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Volume 38, Issue 6
Displaying 1-16 of 16 articles from this issue
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Toshiaki Fujikane, Kyouko Nakanishi, Akinori Takeda, Yasuhiro Yamazaki ...1998 Volume 38 Issue 6 Pages 653-660
Published: October 20, 1998
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSIn order to clarify some problems involved in lung cancer screening, we analyzed characteristics of 177 lung cancer patients detected by screening (screening group), comparing to those of 537 patients detected by other methods (other group). The screening group were younger and showed a significantly larger rate of females and fewer symptoms than the other group. In the screening group, 118 patients who underwent operation (operation group) were younger and showed significantly fewer symptoms than the 59 patients who did not undergo operations (non operation group). There were no significant differences in gender, smoking habits, other chest illness, results of screening examination on the previous year, chest X-ray film changes or the duration from the screening examination to visiting our hospital in either group. A multiple regression model revealed that age and symptoms contributed to determinants for operability and Cox's proportional hazards model revealed that symptoms, age and chest X-ray film changes contributed to survival. These results showed that symptoms had an important influence upon operability and survival.
The 39.5% rate of the screening group showed some subjective symptoms already, which were very poor. We must advise subjects who have some lasting symptoms not to wait for next screening examination but to visit a screening hospital soon.View full abstractDownload PDF (849K) -
Hideaki Yamasawa, Yoshiki Ishii, Masashi Bando, Satoshi Kitamura1998 Volume 38 Issue 6 Pages 661-668
Published: October 20, 1998
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSBetween 1985 and 1996, we encountered 90 cases of primary lung cancer with brain metastasis diagnosed by computed tomography and/or magneticresonance imaging. When the brain metastases were detected, 54 patients had neurological symptoms and 36 patients did not. We compared the clinical features and prognosis between the group with neurological symptoms and the group without symptoms. No significant intergroup differences were found in age, sex, histologic type, clinical T factor, clinical N factor, and the incidence of other organ metastasis. The incidence of neurological symptoms was slightly higher in cases in which brain metastasis was detected during treatment. The incidence of neurological symptoms was significantly higher in cases with infratentorial metastasis than in cases without. The mean size of the metastatic lesion in the group with neurological symptoms was significantly larger than in the group without symptoms. Neurological symptoms were relieved in 83.3% of cases treated by radiotherapy in combination with chemotherapy or by radiotherapy alone. Brain metastasis-related death was found in 4 cases of the group with neurological symptoms, however, none of the patients in the group without symptoms had a brain metastasisrelated death. There was no significant intergroup difference in the survival time from the detection of metastases. Radiotherapy was effective for brain metastasis with or without neurological symptoms. Further examination is needed for critical evaluation of the effectiveness of radiotherapy in combination with chemotherapy on brain metasasis.View full abstractDownload PDF (888K) -
Miwako Doi1998 Volume 38 Issue 6 Pages 669-680
Published: October 20, 1998
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSWe assessed the usefulness of single exposure dual energy subtraction radiography in detecting lung nodules.
In a phantom study, we compared the detectability of energy subtraction images (ES), standard FCR (Fuji Computed Radiography) images (FCR), or the combination of FCR and ES images (FCR+FES) with conventional film-screen images (Cony), using simulated nodules and the chest phantom. Simulated nodules were placed on each of the following 5 sites: 1) lung field overlaid with no major pulmonary vessels or ribs, 2) lung field with overlying pulmonary vessels, 3) 1 overlying rib, 4) 2 overlying ribs, and 5) lung field with overlying mediastinum and diaphragm. A total of 300 sample films were obtained with many patterns of placement of simulated nodules. Evaluation was made using a 5-grade method by 8 radiologists.
In the clinical study, 68 patients with or without lung nodules were examined. We classified the nodules by location and size. Using similar methods to those of the phantom study, we compared ES, FCR, or FCR +ES with Cony. These results were analyzed by the ROC method and statistically assessed. In the phantom study, FCR +ES were significantly superior to Cony at the site with 2 overlying ribs. ES, FCR, and FCR +ES were significantly superior to Cony at the site with overlying mediastinum and diaphragm.
