Objective : To improve the quality of vaginal stump cytology, we examined the suitability of samples obtained using the Orcellex Brush^RT oral cell collection device and processed by the BD SurePath^TM (SP) method.

Study Design : We conducted vaginal stump cytology in 6260 cases during the 5-year 7-month period between March 2014 and September 2019. Samples were collected using the Orcellex Brush^RT, and the tip of the brush was placed into an SP collection vial. The specimens were then prepared using the SP method and evaluated using the Bethesda system. This study was conducted with the approval of the Ethics Committee of Jikei Medical University [31-346 (9925)].

Results : The following results of cytology were obtained using the SP method : NILM (5909 cases : 94.4%), ASC-US (101 cases : 1.6%), ASC-H (16 cases : 0.3%), AGC (14 cases : 0.2%), LSIL (140 cases : 2.2%), HSIL (43 cases : 0.7%), malignant (31 cases : 0.5%), and unsatisfactory (6 cases : 0.1%). In all the unsatisfactory specimens, the cell count was found to be too low. Biopsy was performed in 23 cases (0.4%), and the rate of agreement between the SP method and histological examination was 60.9%.

Conclusion : The Orcellex Brush^RT and SP method contribute to improvement of the specimen collection and sample volume, with a minimal number of unsatisfactory specimens. They can, therefore, be used as tools to achieve consistent quality in vaginal stump cytology.

Background : HHV8-negative common effusion lymphoma (HENCEL) is a type of malignant lymphoma arising in body cavities that differs both clinically and histopathologically from primary effusion lymphoma (PEL) ; their differential diagnosis is crucial in cytology specimens.

Case : A man in his 80s who was undergoing treatment for pulmonary adenocarcinoma presented with left pleural effusion. HENCEL was diagnosed by systemic examination and cytology. The tumor cells were smaller in size in the liquid-based cytology (LBC) specimen than in the conventional smear cytology, however, three-dimensional observation revealed irregularity of the nuclear membrane, which led to the diagnosis. The diagnosis of HENCEL combined with lung adenocarcinoma was confirmed at autopsy.

Conclusion : If cells suspected as belonging to malignant lymphoma are found in the pleural effusion, it is important to rule out secondary involvement of systemic lymphoma as well as PEL, when considering the possibility of HENCEL. Combined use of LBC with smear cytology can provide useful information for the diagnosis and contribute to improvement of the diagnostic accuracy of HENCEL.

Background : Primary effusion lymphoma (PEL) is a rare human herpesvirus (HHV)-8-positive large B-cell lymphoma that arises in body cavities, without any detectable tumor masses. Many effusion-based lymphoma cases reported in Japan are HHV-8-negative, so that they are called PEL-like lymphomas (PEL-LLs). Herein, we report a case of PEL-LL, in which the pleural fluid showed cytologically atypical cells with multilobulated nuclei.

Case : A man in his 70 s, who had undergone surgery for lung cancer, colon cancer, prostatic leiomyosarcoma, and renal cell carcinoma, presented to us with dyspnea that developed during treatment for heart failure. Chest computed tomography (CT) revealed massive left pleural effusion. Cytological examination of the pleural fluid revealed many solitary atypical cells with a high nuclear-cytoplasmic (N/C) ratio. The atypical cells showed conspicuous multilobulated nuclei, increased fine chromatin, and distinct nucleoli, and based on the findings, we diagnosed malignant lymphoma. The results of immunohistochemical analysis of a cell block led to the diagnosis of diffuse large B-cell lymphoma (DLBCL), non-germinal center B-cell (GCB) type ; however, the patient was finally diagnosed as having PEL-LL, because no detectable tumor masses were found on imaging studies and blood examination showed negative results for HHV-8.

Conclusion : Since multilobulated nuclei are not usually observed in cases of DLBCL, a possibility of PEL or PEL-LL should be considered when atypical lymphoid cells with conspicuous multilobulated nuclei are found in body cavity fluids.

Background : Breast carcinoma with osteoclast-like giant cells (OGC) are rare, which account for 0.5-1.2% of breast carcinoma cases. Here, we report a case of invasive ductal carcinoma with multiple OGC identified in the cytology specimen.

Case : A woman in her 30 s noted a 3 cm mass in the BD portion of the right mammary gland. A fine needle aspiration cytology specimen smear showed a combined population of tumor cells and multinucleated giant cells. Epithelial clusters and scattered single glandular cells had hyperchromatic, irregular-shaped, and relatively small nuclei, which are considered as ductal carcinoma cells. The multinucleated giant cells were observed between the epithelial clusters and had 10-40 vesicular nuclei and variable-sized and-shaped ample cytoplasm, suggestive of OGC. Histologic examination revealed atypical epithelial cells proliferate in the solid nests or show a cribriform growth pattern, combined with CD68-immunoreactive OGC. The histological diagnosis was invasive ductal carcinoma, solid type, with OGC. Immunohistochemically, the carcinoma cells were estrogen receptor-positive and progesterone receptor-positive, whereas HER2 was negative.

Conclusion : OGCs are rarely determined in the breast cytology specimens of mesenchymal tumors and various-histological types of breast carcinoma and most of them are luminal type invasive ductal carcinoma. In such cases, the cytologic diagnosis should be made based on cells other than OGCs.

Background : Atypical lipomatous tumor/well-differentiated liposarcoma is a tumor of intermediate malignant grade that shows differentiation into adipose cells. Herein, we report a case of an atypical lipomatous tumor arising in the subcutaneous tissue of the left upper neck, focusing on the findings of fine-needle aspiration cytology of the tumor.

Case : A man in his late 40 s. He was referred to our Department of Otolaryngology for detailed investigation of a swelling in the left upper cervical region. Fine-needle aspiration cytology revealed clusters of cells composed of adipose cells containing enlarged nuclei and atypical pleomorphic stromal cells. These cells included atypical lipoblasts and binucleated cells. In addition, mast cells were found to be in contact with the atypical stromal cells. The cell types atypical lipoblasts could be identified more easily in Giemsa-stained specimens than in Papanicolaou-stained specimens. Immunocytochemistry showed partially positive staining of the nuclei of the atypical cells for murine double minute 2 (MDM2). The histopathological diagnosis of the tumor was also atypical lipomatous tumor.

Conclusion : These findings suggest the usefulness of Giemsa staining for the diagnosis in fine-needle aspiration cytology of lipomatous tumors.

Anaplastic thyroid carcinoma usually progresses from well-differentiated thyroid carcinoma, namely papillary carcinoma and follicular carcinoma. Abrupt transition of these 2 different histological components can be seen on histological examination. We can sometimes observe anaplastic transformation of well-differentiated thyroid carcinoma on histology slides. However, it is quite rare for these different components to appear on the same cytology slide. In this case reported herein, the papillary carcinoma and anaplastic carcinoma components appeared on the same cytology slide. Then, we estimated that the cytology findings suggested papillary thyroid carcinoma with anaplastic transformation.