There has been a trend for increase in endometrial carcinoma in. Japan in recent years, and many attempts have been made to put endometrial cytodiagnosis into practice in order to detect endometrial carcinoma in the early stage. In the Department of Gynecology of the Cancer Institute in Tokyo, endometrial cytodiagnosis by the so-called Masubuchi method for endometrial aspiration has been carried out since 1955. The apparatus used for this suction method is a 10ml injection syringe, which can be placed under negative pressure continuously, connected with a polythylene tubing. It is a simple device, its procedure is simple, and the cells can be collected without any pain to the patient. This procedure can be carried out easily on out-patients, in addition to various tests hitherto used for uterine cervical carcinoma. Endometrial cytodiagnosis by this method has been carried out in the Department of Gynecology since 1955, and the rate of its practice has been 100% in 215 patients who had endometrial carcinoma. This Masubuchi method of aspiration cytology and results of endometrial cytodiagnosis in the Department of Gynecology, Cancer Institute Hospital, Tokyo, will be described.
The cytological characteristics of cervical cancer at Stage Ia are summarized as follows: 1. In 57.2% of the cases the cytological picture are CIS pattern +keratinizing and CIS pattern+ cluster, which we have referred as the cytological pattern of the cancer at Stage Ia. 2. The wider a lesion extends, the more atypical cells are, and the more the cases are which show the tumorous background and are diagnosed to be malignant cytologically. 3. The cytological pictures of dysplasia, CIS and invasive carcinoma are recognized in 10.7%, 10.7%, and 21.4% of the patients with the cancer at Ia, respectively. However, the presence of the cervical cancer at Ia can be considerably well estimated, considering the results of the study of their cytograms that essential dysplasia, CIS and invasive -carcinoma are less than their correspondent small abnormal keratinizing cells, parabasical and middle-layer atypical cells which are dense with chromatin and coarsely granular are frequently seen, or that most of fiber type and tadpole type of malignant cells are small.
Using MOP Digiplan AMO3, the uterine-cervical cells (including superficial, intermediate, parabasal and basal cells) appearing in normal subjects and patients with dysplasia, carcinoma in situ (abbreviated as c. i. s., hereinafter), micro invasive cancer and invasive cancer were measured for the area of cells and nuclei (μ2), length (μ), diameter (μ) and form iridex. On the basis of the measured values for the area, the N/C ratio was accurately determined. The results are as follows. a) Uterine-cervical normal cells 1) Values for the area, length and diameter of cells increased as differentiation progressed from basal cells to parabasal, intermediate and superficial cells. However, measurement of the area, length and diameter of the nucleus revealed little or no significant difference among intermediate, parabasal and basal cells, except for the nucleil of superficial cells showing remarkably low values. 2) With respect to the form index, values of 0.74, 0.86, 0.90 and 0.94 were obtained for the superficial, intermediate, parabasal and basal cells, respectively. This indicates a.decreasing tendency as differentiation progresses. From these results it can be well understood that these cells show polymorphism. The values for nuclear indices were 0.98, 0.97, 0.96 and 0.97, respectively, with no significant difference in the morphology of their nuclei. 3) The N/C ratios were 0.4 for superficial cells, 1.8 for intermediate cells, 16.7 for parabasal cells and 40.3 for basal cells. The N/C ratio of superficial cells was much smaller than that described in the text. b) Dysplasis, c. i. s., micro invasive cancer and invasive cancer 1) Except in the case of dysplasia, measurement of the area, length and diameter of the cells and nuclei revealed greater values as the lesion progressed from c. i. s: to micro invasive cancer and invasive cancer. These results are not consistent with those described by Reagan et al. 2) The cellular form indices obtained for dysplasia, c. i. s., micro invasive cancer and invasive cancer were 0.87, 0.95, 0.95 and 0.83, respectively. Thus, the value obtained for c. i. s. was the closest to I (namaly, circular in form), while that obtained for invasive cancer was the lowest, indicating cellular polymorphism. The values for micro invasive cancer were intermediate between those obtained for the c. i. S. and invasive cancer. 3) The nuclear form indices were.0.92, 0.98, 0.95 and 0.93 for dysplasia, c. i. s., micro invasive cancer, and invasive cancer, respectively, showing a pattern similar to that observed for the cellular form index. It was found that progression of the lesion was accompanied by an increase in nuclear polymorphism. 4) The N/C ratios were 28.24, 61.22, 56.78 and 45.32% for dysplasia, c. i. s., micro invasive cancer, and invasive cancer, respectively. The highest value was obtained for the c. i. s. These results indicate that the values became smaller as the lesion progressed from micro invasive cancer to invasive cancer. The lowered N/C ratio obtained in the case of dysplasia appeared to be due to the presence of more superficial and intermediate cells as well an dyskaryotic cells.
