RU2293987C2 - Method for detecting malignant neoplasm metastases in palatine tonsils - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves detecting atypical reticular cells in combination with irregular (asymmetric) mitoses, polymorphous immature cells, Motte cells , non-differentiated polymorphous single cells or cells grouped into glandula-like polymorphous complexes with asymmetric mitoses.

EFFECT: enhanced effectiveness in detecting metastases in isolated primary neoplasm focus cases.

Description

The invention relates to medicine, in particular to oncology.

There is a method of detecting cancer malignant diseases, neoplasm (H) by screening the formed high-risk groups with precancerous diseases and malignant tumors, based on complaints and anamnesis (P.I. Shelestyuk "Clinical oncology: Course of lectures" // Saransk: Publ. .Mordov. Un-that., 1996).

The described method has low performance and reliability. People more often do not suspect the presence of neoplasm (H). A tumor often develops without symptoms in a sick person. Even when certain symptoms and complaints appear, such patients go from one specialist to another with the 3rd or even 5th erroneous diagnoses for 2 years, until the symptoms accumulate and take on the form known to doctors, however, time is often missed.

A known method for the diagnosis of H (for example, cancer), including puncture of the lymph nodes followed by staining of the cellular material and studying the latter with a microscope (Handbook of a nurse for care / edited by N.R.Paleev. M .: Medicine. - 1981).

The described method is traumatic, expensive, has low productivity and reliability, because cannot be used in the early stages of N. Lymph nodes must be sufficiently affected by H to be punctured. But this is not an early stage. The doctor in this case also becomes in a waiting position. Often the possibility of treatment falls within 2-3 weeks after the establishment of the correct diagnosis.

Known methods for diagnosing cancer based on the detection of metastases (and single metastases) of various types of H by histological method in biopsy samples of tonsils (1. Millar-EK, Vaughan-Jones-R, Zang. S. Prostatic adenocarcinoma metastatic to the palatine tonsil: a case report // J. Laryngol. - Otol. 108 (2) Feb. 1994. P.178-80), rectal adenocarcinomas (2. Wang WS, Chiou TJ, Pan CC, ea Signet-ring cell carcinoma of the rectum with tonsillar metastasic: a case repot // Chung Hua I Hsueh Tsa Chin Taipei. 1996 Sep; 58 (3): 209-12), also metastases of various types of H, including lymphomas (3. Kojima M, Nakamura S, Shuimizu K, et al .: Marginal zone In cell lymphomas of Waldeyer's ring-a report of two tonsillectomy cases resembling h istomorphological features of inflammatory lesions. Pathol Res Pract 2001; 197: 781-784. 4. Anagnostopoulos I, Foss HD, Hummel M, et al. Extranodal mantle cell lymphoma mimicking marginal zone cell lymphoma. Histopathology 2001; 39: 561-565. 5. Reiter ER, Randolph GW, Pilch BZ. Microscopic detection of occult malignancy in the adult tonsil. Otolaryngol Head and Neck Surg 1999; 120: 190-194. 6. Younis RT, Hesse SV, Anand VK. Evaluation of the utility and cost-effectiveness of obtaining histopathologic diagnosis on all routine tonsillectomy specimens. Laryngoscope 2001; 111: 2166-2169). All the described methods (1-6) are performed on pathologically altered tonsils. The described method 6 is a prototype.

The prototype has significant disadvantages: 1. Low productivity and reliability, because detection of metastases and, moreover, a single metastasis in histological samples of NM after tonsillectomy takes a lot of time. 2. Tonsillectomy is an unsafe method. 3. Tonsillectomy is performed according to strict indications (in case of chronic tonsillitis in the stage of decompensation or when HM is directly affected by H), therefore the prototype cannot be used for mass research, like N. screening. 4. The prototype cannot be used on people with unchanged palatine tonsils, like screening H, because at the same time, the very possibility of a mass examination of people for the presence of N. is excluded. However, a mass examination is a hallmark of screening. 5. Tonsillectomy followed by histological examination is an expensive, time-consuming method and requires significant material costs. 6. The implementation of the method described in the prototype takes a lot of time.

