Masayuki Yamauchi

Endometrial cytology and subsequent uterine malignancies in patients treated with long-term tamoxifen for breast cancer

目的:乳癌術後タモキシフェン (TAM) 投与が2年から5年に延長されたことから, TAM長期投与の子宮内膜への影響を解析した.方法:1995-2000年のTAM内服患者を対象に, maturation index (MI), 内膜細胞像の推移, TAM内服中に診断された子宮内膜癌を臨床病理学的に検討した.成績:1995-2000年の対象は, 順に86, 76, 72, 107, 130, 147, 計618例あり, 頸管ポリープ11例 (1.8%), 子宮内膜ポリープ9例 (1.5%), 子宮内膜癌 (癌肉腫1例) 4例 (0.6%) が続発した. MIは小型から中型の中層細胞主体となった. TAM開始後の内膜細胞診は, 類円形で細顆粒状の核を有する分泌期類似の内膜細胞がシート状に出現, 4, 5年目は同所見に加え, 細胞や核の大小不同, 小型濃染核の萎縮細胞, 内膜細胞の重積や扁平上皮化生細胞が混在した. 子宮内膜癌は, Ia期類内膜腺癌 (G1) 3例と癌肉腫1例が2年以内に診断され, 前回細胞診で内膜細胞の3次元構造や土管様配列の強い増殖所見を認めた.結論:TAM開始後は, 早期からの子宮がん検診が重要で, 内膜細胞診では3次元細胞配列などの強い増殖像は注意を要する.

Imprint cytology of breast ductal carcinoma in situ

目的:乳房温存療法の断端判定に切除断端捺印細胞診が行われるようになってきた.そこで, 乳腺非浸潤癌における細胞像を組織像と比較して検討した.方法:乳癌手術例の捺印細胞診標本を作製し, 捺印部の組織像が非浸潤癌あるいは微小浸潤癌であった25例 (非浸潤癌16;微小浸潤癌9) の細胞像と組織像を比較した.成績:面庖型 (5例), 節型 (4例), 低乳頭型 (5例), 充実型の細胞異型の強いもの (2例) は, 個々の腫瘍細胞の核異型が明らかで, 癌との判定は容易であった.乳頭型 (6例), 低乳頭型 (1例) と充実型 (2例) の細胞異型の弱いものは, 細胞異型が乏しく良悪判定が困難であった.面庖型と節型の一部については組織型の推定が可能と思われた.乳管内病変の穿刺吸引細胞診では認められることの多い筋上皮は6例で確認されたが, 線維性の芯はみられなかった.結論:非浸潤性乳管癌を主体とする病変の捺印細胞像は, 悪性との判定が容易な組織型と良悪判定が困難な組織型に分けられた.捺印細胞診による組織像の推定は, 穿刺吸引細胞診よりも困難と思われた.

Concervative therapy with cervical intraepitherial neoplasia and the usefulness of cytology to detect recurrence.

目的:子宮頸部初期病変の増加と若年化から妊孕能やQOLを考慮した子宮温存手術が増加しており, 再発の早期診断のため, 術後検診での細胞診の役割を検討した.方法:1990-1999年の子宮頸部初期病変のレーザー蒸散, 円錐切除後の再発様式, 細胞診像と治療を解析した.成績:異形成, 上皮内癌, Ia期 (旧分類) は順に129,224,201例で, 平均年齢は順に42, 42, 43歳, 30歳未満の若年の割合は順に15, 12, 7%であった. 子宮摘出, 円錐切除, レーザー蒸散は順に, 異形成では8,104, 17例, 上皮内癌では104,113, 7例, Ia期では165, 34, 2例で, 子宮温存の割合は順に94, 53, 18%となった.円錐切除群の再発は異形成4/104 (4%), 上皮内癌3/113 (3%) で, 術後の病変の進行は認められず, 細胞診異常は術後2-108ヵ月 (平均26) に出現, 組織確認後の再治療は9-108ヵ月 (平均36) にレーザー蒸散が5例, 円錐切除が2例になされた.レーザー蒸散群の再発は異形成で4/17 (24%), 上皮内癌は1/7 (14%) となり, class III以上の細胞診異常は術後, 平均6ヵ月 (1-16) に出現し, 組織確認後の再治療は平均26ヵ月 (3-60) 後にレーザー蒸散を3例, 円錐切除を1例, 異形成から上皮内癌進展の1例に腔内照射を施行した. koilocytosisは再発の全例で, 治療前後の細胞診, 組織診のいずれかに観察された.結論:子宮頸部初期病変の子宮温存手術後の再発頻度, 進行はともに少なく, 再発では異型細胞の出現が先行し, 特に術後のkoilocytosisの持続は再発の危険因子と示唆された.

