Objective : We compared the performance of “ThinPrep” liquid-based cytology to that of conventional Papanicolaou smears in detecting high-grade squamous lesions (HSIL) of the cervix.
Study Design : Specimens numbering 8,051 split-sample conventional Papanicolaou smears and “ThinPrep” samples obtained with patients’ consent from May 2007 to March 2008 were compared in a matched-pair double-blind study in which cervical samples were collected and a conventional smear prepared Immediately, following which residual cellular material on the sampling device was rinsed into a proprietary preservative fluid and processed using a ThinPrep 2000 processor. Cytological diagnoses and specimen adequacy were classified using the 2001 Bethesda System for cervical cytological diagnosis, and results compared.
Results : Of these samples, 7,498 (93.1%) were negative in colposcopy or biopsy and 553 (6.9%) were positive at CIN2 or more in biopsies. Sensitivity for the detection of CIN2 or more was 71.3% and specificity 99.0% (conventional) compared to sensitivity of 77.4% and specificity of 98.9% for “ThinPrep” samples.
Conclusions : “ThinPrep” was more effective than conventional Pap smears in detecting HSIL or CIN2 and more serious lesions.

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Objective : This study clarifies the usefulness of hepatocyte nuclear factor-1β (HNF-1β) as an immunocytochemical tool for differentiating variable carcinomas in effusions.
Study Design : (1) The optimum HNF-1β staining condition was studied immunocytochemically, and (2) HNF-1β expression was analyzed in 83 cytological specimens of effusions from a variety of carcinoma specimens. Corresponding tissue sections were representative of immunohistochemical studies.
Results : (1) HNF-1β satisfactorily retrieval antigens using pH9.0 citrate buffer and high molecular detection. (2) Positive ratios were as follows : clear cell adenocarcinoma of ovary (CCO) : 100% (4/4) ; adenocarcinoma of the lung (AL) : 27% (4/15) ; and adenocarcinoma of the gastrointestinal tract : 15% (4/27). Positive tumors cells accounted for 46% of all CCO tumor cells and for 44% of those for AL. The coincidence ratio for histological specimens was 100% in CCOs compared to immunohistochemical studies.
Conclusion : HNF-1β is considered sensitive to but not specific for CCO, so it is important to determine immunocytochemical and immunohistochemical expression profiles in carcinomas originating from different organs when using this as a differential surrogate marker.

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Objectives : We studied the significance of multinucleated giant cells (MGCs) in papillary carcinoma of the thyroid, which has received little attention in Japan.
Study Design : Cases were 50 aspiration biopsy specimens of the thyroid, histologically diagnosed as papillary carcinoma. Cases of adenomatous goiter, Hashimoto’s thyroiditis, and undifferentiated carcinoma were selected as control cases.
Results : MGCs observed in 21 of the 50 specimens were classified in MGCs with dense cytoplasm and MGC with foamy cytoplasm. MGCs with dense cytoplasm contained over 10 to 20 nuclei and cytoplasm stained light green. MGCs with foamy cytoplasm were oval in shape. Both types were positive for CD68, suggesting histiocyte origin. Control cases showed only MGCs with foamy cytoplasm and no MGCs with dense cytoplasm except for one case of undifferentiated carcinoma.
Conclusion : MGCs with dense cytoplasm were found in 42% cases of papillary carcinoma of the thyroid. It can be a useful ancillary finding since very few diseases show MGCs with dense cytoplasm except for papillary carcinomas. The finding of MGCs with dense cytoplasm in daily cytology specimens necessitates considering the possibility of papillary carcinoma and attention to nuclear findings in that specimen.

