Between 1987 and 1991, fine-needle aspiration (FNA) cytology was performed in atotal of 112 cases of histologily confirmed thyroid cancer at the Center for Adult Diseases, Osaka, FNA cytology resulted in a positive diagnosis in 94 (83.9%) of these 112 cases.The diagnostic accuracy of palpation, ultrasonography and radiography in the same cases of thyroid cancer was 67.0%, 58.6% and 50.0%, respectively.Thus, FNA cytology was superior to other methods in diagnosing thyroid cancer.FNA cytology provided much higher accuracy, 87.1%, in diagnosing papillary carcinoma than ultrasonography and radiology.
Suspicious and false negative cases of thyroid cancer were retrospectively analyzed.In papillary carcinoma, there appeared to be three sources of cytology errors.In four cases, identification of cancer cells was difficult because of a lack of characteristic cytological findings of papillary carcinoma.In six cases, the reason for suspicious and false negative diagnoses was related to histologic findings, such as tumor calcification, association with adenoma, and the presence of the follicular variant of papillary carcinoma.In three cases, inadequate smears were the source of cytodiagnostic errors, and in three cases of follicular carcinoma, cytological differentiation from follicular adenoma was very difficult because of cytomorphologic similarity.

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Septate cytoplasmic vacuoles (SCVs) of the thyroid are reported.Cytologically, 37.8% of papillary carcinomas and 3.6% of adenomatous goiters exhibited SCVs. There were no SCVs in follicular neoplasms, medullary carcinomas, malignant lymphomas or Hashimoto disease.The SCVs seen in papillary carcinoma had distinct septa between them, whereas the septa in adenomatous goiters were indistinct. We consider the presence of typical SCVs in aspirates to be useful in diagnosing papillary carcinoma.Histologically, SCVs were seen in the carcinoma cells forming the papillary fronds of the cystic papillary carcinoma and in the intralymphatic spaces of the diffuse sclerosing variant of papillary carcinoma.Electron-microscopically, SCVs seem to represent dilatations of rough endoplasmic reticulum.

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The author reports a comparative study of cytology and pathomorphology in the diagnosis of breast tumors.
Between January 1989 and December 1993, cytologic examination of the breast was performed in 2136 patients at Kurume University Hospital.
The cytologic diagnosis was Class I in 1158 cases (54.2%), Class II in 99 cases (4.6%), Class III in 49 cases (2.3%), Class IV in 32 cases (1.5%), Class V in 170 case (8.0%), and miscellaneous.
Histologic examination was performed in 98 Class I andII cases (negative cases) and as a result 6 cases of breast cancer, consisting of papillo-tubular carcinoma (3cases), scirrhous carcinoma (2 cases) and lobular carcinoma (1 case), were confirmed.In 169 Class IV and V cases (positive cases), 8 cases of benign lesions, i.e., fibroadenoma (3 cases), intraductal papilloma (3cases), intracystic papilloma (1 cases) and benign stromal tissue (1 case) were confirmed histologically.
The accuracy of cytodiagnosis was 93.9% in the negative cases and 95.3% in the positive cases.
In addition, 251 cases were diagnosed as Class III or over, and 178 of them were confirmed to be breast cancer histologically. Fifteen (8.4%) of the 178 breast carcinomas which did not exhibit specific mammographic and ultrasonographic findings suggestive of malignancy but in which preoperative cytologic examination suggested malignancy were examined morphologically.
These 15 lesions consisted of 6 papillo-tubular carcinomas, 4 mucinous carcinomas, 2 scirrhous carcinomas, 1 solid-tubular carcinoma, 1 intracystic papillary carcinoma and 1 non-invasive ductal carcinoma.
The size of 7 of the 15 tumors was less than 1.0 cm, while 8 of the tumors were 1.1-1.5 cm in size. Characteristically, none of the mucinous carcionomas less than 1.5 cm in size exhibited evidence of malignancy on imaging diagnosis.

