Kumio Yokote

The role of mediastinal and multi-organ CT scans in staging presumable surgical candidates with non-small-cell lung cancer.

In order to evaluate the role of CT scan and bone scan in staging patients with non-small-cell lung cancer presumably indicated for surgery, 70 consecutive patients who underwent thoracotomy were reviewed. Most of them received mediastinal and multi-organ (brain, liver and adrenal) CT scans and a bone scan. In the most recent 40 of the 70 patients, CT findings of the mediastinal lymph nodes were compared to the pathology following complete sampling. The overall accuracy of the mediastinal CT was 60.0 per cent (12 true positive and 12 true negative), but the negative predictable value was 12/(12+3) or 80.0 per cent, whereas 3 were false negatives though they showed an acceptable postoperative course. Sixteen out of 21 patients with one, or at the most, three enlarged nodes detected on CT also did well postoperatively and retrospectively, were considered not to have required mediastinoscopy. A group of patients showing no, or at the most, three enlarged mediastinal lymph nodes on CT may be considered as candidates for surgery even without mediastinoscopy. Multi-organ survey by means of CT was believed cost-ineffective and omittable. Bone scan however, retrospectively detected three true positives among 20 patients with a positive uptake, so that it cannot be omitted out of hand, though further examination of this point is required.

Dumbbell neurogenic tumor of the mediastinum: A report of three cases undergoing single-staged complete romoval without thoracotomy

Of a total thirteen patients who underwent surgery for a neurogenic tumor in the posterior mediastinum 4 (30.8 per cent) presented with dumbbell type development of the tumor. Along with a comparatively greater incidence in the number of cases of dumbbell neurogenic tumors in the posterior mediastinum, resection has also recently become more popular, necessitating the establishment of a standard operative approach for this type of tumor. We successfully removed dumbbell neurogenic tumor from the posterior mediastinum in our 3 most recent casesvia a dorsal approach by virtue of a laminectomy and resection of a small portion of the neighbouring rib root without opening the parietal pleura at all. These three aptients were a 14 year old female, a 54 year old male and a 68 year old female, respectively, and the largest diameter in cm and level of origin of the tumors were 5.5 at Th 1 in case 1, 3.0 at Th 2 in case 2 and 3.7 at Th 11 in case 3. The operative approach described herein was easy to perform, felt secure and was less invasive and better tolerated by the patients than the thoractomy approach. Avoiding a thoractomy in such cases has many advantages to enumerate, but does not seem to have been clearly aimed at by others to date. We therefore propose our technique as a standard approach for dumbbell neurogenic tumors in the posterior mediastinum.

A Case of Resected Multiple Subpleural Intrapulmonary Lymph Nodes Preoperatively Thought to be Multiple Lung Metastases from a Sigmoid Colon Carcinoma.

症例は70歳の女性で, 結腸癌手術の術前に胸部CTにて多発結節影を指摘された. 結節影は左右計7個あり, 結腸癌肺転移と考えられた. 原発巣手術後に当科に転じた. 両側開胸下に観察すると腫瘤はいずれも径1cm以下で, 右B5周囲のリンパ節であった1個を除いて全て胸膜直下に存在し, その表面に炭粉沈着を示じていた. 病理学的には6個が胸膜下肺内リンパ節で他の1個は肺門リンパ節であった. 悪性所見は全く認められなかった. 肺内リンパ節が胸膜直下に発現することは希で, 画像上癌の肺転移との鑑別は困難である. 本症例のごとく画像上指摘される多発性の全病巣が反応性肺内リンパ節であるような症例は報告されておらず転移性腫瘍の治療方針上参考とすべき知見と考え報告した. 炭粉沈着が特徴であるから本症の検索には胸腔鏡下の検索が好適であろう.

Prognostic value of E-cadherin expression in resected stage I non-small-cell lung cancers

最近11年間に切除した病理病期1期肺癌102例について, T因子, 組織型, 脈管浸襲, 分化度及び接着分子であるE-カドヘリン (ECD) 発現を調べ, 予後因子としての価値を検討した.全症例の5生率は73.1%であった.T1病例 (61例) の5生率87.0%はT2症例 (41例) の54.9%に比べ有意に良好 (p<0.05) であった.Ly (-) 群の五生率は90.0%, Ly (+) 群は61.1%で有意差 (p<0.05) を見た.ECD染色判定可能であった77例を発現, 減弱の2群に分けると発現群 (32) の5生率100%に対し, 減弱群 (45) は62.1%と有意に不良であった (P<0.0028).T因子にECD発現を組み合わせて5生率をみると, ECD発現T1, 2症例は100%を示し, ECD減弱のT2症例は50.1%と成績不良であった.術後2年以内の再発死亡は5例あり, 全例腫瘍径50mm以上のT2でECDも減弱していた.以上よりI期肺癌に関する限り, ECDの発現程度は信頼に値する予後因子と考えられた.

Craniotomy for Cure of Non-small Cell Lung Cancers with Brain Metastasis as a Single Organ Metastasis.

非小細胞肺癌症例の剖検で遠隔転移が脳に限局している症例は少なくないから, 両病巣各々の局所根治的切除で治癒する症例も亦必ずしも少なくはないと期待される. 我々は従来, 胸部根治術後のその様な脳転移には開頭下転移巣切除を第一選択とし, 同時発見例には当初から脳神経外科医と一体の手術予定を立て, 先ず開頭下転移巣摘出を行い, 新たな転移の発生を極力防ぐ意味でその後僅か7-10日の短期を置くだけで開胸に進み, その後に頭部放治とシスプラチンを含む化療とを施行する方針を採って来た. 脳転移巣を後日切除した7例中2例が開頭後5年以上非担癌健在で実測5生率28.5%を得た. 開頭先行の4例に目下長期生存例はないが, 比較的良いquality of lifeで最長生存期間2年3ヵ月を得ている. 同時・異時を問わず, 根治企図での開胸・開頭による5生率30-40%の報告もあり, 進行癌での例外的手術適応として積極的に症例を蓄積したい.

Relation between prognosis of stage III lung cancer and CT findings of mediastinal lymph nodes.

Stage III非小細胞性肺癌の縦隔リンパ節のCT像と予後の関連を検討した.病理学的N2以上であった26症例を, CT像によりA群: CT陰性例, B群: 周囲浸潤を伴わないリンパ節腫大群, C群: 周囲浸潤を伴うリンパ節腫大群の3群にわけ累積生存率を比較したところ, 順に予後が悪くなる傾向を示した.CT上のリンパ節の形状に注目することは有意義であると考えられた.