Touch smears and lavage specimens and corresponding histologic sections were examined fromeleven patients with myogenic sarcomas (leiomyosarcoma 7, rhabdomyosarcoma 4). And the morpho logical Characteristics of the tumor cells were erucidated. In the specimens of the leiomyosarcomas, therewere many cells to be fibrous and unstriated, irrespective of the differentiation of the tumor. However, giant cells, irregular or round cells and multinucleation were frequently observed in the tumorsof the undifferentiated type. Multinuclei arrangedalong the longer axis of cell were most commonlyobserved in all the leiomyosarcmas examined. On the contrary, the cellular morphology of cell were most commonly observed in all the leiomyosarcmas examined. On the contrary, the cellular morphology of therhabdomyosarcoma varied considerablly each otheraccording the histopathological types of the tumor.Among them the tumor of the pleomorphic type showed a plenty of cellular variety which was chieflymanifested by large fibrous cells presenting thetransverse cross-striation and longitudinal fibrils inthe cytoplasm and the myoblast with round shapeand abundant granules of the eosinophilic nature inthe cytoplasm. The other types of the tumor presented small spider-formed cells among which asmall number of large fibrous cells with transversecross-striation was found.
Touch smears, exsudate specimens and corresponding histologic sections were examined from sevenpatients with liposarcoma. Though their cellularmorphogies varied each other according the histopathologic types, myxoid cells, lipoblasts, sometimsmature lipocyte were often present in the specimens while multinucleation was observed only in theundifferentiated type. In the cytoplasm, fatty bodieswith various figures were always verified by Sudan111 after fixing by 10% formalin. Indentificationof these cell morphology seems to be valid for distinguishing liposarcma from other malignant tumors, particularly of non-epithhlial origin.
Morphological differences by Papanicolaou stainobtained by direct method (scraping and touchpreparation) and exfoliated cancer cells in sputumfrom same patients were examined on 16 cases oflung carcinoma. Degeneration experiments were also done on three surgical specimens of lung carcinoma. 1) Criteria of lung carcinoma cells by The JapanLung Cancer Society can be used as criteria ofcarcinoma cells in sputum. However, it would notbe proper as criteria of fresh lung carcinoma cells. 2) As new criteria for fresh lung carcinomacells, following points should be added to the conventional one; (a) Squamous carcinoma cells: The boundary ofcytoplasm is coalescent. The cytoplasm is pale andmonotonous. The nuclei are mostly round, the nuclear borders are thin and regular or thin and irregular. The chromatin pattern is finely reticular orfinely granular. (b) Adenocarcinoma cells: The nuclear bordersare thin and regular. The chromatin pattern isfinely reticular or finely granular. (c) Small cell carcinoma cells: The tumor cellsare consisted of light stained large cells and darkstained small cells. The chromatin pattern is finelyreticular or finely granular. 3) The fresh malignant cells which have coalescent boundary of cytoplasm, thin regular nuclearborders and finely reticular or finely nodular chromatin pattern decreased in accordance with time.They changed into degenerated cells, their arrangement becoming loosened, whicn have irregularnuclear borders and coarsely reticular, coarselygranular or opaque chromatin pattern.
The usefulness of Pancreozymin-Secretin test (P-S test) for diagnosis of pancreatic pathologiesis doubled by the combination of cytologic examination to its biochemical analysis. The results of806 times of cytologic examination of the duodenalcontent which was obtained by P-S test wereinvestigated and several experimental studies wereperformed to clarify some technical and cytodiagnostic, questions. Each fraction of duodenal content was collected in a chilled test-tube and centrifuged immediately after the test was completed.Th specimens' were stained by Papanicolaou's andGiemsa's technique but the former was used forquantitative analysis. Followings are the conclusions. 1) How to make the specimen of well preservedcells is the most important matter for P-S testcytology. The more excellent specimens wereobtained with the more deterioration of exocrinefunction of the pancreas, and this is favourablefor cytodiagnosis because the function is oftenlow in the cases with pancreatic cancer. Howeverno direct relation was observed between ictericindex or the activity of amylase and the preservation of cells. 2) No significant findings were discovered inthe cellular features of P-S test cytology for thediagnosis of various non-malignant pancreaticdiseases. 3) The differentiation of cells exfoliated fromthe pancreatic duct, biliary system, duodenum andstomach on the P-S test cytology is impossiblefrom their cellular appearances and this wasendorsed by investigation of touch smear specimens made from autopsy materials. 4) The cells, with fragmented nuclei are usuallyobserved on the cytologic specimens of duodenalcontent, and there are different opinions about itsorigin. On our specimens they were stronglysuggested to be the degenerated duodenal or pancreatic ductal cells because columnal cells indifferent stage of degeneration were often observed on the specimens. I have succeeded to makethe cells with fragmented nuclei experimentallyfrom normal duodenal cells. 5) The cellular features of pancreatic cancercells of P-S test cytology were compared withthose of stomach cancer cells of lavage cytology: i) Pancreatic cancer cells were frequently observed in cluster (s) but its number was scanty.ii) The size of cells and nucleus were somewhatsmaller than that of stomach cancer cells andelliptical. iii) Nucleolus was observed in a halfof pancreatic cancer cells and was irregular in itsshape in 1/5 of them. iv) Nuclear hyperchromasiawas not so dominant in half of cells. v) On thecontrary there were no significant differences inN/C ratio, nucleolus/nucleus ratio, number ofnucleus, appearance of nuclear rim and characteristicof nuclear chromatin between pancreatic andstomach cancer cells. 6) P-S test cytology was positive in 18 among43 proven cases of pancreatic cancer and itsaccuracy was calculated as 41.9%. This positive rate was same to those whichwere reported on pancreatic cytology performedby only secretin administration. In 8 cases among18 positive cancer cases (38%) exocrine functionof the pancreas was within normal range and P-Stest cytology played an important role for theirdetection. False positive report was happened in7 cases (0.94%) and 3 of them were chronic pancreatitis.Mean survival period after the positivecytologic diagnosis had been settled was only 3.4months. In conclusion P-S test cytology is indispensablefor the diagnosis of pancreatic cancer but it isunsatisfactory for its early detection. More andmore endeavour is expected for the developmentof pancreatic cytology.
