Haigan
Online ISSN : 1348-9992
Print ISSN : 0386-9628
ISSN-L : 0386-9628
Volume 43, Issue 4
Displaying 1-13 of 13 articles from this issue
  • Tetsuji Kado, Yoshikazu Kotani, Tasuhiro Funada, Shiro Ueda, Kayoko Ob ...
    2003 Volume 43 Issue 4 Pages 295-300
    Published: August 20, 2003
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
    Purpose. We evaluated chronological changes in desire to be told the truth by lung cancer patient. Method. We compared results of a questionnaire for lung cancer patients in our institution, in 1996 and in 2001. We obtained 176 responses in 1996 (response rate 71.3%) and 246 in 2001 (respons rate 89.5%). Result. The percentage of patients who wanted to receive a detailed explanation about their disease increased significantly to 69.5% in 2001 from 46.0% in 1996. The percentage of patients who wanted to be told the truth about their disease increased significantly to 91.1% in 2001 from 65.9% in 1996. Even the patients who were elderly or were in advanced stages of the disease wanted to be told the truth.Conclusions. Lung cancer patients who wanted to know the truth clearly increased in this five-year period.
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  • Shinji Kanemitsu, Motoshi Takao, Kazuya Fujinaga, Koji Onoda, Takatsug ...
    2003 Volume 43 Issue 4 Pages 301-306
    Published: August 20, 2003
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
    Objective and Methods. Recently, the number of surgical cases of primary lung cancer associated with multiple primary cancers in other organs has increased. We studied 90 cases (6.6%) of multiple primary cancers, among 1361 patients with surgically resected lung cancer during a 33-year period from 1968 to 2000. Result. Among the 90 cases of multiple primary cancers there were 78 cases of double cancers and 12 cases of triple cancers. Eleven cases had synchronous and 79 cases had metachronous multiple cancers. The average age of the patients at the time of lung resection was 64.5 (double cancer type), 70.7 (triple cancer type) years. The most common site of the other primary cancers was the stomach (26 cases), followed by colon and rectum (18), the laryngopharynx (7), breast (6), bladder (6) and uterus (5). For metachronous double cancer, the 5-year overall survival rates calculated from the time of lung cancer resection was 75.0%(when the lung cancer was first) and 60.1%(when another cancer was first). The 5-year survival rate of the metachronous type was significantly better than that of the synchronous type. Thirty-six of 90 patients have already died. Twenty (55.6%) of them died of lung cancer. Conclusion. It is considered that multiple primary cancers might increase henceforth, especially in heavy smokers. Therefore, we recommend careful examinations to defect development of a second primary cancer in other organs, as well as surveillance studies to detect recurrence of the first primary cancer.
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  • Toshio Sugane, Ichiro Tsujino, Tetsuo Yamazaki, Noriaki Takahashi, Tsu ...
    2003 Volume 43 Issue 4 Pages 307-313
    Published: August 20, 2003
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
    Objective. Cremophor EL (polyoxythylene caster oil), used as a solvent for cyclosporin A, was investigatedto determine whether it enhances the effects of cell-killing by etoposide (VP-16) in human lung carcinomacells in vitro. Methods. Survival fractions were measured by in vitro growth inhibition assay in PC-14 (human adenocarcinoma), KB (human epidermoid carcinoma), H69 (human small cell lung carcinoma) cells. The results were also confirmedby in vitro clonogenic assay in PC-14 cells. The intracellular accumulations of [3H] VP-16 were counted with a liquidscintillation counter in PC-14, KB, H69 and A549 (human adenocarcinoma) cells. The expression of MDR1 genemRNA was measured by real-time quantitative PCR assay. Results. In PC-14 cells, 250 μg/ml of Cremophor EL enhancedthe VP-16 sensitivity by over 102 times in clonogenic assay without obvious cell damage by itself. The intracellularaccumulation of VP-16 was enhanced by Cremophor EL in both PC-14 and A549 cells, but not in KB or H69. AlthoughCremphor EL has ben known to reverse the multidrug resistance (MDR) phenotype, we did not detect the MDR genen PC-14 and A549 cells. Conclusion. Cremophor EL enhances the effect of cell-killing by VP-16 in human lung adenocarcinomacells via enhancement of VP-16 influx, that is not related with the MDR reversal.
