Many reports dealt with the prognostic significance of central collapse/fibrosis in adenocarcinoma of the lung, since Shimosato et al. denied the concept of “scar carcinoma” in 1980. Most of reports focused on the characteristics of the central collapse/ fibrosis, and there has been no report on the prognostic significance of the ratio of the size of central collapse/fibrosis to that of the tumor. We retrospectively studied 100 adenocarcinomas of the lung 3.0cm or less in maximum tumor dimension to assess the prognostic significance of the ratio of the size of central collapse/fibrosis to that of the tumor. The ratio was determined by the division of maximum tumor dimension with the maximum dimension of central fibrosis on conventional hematoxylin and eosin stain. The overall 5-year survival rate was 75%. In 26 adenocarcinomas in which the maximum dimension of the central fibrosis was less than 30% that of the maximum tumor dimension, the 5-year survival was 91%. The 5-year survival of the 35 cases in which the central fibrosis was more than 60% that of the maximum tumor dimension was 61%. Adenocarcinoma with central fibrosis 30% or less in relation to the maximum tumor dimension tended to be associated with type A or type B adenocarcinomas as defined by Noguchi et al. In multivariate analysis, the ratio of central fibrosis was an independent prognostic factor, as significant as vascular invasion and locoregional lymph node involvement (p=0.041, 0.008, and 0.031, respectively). In type C adenocarcinoma as defined by Noguchi et al., cases in which the maximum dimension of central fibrosis was less than 50% of that of the tumor had a 5-year survival rate of 85%, while other type C adenocarcinomas had a 5-year survival of only 52%(p<0.05). The ratio of the size of the maximum dimension of central fibrosis to that of the tumor was an independent prognostic factor for peripheral lung adenocarcinoma, and was as significant as other well-established prognostic factors such as vascular invasion and lymph node metastasis.

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Home oxygen therapy (HOT) was given to 47 patients with terminal stage lung cancer, out of a total of 139 patients (33.8%) receiving HOT in our center from April 1987 to December 1997. This percentage was significantly higher than the nationwide figure of (12%) of 1995 lung cancer patients receiving HOT. The mean duration of the final hospital admission of the HOT patients was 25.7 days, approximately half that of patients not receiving HOT. This decrease in the hospitalization period is probably due to the early introduction of HOT. We believe that the terminal lung cancer patient's symptoms should be the focus of attention than low arterial partial oxygen pressure (PaO₂) in making the decision to start HOT.

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To evaluate the efficacy of a clinic-based lung cancer screening program in the Takatsuki and Shimamoto (T/S) area, we retrospectively analyzed the outcome of 396 lung cancer patients treated in our department. The lung cancer patients were divided into four groups according to their residential area, i.e., T/S area or other areas (Oth) and the time of their consultation, i.e., before 1990 (early) or after 1991 (late): early T/S, late T/S, early Oth, and late Oth. Median survival times (MST) and 5-year-survival rates (5-YSR) were compared between these groups excluding patients detected by screening programs. MST (weeks) were 47.4, 74.9, 45.7 and 40.9 and 5-YSR (%) were 11.6, 23.5, 16.5 and 9.1 in the four groups, respectively. The outcome in the late T/S group was significantly better than that in any of the other groups (p=0.0184, 0.0267, 0.0363). The MST of MA+MB stage and N stage in the late T/S group (78.4 weeks and 39.7weeks, ) were the best among these 4 groups, but not significantly different.
The results show that after 1991, in the T/S area, lung cancer was detected earlier in patients than in patients in the other areas. We believe it was the unique screening program in the T/S area that made it possible to detect lung cancer at an earlier stage through improving the general management quality of the general practitioners participating in the program.
To evaluate the efficacy of a clinic-based lung cancer screening program, not only the direct benefit to individuals should be considered, but also the benefit returned to an area should be taken into consideration.

