간세포암의 다단계 발암과정

장자준 ( Ja June Jang ) 대한간암학회 2008 대한간암학회지 Vol.8 No.-

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.

점액양 연골 육종 1례의 세침 흡인 세포학적 소견

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.

평활근육종의 세침 흡인 세포학적 소견 -2예 보고-

하창원,명나혜,조경자,장자준,Ha, Chang-Won,Myong, Na-Hye,Cho, Kyung-Ja,Jang, Ja-June 대한세포병리학회 1990 대한세포병리학회지 Vol.1 No.2

Leiomyosarcoma of the soft tissue is a well-defined and characteristic entity histologically, but cytomorphological studes are lacking. A correlaive cytological study of 2 cases of leiomyosarcoma is presented. The smears from case 1 were rich in tumor cells and most cells were arranged in large sheets or clusters. The cells showed round to oval nuclei containing fine chromatin and small promiment nucleoli. The smears from case 2 were moderate in cellularity with loose clusters or isolated cells. The characteristic blunt-ended and cigar-shaped nuclei containing coarse chromatin and prominent nucleoli were identified in case 2. Nuclear atypia, prominent nucleoli and high cellularity permit diagnosis of malignancy, although the atypia is generally less pronounced than in the histology. The cytological diagnosis of leiomyosarcoma may be auxiliary in the diagnosis of recurrence or metastasis in the patients with alleged leiomyosarcoma.

모기질 세포종의 흡인 세포학 - 전이성 암종으로 오진된 2예 보고 -

고재수,하창원,조경자,장자준,Koh, Jae-Soo,Ha, Chang-Won,Cho, Kyung-Ja,Jang, Ja-June The Korean Society for Cytopathology 1993 대한세포병리학회지 Vol.4 No.1

35세 및 22세 여자의 경부에 생긴 종괴의 세침흡인 세포학적 검사에서 악성이 의심되는 병변 및 악성 병변으로 오진되었던 모기질 세포종 2예의 세포학적 소견을 기술한다. 핵 세포질의 비율이 높고 뚜렷한 핵소체를 보이는 기저양 세포, 농염성 핵을 가진 각화된 편평상피세포, 이물형 거대세포 및 괴사성 배경을 보였고, 후속하여 보았을 때 이러한 소견은 모기질 세포종의 특이적인 소견으로서 악성 종양으로 보기에는 염색질의 분포가 균질하고 핵들의 다형성이 없는 점이 악성 종양과는 구별되는 소견이었고, 모기질 세포종은 경부 종괴 및 여하한 부위의 피하 종괴의 세침 흡인에서 상기의 소견을 보일 때 감별 진단의 하나로서 고려해야한 양성 병변이다. We describe cytologic findings of two cases of pilomatrixoma which had been cytologically misdiagnosed as suspicious malignant and malignant lesions in 35 year-old and 22 year-old females who presented a palpable neck mass. The cytologic smears showed many basaloid cells with a high nuclear-cytoplasmic ratio, nuclear hyperchromatism and prominent nucleoli, keratinized squamous cells with pyknotic nuclei, foreign body giant cells, and chronic inflammatory cells in necrotic back-ground. Retrospective view of this aspiration smear revealed that these findings were characteristic features of pilomatrixoma, and the evenly distributed chromatin pattern as well as the lack of nuclear pleomorphism were considered to be the differential points from malignant neoplasm. Pilomatrixoma is a benign neoplasm which should be included in differential diagnosis if the fine needle aspiration cytologic smear of a neck mass or subcutaneous mass of any site showed these features.

유방의 분비성 상피암종의 세침 흡인 세포학적 소견 - 1례 보고 -

하창원,고재수,명나혜,조경자,장자준,Ha, Chang-Won,Koh, Jae-Soo,Myong, Na-Hye,Cho, Kyung-Ja,Jang, Ja-June 대한세포병리학회 1992 대한세포병리학회지 Vol.3 No.1

Secretory carcinoma is a very rare tumor of the breast, having characteristic histologic findings. A cytologic study of a secretory carcinoma is presented. The smears were abundant in tumor cells which were arranged in loosely adherent or large tight clusters in clear background. The individual cells were round or oval, monomorphic, and had abundant eosinophilic cytoplasm. The cytoplasm showed distinct borders and single or fine vacuolization. The nuclei were peripherally located, oval, and vesicular with small prominent nucleoli. As in histology, the cytologic features were so characteristic that a diagnosis of secretory carcinoma could be made by ctyologic study only.

세침흡인 세포학적 검사로 진단된 간 방선균증 - 1예 보고 -

하창원,고재수,조경자,장자준,Ha, Chang-Won,Koh, Jae-Soo,Cho, Kyung-Ja,Jang, Ja-June 대한세포병리학회 1992 대한세포병리학회지 Vol.3 No.2

We experienced a case of primary hepatic actinomycosis which was initially diagnosed by means of fine needle aspiration. The patient was a 31-year-old emaciated man with a 2-month history of 10 kg weight loss, right upper quadrant pain and flank pain. The liver was palpable and tender on physical examination. Computerized tomography scan of the liver showed two ill-defined hypodense masses in gallbladder fossa and inferior pole of right lobe. Hepatocellular carcinoma was clinically suspected. A CT-guided fine needle aspiration was peformed. Microscopically, smears showed numerous radiating clusters of filamentous bacteria with many neutrophils and monocytes in necrotic background. The symptoms were improved by incision and drainage and massive administration of penicillin.

전이성 편평 세포암종의 체액 세포학적 소견

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.

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.