Recently, tumor markers are increasingly utilized for clinical diagnosis and as indices of clinical therapeutic efficacy of cancer. In this study, the authors measured the serum leves of NCC-ST-439 and compared the results with levels of squamous cell carcinoma-related antigen (SCC), neuron-specific enolase (NSE) and carcinoembryonic antigen (CEA) in 67 primary lung cancer patients before treatment (adenocarcinoma=25, squamous cell carcinoma=14, large cell cancer=2, adenosquamous carcinoma=4, small cell cancer=22), 25 healthy volunteers and 25 benign lung disease patients were also studied as control groups.
The serum levels of NCC-ST-439, NSE and CEA were significantly higher in lung cancer patients than in benign lung disease patients. The serum levels of NCC-ST-439 in non-small cell cancer patients were significantly higher than those of small cell cancer patients. NCC-ST-439 and CEA levels in adenocarcinoma patients, SCC levels in squamous cell carcinoma patients and NSE levels in small cell cancer patients were higher than those of other histological types of cancer, respectively. The serum levels of NCC-ST-439, SCC, NSE and CEA were not related to clinical stages, but the NSE level was reduced when the therapy was effective and elevated in cases of therapeutic failure.
In conclusion, measuring the serum levels of NCC-ST-439 was thought to be useful for diagnosis of lung cancer, especially of non small cell cancer, and combined measurement of NCC-ST-439 and CEA yielded a more accurate diagnosis of lung cancer.

View full abstract

Surgical outcomes of early hilar lung cancers treated in our surgical department were analyzed. The definition of early hilar lung cancer was:(1) the lesion was located proximal to the segmental bronchus, (2) the tumor invasion was confined within the bronchial wall with no invasion into the lung parenchyma, (3) no regional lymphnode metastasis or hematogenous distant metastasis.
Since 1977 when the first patient of early hilar lung cancer was found in our department, to date, there were 20 patients of early hilar lung cancer which corresponded to 3.3% of 603 resected lung cancers during that time. The cell types of all thesepatients were squamous cell carcinoma. Five patients underwent standard lobectomy because the lesions were localized within the segmental bronchus. Twelve patientunderwent standard sleeve lobectomy after combined resection of the main bronchus. For three other patients, limited bronchial resections were attempted. Two of them which hada polypoid tumor at the orifice of segmental bronchus underwent sleeve segmentectomyof S6 of the right lung and S6 of the left lung, respectively. The other patient had a minute squamous cell carcinoma which occupied the bifurcafion of the left upper and lowerlobe bronchi. In this patient double-barreled anatstomosis between the left main bronchus and the double ends of the left upper and lower bronchi was carried out. There wasno operative morbidity or mortality in all patients. The five-year and ten-year survival rates ofthese 20 patients were 100% and 88%, resepectively. Two out of the 20 patients developed second primary cancer in the opposite lung, one of which was a synchronous lesion and the other a metachronous one. The synchronous lesion which was a tiny “in situ” carcinoma in an aged patient was cauterized by a YAG-Laser beam after right upper sleeve lobectomy. Bilateral sleeve lobectomies were performed for the patient with metachronous early hilar lung cancer which developed five years later.
It was concluded that minimal pulmonary and bronchial resection should be attempted in the surgical treatment of early hilar lung cancer.

View full abstract

A total of 184 patients with inoperable non-small cell lung cancer were included in a randomized trial comparing the activity of cisplatin plus vindesine (PV) with cisplatin plus ACNU (PN) therapy. In PV therapy, 80mg/m² cisplatin on day 1 and 3mg/m² vindesine on days 1, 8 and 15 were administered and in PN therapy, 80mg/m² cisplatin and 100mg/m² ACNU were administered on day 1. The overall response rates in 152 patients with complete evaluation were 22.9% for PV therapy and 12.2% for PN therapy and there was no significant difference between them. The survival curves were calculated in these 152 patients. The median survival time was 10 months for the PV group and 9 months for the PN group and the two-year survival rate of each group was 14.9% and 12.4% respectively with no significant difference between the two groups. Concerning PS 0-2 cases, the response rate for PV therapy was 23.4%, which was significantly higher than that for PN therapy (11.1%), but the survivals of the two groups were not significantly different.
The frequencies of brain metastases within 40 weeks from the start of the therapy in both groups were of no significant difference (8.6% for the PV group and 10.3% for the PN group).
As for the toxic effects, the frequency of thrombocytopenia in the PN group and the frequency of alopecia and/or peripheral neuropathy in the PV group were significantly greater than in the other group.

View full abstract

Using an IRMA kit, we measured the serum level of tissue polypeptide antigen (TPA) in 191 patients with lung cancer, 379 patients with non-cancerous lung disease and 188 healthy adults. The sensitivity, specificity and accuracy of measuring serum TPA for lung cancer were 57.3%, 87.1% and 77.0%, respectively. After we performed the immunoperoxidase staining method for TPA, strong positive immunoreactivity was demonstrated in the tumor cells of all histological types. Using this IRMA kit, the significance of TPA in lung cancer was confirmed.

