We studied the results of endoscopic brushing cytology and biopsy 282 cases of esophageal cancer and 488 cases of non malignant diseases. The average age of the cancer patients was 64 years and the ratio of males to females was 6.1: 1. Regarding the correlation between correct cytological diagnosis and location of the cancer, the accuracy rate in the upper and middle thoracic esophagus was higher than that in the cervical and abdominal esophagus. With respect to the correct cytological diagnosis according to the radiological classification, endoscopic classification and size of lesion of the esophageal cancer, there was no significant correlation between the classification and size of the lesion.
Cytological diagnosis in the 282 malignant cases was positive in 95.0%, suspicious in 1.4%, and negative in 3.5%, and in the non 488 malignant cases it was positive in 0.2%, suspicious in 3.5%, and negative in 96.3%.

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22 cases of extrahepatic bile duct carcinoma, histologically and clinically diagnosed, were studied among 631 cases of PTCD bile cytology.
(1) Distal bile duct carcinoma was 9 cases (40.9%) among cytologically positive 14 cases (63.6%) and suspicious 4 cases (18.2%).(2) Cytology of positive and suspicious cases showed solitary, scattered cells in superior bile duct carcinoma and cellular conglomeration in distal bile duct carcinoma.(3) Pathologically, superior bile duct carcinoma showed nodular invasive type and infiltrative type with average tumor size 4.2 cm, and distal bile duct carcinoma varietis of morphology with average size 2.1 cm.(4) Cytologically negative cases are nodular invasive type of superior and central bile duct carcinoma size 2.5 cm in average.

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The cytologic studies were made on the 27 noninvasive breast cancer cases diagnosed histologically. The nipple discharge cytology could diagnose as positive 6 cases out of 11 noninvasive cancer cases, 55%. While, 53 invasive cancer cases gave positive result in 27, 57%. The aspiration cytology of 21 noninvasive cancer cases gave positive result in 10, 48%, while, 500 invasive cancer cases gave positive result in 442, 88%. The lack of so-called two cell pattern in cancer cell clusters was one of the characteristic findings for the diagnosis. In addition most of the cancer cell nuclei were round or oval in shape, but some of them were irregular. The average sizes of the cancer cell nuclei of every case ranged from 12.4μm (±1.3) to 18.1 pm (±2.9) in M·EG·EG stain and 8.7μm (±0.9) to 13.2 μm (±1.8) in Pap. method. The average size of the cancer cell nuclei from the total cases examined was 15 pm in M·G·G and 10 pm in Pap. The hyperchromasia of the nuclei was mild. The cytoplasm of the tumor cell was usually well preserved.

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The aspiration biopsy cytology (ABC) findings of idiopathic gynecomastia were studied in 15 cases (ages ranging from 40 to 82 years, with a mean of 64 years). ABC findings of female fibroadenoma (10 cases) and male breast cancer (4 cases) were also examined for purposes of comparison. In each case, the diagnosis was confirmed histologically. Gynecomastia showed the following characteristics: The appearance of cell clusters was one of the most striking features, although they were few in number, with a relative predominance of large ones (more than 100 cells). The clusters were composed of compact piles of cells with scanty cytoplasm. The nuclei were generally small, varied in shape from round to anisometric, and had finely granular chromatin and one or two inconspicuous nucleoli. Mitotic figures, albeit typical and usually only a few per case, were relatively highly frequent (9 cases, 60%). Myoepithelial cells were observed in all cases, although they were apparently fewer in number than those in fibroadenoma. Bipolar naked nuclei were rare (4 cases). The cellular features of gynecomastia were certainly benign in every aspect, enabling distinction from cancer with no difficulty.

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The effectiveness of annual sputum cytology screening for detection of lung cancer in the Miyagi program was studied. A total of 499 primary lung cancers were detected out of a total of 1, 416, 976 participants from 1982 to 1988. Sputum cytology in the high-risk group (above 50 years of age with smoking index above 600) resulted in detection of 148 cases. Of the 148 cases, 120 cases were detected by Sputum cytology only. Among the 120 patients with lung cancer, 116 cases were Squamous Cell Carcinoma.
A total of 84% of the cases detected by sputum cytology were Occult Cancer or clinical stage I and 77% were resectable, compared to 50% and 65% in the x-ray screened group. The 5-year survival rate of the cases detected by cytology only was better than that of the cases detected x-ray only.

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Malignant body cavity fluids cannot always be easily distinguished from nonmalignant ones by Papanicolaou staining. We investigated the silver-binding nucleolar organizer regions (AgNORs) of cells with the suspicion of malignancy, in both malignant and non-malignant fluids. The mean number of AgNORs per nucleus of these cells was significantly larger in the cells in malignant fluids (mean SD: 3.4±0.7, n=29) than in non-malignant fluids (2.0±0.6, n=17)(P<0.01). We found that the AgNORs technique is useful for distinguishing malignant from non-malignant fluids with a high degree of confidence.

