Concerning various vacuoles seen in the cytoplasm, we studied and reviewed the origin, property, differentiation, and diagnostic significance. Materials were stained with Papanicolaou, hematoxylineosin, PAS, alcian-blue, mucicarmine, Giemsa and Sudan III. Vacuoles were classified as follows: 1. Classification by origin. a. functional vacuoles i. secretory type-glandular cells ii. storage type-glandular, fatty cells iii. phagic typehistiocytes, macrophages b. non-functional vacuolesdegenerative vacuoles in various cells. 2. Classification by property a. large vacuoles-glandular cells, signet ring cells b. vesicles-histiocytes, various degenerative cells c. single vacuoles-signet ring cells d. multiple vacuoles-glandular cells, histiocytes, degenerated cells 3. Classification by the kind of cells a. epithelial cells b. non-epithelial cells c. benign/malignant cells of epithelial and non-epithelial cells. Differentiation of these intracytoplasmic vacuoles becomes a problem mainly on the cells within the ascites and pleural fluid. Diagnosis is available mostly by Papanicolaou stain, and by adding the PAS and alcian-blue stainings, vacuoles appearing in the routine specimens can be understood.
The present study is a report regarding observation of exfoliated trophoblastic cells under light microscopy (LM) and scanning electron microscopy (SEM) by our new processing method. The cells were obtained from patients with D & C, spontaneous abortion, hydatidiform mole and destructive mole. The surface of syncytialtrophoblastic cell (ST) in normal early pregnancy has slender microvilli (mV) showing irregular distribution. In these samples adhesion to the adjacent mV and entanglement were observed. In case of abortion, there were two types of ST, with or without mV which showed a strong degeneration. Microvilli of ST observed in hydatidiform mole and destructive mole are thick, short and dense, as compared with normal early pregnancy. Syncytialtrophoblast of destructive mole tended to have thicker and denser mV than that of hydatidiform mole. It was suggested electronmicroscopically that ST appearing on the smear were syncytialsprout exfoliated from villi. Small processes which clearly differed from mV of ST were observed on the surface of multinucleated histiocyte. Cytotrophoblastic cell (CT), which had a smooth surface under SEM observation, showed hardly any difference between each disease. The cell which appeared as CT under LM had mV under SEM. It was suggested that it was probably the so-called intermediate cell which appeared in the shift from CT to ST.
The changes due to acetic acid application in exfoliated cells from carcinoma in situ of the uterine cervix were examined in 20 cases. Results obtained were as follows: Malignant cells showed decrease in nuclear diameter, increase in nuclear staining and decrease in nuclear membrane tension. However N/C ratio and irregular staining of the nuclear membrane were scarecely different from those of control specimen.
In order to study the accuracy of cytology in our mass screening program for cancer of the uterine cervix, 5, 677 negative smears out of 5, 741 cases were reexamined. By this second screening six cases of Class IIIa, one of Class IV, and one of Class V smears were picked up. The missed cases of Class IV and V smears were obtained from the same patient. 42 cases of Class IIIa, 17 of Class IIlb, 4 of Class IV, and 1 of Class V have been found in the first screening, and 8 cases with invasive carcinoma and 7 cases with carcinoma in situ have been detected among them in histologic examination. Accordingly, our false negative rate was 11.8% and false positive rate was 0.9%. The possible methods for quality control in cytology was discussed.
The following conclusion was drawn as result of irradiation of various dosage of radioactive rays, once each time, on the HeLa S3 cell. 1. The number of cells decreases with irradiation, but the tendency of decrease differs according to radioactive dosage. Under 500 rad, the cell was observed to restore to its former condition and even at 1, 000 rad, its existence was still recognizable. But over 2, 000rad, its capacity of infinite multiplication was almost denied. 2. As for the transformation of the cell nucleus, an increase and enlargement was observed. The rate of emergence of increased nuclei was relatively high in the mid-range dosage group (500-1, 000rad). The enlargement of the nucleus showed a difference according to irradiation dosage, and followed a similar tendency as in No.1 so that restoration to its former condition was not observable over 2, 000rad. 3. The enlarging speed of the large-scale nucleus cell of more than 25μ was almost the same, regardless of amount of irradiation dosage. 4. Through this study, we found out that the decrease of the number of cells, nucleus enlargement, and the rate of existence obtained by empirical formula coincide with each other, and that there is a close relation among them. At the same time, we became confident that it is possible to infer the radioactive effects from clinical examination of the nucleus enlarging phenomenon.
