Ryuhei Tateishi

Oat‐cell carcinoma of the lung. Clinical and morphological studies in relation to its histogenesis

Twenty‐four cases of oat‐cell carcinoma of the lung and four cases of bronchial carcinoid tumor were studied electron microscopically. Determinations of serotonin in serum and tissue were performed on these cases, and ACTH was assayed in the tumor tissue of seven cases. Neurosecretory‐type granules were usually observed in the tumor cells, and they were found concentrated in the pseudopod‐like cytoplasmic processes. Serotonin levels in serum and tumor tissue of these cases were frequently elevated and seemed to correlate to the number of neurosecretory‐type granules in tumor cells. In five out of seven cases of oat‐cell carcinoma, ACTH and serotonin were simultaneously detected in the tumor tissue. In 139 cases of other types of lung cancer, these granules were not observed, and either serotonin level or ACTH activity was not elevated in the tumor. These results strongly suggest that oat‐cell carcinoma is a special type of lung tumor producing neurosecretory‐type granules and also that it is a highly malignant variant of bronchial carcinoid tumor developing from Kulchitsky‐type cells found in bronchial glands.

Argyrophil cell carcinomas (apudomas) of the uterine cervix

Of a series of 97 invasive carcinomas of the cervix, 5 were found to have argyrophil tumor cells, and 3 of these 5 tumors were studied by electron microscopy. The ages of the 5 patients ranged from 36 to 49 years, with a mean age of 42.4 years. The morphologic features of these five tumors were well consistent with those described on a variety of endocrine polypeptide neoplasms such as thyroid medullary carcinomas, carcinoids, pancreatic islet-cell tumors, and oat cell carcinomas of the lung. Microscopically, the 5 tumors were characterized by the formation of solid-sheets, ribbons, streams, and rosettes. They were characterized electron microscopically by the presence of neurosecretory-type granules, the abundance of intracytoplasmic microfilaments, the absence of tonofibrils, and the paucity of desmosomal attachments. On the basis of the microscopic, electron microscopic and cytochemical characteristics, it is suggested that the tumors are a specific type of cervical carcinoma derived from the argyrophil cells, normally found among the linings of the endocervical glands and the cervical squamous epithelium. We believe these 5 tumors should be regarded as an endocrine tumor, another member of apudomas.

Bronchial brushing and bronchial biopsy: comparison of diagnostic accuracy and cell typing reliability in lung cancer.

A total of 443 patients with lung cancer underwent brush and forceps biopsy through a fibreoptic bronchoscope. The biopsy was taken from the area of suspected malignancy which had been brushed. Of 443 patients, 400 (90.3%) showed positive results on brushing and 287 (64.8%) on biopsy. A combination of both techniques yielded the highest percentage of positive diagnosis (93.7%). Histologically, there was a high incidence of positive diagnosis for squamous and small cell carcinoma. One hundred and three (83.7%) of 123 specimens obtained by brushing and 75 (81.5%) of 92 specimens obtained by biopsy agreed with the cell type found in the surgical or necropsy specimen. Cell typing accuracy was higher in squamous and in small cell carcinoma in both techniques. As the cell typing accuracy of the two methods is similar, the results obtained by both techniques should be taken into consideration in the management of individual cases of lung cancer.

Argyrophil cell carcinoma (apudoma) of the esophagus

In a series of 79 cases of primary esophageal carcinoma resected at The Center for Adult Diseases, Osaka, there were six tumors with specific histopathologic features valid for the diagnosis of argyrophil cell carcinoma. Of the 6 tumors, 3 were studied electron microscopically and assay for ACTH content was performed on 4 tumors. Clinically, the ages of the 6 patients ranged from 56 to 71 years; two were women and four men. Four of the 6 patients died with widespread tumor recurrences within 9 months of operation. Microscopically, the 6 tumors were composed largely or almost entirely of small, spindle-shaped cells resembling those of oat cell carcinoma of the lung, and were characterized by the arrangement of tumor cells in solid sheets or anastomosing cords, the presence of argyrophil tumor cells, and the deposits of amyloid. Electron microscopically, the three tumors contained neurosecretory-type granules. Using bioassay or radioimmunoassay ACTH activity in the tumor tissues was detected in 3 out of the 4 tumors determined. From the light and electron microscopic characteristics and the assay evidence, it seems reasonable to conclude that the 6 tumors are endocrine polypeptide producing tumors (apudomas) that arise from argyrophil cells normally found among the basal cells of the esophageal mucosa, and that they represent a distinct histopathologic entity clearly distinguishable from other types of esophageal carcinomas.

Glycosaminoglycans in human lung cancer

The quantitative changes of glycosaminoglycans in tumor tissue of human lung cancers (2 squamous cell carcinomas, 4 adenocarcinomas and 5 small cell carcinomas) were studied. The total amount of glycosaminoglycans in human lung cancer tissues increased 1.4 to 4 times in comparison with that in normal lung tissues. The increase in tissue content of glycosaminoglycans was accompanied by an increase in the chondroitin sulfate level in every histologic type of lung cancer, as well as by a marked increase in hyaluronic acid level in squamous cell carcinomas, and a moderate increase in its level in small cell carcinomas. The concentrations of dermatan sulfate and heparan sulfate in lung cancer tissues did not show any significant changes compared with those in normal lung tissues. The increase in total amount and changes in the composition of glycosaminoglycans in human lung cancer tissue were closely related to the histologic type of the tumor.

