Objective : We studied the cytological characteristics of flat epithelial atypia (FEA) in fine needle aspiration cytology (FNAC).

Study Design : We selected 5 cases of FEA diagnosed at the Osaka Breast Clinic in 2019.

Results : The cytological diagnoses included 3 cases labeled as “indeterminate” and 2 cases labeled as “suspicious for malignancy.” We observed a clear cytological background in almost all the cases and calcified material in 3 cases. All cases showed clusters of monotonous cells. Columnar cells with large N/C ratios showed a palisading arrangement in 3 cases and were found as scattered cells in 4 cases.

Conclusion : Our observation showed that we could recommend core needle biopsy for the diagnosis of FEA with FNA. We think that it will become possible to diagnose FEA by FNA through accumulation of more cases.

Objective : Nucleic acid analysis is an important diagnostic tool for the diagnosis of disease or determining treatment options. The aim of this study was to examine the effects of the cell sample storage temperature on the nucleic acid quality in liquid-based cytology samples prepared using fixed in CytoRich Red.

Study Design : We investigated the effects of the storage temperature on the DNA yield and quality, as measured by the DNA integrity number (DIN) and purity (A₂₆₀/A₂₈₀). Culture cells (PC9) and clinical samples (n=11) were fixed overnight in CytoRich Red and then stored for up to 10 days at room temperature or at 4℃ in a refrigerator.

Results : The DNA quality of the PC9 cells fixed in CytoRich Red was adversely affected by storage at room temperature, but not by storage at 4℃ for up to 10 days. In the clinical samples also, the amount of extracted DNA decreased with storage at room temperature (p<0.001), whereas low temperature storage protected against DNA degradation in the samples, as assessed by measurement of the DIN and purity (A₂₆₀/A₂₈₀).

Conclusion : Since the storage temperature influences the nucleic acid quality of the samples, cytological samples should be stored under refrigeration at around 4℃.

Background : Intraoperative diagnosis using frozen sections for Brenner tumor of the ovary is sometimes difficult, since the tumor often contains benign, borderline malignant, and malignant components at the same time. In this case report of borderline malignant Brenner tumor, we demonstrate the usefulness of imprint cytology in addition to the frozen section procedure, to distinguish malignant lesions from non-malignant lesions.

Case : A 51-year-old woman was referred to our hospital because of abdominal fullness. Magnetic resonance Imaging revealed a huge polycystic ovarian tumor with a solid part and uterine leiomyomas. Surgery was performed. Intraoperative histological diagnosis using frozen sections showed a borderline Brenner tumor. Additional intraoperative imprint cytological findings included cells that showed slight anisonucleosis, one or two nucleoli, fine granular chromatin, many nuclear grooves, and no malignant cells. Based on these intraoperative diagnoses, total abdominal hysterectomy, bilateral salpingo-oophorectomy and partial omentectomy were selected as the surgical procedures.

Conclusion : Intraoperative histological diagnosis using frozen section examination with imprint cytology for Brenner tumor, which has diverse histopathological features, is a useful option to determine the appropriate surgical procedures.

Background : Solitary fibrous tumors (SFTs)/hemangiopericytomas (HPC) are mesenchymal neoplasms that rarely arise from the central nervous system. In this article, we report a case of SFT arising from the frontal region.

Case : A 45-year-old Japanese woman was transferred to our hospital with progressively worsening depression that was refractory to therapy. Imaging analysis revealed an irregularly-shaped tumor measuring 75mm in diameter on the frontal region. Meningioma was suspected and tumorectomy was performed. Frozen-section examination revealed patternless growth of short spindle-shaped cells with a high nuclear/cytoplasmic ratio with a large amount of collagen fibers in the storoma. Imprint cytology showed proliferation of short spindle-shaped cells and naked nuclei with collagen fibers. Whorl formation was absent and the findings were not typical of a meningioma. Immunohistochemical examination of the histological specimens showed positive staining of the tumor cells for CD34 and STAT6, and a final diagnosis of SFT/HPC was made.

Conclusion : Cytologists should consider the diagnosis of SFT/HPC when the no findings suggestive of a meningioma show short spindle-shaped neoplastic cells with naked nuclei.

Background : Langerhans cell sarcoma (LCS) is an extremely rare high-grade sarcoma composed of cells resembling Langerhans cells. Herein, we report a case of LCS with a splenic metastasis.

Case : A Japanese male patient in his 70s presented with a mass in his right shoulder. The tumor was resected and diagnosed by histopathology as a LCS. About 1.5 years later, enhanced CT revealed a mass in the spleen, which was diagnosed by ultrasound-guided fine needle aspiration cytology and biopsy as a metastasis from the LCS. Cytology showed a large number of isolated atypical cells of heterogeneous shapes, from round to polygonal, with abundant cytoplasm which showed faint light green staining. Multinucleated cells were also evident. The tumor cells showed a high N/C ratio ; the nuclei varied in size and shape, with increase in fine granular chromatin and contained atypical mitoses. Histopathological examination revealed relatively uniform atypical cells with nuclei containing convolutions and grooves and numerous atypical mitoses. Immunohistochemistry revealed positive staining for CD1a and S100P, partially positive staining for Langerin, and a ki-67 labeling index of c.a. 60%.

Conclusion : Diagnosis of Langerhans cell sarcoma may be very difficult. Detailed morphologic observations and immunohistochemistry and/or immunocytochemistry for specific markers such as Langerin would be helpful for an accurate diagnosis.

We report a case of a 60-year-old woman who was admitted to our hospital with the chief complaint of abdominal pain. Both urothelial carcinoma and adenocarcinoma cells were identified in a cytological smear of a voided urine sample. The urothelial carcinoma cells showed an irregular nuclear margin and opaque cytoplasm. The urothelial carcinoma was eventually diagnosed as a non-invasive papillary urothelial carcinoma, low grade. The adenocarcinoma cells showed peripherally located nuclei and mucinous-like pinkish cytoplasm. The patient was diagnosed as having uterine cervical adenocarcinoma, which was resected, with no evidence of metastasis to the urinary bladder. Accordingly, the finding of adenocarcinoma cells in the voided urine was concluded as being a result of urinary contamination by vaginal secretions containing the cervical adenocarcinoma cells.

We report a rare case of primary synovial sarcoma of the kidney. A woman in her 70s, who presented with a history of right abdominal pain, was found, by abdominal CT, to have a tumor arising from the right kidney. Nephrectomy was performed. The histopathological diagnosis was synovial sarcoma. Imprint cytology of the tumor showed numerous small isolated atypical cells. The cells were monotonous and spindle-shaped, with indistinct cell borders. They had round- to oval-shaped nuclei, thin nuclear membranes, extremely fine granular nuclear chromatin, with the nuclei containing one or two small conspicuous nucleoli. The results of immunohistochemical analysis and DNA analysis of the tumor cells were consistent with the diagnosis of synovial sarcoma. Synovial sarcoma of the kidney is extremely rarely diagnosed by cytology.