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.
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.
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.
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.
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.
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.
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.