18◇ Invited Lecture◇ Global Asia ForumThe IAC Breast FNAB Structured Reporting Sys-

Diagnostic Efficacy of Rapid On- Site Evaluation

tem：an Update. JSCC May 2017

(ROSE) with Different Cytology Practice

GAF-1

Rapid onsite evaluation of FNA withcyto-histologic correlations

Notre Dame University Medical School and St Vincentʼs
Hospital, Sydney, Australia

The Johns Hopkins Hospital, Department of Pathology,
Division of Cytopathology, Baltimore, Maryland, U.S.A.

○Andrew Field(MD）○Syed Z. Ali【Objective】：The aim of the IAC initiative is to produce a【Objective】�The Johns Hopkins Hospital�is a world-

standardized approach to breast FNAB, which will include

renowned 1000 bed tertiary care university hospital with arecommended best practice for the FNAB technique, andhighly acclaimed Cytopathology laboratory. Rapid onsite

establish diagnostic categories with specific diagnostic

evaluation (ROSE) for specimen adequacy is routinely

criteria or checklists, that can be used in reporting andpracticed in near 100％ of FNAs performed at our hospitalassist the establishment of management recommendations.

involving diverse anatomic sites. The presentation will

【Methods】：Breast FNAB has been used successfully forselectively highlight the unique aspects of our FNA practicemore than 60 years to diagnose palpable and more recently

and will elaborate on the role of ROSE in diagnostics,

impalpable lesions, but its usage varies greatly from country

traineesʼ education, clinical management and patient care

to country, city to city and from hospital to private FNAB

with practical illustrations on cyto-histologic correlations.

clinic. It is a very cost effective and accurate diagnostic tool

【Methods】The case material consists of FNAs from Johnsin the developed world.

Hopkins (〜5,500 are performed each year). A group of 10【Results】： In the developing world where there arecytotechnologists (CT), two cytopathology fellows/train-

limited medical resources including a shortage of diagnostic

ees and five cytopathologists are involved in ROSE. The

radiology for mammography and of breast ultrasound andperformance of ROSE not only involves Radiology (ultra-

surgical pathology laboratories for breast core and excisionsound and CT), but a large number of cases are done at the

specimens, there is a huge potential for FNAB to radicallyendoscopy suites (EUS pancreas), bronchoscopy rooms

improve the diagnosis and management of breast lesions.

(EBUS lung) and endocrine clinic (thyroid). The cytopa-

But FNAB of breast faces a significant pre-analytical

thologists are predominantly involved with ultrasound-challenge as do all sites for FNAB： it relies on skilledguided FNAs of liver, kidney/adrenal, soft tissue, lymph

operators performing the FNAB and making the direct

nodes and salivary gland. ROSE for all other anatomic sites

smears. As well, there are specific problem areas inare managed by CTs. For this presentation, the discussion

diagnosing benign proliferative lesions, such as fibroadeno-

will be mostly limited to thyroid and pancreas.

mas and intraduct papillomas, which can show a wide range【Results】Many of our own published studies have shownof features both in surgical pathology and cytopathology.

an excellent diagnostic accuracy for ROSE performed by【Conclusion】： Proliferative lesions can produce highCTs when compared to the cytopathologistsʼ final diagnosis

cellularity, which is usually associated in FNAB withand cyto-histologic correlation. The advantages of ROSE

malignant lesions, and specific diagnostic criteria forare universally known such as a higher diagnostic yield,

proliferative lesions can overlap with malignant lesions in

optimum sample triaging for ancillary testing and guiding

the breast. The distinction of invasive and intraduct lesions

the radiologistʼs hands to the more diagnostically significant

has to be addressed.

areas of the mass lesion. However, ROSE offers many
unique perspectives and advantages to our practice at Johns

19

Hopkins, i.e., it ensures a continuing high involvement of
our highly trained and efficient CT staff in the FNA

GAF-2

The practice of ROSE methodology inRussiacytopathology practice (NOT just a passive�cytoscreening�role), provides an ideal platform to train our fellows indiagnostics and communication skills with strong emphasis
on a multidisciplinary approach.
【Conclusion】In our practice, the involvement of CTs in

Departments of Clinical Laboratory Diagnostic, Russian
Medical Academy of Continuous Postgraduated Education,
Moscow, Russia

ROSE offers diagnostic accuracy comparable to cytopathologists in a variety of anatomic sites. This enable the○Irina Shabalova

cytopathologists to handle a much larger case volume forbetter RVUs for the department. Involvement of trainees in
ROSE offers unique teaching opportunities. Interactions of
the cytopathology staff and radiologists/clinicians leads to【Objective】ROSE is able to play an important role in early

better understanding of the diagnostic issues involved andand precise diagnostics, planning an individual plan foroffers a multidisciplinary approach. Cyto-histo correlations

medical examination, management and treatment, andprovide a quick quality assurance measure.

sometimes for type and volume of surgery.
【Methods】ROSE in Russia has begun in 70 - early 80 , inththP. A. Herzen Cancer Research Institute (intraoperative
diagnostics, fine needle aspiration (FNA) during bronchoscopy), S.P. Botkin Hospital (ROSE during gastroscopy, in
FNA of palpable thyroid, breast, lymph nodes etc.), andsome other healthcare institutions. Quick MGG, immunofluorescence and other techniques were used.
【Results】Nowadays ROSE has demonstrated good resultsin endoscopy including EUS and EBUS, FNA of thyroid,
breast, soft tissues, lung etc. Even if rapid frozen sections
can be performed, cytology can be used because of a lot ofadvantages in rapid assessment of infections, lymphoma,
malignant melanoma, Ewing sarcoma, metastases, etc. The
usage of telecytology, on-line and off-line consultations
gave the additional capabilities for ROSE. Liquid based
cytology with subsequent cell blocks, immunocytochemistry, in situ hybridization, and other molecular studies seems
to be of a great importance in the future. The possibilities of
ROSE will be discussed.
【Conclusion】ROSE per se and as a method for creation ofindividual scheme for subsequent examination seems tohave the limitless diagnostic opportunities. Rapid assessment of obtained material, morphological diagnosis, opinion
or proposal to take more adequate material for cytology andhistology is very important. Liquid-based cytology, that is
rapidly developing in Russia gives the opportunities forsaving cells and tissue fragments for cell blocks, immunocytochemistry, in situ hybridization, and other molecularstudies and can be used as a practical tool in personalized
medicine.

20

GAF-3

Rapid interpretation of breast cytology in

GAF-4

Tissue rinse liquid-based cytology： aa one-stop multidisciplinary breast unit infeasible tool for the intraoperative cyto-

a medical center

pathological evaluation of sentinel lymph
nodes

Department of Pathology, Taipei Veterans General Hospital, Taiwan

Division of Clinical Laboratory, Hokkaido Cancer Center,1)
Hokkaido, Japan ，Division of Pathology, Hokkaido Cancer
Center, Hokkaido, Japan

2)○Chiung-Ru Lai○Kiyomi Taira ，Katsushige Yamashiro【Objective】High-quality one-stop multidisciplinary breast【Background】The evaluation of sentinel lymph nodes fromunit is the most effective way to manage breast diseases,

a woman with breast cancer is frequently challenging. Sinceboth benign and malignant. The one-stop unit could provide

2008 we have performed the cytopathological evaluation of

all the required elements of triple assessment and makesentinel lymph nodes of about 3,500 breast cancer patients

1)

2)

definitive diagnosis for the majority of patients. The

through Tissue Rinse Liquid-based Cytology (TRLBC).

purpose of this study is to assess the efficacy and diagnostic【Methods】Lymph node cut into 2 mm-thick slices is wellaccuracy of a one-stop breast unit in a medical center.

rinsed in CytoRich【Methods】A total of 378 patients with breast cytology

washed out in the preservative were pasted on a glass slide

including fine needle aspiration (FNA) and nipple discharge

by BD SurePathfrom the multidisciplinary breast unit (composed of breast

processed for histological preparation after fixation in& plastic surgery, medical & radiation oncology, surgical &formalin.

cytological pathology, radiology and genetic counseling) of【Results】The cytopathological diagnosis was usually

Taipei Veterans General Hospital in 2015 were included.

reported in 35 minutes. When we employed the histological

The role and efficacy of cytology in the multidisciplinary

diagnosis concurrently using IHC for cytokeratin as a gold

team were evaluated by correlated with final histology andstandard, overall sensitivity and specificity of TRLBCTM

TM

Red and the cancer cells, if any,technique. The tissue specimens wereclinical patientsʼ outcome.

including isolated tumor cells, ITC was 81.3％ and 97.1％,【Results】A total of 321 FNA and 57 nipple discharge

respectively. Only for macrometastasis, micrometastasis,

specimens were included. The cytology results wereand ITC, the sensitivities were 100％, 94.5％, and 42.5％,

benign：79％；atypical：7％；suspicious：2％；posi-

respectively.

tive：6％；inadequate：6％. The results of atypical and up【Conclusion】TRLBC is a feasible and valuable tool forwere considered as positive and inadequate specimens were

surgical oncology. We present a new on-site approach foranalyzed separately. About 85％ of patients could havethe minute tissue material obtained from endoscopic

definitive diagnosis and/or treatment planning in a one-day

ultrasound-guided fine-needle aspiration. The bloody

visit. The overall sensitivity was 93％ and specificity wasmaterial soused in CytoRich92％.

histological diagnosis by its hemolytic activity and the【Conclusion】Cytology, FNA and nipple discharge, in a one-remaining solution is served for cytopathological diagnosis

stop multidisciplinary breast unit can provide quick,as an LBC preparation. We have got the cytological andefficient, and accurate diagnoses in a one-day visit andhistological preparations containing many targeted cells andserve as a model of standard of care of routine practice in a

successfully made a diagnosis in more than 70 cases.

medical center. It could reassure most patients with benign
conditions with no need for further attendance and renderdefinitive diagnosis and/or treatment planning for those
who been diagnosed to have cancers.

TM

Red was easy to pick up for

21

ROSE helps us to triage sample for cell block preparation

GAF-5

Rapid on site evaluation on FNA ofand make accurate diagnosis possible on cytology samples.

unknown primary tumor to diagnose

A series of cases are demonstrated in the talk to emphasize

neuroendocrine tumors
the potential pitfalls in dealing with this differential
Department of Pathology, Beijing Hospital, National Centreof Gerontology, Beijing, PR China○Lan Chen，
Shu-rong He，Dong-ge Liu【Objective】Neuroendocrine neoplasms include a group ofheterogeneous tumors originated from neuro-ectoderm andneural crest. The tumor cells receive neuronal input of
neurotransmitters released by nerve cells or neurosecretory cells and release message molecules of hormones to theblood. They share morphological and immunophenotypic
similarities despite the tumor origin. There is usually blandcytopathology and minimal polymorphism, but less commonly there can be anaplasia and tumor cells may mimicother malignancies. In this study we presented themorphological variants of neuroendocrine neoplasms diagnosed on FNA of unknown primary tumors in our collectionand emphasized the value of rapid on site evaluation(ROSE) for accurate diagnosis by applying ancillary test of
immunohistochemistry (IHC) on smears or blocks fordifferential diagnosis.
【Methods】We reviewed 45 cases suspected of neuroendocrine neoplasms on ROSE in the last four years from FNA of
unknown primary tumors. Tumor origin spanned aspectrum of GI, lung, breast, thyroid and paraganglia. 28
cases were diagnosed of neuroendocrine neoplasms ortumors with neuroendocrine differentiation with ancillary
test of IHC tested in 26 of them and 18(100％) had further
resection samples to confirm the diagnosis, while 8 patients
went on with treatment directly without further biopsy orresection. 17 cases signed out as the suspicious had no cell
blocks available for IHC and 11 of them had pathology
confirmation to be neuroendocrine tumors for 8 cases andother malignancy or benign lesions for 3 cases (27.3％).
The other 6 had no pathology follow-up.
【Conclusion】While morphology forms the fundamental
bases to recognize the neuroendocrine tumors, IHC on cell
block plays an important role for differential diagnosis.

diagnosis.

22◇ Poster Presentation in English

GAF-6

Role and accuracy of rapid on-site evalu-

PE-1-1The effectiveness and clinical signifi-

ation (ROSE) of CT- guided fine needle

cance of cytology specimens from pleuralaspiration cytology of lung nodules

effusions for EGFR mutation tests in nonsmall cell lung cancer

Department of Medicine, Surgical Pathology & Cytopathology Unit, University of Padua, Italy

Department of Pathology, Ditmanson Medical Foundation
1)
Chia-Yi Christian Hospital, Chiayi, Taiwan ，Department of
Cosmetic Science, Chia Nan University of Pharmacy and2)
Science,Tainan, Taiwan ，Executive and managing supervisor, Taiwan Society of Clinical Cytology

3)○Ambrogio Fassina，Lorenzo Nicole，Valeria Maffeis，Rocco Cappellesso○Chien-Chin Chen

【Objective】To prospectively investigate the role of trans-【Objective】Patients with advanced non-small cell lung

1,2,3)

thoracic fine needle aspiration cytology (FNA) and thecancer (NSCLC) may benefit from treatment withvalue of rapid on-site evaluation (ROSE) in the clinicalepidermal growth factor receptor (EGFR) tyrosine kinase

management of patients with pulmonary nodules/masses.

inhibitors (TKIs) when their tumor harbors an activating

Computed tomography (CT)-guided FNA is commonly

EGFR mutation. Malignant effusions frequently occur inemployed for the diagnosis of lung lesions although its
patients with advanced NSCLC. Cytology specimens fromposition in the diagnostic work-up is still a matter of debate.
【Methods】In the last 10 years at the University of Padova

malignant effusions are available for EGFR mutation

we reviewed 611 patients, correlating the results oftesting, but might pose challenges due to low proportion ofcytology with the available histological findings obtained

tumor cells. We aim to better define the suitability andfrom biopsies, surgery or autopsy.

clinical influence of effusion cytology specimens for EGFR

【Results】Smears were adequate in 98％ of cases andmutation testing.

inadequate in 2％；a diagnosis of malignancy was achieved【Methods】NSCLC cases in our institution for EGFR

in 86.2％；12.8％ were non-malignant；1％ suspect for

mutation testing over a 23-month period were retrospec-

malignancy. When correlated with histology, FNA withtively reviewed. Specimens were tested for EGFRROSE discriminated malignant versus non-malignant
lesions with a satisfactory concordance (Cohenʼs kappa

mutation, using real-time polymerase chain reaction0.78), and high sensitivity (96.3％) and specificity

analysis with the Roche Cobas Z480 analyzer and the Cobas(100％). Moreover, a satisfactory overall agreement of

EGFR mutation test kit.

71.4％ was achieved in differentiating the cancer histologi-【Results】A total of 215 specimens were tested, compris-

cal types. Pneumothorax, haemoptysis, and chest pain

ing 39 (18.1％) cytology specimens, 122 (56.8％) small

occurred in few patients with poor Performance Statusbiopsy specimens and 54 (25.1％) resection specimens(PS). A single aspiration was sufficient in 79.6％ of(including 47 lung resection specimens). The averagepatients；two aspirations were needed in 17.4％ and threetumor proportion is 32.8％ (cytology), 37.2％ (small

in 3％. Cell bloc preparation and molecular investigation

biopsy), and 55.6％ (resection), respectively. Except 4

allowed precise and rapid conclusion about the cancer

small biopsy specimens, 211 cases had sufficient DNA for

histotypes and the mutation/deletion profiles.
【Conclusion】Provided a careful clinical and imaging
selection, ROSE FNA demonstrated a safe and useful tool inthe diagnostic work-up of lung cancer patients, with

mutation testing. EGFR mutations were detected in 22
cytology specimens, 66 small biopsy specimens and 41
resection specimens. There was no significant difference inminimal or no contraindications, with election as the firstthe EGFR mutation rate between cytology specimens (22diagnostic procedure for patients with peripheral lungof 39 cases； 56.4％), small biopsy (66 of 122 cases；

lesions or in poor Performance Status. FNA with ROSE

54.1％), and resection specimens (41 of 54 cases；

should be reconsidered in the guidelines for diagnosing and75.9％). Moreover, 12 cases of 22 cytology specimens withmanaging lung cancer.

drug-sensitive EGFR mutation took TKIs for cancer

23
control, and most of them (10 of 12 cases) underwent
cancer regression or stable disease for 2 to 14 months.
【Conclusion】Our results support the effectiveness andclinical significance of effusion cytology specimens for
EGFR mutation testing. Careful evaluation of the adequacy

PE-1-2

Glomus tumor of uncertain malignant
potential of lung： A case report ofbronchoalveolar lavage cytology, withcorrelation of surgical pathology specimen and potential diagnostic pitfallsof small specimens is required to minimize the risk of false
negative or positive results.

