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.     

The Protective Effect of 2-Mercapto-Ethane Sulfonate (MESNA) on Hemorrhagic Cystitis Induced by High-Dose Ifosfamide Treatment Tested by a Randomized Crossover Trial

High-dose ifosfamide (one or two courses of 6 g/m²) with orwithout mesna was administered to 13 patients with advancednon-small cell lung cancer. The protective effect of 2-mercapto-ethanesulfonate (mesna) against the urotoxic side effects inducedby ifosfamide was examined by a randomized crossover trial.A significant reduction in the incidence of hematuria was observedin the patients receiving mesna. Macroscopic hematuria was observedin only one patient who received treatment with mesna versusseven patients treated with ifosfamide alone. Other symptoms,such as frequency and dysuria, tended to be diminished in thepatients receiving mesna, although the difference was not statisticallysignificant. Our results suggest that mesna is effective inpreventing or diminishing ifosfamide-induced hemorrhagic cystitis.Concomitant use of mesna should allow the administration ofa high dose of ifosfamide although more extensive studies areneeded to define the optimal dose and schedule of administrationof mesna to prevent or attenuate the hemorrhagic cystitis.     

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.     

Prognostic Significance of Extranodal Cancer Invasion of Mediastinal Lymph Nodes in Lung Cancer

The presence of perinodal cancer invasion in specimens obtainedfrom the mediastinum during curative surgery on 49 patientswith metastasis-bearing mediastinal nodes was determined andevaluated with special reference to its prognostic significance. When an en-bloc dissection technique for the mediastinal lymphnodes and fatty tissue surrounding the nodes during surgerywas used, lymphatic vessel invasion in fatty tissue other thana breach in the capsule of a lymph node by cancer could be seen.A breach in the node capsule and lymphatic vessel invasion aredesignated as "extranodal invasion" in this paper. A breach in the capsule was seen in 16 cases, lymphatic vesselinvasion in 12 and both a breach in the capsule and lymphaticvessel invasion in 4. In 17 cases there was only intranodalcancer metastasis. The 5-yr survival rate was 37.5% and 17.7%for patients with and without extranodal invasion, respectively.However, extranodal invasion did not seem to be a distinctiveprognostic factor.     

Antiemetic Efficacy of High-Dose Intravenous Metoclopramide and Dexamethasone in Patients Receiving Cisplatin-Based Chemotherapy: A Randomized Controlled Trial

High-dose intravenous (IV) metoclopramide has shown efficacywith few side effects for the treatment of nausea and vomitingon the day of cisplatin administration. From November 1984 toJanuary 1986, two randomized trials in an antiemetic study wereconducted. In trial I, the antiemetic effect of a short courseof high-dose dexamethasone was compared with that of high-dosemetoclopramide in 29 patients with lung cancer receiving chemotherapycon taining cisplatin (80 mg/m² IV) in a randomized controlledtrial. Dexamethasone was given IV at a dose of 16 mg 1/2 hrbefore and 8 mg, 1 1/2, 3 1/2 and 5 1/2 hr after cisplatin.Metoclopramide was given IV at a dose of 2 mg/kg, 1/2 hr beforeand 1 1/2, 3 1/2 and 5 1/2 hr after cisplatin. Major emeticcontrol (0–2 episodes of vomiting) during the 24 hr aftercisplatin administration was achieved in 55% (6/11) and 67%(12/18) of the patients receiving dexa methasone and metoclopramide,respectively, without serious toxicity. The dura tion of nauseaor anorexia was similar for the two treatment groups. In trial11, the combination of metoclopramide and dexamethasone wascompared with metoclopramide alone to assess the additive antiemeticeffect of the two drugs in 23 patients with lung cancer receivingcisplatin at a dose of 120 mg/m IV in a randomized cross-overstudy. A major antiemetic response was observed in 27% (3/11)and 92% (11/12) of the patients receiving metoclopramide aloneand metoclopramide plus dexamethasone, respectively (p <0.005). The duration of nausea and anorexia was similar forthe two treatment groups. Pa tients tended to prefer the combinationof metoclopramide and dexamethasone; however, the differencewas not statistically significant (p = 0.14) in the small numberof patients entered in this study. Despite excellent controlof acute chemotherapy-induced emesis, 45% of 52 patients experienceddelayed nausea and vomiting more than 24 hr after cisplatinadministration even among those who had had an excellent short-termresponse to the antiemetic agents.     

