So called repair cells (Patten and Reagan) which appeared in the regeneration processes following several kinds oftherapeutic manupulation on the female genital tract havebeen a studied by means of cytomorphologic and cytophotometrical methods. Totally 3069 cytologic specimens obtained in the year of 1975 were examined. Repair cells were found after radiation therapy, hysterectomy, cauterization, cryosurgery and curretage, etc. The repair cells were subclassified into two groups; Group A and Group B, on the basis of their cytological features. The former was considered having its origin in squamousepithelium and the latter in endocervical columnar cells. Microspectrophotometric measurements of relative DNAcontent were performed on the both cell types as well as onthe other control cells. Eighty to ninety per cent of the repair cells examinedhave shown a peak in the same range 2n, as the intermediate cells of squamous epithelium have shown andthe remaining 10-20% another small peak in the diploidrange (4n). Distribution of nuclear DNA amount is alittle bit wider among repair cells than the intermediatecells. However, aneuploidy was not seen. There was nodefinite difference in distribution. curve between Group Aand Group B cells, though the latter contained smallernumber of cells which have shown 4n than the former. Whether or not this is a characteristic of the cells derived from coluinnar epithelium or indicate the difference inprocess of cell cycle among both types of cell is open todiscussion. Distribution of nuclear DNA amount of repaircell simulates that of parabasal cells. This might suggestthe repair cells hold the mitotic activity similar in grade asthat of parabasal cells.
Cytologic findings of mammary carcinoma of histologictypes were analyzed in this paper. In the cytologic study, 20 cases with medullary carcinoma, 20 cases with papillarycarcinoma and 20 cases with scirrhous carcinomas wereselected from about 200 cases with mammary cancer. Smears were prepared with carcinomatous tissues obtainedfrom these cases by use of excised surgical materials. The smears obtained from medullary carcinoma were themost hypercellular among those three cancer types, and thecells were found tending to remarkably scatter and separatefrom each other. The smears obtained from papillarycarcinomas were characterized by the papillary or tubularcell arrangement in the cluster. The smears obtained fromtypical scirrhous carcinomas were different from those of other two cancer types. The cell size was commonly small, and the cells with picnotic nucleus were often observed inthe smears. The cell clusters were usually composed of less than 50 cells, so the majority of the clusters were smallin size.
In the present paper, the cytodiagnostic findings of 9patients, having 7 mammary and 2 extramammary Pagetdiseases each, are discussed with emphasis on their cytologic features and mechanism of melanin pigmentationinto the cytoplasma of cancer cells. In the smear specimens collected by scraping or needle-aspiration, largecancer cell clusters occasionally mixed with benign epidermal cells, anisonucleosis, large typical Paget's cells withwide cytoplasma, melanin-pigmentation into the cytoplasma and occasionally presence of melanocytes werecharacteristic for the cytodiagnostic features of the presentdiseases. It is proposed that melanin pigmentation into the cytoplasma of the cancer cells is presumably induced through thesame mechanism as that of epidermal cells reported.
Cytodiagnosis of pulmonary sclerosing hemangiomaseems to be very difficult. Purpose of the present paperwas to establish the cytological diagnostic criteria ofpulmonary sclerosing hemangioma. Morphological features of the disease were studied by using smears obtainedby needle biopsies and imprinted materials of resectedtumors. A comparative study with histological sectionswas performed. Cytological characteristics of sclerosing hemangiomawere summarized as follows: 1. Four-types of cells were differentiated in smears; 1) Endothelial-like cells showing single or doubleribbon-like arrangements. 2) Slightly large mesenchymal cells having dense orcoarse chromatin and light cytoplasm. 3) Single or several loosely grouped mesenchymal cells. 4) Foamy cells and histiocytes. 2. Mesenchymal cells reveals sometimes slight nuclearatypism. It was concluded that pulmonary sclerosing hemangiomacould be diagnosed by differentiation of cells of four typesin the smears obtained by needle biopsy or tumor imprintbefore and during operation.
