The Journal of the Japanese Society of Clinical Cytology
Online ISSN : 1882-7233
Print ISSN : 0387-1193
ISSN-L : 0387-1193
Volume 59, Issue 6
Displaying 1-11 of 11 articles from this issue
Review Article
  • Atsuhiko SAKAMOTO
    2020 Volume 59 Issue 6 Pages 263-268
    Published: 2020
    Released on J-STAGE: December 24, 2020
    JOURNAL FREE ACCESS

    Concerning the reporting systems for cytodiagnosis after Papanicolaou classification, the 3-grade system (negative, suspicious, positive) has been well accepted around the world. However, The Bethesda System for cervical cytology 1988 had a great impact on the cytology reporting systems for other organs. Then, the organ-limited, original reporting systems appeared for cytological examinations of the thyroid, urine and salivary glands. At this moment, new formats for reporting the results of cytology are being prepared for publication in the endometrium, breast and lung. In the Japanese “General Rules,” standardized terminologies and definitions are described as a nationwide standard for diagnosis and treatment of cancer. Cytodiagnoses for 15 organs are included in the “General Rules.” The reporting systems of cytodiagnosis should be described in every “General Rules” for being recognized as a nationwide standard. This article describes the international and domestic history and changes in the reporting systems for cytodiagnosis, in an attempt to promote the discussions and negotiations for making cytodiagnosis take in “General Rules”.

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Clinical Articles
  • Terumi TANIGAWA, Maki MATODA, Hidetaka NOMURA, Sanshiro OKAMOTO, Hiroy ...
    2020 Volume 59 Issue 6 Pages 269-272
    Published: 2020
    Released on J-STAGE: December 24, 2020
    JOURNAL FREE ACCESS

    Background : Endometrioid carcinoma may be accompanied by malignant squamous differentiation. We report a case of endometrioid carcinoma with prominent squamous differentiation in which the diagnosis was made by preoperative endometrial cytology.

    Case : A 52-year-old nulliparous postmenopausal woman was referred to our hospital with suspected squamous cell carcinoma of the endometrium, and diagnostic endometrial cytology at our hospital revealed numerous squamous cells and a cluster of malignant cells that were suspected as being glandular cells. Hence, endometrioid carcinoma with squamous differentiation was suspected. Magnetic resonance imaging revealed a tumor in the uterine body, and multiple lymph node metastases were suspected based on the findings of [18F]-fluorodeoxyglucose positron emission tomography-computed tomography. Surgery was performed under the diagnosis of endometrial cancer. Histopathological examination of the resected tumor of the uterine body confirmed the diagnosis of endometrioid carcinoma with squamous differentiation. Multiple lymph node metastases were observed, and the squamous cell carcinoma component had metastasized. The patient showed relapse with multiple lymph node metastases 8 months post-surgery.

    Conclusion : We encountered a case of endometrioid carcinoma of the uterine body with squamous differentiation. The patient showed a poor prognosis with metastasis of the squamous cell carcinoma component to the lymph nodes and early recurrence.

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  • ―A case report and literature review―
    Kyoko KISA, Kenta KAJIO, Masako ONISHI, Sigekatsu OYAMA, Kayo UEDA, Ku ...
    2020 Volume 59 Issue 6 Pages 273-278
    Published: 2020
    Released on J-STAGE: December 24, 2020
    JOURNAL FREE ACCESS

    Background : Pulmonary tumorlet (PT) is a non-neoplastic proliferative lesion of the neuroendocrine cells along the bronchial basement membrane, and is often associated with bronchiectasis. To the best of our knowledge, there are only two previous reports of the cytological characteristics of PT. Herein, we report an extremely rare case in which we used touch imprint cytology for the diagnosis of PT associated with bronchiectasis.

