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Background Collagenous spherulosis (CS) associated with an adenomyoepithelioma (AME) of the breast is rare. This report describes a case of CS associated with an AME of the right breast, including the cytologic and histopathologic findings. Case A 51-year-old female presented with a slow-growing left breast mass that had been present for 5 months. A preoperative core needle biopsy showed the presence of layers or sheaths of myoepithelial cells around epithelial-lined spaces. Imprint cytology of the surgical material showed the presence of bundles of spindle cells with an admixture of epithelial cells. Spherical structures were also found. They were translucent or slightly light green with Papanicolaou staining and metachromatic with Giemsa staining. Grossly, the 1.5-cm lesion was solid and embedded within the breast parenchyma. Microscopically, it was composed of spindle or polygonal cells with eosinophilic cytoplasm and an epithelium lining spaces with many spherical structures. The spindle or polygonal cells were positive for myoepithelial markers and the epithelium was positive for epithelial markers by immunohistochemistry. Conclusion There is no previous report describing the cytologic findings of CS associated with an AME of the breast. AMEs should therefore be considered an underlying pathology of CS of the breast.

Background Sarcomatoid salivary duct carcinoma (sarcomatoid SDC) is a rare subtype of SDC. We encountered 1 case of sarcomatoid SDC that developed from a submandibular gland pleomorphic adenoma, and we herein report our findings. Case A 42-year-old female had tumentia and pain in the right submental area, and therefore she underwent a close examination, wherein a right submandibular gland neoplasm was detected. Surgery for removing the right submandibular gland was performed in addition to neck dissection. Cytology showed typical findings of conventional SDC. Moreover, isolated and scattered large spindle cells and multinucleated cells were also detected along with atypical epidermal cell clumps showing keratinization. From a histologic perspective, it appeared to be sarcomatoid SDC that developed from a pleomorphic adenoma and also involved a squamous cell carcinoma component. Conclusion This is the first report on the cytologic findings of a case of sarcomatoid SDC with a squamous cell carcinoma component. When sarcomatoid cells appear in the cytology along with findings of typical SDC, sarcomatoid SDC should thus be considered. Furthermore, squamous cell carcinoma component may be involved as in the present case, so it is necessary to be aware of the possibility thereof.

Background Adult-onset renal cell carcinoma (RCC) associated with Xp11.2 translocation/TFE3 gene fusion is a very rare tumor. To date, there are no reports on immunocytochemical study of the primary tumor. We describe such a case that we diagnosed by immunocytochemistry of imprint cytology material. Case A 46-year-old man was found to have a mass in the lower pole of the right kidney. Magnetic resonance imaging (MRI) T2-weighted images showed a hypointense area in the tumor, and papillary RCC was suspected. Imprint cytology showed tumor cells that were isolated or arranged in large or small papillary clusters. Irregularly shaped large oval nuclei, finely granular chromatin and a single large nucleolus were noted. Cytoplasm was abundant and admixed with clear and granular eosinophilic patterns and scattered large vacuolated cells. Almost all tumor cells diffusely expressed immunocytochemical reactivity to TFE3 protein. Hyaline nodules were observed in the stroma. Ultrastructurally, neoplastic cells contained rhomboid crystals identical to those of alveolar soft part sarcoma. Conclusion The immunocytochemistry of TFE3 protein may be a powerful tool for accurate diagnosis when RCC associated with Xp11.2 translocation/TFE3 gene fusion is suspected by imprint cytology even in adult-onset cases, and cytotechnologists should accurately recognize cytologic findings of this tumor.

Background Mature cystic teratomas of the major salivary glands are rare. This report describes a case of a mature cystic teratoma of the left parotid gland, including the cytologic and bistopatbologic findings. Case A 17-year-old young woman presented with a slow-growing left parotid mass that had been present for 4 years. Preoperative fine needle aspiration cytology showed the presence of acinar and ductal cells, foamy cells and multinucleated giant cells. Imprint cytology of the surgical material showed the presence ofsome squamous cells and sebaceous gland-like cells with bair shafts. Cellular atypia was inconspicuous. Grossly, the 3-cm lesion was unicystic and embedded within the parotid gland parenchyma. Microscopically, the inner surface of the cyst was lined with keratinized squamous epithelium. The cyst wall contained skin adnexa such as sebaceous, eccrine and apocrine glands, as well as hair follicles. Some mature cartilage tissue was also detected. Foreign body granulomatous change was seen focally. No immature tissue or malignant transformation was found. Conclusion There is no previous report describing the cytologic findings of a mature cystic teratoma of the parotid gland. Mature cystic teratomas should therefore be considered in the differential diagnosis of a cystic lesion of the parotid gland.

