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Primary urethral malignant melanoma is an extremely rare malignancy with early metastasis and often delayed diagnosis, resulted in poor prognosis. Literature on this entity, especially with regard to urinary cytology is limited. We report here an extremely rare case of primary urethral malignant melanoma (MM) developed in a 95-year-old Japanese woman. A urinalysis showed macrophages containing brown granular pigments, and the urinary cytology was positive for atypical cells containing brown pigments suggestive of MM. Pathological examination of the biopsy specimen from the tumor revealed MM of the urethra. Immunohistochemically, the tumor cells showed strong cytoplasmic reactivities against antibodies, HMB-45 and Malan-A. Melanoma cells were immunohistochemically positive for c-Kit in their cytoplasm and cell membrane, although mutations in BRAF V600E and N/K-RAS were not detected. The urinary cytology and immunohistochemistry were useful for the rapid and accurate diagnosis for the urethral MM.

We report a case of pure struma ovarii tumor diagnosed by cytology during laparoscopic surgery. The patient was a 34-year-old Japanese woman, gravida 1, para 1, who had the left adnexal mass, and was pre-operatively diagnosed as left ovarian endometriotic cyst or mature cystic teratoma by magnetic resonance imaging findings. She underwent laparoscopy, and the content of the left ovarian cystic tumor was found to be yellow gelatinous material, suggesting mature cystic teratoma. The imprint cytology of the tumor showed benign glandular pattern, suggesting struma ovarii. Histopathological findings led us to the diagnosis of pure struma ovarii with positive reactions for thyroglobulin and thyroid transcription factor-1. No metastases or disseminated lesions were detected. The patient has no recurrent signs 7 months after the operation.

We experienced a case of serous tubal intraepithelial carcinoma (STIC), which is the earliest morphologically recognizable precursor of pelvic high grade serous carcinoma, diagnosed by cytology during the operation. A 48-year-old Japanese woman visited to our department because of abnormal cytological result and the left adnexal mass on female cancer screening. Pre-operatively, she was diagnosed as cervical intraepithelial neoplasia (CIN) 3, adenomyosis, and the left adnexal cystic lesion with papillary growth. At laparotomy, the left adnexal tumor turned out to be cystic fallopian tube with small papillary growth on the inner surface, but abnormal findings were not present on bilateral ovaries. The cytology of the imprint smears from the papillary projection and ascitic fluid showed positive, suggesting serous adenocarcinoma. Histopathological examination of the lesion revealed the left fallopian tube lesion was STIC with immunohistochemically positive reactivity against p53. No metastases including disseminated lesions were noted. The patient received four courses of systemic chemotherapy, and had no recurrent signs 10 months after the operation.

Forty-five patients with papillary or follicular thyroid carcinomas with tracheal infiltration were examined by clinical, histologic, and morphometric analyses. Twenty-four patients with completely encapsulated carcinomas (encapsulated cases) and 26 patients with carcinomas confining within the thyroid capsule (nonencapsulated cases) were examined as controls. Patients with tracheal infiltration were significantly more often male and older than the patients without (P less than 0.01 and P less than 0.05, respectively). The histologic grade of differentiation did not correlate with tracheal infiltration. The nuclear area of tumor cells was significantly larger in the cases with tracheal infiltration than in the cases without (P less than 0.01). In 12 recurrent cases with tracheal infiltration, the nuclear area of recurrent tumors was significantly larger than those of their own primary tumors (P less than 0.01). These results confirm that thyroid carcinomas with tracheal infiltration were more frequent in male and older patients and had more significant nuclear atypia than the tumors without tracheal infiltration.

病理病期I-IIIA期の非小細胞肺癌に対する術後化学療法の効果に関する臨床研究の対象となった症例を, DNA ploidy patternによって後層別化し予後を検討した.対象をI期とII・IIIA期の2群に分け, 各群を無作為割付によりそれぞれ2つの治療群に分けた. I期はA群: 術後CDDP+VDS (CV療法)×1コース+5-FU経口投与, B群: 術後化療無施行, II・ III A期はC群: 術後CV療法×2コース+5-FU経口投与, D群: 術後5-FU単独経口投与に分けた. このうちDNA ploidy patternが検索可能であった128例についてDNA ploidy pattern別に予後を検討した.I期のdiploid症例の5生率はA群81.2%, B群100%であり, 無化療のB群に比べCV療法を行ったA群の方が有意に予後不良であった (p=0.03). I期のaneuploid症例の5生率は, A群83.5%, 群78.9%で予後に差を認めなかった (p=0.98). II期・III A期のdiploid症例の5生率はC群25.0%, D群58.3%で, 予後に差を認めなかった (p=0.44). II期・III A期のaneuploid症例の5生率はC群32.7%, D群8.3%であり, CV療法を行わなかったD群に比べCV療法を加えたC群の方が, 予後良好な傾向があった (p=0.07).術後化学療法の検討に際して, DNA ploidy patternによる層別化を図ることは意義があるものと考えられた.

