Adenocarcinoma has been subdivided into several types according to the degrees of differentiation and the modes of spreading throughout the lung. Bronchioloalveolar cell carcinoma, a kind of the adenocarcinoma, has still some questions in the histopathological observations. In the present study, detailed investigations of the questions were histologically and cytologically carried out in 13 autopsies of the bronchioloalveolar cell carcinoma, and following remarkable findings were closed up. Bronchioloalveolar cell carcinoma may likely be subdivided to further two groups: Group A and group B, as follows: Group A (5 cases) was characterized histologically as the uniformity of tall columnar tumor cells, lesser degree of cellular atypism and high content of mucoid. Cytological findings in this group showed numerous cluster formation composed of tumor cells which had only slight atypism, and moderate hyperchromasia with high content of mucoid. Group B (8 cases) was characterized histologically as more atypical cancer cells and less content of mucoid than that of group A. Cytological findings in this group also showed more intensive degree of cellular atypism, hyperchromatia and abnormal nuclear cytoplasmic ratio than those of group A. Such cytological findings of the group B were very similar to that of well differentiated adenocarcinoma. The result of this study defined the relationship between the histological and cytological findings of bronchioloalveolar cell carcinoma, and it may estimate clearly the histopathological character of the carcinoma.
Small cell carcinoma is most malignant in lung cancer. Its prognosis varies according to the histologic subtypes. So, it is important to make the early diagnosis of histologic subtypes for the establishment of suitable treatment. We found that the cytological examination of the bronchial brushing specimens was useful for the early diagnosis of histologic subtypes.We made histological and cytological examination in twenty-three cases with small cell lung cancer. In the examination, it was revealed that cell arrangement, sizes and shapes of nuclei on the cytological specimens were important to make an accurate diagnosis for the histologic subtypes. The following cytological features are manifested for each subtype:(1) for oat cell type, round or ovoid nuclei are very small in size and naked, (2) for intermediate fusiform cell type, naked and spindle nuclei are arranged with a ribbon or a pallisade-like pattern, (3) for intermediate polygonal cell type, large and pleomorphic nuclei are arranged irregularly or with a ribbon-like pattern.
Giant cell carcinoma of the lung was cytologically studied, especially with reference to differentiation from those of adenocarcinoma. The materials used were sputum, and bronchial brushing specimens. The specimens were stained by the Papani colaou method. The giant cell carcinoma cells in sputum and bronchial brushing specimens were seen to be separately isolated pleomorphic cells with light green coloured, lacy cytoplasma. They were large with marked variety of cell size, multinucleated of usually more than three nuclei, and with prominent nucleoli of more than 4μ in diameter. On the other hand, the adenocarcinoma cells were usually arranged in clusters and, though also multinucleated, rarely of more than three nuclei.
The cytological examination of touch smears prepared from 3 patients with neuroblastoma, 2 with Wilms'tumor and 2 with pulmonary small cell carcinoma, were performed. The purpose of this paper is to know whether cytologically differential diagnosis of malignat tumors in childhood is possible or not. The specimens were stained by Papanicolaou's, May-Giemsa's and Giemsa's method. The findings of touch semears were compared with those of histological and electromicroscopic sections. Characteristics of neuroblastoma were as follows: 1) Tumor cells were seen in a single and irregular clusters.A few rossete formation were found. 2) Neuroblastoma cells were round or oval, almost naked, 8-22μ in size. 3) Nuclei of neuroblastoma cells were composed of highly increased chromatin with fine granular structure, and some of them had small nucleoli. 4) Electronic microscopy revealed that immature tumor cells were scanty cytoplasma with small numbers of organellas and moderately mature cells were abundant with many. Feature of these cells was characterized by the presence of numerous cytoplasmic processes excluding into the intercellular space. They contained numerous organellas and some neurosecretory granules. Wilms' tumor was as follows: 1) Epithelial cell clusters and sarcomatous spindleshaped cells in irregularly-overlapping clusters were found. 2) The nuclei of tumor cells were oval in shape, 9-22μ in size, and were composed of moderately increased chromatin with fine reticular pattern. 3) Under electron microscopy, the cytoplasma was fround abundant with many organellas and the desmosome and pseudolumen between adjacent cells were found. Pulmonary small cell carcinoma was followings: 1) The cytological findings were resemble to neuroblastoma in the point of the cell-arrangement and naked nucleus. 2) Tumor cells were 9-19μ in size and nuclei were composed of severe increased chromatin with irregular nuclear membrane. But a quantity of chromatin among the tumor cells was different in Papanicolaous'stain. By the cytological findings described above, it was possible to distinguish neuroblastoma from Wilms'tumor and pulmonary small cell carcinoma in diagnostic cytology.
