The present study revealed that telomere length can be used as an indicator to distinguish malignant and benign cells in cytological specimens. This novel approach may help improve diagnosis for cancer patients.

Objective Cytological diagnosis of pancreatic specimens obtained by endoscopic ultrasound‐guided fine needle aspiration (EUS‐FNA) is often challenging because of the small sample size or well‐differentiated adenocarcinoma with weak cytological atypia. Therefore, the sensitivity and specificity of cytological diagnosis for pancreatic cancer should be improved. Hence, we aimed to clarify the utility of cytological scoring to distinguish malignant from benign lesions for cytological diagnosis of pancreatic EUS‐FNA specimens. Methods Seven reviewers, including four cytotechnologists and three medical doctors, evaluated 20 morphological indices in pancreatic specimens obtained by EUS‐FNA (malignant, n = 111; benign, n = 31). Statistical analyses were performed using Fisher's exact test, logistic regression analysis, the area under the receiver operating characteristic curve, and Youden index. Results Among the 20 indices, there was a high incidence rate (>40%) of the following 13 indices in malignant cases: irregular structure, hyperchromatic nucleus, irregular cell polarity, unclear cell boundaries, nuclear membrane thickening, anisonucleosis, overlapping, irregular nuclei, high nuclear‐cytoplasmic ratio, binding decline, the simultaneous appearance of malignant and benign cells, enlarged nucleoli, and background necrosis. When we diagnosed pancreatic specimens using these 13 cytological indices, the cut‐off value of 8/9 showed the highest Youden index (0.950) as well as high sensitivity and specificity in distinguishing malignant from benign specimens (98% and 97%, respectively). Conclusion Thirteen cytological indices showed high sensitivity and specificity in differentiating malignant and benign lesions using pancreatic EUS‐FNA samples. All 13 indices were important for diagnosing malignancy in the pancreatic cytology smear of EUS‐FNA. Further validation studies are required.

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Cytological characteristics of mucinous carcinoma of the breast in the elderly with bibliographical considerations Hiroto Shirahata, et al. Dept. of Path., Tokyo Metropolitan Geriatric Hosp., Tokyo 75 Clinicopathological study of the two-color pattern TCP on cervical and endometrial cytologic smears Keiko Ishii, et al. Div. of Diag. Path., Okaya City Hosp., Nagano 85 Clinical Articles Leiomyosarcoma of the uterine cervix Noriko Takeda, et al. Dept. of Obst. and Gynecol., Kushiro City General Hosp., Hokkaido 92 Granular cell tumors of the pectoralis major muscle and trachea diagnosed by cytology-Two case reports-Tsubasa Saika, et al. Div. of Diag. Path., Tokai Univ. Hosp., Kanagawa 96 A case of thyroid MALT lymphoma with extreme plasma cell differentiation Shinya Hayashi, et al. Dept., of Path., Niigata Pref. Central Hosp., Niigata Cytological findings of the pleural fluid in a case of rheumatoid arthritis with pleural involvement Hiromi Machida, et al. Div. of Surg. Path., Dokkyo Univ. Hosp., Tochigi Brief Note A case of Langerhans cell histiocytosis of the cranial bone-Case report with emphasis on the cytological features

BackgroundAccurate diagnosis of malignant and benign pancreatic lesions can be challenging, especially with endoscopic ultrasound‐guided fine needle aspiration (EUS‐FNA) samples that are small and/or degraded. In the present study, we determined how to best evaluate abnormal SMAD4 expression by immunohistochemical staining on cell block specimens from EUS‐FNA samples.ResultsIn surgically resected pancreas, when abnormal SMAD4 immunolabelling was evaluated as negative SMAD4 expression, the sensitivity was low (33%), but when it was evaluated as decreased SMAD4 expression, the sensitivity improved (53%). Specificity and positive predictive value were high for both evaluations. There were no false‐positive cases. In cell block specimens, decreased SMAD4 expression showed 47% sensitivity and 72% specificity, while negative SMAD4 expression showed lower sensitivity (20%) and higher specificity (100%). Both evaluations in cell block specimens showed lower sensitivity and specificity compared to resected specimens. False‐positive and ‐negative rates were higher for cell blocks than for resected specimens.ConclusionsDecreased SMAD4 immunolabelling provided improved sensitivity as compared to negative SMAD4 immunolabelling; therefore, it is important to compare SMAD4 expression in a sample to its expression in normal cells. Abnormal SMAD4 labelling showed low sensitivity and high specificity; therefore, SMAD4 staining using EUS‐FNA samples might be helpful to detect malignancies that possess SMAD4 gene abnormalities.