Masanobu Hayakawa

Pulmonary Benign Metastasizing Leiomyoma from the Uterus in a Postmenopausal Woman: Report of a Case

We report a case of pulmonary benign metastasizing leiomyoma (BML) from the uterus in a 77-year-old woman. The patient presented for investigation of multiple pulmonary nodules on a routine chest roentgenogram. Because a preoperative diagnosis could not be made, the largest tumor, 3.5 cm in diameter, was resected from the right lower lobe, and histological examination confirmed BML. She had undergone hysterectomy with oophorectomy for uterine leiomyomas 12 years earlier, at the age of 65. The microscopic findings of the lung tumor were similar to those of the uterine leiomyoma, and both lesions were histologically benign. Although this disease is considered to be hormone-dependent, metastasis was found in this elderly postmenopausal woman whose tumor was negative for estrogen receptor.

Thymus cells in myasthenia gravis: a two-colour flow cytometric analysis of lymphocytes in the thymus and thymoma.

SummaryThe thymus in patients with myasthenia gravis has germinal centres and the thymic lymphocytes spontaneously produce anti-acetylcholine receptor antibody in vitro. This suggests indirectly that the myasthenic thymus contains mature T and B cells that are autoreactive. We report a two colour flow cytometric analysis of the surface antigen phenotype of lymphocytes in the thymus and in thymoma in 24 patients and in 14 normal thymuses. The results show a decline in the proportion of double positive immature thymocytes with age. This process seems to be partially disrupted in patients with myasthenia gravis. In addition titres of anti-acetylcholine receptor antibody were positively correlated with the proportion of mature single positive T cells and non-T DR positive cells.

Bronchoscopically undiagnosed small peripheral lung tumors

Small peripheral lung cancers (2 cm or less maximum diameter) are often surgically resected, and the survival rate of those patients has been reported to be significantly higher than that of patients with tumors 2.1 cm or more in diameter. We evaluated the status of these small tumors diagnosed during surgery, following unsuccessful transbronchial biopsy procedures. In a retrospective study, 84 consecutive patients, with a maximum diameter of 2 cm or less on chest computed tomography, were enrolled. All underwent surgery for diagnosis. Video-assisted thoracoscopic surgery was performed in 49 cases (58%), Video-assisted thoracoscopic surgery+mini-thoracotomy in ten cases (12%), and an open lung biopsy in 25 cases (30%). Primary lung cancer was found in 40 cases (48%), metastatic lung tumors in three cases (3%), and benign lung tumors in 41 cases (49%). Among the 40 primary lung cancer cases, adenocarcinoma was in 38, squamous cell carcinoma was in one, and small cell carcinoma was in one. The rate of stage IA was 90%. Surgical excision of undiagnosed small peripheral nodules without waiting is necessary if transbronchial biopsy diagnosis is unsuccessful, because of the high rate of stage IA non-small cell lung cancer.

A clinical study of lung cancer in patients with active pulmonary mycobacteriosis

近年, 抗酸菌症合併の肺癌症例が増加する傾向にある.1990年以降の10年間に当院にて活動性の抗酸菌症治療中に発見された肺癌手術症例を10例経験した.内2例は非定型抗酸菌症であった.10例の平均年齢は61歳 (47-68歳) で, 全員男性であった.10例全員に喫煙歴を認めた (B.I.550-2, 000).肺癌の組織型は扁平上皮癌7例, 腺癌3例であった.内4例に術前後に重複癌を認めた.臨床病期はIA期4例, IB期2例, IIB期1例, IIIA期3例であり, いずれも十分な抗結核薬治療を行った後に手術を施行した.手術は肺葉切除7例, 肺葉切除+胸壁合併切除1例, 肺全摘1例, 部分切除1例であった.術後抗酸菌症の再燃は認めず, 死亡は手術死1例, 癌死4例の計5例であった.抗酸菌症罹患者は肺癌発生の頻度が高いとされ, 常に両者の合併を念頭に置いて治療しなければならない.

A Case of Primary B Cell Lymphoma of the Lung.

症例は50歳の男性.検診にて右下肺野のair bronchogramを伴う腫瘤状陰影を指摘された.気管支鏡下肺生検標本の組織像にて異型性の少ない小型リンパ球の密な増殖を認め, 悪性リンパ腫が否定できないことから右下葉切除術を施行された.切除標本の免疫染色像ではIgMλのみが陽性となり, また, flow cytometoryでは表面マーカーのCD19と20が著増しており, 表面免疫グロブリンのlgMλが著増していた.この結果, 肺原発の非ポジキンリンパ腫 (diffuse, small cell type) と診断した.Southern blot法による切除標本の遺伝子解析では免疫グロブリンのみに明らかな遺伝子再構成が認められ, 免疫染色の診断を裏付ける結果を得た.術後は後療法を行わず経過観察中であるが, 3年を経過した現在, 再発は認めていない.本疾患の診断には免疫組織染色に加え, 遺伝子再構成の確認が重要であると考えられる.