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Volume 52 (2013)
- Issue 6 Pages 495-
- Issue 5 Pages 399-
- Issue 4 Pages 287-
- Issue 3 Pages 181-
- Issue 2 Pages 77-
- Issue 1 Pages 1-
Volume 52, Issue 2
Displaying 1-16 of 16 articles from this issue
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Review Article
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—Comparison of the conventional preparation method and LBC method—Yoshiaki NORIMATSU2013 Volume 52 Issue 2 Pages 77-86
Published: 2013
Released on J-STAGE: May 01, 2013
JOURNAL FREE ACCESSFor liquid-based cytology (LBC) in cases of endometrial glandular and stromal breakdown (EGBD), it has been thought that examination of the cellular features and comparison with the conventional preparation (CP) method are essential. In this study, the BD SurePathTM (SP) method was employed as the method for the LBC.
The results were as follows : Although the area of the smear prepared by the SP method was smaller than that in the LBC sample prepared using the CP method, the LBC preparation was adequate for examination of the relevant cells, and preparation of the smear with a clean background was possible ; The nuclei of the condensed clusters of stromal cells were reniform in shape and small in size, and the nuclear chromatin tended to show a darker tone. The nuclei of the metaplastic clumps with irregular protrusions were spindle-shaped and larger in size ; The SP method was remarkably advantageous in that the morphological characteristics of the nuclei were better preserved in the preparation obtained using the SP method than in that obtained using the CP method ; A more accurate diagnosis is possible by immunocytochemical examination for a combination of the following markers : CD10, CAM5.2, p53, cyclinA. Recognition of the light green body may be useful for accurate diagnosis of EGBD.
In conclusion, as for the results of the current study, it was expected that the SP method improve the diagnostic precision of endometrial cytology.View full abstractDownload PDF (1119K)
Original Articles
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Yusuke MATSUURA, Haruko OKA, Kosho OBARA, Hitoshi SATO, Hitoshi FUJIWA ...2013 Volume 52 Issue 2 Pages 87-95
Published: 2013
Released on J-STAGE: May 01, 2013
JOURNAL FREE ACCESSObjective : The purpose of this study was to investigate the cytologic findings of liquid-based cytology (LBC) and conventional cervical testing (CCT).
Study Design : We obtained four Pap test samples from each of 705 patients : CCT with a cotton swab (sample A), CCT with a Cervix-Brush (sample B), LBC with a cotton swab (sample C), and LBC with a Cervix-Brush (sample D). Cytologic evaluation was performed according to The 2001 Bethesda System.
Results : Inadequate samples were frequently observed in samples A (10%) compared to samples B (3%). Low squamous cellularity (less than 5,000) was seen in 25% and 9% of samples C and D, respectively, but most of these samples were derived from atrophic or post-irradiation specimens. Endocervical cell detection was as follows : sample A, 7% ; B, 87% ; C, 4% ; and D, 75%. A clean background was noted in 76%, 64%, 90%, and 81% of samples A, B, C, and D, respectively. Although a different cytologic evaluation was made in 44 of 705 with CCT, and 42 of 705 with LBC, Cervix-Brush samples had a higher cytologic abnormality.
Conclusion : LBC with Cervix-Brush is the best procedure in cervical cancer screening except for specimens derived from postmenopausal and post-irradiated women.View full abstractDownload PDF (848K) -
Takashi YURI, Yuichi KINOSHITA, Airo TSUBURA2013 Volume 52 Issue 2 Pages 96-100
Published: 2013
Released on J-STAGE: May 01, 2013
JOURNAL FREE ACCESSObjective : The cytological characteristics of ovarian cancer cells found in endometrial cytology were evaluated.
Study Design : Clinicopathological data from 9 ovarian cancer cases with positive endometrial cytology were summarized and the cytological features were compared with primary endometrial cancer cases.
