Hitoshi Hara

Fine needle aspiration cytology of basal cell adenoma of the salivary gland

OBJECTIVE To formulate cytologic features for differential diagnosis of basal cell adenoma (BCA). STUDY DESIGN The usefulness of 5 items for a cytologically definitive diagnosis of BCA was examined. The 5 items in 8 BCA and 22 non-BCA cases (adenoid cystic carcinoma [ADCC], basal cell adenocarcinoma, myoepithelioma, pleomorphic adenoma and polymorphous low-grade adenocarcinoma) that displayed mimicking cytology were examined cytologically. RESULTS The useful items were < 5.1 microm in mean of epithelial nuclear short diameter; mild atypia on definitive diagnosis; stromal cell cluster combining smooth margin surrounding the epithelial cell cluster or containing the epithelial cell cluster; epithelial clusters surrounded by or adhered to a thick, hyalinized smooth margin without stromal cluster; and closely fastened, tight clusters with denser cytoplasm than ADCC, but an indistinct border, with oval nuclei and no hyaline cells. CONCLUSION Five items are useful criteria for BCA.

Review of the Cytologic Features of Noninvasive Ductal Carcinomas of the Pancreas : Differences From Invasive Ductal Carcinoma

Invasive ductal adenocarcinoma (IDA) of the pancreas (IDAP) originating from the ductal gland has a poor prognosis. Noninvasive carcinomas are principally intraductal papillary mucinous carcinomas (IPMCs) and pancreatic intraepithelial neoplasms 3 (PanIN-3). Small papillary-cohesive clusters, individually well-enveloped nuclei in well-preserved cytoplasm, centrally located nuclei, small nuclei (about 10 mum), euchromatin, clearly defined cell borders, small cytoplasm without prominent anisocytosis and no cytoplasm more than 21 mum in shortest diameter, a mixture of goblet cells, and a pleomorphic aspect are common in IPMC and intraductal papillary mucinous neoplasm (IPMN), whereas malignancy in nuclei are observed only in IPMC. PanIN-3 cells have small papillary-cohesive and compact clusters, a monomorphic aspect, and small dense cytoplasm and are highly suggestive of malignancy. IDA cells have loose sheet and solid clusters, poorly preserved cytoplasm, nuclei that tend to adhere to each other, large nuclei, a combination of large nuclei (short diameter <15 mum) with hyperchromatin, a monomorphic aspect, and abundant cytoplasm more than 21 mum in the shortest diameter. To preoperatively differentiate noninvasive IPMC and PanIN-3 from IDAP, these features would be clinically very useful.

Two Cytologic Patterns in Invasive Ductal Adenocarcinoma of the Pancreas

OBJECTIVE To clarify 2 cytologic patterns: severe ductal dysplasia (SD)/carcinoma in situ (CIS) and invasive components of invasive ductal adenocarcinoma of the pancreas (IDAP). STUDY DESIGN Tumor samples from 12 patients with IDAP were examined cytologically and histologically. Cytologic specimens were obtained by fine needle aspiration (ENA) and imprint smears from resected pancreases. RESULTS In the 12 IDAP cases, roughly 2 cell populations, SD/CIS-type cells and invasive component-type cells, were detected cytologically. The former composed a small portion of the tumor cells, exhibited a small nuclei without anisonucleosis and had a decreased total quantity of chromatin as compared with invasive component-type cells. SD/CIS-type cells were found in small papillary-cohesive and compactly packed clusters and had clearly defined cytoplasmic borders, a nucleus individually enveloped in well-preserved cytoplasm and small amount of cytoplasm (< 15 microm in short diameter) without prominent anisocytosis. The latter comprised mostly of the tumor cells, were present characteristically as a loose and discohesive population and contained a combination of hyperchromatin, large nuclei (> 15 microm) and abundant cytoplasm (>21 microm). Histologically, these 12 cases exhibited IDAP with SD/CIS. Hence, the invasive component-type cells appeared to originate with ordinary invasive spread of IDAP, and the SD/CIS type cells appeared to originate with noninvasive intraductal spread. CONCLUSION Two cytologic patterns originating with SD/CIS and invasive components of IDAP could be differentiated.

Cytological features of atypical carcinoid combined with adenocarcinoma of the uterine cervix

Neuroendocrine tumors of the uterine cervix (UC) are rare, and atypical carcinoid (AC) combined with adenocarcinoma of the uterine cervix (ACAUC) is particularly rare. Only the histopathology has been investigated in the English literature. A 49‐year‐old female with a polypoid lesion of the UC visited Yamanashi Prefectural Central Hospital. Scraping cytology, biopsy, and hysterectomy was performed. EC smears showed solid, rosette, honeycomb, true tubular, and trabecular clusters. Solid clusters were oval, thin edge, delicate, small‐large nuclei, pale, granular, scant, nothing, and well‐preserved (though ill‐defined border) cytoplasm. Rosette clusters were eccentric, oval nuclei, mixture of coarsely granular chromatin and euchromatin, and cyanophilic luminal content. Solid and rosette clusters impress AC. Honeycomb clusters involved a clearly defined border and translucent mucin. True tubular clusters were oval nuclei of fine chromatin or euchromatin, thick cytoplasm, and orange luminal content. Honeycomb and true tubular clusters suspected adenocarcinoma. Trabecular clusters were fusiform, columnar, cuboidal, and polygonal cell shapes of small, monotonous nuclei, and contained coarsely granular chromatin with occasionally intracytoplasmic translucent mucin and were difficult to differentiate typical carcinoid and adenocarcinoma. Histology was AC combined with adenocarcinoma. The aim of this study was to investigate the cytological characteristics of ACAUC. Diagn. Cytopathol. 2012.

