肝・胆道・膵・膨大部領域の細胞診

抄録

The authors studied the microscopic morphology of fresh carcinoma cells obtained by the fine needle aspiration technic from carcinomas of the liver, biliary tract, pancreas and periampullary region which were histologically confirmed to be well differentiated adenocarcinomas.
The specimens were stained by the Papanicolaou method and observed precisely by light microscopy.
The following were the differences found between the carcinoma cells of these organs and region by comparing their histologic features:
(1) Hepatocelluar carcinoma cells: The cytoplasma and nucleus were irregular in shape and the largest in diameter of the carcinoma cells of the groups.
The nucleocytoplasmic ratio (N: C ratio) was most increased among the groups.
The nuclear membranes were unevenly thick in general.
The nucleolei were largest in diameter, prominent, irregular, isolated from chromatin granules, and increased in number.
(2) Carcinoma cells of the biliary tract (differentiated adenocarcinoma): The cytoplasma was intermediate in diameter and markedly polymorphic.
The nucleolei were mostly large, oval and slightly polymorphic.
The nuclear membranes were mostly evenly thin, and the chromatin granules were coarse.
The nucleolei were large and oval. The number of nucleoli in the nucleus ranged from zero to four-in general.
The nucleoli were connected with the chromatin granules.
(3) Carcinoma cells of the pancreas (differentiated adenocarcinoma): The cytoplasma and nucleus were small in diameter. Anisocytosis and anisonucleosis were prominent.
The N: C ratio was large. The nuclear membrane were evenly thin. Hyperchromasia was moderate.
Among these groups, the nucleoli of carcinoma cells of the pancreas were smallestin diameter and oval or round in shape.
The number of nucleoli ranged from zero to two in most nuclei.
(4) Carcinoma cells of the periampullary region (differentiated adenocarcinoma): The cytoplasma was small in diameter and irregular in shape.
Anisocytosis was moderate. The nuclear membrane was generally thin.
The chromatin granules were fine, and slightly increased in number.
The nucleoli were small, and round or oval. The nucleus contained zero to three nucleoli. Clusters of carcinoma cells contained more naked nuclei than normal cells and few mutual inclusions.
No distinguishing features of cell clusters were evident among these groups.
These features of carcinoma cells were useful for differential diagnosis of these groups.
On the basis of these findings, the authors examined 97 patients with lesions in these organs (27 benign, 68 malignant, 2 histologically and/or borderline lesions), clinically and analysed the results.
The cytodiagnosis was done preoperatively and peroperatively.
(1) Preoperatively, the accuracy rate of positive cytodiagnosis of malignant lesions was 33 percent by the percutaneous intrahepatic cholangio-drainage (PTC-D), and 25 percent by the pancreozymin-secretin test (P-S test).
In the benign lesions, the accuracy of negative cytodiagnosis was 83 percent by the PTC-D and 100 percent by the P-S test.
By dudenoscopic biopsy, the accuracy of positive cytodiagnosis of malignant lesions was 80 percent, but all of the positive cases were advanced cancers.
(2) Peroperatively, the accuracy rate of cytodiagnosis by fine needle aspiration was 83 percent both in the benign and malignant cases, respectively.
The accuracy of imprint smears from the specimens by surgery, endoscopy and Vim-Silvermann needle was 100 percent.
The relationship between the results of cytologic diagnoses by various cell collection methods and tumor sizes was studied: consequently, even in small carcinomas 2 or 3 centimeters in diameter, the accuracy of positive cytologic diagnosis was relatively high.