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Volume 34, Issue 6
Displaying 1-18 of 18 articles from this issue
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Atsuhisa Tamura, Osamu Matsubara, Hikotaro Komatsu, Masashi Mohri, Tor ...1994 Volume 34 Issue 6 Pages 843-852
Published: October 20, 1994
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSTo examine features and significance of nonbacterial thrombotic endocarditis (NBTE) in patients with lung cancer, we clinicopathologically reviewed 142 autopsied patients with lung cancer. Eleven (7.7%) of the patients had NBTE. Incidence of NBTE was 13%(8/62 cases) in adenocarcinoma and 8.6%(3/35 cases) in squamous cell carcinoma. None of the patients with small cell carcinoma (34 cases) had NBTE. Eleven of the 142 patients had pathologically proved disseminated intravascular coagulation (DIC), and 4 of the 11 patients (36%) also had NBTE. There was significant correlation between DIC and NBTE (p<0.01). Seven of the 11 patients with NBTE had systemic thromboembolism mostly accompanied by infarction. Organs with thromboembolism were as follows: spleen (7 cases), brain (5 cases), kidneys (4 cases), heart (3 cases), and mesentery (2 cases). Multiple, hemorrhagic cerebral infarction (4 cases) was fatal. Myocardial infarction and peritonitis caused by mesenteric arterial embolization also contributed to death. The present study revealed that NBTE occasionally occured in patients with lung cancer and that systemic thromboembolism due to NBTE affected prognosis of the patients. The authors stress that clinicians should keep in mind the features and significance of NBTE in treating patients with lung cancer.View full abstractDownload PDF (13145K) -
Yasufumi Yamaji, Ichiro Yamadori, Toshikazu Fujita, Jiro Fujita, Jiro ...1994 Volume 34 Issue 6 Pages 853-859
Published: October 20, 1994
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSAlthough rare, small cell lung cancer (SCLC) presenting as a solitary pulmonary nodule (SPN-SCLC) without lymph node involvement, has interesting clinical and biological features. In this study our objectives are to elucidate whether SPN-SCLC is an independent entity and differs clinically or pathologically from usual forms of SCLC. We reviewed the clinical and pathological features of 80 patients treated at Kagawa Medical School Hospital between 1983 and 1992 on a diagnosis of SCLC. The features of SPN-SCLC were compared with those of non-SPN-SCLC or of the peripherally originated, but locally advanced, subgroup in non-SPN-SCLC. Ten SPN-SCLC patients (9 male and 1 female) were identified among the 80 SCLC patients. In terms of histological subclassification, oat cell type was diagnosed in 3 and intermediate cell type in 7.
Good chemotherapeutic response was observed among six SPN-SCLC patients who received induction chemotherapy (one CR and 5 PR). However, 4 out of the 6 SPNSCLC patients relapsed at the primary sites. Surgical operation was performed in 6 (3 surgery alone, 1 neoadjuvant surgery and 2 adjuvant surgery) and additional radiation therapy after induction chemotherapy in one among 10 SPN-SCLC patients. Although, the SPN-SCLC patients had a longer survival time than non-SPN-SCLC patients, we could not find any differences in pathological and biological characteristics between SPN-SCLC and non-SPN-SCLC. Since it was difficult to curatively treat SPN-SCLC patients by chemotherapy alone, additional surgery combined with chemotherapy for the SPN-SCLC patients may be feasible for cure in such cases.View full abstractDownload PDF (6198K) -
Makoto Gomibuchi, Shigeto Kanno, Shuji Haraguchi, Yoshitaka Masaki, Sh ...1994 Volume 34 Issue 6 Pages 861-866
Published: October 20, 1994
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSWe studied the usefulness of AgNORs and fibronectin antibody (FN) to predict the survival in stage I lung cancer patients. A total of 72 lung cancer specimens were used: 36 cases (A group) which had no recurrence for more than five years after operation and 36 cases (B group) which died from cancer recurrence within five years. Both groups consisted of 18 adenocarcinomas, 16 squamous cell carcinomas and two large cell carcinomas.
Cases were divided into 3 groups and awarded point according to the number of AgNORs: cases with less than 3.0 (two points), those between 3.0 and 5.0 (one point) and those 5.0 or more (zero points). The amount of FN was also classified into three groups: ++ (2 points), + (1 point) and -(zero point).
The survival time for each score for AgNORs, FN, and both together was studied. A group and B group were statistically compared using AgNORs scores, FN scores and total scores.
