Search

Background Adult-onset renal cell carcinoma (RCC) associated with Xp11.2 translocation/TFE3 gene fusion is a very rare tumor. To date, there are no reports on immunocytochemical study of the primary tumor. We describe such a case that we diagnosed by immunocytochemistry of imprint cytology material. Case A 46-year-old man was found to have a mass in the lower pole of the right kidney. Magnetic resonance imaging (MRI) T2-weighted images showed a hypointense area in the tumor, and papillary RCC was suspected. Imprint cytology showed tumor cells that were isolated or arranged in large or small papillary clusters. Irregularly shaped large oval nuclei, finely granular chromatin and a single large nucleolus were noted. Cytoplasm was abundant and admixed with clear and granular eosinophilic patterns and scattered large vacuolated cells. Almost all tumor cells diffusely expressed immunocytochemical reactivity to TFE3 protein. Hyaline nodules were observed in the stroma. Ultrastructurally, neoplastic cells contained rhomboid crystals identical to those of alveolar soft part sarcoma. Conclusion The immunocytochemistry of TFE3 protein may be a powerful tool for accurate diagnosis when RCC associated with Xp11.2 translocation/TFE3 gene fusion is suspected by imprint cytology even in adult-onset cases, and cytotechnologists should accurately recognize cytologic findings of this tumor.

Background Primary gastric small cell carcinoma is a rare but important entity. We describe a case that we diagnosed by peritoneal washing cytology. Case A 70-year-old male presented with upper abdominal discomfort and underwent endoscopic evaluation. Gastric endoscopy revealed a diffuse, infiltrating tumor from the body to the antrum. Total gastrectomy with lymph node dissection and intraoperative peritoneal washing cytology were carried out. Peritoneal washing cytology showed the presence of many undifferentiated malignant small cells with a necrotic background. The tumor cells were small and round, with naked, hyperchromatic nuclei and finely granular chromatin. Some tumor cells contained paranuclear blue inclusions (PBls) in the cytoplasm. The tumor cells were positive for neuron-specific enolase and synaptophysin on immunocyto-chemistry. Carcinoembryonic antigen, alpha-fetoprotein (AFP) and leukocyte common antigen were negative. Pathologic diagnosis after the operation was moderately to poorly differentiated adenocarcinoma and small cell carcinoma containing AFP-positive cells. Conclusion The prognosis of primary gastric small cell carcinoma is usually poor. Our patient died of multiple liver metastases and peritonitis carcinomatosa 69 days after surgery. When a gastric small cell carcinoma is suspected in peritoneal washings, immunocytochemical demonstration of neuroendocrine differentiation is required to arrive at the final diagnosis.

BACKGROUND: Primary pulmonary leiomyosarcoma is a rare but important entity. We report a case diagnosed by fine needle aspiration cytology. CASE: A 73-year-old male presented with an asymptomatic, right, pulmonary, subpleural nodule detected by computed tomography during follow-up for chronic obstructive pulmonary disease. Fine needle aspiration cytology showed cellular smears with numerous single or loosely cohesive groups of spindle-shaped to round cells. The tumor cell nuclei were blunt ended (cigar shaped), with fine to fine-granular chromatin, prominent nucleoli and an irregular nuclear rim. The tumor cells were positive for desmin and negative for cytokeratin and S-100 protein by immunocytochemistry. Right upper lobectomy with lymph node dissection was performed. Pathologic diagnosis after microscopic, immunohistochemical and electron microscopic studies was leiomyosarcoma. CONCLUSION: To our knowledge, this is the first reported case of primary pulmonary leiomyosarcoma arising in the subpleural region diagnosed by fine needle aspiration cytology. Immunocytochemistry was useful in establishing the diagnosis in this case.

