Shigehiro Tsuchiya

Three New Regions on Chromosome 17p13.3 Distal to p53 with Possible Tumor Suppressor Gene Involvement in Lung Cancer

We investigated loss of heterozygosity (LOH) at the distal portion of the p53 gene on the short arm of chromosome 17 in lung cancers in order to search for new tumor suppressor genes. The roles of the putative genes were also studied in terms of pathological features. One hundred and forty‐five resected non‐small cell lung cancers were examined for LOH using 11 markers mapped on, and distal to the p53 locus, and deletion maps were constructed. Four commonly deleted regions were found: one from TP53 to ENO3, where the p53 gene resides, and three others from ENO3 to D17S1566, D17S379 to D17S1574 and distal to ABR, with LOH frequencies almost the same as, or higher than, at the TP53 locus. Examination of the relationship between LOH of the latter three regions and histopathological parameters of adenocarcinomas (genetically negative for p53 mutation) revealed allelic losses on D17S379 to be associated with advanced lesions, while D17S513 was more frequently deleted in poorly differentiated tumors. These results indicate that new tumor suppressor gene(s) may reside on these three distinctly deleted regions on chromosome 17p13.3 distal to the p53 gene in lung cancer, with possible roles in progression and differentiation of adenocarcinomas.

Immunophenotypic and molecular analysis of a case of lymphocytic interstitial pneumonia

A case of lymphocytic interstitial pneumonia was studied immunophenotypically and with molecular methods in order to clarify its lymphocytic clonality. The patient, a 43 year old Japanese female, underwent lobectomy for a suspected malignant lymphoma as no clear diagnosis could be made from the biopsy specimen. An ill‐demarcated, yellowish and elastic firm lesion measuring 60 times 35 times 20 mm in size was located in the peripheral part of the middle lobe of the right lung. Histologically, the alveolar, peribronchial‐vascular and subpleural interstitia within the lesion were thickened markedly with severe cellular infiltration largely composed of small lymphocytes with germinal centers. lmmunostaining revealed immunoglobulin (lg) kappa and lg lambda‐bearing cells to be evenly distributed, suggestive of polyspecificity. Immunoglobulin gene analysis further demonstrated the unrearranged germ‐line DNA but no rearranged band. These results strongly indicated a reactive process rather than a neoplastic nature for the lesion.

Mucosal spreading adenocarcinoma at the hilar portion of the lung

The first case of mucosal spreading adenocarcinoma at the hilum of the lung is presented. The patient was a 72 year old Japanese male smoker. The carcinoma was located at the right main bronchus with involvement of the apical, posterior and anterior segmental bronchi. The tumor consisted of stratified oval or polygonal cells and signet ring cells spreading along the bronchial mucosa in an in situ fashion with extension down the bronchial gland ducts and acini. Only a small micro‐invasive focus not extending beyond the bronchial cartilage was seen. Immunohistochemically, the tumor was positive for lysozyme but negative for lactoferrin and PE‐10 indicating that this tumor was possibly showing goblet cell differentiation.

A Case of Adenocarcinoma with Sarcomatous Change of the Lung.

症例は76歳, 男性, 喫煙指数: 20本/日×54年.背部痛にて来院.気管支鏡生検により腺癌と診断, 右上葉切除を施行した.腫瘍はS1bに存在し, 灰白色最大径32mmであった.組織学的には腺癌と肉腫様部分とからなっていた.腺癌の部分は腺房腺癌で一部に胎児肺様の核下空胞を伴う管状構造がみられたがneuroendocrine differentiationはみられなかった.肉腫様部分は紡錘形細胞よりなり, 骨・軟骨・横紋筋などへの分化はみられなかった.免疫染色では紡錘形細胞成分はkeratin, EMAは陰性, Vimentinは散在性に陽性を示した.以上より, 肉腫様変化を伴った腺房腺癌と診断した.肉腫様変化を伴った腺癌13例の報告 (5報) では, 男性10例, 女性3例と男性に多く, 平均年齢68.2歳, 肉腫様部分は紡錘形細胞肉腫様が10例, 悪性線維性組織球腫様が3例で, 本例の臨床病理像と合致していた.