    Case : A 70-year-old woman was admitted to our hospital with a history of hemoptysis. Chest computed tomography (CT) showed consolidation of a homogeneous nodular opacity in the right pulmonary middle lobe, measuring 10 mm in diameter. We prepared a touch imprint cytology sample using the surgically resected pulmonary specimen. Cytologically, the lesion was provisionally diagnosed as a typical carcinoid (TC). Histopathology indicated bronchiectasis as the background underlying pulmonary condition. Immunohistochemistry showed positive staining of the lesion for CD56, chromogranin A, synaptophysin, and thyroid transcription factor (TTF-1). The Ki-67 index was less than 1%. Based on the above findings, the lesion was finally diagnosed as PT associated with bronchiectasis.

    Conclusion : In this case, the diagnosis of PT could be established by histopathology and immunohistochemistry. It is difficult to distinguish PT from TC based solely on the cytological findings, because of similarities in the cell morphologies between the two conditions. Detection of bronchiectasis in the background lung and hypocellularity of the cytological smear, in addition to an awareness of PT, is useful for the cytological diagnosis of PT.

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  • Takuya MURAKAMI, Koji ARIHIRO, Katsunari ISHIDA, Yukari MARUBASHI, Yos ...
    2020 Volume 59 Issue 6 Pages 279-285
    Published: 2020
    Released on J-STAGE: December 24, 2020
    JOURNAL FREE ACCESS

    Background : Perivascular epithelioid cell tumors (PEComas) are rare neoplasms that can develop in any organ.

    Case : A woman in her 60 s underwent right upper lobectomy for four tumors in the right upper lobe, and also partial resection for a tumor in the left lower lobe. One of the four tumors in the right upper lobe was diagnosed by preoperative fine needle aspiration cytology as being an adenocarcinoma. The left lung lower lobe tumor was diagnosed intraoperatively, by frozen section examination and stamp cytology, as being “different from adenocarcinoma.” Macroscopically, this latter tumor, measuring 1.0×1.0×0.7 cm in size, was a well-circumscribed solid tumor, with a grayish-white cut surface. Cytologic examination indicated some atypical cell clusters, with the cells containing ill-defined clear-to-granular eosinophilic cytoplasm, and nuclei with occasional intranuclear cytoplasmic inclusions, fine granular chromatin and small nucleoli. Histologically, the tumor was composed of solid and well-defined cell nests showing a positive Periodic acid Schiff (PAS) reaction, and positive immunohistochemical staining for Human Melanin Black 45 (HMB45) and Melan A in about 30% of the tumor cells. Therefore, this tumor was diagnosed as a PEComa (clear cell tumor).

    Conclusion : The PEComa had been diagnosed as a tumor “different from adenocarcinoma” intraoperatively, so that misdiagnosis as a metastatic carcinoma was avoided. In such a case, it is important not to overestimate the condition as a more advanced stage of carcinoma.

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  • Megumi TATEISHI, Kohki SHIMAZU, Daisuke IWASE, Kana KURASAWA, Rika TAK ...
    2020 Volume 59 Issue 6 Pages 286-290
    Published: 2020
    Released on J-STAGE: December 24, 2020
    JOURNAL FREE ACCESS

    Background : Primary squamous cell carcinoma of the endometrium is rare. Herein, we report a case of primary endometrial squamous cell carcinoma, with a review of the literature.

    Case : The patient, a postmenopausal woman in her 50 s, presented with a history of menstrual disturbance. The findings of uterine cervical cytology were classified as ASC-H. Endometrial biopsy showed atypical squamous cells, either scattered or in a papillary pattern. Therefore, we diagnosed the lesion as squamous metaplasia with severe dysplasia. Laparoscopic hysterectomy with bilateral salpingo-oophorectomy was performed to make a definitive diagnosis. The final histopathological diagnosis was squamous cell carcinoma of the endometrium. We reviewed the cervical cytology findings and considered that the following could have been considered as possible indicators of squamous cell carcinoma : 1) atypical squamous cells ; 2) abnormal keratinizing cells ; 3) anuclear keratinizing cells ; 4) spindle-shaped cells.

    Conclusion : Detection of the four aforementioned findings in the uterine cytology of a patient without apparent uterine cervical lesions should suggest the possibility of primary squamous cell carcinoma of the endometrium.

