Objective : We tried liquid-based cytology (LBC) processing of a bloody sample (BL) using CelVerseTM (CelV : alcoholic level-40.5%) as the cell preservative solution (Cell-Preserv).
Study Design : After the samples of intraoral squamous cells and blood were added to CelV, the samples were preserved at room temperature (RT) or in cold storage (4°C) for equivalent time intervals (longest-72 hours). Then, after hemolytic processing of the LBC specimen, the cell number (CN) and background findings were examined.
Results : (1) In the CelV with BL, the CN at the RT was significantly lower than that at the 4°C. (2) Based on result (1), density gradient processing with a separating agent at RT was attempted ; the CN within 3 hours accounted for about 60% of the CN in CelV without BL, decreasing steadily thereafter with time. (3) Based on result (2), SurePathTM vial as Cell-Preserv was tried as the hemolytic agent, because the alcohol level of this agent was low (23%) in comparison to that of CelV. The CN after 72 hours accounted for about 50% of the CN in CelV without BL, with marked improvement of the CN in comparison with result (2).
Conclusion : Processing of using hemolytic and separating agent was the better method for BL in CelV.
Background : Mucoepidermoid carcinoma (MEC) of the lung is a rare pulmonary neoplasm and sometimes, when it manifests as a submucosal endobronchial tumor, preoperative cytological diagnosis could be difficult. Herein, we report a case of MEC arising from the lung that was difficult to diagnose by bronchial brushing and washing cytology.
Case : A 40-year-old woman visited our hospital with an abnormal opacity on the chest X-ray, that had been detected during a medical checkup. Chest CT revealed a well-defined nodule in the left lower bronchus. Bronchial brushing and washing cytology showed polygonal cells with centrally placed round nuclei, along with tiny foamy cells with cytoplasmic mucin and eccentrically placed nuclei, but no definitive diagnosis of malignancy could be made because of the mild atypia and low cellularity. Eventually, the tumor was diagnosed as a low-grade MEC of the lung by transbronchial biopsy and histopathological examination of the resected specimen.
Conclusion : Cytological diagnosis of low-grade MEC of the lung is sometimes difficult, particularly by bronchial brushing and washing cytology alone. However, the unique cytological characteristics taken into consideration with the clinical and radiological findings may allow a correct diagnosis of low-grade MEC to be made preoperatively.
Background : Adenocarcinoma of the uterine cervix currently accounts for approximately 20% of all cervical cancers, and its incidence has been increasing, particularly in young women. In general, diagnosis is more difficult when glandular and squamous components coexist than when either lesion exists alone.
Cases : Case 1 is a 38-year-old woman, in whom the findings on cervical Papanicolaou (PAP) smears were categorized as high-grade squamous intraepithelial lesion (HSIL). Histological diagnosis after conization revealed coexistence of adenocarcinoma in situ (AIS) and cervical intraepithelial neoplasia 3 (CIN3). Case 2 is a 51-year-old woman, in whom the findings on cervical PAP smears were suggestive of AIS. Histological diagnosis after conization showed coexistence of AIS and CIN1. Case 3 is a 43-year-old woman, in whom the findings on cervical PAP smears were reported as “atypical squamous cells, cannot exclude HSIL (ASC-H) and atypical glandular cells, not otherwise specified.” Histological diagnosis after conization revealed coexistence of stage IA2 microinvasive adenocarcinoma and CIN3. Definitive surgery was performed in all three patients after the conization.
Conclusion : We report the clinicopathological characteristics of three cases of synchronous squamous and glandular lesions that were treated by definitive surgery. However, it is difficult to detect coexisting glandular and squamous lesions of the uterine cervix, and when glandular abnormality is suspected from cytology or HPV typing test, closer investigation is warranted to determine possible coexistence of glandular and squamous lesions.
Background : Carcinoma ex pleomorphic adenoma (CXPA) is a malignancy developing from primary pleomorphic adenoma (PA). It is rare to see both benign and malignant components of CXPA in cytology specimens. We report a case of myoepithelial carcinoma ex pleomorphic adenoma, in which both benign and malignant components were detected in the cytology specimens.
