Out of 159 lung cancer patients irradiated with total dose higher than 3, 000 R, regrowth of the primary lesions were seen in 23 cases (14.5%), and were diagnosed as to be recurrences.
Time interval between the day of recurrence and the last day of radiotherapy was 9.13±7.00 months. Recurrence rate was highest in the stage I patients and decreased gradually as the stage proceeded.This was deduced due to the difference of the survival time of patients of each stage.
About 90 per cent. of recurrences were seen in those patients who received radiotherapy with the doses between 5, 000 to 8, 000 R, but even higher than 10, 000 R, recurrences still occured.
Relationship between the recurrence and the dose given as well as the type of tumor was analysed.
Sixteen patients, received radiotherapy to their recurrent tumors, survived longer than those 7 patients who were not reirradiated.

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Causes of death of lung cancer patients treated by radiotherapy were analysed. From Apr. 1959 till June 1970, 159 patients were irradiated with total dose higher than 3, 000 R to their primary lesions. In the end of June 1971, 11 were alive and 148 dead already. Causes of death were determined in 22 patients at autopsy, and were obvious in 32 patients died during admission. Among 94 patients died after discharge from the hospital, house visit in 42 patients and mail survey in 35 patients disclosed the causes of death. In 22 autopsy cases, dyspnea owing to infection, cardiac involvement or direct air way obstruction by cancer was the cause of death in 7, liver metastasis in 3, and brain metastasis in 4.
Only one patient died of hemoptysis and one other patient of the other disease. In remaining 6 cases, widespread metastasis with cachexia was deduced to the cause of their death. In 109 cases which were not autopsied, causes of death were as follows; dyspnea in 11, liver metastasis in 10, brain metastasis in 20, widespread disease in 59 and miscellaneous in 9. From the stand point of view of the histologic types, widespread disease was the prime cause of death in epidermoid and large cell carcinoma patients, and liver metastasis in ones with small cell carcinoma.In adenocarcinoma patients, dyspnea, brain metastasis and widespread disease evenly attributed to their death. One patient died of cardiac complication after radiotherapy but no patient died of radiation fibrosis.
Among 4 patients died of other diseases, 3 had apoplexia.

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Takizawa's carcinomas induced by treatment of pbenzoquinone were sub cutaneously transplanted in mice. These mice were received six times subcutaneous injections of 10mg Bleomycin per Kg body weight in other sites, soon after the tumor tissue moderately developed. The animals were sacrificed 6 days after the first injection and the tumor tissue carried out histological and histochemical examinations.
In the Bleomycin treated animals was obvious that necrotic lesions of the tumorwere scattered in the perivascular regions, which showed no degenerative changes in the untreated animals. The degenerative changes consisted of vacuolation, fatty degeneration and pyknosis. These changes were observed not only in the perivascular tumor cells but also in the endothelial cells of small vessels. Histochemically decrease of ATPase, ATPase and ALPase activities in the vascular walls was revealed, and ALPase, Acid Pase, SDH and ATPase activities in the perivascular tumor cells as well.
We had previously reported in lung cancer of human cases treated with Bleomycin injection that some proliferative changes had added to these degenerative findings. The proliferative changes seen in human cases were supposed to be reparative in a result of destruction by Bleomycin injection.
When we examine a chemotherapeutic effect, we should observe degenerative changes in perivascular tumor cells.

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A 32 year-old, wiring worker, with a history of bloody sputum three times 2 years ago, was admitted with expectration of bloody sputum several times a day for five days.
A chest film on admission revealed several sharply delinated round lesions up to 3×3cm in size in the both lungs. No other abnformalities were shown by labolatory examinations including bronchoscopy, bronchoscopic biopsy and cytological examination of sputum.
As the tumors on the both sides showed a rapid increase in size and number, and cavitation in some of them during a short period of observation, the exploratory thoracotomy and laparotomy were carried out at the same time for the purpose of detection of the nature of the tumor and location of the primary focus. One tumor in S³a of the right lung was removed.In the abdomen, a thumb tip sized tumor was palpable in the pelvic retro-peritoneal region without detection of any other abnormalities in the other organs.
Histopathologically, the biopsied tumor was diagnosed as undifferenciated polymorphic giant cell carcinoma of the lung, but a possibility of choriocarcinoma could not be excluded.Then, Friedman's reaction test was performed and it revealed a level as high as 100, 000 IU/1. In addition, a gradual development of gynecomastia was noted but no tumor was palpable in the testicles.
Under the diagnosis of choriocarcinoma metastasized to the lung, Methtraxate in a dosis of 15mg once a week, Binblastin in a dosis of 0.1mg/kg twice a week and Dexamethasone in a dosis of 8mg daily were administered continuously for about three and a half months. A LDH value in serum went up to a high level of 3, 540 U. two months after operation but it was gradually decreased in pararell with a reduction of gynecomastia. However, his general condition showed gradual aggravation with an increase of bloody sputum in amount and frequency He died of the respiratory insufficiency five months after admission.
Autopsy showed numerous tumors up to 5×5cm in dimensions in the lungs, three tumors up to 3×3cm in the liver and one tumor of 5×5cm in the pelvic retro-peritoneal region, which were considered to be the metastatic lesions.One small greyish white tumor about 5mm in diameter was found in the left testicle which was considered to be the primary focus.
Tumors found in the both lungs, liver and retro-peritoneal region revealed a quite similar macroscopic and microscopic findings, in which central necrosis was remarkable, and the remaining tumor tissue consisted mainly of sheets of cells with bright cytoplasma and nuclei approximately 12μ in diameter. In addition, giant cells resembling syncytial cells were noted.Accordingly, histological diagnosis of choriocarcinoma was made.
Tumor in the left testicle, however, showed a quite different picture from that of the tumors above mentioned. It consisted of uniformly small round cells with bright cytoplasma and nuclei well stained by Hematoxylin without a honey-cumb structure and was diagnosed as seminoma histologically.
The bioassay of gonadotropin activity of the pulmonary tumors autopsied showed a value of 70 RU, whereas the control was 10 to 50 RU. The pulmonary tumor, therefore, was diagnosed as the gonadotropin producing one.
It is well documented that tumor of germ cell origin has a totipotentiality of differenciating to seminoma, embryonal carcinoma, teratocarcinoma and choriocarcinoma. And it presumably occurred in this patient.Namely, a growth of germ cell origin differenciated into seminoma in the left testicle and choriocarcinoma in the metastatic lesions in the lungs, liver and retro-peritoneal region.

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1. A case of 14year-old boy with bronchogenic carcinoma of the lung is presented in this report. In his clinical course, the metastasis of the bone in left upper arm was first observed and it developed very rapidly with death in spite of chemotherapy. In the postmortem examination, the left lung lesions showed adenocarcinoma, add to partially squamous cell carcinoma, with the other metastasis to the mediastinum, left adrenal body and liver.
2. 39 cases of bronchogenic carcinoma under 15 year-old listed in foreign countries and Japan previously reported.
3. Brochogenic carcinoma in children have high malignancy with a very rapid growth rate, and are extreamly rare in frequency.
4. Curative resection for it is possible in only a very small percentage of cases.

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