자궁경부 세포진에서 임신과 관련된 세포학적 변화에 대한 연구

장회숙,전이경,조정숙,박종숙,양재혁,김희숙 대한임상병리사협회 2005 조직세포검사학회 발표자료집 Vol.2004 No.-

임신 때 나타나는 자궁내막과 자궁경부 및 질의 형태학적 변화는 호르몬의 변화와 관련이 있다. 조직학적으로 영양막(trophoblast) 세포와 혈관으로 구성된 태반이 생기고 자궁내막의 선세포의 Arias-Stella 반응과 간질 세포의 탈락막 변화(decidual change)가 나타난다. 임신과 관련하여 자궁경부 세포진에서 출현할 수 있는 세포는 세 가지로 태반과 관련된 영양막 세포와 특징적인 Arias-Stella 반응을 보이는 선세포, 그리고 간질세포가 변한 탈락막 세포이다. 임신과 관련된 세포의 특수한 형태학적 변화에 익숙하지 않으면 세포진에서 편평상피 이형성증이나 선상피 병변으로 오인하기 쉽다. 본 연구를 통하여 임신과 관련된 세포학적 변화가 진단에 어떠한 영향을 주는지 알아보고자 하였다. 연구대상은 성균관의대 삼성제일병원에서 임신기간 중 혹은 분만 후에 시행한 세포진에서 비정상으로 진단된 106명으로부터 얻어진 117예의 세포진이며, 세포병리사 3명과 병리전문의 2명이 117예의 세포진을 재검토하였다. 117예의 세포학적 진단은 ASCUS 86예 (ASCUS NOS 26, ASCUS R/O SIL 39, ASCUS R/O HSIL 21), LSIL 4예, LSIL R/O HSIL 6예, HSIL 8예, AGUS 13예 이었다. 임신에 대한 임상정보를 참고하고 세포를 재검토한 결과 임신과 관련된 세포변화 중 가장 흔히 보이는 소견은 간질세포의 탈락막 세포변화이며 28예에서 관찰되었고, Arias-Stella 반응을 보이는 선세포는 6예였다. 두 가지 세포를 동시에 보인 예는 2예였고 영양막 세포는 한 예에서도 보이지 않았다. ASCUS 86예 중 13예는 임신과 관련된 세포변화로 재분류되었다. 13예 중 12예는 탈락막 세포를 ASCUS로 판독했었고, 처음 세포진단은 ASCUS NOS 5예, ASCUS R/O SIL 5예, ASCUS R/O HSIL 2예였다. 1예는 Arias-Stella 반응을 보인 선세포를 ASCUS R/O HSIL로 판독했었다. 추적검사결과 세포학적 또는 조직학적 검사에서 탈락막 세포변화를 보였던 12예는 모두 정상이었고, Arias-Stella 반응을 보였던 1예도 조직생검에서 임신과 관련된 정상소견이었다. 결론적으로 임신과 관련된 세포변화는 임신이라는 사실을 모르거나 세포소견을 숙지하고 있지 않으면 ASCUS, AGUS나 그 이상으로 잘못 진단될 수 있다는 것이 확인되었다. 이와 같은 판독 오류를 방지하기 위하여 임신과 관련된 세포변화를 잘 알고 있어야 하고, 또한 임상의에게 임신에 대한 정보를 반드시 제공하도록 요구하여야 한다.

