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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 3
Displaying 1-19 of 19 articles from this issue
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Original Articles
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Kayo KUYAMA, Takashi MATSUMOTO, Yan SUN, Miyuki MORIKAWA, Taku KATO, H ...2013 Volume 52 Issue 3 Pages 181-185
Published: 2013
Released on J-STAGE: August 29, 2013
JOURNAL FREE ACCESSObjectives : The purpose of this study was to clarify histopathological and cytological analyses of oral leukoplakia.
Study Design : The materials were cytological and histological specimens from 137 cases, which were clinically diagnosed as “oral leukoplakia” .
Results : The histopathological findings revealed 75 examples of hyperkeratosis (54.7%), 44 of dysplasia (32.1%) and 18 of squamous cell carcinoma (SCC, 13.1%). The cytological findings revealed suspected positivity in 45.5% (20/44 cases) in the dysplasia group, and 16.7% (3/18 cases) were confirmed as positive in the SCC group. The total number of cases confirmed as positive and suspected as being positive in the SCC group was 77.8% (14/18 cases). Eighteen cases with definitely diagnosed SCC were the histologically atrophic epithelium type (61.1%, 11/18 cases), hyperkeratotic epithelium type (16.7%, 3/18 cases), verrucous carcinoma (11.1%, 2/18 cases) and carcinoma cuniculatum (11.1%, 2/18 cases). The cytological findings in all cases of leukoplakia showed a scant cell number with scattered keratinized squamous cells. As for the dysplasia and SCC cases, cells with thickened and stained bright orange cytoplasm showed an irregular nuclear border and rough chromatin patterns under higher magnification.
Conclusion : To improve the accuracy of cytological analysis of leukoplakia, it is necessary for us to understand the variegated histological findings, and to improve the cell collection technology.View full abstractDownload PDF (699K) -
Yoshiki NAITO, Akihiko KAWAHARA, Tomoki TAIRA, Tomohiko YAMAGUCHI, Hid ...2013 Volume 52 Issue 3 Pages 186-192
Published: 2013
Released on J-STAGE: August 29, 2013
JOURNAL FREE ACCESSObjectives : To investigate the cytomorphology of bile samples obtained from long-term indwelling percutaneous transhepatic cholangiodrainage (PTCD) tubes following bile duct surgery for benign diseases.
Study Design : We examined 12 bile duct washing samples obtained from long-term PTCD tubes in 5 patients. Cytologic evaluation was performed based on the “diagnostic bile cytology criteria” . As controls, we used 5 samples obtained from short-term (less than 6 hour) PTCD tubes of patients with cholangitis and 5 samples from patients with cholangiocarcinoma.
Results : The mean nuclear area of bile duct epithelial cells of the samples from long-term tubes was 24.8μm2. Anisokaryosis was observed in 4 samples (33.3%), and the mean nuclear area of these samples was 29.8 μm2. The mean nuclear area of the other 8 samples without anisokaryosis was 22.3μm2 (p<0.01). All 12 samples showed irregularly shaped groups of cells in a background of mucin. The samples with anisokaryosis also showed nuclear membrane irregularity and prominent nucleoli in addition to the irregular groups. The mean nuclear area of the 4 samples was smaller than carcinoma cases (p<0.01), and larger than the samples from short-term tubes (p<0.01).
Conclusion : Bile duct washing cytology samples from long-term PTCD tubes can be used as cytology specimens to exclude malignancy by using the “Diagnostic bile cytology criteria” and evaluating cell arrangements, nuclear membrane irregularity, and appearance of nucleoli, etc.View full abstractDownload PDF (679K) -
Ayumi RYU, Akemi TAKENAKA, Shigenori NAGATA, Hideo INAJI, Yasuhiko TOM ...2013 Volume 52 Issue 3 Pages 193-199
Published: 2013
Released on J-STAGE: August 29, 2013
JOURNAL FREE ACCESSObjective : The present study was performed to clarify the cytological characteristics useful in the differential diagnosis between low grade ductal carcinoma which is mainly composed of small nuclei and benign breast lesions.
