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Volume 48 (2009)
- Issue 6 Pages 353-
- Issue 5 Pages 257-
- Issue 4 Pages 159-
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- Issue 2 Pages 47-
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Volume 48, Issue 4
Displaying 1-15 of 15 articles from this issue
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Original Articles
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Minoru OHHASHI, Takayuki SUZUKI, Atsushi IMAI, Kumiko OGAWA2009 Volume 48 Issue 4 Pages 159-165
Published: 2009
Released on J-STAGE: November 09, 2009
JOURNAL FREE ACCESSObjective : To simplify cell block (CB) preparation, we studied hematoxylin S solution (HxS) as a reliable agglutinogen.
Study Design : We optimized the agglutination sensitivity of different cytological materials using 7 types of hematoxylin solution. Cell pellets were placed in cassettes, fixed with 10% formalin, and routinely prepared as paraffin-embedded blocks and thin sections. Diagnostic efficacy was evaluated using 224 excess-tissue samples from curettage or smear materials, 46 liquid-specimen precipitates, including pleural and peritoneal fluid, and 9 urinary precipitates as minimal protein materials.
Results : One 30μl drop of HxS effectively agglutinated cytology materials. Aggregates were suitable for thin-slice hematoxylin-eosin staining and a variety of immunohistochemical approaches. Despite some shrinkage and uneven cell staining, tissue structures from curettage and smear materials were clear enough to yield detailed diagnoses in 5 cases (2.2%). The quality of CB slides with precipitated samples was also acceptable, and precise histological diagnosis was possible in 14 cases (30.4%). Adding 30μl of conjugated bovine albumin improved cell recovery from urinary precipitates and made 1 case (11.1%) more informative.
Conclusion : This modified CB procedure using HxS is recommended as a very simple, reliable preparation.View full abstractDownload PDF (783K) -
Junko KAMIO, Takeharu SATO, Yoshie MUROI, Shinichi SHIBATA, Takashi IS ...2009 Volume 48 Issue 4 Pages 166-169
Published: 2009
Released on J-STAGE: November 09, 2009
JOURNAL FREE ACCESSObjective : We studied mass-screening sputum cytology results in detecting squamous-cell lung cancer.
Study Design : Subjects were 169,840 persons mass-screened for squamous-cell lung cancer using sputum cytology in the 19 years from 1987 to 2005.
Results : Cancer cases thus detected from 1987 to 1995 decreased from 183.0 to 146.2 per 100,000 persons from 1996 to 2005 among the total of 270 (162.6 per 100,000) found. No clear differences were seen between 1987-1995 and 1996-2005 in the incidence of central and peripheral sites (p=0.70, χ2 test).
Conclusions : While mass-screening sputum cytology remains useful in detecting early squamous-cell lung cancer, screening could be made more effective by narrowing subjects down to high-risk groups and increasing the number of those screened.View full abstractDownload PDF (356K) -
Kazunobu YAHATA, Tomoaki TERAMOTO, Keiko SHIMIZU, Sachiko NAGUMO2009 Volume 48 Issue 4 Pages 170-175
Published: 2009
Released on J-STAGE: November 09, 2009
JOURNAL FREE ACCESSObjective : We surveyed objective criteria to evaluate cytothechnologist performance to determine practical cytology quality control.
Study Design : Data was from 152 cytotechnologists (CTs) taking the 2005-2007 cytology external quality control survey of 100 cytodiagnostic questions. Two cyological images and 5 multiple-choices questions with 5 choices had to be answered within 1 minute. Response sheets were collected and results analyzed, and the quality of cytological images and choices re-evaluated.
Results : Survey results were 74.3% (S.D.=13.0) in 2005, 69.1% (S.D.=10.5) in 2006, and 79.3% (S.D.=8.8) in 2007. The accuracy rate ranged from 22 to 100% among questions. In proportion to years of experience, CTs who worked in cytological laboratories of commercial medical laboratories or health screening centers scored lower than CTs who worked in cytological laboratories of hospital so CT performance for 20 years or less experience differed little but for over 20 years of experience, there was a 10% disparity between the result of the group of CTs who has screening for cytologic specimens which were obtained from almost all body sites and the result of the other group.
