Peripheral Squamous Cell Carcinoma Research Articles

P1.06C.06 The Prognostic Impacts of Three Invasive Patterns in Pulmonary Peripheral Squamous Cell Carcinoma

P1.06C.06 The Prognostic Impacts of Three Invasive Patterns in Pulmonary Peripheral Squamous Cell Carcinoma

Potentials of computer simulation of lung tumors in comparison with <sup>99m</sup>Тс-MIBI SPECT/CT data

The aim of the study was to develop and validate a software package (SP) for computer simulation of the procedure for examining patients with lung cancer by SPECT/CT and assessing the accuracy of reconstruction of tumor lesions.Material and Methods. Lung scintigraphy for a patient with peripheral squamous cell carcinoma of the upper lobe of the right lung was performed using a two-detector gamma camera GE Discovery NM/CT 670 DR (USA) with high-resolution collimators for an energy of 140 KeV and a radiopharmaceutical (RP) 99mTc-Technetril (MIBI, Diamed, Moscow). The data obtained were subjected to computer processing using a specialized Xeleris 4.0 system from GE (USA). The SP included a program for generating a voxel phantom (“virtual patient”), a program for modeling the “raw” data acquisition (“virtual tomograph”) and an image reconstruction based on the OSEM algorithm (Ordered Subset Expectation Maximization). In order to validate the created SP, computer simulation of the above clinical case was performed. The semi-quantitative comparative image analysis was based on a tumor/background score.Results. There was a good correlation between clinical “raw” data recorded from a real patient and projection data calculated by the Monte Carlo method from a “virtual patient”. The results of the comparative analysis showed that the tumor/background assessment was underestimated in the reconstructed images.Conclusion. The problem of the accuracy of the tumor lesions reconstruction by using standard OSEM reconstruction algorithms has not been studied. This issue is important in the management of patients with tumor lesions of the lungs and requires study and systematization. The SP will be used in further studies to analyze errors and artifacts in images of tumor lesions, as well as to develop approaches to overcome them.

Non-metastatic Squamous Cell Lung Carcinoma: A rare case report

Central and peripheral types of squamous cell carcinoma (SQCC) are classified in different categories due to different clinical-pathological features. Peripheral SQCC, according to histological pattern; it is classified into three subgroups as alveolar space-filling type, expanding type and combined type. Of these three subtypes, alveolar space-filling neither causes lymphatic vessel invasion nor lymph node metastasis and has the best prognosis. Herein, we present a rare case of squamous cell carcinoma that did not metastasize at two and a half years years from initial diagnosis.

Impact of Postoperative Radiotherapy on Overall Survival in Patients with pN1 Non-Small Cell Lung Cancer

Objective: to comparatively analyze overall survival (OS) in patients with non-small cell lung cancer (NSCLC) with affected lymph nodes (pN1) of the lung root after surgical and combination treatment with postoperative radiotherapy (PORT). Subjects and methods. OS was studied in 310 patients with grade 2-3 NSCLC. (pT1a-4N1M0): in 101 patients after lobectomy/bilobectomy, pulmonectomy with ipsilateral mediastinal lymphadenectomy and in 209 patients after combination treatment with the similar surgical volume and hypofractionated PORT (a single focal dose (SFD) of 3 Gy; 5 fractions per week, a cumulative focal dose (CFD) of 36-39 Gy (43.2-46.8 Gy-eq)) or classical fractionation (SFD2 Gy, 5 fractions per week, CFD44 Gy). An analysis was carried out in the groups of patients younger and older than 60 years with central or peripheral cancer, squamous cell carcinoma or adenocarcinoma, with different tumor grading according to the T criterion (T1-4). Results. PORT in radically operated patients with NSCLC increased 5- and 10-year OS rates only in central squamous cell lung cancer (56.1% and 39.5% vs.25.4% and 4.3%, p = 0.002). This group receiving combination therapy showed a statistically significant increasing trend in 5-year OS rates for both pT1-2 tumors (57.5% vs. 21.3%, respectively, p = 0.013) and pT3-4 tumors (53.9% versus 26.0%; p = 0.044), so did patients younger than 61 years (65.5% vs.29.4%, p = 0.008) and those over 60 years old (47.5% vs.21.3%, p = 0.047). Patients with peripheral squamous cell carcinoma or lung adenocarcinoma at any site exhibited no statistically significant increase in OS after PORT. In general, the 5- and 10-year OS rates in the compared groups were statistically significantly higher in the PORT group (47.9% and 28.9% vs. 27.1% and 11.4, p = 0.006). None of the analyzed subgroups showed a decrease in OS after PORT. Conclusion. In patients with pN1 NSCLC who had radical surgery via lobectomy/bilobectomy or pulmonectomy with ipsilateral mediastinal lymphadenectomy, PORT can be recommended only for those with central squamous cell carcinoma, regardless of tumor size and age group. In other subgroups of patients with pN1 NSCLC, PORT can only be performed within the scientific protocols. The expediency of PORT after bilateral mediastinal lymph node dissection needs to be investigated.

