분화도가 높은 간세포암종의 세침흡인 세포학적 소견 - 비종양성 병변과의 감별 -

강신광,이승숙,조경자,하화정,Khang, Shin-Kwang,Lee, Seung-Sook,Cho, Kyung-Ja,Ha, Hwa-Jeong 대한세포병리학회 1997 대한세포병리학회지 Vol.8 No.1

The fine needle aspiration biopsy(FNAB) has become a popular method to diagnose mass lesions of the liver. Although many reports have listed FNAB criteria to be used to diagnose hepatocellular carcinoma(HCC), a diagnostic dilemma still exists at the extreme ends of the spectrum, particularly for well differentiated HCC. The authors reviewed a series of FNAB specimens of the liver to distinguish well differentiated HCC from nonneoplastic liver. Fifteen cytologic features were examined in this study: high cellularity, large sheet formation, trabecular pattern, acinar pattern, dispersed pattern, irregular arrangement, increased nuclear/cytoplasmic ratio, naked nuclei, irregular chromatin, irregular nuclear contour, multinucleation, uniform macronucleoli, multiple nuclei, uniform small cytoplasm and monotony of atypia. These features were examined in a series of 76 FNAB specimens. Fifty two specimens were from patients with HCC and 24 specimens were from patients with nonneoplastic lesion or tumors other than HCC containg adequate amount of nonneoplastic hepatocytes in smear. All specimens were coded as to the presence or absence of the above cytologic features. With the use of step-wise logistic regression analysis, three features were identified as the key cytologic features predictive of HCC: irregular chromatin, monotony of atypia and absence of large sheet formation. When these criteria were used, the sensitivity diagnosing HCC by FNAB was 94.2%, specificity 100%, positive predictive value 100% and negative predictive value was 88.9%.

대퇴부의 횡문근내에서 발생한 과립세포 종양의 세침흡인 세포학적 소견 - 1 증례 보고 -

오미혜,강신광,Oh, Mee-Hye,Khang, Shin-Kwang 대한세포병리학회 1993 대한세포병리학회지 Vol.4 No.1

Granular cell tumor is mostly benign and thought to be of Schwann ceil origin. The head and neck, particularly tongue, breast, and upper respiratory tract are frequently involved. Recently, we have experienced a case of granular cell tumor of the right thigh in a 30-year old male, diagnosed by fine needle aspiration cytology which revealed distinct cytologic features The smear revealed cellular aspirates with clear back-ground. The tumor cells showed uniform small nuclei and abundant eosinophilic, granular cytoplasm with hazy cell border. Mitoses were not found.

척삭종의 세포학적 소견 -5 예 보고-

김동훈,강신광,공경엽,Kim, Dong-Hoon,Khang, Shin-Kwang,Gong, Gyung-Yub 대한세포병리학회 2001 대한세포병리학회지 Vol.12 No.2

Chordoma is a rare, clinically and morphologically well characterized tumor, which arises from remnants of the notochord, The majority(60%) occurs in the sacrococcygeal region, with 25% in the clival legion, and 15% in the spine. Although most chordomas do not develop metastasis, the long term prognosis is very poor due to local progressive tumor growth and tendency to recur if incompletely excised. The chordoma has characteristic cytologic features which make a preoperative diagnosis possible. We reviewed the cytologic findings of five patients with chordoma(one oropharynx, two clivus, and two sacrum). The patients were three male and two female, aged from 29 to 77 years(mean 60). Of five chordomas, there were local recurrences in two cases and metastasis of lymph node In one case. Four were FNA smears and one was squash smear taken from intraoperative consultation. All five cases show similar cytologic features. The dominating tumor cells were large with round nuclei and pale-stained vacuolated cytoplasm. The small round uniform cells and short spindle-shaped cells were frequently noted. The cells were surrounded by myxoid or mucoid matrix. The chordoma has characteristic cytologic features which make a preoperative diagnosis possible.