Every purpose of the former reports in concerning with the cytometrical procedure of malignantcells were to reveal the general tendency of themalignant and to show the characteristics of individual malignant cells. The auther tried to makequantitative criteria managing cells as a represented sample of each case statistically. For thepurpose of possible random sampling, several conditions were determined to reject biassed preference of samplers. 1: 20 cells without degeneration from the mostatypical cell clusters of each case in Papanicolaou's stain. 2: Exception of isolated or vacuolated cells. 3: Measurement of the maximum and minimumdiameters of each cell, nucleus an nucleolus. 15 cases of tubular IIc type early gastric cancerand 4 cases of highly atypical benign regenerativeepitherium of ulcer margin were selected for thematerial. 9 items were examined and three ofthem, nuclear cell (N/C) ratio based on diametersand on areas, and nucleolar cell (N0/C) ratio werefound to show the best separation between themalignant and the benign. Next three criteriawere settled for the statistical diagnosis of unknowncases using the one-side t-table examination. 1. A mean of N/C ratios of 20 cells in max.diameter which is proved to be more than0.57 by the t-examination is conclusive tobe malignant. 2. A mean of N/C ratios in area which isproved to be more than 0.41 by the t-examinationis conclusive to be malignant. 3. A mean of No/C ratios in area which is provedto be more than 0.036 by the t-examinationis conclusive to be malignant. (Statistical probability of error is under 2.5%.) 13 of the 15 malignant cases had significant differences in regard to at least one of these threecriteria. Finally the auther propose a new index for thebetter separation. This index is calculated fromthe next formula which is a composition of N/Cratio and N0/C ratio to indicate a complex distance as a figure. _??_C=the area of a cell N=the area of a nucleus N0=the area of nucleoli K=a constant All means of D.I. of 15 malignant cases wereproved to be more than 0.54 which was settledto be the upper limit of the benign through thet-examination with significancy, when 100 waschosen as the constant K. Equally, the probabilityof error was under 2.5%. It may be more reasonable to take 130 as the K that is the square ofthe quotient of 0.41, the limit of benign N/Cratios, devided by 0.036, the limit of benign N0/C ratios.
The present paper was studied for establishment of the criteria of screening in cytodiagnosis ofgastric cancer. Smear preparations were obtainedfrom biopsied stomach of 169 cases with gastriccancer and of 184 cases of benign lesions. The results obtained were as follows; 1). Following 4 findings were observed; cellswith nuclear diameter of more than 20 micron, cells with nucleolar diameter of more than 5micron, cell cluster with marked anisokaryosis (the largest nuclear diameter show over 2 timesas the smallest one), and cells with nucleoli ofmore than 5 in number. 2). There were statistically significant cytologicalfindings between the malignant and the benigncases. a. Smear preparations which have the cells ofover 20 micron nuclear diameter were foundin 76.33% of cancer cases and in 13.59% ofbenign cases. b. Smear preparations which have the cells ofover 5 micron nucleolar diameter were foundin 79.29% of cancer cases and in 29.89% ofbenign cases. c. Smear preparations which have the cell cluster (the largest nuclear diameter 2: thesmallest one I) were found in 94.67% ofcancer cases and in 54.89% of benign cases. d. Smear preparations which have the cells ofnumerous (over 5) nucleoli were found in79.88% of cancer cases and in 47.28% ofbenign cases. The most significant findings between malignant and benign materials is the nuclear diameter (over 20 micron). 3). Materials which have 3 or 4 findings, abovementioned, were recognized in 82.25 % of cancercases and in 17.39% of benign cases. 4). The nuclear diameter of more than 20 mic- ron or materials with the findings of more than3 were very important criteria for the screeningof gastric cancer clls.