Cytologic findings of pulmonary blastoma. An autopsy case report.

症例は75歳の男性で咳漱, 心窩部痛を主訴とし, 胸部X線検査で右下肺野の腫瘤影を指摘された. 気管支擦過細胞診で, 腫瘍細胞は胞体が比較的豊富で均質, 核は楕円形で1～3個の明瞭な核小体を有していた. 剖検では右肺下葉に径10cmの出血および壊死巣を伴う境界明瞭な黄白色の充実性腫瘍が認められた. 組織所見では腺腔形成を示す上皮性部分と未熟な間葉系細胞や横紋筋, 軟骨様成分の混在を認め, 肺芽細胞腫と診断した.

Neoplastic Multinucleated Giant Cells in Pleural Effusion of Lung Cancer

The patient, a 64-year-old man, complained of pain of the right chest. Lung cancer was suspected by X-ray examination and was confirmed by cytological study of the sputum (Class V, adenocarcinoma).He was treated by Linac X-ray irradiation and with anti-cancer drugs, After 2-week hospitalization, he was pointed out pleural effusion in the right chest. A yellowish-brown exsudate was aspirated and with the first materials was revealed an adenocarcinoma with multinucleated giant cells measuring 15-60 μin diameter. With the second materials, it was difficult to differentiate multinucleated giant cells from giant cell carcinoma or malignant mesothelioma because of a large amount of giant and multinucleated neoplastic cells.The tumor cells were PAS and alcian-blue positive.Electron microscopically, the tumor cells were found to have mucus-forming vacuoles, intracytoplasmic microcysts and cytophagocytosis.Autopsy revealed carcinoma of the upper lobe of the right lung with extensive metastasis to lymph nodes. The right pleura was markedly fibrosed and thickened with tumor cell infiltrations. Microscopic diagnosis was bronchial adenocarcinoma with mucin formation.In this case, cancer cells were observed to become multinucleate and gigantic due to treatment, which made diagnosis difficult. Further, as the therapeutic effect differed between free cells and filling proliferating ones, this cytologically interesting problem and others were discussed.

Cytologic and electron microscopic study of herpes vaginitis and herpes zoster

Two cases of herpes vaginitis (42 and 36 yearold housewives) were diagnosed by cytologic examination. The cytologic, histopathologic and electron microscopic studies were made of patient materials, and infected HEL cells.Three cases of herpes zoster associated with malignant tumors (two cases of uterine cancer-59 and 51 year-old housewives, and a case of reticulum cell sarcoma-49 year-old female) were studied by same methods.The alteration was compared with infected cells of HSV-II and herpes Zoster.Result as follows: -1: The virus was isolated from vaginal materials in case 2, and was identified as HSV-II with the use of HF and UW-268 streins.2: Variable changes were found in the squamous and columnal cells of cervical epithelium. The early visible structural alteration showed glassylike transluent mononuclear cells with swelling of the cytoplasm and the nucleus. Characteristic diagnostic feature is lobulated and multinucleated giant cells with intranuclear inclusion bodies.3: The cultured HEL cells were examined by cytologic and electron microscopic observation at 48, 72 and 96 hrs. after viral infection. The alteration of infected cells revealed similar features for human materials. The immature viral particles (100mμ) with central cores or empty capsid in nucleus, and enveloped mature particles (200 mμ) in cytoplasmic vacuoles were found in the infected HEL cells.4: The materials of herpes zoster were examined by useing vesicular fluid and epidermis. The infected squamous cells revealed enlarged lobular and a few multinuclear changes without glassylike swollen. Electron microscopically, viral particles appeared to have similar structures as HSV-II in infected HEL cells.