The classification and differentiation of malignant lymphoma have been a current problem. Characteristic cytological findings for lymphosarcoma, reticulosarcoma and Hodgkin' s disease were obtained on Papanicolaou-stained smears and imprints. 1. Lymphosarcoma cells had scant cytoplasm; thick nuclear rims; coarse chromatin networks; small, ring-shaped nucleoli; and dendritic pattern of nucleolus-associated chromatin. 2. Reticulosarcoma cells had fine nuclear rims; delicate chromatin networks; nucleoli which were stained darker at their rim than inside; and dendritic pattern of nucleolus-associated chromatin. 3. Hodgkin's cells (Reed-Sternberg' s cells) had abundant formy cytoplasm; fine nuclear rims; delicate chromatin networks; and prominent, round or irregularly shaped, difusely stained, dense nuc leoli, associated with no or thread-like chromatin.
Studies on the method of preparing specimens for diagnostic cytology by Autosmear (CF-12) (from Sakura Fine-technical Co. Ltd.) were carried out. 1) Two kinds of Cells with horizontal axes and square cut surfaces are suitable for diagnostic cytology. One of them has the opening of 14×14mm in space to the glass, and the other 14×30mm. 2) In order to fix cells at wet condition and to gather cells on the glass, the Cells are much more effective in combination with gum plates for packing than with paper filters. 3) Almost all fluid specimens, some brushings, punctures and secretions are prepared by Autosmear in direct treatment or combination with the methods of dilution, hemolysis, preliminary centrifugation and suspending in saline solution according to the characteristics of each specimen. 4) About 1200 specimens of various kinds and properties were prepared by Autosmear in our laboratory and it was proved that the instrument very useful for diagnostic cytology in the effecti. veness of gathering cells and distributing evenly on the limited space of the glass, speeding up ir screening of cancer cells and easy preparation of good smears from fluid specimens.
Cytologic examinations of both bile and duodenal juice were performed on patients with lesion in billiary tract and pancreas. The bile was drained from intrahepatic duct when the percutaneous transhepatic choleangiography was done, and the duodenal juice was obtained on the occasion of the hypotonic duodenography. The drained specimen was poured immediately into a centrifuge tube containing chilled physiological saline water to prevent degeneration of the cells, and centrifuged at1500 rpm for 5 minutes. The sediment was stirred in a cell modified by Shibata with the saline waterand centrifuged again with an Autosmear (Sakura Finetechnical Co. Ltd.). Detection of cancer cells in the bile was more satisfactory by the present method than by direct smearing of the bile. Reliability of cytologic diagnosis of the bile and the duodenal juice was assertained also by pathological diagnosis by autopsy or surgical operation on thirty three patients, and 16 cases were found to be malignant and 17 cases benign. By cytologic diagnosis of the bile on 16 malignant cases, 11 cases were positive, 4 negative, and 1 suspicious. For 9 cases of 16 malignant cases, cytologic diagnosis of the duodenal juice were taken, and 6 cases were positive and 3 negative. As all the 17 benign cases were negative in cytologic diagnosis, there was no false positive. Of 9 cases examined cytologically in both the bile and the duodenal juice, 8 cases were positive for either or both. In conclusion, 13 of 16 malignant cases were positive in cytologic diagnosis on the bile or the duodenal juice.
Both cervical scrapings with our wooden spatula (reformed Ayre spatula) and the cotton applicater can be considered as valuable methods in mass screening for cervical cancer. In order to compare the wooden spatula with the cotton applicater, the cytologically quantitative examination was performed on the histologically diagnosed cases such as invasive cancer, carcinoma in situ and dysplasia of cervix. No disparity was been able to find in the cases of invasive cancer, but malignant cells were decreased by the scraping with cotton applicater. This method failed in accuracy in the cases of carcinoma in situ and also dysplasia of cervix. The positive detectable ratio by this method was 71%, 54.8% respectively. About 84% of dysplasia of cervix and 100% of carcinoma in situ were detected by the screening with the wooden spatula. As a result of our experiment, the cervical scraping with the wooden spatula was estimated the most reliable method for the detection of dysplasia of cervix and carcinoma in situ.
Mass screening for cervical cancer in Miyagi prefecture has been taken chiefly by a cytological method since 1962. The total number of women examined by our screening car from 1962 to 1970 was 131, 084, and smear-positive cases were 238 (0.19% of the total cases). As a result of this program, 493 cases of dysplasia of cervix were detected. In these the cytologically smear-positive caseas were 39 (7.8%). At the 1st screening for cervical cancer 46 were suspected as false positive cases. These cases were examined in our cancer clinic by means of a systematic technique including vaginal smear, colposcopy and punch biopsy. Finally 5 cases revealed no cyto-histological disorders except for inflammation and metaplasia. The smear-positive cases detected both the first and following second screening were rarely given benign lesions. About 23% of smear-positive dysplasia was found of progression to carcinoma in situ or invasive carcinoma.
A case of Enterobius vermicularis, six cases of follicular cervicitis and two cases of Curschmann's type spirals observed in the cervicovaginal smears are presented. (A) A case of Enterobius vermicularis infestation of the cervix occurring in a 21-year-old pregnant woman was detected in a routine cytologic examina tion of the cervix. Approximately 80 ova were cou nted in the slide. The ova were elongate-oval sha ped with one flattened side, measuring 54-57×25-27 microns. The shell was composed of two layers, orangeophilic and refractile. Most of the eggs con tained gray-orange staining larvae. While Enterobius vermicularis and perineal invol vement is rather cammon in pediatrics, this worm is relatively rare in an adult woman and a few cases found in routine cytologic studies of cervical and vaginal smears have been reported. (B) Six cases of follicular cervicitis observed in a routine cytologic examination of the cervix were presented. Our patients ranged in age from 54 to 64. None of these patients had any evidence of leukemia or malignant lymphoma. The cytologic features were characteristic of the presence of a mixture of lymphocytes and their precursors. These cells included mature and immature lymphocytes and reticulum cells. The reticulum cells showed mitotic figures and phagocytosis. Follicular cervicitis is a benign inflammatory condition occurring in a postmenopausal woman. This condition may be diagnosed in Papanicoloau smears of the cervix wth a fair degree of assurance, but may occasionally be confused with leukemia, lymphoma or small cell carcinoma. (C) Two cases of Curschmann's type spirals were found in a routine cytologic examination of the cervix. Both patients were on contraceptive medication. Examination of the cervical smears revealed moderate inflammatory exudate. Most pro minent feature was the presence of Curschmann's type spirals which was identical to those observed in the sputum of patients with asthma or other chronic obstructive pulmonary diseases. Toour knowledge no cases of Curschmann's type spirals of the cervix have been reported.