[Three adults with mild varicella and bronchial mucosal lesions].

We encountered three adults with varicella and bronchial mucosal lesions. Respiratory symptoms were minimal in all three. Chest X-ray films showed bilateral, diffuse, small, nodular shadows. Small, elevated lesions with white plaque's were seen on the bronchial mucosa bronchoscopically. Transbronchial lung biopsy, bronchial mucosal biopsy, and bronchoalveolar lavage were also done. The lung-biopsy specimen showed infiltration of lymphocytes into the interstitial space: VZV antigen was found by immunohistochemical staining of the lesion in one case. Analysis of bronchoalveolar lavage fluid revealed abnormally low CD 4/8 ratios in three cases. These findings suggest a high incidence of respiratory complications, especially bronchial lesions, despite the lack of respiratory symptoms, in adults with varicella.

Bronchogenic cyst with high carbohydrate antigen 19-9 in the cyst fluid and the serum.

A mass of 8 cm in diameter was revealed in the right upper lung field of a 46-year-old female patient. The chest X-ray film taken one year previously revealed only a linear shadow in the same position, which was thought to be a vacant cyst. The levels of carbohydrate antigen (CA) 19-9 in cyst fluid and serum were elevated, at 410,000 and 130 U/ml, respectively. After surgical resection, serum CA19-9 returned to normal. Pathologically, the cyst wall was lined with bronchial epithelium with no evidence of malignancy. Immunohistochemical study revealed CA19-9 positivity in the bronchial epithelium of the cyst wall.

[A case of chronic eosinophilic pneumonia with a subpleural curvilinear shadow].

A 72-year-old woman was admitted to our hospital on May 7, 1990. She had suffered from dyspnea since April and complained of a continuing cough, sputum, and wheezing. A chest roentgenogram revealed bilateral, diffuse infiltration shadows, mainly in the outer zones. A considerable increase in the number of eosinophils was seen in samples of blood and of bronchoalveolar lavage fluid. Chest computed tomography showed a subpleural band-shaped infiltration shadow that was separated from normal lung fields by a subpleural curvilinear shadow. Examination of the specimen taken during open lung biopsy showed considerable eosinophil and lymphocyte infiltration, mainly in alveolar septa. No other abnormality was seen in the alveoli and there was no vasculitis or bronchiolitis. Therefore, we diagnosed this condition as chronic eosinophilic pneumonia. In addition, we discuss the subpleural curvilinear shadow.

[A case of lung cancer with specific calcification].

A 67-year-old male was admitted for detailed investigation of an abnormal chest roentgenogram showing a tumor shadow about 3 cm in diameter in the left S1+2. The shadow was surrounded by minute granular and striate shadows. Small cell carcinoma of the lung was diagnosed and chemotherapy was commenced, but without effect. Hypercalcemia and superior vena caval syndrome followed. Autopsy indicated highly specific calcinosis present in the left upper lobe peripheral to the primary disease. This calcinosis was observed subepithelially in bronchi and bronchioles, in the tunica intima of the veins, and in the alveolar septa. It could not be detected in the tumor or arterial or lymphatic systems. The calcinosis had been present prior to the development of hypercalcemia, and the density of the calcinosis was greatest close to the tumor, gradually decreasing with increased distance from the tumor. The calcinosis appeared to have been caused by some substance, and to have been accelerated by venous congestion, resulting in its unique distribution.

[A case report of multiple pulmonary tumors as a sole manifestation of synovial sarcoma].

A 47-year-old woman was admitted to our hospital for cough and dyspnea. Roentgenologic studies and bronchoscopy revealed multiple lung tumors one of which obstructed the right main bronchus. Right pneumonectomy was performed for the pending obstruction of the trachea. The tumor in the right S1 was found to be protruding into the trachea through the right B1 and the main bronchus in a polypoid fashion. The pathological diagnosis of synovial sarcoma was made on the basis of the characteristic biphasic structure composed of spindle cells and epithelioid cells forming gland-like spaces. Three years and eight months after the pneumonectomy, a nodule in the tendon of the extensor hallucis longus muscle became palpable. It was also a synovial sarcoma pathologically. Synovial sarcoma is a soft tissue sarcoma which usually arises in the extremities. It is very rare for pulmonary metastasis of this tumor to be found while the primary tumor is undetectable.

[Immunohistochemical and electromicroscopic study of a case of primary nodular pulmonary amyloidosis].

A 41-year-old man was hospitalized for further evaluation of an abnormal chest films which revealed a nodular shadow in the right middle lung field, which remarkably enlarged during one year. As no diagnostic procedures ruled out lung carcinoma of right S6, a right lower lobectomy was performed. Pathologically the nodules were composed of amorphous and eosionphilic materials which were diagnosed as amyloid by Congo-red stain and electron microscopic examination. Since there were no deposits in other organs and there was no abnormality of serologic and urinary protein analysis, a diagnosis of primary nodular pulmonary amyloidosis was established.

