Objective : To examine individual histological results and their changes over time in cases with cervical cytology results of “atypical squamous cells, cannot exclude HSIL (ASC-H)” at our facility.

Study Design : The subjects were 47 patients from our facility who underwent cervical cytology and cervical biopsy on the same day (same-day biopsy) with the cytological results categorized as ASC-H ; we investigated the histological results in all of these patients ; histological results of the same-day biopsy → highest diagnosis during the course (highest diagnosis) → final diagnosis. We also examined the histological results with reference to the three types of atypical cells used to diagnose ASC-H : immature metaplastic cell atypia (IM-atypia), intermediate-to-parabasal squamous cell atypia (IPS-atypia), and atrophic squamous cell atypia (AS-atypia).

Results : Of the 47 cases, histology revealed CIN2 or higher (CIN2＋) on the same-day biopsy in 25 (53.2％) cases → as the highest diagnosis in 40 (85.1％) cases → as the final diagnosis in 32 (68.1％) cases. The corresponding percentages of CIN2＋ were 14.3％ → 71.4％ → 42.9％ in the group with IM-atypia, 65.4％ → 92.3％ → 76.9％ in the group with IPS-atypia, and 85.7％ → 85.7％ → 85.7％ in the group with AS-atypia.

Conclusion : These results suggest that in the ASC-H cases examined in this study, the subsequent course and prognosis varied depending on the type of atypical cells on which the diagnosis of ASC-H was based on.

Background : We report a case of sarcomatoid urothelial carcinoma (SUC) of the renal pelvis as which needed to be differentiated from renal cell carcinoma (RCC).

Case : A 70-year-old man visited us with the complaints of low back pain and body CT examination revealed a 61-mm mass in the upper pole of the left kidney, lymph node metastases, multiple bone metastases, and multiple lung metastases. Sputum cytology suggested the diagnosis of lung metastasis from a primary renal cell carcinoma. Cytological examination of voided urine revealed large tumor cells with round nuclei and clear nucleoli. Some tumor cells were sarcomatoid cells with spindle-shaped nuclei, while others plasmacytoid cells with eosinophilic cytoplasm. Histological examination showed proliferation of urothelial carcinoma cells having focal sarcomatoid and plasmacytoid features. Immunohistochemically, these cells showed positive staining for p63, CK 7, CD10, and vimentin, and negative staining for PAX-8. Based on the findings, we made the final diagnosis of urothelial carcinoma of the sarcomatoid subtype.

Conclusion : In this case, exclusion of RCC was required on account of the findings of sputum cytology, but the histological features and positive immunohistostaining for p63 and PAX-8 confirmed the diagnosis of SUC of the renal pelvis.

Background : Lymphangioleiomyomatosis (LAM) is a rare disease characterized by the proliferation of smooth muscle-like cells (LAM cells) in the lungs and somatic lymph nodes, leading to the formation of multiple cysts in the lungs. Its estimated prevalence is 1.9 to 4.5 per million population in Japan. In this report, we describe a case of lymphangioleiomyomatosis.

Case : The patient was a woman in her 20s who presented with abdominal distention and morning-only chest pain. Her serum CA125 level was 858 U/ml and the serum D-dimer level was 13.8 μg/ml. CT and MRI of the thorax and abdomen revealed bilateral pleural effusions and ascites, as well as cyst formation in the retroperitoneum. Numerous small cysts, each measuring a few millimeters in diameter, were also observed in the lungs. Cytological examination and immunohistochemical analysis of prepared cell blocks of the ascitic and pleural fluid as also that of the contents of the cystic lesions in the retroperitoneum, revealed LAM cells. A needle biopsy of the retroperitoneal lymph nodes confirmed the presence of LAM cells. Based on these findings, along with the clinical presentation, we made the final diagnosis of LAM.

Conclusion : In patients with characteristic imaging findings, the diagnosis of LAM can be confirmed by identifying LAM cell clusters in pleural and ascitic fluid specimens. Familiarity with the cellular/immunohistochemical characteristics of LAM cells and the necessary immunohistochemical techniques is crucial, as it allows for the diagnosis to be obtained without invasive histopathology.

Background : Ovarian yolk sac tumors (YST) are rarely found diagnosed by ascitic fluid cytology. Herein, we report the findings of lipid-like vacuoles on May-Giemsa (MG) staining of cytology specimens of ascitic fluid.

Case : A woman in her 40s was diagnosed as having stage ⅢC ovarian cancer. Partial omentectomy and intraoperative cytology of the ascitic fluid were performed. Papanicolaou staining revealed balloon animal-like cell clusters. MG staining revealed distinct small, bumpy vacuoles resembling fat granules in the cytoplasm and nuclei of the cells.

Conclusion : When lipid-like vacuoles are observed in MG staining of ascites, ovarian YST should be suspected.

A man in his 60 s presented with a slow-growing cystic mass in the right submandibular gland. Cytological examination of the fluid aspirated from the cyst revealed scattered papillary cell clusters. The cytoplasm was lacy and partially vacuolated, and contained irregularly shaped, unevenly distributed nuclei with prominent nucleoli. A possible diagnosis of adenocarcinoma was made and the tumor was resected. Histological analysis confirmed the diagnosis of submandibular gland cystadenocarcinoma, which can be cytologically differentiated from lateral cervical cyst, Warthin’s tumor, mucoepidermoid carcinoma, and cystadenoma of the salivary gland, but is difficult to differentiate from secretory carcinoma and intraductal carcinoma.