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Junko MARUTA
1993 Volume 32 Issue 6 Pages
833-839
Published: 1993
Released on J-STAGE: November 08, 2011
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Thyroid aspiration cytological study of the thyroid revealed the presence of intranuclear cytoplasmic inclusions in 82.7% of malignant (723/874) and 0.2% of benign lesions (5/2398). The five benign lesions with intranucler cytoplasmic inclusions were 4 follicular adenomas and 1 adenomatous goiter. Neither capsular nor vascular invasions, suggestive of malignancy, were found in these adenomas. No mor phological differences in intranuclear cytoplasmic inclusions were found between benign lesions and carcinomas, with microscopic and electron microscopic studies.
These results show that the presence of intranuclear cytoplasmic inclusions
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Akihiko GEMMA, Syouji HISAKATU, Yoshimitu YAMANO, Kouzou YOSHIMORI, Ak ...
1993 Volume 32 Issue 6 Pages
840-845
Published: 1993
Released on J-STAGE: December 05, 2011
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Nuclear DNA content analyses were performed in 48 cases of advanced lung cancer using transbronchial biopsy samples. More than one hundred cells were suitable for analysis in 43 cases. Mean nuclear DNA content (MNDC) was 3.36c±0.77 and incidence of aneuploid stem cell lines (IASCL) was 72%(31/43) in all cases. There were no differences in MNDC or IASCL among histologic types. The MNDC of N 3 cases was significantly larger than that of N 0-2 cases (p <0.01), and the MNDC of M 1 was significantly larger than that of M 0 (p <0.05). The IASCL of N 3 cases was significantly higher than that of N 0-2 (p <0.05), and the IASCL of M 1 was significantly higher than that of M 0 (p <0.02). These results were obtained from analyses of non small cell lung cancers.
The cases with larger MNDC (4.00C≥MNDC) had significantly shorter survival than the those with smaller MNDC (4.00 C < MNDC)(p < 0.01) in both total and non small cell lung cancer cases. These results indicate that nuclear DNA content analysis using transbronchial biopsy samples, might be useful for the prediction of tumor progression, especially metastasis, and prognosis in advanced lung cancer.
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Tatsuo YAMAMOTO, Hisashi HORIGUCHI, Hiroshi KAMMA, Takesaburo OGATA, M ...
1993 Volume 32 Issue 6 Pages
846-852
Published: 1993
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The effect of nuclear DNA content on nuclear atypia and clinicopathological factors such as histological type, stage, tumor size, node status, pleural invasion, pulmonary metastasis, and survival, in non-small cell lung carcinoma was studied by means of a newly developed color image analyzer system. Sixty-three cases were divided into 15 cases (23.8%) with DNA diploidy and 48 cases (76.2%) with DNA aneuploidy. We classified four groups based on the DNA histogram pattern; A-1 (diploid, 5 cases), A-2 (diploid with S+G 2/M increase, 10 cases), B-1 (aneuploid, 20 cases), and B-2 (aneuploid with S+G 2/M increase, 28 cases). Differences in the degree of nuclear atypia, such as size, anisokaryosis and roundness, were significant between types 1 and 2 (p<0.001-0.05). However, there was no significant difference between group A and B. Types 1 and 2 significantly correlated with tumor size, node status, and survival (p<0.05), but groups A and B did not correlated with clinicopathological factors. These results indicate that the DNA ploidy status of cancer cells in non-small cell lung carcinoma correlates with nuclear atypia, but not with biological aggressiveness.
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usefulness of chest CT and otolaryngeal observation
Hiroshi MORIYA, Koji YAGINUMA, Hiroko SHIBUYA, Kazuhiro TAKAHASHI, Mie ...
1993 Volume 32 Issue 6 Pages
853-859
Published: 1993
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In order to localize cancers in 55 cases with positive sputum cytology, we examined chest CT and otolaryngeal findings, in addition to performing bronchoscopic examinations. Consequently, 30 cases had lung cancer, 5 had laryngopharyngeal cancer and 3 had cancer of the oral cavity. Otolaryngeal observation was useful for detection of these cancers of the upper respiratory tract. In 30 lung cancers, 23 were roentgenographically occult cancers. But, among these 23, 12 had positive findings on chest CT. CT was useful for the cases of roentgenographically occult lung cancer. Especially, CT was very effective for detection of small cancer lesions in the peripheral lung, which were undetectable bronchofiberscopically. Three of 20 cases, in which no cancers were detected after the initial examination, had cancer lesions 1-2 years later. These results sugest that CT, otolaryngeal observation and intensive follow-up of undetectable cases are useful for localizing cancer in cases with positive sputum cytology.
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Takanori WATANABE, Izo KIMIJIMA, Yoshihide FURUKAWA, Kohichi NAKAYAMA, ...
1993 Volume 32 Issue 6 Pages
860-866
Published: 1993
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The relationship between the morphometric features of the cell nucleus and clinicopathological variables was investigated in primary breast cancer. The female subjects of the present study were 90 patients with primary breast cancer and 13 patients with benign breast lesions. Fine needle aspiration specimens were stained with May-Grunwald-Giemsa and about 200 nuclei in each sample were measured for, mean nuclear area, standard deviation of the nuclear area, and the largest nuclear axis with a morphometric analyzer. The mean nuclear area was significantly larger in breast cancer than in benign breast lesions (P=0.00001). The mean nuclear area was significantly increased with an increase in tumor diameter (P<0.01). The mean nuclear area was significantly larger in PR-negative than in PRpositive cases (P<0.01). Nuclear pleomorphism (indicating the standard deviation of the nuclear area) of breast cancer cells correlated significantly with nuclear pleomorphism (P<0.05), PR status (P<0.01). The cases with large diameters and who were PR-negative showed severe nuclear pleomorphism.
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Masakatsu FUKASAWA, Hirosi KANMA, Takesaburo OGATA, Ei UENO, Hideyuki ...
1993 Volume 32 Issue 6 Pages
867-875
Published: 1993
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Critical factors causing misdiagnosis and indefinite diagnosis of Class III on aspiration cytology of breast tumors were analysed in 373 and 279 cases with benign and malignant tumors, respectively. The frequencies of misdiagnosis were 1.1% and 7.5%, those of indefinite diagnosis 5.6% and 9.3%, in benign and malignant breast tumors, respectively. In benign breast tumors, cytologic misdiagnosis (Class IV or V) in 4 cases was caused by high atypia of tumor cells in 3 cases and by cytologist over-diagnosis in one case ; the Class III diagnosis in 21 cases was based on over-diagnosis by cytologists, high atypia of tumor cells and insufficient materials in 12, 8 and one case, respectively. In breast cancers, cytologic misdiagnosis (Class I or II) in 21 cases resulted from insufficient materials in 17 cases, low atypia of tumor cells in 4 cases ; the Class III cytologic diagnosis in 26 cases was based on insufficient materials, under-diagnosis, and low atypia of tumor cells in 11, 9 and 6 cases, respectively. Therefore, the factors contributing to cytologic misdiagnosis and indefinite diagnosis in breast tumors consisted of insufficient materials, inexperienced cytologists and the nature of the tumor. Though it need scarcely be said that every effort must be made to obtain adequate tumor materials and that careful cytological screening is essential for accuratly diagnosing breast cytology, it may be desirable to perform tissue biopsy immediately if the cytologic diagnosis is unsatisfactory in view of other clinical data.
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Masahiko KAKIHANA, Shigeo SAWAI, Toshiki YAMASHITA, Masahiro URASAKI, ...
