Tasuku Nakada

Clinicopathological analysis of 19 cases of isolated carcinoma in situ of the bronchus

Nineteen cases of isolated squamous cell carcinoma in situ (CIS) of the bronchus were described clinicopathologically from among 149 male heavy smokers with roentgenographically occult lung cancer discovered mainly by mass screening performed from 1982 to 1991. All 19 patients had positive sputum cytology tests and negative chest x-ray films and underwent lobectomy (except one who had segmentectomy because of poor lung function). Prior to operation, localization was accomplished by one to eight bronchoscopies using repetitive brush cytology and biopsy. Five cases were bronchoscopically invisible. Polypoid protuberance was noted in three cases, micronodular swelling in three, thickening of spur in five, and mucosal granularity in three. Histology by serial block sectioning showed that there was no nodal involvement in any cases; the maximum length or diameter was 12 mm. Thirteen tumors were 4≤ mm, four of which were confined to the spur where they occurred. Follow-up data showed a favorable prognosis. Segmentectomy or sleeve resection of bronchus without mediastinal lymph node dissection may be adequate for CIS

Clinical and prognostic assessment of patients with resected small peripheral lung cancer lesions

One hundred fifteen patients with small (≦2 cm in diameter) peripheral lung cancer lesions underwent surgical treatment in the Department of Surgery, the Research Institute for Chest Diseases and Cancer, Tohoku University, Miyagi Prefecture, Japan. the authors investigated several prognostic factors of these cases. the 5‐year survival rate of these 115 patients was 70%. Various factors such as histologic type, nodal involvement, pleural involvement, pathologic stage, and curativity of the operation were revealed to affect survival significantly. in patients with and without nodal involvement, there was no significant difference between the survival rate of patients with lung cancer lesions smaller than 2 cm and those with lesions 2.1 to 3 cm. However, the rate of lymph node metastasis was significantly different in the group with lesions smaller than 2 cm compared with those with lesions 2.1 to 3 cm (21% versus 43%, respectively).

Relationship Between Length of Longitudinal Extension and Maximal Depth of Transmural Invasion in Roentgenographically Occult Squamous Cell Carcinoma of the Bronchus (Nonpolypoid Type)

This study was designed to verify our hypothesis that there are two different growth types in roentgenographically occult squamous cell carcinoma of the bronchus. Serial blocks prepared from the entire bronchial tree of 83 resected specimens of occult carcinoma were used for the evaluation of the relationship between the length of longitudinal extension and the maximal depth of transmural invasion. We prepared a length-depth diagram of 92 lesions, including multifocal carcinomas, which confirmed that there are at least two types: Most of these lesions are of the creeping type, which shows a marked superficial growth; the minority are of the penetrating type, which shows a marked downward growth. The diagram suggests that occult carcinoma has a propensity either for longitudinal growth along the bronchial lumen or for transmural growth into the bronchial wall at the time of occurrence. It is likely that the penetrating type grows rapidly and becomes advanced in a short time. Identification of longer lesions of the creeping type is occasionally problematical both at bronchoscopy and at surgical treatment. The stump is usually positive for carcinoma unless frozen sections or imprint specimens of the margin of resection are examined, because it is frequently difficult to identify the proximal end of extension by bronchoscopy.

Increased Alveolar Fluid Clearance Following Thoracotomy: Report of a Case and Results of an Analysis

Alveolar fluid clearance was studied in the resected lung of a 58-year-old man who had undergone exploratory thoracotomy 9 days earlier. An isosmolar albumin solution was instilled into the distal air spaces, and the albumin and electrolyte concentrations were measured over 4h. Alveolar sodium and fluid clearance had increased by nearly 200% from the control values in the resected lungs of patients without prior thoracotomy (n=5), and histological examination showed that the number of alveolar type II epithelial cells was markedly elevated. These results suggest that an increase in the number of alveolar type II cells may accelerate alveolar fluid clearance under certain clinical conditions.

The granulocyte colony-stimulating factor produced in the human lung and its effect on liquid movement in the rabbit lung

Levels of the granulocyte colony-stimulating factor (G-CSF) were determined in the plasma and resected lung tissue from patients who underwent pulmonary resection. Moreover, the effect of recombinant human (rh) G-CSF on the permeability of pulmonary endothelium and on liquid clearance from the alveolar spaces was investigated in rabbits. The plasma levels of G-CSF increased from 30 pg/ml preoperatively to 409 ± 236 pg/ml 3 h postoperatively (P < 0.05), while the levels of G-CSF in the resected lung tissue were increased in the alveolar fluid, to 1,834 ± 1,054 pg/ml, and in the pulmonary blood, to 5,466 ± 2,019 pg/ml. It was found that rh G-CSF 25 μg administered into the subcutaneous tissue of rabbits increased extravascular lung water to 3.45 ± 0.26 vs 2.98 ± 0.20 in control experiments (P < 0.05); however, rhG-CSF 0.75 pg/kg administered into the alveloar spaces did not affect liquid clearance from the alveolar spaces. The findings of this study led us to conclude that G-CSF is synthesized in the human lung and increases the permeability of pulmonary endothelium, but not liquid clearance across the alveolar epithelium.