The final technical result of the proposed solution is as follows: 1. Increase productivity, profitability and reliability by 20 times by analyzing the reaction of cells obtained by scraping, both from unchanged and from changed NM in the presence of distant H, which is characterized by the appearance of different values of atypical reticular cells in conditions that are accompanied by uncontrolled proliferation of cells of various N; with epithelial tumors, malignant lymphomas and melanoma (polymorphic, usually hypochromic, without nucleoli, with an eccentric irregular shape and with irregular edges of the nucleus, with a gentle bluish or smoky, abundant cytoplasm with sinuous lace edges, their sizes are 14-32 microns, even single large atypical reticular NM cells give rise to include the patient in whom they are found at risk), with liposarcoma, undifferentiated polymorphic (or glandular) complexes appear hyphromic rf cells of different sizes with polymorphic nuclei of heterogeneous stratified chromatin, with foamy or vacuolated cytoplasm and asymmetric mitosis (s); with blood system tumors, hemoblastoses, for example leukemia, the proportion of polymorphic hypochromic immature cells such as blasts and pro-lymphocytes in the NM increases sharply relative to the epithelium and other NM cells and Mott or morula cells appear; with lymphogranulomatosis, an NM reaction is detected, which is expressed in the appearance of atypical reticular cells, as well as huge mature (even single) and young cells specific for this disease in a state of irregular (pathological) division (even single) - lymphogranulomatosis cells, Reed-Sternberg (Hodgkin cells) cells), in the presence of ordinary mitoses. Metastases are also detected. Single small atypical reticular NM cells are detected in the presence of precancerous diseases, for example, with mastopathy, etc.

A method for detecting metastases of malignant neoplasms in the tonsils in the presence of a distant primary focus of neoplasm is performed using a microscopic analysis of cytological material obtained by scraping from the surface of the NM, in which cellular reactions of lymphoid tissue, the surface, intermediate and basal layer of the epithelium are evaluated. Atypical reticular cells, undifferentiated polymorphic cells, Mott or morula cells, individual or associated with epithelium, as well as asymmetric, pathological mitoses, polymorphic immature cells (such as blasts and prolymphocytes), as well as metastases of various types of malignant neoplasms are detected. Scraping is performed in a patient in a sitting position. The patient opens his mouth and sticks out his tongue. In a typical place, there are NM right and left. Scraping of the cytological material of NM is carried out under visual control using the type of spoon to remove gallstones or the type of dental curette. From a cell material obtained by scraping, a smear is made on a glass slide, stained according to Giemsa (or Romanovsky-Giemsa) and examined using a light microscope.

To achieve the final technical result, the following tasks were solved.

A reaction of the cellular composition of NMs is revealed: atypical reticular cells, undifferentiated polymorphic cells with and without asymmetric mitoses, a noticeable increase in the number of polymorphic immature cells (such as blasts and prolymphocytes), Mott cells, as well as the detection of various types of metastases N. Cellular material obtained using scraping with NM, transferred to a glass slide and stained by Giemsa (or Romanovsky-Giemsa) and then examined using a light microscope.

The proposed method is implemented as follows (specific examples).

1. In the case of carcinoma (adenocarcinoma of the stomach): a) the patient is in position (lying down, depends on the patient's condition). The patient is asked to open his mouth, stick his tongue out and say “A”, show the throat. With the right HM under visual control using a dental curette, scraping is performed. The scraping material is evenly distributed on a glass slide and stained according to Giemsa; b) a smear using a microscope (X 400-900) reveals carcinoma metastases, reticular cells of various sizes with atypical signs, asymmetric mitoses.

2. In the case of melanoma: a) ... the conditions of paragraph “a” of case 1 are fulfilled; b) a smear using a microscope (X 400-900) reveals metastases of melanoma, reticular cells of various sizes with atypical signs, asymmetric mitoses.

3. In the case of acute lymphoblastic leukemia (hemoblastosis): a) ... the conditions of paragraph "a" of case 1 are fulfilled; b) a smear using a microscope (X 400-900) reveals polymorphic hypochromic immature cells such as blasts, pro-lymphocytes, which create the background of the smear, Mott cells, metastases.

4. In the case of chronic lymphocytic leukemia (hemoblastosis): a) ... the conditions of paragraph "a" of case 1 are fulfilled; b) a smear using a microscope (X 400-900) reveals polymorphic hypochromic immature cells such as lymphocytes, pro-lymphocytes, blasts in various quantitative proportions that create the background of the smear, Mott cells, metastases.

