Jee Yeon Kim

Comparison of Polymerase Chain Reaction With Histopathologic Features for Diagnosis of Tuberculosis in Formalin-Fixed, Paraffin-Embedded Histologic Specimens

Objective.-To investigate the relationship between various histopathologic features and the results of the tuberculosis (TB)-polymerase chain reaction (PCR) method in routinely submitted histologic specimens for the histopathologic diagnosis of TB. Design.-We used 95 formalin-fixed, paraffin-embedded tissue blocks from 81 patients who were clinically suspected of having TB. We assessed the presence of histopathologic features including well-formed granuloma, poorly formed granuloma, caseous necrosis, and Langhans-type giant cells. We performed nested PCR for IS6110 and Ziehl-Neelsen staining for acid-fast bacilli (AFB). Results.-Of the 81 patients studied, 53 patients had chronic granulomatous inflammation, whereas 28 patients had only chronic inflammation without definite granulomatous inflammation. Of the 53 cases with chronic granulomatous inflammation, 17 (32%) were AFB positive and 36 (68%) were TB-PCR positive. Among cases with chronic granulomatous inflammation, the percentage that were positive and negative by TB-PCR differed significantly with the presence of various histopathologic features. All of the 13 cases with well-formed granuloma, caseous necrosis, and Langhans-type giant cells were TB-PCR positive; however, 10 (36%) of the 28 cases with chronic inflammation without granulomatous lesions were also TB-PCR positive. Conclusions.-TB-PCR is a rapid, sensitive method for the diagnosis of TB in routinely processed formalin-fixed, paraffin-embedded histologic specimens and is readily available in histopathology laboratories. We recommend use of TB-PCR when TB is suspected clinically, especially in cases of chronic inflammation without definite evidence of granulomatous inflammation.

Solitary fibrous tumour of the thyroid

Solitary fibrous tumours of the thyroid are quite rare; only four cases have been reported recently. Although originally regarded as a serosa-associated neoplasm since the first description by Klemperer and Rabin in 1931, recent reports of a solitary fibrous tumour arising from the various extraserosal and even solid organs support its origin from mesenchymal rather than mesothelial cells. We report a case of solitary fibrous tumour of the thyroid with histologic, ultrastructural and immunohistochemical findings.

Expression of cancer-testis antigens MAGE-A3/6 and NY-ESO-1 in non-small-cell lung carcinomas and their relationship with immune cell infiltration.

Cancer-testis antigens (CTAs) are expressed only in many cancers and limited immunoprivileged sites such as the testis and placenta. Dendritic cells (DCs) and CD8+ T lymphocytes (CTLs) play roles in the immune responses to tumor growth and may affect the prognosis of cancers. This study was designed to investigate the clinicopathologic significance of CTA expression in non-small-cell lung carcinomas (NSCLCs) and its relationship with immune cells. Immunohistochemical staining to CTAs such as MAGE-A3/6 and NY-ESO-1 was performed using paraffin blocks from 132 cases of NSCLCs, including 75 cases of squamous cell carcinoma (SqCC) and 57 cases of adenocarcinoma (AdC), and the results were evaluated to correlate with tumor-infiltrating DCs and CTLs and clinicopathologic features. MAGE-A3/6 and NY-ESO-1 were expressed in 50.0% (66/132) and 18.2% (24/132) of NSCLCs, respectively. MAGE-A3/6 was expressed more frequently in SqCC than in AdC, but the expression of NY-ESO-1 showed no difference in both types. CTAs revealed a higher expression in male than in female. In advanced stage III, NY-ESO-1-positive patients showed poorer survival than NY-ESO-1-negative patients. Otherwise, the CTA expression did not correlate with clinicopathologic parameters. No relationship was found between DC and CTL infiltration in all NSCLCs. Regarding DC infiltration, the group showing negative expression to CTAs displayed an even higher number of infiltrating DCs than those showing positivity to one or the other or both CTAs. Although the aberrant expression of MAGE-A3/6 and NY-ESO-1 in NSCLC did not directly influence clinical prognostic factors, the higher expression of MAGE-A3/6 in SqCC suggests its value as a potential target for immunotherapy in this type of NSCLC. The inverse relationship between DCs and CTA expression may indicate that CTA-positive tumor cells would be akin to tumor stem cells escaping host immune response.

