The use of cytologic diagnosis has played an important role on differential diagnosis for various types of diseases which found in the oral cavity and had some similarity with oral malignancies. But the accuracy of the method is depending on the subjective judgement of the researcher or cytologist. As objective and quantitative method of cytodiagnosis, the interference phase contrast micro scopy was introduced into the field of cytologice xamination of oral regions by the author. The studies were performed by ‘Nikon’ interfer ence phase contrast microscope. The measurement of optical path difference was carried out to get the so-called R-value which was given by following equation. _??_ R-value expresses quantitatively the optical mechanism of the formation of phase contrast image. Difference in R-value obtained from nuclei and nuclear membrane between tumor cells and normal epithelial cells originating in inflammatory lesions was significantly higher in the former cells (p<0.05). R-value decreased according to the time elasped after sampling, and the decreasing pattern became the useful measuring standard for squamous cell carcinoma and inflammatory epithelial lesions. Furthermore, cytologic changes of fresh cells in the oral cavity following by the time elasped was pursued by phase contrast microscopy. As for the figure of disappearing nuclei and nuclear membrane, about one-third cells of originating in adenocarcinoma, pleomorphic adenoma and in the inflammatory epithelial lesions showed these changes 90 minutes later after sampling, but the same findings in the tumor cells deriving from squamous cell carcinoma were observed 8 hours later. When the samples were stored at 5°, by occurring of these changes it took the time twice more. Blister formation from the periphery of cytoplasma was observed in epithelial tumor cells with the ocurring rate of 90.6% of 85 cases and in non-epithelial tumors with the rate of 88.9%. The similar blister formation was observed also in the normal epithelial cells originating ininflammatory lesions with the rate of 77.2%.
The nucleolar findings of pulmonary cancer cells stained supravitally with brilliant cresyl blue were analysed with regard to their histological types. 1) Following Kimura's classification, the nucle oli in the cells of squamous cell carcinoma were of types R (especially R1) and C (especially C1 and C3); adenocarcinoma, type C (especially C3 and C2) and undifferentiated carcinoma, type C (especially C1 and C3). The nucleoli of non-malignant cells were of type R (especially R1 and R3). 2) Squamous cell carcinoma cells had 1 to 3, round or irregular shaped, medium or small sized nucleoli, adenocarcinoma cells had 1 or 2 round, medium or large sized nucleoli, and undifferentiated carcinoma cells had 1 to 3 round, medium or small sized nucleoli.
Breast secretion smears were obtained from 179 patients examined for nipple discharge. Aspiration smears of cyst were obtained from 13 patients. Of the total of 192 patients, 21 were breast cancer. Positive smears were in 13 of 21. Cytologic feature of desquamated cancer cell from papillotubular adenocarcinoma was as follows: 1) Several clusters different on number of cells were seen. The cells of the cluster were arranged very irregularly and were overlapped each other. 2) The cytoPlasmic boundary was most indistinct. Vacuolation of the cytoplasm was not seen usually. 3) The nucleus was large and hyperchromatic and variable in size. The chromatin was most fine, however, difference of chromatin patterns may be seen in each different clusters and even in the cells of a cluster. The characteristics of desquamated cancer cells from comedocarcinoma were as follows: 1) The cells usually present as single. 2) The some of cells have round distinct cyto plasm, while others have poorly defined one. 3) The nucleus varies in size, and abnormality was conspicuous. Necrotic nucleus was always seen. 4) Morphologic feature of the cluster of come docarcinoma was similar as of papillotubular adeno carcinoma.
Seven hundred and thirty-nine cases (included 15 cases with malignant breast tumors) were offered for the cytologic examination, using materials of nipple discharge, aspiration smears or smears from operated samples. One group of these cases were 633 cases out of 1351 who presented at the mass survey of the breasts and another one were 103 cases, visited to our hospital with some complaints of the breasts. The results of aspiration cytology of 13 cases with malignant breast tumors were 9 for positive and 4 for negative. On the other hand, all the cases of non--cancerous patients (724 cases) were cytologically negative and there was no false positive case.