Recurrence of Thymoma with Appearance of Myasthenia Gravis 18 Years after Surgery: A Case Report

A 59-year-old woman was admitted to the hospital because ofrecurrence of thymoma with appearance of myasthenia gravis 18years after excision of an invasive thymoma. Recurrence wasobserved in the anterior mediastinum, right pleura, pericardiumand left supraclavicular lymph node. Hashimoto's thyroiditis,vitiligo vulgaris and leukopenia were also seen. After creationof a pericardial window for pericardial effusion, she receivedvincristine, then carbazilquinone intravenously as single chemotherapeuticagents based on the chemosensitivity by clonogenic assay ofthe supraclavicular tumor, but response was not achieved. Atone and a half years after radiotherapy to the mediastinum,she is now doing well without symptoms and is receiving a fairlylow dose of anticholinesterase medication.     

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.     

Juvenile Thyroid Carcinoma with Metastasis to the Bilateral Cervical Lymph Nodes--A Case Report

A case of juvenile thyroid carcinoma with metastasis to thebilateral cervical lymph nodes in a 9-year-old male is reported.The clinical picture of juvenile thyroid carcinoma is characterizedby early metastasis to the lungs and cervical lymph nodes. InEurope, there have been many reports of thyroid carcinoma afterradiation. However, our patient had received no radiation. Surgeryconsisted of subtotal thyroidectomy and right modified neckdissection. The tumor was a papillary adenocarcinoma and metastasiswas seen in 24 out of 38 lymph nodes removed. The serum thyroglobulinlevel, determined by radioimmunoassay, was 184 ng/ml preoperatively,but by 8 months postoperatively the level fell to 48 ng/ml.No signs of recurrence have been found to date (30 months afterthe operation).     

BCG Immunotherapy as an Adjuvant to Surgery in Lung Cancer: A Randomized Prospective Clinical Trial

A protocol was drawn up and a prospective randomized study wascarried out to test the effectiveness of BCG on lung cancer.BCG obtained from the Japan BCG Institute was used. A dose of5.4 mg or 2–4 x 10⁸ viable organisms was administeredinto the arm by the tine technique. Administration of BCG wascarried out once before surgery and four times after surgery.Surgery consisted basically of radical lobectomy or pneumonectomywith complete mediastinal lymphadenectomy. The survival rate in the BCG administered group was significantly(P < 0.05) more than in the control group. Further, whenonly the cases that were treated strictly in accordance withthe protocol were taken into consideration, the effectivenessof BCG was even more significant (P < 0.02). The period ofobservation of these cases was from a minimum of 10 months toa maximum of 28 months. On the basis of these results, it can be said that BCG is beneficialin the treatment of lung cancer.     

Lung Cancer in Chromate Workers--Analysis of 11 Cases

We have experienced 11 cases of lung carcinoma in workers ata chromate factory during the past 14 years. All patients weremales. The age of onset ranged from 41 to 68 years. Ten of the11 were heavy smokers. The time of exposure to chromate wasfrom 17 to 29 years and the average was 23.9 years. Seven patientshad perforation of their nasal septa. The primary sites of thecancers were from the lobar to the subsegmental bronchi. Therewere nine squamous cell carcinomas and three small cell carcinomas.Four squamous cell carcinomas were hilar type early stage cancersand two of them were found in one patient at the same time.The chromium content of the lung tissue in the seven patientstested was from 13.9 to 2,368.4 µg/g of dry tissue andwas higher than that of lung cancer or non-lung cancer caseswithout chromate exposure. There was no severe dysplasia ofthe bronchial epithelium in these 11 patients.