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Fine Needle Aspiration Cytology of Follicular Neoplasm of the Thyroid
조경자,장자준,Cho, Kyung-Ja,Jang, Ja-June The Korean Society for Cytopathology 1993 대한세포병리학회지 Vol.4 No.2
갑상선의 세침흡인 세포학적 검사에서 가장 문제가 되는 점은 여포상 종양의 진단이다. 세포학적 소견만으로는 증식성 결절성 갑상선종, 여포성 선종 및 분화가 잘 된 여포상 암종 간의 감별 진단이 매우 어려운 경우가 많다. 저자들은 최근 4년 5개월 간에 조직학적으로 확진된 여포상 종양 중 수술 전에 적합한 세포학적 검사가 시행된 15예를 대상으로 그 세포학적 소견을 재검토하였다. 여포상 선종 6예의 흡인 도말은 공 모양 또는 합포체를 형성하는 다량의 여포성 세포를 함유하고 있었고, 경도의 핵 다형성 및 작은 핵소체가 각각 2예에서 관찰되었다. 배경은 출혈성으로 교질 성분은 매우 적거나 없었다. 여포상 암종 9예도 기본적으로 선종과 유사한 세포학적 소견을 보였는데, 세포밀도가 좀더 높고, 세포집단의 모양이 더 크고 불규칙하였으며, 흩어진 개별 종양세포가 많은 것이 차이점이었다. 핵의 다형성 및 눈에 띄는 핵소체가 선종에서 보다 많은 6예 및 5예에서 각각 관찰되었으나 그 정도는 심하지 않았다. 대부분의 암종과 1예의 선종에서 종양세포 집단에 밀착한 혈관 내피세포가 관찰되었다. 전반적으로 여포상 선종 및 암종은 미미한 차이를 보여서 세포학적으로 확실히 구별하기는 어려웠으나, 많은 수의 개별 세포와 종양세포 간에 포착된 혈관내피세포의 존재는 양성보다는 악성을 시사하는 소견으로 생각되었다. 여포상 종양의 세포학에 좀더 관심을 가짐으로써 그 발견율을 현저히 높일 수 있다고 생각된다. The major limitation of fine needle aspiration of the thyroid is in the evaluation of follicular tumors. it may be difficult or occasionally, impossible to distinguish on a cytologic basis, between hyperplastic nodular getter, follicular adenoma and well differentiated follicular carcinoma. We reviewed cytologic presentations of 15 histologically confirmed follicular neoplasms of the thyroid. Aspiration smears of 6 follicular adenomas were cell-rich with ball-like or syncytial aggregates of monotonous follicular cells, in contrast to honeycomb-like flat sheets of adenomatous goiter Mild nuclear pleomorphism and a small visible nucleolus were noted in 2 cases, respectively. Nine cases of follicular carcinoma showed very high cellularity, irregularly shaped cell clusters, and numerous isolated tumor cells. Nuclear pleomorphism and visible nucleoli were noted in 6 and 5 cases, respectively. Another characteristic finding, entrapped endothelial cells within the ceil clusters, was noted in 7 carcinomas and 1 adenoma. The background of the smears of all follicular neoplasms was hemorrhagic, with no or scanty colloid. We confirmed that the cytologic features of follicular adenoma and carcinoma were similar in general, with subtle differences in cell morphology, but the presence of isolated tumor cells and entrapped endothelial cells was suggestive of malignancy.
흰쥐에서 유리섬유의 피하삽입에 의한 경시적 병리조직학적 변화
이민재,조수헌,장자준,Lee, Min-Jae,Cho, Soo-Hun,Jang, Ja-June 대한예방의학회 1997 예방의학회지 Vol.30 No.1
To exanime in vivo tissue reactions of glass fibers, we injected glass fibers to rats subcutaneously. We made fibers of average dimensions of approximately $2{\mu}m$ in diameter and $60{\mu}m$ in length. After instilation of glass fiber we sacrificed rats sequentially at 1, 3 and 6 months. At 1 month after injection of glass fibers, the exposure area turned to yellow color and formed well-demarcated round mass. The average size of the mass was $1\times0.3cm$. Grossly detectable mass was decreased in size at 6 months compared to 1 or 3 months. Microscopically, strong foreign body reaction to glass fibers, inflammation and fibrosis were observed until 6 months. Foreign body reaction was increased up to 3 months, but it was decreased after 6 months. In scanning electron microscope, there was many bundles of glass fibers around the inflammation area, but the size of glass fibers were gradually reduced from 1 month to 6 months. These results suggest that subcutaneous exposure of glass fiber can provoke strong tissue reaction including foreign body granulomas, inflammation and fibrosis. But glass fiber itself did not produce any neoplastic changes.
