Primary pulmonary carcinoma in patients with idiopathic pulmonary fibrosis

OBJECTIVE: To identify distinguishing characteristics between patients with idiopathic pulmonary fibrosis (IPF) and primary lung carcinoma and patients with either IPF or carcinoma alone. PATIENTS AND METHODS: The study group consisted of 24 patients with histologically proven usual interstitial pneumonia and lung carcinoma identified through a search of the Rochester Mayo Clinic database for 1990 to 1998. Medical records, radiographs, and histological slides were reviewed. Several variables including survival were compared in 2 control groups, IPF only and carcinoma only, by using various statistical methods. RESULTS: Our study group included 21 men and 3 women (mean age, 72.3 years). Twenty-two were past or current smokers. Approximately half of the lung carcinomas were incidental findings. Of the 14 patients with preoperative computed tomographic scans, 12 had peripheral tumors situated in areas of fibrosis. Squamous cell carcinoma was the most common histological type, accounting for 16 cases. Almost all patients underwent surgical treatment; nearly 40% developed postoperative complications, and 3 died within 30 days of surgery. The ratio of men to women in patients with IPF and carcinoma was 7:1 compared with 1:1 in patients with IPF only (P=.003). Patients with IPF and carcinoma were also older, with a mean age of 72.3 years compared with 64.4 years (P=.001), and were more often smokers (P=.002). Carcinomas involved the lower lobes in 42% of patients with IPF and carcinoma compared with 29% of patients with carcinoma only (P=.004) and were mainly composed of squamous cell carcinoma (P=.004). Mean survival in patients with IPF and lung carcinoma was 2.3 years after the diagnosis of IPF and 1.6 years after that of carcinoma. This finding did not differ significantly from survival of patients with either IPF or carcinoma alone. However, statistical power was limited. CONCLUSION: Carcinoma in patients with IPF arises in older male smokers and usually presents as peripheral squamous cell carcinoma. The prognosis is poor.     

云南省曲靖市631例肺癌患者临床特征分析

目的分析肺癌患者的临床特征,为肺癌的相关预防、诊治提供依据。方法选择云南省曲靖市第二人民医院2015年1月-2018年6月收治的631例肺癌患者作为研究对象,分析所有患者的性别、年龄、地域分布、吸烟史、肺部疾病史、病理类型等临床资料。结果 631例肺癌患者中,有腺癌378例(占59.91%),鳞癌197例(占31.22%),小细胞肺癌44例(占6.97%),其他12例(占1.90%)。肺癌患者男女比例为1.84:1。在鳞癌和小细胞肺癌中,男性所占比例均明显高于女性〔鳞癌:94.42%(186/197)比5.58%(11/197),小细胞肺癌:75.00%(33/44)比25.00%(11/44)〕,差异均有统计学意义(均P<0.01),在腺癌和其他病理分型中,男性和女性所占比例差异均无统计学意义(均P>0.05)。肺癌患者平均发病年龄为(61.95±10.98)岁,男性平均(62.56±10.97)岁,女性平均(60.57±11.66)岁,高发年龄为51~70岁。肺癌患者地域分布为麒麟区(216例)、宣威市(115例)、富源县(98例)、沾益区(81例)最为高发。肺癌患者的吸烟率为46.28%,其中鳞癌、小细胞肺癌患者的吸烟率较高,分别为69.04%、56.82%,腺癌患者吸烟率相对较低,为34.13%。既往有慢性肺部疾病史的肺癌患者共101例,占16.01%。结论云南省曲靖市是云南省肺癌高发地区,分析肺癌患者的临床特征对控制危险因素和促进高风险人群的早期发现具有重要意义。     

Constitutive activation of 5-lipoxygenase in the lungs of patients with idiopathic pulmonary fibrosis.

