• The Korean Journal of Cytopathology
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• v.17 no.2
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• pp.99-107
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• 2006

In the investigation of superficial lymphadenopathy of unknown cause, fine needle aspiration (FNA) cytology plays an invaluable role. It enables the differentiation of benign lymphadenopathy from lymphoid and non-lymphoid malignancies, obviating the need for open biopsy, and allowing the triage of patients. Cytopathologists should be familiar with the typical FNA patterns of benign lymphadenopathy, and recognize and differentiate among categories. In a minority of cases of benign lymphadenopathy, FNA can render a specific diagnosis. Benign lymphadenopathies are generally categorized into reactive lymphoid hyperplasia (RLH), inflammatory or infectious processes, and benign lymphoproliferative disorders. RLH characteristically presents with a heterogeneous and polymorphous smear composed of normal cellular constituents of lymph nodes, in contrast with the homogeneous or monomorphic smear of most lymphomas. The caveat is that various malignant disorders may also present with polymorphous populations. It is also important to recognize thatbenign lymphoid smears may sometimes contain atypical cells that raise the suspicion of malignancy. Clinical information should always be the integral part of the diagnostic criteria in FNA of lymphadenopathy. If there is any doubt about the benign nature of the smear, it is prudent to suggest biopsy and ancillary studies.

• The Korean Journal of Cytopathology
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• v.14 no.2
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• pp.53-59
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• 2003

Fine needle aspiration cytology (FNAC) has been known as a very sensitive and effective method for preoperative diagnosis. We studied cases preoperatively diagnosed by FNAC and confirmed by the histopathologic examination to define the effectiveness of FNAC. A total of 567 cases including breast, thyroid gland, lymph node, and soft tissue confirmed histologically after FNAC were enrolled, among 2,844 FNAC cases from January 1996 to March 2000. Overall sensitivity and specificity of FNAC were 93% and 100%, respectively. Sensitivity and specificity of FNAC by sites or organs were 91% and 100% in breast, 100% and 100% in thyroid, 97% and 100% in lymph node, and 71% and 100% in soft tissue, respectively. Nine cases showed diagnostic discrepancy; eight cases of sampling error and one case of interpretation error. Five cases, diagnosed as fibrocystic change at FNAC but invasive ductal carcinoma after the histopathologic examination, were categorized as sampling error due to the presence of diffuse fibrosis or deep seated location. One case of breast, diagnosed descriptively as atypical ductal and stromal cells suggesting invasive ductal carcinoma at FNAC but malignant phyllodes tumor histologically, was categorized as interpretation error. Other cases of sampling errors were two cases of soft tissue, a case of lymph node, and a case of salivary gland.

• Journal of Yeungnam Medical Science
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• v.28 no.2
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• pp.196-201
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• 2011

A 73-year-old male presented a six-month history of buttock pain radiating into his thigh. The MRI revealed a large enhancing mass lesion involving the sacrum, with extension into the sacral canal. The tumor markers were measured to distinguish skeletal metastasis of carcinoma from primary bone tumor. The CA 19-9 was elevated. Despite the investigation, the primary site of cancer could not be found. Sacral bone biopsy was done. The pathologic examination revealed necrosis, chronic granulomatous inflammation, and multinucleated giant cells, consistent with tuberculosis. Sacral tuberculosis is rare in patients with no history of tuberculosis. Such solitary osteolytic lesions involving the subarticular region of large joints may mimic bone neoplasms and may be called "tuberculous pseudotumors." This case report intends to emphasize that bone tuberculosis should be a differential diagnosis in the presence of atypical clinical and radiological features. As tuberculous lesions may be mistaken for neoplasms, a small amount of fresh tissue should be sent for culture even if clinical diagnosis of a tumor seems likely. Described herein is a case of sacral tuberculosis mimicking metastatic bone tumor with elevated CA 19-9.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.6
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• pp.2327-2331
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• 2015

