The multinucleated giant cells (MNGC) were revie wed from various viewpoint and were examined cyto diagnostic significance. 1. The definition of MNGC give normal cells-me gakaryocytes, osteoclasts, placental syncytial cells-, and above two nuclei and over twice as large as normal cells. 2. The formation of MNGC were classified into two groups of syncytium-the fusion of the cells-, and plasmodium-ivision of the nuclei without cyto plasmic division. 3. The etiologic classification of MNGC were as follows: In normal tissue, the physiologic MNGC revealed the above cells.The pathologic MNGC origi nated in various conditions-infectious granulation, metabolic and neoplastic lesions. 4. The histologic classification were as follows: The epithelial MNGC were included placental syncytial cells, virus infected cells and neoplastic cells. And the others nonepithelial origin were found of histiocytes (macrophages), mesothelial, blood component and other mesencymal cells of numerous conditionsforeign body giant cells, Langhans', Sternberg's giant cell, et al. 5. The relation between various lesions of MNGC, and diagnostic value of MNGC were differe from diseases. Specially, Langhans'cells, herpes infected cells, foreign body giant cells, and a few neoplastic cells were diagnostic value. Mostly neoplastic MNGC were nonspecific anaplastic atypical features. 6. It is difficult that the cytologic identification of MNGC were differ from various giant cells. There fore, it is necessary that differentiation of allid MNGC is with reference to histopathologic, clinical features and laboratory data colectively.
Little attention has been directed in Japan to “Torulopsis glabrata” and its infectious disease, Torulopsis glabrata vaginitis. Until now, a great many clinicians have been likely to misunderstand the illness as “Candida albicans vaginitis”, because of the similarity of the symptoms between them. However, each of the fungi belongs to another genus in mycology, and exact observation has proved that they have different biological characteristics and pathogenicity. A brief review, with special reference to vaginal smear findings of Torulopsis glabrata vaginitis by PAP-stain was pre sented and discussed by the author. For correct diagnosis of Torulopsis glabrata vaginitis, not only cytological technique, but also culture and identification of the clinical material would be necessary.
In order to find out what are the problems between cytologists and cytotechnologists in promoting the ideal cytological system in Japan, the author sent out a questionnaire to 45 cytologists and 60 cytotechnolo gists chosen at random from amongst those actively practising in Japan. Answers were received from 40 of the cytologists and from 52 of the cytotechnologists, and from their collective answers the following points were deduced. Improvements required are: 1. In order to elevate and define clearly the quali fications and position of cytologists in academic circles, they should become qualified as cytologists in two or more specialist areas. At present, if a doctor wants to be a cytologist recognised by the Japanese Society of Clinical Cytology, he can choose only one specialist field.If they were qualified in more than one field, this would help to dissolve the imbalance in the number of cytologists and cytotechnologists in Japan. 2. Many cytologists seem to think of cytotechnologists as mere ciphers, but in order to promote smooth development, and dissolve the problems of the present cytological system in Japan, cytologists must respect cytotechnologists as colleagues, and thus promote better working relations. 3. Many cytotechnologists seem to have a feeling of inferiority to and irritation with cytologists, and thus consider their requests to do extra reading and research to be in excess of their prescribed duties. But it would be better to regard such requests by cytologists as means of guidance towards doing their work better and gaining more selfrespect because of their increased knowledge. 4. Regarding the qualifications of cytotechnologists, the following are requested. At present their qualifications are not government recognised. Though many may be certified by the Japanese Society of Clinical Cytology these certificates command no more respect than those of tea ceremony or ikebana teachers. Further more courses run by the Cytotechnologists' School in Tokyo and Osaka are not government authorised, and licences from these places make no difference to salaries or positions. There is thus an urgent need of official recognition of such schools and their qualifications. 5. Most hospitals or institutions in which cytology is practised still have no proper understanding of the present system. Cytology must be performed as team work by cytologists and cytotechnologists under the proper direction of the Japanese Society of Clinical Cytology.the Society itself must make available ade quate information about the cytological system to the entire medical profession in Japan. If all these things are carried out faithfully, then we may hope for a considerable improvement in the present efficacy of the cytological system.