Intensity‐modulated radiotherapy combined with intensity‐modulated radiotherapy CT–guided iodine 125 seed brachytherapy for non‐small cell lung cancer: A case report

AbstractIntensity‐modulated radiotherapy (IMRT) has been used to treat locally advanced non‐small cell lung cancer (LA‐NSCLC) disseminated to primary gross tumor volume (pGTV) and mediastinal lymph nodes (LNs). However, it is challenging to deliver definitive doses to the pGTV and regional LNs without exceeding the tolerance of the organs at risk (OAR). Iodine‐125 (I‐125) brachytherapy has recently been applied in clinical practice for the treatment of malignant tumors. Its merits include a higher dose to the primary tumor lesion and lower dose surrounding the tumor mass. Using brachytherapy in these settings may maximize the dose delivered to the pGTV while minimizing the dose delivered to the OAR. I‐125 brachytherapy combined with IMRT for the treatment of LA‐NSCLC has rarely been reported. Here we report a patient with peripheral squamous cell carcinoma of the lung who received I‐125 brachytherapy for pulmonary lung lesions and IMRT for metastatic mediastinal LNs. The patient received 16 months of follow‐up care with no evidence of complications or disease recurrence. Moreover, we compared brachytherapy plus IMRT to theoretically planned IMRT dosimetry to evaluate the merits of each approach. This treatment modality resulted in a higher target dose escalation and lower doses delivered to the OAR.

Общая выживаемость больных немелкоклеточным раком легкого группы pN2 после радикальной операции и послеоперационной лучевой терапии

Purpose: Comparative analysis of the overall survival (OS) in different subgroups of the patients with non-small cell lung cancer (NSCLC) with affected mediastinal lymph nodes (pN2) after surgical and combined treatment using postoperative radiotherapy (PORT). 
 Material and methods: A comparative assessment of the overall survival of 243 patients with NSCLC stages IIIA, IIIB (pT1–4N2M0) was carried out: the I group – 79 patients after radical (R0) surgical treatment (lobe/bilobectomy, pulmonectomy with ipsilateral mediastinal lymph node dissection) and the second group – 164 patients after the combined modality therapy with the same volume of surgery and postoperative radiotherapy in the mode of hypofractionation (daily dose 3 Gy, 5 times a week, TD = 36–39 Gy (EQD2 = 43.2–46.8 Gy, α/β = 3) or classical fractionation (2 Gy, 5 times a week, TD = 44 Gy). We analyzed subgroups of men and women, patients younger than 60 years and older, with central and peripheral cancer, squamous cell carcinoma and adenocarcinoma, with different gradation of tumors according to the criterion T (pT1–4). 
 Results: In the compared groups, 2-year and 5-year OS was significantly higher in the PORT group (62.4 and 31.6 vs 44.8 % and 12.3 %, p = 0.0028), at the expense of male patients (62.4 and 31.6 % vs 44.8 and 12.3 %, p = 0.0028), patients with central cancer (59.2 and 43.7 % vs 36.3 % and n/a, p = 0.0023), patients with squamous cell carcinoma (64.0 % and 43.1 % vs 42.3 % and 6.7 %, p = 0.0006), patients older than 60 years (74.8 and 46.2 % vs 45.1 % and n/a, p = 0.007). A more detailed analysis revealed that PORT significantly increased 2- and 5-year OS in the central squamous cell carcinoma of the lung (67.3 and 53.0 % vs. 33.3 and 0 %, respectively, p = 0.0013), and in pT3–4 tumors (2-year OS 57.1 vs. 36.4 %, respectively, p = 0.0102). There was only a tendency of increasing OS after the PORT in T2 tumors (5-year OS 31.1 vs 15.4 %, respectively, p = 0.1319). In T1 tumors, no differences in OS were found, possibly due to the small number of cases (27). In peripheral squamous cell carcinoma there was a statistically insignificant increasing of 5-year OS – 7 %. There was no significant differences in OS survival were obtained in central and peripheral lung adenocarcinoma between the I and II groups. 
 Conclusion: In the patients with non-small cell lung cancer pN2, radically operated (R0) in the volume of lobe/bilobectomy, pulmonectomy with ipsilateral mediastinal lymph node dissection, PORT can be recommended for central squamous cell carcinoma pT1–4. In the patients with peripheral squamous cell carcinoma, PORT can be discussed for the patients with individually assessed high risk of the locoregional relapse. PORT, within the scope of irradiation and total doses used in this study, has no age restrictions. The feasibility of PORT for radically operated patients with pN2 lung adenocarcinoma requires further study.