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This study evaluated the use of indirect immunocytochemical methods for detecting epithelial membrane antigen (EMA), basic fetoprotein (BFP), carcinoembryonic antigen (CEA), NCC-ST-439, carbohydrate antigen 50 (CA 50), secretory component (SC), carbohydrate antigen19-9 (CA 19-9) and squamous cell carcinoma-related antigen (SCC) in the cytodiagnosis of cavity effusions. Cytological smears from cavity effusion from 58 patients with malignant epithelial diseases and 9 patients with benign diseases. immunostained for the 8 markers EMA, BFP, CEA, NCC-ST-439, CA 50, SC, CA 19-9 and SCC staining gave positive reactions in 97, 95, 89, 76, 68, 60, 56 and 17% of the 58 malignant cases, respectively. BFP, NCC-ST-439 and SCC gave positive reactions in reactive mesothelial cells. The remaining 5 markers gave negative reactions in those cells. These results suggest that it is possible to differentiate carcinoma cells from reactive mesothelial cells by immunostaining for EMA and CEA in the cytodiagnosis of body effusions.

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Ninety-five cancer patients and twenty non-cancer patients with pleural or peritoneal effusions were studied to elucidate the relationship between tumor cells and suppressor Tcells. In our previous paper, we described how many T lymphocytes were observed in the pleural or peritoneal effusions of cancer patients. In the effusions containing cancer cells, the incidence of suppressor T cells was higher than that of helper Tcells. On the other hand in the effusions without cancer cells, the lymphocytes were composed of mainly helper T cells. The high incidence of suppressor Tcells in effusions with cancer cells was considered to be due to either a suppressed immune function or some unknown factors inducing supressor T cells which may be produced by tumor cells. Thirteen patients were treated with anti-cancer drugs intraperitoneally or intrapleurally. Before treatment, predominant suppressor T cells were revealed in the effusions taken from six patients. Whereas after treatment, the incidence of suppressor T cells decreased, and that of helper Tcells increased, i.e. the anti-cancer drug treatment shifted Tcell subpopulation from suppressor T cells to helper T cells. In addition, the cancer cells disappeared from the effusions of 3 patients, one of whom showed improved general conditions. It was considered that the increase of helper T cells in patients treated with anti-cancer drugs reflect an improvement of immune functions brought about by these drugs.

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Two cases of T-cell rich B-cell large cell lymphoma are described in which the cytology and initial histology suggested a diagnosis of T-cell Lennert's lymphoma. Patients were a male of ages 74 years and a female of ages 58 years. Imprint cytology of biopsied lymph nodes showed many small lymphocytes accounted for 65% to 70% and sparse large lymphoid cells for 20% to 30%. Medium-sized prolymphocytes, epithelioid cells, plasmacytoid cells and eosinophils were also observed. Flow cytometry for surface antigens of cells from lymph nodes indicated many CD 2 and CD 3 positive T-cells. However, immunohistochemistry on paraffin sections confirmed that many small and medium-sized cells were UCHL 1 and MT 1 positive T-cells and small population of large cells were L 26 positive B-cells. Then the diagnosis was changed to T-cell rich B-cell largecell lymphoma. The differential diagnosis in cytology from reactive changes, Lennert's lymphoma and related diseases was discussed.

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Expression of tumor-associated antigen gp 160 in 23 specimens of body fluids was analyzed by flow cytometry with the use of a monoclonal antibody 5 E 8. Lymphocytes (the negative control) had a mode fluorescence intensity of channel 10; 95% of the cells consistently fell below channel 40. Cells with fluorescence intensity below channel 40 were designated as gp 160 negative and all cells with fluorescence intensity above channel 40 were designated as gp 160 positive. Cultured cells derived from a lung large cell carcinoma, C-1509 (the positive control) had an adjusted mode fluorescence intensity of channel 60; the rate of gp 160 positive cells was 81.7%. All cytologically malignant specimens from patients with lung cancer and stomach cancer showed more than 50% gp 160 positive cells and a wide fluorescence distribution pattern (8/8). It may be useful to detect lung cancer or stomach cancer cells in body fluids by flow cytometry with the monoclonal antibody 5 E 8.

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Usefulness of Rhodamine 123 (Rh-123) which is selectively uptaken into mitochondria of living cells in a new thermosensitivity test that would be changeable with the complicated colony forming methoid so far was studied. In HeLa cells, mitochondria stained with Rh-123 accumulated marked ly around the nuclear membrane after incubation at 43°C for 1 hour. On the other hand, in L929 cells that show higher thermo-sensitivity than HeLa cells for the colony forming rate, mitochondria started to move around the nuclear membrane at 40°C and their marked accumulation around the nuclear membrane equivalent to that occured at 43°C in HeLa cells were observed at 41°C. The degree of these accumulation around the nuclear membrane was temperaturedependent and was related well to the thermo-sensitivity assessed by the colony forming rate. Therefore, a further study was performed using 17 specimens of the primary culutured cells that were removed surgically. In 3 out of the 17 specimens, accumulatoin of mitochondria around the nuclear membrane was observed. Also, in 3 specimens that were able to be assessed for the colony forming rate, the colony forming rate decreased more markedly in 1 specimens compared other 2 specimens. From the above-mentioned, it was considered that it is useful to assess the intracellular lacalization of mitochondria stained with Rh-123 as a more rapid thermo-sensitivity test than the assessment method by the colony forming rate.

