Objective: Mucoepidermoid carcinoma is comprised of variable numbers of mucous cells, intermediate cells, squamous and clear cells. Their cytological characteristics of most of these cell types have been described, but those of the intermediate cells remain controversial. We observed the growth arrangements of tumor cells in resected specimens, and compared them to the findings of imprint cytologic smears. Cytologic findings of mucous cells, intermediate and squamous cells as well as the overall appearance were examined using the imprint cytologic procedure.
Study Design: Between 1996 and 1998, 4 patients with mucoepidermoid carcinoma arising from the parotid gland were studied. All of the imprint cytologic smears were stained with Papanicolaou stain, Giemsa stain, Periodic acid Schiff (PAS) stain and Alcian blue stain.
Result: In tumors with mucous cell nests or squamous cell nests, a different distribution was observed for each case. Therefore, imprint cytologic smears did not clearly correspond to the findings of resected specimens. Cytologic classification of all 6 cell types (Mu-1, Mu-2, In-1, In-2, Sq-1 and Sq-2) is necessary to diagnose mucoepidermoid carcinoma correctly. In overall organization intermediate cells (In-1, 2) appeared in the center of the tumor.
Conclusion: To diagnose mucoepidermoid carcinoma, the cytologic characteristics of mucous cells, intermediate and squamous cells must be understood. These cells show cytologic features with slight differences that are important to confirm In-1 and In-2.

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Objective: We studied the cytological features of myxoid liposarcoma (MLPS). round cell liposarcoma (RCLPS) and mixed myxoid and round cell liposarcoma (M/RCLPS), Study Design:Cytological findings and cell measurements of FNA or imprint materials from MLPS (7 cases), M/RCLPS (3 cases) and RCLPS (2 cases) were investigated. We studied the nuclear shape, background myxoid substance, appearance of atypical lipoblasts, and presence of capillary vessels on cytological materials. The nuclear area and major/minor axis ratio of nuclei of cells were estimated.
Results: Tear-drop shaped nuclei were only observed in MLPS. Atypical lipoblasts were often seen in all types of liposarcoma, and background myxoid substance was seen in every type except RCLPS, but fragmented capillary vessels were not commonly observed on cytological materials. Nuclear area was significantly larger in liposarcomas with a round cell element than in MLPS, whereas the major/minor axis ratio of nuclei was significantly larger in MLPS.
Conclusion: MLPS shows characteristic cytological features, and our results suggest that it is possible to make a cytological diagnosis of MLPS.

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Objective: This study aimed to develop an automatic fixation apparatus for making cytologic preparations.
Study Design: A total of 78 samples of urine and 100 samples of fine needle aspiration material were simultaneously examined by the FIL CUP Super (FS) applied membrane filter method and by a general method, and compared on the basis of preservative condition, collection of cellular materials, and other features.
Results: Overall, FS preparations were better than those made using the general method in the main important characteristics. However, there were several problems with FS preparations including difficulty with mucus rich material, cellular subsidence into the hole of membrane filter with aspiration, difficulty determining the suitable cellular amount, disagreeability of the hole of membrane filter in observation, decreased background features and cytomorphological differences by the smear method.
Conclusion: In this study, we confirmed that the FS was a suitable method for making smear preparations, but still had several weak points, and there is room for improvement before the introduction of this automatic fixation apparatus.

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Telecytology involves the use of telecommunication to transmit cytology images for the purposes of diagnosis, consultation or education. This paper describes the first attempt in Japan to evaluate the diagnostic accuracy of this method in cervico-vaginal smears and breast aspirates.
Cases and methods: We have used a static system which allowed us to send H 1280×V 960 high resolution images between a remote hospital and the pathology laboratory. Specimens were prepared by the cytotechnologist of the hospital, while the focus of interest was selected by the cytopathologist of the laboratory using low resolution motion pictures. Diagnosis was done by high resolution digital output on computer display.
We had a total of 57 cervico-vaginal smears and 45 cases of breast fine needle aspiration.
Results: The overall concordance of telecytology compared with conventional microscopy was 84.2% for cervical cytology. Concordance above the high grade squamous intraepithelial lesion was 81.3%. For breast aspirates accuracy was 91.1% when telecytology was compared with permanent histodiagnosis.
Discussion: Static systems have the advantage of considerably lower cost but appear to have only 80-90% levels of accuracy. Individuals participating in telecommunication of digital images for diagnosis should be properly qualified, and should protect patient confidentiality. Telecytology is particularly needed in long-distance consultation in hospitals where no full-time specialists are employed.