背景:子宮頸部扁平上皮癌の1亜型である子宮頸部乳頭状扁平上皮癌 (Papillary squamous cell carcinoma: PSCC) の2例について報告する.症例:症例1は69歳女性で, 子宮頸部より外向性に発育する径5cmの腫瘍を, 症例2は47歳女性で, 子宮頸部より乳頭状に発育する径4cmの腫瘍を認めた. 細胞診ではどちらの症例でも乳頭状に増生する小型類円形の異型細胞を認めた. 核分裂像が散見され, 乳頭内には血管を含む間質成分がみられた. 核異型は症例1では軽度, 症例2では中等度から高度であった. また, 症例2では扁平上皮異形成類似の大型空胞細胞や移行上皮癌類似の細胞も認められた. 組織学的にはどちらの腫瘍も十数層の異型細胞の乳頭状増生からなり, 間質には, 線維性血管芯を有していた. 免疫組織化学的に腫瘍細胞はCytokeratin 7 (CK7) 陽性, CK20陰性であり, 通常の子宮頸部扁平上皮癌と同様の染色性を示した. Human papillomavirus (HPV) 感染の有無について検索したが, どちらの症例も陰性であった.結論:PSCCの細胞像は多彩であるが, 細胞所見を十分に理解し, 臨床所見を加味することによりPSCCの診断は可能と考えられた.

BACKGROUND Primary small cell carcinoma (SCC) of the bladder is a rare but important entity. We report two cases of SCC of the bladder diagnosed by urinary cytology. CASES A 71-year-old male (case 1) and a 79-year-old female (case 2) presented with asymptomatic gross hematuria. Urinary cytology in case 1 showed the presence of a few undifferentiated malignant small cells and many transitional cell carcinoma (TCC) cells with a bloody and necrotic background. The former cells were small and round, with naked, hyperchromatic nuclei and finely granular chromatin. Pathologic diagnosis after total cystectomy was TCC > SCC > adenocarcinoma, T2M0N0. Urinary cytology of case 2 showed the presence of many undifferentiated malignant small cells and many TCC cells with or without squamous metaplasia. Cytologic features of the former cells were almost the same as those in case 1. Moreover, these cells were neuroendocrine marker positive by immunocytochemistry. Pathologic diagnosis after tumor resection was SCC and TCC > squamous cell carcinoma, T1b. CONCLUSION The prognosis of primary SCC of the bladder is usually poor. Because our cases were found by urinary cytology at a relatively early stage, both have been well, without any evidence of recurrence, 30 and 25 months after surgery even without adjuvant therapy.

乳頭状腎細胞癌 (Papillary renal cell carcinoma; PRCC) の2例を経験したので報告する.症例1は60歳男性で左腎下極に1.5cm大の腫瘍を2個認め, 症例2は62歳男性で左腎上極に壊 死を伴う5.0cm×4.0cm大の腫瘍を認めた. 色調はいずれも黄茶褐色で被膜を有していた. 細胞像では, 泡沫細胞を背景として異型細胞の乳頭状集塊を認めた. 腫瘍細胞の核は小型, 円～類円形でクロマチン増量を示し, 核溝も散見された. 核小体は小型もしくは認めず, 胞体は穎粒状を呈し細胞形は類円～長円形であった. 症例1では細胞質内穎粒を認めた. 組織学的には, いずれも好酸性細胞からなる乳頭状腫瘍で乳頭内への泡沫細胞浸潤を伴い, 症例1では, neuromelaninと考えられる細胞質内穎粒を認めた. 免疫組織学的にはいずれの腫瘍も遠位尿細管系マーカーに優位な染色性を示した. また, in situ hybridization (ISH) 法では, いずれの腫瘍にも17番染色体のtrisomyが認められた. 2例とも術後1年余り経過しているが, 再発・転移の徴候はない. PRCCは通常の腎細胞癌と比べ, 予後良好であることが知られており, 本腫瘍を正確に診断することは臨床的あるいは予後判定に重要であると考えられる.

Adult-onset renal cell carcinoma (RCC) associated with Xp11.2 translocation/TFE3 gene fusion is a very rare tumor. To date, there are no reports on immunocytochemical study of the primary tumor. We describe such a case that we diagnosed by immunocytochemistry of imprint cytology material.A 46-year-old man was found to have a mass in the lower pole of the right kidney. Magnetic resonance imaging (MRI) T2-weighted images showed a hypointense area in the tumor, and papillary RCC was suspected. Imprint cytology showed tumor cells that were isolated or arranged in large or small papillary clusters. Irregularly shaped large oval nuclei, finely granular chromatin and a single large nucleolus were noted. Cytoplasm was abundant and admixed with clear and granular eosinophilic patterns and scattered large vacuolated cells. Almost all tumor cells diffusely expressed immunocytochemical reactivity to TFE3 protein. Hyaline nodules were observed in the stroma. Ultrastructurally, neoplastic cells contained rhomboid crystals identical to those of alveolar soft part sarcoma.The immunocytochemistry of TFE3 protein may be a powerful tool for accurate diagnosis when RCC associated with Xp11.2 translocation/TFE3 gene fusion is suspected by imprint cytology even in adult-onset cases, and cytotechnologists should accurately recognize cytologic findings of this tumor.