Psammoma bodies sometimes appear in the cervicovaginal smears of women who have endometrial or ovarian carcinoma. However, recently the authors have checked for psammoma bodies in the touch smears of 10 out of 39 women who have worn the IUD (5 months-24 years), and who do not have endometrial or ovarian carcinoma. The authors would like to sav that even if we find psammoma bodies in vaginal or endometrial smears, we cannot conclude immediately that the patients have malignancies as was formerly usually suggested.
Atypical cells following D & C in 153 pregnant women, 34 abortion cases and 30 non-pregnant cases were studied in terms of their origin, appearance rate, time of appearance and cytomorphology. Cytologic specimens were obtained by both cervical scraping and aspiration from the uterine cavity at a proper time after D & C. The cells were sub-classified according to their atypicality and appearance formation. They are cells with mild and severe atypia, and cells isolated and in cluster (sheet and overlapping). (1) The atypical cells presenting severe atypia were found in the specimen from the uterine cavity. The original tissue of these cells were the proliferating endometrium. (2) The atypical cells appeared from the second day, and the number of these cells and atypicality reached the peak on the 7th day. Mild atypical cells were still observed in ca. 70% on the 30th day. In a few cases mild atypical cells were recognized after the first menstrual period since D & C. (3) The cells appeared as isolated form in 25% and in cluster in 75%. It was suspected morphologically that the isolated -cell originated in cluster. The cell detouchirig from the cluster showed the identical cytomorphologic features of the cells in isolated form. (4) The appearance rate and cytomorphologic features of the atypical cells in three different conditions revealed no differences except that the cell size of the pregnant cases were larger than other two conditions.
Recently, we established cell lines (epidermoid carcinomas, endometrial adenocarcinomas and leiomyosarcomas) from human uterus or other parts, and explanted these cells into the subcutis of nude mice. Then we obtained the aspiration biopsy smears with #21 fine needle and could study the morphology without remarkable damages of tumors. Finally, we obtained the aspiration biopsy smears from the adenocarcinomas of sex-steroid hormones (estradiol-17β or progesterone)-treated mice and were able to evaluate the effects of hormones on endometrial adenocarcinomas. Estradiol-17β enhanced the growth of tumor, while progesterone inhibited it.
The nuclear DNA of mammary tumor cells in imprint smears taken from 110 patients were quantitatively measured by cytophotometry. The smears stained by the Papanicolaou's method were destained and were re-stained by the Feulgen's method for this study. The diagnosis of all surgical specimens used in this study was verified by histological examination. Differential diagnosis of malignant mammary lesions from benign ones was tried by the cytophotometry and the results were followed. (1) The diagnosis of the DNA histogram was highly accurate. The positive rate was 80.0% and the false negative rate was 3.1% in the malignant lesions. The negative rate was 77.8% and the false positive rata was 2.2% in benign lesions. (2) The positive rate was 55.6%, the rate of suspected diagnosis was 38.9% and the false negative rate was 5.5% in the T1 mammary lesions. The positive rate was 89.4%, the rate of suspected diagnosis was 8.5% and the false negative rate was 2.1% in the T2, T3 and T4 lesions. The quantitative analysis by the DNA histogram of the T1 lesions revealed boundary findings to the benign lesions, when compared with those of the T2, T3, and T4 lesions. (3) The positive rate was 60.0% in papillotubular carcinoma, 81.3% in medullary tubular carcinoma and 86.2% in scirrhous carcinoma. The diagnostic accuracy by the quantitative method was dependent on the histological types. (4) The positive rate was 45.4% in well differentiated adenocarcinoma, 76.9% in moderately differentiated adenocarcinoma and 90.2% in poorly differentiated adenocarcinoma. There was a close relationship between the diagnostic accuracy by the cytophotometry and the degree of differentiation of the malignant mammary lesions.
