The tissues of respiratory tract were obtained at the time of autopsy or operation from 8 chromate workers with lung cancer. The concentrations of chromium in different lobes of the lungs and in the other parts of the respiratory tract were analysed. The concentrations of chromium in lung tissues among chromate workers revealed 36.72μg of mean valve ranging from 0.50/μg to 132.20μg Per 1gm of wet weight, and revealed 0.51μg of mean valve in larger bronchi, ranging from 0.22μg to 0.99μg Per 1gm of wet weight, compared with control valve of 0.21μg in lung tissues and 0.11/üg in larger bronchi.
The longer was the labor period, the higher was the concentration of chromium in lung tissues. The concentration of chromium in the upper lobe was higher than in the lower lobe. The chromium remained in the lung tissues for many years after the ending of exposure to chromium.

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Thirty-five patients with bronchogenic carcinoma treated by pulmonary resection combined with excision of chest wall were studied both clinically and pathologically. Special attention was paid to factors related to survival in patients with bronchogenic carcinoma involving thoracic wall.
The results are as follows:
1) The most common histologic type was epidermoid carcinoma.
2) The majority of the lesions were located in the upper lobe.
3) According to the location of the tumors and its manner of growth, four types of tumor extension to the chest wall were observed.
4) In the majority of the cases of pulmonary carcinoma involving thoracic wall, marked proliferation of fibrous connective tissue in the visceral pleura was recognized, and the reaction was considered to be significant as the cause of pleural adhesion leading to extention of lung cancer to the chest wall.
5) The operative mortality rate was 5.7%. The five-year survival rate was 20% of all cases and 18% of cases with histological evidence of chest wall involvement.
6) The most important factors related to survival were operative curability, growth pattern to the chest wall, and stage of nodal involvement. Histologic type and size of tumor also appeared to be significant for prognosis, but degree of chest wall involvement alone was not a determinant in estimating survival.

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30 patients of pleuritis carcinomatosa underwent Vim-Silverman needle biopsy of the parietal pleura. Consequently, we could obtain specimens in 21 of 30 (70%) and diagnose pathologically in 10 of 21 (47.6%). On the other hand, 12 patients of pleuritis carcinomatosa underwent thoracoscopy. Pleural biopsy was obtained during this examination in all patients. We could diagnose pathologically in 10 of 12 (83.3%). Other 2 patients could not be diagnosed in this examination, and the diagnosis was confirmed later.
Recently, patients with pleural effusion are increasing. Differential diagnosis between pleuritis tuberculosa and pleuritis carcinomatosa is frequently difficult. Therefore, needle biopsy of parietal pleura and pleural biopsy in thoracoscopy are useful methods in diagnosis of pleural effusion of unknown origin.

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During 1962 and April 1972, 43 cases with primary lung cancer were treated by combined thoracic wall resection at National Cancer Center Hospital. At the time of operation, all 43 cases which were classified into the group of“Surgical P₃”, underwent lung resection and lymph node dissection with excision en bloc of the thoracic wall. Histology of lung cancer, lymph node metastasis and the degrees of cancer invasion into the thoracic wall were reviewed pathologically in all cases. Six of the 43 cases were classified into the “Pathological P₀ or P₁”, and 3 out of those 6 cases survived over 5-year. Thiry seven of the 43 cases were classified into the “Pathological P₃”, and 5 out of those 37 cases survived over 5-year. Five cases who survived over 5-year, had no hilar nodes involvement.
Four out of those 5 cases had no intercostal muscle and rib invasions. This report suggests that there is a close correlation between 5-year survivals and the degrees of thoracic wall invasion and hilar nodes involvement.
Therefore, it is proposed that there is a need to sub classifity the degrees of cancer invasion into the thoracic wall in combined thoracic wall resection cases.

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By grading the consistency of subpleural or central fibrotic foci in peripheral pulmonary carcinomas, excluding squamous cell carcinomas, of less than 3 cm in the greatest diameter, the degree of collagenization was found to be well correlated with frequency of pleural invasion, lymph nodes metastasis and blood vessel invasion. Accordingly prognosis of patients with the tumor bearing collagenized or hyalinized “scar” was poorer than those with the tumor possessing no or minimally collagenized fibrotic foci.
These findings also indicate that much of the fibrotic focus was produced during the tumor growth and thus its consistency reflects the period of the existence of the tumor in patients. Therefore, the degree of central desmoplasia in the tumor is animportant parameter for assuming prognosis of patients.

