Shosaku Abe

Prognostic significance of nuclear DNA content in small cell carcinoma of the lung.

The relationship between the nuclear DNA histogram patterns of tumor cells obtained by brushing via bronchoscopy and the survival time of 39 patients with small cell carcinoma of the lung was investigated. The brushing smears were stained by a modified Feulgen method. The nuclear DNA content was measured at 550 nm using a microspectrophotometer. The DNA histogram pattern was classified into type I, which contained a higher proportion of G0G1‐phase cells, and type II, which contained a higher proportion of S, G2M‐phase cells. The median survival times for the patients with limited disease of type I, type II and the patients with extensive disease of type I, type II were 17.2 months, 10.2 months, 10.0 months, and 5.6 months, respectively. Patients with limited disease of type I had a significantly longer survival time than patients with limited disease of type II. A distinct correlation was found between the histogram pattern and the survival of the patients. These results indicated that the nuclear DNA histogram pattern may be an indicator to allow speculation as to the prognosis of patients with small cell carcinoma of the lung. Cancer 56: 2025‐2030, 1985.

Chromate lung cancer with special reference to its cell type and relation to the manufacturing process

The manufacturing process of the chromate industry can be classified into five steps. The main hazardous pollutants of the first step are trivalent chromate compounds, and those of the second and third steps are hexavalent chromate compounds. Analysis of the detailed working history of chromate workers with bronchogenic carcinoma, yielded the following results: the work history of chromate lung cancer patients in the first step, which produced mainly trivalent chromate dust, was rather short. Patients with small cell carcinoma were engaged mainly in the second step (98.1% of the total working months), where they were heavily exposed to hexavalent chromate dusts. Patients with squamous cell carcinoma were engaged rather evenly in the second and fourth steps, and somewhat longer in the third step. Comparisons of the exposure periods revealed that the working history of small cell carcinoma patients was significantly shorter than that of squamous cell carcinoma patients. There were many more heavy smokers among the squamous cell carcinoma group as compared to the small cell carcinoma patients. Based on these results, it is concluded that the cell type of occupational lung cancer was mainly small cell carcinoma when the exposure to carcinogenic agents was heavy, and that the carcinogenicity of chromate was derived mainly from hexavalent chromate rather than trivalent compounds.

Nucleolar organizer regions in precancerous and cancerous lesions of the bronchus.

Using a silver staining technique, nucleolar organizer region‐associated proteins (Ag‐NOR) were studied in paraffin sections of five specimens of normal bronchial epithelium, eight of atypical squamous metaplasia, five of carcinoma in situ, and seven of microinvasive squamous cell carcinoma. The mean number of Ag‐NOR in the nucleus were normal epithelium 1.2 ± 0.1 (mean ± SD), atypical squamous metaplasia (borderline lesion) 2.2 ± 0.5, carcinoma in situ 3.8 ± 0.6, and microinvasive squamous cell carcinoma 4.8 ± 1.1. There was a highly significant difference between the Ag‐NOR numbers in the atypical squamous metaplasia and those in the carcinoma in situ (P < 0.01). The Ag‐NOR staining is a useful technique for the differential diagnosis of difficult borderline lesions in the bronchial epithelium.

Single photon emission computed tomography using201Tl chloride in pulmonary nodules: Comparison with67Ga citrate and99mTc-labeled hexamethyl-propyleneamine-oxime

