The 49th Fall Meeting of Japanese Society of Clinical Cytology (JSCC)
Kobe, Japan


Welcome Message

On behalf of Japanese Society of Clinical Cytology (JSCC), it is my great pleasure to welcome you to the 49th Fall Meeting (Fall Congress), which will be held at Kobe Portopia Hotel on 21st and 22nd of November, 2010.

The special theme of this congress focuses on education, training and continuing education for cytotechnologists and cytopathologists. We will provide you more than 10 educational workshops and lectures on this theme with a free handout to all attendants with registration. Students and trainees who will apply specialty board are also welcome to this congress, and special rate for registration will be applied. Although the official language is Japanese, several programs are conducted by English for audience who are familiar with English more than Japanese.

Aside from the opportunities afforded by the conference's working sessions, you will also have the chance to explore this cosmopolitan port city. Kobe has been famous for the night view of the city as well as the site of one of Japan's most famous hot spring resorts, Arima Onsen.

Welcome again to the 49th Fall Meeting 2010. We hope that you will find the conference informative and enjoyable, and that you will have a great stay in Kobe, Japan.

Kennichi Kakudo



The English programs are as follows;

Asian Forum Slide Conference

Chairman: Mitsuyoshi Hirokawa, Department of Diagnostic Pathology, Kuma Hospital, Japan, Toshio Fukuda, Department of Tumor Pathology, Gunma University Graduate School of Medicine, Gunma, Japan.

Claire W. Michael, M.D. Department of Pathology, University of Michigan, USA

Go to Virtual Slides.


Slide conference case 1: Gynecology
Presenter: Chiung-Ru Lai, MD, FIAC. Department of Pathology, Taipei Veterans General Hospital, Taiwan
Discussant: Minori Tabuchi, C.T., IAC. Marketing Department, Dako Japan

Case: A 46-year-old female with heavy menstrual flow and occasional abnormal vaginal spotting in recent 4-5 months. Pelvic examination revealed huge necrotic mass noted from the cervical os.
Preparation: Conventional Pap smear
Staining: Papanicolaou stain


Slide conference case 2: Breast
Presenter: Yong-Jin Kim M.D., PhD., Department of Pathology, Yeungnam University College of Medicine, Korea
Discussant: Nobuaki Kato, C.T., IAC. Division of Diagnostic Pathology, Tokai University Hospital, Japan

Case: A 47-year-old female with a palpable right breast mass for three months. The breast ultrasonography reveled about 3 cm length hypoechoic long tubular lesion in right upper outer quadrant.
Preparation: Fine needle aspiration from the breast
Staining: H-E stain


Slide conference case 3: Pancreas
Presenter: Jiyou Li, Department of Pathology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, China.
Discussant: Yukari Nishimura, C.T., IAC. Division of Clinical Cytology,
School of Allied Health Sciences, Kitasato University, Japan

Case: A 26-year-old female with upper abdominal pain. Ultrasound examination revealed a mass located in the pancreatic head.
Preparation: Fine needle aspiration from the pancreatic mass.
Staining: Papanicolaou stain


Slide conference case 4: Salivary gland
Presenter: Pamela Tauchi-Nishi, M.D., Department of Pathology, The Queen's Medical Center, USA
Discussant: Yuko Tamano, C.T., IAC. Medical Laboratory, National Hospital Organization Kanazawa Medical Center, Japan

Case: A 30-year-old female with a 3 cm salivary gland mass.
Preparation: Air-dried fine needle aspiration slides prepared by the clinician
Staining: Diff-Quik stain


Quality Management in the United States of America

Claire W. Michael, M.D.
The University of Michigan, USA

Clinical Laboratory Improvement Amendments (CLIA'88) was introduced in USA in 1988 as a result of the media describing some unregulated practices in cytology laboratories allegedly resulting in misdiagnoses. CLIA 88 mandated QA/QC activities particularly in gynecologic samples that require continuous monitoring. Laboratories have to be accredited either by a governmental agent such as Joint Commission on Accreditation of Healthcare Organization (JCAHO) or an agent with deemed status such as College of American Pathologists (CAP). Accreditation is renewed based on an onsite inspection every two years. Quality monitors include those for the general laboratory e.g. written criteria for specimen acceptance and adequacy, preparation and staining, measures to prevent cross contamination etc. Logs should be kept for problems and how they were resolved, overall laboratory workload e.g. number of cases accessioned, slides, cell blocks etc. Workload monitors mandate a maximum of 100 conventional smears to be screened by a cytotechnologist in no less than 8 hours. Monitors for screening quality include random re-screen of 10% of negative, targeted rescreen of high risk cases, review of previous 5 years for every newly diagnosed HGSIL or above etc. In addition, CLIA mandated competency assessment which is fulfilled by check samples that provide an inter-laboratory comparison. Yearly, a proficiency testing is conducted to all cytopathologists and cytotechnologist with stringent criteria to pass.

