Peritoneal cytology in endometrial cancer - an investigation of the source of endometrial cancer-cells in the peritoneal-cavity.

In order to identify the source of endometrial cancer cells in the peritoneal cavity, the incidence of positive peritoneal cytology was assessed according to pTNM classification. In 74 cases free peritoneal fluid in the pelvic cavity was aspirated. In the absence of fluid smears of the cul-de-sac was made by scraping (45 cases). Five of 15 positive aspirated cases were pT1N0 or pT2N0. These five cases underwent surgery alone and are still alive with no evidence of disease. Malignant cells which supposedly gain access to the pelvic cavity via the fallopian tube have low potential for implantation.

Prognostic significance of pleural lavage cytology immediately after thoracotomy in patients with lung cancer.

Pleural lavage cytology immediately after thoracotomy was performed in 467 patients with lung cancer who had little or no pleural effusion. Forty-two patients (9.0%) had positive results. The positivity of pleural lavage cytology was significantly related to the degree of pleural extension of the tumor, microscopic pleural dissemination, cytologic results of minimal pleural effusion, pathologic stage, presence of lymphatic permeation or vascular invasion, and cell type (adenocarcinoma was predominant). The 3-year survival of the patients having negative and positive results of cytology were 68.7% and 22.9%, respectively. The prognosis of the group with positive results was as poor as that of patients with stage IIIB or IV disease. Pleural lavage cytology is an important prognostic factor that indicates microscopic exfoliation of cancer cells into the pleural cavity, that is, subclinical malignant pleural effusion.

Clinicopathologic and immunohistochemical characteristics of bronchial gland cell type adenocarcinoma of the lung.

Twenty-three cases of bronchial gland cell (BGC) type lung adenocarcinoma were examined clinicopathologically and immunohistochemically. BGC type adenocarcinoma was defined as adenocarcinoma showing histologic and cytologic differentiation toward the bronchial gland. This type of adenocarcinoma occurred more frequently in younger patients (mean age, 50.5 years) than in patients with other types of adenocarcinoma (mean age, 60.1 years). It had a tendency to arise from relatively large bronchi and show endobronchial growth. However, there was no difference in disease stage based on tumor, nodal involvement, metastases (TNM) factors and outcome between BGC type adenocarcinoma and peripheral type adenocarcinoma. Immunohistochemically, 50%, 68%, and 64% of BGC type adenocarcinomas were positive for carcinoembryonic antigen, surfactant apoprotein, and secretory component, respectively. Peripheral type adenocarcinomas showed similar rates of immunohistochemical stainability of these antigens. The positive reaction of BGC type adenocarcinomas with anti-surfactant apoprotein antibody may indicate maintenance of traces of differentiation toward peripheral airway epithelium. Lactoferrin is characteristically detected in BGC type adenocarcinomas, although the positive rate was not very high.

Immunohistological study of Crooke's cells.

By immunohistochemical methods, 28 postmortem pituitary glands with unequivocal Crooke's hyaline change were examined to identify the hyaline material. Crooke's hyaline was positive for 55-57 kilodalton (KD) cytokeratin (CK) but negative for 68 KD CK, vimentin, desmin, neurofilament and glial fibrillary acidic protein. Involucrin, a new marker for keratinocyte differentiation, could also not be demonstrated. It was concluded that Crooke's hyaline was an abnormally accumulated CK which is a normal constituent of the ACTH cell.

Further immunohistochemical study of Crooke's hyalin.

For analysis of the cytokeratin (CK) of Crooke's cells, 28 post-mortem pituitary glands with unequivocal Crooke's hyaline change were investigated immunohistochemically using monoclonal antibodies for CK subfamilies. Crooke's hyalin was positive for CK 8 [molecular weight 52.5 kilodalton (KD)] and 18 (45 KD) but negative for skin-, cornea- and esophageal-typed CKs.

Cytologic features of peripheral squamous cell carcinoma of the lung.

Cytologic features of 32 peripheral squamous cell carcinomas of the lung were reviewed. Fine needle aspiration biopsy and curettage showed most of the tumor cells to be arranged in irregular cell fragments consisting of relatively small cells with scanty cytoplasm. They possessed round to oval nuclei with coarsely granular chromatin, and some had large, prominent nucleoli. Keratinization was usually observed in small numbers of scattered cells, and a nuclear streaming arrangement was noted in some areas. When both keratinization and streaming arrangements were absent, correct subtyping was impossible (12 cases). These cytologic features were different from those of 31 hilar squamous cell carcinomas studied as controls; there many carcinoma cells showed keratinization, and small carcinoma cells were infrequent. However, in all cases, sputum cytology was correctly interpreted because squamous differentiation was easily recognized.

Cytologic diagnosis of breast carcinoma with nipple discharge: special significance of the spherical cell cluster.

In order to investigate the cytologic characteristics of breast carcinoma in nipple discharge, 190 histologically proven cases of various breast lesions from 2,723 samples of nipple discharge were studied. The general criteria of malignancy as described for other organs applied also to the breast carcinoma cells. However, the breast carcinoma cells were generally smaller and less pleomorphic than those arising from other organs. In addition to the malignant features of individual tumor cells, the presence of a spherical cell cluster with a smooth rim was also an important finding suggestive of malignancy. The diagnostic rate of breast carcinoma increased significantly when the 190 cases were reexamined on the basis of the findings of this study.

