흉선암의 예후인자

박인규,김대준,김길동,배미경,정경영 대한흉부외과학회 2005 Journal of Chest Surgery (J Chest Surg) Vol.38 No.8

Background: Thymic carcinoma is a rare malignant disease with sparse data for treatment and prognosis. We intended to investigate the prognostic factors of thymic carcinoma. Material and Method: Data of 42 patients, who were diagnosed and treated for thymic carcinoma from January of 1986 to August of 2003 were reviewed retrospectively. Influences of characteristics of patients, Masaoka stage, histologic grade, completeness of resection and adjuvant treatment on survival were evaluated. Result: There were 30 male and 12 female patients and their mean age was 52.0±15.7 years old. There were 28 patients with low-grade histology and 13 patients with high- grade histology. Clinical stage according to Masaoka stage were I in 2, II in 2, III in 15 (35.7%), IVa in 10 (23.8%), and IVb in 13 (31%) patients. Surgical resection was done in 22 patients. Complete resection was possible in 13 patients and incomplete resection was done in 9 patients. Among 20 patients without resection, 8 patients received chemotherapy, 7 patients received radiotherapy and 5 patients received combined therapy. Median survival time was 31.7±6.1 months and 5 year survival rate was 28.6%. High grade histology (hazard ratio=3.009, 95% confidence interval=1.178~7.685, p=0.021) and incompleteness of resection (hazard ratio=3.605, 95% confidence interval=1.154~11.580, p=0.023) were the prognostic factors of thymic carcinoma. Conclusion: In thymic carcinoma, low grade histology is a good prognostic factor and complete resection can prolong the survival of patients. 배경: 흉선암은 악성 종양으로 드문 질환이기 때문에 치료와 예후에 대한 자료가 충분치 않은 상태이다. 저자들은 흉선암 환자의 생존에 영향을 미치는 예후 인자들을 알아보고자 하였다. 대상 및 방법: 1986년 1월 1일부터 2003년 8월 31일까지 흉선암으로 치료 받은 42명의 환자를 대상으로 임상특성, Masaoka 병기, 조직학적 등급, 완전절제여부 및 보조요법 등과 생존율의 관계를 후향적으로 조사하였다. 결과: 평균연령은 52.0 15.7세였고, 남자가 30명, 여자가 12명이었다. 조직학적 저등급(low-grade histology)군이 28명(66.7%), 고등급(high-grade histology)군이 13명(31%)이었고, 세침흡인검사를 시행한 1예에서는 세포유형을 판별할 수 없었다. Masaoka 병기는 I기 2명, II기 2명, III기 15명(35.7%), IVa기 10명(23.8%), IVb기 13명(31.0%)이었다. 수술은 22명에서 시행되었으며, 이 중 13명(59%)에서 완전절제가 가능하였다. 수술 받지 않은 환자 20명 중 8명은 항암화학 요법, 7명은 방사선 치료, 5명은 두 가지 치료를 병행하였다. 중앙생존기간은 31.7 6.1개월이었고, 5년 생존율은 28.6%이었다. 다변량 분석 결과 조직학적 고등급군(위험도=3.009, 95% 신뢰군간=1.178∼7.685, p=0.021)과 불완전절제(위험도= 3.605, 95% 신뢰군간=1.154∼11.580, p=0.023)가 예후에 영향을 미치는 인자로 나타났다. 결론: 흉선암 환자에서 조직학적 저등급군이 예후가 좋았으며, 완전 절제로 생존율을 높일 수 있으리라 생각한다.

Diffuse-Type Histology Is Prognostic for All Siewert Types of Gastroesophageal Adenocarcinoma

Kelly M Mahuron,Kevin M Sullivan,Matthew C Hernandez,Yi-Jen Chen,Joseph Chao,Laleh G Melstrom,I. Benjamin Paz,Jae Yul Kim,Rifat Mannan,James L. Lin,Yuman Fong,Yanghee Woo The Korean Gastric Cancer Association 2024 대한위암학회지 Vol.24 No.3