A total number of 2, 437 high risk subjects, who were mainly males, 40 years or older and chronic heavy smokers, have been examined to detect centrally located lung cancer by sputum cytology. 4, 123 specimens have been examined. There were 504 unsatisfactory specimens (19.7%) out of 2, 553 specimens as detected by Post Tube method, in contrast, there were only 20 unsatisfactory specimens (1.3%) out of 1, 570 specimens as detected by Saccomanno method. Those results demonstrate Saccomanno method is more effective than Post Tube method for cytological mass screening of lung cancer. Results from 3, 599 satisfactory specimens were as follows there were 3, 249 normal specimens (90.3%), squamous metaplasia with mild atypia 286 (7.9%), squamous metaplasia with moderate atypia 29 (0.8%), squamous metaplasia with marked atypia 1, atypia of glander epithelium cells 34 (6.9%), and malignant cells 0. Tow subjects were proved, in X-ray examination during the surveys, to have peripheral lung cancer. It is considered that periodical cytological examination of sputum for several years is necessary to detect centrally located lung cancer.
This is a 51-year old female case, gravida 3, para 1, complaining of postmenopausal spotting. Though nothing could be palpated in both adnexal region and the pathology report on the endometrial curettage was “atrophy of endometrium”, aspiration cytology from uterine cavity was positive (Vaginal pool smear and cervical scraping smear were negative.). Early adenocarcinoma of the endometrium was suspected and total hysterectomy and bilateral salpingo-oophorectomy were performed. Postoperavive pathology of uterus and both adnexe revealed a tiny focus of adenocarcinoma in the right fallopian tube. Eighty five cases with carcinoma of the fallopian tube have been reported in Japanese literature and our case is the 84th. Thirteen cases having carcinoma of the fallopian tube with positive cytology have been reported in Japan and this case is the 14th. We find that endometrial aspiration cytology is very useful for detecting primary carcinoma of fallopian tube.
A case with papillary hidradenoma of the vulva is reported. Cytologic findings of this tumor correspond to the characteristic histologic pattern of these benign growths. Microscopically, papillary hidradenoma derived from apocrine sweat gland, has been readily mistaken for low-grade adenocarcinoma. Therefore, cytology may be helpful in establishing the correct diagnosis of papillary hidradenoma.
A patient with ovarian mesonephric adenocarcinoma which metastasized to lungs is presented. She had neither gynecological nor abdominal symptoms, but had pulmonary symptoms and positive cytological findings in sputum. Two cytological findings, clear cell type and hobnail cell type, are in general present in mesonephric adenocarcinoma. This case showed atypical cells of hobnail cell type.
In a patient with gastric cancer, complaining of a painful mass in the right arm two months after operation biopsy was performed in this part. A definite diagnosis was not made and the disease was not thought to be carcinoma like sarcoma. Three months later, he developed a swelling of the chest wall of the right side. The picture of repeated biopsy seemed to be consistent with metastatic carcinoma. The microscopical and cytochemical findings of the cytologic smears and the electron microscopic findings showed typically the epithelial tumor without evidence of sarcoma. The incidence of the gastric cancer metastasis to the skin is low. The histological diagnosis of cutaneous metastasis is often difficult, especially in anaplastic carcinoma. The cytological and electronmicroscopic examinations are helpful to diagnose this kind of metastasis.
This is a case report of radiologically occult in situ squamous cancer of the right-sided pulmonary hilus, which had been detected. among 2, 377 persons by mass sputum cytology as a lung cancer detection program of Tochigi Cancer Detection Center. As a first clue for the detection, dyskaryotic squamous cells were firstly found in the sputum of a 68-years-old patient. Thrice re-examination of the sputum revealed various kinds of keratotic atypical cells, suggesting a squamous cell carcinoma. Stenosis of B-6-a was disclosed by a bronchoscopic exmination. By detailed histologic exmination of the bronchial tree in resected specimens, it was found squamous cell carcinoma confined to the bronchial epithelial layer of B-6-a, with about half rice-corn sized elevation and extending into the epitheliums of B6-a-i & ii in small parts. As a total, this in situ cancer was less than several millimeter in diameter.