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Background : Little is known about the pathological features of pediatric adrenocortical carcinoma due to its rarity.
Cases : Five pediatric subjects had functioning adrenocortical carcinoma, four with virilization and/or Cushing syndrome. Tumors weighed 430, 33, 52, 72, and 65 grams. Cut tumor surfaces were solid and golden to red-brownish, with one containing hemorrhagic necrosis and cyst formation. Stump cytology in 4 cases showed many round tumor cells stained light-green together with eccentric nuclei and eosinophilic granules. All cases showed multinuclei, irregular nuclei, increased chromatin, prominent nuclear bodies, and increased nuclear cytoplasmic (N/C) ratios. Nuclear pyknosis and intranuclear vacuolization were also evident. Similar findings were seen histopathologically, i. e., solid eosinophilic tumor cell growth with polymorphic nuclei and hyperchromatinism. The severity of atypical mitosis, clear cell ratio, and immunohistochemistry results varied among the five cases. Electron microscopy confirmed that tumor cells were derived from the adrenal cortex.
Conclusions : Pathological findings in these cases shared common features, but individual findings varied strikingly, requiring meticulous pathological assessment for a definitive diagnosis. Special attention should be paid in cytological diagnosis to the presence of tumor cells with high N/C ratios.

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Background : Primary clear-cell lung carcinoma (PCCLC), a very rare lesion, is classified as a variation of squamous cell carcinoma, adenocarcinoma, or large cell carcinoma in General Rules for Clinical and Pathological Records of Lung Cancer. We report a case of PCCLC initially diagnosed as adenocarcinoma in bronchial brushing cytology and transbronchial lung biopsy (TBLB), and later as adenocarcinoma, mixed subtypes, predominantly clear-cell adenocarcinoma, in histopathological examination of the partially resected lung.
Case : An 80-year-old woman admitted for a continuous cough was found in chest x-ray imaging and computed tomography (CT) to have an upper right lung nodule 2.5 cm in diameter. TBLB and bronchial brushing cytology yielded a diagnosis of poorly differentiated adenocarcinoma. A section of resected cancer tissue 3.0×1.8 cm indicated adenocarcinoma with mixed subtypes, predominantly clear-cell adenocarcinoma.
Conclusions : Cytologically, many cancer cells showed naked nuclei but no evident clear-cell change, although resected lung tissue predominantly featured clear-cell adenocarcinoma. The absence of accumulated glycogen and lipid in cytoplasm suggested that one main cause of clear-cell change was cytoplasmic hydropic degeneration, which may make cell membranes susceptible to mechanical procedures, such as bronchoscopy and brushing cytology, yielding significant numbers of cancer cells with naked nuclei.

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Background : Primary signet-ring cell carcinoma of breast is a rare tumor. We report the results of cytomorphological, immunohistochemical, and ultrastructural studies in a case of pure ductal signet-ring cell carcinoma originating in the breast.
Case : A 70-year-old woman admitted for a palpable left breast mass found in fine-needle aspiration cytology to consist of signet-ring cells, necessitating modified radical left-breast mastectomy. Histopathological, immunohistochemical staining, and ultrastructural findings indicating primary pure signet-ring cell carcinoma of the breast from ductal carcinoma.
Conclusion : Primary signet-ring cell carcinoma of the breast is rare, with 100 cases reported in the Japanese literature. Our case is, to our knowledge, the first report of microinvasive signet-ring cell carcinoma of the breast. We found fine-needle aspiration cytology to be simple and useful in detecting signet-ring cell carcinoma cells.

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Diagnostic problems arise in interpreting breast aspiration cytology including the differentiation of several types of benign and malignant lesions. In aspiration cytology, cell pattern appearance reflects the histological image of the needle site, so the histological structure is presumed by observing patterns of the background, epithelial cells, and stromal tissues. It is important to understand these histological findings and differences between benign and malignant lesions to determine a histological diagnosis. Background findings are divided by origin into ductal and stromal. When the epithelial cell proliferation pattern is sheet-like, tubular, wedge-shaped, scattered, and has large clusters, compatible histological structures can be determined. Background findings are useful in considering histological structures as additional findings. Bipolar naked nuclei and myxomatous stroma are often seen in benign lesions. In low papillary ductal carcinoma in situ (DCIS) with scarce nuclear atypia, low papillary and crater-shaped structures are important in making a cytological diagnosis.

