The specialist system of hospital pathology in Korea has adopted the American system in its start, and divided its categories into anatomical pathology(AP), clinical pathology(CP), and combind anatomic and clinical pathology(AP +CP). Since 1975 the society eliminated the category of combined AP and CP specialist. The first qualifying examination took place in 1963. It started out as a written examination and later changed to have two parts, written and practical. One year of internship and 4 years of anatomic pathology were required for AP specialist. CP required the same period of training in CP to be eligible for the specialist qualifying examination. The training period was shortened to 3 years from 4 years, 1981~1990 and then returned to 4 years in 1991. There has been considerable confusion during the adoption period of the pathologist specialist system in Korea, mainly because of an incorrect concept of the term "clinical pathology" in the modern hospital. Many people understood "clinical pathology" to mean "hospital pathology" as an opposing concept of "basic or experimental pathology" at medical school. The misconception arose from the fact that Pathology Department in a Hospital has not been realized under Japanese hospital system that prevailed Korean hospital system until 1950. In old Japanese style, the laboratory examinations including some histopathological examination had been conduced in corresponding clinical departments. And Pathology Department in medical school was responsible only for autopsy and not for making diagnosis of biopsy or operative specimen necessarily. Therefore, there has been a conflict between traditional Pathologists(most of them anatomic pathologists) at medical school and so-called "clinical pathologists" in the hospital, as the Korean medical delivery system adopted American system particularly after the Korean war. Now in Korean, in the great majority of hospitals, clinical pathology is clearly defined from anatomic pathology, and the two-services are at work in separate programs. However, there are still a few university hospitals, where histopathological examination and reporting are done in the Clinical Pathology Department. It is hoped that a combined AP and CP program can be started again in near future for the pathologists who work in community hospitals or most smaller general hospitals where the pathologists with adequate knowledge on both AP and CP at work supervising clinical laboratory technicians and technologists. However, it is fully realized the specialists in subspecialty field such as neuropathology, dermatopathology, hematopathology, clinical microbiology, clinical chemistry, etc. are also needed. For future prospect both the Korean Society of Pathologists and Korean Society of Clinical Pathologists should collaborate with each other in full scale in spite of painful past experiences.
Biopsy

PURPOSE: To evaluate the outcomes of robotic prostatectomy(RP) compared with open radical prostatectomy(OP) in clinically advanced prostate cancer(PC). MATERIALS AND METHODS: Between January 2003 and June 2007 we performed radical prostatectomy in 180 patients with clinically advanced PC (OP, 88; RP, 92). We compared the perioperative parameters and early surgical outcomes between the OP and RP groups in patients with and without neoadjuvant hormonal therapy(NHT). RESULTS: In patients without NHT, there were no significant differences in preoperative characteristics between the OP and RP groups, but in patients with NHT, the RP patients had higher biopsy Gleason scores(GS) and clinical stages. There were no significant differences in lymph node (LN) invasion and extracapsular extension(ECE), but a significant difference existed in the prostatectomy GS between the OP and RP groups, regardless of NHT. The positive surgical margin rates in the RP group were similar to or lower than in the OP groups when stratified by pathologic stages T2 and T3. Irrespective of NHT, in the RP group the mean estimated blood loss was decreased, the mean duration of the hospital stay was less, and the length of bladder catheterization was shorter, but there were no significant differences in the postoperative day the regular diet was started or the frequency of complications. Although there were no significant differences in continence rates between the two groups, all the RP patients had a higher continence rate from 1 month postoperatively, with or without NHT. CONCLUSIONS: Our results suggest that RP may be performed safely and may have results comparable to OP in clinically advanced PC.
Biopsy

PURPOSE: To investigate clinicopathologic characteristics of unilateral, low risk prostate cancers detected via multi(>or=12)-core prostate biopsy. MATERIALS AND METHODS: One hundred four patients who underwent radical retropubic prostatectomy(RRP) for unilateral, low risk prostate cancer (clinical stage biopsy Gleason sum or=12)-core prostate biopsy were enrolled. In this retrospective study, we reviewed the patients' preoperative and pathologic data to assess potential predictors of pT2c or greater disease at the time of RRP, as well as characteristics of such disease. RESULTS: Of the 104 subjects, only 34(32.7%) were pathologically-proven to have unilateral disease, while the others showed pathologically-bilateral or worse disease from analysis of the RRP specimens. Subjects pathologically found to have uni- and bi-lateral disease showed no significant differences regarding age, prostate-specific antigen(PSA), free-to-total PSA ratio, prostate volume, clinical stage, number of positive cores, biopsy Gleason score, number of total biopsy sites, and highest percentage of tumor at any biopsy site. Multivariate logistic regression analysis revealed no significant preoperative predictors of pT2c or greater disease at RRP. CONCLUSIONS: Most patients with unilateral, low risk prostate cancer detected on multi(>or=12)-core prostate biopsy actually had pathologically- worse disease. For clinically-localized prostate cancer, a more accurate method to identify appropriate candidates for unilateral or focal ablative therapy should be developed.
Biopsy