Interleukins in pulmonary sarcoidosis. Dissociative correlations of lung interleukins 1 and 2 with the intensity of alveolitis.

To investigate whether interleukins are involved in the formation of alveolitis in pulmonary sarcoidosis, interleukin-1 (IL-1) production by LPS-stimulated alveolar macrophages (AM) and interleukin-2 (IL-2) production by PHA-stimulated lung and blood T-cells were determined in 35 untreated patients with pulmonary sarcoidosis. The amount of IL-1 produced by AM (BAL IL-1) was significantly increased in patients with pulmonary sarcoidosis compared with that in 18 control subjects. BAL IL-1 showed a significant positive correlation with the intensity of alveolitis assessed by the proportion of lymphocytes in bronchoalveolar lavage fluid (BALF) and the absolute number of lymphocytes per milliliter of BALF. However, the amount of IL-2 produced by lung T-cells (BALT IL-2) showed a significant negative correlation with the intensity of alveolitis. BALT IL-2 was significantly lower than the amount of IL-2 produced by blood T-cells (PBT IL-2). There was no correlation between PBT IL-2 and the intensity of alveolitis. These results suggest that IL-2 contributes to the formation and maintenance of alveolitis in pulmonary sarcoidosis, whereas IL-2 production by lung T-cells is suppressed to down-regulate the enhanced immune processes at the site of disease. The possibility that this hyporesponsiveness of lung T-cells to PHA has resulted from the modulation of the T3-T cell receptor complex remains to be determined.

Choriocarcinoma of the esophagus producing chorionic gonadotropin.

An autopsy case of primary esophageal choriocarcinoma in a 42-year-old Japanese male is reported. The tumor was pure choriocarcinoma typical hemorrhagic and necrotic nature occupying almost the entire circumference of the mid-esophagus. The choriocarcinoma had metastasized to the liver, lung and lymph nodes. In the esophageal tumor, immunohistochemical staining showed the presence of mainly human chorionic gonadotropin (HCG), with human placental lactogen (HPL) in a few syncytiotrophoblastic cells. Only 3 cases of extragonadal choriocarcinoma originating in the esophagus have been reported up to now. The possible pathogenesis and pathological characteristics of primary esophageal choriocarcinoma are discussed.

Nuclear DNA content as an indicator of chemosensitivity in small-cell carcinoma of the lung.

The relationship between the nuclear DNA histogram pattern of tumor cells obtained by bronchoscopic brushing and the response to combination chemotherapy (Cytoxan + Adriamycin + Vincristine) was studied in 28 patients with small-cell carcinoma of the lung. Microspectrophotometric analysis of the tumor cells showed a near-diploid nuclear DNA pattern in 18 patients and a hyperdiploid pattern in 10 patients. Eight of the ten patients with the hyperdiploid pattern showed a good response (complete or partial response) to the chemotherapy. However, of the 18 patients with the near-diploid DNA pattern, only 2 displayed a good response; the remaining 16 patients exhibited no response. The hyperdiploid DNA pattern of tumor cells was thus associated with a better response to chemotherapy than was the near-diploid pattern. These results indicate that the nuclear DNA histogram pattern may be an indicator for predicting the degree of response to chemotherapy in small-cell carcinoma of the lung.

Role of HLA-DR antigens in Japanese patients with sarcoidosis.

Fifty-three Japanese patients with sarcoidosis were tested for HLA-A,B,C, DR, and DQ antigens in order to investigate immunogenetic mechanisms in the pathogenesis of sarcoidosis. All of the patients had abnormal shadows on their chest radiographs, and all had histologically confirmed sarcoidosis. Groups of 60 and 57 unrelated Japanese served as control subjects for HLA-A,B,C and HLA-D region antigens, respectively. The frequency of HLA-DRw52 was 79.2% (42 of 53) in the patient group compared with 50.9% (29 of 57) in the control group, and the difference was significant (chi 2 = 9.66, p less than 0.005, pc less than 0.05, relative risk = 3.69). On the other hand, no significant association was found with HLA-A,B,C antigens. When various clinical features of the patients were taken into account, there was a tendency for the frequency of DRw52 to be lower in the patients who were in an advanced stage or who had resisted treatment with steroids. Furthermore, 31 of the 32 patients without ophthalmic involvement were DRw52-positive, which was highly significant (96.9% as compared with 50.9% of the control group; chi 2 = 19.74, p less than 0.001, pc less than 0.01, relative risk = 29.93), whereas the frequency of DRw52 in the patients with ophthalmic involvement was almost the same as in the control group. These results suggest that HLA-DR antigens play a significant role in the pathogenesis of sarcoidosis, and there may be a heterogeneity in the clinical entity of sarcoidosis.

[Nuclear DNA content and focal relapse of patients with small-cell carcinoma of the lung].

