림프절의 전이성 소세포암종의 세침흡인 세포학적 소견 - 악성 림프종과의 감별을 중심으로 5예 분석 -

김연미,조혜제,고일향,Kim, Yeon-Mee,Cho, Hye-Je,Ko, Ill-Hyang 대한세포병리학회 1996 대한세포병리학회지 Vol.7 No.1

Small cell carcinoma of the lung is characterized by cells with finely stippled chromatin and scanty cytoplasm as well as a particularly aggressive clinical course and favorable response to the chemotherapy. Recently percutaneous fine needle aspiration (FNA) biopsy has become both widely established and highly respected for the diagnosis of lung cancer. However metastatic small cell carcinoma of lymph node should be cytologically differentiated from the small round cell tumor of particular sites, especially malignant lymphoma, because small ceil carcinoma of classic oat cell type nay simulate small cell non-Hodgkin's lymphoma. We report five cases of metastatic small cell carcinoma of in-termediate cell type diagnosed by FNA of the enlarged lymph nodes of the neck and axilla. The cytologic smears contained diffuse small neoplastic cells larger than lymphocytes with dense, pyknotic nuclei and extremely scanty cytoplasm. Apparently viable large tumor cells have vesicular nuclei with granular, sometimes very coarse chromatin. The characteristic cytologic features of small cell carcinoma as compared to malignant lymphoma were as follows.: 1) small cells with dense pyknotic nuclei are evenly distributed in the background of apparently viable larger tumor cells, admixed with mature lymphocytes and phagocytic macrophages. 2) small loose aggregates of cells with nuclear melding are indicative of small cell carcinoma rather than non-Hodgkin's lymphoma. 3) the cytoplasmic and nuclear fragments of tumor necrosis are more dominant in the smears of small cell carcinoma. 4) nuclear membrane and nucleoli are generally indistinct in small cell carcinoma due to condensation of chromatin.

자궁경부 소세포암종의 방사선치료

정은지(Eun Ji Chung),이용희(Yong Hee Lee),김귀언(Gwi Eon Kim),서창욱(Chang Ok Suh) 대한방사선종양학회 1997 Radiation Oncology Journal Vol.15 No.4

