BACKGROUND: Descriptive diagnosis reports have been causing some problems in communication. Our institution decided to use the category diagnosis system since June, 2008. So we evaluated the effectiveness of this change. METHODS: The category system is composed of unsatisfactory, suboptimal for diagnosis but suggestive of, most probably benign, indeterminate, suspicious for malignancy and malignancy. We evaluated 1,525 cases from June, 2008 to September, 2009. We analyzed 159 cases of the indeterminate category. RESULTS: Among the 159 cases, 21 were re-aspirated and 63 underwent an operation. The diagnoses of the re-aspirated cases were 2 positive for malignancy, 5 indeterminate, 13 most probably benign, and 1 unsatisfactory. The surgical diagnoses were 39 malignancies, 2 follicular adenomas and 1 Hurthle cell adenoma, and 21 benign lesions. Re-aspiration for the indeterminate cases could help decide whether the lesions need to be operated or not at above 70%. The indeterminate category could predict the surgical diagnosis of the thyroid nodule with statistical significance when the subcategories were indicated (p < 0.001). CONCLUSIONS: The category diagnosis is replacing the descriptive diagnosis for the thyroid fine needle aspiration. The indeterminate category is useful and effective for making the decision to operate and especially when the indeterminate subcategories are used.
Adenoma ; Biopsy, Fine-Needle ; Thyroid Gland ; Thyroid Nodule

PURPOSE: To assess the sonographic evaluation of the appendix in patients with pelvic inflammatory disease (PID) using CT, clinical, and pathological comparisons. MATERIALS AND METHODS: During a three-year period, 51 patients with PID underwent appendix US and abdomino-pelvic CT. The findings of appendix on US were classified into three categories (normal appendix, normal appendix with inflamed periappendiceal fat, and acute appendicitis). Based on the CT analysis, the condition of the appendix was classified into five categories, namely ('normal, 'probably normal', 'equivocal CT findings for diagnosis of appendicitis', 'probable appendicitis', 'definite appendicitis'). The CT and US results were then correlate with clinical and pathological findings. RESULTS: Of 21 patients with definite or probable appendicitis as shown by CT analysis, US demonstrated normal appendix in 10 patients (48%), normal appendix with inflamed periappendiceal fat in 10 patients (48%), and primary appendicitis in the remaining patient (4%). Of 25 patients with normal or probably normal appendix as shown by CT analysis, US demonstrated normal appendix in 24 patients (96%), and primary appendicitis in the remaining patient (4%). The two patients with primary appendicitis, as shown by US, underwent appendectomy and pathological studies revealed primary appendicitis. CONCLUSION: A sonographic evaluation of the appendix in patients with PID improved the diagnostic accuracy for primary appendicitis.
Appendectomy ; Appendicitis ; Appendix ; Female ; Humans ; Pelvic Inflammatory Disease

The recurrence of viral hepatitis B or C after liver transplantation is almost universal but their clinical courses and outcomes are vary widely. We investigated four cases of rapidly progressive and fatal recurrent viral hepatitis following liver transplantation, which were rapidly progressive and fatal. Case 1 was a 58-year-old male, who developed recurrent viral hepatitisC. Case 2, 3, and 4 were a 59-year-old female, a 42-year-old male, and a 50-year-old male, respectively, who developed recurrent viral hepatitis B. In cases 1 and 2, the histopathological features of the first liver biopsies were prominent ballooning degeneration of the hepatocytes but later biopsies revealed significant lobular activity. Case 3 began with a marked fatty change and mild lobular and porto-periportal activity and progressed to severe lobular activity and septal fibrosis. In case 4, the first liver biopsy revealed minimal lobular activity but the second biopsy revealed severe lobular activity.
Adult ; Biopsy ; Female ; Fibrosis ; Hepatitis B ; Hepatitis* ; Hepatocytes ; Humans ; Liver Transplantation* ; Liver* ; Male ; Middle Aged ; Recurrence

