Haigan
Online ISSN : 1348-9992
Print ISSN : 0386-9628
ISSN-L : 0386-9628
Volume 38, Issue 1
Displaying 1-14 of 14 articles from this issue
  • [in Japanese], [in Japanese], [in Japanese]
    1998 Volume 38 Issue 1 Pages 1
    Published: February 20, 1998
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
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  • Kenichi Togashi, Tatuo Ebe, Kazuhiro Sato, Hiroyuki Saito
    1998 Volume 38 Issue 1 Pages 3-9
    Published: February 20, 1998
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
    To improve surgical results, we investigated the safety record of our surgical treatment for primary lung cancer. A total of 1032 patients consecutively treated at our hospital from 1979 to 1996 were reviewed. There were ten operative deaths (1.0%) and nine hospital deaths (0.9%). Post-operative mortality increased with age and extent of procedures. Cases that died within 1 month included 1 with cardiac rupture, 1 with gastrointestinal bleeding, 2 with cerebrovascular accidents, 1 with pneumonia, 1 with broncho-pleural fistula (BPF), 2 with adult respiratory distress syndrome (ARDS) and 2 died suddenly of unkown causes. Cases of hospital deaths included 1 with acute renal failure and 8 with respiratory complications, which were BPF in 3, ARDS in 2 and others in 3. We conclude it was very difficult to predict or prevent the causes of these deaths. Correct preoperative assessment, careful postoperative management and prompt decision-making are very important.
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  • Takashi Eto, Harumi Suzuki, Atsuro Honda, Yasuyuki Nagashima
    1998 Volume 38 Issue 1 Pages 11-17
    Published: February 20, 1998
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
    Twenty-two surgically resected peripheral lung adenocarcinomas of the non-mucus producing type which measured less than 3 cm in diameter and showed definite vascular invasion were studied histologically. Vascular invasion was defined as definite tumor cell embolization in the vascular lumen on H&E and Elastica van Gieson staining. Tumor stroma was divided into two areas of central fibrosis and replacement growth around the central fibrosis. The central fibrotic area was divided into three types according to the patterns of elastotic framework formation as follows; 1) areas with preserved air spaces with thick elastotic walls, 2) areas without preserved air spaces because of collagenized elastosis or 3) areas of collapsed elastosis. Vascular invasion was detected at 35 sites of replacement growth in 15 cases, 15 sites of Type 1-like elastotic framework in 11 cases, 13 sites of collagenized elastotic framework in 11 cases, and 2 sites of collapsed elastotic framework in one case. It was generally found at the boundary between central fibrosis and the replacement growth. Vascular lesions seen within central fibrosis tended to show occlusive or destructive changes rather than vascular invasion. Vascular invasion in peripheral lung adenocarcinomas may occur in association with angiogenesis caused by tumor invasion, while tumor-specific stroma of central fibrosis is formed, and then is seen more peripheral to central fibrotic area or in replacement growth with progress in collagenization of central fibrosis.
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  • Kazuo Awai, Koichi Fujikawa, Susumu Nakamura, Kosuke Yamane, Takashi N ...
    1998 Volume 38 Issue 1 Pages 19-28
    Published: February 20, 1998
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
    To determine serial changes of the disease over time, we reviewed CT scans of five patients with histologically proven peripheral adenocarcinoma of the lung. All cases had been observed for more than one year. The tumor doubling time was 14.8-36.8 months for well-to-moderately differentiated adenocarcinoma and 10.0 months for poorly differentiated adenocarcinoma. In three patients with well-to-moderately differentiated adenocarcinoma, increase of vessel convergence and pleural indentation toward the tumor were observed although the tumor remained unchanged in size. An air bronchogram was observed in the tumor in all patients, and it became indistinct in three patients in the course of time.
    On follow-up CT examination of small pulmonary nodules, the diagnosis of adenocarcinoma should be suspected when vessel convergence and pleural indentation toward the tumor increases or air bronchogram in the tumor become indistinct in the course of time.
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  • Mitsuhiro Kamiyoshihara, Toshikazu Hirai, Osamu Kawashima, Yasuo Moris ...