Sensitivity of AutoPap Primary Screening System with Location-Guided Screening in Uterine Cervical Cytology

최종순,장회숙,김희숙,전이경,김혜선,박지영,박인서,홍성란,Choi, Jong-Sun,Jang, Hoi-Sook,Kim, Hy-Sook,Chun, Yi-Kyeong,Kim, Hye-Sun,Park, Ji-Young,Park, In-Sou,Hong, Sung-Ran The Korean Society for Cytopathology 2003 대한세포병리학회지 Vol.14 No.2

Objective: The sensitivity of the AutoPap Primary Screening System with Location-Guided Screening (AutoPap LGS) for Identifying atypical cells in cervicovaginal smears was evaluated. Methods: Two hundred forty one slides with atypical cervical cytology randomly sampled were rescreened both manually and by the AutoPap LGS. The AutoPap LGS localized the atypical cells as 15 fields of view(FOVs), which were reexamined by manual review. The sensitivity was also evaluated in accordance with the cellularity of the smears. Results: The AutoPap LGS successfully processed 232 out of 241 slides. The sensitivity of the AutoPap LGS identifying the atypical cells in successfully processed slides was 97.4%(226/232). The false negative rate was 2.6%(6/232). There was no false negative case on high grade squamous intraepithelial lesion (HSIL) or squamous cell carcinoma(SCC) smears in the AutoPap LGS. The FOVs localized the diagnostic-atypical cells in 97.8%(221/226). The number of diagnostic-atypical FOVs was increased in higher-degree of atypical cytology. The AutoPap LGS localized the atypical cells in 100% of adequately cellular smears and in 92.5% even in low cellular smears. Conclusion: The AutoPap LGS showed relatively good sensitivity to detect atypical cells. It can be a valuable system to localize atypical cells, especially in HSIL or cancer slides, even in smears with low cellularity.

인천 정미업을 중심으로 한 산업유산군의 형성에 관한 연구

남지현,장회숙,Nam, Jee-Hyun,Jang, Hoi-Suk 한국건축역사학회 2014 건축역사연구 Vol.23 No.2

The purpose of this research is to clarify the valuable industrial heritages of rice mill industry complex remained in Incheon. In order to clarify the formation of integrated historical setting of rice mill industry of Incheon, we analyzed the old map of Incheon's old Jemulpo area and data on address, locations and happenings surrounding rice mill factories and relevant facilities. From here, we could find out the 4 representative rice mill industry area of integrated historical setting and 2 other supporting service area for rice mill industry in old city center of Incheon. Specifically, we could figure out the incremental stages to establish the rice mill industry in Incheon. In the first stage, the rice mill factories were established near foreign settlement area where trading offices and warehouses were equipped. And the second stage reflect the needs of expanding area for Japanese capitalism with the new landfill area. In the final stage, Korean rice mill owners established the korean laborers community near Korean residential area. This formation of integrated historical setting reflecting Incheon's rice mill industry is the identical industrial heritages and urban structures to show the tension and conflict between Japanese and Korean laborers' life in the Japanese Colonial Period.

자궁경부 세포검사에서 임신과 관련된 세포학적 변화

전이경,장회숙,김혜선,홍성란,최종순,박지영,조정숙,성석주,양재혁,김희숙,Chun, Yi-Kyeong,Jang, Hoi-Sook,Kim, Hye-Suu,Hong, Sung-Ran,Choi, Jong-Sun,Park, Ji-Young,Cho, Jung-Sook,Seong, Seok-Ju,Yang, Jae-Hyug,Kim, Hy-Sook 대한세포병리학회 2004 대한세포병리학회지 Vol.15 No.2

Due to insufficient clinical information, most cervicovaginal smears from pregnant or postpartum women have been screened without regard to pregnancy-related cytological changes. Here, we have reviewed 116 abnormal cervicovaginal smears from 103 pregnant and postpartum women. Initial cytological diagnoses revealed the following: 9 cases of high-grade squamous intraepithelial lesions (HSIL), 8 cases of low-grade squamous intraepithelial lesions (LSIL), 85 cases of atypical squamous cells of undetermined significance (ASCUS), and 14 cases involving atypical glandular cells of undetermined significance (AGUS). 31 cases upon review, involved pregnancy-related cytological changes, comprising 25 cases of decidua cells, 4 cases of Arias-Stella reaction, and 2 cases of cedidual cells coupled with Arias-Stella reaction. Interpretation errors were detected in 14 cases: 13 cases of decidual cells interpreted as either ASCUS favor reactive or ASCUS ruled out HSIL, and one case of Arias-Stella reaction was interpreted as ASCUS ruled out HSIL. Decidual cells and degenerated glandular cells with Arias-Stella reaction can result in diagnostic mistakes. In order to avoid misdiagnosis and unnecessary surgeries, both clinicians and pathologists must be aware of the pregnancy-related cytological changes. The clinician should also always inform the pathologist on the pregnancy status of the patient.

