Case report of large malignant pericardial effusion in a post-surgical setting of endometrial mixed carcinoma: A description of unique cytological, histological, and immunohistochemical findings.

Appearance of endometrial carcinoma in pericardial effusion is extremely rare. Its major etiological factors include lung cancer, breast cancer, lymphoma, and leukemia. We herein report a case of a large malignant pericardial effusion 7 years after surgery for endometrial carcinoma. A 66-year-old woman who underwent modified radical hysterectomy, bilateral salpingo-oophorectomy, and lymph node dissection for endometrial carcinoma 7 years ago and who had self-interrupted subsequent chemotherapy was presented with vertigo and vomiting. Chest computed tomography revealed pericardial effusion. Cytological examination diagnosed it as adenocarcinoma with psammoma bodies and mitoses. Immunohistochemistry analysis revealed that adenocarcinoma cells were positive for p53, p16, and insulin-like growth factor II mRNA-binding protein-3, but negative for estrogen receptor. Adenocarcinoma cells in pericardial effusion were morphologically and immunohistochemically similar to the serous carcinoma component of the surgical specimen. The appearance of psammoma bodies in cytological examination triggered the diagnosis.

Intracytoplasmic Lumen in Urine Cytology Predicts Worse Prognosis in Non-Muscle-Invasive Bladder Cancers.

BACKGROUND: Intracytoplasmic lumina (ICL) are observed in several cancers, including urothelial carcinoma (UC). We have reported that ICL in urine cytology (cICL) is more frequent in high-grade UCs than in low-grade UCs; however, the correlation between the presence of ICL and prognosis is unclear. OBJECTIVES: The aim of this work was to determine the association between cICL and prognosis in bladder cancer. METHOD: We retrospectively investigated 87 patients with bladder cancer who received a histological diagnosis within 3 months of urine cytology at Kanazawa Medical University between 2003 and 2007. The cytological diagnosis and the number of cICL, histological diagnosis, tumor grade or variant, pT stage, ICL in histological specimens, and immunohistochemistry for mucins were evaluated. Data on the treatment type, recurrence, survival, cause of death, and length of follow-up were collected from electronic medical records. RESULTS: Muscle invasion, high-grade UC, lymph node metastasis, distant metastasis, adjuvant therapy, and disease-related mortality were more frequent in patients with cICL-positive bladder cancer than in those without cICL-positive bladder cancer. Immunohistochemistry revealed the expression of Muc-1 and Muc-4 in patients with cICL-positive bladder cancer. Univariate analysis revealed that cytological diagnosis by the Paris system and the 2015 version of the Japanese reporting system, muscle invasion, high-grade UC, lymph node metastasis, distant metastasis, and adjuvant chemotherapy and/or radiotherapy were significant factors associated with prognosis. Furthermore, survival was shorter in patients with cICL-positive non-muscle-invasive bladder cancer than in those with cICL-negative non-muscle-invasive bladder cancer. In the multivariate analysis, only distant metastasis was significantly associated with survival. CONCLUSIONS: cICL predicted shorter survival in patients with non-muscle-invasive bladder cancer, suggesting that ICL is one of the important diagnostic features of high-grade UC with a worse prognosis in urine cytology.

The potential usefulness of sputum cytology in the conclusive diagnosis of methotrexate-associated lymphoproliferative disorders: A case report.

BACKGROUND: Methotrexate has been used as an anchor drug for the treatment of rheumatoid arthritis and is considered to be a cause of methotrexate-associated lymphoproliferative disorder. Spontaneous regression can occur after withdrawal of methotrexate and may be associated with Epstein-Barr virus positivity and non-diffuse large B cell lymphoma histological type. Methotrexate-associated lymphoproliferative disorders are often diagnosed pathologically by lung biopsy. To the best of our knowledge, there have been no studies on the cytological diagnosis of methotrexate-associated lymphoproliferative disorder using sputum smears. CASE: A 70-year-old man, who was diagnosed with rheumatoid arthritis 13 years previously and who had been treated with methotrexate, presented shortness of breath and productive cough. Methotrexate-associated lymphoproliferative disorder was suspected as the sputum cytology showed many atypical lymphoid cells with hyperchromatic enlarged nuclei, foamy cytoplasm and distinct nucleoli. Chest computed tomography revealed multiple nodular shadows with interstitial pneumonia in the bilateral lower lung field. A lung biopsy specimen contained atypical lymphoid cells that were immunohistochemically positive for CD20 and MUM-1, and weakly positive for bcl-6, but negative for CD3 and CD10. There were no Epstein-Barr virus-infectious lymphoid cells by ISH-EBER. He was finally diagnosed with methotrexate-associated lymphoproliferative disorder (non-germinal center B-cell-like diffuse large B cell lymphoma histological type). Most of the nodules disappeared spontaneously following the withdrawal of methotrexate. DISCUSSION AND CONCLUSION: A cytologically conclusive diagnosis of methotrexate-associated lymphoproliferative disorder may be reached using sputum smears and clinical information.

