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Hiroyuki MIURA, Harubumi KATO, Chimori KONAKA, Koumei KINOSHITA, Masan ...
1991 Volume 30 Issue 3 Pages
417-422
Published: 1991
Released on J-STAGE: November 08, 2011
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A total of 160 sputum cytology specimens were studied. Of these 109 specimens were from cases of cancer of the lung or adjacent organs, 34 were from cases of inflammatory disease diagnosed clinically, 7 were from cases of metaplasia diagnosed by biopsy specimens and there were 10 others. Of the 109 specimens from malignant disease, 82 cases had not been treated before.After reinvestigation, 49 were positive for malignancy, 11 were negative and the remainder were suspicious.The reasons why they were not judged as positive at first were mild cell atypia, few atypical cells and degeneration of the cells.In 27 specimens with lung cancer after treatment, 4 were judged as positive in cases with recurrence and 4 were negative.However, the remaining 19 specimens were judged as suspicious.In 41 specimens of inflammatory disease and metaplasia, 17 were compatible with a negative diagnosis and there were no specimens judged as positive.Hyperplasia of the bronchial epithelium must be distinguished from adenocarcinoma.In judging such cases as negative, an inflammatory background and atypical cells with cilia or the brush borders could be useful.
In sputum cytology, detection of atypical cells is necessary for the early detection of malignancy.However, classification as “suspicious” is a problem for clinicians, because the actual meaning of “suspicious” is unclear.It is better to comment on the cytological findings and reasons for that judgement, and to indicate the subsequent steps to be taken, such as reexamination, follow-up or detailed examination. Clinicians should then decide based on the clinical findings.
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Sachiko NAGUMO, Kazunobu YAHATA, Takeshi HORAI
1991 Volume 30 Issue 3 Pages
423-430
Published: 1991
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A criteria for cytologic findings of squamous cell atypia was established by the authors. This criteria gave a satisfactory result for the detection of atypical cells found in sputum collected in mass surveys.
In this criteria, sputum cytologic findings were classified by the degree of squamous cell atypia suspected of malignancy.
In a workshop, the results of this criteria were found to be extremely useful for decreasing the number of false negative cases. The execution of the workshop was valuable for diminution of individual differences of identification of the degree of squamous cell atypia.
The results of sputum cytology showed some difference between the cytotechnologist's experiences of sputum cytology collected in mass surveys. Cytotechnologist who have no previous experience had a tendency to underdiagnose malignant cells found in sputum of early lung cancer cases.
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Kauemon OKADA, Nobuhide MASAWA, Takashi YAMADA, Mayumi OKADA, Yoshiyuk ...
1991 Volume 30 Issue 3 Pages
431-438
Published: 1991
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Seven malignant melanomas of the nasal cavity were cytologically detected in Dokkyo University school of Medicine during past 14 years from 1976 to 1990.
Melanin pigments were observed in six of seven cases, abundant 2, moderate 2, scant 2. The remaining one case was amelanotic. The following cytologic features were also observed: intranuclear vacuole (4 cases), prominant nucleolus (4 cases) and epitheloid arrangement (4 cases). The cellular three types were classified as follows, 3 epitheloid, 3 round and 0 spindle types.
Though these subcellular features observed here were not much different from malignant melanoma arisen in other area, it was unexpectedly found that there were no spindletyped melanoma in the nasal mucosa. This finding may be presumably related with poor prognosis in patients with malignant melanoma of the nasal cavity.
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Saburo HARASHIMA, Katsuhiko HASUMI, Morio HIRATA, Atsuko MINAMI, Masaf ...
1991 Volume 30 Issue 3 Pages
439-447
Published: 1991
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We studied the cellular distribution patterns of aspiration smears from 64 histologically confirmed cases of diseases of the breast. The breast diseases consisted of 5 cases of mastopathy, 2 of intraductal papilloma, 10 of fibroadenoma, 6 of noninvasive ductal carcinoma, 8 of papillotubular carcinoma, 15 of solid tubular carcinoma, 12 of scirrhous carcinoma, 2 of mucinous carcinoma, 1 of medullary carcinoma and 3 of invasive lobular carcinoma.
Sheets of epithelial cells, dispersed foamy cells and apocrine metaplastic cells were found in the cases of mastopathy. Tightly packed papillary clusters were seen in the intraductal papilloma. Myoepithelial cells were adhering to the clusters or dispersed around the clusters in fibroadenoma. In general the ductal cells in benign diseases are tightly conjugated but in some of the fibroadenomas they were not.
The clusters in noninvasive ductal carcinoma were papillary or pleomorphic. Papillary clusters with or without anisocytosis were seen in papillotubular carcinoma. Many pleomorphic clusters and dispersed malignant cells were observed in solid tubular carcinoma. Few dispersed cells or consider: single-file arrangement of small cells were seen in the scirrhous carcinoma, but some of them consisted of many dispersed cells or clusters. Island-like clusters in mucous lakes were observed in mucinous carcinoma. Large malignant cells were surrounded by many lymphocytes in the medullary carcinoma. Few dispersed small cells were seen in the invasive lobular carcinoma.
