Search

application/pdf, A 71-year-old male was treated for suspected bronchial asthma because of dyspnea and stridor for 3 months before presenting at our hospital. Chest computed tomogram and a laryngotracheoscopy revealed a mass occupying the subglottic cavity. Instead of a laryngotracheal resection, the tumor was extirpated from the posterior wall of the subglottis and the first two tracheal rings successfully through a vertical tracheotomy just above the life-saving trachestomy tube, and was diagnosed as pleomorphic adenoma. The patient is alive and well with no recurrent tumor 12 years after surgery, without any effect on the function of the voice or swallowing., Case report

症例は72歳女性, 1年前に胸部打撲の既往あるも放置していた.翌年の検診で胸部異常陰影を指摘され近医を受診, 胸部X線, CTにて胸壁腫瘍と診断され当科へ紹介された.経皮針生検にてMalignant fibrous histiocytoma (MFH) が疑われ胸壁全層切除を伴う腫瘤摘除術を行った.肋骨は第3～6まで4本切除し胸壁欠損部は縫合糸による格子状再建を行った.腫瘍は12×6×5cmで, 異型の強い紡錘形および卵円形の腫瘍細胞が増殖し, storiform-Pleomorphic typeのMFHと診断された.術後CDDP+IFXによる化学療法を行い現在再発の徴候なく外来通院中である.胸壁原発MFHはまれであり, 本邦報告例は自験例を含めても22例のみである.

Patterns of radiologic response of 10 thymomas treated by preoperative radiotherapy (RT) (18-20 Gy/2 weeks) were determined in conjunction with histologic response. Changes in tumor volume were evaluated with CT scans obtained 5 to 36 days before and 14 to 24 days after the initiation of RT and before surgery. The extent of tumor volume reduction (TR) varied widely (40-78%), while the mean daily volume decrement expressed as a percentage of the pre-RT tumor volume correlated significantly with the pre-RT tumor volume. Histologically, the tumors, all of which were resected 17 to 33 days after RT initiation, generally consisted of predominant fibrous tissues, rare necrotic foci, and few epithelial cells. The TR did not correlate with pre-RT tumor volume, observation period, histologic subtype, or quantity of remaining epithelial cells. The TR of thymomas does not predict RT impact on tumor cells but does reflect the quantity of inherent tumor stroma.

症例は62歳男性, 15年前に左肺癌に対し左肺上葉切除術が施行された.約4か月前から出現した断続的な小量の喀血の精査と治療を目的として当院を受診した.胸部単純X線写真・胸部CTにて左S8に不整形の硬化像を, 気管支鏡検査にて左肺下葉気管支の屈曲・狭窄を認めたが肺癌再発の所見はなかった.左肺下葉の換気低下のため炎症が繰り返され気管支動脈が発達, 喀血の原因となったと判断, 気管支動脈塞栓術を計6回施行したが効果は一時的であった.喀血の頻度と出血量が増加してきたことから手術の適応とし, 気管支の屈曲狭窄が原因のため部分切除では不十分と判断し, 左残存肺全摘術を施行した.病理組織検査にてアスペルギルスの感染が証明された.術後経過は良好で患者は1ヵ月で退院し, 術後6ヵ月の現在肺アスペルギルス症の再発の所見もなく外来通院中である.

症例は71歳, 男性.左肺上葉のII期扁平上皮癌と左B6入口部の早期扁平上皮癌の同側性同時性多発肺癌と診断し, 一期的に左肺上葉切除, 左S6管状区域切除および肺門縦隔リンパ節郭清を施行した.多発肺癌および早期肺癌に対する, 根治性と残存肺機能を考慮した外科治療の一例と考えられたので報告した.