Study Design : Fine needle aspiration cytology specimens of 37 cases of breast cancer and 13 benign breast lesions were examined in the following categories : 1) appearance of bare bipolar nuclei ; 2) overlapping pattern of cells ; 3) presence of isolated cells ; 4) appearance of prominent nucleoli ; 5) pattern of chromatin distribution ; and 6) presence of nuclear groove. All the 50 cases were initially diagnosed as suspected malignancy or were difficult to diagnose, because the 37 cases of breast cancer had small nuclei with mild atypia, and the 13 benign breast lesions demonstrated the obscure presence of myoepithelial cells in the cell clusters.
Results : Univariate analysis revealed that the number of bare bipolar nuclei (p=0.007), and presence of nuclear grooves (p=0.02) were statistically significant factors. When cases scored more than 4 points from the two factors suggesting malignancy as follows (many bare bipolar nuclei, score 1 ; a few bare bipolar nuclei, score 2 ; and lack of bare bipolar nuclei, score 3 ; lack of nuclear grooves, score 1 ; and presence of nuclear grooves, score 2), they were categorized as breast cancer. The categorization showed a sensitivity of 76%, specificity of 77%, positive predictive value of 90% and negative predictive value of 53%.
Conclusion : Examination of bipolar bare nuclei and nuclear margins might be useful in the differential diagnosis between benign and malignant breast lesions.View full abstractDownload PDF (628K) -
Ai IKEDA, Kikuo MORI, Kazuki YAMAZAKI, Sanae ONO, Katsumi TAKAHASHI, M ...2013 Volume 52 Issue 3 Pages 200-205
Published: 2013
Released on J-STAGE: August 29, 2013
JOURNAL FREE ACCESSObjective : We reviewed the cytological possibility of estimating the histological subtypes of Hodgkin lymphoma (HL) in the cervical lymph nodes.
Study Design : Our materials were nine examples of cervical lymph nodes. The patients consisted of six men and three women from 19 to 83 years old. We used seven fine needle aspiration specimens and three imprint specimens. Morphometric image analysis of background lymphocytes was also done.
Results : The number of Hodgkin/Reed-Sternberg (HRS) cells and large cells were very few in Case 1 (Negative), and few in Case 2 (False positive). In Case 3, it was difficult to make a differential diagnosis because of metastasis from renal cell carcinoma. Six classical HL cases (Positive) consisted of three with nodular sclerosis, two with mixed cellularity, and one with lymphocyte-rich subtypes. There were significant differences between the size of the background lymphocytes and subtypes, and between the distribution of the nuclei in HRS cells and subtypes.
Conclusion : It is cytologically difficult to make a definite diagnosis without a sufficient number of background lymphocytes and HRS cells in aspiration and imprint specimens. In addition, we observed significant difference between both the size of the lymphocytes and subtypes, and the number of HRS cell nuclei and different subtypes.View full abstractDownload PDF (838K) -
Maki KANNO(ISHIMOTO), Eiji NOMURA, Noriko SUGIYAMA, Kouya HORII, Mami ...2013 Volume 52 Issue 3 Pages 206-211
Published: 2013
Released on J-STAGE: August 29, 2013
JOURNAL FREE ACCESSObjective : To evaluate the usefulness and feasibility of intraoperative diagnosis using imprint cytology (IC) in suspected ovarian cancer.
Study Design : We obtained ICs from 49 surgical specimens of suspected ovarian cancer. They were stained using the Papanicolaou procedure and were later diagnosed by 3 cytological technicians and 1 gynecologist.
Results : Among the 49 specimens, there were 36 (73.5%) malignant tumors, 7 (14.3%) borderline tumors, and 6 (12.2%) benign tumors.
The diagnostic accuracies of ICs were 100% (malignancy), 66.7% (benign), and 71.4% (borderline).
Conclusion : ICs were useful and feasible for determining the intraoperative diagnosis of suspected ovarian cancers.View full abstractDownload PDF (743K) -
Hiroyuki SUZUKI, Masanori YASUDA, Shiori MEGURO, Tomomi KATOU, Yasuo K ...2013 Volume 52 Issue 3 Pages 212-217
Published: 2013
Released on J-STAGE: August 29, 2013
JOURNAL FREE ACCESSObjective : We studied the availability of the endometrial smear test to diagnosis of the fallopian tube carcinoma.
Study Design : We examined the clinical features, cytology, and histology in 17 cases of resected primary fallopian tube carcinoma.
