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Volume 48 (2009)
- Issue 6 Pages 353-
- Issue 5 Pages 257-
- Issue 4 Pages 159-
- Issue 3 Pages 91-
- Issue 2 Pages 47-
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Volume 48, Issue 5
Displaying 1-16 of 16 articles from this issue
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Original Articles
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Hitoshi ITOH, Yoko MIYAJIMA, Nobuaki KATO, Akihiko SERIZAWA, Tomohisa ...2009 Volume 48 Issue 5 Pages 257-262
Published: 2009
Released on J-STAGE: January 22, 2010
JOURNAL FREE ACCESSObjectives : Ductal adenoma of the breast mimics carcinoma both clinically and histologically. We studied cytological findings for this disease.
Study Design : Cytological findings were evaluated in fine-needle aspiration (FNA) material from nine patients with ductal adenoma diagnosed histologically.
Results : Mean patient age was 57.8 years. Six cases were categorized ultrasonographically as suspicious for malignancy. Three cases were classified cytologically as suspicious for carcinoma and two consistent with apocrine carcinoma. Three each were indeterminate or normal or benign. Apocrine metaplastic cells were seen in four cases and high nuclear atypia detected in two. Intracellular mucin was present in three cases. Biphasic clusters consisting of glandular epithelial and myoepithelial cells were seen in eight cases. Cellular cohesiveness was relatively high.
Conclusions : Ductal adenoma may mimic carcinoma, with apocrine metaplastic cells with high nuclear atypia and cells with intracellular mucin observed. In the presence of these findings and with biphasic clusters of a solitary breast mass sampled by FNA, ductal adenoma should be included in potential differential diagnoses.View full abstractDownload PDF (625K) -
Miwa KINO, Yuko SUGIYAMA, Naoko SUZUKI, Kimihiko SAKAMOTO, Kuniko UTSU ...2009 Volume 48 Issue 5 Pages 263-267
Published: 2009
Released on J-STAGE: January 22, 2010
JOURNAL FREE ACCESSObjective : Endometrial carcinoma has been increasing both among middle-aged and younger women. We studied the clinicocytopathological features of endometrial carcinoma in younger women.
Study Design : We clinicocytopathologically compared endometrial carcinoma features in women 39 years old or less (younger group) to those in women 40 or more years old (older group).
Results : The 719 subjects were 48 younger women and 671 older women seen between Jan. 2000 and Dec. 2006. Post operative StageIa or 0 was more common in the younger group. Histopathologically, 15 subjects (31.3%) in the younger group had endometrioid adenocarcinoma with squamous differentation, compared to 118 (17.6%) in the older group (p=0.03). Cytopathologically, suspected cancer or worse diagnoses were made at the same rate for both groups, i. e., 89% and 85%. Cytologically, 15 (34.9%) of the 43 reviewed cases had endometriod adenocarcinoma with squamous differentation in the younger group versus 61 (9.4%) of 650 in the older group, similar to histological features (p<0.001).
Conclusion : Our results indicated that greater care is needed in diagnosing the cytological feature of squamous differentiation in atypical endometrial cytology in younger women.View full abstractDownload PDF (433K) -
Miyoko MAEKAWA, Mitsuyoshi HIROKAWA, Yukari YANASE, Seiji KUMA, Akira ...2009 Volume 48 Issue 5 Pages 268-273
Published: 2009
Released on J-STAGE: January 22, 2010
JOURNAL FREE ACCESSObjective : We clarified the cytological findings for poorly differentiated carcinoma (PDC) of the thyroid.
Study Design : We divided 57 PDC cases histologically based on the proportion of poorly differentiated components—i. e., group 1 with fewer than 20%, group 2 with 20% to 50%, and group 3 with 50% or more. We then observed group cytological features.
Results : Cytology showed trabecular arrangements in 45.6%, large solid nests in 21.1%, and less-cohesive aggregation in 10.5% of PDC. Findings reflect histological trabecular, insular, and solid patterns. Mitotic figures were observed in 24.6% of PDC, especially 71.4% in group 3 of follicular carcinoma PDC. Papillary carcinoma PDC did not always show distinctive features of well-differentiated papillary carcinoma. Follicular carcinoma PDC tended to show nuclear enlargement and macronucleoli.