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Atypical cells in spuum, bronchial scrapings and bronchoalveolar lavage fluid from45cases of interstitial pneumonia and pulmonary fibrosis were examined cytologically.
Our study revealed16cases with no atypical cells, one case of goblet cell hyperplasia, 7cases of squamous metaplastic cells with slight atypisma (one case was later found to be squamous cell carcinoma on examination of a dissected lung), 6similar cases with moderate atypia, 2cases with highly atypical metaplastic cells, 7cases of squamous cell carcinoma (no lung cancer was found at autopsy in one case), 4cases of adenocarcinoma, and2cases of small cell carcinoma.These findings suggest that squamous metaplastic cells are most frequently found in interstitial pneumonia and pulmonary fibrosis, and only17.8%(8cases) were moderate or highly atypical metaplasia belonging to Class III or higher.Cancer cells were found in13cases (28.9%) of squamous cell carcinoma, the most prevalent type.The majority of these cancer patients were heavy smokers, but3 out of the6with moderate atypical metaplasia were nonsmokers.
Our findings demonstrate that cytological follow-up of such specimens as sputum is essential in cases of interstitial pneumonia.

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Sixty-three patients with peripheral pulmonary adenocarcinoma less than2cm in diameter underwent surgical resection in the Center for Adult Diseases, Osaka between 1981 and 1992.The results of bronchial brushings and percutaneous needle aspiration cytology were analyzed to define features that predict diagnostic yield.In 80.4%of the patients with1.5-2.0-cm diameter adenocarcinomas the diagnosis was made by both techniques;but in only 40y.of lesions less than1.5cm indiamete.The bronchial brushing positive rate, inparticular, decreased as tumor size diminished. Small lesions, less than1.5cm in diameter, were more reliably diagnosed by the percutanecus needle aspiration cytology (75.0%) than by bronchial brushing (16.7%).The cytologic characteristics of small peripheral adenocarhinoma were also assessed in relation to postoperative prognosis. Our findings indicated that the presence of several nucleoli and granular chromatin densely and evenly distributed in the nucleus are negative prognostic factors for overall survival of patients with small peripheral adenocarcinoma.

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We retrospectively reviewed 576 cases of intraoperative cytodiagnosis, comparing stamp preparations with frozen histodiagnosis, in the Department of Tohoku University Hospital between 1981 and 1992.Material was obtained from the larynx, pharynx, jaw, esophagus, liver, pancreas, gastrointestinal tract and biliary tract.
Intraoperative cytodiagnosis was useful in making a diagnosis, however, there were several cases disagreement with the histodiagnosis, Sparse numbers of tumor cells and dried specimens were found in cases of inappropriate diagnoses. To improve diagnostic accuracy, we used a razor blade to obtain adequate numbers of cells for stamp proparations and succeeded in collecting large numbers of cells on the glass.when cell drying is unavoidable, suitable staining, such as with DIF-Quick, should be applied.Combined use of cytodiagnosis and histodiagnosis improves the accuracy of intraoperative diagnosis.

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In order to find useful diagnostic methods for urinary bladder malignancy, the squash cytodiagnosis was compared with histopathological examination of paraffin-embedded sections.
Biopsy specimens were obtained cystoscopically from 10 patients with transitional cell carcinoma (TCC) in various stages with and without invasion of the suburothelial layers of the bladder (2 invasive cancers/8 non-invasive cancers). Histological examination of the urinary bladder cancer in one of 10 patients with TCCs, was misleading due to a loss of the urothelial layers, probably during specimen processing. In the squash smear in this case, however, a sufficient number of clusters and individual cells were observed to make a histopathological diagnosis.
In both of the patients with invasive carcinoma, evaluation of invasiveness was possible by squash smears bosed on the presence of atypical cells among the interstitial cells, but, impossible on the basis of exfoliated cells in voided urine sediment or imprint smears of biopsy material.
The squash method is not new, but clinical application to carcinomas arising in the urinary bladder had not been assessed.The results of our study suggest that squash cytodiagnosis can be useful and convenient for detection of bladder carcinomas, including evaluation of invastion/extension of carcinomas and grading of cellular/structural atypia.
We conclude that squash cytodiagnosis should be used to complement histopathological examination in urinary bladder cancer patients.

