An attempt was made to elucidate how the intrauterine device (I.U.D.) disturbs the implantation by means of morphological and cytological changes of endometrium caused by attachment of the I.U.D.
Cytological examinations were made on 125 women who wore I.U.D. by touch smear of removed I.U.D. during mid-luteal phase. Endometrial biopsies were done in 80 of 125 cases.
Cytological examination was studied with histology of corresponding endometrium. The endometrium was fixed and stained by Hematoxylin-Eosin and Watanabe's silver staining, and the touch smear was stained by Papanicolaou's staining. 70% of 80 cases showed abnormal findings of endometrium histologically.
In the silver staining, remarkable increase of the reticulum fibers of endometrial stroma was found in 85% of 80 cases.In the cytological study, 87 cases revealed class I, 38 cases were class II and there was no cases over class III. There is no relationship between cytological findings and wearing period of I.U.D. Histiocytic giant cells were found in 50% of cases and increase of stroma cell was noticed in 91%.
Which shows that reactive change of endometrium against I.U.D. is remarkable and increase of stromal cells consisting mainly by spindle type fibroblast was closely related to the histological findings, which showed hyperplasia of endometrial stroma.
These results imply that stromal changes seem one of the mechanism of the contraception of I.U.D.

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We observed the fluctuations of endometrial alkaline phosphatase (ALP) activity, accompanying the menstrual cycle, was studied by applying the enzyme histochemical method to the cytodiagnosis. At the same time, the influence of sex hormone on the activity of this enzyme was examined by determining its blood levels.
As a result, it was confirmed that the ALP activity of the endometrium is weak in the early proliferative phase; thereafter this activity increases gradually with the menstrual cycle, and on the day of ovulation, or a few days later than that, it reaches a peak, and thereafter maintains a relatively high level of activity until the mid-secretory phase. When it reaches the late secretory phase, the enzyme activity becomes weak again. Furthermore, regarding the relationship with the sex hormone levels in the blood, the activity reaches a peak about two days after a peak of the blood estradiol level had appeared. Also, it was revealed that the activity attains a low value slightly after the mid-secretory phase, during which the progesterone level shows a high value. It was suggested that the activity of this enzyme is activated by estradiol and, on the other hand, suppressed by progesterone.
Although there are still more or less technical problems remaining, in the application of enzyme histochemistry in cytodiagnosis, much more development of the cytodiagnosis may be anticipated in future by adding the enzyme histochemical method to Papanicolaou staining.

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Using a cell line (JOHYL-1) of human ovarian anaplastic disgerminoma, a sensitivity testing of anticancer drugs was studied. After exposure of anticancer agents, a cytomorphological study was made to obtain results as follows.
1) A phase-contrast microscopic examination revealed that (1) large and small prickle cells with swelling of the cytoplasm and the nucleus and (2) cytoplasmic granules.
2) Papanicolaou staining revealed that (1) a decline in staining, swelling, and vacuoles of the cytoplasm, and obscure cell membrane, (2) a reticular change in chromatin, swelling and vacuoles of the nucleus and (3) swollen and obscure patterns of the nucleori.
3) By the measurement of the major axis of the nucleus suggested that the number of the swollen nucleus corelated to the number of dead cells each other.
4) By analysis of nuclear DNA histogram by Impuls cytophotometer. 5 FU, MC and VCR showed a cycle specificity as reported previously. CQ rated as the foremost in the cytocidal effect showed stoppage of the cell cycle.
Therefore, we concluded that it was possible to state that nuclear diameter can be used as the parameters for the sensitivity testing of anticanceragents assess the relationship between swelling of the nucleus and death of the cell can be data of nuclear decline the as the parameters for the sensitivity testing of anticancer drugs.

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Angio-immunoblastic lymphadenopathy is a systemic disease, of which prognosis is usually unfavorable, characterized by generalized lymphadenopathy consisting of dendritic small vessels with swollen endothelial cells and the proliferation of so called immunoblasts. Fever and dysproteinemia are frequently present. Imprints of lymph node biopsies obtained from 11 patients with this disease revealed the pleomorphic cellular findings of the proliferation of plasmacytoid cells and large lymphoid celle in addition to small lymphoid cells, small lymphocytes and prolymphocytes (May-Giemsa's stain).
Both plasmacytoid cells and large lymphoid cells are included in so-called immunoblasts in a wide sense. Patients with high frequencies of plasmacytoid cells and/or large lymphoid cells in imprints of lymph node biopsies were frequently suffered from fever, high serum LDH level and/or decreased lymphocyte counts in the peripheral blood. They often had poor response to therapies, resulted in unfavorable prognosis. Therefore, it was suspected that the cystological findings of lymph nodes were correlative to the clinical findings and prognoses of patients with this disease.

