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Volume 57 (2006)
- Issue 6 Pages 471-
- Issue 5 Pages 407-
- Issue 4 Pages 335-
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Volume 57, Issue 5
Displaying 1-10 of 10 articles from this issue
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Review
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Toshiaki Kawai2006 Volume 57 Issue 5 Pages 407-412
Published: 2006
Released on J-STAGE: October 25, 2006
JOURNAL RESTRICTED ACCESSIn the upper aerodigestive tract, almost all malignant tumors are squamous cell carcinomas. Premalignant squamous epithelial lesions of this tract present dysplasia and carcinoma in situ (CIS), which also characterize nonkeratinizing lesions of the uterine cervix. However, this does not apply to the keratinizing type, and a keratinizing epithelium with dysplasia in the upper aerodigestive tract is associated with increased risk of development of carcinomatous changes.
In the 2004 WHO histological classification of tumours of the lung, pleura, thymus and heart, three kinds of preinvasive lesions were described. Thus (1) both squamous dysplasia and CIS are associated with the development of squamous cell carcinomas. Squamous dysplasia itself is divided into three types (mild, moderate and severe) on the basis of cellular pleomorphism. Studies have implicated (2) atypical adenomatous hyperplasia as a precursor of adenocarcinoma, and this lesion can be difficult to separate from the non-mucinous variant of bronchioloalveolar carcinoma. Pulmonary neuroendocrine cell hyperplasia, and also a rare disorder called (3) diffuse idiopathic pulmonary neuroendocrine cell hyperplasia, may be associated with airway fibrosis and/or obstruction. Neuroendocrine cell hyperplasia appears to be a precursor of the development of both multiple tumourlets and typical or atypical carcinoids. Accurate recognition of these lesions, as well as confirmation using molecular biological techniques, is important. Hence, an understanding of these concepts will contribute to early detection and precise treatment for lung cancer.View full abstractDownload PDF (417K) -
Shingo Ishiguro, Yoshitane Tsukamoto, Tatsuki Kataoka, Makiko Matsumur ...2006 Volume 57 Issue 5 Pages 413-419
Published: 2006
Released on J-STAGE: October 25, 2006
JOURNAL RESTRICTED ACCESSIn Japan, the definition of early cancer varies according to each organ. Early cancer of the esophagus is defined as a case in which the invasion depth is within the intra-mucosa, without lymph node metastasis.
The majority of cases of early esophageal cancer are macroscopically type 0-II. Type 0-II is subclassified into 0-IIa (mild elevated type), 0-IIb (flat type), and 0-IIc (mild depressed type). The invasion depth of a 0-IIb lesion is in the mucosa (pEP) or in the lamina propria (pLPM). The invasion depth of the majority of 0-IIa lesions are pEP, pLPM, or in the muscularis mucosae (pMM). With some 0-IIc lesions, there is pSM carcinome. In 0-type (elevated type), in some cases the lesion is not beyond the lamina muscularis mucosae.
Lymph node metastasis involves few carcinomas of type (pLPM or pLPM). Carcinomas invading the lamina muscularis mucosae (pMM) show lymph node metastasis of around 10%.
Some cases of pMM and pSM (sub-mucosal invasion depth under 200mm) are suitable for EMR. Here, the clinical pathologic findings are reviewed.