갑상선 미분화 "도암종"의 세침흡인 세포학적 소견 - 1례 보고 -

양영일,김찬환,강신광,Yang, Young-Il,Kim, Chan-Hawn,Khang, Shin-Kwang The Korean Society for Cytopathology 1994 대한세포병리학회지 Vol.5 No.1

갑상선 미분화 "도암종"은 예후가 나쁘고 희귀한 종양으로 이 종양의 세침흡인 세포학적 소견에 관한 보고는 1990년 Pietribiasi에 의해 처음 기술된 이후 현재까지 8례가 있을 따름이다. 최근 저자들은 23세 여자의 좌측 경부의 갑상선 종괴로 부터 세침흡인 세포 검사를 시행하여 진단된 갑상선 도암종을 경험하여 그 세침흡인 세포학적 소견을 기술하는 바이다. 환자는 10년전부터 좌측 경부에 서서히 자라는 종괴를 호소하였으며 본 종괴에서 세침흡인 세포학적 검사를 시행하였다. 종괴의 세침흡인 도말은 세포밀도가 높았고 일정한 모양의 작고 둥근 세포들이 "도"구조 혹은 "지주" 구조를 보이며 간혹 개개로 산재되어 있는 세포 및 소포형태도 보였다. "도" 구조 및 "지주" 구조 내에는 미세한 소포형태가 관찰되었고 종양세포들의 핵은 자주 중첩되어 있었다. 갑상선 여포상 선종에서 보이는 성글게 배열된 소포구조도 드물게 관찰 되었다. 세포간의 크기나 모양은 거의 일정하였고 유사분열은 거의 관찰되지 않았다. 핵은 둥글고 뚜렷한 핵막과 미세하게 뭉친 염색질을 가지며 핵소체는 뚜렷하지 않았으며 드물게 젖빛 유리모양의 핵과 핵구가 관찰되었으나 유두상 구조는 관찰되지 않았다. 세포질의 경계는 불명확하였고 간혹 세포질내에 공포가 관찰되었다. 이상의 도암종의 세포학적 소견은 여포상 종양이나 유두상 종양들과는 구분되는 특징적인 소견이라 생각되며 세포학적 소견으로도 도암종의 진단이 가능하다고 생각된다. Fine needle aspiration cytologic features of a case of insular carcinoma of the thyroid in a 23-year-old woman who presented a palpable neck mass is described. The aspirate showed cellular smear arranged in trabeculae, solid or loose clusters, and microfillicles in necrotic background. The tumor cells had uniform, small round, hyperchromatic nuclei. The chromatin was finely granular, and nuclear membrane was smooth. Nucleoli were not discernible. Nuclear pleomorphism was minimal. The cytoplasm was usually scanty, pale, poorly outlined, and almostly amphophilic. Sometimes paranuclear cytoplasmic vacuoles were noted. final diagnosis was confirmed by total thyroidectomy as insular carcinoma.

척수 수질내에 재발한 신경장관성 낭종 - 증례보고 -

이종주,나영신,강신광,노성우,임승철,Rhee, Jong Joo,Ra, Young Shin,Khang, Shin Kwang,Roh, Sung Woo,Rhim, Seung Chul 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.12

Neurenteric cysts are developmental cysts derived from embryonic endodermal layers. Fewer than 100 have been reported in which there were no associated bone or soft-tissue malformations and only six among those cases showed intramedullary location in the literatures. The authors report a 16-year-old young man with a thoracic intramedullary neurenteric cyst which presented with symptoms of axillary pain and paraparesis. The magnetic resonance imaging showed intramedullary mass extended from level of T3 to T7. There was no associated bone or soft-tissue anomaly. This cyst was partially excised and marupialized into subarachnoid space. The pathological findings were compatible with neurenteric cyst. Nine months later, the cyst recurred and at second operation, cyst wall was removed completely.

객담검사에서 진단된 폐효모균증 - 1 례보고 -

양영일,김찬환,강신광,주종은,Yang, Young-Il,Kim, Chan-Hwan,Khang, Shin-Kwang,Joo, Joung-Eun 대한세포병리학회 1993 대한세포병리학회지 Vol.4 No.2

Cryptococcosis is a systemic mycosis that most often involves the central nervous system, followed by subclinical or symptomatic pulmonary involvement. We describe a case of unsuspected pulmonary cryptococcosis in a 69-year-old woman, diagnosed by sputum cytology. Sputum smears revealed numerous yeast like organisms typical of Cryptococcus neoformans measuring from 7 to 17 um in diameter. Mucicarmine, PAS, and methenamine sliver stains showed positive reaction of capsule and cell wall of Cryptococcus neoformans.