Immunocytochemical diagnosis of small cell undifferentiated carcinoma of the cervix.

Ethanol-fixed and Papanicolaou-stained smears of 5 cases of cervical small cell undifferentiated carcinoma and 10 control cases of non-small cell cervical cancer were immunocytochemically examined with monoclonal antibodies (MAbs) against cluster 1 small cell lung cancer (SCLC) antigen, which were found to react with neural cell adhesion molecules (N-CAM). MAbs against cluster 1 SCLC antigen used in this study were NCC-LU-243, NCC-LU-246 and anti-Leu-19. The expression of cluster 1 SCLC antigen was recognized by MAb NCC-LU-243 and NCC-LU-246 in all five cases and by anti-Leu-19 MAb in three. The cluster 1 SCLC antigen was not detected in any of the 10 non-small cell cervical cancers. These results suggest that cluster 1 SCLC antigen is stable and immunocytochemically detectable in Papanicolaou-stained smears and is helpful in the cytologic diagnosis of cervical small cell undifferentiated carcinoma.

Light and electron microscopic analysis of intranuclear inclusions in papillary adenocarcinoma of the lung.

The incidence and nature of intranuclear inclusions found in tumor cells of preoperative and postoperative cytologic, histologic and electron microscopic (EM) specimens were studied in 38 cases of papillary adenocarcinoma of the lung in order to assess the cytodiagnostic significance of these inclusions. The overall incidence of the intranuclear inclusions was 34%; the incidence was higher in the well-differentiated type of adenocarcinoma (48%). Four smear and four EM types of inclusions were recognized. Cytoplasmic invaginations (pseudoinclusions), single-membrane-bound inclusions, aggregates of 50-nm tubules and any combination of the above could be distinguished by EM. There was some correlation between the smear and EM types of inclusions. EM analysis suggests that intranuclear inclusions, except for pseudoinclusions, may be derived from the inner nuclear membrane. In routine cytology, the intranuclear inclusion is a good diagnostic marker for papillary adenocarcinoma of the lung.

Immunocytologic diagnosis of small-cell lung cancer in imprint smears.

Imprints of histologic or autopsy specimens from 12 small-cell lung cancers (SCLCs), 82 non-SCLCs (50 adenocarcinomas, 25 squamous-cell carcinomas, 1 adenosquamous carcinoma and 6 large-cell carcinomas), 2 carcinoid tumors, 1 malignant lymphoma and 8 metastatic carcinomas were examined immunocytologically for the presence of cluster 1 SCLC antigen (neural-cell adhesion molecule: N-CAM), chromogranin A, Leu-7, neuron-specific enolase (NSE) and gastrin-releasing peptide (GRP). The monoclonal antibodies NCC-LU-243 and NCC-LU-246, which are reactive with cluster 1 SCLC antigen/N-CAM, diffusely stained the cell membranes of all SCLCs and carcinoid tumors (100%) and diffusely and focally stained those of two of the large-cell carcinomas, two of the adenocarcinomas, two of the squamous-cell carcinomas and the one adenosquamous carcinoma. Malignant lymphoma and metastatic carcinoma were negative for this antigen. A few cases of large-cell carcinoma, adenocarcinoma, squamous-cell carcinoma and adenosquamous carcinoma were also stained with these antibodies, which may indicate a neuroendocrine differentiation. However, these tumors were different from SCLCs in that their positive tumor cell population was definitely smaller than that in SCLC, in which almost all tumor cells were positive. This confirmed the usefulness of antibodies against cluster 1 SCLC antigen for the immunocytologic diagnosis of SCLC and carcinoid tumor in imprint smears. Chromogranin A, GRP, NSE and Leu-7 were not useful in immunocytologically differentiating the imprints from these cases since only a few tumor cells were reactive with these antibodies. The antibodies against cluster 1 SCLC antigen/N-CAM can also be applied to cytologic preparations of sputum, pleural fluid and fine needle aspirates stained routinely by the Papanicolaou method since the antigen is preserved in such alcohol-fixed smears.

Ultrastructure of Crooke's cells with special reference to their secretory granules.

Twenty-seven postmortem pituitary glands were electron microscopically investigated. Eighteen of them revealed an accumulation of fine microfilaments in the cytoplasm ranging from 70 to 80 A in width, which is equivalent to a hyaline change in Crooke's cells seen with a light microscope. Since Crooke's changes were immunohistochemically evidenced to occur exclusively in ACTH cells, we examined their secretory granules quantitatively and concluded that the majority of them were ovoid, homogeneously electron dense and measured 200 to 450 nm in diameter averaging 332 nm. Occasionally, those irregularly shaped and larger than 600 nm were observed.

Ultrastructure of the "non-pathologic" human pituitary gland.

