Gland Attenuation, a Novel Morphological Feature of Colorectal Cancer: Evidence for an Epithelial-Mesenchymal Transition

백태화,강동욱,김주헌,손현진 대한대장항문학회 2018 Annals of Coloproctolgy Vol.34 No.4

Purpose: Along the invasive margin, colorectal cancer may show distinctive morphologic changes characterized by an asymmetrically attenuating tumor gland with loss of polarity. The author coined the term ‘gland attenuation (GA)’ for these peculiar changes. The aims of this study were to compare the immunoreactivity of the epithelial-mesenchymal transition (EMT) markers E-cadherin and β-catenin and thus determine whether EMTs occurs at tumor budding (TB) or GA sites and to assess the association of TB and/or GA levels with clinicopathological parameters and prognosis. Methods: Expression patterns of E-cadherin and β-catenin in the tumor centers at GA and TB sites were examined in 101 patients with well or moderately differentiated CRCs, and the prognostic significance of TB and/or GA was statistically evaluated. Results: GA foci, as well as TB foci, revealed loss of membranous and cytoplasmic E-cadherin expressions and aberrant β-catenin expression with reduced membranous expression and increased localization to the nucleus, suggesting that EMTs occur in GA as well as in TB. The high-TB and the TB-dominant groups were significantly correlated with advanced invasion depth, presence of lymph node metastasis, advanced pathologic staging and presence of lymphovascular invasion. The high-TB and the TB-dominant groups showed poor overall survival (OS) and recurrence-free survival (RFS), and high TB was an independent prognostic factor in the multivariate analyses for OS and RFS. Conclusion: This study showed evidence that EMTs occurs at GA sites as well as TB foci. TB is a strong and independent prognostic factor, and TB-dominance may be an indicator of adverse clinical outcome.

The Stromal Overexpression of Decay Accelerating Factor (DAF/CD55) Correlates with Poor Clinical Outcome in Colorectal Cancer Patients

백태화,김주헌,박미자,이혜경,손현진,순현기,김창남,고제명,강동욱 대한병리학회 2011 Journal of Pathology and Translational Medicine Vol.45 No.5

Background: Decay accelerating factor (DAF/CD55), regulates the complement system by accelerating decay of the C3 convertase, has been described in several malignancies, however, the clinicopathologic significance of CD55 and its receptor CD97 has not been fully investigated. We examined the expression patterns of both CD55 and CD97 and their association with clinicopathologic parameters in colorectal cancers (CRCs). Methods: Expression patterns of CD55 and CD97 in the stroma and tumor cells at tumor center and invasive front were examined in 130 CRCs, and their significance was statistically evaluated. Results: CD55-high stroma was correlated with tumor border (p=0.006) and invasion depth (p=0.013). CD55-high tumor cells at tumor center and invasive front were correlated with histologic grade, and CD55-high tumor cells at invasive front with tumor, node and metastasis (TNM) stage (p<0.05). CD97-high stroma was correlated with lymph node metastasis (p=0.016) and TNM stage (p=0.030). CD97-high tumor cells at tumor center and invasive front were correlated with tumor size and CD97-high tumor cells at tumor center with tumor border (p<0.05). Patients with CD55-high stroma showed poor overall and recurrence-free survival (p<0.05) in univariate analysis, and were independently associated with short recurrence-free survival (p=0.025) in multivariate analysis. Conclusions: Stromal CD55 overexpression would be an indicator of adverse clinical outcome and a useful prognostic factor.

[이차출판] 엘러스-단로스 제4형 증후군 환자에서 발생한 대동맥 파열

백태화,김민정,기창석,박성환,이헌,김경열,최병하 대한법의학회 2016 대한법의학회지 Vol.40 No.2

Ehlers-Danlos syndrome type IV (EDS IV) is a hereditary disorder of the connective tissue, characterized by easy bruising, thin skin with visible veins, and spontaneous rupture of the large arteries, uterus, or bowel. EDS IV is caused by mutations of the gene for type III procollagen (COL3A1), resulting in insufficient collagen production or a defect in the structure of collagen. EDS IV can have fatal complications such as the rupture of great vessels or organs, which can cause hemorrhaging and sudden unexpected death. Here, we report a case of a 43-year-old female who collapsed after a struggle with a neighbor. In this patient, the bifurcation of the bilateral common iliac artery ruptured, with no evidence of trauma, inflammation, or atherosclerosis. Genetic analysis of COL3A1 showed the presence of a c.2771G>A (p.Gly924Arg) mutation, which may be associated with EDS IV. The forensic pathologist should consider the possibility that the spontaneous visceral or arterial rupture was caused by EDS IV. Genetic analysis is not currently a routine procedure during autopsy. However, in this case, we suggest that the patient possibly had an underlying EDS IV condition, and we recommended family members of the deceased to seek genetic analysis and counseling.

