Fine Needle Aspiration Cytology of the Mediastinal Lesions

박인애,함의근,Park, In-Ae,Ham, Eui-Keun The Korean Society for Cytopathology 1990 대한세포병리학회지 Vol.1 No.1

방사선 검사상 종격동 확장으로 나타나는 질환은 흉선종, 배아종, 신경원성 종양, 림프종 등의 원발성 종격동 종양 및 폐암의 림프절 전이 등으로 매우 다양하고 또 이들의 감별진단이 환자의 치료 방침을 정하는데 중요하나, 조직학적 진단을 하기 위해 외과적 생검을 하기에는 그 위험도가 높은 장기이므로 세침흡인 세포학적 생검이 아주 유용한 방법이 되고 있음에도, 그 세포병리학적 진단 기준은 아직 우리에게 친숙한 편이 아니다. 저자들은 1985년에서 1988년 3월까지 서울대학교 병원 병리과에서 검색된 종격동 병변의 세침흡인 생검 16예를 세포병리학적으로 관찰하고 그 결과를 검토하여 보았다. 판독 적절한 검체가 흡인되었던 15예 중 흉선종이 7예, 배아종이 2예, 신경원성 종양이 2예, 림프종이 1예 폐암의 림프절 전이 3예가 세포학적으로 진단 되었다. 조직학적이나 다른 세포학적 방법으로 확진된 예와 본 연구의 세포학적 진단이 비교 가능하였던 9예중 7예에서 진단이 일치하였는데, 그 중 5예는 흉선종, 1예는 배아종이었고 1예는 전이성 암으로 진단 일치율은 77%였다. 조직학적 진단과 세포학적 진단이 상이하였던 예는 2예로 1예는 흉선종이 림프종으로, 1예는 첨폐가 신경원성 종양으로 오진되었다. 흉선종은 세포학적으로 특징적인 소견을 보여, 대개의 경우 진단에 별 어려움이 없었으나 림프종과 소형세포암이 감별을 요하는 진단이었다. The authors report 16 cases of mediastinal fine-needle aspiration cytology from Jan. 1985 to Mar. 1988 at the Seoul National University Hospital. Among them, diagnostic material were obtained in fifteen cases, establishing the diagnosis of 7 thymomas, 2 germinomas, 2 neurogenic tumosr, 1 lymphoma, and 3 meastatic carcinomas. The 9 cytologic diagnoses could be confirmed by histologic examination in 8 patients and by another cytologic method in one patient, allowing concordance rate of 77%.

폐결핵증 객담의 세포병리학적 관찰

박인애,함의근,이상국,Park, In-Ae,Ham, Eui-Keun,Lee, Sang-Kook 대한세포병리학회 1993 대한세포병리학회지 Vol.4 No.2

Sputum smears of 116 cases in 55 pulmonary tuberculosis patients with the demonstration of acid-fast bacilli in sputum were retrospectively reviewed to investigate the cytologic diagnosis of pulmonary tuberculosis in sputum. Epithelioid cells, multinucleated giant cells of Langhans or nonspecific type, or necrotic materials of caseation or nonspecific nature were found in 40% of the cases, but in 60% of the cases, only nonspecific findings including squamous metaplasia were found. Only in 6% of the cases, the cytologic diagnosis of tuberculosis was possible with the findings of epithelioid cells and muitlnucleated giant cells in a necrotic background.

갑상선 결절의 세침흡인 세포검사: 진단성적의 검토 및 세포학적 진단의 평가

박인애,함의근,Park, In-Ae,Ham, Eui-Keun 대한세포병리학회 1999 대한세포병리학회지 Vol.10 No.1

We retrospectively reviewed the results of 1,850 fine needle aspiration cytology(FNAC) of thyroid nodules performed from 1990 to 1991 in the Department of Pathology, Seoul National University Hospital. Among 1,528 cases and 322 cases aspirated by clinicians and a pathologist, 465 cases(30.4%) and 13 cases(4.0%) of the aspirates were inadequate, respectively. In 227 cases, correlation of the FNAC diagnosis and histologic diagnosis was done. Excluding the inadequate cases, the sensitivity nor the detection of neoplasm(malignancy together with follicular adenoma) was 86.4% and the specificity was 70.7%. The overall diagnostic accuracy was 79.0%. There were 16 false-positive cases(7.0%), and 19 false-negative cases(8.4%). The predictive value of each cytologic diagnosis was 92% in papillary carcinoma, and 100%, in Hashimoto's thyroiditis. The expectancy of malignancy was 52.8% in "suspicious malignancy" and 26.7% in "atypical lesion".

