The Journal of the Japanese Society of Clinical Cytology
Online ISSN : 1882-7233
Print ISSN : 0387-1193
ISSN-L : 0387-1193
Volume 34, Issue 4
Displaying 1-36 of 36 articles from this issue
  • Motoi SASAGAWA, Shiro ISHII, Yoshiichiro SHIOTA
    1995 Volume 34 Issue 4 Pages 599-602
    Published: 1995
    Released on J-STAGE: November 08, 2011
    JOURNAL FREE ACCESS
    The clinical usefulness of cervical smears in the diagnosis of vaginal candidiasis has yet to be evaluated. We, therefore, estimated the sensitivity and the reliability of the diagnosis of candidiasis by cervical smear. The results obtained were as follows:
    (1) Using 45 cases with positive culture for Candida, in which a cervical smear was obtained simultaneously, diagnostic sensitivity was analyzed. The presence of Candida was reported in 23 cases (51%). By careful re-screening of the smears where no Candida was found, fungal pseudohyphae and/or yeast was observed in 14 cases.
    (2) In 17 cases in which Candida was reported to be positive by cervical smear, vaginal discharge was cultured two weeks later. Candida was isolated in 16 of these cases (94%).
    The sensitivity of the diagnosis of Candida infection by cervical smear was approximately 50%, but the detection of fungal pseudohyphae and/or yeast may be possible in 80% of cases with careful screening. Conversely, the positivty rate for Candida was considered to be extremely reliable.
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  • Takashi KITAMURA, Toshiyuki MITSUYA, Hitoshi ITOH, Shigeo SEINO, Shin- ...
    1995 Volume 34 Issue 4 Pages 603-607
    Published: 1995
    Released on J-STAGE: November 08, 2011
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    We conducted a morphological investigation of the Papanicolaou staining (Pap.) of myoepithelial cells (MEC) in the normal lactiferous duct system and mammary gland benign tumors. For the normal lactiferous duct system, extirpated breast tissue from 5 mammary carcinoma cases was employed, and the MEC was sampled from mammary large ducts and peripheral lactiferous ducts. After Pap. staining photography, decoloring was performed, and the enzyme antibody method was used to stain smooth muscle actin (SMA), and the SMA positive cells and Pap. staining results were compared. The same procedure, with aspiration cytology, was used for the comparison of 31 cases of fibroadenoma and 7 cases of intraductal papilloma, the latter of which had been diagnosed histologically. In the study of the normal lactiferous duct system, the N/C ratio of the MEC of the mammary large duct type was very low, and the cells had abundant cytoplasm readily stained light green in fibrous fashion. The MEC of the peripheral lactiferous ducts on the edges of the epithelial cell clusters or above them appeared as spindle-shaped to oval-type naked nuclear cells with unclear cytoplasm. MEC of the fibroadenoma showed denselystained spindle-to-oval-shaped naked nuclear cells with granular chromatin. In the round nuclei, we observed epithelioid MEC with lace-like cytoplasm stained light green. Localization appeared in the form of cell clusters on the outermost layer and above the cell grouping. In the intraductal papilloma, the MEC resembled the naked nuclear-type originating in peripheral lactiferous ducts, or looked like the MEC with clear cytoplasm having a microfibrillar appearance that stained light green or, in some cases stained darkly and originated in mammary large ducts. Based on the findings of the present investigation, mammary gland MEC, both in the normal lactiferous duct system and benign lesions of the mammary gland, can be divided into two types, mammary large duct and peripheral lactiferous duct types, each with markedly different Pap. staining.
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  • elial proliferation with special reference to a comparison of cytological features on fine needle aspiration biopsy
    Taku KATOH, Hisao TAKAHASHI, Tomoko ANDOH, Yoshihiro IDA, Noriyuki TOH ...
    1995 Volume 34 Issue 4 Pages 608-613
    Published: 1995
    Released on J-STAGE: November 08, 2011
    JOURNAL FREE ACCESS
    We performed a comparative analysis for hard-to-diagnose breast diseases with small round cell types on fine needle aspiration cytology. The materials consisted of 10 benign cases (fibroadenoma with epithelial proliferation, mastopathy with ductal hyperplasia and intraductal papilloma) and 20 malignant cases (noninvasive ductal carcinoma excluding comedo type and invasive ductal carcinoma with a predominent intraductal component).
    1. Appearance of background component
    1) Stromal components were seen in 70% of benign diseases cases followed by 25% of invasive carcinomas while the absence of these components was confirmed in noninvasive carcinomas.
    2) A large number of naked nuclei-like cells (fibroblasts) were seen in 70% of benign disease cases and 8% of invasive carcinomas. However, no cells were observed in noninvasive carcinomas.
    3) Although no necrotic substance was identified in benign disease, these findings were present in 25% each of invasive and noninvasive carcinomas.
    2. Appearance of epithelial cells
    1) Connective cells were numeroun in benign disease cases (80%) followed by noninvasive carcinomas (63%) and invasive carcinomas (58%). Whereas, cells were sparse in 42% of invasive carcinomas, 38% of noninvasive carcinomas and 10% of benign disease cases.
    2) Irregular nuclear shape was observed in 25% and 50% of noninvasive and invasive carcinomas, respectively, but, only 10% of benign disease cases demonstrated this pattern.
    3) Coarse chromatin was characteristic of noninvasive carcinoma (100%) and invasive carcinoma (92%). However, it was also seen in 30% of benign disease cases.
    4) No difference was observed in cellular arrangement, nuclear size variability or mitosis.
    We conclude that although cytological differentiation is difficult, specifically in breast diseases with marked epithelial proliferation, it is important to make a diagnosis in consideration of the above-mentioned features.
