A cervical cancer screening was performed on 204, 186 women in Fukuoka prefecture during 1976-1980 and 167 cases of squamous cell carcinoma, 101 cases of carcinoma in situ (CIS), 4 cases of adenocarcinoma and incidentally 1 case of endometrial adenocarcinoma were detected. The detection rate of invasive cancers including CIS was 0.24% for the unscreened population and 0.09% for the rescreened group. The higher detection rate was observed in older age people of the unscreened group, but this tendency was obscure in the rescreened group. This result suggests that a considerable part of mass screening in the older age people may consisted of women who had some complaints or symptoms.
A study on the screening records of 129 cancer patients revealed that 57 cases were detected at the second screening, 31 cases at the third screening, 18 cases at the forth screening, and 23 cases had five or more screenings. Twenty-seven cases (20.9%) had a history of abnormal cytology, but subsequently performed histologic examinations failed to confirm the cancer. Re-examination on the “negative” smear specimens obtained for the screening just before the detection of cancer disclosed abnormal cells in 7 out of 30 patients with squamous cell carcinoma and also in 7 out of 21 CIS patients. The false-negative rate in our laboratory was thus estimated as 9.6-12.5%. Because the rate of CIS to invasive cancer extremely declined when the screening was performed at more than 4-year-interval, more frequent screening must be requested. The follow up of cases with Pap. class III was also considered to be important for detecting early cancers.

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Endometrial aspiration cytology has been carried out in 57 cases with primary ovarian adenocarcinoma. The specimens were observed in comparison with the ascitic ones and those of endometrial carcinoma. The results are as follows;
1. In 47 cases (82.5%) out of 57 the aspiration cytology was successfully performed.
2. Thirteen cases or 27.7% were diagnosed as positive by endometrial aspiration cytology. Among 13 cases 8 were diagnosed only by endometrial aspiration cytology, and in these cases ovarian cancer did not invade to the endometrium.
3. Seven cases out of 17 with positive smear in ascitic 6. Comparing with those of endmetrial carcinoma, specimens of ovarian carcinoma revealed apparently clear background without bleeding or debris and cancer cells with large nuclei.
It is emphasized that this method is useful in making morphological diagnosis of ovarian carcinoma with-out difficulty even if the cancer does not invade to the uterus.

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Atypical cells which look alike malignant cells are often observed in cytology of postmenopausal women. Retrospective studies on cellular features of 54 cases (3.3%) out of 1638 postmenopausal women exhibiting cytological atypia without abnormal findings of colposcopy and histopathologic proof were carried out. Results are as follows;
1) Forty four (67.7%) out of 65 class Ma, 3 (6.3%) out of 48 class Mb and 7 (9.3%) out of 75 class IV or V cases revealed only benign histology both at the first cervical cancer detection clinic and during follow up observasions more than one year.
2) In hormonal cytology, 54 cases were grouped into 4 early menopause, 24 crowded menopause and 26 advanced menopause.
3) Enlarged nuclei with blurred chromatin in parabasal cells, hyperchromatic nuclei in endocervical cells, tissue repair, inspissated mucus, parakeratosis and koilocytosis caused misinterpretation for the presence of neoplasia in class III specimens.
4) Cellular findings of false positive cases were marked enlarged nuclei with blurred hyperchromatic pattern in parabasal cells, irregular nuclear border, unevenly distributed chromatin, macronucleoli, anisokaryosis and karyorrhexis.
5) On reevaluation of 54 cases, 18 (33.3%) were diagnosed as negative, however, 36 (66.7%) were still regarded as suspicious or positive due to atypia in considerable degree observed in postmenopausal samples.

