Forty patients diagnosed cytologically or histologically as pulmonary large cell carcinoma were operated on between 1981 and 1992 in our hospital. These cases were classified into 3 groups;18 cases (CYT-group) were diagnosed cytologically as large cell carcinoma but histologically as another type of lung carcinoma (non-large cell carcinoma), 16 cases (HIS-group) were diagnosed cytologically as nonlarge cell carcinoma and histologically as large cell carcinoma, 6 cases (Concordance-group) both cytologically and histologically as large cell carcinoma. Cellular findings, histologic features and the findings of mucinous staining and immunocytochemistry were analyzed in the 3 groups. Necrosis in the background, giant cancer cells and cytophagocytosis by cancer cells, the apparent characteristics of large cell carcinoma, were found more often in the CYTgroup than in the HIS-group. Moreover, variation in the nuclear size was statistically larger in the CYT-Group than in the HIS-group. Discordance between cytologic and histologic diagnoses was partly due to poor differentiation of the tumo. The results of mucinous staining and immunocytochemistry were not always helpful in making an accurate cytologic diagnosis.

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Numbers of asbestos bodies in sputum and lung tissue were compared in 12 autopsy cases. Intratracheal sputum was examined by sputum cytology and a digestion procedure, and lung tissue was examined by the digestion procedure. Asbestos bodies were found in intratracheal sputum in only one of the 12 cases, bysputum cytology, but in eight by the digestion procedure. Asbestos bodies of varying number were found in the lung tissue of all patients by the digestion procedure. Nine cases were evaluated as highly exposed to asbestos (over 150 asbestos bodies/5g of wet fixed lung tissue), and eight of them were found to have asbestos bodies in their intratracheal sputum by the digestion procedure. Therefore, detection of asbestos bodies in sputum by the digestion procedure is strong evidence of highl exposure to asbestos. The digestion procedure using sputum should be a useful tool in screening for asbestos exposure.

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Mass screening for lung cancer based on radiologic and sputum cytologic examinations was begun in 1981 by the Osaka Lung Project. In this report, we present the results of further examinations and of follow-up studies of the cases identified as category D or E by sputum cytologic examinations during the 10-year period from 1981 to 1990. Sputum specimens were obtained from 16, 992 acceptable high-risk persons, amon which 16, 795 (98.8%) specimens were satisfactory. A total of 402 cases underwent further examinations and 28cases of primary lung cancer were confirmed. Thus, the positive predictive value of sputum cytologic examination was 6.97%. Fifty-three of the 16, 795 sputum specimens were fond to have category D and 14 were found to have category E. Primary lung cancers were confirmed in 14case reported as D. The positive predictive value for category D was thus 26.42%. Nine cases reported as E were confirmed, the positive predictive value being 64.29%. Twelve (85.7%) of 14 cases reported as D and 2 (33.3%) of 6 cases reported as E were detected in clinical stage I. Thus, the freqency of stage I lung cancer was higher in D. Ten out of 14 cases reported as D were found to have lung cancer by sputum cytology only and all were detected in clinical stage I. After 5years of follow-up, 2 of 3 cases reported as E could not confirmed as having either lung orlaryngeal cancer and were thus considered to be false positives.

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We immunohistochemically investgated the expression of ErbB-2 and c-myc proteins in stamped specimens from 43 papillary carcinomas, 26 follicular adenomas and 22adenomatous goiters. Papillary carcinoma had higher positive rates, 65.1%(28/43) for ErbB-2 and 60.5%(26/43) for c -myc protein, than follicular adenoma and adenomatous goiter (all P<0.001, Fisher's exact method). For these oroteins. the immunohistochemical results agreed in 71.4% of specimens. In samples positive for ErbB-2 the number of observed metastases increased with the number of lymph nodes examined, while in samples negative for ErbB-2 the number of metastases had no relation to the number of lymph nodes examined. The tumors positive for ErbB-2 tended to invade adjacent tissues. The c-myc protein had no relation to either metastasis or invasion. For both of these proteins, immunohistochemical results agreed with the cytological and paraffin embedded histological results in as many as 83% of specimens. These results suggest the potential usefulness of cytological examination in the preoperative estimation of metastatic status and the tendency for invasion.

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Though aspiration cytology biopsy of the breast is a useful and important tool for determining the treatment method, there remained some difficult diagnostic cases.
We have been planning to use new criteria for the diagnosis of difficult breast cytology cases. We classified these cases into two groups, i. e. CIIIa and CIIIb. Cells in the CIIIa group show some cellular and nuclear atypism, but not enough to confirm the benign or malignant character of the lesion. Cases of type CIIIa are recommended, according to clinical estimation of all clinical examinations, to undergo re-examination by means of aspiration cytology, or careful follow-up study, or excisional biopsy for pathologic confirmation. In the CIIIb group, cellular atypism of cytologic figures resembles that of malignant cells, but is not conclusive for malignancy, so we recommend excisional biopsy, or reexamination of aspiration cytology.
From Jan. 1988 to Jun 1993, 1510 aspiration cytologies were performed for 1197 breast tumor cases. Out of 83 Cilia cases, 47 cases underwent excisional biopsy, of which 7 (14.9%) cases were malignant, and 40 (85.1) were benign. Follow-up studies were performed in 27 cases. In the 35 out of 44 CIIIb. cases, we performed excisional biopsy, and found that 22 (62.9%) were malignant, while 13 (34.1%) were benign. There were no follow-up cases among the final CIIIb. cases.
Histologic studies revealed that benign cases in group CIlla were mastopathies, fibroadenomas, giant fibroadenomas, and dermato-fibrosarcoma protuberans, and that those in group CIIIb were mastopathies, some of which showed intraductal papillomatosis, fibroadenoma, ductal adenoma, and phyllode tumors. Some of these benign cases were histologically difficult to diagnose cases or borderline lesions.
In the malignant cases from both the CIIIa and the CIIIb group, there were small tumors, or many histologically difficult cases such as papillary carcinoma, and cancers associated with difficulty aspirating adequate malignant cells, such as scirrhous carcinomas and lobular carcinomas composed of small malignant cells and difpuse connective tissues. Thus, our reporting forms have provided surgeons adequate information on breast cytology, facilitating reasonable or correct treatments.