In the clinical study, ES and FCR +ES were significantly superior to Cony in all cases. In terms of nodular sites, ES and FCR +ES were significantly superior to Cony at the sites overlaid with 1 rib and 2 ribs. In terms of nodular sizes, ES and FCR+ ES were significantly superior to Cony in both size groups.
These findings indicate the usefulness of ES and FCR +ES in the detection of lung nodules.View full abstractDownload PDF (6671K) -
Hiroiku Hara, Shigeki Sugiyama, Takuro Misaki1998 Volume 38 Issue 6 Pages 681-690
Published: October 20, 1998
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSIn this study we immunohistochemically stained 23 formalin-fixed thymic tumors (21 thymomas, one carcinoma and one carcinoid) resected in our institutes over the past 14 years, with various antibodies to proteins (p53 protein, PCNA, EMA, CEA, NSE, cytokeratin, TGF-beta 1) which were related to growth of tumors. Positive staining was seen in 35% for p53 protein, 48% for EMA, 17% for CEA, 17% for NSE, 96% for cytokeratin, 0% for TGF-beta 1, respectively. The number of cells staining for PCNA was 478±197 per 1, 000 cells. The positivity for p53 protein, PCNA and EMA was higher in more advanced cases. In particular, the EMA positive group had a significantly worse outcome than the negative group. Though positivity of NSE was low, all NSE positive cases were advanced.View full abstractDownload PDF (6017K) -
Ikkoh Ichinoseki, Takao Tsushima, Satoshi Taniguchi, Seiji Takahashi, ...1998 Volume 38 Issue 6 Pages 691-701
Published: October 20, 1998
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSWe studied the expression of matrix metalloproteinases (MMPs), tissue inhibitors of metalloproteinases (TIMPs), and thymidine phosphorylase (TP) in 242 resected lung cancers by immunohistochemical staining and investigated their value as prognostic factors. Among the patients studied, those with negative staining for MMP-2, MMP-9, TIMP-2, or TP had a significantly higher postoperative disease-free survival rate than those with positive staining. Even when the analysis was limited to subjects in pathological stage I, patients showing negative staining for MMP-2, MMP-9, or TP had longer disease-free survival than patients showing positive staining. In stage I adenocarcinoma, patients with negative staining for MMP-2 or MMP-9 had longer disease-free survival than those with positive staining, but there was no significant difference in patients with squamous cell carcinoma. Multivariate analysis showed that MMP-9, N factor, and T factor were independent prognostic factors for the disease-free survival of patients with lung cancer.
We conclude that the expression of these parameters may be a useful index for evaluation of the clinical prognosis of lung cancer and determination of therapeutic measures.View full abstractDownload PDF (3582K) -
Masao Harada, Takahisa Saitoh, Hiroshi Isobe1998 Volume 38 Issue 6 Pages 703-707
Published: October 20, 1998
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSA 70-year-old man was admitted to our hospital with a mass shadow on chest roentgenogram. The tumor in the periphery of the left lower lobe that abutted the pleural surface was diagnosed as small cell carcinoma by transthoracic needle aspiration performed at the ninth intercostal space. On day 5 of the first course of chemotherapy with carboplatin and etoposide he developed herpes zoster in the area of the ninth thoracic dermatome, followed on day 7 by a disseminated eruption widely over the skin and oral mucosa with high fever. After treating with acyclovir and γ-globulin, he had no other complications of herpes zoster. Patients with solid tumor rarely develop widely disseminated zoster shortly after the initiation of chemotherapy. The clinical course in this case suggests that transthoracic needle aspiration rather than the tumor affects the intercostal nerve, which may have resulted in activation of latent virus in the ganglion, and that chemotherapy may have precipitated the following widespread dissemination.View full abstractDownload PDF (2853K) -
