Useful aspects of diagnosis of imprint cytology in intraoperative consultation of ovarian tumors: comparison between imprint cytology and frozen sections.

BACKGROUND: In the intraoperative consultation of ovarian tumors, the histological diagnosis of frozen sections (FS) of large tumors is frequently difficult because of the limited number of tumor samples. The application of imprint cytology (IC), in which samples are obtained from wide areas of the tumors, is useful for intraoperative consultation. However, the useful aspects of IC have not been clearly defined. The present study is a detailed comparison of IC and FS that clearly defines the useful aspects of IC. METHODS: Fifty-five cases of ovarian tumors that were examined using both IC and FS were evaluated. The histological diagnoses consisted of benign (16), borderline (6), and malignancy (33). All of the malignant tumors consisted of various types of carcinoma. RESULTS: Benignity and malignancy were accurately diagnosed by both IC and FS. In the borderline group, the diagnostic accuracy of IC was very low (1/6: 16.6%) compared with FS (4/6: 66.6%). The diagnostic accuracy including benign, borderline, and malignant groups was 90.9% (50/55) for IC and 96.3% (53/55) for FS. Concerning the diagnosis of the types of carcinoma, the overall diagnostic accuracy of IC (25/31: 80.6%) was greater than that of FS (21/31: 67.7%), especially for the diagnosis of clear cell carcinoma (IC, 100%; FS, 80%) and mixed carcinoma (IC, 66.6%; FS, 16.6%). CONCLUSION: The useful aspects of IC in the intraoperative consultation are the diagnosis of benignity or malignancy and the accuracy of diagnosing clear cell carcinoma and mixed carcinoma.

Application of Returned Cell Block Method (Cell Block from a Papanicolaou Staining Smear on a Glass Slide) for the Evaluation of Fine Needle Aspiration Cytology of Tumors of the Breast.

BACKGROUND: In the fine needle aspiration cytology (FNAC) for tumors of the breast, evaluation is frequently difficult because of the thick-layered cell clusters and blood inclusion. Such problems may be resolved by the returned cell block method, but its use has not spread worldwide. Here, we examined the application of the returned cell block method to cases involving difficulty in the evaluation of FNAC to diagnose tumors of the breast. METHODS: In Juntendo University Nerima Hospital, there were 22 cases which were difficult to diagnose by Papanicolaou stain only, and they underwent additional examination using the returned cell block method (cell block from a Papanicolaou staining smear on a glass slide). The usefulness of the returned cell block method in these cases was examined. RESULTS: Among the 22 cases, a correct diagnosis was facilitated in 20 cases using the returned cell block method. In 16 of the 20 cases, the difficulty in FNAC was because of thick-layered cell clusters (12 cases) and blood inclusion (four cases). Among the 12 cases with difficulty because of the thick-layered cell clusters, 10 cases (83%) comprised intraductal papilloma (six cases) and intraductal papillary carcinoma (four cases). Papilloma and papillary carcinoma were correctly diagnosed by the addition of histological images and immunostaining of myoepithelial cells using the returned cell block method. CONCLUSION: The application of the returned cell block method is useful for precise evaluation of the cytological diagnosis of tumors of the breast, especially papillary lesions. Diagn. Cytopathol. 2016;44:505-511. © 2016 The Authors Diagnostic Cytopathology Published by Wiley Periodicals, Inc.

Isolated necrotizing arteritis (localized polyarteritis nodosa): examination of the histological process and disease entity based on the histological classification of stage and histological differences from polyarteritis nodosa.

INTRODUCTION: Although isolated necrotizing arteritis (INA) has been thought to be an isolated form of polyarteritis nodosa (PAN), a detailed histological comparison between INA and PAN has not been performed. Therefore, we examined the disease entity of INA based on the histological comparison of both diseases. In addition, a histological classification of INA, in which the histological process of INA is included, was described. METHODS: A histological study, including CD3, CD20, and CD68 immunostains, was performed in seven operated patients with INA. Five untreated patients with PAN were also examined. RESULTS: In INA, arteritis with fibrinoid necrosis occurred in small and medium-sized arteries in a single organ. INA was divided histologically into acute (five cases) and healed stage (two cases). Endothelial injury and medial degeneration, followed by fibrinoid necrosis, occurred in the acute stage, and regression of fibrinoid necrosis and fibrosis were present in the healed stage. Infiltration of predominant T lymphocytes and macrophages was also observed in the affected arteries. Histological comparison between INA and PAN led to the finding that the extension of fibrinoid necrosis in the entire arterial wall, which indicates severe wall destruction, intense proliferation of fibroblasts and aneurysm formation occurred in PAN alone. CONCLUSIONS: We demonstrated some histological differences between INA and PAN. Based on the histological similarities and differences between INA and PAN, it was concluded that INA shall be classified as a mildly wall destructive form of PAN-type arteritis located in a single organ.

Autoimmune hepatitis in primary Sjogren's syndrome: pathological study of the livers and labial salivary glands in 17 patients with primary Sjogren's syndrome.

Although primary Sjogren's syndrome (pSS) is an autoimmune exocrinopathy, the involvement of liver has been reported. Because no study focusing on autoimmune hepatitis (AIH) in pSS has been published, the purpose of the present study was to perform a clinical and histological examination of the liver, focusing on AIH, in 17 pSS patients. The patients had liver enzyme abnormalities without hepatitis virus infection. In all cases, biopsied livers were examined, and in 10 cases biopsied labial salivary glands were also examined histologically. Based on the authors' diagnostic criteria for AIH in pSS, the liver diseases consisted of AIH (eight cases, 47%), primary biliary cirrhosis (PBC; six cases, 35%), non-specified chronic hepatitis (two cases, 12%) and acute hepatitis (one case, 6%). Lymphoplasmacytic infiltrate, with predominancy of CD3(+) T cells, was noted in both the liver and salivary glands in the patients with AIH. The patients with AIH with severe interface hepatitis had a good response to immunosuppressive therapy. The comparison of liver histology between the PBC with pSS group and the PBC without pSS group showed that the incidence of lymphoid non-suppurative cholangitis was higher in PBC with pSS. In conclusion, the present study offers new information on the relatively common occurrence, diagnostic criteria and treatment effects of AIH in pSS.