The results were as follows;(1) Cases with a total score of zero had a shorter survival time than cases with 1-2 points (p =0.025, 0.0076). (2) AgNORs scores of the A group were higher than those of the B group (p=0.029). The same result was found for FN score (p=0.022) and total score (p=0.0057). (3) In adenocarcinomas a total score of 2 had longer survival time than that of zero and A group had higher total score than the B group. No statistical difference was found in squamous cell carcinomas. (4) All eight cases with a zero score were in the B group. Five cases out of 6 with a score of 3 were in the A group.
From these results AgNORs and FN have some value for the prediction of the prognosis in stage I lung cancer patients.View full abstractDownload PDF (634K) -
Hideaki Nakayama, Akira Yokoyama, Kouichi Kinameri, Yuzo Kurita1994 Volume 34 Issue 6 Pages 867-874
Published: October 20, 1994
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSThe therapeutic prognosis and long-term survival were evaluated in 207 patients with small cell lung cancer who were treated after October, 1982. There were 121 patients with limited disease (LD) and 86 with extensive disease (ED). Resection was performed in 19% of the cases and 44% were treated with a combination of chemotherapy and radiotherapy. Comparing induction chemotherapy (ICT, 25 cases) and adjuvant chemotherapy (12 cases), ICT was superior in median survival time (MST, 36, 29 months, respectively) and 3-year survival (3YS, 57, 45%, respectively). There was no difference in MST and 3YS (14, 18%, respectively) between the concurrent (7 cases) and sequential method (22 cases) of radiotherapy. The combination chemotherapy of CDDP, ADM and VP-16 with G-CSF for patients with ED had a longer MST (22 months) and better 3YS (21%) than those without G-CSF. Of 24 long-term survivors (greater than 3 years), 21 patients had LD and 3 had ED. Thirteen patients underwent surgical resection. There were 6 CR and 4 PR among 10 SCLC patients who received chemotherapy and radiotherapy. Now 5 are alive and disease free for more than 5 years. One patient had a second cancer. ICT for surgical patients and dose intensive chemotherapy for patients with ED seemed to improve survival rate, but there was no statistically significant difference.View full abstractDownload PDF (874K) -
Katsuo Usuda, Yasuki Saito, Kouichi Aikawa, Akira Sakurada, Yan Chen, ...1994 Volume 34 Issue 6 Pages 875-881
Published: October 20, 1994
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSA total of 174 cases with primary lung cancer which were detected in local municipalities during a limited period were examined with regard to their distribution and the clinicopathological characteristics of tumor doubling time (DT).
1) After logarithmic conversion of DT in lung cancer, a small skew (0.7204) and a small kurtosis (-0.0643) showed a normal distribution. DT was found to have a log-normal distribution.
2) The minimum DT was 30 days, and the maximum 1077 days in the present study. Arithmetic mean±standard deviation of DT was 163.7±177.5 days, and geometric mean was 113.3 days.
3) Mean DT in males was significantly shorter than that in females, and that in cases with a smoking history was significantly shorter than that in cases without a smoking history. In cases with symptoms, DT was also significantly shorter than that in cases without symptoms. The mean DT in cases with adenocarcinoma was significantly longer than that in cases with squamous cell carcinoma, small cell carcinoma and large cell carcinoma. The mean DT in cases with T1 lung cancer was significantly longer than that in cases with T2, T3, and T4 lung cancer, and that in cases with stage I lung cancer was significantly longer than that in cases with stage III lung cancer.View full abstractDownload PDF (737K) -
Noboru Ishii, Yoshifumi Miyamoto, Masayoshi Okada, Noriaki Tubota, Mas ...1994 Volume 34 Issue 6 Pages 883-889
Published: October 20, 1994
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSA study of postoperative adjuvant chemotherapy according to cell type and curability, either combined with or without immunotherapy using OK-432 was carried out in 138 patients with lung cancer who underwent resective surgery. Administration of OK-432 was selected by randomization.
Of the total number of lung cancer cases, 123 patients were evaluable.
Five-year survival rates were 66.3% in OK-432 group (A), and 51.0% in control group (B), with no significant differences between the two groups. However, in patients who were curatively resected, the 5-year survival rate of the OK-432 group were significantly better than that of the control group (group A; 70.9%, group B; 50.8%, p<0.05), in particular in the adenocarcinoma group and Stage I group (p<0.05).
