The transbronchial implantation of Ehrlich ascites tumor cells in NO₂-exposed mice was studied morphologically by light and electron microscopy. Light microscopy examination revealed that tumor cells proliferated 12 hours after implantation in the terminal bronchioles and proximal alveoli injured by NO₂-exposure. Electron microscopy examination demonstrated that tumor cells adhered closely to the basement membrane. There are two patterns of adhesion of tumor cells to the basement mem-brane, one by microvilli and other by cytoplasm. The tumor cells which appeared to receive their nutritions via the basement membrane, became larger and devided, and some tumor cells invaded the interstitium.

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We investigated various background factors in lung cancer patients treated in the chest departments of 7 hospitals in Tokyo.
The 135 cases, surveyed between January, 1981 to June, 1982, were analysed for as many background factors as possible, including occupation, living conditions, school career, mass chest survey, reason for discovery, period before admission and informationof diagnosis before hospitalization.
1) The male: female ratio was 97: 38. The predominant age was 70 years and over (38.5%).
2) Clinical stage I-II cases consisted of 32.1% and 67.9% were stage III-IV. Histologically, there was no characteristic distribution tendency.
3) 57.6% among the present subject had the opportunities of mass chest survey, but the rate for mass chest survey was much lower for those over 60 years of age.
4) The percentage of cases detected by mass chest survey in those who had the opportunity for mass chest survey was 31.6%, and it was 17.8% among the subject as a whole in the present study.
5) Cancer was detected due to symptoms in 60.6%.
6) The clinical stage I-II group represented 58.1% of the lung cancer detected in the mass chest survey group, but only 24.7% in the symptomatic group.
7) In cancer patients with a history of pulmonary disease, pulmonary tuberculosis was most predominant and the clinical stage was predominantly III-IV.
8) Only 5 patients (4.1%) were informed of their lung cancer before admission.

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Sixty seven patients with small cell carcinoma of the lung were treated with combination chemothrapy-radiotherapy. Fifty two patients received concurrent mild combination chemotherapy and radiotherapy. The remaining 15 patients received sequential intensive combination chemotherapy and radiotherapy. Mild combination chemotherapy consisted of Vincristine, Endoxan, Mitomycin C and Toyomycin (VEMT) in 44 patients, Mitomycin C, Endoxan, thio-TEPA and Toyomycin (METT) in 6 patients, and other drugs in 2 patients. On the other hand, intensive combination chemotherapy consisted of Cyclophosphamide, Adriamycin and Vincristine (CAV) in 11 patients, Cyclophosphamide, Oncovin and Methotraxate (COM) in 2 patients, and Adriamycin, Vincristine and ACNU (AVA) in 2 patients. Sixty two (93%) of 67 patients received irradiation of more than 4000 rads in a period of over 5 weeks, although it varied from 2400 to 7500 rads in each patient. The overall response rate was 79% with 25 cases of complete (37%) and 28 partial response (42%). Complete responses were more common among patients with limited disease (51%) compared with those with extensive disease (21%). Patients treated with intensive combination chemotherapy showed more complete responses than patients with mild combination chemotherapy (86% versus 51%). The survival of all patients was 34% at 1 year, 17% at 2 years and 8% at 3 years, with a median survival time (MST) of 8.5 months. Survival for patients with limited disease was better than for patients with extensive disease (MST, 12 months versus 6 months). Long-term survivors over 2 years were noted only in patients with limited disease. Furthermore, patients with intensive combination chemotherapy had better survivalthan those with mild combination chemotherapy (MST, 17 months versus 8 months). The most significant determinant of survival was the attainment of complete response. Where a complete response to therapy was achieved the MST was 18 months; with a partial response it was 8.5 months; when no measurable response to therapy was achieved it was only 4 months.
These results indicate that combination chemotherapy radiation therapy is beneficial, particularly for patients with limited disease. However, when treated with intensive combination chemotherapy and radiation therapy, longterm survivors can be achieved even in patients with extensive disease.

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Four cases of pulmonary adenoid cystic carcinoma were observed by light and electron microscopy. They showed the same histologic and ultrastructural features of adenoid cystic carcinoma as previously reported in other organs. These tumor cells contained at least two antigenically different types of microfilaments; tonofilaments and other thinner microfilaments about 50 A° in diameter. Bundles of the thinner microfilaments were seen in the cytoplasm near the plasma membrane. Indirect immunofluorescence using antibodies against actin and keratin was performed. Using the antiactin anti-serum, linear intracytoplasmic staining in pericellular area was seen in all tumor cells. This area corresponded to the portion of the cytoplasm containing the parallel aggregates of thinner microfilaments by electron microscopy. Intense immunofl uorescent staining for keratin was seen in the cytoplasm of many tumor cells. The fact that tumor cells show differentiation to squamous cells, secretory cells and myoepithelial cells, in addition to the presence of keratin and serous-like granules, suggests that the tumor may arise from reserve cells of the duct in submucosal bronchial glands rather than myoepithelial cell. In order to elucidate ultrastructural stromal acid mucopolysaccharides, Ruthenium Red staining was performed following digestion of tumor tissues with glycosaminoglycan degrading enzymes.

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A method of superimposing two images obtained by ⁶⁷Ga-SPECT and X-CT was applied in 40 cases of primary lung cancer. In lung lesions, reduced accumulation in the tumor or in the atelectasis was more clearly displayed by the above described superimposed method than by conventional methods. In cases of mediastinal lesions, accumulation in the lymph nodes as small as 10 mm in diameter which were not discernible by conventional methods could be detected. It was thus possible to diagnose intramediastinal minute lesions.