Departments of Pathology, MacKay Memorial Hospital,
1)
Taipei City, Taiwan ，Department of Medicine, MacKay
Medical College, New Taipei City, Taiwan○Pao-Shu Wu

2)，Huei-Yu Tseng

1,2)

1)

【Objective】Glomus tumor in visceral organs is very rare
and most of them are of benign nature. Herein we present
an unusual case of glomus tumor of uncertain malignant
potential in the bronchus of left lower lobe of lung from a
15-year-old adolescent.
【Methods】The computational tomography (CT) imaging
exam showed a 2.5 cm intra-bronchial mass in the left
lower lobe lung. The impression from imaging studies
suggested it was most likely a carcinoid. Bronchoalveolar
lavage cytology samples were obtained and followed withvideo-assisted thoracoscopic surgery (VATS) resection.
【Results】The bronchoalveolar lavage cytology samples
revealed clusters or single of uniform, round to ovalshaped, bland-looking cells with clear cytoplasm admixed
with sloughed bronchial epithelium cells. The cytomorphology features are not supportive of the diagnosis of carcinoid
or neuroendocrine tumors. A negative diagnosis of wasgiven. However, subsequent histopathologic examination of
the surgical resection sample showed the tumor composed
predominantly of sheets of ovoid to round cells with clear
border, pale cytoplasm and fine granular chromatin withsmall to inconspicuous nucleoli. The mitotic count was lessthan 5 per 50 high power fields (HPF). There is no invasion
to the surrounding normal bronchial and alveolar tissue.
Immunohistochemical staining showed that the cells werediffusely positive for smooth muscle actin (SMA) andcollagen IV, while negative for neuroendocrine markers(CD56, synaptophysin and chromogranin A). The Ki-67
proliferation index was approximately 15％. Based on themorphologic features and immunohistochemical profile, thetumor was consistent with glomus tumor of uncertain
malignant potential. Re-examination of the bronchoalveolar

24

lavage cytology samples revealed that those oval-shaped,
bland-looking cells with clear cytoplasm are consistent withtumor cells of glomus tumor of uncertain malignant

PE-1-3Lung and pleural effusion metastasis ofsalivary duct carcinoma

potential.
【Conclusion】Glomus tumor has distinct cytomorphologic
features in surgical pathology specimen, but it might be

Department of Diagnostic Pathology, Kurume University
Hospital, Fukuoka, Japan

overlooked in cytology samples such as fine needle
aspiration or as in this case, the bronchoalveolar lavage.
Appropriate clinical history and immunohistochemical
studies (such as SMA, collagen IV) can further help toconfirm the diagnosis.

○Kazuya Murata，Akihiko Kawahara，Tomohiko Yamaguchi，Hideyuki Abe，Tomoki Taira，
Tomoko Yoshida，Yorihiko Takase，Chihiro Fukumitsu，
Yoshiki Naito，Jun Akiba【Introduction】Salivary duct carcinoma (SDC) is a rare but
aggressive form of parotid tumor. It is already known thatthe cytological features of SDC are large sheet clusters withslight overlapping and abundant granular cytoplasm withlight greenphilic cells in the necrotic background. Histopathologically, SDC is characterised by its resemblance toductal carcinoma of the breast. Although the cytologicalcharacteristics of SDC in fine-needle aspiration specimens
have been well-described at the primary site, metastasis israre in SDC. Here, we reported a case of parotid gland SDC
metastasis to lung and pleural fluid.
【Case】A man in 50ʼs was underwent extended total
parotidectomy in 2008, and he was originally diagnosed ashaving left parotid SDC. Six years later, chest CT identified
a mass in the left lung and he was diagnosed with metastatic
SDC by both bronchial biopsy and cytology. Subsequently
he had a recurrent SDC in the left pleural effusion.
Bronchial brushing smear showed small sheet clusters withcribriform-like patterns and isolated cells in the necrotic
background. In the plural effusion cytology, tumor cells
appeared as clusters of epithelioid cells with apocrine-likecytoplasm. Immunocytochemical staining was strongly
positive for HER2/neu and androgen receptor.
【Conclusion】Cytological findings may differ between the
primary and metastatic tumor, and a diagnosis of histological forms can be especially difficult at a metastatic site. It is
important to clarify cytological differences between primaryand metastasis, and to confirm the expressions of specificproteins by immunocytochemistry.

25

ing cases. The diagnostic performance of cytology was also

PE-1-4

Concordance of lung carcinoma subtypes

compared with the final diagnoses based on imaging

between liquid-based cytology and tissue

techniques and all clinical information available. The LBC

specimens： diagnostic aspects of bronchial brushings for lung lesions

preparations had 75.8％ sensitivity and 94.9％ specificity
in the diagnosis of lung cancer, superior to the performance

Division of Pathology, Sijhih Cathay General Hospital, New
Taipei City, Taiwan

of CSC samples.
【Conclusions】In this study, most patients of lung cancer
are diagnosed at advanced stages, with small biopsy or
cytologic samples available for pathological assessment.

○Chih-Yi Liu，Hui-Chih Tsai，
Yu-Lin Ko，
Yi-Jyun Lin

The ability to precisely classify lung carcinoma depends on
the procedure, tumor size and tumor type. The results haveshown that subtyping of lung carcinoma can be achieved in
LBC specimens, with a concordance rate of 70.8％. The【Objective】Liquid-based preparations are proposed todiagnostic accuracy of cytologic specimens is higher in the

improve the quality of cytologic samples and their

non-adenocarcinomas. Due to the reduction of obscuring

diagnostic yield compared with conventional smear cytolo-

elements and the optimal preservation of the cells, LBC

gy. Bronchial brushing cytology is one of several methods

preparations allow a more definitive diagnosis in manyfor establishing confirmative diagnosis of lung lesions. The

cases. These findings can provide important clinicalpurpose of this study was to determine the diagnostic

implications for selecting the proper diagnostic tools.

concordance of lung carcinoma subtypes in cytology andtissue specimens. The possible factors related to thediagnostic quality of liquid-based cytology (LBC) wereanalyzed.
【Methods】A total of 85 patients with suspicious lungcancer were enrolled in this study. The bronchial brushingsamples were prepared by LBC (SurePath), and both
endoscopically visible and non-visible lesions were included. The data were then compared to the histology of lungtissue samples and the clinical factors. The diagnostic
concordance of carcinoma subtypes was evaluated. The
slides from discordant cases were reviewed, and final
diagnoses were made based on immunohistochemical
studies. The sensitivity of liquid-based cytology (LBC)
were also compared to the outcomes of conventional smear
cytology (CSC).
【Results】According to the biopsy and resection specimens, malignant tumors were diagnosed in 38 cases. They
included adenocarcinoma (42.1％), squamous cell carcinoma (39.5％), non-small cell carcinoma, not otherwise
specified (10.5％), and neuroendocrine carcinoma(7.9％). For the diagnosis of histologically confirmed lungcancer, the overall sensitivity of LBC was 63.2％.
Concordance in subtype diagnosis was achieved in 70.8％
of cases. The diagnostic accuracy was higher in nonadenocarcinoma (75.0％). The mean tumor size in the
non-corresponding cases was smaller than the correspond-

26PE-1-5

Metastatic lung cancer of endometrium ―detected and confirmed by conventional

PE-1-6Morphological changes in Doxorubicin
resistant small cell carcinoma

Papanicolaou (Pap) smear with immunocytochemical (ICC) stains
Department of Pathology, Taipei Veterans General Hospital, Taiwan

Department of Medical Technology, Kumamoto Health
Science University, Kumamoto, Japan○Chia-Min Wei，
Yu-Shi Liu，Shiou-Feng Liu，
Chiung-Ru Lai○Masami Nambu，Hiroki Kameyama【Objective】We described a case of metastatic lung cancer【Objective】In most cases of small cell lung cancer (SCLC),of the endometrium, which was detected by conventional

SCLC has already spread by the time it is found, so

Pap smear. The cytological hints for endometrial lesion andchemotherapy is usually part of treatment if a person isusefulness of ICC on conventional Pap smears were

healthy enough. The tumor cells resistant to chemotherapy

emphasized in the current report.

are considered to show peculiar cellular changes for the【Methods】A 47-year-old woman diagnosed to have a stage

action mechanism of the anticancer drug. This time, we

IV lung adenocarcinoma with EGFR L858R mutation andconfirmed cytomorphological changes seen in Doxorubicin

multiple metastases, including bone, brain, adrenal glandresistant small cell carcinoma.

and mediastinal lymph nodes. She was referred to GYN【Methods】Wild type and Doxorubicin resistant typesection due to abnormal vaginal bleeding. Conventional Pap

culture cell line of SCLC (H69) were used for this study.

smear was done. Endometrial sonography and curettage

The area, the circumference, the major and minor axis

were performed due to malignant Pap smear result.

length of both cytoplasm and nucleus were measured. And,

【Results】Clusters of adenocarcinoma cells were degener-

with the measured values, the mean area, the standard

ated and surrounded by endometrial stromal-like histio-

deviation of the area, N/C (nucleus/cytoplasm ratio), thecytes, which represented characteristic hints for shedding

ellipticity, the peround and the pleomorphism werefrom endometrium rather than endocervix. ICC stains

calculated. About nucleolus, number was counted and therevealed positive TTF-1 and negative PAX-8 results,area was measured.

which concurred with the origin from lung metastasis. A【Results】In the area of both cytoplasm and nucleus,

diagnosis of metastatic lung adenocarcinoma of theresistant type was 2 times larger than wild type and showedendometrium was given by Pap smear, which was further

wider size variation. About nucleolus, resistant type wasconfirmed by pathology of endometrial curettage. Target

larger than that of wild type in number and varied in size.

and chemotherapy continued and further surgery for uterus

The nucleus of resistant type was more pleomorphic than

was not given.

that of wild type.

【Conclusion】Although it is generally accepted that the aim【Conclusion】This study revealed that Doxorubicin resist-of Pap test is primarily to detect squamous lesions,ant type showed quite different feature from wild type small

endometrial and extra-uterine cancers might appear on thecell carcinoma. There is a possibility of leading to

Pap smears in our routine practice. The recognition of

misdiagnosis on histological typing when we makecytomorphological hints for endometrial origin and addition-

cytodiagnosis in Doxorubicin resistant case of small cellal ICC stains were important in making correct diagnoses,

carcinoma. This time, we studied cellular changes only inwhich could avoid unnecessary surgery.

Doxorubicin resistant SCLC, and it can be considered that
there are many patterns of cellular change due to resistanceto other anticancer drugs. Therefore we keep it in mind
when we make cytological diagnosis of recurrent cases
underwent chemotherapy.

27

Although the sensitivity of needle aspirate is high, the major

PE-1-7The cytomorphological characteristics

diagnostic problem with fine needle aspiration is related toand clinicopathological features of ana-

sample quality. Tumor necrosis, hemorrhage, leukocytic

plastic thyroid carcinoma：A case cohort
study from Taiwan

infiltration and extensive fibrosis may lead to diagnostic
difficulties. It is crucial to diagnose it early, due to the poor

Department of Pathology, Ditmanson Medical Foundation
1)
Chia-Yi Christian Hospital, Chiayi, Taiwan ，Department of
Cosmetic Science, Chia Nan University of Pharmacy and2)
Science,Tainan, Taiwan ，Executive and managing supervisor, Taiwan Society of Clinical Cytology

3)○Chien-Chin Chen

1,2,3)【Objective】We aim to analyze the cytomorphologicalcharacteristics in fine needle aspiration and the clinicopathological features in anaplastic thyroid carcinoma (ATC).
【Methods】A retrospective slide review and analysis ofeight histologically-proved cases and preoperative six fineneedle aspirates with ATC admitted to the Ditmanson
Medical Foundation Chia-Yi Christian Hospital, Taiwan, in
2001-2016.
【Results】A total of eight cases with ATC are reviewed
with a mean age of 71.6 years, mild male predominance(M：F＝5：3) and preoperatively euthyroid status (8/8).
All patients are died with a mean survival of 6.1 months(range：1 to 12 months), regardless of different treatment
modalities. The average size of tumor is 7.2 cm (range：
5.4 to 9 cm), and all of them have distal metastases (lung：
7/8, bone 1/8). Six of them have preoperative fine needle
aspirates, and 1 (16.7％) was inadequate, 2 (33.3％)
suspicious for malignancy and 3 (50％) diagnostic ofmalignancy. On reexamination, they are intermediate orhigh cellularity, except the inadequate case shows only
blood cells. All of the cellular aspirates revealed mixed
cellular patterns, including 1) spindle cell (3/5), epithelioid
cell (5/5), giant cell (2/5) and squamoid cell (3/5), withnecrosis (4/5), leukocytes infiltrate (4/5) and calcification(1/5). No colloidal background, nuclear grooves andpseudoinclusion are found. In the surgical specimens, three(37.5％, 3/8) patients have co-existing minor componentsof convention papillary carcinoma (5％ to 30％ of tumor
proportion).
【Conclusion】Our results support the clinical aggressiveness, mixed cellular patterns and lack of nuclear features ofpapillary carcinoma in cytology specimens for ATC.

prognosis.

28PE-1-8

Cytological Differential Diagnoses be-

PE-1-9Noninvasive follicular thyroid neoplasm

tween Chronic Thyroiditis and MALT

with papillary-like nuclear features

Lymphoma on Thyroid LBC(NIFTP) ― A newly proposed terminology

Department of Laboratory Science, Kuma Hospital, Kobe,
1)
Japan ，
Department of Diagnostic Pathology and Cytology,

Department of Pathology, Taipei Veterans General Hospital, Taiwan

Kuma Hospital, Kobe, Japan ，Department of Surgery,3)
Kuma Hospital, Kobe, Japan
2)○Chiung-Ru Lai，
Yen-Ying Chen

○Ayana Suzuki ，Mitsuyoshi Hirokawa ，1)
1)
1)
Miyoko Higuchi ，Nami Takada ，Aki Ito ，1)

2)

Naoki Yamao ，Toshitetsu Hayashi ，Seiji Kuma ，
1)

2)

2)

3)

Akira Miyauchi【Objectives】Chronic thyroiditis with nodular formation【Objective】Noninvasive follicular thyroid neoplasm withmay undergo aspiration cytology to distinguish from MALT

papillary-like nuclear features (NIFTP) is a new terminolo-

lymphoma (ML). The cytological distinction between

gy proposed for those tumors previously called encapsulat-

nodular chronic thyroiditis (NCT) particularly associateded follicular variant of papillary thyroid carcinoma

with predominant lymphocytes and ML has been frequently(EFVPTC). Since it almost behaves as benign lesion, it willtroublesome. In addition, the morphology in LBC speci-

be no longer called�cancer�. The aim of this study is tomens (LBC-S) is not same to conventional specimens (C-report the frequency, clinical characteristics, cytology

S). The aim of this report is to clarify the difference of

results and follow up of such cases in our hospital.
【Methods】By reviewing histological slides, cases ofcytological findings between NCT and ML on LBC-S.
【Materials and Methods】We reviewed LBC-S of 19 NCT
cases and 21 ML cases confirmed by histologic examinationin our hospital. LBC samples were obtained from wash-out
TM

NIFTP were retrospectively identified from those tumors
originally diagnosed as follicular variant of papillary thyroid
carcinoma (FVPTC), well-differentiated tumor of uncertain
malignant potential (UMP) and follicular tumor withfluid of the aspiration needles, fixed with Cytorich-RED ,and prepared by SurePathTM

questionable nuclear atypia, from January 2010 to Decemmethod.

【Result】In C-S, the incidence of lymphoglandular bodies
was higher in ML (66.7％) than in NCT (21.1％). In
61.9％ of ML and 5.3％ of NCT cases, lymphoid cells with
the nuclei measuring more than 10 mm occupied more than
10％ of all lymphoid cells. Lymphoid cells associated withber 2011. The clinical and pathological correlation andcytology findings were analyzed.
【Results】There were 389 patients with pathology proved
primary thyroid cancers in the years of 2010 & 2011.
Among them, a total of 18 cases of NIFTP (4.6％ ofprimary thyroid cancers) were identified with female

mesh-patterned, elongated, and cleaved nuclei werepredominance, 15 female (age 23-65, median 45) & 3 malesignificantly observed in ML cases (95.2％, 90.5％, and(age 15-43, median 21). The tumor size ranged from 1.1 to90.5％) compared with NCT cases (26.3％, 42.1％, and4 cm. Median follow up was 62 months, None of these

15.8％). Oxyphilic follicular cell clusters were more seen

patients received radioiodine therapy. All are alive withoutin NCT (94.7％) than ML (42.9％).

evidence of disease. Using Bethesda System for reporting【Conclusion】More than 10％ of lymphoid cells with ＞10

thyroid FNA, over half of the cytology results were

mm nuclei, mesh-patterned nuclei, elongated nuclei, andintermediate categories (with nuclear enlargement and/or

cleaved nuclei are diagnostic clues indicating ML.

optically clear nuclei and/or nuclear groove) (TBS I： 1(9％)； TBS II： 3 (27％)； TBS III： 3 (27％)； TBS
IV：3 (27％)；TBS V：1 (9％)；TBS VI：0 (0％).
【Conclusion】The current study supported the reclassification of EFVPTC to NIFTP due to its almost benign
behavior. FNA frequently revealed intermediate cytologicalresults and could not reach reliable diagnosis preoperatively. More cases are needed for further evaluation.