Idiopathic pulmonary fibrosis (IPF) is a progressive disorder characterized by inflammation, fibroblast proliferation, and accumulation of extracellular matrix proteins. Leukotrienes (LTs) are pro-inflammatory and pro-fibrogenic mediators derived from the 5-lipoxygenase (5-LO) pathway of arachidonic acid metabolism. They are thought to play a role in a number of disease processes, but have received relatively little attention in investigations into the pathogenesis of IPF. In this study, we measured the levels of immunoreactive LTs B(4) and C(4) in homogenates of lung tissue obtained from patients with newly diagnosed, untreated IPF, as compared to levels measured in homogenates of uninvolved nonfibrotic lung tissue from patients undergoing resectional surgery for bronchogenic carcinoma. Compared to homogenates on nonfibrotic control lung, homogenates from IPF patients contained 15-fold more LTB(4) and 5-fold more LTC(4). IPF homogenate levels of LTB(4) were significantly correlated with histologic indices of both inflammation (r=0.861) and fibrosis (r=0.926). Activation of 5-LO is known from in vitro studies to be associated with localization of the enzyme at the nuclear membrane. Immunohistochemical staining for 5-LO protein in alveolar macrophages (AMs) demonstrated that such an "activated" localization pattern was significantly more frequent in IPF lung (19.2+/-3.3% of cells) than in control lung (9.3+/-0.9%); this localization pattern was rarely seen (3.2%) in sections from a truly normal transplant donor lung. Consistent with these data, AMs obtained from IPF patients by bronchoalveolar lavage, purified by adherence, and cultured in the absence of a stimulus for 16 h elaborated significantly greater amounts of LTB(4) and LTC(4) than did control AMs obtained from normal volunteers. These data indicate that the 5-LO pathway is constitutively activated in the lungs of patients with IPF, and the AM represents at least one cellular source of LT overproduction in this disorder. We speculate that LTs participate in the pathogenesis of IPF, and their overproduction in this disorder may be amenable to specific pharmacotherapy.     

肺鳞状细胞癌中人乳头瘤病毒感染的研究

目的通过观察肺鳞状细胞癌及癌旁肺组织中人乳头瘤病毒（humanpapillomavirus，HPV）的感染、分布、存在状态及与临床病理资料间的关系，探讨HPV感染在肺鳞状细胞癌发病中的作用。方法用共有引物PCR检测120例肺鳞状细胞癌及癌旁肺组织中HPV的感染率，用多重PCR对阳性标本的HPV6/11．16．18分型，用原位杂交方法观察HPV在肺鳞癌组织中的分布及存在状态。结果肺鳞癌组织HPV感染率（35％）显著高于癌旁肺组织（67％）（P＜0．01），HPV在肺鳞癌组织中可能以游离和整合两种状态存在并可在肺鳞癌组织中表达，早期（Ⅰ期）肺鳞癌HPV感染率（44.3％）显著高于进展期（Ⅱ～Ⅲ期）肺鳞癌（25．4％）（P＜0．05），重度吸烟组HPV感染率（44．7％）显著高于非吸烟组（18．2％）（P＜0．01）。结论HPV感染在肺鳞癌的发病中可能起一定作用，肺鳞癌组织中HPV感染与吸烟有关。     

Pancreatic metastasis from squamous cell lung cancer: computed tomography and magnetic resonance imaging findings

Metastatic lesions of the pancreas are uncommon. The incidence of pancreatic involvement with squamous cell carcinoma is the lowest among the different histological subtypes of lung cancer. We present the clinical data, pathological findings, and imaging features of two cases of pancreatic metastasis from squamous cell lung cancer with a literature review. A 75-year-old man and a 67-year-old man were both diagnosed with metastatic pancreatic tumors from squamous cell lung cancer during a multidisciplinary team discussion. Both patients were misdiagnosed as having a neuroendocrine tumor of the pancreas by imaging examination before surgery. Squamous cell lung cancer metastasis to the pancreas is extremely rare, and the atypical clinical and radiological presentations make it difficult to distinguish metastatic tumors from primary pancreatic tumors.     