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  • Toshiro YOKOYAMA, Tomoko YOSHIDA, Setsuo SUGISHIMA, Toshihiro KOGA, Sa ...
    1995 Volume 34 Issue 4 Pages 614-620
    Published: 1995
    Released on J-STAGE: November 08, 2011
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    We carried out cytological examinations on smeared cells from 4 cases of intracystic papilloma and 7 cases of intracystic carcinoma to clarify the cytological characteristics of these two conditions. There were differences in the cytological characteristics of clustered cells of the individual cells. The cytological features of the clustered cells were characterized as follows;rich tumor cell cytoplasm at the periphery of the cluster in intracystic papilloma, the long axes of nuclei uero arranged in the same direction in intracystic papilloma and in a radiating fashion in intracystic carcinoma, apocrine like cells were present in the background in intracystic papilloma, and some tumor cells were located away from the cluster in intracystic carcinoma. The characteristics of the individual cells can be summarized as follows; central nuclei and partially thickened cytoplasm in intracystic papilloma, prominent vacuolation of the cytoplasm and deviated nuclei with prominent nuclei in intracystic carcinoma.
    Cytological morphometory revealed that the long-diameter of the nuclei of intracystic papillary carcinoma was 1.2 times greater than that of intracystic papilloma (9.2±1.6μm vs 7.7±1.9 μm;P<0.01).
    The coefficient of the variation of the long-diameter of the nuclei of intracystic papilloma was greater than that of intracystic papillary carcinoma (25.5% vs 18.3%), indicating that intracysitic papilloma showed more variation nuclear in size. On the other hand, there was no significant difference in the mean area of the nuclei of intracystic papillary carcinoma and intracystic papilloma (34.5% vs 33.0%).
    In cytological diagnosis of cystic lesions of the breast, detailed observation of the architecture of clustered cells at low magnification and overall assessment of the individual cells are important.
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  • Mitsugu ISHIZAWA, Yasuo SATO, Sawako MOTEGI, Toshiko FUJINOKI, Masayos ...
    1995 Volume 34 Issue 4 Pages 621-627
    Published: 1995
    Released on J-STAGE: November 08, 2011
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    We studied 6 cases of breast cancer with cyst formation cytomorphologically. During the last 6 years, our hospital treated 162 breast cancer cases and 6 (3.7%) of whom had cysts larger than 1 cm in diameter. Out of these 6 cases, three exhibited elevated cancerous lesions intracystically, termed intracystic carcinoma, all of which were diagnosed as papillotubular carcinoma. The other two cases had no elevated cancerous lesions in the cysts and the histopathological diagnoses were solid-tubular carcinoma and noninvasive ductal carcinoma. Cytological examination of the aspirated cystic fluid was performed in these 5 cases, and four were found to be malignant and one borderline. The last case had skin invasion and cyst formation due to intratumorous necrosis, and the histopathology was squamous cell carcinoma. Malignant cells were also detected by scratch cytology of the skin ulcer. In all 6 cases, atypical cells were detected by preoperative cytology, and the cytological features reflected the histopathology accurately. Thus, cytological examination is valuable especially in cases without elevated lesions that have cancer in the cyst wall and often escape clinical diagnosis. These findings may be considered to be precursors of intracystic carcinoma of the breast.
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  • Yukitoshi SATOH, Motoko IKENAGA, Masafumi TSUZUKU, Saburo HARASHIMA, A ...
    1995 Volume 34 Issue 4 Pages 628-633
    Published: 1995
    Released on J-STAGE: November 08, 2011
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    The authors studied the cytologic characteristics of pulmonary metastasis from breast cancer using 42 resected cases. Two types of typical cell features have been documented, for the first time, herein;small cell type (SCT) and large cell type (LCT). SCT showed small cancer cells, with overlapping and a high nuclear-cytoplasmic ratio (N/C ratio), forming papillary or spherical clusters. The cells contained hyperchromatic nuclei showing fine granularity and were somewhat less than twice the size of neutrophilic leukocytes. These findings were observed mainly in papillotubular and solid-tubular breast carcinomas. In LCT cases, large atypical cells with high N/C ratios sometimes appeared in irregular-shaped or gland-forming clusters with loose cell-to-cell connections. These cells were approximately double, or more, the size of neutrophilic leukocytes, They contained coarse and hyperchromatic nuclei, occasionally showing a papillary process. These findings were observed mainly in solid-tubular and scirrhous breast carcinomas. According to these cytologic characteristics, especially those of cell clusters and nuclei, the diagnosis of pulmonary metastasis from breast cancer is possible based on cytology.
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  • Sakae HATA, Noriko OSUGI, Takuo KANAHARA, Minako BANDOU, Masae YAMAGUC ...
    1995 Volume 34 Issue 4 Pages 634-639
    Published: 1995
    Released on J-STAGE: November 08, 2011
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    We studied the cytomorphologic findings of eight cases with adrenal pheochromocytoma and six cases with extraadrenal paraganglioma. The cytological features were as follows.
    1) Most tumor cells were individually scattered and some showed epithelial-like clusters. 2) The nuclei were round or oval in shape, and variable in size. Huge nuclei, multinucleated giant cells and intranuclear cytoplasmic inclusions were seen. 3) The shapes of the tumor cells were round, polyhedral, or spindle. 4) The cytoplasms were abundant, cyanophilic and fine granular. Nuclear cytoplasmic ratios were low. 5) May-Gruwald-Giemsa staining demonstrated eosinophilic or basophilic granularity in the cytoplasm. 6) Hyaline globules and endothelial cells were seen in the background. 7) Hemosiderin, Melanin-like pig ments, and cholesterin crystals were also seen. The tumor cells in three cases with metastases tended to be less-cohesive, smaller in size and had higher N/C ratios.