29

Bethesda reporting system is an available diagnostic system

PE-1-10

Rapid onsite eveluation is urgent toand should be applied around the whole country of China.

improve the adequacy rate of thyroid

The most accurate diagnosis is the Malignancy group andFNA-based on the retrospective study of2838 cases of thyroid fine needle aspiration from Chinathen the indeterminate group. The diagnosis of indeterminate group was impacted by both the quality and thequantity of the cells. The malignancy risk in benign group is

Department of Pathology, School of Basic Medicine,1)
Shandong University, PR China ，Department of Pathology, Qilu Hospital, Shandong University, PR China ，De-high because of the not so good puncture accuracy. The rate
for Non-Diagnostic/Unsatisfactory group was high, which2)partment of Endocrinology, Qilu Hospital, Shandong
3)
University, PR China ，Department of Thyroid Surgery,4)

Qilu Hospital, Shandong University, PR China

was probably due to the poor cell quantity in initial period.
Therefore, rapid onsite eveluation should be applied to
improve the adequacy of the FNA and to avoid missdiagnosis and misdiagnosis, especially in the early stage of○Zhiyan Liu ，Peng Su ，Xiaofang Zhang
3)4)
4)
Jiang Ling ，Qingdong Zeng ，Bin Lv
1,2)

2)

，

1,2)

【Object】Fine-needle aspiration (FNA) with ultrasonography guidance is one of the optimal techniques for the
diagnostic evaluation of thyroid nodules and it was the initial
two years for thyroid FNA in our diagnostic center. This
study was proposed to evaluate the adequacy rate andaccurate rate of thyroid FNA samples using the Bethesda
reporting system for thyroid cytopathology (TBSRTC).
【Methods】Retrospective study was perfected on 2838
cases of thyroid FNA with routine H&E staining. They
were divided into 6 groups according to TBSRTC, which
were： Non-Diagnostic/Unsatisfactory, benign, atypia ofuncertain significance/follicular lesion uncertain significance, follicular neoplasm/suspicious for a follicular neoplasm, suspicious for malignancy and Malignancy. The
comparison of cytopathological and histopathological samples was performed on 791 cases underwent surgicaloperation.
【Results】Non-Diagnostic/Unsatisfactory samples were
3.56％ (101/2838), the benign lesion accounts for
44.68％ (1268/2838), FN/SFN accounts for 0.18％ (5/2838), suspicious for malignancy accounts for (401/2838),
malignancy accounts for 30.58％ (868/2838).The risk ofmalignancy was 34.44％ (31/90) for Benign lesion,
70.83％ (17/24) for AUS/FLUS, 69％ (138/200) for
Suspicious of malignancy, 97.03％ (457/471) for Malignancy.
【Conclusion】FNA is reliable preoperative diagnostic
method for thyroid lesion. H&E staining is reliable for the
diagnosis of thyroid FNA sample, which is the routine
staining for surgical specimens and easy to be paralleled.

the FNA center.

30

PE-1-11

Atypical adenoma of thyroid glandPE-1-12

Diagnostic accuracy of initial benign

cytologically mimicking papillary carci-

cytology in thyroid nodules with highly

noma；A case reportsuspicious ultrasonographic features

Department of Pathology, Fukuoka University Chikushi
1)
Hospital ，Department of Medical Technology, Kumamoto

Hospital ，Department of Internal Medicine, Kuma
3)
4)
Hospital ，Department of Surgery, Kuma Hospital2)2)

Health Science University○Ryo Hayashida ，Masami Nambu ，1)1)Masahiko Harakawa ，Satoko Ogata ，1)

Department of Diagnostic Pathology and Cytology, Kuma
1)
Hospital ，Department of Clinical Laboratory, Kuma

○Toshitetsu Hayashi ，Mitsuyoshi Hirokawa ，2)
3)
4)
Miyoko Higuchi ，Takumi Kudo ，Akira Miyauchi

2)

1)

1)

Shizuka Yamada ，Hiroshi Tanabe ，Seiji Haraoka ，1)

Akinori Iwashita

1)

1)

1)

【Background】Atypical adenoma of thyroid is a variant of【Objective】A definite cytology is essential for appropriate

follicular adenoma and shows strong structural and cellulartreatment of thyroid nodules. However, the diagnostic

atypia. We present a case of atypical adenoma we suspected

accuracy of initial benign cytology and the role of repeat fineof papillary carcinoma in pre-operative cytology.

needle aspiration (rFNA) for nodules with highly suspi-【Case】78-year-old, male. Ultrasonography revealed acious ultrasonographic features (NHSUF) are not wellsolid mass 2 cm in diameter in right lobe of thyroid gland.

established.

Fine needle aspiration cytology (FNAC) was performed【Methods】Retrospective study of 73 NHSUF cases withand showed a small number of atypical cells appearing to be

initial benign cytology and subsequent rFNA was per-isolated or forming small follicular cluster. They wereformed. All slides were reviewed with detailed evaluation ofalmost naked and their nuclei showed anisonucleosis,

the cytological features, diagnostic accuracy and comparedcleaved shape, groove and intranuclear cytoplasmic inclu-

with the clinicopathological information.

sion bodies. And eosinophilic nucleoli were observed. With

【Result】Upon rFNA, cytological diagnoses of benign andthe cytological findings, we made a diagnosis of�suspicious

malignancy were 40 (54.8％) and 33(45.2％), respective-of papillary carcinoma�. In consideration of cytologically. By reviewing initial benign FNA slides, the false

diagnosis, resection of right lobe of thyroid gland was

negative rate was 8.2％ (5/73). In the cases showing

performed. Histologically, the tumor 1.5 cm in diameterabundant colloid and numerous foamy cells on cytology andwas encapsulated and showed micro-follicular structure andno calcification on ultrasound, both initial and repeated FNA

solid proliferation of atypical cells showing irregular shaped

were benign. Therefore, these parameters were highly

nuclei varied in size, nuclear grooves and intranuclear

predictive of benign lesions.

cytoplasmic inclusion bodies. But neither capsular invasion【Conclusion】The combination of the reviewing thenor vascular invasion was found. Immunohistochemically,cytology preparations and rFNA can increase diagnostic

tumor cells were positive for thyroglobulin and TTF-1, andaccuracy and determine the clinical management ofnegative for CK19, HBME-1, calcitonin and p53, and Ki-67

NHSUF. However, rFNA is not necessary in NHSUF

labeling index was less than 1％, then the pathologicalshowing abundant colloid and numerous foamy cells on

diagnosis was made as atypical adenoma.

cytology and nodules without any internal calcification on【Conclusion】This case was very difficult to makeultrasound.

cytological diagnosis on the ground of poor cellularity andsevere cellular atypia mimicking papillary carcinoma.
Therefore we should keep this important experience ofatypical adenoma in our mind and consider the possibility ofatypical adenoma when we suspect of papillary carcinoma
on the ground of such cellular atypia as nuclear groove andintranuclear cytoplasmic inclusion body.

31

PE-1-13

Anal Cytology Among Men Who Have

PE-1-14

Mucinous carcinoma admixed with neu-

Sex with Men In Taiwan ― Correlation

roendocrine carcinoma of the uterinewith Pathology, p16/ Ki- 67 Stain and
HPV Assay

cervix：cytological features and immunohistochemical profile： Report of acase

Department of Pathology, Taipei Veterans General Hospital, Taiwan

Department of Diagnostic Pathology, Kumamoto University Hospital, Kumamoto, Japan○Li-Ya Lin，
Chiung-Ru Lai，
Chih-Yi Hsu○Tatsuya Katafuchi，Makoto Mori，Naoko Nishiyama，
Yoshiki Mikami【Objective】In recent years, anal cytology has gained【Backglound】Neuroendocrine tumor of the uterine cervix

acceptance as a tool for anal cancer screening for high risk

generally shows an aggressive clinical behavior. A case ispopulations, especially men with sex with men (MSM) withdescribed of intestinal-type mucinous carcinoma of theor without HIV infection, in a role similar to the Pap test.

uterine cervix, admixed with neuroendocrine carcinoma

The purpose of this study is to evaluate the efficacy of anal

imparting a resemblance to atypical carcinoid.

cytology for screening anal squamous epithelial lesions and【Case】A 40-year-old woman with abnormal genital

its correlation with HPV assay and p16/Ki-67 stain.

bleeding was referred to the hospital, and on admission【Methods】Patients from special clinics for MSM who

cervical smear and biopsy were taken. The smear showed

completed a detailed sexual behavior questionnaire wereclusters of small atypical cells with occasional rosette-likeincluded in this study, from August 2015 to July 2016. Analarrangement. Those cells had granular eosinophilic cyto-

cytology was collected in one BD SurePathTMvial for liquid-

based preparation (LBC). HPV assay (BD Onclarity

TM

plasm and round nuclei with fine or granular chromatin

HPVtexture and small nucleoli. Examination of the biopsy

assay) and p16/Ki-67 double staining (CINtec PLUS) were

specimen demonstrated sheets of cells partially arranged inperformed using residual LBC material. Biopsy wasrosette-like pattern, and the histopathologic diagnosis ofperformed in conjunction with high-resolution anoscopy

well-differentiated neuroendocrine tumor was established(HRA) for positive cytology or HRA results.

based on immunoreactivity for chromogranin-A, synapto-【Results】A total of 71 patients were included in the current

physin. In addition, combined with high Ki-67 labelingstudy. Cytology results were negative in 22 (31％)；ASC

index, i. e., exceeding 50％, and empirical evidence, thein 11 (15％)； LSIL in 19 (27％)； HSIL in 19 (27％).

possible co-existence of adenocarcinoma was suggested,

HPV and p16/Ki-67 double staining (CINtec PLUS)

and the attending physicians were advised to manage thepositivity were statistically correlated with cytology

patient as such. Consequently, she underwent radical

severity：50％ & 6％ in negative；60％ & 20％ in ASC；hysterectomy. Grossly the resected uterine tumor showed

94％ & 47％ in LSIL； 92％ & 60％ in HSIL (P value

polypoid appearance, and microscopic examination revealed

0.006； 0.004). The genotypes of HPV assay were： P2

that the polypoid portion was composed of well-differentiat-(39％, HPV 56/59/66)； P1 (37％, HPV 33/58)； P3

ed neuroendocrine carcinoma resembling atypical carcinoid(26％, HPV 35/39/68), HPV 52 (25％)； HPV 16

tumor. Underneath the polypoid tumor, we identified(19％)； HPV 18 (19％)； HPV 45 (16％)； HPV 51

mucinous carcinoma of intestinal-type as well as adenocar-(16％)；and HPV 31 (12％). Two of 6 (33％) with LSIL

cinoma in situ showing intestinal phenotype. Small cell or

and all HSIL (100％) cytology patients show HSIL on

large cell neuroendocrine carcinoma components were notcorresponding biopsy.

【Conclusion】Non-small cell/large cell neuroendocrine【Conclusion】MSM represents high risk population for anal

identified.

HPV infection but the prevalence (carrier status： 50％)

carcinomas rarely arise in the uterine cervix, and appear toand common HPV types (56/59/66；33/58) are different

be frequently associated with adenocarcinoma. The cytology-pathology correlation is mandatory for optimal patientfrom those of cervical smears in women. The majority(69％) of anal cytology among this high risk group isabnormal and showed high predictive value of HSIL. The
p16/Ki-67 double staining was statistically correlated withanal cytology severity, which might aid the cytology
diagnosis.

management.

32

PE-1-15

A cytopathological overview of 5 cases

PE-1-16of lobular endocervical glandular hyper-

The various cytological appearances ofuterine carcinosarcoma

plasiaDepartment of Pathology, Saiseikai Noe Hospital, Imperial
1)
Gift Foundation Inc., Osaka, Japan ，Department of Obstet-

Department of Obstetrics and Gynecology, Kohsei Chuo
1)
General Hospital ，Department of Clinical laboratory,

rics and Gynecology, Saiseikai Noe Hospital, Imperial Gift
2)
Foundation Inc., Osaka, Japan

Kohsei Chuo General Hospital○Shinsuke Shibuya ，Takayuki Kido ，1)
1)
1)
Sachiko Takayasu ，Satsuki Egi ，Seiko Ogura ，○Hisami Kiseki ，Yutaka Tsukahara ，1)
2)
Naohiko Hashimura ，Natsumi Tajima ，1)

1)

Akihiko Ueda ，Keiko S. Yano
2)

1)

2)

1)

1)

Ayako Tanaka ，Aya Horimoto2)

2)【Background】Lobular endocervical glandular hyperplasia【Introduction】We will discuss our findings in regard to the(LEGH) is an endocervical lesion with gastric-type

cytological appearance of carcinosarcoma which has compli-

metaplasia and also a precursor lesion to mucinous

cated reoccurrences on the vaginal stump during post-(gastric-type) adenocarcinoma. The most important differ-

operative chemotherapy.

ential diagnosis of LEGH is adenocarcinoma, including【Case】We examined a 69 year-old woman who had amucinous carcinoma/minimal deviation adenocarcinoma,
which has similar clinical, radiological, immunohistochemi-

history of breast cancer stage II A. Two years ago she
received a debulking operation for uterine carcinosarcoma

cal features. Five cases of LEGH are reviewed clinically,at her prior hospital. The patientʼs post-operative chemocytologically, and histologically.
【Patients】Recent 3-year period surveyed from 2014

therapy began at our hospital.
【The clinical course】The 1stline chemotherapy wasthrough 2016, LEGH were pathologically diagnosed in a
total of 5 patients. The mean age of the patients was 50

performed with�TC�therapy. The cytology on the vaginal

years (range, 46 to 59 years). All patients werestump was normal but became worse, and developed

symptomatic [cervical mass (5), genital bleeding (2), andatypical squamous cells cannot exclude high grade squa-increased watery discharge (2)] and isolated LEGH.

mous intraepithelial lesion (ASC-H) and adenocarcinoma【Cytological findings】Four cases were reported as�AGC�

over 5 months. Next 6 courses of�IFM/CDDP/ADM�

and 1 case as�NILM�. The cytoplasm of all�AGC�cases

were administered. The cytological report revealed atypicalcontained abundant mucin. With a conventional Papanico-squamous cells of undetermined significance (ASC-US)laou stain, mucin was stained orange in our facility. In

and atypical glandular cells (AGC). The pathologicaladdition, the distinctive cellular clusters surrounded bydiagnosis was adenocarcinoma on the vaginal stump. Aftercotton-candy-like abundant mucin were recognized. Nuclei

the 3 line�DOC/GEM�therapy was performed, patho-

were round and mildly enlarged with fine chromatin andlogically the tumor disappeared. AGC, ASC-H and adeno-

micronucleoli. Intranuclear cytoplasmic inclusions (INCIs)
were also identified.
【Histological findings】Small to moderately sized roundrd

carcinoma were found again during the next chemotherapy.
Gradually other small adenocarcinomatous tumors werethfound on the patientʼs vulva. We performed the 6 line
glands proliferated in a distinct lobular fashion, surrounding

�CBDCA/PAC/BV�therapy which included radiation

larger and dilated central gland. Nuclei were round, uniform,
therapy and the tumors became smaller showing no
and basally located. INCIs were also identified. Intracytoplasmic mucin was immunohistochemically positive formalignant cells on her vaginal stump.

MUC6 and HIK1083.

【Comment】We hypothesize that the various histological【Conclusions】It might not be realistic to diagnose LEGH

findings were caused by the effects of the various

by cytological information only. However, exact under-

chemotherapies.

standing and recognition of the cytological characteristics isthe key to facilitate further study such as histologic
examination, and essential for proper management of
LEGH.

33

PE-1-17

A usefulness of cervical cancer screen-

PE-1-18

ing for cervical adenocarcinom

Primary Malignant Melanoma of the
Vagina ― Initially Detected by Urine
Cytology

Department of Obstetrics and Gynecology, Tokushima
1)
University Hospital, Tokushima, Japan ，Department of

Department of Pathology, Taipei Veterans General Hospital, Taiwan

Pathology, Tokushima University Hospital, Tokushima,
2)
Japan○Akiko Abe ，Masato Nishimura ，Ayuka Mineda ，1)
1)
2)
Eri Takiguchi ，Takako Kawakita ，Yoshimi Bando ，
1)

1)

1)

○Zih-Ting Wu，Chiung-Ru Lai

1)Minoru Irahara【Objective】Although cases of cervical adenocarcinoma【Objective】Primary malignant melanoma of the vagina ishave increased, it is said to be more difficult to detect in Pap

extremely rare and accounts for ＜3％ of all primary vaginal

smear than squamous cell carcinoma. To determine howmalignancies. We reported a case of primary vaginalcervical adenocarcinoma is diagnosed, we retrospectively

melanoma initially detected by urine cytology.

investigated patients with cervical adenocarcinoma who had【Methods】Urine cytology from a 61-year-old woman withreceived treatment at our hospital.
【Methods】We retrospectively investigated 58 patientsdiagnosed with cervical adenocarcinoma in situ (AIS) or

hematuria showed a picture of malignant melanoma
composed of discohesive epithelioid cells with large nuclei
and prominent nucleoli. Cytoplasm is abundant and melanin

cervical adenocarcinoma at our hospital between April 2011
pigment is identified. Because the background was clean
and November 2016. All the patients were referred to ourand devoid of apparent tumor diathesis, contamination from
hospital after either positive findings for Pap smear as
cancer screening at previous hospital or being suspected ofcervical cancer by a local physician due to signs such as

GYN tract rather than primary urinary tract melanoma wasfavored. The patient was therefore referred to GYN andbleeding or vaginal discharge. At our initial examination,

received a Papanicolaou (Pap) test, which rendered

Pap smear and biopsy were performed.

identical melanoma cells.

