The Journal of the Japanese Society of Clinical Cytology
Online ISSN : 1882-7233
Print ISSN : 0387-1193
ISSN-L : 0387-1193
Volume 45, Issue 2
Displaying 1-19 of 19 articles from this issue
  • Satoshi IKEDA, Hiroshi KIMURA, Emiko HONMA, Sanae YOKOMIZO, Naoya FUNA ...
    2006 Volume 45 Issue 2 Pages 73-76
    Published: March 22, 2006
    Released on J-STAGE: November 08, 2011
    JOURNAL FREE ACCESS
    Objective: New techniques, such as cell transfer, DNA extraction and the re-staining method, are required for accurate diagnosis in cytology. We investigated the influence of the mounting media in applying the new techniques.
    Materials and Methods: Four kinds of mounting media were evaluated. Specimens without mounting media were used as controls. After 4 days mounting, 60 conditions (6 smears×5 media× 2 antigens) were investigated by immuno-staining for alcohol-fixed cytology smears and formalin-fixed paraffin sections. Similar observations were performed after mounting of one month for about 15 other conditions (3 smears × 5 media). We also extracted DNA from specimens under 30 different conditions (6 smears × 5 media) for PCR detection of β globin.
    Results: The results indicated that the staining intensity and PCR product were dependent on the kind of mounting media used. One type of mounting medium in particular caused deterioration of the antigen and DNA applicability for PCR.
    Conclusion: Mounting media might be a confounding factor in applying new cytological diagnostic techniques.
    Download PDF (2450K)
  • Kiyomi TAIRA, Satoshi MATSUBAYASHI, Manabu AZUMA, Manami NAKAJIMA, Nao ...
    2006 Volume 45 Issue 2 Pages 77-83
    Published: March 22, 2006
    Released on J-STAGE: November 08, 2011
    JOURNAL FREE ACCESS
    Objective: We investigated the utility of liquid-based cytology (LBC) of material from breast tumors obtained by FNA, in addition to conventional preparations.
    Study Design: After preparing a conventional smear, the recoverable material remaining in the FNA needle and syringe was processed by the LBC technique. We assessed whether the two types of preparations were adequate from the standpoint of quantity of cells and artifacts induced by dryness or crushing. The cytological and histological diagnoses were compared, and the cytologic features of LBC have been summarized.
    Results: We performed LBC in 564 cases over the period of one year. The LBC preparations in 126 cases clearly showed an increase in quantity of cells. Dryness and/or crushing was observed in 50 cases in the conventional smears despite a sufficient number of cells. The conventional preparations alone were regarded as adequate in 248 cases (44%), but the number of adequate cases rose to 411 (73%) when LBC preparations were added. No marked differences staging in diagnosis were observed between LBC and conventional smears, but many benign lesions were correctly diagnosed after adding LBC. Some attention must be paid to interpretation of cytologic findings of LBC.
    Conclusion: Adding LBC to conventional smears, resulted in a marked increase in the number of adequate specimens. More accurate diagnoses can be made when the cytologic features of LBC are comprehended.
    Download PDF (2313K)
  • Hiroko YAMADA, Takashi KOSHIKAWA, Yoshiki SUGANUMA, Yasuhisa HASEGAWA
    2006 Volume 45 Issue 2 Pages 84-90
    Published: March 22, 2006
    Released on J-STAGE: November 08, 2011
    JOURNAL FREE ACCESS
    Objectives: We evaluated the diagnostic accuracy of nonaspiration cytology (NAC) specimens from thyroid nodules and cervical lymph nodes.
    Study Design: We studied 1, 044 cases (928 thyroid glands, 116lymph nodes) of ultrasonograpy-guided nonaspiration cytology over a 5-years period.
    Histological diagnosis was definitively confirmed in 176 cases (145 thyroid nodules and 31 lymph nodes), and in 76 cases of lymph nodes observed long-term, we analyzed diagnostic accuracy, sensitivity, and specificity of cytology. We also studied the relationship between estimated cytodiagnosis and pathological diagnosis.
