Benign Tumors and Tumor-Like Lesions (Excluding Adenomas) of the Lung: Radiological and Clinicopathological Analysis of 48 Cases

Forty-eight cases of surgically resected benign tumors and tumor-likelesions of the lung were analyzed, with the following results:1) Hamartoma and sclerosing hemangioma have well defined borders,compressing bronchi and blood vessels, and are loosely boundto the surrounding lung parenchyma. 2) Hamartomas, in 90% ofthe cases, showed "nodularity" on film tomograms. Histologically,nodularity at the edge was produced by lobules of cartilage.3) Fifty-three percent of the patients with sclerosing hemangiomawere middle-aged females and asymptomatic. Only two patientscomplained of hemosputum. Routine roentgenograms showed a roundshadow with homogeneous density. Cut surfaces were solid withvarious degrees of hasemorrhage. 4) Roentgenograms of benignmesothelioma showed large tumors more than 4 cm in diameter,in which extrapleural signs could be observed. 5) "Calcification"was seen on the roentgenograms of seven out of 27 hamartomasand one out of 15 sclerosing hemangiomas. Pleural retractioncould not be seen in our series. Xerotomography was superiorto film tomography in showing calcification. 6) One of the sclerosinghemangiomas was double, and the other 47 benign tumors and tumor-likelesions were solitary; the lesions were peripheral in 45 casesand central in three. All of the patients were free of localrecurrence and distant metastasis.     

Immediate and Delayed Cardiac Herniations after Intrapericardial Pneumonectomy--Report of Two Cases

Two cases of cardiac herniation following intrapericardial lungresections were reported. One was a case of a 29-year-old male with adenocarcinoma ofthe right lower lobe and the other was a 43-year-old male withsquamous cell carcinoma of the right upper lobe of the lung. In the former, cardiac herniation occurred in the recovery room.In the latter, it occurred during the second operation repairingbronchial fistula which appeared 20 days after the previousintrapericardial surgery. The time delay in the second casewas due to the unsuitable quality of prosthesis for the pericardialdefect.     

Renal Cell Carcinoma in a Solitary Kidney Treated by Partial Nephrectomy --Case Report and Review of Japanese Literature

Renal cell carcinoma in a solitary kidney is rather rare. Wepresent a case of this condition occurring in a 50-year-oldman. He was treated by partial nephrectomy and temporary hemodialysisfor postoperative acute renal failure. Perusal of the literaturereveals that in situ partial nephrectomy, if possible, seemsto be a reasonable treatment of choice for renal cell carcinomain a solitary kidney. This is the fifth case ever reported inJapan.     

The Incidence of Cardiac Metastasis in Primary Lung Cancer and the Management of Malignant Pericardial Effusion

The incidence of metastasis to the heart and pericardium was35% in post-mortem studies of 150 cases of carcinoma of thebronchus. Twenty-one patients with malignant pericardial effusion fromcarcinoma of the bronchus were treated at the National CancerCenter Hospital during the last three years. Fifteen patientswere treated by creating a pericardial window through a subxiphoidapproach without complications or mortality, in these 15 patientscardiac compression caused by pericardial effusion was promptlyrelieved by the creation of the pericardial window. There wasno reaccumula tion of the effusion in five of six patients treatedby the pericardial window procedure with intrapericardial instillationof chemotherapeutic agents and eight of nine patients treatedby creating the window without local chemotherapy. On the otherhand cardiac tamponade was controlled in one of three patientsby repeated pericardiocenteses. The median survival periodsfrom the initiation of treatment for the effusion up to deathwere 4 mo in six patients treated by the pericardial windowprocedure with intrapericardial instillation of chemotherapeuticagents, 2 mo in nine patients treated by the window techniquewithout local chemotherapy and 0.8 mo in six patients in whoma pericardial window was not created. The median survival of15 patients treated by the pericardial window procedure (2 nio)was not significantly longer than that of six patients not sotreated. We have come to the conclusion that the creation of a subxiphoidpericardial window is a safe, effective and reliable treatmentprocedure for the manage ment of malignant pericardial effusion,but the prognosis for survival in patients with malignant pericardialeffusion may depend principally on the extent of the primarytumor and the performance status of patients at the initiationof treatment for the effusion.     

Surgical Treatment of Lung Cancer in Patients over the Age of 70 Years

The number of elderly patients receiving surgical treatmentfor lung cancer is rapidly increasing. There were 199 patients over the age of 70 yr among 1,210 patientswho underwent lung resection for lung cancer. Among the 199,156 were between the ages of 70 and 74, 36 between 75 and 79and seven over the age of 80. One hundred and sixty-nine received lobectomy, 25 pneumonectomyand five a smaller lung resection. Mediastinal lymph node dissectionwas carried out in 145 cases. The crude 5-yr survival rate of84 patients who were operated upon during the period from 1962to 1976 was 30% and was similar to that of patients less than70 yr old. Because of the higher postoperative mortality rateof patients with pneumonectomy and with combined resection oflung and neighboring organ(s), 16% and 15% respectively, itwas considered reasonable that the use of these two operativemodalities for elderly patients should be limited. From these results patients over the age of 70 yr can be saidto be a proper target of lung surgery for lung cancer when alobectomy shows that such surgery is indicated.