Nine out of 13 renal cell carcinomas were correctly detected by examining cells exfoliates into urine. Most lesions of these cases, however, had not been demonstrated by other diagnostic procedures. Thus, it is emphasized that cytodiagnostic method is able to detect such cancers of kidney clinically at occult state. Cellular morphology of the cancer was shown, paticularly described in respects to the typical cellular feature available for distingushing them from the other malignant tumors. Clinicopathologic problems in diagnosis of the renal cell cancer were also discussed, with citing case studies.
In this report, the authors introduce an advantage of the mucopolysaccharide stains in differential diagnosis of adenocarcinoma cells in pleural and peritoneal effusions. Periodic acid-Shiff (PAS) positive materials are almost always detected in the cytoplasm of adenocarcinoma cells. There is, however, some differences in size, amount and distributions of PAS-positive materials among adenocarcinoma cells originated from different organs. They show reticular or granular pattern in papillary adenocarcinoma and accumulative pattern in tubular and poorly differentiated adenocarcinoma of the stomach, granular pattern in serous cystadenocarcinoma and diffuse, accumulative or reticular pattern in pseudomucinous cystadenocarcinoma of the ovary, reticular or granular pattern in papillotubular and medullary tubular carcinoma of the breast reticular pattern in adenocarcinoma of the lung, and reticular or granular pattern in adenocarcinoma of the gallbladder, colon and uterine cervix. Alcian blue stain findings are also described. The authors considered the polysaccharide stains as helpful and useful methods, not only for differentiation of carcinoma cells from other benign cells, but also for detection of a primary lesion and of a histological subtype of adenocarcinoma, in combination with Papanicolaou and Giemsa stains.
On five cases of bronchial carcinoid, cytological and histological findings were compared. Cytological materials were obtained by the preoperative bronchial brushing method. On resected cases, additional cytological smears were prepared from the freshly-cut surfaces of resected tumors. The conclusion reached by these examinations is that cytology diagnosed by the bronchial brushing method is useful for establishing preoperative diagnosis of bronchial carcinoid. Essential cytological manifestations of typical carcinoid are as follows;(1) Cytoplasm is foamy and lightly stained, (2) moderately increased chromatin granules are slightly coarse, (3) chromatinic rim is thin and regular and (4) nucleoli are moderately prominent. Aside from these typical findings, various aspects in cytology reflected histological patterns of carcinoid. For example, rosette formation and tubular arrangement appeared in the adenopapillary pattern and spindle-shaped nuclei were found in the smears from the case of spindle cell type. In a poor-prognostic case, nuclear pleomorphism, filled granular chromatin and multiple small nucleoli were found. This nuclear atypism suggests “potential malignancy” as has been suspected by the authors.
Recently, the fine needle aspiration biopsy (ordinary method) has been generally used for the cytologic diagnosis of tumors in various organs. However, the amount of specimens taken by the fine needle aspiration biopsy is occasionally not big enough for the cytologically correct diagnosis. For the improvement of this problem, the puncture cytology of an electrically rotative thorn needle (the new method) was devised and applied to various tumors. The results of cytodiagnosis using the new method were evaluated and discussed as follows. Instruments for the new method consist of a disposable rotative thorn needle (0.64mm in diameter) with its guide needle (1.0mm in outer diameter) and a handy motor. Following cell collection with the thorn needle, aspiration using the guide needle was done and the combined results of these two procedures were taken as the results of the new method. The results by the new method were compared with those by the ordinary one concerning the cytologic findings and the number of collected cells. During the period from 1977 to 1979, 30 mice with implanted tumor and 52 operatively removed tumors and 36 biopsied tumors in dlinical patients were studied. The new method resulted in finer cytologic findings and a larger number of collected cells than did the ordinary method. Especially for solid tumors with hard consistency and of a fibrotic nature, the new method was significantly superior to the ordinary one in the number of collected cells. No complications were experienced in application of the new method to clinical patients. It can be concluded that this new method has good indication for the cytologic diagnosis of the solid tumor with hard consistency and of a fibrotic nature, which is impossible to diagnose correctly by the ordinary fine needle aspiration biopsy because of the small amount of specimens it gives.