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Objective: We investigated the cytological diagnosis of uterine sarcoma.
Study design: We reviewed the cytological findings of endometrial aspiration smears obtained presurgically from 18 cases with uterine sarcomas (6 cases with leiomyosarcoma, 1 case with endometrial stromal sarcoma, and 11 cases with carcinosarcoma) from 1971 to 1997.
Results: Malignant tumor cells were detected in 2 out of 7 cases (29%) with “pure” sarcoma, while in 10 out of 11 cases (91%), malignant cells were detected in presurgical endometrial smears.
The detection rate of sarcoma cells in homologous carcinosarcom was 80.0%(4/5), and that in heterologous carcinosarcom was 83.3%(5/6) in presurgical endometrial smears.
Conclusion: Although it is hard to make diagnosis of sarcoma by endometrial smears in pure sarcoma, malignant tumor cells were detected presurgically in most carcinosarcomas. There was only a narrow margin between the detection rate of sarcoma cells in homologous carcinosarcoma and that in heterologous carcinosarcoma in presurgical endometrial smears. Histlogical subtypes of sarcoma components were not discriminated by endometrial smears from cases with heterologous sarcoma components.

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Background:“Pseudocilia” was first reported by Ebner as a cilia-like structure of ovarian carcinoma cells in peritoneal effusion. The present paper describs the details of adenocarcinoma cells with “pseudocilia” which had been demonstrated in cerebrospinal fluid (CSF) obtained from a patient with meningeal carcinomatosis that resulted from an extension of carcinoma from the lung.
Case: Cytological examination of CSF performed on a 58-year-old female patient revealed adenocarcinoma cells with “pseudocilia”. Following this, the primary focus was found in the lung and the patient died in the third month after the onset.
At the autopsy, none of adenocarcinoma cells with “pseudocilia” were observed in cytological specimens from both touch smear of the lung and CSF. A surface coat was clearly demonstrated on the surface of these cells which were positive for CEA and surfactant apoprotein. The electron microscopic observation revealed lamellar bodies, nuclear inclusions and intracytoplasmic lumina. Further, there were microvilli aligned in a radial pattern on the surface of some carcinoma cells.
Conclusion: “Pseudocilia” observed in the adenocarcinoma cell in CSF may correspond to microvilli of cells that originate from the lung.

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Background: Large cell neuroendocrine carcinoma of the lung (LCNEC) is poorly differentiated lung carcinoma with neuroendocrine features. We encountered two cases of LCNEC and report the cytological findings here.
Cases: Tumor cells were found in bronchial brushing material in cases 1 and 2, and in sputum in case 2. In each case, tumor cells had abundant granular cytoplasm and large irregular shaped nuclei with granular chromatin. Tumor cells showed a partially palisading or rosette-like arrangement.
Conclusion: The cytological and immunohistochemical features of the tumors described above revealed that these tumors had both epithelial and neuroendocrine characters, that is they were LCNEC. In this paper we discuss the diagnostic basis of LCNEC and the strategies for differential diagnosis with small cell carcinoma, atypical carcinoid and large cell carcinoma of the lung.

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Background: Since adenocarcinoma with hepatoid transformation is relatively rare, there have been few case reports with cytological analysis of the tumor in the literature. We report the cytological features of an autopsy case of welldifferentiated tubular adenocarcinoma of the sigmoid colon showing hepatoid differentiation in metastatic lesions.Case: A 60-year-old man received sigmoidectomy for sigmoid colon cancer 4 years ago. Histopathological examination of the primary tumor revealed well-differentiated tubular adenocarcinoma without hepatoid differentiation. Two years after initial surgery, a metastatic lesion developed in the liver and was resected. Histopathological diagnosis was tubular adenocarcinoma. He was admitted to Kumamoto University Hospital because of tumor metastasis in the thoracic wall 3 years after initial surgical treatment. At admission, laboratory examination revealed an extremely high elevation of serum α-fetoprotein (AFP) levels. After admission, intensive chemotherapy was performed; however, the patient died of respiratory failure with multiple pulmonary metastases.At autopsy, multiple cancer metastases were found in the thoracic wall, lungs, bone, mediastinal lymph nodes, liver, and spleen. Imprint cytology revealed two different types of malignant cells; one was high columnar cancer cells with enlarged nucleoli, suggesting the features of well-differentiated adenocatcinoma, and the other was composed of cancer cells resembling the cytological features of hepatocellular carcinoma with loose clusters or a solid-sheet arrangement and with light-green-positive hyaline globules in the cytoplasm. Histopathologically, the metastatic lesions were composed of two different types of cells; The major component was medullarly-grown cancer cells with hepatoid cell characteristics, and the minor was well-differentiated tubular adenocarcinoma. Immunohistochemically, the primary carcinoma of the sigmoid colon was only positive for carcinoembryonic antigen (CEA), while the major component of the cancer cells in the metastatic lesions were positive for AFP, CEA, neuron-specific enolase, chromogranin A, human chorionic gonadotropin, α-1-antitrypsin, α-1-antichymotrypsin, transthyretin and keratin.Conclution: Cytological characteristics of cancer cells in the metastatic lesion are useful for making an accurate cytological diagnosis of adenocarcinoma with hepatoid differentiation.