Results : The FIGO classification was three at IC, two at IIB, two at IIC, eight at IIIC, and two at IV. All five cases with positive endometrial smear were stageIII or stageIV cases and cervical smears were also positive in three of those five cases. Of five patients with ascites, endometrial smears were positive in four. On the other hand, of nine patients without ascites, the endometrial smear was positive in only one case. Of six patients in whom the tumor diameter was 35 mm or less, endometrial smears were positive in five, and of eight cases in whom the tumor diameter was greater than 35 mm, none of the endometrial smears was positive.
Conclusions : The rate of positive endometrial smears of primary fallopian tube carcinoma was 35.7% (5/14). Tumor diameter, ascites and stage were thought to be the factors that were related to endometrial smear positivity.View full abstractDownload PDF (587K) -
Hisae KOSEKI, Takeshi NISHIKAWA, Mao TAKEUCHI, Masayo TANABE, Kyoko TA ...2013 Volume 52 Issue 3 Pages 218-223
Published: 2013
Released on J-STAGE: August 29, 2013
JOURNAL FREE ACCESSObjective : The purpose of this study was to compare the performance of “BD SurePathTM” liquid-based cytology to that of conventional Papanicolaou smears in the junctional zone and vaginal stump.
Study Design : The subjects were 433 patients who underwent screening (junctional zone, 318 ; vaginal stump, 115) in our hospital. A split-sample technique was used to create specimens. The cytological diagnosis and specimen adequacy were classified using the 2001 Bethesda System for cervical cytological diagnosis. Judgment as to whether the specimens were satisfactory or unsatisfactory, influence of the background, and diagnosis were compared between the LBC and conventional methods.
Results : The unsatisfactory rates were significantly reduced in both the junctional zone and vaginal stump. In the BD SurePathTM method, red blood cells and neutrophil significantly decreased and the rate of judgment of detected LSIL was improved, compared to the conventional method.
Conclusions : In vaginal stump cytology, in addition to junctional zone cytology, the BD SurePathTM method proved ideal for preparing satisfactory specimens.View full abstractDownload PDF (354K) -
—The presence or absence of HPV-DNA—Kaori OKAYAMA, Mitsuaki OHKODO, Tomoko KUMAGAI, Hiromi YABUSAKI, Haruk ...2013 Volume 52 Issue 3 Pages 224-230
Published: 2013
Released on J-STAGE: August 29, 2013
JOURNAL FREE ACCESSObjective : The aim of the present study was to investigate the presence of HPV-DNA through cell findings suggestive of HPV infection among cases of ASC-US.
Study Design : The present study materials were liquid cervical cytological specimens from 181 women diagnosed as having ASC-US. We used the PCR method for identification of HPV infection and in situ PCR for identification of HPV-infected cells.
Results : HPV was detected in 91.2% of the ASC-US cases. Among cell features that were suggestive of HPV infection, nonclassic koilocytes had a high sensitivity and high specificity for detection of HPV. HPV was detected by in situ PCR in 88.2% of cells showing nonclassic koilocytes and in 100% of cells with multinucleation. The presence of cells with nonclassic koilocytes and multinucleation was significantly correlated with HPV infection (p<0.001).
Conclusion : The existence of squamous intraepithelial lesions must be taken into account if HPV-infected cells showing nonclassic koilocytes and multinucleation are observed in NILM and ASC-US cases.View full abstractDownload PDF (381K)
Clinical Articles
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Asuka KAJIYAMA, Eri ISHII, Miki NAKAGAWA, Jin HARA, Tomomi HONDA, Atsu ...2013 Volume 52 Issue 3 Pages 231-236
Published: 2013
Released on J-STAGE: August 29, 2013
JOURNAL FREE ACCESSBackground : Micropapillary carcinoma is a histologic type featuring pseudopapillary structures lacking a central fibrovascular core and tubuloalveolar structures freely floating in clear, empty spaces. We report a case of adenocarcinoma of the cervix uteri with a micropapillary pattern.
