Takashi Umezawa

Immunohistochemical Analysis of Debris Captured by Filter-Type Distal Embolic Protection Devices for Carotid Artery Stenting

BACKGROUND Little is known about the micro-debris captured in filter-type distal embolic protection devices (EPD) used for carotid stenting (CAS). This study aimed to determine the histological and immunohistochemical characteristics of such debris by using a new liquid-based cytology (LBC) technique. METHODS Fifteen patients who underwent CAS using a filter-type distal EPD (FilterWire EZ; Boston Scientific, Marlborough, MA, USA) were included in the study. After gross inspection of each recovered filter device, micro-debris were collected using a new LBC technique (SurePath; TriPath Imaging, Inc., Burlington, NC). Histological and immunohistochemical analysis of the recovered debris was performed. The pre- and postoperative brain magnetic resonance imaging and neurological status of each patient were also reviewed. RESULTS No patient developed ipsilateral symptomatic stroke due to a thromboembolic event. All 15 patients (100%) had microscopically identifiable debris in the filters, whereas gross inspection detected visible debris only in 5 patients (33.3%). Histological analysis revealed various types of structural components in an advanced atheromatous plaque, including fragments of fibrous cap, calcified plaque, smooth muscle cells, and necrotic tissue fragment infiltrated with monocytes and macrophages. CONCLUSIONS Filter-type EPDs may contribute to reducing the risk of CAS-related embolic events by capturing micro-debris even when gross inspection of the recovered filter shows no visible debris in the device.

Clinical and Prognostic Value of the Presence of Irregular Giant Nuclear Cells in pT1 Ovarian Clear Cell Carcinoma

In the early stages of epithelial ovarian cancer, histopathological grading is important. However, the grading of ovarian clear cell carcinoma (OCCC) remains controversial. We aimed to identify irregular giant nuclear cells (IGNCs) by a simple method in clinical practice, and to evaluate the prognostic value of IGNCs in pT1 OCCC. Eighty-seven pT1 OCCC patients who underwent initial surgery at Jikei University Kashiwa Hospital, Chiba, Japan, were retrospectively assessed. Paraffin-embedded tissue sections (PTSs) stained with hematoxylin and eosin were reviewed. Giant nuclear cells (GNCs) were defined as cells with a nuclear length of more than twice the median nuclear length. GNCs with irregular nuclear circumferences were defined as IGNCs. Cases where one or more GNCs existed and where IGNCs accounted for >10% of the GNCs were classified as IGNC-positive. We also attempted to identify IGNCs on touch imprint cytology smears (TICSs). Among the 87 cases, 68 were IGNC-negative and 19 were IGNC-positive. The 5-year disease-free and overall survival rates were 88.9% and 90.3% in the total patients, 98.3% and 100% in the IGNC-negative group, and 59.7% and 62.0% in the IGNC-positive group, respectively. These survival rates were significantly lower in the IGNC-positive group than in the IGNC-negative group (adjusted hazard ratio = 14, 95% confidence interval = 2.7–124 and adjusted hazard ratio = 25, 95% confidence interval = 2.9–768, respectively). Prognostic differences were not identified for other factors. IGNC identification on 28 available TICSs predicted IGNC identification on PTSs (sensitivity = 50.0%, specificity = 100%, P = 0.007). The presence of IGNCs has clinical and prognostic value for pT1 OCCC.

Cytological features in 6 cases of glassy cell carcinoma of the uterine cervix.

目的:子宮頸部に原発したすりガラス細胞癌の細胞学的特徴の把握と細胞診による診断基準の向上を目的に細胞学的検討を行った.方法:1994年～2000年の7年間に慈恵医大附属柏病院の産婦人科で治療を受けた, 子宮頸部原発すりガラス細胞癌の6例を対象とした. 年齢は平均54.5歳 (38～75歳), ともに不正出血を主訴に来院した. 採取方法は6例とも子宮腔部から綿棒擦過により採取し, 各細胞診標本を検討した結果, 以下の知見が得られた.成績:術前の子宮腔部擦過細胞診にて症例1, 2は大型の非角化型扁平上皮癌, 他はすりガラス細胞癌と診断した. Retrospectiveに行った細胞形態的検討より, 6例のすりガラス細胞癌に共通した以下6つの特徴的な細胞診所見を見い出せた.(1) 核は大型円形あるいは類円形, 核縁は円滑で肥厚し核型不整は乏しい.(2) クロマチンパターンは粗大顆粒状で不均等に分布.(3) 単一で円形あるいは不整形で数個の明瞭な核小体.(4) 細胞質は豊富で多辺形, 微細顆粒状.(5) 多核巨細胞の混在と多形性が目立った.(6) 角化異常細胞, 腺管構造は認めないであった.結論:細胞学的形態は組織学的所見を裏付けるものであり, 以上の詳細な細胞形態の認識とすりガラス細胞癌の疾患概念をもっことで, 細胞診によって推定することが可能と思われた.