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자궁경부 질환의 세포학적 및 병리조직학적 비교연구

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 (A) correlative study of cytologic and histopathologic features of the uterine cervical lesions 
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The lesions of the uterine cervix, such as inflammation, polyp, dysplasia, carcinoma etc, are common in women but it could be said that carcinoma and precancerous lesions are one of the most significant. Among the Korean women the carcinoma of the cervix is the most common malignant tumor of female(Kim, et al., 1973). A remarkably precise diagnosis of cervical lesions can be rendered with a high degree of accuracy from cervicovaginal smears(Weid, 1964; Kaufman, et al., 1967). The prime goal of cervicovaginal exfoliative cytology has been and remains the detection of epithelial abnormalities. In recent years, with increased knowledge of the cellular manifestations of disease, it is possible to detect the cellular abnormalities related to squamous cell carcinoma in situ of the uterine cervix and to distinguish these changes from those related to other alterations in the surface mucosa(Reagan, 1974). The widespread use of cytologic studies has significantly improved the detection of the precursors of squamous cell cancer. Further-more as a result of improved detection the process referred to as microinvasive squamous cell cancer is more frequently encountered(Ng, et al.,


The classification, for squamous cell cancer of the uterine cervix which was proposed by Wentz and Reagan(1959) consists of 3 distinct groups which includes large cell non-keratinizing, keratinizing and small cell cancer. The important features of this classification is a morphological classification permitting

correlation between tissue and exfoliated cells. A significant difference between the 3 cell types in regard to their radiosentivity and/or radioeurability, and thus a significant difference in the 5 year survival among the 3 types are reported. The present study is an attempt to invertigate the accuracy and value of the cytologic diagnosis, and to further the basis of the early diagnosis of the uterine cervical cancer.

Materials and Methods.

The materials used in this study consists of 88 cases of which cytological studies of cervical and vaginal smears are tissue studies of cervical biopsy or hysterectomized specimen are available during the period of 4 years and 9 months.

The smears were fixed in a equal parts of 95% ethyl alcohol and ether, and stained by routine Paphnicolou method. The cytologic diagnosis was made according to the classification of W.H.D.(1973). The arrangements, shapes and nuclear chromatin

patterns of the abnormal cells were examined as well as the back ground of the smears. The grading system was applied for the arrangements, shape of abnormal cells and back ground of smears, but percentage was applied for the chromatin pattern of nuclei in abnormal cells of smears. The microinvasive cancer of the cervix was separated from the invasive cancer of the cervix was separated from the invasive cancer of the cervix and the report of Alan, et al.(1972) was referred for the microinvasive carcinoma of the cervix. All tissue specimens were fixed in 10%

formalin and paraffin embedded blocks were cut in 6 micron thickness, and the sections were stained with hematoxylin and eosin.

Results and Summary

A comparison study between cervicovaginal smears and cervical tissue is made in 88 cases of the uterine cervical lesions and following results are obtained.

1. The cervical lesions of 88 cases consisted of 34 cases of chronic cervicitis, 9 cases of epithelial dysplasia, 22 cases of carcinoma in situ and 23 cases of invasive carcinoma including 2 cases of microinvasion.

2. The characteristics of the smear in epithelial dysplasia were polyhedral in shape, isolated in arrangement and uniformly finely granular in chromatin pattern(96%) without nucleoli.

3. The characteristics of the smear of carcinoma in situ were abnormal cells with round to oval in shape and either isolated or syncytial in all arrangements. The abnormal cells of the smear had the nuclei with uniformly coarse chromatin in 67 per cent of cells.

4. The characteristics of the invasive carcinoma in smears were round-oval in shape, equal degrees of either isolated or syncytial in arraggements, with frequent inflammetopy and bloody background. The 55 per cent of abnormal cells showed irregularity coarve granular chromatin of nuclei with 6 per cent of micronueleoli and 14 per cent of macronucleoli.

5. The 22 cases of carcinoma in situ of consisted of 2 cases of small cell type and 20 cases of large cell type. The cytologic diagnosis was correct in 15 cases out of 17 cases of non-keratinizing large cell type and 2 cases out of 6 cses of

keratinizing cell type.

6. The ratio of positive correlation between cytologic and histopathologic diagnoses was 100 per cent in moderate to severe degree of dysplasia, 95 per cent in carcinoma in situ, 100% in invasive carcinoma, and 92 per cent in total cases.

In conclusion based on above findings, a high degree of accuracy in diagnosing the various epithelial lesions, such as dysplasia, carcinoma in situ, and invasive carcinoma can be acertained by cytologic examinations. It is also possible to

differentiate the subtypes of invasive carcinoma, which is said to bear prognostic value.
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