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Syringes and needles were examined for cells remaining after their use for preparation of direct smears of the breast by fine needle aspiration. Additionally whether or not cells remaining in the syringes or needles are useful in diagnosis was investigated. The study included 320 cases. Cells remained in the syringes or needles in 217 cases (67.8%). In 25 cases (7.8%), the number of cells found in the syringe or needle was greater than that in the smear. In 10 cases (3.2%), the direct smear did not allow satisfactory cytological diagnosis. In 9 of these 10 cases, however, the rinse specimen (the solution after rinsing the syringe and needle) contained enough cells to allow diagnosis, while in the remaining case, neither the direct smear nor the rinse specimen contained cells. In one case, a diagnosis of malignancy was possible based on the rinse specimen alone. When two rinse solutions (physiological salt solution and Saccomanno's solution) were compared, Saccomanno's solution was found to preserve the cells better because it has both a rinsing and a fixing effect at the same time. However, with both solutions, groups of cells showd a three-dimensional distribution and mild degeneration of the cells tended to occur, indicating the necessity of careful judgment if rinse specimens are to be used diagnostically.
The phenomenon that cells remain in the needle seems to be related to the structure of the disposable syringe. The end of the needle protrudes several millimeters inside the syringe. When the inner cylinder of the syringe is pushed, the syringe contents (aspirated tissue) are not completely discharged but are partially trapped in the space between the needle and the syringe. In any event, the specimens obtained by rinsing the syringe and needle, after preparation of direct smears, were useful in cases where diagnosis based on the direct smear was impossible.

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To establish the cytologic criteria for diagnosing endometrial adenocarcinoma (G 1) and adenomatous hyperplasia, a total of 150 cell samples, consisting of 55 samples of endometrial adenocarcinoma (G 1), 55 of adenomatous hyperplasia and 40 of normal endometrium, were examined retrospectively. The samples which were obtained from the endometrial cavity by the endocyte or aspiration were washed in physiological saline solution, centrifuged and then smeared on slides for fixation and staining. The results were as follows:
1. Papillary cellular clusters were observed in all samples of hyperplasia and carcinoma, but in only 35.0% of normal endometrium. The incidence of arborescent frag ments, in which the epithelial cells are arranged on stalks of spindle cells (stromal A) was 14.5% in hyperplasia, 87.3% in carcinoma and zero in normal endometrium.
2. The average number of papillary clusters per slide was 77.1 in adenomatous hyperplasia, 141.5 in adenocarcinoma and 1.1 in normal endometrium. The mean number arborescent fragments was 0.2 in hyperplasia and 11.6 in carcinoma.
3. Ramifying branches from stromal A were not often present in the samples of hyperplasia, while many of them were seen in the samples of carcinoma.
The results demonstrate the diagnostic value of examination for architectural abnormalities in endometrial cytodiagnosis.

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A series of 70 clusters of benign and malignant endometrial cells were examined by 19 observers (11 cytotechnologists and 8 cytopathologists) to determine the interobserver reproducibility in grading the cellular atypicality. Analysis by kappa (κ) statistics showed poor overall agreement (κ=0.36). Although there was good agreement in grading “negative” and “positive” for malignancy (κ=0.46 and 0.47, respectively), poor agreement was obtained in the diagnosis of “suspicious” of malignancy (κ=0.15). After an intensive educational program for the observers, a second trial of grading was performed. Agreements in “negative” and “positive” were markedly improved (κ=0.55 and 0.61, respectively), showing the need of an educational system to improve the observers' ability to grade the cellular atypicality more accurately. However, the reproducibility in grading “suspicious”. remained poor. This seems to be due partly to the current situation in endometrial cytology in which no distinct definition of “suspicious cells” has been established.

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Detection and typing of human papillomavirus (HPV) DNA in punch biopsy specimens of human uterine cervix by in situ hybridization (ISH), and by Southern blot hybridization (SBH) were compared. HPV DNA was detected in 28 (82.4%) cases by ISH, among 34 cases positive for HPV DNA by the SBH.
Typing was successfull in 26 of the 28 cases in which HPV DNA was detected by ISH. In 25 of the 26, the type corresponded to that determined by SBH.
Histochemical examination of HPV DNA by ISH revealed that in 3 cases of condyloma acuminatum the cells contained HPV DNA 6/11 and that among 17 cases of mild and moderate dysplasia, HPV DNA 6/18 was present in one and 13/33/35 in 12. HPV DNA 16/18 was especially correlated with severe dysplasia and microinvasive carcinomas.
HPV DNA distribution has differed with the patient and histology. An intensified ISH signal was associated with the presence of koilocytosis in the epithelial surface in dysplasia, and a faint ISH signal was associated with all layers in severe dysplasia and microinvasive carcinomas.
It was concluded that ISH using biotin-labeled HPV DNA probes has sensitivity and HPV typing ability equal to the SBH method.

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Cervical scrapings from 106 patients were examined by the polymerase chain reaction (PCR), to detect amplified E₇, gene of the DNA sequence of human papillomavirus (HPV) types 16 and 18. HPV type 16 and/or 18 DNA was detected in 57 of the 106 cases by the PCR (type 16 in 41, type 18 in 15, and both types in one). In comparing the results with those of cervical cytology, the positive rate increased significantly as the cytological grade became higher. Sevety-three cases were examined histological and the HPV positive rate also increased as the histological grade became higher. The PCR requires only a small amount of specimen and is highly sensitive. We believe the PCR is a useful method for screening and retrospective investigation of HPV infection.