A single photon emission computed tomography (SPECT) with201Tl chloride (Tl-201) was carried out prospectively in 50 patients with pulmonary nodules and its diagnostic value was compared with those of67Ga citrate (Ga-67) and99mTc-labeled hexamethyl-propyleneamineoxime (Tc-99m-HMPAO). Tl-201 SPECT provided 88% (early)–91% (delayed) sensitivity, 85% (early and delayed) specificity and 87% (early)–89% (delayed) accuracy. The sensitivity of the Tl-201 planar image was 56 (early)–62% (delayed), which was significantly lower than that of SPECT. Delayed SPECT images at 2 hour postinjection were more preferable to disclose the malignant pulmonary nodule than early SPECT images at 15 minutes postinjection. The application of SPECT with Ga-67 failed to improve the sensitivity of planar imaging for malignant pulmonary nodules. Tc-99m-HMPAO was concentrated in 62% of 13 patients with malignant pulmonary nodules, which was slightly higher than Ga-67 in 54% of 28 patients. In an analysis of the histologic types of lung cancer, the sensitivity of Tl-201 was not significantly different in all types. On the other hand, Ga-67 was positive only in 25% of 12 patients with adenocarcinoma.A combination of SPECT and Tl-201 is the best choice among routine scintigraphic techniques for depicting malignant pulmonary nodules. The Tl-201 SPECT image may play a complementary role in the characterization of pulmonary nodules which are revealed on a plain radiograph and computed tomography.

Picture Archiving and Communication System in Hokkaido University Hospital: Advantage and Disadvantage of HU-PACS Chest Roentgenogram Images in the Outpatient Clinic

A new Hokkaido University picture achiving and communication system (HU-PACS) has been in clinical use in the outpatient clinic at HU Hospital. To evaluate the quality of the cathode-ray tube (CRT) monitor images, we compared the detectability of line shadows in the chest roentgenogram images on the CRT monitor with those on the computed radiography (CR) film. We randomized chest roentgenograms from 20 patients who were admitted to the outpatient clinic with pulmonary disease. Two physicians, whose speciality is chest roentgenogram diagnosis, checked whether they could recognize a horizontal fissure line (hairline) on the posteroanterior view and a minor fissure line and major fissure lines on the lateral view. Only 30% of hairlines were recognized on CRT monitor as compared with 65% on CR film. On the lateral view, only 68% of major fissures and 53% of minor fissures on CRT monitor were recognized as compared with 89% and 79%, respective on CR film. Furthermore, it was somewhat difficult to follow entire lines on some of the CRT monitor images. Clinically, the greatest advantage of the PACS is immediate availability of images, including chest roentgenogram, chest computed tomography (CT) and magnetic resonance imaging (MRI). PACS is also convenient for consulting colleagues in other departments. Unfortunately, the quality of the image on the CRT monitor is not yet good enough to visualize line shadows and small solitary lesions on the chest roentgenogram image. Recent advances in high technology have been so rapid, however, that higher resolution CRT monitors will be available soon.

Lung small cell carcinoma and lung adenocarcinoma detected concomitantly by transbronchial brushing cytology.

経気管支擦過細胞診にて小細胞癌細胞, 腺癌細胞の2種類の悪性細胞が同時にかつ細胞数がほぼ同じ比率で検出され, その解釈に苦慮した原発性肺癌の症例を経験したので報告する.症例は, 79歳, 男性で右側胸部痛を主訴に当科入院となった.胸部X線写真では右S8に結節性病変を認めた.喀痰細胞診は入院時陰性であったが, 病勢の進行とともに経気管支擦過細胞診で検出された2種類の悪性細胞が認められるようになった.胸水細胞診では腺癌細胞が多数認められ, 小細胞癌細胞は検出されなかった.経気管支生検では, 充実性に増殖した小細胞癌細胞の集団中に, 不規則な腺腔を形成した腺癌細胞の小集団が認められる部分が数ヵ所存在した.なお他臓器には原発巣と考えられる病変は認められなかった.患者は約1年2ヵ月後死亡, 病理解剖を施行した.その結果, 腫瘍の大半は壊死に陥っており, 腫瘍の中枢側に小細胞癌, 末梢側に腺癌が別れて存在していた.以上より, 本症例は肺小細胞癌と肺腺癌の重複癌の可能性が第一に考えられたが, 経気管支生検所見, 臨床所見および臨床経過より, combined small cell carcinomaの可能性も否定できなかった

Cytodiagnostic significance of AgNORs in body cavity fluids.