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Background: Infantile hemangioendothelioma of the liver (IHE) is a relatively rare hepatic tumor which is diagnosed by imaging and clinical course, and is usually detected within 6 months of age. However, to our knowledge no cytological reports or observations of IHE have been published.
Case: A seven-week-old female infant who was admitted for heart failure was autopsied. At that time, imprint cytology was performed on multiple solid masses of the liver. Three associated subpleural nodules were detected by autopsy, and the same examination was also performed. The histological diagnosis was a hemangioendothelioma, type 2 and 1.
Conclusion: The tumor cells showed sheet-like arrangements and slight cluster formation with light and green short spindle shaped cytoplasm and centrally located nuclei, and a few cells showing compressed nuclei which were eccentrically located at one end of the cell, as well as a hyalin-like cytoplasm. The overall cytologic figures revealed scanty to mild atypicality and seemed to be different from hemangioma, epithelioid hemangioendothelioma and angiosarcoma.

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Background: Neuroendocrine carcinoma of the bladder is rare, being reported in less than 0.5% of all bladder malignancies. We report a case of neuroendocrine carcinoma found by primary urinary cytology.
Case: A 64-year-old male visited a medical practitioner complaining of gross hematuria and was admitled to the hospital with a suspected bladder tumor. Smears showed many tumor cells with naked nuclei. There cells were separately scattered or formed weakly connected small clusters. Nuclear molding, indian file-like or rosette-like arrangements were also observed. Thus cytologic findings were characteristic of the cellular features of small cell car-cinoma of the lung. Histologically, tumor cells showed solid proliferation and formed foci of various sizes. Immunohistchemicaly, cells were strongly positive for neuron specific enolase. Electron microscopically, dense core granules were observed.
Conclusion: The cytologic findings of bladder tumor were consistent with the charactristic histologic findings of neuroendocrine carcinoma of the bladder. These carcinomas have a rapidly aggressive clinical course, so early detection of them by urinary cytology is very important.

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Background: Aspiration biopsy cytology (ABC) is rarely perfomed on the parathyroid gland itself. However, in cases of differential diagnosis to determine a thyroid or parathyroid origin, ABC and enzyme-cytochemistry of dipeptidyl peptidase IV (DPP IV) are extremely useful.
Case: A 49-year-old Japanese male had a history of hemodialysis due to chronic renal failure for 15 years. For the last three years, he occasionally complained of lumbago, and the serum level of parathyroid hormone was gradually elevated. An ultrasonographic study revealed two masses in the neck region; one was located at the dorsal side of the lower pole of the left thyroid gland, and the other was adjacent to the lower pole of the right thyroid gland. ABC was performed on these masses, and revealed small and uniform cells in sheets without nuclear grooves and pseudo-inclusion bodies in routine Papanicolaou staining. In order to clarify their origin, enzyme cytochemistry and immunocytochemistry were also performed. The cells were strongly positive for DPPIV and parathyroid hormone but not for thyroglobulin, indicating that these cells originated from parathyroid glands. Surgically, the masses were actually swollen parathyroid glands partly attached to the thyroid glands. Histological examination showed a proliferation of chief cells in trabecular or sheeting fashion. The final pathological diagnosis was secondary hyperplasia of parathyroid glands.
Conclusion: In this case, enzyme cytochemistry of DPP IV has helpful diagnostic value for differential diagnosis between hyperplasia of the parathyroid gland and non-papillary tumor of the thyroid gland.

