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Shim, Hyo Sup,Chung, Jin-Haeng,Kim, Lucia,Chang, Sunhee,Kim, Wan-Seop,Lee, Geon Kook,Jung, Soon-Hee,Jang, Se Jin The Korean Society of Pathologists and The Korean 2013 KOREAN JOURNAL OF PATHOLOGY - Vol.47 No.2
<P>Mutations of the epidermal growth factor receptor (<I>EGFR</I>) are the strongest predictive factor for response to EGFR tyrosine kinase inhibitors (TKIs), such as gefitinib and erlotinib. EGFR TKIs are approved in Korea as a first-line treatment for lung cancer patients with mutated <I>EGFR</I>. Rapid and accurate <I>EGFR</I> mutation testing is essential for patient selection and establishing targeted therapies with EGFR TKIs. Thus, a standard set of guideline recommendations for <I>EGFR</I> mutation testing suitable for the Korean medical community is necessary. In this article, we propose a set of guideline recommendations for <I>EGFR</I> mutation testing that was discussed and approved by the Cardiopulmonary Pathology Study Group of the Korean Society of Pathologists.</P>
No Detection of Simian Virus 40 in Malignant Mesothelioma in Korea
Eom, Minseob,Abdul-Ghafar, Jamshid,Park, Sun-Mi,Han, Joung Ho,Hong, Soon Won,Kwon, Kun Young,Ko, Eun Suk,Kim, Lucia,Kim, Wan Seop,Ha, Seung Yeon,Lee, Kyo Young,Lee, Chang Hun,Yoon, Hye Kyoung,Choi, Yo The Korean Society of Pathologists and The Korean 2013 KOREAN JOURNAL OF PATHOLOGY - Vol.47 No.2
<P><B>Background</B></P><P>Simian virus 40 (SV40), a polyomavirus, was discovered as a contaminant of a human polio vaccine in the 1960s. It is known that malignant mesothelioma (MM) is associated with SV40, and that the virus works as a cofactor to the carcinogenetic effects of asbestos. However, the reports about the correlation between SV40 and MM have not been consistent. The purpose of this study is to identify SV40 in MM tissue in Korea through detection of SV40 protein and DNA.</P><P><B>Methods</B></P><P>We analyzed 62 cases of available paraffin-blocks enrolled through the Korean Malignant Mesothelioma Surveillance System and performed immunohistochemistry for SV40 protein and real-time polymerase chain reaction (PCR) for SV40 DNA.</P><P><B>Results</B></P><P>Of 62 total cases, 40 had disease involving the pleura (64.5%), and 29 (46.8%) were found to be of the epithelioid subtype. Immunostaining demonstrated that all examined tissues were negative for SV40 protein. Sufficient DNA was extracted for real-time PCR analysis from 36 cases. Quantitative PCR of these samples showed no increase in SV40 transcript compared to the negative controls.</P><P><B>Conclusions</B></P><P>SV40 is not associated with the development of MM in Korea.</P>
Kim, Mimi,Park, Hyo Jin,Min, Hye Sook,Kwon, Hyeong Ju,Jung, Chan Kwon,Chae, Seoung Wan,Yoo, Hyun Ju,Choi, Yoo Duk,Lee, Mi Ja,Kwak, Jeong Ja,Song, Dong Eun,Kim, Dong Hoon,Lee, Hye Kyung,Kim, Ji Yeon,Ho The Korean Society of Pathologists and the Korean 2017 Journal of Pathology and Translational Medicine Vol.51 No.4
<P><B>Background</B></P><P>The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) has standardized the reporting of thyroid cytology specimens. The objective of the current study was to evaluate the nationwide usage of TBSRTC and assess the malignancy rates in each category of TBSRTC in Korea. </P><P><B>Methods</B></P><P>Questionnaire surveys were used for data collection on the fine needle aspiration (FNA) of thyroid nodules at 74 institutes in 2012. The incidences and follow-up malignancy rates of each category diagnosed from January to December, 2011, in each institute were also collected and analyzed. </P><P><B>Results</B></P><P>Sixty out of 74 institutes answering the surveys reported the results of thyroid FNA in accordance with TBSRTC. The average malignancy rates for resected cases in 15 institutes were as follows: nondiagnostic, 45.6%; benign, 16.5%; atypical of undetermined significance, 68.8%; suspicious for follicular neoplasm (SFN), 30.2%; suspicious for malignancy, 97.5%; malignancy, 99.7%. </P><P><B>Conclusions</B></P><P>More than 80% of Korean institutes were using TBSRTC as of 2012. All malignancy rates other than the SFN and malignancy categories were higher than those reported by other countries. Therefore, the guidelines for treating patients with thyroid nodules in Korea should be revisited based on the malignancy rates reported in this study.</P>