Purpose: To determine the accuracy of visual inspection with acetic acid (VIA) in detecting high-grade cervical intraepithelial neoplasia (CIN) in pre- and post-menopausal women with atypical squamous cells of undetermined significance (ASC-US) and low grade squamous intraepithelial lesion (LSIL) Papanicolaou (Pap) smears. Materials and Methods: Two hundred women (150 pre-menopausal and 50 post-menopausal) with ASC-US and LSIL cytology who attended the colposcopy clinic, Thammasat University Hospital, between March 2013 and August 2014 were included. All women underwent VIA testing and colposcopy by gynecologic oncologists. Diagnostic values of VIA testing including sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for detecting high-grade CIN were determined using the histopathology obtained from colposcopic-directed biopsy as a gold standard. Results: VIA testing was positive in 54/150 (36%) pre-menopausal women and 5/50 (10%) post-menopausal women. Out of 54 pre-menopausal women with positive VIA testing, 15 (27.8%) had high-grade CIN and 39 (72.2%) had either CIN 1 or insignificant pathology. Ten (10.4%), 43 (44.8%) and 43 (44.8%) out of the remaining 96 pre-menopausal women with negative VIA testing had high-grade CIN, CIN 1 and insignificant pathology, respectively. Out of 5 post-menopausal women with positive VIA testing, there were 4 (80%) women with high-grade CIN, and 1 (20%) women with insignificant pathology. Out of 45 VIA-negative post-menopausal women, 42 (93.3%) women had CIN 1 and insignificant pathology, and 3 (6.7%) had high-grade CIN. Sensitivity, specificity, PPV and NPV of the VIA testing were 59.4%, 76.2%, 32.2% and 90.8%, respectively (60%, 68.8%, 27.8% and 89.6% in pre-menopausal women and 57.1%, 97.7%, 80% and 93.3% in post-menopausal women). Conclusions: VIA testing may be used as a screening tool for detecting high-grade CIN in women with minor cervical cytological abnormalities in a low-resource setting in order to lower the rate of colposcopy referral.

• Microbiology and Biotechnology Letters
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• v.46 no.2
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• pp.171-179
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• 2018

Human papillomavirus (HPV) plays a critical role in the development of cervical carcinoma. This study analyzed the efficiency of multiplex real-time PCR in detecting and identifying HPV genotypes in samples from women who visited a Korean hospital for checkups. Cervical swab specimens were obtained from women who attended a checkup at the Health Improvement Center of Hospital in Dankook University Cheonan, South Korea and were referred for an HPV genotyping test between January and September 2014. A total of 1703 cervical swab specimens were collected consecutively during this period. PCR results were compared with those of the traditional cytological assay for the same population. Among the 1,703 specimens, 19.91% were HPV positive, of which 14.50% indicated a single infection and 5.40% indicated multiple infections. However, cytology identified only 2.52% of positive cases, including 1.23% cases of atypical squamous cells of undetermined significance, 1% of low grade squamous intra-epithelial lesion, and 0.29% of high grade squamous intra-epithelial lesion. The rate of high-risk and low-risk HPV in the abnormal cytology group was 48 and 23, respectively, and 274 and 136 in the normal group, respectively. HPV types 56, 52, 43 were the most prevalent in that order. Our results confirm the efficiency of the HPV DNA assay for the detection of 28 different HPV genotypes with reasonable sensitivity. A screening strategy that comprises the HPV DNA assay and cytology would help overcome the low sensitivity of a cytological diagnosis.

• Clinical and Experimental Pediatrics
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• v.49 no.4
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• pp.446-450
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• 2006

Congenital central hypoventilation syndrome (CCHS) or Ondine's curse is a very rare sleep disorder that is the result of a congenital failure of the autonomic control of ventilation caused by insensitivity of the chemoreceptor to hypercapnea during sleep. Gastrointestinal motility disorders, particularly a congenital megacolon (Hirschsprung disease) is often combined with CCHS. This combination can be explained by a defect in the migration of neuronal cells from the neural crest (neurocristopathy) during the intrauterine period. A diagnosis of CCHS is made by confirming the failure of adequate ventilation in response to hypercapnea and hypoxia during sleep and the exclusion of other diseases. Young infants frequently show atypical clinical courses, and their conditions are frequently complicated with the long-term sequela of hypoxemic episodes. Therefore, a high index of suspicion and active treatment with mechanical ventilation are important for reducing recurrent hypoxemic episodes in the neonatal period. This paper reports the follow up of a case of CCHS in a neonate who showed frequent intractable apnea and cyanosis and was given artificial mechanical ventilation during sleep.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.2
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• pp.579-583
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• 2015

This study was conducted on female patients with different gynecological problems attending the gynecology out-patient departments of two tertiary care hospitals in Peshawar city of Khyber Pakhtunkhwa, Pakistan between August 2012 and October 2013. The 200 patients had an age range of 21-65 years. Smears were taken with cervical brushes and preserved in preservative medium and processed for manual liquid based cytology (MLBC) for Pap staining. Out of 200 collected samples, 30 samples were found inadequate on cytology. Of the remaining 170 samples, 164 (96.47%) were normal, 5 (2.94%) were of atypical squamous cells of unknown significance (ASCUS) and 1 (0.6%) was of high grade squamous intraepithelial lesion (HSIL). On PCR all the samples were positive for beta globin gene fragment including those reported inadequate on cytology. Out of the 5 ASCUS samples, 2 samples were positive for HPV, one each for HPV 16 and HPV 18, and the rest of the 3 samples were negative for HPV DNA. The 1 sample of HSIL was positive for HPV 16 on PCR. Out of 164 normal samples on cytology, only 1 sample was HPV 16 positive. So overall, 4 (2%) out of 200 samples were positive for HPV DNA, where 3 were HPV 16 (1.5%), and 1 was HPV 18 (0.5%) positive, and thus the ratio of infection with of HPV 16 to HPV 18 was 3:1 in the general population. In conclusion, PCR based HPV detection is a more sensitive method for screening of HPV infection than cytology as sample inadequacy does not affect the results. However, it can be combined with cytology methods in a HPV positive female to achieve the maximum results.