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Carboplatin (CBDCA) is an agent used frequently in the treatment of various malignancies. Its major hematologic toxicity, thrombocytopenia, is largely dependent on the area under the concentration-time curve (AUC), so it is important to estimate prospectively the individual clearance of plasma carboplatin (CL). CBDCA by intravenous drip infusion over 1 h at a dose of 500mg/m² was given to 24 untreated patients with non-small cell lung cancer at the Hiroshima Red Cross Hospital between April 1992 and July 1996, and pharmacokinetics examination for plasma carboplatin was made. We retrospectively evaluated Chatelut's formula, Calvert's formula and Jelliffe's formula to determine whether they could be applicable to Japanese patients with lung cancer. Although the measured AUC significantly correlated with the degree of thrombocytopenia, AUC estimated by the formulas (AUCest) showed no significant correlation. Furthermore, the CL calculated back was overestimated. Therefore, we concluded that it may be necessary to establish a predictive equation of CBDCA CL for Japanese patients. Because there are significant correlations between age, Ccr24h, and CBDCA CL, we tried to derive a predictive equation from the data of 23 patients by multiple regression analysis. Estimated CL (ml/min) =0.52×Ccr24h-2.62×age+223.3. The CL calculated from this equation closely correlated with the measured CL (r=0.71, p<0.01), however, there are some bias between them (MPE%=7.61, RMSE%=23.3). This study may be significant as the first trial of prediction of CBDCA CL for Japanese patients, and a larger-scale study would be needed to derive the precise formula of the optimal CBDCA dosage for Japanese patients with lung cancer.

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To increase the efficiency of lung cancer detection, we studied the reasons for thoracoscopic or open-lung biopsy in 122 patients with pulmonary nodules less than 30 mm in diameter. The roentgenological findings suggestive of malignancy were notsignificantly different in terms of the reason for biopsy between primary lung cancer (n=44) and inflammatory nodules (tuberculosis or non-specific inflammation) (n=40). The retrospective chest films taken as average of 14 months previously, demonstrated that the primary lung cancers showed enlargement of the nodules more frequently and appearance of new nodules less frequently than inflammatory nodules (P<0.05). Roentgenological findings suggestive of malignancy were seen in all primary lung cancer cases with N1 or N2 disease?csignificantly more frequent than in the patients with NO disease (P<0.05). We concluded the followings:(1) small lung nodules, which had a poor roentgenological findings of malignancy and showed appearance of new nodules in a review of X-ray films in the previous one or two years should be followed up by CT, rather than an immediate VATS biopsy because of the high possibility of inflammatory nodules; and (2) even if these are lung cancers, tumor stages are mostly T1NOMO, and it is uncommon for the tumor stage to advance after slight nodule enlargement during follow-up by CT.

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A prospective clinical study was performed to clarify the role of OK-432 in adjuvant therapy for resected cases of lung carcinoma. A total of 219 patients with resected nonsmall cell lung cancer were registered from July 1986 through June 1989. Patients were stratified according to the pathological TNM classification and assigned to one of treatment arms consisting of UFT (group A) or UFT+Vindesine (group B, D) or UFT+ Vindesine+OK-432 (group C, E).
There were statistically no differences in the survival curves among group A, group B and group C. The survival curve of group E was significantly improved as compared with group D, as evidenced by the logrank test. Subset analysis showed that patients in Stage III and patients with squamous cell carcinoma benefited the most from the treatment including OK-432. Concerning the site of cancer recurrence, the patients in groups C and E had fewer distant metastases than the patients in groups A, B and D.
These results suggest that the adjuvant chemotherapy with OK-432 can be useful for resected non-small cell lung carcinoma, and may prolong the survival of the patients.

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A 70-year-old woman was admitted with a dry cough and an abnormal shadow in the left lung field on chest X-ray film. Chest computed tomography demonstrated an infiltrative shadow with an airbronchogram. Transbronchial lung biopsy obtained no abnormal findings. However, the abnormal shadow was suspected to be lung cancer, and an operation was performed. The intraoperative pathological diagnosis was malignantlymphoma and left pneumonectomy was performed because the tumor directly invaded the left main pulmonary artery and bronchus. The postoperative pathological diagnosis was lymphomatoid granulomatosis. Immunohistochemical study identified the infiltrative lymphocytes as T cells (CD8+).
Adjuvant therapy was not performed after the operation. The patient is alive at 13 months without recurrence.