The Bethesda System for Reporting Thyroid Cytopathology

Claire W. Michael, M.D.

The Bethesda reporting system for thyroid FNA introduced more standard terminology including "Atypia of Undetermined Significance", and "Follicular/Hürthle cell Neoplasm or Suspicious for Follicular/Hürthle Cell Neoplasm".

The atypia of undetermined category is reserved for specimens that contain cells (follicular, lymphoid or other) that exhibit architectural and/or nuclear atypia that is not sufficient to be diagnosed as suspicious for follicular or Hürthle cell neoplasm, suspicious for malignancy or malignant. At the same time, the atypia is more marked than can be confidently dismissed as benign. This diagnosis carries a 5-15% risk of malignancy. Recommended clinical approach is a repeat FNA after reasonable interval, although in specific clinical settings other management options may be appropriate.

Follicular or Hürthle cell neoplasm /suspicious for neoplasm refers to cellular aspirates comprised of follicular or Hürthle cells, most of which are arranged in an altered architectural pattern such as cellular crowding, microfollicles or a predominantly Hürthle cell population provided that papillary carcinoma is excluded. This category carries a 60-75% risk of malignancy. The recommended management is surgical excision of the lesion most often hemithyroidectomy or lobectomy.

Shandon and Wakayama Friendship Workshop.

Chaired by Mareo Yamoto, MD, PhD and Wang Xiaojuan MD, PhD.

Cytopathologist Training in China

Yanhua Bai
Department of Pathology, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University School of Oncology, Beijing Cancer Hospital & Institute, China

With the increasing accuracy of cytologic diagnosis, cytology plays a more and more important role in the preoperative diagnosis because it is less invasive and low cost for the patients. Cytological diagnosis in China becomes more reliable than before for clinicians due to the more systematic and strict training, although as a fact, differences in the diagnostic level are seriously uneven among cytopathologists in different area. This study describes a standard training program for cytopathologists in medical schools and post-graduate educational level in China. Furthermore the common diagnostic procedure using cytology in the Department of Pathology of Beijing Cancer Hospital will be presented as an example.

Diagnostic Approach for Breast Cancer in China

Qifeng Yang, Tingting Ma, Liyu Jiang
Department of Breast Surgery, Qilu Hospital of Shandong University, Ji'nan 250012, P.R. China

Worldwide, it is estimated that more than one million women are diagnosed with breast cancer every year. In some areas of China, the incidence of breast cancer was recorded increasing by 5% per year, greater than 1.5% of the worldwide increase. Breast cancer can present as palpable lesions found by the patient or the clinician, or as non-palpable lesions first detected on screening mammography and/or ultrasonography. Fine needle biopsy is not commonly used in China for cancer screening but are very useful for confirm some kind of benign breast diseases such as a breast cyst, granulomatous mastitis which can clinically mimic a carcinoma of the breast, etc. Core needle biopsy is used for confirming a diagnosis of breast cancer before neoadjuvant chemotherapy, immunohistochemistry analysis could be performed on the core needle samples. Nipple smear cytology and ductoscopy are used for the evaluation of nipple discharge, selected cases are subjected to ductoscopy or operation directly. Ductoscopy is not recommended as a treatment strategy for intraductal lesion. Molecular approaches are developing for breast cancer early detection.

Recent Advances in Cytological Diagnosis

Chaired by Dr Tang Weihua(University of North Carolina) and Dr Claire W Michael (The University of Michigan)

The Use of Ancillary Testing in the Workup of Effusions

Claire W. Michael, M.D. The University of Michigan

The workup of serous effusions requires the answer for three questions. First is it benign or malignant? Second, is it mesothelial or epithelial? And the third, which type of carcinoma, is it? And what is the most likely source. Currently the ability of cytology to answer the above questions has made strides thanks to the newly developed immunostains. Studies have shown that using desmin, EMA and P53 can assist in distinguishing reactive mesothelium from mesothelioma. Meanwhile numerous markers can now establish mesothelial origin with high accuracy thus allowing us to separate mesothelioma from carcinoma, particularly calretinin, podoplanin and D2-40. In addition markers such as CEA, MOC-31, Ber Ep4, Leu M1, etc can confirm the epithelial origin.