Objective: The role of surgery in the treatment of patients with pulmonary and hepatic metastases from colorectal cancer has not been delineated. Methods: Of the 351 patients enrolled in the Metastatic Lung Tumor Study Group of Japan between June 1988 and June 1996 who underwent thoracotomy for pulmonary metastases from colorectal cancer, 47 also underwent hepatic resection for metastatic tumors. The records of these patients were studied. Results: The 47 patients who underwent pulmonary and hepatic resection had a 3-year survival of 36% ± 8%, a 5-year survival of 31% ± 8%, and an 8-year survival of 23% ± 9%. The longest survival was 98 months. This patient was alive without recurrence. There was a significant difference in the cumulative survival of the patients with a solitary pulmonary metastasis and the patients with multiple pulmonary metastases ( P = .04). Neither age, sex, location of the primary tumor, maximum diameter of the pulmonary metastases, method of pulmonary resection, number of hepatic metastases, nor method of hepatic resection was correlated with survival. However, 9 of 10 patients who survived 3 years or more after the initial thoracotomy had only one or two hepatic metastases. Conclusion: Surgical treatment of a solitary pulmonary metastasis concurrent with or after resection of hepatic metastases from colorectal cancer may be appropriate if the hepatic metastases are resectable for cure. Patients with a solitary pulmonary metastasis and a small number of hepatic metastases are good candidates for resection. Long-term survival can be expected. (J Thorac Cardiovasc Surg 1999;118:1090-6)

歯肉溝滲出液成分を用いた診断をさらに発展させるためには液採取法についての共通の了解が必要である。液採取時間や採取回数は極めて重要であるが, 現在, 特に頻回採取についてコンセンサスが得られていない。本研究の目的は歯肉溝滲出液の硫酸化グリコサミノグリカンの測定に際して採取初回と2回目以降のサンプルのどちらが良いかを評価するために行った。健康, 歯肉炎, 成人性歯周炎の歯192本から30秒間, 2回滲出液をペーパーストリップスで採取した。採取後, ストリップスを0.05M塩化マグネシウム, 0.4Mグアニジン塩酸, 0.02M硫酸, 0.25%トライトンX-100を含むpH1.5に調整した0.2%アルシアンブルー溶液で染色し, クロマトスキャナーで分析した。2回目の試料より初回試料に含まれる硫酸化グリコサミノグリカンが多いものは, 81部位 (47.9%) であるのに対し, その逆は37部位 (21.9%) であった。2回目試料が初回試料より多く硫酸化グリコサミノグリカンを含有する比は歯肉炎スコアならびにプロービング深さが大きくなるに従って増加した。in vitroの実験においてペーパーストリップスは液量が過多に存在するときには全ての液を吸い上げが困難であることが分かった。本研究の結果から歯肉溝滲出液の硫酸化グリコサミノグリカン測定のためには2回目試料より初回試料を用いる方が望ましい'と思われる。

この報告は重度な歯槽骨吸収を伴った上顎切歯のスペースクロージングを固定性の小矯正装置を用いて改善した長期臨床例である。患者は47歳の女性であり, 重度な骨吸収を伴う上顎前歯部の病的移動を主訴として来院した。口腔内診査の結果, 大部分の歯に歯周支持組織の破壊が認められた。歯周初期治療後にエラステイック材料を用いた簡易な固定性小矯正装置によってスペースクロージングを行った。スペースクロージング後, 上顎前歯部の残存する深い歯周ポケットに対してフラップ手術を行い, さらに金属性舌面板を接着し永久固定を施した。スペースクロージングならびにフラップ手術後1年間は1カ月の1回, その後は3～6カ月の1回のメインテナンスケアーを行い, 約13年間のプロービングデプスと歯槽骨は良好な状態で安定している。以上の治療経過から, 歯周支持組織が骨破壊を伴う上顎切歯部のスペースクロージング 53著しく減少した患者に対して簡易な固定性矯正装置で上顎前歯の病的移動を改善することができた。この改善された位置はプラークコントロールを容易にし, 長期間の予後も良好である。