1993 Volume 32 Issue 6 Pages
876-883
Published: 1993
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Since 1985, we have planned to use a new reporting system of breast cytology based on new concepts instead of Papanicolau's classifications. Our concepts are (1) to provide the surgeon with information as to whether the aspiration and staining state of the aspirate are good or not, (2) not to diagnose a specimen as malignant, if not conclusively malignant, to avoid false positive diagnosis and inadequate surgery, and (3) to recommend excisional biopsy to obtain histologic diagnosis, in suspicious cases. In this system, we classified cytologic diagnoses into 8 groups ; C 0, C I, C II, C III a, C III b, C IV, and C V. In C 0, specimens are inadequate for evaluation because of inadequate cells except blood cells, or failure in fixing or staining specimens. CI means that there are no epithelial cells in specimens except connective tissue cells. In C II, there are benign epithelial and nonepithelial cells. C II b is a group in which cells in specimens are benign, but show moderate cellular atypism. Cells in C III a show some nuclear atypism and malignancy could not be conclusively ruled out. In the C III b group, cellular atypism of the aspirated specimens resembles that of malignant cells, but is not conclusive for malignancy, so excisional biopsy and histologic examination or follow up studies are recommended. Both C IV and C V groups are unquestionably malignant. C IV are rather better in differentiated malignancy than C V. On our reporting forms, considerable histopathologic detail as to the type of lesion should be written as thoroughly as possible.
According to our results in the past 5 years, from 1988 to 1992, there were no false positive cases in the C IV and C V groups, and 18 cases out of 35 in the C III b group were malignant. On the other hand, 4 out of 64 cases in the C III a group were malignant. Thus, our reporting forms provide correct information on breast cytology to surgeons, facilitating reasonable treatment.
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Michi NAGOYA, Yoshio SHIINA, Kouji YAMAMIYA, Shuichi KOHRI, Junko IIJI ...
1993 Volume 32 Issue 6 Pages
884-894
Published: 1993
Released on J-STAGE: December 05, 2011
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For the adaptation of AgNORs staining to cytological materials, HeLa 229 cells were used for the evaluation of fixation and staining methods, and breast tissues (8 cases of fibroadenoma, 1 case of mastopathy, 1 case of phyllodes tumor, 6 cases of papillo-tubular carcinoma, 6 cases of solid-tubular carcinoma, 2 cases of scirrhous carcinoma, and 1 case of mucinous carcinoma) were used to establish an evaluation method.
As a result, the silver reaction which was performed for 60 minutes at 20°C was found to be the best way to observe the AgNORs positive regions. The evaluation of nucleolus-like AgNORs, found in wet fixation materials were classified on the basis of 5 factors, as follows;(1) number (2) size (3) the propotion of the area of one AgNOR to the area of the nucleus (4) the propotion of the areas of AgNORs to the area of the nucleus (5) the propotion of cells which had irregularly shaped AgNORs. The frequency of irregularly shaped AgNORs was 9.7% in benign lesions and 24.5% in malignant lesions with a significant differences (p <0.005), though there were no differences in number and size. A cell which had more than 10 particles was found in 75.6% of malignant cases and 8.7% of benign cases on dried fixation materials. In addition, a cell in which the nucleolus is filled with AgNOR particles is frequently malignant, suggesting that such cells have a high proliferative ability.
From these results, AgNORs staining for breast cytology may be used for dried fixation materials, and to carefully evaluate their number and distribution.
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Atsuko SHIOTA, Tatsuya IGARASHI, Takaaki KUROSE, Masayuki OHNO, Tamots ...
1993 Volume 32 Issue 6 Pages
895-899
Published: 1993
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We analyzed cytological findings obtained from vulval scraping smears in order to evaluate their usefulness in diagnosing primary vulval cancer. Twenty-two cases were diagnosed by biopsy and their histopathological diagnoses were as follows: 14 cases of squamous cell carcinoma, 3 of adenocarcinoma and 5 of extramammary Paget's disease. The cytological results were as follows: the positive rate was 75.0%(15/20) but the rate rose to 90.0%(18/20) if a suspicious result was included. The cytological positive rate, by histological type, was 84.6%(11/13) in squamous cgll carcinoma, 33.3%(1/3) in adenocarcinoma and 75.0%(3/4) in extramammary Paget's disease. The positive rate with cell samples obtained by scraping was 83.3%(10/12) for Ayer's wooden spatula and 62.5%(5/8) for cotton swabs. These results suggest that the cytological diagnosis of primary vulval cancer may be useful.
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Ken TAKIZAWA, Yuhko KIMURA, Masami KUROSE, Tomiko IGUCHI, Yoshihiko TA ...
1993 Volume 32 Issue 6 Pages
900-905
Published: 1993
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1) Cervical smears from 8012 cases during pregnancy from 1984 to 1992 were cytologically classified as follows; Class V 2 cases, IV 5 cases, III b 7 cases, III 13 cases and III a 22 cases. All 49 (0.61%) were requested to undergo directed biopsy under colposcopy, but only 35 (71.4%) received pathological diagnosis. The ultimate pathological diagnosis revealed 10 cervical cancers (2 invasive, 8 carcinoma in situ (CIS)) and 2 severe dysplasia (SD).
2) The alteration of repetitive cytological and pathological diagnosis during pregnancy in 4 out of 9 patients who had terminated their pregnancy, demonstrated a less advanced cytological diagnosis as compared with pathology. This discrepancy might be due to cervical smear sampling errors. Since no progression after delivery was found in 7 patients with CIS or SD, conservative management is indicated for patients with CIS or less advanced lesions during pregnancy.
3) There were 5 cases with SD or more advanced lesions whose cervical smears during pregnancy were negative. The reasons for their mistaken diagnoses were also considered to be sampling errors.
In conclusion, adequate scraping of the cervix might be essential for making an accurate and useful cytological diagnosis during pregnancy, even if a little bleeding is bothersome for patients and their responsible doctors.
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Hiromitsu MAKINO, Yuko NAKANOMYO, Shinji SATO, Akira YAJIMA, Hisashi H ...
1993 Volume 32 Issue 6 Pages
906-913
Published: 1993
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We re-examined false negative cytology in mass screening for cervical cancer in Miyagi Prefecture.
We regarded 25 cases of invasive cervical cancer (19 squamous cell carcinoma, 6 adenocarcinoma) as false negative, which had been diagnosed, during the 7 year period from April 1984 to March 1991, as having negative cytology on mass screening a year before.
1) We re-screened the negative cytology smears of a year before and 20 cases were found to have satisfactory samples, 3 to be less than satisfactory ones and 2 as unsatisfactory.
2) Out of 23 cases (ignoring the unsatisfactory samples), screening errors were found in 2 out of 17 squamous cell carcinomas and 2 out of 6 adenocarcinomas. Screening error rates for adenocarcinoma were higher than those for squamous cell carcinoma. In the 25 cases, rates of screening error were 16%(4 of 25) and sampling error 84%(21 of 25).
3) We showed that the majority of false negative results could be attributed to sampling error. While inadequate collection of carcinomatous lesions was responsible for the squamous cell carcinoma data, in the case of adenocarcinoma both sampling error and difficulty in interpretation were responsible.
