Metastatic foci of the lung are usually located in the peripheral area and the route of their metastases is mostly hematogenous.Therefore, the bronchial brushing method and sputum cytology are less diagnostic than transthoracic needle biopsy. Thirty-one metastatic lung tumors were diagnosed by the transthoracic needle biopsy, and 27 of the 31 were positive.Sixteen of 19 epithelial tumors and 11 of 12 nonepithelial tumors were positive. Four tumors were less than 3 cm in diameter;two of them, less than 1cm in diameter, and transthoracic needle biopsy was positive in these tumors. The bronchial brushing method and sputum cytology may be valuable in diagnosis when the metastatic tumor invades the bronchial wall.
Cancer cells were negative in the specimens taken from 4 cases by the transbronchial peripheral brushing method through bronchoscope. These lesions had originated in the unsuitable sites for taking the specimens for diagnosis. It was suggested that the transbronchial aspiration cytology with a needle improved by us is suitable for the establishment of diagnosis of such lesions.
The incidence of lung cancer in females is lower than that in males, while histological typing indicates that adenocarcinoma is more common in females, as opposed to squamous cell carcinoma in males.Smoking, pollution and environmental factors and other factors may be considered the causes of the malignancy, and among them, complicated hormonal considerations may be needed for females more than for males. In order to make basic observations concerning the relationship between hormonal patterns resulting from the menstrual cycle and tumors from this point of view, the author made cytological studies of changes in the bronchial mucosal epithelium during the menstrual cycle. Papanicolaou and PAS stains of smear specimens obtained by selective bronchofiberscopic brushing of sites immediately inferior to the bifurcation of the right B8 were examined. The subjects studied included 43 women, aged 20-35, with normal menstrual cycles;7 postmenopause women and 10 men. No changes relating to the menstrual cycle in the width or nuclear size of ciliated columnar cells were observed. The examination of the position of the nuclei in these cells disclosed that cells with nuclei on the ciliar side increased immediately before and after ovulation. From ovulation to the secretory phase, the appearance of nuclei with fine granules was frequent, while in the other phases they were coarsely granulated. The appearance of ciliated columnar epithelial cells with dense or degenerated nuclei was less frequent in the proliferative phase than in the other phase. The above findings were distinctive, compared with the findings in the males or the postmenopause females. No difference in the rate of appearance of cells in relation to the menstrual cycle was detected. Columnar epithelial cells containing lipofuscin-like granulae were very few in the premenopause women, but common in the postmenopause females or the males. Mucopolysaccharides of ciliated columnar epithelial cells were observed by PAS stains, but no significant changes were detected during the menstrual cycle. From the above findings, it may be proposed that procarcinogenic, abnormal cytologic metabolism, which may be considered to result from the repetition of such changes, is possible, since various changes in the bronchial ciliated columnar epithelial cells can be observed hroughout the menstrual cycle.
In this paper is presented the method of sputum cytology which was developed by Saccomanno.This method has been used in the Mayo Lung Project in U.S.A. Comparison between the cellular features of direct smears obtained by the transbronchial brushing or the needle aspiration technique, and of smears that had remained in Saccomanno's solution for 1, 2 and 4weeks showed that epidermoid carcinoma cells did not exhibit much evidence of degeneration, but that adenocarcinoma cells and small cell anaplastic cell carcinoma cells did exhibit some appreciable degree of cellular damage. Cytologic examination, however, was capable of identifying whether they were cancer cells or not. In the authors'laboratory, sputum cytology was performed in 39 cases of lung cancer by Saccomanno's concentration method, and comparison between this method and direct smear was studied.The cytolo gically positive rate was elevated by 18.0%, compared with the direct smear in the same specimens. Morphologic characteristics of cancer cells by Saccomanno's concentration method were observed.Epidermoid carcinoma cells were similar to those found by the direct smear.Adenocarcinoma cells were somewhat different from direct smear cells, that is, irregular overlapping of cells was hardly visible, and scattering of cells was increased;thick cytoplasm was common; chromatin was rather coarsely distributed.In small cell anaplastic carcinoma cells, also chromatin distribution was coarse, and cell clumping was more striking. Since this is a rapid, simple method that permits atypical cells to be readily found, 295 people were screened by chest X-ray and sputum cytology using this method.The sputum cytologic tests utilized 3-day pooled collections of spontaneous sputum.At this point, cancer cells have not yet found, though it may be said that the frequency of discovery of histiocytes in these specimens was higher by 18.5% than in the cases where direct smears were employed.
