Yoshito Matsubara

Operation for lung cancer in patients with idiopathic pulmonary fibrosis: surgical contraindication?

BACKGROUND Patients with idiopathic pulmonary fibrosis have an increased incidence of lung cancer. The purpose of this study was to determine the outcome of surgical treatment of lung cancer with idiopathic pulmonary fibrosis. METHODS From January 1992 through December 2001, 64 patients who had simultaneous lung cancer and idiopathic pulmonary fibrosis were treated. Twenty-one (33%) of them underwent surgical resection of lung cancer, and their data were reviewed. RESULTS There were 56 men and 8 women with an average age of 69 years (range, 43 to 85 years). In the surgical group, there were no early postoperative deaths, and nonfatal complications occurred in 2 patients (10%). Among the 14 patients with stage I cancer, a second primary lung cancer developed in 5 (36%). The causes of death in the surgical group were cancer related in 7 patients, exacerbation of idiopathic pulmonary fibrosis in 7, and other in 2. Five of the 7 patients who died of a cancer-related cause had development of a second primary lung cancer. The actuarial 2-year survival rate of the surgical group was 52% overall, 58% for patients with N0 or N1 disease and 25% for those with N2 disease (p = 0.05). CONCLUSIONS The long-term results in one surgical group were poor partly because of the high incidence of a second primary lung cancer and partly because of the poor natural history of idiopathic pulmonary fibrosis. These patients require intensive surveillance even after curative resection of lung cancer.

Pattern of Lung Cancer in Turkey, 1994–1998

Background: Lung cancer is the most common neoplasm in Turkey, but there is not enough data on the characteristics of this mortal illness in our country. Objectives and Methods: The Turkish Thoracic Society, Lung and Pleural Malignancies Study Group (TTS-LPMSG) conducted a national retrospective hospital-based study to determine the pattern of lung cancer in Turkey. Results: A total of 11,849 lung cancer patients were studied between 1994 and 1998, 90.4% were male and 9.6% were female. The majority of patients were smokers (77.9%) or ex-smokers (10.8%). The mean age at the time of diagnosis was 58.4 years (20–84) and 56.7% of the patients were aged between 46 and 65 years. The most common histological types were squamous cell (45.4%), small cell (SCLC; 20.5%) and adenocarcinoma (20.2%). The majority of patients with non-small-cell lung cancer were diagnosed with metastatic disease (40.4%). Of the patients with SCLC patients, 37.9% had limited stage disease and 62.7% extensive stage disease at diagnosis. Conclusion: The results of the largest data so far collected in Turkey show that the vast majority of patients with lung cancer are male, squamous cell is the most common histological type, and only a small proportion of patients are diagnosed at an early stage.

Carcinoembryonic antigen producing cultured cell lines enable detection of autoantibodies in sera from patients with gastrointestinal cancer

Of 16 human malignant tumor cell lines established in our laboratory, seven lines, including three gastric cancer cell lines derived from patients with cancer, were found to carry carcinoembryonic antigen on their cell surface, as determined by radioimmunoassay and indirect immunofluorescence. The existence of antibodies (IgG class) against the gastric cancer cell lines (HPE‐GAC‐T, ‐2, ‐3) and lung cancer cell line (HPL‐Ad‐K) in the sera of patients with gastrointestinal cancer (incidence 70.8%) was demonstrated by indirect immunofluorescence. In nonmalignant cases and healthy controls, the incidence was 7.7 and 3.2%, respectively. Specificity of the antibodies detected in the sera of patients with gastric cancer was examined by absorption and blocking test methods of immunofluorescence. Even though there was an apparent heterogeneity of the specificity among the antibodies, the detection of such antibodies may be a feasible and practical approach to a clinical diagnosis of malignancy. Cancer 50:1775‐1782, 1982.

Respiratory Failure due to Vocal Cord Paresis in Myasthenia gravis

This report describes a female patient with myasthenia gravis who developed respiratory failure due to vocal cord paresis. The diagnosis was delayed due to the absence of other myasthenic symptoms (e.g. ptosis, muscle weakness and dysphagia). On direct laryngoscopy, her vocal cords were seen to be in the paramedian position and to move apart after the intravenous injection of edrophonium. The patient initially presented with ocular myasthenia and later returned with isolated respiratory failure. A review of the pertinent literature revealed few reports on myasthenia gravis presenting in this manner.