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Toru TASE, Keiko OHTOMO, Nobuo YAEGASHI, Shinji SATO, Akira YAJIMA
1993 Volume 32 Issue 6 Pages
914-920
Published: 1993
Released on J-STAGE: December 05, 2011
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In order to clarify the cytologic findings in early cervical adenocarcinomas and related lesions, 12 cases of glandular dysplasia (GD), 14 of adenocarcinoma
in situ (AIS), 16 of microinvasive adenocarcinoma with AIS, and 9 of invasive adenocarcinoma (invasion < 3mm) were studied using preoperative cytologic smears. 1) In the GD smears, abundant cervical columnar epithelium, palisade like arrangements and acinar formations, and fine slightly increased nuclear chromatin were charactaristic. 2) In the AIS smears, aggregated atypical glandular cells, rosettes, enlarged nuclei with protrusions from the cytoplasm, and moderately increased granular nuclear chromatin were characteristic. 3) In the smears of microinvasive adenocarcinoma, feathering, increased nuclear chromatin, irregular thickening of the nuclear border, frequent mitoses, anisonuclei and irregular nuclei were characteristic. 4) In the smears of invasive adenocarcinoma, tumor diathesis, grape or papillary formations, and prominent nuclear atypia with coarse nuclear chromatin were characteristic. Care must be taken to diagnose the smears of these cervical glandular lesons, as the cytologic findings might differ according to their histologic types and differentiation.
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Hiroki NAKAYAMA, Tsuneo NAKAZAWA, Kenji NISHINAKA, Hisamori KATOH, Hir ...
1993 Volume 32 Issue 6 Pages
921-926
Published: 1993
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When routine endometrial cytology techniques cannot be employed due to difficulty with insertion into the uterine cavity, we attempt endometrial cytology with a “DAICATH”, a disposable artificial insemination catheter. In 23 out of 73 cases, the “DAICATH” could be inserted with minimal discomfort. Inadequate specimens were obtained in 3 cases because of the absence of endometrial clusters. There were cytodiagnostic difficulties including minimal cervical mucus contaminatidon, and same dry sumples. Particularities of less contamination of the cervial mucus and some dry samples.
Of 12 cases with endometrial carcinoma, 11 showed positive cytology and the other had an inadequate sample devoid of endometrial cells. The number of malignant clusters obtained with the “DAICATH” was equal to that collected by Masubuchi's aspiration technique.
The “DAICATH” is considered an adequate secondary device for endometrial cytology.
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comparison between normal endometrium and well-differentiated adenocarcinomas
Junji KOSAKA, Junko NAGATA, Kazuhiiro OKABE, Masaomi TAKAYAMA
1993 Volume 32 Issue 6 Pages
927-930
Published: 1993
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Nucleolar organizer regions are loops of DNA, which in humans are found on chromosomes 13, 14, 15, 21, and 22, and code for ribosomal RNA. They are associated with nonhistone nucleoproteins, which can be stained with silver (Ag-NOR). An increased number of Ag-NOR has been observed in many malignancies and Ag-NOR counts are useful for tumor diagnosis. Ag-NOR were counted in two groups of women: those with endometrial well-differentiated adenocarcinomas (n=9) and another group with normal endometrium in the proliferative phase (n=20). The endometrial endometrial cell samples were taken with an endocyte or uterobrush. Mean Ag-NOR counts were 4.81 in well-differentiated adenocarcinomas and 2.68 in normal proliferative phase endometrium. The results were analyzed and the number of Ag-NOR per nucleus was significantly higher in the endometrial adenocarcinoma cells than in the normal proliferative phase endometrial cells (p<0.01). Ag-NOR counts provide useful information, are inexpensive, can be obtained from endometrial cell samples and may aid in the clinical diagnosis of patints with endometrial well-differentiated adenocarcinomas.
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Shouji YAMADA, Hideaki KIYOTA, Yasuo HIDAKA, Hitoshi YOSHIOKA, Motoshi ...
1993 Volume 32 Issue 6 Pages
931-936
Published: 1993
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Purpose: This study was carried out to evaluate the diagnostic usefulness of three dimensional characteristics of cell clusters in endocyte specimens for the identification of well differentiated adenocarcinoma of the endometrium.
Materials and methods: Thirteen histologically proved carcinoma patients aged 48 to 70 (mean 59) were studied.
For comparison, 90 benign patients aged 16 to 76 (mean 45) were evaluated. Adenomatous or atypical hyperplasia was not included for this study. The cytologic features examined in the cell clusters included the presence or absence of stromal cells, irregularity of cell arrangement, and papillary appearance, and the number of cell layers.
Results: The malignant clusters were characterized by irregular and papillary piles of epithelial cells, with more than three cell layers and no stromal cells. The papillary nature was characterized by many scattered slits in the clusters. The benign clusters, on the other hand, were distinctly evidenced by regular cell piles, having less than three cell layers and many stromal cells. Slit-like epithelial foldings were present but were clearly and readily distinguished in the presence of continuity of epithelial cells from the slits with disruption of epithelial cell continuity in the malignant clusters.
Conclusion: The three dimentional observation of cell clusters in endocytes was useful for the identification of well differentiated adenocarcinoma of the endometrium, which may have cell atypia of insufficient severity to indicate malignancy based on evaluation of the individual cells alone.
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cell cluster structure
Ichiro MORI
1993 Volume 32 Issue 6 Pages
937-947
Published: 1993
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To accurately diagnose endometrial cytology, the pathological diagnosis of 60 samples of normal endometrium, 12 of adenomatous hyperplasia and 20 of well-differentiated adenocarcinoma were reviewed.
Nuclei within cell clusters and architectural structure were analyzed.
Nuclear changes in the chromatin pattern, in nuclear size, cellular area and the long and short diameters of the nuclei showed very little variation.
The appearance of the normal endometrium included a glove-like structure, a sheet-like structure, a stromal cell structure and a papillary structure.
Only the menstrual cycle in normal endometrium, a papillary structure, was observed.
The appearance of adenomatous hyperplasia and welldifferentiated adenocarcinoma included a branching structure, a back-to-back structure and a papillary structure.
Especially, in well-differentiated adenocarcinoma, a branching structure was found in 54.5%.
In the lntra-branching structure, stalks of spindle cells were noted in 80% of well-differentiated adenocarcinoma, but not in cases of adenomatous hyperplasia.
A secondary ramifying structure was observed only in 1% of normal endometrium and in 3% of adenomatous hyperplasia but in 50% of well-differentiated adenocarcinoma.
A third ramifying structure was observed in 4% of welldifferentiated adenocarcinoma only.
In cytologic diagnosis of the endometrium, it is important to evaluate the ramification fragment, branching stucture and stalks of spindle cells.
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Kazuhiro TATEOKA, Toshiko JOBO, Noriyuki KYUSHIMA, Satoshi OHGAWARA, R ...
1993 Volume 32 Issue 6 Pages
948-955
Published: 1993
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Endometrial papillary serous adenocarcinoma is an uncommon variant of endometrial carcinoma and has been described as having a poor prognosis. Between 1971 and 1991, 273 cases of endometrial cancer were experienced at Kitasato University Hospital and 3 cases (1.1%) with serous adenocarcinoma were found. This paper reviews the clinical presentations, histopathological findings and cytological features of these 3 patients. The mean age of the patients at the time of diagnosis was 57.7 years (53, 56 and 64 years) and all were post menopausal. All patients underwent abdominal hysterectomy and bilateral salpingo-oophorectomy with or without pelvic lymphadenectomy and were treated post operatively with combination chemotherapy. Ascites was present in 2 as III A in both cases because ascites or peritoneal washing cytology were positive. One patient was dead at 14 months after initial treatment and one is alive with recurrent tumor. Endometrial smear revealed dark adenocarcinoma cells with anisonucleosis and a thick inlistinct border frequently giving rise to stratified papillary clusters. The N/C ratio was high and cytoplasmic vacuoles were rarely observed. Tumor diathesis with hemorrhage was found in 2 cases with myometrial infiltration. A clear background and small numbers of normal endometrial cells appeared in 1 case without myometrial invasion. No psammoma bodies were seen in any specimens. Peritoneal washing and fluid cytology revealed many atypical cells resembling those in endometrial smears except for marked cytoplasmic vacuoles. The points essential for differential diagnosis of endometrial serous carcinoma and an ovarian papillary serous origin were (1) tumor diathesis (2) large clusters (3) rarely observed normal endometrial cells.
