Cytologic examinations were performed on 13 known oral tumors of glandular origin. These consisted of 5 benign pleomorphic adenomas, 3 adenoid cystic carcinomas, 2 adenocarcinomas of solid type, 1 carcinoma of small cell type, 1 mucoepidermoid carcinoma and 1 metastatic adenocarcinoma. Only 2 cases, both of adenocarcinoma of solid type, out of the 8 malignant tumors, were clearly diagnosed as malignancy from their cytologic smears. But in other 6 cases cytologic diagnosis was very difficult due to lack of cytologic malignant characteristics. Therefore, the morphologic details helpful to diagnosis of malignant tumors of glandular origin have been described.
Preoperative cytological diagnosis is very important for the treatment of mediastinal neuroblastoma. Recently, cytological smears of mediastinal tumor can be obtained by percutaneous needle biopsy. The purpose of this paper is to know whether subtype of mediastinal neuroblastomas can be diagnosed or not. Findings of needle biopsy smears were compared with that of tumor stamps and histological sections. Cytological characteristics of these tumors are followings: 1. Mature tumor ganglion cells were characterized by abundant, dark bluish cytoplasma which has brown pigment granules. The nuclei were single or several and nucleoli were enlarged. 2. Small immature tumor cells were pleomorphic and almost naked. A few rossete formation were found. A ganglioneuroma consisted of mature ganglion tumor cells and a ganglioneuroblastoma had both mature and immature tumor cells, and many transistional type of these cells were found. In neuroblastoma smears, only immature tumor cells were found. It was concluded that ganglioneuroma, ganglioneuroblastoma and neuroblastoma could be diagnosed by characteristical findings of tumor cells obtained by percutaneous needle biopsy.
This is to report the results of cytologic investigation of tyroid disease by the aspiration biopsy. 504 cases of the thyroid diseases were investigated during the period of January, 1975 to September, 1976. The fine needle aspiration cytology are performed by the needle of 22 gauge. These Spedimens are stained by Papanicolau's and M-G-G stain. Our criteria for cytologic diagnosis of thyroid diseases are as follow. In the cases of subacute thyrooditis; 1) Epitheloid cells in groups. 2) Multinnuclear giant cell. 3) Moderate proliferation of macrophages and lymphocytes. 4) Neutrophiles. In cases of chronic thyroiditis; 1) Hyperplasia of small follicular cells with many lymphoid cells. 2) Oxyphilic changes of follicular cells, lymhoid cells, plasma cells and reticulum cells are seem. Important criteria on cytodiagnosis of the hyperthyroidism are established by Dr. Söderström of Sweden, as followes; 1) Marked paravaculoar granulation units, nuclear rings are observed in smear by Giemsa' stain. 2) Marginal vacuolization and large nuclei. In cases of hypothyroidism; 1) Decrease of lymphoid cells compared with chronic thyroiditis. 2) Fairly marked degneration of follicular cells and proliferation of stromal cells. In cases of adenomatous goiter; Degeneration of follicular cells with slight anisokaryosis and nuclear atypism, foamy cells are observed in small number. In cases of adenoma; Monomorphous neoplastic cells with follicular cytoplasma and and fairly marked acinar formation of uniform tumor cells without degeneration are seen. In cases of cystic goiter; Cystic fluid with numerous foamy cells (I type) and cystic flouid with follicular wall framents (II type) are seen. 24 cases of malignant tumors of the thyroid. That is 14 cases of papillary adenocarcinoma, 5 cases of follicular adenocarcinoma, 3 cases of anaplastic carcinoma, 1 cases of squamous cell carcinoma and 1 cases of malignant lymphoma.