The ultrastructure of "non-pathologic" human pituitary gland obtained from eight cases at autopsy, who received no hormonal therapy and who revealed no significant changes in the pituitary and its target organs, was investigated in an attempt to identify human adenohypophyseal cells by comparing their secretory granules with those of experimental animals. Besides the follicular cell, five different granulated cell types were distinguished The Type 1 cell contained abundant, dense secretory granules (350-500 mmu across). The Type II cell was characterized by dense granules, which were the largest in size (500-700 mmu across) and the most irregular in shape. Granules of the Type III cell were less characteristic (200-300 mmu across). The Type IV cell contained dense granules, which were the smallest in size (100-150 mmu across) and were characteristically arranged along the plasma membrane. The Type V cell was characterized by the presence of small, haloed granules (100-200 mmu across). The cells of these five types could presumably be the somatotroph, lactotroph, gonadotroph, thyrotroph and corcitotroph, respectively.

Comparison of cytologic markers for automated lung cancer screening.

In a preliminary study for the development of an automated lung cancer cytology screening system utilizing both flow and image processing techniques, potential markers for the flow cytometric screening for carcinoma cells in sputum were analyzed. Immunostains were applied by the avidin-biotin peroxidase complex method, using antibodies to keratin (55-57 KD), TA-4 and SCC (antigens of squamous cell carcinoma of the human uterine cervix), neuron-specific enolase (NSE), gastrin-releasing peptide (GRP) and carcinoembryonic antigen (CEA), to carcinoma cells from 123 cases with lung cancer (35 with squamous cell carcinomas, 64 adenocarcinomas, 13 large cell carcinomas, 5 small cell carcinomas and 6 other histologic types) and to sputum cells from 113 cytologically negative cases (as controls). The positive rates were 60.1% for keratin, 34.8% for TA-4, 28.2% for SCC, 1.4% for NSE, 0.1% for GRP and 7.9% for CEA for carcinoma cells (P less than .05 for all) and 7.4% for keratin and 1.0% for SCC for sputum cells (P less than .05 for both). It was concluded that keratin is the most effective marker, not only for squamous cell carcinoma, but also for adenocarcinoma and large cell carcinoma. Since most small cell carcinoma cells in sputum have little or no cytoplasm, it is necessary to use an intranuclear marker to detect this histologic type.

Different incidence of loss of heterozygosity on chromosome 16q between intraductal papilloma and intracystic papillary carcinoma of the breast.

Loss of heterozygosity (LOH) on chromosome 16q was examined in DNA isolated from 11 intraductal papillomas and 12 intracystic papillary adenocarcinomas of the breast. Such LOH was detected in 8 (67%) out of 12 intracystic papillary adenocarcinomas, and in 7 (64%) of 11 of these adenocarcinomas of low grade atypia (Grade 1), whereas it was not detected in 11 intraductal papillomas. Therefore, inactivation of tumor-suppressor genes on chromosome 16q was suggested to be involved in acquisition of malignant phenotype rather than in tumorigenesis in mammary gland epithelial cell. Examination of LOH on 16q should be helpful for differential diagnosis of intracystic papillary tumors.

Early stage adenocarcinoma of the uterine cervix. Histopathologic analysis with consideration of histogenesis.

Thirty cases of early stage adenocarcinoma, 5 mm or less in depth, were selected from 1942 primary carcinomas of the uterine cervix for histologic analysis to clarify their histogenesis. There were 16 carcinomas of endocervical type, 12 of endometrioid type, and 2 clear cell carcinomas. There were 22 early invasive adenocarcinomas and 8 adenocarcinomas in situ. In 27 cases the carcinoma was adjacent to the transformation zone and in 3 it was separate from it. In 10 cases adenocarcinoma coexisted with in situ squamous cell carcinoma. Only one patient whose tumor was 3 mm in depth developed a pelvic recurrence after radical hysterectomy. All other patients remained disease-free after treatment by hysterectomy. It is suggested that most adenocarcinomas of the uterine cervix originate from endocervical glands adjoining the transformation zone and that they may develop directly from normal-appearing epithelium without passing through adenomatous or dysplastic changes.

A case of adenocarcinoma of the lung which was successfully treated by chemotherapy with patient survival without recurrence for more than three years.

A 63-year-old man was admitted to the National Cancer Center Hospital on December 20, 1983 for a close examination of the abnormal shadows found in chest roentgenograms. Chest radiographs showed a massive right pleural effusion, a large tumor in the right hilar region and swelling of the left hilar nodes. Transcutaneous needle biopsy revealed the tumor's cytological type to be adenocarcinoma. The clinical stage was considered to be T3N2M1 (American joint committee (AJC) stage III M1), and his performance status was 4, so he was given etoposide (VP-16) alone as the initial chemotherapy treatment. He showed a partial response upon two courses of VP-16 therapy. Subsequently, one course of cisplatin (80 mg/m2) + vindesine (3.3 mg/m2), two courses of VP-16 (80 mg/m2 D1-4), five courses of cyclophosphamide (80 mg/m2) + adriamycin (50 mg/m2) + vincristine (1.4 mg/m2) and two courses of VP-16 (100 mg/m2 D1, 3, 5) were administered sequentially until May 31, 1985. No radiation therapy was given and, up to March 31, 1987, no sign of recurrence had been observed.