Liver is generally known as an organ which is most commonly involved by the metastic tumors. According to the tendency of using fine needle aspiration in the diagnosis of hepatic tumors, the differentital diagnosis between hepatocellular carcinoma and metastatic carcinoma frequently has been a main issue in the poorly differentitated cases, especially to the pathologists of Korea, an endemic area of hepatocellular carcinoma. Until now the problem has been usually solved by the comparison of cytologic characteristics of their tumor cells but not by background cytologic features which rarely have been studied. We observed the background cytologic features helpful for the differential diagnosis through the analysis of 20 cases who had confirmed primary cancer and were diagnosed as metastatic carcinomas in the liver by fine needle aspiration cytology. Twenty cases included 9 adenocarcinomas, 7 spuamous cell carcinomas, 1 small cell carcinoma, 1 carcinoid, 1 adenoid cystic carcinoma, and 1 renal cell cacinoma. Analysis of background cytologic features revealed that 77% of adenocacinoma cases showed benign mesenchymal components and hepatocytes and spuamous cell carcinoma cases disclosed benign mesenchymal tissue (71%) and necrosis (57%). Remaining cases showed variable combinations of benign mesenchymal component, necrosis, hepatocytes, and bile duct epithelial cells. No case revealed atypical hepatocytic naked nuclei, a useful cytologic finding of hepatocellular carcinoma. In summary, the background cytologic features more commonly observed in metastatic carcinomas than in the hepatocellular carcinoma were benign mesenchymal components, hepatocytes, necrosis, and bile duct epithelium. The endothelial cells and hepatocytic naked nuclei, two relatively specific findings of hepatocellular carcinoma were not observed except for renal cell carcinoma. Above background cytologic features are thought to be helpful for the differential diagnosis between the hepatocellular carcinoma and various metastatic carcinomas in the poorly differentiated cases.
Adenocarcinoma ; Bile Ducts ; Biopsy, Fine-Needle ; Carcinoid Tumor ; Carcinoma, Adenoid Cystic ; Carcinoma, Hepatocellular ; Carcinoma, Renal Cell ; Carcinoma, Small Cell ; Diagnosis ; Diagnosis, Differential ; Endothelial Cells ; Epithelial Cells ; Epithelium ; Hemolytic-Uremic Syndrome* ; Hepatocytes ; Korea ; Liver ; Necrosis ; Pneumococcal Infections* ; Ulnar Nerve

Metastatic tumors occur more frequently in the liver than in any other organ, Guided percutaneous fine-needle aspiration (FNA) of the liver is often recommended for confirmative diagnosis of the metastatic lesion, because of its simplicity, high yield, and reasonable safety. The authors studied retrospectively cytologic findings of 110 cases of metastatic tumors to the liver. The frequent primary sites were the stomach (23 cases), pancreas (19 cases), gallbladder (12 cases), and periampullary lesions (6 cases). Most of the metastases were carcinoma (106 cases). There were only 4 cases of sarcoma. The characteristic cytologic findings of FNA of meatastatic tumors were dirty background, abrupt change between hepatocytes and malignant cells, and desmoplasia. Some tumors displayed rather distinctive cytologic appearance that suggests primary sites. For example, the colonic adenocarcinoma showed tall columnar cells with a palisading arrangement, adenocarcinoma of gallbaldder showed focal squamous differentiation in some cases, and metastatic renal cell carcinoma and neuroblastoma showed also distinctive cytologic findings. Because the cytologic features of metastatic tumor are very similar to those of primary tumor, correct cytologic typing may be helpful in pursuit of an occult primary site of metastatic liver lesions, reducing extensive diagnostic investigation in poor prognostic patients.
Adenocarcinoma ; Biopsy, Fine-Needle ; Carcinoma, Renal Cell ; Colon ; Diagnosis ; Gallbladder ; Hepatocytes ; Humans ; Kidney Diseases* ; Kidney* ; Liver ; Melanoma, Amelanotic ; Neoplasm Metastasis ; Neuroblastoma ; Pancreas ; Retrospective Studies ; Sarcoma ; Stomach ; Vagina