BACKGROUND Early lung cancer, not extending beyond the bronchial cartilaginous layer without regional lymph node involvement is considered curable by endoscopic laser therapy or limited surgery. The endoscopic criteria for early squamous cell carcinoma of the bronchus, however, have not yet been determined. METHODS For 44 resected lesions of roentgenographically occult bronchogenic squamous cell carcinomas, the relationship between endoscopic findings and the degree of histologic extent of tumor was examined. RESULTS The lesions were divided into three types: polypoid or nodular (PN), flatly spreading (FS), and mixed. Thirty-three lesions arising from the central bronchus included 7, 19, and 7 of the PN, FS, and mixed types, respectively. In the central lesions, the degree of transmural invasion and the greatest dimension correlated, but the degree of intramural invasion of PN-type lesions was higher than that of the FS type. The PN-type lesions smaller than 10 mm and the FS type smaller than 15 mm in greatest dimension were found within the cartilaginous layer without regional lymph node involvement. All lesions of the mixed type were larger than 20 mm. Three of the lesions larger than 20 mm had regional lymph node involvement. All 11 lesions originating in the peripheral bronchus were of the FS type, and a lesion of only 5 mm in greatest dimension had extracartilaginous invasion. CONCLUSIONS The endoscopic criteria of early squamous cell carcinoma of the bronchus may be applied to central PN lesions smaller than 10 mm and central FS lesions less than 15 mm in greatest dimension. Any lesions of mixed type should be excluded from the criteria.

To determine whether image cytometry (ICM) is advantageous for clinical DNA analyses of tumor cells, nuclear DNA contents measured by ICM were compared with those by flow cytometry (FCM), using 46 samples of non-small cell lung cancers. ICM was performed on smear specimens of fresh materials (f-ICM) and cell suspensions obtained from paraffin-embedded tumors (p-ICM). The same cell suspensions were also analyzed by FCM (p-FCM). Aneuploid rates/coefficient of variation (CV) of f-ICM, p-ICM, and p-FCM were 76.1/4.90, 71.7/5.01 and 60.9/5.31%, respectively. There was a high correlation in the DNA indices between p-ICM and p-FCM (r = 0.80). In the comparative DNA analysis, there were seven discordant samples. Six of them were estimated as aneuploid by p-ICM, but they were miscounted as diploid or undefinable (impossible) by p-FCM. This was caused by measuring condensed nuclei or debris. All "impossible" samples in p-FCM were squamous cell carcinoma with necrosis. In cell cycle analysis, the S and S+G2/M phase fractions in diploid samples were higher in p-ICM than those in p-FCM (P < 0.005), because the G0/G1 phase (2N) fraction presented by FCM was composed of cancer and non-malignant cells in diploid cancers. In ICM, they can be separately measured by means of morphological selection. These findings indicated that ICM is superior to FCM, especially for the practical DNA measurement of a few cancer cells and in the evaluation of the proliferation rates.

原発巣と同側の肺内に転移を持つ肺癌切除67例の術後成績をみて, 同側肺内転移を遠隔転移ではなく腫瘍の局所進展と考えるAmerican Joint Committee on Cancer (AJCC) 新分類の妥当性を検討した. 原発巣と同一肺葉内に留まる肺内転移を持つ41例の術後中間生存期間は25.8カ月で, 他肺葉に及ぶ肺内転移を持つ例に比べて有意に良好であった. 同一肺葉内転移例につき, 肺内転移を除いた病期別にみると, I期11例では42.9カ月と他に比べて有意に良好で, IV期5例では9.6カ月と最も不良であった. AJCC新分類による中間生存期間は, I期とII期を合わせた4例が48.3カ月, IIIA期 21例28.3カ月, IIIB期34例22.2カ月, IV期8例11.1カ月であり, リンパ節転移がないかあっても肺門までに留まる例が最も予後良好で, 肺内転移以外に明らかな遠隔転移を持つIV期例は最も予後不良であった. これは, AJCC新分類が, より臨床に即した有用な分類であることを示すものと思われる.

