The Journal of the Japanese Society of Clinical Cytology
Online ISSN : 1882-7233
Print ISSN : 0387-1193
ISSN-L : 0387-1193
Volume 54, Issue 4
Displaying 1-8 of 8 articles from this issue
Original Articles
  • Kaori INOUE, Yukari WADA, Masahiko OHARA, Keiko MIZUNO, Naoto KURODA
    2015 Volume 54 Issue 4 Pages 233-237
    Published: 2015
    Released on J-STAGE: September 14, 2015
    JOURNAL FREE ACCESS
    Objective : According to the new WHO classification, mucinous carcinoma of the breast is subdivided into types A and B as a pure type, but we often encounter mixed subtypes. There are only a few reports on cytological diagnostic studies on mucinous carcinoma based on the new WHO classification and comparison studies of the pure and mixed types of mucinous carcinoma.
    Study Design : In this study, we investigated 11 cases of mucinous carcinoma of the breast, based on the new WHO classification.
    Results : There were five cases of pure type including one type A tumor and four type B tumors and six cases of mixed type of type B mucinous carcinoma, of which contained neuroendocrine carcinoma and micropapillary carcinoma. The distinction between types A and B seems to be possible, based on the characteristics of cytoplasm and nuclei. However, the distinction between the type B component of both the pure and mixed type and neuroendocrine carcinoma was difficult because of the cytological similarity. The identification of invasive carcinoma and tumors not otherwise specified (NOS in two tumors was possible due to the presence of intracytoplasmic lumina. Additionally, the identification of micropapillary carcinoma was possible because of cytologic small clusters and the application of EMA immunocytochemistry.
    Conclusion : It is important to identify the components in mucinous carcinoma, with the exception of neuroendocrine carcinoma in the mixed type, as some reports have shown that the prognosis of the mixed type is worse than the pure type.
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  • —A Direct-to-vial study—
    Ayana HORIGUCHI, Takashi UMEZAWA, Miyaka UMEMORI, Sachiko TSUCHIYA, To ...
    2015 Volume 54 Issue 4 Pages 238-243
    Published: 2015
    Released on J-STAGE: September 14, 2015
    JOURNAL FREE ACCESS
    Objective : We assessed the diagnostic accuracy and specimen adequacy of endoscopic retrograde cholangiopancreatography (ERCP) brush cytologies prepared with the BD SurePathTM method.
    Study Design : We examined 31 cases with ERCP brush cytology from April 2013 to December 2014. We cut the brush head, rinsed it out in a vial with the CytoRich RedTM fixative and prepared a specimen with the BD SurePathTM method. These cases were classified as negative, suspicious, positive, and unsatisfactory and compared with the histological diagnosis.
    Result : Of the 31, 9 were negative, 8 suspicious, 14 positive and 0 unsatisfactory. Of the 14 positive, 7 were diagnosed as an adenocarcinoma from the histology. Cells in a defined 13-mm diameter area were distributed in thin layers. Air-drying artifacts and crush artifacts were removed from all specimens, and good preservation was ensured.
    Conclusion : The BD SurePathTM method enabled the preparation of good specimens in which many cells were collected and from which unsatisfactory factor could be removed, thereby enhancing the diagnostic accuracy of ERCP brush cytology.
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Clinical Articles
  • Shoji MIYAGAWA, Sumiko YOSHIDA, Nobuhiro YAMASHITA, Eiji KATSUYAMA
    2015 Volume 54 Issue 4 Pages 244-249
    Published: 2015
    Released on J-STAGE: September 14, 2015
    JOURNAL FREE ACCESS
    Background : Primary malignant melanomas of the lung are very rare, constituting only about 0.01% of all lung tumors.
