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Pulse granuloma is a rare pathologic condition considered to be a benign inflammatory reaction to foreign materials originated from ingested legume matter. As for pulse granulomas of the gastrointestinal tract, association with diverticular diseases is relatively common, but only a few pulse granuloma cases associated with appendicitis have been reported. This report presents histopathologic findings of pulse granuloma lesions observed in two appendectomy cases, with some histochemical examinations of cellulose matter which is reportedly a major component to provoke pulse granuloma reaction. Our patients in both cases were girls in their teens, and they underwent interval appendectomy for acute appendicitis. Both appendectomy specimens revealed ruptured walls with inflammatory granulation tissue with marked foreign body reaction including characteristic collections of ring-like, curled ribbon-like, and/or lobulated nephrosclerosis-like hyaline structures and various foreign bodies, in which microorganisms or amyloid deposition were not identified. The presence of cellulose matter was suggested by Sirius red stain, the IKI (iodine potassium iodide)-H2SO4 method, and birefringence by polarized light. Appendectomy materials due to acute appendicitis would include pulse granuloma reaction provoked by ingested materials with cellulose. Pathologists should be familiar with the concept and histopathologic features of pulse granulomas to avoid misinterpreting them as vascular lesions and/or amyloid deposition, or any infectious organisms.

Even compared to other clinical laboratories, the pathological laboratory conducts troublesome work, and many of the work processes are also manual. Therefore, the introduction of the systematic management of administration is necessary. It will be a shortcut to use existing standards such as ISO 15189 for this purpose. There is no standard specialized for the pathological laboratory, but it is considered to be important to a pathological laboratory in particular. 1. Safety nianagement of the personnel and environmental conditions. Comply with laws and regulations concerning the handling of hazardous materials. 2. Pre-examination processes. The laboratory shall have documented procedures for the proper collection and handling of primary samples. Developed and documented criteria for acceptance or rejection of samples are applied. 3. Examination processes. Selection, verification, and validation of the examination procedures. Devise a system that can constantly monitor the traceability of the sample. 4. Post-examination processes. Storage, retention, and disposal of clinical samples. 5. Release of results. When examination results fall within established alert or critical intervals, immediately notify the physicians. The important point is to recognize the needs of the client and be aware that pathological diagnoses are always "the final diagnoses".

背景:中枢性神経細胞腫central neurocytoma (以下, CN) は, 比較的新しい概念の腫瘍で細胞診の報告例はいまだ少ない. 今回われわれは, 右側脳室に発生したCNを経験したので, 術中の捺印および圧挫処理標本の細胞像を中心に報告する.症例:患者は28歳男性で, 頭部打撲にて救急外来を受診した. 頭部CTで右側脳室に石灰化を伴う腫瘍を認め, MRIでは腫瘍内部に嚢胞を伴っていた. 術中捺印細胞診標本で, 腫瘍細胞はライトグリーン淡染性の線維性物質を背景に, 散在性あるいは結合性の緩い細胞集塊としてみられ, 一部ではロゼット様の細胞配列を示していた. また, 核周囲が明るく抜けた細胞質を有する細胞境界明瞭な細胞も一部にみられた. 術中の組織所見では, エオジン淡染性の細胞質と均一な円形～類円形核を有する腫瘍細胞を認め, 細胞境界は不明瞭であった. 術中の細胞・組織所見と臨床所見からCNが疑われ, 術後の組織および免疫染色所見と電子顕微鏡的検索からCNと診断した.結論:CNの術中迅速診断において, 細胞診を併用することで, 凍結切片標本では捉えることのできない所見を得ることができた. これらの細胞学的所見に加え, 組織所見と臨床所見を考慮することによって, CNの術中迅速診断が可能になると思われた.

目的:現在尿路上皮腫瘍のスクリーニング法としては尿細胞診が広く用いられているが細胞異型の弱い腫瘍の場合には検出感度が低く偽陰性が問題となる. 近年開発された尿中腫瘍マーカーのNMP22は, 迅速に結果が得られ早期の尿路上皮癌を確認できるとされスクリーニングに広く用いられつつある. 今回われわれは, 尿中NMP22値と尿細胞診結果を組織診断および膀胱鏡検査と比較し, 今後の尿路上皮スクリーニング法について検討したので報告する.材料および方法:2000年7月から2002年4月までに当院泌尿器科より提出された外来自然尿675例について尿細胞診およびNMP22 (コニカMatritech UNMP22テストキットELISA法) を比較検討した.結果:臨床的および組織学的に31例の癌 (G1: 8例G2: 19例G3: 4例) が確認された. このうちNMP22では陽性が17例, 細胞診では14例, 陰性はNMP22では14例, 細胞診では17例であった. 細胞診では明らかな偽陽性症例 (+) はみられず, 疑陽性症例 (±) 17例に対しNMP22での偽陽性数は96例であった. これらの要因として細胞診で炎症や結石などにより細胞異型を示していたものがあり, NMP22では白血球成分の多い検体で高値を示していた.考察:今回の検討で尿細胞診では検出感度は低いが特異度が高く診断には欠かせない検査である. 一方, NMP22はG1の癌検出が細胞診に比べ優れているが, 膿尿などの白血球成分の多い検体では偽陽性結果が多く細胞診結果と乖離するためNMP22と尿細胞診との併用が望ましいと思われる.