View full abstract

Cytomorphologically, discrimination between atypical hyperplastic cells and well differentiated adenocarcinoma cells of the lung is very difficult. We investigated the nucleolar organizer regions (NORs) among these two cell types which had been difficult to diagnose by Papanicolaou staining. Recently, NORs can be located by the argyrophilic technique (Ploton et al. 1986); the structures thus demonstrated are termed “AgNORs”. The number of AgNORs in the nuclei of 6 patients with hyperplasia (mean±SD, 2.8±0.4) was significantly less than that of 6 patients with adenocarcinoma (5.1±0.5, p<0.01). These results indicate that the number of AgNORs provides useful information to distinguish atypical hyperplastic cells from well differentiated adenocarcinoma cells.

View full abstract

A 34-year-old man with diffuse bilateral lower lung fields nodular shadows was admitted to our hospital.Twenty years ago, right half of his thyroid had beenresected on a diagnosis of thyroid carcinoma.
Bronchoalveolar lavage as well as transbronchial lung biopsy (TBLB) were performed to obtain a definite diagnosis on the pulmonary lesions.Bronchoalveolar lavage revealed an appreciable amount of thyroglobulin, which was highly suggestive of metastasis of thyroid carcinoma to the lung.This was confirmed by the pathological examination on the specimen obtained by TBLB, which revealed hyperchromatic cells originating from follicular type thyroid carcinoma.
Since little thyroglobulin is expected to exist in the normal lung tissue, this study may indicate that detection of thyroglobulin in BALF should be very helpful for confirming pulmonary metastasis of thyroid carcinoma.

View full abstract

A case of small cell carcinoma of the hilum of the right lung in a 47-year-old man was reported. Before treatment, a computerized tomograph scan of the brain after intravenous administration of contrast medium revealed multiple brain metastases. A solitary lesion with peritumoral edema was seen in the right frontal lobe and a cystic lesion with a mural nodule, which had ringed enhancement, was seen in the left occipital lobe. No clinical symptoms and signs related to the brain metastases were noted. After two courses of chemotherapy, a partial response of the primary site was recognized on chest roentgenograms. The cystic lesion including mural nodule in the brain also reduced in size.
Six weeks after the second chemotherapy, the patient developed Gerstmann's syndrome. At that time a brain CT scan demonstrated an enlargement of the cystic lesion and mid-line shift. Administration of mannitol and glucocorticoid steroid failed to improve the symptoms and partial resection of the cystic lesion was performed. The resected specimen showed small cell carcinoma carcinoma similar to the lung cancer. In the literature, cystic brain metastasis with a mural nodule is rare.

View full abstract

Four cases of lung cancer with carcinomatous meningitis are reported, one was small cell carcinoma and others were adenocarcinoma. They had variouneurological symptoms. The mean survival time from diagnosis of carcinomatous meningitis was 41 days. Enhanced CT scan proved to be of value in diagnosis. Several courses of intrathecal injection of Ara-C and methotrexate were followed by tumor cell degeneration in cerebro-spinal fluid. However, symptoms and signs did not improve and their courses were poor. One patient treated with intrathecal injection together with whole brain irradiation survived longest, for 102 days from the diagnosis.

View full abstract

A 72-year-old woman presented with multiple metastatic polypoid lesions in the stomach from primary small cell carcinoma of the lung.
Gastric metastasis from primary lung cancer is rare (1-5%) and ante-mortem diagnosis of this disorder has been established in only a few patients in the literature.
In this case, anti-cancer agents were very effective and lung and stomach lesions completely disappeared. At 10 months after the initial diagnosis, her clinical course is good and she is alive.

View full abstract

A case with lung cancer diagnosed and operated during hemodialysis for chronic renal failure was reported. A 63-year-old man on maintenance hemodialysis was admitted to the hospital because of cough and bloody sputum. A chest X-ray showed a mass shadow on the left upper lung field and sputum cytology revealed malignant cells.
Left upper sleeve lobectomy and mediastinal lymph node dissection was carried out without any major complication. Histologically, moderately differentiated squamous cell carcinoma was diagnosed and metastasis was found in subaortic and hilar lymph nodes (T₂N₂M₀ Stage IIIA)
The postoperative course was uneventful under careful management for hemodialysis and adjuvant chemotherapy including cisplatin was given.
Careful preoperative evaluation of cardiovascular and hematologic disturbances and correction of hyperkalemia and anemia by hemodialysis and blood transfusion are important. Prevention of fluid overload and hyperkalemia by monitoring of ECG and CVP during operation and careful observation of the patients and early hemodialysis within 24 hours after surgery are required to avoid serious postoperative complications.
With the above appropriate perioperative management, pulmonary resection for lung cancer can be carried out without major complication for the patients under hemodialysis for chronic renal failure.

View full abstract