Conclusion : Survey results were affected by three factors— (1) years of CT experience, (2) differences in laboratory, and (3) difference in cytologic specimens screened.View full abstractDownload PDF (309K)
Clinical Articles
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Tetsuya YANO, Takeshi FUJII, Ayako YOSHIDA, Kenichi OHASHI2009 Volume 48 Issue 4 Pages 176-180
Published: 2009
Released on J-STAGE: January 28, 2011
JOURNAL FREE ACCESSBackground : Plasma cell neoplasm is clinically recognizable as a bone and soft-part tumor. We report a case of anaplastic plasmacytoma involving the chest wall in which imprint cytology specimen observation was useful in suggesting its plasmacytic origin.
Case : An 82-year-old man was found in chest computed tomography (CT) to have a left anterior chest mass 10 cm in diameter involving the ribs. The surgically resected tumor, consisting of large atypical cells with eccentric oval nuclei and prominent nucleoli arranged in a medullary growth pattern together with bizarre multinucleated tumor cells, was considered histologically to be anaplastic plasmacytoma. Differential diagnoses included malignant epithelioid neoplasms such as metastatic carcinoma, epithelioid sarcoma, and hematological neoplasm.
Conclusion : Imprint cytology is useful in definitively diagnosing plasma cell neoplasm, including the anaplastic variant.View full abstractDownload PDF (559K) -
Kaname SUZUMURA, Shotaro MAEDA, Masaru HOSONE, Hironori KATAYAMA, Keik ...2009 Volume 48 Issue 4 Pages 181-186
Published: 2009
Released on J-STAGE: January 28, 2011
JOURNAL FREE ACCESSBackground : While body fluid cytology is effective in diagnosing mesothelioma early, some cases are difficult to determine. We report a case of malignant peritoneal mesothelioma diagnosed by body fluid cytology alone.
Case : A 59-year-old man with idiopathic ascites found to have no apparent abnormalities in positron emission tomography (PET) was found in body fluid cytology of ascites to have binucleated and multinucleated mesothelial cells with hypertrophied nucleoli and inflammatory cells such as histiocytes. Cellular cytoplasmic inclusion was also seen, suggesting mesothelioma. Papillary cell clusters later appeared and immunostaining of cells aspirated from ascites by cell transfer showed cells immunopositive for calretinin, CK5/6, mesothelin, D2-40, E-cadherin, epithelial membrane antigen (EMA), and p53, and cells immunonegative for carcinoembryonic antigen (CEA). Electron microscopy by cell block showed numerous elongated microvilli on cells aspirated from ascites, yielding a definitive diagnosis of mesothelioma.
Conclusion : Immunohistochemical staining with several antibodes by the cell block method and cell transfer method is necessary to make a definitive diagnosis of mesothelioma.View full abstractDownload PDF (696K) -
Takayuki SATO, Takeshi FUJII, Tetsuya YANO, Ayako YOSHIDA, Hiroko NAKA ...2009 Volume 48 Issue 4 Pages 187-191
Published: 2009
Released on J-STAGE: January 28, 2011
JOURNAL FREE ACCESSBackground : Japanese practioners rarely encounter malignant effusion due to malignant melanoma in routine cytopathology because the prevalence of melanoma is lower in Japan than in western countries. We retrospectively reviewed effusion samples diagnosed as malignant melanoma.
Cases : Six patients (2.3%) with malignant effusions diagnosed as malignant melanoma were retrieved from hospital files out of 406 tissue samples from 256 patients diagnosed with malignant melanoma between 1989 and 2008. Patients were five men and one woman ranging from 26 to 72 years old (median 56). All had cutaneous melanoma. Effusion appeared 5.5 to 135 (mean 31.7) months after primary lesion resection. The prognosis was dismal, and patients died 18 to 45 (mean 38.2) days after the appearance of malignant effusion. Prominent cytological features included lack of cellular cohesion (6/6), prominent nucleoli (6/6), multinucleation (5/6), melanin pigment (4/6) and cytoplasmic vacuolization (5/6).
