Objective : This is a report of primary screening of Japanese women for cervical cancer, the screening method involving a combination of the HPV status and cytological results ; we also evaluated the usefulness of MPM test as a primary screening method for cervical cancer.

Study Design : The MPM test simultaneously amplifies a total 13 high risk-HPV types by multiplex PCR in a single reaction tube, which are separated by electrophoresis. Seven high risk-HPV, types 16, 18, 31, 33, 35, 52, 58 are examined individually (Sup hrHPV) and the remaining six high risk-HPV are detected together as one (other hrHPV).

Results : The HPV-based screening detected a higher number of ≧CIN3 cases than conventional cytology. The following genotypes were associated with the risk of progression to ≧CIN3 in this small study HPV16, 52, 33, 18, 58. In 5 previous reports based on studies of Japanese women, ≧CIN3 was reported to be most commonly associated HPV genotypes 16, 52, 58, 31, 33, 18 and 35, (ratios of S-hrHPV to total-hrHPV, 94%). On the other hand, in Japanese women with low-grade cervical lesions and NILM, the ratios of S-hrHPV to total-hrHPV was only about 67-69%.

Conclusion : Introduction of “sup hrHPV” for primary screening reduces overdiagnosis. The findings lend support to a screening intervals of 3 years for Japanese women with a negative result of NILM for HPV, similar to the case in the US.

Objective : To present the five-year preliminary results of combination screening that included the human papillomavirus (HPV) DNA test and cytology started by Usa city in the 2012 fiscal year to improve cervical cancer screening rates among young women.

Study Design : This screening was performed in candidates aged 20 to 40 years. We investigated the screening rate, positive rate of high-risk HPV, and results of cytodiagnosis including the 20-year old candidates of HPV vaccinated in 2014 and 2015.

Results : The screening rate was 33.6% with the HPV test in 2016. The highest screening rate among women aged 40 years was 49.0% in 2016. The total positive rate of high-risk HPV was 8.7% ; the rate of positive results on cytodiagnosis, defined as atypical squamous cells of undetermined significance (ASC-US) or worse on cytological findings, was 4.9%. The rate of positive results was 0% among women aged 20 years from the HPV vaccination period.

Conclusion : The positive rate of high-risk HPV was higher than that of cytodiagnosis, suggesting that the HPV DNA test can supplement cytodiagnosis in cervical cancer screening. HPV vaccination might contribute to the decrease in positive result rates on cytodiagnosis.

Background : MALT (mucosa associated lymphoid tissue) lymphomas develop not only in the lymph nodes but also in the extranodal organs. We report herein on a case of MALT lymphoma the diagnosis of which was difficult because of the coexistence of a large number of histiocytes.

Case : A man in his seventies visited our medical center because of swelling of the left parotid gland and left cervical lymph nodes. We suspected sinus histiocytosis of the parotid gland based on the results of aspiration biopsy cytology. Magnetic resonance imaging could not however rule out malignant lymphoma, so a left parotidectomy was performed to make a definitive diagnosis. Imprint cytology of the parotid gland showed centrocyte-like cells (CLCs) slightly larger than mature lymphocytes and a large number of histiocytes. The histological findings revealed three areas. 1) An area mainly consisting of CLCs ; 2) An area consisting of neoplastic plasma cells which were positive for kappa-chain, and negative for lambda-chain ; and 3) An area mainly consisting of histiocytes.

Conclusion : If a large number of histiocytes intermingles with CLCs, it may become difficult to make a diagnosis of MALT lymphoma. In order to make a definitive diagnosis of MALT lymphoma, careful consideration is necessary not only cytologically and histologically but also clinically.

Background : Papillary renal cell carcinoma (PRCC) is the most frequent histopathological variant of renal cell carcinoma, after clear cell renal cell carcinoma, however, there are few reports of its cytological characteristics. Herein, we present a case of type 2 PRCC, with a comparison of its cytological versus histopathological features.

Case : The patient was an 80-year-old man with a tumor in the upper pole of the right kidney. CT-guided core needle biopsy was performed for histopathological diagnosis, and washing of the cells left at the needle tip after biopsy were submitted as the cytological specimen. The wash cytology revealed hemosiderin-laden phagocytic cells and numerous tumor cells forming papillary clusters. The tumor cells were columnar and contained granular cytoplasm and round nuclei with prominent nucleoli and fine granular chromatin. Foam cells were found in the stroma. Histopathological examination of the specimens obtained by the core needle biopsy and surgical resection showed that the tumor was composed of cells forming papillary structures with a stroma of vascular connective tissue. The tumor cells were also columnar and contained eosinophilic granular cytoplasm, and there were collections of foam cells in the stroma. We diagnosed the tumor as PRCC, type 2.

Conclusion : Papillary clusters, granular cytoplasm, hemosiderin-laden phagocytic cells, and foam cells in the stroma comprise the characteristic cytological features of PRCC, type 2.

Background : We report herein on the cytomorphological features of a clear cell variant of a solid pseudopapillary neoplasm in endoscopic ultrasound-guided fine-needle aspiration cytology (EUS-FNAC) and tumor imprint cytology.

Case : A 38-years-old Japanese man presented with abdominal pain. He had a pancreatic tumor measuring about 13 mm. EUS-FNAC and minimized resection were performed. In both the EUS-FNAC and imprint cytology findings, tumor cells were observed with vacuolation, rounded and eccentric nuclei, nuclear grooves and fine evenly distributed chromatin. On the histological findings, the tumor was mostly composed of vacuolated clear cells with solid growth. Immunohistochemistry revealed positive staining for vimentin, CD-10 (membrane staining) and β-catenin (cytoplasm and nuclei staining) of the neoplastic cells. Based on the above panel the tumor was diagnosed as a clear cell variant of a solid pseudopapillary neoplasm (CCV-SPN).

Conclusion : We present a case of a rare tumor diagnosed as a CCV-SPN arising in the pancreatic head and body in a young man. The appearance of tumor cells with large, clear cytoplasmic vacuolation in EUS-FNAC and imprint cytology findings is useful for the accurate diagnosis of a CCV-SPN. Immunohistochemistry is necessary for diagnosing and distinguishing CCV-SPNs from other malignancies.

Background : Pilomatricoma is a benign skin appendage tumor. This tumor is frequently misdiagnosed by skin cytology as a malignant tumor.

Case : A one-year-old girl was brought to us with a mass in front of her left ear. Findings of MRI and fine needle aspiration cytology performed at another hospital led to the suspicion of malignant lymphoma. Subsequently, she was referred to our hospital, and surgical resection of the tumor was performed.

Cytological diagnosis : The specimens showed an uneven distribution of atypical cells and a slightly hemorrhagic background. The atypical cells were isolated or occurred in 3-D clusters, and had naked nuclei with indistinct cell borders, mimicking the features of basaloid cells. A few shadow cells and multinucleated giant cells were found admixed with the basaloid cells. Based on the findings, we made the diagnosis of pilomatricoma.

Histological findings : The resected subcutaneous tumor was a fragile mass. The tumor contained acidophilic cells, basophilic cells, shadow cells, and multinucleated giant cells. The tumor was diagnosed as a pilomatricoma.

Conclusion : In a child or adolescent presenting with a cutaneous nodular lesion, a high cell density of basaloid cells is suggestive, and the presence of shadow cells is helpful, for making a diagnosis of pilomatricoma.