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  • Takahiro TSUJI, Kazuto IIO, Yumiko USHIGAKI, Miho TAKEUCHI, Akiko KODA ...
    1995 Volume 34 Issue 4 Pages 640-645
    Published: 1995
    Released on J-STAGE: November 08, 2011
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    A case of adenoma malignum of the uterine cervix, which recurred in the vaginal stump four years after simple total hysterectomy, is reported. The patient, a 41-year-old woman, gravida 1 para 1, was referred to our department because adenocarcinoma had been detected upon biopsy of masses found in the vaginal stump. At the first examination, several masses the size of small beans were found on the left side of the vaginal stump, suggesting metastatic adenocarcinoma. Computer-assisted tomography of the whole body showed no other tumor suggestive of the primary focus. A microscopical review of the uterine specimen resected four years previously disclosed that some cervical glands had extended beyond the original glandular region to form a small cyst. The histological features of these cervical glands closely resembled those of the masses in the vaginal stump, and immunohistological staining revealed that the glands were positive for CEA. On the basis of these findings, a diagnosis of adenoma malignum of the uterine cervix was obtained from the uterine specimen.
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  • Naruaki MATSUI, Hideyo HURUSHIMA, Ikuo SATO, Norio MATSUOKA, Masahumi ...
    1995 Volume 34 Issue 4 Pages 646-650
    Published: 1995
    Released on J-STAGE: November 08, 2011
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    A case of Adenoma Malignum is reported, with microscopical findings, histopathological stereo-structural findings and the measurement of DNA content. The patient was a 68 year-old married woman. Cytologic examination of the uterine cervical scratch smear showed several clusters in a sheet, with an acinus and a palisade consisting of high columnar epithelial tumor cells containing round nuclei, prominent nucleoli and fine granular or fine reticular chromatin. Histological study revealed the proliferation of cervical columnar epthelial tumor cells with marked mucous production and invasion into the deep muscular layer with papillary growth and the irregular projection of glandular ducts. With the result of stereo-structural study of the neoplastic duct, extraordinary dilatations, irregular bifurcations and lateral projections of glandular ducts were recognized. It was suggested that these findings were consistent with clusters of sheet like or acinus cells in cytology. Comparson of normal cervical glands with neoplastic glandular ducts in the stereo-structural study, suggested the usefulness of this method for distinguishing adenocarcinoma in situ from microinvasive adenocarcinoma regardless of whether or not. acinus cell clusters are presented. The measurement of DNA content showed a diploidy pattern with 2.2C at the peak.
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  • the first case report in Japan
    Emiko NAKAMURA, Masami TAKIZAWA, Toshio SHIMIZU, Hiromichi TSUKADA, Yu ...
    1995 Volume 34 Issue 4 Pages 651-656
    Published: 1995
    Released on J-STAGE: November 08, 2011
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    Adenoid basal carcinoma (ABC) of the uterine cervix is an extremely rare disease and only 20 cases have previously been reported in English. We present the first Japanese case of ABC, occurring in a 60-year-old female who underwent a modified radical hysterectomy with a tentaive diagnosis of early-invasive epidermoid carcinoma. Cytologic smear results of the cervix are summarized as follows; 1) dense cellular aggregates and rather flat cellular sheets composed of small, basaloid cells with oval to elongated nuclei, dense chromatin, and inconspicuous nucleoli were present. 2) glandular structures were sometimes seen in cellular aggregates. 3) atypical intraepithelial squamous components were present in the background. Histologically, ABC is characterized by small nests and cords of uniform round or oval small cells, with scant cytoplasm and small dark nuclei. There are some foci with squamous differentiation, pseudoglandular structures, usually seen in adenoid cystic carcinoma, intraepithelial atypical squamous components and little stromal reaction. In view of its excellent prognosis, ABC should be distinguished from squamous cell carcinoma with basaloid features, small cell carcinoma, adenoid cystic carcinoma and adenosquamous carcinoma.
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  • Masahide SHIOTANI, Tatsuji HOSHINO, Yoshiyuki ONO, Masanori IKEUCHI, E ...
    1995 Volume 34 Issue 4 Pages 657-662
    Published: 1995
    Released on J-STAGE: November 08, 2011
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    In a clinicopathological review of 234 cases of endometrial carcinoma diagnosed in our department between 1980 and 1994, 4 cases of clear cell carcinoma of the endometrium were found representing a frequency of 1.7%.
    Histologically, three basic patterns, papillary, tubular and solid, were identified these four cases. There was an admixture of two or even three patterns in all cases. All cases had PAS positive cytoplasmic materials.
    The cytologic features of three cases with histologically solid pattern included a sheetlike arrangement and abundant clear cytoplasm. Tumor cells of these cases had oval nuclei with anisonucleosis, fine granular chromatin and conspicuous nucleoli. Based on these findings, it may be relatively easy to differentiate clear cell carcinomas from other endometrial adenocarcinomas cytologically. The cytologic features of one case with a tubular pattern histologically were a “yatsugashira” shaped arrangement and a “marimo” shaped arrangement of tumor cells. These findings may also contribute to the cytological diagnosis of clear cell carcinoma of the endometrium.
