MRI was used in 18 cases to retrospectively distinguish central type lung cancer and its secondary changes. The ability of MRI to identify a centrally located tumor and its peripheral secondary changes by signal intensities and mucous bronchograms were evaluated. Using only signal intensities, it was possible to distinguish them in 10 of 18 (56%) cases. Mucous bronchograms which is a very hyperintense band on T2-weighted image, were identified in 11 of 18 (61%) cases with secondary changes. In the six operated cases showing this sign, mucoid impaction was found. Based on this sign and signal intensities, MRI was successful in 13 of 18 (72%) cases in distinguishing tumor from secondary changes. This rate was better than the differentiation rate achieved with CT (7 of 14 cases, 50%) although the difference was not statistically significant. Mucous bronchograms reflected mucoid impaction and were useful in differentiating central type lung cancer from its secondary changes.

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To determine the features of lung cancer in the elderly, we reviewed the autopsy files at Kyushu University Hospital. Lung cancer patients were classified on the basis of age into the following three groups: those 70 or older, those aged 60 to 69, and those 59 or younger. In those 70 or older, much more time had elapsed from the first clinical presentation to the time of diagnosis than in the other groups, while there were fewer stage N patients and fewer numbers of involved organs at autopsy. The proportion of squamous cell carcinoma was high in the oldest group. The duration of survival was somewhat shorter in the oldest group than the youngest group. The number of peripheral blood lymphocytes was significantly lower in the oldest than in the youngest group. On the basis of these findings, we suggest that the tumor progresses more slowly in the elderly than it does in younger patients. It is possible that the shorter duration of survival observed in the elderly is partly due to the fact that many more elderly patients die of non-tumor-related diseases.

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The authors evaluated the prognostic significance of nuclear DNA content by flowcytometry and ras oncogene expression in paraffin-embedded sections of tumors obtained surgically from 112 non-small cell lung cancer patients. Sixty-five (77%) of the 84 tumors had DNA aneuploid patterns, and these were statistically higher in adenocarcinoma than in squamous cell carcinoma. Of the 91 patients analyzed immunohistochemically using anti-ras p21 monoclonal antibody rp-53, positive reactions (weak and strong) were observed in 56% of squamous cell carcinomas and 68% of adenocarcinomas. A better 5 -year survival rate was observed in the DNA diploid group (61%) than in the DNA aneuploid group (35%) (p<0.01). Patients with p21-negative tumors survived significantly longer (5 -year survival rate of 64%) than those with p21-weak tumors (38%, p<0.05) or those with p21-strong tumors (12%, p<0.01).
We calculated risk scores for each patient using the regression equation, and divided tham into three categories;low, intermediate, and high-risk groups. There were highly significant differences of 5 -year survival rates or 50% survival time for these groups. It was possible to separate patients into significantly different risk categories, improving on previous prognostic prediction of individual patients with non-small cell lung cancer.

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An interpretation experiment was performed to study the correlation between the radiographic features and the detectability of pulmonary nodules. One hundred and ninety-two P-A chest radiographs, each with a peripheral-type malignant nodule, and 118 normal control films were interpreted in a random order by 27 respiratory physicians. The observers were asked to check the presence and the site of a nodule within five seconds on each radiograph, and to give one of four grades of confidence ratings; definitely positive, probably positive, possibly positive, and probably negative. These four grades were scored as 3, 2, 1, and 0. The mean of the scores which 27 observers gave was used as the detection score of each nodule.
The diameter of 192 nodules were measured. Radiographic features of nodules, i.e., density, contour characteristics, spicule formation, vascular convergence, and pleural indentati on were visually evaluated and scored. The degree of overlap of a nodule with anterior ribs, and that with posterior ribs were also evaluated and scored.
As for nodule detection, 82% of the nodules were correctly detected and 18% of them were overlooked. The diameter of nodules correlated slightly with their detection score (r_s=0.222, p=0.002). Density of nodules, degree of vascular convergence, degree of spicule formation, and degree of overlap of a nodule with posterior ribs correlated respectively with the detection score. However, characteristics of nodule contour, presence of pleural indentation, or the degree of overlap of a nodule with anterior ribs did not show any correlation with the detection score.

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SSEA-1-related antigens (Lewis^Y, Lewis^X, sialyl Lewis^X-i) are expressed in fetal lung depending on the stage of their development. Some of them persist in the bronchial gland cells throughout life. Normal bronchial gland cells and cancer cells were examined immunohistochemically using monoclonal antibodies to each SSEA-1-related antigen in 22 cases of fetus and child lungs, 45 adenocarcinomas, 11 large cell carcinomas, 2 mucoepidermoid carcinomas and 1 adenoid cystic carcinoma. In normal bronchial gland, Lewis^Y and sialyl Lewis^X-i antigens were expressed not only on the apical cell surface but also diffusely in the cell cytoplasm. In all cases of mucoepidermoid carcinoma and bronchial gland cell type adenocarcinoma, these antigens were positive and their expression patterns were similar to those of the normal bronchial gland cells. In other cell types of adenocarcinoma, however, these antigens were expressed only at the apical surface of cancer cells. From the results, SSEA-1-related antigens might be useful as diagnostic markers for adenocarcinoma of bronchial gland cell type.