The study of patterns of cellular distribution is useful in understanding the relation between histological architecture and cytological diagnosis in diseases of the breast.
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Hitoshi HARA, Toshio OYAMA, Masahiro KIMURA, Eri ISHII, Hachiro KASAI, ...
1991 Volume 30 Issue 3 Pages
448-454
Published: 1991
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The results in cytological studies on six cases of histologically diagnosed adenoid cystic carcinoma (ADCC) were described as follows:
1. The cells originated from ADCC with both cribriform and solid pattern had the same small naked nuclei.Cell findings of ADCC with cribriform pattern had more mucoid globules and lower cellularity than those with other patterns. Cell fingings of ADCC with solid pattern had more scanty mucoid globules and higher cellarity.In ADCC with tubular pattern, outer myoepithelial cells had the same findings as those with cribriform and solid pattern, but luminal cells had abundant and thick cytoplasms with vacuoles and their nuclei and nucleoli were larger than outer myoepithelial cells.
2.Fine needle aspiration cytology reflected histological subtypes.
3.Degree of cellular atypia should be classified according to their rates of solid pattern, but not subtypes.In other words ADCC which had more than 30% of solid pattern was classified into grade 3, ADCC with less than 10% of solid pattern was classified into grade 1, and ADCC with about 10-20% of solid pattern was classified into grade 2.
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Fumiaki TEZUKA, Hisashi HIGASHIIWAI, Noriko ENDOH, Keiko ITO, Kiyomi C ...
1991 Volume 30 Issue 3 Pages
455-459
Published: 1991
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A new quantitative method of analyzing the distribution pattern (DP) of nuclei within cell clusters was described and applied to the differential diagnosis of hyperplastic and malignant lesions in endometrial cytology.The DP index can be defined as r√n
0, where r is the mean distance between the closest nuclei and n
0 represents nuclear density.The mean of estimated DP indices was 0.826±0.029 in 22 normal cases, 0.735±0.019 in 16 cases of adenomatous and atypical hyperplasia, and 0.641±0.046 in 19 cases of well-differentiated adenocarcinoma.The DP indices of these conditions were significantly different (p<0.01).This indicates that the nuclear DP index can be helpful in differentiating between benign and malignant endometrial lesions.
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Koshiro OBATA, Yoshiki INOUE, You WATANABE, Tetsuji TAKAIKE, Masaaki O ...
1991 Volume 30 Issue 3 Pages
460-466
Published: 1991
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We studied the endometrial aspiration cytology of endometrial hyperplasia.The endometrial cell samples were negative in 78.7% of the cases of cystic glandular hyperplasia, 61.5% of adenomatous hyperplasia, 44.1% of atypical hyperplasia.No cellular atypia was found in cystic glandular hyperplasia it was very mild in adenomatous hyperplasia and present in atypical hyperplasia.Irregular arrangement of clusters was mild in cystic glandular hyperplasia, moderate in adenomatous hyperplasia, and severe in atypical hyperplasia.Regular, clubbed or regular, papillary protuberances around clusters were chiefly observed in adenomatous hyperplasia, and irregular, clubbed or irregular, papillary protuberances were observed in atypical hyperplasia. In the cytologic diagnosis of endometrial hyperplasia, it is important to evaluate the irregular arrangement of cluster and the protuberances around cluster.
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Aiko NAKAZAWA, Satoru KYO, Kazuyoshi NAKANISHI, Haruki OGAWA, Toshiyuk ...
1991 Volume 30 Issue 3 Pages
467-472
Published: 1991
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Human papillomavirus (HPV) types 16 and 18 are found in close association with carcinogenesis of the uterine cervix. HPV infections were detected in cervical exfoliated cells by means of the polymerase chain reaction (PCR), dot blot and cytodiagnostic methods.The PCR method showed HPV 16 or 18 infection in11 (16%) out of 69 normal women, 17 (25%) out of67women with cervical intraepitherial neoplasia (CIN) and11 (37%) out of 30 with cervical cancer.The dot blot method revealed only12 (63%) of 19 cases in which HPV infection was demonstrated by the PCR method.When cytodiagnostic analysis was performed the koilocytes, binucleated cells and dyskeratotic cells characteristic of HPV infected cells were found in 26%, 21%and 58%, respectively, of the cases of HPV infection detected by PCR.
Thus, in order to diagnose HPV infection, the dot blot and cytodiagnostic methods are less sensitive than the PCR method.The PCR method is sensitive and useful in the detecting HPV infection in routine clinical samples.
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Yoshihiro YAMAKAWA, Tokuichi KAWAGUCHI, Hideo TESHIMA, Kaoru YOKOSUKA, ...
1991 Volume 30 Issue 3 Pages
473-480
Published: 1991
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A cell line was established from the ascitic fluid of apatient with ovarian clear cell carcinoma and continuouslycultured for more than 3 years.
This cell line has the following characteristics.
1) Doubling time is approximately 53 hours, and saturation density is 6.3×10
4/cm
2.
2) Chromosome analysis revealed aneuploidy with a modal number of 88.
3) PAS-positive substances were present in the cytoplasm, but disappeared after amylase digestion, demonstrating the presence of glycogen.