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To improve the efficacy of aspiration cytology, anticytokeratin-antibody (KL-1) immunostaining was applied to lymph node aspirates, to surgical specimens of the primary lesion and to pelvic lymph nodes in cases of bladder cancer. In surgical specimens, almost all cancer cells of grade 1. 2 stained positively, but immunoreactivity was weaker in grade 3. Tumor cells of lymph nodes stained positively, but histiocytes were not stained by KL-1. Scattered lymph node metastasis overlooked by conventional pathological diagnosis was detected by KL-1. Fine needle aspiration cells diagnosed as class III were also stained by KL-1. These results suggest that KL-1 immunostaining is especially useful, in aspiration cytology and histological diagnosis, for the detection of lymph node metastasis of bladder cancer.

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We report imprint cytologic findings for differentiating multilobated B-cell lymphoma cells from peripheral T-cell lymphoma (cutaneous T-cell lymphoma and adult T-cell lymphoma) and anaplastic large cell lymphoma cells. Fresh lymph node samples from 16 cases were imprinted on glass slides and air-dried, or fixed in 95% ethyl alcohol or a spray-type fixative. They were then observed with hematoxylin and eosin (H-E), Papanicolaou and May-Grunwald-Giemsa stains. The multilobated B-cell lymphomas (four cases) were composed of medium to large-sized atypical lymphoid cells. There were no cells resembling Reed-Sternberg cells in any of these cases. There were 30 to three lobules per nucleus. Each nucleus showed fine chromatin and contained one to three indistinct nucleoli. The cytoplasm was slightly eosinophilic. Peripheral T-cell lymphomas (eight cases) were composed of small to large-sized atypical lymphoid cells having scanty cytoplasm. In contrast to the nuclei of the multilobated B-cell lymphoma cells, those of the T-cell lymphoma cells had coarse granular chromatin and showed strong indentation which was recognizable three dimensionally. The anaplastic large cell lymphomas (four cases) had cells of varying morphology. They had abundant pale-colored cytoplasm, and the nucleus varied in shape; e.g., rounded, kidney-shaped, doughnut-shaped. Reed-Sternberg like cells were seen in three of the peripheral T-cell lymphoma and two of the anaplastic large cell lymphoma cases. Taken together, the results suggest that the characteristic nuclear configurations of these neoplasms should facilitate differentiation of multilobated B-cell lymphomas from peripheral T-cell and anaplastic large cell lymphomas.

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Fluorescence in situ hybridization (FISH) is now one of the most important techniques in molecular genetics. The most time consuming step in FISH is the hybridization which requires being kept longer than overnight in the ordinary method. Recently, manufacturers have provided rapid hybridization kits for FISH to minimize the time. Efficacy and reliability have not, however, been proven. We analyzed the number of FISH signals in changes of hybridization time for 30 min or 2 hr; these are shown as minimal requirement times in a rapid hybridization kit, and for an ordinary overnight hybridization. Using alpha-satellite DNA probes, FISH signals were generated according to the kit. During the ordinary hybridization time, more than 95% of normal lymphocytes showed 2 centromere signals of 17 chromosomes, and the cells that showed the appropriate number of FISH signals in 30 min hybridization, using the kit, were 75.5%. Touch preparations of colon cancers showed a higher number of signals as the hybridization time increased. Both 30 min and 2 hr hybridization provided signal distributio patterns different from those of ordinary overnight hybridization. Therefore, we recommend using a hybridization time of more than 12 hr, even if rapid hybridization kits are used.

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Ten patients with primary malignant melanoma of the vagina were studied cytologically. Scraping smears taken from the vaginal tumor at the first visit were all positive and yielded the following findings.
1) Malignant cells were round, spindle-shaped and pleomorphic.
2) Most of the malignant cells were scattered, but some clusters with an epithelioid arrangement were detected in 4 cases (40%).
3) Intranuclear vacuoles were found in 9 cases (90%), eccentric nuclei in 7 (70%), and multinucleated cells in 6 (60%).
4) The N/C ratio differed depending on cell forms: high in round cells, and relatively low in spindle-shaped cells and pleomorphic cells.
5) Prominent nucleoli were found in 9 cases (90%), while an unusual nucleolar enlargement was found in a very low percentage.
6) Melanin granules were found not only in malignant cells but also in histiocytes in all 8 patients with melanotic melanoma. Very few melanin granules were found in the cytoplasm of malignant cells in one of the 2 patients with amelanotic melanoma.
In our study, sufficient samples could be obtained by scraping from the vaginal tumor with a cytobrush or cotton swab, and we have proven that the characteristic findings appeared in vaginal malignant melanoma at a frequency as high as that at other sites in the body.