명나혜,조경자,장자준,조재일,심영목,Myong, Na-Hye,Cho, Kyung-Ja,Jang, Ja-June,Zo, Jae-Il,Shim, Young-Mog The Korean Society for Cytopathology 1990 대한세포병리학회지 Vol.1 No.2
70세 여자의 늑막에 발생한 점액양 연골육종의 세침흡인세포학적 소견을 기술하였다. 환자는 4개월간의 좌측 흉통과 2개월간의 호흡곤란을 호소하였고 흉부 X-선 및 전산화 단층촬영상 좌측 늑막강에 위치하여 흉벽을 침범하는 커다란 분엽상 저음영성 종괴와 늑막 삼출액이 관찰되었다. 종괴의 세침 흡인 도말은 세포 밀도가 매우 높았고, 세포질이 풍부한 나원형 세포들이 점액성 물질내에 산재되거나 간혹 뭉쳐 있었다. 풍부한 세포질은 불투명한 청색으로 소포를 함유하기도 하였으며 그 경계는 흩어진 세포에서는 비교적 분명했으나 세포집단에서는 불분명하였다. 핵들은 한쪽으로 치우쳐져 둥글거나 난원형을 보였고 염색질은 미세하였으며 다수의 작은 핵소체를 갖고 있었다. 세포들간의 다형성이나 유사분열은 잘 관찰되지 않았다. 이상의 소견은 연공육종의 세포학적 특징과 유사했으나 연골 성분이 관찰되지 않았고 점액성 물질이 매우 풍부하여 확진을 위한 생검이 시행되었고 조직학적으로 점액양 연골육종임이 확인되었다. A 70-year-old female who was diagnosed as myxoid chondrosarcoma by fine needle aspiration of a pleural mass is described. She presented with left chest discomfort of 4 months' duration and aggravating dyspnea and chest pain for 2 months. Chest X-ray and CT scan revealed a large lobulated low density mass invading chest wall at the left pleural cavity and massive pleural fluid. Fine needle aspiration was done under the impression of mesothelioma or metastatic cancer. The aspirates from the mass were very cellular and composed of isolated or clustered forms of large plump cells. Abundant cytoplasm was blulsh opaque and the margin was rounded in the isolated cells, whereas clustered cells show ill-defined ceil borders and aggregating tendency. The nuclei were eccentric, round to ovoid, and had fine chromatin pattern and multiple small nucleoli. Cellular pleomorphism or mitotic figure was not definite. These findings were consistent with cytologic features of chondrosarcoma. Final diagnosis was confirmed as myxoid chondrosarcoma by mediastinoscopic biopsy and the tumor showed strong positivity for S-100 protein.
명나혜,하창원,조경자,장자준,백구현,이수용,Myong, Na-Hye,Ha, Chang-Won,Cho, Kyung-Ja,Jang, Ja-June,Baek, Goo-Hyun,Lee, Soo-Yong 대한세포병리학회 1990 대한세포병리학회지 Vol.1 No.1
Two cases of giant cell tumor of bone diagnosed by fine needle aspiration cytology are described. Case 1 was a 28-year-old male who had pain sense for one year at the right distal thigh. His radiologic finding revealed a destructive cortical lesion with soft tissue extension at medial side of epiphysis of the distal femur. Case 2 was a 21-year-old female complaining pain at left distal forearm for eight months and showed a well-demarcated expansile osteolytic lesion with multiseptation, and cortical destruction at epiphysis and metaphysis of the left distal radius on the X-ray. Fine needle aspiration of each lesion was performed. The aspirate of the case 1 revealed moderate cellularity, which was composed of scattered giant cells of osteoclastic type and small round to oval monotonous stromal cells in large areas. Giant cells were evenly distributed in single or small groups and had irregular but abundant cytoplasms with 10 to 20 nuclei in the center. The nuclei showed ovoid shape, fine granular chromatin, and a small but conspicuous nucleolus. Stromal cells were dispersed in isolated pattern or sometimes aggregated in clusters and showed the same nuclei as those of giant cells and scanty cytoplasms. Comparing to case 1, case 2 had a more translucent abundant cytoplasm in the giant cells and more spindled stromal cells. All two cases revealed neither nuclear atypism nor increased abnormal mitoses In both giant and stromal cells, suggesting no evidence of malignancy. Thereafter the lesions were treated with excision and curettage, and histologically confirmed as giant cell tumors of the bone.
