松井 由紀子

The cytologic findings of the tumor cells characteristic of the stages of thymomas were investigated to assess the invasiveness of the tumors. Forty-six patients with thymoma who underwent extensive thymectomy without preoperative corticosteroid therapy were included in this study. The histologic subtypes included 18 round/oval, 20 mixed, and 8 spindle type. The stages of thymoma classified according to Masaoka's clinicopathological classification included 16 stage I, 20 stage II, 6 stage III, 2 stage IVa, and 2 stage IVb, and myasthenia gravis was recognized in 5 patients. Cytologic findings were retrospectively analyzed in the Papanicolaou-stained stamp smears obtained from the cut surfaces of thymoma specimens. Morphometry of the epithelial tumor cells using Cosmozone-1A was performed to evaluate the validity of our cytologic categories. Compared with the cytologic findings of stage I or II thymomas, those of epithelial tumor cells in stage III or IV more frequently showed necrotic background (50.0%-stage III or IV vs 11.1%-stage I or II, p=0.006), large clusters of epithelial tumor cells (70.0% vs 36.1%, p=0.055), marked nuclear enlargement (90.0% vs 52.7%, p-0.033), marked anisokaryosis (100% vs 52.7%, p=0.006), marked nuclear polymorphism (40.0% vs 5.5%, p=0.004), hyperchromasia (50.0% vs 11.4%, p=0.007) and prominent nucleoli (50.0% vs 16.6%, p=0.028) whereas no significant correlation was observed between cytologic findings and tumor volume. Morphometric studies of thymoma tumor cells revealed that the nuclear size (mean values, 78.8 mum(3)-stage III or IV vs 58.2 mum(3)-stage I or II), the coefficient of variation of the nuclear size (0.326 vs 0.282), and the nuclear rotundity (0.849 vs 0.858) differed significantly between the two categories (p<0.05). Our findings demonstrated that there were significant differences between the cytologic findings of epithelial tumor cells of stage I or II thymomas and those of stage III or IV thymomas, and that the cytologic findings of thymoma tumor cells appear to be useful for distinguishing between noninvasive and invasive thymomas.

BACKGROUND. Large cell carcinoma has been classified as four potential types based on its neuroendocrine morphology and evidence of neuroendocrine differentiation discernible by immunohistochemistry or electron microscopy. However, the clinical relation among these four categories has not been clearly defined. In 1999, the World Health Organization (WHO) categorized large cell neuroendocrine carcinoma as a variant of large cell carcinoma. MATERIAL AND METHODS. The authors analyzed 119 cases of large cell carcinoma from a total of 2070 primary lung carcinoma cases resected surgically between 1969-1999. Using light microscopy, electron microscopy, and immunohistochemical staining, the authors reclassified these cases into large cell neuroendocrine carcinoma (LCNEC), large cell carcinoma with neuroendocrine differentiation (LCCND), large cell carcinoma with neuroendocrine morphology (LCCNM), and classic large cell carcinoma (CLCC). RESULTS. In multivariate analyses, the authors found that large cell carcinoma with neuroendocrine features, which combined LCNEC, LCCND, and LCCNM, impacted both the overall survival and disease-free survival of patients. The clinical behavior of LCCNM was similar to that of LCNEC. CONCLUSIONS. Large cell carcinomas with neuroendocrine features appear to be more clinically aggressive than CLCCs. The authors' findings suggest that the histologic identification of neuroendocrine features in tumor tissue from patients diagnosed with large cell carcinoma of the lung may have clinical relevance. Cancer 2001;91:1992-2000. (C) 2001 American Cancer Society.

21歳男.胸部CTで前縦隔の腫瘤性病変を認めた.血清α-fetoprotein(AFP)が144.7ng/mlと高値を示したため非セミノーマ胚細胞腫瘍と診断し,PEB療法(シスプラチン,エトポシド,ブレオマイシン併用療法)を施行した.血清AFP値に相関しないcomponentの増大を否定しきれず腫瘍摘出術を施行した.病理診断は未熟奇形腫で,抗AFP抗体を用いた免疫染色で,未熟腺組織からのAFP産生を確認した

Clear cell adenocarcinoma of the lung is extremely rare. On radiography, a 45-year-old female with fever was found to have an abnormal shadow in the left lower lung field. Bronchoscopy revealed a polypoid tumor in the left bronchus. On biopsy, the tumor was determined to be adenocarcinoma. Preoperative examination found no tumors outside of the lung. The patient underwent left lower lobectomy with bronchial wedge resection. The tumor had completely obstructed and dilated the left lower bronchus, but had not invaded the tissue outside the bronchial wall. Microscopically, the cytoplasm of the tumor cells contained abundant glycogen, and the tumor had solid and glandular structures. The tumor was diagnosed as clear cell adenocarcinoma of the lung.