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  • Kaichirou MORISHITA, Yukihisa MINAGAWA, Junzo KIGAWA, Naoki TERAKAWA
    1995 Volume 34 Issue 4 Pages 663-665
    Published: 1995
    Released on J-STAGE: November 08, 2011
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    A case of malignant müllerian mixed tumor (MMMT) of the uterine corpus in a 58-year-old woman is presented. Cytologic examination with endocyteR revealed the coexistence of epithelial and non-epithelial malignant cells prior to histologic diagnosis. Histologically, the tumor was composed of well-differentiated endometrial type adenocarcinoma and rhabdomyosarcoma, as a heterologous element. She died of the primary tumor 42 months after the initial operation despite two surgeries and intensive chemotherapy.
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  • Hirokazu IKARASHI, Shoji KODAMA, Norio YOSHIYA, Kenichi TANAKA, Etsuko ...
    1995 Volume 34 Issue 4 Pages 666-669
    Published: 1995
    Released on J-STAGE: November 08, 2011
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    We report a case of carcinoma in situ of the fallopian tube that was detected by atypical cells in a cervical smear obtained on mass screening for uterine cancer. Cervical cytology revealed large tumor cells which displayed overlapping clumps. The tumor cells had large oval nuclei with obvious anisonucleosis, high N/C ratios and fine granular chromatin, as well as prominent nucleoli. The specimen was thus diagnosed as class V, derived from adenocarcinoma. Furthermore, similar tumor cells were observed in the cytological specimens of an endometrial smear and intraperitoneal lavage. In the resected left fallopian tube, no macroscopically abnormal findings were noticed, but carcinoma in situ with increased stratification, micropapillary proliferation, nuclear atypia and abnormal mitotic figures without stromal invasion were detected histologically. The patient was treated with three courses of CAP chemotherapy after the primary operation and has been alive for 2 years and 10 months without signs of recurrence.
    Carcinoma of the fallopian tube is a rare disease and preoperative diagnosis of this disease has been considered to be difficult. The present case demonstrates that it is important to take this disease into consideration in cases in whom cervical or endometrial smears reveal adenocarcinoma cells even when few or no malignant tissues are observed histologically.
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  • Matsuo UI, Kiyoshi OZAWA, Mari IIZUKA, Kohichi SUGAWARA, Yoshito IBUKI ...
    1995 Volume 34 Issue 4 Pages 670-674
    Published: 1995
    Released on J-STAGE: November 08, 2011
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    The case of a 62-year-old woman suffering from ovarian carcinoma complicated with meningitis carcinomatosa is reported. She was diagnosed as having ovarian cancer (FIGO Stage IV) by CT scan, and by peritoneal and pleural fluid cytology. The first laparotomy was performed in November 1992, and was exploratory. After three courses of chemotherapy, a second laparotomy, in which we could remove almost the entire cancer mass with the uterus, omentum, and lymph nodes, was performed in February 1993. The histological diagnosis was ovarian serous cystadenocarcinoma without lymph node metastasis. After receiving another two courses of chemotherapy, she was discharged from the hospital in April 1993. She soon developed headaches and diplopy, and was readmitted. There were no remarkable findings of brain metastasis by CT scan and MRI. In the cytological examination of spinal fluid, however, small papillary masses formed by adenocarcinoma cells, showed metastatic meningitis carcinomatosa.The patient diedabout two weeks after the diagnosis. As a consequence of prolonged survival with improving chemotherapy, central nervous system metastasis from primary ovarian cancer is increasing. Spinal fluid cytology is one of the most effective methods, of early diagnosis.
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  • Hidehiro TOKUNAGA, Junji TSURUTA, Susumu OHGAWARA, Hiroyuki SUGIUCHI, ...
    1995 Volume 34 Issue 4 Pages 675-679
    Published: 1995
    Released on J-STAGE: November 08, 2011
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    We report a case of malignant lymphoma occurring in the thymus, accompanied by emperipolesis in a hydrothorax. The patient was a 13-year-old female who complained of cough, nausea and loss of appetite. A chest X-ray and chest computed tomographic (CT) scan revealed hydrothorax and a mass in the anterior mediastinum. Needle biopsy of the mass lesion led to a histological diagnosis of malignan lymphoma which had. developed in the thymus and was characterized by the proliferation of small or medium size lymphoma cells showing slight atypia and by a remnant of Hussel's body. Cytologically, specimens from the hydrothorax were composed of lymphoma cells, macrophages, mesothelial cells and large cells containing lymphoma cells in their cytoplasms. The majority of intracytoplasmic cells appeared to be viable, because pyknotic nuclear materials and cell debris were rare and mitotic figures were observed. Therefore, this phenomenon was thought to be so-called “emperipolesis”, rather than phagocytosis. Immunocytochemically, host cells possessed macrophage markers including CD 68, lysozyme and so on. Lymphoma cells showed double positivity to CD 4 and CD 8, suggestive of T-lymphoblastic type. To our knowledge, no report describing emperipolesis in specimens from a hydrothorax has been published to date.
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  • Shigeharu HATAKEYAMA, Nobuhiro KAWANA, Seiichi KURODA, Shuji OHKUBO, O ...
    1995 Volume 34 Issue 4 Pages 680-686
    Published: 1995
    Released on J-STAGE: November 08, 2011
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    A case of signet-ring cell carcinoma originating in the BD area of the right breast of a 71 year-old woman is reported with the results of cytomorphology, mucinous stains and immunohistochemistry.
    The tumor, measuring 19.0×13.0 cm in greatest dimension with indistinct margins, was histopathologically composed of signet-ring type cells, with infiltration into fibrous adipose tissue. A few sections revealed the presence of invasive lobular carcinoma with an indianfile arrangement, foci of intraductal carcinoma, and a mucinous component.