Purpose: The optimal treatment for gastroesophageal junction adenocarcinoma (GEJA) remains controversial. We evaluated the treatment patterns and outcomes of patients with locally advanced GEJA according to the histological type. Materials and Methods: We conducted a single-institution retrospective cohort study of patients with locally advanced GEJA who underwent curative-intent surgical resection between 2010 and 2020. Perioperative therapies as well as clinicopathologic, surgical, and survival data were collected. The results of endoscopy and histopathological examinations were assessed for Siewert and Lauren classifications. Results: Among the 58 patients included in this study, 44 (76%) were clinical stage III, and all received neoadjuvant therapy (72% chemoradiation, 41% chemotherapy, 14% both chemoradiation and chemotherapy). Tumor locations were evenly distributed by Siewert Classification (33% Siewert-I, 40% Siewert-II, and 28% Siewert-III). Esophagogastrectomy (EG) was performed for 47 (81%) patients and total gastrectomy (TG) for 11 (19%) patients. All TG patients received D2 lymphadenectomy compared to 10 (21%) EG patients. Histopathological examination showed the presence of 64% intestinal-type and 36% diffuse-type histology. The frequencies of diffuse-type histology were similar among Siewert groups (37% Siewert-I, 36% Siewert-II, and 33% Siewert-III). Regardless of Siewert type and compared to intestinal-type, diffuse histology was associated with increased intraabdominal recurrence rates (P=0.03) and decreased overall survival (hazard ratio, 2.33; P=0.02). With a median follow-up of 31.2 months, 29 (50%) patients had a recurrence, and the median overall survival was 50.5 months. Conclusions: Present in equal proportions among Siewert types of esophageal and gastric cancer, a diffuse-type histology was associated with high intraabdominal recurrence rates and poor survival. Histopathological evaluation should be considered in addition to anatomic location in the determination of multimodal GEJA treatment strategies.

The histology of ovarian cancer: worldwide distribution and implications for international survival comparisons (CONCORD-2)

the CONCORD Working Group,Matz, M.,Coleman, M.P.,Sant, M.,Chirlaque, M.D.,Visser, O.,Gore, M.,Allemani, C. Academic Press 2017 Gynecologic oncology Vol.144 No.2

Objective: Ovarian cancers comprise several histologically distinct tumour groups with widely different prognosis. We aimed to describe the worldwide distribution of ovarian cancer histology and to understand what role this may play in international variation in survival. Methods: The CONCORD programme is the largest population-based study of global trends in cancer survival. Data on 681,759 women diagnosed during 1995-2009 with cancer of the ovary, fallopian tube, peritoneum and retroperitonum in 51 countries were included. We categorised ovarian tumours into six histological groups, and explored the worldwide distribution of histology. Results: During 2005-2009, type II epithelial tumours were the most common. The proportion was much higher in Oceania (73.1%), North America (73.0%) and Europe (72.6%) than in Central and South America (65.7%) and Asia (56.1%). By contrast, type I epithelial tumours were more common in Asia (32.5%), compared with only 19.4% in North America. From 1995 to 2009, the proportion of type II epithelial tumours increased from 68.6% to 71.1%, while the proportion of type I epithelial tumours fell from 23.8% to 21.2%. The proportions of germ cell tumours, sex cord-stromal tumours, other specific non-epithelial tumours and tumours of non-specific morphology all remained stable over time. Conclusions: The distribution of ovarian cancer histology varies widely worldwide. Type I epithelial, germ cell and sex cord-stromal tumours are generally associated with higher survival than type II tumours, so the proportion of these tumours may influence survival estimates for all ovarian cancers combined. The distribution of histological groups should be considered when comparing survival between countries and regions.

Quantitative histology-based classification system for assessment of the intestinal mucosal histological changes in patients with celiac disease

Prasenjit Das,Gaurav PS Gahlot,Alka Singh,Vandana Baloda,Ramakant Rawat,Anil K Verma,Gaurav Khanna,Maitrayee Roy,Archana George,Ashok Singh,Aasma Nalwa,Prashant Ramteke,Rajni Yadav,Vineet Ahuja,Vishnu 대한장연구학회 2019 Intestinal Research Vol.17 No.3

Background/Aims: The existing histological classifications for the interpretation of small intestinal biopsies are based on qualitative parameters with high intraobserver and interobserver variations. We have developed and propose a quantitative histological classification system for the assessment of intestinal mucosal biopsies. Methods: We performed a computer-assisted quantitative histological assessment of digital images of duodenal biopsies from 137 controls and 124 patients with celiac disease (CeD) (derivation cohort). From the receiver-operating curve analysis, followed by multivariate and logistic regression analyses, we identified parameters for differentiating control biopsies from those of the patients with CeD. We repeated the quantitative histological analysis in a validation cohort (105 controls and 120 patients with CeD). On the basis of the results, we propose a quantitative histological classification system. The new classification was compared with the existing histological classifications for interobserver and intraobserver agreements by a group of qualified pathologists. Results: Among the histological parameters, intraepithelial lymphocyte count of ≥25/100 epithelial cells, adjusted villous height fold change of ≤0.7, and crypt depth-to-villous height ratio of ≥0.5 showed good discriminative power between the mucosal biopsies from the patients with CeD and those from the controls, with 90.3% sensitivity, 93.5% specificity, and 96.2% area under the curve. Among the existing histological classifications, our quantitative histological classification showed the highest intraobserver (69.7%–85.03%) and interobserver (24.6%–71.5%) agreements. Conclusions: Quantitative assessment increases the reliability of the histological assessment of mucosal biopsies in patients with CeD. Such a classification system may be used for clinical trials in patients with CeD.