Results : The cell clusters of ovarian cancer found in endometrial cytology were recognized as small spherical clusters with normal endometrial cells regardless of the histological type. The maximum diameters and sizes of cell clusters in ovarian cancer were distinctly smaller than the clusters in primary endometrial cancer.
Conclusions : In endometrial cytology, ovarian cancer cell clusters were significantly smaller than endometrial cancer cell clusters.View full abstractDownload PDF (482K) -
Kayo KUYAMA, Takashi MATSUMOTO, Yan SUN, Miyuki MORIKAWA, Taku KATO, H ...2013 Volume 52 Issue 2 Pages 101-106
Published: 2013
Released on J-STAGE: May 01, 2013
JOURNAL FREE ACCESSObjectives : The purpose of this study was to analyze the results of aspiration cytology of lesions of the jaw bone, and to compare the cytological and histopathological findings among the cases.
Study Design : Samples from jaw bone lesions were obtained from 35 cases for which both clinical and histological diagnoses were available.
Results : Cytologically, 27 samples were negative (77.1%), 2 were positive (5.7%) and 6 were inadequate for diagnosis (17.1%). The estimated diagnoses for the negative cases were cysts of the jaw bone (9 cases ; 33.3%), inflammation (9 cases ; 33.3%), ameloblastomas (5 cases ; 18.5%), and keratocystic odotogenic tumors (4 cases ; 14.8%). The definitive diagnoses of the cysts of the jaw bone were radicular cysts in 3 cases, postoperative maxillary cysts in 3 cases, and dentigerous cysts in 3 cases. Both the cytology-positive cases were diagnosed as squamous cell carcinoma. The diagnostic accuracy rates for keratocystic odontogenic cyst and squamous cell carcinoma, and the diagnostic sensitivity rates for ameloblastoma and cysts of the jaw bone were all 100%. Cytologically, radicular cysts showed loosely coherent polygonal cells with central round nuclei against an inflammatory background. Dentigerous cysts showed small numbers of cell clusters composed of uniform, cuboidal epithelial cells with round nuclei and an increased nucleus/cytoplasm ratio. Keratocystic odontogenics cyst showed scant to moderate number of cells, mostly as scattered keratinized round or odontogenic cells with pyknotic, round nuclei against a background of keratin debris or amorphous material. Ameloblastoma showed varied findings, with clusters of small odontogenic cells like “naked nuclei” , small to medium-sized polygonal cells with projections and squamous metaplasia against a mild inflammatory background.
Conclusion : Since aspiration cytology is a useful screening method for lesions of the jaw bone, an understanding of the differential diagnoses and further accumulation of cell findings are required.View full abstractDownload PDF (671K) -
Yatsuki ARATAKE, Kazuaki KIYOYAMA, Yukio SHIRAHAMA, Tomio HANAMURE, Ka ...2013 Volume 52 Issue 2 Pages 107-115
Published: 2013
Released on J-STAGE: May 01, 2013
JOURNAL FREE ACCESSObjective : The aim of this study was to search for a diagnostic marker that could correctly identify thyroid nodular lesions requiring surgical treatment.
Study Design : We used 1,901 thyroid tissue samples which were diagnosed during the last 21 years. A comparative study of CD26/DPPIV assays (enzyme activity staining, enzyme activity measurement, immunohistochemical staining, Northern blotting, and RT-PCR) were performed.
Results : The results of enzyme activity staining, enzyme activity measurement, immunohistochemical staining, Northern blotting, and RT-PCR correlated well with each other. Overall, almost all of the cases of papillary carcinoma and follicular carcinoma were positive for CD26/DPPIV, while the expression levels in anaplastic carcinoma, medullary carcinoma, and non-malignant lesions (follicular adenoma, adenomatous goiter, Graves’disease, chronic thyroiditis) were low.
