Seiko Ogura

Fine‐needle aspiration cytology of malignant hemangiopericytoma of the salivary gland: A case report

A 79‐yr‐old woman presented with a 5‐yr history of swelling of the left cheek. The fine‐needle aspiration (FNA) smear showed a spindle‐cell neoplasm with capillaries and benign endothelial cells. The spindle cells possessed pleomorphic, hyperchromatic elongated nuclei and a moderate amount of ill‐defined cytoplasm. They also showed papillary arcades surrounded and encased by relatively small ovoid to short spindle cells. Subsequent surgical excision confirmed the presence of malignant hemangiopericytoma (HP). Immunohistochemical studies on the histologic section using vimentin were strongly positive, consistent with HP. To the best of our knowledge, this is the second published report of FNA cellular features of malignant HP of the salivary gland. Besides delineating the FNA cellular features of HP of the salivary gland, the present case illustrates the value of using immunohistochemical approaches. Diagn. Cytopathol. 1999;21:398–401.

Expression of immunoreactivity and genetic mutation in eosinophilic and ciliated metaplastic changes of endometrial glandular and stromal breakdown: cytodiagnostic implications

Various metaplastic changes may be present in endometrium, in which also cellular atypias may often be observed. Particularly, eosinophilic and ciliated changes (ECCs) occur in both nonneoplastic and neoplastic endometrium. This may cause confusion in the cytodiagnosis. This study was enterprised to investigate the possible help of immunocytochemical and cytogenetic study in the diagnostic and biologic assessment of ECC cells. In immunocytochemistry for p53 protein, Ki-67, and cyclin A, the material consists of 40 cases of cytologic smears examined by direct sampling of the endometrial cavity comprising 30 cases of ECC in endometrial glandular and stromal breakdown (EGBD) and 10 cases of well-differentiated adenocarcinoma (G1). After cytodiagnosis, immunostaining for p53 protein, Ki-67, and cyclin A was performed on multiple wet-fixed slides from each single case to evaluate the immunoreactivity, intensity of nuclear staining, and nuclear labeling index (N-LI). The intensity of nuclear staining was scored as negative (0), weak (1), moderate (2), or strong (3), and the N-LI was scored as less than 10% (0), from 10% to 25% (1), from 26% to 50% (2), or more than 50% (3), and the final score was calculated by adding both partial scores. A statistical significance test was performed by using Mann-Whitney U test, and the result was judged as significant when the P value was less than .05. For genetic mutation analysis of p53, the material comprised 6 cases of EGBD in which a high score was measured with immunocytochemistry for p53 protein, and the presence of ECC was confirmed on the hematoxylin and eosin. The ECC cells on paraffin-embedded specimens were captured using laser capture microdissection technology. Mutations in p53 gene (exons 5-8) were examined using DNA sequencing analysis. In immunocytochemistry for p53 protein, Ki-67, and cyclin A, the proportions of immunoreactive cells for p53 were statistically higher in ECC compared with those of G1 (P < .05). The proportions of the immunoreactive cells for Ki-67 and cyclin A were statistically higher in G1 compared with those of ECC (P < .05). (2) In genetic mutation analysis of p53, DNA sequencing of p53 in 6 cases revealed no mutations. The percentage of immunoreactive cells for p53 protein were higher in ECC than in G1, but the mutation point was not confirmed in genetic mutation analysis. The differential expression of these biologic parameters in ECC cells could be considered of possible relevance to the cytopathologic diagnosis in the future.

Diagnostic value of endometrium associated with papillary metaplastic changes in endometrial cytopathology.

Papillary metaplastic changes especially occur in both non‐neoplastic and neoplastic endometrium. We tried to investigate to assess the relationship between endometrial cytologic diagnosis and papillary metaplasia. The material consists of 160 cases of cytologic smears obtained by direct sampling of the endometrial cavity comprising 54 cases of normal proliferative endometrium (NPE), 36 cases of glandular and stromal breakdown (EGBD), and 70 cases of endometrial hyperplasia without atypia (EH). As for the correlation between the appearance of papillary metaplasia and cytological diagnosis, a statistical significance test was performed. The material consists of 40 cases of cytologic smears examined by direct sampling of the endometrial cavity comprising 10 cases of EGBD with papillary metaplasia, 10 cases of G1 without pappilary metaplasia, 10 cases of NPE without papillary metaplasia, and 10 cases of EH without papillary metaplasia. Using the comparison between appearance of papillary metaplasia and cytological diagnosis, a significant difference was only seen in the rate of correct diagnoses in EGBD cases. The nuclear area of papillary metaplastic cells in EGBD was 888.8, G1 was 928.7, NPE was 682.0, and EH was 722.2. Significant difference was observed between ECC cells in EGBD to NPE, between papillary metaplastic cells in EGBD to EH, between G1 to NPE, or between G1 to EH.

Investigation of the Possible Cytopathological Effect of Human Papillomavirus Infection on p-16INK4a Overexpressed Urothelial Carcinomas ofthe Bladder in the Urine

Background and objectives: Human papillomavirus (HPV) is well-known as the etiological agent for uterine cervical cancer or carcinoma of the oropharynx, anus and vulva. However, the cytopathologic effect of the HPV infection in urinary bladder tumors has rarely been reported. The present study has been carried out to search for cytopathologic differences between HPV positive and negative cases with urothelial carcinoma. Methods: We examined 91 specimens from 63 patients who underwent transurethral resection or biopsy for papillary urothelial carcinomas between May 2010 and September 2012. p-16INK4a expression was evaluated by immunohistochemistry. Detection of HPV DNA was carried out by in situ hybridization on formalin-fixed, paraffinembedded tissue sections. Urine smears were compared cytomorphologically between HPV-positive and HPVnegative cases. Results: p-16INK4a overexpression was detected in 29 cases (31.9%, 29/91). Of them, HPV DNA was detected in 11 cases. No significant cytopathologic differences were found in tumor cells when HPV-positive and HPV-negative cases were compared. Conclusion: HPV could be detected in urothelial carcinomas of the urinary bladder. There were no significant differences in cytopathologic features of urine smears between HPV-positive and HPV-negative cases with urothelial carcinomas. These results suggest that HPV infection in urinary tract does not add substantial clinically relevant importance to the carcinogenesis and cytomorphology of urothelial carcinomas.

A case of cevical adenocarcinoma in situ with difficulty in cytological differentiation from recurrent ovarian tumor of borderline malignancy.

背景:近年, 診断法や治療法の進歩に伴う治癒率の向上とともに, 婦人科領域の重複癌発生率が上昇している. 婦人科領域の細胞診断の際に重複癌を疑う像に遭遇することがあるが, その判定に苦慮することは少なくない.今回われわれは, 境界悪性卵巣粘液性腫瘍の再発との鑑別が困難であった子宮頸部上皮内腺癌の1例を報告する.症例:55歳, 女性. 3年前に右卵巣腫瘍破裂のため, 右付属器摘出術が施行され, 右卵巣境界悪性粘液性腫瘍, 腸上皮型, Ic期と診断された. 外来での経過観察中, 子宮頸部擦過細胞診にて異型腺細胞集団が認められ, 子宮頸部腺系病変あるいは卵巣粘液性腫瘍の再発が疑われた. 単純子宮全摘術および左付属器摘出術が施行され, 摘出標本の組織診で子宮頸部上皮内腺癌と診断された. 子宮体部, 左付属器に悪性所見は認められなかった.結論:婦人科領域における重複癌の診断においては, 細胞所見のみならず臨床所見や画像診断を加味した総合的な判断が必要である.