Recommendations for the management of cystic thyroid nodules

Background:  The management of cystic thyroid nodules has not been standardized with respect to an initial fine‐needle aspiration cytology (FNAC) cystic change result, which is defined as fluid aspiration and a smear with numerous macrophages but scant or no follicular cells. In the present study the physical characteristics of cystic thyroid nodules predictive of the pathology were investigated, and recommendations made on their management.

Ciliated adenocarcinomas of the lung: a tumor of non-terminal respiratory unit origin

Whereas most carcinomas occur through a sequential step, atypical adenomatous hyperplasia and bronchioloalveolar carcinoma pathway is known for pulmonary adenocarcinoma. This type is known as terminal respiratory unit adenocarcinoma. Based on our observation of transitions from normal ciliated columnar cells to adenocarcinoma via dysplastic mucous columnar cells, we reviewed our archive of pulmonary adenocarcinoma. Terminal respiratory unit type adenocarcinoma was defined as adenocarcinoma with type II pneumocyte, Clara cell, or bronchiolar cell morphology according to previous reports. Among 157 cases, 121 cases have been identified as terminal respiratory unit type adenocarcinoma and 36 cases as non-terminal respiratory unit type adenocarcinoma. Among non-terminal respiratory unit type adenocarcinoma, 24 cases revealed mucous columnar cell changes that were continuous with bronchial ciliated columnar cells. The mucous columnar cells became dysplastic showing loss of cilia, disorientation, and enlarged nuclei. Adenocarcinoma arose from these dysplastic mucous columnar cells and, characteristically, this type of adenocarcinoma showed acute inflammation, and honeycombing changes in the background. TTF1 immunostaining was consistently negative. In a case study with 14 males and 10 females, including 12 smokers or ex-smokers, EGFR and KRAS mutations were detected in 3 and 6 patients, respectively. We think that this kind of adenocarcinoma arising through mucous columnar cell change belongs to non-terminal respiratory unit type adenocarcinoma, and mucous columnar cell change is a precursor lesion of pulmonary adenocarcinoma.

Novel epitheliomesenchymal biphasic stomach tumour (gastroblastoma) in a 9-year-old: morphological, usltrastructural and immunohistochemical findings

Gastroblastoma is a rare gastric epitheliomesenchymal biphasic tumour composed of spindle and epithelial cells, reported by Miettinen et al in a series of three cases in 2009. All those cases arose in stomachs of young adults. Neither the epithelial nor the mesenchymal component displayed sufficient atypia to diagnose a carcinosarcoma or other malignancy. On immunohistochemistry, the epithelial component expressed cytokeratin, and the mesenchymal component was positive for vimentin and CD10. Miettinen et al designated these neoplasms as gastroblastomas based on their similarities with other childhood blastomas such as pleuropulmonary blastoma and nephroblastoma. This report describes a probable fourth case of this unique type of neoplasm. The present case arose in the gastric antrum of a 9-year-old boy. While similarities were evident with the other cases, there were some differences. The epithelial component was more predominant and showed more mature morphology. Immunohistochemically, the epithelial component showed immunolabelling for c-KIT and CD56. The mesenchymal component was only focally positive for CD10. Ultrastructually, desmosomes and microvilli were found supporting a truly epithelial lesion.

