Abstract. Sarcomatoid variant of urothelial carcinoma (SV-UC) is characterized by the presence of biphasic malignant neoplastic components exhibiting morphological and/or immunohistochemical evidence of epithelial and mesenchymal differentiation. SV-UC is a rare variant of UC and the cytological features of this tumor have not been well described. In the present study, we analyzed the cytological features of a series of SV-UC cases; 6 voided urine specimens from 3 patients with SV-UC were reviewed. Several characteristic cytological features were revealed: i) tumor cells were abundant in a necrotic background and while single tumor cells were predominant, small clusters of cells were occasionally present; ii) tumor cells were large-sized and round to polygonal in shape with ill-defined cell borders; iii) tumor cells had a high nuclear/cytoplasmic ratio and enlarged round to oval nuclei containing coarse chromatin and occasional nucleoli; and iv) spindle-shaped atypical cells were rarely identified (1/6 specimens). The cytological features of i), ii) and iii) are indistinguishable from those of conventional invasive high-grade UC. We hypothesize that these tumor cells originated from the conventional high-grade UC component of SV-UC as this component is usually present in this type of lesion, particularly on the surface of the tumor. Moreover, the sarcomatoid component of SV-UC is usually present in the deeper portion of the tumor and therefore detection of this component in the voided cytological specimen is low. Although cytodiagnosis of SV-UC is extremely difficult, cytodiagnosis of malignancy may prove possible due to the presence of a conventional UC component.

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Herpes simplex virus (HSV) infection is usually observed in the oral cavity and external genitals, and HSV peritonitis is extremely rare. Herein, we report a case of type II HSV peritonitis successfully diagnosed by ascitic cytology. A 66-year-old Japanese man, who had been treated with steroid inhalation for 5 years due to chronic obstructive pulmonary disease, was suspected to have acute cholecystitis. Laparoscopic cholecystectomy and intraoperative cytological examination of ascitic fluid were performed. Cytological study of ascitic fluid revealed that abundant granular cell debris, degenerative cells and apoptotic bodies were present, as well as some single or multinucleated cells with ground glass nuclei. However, vivid mesothelial cells were rarely seen. Immunocytochemical staining for type II HSV was positive in single or multinucleated cells with ground glass nuclei. Therefore, a diagnosis of type II HSV peritonitis was made. This is the first reported case of type II HSV peritonitis successfully diagnosed by ascitic cytology. This report highlights that the presence of abundant cell debris, degenerative cells and apoptotic bodies, and the absence of vivid mesothelial cells are the key cytological findings to suspect HSV peritonitis, and the diagnosis can be confirmed by careful surveillance for characteristic nuclear findings of single or multinucleated cells. The frequency of opportunistic infection is increased because of the increased numbers of iatrogenic immunocompromised patients as seen in this case, therefore, cytological examination is a useful method for early detection of the causative agent of peritonitis including HSV.

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