조경자,고재수,하창원,장자준,Cho, Kyung-Ja,Koh, Jae-Soo,Ha, Chang-Won,Jang, Ja-June 대한세포병리학회 1992 대한세포병리학회지 Vol.3 No.2
A number of studies have shown the value of fine needle aspiration cytology for the diagnosis of breast lesions, but reports on the comparison of cytologic and histologic variations of breast cancers are few. We reviewed histologically proven 106 breast aspirates with an emphasis on the cytology of ductal carcinomas and of an area of uncertain atypia. Positive and negative predictive values of breast aspiration cytology were 100% On review of the cases originally diagnosed as atypia of uncertain nature (19 %), features more suggestive of malignancy or benignancy were recognizable in most underdiagnosed cases and a half of overdiagnosed cases, respectively. However, indistinguishable atypism also remained. Thirty seven cases out of 53 infiltrating duct carcinomas revealed malignant cytology, with variations in background, cellularity, morphology of cell groups, and extent of isolated tumor cells. When classifying the infiltrating duct carcinomas into scirrhous, solid-tubular, and papillotubular types, scirrhous type frequently appeared as irregularly shaped tight or loose cell clusters, and solid-tubular type as round-margined cell balls.
갑상선의 저분화 "도암종"의 세침흡인 세포검사 - 1례 보고 -
이승숙,하창원,조경자,장자준,Lee, Seung-Sook,Ha, Chang-Won,Cho, Kyung-Ja,Jang, Ja-June The Korean Society for Cytopathology 1994 대한세포병리학회지 Vol.5 No.1
저자들은 접할 기회가 흔치 않은 갑상선의 저분화암종인 일명 "도암종"의 세침흡인 세포검사 1예를 경험하고 조직학적으로 확인하였기에 문헌검색과 함께 보고하는 바이다. 흡인 도말된 세포들은 비교적 깨끗한 도말배경에 중등도 이상의 높은 세포밀도를 보였으며, 세포들은 개개로 흩어지는 양상과 판상의 군집을 이루는 양상이 어우러져 관찰되었다. 때로 세포들이 소포배열을 이루는 곳도 관찰되었다. 대부분의 종양세포들은 비교적 비슷한 크기와 모양을 나타내었으나 일부의 세포들은 현저한 다형성을 보였다. 일부의 세포에서 핵에 주름을 보였으나 소수에 불과하여 이는 어떤 갑상선병변에서나 관찰할 수 있는 비특이적 변화로 간주되었다. 세포의 겹침이 별로 없이 높은 세포밀도를 보이는 점, 세포가 개개로 흩어지는 양상과 소수 다형성이 현저한 세포의 혼재 등은 본 종양을 진단하는데 도움이 되는 소견으로 생각되며, 이러한 소견을 염두에 둠으로써 수술전 진단에 도움을 줄 수 있으리라 생각된다. A case of poorly differentiated "insular" carcinoma of the thyroid is presented and discussed with references to the literature. Un fine needle aspiration cytology of our case, the aspirates were highly cellular with tumor cells appearing as dispersed isolated cells as well as in dense clusters and syncytial formations. Occasional microfollicles containing colloid were evident. Most of nuclei were fairly uniform with considerable variability and a few showed definite atypical features. Nuclear grooving was additional features. Necrotic debris was not seen. Our cytologic findings were correlated well with histology, confirming typical insular pattern of tumor cells with the presence of occasional pleomorphic cells and papillary carcinoma-like features. With much attention to cytological features of insular carcinoma, it would be possible to diagnose a preoperative suggestive diagnosis, even though not definitive.
