, they were positive for LN-2 and L26 and negative for UCHL-1, LN-1 and LN-3. In polymerase chain reaction (PCR), Ig heavy chain gene rearrangement was detected. The patient was well for 6 months after the biopsy.

Amniotic Band Syndrome: An autopsy case report

We report an autopsy case of amniotic band syndrome exhibiting microcephaly, asymmetric encephalocele, microphthalmia, nasal deformity, cleft lip and palate accompanied by left maxillary and zygomatic bone deformities. The amniotic membrane of the placenta was also attached to the herniated brain. The twenty-year-old primigravid mother had no history of taking drug, irradiation, infection or trauma before or during pregnancy.

A Pathologic Study on the Common "Epithelial" Tumor of Ovary

One hundred eighty-six cases of ovarian common "epithelial" tumor including 28 endometriosis were reviewed, from the pathology file of the department of pathology of the National Medical Center during a period of 8 years and 6 months from January 1976 to June 1984. The study consisted of 14 cases(77.4%) of benign tumor including 28 cases of ovarian endometriosis, and 21 cases(11.3%) of borderline malignancy and 21 cases(11.3%) of invasive malignant tumors. Among benign common "epithelial" tumors, mucinous cystadenoma(69 cases) was the most frequent tumor, followed by serous cystadenoma (42 cases) and Brenner tumor (5 cases). Of borderline tumor, borderline mucinous tumor (18 cases) was more frequent than serous tumor (3 cases). Serous cystadenocarcinoma(9 cases) was the most frequent malignant tumor, followed by mucinous cystadenocarcinoma(6 cases), endometrioid carcinoma(3 cases) and undifferentiated carcinoma(3 cases). Most ovarian common "epithelial" tumors were prevalent during the reproductive age, but malignant tumors were more prevalent after the age of 40. Although right side was more frequently found (85 vs. 67) there is no significant site predilection. Bilaterality was the most common in undifferentiated carcinoma(66.7%), followed by serous cystadenocarcinoma(44.4%) and Brenner tumor(40%). The size of tumor tended to be larger in malignant tumor than benign. Mucinous tumor were usually larger than serous tumor. There were 7 intrauterine and 1 ectopic tubal prognancy which were associated with ovarian common "epithelial" tumors. Three cases of tumors were excised during Cesarian section. In summary these findings are comparable to other reports in Korea and English literatures. Histologic analysis of borderline and malignant epithelial tumor was done to emphasize their biologic behavor. Further study is required to compare their histological grading and clinical staging with thier survival rate.

Cytologic and Histologic Findings of Acinic Cell Carcinoma of the Salivary Gland Related to Malignant Behavior: 2 Cases Report / 대한세포병리학회지

Acinic cell carcinoma is a slow-growing solid neoplasm of salivary gland. Although their cytological and histological finding is bland-looking, their biological behavior is unpredictable. We experienced two cases of acinic cell carcinoma of the salivary gland diagnosed by fine needle aspiration biopsy and confirmed by tissue examination. They showed different clinical courses. We compared their cytologic and histologic findings. The first case was a right preauricular mass in a 58 year-old female of 3 years duration. The cytologic smear revealed sheets or small clusters of monotonous cells mimicking normal serous acinar cells with little cellular pleomorphism. She underwent superficial parotid lobectomy. The tumor was a well demarcated 1.5cm sized nodular mass without infiltration into surrounding parenchyme. The second case was a left submandibular mass in a 23 year-old male of 4 years duration. The smear showed more severe pleomorphism of the tumor cells than those of previous case. Excisional biopsy was done. The excised tumor was 5.5*3.5*3cm sized multilobulated solid mass with invasion into surrounding parenchyme. The tumor recurred after 20months, thus total excision of the mass and modified radical neck dissection was carried out. From the above findings, cytologic atypism, infiltrative growth pattern and type of initial therapy may be correlated with biologic behavior.

Angiofollicular Lymph Node Hyperplasia(Castleman's disease): 3 cases report

Angiofollicular lymph node hyperplasia(AFLNH) was first described in 1956 by Castleman et al. It was initially reported as a solitary mediastinal mass but multicentric and extranodal disease is now well known. Histologically two distinct variants, e.g. the hyaline vascular type and the plasma cell type, of AFLNH are recognized. And the plasma cell type is typically associated with clinical syndrome consisting of fever, anemia, elevated erythrocyte sedimentation rate and polyclonal hypergammaglobulinemia. Recently, we experineced three cases of AFLNH. Histologically, two cases were hyaline vascular type, that were presented as a right supraclavicular mass of 49-year-old female, and as an anterior mediastinal mass of 53-year-old female. The remaining one case was plasma cell type that was presented as a left axillary mass of 63-year-old male. The former two cases showed typical features of hyaline vascular type but in case 1, exuberant proliferation of hyalinized vessels of capillary size was characteristic feature. The latter case of plasma cell type characteristically showed clinical syndrome consisting of fever, hypoalbuminemia, polyclonal hypergammaglobulinemia. All cases were presented as a single mass and they were well after surgical excision.