上前縦隔に発生したパラガングリオーマの1例を報告した.患者は65歳女性で, 住民検診で胸部X線写真上異常陰影を指摘され, 左鎖骨上窩の腫瘤と左Horner徴候を認めた.生検を施行したが易出血性のため十分な組織が得られなかった.血管造影で著明な腫瘍血管の増生を認め, 術前に血管塞栓術を施行した。血管由来の上前縦隔発生悪性腫瘍を疑って手術を施行し, 術後の病理検索にて悪性パラガングリオーマと診断された。総頸動脈壁に腫瘍が遺残したため術後放射線照射を行った, 患者は4年後の現在も再発の徴候なく外来通院中である.パラガングリオーマは血管成分に富み, また発生部位が大血管に近接することが多いので, 術前血管造影と, 大量出血の予防のための塞栓術が有用であると思われた.

患者は28歳の女性で呼吸困難を主訴として入院となった.胸部X線側面像・CTにて気管内腫瘍と診断し, 気管支鏡検査で内腔をほとんど閉塞する気管腫瘍を確認した.検査中気道閉塞の危険性が生じてきたため, 消化管用高周波スネアを用いて緊急の気管支鏡下腫瘍切除を行なった.組織診は多形性腺腫であったが, 腫瘍茎の残存を認めたため, 2ヵ月後気管管状切除術を追加して根治した.患者は根治術後6年目の現在再発なく健在である.

過去5年間に肺犬糸状虫症5例を経験した.うち2例は咳, 疾などの症状を有し, 3例は無症状で検診で発見された.胸部X線写真上は4例は銭型あるいは結節状陰影であったが, 症状が強く好酸球増多の著しかった1例では扇形陰影から1週間後に腫瘤状陰影へと変化した.5例とも診断確定のため開胸肺生検を施行した.切除標本の組織像は炎症細胞浸潤を伴う梗塞巣で, 血管内にDirofilaria immitisの塞栓を認めた.本症は必ずしも特別な治療を必要としないため, 診断には非侵襲的方法が望ましい.今回経験した5例全例にEHSA法による血清中の犬糸状虫抗体価の上昇を認め, 免疫学的検査の有用性が確認された.

早期肺扁平上皮癌組織表層の角化の程度と, 表層細胞の核形態および腫瘍進展度との関係を検討した. 対象は切除した早期肺扁平上皮癌32例の33病巣で, これらを腫瘍表層の角化の程度によって, 明らかな角化のない軽度角化7病巣, 角化は明らかだが最表層の数層に留まる中等度角化8病巣, 角化の著明な高度角化18病巣に分類した. 角化の明らかな中等度ないし高度角化8病巣が, 異型の少ない小型核を持つ角化細胞で覆われていた. これらは細胞診にて見逃され易いものである. 高度角化18病巣中, 中心型が14病巣, 気管支軟骨外進展が7病巣で, いずれも3型中最も多かった. 一方, 軽度角化7病巣では, 表層進展型が5病巣, 20mm以上の大きさの病巣が4病巣と多数を占めた. 従って, 高度角化病巣には中心型で深達進展高度なものが多く, 軽度角化病巣には表層進展型で比較的広がりの大きいものの多いことが知られた.

最近開発されたカラー画像解析装置を用いて, 非小細胞肺癌の核DNA量の計測を行い, 同時に計測した細胞形態との関係, および臨床病理所見との関係を検討した.全症例63例中, diploidyは15例 (23.8%), aneuploidyは48例 (76.2%) にみられた.まず, 得られたヒストグラムパターンからDNAploidy (diploidy: A群, aneuploidy: B群) と細胞周期のS+G2/M期の細胞数 (増加なし: タイプ1, 増加あり: タイプ2) に注目して, A-1 (5例), A-2 (10例), B-1 (20例), B-2 (28例) の4グループに分類した.A群とB群間では, 測定しえた核異型度 (核の大きさ, 核の大小不同性, 核縁の不整度) に違いがみられたが (p