Sixty-four cases of dysplasia, high degree, of cervical epithelium were histologically classified into immature, premature and mature dysplasia according to their cytoplasmic maturation. Cytologic samples of the same cases were also classified into metaplastic, nonkeratinizing and keratinizing dysplastic cell type by the description of Dr. S. F. Patten. No keratinizing dysplastic cells were found in the immature dysplasia classified histologically. Metaplastic dysplastic cells were scarcely included in the mature dysplasia. The samples classed to the premature dysplasia had various cell types.
Accuracy of cytology and directed punch biopsy in 112 borderline lesions of the uterine cervix was evaluated by the final histologic diagnoses which were made mostly on many conized and a few hysterectomized cervices. 1. There were 9 cases diagnosed as benign cervicitis in the directed punch biopsy group. Eight of them were of the patients aged over 45. Cytology was positive in all the 9 cases and the cytological diagnoses dgreed with the final diagnoses in 6 cases out of the 9. 2.The accuracy of directed punch biopsy was 71% in dysplasia, 65% in carcinoma in situ (CIS), and 32% in microinvasive carcinoma. 3. The accuracy of cytology was 71% in dysplasia, 44% in CIS, and 36% in microinvasive carcinoma. Cytology and directed punch biopsy were similar in accuracy of diagnosis of dysplasia and microinvasive carcinoma to each other. 4. The extent of the epthelial lesion was not narrow even in cytologically underdiagnosed cases and there was a tendency that the more advanced the lesion, the wider was the extent of the lesion. 5. There were 5 cytologically false negative cases, all of which were not the cases examined for the first time in our clinic.Four of them had previous pelvic examinations and punch biopsies elsewhere not less than 3 weeks previously. 6.There were several Pap smear examples, of which diagnoses were quite different from those of histology in spite of repeated observations. It was reconfirmed that the time and method of sampling, fixation, and staining were important factors for preparing adequate smears for cytologic diagnosis.
A study was made of discrepancy between cytologic diagnosis and histologic diagnosis of 64 cases in collective examinations of patients with suspected uterine cancer in Fukushima Prefecture. A few find ings in this study are described hereunder: 1.The average age of the patients was 48.4. of these patients, 73.43% displayed no signs of vaginal or uterine erosion. 2.The average age of patients who are found at the time of surgery to have been affected by intraepithelial cancer was 46.8, while that of patients with early invasive cancer was 50.9, there being a difference of about four years between these two averages. 3. The accuracy of punch biopsy in the cases which had been cytologically diagnosed as Class IV or Vwas 73.91% in the calendar year 1972 and 70.16% in the calendar year 1973. 4. The accuracy in diagnosing cancer by means of cytologic checks was 95.31%. 5. The discrepancy between cytologic diagnosis and histologic diagnosis may be attributed to retro gression of the squamocolumnar junction, i. e., it should be located within the cervix, and also to the minor share of less than 1/4 by ring-shape propagation of foci in the cases of intraepithelial cancer, whereas they were mainly located within the S. C. J. 6.On the basis of the above findings, it is considered mandatory to perform cone biopsy and cone section diagnosis (Sturmdorf's operation) for purposes of deciding which surgical procedures may be required.
Active alterations in urinary excretion of estriol were studied by vaginal cytology and endocrinology on pregnant women given 50mg of DHEA-S intravenously. Twenty of the women examined were in the 3rd trimester of normal pregnancy, 5 in the second trimester, and 3 in the state of intrauterine fetal death. The vaginal smears were fixed by an ether alcohol solution, and stained with either Papanicolaou EA 36 or PAS. Estriol in the 24-hour urine was assayed by means of the commercial E3-Kit available from Teikoku Hormone Mfg. Co. Ltd. In women in normal pregnancy, regardless of whether they were in the 2nd or 3rd trimester, the urinary excretion of estriol increased after adminis tration of 50mg of DHEA-S, and vaginal smears showed a tendency to a typical pregnant pattern. On the other hand, in patients with intrauterine fetal death, the vaginal smears revealed a postmaturity pattern, which was characterized by the absence of placards, increased acidophilic karyopyknotic superficial cells and leucocytes, and decreased cytoplasmic glycogen.