4) CA 15-3, CA 19-9, CA 72-4 and BFP were detected immunohistochemically in both the original tumor and the cultured cells.
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Ryo KONNO, Kazuo SHIKANO, Kiyoshi ITO, Hiromitsu MAKINO, Atsushi ENDO, ...
1991 Volume 30 Issue 3 Pages
481-488
Published: 1991
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The presense of human papillomavirus (HPV) DNA was demonstrated in scraped uterine cervix cells by combined dot blot and Southern blot hybridization assay using nonradioisotopic probes (FO-8830).
1) HPV DNA was detected in 19.7%(34/173) of dysplasias by dot blot hybridization (screening test) withmixed HPV DNA probes (HPV 6, 11, 16, 18, 31, 33 and 35) under stringent conditions.
2) Forty-six dysplasias were also examined for the presense of HPV DNA using another dot blot method with isotopic RNA probes (ViraPap) for comparison with the non -isotopic assay (FO-8830).HPV DNA was detected in32.6%(15/46) with FO-8830 and in 23.9%(11/46) with Vira Pap. There was an 84.8% rate of agreement in the detection of HPV DNA by the two methods.
3) HPV DNA was detected in 2.2%(4/180) of healthy women mass screened for cervical cancer. Class III abnormal cervical smears were observed in 2 cases, but normal smears were found in 2 cases.
4) We were able to determine the HPV type in 82.6% of the HPV dot blot positive cases using a typing test (Southern blot hybridization). HPV 16 was identified in 3 dysplasias, HPV 18 in one, HPV 31 in 3, and HPV 35 in 2.
5) The incidence of HPV DNA rose as the grade of the cytological and pathological findings increased.
The results indicate that this non-radioisotopic assay to detect HPV DNA in dysplasias is useful and of value in clinical research.
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Junko UEDA, Takako IWATA, Tokuhiro ISHIHARA, Yoshimi YAMASHITA, Toshik ...
1991 Volume 30 Issue 3 Pages
489-495
Published: 1991
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Colorimetric in situ hybridization (ISH) was used to identify human polyomaviruses JC (JCV) and BK (BKV) in smears of urinary sediment containing inclusion-bearing cells.
Positive results were obtained in 8 of the 15 cytologically suspicious subjects, 3 of whom were renal transplant recipients, 3 patients with hematopoietic disease, and 2 patients with diabetes mellitus.ISH identified JCV excretion in 4 patients, BKV excretion in one patient and both JCV and BKV excretion in 3 patients.
Based on these results cytological findings in infected cells on Papanicolaou smears of urinary sediment were reviewed, but we could not distinguish any cytopathic changes specific for polyomaviruses.
Urinary cytology and the ISH method are rapid and sensitive methods of detecting and identifying urinary excretion of JCV and BKV. The technique we have described enabled us to identify the virus responsible for the cytopathic changes in the Papanicolaou smear.
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Sumitaka HISA, Hiroshi MORIYA, Shigeki SUZUKI, Hiroko SHIBUYA, Kazue K ...
1991 Volume 30 Issue 3 Pages
496-501
Published: 1991
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In order to be able to choose the best method of rapid staining during bronchofiberscopy as well as for needle aspiration cytology and pleural effusion smears, we compared three types of rapid staining, i.e., Diff-Quik staining, Cytocolor staining, and Gill-Shorr staining. The most rapid staining was obtained by Diff-Quik staining, which took approximately 30 seconds. We believe is the most accurate staining with respect to Gill-Shorr staining diagnosis. Simultaneous Diff-Guik and Gill-Shorr staining proved to be the best method.
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Noriyuki FUKUSHIMA, Tetsuo NISHIYAMA, Satomi KASAI, Satomi YOSHIZAWA, ...
1991 Volume 30 Issue 3 Pages
502-506
Published: 1991
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We report three lung cancer patients with high titers of salivary gland-type amylase in their serum. All three cases consist of primary adenocarcinoma of the lung and two cases have been autopsied. The first patient is a 48-year-old male, and the second is a 63-year-old male. Adenocarcinoma cells were detected in their pleural effusions. The third patient is a 38-year-old male, and adenocarcinoma cells were found in his pericardial effusion.
Cytological features common to all three of these cases of lung cancer were observed. The cells were clustered forming papillae and had eccentric nuclei. The inner cytoplasm was densly lamellar and thick green in color, and the outer cytoplasma was finel vesicular. Microvilli were present on the cell surface. P.A.S staining of the inner cytoplasm was positive, and Alcian Blue staining was positive on the cell coat. Their cytoplasm stained positively for salivary-type amylase using the P.A.P. method.
Histologically, the former two cases of lung cancer were papillary adenocarcinoma. Salivary-amylase staining of paraffin sections also revealed positive cancer cells.
The electron microscope picture revealed exocrine secretory granuls and intracytoplasmic canaliculi surrounded by microvilli.
We attempted to determine the primary lesion of these cancers. The first possibility was bronchoalveolar cells, because these cells are positive when stained for salivary amylase. The second possibility was neuroendocrine cells. Carcinoid tumors which originate from neuroendocrine cell, often exhibit endocrine and exocrine activity simultaneously. Hence, amylase production may be an ectopic exocrine activity of these papillary adenocarcinomas.
