The effects of the selective cyclooxygenase-2 inhibitor on endometrial cytological findings in uterine endometrial cancer patients.

OBJECTIVE: We previously reported that oral administration of the selective cyclooxygenase-2 (COX-2) inhibitor etodolac results in antitumor effects in endometrial cancer tissue. Herein, we investigated whether these antitumor effects could be assessed using endometrial cytological findings. STUDY DESIGN: Etodolac (400 mg b.i.d. for 2 weeks) was administered preoperatively to 21 endometrial cancer patients: 16 had COX-2-positive disease and 5 had COX-2-negative disease. Twenty-one pairs of pre- and post-etodolac-treatment endometrial cytological samples were collected to review changes in the cytological features. RESULTS: In the COX-2-positive patients, nuclear atypia was slightly decreased in 3 of the 16 cases, while the mitotic index was decreased in all cases. Cellular overlapping and tumor cell cluster outlines were somewhat affected in 6 and 8 cases, respectively. Nuclear/cytoplasmic ratio, anisokaryosis and hyperchromasia were also reduced in 6, 4, and 2 cases, respectively; however, tumor diathesis and nucleoli features were unchanged. In contrast, endometrial cytological features did not appear to be affected in the 5 COX-2-negative patients. CONCLUSIONS: We conclude that the antitumor effects observed in endometrial cancer tissues following oral administration of etodolac are reflected in and can be easily assessed by evaluating endometrial cytological features.

A cell-block preparation using glucomannan extracted from Amorphophallus konjac.

To evaluate a cell-block preparation using glucomannan, which was extracted from Amorphophallus konjac. Ten specimens were centrifuged at 1,500 rpm for 5 minutes, the supernatant was removed; the remnant after the preparation of smear specimens for routine cytological examination was fixed with 20% formalin. The specimen was recentrifuged at 1,500 rpm for 5 minutes, and the supernatant was removed. The residue was resuspended with 2 ml of eosin solution and 1-5 ml of 80% alcohol, and stirred well. After further centrifugation, the supernatant was removed, and one drop of a glucomannan-formalin water solution was added gently. After immersion in methanol for 2 hours, glucomannan is solidified and becomes gelatinous. The obtained cell block was placed in the cassette for the preparation of tissue specimens, dehydrated by the routine method, infiltrated with paraffin, and a paraffin-embedded block was prepared. Thin sections were prepared from the paraffin-embedded cell block, and hematoxylin-eosin (H&E) stain with immunological stains was performed. H&E stain, periodic acid-Schiff reaction, Alcian blue, and immunohistochemical stain were clearly demonstrated.We evaluated a new modality of cell-block preparation using a glucomannan-formalin water solution. We found that the method was easy to perform and thought it could be useful as an alternative technique for cell-block preparations. Thus, this novel technique should find wide application in the future.

Histochemical study of the definitive erythropoietic foci in the chicken yolk sac.

It is well known that avian yolk sac is involved in both primitive and definitive erythropoiesis during embryonic development. Definitive erythropoiesis is first detected at about 4-5 days incubation and its maximum activity is reached between day 10 and 15 of incubation, ending between days 18 and 20 of incubation. We confirmed the definitive erythropoietic foci in the chicken yolk sac throughout the 5th to 19th day of incubation by histochemical light and electron microscopy. The definitive erythropoietic foci were observed in the yolk sac endodermal layer from day 5 until day 19, just before hatching. Ultrastructurally, definitive erythropoietic foci were observed extravascularly in the yolk sac endodermal cell layer in direct contact with the vitellolysis zone. These findings provide a basis for clarifying definitive erythropoiesis in vertebrates.

Langerhans cell histiocytosis of the skull on cytologic squash preparations.

