Yon Hee Kim

Expression of autophagy related proteins in invasive lobular carcinoma: Comparison to invasive ductal carcinoma

The purpose of this study is to investigate the difference in expression of metabolism-related proteins in invasive lobular carcinoma (ILC) compared to those of the invasive ductal carcinoma (IDC). Tissue microarray was manufactured for 114 cases of ILC and 692 cases of IDC. Immunohistochemical stains were performed as follows: glycolysis (Glut-1, hexokinase II, CAIX, MCT4), glutaminolysis (GLS1, GDH, ASCT2), mitochondria (ATP synthase, SDHA, SDHB), and serine/glycine metabolism (PHGDH, PSAT1, PSPH, SHMT1, GLDC) related proteins. Pleomorphic type (n = 12) of ILC revealed higher expression in hexokinase II, SDHB, and GLDC than classic type (n = 102) (p < 0.05). IDC showed a higher expression of glycolysis (Glut-1, CAIX, MCT4), glutaminolysis (GLS1, ASCT2), and serine/glycine metabolism (PSPH, SHMT1, GLDC) related protein than ILC in tumor cells, whereas ILC revealed higher expression in GDH, SDHA, PHGDH, and PSAT1 than IDC in tumor cells (p < 0.05). In addition, IDC demonstrated a higher expression of metabolism-related proteins than ILC in stromal tissue (p < 0.05). In ILC, tumoral GLDC positivity was correlated with higher nuclear grade (p = 0.026) and higher histologic grade (p = 0.026), and tumoral Glut-1 positivity correlated with higher histologic grade (p = 0.026). Additionally, tumoral PSPH positivity showed a significant correlation to ER negativity and PR negativity (p = 0.026). In conclusion, it reveals different expression patterns of metabolism-related proteins between IDC and ILC

A testing algorithm for detection of the B-type Raf kinase V600E mutation in papillary thyroid carcinoma

The B-type Raf kinase (BRAF) V600E mutation is a useful diagnostic marker for papillary thyroid carcinoma (PTC). We developed a testing algorithm for the BRAF mutation using BRAF immunohistochemistry (IHC) in PTC. Formalin-fixed, paraffin-embedded PTC tissues from 91 patients were immunostained with a BRAF V600E mutation-specific antibody. The immunostaining results were interpreted semiquantitatively by adding the scores of the proportion of positive cells (scored 0 to 5) and staining intensity (score 0 to 3). To validate BRAF IHC, 4 molecular methods were used: direct sequencing, pyrosequencing, peptide nucleic acid clamping polymerase chain reaction, and real-time polymerase chain reaction. The cut-off score of BRAF IHC for predicting the BRAF mutation was 5.5. In 68 cases, where the BRAF IHC score was 6 or more, 89.7% were positive for the BRAF mutation by 2 or more molecular methods and 97.1% by one or more methods. In 13 cases, where the IHC score was between 4 or more and less than 6, 61.5% were positive for the BRAF mutation by 2 or more methods and 69.2% by at least one method. In 10 cases, where the IHC score was less than 4, BRAF mutation was noted in one case only by one molecular method. BRAF V600E IHC scores of less than 4 or 6 or more should not require confirmation by additional tests. However, BRAF V600E IHC scores of 4 or 5 may require confirmation of the BRAF V600E mutation. In addition, BRAF IHC scores 6 or more were more sensitive than any single molecular method; therefore, BRAF IHC may overcome the limitations of using a single type of molecular method.

Perianal Paget's Disease

The incidence of extramammary Pagets disease (EMPD) is very low. An 84-year-old Korean man was treated with topical and oral medications at a local dermatologic clinic for a year, but the symptoms did not improve. He visited Severance Hospital and underwent a perianal skin biopsy and was finally diagnosed with EMPD. The authors performed a wide local excision according to a 1-cm margin around the lesion. For the skin and the soft tissue defects, bilateral inferior gluteal artery perforator flap transpositions were performed. The size of the lesion was 14 cm2 × 9 cm2, and the lateral and the basal margins were all disease free.

Primary omental yolk sac tumor

Extra-ovarian yolk sac tumor arising in the omentum is extremely rare. As yolk sac tumor originated from the omentum has been rarely reported, its clinical information is very limited. The authors encountered a case of yolk sac tumor originated from the omentum, and reported the case herein. A 32-year-old woman was presented with developed low abdominal distension for a month. Magnetic resonance imaging findings were suggestive of ovarian malignancy with ascites and peritoneal seeding nodules. Explorative laparotomy was performed and then the findings from frozen biopsy of omentum were suggestive of poorly differentiated tumor though whether it was primary or metastatic was uncertain. Thus, staging laparotomy were performed. Histopathology confirmed that the tumor was a yolk sac tumor of omentum origin. Then, 6 cycles of postoperative adjuvant chemotherapy at intervals of 3 weeks were performed using bleomycin, etoposide, and cisplatin regimen. Four-year outpatient follow-up thereafter showed no relapse.

Renal Histologic Parameters Influencing Postoperative Renal Function in Renal Cell Carcinoma Patients

Background Pre-existing non-neoplastic renal diseases or lesions may influence patient renal function after tumor removal. However, its description is often neglected or omitted in pathologic reports. To determine the incidence and clinical significance of non-neoplastic lesions, we retrospectively examined renal tissues obtained during 85 radical nephrectomies for renal cell carcinoma. Methods One paraffin-embedded tissue block from each case containing a sufficient amount of non-tumorous renal parenchyma was cut and processed with hematoxylin and eosin and periodic acid-Schiff methods. Non-neoplastic lesions of each histological compartment were semi-quantitatively and quantitatively evaluated. Results Among the various histologic lesions found, tubular atrophy, arterial intimal thickening, and glomerulosclerosis were the most common (94.1%, 91.8%, and 88.2%, respectively). Glomerulosclerosis correlated with estimated glomerular filtration rate at the time of surgery, as well as at 1- and 5-years post-surgery (p=.0071), but tubulointerstitial fibrosis or arterial fibrous intimal thickening did not. Post-hoc analysis revealed that glomerulosclerosis of more than 20% predicted post-operative renal function. However, its significance disappeared when gender and age were considered. Conclusions In conclusion, non-neoplastic lesions, especially with regard to glomerulosclerosis percentage, should be described in pathology reports to provide additional information on renal function decline.

Urinary Decoy Cell Grading and Its Clinical Implications

Background Examination of urine for decoy cells (DCs) is a useful screening test for polyomavirus (PV) activation. We explored the significance of the amount of DCs in persistent shedding, PV nephropathy and acute rejection. Methods A case-controlled study was performed in 88 renal allograft patients who had DCs detected at least once in four or more urine samples. Results Fifty one patients were classified into the high-grade shedding group (HG) and 37 patients into the low-grade shedding group (LG) according to DC shedding (≥10 or <10 DCs/10 high power field [HPF]). DC shedding of more than three consecutive months was significantly more prevalent in the HG as compared with their LG counterparts (p<0.0001). Urinary DCs were present for more than one year in 29.4% of the HG and 8.1% of the LG. Real-time polymerase chain reaction for PV was higher in both urine (51.4% vs. 11.1%) and plasma (9.1% vs. 0%) of the HG than the LG. The prevalence of PV nephropathy was higher in the HG than the LG (p=0.019). However, there was no significant difference in the prevalence of acute rejection. Conclusions Shedding of ≥10 DCs/10 HPF is associated with sustained shedding, polymerase chain reaction positivity and PV nephropathy, but not a predictor of acute rejection.