1. 172 cases of lymphadenopathies in surgical field are presented.Especially metastatic lymph nodes of these cases have been studied cytologically. 2. The smears were made from the imprint technique or aspiration biopsy. They wer stained by the methods of Giemsa, quick Giemsa, papanicolaou, Mann, and periodic-acidschiff reaction. 3. The criteria of malignancy in metastatic lymph node cytology are created. 4. In the imprint technique, the lymph nodes which have more than one-thirds pathological metastasis in these cut-surface tend to be positive cytologically, and the others which have less than one-thirds tend to be negative. 5. In the lymph node cytology during operation, the accuracy rate of the histologically possitive 7. The cytological study of metastatic lymph nodes could be one of the diagnostic methods in the speculation of the primary unknown carcinoma cases is 91.5%, and of the negative cases is 92.2%. 6. In the 35cases, the microscopical comparison are done between the primary and metastatic carcinoma cells. Cytological and cytochemical resemblances are recognized in the both carcinoma cells.
Cytological examinations for pancreatic fluid and bile by cannulation of vater's papilla using duodenofiberscope were performed for 35 cases of cancer and 36 of benign disease in the field of biliary tract and pancreas. The results of this study are as follows: 1. Author compared the results of cytological examination by the flowing, aspiration with la vage method technics. Volume of bile or pancrea tic fluid collected by these technics was not so much in cases of cancer of common bile duct and pancreas and so the investigation for cytol ogy was sometimes difficult. But the result of cytology by lavage method was more favorable compared with other technics. 2. Numbers of exfoliated cells by lavage method were much more than by the flowing or aspiration technique. Lavage method was more effective for the cytological diagnosis of cancer in these fields. 3. 26 cases out of 35 of cancer of pancreas, biliary tract and duodenum were positive cytolo gically by these 3 methods. Positive rate was 74.3%. Only one case (2.8%) was false positive in cytological examinations. 4. 7 cases out of 12 of cancer of the pancreas (58.3%), and 5 out of 9 (55.6%) of cancer of biliary tract were positive in cytology by these technics with combination. But by lavage method only 7 cases out of 10 of cancer of the pancreas (70.0%) and 5 of 8 of cancer of the common bile duct (62.5%) were positive. Also by combination of direct smear method of biopsy specimens from the duodenal mucosa in cases of cancer of panc reas and biliary tract in which cancer cells infil tration were reached in the mucosa of the duode num, 12 cases out of 16 in cancer of the pancreas (75.0%) and 8 of 13 in cancer of biliary tract (61.5%) were positive cytologically. 5. The cytological result was most favorable in cases in head of cancer of the pancreas.This result seems to be depend on the localisation of cancer and the grade of cancer cells infiltration of cancer and the grade of cancer cells infiltra tion to the main duct of the pancreas. 6. All cases of 6 cancer in the duodenum were positive in cytological examinations and all were performed the pancreaticoduodenectomy. However Pancreatico-duodenectomy was performed only 3 cases out of 16 in cancer of the pancreas (18.8%), and 2 of 13 in cancer of biliary tract (15.4%). 7. By combination of endoscopical pancreato graphy and cholangiography and cytology, 13 cases out of 16 in cancer of pancreas (81.3%) and 10 out of 13 of biliary tract (76.9%) were diag nosed correctly before surgery. Cytological exa mination is very effective to make correct diag nosis for cases of negative or suspicious findings by endoscopic pancreato-and cholangiography. 8. Author studied the characteristics of cancer cells from these fields collected by endoscopical technics described above. Cancer cells of pancreas show features of small (under 20μ in diameter), and round nuclei, coarsely aggregated nuclear chromation, little thickning of nuclear border, usually one nucleolus and naked cells are not so many. On the contrary, nuclei of cancer cells of the duodenum are large (over 20μ in diameter). Shape of nuclei are round to long oval. Aggregation of nuclear chromation is remarkable and N/C ratio is increased. Cancer cells of common bile duct showed features between both cancer cells.
