Objective and Methods. A questionnaire concerning notification of lung cancer was given to 67 patients with lung cancer and their families after the operation, between March 1999 and December 2001. Result. Forty percent of the patients answered that they were very concerned and worried about recurrence irrespective of the cancer stage. Moreover, most of the patients were predominantly anxious about the future of their families, rather than with any other aspect of their lives. Eighty percent or more of the patients and their families accepted the notification of their disease in a positive manner, and half of the patients recovered from the shock within one week. Although 80 percent or more of both the patients and the families accepted the notification of their disease in cases of early-stage cancer, 60 percent or more revealed negatively in cases of advanced cancer. Conclusion. The informed recipient's state of mind and the state of family relations are important factors. From now on, we the doctors with the medical team, need to learn, develop and improve technique of how to tell about the disease in order to proper information and obtain informed consent, for the sake of the patients and their families in a concise and effective way.

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Objective. Efficacy and safety of combination chemotherapy with Docetaxel (D) and Carboplatin (C) were evaluated in this early phase II study in patients with postoperative recurrent adenocarcinoma of the lung. Study design. D (60mg/m², day 1) and C (5 area under the concentration-time curve, day 1) were given every 3 weeks to patients with aged under 70 years old and a Performance Status of 2 or less. Subsequently, D and C were given every 2 months until PD. This early phase II study was based on the Fleming method with two steps, was stopped early if significant efficacy was recognized in interim analysis. Result. The total of number courses was 66, the median was 4 courses (range 2-9 courses), follow up period 10.6-23.1 months (median 20.3 months). The overall response rate was 26.7%(95% CI: 4.2-49.0%), with 1 CR, 3 PR, 9 NC and 2 PD. Median time to response was 4 weeks (range: 3.6-8 weeks), and median response duration was 43.6 weeks (range: 9.4-68.7 weeks). Grade 3 or more toxicity consisted of 2 cases of anemia (13.3%), 7 cases of leucocytopenia (46.7%), 10 cases of neutrocytepenia (66.7%) and 2 cases of thrombocytopenia (13.3%). There was one treatment-related death (6.7%). One-year survival Is 51.9%(95% CI: 25.9-77.8%) and median survival has not yet been reached. Conculusion. This combinatin chemotherapy shows efficacy and warrants further investigation in future.

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Objective. The incidence of synchronous multiple lung cancers is reported to be 0.3 to 3.6% in lung cancer patients. It has been reported that synchronous multiple lung tumors (SMPLT) cases had poor prognosis in spite of early diagnosis and exploration. We tried to evaluate the difference of clinical and pathological features between synchronous multiple lung cancers and single non-small cell lung cancers using immunostains for oncogenes, oncosupressors, and the cell cycle-associated marker of each lesion of lung cancer. Methods. We examined 83 patients with nonsmall cell lung cancer who underwent resection in our hospital from 1998 to 2001. There were 7 patients who had synchronous multiple lung cancer: two patients with squamous/squamous cell carcinoma, three patients with adenocarcinoma/adenocarcinoma and one with three adenocarcinomas and one patient with adenocarcinoma/large cell carcionma. Immunohistochemical study was performed for the 15 lesions in this group of 7 multiple cancer patients and the group of 36 randomly-selected single non-small cell lung cancer patients who had selected at random and the group of 6 patients who had had pumonary metastatic lesions. p53, Ki-67, c-erbB-2, bcl-2 were selected for immunostaining of each lesion to investigate the characteristics of synchronous multiple lung cancer. Result. The rate of positive immunostain-ing for p53 in SMPLT (100%) was higher than in the single tumor group (58.3%) with statistical significance (p<0.01). The rate of high expression (LI>10) of p53 in the SMPLT group (73.3%) was higher than in the single tumor group (38.9%) with statistical significance (p<0.05). The rate of high expression of c-erbB-2 in SMPLT (80%) was statistically higher than in the single tumor group (33.3%) (p<0.01). No significant difference was seen for bcl-2 and Ki-67 between the SMPLT group and the single tumor group. There were significant differences in the positive cell counts for p53 and Ki-67 between the 1st tumor and the 2nd or the 3rd tumor in SMPLT patients. On the other hand, there was no statistical significance between the primary tumor and pulmonary metastatic lesions in terms of p53 and Ki-67 cell counts. The expression patterns of c-erbB-2 and bcl-2 was very similar to those of the primary lesion. Conclusion. p53 and c-erbB-2 tend to be expressed at a higher rate in SMPLT than single lung cancer. That phenomenon suggested that high expression of tumor associated factors may be related to the poor prognosis of SMPLT after surgery. Semicountatative evaluations for immunostains of p53 and Ki-67 or other antigens may be helpful to distinguish multiple tumors between synchronous multiple primary carcinoma and pulmonary metastasis in cases with the same pathology.