명나혜,고재수,하창원,조경자,장자준,Myong, Na-Hye,Ko, Jae-Soo,Ha, Chang-Won,Cho, Kyung-Ja,Jang, Ja-June 대한세포병리학회 1992 대한세포병리학회지 Vol.3 No.1
It is very rare to diagnose a squamous cell carcinoma when the carcinoma cells are observed in various body fluids. The effusion cytology of squamous cell carcinoma has not been sufficiently studied till now. We examined 10 cases of body fluid cytologic specimen diagnosed as metastatic squamous ceil carcinoma, which were selected among 2,100 body fluid cytology cases collected from 1986 to 1991. The patients had been confirmed to have primary squamous ceil carcinomas. The backgrounds of cellular aspirates were necrotic in most and the cells appeared in clusters or individually. The cell clusters showed round and smooth margins, mimicking adenocarcinoma, but in flat sheets rather than three-dimensional bails. the individual cells were most frequently Graham's 3rd-type cells, found in all cases, which were described as 1.5 times large as the parabasal cells and having small cytoplasmic rims. Other malignant squamous cells were undifferentiated cells, polygonal cells, fiber cells, and tadpole cells with decreasing order of frequency. The recognition of various features of malignant squamous cells would be helpful for the diagnosis of squamous ceil carcinoma found in effusion cytology.
고재수,하창원,명나혜,조경자,장자준,Koh, Jae-Soo,Ha, Chang-Won,Myong, Na-Hye,Cho, Kyung-Ja,Jang, Ja-June 대한세포병리학회 1991 대한세포병리학회지 Vol.2 No.2
A total of 362 bile samples from 104 patients with evidence of biliary tract obstruction were submitted for diagnostic cytology from January, 1989 to April, 1991. The patients were classified based on the obstructive cause, and the cytologic results were reviewed. 298 of the specimens were from patients with intrabiliary malignant structure, and 17 were from patients with extrabiliary malignant compression or benign biliary obstruction. Bile cytology was positive for carcinoma in 42 samples from patients with intrabiliary malignant stricture, and the diagnostic sensitivity was 14%. There were no false positive cases. We concluded that the cause of low sensitivity was degenerative change of cell due to prolonged sampling time. What is noteworthy was the high prevalence of Clonorchis sinensis eggs, being detected in 25 patients with intrabiliary malignancy, supporting the association between clonorchiasis and biliary tree malignancy.
간의 전이성 상피암 20예의 세침 천자 흡인시 배경 병변의 세포학적 소견
명나혜,고재수,하창원,조경자,장자준,Myong, Na-Hye,Koh, Jae-Soo,Ha, Chang-Won,Cho, Kyung-Ja,Jang, Ja-June 대한세포병리학회 1991 대한세포병리학회지 Vol.2 No.2
Liver is generally known as an organ which is most commonly involved by the metastic tumors. According to the tendency of using fine needle aspiration in the diagnosis of hepatic tumors, the differentital diagnosis between hepatocellular carcinoma and metastatic carcinoma frequently has been a main issue in the poorly differentitated cases, especially to the pathologists of Korea, an endemic area of hepatocellular carcinoma. Until now the problem has been usually solved by the comparison of cytologic characteristics of their tumor cells but not by background cytologic features which rarely have been studied. We observed the background cytologic features helpful for the differential diagnosis through the analysis of 20 cases who had confirmed primary cancer and were diagnosed as metastatic carcinomas in the liver by fine needle aspiration cytology. Twenty cases included 9 adenocarcinomas, 7 spuamous cell carcinomas, 1 small cell carcinoma, 1 carcinoid, 1 adenoid cystic carcinoma, and 1 renal cell cacinoma. Analysis of background cytologic features revealed that 77% of adenocacinoma cases showed benign mesenchymal components and hepatocytes and spuamous cell carcinoma cases disclosed benign mesenchymal tissue (71%) and necrosis (57%), Remaining cases showed variable combinations of benign mesenchymal component, necrosis, hepatocytes, and bile duct epithelial cells. No case revealed atypical hepatocytic naked nuclei, a useful cytologic finding of hepatocellular carcinoma. In summary, the background cytologic features more commonly observed in metastatic carcinomas than in the hepatocellular carcinoma were benign mesenchymal components, hepatocytes, necrosis, and bile duct epithelium. The endothelial cells and hepatocytic naked nuclei, two relatively specific findings of hepatocellular carcinoma were not observed except for renal ceil carcinoma. Above background cytologic features are thought to be helpful for the differential diagnosis between the hepatocellular carcinoma and various metastatic carcinomas in the poorly differentiated cases.