In the diagnosis of Mailing Smears, we are often hampered by most inadequate information accompany ing the smears, by the many factors which induce degenerative cell changes in specimens, and by difficulties inherent in the patients themselves. Inadequate information concerning such things as estrogen deficiency and/or inflammatory changes is a real problem in smear diagnosis. Cell changes causing problems may be classed as degenerative, autolytic or atrophic. Papanicolaou first suggested the administration of estrogen to such patients in order to induce maturation of the normal squamous epithelium, and to reduce the above problems without affecting the cytomorpho-logy of possibly present malignant tumour cells. The authors' purpose in presenting this paper is to evaluate the Short-Term Estrogen Test in 33 women who exhibited degenerative, autolytic, atrophic and inflammatory cell changes in their mailing smears. The method of administration of the Estrogen Test is as follows: 1. Oral administration of 3 mg of Estriol daily through 5 days. 2.Intramuscular injection of 10 mg long acting Estrogenic substances. In order to evaluate the effectiveness of this test, the authors used 3 indexes, as follows: 1. Maturation index. 2. EI/KPI Pundel's Index. 3. Coincidence of Papanicolaou's classification with histology. If, after estrogen administration, the smear exhibited a good response to all 3 indexes, its response was classed as good. If there was good response to two, the classification was fair, and if to only one, or even to none at all, the classification was poor. The results of this study are as follows: - ESTROGEN TESTS REQUESTED-33 CASES. Good response 20 Fair response 5 Poor response 5 Follow-up failed 3 9 of the cases with good response had been classed as equivocal smears before this test, but afterwards were classed as having good response, and were clearly diagnosable as malignant smears. The authors therefore recommend this test as a help - ful and useful method of ruling out equivocal maliing smears to make a good diagnosis, and thus avoiding unnecessary biopsies.
Carcinoid is known to be an endocrine tumor producing the biologically active substances, and is of interest in its histogenesis. Occasionally, bronchial carcinoid shows the malignant potential by the spread resulting in generalized metastasis. Accurate diagnosis of carcinoid is necessary espe cially in relation to its treatment. The cytologic diagnosis of cacinoid is very difficult because of the lack in cytologic malignant characteristics. Therefore, we reviewed the smears from 7 cases of bronchial carcinoid in order to establish the cytologic criteria for bronchial carcinoid. Cytologic findings in the observed cases of bronchial carcinoid were as follows: the arrangement of tumor cells was irregular and had a pavement-like appearance;the cytoplasm was wide, and the N/C ratio was decreased; the cytoplasmic rim was poorly defined; the nuclei were small, oval or round, as compared with lung cancer cells; the nuclear borders were generally thin; anisokaryosis was infrequent;usually, the amount of chromatin was not increased;chromatin was finely granular, and its distribution was irregular; the nucleoli were usually small and round, and almost all of them were located in the center of the nucleus.
In this report an examination was made of the cytomorphologic features of scraping smears from nodular lesions of the thyroid. The series comprised fourty-two cases including seventeen cases of papillary adenocarcinoma, one of follicular adenocarcinoma, one of small cell anaplastic carcinoma, two of papillary adenoma, four of follicular adenoma and sixteen of hyperplastic nodule. The cells derived from papillary adenocarcinoma were arranged in epithelial sheets indicative of papillary structures, and the presence of intranuclear cytoplasmic inclusion bodies and many small intranuclear vacuoles was considered to be important diagnostic aids in recognizing this type of carcinoma. No intranuclear cytoplasmic inclusion bodies were seen in the cases of other types of carcinoma, adenoma and hyperplastic nodule except for one case of papillary adenoma. The cytologic differentiation between adenomas and hyperplastic nodules was impossible with smears.