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Objective. The usefulness of extended segmentectomy for small peripheral non-small-cell lung cancer was assessed by comparison with lobectomy. Study Design. From 1992 to 1994, 155 patients were enrolled in a multiinstitutional prospective trial for peripheral lung tumors. Fifty-five patients out of 155 were registered in the intended extended segmentectomy group and 100 patients who had preoperative complications were registered in the compromised group. In the extended segmentectomy group, the tumors were 2cm or less in diameter and no metastatic lesion was detected by routine examinations. Twenty patients out of 100 who were enrolled in the compromised group had tumors smaller than 2 cm in diameter and NO disease. They received similar operations as patients in the intended extended segmentectomy group. Fifty-five patients in the intended extended segmentectomy group and 20 patients in the compromised group received extended segmentectomy, and these 75 patients were unified as the extended segmentectomy group. Fifty-five patients who received lobectomy in Sumitomo Hospital and Hyogo Medical Center for periph-eral non-small-cell lung tumors 2cm or less in diameter and no metastatic lesion were compared with the extended segmentectomy group. Result. There were 17 deaths in the extended segmentectomy group and 7 died due to lung cancer. In these 7 cancer-related deaths, 3 patients died due to lung tumors, 2 died due to distant metastases and 2 died as a result of local recurrence. In the lobectomy group, 19 patients died, 9 due to lung cancer. In these 9 patients, 2 died due to lung tumors, 4 died due to distant metastasis and 3 died due to local recurrence. Five-year survival rates of the extended segmentectomy group and the lobectomy group were 89.5% and 81.3%, respectively, and the difference was not statistically significant between these two groups. Postoperative reduction rates of FVC in the extended segmentectomy group and the lobectomy group were 11.3% and 18.3%, respectively, and the difference was statistically significant (p=0.0046). Postoperative reduction rates of FEV1.0 in the extended segmentectomy group and the lobectomy group were 13.4% and 16.0%, respectively, and no statistically significant difference was recognized (p=0.247). & Conclusion. Extended segmentectomy is a reasonable operation for small peripheral lung cancer.

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Objective. It is usually difficult to distinguish between breast carcinomas metastatic to the lung and primary pulmonary adenocarcinomas in patients with a past history of breast cancer. Immunohistochemical examination was performed to evaluate whether thyroid transcription factor-1 (TTF-1) was useful in distinguishing between breast carcinomas metastatic to the lung and primary pulmonary adenocarcinomas. Subjects and Methods. Eleven specimens of pulmonary adenocarcinomas obtained from patients with a past history of breast cancer were studied. Pathological diagnosis was evaluated morphologically by hematoxylin-eosin staining. Sections of pulmonary tumors and breast carcinoma specimens were immunohistochemically stained with monoclonal anti-TTF-1 antibody or monoclonal anti-estrogen receptor (ER) using the avidin-biotin immunoperoxidase technique. Pulmonary tumors included 10 metastatic adenocarcinomas from the breast and one primary pulmonary adenocarcinoma. In 8 cases the original breast cancer specimens were also examined in the same manner. Results. None of the 10 metastatic tumors showed immunoreactivity for TTF-1, and one pulmonary adenocarcinoma was positive. On the other hand, for ER, 8 of the 10 metastatic lung tumors were positive and one primary lung cancer was negative. In two cases whose metastatic carcinoma showed negative reactivity for ER, the original breast carcinomas were also negative for ER. These studies could be used for biopsy specimens from lung tumors. Conclusion. The use of antibody staining for TTF-1 and ER might help to distinguish adenocarcinomas of the lung from others arising in the breast.

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Objective. We attempted to detect a polypeptide related to drug resistance and investigated its clinical effects in cases of primary lung cancer. Study Design. Comparing the two-dimensional polyacrylamide gel electrophoresis (2-DE) patterns of the parent strain and CDDP-resistant cultured lung cancer cells (H69 and PC14), we detected a polypeptide in which the expression levels clearly changed. Measurement of clinical materials in 2-DE was successful in 80 patients with primary lung cancer between 1994 and 1998. We evaluated the relationship between the expression levels of this polypeptide, clinicopathological factors and outcome. Conclusion. We detected a polypeptide (molecular weight 44.0kDa) which significantly decreased in expression level in CDDP-resistant cells. The amino acid sequence suggested that this polypeptide might be homologous with reticulocalbin-1. We could not recognize any statistically significant relationship between the expression of reticulocalbin-1 and any clinicopathological factors. However, only in cases with adjuvant chemotherapy using platinum-based drugs with positive expression of reticulocalbin-1 was a better outcome obtained compared with cases without reticulocalbin-1 expression. Therefore, it was suggested that the reticulocalbin-1 molecule might have some kind of involvement in the chemical toleramce mechanism of platinumbased drugs.