The patient, a 64-year-old man, complained of pain of the right chest. Lung cancer was suspected by X-ray examination and was confirmed by cytological study of the sputum (Class V, adenocarcinoma). He was treated by Linac X-ray irradiation and with anti-cancer drugs, After 2-week hospitalization, he was pointed out pleural effusion in the right chest. A yellowish-brown exsudate was aspirated and with the first materials was revealed an adenocarcinoma with multinucleated giant cells measuring 15-60 μin diameter. With the second materials, it was difficult to differentiate multinucleated giant cells from giant cell carcinoma or malignant mesothelioma because of a large amount of giant and multinucleated neoplastic cells. The tumor cells were PAS and alcian-blue positive. Electron microscopically, the tumor cells were found to have mucus-forming vacuoles, intracytoplasmic microcysts and cytophagocytosis. Autopsy revealed carcinoma of the upper lobe of the right lung with extensive metastasis to lymph nodes. The right pleura was markedly fibrosed and thickened with tumor cell infiltrations. Microscopic diagnosis was bronchial adenocarcinoma with mucin formation. In this case, cancer cells were observed to become multinucleate and gigantic due to treatment, which made diagnosis difficult. Further, as the therapeutic effect differed between free cells and filling proliferating ones, this cytologically interesting problem and others were discussed.
Cytomorphological studies were made of the cells of urinary sediments in 28 patients with malignant lymphoma and 19 with leukemia. Two kinds of characteristic cells were detected. One of them showed moderately increased nuclei, prominently increased N/C ratio and ground-glass structure of nuclei. Cells of this kind were found in 9/28 (32%) of the patients with malignant lymphoma and 5/19 (26%) of those with leukemia. Cells of the other type were characterized by intracytoplasmic inclusion bodies. These cells were observed in 13/28 (46%) of the patients with malignant lymphoma and 4/19 (21%) of those with leukemia. Electron-microscopic study exhibited mosaic arrangement of viral particles in the area consistent with the ground-glass texture of nucleus. Hence, the above-mentioned cytological findings may be considered to have been associated with viral infection, which have been brought about by the immuno-suppressed conditions of leukemia and malignant lymphoma.
A study was made of the ceUular features of carcinolna of the uterine cervix in 45 patients with carcinoma in situ, microinvasive carcinoma and definite invasive carcinoma as diagnosed by means of histological examination of removed uterus. The results may be summarized as follows; 1) The number of atypical cells tended to increase with circular extension of the lesion rather than with the depth of invasion. 2) There was no substantial difference in the degree of differentiation of atypical cells between carcinoma in situ and microinvasive carcinoma, although the latter exhibited a slight increasing tendency of small cornified cancer cells. 3) Cellular atypism became more pronounced with the progresion of the lesion. Pyknotic nuclei were more eminent in microinvasive carcinoma than in carcinoma in situ. 4) The N/C ratio was smaller in definite invasive carcinoma than in carcinoma in situ or microinvasive carcinoma, indicating a tendency toward differentiation. 5) No significant difference was present between these 3 types of carcinoma in the number of cancer cell clusters, which appeared to be influenced by the strength of cervical scraping for the collection of smears. 6) The presence of cellular detritus in the background was helpful as an indicator of invasive carcinoma.
Sequential cytological examinations were made on 155 women with IUD application. The application extended up to 4 years. Eighty of the women were over 3 years after the initiation of IUD application. The IUD used was made of polyethylene screw-ring. The following specimens were examined: conventional PAP smears, imprint smears from the removed IUD, tissue fragments removed from the ring and endometrial curettage, for cytological and histological examination, as well as scratch smears taken from the vaginal wall for hormonal assessment. Atypical cells, often multinucleated, were frequently encountered. They appeared to be histiocytic derivatives and might accoount for the foreign body type giant cells. Glands were reduced in their number, especially in the fibrotic zone adjacent to the IUD. Whereas in the progestronic phase, the endometrial pattern frequently remained that in the proliferative phase. KI was distributed mostly above and below the physiological limits. This finding may indicate a hormonal incoherence. In addition to irregular and focal fibrosis, chronic inflammatory cell infiltrations were focally observed. Atypical glands, irregular ripening and some irregularly cystic glands, those reminiscent of so-called metropathic lesions were encountered as many as in 29% of the women. Thus, carcinogenecity on the endometrium may be assumed and wer recommend that the IUD application should not exceed 2 years.
There are a few reports on atypical cells appearing in the cytology specimens after D & C of pregnant women. Sequential cytopathological observations were made on 212 pregnant women receiving D & C at 2-3 months of pregnancy. Specimens were obtained with the endometrial aspiration instrument developed by the Cancer Institute Hospital, Tokyo. The sequential examinations were made on the 1st, 4th, 7th, 10th and 14th days after D & C. In addition to these smear specimens, histopathological as well as hormonal cytology examination was simultaneously made. Atypical cells, both single isolated and in clusters, as well as of syncytial type, were frequently detected. Their origin appears to be trophoblasts as well as the regenerative endometrial surface and glandular epithelium. Such kinds of atypical cells are sometimes deceivable as malignant neoplastic cells for their features, unless clinical information is noticed. We examined the nuclear DNA content of the atypical cells by microspectrophotometry. Some atypical cells were occasionally ploidy-like as malignant mode. These findings appear to be problematic.