Background: We report a case of a 61-year-old Japanese woman who developed intra-abdominal angiosarcomatosis 20 years after receiving radiotherapy for squamous cell carcinoma of the cervix. Methods and Results: The surgically resected portion of the ileum showed diffuse proliferating angiosarcoma, with irregular channels lined by atypical vascular endothelial cells. Immunohistochemical studies showed that the tumour cells were positive for Factor VIII-related antigen and ulex europaeus agglutinin 1. At autopsy, the tumour had disseminated to the peritoneum and invaded into the right thoracic cavity. Conclusions: These findings were compatible with radiation-induced angiosarcomatosis.

We report a rare case of secretory carcinoma of the breast in a 50-year-old Japanese woman. The patient had been aware of a right breast tumor for 8 years, but had left it untreated. The tumor enlarged in size and became painful, and she visited our hospital. Breast carcinoma was diagnosed, and mastectomy was performed. Histopathological examination revealed features of a secretory carcinoma characterized by prominent secretory activity in the glandular and microcystic spaces, with some areas showing a follicular pattern resembling the thyroid gland. The secretory material was PAS-positive and immunohistochemically alpha-lactalbumin-positive. Ultrastructurally, the tumor cell contained many secretory vacuoles in the cytoplasm. In addition, extracellular and intracytoplasmic lumina were conspicuous; these were lined by microvilli projection and contained secretory material. By flow cytometric analysis, the DNA index was 1.14, which was diploid, showing relatively low proliferative activity.

BACKGROUND: Placental site trophoblastic tumor (PSTT) is a rare form of trophoblastic neoplasm. Approximately 100 cases of PSTT have been reported, but we found no report on its cytodiagnosis. CASES: Case 1, a 39-year-old female, came to the hospital because of abnormal genital bleeding. Case 2, a 36-year-old female, came because of amenorrhea for a year. In both cases, endometrial smear and intrauterine curettage suggested trophoblastic disease, and hysterectomy was performed. Laboratory data revealed a mild increase in human chorionic gonadotropin (hCG) and β-hCG but normal human placental lactogen (hPL). In the cytologic examination, the background contained some hemorrhagic and fibrinous areas but no necrosis. Most tumor cells stained light green, were round or polygonal, and contained abundant cytoplasm. Some were palely stained and had vacuoles. Some cells showed hyperchromatism, an irregular nucleus, fine-to-coarse chromatin granules and markedly different sizes. Most of the cells were hPL positive, and a few were hCG positive. CONCLUSION: Both cases were considered benign because of rare mitoses despite cellular pleomorphism. However, careful follow-up is required. The differential diagnosis of PSTT is difficult from cytologic and biopsy specimens alone but may be achieved with additional magnetic resonance imaging findings and positive staining of hPL and hCG.

BACKGROUND Endodermal sinus tumor (EST) of vaginal origin is extremely rare, and few previously published reports have described the cytology of this tumor. CASE A high serum alpha-fetoprotein (AFP) level and magnetic resonance imaging findings in a 10-year-old female suggested EST of the lower genital tract. Laparotomy revealed EST occupying the pelvic cavity. The patient died on the 17th postoperative day due to complications from disseminated intravascular coagulation. Autopsy was performed immediately after death. The tumor originated in the posterior vaginal wall directly below the ectocervical area. Both ovaries were involved, and the tumor proliferated to occupy the cavity of the pelvis minor. A vaginal smear, obtained on two occasions, revealed severe necrosis with few cells, and a diagnosis could not be made. An imprint smear of the tumor obtained during surgery showed relatively characteristic cytologic findings of EST. Immunocytochemical and immunohistochemical studies revealed staining positive for AFP. CONCLUSION Vaginal EST usually occurs in patients under 3 years of age. This 10-year-old patient was the oldest among the reported cases. Vaginal EST is clinically similar to sarcoma botryoides and clear cell carcinoma, and a differential diagnosis is necessary. Immunocytostaining for AFP is essential for a definitive cytologic diagnosis of EST.

