A case of malignant mixed mesodermal tumor of the corpus uteri was studied by electron microscopy and compared with cytological findings. The clinical course of this case was specific; the patient had previous irradiation before 35 years. A history of previous irradiation in a patient with mixed mesodermal tumor suggests an extremely poor prognosis. A time of servival was 4.5 months after operation. The diagnosis of fibrosarcoma of the corpus uteri was made by cytology preoperatively, but the findings of adenocarcinoma was not observed cytologically. The cytological findings of the fibrosarcoma was explained in details. Histologically, the carcinomatous element was composed of papillary adenocarcinoma and the sarcomatous element was composed of fibrosarcoma, leiomyosarcoma and heterologous element (chondrosarcoma, osteosarcoma). The ultrastructural study on the mixed mesodermal tumor of the corpus uteri is extremely rare, in our study there were observed four types of malignant cells, that is, adenocarcinoma, fibrosarcoma, leiomyosarcoma and osteosarcoma. The problem of the histogenesis of this tumor is one which still remains to be solved. The rese mbrance was seen on the each sarcomatous elements ultrastructurally, but no transitions from carcinoma cells to these types was noted. In view of these findings, it is suggested that the carcinomatous element are originated from Miillerian epithelium and the sarcomatous element appeared to be originated simultaneously from the mesenchyme formed from surrounding Mallerian duct.
Exfoliative cytological study about recent 9 cases of mixed mesodermal tumor of the uterine corpus were performed in our laboratry. It was emphasized that the proof of coexistence of epithelial and nonepithelial malignant cells, especially atypical striated muscle cells, is very important in cytological diagnosis of this tumor.
Studies were made on the variation in the rate of detection of patients with cervic cancer due to the difference in the method of the mass screening for cervic cancer in Fukushima Prefecture, Japan. The results of the studies were published in the present paper. The studies were made statistically on the differences in the results obtained from the screening which was chiefly focused on macrosco pical and histological examinations in 1969 and that focused on cytological, corposcopical and histolo gical examinations in 1971. 1) There was a significant difference in the detection of patients with cancer between 16 cases of cancer detected chiefly by histological examina tion in 1968 and 88 cases detected by cytological examination in 1971 with the detection of more cases of cancer in the latter group with P=0.1%. This fact evidently shows that the cytological examination is superior to the macroscopical examination or histological examination. 2) In the mass screening by the macroscopical and histological examinations, more cases of cancer were detected from among the cases with cervical erosion. When compared with the mass screening by the cytological examination, it is evident that the rate of detection of cancer from among the cases without cervical erosion is larger than the other screening method with P=5%. In other words, the cytological examination in the mass screening helps detecting cancerous patients from among those without the symptom of cervical erosion. 3) In detecting patients with cancer on the basis of the presence or absence of abnormal hemorrhage in the genital organs, more cancerous patients can be found by the cytological examination from among the cases without symptoms and with subjective symptoms. Among the cases detected in 1968 and 1971, a greater number of cases in the former showed the symptom of abnormal hemorrhage in the genital organs, whereas in the latter group asymptomatical cases were prevalent with P=2%. 4) A comparison between the cases of cancer at early stage and infiltrating cancer revealed a larger number of the cases of cancer at early stage in the group of the cytological examination with P=2%. 5) In the mass screening for cancer of the cervix conducted in 1971, 298 cases of 32, 213 who received the examination were revealed as over Class III by the cytological examination. Of these 298 cases, 77 cases were judged as Class IV, and 23 cases as Class V. From among these cases judged as over Class III by the cytological examination, 88 cases of cancer of the cervix were detected.
The cell collection methods for gastric cytology have been developed from the simple aspiration method of gastric juice, lavage with physiological saline, lavage with α-chymotrypsin solution, abrasive balloon, and gastroscopic cell biopsy to cytology with fibergastroscope under direct vision. Authors reported already in many papers the result of cytology for gastric malignancies by various technics described above, and emphasized the effectiveness of cytology for the diagnosis of early gastric carcinoma. Since last 1971, authors deviced the instrument for brushing cytology, constituted from thin vinyl tube and small nylon brush with wire. The thin vinyl tube putting small brush in it is inserted into the fibergastroscope. When examiner finds the lesion in the stomach, the vinyl tube is pushed out from the distal part of the scope at first, then the small brush is pushed out from the covering vinyl tube under direct vision. By the manipulation of the handle at the proximal part of the scope, the brush is abrassed the surface of the lesion. After these manipulations have finalized, the brush is pulled into the vinyl tube, and then the latter is pulled out from the scope. Smear preparations are made by touching this brush on slide glasses. This brushing cytology with fibergastroscope was performed for 112 cases of various gastric diseases including 31 of gastric cancer. The positive result by this technique was 90.3% cytologically. 5 cases of early gastric cancer were positive in all. This technique is significant with many merits as described below. 1) The procedure is very simple and the examination is carried out with biopsy technique at the same time. 2) The cell collection from the wider area and from the lesion of the difficult biopsy examination is possible. 3) The damage for the lesion is a little. 4) The technique of smear preparation is very easy and it is not necessary to make many smears. Usually 2 or 3 smears are enough to perform the cytological examination. 5) Cells taken by this technique are rather fresh and easy to make correct diagnosis. In conclusion, the brushing cytology with fibe rgastroscope is very useful for the diagnosis of early gastric cancer, especially small cancers.
The aim of the present study was to recognize the carcinoma cells of the prostate and to estimate the usefulness of the cytological examination. Specimens gained by the following three procedures were prepared by Papanicolaou and Giemsa stain ings. 1. Secretion of the external urethral orifice by prostatic massage. 2. Voided urine after prostatic massage. 3. Aspirate of the prostate by means of fine needle transrectal puncture. The results obtained were as follows; 1. Making comparison between direct tissue stamp of 14 non-malignant adenoma removed in surgery and each specimen above mentioned, prostatic elements were found to appear higher in voided urine and aspirate than in simple secretion. 2. Voided urine was concluded to be the best specimen for cytological diagnosis of the prostatic cancer. 3. Cytological diagnosis in 144 cases of benign prostatic hyperplasia falled in positive for malignancy 0%, suspicious 4% and negative 96%. 4. Cytological diagnosis in 25 cases of prostatic carcinoma resulted in positive for malignancy 92%, suspicious 4% and negative 4%. 5. Of 14 cases of prostatic carcinoma, comparison of cytological and histological diagnosis was done. Twelve cases (85.7%) were concordant, and 2 were diagnosed malignancy cytologically alone. 6. Three types of prostatic carcinoma cells were recognized.
Two cases of synchronous double carcinoma were experienced, which was detected primarily endometrial malignant cells by aspiration smear. Endometrial biopsy showed adenocarcinoma in uterine cavity. One case had adenocarcinoma at the right upper lateral wall of uterine cavity, which was measured 3.5×2.5cm in dimension as primary lesion. As secondary lesion, adenocarcinoma which was mea sured 2.7×2.2cm in dimension was recognizable at 7 or 8 o'clock position located 16cm from anal sphicter. Other case had adenocarcinoma at the left upper lateral wall of uterine cavity, which was measured 3.5×2.0cm in dimension as primary lesion. Squamous carcinoma of the cervix metastatic to r. ovary was noted as secondary lesion.