Atypical polypoid adenomyoma (APA) is a rare mixed epithelial and mesenchymal tumor characterized histopathologically by the presence of disorganized hyperplastic glands with cytological atypia embedded in intersecting fascicles of fibromuscular stromal cells. Herein, we report the first documented endometrial cytological case of APA. A 35-year-old Japanese female presented with irregular menstrual cycles and then was found to have polypoid lesions of the endometrium. Cytological examination of the endometrium and endometrial curettage were performed. The Papanicolaou smear revealed the presence of abundant clusters of crowded glandular cells in a clean background. These clusters exhibited irregular branching and dilatation, and these glandular cells had mild to moderately enlarged round to oval nuclei. Within the dilated glands, metaplastic squamous cells (squamous morules) were observed. The most striking feature was the presence of short fascicles of the spindle cells without atypia around the dilated atypical glandular cell clusters with squamous morules. Histopathological and immunohistochemical examinations revealed a diagnosis of APA. Our report demonstrates that the characteristic cytological feature suggestive of APA is the presence of short fascicles of the spindle cells without atypia surrounding dilated atypical glandular cell clusters with squamous morules in a clean background, and their appearance can allow cytologists/cytopathologists to consider APA in differential diagnosis in the endometrial cytological specimens. Diagn. Cytopathol. 2017;45:345-349. © 2016 Wiley Periodicals, Inc.
Secretory carcinoma (SC) of the salivary gland is a rare distinct clinicopathological entity characterized by the presence of the ETV6‐NTRK3 fusion. Although the characteristic cytological features of SC have been recognized, its cytodiagnosis, especially differentiating SC from acinic cell carcinoma, is challenging. Recent studies have revealed that immunohistochemistry for pan‐tyrosine receptor kinase (Trk) and nuclear receptor subfamily 4 group member 3 (NR4A3) are specific for SC and acinic cell carcinoma, respectively. However, the usefulness of immunocytochemical detection of these markers in the diagnosis of SC has not been addressed. Hence, the present study aimed to analyze the usefulness of immunocytochemical staining for pan‐Trk and NR4A3 in the cytodiagnosis of SC. We enrolled eight patients with a histopathological diagnosis of SC who underwent preoperative fine‐needle aspiration cytological examination. The cytological characteristics were reviewed and immunocytochemical staining for pan‐Trk and NR4A3 was performed. The characteristic cytological features noted in the patient cohort included neoplastic cell clusters with a sheet‐like and papillary cluster arrangement as well as single cells. Additionally, neoplastic cells with mild to moderately enlarged nuclei and small nucleoli, multi‐vacuolated cytoplasm, and intracytoplasmic mucin were also observed. The immunocytochemical analyses clearly demonstrated that all eight specimens showed positive nuclear staining for pan‐Trk, but were negative for NR4A3 expression. Although all cases of SC do not always show positive immunoreactivity for pan‐Trk, immunocytochemical analysis for pan‐Trk may be useful for the cytodiagnosis of SC along with assessment of the characteristic cytological features.
This study highlights the cytomorphological features of atypical polypoid adenomyoma (APAM). Squamous morules and/or short fascicles of spindle cells were found in five of the six cases. A combination of cytomorphological features can lead to a suspicion of APAM and avoid an overdiagnosis as endometrioid carcinoma.
Background Basal cell adenoma (BCA) of the salivary gland is a relatively rare benign tumor. Although the presence of stromal spindle cells is a characteristic histopathological feature, this finding has not been the focus of much attention in the cytodiagnosis of BCA. Thus, we analyzed the cytological features of BCA, especially the presence of stromal spindle cells. Methods Patients who were histopathologically diagnosed with BCA and underwent preoperative fine‐needle aspiration cytological examination were enrolled in this study. The cytological characteristics including arrangement and shape of the neoplastic cells, nuclear and cytoplasmic features, and the presence of stromal spindle cells were reviewed. Results Nineteen patients were enrolled in the study. The cytological specimens were cellular and composed of small or large clusters or both. The neoplastic cells had scant cytoplasm and small round to oval nuclei. Basement membrane‐like material was observed in 57.9%, and peripheral palisading was noted in 84.2%. Loose aggregates of stromal spindle cells were present in 63.2%, and the stromal spindle cells shown in the histological examination of 85.7% of cases were expressed in the cytological specimens. Conclusion This study clearly demonstrated the relatively high frequency of stromal spindle cells in cytological specimens of BCA. This finding is characteristic of BCA, and therefore, the combination of cytological features, including packed clusters of neoplastic cells with scant cytoplasm and small nuclei, peripheral palisading, and basement membrane‐like material, and the presence of stromal spindle cells could increase the diagnostic success of BCA.
Abstract. Combined small cell lung carcinoma (SCLC) is a rare variant of SCLC and is defined as a mixture of SCLC and non-SCLC components. Although any histopathological subtype may be present as a non-SCLC component, the presence of pleomorphic carcinoma components are extremely rare. The present report describes the first documented cytological features of combined SCLC with a giant cell carcinoma component. A 50-year-old Japanese female with a history of smoking presented with a mass lesion in the left lung. Computed tomography-guided fine-needle aspiration cytology and needle biopsy were performed, followed by a lobectomy. A Papanicolaou smear revealed the presence of two distinct neoplastic components in a necrotic background. One component was SCLC, which comprised small-sized neoplastic cells containing scant cytoplasm and round to oval nuclei with dispersed granular chromatin without nucleoli. The other component was giant cell carcinoma, which was composed of large-sized neoplastic cells containing irregular large hyperchromatic nuclei (approximately 7 to 10 times larger than those of SCLC). SCLC was demonstrated in the biopsy specimen, however no giant cell carcinoma component was present. Histopathological study of the lobectomy specimen verified a diagnosis of combined SCLC with giant cell carcinoma component. Both SCLC and giant cell carcinoma exhibit characteristic cytological features, therefore, albeit extremely rare, careful observation may lead to a correct diagnosis of combined SCLC in the cytological specimen. IntroductionCombined small cell lung carcinoma (SCLC) is categorized as a histopathological variant of SCLC, and defined as an admixture of SCLC and non-SCLC components (1). The incidence of combined SCLC is 0.2%-1.3% of the surgically resected primary lung cancers (2,3), and comprises up to 28% of the surgically resected SCLC cases (4). Adenocarcinoma and squamous cell carcinoma are the common components of non-SCLC (2-5). In the case series reported by Yamada et al adenocarcinoma is the most common histopathological subtype of the non-SCLC component (6/9 cases), followed by adenocarcinoma and squamous cell carcinoma (2 cases) and squamous cell carcinoma (1 case) (2). Any histopathological subtypes can be present as a non-SCLC component (1). However, the occurrence of a pleomorphic (giant cell) carcinoma component in combined SCLC is extremely rare (6-9). We have already reported on the clinical and histological characteristics of this case (10), and this report we described the detailed cytological features of combined SCLC with giant cell carcinoma component in order to draw attention to a potential cause of diagnostic error. Case reportA 50-year-old Japanese female was referred to Kansai Medical University Hospital because of an abnormal chest shadow, which had been detected by a chest X-ray examination at an out-patient clinic. She was a heavy smoker (30 cigarettes daily over 30 years). Chest computed tomography (CT) demonstrated a relatively well-circumscribed mass lesion, measuri...
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