Cytologic findings of nipple discharges from 71 histologically confirmed breast cases were analysed in this paper. The papillary clusters composed of over 30 ductal cells were found in the discharges from 18 out of 29 malignant breast cases and from 6 out of 42 benign breast cases. All of six benign cases with the papillary clusters had papilloma. Bloody discharges were found in 15 out of 29 malignant breast cases with discharge and in 5 out of 42 benign breast cases. 4 out of 5 benign cases with bloody discharge had papilloma. Bloody discharges with the papillary clusters composed of over 30 ductal cells were observed in 14 out of 29 malignant cases and only from 2 out of 42 benign cases. Marked atypical ductal cells were detected in the discharges from 15 out of 29 malignant breast cases. In the remaining 14 cases, it was available for diagnosis to take care of papillary ductal cell clusters.
In 1962, Umiker reported the difficulty of cytological diagnosis of voided urine, especially in class III group. Up to the present, it seems that this problem has been not resolved. We performed a statistical analysis and a karyomethric examination using available materials for cytology of Sakai Municipal Hospital from 1974 to 1977. Our statistical data were similar to Umiker's. In 84% we observed desquamated cell clusters in the voided urine of patients with transitional cell carcinoma. Consequently we conducted a karyometry on cells in clusters in the voided urine of patients with transitional cell carcinomas grade III, II, I and false positive. Totally 33 patients were karyometrically examined. The discriminant point between transitional cell carcinoma grade I and grade II was determined by the comparison of nuclear sizes (p<0.01). In examination of two more cells in a transitional cell cluster, if the sum of long diameter and short diameter of a tumor cell nucleus is 2.5 times larger than that of lymphocyte, the cell cluster is considered to belong to transitional cell carcinoma grade II or grade III. The comparison of the nuclear diameters among them, however, did not seem to be easy under microscope. Therefore we tried to convert the length to the dimensions concerning the discriminant point, using the ratio of long diameter/short diameter of the tumor cell nucleus with the size of discriminant point, that of the lymphocyte's nucleus of average size in the urine and the discriminant value of the sum of long and short diameters of tumor cell nucleus. Consequently, in case that observed more than two cells 6 times larger than a lymphocyte's nucleus in a transitional cell cluster, we suspected transitional cell carcinoma grade II or III. But in microscopic examination, when we put lymphocyte's figure on a tumor cell nucleus in the above condition, we are just able to place four lymphocytes on it, because we cannot put six figures of almost circle like lymphocyte on an elliptical figure like a nucleus of transitional cell carcinoma without an unfilled space. In this study the renewed transitional cells with clear cell dysplasia, renal tubular epithelium and glandular epithelium were excluded out of the karyometric examination of transitional cell carcinoma. Additionally we studied on the features of nuclei in all groups of transitional cell carcinomas grade III, II, I, false positive and negative respectively. The result concerning the karyometrical differentiation between transitional cell carcinoma grade I and grade II should be evaluated as a preliminary one, because the condition of desquamated cells, e. g. shrinkage, swelling, or other degenerative changes, could not be uniform as long as we would use the voided urine as materials and because the number of cases examined karyometrically were not enough to settle the conclusion. So we continued to confirm the above results in the practice of urine cytology almost for two years. In other words, we conducted supplementarily the urinocytological examination cytology from January 1978 to October 1979 on the basis of the above results. As result, we obtained more accurate information of urinary cytology in class V, IV, II follow up, II and I. In fact, a correct diagnosis could be made 94% in class V, IV and 83% in class H follow up, while the former 86%, the latter 55% in the previous data. However a correct diagnosis rate became lower in class III. The result in class III suggests that it is very difficult to distinguish between transitional cell carcinoma grade I and hyperplasia of non-malignant transitional epithelium only by the estimation of nuclear sizes.