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Cervical infection of Chlamydia trachomatis in the infertile women was screened by enzyme immunoassay (EIA, Chlamydiazyme), and the cytological findings of chlamydial infection were investigated.
Forty of 746 cases were positive in EIA, and the positive rate was 5.4%. In hysterosalpingography, 7of17 (41%) positive EIA cases and 11 of 60 (18%) negative EIA cases presented bilateral or unilateral tubal occlusion, and a significant difference was confirmed between the two rates (p<0.05).
Cervical smears were sampled in 22 of total positive EIA cases simultaneously with EIA, and chlamydial infection was diagnosed in 15 of 22 (68%) cases by cytology. The intracytoplasmic inclusions which suggest chlamydial infection, intracytoplasmic inclusion (ICI), Nebular inclusion (NI) and central target formation (CTF) were appeared in 11, 6 and 2 cases, respectively.
So it was confirmed that screening of chlamydial infection in the infertile women is important for management of the patients. In cytology of cervical chlamydial infection, it is necessary to pay attention to not only NI but ICI.

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We report a case of herpetic esophagitis in which direct vision brush cytology showed characteristic findings. A 78-year-old woman was treated for a femur fracture. Since she experienced hematemesis and anemia, an upper gastrointestinal endoscopy was performed. Brush cytology showed many small round epithelial cell singly or in small aggregates. Characteristic “ground-glass” appearance of the nucleus, with deposition of chromatin material beneath the nuclear membrane (full type), and large eosinophilic intranuclear inclusion bodies (Cowdry type A) were observed. These epithelial cells also formed multinucleated giant cells. In addition to these findings, a few bizzare cells with atypical nuclei had orangeophilic cytoplasm.
Paraffin-embedded tissue was stained by the standard immunoperoxidase anti-peroxidase technique with antiherpes simplex type 1 and 2 antisera. Positive staining of intranuclear and paracytic inclusions was observed. Electron microscopy showed that the infected cells contained numerous intranuclear and paracytic viral capsids approximately 100 nm in diameter. The diagnosis of herpetic esophagitis was suggested from light and electron microscopic examination and confirmed by immunoperoxidase staining.

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A case of mucinous cystadenocarcinoma of the pancreas diagnosed by aspiration cytology prior to surgery is reported.
A 56 year-old woman with a tumor in the left upper abdomen was admitted to our hospital. A past history of injury to her back and a CT-scanning image suggested urinoma. Aspiration cytology, however, revealed the presence of malignant atypical adenocarcinoma cells among less anaplastic adenoma cells. Thus mucinous cystadenocarcinoma of the pancreas was strongly suspected. The resected tumor showed multicysts containing abundant mucin. Histologic a examination of the tumor showed that the cyst wall was surrounded by papillary growth of tall columnar cells, indicating benign cystadenoma ; however, apparent invasive growth of the more atypical tumor cells was observed in the specimen resulting in the final diagnosis of mucinous cystadenocarcinoma of the pancreas. Aspiration cytology is considered to have a good correlation with the histological finding and to be a usefull aid for the diagnosis of this kind of tumor.

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A rare case of papillary-cystic neoplasm (PCN) of the pancreas in a 8-year-old girl and a case of pancretoblastoma in a 10-year-old boy were reported clinicopathologically. Cytological examination of imprint samples showed that tumor cells of PCN and pancreatoblastoma had much in common: 1) tumor cells were homogeneous cuboidal cells of a moderate size that had an oval uniform nuclei. 2) the nuclei had fine granular chromatin, smooth and thin nuclear border, and some small roud nucleoli. 3) cytoplasm was moderate in amount and contained fine or foamy granules. 4) most of tumor cells were immunohistochemically positive for alpha-1-antitrypsin and pancreatic amylase. A unique cell feature of PCN was that some cells had coarse hyaline globules in cytoplasm. On the other hand, a diagnostic finding of pancreatoblastom was cytoplasmic glycogen that revealed by periodic acid Schiff reaction.

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Cytologic features in three cases of hepatoblastomas and their histopathologic backgrounds are reported. All the patients were infants shortly after birth. The cytologic findings divided the tumors into two types, well differentiated and poorly differentiated hepatoblastoma according to maturation or differention of the neoplastic cells.
The tumor cells of the first type expressed more or less a tendency of differentiation to hepatic cells. They had round or oval nuclei with increasing mid-granular clumps of chromatin. Most of the cell clusters formed a paving-stone like arrangement. The nucleo-cytoplasmic ratio (N/C) was 1/3-4. Extramedullary hematopoietic cells including giant cells were frequently observed.On the other hand, the nuclei of the tumor cells of the second type had slightly irregular outlines with increased coarse clumps of chromatin. The N/C was high (1/1-3) and none of the cells showed frank differentiation of hepatic cells. Mitosis was occasionally observed. The immature cells formed various kinds of clusters including such as clusters of tightly connected cells or of loosely connected cells (grapeshaped), or rosette-forming arrangements.

