The attempt to demonstrate cancer cells in the blood of patients was first carried out systematically by Pool & Dunlop in 1934. Since then many clinical and experimental reports on malignant tumour cells in the circulating blood have been published. But the report of this study in the otorhinolaryngological region was presented only by Herrmann et al. in 1960 and 1961. They emphasized that the appearance of malignant tumour cells in the circulating blood was differently affected by the functional difference of organs with primary tumour.
The author studied the relationship between the appearance of cancer cells in the peripheral vein blood, especially in cases of maxillary cancer, and the radiation treatment, the operation, the pathologic findings of primary tumour.
The materials for study were collected from 1961 to 1963 in the Otorhinolaryngological Clinic of the Kyushu Unversity. They consisted of 247 blood samples from the peripheral vein blood (cubital vein) of 82 patients, the 50 of whom were diagnosed to be the patients of maxillary tumour, the 16 the ones of larynx tumour, and the 16 the ones of other malignant tumour. The sampling was done 1) before the treatment, 2) during and after the pre-operative radiation with ⁶⁰Co gamma ray, and 3) during and after the operation for malignant tumour.
The process of isolation and concentration of the tumour cells from the whole blood is divided into three stages, that is, segimentation, hemolyzation, and flotation.
As to hemolyzation the author used the method which was reported by Malmgren in 1958, for the reason that the loss of tumour cells by this method is smaller than that by other methods. By adding the enzyme Streptolysin-O to the blood, and incubating it at 38-40°C for 20 minutes, the erythrocytes and polynuclear leucocytes were hemolyzed, and then the sediment of the tumour cells and lymphocytes remained by itself. This sediment was prepared for staining in 20 sheets of smear preparation. It was stained in the Papanicolaou technique.
All through the experimentation the cases in which tumour cells were found in the circulating blood once or more than once were 29 (35.4 per cent) among 82. They included 17 cases of maxillary cancer, 5 of larynx cancer, and 2 of cancer in other parts of the body, and 4 of sarcoma, and one of malignant melanoma of the nose. About the 50 cases of maxillary cancer was investigated the relationship between the appearance of cancer cells in the circulating blood and 1) pathological malignancy, 2) metastasis, 3) the extention of tumour, 4) pre-operative radiation, and 5) operation.
In the 23 cases among them pathologic malignancy was shown both in the C. P. L. form by T. Imai, and in the anaplasia grading method by A. C. Broders. Most of the cases in which tumour cells were found in the circulating blood were in the third or fourth grade by Broders, and 4 cases showed the L form by Imai, that is, lymphatic and blood vessel permeating form.
In the 29 cases in which the metastasis in the regional lymphnodes was discovered, 9 cases were found to have tumour cells in the circulating blood.
Among 7 cases in which the hematogenous metastasis was discovered, 3 cases were shown to have tumour cells in the blood.
It is not always the advanced stage of malignant tumour that many tumour cells appear in the peripheral vein blood. This fact has already been reported.
Summing up the cases the author has dealt with he assumes that the appearance of tumour cells in the circulating blood is not necessarily affected by the extension of tumour, but by the pathologic malignancy.
It is a very interesting program to study how the state tumour cells in the circulating blood changes by the irradiation on the tumour tissue.

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