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In order to advance the accuracy of gynecological cytodiagnosis, we studied patients in the Department of Gynecology, Cancer Institute Hospital, who were falsenegative and false-positive in cytodiagnosis.
Of 1525 patients with cancer of the uterine cervix, including patients with stage 0 cancer, 55 (3.6%) were false-negative, and 80% of these patients had stage 0 cancr.
False-positive patients comprised 0.5% of about 53000 outpatients (216 patients of class IIIa, 34 of class IIIb, 18 of class IV, nine of class V; total, 277), and they accounted for 15.9% of 1747 positive patients including those with cancer.
False-negative findings are frequent if the lesion is limited in a small range or in patients in whom samples are re-taken within one month after intravaginal procedures.
This suggests the necessity for the time of reexamination of cytodiagnosis to be considered.
In false-positive patients, it is necessary to clearly differetiate those who are true false-positive in cytodiagnosis form those who are true positive in cytodiagnosis, but false negative in histopathologic diagnosis.
And, in some cases, it is difficult to resent the appropriate lesion by histopathologic diagnosis in the outpatient clinic if the lesion is an initial one
In our department, approximately 12% of the patients with stage 0 cancer are negative in histopathologic diagnosis. Therefore, these patients are definitely diagnosed by conization.
Target punch biopsy under colposcopy should always be undertaken in outpatient, and the diagnosis should be confirmed by conization if there is any doubt.
In addition, it is important to follow up the patients who are positive in cytodiagnosis, but negative in histopathologic diagnosis for a long time.

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The following results were obtained from the 80 cases of endometrial carcinoma by aspiration cytological tests which were carried out during recent seven years since 1976 at Kanagawa Center for Adult Diseases.
1) These 80 cases were constituted of 60 cases of class V, 10 of IV, 6 of III, 3 of II and 1 case of class I, and the percentage of 76 cases of higher classes than III reached 95.0%.
2) For the identification of the present carcinoma cells, the use was proposed of the average nuclear diameter of neutrophilic leucocytes as the standard. While the nuclear diameter of normal endometrial cells to this value was in the ratio of 0.8-1.0, most of the carcinoma cells were exclusively in the ratio of 1.0-1.5, some being more than 2.0. In the cases of endometrial hyperplasia, the ratio was 0.8-1.2.
3) The background of the smear specimen of the present carcinoma usually showed many necrotic masses, and it was diagnostically important to find out degenerating carcinoma cells among these masses.
4) The nuclear chromatin pattern was not sufficient to diagnose the cells as carcinomatous. Though the nucleolus is important for the diagnosis, it is not always observed in the present carcinoma cells. In conclusion, it is necessary to check up the mode of cell mass, the background of smear specimen and the nuclear diameter.

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[in Japanese]

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One hundred and two bone marrow biopsies using Jamshidi needle were performed and imprinted on glass slides immediately after removal of marrow in patients with malignant lymphoma and some solid tumors. The accuracy of imprint's diagnosis was compared to that of histopathological diagnosis for these biopsy specimens. The histopathological diagnosis of bone marrow biopsies was positive in 25 of 102 cases and all of them were also positive by imprint cytology. However, since one benign patient with drug-induced granulocytopenia was wrongly diagnosed as acute leukemia by both methods, 24 cases were truly positive for infiltration of bone marrow. On the other hand, 4 (5.5%) of 73 patients with negative histopathological diagnosis of biopsies were falsely positive in imprints. All these 4 cases were patients with non-Hodgkin's lymphoma. lymphoma. Imprint cytology of bone marrow was able to make a diagnosis quickly and found to be useful for diagnosing bone marrow involvement in ureent cases.

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We performed a non-spesific esterase staining with its sodium fluoride (NaF) inhibition test for differentiating histiocytes from adenocarcinoma cells in the cystology of effusions and found that the staining method was very useful.
1. Histiocytes (or macrophages) had numerous brown granules of esterase in the cytoplasma which were completely inhibited by sodium fluoride inhibition test and them disappeared. On the other hand, adenocarcinoma cells and mesothels usually had no or few (30 or less) brown granules which were not inhibited by NaF at all.
2. The number of cells containing brown granules inhibited by NaF was almost the same or slightly lower than that of the cells engulfing latex particles (carbon particles). The result may indicate that the cells with engulfed particles of latex or carbon do not always contain lysozomal enzyme such as esterase due to their immaturity or breaking down.
3. The former cells showed a characteristic arrangement in folds and ridges on their surface by scanning electron microscopy. They also showed to have many long microvilli and lysozomes by transmission, identyfying them as macrophages.
4. Imprint smears of various kinds of organs from autopsy materials were examined by the same non-specific esterase staining and its inhibition test. The smears of esophageal squamous epithelium, transitional cells of urinary bladder, tubular epithelium of kidney, columnar cells of intestine, hepatocytes and so fourth showed no or little positive staining of esterase.
Therefore, we could conclude from these findings that the nonspecific esterase staining and its NaF-inhibition test are of very specific method for histiocytes and very useful to differentiate them from adenocarcinoma cells and other malignant cells in effusions.