• Tuberculosis and Respiratory Diseases
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• v.75 no.2
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• pp.67-70
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• 2013

A 52-year-old man was referred to our clinic for an 11.3 mm nodule in the left lower lobe that was discovered on a chest computed tomography (CT) scan. Eleven small nodules were subsequently found in both lungs. Initially, we performed a transthoracic needle aspiration using CT scan guidance. The pathologic report showed a few clusters of atypical cells that were suspicious for malignancy. The positron emission tomography images revealed multiple lung nodules scattered throughout both lungs. The largest nodule (11.3 mm) in the left lower lobe did not have any discernible fludeoxyglucose uptake. For pathologic confirmation, we consulted a thoracic surgeon to perform the video-assisted thoracoscopic surgery. The final diagnosis was minute pulmonary meningothelial-like nodules (MPMNs). MPMNs are benign in nature, and only a few cases require treatment. However, when clinicians are suspicious of potential malignancy, a pathological correlation is essential, even if the final diagnosis is MPMNs.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.15
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• pp.6375-6379
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• 2015

Background: Cervical cancer is the second most common cancer in women worldwide, with about 500,000 new cases and 270,000 deaths each year. Globally, it is estimated that over one million women currently have cervical cancer, most of whom have not been diagnosed, or have no access to treatment that could cure them or prolong their lives. In the United Arab Emirates (UAE) cervical cancer is the third most common cancer in women. Materials and Methods: A population-based cross-sectional retrospective survey of cervical smear abnormalities was conducted in the Emirate of Abu Dhabi, UAE, from January 2013 to December 2013 by collecting consecutive liquid-based cytology samples from the Department of Pathology at the SKMC Hospital in Abu Dhabi city. Results: The total number of women screened for cervical cancer for the year 2013 at SKMC was 4,593, with 225 (4.89%) abnormal smears. The majority of the abnormal smear results were atypical squamous cells of undetermined significance (ASCUS) 114 (2.48%). This study showed 60% increase in the rate of abnormal cervical smears in the UAE over the last 10 years. In this study the highest incidence of high grade abnormalities were seen in women above the age of 61years (1.73%), this might be due to the fact that this group of women missed the chance of screening of cervical cancer earlier in their lives or could be explained by the well-known second peak of HPV infection seen in many prevalence studies. Conclusions: We conclude that the rate of abnormal cervical smear in the screened Abu Dhabi women is not different from the rate in developed countries. A notable increase in both low and high grade abnormalities has occurred within the last decade.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.12
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• pp.6039-6045
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• 2012

This study was conducted to assess the predictive value of p-glycoprotein (p-gp) and p53 immunoexpression in human papillomavirus (HPV) infected cases of cervical dysplasia. Expression of both p-gp and p53 proteins was detected in cervical smears from 177 squamous intraepithelial lesions (SIL) cases along with 183 "atypical squamous cells of unknown significance" (ASCUS) and 150 normal cases. HPV 16 and 18 infection was detected by polymerase chain reaction using type-specific primers for HPV sub-types. There were no significant detectable p53 and p-gp expression in the normal cervix smears (p>0.05). In the ASCUS group 10 cases were positive for both p53 and p-gp immunoreactivity. In cervical dysplasia cases, p53 was positive in 86 (48.58%) while p-gp was positive in 93 (52.54%) and the two markers showed a highly significant correlation (r=0.92, p<0.001). Expression of p53 and p-gp was associated with grade of SIL (p<0.001). A positive correlation between the presence of HPV and expression of proteins p53 and p-gp in smears of patients with cervical lesions was also noted (p<0.001). Thus, p53 and p-gp immunostaining in cervical smears may act as an auxiliary biomarker for detection of HPV-associated cervical lesions. Additionally, a significant positive correlation between ascending grades of SIL and labeling indices of markers suggests that p53 and p-gp can be used as an adjunct to cytomorphological interpretation of conventional cervical Pap smears.