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Background: Warthin-like tumor of the thyroid (WLTT) is a newly recognized variant of papillary carcinoma of the thyroid. We report a case of WLTT with fine needle aspiration findings as well as histological and immunohistochemical findings.
Case: A 52-year-old female presented with a right lobe thyroid mass. Fine needle aspiration of the nodule yielded cellular smears, mostly in large and small clusters of eosinophilic cells, with ground-glass nuclei, nuclear grooves, and intranuclear cytoplasmic inclusion bodies in a lymphoplasmacytic background. Various sized multinucleated giant cells were also seen. Histologically, the main tumor consisted of papillary structures of eosinophilic tall cells with extensive lymphoplasmacytic infiltration. Nuclear features were similar to those seen in conventional papillary carcinoma of the thyroid. The background thyroid tissue showed Hashimoto's thyroiditis with hyperplastic nodules. Minute papillary carcinoma with psammoma bodies was also detected. Immunohistochemically, the tumor cells were positive for EMA, cytokeratins such as CK 8, CK 19, and AE 1/AE 3, CD 15, and mitochondria.
Conclusion: The cytological hallmarks of WLTT were cellular smears composed predominantly of eosinophilic cells in papillary clusters in a background of lymphoplasma cells and giant cells as well as nuclear features of conventional papillary carcinoma.

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Background: Primary cardiac angiosarcoma is a rare tumor and the cytological features of this tumor remain poorly defined. To clarify its cytological features we report here a case with histological and immunohistochemical findings.Case: A 60-year-old man presented himself to another hospital in November 1996 with dyspnea and fever. Chest computed tomography revealed a tumor in the right atrium. He was admitted to our hospital and tumorectomy of the right atrium was performed. Imprint cytology from the resected tumor showed that the tumor cells were scattered or formed medium-sized clusters. Spindle-shaped, polygonal and oval atypical cells were identified against a hemorrhagic background. The nuclei of the tumor cells were oval and eccentric, and the nuclear margin was uniformly thick. The nuclear chromatin was granular, and the nucleoli were prominent. Histologically, the tumor was composed of abnormal proliferations of malignant endothelial cells forming vascular channels. Immunohistochemistry for vimentin, factor Vlll-related antigen and CD 34 was positive. The diagnosis of angiosarcoma was established from these pathological findings.
Conclusion: The cytological features of the tumor cells on imprint cytology may be a useful finding for the diagnosis of angiosarcoma arising in the heart.

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Background: We report a case of meningioma, in which intraoperative histologic and cytologic consultation was useful in the diagnosis.
Case: A patient had a tumor within the left margo supraorbitalis and temporal bone. A crush preparation and a biopsy specimen from the tumor revealed spindle or polyhedral atypical cells with whorl formation. Intranuclear cytoplasmic inclusions and proteinous hyaline materials were also observed. Histologic examination revealed transitional cell type meningioma with marked infiltration into the diploic space. The MIB-1 positive rate was 2.5% of the tumor cells.
Conclusion: The high index of MIB-1 positivity of the present case may be related to the marked infiltration into the diploic space.

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Background: Primary serous adenocarcinoma of the uterine cervix is very rare. We report a case of primary serous adenocarcinoma of the uterine cervix that was very sensitive to chemotherapy.
Case: The presenting manifestation of this case, a 58-year-old woman, was abnormal cells on a routine cervical Papanicolaou smear with metastasis to the left scalenlymphnode tumor. On cytological examination, there was a ten dency for malignant cells to from clusters with stratification. Their nuclei showed anisonucleosis with remarkable nucleoli. Microscopic examination revealed serous adenocarcinoma indistinguishable from typical endocervical adenocarcinoma. She was treated by radical hysterectomy after neoadjuvant chemotherapy (cisplatin+5-fluorouracil) and postoperative chemotherapy.
Conclusion: This case suggests that serous adenocarcinoma of the uterine cervix is very sensitive to cisplatin+5-fluorouracil, like serous ovarian cancer.

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Background: The appearance of cells from squamous cell carcinoma of the uterine cervix in pericardial effusion is rare. At first sight, tumor cells are often misdiagnosed as adenocarcinoma cells because they form balls of cells.
Case: A 30-year-old woman visited our hospital with irregular genital bleeding and was diagnosed as squamous cell carcinoma by cytology and biopsy of the uterine cervix. Hysterectomy, radiation therapy and chemotherapy were performed. Two years and six months later, pericardial effusion was found and the bloody effusion was drawn.However she died after 1 month and an autopsy was performed.
Conclusion: Tumor cells formed cell balls and a lot of these balls were observed in the pericardial effusion. The cytoplasmic rim was clear. Nuclei were round and located in the central area of the cells. The majoritn of tumor cells were stained granular by PAS and were positive for keratin-13 (K-13) on immunocytochemistry. We diagnsed these tumor cells as squamous cell carcinoma cells.

