Kenji Sawamura

Non-Hodgkin's lymphoma of the pleural cavity developing from long-standing pyothorax

Malignant lymphomas developing in tissue affected by a long‐standing severe inflammatory process of nonautoimmune nature are presented. Two men and a woman aged 50, 58, and 73 years, were admitted after 22 to 30 year histories of pyothorax resulting from artificial pneumothorax for the treatment of pulmonary tuberculosis or tuberculous pleuritis. The diagnoses at admission were chronic pyothorax associated with a lung mass. Microscopically, tumors diffusely or locally proliferated with thickened pleura were present. A histologic examination showed that all the tumors were diffuse non‐Hodgkins lymphomas (NHL) of immunoblastic type with (one case) or without (two cases) plasmacytoid differentiation. Immunohistochemistry on paraffin sections revealed restricted expression of immunoglobulin light chains in one case showing plasmacytoid differentiation. A review of the literature showed that malignant lymphomas of this type have been reported exclusively from Japan but never from Western countries.

Case‐Control Study for Lung Cancer and Cigarette Smoking in Osaka, Japan: Comparison with the Results from Western Europe

In order to clarify the relation between cigarette smoking and lung cancer, a case‐control study was conducted. The case series consisted of 1,376 lung cancer patients (1,082 males and 294 females) who were newly diagnosed and admitted to eight hospitals in Osaka during 1986–88. Smoking histories were compared with those of 2,230 controls (1,141 males and 1,089 females) admitted to the same hospitals during the same period without established smoking‐related diseases. Odds ratios of current smoker versus nonsmoker were 18.1, 1.9, 21.4, and 3.8 for squamous, adeno, small, and large cell carcinoma, respectively, for males, and 9.7, 1.3, 12.1, 3.7, respectively, for females. Compared to the results from previous studies in Japan, the magnitude of the odds ratios for squamous and small cell carcinoma is approaching the level of Western Europe in the late 1970s. Population attributable risk of exsmokers has also been increasing to the level of Western Europe. Among male current smokers, smoking intensity, such as number of cigarettes per day or fraction smoked per cigarette, seemed to have a slightly greater influence on squamous cell carcinoma than adenocarcinoma, while factors associated with the spread of cigarette smoke, such as inhalation, seemed to have greater influence on adenocarcinoma. The difference in the distribution of these smoking characteristics between Japan and Western Europe could not fully explain the difference in lung cancer incidence and distribution of histologic types between the two areas.

Lung Cancer Risk among Exsmokers

Lung cancer risk among exsmokers according to years since cessation of smoking was assessed by means of a case‐control study. The case series consisted of 1,052 lung cancer patients who were newly diagnosed and admitted to eight hospitals in Osaka in 1986–88. Smoking histories were compared with those of 1,111 controls admitted to the same hospitals during the same period without any diagnosis of smoking‐related disease. The odds ratio of lung cancer for exsmokers compared to current smokers was estimated to be 0.90, 0.50, 0.51, 0.59, 0.48 and 0.29, for 1–4, 5–9,10–14,15 19, 20 24 and ± 25 years after cessation of smoking, respectively. Risk reduction appeared to be greater for those who smoked less than the 1200 cigarette index, compared to those who smoked more. In classification according to histologic type, small cell and large cell carcinoma showed a rapid decrease compared to adenocarcinoma, while squamous cell carcinoma showed an intermediate pattern. Quantitative estimates for reduction of lung cancer risk among exsmokers can be used for projecting lung cancer incidence in the future, by assuming future trends of smoking prevalence, as well as for health education among individual smokers.

Lung Cancer Incidence Rate for Male Ex-smokers According to Age at Cessation of Smoking

Lung cancer incidence rate after the cessation of smoking was assessed for male ex‐smokers according to the age at cessation, using the results from a case‐control study for ex‐smoker versus continuing smoker, and the lung cancer incidence rate function for continuing smoker estimated from Japan Vital Statistics and the “Six‐prefectural Cohort Study” in Japan. This hospital‐based case‐control study consisted of 776 lung cancer cases (553 current smokers and 223 ex‐smokers) and 772 controls (490 current smokers and 282 ex‐smokers) who started smoking at ages 18–22. The odds ratio of developing lung cancer for ex‐smokers compared to continuing smokers according to years since the cessation of smoking was estimated for four age groups (55–64, 60–69, 65–74 and 70–79). Given that the number of years since cessation of smoking is the same, reduction of the odds ratio appeared to be greater for the younger age group than for the older age group, reflecting the shorter period of exposure for the younger age group. Lung cancer incidence rate (per 100,000) was assumed to be expressed by the following function; 1.7 × 10−5× (age – 24.3)4,5 for continuing smokers and 0.15 × 10−5× (age)4 for nonsmokers. Lung cancer incidence rate among ex‐smokers according to years since cessation was then estimated to be the above function multiplied by the odds ratio from the case‐control study for each age group. In contrast to the greater reduction of the odds ratio among younger ex‐smokers, reduction of the incidence rate, in terms of rate difference, was considerably greater for older ex‐smokers due to a high incidence rate of lung cancer for older continuing smokers. This indicates that the absolute magnitude of reduction of the lung cancer incidence rate after cessation of smoking is greater for older ex‐smokers, although the relative magnitude of reduction is greater for younger ex‐smokers.