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  • Fumiaki KINOSHITA, Takumi SUGITANI, Taeko KONDO, Takuya MATSUOKA, Miya ...
    2020 Volume 59 Issue 6 Pages 291-298
    Published: 2020
    Released on J-STAGE: December 24, 2020
    JOURNAL FREE ACCESS

    Background : Pigmented perivascular epithelioid cell tumor (PEComa) with marked melanin pigment deposition is a very rare tumor, that has been reported to arise mainly in the kidney and liver. We report a case of PEComa showing marked melanin pigment deposition arising from the retroperitoneum.

    Case : A female patient in her 40 s was detected, during a medical checkup, as having a liver tumor. However, MRI revealed a retroperitoneal tumor. EUS-FNA was performed for cytological and histological diagnosis, which revealed round and spindle-shaped tumor cells. The tumor cell nuclei had granular chromatin and prominent nucleoli ; in addition, numerous brown granules were seen in the cytoplasm of the tumor cells, which were considered as being melanin granules.

    Paraganglioma, PEComa and metastatic melanoma were considered in the differential diagnosis. Histologically, the tumor cells containing prominent melanin granules proliferated in an alveolar pattern, within a stroma containing proliferating large or small capillaries. Cellular atypia was prominent, but there were no mitoses. Immunohistochemically, the tumor cells showed positive staining for HMB-45, and negative staining for α-smooth muscle actin and S-100 protein. MIB-1- positive cells comprised less than 1% of the total cell population. The tumor was diagnosed as a pigmented PEComa.

    Conclusion : It is important to recognize the cytological features of PEComa. The possibility of PEComa should be borne in mind in the differential diagnosis of tumors containing melanin granules in the cytoplasm.

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  • Tomoka MAEHANA, Yuki YAMADA, Sumire SUGIMOTO, Tomoko UCHIYAMA, Ryuji K ...
    2020 Volume 59 Issue 6 Pages 299-304
    Published: 2020
    Released on J-STAGE: December 24, 2020
    JOURNAL FREE ACCESS

    Background : Endometrial smear cytology is currently one of the most common methods used to detect endometrial cancer. While no conclusive method has been established yet to detect ovarian cancer, ovarian cancer can sometimes be incidentally detected through endometrial cancer screening.

    Cases : Case 1 : A 58-year-old female presented with cytologic abnormalities detected during endometrial cancer screening. The endometrial biopsy results were negative, and computerized tomography (CT) and magnetic resonance imaging (MRI) findings were unremarkable. An exploratory laparoscopic surgery was performed owing to inconsistencies between the cytology and imaging findings. The final diagnosis was serous borderline tumor of the left ovary. Case 2 : A 51-year-old woman consulted her doctor with a 1-year history of persistent cough and palpitations. She was diagnosed as having pleural mesothelioma from the imaging findings and tumor biopsy. After completion of chemotherapy, gynecological cancer was suspected. An exploratory laparotomy was performed, and she was diagnosed as having high grade serous carcinoma of the left ovary.

    Conclusion : We diagnosed two cases of ovarian cancer by endometrial cytology, despite the lack of remarkable CT or MRI findings. Extrauterine tumors should be suspected if aggregates of tumor cells are found to coexist with normal atrophic endometrial cells on endometrial cytology.

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  • Chisa KOSHIMIZU, Yoshiiku OKANEMASA, Toshie TERAUCHI, Mariko NAKANO, M ...
    2020 Volume 59 Issue 6 Pages 305-310
    Published: 2020
    Released on J-STAGE: December 24, 2020
    JOURNAL FREE ACCESS

    Background : Primary squamous cell carcinoma of the salivary gland is extremely rare and is known to be associated with a very poor prognosis. Herein, we report the cytological features of a diagnostically difficult case of primary salivary gland squamous cell carcinoma with intracytoplasmic vacuoles, which resembled a mucoepidermoid carcinoma.