According to the principle of the Saccomanno technique, a simplified device was made for cell collection of sputum. It consists of a small motor, springjoint, metal shaft, a pairof screws and two batteries (SUM-3/1.5 V). It measures 20cm long and weighs only 140g. Stirring the specimen for 30 seconds at about 6, 000 rpm produces complete emulsion of sputum. The authors tentatively designate it “Simplifed Saccomanno Technique” (S. S.). A homogenizer (HG) was alsoadopted for comparison. Its function is similar to Saccomanno's original blender. One hundred twelve specimens taken from 95 patients who had been suspected of lung cancer were examined by means of direct smears, S. S. and HG. Thirteen out of the 95 patients proved to havecancer. Numerical evaluation was made on squamouscarcinoma and adenocarcinoma group. Generally, in S. S. and HG slides there were more malignant cells per unit slidearea than in direct smears of the same specimen. As to small anaplastic carcinoma, identifying cells wouldseem to be easier on direct smear, but it was not as simpleas might be thought on S. S. and HG because of the changein nuclear pattern. Degenerated benign epithelial cells were likely to be mistaken for small anaplastic carcinomacells. The characteristics of large cell carcinoma appearedin S. S. and HG were quite different from those in directsmear. An attempt was made to classify the grade of atypia ofsquamous cell metaplasia according to Saccomanno'scriteria on each slide of squamous carcinoma, smallanaplastic carcinoma and large cell carcinoma totaling to 5cases. The number of metaplastic cells seems to vary withthe case. Occasionally it was difficult to differentiatesingle metaplastic cells from the cells of squamous epithelium origin. This S. S. method, like the Saccomanno technique, facilitates the recognition of the cells in clear background. Since the effect of this simple blender was confirmed tocertain extent, it would be worth utilizing this device forcell collection.
Twenty-three cases of non-Hodgkin's malignant lymphoma were studied with referrence to Lukes and Collinsclassification. These cytological pictures were investigated in detail by using a touch smear method. The densityof nuclear pore in some cases was measured with freezefracture method and the relationship between mitotic indexand nuclear pore density was studied and discussed.Surface marker analysis of our cases showed that mostcases of these lymphoma were B cell type. Some of thecases were T cell or Null cell type lymphoma and one casewas a mixture of T cell and B cell types Follicular centercell origin (FCC) was found in 74% of the total cases andthey had B cell surface marker in all cases examined. Most of them were large transformed type lymphoma. Allcases of convoluted type were T cell nature. Undefinedtypes decided in this series showed high degree of variationmorphologically and most of them were Null cell type. There were no difference of mitotic index in nodular typeand the control cases. The mitotic index of the lymphomaof follicular center cell origin among diffuse type showed anincreasing number in this order, small cleaved, largecleaved, small transformed, large transformed, and immunoblastic sarcoma. Our study using a freeze-fracture method showed goodcorrelationship between the density of nuclear pore andmitotic indices.
A cytologic study in 9 cases with leiomyosarcoma wascarried out with several materials (vaginal smear 1, touchsmears 9, sputum1, pleural effusion 1, ascites 1) obtainedfrom various organs (uterine corpus 3, uterine cervix 1, stomach 1, duodenum 1, rectum 1, soft tissue 2). Histologically, there were found the spindle cell type in 2cases, the pleomorphic type in 4 and the immature type in 3. The cytologic materials were examined by means ofhistologic methods for H-E, Giemsa, Azan, van Gieson, Masson's trichrome, PTAH, PAS, alcianblue stains, andadditionally by cell block and electrone-microscopic observation especially for the pleural effusion from cases withthe disease in uterine cervix. But there was no definitiveevidence of the cytoplasm of tumor cells in view ofmyogenic characteristics.Cytologic observation of leiomyosarcoma differed fromthe differentiation of the tumor. Spindle cells were foundpredominant in the mature type. The pleomorphic typewere revealed as multinuclear giant cells. The immaturetype were observed in a dense blue area in the poorcytoplasma by Papanicolaou stain, and revealed a densebody with myofilaments in similar areas under electronemicroscopic observation.
Gastric brushing cytology and biopsy under direct visionby gastrofiberscope were performed to about 2500 casesduring the periods from 1972 to 1977. We compared theresults of gastric cytology with the results of gastric biopsy, and studied the problems of gastric cytodiagnosis. 1) By biopsy, positive results were obtained in 93.1% ofcarcinomas and by cytology in 88.3%. When gastricbiopsy and cytology were combined, positive results wereraised to 96.6%. 2) There were two false positive cases (0.08%) bycytodiagnosis.These clinical final diagnoses were allbenign gastric ulcers. In these cases, we overdiagnosedhigh grade atypical hyperplasti ccells into carcinoma cells. 3) In benign lesions, there were eighteen cases of suspicious for malignancy. By retrospective studies, weconsidered that these cells were atypical regenerative cells, atypical hyperplastic cells, atypical intestinal metaplasticcells and benign signet ring cells. In cases that the lesion has not been brought into thecenter of the visual field because of stenosis or location, gastric brushing cytology should be done.