The following conclusions were obtained from the impulse cytophotometric studies on DNA contents of specimens of various cervical lesions for the automated analysis. The specimens were obtained by shaving the cervical lesions with a Castroriejo electro-keratotome to a depth of 0.2mm.The measurements were made for DNA contents of the cells in various cervical lesions as follows: Normal squamous epithelium (4 cases); metaplastic epithelium (4 cases); mild dysplasia (2 cases); carcinoma in situ (4 cases);invasive carcinoma (3 cases); 1. In the cases with normal squamous epithelium, only diploid DNA value was predominant. 2. In the cases with metaplastic epithelium, the predominance of diploid DNA value with slight hyperdiploid value was characterized by its mode and its distribution was confined between diploid and hexaploid levels. 3. In the cases with mild dysplasia, the distribution of DNA contents was spreading over 8C. But, in the cases with dysplasia, the patterns of DNA contents in scraped cells were different from the mode of dysplasia for lack of dysplastic cells. 4. The cases with carcinoma in situ, it was tended to show further wider range of DNA distribution, spreading over 10C, and characteristic high level distribution from 3C to 6C. But, in the cases with carcinoma in situ, the patterns of DNA contents of scraped cells were so much influenced by other elements that stable CIS patterns could not be got from their histograms. 5. In the cases with invasive carcinoma, the range of DNA distribution was not significantly different from the range of CIS, but the hyperploid level value was lower than CIS value. In the cases with invasive carcinoma, scraped smears tended to show a wider range of DNA distribution and higher level distribution of hyperploid than the cases of cancer nestles did. 6. In the cases with invasive carcinoma, scraped smears can be utilized for automated cytology by ICP. But, in the cases with dysplasia and carcinoma in situ, scraped smears include very few cells derived from the lesions, so it needs to improve the analysis of histograms and combine a new technique to separate the hyperploid cells by flow system with cell sorter.
Cytological studies were performed for the purpose of comparing two kinds of smear preparations obtained by a cotton-bud and a spatula from the uterine cervix. The spatula scraping method was proved to be superior to the cotton-bud method in accurate detection, especially in the cytological diagnosis of dysplasia, while the spatula method is apt to give cytological specimen suggesting more advanced lesions than they really are, or apt to overdiagnose. Smears obtained by a spatula indicated smaller size of cells and higher nuclear cytoplasmic ratio than those by a cotton-bud. These contrasts come from the fact that a spatula scrapes epithelial cells from relatively deeper layers than a cotton-bud. Hence different criteria of morphological identification is required in the diagnosis of smear preparations by these two methods.
In order to avoid the quality degradation of Papanicolaou's staining frequently observed during coating procedure for fixation, we prepared and evaluated various fixatives for “dip-and-dry” method, and studied the practical application. The most suitable fixative was found to be 95% ethyl alcocol containing 4 to 6% polyethylene glycol with molecular weight in range from 1, 000 to 2, 000. Immediately after the smear was prepared, it was dipped in this fixative solution for more than 30 minutes and then dryed at room temperature. This preparation was kept in good staining condition at least for a week. This fixative is less expensive than coating fixatives on the market and its application for “dip and dry” method is more excellent than conventional coating method for preservation of good cytologic finding of Pap.-smear.
The clinical course in a case with arrhenoblastoma has already been reported in Sexual Medicine 5: 5, 34, 1978. Here are discussed pre-and post-operative vaginal smear findings and the levels of the circulating sexual hormones. Preoperative serum levels of estradiol and progesterone were normal (17.4-41.1pg/ml and 1.90-1.98ng/ml, respectively). However, the serum levels of testosteronew, re high (2.16-5.61ng/ml). Preoperative vaginal smears showed maturation index (MI) of 82/16/2, karyopyknotic index (KPI) of 5/29, and eosinophilic index (EI) of 2/98, indicating many parabasal cells, while intermediate cells were pale, isolated, and disseminated. These findings were similar to those in women after menopause. Immediately after the operation, the serum levels of the sexual hormones were within the normal range, and the patient had menstruation about 3 weeks later. One year after the operation, vaginal smear taken on the 11th day of the menstrual cycle indicated MI of 0/22/78, KPI of 74/26, and EI of 79/21. These findings were similar to those in normal women. The preoperative vaginal smear findings are considered to be specific cell findings attributable to the effect of testosterone.