非小細胞癌の治癒ないし相対的非治癒切除術後の症例に対し, 術後化学療法が生存期間を延長させうるかどうかを検討するため無作為抽出試験を行った.I期症例をA群 (n=63), B群 (n=66) に分け, A群には術後CDDP+VDSを投与し, さらに術後2年間5-FUの経口投与を行った.B群は無治療群とした.II期, III期をC群 (n=32), D群 (n=31) の2群に分け, C群には術後CDDP+VDSを2クール行い, さらに術後2年間5-FUの経口投与を行った.D群は術後2年間5-FUの投与を行った.5年生存率はA群79.4%, B群86.3%, C群25.0%, D群22.6%で, AB群間, CD群間とも有意差を認めなかった.CDDP+VDSによる術後化学療法はこれらの症例における術後生存率を改善しなかった.

Benign cystic mesotheliomas (BCMs) are extremely rare tumors usually occurring in females of reproductive age. A 13-year-old Japanese girl presented with abdominal pain, and an adnexal cystic tumor was suggested by images. At

Thirty-six patients underwent tracheobronchoplastic procedures for treatment of tuberculous tracheobronchial stenosis. The modes of operations were left upper sleeve lobectomy in 13 patients, sleeve resection of the left main bronchus in 12 patients (two underwent concomitant left upper lobectomy), right upper sleeve lobectomy in five patients, sleeve resection of the right intermediate bronchus in two patients, right sleeve superior segmentectomy of the lower lobe in one patient, sleeve resection of the trachea with concomitant left pneumonectomy in one patient, carinal resection with right upper sleeve lobectomy and middle lobectomy in one patient, and dilatation of the left main bronchus with a free skin graft reinforced with a steel wire in one patient. One patient died of pulmonary edema of unknown cause on the first postoperative day. Anastomotic stenosis occurred in seven patients. One of these patients underwent reoperation and six underwent endoscopic dilatation. One patient died in the hospital of massive bleeding during endoscopic dilatation 4 months after operation. Slight to moderate stenosis resulted in the remaining patients. Although there are some complications, we believe bronchoplastic operation is worthwhile for restoring pulmonary function in patients with tuberculous tracheobronchial stenosis. ( J Thorac Cardiovasc Surg 1993;106:1118-21)

Seventeen patients with tracheobronchial stenosis due to mediastinal disease were treated. These were twelve males and five females and ranging in age from 23 to 77 years. Diseases included esophageal carcinoma in 8, mediastinal tumor in 5 (2 intrathoracic goiter, 1 teratoma, 2 germ cell tumor), metastatic lymphadenopathy in 3 (2 breast cancer, 1 thyroid cancer), and aortic aneurysm in 1. The stenotic site was the intrathoracic trachea in 10, the right main bronchus in 2, and the left main bronchus in 5.Irradiation by a YAG laser and insertion of a T-tube for tracheobronchial stenosis due to esophageal carcinoma was very useful for improving dyspnea. In cases of benign mediastinal tumor and aortic anerysm, tracheal stenosis was diminished by surgical treatment.

Two hundred and twenty five cases of metastatic lung tumor treated by operation were studied. The cases and ten years survival according to the primary site are following. 1) osteosarcoma; 32, 20%, 2) soft part sarcoma; 22, 19%, 3) choriocarcinoma; 33, 49%, 4) colo-rectal cancer; 43, 14%, 5) renal cell carcinoma; 21, 23% 6) carcinoma of the uterus (cervix); 22, 44%, 7) carcinoma of the uterus (body); 7, 71%, 8) breast cancer; 20, 23%, 9) tumor of the testis; 13, 38%, 10) melanoma; 6, 0%, and others; 9. Of 9 patients with more than 9 years-disease free interval, only 4 are alive less than 5 years, while remainders could not survive more than 6 years. On the contrary fifteen patients, whose disease free interval were less than 1 year are alive more than 5 years, 7 patients of them more than 10 years.These results means the survaival is strictly restricted to the character of the original tumor. We emphasized that 1) Surgical indication must be cared from the oncological standpoint, 2) Full disccusion between the involved departments and enough chemotherapy to start operation are needed, 3) Bilateral posterolateral thoracotmy is superior to the median or transverse sternotomy because of providing best operating field concerning individual side of the thorax for gentle handling to the tumor with minimum traction. This approach, even in a same day, assures sufficient resection which means nor excessive, neither too small resection.