    Cytologically, the tumor cells appeared mainly as single cell, with foamy cytoplasms which were faintly orange to reddish on Pap. stain. The nuclei were oval, and nuclear chromatin showed a coarsely granular pattern, which was evenly distributed, with prominent nucleoli, usually displaced to one side. There was no extra cellular mucin in the background. The foamy cytoplasms showed strong positively staining with PAS and pH 2.5 AB reactions. In addition, a small number of cells reacted by turning black in colar with HID-AB staining. The results obtained with these stains showed that the signet-ring cells contained both sialo-and sulfomucins in the cytoplasm.
    Immunohistochemically, the signet-ring cells were positively stained for GCDFP-15, EMA, and CEA antibodies.
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  • Diagnostic pitfalls in fine-needle aspiration cytology of parathyroid adenomas
    Mamoru MOCHIZUKI, Kyoko YOSHIDA, Michiko HIRUTA, Kikuo MORI, Mamoru NA ...
    1995 Volume 34 Issue 4 Pages 687-691
    Published: 1995
    Released on J-STAGE: November 08, 2011
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    A 46-year-old woman presented at Iwaki Kyoritsu General hospital with an approximately 3.0×2.0cm elastic, hard, movable right neck mass.
    On admission, the serum intact parathyroid hormone (intact PTH) level measured by radioimmunoassay was 1, 092 pg/ml: about 15 times the upper limit of the normal range. Fine needle aspiration cytology was performed on the mass. The aspirated material showed cohesive clusters with papillary formation, intra-nuclear inclusion and nuclear groove, which were suggestive of thyroid papillary carcinoma. We made a preoperative diagnosis of suspected co-existent parathyroid adenoma and thyroid papillary carcinoma. Tumor resection and intraoperative rapid diagnosis were planned. At operation, a well-encapsulated and smooth surfaced tumor, measuring about 1.5×2.5×0.5cm, located on the right dorsal side of the upper lobe of the thyroid, was resected. Stamp cytology specimens showed small clusters of uniform sized cells with a small follicular arrangement, possessing round or oval nuclei and abundant granular cytoplasm. Frozen sections showed various sized follicles composed of ovoid cells, with eosinophilic cytoplasm, and absence of fat cells within the proliferation. These cellular and histological appearances were characteristic of parathyroid adenoma. She underwent additional right thyroidectomy. Histological examination of the resected thyroid revealed three small nodular lesions of thyroid papillary carcinoma in the upper lobe each measuring about 5mm in diameter.
    Since parathyroid adenomas display diverse histologic appearances, fine-needle aspiration may rarely lead to a mistaken diagnosis of thyroid neoplasm in patients with parathyroid adenomas. On the other hand, between 5% and 12% of patients with parathyroid adenomas harbor a coexistent non-medullary thyroid carcinoma. This co-existence may also result in a discrepancy between the clinical impression and the aspiration cytology diagnosis.
    This case merits reporting in that the diagnostic pitfalls in fine-needle aspiration cytology of parathyroid adenomas must be considered.
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  • Yoshihiko HOSHIDA, Shigekazu HARATOME, Nobuhiro YAMASHITA, Ichirou MUR ...
    1995 Volume 34 Issue 4 Pages 692-697
    Published: 1995
    Released on J-STAGE: November 08, 2011
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    The authors report the case of a 67-year-old woman with thyroglossal duct carcinoma which was successfully diagnosed by fine-needle aspiration cytology before surgery. The patient had noticed a small nodule in the anterior portion of the neck two years previously. She did not seek medical advice because there was no pain. Subsequently, the nodule enlarged rapidly and she consulted the Kobe West City Hospital. She was diagnosed as having a thyloglossal duct cyst. Fine-needle aspiration of the cyst revealed the presence of malignant cells with intranuclear cytoplasmic inclusions indicating papillary carcinoma. The tumor and regional lymph nodes were resected by the Sistrunk method. The tumor was about 6cm in diameter and elastic hard. The surface was smooth. The cutsurface showed a cyst which contained a papillary tumor. The tumor was histologically diagnosed as a papillary carcinoma. Thyroglossal duct carcinoma has been reported to occur in 1.61% of thyroglossal duct cysts. Our case is the 26 th case reported in Japan. It is very important to identify malignant changes in thyroglossal duct cysts before surgery. However, radiological examination rarely reveals these changes. This report suggests the usefulness of fine-needle aspiration cytology for identifying malignant changes in thyroglossal ducts before surgery.
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  • Acase study
    Hiromi KITAZUME, Yukio NAKATANI, Kazuhisa KITAMURA, Miho KIKUCHI, Hito ...
    1995 Volume 34 Issue 4 Pages 698-703
    Published: 1995
    Released on J-STAGE: November 08, 2011
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    True malignant mixed tumor (carcinosarcoma) of salivary gland origin is a very rare neoplasm. Only a few descriptions of the cytologic features of this tumor are found in the literature. We report our experience with Fine-Needle Aspiration Cytology (FNAC) of a true malignant mixed tumor of the parotid gland in a 60-year-old man together with a brief review of the literature.
    The patient visited our hospital complaining of a right parotid mass, which he had noticed two months earlier. A conclusive diagnosis was not obtained by computed tomography scan and magnetic resonance imaging scan, and FNAC was carried out. Cytologically, the aspirated material showed three components: 1) loosely cohesive spindle to oval cells with enlarged hyperchromatic nuclei, suggesting undifferentiated carcinoma, 2) atypical chondrocytes in a chondromyxoid matrix, suggesting chondrosarcomatous differentiation, and 3) osteoclast-like multinucleated giant cells with no significant atypism.
