Haigan
Online ISSN : 1348-9992
Print ISSN : 0386-9628
ISSN-L : 0386-9628
Volume 46, Issue 7
Displaying 1-13 of 13 articles from this issue
Case Report
  • Yasuki Hachisuka, Masashi Uomoto, Akihisa Akamune
    2006 Volume 46 Issue 7 Pages 799-802
    Published: 2006
    Released on J-STAGE: February 05, 2007
    JOURNAL OPEN ACCESS
    Background. Cavitation in metastatic lung tumors is rare, compared with primary lung cancer. It is also sometimes difficult to differentiate from benign lung cyst by chest CT. We report a case of lung metastasis from colon cancer presenting as a solitary cystic lesion. Case. A 50-year-old man underwent right hemicolectomy for cecal cancer in April 2003. He was followed up by the department of gastroenterological surgery in our hospital after adjuvant chemotherapy. In January 2006 chest CT showed a 1.5-cm solitary cystic lesion with a slightly thickened wall in the left upper lung. Retrospective evaluation of chest CT revealed a minute cystic lesion at the same site in the left upper lung in February 2005. Partial pulmonary resection for biopsy by video-assisted thoracoscopic surgery was performed in February 2006 because of the growing cystic lesion on chest CT. Pathological findings showed a metastatic lung tumor from cecal cancer. Conclusion. Close follow up is recommended for atypical forms of solitary lung cysts and the possibility of metastatic lung tumor should be kept in mind.
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  • Hiroyuki Sakurai, Masao Hada, Yoshihiro Miyashita
    2006 Volume 46 Issue 7 Pages 803-809
    Published: 2006
    Released on J-STAGE: February 05, 2007
    JOURNAL OPEN ACCESS
    Background. Although a multidisciplinary surgical approach to lung cancer involving the superior sulcus might be helpful, no standard recommended treatment has been established. We report a case of surgical resection after curative intent chemoradiation for lung cancer involving the superior sulcus. Case. A 53-year-old man presented in August 2004 with right shoulder pain. He was given a diagnosis of non-small cell lung cancer invading the superior sulcus. Because the tumor showed rapid growth during a short pretreatment work-up, he received curative-intent chemoradiation. After that, he underwent salvage surgery for the residual tumor because of the tumor reduced in size. Microscopically, the tumor was composed of only necrosis without viable tumor cells in the resected specimen. He was well and with no evidence of recurrence 15 months after the operation. Conclusion. We reported a case of surgical complete resection after the curative intent chemoradiotherapy for non-small cell lung cancer invading the superior sulcus.
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  • Chiyuki Furukawa, Masaki Hanibuchi, Tsutomu Shinohara, Hisashi Ishikur ...
    2006 Volume 46 Issue 7 Pages 811-815
    Published: 2006
    Released on J-STAGE: February 05, 2007
    JOURNAL OPEN ACCESS
    Background. Pulmonary epithelioid hemangioendothelioma (PEH) is a rare tumor of the lung deriving from vascular endothelial cells. Case. A 19-year-old woman was referred to our hospital because of an abnormal shadow on her chest X-ray film. Chest radiograph and CT on admission showed well-defined multiple small nodules in bilateral lung fields. As pathological findings of specimens resected by video-assisted thoracoscopic surgery revealed atypical epithelioid cells and stained for factor VIII-related antigen and CD34, a diagnosis of pulmonary epithelioid hemangioendothelioma was made. She was given no medication but has no symptoms without specific medication for 2 years after her first admission, although chest CT findings demonstrated mild progression of the disease. Conclusion. We report a case of pulmonary epithelioid hemangioendothelioma found on a school medical check up.
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  • Koichi Tanaka, Masaru Hagiwara, Satoshi Kaneko, Tsukasa Saito, Masaki ...