An unusual benign lung neoplasm, a papillary adenoma of type II pneumocytes, was resected from a 26-year-old man who showed no clinical symptoms. The tumor was 2.0 cm in diameter and was localized in the subpleural region of S7 of the right lung; the cut surface showed a spherical medullary mass encapsulated by a thin layer of connective tissue. Histologically, there were cuboidal to columnar epithelial cells with a little nuclear atypia showing a monotonous papillary pattern with a delicate stroma in most parts of the tumor. There was neither capsular invasion nor metastasis of tumor cells. Nuclear DNA analysis of the tumor cells showed a diploid pattern and a low S-phase fraction. The immunohistochemical study revealed that most tumor cells contained a large amount of surfactant apoprotein in the cytoplasm. Osmiophilic lamellar bodies characteristic of type II pneumocytes were frequently found by electron microscopy. These findings indicate that this was a benign adenoma of the lung arising from type II pneumocytes.

最近経験した術後 MRSA 膿胸9例を対象とし, 気管支瘻の有無と残存肺容量の違いからみた膿胸の治療と転帰について検討した.無瘻性膿胸5例中4例は治癒し, 1例は開窓ドレナージで安定している.有瘻性膿胸4例中1例は内視鏡的処置で無瘻性となり治癒し, 1例は開窓ドレナージ中だが2例は呼吸不全死した.肺切除を行わなかった2例はいずれも胸腔洗浄ドレナージのみで治癒した.肺葉切除2例中胸郭成形+筋肉弁充填例は治癒し, 残る1例は開窓ドレナージで安定している.肺摘除5例中開窓+大網充填例および開窓+胸成例の2例が治癒し, 1例は開窓ドレナージ中だが残る2例は死亡した.術後 MRSA 膿胸の治療には気管支瘻の内視鏡的あるいは外科的閉鎖がまず必要であり, 次に残存肺容量に応じた縮腔術と適切な抗生剤 (バンコマイシン, 硫酸アルベカシン) 投与が重要であった.

喀痰検診5年間の成績を踏まえて, より効率的な早期肺扁平上皮癌の発見をめざした異型扁平上皮細胞判定基準と事後指導の方法を検討することを目的とした.延べ37015名の受診者のうち, 肺癌学会分類を基にして作成した筆者らの細胞判定基準による判定C (中等度異型) からの癌の発見はなかったが, 判定D (高度異型扁平上皮および癌疑い) では, 高度異型扁平上皮の精検受診者77名から4名 (5.2%), 癌疑いでは36名から10名 (27.8%) の癌が発見された. 従って, 判定Cでは次年度の喀痰検診による追跡で十分であると思われ, 判定Dでは, 癌が疑われると判定された場合には直ちに精検が必要だが, それよりも異型が弱く高度異型と判定された場合には直ちに喀痰細胞診を再検し, 細胞異型が同様に比較的弱ければ, 以後喀痰細胞診と胸部X線写真で追跡すればよいものと思われた.

左上葉原発の扁平上皮癌に対する左上葉切除術及び縦隔リンパ節郭清術施行後の乳糜胸に対して, 術後6日目に気管支ファイバースコープを使用した胸腔鏡で乳糜の漏出部位を確認し, 同部にフィブリン糊 (ベリプラスト P3ml) を注入して乳糜の漏出を直ちに完全に止めることができた.胸腔ドレーンは治療終了後すぐに抜去した.本法は手術侵襲も少なく, 乳糜の漏出部位を直接確認できるため, 確実に乳糜の漏出を止めることができ, かつ短期間で完治できる点で, 乳糜胸の治療において第一に施行すべき優れた方法であると考えられる.