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In the past five years, 167 cases with mammary tumors were examined by fine needle aspiration cytology. The results were studied and the diagnostic difficult cases were reviewed in this parer. Of 40 cases histologically diagnosed as malignant, 31 cases (78%) were diagnosed as positive by the initial examination and 4 cases (10%) were added as positive by the second examination (in total 88% accuracy rate). The diagnostic accuracy rate in scirrhous carcinoma was 79% which was lower than other histological types. No correlation was revealed between the diagnostic accuracy and the size of tumors examined. Of 127 cases which were diagnosed as benign in the final diagnosis, the histological examination was carried out in 8 cases. Five of these 8 cases were suspected of malignancy by aspiration cytology. 4 diagnostic difficult cases, 2 malignant cases and 2 benign cases, were then selected for the subsequent retrospective examination. In these 4 cases, the cellular findings were compared as for several parameters including collected cell density, number of nucleolus and diameter of nucleus and nucleolus.
As the result, the density of the cells and the grade of anisokaryosis were higher in the malignant group than the benign group, however, no significant difference was demonstrated between the two groups.
It was suggested that the dispersibility and irregularity in size of cells could be listed as a differential diagnostic point between malignant and benign tumors.

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Among adenocarcinoma patients detected early to have small solitary lesions on chest films, quite a few died of recurrence in distant sites in a short time after the curative curative resection. It would be interesting if certain cytologic characteristics of adenocarcinoma could be correlated with post-operative prognosis.
Cellular features of adenocarcinoma obtained directly from tumors by TV-brushing method or needle aspiration were compared between the early recurrence group and the long survival group. The patients in these groups were stage I or II and were proved histologically well differentiated adenocarcinoma.
The cells which appeared more often in the early recurrence group were regarded as “malignancy-high” cells. The cells which appeared more often in the long survival group were regarded as “malignancy-low” cells. A “malignancy-high” cell was characterized by a large nucleus and increased nuclear cytoplasmic ratio. The nucleus was round in shape and had a smooth border. Chromatin was tightly compact and evenly distributed. There were several large nucleoli. A “malignancy-low” cell was characterized by a small nucleus and slight increased neuclear cytoplasmic ratio. The nuclear border was folded. Chromatin was sparse and unevenly distributed. The nucleus was solitary and small in size.
All the adenocarcinoma patients who had had resections were classified into three categories of “malignancy-high”, “moderate”, and “malignancy-low” according to the appearance rate of cancer cells. The survival curves of the three groups show a good correlation between the cytology of malignancy and the length of the patients survival.
Cytologic characteristics may be an indicator to predict the post-operative prognosis of adenocarcinoma of the lung.

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Aspiration cytology and needle biopsy specimens were simultaneously obtained from 61 cases of the prostate with cancer and other diseases by transrectal and transperineal biopsies, respectively. Positive diagnosis was made on 13 cases by cytology, in contrast on 21 cases by histology. There were 7 false-negative cases, but no false-positive cases by cytology being found in our series. Half of false-negative cases were included in the cases given the histological diagnosis of well differentiated adenocarcinoma, showing mild atypia. A total of 53 cases (86.9%) were given the same cytological diagnosis as the histological one. In conclusion, aspiration cytology is considered to be a valuable method for prostatic cancer diagnosis.

