Takeshi Yoneyama

Cell incohesiveness and pattern of extension in a rare case of bronchioloalveolar carcinoma.

A unique case of adenocarcinoma of the lung that showed aerogenous extension is presented. Although the primary focus was the usual invasive bronchioloalveolar carcinoma, the tumor cells were dissociated, floating and filling the alveolar spaces, the bronchioli, and the small bronchi at the periphery of the primary tumor and in every involved area in other lobes of the lung. Massive tumor cells were expectorated in coincidence with the appearance of abnormal densities on chest X-ray films. Ultrastructurally the dissociated tumor cells had numerous microvilli on the cell surface and rarely showed intercellular junctions. The tumor cells also contained well-developed rough and smooth endoplasmic membranes, crista-vesicular-type mitochondria, electron-dense granules, and granules with myelinlike figures. No mucous granules and no Clara-cell-type secretory granules nor lamellar bodies of the type seen in normal granular pneumocytes were seen. From these findings, it was concluded that the tumor cells in this case were rather poorly differentiated but somewhat resembled the hyperplastic cuboidal alveolar cells seen in the damaged lung and that they proliferated freely in airways, presenting aerogenous metastases. The biologic behavior of this tumor might be partly explained by the incohesive nature of the tumor cells.

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.

Treatment for the post-surgical collapse of the lung using Flexible Bronchofiberscopy

最近, 抗生物質の進歩により, 術後肺合併症のうちで重要なる気管支炎および肺炎は, はなはだしく減少せるも, 術後急性肺虚脱は依然として減少せず, 術後肺合併症として重要性が増した. 術後胸廓換気運動の障害が急性肺虚脱発生の主因と考えられる. 肺虚脱が発生すると頻脈, 不整脈が出現し, 過剰換気のために換気血流の不均等性がより一層, つよまる. 以上の病態を改善する目的で, 33症例に気管支ファイバースコープを使用し, 積極的に気道分泌物を排除する治療法を実施し, 治療効果を検討した.1) 臨床的に呼吸数の増加, 脈搏頻数, チアノーゼ等の換気循環障害を認めた症例に対して, Therapeutic bronchofiberscopeを行い, 気道内の分泌物を吸引排除すると, 換気循環障害が改善された.2) 胸部X線写真上では33例中31例に無気肺陰影の消腿が認められた3) 気管支ファイバースコープで気道内の分泌物を吸引除去すると, 機械的に気管, 気管支に刺激を加えるために, 咳反射が回復し, 肺換気機能が亢進することによって, hypoxiaの改善をもたらした.4) 気道内の分泌物が膿性の場合には蛋白分解酵素, N-Acetyl-L-Cysteine等の粘液溶解剤を注入したのちに吸引することが良い.5) 術後急性期の患者に対して, 全く危険がないこと, 苦痛が少ないことである.