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Twenty two cases of T cell type lymphoma out of fourty four cases of malignant lymphoma in Kyoto National Hospital from 1975 to 1981 were classified according to LSG and Lukes-Collins classification.
The following is the morphological and cytochemical features of T cell lymphoma cells.
1) The cells of T cell lymphoma occured in adults showed pleomorphism including marked variability in cell size, and lobulation, distortion, and convolution of nuclei.
The nuclear to cytoplasmic area ratio was larger and the cytoplasm stained weaker in T cell type than B cell type.
Some of the large malignant cells were morphologically similar to Hodgkin cells.
2) The histological and cytological features of pleomorphic T cell type were similar to adult T cell leukemia, but in adult T cell leukemia the number of small lymphocyte like malignant cells was more than that of pleomorphic T cell type.
3) Two cases with thymoma occured under twenty years of age, and in these cases the malignant cells were less pleomorphic.
4) On the other hand, the cells of B cell lymphoma showed monotonous pattern.
Malignant cells which had cleaved nuclei were follicular type in general, and those cells which had noncleaved nuclei were all diffuse type.
5) The cytoplasm of T cell lymphoma and T cell line contained PAS positive granules which were thought to be glycogen. And these granules stained differently according to cell size. Those of B cell lymphoma, B cell line, and Null cell line contained no PAS positive granules. But in some of the immunoblastic sarcoma, a few PAS positive granules were observed in cytoplasm which showed the presence of immunoglobulin.
6) The small malignant cells in T cell lymphoma showed a focal dot like stain in cytoplasm with acid phosphatase, but the large cells showed a diffuse stain.
In B cell lymphoma, B cell line, and Null cell line only several acid phosphatase positive granules were observed diffusely in cytoplasm.

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A cytofluorometric evaluation of the DNA contents of tumor cell nuclei was undertaken in 6 cases of giant cell tumor of bone. These DNA histograms and DNA distribution patterns were compared with other bone tumors and each other.
1) By the method of cytofluorometry, it was difficult to measure accurately the DNA contents of the giant cell nuclei.
2) In the stromal cells, the nuclei, whose DNA contents were larger than 8C or whose DNA contents were intermediate between 2C and 4C or between 4C and 8C, appeared and increased. The DNA histograms and the DNA distribution patterns of giant cell tumor of bone were similar to that of the bone malignant tumors.
3) There were no ovbious difference between the DNA contents of giant cell tumor Grade I, II and III, and no ovbious difference whether this tumor had any recurrence and metastasis or not. In Grade I tumor, the proportion of the cell nuclei which had the DNA contents more than 4C seemed to be lower compared with Grade II and III tumor.
4) On the view of the DNA contents, giant cell tumor of bone can be identified as a border line lesion between benign tumor and malignant, or as an occult premalignant lesion. It is significant to measure the method of cytofluorometry also on this point.

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Distributions of nuclear DNA content in 40 cases of human gastric cancer were assessed by microspectrophotometry of Feulgen-stained imprints and the relationship to the histologic types was evaluated. Although correlation was not clearcut, there was a tendency that well differentiated adenocarcinomas exhibit a bimodal DNA histogram pattern and poorly differentiated adenocarcinomas demonstrate a very broad DNA distribution with or without a distinct peak. Cellular DNA content was in a linear relationship to nuclear size, and it seemed possible to grossly estimate the variability of DNA content by eye on an usual cytology preparation. DNA histogram of signet-ring cell carcinomas was rather characteristic and showed a high peak of narrow width which was composed of typical signet-ring cells, suggesting that the cells are Go population.