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Background. Cancer-associated retinopathy (CAR) is one of the paraneoplastic syndromes and is characterized by retinal degeneration. CAR is often associated with epithelial cancers, mostly small-cell lung carcinoma. We describe the second report of CAR associated with invasive thymoma. Case. A 41-year-old woman was admitted for visual disturbance. Chest X-ray film and CT scanning images showed a mediastinal tumor. In her serum antiacetylcholine receptor antibody was elevated and CAR autoantibody was detected. CAR and thymoma with myasthenia gravis were diagnosed, and steroid pulse therapy was performed. Her visual disturbance progressed but the tumor diminished. She underwent extended thymectomy and resection of the mediastinal tumor, which was invasive thymoma. After operation radiotherapy and steroid therapy were performed. Ten months after operation CAR autoantibody was negative, but her visual loss had not improved. Conclusion. CAR is often associated with lung cancer, but may occur in a patient with invasive thymoma.

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Background. Malignant fibrous histiocytoma (MFH) is the most common soft tissue sarcoma in adults, usually arising in the extremities or trunk, however primary MFH of the lung is rare. Case. A 65-year-old woman was admitted because of an abnormal shadow on chest X-ray film. Chest CT scan showed an ill-defined solid mass shadow in the left S6 region. We performed partial resection of the left lower lobe, as the frozen section diagnosis was sarcomatous tumor, suggesting pulmonary metastasis from soft tissue sarcoma. Tumor cells were positive for CD68, but we could not detect any primary lesions. Therefore, the final diagnosis was primary MFH of the lung. Conclusion. Previous clinical reports suggest a poor prognosis of primary MFH of the lung because of the high incidence of local recurrence or distant metastasis after surgery. To prevent recurrence after surgery, pulmonary lobectomy was recommended as a curative procedure in several reports in the literature. In this case, partial resection was performed without additional lobectomy and postoperative adjuvant therapy. However, the patient has been doing well with no evidence of local recurrence or distant metastasis for 3 years postoperatively.

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Background. Because of combined modality therapy, long-term survival of small cell lung cancer can be achieved more frequently. However, an increasing risk of second primary malignancies has been reported. Case. The patient was a 71-year-old man. In 1991 small cell lung cancer, clinical stage IIIA (T2N2M0) was diagnosed. Partial response (PR) was achieved after chemotherapy with concurrent radiotherapy. In 1993 chest X-ray revealed tumor recurrence only in the primary site and right upper lobectomy was performed after chemotherapy. The pathological stage was IA (T1N0M0) and no tumor recurrence has been observed. In 1997 bladder cancer was diagnosed and he underwent transurethral resection with chemoradiotherapy. In August 1999 a bulky mass developed on the right side of his neck. Microscopic findings of the biopsy specimen showed malignant lymphoma, diffuse large B cell type. His serum CEA level was elevated and colonoscopy also revealed advanced cancer in the sigmoid colon. Conclusion. We discuss combined modality therapy and second primary malignancies in small cell lung cancer.

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Case. A 48-year-old man with primary adenocarcinoma of the lung in the right upper lobe (clinical stage IV), treated as an inpatient with chemotherapy and radiation therapy is reported. He was again admitted due to nausea and anorexia during the follow-up period after discharge. Physical findings included severe pigmentation in the oral mucosa, gingiva, and skin of the entire body. Abdominal sonography demonstrated enlargement of the bilateral adrenal glands. In hematological examination, his ACTH level was elevated, while his early-morning serum cortisol level remained within the normal range. After we gave 24-hour continuous drip infusion of hydrocortisone at 100mg/day based on the suspicion of Addison's disease due to bilateral adrenal metastasis from the lung cancer, his general condition improved. But he suffered from pneumonia and eventually died. At autopsy, his adrenal glands were about 10cm in diameter due to metastasis from the lung cancer, and both glands were almost entirely replaced by tumor cells. Conclusion. We report this case because it is rare to experience a case developing Addison's disease due to metastasis of lung cancer to the adrenal gland.

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Background. It has been recognized that lung adenocarcinomas, mucinous bronchioloalveolar cell carcinomas in particular, sometimes spread aerogenously and show an air-space pattern in chest roentgenogram or CT. We report a case of nonmucinous papillary adenocarcinoma showing air-space pattern by extensive aerogenous metastasis. Case. A 73-year-old man was found to have a solitary pulmonary nodule on chest X-ray film and CT. Middle lobe lobectomy was performed and the pathologic diagnosis was moderately differentiated papillary adenocarcinoma. The tumor had a desmoplastic reaction in the central portion. In the peripheral portion, atypical cuboidal cells similar to alveolar epithelial cells lined the alveolar walls and floated in the alveoli. No mucin secretion was found. The tumor partially invaded into the upper lobe across the interlobar fissure. One year later, a solitary metastatic tumor appeared in the right lower lobe. Partial resection of the right lower lobe was performed. Another year later, a nodule appeared in the upper lobe and extensive air-space pattern appeared in the right lower lobe. Right pneumonectomy was performed. The nodule of the upper lobe was papillary adenocarcinoma, identical to the primary cancer. In the lower lobe cancer cells diffusely flooded in the alveoli. Conclusion. The extensive alveolar pattern in this case was reflected by diffuse aerogenous metastasis. This case might be a rare adenocarcinoma characterized by extensive aerogenous metastasis.

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