Adenocarcinoma cells of papillary cystadenocarcinoma of the ovary were found out, during mass screening, in the smear obtained from 46year old woman who had a normal hormonal cycle and have no subjective complaints. While many case-reports concerning ovarian cancers detected by the vaginal smear have been made, there have been only few reports of this kind in Japan. As four ovarian malignant tumors successively diagnosed by the vaginal smear for uterin cancer importance of the vaginal smear, should be reevaluated. From the findings of this smear the presumptive site of the lesion could not be determined as to whether it was in the endmetrium or the ovary. In subsequent examinations of smear of uterine corpus, cervical canal, and histology of endmetrium, similar cancer cells were not detected at all. When adenocarcinomous cells, found out once, are not detected in subsequent examinations of the smears, we must emphasize that we should bear in mind the strong possibility that ovarian cancer is the origin of the malignant cells. From the results of pathological examination of post operative specimens and the fact that the malignant cells were not detected in repeated subsequent examinations, the appearance of cancer cells in the vaginal smear was due to discharge of cancer cells from the peritoneal cavity into the vagina via the fallopian tube, uterine cavity and cervix. At the same time, the freshness of the adenocarcinoma cells, in spite of their long passage through the uterus, was to be noted.
Presented case is a 24-year-old female bearing in her cervical portion of the uterus an extra-embryonic germ cell tumor which has the ability to produce a-fetoprotein. The smear before operation could not be obtained because of the previous removal of the impared uterus performed in another hospital. The cytological examina tion on the neoplastic cells in ascitic fluid at recurrence shows the following points. These cells are apt to con gregate in three dimensions and present the positive reaction to PAS staining. Thus, it seems unable to differentiate this disease from adenocarcinoma in morp hological point of view. The charactaristic faint granules within the tumor cells are, however, PAS-positive and diastaseresistant. In addition, biochemical findings such as elevation of α-petoprotein level in plasma and some other fetal plasma protein level may be considered as factors favoring a yolk sac tumor.
A reliable histological feature of rhabdomyosarcoma is the cross-striation of myofibrills in the cytoplasm of tumor cells. Though the patients with rhabdomyosarcoma develope rarely the fluid accumulation in the abdominal cavity, the identification of origin of tumor cells found in the ascites is difficult. The patient was a 26-year-old female, from whom rhabdomyosarcoma of the left foot had been excised, the tumor cells appeared in the ascites were identified as rhabdomyosarcoma cells by means of immunopathological method. The tumor cells from ascites were treated with allogeneic anti-skeletal muscle serum obtained from the patient with myasthenia gravis and then reacted with rabbitanti-human immunoglobulin serum labeled with FITC. Clusters of granular specific immunofluorescence were observed in the cytoplasm of tumor cells. The site of specific immunofluorescence was coincide with the location of myofibrills in the cytoplasm observed by electron microscopy. The immunopathological method employed might be adjunctive importance for the determination of Origin of tumor cells existing in the.fluid of abdominal or thoracic cavity.
A case of malignant astrocytoma arising from hypoth alamic resion with tumor dissemination to abdominal cavity led to ascites was reported. The patient was a 6-year-old girl with suffering from headache, nausea and visual disturbance. Because of increased intracranial pressure, V-P shunt operation was performed, and approximately 8 months after shunt operation ascites with cytological malignant cells appeared, and finally expired. Very rare case for peritoneal cytology was discussed from the point of differential diagnosis as an unexpected case to be ruled out.
A 62year-old man visited our institute with a coin lesion on chest film. By sputum cytology by Saccomanno's method (modified by Sato) atypical cells in cluster were found with following characteristics; Abundant cytoplasm with vacuoles, large round nuclei which are deviated in part, lots of chromatin, and one round nucleoli. Also in the bronchial brushing smear, atypical cells were found in sheets. Right lower lobectomy under the diagnosis of lung cancer revealed that the lesion was pulmonary hamartoma. The pathological examination showed that the tumor was surrounded by the monolayer cuboidal epithelium. And atypical proliferation was noted in the epithelium. The origin of atypical cells was discussed in cytological and histological point of view.