Aspiration biopsy cytology is extremely useful in the clinical treatment of the metastatic cancer from the female genital organs. Though haematologists have been using this method for diagnosis of the condition of the bone marrow, spleen and lymph-nodes for the past several years, aspiration cytology for the diagnosis of the metastatic carcinoma from the female genital organs is not so popular in Japan yet. During the last 6 years, aspiration cytology has been performed 264 times in 185 cases suspected of metastatic carcinoma from the female genital organs in the National Cancer Center Hospital, Tokyo. In the cytology, 214 specimens were from the lymph nodes of the 153 patients, 26 from the subcutaneous masses of the 19 patients, and 24 from the masses on pelvic wall of the 13 patients. In our series of 185 cases, 110 were interpreted as positive, 69 as negative, 3 as suspicious and 3 as unsatisfactory needle aspirations. Though there was one false positive case, we have concluded that the needle aspiration cytology is very reliable. According to our experience, aspiration cytology is a simple and valuable method for the diagnosis of metastatic carcinoma from the female genital organs.
In a previous enzyme histochemical study, we showed that some of the uterine reserve cells carried heat stable alkaline phosphatase (ALP), but most of the cervical epidermoid cancers, heat sensitive ALP. From these result, we suspect that ALP isoenzyme pattern may change after malignant transformation (“enzyme deviation”). ALP reaction products in ALP positive cases, however, were not detected in all parts of the lesions but usually only in some parts. In this report, enzyme cytochemical two inhibition tests (heat stability and L-phenylalanine inhibition tests) were also applied to 55 cytological specimens from benign and malignant uterine tissues in order to find how often cell clusters of various of kinds of lesions have ALP activity and which type of ALP isoenzyme they have. The findings in this study may be summarized as follows: 1. As in histochemical specimens, ALP activity was also found in cytological specimens of reserve cell, reserve cell hyperplasia after cryosurgery, cervical gland, cervical epidermoid cancer, endometrium in the proliferative phase and endometrial adenocarcinoma. 2. In the heat stability test (65°C, 30min.) for cytological specimens, ALP of reserve cell, reserve cell hyperplasia after cryosurgery and cervical gland were heat stable. ALPs of endometrium and epidermoid cancer, however, were heat sensitive. Of 18 cases of endometrial cancer, the ALPs from six were heat stable, and the others heat sensitive. 3. In the L-phenylalanine inhibition test, ALPs from all lesions were sensitive to a lesser or greater extent. From these cytochemical studies of ALP, it may be postulated that “enzyme deviation” exists in the course of carcinogenesis of both uterine cervical epidermoid cancer and endometrial adenocarcinoma.
Oat cell carcinoma or undifferentiated carcinoma arising from esophagus is very rare. Some authors have described this tumor and its cytological characteristics. We report an autopsy case of esophageal oat cell charcinoma (undifferentiated carcinoma). We found the caracteristic cancer cells in pleural fluid in the case who was resected esophagus partially for esophageal carcinoma. We reviewed these cancer cells, and compared them with cancer cells in pleural fluid from a case of bronchial oat cell carcinoma. Cytological characteristics of this case were as follows; 1) They are small and are arranged as mosaic pattern. 2) They are slightly larger than cancer cells from a case of bronchial oat cell carcinoma. 3) Nuclei are polygonal or round in shape, and they are less irregularly shaped than those of bronchial oat cell carcinoma. 4) Nuclear membranes are thin, and chromatin is finely granular and is distributed evenly. 5) Nucleoli are small, and not conspicuous. Histologically, they were negative for argyrophil reaction by Grimelius stain or Bodian stain. They were also negative for argentaffin reaction by Fontana-Masson stain. By electronmicroscopy we detected a small number of neurosecretory granules.
