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Volume 53 (2014)
- Issue 6 Pages 419-
- Issue 5 Pages 337-
- Issue 4 Pages 251-
- Issue 3 Pages 169-
- Issue 2 Pages 89-
- Issue 1 Pages 1-
Volume 53, Issue 3
Displaying 1-13 of 13 articles from this issue
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Original Articles
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Akimasa TAKAHASHI, Mitsuaki ISHIDA, Akiyoshi YAMANAKA, Tsukuru AMANO, ...2014 Volume 53 Issue 3 Pages 169-175
Published: 2014
Released on J-STAGE: June 26, 2014
JOURNAL FREE ACCESSObjective : Diagnostic accuracy in determining the cause of fetal ascites has improved with advances in ultrasonic techniques, on the other hand, a definitive diagnosis is not always achieved. More reliable diagnostic techniques need to be developed. We investigated the usefulness of cytological examination for fetal ascites in the early diagnosis.
Study Design : Concordance among the clinical picture, cytological findings, and final diagnosis were investigated for 8 patients who were referred to our hospital with fetal ascites and underwent cytological examination, between April 2010 and September 2013.
Results : Exudative ascites, meconium peritonitis, and chylous ascites were diagnosed in 1, 2, and 5 patients, respectively. The patient with exudative ascites had low levels of cell components. Patients with meconium peritonitis showed clusters of squamous epithelial cells with comparable levels of neutrophils, histiocytes, and lymphocytes. In patients with chylous ascites, squamous epithelial cells were observed in some cases ; however, they were sporadic, and lymphocytes accounted for ≥90% of the differential leukocyte count. Results of cytological examination matched the final diagnosis in all cases.
Conclusion : These findings suggest that cytological examination for fetal ascites enables more reliable diagnosis than ultrasonography alone, and that it should be actively used in cases in which diagnosis proves difficult.View full abstractDownload PDF (909K) -
Mika SUGAI, Makoto NAITO, Kanae TAKAHASHI, Chikashi IKEGAME, Chiaki SA ...2014 Volume 53 Issue 3 Pages 176-181
Published: 2014
Released on J-STAGE: June 26, 2014
JOURNAL FREE ACCESSObjective : We examined the usefulness of HNF4α immunocytochemistry for differentiating cancer cells from normal or benign cells in body cavity fluids, and investigated the possibility of diagnosis of primary lesions.
Study Design : We studied the HNF4α expression in 120 cavity fluid preparations from patients with gastric cancer (24), pancreatic cancer (18), colorectal cancer (7), bile duct cancer (5), ovarian cancer (35), lung cancer (14), renal cell carcinoma (2), malignant mesothelioma (6), and malignant lymphoma (2).
Results : The cancer cells in all cases, from adenocarcinoma of the digestive organs to renal cell carcinomas, were positive for HNF4α. In 4/35 cases of ovarian cancer and 1/7 cases of endometrial carcinoma in which the test result was positive, the histological type of cancer was mucinous adenocarcinoma. On the other hand, mesothelial cells, macrophages and other inflammatory cells were negative for HNF4α.
Conclusions : We concluded that HNF4α is a very useful marker for discrimination between cancer cells and benign cells in ascitic fluid. In pleural fluid also, it is useful for differentiating between metastatic and primary lung adenocarcinoma. Thus, immunocytochemical staining for HNF4α is useful for the diagnosis of cancer, especially when used together with staining for other known antibodies.View full abstractDownload PDF (634K) -
Junko MARUTA, Hironobu HASHIMOTO, Hitoshi NOGUCHI, Hidehiro TSUNEOKA, ...2014 Volume 53 Issue 3 Pages 182-189
Published: 2014
Released on J-STAGE: June 26, 2014
JOURNAL FREE ACCESSObjective : Morphometric analyses of fine needle aspiration smears from thyroid lesions were performed. The importance of the measured variables was evaluated and logistic regression equations were formulated to estimate the histology.
Study Design : Specimens from 28 papillary carcinoma (PC) s, 19 follicular carcinoma (FC) s, 23 follicular adenoma (FA) s, and 29 adenomatous goiter (AG) s were examined, and the nuclear area and its standard deviation (SD) within samples, nuclear perimeter, major/minor axis ratio, nuclear overlapping, and the number of nuclear layers were compared. The variables were selected to estimate the histology using a backward selection procedure. The probabilities for the histology were estimated using the medians and quartiles of the selected variables.
Results : The values of all the measured variables were higher in the malignant lesions than in the benign lesions. PCs showed the largest mean values for the nuclear area, its SD, the nuclear perimeter, the major/minor axis ratio, and nuclear overlapping. FCs showed the largest mean value for the number of nuclear layers. The nuclear area, major/minor axis ratio and nuclear overlapping were selected for the estimation of the histology of PC and AG, and the number of nuclear layers was selected for that of FC and FA. The quartiles gave the probability of 93% for PC, 98% for AG, 65% for FC, and 45% for FA.