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A 51-year-old patient with extensive small cell lung cancer was treated with a total of 560mg (320mg/m2) of irinotecan hydrochloride (CPT-11) following two cycles of cisplatin and etoposide. In the seventh week after the start of CPT-11 therapy, the patient complained of hacking cough and exertional dyspnea with a high fever. Chest X-ray film and chest computed tomogram showed ground-glass opacity mainly in both lower lung fields. Drug-induced pneumonitis due to CPT-11 was strongly suspected, and prednisolone was orally administered and methylprednisolone was administered intravenously. After the steroid therapy, the symptoms and lung opacity gradually disappeared. Although CPT-11-induced pneumonitis is rare, oncologists should be aware of the possibility of its occurring during or following CPT-11 administration.

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A 70-year-old asymptomatic man was admitted to our hospital due to an increasing infiltrative shadow on the chest roentgenogram, which had been followed up for tenmonths. Chest roentgenogram and CT scan demonstrated pneumonia-like infiltrative shadow with air space consolidation containing bubble-like areas. Transbronchial lung biopsy yielded a diagnosis of interstitial pneumonia, and steroid therapy was initiated. However, the infiltrative shadow increased, therefore transbronchial lung biopsy was performed once more. Because the second one strongly implied the possibility of malignancy, exploratory thoracotomy and right lower lobectomy were performed. The specimen, the weight of which was 750g, was dark-red with a liver-like appearance, and was filled with abundant mucoid material. The columnar or cuboidal cells replaced the normal alveolar cells and were scattered along the alveoli and the bronchi throughout the right lower lobe. Pathologic diagnosis was bronchiolo-alveolar carcinoma (pT2NOMO) with mucin-producing cells. In this case, the tumor was limited to within one lobe and it was completely resected. Due to the difficulty of the preoperative diagnosis, about one year elapsed from when the first abnormality was recognized to surgical treatment. Careful follow-up is needed because of the possibility of transbronchial dissemination.

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A 64-year-old woman was admitted with a swelling in the neck, sore throat and cough.Chest X-ray film and chest CT revealed a tumor in the upper mediastinum with deviation of the trachea and occlusion of the left innominate vein. Under a diagnosis of invasive thymoma, extended thymectomy and partial resection of the left upper lobe of the lung with resection of the innominate vein was performed. An E-PTFE graft bypass was placed to link the right atrium and the left innominate vein, and 4 small nodules in the upper and lower lobes of the left lung were palpated and removed. Histopathological findings showed primary thymic adenocarcinoma with lung metastasis.After 2 courses of chemotherapy containing CDDP and VP-16, the patient was discharged. She has survived for 6 years without recurrence.
Reported cases of long-term survivors after resection of advanced thymic carcinoma are more frequent than in cases of lung cancer, therefore surgical treatment should be selected.

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A 76-year-old man (smokingindex, 1, 080, 20 cigarettes/day×54 years) was admitted with back pain. Transbronchial lung biopsy revealed adenocarcinoma, and right upper lobectomy was performed.
Grossly, the tumor was grayish-white, measured 32 mm, and was located in S1b. Histologically, the tumor was composed of acinar adenocarcinoma partly showing a tubular structure with subnuclear vacuole (simulating fetal lung, but with no neuroendocrinedifferentiation), and spindle cell component with no differentiation to the specific mesenchymal tissues, such as bone, cartilage, or striated muscle.
Immunohistochemically, the spindle cell component did not stain with keratin or EMA, but showed scattering positive stain with Vimentin. Based on these findings, we diagnosed ‘acinar adenocarcinoma with sarcomatous change’.
In 13 other cases of adenocarcinoma with sarcomatous change, collected from five papers, males outnumbered females (10 males and 3 females), and the mean age was 68.2 years. Histology of the sarcomatous parts resembled spindle cell sarcoma in 10 cases, and malignant fibrous histiocytoma in 3 cases. The clinicopathological findings of our case are consistent with these reported cases.

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We describe a case of small adenocarcinoma which showed a distinctive MR finding consisting of two different zones of MR signal intensities (SI), central intermediate- and peripheral high-SI on T2-weighted MR imaging, due to different histologic subtypes. The central zone consisted of poorly differentiated adenocarcinoma and the peripheral zone consisted of well differentiated adenocarcinoma, with abundant clear cytoplasm. CT images showed a low density-, nearly homogeneous-nodule, which did not allow recognition of the presence of different histologic subtypes in the tumor. Contrast-enhanced CT and MR imagings showed slight enhancement. T2-weighted MR imaging was most effective in demonstrating uncommon findings of internal structures in the mass.

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