Six cases of pseudomyxoma peritonei were reviewed cytologically and histologically. Abundant mucus and epithelial cells with invariable size and figure were commonly observed as the ascitic picture of the present disease.Intestinal epithelium-like fragments were also often intermingled, associated with signet ring cells. In addition, atypical cells, though small in number, were found in all 6 cases.The cells were characterized by enlargement in size, prominent nuc leoli and coarse chromatin. And in these cases, in which the cells were more atypical in morphology and larger in number, survival times were shorter.
For the review of the results of cytologic evaluation, eighteen cases histologically diagnosed as intraductal papillloma and duct papillomatosis were classified into three groups; cases of typical duct papillomatosis, borderline cases between malignancy and benigncy, and cases with cancer lesions. In typical duct papillomatosis cellular atypism was not so striking either in nipple discharge or aspiration smear. In borderline cases and cases with cancer lesions, some degree of cellular atypism was not infrequently observed; e. g.nuclear enlargement, abnormal nuclear shape and irregular piling of nuclei etc., so the majo rity of such cases were diagnosed cytologically as cancer cell positive, especially in touch smear speci mens of surgical materials.
The degeneration process of the cancer cell was studied by using Ehrlich ascites tumor, from both morphological and biochemical points of view. As morphological methods, phase contrast microscopy was used for a raw sample, Papanicolaou staining for nuclear structure and Fast Green staining for nuclear structure as well as for quantitative analysis of histone by microspectrophotometry; and as a biochemical method, SDSpolyacrylamide gel electrophoresis was used for histone fractionation. With the sample in a well preserved state (i.e. immediately after collection of the ascites), the nuclear structures of the cancer cells observed on the Papani colaoustaind smear were mostly the same as those on the Fast Greenstained one;however, the progression of cell degeneration, a further increase in densechromatin on the Papanicolaoustained smear, and a decrease in stainability with Fast Green were observed. It was postulated that the histone-bound phosphoric acid radicals of DNA were disclosed during cell degeneration as!free radicals which would bind to more hematoxylin in the Papanicolaou stain, whereas the drop in the isoelectric point of the nucleus during cell degeneration might reduce the staining effect of Fast Green. A microspectrophotometric study of Fast Green reactive histone revealed that the histone decreased mostly in parallel with the morphological changes. A follow-up study of histone fractions revealed that F1 fraction of histone disappeared in early cell degeneration. From the result described above, it may be concluded that degeneration of the nucleus is related to the disappearance of F1 fraction of histone.
A case of primary carcinoma of the fallopian tube detected in the early stage is reported. It could be diagnosed pre-operatively because adenocarcinoma cells had been found by means of aspiration smear from the uterine cavity. Hysterosalpingography showed a round, partially irregular shadow of retention on the ampulla of the right fallopian tube. At the present moment, we find no moe useful procedure than aspiration cytology from the uterine cavity and hysterosalpingography for detecting primary carcinoma of the fallopian tube in such an early stage when it is not yet palpable as a mass.
The clinical, pathological and cytological features of a patient with undifferentiated carcinosarcoma of the uterus are reported. The patient had a past history of squamous carcinoma of the uterine cervix 4 years previously, for which irradiation therapy had been carried out. Three kinds of atypical cells detected in the smear consisted of the following distinguishing features; 1) Atypical fibrous cells with hyperchromatic nucleiand marked anisocytosis. 2) Flat bizzare cells with broad cytoplasma, associated with anisonucleosis and mutual inclusion. 3) Fpithelial sheet of atypical small cells with prominent nucleolus and chromatin aggregation, occasionally with mucous vacuoles in the cytoplasm. These different cytological features were compared respectively with the corresponding elements of the histopathological specimens which had been proved to be a tumor that had arisen independenly in the endo metrium, being different from the previous squamous cancer of the cervix.And the former one cell group, shown above, was found to have been delivered from the sarcomatous element, and the latter two cell groups were found to be of carcinoma origin. In addition, it is briefly discussed whether the irradiation given4years previously may have played a role in carcinogenesis of the present carcinosarcoma of the uterus or not.