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A cytological study of four cases of hemangiosarcoma of the craniofacial skin and heart was performed.
The age of the patients ranged from 43 to 79 years. Three were males, and one was female.
Cytologically, the tumor cells were scattered and/or formed medium-sized clusters.Spindle-shaped and polygonal atypical cells were identified against a hemorrhagic and/or inflammatory background.The nucleus of the tumor cells was eccentrically located.The chromatin pattern was granular, and the nucleoli were prominent. Multinucleated tumor cells were occasionally observed.Thetwo-cell-thick parallel arrangement of the tumor cells was observed in two of our four cases.In all of the cases, intracytoplasmic erythrocyte-like inclusions with halos were seen in the tumor cells.Immunohistochemically, the tumor cells were positive for Factor VII-related antigen, Q-Bend-10, vimentin, and Ulex europeaus agglutinin I.
Hemangiosarcomas are usually diagnosed on the basis of their histological structure, such as vascular-channel formation. Thus, cytological diagnosis may be difficult in many cases.The two-cell-thick parallel arrangement of the tumor cells and intracytoplasmic erythrocyte-like inclusions, however, appeared to be pathognomouic cytological findings of hemangiosarcoma.Immunohistochemical studies using endothelial markers are also useful in differential diagnosis cytologically.

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The fluorescence staining method using a confocal laser scanning microscope (CLSM) was performed to investigate the detailed localization of tumor marker antigens in ovarian tumor tissue, and the results obtained were compared to those of immunoperoxidase staining (ABC method).Formalinfixed paraffin-embedded ovarian tumor tissue (6 types from 52 cases) and 7 tumor marker antibodies (CA 125, CEA, CA 19-9, AFP, CA 54, CA 61, and CA 602) were used in this study.For fluorescence staining, the tissue was cut into about 20-μm thick sections in order to observe three-dimensional images by CLSM, and optimal antibody concentrations, reaction times and reaction temparatures were determined in preliminary experiments.The results of fluorescence staining findings for CEA, CA 19-9, CA 54, and CA 602 using CLSM differed from those of immunoperoxidase staining. Since specimens suitable for examination by CLSM were prepared, it was possible to more precisely localize tumor marker antigens using CLSM than by light microscopy.

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We encounter interpretive difficulties with atrophic cell patterns in postmenopausal women because of the possible presence of malignant tumor cells derived from squamous cell carcinoma.
Recently the relationship between human papillomavirus (HPV) and cervical carcinoma has been discussed. Cytodiagnostic criteria for HPV infection have been established and parakeratosis (dyskeratosis), koilocytosis, smudgednuclei, giant cells Multinucleation are regarded as cytologic evidence of HPV infection.
Occasionally we encounter the atrophic cell pattern with a few parakeratocytes and koilocytes intermingled.Theproliferation test was performed in these patients, the conjugated estrogen was administered to 8 patients as an oral a dose of Premarin, 1.25 mg daily for 2 weeks with repeat smears after completion of the test.
The cytologic manifestations of HPV infection after the test were parakeratosis in 100%(8/8), koilocytosis in 75%(6/8), smudged nuclei in 75%(6/8), giant cells in 50%(4/8) and multinucleation in 62.5%(5/8) with a clean background.
HPVs were detected by the Southern blot hybridization method in 5 patients, HPV 16 DNA was positive in 4 patients and HPV 58 DNA in 1.HPV 6/11 was detected in 1 case of 3 patients by the in situ hybridization method.
The administration of estrogen (Premarin) allows differentiation not only of malignant cells but of HPV infection from the epithelial atrophic pattern of squamous origin.

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Identical cytologic material obtained from normal endometrium (proliferative and secretory phase) and endometrial adenocarcinoma (Grade 1, Grade 2 and Grade 3) was successively examined by light microscopy (LM), scanning electron microscopy (SEM) and trasmission electron microscopy (TEM).Other specimens of endometrial adenocarcinoma were also examined by TEM.
SEM revealed that the surface of the proliferative endometrial cells consisted of small microvilli (MV), whose distribution was almost perfectly regular, and of some slender cilia.Slightly irregular MV and longer cilia than in the proliferative phase were observed in secretory endometrial cells.The MV of endometrial adenocarcinoma cells, on the other hand, were significantly more irregularly distributed and exhibited a greater variety of form than in normal endometrial cells.The cluster cells of G 1 lesions had giant projections consisting of a small number of adenocarcinoma cells and many increasingly smaller cells budding from the cluster margin.These ultrastructural findings of giant projections and cell budding may be useful in cytological examinations for malignancy.
TEM examination revealed that the internal ultrastructure of the endometrial adenocarcinoma cells consisted of an irregularly shaped nucleus, a giant mesh-like nucleolus, and a small number of swollen mitochondria.Moreover, as the endomentrial adenocarcinoma cells became more poorly differentiated, they developed marked indentations of the margin of the nucleus, a high N/C ratio and low numbers of mitochondria, lysosomes and Golgi apparatus.These findings, especially in the nucleus, are consistent with the LM evidence.
During our examination of intercellular junctions by TEM we counted the number of desmosomes.The number in G 3 lesions was significantly lower than in G 1 and G 2 lesions.We believe that the intercellular junction is a key site in the differentiation of endometrial adenocarcinoma, and that the strength of junctions greatly influences the pattern of distribution of adenocarcinoma cells observed under the light microscope.