뇌척수액에서 진단된 악성 종양세포의 세포학적 분석

서재희,공경엽,강신광,김온자,Suh, Jae-Hee,Gong, Gyung-Yub,Khang, Shin-Kwang,Kim, On-Ja 대한세포병리학회 1998 대한세포병리학회지 Vol.9 No.1

Cytologic evaluation of cerebrospinal fluid(CSF) is an effective tool in diagnosing many disorders involving the central nervous system(CNS). CSF examination has been found to be of particular value in the diagnosis of metastatic carcinoma, lymphomatous or leukemic involvement of CNS and certain primary CNS tumors. As a survey of metastatic tumors to CSF and an evaluation of the preparation techniques increasing cellular yield in our laboratory, 713 CSF specimens examined between July 1995 and April 1997(1 year 10 months), were reviewed. There were 75 positive and 5 suspicious cases, the latter have had no evidence of tumors clinically. Primary tumors of 75 positive cases were classified as follows; 4(5.3%) as primary brain tumors, 40(53.3%) as secondary carcinomas, 13(17.3%) as leukemias, and 18 (24.0%) as lymphomas. The most common primary site of metastatic carcinomas was the lung in 17 cases(42.5%) followed by the stomach in 13(32.5%), breast in 8 (20.0%), and unknown primary in 2(5.0%). Four primary brain tumors were 3 cerebellar medulloblastomas and a supratentorial primitive neuroectodermal tumor (PNET). All 40 metastatic carcinomas were adenocarcinoma presented as single cells or cell clusters. Although signet ring cells were frequent in the cases of gastric primary cancers, no significant cytologic differences according to the primary site were observed. The cytologic features of leukemia and lymphoma were characterized by hypercellular smears presenting as individual atypical cells with increased N/C ratio, presence of nucleoli, and nuclear protrusions. In medulloblastomas and PNET, the principal cytologic findings were small undifferentiated cells arranged singly or in loose clusters with occasional rosettoid features. This study suggests that the CSF cytology is useful in the diagnosis of malignancy, especially metastatic extracranial tumors and the diagnostic accuracy can be improved by increasing cellular yield using cytocentrifuge.

대한세포병리학회 정도관리 현황 및 결과

이혜경,김성남,강신광,강창석,윤혜경,Lee, Hye-Kyung,Kim, Sung-Nam,Khang, Shin-Kwang,Kang, Chang-Suk,Yoon, Hye-Kyoung 대한세포병리학회 2008 대한세포병리학회지 Vol.19 No.2

In Korea, the quality control(QC) program forcytopathology was introduced in 1995. The program consists of a checklist for the cytolopathology departments, analysis data on all the participating institutions' QC data, including the annual data on cytologic examinations, the distribution of the gynecological cytologic diagnoses, as based on The Bethesda System 2001, and the data on cytologic-histolgical correlation of the gynecological field, and an evaluation for diagnostic accuracy. The diagnostic accuracy program has been performed 3 times per year with using gynecological, body fluid and fine needle aspiration cytologic slides. We report here on the institutional QC data and the evaluation for diagnostic accuracy since 2004, and also on the new strategy for quality control and assurance in the cytologic field. The diagnostic accuracy results of both the participating institutions and the QC committee were as follows; Category 0 and A: about 94%, Category B: 4-5%, Category C: less than 2%. As a whole, the cytologic daignostic accuracy is relatively satisfactory. In 2008, on site evaluation for pathology and cytology laboratories, as based on the "Quality Assurance Program for Pathology Services" is now going on, and a new method using virtual slides or image files for determining the diagnostic accuracy will be performed in November 2008.