    Case : An abnormal shadow on the lung of a 46-year-old woman was detected on a chest X-ray. A CT scan showed a nodule measuring about 3 cm in her left lower lobe. With bronchoscopy we found a polypoid lesion in the left B8, and performed a cytological and tissue biopsy. Cytological examination revealed atypical cells as loose clusters or scattered single cells. We found brown granules in the background. Enlarged cleaved nuclei were eccentrically located. Increased amounts of nuclear chromatin demonstrated fine or coarse granules. Nucleoli were prominent. We found nuclear inclusion bodies. The abundant cytoplasm was weakly cyanophilic and contained brown-colored granules. Pathological examination showed round or spindle shaped atypical cells. The tumor cells had irregular-shaped nuclei and abundant eosinophilic cytoplasm, containing brown to black pigment. On immunohistochemistry, tumor cells were positive for HMB-45, Melan-A and S-100, but were negative for TTF-1. Because extensive examination outside the lung revealed no primary tumor, we diagnosed this case as a primary malignant melanoma of the lung.
    Conclusion : Brown pigment in cytology specimens may suggest a diagnosis of malignant melanoma of the lung.
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  • Hiromi MACHIDA, Masaru TUMURAYA, Tamiko NAGAI, Hideo SASAKI, Hikaru KA ...
    2015 Volume 54 Issue 4 Pages 250-257
    Published: 2015
    Released on J-STAGE: September 14, 2015
    JOURNAL FREE ACCESS
    Background : Pleural effusion cytology has been suggested as a useful diagnostic tool in the early stages of malignant pleural mesothelioma (MPM). We report herein on a patient with MPM who presented with intranuclear and eosinophilic intracytoplasmic inclusions in pleural effusion cytology.
    Case : Left-sided pleural effusion was discovered in a 38-year-old woman without asbestos exposure on a routine medical checkup, and she was admitted. Computed tomography demonstrated thickening of the left pleura. During the follow-up period for pleural effusion, MPM was suspected based on the pleural effusion cytology findings. A diagnosis of MPM was made based on the immunocytochemical examination, using cytologic smear and cell block specimens, and electron microscopical examination of pleural effusion. A left parietal pleurectomy was performed, and the diagnosis of MPM was histopathologically confirmed. Cytological specimens of pleural effusion revealed malignant mesothelial cells containing numerous eosinophilic cytoplasmic inclusions and scattered intranuclear inclusions. Ultrastructurally, the intranuclear inclusions were made up of colloidal material surrounded by a single membrane. The eosinophilic intracytoplasmic inclusions consisted of an expanded rough endoplasmic reticulum and tubular structures forming whirl complexes of various sizes.
    Conclusion : Based on our findings, we conclude that examination of intranuclear and eosinophilic intracytoplasmic inclusions in mesothelial cells of pleural effusion cytology appears to be important in the diagnosis of MPM. Eosinophilic cytoplasmic inclusions in mesothelial cells may be of diagnostic significance for MPM.
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  • Arisa SHIGA, Nobuyuki ARIMA, Kiminari KAWANO, Ritsuo MATSUMOTO, Tomoko ...
    2015 Volume 54 Issue 4 Pages 258-263
    Published: 2015
    Released on J-STAGE: September 14, 2015
    JOURNAL FREE ACCESS
    Background : We report the case of a 24- year-old male with mammary analogue secretory carcinoma arising from the right accessory parotid gland, which had initially been diagnosed both cytologically and histologically as acinic cell carcinoma.
    Case : Morphological similarities between the resected tumor and mammary secretory carcinoma, such as the abundant secretory material within the follicular structures, prompted us to examine the resected tissue for the ETV6-NTRK3 chimeric fusion gene, which confirmed the diagnosis of MASC. Although we reviewed the cytological findings of this tumor as compared to those of acinic cell carcinoma, there were no definitive characteristic cytological findings other than the mucous globular structures and scant zymogen granules.
    Conclusion : For a conclusive diagnosis for MASC, we should perform RT-PCR for confirming the presence of the fusion gene generated by chromosomal translocation after careful evaluation of the mammary secretory carcinoma-like morphology and immunohistochemistry.