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In order to improve the specificity of endometrial cytology specimens judged to be suspicious, a total of 53 such specimens samples were reviewed.
The results were as follows:
1) Papillary cellular clusters were observed in all samples judged suspicious.The average number of papillaryclusters per slide was 81.2±45.3 SD in the absence of histologicalabnormalities, 61.1±51.4 SD in adenomatoushyperplasia, 78.7±66.0 SD in atypical hyperplasia and 60.5±14.9 SD in endometrial adenocarcinoma.
The average numbers of papillary clusters with branches were 42.2±21.6 SD, 38.5±27.7 SD, 49.0±43.4 SD, 44.0±14.1 SD, respectively.
2) The rate of occurrence of papillary clusters with more than 6 lumens was 0% in normal endometrium, 36% in adenomatous hyperplasia, 62% in atypical hyperplasia, and 100% in carcinoma, while rates of occurrence the of papillary clusters with closely packed, so-called back-to-back lumens were 10%, 32%, 38%, 100%, respectively.
3) The rate of occurrence of arborescent fragments in which the epithelial cells were arranged on stalks of spindle cells (stromal A) was 0% in normal endometrium, 3.6% in adenomatous hyperplasia, 15% in atypical hyperplasia and 100% in carcinoma.
The results demonstrate that accurate observation of the architectural abnormalities of cellular clusters is useful in endometrial cytodiagnosis.

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To clarify the cytopathologic findings of cervical dysplasia in the elderly, cytologic and histologic material from 16 elderly patients (average age: 75.4 yrs.) were analyzed in comparison with material from 17 younger patients (average age: 38.1 yrs.).
A.The dysplasia in the elderly exhibited certain cytologic and histological characteristics.(1) Cytologically, parabasal type dyskaryotic cells displayed morphologic variety (11/16) and could be classified into the atrophic types we have reported before: syncytial cells (S type), naked cells (N type), round cells (R type), polygonal cells (P type) and tissue fragments.(2) Histologically, the dysplastic epithelium was composed of thin (less than 10) layers of atypical parabasal cells (9/16).(3) Cytologically and histologically, mild dysplasia consisting of parabasal type dyskaryotic cells was observed in some cases (6/16).
B.The dysplasia in the elderly revealed evidence of human papillomavirus infection, as well as the dysplasia in the younger patients, on the cytologic (6/16), histologic (9/16), immunohistochemical (2/16) and in situ hybridization (2/16) studies.

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To diagnose human papilloma virus (HPV) infection by cervical cytology, we classified dyskaryotic cell nuclear findings, and examined HPV capsid antigen positive rates.We also tried the blind test based on nuclear findings with high positive rates, and examined the possibility of diagnosis. Detection of capsid antigen (CA) was performed by the immunoperoxidase method after de-staining Papanicolaou preparations.
The nuclear findings in dyskaryotic cells in ten cases of dysplasia with HPV CA showed a positive rate for homogeneous nuclei (HN) of33.2%and inclusion-like body bearing nuclei (IB) of 48.4%.The positive rates for HN and IB were higher than for fine (2.4%) or coarse (1.2%) chromatin nuclei.IB hyperchromatic (IB-H: 50.3%) and brownish (IB-B: 56.4%) nuclei had high positive rates for HPV CA.
In the blind test, we suspected HPV infection when HN and IB-H were observed in the same preparation.Twentythree of the 33 cases of dysplasia were suspected of HPV infection.HPV CA was detected in 19 (82.6%) of these 23 cases.IB-B was also present in 14 of the 23 cases, and 13 (92.9%) were positive for HPV CA.
Based on these results, the appearances of HN, IB-H and IB-B appeared to be important findings for the diagnosis of HPV infection.

