Kunihisa Hashimoto

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).

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.

Pattern of fibronectin distribution in human lung cancer.

SummaryThe pattern of fibronectin (FN) distribution in human lung cancer was studied by indirect immunofluorescent staining, and by the peroxidase-antiperoxidase method in a total of 60 surgical specimens. They comprised 8 small cell carcinomas, 4 large cell carcinomas, 19 squamous cell carcinomas, 28 adenocarcinomas, and 1 adenoid cystic carcinoma.Of the 60 specimens 13 were FN-positive. They included 4 large cell carcinomas, 4 small cell carcinomas, 3 poorly differentiated squamous cell carcinomas, and 2 poorly differentiated and 1 moderatety differentiated adenocarcinomas.On the other hand, none of the well differentiated carcinomas was FN-positive around tumor cells. Our data suggest that undifferentiated, or poorly differentiated carcinomas of the lung tend to be FN-positive.

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.

A cytomorphometrical study of early squamous cell carcinoma of the bronchus. Its comparison with electron microscopic findings.

気管支原発早期扁平上皮癌17切除例の術前擦過細胞所見 (細胞異型度, 核・細胞質の面積, 核/細胞質比, 角化細胞の出現頻) 度など) を定量形態学的に検討した.さらに光顕および電顕所見 (分化度, 深達度, 浸潤様式, 電顕上の細胞型など) と比較検討した.その結果, 擦過細胞所見上, 中～表層および深層の癌細胞の核面積, 核/細胞質比および細胞異型度の増加に伴い, 深達度や浸潤傾向の増加がみられ, さらに電顕上, 比較的明調な細胞質を有し細胞間隙が狭く比較的密に接した細胞が多くなる傾向がみられ, それぞれの問には, 良好な順位相関がみられた.また, 角化細胞の出現頻度と光顕および電顕上の分化度との間にも良好な順位相関がみられ, さらに表層角化細胞の擦過細胞像と, 電顕細胞像を対応させることが可能であった.なお, 核および細胞質の面積は中～表層細胞が最も大きく, 孤立散在性角化細胞が最小であった.

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 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.