Case : An 87-year-old woman complained of genital bleeding, and was diagnosed cytologically with adenocarcinoma. Histological specimens showed small papillary tufts resembling micropapillary carcinoma, and immunoreactivity for MUC-1 limited to the cytoplasmic membrane oriented toward the stroma. MRI and CT showed a 4 cm mass in the ostium uteri to vagina and multiple lymph node metastases and mesenteric dissemination. From these findings, we disgnosed her with adenocarcinoma of the cervix uteri with a micropapillary pattern, Stage IVb (cT3bN1M1). Although radiation therapy was performed, she passed away 6 months after the first visit.
Conclusion : We have to keep in mind that a micropapillary pattern is one of the histologic types of cervical cancer. Immunocytochemical findings are useful in diagnosing micropapillary carcinoma.View full abstractDownload PDF (1017K) -
Tadanori YAMAGUCHI, Yoshiaki IMAMURA, Takako KAWADA, Makoto OHTA, Mits ...2013 Volume 52 Issue 3 Pages 237-241
Published: 2013
Released on J-STAGE: August 29, 2013
JOURNAL FREE ACCESSBackground : We report an extremely rare case of malignant epithelioid angiomyolipoma (EAML) focusing on the imprint cytology.
Case : The patient was a 48-year-old female without tuberous sclerosis, with no history of malignant melanoma. Imprint cytology of the resected right renal tumor showed large polygonal granular cells with pleomorphic swollen nuclei, prominent nucleoli, intranuclear inclusions, and occasional atypical mitotic figures. Necrotic cellular debris was found in the background. The EAML cells were immunocytochemically positive for HMB-45 and melan-A. Histologically, the tumor consisted of a solid growth of large-sized polygonal epithelioid cells with deeply eosinophilic cytoplasm. Immunohistochemically, the tumor cells were positive for melanocytic markers and α-smooth muscle actin, but not for S-100 protein or epithelial markers.
Conclusion : It is very important to distinguish EAML from renal cell carcinoma and malignant melanoma, because the treatment options and prognoses may vary. We suggest that a definitive diagnosis of EAML can be made by evaluating imprint cytology.View full abstractDownload PDF (964K) -
Shiori MEGURO, Masanori YASUDA, Yusuke HOSONUMA, Tomomi KATOH, Masaru ...2013 Volume 52 Issue 3 Pages 242-247
Published: 2013
Released on J-STAGE: August 29, 2013
JOURNAL FREE ACCESSBackground : Adult granulosa cell tumors account for about 1.5% of all ovarian tumors, and 10% of granulosa cell tumors are accompanied by ascites. We herein present on 3 cases of granulosa cell tumors in ascitic fluid.
Case 1 : A 46-year-old woman with massive hemorrhagic ascites was clinically diagnosed as having surface epithelial malignancies of the bilateral ovaries. Intraoperative cytological findings of the ascitic fluid showed many atypical cells arranged in a loose monolayer pattern. These atypical cells were considered to be tumor cells. However, it was difficult to determine the histological type of the tumor.
Case 2 : A 70-year-old woman was clinically suspected of having an epithelial malignancy of the right ovary. As atypical cells arranged in 3-dimmensional clusters were noted in the ascitic fluid, the cytological diagnosis was adenocarcinoma.
Case 3 : A 36-year-old woman with menstrual irregularity was clinically diagnosed as having an endometriotic cyst of the right ovary. Although a few clusters of atypical cells were recognized in the ascitic fluid, it was hard to distinguish between tumor cells and mesothelial cells.
Conclusion : The cytological features of adult granulosa cell tumors in ascitic fluid were characterized as uniform round nuclei, fine or granular chromatin, a high N/C ratio, and many kinds of structures.View full abstractDownload PDF (806K) -
Tatsuya KATAFUCHI, Hidehiro TOKUNAGA, Sayaka TANOUE, Mitsuhiro ISHIHAR ...2013 Volume 52 Issue 3 Pages 248-252
Published: 2013
Released on J-STAGE: August 29, 2013
JOURNAL FREE ACCESSBackground : Eccrine porocarcinoma is a rare malignant skin tumor. To the authors’ knowledge, no case of eccrine porocarcinoma with pleural dissemination has ever been reported.