【Results】The median age of the patients was 53 years【Results】During GYN consultation, the presenting symp-(range： 26-87 years). Eight were nulliparous, and thetom was found to be post-menopausal vaginal bleedingremaining 50 were parous. The distribution of stage was aswhich was mistaken for hematuria by patient herself. After

follows：AIS, n＝9；IA, n＝5；IB1-IB2, n＝22；IIB, n＝meticulous clinical survey, no other primary sites could be

8；IIIA-B, n＝5, and IVA-B, n＝9. A total of 21 patientsfound. Bladder mucosa was free from tumor involvement by

were diagnosed in cancer screenings；all of these patients

cystoscope and repeat clean catch urine was negative,

were asymptomatic. Of these, 20 were in stages AIS-IB1,

which confirmed that melanoma cells in urine were fromand we could diagnose and treat at early stage. The
remaining 37 patients were diagnosed in gynecological

GYN contamination. Then, complete staging surgery was
performed and confirmed a stage III primary vaginal

examinations；four of these patients had vaginal dischargemelanoma.
with no irregular bleeding, and other 33 had abnormal【Conclusion】Abnormal vaginal bleeding could be mistaken

bleeding. In addition, the initial cytological screening
for hematuria which might mislead the workup and delay
revealed NILM for 5 patients, squamous epithelial abnormality for 14 (ASC for 3 patients, HSIL for 5 and SCC for

the correct diagnosis. The recognition for possible GYN

6) patients, and glandular abnormality for 35 patients (AGC

contamination of cancer cells in urine is very important forfor 11 patients, AIS for 1, adenosquamous carcinoma for 1,

tumor origin confirmation. Primary malignant melanoma ofand adenocarcinoma for 22).

vagina, an extremely rare malignancy, may successfully be【Conclusion】Overall cervical adenocarcinoma was diag-

detected by urine cytology.

nosed by cancer screenings in 36％ (21/58) of patients. In
particular, 64％ (20/31) of patients up to stage IB1 werediagnosed in cancer screenings with asymptomatic.

34

cytokeratin 20 and CDX2. The final pathological diagnosis

PE-1-19

Primary intestinal- type mucinous adenocarcinoma of the vulva

was intestinal-type mucinous adenocarcinoma of the vulva(pT1bN0M0).
【Conclusion】Primary intestinal-type mucinous adenocar-

Departments of Obstetrics and Gynecology, University of1)
Occupational and Environmental Health, Japan ，Departments of Nursing of Human Broad Development, Universi2)
ty of Occupational and Environmental Health, Japan○Tomoko Kurita ，Taisei Honda ，Rie Urabe ，1)1)1)
Taeko Ueda ，Seiji Kagami ，Toshinori Kawagoe ，
1)

1)

1)

Yusuke Matsuura ，Toru Hachisuga
2)

1)【Background】Adenocarcinomas of the vulva are rarediseases, and usually arise in a Bartholin gland or occur inassociation with Pagetʼs disease. Adenocarcinoma of theintestinal type of the vulva is an extremely rare neoplasm,
and a few cases have been reported to date. We report acase of primary villoglandular mucinous adenocarcinoma
arising in the surface epithelium of the vulva near theurethra.
【Case report】A 63-year-old woman, gravid 3, parity 2, wasreferred to our hospital because of postmenopausal
bleeding. A papillary and easy contact bleeding mass with 18
mm in diameter was seen near the urethra. Magnetic
resonance imaging (MRI) of the pelvis revealed a 18 mmsized enhanced mass, and uterus and both ovaries werenormal shape and size. Scrape cytologic specimen from thevulvar tumor revealed atypical epithelial cells in mucinous
background. Tumor cells formed loose clusters, and thecytoplasm had enrich mucinous material. Nuclei of tumor
cells were elongated. Biopsy specimen showed a proliferation of signet ring cells embedded in an abundant myxoid
stroma and irregular tubular structures of atypical columnar
epithelium were seen. An extensive workup, including
systemic positron emission computed-tomography (PETCT) and gastrointestinal tract fiberscope were performed,
but any other cancers or metastases were detected. Radical
vulvectomy and bilateral superficial inginal lymph nodedissection and Cloquet lymph node biopsy were performed.
Mass was 2 cm in diameter and the depth of stromalinvasion was 1 mm. The tumor was composed of papillary
and complex glandular structures lined by large columnar
cells with hyperchromatic nuclei. Cancer cells contained
mucinous materials in the cytoplasm. Immunohistochemically, the tumor cells showed diffuse positive staining forcinoma is very rare tumor and the cause is unknown.
Further cases need to clarify the diagnositic criteria and to
determine a successful treatment modality.

35

PE-1-20

The findings of cervical smears in

PE-1-21

Characteristics of intraoperative cytolo-

women with endometrial carcinoma-gy for accurate diagnosis of mucinous

Any hint of endometrial lesions andprognostic significance?

borderline ovarian tumor

Departments of Obstetrics and Gynecology, Shonan
1)
Kamakura General Hospital ，Departments of Clinical2)
Laboratory, Shonan Kamakura General Hospital ，Departments of Diagnostic Pathology, Shonan Kamakura General3)
Hospital○Kazuya Onuma ，Kazuhiko Obokata ，2)
2)
1)
Shu Hodoshima ，Hidenori Chino ，Hiromi Inoue ，1)

Shinichi Teshima

2)

3)

Department of Obstetrics and Gynecology, Saiseikai Noe
1)
Hospital, Imperial Gift Foundation Inc., Osaka, Japan ，Department of Pathology, Saiseikai Noe Hospital, Imperial
2)
Gift Foundation Inc., Osaka, Japan○Akihiko Ueda ，Keiko S. Yano ，Takayuki Kido ，2)
2)2)
Seiko Ogura ，Satsuki Egi ，Sachiko Takayasu ，
1)

2)

2)

2)

Shinsuke Shibuya【Objective】Pap smear is to detect cervical precancerous【Objective】Accurate and efficient intraoperative diagnosis

lesions and cancers. It may also exhibit cytological findingsof mucinous borderline ovarian tumor (mBOT) is challeng-

to be the hint of endometrial lesions. This study

ing. The aim of this study was to evaluate the characteris-investigated whether Papanicolaou (Pap) smears show

tics and diagnostic capability of cytological techniques such

cytological findings leading to detect endometrial carcinoma

as squash smears and touch imprints for mBOT.

(EMCa), and is associated with any histologic parameters.

【Methods】Our retrospective study included a consecutive【Methods】Among forty three cases of EMCa surgicallycase series of 18 patients with mBOT, who were examinedtreated and staged at our institution in a two year period, 40

using intraoperative cytology at the Saiseikai Noe Hospitalcases with routine Pap smears within six months prior to

between 2006 and 2016. The diagnoses were reviewed withsurgery were subjected to this study. The Pap findings

reference to the histopathological analysis of paraffin-

including interpretation, presence/absence of endometrial

embedded tissue section.

cells were recorded for each case, and analyzed in relation【Results】Intestinal and seromucinous types of mBOT

to histologic parameters including histologic type, grade,were diagnosed in 17 (94％) and one (6％) cases,stage and tumor size.

respectively. Touch imprint cytology of 1 case (6％)

【Results】Eleven cases (27.5％) had Pap findings sugges-

showed papillary-like tumor architecture, and half of thetive of EMCa, and 30 cases (72.5％) had negative cytology

remaining 16 cases indicated scant epithelial components,(NILM). Only one case with negative Pap (2.5％) had thewhile the other half revealed sheet structure. The

presence of endometrial cells which should be reported as

background was relatively clear without necrotic material.

per the Bethesda system (TBS). The positive Pap group

In contrast, the squash smear revealed papillary-like orcomprised 8 low grade endometrioid carcnomas (LGEC), 1

ball-like architectures in 17 cases (94％), with mild and nohigh grade endometrioid carcinomas (HGEC), 1 serous

cytologic atypia in 2 and 15 cases, respectively.

carcinoma (SC) and 1 small cell carcinoma (SCC), and the【Conclusion】In the intraoperative diagnosis of mBOT,

negative Pap group did 23 LGEC, 2HGEC and 3 SC.

touch imprints may be suitable for the observation of the

Positive Pap or EMCs were not associated with any

background, whereas squash smear may be accurate for thehistologic parameters including cervical involvement anddetection of architectural atypia. Combination of both

tumor size.

techniques is recommended to improve the diagnostic【Conclusions】In contrast to previous reports, our study

accuracy.

demonstrated lower sensitivity of Pap smear to detect
EMCa. Despite TBS category, the presence of EMCs is rarein EMCa cases. There is no specific association between
Pap findings and histologic parameters.

36

PE-1-22

Cytologic features of malignant Bren-

PE-1-23

ner tumor：A case report

Cytologic features of Papillary squamotransitional cell carcinoma in Liquidbased cytology ：A case report

Department of Diagnostic Pathology, Kumamoto University
Hospital, Kumamoto, Japan

Department of Pathology, Seoul National University
Bundang Hospital○Makoto Mori，Tatsuya Katafuchi，Naoko Nishiyama，
Yoshiki Mikami○Younghwa Choi，
Jihye Kim，
Juhyeok Park，
Daehyun Hwang，
Jin-haeng Chung，Haeryoung Kim【Background】Malignant Brenner tumor is uncommon【Background】Papillary squamotransitional cell carcinoma

neoplasm. We describe cytologic features of malignantof the uterine cervix is an uncommon tumor that tends to be

Brenner tumor identified in ascites.

recurrent and has metastases. Tumors can be divided three【Case】A 80-year-old woman was referred to hospitalgroups based on there histologic appearance： predomi-

because of abdominal distension, and imaging studies

nently squamous, predominently transitional and mixed
squamous and transitional.

demonstrated a left ovarian mass. Microscopic examination【Case】A 77-year-old female was referred to SNUBH forof the ascitic fluid revealed isolated or small clusters offurther evaluation of a cervical lesion diagnosed as ”high-highly atypical cells, showing heterogeneity in nuclear sizes

grade squamous intraepithelial lesion (HSIL) with papillaryand shape. Occasional cells showed squamoid appearance aspattern” at an outside hospital. Colposcopy was performed,

well as intracytoplasmic mucin droplets. These features

and a protruding neoplastic mass was seen in the exocervix.

suggested high-grade adenocarcinoma, but immunohisto-

A punch biopsy with curettage was performed, and achemistry for cell-block demonstrated that atypical cells

diagnosis of papillary squamotransitional cell carcinoma waswere positive for pancytokeratin (AE1/AE3), cytokeratin

rendered. She had a hysterectomy, and on routine

5/6, p63, and were negative for p53, WT1, estrogen

colposcopic examination two years later, the vaginal stump

receptor, calretinin. Based on these findings, differential

was friable and eroded. A cervicovaginal smear and punch

diagnosis included squamous cell carcinoma, high-grade

biopsy was taken under the impression of a stump
recurrence.

endometrioid carcinoma and malignant Brenner tumor. She【Results】The liquid-based cytology preparation of theunderwent total hysterectomy, bilateral salpingo-oophoreccervicovaginal smear demonstrated a few papillary tissue
tomy, and omentectomy. Extensive sampling identified

fragments and many scattered atypical cells. The papillarycomponents of proliferating Brenner tumor, and thus thefragments contained fibrovascular cores and were lined bydiagnosis of malignant Brenner tumor was established.

loosely cohesive epithelial cells. The background was【Conclusion】In general, high-grade morphology in ascetic

cellular and showed individually scattered atypical cells withfluid may suggests high-grade serous carcinoma, buthigh nuclear/cytoplasmic ratio, nuclear hyperchromasia,

features of divergent differentiation, i.e., mucin droplets andirregular nuclear membranes, consistent with high-grade

squamous differentiation should make malignant Brenner

squamous intraepithelial lesion (HSIL) cells. There was notumor a diagnostic concern.

definite evidence of HPV cytopathic effect (koilocytosis).
The concurrent punch biopsy tissue demonstrated abundant
papillary excrescences with marked cytologic atypia and thetumor cells partly resembled urothelial cells, consistent
with recurrent PSTCC. HPV test performed by the realtime PCR method was negative.
【Conclusion】PSTCC of the uterine cervix is a raremalignant tumor that should be distinguished from benign
papillary lesions such as squamous papillomas or condylomas. The most distinctive feature of PSTCC is the threedimensional papillary configuration with fibrovascular coresand scattered HSIL cells.

37

PE-1-24Single Claudin-4 immunostain has highPE-1-25Comparison of three different cell blocksensitivity and specificity to differenti-

preparations for malignant body fluid

ate adenocarcinoma from mesothelial
cells in body effusion

specimens
Department of Pathology, Taipei Veterans General Hospital

Departments of Pathology, Mackay Memorial Hospital,
Taipei, Taiwan○Bao-Rung Zeng，
Shiou-Feng Liu，
Chiung-Ru Lai○Jie-Yang Jhuang，Shu-Chen Chang【Objective】The cell block (CB) in non-gynecologic
cytopathology has gained significance because of its pivotal【Objective】For body cavity effusion specimens, it isrole in molecular diagnosis and ancillary studies. There areimportant to differentiate metastatic adenocarcinoma from

3 benefits of cell block：it could capture all of the material

reactive mesothelial cells. Since they may have overlappingin malignant body fluid specimens, obtain the highest

cytomorphology, immunohistochemical stains are required

cellular yield including tissue fragments and free-floating

to distinguish them. This study aimed to evaluate thesingle cells, and preserve the cytomorphology and architec-

diagnostic value of claudin-4 marker in making such ature. CB enables the cytopathologist to know additional

distinction in our institute.

cytomorphologic specimen detail including the architecture【Methods】In this retrospectively study, we searched ourof the lesion. Most importantly, they allow the evaluation of

database and found a total of 91 pleural/peritoneal effusions

immunocytochemistry to improve diagnostic accuracy.

have been studied, including 30 cases of metastatic【Aims】To investigate and find out the best method fromcarcinoma and 61 cases of reactive mesothelium without

three different cell block preparations for malignant bodymetastatic malignancy. Specimens were from routine body

fluid specimens.

cavity effusion collected from patients. Both cytology slides【Materials and Methods】We analyzed the cytologic

and cell blocks were prepared. The later was used forfindings of pleural effusion and ascites specimens from 35

immunohistochemical staining. Monoclonal anti-claudin-4

adenocarcinoma cases using 3 different cell block prepara-

antibody was used for immunohistochemical labeling intions：95％ alcohol, HistoGel (HG) and Gelfoam techni-

conjunction with autostainer (Ventana system). For theque. Two cytopathologists blindly evaluated H&E and IHC

interpretation criteria, membrane-bound reactivity was

sections of the 105 cell blocks from 35 specimens, andconsidered as significant and percentages of positive tumor

scored them on a scale of 0 (suboptimal, worst) to 3

cells were recorded.

(optimal, best) evaluating cellularity, cell distribution,【Results】Claudin-4 protein was positive in 31 specimens

morphology, background, pellet size, and overall quality.

(29 metastatic carcinoma and 2 reactive mesothelial cells),

Averages were then obtained and compared with each of theand negative in 60 specimens (1 metastatic carcinoma andpreparation method.

59 reactive mesothelial cells). Positive staining for claudin-【Results】Our study illustrates that if the specimens are

4 was significantly more frequent in metastatic carcinoma

not fixed, the cells cannot concentrate. The staining results

than in the reactive mesothelium (P＞0.0001). The

show that the method of 95％ Alcohol makes chromatin wellsensitivity and specificity of claudin-4 to distinguishrevealed in H&E stain, but pale in IHC stain. The methods

reactive mesothelium from metastatic carcinoma wereof HG and Gelfoam show a better staining intensity in IHC

96.7％ (95％ confidence interval [CI], 0.80947-

stains than 95％ Alcohol. In HE stain, the cellularity of HG

96.7％ (95％0.876433-

is better than Gelfoam, and the background of Gelfoam

0.994301％), respectively. Furthermore, negative likeli-

disturb the interpretation. The results indicate that the HG

hood ratio was 0.035. (95％ CI, 0.005012-0.236986).

technique succeeded in achieving the goals of capturing all【Conclusion】The results of this study demonstrated thatthe free-floating cells, preserving the cytomorphology andclaudin-4 is less frequently expressed in reactive mesothe-architecture, and better staining results.

lium and almost always expressed in metastatic adenocarci-【Conclusion】Based on our data and technique, we foundnoma. Thus, this claudin-4 may be helpful in differentiatingthat it is important to fix the specimens with 10％ formalin

metastatic carcinoma from reactive mesothelial cells inor cytorich red fixative or 95％ alcohol before doing the cell

pleural and peritoneal fluid cytology specimen with both

blocks. When there is only a little residuel specimen, doinghigh sensitivity and specificity.

a cytospin would be better than a cell block.