Conclusions : Tumor cell arrangements are more important than cellular findings for diagnosing PDC in cytology. PDC is cytologically diagnosable if cases involved majority of PDC components for each tumor.View full abstractDownload PDF (684K) -
Sachiyo OHNO, Yoichi WATANABE, Kiyoshi TONE, Sayaka TOKUSHIGE, Reiko W ...2009 Volume 48 Issue 5 Pages 274-279
Published: 2009
Released on J-STAGE: January 22, 2010
JOURNAL FREE ACCESSObjective : We determined which of four media-saline solution, RPMI1640, lactate Ringer’s solution, or low-molecular-weight dextran-containing lactate Ringer’s solution (D-Ringer’s solution)-best preserved brushed cytological specimens morphologically.
Study Design : Brushed cytological specimens taken from 5 colon-adenocarcinoma and 5 lung-adenocarcinoma lesions were each suspended in 4 types of media—saline, RPMI1640, lactate Ringer’s solution, and D-Ringer’s solution—and kept for 0.5, 1, 3, and 5 hours at room temperature and 24 and 72 hours at 4 degrees Centigrade. After that, specimens were examined morphologically using Papanicolaou or May-Giemsa stained smear preparations.
Results : D-Ringer’s solution best preserved specimens, morphologically preserving nuclear chromatin, preventing nuclear expansion and/or deformity, but condensing some cell chromatin and shrinking nuclei.
Conclusion : D-Ringer’s solution is practical and useful in preserving cell morphology in cell suspension for handling brushing cytology specimens.View full abstractDownload PDF (607K)
Clinical Articles
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Michiyo USHIJIMA, Yoshihiro YAMAKAWA, Yuko TAKAGOSHI, Kiyoshi KATOU, E ...2009 Volume 48 Issue 5 Pages 280-284
Published: 2009
Released on J-STAGE: March 18, 2011
JOURNAL FREE ACCESSBackground : Endometrial stromal sarcomas—very rare neoplasms accounting for less than 0.5% of all malignant uterine tumors—are difficult to diagnose preoperatively. We report a case of high-grade endometrial stromal sarcoma diagnosed using cytological, histological, and immunohistochemical findings from preoperative specimens.
Case : A 52-year-old woman seen for abnormal uterine bleeding was found in a gynecological examination to have an enlarged fist-sized uterus. Cytological and pathological specimens from endometrial aspiration cytology and endometrial biopsy showed malignant nonepithelial cells diagnosed immunohistochemically as uterine endometrial stromal sarcoma necessitating simple hysterectomy and bilateral salpingo-oophorectomy.
Histologically, tumor cells had a pleomorphic pattern and frequently invaded surrounding blood vessels. Immunohistochemistry staining showed tumor cells to be positive for CD10 and vimentin, partially positive for PR, and negative for cytokeratin AE1/AE3, SMA, S-100, and ER.
Conclusion : Cytological and immunohistochemical findings were useful in preoperatively diagnosing and selectively treating endometrial stromal sarcoma.View full abstractDownload PDF (693K) -
Misao YONEDA, Yuji KOZUKA, Hiroshi IMAI, Akiko SHIBAHARA, Mika KITAYAM ...2009 Volume 48 Issue 5 Pages 285-289
Published: 2009
Released on J-STAGE: March 18, 2011
JOURNAL FREE ACCESSBackground : Duodenal carcinoid tumors are relatively rare. We present a case of duodenal carcinoid tumor diagnosed by endoscopic ultrasonography with fine-needle aspiration (EUS-FNA). Diff-Quik bedside staining was useful in the diagnosis of such lesions.
Case : A 60-year-old man was found in abdominal ultrasound sonography to have a tumor 18 mm in diameter in duodenal submucosa and the pancreatic head. No Duodenal mucosal abnormality was observed in upper digestive endoscopy. EUS-FNA and cytological diagnosis were made using Diff-Quik staining. Cytological findings showed rosette formation, scattered binucleate or trinucleate cells, and salt-and-pepper chromatin patterns. An endocrine tumor was suspected, so additional aspirations were performed for a cell block specimen. Pap stain showed findings similar to Diff-Quik staining. The cell block specimen, which fixed all samples, showed clusters of atypical cells with intranuclear inclusion bodies. In immunostaining, atypical cells were positive for CD56 and synaptophysin. A tumor was later surgically resected. Histology of the excised specimen showed an alveolar tumor cell structure, vascular invasion, and lymph node metastasis. Immunostaining showed the lesion to be positive for CD56 and synaptophysin.