    Case : A 65-year-old man presented to a physician with a swelling on the right mandible, which he had first noticed about a month earlier. Fine needle aspiration cytology revealed orange G-philic keratinized cells and strongly light green-stained cells in Papanicolaou stain, based on which the lesion was diagnosed as a squamous cell carcinoma. However, it was difficult to distinguish it from mucoepidermoid carcinoma because the tumor cells contained intracytoplasmic vacuoles. Histological examination showed moderately to poorly differentiated squamous cell carcinoma without any evidence of mucus production. Electron-microscopic examination of a formalin-fixed tissue specimen revealed dilated endoplasmic reticula, suggestive of intracytoplasmic vacuoles.

    Conclusion : It is important to distinguish squamous cell carcinoma with intracytoplasmic vacuoles from mucoepidermoid carcinoma.

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  • Rikiya OKUYAMA, Tomoko IZUMI, Kazumi SATO, Masakazu ARAI, Hirotomo KOD ...
    2020 Volume 59 Issue 6 Pages 311-317
    Published: 2020
    Released on J-STAGE: December 24, 2020
    JOURNAL FREE ACCESS

    Background : Gastric schwannoma is a rare submucosal tumor, accounting for 0.2% of all gastric tumors, and it is difficult to clinically differentiate this tumor from GIST (gastrointestinal stromal tumor) and leiomyoma. We encountered two cases of gastric schwannoma with in which we performed endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). Herein we report the cytological features of gastric schwannoma and the differential diagnosis of this tumor from other gastric submucosal tumors.

    Cases : Two women, one in her 50 s and the other in her 70 s, were diagnosed as having gastric submucosal tumors, measuring 15 mm in diameter. In both cases, the tumors increased in size during follow-up. Therefore, EUS-FNA was performed, and in both cases, cytological and histological examinations using cell block specimens revealed spindle cells with pale eosinophilic cytoplasm, and a positive result of immunohistochemistry for S-100. Therefore, the tumors in both cases were diagnosed as gastric schwannomas. The resected surgical specimens showed similar histological findings, confirming the diagnosis of gastric schwannoma.

    Conclusion : Although it is difficult to confirm the diagnosis of gastric schwannoma by cytology alone, we consider that the elliptical tumor cell nuclei, short cell bundles, cellular protrusions from clusters, and presence of numerous lymphocytes and crushed nuclei in the background are suggestive of gastric schwannoma, and that therefore, it might be possible to surmise the histological type by EUS-FNA.

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Brief Notes
  • Takumi ASHIDA, Yoshito SAWADA, Yuka HAMASUNA, Yuichi NAKAZONO, Yasuji ...
    2020 Volume 59 Issue 6 Pages 318-319
    Published: 2020
    Released on J-STAGE: December 24, 2020
    JOURNAL FREE ACCESS

    Cytological examination of the cerebrospinal fluid (CSF) in a woman in her 70 s with a clinical diagnosis of right optic perineuritis showed loosely-cohesive clusters of small cells with round nuclei and mildly acidophilic cytoplasm. The abnormal cells were small in number in the first sample, but gradually increased in number in succeeding specimens. Incidentally obtaining the patient’s past history of left mastectomy for invasive lobular carcinoma 5 years 7 months earlier, we performed an immunohistochemical analysis of the cells at the fifth lumbar puncture specimen. It showed positive staining for estrogen receptor, GCDFP-15 and GATA-3 and negative staining for e-cadherin. Based on the findings, we made the final diagnosis of metastatic meningeal carcinomatosis from invasive lobular carcinoma of the left breast.

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  • Eriko NOSE, Keita MATSUKURA, Hiroshi ARAI, Toshikazu GONDO
    2020 Volume 59 Issue 6 Pages 320-321
    Published: 2020
    Released on J-STAGE: December 24, 2020
    JOURNAL FREE ACCESS

    Rosai-Dorfman disease is a rare benign disease characterized by proliferation of histiocytes in the lymph nodes. We report a case of Rosai-Dorfman disease in a 60-year-old man who presented with multiple cervical and axillary lymphadenopathy and an abdominal mass. Liquid-based cytology of aspirated material revealed many large histiocytes with emperipolesis. The diagnosis of Rosai-Dorfman disease was established on the basis of the cytological and histopathological features.

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