    Result: Specimens (1.7% as a whole) of 6 thyroid lesions (0.7%) and 12 lymph nodes (10.3%) were found to be inadequate. Thyroid lesion cytodiagnostic accuracy was 89.5%, sensitivity 85.0%, and specificity of thyroid lesions, and 95.6%. Results for lymph nodes were 98.1%, 96.6%, and 98.7%. Diagnostic concordance between cytology and histology for thyroid lesions was 72.4% and lymph nodes93.9%.
    Conclusion: Compared to normal aspiration biopsy cytology (FNA), and ultrasonography-guided NAC is superior for thyroid lesions and lymph nodes in both diagnostic accuracy and specimen collection.
    Download PDF (1288K)
  • Comparison of sampling methods
    Setsu AKAMATSU, Yukari HIMEJI, Yuuko NAGASAWA, Miyako YAMADA, Yukari I ...
    2006 Volume 45 Issue 2 Pages 91-95
    Published: March 22, 2006
    Released on J-STAGE: November 08, 2011
    JOURNAL FREE ACCESS
    Objective: We studied the efficacy of clinical sumpling in cervical cancer examination comparing cotton swabs and Cervex brushes. Subjects were 26, 344 women who participated in a cervical cancer screening program from 1999 to 2004.
    Study Design: For sampling with cotton swab and brush, at those who took medical examination two or three years successively and every other year (hereinafter interval), rate of ‘close examination required’ and clinical state found in the close examination was comparatively examined.
    Result: For either device, two years successively were significantly higher than three years successively but no significant difference for interval. In comparing a sampling for rate of ‘close examination required’ for three years successively, cotton swab was higher than brush. For clinical state found, no significant difference of two years successively and three years successively with cotton swab, but with brush, only Mild dysplasia was found for three years successively.
    Conclusion: In performing cervical cancer screening every other year, it is desirable that samples, we have to have history of one or more than two years successively and sampling device should be specified.
    Download PDF (783K)
  • Akira FUJIWARA, Hiromi TERASHIMA, Akemi SHISHIDO, Junko NISHIKI, Kyota ...
    2006 Volume 45 Issue 2 Pages 96-102
    Published: March 22, 2006
    Released on J-STAGE: November 08, 2011
    JOURNAL FREE ACCESS
    Objectives: Fine-needle aspiration (FNA) biopsy of breast tumors is reliable in diagnosing breast carcinoma, but cytological difficulties way exist in definitively distinguishing malignant from benign lesions. To improve the reliability of cytological diagnosis, we evaluated the usefulness of carcinoembryonic antigen (CEA) in such diagnosis.
    Study Design: We evaluated 176 breast tumors, determining CEA expression via immunocytochemistry. We compared immunocytochemistry and molecular analysis using RT-PCR in 36 fresh breast tumors and 6 human cancer cell lines.
    Results: Immunocytochemistry showed that the sensitivity of cytological diagnosis was 64.7% and that the specificity was 90.9%. The concordance between the two was 83% in fresh tumors and 100% in human cancer cell lines.
    Conclusion: We found CEA to be useful in the cytological diagnosis of breast malignancy, because it helps distinguish malignant from benign breast tumors. Molecular analysis is thus expected to improve the accuracy of cytological diagnosis.
    Download PDF (2510K)
  • Katsuaki SATO, Michiho TAKENAKA, Mariko NAKANO, Toshie TERAUCHI, Yoshi ...
    2006 Volume 45 Issue 2 Pages 103-105
    Published: March 22, 2006
    Released on J-STAGE: November 08, 2011
    JOURNAL FREE ACCESS
    Background: Mixed mucinous and nonmucinous type bronchioloalveolar carcinoma (mixed BAC) fulfilling WHO criteria is extremely rare. We report a case of mixed BAC, focusing on cytology.
    Case: A 57-year-old man was found in chest computed tomography (CT) to have a mass 3.0 cm in maximum diameter detected peripherally in the lower lobe of the right lung. Imprint smear cytology showed sheet-like clusters of atypical cells with or without mucin in cytoplasm, or of only nonmucinous atypical cells against a background of abundant mucin. Tumor cells of both components had similar nuclei with fine chromatin, distinct nucleoli, and the nuclear grooves typical of bronchioloalveolar carcinoma. A few psammoma bodies were observed. Histologically, the tumor consisted of atypical alveolar epithelium with lepidic growth along the alveolar wall and mucin in the alveolar space. Two types of neoplastic epithelium were identified: tall columnar cells with cytoplasmic mucin and cuboidal cells without mucin. No evidence was seen of stromal or pleural invasion.