Conclusion : Cytological diagnosis with Diff-Quik staining is useful for cytologically diagnosing a carcinoid tumor.View full abstractDownload PDF (800K) -
Takuji INAYAMA, Kayoko MARUYAMA, Kenichirou ABE, Kuniyoshi INO, Sigeka ...2009 Volume 48 Issue 5 Pages 290-295
Published: 2009
Released on J-STAGE: March 18, 2011
JOURNAL FREE ACCESSBackground : Invasive carcinoma derived from an intraductal papillary mucinous tumor of the pancreas has a prognosis equally as dismal as that of ordinary invasive ductal carcinoma, making it mandatory to detect such cases as early as possible. We report a case of invasive carcinoma derived from intraductal papillary mucinous tumor in which cytology was useful in making a preoperative diagnosis.
Case : A 63-year-old man reporting appetite loss was found in radiology to have a cystic tumor with an inner papillary protrusion into the pancreatic head. Endoscopic observation showed that the tumor had invaded the duodenal mucosa with mucus secretion. Aspiration cytology of the mucus showed variously sized sheet-like, papillary epithelial clusters of benign cells and irregular clusters of atypical nonmucinous cells with hyperchromatic nuclei and increased nuclear-cytoplasmic ratio, yielding a definitive diagnosis of adenocarcinoma. Biopsies from duodenal invasion foci showed only a benign papillary component. Under a clinical diagnosis of pancreatic cancer, we conducted pancreatoduodenectomy. Much of the tumor corresponded to intraductal papillary mucinous adenoma, while a small part showed transition from the adenoma component to tubular adenocarcinoma. Cancer had directly invaded the duodenum and perforated the lumen.
Conclusion : When a tumor biopsy failed to detect cancer cells, cytology alone yielded a definitive preoperative diagnosis of adenocarcinoma associated with intraductal papillary mucinous neoplasm.View full abstractDownload PDF (725K) -
Tomoharu TAKUMI, Ikuo SAITO, Fumikazu KIMURA, Yoshitaka FURUYA, Keiko ...2009 Volume 48 Issue 5 Pages 296-300
Published: 2009
Released on J-STAGE: March 18, 2011
JOURNAL FREE ACCESSBackground : Lymphoepithelial carcinoma of the parotid gland is rare, accounting for fewer than 1% of all parotid gland tumors. We report a case diagnosed by aspiration and imprint cytology. We also review its cytological, histological, and immunocytochemical features.
Case : A 50-year-old man reporting swelling of the left parotid area was found in radiological examination to have a solid mass with limited mobility. Ultrasonography-guided fine-needle aspiration of the parotid gland was done. The man later underwent parotidectomy of the superficial left parotid gland.
Aspiration and imprint cytology showed squamous cell carcinoma-like clusters with nuclear overlapping against a lymphocytic background. Atypical cells had oval to spindle-shaped nuclei of varying size, with coarsely granular chromatin and small prominent nucleoli.
Histologically, the tumor consisted of irregularly arranged islets and solid nests. Surrounding tissue was infiltrated predominantly by tumor cells and lymphocytes.
Conclusion : Lymphoepithelial carcinoma of the parotid gland, a rare malignancy with a generally good prognosis, is considered to be a form of lymphoepithelial carcinoma, similar to squamous cell carcinoma, and shown by aspiration cytology to have clusters of numerous lymphocytes in the background.View full abstractDownload PDF (635K) -
Miyuki IWAGAMI, Kozue YONEYAMA, Maki KAGOSHIMA, Harumi KAMIYAMA, Shige ...2009 Volume 48 Issue 5 Pages 301-305
Published: 2009
Released on J-STAGE: March 18, 2011
JOURNAL FREE ACCESSBackground : Myeloid sarcoma, a rare extramedullary tumor consisting of neoplastic myeloid cells, may be multiple in occurrence and involve any bodily site. We report fine-needle aspiration (FNA) cytologicy findings from a case of myeloid sarcoma presenting as bilateral breast masses.
Case : A 48-year woman underwent FNA for multiple swellings in both breasts. Giemsa-stained aspiration smears were hypocellular and had a few immature myeloid cells and promyelocytes, but few erythroblasts. Papanicolaou-stained smears did not identify any immature myeloid precursors. A full blood count showed an elevated white cell count of 186.8×109/l with 29% myeloblasts. The biopsy specimen contained numerous immature myeloperoxidase-positive myeloid cells. The definitive diagnosis was acute myeloid leukemia M2.