Twenty two patients with cervical carcinoma in situ were clinically and cytopathologically studied during the past 5 years in the Koseiren Takaoka Hospital. Incidence of the carcinoma in situ was 0.25% of all the gynecological patients and the ratio of the carcinoma in situ was 21.4% of all cervical neoplasia. The mean age of these patients was 43.5 years old. Macroscopically, slight cervical erosion or smooth cervixes were observed in 77.2% of the 22 cases. According to the histologic classification by Frick's three types, type III was 59.1%. As regards the differenciation of the carcinoma, poor differenciated type was 68.2%. And the carcinoma in situ accompanied with dysplasia was 80% of these cases. Accuracy of the cytological diagnosis was 54.5% out of the 22 specimens. Both IIIa and IIIb classified by the ‘Smear Test’ were keratinized types or minimal cancer. Though it was difficult to classify into small cell types or large cell types by ‘Patten's Method’, it was possible to differenciate into keratinized types and non keratinized types; the ratio of the keratinized-type carcinoma in situ was 27.3%. In addition to this, the third type differenciated cell proposed by Graham was found in 72.7% of these specimens. These results apparently indicate that Graham's proposal is useful for diagnosis of carcinoma in situ. We also confirm that the higher grade type of carcinoma in situ is more easily found than that of the lower one, because the ‘Frick's Type III’ was the majority of all carcinoma in situcases.
Metastatic carcinoma of the uterine cervix of extrapelvic origin is very rare. From our experience, however, the incidence of metastatic adenocarcinomas among metastie carcinomas of the cervix is as high as 26.1%. The paper is to report seven cases of those carcinomas, of which six were originated in the stomach and a case in the sigmoid colon. The histology of 3 cases of gastric origin showed signet-ring cell carcinomas and the remaining 3 were tubular adenocarcinomas. Cytologically, average sizes of cells (17.0-10.9) and nuclei (10.3-7.77) which have been metastasized from a gastrid carcinoma are smaller than those of the primary carcinoma respectively. The number of nucleoli in the carcinomas of gastric origin is 1 or 2 which are fewer than that in the primary carcinoma. Appearance of signet-ring cells in cytology is undoubtedly characteristic of the tumor of the same histology type and is observed in 10-20% of tumor cells calculated on the scattered cell area, whereas in the cases of tubular adenocarcinomas, signet-ring cells appear only exceptionally (0.7-6.4%). Clusterization, although not prominent, is still seen in. both types of gastric carcinomas, but the grape formation, honeycomb pattern, and pallisading pattern are rarely observed. In the case of the carcinoma from the sigmoid colon, the cells are high-columnar with abundant cytoplasm. Their nucleoli resemble those of the primary adenocarcinoma in number. Pallisading pattern which consists of highcolumnar cells is most striking findings in this case. The clinical findings reveal that the average age of patients in 7 cases was 38.1 years and most of the cases developed abnormal genital bleeding as a chief complaint with ovarian enlargement. The significance of the metastatic adenocarcinoma of extragenital origin on a routine cytological survey of the cervix is emphasized, if adenocarcinomas of the cervix uteri are seen in young patients associated with a mass in the ovary. Clinical and cytological findings of the neoplasm are also discussed in comparison with the review of the literature.
A case of 15 year-old-girl with the ovarian papillary cystadenoma with borderline lesion was presented with special reference to the comparison between histology of the tumor and cytology of the cyst fluid incidentally obtained by peritoneal paracentesis. The patient visited to the hospital because of increasing abdominal girth. The physical and laboratory examinations revealed the cystic tumor of left ovary and profuse ascites which contained a few clumps of slightly atypical columnar cells with occasional mutual inclusion in the cytological examination suggestive of borderline malignancy. At surgery, there were 7000ml of bloody ascites and the cystic tumor of left ovary with rupture. The cytological examination of the ascites at operation also showed several large groups of columnar cells with nuclear overlapping and variation in size. The pathological examination revealed the papillary cystadenoma with borderline lesion characterized by the noninvasive papillary growth of the cuboidal cells with single layer and considerable exfoliation of the tumor cells into the lumens and minimal nuclear abnormalities. From the view of the pathological and surgical findings, it was inserpreted that the atypical cells detected in the initial ascites were derived from the detached tumor cells of papillary cystadenoma with borderline lesion. The cytological characteristics of the ovarian papillary cystadenoma with borderline lesion was described and further discussed in terms of the cytological difference between 4 cases of frank papillary cystadenocarcinoma of the ovary and our particular case.