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Msayuki OHNO, Tatsuya IGARASHI, Atsuko SHIOTA, Takaaki KUROSE, Tamotsu ...
1993 Volume 32 Issue 6 Pages
956-959
Published: 1993
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The early detection of intraperitoneal recurrence in ovarian cancer patients has been achieved by serological assay of tumor markers or radiological (CT, MRI, USG) study. We tried a new follow up method for ovarian carcinoma patients using serial peritoneal washing cytology from a subcutaneously implanted Infuse-A-Port.
Two cases of 7 showed no correlation between clinical findings (ascites, serological assay and radiological study) and peritoneal washing cytology. One case had no ascites, a normal serum CA-125 value and no evidence of disease on radiological study, but was found to have intraperitoneal dissemination of ovarian carcinoma on second look laparotomy. This case had malignant cells in the peritoneal cavity on peritoneal washing cytology before normal clinical findings. This suggests that serial peritoneal washing cytology has potential use in the follow up of ovarian cancer patients when the intraperitoneal port is implanted under the skin.
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morphological changes in peritoneal non-cancerous cells in response to immuno/chemotherapy
Yasuo HIRAI, Yoshio SHIMIZU, Motoko IKENAGA, Atsuko MINAMI, Masafumi T ...
1993 Volume 32 Issue 6 Pages
960-964
Published: 1993
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Repeated peritoneal cytologic examinations were performed on 28 peritoneal malignancy patients with the use of a reservoir for intraperitoneal chemothrapy. The following results were obtained by investigating morphological changes in peritoneal non-cancerous cells yielded in response to immuno/chemotherapy.
1. Intraperitoneal chemotherapy with CDDP produced several changes in peritoneal cytology, as follows; histiocytosis, many atypical non-cancerous cells possibly derived from swollen reactive histiocytes and/or mesothelial cells, and rare eosinocytosis. These findings lasted one to three weeks. Some of the cells occasionally mimicked cancer cells.
2. Immunotherapy with intraperitoneal BRM, such as Shizophilan or Lentinan, produced histiocytosis and many highly multinucleated, swollen histiocytes. Papillary, growing mesothelial cells later appeared to closely mimick a cluster of adenocarcinoma cells.
3. By using the resorvoir, peritoneal washing smears can be obtained easily at any time. To reach a correct cytodiagnosis based on peritoneal smears, it is important to consider cytological changes in non-cancerous peritoneal cells in response to immuno/chemothrapy.
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Masateru DOI, Makoto ITAKURA, Akio KINOSITA, Shou OHBA, Eiichi SHIBAYA ...
1993 Volume 32 Issue 6 Pages
965-969
Published: 1993
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We report a rare case of primary meningeal malignant melanoma in a 23-year-old female. The patient was admitted to our hospital for sudden onset of consciousness disturbance. Prominent nevi were observed on her trunk.
From the spinal fluid, a small number of tumor cells, highly suggestive of malignant lymphoma were evident. However, final cytological diagnosis could not be completed. The cells showed no definitive melanin pigment whatsoever.
Shortty there after, biopsy specimens taken during decompression surgery revealed a small number of atypical cells in the specimen containing definitive melanin pigment with vivid nucleoli. These findings lead us to a final diagnosis of malignant melanoma. Special staining i.e. Grimelius, Fontana-Masson and immunostains such as NSE, and S-100 protein supported the diagnosis. Ultrastructural study demonstrated abundant mature melanosomes.
Finally, autopsy findings revealed neither metastasis nor lesions indicating another primary focus.
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Shinya SATO, Akinobu OHNO, Yuji HINOURA, Atsushi KISANUKI, Tohru HAYAS ...
1993 Volume 32 Issue 6 Pages
970-973
Published: 1993
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Reports of two cases of sebaceous carcinoma occurring in the eyelid are presented. They were diagnosed using imprint smears and frozen sections during operation. In case 1, a 69-year-old woman had a nodule in the lateral portion of the right lower eyelid. Imprint smear cytology revealed characteristics of adenocarcinoma cells except for demonstrable mucin. Oil red 0 (ORO) staining of frozen sections clearly demonstrated intracytoplasmic lipid droplets. In case 2, an 83-year-old man had a tumor involving two thirds of the left upper eyelid. Imprint smears contained cohesive clusters of small tumor cells resembling basal cell carcinoma cells. However, ORO staining revealed intracytoplasmic lipid droplets. Histologically, it was less differentiated than sebaceous carcinoma. It is not always easy to differentiate sebaceous carcinoma clinically from chalazion or blepharitis. If chalazion-like localized swelling in the eyelid with or without inflammation is recurrent or persistent in the same area, cytological examination of secreted or aspirated material should be performed to rule out malignancy. An adequate understanding of cytological features of sebaceous carcinoma as well as ORO staining permits differentiation from other tumors or inflammation. Thus, a careful cytological examination appears to be essential for early detection of sebaceous carcinoma.
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cell pathology and proliferative activity
Hiroshi KIYOKU, Tamotsu TAKAHASHI, Toshiaki MORIKI, Shyosuke UETA, Chi ...
1993 Volume 32 Issue 6 Pages
974-979
Published: 1993
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A case of medullary thyroid carcinoma resembling a pheochromocytoma is presented with its cytology, histopathology, immunohistochemistry, electron microscopy and proliferative activity using proliferating cell nuclear antigen (PCNA).
A 65-year-old female was found to have elevated serum calcitonin and CEA. Physical examination and CT scanning revealed a left thyroid tumor. A total thyroidectomy was performed. Grossly, the tumor was solid, firm, non-encapsulated but relatively well-circumscribed and measured about 1.5×1.3cm in size. Imprint cytology showed a pleomorphic cell population with granular cytoplasm scattered diffusely or arranged in small clusters. Histologically, the tumor was composed of round to polygonal cells with abundant eosinophilic granular cytoplasm arranged in trabecular and nesting patterns (thus simulating a pheochromocytoma). The tumor cells had many argyrophilic granules in their cytoplasms with Grimelius staining. Immunohistochemical staining by the ABC method demonstrated that the cells were positive for calcitonin, CEA, NSE and keratin. Ultrastructurally, numerous cytoplasmic electrondense round secretory granules, about 200-500 nm in diameter, and abundant mitochondria were present. The percentage of PCNA positive cells was about 50%. This rate was between those of undifferentiated carcinoma and well differentiated papillary or follicular carcinoma of the thyroid gland.
The present case of medullary carcinoma was very similar to a pheochromocytoma cytopathologically. We conclude that immunohistochemical staining for calcitonin is useful for diagnosing medullary thyroid carcinoma.
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Takao SATOU, Motohiro IMANO, Mituyo MAEDA, Syunji MAEKURA, Katuaki KUB ...
