Objective : The use of liquid-based cytology for standardization of preparation and high cell recovery rates has attracted attention. Although SurePath^TM has been demonstrated as being an efficient method to collect cells, it is unclear how many malignant cells might be needed for detection of the cells in a slide. Therefore, in this study, the smallest number of malignant cells necessary for detection in a prepared slide was examined using simulated specimens, which contained an admixture of malignant and normal cells.

Study Design : Squamous and HeLa cells were used as normal and malignant cells, respectively. Slides were prepared using SurePath^TM specimens containing 5000, 500, 50, and 5 HeLa cells per 500000 squamous cells. The number of HeLa cells detected in the slides was counted under a microscope.

Results : An average of 57.3 HeLa cells was detected in the slides prepared from specimens containing 5000 HeLa cells and 4.7 HeLa cells was detected in slides prepared from specimens containing 500 HeLa cells. Any HeLa cells were detected at all in only one of the three slides prepared from specimens containing 50 HeLa cells. No HeLa cell was detected in the slides prepared from the specimens containing 5 HeLa cells.

Conclusion : The results suggest that for HeLa cells to be detected in a slide, the specimen must contain a minimum of 500 HeLa cells.

Background : Few studies have investigated the usefulness of liquid-based cytology (LBC) specimens in patients with primary clear cell carcinoma of the cervix, a rare neoplasm. Herein, we report the case of a patient who was diagnosed as having primary clear cell carcinoma of the cervix based on LBC, and discuss the differences between LBC and smear cytology, and useful findings for differentiation from other adenocarcinomas.

Case : The patient was a 70-year-old woman. LBC examination revealed both isolated tumor cells and tumor cells in clusters ; glandular, papillary, and hobnail-like formations were also observed. On LBC, tumor cells with abundant and fine granular cytoplasm, enlarged round nuclei, and large and prominent nucleoli were observed.

Conclusion : These findings could be helpful in the diagnosis of cervical cell carcinoma using LBC.

Background : Invasive urothelial carcinoma of the bladder with trophoblastic differentiation is usually diagnosed at an advanced stage and carries a poor prognosis. Herein, we report a case of invasive urothelial carcinoma with trophoblastic differentiation that was detected on a repeat cytopathologic review of 54 archived cases of surgically resected invasive bladder cancer.

Case : An 82-year-old woman with symptoms of cystitis was detected by ultrasonographic examination as having a tumor in the anterior wall of the urinary bladder. Urinary cytology showed papillary clusters identical to those in urothelial carcinoma, scattered giant mononuclear cells with lacy abundant cytoplasm and large nuclei containing coarse chromatin, and pleomorphic cells with multiple or hypersegmented nuclei. Histological examination of the tumor showed the features of papillary urothelial carcinoma with syncytiotrophoblast-like giant cells, muscle invasion, and lymphovascular involvement. Immunohistochemistry showed positive staining of the giant cells for HSD3B1, a specific marker of trophoblastic differentiation. The patient developed multiple distant metastases and died 3 years after surgery.

Conclusion : Urinary cytology can contribute to early diagnosis of invasive urothelial carcinoma with trophoblastic differentiation. Immunostaining using specific markers can be useful for reliable cytologic diagnosis.

Background : Ovarian metastasis from hepatocellular carcinoma is extremely rare. Herein, we report a case of a metastatic ovarian tumor in a patient with hepatocellular carcinoma with characteristic findings of tumor imprint cytology, along with a review of the literature.

Case : A woman in her 60 s was admitted to the hospital for treatment of a pelvic tumor. She begun to receive treatment for hepatic cirrhosis 9 years previously and also undergone surgical treatment for hepatocellular carcinoma 3 years previously. She was being followed up by her previous doctor, but computed tomography of the chest and abdomen revealed a nodule in the right lung measuring 10 mm in diameter and a tumor in the left pelvis measuring 63×56 mm in size. A primary ovarian tumor was suspected, and laparoscopic bilateral adnexectomy was performed. Intra-abdominal examination revealed no disseminated lesions, and ascitic fluid cytology was negative. The left ovarian tumor was yellowish brown in color, very fragile, and highly angiogenic. The tumor cells were solitary or arranged in cords, against a relatively clean background. Tumor touch imprint cytology showed tumor cells with abundant eosinophilic cytoplasm, hyperchromatic nuclei with mild variability in size, increased chromatin, and prominent nucleoli. Bile was observed within the cytoplasm, which is a characteristic, but extremely rare finding. Histological examination revealed cord-like proliferation of tumor cells with atypia and abundant acidophilic cytoplasm and bile, resembling the features of hepatocellular carcinoma. Immunohistochemistry showed sporadically positive staining of the tumor cells for hepatocyte paraffin 1.

Conclusion : The findings of tumor imprint cytology were suggestive of ovarian metastasis from hepatocellular carcinoma.

Background : We report a case of double ductal adenocarcinoma and neuroendocrine tumor of the pancreas, which was diagnosed preoperatively by endoscopic ultrasound-fine needle aspiration cytology (EUS-FNAC).

Case : A man in his 70 s presented to us with a history of abdominal pain. EUS revealed a hypoechoic mass measuring 18 mm in diameter in the head of the pancreas and another hypoechoic mass measuring 7 mm in diameter in the tail of the pancreas. EUS-FNAC was performed, which led to a histopathological diagnosis of double ductal adenocarcinoma and suspected neuroendocrine tumor or acinar cell carcinoma.

Conclusion : It is important to make a careful diagnosis, keeping in mind that multiple tumors could be present, rather than just a single type of lesion.