Conclusion : Based on this study, the ectopic expression of CD26/DPPIV in differentiated thyroid carcinomas is thought to be mainly caused by increased CD26/DPPIV mRNA expression. CD26 activity staining is a simple and specific assay which should be added to the usual cytological examinations in order to distinguish differentiated thyroid carcinomas from benign thyroid disease.View full abstractDownload PDF (1474K) -
Nozomi TAKAGI, Mitsuyoshi HIROKAWA, Yuri NOBUOKA, Miyoko HIGUCHI, Seij ...2013 Volume 52 Issue 2 Pages 116-121
Published: 2013
Released on J-STAGE: May 01, 2013
JOURNAL FREE ACCESSObjective : The purpose of this paper is to clarify the cytologic findings of Warthin tumor-like papillary carcinoma (WTL-PC).
Study Design : We retrospectively examined cytologic specimens of 33 WTL-PC cases.
Results : In all cases we ascertained that a diagnosis of papillary carcinoma had been made but only two cases were suspicious for WTL-PC. All of the following were identified in 27 cases (81.8%) : 1) abundant lymphocytes and plasma cells ; 2) papillary configuration and sheet-like arrangement ; 3) tall columnar carcinoma cells showing a palisading pattern ; 4) eosinophilic cytoplasm ; and 5) a fine to coarse chromatin pattern that seemed to be characteristic of this subtype. We noted the presence of carcinoma cells showing pseudokeratinization or clear cytoplasm.
Conclusions : There were no particularly significant cytological findings when making a diagnosis of this subtype. However, we should be aware of the cytologic findings which can distinguish it from the tall cell variant and diffuse sclerosing variant of papillary carcinoma, the oxyphilic variant of follicular neoplasm, and Hashimoto disease.View full abstractDownload PDF (802K)
Clinical Articles
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Keisuke ASHIHARA, Tomohito TANAKA, Michihiko NAKAMURA, Satoru MUNAKATA ...2013 Volume 52 Issue 2 Pages 122-127
Published: 2013
Released on J-STAGE: May 01, 2013
JOURNAL FREE ACCESSBackground : Umbilical nodule, also known as Sister Mary Joseph’s nodule (SMJN), is mostly a metastatic manifestation of an underlying advanced malignant disease.
Case : A 52-year-old woman with lower abdominal pain was diagnosed as having a right ovarian tumor. The patient underwent hysterectomy, bilateral salpingo-oophorectomy, partial omentectomy and tumor resection, followed by adjuvant chemotherapy with carbopratin and paclitaxel. The final diagnosis was ovarian endometrioid adenocarcinoma, stage IIIc. Twelve months after the surgery, the patient noticed a dark reddish-colored skin nodule measuring 3.0 cm in diameter around the umbilicus. Fine needle aspiration cytology (FNAC) showed scattered clusters of cells in a necrotic background. Most of the clusters were three-dimensional. Occasional papillary clusters were also seen. The tumor cells had large and hyperchromatic nuclei with prominent nucleoli. Based on these findings, the patient was diagnosed as having a recurrent tumor in the umbilicus. Subsequently, resection of the umbilical tumor was performed. The final diagnosis was umbilical metastasis from recurrent ovarian cancer.
Conclusions : Although patients with SMJN have a dismal prognosis, treatments such as surgical resection or chemotherapy may improve the prognosis. FNAC could be a simple, inexpensive and reliable technique for the diagnosis of SMJN. In the current case, the patient underwent surgical resection of the SMJN after the diagnosis had been made by FNAC.View full abstractDownload PDF (1064K) -
Kazuo MASAKI, Tsuyoki KUGIMIYA, Chizu AOKI, Naomi TANABE, Youko MIYAKE ...2013 Volume 52 Issue 2 Pages 128-133
Published: 2013
Released on J-STAGE: May 01, 2013
JOURNAL FREE ACCESSBackground : We report on a rare case of carcinosarcoma of the uterus with neuroectodermal differentiation.