Conclusion : Logistic regression equations could provide high estimated probabilities for the diagnosis of PC and AG.View full abstractDownload PDF (736K)
Clinical Articles
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Mikio TAKEHARA, Hiroshi OHASHI, Mariko IWAKI, Takayuki KANEMOTO, Masar ...2014 Volume 53 Issue 3 Pages 190-194
Published: 2014
Released on J-STAGE: June 26, 2014
JOURNAL FREE ACCESSBackground : Ovarian mixed germ cell tumors are rare and occur primarily in young women. We report herein on the case of an ovarian mixed germ cell tumor composed of a yolk sac tumor (YST) and a mature cystic teratoma with elevated serum beta-human chorionic gonadotropin (hCG) levels.
Case : A 16-year-old girl presented with abdominal fullness. Pelvic magnetic resonance imaging revealed a 20 cm diameter solid tumor, and serum levels of alpha-fetoprotein and beta-hCG were elevated. Surgery was performed and a right ovarian tumor with metastasis to the left ovary and pelvic peritoneum was found. Histological examination of the right ovarian tumor revealed a YST associated with a mature cystic teratoma. According to cytological examination, “balloon animal”-like cell clusters were observed in the imprint specimens. On the other hand, acute-angled cytological atypia was observed in the ascitic fluid as well as the imprint specimens. Immunohistochemically, the syncytiotrophoblastic giant cells in the YST were positive for hCG.
Conclusion : In addition to hyaline globules, “balloon animal”-like cell clusters and acute-angled cytological atypia may play an important role in the diagnosis of YST.View full abstractDownload PDF (736K) -
Akiko ABE, Reiko FURUTA, Yuji ARAI, Hidetaka NOMURA, Akiko YAMAMOTO, M ...2014 Volume 53 Issue 3 Pages 195-199
Published: 2014
Released on J-STAGE: June 26, 2014
JOURNAL FREE ACCESSBackground : We report herein on a case of coexistence of lobular endocervical glandular hyperplasia (LEGH) and adenocarcinoma in situ (AIS).
Case : A 53-year woman was referred to us for postmenopausal bleeding. Endometrial cytology showed well-differentiated endometrioid adenocarcinoma, and cervical cytology showed yellowish intracytoplasmic mucin associated with LEGH, light yellowish color atypical of LEGH, and hyperchromatin associated with AIS. The LEGH component was positive for HIK1083 whereas the atypical LEGH and AIS were negative. The region of LEGH was separated from the endometrial tumor.
Conclusion : A case of LEGH and AIS was evaluated, and we were able to detect the characteristic findings with preoperative cytology.View full abstractDownload PDF (858K) -
Takeo NAGASHIMA, Satoru UTSUGI, Yoshiaki FUKUSHIMA, Koichi OTSUKA, Yuz ...2014 Volume 53 Issue 3 Pages 200-205
Published: 2014
Released on J-STAGE: June 26, 2014
JOURNAL FREE ACCESSBackground : We report a case of advanced cervical cancer with a large retroperitoneal lymph node metastasis, which was preoperatively misdiagnosed as a uterine leiomyoma.
Case : A 43-year-old woman was referred to our department for pelvic pain. Gynecological examination revealed unremarkable findings. Transvaginal ultrasound and magnetic resonance imaging showed a solid mass measuring around 6 cm in diameter in the upper pelvis. Based on the findings, this solid mass was diagnosed as a subserosal uterine leiomyoma. Cervical and endometrial smears showed no malignant findings. The patient was taken up for surgery, when it became apparent that the mass was retroperitoneal, probably a lymph node swelling. Biopsy of the mass revealed the presence of metastatic highly differentiated squamous cell carcinoma.
Conclusion : Systemic examination for the primary site resulted in vain. No primary cancer could be detected. Then, cervical cytology and endocervical curettage were performed again, which led to the diagnosis of cervical cancer. Finally, the uterine cervix was determined to be the primary origin of the retroperitoneal lymph node metastasis.View full abstractDownload PDF (1069K) -
Sumiyo ADACHI, Kazuto YAMAZAKI, Yoshinari YAMAMOTO, Yasuhiro TOYONAGA, ...2014 Volume 53 Issue 3 Pages 206-212
Published: 2014
Released on J-STAGE: June 26, 2014
JOURNAL FREE ACCESSBackground : Papillary squamous cell carcinoma (PSCC) is a rare variant of the cervicovaginal carcinoma, and it is difficult to judge the presence of stromal invasion pre-operatively. We report the liquid based cytology (LBC) findings of a case of vaginal PSCC.
