Transitional cell carcinoma of the urinary bladder is common in the genitourinary tract. The gold standard for the diagnosis of bladder cancer has been cystoscopy, along with urine cytology. Cystoscopy is an invasive and relatively expensive technique. By comparison, urine cytology is easy to perform and specific for a diagnosis of bladder cancer, although less sensitive, especially in low-grade tumors. For this reason, there has been a need for superior noninvasive technology to increase our confidence in being able to detect bladder cancer. There are many reports of the various urinary tests that are available to facilitate the diagnosis. In this article, I reviewed the literature on urinary markers and tests that may be clinically useful, including fluorescence in situ hybridization, uCyt+/Immunocyte, the BTA(R) test, the NMP 22TM, the FDP(R) test, the telomerase activity test, the HA and HAse tests, and flow cytometry. Most of these tests have a higher sensitivity and specificity than cytology. However, urine cytology has the highest specificity, especially in individuals with a high-grade tumor. We conclude that no urinary markers or tests can replace the role of cystoscopy along with cytology in the diagnosis of transitional cell carcinoma of the bladder. However, some markers could be used adjunctively to increase the diagnostic accuracy during screening or during the postoperative follow-up examination of patients with bladder cancer.
Carcinoma, Transitional Cell ; Cystoscopy ; Diagnosis ; Flow Cytometry ; Fluorescence ; Follow-Up Studies ; Humans ; In Situ Hybridization ; Mass Screening ; Sensitivity and Specificity ; Telomerase ; Urinary Bladder ; Urinary Bladder Neoplasms

Fine needle aspiration has been widely used to diagnose of breast lesions whether they are malignant or not. When applied by experienced and well-trained practitioners, its accuracy can approach that of histopathology, In order to make optimal use of FNAB in breast lesions, this article has reviewed the criteria for sample adequacy, the diagnostic terminology and the cytomorphologic approach to making a diagnosis and avoiding diagnostic pitfalls.
Biopsy, Fine-Needle* ; Breast* ; Diagnosis

Cytologic evaluation of cerebrospinal fluid(CSF) is an effective tool in diagnosing many disorders involving the central nervous system(CNS). CSF examination has been found to be of particular value in the diagnosis of metastatic carcinoma, lymphomatous or leukemic involvement of CNS and certain primary CNS tumors. As a survey of metastatic tumors to CSF and an evaluation of the preparation techniques increasing cellular yield in our laboratory, 713 CSF specimens examined between July 1995 and April 1997(1 year 10 months), were reviewed. There were 75 positive and 5 suspicious cases, the latter have had no evidence of tumors clinically. Primary tumors of 75 positive cases were classified as follows; 4(5.3%) as primary brain tumors, 40(53.3%) as secondary carcinomas, 13(17.3%) as leukemias, and 18 (24.0%) as lymphomas. The most common primary site of metastatic carcinomas was the lung in 17 cases(42.5%) followed by the stomach in 13(32.5%), breast in 8 (20.0%), and unknown primary in 2(5.0%). Four primary brain tumors were 3 cerebellar medulloblastomas and a supratentorial primitive neuroectodermal tumor (PNET). All 40 metastatic carcinomas were adenocarcinoma presented as single cells or cell clusters. Although signet ring cells were frequent in the cases of gastric primary cancers, no significant cytologic differences according to the primary site were observed. The cytologic features of leukemia and lymphoma were characterized by hypercellular smears presenting as individual atypical cells with increased N/C ratio, presence of nucleoli, and nuclear protrusions. In medulloblastomas and PNET, the principal cytologic findings were small undifferentiated cells arranged singly or in loose clusters with occasional rosettoid features. This study suggests that the CSF cytology is useful in the diagnosis of malignancy, especially metastatic extracranial tumors and the diagnostic accuracy can be improved by increasing cellular yield using cytocentrifuge.
Adenocarcinoma ; Brain Neoplasms ; Breast ; Cerebrospinal Fluid* ; Diagnosis ; Leukemia ; Lung ; Lymphoma ; Medulloblastoma ; Neuroectodermal Tumors, Primitive ; Stomach