0.998258％)

and

CI,

38

PE-1-26

Metastatic Embryonal Rhabomyosarcoma in the Pleural Effusion

PE-2-1Long- term exposure to nicotine derivatives and arecoline accelerates and contributes to the progression of Head andneck squamous cell carcinoma

Department of Pathology, Faculty of Medicine, Chiang Mai
University, Thailand

Graduate Institute of Pathology and Parasitology, National
1)
Defense Medical Center, Taipei, Taiwan ，Tri- Service
2)

General Hospital, Taipei, Taiwan○Sarawut Kongkarnka，Tip Pongsuvareeyakul，Surapan Khunamornpong，Jongkolnee Settakorn○Chun An Ho ，Shin Nieh

【Introduction】Rhabdomyosarcoma (RMS) rarely presents

Head and neck squamous cell carcinoma (HNSCC) is one ofwith malignant effusion. Herein we report the cytologicalthe leading causes of cancer-related death in Taiwan andfeatures of metastatic embryonal RMS (ERMS) in theworldwide. Chewing betel nut, smoking, and alcoholism arepleural effusion with a literature review.

the three major risk factors which may contribute to the【Case Report】An 18 years old woman had presented with

development of HNSCC. Recent reports have demonstrated

toothache and left face bulging for 2 months. Computedthat long-term exposure to either nicotine derivatives or

tomography showed an 8.1 cm inhomogeneous enhancing

arecoline may be associated with tumor progression ofmass at left maxillary sinus with soft palate and left frontal

HNSCC. However, the underlying nicotine derivatives-or

sinus involvement. An incisional biopsy exhibited aarecoline-mediated mechanism contributing to the aggres-malignant small round cell tumor (MSRCT). ERMS wassiveness of HNSCC has not been thoroughly studied.

diagnosed. Despite chemotherapy, she developed dyspnea

Therefore, the study is aimed to evaluate the possible

from left pleural effusion three months later. Pleural fluid

phenomenon contributing to the progression of HNSCC,

cytology demonstrated high cellular specimen composed ofwith special emphasis on the reciprocal effects of both risk

numerous single, round-to oval-shaped neoplastic cells

factors in terms of cellular and molecular changes in thewith high nuclear cytoplasmic ratio within diluted blood

aggressive potential of HNSCC. In this study, the cell model

background. The tumor cell size was variable ranging fromof long-term exposure to nicotine derivatives and arecoline

2 to 5 times of the size of neutrophils. The nuclei were

was established. A comparative analysis using SCC-25 andhyperchromatic and pleomorphic noticeably, including oval,

Fadu cells with or without nicotine derivatives and arecoline

round, indented, bilobated or multilobated appearance.

exposure was performed to evaluate cell proliferation,

Large intranuclear inclusion was frequently seen. The

migration, and invasion as well as the expression ofcytoplasm was rather condensed. Immunostains for myoge-

epithelial-mesenchymal transition (EMT) marker, drug-

nin and desmin on cell block preparation slides corroborated

resistance gene expression, cancer stem cell properties,

1)

1,2)

the diagnosis of metastatic ERMS.

and anti-apoptotic activity. As a result, either long-term【Conclusion】Although the cytological features of ERMS

nicotine derivatives or arecoline exposure, or exposures toare more or less different from the other MSRCTs；rareboth risk factors was found to stimulate cell proliferation,encounter of metastatic RMS in body fluids may lead toenhance migration and invasion, induce EMT with morpho-

diagnostic difficulty or error, especially in those unknown

logical alterations in a dose-dependent manner, andcases. Desmin and myogenin stain in cell block material isattenuate apoptosis. Furthermore, either long-term nico-recommended in such cytology fluids with MSRCT as it is atine derivatives and arecoline exposure, or exposures tobeneficial and easy technique.

both risk factors promoted sphere-forming capacity,【Disclosure of Interest】None declared.

upregulation of Snail, and overexpression of CD133, CD24/
44＋, Nanog, and OCT4, and the drug resistant genes,
ABCG2 and MDR1, as well as increased resistance toradiation and chemotherapy. In conclusion, treatment of39

HNSCC with nicotine derivatives, in accordance with
exposure to arecoline elicited the similar results, whereas
exposures to both risk factors accelerated and enhanced
almost all the phenomenon in terms of the progression of
HNSCC.
【Keywords】Nicotine derivatives； Arecoline； Head andneck squamous cell carcinoma；Tumor progression

PE-2-2

The

Role

of

Cancer-associatedFibroblast-induced Chemokine (C-C motif) ligand 11 in Tumor Microenvironment Contributes to the Promotion of
Head and Neck Squamous Cell Carcinoma
Graduate Institute of Pathology and Parasitology National
1)
Defense Medical Center, Taipei, Taiwan ，Department of
Pathology Tri-Service General Hospital, Taipei, Taiwan

2)○Hsin-Jou Huang ，Shin Nieh
1)

1,2)

Head and neck squamous cell carcinoma (HNSCC) is one of
the leading causes of cancer-related death in Taiwan andworldwide. The prognosis of HNSCC is usually poor
because of its propensity of extensive invasion, local
recurrence and frequent regional lymph node metastasis,even at initial diagnosis. Recent studies showed carcinomaassociated fibroblasts (CAFs), a major type of tumorsurrounding stromal cell, generate certain mediators
through which CAFs interact with tumors and contribute tocancer progression in numerous cancers. The orchestration
between CAFs and cancer cells is complex and its
underlying mechanism needs to be explored. In the present
study, we used organotypic culture to investigate CAFs that
promote aggressive behavior of cancer cells. Using
microarray analysis, we detected abundant expression ofchemokine (C-C motif) ligand 11 (CCL11) in CAFs andidentify CCL11as a critical mediator in CAF-induced
invasiveness. We validated that CCL11 played a major rolein the crosstalk between fibroblasts and HNSCC cells via
the paracrine manner. CCL11was found upregulated in
CAFs than in normal fibroblasts via Western blot analysis.
HNSCC cells treated with recombinant CCL11 increased
capabilities of sphere formation in ten days. Administrationof CCL11 promoted migration and invasion abilities throughinduction of the epithelial-to-mesenchymal transdifferentiation with corresponding morphological alterations ofcancer cells. Counteracting CCL11 activity diminished theaggressive phenotype of cancer cells induced by CAFs. We
further studied the relationship between the expression of
CCL11 in both CAFs and HNSCC cells and clinical outcomein the patients with HNSCC. As a result, a high CCL11
expression level was associated with poor prognosis in40

terms of nodal metastasis and survival. These results
indicate that CAFs promote cancer invasiveness via aparacrine effect on microenvironmental CCL11 signaling

PE-2-3

Cytomorphology of Mammary Analogue
Secretory Carcinoma of Parotid：A casereport and a brief discussion

and suggest that CCL11 is a potential prognostic biomarker
that could be considered in therapeutic strategies for thetreatment of patients with HNSCC.
【Keywords】Carcinoma-associated fibroblasts (CAFs)；
Chemokine (C-C motif)
ligand 11 (CCL11)； Microenvironment； invasiveness；

Department of Pathology, Chiayi Branch, Taichung Veter1)
ans General Hospital, Chiayi, Taiwan ，Department of
Pathology, Taichung Veterans General Hospital, Taichung,2)
Taiwan○Ya-Ju Wu ，Chi-Shun Yang ，Yee-Jee Jan
1)

2)

2)

Head and neck squamous cell carcinoma (HNSCC)【Abstract】Mammary analogue secretory carcinoma(MASC) is a recently described low grade carcinoma of
salivary gland that has similar histologic features andimmunohistochemical profile to the secretory carcinoma of
the breast. They both harbors a recurrent balanced
chromosomal translocation t(12；15) (p13；q25), whichleads to the ETV6-NTRK3 fusion gene. Cytologically,
MASC can be confused with other low grade salivary glandtumors, particularly the acinic cell carcinoma (AciCC). It is
often difficult to distinguish MASC from other mimics basedon cytomorphology alone. Herein, we report a case of
MASC in the parotid gland in a 20-year-old man. The
preoperative diagnosis of the fine needle aspiration (FNA)is�Acinic cell carcinoma is firstly favored�. The diagnosis of
MASC is confirmed by detection of ETV6-NTRK3 fusion
gene by FISH analysis on the surgical specimen. We will
discuss how the cytological features and ancillary studies(immunohistochemical stains and FISH analysis) can help
use differentiate MASC of salivary gland from other mimics.

41

PE-2-4

A case of simultaneous occurrence of

PE-2-5

Mammary Analogue Secretory Carcino-

double cancer (tongue cancer and breast

ma： A Case Report with Review of thecancer ) as two separate primary tumor

Literature

Departments of Cytopathology, Fujita Health University
1)
School of Health Sciences, Toyoake, Aichi, Japan ，Division

Dept. of Pathology, Changhua Christian Hospital, Changhua, Taiwan

of Health Sciences, Osaka University Graduate School of2)
Medicine, Osaka, Japan ，Department of the Cytopathology,
Inazawa City Hospital, Inazawa, Aichi, Japan ，Department
3)4)

of Pathology, Shiga Medical University, Otsu, Shiga, Japan○Chiyuki Kaneko ，Tadao K. Kobayashi ，3)3)4)Masanori Ezaki ，Daisuke Taniguchi ，Masato Abe ，
1)

2)○Yu-Lan Yeh，
Mei-Ling Chen，
Yueh-Min Lin

4)

Muneo Iwai

【Case Report】The patient was an 80-year-old woman with

【Objective】Mammary analogue secretory carcinoma

a medical history of hyperlipidemia and hypertension. The(MASC) is a low-grade adenocarcinoma described in thepatient visited dental department of a local hospital in 2014,salivary gland in a 2010 report of mainly parotid tumors withand was found to have tongue cancer, which was diagnosedfeatures resembling breast secretory carcinoma. Itʼs a

as well-differentiated squamous cell carcinoma on biopsy.

recently described salivary gland tumor that harbors the

Pre-operative assessment showed cervical lymphadenop-

recurrent ETV6-NTRK3 translocation. Although there isathy on physical examination. Fine needle aspiration (FNA)

paper described the morphology of cytology, due to itʼscytology of the enlarged lymph nodes was performed which

rarity, the cytological characteristics of MASC are still notrevealed that squamous cell carcinoma originates in the

fully understood. Here, we report the case from parotid

tongue. Subsequent positron emission tomography (PET)

gland.

detect a breast mass. FNA cytology of the mass revealed【Methods】Fine needle aspiration, smear were fixed in 95％

the positive cytology with prominent tubular proliferation.

ethanol for Papanicolaou stain and air-dried for Liuʼs stain.

The tumor was diagnosed as solid tubular carcinoma of the

Immunohistochemistry and fluorescence in situ hybridiza-breast histologically.

tion (FISH) were performed.

【Materials and Methods】FNA cytology of the cervical【Results】Cytological findings were cellular smear, thelymph nodes and breast mass were processed with thepapillary structures with the vascular cores and loosely

liquid-based cytology (LBC) and cell blocks were prepared

cohesive syncytial clusters. The tumor cells were polygonal

from the remaining material.

with abundant bubbly cytoplasm and focal eccentric, round【Results】The cytoplasm of tongue cancer cells wasto oval uniform nuclei, vesicular chromatin and smallorangeophilic, and no histological features of well-differen-

nucleoli, with lack or inconspicuous cytoplasmic granules.

tiated squamous cell carcinoma, such as the so-called

The background was clear. FISH shows rearrangement ofcancer pearls or tadpole-shaped cells, were found. Biopsies

the ETV6 gene.

showed well-differentiated squamous cell carcinoma form-【Conclusion】MASC can be easily be mistaken with othering cancer pearls. Breast cancer cells were small, with asalivary gland tumors. Cytological morphology appears thehigh N/C ratio, and proliferated in a solid pattern. Fibrosis

papillary structures with the vascular cores, abundant/

was observed in areas of invasion.

bubbly cytoplasm and lack or inconspicuous cytoplasmic【Discussion】We encountered a case of tongue cancer with

granules. Immunohistochemical stain is useful for differen-cervical lymph node metastasis and concomitant breast

tiating MASC from other tumors, immunostains positive forcancer, and report the cytological and histological appearan-

S100 and negative for DOG1 would favor MASC. However,ces of these cancers, with a review of the literature.

to date, only ETV6 rearrangement stands as the defining
diagnostic criterion.

42

PE-2-6

Cytopathology practice in Hungary

PE-2-7The liquid based cytology for cervicalcancer screening in Mongolia

School of Medical Technology, Faculty of Health andMedical Care, Saitama Medical University, Saitama,
1)
Japan ，
Pathology & Cytology Laboratory, BML Group,

Graduate school of Health Sciences, Gunma University,
1)
Japan ，Mongolian National University of Medical
2)

Sciences

PCL Japan, Tokyo, Japan ，International Education and2)

Training Center, Saitama Medical University, Saitama,
3)Japan○Masayo Shuto ，Maria Mernyei ，Yoshitaka Tsuji ，1)
1)
Hiroshi Watanabe ，Mika Narikiyo ，
1)

2)

3)

1,3)

Hidekazu Kayano○Batchimeg Tsedenbal ，Bayarmaa Enhbat ，2)
1)
Munkhtulga Lhagvasuren ，Tomomi Yoshida ，
1,2)

2)

1)

Toshio Fukuda【Objective】Qualification systems for cytopathological【Objective】Conventional cytology test is major in Mongo-

diagnostic practice vary among countries. We aimed tolia, but its numerous inflammatory cells, mucus aredifferentiate the features of cytopathology practices be-difficulty. Liquid based cytology (LBC) test is not familiar

tween Japan and Hungary.

in Mongolia, then we aimed to assess its sensitivity and【Methods】The author (MS) visited the Second Depart-accuracy.

ment of Pathology, Semmelweis University, Szent Janos【Methods】The total 150 cervical split samples were

Hospital, Korányi TB and the Pulmonology Institute inincluded from 75 women, using cervix-brush. Initially,

Hungary in 2015 to study their cytopathology practices

conventional smears were prepared from brush and brushsupported by a grant from the faculty short-term study

head was suspended in LBC vial and processed byabroad program of Saitama Medical University.

TACAS【Results】Medical technologist qualifications do not exist in

system. Women with the abnormal smears were analyzed

Hungary, but other occupational categories are available.

by colposcopy directed biopsy.

Qualified pathologists with two yearsʼ experience imple-【Results】There were unsatisfactory 14％ conventional,

ment cytopathology practices and laboratory technicians are

and 6％ LBC smears (p＜0.05). The out of the 13 women

involved in specimen preparation for cytopathology.

with the abnormal conventional smears, 9 true positive, 3

Cytologists who undergo a two-year training program tofalse positive, 1 false negative results were assessed in

obtain a qualification that is superior to that of a laboratory

histology. Thus, conventional cytology test has 90％

technician perform cytoscreening. Pathologists are involved

sensitivity, and 69％ analytic accuracy. Therefore, out of thein medical interviews with patients, ultrasonography and13 women with abnormal LBC, 10 true positive, 1 false

fine needle aspiration, prepare and fix smear preparations

positive, and 2 true negative, no false negative results werethat are routinely stained with hematoxylin and eosin (HE)in histology. This result shows LBC test has 100％and Giemsa, with occasional Papanicolaou staining usuallysensitivity and 92％ analytical accuracy (p＝0.005).

limited to gynecological and urological specimens. When

【Conclusion】Specimen adequacy was better in LBC test.

necessary, cytopathologically diagnosed specimens stained

The sensitivity and analytic accuracy was both higher inwith HE on glass slides are then immunostained.

LBC test.

【Conclusions】Cytopathology practices differ between
Japan and Hungary. Understanding such differences in othercountries will help to improve cytopathology practices inJapan.