Case : An 80-year-old woman with fever, dyspnea and pleural effusion underwent thoracocentesis and aspiration cytology which revealed atypical large epithelial cells. An eccrine porocarcinoma had been excised from her lower abdomen three months previously. The cytopathological finding of atypical epithelial cells was neither compatible with lung adenocarcinoma nor reactive mesothelial cells. The atypical epithelial cells were immunohistochemically positive for Cytokeratin 7 (CK7), CK19, EMA and CEA, and negative for CK20, TTF-1, calretinin and GCDFP-15. Some atypical cells had characteristic intracytoplasmic inclusion-like bodies expressing CK7 and CK19. According to the clinical history and immunohistochemical findings, we diagnosed her condition as pleural dissemination of eccrine porocarcinoma of the skin.
Conclusion : We present a rare case of eccrine porocarcinoma of the skin with pleural dissemination. Although the specificity of the intracytoplasmic inclusion-like bodies is unclear, it may be one of the characteristic cytological feature of eccrine porocarcinoma in pleural effusion.View full abstractDownload PDF (710K) -
Yuhki KOMURA, Yoshiaki UCHIDA, Kaori ABE, Masaharu SHIBATA, Masahiro Y ...2013 Volume 52 Issue 3 Pages 253-258
Published: 2013
Released on J-STAGE: August 29, 2013
JOURNAL FREE ACCESSBackground : Although small cell carcinomas of neuroendocrine origin are commonly identified in the lung, they are known to occur in other organs but are relatively rare in the urinary tract. We report herein on two cases of small cell carcinoma arising primarily in the ureter with tumor cells observed in the urine on cytological examination.
Case : Case 1 was a woman in her eighth decade. A urologic consultation was obtained for complaint of right back pain, and atypical cells were observed in her urine sample obtained by urethral catheter. These atypical cells were dispersed or appeared as small aggregates partly with a molding arrangement. The cells showed bare nuclei with fine granular chromatin. Case 2 was a man in his ninth decade. He was admitted to the hospital for asymptomatic hematuria and small atypical cells were observed in his urine sample. These cells showed a high nuclear-cytoplasmic ratio, irregular shaped nuclei with dense chromatin and prominent nucleoli. Histologically, small sized tumor cells with sparse cytoplasm and dense nuclei were closely arranged.
Conclusion : Small cell carcinomas are known, albeit uncommonly, to arise from the urinary tract. One factor might be the difficulty in finding characteristic neoplastic cells. To verify whether the neoplastic cells have the phenotype of neuroendocrine origin, an additional technique such as immunocytochemistry will be needed for adequate diagnosis in the future.View full abstractDownload PDF (1434K) -
Atsushi KIHARA, Masakazu ARAI, Tomonori USHIJIMA, Mariko GUNJI, Kenich ...2013 Volume 52 Issue 3 Pages 259-264
Published: 2013
Released on J-STAGE: August 29, 2013
JOURNAL FREE ACCESSBackground : Chondroblastoma is a benign bone tumor which usually occurs in the epiphysis of long bones in young persons. Chondroblastoma involving the temporal bone is rare. Few case reports on its cytological findings have been published.
Case 1 : A 50-year-old man presented with a 1.5 cm mass in the left temporal bone. Pre-operative fine needle aspiration cytology made no definite diagnosis. The lesion was partially removed, and histologically diagnosed as a chondroblastoma. Stamp preparation was obtained at additional excision of the remaining tumor. Both aspiration and touch smear cytology showed a mixture of mononuclear round tumor cells and osteoclast-type giant cells (OCGCs) within a clear background. Mononuclear cells had round to oval nuclei with grooved or constricted nuclear membrane. Their cytoplasm was well circumscribed and stained light green.
Case 2 : A 58-year-old man presented with a 2 cm mass in the right temporal bone. The touch smear preparation which was obtained at tumorectomy contained the same mononuclear cells and OCGCs as case 1. Additionally, extracellular matrix with metachromasia was observed.