Therefore, the postoperative administration of OK-432 with chemotherapy contributed to improve the survival rate of curatively operated patients with lung cancer.View full abstractDownload PDF (795K) -
Tsuneo Matsumoto, Hitomi Awaya, Hiroshi Nakamura, Goji Miura, Isao Ari ...1994 Volume 34 Issue 6 Pages 891-901
Published: October 20, 1994
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSTo improve the differential diagnosis of solitary pulmonary nodule (SPN), we analyzed the results of an observer test in 26 cases with non-calcified SPN less than 3cm in maximal diameter including 13 malignant and 13 benign cases. Using evaluation of the edge and internal characteristics of the nodule, eight observers made differential diagnoses with five levels of confidence for SPN on both high-resolution computed tomography (HRCT) and conventional tomography (TOMO). The results of HRCT diagnoses were compared with those of TOMO diagnoses.
HRCT diagnosis of SPN (Az=0.897) was significantly better than TOMO diagnosis (Az=0.705) in the receiver operating characteristics (ROC) curve, because of the improvement in confidence level for malignant nodules in HRCT diagnosis. On the contrary, the diagnostic accuracy in benign nodules on HRCT was almost equal to that on TOMO. When one or more findings suggestive of malignancy, such as spicula or notching, were recognized, the nodules were diagnosed as possible malignancy. However, interindividual variations in interpretations of such findings were great among observers. In the differential diagnosis of SPN on HRCT, benign findings used were few compared with malignant findings.
Our results indicate that, (1) a method of handling interindividual variation of interpretations should be devised and (2) the diagnostic characteristics of each HRCT finding suggestive of benignity as well as malignancy, should be established in a larger series.View full abstractDownload PDF (13212K) -
Comparison of the Incidence of Carcinomatous Pleuritis and Peritonitis in Various CarcinomasShoko Sakuraba, Miyoji Aiba1994 Volume 34 Issue 6 Pages 903-910
Published: October 20, 1994
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSTo study the role of the diaphragm as a barrier to hinder transdiaphragmatic spread of cancer cells, the incidence of carcinomatous pleuritis and peritonitis was retrospectively evaluated in 6, 145 cases with various carcinomas admitted to the Juntendo University Hospital from 1979 to 1988. The patients were divided into two groups according to the primary sites of the carcinomas, e.g. SD group (1, 199 cases) included the patients who had the primary site in supradiaphragmatic organs, and ID group (4, 969 cases), in infradiaphragmatic organs. The incidence of carcinomatous pleuritis alone, carcinomatous peritonitis alone, and both the pleuritis and peritonitis was 12.3%, 0.3% and 1.1% in the SD group, and 0.7%, 9.9% and 2.0% in the ID group, respectively. The incidence of carcinomatous pleuroperitonitis in the ID group was significantly higher than that in the SD group (p<0.01). Of those complicated with carcinomatous pleuritis and/or carcinomatous peritonitis, 190 cases were available for analysis of autopsy findings. Transdiaphragmatic lymphogenous metastasis were more frequent in patients with carcinomatous pleuroperitonitis than those with pleuritis alone or peritonitis alone (73.3%vs 38.7% in the SD group (p<0.05), and 78.3% vs 37.3%(p<0.01) in the ID group, respectively). These results indicate that the diaphragm usually protects against direct invasion of cancer cells between the pleural and peritoneal spaces. However, this barrier was sometimes disrupted by the spread through the transdiaphragmatic lymphogenous pathway. In addition, cancer spread from infradiaphragmatic organs to the pleural space occurs more frequently than that from supradiaphragmatic organs to the peritoneal space.View full abstractDownload PDF (913K) -
Reevaluation of Usefulness: Comparison with CT, Conventional MRI and MRI with the STIR TechniqueKiminori Fujimoto, Shigenobu Meno, Toshi Abe, Osamu Edamitsu, Hiroshi ...1994 Volume 34 Issue 6 Pages 911-922
Published: October 20, 1994
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSSixty-one patients with primary lung cancer who had previously undergone CT and MR imaging (MRI) within two weeks before surgery were studied retrospectively. The accuracy of diagnosis of mediastinal lymph node metastasis was 80% on CT, 79% on conventional MRI (C-MRI), and 87% on conventional MRI with the STIR technique (STIR-MRI) according to our criteria. Ninety-one new patients with primary lung cancer were studied prospectively according to the same methods. The accuracy of diagnosis of mediastinal lymph node metastasis was 81% on CT, 81% on C-MRI, and 87% on STIR-MRI. As the results of reevaluation using a prospective study corresponded to those of the retrospective study, it is suggested that STIR-MRI is useful to diagnose mediastinal lymph node metastasis from lung cancer.
