Since cervical cancer is predominant in Asia and Africa, the promotion of human papillomavirus (HPV) vaccine is a first priority in these regions. Implementation of the HPV vaccine has been reported to reduce HPV infection and decrease the incidence of condyloma, CIN2, and invasive cancer. There have been reports of herd immunity effects as the immunization coverage has increased. Worldwide, there has been a shift from a 3-dose vaccination to a 2-dose vaccination, and verification of a 1-dose vaccination has begun. Although regularly offered vaccination in Japan had begun, a suspension of the recommendation for HPV vaccination has been implemented. Low awareness of the HPV vaccine among the target population is also a problem, and further enlightenment activities are required.

Objective : Mucoepidermoid carcinoma is the most common type of malignant salivary gland tumor, and its cell morphology differs depending on the histopathological grade, making cytodiagnosis difficult. We analyzed the cell morphologies in the cytological specimens reported according to the Milan system in relation to the malignant grade, and examined its usefulness.

Study Design : From 1983 to 2019, there were 18 patients who had been histopathologically diagnosed as having mucoepidermoid carcinoma by FNA cytology or intraoperative imprint cytology.

Results : The average age of the patients was 43.4 years, but it increased as the malignancy grade of the tumor increased from low to intermediate to high (39.2, 46.3, and 63.5 years, respectively). Of the 18 patients, 11 cases were diagnosed as having mucoepidermoid carcinoma, and 3 cases as suspicious, and in all the cases, the characteristic findings of mucous-producing cells scattered in intermediate cell clusters were observed. In regard to the Milan system classification in relation to the histopathological grades, high-grade cases were classified as “high-malignancy”, intermediate-grade cases as “malignant” or “SUMP”, and low-grade cases as “low-malignancy”, “malignant”, “suspicious for malignancy” or “AUS”.

Conclusion : Cytological findings of mucoepidermoid carcinoma were reported according to the Milan system, which helped to determine the histopathological grade.

Objective : To objectively evaluate the diagnostic accuracy by standardizing the method of preparation of urinary cytology specimens, we compared the diagnostic accuracies of urinary cytology at our hospital obtained using various methods of preparation of the urinary cytology specimens.

Study Design : Samples from the past two years were compared and the diagnostic accuracies obtained using the wedge method (W method), cytospin method (CS method), the BD CytoRich method (CR method) for preparation of the specimens were compared. Specimens confirmed to be malignant by histological diagnosis were used to determine the sensitivity, while specimens confirmed to be benign by histological diagnosis and clinically negative specimens were used to determine the specificity ; based on “The 2015 Japan Reporting System for Urinary Cytology,” all urine samples were examined to analyze the risk of malignancy.

Results : The sensitivities obtained for the CS and CR methods were greater than 90%, higher than the sensitivity obtained for the W method (65%). The specificity for the CR method was lower than that for the CS method. When clinically negative specimens were included, a specificity of greater than 95% was obtained for all three methods of specimen preparation, with no significant differences. The risk of malignancy was less than 5% in the urine samples with negative cytology and greater than 80% in the urine samples showing malignant cytology.

Conclusion : The diagnostic accuracies of urine cytology obtained using the CS and CR methods for specimen preparation were higher than the diagnostic accuracy obtained for the W method. It is believed that objective evaluation of the diagnostic accuracy by standardizing the method of preparation of urinary cytology specimens, with strict operating procedures, will improve urinary cytology investigations.

Objective : We investigated different methods of preparation of urinary cytology specimens at facilities in Chiba prefecture. In addition, we also examined the advantages and disadvantages of liquid-based cytology (LBC).
Study Design : A total of 20 facilities in Chiba prefecture participated in the study. The cooperating facilities included eight general hospitals, six university hospitals, four public hospitals, one cancer hospital, and one inspection center. The current status of urinary cytology specimen preparation was surveyed and opinions on the LBC method were compiled in an MS-Word. The respondents were requested to provide descriptive responses and return the questionnaire by e-mail. Answers were then divided into set items and investigated.
Results : All facilities emphasized the importance of “a method of collecting and smearing cells that can be judged with little exfoliation.” The major advantage of LBC reported by each facility was “uniform and abundant specimen preparation,” and the major reported disadvantage was “costly.”
Conclusion : The LBC urine cytopathology method has a high cell collection rate, is not dependent on the skill of the examiner, and has high reproducibility. Although it has the disadvantage of being “costly,” we believe that the LBC method should become established as the recommended method in the future in order to establish standardization of sample processing/preparation and cell determination.

Background : Cervical smear cytology is not a reliable diagnostic tool for primary fallopian tube carcinoma (PFTC). However, in some cases, cervical cytology is positive for PFTCs. Herein, we report a case of atypical glandular cells (AGC) on cytology, which was eventually diagnosed, by closer examination, as a case of asymptomatic primary fallopian tube carcinoma.

Case : 66-year-old woman with a cervical cytology report of AGC for the first time in her annual uterine cancer checkup was examined further : colposcopy revealed Unsatisfactory Colposcopic Findings (UCF), re-examination of a cervical cytology smear showed NILM, endometrial cytology was reported as suspicious, and the test for HPV was negative. Ultrasonography revealed mild thickening of the uterine endometrium ; there was no adnexal mass or ascites. No evidence of malignancy was detected on endometrial curettage. However, repeat cytological studies after 3 months showed persistent abnormalities. Measurement of tumor markers for adenocarcinoma and MRI also showed no evidence of malignancy. Finally, laparoscopic surgery was performed for diagnosis, and papillary masses were detected on the surface of the fallopian tube and peritoneum, which led to the diagnosis of PFTC.