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Thirty-four routine cytological smears were contaminated with malignant cells from other smears during the process of Papanicolaou staining.
The sources of the contamination in the order of high frequency, were serous fluids, urine, cervical smear and bronchial aspiration smear. They contain great number of malignant cells. For this reason, these smears should be processed after all other smears were stained.
The contaminated smears, in the order of high frequency, were sputum, urine, cervical smear, serous fluids and bronchial washing smear.
Judging from the fact that cell-floaters were found in all batches, it is clear that such contamination might be caused easily in the fixation and the staining procedures. Cytological findings of the attached malignant cells from other smears were, increased nuclear cytoplasmic ratio, small in size, round or oval in shape regardless of primary situ and histological type.
In order to avoid such cross contamination, induvidual fixation, coating of the slide glass, improvement of the staining basket and careful consideration of the staining order are suggested from our experience.

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Hyperthermic toxicity and effects of thermochemotherapy of some anti-cancer agents for cultured human uterus cervical cancer cell (HeLa) and two types of cultured human brest cancer cells (HBC 4 and BHC 5) were analyzed by the use of multi-well screening method and cinemicrographic method.
At 43°C, HBC 4 and HBC5 proliferation was markedly inhibited due to the suppression of cell division and increase in the killing of cancer cell, whereas this phenomenon was not seen in HeLa cell. HeLa and HBC5 were inhibited in cell division at 25°C, but HBC 4 was not inhibited during 50 hours treatment. Analyzed from these detas, authors cuncluded that the hyperthermic sensitization was different among the cell types.
Adriamycin, 5 FU, Mitomysin C and Neocartinostatin were tested as the anti-cancer agents at different temperature (25°37°and 43°C) to clarify the effects of thermochemotherapy.
Among the anti-cancer agents tested in this study, the highest enhancement in the killing of cell was obtained by Adriamycin treatment at 43°C.
While Neocartinostatin did not show obvious enhancement of cell toxicity at any temperature during 48 hours treatment. When the cancer cells were treated by Neocartinostatin for over 48 hours, the toxicity of this agent at 43°C was much less than at 37°C
The effect of thermochemotherapy was different among the type of the anti-cancer agents.
In this study, authors developed the multi-well screening method and cinemicrographic method for the analysis of the effect of thermochemotherapy for cancer cells.
This method is very simple and easily carried out comparing with the previous method. If concer cells are obtained from various organs by surgical. It is certainly possible to choose the anti-cancer drug adequately for the case using this method.

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Crush cytology preparation of 74 cases of the nervous system tumors obtained at the Kawasaki Medical School Hospital from 1971 to 1982 were compared with frozen and permanent tissue section for the histological features.
The crush cytology specimens were more rapidly prepared with simpler procedures than the frozen section. In some cases they even gave more distinctive pictures for diagnosis.
Crush cytology techniques were thought to be more useful when used together with the frozen sections for rapid neurosurgical diagnosis.

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The present paper describes the detailed morphological alterations caused either by the routine Papanicolaou or May-Giemsa staning in cultured human gastric adenocarcinoma cells. These alterations were investegated with standard scanning and transmission electron microscopies before and after staining.
In the control group (I), the specimens were prepared for the routine electron microscopic observation.
In the experimental groups, the specimens were 95% ethanol-fixed (IIa), Papanicolaou-stained (IIb), fixed by dryer-produced cool wind desiccation (III a), and May-Giemsa stained (Mb) followed by routine preparation for electron microscopic observation.
In both groups Ha and IIb, preservation of the cell membrane was extremely poor and theminute cellular structure was scarcely retained, with vacuolation being marked in the cytoplasm and nucleus despite the maintenance of the cellular appearance.
In group IIIa, the unit membrane structure was well preserved similar to the controlgroup, and the ultrafine structures of both nucleus and cytoplasm approximated to those of the control.
In group IIIb, the structure of membrane was poorly preserved, with elevated electron density in both cytoplasm and nucleus.

