A series of 18 cases of operated bronchiolo-alveolar cell carcinoma of the lung is reviewed clinicopathologically.
Sputum cytology and bronchial brushing are available for properative diagnosis with special emphasis on bronchial brushing.
Chest x-ray and surgico-pathological findings revealed various patterns. They are summerized in 4 histological groups as follows.
Gourp A presents tall columnar cells with ample much which are similar to goblet cells.
Group B presents tall columnar cells without ample mucin.
Group C presents cuboidal and/or peg-shaped cells with infiltrative growth.
zGroup D presents cuboidal and/or peg-shaped cells with nodal growth.
Cases of group A characteristically showed a diffuse consolidation on chest x-ray film, and postsurgical prognosis are favourable.
Case of group C showed an ill-defined and irregularly mottled shadow on chest x-ray film, and all of them died within 2 years after operation even if nuclear atypism of some cases were slight.

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Out of 479 cases of primary lung cancer seen during the period from April 1959 until December 1976, 56 cases were small cell carcinomas. Eighteen of 56 cases were oat cell type and 38 of 56 cases were intermediate cell type. Distant metastases were seen more frequently in oat cell type than in intermediate cell type. Roentgenologically oat cell type revealed infiltrating mass, whereas intermediate cell type revealed expanding mass. In oat cell type, better survival was obtained by a combination of radiotherapy and chemotherapy than by radiotherapy alone.

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For the purpose of study on pathogenesis of thin-walled cavities in metastatic lung tumor, the lungs of an autopsy case having multiple thin-walled cavities associated with pulmonary metastasis from squamous cell carcinoma in the foot, were examined. One of these cavities had developed into about 5 cm in diameter within a week in this clinical course. The lungs included 634 cavities and/or air spaces over 5 mm in diameter. The cavities and/or air spaces were divided to four groups in according to morphological criteria; 459 emphysematous cavities, 89 cavities with cancer thrombi, 64 cavities with inflammation and 22 cavities with cancer thrombi and inflammation. A morphometrical analysis on size and number of cavities revealed a close relationship between cavities with cancer thrombi and emphysematous cavities. Histological examination on the serial sections of the cavities revealed that the drainage bronchi were obstructed by nodular valves of perivascular fibrosis surrounding carcinoma thrombotic arteries. The large thin-walled cavities probably seen on chest x-ray films were associated with carcinoma thrombi in one part of the cavity wall. The size of cavities depended on the degree of fibrosis. Inflammation would be considered as an another increasing factor.

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Lung ventilation study by the continuous inhalation of ^81mKr gas from a ⁸¹Rb-^81mKr generator and lung perfusion study with ^99mTc-MAA were performed on 36 patients suffering from bronchogenic carcinoma.
The patients were measured in a sitting position using a scintillation camera in conjunction with a data processor.
In a same patient of pulmonary carcinoma ^81mKr technique and ¹³³Xe study were demonstrated for comparison of ventilation imaging.
There were 13 cases with discrepancy between ventilation with ^81mKr gas and perfusion with ^99mTc-MAA. Eight out of 13 patients showed more impaired perfusion (V/Q>1.2) and 5 out of 13 patients showed more severe ventilation (V/Q<0.8). We discussed the ventilation / perfusion mismatching cases.
Eight patients were studied before and after irradiation. The ventilation-perfusion ratios of the affected lung have markedly improved after radiation therapy.
Lung ventilation and perfusion studies with ^81mKr gas and ^99mTc-MAA easily allowed quantitative controls of radiation therapy.

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Forty-four lung cancer patients with malignant pleural effusions were studied. For the treatment of pleural effusions, both BCG-CWS and anticancer drugs were instilled intrapleurally through thoracentesis or tube thoracostomy in 21 patients. Effusions were disappeared in 100% of 10 patients treated with tube thoracostomy and 37% of 11 patients treated with thoracentesis. In contrast, effusions were disappeared in only 17% of 23 historical control patients treated with the intrapleural instillation of anticancer drugs alone through thoracentesis.
The survival period of those 21 patients treated with BCG-CWS were significantly different from those of the historical control patients (p<0.05).
These results indicate that BCG-CWS not only controls the reaccumulation of pleural effusions, but also is effective to prolong the survival as an immunopotentiator.