Koji Kojima, Hiroaki Osada, Kumio Yokote, Atsushi Shimada, Noboru Yama ...1998 Volume 38 Issue 6 Pages 709-713
Published: October 20, 1998
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSA 70-year-old woman was found to have multiple coin lesions on chest CT scans prior to a planned sigmoidectomy for a cancer. Seven coin lesions scattered over both lung fields were thought to be metastases of the colon cancer. Following the sigmoidectomy the patient was transferred to us for thoracotomy. On the bilateral thoracotomy the lesions, each around lcm in diameter, were recognized to all be located subpleurally and have anthracosis. Pathological examination revealed that each lesion was a subpleural lymph node encountered only rarely in the vicinity of visceral pleura. In the present case it had been impossible preoperatively to distinguish the lesions from lung metastases. In the differential diagnosis of peripheral pulmonary nodules it should be kept in mind that they may be subpleural intrapulmonary lymph nodes case even if they are multiple. Thoracoscopic treatment of these lesions may be the first choice in light of the visible superficial anthracosis uniformly found in them.View full abstractDownload PDF (6091K) -
Mitsuo Kawamura, Ichirou Suzuki, Kimito Orino, Yoshirou Sazawa1998 Volume 38 Issue 6 Pages 715-720
Published: October 20, 1998
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSWe report two cases of malignant mediastinal schwannoma with von Recklinghausen's disease. A 16-year-old girl (case 1) was admitted with right chest pain due to right pleural effusion. Her chest X-ray after aspiration of the effusion showed a giant cystic tumor in the posterior mediastinum. Tumor extirpation failed because of marked bleeding and only biopsy was performed. The histological diagnosis was malignant schwannoma. She died 3 months after the biopsy.
A 39-year-old woman (case 2) was admitted with dyspnea. Her chest X-ray showed a large tumor shadow in the right upper lung field. Tumor extirpation was performed using the partial cardiopulmonary bypass. In spite of reoperation for postoperative bleeding, she recovered and was discharged. Histological examination disclosed malignant schwannoma with rhabdomyosarcoma (malignant triton tumor). The tumor recurred at the left adrenal gland, but was totally removed through laparotomy. She is alive 29 months after the initial operation. In patients with von Recklinghausen's disease, careful attention to the malignant mediastinal neurogenic tumor is necessary.View full abstractDownload PDF (8533K) -
Zhigang Yang, Shusuke Sone, Shodayu Takashima, Feng Li, Takayuki Honda ...1998 Volume 38 Issue 6 Pages 721-725
Published: October 20, 1998
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSWe present a case of a small lung cancer that had developed in the lung periphery engulfing a bulla and showing a mass with a cavitary area at the center on the high resolution CT (HRCT) image. It was difficult to make a differential diagnosis between lung cancer and tuberculoma. Longitudinal reconstruction of HRCT images helped us to understand the distribution of an air-space in the mass, which was continuous to the adjacent lung. A contrastenhanced magnetic resonance (MR) study gave additional information on the vascularity of the mass and helped to rule out tuberculoma.View full abstractDownload PDF (8371K) -
Yoshirou Sazawa, Mitsuo Kawamura, Ichirou Suzuki, Kimito Orino1998 Volume 38 Issue 6 Pages 727-731
Published: October 20, 1998
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSA 36-year-old female was admitted with an abnormal shadow on chest X-ray. Her chest CT scan showed an anterior mediastinal mass invading the superior vena cava and the right lung. Roentogenologically, invasive thymoma was suspected. As transcutaneus needle aspiration cytology failed to provide a diagnosis, open biopsy was performed. The resected specimens revealed Hodgkin's disease (nodular sclerotic type). She underwent 10 cycles of chemotherapy and complete remission was obtained.