폐에 전이된 점액표피양 암종의 세포병리학적 소견

박원서,함의근,Park, Weon-Seo,Ham, Eui-Keun 대한세포병리학회 1994 대한세포병리학회지 Vol.5 No.2

A case of metastatic mucoepidermoid carcinoma of the lung, originating from the hard palate, was diagnosed by sputum and bronchial washing cytology. Although the cytologic features of mucoepidermoid carcinoma have been well described, it is easy to confuse mucoepidermoid carcinoma with the more common primary adenocarcinoma or squamous cell carcinoma of the lung. The features distinguishing mucoepidermoid carcinoma from other primary neoplasms include 1) mucus-secreting cells individually and in clusters admixed with other cell components, 2) epidermoid cells identified by the presence of abundant spread-out cytoplasm and an oval dark nucleus and 3) intermediate cells resembling normal ductal epithelial cells with moderate-to-scanty cytoplasm, a central, round vesicular nucleus and a prominent nucleolus. The morphologic features of metastatic mucoepidermoid carcinoma in this case were similar to those of primary salivary mucoepidermoid carcinoma.

Monocrotaline을 투여한 백서 폐의 초기 혈관병변에 관한 주사전자현미경적 관찰

박인애,함의근,Park, In-Ae,Ham, Eui-Keun 한국현미경학회 1991 Applied microscopy Vol.21 No.1

An experimental study was performed to observe the early effects of monocrotaline on pulmonary vascular system by means of light microscopy and scanning electron microscopy, attempting to expore the mechanism behind the process of pulmonary hypertension. Experimental animal(Sprague-Dawley male rats ; 150-200g B. W.) were intra-peritoneal administered with 100mg/kg B. W. monocrotaline. Authors observed light microscopically various gradational increase of wall thickness in pulmonary muscular and non-muscular arteries in duration from 2 weeks to 5 weeks after monocrotaline administration and the changes were more sever in the latter than the former. The scanning electron microscopy shows severe and diffuse endothelical cell swelling, microvilli and microbleb formation since 1 hour after monocrotaline administration and during the course, after 5 hours the severity of endothelial cell damage was prominent with presence of fibrin, webs, platelet thrombi and white cell adherence. It was concluded that the monocrotaline primarily induced severe and diffuse endothelial cell damage of pulmonary arteries and laterly added the participation of platelets, which attributed to the pathogenesis of monocrotaline induced pulmonary vascular lesions in relation to pulmonary hypertension.

자궁 경질부 도말 표본에서 관찰된 Curschmann 나선체 검색

박인애,함의근,Park, In-Ae,Ham, Eui-Keun 대한세포병리학회 1991 대한세포병리학회지 Vol.2 No.1

Curschmann's spirals morphologically similar to those seen in sputum were found in cervico-vaginal smears of six patients ranged from 28 to 40 years of age, during 18 months from January. 1985 to June 1986. The prevalence was 1 in 2147 smears in that period. All of them had gynecologic disorders without systemic effect such as chronic cervictis in three, leiomyoma in one, pelvic inflammatory disorder in one, and primary infertility in one. The Curshmann's spirals in the smear showed varying degrees of maturation from wavy incipient ones to highly celled mature ones, admixed with thick mucinous back-ground, suggesting of their production in the uterine cervix itself. Also the recent history of undergone cryocautery, electrocautery or parturition suggest its production in the endocervical gland due to mechanical obstruction and/or change in biochemical composition of mucus.

Recent Advances in Cancer Diagnosis: On an Overview of Diagnostic Cytopathologic Modalities and Ancillary Techniques

김기태,함의근,Kim, Ki-Tai,Ham, Eui-Keun The Korean Society for Cytopathology 1996 대한세포병리학회지 Vol.7 No.1