5. In the case of liposarcoma: a) ... the conditions of paragraph “a” of case 1 are fulfilled; b) a smear using a microscope (X 400-900) reveals liposarcoma metastases, undifferentiated polymorphic hypochromic cells of different sizes with foamy, vacuolated cytoplasm, located separately or grouped into polymorphic complexes, asymmetric mitoses, metastases.

6. In the case of lymphoreticulosarcoma (malignant lymphoma): a) ... the conditions of paragraph “a” of case 1 are fulfilled; b) in the smear using a microscope (X 400-900), atypical reticular cells, asymmetric mitoses, metastases, which are represented by the growth of atypical lymphocytes and polymorphic reticular cells, are detected.

7. In the case of lymphogranulomatosis (malignant lymphoma): a) ... the conditions of paragraph "a" of case 1 are fulfilled; b) in the smear using a microscope (X 400-900), atypical reticular cells, Reed-Sternberg cells, asymmetric mitoses, metastases are detected.

8. In case of mastopathy (pretumor disease): a) ... the conditions of paragraph “a” of case 1 are fulfilled; b) single small atypical cells are detected in a smear using a microscope (X 400-900).

9. In the case of a neck cyst (precancerous disease): ... the conditions of paragraph “a” of case 1 are fulfilled; b) single small atypical cells are detected in a smear using a microscope (X 400-900).

Significant advantages of the proposed solution.

1. The proposed method allows to significantly increase the number of subjects with unchanged NM, without ENT pathology, patients do not complain about ENT organs, as well as NM, as well as with altered NM, thereby increasing productivity by 12 times due to an increase in the number of examined groups of patients and the expansion of indications for the proposed method: Indications for the method: 1. People working in hazardous industries. 2. People genetically predisposed to cancer and other diseases whose relatives suffer or have suffered from cancer. 3. Patients suffering from malignant diseases with an already established diagnosis (to exclude them from the 4th stage of the spread of the disease). 4. Patients with benign tumors: polyps, popilomas, adenomas, lipomas, fibromas, lymphangiomas, hemangiomas, dermoid cysts, myxomas, etc. 5. Patients suffering from precancerous conditions: mastopathy, polyposis of the gastrointestinal tract (stomach, intestines, etc.), mammary gland hyperplasia, xeroderma pigmentosa; chronic inflammatory processes: bronchitis, non-healing ulcers, dysplasia, cervical erosion, etc. 6. Patients treated for an oncological disease (systematic examination). 7. Patients with fever of unknown origin (fever), with a variety of dubious or incomprehensible x-ray (ultrasound) findings, etc. 8. Patients with increased ESR, with anemia and other changes in blood counts, as well as with endocrine disorders. 9. Patients with enlarged and / or compacted, painful lymph nodes. 10. Patients with unclear, doubtful diagnoses. 11. Patients with cachexia, changes in appetite, weight loss, impaired motor function, an act of swallowing, bleeding, etc. 12. Any patient who wishes to be examined by this method; periodically monitor and adjust the resistance of your body to cancer. These patient groups are predominantly without ENT pathology, excluding tonsillitis. The proposed method has no contraindications. The prototype does not allow to fulfill the above 12 points and is performed retrospectively, after tonsillectomy, which is carried out according to strict indications only in a hospital.

2. The proposed method allows you to determine the risk group relative to neoplasm (H), but in some cases to predict the result of verification of H, to differentiate carcinomas from hemoblastoses (leukemia) and lymphomas not just at the early stage of development of these tumors, but even at the stage of the first attack, unchanged NM. The prototype does not allow this to be done with unchanged NM.

3. The proposed method can cover almost all segments of the population, it is successfully performed both in the hospital, in the outpatient department, and at home and at the patient’s bed in the hospital directly. - The prototype does not allow this.

4. The proposed method is performed with minimal damage to the tissues of the NM and without complications. Since 1964 - 1,600 observations without complications. The prototype is sometimes performed with complications.

5. The proposed method has no contraindications. The prototype has contraindications (for example, biopsy is contraindicated in hemoblastoses, especially tonsillectomy) and is carried out according to strict indications.

6. The proposed method many times (more than 200 times) increases the productivity and reliability of the study. The proposed method in one patient takes an average of 1 hour: from the beginning of scraping and issuance of a conclusion on hand. The prototype has low performance and reliability. A tonsillectomy of NM with subsequent histology of samples of NM will take at best at least 12 days. Many patients with H do not have changes on the part of NM and therefore cannot be investigated using the prototype.