Case : A 69-year-old woman, G3P2, was referred to our hospital with the complained of a bloody vaginal discharge. Pelvic examination revealed a vaginal pednuclated mass. A cervical smear showed some characteristic features ; (1) large atypical cell clusters in a clear background, (2) the atypical cells in the clsters often showed a papillary to whorled arrangement with a fibrovascular core, (3) the atypical cells showed basaloid features with round to oval nuclei containing small nucleoli and thick cytoplasm, (4) the cell borders were not distinct, (5) single cell keratosis or koilocytosis was not observed. Histologically, the resected tumor was diagnosed as PSCC with minimal stromal invasion.
Conclusion : These characteristic cytological findings were more apparent in LBC preparations as compared to conventional cytology smears. LBC seems to be a useful method for detecting cervicovaginal PSCC.View full abstractDownload PDF (1223K) -
Yoshiaki MARU, Shigenari ARITA, Eri SAKAI, Shigeru NAKAYAMA, Tetsushi ...2014 Volume 53 Issue 3 Pages 213-217
Published: 2014
Released on J-STAGE: June 26, 2014
JOURNAL FREE ACCESSBackground : Signet ring cell lymphoma is a rare morphologic variant of non-Hodgkin’s lymphoma. Herein, we report a case of follicular lymphoma (FL) with signet ring cell features, which was diagnosed by EBUS-TBNA.
Case : A 68-year-old man was diagnosed as having FL by excisional biopsy of a submental lymph node a few months previously. Subsequently, PET/CT performed in an untreated status showed lymphadenopathy and FDG accumulation localized to the mediastinal lymph nodes. EBUS-TBNA was performed of subcarinal lymph node #7 to rule out the possibility of lung cancer at the Chiba Cancer Center. The cytology specimens showed small-to medium-sized lymphoid cells with irregular nuclei and cleaved cells with a binucleated appearance in a bloody background. Furthermore, scattered cells containing clear vacuoles were also seen. The histological specimens showed clusters of atypical cells with marked irregular nuclei and numerous cells containing cytoplasmic vacuoles, imparting a signet ring cell appearance. On immunohistochemistry, the atypical cells showed positivity for CD10, CD20, and BCL2 expressions.
Conclusions : The second biopsy revealed this case to be one of FL with signet ring cell features, while the signet ring cell features were not identified on the first biopsy. This case serves to underline the need to bear in mind the possibility of encountering such cases. Careful observations of the cytological features, including the findings of immunohistochemical analysis, are useful for the diagnosis.View full abstractDownload PDF (930K) -
Shunichi SUZUKI, Toshihiro KONDO, Noriko KATO, Shinya UCHIGASAKI2014 Volume 53 Issue 3 Pages 218-223
Published: 2014
Released on J-STAGE: June 26, 2014
JOURNAL FREE ACCESSBackground : ALK-positive anaplastic large cell lymphoma (ALK+ALCL) mostly occurs in patients under 40 years of age, and often involves both lymph nodes and extranodal sites, including soft tissues. In those cases where it forms a large soft tissue mass, it suggests a soft tissue tumor of various differential diagnoses, including small round cell tumors, sarcomas or metastatic tumors.
Case : A female patient in her middle thirties was admitted with the chief complaint of hip pain. Magnetic resonance images revealed an irregular mass more than 6.5 cm in diameter in the left retroperitoneum. At needle biopsy, cells were collected from the needle by washing. On the cell smears, there were numerous roundish or polygonal atypical cells. Some cells were small and showed a high N/C ratio, and others had abundant clear cytoplasm and horseshoe-like or kidney-shaped nuclei, which were the so-called “hallmark cells” of ALK+ALCL. Small epithelioid clusters or paired cells were also found. Such cytologic features were almost concordant with the histologic features of biopsy specimens. Immunohistochemistry confirmed that the tumor cells were diffusely positive for CD30 and ALK.
Conclusion : Cytology is helpful in the diagnosis of ALK+ALCL that involves deep soft tissues.View full abstractDownload PDF (938K) -
Tomoya MINAMI, Eri OGIHARA, Shinichiro MATSUKI, Kazuyo TAKAGAKI, Yukar ...2014 Volume 53 Issue 3 Pages 224-228
Published: 2014
Released on J-STAGE: June 26, 2014
JOURNAL FREE ACCESSBackground : Yolk sac tumors (YST) are one of the germ cell tumors producing alpha fetoprotein (AFP) and a relatively rare gonadal tumor occurring at a young age. In the extremely rare cases, it arises in extragonadal sites. We report herein on a case of YST in the mediastinum.
