The Journal of the Japanese Society of Clinical Cytology
Online ISSN : 1882-7233
Print ISSN : 0387-1193
ISSN-L : 0387-1193
Volume 57, Issue 3
Displaying 1-5 of 5 articles from this issue
Original Articles
  • Junko MARUTA, Mitsuyoshi HIROKAWA, Eiji SASAKI, Takashi KOSHIKAWA, Ryo ...
    2018 Volume 57 Issue 3 Pages 151-158
    Published: 2018
    Released on J-STAGE: July 10, 2018
    JOURNAL FREE ACCESS

    Objective : We examined the cytological features of medullary carcinoma (MC) of the thyroid gland, including the nuclear dimensions, in order to identify useful diagnostic features for MC that are unlikely to be beset by errors arising from inter-examiner differences, and propose a diagnostic algorithm for improvement of the diagnosis rate.

    Study Design : Using cytological specimens obtained from 78 cases of MC, 20 cases of papillary carcinoma, 20 cases of follicular carcinoma and 20 cases of poorly differentiated carcinoma of the thyroid gland, we compared the rates of detection of salt and pepper chromatin, nuclear grooves, nuclear cytoplasmic inclusion bodies and multinucleated carcinoma cells, the amyloid and nuclear areas, the nuclear aspect ratio (ratio of the major axis diameter to minor axis diameter?), and the long diameter of the nuclei in order to identify features useful for the diagnosis of MC.

    Results : Diagnosis of MC was confirmed in 59 cases. It was estimated by logistic regression analysis in a further 7 cases. Based on our findings, we suggest the following as useful features for the diagnosis of MC : 1) salt and pepper appearance of the nuclear chromatin ; 2) 4 or more multinucleated carcinoma cells ; 3) presence of amyloid ; 4) nuclear aspect ratio≥1.6 ; 5) CV of the nuclear aspect ratio≥25%, 6) ratio between the minimum and maximum longest diameters of the nuclei≥3.7.

    Conclusion : Among the 78 specimens of MC, the diagnosis could be made by cytologic examination in 66 cases (84.6%).

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  • Rinko OZEKI, Keiichi IWAYA, Yuko UMAYAHARA, Yuka MORITA, Mie ARAI, Yuk ...
    2018 Volume 57 Issue 3 Pages 159-168
    Published: 2018
    Released on J-STAGE: July 10, 2018
    JOURNAL FREE ACCESS

    Objective : This study was conducted to evaluate the cellular morphologies in specimens prepared using Cellprep Plus® (a liquid-based cytological adaptation of the filter-transfer method by using wind pressure).

    Study Design : The study cohort comprised 223 patients who were followed up from March 2014 to June 2015 for cervical lesions. The cervical lesions were evaluated in cytological specimens prepared by the conventional method and those prepared by the Cellprep method. The cellular morphologies in the Cellprep Plus® specimens were compared with those in the conventional smear specimens.

    Results : The smear background of inflammatory cells, necrotic debris, pathogens, and/or mucus was maintained in the Cellprep Plus® specimens. There were no evident differences in the cellular sizes or shapes between the Cellprep Plus® and conventional smear specimens. Although large clusters of epithelial cells were deformed in the Cellprep Plus® specimens, the morphological criteria for differentiating between “negative” and “positive” cases remained the same as those used in the conventional smear specimens. The sensitivity of the Cellprep Plus® method for detecting intraepithelial lesions was significantly higher than that of the conventional smear method ; however, no significant difference in the specificity, negative predictive value or positive predictive value was found between the two methods.

    Conclusion : The Cellprep Plus® method should be considered as a suitable alternative to the conventional smear method for preparation of specimens for cytology.

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Clinical Articles
  • Akemi TAGUCHI, Mitsutoshi SHIBA, Hisami KANEOYA, Kiyoshi SHIBUYA, Yuki ...
    2018 Volume 57 Issue 3 Pages 169-176
    Published: 2018
    Released on J-STAGE: July 10, 2018
    JOURNAL FREE ACCESS

    Background : Nasopharyngeal carcinomas are rare tumors with an annual incidence of 500 cases in Japan and are often found in advanced cancer. It is also difficult to diagnose small cell lung carcinoma at an early stage and surgical cases are rare. We report herein on a case of nasopharyngeal carcinoma diagnosed with sputum cytology, combined with stage Ⅰ small cell lung cancer detected during the examination.

