Normal tissues and cancers of the lung were examined immunohistochemically for distribution of secretory component (SC) and lactoferrin (LF), using anti-SC and anti-LF immunoglobulin. In the normal lung, SC was present in bronchial ciliated columnar epithelial cells and bronchial gland serous cells and almost all was in bronchial gland serous cells. In terms of histologic type, SC was detected in over 70% of adenocarcinoma cases, and some large cell carcinoma, small cell carcinoma and peripheral squamouscell carcinoma cases. LF was mainly detected in bronchial gland cell type adenocarcinoma cases, and to lesser degrees in other subtypes of adenocarcinoma, large cell carcinoma and small cell carcinoma cases. In these studies, which incidentally demonstrated that LF is a good marker of the bronchial gland cell type adenocarcinoma, the author concluded that not only adenocarcinoma but also large cell carcinoma, small cell carcinoma and squamous cell carcinoma show some degree of differentiation to bronchial epithelial cells or bronchial gland cells. It is therefore possible that these four histologic types of lung cancer are not completely independent entities and may possess common histogenetic characteristics.

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Serum carcinoembryonic antigen (CEA) and ferritin levels were measured by radioimmunoassay in 151 patients with lung cancer and 119 patients with non-malignant pulmonary diseases. Elevated serum CEA and ferritin levels were found in53% and 40.4% respectively in patients with primary lung cancer. Both markers showed a statistically significant difference between primary lung cancer and non-malignant pulmonary diseases. Combination assay of serum CEA and ferritin was highly positive compared with CEA assay only. Serum CEA levels were statistically higher in stage IV than that in stage III. Serial measurement of CEA as well as ferritin was useful to evaluate the efficacy of therapy and tumor growth.
Pleural effusion from 41 patients with primary lung cancer and 29 patients with tuberculosis were examined for CEA, ferritin, and adenosine deaminase (ADA). Mean CEA levels in malignant and tuberculous pleural effusion were 24.2 ng/ml and 1.8ng/ml, respectively. More than 2.5 ng/ml CEA levels were found in 37 of 41 malignant pleural effusions, while only 4 of 29 tuberculous effusions. Mean ADA levels in malignant and tuberculous pleural effusion were 22.6U/1 and 89.2U/1, respectively, and significantly higher in the latter than in the former. Effusion from 2 of 41 patients with malignancy and from 24 of 29 patients with tuberculosis were above 50U/1 ADA level.

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Of 424 non resected lung cancer cases observed more than 3 years after diagnosis, 17cases (4%) survived for more than 3 years. These long-term survival cases showed thefollowing characteristics, compared with non-resected cases.
1. Higher survival rate was observed in female cases up to 3 years follow up but no sex difference was observed after 3 year follow up.
2. Of the 17 long-term survival cases, 12 cases were over 70 years old, but with increasing age (more than 70) more survival cases were observed in stage I, but no relation was seen in stage II & III.
3. No significant difference was observed between the histologic types.
4. Of these survival cases, stage I cases represented about half and the, remaining cases were stage II or III. These results suggest that multidisciplinary treatment should be provided for stage III cases

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The diagnostic value of transbronchial aspiration cytology (TBAC) for lung cancer was examined in terms of diagnostic ability and its safety. In National Sakura Hospital, TBAC and brushing cytology for 33 primary lung cancers yielded a diagnosis in 97% and 88% respectively.
At bronchofiberscopy, no severe intrabronchial bleeding occurred in TBAC cases and bleeding was much less than in brushing cytology cases. No other complications were observed.
We concluded that TBAC is the first method of choice for cytological diagnosis in lung cancer patients especially in peripheral type.

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According to the general rule for clinical and pathological records of lung cancer provided by the Japan Lung Cancer Society, lung cancers which contain neoplastic cells of more than two histological types are grouped into those with the most predominant tumor type in quantity, and their differentiation is graded based on the most predominant tumor type. This rule, however, is not always applicable to large cell carcinoma which is admixed with other types of cell even in very minor portions. The large cell carcinoma of this sort is grouped into carcinoma of the most predominant cell type among admixing cancer cells and graded to poorly differentiated type regardless of admixing cell types.
We investigated the validity of this rule about large cell carcinoma of lung based on the analyses of 67 surgically removed similar carcinomas in our hospital. Sixty-three tumors (94%) belonged to the mixed type, and the remaining 4 (6%) were pure type.
There was no remarkable difference in the 5-year survival rates between well or moderately differentiated squamous cell carcinomas or adenocarcinomas grouped by histological predominancy and large cell carcinomas graded to poorly differentiated group, in our series.
From the results obtained, we proposed that the general rule for the histological typing of lung cancer regarding the histological dominancy could be applicable to large cell carcinomas as well, and that large cell carcinomas should be subgrouped according to the histological cell types of minor groups such as squamous cell carcinoma type and adenocarcinoma type.