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Hitoshi HIRATA, Yutaka MIZUSHIMA, Saburo YANO, Mikio KITASAWA, Ken FUK ...
1991 Volume 30 Issue 3 Pages
507-511
Published: 1991
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The patient was a 49-years-old male who complained of cough and dyspnes. His chest X-ray film showed a tumor shadow in left upper lobe of the lung with pleural effusion in May, 1988. Transbronchial biopsy specimen from left B
1+2 showed small cell carcinoma. On the other hand cell block specimen from pleural effusion showed adenocarcinoma, because the tumor cells had abundant cytoplasm and some nucleoli were remarkable. Clinically double cancer was strongly suggested. When re-admitted in October-December, 1988, cytologic examination of sputum revealed small cell carcinoma. But during last hospitalization in April, 1989, cytologic examination of sputum revealed adenocar cinoma cells on two occasions and squamous cell carcinoma cells on two occasions and small cell carcinoma on only one occasion.
CEA level in the serum increased without the response of cancer to chemotherapy or radiotherapy. CA 125 level decreased temporarily, but increased again. NSE level was almost within normal limit during clinical course.
Autopsy showed that some part of tumor was composed small cell type while other part was composed of large cell type arranging in sheets and transitional forms were seen between these components. Small cell carcinoma with characteristic of adenocarcinoma might differentiated toward large cell carcinoma and adenocarcinoma when carcinoma became refractory to therapy and progressive.
In retrospect we can see these changes in cytologic examination of sputum and this case reveals heterogeneity of lung cancer typically.
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Akira KAMIMORI, Akinori ISHIHARA, Tamiko KIMURA, Hideyuki KOYAMA, Masa ...
1991 Volume 30 Issue 3 Pages
512-516
Published: 1991
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A case of undifferentiated carcinoma of the epipharynx was reported. A 62-year-old woman was admitted with complaints of hemosputum and chest pain. Chest X-ray showed no abnormality. Computed tomography showed a tumor of the epipharynx. Histologically, the tumor was diagnosed undifferentiated carcinoma (lymphoepithelioma).
In sputum cytology, the atypical epithelial cells were observed, which were in syncytia or loosely cohensive, small groups. They had oval and polygonal cytoplasm and plump, irregular, vesicular nuclei with eosinophilic macronucleoli. A small number of lymphocytes were intermingled with these epithelial cells.
In the present case, sputum cytology was a useful procedure in the diagnosis of the epipharynx carcinoma.
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Raj K. Gupta, St. John Wakefield, Tadao K. Kobayashi, Robert J. Fauck, ...
1991 Volume 30 Issue 3 Pages
517-521
Published: 1991
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A case of so called multivacuolated (Globoid) cell apocrine carcinoma of the breast is described in which the diagnosis was suggested by needle aspiration cytology. It is questionable whether this tumor should be regarded as a distinct subtype, in view of the differences in reported incidence and diagnostic criteria quoted. The needle aspiration cytology, histochemistry and ultrastructural features of such a tumor are presented. Since our special stains showed that the nature of the globoid vacuolated cells was more consistent with a resemblance to the foamy macrophages that are frequently found in aspirates of the breast and since it does not help to clarify the existing confusion in the definitions, it is felt that the recently coined term of apocrine breast carcinoma with multivacuolated, lipid-rich giant (globoid) cells is not justified at this time.
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Akiko DATE, Yoshiaki NORIMATSU, Takashi ITO, Isami KAWANISHI, Hideki N ...
1991 Volume 30 Issue 3 Pages
522-526
Published: 1991
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A case of ovarian endodermal sinus tumor (EST), in which neoplastic cells were identified in pleural effusions and ascites, was reported with cytological, immunohistochemical and electro-microscopical findings. A 28-year-old female, who had experienced three gestations and one delivery, consulted the hospital because of a lower abdominal pain and an abnormal genital bleeding. An ultrasonography and a computed tomographic (CT) scan showed a solid mass in the upper part region of the uterus. The serum levels of the CA-125, the neuron-specific enolase (NSE), the α-fetoprotein (AFP), and the α
1-antitrypsin (AAT) were elevated. A surgical procedure and a chemotherapeutic regimen were performed. After ten months of the operation, ascites and pleural effusion appeared. Cytologically in these effusions, neoplastic cells, which had a foamy cytoplasm and an irregularly sized-and shaped-nucleus, formed clusters in a hemorrhagic background, and periodic acid-Shiff (PAS)-positive hyaline globules (HG) were observed. The neoplasm was histologically consisted of Shiller-Duval bodies and endodermal sinus structures. Many HG were observed at the center of reticular structures, and showed PAS-positivity and diastase-resistance. The immunohistochemical stainings for placental alkaline phosphatase, NSE, Leu 7 and chromogranin demonstrated positive reaction in the neoplastic cell cytoplasm, and those for AFP and AAT in the neoplastic cell cytoplasm and HG. The cytological diagnosis of the pleural effusions and ascites in this case was difficult to differentiate from adenocarcinoma, but PAS-positive HG in and outside the cytoplasm favored a diagnosis of EST.