    1998 Volume 38 Issue 1 Pages 29-35
    Published: February 20, 1998
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
    A 70-year-old man was admitted to our hospital because of chest pain on November 1996. The patient underwent bilateral bullectomies on September 1995. Physical examination revealed no abnormal signs. Chest roentgenogram and computed tomogram of the chest showed a mass shadow in segment 10 of the left lung. Transbronchial lung biopsy yielded a diagnosis of adenocarcinoma of the lung. A left lower lobectomy was carried out. In pathologic findings, the tumor was contiguous to emphysematous bulla. Squamous metaplasia and well differentiated adenocarcinoma coexisted on the bullous wall. The tumor cells were mainly composed of poorly differentiated adenocarcinoma. We present herein this case because primary pulmonary carcinoma contiguous to the wall of an emphysematous bulla is relatively rare. The Japanese literature was reviewed.
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  • Atsushi Morio, Kouzou Sakaguti, Toshirou Futagawa, Enjo Hata, Hideaki ...
    1998 Volume 38 Issue 1 Pages 37-42
    Published: February 20, 1998
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
    A 38-year-old woman with bilateral pulmonary bullae had been followed in another hospital since 1986. She had right chest pain and hemoptysis, and chest x-ray revealed a mass in the right upper lobe in December 1995. Percutaneous lung biopsy failed to obtain sufficient tissue for diagnosis, which suggested the possibility of poorly differentiated adenocarcinoma of the lung. On the other hand, roentgenographic findings suggested the possibility of a tumor arising from the chest wall. Thoracoscopy revealed the infiltration of lung cancer into the chest wall. Resection of the right upper and middle lobes and the invaded chest wall as well as R2b dissection was performed. The lesion, which originated from the wall of a pulmonary bulla, spread by filling inside the bulla and infiltrated into the chest wall. The pathological diagnosis was a poorly differentiated adenocarcinoma of lung (pT3N0M0-stage IIIA). In addition to this case, 12 patients with resected lung cancers arising from pulmonary bullae in our hospital were reviewed.
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  • Kazuyuki Yamaguchi, Shinsuke Naitoh, Shigeo Nomura
    1998 Volume 38 Issue 1 Pages 43-48
    Published: February 20, 1998
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
    A case of malignant pleural mesothelioma with cystic formation in the mediastinum is reported. In April 1995, a 77-year-old woman was admitted because of persistent nonproductive cough. Chest radiographs and CT revealed pleural effusions, a rimenhanced cystic tumor in the mediastinum, an oval tumor of the right posterior chest wall, and severe compression of the trachea by the tumor. The tumor cells were biphasic. Cytoplasm of tumor cells stained by Alcian blue but the staining disappeared following hyaluronidase digestion. Immunohistochemical examinations showed positive staining for keratin but not for CEA. Based on these findings, malignant pleural mesothelioma of the biphasic type was diagnosed. The chest radiographs and CT of the case showed unique images. In patients with cystic lesions of the mediastinum, malignant mesothelioma should be considered in the differential diagnosis.
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  • Makoto Suzuki, Hideki Kimura, Naomichi Iwai, Yosiyuki Takahasi, Takehi ...
    1998 Volume 38 Issue 1 Pages 49-55
    Published: February 20, 1998
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
    N3 disease in lung cancer is usually unresectable, and prognosis is extremely poor. Five clinical N3 cases with good performance status were treated by extended lymphadenectomy and pre-or-post surgical adjuvant therapy in our hospital from January, 1994 to March, 1996. Induction chemotherapy was performed for three cases, and extended bilateral mediastinal dissection up to the neck was applied in all cases. Post -surgical local chemo -and/or -immunotherapy was added in foiir cases. Two patients are still alive and tumor-free 22 months after the initiation of treatment. Three patients died because of distant metastases 34, 19, and 18 months after the therapy. In conclusion, bilateral extended lymphadenectomy combined with pre-and/or post surgical adjuvant therapy may be beneficial for patients with N3 disease and contribute to improved better prognosis.
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  • Mutsumi Kondo, Kouzo Yamada, Fumihiro Oshita, Kazumasa Noda, Michihiko ...
    1998 Volume 38 Issue 1 Pages 57-62
    Published: February 20, 1998
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
    A 49-year-old women was referred to our hospital because of an abnormal shadow in the upper right lung field and swelling of the mediastinal lymph nodes on chest X-rays. Lung cancer was diagnosed because adenocarcinoma cells were detected by brushing cytology with a bronchofiberscope. A diagnosis of stage IIIA (T1N2M0) lung cancer was made based on these findings and on CT images of the swollen mediastinal lymph nodes. An upper right lobectomy was undertaken. Pathologically metastasis was not revealed in the swollen lymph nodes, and epitheloid granuloma without necrosis replaced the follicular structure of the lymph node. A pathological diagnosis of stage I (p-T1N0M0) of well-differentiated adenocarcinoma and sarcoid-like reaction in the mediastinal lymph nodes was made, although she had no clinical sign of sarcoidosis. In summary, our case shows that the N factor is important in judging the operability of the lung cancer staging, although swelling of the mediastinal or hilar lymph nodes do not always indicate metastasis. Size criteria is not sufficient for the correct diagnosis of lymph node metastasis.