Synovial Sarcoma of the Mediastinum: Report of a Case

We report a case of synovial sarcoma of the mediastinum, a very rare tumor, in a 50-year-old man hos-pitalized with anterior chest pain. Chest X-ray and computed tomography (CT) on admission showed a 10 × 8-cm mass in the right anterior mediastinal space, compressing the superior vena cava. A diagnosis of sarcoma was established by a CT-guided percutaneous needle biopsy. Systemic examination revealed no metastasis to the contralateral pleural cavity or other distant organs, and we resected the mediastinal sarcoma. Pathological and immunohistochemical analyses confirmed a diagnosis of monophasic synovial sarcoma. The patient is alive with recurrence 9 months after his operation, and is receiving chemotherapy with ifosfamide.

An Amebic Lung Abscess: Report of a Case

Abstract Recently the number of amebiasis cases has increased in Japan. Pleuropulmonary amebiasis is a very rare complication of liver amebiasis. We report herein the case of a 54-year-old man presenting with an amebic lung abscess in his right lower lung. The diagnosis of lung amebiasis was established from a direct examination of the pus in which trophozoites of Entamoeba histolytica were detected. After the oral administration of metronidazole, the laboratory findings improved and he thus underwent a right lower lobectomy. He was discharged without any relapse of infection 20 days after a thoracotomy. We conclude that a protozoan infection should thus be suspected in the case of a pleuropulmonary infection in which several types of antibiotics prove to be ineffective.

Study of NCC-ST-439 in patients with lung cancer

Abstract NCC-ST-439 is a glycoprotein recognized by a monoclonal antibody (ST-439) which is obtained by using a human gastric cancer xenograph, ST-4, as an immunogen. Using a Lana Enzyme Kit from Nippon Kayaku, we measured the serum level of NCC-ST-439 in 223 patients with lung cancer, 344 patients with benign lung diseases and 97 healthy adults. When we adopted a cut-off level of 4.5 U/ml for women aged 50 years or more and for men of any age, and 7.0 U/ml for women aged less than 50, the overall positive rates were 22.0% for the lung cancer patients, 7.0% for patients with benign lung diseases and 3.1% for the healthy adults. The positive rate of the lung cancer patients was significantly higher than for patients with benign lung diseases (P According to the histological type of lung cancer, the positive rates were 34.3% for 105 patients with adenocarcinoma, 9.8% for 68 patients with squamous cell carcinoma, and 16.7% for 6 patients with large cell carcinoma. Classification of the lung cancer patients revealed positive rates for serum NCC-ST-439 of 0% for 40 Stage I patients, 8.3% in 12 Stage II patients, 12.5% in 48 Stage IIIA patients, 37.0% in 46 Stage IIIB patients, and 33.3% in 45 Stage IV patients. After we performed immunostaining for NCC-ST-439 using ST-439, positive immunoactivity was demonstrated mainly in the membrane of adenocarcinoma cells. NCC-ST-439 thus seems to be a tumor associated marker in patients with lung adenocarcinoma.

Correlation between Loss of Heterozygosity of p53 Gene and Amplification of Oncogenes in Cases of Resected Lung Cancer.

凍結保存していた切除肺癌組織と同一患者の正常肺組織60例を用いて, p53遺伝子の腫瘍特異的多型性喪失 (LOH) と, myc系, ras系, c-erbB-2遺伝子の増幅について検討した. 対立遺伝子がhomozygote (HOMO) であったのは37例, heterozygote (HETERO) であったのは23例で, このうち7例でLOHを認めた. LOHのあった症例のうち他の癌遺伝子に増幅を認めたのは1例だけであり, HOMO症例では12例 (46%) で他の癌遺伝子の増幅を認めた. LOHは病期別ではI期2例 (8%), IIIA期3例 (19%), IV期2例 (25%) で認め, 組織型別では腺癌5例 (15%), 扁平上皮癌2例 (9%) で認めた. HETERO症例のうち, LOHのあった症例の平均生存期間 (MST) は22カ月, LOHの無かった症例のMSTは19カ月で有意差はなかった. p53のLOHは病期が進むほど増加するが予後との関連性は無く, 組織型との関連性も無かった. 癌遺伝子の増幅はLOHを認めない症例で多くみられた.