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  • Toshiyuki Harada, Satoshi Oizumi, Koichi Yamazaki, Shigeaki Ogura, Hir ...
    2003 Volume 43 Issue 4 Pages 315-318
    Published: August 20, 2003
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
    Background. We report a case of a small lesion of squamous cell carcinoma of the peripheral lungdiagnosed two years after sputum cytology indicated malignancy.Case. A 77-year-old man had positive findings on sputumcytology mass screening, but no abnormality was found on investigation. Chest radiography and computed tomographyperformed two years later revealed a 12mm nodule in the S3 segment of the right upper lobe. Bronchoscopyof the area that could be visualized and selective brushing cytology of each segmental bronchus were negative. The nodulewas estimated to be located in the sixth bronchial branch or a more peripheral region, and percutaneous biopsy ofthe nodule aided by computed tomography was performed, resulted in a diagnosis of squamous cell carcinoma. He subsequentlyreceived stereotactic radiation therapy (60 Gy in 8 fractions). During four years of follow up, sputum cytologyhas continued to be negative.Conclusion. Positive findings on sputum cytologic examination in the present case weredue to a small lesion of squamous cell carcinoma of the peripheral lung.
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  • Masaki Hanibuchi, Masakazu Goda, Kazuyoshi Manabe, Takanori Kanematsu, ...
    2003 Volume 43 Issue 4 Pages 319-324
    Published: August 20, 2003
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
    Background. Metastasis of a tumor to the tonsil is a rare event. We report two cases of non-small cell lung cancer with tonsillar metastasis. Twenty-eight cases of primary lung cancer with tonsillar metastasis including these two cases that have been reported in Japan are also reviewed. Case 1. A 52-year-old-man complaining of dyspnea was referred to our hospital for further examination of chest abnormal shadow. He was diagnosed as having poorly differentiated squamous cell carcinoma in the left upper lobe of the lung, T4N2M0, stage IIIB. During radiotherapy, he complained pharyngalgia. A tumor was noted in the left palatine tonsil, the surface of which was covered with white crust. A histopathological examination resulted in the diagnosis of metastatic tonsillar tumor from lung cancer (poorly differentiated squamous cell carcinoma). Radiotherapy was markedly effective to the metastatic tonsillar tumor. He died due to progression of primary lesion 9 months after the diagnosis of tonsillar metastasis. Case 2. A 52-year-oldman complaining of pharyngalgia was referred to our hospital for further examination of an abnormal chest shadow and bilateral tonsillar tumors. Large cell carcinoma in the right upper lobe of the lung, T3NOM1, stage IV was diagnosed. Uneven tumors which were ulcerated and covered with white crust were revealed in the bilateral palatine tonsils. The histopathological examinations resulted in the diagnosis of metastatic tonsillar tumor from lung cancer (large cell carcinoma). Metastatic tonsillar tumors completely disappeared after systemic chemotherapy. Nine months after the diagnosis of tonsillar metastasis, he was still alive. Conclusion. We described two rare cases of non-small cell lung cancer with tonsillar metastasis.
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  • Yoshihiro Kobashi, Kouichiro Yoshida, Naoyuki Miyashita, Yoshihito Nik ...
    2003 Volume 43 Issue 4 Pages 325-329
    Published: August 20, 2003
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
    Background. Most cases of squamous cell carcinoma of the lung in women are peripheral type. Therefore, we consider the present case with complete atelectasis of the left lung to be a rare case. Case. An 84-year-old woman was admitted complaining of increased shortness of breath.Complete atelectasis of the left lung was revealed on chest X-ray film. A chest CT scan showed an obstruction of the left main bronchus and we performed bronchoscopic examination, thinking the obstruction might be due to mucoid impaction because of her past history of bronchial asthma. Subsequently, an irregular white-coated tumorous lesion was recognized in the left main bronchus and biopsy showed it to be hilar type squamous cell carcinoma of the lung. Conclusion. When cases showing complete atelectasis in the unilateral lung field are encountered, it is important to perform a bronchoscopic examination and to consider that hilar type squamous cell carcinoma could be the cause of obstruction.