목 적 : 자궁경부 소세포암종으로 진단되어 방사선치료를 받은 환자에서 조직병리학적인 재검사를 시행하여 조직병리학적 특성을 알아보고, 환자 및 종양의 특징, 방사선치료 후의 치료 성적 등을 조직병리학적 유형에 따라 후향적으로 비교 분석해 보았다. 대상 및 방법 : 1981년 10월부터 1995년 4월까지 연세의대 연세암센터 치료방사선과에서 자궁경부암으로 방사선치료를 받은 환자 총 2890명 중 조직학적 유형이 소세포암종이었던 환자는 60명으로 2.08%였다. 타병원에서 조직검사 및 병기 결정 후 방사선치료 만을 위해 전과되었던 36예에서는 자궁경부 생검 조직을 확보할 수 없었고, 이들을 제외한 24명에서 조직에 대한 병리학적 재검사가 가능하여 H & E 염색 및 신경내분비 표지인 neuron-specific enolase(NSE), chromogranin, synaptophysin, Grimelius 면역조직화학 염색을 시행하였다. 이들 24예의 환자 및 종양의 특성, 방사선치료에 대한 반응, 치료 실패 양상, 5년 생존율 및 5년 무병 생존율 등을 후향적으로 분석하였다. 결 과 : H & E 염색 및 4가지 neuroendocrine marker 검사 후 13예는 신경내분비암종으로 진단되었고 11예는 소세포 유형의 편평상피암종으로 진단되어 병리학적으로 크게 2가지 군으로 분류하였다. 신경내분비암종으로 분류된 13예 중 5예는 중등도 이상으로 분화가 좋은 편이었으나 8예는 분화가 나쁘거나 미분화되었다. 전체 24예 대상 환자들의 연령은 23-79세로 중앙 연령치 54세였으며 FIGO 병기 분포는 Ib 8예(33.3%), IIa 1예(4.2%), IIb 11예(45.8%), IIIa 2예(8.3%), IIIb 1예(4.2%), IV 1예(4.2%)로 병기 I- II가 20예로 대다수를 차지하였다. 골반 림프절에 전이가 있었던 환자가 5예(20.8%) 있었는데 이 중 3예는 수술후 조직학적으로 확인되었고(2예는 근치적 수술, 1예는 골반 림프절 생검) 다른 2예는 전산화 단층 촬영상 골반 림프절이 커져 있어 전이로 판단되었다. 이들 2가지 병리학적 분류군에 따라 환자 및 종양의 특성을 비교해 보았는데 특별한 차이는 발견할 수 없었으며, 방사선치료에 대한 반응, 치료 실패 양상, 5년 생존율 및 5년 무병 생존율 등의 치료 결과를 비교해 보았을 때 치료 실패 양상에 있어서 소세포형의 편평상피암종에서는 원격 전이가 2예(18.2%)인데 반해 신경내분비암종에서는 6예(46.2%)로 신경내분비암종(neuroendocrine carcinoma)에서 원격 전이율이 높았으나 환자 수가 적어 통계학적인 유의성은 없었다(P>0.05). 결 론 : 병리조직학적 재검사가 가능하였던 24예의 자궁경부 소세포암종 환자 중 13예가 신경내분비암종으로 진단되었으며 나머지 11예는 소세포형의 편평상피암종으로 분류되었는데 환자 및 종양의 특징, 방사선치료 성적을 비교해 볼 때 신경내분비암종에서 원격 전이가 호발하였으나(46.2% vs. 18.2%), 5년 생존율과 5년 무병 생존율의 차이는 없었다. 이런 결과로 자궁경부에서 발생한 소세포암종 중 신경내분비암종의 경우는 원격 전이가 많으므로 방사선치료, 수술 등의 국 소 치료와 더불어 적절한 항암화학요법을 추가하여 치료 결과를 증진시킬 수 있으리라 생각한다. Purpose : This study was performed to identify the histopathologic feature by the reevaluation of the pathologic specimen of the cervical tumors and to evaluate the clinical findings and the treatment results of the patients with small cell carcinoma of the cervix treated by radiotherapy. Materials and Methods : 2890 patients with cervical carcinoma received radiotherapy at the Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine between October 1981 and April 1995. Of the 2890 patients in this data base, sixty were found to have small cell carcinomas (2.08%). Among them thirty six patients were transferred from other hospitals, the biopsy specimens of those patients were not available. So we could review the slides of the other twenty four patients who were diagnosed at our hospital. Twenty four patients with small cell carcinoma of the cervix were analyzed retrospectively based on the assessment of H & E staining and other four immunohistochemical stains for neuroendocrine differentiation (neuron specific enolase, chromogranin, synaptophysin and Grimelius stain). And we also evaluate the patients and tumor characteristics, response to radiation, patterns of failures, 5 year overall and disease free survival rates. Results : Thirteen tumors were neuroendocrine carcinomas (13/24=54.2%) and eleven tumors were squamous carcinomas, small cell type (11/24= 47.8%) based on the assessment of H & E staining and other four neuroendocrine marker studies. So we classified the patients two groups as neuroendocrine carcinoma and small cell type of squamous carcinoma. Among the 13 neuroendocrine carcinomas, five were well to moderately differentiated tumors and the other eight were poorly differentiated or undifferentiated ones. The median age was 54 years old (range 23-79 years). Eight patients had FIGO stage IB disease, 12 had stage II, 3 had stage III and one had stage IV disease. Pelvic lymph node metastases were found in five patients (20.8%), three of them were diagnosed by surgical histologic examination and the other two were diagnosed by CT scan. There was no difference between two histopathologic groups in terms of patients and tumor characteristics, response to radiation, 5 year overall and disease free survival rates. However the distant metastases rate was higher in neuroendocrine carcinoma patients (6/13:46.2%) than in small cell type of squamous carcinoma patients (2/11:18.2%), but there was no statistically significant difference because of the small number of patients (P>0.05). Conclusion : More than half of the small cell carcinoma of the cervix patients were neuroendocrine carcinoma (13/24 : 54.1%) by reevaluation of the biopsy specimen of the cervical tumors. The tendency of distant metastases of the neuroendocrine carcinoma was greater than those of the small cell type of squamous carcinoma (46.2% vs. 18.2%). But there were no differences in the patients and tumor characteristics and other clinical treatment results in both groups. These data suggest that radical local treatment such as radiotherapy or radical surgery combined with combination systemic cytotoxic chemotherapy might provide these patients with the best chance for cure.