In pathological diagnosis, severe dysplasia according to WHO classification is often diagnosed in Japan as carcinoma in situ.View full abstractDownload PDF (472K)
Related Paper
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Kiyoshi Shibuya, Takahiro Nakajima, Kazuhiro Yasufuku, Takehiko Fujisa ...2006 Volume 57 Issue 5 Pages 420-426
Published: 2006
Released on J-STAGE: October 25, 2006
JOURNAL RESTRICTED ACCESSThe selection of a treatment modality can be difficult for early hilar lung cancers due to problems associated with multiple lung carcinomas and the large number of heavy smokers afflicted. Many patients also have decreased pulmonary function. If carcinoma in situ and micro invasive carcinomas (endoscopically early hilar lung cancers) can be detected early, it may be possible to treat them radically with a less invasive method than surgery, such as photodynamic therapy (PDT). We describe a strategy for early hilar lung cancer detection and treatment.View full abstractDownload PDF (492K) -
Soichiro Yamamoto, Hiroyasu Makuuchi, Hideo Shimada, Osamu Chino, Taka ...2006 Volume 57 Issue 5 Pages 427-433
Published: 2006
Released on J-STAGE: October 25, 2006
JOURNAL RESTRICTED ACCESSDiverse treatments for early cancer of the esophagus have become available in recent times. Endoscopic treatment has become the therapy of first choice for early cancer of the esophagus as it enables complete recovery with minimal invasion. However, because broad metastasis to the lymph nodes easily develops when esophageal cancer infiltrates the submucosa, diagnosis is indispensable both for early detection and to know the precise invasion depth and stage of the disease. In superficial esophageal cancer, which shows minimal symptoms, failure to examine aggressively can prevent early diagnosis. In particular, the high-risk group for esophageal cancer (males older than 55 who imbibe large quantities of liquor and tobacco; case of head and neck cancer, corrosive esophagitis, achalasia, or Barrett's esophagus with protracted and chronic inflammation; and males in cancer-prone families) requires periodic examination. Periodic endoscopy is most effective for discovery of mucosal carcinoma (m1, m2) among esophageal superficial carcinomas. By taking an iodine stain, mucosal carcinoma is clearly diagnosed as the unstained lesion, thereby preventing early cancer from overlooked. Iodine stain should be actively performed in all cases showing slightly abnormal mucosal findings and the high-risk group of esophageal cancer.View full abstractDownload PDF (483K) -
Misao Yoshida, Kumiko Momma, Yosuke Izumi2006 Volume 57 Issue 5 Pages 434-438
Published: 2006
Released on J-STAGE: October 25, 2006
JOURNAL RESTRICTED ACCESSEarly esophageal cancer can be defined as a cancer with invasion confined to the mucosa. A cancer at this stage seldom has lymph node metastasis and can be identified as a mucosal lesion that has slight elevation (type 0-IIa), slight depression (type 0-IIc) or is completely flat (type 0-IIb). Mucosal cancer can be differentiated from submucosal cancer when the gross classification is applied, for submucosal cancer has a distinct elevation (type 0-I) or remarkable depression (type 0-III). Endoscopic mucosal resection (EMR) is recommended as the standard treatment for a mucosal cancer because of low incidence of lymph node metastasis. In the case of submucosal cancer, radical esophagectomy with lymph node dissection is recommended, owing to their frequent lymph node metastasis (30-50%). Although chemoradiotherapy (CRT) has been reported as another effective measure for treatment of superficial esophageal cancer, adverse effects due to later complications such as radiation pneumonitis, pericarditis and pleuritis have not yet been studied.View full abstractDownload PDF (511K)
Case Report
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Shinsuke Suzuki, Tatsuya Fujiyoshi, Kenji Ikegami, Kazuo Ishikawa2006 Volume 57 Issue 5 Pages 439-445
Published: 2006
Released on J-STAGE: October 25, 2006
JOURNAL RESTRICTED ACCESSAlthough percutaneous needle cricothyrotomy is well known as a crucial technique for emergency airway management, nowadays the technique is also often used for airway treatment after surgery. Here, we report a case of subglottic stenosis caused by a percutaneous needle cricothyrotomy using a prepackaged kit.
A 59-year-old male was referred to our hospital with complaints of dyspnea and stridor after percutaneous needle cricothyrotomy for post-operative airway management. A reddish tumor with rough surface was observed in the subglottic space. Biopsy revealed that the mass was an inflammatory granuloma. Computed tomography and magnetic resonance imaging showed that the cricoid cartilage was ossificated, with the mass rising from the left anterior portion of the subglottic lumen. These findings indicated that the cricoid cartilage was injured when the percutaneous needle cricothyrotomy was performed, and that a granulation tumor had resulted from this lesion.
The granulation tissue was resected under endoscopic surgery, and then a silicon T-tube stent was placed in the subglottic lumen for two months. After eight months of follow-up subsequent to removal of T-tube, the patient showed no evidence of recurrent disease.