1. The case of a forty-nine year old woman, who complained of bloody discharge, was diagnosed as destructive mole by smear tests which exhibited aty pical cytotrophoblasts. Cytologic figures: cytoplasm showed extreme irregu larities in contour and staining reaction. Structural abnormalities of nuclei such as aberrant form, enlargement over 100μ in diameter, coarse granular chromatin pattern were seen. Syncytial endometritis was the pathologic diagnosis by operative specimen. 2.The literature on the cytologic findings of cho rionic diseases is reviewed, and the findings of syncyial endometritis discussed.
In 1949, French described a carcinoma of the ovary with malignant cells in the patient's vaginal smears. The infrequency of this finding is indicated by sparsity of subsequent similar articles. Cancer cells were detected in the vaginal smear from a 51 year old woman who had been radically operated on for right breast cancer 4 years previously. Her chief complaints were a lower abdominal tumor and abnormal genital bleeding. The malignant cells in the smear were suspected from morphology of the cells which had large, prominent and red nucleoli, and coarsely granulated neclei, and formed papillary arrangement. Patholo gical examination of postoperative specimens proved the presence of metastatic adenocarcinoma in the right ovary from the right breast cancer. Another metastasis was found in the peritoneal cavity. It is considered that the appearance of cancer cells in the vaginal smear was due to the passage of the cancer cells through the Fallopian tube from the peritoneal cavity.
Atypical cells were found in the duodenal juice as pirated by pancreozyminsecretin stimulation method from two cases of early gastric cancer. And cell morphology of the gastric cancer was found to differ from that of pancreaticobiliary cancers in some respects. It is emphasized that it is important to distinguish them from each other by identifying their morphologic differences in exfoliated cancer cells, so as to eliminate the risk of gastric cancer cells being misplaced in the duodenal juice.
The increased incidence of carcinoma in association with chronic ulcerative colitis has been well described. Cytology is playing an important part in the early detection and diagnosis of carcinoma. We have recently made a cytological study on a patient with ulcerative colitis.Scraping smears of the diseased mucosa of the resected colon showed atypical epithelial cells compatible with welldifferen tiated carcinoma cells. However, histological sections revealed no foci of carcinoma. The inflammatory and regenerating processes of active ulcerative colitis is considered a cause of these cellular changes that are often indistinguishable from cancer. Differences of the atypical cells seen in smears of ulcerative colitis from the carcinoma cells and the nature of these atypical cells are discussed.
Myelofibrosis with myeloid metaplasia is characte rized by anemia, abnormal proliferation of erythroids, myeloids and other hematopoietic precursors, varying degrees of the marrow, and myeloid metaplasia in the liver and spleen. Reported herein is the first case (probably) which was diagnosed as myeloid metaplasia of the pleura in a cytologic preparation from the pleural fluid of a 69 year old, female patient with myelofibrosis of over 20 year duration. Terminally she developed left hydro thorax, and cytologic examination led to a diagnosis of myeloid metaplasia. The postmortem examination also confirmed the clinical impression.
A case of primary lung leiomyosarcoma, which was treated surgically, is reported.Bronchoscopy revealed no endobronchial lesion, and malignant cells were nagative in the sputum. A biopsy material taken during surgery revealed nonepithelial malignant cells. These cells had oval to round nuclei displaying heavy, irregular chromatin patterns, and indentation of the nuclear border. A few spindleshaped giant cells were noted. Microscopic diagnosis of the resected material proved the tumor to have originated in the bronchial muscle of the left upper lobe bronchus. The main pathological and clinical features are discussed.