Operative ultrasonography was performed in 9 operations for lung cancer in which preoperative imaging studies such as CT and angiography were indeterminate in assessing cardiovascular invasion of tumor.
In 8 of 9 operations, operative ultrasonography prior to tissue dissection correctly diagnosed the presence or absense and the extent of cancer invasion to the cardio-vascular system, including the pulmonary artery and vein and their branches, vena cava, aorta, and atrium. This new technique is useful to evaluate cardiovascular invasion of lung cancer and thus to decide on the operative procedure and also to reduce unnecessary tissue dissection.

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In this study, small cell carcinoma of the lung was subclassified into 4 subtypes: oat cell carcinoma (OAT), intermediate cell type (INT), combined oat cell carcinoma and undifferentiated carcinoma, small cell type (UCS). The relationship between the effectiveness of chemotherapy and prognosis among these subtypes was examined in 66 cases. They consisted of 54 cases of OAT and INT and 12 cases of UCS. Patients received courses of therapy consisting of vincristine/nimustine or vincristine/adriamycin from January, 1977 to July, 1980 and vincristine/nimustine/ cyclophosphamide or vincristine/nimustine/adriamycin from August, 1980 to December, 1984.
The response rates to these combined chemotherapeutic regimens were 75.9% for OAT and INT, and 25.0% for UCS and this difference was statistically significant (p<0.005). On the other hand, median survival time and percent 2-year survival were almost the same in the two groups. From these findings, it was suggested that UCS might be a biologically different tumor from OAT and INT, and that different treatment approaches are required for the two types of tumor.

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Phase II trials of combination chemotherapies with cis-platinum (100 mg/m²) plus adriamycin (30 mg/m²) plus mitomycin-C (8 mg/m²): PAM, cis-platinum (80 or 100 mg/m²) plus vindesine (3 mg/m² ×3): PV, and cis-platinum (100 mg/m²) plus vindesine (3 mg/m²×2) plus mitomycin-C (8 mg/m²): PVM were carried out in advanced non-small cell lung cancer, and their responses and toxicities were studied.
No patients achieved complete response in PAM, PV, and PVM. Among the 30 evaluable cases treated with PAM, there were 11 partial responders (36.7%). Among the 20 evaluable cases treated with PV, there were 8 partial responders (40.0%). Among the 9 evaluable cases treated with PVM, there were 3 partial responders (33.3%). The toxic effects were evaluated in the first course of PAM, PV and PVM. Leukocytopenia was seen more in PAM than in PV and PVM (p<0.05). Thrombocytopenia was seen more in PAM and PVM than in PV (p<0.025).A fall in hemoglobin was seen more in PV than in PAM and PVM (p<0.05). There were few differences in nonhematologic toxicities between PAM, PV, and PVM.
From the above results, it should be said that there were few differences in responses and toxic effects other than hematologic toxicity between PAM, PV, and PVM.

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In order to analyze radiographic findings of small peripheral adenocarcinoma of the lung, diagnostic xerotomograms of 43 cases of primary adenocarcinoma and 12 cases of non neoplastic lesions, which were less than 2cm in diameter, were retrospectively examined.
Small solitary peripheral mass densities on xerotomogram were classified into three groups; 1) solid type with well-defined margin, and moderate or high density 2) infiltrative type with ill-defined margin, and low density 3) mixed type consisting of the solid type and infiltrative type.
In this study concerning small peripheral adenocarcinomas which were less than 2cm in diameter, the characteristics of peripheral adenocarcinoma on radiogams, spicula, notch lobulation, involvement of surrounding bronchi or vessels, and involvement of more than two subsegments were distinctly demonstrated on xerotomograms, which had excellent edge enhancement and tolerance. Based on findings of spicula plus lobulation, it was possible to differentiate adenocarcinoma appearing as a small solid type solitary mass density from non neoplastic lesions. Furthermore, a new scoring system was presented based on the findings of the margin of the lesion, vascular and pleural involvements. There was a difference in the scores of adenocarcinoma and non-neoplastic lesions. To obtain more precise differential diagnosis of small solitary peripheral mass densities, it is necessary to accumulate more knowledge concerning radiologic-pathologic correlation and to obtain better quality of images.

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We analyzed 28 resected cases of Stage IV lung cancer treated from 1975 to 1982. Each patient was assigned a pathological stage classification on the basis of examination of resected specimens. The histological types were as follows: 10 squamous cell carcinomas (38%) and 18 adenocarcinomas (64%). There were 18 cases with intrapulmonary metastasis and the remainder showed other distant organ metastasis. The 3-year survival rate of cases with solitary intrapulmonary metastasis was 46.1%, which was better than cases with distant organ metastasis (18.9%).
The group with the best prognosis consisted of cases with solitary intrapulmonary metastasis in the same lobe as the primary tumor. We considered that some cases of this group might actually be cases of multiple primary lung cancer.

