The Journal of the Japanese Society of Clinical Cytology
Online ISSN : 1882-7233
Print ISSN : 0387-1193
ISSN-L : 0387-1193
Volume 56, Issue 6
Displaying 1-8 of 8 articles from this issue
Review Article
  • Shinya UCHINO
    2017 Volume 56 Issue 6 Pages 265-270
    Published: 2017
    Released on J-STAGE: January 18, 2018
    JOURNAL FREE ACCESS

    Multiple endocrine neoplasia type 2 (MEN2) is autosomal dominantly inherited disease and characterized by medullary thyroid cancer, pheochromocytoma and primary hyperparathyroidism. The causative gene of MEN2 is RET oncogene and this gene testing is covered by health insurance in Japan. Genetic analyses of the PTEN gene for Cowden syndrome, APC gene for cribriform morula variant of papillary thyroid cancer associated with familial adenomatous polyposis, PRKAR1A gene for Carney complex and WRN gene for Werner syndrome are performed by research level. Multiple endocrine neoplasia type 1 (MEN1) is also autosomal dominantly inherited disease and characterized by primary hyperparathyroidism, gastroenteropancreatic neuroendocrine tumor and pituitary tumor. MEN1 gene testing is performed by advanced medical care in a few certified medical institution in Japan. CDC73 gene testing for hyperparathyroidism-jaw tumor syndrome is performed by research level.

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Original Articles
  • Miyaka UMEMORI, Takashi UMEZAWA, Ayana HORIGUCHI, Sachiko TSUCHIYA, Se ...
    2017 Volume 56 Issue 6 Pages 271-275
    Published: 2017
    Released on J-STAGE: January 18, 2018
    JOURNAL FREE ACCESS

    Objective : We attempted to improve the cell collection methods during the preparation of urine specimens and performed cytological analysis for high-grade urothelial carcinoma (HGUC) to increase the diagnostic accuracy.

    Study Design : The study specimens comprised 491 natural urine samples. We compared the numbers of the collected cells and the detection rates of the atypical cells between the wing-type and conventional-type of centrifuge. Suspicious cases were compared to the histological diagnosis.

    Results : The median of the collected cell number and the detection rate of the atypical cells in the wing-type centrifuge were significantly larger than those of the conventional-type (p<0.001). The “Suspicious cases” included six Negative, 53 Atypical cells, 74 Suspicious for malignancy, and two Malignant. Nine out of 15 (60%) Atypical cells, and 24 out of 35 (69%) Suspicious for malignancy were histologically diagnosed as HGUC. The specimens assessed as Suspicious contained small atypical cells.

    Conclusion : Usage of the wing-type centrifuge can improve cell collection numbers and atypical cell detection.

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  • Takashi UMEZAWA, Kazuhiko OCHIAI, Kyosuke YAMADA, Kazunori OCHIAI, Aik ...
    2017 Volume 56 Issue 6 Pages 276-282
    Published: 2017
    Released on J-STAGE: January 18, 2018
    JOURNAL FREE ACCESS

    Objectives : We investigated the detection rate and genotypes of HR-HPV in endocervical cytology specimens to examine the importance of HR-HPV detection and HR-HPV genotyping in cervical cancer screening.

    Study Design : The study population was composed of women being followed up by periodic checkups for SIL and those undergoing secondary health examinations ; the women from both subgroups were aged ≥20 years. Cases with ASC-US or more severe abnormalities on BD SurePathTM were subjected to genotyping for HR-HPV and underwent cervical biopsy.

    Results : Of the 134 subjects examined, 108 (80.6%) were found to be positive for HR-HPV. There were 86 subjects in whom the HR-HPV types could be identified, with types 16, 52 and 58 accounting for ≥10% of cases each, and for 48.8% (42/86) overall. Of the subjects with CIN 2 or more severe lesions, 82.6% (38/46) were found to be positive for any of the HR-HPV types 16, 52 and 58, with this percentage increasing to 95.7% (44/46) when types 18, 31 and 33 were also included. The HR-HPV positive rates in cases with CIN 2 or more and<CIN 2 lesions were 92.3% (48/52) and 68.0% (34/54), respectively.