肺重复癌的临床特点分析

目的分析肺重复癌的临床特征、吸烟影响、肺癌与肺外器官恶性肿瘤间关系、治疗及预后。方法收集我院近10年收治的4 589例肺癌患者中肺重复癌患者31例进行回顾性分析。结果本组31例中腺癌12例,小细胞肺癌10例,鳞癌6例,支气管肺泡癌1例,腺鳞癌1例,大细胞癌1例。所合并的第一原发肿瘤为膀胱癌6例,宫颈癌3例,食管癌3例,胃癌3例,肾癌3例,肺癌3例,乳腺癌2例,甲状腺癌1例,左颌下腺淋巴上皮癌1例,嗅神经母细胞瘤1例,喉癌1例,鼻咽癌1例,脑胶质瘤1例,结肠癌1例,多发性骨髓瘤1例,其中28例患者行手术治疗,术后进行放化疗者26例,3例单纯放疗。两种原发肿瘤发生的时间间隔平均为55个月,有肿瘤家族史者8例,吸烟者22例。有咳嗽、咯血症状者22例。结论肺重复癌与第一原发性肺癌的临床特点与预后相似,吸烟率更高,肿瘤患者发生第二肿瘤的风险较大,放化疗及手术可能会诱发第二原发肿瘤的发生,肿瘤家族史是高危因素。定期复查,及时诊断,综合治疗可改善患者的预后。     

着色性干皮病基因D和X线交叉互补修复基因1的多态性与肺癌的相关性分析

目的:探讨着色性干皮病基因D(Xeroderma pigmentosum gene D,XPD)和X线交叉互补修复基因1(X-ray repair cross complementing gene 1,XRCC1)的多态性与肺癌之间的相关性。方法:采用聚合酶链反应—限制性片段长度多态性(polymerase chain reaction-restriction fragment length polymorphism,PCR-RFLP)技术,对150例肺癌患者(肺癌组)以及150例健康志愿者(健康对照组)的XPD-751、XRCC1-399两个多态位点进行基因型分析。结果:肺癌组及健康对照组XPD-751的基因型频率及突变等位基因频率差异有统计学意义(P分别为0.046、0.003);肺癌组及健康对照组的XRCC1-399基因型频率及突变等位基因频率则差异无统计学意义(P分别为0.395、0.105)。非小细胞肺癌组和小细胞肺癌组XPD-751的突变等位基因频率差异有统计学意义(P=0.012),鳞癌组、腺癌组及其他类型非小细胞肺癌组XPD-751的突变等位基因频率差异亦有统计学意义(P=0.023)。吸烟和XPD-751多态性两个危险因素共同存在时,罹患肺癌的相对危险度为2.812(95%CI:0.956~6.415),P=0.336。结论:XPD-751基因多态性与肺癌的发生相关,尤其与非小细胞肺癌中的鳞癌关系密切;而XRCC1-399基因多态性则与肺癌的发生无关;吸烟和XPD-751多态性在肺癌的发生中无交互作用。     

周围型肺癌钙化的CT表现及鉴别诊断意义

目的 评价周围型肺癌钙化的CT征象及诊断意义。材料与方法 98例经CT检查并有病理证实的周围肺癌中，17例可见钙化。其中腺癌10例，鳞癌5例，肺光癌2例。用2－3mm薄层扫描评价的钙化征象。结果 肺癌钙化征象的CT形态有三种：（1）细点状钙化：12例，其中腺癌6例，鳞癌4例，肺泡癌2例。钙化呈细小点或沙粒状偏心分布。（2）斑片状钙化：3例，其中腺癌2例，鳞癌1例。钙化呈不规则斑片状，偏心分布。（3）结节状钙化：2例均为腺癌，1例为单发结节，另1例为多发结节。结论 CT上肺结节或肿块内出现钙化，尤其是细点状钙化不能作为排除肺癌的指征，而应结合其它CT征象才能作出鉴别诊断。     