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Between January 1979 and December 1984, 74 of 344 patients with primary lung cancer presenting radiographic findings of atelectasis were treated with radiation therapy. Radiographic improvement of atelectasis was noted in 45 patients. The response rates of atelectasis according to histologic type were 80% in 15 small cell carcinoma patients 56% in 45 epidermoid carcinoma patients and 57% in 14 patients of other histologic types. There was no relationship between the response rate of atelectasis and the clinical stage. On the other hand, by bronchoscopic types, the response rate of atelectasis was higher in the tumorous type than in the infiltrative type. Patients who were treated with radiation therapy beginning over 2 months from the onset of atelectasis had a poor response rate. Split-course irradiation was effective against lung cancer with atelectasis, particularly epidermoid carcinoma. Reduction of fever caused by infection secondary to atelectasis was rarely obtained by antibiotic therapy. Fever subsided in 7 of 10 patients with atelectasis who responded to radiation therapy. There was no difference in the prognosis of primary lung cancer between patients with and without atelectasis.

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Four patients with untreated lung cancer were initially treated with high-dose combination chemotherapy. Three patients with small cell carcinoma were treated with 2 courses of cyclophosphamide (1.4 g/m²), adriamycin (60 mg/m²), nimustine (90 mg/m²), and vincristine (2 mg). One patient with large cell carcinoma was treated with 5 courses of cyclophosphamide (1000 mg, day 1, 8), adriamycin (40 mg, day 1, 8), methotrexate (25 mg, day 1, 8), and procarbazine (200 mg, day 1-10). To ameliorate hematopoietic toxicity, autologous bone marrow cells collected and cryopreserved prior to treatment were reinfused on day 3 or 4 in three patients with small cell carcinoma or on day 9 in one patient with large cell carcinoma, respectively. All four patients achieved a partial response. In two patients with small cell carcinoma the response duration was 24 weeks and the survival time was 57 and 35 weeks, respectively. These results were similar to those of other conventional chemotherapeutic regimens. In the patient with large cell carcinoma, the response duration was 26 weeks and the survival time was 54 weeks. Non-hematological side effects included a febrile episode in two patients and interstitial pneumonitis in one. The indications and problems in high-dose chemotherapy with autologous bone marrow transplantation were discussed.

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Five patients with extensive small cell carcinoma of the lung (SCLC) were treated by highdose chemotherapy with autologous bone marrow rescue (Auto-BMT). At the time of Auto-BMT, 2 of five patients were in partial response (PR), and the remaining patients were in a resistant state to conventional chemotherapy.
By Auto-BMT, the two patients in PR status achieved complete remission (CR), and 2 of the three patients in resistant status achieved PR. The other patient was not evaluable because he died of drug-related leukopenia and sepsis.
Survival of the patients showing PR was 1.5 and 6 months after Auto-BMT, while that of one patient in CR was 9.5 months (21.5 months after onset). The cause of death of the above three patients was relapse. However another patient in CR remains alive and disease-free without maintenance chemotherapy for more than 17 months (39 months after onset). This report suggests that Auto-BMT may be useful for patients with extensive SCLC, if they are not in the resistant state.

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In order to investigate the relationship between the reactivity of immunohistochemical markers and chemotherapeutic effects, 82 biopsy cases initially diagnosed as small cell carcinoma of the lung at the National Cancer Center Hospital were examined clinicopathologically and immunohistochemically.
Of 82 biopsy cases, the histology of the tumor was reconfirmed in 33 by resection and/or autopsy. In about one fifth of the cases (7 of 33) the histology was shown to change from small cell carcinoma at initial biopsy to non-small cell carcinoma.
As a result of an immunohistochemical study, positivity for keratin (Immunotech), epithelial membrane antigen and neuron-specific enolase were frequently observed in biopsy samples of small cell carcinoma. Although the positivity of keratin (Dako), secretory component, chromogranin A and gastrin-releasing peptide was low, these markers, excluding gastrin-releasing peptide, were useful for distinguishing non-small cell carcinoma from true small cell carcinoma at the initial biopsy.
In 41 of 82 small cell carcinoma cases immunohistochemically investigated in this study, the effect of chemotherapy was evaluated clinically. As compared with chemotherapeutic effects and the positivity of immunohistochemical markers, only keratin (Immunotech) positivity seemed to be inversely related to chemotherapeutic effect. Therefore, immunohistochemistry for keratin might be useful for evaluating chemotherapeutic effect at the initial biopsy of small cell carcinoma of the lung.