A Case of Endobronchial Plasmacytoma.

症例は50歳男性, 胸部X線写真にて左肺門部に異常陰影を指摘され, 当院受診.胸部X線写真及び胸部CTにて左B3b気管支内の腫瘍が疑われた.気管支鏡検査では, 左B3bを完全に閉塞する表面平滑光沢のあるポリープ状腫瘤を認めた.生検組織所見では粘膜内に異型のある形質細胞の浸潤が見られ, 細胞質内の免疫グロブリン軽鎖はx鎖であり, 形質細胞腫と診断した.多発性骨髄腫に関する全身検索の結果, 骨髄生検, 血清蛋白では異常を認めなかったが, 頭蓋骨にpunched-out lesionを認めた.気管支内腫瘍に対して放射線療法を施行し, 気管支内腫瘍は消失した.現在, 16ヵ月経過したが明らかな病状の増悪は認めていない.気管支内形質細胞腫は非常に稀であり, 若干の考察を加え報告した.

Solid Carcinoma with Mucus Formation. Clinicopathological Correlation.

原発性肺癌のうち, WHO分類にいう粘液産生充実癌について, 腺癌および大細胞癌との比較を中心に切除肺を用いて臨床病理学的検討を加えた. 対象は1980年から1992年までに当院にて切除された原発性非小細胞肺癌709例のうち, WHO分類に基づいて診断された粘液産生充実癌20例, 高分化腺癌179例, 中分化腺癌142例, 低分化腺癌61例, ならびに大細胞癌57例の合計459例であった. 臨床病理学的検討から, 粘液産生充実癌の男女比は4:1で, 大細胞癌 (13:1) よりむしろ低分化腺癌 (3:1) に近く, また予後に関しては生存曲線が中分化腺癌とほぼ同様の傾向を示していた. さらにリンパ節転移に関しては, 腫瘍径が大きくともNOの頻度が50%と高く, 中～低分化腺癌に傾向が類似していた. このように粘液産生充実癌は大細胞癌とは異なった臨床病理学的特徴を示しており, むしろ低分化から中分化腺癌に近い性格を有するものと思われた. したがって, 現時点では本組織型を大細胞癌と分類するよりは腺癌の亜型の一つと分類しておく方が妥当であると思われる.

A Case Report of Endobronchial Metastasis of Renal Cell Carcinoma with Reference to its Metastatic Pathway and Endobronchial Growth

腎癌のいわゆるendobronchial metastasis例を経験した. 症例は50歳男性. 右腎摘出から2カ月後に咳, 痰, 胸痛, 呼吸困難が出現した. 胸部X線写真にて左上葉無気肺を認めた. 気管支鏡検査では左上幹に内腔を閉塞する腫瘍を認め, 同部のpolypectomyにて腎癌の転移と診断され, いわゆるendobronchial metastasisと考えられた. 左上葉切除を施行し, 切除標本で, 腫瘍は大きさ12mmで, B1+2c壁から細い茎を有し気管支内腔に突出し, B1+2内にポリープ状に進展していた. 病理所見では, ポリープ状の突出部は扁平上皮に覆われその下層にclear cell carcinomaの病巣が存在した. この転移巣は気管支壁内に限局しており, 経気管支動脈性転移によるendobronchial metastasis形成の典型像を呈していると考えられた.

Therapeutic problems in 51 cases of tracheobronchoplasty for primary lung cancer.

過去10年間に切除された原発性肺癌のうち, 気管・気管支形成術施行51例を対象として, その術式ならびに治療上の問題点について検討した.絶対的非治癒切除9例のうち, 切除断端癌陽性が5例あり, その部位と術中診断につき考察を加えた.縫合不全が4例にみられ, 3例を気管支肺動脈痩にて失った.4例すべて術前合併療法施行例で, 3例は気管支切除範囲が長かった.