TM

system, Pap stained, and diagnosed by Bethesda

43

PE-2-8Current situation in regards to cytologyof cervical cancer in Cambodia

PE-2-9Usefulness of liquid- based cytology forthe diagnosis of oral squamous cell
carcinoma ― Comparison of conventional

Khmer Soviet Friendship Hospital, Cambodia ，Department
1)of Obstetrics and Gynecology，Juntendo University ，All
2)

Japan Labor Welfare Foundation ，Deartment of Pathology,
3)

method and liquid-based cytology ―Department of Cytopathology, Iizuka Hospital ，Depart2)
ment of Pathology, Iizuka Hospital
1)

4)

Nara Hospital, Kindai University

1)○Sophana Sam ，Kyna Uy ，Tsuyoshi Ota ，3)
4)
Ruriko Nishino ，Tomoko Wakasa
1)1)○Daisuke Kawashima ，Toshitaka Uehara ，1)1)1)
Naoya Kanatani ，Yuko Matsushima ，Kanako Inoue ，2)1)Isao Kuwaoka ，Yuka Hotokebuchi ，Mizuki Handa ，1)Masahumi Oya

2)

2)

2)

【Background】In Cambodia, cervical cancer is the leading【Objective】Since oral squamous cell carcinoma (OSCC),

cause of cancer deaths among females with an estimatedwhich represents the greater part of the malignant tumors

800 cervical cancer deaths per year. Patients come to theoccurring in the oral cavity, often has hyperkeratosis. Thishospital mostly in the very late stage of cervical cancer andmakes it harder to obtain enough cells for the cytologicalthe clinicians often performed cervical biopsy directly for

diagnosis on the smear, and this sometimes makes it

suspicious invasive cancer cases without cytology, anddifficult for us to diagnose. When we observe atypical cells
performed Pap tests in patients who showed no pathologicalof basal type or cancer pearls in the specimen, it becomeschanges. Some biopsy cases were performed after theabnormal cytology results.

easier. In this study, we focused on some features to be the

In Cambodia, the process of diagnose cervical cancer has

basis of OSCC such as keratinized superficial atypical cells,

not established such as cytology and colposcopic diagnosis.

cancer pearls and basal type atypical cells. We aimed toHere we reviewed the cervical cancer statistics in Khmer

evaluate the usefulness of liquid-based cytology (LBC) for

Soviet Friendship Hospital.

the diagnosis of oral lesions with malignant suspicion by【Methods】Khmer Soviet Friendship Hospital is a national

comparing the conventional method and LBC.

general hospital situated in the capital, Phnom Penh, and【Materials and Methods】Samples collected from 25

working as the only cancer center where comprehensive

patients were underwent cytological and pathologicalcervical cancer diagnosis and treatment can be provided.
From August to October, 2016, we reviewed and analyzed

testing, and were pathologically diagnosed with oral
intraepithelial neoplasia (OIN) and OSCC at the depart-the pathology and gynecology registration book to reveal
ment of oral surgery in Iizuka Hospital. Conventional
the current situation of diagnosing cervical cancer.
【Results】2175 patients consulted with the gynecology

smears were prepared first, using interproximal brushoutpatient department. There were 175 cervical cytology

device. Then the brush, containing the residual material,cases and 127 cervical biopsy cases. Among the 175

was immersed in a preservative fluid (TACAS Ruby ).

cytology cases, there was only one LSIL case and the others

Both slides were stained by the Papanicolaou method. We

were all NILM. On the other hand, the biopsy results

investigated whether keratinized atypical cells, cancer

revealed 70 SCC, 11 Adeno Carcinoma, 1 lymphoma, 7

pearls and basal type atypical cells appeared in the specimen

CIN1, 3 CIN2, 8 CIN3 (4 were CIS), 2 tuberculosis and 25

or not. Fisherʼs exact test was used to compare differences

cases showed no significant change. The biopsy results

between the conventional method and LBC specimen using

showed 82 malignant (64.6％) cases and the cytologyⓇ

split-sample. When the P-value ＜0.05, the difference wasspecimens, however, there were 25 normal results(19.7％) among the biopsy cases.
【Conclusion】There was a big discrepancy between thecytology and biopsy results. The situation in Cambodia

regarded as statistically significant.
【Results】Cytological diagnosis by the conventional method was positive in 23/25 cases, negative in 1/25 case andcannot be changed unless cervical cancer screening is

inadequate in 1/25 case. Cytological diagnosis of LBC

implemented widely, but pathology departments andmethod was positive in 25/25 cases, nothing for negative or

gynecology departments need to establish further collabora-

inadequate case. In the conventional method, keratinizedtion to give more feedback to each other for more accurate

atypical cells, cancer pearls and basal type atypical cells

diagnoses of cervical cancer.

were observed in 23/25, in 3/25, in 11/28 cases, whereas in44

LBC method, they were in 24/25, in 8/25, in 18/25 cases.
The frequency of basal type atypical cell was significantly

PE-2-10The Usefulness of the Cell Transfer

higher in LBC as compared to the conventional method (PTechnique for Routine Cytology Prac-＝0.04).

tice in Taiwan【Conclusion】As for the results of the current study, it was
expected that the LBC improved the diagnostic precision of

Department of Pathology, Taipei Veterans General Hospi1)
tal, Taiwan ，Department of Pathology, Mackay Memorial

oral brush cytology because of being excellent for detecting

Hospital, Taiwan

2)

the atypical cells in the oral cavity.
○Ho-Han Chen ，Shu-Chen Chang ，Shiou-Feng Liu ，1)
Chiung-Ru Lai
1)

2)

1)

【Objective】At present, the use of liquid based cytology(LBC) is not so popular in routine cytology practice in
Taiwan. Although additional immunocytochemical staining(ICC) is necessary for the workup of cytology diagnosis,
the application of ICC is restricted due to limited specimen
especially in fine needle aspiration (FNA). The purpose ofthis study is to evaluate the efficacy of cell transfer
technique for its usefulness in daily routine cytology
practice.
【Methods】A total of 20 cytology samples, with ICC
performed on cell transfer slides, were retrieved from thedepartment of Pathology, Taipei Veterans General Hospitaland Mackay Memorial Hospital after the introduction of celltransfer technique in 2014. The results and contribution
were recorded and analyzed.
【Results】Cell transfer technique was performed in 20
cytology samples, including 6 FNA, 1 CSF, 1 pleural
effusion, 2 ascites, 1 vitreous fluid, and 9 Pap smears. A
total of 34 ICC stains were performed and ranged from one
to 3 stains per each case. In 18 cases (90％), ICC stains
were contributory for diagnosis：p16 and/or Ki-67 in Pap
smears for HSIL and AIS；CD20 & CD3 for lymphoma inbody fluids and FNA；PAX-8, GATA-3, TTF-1 & CDX-2
for origins of metastases in Pap smears, body fluids and
FNA.
【Conclusion】Cell transfer technique is very easy anduseful in the workup of cytology specimens for thoselaboratories not using LBC. Although it is not usedfrequently, it did provide contributory results and helped ingetting final diagnosis in 90％ of cases using this technique.

45

PE-2-11

Rapid on site evaluation on FNA of

PE-2-12A Novel Method for DNA Cytometry for

unknown primary tumor to diagnose

Exfoliated Cells

neuroendocrine tumors
Department of Pathology, Beijing Hospital, National Centreof Gerontology, Beijing, PR China

Marketing Development, UB Product Engineering, HU
1)Business Unit, Sysmex Corporation, Kobe, Japan ，ProductDevelopment, UB Product Engineering, HU Business Unit,
2)
Sysmex Corporation, Kobe, Japan○Lan Chen，
Shu-rong He，Dong-ge Liu【Objective】Neuroendocrine neoplasms include a group of○Hiromi Morisaki ，Shigeki Abe ，Masahiko Oguro ，1)2)1)Kaori Yonekura ，Noriko Oka ，Tamiaki Kondo ，
1)

2)

2)

2)

Junya Inoueheterogeneous tumors originated from neuroendodermal
and neural crest. The tumor cells receive neuronal input of【Objective】Understanding proliferative status of samples

neurotransmitters released by nerve cells or neurosecreto-from precancerous lesions can be difficult when proliferat-ry cells and release message molecules of hormones to theing cells are mixed among majority of normal cells. Here,blood. They share morphological and immunophenotypic
similarities despite the tumor origin. There is usually blandcytopathology and minimal polymorphism, but less com-

we report a novel flow cytometry method to enabledetection of proliferative cell populations.
【Methods】Suspended cells were measured by the flow

monly there can be anaplasia and tumor cells may mimic
cytometer, and the acquired signals were used to obtainother malignancies. In this study we presented theinformation corresponding to cell morphology and DNA
morphological variants of neuroendocrine neoplasms diagnosed on FNA of unknown primary tumors in our collectionand emphasized the value of rapid on site evaluation

content. Next, the morphological characteristics of proliferating cells were used to select high N/C ratio-populations,(ROSE) for accurate diagnosis by applying ancillary test ofand subsequent DNA ploidy analyses were conducted.

immunohistochemistry (IHC) on smears or blocks for

Finally, the state of proliferation was indicated by an original

differential diagnosis.

cell proliferation index (CPIx) that represents the prolifera-【Methods】We reviewed 45 cases suspected of neuroendo-

tive characteristics of cell populations.

crine neoplasms on ROSE in the last four years from FNA of【Results】Human buccal cells and human umbilical vein

unknown primary tumors. Tumor origin spanned aendothelial cells (HUVECs) were measured to calculate

spectrum of GI, lung, breast, thyroid and paraganglia. 28

the ratios of nuclear and cell diameters (N/C ratio) of

cases were diagnosed of neuroendocrine neoplasms orindividual cells using the FSC_W and RFL_W values, astumors with neuroendocrine differentiation with ancillarythese values correspond to the lengths of the cell andtest of IHC tested in 26 of them and 18(100％) had further
resection samples to confirm the diagnosis, while 8 patients

nucleus, respectively. By drawing scattergrams of cell
lengths and N/C ratios using measurement values of buccal

went on with treatment directly without further biopsy orcells and HUVECs, respectively, these cells could beresection. 17 cases signed out as the suspicious had no cell

discriminated as low-N/C ratio group (buccal cells) andblocks available for IHC and 11 of them had pathology

high-N/C ratio group (HUVECs). In addition, CPIx values

confirmation to be neuroendocrine tumors for 8 cases andother malignancy or benign lesions for 3 cases (27.3％).

of HUVECs well represented the proliferative conditions of

The other 6 had no pathology follow-up.

each cell culture. Finally, when low-proliferative HUVECs【Conclusion】While morphology forms the fundamental

and high-proliferative Hela cells were mixed and measuredbases to recognize the neuroendocrine tumors, IHC on cellin this system, CPIx values of mixed samples were wellblock plays an important role for differential diagnosis.

correlated with the proportion of Hela cells.

ROSE helps us to triage sample for cell block preparation【Conclusion】CPIx value is suggested to represents

and make accurate diagnosis possible on cytology samples.

proliferative status of samples. Therefore, this method is

A series of cases are demonstrated in the talk to emphasize

expected to substantially contribute to know the prolifera-

the potential pitfalls in dealing with this differential

tive status of clinical samples such as cervical dysplasia.

diagnosis.

46

intensity and number of true signals clearly reduced with

PE-2-13The Effects of Formalin Fixing Condi-

the passage of time.

tions on Fluorescence in situ hybridiza-【Conclusion】Compared with prolonging fixation time,tion in cell block of effusion cytology
delaying formalin fixation has more serious negative effects
Department of Pathology, Fukuoka University School of
Medicine and Hospital, Fukuoka, Japanon FISH result in cell block. We recommend to performformalin fix as immediately as possible, and not to leavespecimens at room temperature.

○Shinji Matsumoto，Yuko Ouchi，Katsumi Kobata，
Makoto Hamasaki，Kazuki Nabeshima【Background】A cell block method can be applied for
immunocytochemical analysis or molecular biological
technique of specific biomarkers, and it contributes for
accurate diagnosis of effusion cytology. On the other hand,
many studies have investigated the effects of formalin
fixation for the biomarker expression in tissue samples,
there is no study in cytological materials. In the present
study, we investigated the effect of formalin fixing
conditions on fluorescence in situ hybridization (FISH) incell block preparation using the cell line.
【Methods】The normal human mesothelial cell line (Met5A) was used. Cells were collected after washing with PBS,
and suspended in 0.9％ NaCl normal saline solution with 4
mg/dL BSA (albumin from bovine serum) to closely
resemble effusion microenvironment. Cell block was
prepared by formalin superposition method. The variation ofFormalin fixation condition was as follows. 1) Fixing
solutions； 10％ neutral buffered formalin (NBF), 10％
non-buffered formalin or 20％ non-buffered formalin. 2)
Delay to fixation time；stored at room temperature or 4℃
for 0h, 2h, 4h, 8h, 24h, or 48h before fixed. 3) Fixation
time； 24h, 72h, 1week or 2 weeks. After embedding inparaffin, the above samples examined respectively by FISH
using p16/CDKN2A gene probe. Presence of the following
factors were observed in each sample. 1) Non-uniform
unscorable weakly signal. 2) Decrease or loss of signal. 3)
Non-specific signal over nuclei and cytoplasm (autofluorescence or background obscures signal).
【Results】The sufficient intensity of signals could be
detected in over-fixation samples longer than 72h,
however, decreased the number of signals especially p16
gene (red signals). Specimens left for longer than 4h inroom temperature before fixation tended to induce autolysis
and increase non-specific background signals. Moreover,47

tests were performed successfully from 26-50 cases. The

PE-2-14

EBUS- TBNA with ROSE： introducing

sensitivity, negative predictive value (NPV), and diagnostic

the procedure to a cancer center

accuracy for the 8 groups of the first 200 case wererelatively stable with ROSE. The overall sensitivity, NPV

Department of Pathology, Shanghai Cancer Center, Fudan
1)
University, Shanghai, PR China ，Department of Thoracic
Surgery, Shanghai Cancer Center, Fudan University,
2)
Shanghai, PR China

and diagnostic accuracy for the first 200 cases and thefollowed 200 cases were 95.4％ and 97.7％, 88.0％ and95.5％, 92.3％ and 96.9％, respectively. Without ROSE,
the diagnostic yield continued to increase slightly after the○Ying Chen ，Bo Ping ，Liqing Feng ，Longfu Wang ，1)
1)
2)
Weiping Xu ，Lianghong Gu ，Hong Hu ，
1)

1)

1)

1)

initial 200 cases.
【Conclusion】ROSE provided a clear advantage in provid-

2)

HaiQuan Chen

ing high diagnostic accuracy for EBUS-TBNA by ensuring
adequate sampling. Without ROSE, the diagnostic yield【Objective】Due to practice patterns and concerns about

continued to increase slightly after the initial 200 cases. If

manpower cost and time consume, rapid on-site evaluation

further sample triaging was not considered, it was cost and(ROSE) of endobronchial ultrasound-guided transbronchial

time effective that ROSE could be no longer performed

needle aspiration (EBUS-TBNA) appears to be performed

when the inadequacy of first sampling was low enough andat only limited centers. And uncertainty surrounds the

EBUS-TBNA continued to be accomplished by the same

optimal number of cases needed to do ROSE for achieving

operator.

acceptable yields.
【Methods】The primary consecutive 400 cases in two years(2009-2011) performed EBUS-TBNA by one operator in
Shanghai Cancer Center were retrospectively analyzed.
The first 200 cases were performed with ROSE, and thefollowed 200 cases were performed without ROSE. The
first 200 cases were divided into 8 groups by incremental 25
cases aliquots. Except for Smears and cell blocks, any coretissues found in the aspirates were histologically processed.
We focused on the diagnostic yield of EBUS-TBNA,
inadequacy of first sampling, inadequacy of sampling, cell
block (CB)/biopsy success rate, immunohistochemistry(IHC) success rate, and molecular tests carried out on CB
and/or core tissues.
【Results】912 lesions were aspirated from 400 patients,
including 269 males and 131 females with a mean age of
57.4, a median age of 59, and ranging from age 24 to 84. In
cases without EBUS-TBNA biopsy or subsequent mediastinoscopic or surgical staging resections, clinical follow-up
was taken as the gold standard. The inadequacy of firstsampling and inadequacy of sampling decreased steadily
after the initial 25 cases and remained low thereafter.
Inadequacy of first sampling were 48％ (12/25) and 8％(2/25) of the 1-25 cases and 176-200 cases. With the helpof ROSE, inadequacy of sampling were 20％ (5/25) and
0％ (0/25) of the 1-25 cases and 176-200 cases,
respectively. The CB/biopsy success rate and IHC successrate increased steadily after the initial 100 cases. Molecular

48

PE-2-15

A novel flow cytometry (FCM) based

PE-2-16

A Case of Plasmablastic Lymphoma

system for cervical cancer testing

Obstetrics and Gynecology, Japanese Red Cross Musashino
Hospital

Diagnostic Pathology, Yokohama City University Medical
Center○Tatsuo Yamazaki，Nobuko Akamata，Hiroyuki Kurosu，Satoshi Umezawa○Teruaki Kodera，Masako Otani，Chiemi Ebizuka，Mikiko Tanabe，
Yoshiaki Inayama【Objective】The aim of this study was to assess the utility

Plasmablastic lymphoma is a rare malignant lymphoma,of a novel FCM based system for cervical cancer testing

which occurs commonly in HIV-positive or immunodefi-

through comparisons of measurement results from theciency state, including advanced age. We discuss on

system with clinical data.

cytological features of plasmablastic lymphoma with an【Method】Cell samples were collected from patients who

HIV-negative patient.

were treated at our department between September 2011

【Case】The patient is a 63-year-old male, who had been

and February 2013 using the Cervex-Brush Combi. Direct

followed up as having nodular goiter of the thyroid. He

smears were prepared and cells remaining after this process

noticed swelling of the right neck and supraclavicularwere preserved in preseavation solution to prepare liquid-

region. Pharyngeal tumor was suggested by PET. Fine-

based cytology specimens (n＝746). Specimens wereneedle-aspiration (FNA) cytology of the lymph node andmeasured using a prototype FCM system (Sysmex

biopsy of the pharynx were perfomed.

Corporation) and an original index, cell proliferation index【Cytological findings】In necrotic backgound, there were a(CPIx) was used in this study to calculate cell proliferation.

lot of large atypical cells sparsely. They had cytoplasmic

The measurement results were verified against the clinicalvacuoles and a single or multiple large nuclei with distinct

information. Hybrid Capture II (HC II) was also conducted.

nucleoli and coarse chromatin. Some nuclei located【Results】Probability values of correlations between the

peripherally.

median CPIx value for each specimen and histological grade【Histological findings】There were some large atypical cells

were as follows：0.186 for normal and cervicitis (n＝32),

mainly in vessels. They resembled plasma cells, having a

0.238 for CIN1 (n＝47), 0.351 for CIN2 (n＝18), 0.534

single peripherally located nucleus with perinuclear halo.

for CIN3, (n＝24), and 0.759 for squamous cell carcinoma

However, some had multiple nuclei and distinct nucleioli.

(n＝15). The clinical performance of this system was as

Immunohistochemically, they were positive for EMA andfollows：the sensitivity was 95.2％ (58/61) to detect ≥CD138, indicating plasmablastic lymphoma.

