EXFOLIATIVE CYTOLOGY OF THE BLADDER TUMOR
1967 Volume 58 Issue 2 Pages 156-175
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1967 Volume 58 Issue 2 Pages 156-175
The opinions among urologists about the clinical usefulness of the exofliative cytology of the bladder tumor are widely diverse. This is probably due to the fact that the well-defined criterion and the reasonable interpretation of cytological grading for the bladder tumor has been not yet established.
The author has applied a new method to obtain a large amount of fresh exfoliated tumor cells in well-preserved form. The bladder is emptied and irrigated with α-chymotrypsin solution (200ml, 5mg of α-chymotrypsin per 100ml of the saline solution) through the catheter inserted into the bladder. The irrigated fluid is collected and is centrifuged. The half-dried sediment mounted on the slide glass is fixed in the alcohol-ether solution, and is stained with Papanicolaou's method or Harris' hematoxylin-eosin.
There is little difference between two staining methods. The morphology of exfoliated cells, thus obtained and stained as abovementioned, was demonstrated to correspond very closely to the histological appearance of the original tumor cells (see photography plates in the Japanese text).
By comparing the microscopical features of exfoliated tumor cells with that of tumors, the author presented a new cytological classification of the bladder tumor, which was graded in four classes (Class I, II, III, IV).
In this classification, special interpretation and significance of Class III are emphasized. Practically in fifty-six cases of benign papilloma and well-differenciated papillary carcinoma, except two cases of papillary carcinoma, the grading of exfoliated cells was revealed to be included definitely in Class III or Class IV of the author's classification. The result indicates that demonstration of the exfoliated cells judged as Class III is reasonably considered to show positive evidence of a bladder tumor.
The clinical experiences with the author's cytological classification reveals clinical reliability and availability of exfoliative cytology of the bladder tumor, especially in those cases in which severe inflammation may make the exact diagnosis very difficult, or conventional urological examinations such as X-rays an endoscopy can be hardly applied. Also, this classification of the exfoliative cytology is expected to be useful.