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Aspiration cytology was carried out in 8 patients with lung cancer and CEA levels were determined in diluted solution of those aspirated specimens.
CEA levels in the aspirated specimens were higher than those in plasma in all lung cancer-patients with positive malignant cells by smear cytology.
In other malignant diseases except for lung cancer, similar management was done and CEA levels in diluted solution of aspirated specimens showed also high compared with those in plasma.
But CEA levels of aspirated specimens did not increase in patients with cytologically negative diseases.
Therefore, it is concluded that the determination of CEA level in diluted solution of aspirated specimen is useful in tumor diagnosis.

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The concept of corrected tumor size originates from clinical data that prognosis of adenocarcinoma of the lung will be more accurately determined by the strength of constricting transformation of the tumor than the practical tumor size. We have observed that prognosis and TNM classification of the adenocarcinoma of the lung were not well correlated. We suppose that the concept mentioned above would explain successfuly some of the discrepancy between prognosis and TNM classification of the adenocarcinoma. There is, however, a question whether this concept can be applied to the whole adenocarcinoma of lung. For these reasons, we studied on subtypes of adenocarcinoma of the lung (1. bronchioloalveolar type 2. bronchial surface type 3. bronchial gland type 4. mixed type 5. undetermined type) clinicopathologically. Whereas bronchioloalveolar type carcinoma developes invasively, it also constricts in size on the progress. The mode of developement of bronchial surface as well as gland types is mainly expansive. Therefore, the concept of corrected tumor size appears to be applicable only to bronchioloalveolar type and some cases of mixed type but not to bronchial surface and gland types.

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A 73 year-old man complained of bloody sputum and pain in the right shoulder. On chest X-ray film, abnormal density was observed in the right upper lung field.
At operation, hilar and mediastinal lymph nodes were free from metastasis but parietal pleura was extensively invaded. The parietal pleura and right upper and middle lobes were resected.
There was no tumor in the right upper lobe but peribronchial outgrowth was observed along the right apical branch of the bronchus.
Four months later from onset of symptoms, he died from SVC syndrome. On autopsy, metastasis to the pericardium, opposite lung, pancreas, bilateral adrenal gland, small intestine and retroperitoneal lymph nodes were found.
Histological examination of the specimens obtained at operation and autopsy revealed giant cell carcinoma which explained the extreamely rapid fatal course.

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Disease of true benign solitary papilloma of the bronchus is very rare. One case of a 58 years old woman is reported which was checked up with hemosputum and Rt-S4 atelc.tasit.ln chest X-ray film.
Radiologically and endoscopically, there were some vague factors to determine as squamous cell carcinoma of maior bronchi, and it was diagnosed papilloma by transbronchial biopsy. Middle lobectomy was performed on 24 July, 1978.
The pink v-white califlower like tumor is 0.7×0.7 cm in size, protruded on B4 and confined itself within bronchial wall. Microscopically, it consists of non-malignant papillary mucosal folds with a core of thin walled blood vessels and connective tissue.
Usually, true benign solitary papilloma has malignant potentiality. This report illustrates the necessity of surgical resection for this lesion because it is difficult to diagnose benign lesion only by biopsied material.

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Although protruding type into the bronchial lumen with wide basis is by far the most common in adenoid cystic carcinoma, this report presented a case of extensive infiltration along the bronchial wall.
A 39-year-old man was admitted with cough, hemosputum and swelling of the left hilum on the chest X-ray film. Bronchofiberscopic examination revealed marked stenosis on the left main bronchus, and extensive and long infiltration along the bronchial wall toward the left superior bronchus and the right main bronchus. The patient was treated with 60Co 4920 rads irradiation combined with chemotherapy using FMC (5-Fu, Mitomycin C and Cytosin arabinoside) and immunotherapy using Picibanil and BCG-CWS, and the tumor shadow was reduced and bronchofiberscopy revealed stenosis disappeared. This patient is well without any signs of recurrence one year after therapy

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