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Small-cell neuroendocrine carcinoma (SCNC) of the uterine cervix is a rare disease, but its prognosis is grave. The correct cytodiagnosis is, therefore, required especially for differentiation from other types of small-cell tumors.
We encountered 1917 cases of invasive cervical carcinoma in the period from 1977 throughout 1993. Six (0.31%) of these cases were definitively diagnosed as having SCNC from cytological findings including hematoxylin-eosin staining, immunohistochemistry and electron microscopic observation.
Analyzing the cytological findings obtained in these six cases in a retrospective manner, we identified the following cytological characteristics of SCNC: 1) Presence of abundant cell necrosis and few inflammatory cells, 2) dispersion of cancer cells, some of which formed loosely-arranged clusters (no consistent direction of cell arrangement), 3) nuclei were exposed and untangled in some of these clusters, 4) round to oval nuclear forms, scanty cytoplasm, high nuclear/cytoplasm ratio, finely granular chromatin and inconspicuous nucleoli, and 5) occasional presence of components of squamous cell carcinoma and/or adenocarcinoma.
It is possible to diagnose SCNC, if all of these characteristics are confirmed.

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A morophological and immunocytochemical study was performed in 24 cases with non-neoplastic elongated cells in cervical smears. Non-neoplastic elongated cells were observed in 0.19% of cases and were divided into three cell types; type 1 showing cell cohesiveness and well-defined cell borders, type 2 having markedly elongated cytoplasms, and type 3 demonstrating isolated arrangement and unclear cytoplasmic borders. Both type 1 and type 2 cells showed postive keratin staining. We conclude that type 1 and type 2 elongated cells can be regarded as squamous epithelium or metaplastic cells. Type 3 cells did not react for keratin, vimentin or lysozyme. Therefore, we cannot speculate on the origin of these cells. The appearance of non-neoplastic elongated cells was not related to age, clinical diagnoses or menstrual cycles.

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Thirteen cases of adenocarcinoma in situ (AIS), consisting of 8 pure AIS and 5 with co-existence of AIS and squamous cell carcinoma, were studied cytologically to determine the early stage cervical adenocarcinoma, and the following results were obtained. 1) One false negative case and 7 cases which were diagnosed as suspicious or positive were observed in pure AIS. All cases with the co-existence type were suspicious or positive and 4 out of 5 cases had an abnormality of the squamous epithelium. 2) Cancer was located in the lower side (3 cases), upper side (6 cases), or both sides (4 cases) of the squarno-columnar junction. The cancer depth was<3mm (10 cases, 76.2%), 3-5mm (2 cases) or>5mm (1 case) from the surface of the cervical epithelium. 3) The following characteristics were observed in pure AIS: clear background, crowded sheets of cells and strips of cells in palisading configuration, protrusion of nuclei, oval nuclear shape with less irregularity, and smooth nuclear edge with mild thickness. 4) Nuclear sizes of AIS cells ranged from 11.24×6.69μm for cells in palisading configuration to 9.79×7.52μm for cells in crowded sheets. The long axis of AIS nuclei was significantly longer than that of the nuclei in the follicular and luteinizing phases. The short axis of AIS nuclei was shorter than that of the nuclei in invasive adenocarcinoma. In conclusion, understanding of these cytological features of AIS is important for detecting cervical adenocarcinoma in the early stage.

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We studied the clinical features of 7 cases with adenoma malignum of the uterine cervix diagnosed at the Cancer Institute Hospital over the past 45 years. Microscopic reviews of the cytologic specimens were performed successfully in 4 of the 7 cases.
The 7 cases accounted, among 454 total cases with adenocarcinoma of the uterine cervix, for 1.54%, the avarage age was 52.3 years old, frequent chief complaints were watery discharge and abnormal bleeding, and the 5-year survival rate was 71.4%.
By examining features of the 4 cases in which adenoma malignum, specimens were successfully reviewed, the following characteristic features were identified
1.Large sheets of tumor cells are apparent. The tumor cells have abundant mucin and are arranged in palisades at the circumferences of the sheets. 2.In the part with a palisading arrangement, nuclei are constantly positioned in the cytoplasma and a overlap side by side.
3.Nuclei are tensile and some are irregular in shape. The nuclear chromatin is fine granular, and shows frequent nuclear clearing, suggestive of increased euchromatin.
We propose that these cytologic findings maybe useful clues for the correct cytodiagnosis of adenoma malignum of the uterine cervix.

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To improve the diagnostic accuracy of endometrial cytology, the cell block method was used in combination with cytology for endometrial cancer screening in cytological specimens. The specimens were obtained using a brush from 87 patients who visited the Gynecology Clinic of Aichi Medical University Hospital complaining of irregular vaginal bleeding or requesting cytological examinations.
Based on endometrial cytological evaluation, the 87 subjects consisted of 78 cases considered negative, 3 cases with suspicious positive lesions and 6 cases with positive lesions. Evaluation with the cell block method served to classify them into 62 cases with no malignancies, one with atypical hyperplasia, 8 with adenocarcinomas, and 16 with sampling errors. In 67 (94.4%) of 71 cases, excluding those with sampling errors, the cytology results agreed with those obtained by the cell block method. However, 2 cases judged to be suspicious positive by cytology were diagnosed correctly as adenocarcinoma by the cell block method; and one case judged to be negative by cytology was diagnosed as atypical hyperplasia with the cell block method. Eight (88.9%) of 9 cases of endometrial adenocarcinoma diagnosed histologically with specimens obtained by endometrial biopsy curettage proved to be adenocarcinoma by the cell block method, although 6 cases (66.7%) among them were also positive by cytology. Another case was negative in both cytology and the cell block method.
These results led us to conclude that the cell block method, in combination with endometrial cytology, improved the diagnostic accuracy of mass screening for endometrial cancer.

