NASAL CELL SMEARS 



220 



NASAL CELL SMEARS 



to malignancies, other tumors and le- 

 sions occurring in this area. Morrison, 

 L. F., Hopp, E. S. and Wu, R. (Ann. 

 Otol., Rhinol. and Laryngol., 1949, 58, 

 18-31) have employed the smear tech- 

 nique as an adjunct in the diagnosis of 

 exfoliating neoplasms of the naso- 

 pharynx. This proved so reliable that 

 a positive smear demanded discovery 

 of the source of the malignant cells. 

 Sooy, F. A. (The Laryngoscope, 1950, 

 60, 964-992) in a study of primary tu- 

 mors of the nasal septum, has also used 

 the smear technique to advantage. 

 Early diagnosis of carcinoma of the 

 maxillary sinus in a series of cases re- 

 ported by Fitz-Hugh, G. S., Moon, C. 

 N. Jr. and Luptom, C. H. Jr. (The 

 Laryngoscope, 1950, 60, 376-387) was 

 thus facilitated. 



This cell smear method is not only an 

 aid in diagnosis, but also is a convenient 

 means for studying the microscopic 

 course of a lesion during and after treat- 

 ment. Biopsies are not always possi- 

 ble, but smears are easily obtained with- 

 out discomfort to the patients. The 

 effects on the cells of x-ray or radium 

 therapy comprise a whole new field 

 of cytological research. New knowl- 

 edge thus gained is of great importance 

 when closely correlated with clinical 

 symptoms. 



Satisfactory techniques for staining 

 nasal secretions include the following: 



1. Wright's Stain. Slides are dried 

 in air (avoid flaming). Many direc- 

 tions advise staining as a blood film; 

 but two points will improve this tech- 

 nique for nasal work, namely the use 

 of a buffer solution for the diluent and 

 the shortening of the time recommended 

 for blood smears to only 15 or 20 sec. 

 of staining. After marking off the 

 ends of the slides with a wax pencil, 

 they are flooded with the dye for 15 

 sec. The buffer diluent is added to the 

 stain and allowed to mix well for 15 

 sec. more. The slides are then washed 

 in buffer solution and placed on end 

 on a blotter to drain and thus to dry 

 more rapidly. This light rapid stain- 

 ing shows cellular detail better in the 

 nasal smear than the usual technique. 

 The slides can be kept and stored for 

 many years without coverslips and 

 thereafter show no signs of deteriora- 

 tion. The cellular details are even 

 better if the slides are stained within 

 30 min. after being made and dried. 

 The stain is especially good for eosino- 

 philes, neutrophiles and mononuclears. 

 It is not very suitable for differentiating 

 epithelial cells. 



2. HanseVs Stain. Color slide 30 

 sec. with his dye which is an eosin- 



methylene blue combination and can 

 be obtained directly from him (Dr F 

 K. Hansel, 634 N. Grand Blvd., St. 

 Louis 3, Mo.). Then add alkaline 

 water which is made by adding one 

 drop of 1% potassium carbonate to 60 

 cc. aq. dest., for 30 sec. Wash in alkaline 

 water followed by washing in acid water 

 which is made by adding one drop of 

 1% hydrochloric acid in 60 cc. aq. dest. 

 Wash again in alkaline water and finally 

 rinse in 95% ethyl alcohol. This stain 

 is especially good for eosinophiles. 

 The granules are very brilliant and re- 

 fractile. Other cellular detail may be 

 somewhat dark and indefinite. 



5. Gtemsa Stain. The preparation 

 from Gradwohl is very satisfactory. 

 The dilution is one drop of stain to 1 cc. 

 ac[. dest. The slide is flooded with 

 diluted stain for one minute then 

 washed with aq. dest. If overstaining 

 occurs, this may be decolorized with 

 ethyl alcohol. The restulting colora- 

 tion is excellent for eosinophiles but is 

 not especially recommended for the 

 other cells. 



4. Supra-Vital Staining. This tech- 

 nique is particularly useful for study- 

 ing secretions in the fresh condition 

 when one wishes to observe motility 

 of eosinophiles and neutrophiles, the 

 phagocytic activity of neutrophiles and 

 of mononuclears, as well as the ciliary 

 activity of the exfoliated columnar 

 epithelial cells. One drop of exudate 

 may be mi.xed with a drop of 1:15,000 

 aqueous Neutral Red or Janus Green, 

 or of both in combination. The tech- 

 nique is fully described by Sabin, F. 

 R. (Bull. Johns Hopkins Hosp., 1923, 

 34, 277-288) who used it to study living 

 human blood cells. The stock solution 

 of Neutral Red contains 100 mg. of 

 dye to 10 cc. of absolute alcohol. The 

 dilute solution contains 0.4 cc. of stock 

 Neutral Red in 10 cc. of absolute al- 

 cohol. An even dye film is obtained 

 by flaming the slide, then flooding it 

 with the dilute Neutral Red solution or 

 with a mixture of Neutral Red and 

 Janus Green, which is 2 cc. of dilute 

 Neutral Red to 3 drops of saturated 

 solution of Janus Green in absolute al- 

 cohol. The slide is quickly drained and 

 placed upright to dry. Fresh exudate 

 IS mounted on the slide with coverslip 

 and ringed wth vaseline. The cells 

 may last for 2 to 3 hrs. if examined un- 

 der a warm stage. The mitochondria 

 of the cells may be studied when Janus 

 Green is used. This dye is more toxic 

 to the cells than Neutral Red. The 

 ciliated epithelial cells are of particular 

 interest and the motility of the cilia is 

 not impaired. Nuclear staining of the 



