Keiji Kanma

Clinicopathological analysis of 19 cases of isolated carcinoma in situ of the bronchus

Nineteen cases of isolated squamous cell carcinoma in situ (CIS) of the bronchus were described clinicopathologically from among 149 male heavy smokers with roentgenographically occult lung cancer discovered mainly by mass screening performed from 1982 to 1991. All 19 patients had positive sputum cytology tests and negative chest x-ray films and underwent lobectomy (except one who had segmentectomy because of poor lung function). Prior to operation, localization was accomplished by one to eight bronchoscopies using repetitive brush cytology and biopsy. Five cases were bronchoscopically invisible. Polypoid protuberance was noted in three cases, micronodular swelling in three, thickening of spur in five, and mucosal granularity in three. Histology by serial block sectioning showed that there was no nodal involvement in any cases; the maximum length or diameter was 12 mm. Thirteen tumors were 4≤ mm, four of which were confined to the spur where they occurred. Follow-up data showed a favorable prognosis. Segmentectomy or sleeve resection of bronchus without mediastinal lymph node dissection may be adequate for CIS

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.

Moderately Atypical Squamous Cells and Cancer Risk.

宮城県における喀痰細胞診でC判定の意義を検証する目的で, 喀痰細胞診C判定からの癌発生をB判定からの癌発生と比較して相対的な癌発生の危険度として算出した.昭和58年度に宮城県肺癌検診で喀痰細胞診を受診した男性のうち, 受診年度内に癌が確定した症例を除いたC判定82例, B判定7167例を対象とし, 昭和62年12月末までの肺癌および上気道癌罹患状況を宮城県地域癌登録, および検診結果との照合により把握した. その結果, 人年法で算出した10万人対の癌罹患率はB判定で274, C判定で547.8で, C判定からの癌発生の相対的危険度はB判定の1.99倍であった. しかし, 両判定からの癌発生に有意差はなかった. これらの結果から, 宮城県におけるC判定から癌が発生するリスクはB判定より高いとは言えず, C判定は本来陰性とすべきとする肺癌学会の指導区分の定義に合致した診断的意義を有していると考えられた.

Multicentricity in resected occult bronchogenic squamous cell carcinoma

The frequency and the treatment of multicentricity in 127 patients with resected roentgenographically occult bronchogenic squamous cell carcinoma were studied. The cumulative rate and the incidence of postoperative metachronous multiple primary lung cancer were 0.11 at 5 years after initial operation and 0.022 per patient-year, respectively. The cumulative rate and the incidence of second primary lung cancer, which includes synchronous and subsequent metachronous cancer in patients with initial lung cancer, were 0.17 at 5 years after the initial operation and 0.041 per patient-year, respectively. The cumulative rate and the incidence of third primary lung cancer in patients with second primary lung cancer were 0.47 at 5 years, which was significantly higher (p = 0.05) than that of second primary lung cancer, and 0.11 per patient-year, respectively. In all 12 patients with synchronous multiple primary lung cancer, no recurrence was observed after treatment, but 3 had subsequent multiple primary lung cancer. Among the 13 patients with postoperative metachronous multiple primary lung cancer, recurrence was observed in 1 of the 6 patients who underwent resection and in 2 of the 4 patients treated with laser or radiation therapy or both. The overall survival rate at 5 years after initial operation in patients with solitary and those with multicentric occult bronchogenic squamous cell carcinomas was 0.90 and 0.59, respectively.

Prognostic Factors of Primary Lung Cancer. Assessment of Tumor Doubling Time in Survival.

原発性肺癌174例に関し, 予後因子別に生存率を単因子分析し, Coxの比例ハザードモデルによる多変量解析で, tumor doubling time (DT) および他の予後因子が死亡率へ寄与する程度を検討した.1) 予後因子別に生存率を単因子分析した結果, DTの長短・年令の高低・性別・発見方法・喫煙の有無・症状の有無・治療方法・組織型・T因子・N因子・M因子・病期において有意差を認めた.2) Coxのモデルを用いた分析より, 死亡率への寄与度の大きな予後因子は, 順にN因子 (P=0.0001), 治療方法 (P=0.0016), DT (P=0.0140), M因子 (P=0.0421) であった. DTは有意でかつ独立した予後因子と判明した.

Localization of double roentgenographically occult lung cancers from the analysis of cytological findings: Discrimination of cross-contaminated cancer cells.

胸部X線無所見同時性肺二重癌における擦過標本上の癌細胞の出現様式を分析した. 結論:(1) オレンジG好性で散在性に出現する癌細胞は紛れ込んだ細胞と考えるべきである. (2) オレンジG好性で集団で出現する癌細胞や, 変性のある癌細胞は, 擦過部位から剥離したものか否かは不明であり, 他部位の擦過細胞所見との比較が董要である. (3) ライトグリーン好性で変性がなく集団で出現する癌細胞は, 擦過部位から剥離したと見なすべきである.

Prognostic studies on pulmonary metastasis in cases of resected primary lung cancer from the aspect of diagnosis of multiple primary lung cancer.

肺癌切除例におけるpm症例を検討した.その結果, pmは腺癌・女性に有意に多く, またpT4例またはpN2例に有意に多くみられた.pm1を含めた腫瘍病変が肉眼的に完全に切除された非小細胞癌症例で予後を検討すると, 単発性pm例, pm1例で予後が良好であった.さらに単発性pm例およびpm1例で, それぞれpN因子別に予後を比較検討すると, pN0例・pN1例の予後は極めて良好であった.また, これら長期生存例には多発癌症例が含まれていると考えられた.従って, これらの条件を満たす症例では今後PM (pm) 例でも外科療法の適応となると考えられた.

An attempt to determine the origin of cancer by a histopathological study of squamous cell carcinoma of the bronchus less than 1mm in size.

気管支扁平上皮癌の発生母地を追究するために, 細胞診検査で発見された胸部X線写真無所見肺癌 (ROLC) 切除標本の連続ブロック切出しによる組織切片を鏡検した. その中で大きさ1mm以下の癌と, 高度異型細胞の集簇がみられたブロックをすべて連続切片にして発見された微小癌の計11病巣について, 癌の形状と隣接上皮の形態変化を検索した. 一見正常な上皮からの発生の可能性もあったが, 高度異型扁平上皮化生と高度異型基底細胞列が発生母地である可能性が示唆された.

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.