Conclusion : The breast is reportedly an unusual site for myeloid sarcoma. Myeloid breast sarcoma should, however, be differentiated from lobular carcinoma and non-Hodgkin lymphoma despite morphological similarities.View full abstractDownload PDF (500K)
Special Articles <Recent advances on cytological diagnosis of mesothelioma>
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[in Japanese], [in Japanese]2009 Volume 48 Issue 5 Pages 306
Published: 2009
Released on J-STAGE: March 18, 2011
JOURNAL FREE ACCESSDownload PDF (120K) -
Shinji HAMAKAWA, Yoshimi KASHIWASAKI, Youichi KONDO, Mie KOSAKA, Kazum ...2009 Volume 48 Issue 5 Pages 307-311
Published: 2009
Released on J-STAGE: March 18, 2011
JOURNAL FREE ACCESSObjectives and Study Design : We analyzed 10 cases of malignant mesothelioma (MM) using body fluid cytology specimens to determine morphological and cytological findings.
Results : With background consisting of histiocyte and lymphocyte, numerous tumor cells appear in clusters or isolated in 7 cases. Ball-like and papillary cell clusters appear in 9 cases, petal-like and tortoise-shell-like arrangements in 6 cases, and molded or mutual-inclusion cell clusters in 5 cases. The nuclear-to-cytoplasm (N/C) ratio of isolated tumor cells was low with axis-symmetrical double nuclei.
Conclusion : MM showed widely varied cell-cluster patterns, characterized by molded or mutual inclusion patterns and petal-like and tortoise-shell-like arrangements.View full abstractDownload PDF (480K) -
—Characteristic features and their clinicopathological significance—Sakae HATA, Takuya MORIYA, Nobuhisa IWACHIDOU, Toshiaki KAMEI2009 Volume 48 Issue 5 Pages 312-318
Published: 2009
Released on J-STAGE: March 18, 2011
JOURNAL FREE ACCESSObjective : We analyzed typical features of cell clusters surrounding collagenous stroma (CS) in body fluid cytology and considered their significance in routine cytological diagnosis.
Study Design : Cytological specimens from 36 cases of malignant mesothelioma (MM) and 4,306 cases with reactive mesothelial cells (RM) were reviewed. CS was detected in 148 cases—23 of MM and 125 of RM. Cell clusters surrounding CS were divided into three structural patterns and cytochemistry, immunocytochemistry, and electron microscopy were conducted.
Results : TypeI clusters were seen in 118 cases (2.7%) of RM, but not in MM. They were often seen in the washing cytology (10.9%) but very rarely seen in the aspiration cytology (0.03%) (p<0.001). TypeII and III clusters were significantly frequently detected within MM cases—typeII, 23 cases, 63.9% ; typeIII, 7 cases, 19.4%—than RM—6 cases each, 0.14% (p<0.001). CS was invariably PS-positive, diastase-resistant, and metachromatic in Giemsa staining. In immunocitochemisty, some typeII CS showed positivity for laminin or typeIV collagen.
Conclusions : TypeI clusters were specific for RM and typically seen in peritoneal washing specimens. TypeII and III clusters were significantly seen in Mm cases. Some typeII CS contained basement membrane material, indicating that cytomorphological features of cell clusters surrounding CS may be of diagnostic use in evaluating the malignant potential of mesothelial cells.View full abstractDownload PDF (666K) -
—Potential problems and differential diagnosis from reactive mesothelial cells—Hiroshu MIURA, Yudu ADACHI, Natsuko YASUDA, Mika WATANABE, Kazuyuki IS ...2009 Volume 48 Issue 5 Pages 319-326
Published: 2009
Released on J-STAGE: March 18, 2011
JOURNAL FREE ACCESSObjective and Study Design : We improved the cytopathological diagnosis of malignant mesothelioma (MM) in serous effusion by retrospectively evaluating the cytological features of 16 cases of histopathologically proven MM because only 7/16, or 43.8%, of cases were diagnosed as MM in the original diagnosis and compared cytopathological findings to those of reactive mesothelial cells (RM) in 65 cases benign serous effusion.
Results : An initial diagnosis of serous effusion from 16 cases of histologically proven cases of MM showed 7 cases of MM, 4 cases suspected of being MM, 4 cases of no malignancy, and 1 case of metastatic adenocarcinoma. Retrospective study revealed that 3 of 4 cases originally diagnosed as “no malignancy” had a few MM cells with individualized dispersed malignant cells, and smaller cell clusters than those detected in the cases initially diagnosed as MM. These malignant cells were nearly equal to or smaller than the average size of 65 RM (243.6μm2). The study of 4 of 5 cases originally diagnosed as “suspected MM” and as metastatic adenocarcinoma showed many MM cells, both single and in large cell aggregates. Cells and nuclei in these 4 cases were all significantly smaller than for RM.