An improved method for inserting a silicone T tube through a tracheostomy stoma in patients with subglottic stenosis is presented. A silicone T tube is pulled into the trachea with a catheter that is inserted into the tracheostomy stoma, advanced through the stenotic subglottic space, and pulled out the mouth. A cone-shaped dilator is placed beforehand at the proximal end of the vertical limb of the T tube to facilitate the passage of that end through the stenotic subglottic space. This method was used in 4 patients with good results. We suggest this technique be tried when attempts to insert a T tube by the usual method fail, as it can be performed under local anesthesia without special instruments and is technically easy.

We developed a method for measuring the activity of type III collagenolytic enzyme in lung cancer tissue, using as substrate, type III collagen purified from human placenta. In this method [3H]propionate is used for labeling type III collagen, with bacterial collagenase used for making the standard curve. It, therefore, becomes possible to compare type III collagenolytic activity with those of other collagen subtypes (types I and IV). As this method is a fibril assay it is not susceptible to trypsin or other proteases. The average type III collagenolytic enzyme activity was higher in squamous cell carcinoma than in adenocarcinoma, while that of lung cancer tissue exceeded that of normal lung tissue. The activity of type III collagenase increased with the progression from one disease stage to the next.

Operative methods, in relation to the completeness of resection and surgical results, and postoperative complications, in relation to operative methods, were discussed in 60 patients with advanced thyroid carcinoma in whom tumor invading the trachea was resected along with thyroid carcinoma. Laryngotracheal anastomosis was performed in 41 patients and tracheotracheal anastomosis in 19 patients. Complete resection was performed in 22 patients in the former group and in 12 patients in the latter group. Three-, 5-, and 10-year survival rates in patients undergoing complete resection were 87.0%, 78.1%, and 78.1%, respectively. Those for patients undergoing incomplete resection were 64.9%, 43.7%, and 24.3%, respectively. The locations of remaining tumor were the tracheal stump in patients in whom resection was incomplete. In four patients with esophageal invasion, the muscular layer of the esophagus was resected. Three of these patients had good postoperative results. Postoperative complications consisted of stenosis at the anastomosis in two patients, temporary mis-swallowing in three patients, temporary lower pharyngeal stenosis in one patient, temporary vocal cord edema in one patient, and tetany in two patients.

A case of massive true thymic hyperplasia with non-Hodgkin's lymphoma of the mediastinum is reported in a 14-year-old boy. Computed tomographic scan of the chest showed a mass of the anterior mediastinum and conspicuous swelling of the lymph nodes in the upper and lower mediastinum. They were grossly resected. The tumor of the anterior mediastinum was histologically diagnosed as true thymic hyperplasia. All of the mediastinal lymph nodes were diagnosed as non-Hodgkin's lymphoma, diffuse, mixed small and large cell type.

Fifty-eight patients (47 with papillary, 6 with follicular, 2 with medullary, and 3 with undifferentiated carcinoma) were treated surgically for thyroid carcinoma infiltrating the trachea. Thirty-eight had had prior thyroidectomy. Tracheal resection lengths were 1 ring to eleven rings (average 6 rings). After circumferential resection of the involved segment of the trachea, 39 were reconstructed by laryngotracheal anastomosis and 19 by end-to-end tracheal anastomosis. For the 58 patients, the 10-year survival rate was 57.5%. Resection and reconstruction of the trachea invaded by thyroid carcinoma provides not only prevention of suffocation due to airway obstruction but also an opportunity for cure.

Nine patients with adenoid cystic carcinoma of the trachea were managed by resection, on occasion combined with postoperative radiation therapy. In all patients the trachea was reconstructed by primary anastomosis and there were no serious postoperative complications. Residual microscopic disease was found in 6 patients and they received a course of postoperative irradiation. Of the 6 patients, one died of advanced multiple pulmonary metastases without local recurrence in the fifth year after treatment, and five are alive and clinically free of tumor at 1, 2, 3, 4, and 5 years respectively after finishing the treatment. It is suggested that postoperative radiation therapy may be effective to delay or obviate local recurrence in patients with adenoid cystic carcinoma of the trachea.