BACKGROUND: We have retrospectively assessed the incidence and outcome of women diagnosed during a hospital-based cytology screening program with "atypical squamous cells (ASC)" and followed-up with loop electrical excision procedure (LEEP). METHODS: We analyzed 173,947 cases of cervical smears' follow-up cytology and histology findings. Previous or archival cytology with LEEP results were retrieved for 390 women with ASC of undetermined significance (ASC-US) and 112 with ASC, cannot exclude high-grade squamous intraepithelial lesion (ASC-H). RESULTS: On the follow-up cytology, of the 390 women initially diagnosed with ASC-US, 130 (33.3%) had no follow-up records of smears before LEEP; smears of 18 (4.6%) were negative for cytologic abnormalities, 193 (49.5%) were ASC-US, 24 (6.2%) were ASC-H, 111 (28.5%) were low grade squamous intraepithelial lesion (SIL), and 44 (11.4%) were high grade SIL. LEEP findings in these 390 women showed that 183 (46.9%) were negative, 73 (18.7%) were graded as cervical intraepithelial neoplasia (CIN) 1, 25 (6.4%) as CIN 2, 102 (26.2%) as CIN 3, and 7 (1.8%) had carcinoma. LEEP was performed in 112 women initially diagnosed with ASC-H; 36 (32.1%) were negative, 4 (3.6%) were graded as CIN 1, 7 (6.3%) as CIN 2, 60 (53.6%) as CIN 3, and 5 (4.5%) with carcinoma. CONCLUSIONS: Patients with ASC-H smears were at increased risk of SIL or carcnoma compared with patients with ASC-US. Careful follow-up is required in ASC patients.
Cervical Intraepithelial Neoplasia ; Cervix Uteri ; Female ; Follow-Up Studies ; Humans ; Incidence ; Mass Screening ; Retrospective Studies

Secondary hyperparathyroidism is the condition is which parathyroid hormone(PTH) is over secreted to compensate for a chronically low serum calcium level and chronic renal failure is the most common cause. In 1934, Albreight reported an association between hyperparathyroidism and the chronic renal failure and in 1960, Stanbury first reported subtotal parathyroidectomy for the treatment of secondary hyperparathyroidism. The physiologic mechanism leading to secondary hyperparathyroidism in the chronic renal failure are well known and relatively well controled with medical management, but sometimes may necessitate surgical intervention in medically intractable cases. In Korea, the surgery for secondry hyperparathyroidism is not frequently performed yet as in western countries. We experienced two cases of secondary hyperparathyroidism recently and report its results of subtotal parathyrodiectomy.
Calcium ; Hyperparathyroidism ; Hyperparathyroidism, Secondary* ; Kidney Failure, Chronic ; Korea ; Parathyroidectomy

PURPOSE: The purpose of this study was to describe the thin-section computed tomography (CT) findings andhistopathologic findings of squalene aspiration pneumonia. MATERIALS AND METHODS: Thin-section CT scans wereobtained from nine patients with proven exogenous lipoid pneumonia resulting from aspiration of squalene (derivedfrom shark liver oil). The condition was diagnosed by biopsy (n=3), bronchoalveolar lavage (n=4), or sputumcytology and clinical history (n=2); a clinical history of squalene use was confirmed in all patients. Specimensof transbronchial lung biopsy were also reviewed and compared with thin-section CT findings. RESULTS: Thin-section CT findings included ground-glass attenuation (n=8), consolidations obliterating vascular marking(n=4), scattered centrilobular ground-glass attenuation (n=2), and interlobular interstitial thickening (n=6).Geographic lobular distribution with peripheral spared lobules was observed in all patients. These diseasesinvolved multiple lobes (n=5) and abnormalities were usually located in the dependent portion of the lung. Inthree cases, histopathological correlation showed that ground-glass attenuation reflected intra-alveolarinfiltration of lipid-laden macrophages with exudative fluid. Interlobular septal thickening representedhyperplasia of type II pneumonocytes with mild fibrosis. CONCLUSION: On the basis of these results, we concludedthat squalene aspiration pneumonia can be reliably diagnosed by thin-section CT findings particularly when theappropriate history is known.
Biopsy ; Bronchoalveolar Lavage ; Fibrosis ; Humans ; Liver ; Lung ; Macrophages ; Pneumonia ; Pneumonia, Aspiration* ; Sharks ; Squalene* ; Tomography, X-Ray Computed

We encountered a patient with a breast mass which had metastasized from gastric carcinoma representing as aninflammatory carcinoma on ultrasonography. We described the radiologic and clinical features, and review theliterature. The patient had advanced gastric carcinoma and breast ultrasonography demonstrated the presence ofvery ill-defined, infiltrating, and mixed echoic lesions indistinguishable from findings of primary inflammatorybreast carcinoma. Metastatic gastric adenocarcinoma was confirmed pathologically.
Adenocarcinoma ; Breast Neoplasms* ; Breast* ; Humans ; Stomach Neoplasms* ; Ultrasonography ; Ultrasonography, Mammary