A Study of Nucleolar Organizer Regions in Normal and Neoplastic Epithelial Cells of Stomach

Nucleolar organizer regions are DNA loops encoding rihbosomal RNA production and detectable by the argyrophilia of their associated proteins(AgNORs). AgNOR numbers correlate with cellular proliferating activity. Many studies have shown a significnt difference in AgNOR counts between benign and malignant tumors. AgNOR counts were also helpful in differential diagnosis. For the evaluation of its diagnostic utility in gastric lesions, a silver staining technique was carried out in paraffin sections of 5 control cases, 5 benign peptic ulcers, 7 hyperplastic polyps, 10 tubular adenomas, 16 early gastric adenocarcinomas and 15 advanced gastric adenocarcinomas. The results were as follows. The mean numbers of AgNORs in early and advanced gastric adenocarcinomas(1.94 and 2.16) were significantly higher than those of normal foveolar epithelium(1.43) and epithelia of benign gastric ulcers(1.54), hyperplastic polyps(1.64) and tubular adenomas(1.79). In malignancy, there was increased variability in size and shape of AgNORs. There was little differences in mean AgNOR numbers between early and advanced gastric adenocarcinomas. Differentiation of the tumor made no difference in AgNOR numbers. From the above results, the AgNORs count, if its morphologic change are taken into consideration, is helpful in differentiation between malignant and non-malignant lesions.

Intra-abdominal Angiosarcomatosis Induced by Irradiation

Therapeutic irradiation can induce angiosarcoma. Radiation-induced angiosarcoma constitutes 20% of all angiosarcomas. Although its common site of origin is the skin and subcutaneous tissue, it rarely arises in small or large bowels with a presentation as multifocal abdominal angiosarcomatosis. We report a case of intra-abdominal angiosarcomatosis involving the jejunum, ileum, transverse colon, mesentery and right ovary in a 63-year-old female. It developed 10 years after therapeutic irradiation for squamous cell carcinoma of uterine cervix. She developed panperitonitis due to intestinal perforation. She died from sepsis 3 days after segmental resection of the small bowel and right oophorectomy. We reviewed the previously reported cases and describe the clinicopathologic features of this tumor.

Polymorphic Reticulosis

Polymorphic reticulosis(PMR) is a unique clinicopathological entity of unknown etiology, which commonly present as an aggressive, necrotizing lesion of the upper respiratory tract. It is a separate nosologic entity from Wegener's granulomatosis and idiopathic mildine destructive disease. The origin of the cells composing polymorphic reticulosis has been controversial. We reviewed 15 cases of polymorphic reticulosis with respect to clinical and histologic bases, and immunohistochemical studies were done using UCHLI (CD45RO), as a T cell marker, CD-20 as a B cell marker and alpha- I -antichymotrypsin as a histiocytic marker. Almost all cases showed characteristic histologic and immunohistochemical features similar to those of peripheral T cell lymphoma. Thus, this study indidcated that polymorphic reticulosis is a type of malignant lymphoma of T cell lineage.

Cytophagic Histiocytic Panniculitis: 2 cases report

Cytophagic histiocytic panniculitis is a rescently described histiocytic disorder. It is characterized by the presence of fever, pancytopenia, and subcutaneous nodules resulting from the infiltration of lympho-histiocytes in the dermis and subcutaneous adipose tissue. The characteristic findings is presence of bean-bag histiocytes containing phagocytized red blood cells, lymphocytes, and platelets. We experienced two cases of cytophagic histiocytic panniculitis with hard and erythematous subcutaneous nodules. These skin lesions exhibited infiltration of the subcutaneous tissue by large, benign histiocytes with cytophagic features. Hemophagocytic histiocytes were observed in the cervical lymph node in case 1, and bone marrow in case 2. One patient is alive, while the other one died with hemorrhagic complications.

Fine Needle Aspiration Biopsy for Metastatic Cervical Lymphadenopathy / 대한암학회지

PURPOSE: This study was intended to evaluate the value of the FNAB in the diagnosis of the suspected metastatic cervical lymphadenopathy. MATERIALS AND METHODS: 221 patients diagnosed as metastatic cervical lymphadenopathy by FNAB from Jan., 1990 to Oct., 1994 were analyzed retrospectively. They represented 92.1% of metstatic cervical lymphadenopathy managed and 15.7% of 1,411 FNAB's performed during the same period. 33 cases with lymphoma were excluded in this study. RESULTS: In 107 patients with cervical lymphadenopathy who also received confirmatory node biopsy, the sensitivity, specificity, positive and negative predictive values of FNAB for the metastatic cervical lymphaenopathy were 79.3%, 100%, 100% and 44.1% respectively. In 76 (33.4%) patients the histopathologic types of the primary cancers were decided by information gained from FNAB alone. There were two kinds of tendency that GI cancers metastasized to left-sided cervical nodes (88.1%) and breast and lung cancers to ipsilateral supraclavicular nodes in high frequencies (94.1% and 86.8%, respectively). No complications were associated with FNAB. CONCLUSION: FNAB is a simple, rapid, inexpensive and highly specific diagnostic tool in the evaluation of suspected metastatic cervical lymphadenopathy. The sensitivity and negative predictive value, however, are relatively low. When the clinical findings strongly suggest metastatic lymphadenopathy, the negative FNAB should be followed by confirmatory biopsy. Information gained from it guides further diagnostic and therapeutic plans. Surrounding normal tissues are not damaged, and the theoretical hazards of local implantation of tumor cells and complication are negligible.