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A case of amoebic (Entamoeba histoytica) empyema is reported. The patient was a 34-yearold male hairdresser who presented with complaints of fever, hemosputum and pain in the left anterior chest. After admission a diagnosis of amoebic empyema was made by open peural biopsy performed under the diagnosis of intractable left pleuritis and empyema. The cytology specimens from the left pleural effusion were reexamined thoroughly, and a few trophozoytes and cysts of E. histolytica were found. However, it seemed to be quite difficult to find the parasitic organisms in the routinely stained specimen with a heavily necrotic background. Therefore, the possibility of amoebic infection would also have to be considered in a patient with intractable pleuritis and empyema associated with mucosanguineous effusion and a suggestive history. Our patient is in good health after treatment with Flagyl (metronidazole).

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We experienced a case of male breast cancer and comparied it with 22 female breast cancers in cytology, histology, levels of hormone receptors, and expression of the c-erb B-2 gene product. The male breast cancer was of the invasive papillotubular type with severe atypia and lymph node metastasis, positive for hormone receptors, and negative for c-erb B-2. The 22 papillotubular carcinomas of the females were divided into two groups, with higher atypia (7 cases) and with lower atypia (15 cases). The first group was prone to be negative for hormone receptors and 3 of the cases revealed positive staining of c-erb B-2, Whereas the group with lower atypia was positive for hormone receptors and negative for c-erb B-2. The male breast cancer was different from the female breast cancers in the relation between cell atypism and hormone receptors. Prognosis of male breast cancer could be related not only to cell atypia, but also to hormone receptors and the c-erb B-2 gene product. Therefore in a case such as ours the prognosis may not always be poor.

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There are a few reports of breast cancer diagnosed cytologically with stromal osteoclast-like multinucleated giant cells. We report here a case of 41-year-old woman with presenting of cytological findings and discuss about the origin of giant cells by various cytological, histological and electron-microscopical examinations. The specimen for cytology contained a ball-like or papillary clusters of cancer cells, mononuclear cells and multinucleated giant cells. The giant cells were of osteoclast type containing up to 35 nuclei located mainly at the center of the cytoplasm. Enzymatic cytochemical examination showed a strong reactivity of acidphosphatase, acidphosphatase, weak reactivity of alkali-phosphatase and esterase in the cytoplasm of giant cells. The extirpated tumor was papillotubular carcinoma histologically. Immunocytochemical and immunohistochemical examinations showed that some of the giant cells revealed some antigenicity of lysozyme and α1-antitrypsin in the cytoplasm. Electron-microscopical examination showed that no transition and direct adhesion with desmosome structure in the cancer cells. From these findings we conclude that the multinucleated giant cells are considered to be a stromal one derived from histiocytes as previously reported by others, but, not as an element of cancer parenchyme.

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A case of breast carcinoma containing osteoclast-like giant cells (OGC) in a 41-year-old woman was reported. The cytological, histological and immunohistochemical studies were presented and the possible histogenesis of OGC was discussed. Smears obtained by touch preparation of the tumor showed a mixture of epithelial elements and multinucleated giant cells. The epithelial cells occured as cohesive clusters and atypia of these cells was mild. The multinucleated giant cells had vesicular nuclei with prominant nucleoli and mostly existed around the epithelial cells. The number of nuclei varied from a few to 50 or more per cell. Histologically, the tumor showed a pattern of invasive ductal carcinoma, in which the stroma was crowded with numerous OGC. The OGC were only in the carcinomatous tissue and were intimately associated with carcinoma cells. Immunohistochemically, the OGC showed immunoreactivity to vimentin, but not to epithelial markers. Staining for the markers of monocytic/histiocytic lineage cells was negative in the OGC. Thus, the OGC were distinguished from the neoplastic epithelial cells and were suggested to be stromal origin.

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This paper concerns a case of sarcoidosis which showed nodular shadows on chest X-ray, A curetting cytology was done and led to the suspicion that sarcoidosis was present. This was confirmed by a transbronchial biopsy (T.B.B.) and clinical findings.
The patient was a 55-year-old female. Abnormal shadow on her chest X-ray was detected at an annual check-up in Nov. 1984, and she was referred to Asahi Central Hospital.
The chest X-ray showed three nodular lesions in the lungs and bilateral hilar lymphadenopathy.A curetting cytology and a T.B.B. were performed.
Cytologic slides showed many aggregates of epitheloid cells whose nuclei had diffuse chromatin pattern, minute nucleoli, and occasional indentation of the nuclear margins. Multinucleated giant cells were occasionally found.The longest diameter of these aggregates measured 650 it with a microscopic micrometer.The mean length of minor axes of the nuclei of epithelioid cells measured 6.1μ±1.1 (SD), and that of major axes measured 17.2μ±4.0 (N=437).There wasn't any necrotic debris in background of the slides.No malignant cell, foreign body nor fungi were identified. Microscopic slides of T.B.B. showed non-necrotizing epoithelioid cell granulomas.No abnormal laboratory data was detected but high value of serum angiotensin-converting enzyme and lysozyme.Findings of cytology, T.B.B. and clinical data led the authors to confidential diagnosis of sarcoidosis.
This case suggests that curetting cytology is useful for diagnosis of sarcoidosis in cases with nodular lesions.