A total of 362 bile samples from 104 patients with evidence of biliary tract obstruction were submitted for diagnostic cytology from January, 1989 to April, 1991. The patients were classified based on the obstructive cause, and the cytologic results were reviewed. 298 of the specimens were from patients with intrabiliary malignant stricture, and 17 were from patients with extrabiliary malignant compression or benign biliary obstruction. Bile cytology was positive for carcinoma in 42 samples from patients with intrabiliary malignant stricture, and the diagnostic sensitivity was 14%. There were no false positive cases. We concluded that the cause of low sensitivity was degenerative change of cell due to prolonged sampling time. What is noteworthy was the high prevalence of Clonorchis sinensis eggs, being detected in 25 patients with intrabiliary malignancy, supporting the association between clonorchiasis and biliary tree malignancy.
Bile ; Biliary Tract ; Clonorchiasis ; Clonorchis sinensis ; Constriction, Pathologic ; Eggs ; Humans ; Nephrotic Syndrome* ; Ovum ; Prevalence

Curschmann's spirals morphologically similar to those seen in sputum were found in cervico-vaginal smears of six patients ranged from 28 to 40 years of age, during 18 months from January. 1985 to June, 1986. The prevalence was 1 in 2147 smears in that period. All of them had gynecologic disorders without systemic effect such as chronic cervictis in three, leiomyoma in one, pelvic inflammatory disorder in one, and primary infertility in one. The Curshmann's spirals in the smear showed varying degrees of maturation from wavy incipient ones to highly coiled mature ones, admixed with thick mucinous back- ground, suggesting of their production in the uterine cervix itself. Also the recent history of undergone cryocautery, electrocautery or parturition suggest its production in the endocervical gland due to mechanical obstruction and/or change in biochemical composition of mucus.
Cervix Uteri ; Diabetes Insipidus* ; Electrocoagulation ; Female ; Humans ; Infertility ; Leiomyoma ; Mucins ; Mucus ; Parturition ; Pedigree* ; Pilomatrixoma ; Prevalence ; Receptors, Vasopressin* ; Sputum ; Vasopressins*

Glassy cell carcinoma is an unusual neoplasm of the uterine cervix with highly aggressive clinical behavior. On cervico-vaginal smear examination, the tumor has well confused of atypical repair cell of the endocervix. Recently, we have experienced two cases of glassy cell carcinoma of the uterine cervix, diagnosed on cervico-vaginal smears and confirmed on following histologic sections. The cervico-vaginal smears revealed abundant clusters with well defined boarders. The cell clusters were composed of large tumor cells. The tumor cells had distinct granular cytoplasm and eosinophilic macronucleoli. Characteristic cytologic features of this tumor were discussed in view of differential diagnosis.
Adenocarcinoma ; Breast ; Cervix Uteri ; Cytoplasm ; Diagnosis, Differential ; Eosinophils ; Female ; Hydronephrosis*

The diagnosis of carcinoma in situ of urinary bladder is difficult in that the symptoms and cystoscopic findings are nonspecific. The cytology of urine could be helpful for diagnosis of carcinoma in situ of urinary bladder. We present a case of bladder washing cytology of carcinoma in situ. A 54-year-old man presented with dysuria for 1 year. Cystoscopic findings revealed multifocal reddish trabeculated lesions. The bladder washing cytology revealed rather uniform tumor cells which were singly scattered or forming syncytium in the clean background. The nuclei were round to oval with inconspicious nucleoli. The cystoscopic biopsy revealed typical histologic features of carcinoma in situ of urinary bladder.
Biopsy ; Biopsy, Fine-Needle ; Carcinoma in Situ ; Child* ; Diagnosis ; Dysuria ; Giant Cells ; Humans ; Kidney* ; Middle Aged ; Thymoma ; Urinary Bladder

A case of malignant epithelial mesothelioma of the peritoneum diagnosed by fine needle aspiration cytology is described. The smear showed many individually scattered or clustered large round malignant epithelial cells intermingled with relatively small nonneoplastic mesothelial and mesenchymal cells. Papillary configurations with thick fibrous core were also seen. The malignant cells were virtually reminiscent of reactive mesothelial cells but they were larger in size and had more prominent nucleoli and more frequent binucleated or multinucleated cell formations than reactive mesothelial cells. The characteristic features of malignant cell of mesothelioma compared with the metastatic adenocarcinoma were relatively uniform cellular size, prominent round nucleoli, large round vesicular nuclei with finely granular chromatin pattern, smooth nuclear membrane, abundant glassy cytoplasm rather than bubbly mucin-containing cytoplasm and fuzzy cell border.
Adenocarcinoma ; Biopsy, Fine-Needle ; Child* ; Chromatin ; Cytoplasm ; Epithelial Cells ; Humans ; Mesothelioma ; Nuclear Envelope ; Pancreas ; Peritoneum