胸水・腹水などの体腔液細胞診で悪性細胞か否かの診断が困難な異型細胞に遭遇することがある.このような細胞の鑑別のため, 疑陽性と判定された異型細胞のSilver-bindingnucleolarorganizer regions (AgNORs) について検討した.同じく疑陽性と判定された異型細胞でも, 悪性体腔液中の異型細胞では核内AgNORs平均個数 (mean±SD) は3.4±0.7であり, 非悪性体腔液中にみられた異型細胞での2.0±0.6に比べて有意に高値であった (P<0.01).特に核内AgNORs平均個数が3以上のときは, その体腔液が悪性である可能性がきわめて高かった.また, 疑陽性と判定された悪性胸水では, 多くが胸水CEA・核内AgNORs平均個数とも高値であるが, 前者が正常, 後者が高値の例もあった.体腔液に疑陽性と判定された異型細胞がみられた場合, 核内AgNORsの計測は体腔液の良性・悪性の鑑別に有用であった.

Immunohistochemical analysis and clinical behavior of squamous cell carcinoma indistinguishable from small cell carcinoma of the lung.

細胞診で肺小細胞癌細胞と判別しがたい低分化扁平上皮癌8例を, Neuronspeci且cenolase, Keratinに対する抗体を用いて免疫組織染色を行い, その染色性と臨床像について検討した. NSEのみ強陽性の症例は3例, Keratinのみ強陽性の症例も3例, NSEとKeratinがともに陽性のものは2例であった. NSEが染色される腫瘍の増大率は, Keratinのみ陽性の腫瘍の増大率に比して有意に高く (P<0.05), 患者の予後も不良であった (P<0.05). NSEが強く染色される低分化扁平上皮癌は臨床的悪性度も高く, 肺小細胞癌の性格を有する腫瘍と考えられた.

Nuclear DNA content of small cell carcinoma of the lung and its relationship to the cytomorphologic features.

肺小細胞癌18症例の経気管支擦過細胞を用いて核クロマチンの形態と核DNA量ヒストグラムパターンとの関係について, 化学療法に対する有効性の面から検討した.核DNA量の多いB typeを示した7症例のうち, 核クロマチンが微細顆粒状で均一に分布している細胞の多い症例は6例と多く, 化学療法に対する反応性も良好であった.核DNA量の少ないA typeを示した11症例のうち, 核クロマチンが微細顆粒状で均一に分布している細胞の多い症例は5例, 粗大顆粒状で不均一に分布する細胞の多い症例は6例であった.微細顆粒状で均一に分布する細胞の多い症例でも化学療法に対する反応性は不良であった.核クロマチンが微細顆粒状で均一に分布する細胞の多い肺小細胞癌は核DNA量も多く, 化学療法に対する反応性も比較的良好であった.しかし, 核DNA量ヒストグラムがA typeを示した肺小細胞癌は相関しなかった。肺小細胞癌症例の化学療法に対する反応性などの特異な臨床病態を推定するには核クロマチン形態のみの検討では十分とはいえず, 核DNA量の測定, 分析がより重要であることが示された.

Ultrastructure of experimental atypical metaplasia in brochial epithelium and carcinoma in situ.

20メチルコラントレン気管支粘膜下注入により実験的に気管支異型化生上皮と上皮内癌を作製し, 両者の核構造を超微形態学的に比較検討した. 上皮内癌は核不整が強く, 比較的大型の核小体を有する細胞が数多く認められた. また, 核膜周辺部にperichromatin granuleが多数観察された. 高度異型化生上皮では, 表層の細胞は核不整が強いが, 中層および基底層の細胞は不整の程度は軽度であった. また上皮内癌に比較しperichromatin granuleの出現頻度は少なく, 核小体の肥大も明らかでなかった.以上の結果から, いくつかの類似する所見を認めたものの, 核輪郭の不整の程度, perichromatingranuleの出現頻度, 核小体の肥大などの点で異型化生上皮と上皮内癌との間に差があることが示唆された.