Three Cases of tracheal stencsis due to metastasis to paratracheal and paraesophageal lymphnodes from esophageal carcinoma were reported.Though the most common symptom associated with esophageal carcinoma is dysphagia, chiefcomplain of the 3 cases was dyspnea followed by hoarseness. When patients have dyspneawithout dysphagia, it is usually delayed to be diagnosed esophageal carcinoma, because trachealobstruction is a life-threatening emergeney that requires immediate therapy.The first patient had dyspnea and hemoptysis followed by hoarseness. Bronchoscopic examinationdisclosed carcinoma which occluded the lumen of the mid-trachea. Nine tracheal ringswere resected and a primary anastomosis was carried out. After operation, esophagographyshowed filling defect of middle third of esophagus due to carcinoma.The second patient complained of worsening dyspnea and hemoptysis followed by hoarseness.A tracheostomy was carried out immediately, and a tracheal tube was inserted. Tomogramsconfirmed tracheal narrowing above the carina, so diagnosed the mediastinal tumor that compressedthe frachea. An emergency operation to excise the tumor was performed. Microscopic examinationshowed that the tumors was metastatic lymph nodes of squamous cell carcinoma.After operation, esophagography showed filling defect of lower esophagus due to carcincma.The third patient was admitted for dyspnea and dysphagia followed by hoarseness. Bronchoscopyshowed a circumferential constriction 5 cm below the cords. Dyspnea was not so severethat he received 6000 rads of Linac. Brushing the lumen of the pcsterior wall of the occludedtrachea yielded the diagnosis of squamous cell carcincma. Esophagography showed stenosis ofmiddle third of esophagus due to carcinoma.The first presenting symptom was hoarseness, but at that time they were diagnosed as idiopathic paralysis of recurrent laryngeal nerve. When paralysis of recurrent laryngeal nerveappears, the true cause must be sought for by means of chest x-ray film, tomography and endoscopic examination of the trachea and esophagus.

The effect of bronchial circulation on wound healing at the site of anastomosis after right upper sleeve lobectomy was studied in dogs. In two dogs (Group I), the bronchial arteries were carefully preserved during the sleeve lobectomy. In 16 dogs (Group II), only sleeve lobectomy was performed after all bronchial arteries in the hilum were ligated. In three dogs (Group III), the site of anastomosis was wrapped by a Penrose drain after sleeve lobectomy. In three other dogs (Group IV), the site of anastomosis was wrapped with a free pleural flap after sleeve lobectomy. In another group of 11 dogs (Group V), the anastomotic site was wrapped with a pedicled pleural flap. The dogs in Group I were put to death immediately and bronchial arterial circulation was recognized to consist primarily of systemic arterial blood. In Group II dogs, bronchial arteries distal to the anastomosis filled with pulmonary arterial blood immediately after the sleeve lobectomy. Although the majority of bronchial arteries became filled with systemic arterial blood with time, some vessels were filled with pulmonary arterial blood even 7 days after the sleeve lobectomy. In Group III dogs, wound healing at the site of anastomosis was severely delayed, and 7 days after the sleeve lobectomy the majority of bronchial arteries in the bronchial wall distal to the anastomosis were filled with pulmonary arterial blood. In Group IV dogs, the state of wound healing at the bronchial anastomotic site was similar to that of Group III dogs. In Group V, although the state of wound healing at the anastomosis was relatively good in most of the animals, the pedicled pleural wrap did not significantly improve bronchial circulation over that of Group II.

With recent progress in surgical techniques and postoperative managements, radical operations for lesions in the trachea and bronchus have been aggressively performed. Tracheoplasty is mainly performed in patients with tracheal stenosis secondary to tracheostomy, tracheal invasion of thyroid carcinoma, tracheal injuries and primary malignant tumors. Bronchoplasty is performed in patients with lung cancer, tuberculosis, bronchial injuries and benign tumors. Operations for lesions in the tracheobronchus consist mainly of sleeve resection and end-to-end anastomosis. It is now evident that primary anastomosis is possible even if it necessitates a wide resection of the trachea.In tracheobronchoplasty, not only operative technique but also anesthetic technique is important. Accumulation of carbon dioxide and the occurrence of arythmia should be prevented.This paper summarizes the indicaion, surgical method and anesthetic technique for surgery of the tracheobronchus.