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Sigeto KAWAUCHI, Masamichi HARA
1991 Volume 30 Issue 3 Pages
527-531
Published: 1991
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A 38-year-old woman, treated with the CDDP-Peplomycin regimen for a lung metastasis from recurrent uterine cervical carcinoma (squamous cell carcinoma), developed a pericardial effusion and signs of cardiac tamponade appeared. Pericardial drainage was performed and bloody pericardial fluid was obtained. Although routine cytological examination of the pericardial fluid revealed no malignant cells, cell block cytohistological examination enabled us to find some squamous cell carcinoma tissue with cancer pearls. Thus, a cardiac metastasis from uterine cervical carcinoma was diagnosed.
It is suggested that cell block cytohistological examination of a pericardial effusion originating from pericarditis carcinomatosa may be useful if smear cytological examination fails to show any malignant cells.
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A cytological study
Hitoshi HARA, Koichi SUDA, Masahiro KIMURA, Eri ISHII, Toshio OYAMA, M ...
1991 Volume 30 Issue 3 Pages
532-535
Published: 1991
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A case of polymorphous adenocarcinoma was studied both cytologically and histopathologically. A 57 years old male noticed a rapidly growing tumor at the right parotid area. Although the tumor was excised, both recurrence and metastasis in lung occurred, and finally he was expired. The smears from cut surface of the excised tumor at operation showed cells with round or oval-shaped nuclei and scant cytoplasms. The cells were found in either scattered or clumped fashion. Some cells showed spindle-shaped nuclei. Another cells with well preserved cytoplasm formed either a tubule or a mucoid globule. The nuclei were usually uniform and small or medium sized with nuclear clearing and round nucleoli. Hence, these tumor cells were thought to be malignant. Histologically the tumor showed an admixture of epithelioid patterns including solid, tubular and microcyst composed of round to oval-shaped clear cells, and spindlecell sarcomatous pattern. Therefore, this tumor was diagnosed as polymorphous adenocarcinoma.
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Masaru HAMADA, Yasuo NAKATA, Chizuru ENDO, Mutsuko MORI
1991 Volume 30 Issue 3 Pages
536-538
Published: 1991
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A case of epithelioid leiomyomatous tumor of the stomach in 71-year-old male is presented.
The cytological feature of tumor cells showed no cytoplasmic cohesion but the tumor cells have a tendency to be in clusters or in side-by-side arrangement and focal pseudoroset or pseudoglandular arrangement. These tumor cells were suggested malignant leoimyomatous tumor.
Histology of the tumor showed epithelioid leiomyomatous tumor (low grade malignancy), arising the muscular layer of the stomach. Tumor cells were positive for vimentin, actin and myosin, and were negative for desmin, S-100, cytokeratin, EMA and CEA by immunohistochemical stainings.
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Tohru SHIMIZU, Noriko FUKUSHIMA, Yohko ASAKUMA, Hidenori CHINO, Toshiy ...
1991 Volume 30 Issue 3 Pages
539-545
Published: 1991
Released on J-STAGE: December 05, 2011
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We reported a rare ease of bladder carcinoma, presenting unique cytological features, similar to clear cell carcinoma of female genital tract. A 72-year-old male patient was admitted to our hospital complaining of macroscopic hematuria. The tumor was non-papillary, and located in the trigone and the left lateral, posterior wall of the bladder. Cytological and histological examination revealed that the neoplastic cells had very clear cytoplasm with abandant glycogen, and targetoid intracytoplasmic vacuoles. The cells proliferated in solid nests with incomplete tubular structure, mainly in lamina propria and muscularis, but both papillary structure and hobnail cell were not seen. This case has many common ultrastructural findings similar to clear cell carcinoma of female genital tract. As the targetoid vacuole can be seen in transitional epithelial cell and transitional cell carcinoma, this case may be diagnosed as transitional cell carcinoma with adenomatoid metaplasia.
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Ken SHIMIZU, Nobuhide MASAWA, Takashi YAMADA, Hideo SASAKI, Toru SUZUK ...
1991 Volume 30 Issue 3 Pages
546-551
Published: 1991
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Two cases of so-called nephrogenic adenoma of urinary bladder are reported.The patients are 13 year-old-boy and 72 year-old-female.In both cases, urinary cytology specimens reveal cell clusters showing benign glandular cells with mild crowding and moderate overlapping, associated with inflammatory background.Each cell has a clear or lacy cytoplasm showing columnar or cuboidal shape.N/C ratio increases mild to moderately.Oval nuclei are eccentrically located, showing mild thickening of nuclear envelope and mild to moderate increase in euchromatin.A few, small nucleoli are also seen.Irregularity of nuclear shape, irregular chromatin pattern or swelling of nucleoli aren't seen. These cells were considered to be derived from benign adenomatous lesion.Histological examination in first case reveals polypoid tumor covered by columnar epithelium with focal hobnail pattern, associated with granulation tissue formation and marked inflammatory changes in the lamina propria.Some cells show intracytoplasmic vacuolation. Because of brush border-like structure, these epithelium is similar to that of renal tubules.Light microscopic examination in second case reveals diffuse proliferation of tubules of varying sizes in the lamina propria, which are composed of clear cells.No stromal invasion or no marked atypism are seen in both cases.When adenomatous fragments are seen in urine specimen, following diseases or conditions should be differentiated: as benign condition, nephrogenic adenoma renal tubular epithelium;as malignancy, adenocarcinoma of urinary bladder and prostate, renal cell carcinoma and inva sion of a colon or uterine adenocarcinoma.