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In the past 10 years, we have treated 68 patients with endometrial carcinoma in Kagawa Medical School Hospital. Among them, 47 cases were examined by intraoperative peritoneal cytology, of whom 5 cases (10.6%) showed positive results. Four (9.8%) out of 41 cases of clinical stage I endometrial carcinoma showed positive peritoneal cytology, but a case with postsurgical stage III was included among them. Positive peritoneal cytology was presumed to be associated with adenosquamous cell carcinoma, poorly differentiated adenocarcinoma and deep myometrial invasion. One of the 5 cases with positive peritoneal cytology showed cytologic findings compatible with malignancy but it is hard to speculate on an origin from endometrial carcinoma. Hysteroscopic examination was done before surgery in 46 cases, but only 4 cases showed positive peritoneal cytology. This suggests that hysteroscopy does not necessarily induce positive peritoneal cytology during surgery.

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Nonepithelial malignant tumor (NEMT) of the uterine corpus is relatively rare and the prognosis is very poor. In 17 cases of uterine NEMT treated during a period of 14 years, from 1981 to 1994, the correlations between the results of preoperative intracavitary cytologic examination and histopathologic diagnosis, growth pattern of the tumor, surgical stage and symptoms were examined. All cellular samples were obtained from the uterine cavity by the Endocyte technique.
Positive intracavitary smears were seen in eight cases (47.1%) of NEMT, 2/9 cases (22.2%) of leiomyosarcoma (LMS), 1/1 cases of rhabdomyosarcoma, 2/3 cases of high grade endometrial stromal sarcoma and 3/4 cases (75%) of malignant Mallerian mixed tumor (MMT), Though six cases with positive smears were suspected to be NEMT based on cytologic findings, one case was diagnosed only as an unclassified malignant tumor with degeneration, and another case (MMT) was suspected to have poorly differentiated adenocarcinoma.
Five cases of LMS were the intramuscular localized type, all of whom were cytologically negative. The positive rates in surgical stage I and II-IV cases were 36.4%(4/11 cases) and 66.7%(4/6 cases) respectively, and six positive cases were found among 12 cases with genital bleeding, suggesting that the positive rate correlated with surgical stage but not with genital bleeding.
The cytologic findings of MMT were characterized by admixture of carcinomatous cell clusters and single and dyshesive clusters of sarcomatous cells. Sarcomatous cells had ill-defined cytoplasm varying from scanty to abundant and wispy. The nuclei of these cells showed variations in size and shape. The chromatin structure appeared coarsely granular and unevenly distributed. The nucleoli were eosinophilic and prominent in some of the cells.

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We report the cytological characteristics of invasive thymoma and thymic carcinoma. First, left pleural effusion and an anterior mediastinal mass were found in a 62-year-old woman. Fine needle aspiration cytology showed cohesive clusters of epithelial cells and numerous scattered lymphocytes. Elliptical and polygonal tumor cells contained round and elliptical nuclei, fine aggregated chromatin and small nucleoli. The histological diagnosis was invasive thymoma. Next, an anterior mediastinal mass was found on medical examination. Metastatic liver cell tumors were detected by abdominal CT scan. Fine needle aspiration cytology showed scattered epithelial cells and lymphocytes. The nuclei were large and pleomorphic with coarsely granular chromatin and a few prominent nucleoli. The histological diagnosis was thymic carcinoma. Cytologically the differences between invasive thymoma and thymic carcinoma were pleomorphism of nuclei, increases in the N/C ratio and nuclear mitosis, coarsely granular chromatin and large nucleoli. It was difficult to determine the invasiveness of thymoma cytologically.

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We report a case of adenomatous goiter with inspissated colloid mimicking psammoma bodies and squamous epithelium. The patient was a 60-year-old female with a mass in the left thyroid, measuring 3 cm. Fine needle aspiration cytology revealed Htirthle cells and calcific concretions showing concentric laminations. At intraoperative consultation, H-E stained-touch preparation of the mass showed Htirthle cells and squamous epithelium-like colloid. The histologic diagnosis was adenomatous goiter. Microscopically, numerous calcified concretions were seen in the inspissated colloid of follicular lesions formed by the Hfirthle cells. We consider the presence of the concretions to be of no diagnostic significance and they should be differentiated from true psammoma bodies seen in the stroma of a papillary carcinoma. The squamous epithelium-like material was regarded as inspissated colloid with central calcifications.

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Hyalinizing trabecular adenoma of the thyroid (HTA) as proposed by Carney et al. is a special type of follicular adenoma which is histologically similar to papillary carcinoma and medullary carcinoma. We experienced 2 cases of HTA and obtained cytological examination findings which were different from those of papillary carcinoma. Both cases are reported here. The cytological characteristics of HTA are as follows.(1) In the background, there were non-structural hyaline materials which were densely stained light green and showed metachromasia using Giemsa staining.(2) The celluarl mass revealed a strongly connective sheet-like or fence-like arrangement, it tended to be arranged mainly with interstitial connective tissue and non-structural substances.(3) The tumor cells were ellipsoid, spindle, or oval shaped, and the cytoplasm was stained lightly with light green.(4) The nuclear chromatin was distributed evenly as small granular forms and intranuclear cytoplasmic inclusions and nuclear grooves existed in about 10-20% within a single cellular mass. Dispersed perinuclear halos were seen. Excluding the intranuclear cytoplasmic inclusions and nuclear grooves, the findings of (1) to (4) were valid for differential diagnosis from papillary carcinoma. These findings indicated the necessity of taking into consideration that intranuclear cytoplasmic inclusion bodies and nuclear grooves may be observed in benign thyroid diseases including HTA, but not papillary carcinoma.