Conclusions : The diagnosis of malignant melanoma in effusion can be challenging when tumor cells lack melanin pigment especially in the absence of a clinical history. Differential diagnosis included malignant mesothelioma, reactive mesothelial cells, and poorly differentiated adenocarcinoma. A combination of morphology and immunocytochemical analysis using MART1/melan A, HMB45, and S100 antibodies and the acquisition of a clinical history should yield an accurate diagnosis.View full abstractDownload PDF (589K) -
Hiroyuki OYAMADA, Hitoshi ITOH, Yoko MIYAJIMA, Akihiko SERIZAWA, Nobua ...2009 Volume 48 Issue 4 Pages 192-196
Published: 2009
Released on J-STAGE: January 28, 2011
JOURNAL FREE ACCESSBackground : Neuroblastoma tumors, considered to originate in the neural crest, occur mostly in children less than four years old and very rarely in adolescents or adults. We report a case of poorly differentiated neuroblastoma with atypical multinucleated giant cells arising in the adrenal gland of an 18-year-old woman.
Case : An 18-year-old woman admitted for a suspicious left adrenal gland mass underwent laparoscopic adrenalectomy for a preoperatively diagnosed nonfunctional adrenal gland tumor and intraoperative aspiration cytology of the tumor’s cystic content. Cytological results showed scattered ovoid to spindle-shaped cell nuclei against a microfibroid background. Cells were admixed among atypical multinucleated giant cells with marked nuclear atypia, peripheral nuclei, and abundant cytoplasm.
Conclusion : Cytological diagnosis of an adrenal tumor is rare. Neuroblastomas commonly occur in infants and usually consist of uniform cells. Neuroblastomas occurring in young adults are rarely pleomorphic.View full abstractDownload PDF (741K) -
—Consideration of differentiating from metastatic mucinous carcinoma—Mitsuaki ISHIDA, Keiko YOSHIDA, Keiko MIYAMOTO, Muneo IWAI, Yoshimitsu ...2009 Volume 48 Issue 4 Pages 197-200
Published: 2009
Released on J-STAGE: January 28, 2011
JOURNAL FREE ACCESSBackground : Myxoid adrenocortical tumors are extremely rare, with only 12 adenomas and 13 carcinomas reported in the literature. We report a case of myxoid adrenocortical adenoma and discuss the differential diagnosis.
Case : A 60-year-old Japanese woman on hypertension medication was found in abdominal ultrasonography to have a right adrenal gland tumor, necessitating laparoscopic adrenalectomy. Touch smears of the adrenal tumor showed loose aggregates of variable-sized large oval to polygonal cells in the abundant myxoid background. Scattered elongated fusiform cells were also seen. Nuclei were located in the center of cytoplasm and varied in size. Nuclear chromatin was finely granular and evenly distributed, although some of the nuclei had prominent nucleoli. Alcian-blue-positive myxoid material was confined to the extracellular space and digested by hyaluronidase.
Conclusion : Demonstration of the hyaluronidase-sensitive character of extracellular myxoid material is a clue in the cytopathological diagnosis of myxoid adrenocortical tumors distinguishing them from metastatic mucinous carcinoma. Careful observation of necrosis and mitotic figures are required for the differential diagnosis between benign and malignant myxoid adrenocortical tumors.View full abstractDownload PDF (523K) -
Sanae TAKAKI, Hisashi SHIGEMOTO, Yoshihiro KURISU, Yukio TAKESHIMA2009 Volume 48 Issue 4 Pages 201-205
Published: 2009
Released on J-STAGE: January 28, 2011
JOURNAL FREE ACCESSBackground : Nodular fasciitis, also known as subcutaneous pseudosarcomatous fibromatosis, is a benign, reactive fibroblast proliferation in subcutaneous tissues commonly associated with the deep fascia.
Case : We report a case of nodular breast fasciitis found by mammography in a 57-year-old woman. The 4.0×2.5 cm tumor located in the AB region of the left breast was extirpated.