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The clinical usefulness of endometrial cytology using Masubuchi's aspiration tubes was assessed in 154 cases of ovarian cancer and20cases of fallopian tube carcinoma. The endometrial cytology positive rate was 13.6% in ovarian cancer and55.0%in fallopian tube cancer.
In ovarian cancer, cases of serous adenocarcinoma had the highest positive endometrial cytology rate (18.9%), whereas cases of mucinous cystadenocarcinoma exhibited the lowest positive rate (4.3%).The endometrial cytology positive rate also increased in parallel with the clinical stage.
In ovarian cancer without endometrial metastasis, 22.5% of the positive peritoneal cytology cases had positive endometrial cytology, while75.0%of the positive endometrial cytology cases exhibited positive peritoneal cytology.
In ovarian cancer, the positive peritoneal cytology rate increased in parallel with the volume of ascites, whereas no clear relationship was observed between the positive endometrial cytology rate and the volume of ascites.
The appearance of solitary malignant cells and small malignant clusters without tumor diathesis was the specific feature of endometrial cytology in ovarian and fallopian tube cancer.
Based on these observations, endometrial cytology using Masubuchi's aspiration tubes appears to be a potent method of detecting ovarian and fallopian tube cancer.

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A case of pituitary adenocarcinoma in which tumor cells were detected in the cerebrospinal fluid (CSF) is described. A 48-year-old woman was diagnosed by CT as having a tumor spreading over not only the suprasellar superior cisterna but the left frontal lobe as well.The tumor was eventually determined to have metastasized into the left occipital lobe, brain stem, cerebrellopontile angles bilaterally, and spinal cord.
Cell features: Tumor cells in the CSF varied greatly in size and were roundish in shape.They were sporadic or formed sheets, although a few large multinucleate giant cells with many vacuoles in their extensive cytoplasm were also observed sporadically.
Immunocytochemical findings: The GH, ACTH and prolactin (PRL) reactions were performed using tumor cells in the CSF.Dark-brown granules predominantly positive for GH were observed in the tumor cell cytoplasm, whereas testing was negative for ACTH and PRL.
Immunoelectron-microscopic findings: The GH reaction was performed on tumor cells in the CSF by the protein-A gold method. A large number of mitochondria and secretory granules with high electron density measuring about 200nmin diameter were observed in the cytoplasm of the tumor cells.The fact that GH-positive gold granules were always observed in association with round secretory granules proved that the tumor cells produced GH themselves, and had not trapped GH from their surroundings.

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A case of adenoma of the nipple is presented with its cytologic and histopathologic features.
A42-year-old female complained of a bloody dischargefrom her right nipple.Carcinoma of the breast was suspected on the basis of the cytological findings in the nipple discharge, but no nodular lesions were found in the right breast by palpation or mammography, and total mastectomy was performed.The smear of the nipple discharge was highly cellular, with both numerous large epithelial cell clusters and dissociated single epithelial cells.These cells had a round, oval, or sometimes pleomorphic shape.The nuclei were uniform with finely granular chromatin and small conspicuous nucleoli, but enlarged nucleoli were often seen. Some cells contained hyperchromatic nuclei.Myoepithelial cells were often observed in the epithelial cell clusters and/or between the dissociated cells.Three tiny nodular lesions were found histologically, one in the middle portion of the nipple and other two beneath the nipple.These nodules were circumscribed but unencapsulated.The ducts and duct epithelial cells had markedly proliferated and formed solid nests and tubular-like structures.Myoepithelial cells and fibrous stromal cells were observed in the tumors.High cellularity and many dissociated single cells and cells with enlarged nucleolis were misleading in the cytological diagnosis of the present case.