Pathological findings of false positive cases were reactive lymphadenopathy and those of false negative cases were micrometastases from adenocarcinomas. It seems to be difficult to distinguish reactive lymph adenopathy from metastatic lymphadenopathy and to distinguish normal node from micrometastatic node, even though STIR-MRI is used.
However, the accuracy of STIR-MRI was higher than CT and C-MRI, and the possibility of enhancement of diagnostic accuracy of lymph node metastasis from lung cancer is suggested by combining MR imaging with the STIR technique with CT.View full abstractDownload PDF (12300K) -
Maki Kubota, Noriaki Tsubota, Masahiro Yoshimura, Akihiro Murotani, To ...1994 Volume 34 Issue 6 Pages 923-929
Published: October 20, 1994
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSA 53-year-old man had a rapidly growing tumor in the right pleural cavity with positive Ga scintigraphy findings and a serum alpha-fetoprotein level of 296ng/ml. CT scan, echography and scintigraphy showed no space-occupying lesions in the liver. Moreover there were giant bullae on the contralateral side. Right upper and middle lobectomy with S6 segmentectomy was performed in order to preserve lung function. This T2N2M0 case was poorly differentiated adenocarcinoma postoperatively and the serum AFP level returned to the normal range. His performance status is good and there has been no recurrence 22 months after surgery. The immunoenzyme labeling technique using the peroxidase-antiperoxidase method confirmed AFP secretion by this tumor. E-PHA affinity electrophoresis of AFP from serum showed a different pattern from primary hepatocellular carcinoma. This rare case was diagnosed primary lung cancer producing AFP.View full abstractDownload PDF (8876K) -
Tadafumi Shimizu, Kensuke Ashina, Miwako Doi, Ritsuo Matsui, Kozo Suey ...1994 Volume 34 Issue 6 Pages 931-936
Published: October 20, 1994
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSA rare case of metastatic lung cancer accompanied by needle tract seeding after CT guided fine needle aspiration biopsy was reported. The patient was a 66-year-old female with renal cell carcinoma and right iliac bone metastasis. After treatment with transcatheter arterial embolization, chemotherapy and radiotherapy, she had been followed up as an outpatient. Chest X-ray film showed a nodular shadow in the left middle lung field. Therefore, CT guided fine needle aspiration biopsy was performed with a 22G Westcott needle and revealed renal cell carcinoma histologically. After 5 months, a subcutaneous nodule appeared at the site of the needle biopsy. Enhanced chest CT demonstrated 4 ringlike nodules in a row in the left chest wall. Renal cell carcinoma was histologically revealed by the subcutaneous nodule biopsy.View full abstractDownload PDF (8079K) -
A Case Report with Special Reference to Pathological Differential DiagnosisYoshiyuki Abe, Eiichiro Ota, Yoshiro Ohsika, Ryuji Suto, Hiroshi Inoue ...1994 Volume 34 Issue 6 Pages 937-942
Published: October 20, 1994
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSA 17-year-old man was hospitalized with a complaint of right chest-back pain. The chest X-ray and thoracic CT scan revealed a mass in the right chest wall. Bonescintigraphy revealed abnormal accumulation in the right posterior chest wall. He underwent resection of the tumor and partial resection of the right lung on October 25, 1993. Postoperative chemotherapeutic and radiation therapy were also performed. The light yellow tumor (100×80×60mm) invaded the 9th rib, but not the lung. Tumor showed the proliferation of small round cells with a moderate amount of connective tissue. A few tumor cells showed diastase-digestion sensitive PAS-positive cytoplasm and immunohistochemical staining demonstrated many p53-positive features in the tumor cells. These features are consistent with Ewing's sarcoma of the right rib. The results suggested that p53 is a helpful marker to diagnose Ewing's sarcoma.View full abstractDownload PDF (11719K) -
Kazuo Shibata, Ryouhei Matsuda, Hiroko Oota, Tosiyuki Mori, Masaru Miz ...1994 Volume 34 Issue 6 Pages 943-947
Published: October 20, 1994
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSA mediastinal tumor shadow was pointed out on a mass screening chest x-ray in a 74-year-old male. His chest CT happened to show a lung tumor in the left lower lobe in addition to the mediastinal tumor. His peripheral lymphocyte subset revealed a markedly low ratio of OKT4 to OKT8 and a deficit of the T-cell population. Both the mediastinal tumor and the lung tumor were simultaneously resected through the median sternotomy with left anterior intercostal thoracotomy. Histological examination revealed a spindle cell type thymoma and a primary lung cancer (squamous cell carcinoma), respectively. There was no change in the ratio of OKT4/8, postoperatively. In this case, it was unclear whether the thymoma itself caused the immunodeficiency and development of the lung cancer as a result of the failure of immunosurveillance system.View full abstractDownload PDF (6334K) -
