Abstract
Background : Nasopharyngeal carcinomas are rare tumors with an annual incidence of 500 cases in Japan and are often found in advanced cancer. It is also difficult to diagnose small cell lung carcinoma at an early stage and surgical cases are rare. We report herein on a case of nasopharyngeal carcinoma diagnosed with sputum cytology, combined with stage Ⅰ small cell lung cancer detected during the examination.
Case : A 68-year-old man, a heavy smoker (smoking index : 45 pack-year), consulted our institute because marked atypical cells (level D) were detected on sputum cytology during a mass screening program for lung cancer. The chest CT examination was negative, and abnormal findings were not observed in the endoscopic examination. After 2 years, endoscopy was performed again because cancer cells (level E) were screened on sputum cytology and stage Ⅰ nasopharyngeal carcinoma was diagnosed with an endoscopic biopsy. In addition, as a pulmonary nodule, which had appeared in the chest CT examination, increased during follow-up, a thoracoscopic right middle lobectomy was performed, and diagnosis of stage Ⅰ small cell lung carcinoma was obtained. In sputum smears, non-keratinizing squamous epithelial cells stained with light green were useful for the diagnosis.
Conclusion : Scrutiny and follow-up with a combination of sputum cytology and chest CT examination were useful for the early detection of multiple cancers. In sputum cytology, it was necessary to pay attention not only to yellowish photo-luminescent but also to light green-philic atypical epithelial cells. Our experience suggested that sputum cytology could contribute to early detection of head and neck cancers that are otherwise difficult to detect.