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  • Takatoyo Kambayashi, Eiji Ogawa, Toshiki Hirata
    2003 Volume 43 Issue 4 Pages 331-334
    Published: August 20, 2003
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
    Background. It is rare for intramedullary spinal cord metastasis to be diagnosed antemortem. Case. The patient was a 70-year-old man with small cell lung cancer (T4N2M0, Stage IIIB).Chemotherapy with a CDBCA+VP-16 regimen and radiation therapy with a total dose of 50 Gy were performed. After 5 courses of chemotherapy, a partial response was obtained. Pain and numbness of his legs aggravated rapidly. Subsequently, paraplegia and dysfunction of the bladder and bowel also progressed. Spinal cord MR imaging demonstrated intramedullary spinal cord metastasis from lung cancer at the Th 11 and Th12 levels. Immediately, radiation therapy was performed for the spinal cord lesion, but neurologic manifestations did not change. He died of respiratory failure two months after the diagnosis of spinal metastasis. Conclusion. We reported a case of small cell lung cancer that developed intramedullary spinal cord metastasis. Spinal cord MR imaging was useful for diagnosing intramedullary spinal cord metastasis. However the outcome was very poor.
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  • Hirokazu Tanaka, Toshiaki Wakayama, Masaharu Nakade, Hiroyoshi Watanab ...
    2003 Volume 43 Issue 4 Pages 335-340
    Published: August 20, 2003
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
    Background. Standard treatment for advanced thymic carcinoma has notyetbeen established, and the prognosis is very poor. Case. A 49-year-old man suffered from undifferentiated thymic carcinoma with superficial cervical lymph node metastasis, corresponding to stage NB of Masaoka' s classification. He was treated with two cycles of chemotherapy consisting of paclitaxel and carboplatin, and concurrent radiotherapy of 40 Gy. The reduction rate of the tumor size was 77.4%, enabling it to be completely resected. The pathologicalexamination revealed neither residual tumor cells in the resected specimen nor lymph node metastasis. Two cycles of postoperative chemotherapy with the same regimen and concurrent radiotherapy of 20 Gy were added. Conclusion. Preoperative chemotherapy with paclitaxel and carboplatin, and concurrent radiotherapy might be effective in advancedthymic carcinoma.
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  • Gyoukei Kan, Hiroshi Okitsu, Takanori Miyoshi, Shoji Sakiyama, Kazuya ...
    2003 Volume 43 Issue 4 Pages 341-344
    Published: August 20, 2003
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
    Background. Metastatic adrenal tumors of lung cancer are frequently found at autopsy, but are rarely surgically treated. However, recently metastasis is detected earlier because of progress in radiological diagnosis. Therefore, there are increasing reports that adrenalectomy could obtain long-term survival. We report two resected cases of adrenal metastases after resection for lung cancer. Case 1. A 68-year-old man underwent right upper lobectomy at age 66 (pT1NOMO stage IA). One year and 3 months later, CT scan showed a left adrenal gland tumor. Although it was thought to be metastasis from lung cancer, the patient was not treated. Later, at the time when he underwent laparotomy for another disease, adrenalectomy was performed. The adrenal tumor was confirmed pathologically to be metastasis from lung cancer and 3 years and 9 months after the adrenalectomy, the patient is well without evidence of recurrent disease. Case 2. A 65-year-old man underwent right middle and lower lobe resection at age 64 (pT1N2M0 stage IIIA). One year later, right adrenal tumor was pointed out on a CT scan. Solitary adrenal metastasis of lung cancer was suspected and adrenalectomy was performed. However, relapse occurred 7 months later and he died 1 year and 3 months after the adrenalectomy. Conclusion. Metastatic adrenal tumors should be excised if the tumor is solitary and the patient's general condition permits it, because there is possibility of long-term survival.