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An opportunity was presented to us while observing the imprint cytology of a mixed papillary and squamous carcinoma of the thyroid gland. Histological and immunohistochemical studies were performed.
The patient was a 74-year-old female. Total thyroidectomy was performed. The thyroid contained a tumor, measuring 3× 2cm in diameter, in the left lobe. Imprint cytology yielded both papillary carcinoma with intranuclear cytoplasmic inclusions and squamous cell carcinoma with a thick cytoplasmic appearance and keatinization on a necrotic background. Histologically, the tumor also consisited of both papillary and squamous elements. Immunohistochemically, almost all parts of the papillary carcinoma were strongly positive for both anti-human epidermal keratin serum and anti-bovine muzzle epidermal keratin serum. Anti-thyroglobulin and epidermal membrane antigen (EMA) were partially positive, but cytokeratin? squamous epithelium was negative. The squamous part was strongly positive for all three anti-keratin sera tested and weakly positive for EMA but negative for thyroglobulin.
In addition, out of 65 papillary carcinoma surgical specimens, three with benign squamous metaplasia (4.6%) were found. Squarnous metaplasia in the thyroid gland, from which some investigators suggest squamous cell carcinoma is derived, is sometimes seen in a papillary carcinoma. However, in our case, transitional foci were noted hitologically between the papillary carcinoma and squamous cell carcinoma. Therefore, it is most likely that papillary carcinoma had changed directly into a squamous cell carcinoma.

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We report a case of chronic thyroiditis with a nodular lesion in which the histology showed reactive lymphoid hyperplasia. However, gene analysis showed a rearrangement of the immunoglobulin heavy chain.
The patient, a 58-year-old woman, visited Itami City Hospital on Nov.24, 1994, complaining of a swelling of the anterior neck. Blood examinations were normal with the exception of a high level of thymol and zinc turbidity tests. Thyroid function data were normal, and microsome and thyroid tests were negative. Both ultrasonography and computed tomography of the thyroid gland demonstrated a nodular lesion. Ga-67 scintigraphy showed a hot area in the neck. Aspiration smear specimens were composed of a mixture of small, medium and large sized lymphocytes, although small lymphocytes with a fine nuclear-chromatin pattern were predominant. A partial thyroidectomy was performed on Dec.23. The nodular lesion was composed of many lymph-follicles. The histology of the other region of the thyroid gland was typical of chronic thyroiditis. Immunohistochemical stainings of the nodular lesion for L-26 and UCHL-1 showed distributions of B and T cells that were within normal limits. The preponderance of staining for x and λ immunoglobulin light chain was not demonstrated. From these histological findings, a diagnosis of reactive lymphoid hyperplasia (RLH) associated with chronic thyroiditis was made.
In contrast, gene analysis of Hind III digested DNA extracted from the nodular lesion using a DNA probe against the J_H gene revealed a rearrangement of the immunoglobulin heavy chain. This implied that a component of B-cell malignant lymphoma was contained in the histologically RLH lesion of the thyroid gland in this patient. Thus, gene analyis can be helpful in making the diagnosis of malignant lymphoma of the thyroid gland, even in cases appearing cytologically or histologically benign.

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A 46-year-old female patient subjected to aspiration cytology of a mucocele-like tumor of the breast with atypical ductal hyperplasia is reported. Due to a multicystic mass in the left breast being detected by mammography, aspiration cytology was performed. Cytological smears showed a large amount of mucus and a small number of epithelial cells. As mucinous carcinoma can not be excluded on the basis of cytology, an open surgical biopsy was recommended. Histologically, the lesion was a mucocele-like tumor with mucus-filled cysts. It was partly accompanied by foci of atypical intraductal hyperplasia, which was difficult to differentiate from intraductal carcinoma. Three months later, a simple mastectomy was performed and the lesion proved to be a mucocele-like tumor with atypical ductal hyperplasia, with no malignant elements. While aspiration cytology identified a large amount of mucus, it detected only a few epithelial cells not showing any obvious nuclear atypia. Furthermore, the mucus spread in masses thinner than that of mucinous carcinoma, probably because of its lower viscosity. Therefore, cytological features are rather suggestive of mucocelelike tumors. When a large amount of mucus is detected in a breast aspiration cytology, it is necessary to differentiate between mucinous carcinoma and a mucocele-like tumor. The amount and atypia of epithelial cells and the nature of the mucus are important for the differential diagnosis. However, even if cytological features are suggestive of mucocele-like tumors, histological confirmation is absolutely necessary, as there are also atypical ductal hyperplasia cases like our patient.

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A 65-year-old woman who noticed a mass in her right breast was admitted to our hospital. Malignancy was suspected clinically, and excisional biopsy was performed. Cytologically, there were clusters of atypical cells with hyperchromatic, irregular sized nuclei. Individual cells were scattered and polynuclear giant cells were observed surrounding the clusters. Histologically, most of the tumor consisted of sarcomatous areas in which large polygonal and spindle cells with marked pleomorphism proliferated in a solid pattern. Bone matrix had formed in the sarcomatous areas. Transitions between the sarcomatous cells and bone matrix were also seen. Atypia was found in the bone matrix cells, and they exhibited differentiation into osteosarcoma. Osteoclast-like giant cells (OGCs) were found in the sarcomatous areas. Adjacent to the sarcomatous areas, invasive and non-invasive ductal carcinomas were observed focally. An intervening spindle cell zone was noted between the overt carcinomas and sarcomatous areas. Immunohistochemically, overt carcinomas were positive for EMA and keratin. Polygonal and spindle cells in the sarcomatous areas reacted positively for vimentin and actin, and the OGCs were focally positive for vimentin. Metaplastic carcinoma was diagnosed based on these findings. We have described the cytological findings of metaplastic carcinoma and discussed the histogenesis of the tumor.