Cytologic examination of cervical carcinoma is most useful for population screening in the world over, and it is anticipated that this will permit the efficient screening of a lot of specimens in automation cytology. However, it is important to obtain satisfactory monodisperse cell samples without clusters and aggregates of cells for the slide system. In this series, we evaluated the monodisperse state of cells on given one-mm2 areas of slide glasses in 35 premalignant and malignant lesions of uterine cervix. We scraped the target area of the uterine cervix by Ayre's wooden spatula, and then prepared cell samples by shaking spatula in 50% ethanol 5ml, diluted those materials with 1.0% Pluronic F 68, a surfactant, and made cell suspensions with as equal turbidity as the color of faint frosted glass.Smearing on slide glasses was done by autosmear apparatus provided with a cell container which has a stainless steel mesh filter. As the result, the following were found: 1) Wooden spatula scraping was suitable for the cell sample requirements. 2) Approximately 50 cells were included in given 1-mm2 areas on slide glasses and 5-7% of these cells were malignant cells. 3) 1% Pluronic F68was the most effective dispersing agent. 4) Aggregates of cells were minimal by filtration with a 37μ pore size stainless steel mesh. 5) Centrifugation was performed at 2, 000 r.p.m. for 5 minutes. 6) A 0.26-mm packing filter paper was available for monodispersing.
A large number of methods for cell collection in pancreatobiliary cytodiagnosis have been proposed. However, none of them may be considered ideal for cell collection. Nonsurgical decompression of a biliary obstruction by percutaneous transhepatic biliary drainage using a catheter (PTBD) has become imperative in patients with obstructive jaundice when an imme diate or even a delayed surgical procedure cannot be employed. During PTBD, cells of the biliary tract were readily obtained through the PTBD tube by gentle irrigation, using normal saline solution. This approach and cytodiagnostic study have been introduced and made on 39 patients with obstructive jaundice during the last 2 years. The results by this diagnostic method have been excellent, and positive tumor cells found in 91 percent of carcinoma cases. The purpose of this paper is to present the technique of PTBD and demonstrate the diagnostic value of the procedure by presenting representative cases of benign and malignant stenoses of the biliary tract.
Free cancer cells in the peritoneal cavity from 60 cases of gastric cancer were examined by means of Douglas's cavity lavage, to study the relationship bet ween free cancer cells in the peritoneal cavity and the cancer infiltration to the gastric peritoneum. The results were summarized as follows. 1. Free cancer cells in the peritoneal cavity were observed in the cases where the cancer infiltration had reached the gastric peritoneum (S2:37%;S3: 59%). 2. The gastric peritoneum was cytologically examined by touchsmear method, and cancer cells were found on the surface of the gastric peritoneum in almost all cases of S2 and S3 (S2:95%;S3: 100%). 3. In the cases where free cancer cells were proved in the peritoneal cavity, the gastric peritoneal infiltration covered an area of 15-20cm2 or more, and the center of the surface of the gastric peritoneal infiltration macroscopically looked like white moss and the periphery of it, like small granules, in most of the cases. Poorly differentiated adenocarcinoma was revealed in the histological findings. 4. The viability of free cancer cells in the peritonealcavity was relatively high.
The characteristics of macrophages and mesothelial cells in serous effusions were studied morphologically, cytochemically and functionally.The macrophages and mesothelial cells had distinct characteristics, respectively.These findings appear important to the cytologic diagnosis of effusions. The two kinds of cells seem essentially different in properties, and do not seem to transform themeselves into each other. The mesothelial cells in effusions morphologically differed from the peritoneal mesothelium cells of patients without ascites, but resembled those of patients with longstanding ascites. It was suggested that the mesothelial cells in effusions had originated from the cells of pathological mesothelium.