1985年から1988年までの4年間に喀痰検診で発見された57例の肺癌例を対象として診断と治療上の問題点を検討した.胸部X線有所見例は21例で, 無所見例は36例であった.胸部X線有所見21例中9例は, 検診時間接X線写真での見落とし例であった.従って喀痰細胞診により, 胸部X線上見逃され易い所見を有する肺癌が少なからず発見されていることが知られた.胸部X線無所見例中14例は気管支鏡的にも無所見で, そのうち7例が検査の途中で治療を拒否して退院した.気管支鏡無所見例のほとんどは末梢型早期気管支扁平上皮癌であった.切除標本により早期気管支扁平上皮癌と確定した症例は23例あり, その術後5年生存率を術前肺機能の程度別にみると, 肺機能正常例では100%,%VCあるいは1秒率が60%に満たない低肺機能例では35%であった.従って低肺機能早期気管支扁平上皮癌の手術適応には注意すべきである.

A 54-year-old woman was referred to our hospital for the treatment of a tumor of the right chest wall. Clinical examination revealed hypertension, hypokalemia, metabolic alkalosis, hyperaldosteronism and hyperreninemia. Computed tomography and an abdominal echogram indicated a tumor in the right phrenic area and two tumors in the retroperitoneum near the pancreas head. After the surgical resection of these tumors, the primary reninism was diminished. The pathological diagnosis of these tumors was leiomyosarcoma. Plasma active and inactive (trypsin-activated) renin activities (PRA) were 85.7 and 38.9 ng angiotensin I/ml/h, respectively. These PRA did not respond to either postural stimulation or suppression by the volume expansion. Active and inactive renin activities in a right phrenic area tumor were 208 and 32 ng angiotensin I/mg protein /h, respectively. Those of an abdominal tumor were 196 and 30 ng angiotensin I/mg protein/h, respectively. Renin mRNA identical in molecular size to that of the human kidney was identified by northern blot analysis. This is the first case report of renin producing leiomyosarcoma derived from the lung, which is characterized by relatively lower plasma prorenin concentrations.

症例は喫煙指数1,000の73歳男性.喀療検診D判定で, 胸部X線写真に異常はなかった. 気管支鏡検査でも病変は明らかではなく異型細胞は認められなかったため, 外来経過観察とした.3カ月後の初めての再来時の胸部X線写真上, 左下肺野に薄壁空洞陰影が出現, その後薄壁空洞はさらに拡大した.左B9a末梢発生の扁平上皮癌と診断し, 左下葉切除を施行した.左B9a末梢気管支に発生した角化型扁平上皮癌で, 主にそのチェックバルブ作用によって薄壁空洞が形成されたものと考えられた.また, 喀淡検診でチェックされた扁平上皮癌疑い患者の外来経過観察は, 少なくとも初めのうちは3カ月毎に行う必要があると思われた.

気管狭窄は直接生命にかかわる重大な病変であり,早急に正確な気道確保を要する。本報告では,狭窄症状のために処置を要した気管狭窄30例について原因と処置の方法を検討した。原因は再発を含む肺癌9例,気管腫瘍(腺様嚢胞癌,良性腫瘍)6例,隣接臓器(甲状腺,食道)腫瘍7例,非腫瘍性の狭窄(瘢痕,肉芽)8例であった。部位別にみると,分岐部以外の気管狭窄の原因は隣接臓器腫瘍や瘢痕,肉芽が多く,気管分岐部狭窄の原因は肺癌が多かった。救急処置はレーザー治療(気管支鏡下のYAGレーザー照射による狭窄部組織の焼灼,蒸散)8例,ステント挿入(気管内あるいは主気管支内挿管)6例,レーザー治療+ステント挿入8例,緊急手術6例,緊急放射線照射2例であった。緊急の気道開大を要する症例には,まずレーザー治療を試み,それが不可能あるいは不十分ならステント挿入,多少でも時間的余裕があれば手術や放射線照射を選択した。以上の処置および治療によって気管狭窄は軽快させることができた。したがって気管狭窄に対する緊急治療法として,第一にYAGレーザー照射を選択すべきであると思われた。レーザー治療が困難な例や気道の開大が不十分な例には,ステント挿入で気道を確保する必要がある。とくに気管分岐部狭窄例の気道確保に,ファイバースコープガイド下での十分な長さのチューブによる左主気管支内ステント挿入が有効であった。

