1. Thirty-two cases of primary adenocarcinoma of the lung were selected for a comparative study of morphological findings in the tumor cells in cytology smears by the bronchial brushing method, in relation to the histological appearance of the primary tumor in the lung. 2. The cases were divided into two major groups: the peripheral tumor group and the central tumor group. The former was further divided into three subgroups by the histological grade of tumor tissue differentiation, i. e., well, moderately, and poorly differentiated groups. Accordingto this classificationn, the 32 cases were divided to 4: 10 peripheral well differentiated, 17 peripheral moderately differentiated, 1 peripheral poorly differentiated, and 4 central cases. In the cases of each group, the tumor cells appearing in the bronchial brushing smears were carefully investigated in order to clarify the cytological features of these cells and to relate the features to the cellular as well as to the structural features in the tumor tissue histology of each group. 3. One of the most distinctive features of the adenocarcinoma cells in the bronchial brushing smears was that the tumor cells grouped together and tended to be arranged in a particular fashion making a papillary and/or luminal appearance. In fact, the former cell arrangement was detected in 26, and the latter, in 10 of of the cases. 4. It was often difficult to estimate the histologic type of adenocarcinoma from the findings in individual carcinoma cells. Among these cases were 7 cases in which intracytoplasmic mucus-like vacuoles were noticed within the tumor cells. Besides, there were only 3 cases in which the nucleus was distinctly eccentric in the tumor. cells. These are usually more frequent in adenocarcinoma cells in the exfoliated cell smear. 5 In general, adenocarcinoma cells were smaller, less anisocytotic and less pleomorphic than the cells of squamous cell carcinoma, in the bronchial brushing smear. 6. It sometimes appeared fairly reasonable in a few cases of adenocarcinoma, poorly differentiated or even moderately differentiated, to estimate the original tumor from the cytological findings as a tumor of large anaplastic cell type, because of the fact that the primary adenocarcinoma, regarded as either poorly or moderately differentiated in the tissue preparation, was often composed largely of rather anaplastic carcinoma cells and that an adenocarcinomatous feature was found only in the minor part of the tumor tissue.
The purpose of this study is to compare cytological findings of leiomyoma and leiomyosarcoma of the stomach. The two groups of 7 cases with leiomyoma and 4 cases with leiomyosarcoma were analysed Cytological materials were obtained by direct smear method from surgical specimen, and observed microscopically under 1000×magnification with Pap. staining. 1. leiomyoma cells: The means of the minor axis diameter of nuclei was found to be 4.6μ and narrowly distributed. Nuclei were cigar-shaped with rounded tips and contained normally stained granular chromocenters. 2. leiomyosarcoma cells: Nuclei of most cells were oval or rounded shaped and pleomorphic, containing deeply stained granular chromocenters and clumpy chromocenters. The means of minor axis diameter was 7.5μ and showed a wide scattered distribution pattern. It may be concluded that differential diagnosis by these cytological findings between leiomyoma and leiomyosarcoma could be made.
The authors studied the microscopic morphology of fresh carcinoma cells obtained by the fine needle aspiration technic from carcinomas of the liver, biliary tract, pancreas and periampullary region which were histologically confirmed to be well differentiated adenocarcinomas. The specimens were stained by the Papanicolaou method and observed precisely by light microscopy. The following were the differences found between the carcinoma cells of these organs and region by comparing their histologic features: (1) Hepatocelluar carcinoma cells: The cytoplasma and nucleus were irregular in shape and the largest in diameter of the carcinoma cells of the groups. The nucleocytoplasmic ratio (N: C ratio) was most increased among the groups. The nuclear membranes were unevenly thick in general. The nucleolei were largest in diameter, prominent, irregular, isolated from chromatin granules, and increased in number. (2) Carcinoma cells of the biliary tract (differentiated adenocarcinoma): The cytoplasma was intermediate in diameter and markedly polymorphic. The nucleolei were mostly large, oval and slightly polymorphic. The nuclear membranes were mostly evenly thin, and the chromatin granules were coarse. The nucleolei were large and oval. The number of nucleoli in the nucleus ranged from zero to four-in general. The nucleoli were connected with