Effects of hypothermia and hyperpotassium on alveolar fluid clearance in the resected human lung

The effect of hypothermia and hyperpotassium on alveolar fluid clearance in the resected human lung was examined by instilling an isosmotic albumin solution with a potassium concentration of 0.3 mEq/l or 20 mEq/l into one segment of a resected lobe within 10 min of surgical removal for bronchogenic carcinoma. The experiments were carried out at 37°C, 25°C, and 8°C over 4h, after which the alveolar fluid was aspirated. Alveolar fluid clearance was calculated by a simple equation using the changes in the albumin concentration of the alveolar fluid. It was found that although hypothermia at 8°C abolished alveolar fluid clearance completely, alveolar fluid clearance at 25°C was not different from that at 37°C. Moreover, although the potassium concentration increased in the alveolar fluid at 37°C and 8°C, hyperpotassium did not affect the alveolar fluid clearance. These findings indicate that the net transport of potassium leans to influx from the alveolar epithelial cells into the alveolar spaces when the alveolar potassium concentration is low, and to efflux from the alveolar spaces when the alveolar potassium concentration is high. Thus, we conclude that hypothermia abolishes alveolar fluid clearance in resected human lungs, but that the potassium concentration in alveolar fluid does not affect alveolar fluid clearance.

Preoperative estimation of pulmonary extravascular thermal volume in patients undergoing pneumonectomy

Pulmonary extravascular thermal volume (PETV) was measured during pulmonary artery occlusion in 18 patients preoperatively and 7 patients postoperatively who were undergoing pneumonectomy. We found that the PETV decreased from 6.6±2.3 ml·kg−1 before occlusion to 4.1±1.6 ml·kg−1 during occlusion. There was a significant correlation between the PETVs before and during occlusion multiplied by the fraction of pulmonary perfusion (r=0.77,P<0.001). Although the PETV increased in two patients and decreased in four within 48 h after pneumonectomy, it returned to the value during occlusion at 3 weeks after pneumonectomy in seven patients. There was a significant correlation between the PETV during occlusion and that at 3 weeks after pneumonectomy (r=0.66,P<0.05). In conclusion, PETV during pulmonary artery occlusion is a reliable baseline value in the assessment of postoperative pneumonectomy values.

Prediction of Survival Time for Patients with Lung Cancer and Assessment of Therapeutic Effect.

肺癌174例に対して, Geddesのノモグラムを用いて腫瘍径とTumor doubling time (DT) から予測生存期間を求め, 実生存期間と比較した. 予測生存期間から予測生存曲線を求め, 実際の生存曲線と比較した. さらに, 非切除48例を対象にCoxの比例ハザードモデルを用いて予測生存期間の意義を検討した. 1) 検討肺癌例では, 実生存期間と予測生存期間との間に有意な相関があるとはいえない. 2) 非切除例では, 実生存曲線は予測生存期間より求めた予測生存曲線に近接した. 一方, 切除例では, 実生存曲線は予測生存曲線より有意に良好であった (p<0.0001). 治療法の効果判定に予測生存期間の算出は有用であった. 3) Coxのモデルによる分析の結果, 非切除例では, N因子 (p=0.0011), M因子 (p=0.0146), 予測生存期間 (p=0.0265) が有意な予後因子であった.

Prognostic studies on pulmonary metastasis in cases of resected primary lung cancer from the aspect of diagnosis of multiple primary lung cancer.

肺癌切除例におけるpm症例を検討した.その結果, pmは腺癌・女性に有意に多く, またpT4例またはpN2例に有意に多くみられた.pm1を含めた腫瘍病変が肉眼的に完全に切除された非小細胞癌症例で予後を検討すると, 単発性pm例, pm1例で予後が良好であった.さらに単発性pm例およびpm1例で, それぞれpN因子別に予後を比較検討すると, pN0例・pN1例の予後は極めて良好であった.また, これら長期生存例には多発癌症例が含まれていると考えられた.従って, これらの条件を満たす症例では今後PM (pm) 例でも外科療法の適応となると考えられた.

An attempt to determine the origin of cancer by a histopathological study of squamous cell carcinoma of the bronchus less than 1mm in size.

気管支扁平上皮癌の発生母地を追究するために, 細胞診検査で発見された胸部X線写真無所見肺癌 (ROLC) 切除標本の連続ブロック切出しによる組織切片を鏡検した. その中で大きさ1mm以下の癌と, 高度異型細胞の集簇がみられたブロックをすべて連続切片にして発見された微小癌の計11病巣について, 癌の形状と隣接上皮の形態変化を検索した. 一見正常な上皮からの発生の可能性もあったが, 高度異型扁平上皮化生と高度異型基底細胞列が発生母地である可能性が示唆された.