In this article, we report a case of 76-year-old woman with a rare variant of chromophobe renal cell carcinoma (CRCC). Cytologically, renal tumor cells obtained from imprint cytology were isolated or arranged in small or monotonous population cells with abundant granular cytoplasm. Neoplastic cells showed regular and uniformly shaped small round to oval nuclei with smooth margin. Binucleation was occasionally seen. Immunocytochemically, the cytoplasm of almost all tumor cells was diffusely positive for vimentin and CK 7. Histologically, the cytoplasm was abundant granular eosinophilic and composed of solid cell sheets or pseudoacinar structures. Additionally, tumor cells showed infiltration into some small renal veins covered by a single layer of endothelial cells. These cytological and histological features entirely resembled those of renal oncocytoma. We performed the analysis of von Hippel-Lindau (VHL) gene mutation, 3p loss of heterozygosity (LOH), and fluorescence in situ hybridization (FISH) on chromosomes 7, 10, 13, 17, and 21. As a result, we confirmed monosomy of chromosomes 7, 10, 13, and 17, and these findings corresponded to the diagnosis of CRCC. Finally, we present a case of renal tumor morphologically resembling renal oncocytoma but genetically showing CRCC. We suggest that oncocytic variant of CRCC may actually exist. Diagn. Cytopathol. 2010. © 2009 Wiley-Liss, Inc.

Primary gastric small cell carcinoma is a rare but important entity. We describe a case that we diagnosed by peritoneal washing cytology.A 70-year-old male presented with upper abdominal discomfort and underwent endoscopic evaluation. Gastric endoscopy revealed a diffuse, infiltrating tumor from the body to the antrum. Total gastrectomy with lymph node dissection and intraoperative peritoneal washing cytology were carried out. Peritoneal washing cytology showed the presence of many undifferentiated malignant small cells with a necrotic background. The tumor cells were small and round, with naked, hyperchromatic nuclei and finely granular chromatin. Some tumor cells contained paranuclear blue inclusions (PBls) in the cytoplasm. The tumor cells were positive for neuron-specific enolase and synaptophysin on immunocyto-chemistry. Carcinoembryonic antigen, alpha-fetoprotein (AFP) and leukocyte common antigen were negative. Pathologic diagnosis after the operation was moderately to poorly differentiated adenocarcinoma and small cell carcinoma containing AFP-positive cells.The prognosis of primary gastric small cell carcinoma is usually poor. Our patient died of multiple liver metastases and peritonitis carcinomatosa 69 days after surgery. When a gastric small cell carcinoma is suspected in peritoneal washings, immunocytochemical demonstration of neuroendocrine differentiation is required to arrive at the final diagnosis.

Primary pulmonary leiomyosarcoma is a rare but important entity. We report a case diagnosed by fine needle aspiration cytology.A 73-year-old male presented with an asymptomatic, right, pulmonary, subpleural nodule detected by computed tomography during follow-up for chronic obstructive pulmonary disease. Fine needle aspiration cytology showed cellular smears with numerous single or loosely cohesive groups of spindle-shaped to round cells. The tumor cell nuclei were blunt ended (cigar shaped), with fine to fine-granular chromatin, prominent nucleoli and an irregular nuclear rim. The tumor cells were positive for desmin and negative for cytokeratin and S-100 protein by immunocytochemistry. Right upper lobectomy with lymph node dissection was performed. Pathologic diagnosis after microscopic, immunohistochemical and electron microscopic studies was leiomyosarcoma.To our knowledge, this is the first reported case of primary pulmonary leiomyosarcoma arising in the subpleural region diagnosed by fine needle aspiration cytology. Immunocytochemistry was useful in establishing the diagnosis in this case.