Two cases of herpes vaginitis (42 and 36 yearold housewives) were diagnosed by cytologic examination. The cytologic, histopathologic and electron microscopic studies were made of patient materials, and infected HEL cells. Three cases of herpes zoster associated with malignant tumors (two cases of uterine cancer-59 and 51 year-old housewives, and a case of reticulum cell sarcoma-49 year-old female) were studied by same methods. The alteration was compared with infected cells of HSV-II and herpes Zoster. Result as follows: -1: The virus was isolated from vaginal materials in case 2, and was identified as HSV-II with the use of HF and UW-268 streins. 2: Variable changes were found in the squamous and columnal cells of cervical epithelium. The early visible structural alteration showed glassylike transluent mononuclear cells with swelling of the cytoplasm and the nucleus. Characteristic diagnostic feature is lobulated and multinucleated giant cells with intranuclear inclusion bodies. 3: The cultured HEL cells were examined by cytologic and electron microscopic observation at 48, 72 and 96 hrs. after viral infection. The alteration of infected cells revealed similar features for human materials. The immature viral particles (100mμ) with central cores or empty capsid in nucleus, and enveloped mature particles (200 mμ) in cytoplasmic vacuoles were found in the infected HEL cells. 4: The materials of herpes zoster were examined by useing vesicular fluid and epidermis. The infected squamous cells revealed enlarged lobular and a few multinuclear changes without glassylike swollen. Electron microscopically, viral particles appeared to have similar structures as HSV-II in infected HEL cells.
The cytology of genital herpes simplex in the female Auckland Experience S. Noda: The center for adult diseases, Osaka. M. Churchouse, D. Walker and W. A. Mclndoe: Post graduate school of obstetrics and gynecology, Auckland University, National Women's Hospital. In this study we carefully review the cytology findings from 65 patients in whom the diagnosis genital herpes simplex was made in the period January 1968 to April 1973. The typical inclusion body was present in only eleven of these specim ens. The most useful diagnostic finding in our material was the characteristic“ground glass” cell usually found in clusters-the so-called“he rpes giant cell”.
The cytologic findings of a leiomyosarcoma of the uterine cervix are reported. Generally, it would be impossible to distinguish the sarcoma cells from carcinoma cells of the undifferentiated cell type. This case was histologically diagnosed as carcinoma simplex, but we suspected sarcoma cytologically. After operation, pathological examinations of tumor tissue were carried out, and histological diagnosis was given as leiomyosarcoma. The cytologic findings of the tumor cell in vaginal scraping smear are as follows; 1) no differentiations. 2) tendency of scattering. 3) great variation in size and shape. 4) cytoplasma is not clear. 5) irregularity of nuclear pattern. 6) N/C ratio increased
Touch smears and corresponding histologic sections were examined from three dermatofibrosa rcoma protuberans, one malignant fibrous histioc ytoma, and two subcutaneous fibrosarcomas. There are some differences in cytologic morphology among these three types of malignant fibrous tumors. The former two sarcomas have two kinds of cellular group, i.e. fibroblastic and histiocytic type, in cytologic morphology. In the fibrous histiocytoma, however, histiocytic cell groups are predominant in frequency and foamy cells, giant mutinucleated cells and abundant mitotic figures are characteristic in morphology. On the cotrary, the cytologic feature of the last sarcoma, subcutaneous fibrosarcoma, consists solely of the pleomorphic fibroblastic cells.
From January, 1966, to July, 1973, the transbronchial brushing method was performed on 541 cases with primary lung cancer in order to get exact diagnosis in our hospital. The diagnostic significance of the transbronchial brushing in the primary lung cancer was discussed, being based on the results of the bronchoscopic examination, the transbronchial biopsy under the bronchoscopic control, the transbronchial brushing and also the predictive histological type from the obtained specimens. (1) The rate of direct vision of the primary lung cancer by using a bronchofiberscope amounted to 50-56 per cent, while the bronchoscopy by using a rigid scope revealed 31-36 per cent of the rate of direct vision. (2) The percentage of definite diagnosis by transbronchial biopsy under the bronchoscopic control was 76.9 per cent in the cases of primary lung cancer with direct vision, however, the ratio to all cases in this series was 41.0 percent. (3) The transbronchial brushing cytology has come to be positive in 84.7 per cent of all cases under the bronchofiberscopic control, and was positive in 72.8 per cent of all cases by using a rigid scope. The positive ratio was unchanged in the cases of primary lung cancer invisible under the bronchofiberscopic observation. (4) The simultaneous use of the transbronchial brushing method under the bronchofiberscopic control and the brushing method by using a brush with a maneuvable tip through a Metras catheter contributed to the great incresse in positive results of cytology in type I (the positive rate of 100 percent), type II (96.2 percent), type III (93.6 percent) and the average was 97.5 per cent. This positive ratio amounted to 94.3 per cent in the resected cases of primary lung cancer. (5) The predictive histological type of primary lung cancer from the obtained specimens was coincident to the histological diagnosis in 86.3 per cent of all cases, and there was no cytological problem in the cornified squamous carcinoma, the differetiated adenocarcinoma and also the undifferentiated small cell carcinoma from the diagnostic standpoint. On the other hand, there were some difficult cases to differentiate the non-cornified squamous carinoma, undifferentiated large cell carcinoma, and undifferentiated adenocarcinoma respectively, and in these cases there were difficulties to do even on the histological basis. These difficulties must be attributed to the fact that the histologic classification compatible to these cytological features is not established.