    2006 Volume 46 Issue 7 Pages 817-821
    Published: 2006
    Released on J-STAGE: February 05, 2007
    JOURNAL OPEN ACCESS
    Background. Pleomorphic carcinoma with choriocarcinomatous differentiation is rare, and is considered to be a high-grade malignant lung tumor that can lead to early metastasis and recurrence. Case. A 39-year-old woman was admitted to our hospital because of anemia. Upon examination, we detected a hemorrhagic duodenal tumor and a tumor in the right lower lobe of the lung. Based on the results of endoscopic biopsy, which obtained poorly differentiated carcinoma from both tumors, we ascertained that this case represented primary lung cancer with a metastatic duodenal tumor. We performed surgical resection of both the duodenal and the lung tumors. Heterogeneous tumor tissue, including choriocarcinomatous, giant cell, and large cell-like features, was observed microscopically in the resected specimens, which stained immunohistochemically for human chorionic gonadotropin (hCG). The pathological diagnosis was "pleomorphic carcinoma with choriocarcinomatous differentiation, pT2N0M1 stage IV". Conclusion. We treated a rare case of hCG-producing pleomorphic carcinoma with choriocarcinomatous differentiation that was discovered after hemorrhage of a metastatic duodenal tumor. The usefulness of surgical resection for primary and/or metastatic lesions of stage IV lung cancer is not sufficiently well established. However, it could be an effective treatment for some patients.
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  • Yasunori Kurahashi, Takashi Hirai, Taku Okamoto
    2006 Volume 46 Issue 7 Pages 823-827
    Published: 2006
    Released on J-STAGE: February 05, 2007
    JOURNAL OPEN ACCESS
    Background. We often encounter cases of lung cancer accompanied by localized ground glass opacity (GGO) surrounding the main tumor. Here, we report a case of lung cancer which showed widespread GGO surrounding the main tumor. Case. A 57-year-old man was referred to our hospital because of an abnormal shadow on his chest X-ray film. Computed tomography of the thorax revealed a 25-mm solid tumor in the right lower lobe and widespread GGO, 80 mm in diameter, around the main tumor. We diagnosed it as lung cancer (cT2N0M0, stage IB) and performed right middle and lower bilobectomy. During the operation, we found lymphangiectasis in the visceral pleura of the right lower lobe, a small nodule of pulmonary metastasis in the right S2, and the metastasis to the hilar lymph node (#11i). The final diagnosis was poorly differentiated adenocarcinoma (pT1N1M1). No malignant cell could be identified in the area of GGO around the main tumor, where we could see lymphangiectasis, capillary dilation, and an accumulation of erythrocytes and macrophages in the alveolar space. It was suggested that lymphostasis and hemostasis due to the metastatic hilar lymph node resulted in localized pulmonary edema. Conclusion. We experienced a case of lung cancer which showed widespread GGO surrounding the main tumor. The widespread GGO in this case was thought to be caused by localized pulmonary edema due to the metastatic hilar lymph node.
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  • Satoshi Hayashi, Masahiro Kitada, Keisuke Ozawa, Kazuhiro Sato, Yoshih ...
    2006 Volume 46 Issue 7 Pages 829-833
    Published: 2006
    Released on J-STAGE: February 05, 2007
    JOURNAL OPEN ACCESS
    Background. Basaloid carcinoma (BC) of the lung is rare and prognosis is poor. It is histologically classified on a variant of large cell carcinoma. We report a case of BC. Case. A 67-year-old man presented with a 10-mm tumor located in the left upper lobe. The preoperative cytological diagnosis was large cell neuroendocrine carcinoma. We performed left upper lobectomy and node dissection. The case was diagnosed as BC of the lung by histopathological findings. Conclusion. BC is considered to have poor prognosis, and careful follow-up is necessary.