Papillary immature metaplasia (PIM) is a distinctive exophytic lesion of the uterine cervix and shares some histologic and cytologic features with ordinary squamous metaplasia (SM), atypical immature squamous metaplasia (AIM), high-grade squamous intraepithelial neoplasia (HSIL) and papillary squamous cell carcinoma (PSC). PIM has been suggested to be a subset of condyloma associated with low-risk type human papilloma virus (HPV), however, the etiologic role of HPV and biologic behavior of the disease are still elusive. We compared the clinical and histopathological findings, immunohistochemical expression of Ki-67 and p53 protein, and HPV typing of 5 cases of PIM with SM (n=9), HSIL (n=6), and PSC (n=4) to know the helpful features for the differential diagnosis. Histologically, all 5 cases showed a papillary proliferation of immature metaplastic cells involving the proximal transformation zone and endocervix. On HPV typing by polymerase chain reaction-restriction fragment length polymorphism, 2 out of 5 PIM were confirmed to have HPV 6 or HPV 11, while 2 out of 4 PSC were proved having HPV 31 and HPV 16 each. Ki-67 labeling index and mitotic index of PIM were significantly lower than those of HSIL or PSC. There were no significant differences of Ki-67 labeling index and mitotic index between PIM and SM. The expression of p53 varied among the groups and thus it was not helpful for the differential diagnosis.
Adult ; Carcinoma in Situ/*pathology ; Carcinoma, Papillary/*pathology ; Carcinoma, Squamous Cell/*pathology ; Cervix Neoplasms/*pathology ; DNA, Viral/analysis ; Diagnosis, Differential ; Epithelial Cells/chemistry/pathology ; Female ; Follow-Up Studies ; Human ; Ki-67 Antigen/analysis ; Papillomavirus/genetics ; Papillomavirus Infections/pathology ; Protein p53/analysis ; Tumor Virus Infections/pathology ; Vaginal Smears

We described a case of mixed germ cell-sex cord-stromal tumor of non-gonadoblastoma type (GCSCT-NG) of the ovary in a 2-year-old girl and compared its histological, immunohistochemical and ultrastructural findings with those of gonadoblastoma. The germ cell component showed an immunopositivity for cytokeratin and epithelial membrane antigen (EMA), and a negative reaction for -inhibin, alpha-fetoprotein (AFP), placental alkaline phosphatase (PLAP), vimentin and CD99. The sex cord elements showed an immunopositivity for cytokeratin, EMA, vimentin and inhibin, but negativity for AFP, PLAP, and CD99. The ultrastructural features showed desmosome-like cell junctions, suggesting spermatocytic differentiation from the primordial germ cells or gonocytes. Immunohistochemical and ultrastructural findings suggested that GCSCT-NG is probably a more differentiated form of mixed germ cell- sex cord-stromal tumor than gonadoblastoma.
Alkaline Phosphatase ; alpha-Fetoproteins ; Child, Preschool ; Female ; Germ Cells ; Gonadoblastoma ; Humans ; Inhibins ; Intercellular Junctions ; Keratins ; Mucin-1 ; Ovary* ; Sex Cord-Gonadal Stromal Tumors ; Vimentin

Sarcoidosis, in general, has a low mortality rate. But cardiac sarcoidosis (CS) is a serious condition which may lead to death. Here, we report a rare case of CS that was treated by heart transplantation. A 47-year-old male had occasional syncopes and atypical chest pain. Ventricular tachycardia with right bundle branch block was noted by electrocardiogram. Multiple fixed myocardial perfusion defects in the interventricular septum and both the inferior-posterior ventricular walls were observed by thallium scan. Coronary angiography was unremarkable. Neither perihilar nor mediastinal lymphadenopathy was noted. The patient also suffered three times from tonic-clonic generalized seizures in 3 years, but no neurologic abnormalities were detected. The explanted heart displayed multiple white patches on the endomyocardial surface, measuring up to 8x7 cm. On microscopic examination, the lesion consisted of multiple well-formed and confluent granulomas with numerous scattered multinucleated giant cells, CD68-positive epithelioid histiocytes, and T-lymphocytes. Neither microorganisms nor foreign material was identified on special stain and culture study. It has been six months since the heart transplant, and the patient has been doing well.
Bundle-Branch Block ; Chest Pain ; Coronary Angiography ; Electrocardiography ; Giant Cells ; Granuloma ; Heart ; Heart Transplantation* ; Histiocytes ; Humans ; Lymphatic Diseases ; Male ; Middle Aged ; Mortality ; Perfusion ; Sarcoidosis* ; Seizures ; Syncope ; T-Lymphocytes ; Tachycardia, Ventricular ; Thallium

PURPOSE: Tuberculous pleurisy is the most frequent extrapulmonary manifestation of tuberculosis. In spite of adequate treatment, pleural fibrosis is a common complication, but the mechanism has not been elucidated. This study is to determine whether epithelial to mesenchymal transition (EMT) of mesothelial cells occurs in tuberculous pleurisy. MATERIALS AND METHODS: Normal pleural mesothelial cells, isolated from irrigation fluids during operations for primary spontaneous pneumothorax, were characterized by immunofluorescence and reverse transcription polymerase chain reaction (RT-PCR). These cells were treated in vitro with various cytokines, which were produced in the effluents of tuberculous pleurisy. The isolated cells from the effluents of tuberculous pleurisy were analyzed by immunofluorescence and RT-PCR analysis. RESULTS: The isolated cells from the irrigation fluid of primary spontaneous pneumothorax had epithelial characteristics. These cells, with transforming growth factor-beta1 and/or interleukin-1beta treatment, underwent phenotypic transition from epithelial to mesenchymal cells, with the loss of epithelial morphology and reduction in cytokeratin and E-cadherin expression. Effluent analysis from tuberculous pleurisy using immunofluorescence and RT-PCR demonstrated two phenotypes that showed mesenchymal characteristics and both epithelial & mesencymal characteristics. CONCLUSION: Our results suggest that pleural mesothelial cells in tuberculous pleurisy have been implicated in pleural fibrosis through EMT.
Cells, Cultured ; Epithelial Cells/*pathology ; Epithelial-Mesenchymal Transition/*physiology ; Fluorescent Antibody Technique ; Humans ; Pleura/*pathology ; Reverse Transcriptase Polymerase Chain Reaction ; Tuberculosis, Pleural/*pathology