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Setsuo SUGISHIMA, Toshiro YOKOYAMA, Tomoko YOSHIDA, Yuuji OYABU, Kosak ...
1991 Volume 30 Issue 3 Pages
552-557
Published: 1991
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We report a case of primary malignant melanoma of the male urethra. Primary malignant melanoma of the urinary tract is rare and accounts for less than 0.3% of all melanomas.
A 64-year-old man was admitted to the hospital with dysuria and hematuria. An excretory urogram revealed a filling defect in the bulbous urethra.
Tumor cells obtained from the urine appeared solitary and took on a sheet-like arrangement. Most of the tumor cells were round, and several tumor cells had irregularly shaped nuclei and prominent nucleoli. These cells were very similar to the malignat cells of transitional cell carcinoma, however, the cytoplasm of a few tumor cells was filled with fine granular melanin pigmentation.
Immunostaining for S-100 protein and NSE (neuronspecific enolase) was positive. An electron micrograph showed numerous melanosomes in the cytoplasm.
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Miyuki MATSUBARA, Yasuhiko WATARAI, Tsunemichi SUZUKI, Shinichi URATA, ...
1991 Volume 30 Issue 3 Pages
558-563
Published: 1991
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Epithelioid sarcoma is a relatively rare soft tissue tumor which mainly occurs in the fingers, hands, and forearms of young adults. This tumor is important to the cytologist, because it is often confused with a variety of benign and malignant conditions.
We report a case of recurrent epithelioid sarcoma, in wihch the diagnosis was suggested by aspiration cytology.
A 44-year-old female was admitted to our hospital complaining of a palmar tumor.
Cytologically, large ovoid or polygonal cells were revealed mainly in the form of loosely connected clusters, and occasionally as scattered fibroblastic cells.
Histologically, the tumor cells formed nodules with a tendency toward central necrosis.
Keratin, EMA, TPA, CEA, vimentin and actin were positive in the cytoplasm on the basis of immunocytochemical testing.
Intermediate filament and desmosome-like junction were demonstrated by means of electron-microscopy.
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Shigeyuki SUGIE, Akiyoshi NISHIKAWA, Naoki YOSHIMI, Takuji TANAKA, Kaz ...
1991 Volume 30 Issue 3 Pages
564-570
Published: 1991
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Cytological findings of two cases of hemangiosarcoma developed in spleen and skin were reported. The first case (53-year old female) was spleen origin. The tumor metastasis to various organs were found 3 years after splenectomy. The tumor cells were diagnosed by cytology of ascites. She died 5 months after the readmission. Imprint cytology were performed at autopsy. The second case was 66-year old female, whose primary lesion was face skin. Although the primary lesion was removed after radiotherapy, the recurrence was found after chemotherapy and radiotherapy and the repeated resections were performed. She died 14 months after the first admission. The autopsy and aspiration and imprint cytology were performed. Cytological findings of aspiration and imprint smears of these two cases were quite similar to each other. Cytological findings in common with both cases were as follows:
(1) Single and small clusters of tumor cells were observed in hemorrhagic background. Rosette-like formation and vascular structure were present.
(2) Most of tumor cells were polygonal. Spindle shaped cells and some multinuclear giant cells were also found. Tumor cells usually had round or oval nuclei and light-green stained cytoplasms, and N/C ratio were ralatively high.
(3) Some variation of nuclear size, irregular nuclear membrane and nuclear atypism were observed.
(4) Neoplastic cells were negative for PAS reaction and showed positive reaction of factor VIII related antigen in immunocytochemistry.
The cytological diagnosis of hemangiosarcoma is thought to be quite difficult, since the various cytological findings were observed in a single case of hemangiosarcoma. However, it is possible to provide a complete diagnosis when combining cytological findings including immunocytochemistry with clinical data.
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Taku KATOH, Hisao TAKAHASHI, Fujio ENDHO, Takashi MATSUMOTO, Hirotsugu ...
1991 Volume 30 Issue 3 Pages
571-578
Published: 1991
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A case of malignant Schwannoma of the right thigh developed in Von Recklinghausen's disease (neurofibromatosis) in a 46-year-old male is presented. Cytological of the neurofibroma potion showed two cell patterns composed of (1) tumor cells with spindle nuclei containing fine chromatin in fibrous cytoplasm and (2) tumor cells with ovoid or short spindle, hyperchromatic nuclei. Malignant Schwannoma potion was cytologically composed of spindle cells often in interlacing, partly loose and partly dense fascicli. Nuclear pleomorphism was seen in some tumor cells.