To determine the histologic grade of malignancy of thymoma, the nuclear areas of epithelial cells of 42 thymomas, 14 thymic hyperplasias, and ten normal thymuses were measured by morphometry and the results were compared with the extent of disease, association with myasthenia gravis (MG), and histologic subtypes of the thymomas. The nuclei of epithelial cells of thymomas were significantly larger than those of both of thymic hyperplasias and normal thymuses (P < 0.01). The nuclei of epithelial cells of invasive thymomas were significantly larger than those of noninvasive ones (P < 0.001). In the noninvasive group, the nuclei of epithelial cells of thymomas associated with MG were significantly larger than those without MG (P < 0.02), and were similar to those of invasive thymomas. These results confirm that invasive thymomas are morphometrically malignant tumors, and suggest that noninvasive thymomas associated with MG might have malignant potential. Cancer 61:982-988, 1988. HERE HAS BEEN a great deal of controversy regardT ing the pathologic and clinical characteristics of thymoma. In describing thymomas. it is usual to divide them into benign and malignant types. Many authors deny the possibility of differentiating between them on the basis of histologic findings, and emphasize that the most important prognostic factors are gross findings at It also has been shown histologically and immunohistochemically that the epithelial cells of most thymomas, even invasive ones, resemble those of the normal thymic On the other hand, some other authors emphasize that it is possible to differentiate between benign and malignant types on the basis of histologic criteria.*-1° This controversy is due to a lack of objective data to determine the histologic criteria. In general, nuclear changes in tumor cells are determinant factors in the assessment of the grade of malignancy. These include changes in size, shape, and texture of nuclei which can be measured morphometrically by

There are three types of tracheal stenosis following intratracheal intubation and tracheostomy. They are; stomal stenosis which occurs at the site of tracheostomy, cuff level stenosis which occurs at the site of an inflated cuff of an intratracheal tube and tip stenosis at the site of a canula tip by irritation of a tracheal tube.Up to date we have treated 3 cases of stomal stenosis, 3 cases of cuff level stenosis and one case of tip stenosis by means of tracheal reconstruction. In one case of stomal stenosis, tracheal stenosis recurred after reconstruction. This was due to an inadequate resection of the lesion of tracheal malacia. Operative results were satisfactory in the other cases.Oblique tomography and flow-volume curve to diagnose tracheal stenosis and high speed ci ne tracheography to evaluate the state of postoperative airway passage were useful.This paper deals with the methods of diagnosis and surgical technique for tracheal stenosis and also deals with methods to evaluate the airway passage following reconstruction of tracheal stenosis.

Delayed hypersensitivity reactions before therapy in 137 patients with lung cancer and in 50 patients with benign thoracic lesions were evaluated by 2,4-dinitrochlorobenzene (DNCB) contact sensitization using the patch test. Ninety-eight percent (49/50) of control patients and 46 percent (62/137) of patients with lung cancer were sensitized by 250 mug of DNCB. There was an excellent correlation between the initial reactivity to DNCB and resectability. In patients with resectable lung cancer, preoperative DNCB reactivity has no prognostic value. However, an excellent correlation was found between postoperative reactivity and 2 year survival, i.e., conversion from unresponsive to responsive status was observed on sequential testing. In 15 of 74 patients with resectable disease, the conversion was noted postoperatively, and among 12 patients followed for 2 years, only two patients had died. Conversion from a reactive to nonreactive status to DNCB occurred only in the terminal stage of the disease. From these observations, we found that, in order to evaluate the afferent limb of cellular immunity in patients with lung cancer who have once expressed reactivity to DNCB, one must use some new sensitizing agents which show no cross-sensitivity with each other thereafter.

Twelve cases of adenoid cystic carcinoma of the trachea and main-stem bronchus were histologically analyzed, and the results were examined with reference to the growth pattern of the tumor and the prognosis. The tumors were histologically classified into tubular, cribriform, and solid subtypes. Three histologic grades were established: grade I, tumors with tubular and cribriform subtypes but without solid subtype; grade II, tumors with tubular and cribriform subtypes in which the solid subtype comprised less than 20% of the area; grade III, tumors in which the solid subtype comprised more than 20% of the area. Three gross infiltrating types were established: type I, entirely intraluminal; type II, predominantly intraluminal; type III, predominantly extraluminal. In most cases histologic grade correlated with gross tumor type; that is, grades, I, II, and III were grossly types I, II, and III, respectively. The tumors infiltrating along the tracheobronchial wall were of the tubular or cribriform subtype, but not of the solid subtype. In two patients who died of distant metastasis, the histologic studies revealed the solid subtype. Immunohistochemical analysis demonstrated that the tubular subtype was the most differentiated form and the solid subtype, the most undifferentiated form. The histologic subtype of adenoid cystic carcinoma of the tracheobronchial tree was an important factor in the growth pattern of the tumor and the prognosis.

