腹水細胞診で気管支カルチノイド細胞を検出しえた1剖検例

抄録

An autopsy case of bronchial carcinoid tumor is reported. The case terminated fatally after a rapid clinical course of four months since its onset. The carcinoid tumor was metastasized to many lymph snodes and many organs such as the liver, adrenals, vertebrae and so forth. One of the metastatic tumor nodes in the liver was ruptured into the peritoneal cavity. The tumor cells were first detected in the peritoneal fluid but not in the sputum. In cytologic preparations from the ascites both characteristics of oat cell carcinoma and typical carcinoid tumor were observed. Rosette formation and flat arrangement were the distinguishing findings. The N/C ratio of the tumor cells was slightly large, but was smaller than that of oat cell carcinoma. The nuclei were 8-20 (25) microns in diameter and ovoid or spindle in shape. Moderate atypism of the nuclei was noted, and the tumor was judged as malignant. The nuclear chromatin was increased, and showed fine to coarse granular patterns. A few small nucleolei were also observed. The tumor cannot be definitely diagnosed as an oat cell carcinoma from these cytological findings described above, but appears more malignant variant in carcinoid tumors which are potentially malignant. This tumor may then be considered to be an intermediate type or a transitional type between both tumors.
The cytoplasm of the tumor cells is slightly positive by the Grimelius reaction. Most tumor cells are electromicroscopically found to have a few neurosecretory granules. These findings indicate that the tumor has originated from Kultschitzky cells of the bronchus, and there is an intimate relationship between carcinoid tumor and oat cell carcinoma.