Six patients with large invasive thymomas were treated by preoperative irradiation with 12 to 20 Gy before total or partial resection of the tumor. The responses of these 6 thymomas were estimated on the chest radiograms as follows; complete response in 2 patients, partial response in 3 and no response in one. Although the clinical responses varied, the surgical specimens of all the tumors pronounced severe fibrosis, probably not related to irradiation, and necrotic foci with a few viable tumor cells. Total resection of the thymoma was performed in 3 patients and subtotal resection in 3. Adhered or involved surrounding tissues such as the pericardium, pleura and/or veins were also resected in most patients. Preoperative radiotherapy facilitated total or subtotal resection of the invasive thymoma mass by reducing the tumor volume.

We studied the effects of thrombin generation due to surgical stress on prostanoid formation and peripheral circulation in anesthetized dogs. Three experimental groups were used, consisting of a control group (group 1), a thoracotomized group (group 2), and a thoracotomized group treated with thrombin inhibitor (MD805: a synthetic arginine derivative) (group 3). The plasma concentrations of thrombin-antithrombin III complex (TAT) and prostanoids were measured along with the hemodynamic parameters. The plasma concentrations of TAT and thromboxane B2 significantly increased 1h after a thoracotomy in group 2. However, neither concentration increased after a thoracotomy in group 3. The flow ratio of the brachial and femoral arteries to cardiac output significantly decreased 1h after a thoracotomy in group 2. This study indicates that thromboxane A2 was thus synthesized by the stimulation of endogenous thrombin, while it also reduced the peripheral blood flow after surgery.

From 1983 to 1994, 12 advanced thymomas with invastion to the great vessels were initially treated by irradiation (mean dose, 18.3 Gy) and subsequent surgical resection. In nine patients, complete resection was possible by concomitant resection of the surrounding tissues, mainly pericardium and/or brachiocephalic vein. Histologically, all tumors showed prominent fibrosis. Ten patients also received postoperative radiotherapy (mean dose, 42.3 Gy). Tumor-related deaths occurred in only two patients ; one who did not receive postoperative irradiation 21 months and one who had viable cells at the surgical margin 10 months after operation. However, there were also 2 patients who died of respiratory failure due to operation and/or irradiation, one 45 days and the other 7 years after the treatment. Preoperative radiotherapy could facilitate complete resection of the advanced thymomas. The prognosis of the patients treated with preoperative radiotherapy seemed fair if followed by adequate resection and subsequent irradiation.

The aims of this study are to evaluate the diagnostic ability of chest computed tomography (CT) in the early detection of pleural disease and to analyze the results of surgical treatment for lung cancer with pleural dissemination. Twenty-three non-small cell lung cancer patients with pleural dissemination, but without distant metastasis, underwent pleuropulmonary resection during the past 15 years. Chest CT scans were obtained preoperatively in 21 of those patients. In eight patients without pleural effusion, small pleural nodules, about 3-5 mm in size, were found in their chest CT. However, during surgery, small nodules were more frequently observed on the parietal pleura than on the visceral pleura in five of them. Therefore, early detection of the dissemination by chest CT seemed limited to only those of the visceral pleura. In the survival curve after resection, there was no difference among the patients with n2 disease, but there was a significant difference between the patients without n2 disease and those with it (P < 0.05). The presence of n2 disease appeared to be a poor prognostic sign in this form of advanced lung cancer.