Twenty-seven cases with invasive thymoma were treated with surgery and/or radiotherapy. Twenty-six of them consisted of 9 stage II, 11 stage III and 6 stage IV a tumors by Masaoka's classification, while remaining one had recurrent tumors. All cases of stage II were treated with resection only; and there has been no recurrence of tumors. Among stage III patients, all 4 patients treated with local irradiation and 2 of 3 treated with only resection were deceased from the recurrence of tumors. The remaining 4 stage III patients were treated with entire hemithorax irradiation after resection, all of whom are alive and free from relapse for 13 to 81 months. Two stage IV a patients treated with entire hemithorax irradiation of 20 Gy suffered from recurrent pulmonary infections secondary to irradiation pneumonitis. In 2 of stage IV a cases and relapsing one, intensive chemotherapy (CHOP) before radiotherapy up to 15 Gy including entire hemithorax was performed, which proved quite recommendable because all 3 patients are alive and well with no pulmonary complications or relapse for 9 to 15 months.

The changes in small cell carcinoma of the lung (SCLC) in response to chemotherapy and/or radiotherapy were examined immunohistochemically. Epithelial and neuroendocrine markers were analyzed in eight patients with SCLCs who had preoperative adjuvant therapy and in 18 who did not have preoperative therapy. In the former group, five patients had chemotherapy only, two had radiotherapy only, and one had both radiotherapy and chemotherapy. Keratin and secretory component (SC) were used as markers of epithelial cells, and gastrin releasing peptide (GRP), neuron specific enolase (NSE), and Leu 7 were used as markers of neuroendocrine cells. There were no differences in percentages of positive staining for keratin, SC, NSE, and Leu 7 between the two groups. On the other hand, fewer patients who had received preoperative adjuvant therapy showed positive staining for GRP than those without preoperative therapy. It appears that the neuroendocrine nature expressed by GRP was decreased in SCLC by chemotherapy and/or radiotherapy.

We consider that in the majority of cases, bloody sputum or hemoptysis in nonmalignant diseases is derived from the bronchial circulatory system. Selective bronchial arteriographic examination was performed in 122 patients with benign pulmonary diseases. In the markedly hypervascular group, the patients who had blood in sputum were significantly larger in number than those of moderate or mild groups. Bronchopulmonary anastomosis was found in 45 patients. Out of the 45 patients, 23 had blood in sputum or hemoptysis whereas 19 of the remaining 77 without anastomosis had this episode. The difference in frequency of blood in sputum or hemoptysis between these two groups with or without the anastomosis was statistically significant (P

Lung cancer tissues from 68 patients were examined for epidermal growth factor (EGF) receptor levels and EGF receptor gene copy numbers. Histologic cell types of these lung cancer tissues included squamous-cell carcinoma (n = 30), adenocarcinoma (n = 28), large-cell carcinoma (n = 4), and small-cell carcinoma (n = 6). Tissues of squamous-cell carcinoma exhibited exceptionally high 125I-EGF binding activity, and those of small-cell carcinoma showed no EGF binding activity. Southern blot hybridization analysis revealed EGF receptor gene amplification in the squamous-cell carcinomas with high EGF binding activity. The EGF receptor levels in squamous-cell carcinomas and adenocarcinomas were compared with their pathological staging grouping and pathological findings, including degree of differentiation, diameter of tumor, and lymph node metastasis. However, unlike previous reports on breast and bladder cancers, there was no obvious correlation between these pathological characteristics and the EGF receptor levels of lung cancer.

A 31-year-old Japanese woman, who had been treated for 8 years with steroids and azathioprine for systemic lupus erythematosus for 8 years, was referred to our hospital for surgical treatment of right spontaneous pneumothorax. Air leakage was massive despite chest tube drainage for more than 40 days. Bacteriological examination of the discharge through the chest tube revealed Pseudomonus maltophilia and β-Streptococcus.Operation was performed on the 57th day after insertion of the chest tube. At operation several bullae were present mainly in the right upper lobe. Pneumothorax was due to rupture of one of them.Bullectomies were performed. The patient was discharged on the 58th POD although wound infection had occurred postoperatively.Microscopic examination of biopsied lung tissue revealed no typical parenchymal changes of SLE.

Thymic epithelial cells of cortex and medulla were studied by histological, morphometric, and immunohistochemical analysis. Epithelial cells in the cortex had large round nuclei with fine chromatin and conspicuous nucleoli. Those in the medulla had oval to spindle-shaped nuclei with irregular margins, coarse chromatin, and inconspicuous nucleoli. The nuclear area of epithelial cells in the cortex was significantly larger than in the medulla. Immunohistochemical studies showed that the epithelial cell in the outer cortex contained Leu7 and keratin, while those in the inner cortex and in the medulla contained keratin but no Leu7. These results show that the epithelial cells of the cortex and medulla differ histologically, morphometrically, and immunohistochemically.