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Two cases of localized pulmonary amyloidosis and their cytological findings are reported.The Papanicolaoustained necrotic and/or amorphous substance from these cases with amyloidosis showed birefringence under polarized light.The substance proved to be an amyloid substance by the fact that it showed a positive stain when the specimens were decolorized and restained with Congo Red, and showed birefringence under polarized light.The necrotic and/or amorphous substance in cytological specimens from cases with lung cancer and tuberculosis did not show birefringence under polarized light, and was therefore easily differentiated from that of amyloidosis.Therefore it was concluded that polarizing microscopy on cytological specimens is quite useful for diagnosing pulmonary amyloidosis.

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The cytological features of two cases of pulmonary sclerosing hemangioma were studied by examining smears obtained by fine needle biopsy and aspiration.The cytological characteristics of these sclerosing hemangioma were as follows: 1) Small round cells were dispersed or arranged in papillary patterns. 2) Large polygonal cells, which had a large amount of cytoplasm, a large nucleus and significant numbers of nucleoli, were dispersed. 3) Small cells, which had a smaller nucleus and clear cytoplasm, were present. 4) Spindle-shaped nuclei were noted in a papillary arrangment. 5) Many histiocytes, containing hemosiderin were scattered among the cellular clusters. 6) Inflammatory cells were found.
For immunoperoxidase staining, cytological specimens were stained with PE-10, and paraffin-embedded tissue sections were stained with PE-10, keratin and EMA.Small round cells and large polygonal cells showed immunoreactivity with PE-10 and keratin.Therefore we thought those cells might be epithelial and of pneumocytic origin.
The valuable features in differential diagnosis are the presence of numerous cell types, spindle-shaped nuclei, hemosiderinladen histiocytes, bloody background, etc.
In conclusion, we believe it is possible to make a preoperative diagnosis of pulmonary sclerosing hemangioma from clinical findings and the above features.

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A patient with a lymph node tumor consisting of cells having the characteristics of a lymph node interdigitating cell (IDC) was reported.The imprinted cytologic and cyto chemical findings were demonstrated.A 54-year-oldman was admitted because of right cervical lymphadenopathy of weeks duration.Biopsy of thelymph node was examined and was suggestive of lymph node IDC sarcoma. Cytologically, large atypical cells, often with pseudopodialike cytoplasmic extensions were found to be intermingled with necrotic materials and a few small lymphocytes and plasma cells.The tumor cells had the characteristic pleomorphic nuclei with prominent convolution, indentation, or lobulation.These cytological features are highly suggestive of IDC sarcoma, and confirmation should be made by the cytochemical demonstration of adenosine triphosphatase, S 100 protein, CD 1 a, CD 4, CD 45, and HLA-DR antigens.

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Peritoneal cytological findings of a rare case of malignant lymphoma with Russell like bodies of the ileocecal region was reported.
A 64-year-old man was admitted to Hirata Municipal Hospital with complaints of constipation and colicky abdominal pain.Eight month later, operation was performed. Operative material showed a circumferential ulcerative tumor of the ileocecal region and metastasis to the hepatic flexure colon and regional lymph nodes.
Histologically, diffuse and obscure nodular infiltration of mixture of medium and large sized lymphocytes were found transmurally and this tumor was thus identified to be malignant lymphoma, non-Hodgkin, diffuse, mixed cell type, according to LSG (lymphoma study group) classification.It was quite unusual that there were numerous cells which exhibited marginal located nuclei and Russell like bodies with abundunt eosinophilic globular inclusions in the cytoplasm among the usual lymphoma cells with occasional cleaved nuclei.Some of these cells with Russell like bodies had the same atypical nuclei as usual lymphoma cells had. The Russell like bodies were strongly positive for PAS stain (diastase resistant).By the immunohistochemical study using the Streptoavidin-Biotin method, the Russell like bodies revealed to be monoclonally stained with anti-IgM and anti-x.Many lymphoma cells with usual morphology were also positive with these antibodies monoclonally. These results indicate that the cells with Russell like bodies originated from lymphoma cells and produced IgM-k type immunoglobulin which led to the formation of Russell like bodies.
One month after operation, Peritoneal effusion appeared and aspiration cytology was performed.Among scattered tumor cells, signet ring like cells consisted of core-like eosinophilic globular cytoplasm which was consistent with Russell like bodies and marginal located nuclei were mixed with cleaved and non-cleaved lymphocytes.In Giemsa stain, these cells also showed prominent nulcear irregularity and cytoplasmic vacuolar change.
In this case, if no clinical information had be obtained, it would be difficult to diagnose them as malignant lymphoma cytologically.

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A case of clear cell sarcoma arising in the right first toe was reported. A 27-year-old female had suffered from a small nodule with tenderness of the right first toe. Two years after the initial symptoms, amputation of the first toe was performed. In preoperative aspiration biopsy cytology, relatively uniform spindle tumor cells, medium to large sized, were found. The tumor cell nuclei were short-spindle, with thin nuclear membrane. The chromatin pattern was finely granular. One distinctive, centrally located nucleolus was found. Histological diagnosis was clear cell sarcoma. Some tumor cells contained melanin granules demonstrated by Masson-Fontana preparation. Immunohistochemically, the tumor cells were positive for S 100 protein. Ultrastructurally, some tumor cells contained melanosomes. The distinctive nucleolus of the tumor cell is characteristic cytologically and histologically. This is an important finding to differentiate clear cell sarcoma from other types of spindle cell sarcoma such as synovial sarcoma on cytology.

