Sequential cytological changes during the development of tracheal tumors in hamsters are reported. Two newly devised instruments, the one with two special catheters called a localized tumor induction system (LTIS) and the other for cytological sampling, were constructed. A solution of 1% N-nitroso-N-methylurea (NMU) was applied twice a week for 10 weeks by means of the LTIS. With this system, a predetermined area of trachea can be washed with a predetermined dose of carcinogen. One week after the cessation of carcinogen exposures, cytological sampling by tracheal washing with saline from the one exposed to carcinogen was started and repeated every three weeks. Enough cells could be obtained for cytological diagnosis. At the first sampling, marked atypical squamous metaplastic cells and bizarre cells called “early reaction cells”, because of the use of a high concentration (1%) NMU, were observed in almost all cases. In all cases, varying degrees of atypical squamous metaplastic cells and hyperplastic cells were made at 2 to 28 (average 13) weeks before death. The carcinoma incidence was 76% and the average time interval from commeneement of carcinogen application to death was 31 weeks. These results resembled those of a tumor induction study with 20 exposures of 1% NMU. It was shown that repeated tracheal washings for cytological sampling were harmless to the tracheal epithelium and the process of tumor development. Since a high concentration of NMU was used, suitablity to elucidate the sequential cytology of precursor lesions is limited. But at lower concentrations (0.5% or 0.25%), this expermental model appears to be very promising in the study of the sequential changes during the development of respiratory tract tumors.

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Seventeen patients with small cell carcinoma of the lung treated in our clinic during 8 years from 1972 to 1979, were evaluated and 4 long-term survivors of more than 2 years were recognized.The possible conditions that can be expected to yield long term survival are considered to be as follows;
(1) Peripherally located solitary nodule.
(2) Intermediate cell subtype.
(3) Marked response to initial chemotherapy or radiation therapy.
In addition to the above conditions, bronchial artery infusion therapy (BAI) with anti-cancer agents as initial treatment and long-term immunochemotherapy seem to be considerably effective and important to improve the poor prognosis of small cell carcinoma of the lung.

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Spontaneous pneumothorax occured as a complication in out of 419 cases of primary lung cancer treated with radiation therapy during the last ten years. Two cases were seen during the course of radiation therapy with improvement of atelectasis and the 4 other cases were observed after completion of radiation therapy with radiation pneumonitis and fibrosis. One of the 4 cases was treated with combined chemotherapy. Continuous suction was necessary in only 2 cases. Prognosis was unchanged by this complication.

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The aerosol technique of sputum induction was used in 127 patients with proven primary lung cancers.
When conventional cytology technique was used in expectorating patients, 3 day's pontaneous sputum yielded a positive diagnostic ratio of 64.1 %, whereas, single induced sputum specimens yielded positive specimens in 43.2%. Therefore, out of all lung cancer cases, the cytologically positive ratio was higher in expectorating patients than in those with induced sputum. Later the aerosol technique was used with 60 cases who did not produce sputum spontaneously and the specimens of aerosol-induced sputum were positive in 24 cases (40.0%).
These results show that the detection rate of lung cancer increased from 33.8% with the conventional sputum cytology technique to 56.6% for all cases, using spontaneous sputum plus induced sputum.
Centrally located lesions of the main and lobar bronchi yield higher diagnostic rates on induced sputum examination. Among centrally located lesions, all superficially infiltrating type lesions were positive by cytology.
The highest yield in the diagnosis of lung cancer by induced sputum examination was obtained for epidermoid carcinoma followed by small cell carcinoma.
Centrally located epidermoid carcinoma can be detected effectively in its early occult stage by cytologic examination of the sputum. However, in our experience, 13 out of 27 patients with centrally located epidermoid carcinoma of the lung could not provide sputum specimens. As a result the aerosol technique was used in these 13 patients and sputum cytology was positive in 9 patients. Therefore, the detection rate of centrally located epidermoid carcinoma with or without sputum increased from 48.1% to 81.4%. It may prove valuable as a screening device for cancer detection, particularly in mass surveys.
On the basis of the above findings, it may be said that the induction procedure seems to be a good screening method for lung cancer patients who do not produce sputum spontaneously, and that cytologic examination of these induced sputum and spontatneous sputum specimens tend to complement one another.

