Usefulness of transmission electron microscopy analysis using cell block for accurate diagnosis of high-grade serous carcinoma: A case report

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  • MATSUYAMA Kinichi
    Department of Pathology, Dokkyo Medical University Hospital
  • MACHIDA Hiromi
    Department of Pathology, Dokkyo Medical University Hospital
  • KATO Hikaru
    Department of Pathology, Dokkyo Medical University Hospital
  • ISHIZAKI Satomi
    Department of Pathology, Dokkyo Medical University Hospital
  • NAGAI Tamiko
    Department of Pathology, Dokkyo Medical University Hospital
  • NODA Shuhei
    Department of Diagnostic Pathology, Dokkyo Medical University
  • ISHIKAWA Mihoko
    Department of Pathology, Dokkyo Medical University Hospital
  • ISHIDA Kazuyuki
    Department of Pathology, Dokkyo Medical University Hospital Department of Diagnostic Pathology, Dokkyo Medical University

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Other Title
  • 腹水セルブロック検体の透過電子顕微鏡観察が高異型度漿液性癌の診断に有用だった一例 ―セルブロック検体を用いた透過電子顕微鏡観察―
  • フクスイ セルブロックケンタイ ノ トウカ デンシ ケンビキョウ カンサツ ガ コウイケイドショウエキセイガン ノ シンダン ニ ユウヨウ ダッタ イチレイ : セルブロックケンタイ オ モチイタ トウカ デンシ ケンビキョウ カンサツ

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<p>We report a case in which cytological diagnosis, cell block immunohistochemistry, and transmission electron microscopy (TEM) were used on a cell block to differentiate between adenocarcinoma and malignant mesothelioma (MM) in ascites. A woman in her 70s came to our hospital with abdominal distention, and a large number of ascites were found in an imaging examination. Ascites cytology showed atypical cells with irregular nuclear shapes, nuclear inclusion bodies, and intracytoplasmic vacuoles on a hematogenous background, suggesting high-grade serous carcinoma (HGSC) of the female genital tract. However, MM could not be ruled out owing to the presence of squamoid orangeophilic cells and atypical cells with marginal obscuration and abundant cytoplasm. The immunohistochemistry of the ascites cell block showed that the atypical cells were positive for cytokeratin 7, PAX8, WT-1, and ER, and overexpressed p53. Ep-CAM, CEA, and claudin 4 were negative. Mesothelial markers were partially positive for calretinin and D2-40 and positive for HEG1. We performed a TEM observation of the ascites cell block after obtaining the immunohistochemical results. A tumor cell with a retained microvillus shape was identified, and the length-to-diameter ratio (LDR) was measured for each of the 10 microvilli from the longest to the shortest parts. The mean LDR of the 10 microvilli was 6.58, which was characteristic of adenocarcinoma with fewer than 10 microvilli, and malignancy in ascites due to HGSC was diagnosed. The LDR measurement of microvilli with TEM was considered useful for differentiating HGSC from MM in ascites.</p>

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