Immunohistochemical study showed strong positivity for S-100 protein in (2) tumor cells of neurofibroma and in cells of loosely arranged portion of malignant Schwannoma. As to the subunits of the protein. S-100 α positive cells were predominant and S-100 β positive cells seemed to be decreased in malignant Schwannoma. Myelin basic protein and neuronspecific enolase were positively demonstrated only in occasinonal tumor cells of malignant Schwannoma.
Ultrastructurally malignant Schwannoma was composed of pleomorphic Schwannian origin cells, fibroblast cells, and few perineurial cells.
Both tumors suggested to compose of Schwannian origin cells, fibroblast cells, and perineurial cells, pleomorphism and character of these cells was transformed as malignant change.
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Masaharu NOMURA, Masaki FUJIMURA, Haruhiko OGAWA, Shinobu NAKAMURA, Ta ...
1991 Volume 30 Issue 3 Pages
579-583
Published: 1991
Released on J-STAGE: November 08, 2011
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A case of primary plasma cell leukemia presenting with initial respiratory symptoms, such as dry cough, hemoptysis and dyspnea, is reported. The patient was a 68-year-old man who was diagnosed as having plasma cell leukemia by hematological and immunohistological (monoclonal antibody) examinations. He initially complained of respiratory symptoms. Chest x-ray examination revealed diffuse interstitial and infiltrative shadows in the bilateral lower lung fields. Transbronchial lung biopsy (TBLB) showed infiltration of leukemic cells into the alveolar interstitium and hemorrhage in the alveolar spaces. There were no abnormal findings in blood coagulation. Therefore we thought that this bleeding was due to infiltration of leukemic cells into the alveolar interstitium. TBLB is a very useful method for revealing infiltration of leukemic cells.
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Nobuzo IWA, Chikao YUTANI, Yoshitaka TABARU, Masami IMAKITA, Kazunori ...
1991 Volume 30 Issue 3 Pages
584-587
Published: 1991
Released on J-STAGE: November 08, 2011
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The cytologic findings in a case of hydrops fetalis (fetus ages 27 weeks) infected with parvovirus (B 19) is presented.
The diagnosis of parvovirus infection was established by immunoperoxidase technique.
Intranuclear inclusions were observed in the ascites fluid cytology stained with bluish purple by the Papanicolaou stain.
In the paraffin-embedded tissues of spleen, liver, kidney, heart, and placenta at the autopsy, the intranuclear inclusions were observed. The parvovirus (B 19) antigen was also detected in the cytoplasm by means of ABC staining.
It is hopeful that recognition of these virus infected cells in the body cavity fluid will be helpful in making a diagnosis of the hydrops fetalis associated with parvovirus (B 19) infection during the pregnancy.
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Detection of CMV DNA in bronchial brush specimens
Masaomi SASAKI, Nobuzo IWA, Kenichi WAKASA
1991 Volume 30 Issue 3 Pages
588-592
Published: 1991
Released on J-STAGE: November 08, 2011
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A 56-year-old woman presented with a iching exanthema in her skin and dry cough. Her skin biopsy showed malignant lymphoma. Then, anti-chemotherapy treatment was started immediatly with vincristin, endoxan, leukerin, and predonin. Drug induced pneumonia, lymphoangitis carcinomatosa or carini pneumonia were suspected by chest Xray. The bronchial brush specimens were obtained and cytological examination revealed cytomegalovirus (CMV) infected cells having intranuclear and intracytoplasmic inclusions in alveolar pneumocytes. These inclusions showed positive for Feulgen reaction and also CMV specific antigen was demonstrated by immunofluorescence techiniqne. Moreover, in situ hybridization of biotinylated CMV prove to cellular specimen and paraffin embedded tissue section were used in this study. Hybridization was considered positive when one or more cells were identified with unambiguous nuclear or cytoplasmic staining.
The reported method is now clinically useful for the diagnosis of CMV, and it provides a practical alternative to standard immunocytochemistry methods, especially when frozen tissue is unavailable.
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Ikuyo TAKAMURA, Michio SUGA, Mitsuhiro KAIMORI, Misae TAKEKOSHI, Shizu ...
1991 Volume 30 Issue 3 Pages
593-599
Published: 1991
Released on J-STAGE: November 08, 2011
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Dermatomyositis, which has been classified as a collagen disease, is an idiopathic disease characterized by symmetrical, proximal muscle weakness and typical cutaneous lesions. An association between this disorder and malignancy has long been suspected in adult patients, especially older than the fifth decade. Recently we encountered a case of serous cystadenocarcinoma arising in a normal sized ovary which was associated with dermatomyositis. A 44-year-oldfemale whose dermatomyositis pursued an unrelenting course was admitted to our hospital.
On admission the malignancy was asymptomatic. Pelvic examination, CT scan and ultrasonography were negative because of the normal size of the primary ovarian cancer. The malignancy was detected by cytology. Cervical and endometrial smears showed adenocarcinoma cells with psammoma bodies, and tumor diathesis was absent. Similar malignant cells were also found in the cell samples obtained by cul-de-sac needle aspiration. Cervical and endometrial biopsies, however, failed to reveal any apparent malignancy. These cytological findings were highly suggestive of extrauterine malignancy: possibly serous cystadenocarcinoma of the ovary. Cancer cells may have appeared in the cervical and endometrial smears after passing through the fallopian tube.