肺巨细胞癌6例临床病理分析

目的：探讨肺 巨细胞癌（GCC）的临床及病理特点。方法：利用HE染色及免疫组化方法对6例GCC的组织形态进行观察。对其临床特点及随访材料进行分析。结果：患者均为男性，平均年龄63．8岁，临床表现为胸痛，咳嗽，血痰，右肺4例，左肺2例，3例肿瘤位于周边，3例近肺门，肿瘤直径3－9cm，平均6．8cm，GCC的主要组织学特征是大量肿瘤性巨细胞的存在，巨细胞体积较大，形态各异，胞质丰富，单核或多核伴明显异型，排列疏松，部分区域似多形性肉瘤，可见巨细胞形成的腺管样结构，2例有明显的中性粒细胞浸润，巨细胞对上皮性标记呈阳性表达，尤其是CK18，同时也高比例地表达Vim，随访3例，均死亡，平均存活13．3个月，结论：肺巨细胞癌具有临床及组织形态特点，与腺癌密切相关，预后比腺癌及鳞癌差。     

CT引导下经支气管针吸活检在周围性肺癌诊断中的应用

目的探讨CT引导下经支气管针吸活检（TBNA）对直径≤30mm的周围性肺癌检查的可行性、安全性和有效性。方法2005年5月至2008年11月在常规支气管镜检查过程中,对住院经CT扫描、临床上诊断为周围性肺癌的87例患者,在CT引导下进行TBNA检查。结果本组患者经TBNA确诊为肺癌81例,占93．1％（81／87）,其中原发性肺癌76例（腺癌36例,小细胞癌肺癌29例,鳞癌11例）,结肠癌和绒毛膜上皮癌肺转移各2例,腺泡细胞腮腺癌肺转移1例。其余6例均经手术后病理证实,其中腺癌4例,小细胞癌和鳞癌各1例。结论经CT引导下进行TBNA检查简便安全、经济有效,可作为周围性肺癌的常规检查方法之一。     

Smoking and lung cancer: current trends in Austria

BACKGROUND: Despite a recent decline in smoking behavior in many European countries, lung cancer rates remain high, especially in Central and Eastern Europe. This paper aims to describe trends in smoking behavior and lung cancer incidence and mortality, including histopathological classification of lung cancer, in a Central European country: Austria. METHODS: Using data from the Austrian Central Cancer Registry, we calculated age-standardized incidence, histopathology-specific incidence, and age-standardized and birth cohort-specific mortality rates for all lung cancer cases in Austria. Using national survey data, we estimated prevalence of smoking in the Austrian population. Our analysis covers the time period from 1970 to 2009. RESULTS: In 2009, lung cancer incidence rates were 41.3/100,000 and 18.5/100,000 and mortality rates were 36.3/100,000 and14.5/100,000, for males and females, respectively. Male lung cancer rates declined but increased steadily in females over the past three decades. In 2009, the most common histological type is adenocarcinoma, which reflects a shift from predominantly squamous cell carcinoma and large cell carcinoma in the mid 1980s. In 2009, 27?% of men and 19?% of women were smokers, which represent a rise of smoking rates in women, especially in younger women, and a decline in the men. CONCLUSIONS: While in Austrian men the lung cancer rates, in accordance with their decreasing prevalence of smoking, declined over the past 30 years, the increasing smoking prevalence and lung cancer rates in women remain a public health concern. Antismoking laws and public health initiatives to curtail smoking habits are needed in Austria, especially targeting younger women.     