    Conclusion: Cytological findings are useful in diagnosing mixed BAC.
    Download PDF (1380K)
  • Ayano AOKI, Kiyomi TANIYAMA, Takeshi KABUTO, Kumi SORA, Kae IZUMI, Kum ...
    2006 Volume 45 Issue 2 Pages 106-110
    Published: March 22, 2006
    Released on J-STAGE: November 08, 2011
    JOURNAL FREE ACCESS
    Backgrounds: Pagetoid carcinoma accounts for 0.5% of all breast carcinomas and has a poor prognosis. Clinical and cytological features of Pagetoid carcinoma are similar to those of Pagefs disease, and differentiation of both from squamous cell carcinoma or melanoma may not always be possible.
    Case: An 84-year old woman complained of eczematoid conditions of, and bloody discharge from the right nipple. In the nipple discharge specimens, there were many neutrophils, keratinizing squamous cells with varying degrees of atypism and some atypical epithelial cells. Cytological diagnosis was a squamous cell carcinoma with a differential diagnosis of adenocarcinoma. Pathological diagnosis of the biopsy specimen from the nipple skin was Paget's disease. After radical mastectomy of the right breast, pathological examination revealed a Pagetoid carcinoma, in which a solid-tubular type of invasive ductal carcinoma of 1.3 cm in size showed an extension into the nipple skin via the mammary ducts. Pagetoid carcinoma cells and ductal carcinoma cells were demonstrated to be immunoreactive for and-Her 2 antibody.
    Conclusion: Even when atypical squamous cells are predominant in large amounts in nipple discharge specimens, glandular epithelilal cells may provide better diagnostic clues if there is an eczematoid area on the nipple. Immunostaining for anti-Her 2 antibody may be useful for the cytological diagnosis.
    Download PDF (2026K)
  • Nobuhiro YAMASHITA, Sumiko KAJI, Eiji KATSUYAMA
    2006 Volume 45 Issue 2 Pages 111-115
    Published: March 22, 2006
    Released on J-STAGE: November 08, 2011
    JOURNAL FREE ACCESS
    Background: Spindle cell carcinoma of the breast is a rare neoplasm.
    Case: A 52-year-old woman noticed a tumor about 4 cm in diameter in the left breast. The first aspiration biopsy cytology specimen showed a few atypical cells with large multiple nuclei and thin, abundant cytoplasm. The second aspiration cytology specimen showed atypical epithelial cells with thick cytoplasm. We also noticed atypical spindle cells with features transitional toward atypical epithelial cells. Histologically, the mastectomy specimen showed spindle sarcomatous tumor admixed with focal epithelial tumor nests and a few multinucleated tumor cells. Transitional features from epithelial to sarcomatous tumor cells enabled us to diagnose this tumor as spindle cell carcinoma.
    Conclusion: It is important to find features transitional from epithelial toward sarcomatous tumor cells in diagnosing spindle cell carcinoma of the breast.
    Download PDF (3134K)
  • Kazutoshi OKUBO, Miki KUSHIMA, Mitsuharu KANO, Takahiko TONOIKE, Miyok ...
    2006 Volume 45 Issue 2 Pages 116-120
    Published: March 22, 2006
    Released on J-STAGE: November 08, 2011
    JOURNAL FREE ACCESS
    Background: Uterine sarcoma is uncommon in gynecological malignancies, and the presence of sarcoma cells in ascites is extremely rare.
    Case: In a 38-year-old woman who had abdominal distension, a huge abdominal mass, massive ascites and normal sized uterus and ovaries were observed on imaging examination. Ascitic cytology showed large malignant cells both in small clusters and in isolation. The tumor cells exhibited polymorphic and spindle shapes with multinucleation. Occasional mitotic figures were seen. Gynecological malignancy was suspected and surgery was performed. A tumor protruding from the uterine body with a thin stalk was resected. Peritoneal dissemination of the tumor was seen. the histopathological diagnosis with immunohistochemical staining revealed that the tumor was more likely to be an undifferentiated uterine sarcoma than a poorly differentiated leiomyosarcoma of the uterus.
