Esophageal cytology was performed in 625 cases at the Medical Department of Professor S.Yamagata, Tohoku University School of Medicine. The results were as follows: 1. Positive cytologic results were obtained in 200 (99.5%) of 201 esophageal cancer cases, and false positive results were found in 5 (1.2%) of 424 non-malignant cases. 2.The various method of cell collection, the location and size of the cancer lesion, and the depth grade of cancer cell infiltration were found not to be the important factors to influence the cytological results. Positive cytology results were obtained in 5 cases of 2 mucosal and 3 submucosal cancer of the esophagus. 3.In 1972 a new-type apparatus of cell collection became available in our department. This method was found to be simple, economical, requires less than 3 minutes, to be well tolerated by the patient, and therefore to be favourable as the first choice of the screening test in the mass survey for the early detection of the esophageal cancer. 4.In this series of esophageal cytology, almost all cases with esophageal cancer were correctly diagnosed to have epidermoid cancer being distinguished from adenocarcinoma.
In the past 12 years fine needle aspiration biopsies were performed in 49 patients, who were suspected to have liver tumors in the National Cancer Center Hospital., The smeared aspirates were stained with Papanicolaou and MayGiemsa techniques.In this series, there were seven cases of liver cell carci noma, two of bile duct carcinoma, two of liver cyst, one of liver hemangioma and 37 of metastatic cancer. Cases, whose slides contained neither liver cells nor tumor cells, were referred to “unsatisfactory” cases and excluded in this study.Three cases of liver cell carcinoma were cytologically diagnosed as such, one was suspected of adenocarcinoma, one was negative, two were “unsatisfactory”;one case of bile duct carcinoma was diagnosed as adenocarcinoma, one was negative and three of benign liver tumors were all negative.As to the metastatic cancers, 28 cases were positive, eight were negative and one was “unsatisfactory”. Sum marizing the above, cancer diagnosis was made on 33 of 45 cases (79%).There were 12 false negative but none of false positive cases.Cytological features of liver cell carcinoma was a presence of large cells with an enlarged nucleus and well developed cytoplasm, an enlarged, distinct nucleolus and intracytoplasmic bile pigment. However, exactly speaking, even these features except for bile pig ment, were not pathognomonic for liver cell car cinoma, since there was a case of transitional cell carcinoma of the ureter, whose cancer cells resem bled those of liver cell carcinoma.The amino acid naphthylamidase reaction in liver aspirates, which demonstrated bile canaliculi, seemed valuable in the diagnosis of liver cell carcinoma.Poorly diffe rentiated liver cell carcinoma and bile duct carci noma had no cytological features, therefore specific diagnosis could not be made on cytological criteria alone.The aspiration biopsy of the liver was suffi - ciently free of hazards;there was neither mortality nor serious complication in our series.Since primary liver cancer in the early stage could not be detected with aspiration biopsy and most of liver tumors are metastatic, the aspiration biopsy of the liver should not be evaluated on the same level with that of breast, lung and so forth.The aspiration biopsy of the liver is simple, safe, reliable and a useful tool in the diagnosis of liver tumors.
As a basis for automatic cytodiagnosis nuclear mass of the cells from vaginal smears was measured by microspectrophotometer.The smear samples were stained with Feulgen reaction and Papanico laou staining, and 300 nuclei in each slide were measured. 1. Histogram of nuclear mass made from Papa nicolaou staining showed almost same pattern with that from Feulgen staining. 2. Histogram made from normal cervix and benign cervicitis showed a apparent mode at 2N range, when 2N was settled from the value of nuclei of intermediate cells of squamous epithelium. 3. In cases of cervicitis or colpitis there were several cells with nuclei over diploid, but very few nuclei exceed 5N.In contrast to this fact nuclei over 5N were constantly observed in dysplasia, carcinoma in situ and invasive carcinoma. So, if cut off line was set at 5N of the nuclear mass, all cases of malignant or borderline lesion were picked up. But there were considerable numbers of false posi tive cases. 4. When nuclear and cytoplasmic ratio was combined as another parameter, the false positive was markedly decreased, but there appeared few false negative cases. From these result it was considered that the measurement of nuclear content could not differen tiate the cases benign or malignant, but be able to classify to normal or abnormal with cut off line of 5N.
1) A case of double cancer (endometrioid carcinoma of ovary and endometrial adenocarcinoma of uterus) occurred in a 61 year-old nullipara is presented. 2) On cytological specimen of a sucked fluid ob tained from the ovarian tumor, malignant cells derived from columnar epithelium and benign squamous cells were found, so that this ovarian tumor was diagnosed as adenoacanthoma which as later supported by histopathological find ings. 3) On imprinted specimen of the endometrial outgrowth, measured less than 2cm. in diam eter, only adenocarcinomatous cells were found as on the histological specimen. 4) From macroscopic and microscopic findings, this case was considered as of double cancer. Endo metrioid carcinoma of ovary and endometrial adenocarcinoma of uterus are a specific double cancer which has a close relationship to each other, because these neoplasms have common histogenesis of “coelomic epithelium”.
Recently cytological studies on trophoblastic disease have been published and we have come to recognize the clinical value of cytology. In a trophoblastic tumor buried in the uterine muscle layer, we cannot detect a lesion by cytologic specimens of the uterine cavity, but in some cases, where the cavity has been invaded, finding tropho blastic cells in the specimens is of great diagnostic significance. Furthermore it is said that the presence of trophoblastic cells and their varying degrees of atypicality make the differential diagnosis of hydatidiform mole, destructive mole and chorion epithelioma possible. Such easy, safe and rapid cytological techniques as brushing smear, cotton-swab smear and jet washing method seem to be used more often in the follow up of hydatidiform mole patients but, at the same time, we have to remember that these techniques are limited.
A 64 year old man was admitted to Keio Univ. Hospital with the chief complaint of dyspnea on excertion.Diagnosis of pulmonary tuberculosis was made on X-ray findings.Cytological examination of sputum revealed the presence of atypical cells, which at first was diagnosed to be of small cell undifferentiated carcinoma.Cytological diagnosis was later revised as possible reticulum cell sarcoma. Autopsy, 5months later, cofirmed the massive involvement of the pulmonary parenchyma by generalized reticulum cell sarcoma. Cytological details of the tumor cells in sputum were presented with special reference to the diffe rential diagnosis between reticulum cell sarcoma and undifferentiated carcinoma.Absence of adhes iveness, presence of wider foamy cytoplasm and small prominent nucleolus were thought to be the important differential points.
A 75 year old male was admitted with a com plaint of hemoptysis, histological examination on the specimens biopsized showed unknown in nature, however cytological findings suggested sarcoma. After right middle and lower lobectomy, histolo gical examination on the surgical specimen indica ting fibrosarcoma revealed that cytological findings were trustworthy for the diagnosis of sarcoma. Report on the cytological findings in this case was made.
Papanicolaou-stained smears of the duodenal con tent which was obtained by P-S test demonstrated numerous rhabditiform larvae in a case of Strongy loidiasis. A 50 year-old man suffered from abdominal dist ention and vomiting over ten years duration. The patient now lived in Nagasaki city, however he had a history of living in Burma for two years. This case stresses the examination of the routine cytologic smears may demonstrate larvae of strong yloides in the endemic area.