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There have been some instances of dying from adenocarcinoma which arise in the peripheral bronchus of the lung and tend to spread by way of vascular system early in the postoperative course of the disease unexpectedly.
Accordingly the cytomorphology of those adenocarcinoma cells in correlation with their histological differentiation and clinical stage were reviewed in order to determine whether it may offer valuable information for improving the result in the treatment of those neoplasms.
Material and Methods: The specimen examined in this study consisted of imprint touch smear and histological sections from a total of 53 cases in which surgical resections had been performed.
All of the cytological slides were stained with Papanicolaou, PAS and alcian-blue stain respectively.
As far as the histological differentiation is concerned, all of the cases were classified as well differentiated type in 29, moderately differentiated type in 9 and poorly differentiated in 6, including 9 cases composed of tall columnar epithelial cells as alveolar cell type, separately.
With assignment of the clinical stage, they included 24 cases in stage I, 7 cases in stage II, 17 cases in stage III and 5 cases in stage IV.
Results: Based on the observation made in this study, there was a striking correlation between the histological differentiation and clinical stage.
The degree of the histological differentiation increased with the number of cases belonged to stage I and II.
Subsequently, the incidence of the alveolar cell type was approximately, in accordance with that of well differentiated type.
The pleomorphism, hyperchromasia, folding effects of nuclei among cytologic findings observed in the slides stained with Papanicolaou's method related to both of the histological differentiation and the clinical stage.
There was, however, scanty of impressive cytologic findings considered useful for comparison with the histological differentiation and the clinical stage in all cases of alveolar cell type.
In view of objective cells stained with PAS were classified them into diffuse, granular and block type, if they were positive.
A total of 100 adenocarcinoma cells were observed in each of them and the poorly differentiated type yielded the lowest positive rate, compared with other types among which the positive rate did not significantly differ.
No difference was, however, noted in between the positive rate of cells stained with PAS and the clinical stage.
By the classification mentioned above, the diffuse type found to be rare in the poorly differentiated types was noted in a large percentage of cases belowing to alveolar cell type.
Furthermore, granular type was found to be inconscpicuous in poorly differentiated types, whereas the block type was present remarkably at a high rate in the alveolar cell types.
Those three types had no relationship to the clinical stage.
The incidence of the cells which had positive with alcian-blue stain and belonged to IX type (cell surface type) by Yatani's classification was significantly high in the alveolar cell type.
From the view of the clinical staging, the positive rate was relatively low in the cases of clinical stage III and IV.

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The present communication describes cytologic and histologic features of a carcinoid tumor (argyrophil cell carcinoma) in the uterine cervix, a rare condition in the female genital tract. A 49-year-old Japanese woman complaing of abnormal genital bleeding was diagnosed as in stage 2a carcinoma of the uterine cervix. In spite of the extended hysterectomy with pelvic lymph node dissection, the patient died from pelvic recurrence and systemic metastasis, which resisted against X-irradiation and chemotherapy. The tumor was composed of undifferentiated or poorly differentiated cells with round nuclei and scanty cytoplasms the cell were arranged compactly in major portions of the tumor but in trabecular pattern in some portions. A fairly large number of neoplastic cells showed argyrophilia by the Grimelius stain, and cytoplasmic neurosecretory-type glanules were found in the cytoplasm by electron microphotographs. The cytological findings as follows: Exfoliated tumor cells with round or oval nuclei of minimum polymorphism were either separated from each other or arranged in a loose clusters. The cytoplasm was scanty, and there were a fair numbers of naked nuclei. The nuclear chromatin was moderately increased and showed coarsely granular pattern. The nucleoli were not so prominent.
Unlike carcinoid tumors of digestive organs, the tumor in the uterine cervix was proven malignant in its clinical course, because of this, cytological and histochemical screening of undifferentiated carcinoma of the cervix has been highly recommended to find out this variety of malignant lesion.

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Operative vaginoplasty using the rectum was carried out on five patients, between the ages of 18 and 21, with congenital abscence of the vagina. The long term results, 2-5 years, were analysed for cytological, histological, and physiological changes.
Two weeks after the operation the neovaginas were found to bleed easily and smears showed the presence of a large number of erythrocytes, leucocytes and mucoussecreting goblet cells. Up to 4 months after the operation, inflammatory cells and cell-fragements were occationally observed.
Throughout the observation period columnar epithelial cells were present in each smear, though mucoussecreting goblet cells gradually decreased.
The histology of the neovagina 5 years after the operation was similar to that of the original rectum. No squamous metaplasia was detected either cytologically or histologically.
Clinical observation indicated no vaginal atrophy nor stricture and patients were satisfied with their sex life, indicating favolable prognosis.