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  • Motoki Sakuraba, Masahide Murasugi, Takamasa Onuki
    2003 Volume 43 Issue 4 Pages 345-349
    Published: August 20, 2003
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
    Background. A mass forming carcinoma associated with a bullous wall or carcinoma attached to a bullous wall have been reported. However, multiple focal carcinoma on a bullos wall is rare. We report such a case.Case. A 49-year-old man underwent partial resection of the lung, 4 years previously, because of right pneumothorax. The resected specimen showed no malignancy. After receiving treatment for pneumonia, the bulla was found to be enlarged in 1999. Bronchoscopic cytology revealed squamous cell carcinoma. Chest CT showed no mass lesion. Right upper lobectomy and mediastinal lymph node dissection were performed. Not only squamous cell dysplasia but also multiple focal squamous cell carcinomas were demonstrated on the bullous wall. Three months after resection, chest CT showed a recurrence of multiple thin-walled cystic lesions. Conclusion. This was a rare case of thin-walled cavity formation with multiple focal squamous cell carcinomas verified pathologically.
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  • Shoichi Mori, Yoshitaka Sekido, Kikuo Shigemitsu, Hiromu Yoshioka, Mun ...
    2003 Volume 43 Issue 4 Pages 351-355
    Published: August 20, 2003
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
    Background. Well differentiated fetal adenocarcinoma (WDFA) is a very rare lung tumor, and there have been very few studies reporting genetic mutations in the development of this type of tumor. Case. A 38-year-old man was admitted to our hospital for investigation of an abnormal shadow in the left lung on a chest roentgenogram. After metastasis was ruled out, he underwent left upper lobectomy and mediastinal lymph node dissection. Although the preoperative diagnosis by needle biopsy was adenocarcinoma, pathological examination of the surgical specimen confirmed the diagnosis of well differentiated fetal adenocarcinoma. We performed mutation analysis of the p53, KRAS, and β-catenin genes and found a missense mutation at codon 37 of the β-catenin gene exon 3, leading to an amino acid substitution of TCT (Ser) to TGT (Cys), but no mutations were present in p53 or KRAS. Furthermore, immunohistochemical analysis detected positive staining of synaptophysin and CD 56, indicating that the tumor cells showed neuroendocrine differentiation. Conclusion. Our results suggested that a β-catenin gene alteration might be involved in the development of WDFA.
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  • Toshikazu Yusa, Tomohisa Yasukawa, Fumio Kunitomo, Tsukasa Yamamoto, D ...
    2003 Volume 43 Issue 4 Pages 357-361
    Published: August 20, 2003
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
    Background. No standard treatment for diffuse malignant pleural mesothelioma has yet been established, but various treatments are being attempted. We report a case of diffuse malignant pleural mesothelioma treated by intrathoracic perfusion chemohyperthermia after pleuropneumonectomy. Case. A 62-year-old man with common cold like symptoms visited a clinic in February 1999. Pleural effusion on the left side was pointed out on chest X-ray film, and he was then followed up. In October 1999, he was referred to our hospital due to increased pleural effusion. Thoracoscopic pleural biopsy revealed diffuse malignant pleural mesothelioma. Pleuropneumonectomy with mediastinal lymph node dissection, and combined resection of the diaphragm were performed in January 2000. Histopathological examination of resected specimens showed that tumor cells were located diffusely in the parietal pleura and partly invaded the subpleural fat tissue. Five months after the operation, intrathoracic perfusion chemohyperthermia was performed. After intrathoracic observation using a thoracoscope, intrathoracic perfusion was performed using sa line solution at 42-43°C containing 20 μg ml of CDDP for 60 minutes. The patient had no intraoperative or postoperative complications. For three years after the resection, recurrence was not observed and the patient was followed up as an outpatient. Conclusion. Intrathoracic perfusion chemohyperthermia could be considered as one type of useful adjuvant therapy after surgery to prevent recurrence of diffuse malignant pleural mesothelioma.
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  • 2003 Volume 43 Issue 4 Pages 362-391
    Published: August 20, 2003
    Released on J-STAGE: August 10, 2011
    JOURNAL FREE ACCESS
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