52

Under biplane TV monitoring, we firstly

performed TBLB in cases available followed by brushing cytology in all cases using mainly special brush with angle mechanism near the tip.

The overall preoperative definite diag- nostic rate was 95% (72/76), consisted of 89% (8/9), 100% (17/17) and 94% (47/50) when classified by tumor size of less than 15 mm, 16 - 20 n~n and 21 - 30 mm, respec- tively. Diagnostic rate of TBLB was 29%, that of brushing cytology was 89% and that of combination of both showed 95%. Two out of 4 cases unsuccessfully diagnosed were due to cytological false negative and were supposed that brushing was success~ fully done. The other two cases failed were due to inadequate brushing. The first examination showed 83% successful rate and this rate went up to 95% after the second examination. We have experienced no com- plications due to examination in all cases.

We conclude that combined bronchoscopic examination of TBLB and brushing cytology under biplane TV monitoring is useful method for the diagnosis of small periphe- ral lung cancer. But to increase the suc- cessful rate, the second examination is necessary if the first one is failed.

Preoperative Cytodiagnosis for Peripheral Lung CA. Shiba, M., Yamaguchi, Y., Fujisawa, T., Kimura, H., Arita, M. Institute of Pulmo- nary Cancer Research, Department of Sur- gery, Chiba University, Chiba, Japan.

With the recent advancement of flexible bronchoscope and cell sampling technique, preoperative diagnostic rate for periphe- ral lung cancer is getting better. Recent- ly transbronchial lung biopsy-stump cyto- logy (TBLB-SC) and transbronchial aspira- tion cytology (TBAC) were employed in our institute and good preoperative diagnostic rate has been obtained, combining with per- cutaneous fine needle biopsy (PCNB). We report preoperative cyto-diagnostic rate for peripheral lung cancer in our insti- tute during recent 2 years.

A total of 61 resected peripheral lung ca. were examined. Histologic types of these cases were 45 for adeno ca., 12 for epidermoid ca., 2 for large cell ca., 1 for small cell ca. and 1 for carcinoid,

For all 61 cases bronchofiberscopy was performed and transbronchial cell sampling was tried under bi-plane fluoroscopy. Po- sitive rates for each cell sampling methods were as following. Brushing: 28/43 (65%), TBLB-SC: 39/49 (80%), TBAC: 37/46 (80%). And total transbronchial diagstic rate was 51/61 (84%). For the negative eight cases, PCNB was also performed and positive re- sults were obtained in 7 cases. Total pre- operative diagnostic rate was 95%.

Conclusion: Transbronchial cell sampling tech- nique combining with TBLC-SC and TBAC was ef- fective for the diagnosis of peripheral origi- nated lung cancer and PCNB was indicated only

for the transbronchial negative cases. These procedures under transbronchial or percutane- ous approaches could not only improve the pre- operative diagnostic rate but also accelerate the decision of therapy including surgery.

Bronchoscopic Findings and Pathological Signi- ficance in Cases with Large Cell Carcinoma of the Lung. Niitsuma, M., Kunii, T., Yamada, T., Uehara, A., Nakamura, H., Amemiya, R., Oho, K., Hayata, Y.. Department of Surgery, Tokyo Medical College, Tokyo, Japan.

Detailed analysis of bronchoscopic abnormal findings make it possible to distinguish large cell carcinoma from adenocarcinoma, squamous cell carcinoma or small cell carcinoma of the lung. Pre-operative bronchoscopic findings and pathological findings obtained by surgical treatments were compared in resected cases of large cell carcinoma in Tokyo Medical College Hospital.

Results: (I) Bronchoscopic findings in cases with large cell carcinoma were classified in 6 types, 8 cases with normal folds, 3 cases with intramural type invasion, 2 cases with extra- mural invasion, 5 cases with intramural+extra- mural type, 2 cases with mucosal+intramural+ extramural type and 1 case with mucosal type. (2) 38% of large cell carcinomas and 60% of adenocarcinomas showed normal folds. 43% of large cell carcinomas and 8% of adenocarcinomas showed extramural type invasion. (3) Large cell carcinomas increase rapidly and cause stenosis of large bronchi by compression. In contrast, adenocarcinomas increase submucosally with in- vasion into lymph ducts. (4) Irregular compres- sed folds in the bronchial mucosa caused by infiltration of inflammatory cells without in- vasion of malignant cells are seen in cases of large cell carcinomas. In contrast, irregular- ly thick compressed folds caused by extra-mus- cular invasion of malignant cells are seen in cases with adenocarcinoma or small cell carci- nomas.

Malignant Pulmonary Neoplasms Associated with Emphysematous Giant Bulla. Nishiki, M., Okumichi, T., Yoshioka, S. Depart- ment of Surgery, Hiroshima University School of Medicine, Hiroshima, Japan 734.