BACKGROUND: Malignant melanoma of soft tissue (MMST) is a rare tumor and consists of

HPV-DNAが組み込まれている培養細胞を用い, 細胞・組織切片上におけるDNA検出の増感法であるPCR-ISH法およびIn situ PCR法の反応条件などにつき基礎的検討を行い以下の結果を得た.1) PCRの反応条件は, 熱変性 (denature) 90.C1分, アニール (anneal) 55.C2分, 伸長 (extension) 72℃3分の20サイクルで最も良好な染色性をしめした.2) PCR-ISH法, In situ PCR法いずれも, 細胞診に用いられる95%エタノール固定細胞材料からのDNA検出は可能であった.3) PCR-ISH法およびIn situ PCR法にてISH法では検出が不可能とされているHPV-DNA1コピーの培養細胞SiHaの核内に陽性像を認めた.以上よりこれら方法はISH法が有する感度が低いという欠点を克服し, かつ, DNAの局在を形態学的に確認できることから臨床細胞診材料を対象にウィルスDNAの検出, さらに, 腫瘍遺伝子などの検出にも十分応用が可能であると考えられる. また, PCR法の問題点であったコンタミネーションについては, 形態学的にそれを識別できるという点で, DNA診断の信頼性も高まると考えられた.

Recently, cervical adenocarcinoma has been increasing especially among young women and account for 10-20% of cervical cancer. However, the detection rate of HPV-DNA was 35-85% and lower than that of squamous cell carcinoma. Furthermore, the relationship with HPV in cervical adenocarcinoma was not much investigated in Japan, so we studied HPV status in cervical adenocarcinoma by in situ PCR method using biotin-labeled DNA probes, because in situ PCR method possesses the advantages of both PCR and in situ hybridization in being highly sensitive and enabling visualization of the cellular localization of the DNA. HPV infection was analyzed in 60 cervical adenocarcinomas, including 1 adenocarcinoma in situ and 15 adenosquamous carcinomas. HPV-DNA was detected in 47 of all 60 cases(78%): 35 of 45(78%) in adenocarcinomas and 12 of 15(80%) in adenosquamous carcinomas. No significant correlation was found between the HPV-DNA detection rate and histological subtypes of adenocarcinoma. In conclusion, cervical adenocarcinoma demonstrates a high prevalence of HPV-DNA as well as other previous studies. Therefore, HPV infection plays a very important role in not only squamous cell carcinoma but also adenocarcinoma in uterine cervix.

Although formalin-based fixatives are used in pathologic laboratories, there is no strictly standardized fixation protocol in Japan. To examine interlaboratory variation caused by different conditions of fixation in the assessment of human epidermal growth factor receptor (HER) 2 status on pathologic tissues, 274 archival invasive breast carcinomas from 5 different laboratories were evaluated using the HercepTest. In 1 laboratory in which 10% neutral buffered formalin was used, as recommended by the manufacturer, the overexpression rate was 22.4% and fell within the statistical expected range (20%-30%) for HER2 overexpression in breast carcinomas. The overexpression rates in the other 4 laboratories, in which either 20% nonbuffered formalin or 15% neutral buffered formalin was used, were near the expected range for HER2 overexpression. To clarify the influence of prolonged formalin fixation on the HercepTest, we compared 1-day with 7-day fixations using 36 cases fixed with 20% nonbuffered formalin. Of the 36 cases, 7 showed 3+ staining with 1-day fixation and sustained the same scoring results with 7-day fixation, although the staining intensities in these cases were reduced with the prolonged fixation. These results indicated that the immunohistochemical assessment of HER2 status with the HercepTest was comparatively resistant to prolonged fixation conditions and provided stable staining results in positive cases, particularly 3+ patients.

OBJECTIVE: To examine estrogen receptor (ER) detection using cytologic specimens and to compare the results with those obtained by the dextran-coated charcoal (DCC) method and enzyme immunoassay (EIA). STUDY DESIGN: Immunocytochemical staining was conducted on 60 cases of breast cancer resected at our hospital between April 1993 and November 1997 in which ER had been measured by DCC or EIA. Specimens for immunocytochemical staining were prepared by a cell transfer method using archival Papanicolaou-stained imprint smears, and ER staining was performed by the labeled streptavidin method using an anti-ER monoclonal antibody, These results were compared with those obtained by DCC or EIA. RESULTS: In immunocytochemical staining for ER, positive staining was observed in the nuclei of tumor cells. A good correlation was obtained between the immunocytochemical staining results and biochemical results. Five cases were positive in anti-ER staining but negative in biochemical tests, and two cases were negative in anti-ER staining and positive in biochemical tests. CONCLUSION: Unlike biochemical assays, the immunocytochemical method does not necessitate use of fresh frozen materials and can be performed even using archival Papanicolaou-stained smears. Immunocytochemical study is a highly useful method for routine ER determination.

We report 2 cases of urachal carcinoma having totally different cytological features. Tumor cells in case 1 were highly atypical. having scanty mucin in the cytoplasm and growing in papillary patterns. Tumor cells in case 2 showed mild atypia with abundant mucin. Case 1 was difficult to distinguish cytologically from poorly differentiated transitional cell carcinoma. Case 2 was difficult to distinguish from adenoma. A definitive diagnosis of urachal carcinoma having these cytological features can only be made combining characteristic clinical findings.