the chromatin granules. (3) Carcinoma cells of the pancreas (differentiated adenocarcinoma): The cytoplasma and nucleus were small in diameter. Anisocytosis and anisonucleosis were prominent. The N: C ratio was large. The nuclear membrane were evenly thin. Hyperchromasia was moderate. Among these groups, the nucleoli of carcinoma cells of the pancreas were smallestin diameter and oval or round in shape. The number of nucleoli ranged from zero to two in most nuclei. (4) Carcinoma cells of the periampullary region (differentiated adenocarcinoma): The cytoplasma was small in diameter and irregular in shape. Anisocytosis was moderate. The nuclear membrane was generally thin. The chromatin granules were fine, and slightly increased in number. The nucleoli were small, and round or oval. The nucleus contained zero to three nucleoli. Clusters of carcinoma cells contained more naked nuclei than normal cells and few mutual inclusions. No distinguishing features of cell clusters were evident among these groups. These features of carcinoma cells were useful for differential diagnosis of these groups. On the basis of these findings, the authors examined 97 patients with lesions in these organs (27 benign, 68 malignant, 2 histologically and/or borderline lesions), clinically and analysed the results. The cytodiagnosis was done preoperatively and peroperatively. (1) Preoperatively, the accuracy rate of positive cytodiagnosis of malignant lesions was 33 percent by the percutaneous intrahepatic cholangio-drainage (PTC-D), and 25 percent by the pancreozymin-secretin test (P-S test). In the benign lesions, the accuracy of negative cytodiagnosis was 83 percent by the PTC-D and 100 percent by the P-S test. By dudenoscopic biopsy, the accuracy of positive cytodiagnosis of malignant lesions was 80 percent, but all of the positive cases were advanced cancers. (2) Peroperatively, the accuracy rate of cytodiagnosis by fine needle aspiration was 83 percent both in the benign and malignant cases, respectively. The accuracy of imprint smears from the specimens by surgery, endoscopy and Vim-Silvermann needle was 100 percent. The relationship between the results of cytologic diagnoses by various cell collection methods and tumor sizes was studied: consequently, even in small carcinomas 2 or 3 centimeters in diameter, the accuracy of positive cytologic diagnosis was relatively high.
The cytological findings were studied in four cases of carcinoid of digestive organs; one case each of gastric, pancreatic, small intestinal and rectal carcinoid. The following were found cytologically; in gastric, pancreatic and rectal carcinoid, the tumor cells were arranged flat and slowed partly a trabecular, ribbon like, rosette-like formation or columnar appearance; the cytoplasm was clearly demarcated, shaped like a columnar epithelial cell or polygonal; the nucleus was round or oval in shape, and the nuclear border was smooth and thin; the nucleocytoplasmic ratio was not increased, and the size and shape were neither various; the chromatin pattern was finely granular, and exhibited an almost normal limit in distribution; the chromation arrangement was not increased in amount; thce nucleolus was small, and not prominent in shape; in general, the tumor cells were uniform. In the case of small intestinal carcinoid, the tumor cells were scattered or overlapping, and arranged irregularly. The cytoplasmic border was unclear. The nucleus was usually round. The nucleocytoplasmic ratio was increased and anisonucleosis was observed. The nucleus was in part shaped irregular and large. Polynucleated large cells and inclusion cells were also seen. The nucleolus was not usually prominent, but partly large and prominent. In this case, cellular atypia was more conspicuous than in the others. It is interesting that prognosis in this case was poorer than in the others.
A series of 243 cases with koilocytotic atypia of the uterine cervix is reported. They were screened out from 597 cases of the cervical histologic specimen performed between autumn 1976 and summer 1977. 162 cases of minimal, 60 cases of moderate, and 21 cases of marked grade according to Koss were found. 123 patients of 243 women with koilocytotic atypia were found from our population screening programms. We found 34 patients with koilocytotic atypia in the patients of C. I. S. who were operated on recently. In 28 stage Ia patients we fond 12 koilocytotic patients, and 8 cases in stage 19 stage Ib patients. None of them in stage II. The most of these koilocytotic changes had passed unnoticed or were labeled chronic cervicitis. From the standpoint of morphologic features, we interprete as follows, the koilocytotic atypia is the same lesion to the flat type of the condylomatotis lesion of the cervix uteri (A. Meisels).