Next, it is important to distinguish adenocarcinoma from other rare carcinomas such as squamous cell carcinoma, urothelial carcinoma etc. Also, it is equally important in some cases to determine its primary site. Current markers can frequently identify the primary site e.g. TTF-1 and Napsin for lung, Pax 8 and ER/PR for ovary, Mammaglobin and Natrin 4 for breast etc.

Molecular testing such as FISH and PCR can have a significant role in effusion work-up. These tests may be used to confirm malignancy in an effusion that is cytologically negative or in looking for specific mutations that identify a specific malignancy particularly in patients with more than one potential primary.

Preserving DNA, RNA and Protein for Downstream Molecular Analysis
in Cytopathology Practice

Weihua Tang MD PhD1, Carlie Sigel MD1, Susan Maygarden MD1, Leigh Thorne MD1,2, Clifford Wokocha3, Carol Shores MD PhD2,4, Margaret L Gulley MD1,2

1 Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill (UNC-CH)
2 Lineberger Comprehensive Cancer Center, UNC-CH
3 Department of Pediatrics, Kamuzu Central Hospital, Lilongwe, Malawi
4 Department of Otolaryngology/Head & Neck Surgery, UNC-CH

Ancillary testing of cytology samples relies on adequate preservation of target molecules, yet little is known about the impact of methanol-based fixatives on DNA, RNA and protein. Fresh fine needle aspirates of reactive tonsils and Burkitt lymphomas were immediately placed in PreservCyt fluid, then refrigerated up to 12 months before analysis. RNA integrity number (RIN) was evaluated on a Bioanalyzer, and ABL1 transcripts were measured by Q-rt-PCR. Cell blocks were prepared by formalin fixation and paraffin embedding, and cells were then assayed for human APOB DNA by Q-PCR, for mRNA by in situ hybridization to polyA tails, and for protein by CD20 immunohistochemistry. After PreservCyt storage up to 12 months, cytologic features were intact as visualized by microscopy. Histochemical analysis revealed CD20 protein and mRNA expression in an appropriate distribution of cells, with modest degradation of signal after prolonged storage. While RIN scores declined over time, mRNA transcripts remained amplifiable with minimal degradation. Clearly, ancillary molecular testing is feasible on cytologic samples stored in a methanol-based solution. These findings imply that, with prudent pre-analytic handling and storage, biochemical test results can be obtained on scant samples collected by minimally-invasive methods and stored for extended periods prior to testing.

Highthroughput florescence in situ hybridization screen
using single nuclei preparation from paraffin-embedded tissues

Bo Han
Department of Pathology, Shandong University Medical School, China

Interphase Florescence in situ Hybridization (FISH) can be applied to cytology smears and histological sections from formalin-fixed and paraffin-embedded (FFPE) tissues. However, FISH is time-consuming and labor intensive. Here, we modified and tested a new technique to isolate individual nuclei from tissue cores of FFPE tissue. Tissue microarray was subsequently constructed by manual for highthroughput FISH screen. The FISH protocol presented is with optimization of the nuclear isolation and nuclei pretreatments with pepsin. The efficacy of this method was investigated in 20 prostate cancer and four benign prostate FFPE tissues. Two tissue microarrays were established and rearrangement involving ERG gene was detected using break-apart FISH probes. Overall, FISH signals were successful for 96% (23/24) samples and ERG rearrangement was identified in 60% (14/23) of the cancer samples, but not in the benign prostate tissues. This result is identical with that was established by other genetic technique. In contrast to standard FISH technique, this protocol is more rapid, money-saving, and helpful to detect chromosome anomalies in FFPE tissue. It may also be potentially successful on cytological materials.

Congress Information

Date: November 21st-22nd, 2010
Venue: Kobe Portopia Hotel (
Kobe International Exhibition Hall (
Location: Kobe, Hyogo prefecture, Japan
President: Kennichi Kakudo, M.D, Ph.D. FIAC
Vice president: Kazuhiko Ino, M.D, Ph.D.
Secretariat: Department of Human Pathology,
Wakayama Medical University
Kimiidera 811-1, Wakayama City,
Wakayama prefecture, Japan
TEL: +81-73-441-0635
FAX: +81-73-446-4825
Other information:
Registration fee ¥12,000