1993 Volume 32 Issue 6 Pages
980-986
Published: 1993
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Total right nephroureterectomy was performed on a 60-year-old man with gross hematuria and back pain under a diagnosis, based on radiological findings, of suspected pelvic tumor. Two types of tumor were revealed in the right kidney on histopathological examination. One was transitional cell carcinoma (TCC) with papillary proliferation at the pelvis and the other was renal cell carcinoma (RCC), with mixed and pleomorphic cell types, at the upper pole of the kidney. The two types of tumor were intermingled and transformed continuously at their junction in the medulla. Lotus tetragonolobus aggulutinin (LTA), peanut aggulutinin (PNA), soy bean aggulutinin (SBA) and dolichos biflorus aggulutinin (DBA) were used for lectin staining of the tumor tissue. Anti-epithelial membrane antigen (EMA) and antihuman granulocyte associated antigen (M 1) were used for immunohistochemical study of the tumor tissue. Positive reaction was demonstrated in the part with both RCC and TCC tissue for PNA, SBA, DBA and EMA, which are markers of the lower nephron. LTA showed a focal positive reaction in the part with both tumors. M 1 was completely negative in both tumors. These findings indicate that the present tumor was a Bellini duct carcinoma which had originated from the Bellini ducts. These ducts have bipotentiality for epithelial differentiation. That is, they have the possibility of differentiating into either transitional epithelium or the epithelium of renal tubules. Metastasis to the lungs and local recurrence of the RCC component were noted postoperatively because only adenocarcinoma cells with conspicuous pleomorphism were found on cytology of the sputum and an aspiration specimen from the site of local recurrence. The patient died due to respiratory failure 7 months after surgery. At autopsy, histological findings showed local recurrence and metastasis to the lung, bone and bone marrow for the RCC component but not TCC, which confirmed cytological findings from the sputum and the aspiration specimen.
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Mutsuo KUBA, Morio OOSHIRO, Keiichiro GENKA, Akihisa KISHIMOTO, Teruo ...
1993 Volume 32 Issue 6 Pages
987-994
Published: 1993
Released on J-STAGE: November 08, 2011
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The cytologic findings of a case of bronchial granular cell tumor is reported. The imprint cytology of the excised tumor contained clusters of cells exhibiting abundant cytoplasm with indistinct borders. The cytoplasm was basophilic and contained an abundance of eosinophilic granules. The cytoplasmic granulations were strikingly PAS positive, both before and after diastase digestion. Most nuclei were round and uniform in size. The chromatin was uniformly finely granular, and the nuclear membrane was thin and regular. A single micronucleolus was found in half of the nuclei.
Histologically, the tumor was located beneath the bronchial epithelium. Most of the tumor cells were oval or polyhedral. Abundant cytoplasm was granular and eosinophilic. The nuclei were mostly round, sometimes spindle shaped, and eccentric.
Electron microscopic observation revealed numerous electron-dense or light granules and a few myelin-like structures in the cytoplasm. Tumor cells were surrounded by basal laminae. Immunohistochemically, the tumor cells showed positive reaction to S-100 protein and NSE. These observations appear to support the concept that bronchial granular cell tumor has a neurogenic origin.
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Koichi MANDAI, Masayuki YAMAUCHI, Hiroyuki OHSAKI, Natsu KONDOH, Tamam ...
1993 Volume 32 Issue 6 Pages
995-999
Published: 1993
Released on J-STAGE: November 08, 2011
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Two cases with pulmonary cryptococcosis confirmed using aspiration cytology and biopsy are reported. Case 1, a 75 year-old woman, was incidentally found to have a nodular abnormal shadow on a chest X-P during treatment of idiopathic systemic edema. Lung aspiration cytology and biopsy with endoscopic bronchofiberscopy showed yeast like cells, some of which were laden with multinucleated macrophages. The nodular shadow diminished with medication. Case 2, a 46 year-old female, was found to have a cavitary lesion on a chest X-P during occupational mass screening. Transcutaneous aspiration cytology and biopsy of the lung demonstrated yeast like cells with a clear zone of variable width, representing the space occupied by a mucoid capsule positive for periodic acid-Schiff reaction. In the surgically resected lung, a solitary fibrocaseous granuloma was located, and fragmented and unevenly stained cryptococci were found within the central caseous material. While it was a clinical problem to differentiate both of these cases from pulmonary carcinomas, aspiration cytology and biopsy were very useful in making the histopathologic diagnosis of cryptococcosis.
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Yasue SHITARA, Yasuko HASEGAWA, Keiko MAJIMA, Etuko FURUKAWA, Kumiko N ...
1993 Volume 32 Issue 6 Pages
1000-1006
Published: 1993
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Three cases of thymic carcinoma presenting with pleural effusion are reviewed. Two were undifferentiated carcinoma and one was squamous cell carcinoma, though most of the tumor consisted of undifferentiated cells. Cytological aspects of the cancer cells in pleural effusions were similar and are summarized below;
1. Cancer cells are tightly cohesive, and appear in clusters which are small or medium in size.
2. They are arranged in a concentric pattern or “onion-skin like” figure.
3. Tumor cells are small and have scanty cytoplasm.
4. Nucleus is irregular in shape and has coarse nuclear chromatin. Nuclear border is thick and irregular. Nucleoli are prominent.
5. Cytoplasm is negative for PAS and alcian blue.
Fine needle aspiration cytology of the mediastinal tumor was done in two cases and disclosed similar cytological findings; small cancer cells forming cohesive clusters, and irregular pleomorpic nuclei with prominent nucleoli. Lymphocytes were scant, resulting in a non-biphasic pattern which was different from that of thymoma.
When cancer cells with the cytological features described above are encountered in a plueral effusion in association with an anterior mediastinal mass, thymic carcinoma should be considered.
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Takako URAOKA, Masahiko TSUJIMOTO, Kazuo KUROKAWA, Manami HAYASHI, Ayu ...
1993 Volume 32 Issue 6 Pages
1007-1011
Published: 1993
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The aspiration cytologic findings of a case of thymic carcinoid tumor with pulmonary metastasis, showing more cytologic atypia than previously reported cases, are presented.
The patient was a 61-year-old woman. A large anterior mediastinal tumor and a small coin lesion in the left lung were discovered by plain chest film and chest computed tomography. Excisions of both the mediastinal and the pulmonary tumor, in addition to lymph node dissection, were performed. The mediastinal tumor was about 5 cm in diameter, yellow-white in color on cut section, with spots of hemorrhage and necrosis.
Preoperative aspiration cytology on the mediastinal tumor revealed irregular clusters or a sheet-like structure of relatively small tumor cells. They were almost uniform in size and shape, but some showed anisocytosis, anisokaryosis and nuclear indentations. The nuclear chromatin was increased and appeared to be fine and granular. Nucleoli were occasionally prominent.
Histological findings of the tumor included a solidgrowth pattern of the tumor cells, which showed anisocytosis and anisokaryosis like those seen in the aspiration cytology specimen. One or two mitotic figures were recognized in. 10 HPF. Tumor cells were positive for Grimelius stain and for chromogranin immunohistochemical stain. Electron-microscopical study revealed the presence of neurosecretary granules in the cytoplasm of the tumor cells. A histological diagnosis of carcinoid tumor of thymic origin was thus made.
Because of its cytological atypia, differential diagnosis was difficult in the aspiration cytology specimen of this case. Immunohistochemical staining for chromogranin in the aspiration cytology specimen was useful.
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Daisei YASUDA, Chiaki YAMAGAMI, Masuo ISHIGAMI, Akihiro HIRATA, Chiho ...
1993 Volume 32 Issue 6 Pages
1012-1016
Published: 1993
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A case of mediastinal diffuse large cell lymphoma in a 26-year-old woman is reported. She was admitted complaining of facial swelling. A large tumor was found in the anterior mediastinum and open-biopsy was performed. The imprint smears revealed a scattered distribution of large neoplastic cells with very irregular, sometimes cleaved, nuclei containing abundant heterochromatin. Cytoplasm was scanty with ill-defined borders and occasional vacuoles.
Histological examination showed diffuse proliferation of pleomorphic cells with sclerosing fibrosis, giving the false impression of an epithelial malignancy. Immunohistochemistry revealed that the neoplastic cells were Blymphocytic, and that many reactive T-cells had infiltrated surrounding capillaries.
The markedly irregular shapes of nuclei, the abundance of heterochromatin, and a paucity of cell organellae were revealed by electron microscopy.