Conclusion : Chondroblastoma of the temporal bone should be distinguished from other diseases that are composed of mononuclear cells and OCGCs. Along with clinical and radiological findings, cytological features such as characteristic chondroblasts and extracellular matrix with metachromasia are helpful for differential diagnosis.View full abstractDownload PDF (1029K)
Brief Notes
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Kumiko AIHARA, Kimiko MAEKAWARA, Yoshinori MATSUKI, Akiko FUJII, Masay ...2013 Volume 52 Issue 3 Pages 265-266
Published: 2013
Released on J-STAGE: August 29, 2013
JOURNAL FREE ACCESSMaking a cytologic diagnosis of basal cell adenocarcinoma (BCAC) of the salivary gland is difficult due to the similarity of its morphologic features to other benign and malignant tumors of the salivary glands. Morphometric analysis revealed that the average minimum diameter of the nuclei of BCAC was significantly wider than that of basal cell adenoma (BCA). BCAC was associated with a higher nuclear circularity compared with BCA. Our case report shows that roundness of the nuclei, formation of a palisading pattern, and presence of a basement membrane-like material in fine-needle aspiration specimens could lead to a specific diagnosis of BCAC.View full abstractDownload PDF (309K) -
Norikazu NAGATA2013 Volume 52 Issue 3 Pages 267-268
Published: 2013
Released on J-STAGE: August 29, 2013
JOURNAL FREE ACCESSWe report herein on a case of cutaneous apocrine carcinoma, a rare malignant tumor of the skin, arising in the axilla of a 72-year-old female. Aspiration cytology showed tumor cells with abundant cytoplasm and decapitation secretion, arranged in papillary, tubular and solid patterns. Although cytological atypia was weak, the lack of myoepithelial cells and the presence of pair cells suggested malignancy. In this case, it was difficult to determine the presence or absence of malignancy, since the tumor was a well differentiated type (low grade) as shown by the histopathological findings.View full abstractDownload PDF (396K) -
—cytological findings of pleural effusion and their clinical significance—Mayumi KINOSHITA, Yuri HAMASHIMA, Mina HIRAISHI, Motoji SAWABE, Tomio ...2013 Volume 52 Issue 3 Pages 269-270
Published: 2013
Released on J-STAGE: August 29, 2013
JOURNAL FREE ACCESSWe report herein on a case of spontaneous perforation of the esophagus (Boerhaave’s syndrome) in a 61-year-old man. The pleural effusion specimen was a dirty dark brown liquid and the cytological findings showed scattered orangeophilic superficial or intermediate squamous epithelial cells without atypia as well as bacteria and food in the inflamed pleural effusion. These findings indicated the possibility of an esophageal perforation. Quick diagnosis may improve the survival rate of this disease. Both pathologists and cytologists should pay close attention to dirty black pleural effusion which contains superficial or intermediate squamous cells without atypia.View full abstractDownload PDF (408K) -
Kentarou OHTAKE, Masanao SAIO, Yoshikatsu KUROSHIMA, Ryouko ASATO, Nao ...2013 Volume 52 Issue 3 Pages 271-272
Published: 2013
Released on J-STAGE: August 29, 2013
JOURNAL FREE ACCESSWe examined how to improve the cell recovery for cell block preparations using cervical liquid-based cytology (LBC) samples. Forty cases of both NILM and LSIL, respectively, were split into three groups and three different cell block preparation methods were applied such as nylon mesh, OCT compound and cotton. The total cell number (isolated cells and cells in cell clusters) and the incidence of cases with large clusters (≥50 cells) in specimens were counted. We found that the cotton method, by which clusters were significantly recovered, was better than the others. The cotton method is a useful tool for cell recovery in block preparations from LBC samples.View full abstractDownload PDF (344K) -
Hidehiko MASAOKA, Atsushi SASAKI, Shin-ichi MURATA, Masanori YASUDA, M ...2013 Volume 52 Issue 3 Pages 273-274
Published: 2013
Released on J-STAGE: August 29, 2013
JOURNAL FREE ACCESSWe report herein on a case of prostatic duct adenocarcinoma in a 74-year-old man, who presented with urinary retention. A cytology specimen obtained by catheterization showed loose clusters or aggregates composed of small round to oval cells. These cells revealed fine chromatin with prominent nucleoli. A TUR-P specimen revealed adenocarcinoma with a papillary pattern. The immunohistochemical analysis revealed that these tumor cells were positive for PSA and PAP. Although it is rare, prostatic duct adenocarcinoma cells can be observed in urine specimens, therefore it should be kept in mind as a differential diagnosis. In addition, immunohistochemistry may be useful for such differential diagnoses.View full abstractDownload PDF (408K)
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