Small cell carcinoma of the lung and its histological origin. Report of a case.

A rare lung cancer consisting in part of small cell carcinoma of intermediate cell type and in part of well-differentiated papillotubular adenocarcinoma is described. Alcian blue-PAS staining was observed in the cytoplasm of the small cell carcinoma cells; the Grimelius argyrophil reaction was also positive in the cytoplasm of these cells. Electron microscopy revealed neurosecretory granules in the cytoplasm. At autopsy, a small cell carcinoma of intermediate cell type was found with both squamous features and gland formation. The cellularity and histological pattern of this tumor suggested the existence of a transitional pattern between small cell carcinoma of intermediate cell type, squamous cell carcinoma and adenocarcinoma. From the above findings, we think that small cell carcinoma including the intermediate cell type is derived from respiratory epithelial cells of endodermal origin with dedifferentiation of those cancer cells into neurosecretory cells.

Survival Rates of Adenocarcinoma of the Lung According to Histological Subtype and the Grade of Morphological Differentiation in Resected Cases

Postoperative survival rates in 393 patients with adenocarcinoma of the lung were studied according to histological subtype, the grade of differentiation, clinical stage, size of tumor and the mode of operation.Regardless of histological subtypes better survival rates were achieved in the cases with well-differentiated adenocarcinoma. Stage I cases and curatively operated cases also showed good prognosis. There was no difference in post-operative survival rates between papillary type and tubular-cribriform type of adenocarcinoma, irrespective of the grade of morphological differentiation. This suggests the necessity of a new device for subtyping adenocarcinoma of the lung.Combination chemotherapy with cyclophosphamide, mitomycin C and 5 -fluorouracil was found to be the best postoperative adjuvant chemotherapy in this study.

Latent bronchogenic carcinoma complicated by active pulmonary tuberculosis: A case report.

症例は62歳の男性で, 排菌陽性の肺結核患者を化療中, 同一肺葉内の結核病巣内に腺癌を発見し, 外科的切除を行ないえた.活動性肺結核に肺癌が合併した場合は診断が遅れ易い.中高齢者で重喫煙者の肺結核患者には, 定期的な喀痰細胞診, 胸部X線撮影が望ましく, 疑わしい陰影が出現した時には経気管支鏡生検等の積極的診断が必要である.

Postoperative Use of Fiberoptic Bronchoscope for Bronchoplastic Surgery on Lung Cancer

Recently in many instances, bronchoscope has come to be the method of choice in order to obtain as much curability and reserve as much pulmonary function as possible in the treatment of lung cancer. After the procedure therapeutic use of bronchoscope is indicated often in the postoperative period. Here we discuss about the experience of our postoperative use of bronchoscope.

Morphological Characteristics and Prognosis of the Small Size of Peripheral Squamous Cell Carcinoma of the Lung

手術的に摘出された腫瘍径3cm以下の気管支の末梢に発生した小型扁平上皮癌15例及び中間層部に発生した小型扁平上皮癌4例の計19例について臨床病理学的に検討した. その結果, 末梢に発生した小型扁平上皮癌の中には胸膜の陥凹と腫瘍中心部に線維化巣のみられるものがあり, 末梢発生腺癌と胸部X線学的, 肉眼的に区別困難なことがしばしばであった. しかし, 胸膜の弾性板を越えて浸潤しているものはなく (p0), リンパ節転移のない (n0) ものが大部分で予後の良好なものが多かった. 末梢発生腺癌にみられた癌の中心部の線維化巣における膠原化の程度との腫瘍進展度, 予後との関係は認められなかった.

A New Trial of Mass Survey for Lung Cancer

急 増 を続 け て お り しか も進 行 癌 の 多 い肺 癌 を 如 何 に早 く発 見 す るか は,現 在 の最 大 の 命 題 の 1つ で あ る. 我 が国 よ り も10倍 近 くも肺癌 の 多 い 米 国 で は, す で にNationalLungProgramがJohnsHoPkins大 学,MayoFoundationMemorialSloanKetteringCancerCenter等 の 協 力 に よ り発 足 して お り,肺 癌 集 検 に お け る喀 疾 細 胞 診 の 意 義 が 初 め て 紹 介 され たP 我 々 は(財)大 阪 か ら肺癌 をな くす 会2)の 事 業 の 一 環 と し て,昭 和50年 以 降3年 間 に亘 り,こ の 米 国 のLungProjectの 方 法 を参考 に し て我 々 独 自の方 法 に よ り肺癌 集 検 を行 っ て きた.そ の 成 績 と今 後 の 問 題 点 につ い て述 べ てみ た い.