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We have experienced 4 cases of primary carcinoma of Fallopian tube during the last 8 years since the opening of the Jichi Medical School Hospital. Excluding one case of double cancer, we made retrospective studies of cytolo-gical findings of cervix and ascites in the remaining 3 cases. The results were as follows:
(1) The ratio of the minor and the major axis of cyto-plasm as well as that of nucleus was found closer to 1, indicating that many of those cells had a round shape.
(2) As for the shape of cluster, acinous clusters were more dominant, while “arborescent arrangements” were hardly found in any of them.
(3) In many of them, only one nucleolus of a small to medium size was observed.
(4) In our experience, there was a case in which psammoma bodies were prominently recognized.
Although it would be difficult to give a diagnosis of carcinoma of Fallopian tube based solely on cytological findings, accumulation of rare cases such as the above, as well as objective studies of them would result in more accurate and reliable diagnosis in the future.

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Metastatic choriocarcinoma of the breast was found in a pregnant patient She had been delivered of a hydatidiform mole 3 years earlier. Diagnosis of choriocarcinoma was first made by the aspiration cytology and was confirmed histologically. Two types of trophoblastic cells, syncytio-trophoblasts and cytotrophoblast, were found in the cytologic specimen. Isolated arrangement of the cells, thick cytoplasm, and coarse nuclear chromatin were noted in the cytotrophoblasts, multinuclei, coarse nuclear chromatin, and chromatinic materials were noted in the syncytiotrophoblasts. Although differential diagnosis of trophoblastic disease is difficult by the cytological examination, aspiration cytology is considered to have much value in the diagnosis of metastatic lesion of choriocarcinoma in this series.

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Three interesting cases of herpesvirus infection were reported. Case (1) of 36 years old and Case (2) of 44 years old, both developed pain and vesicle formation of the external genitalia, 13 days and 9 days after the abdominal hysterectomy. Serology complement fixation test for herpes simplex type 1 showed positive rise. This herpes vulvitis seemed to be provoked and caused by a stress of surgical treatment. Case (3) of 36 years old appeared to the clinic with complaints of high fever, walking and voiding difficulties. She developed redness, edema, bleeding, vesicle formation, erosion and ulcer in various degrees all over the external genitalia extending to the perianus. She was set in bed rest, and got Foley catheter in. The affected areas were painted with Povidone-iodine solution. Bladder urine was obtained two hours after the clamping of the cather in the early morning.
Urinary sediment smears were made. Transitional cells showed multinucleation with smudgy nuclear chromatin distribution. Imprint cytologic specimens were taken from the unroofed vesicles using frosted slide glasses on these three patients. The cytologic specimen showed enlarged cells, multinucleation, gray degeneration of nuclear pattern and intranuclear inclusion bodies with inflammatory backgraund.

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It is often reported that cervical adenocarcinoma coexists with squamous carcinoma in situ (CIS) or dysplasia. But it is known that cervical adenocarcinoma with endometrial adenocarcinoma is a rare occurrence. With cervical adenocarcinoma, recently adenocarcinoma in situ has been paid attention about cytologic detection, histological criteria or choice of treatment. In the present report, a case of cervical adenocarcinoma in situ with endometrial adenocarcinoma is presented and discussed. The patient was a 44 year-old married woman gravida 2, para 2. Her first cervical cytologic examination (August, 1980) showed papanicolau class I. The second cytologic smear (June, 1981) showed papanicolau class Mb, suggesting severe dysplasia with slightly changed endocervical columnar cells. Cervical punch biopsy (August, 1981) demonstrated adenocarcinoma in situ with dysplasia, and endometrial specimens showed endometrial adenocarcinoma. The patient was administered semipanhysterectomy with pelvic lymphadenectomy. Postoperative findings demonstrated that both adenocarcinomas were completely separated and different on the histological pattern.