Clear cell carcinoma of the lung is an extremely rare type of lung cancer with doubtful etiology. This present case showed that the tumor cells contained abundant cytoplasmic glycogen with a diffusely distributed pattern and intracellular glandular structure electron microscopically. Immunohistochemical study revealed that the tumor cells expressed not only epithelial marker including cytokeratin and epithelial membrane antigen, but also Ley, one of stage-specific embryonic carbohydrate antigens. The diagnosis of pulmonary clear cell carcinoma should be done carefully, because benign clear cell tumor and secondary renal cell carcinoma show similarities in a histologic appearance but not in their management and prognosis.

To investigate the role of endothelin-1, a potent vasoconstrictor peptide produced by vascular endothelial cells, in the physiologic response to surgical stress, we measured plasma endothelin-1 concentrations by a sandwich-enzyme immunoassay in patients with lung cancer undergoing pulmonary operations (n = 12). In the first group (n = 6), we measured plasma endothelin-1 concentrations at multiple sampling sites (median cubital vein, pulmonary artery, and left atrium). Plasma endothelin-1 levels were significantly increased at all sampling sites at the end of the operation. Although there was no difference between the increased plasma levels of endothelin-1 in the pulmonary artery and in the left atrium, the increased level in the median cubital vein (peripheral venous blood) was significantly higher than that in the pulmonary artery (mixed venous blood). This result suggests that the production of endothelin-1 might differ between various organs under surgical stress. In the second group (n = 6), we measured plasma endothelin-1 concentrations both in the median cubital vein and in the ipsilateral radial artery, and also measured cardiac output and forearm blood flow. The increase in endothelin-1 levels in the median cubital vein was significantly higher than that in the radial artery after the operation. The endothelin-1 output from the forearm, calculated by the forearm blood flow and the arteriovenous difference of endothelin-1 concentrations, significantly increased after the operation. Although the cardiac output significantly increased after the operation, the forearm blood flow significantly decreased. The present findings provide a novel hypothesis that the preferential release of endothelin-1 from the peripheral vasculature of the forearm may partly contribute to a compensatory response to surgical stress, for example, the reduction of local blood flow in nonvital organs so as to increase the blood flow in vital organs.

This report presents a case of tracheal undifferentiated carcinoma with marked lymphocytic infiltration. The tumor was histologically similar to the so-called lymphoepithelioma of the nasopharyngeal region. After resection of the tumor, radiotherapy was performed. No recurrence has been found for six years. To our knowledge, this so-called lymphoepithelioma in the trachea is the first case reported in the literature.

胸部X線写真上肺野腫瘤状陰影を呈した2例の非腫瘍性肺良性疾患の擦過細胞診に出現した異型細胞について検討した. 第1例は4O歳主婦の器質化肺炎例で, 核小体の著しく肥大した大型の類円形の核を有する異型細胞を認めた. この細胞の核所見からのみでは高分化腺癌との鑑別が困難であったが, 細胞の数が少なく結合性の強いことが悪性との鑑別の要点であると考えられた. 第2例は33歳の主婦で, 肺硬塞発症後3～4日めに核小体の目立つ未熟な扁平上皮化生細胞に類似した細胞を認め, 組織修復細胞との関連が考えられた.

局所進行非小細胞癌71例を対象として, 切除の根治性, 縦隔リンパ節転移部位数などの観点から術後照射の意義を検討した.39例に照射が行われたが, 39Gy以上照射されたものは30例であった. 相対的治癒切除例では局所再発率の低下, 遠隔成績の向上に照射が貢献しており, その再発様式から2ヶ所以上に縦隔リンパ節転移があった場合は, 鎖骨上窩も照射野に含める必要があると考えられた. しかし術後病巣遺残例では照射を企図あるいは完遂できなかったものが多く, 予後不良であった.

Congenital complete left pericardial defect was found incidentally in a 61-year-old man, during operation for left lung cancer. We performed a left upper lobectomy for the cancer without repair of the pericardial defect. He had a good post-operative course with no complications associated with the defect.However, we conclude that, if a pericardial defect is found during lung surgery, it should be repaired to prevent dislocation of the heart postoperatively.