甲状腺腫の穿刺吸引細胞診

特にその病理組織像と細胞像の対比について

抄録

The purpose of this paper is to examine whetherthe cytological fine needle aspiration biopsy is useful, or not, to make settled diagnosis of diseasewith goiter. To study this possibility, both histological and cytological examinations were made onthe same case.
A new instrument for the aspiration biopsy wasused in this study. The instrument is devised soas to be fitted, without any aseptic precaution, witha 10ml syringe, which is usually used in a clinic. Afine needle, 6 cm in length and 0.7mm in outerdiameter, is attached to the syringe.
Using the instrument, the aspiration biopsy wasapplied to 123 patients with goiters, the histologicalclassification of which consisted of 25 carcinomas, 42 adenomas, 10 simple cysts, 25 Graves' diseases, 15 Hashimoto's diseases, 5 adenomatous goiters andone subacute thyroiditis.
The conclusions of this study are as follow:
1. In 121 of 123 examined cases, aspirated cellswere sufficient for diagnosis. Both the remainingcases histologically showed “adenocarcinoma withmassive fibrosis and scant tumor cells”.
2. No complication of hemorrhage, infection ortumor cell spreading was accompanied by this procedure.
3. The smear from thyroid carcinoma was usually abundant in cancer cells. Frequently, they ga- thered to form characteristic clusters of cells, which were large in size and showed irregular anddense crowding of cells. Although the cancer cellsaspirated from the thyroid also showed the generalfeatures of malignant cells, it was peculiar to theformers that many of their nuclei had rather finegranuloreticular patterns of chromatin structure.
4. Adenoma cells considerably differed in morphology from cancer cells, and cytological diagnosisof benign adenoma was not so difficult.
5. The diagnosis of cyst was determined byaspiration of massive fluid and observation of characteristic foamy cells.
6. There were medium-sized to small clustersin the aspiration smears of Graves' diseases, all ofwhich had fallen into euthyroidism with treatments.The epithelial cells, of which the clusters consisted, were slight in atipism, large in size and regular in arrangement.
7. Cytological diagnosis of Hashimoto's diseasewas based upon a large number of lymphocytes anda few degenerative epithelial cells.
8. Some characteristic, multinucleated giantcells were aspirated from a goiter of subacute thyroiditis.
9. Based upon such cytological features of aspiration smears from various kinds of goiters asmentioned above, cyto-diagnosis was retrospectivelytried again on the blind specimens of 123 examinedcases. In 21 out of 25 thyroid cancers, cyto-diagnosis of cancer was settled, in one case cancerwas suspected, in one a diagnosis of benign adenoma was made, and in 2 the cells were too insufficiently aspirated to an exact cyto-diagnosis. In addition, there was one false-positive