Imprint cytology, performed concomittantly with immunohistochemistry, is thought to be useful for obtaining an accurate diagnosis of mediastinal diffuse large cell lymphoma.
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Takeshi FUJII, Mitsuhiro NOKUBI, Toshiro KAWAI, Sachiko KUBONO, Akira ...
1993 Volume 32 Issue 6 Pages
1017-1020
Published: 1993
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We describe a case of epithelioid sarcoma arising in the thoracic wall. A 64-year-old man visited our hospital complaining of a lump in the dorsal thoracic wall. CT scan revealed a mass shadow with calcification within the left erector spinae muscle. Aspiration cytological examination disclosed loosely connected clusters composed of large oval or polygonal atypical cells, and a few scattered spindle cells. The resected tumor was white, solid and lobulated, and showed focal hemorrhage and central necrosis on the cut surface. Ossification was evident in the periphery of the tumor.
Histologically, the tumor consisted of epithelioid tumor nests and spindle tumor cells, which gradually merged. A few tumor cells presented a rhabdoid feature. Immunohistochemically, tumor cells were immunoreactive for CAM 5.2, EMA, CEA, vimentin, HHF 35, α-smooth muscle actin and NSE, but were negatively stained for desmin, S-100, factor VIII-related antigen. Electron microscopy revealed abundant intermediate filaments in the cytoplasm.
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Sachiko NAGUMO, Hiroko SONE, Akira WADA, Minoru MATUDA
1993 Volume 32 Issue 6 Pages
1021-1024
Published: 1993
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The cytologic features of smears from fine needle aspirates obtained from a rare case of tubular breast carcinoma are reported. A 45-year-old woman noticed a right breast mass and visited our hospital. The mass was suspected to be a malignancy by palpation, echography and mammography. Fine needle aspiration cytology confirmed this diagnosis. Radical mastectomy was performed and her mass was diagnosed as papillomatosis and sclerosing adenosis on frozen section. However, on paraffin section, tubular carcinoma was found.
On the cytologic smears, cell clusters consisted of 10 to 30 tumor cells and showed an acinar arrangement and tightly cohesive angular clusters with a tubular arrangement. The nucleocytoplasmic ratio of tumor cells was large, but anisokaryosis was not remarkable. Nuclei were round and chromatin showed a finely granular distribution. Nucleoli were unremarkable. Bipolar naked nuclei were sparse in the background. The most striking feature of the fine needle aspirates from this tubular breast carcinoma was the structural pattern of tightly cohesive three-dimensional tubular clusters regardless of mild cellular atypia. This cytologic picture was considered to be clearly diagnostic of malignancy.
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Takeo NISHINO, Toshimi TAKAHASHI, Seiya NABESHIMA, Yoshio OOEDA, Toshi ...
1993 Volume 32 Issue 6 Pages
1025-1030
Published: 1993
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A case of adenoidcystic carcinoma of the breast, studied cytologically and histologically, is reported. A 45-year-old housewife noted a lump measuring 14.2 mm at the upper outer region of left breast. Cytologically, the tumor cells were shown to be in sheets and/or clumps accompanied by mucoid globules, red-purple in color on Giemsa staining. The nuclei of tumor cells were relatively small and unremarkable with fine granular chromatin which was slightly increased in amount. The nucleoli were small and few in number. Histologically, there were solid and trabecular tumor cell nests with the cribriform pattern admixing two types of lumina, true glandular and pseudocystic. The lining epithelium of the former lumen was stained with CEA, EMA and Keratin and possessed microvilli ultrastructurally. The content of the lumen stained with PAS. On the other hand, the epithelium of the pseudocystic lumen stained only with vimentin. The lumen content stained mainly with alcian blue and focally with PAS, also being red-purple, as is compatible with metachromasia, in color with Giemsa and toluidin blue. Ultrastructurally, the lining epithelium showed myoepithelial differentiation in a few cells. The lumen contained a basal lamina like substance and immature collagen fibers.
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Moriyasu OIKAWA, Shunichi SASOU, Tamotsu SUGAI, Junichi ANBO, Motoo IS ...
1993 Volume 32 Issue 6 Pages
1031-1036
Published: 1993
Released on J-STAGE: November 08, 2011
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A case of spindle cell carcinoma of the breast is presented. The patient was a 36-year-old female. A tumor of the left breast was found by a surgeon at a time of mass screening for breast cancer and was studied by fine-needle aspiration cytology. The smears contained many atypical tumor cells with fiber-like, spindle and polygonal shapes, as well as multinuclear giant cells of various sizes. Sarcoma was strongly suspected. The size of the tumor was 3×1.5 cm. Histologically, the tumor was composed of two lesions. One was a large, solid part occupied by spindle cells, the other a smaller nest near the large tumor. The small tumor was a papillotubular carcinoma. Immunohistochemically, spindle cells were stained with vimentin, actin, myoglobin and keratin. On electron microscopic study, desmosome-like cell attachments were observed between the tumor cells of the spindle cell carcinoma.
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Makiko ONUMA, Hiroyoshi ONODERA, Tetsutaro TAKEDA, Kuniko KOMURO, Taka ...
1993 Volume 32 Issue 6 Pages
1037-1041
Published: 1993
Released on J-STAGE: December 05, 2011
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We describe the cytologic features of touch smears in four histologically confirmed islet cell tumor cases.
In case 1, the smears contained uniform tumor cells in isolated, loose aggregates and occasional rosette like arrangements. The cells had eccentrically located round-to-oval nuclei with granular chromatin and a single small nucleolus. The mean maximal diameter of nuclei was 8.77± 1.07 μm. The cytoplasm was moderate in amount.
In case 2, the tumor cells were similar to those of case 1. The mean maximal diameter of nuclei was10.26±1.53 μm.
In case 3, the smears contained isolated tumor cells and cohesive clusters of tumor cells. The cells had oval-to-spindle like hyerchromatic nuclei with one-to-two small nucleoli. The mean maximal diameter of nuclei was 9.89±2.00 μm. Although the cytoplasm of tumor cells which composed cohesive clusters was moderate in amount and stained light green, the isolated tumor cells had little cytoplasm.
In case 4, the tumor cells were similar to those of case 3. The mean maximal diameter of nuclei was 10.26±2.33 μm.
In our cases, the cytologic features did not reveal the malignancy of the tumor or hormone production.
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Nobuyasu NISHISAKA, Masaomi SASAKI, Kenichi WAKASA
1993 Volume 32 Issue 6 Pages
1042-1045
Published: 1993
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We report a case of primary carcinoma
in situ (CIS) of the ureter which was found during follow-up of urinary stone. A 57-year-old woman comlained of macroscopic hematuria and left flank pain. Since the initial visit, she had been treated with oral medication under a diagnosis of left renal and ureteral stone. As left hydronephrosis appeared, she received left retrograde pyelography. Tumor cells were found in the urine obtained by catheterization at that time. Subsequently, positive cytology was obtained on 5 separate occasions. Therefore, CIS of the left upper urinary tract was suspected and a total left nephroureterectomy was performed. Histologically, grade 3 CIS and dysplasia were recognized in the entire ureter. The diagnosis of CIS developing in the upper urinary tract is very difficult. If CIS is complicated by contralateral urinary stone, its diagnosis and treatment are more difficult. Urine cytology thus plays an important role in diagnosis and accurate evaluation of the results is necessary.
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Kiyomi TAIRA, Arisa IDE, Kazuhiko IWAMOTO, Katsushige YAMASHIRO, Masah ...
