To evaluate the efficacy of the Cytobrush method in aged patients, a comparative study between the Cytobrush smears and cotton swab smears from the uterine cervix was performed. Consecutive 319 cotton swab smears of the endocervix were attempted on aged patients (60-98 yr, average 77.5 yr) from 1987 to 1988 (A group). Subsequently 391 endocervical smears were attempted by the Cytobrush on aged patients (60-100 yr, average 76.9 yr) from 1988 to 1990 (B group). The Cytobrush method was more effective in the following two points: (1) The rate of insert-impossible case in B group (7.2%) was lower than A group (12.5%). (2) The rate of case containing endocervical columnar cells increased in B group (64.7%) compared with A group (47.7%). In contrast, benign epithelial fragments (BFs) were observed in 6.8% of A, in 28.4% of B group. In smears positive for squamous cancer, malignant epithelial fragments (MFs) were noted in 24.5% of A, and 55.1% of B group. Consequently, the differential diagnosis of MFs from BFs is of more importance on the Cytobrush smears of aged patients.
Presented is a case report of a urinary bladder carcinoma that had an unusual morphology and phenotype. A 65-year-old Japanese man complained of gross hematuria. Cytological examination of the urine before a partial cystectomy revealed small, round atypical cells with a high nuclear/cytoplasmic ratio, scant cytoplasm, and hyperchromatic nuclei with coarse and granular chromatin in a bloody background. Several tumor cells had relatively large and vesicular nuclei with prominent eosinophilic nucleoli and obscure perinucleolar halos. A small number of large atypical urothelial cells were also recognized. The tumor recurred locally 3 months after the operation. The urine cytology during recurrence showed the same features without the atypical urothelial cells. These cytological findings suggested a case of small cell undifferentiated carcinoma (SCUC) combined with transitional cell carcinoma (TCC). An histology of the resected specimen before the recurrence revealed that the SCUC was consistent with a variant type of SCUC proposed for the lung and showed transition with TCC in situ. M-VAC chemotherapy after a total cystectomy was less effective. The patient died 6 months after diagnosis. A variant subtype of SCUC of the urinary bladder associated with TCC in situ has not been previously reported. Although this histological type is very rare, its earlier cytological detection is needed for appropriate therapy.
and 4 Cho Ray Hospital Introduction: Secondary metastatic tumors of the spleen are rare. The primary tumors that known to metastasize spleen are breast, lung, skin. There have been no reports of ampullary cancer metastasizing to the spleen in the previous day. We introduced here an oligometastasis in which ampullary carcinoma metastasizing to the spleen. Method: Case report. We describe a case of ampullary cancer metastasizing to the spleen at Cho Ray Hospital. Results: The patient was a 65 year-old woman who had been performed a pancreatoduodenectomy and splenectomy. The preoperative imaging revealed a tumor of ampullary and a suspicious splenic mass related malignancy. The post-operative pathology revealed the ampullary carcinoma metastasizing to the spleen. The operating time was 7 hours, postoperative hospital stay was 7 days, there was no any complication. Conclusions: This is the first report about a metastasis of ampullary carcinoma to the spleen. This was also an oligometastasis case. Pancreatoduodenectomy and splenectomy is a suitable approach in this case. The patient will be received supported chemotherapy after that.
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