Comprehensive Cytomorphologic Analysis of Pulmonary Adenoid Cystic Carcinoma: Comparison to Small Cell Carcinoma and Non-pulmonary Adenoid Cystic Carcinoma

김석휘,한정호,주진아,김호중 대한병리학회 2015 Journal of Pathology and Translational Medicine Vol.49 No.6

Background: Cytologic diagnosis of pulmonary adenoid cystic carcinoma (AdCC) is frequently challenging and differential diagnosis with small cell carcinoma is often difficult. Methods: Eleven cytologically diagnosed cases of pulmonary AdCC were collected and reviewed according to fifteen cytomorphologic characteristics: small cell size, cellular uniformity, coarse chromatin, hyperchromasia, distinct nucleolus, frequent nuclear molding, granular cytoplasm, organoid cluster, sheet formation, irregular border of cluster, hyaline globule, hyaline basement membrane material, individual cell necrosis or apoptotic body, and necrotic background. Twenty cases of small cell carcinoma and fifteen cases of non-pulmonary AdCC were also reviewed for the comparison. Results: Statistically significant differences were identified between pulmonary AdCC and small cell carcinoma in fourteen of the fifteen cytomorphologic criteria (differences in sheet formation were not statistically significant). Cellular uniformity, distinct nucleolus, granular cytoplasm, distinct cell border, organoid cluster, hyaline globule, and hyaline basement membrane material were characteristic features of AdCC. Frequent nuclear molding, individual cell necrosis, and necrotic background were almost exclusively identified in small cell carcinoma. Although coarse chromatin and irregular cluster border were observed in both, they favored the diagnosis of small cell carcinoma. Hyaline globules were more frequently seen in non-pulmonary AdCC cases. Conclusions: Using the fifteen cytomorphologic criteria described by this study, pulmonary AdCC could be successfully distinguished from small cell carcinoma. Such a comprehensive approach to an individual case is recommended for the cytologic diagnosis of pulmonary AdCC.

방광에 발생한 원발성 소세포암종의 세포학적 소견 -1 예 보고-

권미선,안긍환,정진행,이승숙,고재수,Kwon, Mi-Seon,Ahn, Geung-Hwan,Chung, Jin-Haeng,Lee, Seung-Sook,Koh, Jae-Soo 대한세포병리학회 2001 대한세포병리학회지 Vol.12 No.2

Primary small cell carcinoma of the urinary bladder is a rare malignant tumor. A more rapidly fatal course may be seen in advanced stages of small cell carcinoma as compared to similar stages of urothelial carcinoma. It is very important to recognize this distinct form of bladder cancer by urinary cytology The differential diagnosis of small cell carcinoma of the urinary bladder includes metastatic small cell carcinoma, urothelial carcinoma, and primary or secondary malignant lymphoma. This article highlights the urinary cytologic diagnosis of a case of primary small cell carcinoma. A 59-year-old male presented with gross hematuria for five months. Urinary cytology showed high cellularity consisting of tiny monotonous tumor cells in the necrotic background. The tumor cells occurred predominantly singly, but a few in clusters. The cytoplasm was so scanty that only a very narrow rim of it was seen. The nuclei were oval or round and had finely stippled chromatin. Rarely, the nuclei contain visible nucleoli. Frequently cell molding was noted in clusters. Many single cells demonstrated nuclear pyknosis or karyorrhexis. The histologic findings of transurethral resection and partial cystectomy specimen were those of small cell carcinoma. Cytologic distinction may be very difficult but careful attention to clinical features and cellualr details can classify these neoplasms correctly.