1993 Volume 32 Issue 6 Pages
1046-1051
Published: 1993
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We report a case of adenocarcinoma occurring in the bladder mucosa 30 years after ileocystplasty. The patient was a 47-year-old man, who had undergone a closed-loop type of ileocystplasty at the age of 17 for a tuberculous contracted bladder. He had since often suffered from urinary tract infection, and visited our hospital with a complaint of hematopyuria. Urinary cytology revealed atypical cell clusters suspected of being malignant. Cystoscopy showed a large elevated tumor on the left wall. Total cystectomy and ileal ring resection were performed after transuretheral biopsy of the tumor. Histologically the tumor was an adenocarcinoma resembling small intestinal mucosa which had massively invaded the subserosal tissue. With a serial cutting procedure, it was disclosed that the tumor was located mainly on the urinary bladder mucosa, and that the bladder mucosa had been almost replaced by the intestinal type of columnar epithelia. A small cancerous focus separate from the main tumor was also found. We conclude that this tumor originated from the bladder mucosa, replaced by intestinal metaplastic cells, and had been induced by chronic cystitis.
Cytologically we were concerned about distinguishing among tumor cells, intestinal metaplastic cells, and the degenerated intestinal epithelia inevitably presenting in the ileal conduit urine, because less atypical adenocarcinoma cells were very similar to the latter two. However, it is possible to differentiate adenocarcinoma cells from benign cells, if attention is paid to the slightly enlarged nuclei, thickening of the nuclear membrane, eosinophilic nucleolii, and cell-in-cell features. Post-ileocystplasty patients must be followed up long-term, using repeat cytologic examination of the urine, considering the occurrence of adenocarcinoma in the urinary bladder stemming from intestinal metaplasia.
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Shinji FUNAHASHI, Yoko ASAKUMA, Hidenori CHINO, Toshiyuki NOMURA, Maki ...
1993 Volume 32 Issue 6 Pages
1052-1057
Published: 1993
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A case of small cell carcinoma (SCC) of the prostate is reported with cytological findings. A 78-year-old man with a complaint of difficulty in urinating was diagnosed as having SCC, combined with well-differentiated adenocarcinoma, by prostatic biopsy. Washing cytology of the urinary bladder contained numerous small, round cells, resulting in someresemblance to SCC. During the follow-up, SCC cells were also observed in sputum cytology. Autopsy showed a small cell carcinoma involving the prostate with tumor extension into the urinary bladder. Metastasis was present in the lungs, liver and lymph nodes. Imprint cytology revealed an intermediate type of SCC. Cancer cells were extensively positive for Grimelius staining and reacted with anti-neuron-specific enorase (NSE), chromogranin A and keratin antibodies. Electron microscopy revealed neurosecretory granules in the cytoplasm of SCC cells. We have also briefly reviewed the literature on cytopathological features and discussed the pathogenesis of SCC of the prostate.
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Masashi Imachin, Yasuo Kato, Kuniaki Funakoshi
1993 Volume 32 Issue 6 Pages
1058-1061
Published: 1993
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The cytologic and histologic findings in an extremely rare case of primary squamous cell carcinoma of Bartholin's gland are described. The tumor cells in fine needle aspiration smears were seen to be isolated or in clusters. The nuclei were round-to-oval, and uniform in shape and size. The chromatinic material was slightly increased. The tentative diagnosis was primary squamous cell carcinoma of Bartholin's gland, based on the cytologic findings and the location of the tumor. Similar findings were noted in the biopsy and surgical specimens. Fine needle aspiration smears have greater diagnostic value for a Bartholin's gland tumor.
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Toshihiko MORI, Kenichi FUNAKI, Makoto TAKAHASHI, Akio OTANI, Noriko K ...
1993 Volume 32 Issue 6 Pages
1062-1067
Published: 1993
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Pulmonary lymphangitic carcinomatosis is an unusual presentation of diffuse infiltrative lung disease. In this report, we present a case secondary to carcinoma of the uterine corpus. The diagnosis was made on the basis of chest X-Ps, CT scans and cytological findings of the sputum.
Microscopic findings in the uterine corpus resembled those of ovarian serous carcinoma and showed deep myometrial invasion and lymphatic permeation.
The clinical course is one of rapid deterioration withmarked respiratory symptoms.
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Norimitsu TOMIMATSU, Mihoko GOYA, Iwao NAKAMURA, Hujitsugu MATSUBARA, ...
1993 Volume 32 Issue 6 Pages
1068-1073
Published: 1993
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Two cases of serous surface papillary carcinoma of the ovary (SSPC) are reported with clinical, cytological and histopathological findings.
Two women, 66 and 63 years old, were admitted with massive ascites of unknown origin. Serological tests demonstrated very high CAl25 levels. On cytological examination of the endometrium or ascitic fluid, many tumor cells formed clusters of various sizes and shapes. Tumor cells showed different nuclear sizes, prominent nucleoli and increased nuclear chromatin with psammoma body-like materials on a dirty background.
Histologically, the operative specimens revealed tumor cells showing papillary proliferation with psammoma bodies, commonly considered to be characteristic of ovarian serousadenocarcinoma. These findings were seen only on the surface of the ovary.
The two patients are now in remission following radical operation and CAP chemotherapy. Preoperative serological, radiological and cytological examinations have been shown to be useful for the diagnosis of SSPC.
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Hiromitsu YASUMATSU, Nobutoshi TANAKA, Nobuhiro WAKABAYASHI, Hiromi EG ...
1993 Volume 32 Issue 6 Pages
1074-1077
Published: 1993
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We experienced a case of endometriosis of the leftinguinal region in which the fine needle aspiration cytology (FNAC) was very useful in making a diagnosis.
The patient was a 35 year-old woman who came to our hospital with a chief complaint of left inguinal mass. The mass was painful during menstruation and on palpation. FNAC of the mass was then performed and a Papanicolaou stain of the smear showed groups of epithelial cells with a sheet arrangement, stromal cells with an irregular arrangement and regenerative cells with a sheet arrangement without nuclear atypia. The background of the smear was fresh blood. The above findings were consistent with endometriosis and therefore, the diagnosis was easily made in this case.
FNAC was thought to be an efficient tool for the identification of endometriosis.
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[in Japanese]
1993 Volume 32 Issue 6 Pages
1078
Published: 1993
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Atsuhiko SAKAMOTO
1993 Volume 32 Issue 6 Pages
1079-1085
Published: 1993
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Fine needle aspiration is nowadays recognized as a meaningful tool for the diagnosis of thyroid diseases, especially of malignant tumours. Accuracy rates for papillary carcinoma, undifferentiated carcinoma, medullary carcinoma and malignant lymphoma are high, and satisfactory for most clinicians. However, a problem lies in making the differential diagnosis between follicular carcinoma and follicular adenoma. On the histological criteria of follicular carcinoma, cellular atypia plays no important role in evaluating a malignancy. Therefore, making a diagnosis of follicular carcinoma will remain difficult using cytology alone, if histological criteria are not altered in future.
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Ryuichi YATANI, Taizo SHIRAISHI, Akinori ISHIHARA
1993 Volume 32 Issue 6 Pages
1086-1095
Published: 1993
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A clinicocytological study was performed in 104 cases of breast carcinoma and 127 women with benign breast lesions in which the diagnosis had been histologically confirmed. Of the carcinoma cases, 86.5% had been correctly diagnosed by aspiration biopsy cytology (ABC), and 2.9% were false negatives. Most false negative of suspicious diagnoses were made for well differentiated carcinoma with tight cellular cohesion, small size and mild atypia (ex. papillary or cribriform carcinoma), or sparse cellularity, especially from scirrhous carcinoma. Of the benign lesions, 85% were diagnosed correctly, and 1.6% were false positives. Lesions with active cellular proliferation such as intraductal papilloma, adenoma of the nipple, or fibroadenoma of active epitheliosis were incorrectly diagnosed as positive or suspicious. These lesions showed abundant cellularity and scattered ells with abnormalities in the nucleus or chromatin pattern.
