Hideichi Suda

Clinical and prognostic assessment of patients with resected small peripheral lung cancer lesions

One hundred fifteen patients with small (≦2 cm in diameter) peripheral lung cancer lesions underwent surgical treatment in the Department of Surgery, the Research Institute for Chest Diseases and Cancer, Tohoku University, Miyagi Prefecture, Japan. the authors investigated several prognostic factors of these cases. the 5‐year survival rate of these 115 patients was 70%. Various factors such as histologic type, nodal involvement, pleural involvement, pathologic stage, and curativity of the operation were revealed to affect survival significantly. in patients with and without nodal involvement, there was no significant difference between the survival rate of patients with lung cancer lesions smaller than 2 cm and those with lesions 2.1 to 3 cm. However, the rate of lymph node metastasis was significantly different in the group with lesions smaller than 2 cm compared with those with lesions 2.1 to 3 cm (21% versus 43%, respectively).

Isolated unilateral absence of a pulmonary artery: influence of systemic circulation on alveolar capillary vessels.

We report a case of isolated unilateral absence of a pulmonary artery. The first clinical symptom that was manifested in the patient was recurrent hemoptysis, and subsequent angiography revealed that the main pulmonary artery was absent in the right lung, which was being fed only from the systemic circulation. Right pneumonectomy was performed, and neither the main pulmonary artery nor its remnant was detected in the resected right lung. Histologically, there were many muscular vessels in the resected lung, with intimal proliferation, or with plexiform‐like lesions. The alveolar septum was moderately thickened and alveolar capillary vessels were dilated. We examined the alveolar capillary endothelial cells of the resected lung for immunoreactivity to thrombomodulin (TM) and von Willebrand factor (vWF) . The endothelial cells were negative for TM and positive for vWF, while in the normal lung control group, these cells were positive for TM and negative for vWF. We considered that the hemodynamics of the systemic circulation in the resected lung caused the alteration of immunohistochemical characteristics in alveolar capillary endothelial cells.

Relationship Between Length of Longitudinal Extension and Maximal Depth of Transmural Invasion in Roentgenographically Occult Squamous Cell Carcinoma of the Bronchus (Nonpolypoid Type)

This study was designed to verify our hypothesis that there are two different growth types in roentgenographically occult squamous cell carcinoma of the bronchus. Serial blocks prepared from the entire bronchial tree of 83 resected specimens of occult carcinoma were used for the evaluation of the relationship between the length of longitudinal extension and the maximal depth of transmural invasion. We prepared a length-depth diagram of 92 lesions, including multifocal carcinomas, which confirmed that there are at least two types: Most of these lesions are of the creeping type, which shows a marked superficial growth; the minority are of the penetrating type, which shows a marked downward growth. The diagram suggests that occult carcinoma has a propensity either for longitudinal growth along the bronchial lumen or for transmural growth into the bronchial wall at the time of occurrence. It is likely that the penetrating type grows rapidly and becomes advanced in a short time. Identification of longer lesions of the creeping type is occasionally problematical both at bronchoscopy and at surgical treatment. The stump is usually positive for carcinoma unless frozen sections or imprint specimens of the margin of resection are examined, because it is frequently difficult to identify the proximal end of extension by bronchoscopy.

Combined resection of distal aortic arch for T4N0 non-small-cell lung cancer with aortic arch invasion.

Three men age: 39-51 years (mean: 43.3 years) with T4N0 lung cancer infiltrating the distal aortic arch underwent combined resection of the left upper lobe, distal aortic arch, and left subclavian artery using partial extracorponeal circulation. Selective cerebral perfusion was used in 2. One underwent induction therapy (CDDP + VP - 16 x 2 + radiation 30 Gy), and all underwent adjuvant therapy. No postoperative complications or postoperative death occurred. Average ICU stay was 2.3 days. All patients are alive without local recurrence. Two were disease-free 37 and 26 months after surgery, and 1 had adrenal gland metastasis 8 months after surgery. Extended resection of the aortic arch in lung cancer is thus feasible and worthwhile in patients with T4N0 non-small-cell lung cancer.

Results of lung cancer screening for 6 years in the miyagi program in terms of resection rate and postsurgical stage.

昭和57年～62年の6年間に延べ1,088,009名が肺癌集団検診を受診し, 398例の原発性肺癌が発見された.胸部X線写真読影により291例が, また, 高危険群 (50歳以上喫煙指数600以上) の喀淡細胞診により131例が発見された。全発見肺癌398例中278例を切除した (切除率69.8%).術後病理病期0期例と1期例の合計は全発見肺癌の48.2%を占めた.

Study of correlation between clinical malignancy and cytomorphometrical features in peripherally located adenocarcinoma of the lung.