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The 21st Lung Cancer Mass Screening Seminar
  • Takeshi Iinuma
    2006 Volume 46 Issue 7 Pages 835-841
    Published: 2006
    Released on J-STAGE: February 05, 2007
    JOURNAL OPEN ACCESS
    Objective. We predict the reduction of lung cancer mortality in Japan in the year 2025 employing LSCT screening and propose a realistic method to achieve this goal. Methods. Using the data of LSCT screening in Japan and a deterministic model of cancer screening developed by the author, the relative risk of death of the screened group and of the non-screened group is calculated. Then the incidence of lung cancer in 2025 is estimated from population statistics and age-specific incidence rates. The number of lung cancer deaths at 2025 is calculated using the model assuming 50% of Japanese of 40-84 years old undergo the annual LSCT screening. Results. The incidence of lung cancer is predicted to be 74,982 men and 29,616 women in 2025 for all ages and the figures for the 40-84-year-old group are 62,982 men and 21,314 women. The incidence shows a 50% increase compared with 2002. If LSCT screening is performed on 50% of the population aged 40-84 years, the numbers of deaths due to lung cancer are expected to be 51,738 men and 21,326 women. The relative risk rates compared with the non-screened group are 0.77 for men and 0.80 for women. Conclusion. It is possible to reduce the lung cancer mortality in Japan by 22%, if we can perform LSCT screening in more than 50% of the population aged 40-84 years old in 2025.
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  • Masakazu Nakamura
    2006 Volume 46 Issue 7 Pages 843-851
    Published: 2006
    Released on J-STAGE: February 05, 2007
    JOURNAL OPEN ACCESS
    The essence of tobacco use is nicotine dependence. Nicotine dependence is a chronic disease that often requires repeated intervention. There is strong evidence that smoking cessation intervention is effective and cost-effective. In Japan, smoking cessation treatments had not been established, but the Ministry of Health, Labor and Welfare decided to start health insurance coverage to smoking cessation treatments from April 2006. Future plans call for increased accessibility and effectiveness of smoking cessation services in medical settings, and the initiation and implementation of smoking intervention at health examination and cancer screening, linked with reimbursed medical treatments.
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  • Masakazu Aoki
    2006 Volume 46 Issue 7 Pages 853-857
    Published: 2006
    Released on J-STAGE: February 05, 2007
    JOURNAL OPEN ACCESS
    Objectives. To consider the future perspective of lung cancer screening strategy in Japan. Methods. Present lung cancer screening strategy in Japan and literatures were reviewed. Results. (1) It was strongly recommended to strengthen the anti-smoking movement because lung cancer mortality is increasing linearly as a result of the weak anti-smoking movement in Japan. (2) Lung cancer screening by conventional method has been carried out since 1987, and the number of examinees is about 7.5 millions annually. It is necessary to improve the level of quality control more for the present screening strategy to be accepted by the public. (3) Lung cancer screening using CT is gradually spreading in Japan, although it is not recommended officially. It is advised to try to carry out screening using CT to prepare for the future. Conclusion. To strengthen the anti-smoking movement, to continue conventional X-ray screening, and to try to implement CT screening on trial or study bases are needed to improve the lung cancer strategy in Japan.
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  • Tomotaka Sobue
    2006 Volume 46 Issue 7 Pages 859-862
    Published: 2006
    Released on J-STAGE: February 05, 2007
    JOURNAL OPEN ACCESS
    In Japan, lung cancer screening using chest X-ray and sputum cytology has been conducted for 18 years since 1987. Although it is retrospective, the efficacy of lung cancer screening in terms of lung cancer mortality reduction has been evaluated by several case-control studies, such as those conducted in Miyagi, Niigata and Okayama Prefectures, and positive results have been reported. Therefore, if it is implemented properly, its effect should be observed in national statistics. However, age-adjusted incidence and mortality for lung cancer have been showing almost parallel trends so far, which means effectiveness of lung cancer screening has not been observed at the national level. On the other hand, in Miyagi, Niigata and Okayama Prefectures the magnitude of decrease in lung cancer mortality seemed to be greater than the national average, which suggested high-quality screening had been conducted with higher participation rate in these areas. In other areas, no apparent effects can be expected by continuing current activities, and fundamental discussion of the problem is needed.