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  • Mari NARITOMI, Sakae HATA, Yasumasa MONOBE, Akihiko KAWAHARA, Hideyuki ...
    2015 Volume 54 Issue 4 Pages 264-269
    Published: 2015
    Released on J-STAGE: September 14, 2015
    JOURNAL FREE ACCESS
    Background : We report herein on a case of breast cancer with solid tubular carcinoma together with squamous cell differentiation and secretory carcinoma.
    Case : In a female in her 80 s, ultrasound imaging showed a right breast mass of 30 mm in diameter. Core needle biopsy and imprint cytology were performed. On the imprint cytology, against the background of the mucus, and appearing in loosely-coupled clumps, a large number of atypical cells were seen with unclear boundaries, oval nuclei, and coarse-fine granular nuclear chromatin. Atypical cells also appeared surrounding a plurality of mucus, marked mucus globular structures and signet ring like cells. Aggregation of mixed squamous and glandular cells was observed against the background of necrotic material. The tumor was determined to be malignant. At a later date, a right mastectomy was performed. The tumor was located in the C area, about 40% secretory carcinoma and 60% solid tubular carcinoma. The latter component demonstrated squamous cell differentiation. Breast cancer was diagnosed with solid tubular carcinoma together with squamous cell differentiation and secretory carcinoma.
    Conclusion : Because some examples of breast cancer consist of different components, it would appear that a careful diagnosis based on a cytological diagnosis of the LBC specimen is essentially required, together with conventional methods.
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  • Hidenori TSUKIJI, Seiko MAWATARI, Yoko TSUTSUMI, Akashi NAKAMURA, Taka ...
    2015 Volume 54 Issue 4 Pages 270-274
    Published: 2015
    Released on J-STAGE: September 14, 2015
    JOURNAL FREE ACCESS
    Background : We have diagnosed a case of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) with Hodgkin-like cells distinct from Hodgkin lymphoma.
    Case : A 79-year-old man with CLL/SLL was followed for 14 years. He was suspected of a third recurrence and underwent an excisional biopsy. Imprint cell images showed Reed-Sternberg (RS) -like cells exhibiting a mirror image, polynuclear cells and Hodgkin-like cells against the background of monotonous medium-sized lymphocytes with scattered eosinophils. Histopathologically, the lymph node showed a pseudofollicular pattern. The immunohistochemical study showed that most of the small to medium sized lymphocytes were positive for CD5, CD20, and CD23. Hodgkin/Reed-Sternberg (HRS) -like cells were positive for CD30, CD15, PAX-5, MUM-1, and Epstein-Barr virus encoded small RNA in situ hybridization (EBER-ISH). The histological diagnosis was CLL/SLL with Hodgkin-like cells.
    Conclusion : Most cases of Richiter syndrome develop to diffuse large B-cell lymphoma (DLBCL). We should check for the appearance of HRS-like cells when following CLL/SLL patients.
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Brief Note
  • Hiroko HINO, Sakae HATA, Hirohisa TAKASUGA, Mari NARITOMI, Yasumasa MO ...
    2015 Volume 54 Issue 4 Pages 275-276
    Published: 2015
    Released on J-STAGE: September 14, 2015
    JOURNAL FREE ACCESS
    We report herein on the case of a woman in her late 80 s with mammary squamous cell carcinoma. The ultrasonography showed multiple cystic lesions. Cytology in LBC specimens showed atypical cells with circular-spindle or bizarre morphology, with cell clusters consisting of round cells also being observed. A mix of adenocarcinoma and squamous cell carcinoma was initially suggested from immunostaining with p40. Histologically, the tumor was a mixed type squamous cell carcinoma with solid lesion and three cystic lesions.
    It was considered that immunostaining of LBC specimens with p40 is a useful method in the cytological diagnosis of the subtype of squamous cell carcinoma.
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