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  • Hiroshi Okitsu, You Tsuda, Masasi Kawata, Hiroshi Tabuchi, Nobuo Saoya ...
    1998 Volume 38 Issue 1 Pages 63-68
    Published: February 20, 1998
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
    A 62-year-old woman had undergone right middle and lower bilobectomy with resection of the left atrium for an atypical pulmonary carcinoid in March 1991, and the postsurgical pathological stage was pT4N1M1 (pm2). As she had a left breast metastasis 4 years and 3 months later, a quadrantectomy was performed in August 1995. In Nov. 1995, she developed the symptoms of carcinoid syndrome. Serum serotonin, serum 5-HIAA and urine 5-HIAA were much higher than normal. Injections of octreotide relieved symptoms. Other metastases were found at the bronchial stump in April 1996, the abdomen in Oct. 1996 and the right breast in March 1997, and were treated when detected. Head skin and abdominal wall metastases were observed, after 6 years and 9 months from the resection of the primary lesion.
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  • Takahiro Morisako, Hideo Kobayashi, Naokazu Nagata, Teruhiro Aoki, Shi ...
    1998 Volume 38 Issue 1 Pages 69-73
    Published: February 20, 1998
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
    A 75-year-old man was admitted to our hospital because of multiple infiltrative shadows on a chest roentgenogram. Infiltrative shadows had progressed subacutely in comparison to the findings of 3 months previously. Chest CT scans demonstrated air space consolidation containing bubble-like areas. Sputum and bronchial washing cytology were negative. Bronchoalveolar lavage revealed an elevation of lymphocyte fraction. Open lung biopsy (OLB) was performed to make a distinction between idiopathic BOOP and other diseases. The specimen obtained by OLB histlogically revealed BOOP pattern in the bronchioles and alveolar ducts, showing granulation tissue with proliferation of fibroblasts, and bronchioloalveolar carcinoma with mucinproducing cells (BAC), in which small cystic spaces were observed with mucus in alveoli. We concluded that TBLB was important in the case of air space consolidation with bubble-like areas of low attenuation on the chest CT because mucin in the alveoli with or without malignant cells highly suggested BAC.
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  • Yuzo Yoshimi, Kazuhiro Okafuji, Hiroaki Kobayashi
    1998 Volume 38 Issue 1 Pages 75-79
    Published: February 20, 1998
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
    A 83-year-old man was admitted with lumbago and back pain. An abnormal shadow was pointed on chest X-ray film. CT-guided lung biopsy was performed, and the pathological diagnosis was malignant melanoma. Various investigations failed to reveal any other lesion. He died of respiratory failure three months after the first admission. On autopsy, systemic metastases were found but there was no other suspected primary lesion except that in the left lung. Pathologically “junctional change” was found in the lower lobe of the left lung. Based on these findings, we diagnosed primary malignant melanoma of the lung. Primary malignant melanomas of the lung are very rare and only about 30 cases have been reported. The prognosis is very poor. Patients died within one year in most cases.
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  • Minoru Fukuda, Mikio Oka, Kenji Terashi, Keiji Inoue, Hiroshi Soda, Sh ...
    1998 Volume 38 Issue 1 Pages 81-86
    Published: February 20, 1998
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
    A 29-year-old man was admitted complainting of hoarseness. Mediastinal widening was seen on his chest radiograph. Carcinoid was histologically diagnosed by biopsy of the left supraclaviculal lymph node, and the tumor involved the aorta and its branches. Drug sensitivity of the tumor cells against several anticancer drugs was examined, but they were resistant to all drugs. Three cycles of chemoradiotherapy (total 55 Gy) were performed, and the reduction rate of total tumor volume was only 29%. Chemoradiotherapy for advanced mediastinal carcinoid tumor needs further investigation.
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  • 1998 Volume 38 Issue 1 Pages 87-96
    Published: February 20, 1998
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
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