Conclusion : Fine-needle aspiration cytology showed numerous spindle cells with slight nuclear atypia and small ductal cell clusters. The pathological diagnosis was nodular fasciitis. We discuss the clinical features and differential diagnosis of this case.View full abstractDownload PDF (575K) -
Kikuko HAMANAKA, Fumiaki TEZUKA, Teruhiko SATO, Maki TAKAHASHI, Hiroyo ...2009 Volume 48 Issue 4 Pages 206-210
Published: 2009
Released on J-STAGE: January 28, 2011
JOURNAL FREE ACCESSBackground : Malignant adenoma of the uterine cervix, a form of very-well-differentiated mucinous adenocarcinoma, is designated as a minimal deviation adenocarcinoma (MDA) in World Health Organization (WHO) classification (2003). Its cytological diagnosis is difficult. We report a case of MDA with typical cytological features.
Case : A 29-year-old woman with massive mucoid vaginal discharge was suspected in cytological examination of so-called malignant adenoma, necessitating radical hysterectomy. Cervical scraping Pap smears showed two types of epithelial cell clusters-type A, a large number of sheet-like clusters of benign-looking glandular cells with yellowish intraplasmic mucin, and type B, a small number of clusters of non mucinous atypical cells showing three-dimensional (3D) irregular clustering with slightly enlarged nuclear coarse chromatin texture and prominent nucleoli. Histological examination of the hysterectomy specimen showed (1) massive growth in the central portion showing glands of a cumuliform pattern irregular in size and shape lined by mucin containing columnar cells with basal nuclei and (2) invasive growth in the peripheral portion withless-well-differentiated inflammatory or desmoplastic stromal glandular cells. The type A cell cluster on cytological preparation was thought to derive from the central portion and the type B cell cluster from the peripheral portion.
Conclusion : It is cytologically difficult to diagnose minimal deviation adenocarcinoma, especially in distinguishing it from lobular endocervical glandular hyperplasia. One clue may be to identify less-well-differentiated cell clusters among a large number of benign-looking mucinous glandular cells in MDA. Sampling from deep portions of the endocervical lesion is also desirable.View full abstractDownload PDF (587K) -
Takashi ENDO, Takeshi FUJII, Misao NAKANISHI, Akihiro OHTA, Masumi NUM ...2009 Volume 48 Issue 4 Pages 211-215
Published: 2009
Released on J-STAGE: January 28, 2011
JOURNAL FREE ACCESSBackground : Peutz-Jeghers syndrome, a hereditary gastrointestinal polyposis with mucocutaneous pigmentation, puts its sufferers at 3% to 24% risk for cancer including sex cord tumor with annular tubules of the ovary, well-differentiated adenocarcinoma (adenoma malignum) of the uterine cervix, and breast cancer.
Case : A 39-year-old woman hospitalized for melena, abdominal pain, and fever had a long history of Peutz-Jeghers syndrome with repeated episodes of intestinal obstruction since childhood. Examination showed ascites and bilateral pleural effusion cytologically positive for adenocarcinoma cells containing intracytoplasmic mucin. Upper and lower gastrointestinal endoscopy showed polyposis consistent with Peutz-Jeghers syndrome and irregular genital bleeding. Abdominal computed tomography (CT) showed swelling of the uterine cervix suggestive of cervical cancer, confirmed by a Pap smear and uterine cervical biopsy to be endocervical mucinous adenocarcinoma. She died about a month later.
Conclusion : Adenocarcinoma of the uterine cervix should be considered in differential diagnosis when mucinous adenocarcinoma cells are encountered in effusion cytology specimens from those with Peutz-Jeghers syndrome.View full abstractDownload PDF (607K) -
Rie GOCHO, Emiko NAKAMURA, Kyoichi MIYAGAWA, Jun KANEMOTO, Toshio SHIM ...2009 Volume 48 Issue 4 Pages 216-219
Published: 2009
Released on J-STAGE: January 28, 2011
JOURNAL FREE ACCESSBackground : The pathogenetic relationship of fallopian tube carcinoma to tamoxifen or BRCA gene mutation has been discussed in the literature. We report a case of fallopian tube carcinoma in situ in a woman treated with tamoxifen as adjuvant breast carcinoma therapy.