Case of myoepithelioma originating from the palate: Collagenogenesis in myoepithelial tumor cells

We report a case of myoepithelioma of the palate in a 53‐yr‐old man. Myoepithelioma cells consisting of both plasmacytoid type and spindle type were obtained. A reticular pattern composed of a mosaic arrangement of hyaline‐like abundant cytoplasm, and scant matrix and considerable fiber formation were characteristic features of the plasmacytoid type; granular cytoplasm and a snake‐like shape were characteristic features of the spindle type. These are important points in differentiating this tumor from cellular type pleomorphic adenoma. The present study shows that tumorous myoepithelial cells can synthesize and secrete extracellular components such as proteoglycans, basal lamina, collagen fibers, and elastic fibers. Diagn Cytopathol 1996;15:415–420.

Differential diagnosis of well-differentiated squamous cell carcinoma from non-neoplastic oral mucosal lesions: New cytopathologic evaluation method dependent on keratinization-related parameters but not nuclear atypism: KERATINIZATION IN ORAL CANCER CYTOLOGY

The cytology of oral squamous cell carcinoma (SCC) is challenging because oral SCC cells tend to be well differentiated and lack nuclear atypia, often resulting in a false negative diagnosis. The purpose of this study was to establish practical cytological parameters specific to oral SCCs.

Fine Needle Aspiration Cytology of Noninvasive Ductal Carcinomas of the Pancreas

Invasive ductal adenocarcinoma (IDA) of the pancreas (IDAP) originating from the ductal gland has a poor prognosis worldwide. To improve the prognosis, treatment for noninvasive carcinoma stages is

Cytologic study of pancreatic mucinous cystadenocarcinoma.

膵の粘液性嚢胞腺癌を1例経験し, その細胞像を検討した. 症例は35歳女性, 主婦. 左季肋部痛, 左背部痛出現. 超音波検査にて膵尾部に中心低エコー領域を示す大きな腫瘤があった. エコー下吸引細胞診では出現パターンが多彩で, シート状, 柵状, 乳頭状配列があり, これらは相互に移行していた. すなわち, シート状配列は密で1～6層の円柱状細胞からなり, 表面に細網状の赤色物質がみられた. また小型で良性にみえる細胞からなるシート状集団もあった. 柵状配列は淡緑色の高円柱状細胞からなり, 核偏在や核の重畳化がみられた. 乳頭状配列は細胞境界が明瞭で, 核のくびれや陥入像が顕著であった. 以上の細胞像および画像所見より粘液性嚢胞腺癌の診断のもとに膵体尾部脾切除術施行. 摘出腫瘍は11×10×8cmで, 組織学的には粘液性嚢胞腺癌であった. 術後10年経過の現在まで再発はない. また本例のような粘液性嚢胞腺癌と膵管内乳頭腺癌や粘液産生が目立つ管状腺癌との鑑別についても考察した.

A case of polymorphous adenocarcinoma originating from parotid gland. A cytological study.

耳下腺原発のpolymorphous adenocarcinomaの1例を報告する.症例は57歳男性で左耳下部に腫瘤を触知し, その後急速に増大し, 腫瘤を摘出するも再発を繰り返し肺転移を併発して死亡した.術中の細胞診では円-卵円および紡錘形の核からなる多数の腫瘍細胞が孤立散在性または集団で出現し, 孤立性の細胞はすべて裸核状であり, 紡錘形核の細胞は束状に配列していた.細胞質の保たれているところでは腺管形成と粘液様球体が認められた.核はいずれも小型から中型で約10μ 前後と大小不同に乏しく, 核形の不整も認められなかったが, 明瞭なnuclear clearingと赤い円形核小体がみられ, 悪性が示唆された.病理組織学的には明るい細胞質と円-卵円形核の腫瘍細胞が充実性に増殖し, その中に腺管-小嚢胞形成や肉腫様の配列がみられpolymorphous adenocarcinomaと診断された.

A cytological study on two cases of meningioma with chest metastasis.

2例の髄膜腫の頭蓋外転移巣を臨床細胞学的に検討した. 症例1は髄膜上皮型髄膜腫, Grade I で肺転移を伴っているものの, 細胞学的には渦紋状の配列を示す腫瘍細胞が集団をなしてみられ, 核には悪性細胞としての特徴に乏しかった. 症例2は髄膜上皮型髄膜腫, Grade III (狭義の悪性髄膜腫) で胸壁に転移を伴っていた. 細胞学的に, 腫瘍細胞は多面形または紡錘形で細胞質に富み, N/C比はあまり高くないものの, 核が大きく, 核小体も顕著であり, 悪性の非上皮性腫瘍が疑われた. 本例は再発を繰り返し, 発症から13年後に全身転移をきたし, 死亡した. 以上の2症例はいずれも頭蓋外の胸部に転移を伴った髄膜上皮型髄膜腫であるが臨床的に, また臨床細胞学的に相違が認められた.