Noriyuki Furuta

Peripheral primitive neuroectodermal tumor of the vulva: Report of a case with imprint cytology

BACKGROUND Peripheral primitive neuroectodermal tumor (PNET) of the vulva is an extremely rare disease, and, to our knowledge, only two cases have been previously reported. CASE A 45-year-old woman presented with a mass in the right labium major. Three years after removal of the tumor, she noticed a new lesion in the same place and underwent a partial vulvectomy. The imprint cytology of the recurrent tumor showed a monomorphic appearance, composed of small round cells with scant cytoplasm against a hemorrhagic background. These tumor cells were loosely connective, but rosettelike structures were observed focally. On pathologic examination, the neoplasm was composed of small round tumor cells showing sinusoidal, diffuse or micropapillary growth. Immunohistochemically, the neoplastic cells stained positively for neuron-specific enolase, vimentin and HBA 71 and negatively for cytokeratin, HBA 45 and muscle-specific actin. The morphologic characteristics of the disease were well expressed in the imprint cytology, and this influenced the selection of immunohistochemical studies. CONCLUSION Cytologic examination for vulvar tumors, even imprint cytology, can be a useful tool in obtaining an accurate pathologic diagnosis of a rare disease, such as peripheral PNET.

Discriminant Model for Cytologic Distinction of Large Cell Neuroendocrine Carcinoma from Small Cell Carcinoma of the Lung

Background: To establish cytologic criteria for pulmonary large cell neuroendocrine carcinoma (LCNEC), we developed and evaluated a discriminant model for cytologic differential diagnosis between LCNEC and small cell lung carcinoma (SCLC). Methods: Aspiration cytologic and/or imprint smears from 29 LCNEC cases were reviewed in comparison with 26 SCLC cases. We selected the following parameters for assessment: background, cellular arrangement, cell clusters, cell cohesion, arrangements, cell dimensions areas, the presence of cytoplasm and/or prominent nucleoli, nuclear features, mitosis, naked nuclei, and nuclear streaking. To demonstrate the utility of differences in frequencies of cytologic parameters for LCNECs and SCLCs, a discriminant model was developed and evaluated. Results: Among the cytologic parameters investigated, large clusters (consisting of ≥60 tumor cells) with tight cohesion and small tumor cells (showing ≤120 &mgr;m2) without prominent nucleoli on each case were particular focuses of attention, because statistically significant differences with good power were evident between the LCNEC and SCLC groups for their frequencies (p < 0.0001). On the basis of variation in plotted location on scatter plots, a discriminant model for LCNEC and SCLC was made and evaluated by logistic discriminant analysis. Sensitivity, specificity, and accuracy were all 100%. With leave-one-out cross validation, the predicted error rate of the discriminant model for new cases was 0.00545. Conclusion: Our model based on the cytologic features of large cell clusters with tight cohesion and of small tumor cells without prominent nucleoli should be a useful aid for distinction between LCNECs and SCLCs.

Discriminant Analysis of Malignant Mesothelioma and Reactive Mesothelium Using Three-Dimensional Nuclear Estimation

Objective: The cytological diagnosis of coelomic fluid is essential for examining malignant mesothelioma (MM). However, reactive mesothelium (RM), caused by various factors, is morphologically similar to MM and thus often complicates the differential diagnosis. Here, nuclear luminance and steric alterations were assessed for the discriminant analysis of MM and RM. Study Design: Thirteen epithelial MM and 11 RM cases were included. One hundred alterations in the numbers of nuclear pixels and focus layers and the coefficient of variation of nuclear luminance among layers were determined for each case to conduct discriminant analysis using the Mahalanobis distance. Results: A cutoff value of 0.072 allowed highly accurate discrimination of MM (89.5%) and RM (89.6%). Fifteen cells appeared in 6 agglomerates of indiscriminable MM cases. The 6 agglomerates were individually examined. Malignant cells were dominant in 3 agglomerates (50%), allowing the discrimination of malignant cases. Conclusion: Discrimination using nuclear luminance and steric alterations is useful for morphologically indiscriminable MM cases. Three-dimensional analysis of agglomerates will be further investigated to improve the diagnostic accuracy.

Usefulness of intraoperative imprint cytology in ovarian germ cell tumors.

Objective: This study retrospectively investigated the usefulness of intraoperative diagnosis based on imprint cytology and frozen sections for ovarian germ cell tumor. Study Design: Intraoperative studies were reviewed for 23 cases with ovarian germ cell tumor treatment for which both frozen sections and imprint cytology were available. Final histopathologic diagnoses were compared with those based on intraoperative examinations. Results: Underlying pathologies included dysgerminoma (n = 6), yolk sac tumor (n = 1), non-gestational choriocarcinoma (n = 1), mature cystic teratoma with malignant transformation (n = 1), immature teratoma (n = 11), and mixed germ cell tumor (n = 3). Discrepancies between intraoperative imprint cytology and definitive histologic diagnosis were seen in 6 of the 23 cases. Accuracy was 54.5% (6/11) for immature teratoma and 91.7% (11/12) for other tumors. Cytologic examination facilitated accurate diagnosis in both of our cases, and intraoperative diagnosis by frozen section proved inaccurate. Conclusion: These results demonstrate that intraoperative assessment based on imprint cytology for immature teratoma has a relatively lower sensitivity, but an acceptable sensitivity for other germ cell tumors. Diagnostic approaches combining frozen sections and imprint cytology are advisable to improve the yield for intraoperative diagnosis.

