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.

野島 孝之 1,3) 金沢医科大学病院病理部 1) ，金沢医科大学病理病態学 2) ，同 病態診断医学 3) 目的：尿路上皮癌細胞における細胞質内小腺腔(intracytoplasmic lumina：以下 ICL)を検索し，その診断 的意義について検討した． 方法：組織学的に初発膀胱尿路上皮癌と診断された 63 例と非腫瘍性病変 22 例を対象とし，組織診検体と それらに対応する尿細胞診検体における ICL を検索した．ICL としては，Papanicolaou 染色でも同定が容易 な内腔に分泌物を認める A 型 ICL のみを検討の対象とした．細胞診検体では 2 個以上/標本を，組織診検体 では 2 個以上/対物 40 倍視野の出現を ICL 陽性とした． 成績：尿路上皮癌症例においては，尿細胞診検体の 25.4％(16/63) ，組織診検体の 27.0％(17/63)で ICL 陽性であった．非腫瘍性病変症例においては，組織診検体の 4.5％(1/22)に ICL 陽性であったが，細胞診 検体では ICL は認められなかった(0/22) ．癌症例では高異型度の尿路上皮癌における尿細胞診検体の ICL の出現率は 44.4％(12/27) ，低異型度の尿路上皮癌では 11.1％(4/36)であった．尿細胞診検体で ICL は非 腫瘍性病変症例より尿路上皮癌症例に有意に多く出現し，また低異型度の尿路上皮癌より高異型度の尿路上 皮癌に有意に出現率が高かった． 結論：A 型 ICL は，尿路上皮癌の判定に寄与しうる指標と考えられた． Key words：Urothelial carcinoma，Cytology，Urine，Urinary bladder，Intracytoplasmic lumina Intracytoplasmic lumina of urothelial carcinoma in urine cytology Toshie TERAUCHI 1) , C. T., I.

Hepatocellular carcinoma (HCC) accounts for most primary tumors of the liver.Although bone metastasis does not occur in a high percentage of patients, bone metastasis is often found first, which leads to the diagnosis of HCC. In this report, we describe a case of bone metastasis from HCC in which bone lesions were detected incidentally, and in which a cytological diagnosis was difficult to make. The patient was a 78-year-old man with a history of renal dysfunction after orthopedic surgery.He underwent a thorough examination after a bone tumor was incidentally found on abdominal CT. Plasmacytoma was suspected. Fine needle aspiration cytology revealed irregular clusters of medium-to-large atypical epithelioid polygonal cells with relatively abundant eosinophilic, somewhat granular cytoplasm, and indistinct cell borders, which led to a diagnosis of malignancy. Histologically and immunohistochemically, the tumor was diagnosed as bone metastasis of HCC. Re-examination of the cytological specimen revealed characteristic Mallory hyaline bodies (MHBs).Immunohistochemistry using a cell transfer method revealed that they were positive for low molecular weight cytokeratin, Cam5.2, in a densely granular fashion. In this case, the cytological diagnosis of HCC was difficult to make due to the unclear cytoplasmic borders and absence of bile pigment. However, the identification of MHBs can potentially guide me to the correct cytological diagnosis.

Background We report a surgical case of urothelial carcinoma of the renal pelvis, resulting in diagnostic difficulties on cytological examination. Case presentation A man in his late 70s underwent nephrectomy for giant hydronephrosis and renal cysts after nephrostomy and renal cyst puncture and drainage. On all cytological examinations performed before surgery, including nephrostomy urine, renal cyst fluid, catheterized bladder urine, and bladder washings, we were unable to make any conclusive diagnosis of malignancy. The pathological diagnosis of the surgical specimen concluded that this was a case of high-grade urothelial carcinoma of the renal pelvis with focal squamous differentiation (pT4). Liver and lung metastases were identified 3 months after surgery, and the patient died 2 months later. Conclusion It was very difficult to make a conclusive diagnosis using cytological specimens because of the presence of a small number of atypical cells with severe degenerative changes. Since clinicians cannot predict the potential for malignancy on preoperative imaging findings, it is critical to consider the difficulties in clinically making a correct diagnosis of urothelial carcinoma of the upper urinary tract, especially in cases complicated with giant hydronephrosis.

No abstract