Fineneedle aspiration cytology was done on mammary tumors in 314 breasts.The aspirated material was immediately smeared onto glass slides and stained by the Papanicolaou method.Of the 80 histologically confirmed mammary carcinoma, 63 (78.8%) had concord ant cytologic diagnosis: 2 (2.5%) were diagnosed as suspected: 11 (13.7%) were false negative: and the smears were inadequate in 4 cases (5.0%). The purpose of this study was to analyze the reasons for failure to diagnose mammary carcinoma by aspiration cytology. At first, the relationships between tumor size, histologic types and cytologically positive rate were studied. There was a tendency to smaller size of tumors in cytolagically negative cases as compared with the cytologically positive cases. Among histological types of mammary carcinoma, scirrhous type, which have more abundant fibrosis, show the lowest positive rate cytologically. The degrees of fibrosis were often factors to be considered in explanation of failure to obtain adequate carcinoma cells. Secondly, cytologic smears from mammary carcinoma which had received false negative or suspected cytologic reports were reevaluated and compared with the observations of smears in which a definite cytologic diagnosis of malignancy had been made. We observed 9 points concerning smears of concordant positive cases and false negative cases.These 9 points were as follows: Cellular arrangement with irregular overlapping, loose intercellular connection, large nucleocytoplasmic ratio, marked anisokaryosis, marked nuclear pleomorphism, appearance of cells with nuclei over 15μ in diameter, hyperchromasia wtih finely compact chromatin pattern and appearance of cell with nucleoli over 2.5μ in diameter or with more than 3 nucleoli in number. In the observation of smears from concordant positive cases, more than 4 points were found, while in the observation of smears from false negative or suspected cases, only 2 or 3 points were shown. Even though cytologic smears from rare cases with false positive diagnosis have 2 or 3 points, but, to avoid false negative diagnosis, we concluded that if 2 or 3 points out of the above 9 were found in a given sample of aspirated material, an excisional biopsy should be performed.
In this paper, we discuss the possibility of cytological judgment of radiosensitivity of uterine cervical cancer by comparison between pre and postirradiation smears given 1, 000 rads by telecobalt external test irradiation. The estimation of radiation effects on nuclei and the cytological presumption of histological typing in preirradiation smears have brought about satisfactory results;agreement between histological and cytological judgments of radiosensitivity was about 96.8%. Cytological criteria of good sensitivity are as follows; 1) Disparity in size of chromatin particles and irregular distribution. 2) Irregularity of nuclear membrane with nuclear wrinkling with diminution of thickness of nuclear membrane. 3) Mature squamous cell carcinoma without pearlformation. Those of poor sensitivity are as follows; 4) Existence of many unchanged viable cells and less disturbances of chromatines. 5) Existence of cells exibiting adenocarcinoma and carcinoma of intermediate type. 6) Clusters of cyanophilic cells having lacy, indistinct cell borders.
Cytohormonal evaluation was made on vaginal smears and smears of urinary sediment taken from 56 premenopausal and 16 postmenopausal castrated women. 1) The atrophic type appeared soon after castration in the normally menstruating women. The breakdown after 25 weeks was 37.0% atrophic type, 55.6% intermediate type and 7.4% estrogenic type. 2) There were a few cases which later turned out to be of the estrogenic type, although they had initially been of the intermediate type. 3) Histological findings of vaginal epithelium 16 weeks after castration gave such a breakdown which was 11.8% estrogenic type, 50.0% intermediate type, and 38.2% atrophic type. 4) The foregoing results suggested the existence of some mechanism which assists the vaginal epithelium in proliferating and maturating after castration. 5) Also suggested was the existence of a slightestrogen secretory function in the menopausal ovary. 6) Serum estradiol was as low as 30-60 pg/ml one week after castration. 7) Changes in the smears of urinary sediment kept pace with those of the vaginal smears, and they were found satisfactory as test objects for cytohormonalevaluation.