Quantitative measurement of lipid rich plaque by coronary computed tomography angiography: A correlation of histology in sudden cardiac death

Han, Donghee,Torii, Sho,Yahagi, Kazuyuki,Lin, Fay Y.,Lee, Ji Hyun,Rizvi, Asim,Gransar, Heidi,Park, Mahn-Won,Roudsari, Hadi Mirhedayati,Stuijfzand, Wijnand J.,Baskaran, Lohendran,ó,Hartaigh, Br&i Elsevier Scientific Publ. Co 2018 Atherosclerosis Vol. No.

<P><B>Abstract</B></P> <P><B>Background and aims</B></P> <P>Recent advancements in coronary computed tomography angiography (CCTA) have allowed for the quantitative measurement of high-risk lipid rich plaque. Determination of the optimal threshold for Hounsfield units (HU) by CCTA for identifying lipid rich plaque remains unknown. We aimed to validate reliable cut-points of HU for quantitative assessment of lipid rich plaque.</P> <P><B>Methods</B></P> <P>8 post-mortem sudden coronary death hearts were evaluated with CCTA and histologic analysis. Quantitative plaque analysis was performed in histopathology images and lipid rich plaque area was defined as intra-plaque necrotic core area. CCTA images were analyzed for quantitative plaque measurement. Low attenuation plaque (LAP) was defined as any pixel < 30, 45, 60, 75, and 90 HU cut-offs within a coronary plaque. The area of LAP was calculated in each cross-section.</P> <P><B>Results</B></P> <P>Among 105 cross-sections<B>,</B> 37 (35.2%) cross-sectional histology images contained lipid rich plaque. Although the highest specificity for identifying lipid rich plaque was shown with <30 HU cut-off (88.2%), sensitivity (e.g. 55.6% for <75 HU, 16.2% for <30 HU) and negative predictive value (e.g. 75.9% for <75 HU, 65.9% for <30 HU) tended to increase with higher HU cut-offs. For quantitative measurement, <75 HU showed the highest correlation coefficient (0.292, <I>p</I> = 0.003) and no significant differences were observed between lipid rich plaque area and LAP area between histology and CT analysis (Histology: 0.34 ± 0.73 mm<SUP>2</SUP>, QCT: 0.37 ± 0.71 mm<SUP>2</SUP>, <I>p</I> = 0.701).</P> <P><B>Conclusions</B></P> <P>LAP area by CCTA using a <75 HU cut-off value demonstrated high sensitivity and quantitative agreement with lipid rich plaque area by histology analysis.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Lipid rich plaques are related to future risk of acute coronary syndrome. </LI> <LI> Quantitative coronary plaque (QCT) analysis enables to quantify lipid rich plaques. </LI> <LI> 75 HU is a reliable cut-off for quantification of lipid rich plaque in QCT analysis. </LI> </UL> </P>

Prognostic assessment of sarcomatous histologic subtypes of ovarian carcinosarcoma

( Hyun Jin Kim ),( Hyun-mi Lee ),( Mi Kyung Kim ),( Yoo-kyung Lee ),( In-ho Lee ),( Ki-heon Lee ),( Hyesun Kim ) 대한산부인과학회 2017 Obstetrics & Gynecology Science Vol.60 No.4

Objective Ovarian carcinosarcoma is a rare subtype of this disease that has not been thoroughly investigated. The aim of this study was to evaluate the prognostic factors and out comes in patients with ovarian carcinosarcoma. Methods All patients with histologically confirmed ovarian carcinosarcoma who were treated at Cheil General Hospital and Women`s Healthcare Center between January 2000 and December 2015 were identified and analyzed. Data were extracted from medical records, and statistical analyses were performed to determine correlations between clinicopathological parameters and survival outcomes. Results Of the 822 patients diagnosed with ovarian cancer over 16 years, 11 (1.3%) had ovarian carcinosarcoma histology. Every patient underwent surgery as the initial treatment followed by intravenous adjuvant chemotherapy. Only 18.1% of cases were early stage (I or II) while 81.8% were advanced stage (III or IV) according to the FIGO (International Federation of Gynecology and Obstetrics) classification. Six cases were of the homologous subtype (54.5%) and five were of the heterologous subtype (45.5%). There was no significant difference in survival according to stage (P=0.24). The heterologous subtype and residual disease were associated with poor disease-free survival (P=0.02 and P=0.04) and overall survival (P=0.02 and P=0.04), On multivariate analysis, the histological subtype was an independent prognostic factor (P=0.02). Conclusion Optimal cytoreduction without gross residual disease and a homologous subtype are favorable prognostic factors in terms of disease relapse and survival.

