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Patients with skin metastasis always had disseminated metastases in many organs. We herein report an unusual case with skin metastasis from small cell lung cancer (SCLC). The patient was treated with platinum-containing chemotherapy, and the response to the therapy was evaluated as partial response. The patient had slowly progressive disease and died of SCLC 16 months after the diagnosis of the diseases. If skin lesions, whether it may be typical or not, are found in SCLC patients, biopsy from the lesion would be considered to perform. Although trunk may be the most common sites, it is important to suspect such metastasis occurs in patients with SCLC.

The non-interventional management (NIM) of elderly patients with small pneumothorax has rarely reported. We show herein three elderly cases of successful treated with NIM for small pneumothorax (< 20% on chest computerized tomography scan). With adequate evaluation of chest radiographs and careful cardiopulmonary monitoring, we evaluated that NIM for small pneumothorax can be a possible therapeutic choice even in the elderly.

We report a rare case of lung adenocarcinoma with endobronchial growth in a 65-year-old woman. Chest computed tomography revealed an ill-defined mass in the lower lobe of the left lung and multiple sized nodular shadows in the both lungs. An endobronchial polypoid tumor in the left B8 bronchus was found by bronchoscopic examination. A biopsy specimen obtained from the tumor diagnosed lung adenocarcinoma. Although very rare, we should therefore keep in mind that patients who have a pulmonary tumor adjacent to the bronchus with an endobronchial polypoid lesion may have lung adenocarcinoma.

There have been few reports on clinical characteristics of lung cancer patients with previous or simultaneous upper aerodigestive cancers. To evaluate them, we conducted a retrospective study. The medical records of all lung cancer patients at our division from January 1984 through July 2008 were reviewed. Twenty-one (1.7%) of 1242 patients had previous or simultaneous upper aerodigestive cancers. Twenty patients were smokers. For non-small cell lung cancer (NSCLC), 6 patients underwent surgical resection and 3 were treated with chemotherapy. Three small cell lung cancer (SCLC) patients had chemotherapy. None of the severe complication related to the comorbidities were observed. The median survival for NSCLC and SCLC patients was 15 and 6 months, respectively. For patients with upper aerodigestive cancers, smoking cessation, a chest radiograph or computed tomography scan at least yearly and swift evaluation of signs or symptoms that are suggestive of lung cancer should be recommended.

Large-cell neuroendocrine carcinomas (LCNECs) are relatively rare, and most reported occurrences tend to involve relatively large tumors. We report a small LCNEC in a 63-year-old male patient with pulmonary emphysema. The peripheral pulmonary nodule did not have lobulation and spiculation, and it was difficult to establish correct diagnosis before surgery because of its small size and effect of surrounding emphysematous change.

Utilization of psychotropic drugs including hypnotics, sedatives, and parenteral morphine for terminally ill patients with respiratory disease has not been reported precisely. To better understand these drugs for dying patients with respiratory disease, we focused on the last month of life of them. A chart review, which was focused on symptoms and managements, in the last month of life of 337 patients who died of respiratory disease between April 2000 and March 2005 were performed. Hypnotics were prescribed in 35.8% and 23.2% of patients with malignant and non-malignant disease, respectively. Sedatives such as haloperidol and midazolam were utilized in 34.4% of patients with malignant disease, and 30.4% of those with non-malignant disease. Sixty-seven percent of patients with malignant and 22.4% of those with non-malignant disease had parenteral morphine. In patients with malignant disease, three of the main reasons for administration of morphine were pain, dyspnea, or terminal restlessness. In all of the patients with non-malignant disease, however, parenteral morphine was prescribed for the treatment of dyspnea. Our results showed that psychotropic drugs and parenteral morphine are required in some of terminally ill patients with respiratory disease. Although careful individualization of medication is appropriate, guideline for the prescribing psychotropic drugs for these patients will be required.