Case : A 59-year-old woman presented with vaginal bleeding. On pelvic examination, the uterus was enlarged to newborn head size. Preoperative endometrial cytology was performed. Cytological findings revealed giant, bizarre or round tumor cells and papillary clusters or keratinizing cells were found isolated or in small clusters or groups in a background of necrosis. The patient underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy, para-aortic lymphadenectomy and omentectomy. On histological analysis the tumor was comprised of carcinosarcoma containing both components of adenocarcinoma and sarcoma. In the tumor, immature components of the central nervous system were found such as primitive neural tubules, fat, bone, cartilage, and squamous epithelium. On immunohistochemical analysis tumor cells were positive for glial fibrillary acidic protein, S-100 protein and neuron-specific enolase.
Conclusion : Although preoperative diagnosis of uterine carcinosarcoma is difficult, cytological and immunohistochemical findings are useful in diagnosing carcinosarcoma with neuroectodermal differentiation.View full abstractDownload PDF (1133K) -
Namie ARITA, Mitsuaki ISHIDA, Yoshimitsu MIYAHIRA, Muneo IWAI, Keiko Y ...2013 Volume 52 Issue 2 Pages 134-138
Published: 2013
Released on J-STAGE: May 01, 2013
JOURNAL FREE ACCESSBackground : The adult granulosa cell tumor (AGCT) is classified as a borderline malignant ovarian tumor, characterized by its frequent relapse after long postoperative intervals. We report herein on the cytological features of a metastatic AGCT in the chest wall.
Case : A gradually enlarged mass was found in the right thorax of a 44-year-old female on chest computed tomography. Intraoperatively, the tumor was present in the pleura and had directly invaded the right lung. An intraoperative tumor touch smear showed relatively uniform round to oval cells with scant cytoplasm and fine granular chromatin. Some of these cells contained coffee bean-like longitudinal nuclear grooves. Immunocytochemical analysis revealed that these cells were positive for alpha-inhibin. According to these features, metastatic AGCT was suspected based on the cytological data. Histopathological study confirmed the diagnosis of metastatic AGCT in the chest wall taking the patient’s past history of ovarian AGCT 13 years earlier into consideration.
Conclusion : It is well known that AGCTs frequently relapse after long postoperative intervals, and we sometimes experience difficulty in diagnosis of metastatic AGCT because of the unexplained patient past history. Careful observation of the cytological features, such as nuclear grooves, and immunocytochemical analysis are useful for the diagnosis of metastatic AGCT.View full abstractDownload PDF (738K) -
Teruhiko EHARA, Motoko KOREMATSU, Ken-ichi KAWAMURA, Keikichi SHIMOJI, ...2013 Volume 52 Issue 2 Pages 139-142
Published: 2013
Released on J-STAGE: May 01, 2013
JOURNAL FREE ACCESSBackground : Endometrial malakoplakia is an extremely rare disease. In previous reports and our case, it occurs in elderly women (av. 62 years old), mostly postmenopausal, and irregular bleeding is the most common symptom. It is most important that malignancy should be ruled out. We report herein on the cytological features of an endometrial smear.
Case : A 87-year-old women presenting with irregular genital bleeding and endometrial thickening seen on uterine ultrasound echography underwent an endometrial smear and curettage biopsy. The endometrial smear showed clusters of large histiocytes with a foamy cytoplasm (von Hanseman cell) with targetoid-shaped calcified spherules (Michaelis-Gutmann bodies) on a background of plenty of neutrophils. Endometrial glands were atrophic. Microscopic examination of a curettage biopsy specimen yielded the diagnosis.
Conclusion : The correct diagnosis of endometrial malakoplakia can be achieved based on the presence of clusters of large foamy histiocytes with lamellar calcified spherules.View full abstractDownload PDF (760K) -
Shigeru TSUCHIDA, Yoshimasa NAKAZATO, Harumi KAMIYAMA, Takuya FUSEGAWA ...2013 Volume 52 Issue 2 Pages 143-146
Published: 2013
Released on J-STAGE: May 01, 2013
JOURNAL FREE ACCESSBackground : Primary signet-ring cell carcinoma of the lung is a rare tumor classified as a special subtype of adenocarcinoma under the WHO classification of lung cancer and the General Rule for Clinical and Pathological Record of Lung Cancer of the Japan Lung Cancer Society. We report herein on a case of primary signet-ring cell carcinoma of the lung.