    Histopathologically, the resected mass, measuring 5.0 cm in greatest diameter, consisted of areas of undifferentiated carcinoma in sheet-like growth and chondrosarcomatous areas: osteoclast-like giant cells were frequently seen admixed with the undifferentiated carcinoma. A remnant of pleomorphic adenoma was found in a hyalinizing and markedly calcified area in the periphery of the main tumor.
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  • with stamp cytologic and electron microscopic studies of the intraoperative biopsy specimen
    Kunio UEMATSU, Tadashi YAMAMOTO, Nobuhiro TAIRA, Yoshitaka TORII, Yosh ...
    1995 Volume 34 Issue 4 Pages 704-711
    Published: 1995
    Released on J-STAGE: November 08, 2011
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    A case of malakoplakia (Mp) found in both the urinary bladder and the left renal pelvis of a 51-year-old female is reported. This combination of tissues is very rare in the literature. The Mp lesion in both tissues showed the same histology. Touch smears and specimens for electron microscopy were obtained from a surgically resected specimen of the renal pelvic Mp lesion. Cells with Michaelis-Gutmann bodies (M-G body) could not be observed on 2 occasions in the urinary sediment cytology. In the touch preparations of the Mp lesion, many histiocytes contained 1 or 2 pieces of laminated M-G body which resembled the eye of an owl or a target, and measured 3.5 to 7.0 μm in diameter. In addition to the M-G bodies, many smaller round bodies less than 2μm in diameter which did not show the laminated stfucture were observed in the cytoplasm. Immunohistochemistry for α1-antichymotrypsin in the histological section revealed many positive granules in the cytoplasm which corresponded to phagolysosomes (Pl). The M-G bodies were also positively stained. The M-G bodies were observed electron-microscopically, and were comprised of electron-dense cores with needle-like crystals and homogeneous, less dense peripheral zones. In addition to the M-G bodies, many Pl were observed in the cytoplasm of histiocytes, and two types of Pl were recognized. In the M-G bodies, finger print-like laminated structures, which had been observed in Pl, were also found. This may suggest that the M-G bodies are derived from Pl, by fusion of the latter.
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  • Noboru KOIKE, Hidemi KOIWAI, Motoji SAWABE, Kaiyo TAKUBO
    1995 Volume 34 Issue 4 Pages 712-715
    Published: 1995
    Released on J-STAGE: November 08, 2011
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    Five cases of human papillomavirus (HPV) infection affecting the cytology of the voided urine are reported.
    Five male patients (A, B, C, D and E) aged from 73 to 84, average 79.4 years, were admitted for bladder tumor, ileus, liver cirrhosis, prostatic hypertrophy and lumbago after gastrectomy for cancer, respectively.
    The smears of urinary sediments revealed characteristic changes in squamous cells: koilocytotic cells, dyskeratocytes and binucleated or multinucleated cells with mild to severe nuclear atypia in all cases.
    In one case (A), HPV capsid antigen was demonstrated by immumocytochemistry.
    These atypical cells were suspected to have been derived from urethral lesions, based on the following evidenc;(1) the histologic or cytologic examinations of the bladder, ureter and renal pelvis showed neither HPV infectious change nor squamous metaplasia in cases A and B. (2) the smear of case D contained trichomonads, which are commonly found in the male urethra.
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  • Yutaka HIRASAWA, Kensuke SUDO, Yuko ITO, Masanori FUNAHASHI, Makoto KU ...
    1995 Volume 34 Issue 4 Pages 716-721
    Published: 1995
    Released on J-STAGE: November 08, 2011
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    In this report, the cytologic and histopathologic findings of chordoma of the cervical vertebra in a 44-year-old woman, and of the clivus in a 16-year-old boy, are described. The most common cytological findings were abundant mucous background, a sheet-like arrangement, and the presence of physaliferous, intermediate and stellate cells. Comparative studies between these two chordoma cases and chondrosarcoma, myxoid type, revealed the importance of discriminating the findings of epithelial-like attachment. Electron microscopy revealed abundant glycogen granules, rough endoplasmic reticulum and mitochondorial complexes in the cytoplasm around nuclei.
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  • Noriyuki FURUTA, Masafumi TSUZUKU, Rira HOSHI, Atsuko MINAMI, Reiko FU ...
    1995 Volume 34 Issue 4 Pages 722-727
    Published: 1995
    Released on J-STAGE: November 08, 2011
    JOURNAL FREE ACCESS
    Epithelioid hemangioendothelioma is a distinctive vascular tumor often arising from a vessel. This rare tumor is characterized by epithelioid endothelial cells with cytoplasmic vacuolation.
    The term was first used by Weiss and Enzinger on 1982.
    We recently experienced a case of epithelioid hemangioendothelioma of the soft tissue. The patient was a 60-year-old woman with a 3×3×2 cm mass in her left axilla.
    Tumor cells were cytologically characterized by epithelioid cell clusters in papillary or sheet like configurations. The cellular morphology varied from oval to polygonal. These cells were stained light-green and had cytoplasmic vacuoles which occasionally included red blood cells. The cytoplasmic vacuoles varied in size from small to large. The small vacuoles looked like intracytoplasmic lumina (ICL) while the large vacuoles looked like signet-ring cell carcinoma. The nuclear shapes were round to oval. The nuclei were characterized by grooves and intracytoplasmic inclusion or vacuole like structures. The nuclear chromatin pattern was fine granular with 1 to 2 small nucleoli. Mitosis was not recognized. The background was clean and there were few red blood cells. The tumor cells stained positive immunohistochemically for factor VIII related antigen in cytological material. We propose that the characteristics of epithelioid hemangioendothelioma cells include cytoplasmic vacuolation and intracytoplasmic nuclear inclusion like structures, and that these cytological findings are very useful for distinguishing this rare tumor from other tumors resemble it.
