Masumi Toyonaga

Cytological significance of abnormal squamous cells in urinary cytology.

The aim of this study was to evaluate the significance of abnormal squamous cells (ASCs) in urinary cytology to clarify whether finding of ASCs could improve diagnostic accuracy. A total of 3,812 urine specimens were reviewed. We focused on three parameters of ASCs, necrotic debris, and ASC clusters, and linked them to histological diagnosis and clinical information. ASCs were identified in 34 (0.9%) specimens from 21 different patients. The incidence of ASCs was higher in females than in males. The 34 urine specimens were categorized as voided urine (16 cases), bladder‐catheterized urine (17 cases), and bladder‐washed fluid (1 case). Six (28.6%) of 21 patients were histologically diagnosed as having combined urothelial carcinoma and squamous cell carcinoma (SCC). Eight patients (38.1%) were histologically diagnosed as having SCC originating from sites other than the urinary tract; those urine specimens showed ASCs that were likely to have been exfoliated from malignant lesions. Necrotic debris and ASC clusters were identified in 12 specimens (35.3%) from 11 patients and 4 specimens (11.8%) from 4 patients, respectively, from a total of 34 specimens. Our results indicate that a great amount of care is needed for cytological diagnosis when attempting to recognize ASCs in urine specimens because ASCs were identified in not only SCC of the bladder but also in carcinoma or nonmalignant lesions of nonurinary tracts. Necrotic debris was found not only in patients who had malignant bladder tumors but also in those who had malignant lesions in locations other than the bladder. Diagn. Cytopathol. 2012.

Immunohistochemical, molecular, and clinicopathological analyses of urothelial carcinoma, micropapillary variant.

The prognosis of urothelial carcinoma, micropapillary variant (MPV), of the bladder has been shown to be worse than that of the conventional urothelial carcinoma (UC). However, it remains to be clarified why the MPV is more aggressive. We therefore here focused on the correlation between clinical features and histological, immunohistochemical and molecular findings for eight MPV and 35 UC, evaluating expression of MUC1, Ki‐67, p53, CD147, CD34, D2‐40, and extracellular matrix proteins. The Ki‐67 labeling index was significantly higher in UC than in MPV but densities of venous and lymphatic tumor emboli were significantly higher in the MPV cases and lymph node metastasis was more frequent, with a poorer prognosis. Tenascin‐C and fibronectin also showed significantly greater expression in MPV than in UC at the epithelial–mesenchymal interfaces. Direct sequencing showed point mutations of KRAS exon 1 in three MPV with significantly more frequency compared to UC. Occupation rate of the MPV area in the tumor showed significant inverse correlation with overall survival. Thus our histopathological findings provide clues to explaining why prognosis is poorer in the MPV than UC.

Comparative image analysis of conventional and thin-layer preparations in endometrial cytology.

We evaluated the differences in cytologic findings between conventional and thin‐layer preparations in endometrial cytology to introduce the thin‐layer method into routine cytology. Eighty patients who had undergone endometrial cytology and biopsy on the same day were selected and we compared the cytological findings between conventional‐ and thin‐layer preparations (TLP) in endometrial cytology. The numbers of neutrophils and cell clusters in the thin‐layer method were lower than those in the conventional smear (CSS) method. The average number of neutrophils in endometrioid adenocarcinoma was significantly higher than that in normal morphology endometrium and endometrial hyperplasia. Regarding the shape of the cell clusters, ball‐like patterns and round‐edged cell clusters were not identified in CSS. The average number of clusters in CSS was significantly greater than that using the TLP. The average of the nuclear area in CSS was significantly larger than that using the TLP, indicating that the nuclear areas in CSS were more uneven than that using the TLP. In the future, it is expected that liquid‐based cytology will be applied to the cytological diagnosis of a variety of lesions. The influence on cells due to fixation is considerable in liquid‐based preparations. Therefore, if we strive to pick up the differences between CSS and TLP of endometrial samples, the diagnostic accuracy of the latter could be improved. Diagn. Cytopathol. 2013.