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From January, 1977 to December, 1986, a total of 202 patients with primary carcinoma of the lung were treated surgically in our department. Eleven peripheral early lung cancer cases (A group) in which the diameter did not exceed 2.0 cm were studied clinically. Seven cases (B group) of the same size lung cancer were advanced cases (Stage III).
In group A, histological diagnosis showed adenocarcinoma in 7 cases, squamous cell carcinoma in one case, adenosquamous cell carcinoma in one case and bronchioloalveolar carcinoma in 2 cases. In goup B, the histological findings showed adenocarcinoma in 3 cases, squamous cell carcinoma in 2 cases, adenosquamous cell carcinoma in one case and large cell carcinoma in one case.
The survival rate for A group (early cancer) was 85.7% at 3 years and 85.7% at 5 years. On the other hand, the survival rate in patients with B group was markedly poor, 42.8% at 3 years and 28.5% at 5 years.
In conclusion, we consider that this A group carcinoma satisfied the criteria of peripheral type early stage lung cancer.

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CT scans of 36 patients with lung cancer, which showed possible contact with the pleural surface, were reviewed retrospectively, based on the surgical-histological evidence. The CT features of the primary lesions included: the angle and amount of contact with pleural surface, the long dimension, area of contact with pleural surface, and associated pleural thickening along with the extrapleural fat plane. From these data, more significant CT findings of tumor invasion to the parietal pleura (Stage p3) were summarized as follows: 1) obtuse angle, 2) 3 cm or more contact with pleural surface (10 cm² or more areas), 3) associated pleural thickening, and 4) loss of the extrapleural fat plane. Statistically, in spite of showing a high negative predictive value in each item (84-93%), the positive predictive value still remained unsatisfactory (48-56%). However, specificity, calculated by combining all items using a scoring method (1 point for each item), resulted in such improvement that 71% of the cases given 3 points or more were in Stage p3 while 91% of those given 2 points or less were in Stage p2 or lower. Another histology-oriented investigation suggested that adenocarcinoma was more invasive than squamous cell carcinoma.

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A case of a 32-year-old man with primary sarcoma originating from the left main pulmonary artery was reported. The left hilar mass was found on chest roentgenogram. Pulmonary arteriography showed complete obstruction of the left main pulmonary artery and long segmental stenosis of the right main pulmonary artery.
The open biopsy specimen was composed of pleomorphic tumor cells vaguely fascicular but generally disorganized. By electron microscopy, the tumor cell cytoplasm was shown to contain numerous microfilaments aligned longitudinally, associated with dense bodies, suggestive of myogenic sarcoma
Regression of the tumor was obtained by radiation therapy followed by chemotherapy without improvement of the pulmonary arterial obstruction. The patient died of acute renal failure after high dose methotrexate chemotherapy. At autopsy, the tumor was confirmed to originate from the left main pulmonary artery and was almost completely composed of necrotic cells suggestive of the effect of treatment.

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We reported a case of surgical resection of bilateral lung cancers which were both negative on chest X-ray film but were detected by sputum cytology.
A 64 year-old male was found to have positive sputum cytology at a mass screening examination. Bronchofiberscopic examination demonstrated epidermoid carcinoma in the right lower lobe bronchus and in the left upper division bronchus. Right lower lobectomy and left upper division segmentectomy were carried out. Macroscopically, both lesions showed early stage cancer. Microscopic examination revealed lymph node metastasis in the right lung and carcinoma in situ in the left lung lesion.

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A case of primary malignant mediastinal teratoma in a 20-year-old man with Klinefelter's syndrome was reported.
The chest roentgengram and computed tomography revealed a fist-sized anterior mediasti-nal mass protruding into the left thoracic cavity and multiple metastatic lesions in both lungs. The levels of serum AFP and HCG were abnormally high, 7400 ng/ml and 46.0 mIU/ml respectively. There was no gynecomastia but his testes were small. Chromosomal karyotyping revealed 47XXY. Histological study of the tumor showed embryonal carcinoma within mature teratoma and an immunohistological study demonstrated the presence of AFP in the embryonal carcinoma and also CEA in glandular epithelial cells in the mature teratoma.
He responded to chemotherapy consisting of Cis-Diamminedichloroplatinum, Vinblastine, Pepleomycin, applied before and after the extirpation of the mediastinal mass, and has been well for 23 months without evidence of the disease, providing supportable evidence for the effect of this regimen in germ cell tumors even of extragonadal origin

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