From February 1973, a scintigraphic study with ⁵⁷Co-Bleomycin was performed in 286 patients with various pulmonary diseases including primary lung cancer, metastatic pulmonary tumors, pulmonary inflammation, etc. In this study it was concluded that ⁵⁷Co-Bleomycin scintigraphy was effective for diagnosis of primary lung cancer.
Ninety percent of the patients with primary lung cancer revealed positive signs from (+) to (+++) on the ⁵⁷Co-Bleomycin scintigram. Positivity rate on the scintigram was not influenced by difference of histological findings and classification of rentgenographic findings but by the size of tumors.
Lung cancer with a lesion over 2cm in diameter was detectable by the scintigraphy in the great majority. The diameter of the smallest positive tumor was 1.5cm. However in patients with lung cancer less than 3cm in diameter only 55% showed moderately positive (++) and markedly positive (+++) signs and positive scintigram turned negative after radiation treatment with ⁶⁰Co.
An acurate diagnosis was possible for tumors which were masked by pleural effusion or pulmonary atelectasis. Metastatic tumors of lung cancer revealed also positive signs on the ⁵⁷Co-Bleomycin scintigram. Metastatic tumors of breast cancer were negative while those of thyroid and uterine cancer were positive.
Fifteen percent of patients with plumonary inflammation were positive. Twenty-two cases with pulmonary tuberculoma showed all negative scintigram. The differential diagnosis between lung cancer and pulmonary tuberculoma was possible if the tumor size exceeded 2cm in diameter.
The urine of the patients who underwent injection of ⁵⁷Co-Bleomycin should be carefully managed because of the long radioactivity of ⁵⁷Co.

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Recently, squamous cell metaplasia of the bronchial epithelium is being given attention in regard to the carcinogenesis of bronchogenic squamous cell carcinoma. It is apparent that various degrees of atypia occur in the metaplastic squamous cells and corresponding histopathologic lesions.
The study of such changes gives the impression that a series of progressive epithelial changes with increasing cellular atypia may occur in the bronchial epithelium. Also correlation between the occurrence of atypical squamous metaplasia and bronchogenic carcinoma has been suggested.
In this present investigation, cytophotometric DNA analysis was performed in order to investigate the relationship between them. It seems that increasing cytological atypia of various cell populations is related to a decrease of the fraction of cells with diploid and tetraploid values and a corresponding increase of the fraction of the cells with heteroploid DNA content. It is suggested that the results presented herein support the supposition that increasing cellular atypia in metaplastic cells reflect a sequence of cellular events in squamous bronchial epithelium finally resulting in squamous bronchogenic carcinoma.
The results of the characteristic histograms of each grade of squamous cell metaplasia in the bronchial epithelium also indicates that cytophotometric analysis of DNA contents can provide us with objective criteria in addition to the subjective morphological criteria of the grade of atypical squamous cell metaplasia.

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The author introduces the method of sputum cytology which was developed by Saccomanno. This method has been used in the Mayo Lung project in U.S.A.
In my laboratory, sputum cytology was undertaken in 39 cases with lung cancer by this method, and comparison between this method and direct smear was studied. The cytologically positive rate was elevated 18.0% compared with direct smear in the same specimens.
Morphologic characteristics of cancer cells by this method were observed. Epidermoid carcinoma cells showed no differences whether examined by direct smear or by Saccomanno's method, but adenocarcinoma cells and small cell anaplastic carcinoma cells revealed some cellular damage, so that, Saccomanno's method was judged unsuitable for observing the fine structure of cancer cells, and presented difficulties in cell typing of cancer cells.
But, this method was found to have the following advantages compared with other concentration methods; that is, the sputum may remain in this fixative for many days, the technique is rapid, simple and make it easy to find atypical cells. Therefore, it can be adapted for use in sputum cytology screening for lung cancer.

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Forty-five cases of stage I and II lung cancer in an inoperable condition were treated with radiation over the past ten years. All patients were diagnosed histologically and received a total dose of more than 4500 rad in four weeks.
Relative 5-year survival rate of the present series were 29% for stage I squamous cell carcinoma cases, 11% for stage II squamous cell carcinoma cases, and 0% for either adenocarcinoma or undifferentiated carcinoma, respectively. The survival curve obtained by the combined use of radiotherapy and cancer chemotherapy was not significantly better than that obtained by radiation therapy alone. Regarding the radiation dose, a dose ranging from 1700 to 1950 ret resulted in most favorable prognosis. However, to prevent the occurence of radiation myelopathy, the radiation dose to the spinal cord should not exceed 1500 ret.

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A 68-year-old man was admitted for the evaluation of abnormal mass shadow on the chest X-ray film and was diagnosed as having ACTH-producing tumor originated in thymus after endocrinologic examinations. The left thoracotomy revealed this case was inoperable because of the invasion to surrounding organs. Histologic specimens were obtained at the biopsy and the autopsy, and utilized for light and electron micro scopic observations.
Under light microscopy the Glimerius stain was positive. Histologic diagnosis was carcinoid tumor originated from thymus. Ultrastructurally, in biopsied specimen light and dark cells were found. The former was abundant with mitochondria and possessed many neurosecretory granules. In autopsied specimen, numerous granules were observed and these were identified as hormonal granules containing ACTH and MSH.

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