CIN2 lesions, whereas the specificity was 76.3％ (455/【Conclusion】The specimen by FNA from lymph node596) when NILM and ≤CIN1 were defined as negative.

contained rather necrotic and degenerated atypical cells,

Compared with FCM system and HC II, the sensitivity towhich had no apparent perinuclear halo in Papanicoloau

detect ≥CIN2 lesions by FCM system was 95.2％ (40/stain. The diagnosis of plasmablastic lymphoma is difficult42), whereas that of HC II was 92.9％ (39/42).

without characteristic findings of plasma cell.

【Conclusion】The system showed a favorable clinicalperformance to detect ≥CIN2 lesions. This shows that it
might be utilized to provide healthcare professionals withsupport information for the diagnosis of cervical cancer.

49

PE-2-17Fine Needle Aspiration Cytology of

PE-2-18

Kikuchiʼs lymphadenitis - Experiences

Primary Intraocular Lymphoma Masqueraded as Uveitis：A Case Reportof Korea Cancer Center Hospital
Department of Pathology, Korea Cancer Center Hospital,
Kirams, Seoul, Korea

Department of Pathology, Kaohsiung Veterans General
Hospital, Kaohsiung, Taiwan○Hwa-jeong Ha，Jung-soon Kim，
Myung-soon Shin，
Woo-tack Song，
Jae-kyung Myung，Hye-sil Seol，
Sun-hoo Park，Jae-soo Koh，Seung-sook Lee○Yu-ju Lin，
Ting-Ying Fu【Objective】Kikuchiʼs lymphadenitis (KL) is a benign【Objective】Primary intraocular lymphoma (PIL) is a rarelymphadenopathy with spontaneous regression. It can behematopoietic malignancy which is difficult to diagnose. PIL

not only clinically but also pathologically mistaken for

predominantly occurs in the elderly and often involves

lymphoma, tuberculosis or SLE. Surgical biopsy is unneces-bilateral orbits with central nervous system involvement.

sary if a firm diagnosis can be rendered by fine-needle【Methods】We used Papanicolaou and immunohistochem-

aspiration cytology (FNAC). In order to find out helpful

istry stains to analyze cytological morphology and differen-

diagnostic points in the initial diagnostic step FNAC, wetial lymphoid lineage. Flow cytometry was performed as an

examined cytologic details of histologically proven KL.

ancillary test.

【Methods】Retrospective review was done for 108 patients【Results】Herein, we report a 57-year-old woman withof FNAC of lymph nodes in which KL was diagnosed orunilateral PIL diagnosed by vitreous aspiration, initiallysuggested by FNAC and/or biopsy at the department ofpresented as uveitis. Our case illustrated the importance ofPathology, Korea Cancer Center Hospital during the period

a careful clinical examination and investigation as uveitis is

of January 2010 and June 2016. Histologic sections of FNAC

a common inflammatory eye disorder. PIL should becell blocks and subsequent biopsy specimens were available

considered as differential diagnosis for uveitis that isin 22 and 31 patients, respectively, for confirmation of theunresponsive to therapy, as PIL could be a great mimicker.

diagnosis.

Vitreous smear showed atypical lymphocytes with enlarged【Results】Smears of all the 22 cell block available cases

nuclei, prominent nucleoli, and clumping chromatin. On

were in concordance with cell block histology andimmunohistochemistry stains, these atypical cells were

immunohistochemistry of KL. Among 31 biopsy-provenpositive for B-cell marker (CD20) and negative for T-cellcases, 19 showed diagnostic concordance of FNAC smears

marker (CD3), indicating the presence of monoclonality.

with biopsy. Three of the 14 discordant cases were

Flow cytometry showed 45.1％ aspirated cells werecytologically diagnosed as KL but were histologically

positive for CD20 surface marker, and 26.1％ positive forproven to peripheral T-cell lymphoma(1), reactive hyper-

T-cell surface marker (CD3). Taken together the results ofplasia(1) and granulomatous inflammation(1), respective-

cytological morphology, immunostains, and flow cytometry,ly. The other 11 of the 14 discordant cases were suggested

intraocular B-cell lymphoma was diagnosed. The CSF

as reactive hyperplasia on FNAC and were finally diagnosed

cytology and bone marrow biopsy was performed to exclude

as KL on biopsies.

systemic lymphoma, and there was no evidence of【Conclusion】From our retrospective analysis, we suggest

extraocular lymphoma.

it would be the most helpful to thoroughly find out the【Conclusion】Accurate cytological diagnosis of primarycharacteristic phagocytic histiocytes including crescentic

intraocular lymphoma via vitreous aspiration affects bynucleus, especially focusing on the presence of eosinohilic

specimen quality. Ancillary tests in combination with cell

granules in their cytoplasm.

morphology may be helpful to facilitate accurate diagnosis.

50PE-2-19

T-Cell Lymphoma Diagnosed in Sputum
in a Patient with Tuberculosis

PE-2-20

NUT Carcinoma with Cytoplasmic Basophilia Mimicking Lymphoma：Diagnostic Pitfall

Department of Anatomic Pathology, Taipei Institute of1)
Pathology, Taiwan ，Department of Pathology and Labora-

Department of Pathology and Laboratory Medicine, Taipei
Veterans General Hospital, Taipei, Taiwan

2)

tory Medicine, Taipei Veterans General Hospital, Taiwan○Yeh-Han Wang ，Chiung-Ru Lai○Yen-Ying Chen，
Chiung-Ru Lai【Objective】To demonstrate a difficult case of T cell

【Background】NUT carcinoma is a rare, poorly differentiat-

lymphoma diagnosed in sputum cytology in a patient withed carcinoma characterized by the presence of NUT geneconcurrent mycobacterial infection.

rearrangement. The cytopathologic features of NUT【Methods】This 69-year-old female suffered from persis-

carcinoma are nonspecific and overlap with other poorly

1)2)tent dry cough without fever for more than one month,differentiated carcinomas or round cell tumors.

associated with progressive short of breath. She also

【Case】A 36-year-old man presented with cough for twocomplained poor appetite and weight loss by 4 kg in recent

months. Chest CT showed a large infiltrative massmonths. After the check-up, the radiographic examination

involving left upper and lower lobes of lung, with(CXR and CT) revealed patchy infiltration and consolida-

mediastinal invasion, lymphadenopathy, pleural and pericar-

tion over the right lung and enlarged lymph nodes indial effusion. He underwent LUL wedge resection and thebilateral hilum and cervical region. Needle biopsy of theinitial diagnosis from another hospital was poorly differenti-

cervical lymph node was performed, showing caseous

ated squamous cell carcinoma. Our department reviewed

necrotizing granuloma with acid-fast positive mycobacteri-

the slides and the diagnosis is revised to NUT carcinoma

um. Q-PCR confirmed the mycobacterial infection. After 3-

after additional immunostain for NUT. Pericardiocentesis

month treatment, the symptoms were persistent andwas done to relieve his orthopnea. Cytospins of pericardial

progressive. Cytology specimens from sputum, pleural

fluid show a cellular specimen consisting of noncohesive,

effusion and ascites were collected and examined in her 2nd

monomorphic, large-sized tumor cells with round to ovoid

time admission.

nuclei, open chromatin and prominent nucleoli. The【Results】The sputum smears reveal small and loose

cytoplasm is scant and deeply basophilic in Liuʼs stain. The

atypical lymphoid infiltration scattered between squamous

tumor cells on cell block are positive for P40 and NUT,

cells or in the background. The atypical lymphoid cells

while negative for CD3 and CD20.

manifest small to medium size with pleomorphism,【Conclusion】We present a case of NUT carcinoma which

hyperchromasia and irregular nuclear membrane. The

shows intense cytoplasmic basophilia and strongly mimics a

atypical lymphocytes are positive for LCA, CD3 andlymphoma. Although it is rarely seen in NUT carcinoma,

negative for CD20. The malignant lymphoma cells are also

awareness of this feature is important as it can lead to apresent in the pleural effusion and ascites.

diagnostic pitfall.

【Conclusion】Pulmonary involvement of T cell lymphomawith positive sputum cytology is very rare. Concurrent
mycobacterial infection may also distract examinerʼs focus.
Being alert to atypical inflammatory cells is very important
not to miss such cases in cytology.

51care. In a median follow-up of 3 months (range, 0-33), 13

PE-2-21

Most primary effusion lymphomas inpatients died of disease in 0 to 33 months (median, 2.5

Taiwan are unrelated to HIV and HHV8months). The 1-and 2-yr survival rates were 33％ and13％, respectively. The HHV8-positive group (n＝3)

Department of Pathology, Taipei veterans General Hospi1)
tal, Taipei ，Department of Pathology, Shuang-Ho Hospital, Taipei Medical University, New Taipei City ，Depart2)

ment of Pathology, Chi-Mei Medical Center, Tainan

3)

showed more frequent expression of CD30 (100％ vs.
21％； p＝0.0097, Chi-squared test) as compared to the
HHV8-negative group (n＝14). None of the HHV8positive cases expressed any of the pan B-cell markers or○Man-Hsu Huang ，Bo-Jung Chen ，Shih-Sung Chuang
1)

2)

3)

bcl2, in contrast to 93％ (13/14) and 85％ (11/13),
respectively, in the HHV8-negative group (p＝0.0058 and0.004, respectively). EBER was positive in 33％ (1/3)
and 15％ (2/13) cases, respectively. One HHV8-negative【Introduction】Primary effusion lymphoma (PEL) is acase was a double-hit lymphoma with rearranged IGH,

HHV8-associated large B-cell lymphoma presenting in

BCL2 and MYC.

body effusion without forming a mass. Cases of HHV8-【Conclusion】1. There are more cases of HHV8-negative

negative effusion-based lymphoma have been reported withPEL (or effusion-based lymphoma) than HHV8-positive

distinct immunophenotype and occasional association withclassical PEL (82％ and 18％, respectively) in Taiwan.

fluid overload status and/or HCV infection. Up to date,

Interestingly, the two HHV8-positive cases tested for HIV

there is no large series of PEL with comparison of the twowere both negative. The clinical settings, including age, sex,groups from Taiwan.

infection of HIV, HBV or HCV and fluid overload status, are【Materials and Methods】1. Patients：A total of 18 PEL

not significantly different between two groups in our series.

cases from Taiwan were retrospectively collected, and cell

2. The two groups reveal indistinguishable cytomorphology,

blocks were available in 17 cases for study. 2. Immunohisto-

but distinct immunophenotype. All 17 cases are non-chemistry： Antibody to bcl2, bcl6, CD3, CD10, CD19,

germinal center phenotype without CD10 expression. But

CD20, CD138, cyclin D1, HHV8-LANA (latent-associated

HHV8-negative cases reveal more expression of pan B-cellnuclear antigen), MUM1 and myc were used. The cut-off

antigens (93％ of cases), but less bcl2, CD30 and CD138

value of myc was set as 40％ of tumor cells with nuclear(85％, 21％ and 21％ of cases, respectively). 3. The

staining. 3. EBV in situ hybridization (EBER) Fluores-

positive rates of EBER and rearrangement of BCL2, BCL6,

cence in situ hybridization (FISH)：Locus-specific inter-

IGH and MYC loci are not significantly different between

phase FISH with BCL2, BCL6, IGH and MYC dual color

two groups in our series. 4. Both groups in our series

break-apart probes were used on paraffin-embedded cell

display dismal prognosis, comparing to better prognosis ofblock section.

HHV8-negative cases in the series of Alexanian et al. (Am【Results】The 18 cases included13 males and 5 females,

J Surg Pathol 2013；37：241-249)

with M/F ratio of 2.6 and a median age of 77 (range, 4692). The most common effusion site was pleural (78％).
HIV, HBV, and HCV infection were positive in 1/7, 0/8 and1/11 patients, respectively. Immunohistochemically, 78％cases expressed at least one of the pan B-cell markers(CD19, CD20 or CD79a)；35％ cases expressed CD30；
29％ cases expressed CD138. CD10 was negative in allcases. Bcl2, bcl6, MUM1, and myc was expressed in 69％,
38％, 88％, and 40％ cases, respectively. Three (18％)
were positive for HHV8；14 (82％), negative. IGH, BCL2,
BCL6 and MYC were rearranged in 69％, 23％, 25％, and
25％ cases, respectively. One patient was lost to follow-up.
Ten patients received chemotherapy, and 7, supportive

52

long and fibrillary cytoplasmic processes are usually seen.

PE-2-22

Intraoperative smear cytology of chor-

By contrast, bizarre and pleomorphic nuclei are characteris-

doid meningioma： a case report andtic of chondrosarcoma and metastatic adenocarcinoma. In

literature review
chordoid meningioma, tumor cells are always bland looking.
Department of anatomic pathology, Chiayi Chang Gung1)
memorial hospital, Chiayi, Taiwan ，Department of patholo-

Chordoid meningioma is immunoreactive for EMA andvimentin. Stainings for S100, AE1/AE3 and GFAP are

2)gy, Saint Maryʼs Hospital, Luodong, Taiwan

negative. In conclusion, the diagnosis of chordoid meningioma made by smear cytology is challenging owing to its rarity○Huei-Chieh Chuang ，Hou-yu Chen1)

2)

and different features compared to classical meningioma. A
quick, correct diagnosis during intraoperative consultation
depends upon successful recognition of the distinctive
cytomorphology of this tumor.

【Introduction】Chordoid menigioma is a rare subtype ofmeningioma displaying a greater tendency of recurrence
and locally aggressive behavior. Herein we report featuresof this rare tumor by an intraoperative smear cytology anddo a literature review.
【Case report】This 47-year-old woman complained ofintermittent dizziness for months. Brain magnetic resonance images revealed a parietal tumor measuring 6.1 x
5.4 x 4.4 cm. Intraoperative smear cytology showed
moderately cellular sheets of ovoid to spindle tumor cells.
The cells had vesicular nuclei with small nucleoli andmoderate amounts of eosinophilic cytoplasm with indistinct
cell borders. Some inflammatory cells and myxoid materials
were found in the background. Histologically, cords andtrabeculae of epithelioid tumor cells were separated by afibrous and mucous-rich matrix containing delicate bloodvessels. Tumor cells were positive for vimentin and EMA
but negative for AE1/AE3, S100, GFAP, HepPar-1, CD34
and NeuN immunohistochemically. The final diagnosis ofchordoid meningioma was made. Gross total tumor
resection was achieved, and no recurrence was detected
after a 6-month follow-up.
【Discussion】Meningioma is a common intracranial tumor
and majority of subtypes behave in a benign clinical manner.
Chordoid meningioma is classified as WHO grade II tumors
because of a high rate of recurrence and less favorable
outcomes. In smear cytology, it is characterized by sheets
and clusters of ovoid, vacuolated tumor cells in a
background of myxoid materials and chronic inflammatory
cells. The differential diagnoses include chordoma, chordoid
glioma, chondrosarcoma and metastatic adenocarcinoma.
Chordoma is composed of large tumor cells having copious
vacuolated bubbly cytoplasm in a discohesive manner. In
chordoid glioma, binucleated tumor cells with relatively

53

PE-2-23

A case of anaplastic oligodendroglioma

PE-2-24that proved difficult to diagnose

Cytopathologic analysis in pediatric andyoung adult age group： review of ourexperiences

Department of Diagnostic Pathology, Kurume University
1)
Hospital, Kurume, Japan ，Department of Pathology,
Kurume University School of Medicine, Kurume, Japan

2)○Naomi Ishii，Hiroko Fukushima，
Kakeru Yamahata，
Yuri Seko，Yuka Yokota，Takeshi Inoue○Yorihiko Takase ，Yasuo Sugita ，Hideyuki Abe ，1)
1)
Akihiko Kawahara ，Tomohiko Yamaguchi ，1)

2)

Department of Pathology, Osaka City General Hospital,
Osaka, Japan

1)

Tomoki Taira ，Chihiro Fukumitsu ，Kazuya Murata ，
1)

1)

1)

Yoshiki Naito ，Jun Akiba
1)

1)【Background】Anaplastic oligodendroglioma is a rare brain【Background】In pediatric and young adult age group, raretumor, and few cytological reports are available. We reportvarious malignant tumors that have an aggressive course

here a case of anaplastic oligodendroglioma diagnosed on

can be seen. A rapid accurate diagnosis for them fromsquash cytology.

cytology specimens is important, although cytopathlogists【Case】A man in his 70ʼs visited a nearby hospitalare relatively unfamiliar with them. We evaluate the role ofcomplaining of pain and numbness in his left hand and rightcytology for young age group with our cases.

leg. A mass was found in the left parietal lobe by magnetic【Methods】We conducted a retrospective study of cytology

resonance imaging and oligodendroglioma or astrocytoma

in pediatric and young adult patients ≤29 years of age.

was suspected clinically. Squash cytological smears showed

Distribution of cases in different age groups, sample types,

loose clusters of tumor cells. Individual tumor cells showedhistologic types were analyzed.

abundant eccentric eosinophilic cytoplasm, like that seen in【Results】379 positive samples (2.3％) from 205 cases

gemistocyto-like cells. Frozen section findings were(2.0％) in young age group were collected from 16,676

consistent with those of squash cytology, and the tumor was

positive samples (10,425 cases) in our institution for 22

diagnosed as gemistocytic atypical astrocytoma. After

years. Sample types were CSF (54.9％), uterine smears

surgery, about two thirds of the tumor was found to be(23.5％), body cavity fluid (10.3％), and others. The

typical oligodendroglioma, while the remaining third was

cytological diagnosis were classified as follows；leukemias

anaplastic oligodendroglioma with gemistocyto-like cells.