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The recent incidence of lung cancer in young adults was evaluated through the Annual of the Pathological Autopsy Cases in Japan. Although the absolute number of lung cancer cases in young adults has been increasing, the relative rate has been decreasing because of the greater number of lung cancer patients aged more than 40.
A clinical study of 48 lung cancer cases aged less than 40, constituting 4.2% of 1141 patients with lung cancer, was carried out. They consisted of 26 males and 22 females. Of these 39 were adenocarcinoma, 5 were epidermoid carcinoma, 2 were small cell cancer and 2 were large cell cancer.
The number of cigarette smokers was 21, including 8 heavy smokers. This suggests that the relationship between lung cancer in young adults and cigarette smoking may not be significant. Over 80% of the 48 patients were advanced lung cancer. This problem may be related to the facts that the period between initial symptom and first visiting a chest physician was long and that some cases were misdiagnosed as pulmonary tuberculosis and treated by antituberculosis drugs for some months. In spite of the advanced stage their perofrmance status was not poor. If they had been diagnosed as lung cancer in an early phase, all of them could have received successful surgical treatment.
The median survival time of the young adult cases with lung cancer was 10 months and there was no difference concerning the survival between young adults and cases over 40 years old.

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This study was designed to investigate the possible correlation between pneumoconiosis and lung cancer, and differences in the incidence and clinicopathological features of lung cancers in patients with coal miners' silicosis and those with metal miners' silicosis.
65 cases of lung cancers were detected out of 14, 711 patients with pneumoconiosis. The incidence of lung cancer among those with coal miners' silicosis was 1.6 times higher than that of the general population (n.s.), while it was 4.3 times higher among those with metal miners' silicosis (P<0.01).
There were significant differences in terms of the sites of lung cancer, the histologic types of lung cancer and the average duration of dust exposure period, between these two occupational groups.
From the results obtained we can conclude that there is no strong correlation between silicosis and lung cancer, but lung cancers associated with metal miners' silicosis may be related to inhalation of exogenous carcinogens.

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²⁰¹ Tl to ⁶⁷Ga Crude Uptake Ratio (CUR) was measured in 40 patients with primary lung cancer using quantitative ²⁰¹Tl and ⁶⁷Ga scans, and their CURs were compared with histological types. After regions of interest (ROIs) were set on the tumor and the normal lung, the mean counts (T: at the tumor, N: at the normal lung) for ROIs were measured on both scans, and the CUR of ²⁰¹ Tl to ⁶⁷Ga (both crude uptakes: T-N/N) was calculated on the same patients. Seventeen adenocarcinomas had a high CUR of 1.82±1.27, many of them taking up more ²⁰¹ Tl than ⁶⁷Ga. Fourteen epidermoid carcinomas had a significantly lower CUR of 0.41±0.25 than adenocarcinoma (p<0.001), taking up more ⁶⁷Ga than ²⁰¹ Tl. Compared with adenocarcinomas, 3 oat cell carcinomas also had a significantly lower CUR of 0.40±0.07 (p<0.001), a value similar to epidermoid carcinoma. On the other hand, 2 adenosquamous carcinomas had a CUR of 0.95±0.19, intermediate between adenocarcinoma and epidermoid carcinoma. The 40 patients with lung cancer were generally classified into the following 3 groups by CUR: Group I, ⁶⁷Ga uptake greater than ²¹ Tl uptake (CUR≤0.80). Group II, no definite difference between two uptakes (0.80≤CUR≤1.25), Group III, ²⁰¹ Tl uptake greater than ⁶⁷Ga uptake (CUR≥1.25). Many epidermoid carcinomas and small cell carcinomas belonged to Group I, whereas many adenocarcinomas belonged to Group III. Furthermore, the 40 patients showed a continuous distribution from low-CUR epidermoid carcinoma to high-CUR adenocarcinoma. It was found that the measurement of ²⁰¹ Tl to ⁶⁷Ga Crude Uptake Ratio by tumors enables not only a quantitative estimation of lung cancer but a presumption of various histogeneses in lung cancer.

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Ectopic production of ADH has recently been observed in two inpatients with small cell carcinoma in our institute.
In these two patients, the serum and urinary concentrations of ADH decreased markedly almost in parallel with the response of cancer to chemotherapy or radiotherapy. However, when cancer became refractory to therapy and progressive, the ADH concentration in serum and urine increased again.
This fact suggested that the results of sequential measurements of ADH concentrations during treatment might be a useful parameter for the evaluation of the effectiveness of anticancer therapy and also for the prediction of prognosis.

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A 13 year-old male patient complained of left chest and back pain. An abnormal oval shadow was pointed out in the left upper lung field on his chest X-ray film and the 2nd rib seemed lytic. His blood pressure was within the normal range and no hormonal abnormality was found on admission.
On thoracotomy a 4×3×3 cm mass was recognized at the costovertebral sulcus. The patient's blood pressure was stable during the operation.
As the mass was diagnosed as malignant paraganglioma by pathological examination, radiation was performed postoperatively.

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A 75-year-old male participated in a mass survey for lung cancer. Although the chest X-ray findings were normal, sputum cytology suggested squamous cell carcinoma. He was admitted to our hospital in January, 1980. His cigarette index was 900. Bronchofiberscopically, tumors were recognized as superficial infiltration in the left upper lobe bronchus and left B₈ as a nodular in left B⁸ tumor. Biopsies of both sites revealed squamous cell carcinoma.
Because surgery was refused, he was treated with PQ therapy using peplomycin (20mg/week) and carboquone (6mg/week) for four weeks. Since then bronchofiberscopy has been performed once every six months in order to evaluate anticancer drugs effect. To date there has been no evidence of recurrence. Consequently, the evaluation of complete response remains unchanged four years and three months after commencement of treatment, remains unchanged.

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