Both cervical scraping with the spatula and the cotton applicater can be considered as valuable methods in screening for cervical neoplasia. An attempt to compare the spatula with cotton applicater for usefullness to detect not only the presence of cervical neoplasia but also to prognosticate its severity was made. Furthermore, cellular changes after application of acetic acid and the effect of repeated sampling on cellular features were investigated. The following results were obtained. 1) The positive detectable ratio by the screening with the spatula was 83.9% in dysplasia and 100% in carcinoma in situ (CIS), on the other hand, 54.8% of dysplasia and 71% of CIS were detected by the screening with the cotton applicater. 2) The accuracy of cytology with the spatula was 87.0% in CIS, 84.1% in microinvasive cancer and 97.0% in frank invasive cancer, with cotton applicater was respectively 41.7%, 40.0%, 84.4%. Thus, recognition of CIS, microinvasive cancer and frank invasive-cancer with the spatula can be made in a high proportion of cases. 3) The cellular features after application of acetic acid had a tendency to over diagnosis. 4) Three weeks'interval was needed the restration for the cellular sampling.
The definition of tissue repair cells was proposed. “Tissue repair is a cell group with characteristic features; round or oval in nuclear shape, prominent nucleoli, fine granular chromatin pattern, moderate anisonucleosis and relatively abundant cytoplasm, deriving from reparative tissue. Neoplasia should be ruled out in tissue repair” Cellular origin of tissue repair cells, differential diagnosis between tissue repair cells and cells from neoplasia, and histology from which tissue repair cells were derived were discussed.
(1) The cytologic features of the imprint smear preparations of pseudosarcomatous fasciitis exstirpated from the right forearm of a 48-year-male were described. (2) Differential diagnosis in cytologic figures between pseudosarcomatous fasciitis and sarcoma were discussed.
1) A 46 year-old female visited our clinic and complained of nipple discharge, excoriation of the nipple, and a hard mass in the right breast. 2) Exfoliative cytology of the nipple discharge revealed many large atypical cells with melanin granules in the cytoplasm, two types of melanocyte, and histiocytes with melanin granules. We were slightly confused whether these atypical cells with melanin were malignant melanoma ur not. However, these cells had pale cytoplasm, perinuclear halo, and relative large nuclei, and were lined similary to the epithelial arrangement. 3) Exfoliative cytology of the mass of the breast, obtained by a needle aspiration, revealed a large number of single or clumped large atypical cells with large pale granular cytoplasm, a perinuclear halo, prominent irregular hyperchromatic nuclei and prominent nucleoli, but entirely without melanin pigment. These cells were considered to be Paget's cells. 4) It must be sure that these two types of malignant cells originated from the same tumor, i. e. Paget's cancer of the breast, even though the one had the melanin granules and the other did not. In our opinion, Paget's cells in the nipple discharge must have received the melanin granules from the melanocytes by some mechanism. 5) We should always consider the possibility that the Paget's cells in the nipple discharge might contain melanin granules in their cytoplasms. 6) Relations between Paget's cells and melanin pigment were discussed in this paper.
This paper has reported a case of the so-called early gastric reticulum-cell sarcoma a case in which no malignant tumor was proved by X-ray and endoscope inspections but atypical cells were found by proteolytic lavage cytology and diagnoses were subsequently repeated for two years until finally typical malignant cells were found. The paper has also emphasized the importance of studying the cell morphology of malignant lymphoma and of the follow-up by cytodiagnoses.
Three cases of aberrant pancreas in the gastric wall diagnosed cytologically by the thorny needle biopsy are reported. The thorny needle biopsy is a newly developed cytological method by us for the diagnosis of submucosal tumors of the stomach. A thorny needle, 0.5mm in diameter, is inserted to the tumor under fibergastroscopic guidance and the gentle rotation of the needle at that position makes it possible to obtain the cytological samples even in submucosal tumor without ulceration. By this method, some grandular cells were obtained in these three cases, showing the common cytological findings as follows; Nuclei of most cells were small and round, containing normally or deeply stained granular chromocenters and relatively prominent nucleoli. Nuclear chromocenters had a tendency to concentrate on the nuclear rim, giving a clear appearance to inside of the nucleus. The cytoplasm was well-preserved and uniformly stained with right-green on the Pap. staining. The cells constituted a characteristic acinar structure. Cytological study revealed that these grandular cells obtained from aberrant pancreatic tissue showed almost same cytological feature as original pancreatic acinar cells. So it may be concluded that cytological diagnosis of aberrant pancreas could be made by the presence of pancreatic acinar cells in the gastric smear.