Adequacy evaluation of endometrial cytology using Thinlayer specimens

目的: 子宮内膜細胞診において, Thinlayer 標本と従来の塗抹標本 (Conventional 標本) の診断成績を比較し, Thinlayer 標本の特性を明らかにする.方法: 内膜組織診とエンドサイトによる内膜細胞診を同一日に施行した 96 例を対象とした. 塗抹後のエンドサイトから Thinlayer 標本を作製し, 従来の診断基準で Thinlayer 標本も診断した. 組織診の結果を基に, 両細胞診標本の感度および特異度を求め, 細胞塗抹量, 鏡検時間, 細胞像について検討した.成績: Conventional 標本の感度/特異度は 87.0%/89.4%, Thinlayer 標本は 73.9%/70.2%であり, 後者が低かったがいずれも有意差は認めなかった. Thinlayer 標本は重積性が軽減され, 背景の赤血球や炎症細胞が大きく減少していた. 鏡検時間は Thinlayer 標本で有意に短縮された. しかし Conventional 標本とは異なる細胞像を示す傾向があった.結論: Thinlayer 標本による内膜細胞診標本は Conventional 標本と同程度の感度/特異度であり, Thinlayer 標本の特性を十分理解したうえで臨床応用は可能と思われる.目的: 子宮内膜細胞診において, Thinlayer 標本と従来の塗抹標本 (Conventional 標本) の診断成績を比較し, Thinlayer 標本の特性を明らかにする.方法: 内膜組織診とエンドサイトによる内膜細胞診を同一日に施行した 96 例を対象とした. 塗抹後のエンドサイトから Thinlayer 標本を作製し, 従来の診断基準で Thinlayer 標本も診断した. 組織診の結果を基に, 両細胞診標本の感度および特異度を求め, 細胞塗抹量, 鏡検時間, 細胞像について検討した.成績: Conventional 標本の感度/特異度は 87.0%/89.4%, Thinlayer 標本は 73.9%/70.2%であり, 後者が低かったがいずれも有意差は認めなかった. Thinlayer 標本は重積性が軽減され, 背景の赤血球や炎症細胞が大きく減少していた. 鏡検時間は Thinlayer 標本で有意に短縮された. しかし Conventional 標本とは異なる細胞像を示す傾向があった.結論: Thinlayer 標本による内膜細胞診標本は Conventional 標本と同程度の感度/特異度であり, Thinlayer 標本の特性を十分理解したうえで臨床応用は可能と思われる.

A case of ovarian carcinosarcoma with a recurrence of sarcomatous component suggested by ascites cytology

背景:卵巣癌肉腫はきわめてまれであり, 卵巣悪性腫瘍の1%以下とされている. 加えて, 腹水中に出現した卵巣癌肉腫の細胞所見を詳細に記載した報告もまれである. また, これらの報告では腺癌と組織型推定されている. 今回, 再発患者の腹水中に肉腫と判断される細胞が出現した症例を経験したので, その細胞像と病理組織像を比較検討した.症例:50歳, 女性. 主訴は下腹部痛. 平成12年6月, 内診および画像診断により最大径20cm大の卵巣腫瘍が指摘された. 同年7月, 術中の腹水細胞診にてClass V腺癌, 迅速組織診にて癌肉腫とされ, 単純子宮全摘術, 両側付属器切除術, 大網切除術および骨盤リンパ節郭清術が施行された. その後, 化学療法が行われたが再発し, 翌年3月, 腹腔内再発腫瘍切除術が施行された. 同時に行われた術中の腹水細胞診にて, 上皮性結合, 細胞質内の粘液や核縁の肥厚は認められず, 細顆粒状のクロマチン, 核の切れ込み, 核小体周囲の明庭などが確認されたところから, 肉腫細胞が示唆された.結論:まれな卵巣癌肉腫の細胞所見を呈示した. 腹腔内に進展する場合, 腺癌と細胞診断されることが多いが, 本症例では肉腫が再発の原因であった.

Cellular manifestation of uterine leiomyosarcoma combined with epithelioid clusters. Report of a case.

上皮様結合を示す腫瘍細胞集塊が出現したために, 捺印細胞診による組織型の推定診断が困難であった子宮体部平滑筋肉腫を経験した. 症例は34歳, 1回経妊未産の女性で, 月経不順, 立ち眩みなどを主訴に来院し, 子宮筋腫を指摘され, 手術目的で入院した. 術中迅速組織診にて悪性と診断, 摘出標本からの捺印細胞診が施行された. 腫瘍細胞として, 上皮様結合を示し乳頭状に配列する腺癌様細胞と, 孤立散在性に出現する紡錘形細胞や巨細胞の肉腫様細胞が認められたため, 当初ミュラー管混合腫瘍を考えた. しかし, 免疫細胞化学的に腺癌様細胞ならびに肉腫様細胞はデスミン, ビメンチンおよび平滑筋アクチンがいずれも陽性であり, ミオグロビン, CEA, EMAおよびSCがすべて陰性であったことより, これらの腫瘍細胞は同一系統で平滑筋由来であると判断した. パパニコロー標本を再検討した結果, 腺癌様細胞と肉腫様細胞は核縁が薄いことやクロマチンが細かい点で類似性が認められた. 以上より, 平滑筋肉腫の捺印細胞診では, 腫瘍細胞が集塊で出現する場合もあるため, 核縁およびクロマチンパターンなどの所見を総合して組織型の推定を行うことが重要であると思われた.