The rapid frozen section method is a means of intraoperative pathological diagnosis, first introduced by Welch in 1891 and developed as a diagnostic tool by Cullen, Wilson, MacCarty et al. This method serves useful purposes, such as determining the malignancy or benignancy of a suspected lesion, determining the adequacy of a biopsy of a suspected lesion, confirming the presence or absence of metatasis, and identifying small structures. But it bears many disadvantages, the most of which is the danger of incorrect diagnosis. We studied the indications, the limitations and the accuracy of the frozen section method and the materials studied was total cases of frozen section during recent 5 years. The ovarall accuracy of the frozen section diagnosis of 1,603 cases was 96.2% with 0.3% of false positive, 3.5% of false negative and 2.8% of incorrect histological diagnoses or grading errors the tissues submitted for frozen section were lymph node, breast, gastrointestinal tract and soft tissue in decreasing order of frequency. The false positive cases were four in number, while the false negative cases were 53, one third of which were the misdiagnoses of the presence of ganglion cells in Hirschsprung's disease.
Biopsy

BACKGROUND: Pseudoepitheliomatous hyperplasia (PEH) is a reactive proliferation of surface epithelium and can be confused with invasive squamous cell carcinoma (SCC) in head and neck biopsy specimens. To distinguish PEH from invasive SCC, immunohistochemical staining for claudin-1, E-cadherin and p53 was performed. METHODS: Eighteen cases of PEH and 29 invasive SCC from head and neck lesions were immunostained and examined. RESULTS: The invasive SCC showed increased staining of claudin-1 (p<0.001) and p53 (p<0.001) and decreased staining of E-cadherin (p=0.005) compared to the PEH specimens. The combined score calculated by adding the positive sum of claudin-1 and p53 and subtracting E-cadherin was useful for the differentiation of SCC from PEH (89.7% sensitivity and 88.9% specificity, p<0.001). CONCLUSION: The combined immunostaining for claudin-1, p53 and E-cadherin may help differentiate PEH from invasive SCC. The results of this study suggest that the increased expression of claudin-1 and p53 and the decreased expression of E-cadherin maybe markers for the aggressive growth of invasive SCC.
Biopsy

PURPOSE: The purpose of this study was to evaluate the impact of the use of external radiation therapy (ERT) in terms of survival and compliance in patients with anaplastic thyroid carcinoma. MATERIALS AND METHODS: The medical records of 17 patients with anaplastic thyroid carcinoma treated with ERT between 1993 and 2002 were retrospectively reviewed. ERT was administered after surgery in 14 patients and after a biopsy in three patients. Among the 14 patients who had undergone surgery, nine underwent a curative resection and five underwent a palliative resection. Six patients had associated well-differentiated thyroid carcinomas and 14 patients were diagnosed with a tumor size exceeding 5 cm. The radiation dose ranged from 6~70 Gy (median dose, 37.5 Gy). Eleven patients completed the planned course of ERT, whereas six patients did not. The follow-up period ranged from 1~104 months (median, 5 months; mean, 20 months). RESULTS: Five patients started the ERT without the presence of a gross mass and all of the patients completed ERT without a re-growth of tumor. Twelve patients (four patients after a curative resection, five patients after a palliative resection and three patients after a biopsy) started ERT with a gross mass present and only six patients were able to complete the planned course of ERT. Among the six patients who completed ERT, two patients showed a marked regression of the tumor mass, whereas two patients showed slight regression and two patients showed no response. The median survival was five months (range, 1~104 months) and the mean survival was 21 months. The overall survival was 41% at 1-year, 24% at 2-years and 12% at 5-years. Significant prognostic factors included the number of primary tumors present, tumor size, whether surgery was performed and completion of ERT as planned. Long-term survivors showed a tendency of having smaller sized initial tumors and smaller sized pre-ERT tumors than the short-term survivors. CONCLUSION: This study suggests that patients with a small initial tumor (< or =5 cm), which was treated by surgery (curative resection or palliative resection) before ERT, and without rapid re-growth of the mass seen at the surgical site at the beginning of the ERT course, would be the best candidates for postoperative ERT. In contrast, patients with a large initial tumor (>5 cm) and did not undergo surgery before ERT or that rapid re-growth of the mass was observed at the surgical site are likely to have a short survival time, along with the interruption of ERT. In these cases, the role of ERT is very limited and the omission of ERT could be considered.
Biopsy