자궁경부세포진에 있어서 AutoPap 300 QC System의 임상경험과 민감도 검사

홍성란,박종숙,장회숙,김의정,김희숙,박종택,박인서,Hong, Sung-Ran,Park, Jong-Sook,Jang, Hoi-Sook,Kim, Yee-Jeong,Kim, Hy-Sook,Park, Chong-Taik,Park, In-Sou 대한세포병리학회 1998 대한세포병리학회지 Vol.9 No.1

OBJECTIVE: False negatives of cervical smears due to screening errors pose a significant and persistent problem. AutoPap 300 QC System, an automated screening device, is designed to rescreen conventionally prepared Pap smears initially screened by cytotechnologists as normal. Clinical experience and sensitivity of the AutoPap 300 QC System were assessed and compared with current 10% random qualify control technique. MATERIALS AND METHODS: In clinical practice, a total of 18,592 "within normal limits" or "benign cellular changes" cases classified by The Bethesda System were rescreened by the Autopap System. In study for sensitivity of The AutoPap System to detect false negatives, a total of 1,680 "within normal limits" or "benign cellular changes" cases were rescreened both manually and by the AutoPap System. The sensitivity of the AutoPap System to these false negatives was assessed at 10% review rate to compare 10% random manual rescreen. RESULTS: In clinical practice, 38 false negatives were identified by the AutoPap System and we had achieved 0.2% reduction in the false negative rate of screening error. In study for sensitivity, 37 false negatives were identified by manual rescreening, and 23 cases(62.2%) of the abnormal squamous cytology were detected by the AutoPap System at 10% review rate. CONCLUSONS: The AutoPap 300 QC System is a sensitive automated rescreening device that can detect potential false negatives prior to reporting and can reduce false negative rates in the laboratory. The device is confirmed to be about eight times superior to the 10% random rescreen in detecting false negatives.

통풍성 관절염 환자에서 관절강 내 윤활액의 세포 소견 - 증례보고 2예 -

김지영,전이경,장회숙,김복만,안재용,홍성란,김희숙 대한병리학회 2009 Journal of Pathology and Translational Medicine Vol.43 No.1

Synovial fluid (SF) aspiration cytology is a useful diagnostic tool. For patients with gouty arthritis, the diagnosis is confirmed by the presence of monosodium uric acid (MSU) crystals in the SF, and these crystals are long, pointed ended and needle-shaped and they show strongly negative birefringence. So metimes, it is difficult to diagnosis between gouty arthritis and other type of inflammatory arthritis. We experienced two unusual cases of gouty arthritis that we performed SF analysis for. The first patient was a 35 year old male who presented with relatively typical clinical symptoms with hyperuricemia, but the SF showed acute inflammatory cells without crystals on light microscopy. Only a few suspected crystals of MSU were identified on polarizing microscopy. The second patient was a 45 year old male who presented with atypical symptoms and pain and swelling of the left ankle and knee joint for 3 weeks. The uric acid level in the serum and urine was increased, but not over the normal limit. However, on light and polarizing microscopy, there were numerous MSU crystals in the SF. Conclusively, in some cases of gouty arthritis, the crystals are not identified on light microscopy or the uric acid level is not dramatically increased. So, the polarizing microscopy, the clinical information and the laboratory findings are all included in the work-up when evaluating the SF cytology of arthritis patients.