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갑상선의 여포상 종양과 결절성 갑상선 종대에 대한 세침 흡인 세포학적 연구
유진예,조혜제,고일향,Yoo, Jin-Ye,Cho, Hye-Jae,Ko, Il-Hyang 대한세포병리학회 1998 대한세포병리학회지 Vol.9 No.1
There is a lot of difficulty in the diagnosis of follicular lesions of the thyroid by fine needle aspiration cytology(FNAC). The main purpose of this report is offering more guidance regarding the cytologic appearance to distinguish follicular neoplasm from nodular golfer and laying stress on the presence of mixed group. The histologic and cytologic findings of 23 follicular neoplasms and 13 nodular (adenomatous) getters were reviewed. Histologic specimens were classified into the microfollicular(MIF), mixed(MIX), and nodular getter(NG) groups. The comparison of histologic patterns with histologic diagnosis revealed that all the lesions with predominantly microfollicular, trabecular, or solid pattern were follicular carcinoma and all the lesions with predominantly macrofollicular pattern were nodular goiter. The distinguishing cytologic features for the MIF group were irregular cell arrangement in cell groups(100%, p=0.00001), absence of atrophic follicular cells(100%, p=0.0007), abundant microfollicles(100%, 0=0.002), pleomorphic nuclei(100%, p=0.002), not predominant syncytial smear pattern(100%, p=0.002), heterochromatin(100%, p=0.032), absence of macrofollicles(100%, p=0.038), scant colloid(100%, 0=0.04), clear back-ground(83%, p=0.00006), and uniform sized follicles(83%, p=0.014). And regular cell arrangement(honeycomb appearance) in cell groups(85%, p=0.0000), atrophic change of follicular cells(69%, p=0.0002), syncytial smear pattern(54%, p=0.000), monomorphic nuclei(85%, p=0.008), and hemorrhagic background(100%, p=0.027) were characteristic features of the NG group. Seventeen out of 36 cases(47%) were the MIX group composed of combined cytologic features of the MIF and NG groups. Therefore the frequent presence of the MIX group is considered to be main cause of the difficulty in the diagnosis of follicular lesions by FNAC. The mixed morphologic feature may support the hypothesis of a biologic 'continuum' between nodular goiter and follicular neoplasm of thyroid gland.
주미,유진예,민한내,김혜성,강윤경,이혜경,이홍섭 인제대학교 1998 仁濟醫學 Vol.19 No.1
폐의 소종양은 만성 폐질환에 동반된 신경분비성 세포의 증식성 병변으로 그 자체로는 무증상이며 수술적으로 제거된 폐 조직에서 우연히 발견되므로 그 본질이나 임상적 의의에 대한 논의가 오래 전부터 있었다. 그러나 드물기는 하나 원격전이 및 국소 전이의 예가 있고 조직학적, 특수 염색상 특징이 유암종(carcinoid)과 같으므로 최근에는 유암종의 한 아형으로 보는 경향이다. 본 예는 기관지확장증을 오랫동안 앓아오던 60세 여자 환자의 폐 설구역 절제술을 통해 우연히 발견된 전형적인 임상 상을 보이는 증례로써 육안적으로는 잘 식별이 되지 않는 2∼4mm의 소결절 형태였고, 조직학적 소견 및 은친화성을 보이는 전형적인 폐 소종양 1예를 경험 하였기에 이에 문헌고찰과 함께 보고하는 바이다. Pulmonary tumorlets are minute tumor-like lesions incidentally found in damaged lungs, such as bronchiectasis, unresolved pneumonia, and autopsy material. Histochemical and ultra-structural studies identify proliferating cells in the tumorlets as Kulchitsky-type cells and histologic features are very similar to typical carcinoid. So some investigators believe that tumorlets are peripheral bronchial carcinoid tumors and have proposed the terms "bronchial carcinoid, tumorlet type" or "carcinoid tumorlet". However, the pathological and clinical significance of tumorlets is still controversial. We experienced a case of pulmonary tumorlets in a 60-year-old women presented with a long history of mucopurulent sputum, cough, and chest pain. A chest x-ray film and high resolution CT demonstrated bronchiectasis and unresolved pneumonia without mass-like lesion. She underwent a segmentectomy of lingular segment of left upper lobe for proper diagnosis. Grossly, no mass lesion was identified. However, microscopically, multiple tumorlets were scattered along the bronchial & bronchiolar walls, subpleural location, and within the thickened interalveolar septa. They measured up to 5mm. The cytologic features were verb similar to those of typical carcinoid. Grimelius staining revealed cytoplasmic argyrophilic granules and immunohistochemical staining for neuron specific enolase (NSE) and chromogranin were positive in the tumor cells.