sPD-L1在肺癌患者血清及胸膜腔积液中水平差异及相关性分析

目的分别检测肺腺癌和肺鳞癌患者血清及胸膜腔积液中sPD-L1水平的差异并进行相关性分析。方法收集2016年12月至2018年5月于重庆三峡中心医院就诊,伴发恶性胸膜腔积液的肺腺癌和肺鳞癌患者的外周血和胸膜腔积液,采用试剂盒检测sPD-L1水平,并对检测结果进行统计学分析。结果 sPD-L1在肺腺癌患者外周血和胸膜腔积液中的表达水平分别为1.71±0.13(ng/mL)和1.26±0.11(ng/mL),在肺鳞癌患者外周血和胸膜腔积液中的表达水平分别为1.86±0.30(ng/mL)和0.89±0.14(ng/mL)。患者外周血中sPD-L1水平高于胸膜腔积液中sPD-L1水平(P<0.05),肺鳞癌患者外周血中sPD-L1水平略高于肺腺癌(P=0.01),而胸膜腔积液中sPD-L1水平低于肺腺癌(P<0.01),肺腺癌患者外周血和胸膜腔积液中sPD-L1水平存在相关性。结论不同病理类型NSCLC外周血液和胸膜腔积液内sPD-L1水平不同,肺腺癌患者外周血和胸膜腔积液中sPD-L1水平存在相关性,提示不同病理类型的NSCLC的sPD-L1水平标准和检测方式可能存在差异。     

联合检测血清IGF-1、CEA、CYFRA21-1、NSE、CA199在肺癌诊治中的应用

目的探讨血清胰岛素样生长因子（IGF-1）、癌胚抗原（CEA）、细胞角蛋白19片段（CYFRA21-1）、神经特异性烯醇酶（NSE）、糖类蛋白19-9（CA19-9）联合检测在肺癌诊治中的具体应用价值。方法对98例肺癌组患者治疗前后,46例肺良性病变组患者,42例健康组受检者使用化学发光免疫分析法检测血清5项肿瘤标志物的表达水平,并进行比较分析。结果肺癌组患者血清5项肿瘤标志物均明显高于肺良性病变组和健康组（P〈0.05）。肺癌细患者治疗后血清5项肿瘤标志物水平明显下降（P〈0.05）。肺癌组中Ⅲ/Ⅳ期患者血清5项肿瘤标志物含量均明显高于Ⅰ/Ⅱ期（P〈0.05）。腺癌中CEA表达水平明显高于小细胞肺癌和鳞癌（P〈0.05）,小细胞肺癌中NSE表达水平明显高于腺癌和鳞癌（P〈0.05）,鳞癌中CYFRA21-1表达水平明显高于小细胞肺癌和腺癌（P〈0.05）。联合检测血清5项肿瘤标志物对肺癌的效能最高为0.986。结论肿瘤标志物在肺癌疾病的发展过程中表现出一定的差异性,特别是多项指标的联合检测对于肺癌的诊断、分期及疗效判定具有一定的临床应用价值。     

256排螺旋CT联合血清CEA、CYFRA21-1、ProGRP在诊断原发性肺癌中的应用

目的  探究256排螺旋CT联合血清癌胚抗原（CEA）、细胞角蛋白19片段（CYFRA21-1）、胃泌素释放肽前体（ProGRP）在诊断原发性肺癌中的应用价值。方法  回顾性分析2020年1月~2022年4月收治的181例原发性肺癌患者临床资料,患者均已接受256排MSCT检查及血清肿瘤标志物CEA、CYFRA21-1、ProGRP检查,分析影像学表现及血清学检查结果,并以病理学诊断结果为金标准,判定各项指标对原发性肺癌的诊断正确率。结果  病理组织学检查：181例原发性肺癌患者中腺癌91例,鳞癌61例,小细胞癌29例。CT影像学特征：腺癌以周围型为主,多见磨玻璃影、血管集束征、分叶状、毛刺样改变、强化不均匀、胸膜凹陷;鳞癌、小细胞癌均以中央型为主,鳞癌多见支气管充气征、空泡征、分叶状、强化均匀,小细胞癌多见支气管充气征、空泡征、强化均匀,鳞癌分叶状征象占比多于小细胞癌（P < 0.05）,小细胞癌强化均匀占比多于鳞癌（P < 0.05）;各类型肺癌均伴有少量钙化;腺癌者、鳞癌者CEA、CYFRA21-1水平均高于小细胞癌者,ProGRP水平均显著低于小细胞癌者,腺癌者CEA水平高于鳞癌者,腺癌者MSCT、CEA检测阳性率高于CYFRA21-1、ProGRP,鳞癌者MSCT、CYFRA21-1检测阳性率高于CEA、ProGRP,小细胞癌者MSCT、ProGRP检测阳性率高于CEA、CYFRA21-1,差异有统计学意义（P < 0.05）。4项联合检测对腺癌、鳞癌、小细胞癌3类的检测阳性率均提高。结论  256排MSCT诊断原发性肺癌可清晰显示病变CT影像学特征,与血清肿瘤标志物CEA、CYFRA21-1、ProGRP均可较好诊断不同病理类型的原发性肺癌,且四项联合诊断可提高阳性检出率。     

