A 49-year-old patient with microglandular hyperplasia of the uterine cervix was reported, and might be the first reported case of Japanese woman from our review of literatures. The cyto-and histo-pathologic findings are described in comparison with those in the literatures. The correlation between the disease and contraceptive pills is emphasized. Adenocarcinoma must, additionally, be ruled out.
It has been ascertained that the mirror ball pattern normally observed with HAC-2 cells (an established cell line of ovarian clear cell carcinoma) growing in vitro can also be demonstrated in ascites from patients with this tumor. Mirror ball pattern is a spherical aggregate of cells arranged in a single layer encacing a PAS-and alcian blue-staining substance. These findings were represented by the cell block technique. This unique structure is observed as a cystic pattern in the tissue, forming presumably from attend epithelial components of tissue as the tumor tissue borders on ascites or the solid tissue borders on the cystic space. Microscopic reviews of the ascites specimens obtained during the last five years revealed mirror ball patterns not only in cases of ovarian clear cell carcinoma but in cases of other tumors as well. But, the findings indicate that clearcell carcinoma is highly probable in such cases diagnosed clinically as tumor of the ovary with microscopic evidence of numerous mirror ball patterns in ascites.
Primary carcinoma of the vagina is relatively rare among female genital malignancy, and early cancer is much more rare. Out of a total of 65 cases of vaginal cancer treated in the Cancer Institute Hospital, Tokyo, there were four cases of early cancer. Average age of patients with vaginal cancer is approximately the same, compared to those with cervical carcinoma, and there was a tendency for them to have married young and a high rate of no experience in pregnancy or delivery. The lesion was present in the posterior upper third of the vaginal wall in the majority, and the four cases of early cancer had the lesion in the posterior vornix. Cytological examination was most useful for the diagnosis of early cancer and the above four cases showed positive cytological findings. The cytodiagnostic evidence in these four cases was chiefly parabasal type of malignant cells similar to cervical carcinoma in situ, and a mixture of parabasal type malignant cells and keratinizing atypical cells.
Light microscopic studies were performed to evaluate the intranuclear cytoplasmic inclusions of the thyroid on 102 patients with thyroid disease during the period of from 1971 to 1977. The patients consisted of 35 patients with adenoma, 8 with hyperthyroidism, 5 with chronic thyroiditis, 12 with cyst, 31 with papillary carcinoma, 9 with follicular carcinoma, one with medullary carcinoma and one with anaplastic carcinoma. Normal cytology of the thyroid gland was studied on seven of them. The following results were obtained. (1) By the Papanicolaou method the inclusions were stained light bluish or greenish gray, and by the Giemsa method, light reddish-brown. They were mostly round in shape, but were clearly differentiated from degenerative vacuoles for the following features they invariably contained some fine structures and were demarcated by athick and relatively distinct border. By the Papanicolaou, Giemsa, Azan and PAS methods the inclusions were stained in a similar manner to their cytoplasma. By Shorr's and Mann's methods, however, they appeared quite different from nucleoli. The mean diameter of the inclusions was about half a nucleus. (2) The inclusions were detected in 26 of the 31 patients with papillary carcinoma, one of the 9 patients with follicular carcinoma and one of the one with medullary carcinoma. On the other hand, they were never found in the other histological types of thyroid disease or in the normal thyroid gland in this series. (3) In the cases of thyroid carcinoma with the inclusions, the ratio of number of carcinoma cells having the inclusions to the number of whole carcinoma cells ranged from 0.48 to 4.01% on the Papanicolaou-stained smears and from 0.29 to 3.87% on the Giemsa-stained smears. The higher this ratio, the more frequently was encountered cellular atypism such as nuclear enlargement, anisonucleosis, abnormal appearance of chromatin, polychromasia of nuclei, nucleolar abnormalities and increased nucleo-cytoplasmic ratio. (4) It may be concluded that the existence of the inclusions is of significant diagnostic value in indicating malignancy in cytodiagnosis of thyroid disease.
A case of cervical adenoacanthoma which was cytodiagnostically interesting is reported. The cervico-vaginal smear showed adenocarcinoma cells, squamous metaplastic cells and hyalinized masses of keratin material (keratin bodies). The existence of adenocarcinoma cells and squamous metaplastic cells enabled us to correctly predict adenoacanthoma. On the other hand, the keratin bodies on the cytology smear were thought to be correlated to those of the tissue section.
A case of primary malignant melanoma of the vagina diagnosed cytologically was reported. A dark-brownish tumor of fingertip-size was observed, which had developed on the vaginal wall near the introitus of an 87-year-old female. The main cytologic features on vaginal and scraping smears of the tumor were the scattered distribution of atypical cells, anisocytosis, eccentric nuclei with a finely granular chromatin pattern, unusually large red nucleoli, intranuclear vacuoles and finely granular melanin pigment packed in the cytoplasm. No other lesions showing signs of malignant melanoma than the vaginal one could be found anywhere else in the patient's body. A radical vulvectomy with bilateral groin dissection, wide excision of the vagina and external Co60 irradiation for pelvic lymph nodes were carried out. There has been no sign of recurrence during the 6 months following an operation. Cytologic diagnosis of malignant melanoma of the vagina seems to be extremely important in order to avoid its tendency toward hematogenous metastasis.
Extragenital metastatic carcinoma to the uterine cervix is a rare lesion. Still less frequent is the metastasis of gastric carcinoma to the cervix; hence, few published reports. In the 15-year period from January, 1964 through December, 1978, about 36, 000 smears of gynecological cytology were studied at the Yamagata Prefectural Center for Adult Diseases and the Yamagata Prefectural Central Hospital and these smears included two cases of metastatic adenocarcinoma of the stomach to the uterine cervix whichwere positive for malignant cells. The occurrence rate of this diagnosis was one in every 18, 000 semears. The examination of the smears revealed irregular clusters of malignant cells, hyperchromasia, irregularities of nuclei, and prominent nucleoli. It was extremely difficult to determine the exact primary site of the tumor from the smear findings only, but in these two cases the diagnosis of metastatic adenocarcinoma of the stomach to the uterine cervix was suggested strongly by the histories of the patients, pelvic findings and pathological studies.