경부에 발생한 원발불명의 소세포암 1례

이소영,김영철,홍창균,김정아,김성환,유진영,노혜일,김훈교,Lee So-Young,Kim Young-Chul,Hong Chang-Kyoun,Kim Jung-A,Kim Sung-Whan,You Jin-Young,Noh He-Il,Kim Hoon-Kyo 대한두경부종양학회 2000 대한두경부 종양학회지 Vol.16 No.2

Small cell carcinoma usually occurs in lung, but extrapulmonary small cell carcinomas can occur in any sites of body. Most sites of extrapulmonary small cell carcinoma reported were esophagus. And small cell carcinomas occurred in head and neck area were reported rarely. Extrapulmonary small cell carcinoma could be diagnosed when there is no evidence of primary lung lesion on chest X-ray, CT scan of chest and bronchoscopy. The authors experienced a case of small cell carcinoma of left submandibular lymph node in 64-year-old male patient. Biopsy specimen showed poorly differentiated carcinoma but immunohistochemical study showed small cell carcinoma. The chest X-ray and CT scan of chest showed no evidence of primary lung lesion. The patient received chemotherapy(etoposide plus cisplatin) and concurrent chemoradiotherapy using weekly taxol which resulted in good clinical remission. He is still alive 8 months after diagnosis without evidence of lung disease. We report our case with a brief review of literatures.

Primary Breast Small Cell Carcinoma With Merkel Cell Features: A Case Report and Literature Review

Ya Jiang,Ziran Gao,Yuanyuan Wang,Wenmang Xu 한국유방암학회 2023 Journal of breast cancer Vol.26 No.3

Neuroendocrine carcinoma of the breast is a rare malignant tumor which, with the features of Merkel cells is even rarer. Herein, we report a case of small cell carcinoma with Merkel cell features in a 52-year-old female. Microscopically, the tumor was characterized by diffuse and consistent small round cells that were de-adherent. The tumor cells had round or oval nuclei with delicate chromatin and small nucleoli, the cytoplasm was sparse and eosinophilic. Additionally, the tumor was accompanied by high-grade ductal carcinoma in situ. Immunohistochemical staining showed that infiltrating tumor cells were positive for neuroendocrine markers, and punctately positive for CK20. The patient underwent modified radical mastectomy, axillary lymph node dissection, and postoperative adjuvant chemotherapy. No recurrence or metastasis was observed during follow-up period. Primary breast small cell carcinoma with Merkel cell features is rare and easily misdiagnosed as Merkel cell carcinoma. Early diagnosis and treatment may improve patient prognosis.

p40 Immunohistochemistry Is an Excellent Marker in Primary Lung Squamous Cell Carcinoma

Khairunisa Ahmad Affandi,Nur Maya Sabrina Tizen,Muaatamarulain Mustangin,Reena Rahayu Md Zin 대한병리학회 2018 Journal of Pathology and Translational Medicine Vol.52 No.5