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A case of argyrophilic mucinous carcinoma of the breast in a 75-year-old female is reported.The cytological findings are discussed in comparison with a non-argyrophilic case.
The cytological features of argyrophilic mucinous carcinoma were cluster formation with loss of cell connectivity in the peripheral region, plump cytoplasm and nuclei with a smooth contour.
In contrast, non-argyrophilic mucinous carcinoma formed small clusters with well-preserved cellular connectivity. Immunochemical and electron microscopic observation revealed endocrine features, such as positive endocrine markers and dense-cored granules in the case of argyrophilic carcinoma, whereas non-argyrophilic carcinoma showed no endocrine features.
Argyrophilic mucinous carcinoma of the breast appears to be characterized by abundant mucus production and endocrine features, but its histological appearance was different from that of conventional carcinoid tumors of other organs.

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The patient was a 71-year-old man.Two years after atypical cells were detected in his sputum, pneumonectomy was performed with a diagnosis of squamous cell carcinoma. The resected lesion was a squamous cell carcinoma in the bronchial mucosa measuring 0.4 cm by 0.3 cm.Cytological examination of the sputum failed to demonstrate the carcinoma, but the atypical cells detected in the lesion tended to be free.The atypical cells also exhibited an increased nucleus-cytoplasm ratio and an increase in the amount and concentration of nuclear chromatin.The cytoplasm stained with orange G or appeared orange-yellow.The atypical cells were irregular in size.Those apoptotic cells with atypical nuclei were compatible with squamous cell carcinoma.

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A 79-year-old man was admitted to our hospital because of pain in the right side of the chest.A chest X-ray and chest computed tomography (CT) scan showed a round mass shadow a in right S₈.Transbronchial brushing cytology disclosed two types of malignant cells, small cell carcinoma and adenocarcinoma.Sputum cytology failed to reveal any malignant cells on admission, but both types of malignant cells appeared as the tumor progressed.Cytology of the pleural effusion showed many adenocarcinoma cells. Transbronchial biopsy demonstrated a few glandular structures lined by adenocarcinoma cells mixed with typical small cell carcinoma.The patient died one year tow months later. Postmortem autopsy examination revealed that most of the tumor had been replaced by necrotic tissue, and that the two types of malignant cells in the tumor, were separate.The small cell carcinoma cells were present in the bronchial walls of the proximal portion of the tumor, while the adenocarcinoma cells were in the distal portion of the tumor.
In summary, autopsy examination of the primary lesion indicated double cancer consisting of lung small cell carcinoma and lung adenocarcinoma.However, we could not rule out the possibility of combined small cell carcinoma, on the basis of the transbronchial biopsy, clinical data and clinical course of our patient.

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A 58-year-old man with pulmonary actinomycosis diagnosed by bronchial brushing cytology is reported.He came to our hospital complaining of cough and blood in his sputum.A chest X-ray revealed an infiltrative shadow in the left upper lobe of the lung.Bronchial brush specimens were obtained, and cytological examination revealed Actinomyces organisms in clusters.Antibiotic therapy was started immediately.He experienced pulmonary hemorrhage during treatment in the clinic and was admitted. Repeated transbronchial biopsy and brush specimens were obtained, and cytological and histological examination established the diagnosis of pulmonary actinomycosis.Left upper lobectomy was then performed.The cytological features of the Actinomyces organisms were aggregated “sulphur granules” hforming irregular islands of amorphous clumps.The color of these aggregates was green to yellowish brown, and they possessed numerous filamentous structures radiating from the center.
Organisms exhibiting branching, spores and septa were observed on the silver stained specimen.
Histochemically, the sulfur granules stained diffusely with periodic acid-Schiff (PAS), alcian-blue and mucicarmine stain, suggesting that they are composed of numerus filamentous organisms and mucopolysaccharides.

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We report a case of primary pulmonary cryptococcosis diagnosed by bronchial brushing cytology.An 18-year-old female was discovered to have multiple nodular shadows in right S⁶ on a chest X-ray as an incidental finding. Minomycin, 200mg per day, was administered intravenously, but the shadows grew worse.Bronchial brushing cytology with bronchofiberscopy yielded yeast-like organisms laden with mononuclear and multinuclear macrophages.The organisms with capsules were positive with alcian blue stain, and they were positive with Fontana-Masson stain regardless of the presence or absence of capsules.The patient was treated with an oral antifungal agent, fluconazole, 200mg a day, and the shadows on her chest X-ray improved considerably. Both Fontana-Masson stain and alcian blue stain were very useful in the diagnosis of pulmonary cryptococcosis.