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IAP values were measured by single radial immunodiffusion (SRID) in 92 cases of lung cancer and were compared in terms of clinical data and immunological parameters.
The mean value of IAP in the lung cancer group was significantly higher than those in normal controls and chronic inflammatory respiratory diseases, however it showed no definite difference compared to that in the group of acute inflammatory respiratory diseases. Histologically the mean values of IAP in the groups of squamous cell carcinoma and large cell carcinoma were significantly higher than in the group of adenocarcinoma.
The mean value of IAP showed no significant differences among the clinical stages. The values of IAP were closely related to those of acute phase reactants in comparison with other immunological parameters. Therefore, IAP was thought to have the characteristics of an acute phase reactant rather than a tumor marker. Furthermore the values of IAP were much closely related (r=0.988) to those of α₁-acid glycoprotein (α₁-AG). IAP which was measured by SRID was thought to be the same substance as a1-AG, because of the fact that their antigenicities were the same.

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In order to determine the extent to which small cell carcinoma of the lung (SCCL), bronchial carcinoid (BC) and pulmonary tumorlet (PT) differentiate toward neuroendocrine cells, immunoperoxidase histochemistry for polypeptide hormones, serotonin and neuron-specific enolase (NSE) was applied on consecutive formalin-fixed paraffin sections.
Tissue blocks from 49 cases of SCCL, 25 cases of BC and 5 cases of PT were selected from surgical or autopsy files. In addition, to elucidate whether a numerical change of Kultschitzky cells occurs in relation to the development of SCCL, the distribution and incidence of gastrin releasing peptide (GRP)-immunoreactive cells in bronchial and bronchiolar epithelium surrounding tumors in 29 cases of SCCL were compared with those in 21 cases of squamous cell carcinoma (SqCC) in the peripheral airways of the lung.
Positive immunoreactive cells for polypeptide hormones, serotonin and NSE were found in 51%, 14%, 59% of SCCL cases, in 64%, 64%, and 65% of BC cases, and in all cases of PT. Multihormonal production was found in 27% of SCCL, 32% of BC, and 100% of PT cases. No significant difference in the incidence of GRP-immunoreactive cells in bronchial epithelium of SCCL and SqCC cases was observed.
These results suggest that SCCL and BC strongly differentiate toward neuroendocrine-like cells with multihormonal production, and that PT is hyperplasia of neuroendocrine-like cells.

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A case of squamous cell carcinoma in the anterior mediastinum is reported. The patient was admitted to Metropolitan Komagome Hospital because of a mass in the anterior mediastinum which grew slowly for a period of two years. The resected specimen showed a multicystic tumor and at the lower part a papillary white tumor was identified.
Histological examination showed that the papillary tumor was squamous cell carcinoma and that the other cystic part was lined by one of the following three kinds of epithelia; one consisting of mucin containing cuboidal cells, another of keratinized squamous cells and the other of cuboidal cells on the surface with spindle or polygonal cells beneath them. The existence of non-carcinomatous cyst and the nature of the epithelial elements in this specimen suggests that the squamous cell carcinoma originated in the thymic cyst.
Although there have been only a few cases of carcinoma originating in thymic cyst, the variability of histological types of reported cases seems to indicate the multipotentiality of fhe epithelium of thymic cysts.

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A case of pulmonary carcinoma in a man aged 66 employed in chromate manufacturing for 40 years was reported. Roentgenographically, the tumor was located in left S³ a. Left upper lobectomy was performed. Histologically the tumor was a moderately differentiated adenocarcinoma. In view of the reported predominance of squamous cell carcinoma in occupational lung cancer, it is of interest that the histological type of the lung cancer of this patient was adenocarcinoma. Using an atomic absorption spectrophotometer, the analysis of the chromium content in the resected regional lymph node and lung tissue showed a remarkable augmentation of chromium in the lymphnode and in the deep anthracotic region of the lung tissue, compared with that of similar anthracotic lung tissue from an elderly man without apparent exposure to chromate dust. Through X-ray microanalysis, a remarkable number of particles containing chromium were found in the anthracotic region of the lung. These findings suggest that long-term exposure to chromate dusts may lead to the occurrence of lung cancer.

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A 19 year-old male was admitted with complaints of fever, chest pain and dyspnea. Chest roentogenogram revealed a homogeneous mass in the right thorax. A diagnosis of primary mediastinal germ cell tumor was made by elevated levels of various sex hormones including AFP, HCG, HCG-β submit, HPL, estron, estradiol and testosterone. After intensive Cisplatin-containing combination chemotherapy, tumor size was significantly reduced and the hormone levels deereased to almost normal values. The patient was disease-free after surgical removal of residual lesion, which was confirmed histologically to be teratoma with embryonal carcinoma and yolk sac tumor. He has been on maintenance chemothrapy, and is disease-free 13 months after the onset of the disease.

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A fifty year-old male lung carcinoid case with a high level of plasma ACTH was reported. A tumor shadow was found in the left lung field approximately 6 years before by mass survey. He had no complaints, but since the tumor shadow gradually increased in size, he was referred to our Department. Cytologic diagnosis was obtained by percutaneous lung needle biopsy. Plasma ACTH was 350 pg/ml. We found no particular clinical abnormalities of the pituitary gland, thyroid gland, digestive organs. Left upper lobe lobectomy with complete mediastinal lymphnode dissection was performed. The tumor was 4×3×3.5cm with a well-defined margin. The histologic diagnosis was histologic carcinoid. No particular complication occurred postoperatively, but plasma ACTH levels remained high for about 3 months. At 5 months after surgery the plasma ACTH level was normal (60pg/ml). Therefore, we consider that this lung carcinoid produced so-called big-ACTH, nevertheless we could find no manifestation of ectopic ACTH syndrome.

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