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We studied a case of undifferentiated retinoblastoma in which fine needle biosy established the correct diagnosis. This 3-year-old girl was referred because of cloudy vitreous body. Examination of the left eye disclosed retrolental mass. Ultrasound and computed tomography demonstrated the mass without detectable calcification. The smears of the aspiration were richly cellular and showed a few intact retinoblastoma cells. The cells occurred in loose clusters or individually and had scanty cytoplasms and round hyperchromatic nuclei. In the background are abundant ghost cells without inflammatory cells. Immunohistochemically, most tumor cells reacted with NSE: a few cells reacted with GFAP.

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A case of myelofibrosis with ascites is reported. A 75-year-old women was admitted because of increase in body weight and abdominal fullness. Many multinucleate cells, both erythrocytic and granulocytic, were found in the peritoneal fluid. These large multinucleate cells were positive for PAS Stain and immunologically positive for Factors V III and GP III a, and were found to be megakaryocytes. We believe that in this case the hematopoietic cells in the ascitic fluid resulted from extramedullary hematopoiesis in the peritoneum. In cytologic examination of the peritoneal fluid, it is important to differenciate between megakaryocytes and other malignant cells such as poorly differentiated carcinoma and sarcoma. In this case, PAS stain and immunological study were effective methods for the differential diagnosis of large multinucleate cells in the ascitic fluid.

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We report the aspiration cytologic findings of a very rare neoplasm, mesothelioma of the tunica vaginalis testis. Before two years ago a 20-year-old man suffered left-sided scrotal swelling and was treated by hydrocelectomy under the diagnosis of hydrocele testisafter fluid aspiration three times. In April of 1990 he underwent a left orchiectomy because of suspicion of mesothelioma, with the aspiration cytologic findings of reaccumulated hydrocele fluid and intraoperative histopathologic findings. A final pathologic report revealed malignant mesothelioma of the tunica vaginalis.
In aspiration cytology there are many large papillary clusters that mimic mesothelial cells but show less atypicality and lack obvious malignant features characteristic of the malignant mesotheliomas arising in other body cavities. It is difficult to diagnose such a case as malignancy on the basis of cytologic findings alone.
Aspiration cytology of hydrocele fluid is a useful method for preoperative diagnosis of the mesothelioma of the tunica vaginalis, but sufficient attention must be paid to diagnosis because low grade malignant neoplasms may display less atypical features.

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A case of 56-year-old man with an adenomatoid tumor of the tunica vaginalis testis is presented. The patient had a painless nodule inside the left hemiscrotum for 15 years and then underwent an operation because of its enlargement.
Grossly, this nodular tumor was not encapsulated, but showed a distinct boundary separated by fibrous tissue from surrounding tissue.
Imprint smears of this tumor revealed; 1) intranuclear inclusion; 2) the nuclear chromatin was fine and uniformly distributed; 3) small, central and round nucleoli; 4) intracytoplasmic vacuolations; 5) normal mesothelial celllike conjunction (intracellular clear zones described by Koss); 6) alcian blue-positive and PAS-negative intracytoplasmic materials; 7) predominant cellular pattern was epithelial-like cells rather than endothelial-like cells.
Histologically, both epithelial-like cells and endotheliallike cells were arranged as glandular structures or solid cordlike structures. The stroma was composed of elastic fiber and lymphocytic infiltration.
Immunohistochemically, tumor cells were positive for cytokeratin and vimentin, and negative for EMA and factor VIII related antigen.
Electron microscopic features were showed several canalicular lumina with microvilli, tonofilaments and desmosomes.
This adenomatoid tumor is cytokeratin-positive, vimentin-positive and has also microvilli and desmosomes. These findings confirmed this tumor was compatible with an adenomatoid tumor and strongly support the concept of mesothelial origin.

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A case of adenocarcinoma of the thyroid with carcinomatous pleuritis is reported. In cytological examination of the pleural fluid, clusters of cancer cells revealed papillary and follicular manifestations. The cells were small and fairly uniform in size and shape, however, they had a high nucleus/cytoplasm ratio. Intranuclear inclusion bodies and psammoma bodies were also observed. These cytological findings suggested carcinama of the thyroid. Further investigation resulted in a diagnosis of carcinoma of the right thyroid. After total thyroidectomy, the pathological diagnosis was papillary adenocarcinoma with metastasis to lymph nodes (#5). Retention of pleural fluid was observed 9 months later. By cytological examination of the fluid, papillary adenocarcinoma found again. Levels of thyroglobulin in the blood and in the pleural fluid were 87.8 and 1549 ng/ml, respectively, and were significantly increased compared with the normal level. Consequently, this case was diagnosed as primary carcinoma of the right thyroid with left carcinomatous pleuritis. However, we could not detect pulmonary metastasis or an intrathoracic lesion of thyroid carcinoma. This is a rare case from the point of view of tumor metastasis, and cytological examination was very useful in the clinical diagnosis.