In Japan, reports of Hodgkin's disease in the anterior mediastinum are rare. Differentiating between malignant lymphoma and invasive thymoma is important because of their different therapeutic modalities: irradiation is effective in invasive thymoma, whose chemotherapy is effective in malignant lymphoma.View full abstractDownload PDF (7996K) -
Munehiro Nishida, Shinji Maebeya, Toshiya Bessho, Tatsuya Yoshimasu, S ...1998 Volume 38 Issue 6 Pages 733-737
Published: October 20, 1998
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSA 66-year-old man complained of bloody sputum. A chest computed tomography scan revealed a cavity containing a mass lesion suggestive of a fungus ball within the cavity. A serum test for antigen against Aspergillus was positive. Examination of his sputum showed hyphae of aspergilli. Pulmonary aspergillosis was diagnosed and he underwent right upper lobectomy. The histological examination of the resected specimen showed colonies of aspergilli in the cavity and well differentiated adenocarcinoma in the cavitary wall. Reported cases of lung cancer with intracavitary aspergillus infection are rare and only 11 cases have been reported in Japan.View full abstractDownload PDF (4919K) -
Masaharu Inagaki, Hiroo Okazaki, Naoya Funakoshi, Kazuhiko Takabe, Yok ...1998 Volume 38 Issue 6 Pages 739-744
Published: October 20, 1998
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSA 66-year-old man presented with a cough that had continued for 8 months. He was given medication for bronchitis, because there was no abnormality on chest X-ray film and his sputum cytology was normal. However, since the symptom did not improve, chest CT scan was performed, revealing a tumor shadow in the central portion of the left B6, obstructing the left upper lobe, lower lobe and main bronchi. Fiberoptic bronchoscopic findings showed a polypoid tumor which almost completely obstructed the left main bronchus. Biopsy suspected sarcoma. Because of atelectasis of the entire left lung, YAG laser therapy was employed, but it failed to open the left main bronchus. Therefore left pneumonectomy and mediastinal node dissection were performed. The pathological diagnosis was sarcoma of the lung, consisting of spindle cells without a carcinoma component. The patient is alive without recurrence one year and two months after the operation.View full abstractDownload PDF (9116K) -
Kazuhiro Sakamoto, Satoshi Hirokawa, Katsuya Watanabe, Yasunobu Yamaza ...1998 Volume 38 Issue 6 Pages 745-749
Published: October 20, 1998
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSA 42-year-old man was admitted to our hospital with a diagnosis of left pneumothorax. Chest CT scan accidentally showed a nodular shadow 5 mm in diameter in the left upper lobe (S4a). This was his first episode of pneumothorax and chest drainage resulted in improvement. The pulmonary nodule was suspected to be lung cancer based on thinsection CT findings. Bronchoscopic examination failed to obtain a definitive diagnosis.
Thoracoscopic resection of the nodule was performed, and the pathological diagnosis of the nodule was adenocarcinoma. Left upper lobectomy with mediastinal lymph node dissection (R2a) and bullectomy were performed serially. The final histopathological diagnosis was bronchiolo alveolar cell carcinoma (p-T1N0M0 p0pm0). Because the tumor was located apart from the visceral pleura, this pneumothorax was due to the bulla.
As in the case of elderly patients, we should keep in mind associated lung diseases.View full abstractDownload PDF (6316K) -
Yoshiki Umemori, Shigeki Makihara, Tetsuzi Fukuhara, Kazutaka Nakashim ...1998 Volume 38 Issue 6 Pages 751-756
Published: October 20, 1998
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSA 72-year-old man had undergone right lower lobectomy for a typical bronchioloalveolar carcinoma in January 1992, and the pathological stage was pT2N0M0. As he had two localized metastases in the right upper and middle lobes 5 years and 6 months later, right completion pneumonectomy with partial resection of the chest wall and diaphragm was performed. Serum CA19-9 was extraordinarily elevated, and gradually increased in parallel with deterioration of his condition. The pathological diagnosis was a moderately differentiated papillary adenocarcinoma, with bronchiolo-alveolar type foci. Immunohistochemical examination of the lung specimens from first and second operations showed positive staining for CA19-9 on tumor cells. Our final diagnosis was CA19-9 producing adenocarcinoma of the lung.View full abstractDownload PDF (6422K) -
1998 Volume 38 Issue 6 Pages 757-772
Published: October 20, 1998
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSDownload PDF (2268K) -
1998 Volume 38 Issue 6 Pages 773-781
Published: October 20, 1998
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSDownload PDF (1281K)
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