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A study was conducted to determine whether transfusion with glucose plus amino acid is effective in alleviating CDDP nephrotoxicity. Patients with primary lung cancer receiving CDDP were devided into two groups according to the transfusion method, and their renal functions were studied.
One group (Group A) was given 100g/day glucose on the day of CDDP administration and the following day, the other group (Group B) was given a transfusion of 200-250 g/day of glucose accompanied by 40g/day of amino acid. The results showed that the elevation following CDDP administration in free excretion of β₂ microglobulin, NAGindex and uric γ-GTP excretion, which reflect renal tubular functions, were less in group B than in group A, Group B showed a tendency toward rapid recovery to the levels prior to CDDP administration.
Accordingly, these findings indicate that when CDDP is used, transfusion with higher concentrations of glucose and amino acid than conventionally administered would be effective in alleviating renal function impairment caused by CDDP.

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From 1976 to 1985, 57 elderly patients over 75 years of age with stage I-III nonsmall cell carcinoma of the lung received curative radiotherapy at our clinic. The treatment results of the elderly were compared with those of 127 younger patients under 75 years of age in the same period. The results showed that there was no significant statistical difference in the survival rates between the elderly and the younger groups. However, it was suggested that a total dose at the lower limit for curative treatment (60 Gy) and as small a treatment field size as possible should be employed in the elderly. Radiotherapy, as a less invasive treatment modality, might contribute to the good quality of life of elderly patients with lung cancer.

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Fifty-two cases of small-sized adenocarcinomas less than 3 cm of peripheral lung, which were surgically resected, were investigated in terms of argyrophil nucleolar organizer regions (AgNORs) to evaluate correlation to histopathological findings and prognosis. Nuclear atypia and histologically defined mitotic index correlated well with mean numbers of AgNORs per cell (P<0.01), but there was no significant relationship between histological differentiation of tumor or pathological grade. When the cases were divided into 3 groups, including a lower group (AgNORs<2.5), medium group (2.5≤AgNORs<4.0) and higher group (4.0≤AgNORs), the survival curves of 3 groups showed statistically significant differences (P<0.05), that is, the cases in the lower group had longer survival time than those in the higher group, but there was no significant difference in survival time among 30 cases of stage I, even if divided into 3 groups in the same manner.

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In order to explore the use of adoptive immunotherapy in primary lung cancer patients, small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC), cell lines were established from pleural effusions. STCl, an SCLC cell line, and L0301, an NSCLC cell line were exposed to various concentrations of CDDP and CDDP-resistant cell lines (STCl/CDDP and L0301/CDDP) were established. In MTT assay, STC1/CDDP was resistant to several anti-cancer agents, such as CDDP, MMC, VCR, CPA, and VP-16. L0301/CDDP was resistant to CDDP, ADM, MMC, VCR, and VP-16. The autologous effector T cells generated from each patient's lymphocytes obtained from either pleural effusion or peripheral blood showed cytotoxic activity against not only the parenteral tumor cells but also the drug-resistant tumor cells. These results demonstrated that adoptive immunotherapy may be useful for the treatment of lung cancer patients who become resistant to chemotherapy.

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Extramedullary plasmacytoma is relatively rare, and it arises most commonly in the nasopharynx and upper respiratory tract. We report herein a case of solitary extramedullary plasmacytoma of the lung.
A 60-year-old asymptomatic woman was referred to our hospital for further examination of an abnormal shadow on chest x-ray film. Endoscopic examination did not yield a histological diagnosis, therefore partial lung resection was performed under general anesthesia. The histological findings of the tumor showed an extramedullary plasmacytoma. The plasmacytoma cells were selectively stained with IgG and λ chain. The blood examination showed no myeloma protein. She is doing well 4 years and 3 months after the operation.

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A carcinoma of the lung showing diffuse calcification in the mass is reported. The patient had been under hemodialysis treatment for polycystic kidney disease for fourteen years. Calcified foci in the mass were shown on both preoperative thin section CT images and the soft X-ray radiogram of the excised specimen. Bone scans with ^99mTc-MDP showed an increased uptake both in the lung fields and diffusely in the lung mass. The dense calcification in the tumor probably resulted from metastatic calcification secondary to chronic renal failure and the long-term history of hemodialysis, although hypercalcemia and hyperparathyroidism were not evidenced by the laboratory data. This case suggests that a diffuse calcification in lung nodules, which may be seen specifically in patients with long-term hemodialysis, must be taken into consideration for differential diagnosis in order to rule out malignancy.