经纤维支气管镜确诊的不同病理类型支气管肺癌的临床研究

目的评价不同病理类型的支气管肺癌的临床特点和纤维支气管镜下不同的表现以及纤维支气管镜下所见与病理类型的关系。方法回顾性分析宁夏医学院附属医院呼吸内科支气管镜室1984～2002年1882例经纤维支气管镜确诊的支气管肺癌患者的镜下所见以及不同病理类型的性别、年龄、吸烟指数、临床表现及镜下表现等分布特点。结果经纤维支气管镜确诊的鳞癌、小细胞癌、大细胞癌男性均明显多于女性,而腺癌男女性别比例差异不大;鳞癌、小细胞癌好发于上叶,而腺癌好发于下叶;病理以鳞癌所占比例最高(59.6%),小细胞癌次之(22.6%),腺癌较少(6.8%)。鳞癌、小细胞癌均以增殖型为主,腺癌以浸润型为多。结论不同病理类型的支气管肺癌的临床特点、镜下所见均有所不同。     

Non-small cell lung cancer

Lung cancer stands as the most important malignant neoplasm in the United States because of its high prevalence, increasing incidence, high rate of mortality, and great potential for prevention through the control of cigarette smoking. The World Health Organization (WHO) classification of lung cancer identifies four major types: squamous cell carcinoma, adenocarcinoma, large cell carcinoma, and small cell carcinoma. These tumors are commonly divided into two groups based on differences in their biology and treatment: small cell (SCLC) and non-small cell carcinomas (NSCLC). This review analyzes NSCLC with a strong emphasis on the practical aspects of treatment. We give recommendations about smoking cessation and early diagnosis through screening of high-risk individuals. We review contemporary diagnostic and staging techniques in the context of the new international TNM system of staging. Subsequent discussions of treatment are based on this new staging system. We stress the pivotal role of surgery for the management of local disease, and in addition present the potential contributions of newer radiation therapy techniques. We examine chemotherapy in detail, including a review of the comparative activity of the available cytotoxic agents against NSCLC, the relative contribution of combination chemotherapy, and the role of surgical adjuvant treatment with either chemotherapy or immunotherapy. We advise that patients with NSCLC be treated under the aegis of modern clinical trials of new therapy whenever possible. When this is not possible, we recommend an individualized approach based on such factors as the patient's age, general state of health, cardiopulmonary status, psychosocial status, and personal system of values.     