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Objective : To differentiate between benign and malignant, conditions, we studied bile cytology and possibly determining histopathological structure from cytology alone.
Study Design : Subjects were 45 suspicious cases from 1,627 specimens diagnosed between 1999 and 2008 for which we assessed cytological variables in bile cytology for irregular nuclear overlapping, nuclear arrangement, and cell clusters. We also studied nuclear enlargement, abnormal chromatin, anisokaryosis, nucleoli, necrotic background, and the presence of cell clusters. We then chose 26 surgical cases to further study bile duct carcinoma, histology, histological mucosal pattern, cell cluster appearance and cell atypia.
Results : Disordered nuclear arrangement, pleomorphism, and anisokaryosis occurred in bile duct carcinoma, unlike in benign cases, which showed no irregular cluster margin, abnormal chromatin, necrotic background, or cell cluster variations. Cytologically, where large and small cell clusters are the main constituent, the tall cylindrical configuration, must be considered, but when solitary cells are predominant, small cluster-like pattern must be considered. Mixed large or small clusters and solitary cells involve tall cylindrical, fused, or small cluster-like patterns. Cases of carcinomas with low-or high-grade atypia, however, showed no specific cytological or cell cluster features.
Conclusions : Benign or malignant cases judged by bile cytology alone based on cytological cell cluster findings, individual cells, and background must be carefully differentiated because the histopathological structure is difficult to evaluate using cytological findings alone.

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To determine histological pictures from cytologic findings in urolothelial ureter/renal pelvis carcinoma, cell block slides were made from urine samples procured with selective ureter lavage. In 67% of cases with ureter/renal pelvis cancer, cell block/mount quick cell block specimens were prepared. Cytologic findings could be compared with those of histology, So complementary examination of histological and cytological specimens improve diagnostic accuracy in the interpretation of cytological specimens with complementary urolothelial ureter/renal pelvis carcinoma.

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Minimal pain to subjects makes cytological examination simpler and easier than histopathological examinations, but cellular atypia is poor in endometrial hyperplasia and well-differentiated endometrioid adenocarcinoma, limiting differential diagnosis of endometrial lesions based on cellular atypia.
Hormonal conditions and metaplastic changes adversely affect cytological findings when endometrial lesions change from benign to malignant, decreasing diagnostic utility.
We therefore regard diagnostic criteria setup in cell clump architecture reflecting histological architecture important in improving cytological diagnosis.

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We report a case of primary granular cell tumor of the breast. A 40s female seen for an upper inner-quadrant right-breast mass was found in preoperative fine-needle aspiration cytology (FNAC) to have clustered or disassociated tumor cells with abundant granular cytoplasm and small oval nuclei. Cell boundaries were ill-defined. Extracellular granular materials were seen in the background. Histologically, we diagnosed granular cell tumor of the breast. Clinically, granular cell tumors mimic breast carcinoma, and pathologists should bear this in mind in FNAC to avoid a misdiagnosis of breast carcinoma.

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We report the case of aneurysmal bone cyst (ABC) of the vertebrae in a 11-year-old girl. Radiographic results suggested ABC or osteosarcoma. Intraoperative pathological examination showed slit-like spaces separated by cellular and collagenous fibrous tissue including some osteoclast-like giant cells and numerous fibroblastic cells, with bone and osteoid tissue present. Imprint cytology showed some atypia-free osteoclast-like giant and fibroblastic cells against a bloody background, diagnosed as aneurysmal bone cyst. Although we consider ABC, giant cell reparative granuloma, conventional giant cell bone tumor, and osteosarcoma included in the differential diagnosis, cytological findings were useful in diagnosis, especially distinguishing between benign cells and malignancy.

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