Lately the cytodiagnose of the stomach has been given a satisfactory result by the improvement of gastrofiberscope. Consequently fresh desquamative cellular materials, especially cancer cells which does not always satisfy the criteria of malignancy so far accepted can be quite easily and frequently scraped. Because of the difficulty on determining direct smear preparation from the stomach during operation as positive or negative we attempted to reappraise the criteria of malignancy from the viewpoint of the process of degenerative changes of cancer cells and moreover the factor in gastric juice constituents which influenced cancer cells exfoliated in the sto-. mach. The phase contrast microscopy and the supravital staining technic of acridine orange and methylene blue were applied. Uninjured fresh living cancer cells of the stomach were unstained with methylene blue, whereas with acridine orange each entire cell, whose nucleolus and cytoplasm showed no metach romasia, was stained light green. The cells under different degrees of injury were stained diffusely and clearly with methylene blue and their uncleolus and cytoplasm showed a metachromasia with acrid ine orange. The phase contrast microscopy elucidated that the cellular portion stained densely with meth-ylene blue and also the metachromatic portion with acridine orange were of considerable high density. It was possible to identify these functional changes not with fixed staining procedures, Giemsa and Papanicolau, but with the supravital staining method. Morphological changes such as the findings of chromatin movement to the periphery of nucleolus and nuclear membrane, intranuclear vacuolization, thick ness and irregular margin of nuclear membrane and striking cytoplasmic deformity occurred even in benign cells in proportion to the cellular degener ation. These findings were not characteristic of malignant cells, but were rather responsible for the degeneration of dead cells. For the purpose of evaluating the influence of gastric juice on exfoliated cancer cells of the sto mach, the solutions of various concentrations were prepared by diluting hydrochloric acid with physi-ologic saline solution and into each solution was added 10000 Fuld unit/ml pepsin. Following the suspension of cancer cells desquamated from the resected gastric specimen into above prepared each solution, the influence of pepsin and acidity were observed. On adding pepsin into 1/30, 1/50 and 1/100N hydrochloric acid solutions respectively, the swelling types of nuclei were far more numerous than those in each pepsin non-administered solution. On add ing pepsin into 1/10 and 1 N hydrochloric acid solutions, cancer cells occurred nuclear pycnosis si milar to those in each pepsin non-administered so-lution and there appeared no differences between both cases. Moreover, when suspending desquama tive cancer cells in patient's own gastric juice, their chromatic and morphological changes were observed at regular intervals. Such changes were influenced by acidity of gastric juice and seemed to be irres pective of the quantity of pepsin. on the other hand, the propagation of bacillus was prominent in gastric juice of hypoacidity, whose action and osmotic pressure must be one of inevi table factors in the degeneration of cancer cells.
Malignant melanoma arising primarily in the vagina is extremely rare and only about 30 cases have been reported to date. There are no cytological details in all of these reports, except for 2 cases. We have made cytological examination in one case of primary malignant melanoma of the vagina in a 65-year-old woman. Chief complaint was geni tal bleeding. A tumor was found in the vagina, as shown in Fig. 1, by initial examination and the tumor was diagnosed as malignant melanoma by means of punching biopsy and scraping smear from the surface of the tumor. Extrication of the tumor and irradiation treatment were carried out. About one month later, radical hysterectomy was carried out and metastasis was not found in any of the lymph nodes by pathological examination. This case is now under observation and recurre nce of malignant melanoma has been noticed in vu-Ivo-vaginal region in the latest examination. Most of the cells in the smears were bizarre cells, as shown in Fig. 2-5, and their characteristics are as follows A) Aggregation of cell and size 1) Scattering, no tendency of grouping 2) Anisocytosis and anisokaryosis B) Cytoplasm of cell and N/C ratio 1) Acidophilic cytoplasm 2) Melanin pigmentation 3) Low N/C ratio, relatively aboundant cyto-plasm C) Nucleus 1) Extremely eccentric nucleus 2) Thin and irregular nuclear membrane 3) Even chromatin distribution (some cells have chromatin clumping) 4) Prominent nucleoli 5) Giant malignant cells 6) Vacuoles in nuclei 7) Mitosis Examination of scraping smears by DOPA reac - tion showed the presence of tyrosinase activity in all the atypical cells without melanin pigmentation, which resemble the cells of sarcoma, especially of reticulosarcoma.
1) Purpose and methods: In recent years, the mass population of screening of uterine cancer by methodof irrigation smears has been carried out in many cities, and considerable results have been obtained. Setting aside positive cases by this method, however, early cancer may be found in negative cases. The re-check-up correctly in the level of mass population of screening has been thought as a difficult problem. The studied about the degree of appearance and quantity of malignant tumor in each cases by method of irrigation smears by patients (a), of smears taken from patients by a gynecologist (doctor) in the some method (b), and the smears in the first examination (c) in 40 cases of Dysplasia and carcinoma in situ by histological examination. 2) Results: In stage II and more cases of cervical cancer of uterus, the three cases of (a), (b) and (c) are positive. In the irrigation smears taken by a gynecologist, a little better results were obtained than bpatients, however, there is no great difference bey tween them. Carcinoma in situ and Dysplasia are apt to be missed only by the method of irrigation smears. In early cancer, a number of malignant cases are found by cytologic finding at out-clinic and are easy to be diagnosed, while in the method of irrigation smears, there is a small number of cells and more abnormal cells than stage II cases tend to be found. Comparing the irrigation smears taken correctly by doctors with smears taken by patients, there is no great difference in quantitative relation of malignant tumor.