Zytologische Diagnose des Magenkarzinoms¹

Zusammenfassung

Es wird über Erfahrungen in der Zytodiagnostik des Magenkarzinoms an etwa 500 Kranken berichtet. 70 Fälle mit einem für Karzinom charakteristischen zytologischen Befund wurden histologisch eingehend kontrolliert. Nur in 6 Fällen konnte das zytologisch diagnostizierte Karzinom durch die histologische Untersuchung nicht bestätigt werden. In diesen, wie überhaupt in vielen ulkus- und karzinomhaltigen Mägen fand sich aber stets eine mehr oder weniger ausgesprochene chronische atrophisch-hyperplastische Gastritis. Inwieweit dieser Form der Gastritis eine Bedeutung für die Entstehung des Karzinoms zukommt, müssen weitere Untersuchungen zeigen. Der Zytodiagnostik kann also zur Früherkennung des Magenkarzinoms großer Wert zukommen, wie an 3 typischen Fällen ausgeführt wird.

Summary

A method is cescribed for obtaining, through a series of gastric lavages, the necessary material for cytologic examination of desquamated gastric mucosa. This report is based on findings in about 500 patients in whom this technique has been used for the diagnosis of gastric neoplasm. More particularly, results are presented of 70 cases in which the diagnosis of gastric carcinoma had been made by cytologic examination and could be compared with histological findings after gastric resection. The following cytologic criteria were used: Tumour cells often “in bunches”; closely packed nuclei; nuclei with irregular chromatic structure; large and multiple nucleoli; intensely stained nuclear membranes; usually hyperchromatic nuclei; increased nucleus/cytoplasm ratio; rare mitoses; very variable cell size; many giant cells. In addition, there were usually many leucocytes, fresh blood and altered bacterial flora in the washings. In only 6 of the 70 cases was the cytologic diagnosis not confirmed histologically. But in these instances, as in most cases where ulcer or carcinoma was present, there was chronic atrophie hyperplastic gastritis. Only future examinations can decide in what way, if any, this type of gastritis is related to carcinogenesis. Three typical cases are briefly reviewed to show the potentialities of cytologic examinations in making an early diagnosis of carcinoma of the stomach. In these instances, even at time of operation, carcinoma could not be diagnosed from the gross appearance of the stomach mucosa, after cytologic findings had been characteristic.

Resumen

Diagnóstico citológico del carcinoma gástrico

Se informa sobre experiencias en el diagnóstico citológico del carcinoma gástrico recogidas entre 500 enfermos aprox imadamente. 70 casos con un hallazgo citológico característico de carcinoma, fueron sometidos a un minucioso control histológico. Solo en 6 de ellos no se pudo comprobar por examen histológico el carcinoma diagnosticado citológicamente. En éstos, como en general en muchos ulcus y carcinomas gástricos, se encontró siempre una gastritis crónica atrófica-hiperplásica más o menos acentuada. Hasta qué punto esta forma de gastritis tiene una significación en la génesis del carcinoma, solo lo podrán señalar investigaciones posteriores. El diagnóstico citológico puede ser por tanto de gran utilidad para el conocimiento precoz del carcinoma gástrico, como se expone en 3 casos típicos.