The confirmative diagnosis of leptomeningeal metastasis depends on detecting malignant cells on the cytologic examination of cerebrospinal fluid (CSF). The presence of leptomeningeal metastasis is a very important factor to determine the aggressiveness of treatment. We analyzed 273 cases that were diagnosed as malignancies on the CSF cytology. The most common metastatic carcinoma was lung cancer (76 cases, 27.8%). There were 49 cases (17.9%) and 40 cases (14.7%) of breast and stomach cancers, respectively. There were 49 cases (17.9%) of lymphoma and 40 cases (14.7%) of leukemia. There were 19 cases of other types of cancer (6.9%). For the cases of primary lung cancer, there were 60 cases (78.9%) of adenocarcinoma and 7 cases (9.2%) of squamous cell carcinoma, but only 4 cases (5.3%) of small cell carcinoma. For the case of breast cancer, all of those were invasive ductal carcinoma and 25 cases (51.0%) were grade 3. Diffuse large B-cell lymphoma was the most common type of all metastatic lymphomas (22 cases, 44.9%) and lymphoblastic lymphoma was the second most common (8 cases, 16.3%). In our hospital, the most common leptomeningeal metastasis was adenocarcinoma of the lung, and breast cancer and lymphoma were the second most common. On CSF cytology, malignancies that have a tendency towards CSF metastasis should be carefully examined for to select the proper treatment.
Adenocarcinoma ; Breast ; Breast Neoplasms ; Carcinoma, Ductal ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Leukemia ; Lung ; Lung Neoplasms ; Lymphoma ; Lymphoma, B-Cell ; Meningeal Neoplasms ; Neoplasm Metastasis ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Stomach Neoplasms

PURPOSE: Silver-enhanced in situ hybridization (SISH) is a newly developed method to evaluate HER2 gene amplification in invasive breast carcinomas. Most laboratories widely use fluorescence in situ hybridization (FISH) to evaluate the HER2 gene amplification status because FISH is a very sensitive and accurate technique. However, this technique is not the best because it requires specialized equipment and interpretation skills. We compared a new technique of SISH with FISH for assessing HER2 gene amplification in invasive breast carcinomas. METHODS: HER2 gene amplification was assessed in 165 cases of invasive breast carcinoma by FISH and SISH with constructing a tissue microarray. The tumors were assessed by the guidelines of the American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP). Positivity was defined as a HER2/Chromosome 17 ratio greater than 2.2. Negativity was defined if the ratio was less than 1.8. The tumor was considered as equivocal for HER2 gene amplification if the ratio was between 1.8 and 2.2. The HER2 protein status was assessed. Immunostaining for HER2 protein was performed in a Benchmark automatic immunostaining device with using whole tissue sections. RESULTS: There was agreement of the HER2 gene amplification status by SISH and FISH in 162 of 165 cases, which is a concordance rate of 98.2% (kappa=0.94). There were three discrepant cases, with two of them being FISH positive and SISH negative (one case was IHC negative and one case was IHC positive) and one case was FISH negative and SISH equivocal. CONCLUSION: The 98.2% concordance between FISH and SISH meets the ASCO/CAP requirements for test validation of >95% concordance. These results indicate that SISH can be used as an alternative to FISH for assessing the HER2 gene amplification status in breast carcinomas.
Breast ; Breast Neoplasms ; Fluorescence ; Genes, erbB-2 ; In Situ Hybridization ; Receptor, erbB-2

Adrenal cortical neoplasm, especially carcinoma, is extremely rare in pediatric patients. We describe here a rare pediatric case of adrenal cortical neoplasm. A 2-year-old girl presented with an enlarged clitoris. The other physical findings and laboratory tests were nonspecific. The magnetic resonance imaging showed a 4 cm-sized heterogeneously enhancing soft tissue mass with calcification in the left adrenal gland. The mass was removed by laparoscopic operation. Grossly, several fragments of reddish tan soft tissue were present, and they weighed 19 gm in total. Microscopically, there were capsular invasion, diffuse/solid growth pattern with focal necrosis, high cellularity, cytoplasmic eosinophilia, marked nuclear pleomorphism, high N/C ratio, prominent nucleoli, atypical mitotic figures and calcifications, which all suggested adrenal cortical neoplasm of histologic malignancy. On immunohistochemistrical staining, there were positive reactivities to pancytokeratin, cytokeratin 7/20, CEA, inhibin and p53. The Ki-67 labeling index was about 6%. All these findings were indicative of adrenal cortical neoplasm of histologic malignancy.
Adrenal Cortex Neoplasms ; Adrenal Glands ; Child ; Child, Preschool ; Clitoris ; Cytoplasm ; Eosinophilia ; Female ; Humans ; Inhibins ; Keratins ; Magnetic Resonance Imaging ; Necrosis ; Triacetoneamine-N-Oxyl