경피적 경막외 신경성형술 중 발생한 의도하지 않은 척수강 내 조영제 주입: 부검 2증례

백태화 대한법의학회 2023 대한법의학회지 Vol.47 No.2

Percutaneous epidural neuroplasty (PEN) is an interventional technique used to manage spinal pain. However, the procedure may lead to various complications, such as dural puncture and inadvertent intrathecal injection of contrast agents. Conventional autopsy techniques may have limitations in identifying these complications, but postmortem computed tomography (PMCT) scans may be helpful in this respect. The pseudosubarachnoid hemorrhage sign on a PMCT scan is an important finding that suggests an inadvertent intrathecal injection of a contrast agent during the procedure. Here, we report on two rare cases of intrathecal contrast injection that mimicked a subarachnoid hemorrhage after PEN. These rare cases should be considered during autopsies of PEN-related deaths, and a PMCT scan should always be performed prior to such autopsies.

감금 메켈 게실(리트레 탈장)로 인한 예기치 못한 사망

백태화 대한법의학회 2021 대한법의학회지 Vol.45 No.2

Meckel’s diverticulum is the most common congenital malformation of the small intestine that can cause various complications, including obstruction, intussusception, inflammation, hemorrhage, or perforation. Littre hernia is a rare complication that refers to a Meckel’s diverticulum within the hernia sac. This condition is usually asymptomatic and is often discovered incidentally intraoperatively or at autopsy. Therefore, only extremely rare cases of death caused by Littre hernia are described in the literature. We report a rare case of unexpected death secondary to Littre hernia, which was diagnosed at the time of autopsy in a 71-year-old man.

Expression of HuR and Cyclooxygenase-2 in Nodular Fasciitis and Low-Grade Sarcoma: An Immunohistochemical Study

손현진,백태화,이승윤,김주헌,강동욱,이혜경,박미자 대한병리학회 2014 Journal of Pathology and Translational Medicine Vol.48 No.4

Background: Nodular fasciitis is the most common reactive mesenchymal lesion to be misidentified as a type of sarcoma. HuR is an mRNA-binding protein that can stabilize cyclooxygenase-2 (COX-2) mRNA leading to COX-2 overexpression. The aim of this study is a comparison of the expressions of COX-2 and HuR and the relationships between their expressions and the clinicopathologicalparameters in nodular fasciitis and low-grade sarcoma. Methods: We measured the expression of HuR and COX-2 in 21 cases of nodular fasciitis and 37 cases of low-grade sarcoma using immunohistochemistry. Results: The frequency of cytoplasmic immunoreactivity for HuR was 5 of 21 cases of nodular fasciitis (23.8%) and 23 of 37 cases of low-grade sarcoma (62.1%) (p=.013). COX-2 expression was moderate or strong in nodular fasciitis (12/21, 57.1%) and in low-grade sarcoma (29/37, 78.4%) (p=.034). In addition, a significant difference existed between these two entities in terms of the relationship between moderate or strong COX-2 expression and HuR cytoplasmic immunoreactivity (p=.009). Moderate or strong COX-2 immunoreactivity correlated with nuclear (p=.016) or cytoplasmic HuR (p=.024) expression in low-grade sarcoma but not in nodular fasciitis. Conclusions: This study suggests that HuR and COX-2 expression may be useful to differentiate nodular fasciitis from low-grade sarcoma.