In order to raise accuracy, the key is ; 1) to improve the method of collecting adequate amounts of tumor cells, 2) to establish criteria focusing on the arrangement and shape of the cell clusters as well as individual cellular findings, 3) to create additional methods with subjective criteria. c-erbB-2 oncogene product or p 53 antioncogene products may be useful for the cytological diagnosis of breast cancer.
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Osamu MATSUZAKI
1993 Volume 32 Issue 6 Pages
1096-1102
Published: 1993
Released on J-STAGE: November 08, 2011
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Fine needle aspiration biopsy (FNA) of the prostate was first reported by Ferguson in 1930. Since improvement of the aspiration route and instruments by Franzen et al. in 1960, the accuracy rate of FNA has become more than 90%. Moreover, histological differentiation can be cytologically estimated.
Recent progress in FNA of the prostate includes a new aspiration transpubic echo-guided procedure and a concentration method for physiological saline solution.
Finally, recent concepts for the evaluation of FNA material of the prostate include cytological estimation and the prospect for chemotherapeutic effects. In the specific type of prostatic cancer that had a low chemotherapeutic effect, the important cytologic findings were papillary carcinoma cluster, for large duct type adenocarcinomas, necrotic materials with carcinoma cell cluster, for the combined type, and malignant cells suggesting transitional or undifferentiated carcinoma with adenocarcinoma cells, for combined type prostatic carcinoma, respectively.
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Shinichiro USHIGOME, Tohru HARADA, Masami SUGISHITA, Sachiko MIURA, Yu ...
1993 Volume 32 Issue 6 Pages
1103-1111
Published: 1993
Released on J-STAGE: December 05, 2011
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Cytologic characteristics of aspiration cytology, and partly of imprint cytology, in relatively common bone and soft tissue tumors are presented. Tumors were conveniently categorized as 1) bone and osteoid matrix-forming tumors, 2) predominantly chondroid matrix-forming tumors, 3) giant cell lesions, 4) small round cell tumors, 5) spindle cell tumors, 6) pleomorphic tumors, and dedifferentiated sarcomas. Characteristic cytologic features for the differential diagnosis in each category are described. Application of immunocytochemistry as a diagnostic tool and its limitations are also presented. Although the cytologic interepretation is fundamentally important, clinical information such as age, location and imaging data, in addition to cytologic findings, were emphasized as also being necessary for the identification of histologic type in a given case.
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Soji KURITA, Takashi KOSHIKAWA, Shigeo NAKAMURA, Sadayuki KABA, Kiyoko ...
1993 Volume 32 Issue 6 Pages
1112-1117
Published: 1993
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From 1980 to 1991, 808 aspiration cytology specimens ofsuperficial lymph nodes were obtained from 740 patients. In228 of the 740 patients, the results of aspiration cytology werecompared with the histological diagnosis made on subsequent surgical biopsy. Of 110 cases of metastatic tumor, 99 (90%) were cytologically diagnosed as metastatic tumor, and 1 (1%) as malignant lymphoma. Of 72 cases of malignant lymphoma, 53 (74%) were cytologically diagnosed as malignant lymphoma, and 1 (1%) as metastatic tumor. Of 46 cases of reactive disease, 2 (4%) were considered to be false for malignant lymphoma. Malignant lymphoma was classified into 3 groups: B cell lymphoma, T cell lymphoma and Hodgkin's disease. The rate of positive cytologic diagnosis for malignancy was 87%(40 of 46) for B cell lymphoma, 50%(10 of 20) for T cell lymphoma and 67%(4 of 6) for Hodgkin's disease. T cell lymphomas were subclassified by the malignancy grade using the updated kiel classification. The positive diagnosis rate was 86%(6 of 7) for the high grade group and 31%(4 of 13) for the low grade group.
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[in Japanese], [in Japanese]
1993 Volume 32 Issue 6 Pages
1118-1119
Published: 1993
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Hideo TESHIMA, Sumiko KOI, Katsuyosi KATASE, Satoshi UMEZAWA, Tomoyasu ...
1993 Volume 32 Issue 6 Pages
1120-1125
Published: 1993
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We have followed up patients with dysplasia to study the relationship between HPV infection as an oncogenic factor and cervical cancer. For this purpose, we did not perform punch biopsy except as the first biopsy for diagnosis. Cervical and vaginal pooled cells were collected to detect HPV DNA by Southern blot hybridization.
Although a plurality of HPV types was detected in CIN lesions, HPV 16 was prevalent in CIN III. HPV 16 was also prevalent in squamous cell carcinoma, whereas HPV 18 was predominant in adenocarcinoma of the uterine cervix.
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Junzo KIGAWA, Hiroaki ITAMOCHI, Yasunobu KANAMORI, Yukihisa MINAGAWA, ...
1993 Volume 32 Issue 6 Pages
1126-1131
Published: 1993
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The purpose of this study was to clarify the usefulness of detection methods for human papilloma virus (HPV) using cell specimens and possibilities for their clinical application. A total of 149 women who visited Tottori University Hospital were examined in the present study. Using cell specimens, immunohistochemistry (ICH), in situ hybridization (ISH), Dot blot, Southern blot, and polymerase chain reaction were carried out. In addition, the incidence of HPV infection, detected by only smear, was determined in a total of 47, 868 women who received cancer mass screening in Tottori Prefecture. The present study revealed both advantages and disadvantages of each method. Retrospectice studies with ICH or ISH showed that of 11 patients with dysplasia and positive HPV, 9 had had previous infections with normal smears. The follow-up study on women who were HPVpositive showed that HPV disappeared within one year in 3 of 4 cases with normal smears. If the above-mentioned methods were to applied in mass screening, the incidence of HPV detection would increase to more than 100 times what it is using only smears. In conclusion, although it is possible to detect HPV with cell specimens, our results suggest that certain problems with these detection methods exist in women with normal smears.
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Tomoko HASHIMOTO, Yasuhiro SOTOZONO, Atsuko OGAWA, Yoshito EIZURU, Ken ...
1993 Volume 32 Issue 6 Pages
1132-1137
Published: 1993
Released on J-STAGE: November 08, 2011
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For rapid detection of an active stage of humancytomegalovirus (HCMV) infection, the polymerase chain reaction (PCR) technique was used to amplify CMV-DNA existing in cells of patients after bone marrow transplantation (BMT). DNAs were extracted from peripheral blood leukocytes, bone marrow cells, urine sedimentation cells, bronchoalveolar lavage fluid cells, and salivary cells using a DNA isolation kit and 0.1-1 μg of DNA was used for PCR. PCR-primers had CMV-specific sequences corresponding to the HindIII V-region of CMV, and PCR-amplified bands were detected by agarose gel electrophoresis. Therefore, in order to detect CMV-DNA, four hours were required after sample collection.
All samples found to be CMV-positive by PCR were also positive by both direct immuno-peroxidase staining and CMV isolation using cultivation. Although approximatery 90% of adults are reported to have latent CMV infection, no bands were amplified from samples obtained from normal adults or from patients before BMT. Since interstitial pneumonia caused by CMV is highly lethal for post-BMT patients, we periodically screened for active CMV infection in these patients by PCR. When patients were found to be CMV-positive, ganciclovir was adminstrated until CMVDNA was no longer detected by PCR. Twelve post-BMT patients were found to have active CMV infection without symptoms, and all of them survived after rapid diagnosis followed by ganciclovir administration. Consequently, the rapid diagnostic method described here was valuable for determining whether ganciclovir should be prescribed for these patients.
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