Background: Lung cancer is the third most common cancer worldwide. With major advances in the molecular testing of lung cancers and the introduction of targeted therapies, the distinction between adenocarcinoma and squamous cell carcinoma as well as pathologic subtyping has become important. Recent studies showed that p40 is highly specific for squamous and basal cells and is superior to p63 for diagnosing lung squamous cell carcinoma. The aim of this study was to evaluate the use of p40 immunohistochemical stain in the diagnosis of non-small cell lung carcinoma and its potential to replace current p63 antibody as the best immunohistochemical squamous marker. Methods: Seventy formalin-fixed paraffin-embedded cases previously diagnosed as primary lung squamous cell carcinoma (n = 35) and lung adenocarcinoma (n = 35) from January 2008 to December 2016 were retrieved. The results of tumour cell immunoreactivity for p40 and p63 antibodies in lung squamous cell carcinoma and lung adenocarcinoma were compared. Results: p40 was expressed in 27 cases of lung squamous cell carcinoma (77.1%). All cases of lung adenocarcinoma (35/35, 100%) were negative for p40. p63 expression was positive in 30 cases of lung squamous cell carcinoma (85.7%) and 13 cases of lung adenocarcinoma (37.1%). Reactivity for both p40 and p63 in lung squamous cell carcinoma was strong and diffuse, whereas variable reactivity was observed in lung adenocarcinoma. Conclusions: p40 is an excellent marker for distinguishing lung squamous cell carcinoma from adenocarcinoma, and p40 expression is equivalent to p63 expression in lung squamous cell carcinoma.

방광의 소세포 신경내분비 암종의 요 세포학적 소견 - 1 예 보고 -

김동훈,강동욱,김경희,김주헌,박미자,Kim, Dong-Hoon,Kang, Dong-Wook,Kim, yuug-Hee,Kim, Ju-Heon,Park, Mee-Ja 대한세포병리학회 2002 대한세포병리학회지 Vol.13 No.2

We report the cytologic features of a case of primary small cell carcinoma of the urinary bladder with high grade transitional cell and signet ring cell carcinomatous components. A 64-year-old male presented with gross hematuria for one week. Computed tomography revealed an ill-defined mass in the left lateral wall of the urinary bladder. Urinary cytology showed hypercellularity with predominantly isolated single cells and clustered cells. They have scanty cytoplasm and naked hyperchromatic nuclei with finely granular nuclear chromatin and rare nucleoli. The tumor cells occurred predominantly singe cells, but a few in clusters. Nuclear molding was prominent. No glandular formation or nesting was noted. The second tumor cells had high nuclear/cytoplasmic ratio, irregular nuclear membrane, and coarse granular chromatin. The background was inflamed and necrotic. The histoiogic findings of transurethral resection were mainly composed of small cell carcinoma, and partly transitional cell and signet ring cell carcinomatous components. Small cell neuroendocrine carcinoma have distinctive cytologic features to make a proper diagnosis.

소세포 및 영양아세포성 분화를 보이는 자궁내 막의 미분화암-1예 보고-

김철환,박성혜,김인선,백승룡 대한병리학회 1990 Journal of Pathology and Translational Medicine Vol.24 No.1

췌장에 전이된 폐 소세포암

이태훈 ( Tae Hun Lee ),정일권 ( Il Kwun Chung ),길효욱 ( Hyo Wook Gil ),박현준 ( Hyun Jun Park ),김영훈 ( Young Hoon Kim ),박상흠 ( Sang Heum Park ),김홍수 ( Hong Soo Kim ),이문호 ( Moon Ho Lee ),김선주 ( Sun Joo Kim ),조현득 ( Hy 대한소화기학회 2003 대한소화기학회지 Vol.41 No.5

The incidence of small cell carcinomas of the pancreas is approximately 1% of malignant pancreatic diseases. About 10% of metastatic small cell carcinomas of the pancreas are originated from the lung. Diagnosis of primary small cell carcinomas of the pancreas should be done after exclusion of any extraabdominal presence of small cell carcinomas. Metastasis-induced acute pancreatitis is unusual and the case manifested by primary pancreatic cancer is also unusual. We experienced a rare case of metastatic small cell carcinoma of the pancreas, which was suspected to be originated from the lung. He presented with clinical features of acute pancreatitis and was diagonsed having small cell carcinoma of the pancreas by histologic examination. The radiographic finding on his chest was normal, but small cell lung cancer was detected by more active evaluation of the lung. (Korean J Gastroenterol 2003;41:417-420)