Background Primary gastric small cell carcinoma is a rare but important entity. We describe a case that we diagnosed by peritoneal washing cytology. Case A 70-year-old male presented with upper abdominal discomfort and underwent endoscopic evaluation. Gastric endoscopy revealed a diffuse, infiltrating tumor from the body to the antrum. Total gastrectomy with lymph node dissection and intraoperative peritoneal washing cytology were carried out. Peritoneal washing cytology showed the presence of many undifferentiated malignant small cells with a necrotic background. The tumor cells were small and round, with naked, hyperchromatic nuclei and finely granular chromatin. Some tumor cells contained paranuclear blue inclusions (PBls) in the cytoplasm. The tumor cells were positive for neuron-specific enolase and synaptophysin on immunocyto-chemistry. Carcinoembryonic antigen, alpha-fetoprotein (AFP) and leukocyte common antigen were negative. Pathologic diagnosis after the operation was moderately to poorly differentiated adenocarcinoma and small cell carcinoma containing AFP-positive cells. Conclusion The prognosis of primary gastric small cell carcinoma is usually poor. Our patient died of multiple liver metastases and peritonitis carcinomatosa 69 days after surgery. When a gastric small cell carcinoma is suspected in peritoneal washings, immunocytochemical demonstration of neuroendocrine differentiation is required to arrive at the final diagnosis.

BACKGROUND: Sclerosing polycystic adenosis (SPCA) of major salivary glands is a rare recently described entity. We report a case of SPCA of the left parotid gland, including the cytologic and histopathologic findings. CASE: A 20-year-old man presented with a left parotid mass that had been growing slowly for 3 years. Fine needle aspiration cytology showed many syncytial cell clusters of variable size and some ductal structures with an inflammatory background. The cells forming syncytial clusters were large and polygonal, with abundant, eosinophilic, granular or lacelike cytoplasm. Apocrine differentiation with decapitation secretion was commonly seen. The ductal cells had a relatively high nuclear/cytoplasmic ratio, with granular cytoplasm. Grossly, the 5-cm lesion was a discrete, pale, cystic nodule embedded within the parotid gland parenchyma. Microscopically, the lesion was a nonencapsulated, circumscribed mass of sclerotic and hyalinized, collagenous tissue with lymphoplasmacytic infiltration. Sclerosing adenosis and cystic ducts with frequent apocrinelike cells were commonly seen. Some acinar cells contained eosinophilic, intracytoplasmic granules of various sizes. CONCLUSION: The presence of syncytial clusters with apocrine metaplasia and ductal structures in a lymphoplasmacytic background should suggest a diagnosis of SPCA of a major salivary gland.

Background Pleural effusion caused by varicella-zoster virus (VZV) is rare. We report a case of a woman with acute lymphocytic leukemia (ALL) who developed a pleural effusion caused by VZV infection. Case A 55-year-old woman with ALL treated with consolidation therapy developed skin vesicles and a pleural effusion. Pleural fluid smears contained numerous mesothelial cells, which had ground-glass nuclei or eosinophilic nuclear inclusions. Some multinucleated giant cells were also seen. Electron microscopic examination revealed intranuclear virus particles, about 150 nm in diameter, in some mesothelial cells. Tissue samples from the skin, lungs, pleura, liver, pancreas, kidneys and gastrointestinal tract, obtained at autopsy, contained many virus-infected cells. They were positive for VZV glyco-protein 1 by immunohistochemistry. Conclusion VZV infection should be considered in the differential diagnosis of an unexplained exudative pleural effusion, especially in immunocompromised hosts.

BACKGROUND: Primary pulmonary leiomyosarcoma is a rare but important entity. We report a case diagnosed by fine needle aspiration cytology. CASE: A 73-year-old male presented with an asymptomatic, right, pulmonary, subpleural nodule detected by computed tomography during follow-up for chronic obstructive pulmonary disease. Fine needle aspiration cytology showed cellular smears with numerous single or loosely cohesive groups of spindle-shaped to round cells. The tumor cell nuclei were blunt ended (cigar shaped), with fine to fine-granular chromatin, prominent nucleoli and an irregular nuclear rim. The tumor cells were positive for desmin and negative for cytokeratin and S-100 protein by immunocytochemistry. Right upper lobectomy with lymph node dissection was performed. Pathologic diagnosis after microscopic, immunohistochemical and electron microscopic studies was leiomyosarcoma. CONCLUSION: To our knowledge, this is the first reported case of primary pulmonary leiomyosarcoma arising in the subpleural region diagnosed by fine needle aspiration cytology. Immunocytochemistry was useful in establishing the diagnosis in this case.

BACKGROUND Primary small cell carcinoma (SCC) of the bladder is a rare but important entity. We report two cases of SCC of the bladder diagnosed by urinary cytology. CASES A 71-year-old male (case 1) and a 79-year-old female (case 2) presented with asymptomatic gross hematuria. Urinary cytology in case 1 showed the presence of a few undifferentiated malignant small cells and many transitional cell carcinoma (TCC) cells with a bloody and necrotic background. The former cells were small and round, with naked, hyperchromatic nuclei and finely granular chromatin. Pathologic diagnosis after total cystectomy was TCC > SCC > adenocarcinoma, T2M0N0. Urinary cytology of case 2 showed the presence of many undifferentiated malignant small cells and many TCC cells with or without squamous metaplasia. Cytologic features of the former cells were almost the same as those in case 1. Moreover, these cells were neuroendocrine marker positive by immunocytochemistry. Pathologic diagnosis after tumor resection was SCC and TCC > squamous cell carcinoma, T1b. CONCLUSION The prognosis of primary SCC of the bladder is usually poor. Because our cases were found by urinary cytology at a relatively early stage, both have been well, without any evidence of recurrence, 30 and 25 months after surgery even without adjuvant therapy.