    Conclusion : HR-HPV types 16, 52, 58, 18, 31 and 33 were common in subjects with CIN 2 or more severe lesions. Therefore, particular care is required in the management of cases where any of these HR-HPV types is identified in the presence of ASC-US or more severe abnormalities.

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  • Satoko NAGAO, Yukari MAEDA, Manami KAIKURA, Yoko KITAZONO, Kazuhito HA ...
    2017 Volume 56 Issue 6 Pages 283-288
    Published: 2017
    Released on J-STAGE: January 18, 2018
    JOURNAL FREE ACCESS

    Objective : The aim of the present study was to establish an algorithm for cytological diagnosis of mucinous carcinoma of the breast by a standardized liquid based cytology (LBC) method.

    Study design : We reviewed the findings in 10 fine-needle aspiration cytology specimens obtained from patients who had been histologically diagnosed as having pure mucinous carcinoma at Sagara hospital between September 2013 and December 2015. LBC specimens had been prepared by washing out the needle in CytorichTM RED after the preparation of conventional smears. The morphological characteristics of mucin, epithelial clusters, cancer cells and vessels were evaluated in 7 of the 10 cases in which sufficient epithelial cells were found on the LBC slides.

    Results : Histologically, all the cases had been diagnosed as having type B mucinous carcinoma. Examination of the LBC specimens in these cases revealed the following features ; 1) fragmented mucin, with various sizes of fragments ; 2) transparent mucin with streaks ; 3) solid and discohesive clusters of small-to-medium sizes ; 4) mild nuclear atypia. Granular cytoplasm and delicate branching vessels, which are characteristic features of mucinous carcinoma, were observed in four cases (57.1%).

    Conclusion : One of the most characteristic features of mucinous carcinoma in LBC specimens is the presence of fragmented mucin. Findings of a granular cytoplasm of the cells and delicate vessels may be helpful.

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Investigation Report
  • ―Report of a case with breast cancer recurrence 28 years after surgery―
    Akane ISHIDA, Makoto SAITO, Taihei NAGASE, Hideo ARAI, Hayato IKOTA, T ...
    2017 Volume 56 Issue 6 Pages 289-296
    Published: 2017
    Released on J-STAGE: January 18, 2018
    JOURNAL FREE ACCESS

    Objective : Differential diagnosis among primary lung adenocarcinoma, malignant mesothelioma and breast cancer metastasis is difficult in cases of malignant pleural effusion. We discussed the morphological and immunohistochemical pitfalls in the differential diagnosis among these conditions based on pleural fluid cytology.

    Study Design : At first, we report the case of a 62-year-old woman who had undergone resection for breast cancer 28 years ago and presented with malignant pleural effusion. Additionally, immunohistochemical analysis was conducted on 16 invasive lobular and 24 invasive ductal carcinoma cases of the breast.

    Results : The cytological findings of pleural effusion were consistent with a diagnosis of malignant mesothelioma. Immunohistochemically, the tumor cells in the pleural fluid cytology specimen were positive for cytokeratin 7, EMA, calretinin, CEA and estrogen receptor, and negative for cytokeratin 20, MOC-31, cytokeratin 5, D2-40, WT-1, CD146, progesterone receptor, HER2, GCDFP-15, TTF-1 and napsin A. Based on the histological and immunohistochemical findings of a pleural biopsy specimen, we finally concluded that the tumor was a breast lobular carcinoma recurrence. Additional immunohistochemical revealed that three of 16 (19%) invasive lobular carcinomas (ILC) and 12 of 24 (50%) invasive ductal carcinomas (IDC) of the breast were positive for MOC-31, and three of 16 ILC (19%) and two of 24 IDC (8%) were positive for calretinin.

    Conclusion : It is important to be aware that there are morphological and immunohistochemical pitfalls in the differential diagnosis among primary lung adenocarcinoma, malignant mesothelioma and breast cancer metastasis based on pleural fluid cytology.

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Clinical Articles
  • Sanae ARIYASU, Hiroyuki YANAI, Yumiko FUKUDA, Chikako NAKAGIRI, Masaka ...
    2017 Volume 56 Issue 6 Pages 297-302
    Published: 2017
    Released on J-STAGE: January 18, 2018
    JOURNAL FREE ACCESS

    Background : We report herein on a case of metastatic angiosarcoma that appeared similar to clear cell renal cell carcinoma on fine needle aspiration. Giemsa staining was useful for the differential diagnosis.