Although metastatic thyroid tumors are rarely seen clinically, patients with this metastasis usually have a poor prognosis. On occasion, a favorable prognosis can be obtained by surgical treatment of the thyroid, as seen in cases with metastatic thyroid tumor from renal cancer. Therefore, early, accurate diagnosis of this metastatic lesion is necessary to improve the prognosis of patients with this type of metastasis.The first case was a 48-year-old female who presented with multi-nodular goiter accompanied with tenderness. She was diagnosed as having metastatic undifferentiated adenocarcinoma. Exploration for the primary nidus revealed thyroid metastasis from stomach cancer. Although chemotherapy was started, she soon took and unfavorable turn.The second case was a 58-year-old female who presented with a nodular goiter in the left thyroid lobe. She had undergone resection of the rectum due to rectal cancer 7 years before, and left pneumonectomy due to metastatic lung tumor 4 months before. Left lobectomy of the thyroid was performed. Pathological diagnosis was made, and thyroid metastasis from rectal cancer was determined. She has been leading a normal daily life since the last operation.

Tracheal silicone T-tube was used as a stent in the management of 5 patients with glottic stenosis due to bilateral vocal cord paralysis occurred after the resection of the trachea infiltrated by thyroid carcinoma. The upper limb of the T-tube is brought through the vocal cords with preservation of a functional voice and without injury to the vocal cords. The T-tube provides respiration through the nasopharynx, so that humidification and phonation are maintained. It is generally trouble free and remains in place for five or six months. After the extubation of T-tube, the patients are possible to breathe and phonate almost normally without dyspnea.

We have treated surgically 7 patients with tracheal injury, 6 patients with tracheal stenosis caused by tracheostomy, and 20 patients with primary or secondary tracheal tumors in the past 20 years. Five of the 20 patients with tracheal tumors had resection of the carina. In 3 of the 5 patients, a new carina was created by anastomosing the trachea with the left main bronchus and the right intermediate trunk. In 4 patients, 9 rings or more the trachea were resected.All of the 33 patients were treated by primary anastomosis.Eight of the 33 patients died. In 3 of the death cases, the cause was unrelated to the surgery. Eight patients had complications.

We have treated surgically 20 patients with malignant tracheal tumors for the past 14 years.In 11 of the 20 patients, thyroid cancer had infiltrated into the tracheal wall. Ten of the 11 patients had the damages of the cervical trachea. In the remaining one patient, thyroid cancer which had occurred in the mediastinum infiltrated into the lower trachea and the right main bronchus.In 4 patients with lung cancer, cancer which had in the right upper lobe bronchus infiltrated into the lower trachea through the right main bronchus.There were 2 patients with adenoid cystic carcinoma and one patient with leiomyosa rcoma.The remaining 2 patients consisted cf a patient in whom the parathyroid cancer had infiltrated into the cervical trachea, and a patient in whom the lymph nodes with metastasis of the esophageal cancer had involved the large part of the trachea.Five of the 20 patients died. A patient with thyroid cancer in the mediastinum died 7 days after the operation because the suturing was inadequate. A patient with lung cancer died of sudden hemoptysis 24 days after the operation. A patient with thyroid cancer extended from the trachea to the right subclavian artery and the right common carotid artery died of bleeding 4 months after the first operation. A patient with adenoid cystic carcinoma died of a metastatic tumor of the lung 5 years and 4 months after the operation. A patient with esophageal cancer died of general weakness.

原発性肺癌に対して肺切除術を行った130例の術前循環器系既往歴, 合併疾患, 心電図所見, 術後不整脈発生率等を各年令群別に比較し, 高年令者の循環器系の特徴を検討した.術前の高血圧合併, 心電図異常, 術後不整脈発生率は60才を境にして上下で有意差があった.狭心症の既往を有する60才台の3例中2例が術後早期に心筋梗塞で死亡し, 高令でかかる循環器系疾患を合併した肺癌患者の手術に於いては慎重な配慮が必要と言われた.

The patient of osteogenic sarcoma develops pulmonary metastasis with high incidence. To estimate the duration of a given tumor and the time of inception, we calculated retrospectively the growth rate of tumor. If the growth rate of tumor before treatment is assumed to be constant, the majority of patients of osteogenic sarcoma had already developed pulmonary metastasis when symptoms from primary tumor appeared. Patients who are diagnosed as osteogenic sarcoma should be treated for pulmonary metastasis as well as for primary tumor even if there is no abnormal density on the chest roentgenogram.Bronchial artery or pulmonary artery infusion using anticancer agents for osteogenic sarcoma without visible metastasis on the chest roentgenogram is a treatment of choice.