Cytologic smears for uterine cancer screening tests in Fukushima Prefecture in 1972 were obtained by scraping with a cotton swab and in 1973 with a (Tohoku University-type) spatula. The results of the cytologic examinations were subjected to statistical analysis in order to determine whether there was any significant difference between the two methods in regard to the detection of atypical epithelial cells and uterine cancer. The results were as follow: 1) No significant difference (5% level of signi ficance) between the two methods was found in the rate of detection of uterine cancer. 2) The rate of detection of cervical dysplasia was significantly higher with the spatula method than the cotton swab method (x2c=25.4128<p=0.001, 0.1% level of significance). 3) The rate of detection of preinvasive cancer (carcinoma in situ) also was higher with the spatula method (2% level of significance). 4) There was a proportionately higher number of smears obtained by the spatula method falling in the Class II and Class III categories. A comparison between the two years of the relative rates of negative smears (Class I or II) and those indicating highly suspicious atypical or malignant cells (Classes III, IV or V) revealed a significant difference (x2c=168.41945>p=0.001, 0.1% level of singnificance) which would indicate greater reliability of the spatula method in the detection of malignancy. 5) A significantly higher rate of malignancies was found in smears showing Class III cytologic findings among those obtained with the cotton swab method than those obtained by the spatula method (x2c36.9744>p=0.001, 0.1% level of significance). This would indicate the need for great care in searching for malignant changes when the cotton swab method is utilized. 6) Judging from the results obtained when the two methods were utilized for the same patient on separate occasions within a one-month period, the spatula method was better suited for the detection of atypical cells and the possible presence of preinvasive lesions, providing a more accurate assessment of the histological changes. 7) It is considered, on the basis of these observations, that the spatula method of obtaining specimens for cytologic examination is superior to the cotton swab abrasion method for screening tests.
An increasing attention has recently been paid to large lymphocytes which appear in cervical smears in case of certain types of chronic cervicitis, because of its benign condition that is reque sted to distinguish from some rare lesions such as leukemic infiltration and malignant lymphoma of the uterine cervix. A systemic, cytological study of 4, 253 cases was performed, and the following results were obtained: 1. A great number of large lymphocytes were found in the smears in 34 cases (0.8%). 2. A histopathological examination of the uterine cervix is performed in 18 out of 34 cases. All showed the feature consistent with that of chroniclymphocytic cervicitis. Lymphoid follicles were found in 2 cases. 3. Characteristic cytological features, helpful for the diagnosis of chronic lymphocytic cervicitis, were as follows: (1) The cells, large lymphocytes, have scant cytoplasm and oval nuclei with thin nuclear rims, a fine chromatin network and often one or two nucleoli. (2) Large and small lymphocytes were inter mingled with each other, forming large or small clusters or in a diffuse fashion in the smears. (3) Large lymphocytes, small lymphocytes and polymorphonuclears constituted almost over 90% in the cytogram. Percentage of small lymphocytes predominated that of large lymphocytes which is always less than 40%. (4) Large reticulum cells phagocytosing various granules were often encountered. (5) Appearance of large lymphocytes in the cervical smears was not constant, even when the smears were taken from the same patient at the same time. In addition, the cells were often decreased in number or disappeared in the smears taken from the same case on the lollowing days. 4. Age of patients of chronic lymphocytic cervicitis ranged from 31 to 78. Many were in post-menopausal period.
Ehrlich ascites cells were observed by means of scanning electron microscopy. For drying the materials the critical point drying method was used by which the surface of the cells is believed to keep their native structure. The cells observed manifest the following three types accoding to their surface structures. I) The cell having typical microvilli. II) The cell having special microvilli whose tip bulges are round and oval. III) The cell having larger cytoplasmic processes like pseudopodiums. The surface of the cell during mitotic division generally has typical microvilli (Type I), however the functional significance of these three types of surface structure is still unknown and left for future investigations.
To stain the nuclei in the cytologic specimen and the histologic section, two synthesized basic dyes, Gallein-alminium and Pyrocatechol violet alminium, were found to be substituted for Hematoxylin. Since these dyes have also o-hydroxy quinoid ring in molecular structure and are lacked with alminium, their staining mechanisms might presumablly simulate the one of Hemato xylin.