Cytological findings of thyroid diseases, especially tumor, were investigated by using the fine needle aspiration cytology. The aspiration was performed with a fine needle (21gauge) and a disporsable plas syringe (20ml). The specimens were stained by Papanicolaou's and May-Giemsa's technique. 1, 073 aspirations in 997 patients were performed during 6 years, 1971 to 1976. Following conclusions were obtained: 1. In order to know the accuracy of the diagnosis obtained by the aspiration cytology, 51 malignant and 47 benign cases were compared, these cases were histologically confirmed by surgery or autopsy. 45 out of 51 (82%) cases were correct in malignant cases, and 42 out of 47 (89%) in benign cases, 2 false negative and 2 false positive cases were observed. 2. Cystic fluid was obtained in about half of 997 patients. 9 of 10 adenocarcinoma cases were correctly diagnosed by the cytology of cystic fluid prior to operation. It was easy to diagnose. for malignancy form centrifused sediment smear of cystic fluid, because cytological characteristics of carcinoma cells were emphasized by degenerative process. Therefore, it should be stressed that not only aspiration cytology from solid tumor but also from cystic fluid is very important. 3. The microscopical findings of benign adenoma, cyst, Hashimoto disease, subacute thyroiditis, well differentiated adenocarcinoma and anaplastic carcinoma were examined and analyzed with respect to their cell patterns, cellular details and background features. Compare to the fresh touch smear cells of stomach cancer, it seems that thyroid cancer cell have not so much cellular atipism than stomach cancer cell. 4. Intranucleic inclusions were observed in 19 of 33 patients of papillary cancer of thyroid. And they were neither detected in the cases of other types of carcinoma nor in all of benign cases. 5. We have never had complications clinically including bleeding, infection and cancer metastasis in our extended experience.
The purpose of our study was to examine the histopathological factors responsible for an incidence for which examination of sputum for metastatic tumor cells yields positive results. The clinico-pathological background of 7 cases of metastatic pulmonary tumors which were diagnosed by sputum cytology was examined. Autopsy was performed in all of these cases, and they were confirmed to be primary cancers of the skin, stomach, breast, gallbladder and pancreas, and hepatoma. 1. The rate of positive results varied not only with the position of the metastatic tumor but also with the grade of malignant cell invasion of the air way from the main bronchi to the alveolar spaces. 2. There were three cases which could not be diagnosed by chest X-ray. In one of these cases, metastasis to the left main bronchus was found, and in the othet two, peripheral metastatic lesions, were found, one of which was microscopical. 3. Whether malignant. cells in the sputum had been derived from primary pulmonary carcinoma or not was not determined in 6 of the cases, but one case was diagnosed as hepatoma cytologically by intracytoplasmic bile pigments.
16 patients who had severe dysplasia of the uterine cervix were given Bleomycin suppository to the uterine cervix, and the effect of Bleomycin against severe dysplasia. was cytologically studied. We examined the cytologic specimens at 1 day, 7 days and 1 month of the Bleomycin application. Bleomycin was. administered in a dose from 30-150mg, to a total dose from 90-300mg. The cytological effects of Bleomycin were enlargement of cytoplasm and nucleus, appearance of multinucleated cells, vacuolization of cytoplasm and appearance of reparative cells. These effects were a marked in the specimens at 7 days of the Bleomycin treatment. Duration of regression of severe dysplasia was about 7.1 months and there was no recurrent dysplasia during a 3.5-year follow-up.
A carbon dioxide laser instrument has, been employed with remarkable success in the treatment of erosio portionis. The carbon dioxide laser emits an electromagnetic wave at 10.6 microns which is absorbed by tissue depending on the water content. This energy absorption converts the water to steam vaporization thus occurs and consequently cells are blown apart with the steam. The change so caused is confined to a small area, and there seems to be a minimum damage to the adjacent tissue with no bleeding. There occur rapid repair and regeneration. The cytologic specimens taken immediately after the laser treatment revealed only mild transformation of squamous cells in the area of vaporization. But columnar cells appeared greatly elongated and thin. The nuclei of the columnar cells were elongated. Recovery following the laser treatment was rapid. The cytologic pattern revealed acute inflammatory changes 1-4 week after the laser treatment. The cytologic specimens contained many tissue repair cells and metaplastic cells with some histiocytes. By the 5th week these cells disappeared and cytologic presentation consisted mostly of squamous epithelial cells.