7. The proposed method is 10 times more economical. The prototype includes material costs, except histological equipment, preoperative preparation, surgical instruments, anesthesia, dressing for tonsillectomy, bed days.

8. The proposed method is performed with minimal stress. The prototype includes operational stress and long-term stress stress.

9. In the proposed method, the reaction of HM cells is detected in the presence of distant H: a few large atypical reticular cells, or an increase in the number of these cells of various sizes with carcinomas and lymphogranulomatosis, as well as metostases; undifferentiated polymorphic cells and asymmetric mitoses in liposarcomas, polymorphic immature cells such as blasts and pro-lymphocytes and Mott cells in leukemia. This is easily detected even with a quick inspection of the smear. The prototype includes the detection of metastasis, which is unproductive, especially if you look for a single metastasis. Moreover, metastases in NM are rare, and the reaction of NM cells in the presence of distant H always appears.

Significant differences of the proposed method from the prototype.

1. In the proposed method is scraping. In the prototype, tonsillectomy (biopsy). 2. In the proposed method, scraping is performed at the patient’s bedside in a hospital, in his house, in a clinic, in an outpatient clinic, in a field, in a train, at elevated temperature and at normal temperature. In the prototype - in a hospital, in the operating room, at normal temperature. 3. The proposed method is carried out by one tool such as a dental curette. In the prototype, a set of surgical instruments for tonsillectomy. 4. The proposed method includes the manufacture of a smear of the obtained material. In the prototype - wiring and manufacturing of histological sections. 5. In the proposed method, smears are stained. In the prototype, histological sections. 6. In the proposed method is not used microtome for the manufacture of histological sections. In the prototype, it is used by a microtome. 7. When performing the proposed method, the patient does not lose the lymphoid organ of the NM, which provides the body's immunity, etc. When performing the prototype, patients lose the lymphoid organ of the NM, which provides the body's immunity and other important functions. 8. The proposed method has no contraindications. The prototype is shown only in one case: chronic tonsillitis in the stage of decompensation. 9. The implementation of the proposed method takes about 1 hour. The prototype is an average of 12 days. 10. The proposed method does not require special preparation of the patient. The prototype includes preoperative preparation. 11. The implementation of the proposed method does not require laboratory preliminary tests of blood and urine, etc. In the prototype laboratory tests are required. 12. Any person who wants to be examined and periodically monitor their body's resistance to cancer can use the proposed method. 13. The proposed method proposes to evaluate the reaction of NM in the presence of distant neoplasm. The prototype does not evaluate the response of NM. 14. The proposed method takes into account large atypical reticular cells, undifferentiated polymorphic cells, an increase in the number of polymorphic immature cells (such as blasts and pro-lymphocytes), Mott cells. The prototype of these structures does not take into account. 15. The proposed method takes into account undifferentiated polymorphic cells and asymmetric mitoses with unchanged NM with distant liposarcoma. In the prototype, this feature is not taken into account. 16. The proposed method has no contraindications. The prototype is contraindicated for all people who do not suffer from chronic tonsillitis in the stage of decompensation (at the present time and with this disease they try to preserve the NM) or neoplasm localized in the NM itself. 17. The proposed method is performed on unchanged NM and modified NM. The prototype is performed only on modified NM.

Claims (1)

A method for detecting metastases of malignant neoplasms in the tonsils in the presence of a distant primary focus of neoplasm, characterized in that they conduct a microscopic analysis of cytological material obtained by scraping from the surface of a visually unchanged palatine tonsil for the presence of reticular cells of various sizes with atypical signs, undifferentiated polymorphic cells with asymmetric mit polymorphic immature cells, Mott cells, Reed-Sternberg cells, atypical reticular cells detecting in the presence of metastases with carcinomas, melanomas, or malignant lymphomas, atypical reticular cells together with Reed-Sternberg cells are detected in the presence of metastases in lymphogranulomatosis, hypochromic polymorphic immature cells and Mott cells in the presence of metastases in leukemia, in the presence of metastases of distant lesions cells located separately or grouped into polymorphic complexes with asymmetric mitosis, and in pre-tumor diseases detect single small atypical cells.