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A fifty two year old slender woman, subjected to supravaginal hysterectomy with right adnexectomy for myoma uteri and right ovarian cyst seven years ago, was diagnosed as suffering from pseudomyxoma peritonei with left ovarian cyst by cytology and computerized tomography.
The paracentesis fluid from the Douglas' pouch was yellowish, jelly-like and mucinous but mucin secreting cells were not found in it.
Exploratry laparotomy and biopsy of the so-called omental cake were performed for histological examination and imprint smear test.
The imprinted smears were positive in PAS staining and alcian blue staining.
Small round cells, small signet ring cells with vacuolated mucinous cytoplasma and non-hyperchromatic nuclei oppressed to look like the crescent moon in sheets and mucus secreting large cells that were partially overlapped and had nuclei of various sizes with mitosis and indistinct nucleoli were disseminated in these imprinted smears. It seemed, although, that these tumor cells were not malignant cytologically.
On the other hand, in computerized tomography the mucin could not be discriminated from the ascites in density, although the mucin was different from the ascites from the point that, for example, the border between the liver and the mucin was found to be uneven.

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We experienced a case suspected of polyoma virus infection, recognizing extremely varied intranuclear inclusionsin the urine of a five-year-old girl under the treatmend for acute renal insufficiency. The nuclei of intranuclear inclusions swelled quasicircularly to a diameter of 11 to 18 microns. Irregular chromatin blocks deposited on the nuclear membrane. The cytoplasm was vesicular, suggesting a strong tendency of degeneration, and many nuclei were oddly shaped or bare in a disintegrated dropout state. The intranuclear inclusions exhibited a deep bluish green ground-glass appearance, and the cells could be roughly classified into types I, II, III, and III' based on their characteristic appearances.
Type I refers to cells appearing opaque like ground glass having a relatively well preserved cytoplasm, in which a large single intranuclear inclusion occupied the whole inside of nucleus.
Type II refers to cells having a lot of relatively small inclusions, in a oval, or irregular form.
Type III refers to cells having a large single inclusion in a circular or quasicircular form measuring 8 to 11 microns in diameter with “bird eye” or “owl eye” halo between the periphery and nucleus.
Type III' refers to cells showing a large single inclusion similar to those of type III by low-power magnification, but this indusion was revealed to be conoisted of several small inclusions by high-power magnification.
Intranuclear inclusions of two nuclei were also noted.
Chronologically, most intranuclear inclusions deteced in the urine may belong to type I initially, but the incidence of this type gradually decreased later on while types II, III, III' increased.
Considering the varied forms of intranuclear inclusions, it was estimated from the findings with light microscope and electron microscope that the viral particles in the type I nuclei cyrstallized with time lapse and reduced in volume to produce an open space in the nuclei, eventuall progressing to types II, III'.
The duration of appearance of intranuclear inclusions was about a week, and no change was found in the clinical symptoms.

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A case of transitional cell ca with squamous metaplasia and glandular metaplasia, considered to be relatively rare, was encountered. We reported the cytologic, histologic and ultrastructural findings and discussed the histogenesis of this tumor. In the differential diagnosis of cytology, it is very difficult to distinguish glandular metaplastic cells from transitional ca cells seen in the same cytologic preparation. Both an overlapping cell cluster and many little nucleoli may suggest the presence of “glandular metaplasia”.

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Two cases of a three-year-old boy with retroperitoneal ganglioneuroblastoma and a sixteen-year-old boy with mediastinal ganglioneuroma correctly diagnosed by cytology in the operating room are reported.
There are three degrees of differentiation in nonchromaffin tumors of the sympathetic nervous system; mature type is ganglioneuroma, immature type is neuroblastoma and intermediate type is ganglioneuroblastoma.
Ganglioneuroblastoma is composed of both elements, neuroblastoma and glanglioneuroma. In smears, ganglion cells are scattered singly between elongated spindly Schwann cells and connective tissue elements, and neuroblasts can be seen also. Ganglion cells are large polyhedral cells and have abundant cytoplasms, occasionally with multiple projections and granules. They have single nucleus or multinuclei with prominent nucleoli. Neuroblasts are small elliptical cells and have scanty cytoplasms with dark nuclei.
Ganglioneuroma is composed of ganglion cells, Schwann cells and connective tissue elements, but no neuroblasts can be seen.
Recently indications for cytology in the operating room and fine needle aspiration cytology guided by ultrasound have been increasing. This report indicates that cytology is a very useful procedure for diagnosing non-chromaffin tumors of sympathetic nervous system.