Cases which were negative by cytologic diagnosis but which were histologically diagnosed as dysplasia, carcinoma in situ and invasive carcinoma were analyzed by colposcopic findings as well as by cytologic findings; and the following were found: 1) Cases where dyskaryotic cells are observed but count as few as 1-4 cells and cases where there are cells with active nuclei which can be surmised as having originated in metaplasia or tissue repair are classed by cytologic diagnosis to class IIb. Since the incidence of lesions of dysplasia of class IIb or more advanced is about 100 times as high as the incidence of lesions of classes I-IIa by cytologic diagnosis and about 1/5 as high as that of lesions of class IIIa, the provision of class IIb by cytologic diagnosis is effective for efficient screening in the mass survery for cancer of the uterus. 2) Examination of abnormal colposcopic findings in cases which were false negative by cytologic diagnosis disclosed that the rate of occupation in the transformation zone was extremely low. From these findings, it has been proved that colposcopy in the primary mass survey for cancer of the uterus leads to the detection of few such cases which are false negative by cytologic diagnosis.
The result of the mass screenings of Cervical Cancer which were made by the Ishikawa Prefectural Office from 1971 to 1975 is presented in this paper, and some comments are added. 1) From 1971 to 1973, 25, 724 women were examined; 447 of them were histologically examined, and as the result, 79 cancers were were detected with cancer detection ratio; 0.31% 2) As the age advances, the (positive smars)/(negative smears) ratio becomes higher. 3) The cancer detection ratio becomes higher with the age fo the subjects. 4) It is important to determine what the ideal age distribution pattern should be for mass screenings, of cervical cancer. 5) To make efficient mass screenings, it is necessary to increase those examinees who have not been examined before.
A 64-year-old female patient had a complaint of a finger tip size erythematous focus gradually growing in the left inguinal region.The patient has recently noticed this erythematous focus of the 3-year duration enlarging rapidly, reaching the left labium majus. The microscopic findings of the scrape smear of the focus was such that a few malignant cells were scatte red among many ghost cells.The eccentric nuclei of the malignant cells had developed anisonucleosis and the size of the nuclei were12-18μAin diameter. The chromatin pattern was uniformly coarsely granular with irregular concentration of chromatin around the nuclear membrane. The nucleole was centric and showed a tendency to macronucleole. The cytoplasm was rather abundunt and was usually vacuolated. Its cytoplasmic margin was clearly defined. Periodic acid Schiff staining revealed the presence of fine PAS positive granules around the cytoplasmic margin.By alcian blue double staining method, the cells showed a weak positive reaction; i. e. the evidence of adenomatous malignant cells. In addition, pathological tissue examination showed a strong PAS positive reaction (diastase digestion was used), and from the morphologic aspects of the cells, the patient was diagnosed as having extramammary Paget's disease. As the so called P-cells assume a character of adenoma tous malignant cells in cytology, the detection of these cells in a scrape smear test of the vulvar requires the consideration of Paget's disease.
This paper presents an extremely rare case of extra nodal lymphoma of the uterine cervix in a 57year-old multiparous woman. The histology of this case should be classified into histiocytic malignant lymphoma (re ticulum cell sarcoma) by the Rappaport classification of malignant lymphomas. Cytology in this case was a poor ly differentiated reticulum cell sarcoma whose cells it was necessary to differentiate from those of lympho sarcoma. The patient was treated by external radiation therapy with the telecobalt unit up to 1, 000 rads, following a simple hysterectomy. Unfortunately, she died in a rapid course of two month duration after onset of the disease. Perhaps, her acute death may be explained by the fact that she had already been in the advanced stage in view of the clinical and laboratory findings, and also of the studies of the removed specimens.
The present report on primary vaginal carcinoma in situ (CIS) is to be here presented with special reference to cytological examination because of its rarity. The patient is 42 years old. The lesion was occupying one third of posterior vaginal wall as its center, of which histology was confirmed to be ovoidshaped CIS after operation. In this case, presence of carcinoma was estimated on scraping smear method of portio, though no abnorma rity was in evidence both on the portio and in the cervix by punch biopsy. Subsequent thorough colposcopic examination revealed mosaic pattern on the posterior vaginal wall. Histolo gical investigation also showed that its existence had nothing to do with the portio itself. Cytological appearance revealed trend differentiation to some degree. In particular, because of abundance in intermediate dyskaryotic cells and morphological alter nations of parabasal cells, it was quite similar to that of coexisting CIS in cervix and dysplasia high degree.