    Conclusion: Although uterine sarcoma is difficult to diagnose before an operation, this case was positive for malignant cells in the ascitic cytology, and a malignant non-epithelial tumor could be suspected. It is important to know that uterine sarcoma is rare, but sarcoma cells can be seen in peritoneal fluid cytology specimens.
    Download PDF (2582K)
  • Koichi HIRANO, Kayoko NAKAMURA, Akira MUKAINO, Tomoko OKUNO, Tomoyuki ...
    2006 Volume 45 Issue 2 Pages 121-124
    Published: March 22, 2006
    Released on J-STAGE: November 08, 2011
    JOURNAL FREE ACCESS
    Background: The incidence of small cell carcinoma of the uterine cervix is 5% or less of all uterine cervical cancers. We report an extremely rare case of a small cell carcinoma with syndrome of inappropriate antidiuretic hormone secretion (SIADH).
    Case: A 41-year-old woman developed behavior changes thought to be due to an ectopic hormone-producing tumor. No tumor was detected by thoracoabdominal computed tomography. A colposcopic examination revealed a protruding tumor in the uterine cervix. Brush cytology showed atypical small cells assembled in nests with a loose arrangement. The tumor cells had scant cytoplasm, except for spottedly acidophilic ones. Imprint cytology performed during surgery revealed spotty tumor clusters forming a molding pattern. Histologically, the tumor was proliferative with a solid architecture of atypical small cells with rosette and ribbon-like arrangements and foci of squamous differentiation. Immunohistochemical studies of the tumor produced positive findings for chromogranin A and synaptophysin. Electron microscopy revealed that the cytoplasm contained membrane-bound electron-dense neurosecretory granules.
    Conclusion: A functioning small cell carcinoma of the uterine cervix with a poor prognosis is very rare. Clinically, early confirmation of this diagnosis is necessary. Brush and imprint cytology were very useful for determining the localization and characterization in the present ease because the patient had neither symptoms of the uterine cervix nor high titers of common tumor markers.
    Download PDF (1875K)
  • [in Japanese], [in Japanese]
    2006 Volume 45 Issue 2 Pages 125
    Published: March 22, 2006
    Released on J-STAGE: November 08, 2011
    JOURNAL FREE ACCESS
    Download PDF (133K)
  • Akihiko HASHI, Tsutomu YUMINAMOCHI, Shinichi MURATA, Tetsuo KONDO, Mas ...
    2006 Volume 45 Issue 2 Pages 126-133
    Published: March 22, 2006
    Released on J-STAGE: December 05, 2011
    JOURNAL FREE ACCESS
    Objective: We studied the cytological features of LEGH and MDA.
    :Study Design:: We retrieved 13 cases of 11 LEGH and 2 MDA cases of the uterine cervix. There were 26 cytologic smears from 13 patients available for this study. Cytological features were carefully observed under light microscopy.
    Results: Abundant yellow mucin is frequently found in LEGH and MDA. 1) INCI (intranuclear cytoplasmic inclusion) was observed at 63.6%(7/11) in LEGH and it was not found in any MDA. 2) Neither cell atypia nor architectural distortion was observed in LEGH; 3) In MDA, 3-dimensional irregular cell clustering and prominent nucleoli were seen.
    Conclusion: 1) INC' is a good parameter in diagnosing LEGH; 2) Cytological examination is a potent aid to differentiating LEGH from MDA.
    Download PDF (4717K)
  • Sakae HATA, Yoshiki MIKAMI, Takashi AKIYAMA, Yoshito SADAHIRA
    2006 Volume 45 Issue 2 Pages 134-140
    Published: March 22, 2006
    Released on J-STAGE: November 08, 2011
    JOURNAL FREE ACCESS
    Objective: We reviewed the cytologic features of benign endocervical glandular cells, glandular dysplasia, and adenocarcinoma in situ (AIS) to determine diagnostic features of adenoma malignum and lobular endocervical glandular hyperplasia (LEGH).