Yoshinori Kusajima, Teisuke Hirono, Masami Sugihara, Eiichi Shimazaki, ...1994 Volume 34 Issue 6 Pages 949-954
Published: October 20, 1994
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSPrimary malignant melanoma of the lung is a extremely rare neoplasm: to date, there have been only approximately 10 cases reported in Japanese literature. A resected case of primary malignant melanoma of the lung is reported. The patient was a 73-year-old man, whose chest roentgenogram revealed a coin lesion in the right lung field. Chest CT scan showed a mass in the right S6. The tumor mass was hyperintense on T1-weighted MRI and hypointense on T2-weighted MRI. The tumor was diagnosed as malignant melanoma by percutaneous lung biopsy. No other lesions could be found, and right lower lobectomy and partial resection of S2with mediastinal lymph node dissection were carried out. The resected specimen showed a blackish tumor measuring 4.6 × 4.0cm in S6, and which invaded to S2. Histopathological examinations of the tumor revealed primary malignant melanoma of the lung, as junctional changes of melanoma cells beneath the bronchial epithelium were found in the bronchial tree adjacent to the tumor mass. Primary malignant melanoma of the lung in the literature were reviewed.View full abstractDownload PDF (6637K) -
Mitsuharu Kokubo, Kenji Ishikawa, Kenitiro Tateyama, Akira Sugiyama, M ...1994 Volume 34 Issue 6 Pages 955-958
Published: October 20, 1994
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSA 52-year-old man was admitted to our hospital because of leucocytosis (15000/mm3) detected by a medical check-up. Chest X-ray revealed a tumor shadow in the right upper lung field. Brushing cytology revealed class V. Laboratory data showed increased CRP (6.4mg/dl). Serum G-CSF was 60.4pg/ml (normal < 30). Right upper lobectomy (pT2N0M0) was performed in June, 1993. Histological study revealed giant cell type large cell carcinoma. Immunohistochemical study showed that tumor cells stained positively with anti-recombinant human G-CSF monoclonal antibody. This finding indicated production of G-CSF by the tumor cells. Postoperative laboratory data showed a normal serum G-CSF level and a normal CRP level.View full abstractDownload PDF (6074K) -
Tsugio Furukawa, Kotaro Koyanagi, Yosinobu Soejima, Makoto Sugihara, T ...1994 Volume 34 Issue 6 Pages 959-964
Published: October 20, 1994
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSA 50-year-old male was admitted to our hospital with a complaint of hemosputum. Bronchoscopy revealed 4 independent lesions in right B1, right B3, the orifice of the right lower lobe bronchus, and in left B1+2. All four lesions showed squamous cell carcinoma by bronchoscopic biopsy. It seemed impossible that all four lesions could be resected surgically. We selected a combination of laser therapy, radiation therapy and additional chemotherapy.
The disappearance of all 4 lesions was demonstrated by bronchoscopic biopsies at the time of discharge. Following-up every three months by bronchoscopy, we continued Laser therapy only for the lesion at the orifice of the right lower lobe bronchus.
The patient is alive for two years since the beginning of treatment without any sign of recurrence.View full abstractDownload PDF (5867K) -
Takefumi Komiya, Toshiharu Matsushima, Makoto Kimura, Ikuho Koyama1994 Volume 34 Issue 6 Pages 965-969
Published: October 20, 1994
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSA 52-year-old female was admitted to our hospital because of hemoptysis. A chest X-ray showed a cavity in the left middle lung field in which a fungus ball-like material was recognized by tomography and CT. The nodule decreased in size over several days, and the fungus ball-like material also disappeared. We diagnosed the lesion as epidermoid carcinoma based on the microscopic findings of biopsied material. Regarding the macroscopic and microscopic findings of surgical specimen, there was only a small amount of blood clot without any fungus in the cavity. From the patient's history of hemoptysis and the blood clot found in the fungus ball-like shadow removed during the operation, we considered it to have been related to the blood clot and bleeding in the carcinomatous cavity.View full abstractDownload PDF (6340K) -
1994 Volume 34 Issue 6 Pages 971-989
Published: October 20, 1994
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSDownload PDF (2831K)
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