臨床的悪性度別に擦過細胞形態の定量的解析を行い, 擦過細胞診上の予後推定因子を検討した、臨床的悪性度は, I期腺癌の予後と腫瘍陰影の増大速度で評価した.I期腺癌の絶対的治癒切除例中, 術後5年未満に癌死した10例を予後不良群, 術後5年以上の生存が確認された24例を予後良好群とした. 次に, 肺癌集検の胸部間接写真で発見し切除した末棺型腺癌のうち, 過去の間接写真にも腫瘍陰影が存在した20例を陰影増大速度小の群, 以前に腫瘍陰影は存在しなかった8例を陰影増大速度大の群とした. 予後不良群と陰影増大速度大の群を合わせたものを臨床的悪性度大の群, 予後良好群と陰影増大速度小の群を合わせたものを臨床的悪性度小の群とした。擦過細胞の,(1) 核小体数,(2) 核小体数の変動係数,(3) 核面積,(4) 核の大小不同性,(5) 核径,(6) 核円形度,(7) N/C比を画像解析装置で定量的に計測し, 両群で比較検討した.その結果, 臨床的悪性度大の群の擦過細胞像では, 核1個あたりの核小体数が多く (p<0.05), 核は正円形に近く (P<0.05), N/C比が大であった (P<0.001). 肺末梢型腺癌の擦過細胞像において核小体数, 核円形度, N/c比は予後推定因子となりうると考えられた.

In vitro growth of lung cancer cells collected by an aseptic brushing and/or biopsy via the bronchoscope.

気管支鏡下に採取した肺癌細胞の培養を試みた.カブ付き気管内チューブまたは抗真菌剤をもちいることにより細菌真菌の混入増殖を防止しえた.生検と擦過を併用して細胞を採取した11例、及び擦過によって細胞を採取した14例のうち各々8例に癌細胞の生着ないし増殖がみられた.中心型肺癌14例中10例に、また末梢型肺癌の3例では1例に癌細胞の生着又は増殖が認められた。特に気管支鏡可視範囲内に腫瘍が直接露出している小細胞癌は本法の最も良い適応と考えられた.また, 気管支鏡下に採取した正常気道上皮細胞の培養も可能であった.組織片から上皮細胞が伸展し活発な線毛運動が観察された.

Cytological Diagnosis of Bronchial Carcinoid by Bronchial Brushing Method

On five cases of bronchial carcinoid, cytological and histological findings were compared. Cytological materials were obtained by the preoperative bronchial brushing method. On resected cases, additional cytological smears were prepared from the freshly-cut surfaces of resected tumors.The conclusion reached by these examinations is that cytology diagnosed by the bronchial brushing method is useful for establishing preoperative diagnosis of bronchial carcinoid. Essential cytological manifestations of typical carcinoid are as follows;(1) Cytoplasm is foamy and lightly stained, (2) moderately increased chromatin granules are slightly coarse, (3) chromatinic rim is thin and regular and (4) nucleoli are moderately prominent.Aside from these typical findings, various aspects in cytology reflected histological patterns of carcinoid. For example, rosette formation and tubular arrangement appeared in the adenopapillary pattern and spindle-shaped nuclei were found in the smears from the case of spindle cell type. In a poor-prognostic case, nuclear pleomorphism, filled granular chromatin and multiple small nucleoli were found. This nuclear atypism suggests “potential malignancy” as has been suspected by the authors.

A case of multiple myeloma of the rib and thoracic vertebrae

A case of multiple myeloma of the rib and thoracic vertebrae in a 75-year-old man is presented, together with the results of cytologic and light microscopic examinations.The specimens were obtained by needle aspiration biopsy from the bone marrow of the sternum and the lesion of the rib. The M-G stain of the specimen obtained from the bone marrow revealed that the tumor cells had the features of myeloma cells.The cytological findings of myeloma cells stained by the method of Papanicolaou have rarely been reported. The examination of the smears after Papanicolaou stain of the lesion of the rib in the present case revealed the following features ; the cells were round to oval; the cytoplasma was faintly stained by light green and had granules; the nuclei were all eccentric, and mostly had coarse granules and prominent nucleoli.

A Case Report of Pulmonary Hamartoma with False Positive in Cytology

A 62year-old man visited our institute with a coin lesion on chest film. By sputum cytology by Saccomannos method (modified by Sato) atypical cells in cluster were found with following characteristics; Abundant cytoplasm with vacuoles, large round nuclei which are deviated in part, lots of chromatin, and one round nucleoli. Also in the bronchial brushing smear, atypical cells were found in sheets.Right lower lobectomy under the diagnosis of lung cancer revealed that the lesion was pulmonary hamartoma. The pathological examination showed that the tumor was surrounded by the monolayer cuboidal epithelium. And atypical proliferation was noted in the epithelium.The origin of atypical cells was discussed in cytological and histological point of view.