    Study Design: We studied the appearance of cell clusters and backgrounds, cell morphology, including nuclear features and staining patterns of intracytoplasmic mucin on Pap smears, in 85 cases of endocervical glandular lesions. We also studied the validity of histological scoring for discriminating between glandular dysplasia and adenocarcinoma in situ, proposed by Ioffe et al., in cytological diagnosis. The frequency of large monolayered sheets of cells in adenoma malignum, was 21%, in glandular dysplasia 50%, and in LEGH 42%. Clusters showing two to three layers of nuclear pseudostratification were seen in 17% of AIS, 11% of microinvasive adenocarcinoma, 5% of LEGH, and 12% of adenoma malignum. Clusters with more than four layer nuclear pseudostratification were only 0.3%, and 2% in LEGH and adenoma malignum. It was 9% in AIS and 35% in microinvasive adenocarcinoma. Irregular nuclear contour, coarse chromatin texture, and prominent nucleoli were observed in adenoma malignum. We saw no distinct nuclear abnormalities in LEGH, however in about 1/3 of LEGH and 2/3 of adenoma malignum, intranuclear cytoplasmic inclusions were also seen. Yellowish intracytoplasmic mucin was identified in both LEGH and adenoma malignum. Following Ioffe et al., the combined score was 3.5 in glandular dysplasia, 3.8 in LEGH, 4.2 in adenoma malignum, and 6 in adenocarcinoma.
    Conclusion: LEGH and adenoma malignum are distinguished from other benign endocervical glandular lesion by yellowish intracytoplasmic mucin and intranuclear cytoplasmic inclusion. Adenoma malignum is distinguished from LEGH by the morphology of cell clusters, distinct nuclear abnormalities, i.e., irregular shape and size variation, coarse chromatin architexture and prominent nucleoli.
    Download PDF (2216K)
  • Ryo ONOSE, Etsuko MIYAGI, Hisamori KATOH, Ken SUGIURA, Takashi YAMADA, ...
    2006 Volume 45 Issue 2 Pages 141-146
    Published: March 22, 2006
    Released on J-STAGE: November 08, 2011
    JOURNAL FREE ACCESS
    Objective: We reviewed problems with the diagnosis and theclinical management of adenoma malignum of the uterine cervix.
    Study Design: Using the criteria proposed by Tsuda et al., we clinicopathologically reexamined all cases previously diagnosed as adenoma malignum at the Kanagawa cancer center.
    Results: When 6 previously diagnosed cases of adenoma malignum were reexamined, only one of the cases met the new criteria. Consequently, adenoma malignum accounted for only 0.1% of all cancers of the uterine cervix in a similar age group. Conization was sometimes difficult to evaluate in cases of suspected adenoma malignum. In addition, characteristic cytological findings were not always recognized.
    Conclusion: The recognition of conization is desirable for the diagnosis of adenoma malignum. Adenoma malignum is very rare. A multi-institutional study is needed to determine the optimal management of this disease.
    Download PDF (4575K)
  • Hitoshi TSUDA, Yoshiki MIKAMI, Tsunehisa KAKU, Futoshi AKIYAMA, Yuko S ...
    2006 Volume 45 Issue 2 Pages 147-153
    Published: March 22, 2006
    Released on J-STAGE: November 08, 2011
    JOURNAL FREE ACCESS
    Objective: To determine the status of histopathological diagnosis of minimal deviation adenocarcinoma (MDA), i.e., adenoma malignum, and to see if replicable, clinically useful differential diagnosis is possible between MDA and lobular endocervical glandular hyperplasia (LEGH).
    Study Design: Four gynecological pathologists independently diagnosed 52 cervical glandular proliferative lesions based on their own criteria. Based on common criteria, 7 gynecological pathologists diagnosed 44 cervical glandular lesions into LEGH, LEGH+adenocarcinoma in situ (AIS), MDA, and common adenocarcinoma. Interobserver agreement was evaluated by κ statistics.
    Results: In the first study, interobserver agreement was slight (κ=0.115), and 5-year survival of patients with MDA varied from 13% to 60% among observers. In the second study, interobserver agreement improved to be substantial (κ=0.618), and the level between invasive lesions (MDA and common adenocarcinoma) and noninvasive lesions (LEGH and LEGH + AIS) was almost perfect (κ=0.928). Five-year survival was 100% for noninvasive lesions and 54% for invasive lesions (p<0.01).