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  • [in Japanese], [in Japanese]
    1995 Volume 34 Issue 4 Pages 728
    Published: 1995
    Released on J-STAGE: November 08, 2011
    JOURNAL FREE ACCESS
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  • Koichi FUKUDA, Satoru NAKAMURA, Kyoko IWAI, Norihito MATSUO, Tsuyoshi ...
    1995 Volume 34 Issue 4 Pages 729-736
    Published: 1995
    Released on J-STAGE: November 08, 2011
    JOURNAL FREE ACCESS
    Cytopathological and therapeutic effects obtained in 14 patients with cervical adenocarcinoma, who underwent neoadjuvant chemotherapy, were examined. Two courses of combination chemotherapy were administered prior to the treatment: MMC 10 mg/body day #1, Etoposide 100 mg/m2 days #1, 3 and 5, and Cisplatin 50 mg/m2 day #1 (MEP). The relationship between cytopathological and clinical effects was evaluated after chemotherapy. The cytologic changes produced by chemotherapy were a sheetlike cell arrangement, vesicular cytoplasm or cytoplasmic vacuoles, amphophilia, enlargement of some nucleoli, multinucleation and a regular distribution of very finely granular chromatin. These cytological findings appear to reflect a good chemotherapeutic effect. In contrast, when the epithelial surface was necrotic or had no lesion with deep stromal invasion, there was a disparity between the results of cytology and those of histology. In addition, glandular structures and nuclear atypia tended to persist although the cytoplasmic degeneration was marked in cases with mucus producing adenocarcinoma cells. With respect to the direct anti-tumor effect of MEP therapy, there were 2 CR, 4 PR and 7 NC cases. The therapeutic effect was relatively good with an overall efficacy rate of 46.2%, and there was a clear correlation between therapeutic and cytopathological effects.
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  • Toshihiko IZUTU, Iwao NISHIYA
    1995 Volume 34 Issue 4 Pages 737-742
    Published: 1995
    Released on J-STAGE: November 08, 2011
    JOURNAL FREE ACCESS
    The present study was designed to analyze cervical cancer cells treated with radiotherapy or intraarterial infusion of CDDP using image analysis.
    Total nuclear extinction (TE), 5 N-exceeding rate (5 NER) and nuclear area (NA) gradually increased following irradiation, in cervical cancer cases.
    TE and 5 NER increased markedly following radiotherapy in good response cases. TE, 5 NER and NA were notchanged following irradiation in poor response cases.
    5 NER, in good prognostic cases was higher than in poor prognostic cases, significantly among cervical cancer cases treated with radiotherapy.
    5 NER and NA increased dramaticaly in good response cases treated with intraarterial infusion of CDDP.
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  • Isao SEKIGUCHI, Mitsuaki SUZUKI, Ikuo SATO, Michisato MURATA, Syuichi ...
    1995 Volume 34 Issue 4 Pages 743-750
    Published: 1995
    Released on J-STAGE: November 08, 2011
    JOURNAL FREE ACCESS
    The cytomorphological manifestations of five human ovarian carcinoma cell lines treated with cisplatin were investigated. The cells of the five lines were killed not only by necrosis but also by apoptosis. In the early stage, cell death showed an apoptotic pattern, however, later presented a necrotic death pattern. The apoptotic cells tended to appear more often in the sensitive lines than in the resistant ones. The pattern of cell death could be diagnosed by cytological specimens, and the assessment of patterns of cell death by cytology was suggested to have clinical usefulness.
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  • Yasuo HIRAI, Yoshio SHIMIZU, Satoshi UMEZAWA, Takaharu YAMAWAKI, Ikuno ...
    1995 Volume 34 Issue 4 Pages 751-756
    Published: 1995
    Released on J-STAGE: November 08, 2011
    JOURNAL FREE ACCESS
    Repeated peritoneal washing cytology using a subcutane ous reservoir was performed to evaluate the usefulness of this method for assessing the efficacy of chemotherapy.
    1. Peritoneal washing cytology using a reservoir can be repeated easily to assess peritoneal cytologic features over time.
    2. The results of preoperative peritoneal washing cytology using a reservoir coincided with the cytologic findings obtained at laparotomy.
    3. The specificity of peritoneal cytology in specimens cytologically positive for cancer was 100%. The sensitivity of this cytology for detecting malignancies was 62.5%. In the cases in which the results of peritoneal cytology converted to cancer-negative after chemotherapy, the specificity of the results of cytology for demonstrating the efficacy of chemotherapy was 86%. In contrast, most of cases in which the cytology results converted to cancer-positive were negative on imaging examinations and/or negative for tumor markers, suggesting that this cytology by reservoir is useful for early detection of peritoneal recurrences.
    4. After intraperitoneal chemotherapy, degenerative cytologic changes of malignant cells appeared in both chemosensitive and non-chemosensitive cases, and were not always correlated with the chemosensitivity of individual tumors.
    5. Intraperitoneal anticancer agents and/or BRM (Sizofiran/Lentinan) considerably altered intraperitoneal cytologic features.
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  • Noriyuki BABA, Hidetaka KAWABATA, Masatoshi MAKUUCHI, Etsuko UCHIDA, J ...