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A case of malignant lymphoma, in which atypical lymphocytic cells were revealed by the cytologic examination of vaginal smear and urinary sediment, was presened.
The patient, 71 year-old female, visited our hospital because of atypical genital bleeding and urinary retension.
The vaginal smear (Papanicolaou-stained) showed many scattered single cells, which were small, round or oval shaped and had scanty cytoplasm. The nuclei were mostly round-like and a few cleaved in shape, and had fine or coarse granular chromatin. Some mitotic figures were observed, however, one or two nucleoli were present in a few of the cells. Also in the urine and ascites, the same tumor cells were showed by the cytologic study.
On further examination of the vaginal biopsy specimen, this case was diagnosed as small-cell-type of non-Hodgkin's diffuse lymphoma by the classification of LSG. The origin of this lymphoma was presumed to be in the vagina, although the pelvic organs had been widely invaded by the tumor, as the result of autopsy.
We think that exfoliative cytology may be useful in establishing a diagnosis of malignant lymphoma.

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Histochemical staining for alkaline phosphatase was applied to cytological specimens from a mixed mesodermal tumor of the corpus uteri, for the aid of morphological diagnosis of cytology.
In cytological and histological findings, the main tumor consisted of endometrial carcinoma-like cells and sarcomatous cells. Cartilaginous tissue and osteoid-like elements were observed histologically, but those elements were not recognized on imprinted materials. Cytochemically, carcinomatous cells had high activities of alkaline phosphatase but sarcomatous cells did not show activities of alkaline phosphatase.
It is convenient to diagnose epithelial cells and mesenchymal cells on imprinted materials by staining for alkaline phosphatase.

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The occurrence of the mesenteric fibromatosis is rare. The mesenteric fibromatosis of 49 year-old female positively diagnosed by imprint cytodiagnostic procedure during operation is reported hereinef ter.
The tumors were 9.5×13, 4.5×6 cm in size, oval shaped, light yellowish-white in colour and elastic hard in consistency, which invaded submucosal layer of the small intestine.
Imprint cytodiagnosis revealed that the tumor cells were spindle, pleomorphic and round in shape and scattered isolatedly or in small groups.
The cytoplasma were distinct, stained light green by Papanicolaou's staining method, and their margin showed fine fibrillary pattern.
Their nuclei were oval or short-spindle shaped, and chromatin pattern were granular with prominent nucleoli.

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A case of 49 year-old male with chronic pancreatitis was reported. His chief complaints at admission were right epigastralgia and jaundice. Percutaneous transhepatic cholangiography (PTC) showed a stricture of the distal common bile duct with dilatation of the proximal portion and pooling in the pancreatic head, suggestive of cancer of the pancreatic head. Cytological study in the bile from PTC-drainage also showed atypical cells diagnosed as Positive. Laparotomy was performed and a swollen pancreas in head was found. So, pancreatectomy was done. However, histopathological study showed no cancer, but confirmed chronic relapsing pancreatitis with benign stricture of the distal common bile duct and inflammation in the dilated proximal bile duct.
Therefore, we had erroneously considered the abnormal regenerating epithelia in the bile duct to be the malignant cells.

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Malignant fibrous histiocytoma probably arising from the greater omentum of 47 y. o. woman was examined pathologically and cytodiagnostically, in parallel with its ultrastructual examination. The results are summarized as follows:
1) Pathological findings included the bundle like arrangement of short or long spindle cells and vacuolated mononuclear and large multinuclear cells.
2) Cytodiagnostically, two types of cells were found; fibroblast-like cells and histocyte-like cells. The former was composed of spindle and fibrous cells whose chromatins were sometimes coarse granular and histiocytic cells whose cytoplasmas were foamy with prominent nucleoli.
3) Ultrastructurally, the presence of fibroblast like and histiocyte like cells were confirmed, although the latter was less encountered.

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A case report of a 76-year old female with malignant pulmonary adenomatosis was presented. With sputum cytology after transbronchial lung biopsy (TBLB) class IV was concluded. Right lobectomy was done and the histological finding suggested a specific type of welldifferentiated adenocarcinoma of the lung.
It was found cystologically that desquamative atypical cells had a tight intercellular binding with a formation of well-differentiated adenocarcinoma mass. In the histological findings, a tall cylindrical cancer cell with almost no atypism of nucleus and cytoplasm proliferated forming islet-like clusters around the alveolar wall. The reaction of interstice was poor.

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