Case : The patient was a 41-year-old woman who was found to have an abnormal shadow on chest X-ray at a regular medical checkup. Computed tomography revealed a mass in the lower lobe of the right lung. Since lung cancer was suspected, she underwent a bronchoscopic lung biopsy. Cytologic imprints of the biopsy specimen showed signet-ring tumor cells containing large amounts of a mucoid substance, suggesting mucin-producing adenocarcinoma. On immunohistochemical examination, the tumor cells were positive for CK7 and negative for CK20, and about half of them were positive for TTF-1. These findings led to a diagnosis of primary signet-ring cell carcinoma of the lung.
Conclusions : Primary signet-ring cell carcinoma of the lung is a rare tumor, but its possibility should be considered in conjunction with the examination of other organs when cytological specimens from lung tumors show signet-ring tumor cells containing mucin in the cytoplasm.View full abstractDownload PDF (583K) -
Ayako ARAKAWA, Moriyuki NAKAMA, Yukinori MURATA, Hideaki TAJIMA, Yukio ...2013 Volume 52 Issue 2 Pages 147-151
Published: 2013
Released on J-STAGE: May 01, 2013
JOURNAL FREE ACCESSBackground : We report herein on a case of microcystic meningioma with prominent nuclear-size variation and hyperchromasia superficially mimicking an anaplastic meningioma.
Case : A 77-year-old male suffered from a seizure and a subsequent magnetic resonance imaging study revealed a well-circumscribed tumor of the right frontal region. Smear and crush cytology was performed using an intraoperative rapid diagnosis specimen. Cytologically, sheet-like tumor cell clusters with round to oval nuclei with nuclear size variation and abundant cytoplasm were noted against a vasculature-rich background. Large cells with irregular nuclear shape, multinucleate cells, tumor cells with nuclear pseudoinclusions, and tumor cells with a foamy cytoplasm were observed. Intercellular lumen-like spaces were also found that were composed of tumor cells with cytoplasmic projections within the tumor cell clusters.
Conclusion : Although the tumor cells of microcytic meningioma showed muclear-size variation and irregular-shaped pleomorphic nuclei, low N/C-ratio and absence of necrosis and mitotic figures are findings that can differentiate it from malignant brain tumors. Intercellular lumen-like spaces are easily visible on cytology specimens but not on frozen histological sections, therefore intraoperative cytology is a very reliable tool for presumptive diagnosis of this particular subtype of meningioma.View full abstractDownload PDF (742K) -
Hideaki TAJIMA, Ayako ARAKAWA, Hiroki SAITHO, Yukinori MURATA, Yukio I ...2013 Volume 52 Issue 2 Pages 152-157
Published: 2013
Released on J-STAGE: May 01, 2013
JOURNAL FREE ACCESSBackground : Pulmonary alveolar proteinosis (PAP) is a rare pulmonary disease characterized by accumulation of surfactant in the alveolar spaces. We report herein on a case of PAP with the presumptive diagnosis made based on the results of bronchoscopic aspiration sputum cytology.
Case : An abnormal shadow on chest CT was discovered in a 46-year-old woman during a left breast mass examination. Bronchoscopic sputum aspiration cytology showed a small amount of finely granular materials and globular amorphous materials that were suggestive of PAP, however, we could not make a definitive diagnosis. A bronchoalveolar lavage (BAL) was then performed and milky fluid was collected. In cytology using the BAL fluid, numerous globular amorphous materials stained by Orange G, and light-green and foamy alveolar macrophages, some of which contained globular materials, were observed on a background of fine granular materials. These materials were positive for Periodic acid-Schiff reaction. Their internal structure was homogeneous, and did not show a concentric pattern. Transbronchial lung biopsy confirmed the diagnosis of PAP.