19세기말과 20세기초에 각각 비르효와 파파니콜로에 의해 명료하게 된 세포 병리학과 탈락세포학의 개념에서 오늘날의 암진단의 일차적인 방법이 발전해 왔다. 파파니콜로의 탈락세포학의 개념에서 1960년대 초반에 세침흡인 세포검사가 개발되었다. 이 세침흡인 세포검사는 주된 진단방법이 되어져, 절개생검을 감소하게 하고 의료비용의 효과적인 이용에 공헌하였다. 1980년대에는 면역생화학적 기술들이 암 진단에 보충역활을 하게 되었다. 단 클론 항체를 이용하는 면역과산화효소법이 먼저 암의 본성을 밝히는 보조적인 방법으로 쓰여졌다. 특정 단클론 항체들이 이용가능하게 되어 세포산물이나 표면 표지자들을 인지하는 것을 훨씬 용이하게 하였다. 예를 들면 중간세사에 대한 항체들이 분화가 나쁜 종양의 조직기원을 결정하는데 가치가 있는 것이 증명되었다. 종양표지자들은 종양존재의 생화학적 표시자로 이용될 수도 있는데 이러한 종양표지자들은 혈장이나 다른 체액들에서 검출할 수 있다. 이 종양표지자들을 농출한 것을 진단적 검사에 이용하여 이미 진단된 암의 임상 경과를 추적하고 암 발생의 위험이 있는 집단에서 특정 종양을 발견해 내기 위한 선별검사로써 이용할 수 있다. 유세포 검사는 백혈병이나 림프종 세포들의 면역표현형을 알아내고, 종양세포들의 DNA함유량을 알아내며, 세포증식율을 알아내는 등의 몇가지의 세포의 특성을 분류해내는데 유용한 도구이다. 분자생물학적 방법들은, 암 환자를 진료하는데 있어 진단, 예후평가 및 치료 등의 분야에서 일보 전진하게 하였다. 핵산교잡법이 Southern blots, Nothern blot, Dot blot 및 in situ hybridization으로 이용된다. 분자생물학 및 그 기술이 암종 생물학을 이해하고 유전자 조작을 기초로한 치료법을 계획하는데 밝은 새로운 지평선을 열어줄 수 있을 것이다. From the concepts of cellular pathology and of exfoliative cytology, as elucidated by Virchow and Papanicolaou respectively in the late 19th and early 20th century, have evolved the primary methods for the diagnosis of cancer today. From Papanicolaou's concept of exfoliative cytology developed fine needle aspiration biopsy in the early 1960's, this has become a major diagnostic procedure and has contributed to a significant reduction in open biopsies and, therefore, to medical cost-effectiveness immunobiochemical techniques provided us with a supplement to cancer diagnosis in the 1980's. The immunoperoxidase method, using monoclonal antibodies, is applied primarily as an ancillary measure to elucidate the nature of cancers The availability of specific monoclonal antibodies has greatly facilitated the identification of cell products or surface markers. For example, antibodies directed against intermediate filaments have proved to be of value in determining the histogenesis oi poorly differentiated neoplasms. Tumor markers may serve as biochemical indicators of the presence of a neoplasm. They can be detected In plasma and other body fluids. Their concentration can be applied as a diagnostic test, for monitoring the clinical course of known cancer, and as a screening measure to detect certain cancers in a population at risk. Flow cytometry is a useful tool for distinguishing several cell characteristics, such as the immunophenotype of leukemia-lymphoma cells, the DNA content of neoplastic cells, and cell proliferation rate. Molecular biologic techniques provided a giant step for the management of cancer patients encompassing diagnosis, prognostic evaluation, and therapy. Nucleic acid hybridization techniques are utilized as Southern, Northern, and dot blots and in situ hybridization. Molecular biology and its techniques may bring a blight new horizon for understanding cancer biology and in designing therapy on the basis of gene manipulation.

폐암의 세포병리학적 진단에 관한 검토

박인애,함의근,Park, In-Ae,Ham, Eui-Keun 대한세포병리학회 1991 대한세포병리학회지 Vol.2 No.1

In order to evaluate the role of cytopathologic diagnosis of sputum, bronchial washing and bronchial blushing in the diagnosis of lung cancer, we performed this study. The patients included in this study had undergone sputum, bronchial washing and brushing cytology over the 20-month period of 1985 through 1987. The total number of specimens was 5,495 of 2,242 patients, including 4,830 sputa and 665 bronchial washing and brushings. The average number of sputa and bronchial washings and brushings per case was 2.4 and 1.2 respectively. Among them, about 10% were unsatisfactory specimen, and three-fourths were negative specimens. In sputum cytology, the diagnosis of "atypical cells" was given to 3%, "suspicious for malignancy" was given to 1 %, and "malignancy" was given to 13%. In bronchial washing and brushing cytology, the diagnosis of "atypical cells", "suspicious for malignancy" and malignancy" was given to 6%, 3%, and 20% respectively The cases diagnosed as "atypical cells" in cytology were actually malignancy in 95% and 84.8% of sputum and bronchial washing and brushings respectively, and the "suspicious for malignancy" were actually malignancy in 100% in both methods. The detection rates of malignancy were 504% and 55.2% in sputum and bronchial washing and blushing respectively, and the specificity was 100% in both methods. The accuracy of cell typing was 92% in sputum and 89.7% in bronchial washing and blushing.

경흉세침흡인 생검에 의한 폐질환의 세포병리학적 진단

박인애,함의근,Park, In-Ae,Ham, Eui-Keun 대한세포병리학회 1990 대한세포병리학회지 Vol.1 No.1

The authors report series of 360 cases of transthoracic fine-needle aspiration cytology (TFNA) from Oct. 1982, through Aug. 1986 at the Seoul National University Hospital. A diagnosis of neoplastic lesion was established in 50.3% of the cases. A non-neoplastic diagnosis was made in 38.5%, nondiagnostic one in 6.5% and inadequate one in 4.7% of the total. Statistical findings on cytological diagnoses were as follows. Specificity was 100% ; sensitivity, 92% ; predictive value for positive, 1.0 ; predictive value for negative, 0.9 ; concordance rate, 84.2% ; diagnostic accuracy in non-neoplastic lesion, 65.4%, and typing accuracy in malignant tumor, 0.77.