Diabetic nephropathy is a clinical syndrome characterized by persistent albuminuria, a relentless decline in GFR and raised arterial blood pressure, and usually diagnosed on clinical grounds without a renal biopsy. Their renal injuries are irreversible and they become eventually end-stage renal disease. Recently, it has been reported that proteinuria are also induced by other causes, and some of the renal diseases was treatable. The detection of non-diabetic renal disease in diabetic patients by renal biopsy has the prognostic and therapeutic importance. We report a case of type II diabetic mellitus with minimal change nephrotic syndrome, and no evidence of diabetic glomerulosclerosis.
Biopsy

No abstract available.
Biopsy*

BACKGROUND: The detection and early elimination of the causes for acute respiratory distress syndrome (ARDS) at the initial stage can result in a more favorable prognosis. Miliary tuberculosis as a cause of the ARDS is quite rare. A diagnosis of miliary tuberculosis is difficult due to the diversity of radiological patterns and non-specific clinical findings, and low sensitivity of sputum examinations for acid-fast bacilli(AFBs). An analysis of the clinical data is the first step in diagnosing these unusual, rare cases. METHODS: In this study the clinical features, laboratory data, radiological findings and diagnostic methods were analyzed in 9 cases with an initial presentation of ARDS due to miliary tuberculosis. The ARDS was defined by the definition of the American-Europian Consensus Conference 1992. RESULTS: The mean age of the patients was 67+/-18 years (F:M=7:2). The chief complaints were dyspnea (5/9), coughing (3/9) and fever(5/9). On a physical examination, fine or coarse crackles were noted(6/9). The ARDS developed on average 6.7 days after the initial respiratory symptoms. The mean PaO2/FiO2 of the patients was 133.5+/-53.4, the number of cases with a WBC <5000/mm3 was 4 out of 9 cases. A platelet count <70,000/mm3 was observed in 2 out of 9 cases, and the serum albumin level was 2.6+/-0.6 g/dL. The initial simple chest PA showed ground glass appearances and consolidation in all cases, However, the miliary nodular densities were observed in only 4 out of the 9 cases. HRCT revealed alveolar densities and a consolidation in 5 out of 6 cases, and miliary nodules in 5 out of 6 cases, The diagnosis of tuberculosis was made by a liver biopsy (4/4, 100% sensitivity), a bone marrow biopsy (1/2, 50% sensitivity), and an open lung biopsy (1/1), the sputum AFB was positive in only 2 out of 9 cases. The patient was treated with INH, RFP, EMB, PZA, and steroids. The survival rate was 55.5%. CONCLUSION: Miliary tuberculosis should be considered as one of the causes for ARDS in areas where there is a high prevalence of tuberculosis. The chief complaints of the patients on admission are dyspnea, fever and coughing without any specific riskfactors. A liver biopsy is particularly useful in ARDS patients with mechanical ventilation to determine the causes of the ARDS if miliary tuberculosis is suspected as being the underlying disease.
Biopsy

We analysed 8 cases of gastrointestinal cytomegalovirus(CMV) infection including one autopsy, three surgically resected and four endoscopic biopsy cases. Involved sites were colon in four,stomach in three and small intestine in one. Three of them were associated with immu-nosuppressed condition but others had no clinical evidence of immune deficiency. Multiple aphthous mucosal ulceration was a common presentation, but one revealed a mucosal ulcer with segmental narrowing and thickening of wall. Microscopically, six showed cytomegalic inclusions in endothelial cells and fibroblasts, one in mucosal epithelial cells and the remaining one in both endothelial cells and mucosal epithelial cells. Immunohistochemical staining using monoclonal antibody against CMV confirmed postive result in seven cases. Serum IgM anti-CMV antibody was elevated in one case. We conclude that gastrointestinal CMV infection is currently not a rare condition and frequently associated with non-immunosuppressed condition, and thus a thorough histologic examination is required especially in the gastrointestinal ulcerative lesion. Once cytomegalic inclusion is suspected, immunohistochemical identification of CMV seems essential for specific diagnosis.
Biopsy