This study was performed to compare manual liquid-based preparation with conventional Papanicolaou tests in view of the cytologic diagnoses and specimen adequacy. The specimens of 5,979 women from 33 local clinics and 1 general hospital were prepared by both manual liquid-based preparation and conventional Papanicolaou test. The cytologic diagnoses and specimen adequacy were evaluated in Department of Fathology in Kyoungpook National University School of Medicine. A conventional Papanicolaou test was always prepared first, after that residual material on the sampling device was rinsed into a liquid preservative, and then thin-layer slides were prepared using manual method of liquid-based cervicovaginal cytology. Conventional and liquid-based slides were read independently, and cytologic diagnoses and specimen adequacy were classified using the Bethesda System. Of the cases, 5,763 (96.3%,) had the same interpretation, and there was no significant diagnostic difference in 5,853 (97.8%) cases. When evaluating cases with more than one diagnostic class difference, the manual liquid-based preparation demonstrated a statistically significant overall improvement (2.1%) in the detection of squamous intraepithelial lesion and invasive cancer. Using manual method of liquid-based preparation, there was 14.1%, reduction in unsatisfactory slides through excellent cellular presentation. In conclusion, the manual liquid-based preparation produces standardized quality, superior sensitivity and improved adequacy as compared to the conventional method.

The objective of this study was to ascertain whether or not the high-risk human papillomavirus (HPV) test, when coupled with Papanicolaou (Pap) smears, would prove useful in the screening and management of patients in whom abnormal Pap smear results had been obtained. Concomitant high-risk HPV detection using the hybrid capture II test and colposcopy with a Pap smear were performed with 176 patients, all of whom had been screened for both cervical carcinoma and precancerous lesions. We concomitantly performed colposcopies on these patients. Upon the follow-ups, the histologic diagnoses of these patients were confirmed via either biopsy or hysterectomy. The rate of high-risk HPV detection was correlated with cytologic diagnoses and colposcopic findings. The group composed of the high-risk HPV-positive ASCUS patients exhibited a 55.7% rate of cervical intraepithelial neoplasia (CIN), a significantly higher rate than the 7.5% result obtained in the high-risk HPV-negative ASCUS group. HPV test showed high sensitivity (87%) and low specificity (62.6%) in detection of CIN and colposcopy also showed high sensitivity (88%) and low specificity (22%). Any combination of these tests improve sensitivity, but not specificity. High-risk HPV tests, when coupled with Pap smears, constituted a useful triage approach with regard to colposcopy-directed biopsies in patients in whom a cytologic diagnosis of ASCUS had been rendered.

Pseudoangiomatous stromal hyperplasia (PASH) was initially described by Vuitch et al. as a benign breast lesion, consisting of mammary stromal proliferations which simulate vascular lesions, and which might be mistaken for a low-grade angiosarcoma. This condition occasionally presents as a palpable mass in postmenopausal women, but is more frequently encountered as an incidental component in premenopausal women. Clinical, radiological, and fine-needle aspiration (FNA) findings associated with this condition can mimic those observed in conjunction with a phyllodes tumor or a fibroadenoma. The cytological features of PASH are generally nonspecific, and its diagnosis by FNA cytology is fairly difficult. In this study, we report a case on PASH, manifesting as a palpable mass.

Eccrine acrospiroma is a rare adnexal tumor of the skin. When the clinical presentation is that of a breast lump, diagnosis can be difficult. Also, most of the cytopathologists are not familial with the cytologic features of this tumor and this is responsible for diagnostic pitfalls. We experienced a case of eccrine acrospiroma of the right breast in a 41-year-old female, misdiagnosed by fine needle aspiration cytology (FNAC). FNAC was characterized by tight clusters or sheets of small round cells, polygonal cells, and spindle cells and tubule like structures within clusters. Myoepithelial cells were not noted in the clusters. The diagnosis of eccrine acrospiroma was confirmed by histology.

The mucoepidermoid carcinoma is a rare tumor in the lung for less than 1% of all pulmonary neoplasm. It is mostly presented as a solitary pulmonary nodule at a large bronchial tree on bronchoscope. But more peripheral located tumor that not accessible to the bronchoscope are rarely reported on literature. The cytologic findings of these tumors are discribed as a mixture of squamous cells, mucous cells, and intermediate cells with overlapped cellular clusters. We experienced a case of peripheral mucoepidermoid carcinoma of lung diagnosed by fine needle aspiration cytology. The smear showed many cellular clusters on mucoid background. They consisted of many intermediate cells with occasional mucus-secreting cells, but malignant squamous cells were not present.

