Objective : We have reported that use of 10% formalin-fixed cell blocks (CBs) is the best way to conduct receptor analysis in breast cancer cytology specimens. We conducted this study to examine if residual specimens after liquid-based cytology (LBC) could be used as same as formalin for the receptor analysis.
Study Design : Cell samples from excised breast cancers were fixed in six different types of fixatives : 10% buffered formalin ; BD CytoRich red preservative (BD solution) ; ThinPrep PreservCyt Solution (PreservCyt solution) ; TACASTM Ruby ; Cellprep Body Fluid, FNA Solution ; and 95% ethanol. The fixed cells were embedded in paraffin to prepare CBs. The following tests were performed : immunostainings for hormone receptors, HER2 protein, and the HER2 dual in situ hybridization (DISH) assay. The staining results were compared with those obtained from the corresponding formalin-fixed CBs.
Results : Only BD solution-fixed cell blocks yielded the same results as the formalin-fixed cell blocks.
Conclusion : BD solution-fixed cell blocks can be used as an alternative to formalin-fixed cell blocks for breast cancer receptor analysis.
Background : Mixed adenoendocrine carcinoma (MANEC) is a composite neoplasm containing both adenocarcinoma and neuroendocrine carcinoma components (NEC). Although it is the most prevalent neuroendocrine tumor of the bile duct, there are few reports of preoperative confirmation of the diagnosis. We present a case of biliary MANEC which was suspected on preoperative cytology.
Case : A 71-year-old man presented with generalized fatigue and jaundice. Endoscopic retrograde cholangiopancreatography (ERCP) revealed narrowing of the lower bile duct. Brushing and biliary cytology showed tumor cells suggestive of adenocarcinoma. Moreover, tumor cells with fine or coarse granular chromatin and high N/C ratios, indicative of NEC, were found in the same specimen. The cells were positive for synaptophysin on immunocytochemistry. A composite neoplasm containing adenocarcinoma and NEC components, possibly MANEC, was suspected. Histological examination of the resected specimen confirmed the diagnosis of MANEC.
Conclusion : A careful search for NEC cells in cases of poorly differentiated adenocarcinoma could lead to an early and accurate diagnosis of MANEC.
Background : Myeloid sarcoma (MS) is an extramedullary tumor composed of immature myeloid cells. Herein, we report a case of myeloid sarcoma in whom the presenting manifestation was a vulval mass.
Case : A female patient in her 30’s presented to our hospital with pain in the right labium minus and clitoral swelling. Physical examination revealed a yellow tumor measuring 2 cm in diameter, extending from the right labium minus to the clitoris. Pelvic MRI revealed an enhanced irregularly shaped mass lesion measuring 3×4×2 cm in size. Hematological examination revealed normal results of a complete blood count (CBC) : WBC count 5600/μl ; Neutro : 65.3%, Lymph : 20.9%, Mono : 8.2%. The results of conventional cervical, endometrial and vulval cytological examinations were normal. On the basis of tumor imprint cytology, the mass was diagnosed as a small round cell tumor, the differential diagnosis including malignant lymphoma, malignant melanoma and MS. The biopsy specimen showed proliferative small round cells with scant basophilic cytoplasm and nuclei containing occasional prominent nucleoli, suggesting the diagnosis of a lymphoproliferative disorder. Immunohistochemical examination revealed positive staining for myeloperoxidase, CD34, CD13, and CD117. Based on the findings, the patient was diagnosed as having myeloid sarcoma.
Conclusion : We report a case of vulval myeloid sarcoma diagnosed by tumor imprint cytology and biopsy.
Background : Large cell neuroendocrine carcinoma (LCNEC) arising from the ampulla of Vater is a rare and aggressive neoplasm, whose cytological characteristics are still poorly defined. Herein, we report a case of LCNEC of the ampulla of Vater, in which biliary duct brushing cytology combined with liquid based preparation (LBP) was useful for preoperative diagnosis.
Case : A 70-year-old man underwent biliary duct brushing cytology as part of evaluation of obstructive jaundice. The smears revealed two cell populations : one consisting of a small population of atypical cells with intracytoplasmic mucin, consistent with the characteristics of well-differentiated adenocarcinoma and another larger population of small-sized tumor cells occurring as both loosely crowded aggregates and in cohesive alveolar clusters, consistent with the features of poorly differentiated adenocarcinoma. The cells showed high nuclear-to-cytoplasmic ratios, round to oval nuclei with hyperchromasia, unevenly distributed coarsely to finely granular chromatin and occasional small nucleoli. Nuclear mitoses and rosette-like formations were also seen. In LBP, these cells were immunopositive for neuroendocrine markers. Histopathological examination revealed the diagnosis of LCNEC.
Conclusion : The cytomorphological characteristics of LCNEC of the ampulla of Vater are similar to those of LCNEC of the lung, but there are diagnostic difficulties. LBP applied to biliary duct brushing cytology provides improved diagnostic yield for LCNEC.
Background : Glomus tumor represents a neoplastic proliferation of modified smooth muscle cells of the glomus body. The tumor usually occurs in the deep dermis or subcutaneous tissue of the extremities, and only rarely occurs in the stomach. Herein, we report a case of glomus tumor of the stomach that was diagnosed preoperatively by endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA).
Case : A 44-year-old woman was referred to us for investigation of a gastric submucosal tumor. The specimen obtained by EUS-FNA showed variable cohesive cell clusters composed of uniform round cells admixed with myxoid material and capillary vessels. The nuclei were round to oval, with smooth nuclear membranes and evenly distributed salt-and-pepper chromatin. The most critical differential diagnosis was neuroendocrine tumor, because of the cytomorphological resemblance. However, the cytomorphological finding of cohesive clusters intermingled with myxoid material, which is usually not seen in neuroendocrine tumors, was helpful to diagnose this case as a glomus tumor. Immunohistochemical studies revealed positive staining for αSMA and synaptophysin, and negative staining for CD56, chromogranin A and c-kit, findings compatible with the diagnosis of glomus tumor.
Conclusions : Careful morphological examination and immunohistochemistry are needed to diagnose glomus tumor in EUS-FNA specimens.
A woman aged in her 50’s was incidentally diagnosed as having a carotid body tumor, which was then completely excised.
The cytological findings showed tumor cells arranged singly and in small clusters, with abundant or granular cytoplasm. The nuclei were round, with granular chromatin and small nucleoli. Histopathological examination of the resected tumor specimen revealed the characteristic Zellballen pattern, and immunohistochemistry revealed a diffusely positive reaction in the cytoplasm for neuroendocrine markers. Based on the findings, we diagnosed the tumor as a paraganglioma arising from the carotid body.
We report this relatively rare case here and consider that the diagnosis of this tumor could be confirmed or supported by the characteristic cytological findings.