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A case of Paget's disease showing peculiar cytological features which could be confused with those of malignant melanoma is reported. A 59-year-old woman was admitted to our hospital because of itching and discharge from the right nipple. Smear cytology showed large and sparsely aggegated atypical cells with abundant basophilic cytoplasm where significant amounts of melanin granules were found. Some non-neoplastic dendritic melanocytes and many inflammatory cells were also identified.
The histological examination of the biopsied nipple revealed large atypical cells with pale basophilic cytoplasm in the epidermis of the right nipple. The tumor cells showed marked nuclear atypism and had significant amounts of cytoplasmic melanin granules. They tended to gather into small cell nests accompanying non-neoplastic dendritic melanocytes. Immunohistochemical examination revealed the tumor cells to be negative for carcinoembryonic antigen (CEA), cytokeratins, and equivocal for S-100 protein. Immunoperoxidase staining for anti-human melanoma antibody (HMB 45) and the tissue DOPA reaction test were negative. Simple mastectomy was done and the resected breast tissue showed typical features of Paget's disease.
The Paget's cells in our case had significant amounts of melanin granules in the cytoplasm. We know that the Paget's cell occasionally has cytoplasmic melanin granules, but with significant pigmentation, such as in our case, it is difficult to distinguish from malignant melanoma on routine examination. In addition to immunoperoxidase staining for HMB 45 and the tissue DOPA reaction test, the authors emphasize that identyfying the coexistence of normal melanocytes is a good supportive finding for the cytopathological diagnosis of Paget's disease. Normal melanocytes can be found using a routine Papanicolaou stain or hematoxylin and eosin stain, and are rarely found in malignant melanoma.

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A case of stromal sarcoma of the breast is reported.
The patient was a 59-year-old female with a mass in the right breast measuring 5×7cm. A malignant tumor was suspected clinically. The findings of preoperative aspiration cytology showed thick stromal fragments composed of large numbers of spindle-shaped cells with sparse individual spindle-cells dispersed in the background. These cells revealed no significant atypia. No epithelial elements were seen. The intra-operative frozen-section diagnosis was malignant stromal tumor and a right mastectomy was done. The findings of smears from the resected tumor were indicative of spindle cell sarcoma and the permanent-section diagnosis of the tumor was stromal sarcoma composed of low-grade fibrosarcoma with osseous metaplasia.
The diagnostic problems of stromal sarcoma of the breast are discussed with reference to the pertinent literature.

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We report the cytological findings of a case of renal oncocytoma and a case of granular cell renal cell carcinoma. The renal oncocytoma showed monotonous populations of polyhedral or columnar cells with fine granular cytoplasm. They appeared as clusters (sheet, gland-like, or trabecular) or as single cells. Their cytoplasms showed distinct borders. The granular cell type of renal cell carcinoma consisted of round cells with somewhat variable N/C ratios. Most of the tumor cells appeared as single cells and had indistinct cell borders, occasional prominent nucleoli and unevenly distributed chromatin. The cytoplasmic granularity of the renal cell carcinoma was more extensive and thicker than that of the oncocytoma. We consider the difference between the two tumors to have originated from a difference in the distribution and density of mitochondria.

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A case of extramedullary plasmacytoma of the testis in an 82-year-old male is presented. Scrotocentesis allowed a cytological diagnosis to be made before orchiectomy. Preoperative examination revealed a high level of serum IgG, which normalized rapidly after surgical resection. Immunocytochemical and immunohistochemical studies demonstrated a monoclonal plasmacytic proliferation producing IgG with λ light chain.
Whether the testicular nodule was primary or metastatic from another site remains an important question, but neither post-operative recurrence of multiple myeloma nor plasmacytoma of any other site has occurred in the more than 2 years since the initial diagnosis, pointing to a primary testicular plasmacytoma. Though extramedullary testicular plasmacytoma is very rare, careful cytoscreening will greatly facilitate accurate diagnosis.

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We report a case of epithelioid leiomyosarcoma of the small intestine with metastasis to the liver. The patient was a 55-year-old female. The tumor was located in the submucosal layer of the jejunum, and measured 9×13×8cm. The imprint specimen revealed clusters of large polygonal cells with slight irregular pilings. Moldings were seen in these clusters. Individual neoplastic cells were scattered around the clusters. The cytoplasms of these tumor cells were pale and vocuolations were found in some cells. Nuclei were ovoid or round and had increased chromatin. These findings mimicked those of moderatel differentiated adenocarcinoma. However, immunohistochemical analysis revealed s-100 protein, vimentin, smooth muscle action and myosin in these cells while cytokeratin was negative and the findings were compatible with epithelioid leiomyosarcoma. Ultrastructural findings also supported the diagnosis of epithelioid leiomyosarcoma.