    1995 Volume 34 Issue 4 Pages 757-765
    Published: 1995
    Released on J-STAGE: November 08, 2011
    JOURNAL FREE ACCESS
    We attempted to evaluate the clinical and cytomorphological effects of multidisciplinary therapy on cases with primary breast cancer. Fifteen cases of clinically advanced (stage III or IV) breast cancer and 4 cases of recurrent breast cancer were treated with chemoendocrine therapy, irradiation or a combination of these modalities. Among these, 16 cases were evaluated as clinically effective (CR 2 cases, PR 14 cases). Cytomorphological changes were most marked in the nuclei of cancer cells. Changes in the concentration or distribution of chromatin (18 cases), and nuclear enlargement or deformation (16 cases), were frequent in cytologic specimens sampled following these therapies. However, vacuolization of nuclei (3 cases) or degenerative changes occurring in cytoplasma of cancer cells were less frequent than previously reported. Irradiation seemed to cause the most dramatic cytomorphological changes, as compared with chemoendocrine therapy. There seemed to be no relationship between cytomorphological changes and the clinical effects of these therapies.
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  • Yasuaki HIROOKA, Ryuichi HAMAZOE, Setsujyo SHIOTA, Shinji OHTANI, Mako ...
    1995 Volume 34 Issue 4 Pages 766-772
    Published: 1995
    Released on J-STAGE: November 08, 2011
    JOURNAL FREE ACCESS
    We evaluated the effects of chemotherapy for breast cancer and metastatic liver cancer using aspiration biopsy cytology.
    In 3 patients with breast cancer and 14 patients with liver metastases (10 from colorectal cancer and 4 from gastric cancer), cancer cells were obtained by the aspiration technique before and after treatment with intra-arterial infusion chemotherapy combined with local hyperthermotherapy. The degeneration indices (DI) of cancer cells were scored with predetermined criteria before and after treatment, and the correlation between changes in DI and the clinical response rate to treatment was investigated.
    The morphological changes in cancer cells consisted mainly of nuclear changes such as enlarged or swollen nuclei, giant cell formation with multiple nuclei and rough nuclear chromatin. The change in DI showed a good correlation with the rate of clinical responsiveness to treatment, and all of the patients with a DI difference exceeding 5 points between pre-and post-treatment showed a partial response to chemotherapy. There was a significant correlation between the DI difference and the survival period in patients with liver metastases from colorectal cancer (P<0.001).
    These results suggest that the DI change in cancer cells obtained by aspiration biopsy cytology is a useful means of evaluating chemotherapeutic effects at the local level and may serve as a prognostic parameter in patients with liver metastases from colorectal cancer.
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  • Makoto MOTOI, Toru KURASHIGE, Mariko MORI, Yoshie FUJIWARA, Wataru MUR ...
    1995 Volume 34 Issue 4 Pages 773-779
    Published: 1995
    Released on J-STAGE: November 08, 2011
    JOURNAL FREE ACCESS
    Evaluation of the response of patients to various treatment methods and follow-up to detect recurrence are important in the management of bladder cancer. Urinary cytology is useful in achieving these purposes and can be performed repeatedly because of less distress to the patients and the ease of sampling. The efficacy of urinary cytology in evaluating treatment and following up patients with bladder cancer was assessed.
    Classification of response to treatment was performed using the radiotherapy criteria response for cancer of the cervix (Moriwaki et al.). Responses were classified from RO (non-effective) to R, (complete response) according to the degree of degeneration and diminution of cancer cells.
    The subject of this study was 43 bladder cancers (42 TCCs and 1 SCC). The total number of samples was 428 (average: 10 samples/case). There were 3 G 1 cases, 29 G 2, 9 G 3, 1 GX, 8 pTis (CIS), 2 pTa, 7 pT 1, 1 pT 2, 2 pT 4, and 22 pTX.The pTis (CIS) patients were treated by intravesical instillation of anti-cancer drugs and BCG, pT 1 patients by transurethral resection, and advanced cases by partial or total cystectomy with adjuvant therapy.
    Reports to clinicians of response grading by urinary cytology seem useful in improving the efficacy of the treatment of bladder cancer. Response to treatment of CIS be could judged by urinary cytology alone. Using this methods, necessity of continued treatment and early detection of recurrence of bladder cancer are possible, and recurrence of ladder cancer was detected in 9 cases within the follow-up period of the study. The viability of cancer cells and differentiation between cancer cells and reactive atypical cells are discussed.
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  • Toshinori JOUZAKI, Osamu ISHIDOU, Ichiro ITO, Takahisa ONO, Suguru HAN ...
    1995 Volume 34 Issue 4 Pages 780-781
    Published: 1995
    Released on J-STAGE: November 08, 2011
    JOURNAL FREE ACCESS
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  • Masakatsu FUKASAWA, Hiroshi KAMMA, Yasushi NAKAMURA, Tsuyoshi IKEZAWA, ...
    1995 Volume 34 Issue 4 Pages 782-783
    Published: 1995
    Released on J-STAGE: November 08, 2011
    JOURNAL FREE ACCESS
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  • Mitsugu ISHIZAWA, Yasuo SATO, Sawako MOTEGI, Kunio MIZUGUCHI, Kyoji NA ...
    1995 Volume 34 Issue 4 Pages 784-785
    Published: 1995
    Released on J-STAGE: November 08, 2011
    JOURNAL FREE ACCESS
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  • Mitsuhiro NOKUBI, Kazumasa HONMOU, Sachiko KUBONO, Toshirou KAWAI, Ken ...
    1995 Volume 34 Issue 4 Pages 786-787
    Published: 1995
    Released on J-STAGE: November 08, 2011
    JOURNAL FREE ACCESS
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  • Toyonori TSUZUKI, Hidetoshi INAGUMA, Mitsuji AOKI, Masakazu KATO, Hiro ...
    1995 Volume 34 Issue 4 Pages 788-789
    Published: 1995
    Released on J-STAGE: November 08, 2011
    JOURNAL FREE ACCESS
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