    Case : A man in his 50s presented in poor physical condition. Imaging examinations revealed a retroperitoneal tumor and multiple metastases. On aspiration cytology, there were epithelioid cell clusters in a hemorrhagic background. The epithelioid cells had clear nuclei with prominent nucleoli and vacuolated cytoplasm. Although these cytological findings were similar to those of clear cell renal cell carcinoma, erythrophagocytosis was noted on Giemsa staining.

    Histologically, the tumor showed nested proliferation of polygonal cells with large round nuclei. No vascular formation was seen. The tumor cells were positive for CD31 and D2-40. Based on these findings, the tumor was diagnosed as an angiosarcoma.

    Conclusion : Giemsa staining highlighted erythrophagocytosis, which is a characteristic of angiosarcoma and is useful in cytological diagnosis.

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  • ―A case report with cerebrospinal fluid cytological findings―
    Tetsuya HASHIMOTO, Toshiko KANAMURO, Yuji NONAMI, Yasuo AIHARA, Takaka ...
    2017 Volume 56 Issue 6 Pages 303-307
    Published: 2017
    Released on J-STAGE: January 18, 2018
    JOURNAL FREE ACCESS

    Background : Atypical teratoid/rhabdoid tumor (AT/RT) is a rare embryonal neoplasm of the central nervous system, classified into WHO grade Ⅳ, that frequently affects young children. Herein, we report the cerebrospinal fluid (CSF) cytological findings in a case of AT/RT in a case with postoperative development of intradural metastasis at the lower lumbar vertebral level with CSF dissemination.

    Case : A 7- year-old boy with AT/RT of the brain stem was treated by surgery and postoperative chemotherapy and radiation. Three years after the surgery, he presented with hydrocephalus of acute onset. Magnetic resonance imaging of the head revealed a tumorous lesion in the lumbar spinal cord. Cytology of the CSF showed atypical round cells with occasional rhabdoid morphology, and immunohistochemistry revealed negative staining of the cells for INI-1 protein. Based on these findings, the patient was diagnosed as having recurrent metastatic AT/RT.

    Conclusion : To establish the cytological diagnosis of AT/RT, it is important to demonstrate the absence of INI-1 protein expression by immunocytochemistry, especially when the tumor cells exhibit round cell morphology with rhabdoid cells.

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  • Shin SAITO, Tatsuya MATSUNAGA, Tae MOGAMI, Naho RUIZ YOKOTA, Takashi H ...
    2017 Volume 56 Issue 6 Pages 308-313
    Published: 2017
    Released on J-STAGE: January 18, 2018
    JOURNAL FREE ACCESS

    Background : Uterine metastasis from extrauterine malignant tumors is rare. In particular, there are few reports of uterine metastasis from gallbladder cancer. We report a case in which uterine metastasis from a malignant tumor was suspected from the findings on endometrial cytology.

    Case : The patient was a 55-year-old female. She visited our hospital with the chief complaint of lower abdominal pain with atypical genital bleeding 2 years after the initial therapy for gallbladder cancer had been completed (operation and chemotherapy). MRI imaging examinations revealed an irregularly shaped tumor mass measuring 30 mm in diameter in the posterior myometrium, with intratumoral heterogeneity. Endometrial cytology revealed high columnar heterogeneous cells agglutinate with a long elliptical nuclei appeared in a clear background. Histopathological examination of the endometrium revealed coexisting atypical gland tissue and existing normal endometrial glands infiltrating the endometrium and myometrium. These features were different from those of typical endometrioid cancer, and the lesion was suspected as a metastasis from the gallbladder cancer. A laparotomy was performed for controlling the bleeding and for obtaining a definitive diagnosis. It revealed a tumor mass was occupying the pelvis that was adherent to the uterus and rectum in the pouch of Douglas, and total removal of the uterus was difficult.

    Conclusion : Histological examination of the resected specimen revealed a features consistent with those of the previously treated gallbladder cancer, with the tumor cells infiltrating the endometrial stroma and myometrium. Immunostaining assay also revealed results consistent with those of the previously treated gallbladder cancer. Therefore, we diagnosed the lesion as a uterine metastasis from gallbladder cancer.

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