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Background: Endometrial stromal carcinoma (ESS) is characterized by proliferation of blood vessels and comparatively uniform tumor cells resembling the stromal cells in proliferative endometrium. We performed a cytomorphologic study of imprinted materials of three histologically confirmed ESS (1 low grade, 2 high grade).
Cases: In addition to previously reported features, all three cytologic specimens showed characteristic vascular features; fine vascular structures surrounded by tumor cells. This cytologic feature would reflect the histological concentric proliferation of blood vessels and tumor cells surrounding the vessels.
Conclusion: This vascular finding in cytology will prove to be useful for discriminating ESS from uterine leiomyomas and other tumors when included with the conventional cytomorphological features of the ESS.

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Background: Carcinosarcoma arising from the uterine body, which often appears in the menopausal women, is an uncommon tumor compared to other malignancies of the uterine body. Usually it has a poor prognosis, so early diagnosis is important, but it is very difficult to diagnose correctly before surgery. We report a case of heterologous carcinosarcoma which appeared on the uterine body, which was characterized by squamous differentiation.
Case: An 88-year-old woman complaining of genital bleeding was examined at a private clinic. The cytological diagnosis of uterine cervix proved to be Class III b, with cartilaginous components found in the necrotic tissue. It was originally suspected to be carcinosaecoma with cartilagious tissue. By re-examination, both endometrioid adenocarcinoma and squamous metaplasia with nuclear atypia was found in the endometrium, so surgical operation was performed under suspicion of endometrial carcinoma.
Conclusion: Based on histological examination before the surgical operation and histopathological findings and results of immunohistochemistry, this case was diagnosed as heterologous carcinosarcoma with squamous differentiation arising from the endometrium.

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Background: Endometrial stromal sarcoma is a rare malignant tumor, most of which are diagnosed by histopathology. We describe a case of endometrial stromal sarcoma diagnosed by endometrial scraping cytology before the operation.
Case: The patient was a 50-year-old woman. Preoperative endometrial scraping cytology revealed many atypical round or spindle-shaped cells. The cytoplasm of these cells were scanty and light-greenish, and the nuclei were round with evenly distributed granular nucleolar chromatin. Pleomorphic tumor cells with large nuclei were also recognized. The tumor was diagnosed as endometrial stromal sarcoma because of the cytologic features. Histologically, the tumor was composed of round or spindle-shaped cells, and they were positively immunostained with antibodies for vimentin, αl-antitrypsin and αl-antichymotrypsin.
Conclusion: We report the cytological findings of endometrial stromal sarcoma, a rare malignant tumor, with new immunohistochemical features.

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Background: Malignant Brenner tumor is a very rare ovarian tumor with the cytological characteristic findings of which remain poorly reported in the literature. We study the cyto-clinicopathology of a case of malignant Brenner tumor.
Case: The patient, a 54 year-old female, complained of lower abdominal pain, nausea and vomiting. She had low level ascites in her abdominal cavity and many malignant cells were detected on stab cytology, which seemed to originate from an adenocarcinoma. Two tumor markers, STN (2000 U/ml) and CA 125 (1132 U/ml) were elevated and she had slightly enlarged bilateral ovaries. She therefore underwent bilateral oophorectomy and omentectmy. The tumor was diagnosed as malignant Brenner tumor from histopathological examination. In print cytology of the resected tumor, the cancer cells had round nuclei, a high N/C ratio with large nucleoli and coarse granular chromatin, and they formed clusters with overlapping cells.
Conclusion: These cytological findings were similar to other ovarian adenocarcinomas, so cytological findings alone were not sufficient to diagnose malignant Brenner tumor.