Adenosquamous carcinoma of the uterine cervix displaying tumor-associated tissue eosinophilia.

BACKGROUND: Tumor-associated tissue eosinophilia is defined as an inflammatory response with the marked infiltration of eosinophils within tumor tissues. Tumor-associated tissue eosinophilia has been reported in various organs; however, no studies have examined the detailed cytopathological findings of tumor-associated tissue eosinophilia. CASE PRESENTATION: A 49-year-old woman presented with lower abdominal and back pain that had started 1 month earlier. A cervical biopsy revealed a diagnosis of non-keratinizing squamous cell carcinoma. A mildly increased number of eosinophils was observed in both cervical cytology and a biopsy. On pelvic computed tomography, a tumor mass measuring up to 5.5 cm in the largest diameter was seen in the uterine cervix. After 1 month, endometrial cytology was performed, and non-keratinizing squamous cell carcinoma together with normal endometrial glands was obtained in a background of marked eosinophil numbers. Tumor cells in an irregular-shaped solid nest had variable-sized hyperchromatic nuclei and light-green-stained cytoplasm. The number of eosinophils was obviously increased. Considering the possibility of tumor-associated tissue eosinophilia, we evaluated a peripheral blood sample and confirmed an increased number of eosinophils. Radical hysterectomy was performed, and the final pathological diagnosis was adenosquamous carcinoma. Although the number of eosinophils decreased after surgery, it increased again at the time of recurrence 1 year later. Chemo-irradiation was performed, but the patient died 1 year and 8 months after the operation. CONCLUSION: Cytopathologists should consider the presence of tumor-associated tissue eosinophilia by focusing on not only tumor cells but also the markedly eosinophilic background. The eosinophil count might be a useful marker of the disease activity.

The Combination Of Weak Expression Of PRDX4 And Very High MIB-1 Labelling Index Independently Predicts Shorter Disease-free Survival In Stage I Lung Adenocarcinoma.

Background: Oxidative stress plays pivotal roles in the progression of lung adenocarcinoma (LUAD) through cell signaling related closely to cancer growth. We previously reported that peroxiredoxin 4 (PRDX4), a secretory-type antioxidant enzyme, can protect against the development of various diseases, including potential malignancies. Since many patients with early-stage LUAD develop recurrence, even after curative complete resection, we investigated the association of the PRDX4 expression with the clinicopathological features and recurrence/prognosis using post-surgical samples of stage I-LUAD. Methods: The expression of PRDX4 and MIB-1, a widely accepted Ki67 protein, was immunohistochemically analysed in 206 paraffin-embedded tumour specimens of patients with stage I-LUAD. The PRDX4 expression was considered to be weak when less than 25% of the adenocarcinoma cells showed positive staining. Results: A weak PRDX4+ expression demonstrated a significantly close relationship with pathologically poor differentiation, highly invasive characteristics and recurrence. The decrease in PRDX4-positivity potentially induced cell growth in LUAD, which was correlated significantly with a very high MIB-1 labelling index (≥17.3%). Univariate/multivariate analyses revealed that the subjects with both weak PRDX4+ expression and a very high MIB-1 index had significantly worse disease-free survival rates than other subjects. Conclusions: The combination of weak PRDX4 expression and a very high MIB-1 index can predict high proliferating activity and recurrence with a potential poor prognosis, especially in post-operative stage I-LUAD patients.