Lürmann reviewed 200 cases with carcinoma of Itartholin's gland reported tiil 1974. But the reports about the exfoliative cytology of carcinoma of Bartholin's gland are very few. Recentic, we have experienced two cases with primary squamous cell carcinoma of Bartholin's gland, and we could make the diagnosis from the exfoliative cells. In this paper, we report the cytological findings obtained in these two cases with typical features of squamous cell carcinoma.
Although the exfoliative cytology is widely accepted as a diagnostic tool for vaginal, sputum and body fluid smears, it's application on dermatologic field is still extremely limited. Here, we present twelve cases of the dermatologic diseases, in which we could make exact diagnosis by cytologic procedures on the smears from the skin surface lesions. These cases include six squamous cell carcinomas, one basal cell epithelioma, one extramammary Paget's disease, one malignant melanoma, and one adenocarcinoma of sebaceous gland. The diagnosis of these cases were confirmed later by histologic examination on the biopsy specimen. Our results strongly suggest that the cytologic approaches for dermatologic malignancy will be a useful diagnostic tool, especially in those of the ulcerated skin lesion.
This report describes a rare mammary cancer consisting of argvrophii cells, which was found in the right breast of a 56-year-old woman. The tumor was solid and 2.2×1.6cm in size. The imprint smears showed a relatively uniform cellular morphology with sligh atypicality and partly, a glandular arrangement of tumor cells. Although the lesion was histologically diagnosed as mammary intraductal carcinoma due to conventional pathology; many tumor cells were proved to contain the argyrophil granules in the cytoplasm by Grimelius stain. Also, an electron-microscopic study revealed a cored type of secretory granules in the cytoplasm from 250 to 500mμ in diameter.
This paper has reported the results of histopathological observation of thyroid gland in a 67-year old woman treated with Sodium Iodine 131I (13, 500 rads) for hyperthyroidism 12 years before. The left lobe of thyroid gland was nodular, elastic firm, and enlarged to thumb tip in size. Thyroid scan revealed evidence of selective accumulation of 131I as hot nodule within the region of the left nodular goiter and outside of the right lower lobe. Aspiration biopsy smears of the goiter are as follow; Epithelial cells found in tight cluster and a. few sheets. On M-G-G staining, there were blue-stained coarse granules of various sizes in the cytoplasma. The cell borders were ill-defined. Most of nuclei showed nuclear abnormalities with hyperchromatism and giant atypical forms. Some of nuclei had ill-defined nuclear border and intra-nuclear vacuoles. Histological findings of goiter revealed follicular adenoma and reduction in the size of the right entire lobe and left one except adenoma. Dense hyaline fibrosis was noted in many areas. In these regions, the follicles were clearly atrophic and lining cells were seen to have large irregular, hyperchromatic nuclei and cytoplasmic vacuoles. These changes were considered to be consistent with radiation effect due to Sodium Iodine 131I treatment. Irradiation changes of follicular epithelials should be recognized and differentiated from the ne plastic changes which they resemble, in.needle aspiration biopsy of thyroid gland of patients previously treated with 131I for hypertyroidism.
Cytological examination of the urinary bladder carcinoma with a chorioncarcinoma component in a 67-years old male is described. Papanicolaou staining of urine sediment showed cell clusters of malignant cells and large mononuclear, large multinuclear cells mingled with red and white blood cells. The patient's urinary pregnosticon planotest during preand post-operative periods was positive, and gynecomastia was present after surgery. Histological investigation of the bladder tumor revealed the presence of transitional cell carcinoma and chorioncarcinoma.
Six cases with primary carcinoma of the biliary tract diagnosed from the cytology of the bile obtained by percutaneous transhepatic cholangiographic drainage (PTCD) were presented. Early adenocarcinomas in 3 out of the 6 cases in which one extrahepatic duct carcinoma, one common bile duct carcinoma and one duodenal carcinoma at the papilla Vater involving the ampula were included, were resected with complete recovery. Tumors in other 3 cases all of which were not removed, were diagnosed as an advanced squamous cell carcinoma of the pancreas head, an advanced adenocarcinoma of the common bile duct and an advanced adenocarcinoma of the pancreas head. It was noted that all cases with the carcinoma arising in the biliary tract were correctly diagnosed by the cytology of the PTCD bile. Valuability of the cytologic diagnosis on the bile and cytological characteristics of the carcinoma cells found in the bile in comparison with histology were discussed.