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A case of renal oncocytoma and renal cell carcinoma within the same kidney is reported with emphasis on comparison of their cytological features.
Two separate tumor masses within the diseased kidney of an asymptomatic 42-year-old woman were detected by chance during an US survey as part of a health check-up. Both lesions appeared as homogeneous masses on US, isodensity areas on X-CT, high-signal areas on NMR imaging and hypervascular masses on conventional angiography.We failed to differentiate between the two based on this preoperative information.However, because of suspicion of bifocal renal cell carcinoma, the patient was subjected to radical nephrectomy with para-aortic lymphadenectomy.
Grossly, the first mass was encapsulated, well-circumscribed, tan-brown in color and 28×28 mm in size, with a hemorrhagic area, but without apparent necrosis, while the second was a firm, rounded 15×15 mm mass, yellow to white in color, with no areas of hemorrhage or necrosis.The final diagnosis of the former was renal oncocytoma, an uncommon, benign neoplasm arising in the kidney, while the diagnosis of the latter was renal cell carcinoma, subvariety clear.
Imprint cytology was carried out on a cross section of the surgical specimen.Smears of the first tumor showed the presence of characteristic eosinophilic cells with abundant granular cytoplasm, while smears of the second revealed clusters of clear cells.These findings were pathognomonic for renal oncocytoma and renal cell carcinoma, respectively. Thus, it was possible to successfully make a differential diagnosis between the two using cytological criteria.
Cytomorphologically, renal oncocytoma took the form of single cells or small loose-connected clusters with round-oval nuclei, without prominent nucleoli, in abundant eosinophilic granular cytoplasm.Some of the cells were bi-nucleated, however there was no evidence of mitotic activity, papillary configuration of the clusters or necrosis of the background. Nuclear size in the renal oncocytoma was 8μm, and the nuclei were approximately uniform in diameter.Slight but not negligible nuclear pleomorphism, ranging in size from 5 to 10μm, was seen in the renal cell carcinoma.Therefore, we anticipate that cytological analysis of fine needle aspiration smears may become useful and available for preoper ative diagnosis and differntiation between renal cell carcinoma and oncocytoma.

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A very rare case of carcinosarcoma of the prostate is reported.The patient was a 32-year-old man with a 6-cm diameter prostate tumor detected by CT-scan and ultrasound echogram.A fine needle biopsy suggested leiomyosarcoma. Touch cytology of the tumor during total prostatectomy revealed scattered cells and combined cells.The scattered cells consisted of spindle cells with a funicular pattern, atypical chondrocytes in a myxomatous background, and osteoclasts and osteoid substance, while the combined cells showed naked nuclei of the round type and frequently molding, and lack of differentiation.The spindle cells were immunocytochemically positive for vimentin and muscle actin, the atypical chondrocytes were positive for s-100 protein, and the combined cells were positive for CEA, EMA and keratin. Histological examination resulted in a diagnosis of carcinosarcoma of the prostate.The non-epithelial portion consisted of chondrosarcomatous, osteosarcomatous and leiomyosarcomatous components and the epithelial portion of undifferentiated carcinoma.The tumor showed growth of medullary, many nuclear mitoses, and strength vessel infiltration. The pathogenesis of this tumor appeared to be from immature mesenchymal cells of mesodermal tissue.

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This is a report of a case of Hand-Schüller-Christian disease (HSC) diagnosed by aspiration cytology.A 7-year -old female complained of swelling of her left forehead.A CT scan and X-ray of the head revealed punched-out lesions and osteolytic lesions of the skull.To make a definitive diagnosis, aspiration cytology was performed on the cystic mass in the forehead.Aspiration cytology revealed dendritic cells characterized by abundant eosinophilic cytoplasm and grooved nuclei, with some foamy cells and eosinophils in the background.Immunohistochemical studies were positive for S-100 protein, OKT-6 (CD 1 a) and Leu 3 a (CD 4). Electron microscopically, a few Birbeck granules were observed in the cytoplasm of these cells.This is a rare case of HSC discovered because of a cystic lesion resulting from a bruise of the left forehead.It is significant that we were able to make a definitive diagnosis of HSC by aspiration cytology, a comparatively non-invasive technique.