    Conclusions: Replicable, clinically meaningful differential diagnosis was possible between LEGH, LEGH with AIS, and MDA. Expansion of criteria and their application to preoperative diagnosis could prove to be very useful.
    Download PDF (3732K)
  • Yoshiki MIKAMI
    2006 Volume 45 Issue 2 Pages 154-159
    Published: March 22, 2006
    Released on J-STAGE: November 08, 2011
    JOURNAL FREE ACCESS
    Adenoma malignum, a form of very well-differentiated mucinous adenocarcinoma of the uterine cervix, has been a focus of controversies among gynecologic oncologists and pathologists. Gastric phenotype, as evidenced by HIK1083-immunohistochemistry and glandular cells with “golden-yellow” intracytoplasmic mucin on Pap smears, as well as watery vaginal discharge and multiple cysts on MRI/CT have been considered diagnostic features for this rare tumor, without any confirmation of specificity. Consequently, lobular endocervical hyperplasia, also known as pyloric gland metaplasia, has been erroneously regarded as adenoma malignum. Both conditions should be distinguished from each other based primarily on morphology, rather than mucin histochemistry and/or immunohistochemistry. This distinction iscrucial for optimal patient management.
    Download PDF (3766K)
  • Mitsuru HASEGAWA, Masato HASHIMURA, Tetsuro NAGASAKA
    2006 Volume 45 Issue 2 Pages 160-161
    Published: March 22, 2006
    Released on J-STAGE: November 08, 2011
    JOURNAL FREE ACCESS
    We report a rare case of cervical ectopic thymoma. A 54-year-old man was found in computed tomography (CT) to have a nodule below the lower pole of the left lobe of the thyroid. Fine-needle aspiration cytology showed spindle cell clustersintermingled with small lymphocytes. The tumor was resected together with the left thyroid lobe and diagnosed histologically as cervical ectopic thymoma. Giventhe rarity of this tumor, fine-needle aspiration cytology assists in correct diagnosis.
    Download PDF (1351K)
  • Takahiko SAKUMA, Ryuichi TAKAMIZU, Akihiro MIMURA, Hiroshi OHASHI, Kiy ...
    2006 Volume 45 Issue 2 Pages 162-163
    Published: March 22, 2006
    Released on J-STAGE: November 08, 2011
    JOURNAL FREE ACCESS
    The case of a 67-year-old woman with a solid breast neuroendocrine carcinoma is presented. Cytological findings for breast neuroendocrine carcinoma have rarely been described. Cytopathologic examination using a fine needle aspiration (FNA) sample of the tumor revealed clusters of relatively uniform tumor cells. The tumor cells had round to oval nuclei with little to mild atypia, fine granular chromatin, and showed rosette formation. These features strongly suggested a neuroendocrine tumor, which was confirmed by a histopathologic examination of the resected specimen. The diagnosis of neuroendocrine carcinoma was further confirmed by immunostaining for neuron-specific enolase/chromogranin A/synaptophysin. Preoperative FNA successfully predicted this special type of breast carcinoma.
    Download PDF (1218K)
  • Sachiho NETSU, Ryo KONNO, Akemi ENOMOTO, Michitaka OHWADA, Mitsuaki SU ...
    2006 Volume 45 Issue 2 Pages 164-165
    Published: March 22, 2006
    Released on J-STAGE: November 08, 2011
    JOURNAL FREE ACCESS
    We evaluated the feasibility of cervical cytology and human papillomavirus (HPV) testing, analyzing 67 patients cytologically diagnosed with at least mild dysplasia. Positive criteria of cytology, histology, and HPV tests were class HSIL or greater, CIN2 or more, and HPV index >1. The gold standard was punch biopsy histology. The sensitivity of cytology was 47.7%, 86.4% HPV testing and both 89.3%. The negative predictivity of cytology, was 67.6%, 87.0% HPV testing and both 83.3%. Cervical screening with both cytology and HPV testing effectively distinguishes the disease requiring treatment.
    Download PDF (264K)
feedback
Top