Cytopathologic Diagnosis of Bile Obtained by Percutaneous Biliary Drainage

박인애,함의근,Park, In-Ae,Ham, Eui-Keun The Korean Society for Cytopathology 1992 대한세포병리학회지 Vol.3 No.1

췌-담도 및 배터 팽대부 주위의 암은 조기진단이 어려워 처음 발견시 질병이 상당히 진행되어 있어, 근치술은 물론 생검진단도 수행하기가 어려운 경우가 흔히 있다. 과거 이런 환자들의 진단 방법의 하나로 십이지장에서 담즙을 얻어 세포병리 검사가 시도 되었었으나, 이 경우 얻어진 담즙에 위액 및 췌액이 섞여 있어 변성을 쉽게 초래하고, 염증세포들이 많이 섞여 있을 뿐만 아니라 주위의 염증으로 비정형 세포변화를 초래하여 진단이 어려운 경우가 흔히 있었다. 최근 이런 환자들에 있어 수반되는 증상인 폐색성 황달의 완화와 방사선학적 진단을 위해 경피 경간 담도 조영술 및 담즙배출술이 시행되고 있는데, 이때 비교적 세포형태가 잘 유지된 담즙을 반복 채취하여 세포 병리검사가 시행된다. 저자들은 이 방법으로 얻어진 담즙의 세포 병리학적 진단 성적을 검토하여 다음과 같은 결과를 얻었다. 총 검체는 148명 환자의 275 검체로 이들의 세포 병리학적 진단은 선암 30예 (20.3%) 편평상피 세포암 1예 (0.75%), 전이성 소 세포암 1예 (0.7%), 선조성 비후 8예 (5.4%) 비정형 6예 (4.1 %), 간 흡충증 17예 (11.5), 양성 질환 57예 (38.5%)였고 28명 (18.9%)에서는 부적합 검체가 의뢰 되었었다. 그중 105명에서 의무기록의 확인이 가능하였는데 이들의 임상진단은 99명에서는 악성 질환 이었고 6명에서는 총 담관 결석과 협착과 같은 양성 질환 이었다. 담즙 세포 병리검사에서의 이들 악성 진단율은 23.2%이었다. 이들 악성 질환을 담도 유래의 종양과(1군)부근 림프절의 전이성암, 췌장암, 배터 팽대부 주위암 등의 외인성으로 담도를 압박하는 종양(2군)으로 나누어 보면 악성 진단율은 각각 37%와 11.6%로 현저한 차이가 있었다. 이들중 조직학적 진단이 가능 하였던 9예의 경우 세포 병리 진단율은 각각 50%(1군)와 20%(2군)로 역시 현저한 차이가 있었다 임상진단이 양성 질환 이었던 예들은 전예에서 세포 병리학적으로 양성으로 진단되어 담즙 세포 병리검사의 임상진단과의 일치율은 27.6%, 특이도는 100%이었다. 이상으로 이 담즙세포 검사의 악성 진단율은 그리높지 않으나, 경피 경간 담즙 배출술로 환자의 증상을 완화 시키면서 부수적으로 진단도 얻을 수 있는 유용한 방법이라 하겠고, 그중 담도유래의 종양군에서 외인성으로 담도를 압박하게 되는 종양군에 비해 현저히 높은 진단율을 보였다. From the one hundred forty eight patients with evidence of biliary tract obstruction, 275 bile samples were obtained from percutaneously placed biliary drainage catheters. Of the 148 patients, ova of Clonorchis sinensis were demonstrated in 17 patients (11.5%), with the epithelial cells. Among them, one case also demonstrated coexisting adenocarcinoma. In 105 patients, the medical records were available for review and the clinical diagnoses were malignancy in 99 patients and benign lesion in 6 patients. Of the 99 patients in which clinico-radiologic diagnosis were malignant, cytologic results were positive in 23.2%. Dividing the patients Into two groups, the ones with tumor of bile duct origin (group I) and the others with tumors producing extrinsic compression of bile duct, such as periampullary carcinoma, pancreas head carcinoma or metastatic carcinoma in lymph nodes from tumors of adjacent organs (group II), the cytologic results were positive in 37% and 11.6%, respectively. In patients with histologic confirmation, the positive correlation was found in 50% and 20% in group I and group II, respectively, with remarkable difference between two groups. There were no false positives in cytologic diangosis. The overall concordance rate of cytologic diagnosis with diagnosis of clinical investigation in both benign and malignant lesions was 27.6% and the diagnostic specificity was 100%.