This is a case of 53 years-old female, gravida 0 with positive vaginal, endocervical, and endometrial aspira tion cytology. Preoperative diagnosis was carcinoma of the endometrium. Postoperative examination of the removed uterus and both ovaries failed to reveal a ma lignancy, but on the basis of the positive cul-de-sac smear taken at the operation, malignancy of the fallo pian tube was suspected and very small lesion was fo und in the left fallopian tube. In this case, cul-de-sac smear was very helpful making the correct diagnosis.
A malignant fibrous histiocytoma occurring in a der moid cyst of the ovary was examined cytologically in the imprint smear. Among the exfoliated cells, the histiocytic elements were predominant and looked aty pical, including foamy cells, multinucleated giant cells (Touton type) and various neoplastic giant cells. The fibrous elements were generally uniform and looked benign. These cytological features were in good acco rdance witn the diverse histologic pattern of the pres ent tumor.
Primary leiomyoma and leiomyosarcoma of the lung are rare, and in the majority of reported cases of leio myoma and leiomyosarcoma of the lung, neither bron choscopic examination nor sputum cytological examina tion was of diagnostic value. The definitive diagnosis was made after exploratory thoracotomy or at necropsy in most cases of leiomyosarcoma of the lung. The lei omyoma and leiomyosarcoma of the lung presented in this report were successfully diagnosed by bronchial brushing cytology and bronchial biopsy under the bro nchoscopic control. Imprint smear of the biopsied material of the leiom yoma showed apparently naked nucleus and was scant of cytoplasm. The nucleus was caterpillar-, spindle-, “B”-, or cigarshaped. Nuclear chromatin was fine and granular, and it was dispersed homogeneously. Small bodies of calcium deposits were seen in the cells. Cytological findings of the bronchial brushing of the leiomyosarcoma cells were pleomorphic.The tumor cells were essentially spindleshaped, but other varie ties were also observed.The nuclear chromatin was fine, and dispersed evenly in the nucleus. These two patients underwent lobectomies and both of them have been uneventful since surgery. Comparative cytological features of these tumors were interesting, and these suggest the usefulness of clinical cytology.
A small lesion of type IIb early gastric cancer was diagnosed by cytologic examination using the lavage method. The patient was a 72year-old male with gastric ulcer. He was being treated for an ulcer in the gastric angle, which had been diagnosed by upper G-I series, endoscopy and biopsy. Four months after the first upper G-I series, cytologic examination using the lavage method revealed typical malignant cells. Following the detection of the malignant cells, frequent examinations of upper G-I series and endoscopy were performed;however, no abnormal findings were achieved except for the ulcer in the gastric angle. No carcinoma was found in the biopsy specimens derived from the ulcer and the mucosa adjacent to it. He underwent subtotal gastrectomy 8 months after the detection of malignant cells, because of possible carcinoma other than the ulcer. Gross findings of the resected stomach appeared quite normal except the ulcer. But, histopathologically, carcinoma was found in the anterior wall far from the ulcer. Histologically it was an adenocarcinoma tubulare confined to the mucosal layer, 8×4mm in size. This case suggested that it is quite difficult to diagnose a type IIb early gastric cancer by the methods of upper G-I series and endoscopy, and the cytologic examination using the lavage method may play an important role in the diagnosis.
A 47years-old Japanese male was admitted to Kosei General Hospital with chief complaints of macroscopic hematuria and a right abdominal mass with pain. Cytological diagnosis was a renal cell carcinoma which was characterized by a group of adenocarcinoma cells with prominent pink nucleoli. He was operated on by a right nephrectomy 12 days after admission. Patho logical diagnosis of the resected kidney was a renal cell carcinoma with areas of cytoplasmic sudanophilia. Postoperative X-ray therapy (with a total dose of 2, 850 rads) was performed. Unfortunately he was scintigra phically found to have liver metastasis, and died 8 months after admission. Autopsy study revealed the xtensive metastasis of renal cell carcinoma to the lungs and the liver.