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Background: The cytologic findings of immature teratoma in ascites remain poorly described.
Case: A 20-year-old Japanese woman was referred with a pelvic cystic mass and massive ascites. The patient underwent right salpingo-oophorectomy. The microscopic examination revealed grade 3 immature teratoma. Cytologic findings of ascites were characterized by a small, round, hyperchromatic nucleus, one or two small nucleoi and scanty cytoplasm, resembling the cytomorphology of neuroblastoma or granulosa cell tumor. The tumor cells were seen in solitary or aggregated arrangement. Rosette formation was partly noted. The patient received 6 courses of chemotherapy with bleomycin, VP-16 and cisplatin and remain alive with no evidence of disease 3 years after initial surgery.
Conclusion: This is the second only report on the cytologic findings of immature teratoma in ascites, mimicking neuroblastoma or granulosa cell tumor.

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We report a case of Extraskeletal Ewing's sarcoma arising in the right chest wall. An I8-year-old female was admitted to our hospital with right chest pain. Fine needle aspiration cytology revealed loose clusters of cells and isolated small round cells with a few nucleoluis. The case lacked formation of Homer-Wright type rosettes, and a peritheliomatous pattern was prominent. The tumor cells immunohistochemically expressed NSE and MIC 2 (0 13, 12 E 7), and the tumor was considered to belong to the Ewing/PNET family.

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We report a case of a 77-year-old woman with tubular adenoma of the breast mimicking cytological features of adenomyoepithelioma. Fine needle aspiration revealed many clusters of ductal epithelial cells mixed with myoepithelial cells. Polygonal cells with abundant cytoplasm and psammoma bodies were also found. Histological examination disclosed glandular structures outlined by round to polygonal cells with clear cytoplasm. The glandular components surrounded by hyalinous stroma often contained psammoms bodies. There was no area of monotonous growth of tumor cells with clear cytoplasm devoid of glands. Immunostaning demonstrated distinct reactions for two cellular components. Epithelial cells were positive for epithelial membrane antigen and cytokeratin, whereas myoepithelial cells were reactive with alpha-smooth muscle actin. Based on these findings, the present case was diagnosed as tubular adenoma with focal proliferation of myoepithelial cells.

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An 83-year-old male was diagnosed with apocrine sweat gland carcinoma in the right axillary region. After the first operation, a metastatic lesion near the primary site was noticed and a second operation was performed. Cytological examination showed tumor clusters arranged in papillary or sheet-like pattern. Some of the tumor cells had abundant eosinophilic cytoplasm with Orange G-stained coarse granules and were positive for GCDFP-15 and B 72.3 immunohistochemically.
In conclusion, cytological features of the metastatic lesion retain the characteristic cytological appearance of apocrine sweat glands, which enabled a diagnosis of carcinoma of apocrine sweat gland origin.

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We describe a rare case of multicystic peritoneal mesothelioma. A 20-year-old female presented with a multicystic mass, measuring 12×9×5cm, in the pelvic cavity. The radiological differential diagnosis included lymphangioma, dissemination of malignant tumor, and unusual type of peritoneal mesothelioma. The levels of CA 19-9 and CA 125 were elevated. Cytological examination of the fluid from the ruptured tumor in the Douglas pouch showed clusters of benign mesothelial cells. Histological examination of the resected mass revealed it was benign cystic mesothelioma. The lining cells were positive for Alcian blue, and decolorized with hyaluronidase treatment. Immunohistochemically, the lining cells were positive for cytokeratin.

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Prostatic duct adenocarcinoma (PDC) is a rare variant of prostatic cancer which simulates uterine endometrioid adenocarcinoma on histology.
A 77-year-old male presented with gross hematuria. Cystoscopically, there was an exophytic lesion protruding into the prostatic urethra at the verumontanum. Voided urine cytology showed irregular-sized numerous aggregations of small epithelial cells with columnar features. They had small, hyperchromatic, round to oval nuclei arranged in a palisading pattern with inconspicuous nucleoli and varying amounts of cytoplasm. Immunocytochemically, the tumor cells were positive for prostate specific antigen (PSA).
Differentiation between PDC and transitional cell carcinoma depends on identification of columunar features and immunocytochemical staining for PSA.

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The morpholic features and an incidence of Herxherimer spiral (HS) have not been well described. We reviewed the cervico-vaginal smears of 111 cases of squamous cell carcinoma and 3480 benign cases. HS was observed in 18.0% of the cases of squamous cell carcinomas and in 0.34% the of benign cases. HS was present in the cell processes of spindle and/or tadpole type tumor cells of squamous cell carcinoma. In bening cases it was seen in metaplastic cells. The presence of HS may mean an abnormal differentiation of squamous cells or squamous cell carcinoma, but the diagnstic value of HS seems to be poor.

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