From April 1971 to March 1973, selective proteolytic lavage cytology under fluoroscopy wasperformed in 106 patients and biopsy in 134 patients with gastric lesions. Positive cytodiagnosis were obtained in 20 (80%) of 25 proven gastric cancers at advancedstages, and in 12 (85.7%) of 14 proven mucosaland submucosal gastric cancers (early cancers ofthe stomach). Positive biopsy results were obtained in 15 (93.7%) of 16 gastric cancers. in 12 patients with mucsal and submucosal gastric cancers in which both procedures were performed, at least one was positive, and in 10 bothwere positive. It was emphasized that a reasonable evaluationon gastric cytodiagnosis should be obtained notonly by the diagnostic accuracy, but also by theclinical back ground for the diagnostic procedure.Several cases to show the clinical backgroundmentioned above were demonstrated.
Gravely icteric neonates including those having Rh incompatibility, were submitted to an observ- ation of vaginal smears and estimation of hormones in the urine for consecutive postnatal days.This was done in order to compare the resultswith those previously reported in respect to nor- mal mature infants, and at the same time to ex- plore liver functions in neonates suffering fromicterus gravis as well as the involvement of adrenal glands in diseases of the liver. 1. Vaginal smears were found to be geneoallyhypochromatic. Estrogen effect observed on the1st and 2 nd postnatal days was not significant, but disappeared somewhat later. An and rogeneffect manifesten itself around the 8 th day andwas slightly observable during the 12 th to 15 thdays. This effect was a little more marked thanin normal infants. 2. Regarding hormones in the urine, estriol generally indicated low levels and disappearedslowly. A high 17-OHCS level was reached whentotal bilirubin began to fall from a peak. A high 17-KS level was seen later, i. e., when total bili- rubin returned to normal value. 3. These variations in vaginal smears approx- emately corresponded with those in urinary hormone levels. 4. The protracted excretion of estriol may bedue to the reduction associated with severe jaundice in the liver's metabolic capacity to createestrogen. The finding that high 17-OHCS and 17KS levels were obtained in concent with or alittle later than the peak of total bilirubin maybe explained by the defensive function of theadrenocortex being mobilized in the event of ict- erus gravis, with the resultant transitory increasein hormonal secretion. 5. The finding that 17-OHCS levels varied incloser correspondence with total bilirubin than 17-KS levels may be reasonably understood inview of 17-OHCS being derived from adrenocortical glucocorticoid and hence is considered to bea more sensitive indicator of adrenocortical fun- ctioning than 17-KS. 6. In cares of no serious jaundice with Rhincompatibility, vaginal smears approximatelycorresponded with those in normal mature infa- nts. This suggests that hormonal secretion ormetabolism may be affected not by Rh incompa- tibility per se but by icterus gravis.
It is a deniable fact that cytoplasma showsvarious picture by varying fixatives. For the purpose of observing this effect, scan- ning electron microscie was used. Materials are superficial and intermedate squamous cells of female genital tract, taken directlyfrom the cervix with an Ayres spatula. These specimens were prepared with 3 typesdifferent fixatives each consist of following ingr- edient. 1) 1% glutaraldehyde. (standard) 2) 20% ethylalcohol. 3) 50% ethylalcohol. Then dehydrated in aceton series, and coatedwith 200A thick layer of carbon and gold, exa- mined in a JSM-SI scanning electron micrscope. The surface of cells appeared rough and cove- red by prominent network such as microridgesor micro villi like structures, but there is noevidence among different techniques of specimenpreparation. One week later appeared small and irregularchanges on the surface of cytoplasmic rim. This findings may be degeneration, and remarkable in specimen prepared with 20% alcohol. Two weeks later, cytoplasmic changes progressed vastly whole surface showed degenerative findin- gs, but in specimen prepared with 50% alcohol, nuclear shape were barely distinguished.
The results of the follow up study of So-Calledsuspicious posititve smear patients who weredetected from 10955 cases by mass-screening forthe uterine cancer during the past two years andeight months are discussed to make the management-methods of those cases. 1) The cases of class III were 165. 2) The cases of class Ina were 142, and Smear positive cases were not detected by thefollow up in this group. 3) The cases of class IIIb were 23. 56, 5 percent of them came to the normal Smear duringone week or five months. 4) The cases of class IV and negative punchbiopsy were 12. 41, 7 per cent of them came tothe normal smear during one week or five months. 5) Both 21, 7 per cent of the cases of classIIIb and 25.0 per Cent of the cases of class IVwere found of progression to carcinoma by punchbiopsy. 6) When the suspicious positive Smear andnegative punch biopsy cases are detected boththe first and following second screening, the cytological examination after untreat-period overthree months, for the women who are under 50year of age, is the useful method for more accurate diagnosis. As the above method is not effectiveness for the women who are over 50 yearof age, it is desired to take another methode, forexample, cone biopsy.