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A typical case of the oat-cell carcinoma of the lung with ectopic ACTH production was reported. The signs compatible for Cushing's syndrome manifested clinically later on the second admission, though they were undetectable clinically and also endocrinologically on the first admission. The reason for this delayed appearance of the syndrome are not clear and of matter of discussion. Although ectopic production of ACTH was confirmed histologically with the assay of the hormone in tumor tissue obtained at the autopsy and endocrinologically in the medium of the tumor cell culture, the high level of ACTH was detected in the tumor cells collected from the carcinomatous pleural fluid before her death. The determination of the hormone in the tumor cells in the fluid from body spaces may become a histological support for establishing clinical diagnosis of the ectopic hormone production by neoplasma.

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Reconstruction of the superior vena cava (SVC) was attempted in three patients with incomplete obstruction by malignant tumor, using a temporary internal shunt which was made with a caval catheter introduced from the right auricular appendage into the upper part of the SVC. The technique and results are reported herein.
Two women, 56 and 54 years old respectively, were operated upon because of carcinoma in the upper lobe of the right lung. In these two patients using a temporary internal shunt, the involved area of the SVC, 1×2cm in size in both patients, was resected together with the right lung. The resected area of the SVC was reconstructed with an azygos vein patch in the first patient and with a pericardial patch in the second patient. The patency of the reconstructed SVC of the first patient was proved by angiography six months after surgery. No clinical symptoms of SVC obstruction were observed in either patient, up until the time of death from recurrent carcinoma twelve months after surgery in the first patient, and from the pneumonia 14 days after surgery in the second patient.
The third patient, a 71-year-old man, was operated upon because of a progressive SVC syndrome caused by a thymoma. The pressure of the right innominate vein was 40cmH₂0. The tumor occluded completely the left innomintae vein and also envolved the right innominate vein and SVC, producing marked stenosis. Using a temporary internal shunt, the involved area of the veins was resected together with the tumor, leaving only one quater of the original circumference of a 7 cm portion of the SVC and the right innominate vein. During the procedure, the left innominate vein and azygos vein were ligated and the involved portion was divided. The venous system was reconstructed by joining three long strips of saphenous and external juglar vein grafts. The venous pressure after reconstruction was 5cmH₂O and superior vena-cavogram done 12 months after surgery showed satisfactory patency. The patient has been healthy and asymptomatic for 27 months after surgery.

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A case of mucoepidermoid tumor of the bronchus is described with a discussion on the various nature of this tumor. The tumor was situated in the upper part of the intermediate bronchus. For a period of five years, symptoms of bronchial asthma continued. The first biopsy specimen was diagnosed as undifferentiated epidermoid carcinoma. Irradiation therapy without any effect was followed by radical resection of the middle and lower lobes. Histologically, the predominance of epidermoid pattern and occasional atypical cells indicated a low differentiated nature of this tumor, whereas clinically, a rather benign nature were suggested by the fact that, in spite of a long symptomatic period, neither extrabronchial extentions nor any metastases were detected. According to case reports in the literature, such cases as this, with a tumor limited within the bronchus, have a good prognosis, so far as total resection of the tumor is performed. The patient of this case is well without any sign of recurrence 5 months after surgery, and her good prognosis may be also expected.

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Multidisciplinary treatment was done for 247 cases of small cell carcinoma of the lung. Out of 247 cases, 146 were non-resected cases and 101 were surgically resected cases. Fifty percent survival of small cell carcinoma patients was the longest in the stage I group and shortest in the stage III group, regardless of the secondary treatment. In non-resected cases, marked responders to the initial treatment survived longest; complete regression was observed in 21 cases and its 50% survival was 12.5 months, and non-response was observed in 43 cases and its 50% survival was 4 months.
Polygonal cell type having larger cytoplasm, less hyperchromatic nuclei with a large prominent nucleolus is sometimes histologically indistinguishable from the large cell carcinoma. This polygonal cell type is mostly located in lung periphery and has good prognosis after the resection of the tumor.
In our research group, there are 27 cases of small cell carcinoma surviving more than 2.5 years. Out of 27 cases 13 were non-resected cases. Reason for long surviving in these cases are now being examined.

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