방사광 전파위상대조 동결미세단층촬영법을 활용한 3차원 조직학

김주헌,한성미,송현욱,서윤경,문용석,김홍태 대한체질인류학회 2018 해부·생물인류학 (Anat Biol Anthropol) Vol.31 No.4

3D histology is a imaging system for the 3D structural information of cells or tissues. The synchrotron radiation propagation phase contrast micro-CT has been used in 3D imaging methods. However, the simple phase contrast micro-CT did not give sufficient micro-structural information when the specimen contains soft elements, as is the case with many biomedical tissue samples. The purpose of this study is to develop a new technique to enhance the phase contrast effect for soft tissue imaging. Experiments were performed at the imaging beam lines of Pohang Accelerator Laboratory (PAL). The biomedical tissue samples under frozen state was mounted on a computer-controlled precision stage and rotated in 0.18° increments through 180°. An X-ray shadow of a specimen was converted into a visual image on the surface of a CdWO4 scintillator that was magnified using a microscopic objective lens (X5 or X20) before being captured with a digital CCD camera. 3-dimensional volume images of the specimen were obtained by applying a filtered back-projection algorithm to the projection images using a software package OCTOPUS. Surface reconstruction and volume segmentation and rendering were performed were performed using Amira software. In this study, We found that synchrotron phase contrast imaging of frozen tissue samples has higher contrast power for soft tissue than that of non-frozen samples. In conclusion, synchrotron radiation propagation phase contrast cryo-microCT imaging offers a promising tool for non-destructive high resolution 3D histology. 조직표본의 실제적인 3차원 구조에 대한 정보를 3차원 조직학이라고 하였다. 무른 성분들이 섞여 있고, 물을 포함 하고 있는 조직 내부의 미세구조의 3차원적 분석을 위해 방사광의 X선을 광원으로 하는 위상대조 미세단층촬영이 활용되고 있다. 하지만, X선 위상대조영상 분석에서 물을 포함하고 있는 조직에서는 위상대조가 제대로 구현되지 않다는 것을 알게 되었다. 이러한 현상을 해결하기 위해 다양한 방법들을 적용하였으며, 표본을 얼렸을 때 위상대조가 강화된다는 사실을 확인하였다. 방사광 전파위상대조 동결미세단층촬영은 포항가속기연구소 X선 영상빔라인에서 수행하였다. 표본을 동결상태로 유지하면서 0.18° 간격으로 180° 회전하였으며, 표본을 통과한 X선에 의해 섬광기에 맺힌 영상을 광학렌즈로 확대하여 CCD카메라로 모았다. 각 표본 전체 투사영상을 OCTOPUS 소프트웨어로재구성하여 2차원 단면영상으로 만들고, Amira 소프트웨어를 이용하여 3차원 영상으로 재구성하였으며, 단면영상에서 각 구조에 대한 구역화와 랜더링 작업을 수행하였다. 물에 의한 위상대조 방해 영향을 줄이기 위해 표본을 얼렸을때 위상대조는 강화되었으나 동결팽창에 의한 조직변형이 관찰되었다. 표본을 막힌 공간에 넣고 주위를 포매제로 채워 급속냉동 동안 표본이 압박되도록 하였을 때 위상대조의 강화와 동결팽창에 의한 조직변형을 줄일 수 있었다. 결론적으로, 생체조직 내부 미세구조의 비파괴, 고해상도 3차원 영상분석에 있어 조직표본을 동결포매제로 포매 후 급속냉동하고, 방사광에서 방출되는 X선을 광원으로 하는 전파위상대조 동결미세단층촬영법은 효과적인 방법이 될 수있을 것으로 기대한다.

Liver Metastasis of Early Gastric Cancer with Mixed Histology after Endoscopic Submucosal Dissection

한양희,박종규,권준성,김영돈,정우진,이상진,한군희,천갑진 대한소화기내시경학회 2015 Clinical Endoscopy Vol.48 No.3

The Japanese Classification of Gastric Carcinoma histologically classifies endoscopically resected gastric cancer into differentiated and undifferentiated types according to the presence or absence of tubular structures on histology. The former includes papillary adenocarcinoma and tubular types, and the latter includes poorly differentiated adenocarcinoma, signet ring cell carcinoma and mucinous adenocarcinoma. However, gastric cancer sometimes contains a mixture of differentiated and undifferentiated components, and the clinical outcomes of the histological mixture are unknown, especially following endoscopic resection of early gastric cancer (EGC). This case was within the guideline indications for endoscopic submucosal resection (ESD), although it contained a partly signet ring cell carcinoma component; it recurred after 19 months with multiple lymph node and liver metastases. This case shows that additional surgical resection after ESD should be performed for patients with any mixed signet ring cell component, even in mild or moderately differentiated EGC.