Jung, Chan Kwon,Min, Hye Sook,Park, Hyo Jin,Song, Dong Eun,Kim, Jang Hee,Park, So Yeon,Yoo, Hyunju,Shin, Mi Kyung The Korean Society of Pathologists and the Korean 2015 Journal of Pathology and Translational Medicine Vol.49 No.4
<P>In recent years throughout Korea, the use of ultrasound-guided core needle biopsy (CNB) has become common for the preoperative diagnosis of thyroid nodules. However, there is no consensus on the pathology reporting system for thyroid CNB. The Korean Endocrine Pathology Thyroid Core Needle Biopsy Study Group held a conference on thyroid CNB pathology and developed guidelines through contributions from the participants. This article discusses the outcome of the discussions that led to a consensus on the pathology reporting of thyroid CNB.</P>
Nodular Fasciitis of the Parotid Gland, Masquerading as Pleomorphic Adenoma
Hwang, Chung Su,Lee, Chang Hun,Kim, Ahrong,Shin, Nari,Park, Won Young,Park, Min Gyoung,Park, Do Youn The Korean Society of Pathologists and The Korean 2014 KOREAN JOURNAL OF PATHOLOGY - Vol.48 No.5
<P>It is difficult to distinguish nodular fasciitis (NF) from other neoplasm of the parotid gland, especially pleomorphic adenoma (PA) by fine needle aspiration cytology. A 39-year-old female noticed a mass in the parotid region. The aspirate material showed cohesive parts composed of the cells that had oval or spindle-shaped nuclei and relatively abundant cytoplasm and some cells with plasmacytoid features. The background substance was fibromyxoid. PA was diagnosed based on the cytologic findings. Subsequently, parotidectomy was performed and NF was diagnosed based on histologic and immunohistochemical findings. NF in the parotid region is rare and may be misdiagnosed as other benign or malignant tumors of the parotid gland. The clinical history of rapid growth and the presence of mitoses and inflammatory cells help to distinguish NF from PA. In addition, immunohistochemical stains for smooth muscle actin and CD68 are useful to confirm the diagnosis of NF.</P>
Lee, Eunjung,Jung, Wonkyung,Woo, Jeong-Soo,Lee, Jae Bok,Shin, Bong Kyung,Kim, Han Kyeom,Kim, Aeree,Kim, Baek-hui The Korean Society of Pathologists and The Korean 2014 KOREAN JOURNAL OF PATHOLOGY - Vol.48 No.2
<P><B>Background</B></P><P>Identification of poor prognostic factors in papillary thyroid carcinoma (PTC) patients is important for the patients' care and follow-up. We can sometimes see small tumor clusters without desmoplasia and no evidence of lymphatic emboli around the main tumor mass of PTC. We termed this form of tumor clustering, 'tumor sprouting,' and determined whether these tumors correlate with lymphovascular invasion, lymph node metastasis, and recurrence.</P><P><B>Methods</B></P><P>We analyzed a total of 204 cases of papillary thyroid macrocarcinoma. Number, size and distance from the main tumor of the tumor sprouting were observed and analyzed with clinicopathologic characteristics.</P><P><B>Results</B></P><P>Tumor sprouting was observed in 101 patients. Presence of tumor sprouting was significantly associated with positive resection margin (p=.002), lymphovascular invasion (p=.001), lymph node metastasis (p<.001), and recurrence (p=.004). Univariate analysis of recurrence-free survival revealed that tumor multiplicity (p=.037), positive resection margin (p=.007), lymphovascular invasion (p=.004), lymph node metastasis (p<.001), and tumor sprouting (p=.004) were poor prognostic factors. In multivariate analysis, positive resection margin was an independent poor prognostic factor of recurrence.</P><P><B>Conclusions</B></P><P>In conclusion, tumor sprouting is significantly correlated with lymph node metastasis and recurrence. Evaluation of tumor sprouting in PTC patients could be helpful in predicting tumor recurrence or lymph node metastasis.</P>