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Between September 1968 and August 1978 613 primary lung cancer cases were treated with non-surgical therapeutic modalities. Males predominated. (492: 121) and 88% of all case ranged from 50 to 70 years old.
Histologically, 42: 4% were squamous cell carcinoma, 29.2% adenocarcinoma, 24% small cell anaplastic carcinoma and 2.8% large cell anaplastic carcinoma. Only 1.0% of the patients were in clinical Stage Ia and 2.8% in Stage Ib, 10.6% were in Stage II, 37.7% in Stage III and 47.9% in Stage IV.
The therapeutic modalities included radiotherapy (17.1%), chemotherapy (24.8%) and combined radiotherapy plus chemotherapy (51.1%). Seven percent of the patients received no antitumor therapy. Radiotherapy plus chemotherapy were performed in 47% of Stage Ib, 53.8% of Stage II, 55.4% of Stage III and 47.6% of Stage IV.
The number of cases over 60 years old increased in proportion to the length of survival. 169 of 613 patients survived more than 1 year and 50 of these 169 patients survived more than 2 yrs. Furthermore, 14 of these 50 patients survived more than 3 yrs. and 8 of these 14 patients survived more than 4 yrs. Finally, 5 of 613 patients survived more than 5 yrs. Stage I and Stage II cases increased with length of survival. The 5 patients who survived more than 5 years included two squamous cell carcinomas, two small cell carcinomas and one adenosquamous carcinoma. The numbers of patients with adenocarcinoma decreased markedly after three years, and no patient treated with chemotherapy alone survived more than three years.
Application of the generalized Wilcoxon test showed that the survival rate of small cell carcinoma cases was significantly lower than those of squamous cell carcinoma (p<0.001) and adenocarcinoma (p<0.05). However, the test showed no significant difference of the survival rate between squamous cell carcinoma and adenocarcinoma.

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By intraperitoneal injection of dimethylnitrosamine once a week for 3 weeks, a high incidence of lung tumor in ddN. strain mice was obtained 6-8 months after the final injection. The incidence of adenocarcinoma in the lung was relatively high. Injections are few in number and the induction period is short. This carcinogenic experimental model permits studies on carcinogenesis in the lung.

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The incidence of bronchial cystadenoma is very rare, and it should be dirrerentiated from the common low-grade malignant tumors of the bronchus. A 69 year-old female under went right upper and middle lobectomy and concomitant mediastinal lymph node dissection for squamous cell carcinoma of the lung. The lesion was in S5. Histopathological findings of the specimen obtained the orifice of the right B3 revealed a bronchial cystadenoma. No direct continuity was noted between the bronchial cystadenoma and the carcinoma.
To date, only 17 cases of bronchial cystadenoma have been reported in the world literature and this case is the second one in Japan.

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A 45 year-old female developed a coin lesion in the right upper lobe of the lung discovered by chest X-ray film. The nodular lesion was histologically compatible with “sclerosing hemangioma of the lung” described by Liebow and Hubbell. Light and electron microscopy of the nodule revealed papillary and solid proliferation of epithelial cells. These cells showed morphological characteristics of the granular pneumonocytes at different developmental stages, suggesting the hamartomatous nature. This was an interesting case in that inflammatory episodes-that had taken place prior to growth of the nodule in the patient appeared to trigger abnormal proliferation of pneumonocytes.

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A 45 year-old male case of pulmonary blastoma, squamous cell carcinoma and adenocarcinoma of the lung was reported with some discussion of the nature of pulmonary blastoma. He had three tumors, 2 in the right upper lobe and one in the left. The tumors were expanding rapidly on chest X-ray film. Right upper lobectomy was performed. Pathologic examination revealed the tumor in the right S₁ to be pulmonary blastoma and squamous cell carcinoma, and that in the right S₂ to be adenocarcinoma. Neither surgery nor pathologic examination were performed on the tumor in the left lung. The histologic results of this case supports, we feel, the single germinal origin theory, i.e. both adenomatons and the squamous components are derived from stromal cell of pulmonary blastoma.
This is the 64th case of pulmonary blastoma in the world and the 11 th in Japan.

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A case of a 68-year-old asbestos worker, with a history of 34 years exposure, with double primary lung cancer was reported. Chest X-ray film showed bilateral tumorous shadows. Sputum cytology and needle biopsy revealed double primary bronchogenic carcinoma. One was squamous cell carcinoma and the other oat cell carcinoma.
The autopsy revealed the oat cell carcinoma to originate in the periphery of the right upper lobe (Si a), and the squamous cell carcinoma in the periphery of the left lower lobe (S10), associated with moderate asbestosis, squamous metaplasia and a tumorlet lesion.
A clinico-pathological study of 8 cases of multiple primary bronchogenic carcinoma associated with asbestos exposure, including the present case, suggested the possibility of multicentric occurrance of lung cancer associated with asbestos exposure and smoking.

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[in Japanese]

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[in Japanese]

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