Factors Associated with Cyto-Histological Misinterpretation of Cervical Smear according to Menopausal Status

Min Seong Choi,Young Jin Lee,Eun Hyun Lee,Yong Il Ji,Min Jeong Park 대한폐경학회 2022 대한폐경학회지 Vol.28 No.2

Objectives: This study aimed to compare histological outcomes between pre-menopausal and post-menopausal women with cervical cytological abnormalities and to investigate the clinical factors affecting the misinterpretation of cytology and histology.Methods: We conducted a retrospective analysis of 599 patients with abnormal cervical cytology who underwent loop electrosurgical excision procedure (LEEP) between January 2010 and May 2019. Baseline characteristics were collected, including age, height, weight, body mass index, gravity, parity, and menopausal status. In total, 477 pre-menopausal women and 122 post-menopausal women were recruited.Results: Atypical squamous cells of undetermined significance (ASC-US) or low-grade squamous intraepithelial lesions were cytologically observed in 73.4% (135/184) of the pre-menopausal women, which were high-grade lesions confirmed by LEEP. In post-menopausal patients with cytology results that cannot exclude high-grade squamous intraepithelial lesions (ASC-H) or high-grade squamous intraepithelial lesions (HSIL), 27.0% (24/89) were confirmed to have histologically low-grade lesions. High-risk HPV (hrHPV) prevalence in abnormal cervical smears was 92.2%. Moreover, other hrHPVs had a higher risk of unexpected histological outcomes unrelated to cytologic results.Conclusions: Menopausal status and HPV infection are associated with misinterpretation of cervical cytology and histology. Therefore, the menopausal status of patients should be considered for the management of cervical cytology, and primary co-testing is recommended to identify women at risk of cervical abnormalities.

Discrepancy between Cytology and Histology in Cervical Cancer Screening: a Multicenter Retrospective Study (KGOG 1040)

Ouh Yung-Taek,Park Ji Jeong,Kang Minjoo,Kim Miseon,Song Jae Yun,Shin So Jin,Shim Seung-Hyuk,Yoo Heon Jong,Lee Maria,Lee Sung-Jong,Shin Whan,Chong Gun Oh,Choi Min Chul,Choi Chel Hun,Min Kyung-Jin 대한의학회 2021 Journal of Korean medical science Vol.36 No.24

Background: Cervical cancer is the fourth common cancer in women worldwide. The Papanicolau test is the primary screening procedure to detect abnormal cervical cells. Colposcopy is the main procedure for discriminating high-grade cervical lesions. The study aimed at clarifying the discrepancy between cervical cytology and colposcopic biopsy histology as well as confounding factors. Methods: Eligible patients visited thirteen tertiary hospitals for colposcopic biopsy following cervical cytology and human papillomavirus (HPV) genotypes between January and December 2018. Baseline characteristics including age, body mass index (BMI), and parity were collected. Results: In our study, 3,798 eligible patients were included. Mean age of patients was 42.7 (19–88) years and mean BMI was 22.5 (16.9–34.1) kg/m2 . The referred cervical cytologic findings consisted of 495 normal, 1,390 atypical squamous cells of undetermined significance, 380 atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion, 792 low-grade squamous intraepithelial lesion, 593 high-grade squamous intraepithelial lesion, 79 atypical glandular cells, 46 squamous cell carcinoma, and 23 adenocarcinoma. HPV-positive findings were found in 3,008 (79.2%) patients and were not detected in 914 (24.1%) cases. The risk of unexpected low-grade lesions from histology was higher in patients > 45 years (odds ratio [OR], 2.137; 95% confidence intervals [CIs], 1.475–3.096). In contrast, the risk of unexpected high-grade lesions from colposcopic biopsy was lower in patients ≥ 45 years (OR, 0.530; 95% CI, 0.367–0.747) and HPV 16/18 infection was higher than other HPV (OR, 1.848; 95% CI, 1.385–2.469). Conclusion: Age and HPV genotypes were responsible for the discrepancies between cytology and histology. Precautions should be taken for women over the age of 45 in triage for colposcopy in order to avoid unnecessary testing.