Conclusion : It is possible to make a presumptive cytological diagnosis of PAP using not only BAL fluid but also bronchoscopic aspiration sputum by taking into account the findings of characteristic non-cellular components and clinical information.View full abstractDownload PDF (1115K) -
Misao YONEDA, Hirosi IMAI, Yosio FUKUTOME, Yosihiro FUZITA, Mika KITAY ...2013 Volume 52 Issue 2 Pages 158-163
Published: 2013
Released on J-STAGE: May 01, 2013
JOURNAL FREE ACCESSBackground : Solid pseudopapillary tumor of the pancreas (SPTP) is rare. We discuss cell imaging obtained through endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA).
Case : A woman in her 20s seen for nausea and vomiting was found in computed tomography (CT) and magnetic resonance imaging (MRI) to have a mass 30 mm in diameter in the pancreatic body. Cytological findings in bedside Diff-Quik staining at EUS-FNA detected dendritic sequences and pseudopapilledema, suggesting SPTP. Pap staining and cell block (HE) immunostaining showed similar staining and positive reactions for β-catenin, cyclin D1, vimentin, synaptophysin, and αAT, and a slightly positive reaction for chromogranin A.
Conclusion : We found EUS-FNA effective in cytosreening for SPTP.View full abstractDownload PDF (1229K) -
Noriko YANAGITANI, Keita KUDO, Myngyon MUN, Rira HOSHI, Noriko MOTOI, ...2013 Volume 52 Issue 2 Pages 164-168
Published: 2013
Released on J-STAGE: May 01, 2013
JOURNAL FREE ACCESSBackground : The inflammatory myofibroblastic tumor (IMT) of the lung is a rare non-neoplastic tumor, and only a few cases describing a preoperative cytologic diagnosis of such tumors have so far been reported.
Case : A tumor shadow in the right lung in a 25-year-old male non-smoker was incidentally discovered on a chest X-ray during a routine health check-up. A computed tomographic (CT) scan of the chest revealed a mass lesion in the upper lobe of the right lung. Preoperative fine needle aspiration cytology (FNAC) showed the characteristic features of cohesive clusters of fibroblast-like spindle cells arranged in a vague storiform pattern with plasma cells and lymphocytes. The degree of nuclear atypia was poor, although the cells were of various sizes. Some tumor cells had intranuclear cytoplasmic inclusions. Although a bronchofiberscopic biopsy specimen obtained from the tumor did not lead to any definitive diagnosis, a low grade malignancy or benign tumor was suspected from the FNAC findings. We performed video assisted thoracic surgery (VATS) to resect the tumor. The pathological findings revealed IMT. The spindle cells were positive for ALK. The final diagnosis of the tumor was IMT of the lung.
Conclusion : When making a differential diagnosis of a solitary tumor of the lung, FNAC can provide important information to make an accurate preoperative diagnosis.View full abstractDownload PDF (621K)
Brief Note
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Mineko KINNO, Mieko DOI, Atsushi SASAKI, Masanori YASUDA, Michio SHIMI ...2013 Volume 52 Issue 2 Pages 169-170
Published: 2013
Released on J-STAGE: May 01, 2013
JOURNAL FREE ACCESSWe report herein on a case of adenosquamous carcinoma of the pancreas, in which cells from both adenocarcinoma and squamous cell carcinoma could be identified in the ascites. Although adenosquamous carcinoma of the pancreas has a poor prognosis in general, its clinicopathologic evaluation has not been fully conducted. Our case was very rare since both types of carcinoma cells, namely adenocarcinoma and squamous cell carcinoma, appeared in the same abdominal fluid specimen. The squamous cell carcinoma component was conspicuous, and peritoneal dissemination was noted.View full abstractDownload PDF (339K)
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