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We reported a case of adenoma malignum (extremely well differentiated adenocarcinoma) of uterine cervix with special reference to microscopical feature and DNA analysis. Patient was 47 yrs. female. The macroscopical findings revealed remarkable enlargement of uterine cervix. Histopathological findings revealed abnormal proliferation of glands lined with simple layer of columnar cells without cellular atypism, and regular well-formed glands extending deep into cervical wall. Cytological findings revealed mainly monolayer sheets composed of columnar cells without atypical nuclei, but there were a few diagnotic findings of malignancy which revealed multilayered sheets with acinus formation and projecting small acinus arrangement composed of cells with remarkable atypical nuclei originated from structural atypism (irregular gland and angular outpouching) of adenoma malignum. DNA analysis revealed near tetraploidy pattern.

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Four cases of adenosquamous carcinoma of the uterine cervix are reported. Cytological and pathological findings and immunohistochemical study using anti-keratin antibody (anti-56 KD keratin and 68 KD keratin) suggested one case was immunohistochemically different from other cases. The result of the study on the other three cases suggested that the squamous component of adenosquamous carcinoma was morphologically almost same to the ordinary type of squamous cell carcinoma (large cell, non-keratinizing type), but immunohistochemically different. And also suggested that AIS (adenocarcinoma in situ) and CIS (carcinoma in situ) which was immunohistochemically similar to the endocervical glandular cell, were the early form of adenosquamous carcinoma.

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In spite of recent advances in the management of ovarian malignancy, the prognosis of ovarian carcinosarcoma, which contains both epithelial and homologous mesenchymal elements, is extremely poor. Since the amount of information concerning carcinosarcoma is so limited, immunohistochemical study of a patient with ovarian carcinosarcoma was conducted.
This 57 year old patient exhibited rapidly increasing abdominal fullness and elevated tumor markers. At laparotomy, the dominantly enlarged right ovary seemed to be the primary lesion, and metastases into the omentum and the subphrenic area were observed. The tumor was removed and post operative combination chemotherapy was administered. Although the levels of CA-125 were normalized after this therapy, the patient died 5 months after surgery. The pathological diagnosis was carcinosarcoma of the ovary. The main component of the primary lesion consisted of mesenchymal elements, but the main component of the metastatic lesions was composed of epithelial elements. Autopsy revealed carcinomatous peritonitis, but most of the elements were mesenchymal. Imunohistochemical analyses indicated that only the epithelial elements stained positively for CA-125.
The specific pattern of changes in CA-125, which was shown immunohistochemically to have originated in the epithelial elements of the tumor, suggests that the treatments given to this patient were effective on the epithelial elements exclusively. It is urgent to develop diagnostic and therapeutic measures for the mesenchymal elements of this malignant neoplasm.

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A case of poorly differentiated adenocarcinoma with neuroendocrine defferentiation of the uterine cervix is reported. The cyto-histological features of this case were studied by transmission electron microscopic and light microscopic techniques including Grimelius' argyrophil staining and immunohistochemistry.
The patient was a 38-year-old woman (gravida IV, para II) with chief complaint of genital bleeding. A cervical smear suggested adenocarcinoma and biopsy showed cervical adenocarcinoma with neuroendocrine differentiation. Postoperative histological examination revealed medium sized round to polygonal neoplastic cells growing in sheets, cords or ribbons in the subepithelial layer of the endocervix. The lesion was partially covered with cervical epithelium with adenocarcinoma in situ. The tumor was diagnosed as poorly differentiated adenocarcinoma with neuroendocrine differentiation since some of the neoplastic cells were argyrophilic and positive for chromogranin A. Electron mircoscopic observation revealed neurosecretory granules in the tumor cell cytoplasm. The tumor cells positive for argylophilic granules had smaller nuclei than the tumor cells without granules. The difference between these two groups was significant (p<0.01).It is emphasized that investigation of the neuroendocrine component by means of argyrophil staining, immunohistochemistry and electron microscopy is necessary in the case of poorly differentiated adenocarcinoma of the uterine cervix, because cervical adenocarcinomas with a neuroendocrine component are biologically aggressive and tend to escape detection in routine cervical smears.

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Primary non-Hodgkin malignant lymphoma of the uterine cervix is fairly rare lesion.The cytologic diagnosis of the disease is not always possible. The absence of surface ulceration or trauma of the cervical epithelium leads to a negative cytologic examination.It is important to distinguish malignant lymphoma from undifferentiated carcinoma, endometrial stromal sarcoma or follicular cervicitis.
A 35 years old woman, gravida 4 para 2-0-2=2, was examined in our hospital because of genital bleeding. The cervical cytology revealed many lymphoblastic atypical cell, including cleaved cells and nipple like nuclei. The colposcopic findings showed no abnormalities. Histological examination showed monotonous proliferation of lymphoid cells including atypical cell intermingled by medium sized lymphocytes.Immunohistochemical staining of the specimen showed positive for SL 26 (B-cell marker) but negative for UCHL-1 (T-cell marker). Pathological diagnosis was diffuse malignant lymphoma, medium sized, B-cell type.
General examination of the patient revealed no abnormalities, including lymphadenopathy or splenomagaly.Routine blood analysis and radiological examination were normal. The patient was diagnosed as stage I (FIGO classification) and IE (Ann-Arbor classification). Semiradical hysterectomy and lymphnodes dissection were performed and now she has no evidence of recurrence.

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