Conclusion : Although the introduction of HPV-only testing in medical examinations has been considered, our case once again underscores the usefulness of cervical cytology.

Background : Myoepithelial carcinoma is a rare malignant tumor of the salivary gland. We analyzed oral exfoliative cytology preparations sampled from biopsy-diagnosed myoepithelial carcinoma of the oral cavity, clear-cell type.

Case : A Japanese man in his 70’s was referred to the department of oral surgery of our hospital, because of a rapidly growing swelling in his left upper gingiva. Magnetic resonance imaging revealed a mass measuring 53×44×30 mm in size, and incisional biopsy and oral exfoliative cytology were performed. Cytologically, cell clumps consisting of elliptical to short spindle-shaped cells were observed. Histologically, the diagnosis was consistent with myoepithelial carcinoma of the clear cell type, and the Ki-67 labeling index was 12%. The tumor cells were diffusely immunoreactive for myoepithelial markers. Heavy ion radiotherapy was transiently effective, but the tumor recurred two years later.

Conclusions : The cytological features of oral scrapings in a case of myoepithelial carcinoma are described. When squamous cell carcinoma is excluded and myoepithelial features are observed in a tumor, it is necessary for cytologists and pathologists to keep in mind the possibility of tumors of salivary gland origin.

Background : In women with a pelvic mass and massive ascites, gynecologic cancer, such as ovarian cancer, is often suspected. When ascitic fluid cytology reveals adenocarcinoma cells, it is sometimes difficult on the basis of cytology alone to diagnose the primary cancer site. Two patients with massive ascites were referred to the gynecology department by physician. Colorectal cancer was suspected from the results of ascitic fluid examination by the cell block technique, and lower gastrointestinal endoscopy led to the diagnosis of advanced colorectal cancer.

Cases : Case 1 : A 71-year-old woman was admitted to our hospital because of abdominal distention. She had ascites and other evidence of peritoneal dissemination, and was suspected as having ovarian cancer. Ascitic fluid cytology revealed evidence of adenocarcinoma. Immunohistochemical examination of cell blocks prepared from the cytology specimens revealed positive staining of the tumor cells for CDX2 and CK20. Lower gastrointestinal endoscopy led to the diagnosis of appendiceal cancer. Case 2 : A 72-year-old woman was presented with abdominal distension was suspected as having ovarian cancer with peritoneal dissemination. Ascitic fluid cytology revealed adenocarcinoma cells. Immunohistochemical examination of cell block specimens prepared from the cytology specimens revealed positive staining for CDX2 and CK20. Lower gastrointestinal endoscopy led to the diagnosis of cecal cancer.

Conclusion : In patients with peritonitis carcinomatosa, it is very useful to use the cell block technique in combination with ascitic fluid cytology to diagnose the primary cancer site.

Background : Microcystic stromal tumor (MCST) of the ovary was first reported in 2009 as a new subtype of benign ovarian sex cord-stromal tumors. MCST is thought to arise as a result of a dysregulated Wnt/β-catenin pathway, and is histologically characterized by the presence of 3 components : microcysts, solid cellular zones, and collagenous stroma. Because MCST is a relatively new and rare subtype of sex cord-stromal tumors, its cytological features are not yet well-known.

Case : We report the case of a 62-year-old patient with MCST of the ovary. The tumor was a reddish brown solid-cystic mass, measuring approximately 30 mm in diameter. Histologically, the tumor consisted of macro- and microcysts, solid cellular zones, and collagenous stroma. On immunohistochemistry, the tumor cell nuclei showed positive staining for β-catenin and WT-1, and the tumor cell cytoplasm showed positive staining for CD10. Touch smear cytology showed cell clusters admixed with numerous microcysts. The cells contained small, round-to-oval central nuclei with finely granular and evenly distributed chromatin and abundant cytoplasm. These aforementioned features are useful to differentiate MCSTs of the ovary from other sex cord-stromal tumors, such as adult granulosa cell tumor, Sertoli-Leydig cell tumor, and sclerosing stromal tumor.

Conclusion : The presence of microcysts is a characteristic feature of MCSTs, and cytological analysis is useful for the diagnosis.

Background : Cervical squamous cell carcinoma (SCC) spreading to the upper genital tract is very rare. We report the case of a patient with cervical SCC extending to the endometrium and fallopian tubes who was treated by radical hysterectomy based on intraoperative cytologic diagnosis.

Case : A gravida 1, para 1, postmenopausal woman in her 50 s, 2 years post-conization for cervical intraepithelial neoplasia (CIN), presented with an abdominal mass and pain. Although magnetic resonance imaging (MRI) revealed a cervical mass that was suspected as being malignant and pyometra, preoperative pathological diagnosis by cervical biopsy failed because of cervical stenosis. Intraoperative exploration revealed bilateral pyosalpinx and pyometra, and cervical SCC was diagnosed by positive intraoperative fallopian tube fluid cytology. Radical hysterectomy was performed based on the positive cytology, followed by pelvic lymphadenectomy based on frozen section diagnosis of the cervix. Histologically, the SCC was found to invade almost the entire cervix, and extended to the endometrium of the uterine body and epithelium of the fallopian tubes of both sides.

Conclusion : A radical hysterectomy with pelvic lymphadenectomy was performed successfully, based on diagnosis by intraoperative cytology, in a rare case of cervical SCC spreading to the endometrium and fallopian tubes.