We present a case in which a primary cytodiagnosis of Langerhans cell histiocytosis (LCH) of the skull was made using squash preparations. The patient, a 25-year-old male, presented with raised intracranial pressure and decreased visual acuity. Magnetic resonance imaging revealed a large skull lesion with osteolytic features in the left frontal bone. The patient underwent surgical resection by the extended basal frontal epidural approach. The squash preparation smears were cellular and demonstrated a mixed population of small, mature lymphocytes, eosinophils, and a high histiocytes content. The histiocytes occurred as isolated or loosely cohesive and clustered. They possessed abundant cytoplasm with rounded cell shape and had characteristic nuclear features, composed of fine chromatin and delicate nuclear membranes. The cytologic features of these histiocytes were consistent with Langerhans cells (LCs). A final impression of LCH of the skull was rendered. Subsequent histopathology confirmed the diagnosis. LCs reacted with both S-100 protein and CD1a immunohistochemically. The demonstration of Birbeck granules on electron microscopic study was also noted. Whenever squash preparation yields a mixed population of mature lymphocytes, eosinophils, and histiocytes, the cytologists should be aware of and consider LCH as a diagnostic possibility.

Cytologic diagnosis of endosalpingiosis with pregnant women presenting in peritoneal fluid: a case report.

The cytologic appearance of endosalpingiosis in peritoneal fluid cytology smears has not been extensively described. We report a case of endosalpingiosis in a 29-year-old pregnant female who presented with peritoneal fluid. Dense papillary epithelial clusters with indistinct ciliated cells were found in the Papanicolaou-stained smears. However, long and delicate cilia were obvious in papillary cluster with scanning electron microscopy. Cell nuclei were oval, with finely dispersed chromatin and uniform nuclear membrane. Peritoneal fluid cytology with these findings may be helpful to suggest the probable preoperative diagnosis of endosalpingiosis or benign glandular inclusions involving the pelvic peritoneum.

Papillary clusters as a diagnostic pitfall in urinary cytology of pseudosarcomatous fibromyxoid tumor of the bladder. A case report.

BACKGROUND: Pseudosarcomatous fibromyxoid tumor (PFT) of the urinary bladder is an uncommon benign lesion that can involve any site in the bladder. Cellular features of PFT of the bladder are exceedingly rare. We describe the urinary cytology in a PFT patient who displayed numerous papillary fragments that suggested a malignant tumor. CASE: A 52-year-old man was seen at the hospital for evaluation of gross hematuria. At cystoscopy, the urologist observed a 3-cm, smooth, polypoid and ulcerated mass extending from the trigone to the bladder neck. Urinary cytology showed many papillary clusters with irregular nuclear margins in the bloody cell background. No spindle cells were noted. Cytology was interpreted as papillary growth, factor transitional cell carcinoma, grade 2-3. A laparotomy with partial resection of the urinary bladder was carried out, and histologically the tumor was composed of spindle, stellate, fibroblastic cells embedded in myxoid stroma with little collagen. Immunohistochemical and ultrastructural studies revealed the fibroblastic nature of the lesion. The final diagnosis was PFT of the bladder on the basis of histologic examination of the resected material. CONCLUSION: Papillary fragments are a diagnostic pitfall in urinary cytology of PFT lesions.

An effective method for suspicious cases in urinary cytodiagnosis by the combined use of scanning and transmission electron microscopy following light microscopy.

In urinary cytodiagnosis, pathological characterization of atypical cells is sometimes difficult because cells in urine samples tend to be degenerated. To overcome this problem, we adopted serial examination under light microscopy (LM), scanning electron microscopy (SEM), and transmission electron microscopy (TEM). Five patients with transitional cell carcinoma primarily developed in the bladder, three patients with dysplastic cells, and one patient with metastatic and infiltrative colorectal carcinoma were subjects of the present study. Sample cells were smeared on a film slide especially suitable for serial use (a film slide used in X-ray diagnosis), fixed in 1% glutaraldehyde (GA) for 30 min, stained with Papanicolaou (Pap) staining, and immediately processed for fixation in 2% paraformal-dehyde (PA) and 2.5% GA. Slides were postfixed in 0.5% osmium tetroxide. Then, cell samples were subjected to a series of observations under LM, SEM, and TEM. One of three patients in whom dysplastic cells were suggested under LM was finally diagnosed as transitional cell carcinoma by subsequent examination under SEM followed by TEM. Thus, serial use of LM, SEM, and TEM proved useful in discriminating transitional cell carcinoma (grade 1) from dysplastic cells and also in distinguishing metastatic tumor cells from primary tumor cells in urine samples.