Case : A 58-year-old woman who underwent left mastectomy for breast carcinoma at 50 years of age then underwent adjuvant tamoxifen therapy. After one year, cervical cytology showed malignant cells suggestive of endometrial carcinoma. Gynecological examination showed no tumor in the uterus, ovaries, or fallopian tubes. Total abdominal hysterectomy and bilateral salpingooophorectomy were done two months later. Grossly, the uterus, ovaries, and fallopian tube were normal, but microscopic examination of serial sections of the fallopian tubes showed bilateral fallopian tube carcinoma in situ.
Although two lymph nodes with cancer metastasis were excised twice during the 6 years after surgery, she has no evidence of cancer at present.
Conclusions : 1. Caution should be used in the development of fallopian tube carcinoma in patients with breast carcinoma and treatment using tamoxifen.
2. Fallopian tube carcinoma should be taken into consideration when no clinically apparent lesions are found despite the presence of malignant cells in cervical cytology.View full abstractDownload PDF (454K) -
—A report of two cases—Katsuo USUDA, Motoyasu SAGAWA, Hirokazu AIKAWA, Masakatsu UENO, Yuichi ...2009 Volume 48 Issue 4 Pages 220-225
Published: 2009
Released on J-STAGE: January 28, 2011
JOURNAL FREE ACCESSBackground : Pulmonary pleomorphic carcinoma is a rare pulmonary tumor. The cytological characteristics of pulmonary pleomorphic carcinoma are not clear in medical literature.
Cases : The cytological components of pulmonary pleomorphic carcinoma in two cases were analyzed to determine what components were dominant in pulmonary pleomorphic carcinoma. Imprinting cytological specimens which were obtained from the cut surface of resected tumors were stained in Papanicolaou stain or Giemsa stain. The main cytological components associated with the carcinoma were selected from the specimens, and their frequency in cytological specimens were analyzed. The most main cytological components of pulmonary pleomorphic carcinomas were various types of cells including giant cells, two-nucleated cells, multinucleated cells, bizarre nucleus, nuclear mitosis, mixture of cancer cells and neutrophils, or large naked cells as well as glandular differentiated cells, large undifferentiated cells. Surprisingly, there were few spindle cells in the cytological specimens of pleomorphic carcinoma.
Conclusion : A cytological diagnosis of pulmonary pleomorphic carcinoma can be strongly suspected based upon the multitude of cancer cells, regardless of the presence or the absence of spindle cells.View full abstractDownload PDF (788K)
Brief Notes
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Kayoko NAKAMURA, Kazuaki HASHIMOTO, Masafumi KITANO, Hiromi SAKASHITA, ...2009 Volume 48 Issue 4 Pages 226-227
Published: 2009
Released on J-STAGE: January 28, 2011
JOURNAL FREE ACCESSWe report a case of adenoid cystic tracheal carcinoma with cytological examination of fluid obtained by tracheal washing. The trachea was partially resected and the adenoid cystic carcinoma diagnosis confirmed. Tracheal washing is safe and enables adenoid cystic carcinoma to be diagnosed by carefully examining the tracheal washing specimen cytologically.View full abstractDownload PDF (402K) -
Yasuo SHIBUKI, Koji TSUTA, Naobumi TOCHIGI, Naoshi SASAKI, Yuko SASAJI ...2009 Volume 48 Issue 4 Pages 228-229
Published: 2009
Released on J-STAGE: January 28, 2011
JOURNAL FREE ACCESSWe analyzed the usefulness of mammaglobin, a breast-cancer-specific immunohistochemical marker, in cytological pleural effusion material. Pleural effusion was immunocytochemically stained for mammaglobin and gross cystic disease fluid protein 15 (GCDFP-15) in 60 subjects, i. e., 20 cases each of breast cancer, lung cancer, and benign. Of breast cancer case fluid, 12 cases (60%) were immunoreactive for mammaglobin and 9 (45%) for GCDFP-15. Combining the two raised breast-cancer identification sensitivity to 70%. The specificity of mammaglobin was 100% and that of GCDFP-15 95%.View full abstractDownload PDF (171K)
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