Intraabdominal metastases from lung cancer were reviewed in both autopsied and clinical materials. In the autopsiy study, intraabdominal metastases were found in 67 of 94 cases (71.3%), the majority being in the liver and adrenal gland (45.7 & 41.5%, respectively). In terms of histologic type, adenocarcinoma metastasized to the abdominal organs more frequently than squamous cell carcinoma. In adenocarcinoma, adrenal metastases were most frequent (67.7%). In ten of 67 cases (14.9%), metastases were recognized only in the adrenal gland. In the clinical study, abdominal CT scans were performed in 39 patients with proved lung cancer. Thirteen cases (33.3%) had CT evidence of intraabdominal metastases proved by autopsy or follow-up CT studies. Ten cases (25.6%) had evidence of adrenal metastases on the CT scan and eight (20.5%) had hepatic metastases. Adrenal metastases were most commonly detected in patients with adenocarcinoma (40%). Three of ten patients with adrenal metastases did not have any other intraabdominal metastases on CT examination. In only one patient, multiple small adrenal metastases with negative CT findings were observed. One patient with only adrenal metastases was considered to be free of distant metastases prior to CT scan. The detection of metastases in about one third of patients with lung cancer indicates that CT scan has great value as a diagnostic tool. Consequently, the liver and adrenal gland should be examined carefully on the CT scan, especially in cases of adenocarcinoma.

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The incidence of ferruginous bodies in the lungs was investigated by squeezing and dissolving methods in autopsies performed at random of 243 patients over 40 years of age who had been residents of the Kokuriku District. In the squeezing samples, results were positive for bodies in 64 of the total of 243 cases (26.3%); 44 of 141 (31.2%) in males and 20 of 102 (19.6%) in females. In the dissolving method, in which the specimens were obtained from the three segments described below of every right lung of 235 cases (males 136, females 99), results were positive for asbestos bodies in 88.9% of S-3, 86.4% of S-6 and 85.5% of S-10, respectively. The total positive rate of the three segments was 97.4%. All of the 61 bodies from ten patients analyzed by electron microprobe were found to be “asbestos” bodies composed of amphibole fibers.
This high incidence implies that pollution by asbestos has widely affected the residents in this area and that the number of the bodies in an unit volume of the lung tissue is more significant than the positive rate alone as the indicator of this pollution. The statistically significant higher distribution of the bodies in S-3 is probably due to greater motility of this area for the fiber-shaped asbestos dust.

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[in Japanese]

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[in Japanese]

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Clinical and pathological investigation of surgically resected squamous cell carcinoma of the lung in non-smokers and women revealed the following results:
1) Non-smokers constituted 10 out of a total of 386 squamous cell carcinomas (2.6%), and women accounted for 24 cases (6.2%).
2) Non-smokers with squamous cell carcinoma possessed a positive family history and a past history of cancer more frequently than smokers with squamous cell carcinoma.
3) Pathological examination revealed that 9 out of 10 non-smoker squamous cell carcinomas were peripheral type lung cancer, i.e., arising in subsegmental or more distal bronchi. Eighteen out of 24 female cases (75%) showed peripheral lesions.
4) The existence of squamous metaplasia including dysplasia of the bronchial epithelium was confirmed in 47 out of 253 cases (18.6%) without preoperative adjuvant radio-or chemotherapy, and was observed almost equally in non-smokers, mild smokers and heavy smokers. This change was also confirmed in 4 out of 19 female cases (21.1%). There was no correlation between the occurrence of squamous metaplasia or dysplasia and cigarette smoking.

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The serum levels of α2-PAG in 122 lung cancer patients were determined by rocket immunoelectrophoresis, and compared with those in healthy subjects. The α2-PAG levels in healthy subjects failed to demonstrate any difference with age in males, but in females it increased with age. The mean values of α2-PAG in lung cancer patients (male: 1.6±1.9 mg/dl, female: 4.5±3.0 mg/dl) increased significantly (p<0.001) as compared with sex-and age-matched healthy subjects (male: 0.4±0.6 mg/dl, female: 1.8±1.2mg/dl). The α2-PAG level in male patients in stages II (1.8±2.0 mg/dl), III (2.1±2.1mg/dl) and IV (1.8±2.0 mg/dl) increased even more markedly as compared with that in stage I (0.7±1.2 mg/dl). However, in male patients with adenocarcinoma, the α2-PAG level (0.6±0.9 mg/dl) was not elevated.
There was no significant correlation between α2-PAG and CEA levels in lung cancer patients, but most of the cases with increased levels of α2-PAG had normal level of CEA and vice versa. Increase of α2-PAG level was observed in 40.6%, that of CEA in 46.8% of the patients with lung cancer. An increase of both α2-PAG and CEA was found only in 15.3%, but an increase of either α2-PAG or CEA was found in 73.0% of the patients. Cases in which elevations of α2-PAG were observed prior to the establishment of the diagnosis of lung cancer were described. The values of α2-PAG ran parallel with the changes of clinical status of patients.