We report 4 cases of malignant thymoma which were composed of 2 cases of invasive thymoma and 2 cases of thymic carcinoma. The cytologic findings of invasive thymoma were similar to those of benign thymoma. The distinctive cytologic features of thymic carcinoma were necrotic background, irregular clusters and individually scattered arrangement of anaplastic epithelial cells, and some scattered mature small lymphocytes. These findings may be found in the Hodgkin's lymphoma, seminoma, and metastatic squamous cell carcinoma, undifferentiated carcinoma, and large cell carcinoma of the lung. But, the feature of irregular clustering of anaplastic epithelial cell having scanty cytoplasm was different from Hodgkin's lymphoma and seminoma. Clinical and radiologic findings as well as cytologic finding were helpful in differential diagnosis of thymic carcinoma from metastatic carcinoma.
Breast ; Carcinoma ; Carcinoma, Large Cell ; Carcinoma, Squamous Cell ; Child* ; Cytoplasm ; Diagnosis, Differential ; Epithelial Cells ; Hodgkin Disease ; Humans ; Infant* ; Lung ; Lymphocytes ; Seminoma ; Thymoma ; Urinary Tract Infections* ; Urinary Tract*

So-called sclerosing hemangioma of the lung is a rare benign neoplasm which usually presents with a coin lesion detected through routine chest X-ray. We report two cases showing characteristic cytologic appearances which have been rarely reported. Both cases were young females with coin lesions in the lung. Fine needle aspiration of each case revealed unique but some different cytologic features. Case 1 showed bland-looking polygonal epithelial cells resembling bronchioloalveolar cells having pre- dominantly papillary configurations with loosely arranged solid sheets or isolated cells. Cytoplasms were plump, cyanophilic, and finely granular, with eccentric nuclei, The nuclei were usually monotonous, round-to-ovoid, and vesicular with a small but conspicuous nucleolus. In comparison to case 1, case 2 revealed largely loose pavement-like solid sheets or clusters rather than papillary patterns in the hemorrhagic background. The size of tumor cells were a little smaller than that of case 1. Bronchioloalveolar carcinoma and papillary adenocarcinoma of metastatic origin were considered to be one of the important differential diagnoses with these cytologic features. Histologically, both cases exhibited findings compatible with so-called sclerosing hemangioma of the lung.
Adenocarcinoma, Bronchiolo-Alveolar ; Adenocarcinoma, Papillary ; Biopsy, Fine-Needle ; Cytoplasm ; Diagnosis, Differential ; Epithelial Cells ; Female ; Humans ; Kidney* ; Lung ; Numismatics ; Pulmonary Sclerosing Hemangioma ; Renal Insufficiency* ; Thorax

In order to evaluate the role of cytopathologic diagnosis of sputum, bronchial washing and bronchial brushing in the diagnosis of lung cancer, we performed this study. The patients included in this study had undergone sputum, bronchial washing and brushing cytology over the 20-month period of 1985 through 1987. The total number of specimens was 5,495 of 2,242 patients, including 4,830 sputa and 665 bronchial washing and brushings. The average number of sputa and bronchial washings and brushings per case was 2.4 and 1.2 respectively. Among them, about 10% were unsatisfactory specimen, and three-fourths were negative specimens. In sputum cytology, the diagnosis of "atypical cells" was given to 3%, "suspicious for malignancy" was given to 1%, and "malignancy" was given to 13%. In bronchial washing and brushing cytology, the diagnosis of "atypical cells", "suspicious for malignancy" and malignancy" was given to 6%, 3%, and 20% respectively. The cases diagnosed as "atypical cells" in cytology were actually malignancy in 95% and 84.8% of sputum and bronchial washing and brushings respectively, and the "suspicious for malignancy" were actually malignancy in 100% in both methods. The detection rates of malignancy were 50.4% and 55.2% in sputum and bronchial washing and brushing respectively, and the specificity was 100% in both methods. The accuracy of cell typing was 92% in sputum and 89.7% in bronchial washing and brushing.
Biopsy, Fine-Needle ; Child* ; Diagnosis ; Humans ; Lung Neoplasms ; Mass Screening* ; Sensitivity and Specificity ; Seoul* ; Sputum