Primary Alveolar Soft Part Sarcoma of the Lung

Alveolar soft part sarcoma (ASPS) is a rare epithelial-like soft tissue sarcoma. The two main sites of its occurrence are the lower extremities in adults and the head and neck in children. Primary pulmonary involvement of this sarcoma, without evidence of soft tissue tumor elsewhere, is very exceptional. We present a case of primary ASPS of the lung in a 42-yr-old woman. A computed tomographic scan of the thorax demonstrated a well-circumscribed, solid tumor located in the right upper lobe. The mass was resected by right upper lobectomy. After 5 months, three metastatic lesions, involving lumbar vertebrae and occipital scalp, were found. Histologically, the tumor consisted of alveolar nests of large polygonal tumor cells, the cytoplasm of which frequently revealed periodic acid-Schiff-positive, diastase-resistant intracytoplasmic rod-like structures. On immunohistochemical staining, the tumor cells were positive only for vimentin and alpha-smooth muscle actin. Ultrastuctural study using electron microscopy revealed characteristic electron-dense, rhomboid intracytoplasmic crystals.

Polycomb protein EZH2 expression in diffuse large B-cell lymphoma is associated with better prognosis in patients treated with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone.

Abstract Polycomb group (PcG) proteins are evolutionarily conserved regulators of gene expression that contribute to normal lymphocyte development, and are involved in malignant transformation of these cells. Recently, BMI1 and EZH2 have been shown to be involved in lymphomagenesis and oncogenesis. We tried to elucidate the role of EZH2 as a prognostic factor for diffuse large B-cell lymphoma (DLBCL). High-level expression of EZH2 (EZH2 ≥ 70%) was associated with superior overall survival (OS) of 85.8% compared to low expression (EZH2 < 70%), with OS of 44.5% (p = 0.005). Subgroup analysis showed that the activated B-cell (ABC) subtype with high EZH2 expression had the highest overall survival (p = 0.011). In analysis of EZH2 expression within low International Prognostic Index (IPI) score, high EZH2 expression had a significant statistical correlation with longer OS (p = 0.034). With high IPI score, high EZH2 expression tended to be associated with longer OS (p = 0.130). Our results showed that EZH2 expression had a high prognostic relevance to survival outcomes. We demonstrated that DLBCL was associated with increased expression of the EZH2 PcG protein and Ki67. The distribution of EZH2 expression was wider than that of Ki67. In summary, increased EZH2 expression of tumor cells was associated with improvements in OS.

Reticulated Myxoid Tumor of the Tongue: 2 Cases Supporting an Expanded Clinical and Immunophenotypic Spectrum of Ectomesenchymal Chondromyxoid Tumor of the Tongue

An ectomesenchymal chondromyxoid tumor (ECMT) is a rare neoplasm that exclusively occurs in the anterior dorsum of the tongue. The tumor consists of small round to fusiform or spindle cells with myxoid or chondroid stroma. The tumor consistently shows a positive reaction with glial fibrillary acidic protein antibodies, especially polyclonal antibodies. We report 2 cases of reticulated myxoid tumors arising in the tongue. One tumor occurred in the posterior dorsum of the tongue and another in the anterior. Both tumors showed characteristic morphology of ECMT; however, both were negative for reactions with monoclonal and polyclonal glial fibrillary acidic protein antibodies. On the basis of morphology, they are thought to be belonging to ECMT. Hence, we suggest that ECMT can show broader spectrum of clinical and immunophenotypic feature.

Malignant Osteoclast-like Giant Cell Tumar of the Kidney with Osteosarcomatous Transformation

Malignant giant cell tumor of osseous or extraosseous origin is extremely rare, and diagnosis is reserved for those lesions that display bizarre mitosis and cytological atypia or an association with sarcoma.1 Heller et al first reported malignant giant cell tumor of the kidney without accompanying sarcoma or carcinoma.2 Their case showed a high mitotic index, variable cytological atypia in mononuclear stromal cells and widespread metastasis of perirenal tissue. We report an unusual case of malignant giant cell tumor of the kidney with osteosarcomatous transformation. CASE REPORT