A total of 2, 600 cytotrophoblastic cells from the molar tissue of 13 cases of non-invasive mole at the implantation site, and 1, 200 cytotrophoblastic cells from the molar tissue of 6 cases of invasive mole in the myometrium were studied cytomorphologically. Variation in size and shape of cytoplasma and nucleus, increased N/C ratio, granular chromatin pattern, multinucleation, and increased number of prominent nucleoli were characteristic of both groups. These characteristic morphologies are common with many other malignant cells in the current sense of cytodiagnosis. The leading papers so far published say that trophoblastic cells of non-invasive mole are easily distinguishable cytologically from those of invasive mole. To the contrary, our results led to the conclusion that the cytomorphological difference of cytotrophoblastic cells between non-invasive mole and invasive mole was rather quantitative than qualitative. Discussion is made on these results in relation to the nature of invasive mole.
Many reports on hormonal activity and the effects on the epithelium have been presented, but careful study of the hormonal influences on the epithelium in the early stages of cervical carcinoma is important as it appears to present a possibility of preventation and hormonal therapy. Whether complete prevention of cervical carcinoma by sex steroid treatment is possible or not, it is of interest to know how much, and at which stages influence from cyclic hormonal changes is felt. And with this in mind, the cytological changes of the epithelium in cases of cervical carcinoma during the early stages were studied in relation to the menstrual cycle and the influences of hormone milieu. Irregularities in the menstrual cycle were also noted. It was found that: (1) In early cervical carcinoma the epithelium repeats its exfoliation and reproduction under the influence of ovarian hormones. (2) Patients with hyperestrogenic milieu tend to have much more histologic malignancy. (3) Menstrual irregularities tend to increase as the clinical stages of cervical carcinoma progress. (4) These irregularities have an influence on the epithelium encouraging the process of carcinoma. (5) The cycle date is necessary for a complete diagnosis of a smear and should always be noted.
When Emulgen 810 was added to Harris He. and FA-50 as a new method of restaining of, discolored specimens. It was effective. However, this method can not always be applied to all discolored specimens. There still remain many unsolved problems regarding chemical mechanism and the theoretical background of staining and discoloration. Therefore, the author will study further in the hope of developing a superior restaining method.
The cytological diagnosis of malignancy is based on nuclear findings. Hematoxylin solution is used to demonstrate this nuclear detail. Fomula for making hematoxylin solution most often used for smears is. Harris. Recently, harmful chemicals; Cd As, Hg, Cr, P, CN, PCB, etc., are limited in use. Harris hematoxylin solution contains plenty of mercuric oxide. We have to care about use of it. Our present study was hematoxylin solution without harmful chemicals. Based on our results, two useful formulas for making hematoxylin solution were Gill and Lillie Mayer for Papanicolaou stain.
A 54 year old male was admitted to Hamanomachi Hospital complaining of discomfort in the right upper quadrant of the abdomen in Aug., 1978. A diagnosis of hepatic tumor was made by scintigram and angiography. Chest X-ray taken in September revealed an ill-defined mass density in the left hilar region. His general conditions became steadily worse and he expired on October 25, 1978. Autopsy confirmed hepatocellular carcinoma and its metastasis to the left lung. Tumor cells were present in the bronchial lumen microscopically. The sputum was collected for cytology three weeks prior to his death. The characteristics of these tumor cells in sputum were presented, i. e. considerable variation in size and shape, a fairely large N/C ratio, trend of multinucleation, etc. Cytology of hepatocellular carcinoma has been reported regarding ascitic fluid and aspiration smears of the liver. They unanimously pointed out the presence of prominent nucleoli, whereas in our case, nucleoli were not clearly seen.