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The following conclusions were made from reports of 148 clinical studies of bronchial carcinoid in Japan in addition to 13 cases treated by the authors.
Most of the cases with carcinoid syndrome or increased urinary excretion of 5-HIAA had metastatic lesions. Therefore these clinical findings were thought to be signs indicating the spread of the tumor.
Metastatic lesions were found in atypical carcinoid with a primary tumor less than 2 cm in largest diameter. Therefore the tendency to metastasize was not always related to the size of the tumor but to the histological characteristics. It was suggested that even in typical carcinoid, the potential for metastasis increased in accordance with the number of atypical foci.

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Twenty-two patients with primary lung cancer were treated with combination chemotherapy using Cis-diamminedichloroplatinum (CDDP), Cyclophosphamide (CTX) and Vincristirle (VCR). Small cell carcinoma was more responsive than non-small cell carcinoma, with response rates of 88.9% and 23.1%, respectively.
All patients were divided into two groups. In one group (Type I), CDDP was given at 20 mg/m² per day for five consecutive days, and in the other group (Type II), CDDP was given at 80 mg/m² at one time.
No difference was detected in the degree of nausea and vomiting, but their duration is much longer in Type I. Therefore, we concluded that Type II was superior to Type I from this viewpoint. Subclinical renal damage was seen in three patients, so that the limitation of total given dose of CDDP must be considered.

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To examine the risk of chromate in relation to lung cancer, we carried out a prospective study on 84 male workers who had worked at a chromate processing. factory. Cytological examinations of sputum were repeatedly performed during the period from Oct., 1975 to Oct., 1981. Bronchoscopy was performed for cases with atypical squamous metaplasia or malignant cells. As a result, 6 cases with lung cancer were found, 2 of which were double primary lung cancer cases.
The mean age of these 6 cases was 66 at the time of diagnosis and the mean duration of exposure to chromate was 21 years and 8 months. Five of the lesions weresquamous cell carcinoma and 2 were small cell carcinoma. Five lesions were able to find by bronchoscopy, and 5 were diagnosed as early cancer or almost early cancer.
The morbidity of lung cancer in this group was estimated to be as high as 1, 190 per 100, 000 population. Morbidity rate of this group was 16.6 times higher than that of general population after ajusting for age and sex, and it was 21.6 times higher in workers who worked more than 9 years at a chromate factory.
These results emphasize the usefulness of cytological examination and bronchoscopy for detection of such an occupational lung cancer and demonstrate that chromate is a high risk factor for lung cancer.

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Cytologic examinations of sputum collected periodically since 1973 in a group ofchromate workers were carried out to detect of early lung cancer involving largebronchi. Thirteen lung cancer cases were detected, of which 2 cases of carcinoma in situ and 3 cases of microinvasive carcinoma were first detected by sputum cytology.
Early stage lung cancer was detected as a result of the discovery of marked atypical metaplasia in sputum specimens. Bronchoscopy revealed almost normal findings when-ever moderate atypical metaplasia was discovered in sputum specimen.
The findings suggest that sputum cytology is an effective method for the detection of early stage squamous cell carcinoma involving major bronchi and that long-term periodical cytology screening is necessary.

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An autopsied case of a 12 year-old boy with small cell carcinoma (intermediate cell type) was reported. He was admitted with a complaint of cough, and chest X-ray on admission revealed scattered nodular shadows in both lung fields. A diagnosis of small cell carcinoma of the lung was made by transbronchial biopsy after he had been treated by anti-tuberculous agents for 3 months. He died 11 months later after treatment with a combination of COMP and ACNU. Primary lung cancer in children is extremely rare, and only 18 cases, including this case, were reported from 1953 in Japan.

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A 48-year-old male patient was admitted to our hospital. In 1968 he underwent surgical resection of a left axillary soft tissue tumor, 6.0×5.2×3.4 cm in size, which was diagnosed as extraskeletal chondrosarcoma. He had been well since but in 1981 a small nodular lesion, containing calcifications, was found on the chest X-ray film in the right middle lung field. Anti-tuberculosis therapy was continued for six months without success, and he was referred to our hospital. Metastasis was suspected and segmentectomy of right S-4 which contained the tumor was performed. The histopathological findings were identical to those of the tumor removed in 1968. The doubling time was about 4.5 years. Extraskeletal chondrosarcoma is a rare tumor and remote metastasis may develop after a long interval. Nevertheless, there are few cases like ours in which metastasis occurred as long as over ten years after the first operation. In such cases a differential diagnosis is extremely important.

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