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To provide observations useful for avoiding misdiagnosis of benignlesions or a malignancy, two complicated cases of non-epithelial tumors of the gallbladder are reported. The diagnosis was not successful with intraoperative cytodiagnosis. From the incised surface of the surgically resected gallbladder, imprint smears were prepared in the former and squash smears in the latter. The two showed similar cytologic features; bizzare and atypical spindleshaped cells with prominent nucleoli were predominant in the background of polymorphic inflammatory cells and collagen fibers.
In the first case, a cauliflower-like tumor was resected. On the imprint specimen of this lesion, the presence of atypical spindle-shaped cells suggested a sarcoma of the gallbladder. On the contrary, the tumor was mostly composed of activated fibroblasts. Histiocytes were observed only in part and characteristic foam cells were rarely seen, histologically. The final diagnosis of this lesion was a pseudotumorous type of fibro-xanthogranulomatous cholecystitis, an uncommon, benign disease of the gallbladder. It was apparent that the benign atypical cells of mesenchymal origin were mistaken for sarcoma cells because of our lack of knowledge of xanthogranulomatous cholecystitis.
In the second case, the squash specimen looked like a xanthogranulomatous lesion and the spindle cells showed no remarkable pleomorphism. Based on these findings, the differential diagnosis between inflammatory pseudotumor and the sarcoma was complicated. Fortunately, from the bundle-like arrangement of spindle cells, it was possible to diagnose sarcoma intraoperatively and the 40 × 35 × 8 mm illcircumscribed tumor was then resected. Histologically, the tumor was composed of spindle-shaped cells with a frequent storiform pattern in the fibrous areas, and it was diagnosed as a primary sarcoma (malignant fibrous histiocytoma) of the gallbladder, a very rare clinical entity.
As in the cases reported above, there are many difficulties in the intraoperative cytodiagnosis of non-epithelial tumors of the gallbladder. To improve the cytodiagnosis of gallbladder diseases, we resolve the diagnostic problems. Actually, we believe that the conventional cytological technique is useful for the diagnosis of gallbladder tumors and that the correct diagnosis can be made if the cytological findings are collected and accumulated.

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A case of soft tissue rhabdoid tumor is presented. Rhabdoid tumor is a rare malignant tumor of unknown origin. These tumors were orignally reported in the kidneys of children. However, the same kinds of tumors have also been found in other organs including soft tissue.
Our case was a 45 year old female who was noted to have a soft tissue tumor in her right chest wall two months before admission. She underwent tumorectony (2.0 × 1.5cm) and touch preparation materials for cytological examination were sent to our laboratory. Other detailed examinations revealed multiple metastases in the brain, lungs and lymphnodes. She died two months after admission of pneumonia and cardiorespiratory failure. There was no other primary site though an autopsy was not conducted.
Cytological examination revealed diffuse, rather monotonous proliferation of round to ovoid tumor cells with ground-glass like cyanophilic cytoplasm. No cohesiveness was seen. The nuclei were eccentric with fine chromatin. The nuclear membrane was not thickened. The nucleoli were prominent. The initial impression was signet ring cell carcinoma because of mucus like cytoplasm, though the possibility of sarcoma could not be entirely ruled out. Histology was almost the same as cytology. Rhabdomyosarcoma, malignant melanoma and epithelioid sarcoma, as well as rhabdoid tumor, were included in the differential diagnosis.
Immunohistological examination showed a strongly postive result for vimentin, weakly positive results for keratin and EMA. Electronmicroscopy of the tumor cells showed abundant intermediate filaments in the cytoplasm. Overall results were compatible with the diagnosis of rhabdoid tumor. These diagnostic methods were helpful and essential for making the diagnosis of rhabdoid tumor.

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A case of Ki-1 lymphoma suspected on the basis of aspiration cytology of cervical lymph nodes is reported.
The patient was a 43-year-old male with the chief complaint of a rapdily growing rt cervical mass.
Aspiration cytology revealed large tumor cells with multinucleated giant cells, which were similar to those in non-Hodgkin lymphoma, large cell type.
The nuclei were mostly round-shaped, but some were convoluted or ring-shaped. Ki-1 lymphoma was suggested by the presence of characteristic ring-shaped nuclei. The giant cells looked like Reed-Sternberg cells, but differed in that the chromatin pattern was rougher with darker appearance of the nucleus and smaller nucleoli.
The cytoplasm was basophilic and vacuolated, and some cells were even filled with large vacuoles, thought to be a characteristic cytoplasmic feature of Ki-1 lymphoma. Erythrophagia was also seen in some cells.
Acid phosphatase showed stronger activity than in T cell lymphoma or Reed-Sternberg cells, but was weaker than that of histiocytes. Immunocytochemical staining was positive for Ki-1, EMA, HLA-DR, IL-2 R and was partially positive for LCA, MT-1, UCHL-1. No monoclonality was observed based on rearrangement of immunoglobulins and T cell genes.
The above mentioned characteristic features of the tumor cell and confirmation by immunocytological staining were crucial in the diagnosis of this disease.

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Papillary squamous cell carcinoma (PSCC) of the uterine cervix is an infrequently described subtype of cervical malignancy. As the name indicates, it is characterized by epithelial tumors arising from the cervix and consists of stratified squamous epithelial tumor cores or papillae of connective tissue.
This report describes a case with demonstrable gross papillae observable by colposcopy. The cytological and histological findings of this case closely reflected the macroscopic findings and such that our case was considered to be a model example of PSCC. In terms of the cytological features, a core existed within the clusters containing edematous or fibrous stroma with prominant capillaries, and the existence of a lesion showing papillary growth was also observed. Otherwise, cervical cytologic specimens showed CIN III. This case was therefore characterized by a condition in which the superficial portion of the tumor consisted of papillary fronds covered with predominantly in situ carcinoma.
A high level of suspicion on the part of the clinician and an awareness of PSCC from colposcopic and cytologic findings are required together with deep biopsy or cervical conization, as appropriate.

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A nineteen-year-old Japanese woman has complained of general fatigue and excessive menstrual bleeding. Medical workup revealed profound anemia without failure of hemostatic function. Subsequently, she underwent endometrial cytology and endometrial curettage due to assessing uterine bleeding. Endometrial cytology displayed abundant atypical cells with hemorrhagic background. Endometrial biopsy revealed advanced atypical hyperplasia. In this case a reproductive function should be preserved, so that hysterectomy specimen was not available. She has been treated by medroxyprogesterone acetate (MPA) since then. Four weeks later, a follow-up curettage appeared atrophic endometrium without malignant potential. We reported a rare case of endometrial hyperplasia in less than 20 years. Although appropriate treatment for this entity remains a controversial, we should account for endometrial pathology, potentially progressing to malignancy, in very young woman.

