Hidehiko Matsumoto

Expression of thrombomodulin in squamous cell carcinoma of the lung: its relationship to lymph node metastasis and prognosis of the patients☆

Thrombomodulin (TM) is a type of thrombin receptor that was identified originally on the endothelium and acts as a natural anticoagulant through converting thrombin from a procoagulant protease to an anticoagulant. We reported previously that TM was also expressed in the squamous epithelium mainly at the intercellular bridges. In this study, we examined TM expression in the primary lesions of 81 patients with squamous cell carcinomas (SCCs) of the lung and in the lymph node metastatic lesions of 39 patients using immunohistochemical methods. The carcinoma tissues expressed TM mainly at the cell-cell boundaries and also in the cytoplasm. When TM expression was compared between the primary and metastatic lesions in the 39 patients who had lymph node metastasis, 26 (67%) showed decreased TM expression, 13 (33%) showed no change, and none (0%) showed an increase in the metastatic lesions. Wilcoxons signed-rank test indicated that tumor cells that were positive for TM expression were significantly rarer in the metastatic lesions than in the primary tumors (P < 0.0001). The present study also showed that the patients with TM-negative expression in the primary tumors showed significantly poorer survival than those with TM-positive expression, mainly due to distant metastases of poorly-differentiated SCCs with negative TM expression in the primary tumors. These results indicate that the reduction of TM expression seems to play an important role in the metastatic process of lung SCCs.

Carbohydrate profiles shown by a lectin and a monoclonal antibody correlate with metastatic potential and prognosis of human lung carcinomas

The expression of two carbohydrate markers—namely, 4C9 antigen, which is an Lex antigen, and the Dolichos biflorus agglutinin (DBA) binding site, which is an N‐acetylgalactosamine marker—was examined histochemically in tumors and adjacent nontumorous tissues of 102 cases of human lung carcinomas. In nontumorous tissues, the DBA binding site was expressed more frequently than 4C9 antigen, and the DBA binding site had a tendency to be expressed more significantly than in tumor cells. Adenocarcinomas and well‐differentiated tumors had a tendency to more cell surface staining. Patients with tumors that expressed DBA binding sites but not 4C9 antigen (4C9‐, DBA+) had fewer metastasis and significantly better prognoses than patients with tumors of other carbohydrate profiles. Better prognosis of patients with 4C9‐, DBA+ tumors was observed in those with blood group A antigen and those without it, and the better prognosis also was observed in patients with Stage I and IIIA disease.

A Case of Long Surviving Lung Cancer with Concomitant Multiple Intrapulmonary Metastasis.

症例は62歳男性. 微熱., 血痰を主訴に来院した. 胸部X線写真, CTで右肺門部の腫瘤影と下肺野に多発性の結節影を指摘された. 縦隔リンパ節郭清を伴う右中下葉切除が施行され, 主病巣と同一肺葉内に多数の肺内転移をともないp-T4N0M0, Stage IIIB中分化型の扁平上皮癌と診断された. 本症例の同一肺葉内の多発肺内転移様式として, 従来より提唱されている肺動脈を介しての肺内転移のみならず経気道性の播種性散布も示唆された. その根拠は主病巣が右B8とB9+10分岐の気管支壁より発生しB8とB9+10気管支内腔へそれぞれ進展しており, 末梢S8, 9の2区域内に多発する12個 (最小2×2mm, 最大14×7mm) の肺内転移巣のうち数ヶ所に末梢気管支内腔からの気管支壁への腫瘍の浸潤が認められたことである. 本症例は術後12年という長期にわたり生存した.