磁共振弥散加权成像(DW-MRI)在肺部肿瘤诊断中的应用价值

目的:分析核磁共振弥散加权成像在肺部肿瘤诊断中的应用价值。方法:选取2017年11月至2019年11月两年期间我院收治的肺部肿瘤患者作为研究对象,人数有68名。其中有恶性肿瘤60例,其中腺癌21例、鳞癌17例、大细胞癌22例。对这68名肺部肿瘤患者进行核磁共振弥散加权成像检查,之后再对患者进行病理检查和癌胚抗原检查,比较弥散加权成像检查与癌胚抗原检查的诊断率。结果:经弥散加权成像检查后恶性肿瘤为56例,腺癌19例、鳞癌14例、大细胞癌19例,而经癌胚抗原检查出的恶性肿瘤为40例,腺癌10例、鳞癌8例、大细胞癌12例。弥散加权成像检查的检出率更高,差异具有统计学意义(P<0.05)。结论:在对肺部肿瘤进行诊断的过程中运用核磁共振弥散加权成像诊断有着很好的恶性肿瘤检出率,对患者肺癌的确诊有着较好的依据,临床检测应用价值高。     

中性粒细胞对肺鳞状细胞癌杀伤效应的研究

目的探索中性粒细胞(PMNS)对人肺鳞状细胞癌的杀伤效应。方法随机选取人肺鳞状细胞癌石蜡包埋标本300例,行G-CSF的免疫组化染色,分析其阳性强度与中性粒细胞分布的关系;分离人肺鳞状细胞癌患者及健康志愿者的外周血中性粒细胞各5例,体外杀伤建系及原代培养的肺鳞状细胞癌细胞;MTT法检测杀伤效应,观察中性粒细胞和肺癌细胞的形态变化。结果 300例人肺鳞状细胞癌中221例可见中性粒细胞浸润,且其浸润程度和G-CSF的阳性强度成显著正相关(P<0.01),HE切片可见中性粒细胞致肺鳞癌细胞凋亡现象,其杀伤效应需直接接触癌细胞,并围绕癌细胞形成花环状,PMNs∶癌细胞=500～600∶1时,杀伤效率最高。结论中性粒细胞可在体内、外对肺鳞状细胞癌具有杀伤作用,其杀伤效应需要和肿瘤细胞直接接触,癌细胞分泌的G-CSF能促进PMNs对肿瘤的杀伤作用。     

Head and neck cancer arising after endoscopic mucosal resection for squamous cell carcinoma of the esophagus

BACKGROUND AND STUDY AIMS: It is well known that patients with head and neck cancer often have synchronous or metachronous squamous cell carcinoma of the esophagus. However, the prevalence of subsequent head and neck cancer in patients with early-stage esophageal cancer is still unknown. The aims of this study were to analyze the frequency of metachronous head and neck cancer after endoscopic mucosal resection (EMR) for esophageal cancer and to investigate whether minute iodine-unstained areas, often associated with squamous cell carcinomas, would be an index for metachronous head and neck cancer. PATIENTS AND METHODS: 99 patients with esophageal squamous cell carcinoma who underwent EMR were studied. Based on the iodine-staining pattern at initial EMR, they were categorized into those with uniform (group U) and scattered (group S) types of background mucosa. Patients were monitored endoscopically and otolaryngologically (group U, median 46 months, range 12-83 months; group S, median 44 months, range 13-80 months). RESULTS: In total, 5/99 patients (5.1 %) were found to have metachronous head and neck cancer during the follow-up, including 4/20 patients (20 %) in group S. In three cases laryngeal or hypopharyngeal cancer was found by endoscopic examination. The cumulative proportion of metachronous head and neck cancer-free subjects was significantly lower in group S than group U (P = 0.0007). CONCLUSIONS: Among patients who undergo EMR for esophageal carcinoma, those with scattered-type iodine staining of the background mucosa have an increased risk of metachronous head and neck cancer, and should therefore be closely observed. Careful endoscopic observation led to early detection of laryngeal and hypopharyngeal cancer.     

Synchronous quadruple lung cancer treated curatively by photodynamic therapy

A 54-year-old male was diagnosed as having synchronous quadruple early stage lung cancer. All four tumors showed the same histologic type of in-situ or microinvasive squamous cell carcinoma, but existed independently in different bronchi. Photodynamic therapy of these four lesions was successfully performed by fiberoptic bronchoscopy because of the patient's poor pulmonary function. The patient is alive and well 51 months later.