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A 42-year-old male was admitted to our hospital complaining of general fatigue and fever. The chest roentgenogram showed an oval shadow in the right upper lung field with involvement of the chest wall. The white blood cell count increased to 60, 600/mm³, and the platelet count 736, 000/mm³ on the day before operation. Under a diagnosis of large cell carcinoma of the lung, c-T 3 N0 N0, right upper lobectomy and R2-lymphnode dissection were performed with chest wall resection. White blood cell count, platelet count and tumor markers decreased to normal levels after surgery. The pathological examination showed large cell carcinoma of the lung (giant cell type). Tumor cell lines were established from the tumor tissue obtained by surgery. Following transplantation in nude mice and measurement of CSF (GM-CSF, IL-6) by ELISA in tumorconditioned medium, it was suggested that leukocytosis and thrombocytosis in this case could be due to the production of GM-CSF and IL-6 by tumor cells. This case of large cell carcinoma of the lung producing colony stimulating factor (CSF) was described with reference to the Japanese literature.

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A 68-year-old man was re-admitted to our hospital in March 19, 1991. An abnormal lung shadow had been pointed out since 1980, and was diagnosed as pulmonary malignant lymphoma (diffuse, small cell type) with IgG (κ) monoclonal gammopathy by open lung biopsy in 1985. The pulmonary lesion and monoclonal gammopathy improved remarkably by corticosteroid treatment. Five years after cessation of steroid therapy, the abnormal lung shadow and IgG (κ) and IgM (κ) biclonal gammopathy gradually became worse again. Relapse of malignant lymphoma was confirmed by transbronchial lung biopsy, and immunological examinations showed diffuse proliferation of monoclonal small B cells. The clinical and histological changes of this case may suggest a close relationship between malignant lymphoma and pseudolymphoma.

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A 76-year-old male was admitted because of cough and hemoptysis. Diagnosis of primary lung adenocarcinoma (stage T2 N2 M1 (PUL)) associated with lung fibrosis was confirmed and combination chemotherapy with CDDP, IF X and VDS was initiated. Twenty days after the second course of the therapy, the patient developed purpura, abdominal pain, hematuria and proteinuria, and was diagnosed as having Henoch-Schönlein purpura. Slight elevation of immune complexes in sera was observed. Histological examination of skin biopsy revealed simply mild angitis. The administration of prednisolone resulted in a remarkable improvement of symptoms including purpura and abdominal pain. The clinical course suggested that the responsible antigen might be derived from either cancer cells or the chemotherapeutic drugs.

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A 32-year-old man was admitted complaining of cough and anterior chest pain. Chest X-ray film showed a mass in the right hilum with cervical subcutaneous emphysema and pneumomediastinum. CT scan revealed a tumor in the right lower lobe bronchus with luminal obstruction and hyperinflation of the right lower lobe. Suspecting lung cancer, right pneumonectomy was performed. On the cut section almost complete obstruction of the right lower bronchial trunk by a well-circumscribed tumor and hyperinflation of the right lower lobe were recognized. The tumor was typical carcinoid. The possible mechanism to explain the pneumomediastinum is that pulmonary alveolar rupture occurred as a result of increased intra-alveolar pressure by a check-valve mechanism of the narrowed bronchus, then the air leaked to the hilum and passed through the mediastinum. This is the first reported case of pneumomediastinum due to bronchial carcinoid.

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A 72-year-old woman was admitted to our hospital with exertional dyspnea (Hugh-Jones III). Chest X-ray films showed right pleural effusion and pleural biopsy revealed pleural carcinomatosis (adenocarcinoma). Despite the intrathoracic administration of MMC and OK-432, an encapsulated pleural effusion remained and pulmonary lymphangitic carcinomatosis developed. Subsequently, a subcutaneous tumor that showed cancer cell infiltration became palpable at the site where the intrathoracic catheter had been inserted, and diffuse subcutaneous swelling extended over the right side of the trunk with right axillary lymphadenopathy. CT scans of the chest and abdomen showed a network of high density lesions in the subcutaneous tissue of the trunk.
These physical and CT findings suggested diffuse subcutaneous infiltration of adenocarcinoma. Although systemic chemotherapy with CBDCA and VP-16 was performed, she died of respiratory failure.
Autopsy findings revealed that the tumor was a poorly differentiated adenocarcinoma that originated from the right lower lobe, and both direct tumor infiltration from the pleura and the chest wall into the subcutaneous tissue and cutaneous lymphangitic carcinomatosis caused the diffuse subcutaneous swelling.

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A 56-year-old man was hospitalized for further examination of an abnormal shadow on his chest X-ray. He was asymptomatic and did not show leukocytosis in his laboratory data. Left lower lobectomy and dissection of regional lymph nodes was performed. Pathological diagnosis was large cell carcinoma, T2N1M0. He complained of an acute abdominal pain 6 months after the operation. The laboratory data showed marked leukocytosis (WBC 26, 800/μl) in spite of no obvious infectious foci. Echography and CT scan pointed out a giant abdominal tumor. Palliative surgery for metastatic abdominal tumor was performed. He died of systemic metastasis of cancer 23 days after the second operation. The enzyme immunoassay demonstrated an apparent increase of granulocyte colony-stimulating factor (G-CSF) in the serum (146pg/ml, normal<60). Northern blot analysis with total cellular RNA (15μg) prepared from the specimens of both primary lung cancer and metastatic abdominal tumor showed apparent expression of G-CSF gene. We reported a case with leukocytosis definitively proved to be due to autonomous production of G-CSF by lung cancer.

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