Implications for Differential Diagnosis of Lung Cancer-Associated Lymphadenopathy in Lymphoepithelioid Cell Lymphoma (Lennert's Lymphoma) Arising Simultaneously with Lung Cancer

BACKGROUND Lymphoepithelioid cell lymphoma (LCL) is a rare morphologic variant of peripheral T-cell lymphoma, and its cytologic features have not been well characterized. We describe details from fine needle aspiration cytology (FNAC) of LCL in a patient simultaneously suffering from lung cancer, in whom extensive lymph node metastasis was suspected clinically. CASE A 54-year-old man had a lung nodule diagnosed as an adenocarcinoma by biopsy. 18F-fluoro-deoxyglucose positron emission tomography showed high uptake in the lung nodule as well as interlobar, supraclavicular and axillary lymph nodes. FNAC from interlobar and supraclavicular lymph nodes revealed abundant lymphoid cells intermingled with epithelioid cell clusters. Most lymphoid cells were small, with teardrop-shaped nuclei. Occasionally, large lymphoid cells with hyperconvoluted nuclei and prominent nucleoli were observed. An extensive sarcoid reaction was suspected on cytology, and lobectomy was performed. LCL with lung adenocarcinoma was diagnosed on the immunohistochemical findings. CONCLUSION Detailed observation of lymphoid cells with FNAC is important even in patients with lung cancer and massive regional lymphadenopathy. Presence ofa teardrop nuclear shape and nuclear irregularities of lymphoid cells provides important information for cytologic diagnosis of LCL when epithelioid cell clusters are evident.

Clinical management of the status of atypical endometrial cells using the descriptive reporting format for endometrial cytology

We aimed to develop and reinforce a clinical management regimen for atypical endometrial cell (ATEC) categories within the descriptive reporting format for endometrial cytology.

Cytological Findings of Gastrointestinal Stromal Tumor-Derived Bone Metastasis

Objective: Procedures for diagnosing bone tumors should be rapid and minimally invasive. Thus, cytological examinations are more useful for such purposes than histological examinations. In order to identify cytomorphological findings that could be used to diagnose bone metastasis from gastrointestinal stromal tumors (GIST), previous cases were reviewed. Study Design: Cytological samples of 7 lesions from 4 patients with GIST-derived bone metastasis, which were obtained from 2001 to 2017 at the JFCR Cancer Institute Hospital, were reviewed. Results: The metastasis of GIST to the bone was clinically suspected before the cytological and histological examinations in all cases since they all involved other metastatic lesion(s), and characteristic osteolytic lesions were detected on radiological images. Although various cell shapes were encountered, spindle cell proliferation was seen in all cytological samples. No pleomorphism was apparent. Characteristic nuclear findings were observed. All of the cases could be diagnosed as GIST-derived bone metastasis. Conclusion: GIST-derived bone metastasis can be diagnosed by examining cytological samples.

Touch cytology smear of an inflammatory hepatocellular adenoma displaying an unusual pattern: A case report

The cytological diagnosis of hepatocellular adenoma (HCA) is difficult since it is a very rare tumor and lacks characteristic cytological features. We have just reported a case of inflammatory HCA that displayed an unusual histological pattern (Clin J Gastroenterol 8:426–434, 2015). A touch cytology smear sample was obtained from the surgical specimen, and it also exhibited very unique features. A 56‐year‐old male underwent partial hepatectomy for an inflammatory HCA (diameter: 1.4 cm) in the right posterior lobe of the liver. The cytological sample displayed a characteristic two‐cell pattern. One type of cells contained thick cytoplasm, a high nucleus/cytoplasmic (N/C) ratio, and well‐defined cytoplasmic borders. The other type demonstrated small pyknotic nuclei and a lower N/C ratio. The immunohistochemical staining pattern of the histological specimen suggested that the latter cells might have been undergoing apoptosis. We report a case of inflammatory HCA with characteristic features. To diagnose this type of variant, it is important to recognize the unique pattern described in this study. Diagn. Cytopathol. 2016;44:1074–1077.

A case of epithelioid hemangioendothelioma of the soft tissue.

60歳, 女性の腋窩部に発生した類上皮血管内皮腫の1例を経験し, その細胞像について鑑別診断を中心に検討した.腫瘍細胞は主に乳頭状ないし平面状の上皮様細胞結合を示す集塊として出現していた. その細胞質には病理組織学的に特徴とされている大小の細胞質内空胞がみられた他に, 核には溝や, 核内細胞質封入像様の構造がみられた. 鑑別すべき腫瘍に上皮様細胞結合を示す腫瘍, 核溝や核内細胞質封入像様の構造がみられる腫瘍, 細胞質に空胞様の構造がみられる腫瘍があげられるが, 核, 細胞質双方に所見を合わせもっている腫瘍は少なく, 腫瘍の出現様式, 核所見, 細胞質所見を合わせて検討することで, 本腫瘍を推定診断することが可能ではないかと思われた.

Study on the endoscopic brushing cytology of the esophageal cancer

1970年より15年間に癌研究会附属病院細胞診断部で, 生検と直視下ブラッシ細胞診併用し, 検索した食道癌282例と食道良性疾患488例について細胞診陽性率を検討した.食道癌症例の平均年齢は64歳で, 60歳代に頻度が高く, 男女比は6.1: 1であった.食道癌は胸部中部に多く, X線分類ではらせん型, 内視鏡分類では潰瘍浸潤型が多かった.長径としては4.0～6.9cmの範囲の分布が多かった.食道癌細胞診陽性率は部位的にみると, 胸部上部と中部が頸部と腹部より高かった.X線分類別, 内視鏡分類別, 長径別では有意の差がなかった.食道癌282例の細胞診成績は, 陽性95.0%, 疑陽性1.4%, 陰性3.5%であった.食道良性疾患488例では, 陽性0.2%, 疑陽性3.5%, 陰性96.3%であった.