Serous cystadenocarcinoma was confirmed hitologically bilaterally in the normal-size ovaries at autopsy.
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Masato KINUGASA, Taiichiro AKAHORI, Masayuki OKAMURA, Kazuo HASEGAWA, ...
1991 Volume 30 Issue 3 Pages
600-606
Published: 1991
Released on J-STAGE: November 08, 2011
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A 56-year-old woman was admitted because of genital bleeding, abdominal pain and distention. Laboratory studies showed elevated serum and urine amylase activity, and isozyme analysis revealed the predominance of salivary-type amylase. At laparotomy, bilateral ovarian cancer, stage III c, was found, and the pathological findings resulted in a diagnosis of endometrioid adenocarcinoma.
Following total hysterectomy with bilateral salpingooophorectomy and omentectomy, the patient's amylase levels and isozyme pattern became normal. Immunocytochemical testing revealed the presence of amylase in tumor cells. Despite several courses of chemotherapy and radiotherapy, the patient died of recurrence 9 months after initial treatment. Although her amylase levels and isozyme pattern were within the normal range after surgery, the patient's CA 125 levels increased as the tumor progressed. These results suggest that amylase is only of limited value as a clinical tumor marker in ovarian cancer. It may, however, be a useful marker in immunocytochemical studies of cases of hyperamylasemia of unknown origin.
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Yutaka HIRASAWA, Masanori FUNAHASHI, Makoto KURODA, Yoshikazu MIZOGUCH ...
1991 Volume 30 Issue 3 Pages
607-610
Published: 1991
Released on J-STAGE: November 08, 2011
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In this paper, the cytologic and histopathologic findings of a rare case of well-differentiated squamous cell carcinoma of the uterine body in an 80-year-old woman are described. Preoperatively, routine examination of endocervical and endometrial smears and endometrial biopsies were in conclusive with respect to malignancy. Cytological features consisted of many atypical cells with inflammatory cells and the lack of tumor diathesis.
The most commonly observed cells were spindle-shaped or fibrous-shaped cells associated with parakeratosis.
Histopathological examination of the resected uterus revealed features of highly differentiated squamous cell carcinoma of the uterine body.
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Toshiya KOMATSU, Kenichiro IKUMA, Yae TAISHI, Takashi KOROGI, Tadashi ...
1991 Volume 30 Issue 3 Pages
611-617
Published: 1991
Released on J-STAGE: November 08, 2011
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A placental site trophoblastic tumor (PSTT) was found in a 44-year-old woman 9 years after an induced abortion. The patient came to our clinic with a complaint of vaginal bleeding during intercourse. The initial examination revealed a polyp-like elevation at the ostium uteri.
Cytology of a curetted specimen from the uterine canal disclosed mononuclear and binuclear cells which were larger and had more conspicuous nucleoli than the cells observed in the smear. Based on pathological examination of biopsied tissue, the patient was suspected of having villous disease, including PSTT, and total abdominal hysterectomy revealed a tumor occupying the cervical canal.
When immunohistochemical staining for hPL and hCG was performed, tumor cells were responded strongly for hPL and weakly for hCG, permitting a diagnosis of PSTT composed of intermediate trophoblasts.
When the Papanicolaou-stained cytological specimen was decolored and then stained for hPL, a positive response was clearer in oval or short spindle-shaped mononuclear cells, consistent with the reactions in the pathological specimen.
These results indicate that cytological examination is important to the diagnosis of PSTT consisting of mono-or binuclear intermediate trophoblasts.
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A cytological study
Hitoshi HARA, Koichi SUDA, Masahiro KIMURA, Eri ISHII, Toshio OYAMA, H ...
1991 Volume 30 Issue 3 Pages
618-619
Published: 1991
Released on J-STAGE: November 08, 2011
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Muneo IWAI, Yoshimitsu MIYAHARA, Shigeru OHTA, Hidetoshi OKABE
1991 Volume 30 Issue 3 Pages
620-621
Published: 1991
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Yutaka DAIMARU, Tsuguyuki TOKUNAGA, Hiroko GODA
1991 Volume 30 Issue 3 Pages
622-623
Published: 1991
Released on J-STAGE: November 08, 2011
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Kazuko TSUZAKI, Kazuyo NISHIHARA, Tomofumi NAGAREDA, Kiyoshi KOTOH
1991 Volume 30 Issue 3 Pages
624-625
Published: 1991
Released on J-STAGE: November 08, 2011
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Toshiro KAWAI, Sachiko KUBONO, Fumio MURAYAMA, Ken SAITO
1991 Volume 30 Issue 3 Pages
626-627
Published: 1991
Released on J-STAGE: November 08, 2011
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Katsunari KINA, Junichi KOYATSU, Tooru KAWASHIMA, Hiroshi UTSUNO, Kazu ...
1991 Volume 30 Issue 3 Pages
628-629
Published: 1991
Released on J-STAGE: November 08, 2011
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