Leptomeningeal carcinomatosis is defined as the diffuse infiltration of the leptomeninges by malignant cells metastasized from systemic cancer. We report a case of leptomeningeal carcinomatosis presenting bilateral sensorineural hearing loss and dizziness. A 51-year-old woman who was diagnosed with non-small cell lung cancer with leptomeningeal carcinomatosis was referred to our department because of progressive hearing loss and dizziness. Magnetic resonance imaging revealed an abnormal enhancement of the vestibulocochlear nerves within the internal auditory canals bilaterally. The patient received chemotherapy concurrently with an intrathecal methotrexate injection. Leptomeningeal carcinomatosis must be considered in the differential diagnosis of cancer patients with bilateral progressive sensorineural hearing loss.
Carcinoma ; Carcinoma, Non-Small-Cell Lung ; Diagnosis, Differential ; Dizziness ; Female ; Hearing ; Hearing Loss ; Hearing Loss, Bilateral ; Hearing Loss, Sensorineural ; Humans ; Magnetic Resonance Imaging ; Meningeal Carcinomatosis ; Methotrexate ; Middle Aged ; Vestibulocochlear Nerve

The bronchus-asociated lymphoid tissue(BALT) lymphoma is a low-grade primary malignant lymphoma that originates from bronchus associated lymphoid tissue. A 67-year-old woman was admitted for evaluation of cough, sputum, rhinorrhea which had persisted for one month. Physical examination showed decreased breathing sound on the left upper lung field. High resolution chest computed tomography demonstrated consolidation which showed air-bronchogram and surrounding ground glass opacity in left upper lobe. These findings implicated inactive tuberculosis, organizing pneumonia, or bronchiolo-alveolar carcinoma. The histologic findings from percutaneous needle aspiration biopsy revealed aggregated atypical small lymphoid cells with lymphoepithelial lesions. With immunohistochemical staining, the atypical lymphoid cells reacted positively with CD 20 antibody and negatively with CD 3 antibody. Thus, we could diagnosed her as a patient with BALT lymphoma. After left upper lobectomy, she has been well without recurrence of the disease for 14 months. In this country of Republic of Korea, it was the 1st case of BALT lymphoma surgically treated when histological diagnosis had been done. Based on this case, we wanted to demonstrate the importance of early histological diagnosis and treatment of BALT lymphoma.
Adenocarcinoma, Bronchiolo-Alveolar ; Aged ; Biopsy, Needle ; Bronchi ; Cough ; Diagnosis ; Female ; Glass ; Humans ; Lung ; Lymphocytes ; Lymphoid Tissue ; Lymphoma* ; Needles ; Physical Examination ; Pneumonia ; Recurrence ; Republic of Korea ; Respiratory Sounds ; Sputum ; Thorax ; Tuberculosis

Sarcoidosis is a systemic granulomatous disease that primarily affects the lung and lymphatic system of the body. Since Brincker first noted a statistically significant increase of malignant tumors among sarcoidosis patients, there have been several reports on simultaneously developed sarcoidosis and malignancy. A 30-year-old man was admitted to our hospital because of multiple enlarged mediastinal lymph nodes. The patient had been well until approximately 10 days before admission, when he developed a cough. Chest X-ray and computed tomography (CT) of the chest that were performed at the outpatient department revealed multiple enlarged mediastinal lymph nodes. Cervical lymph node biopsy revealed both non-caseating granuloma and metastatic papillary carcinoma, whereas the mediastinal lymph node showed only non-caseating granuloma. The thyroid gland surgical specimen showed papillary carcinoma. We report here on a case of a 30-year-old man who had sarcoidosis and thyroid cancer, and we include a review of the literature.
Adult ; Biopsy ; Carcinoma, Papillary ; Cough ; Granuloma ; Humans ; Lung ; Lymph Nodes ; Lymphatic System ; Outpatients ; Sarcoidosis ; Sarcoidosis, Pulmonary ; Thorax ; Thyroid Gland ; Thyroid Neoplasms