Carcinoid tumors of the thymus are vanishingly rare, and the characteristic cytologic findings of this condition have never before been reported in Korea. Recently, we encountered a 58-year-old woman who had been suffering from general weakness and weight loss for several months. Radiological imaging revealed a large anterior mediastinal mass. A fine needle aspiration biopsy (FNAB) of the mass showed predominantly scattered single cells, as well as some loose clusters of small cells with scanty cytoplasm. Some of these small cells exhibited plasmacytoid features, with moderately granular cytoplasm. We also discuss the cytological differential diagnosis between thymic carcinoid and other mediastinal tumors.

Plasmablastic lymphoma (PBL) is a recently described aggressive B-cell neoplasm, which usually manifests as a localized disease of the oral mucosa in individuals infected with human immunodeficiency virus (HIV). Recently we encountered a case of plasmablastic lymphoma manifesting in the left maxillary sinus and cervical lymph node of a previously healthy HIV-negative man, 48 years of age. we conducted a fine-needle aspiration smear of the cervical lymph node, and this was found to be highly cellular with numerous large cells exhibiting eccentrically positioned nuclei, prominent nucleoli, and moderate quantities of basophilic cytoplasm. A biopsy of the mass in the maxillary sinus evidenced diffuse growth of similar plasmablastic cells. These tumor cells were negative for the leukocyte common antigens, CD20, CD3, CD30, and EMA. However, the cells tested positive for CD79a and CD138/syndecan-1. The tumor cells also exhibited L-light-chain restriction. The Ki-67 proliferation index was measured at almost 100%. The patient was diagnosed with plasmablastic lymphoma. After three cycles of combination chemotherapy and radiotherapy, the patient went into complete remission, and currently remains in this state.

Fine-needle aspiration cytology (FNAC) has been used extensively in the diagnosis of metastatic malignancies. However, metastatic soft tissue sarcomas are often overlooked, primarily due to the low frequency with/ which they occur. Here, we report a rare case of metastatic rhabdomyosarcoma in both cervical lymph nodes, which was detected by FNAC. A 45-year-old woman presented with anosmia, postnasal drip, and sneezing, symptoms which had persisted for 1 month. The patient was found to have a tumorous lesion at the upper portion of the mid-turbinate, with multiple enlarged cervical lymph nodes, and this lesion was examined closely at our facility. FNA cytology smears obtained from both cervical lymph nodes revealed a high degree of cellularity, and displayed cohesive clusters with gland-like spaces, as well as single isolated cells with abundant karyorrhectic debris. The tumor cells exhibited round to oval nuclei containing fine chromatin, occasional small nucleoli, and scanty cytoplasm, or a total lack of cytoplasm. Some of the tumor cells were arranged in multinucleated forms and abundant dense eosinophilic cytoplasms, reminiscent of a rhabdomyoblast. The histological findings on the lymph nodes revealed an outstanding sinusoidal infiltration and a prominent alveolar growth pattern, interspersed with occasional typical rhabdomyoblasts. The immunohistochemical results [desmin (+), myoglobin (+), myogenin (+), pan CK (-), synaptophysin (-), neuron specific enolase (-)] supported a confirmative diagnosis of alveolar rhabdomyosarcoma. Alveolar rhabdomyosarcoma is a representative sarcoma, which typically manifests with nodal metastasis and carcinoma-like clustering. The cytopathologist should remain alert upon encountering unusual morphology, so that the possibility of this condition, although somewhat remote, should not be dismissed or overlooked.

A patient with actinomyces infection of the submandibular soft tissue was diagnosed by fine needle aspiration cytology (FNAC). A 38-year-old woman presented with a right submandibular mass which slowly grew in size over one month. Clinically and radiologically, the lesion was considered as tuberculous lymphadenitis or cellulitis. The polymerase chain reaction for tuberculosis was done by aspirated specimen but the result was negative. The smears of aspiration cytology showed characteristic colonies (sulfur granules) of actinomyces in inflammatory background. After antibiotic therapy for eight months, the patient has been well, showing no detectable mass. This patient was simply and rapidly diagnosed by FNAC and can avoid unnecessary surgical biopsy.

Fibromatosis colli is a benign fibrous tissue proliferation of sternocleidomastoid muscle, which is usually observed during the first month of life, often associated with congenital torticollis. It should be differentiated from other neck masses in infants because the usual initial treatment of fibromatosis celli is conservative management and invasive therapy should be avoided. Fine needle aspiration cytology provides an excellent minimally invasive diagnostic way for evaluation of infantile neck masses. We describe three cases of fibromatosis colli diagnosed by fine needle aspiration cytology. All of them were younger than one month and presented as a neck mass. Clinical impressions were malignant tumors in two cases and fibromatosis colli in one case. Fine needle aspiration cytology revealed benign and mature fibroblasts and atrophic striated muscle fibers. The cytologic diagnosis was fibromatosis colli or benign fibous lesion.