Conclusions : MM showed a wide range of cytological features in serous effusion. The presence of small number and size of MM cells usually resulted in a cytological diagnosis of negative or suspected MM in our retrospective analysis. Complex arrangements of cells, thick cytoplasm, large eosinophilic nucleoli, and the number of multinucleated tumor cells should be used to differentiate RM from MM serous effusion, in addition to traditional diagnostic criteria.View full abstractDownload PDF (587K) -
Kunimitsu KAWAHARA, Teruaki NAGANO, Shigekatsu OHYAMA, Koji ASAI, Yaek ...2009 Volume 48 Issue 5 Pages 327-335
Published: 2009
Released on J-STAGE: March 18, 2011
JOURNAL FREE ACCESSDue to the difficulty in differentiating between reactive mesothelia (RM) and epithelial malignant mesothelioma (EMM) in effusion cytology, we attempted to distinguish EMM from RM cytologically.
The 12 cytomorphological parameters we studied in 15 EMM and 17 RM cases were (1) cell arrangement, (2) cytoplasmic thickness, (3) nuclear size variability, (4) nuclear size, (5) number of nuclei, (6) nuclear shape, (7) nuclear irregularity, (8) chromatin pattern, (9) number of nucleoli, (10) mitotic figures, (11) cell-to-cell apposition, and 12) intracytoplasmic vacuoles.
Cell in EMM were predominantly arranged in clumps, showed a wide range of sizes, and frequently had multiple nuclei. Cells in RM alone had no apparent nucleolus and were typically solitary. In EMM, mitotic figures were seen more frequently, as were intracytoplasmic vacuoles.
In conclusion, cell arrangements and intracytoplasmic vacuoles were most useful for differential diagnoses, and nuclear size variability, nuclear size, number of nuclei, number of nucleoli, and mitotic figures were highly useful.View full abstractDownload PDF (568K) -
Noriko KIMURA, Kimiko DOTA, Yoshikazu ARAYA, Katsunori TAKASHIMA, Kazu ...2009 Volume 48 Issue 5 Pages 336-341
Published: 2009
Released on J-STAGE: March 18, 2011
JOURNAL FREE ACCESSObjective : We designed effusion-cytology scoring for malignant mesothelioma to differentiate reactive mesothelial cells.
Study Design : Mesothelioma cells in effusions from 19 patients—17 pleural and 2 peritoneal—were compared to reactive mesothelial cells from 13 patients without obvious tumor cells, and 30 effusions containing metastatic carcinoma cells. Scoring, which includes characteristic mesothelial and malignant cell features, totals up to 10 points—1 point each for villosity, cell pleomorphism, sheet-like arrangement, mirror-ball-like cluster, nuclear atypia such as hyperchromasia and irregular nuclear contour, and cannibalism and 2 points each for large acidophilic nucleoli and multinucleated cells having over 8 nuclei.
Results : Each of the 19 patients with mesothelioma scored 5 or more points, compared to the 3 or fewer points scored in the other 2 groups—excluding one case each of peritoneal papillary carcinoma and treatment with OK432. Mesothelioma showed no single characteristic feature. Ancillary use of immunocytochemistry such as podoplanin and calretinin confirmed the scoring’s diagnostic accuracy.
Conclusions : The scoring we designed proved useful in the differential diagnosis of mesothelioma.View full abstractDownload PDF (576K)
Brief Note
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Yuki TERATANI, Yuhei OKADA, Yuji OHTSUKI2009 Volume 48 Issue 5 Pages 342-343
Published: 2009
Released on J-STAGE: March 18, 2011
JOURNAL FREE ACCESSWe report a rare case of fibroadenoma associated with mucocele-like tumor (MLT)-like changes in a 50-year-old woman whose cytological specimen contained both fibroblastic spindle cells containing mesenchymal and acellular epithelial mucin. Histopathologically, the fibroadenoma contained abundant mesenchymal mucin, and stroma compressing the small surrounding ducts, whose epithelium showed mucinous metaplasia, rupturing the mucus cyst. The definitive diagnosis was fibroadenoma associated with MLT-like changes. Both epithelial components and mucin features should thus be considered in fine-needle aspiration cytology for precisely differentiating diagnosis of the breast.View full abstractDownload PDF (264K)
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