Case : A woman in her nineties presented to us with a submucosal mass on the right palate that she had had for 13 years. She had been followed up as a case of benign tumor. However, in the previous seven months, the mass had enlarged rapidly. Fine needle aspiration cytology was performed to determine the appropriate treatment strategy. Cytological examination revealed weakly cohesive clusters of large atypical cells, consistent with the features of carcinoma cells. Histologic examination of the resected tumor showed tumor nests composed of polygonal cells with enlarged irregular nuclei. Based on the histologic and immunostaining results, the tumor was diagnosed as a myoepithelial carcinoma. In addition, PA components were also identified in the tumor tissue, based on which we made the diagnosis of CXPA. A review of the cytological finding after the histological diagnosis revealed the PA components.
Conclusion : In a case with a clinical course suggestive of CXPA, cytological observation should be performed bearing in mind the possibility of finding both PA and carcinoma components.
Background : We report a case of lung cancer diagnosed by cytological examination of a fluid specimen collected from a lesion on the patient’s buttock, with no detectable primary lesion.
Case : A man in his 60 s presented with a painful abscess around the anal region. Cytological examination of a fluid specimen obtained from the abscess revealed atypical cells with large and irregularly shaped nuclei, increased nuclear chromatin, and conspicuous nucleoli in a necrotic background, and multinucleated cells. Although cancer metastasis was suspected from these findings, the primary lesion had not yet been identified. CT led to the discovery of a mass lesion in the lungs, and bronchial scraping cytology revealed atypical cells similar to those observed in the fluid from a lesion on the buttock. Based on immunohistochemistry, the lung lesion was diagnosed as a primary non-small cell lung cancer.
Conclusion : In our case, we diagnosed lung cancer based on cytological examination of a fluid specimen obtained from a lesion on the buttock. We identified the primary lesion by CT imaging, comparison of the findings of cytological examination of a fluid specimen obtained from a lesion on the buttock, and immunohistochemical examination of bronchial brushing specimens. Molecular pathological examination of the lung tumor revealed a high expression level of PD-L1. This patient showed complete response to pembrolizumab treatment, which led to shrinkage of the tumors in the lung, buttock, and lymph nodes. Since then, the patient has had a good clinical course.
Background : Epithelioid hemangioendothelioma (EHE) is a malignant vascular neoplasm with a predilection for the lung, liver, bone and soft tissues, and harbors the specific WWTR1-CAMTA1 fusion gene.
Case : A 62-year-old male was referred to our hospital with pleural effusion and diffuse pleural thickening. Pleural biopsy revealed the diagnosis of EHE, and the patient was treated by extrapleural pneumonectomy. After the surgery, the residual tumor in the pleura enlarged and the patient also developed ascites. Post-operative chemo-radiotherapy proved ineffective, and the patient died 3 months after the surgery. Histological findings : The tumor was composed of proliferating epithelioid cells, that sometimes showed intracytoplasmic vacuoles, arranged in cords or small nests. The WWTR1-CAMTA1 fusion transcript was detected by reverse transcription-polymerase chain reaction using formalin-fixed, paraffin-embedded tumor tissue. Cytological findings : The specimen showed epithelioid or spindle-shaped tumor cells having eccentric and irregular-shaped nuclei and pale-staining cytoplasm that sometimes contained intracytoplasmic vacuoles. Immunocytochemistry using a cell block specimen showed positive staining for endothelial markers and CAMTA1 in the tumor cells.
Conclusion : The diagnosis of pleural EHE can be made in cytology specimens, and CAMTA1 immunocytochemistry using a cell block specimen is a useful diagnostic adjunct.
In this study, we developed a new immunocytochemistry method, which is performed on floating cells. After antigen-antibody reaction and colorization carried out under the floating condition in a microtube, the cells are on a slide glass. This floating immunocytochemical method allows stronger colorization than the conventional immunocytochemical method. This cell floating method could also improve the immunostaining by shortening the staining time in comparison with the conventional method.
We report the case of a 59-year-old woman with pancreatic mixed adenoneuroendocrine carcinoma (MANEC) and liver metastasis. The EUS-FNA smear was hypercellular with neoplastic cells scattered in loosely cohesive clusters. The tumor cells had large round nuclei, coarse granular chromatin and light green cytoplasm. Although the diagnosis was suspected as NET or adenocarcinoma, the lack of a definite pattern and unclear differentiation prevented a definitive cytological differential diagnosis. Histopathological examination of the liver biopsy specimen revealed that the tumor nests contained intraluminal mucin and immunohistochemistry revealed that the cells were positive for neuroendocrine markers. Thus, we finally made the histopathological diagnosis of MANEC.