THE DEMONSTRATION OF MALIGNANT CELLS EXFOLIATED FROM THE PROXIMAL COLON

Abstract

The cytologic diagnosis of cancer is especially valuable in the diagnosis of carcinomatous le sions of the colon beyond the reach of the sigmoidoscope where clinical and radiological methods are inadequate. Previously reported work is scant and described principally the cytology of lesions visible through the sigmoidoscope. The present study embraces the demonstration of malignant cells exfoliated from carcinomatous lesions beyond the reach of the sigmoidoscope. These cells are collected by small vol ume, 0.9% saline washings of the clean colon. Their appearance is outstanding because the earmarks of malignancy in large bowel cells are prominent. The technique of collection, preservation and demon stration of cells is described. Cytologic criteria for malignancy are given. Photographs depict normal and malignant cells. Eight selected cases are described briefly. Four had carcinoma of the cecum or ascending colon; 2, carcinoma of the hepatic flexure; and 2, carcinoma of the descending colon. None of these could be reached sigmoidoscopi-cally. In some the cytologic diagnosis of cancer antedated other definitive diagnostic reports. In conclusion, carcinomatous lesions of the colon are particularly amenable to diagnosis by cytologic techniques. It is possible to demonstrate malignant cells exfoliated from lesions as far proximal as the cecum.