A cytologic study on small cell carcinoma of the esophagus

The cytologic picture of small cell carcinoma primarily arising from the esophagus was studied with 7 cases which were confirmed by histologic examination. Cytomorphologic characteristics of small cell carcinoma of the esophagus are as follows: the arrangement of groups of tumor cells is irregular and overlapping with indistinct cell boundaries. The cytoplasm is small, or sometimes absent. The nuclei are round, oval or occasionally spindle shaped. Nuclear borders are thin. The chromatin of finely granular pattern has increased and is evenly distributed.

Pleural lavage cytology immediately after thoracotomy and before closure of the thoracic cavity for lung cancer without pleural effusion and dissemination: Clinicopathologic and prognostic analysis

AbstractBackground: The significance of intraoperative pleural lavage cytology (PLC) in lung cancer patients without malignant effusion remains undetermined in terms of staging, prognosis, and local management. Methods: PLC was performed both after thoracotomy and before closure of the thoracic cavity in 325 patients with lung cancer without malignant pleurisy. Results: According to the PLC results (positive [+] or negative [−] after thoracotomy/before closure), the patients were classified as follows: group A (−/−), 262 patients; group B (+/−), 19; group C (−/+), 22; and group D (+/+), 22. In comparison with group A, group C showed more advanced stage with aggressive nodal involvement, and group D showed more advanced lung cancer related to pleural and nodal involvement, whereas group B showed characteristics similar to those of group A. The rate of pleural recurrence in group D was the highest (26%). In particular, pleural recurrence was seen in the patients with a relatively large number of adenocarcinoma cells in PLC after thoracotomy. The patients in groups C and D, especially those with adenocarcinoma, showed poorer prognosis, but in a multivariate analysis, PLC status was not an independent prognostic factor. Conclusions: PLC status after thoracotomy provides useful information in the detection of high-risk subgroup for pleural recurrence. Although PLC status is closely associated with survival, its prognostic value is not independent.

bcl‐2 oncoprotein in surgically resected nonsmall cell lung cancer: Possibly favorable prognostic factor in association with low incidence of distant metastasis

The bcl‐2 oncoprotein serves a regulatory function in permitting several cell types to die in an apoptotic process. Its overexpression probably plays a role in tumorigenesis and tumor development. The aim of this study was to determine the clinicopathological and prognostic significance of the bcl‐2 oncoprotein in patients with nonsmall cell lung cancer (NSCLC).

Prognostic Factors for Surgically Treated Lung Adenocarcinoma Patients, with Special Reference to Smoking Habit

Prognostic factors for lung adenocarcinoma patients who had been treated surgically at the Center for Adult Diseases, Osaka, in 1978–87 (N = 267) were analyzed In terms of year of operation, sex, age at operation, postsurgical stage, grade of differentiation, and smoking habit. Survival was improved for later year of operation (1983–87), younger age at operation, stage I or II, well or moderately differentiated adenocarcinoma, and nonsmoking status in univariate analysis. A proportional hazards model including the above variables showed that stage III and stage IV patients had 4.06 and 8.81 times higher risk of death compared to stage I and II patients. Poorly differentiated adenocarcinoma showed 2.01 times higher risk of death than well or moderately differentiated adenocarcinoma. Earlier year of operation and female status showed 1.70 and 1.82 times higher risk of death, respectively, as compared to each reference group. All these hazard ratios showed statistical significance. Current smokers who smoked 1,000 or more on the cigarette index showed 2.38 times higher risk of death than nonsmokers with statistical significance. This indicates that smoking is another independent prognostic factor for patients who undergo operations for adenocarcinoma of the lung.

Primary and metastatic pulmonary meningioma

Patient 1 was a 53‐year‐old man who had a very rare primary pulmonary meningioma that developed in the left lingular segment. When this report was written, 7 years had passed since he underwent operation, and no recurrence of the meningioma had been detected. In Patient 2, a 61‐year‐old woman, multiple pulmonary metastases were confirmed 19 years after she had undergone operation for multiple cerebellar meningiomas, and the metastases were resected. After 2 years, multiple intraperitoneal metastases were found, and thus aggressive surgery was performed. Currently, 22 years after the operation for the primary cerebellar meningioma, the patient is alive without any subjective symptoms, although intraperitoneal metastases have recurred. To date, only four cases (all in women) of primary pulmonary meningioma have been reported. Case 1 reported in this article is thus the first case in a male patient to be reported, and, in addition, this patient also has the first reported case to have been evaluated for more than 5 years. In Case 2, however, each of the excised extracranial tumor lesions was histologically homogeneous and showed a hemangiopericytomatous pattern. The histologic picture of those tumor lesions was exactly the same as the picture of a small portion of the cerebellar meningiomas excised 19 years earlier. Thus, all those extracranial tumor lesions were diagnosed to be metastatic meningiomas. However, it is difficult to explain why there had been no symptoms for as long as 19 years until the pulmonary metastases were discovered.