In 48-year-old female, patient suffering from debilitating disease, who was treated with antibiotics, steroids and transfusion for the fever of unknown origin for 15 months, cytomegalovirus (CMV) infected cells were observed in the gastric biopsy specimens cytologically and histologically three months befor death. In the autopsy materials, CMV infected cells were also found in the gastric mucosa and renal tubules. Cytologic appearances of CMV infected cells vary in intra-cellular structures. Some infected cells have the characteristic intranuclear inclusion bodies with surrounding clear halo, the so-called “owl's eye” appearance. Irregular or dim intranuclear halo, and/or coarse granules in their abundant cytoplasm were observed in the other infected cells. All infected cells, however, were greatly enlarged and were spherical, having the homogeneous inclusion bodies in the nuclei. The diagnosis of disseminated CMV infection disease could be made cytologically and histologically.
Two cases of gastric carcinoma which were as small as not more than 2mm and 1mm in maximum diameter and which were confined to the gastric mucosa, respectively, were found by protease lavage cytologic diagnosis. These cases have been presented, with special reference to the courses of their diagnoses. Clinico-pathologic problems in the diagnosis of minor gastric carcinomas difficult to grossly distinguish have been discussed.
A 17-year-old boy, who had a diagnosis of glioblastoma diagnosed by surgical specimen and postmortem examination, was investigated cytologically. CSF and cell culture of CSF revealed RNA-virus-like particles electron microscopically, showed characteristically a variable number of large, bizarre, mononucleated and multinucleated giant cells with pleomorphic nuclei exhibiting varing degrees of hyperchromasia, coarse clumping of chromatin, and significant cell protrusions.
Primary carcinoma of the Fallopian tube is the least common malignancy of the female genital tracts. 1) A case of primary carcinoma of the Fallopian tube, which was preoperatively diagnosed by positive vaginal smears, was reported. 2) Eighty cases of primary carcinoma of the Fallopian tube have been reported in Japan. These, with a additional one case presented here, make a total eighty one cases in this country. 3) As many authors have reported, accurate preoperative diagnosis of this malignant disease is difficult. If the vaginal cytology is positive and suggestive of adenocarcinoma without malignant lesion in either uterine cervix and body, one should also suspect the tube as the site of a primary lesion. Effectiveness of cytology for diagnosis of primary carcinoma of the Fallopian tube was emphasized. 4) Electron microscopic study has scarcely been reported. In this paper, scanning and transmission electron microscopical observations were reported.
In a case of umbilical metastasis of ovarian cancer, cytology of the primary lesion were compared with those in the metastatic lesion. The patient (a 3-gravida), a 42-yearold woman, had tumors in the lower abdomen and in the umbilical area. Cytology of the umbilical tumor revealed that the tumor was adenocarcinoma. The primary ovarian tumor and the umbilical tumor were resected at laparotomy on January 27, 1977. It was diagnosed pathohistologically as the serous papillary cystadenocarcinoma of ovary and its umbilical metastasis. The touch smears of the primary tumor were compared with the cytologic smears of preoperative umbilicus. 1. The mean diameter of nucleus was 10.28+2.22y (+S. D.) in the umbilicus and 9.58+2.12 in the ovary. The ratio of short diameter to long diameter of the nucleus was 0.710+0.145 in the umbilicus and 0.670+0.175 in the ovary, which showed that the nucleus in the umbilicus was slightly rounder than that in the ovary. However, there was no significant difference in the incidence of the irregularities of the nucleus between the umbilicus and the ovary. 2. Pattern of chromatin: The granules in the umbilicus were slightly larger than those in the ovary. There were no significant differences of the distribution, thickening of nuclear membrane and the indentation of nuclear membrane between the umbilicus and the ovary. 3. Nucleoli: The incidence was 0.904+0.0131 in the umbilicus and 0.655+0.0212 in the ovary. The number of nucleoli per cell was 1.25+0.76 in the umbilicus and 0.80+0.72 in the ovary. The incidence of irregular nucleoli in the umbilicus was higher than that in the ovary. The mean diameter of nucleoli was 3.93+1.51, u in the umbilicus and 3.36+1.19 II in the ovary. The mean long diameter of the maximal nucleoli was 3.84+1.34 it in the umbilicus and 3.38+1.06 g in the ovary. As mentioned above, there was a significant difference in the cytology, especially in nucleoli between the primary lesion and the metastatic lesion.