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  • Masami Sato, Yasuki Saito, Satomi Takahashi, Zenichi Nishino
    2006 Volume 46 Issue 7 Pages 863-870
    Published: 2006
    Released on J-STAGE: February 05, 2007
    JOURNAL OPEN ACCESS
    Sputum cytology is the only method that can detect early hilar type lung cancer. No other method such as CT or bronchoscopy could be an alternative for huge mass screening. According to the results of famous randomized control studies conducted in 1970s and 1980s in the US and those of Miyagi Prefecture in 1990s, sputum cytology showed that higher sensitivity for lung cancer detection and better prognosis in the 1990s. In addition, Miyagi Cancer Registry revealed that the incidence of lung squamous cell carcinoma was higher than that of adenocarcinoma in male smokers in 1990s. Also the Registry showed that the number of male squamous cell carcinoma patients of the lung was almost equal to that of male adenocarcinoma patients. The ratio of male smokers in Japan is double that of the US. These findings suggest that lung cancer screening with sputum cytology is important in Japan. However, the detection ratio of lung cancer with sputum cytology varied in prefectures in Japan. Thus, it is evident that quality control for sputum cytology is necessary in each prefecture.
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  • Tomio Nakayama, Takaichiro Suzuki
    2006 Volume 46 Issue 7 Pages 871-876
    Published: 2006
    Released on J-STAGE: February 05, 2007
    JOURNAL OPEN ACCESS
    Objective. The low dose helical computed tomography (LDCT) screening for lung cancer is attracting attention because of its high detection rate, ability to detect small tumors, and high survival rate of detected cases. However, an epidemiologic study in which the endpoint is cancer mortality is necessary to evaluate the effectiveness of cancer screening because these case studies have easily contaminated biases. Method and Result. Japan Lung Cancer Screening Study (JLCSS) is a cohort study that compared the lung cancer mortality rates of CT screened group and chest X-ray screened group as an endpoint. Since 1995, 46,733 people registered in the CT screening group and 91,970 people registered in the chest X-ray screening group, and they were followed up until 2002. Conclusion. There is a problem to cancel three disadvantages such as high dose examination rate, cost and radiation exposure in addition to the results of this study for LDCT screening. The spread of the LDCT screening for lung cancer cannot be recommended until this problem is solved.
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  • Mieko Masakage, Kenji Nishii, Hiroshi Ueoka, Masahiro Tabata, Nagio Ta ...
    2006 Volume 46 Issue 7 Pages 877-881
    Published: 2006
    Released on J-STAGE: February 05, 2007
    JOURNAL OPEN ACCESS
    Because of the consolidation of smaller municipalities and revision of the Tuberculosis Prevention Law in 2005, the Japanese lung cancer screening system underwent a great change. Since the proportion of individuals receiving chest mass screening in Okayama prefecture has decreased since revision of the Tuberculosis Prevention Law, we investigated the problems in the current lung cancer screening system. As the causes of the decrease, we considered the following. First, individuals aged 64 or less were excluded from screening by the Tuberculosis Prevention Law in 2005. Second, the chest screening was included in the general screening program for the elderly population in many municipalities. Third, the cost for individuals receiving screening increased and the following diagnostic work-up costs were charged to health insurance instead of municipalities. Furthermore, the municipalities recently initiated the bid for the screening, which may have resulted in assignment of screening to the companies conducting it at low cost without sufficient consideration of accuracy. As a result screening participants may not be offered a uniformly accurate screening program. If the lung cancer screening is conducted without consideration for quality control, the usefulness of lung cancer screening will be lost. Therefore, it is necessary for municipalities to disclose information about the screening outcome, and we must reconsider the best lung cancer screening system for all municipalities and participants.
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