喀痰細胞診要精査例を中心に31症例45部位に対し,蛍光気管支内視鏡による異常蛍光部位に拡大気管支ビデオスコープを用いた微細観察を行った.その結果,異常蛍光部位の血管パターンは,(1)微細な血管がわずかに認められる,(2)血管網か血液のプーリングを認める,(3)蛇行した血管網が錯綜している,の3型に大別された.病理組織学的に,正常もしくは気管支炎24部位では,20部位が(1)か(2)であったが,dysplasia 21部位中15部位では(3)が観察された.type別の血管面積比の比較では,各typeごとに推計学的有意差を認め,正常もしくは気管支炎24部位とdysplasia21部位の比較では,後者が推計学的に有意に高値を呈した.蛍光気管支内視鏡での異常蛍光部位には,病理組織学的に正常または気管支炎に比べ,bronchial dysplasiaでは蛇行した血管網が錯綜,増生しており,その血管面積比も高値を示し,bronchial dysplasiaと血管新生の関連が示唆された

51歳女.強い咳嗽発作を主訴とし,前医にて中葉気管支の閉塞を指摘された.胸部X線像にて中葉の無気肺を,気管支鏡検査にて中葉支を閉塞する炎症性肉芽を認めた.中葉切除術を施行し,術後症状の改善を見た.病理学的には結核を示唆する所見は見られなかったが,画像所見,手術所見より本症例は結核性と思われる石灰化したリンパ節の気管支内穿孔による気管支結石症であると考えられた

肺切除18例を対象に,運動負荷肺機能検査を施行した.その結果,最大酸素摂取量(OM)は,術前平均18.8ml/min/kg,術後3ヵ月14.9ml/min/kg,術後6ヵ月17.4ml/min/kgで,術前に比べて術後3ヵ月では有意に低下したが,術後6ヵ月では有意差はなく,回復傾向を示した.また術後6ヵ月のOMが術前の90%以下に低下した肺葉切除例(A群)と低下しなかった例(B群)を比較したところ,術前の呼吸予備能はA群が平均10.3L/min,B群が47.7L/minと有意差を認めた.術前呼吸予備能が低下している症例は,肺切除術後に運動耐容能が低下することが示唆された

31例中29例でステント留置後自覚的に気道狭窄症状の改善を認めた.ステント留置により31例中23例で在宅治療が可能となった.悪性疾患の3例で合併療法の奏効によりステントを抜去でき,良性疾患でも1例抜去可能であった.悪性疾患の治療後生存期間は,ステント群ではMST 152日,5生率22.4%,Nd-YAGレーザー群ではMST 159日,5生率9.6%であり有意差は認めないが,長期生存例はステント群に多かった.良性疾患の留置期間は9ヵ月から最長6年9ヵ月であり,長期間に及ぶ有効性と安全性が示された.ステントの合併症として殆どの症例で留置後早期の排痰困難をまた長期留置症例で肉芽の発生を認めたが,重篤なものは認めなかった

対象は切除腫瘍径15mm以下の86例,病理病期はIA 54例,IB 2例,IIA 5例,IIIA7例,IIIB 14例,X4例であった.術前の生検法別の細胞診の診断率は擦過(n=44)が40.9%,鉗子生検擦印(n=50)が50.0%,経気道吸引(n=74)が66.2%,経皮吸引(n=19)が84.2%であり,総合すると術前の経気道生検が74.0%(n=77),経皮生検を含めると86.7%(n=83)と高率であった.cN0の肺葉切除例70例中pN1-3は10例であったが,腫瘍径10mm以下ではリンパ節転移はなかった.組織分化度の検討では高分化型(n=18)が全例pN0であった.今回リンパ節転移を認めた症例が含まれる腫瘍径11～15mm(n=71)では術前の総合診断率が88.7%と上昇した