The relationship between the nuclear DNA content and the focal relapse of 17 patients with small-cell carcinoma completely responsive to treatment was studied. The nuclear DNA content was measured at 550 nm using a microspectrophotometer. The nuclear DNA histogram pattern was classified as either "Type A" (near-diploid) or "Type B" (hyperdiploid). Of the nine patients with type A, only one was found to have focal relapse of the intrathoracic lesion. However, of the eight patients with type B, focal relapse was observed in six (75%). No significant difference was discerned between the metastasis to other organs and the nuclear DNA histogram patterns. The nuclear DNA histogram patterns in small-cell carcinoma of the lung are correlated to the outcome of the patients.

Prognostic significance of nuclear DNA content in small cell carcinoma of the lung.

The relationship between the nuclear DNA histogram patterns of tumor cells obtained by brushing via bronchoscopy and the survival time of 39 patients with small cell carcinoma of the lung was investigated. The brushing smears were stained by a modified Feulgen method. The nuclear DNA content was measured at 550 nm using a microspectrophotometer. The DNA histogram pattern was classified into type I, which contained a higher proportion of G0G1-phase cells, and type II, which contained a higher proportion of S, G2M-phase cells. The median survival times for the patients with limited disease of type I, type II and the patients with extensive disease of type I, type II were 17.2 months, 10.2 months, 10.0 months, and 5.6 months, respectively. Patients with limited disease of type I had a significantly longer survival time than patients with limited disease of type II. A distinct correlation was found between the histogram pattern and the survival of the patients. These results indicated that the nuclear DNA histogram pattern may be an indicator to allow speculation as to the prognosis of patients with small cell carcinoma of the lung.

[Ultrastructural studies of central-type early squamous cell carcinoma of the lung].

Characteristics of the nuclei in histopathologic preparations obtained from a patient with bronchial carcinoma and two patients with microinvasive bronchial carcinoma were studied by transmission electron microscopy. In carcinoma in situ, the nuclei showed slight or moderate irregularity in the nuclear outline. The number of perichromatin granules was usually one to 10 per nucleus section. Formation of fibrillar centers was not marked. In microinvasive carcinoma, the nuclei were more irregular in nuclear outline than in carcinoma in situ. The number of perichromatin granule was usually more than 11 per nucleus section. Formation of fibrillar centers was predominant.

Gallium-67 scintigraphy, bronchoalveolar lavage, and pathologic changes in patients with pulmonary sarcoidosis.

The intensity of gallium-67 scintiscans, lymphocyte counts in bronchoalveolar lavage fluid, and pathologic changes were studied in 26 patients with untreated pulmonary sarcoidosis. Noncaseating granulomas were recognized with significantly greater frequency in stage 2 (80 percent; 8/10 cases) than in stage 1 (43 percent; 6/14 cases). Alveolitis showed little relation to the roentgenographic stage. There was a strong correlation between the intensity of gallium uptake in pulmonary parenchyma and the detection rate of granuloma; however, the detection rate of alveolitis was not statistically different from the intensity of gallium uptake. A highly significant correlation was revealed between the lymphocyte counts in bronchoalveolar lavage fluid and the intensity of alveolitis. These observations suggest that the gallium uptake reflects mainly the presence of granuloma, and the lymphocyte count in bronchoalveolar lavage fluid reflects the intensity of alveolitis in patients with pulmonary sarcoidosis.

[Investigations of the pathogenesis of lung cancer observed among chromate factory workers].

In order to clarify the relationship between the chromate compound and occurrence of lung cancer, the author studied the characteristics of patients with lung cancer among workers of chromate factory and measured the chromium contents of each tissues obtained from 14 patients at surgery and autopsy. The incidence of the chromate lung cancer was 413 per 100,000 population, which was 16 times that of the general population. All were male. The age ranged from 26 to 74 year old (average 53). The histological type was mostly squamous and small cell carcinoma. Location of carcinoma occurrence was mainly limited to the large bronchi. The average total labor period of patients with lung cancer was 258 months and the latent period was 305 months. The working history of the patients in hexavalent-chromium producing process was longer than that of the control group. Patients with small cell carcinoma was mainly engaged in the monochromate producing process. The labor and latent period of patients with squamous cell carcinoma was longer than those of small cell carcinoma. Measurement of chromium contents in the respiratory system of chromate workers revealed much higher chromium content than in control group. The chromium content of tissues in the non-respiratory system was a little higher than that of the control group. High chromium content itself did not have any relation with the occurrence of lung cancer because the primary location of chromate lung cancer was limited to the large bronchi, not to the peripheral lungs which contained the highest chromium content. The longer was the exposure period, the higher was chromium content in the lung. Chromium content in the upper lobe was higher than that in the lower lobe. From these studies, the author concluded that hexavalent-chromate compound might be the compound responsible for lung cancer occurrence.