This case suggests that careful attention should be paid for possible subglottic stenosis caused by percutaneous needle cricothyrotomy.View full abstractDownload PDF (477K) -
Chiaki Koizumi, Hiroyuki Ito2006 Volume 57 Issue 5 Pages 446-450
Published: 2006
Released on J-STAGE: October 25, 2006
JOURNAL RESTRICTED ACCESSThis study investigates the amount of liquid which a patient with dysphagia drinks, the time required to swallow it, the number of times she chokes on the liquid, and the number of expectorations pooled in the hypopharynx in one day. The subject was a woman aged 37 with dysphagia after operation for cervical tumor in the vagus. She was independent with respect to ADL except for deglutition. She came to eat orally by conservative therapy. We recorded the amount of liquid which she could drink, the number of expectorations of the liquid which remained in the hypopharynx after drinking until nothing was expectorated, and the number of times she choked on liquids in a day. The average amount of liquid intake per minute per day increased. The number of expectorations and choking incidents decreased. The increase in the average amount of liquid per minute correlated significantly with the decrease in the number of expectorations. The increase in the average amount of liquid intake per minute did not correlate with the decrease in the number of choking incidents. These findings suggest that the number of expectorations is an indicator of development of swallowing function.View full abstractDownload PDF (492K) -
Kei Nishiya, Sanafumi Niijima, Hidenori Edo, Jiro Terada, Takayuki Ish ...2006 Volume 57 Issue 5 Pages 451-457
Published: 2006
Released on J-STAGE: October 25, 2006
JOURNAL RESTRICTED ACCESSIn August 2004, a 32-year-old male was admitted to our hospital due to progressive coughing and bloody sputum. He was found to have a tumor in the right main bronchus, which was histologically proven to be non-small-cell lung cancer (cT4N2M0: clinical stage IIIB). Radiotherapy (total 60Gy) and chemotherapy (CDDP 80mg/m2, VNR 20mg/m2) were administered. In October, he developed atelectasis of the right lung and pleural effusion in the right thoracic cavity. Despite insertion of a chest tube, dyspnea progressed and stenosis of the left main bronchus became a concern. In order to avoid asphyxia, we inserted two Ultraflex tracheobronchial stents, one stent was placed in the distal trachea and one in the left main bronchus. Two days later, the food remains flowed out from the chest tube and the esophagopleural fistula from the middle thoracic esophagus was confirmed by a contrast study. A covered Ultraflex esophageal stent was inserted. Gastrografin swallow on the second day after the esophageal stent insertion showed occlusion of the esophagopleural fistula. After administration of gefitinib, marked reduction of the lung cancer and complete regression of right lung atelectasis were obtained. The patient died of tumor reprogression five months after the tracheobronchial stent insertion. This case shows how esophagopleural fistula can be successfully treated with a covered esophageal stent in combination with multimodality treatment for inoperable non-small-cell lung cancer.View full abstractDownload PDF (467K) -
Hiroyuki Yamada, Tomotaka Miyamura, Tomohito Fuke, Toshifumi Tomioka2006 Volume 57 Issue 5 Pages 458-463
Published: 2006
Released on J-STAGE: October 25, 2006
JOURNAL RESTRICTED ACCESSTwo patients with complications accompanying trachestomy were treated in our department. Both patients initially formed a tracheocutaneous fistula. Both patients had been tracheostomized by digestive surgeons and tracheal cannulae had been exchanged by part-time otolaryngologists. A mediastinal tracheocutaneous fistula was formed by sternotomy in the first case. In the second case, percutaneous dilatational tracheostomy was performed, and separation of the larynx and trachea was observed. These findings suggest that surgical tracheotomy should be elected except in especial cases.
Otolaryngologists should carefully observe the stoma and tracheal wall when the tracheal cannula is exchanged.View full abstractDownload PDF (415K)
Glossary
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[in Japanese]2006 Volume 57 Issue 5 Pages 464-465
Published: 2006
Released on J-STAGE: October 25, 2006
JOURNAL RESTRICTED ACCESSDownload PDF (212K)
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