Twenty-three cases of emphysematous giant bulla were experienced in our clinic. Twenty- two times of surgical treatment were perform- ed on 21 of the 23 cases. Malignant pulmonary neoplasms were obsemved in 8 (35%) of the 23 cases, which consisted of 7 cases of lung can- cer and one of malignant mesothelioma. The 7 cases of lung cancer of histological type con- sisted of 3 of squamous cell-type, 2 of small cell-type, and one each of large cell-type

53

and adenocarcinoma. The tumor-generated time was observed

in 1 case after bullectomy, in 3 cases du-

ring follow up and in 4 cases at the same time of bulla diagnosis. Of the 7 lung cancer cases, 6 were of advanced cancer and 1 of occult cancer.

From the above fact, attention should always be given to possible occurrence of malignant pulmonary neoplasms whenever em- physematous giant bulla is diagnosed.

This paper describes the results of the study on such malignant pulmonary neoplasms and their positional relation with giant bulla, results of their operations, lung function, and other oncogenic factors.

A Clinico-Pathologic Study of Lung Carci- noid T~nors. Mackay, B., Ordonez, N.G. The University of Texas, M.D. Anderson Hospital and Tumor Institute, Houston, Texas 77030.

Thirty-one primary carcinoid tumors of the lung have been studied by routine light microscopy, immunocytochemistry and ~lec- tron microscopy, and the findings correla- ted with the clinical presentation and course. The cases encompassed the range of histology that is displayed by lung carci- noids. A number of criteria for atypical carcinoids were investigated: not all were present in a particular case, and none appeared to specifically relate to the biologic behavior of the tumors. Immunostain- ing using a total of 24 antibodies revealed that some tumors were producing several hor- monal polypeptides and related substances. Electron microscopy showed a broad spectrum of cell size and shape, cytoplasmic contents, and caliber of secretory granules. The ul- trastructural features were compared with those of undifferentiated large and small cell bronchogenic carcinomas from our files to define differences useful in diagnosis. An unexpected finding was the presence of myoepithelial-like cells in several of the tumors: the cells stained with S-100 pro- tein, and showed structural differences from the earcinoid cells including an absence of secretory granules. We conclu- de that lung carcinoids are structurally and functionally a heterogeneous group of neoplasms, that the behavior can not be predicted from the pathologic features, and that electron microscopy is useful in establishing or confirming the diagnosis.

A Clinico-Pathological Study of Bronchial Carcinoids. Hasleton, P.S., Gomm, S., Blair, B., Law- son, W.R., Thatcher, N. Wythenshawe Hospi- tal, Manchester, U.K.

Histology from 41 patients diagnosed over the past decade as bronchial carci-

noid were reviewed and clinico-pathologi-

cal association sought. Thirty-six patients of

the 41 on review were confirmed with a spec- trum ranging from benign to malignant carci- noid. There were 22 male and 14 female pati- ents, median age 54 years (range 18-76). All patients were considered resectable at pre- sentation, 23 underwent lobectomy, ii pneu- monectomy and 2 were inoperable. The follow- ing clinical features were associated with a significantly inferior survival on log rank chi analysis: cigarette smoking p=0.03 and the presence of ipsilateral hilar lymphadeno- pathy p=0.01. Age, sex, type of resection, primary site, T stage, N stage, abnormalities of routine haematological and biochemical pro- files were not statistically significant (p>0.05).

The following histological features were associated with a significantly worse survi- val: mitotic count > i0, HPF, p=0.05: presen- ce of, vascular invation P=0.02; lymph node involvement p=0.000; nuclear pleomorphism p=0.007; necrosis p=0.04; disorganisation of architecture p=0.03; argyriophilia p=0.05. Features not associated with significant dif- ferences in survival were depth of bronchial wall invasion, tumour site, lymphatic vessel invasion, growth pattern (insular, trabecular, glandular, undifferentiated or mixed pattern), oncocytic change, mucin or CEA production.

Twenty-seven patients remain alive with no evidence of tumour, 7 patients have died of carcinoid, 1 patient alive has relapsed and 1 patient died of non tumour cause.

The results of surgical resection for bron- chial carcinoid are extremely good and several pathological features give guidance to the prognosis.

Evaluation of Needle Cytology for Diagnosis in Lun~ Cancer. Konaka ,C., Kato, H., Kawate, N., Nishimiya, K., Shinohara, H., Takahashi, H., Saito, M., Kinoshita, K., Noguchi, M., Sakai, H., Kito, T., Hayata, Y. Department of Surgery, Tokyo Medical College, Tokyo, Japan. i. Department of Surgery, Toyama Medical and Pharmaceutical University, Toyama, Japan.

The rate of diagnostic accuracy in lung cancer cases has been improved remarkably due to recently developed methods. In 1967 we de- veloped a percutaneous needle cytology set for the diagnosis of lung cancer. From 1973 to 1984 we performed examination in 1,056 ca- ses. Among them 232 were primary lung cancer cases. We evaluated the results according to tumor size, histologic type and comparison with other diagnostic methods. Diagnostic accuracy was 91.0% in peripheral type lung cancer, 89.0% in tumors less than 2 cm and 91.3% in tumors 2 cm or more. This method is the most effective method available in terms of diagnostic accuracy for small peri- pheral tumors. In 1977 we developed a flexible

needle for transbronchial needle aspiration