Difference of the Nuclear Green Light Intensity between Papillary Carcinoma Cells Showing Clear Nuclei and Non-neoplastic Follicular Epithelia in Papillary Thyroid Carcinoma

이혜경,백태화,박미자,이승윤,손현진,강동욱,김주헌,김수영 대한병리학회 2016 Journal of Pathology and Translational Medicine Vol.50 No.5

Background: There is subjective disagreement regarding nuclear clearing in papillary thyroid carcinoma. In this study, using digital instruments, we were able to quantify many ambiguous pathologic features and use numeric data to express our findings. Methods: We examined 30 papillary thyroid carcinomas. For each case, we selected representative cancer cells showing clear nuclei and surrounding non-neoplastic follicular epithelial cells and evaluated objective values of green light intensity (GLI) for quantitative analysis of nuclear clearing in papillary thyroid carcinoma. Results: From 16,274 GLI values from 600 cancer cell nuclei and 13,752 GLI values from 596 nonneoplastic follicular epithelial nuclei, we found a high correlation of 94.9% between GLI and clear nuclei. GLI between the cancer group showing clear nuclei and non-neoplastic follicular epithelia was statistically significant. The overall average level of GLI in the cancer group was over two times higher than the non-neoplastic group despite a wide range of GLI. On a polygonal line graph, there was a fluctuating unique difference between both the cancer and non-neoplastic groups in each patient, which was comparable to the microscopic findings. Conclusions: Nuclear GLI could be a useful factor for discriminating between carcinoma cells showing clear nuclei and non-neoplastic follicular epithelia in papillary thyroid carcinoma.

Sudden Cardiac Death caused by a Septic Coronary Artery Embolism as the First Clinical Presentation of Infective Endocarditis

김어진,백태화,이수경,김한나 대한법의학회 2021 대한법의학회지 Vol.45 No.4

This report describes an uncommon and fatal case of acute coronary infarction due to a coronary embolus arising from vegetation in the aortic valve with the background of infective endocarditis (IE). There are various causes underlying fatal IE. Acute coronary infarction from septic emboli is rare. We report a case of sudden death in a 69-year-old woman with hyperlipidemia and no known cardiac disease. She had severe general weakness and had been hospitalized for colonoscopy. She unexpectedly presented with cardiac arrest and died. The autopsy showed total occlusion of the left anterior descending artery by an embolus, which originated from septic vegetation of the aortic valve. Among patients with IE, myocardial infarction from septic emboli has a fatal outcome. It should be considered that acute coronary infarction can be shown as the first presentation of IE. Prompt treatment, such as surgical intervention combined with antibiotic therapy, should be considered.

Langerhans Cell Sarcoma Arising in a Lymph Node - A Case Report and Review of the Literature -

강동욱,손현진,백태화,이혜경,허주령,김주헌,박미자 대한병리학회 2011 Journal of Pathology and Translational Medicine Vol.45 No.1

We report a case of Langerhans cell sarcoma presented as a solitary mass in the left supraclavicular area in a 31-year-old woman. Computed tomography revealed a relatively well-defined and lightly enhancing mass in the left supraclavicular area, measuring 5.5×4.5×3.2 cm. Excision was subsequently performed. Microscopically, the specimen consisted of an enlarged and partially effaced lymph node. Nests of different size composed of atypical tumor cells were located in the paracortex and the medulla of the lymph node. The tumor cells exhibited abundant eosinophilic or clear cytoplasm and displayed marked nuclear atypia and increased mitotic figures. Infiltration of many eosinophils was identified in the periphery and between the tumor cells. The tumor cells were reactive for CD1a and S100 protein. Ultrastructually, they were found to have Birbeck granules in the cytoplasm.

Nuclear Image Analysis Study of Neuroendocrine Tumors

박미자,이혜경,백태화,백종호,손현진,강동욱,김주헌 대한병리학회 2012 Journal of Pathology and Translational Medicine Vol.46 No.1

Background: There is a subjective disagreement about nuclear chromatin in the field of pathology. Objective values of red, green, and blue (RGB) light intensities for nuclear chromatin can be obtained through a quantitative analysis using digital images. Methods: We examined 10 cases of well differentiated neuroendocrine tumors of the rectum, small cell lung carcinomas, and moderately differentiated squamous cell lung carcinomas respectively. For each case, we selected 30 representative cells and captured typical microscopic findings. Using an image analyzer, we determined the longest nuclear line profiles and obtained graph files and Excel data on RGB light intensities. We assessed the meaningful differences in graph files and Excel data among the three different tumors. Results: The nucleus of hematoxylin and eosin-stained tumor cells was expressed as a combination of RGB light sources. The highest intensity was from blue, whereas the lowest intensity was from green. According to the graph files, green showed the most noticeable change in the light intensity, which is consistent with the difference in standard deviations. Conclusions: The change in the light intensity for green has an important implication for differentiating between tumors. Specific features of the nucleus can be expressed in specific values of RGB light intensities.