119 (31.4％), brain tumors 90 (23.7％), uterine cervicalThe anaplastic oligodendroglioma was positive for OLIG2,

neoplasms 84 (23.2％). In children ≤10 years of age, theIDH-1 and GFAP by immunohistochemistry, and a deletion

most common diagnosis were leukemias 19 cases (67.9％)

of 1p19q was detected by FISH analysis.

and brain tumors 21 cases (70％). Uterine cervical【Conclusion】The intraoperative diagnosis of brain tumors

neoplasms were not found under 15 years of age. Definite

is often difficult because of small sample sizes, and a morediagnosis could be offered on cytology in most cases, while

comprehensive diagnosis using IHC and FISH analysis isin 16 cases (7.8％) specific diagnosis could not be offered.

necessary in rare cases. The intraoperative diagnosis of

Most of them were small round cell tumors like rhabdomyo-brain tumors can be important to achieve a differential

sarcoma, AT/RT, etc.

diagnosis.

【Conclusions】Cytology is a simple and useful diagnostic
procedure. This study showed an efficacy of cytology in thepediatric and young adult age group, although cytopathologists should be aware of performing immunocytochemistry
and/or FISH to achieve the correct diagnosis of small roundcell tumors.

54

PE-2-25

A Retrospective Study on the Risk of

PE-2-26

The Cytological examination of gastric

Malignancy Associated With the Papani-disease for the patients on the emergen-colaou Society of Cytopathology Guidelines in Endoscopic Ultrasound- Guided
Fine-Needle Aspiration Specimens of
Pancreatic Lesions

cy department

Department of Pathology, Peking Union Medical College
Hospital, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beijing, PR China

Kazakhstan Institute Oncology and Radiology ，Hospital1)

emergency first aid Almaty ，Pathology anatomical Bureau
2)

Almaty ，The Associaton of Kazakhstan Cytologists
3)

4)○Zhilan Meng，
Bo Chen，Yu Zhao，
Jiangang Gu，
Huanwen Wu，Zhiyong Liang○Z. B Yeleubayeva ，A. E. Nartaeva ，B. D. Alibekov ，4)
G. B. Abdrakhimova【Objective】The Papanicolaou Society of Cytopathology

The paper discusses the cytological characteristic of(PSC) has recently proposed a standardized terminology

inflammatory, atrophic and dysplastic changes of the gastricand nomenclature guidelines for pancreatic cytology.

mucosa.

However the risk of malignancy associated with the new

Keywords： Gastric mucosa, hyperplasia, intestinal meta-

guidelines has been scarcely studied. In this study, we

plasia, atrophic gastritis, gastric epithelial dysplasia,

investigated the risk of malignancy for endoscopic ultra-

Helicobacter pylori.

sound-guided fine-needle aspiration (EUS-FNA) cytology

Chronic gastric diseases are one of the leading places in theaccording to the PSC new guidelines.

clinic of internal medicine diseases. Their share in the total【Methods】294 patients who had undergone pancreaticburden of disease is more than 60％.

EUS-FNA procedures were retrospectively studied. The

Helicobacter pylori (HP) -one of the most common

cytologic diagnoses were re-classified according to PSC

infections in the world.

new guidelines. The risk of malignancy was calculated andRetrospectively analyzed the results of 146 cytological

1)

2)

3)

the receiver operating characteristic (ROC) curve analysis

studies of emergency medical patients with gastric

was performed.

pathology for 2 years, which amounted to 584 study.

【Results】The risks of malignancy were 18.1％ for�nega-

Cytological samples obtained primarily to biopsy the tissue

tive,�20.0％ for�neoplastic,�57.1％ for�nondiagnostic,�

pieces are also used blind lavage with saline is endoscopy.

69.2％ for�atypical,�87.5％ for�suspicious,�and 100.0％

The Results：Regardless of the method of producing thefor�positive�respectively. The area under the receivermaterial in 81.3％ cases of cytological material presented

operating characteristic (AUROC) was 0.93 (95％ CI,

multicellular clusters covering epithelium are with severe

0.90-0.96), which was significantly higher than thatdegenerative changes, elements necrosis and infiltrations

associated with old classification (0.82； 95％ CI, 0.77-

with neutrophilic leukocytes that matched the clinical0.87) conventionally used in China.

diagnosis of acute gastritis. In 8.8％ of cases in cytological【Conclusion】Our investigation demonstrated that the newsmears detected cell secretory type glands, accumulation ofguidelines have a greater ability of risk stratification thancovering foveolar type epithelium and intestinal metaplasia

the old classification system conventionally used in China.

with the inflammation signs. In 7.3％ of cases severeThis may be helpful in giving better predictions ofrestructuring epithelial cells with reactive changes. Dyspla-

malignancy, thus leading to more personalized treatment

sia of mild to moderate degree in 1.3％ of cases, in 0.7％

strategies.

dysplasia of glandular epithelium severe structural atypia,
with increased cell proliferation. In 40％ studied byimmersion in the epithelium of the mucous glands andsurface epithelium revealed different degrees of contamina-

55
tion H. Pylori. Background -92％ of cases, the inflammatory
process, and in 8％ of cases reactive regenerative epithelialchanges. In 0.7％ in the case detected stomach cancer.
Conclusion： 1. Application of the method of cytologicaldiagnosis of patients admitted to the emergency hospitalPE-2-27

Inconsistency Analysis between FineNeedle Aspiration Cytology and Imprint
Cytology during Hepatic Tumor Sampling- Five -year Experiences in a Tertiary Center

emergency gastric pathology, found in 80％ of cases ofacute gastritis, with varying degrees of inflammation
prevalence of severe degree, including 40％ of the cases

Department of Laboratory Medicine, National Taiwan
University Hospital

was detected Helicobacter pylori.
2. Cytological examination revealed morphologic processes
in the form of intestinal metaplasia, atrophy and different
degrees of dysplasia epithelium of the gastric mucosa.
3. In severe dysplasia of the epithelium of the mucous○Ya-Ting Lee，
Tsu-Yao Cheng，
Chun-Ming Wang，
Ping-Fung Chung，
Min-Se Huang，Ming-Hsiang Weng，
I-Shiow Jan

membrane of the stomach to prevent gastric cancer patientsshould be advised to repeat the survey to take the material【Background】The preoperative diagnosis of suspected

for histological analysis.

neoplastic hepatic lesions mostly depends on either fineneedle aspiration (FNA) cytology or core biopsy. Undersonographic guidance, hepatic lesions can be detected andsampled properly and safely. The touch imprint cytology canbe done at the same time on processing biopsy specimens.
Previous studies have shown that both FNA and imprint
cytology can yield similar sensitivity and specificity (around85％, 100％ vs. 87.1％, 100％ respectively). But there did
exist inconsistency of final diagnosis between these two
methods. The aim of this study is to investigate the possible
causes of discrepancies between FNA and imprint cytologyof hepatic tumors.
【Materials and Methods】From January 2011 to December
2015, 4,044 cases of liver imprint and 1,245 cases of liver
FNA cytology examinations were performed at our institute
NTUH. Among these cases, 990 cases out of 938 patients
had concurrent FNA and imprint cytology smears. All thesecases were sampled under sonographic guidance, and slides
were stained with both Papanicolaou and Liuʼs stain (a kindof Romanowsky stain). The slides of inconsistent pairs
were reviewed and were compared with clinical-imaginghistopathological diagnosis.
【Results】Thirty seven cases had diagnostic discrepancy
between FNA and imprint cytology. After excluding ninecases with consistent clinical diagnosis, cytology specimensof six cases in the FNA (＋)/imprint (-) group werereviewed. Most cases (83％, 5/6) had adequate cellularity,
but there was no obvious malignant cell after thoroughreviewing. Twenty two cytology cases in the FNA (-)/
imprint (＋) group were also reviewed. Up to thirteen
cases (59％) had poor cellularity for interpretation. Four56

cases showed degenerated cells in the inflammatory/
necrotic background. Five cases showed no obvious
malignant cells after thorough microscopic reviewing.
【Conclusion】In this study, weʼve found that cellularity

PE-2-28

Perivascular epithelioid cell tumor (PEComa) of the retroperitoneum diagnosed by preoperative EUS-FNA cytology：a case reportadequacy was one of the important causes for false-negative
FNA cytology but not imprint cytology examinations.
Technical improvement for proper smear preparation may
be helpful for FNA(＋)/imprint(-) cases. Adequate FNA

Department of Diagnostic Pathology, Takatsuki Red Cross1)
Hospital, Osaka, Japan ，Cancer Education & ResearchCenter, Osaka University Graduate School of Medicine,
2)
Division of Health Sciences, Osaka, Japan

sampling passes may decrease false negativity for FNA(-)/
imprint(＋) cases.

○Koichiro Araki ，Chihiro Watanabe ，1)
1)
1)
Hiroko Murakami ，Tomomi Hirota ，Wataru Chiba ，
1)

Tadao K. Kobayashi

1)

2)【Background】Perivascular epithelioid cell tumors (PEComas) are rare mesenchymal neoplasms which can arise
from almost any location in the body.
【Case】A women in her 50s with a 3.5 x 2.3-cm mass wasobserved in the body of the pancreas on abdominal plain CT
performed to follow the course after left breast cancer
surgery performed 8 years ago. Endoscopic ultrasoundguided fine needle aspiration (EUS-FNA) cytology of thepancreas was performed. Wet-fixed and cell block preparations were prepared.
【Results】On Papanicolaou staining, atypical cells population accompanied by tumor vessels was present with small
lymphocytes in the background. Atypical cells occurredcells formed a solid nest with microvacuolated, lace-likecytoplasm. Therefore, the diagnosis of this lesion based on
EUS-FNA cytology findings was suspected adenocarcinoma
but neither increase in chromatin nor nuclear division wereobserved. Therefore, it was difficult to make a diagnosis
based on the cellular morphology alone. Immunostaining
was performed using cell blocks. HMB-45, a-SMA, andMelan-A were positive, and AE1/3, S-100, c-kit, synaptophysin, CD10, and bcl-2 were negative. Based on these, thelesion was diagnosed as a PEComa. Laparoscopic excisionof the tumor was performed. It was located at theretroperitoneum alongside the inferior margin of the body ofthe pancreas. The excised tumor had a fibrous capsule, theboundary was clear, and the cut surface was solid with afibrous septum. The pathological diagnosis was PEComa,
the same as that on preoperative cytology.
【Discussion】PEComas are defined as tumors that differentiate into perivascular epithelioid cells, and angiomyolipoma in lymphangioleiomyomatosis of the kidney and liver are
included. The present case was a rare tumor classified as

57

PEComas-NOS that originated from the retroperitoneum.
Ultimately, this patient was diagnosed with EUS-FNA

PE-2-29

Expression of vimentin and high molecular weight cytokeratin in the differentia-

cytology before surgery using the cell block method.

tion between reactive renal tubular cells
and low-grade urothelial carcinoma
cells in voided urine【Conclusion】We report the case of PEComa and review
the literature on outcomes and the search for markers
associated with this rare disease.

Department of Medical Biophysics, Kobe University
1)
Graduate School of Health Sciences, Hyogo, Japan ，Laboratory of Pathology, Department of Medical Technology, Kagawa Prefectural College of Health Sciences,2)
Kagawa, Japan ，Division of Pathology, Department ofClinical Research, Shikoku Medical Center for Children and3)
Adults, Kagawa, Japan ，Department of Diagnostic Pathology, University Hospital, Faculty of Medicine, Kagawa
4)
University, Kagawa, Japan○Hiroyuki Ohsaki ，Eiichiro Hirakawa ，3)
4)
Muneo Nakamura ，Reiji Haba
1)

2)

【Objective】Reactive renal tubular cells show features of an
atypical repair reaction. Differentiation between reactive
renal tubular cells and low-grade urothelial carcinoma cells(LG-UCs) therefore can be a diagnostic challenge based onmorphology alone. In this study, we evaluated the
diagnostic utility of vimentin and high molecular weightcytokeratin (HMWCK) antibody in differentiating reactive
renal tubular cells from LG-UCs.
【Methods】We evaluated voided urine cytology and surgical
specimens from 40 patients with renal disease, and 17
patients with low-grade urothelial carcinoma. All slides
were stained with vimentin and HMWCK.
【Results】In the reactive renal tubular cells in voided urine
cytology, vimentin showed strong cytoplasmic staining in
39/40 (97.5％) cases, but all forty cases were negative for
HMWCK. The LG-UCs showed positive for HMWCK in 3/
17 (17.6％) cases, whereas none were positive forvimentin. The reactive renal tubular cells of histological
specimens in the renal disease group demonstrated positivefor vimentin in all (40/40) cases, but all 40 cases were
negative for HMWCK. The low-grade urothelial carcinoma
group showed abnormal staining for HMWCK in 4/17
(23.5％) cases, whereas none were positive for vimentin.
【Conclusions】Vimentin expression in urine cytology canhelp to distinguish reactive renal tubular cells from LGUCs. However, HMWCK does not appear to be a usefuladjunct to distinguish these 2 groups in voided urine
cytology.

58

PE-2-30

Type 2 papillary renal cell carcinoma

PE-2-31

Malignant lymphoma in urine cytolo-

invasion of the renal pelvis by pelvic

gy： a report of two cases with B cellirrigation cytology

lymphoma involving urinary bladderand kidney

Division of Cytopathology & Histopathology, Kansai
1)
Medical University Medical Center, Osaka ，Department of
Pathology and Laboratory Medicine, Kansai Medical
2)
University, Osaka ，Division of Surgical Pathology, Ayabe
City Hospital ，Cancer Education & Research Center,
4)
Osaka University Graduate School of Medicine, Osaka
3)○Yuichi Kinoshita ，Mayumi Inaba ，Naoki Hosaka
3)
4)
Tadanori Yamaguchi ，Tadao K. Kobayashi ，Department of Pathology, Kaohsiung Medical University
Hospital, Kaohsiung Medical University, Kaohsiung,1)
Taiwan ，Departments of Pathology, Taipei Veterans
General Hospital, Taipei, Taiwan ，Departments of Pathol3)ogy, E-Da Cancer Hospital, Kaohsiung, Taiwan
2)，○Chien-Hui Wen ，Sheau-Fang Yang ，Chiung-Ru Lai ，3)
Yue-Chiu Su【Objectitive】Papillary renal cell carcinoma (pRCC) is a

【Objective】Diagnosis of malignant lymphoma in urine

comparatively common tumor comprising about 7-15％ of

cytology is very rare and difficult. We describe theall malignant renal tumors. However, the previous reports

cytomorphological features of lymphoma cells in urineof pRCC were based on fine-needle aspiration or tumor

cytology and discuss the differential diagnosis.

imprint cytology. To our knowledge, there are no reports of【Methods】We report two cases with secondary lymphoma

1)

Koji Tsuta

1,2)

1,2)

1)

1)

2)

2)

using pelvic irrigation cytology to diagnose pRCC.

involving the urinary bladder and kidney. We also carry out【Case】We here report a case of type 2 pRCC that wasa review of the literature regarding the infrequency of thisdiagnosed by pelvic irrigation cytology. The patient was 74-

cytology.

year-old man presented with hematuria during hospitaliza-【Results】Case1： A 65-year-old male was admitted

tion in the Coronary Care Unit due to a heart disorder.

because of hematuria. Urine cytology showed individualized

Renal tumor was detected. After urine and pelvic irrigation

single abnormal cells with high N/C ratio and irregularcytology, nephrectomy was performed.

nuclear contour. The final pathologic diagnosis was large B【Results】On pelvic irrigation cytology, numerous large andcell lymphoma involving urinary bladder. Case 2： A 61-

small papillary clusters composed of atypical cells having

year-old male had a history of hepatocellular carcinoma andabundant cytoplasm were seen in the necrotic background.

chronic renal disease. He presented with dysuria, nocturia

The most cytoplasms were granular and a few cells which(about＞3-5 times/night), frequency (void＞12 times/

has clear cytoplasmic features. Macrophages were notday) and hematuria. Urine cytology showed many single

found in the background. Histologically, the tumor cells

large pleomorphic cells with high N/C ratio. Mitosis waswere similar to those of cytology. Immunohistochemically,

conspicuous. The background had obvious necrotic debris.

the tumor cells were positive for cytokeratin (CK) 7,

The final pathologic diagnosis was large B cell lymphoma

vimentin, epithelial membrane antigen, CD10, alpha-meth-involving kidney.

ylacyl-Co A racemase, and negative for CK 20 and【Conclusion】Diagnosis of malignant lymphoma in urine

CK34bE12, TFE3.

cytology is infrequent and difficult. The most important【Conclusions】Finally, the tumor was diagnosed as type 2

characteristic is a lack of cellular cohesion, followed by

pRCC. Although, it is necessary to differentiate type 2

tumor cells with high N/C ratio and scanty cytoplasm.

pRCC from other diseases on cytology, we consider the

Furthermore, the immunocytochemistry and the clinicaldiagnosis of type 2 pRCC may be established by meticulous

history are also very important in differential diagnosis

cellular observation.

between malignant lymphoma and high-grade urothelial
carcinoma.