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Mucinous adenocarcinoma of the endometrium is uncommon. A case of this malignancy is described cytologically and histologically. A 61-year-old woman with a history of postmenopausal bleeding produced copious mucins. Endometrial smears were poisitive and included bubbles in the cytoplasm, suggesting the presence of intracytoplasmic mucin. Histologically, most of the tumor consisted of well differentiated cell types and a portion showed distinctive nuclear atypia. Dilated glands filled with mucin and tumor cells surrounded by extracellular lakes of mucin were seen. About 90% of the tumor cell population contained PAS and alcian blue-positive intracytoplasmic mucin. If copious mucins are produced clinically and cytology shows the typical bubbles in the cytoplasm, mucinous adenocarcinoma can be diagnosed preoperatively.

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A case of poorly differentiated endometrial sarcoma is reported with reference to the cytologic findings. The paitent, a 52-year-old woman, visited our hospital because of brownish vaginal discharge, hypermenorrhea and lumbago. A uterine tumor of the size of a child's head was disclosed, and total hysterectomy with bilateral salpingo-oophorectomy was performed. The uterine cavity was filled with a polypoid mass originating from the endometrium and involving the myometrium, the cervix and the right parametrium. The histology of the tumor mass demonstrated a poorly differentiated endometrial sarcoma thought to be a monophasic variant of malignant mixed Mtillerian tumor. On the imprint cytology from the tumor, numerous atypical cells were observed diffusely. Their nuclei showed anisonucleosis, an irregular shape, pleomorphism and hyperchromasia with a fine granular distribution, and had one or two nucleoli and thin nuclear rims. Many mitotic figures were seen and multinucleated giant cells or bizarre cells were also observed. The cytoplasms were faintly stained and the boundaries were indistinct. The cytologic findings were suggestive of an anaplastic type of non-epithelial malignant tumor.

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We report a case of endometroid stromal sarcoma of the ovary. Stromal sarcoma of the ovary is classified into the endometroid tumor of the ovary category, and is an uncommon disease. Most endometroid stromal sarcomas are thought to arise in pre-existing endometriosis. This case was a 62-year old woman who complained of a major mass in the hypogastrium. It was a neonatal caput size tumor by internal examination, and was a 12cm×12cm solid mass having fluid parts on imaging. The uterus was normal appearing. There was a small volume of ascites and the tumor was adherent to the cul de sac. There were metastatic lesions on the omentum. Atypical cells were in cluded in the cytologic specimens of ascites and showed scant cytoplasm, with small round to oval nuclei. Microscopic features of the tumor included closely packed sheets of small, round to oval cells which were often whorled around a fine meshwork of small arteriolar vessels, Reticulin fibers inverted individual cells and accentuated the vascularity on argentation and Azan-Mallory stainings. Nuclei were unremarleable and mitoses fewer than 10 MF/10 HPF, while almost 2-3 MF/10 HPF pointed to a low grade diagnosis. The results of lmmunohistchemical staining were Vimentin (+), Smooth muscle actin (+), Desmin (+), S 100 Protein (-). There was no endometriosis of the uterus. We carried out CAP (CDDP 70 mg/m², ADR 50 mg/m², CPM 500 mg/m²) therapy, as an adjuvant, 3 times. There were no signs of reccurence after 28 post-operative months.

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A rare case of sex cord tumor with annular tubules (SCTAT) of the ovary is reported with its histologic and cytologic features. The patient was a 49-year-old woman, who underwent laparotomy under the diagnosis of left ovarian tumor. Histologically, the tumor was composed of numerous characteristic simple and complex annular tubules that consisited of central hyalinized bodies surrounded by tumor cells. The tumor was diagnosed as SCTAT. Imprint cytology of the tumor revealed abundant round hyaline materials. They were densely stained with lightgreen and were surrounded annularly by tumor cells that had ovoid nuclei with small nucleoli and scant lacy cytoplasm. It was presumed that the presence of the annular tubules, particularly the hyaline materials, on imprint cytology of an ovarian tumor was suggestive of SCTAT.

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The Cooperative Early Lung Cancer Group was organized by the Mayo Clinic, Memorial Sloan-Kettering Cancer Center and The Johns Hopkins University in 1972. The major aims of this group were determine (1) Whether thedetection rate of lung cancer can be improved by adding sputum cytology to radiologic screening.(2) Whether the death rate from lung cancer can be reduced significantly by this type of screening program. The latter program (2) is well known in Japan, but the former program (1) has not yet been introduced in Japan. Thus, I introduce the method and describe the results of the initial cytologic screening of this group for comparison with those of the Osaka Lung Project. The detection rate of lung cancer by cytologic screening was higher in this group, but the ratios of resected or stage I cases were almost the same as compared with the Osaka Lung Project. In dual-screening, a greater proportion of lung cancers was detected at an earlier stage, but, the lung cancer prevalence rate is slightly high in Sloan while being about the same in Hopkins. In Sloan, half the stage I lung cancers on initial examination were detected by cytology while about one-fourth of incidence cases were also found in stage I. This is believed to be a length bias effect due to an accumulation of slowly growing, early stage epidermoid carcinomas before the study began. The Lung Project in the U.S.A. concluded that cytologic screening does not add to the benefit of annual X-ray screening.

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