Case : A giant mass in the left lung field was seen on chest X-ray and computed tomography (CT) imaging in a woman in her 20s. Taking the result of aspiration cytology into consideration, we suspected the presence of an undifferentiated malignant tumor. Judging from immunohistochemistry of the cell block, we diagnosed the tumor as a YST. After retrospective observation of the same aspirated specimens, we were able to identify the characteristic cytological findings of a YST such as so-called “balloon animal”-like cell clusters and hyaline globules.
Conclusions : Although finding “balloon animal”-like cell cluster and hyaline globules is valuable in diagnosing YST, it is difficult to identify YST from other similar diseases judging from only these cytological findings. It is very important to make the diagnosis, taking into general consideration results from other examinations, such as HE staining, cell block immunohistochemistry and clinical information.View full abstractDownload PDF (890K) -
Gen TAMURA, Shinya OGATA, Naoki YANAGAWA, Mitsumasa OSAKABE, Mitsunobu ...2014 Volume 53 Issue 3 Pages 229-234
Published: 2014
Released on J-STAGE: June 26, 2014
JOURNAL FREE ACCESSBackground : Difficulties diagnosing adenomyoepitheliomas of the breast based on fine-needle aspiration cytology have often been reported. Similar false-positive results may occur for intraductal papillomas of the breast that demonstrate prominent myoepithelial proliferation.
Case : We report the cytological and histopathological features of two cases of intraductal papilloma of the breast judged to be malignant (ductal carcinoma) based on fine-needle aspiration cytology. Cytologically, the presence of atypical cells with loose cellular adhesions and isolated atypical cells led to the diagnosis of malignant (ductal carcinoma) in both cases. A partial mastectomy was performed in both cases, with histopathological and immunohistochemical findings of the surgical specimens showing that both tumors were intraductal papillomas with prominent myoepithelial proliferation.
Conclusion : Proliferating myoepithelial cells can be present as atypical cells with loose cellular adhesions that mimic ductal carcinoma cells. The cytological characteristics of proliferating myoepithelial cells that may be helpful for differentiating them from ductal carcinoma cells include 1) a low N/C ratio, 2) a fine granular chromatin pattern, and 3) intranuclear inclusions.View full abstractDownload PDF (944K) -
Mari NARITOMI, Sakae HATA, Yoshito SADAHIRA, Toyoko ARAKI, Hirohisa KO ...2014 Volume 53 Issue 3 Pages 235-240
Published: 2014
Released on J-STAGE: June 26, 2014
JOURNAL FREE ACCESSBackground : We report herein on a case of suspected malignant lymphoma based on findings from urine via the patient’s catheter. In addition to the conventional method, our report focuses on the cytological findings from liquid-based cytology (LBC method).
Case : One year previously, a 200 mm tumor was found in the left ureter on MRI in an 85-year-old-male. The tumor was diagnosed as a diffuse large B-cell lymphoma (DLBCL), and chemotherapy was performed. At the present hospital visit, prostate removal surgery was performed, and the diagnosis was confirmed as DLBCL. Malignant lymphoma was suspected based on the first catheter urine. Atypical cells appeared with a large nucleus/cytoplasmic (N/C) ratio, with large bizarre nuclei demonstrating coarse granular chromatin and nucleoli. With the LBC method, cells were easily observed to appear to fall apart. Atypical cells in the LBC specimen tested positive for CD20 and CD79a.
Conclusion : The LBC method is useful if immunostaining is required for most inflammatory cells.View full abstractDownload PDF (797K)
Brief Note
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Yukiko SHIOMORI, Yuki MIURA, Takashi HOMMA, Yasuhiko ENDO, Masaharu FU ...2014 Volume 53 Issue 3 Pages 241-242
Published: 2014
Released on J-STAGE: June 26, 2014
JOURNAL FREE ACCESSThe significance of ascites cytology has been controversial as far as the diagnosis and staging of ovarian immature teratoma is concerned.
A 22-year-old female presented with pelvic masses. Cytologic findings of the ascites were characterized by the presence of abundant sheets of glia cells with small uniform round nuclei, moderate amount of lace-like cytoplasm and cytoplasmic processes. Moreover, clusters of round cells with hyperchromatic small round nuclei, and scant cytoplasm, resembling neuroblastoma cells, were observed. Small rosette formations were also noted. Microscopic examination showed immature teratoma, grade 2 in the right ovary and gliomatosis peritonei with small foci of immature neuroepithelial elements. The patient underwent postoperative chemotherapy and is alive at 3 months later.
Ascites cytology can be useful for diagnosis of gliomatosis peritonei with an immature ovarian teratoma in the clinical context.View full abstractDownload PDF (339K)
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