Kim, Jung Ho,Bae, Jeong Mo,Kim, Kyung-Ju,Rhee, Ye-Young,Kim, Younghoon,Cho, Nam-Yun,Lee, Hye Seung,Chang, Mee Soo,Kang, Gyeong Hoon The Korean Society of Pathologists and The Korean 2014 KOREAN JOURNAL OF PATHOLOGY - Vol.48 No.4
<P><B>Background</B></P><P>Recent studies have revealed that a small subset of Lynch syndrome-associated colorectal carcinomas (CRCs) is caused by a germline <I>EPCAM</I> deletion-induced <I>MSH2</I> epimutation. Based on the finding of this genetic alteration, we investigated the implications of EPCAM expression changes in microsatellite instability-high (MSI-H) CRCs.</P><P><B>Methods</B></P><P>Expression of EPCAM and DNA mismatch repair proteins was assessed by immunohistochemistry in 168 MSI-H CRCs. Using DNA samples of these tumors, <I>MLH1</I> promoter methylation status was also determined by methylation-specific real-time polymerase chain reaction method (MethyLight).</P><P><B>Results</B></P><P>Among 168 MSI-H CRCs, complete loss (CL) and focal loss (FL) of EPCAM expression was observed in two (1.2%) and 22 (13.1%) cases, respectively. Both of the EPCAM-CL cases were found in MSH2-negative tumors without <I>MLH1</I> promoter methylation. However, only nine of the 22 EPCAM-FL tumors had MSH2 deficiency. Of the 22 EPCAM-FL tumors, 13 showed MLH1 loss, and among them, nine cases were determined to have <I>MLH1</I> methylation. EPCAM-FL was significantly associated with advanced stage (p=.043), distant metastasis (p=.003), poor differentiation (p=.001), and signet ring cell component (p=.004).</P><P><B>Conclusions</B></P><P>Loss of EPCAM expression is differentially associated with clinicopathological and molecular features, depending on the completeness of the loss, in MSI-H CRCs.</P>
Kim, Joo-Yeun,Shin, Na Ri,Kim, Ahrong,Lee, Hyun-Jeong,Park, Won-young,Kim, Jee-Yeon,Lee, Chang-Hun,Huh, Gi-Young,Park, Do Youn The Korean Society of Pathologists and The Korean 2013 KOREAN JOURNAL OF PATHOLOGY - Vol.47 No.1
<P><B>Background</B></P><P>Gastric cancers with microsatellite instabilities (MSI) have been reported to be associated with favorable prognosis. However, the significance of the effect of MSI on the clinicopathological features, as well as its association with mucin phenotype, remains unclear.</P><P><B>Methods</B></P><P>MSI status was assessed in 414 cases of gastric cancer using polymerase chain reaction analysis of five microsatellite loci, as recommended by National Cancer Institution criteria. The expression of mucins (MUC5AC, MUC6, MUC2, and CD10) was assessed.</P><P><B>Results</B></P><P>Out of 414 total cases of gastric cancer, 380 (91.7%), 11 (2.7%), and 23 (5.6%) were microsatellite stable (MSS), low-level MSI (MSI-L), and high-level MSI (MSI-H), respectively. Compared to MSS/MSI-L, MSI-H gastric cancers were associated with older age (p=0.010), tumor size (p=0.014), excavated gross (p=0.042), intestinal type (p=0.028), aggressive behaviors (increase of T stage [p=0.009]), perineural invasion [p=0.022], and lymphovascular emboli [p=0.027]). MSI-H gastric cancers were associated with tumor necrosis (p=0.041), tumor-infiltrating lymphocytes (≥2/high power field, p<0.001), expanding growth patterns (p=0.038), gastric predominant mucin phenotypes (p=0.028), and MUC6 expression (p=0.016). Tumor necrosis (≥10% of mass, p=0.031), tumor-infiltrating lymphocytes (p<0.001), intestinal type (p=0.014), and gastric mucin phenotypes (p=0.020) could represent independent features associated with MSI-H gastric cancers. MSI-H intestinal type gastric cancers had a tendency for poor prognosis in univariate analysis (p=0.054) but no association in Cox multivariate analysis (p=0.197).</P><P><B>Conclusions</B></P><P>Our data suggest that MSI-H gastric cancers exhibit distinct aggressive biologic behaviors and a gastric mucin phenotype. This contradicts previous reports that describe MSI-H gastric cancer as being associated with favorable prognosis.</P>