    Case : A 68-year-old man, a heavy smoker (smoking index : 45 pack-year), consulted our institute because marked atypical cells (level D) were detected on sputum cytology during a mass screening program for lung cancer. The chest CT examination was negative, and abnormal findings were not observed in the endoscopic examination. After 2 years, endoscopy was performed again because cancer cells (level E) were screened on sputum cytology and stage Ⅰ nasopharyngeal carcinoma was diagnosed with an endoscopic biopsy. In addition, as a pulmonary nodule, which had appeared in the chest CT examination, increased during follow-up, a thoracoscopic right middle lobectomy was performed, and diagnosis of stage Ⅰ small cell lung carcinoma was obtained. In sputum smears, non-keratinizing squamous epithelial cells stained with light green were useful for the diagnosis.

    Conclusion : Scrutiny and follow-up with a combination of sputum cytology and chest CT examination were useful for the early detection of multiple cancers. In sputum cytology, it was necessary to pay attention not only to yellowish photo-luminescent but also to light green-philic atypical epithelial cells. Our experience suggested that sputum cytology could contribute to early detection of head and neck cancers that are otherwise difficult to detect.

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  • Tomoya TAKEBUCHI, Takaaki SANO, Yusuke GOTO, Satomi HOSHIKAWA, Yasunor ...
    2018 Volume 57 Issue 3 Pages 177-182
    Published: 2018
    Released on J-STAGE: July 10, 2018
    JOURNAL FREE ACCESS

    Background : LCH is a disease of unknown etiology that is mainly characterized by the proliferation of Langerhans cells. While it is known to affect many organs, involvement of the thyroid gland is rare.

    Case : A man in his 40’s presented to us with a history of having suffered from pneumothorax when he was in his 20’s and of having been diagnosed, based on histopathology of a surgical specimen, as having eosinophilic granuloma syndrome of the lung. However, he had not been followed up since. Only recently, he had noticed an axillary lump on both sides and swelling of the right shoulder, and he was referred to our hospital. Axillary skin resection was carried out on both sides. The patient developed pneumothorax and partial lung resection was performed. Histopathology of both the resected surgical samples revealed features consistent with the diagnosis of Langerhans cell histiocytosis (LCH). Infiltration into the thyroid gland was also suspected, and fine-needle aspiration cytology examination of the thyroid gland was performed. This examination revealed tumor cells with enlarged nuclei and pale cytoplasm, and some cells showed prominent nuclear grooves. Multinucleated cells with 2-9 similar-looking nuclei with abundant cytoplasm were also seen. Immunocytochemical analysis revealed that these cells were positive for CD1a and langerin, and negative for TTF-1. Based on these features, the diagnosis of LCH of the thyroid gland was made.

    Conclusion : Fine-needle aspiration cytology of the thyroid gland enabled us to make a diagnosis of LCH from the morphological characteristics of the cells.

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  • Chisato SETOGUCHI, Takumi AKASHI, Akira SAKURAI, Yutaka NAKAJIMA, Yasu ...
    2018 Volume 57 Issue 3 Pages 183-188
    Published: 2018
    Released on J-STAGE: July 10, 2018
    JOURNAL FREE ACCESS

    Background : Desmoplastic small round cell tumor (DSRCT) is a rare malignant tumor of unknown origin that is predominantly found in the abdominal region in young adults. Herein, we report a case of DSRCT which could be suspected by the findings of cytology.

    Case : A 15-year-old male patient was admitted to the hospital because of abnormal opacities detected on a plain chest x-ray. Computed tomography and positron emission tomography (PET-CT) revealed multiple tumors in both the lungs, liver, and abdominal cavity, and bilateral enlarged hilar, mediastinal and supraclavicular lymph nodes showing fluorodeoxyglucose uptake on PET. EBUS-TBNA cytology of an enlarged mediastinal lymph node revealed small round tumor cells with irregular and hyperchromatic nuclei. Immunocytochemistry revealed positive staining for cytokeratin and desmin with a globular pattern, and negative staining for CD3, CD20, and CD56. Based on these findings, DSRCT was considered as the most probable diagnosis and rhabdomyosarcoma was considered in the differential diagnosis. Fluorescent in situ hybridization analysis and reverse-transcriptase polymerase chain reaction analysis of a histological specimen revealed split signals for the EWSR1 gene and EWSR1-WT1 fusion transcript, respectively, confirming the diagnosis of DSRCT.

    Conclusion : DSRCT can be cytologically suspected based on the morphological characteristics and immunocytochemical findings.

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