Role of Cytologic Scoring System in Minimizing "Gray Zone" in Breast Aspiration Cytology

김정연,조경자,이승숙,강신광,Kim, Jung-Yeon,Cho, Kyung-Ja,Lee, Seung-Sook,Khang, Shin-Kwang The Korean Society for Cytopathology 1996 대한세포병리학회지 Vol.7 No.1

세침흡인 검사는 촉지되거나 혹은 촉지되지 않는 양성과 악성 유방 질환을 인지하는 매우 유용한 방법이나 진단이 애매한 회색 지역이 존재한다. 1년동안 시행한 697예의 유방 세침흡인 검사 중 111예가 비정형적 혹은 악성이 의심된 다고 보고되었으며 이 중 조직학적으로 확진된 74예를 재검색하여 Masood 등 (1990)이 제안한 등급 점수표가 회색 지역을 줄이는데 유용한지 살펴보았다. 기술적 문제가 19예에서 나타났으며 나머지 55예 중 18예는 양성으로, 37예는 악성으로 조직학적으로 진단되었다. 양성 질환 중 섬유선종(5예)및 섬유선종의 성상을 지닌 섬유낭성 질환(3예)이 가장 많았고 악성은 대부분 침윤성 관암종이였으며 (29예), 관상암종(3예), 사상암종(2예) 및 점액 암종(2예) 등 분화가 좋은 암종들이 상대적으로 많았다. 등급 점수표는 회색 지역을 줄이는데 상당히 유용하여 29예의 관암종중 27예가 세포학적 악성 범주에 속했다. 그러나 분화가 좋은 암종은 7예중 2예만이 세포학적 악성 범주에 속했고 섬유선종 및 섬유선종의 성상을 지닌 섬유낭성 질환은 비교적 높은 점수를 보였다. 따라서 등급 점수표의 응용은 유방 세침흡인 검사에서 양성과 악성 병변의 감별에 매우 유용하게 이용될 수 있으나 분화가 좋은 암종들과 섬유선종의 진단에는 주의가 필요할 것으로 사료되며 유방 세침흡인 세포학적 검사에는 세포 병리 의사의 경험 및 유방질환의 세포학적 변조에 대한 친숙성이 강조되어야 할 것이다. Fine needle aspiration(FNA) has been quite successful in identifying benign and malignant breast lesions, but a "gray zone" exists. A total of 697 FNAs of breast were performed at Korea Cancer Center Hospital for a period of one year. One hundred and eleven of the 697 FNAs were diagnosed as atypical or suspicious for malignancy. Among them, we reviewed 74 FNAs, un which histologic diagnoses were made, and applied cytologic grading system proposed by Masood et al (1990) to evaluate the usefulness of this system in minimizing the size of gray zone. Technical problem was responsible for equivocal diagnoses in 19 FNAs Of the remaining 55 FNAs, 18 were benign and 37 were malignant. Among benign conditions, fibroadenoma(5 cases) and fibrocystic disease with fibroadenomatous feature(3 cases) constituted the largest groups. The majority of malignant conditions were infiltrating ductal carcinoma(29 cases), however, those low grade carcinomas Including tubular carcinoma(3 oases), cribriform carcinoma(2 cases), and mucinous carcinoma(2 cases) occupied a relatively large proportion Cytologic grading system was quite useful in minimizing the size of gray lone. The scores of 27 out of 29 usual infiltrating ductal carcinomas belonged to the group of cytologic malignancy, how-ever, only 2 out of 7 low grade carcinomas got scores of malignancy FNA from fibroadenoma or fibrocystic disease with fibroadenomatous features showed a tendency toward high scores. Experience of the cytopathologist and familiarity with cytologic alteration in breast disease cannot be overemphasized.

유상피 육종의 흡인 세포학 - 1예 보고 -

조경자,김정연,이승숙,강신광,Cho, Kyung-Ja,Kim, Jung-Youn,Lee, Seung-Sook,Khang, Shin-Kwang 대한세포병리학회 1996 대한세포병리학회지 Vol.7 No.1

Cytologic features of the fine needle aspiration of metastatic epithelioid sarcoma are presented. The patient was a 48 year-old male who had been sufferring from recurrent and metastatic tumors of the right upper extremity for 6 years. The aspirate from the axillary mass cytologically consisted of isolated large polygonal cells with abundant, cyanophilic, slightly granular cytoplasm. Eccentrically located large round nuclei showed finely dispersed chromatin, small nucleoli, occasional convolution and folding of nuclear membrane, and frequent binucleation. Although both histologic and cytologic similarity of epithelioid sarcoma to squamous cell carcinoma is well known, findings of cyanophilic granular cytoplasm, convoluted nuclei, and binucleation appeared to be the differential points.