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A 44 year-old man was admitted to the hopital because of hemoptysis and abnormal shadow in the left upper lobe. Bronchographic examination revealed obstructive shadow in B3. When seen with endoscopy, the tumor having the smooth and shinny surface with focal ulceration was found to have almost completely impacted the lumen of the B3.
Cytologically the tumor was exclusively composed of spindle-shaped cells. Nuclei of these cells are oval or spindle in shape. Finely granular chromatin of the nucleus was evenly distributed. Cytological diagnosis of spindle cell sarcoma was made tentatively. The left-upper lobectomy was performed under the diagnosis of fibrosarcoma made on the histology of the biopsy performed simultaneously.
On gross examination the tumor was demarcated from the surrounding lung tissue, and protruded into the bronchus at one point. The cut surface was pale but not hemorrhagic.
Histologically the tumor was composed of spindle cells forming interlacing pattern. Mitosis was seen frequently. The diagnosis of fibrosarcoma seemed most likely with the aid of electron microscopy. The follow up study failed to detect the metastasis or recurrence for 9 months.

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Plantar, fibromatosis is a very rare tumor among the benign soft tissue tumors. Differential diagnosis of plantar fibromatosis prior to the surgical dissection is very difficult. We performed needle biopsy before operation and studied the cells cytologically.
The findings of the smear from the aspirated material are compared with those of imprint smears from dissected tumors and those of histological sections. In smears from the aspirated material, the cells are mainly so-called active fibroblasts which have round or oval nuclei and spindleshaped cytoplasms. Tissue fragments such as collagenfibers and so-called mature fibroblasts which have fiberlike nuclei and cytoplasms are also observed. We can not find lymphcytes or neutrophils.
Histologically, the picture of the nodules is characterized by proliferation of well-differerentiated spindle-shaped fibroblasts and by a large amount of collagen-fibers. The fibroblasts tend to form parallel arrangements in a dense collagen matrix. In the center and margin of the nodules, blood vessels proliferate and the fibroblasts are in an active state.
In conclusion, needle aspiration cytology is very useful in the diagnosis of plantar fibromatosis.

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The present case of tumor is rare. The first case of this tumor was reported as a mixture of neurilemmoma and rhabdomyosarcoma. A transplantation experiment was carried out with this mixed type of tumor, which was successfully reproduced in an animal by transplantation. As a result, the mixed type of tumor was called triton tumor after the name of this animal. In the present case a 31-year-old woman was first affected with Von Recklinghausen's disease and had tumor developed in the occipital region on the right side. Then large tumor was found in the mediastinum in her. The occipital tumor was excised and examined cytologically, histologically and electron microscopically. Cytologically it consisted mostly of two types of tumor cells. The cells of one type had a striated structure and were spindle-, racket-, ortadpole-like in shape. Those of the other type contained eosinophilic granules in the cytoplasm. In addition, there were polynuclear cells, cells containing a large nucleus and cells possessing a rosary nucleus in the tumor. Histologically, the tumor was rhab domyosarcoma polymorphous and distinctly striated. Electron microscopically, there were fascicular filaments, reticular microfilaments and a striated structure with zone A and 0.3μ in width, respectively. On the other hand, fiber cells and spindle cells were found among tumor cells. They strained thin light green and had striated structure. Their cytoplasm was flattened, containing a single elliptic nucleus. No mitotic figures were noticed. These findings were the same as those of neurilemmoma. Histologically, essentially the same findings were found in mixture. Transitional changs were also observed. Autopsy revealed large mediastinal tumor. Metastatic foci were observed in the pancreas and ovary. Cytologically and histologically, these tumors were diagnosed the malignant neurilemmoma.
It is known embryologically that peripheral nerves are developed from the neuroectoderm. Peripheral nerve tumor is sometimes complicated with osteoid, angioma, myogenic tumor, and lipoma. It has frequenty been found in patient especially with Von Recklinghausen's diseas. This phenomenon seems to indicate that is of interest in studying the development of tumorous tissue originated from the mesemchymal system.

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