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Tenosynovial giant cell tumor, diffuse type, especially the extra-articullar form, is extremely rare.We report a case of this tumor in which a presumptive diagnosis was made by fine-needle aspiration cytology, after a malignant tumor was suspected clinically.
The patient was a 50-year-old female with a 13×8cm mass in the immediate vicinity of her right knee joint.We suspected a malignant tumor because of its size and radiographic findings, but fine-needle aspiration cytology suggested tenosynovial giant cell tumor (class II).Cytologic findings consisted of many histiocytotic cells, including cells with intracytoplasmatic hemosiderin-like granules, and xanthomatous cells.Multinucleated giant cells and spindle cells were also seen.The diagnosis by open biopsy was tenosynovial giant cell tumor, diffuse type.At operation, a solid mass was found centered on the pes anserinus, and did not involve the joint.Microscopically, the tumor displayed multilobulated, slit-like cavities and villus formation, so we made a diagnosis of tenosynovial giant cell tumor, diffuse type.Fine-needle aspiration cytology appeared to be useful in the diagnosis of tenosynovial giant cell tumor, diffuse type.

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We report a case of primary soft tissue lymphoma.The patient was a 75-year-old woman who complained of pain and swelling in her right leg.The tibialis anterior muscle was replaced by yellowish soft tumor, and a frozen section revealed diffuse proliferation of atypical cells with occasional lipid droplets. Imprint cytology showed scattered neoplastic cells with round, sometimes cleaved nuclei containing one or several nucleoli.The cytoplasm was scarit, but small numbers of tiny lipid droplets were seen. Pathologically, round-cell type liposarcoma was suspected at first, but immunohistochemical positivity for LCA and L-26 demonstrated the tumor to be a genuine lymphoma.No dissemination was discovered upon examination by palpation, radiography, CT scans, MRI, and gailium scintigraphy. Systemic chemotherapy was performed, and no evidence of disease has been detected for nearly three years.Cytological and immunohistochemical studies appear to be potential diagnostic tools for primary soft tissue lymphoma.

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We report a case of vaginal clear cell adenocarcinoma diagnosed cytologically before biopsy.The patient was referred to our hospital with atypical genital bleeding and a tumor in the vaginal wall.The surface of the tumor was eroded and bled easily.Vaginal smear cytology was positive.
The smear background showed tumor diathesis. The malignant cells formed several clusters, like a ball or bunch of grapes in a sheet-like arrangement.The tumor cells had abundant, clear cytoplasm.The nuclei were large and round, with fine granular chromatin and prominent, large nucleoli.Histologically the tumor cells which had abundunt clear cytoplasm, exhibited glandular fomations and partially displayed a hobnail pattem.Their cytoplasm was PAS positive.Thus, we made a diagnosis of vaginal clear cell adenocarcinoma.The patient was treated with radiotherapy and chemotherapy because the tumor was too large to resect at one time.After these treatments the tumor had diminished enough in size to be able to resect it completely. The surgical specimen revealed no surving tumor cells.The patient was discharged and has been followed up as an outpatient.
In spite of relatively characteristic cytological features, this tumor is diagnosed prior to histological examination in only 30-70% of cases.This may be due to the method of collection.A routine smear of the cervix may not reveal evidence of a vaginal neoplasm.It is concluded that careful inspection and palpation are important and that cytologic examination of the quadrants of the vagina is necessary to detect this tumor at an early stage.

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A case of uterine leiomyosarcoma which was difficult todiagnose cytologically because of the presence of epithelioidclusters is reported.Three different cellular componentsincluding scattered spindle-shaped and giant cells, and epithelioidclusters, first suggested Miillerian mixed tumor.Immunocytochemistrystudies, however, were positive for desmin, vimentin and smooth muscle actin, but negative for CEA, EMA, SC and myoglobin, indicating the same origin as smooth muscle.Retrospective examination of Papanicolaou -stained specimens revealed common findings of finely granulated chromatin and thin nuclear borders in these cells. It is concluded that detailed analysis of nuclear borders and chromatin patterns is mandatory to clarify the origin of the cells, especially in the case of stump specimens of uterine leiomyosarcoma.

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