Clinicopathological features of small-sized peripheral squamous cell lung cancer.

Recent advances in imaging technology have enhanced the detection rate of small-sized peripheral lung cancers. The present study aimed to identify the clinicopathological differences between patients with small-sized peripheral squamous cell carcinoma (SCC) and adenocarcinoma (ADC). Patients with lung cancer who underwent radical surgical resection at Gunma University Hospital between July 2007 and October 2012 were retrospectively analyzed. Patients who exhibited small-sized peripheral tumors (pathological size, ≤2 cm) located within the outer-third of the lung field on preoperative computed tomography were enrolled in the present study. A total of 26 patients were diagnosed with SCC and 214 with ADC. The results revealed that patients with SCC exhibited higher rates of pleural invasion, vascular invasion and lymphatic invasion compared with ADC patients. Additionally, the rate of postoperative recurrence was higher in patients with SCC compared with ADC patients. Patients with ADC were subsequently into two groups: Solid ADCs (sADC) and non-solid ADCs (nsADC), which included pure ground glass nodules and part-solid ADCs. The results revealed that the incidence of pleural invasion, vascular invasion and lymphatic invasion, and the rate of postoperative recurrence in patients with sADCs were similar to those with SCC, but were also significantly higher when compared with nsADC patients. The present study concluded that patients with SCC and sADC may not be suitable candidates for sublobar resection, despite exhibiting small tumors that are located in the peripheral lung.

Growth patterns of small peripheral squamous cell carcinoma of the lung and their impacts on pathological and biological characteristics of tumor cells.

The growth pattern of peripheral squamous cell carcinoma (SCC) of the lung is divided into two types: alveolar space-filling (ASF) growth and alveolar space-destructive (ASD) growth. The aim of this study was to investigate the clinicopathological differences between cancer cells displaying ASF and ASD growth. We analyzed 155 patients with peripheral SCC measuring 30mm or less in diameter. The proportion of ASF in the total tumor area (%ASF) was determined using digital image analysis. We examined the clinicopathological characteristics of the cancer cells and compared the immunophenotypes of high %ASF tumors (> 30%) and low %ASF tumors (0%). Finally, we analyzed the prognostic impact of ASD area with small SCC cases (≤ 2.0cm, n = 72). Cases of high %ASF tumors showed significantly lower frequencies of lymphovascular invasion (p = 0.008). Immunohistochemical staining revealed that the expression score of laminin-5, invasive-related molecule, in cancer cells was significantly lower in high %ASF cases than in low %ASF cases (p = 0.001). Within the same tumor, laminin-5 expression in the ASF area was significantly lower than that in the ASD area (p = 0.001). The overall 5-year survival rate of patients with a larger ASD area (> 1.0cm2) was significantly lower than that of patients with a smaller ASD area (≤ 1.0cm2) (p = 0.017). In this study, we clearly showed that cancer cells presenting with ASF represents a "less invasive phenotype" in peripheral SCC.

Clinicopathologic characteristics of peripheral squamous cell carcinoma of lung

Clinicopathologic characteristics of peripheral squamous cell carcinoma of lung

P1.05-006 Clinicopathological Features of Small-Sized Peripheral Squamous Cell Lung Cancer

Recent advances in imaging technology have enhanced the detection rate of small-sized peripheral lung cancers. While squamous cell carcinoma (SCC) had previously been regarded as a representative histological type of centrally-located lung cancer, recent studies have reported an increase in peripheral SCC. In order to reveal the malignancy of such peripheral lung cancer, we retrospectively compared the clinicopathological features of small-sized peripheral SCC with that of adenocarcinoma (ADC) in surgically resected cases.

Restrictive ventilatory impairment is associated with poor outcome in patients with cT1aN0M0 peripheral squamous cell carcinoma of the lung.

Patients with squamous cell carcinoma (SqCC) of the lung sometimes have a comorbid pulmonary disease such as pulmonary emphysema or an interstitial lung disease (ILD), both of which negatively affect patient outcome. The aim of this study was to determine the outcome of patients in a multicenter database who underwent surgery for cT1aN0M0 peripheral SqCC lung cancer. The medical records of a total of 228 eligible patients from seven institutions were reviewed to evaluate the impact of concomitant impaired pulmonary function and other clinicopathological factors on overall survival (OS) and relapse-free survival (RFS). Six patients with positive or unclear tumor margins were excluded. Of the 222 remaining study patients, 42 (18.9%) and 97 (43.7%) patients were found to have coexisting restrictive or obstructive ventilatory impairment, respectively. Over a median follow-up period of 30.6 months, the 5-year OS and RFS were 69.0% and 62.6%, respectively. By multivariate analysis, ILDs identified on high-resolution computed tomography (HRCT), pulmonary function test results indicating a restrictive ventilatory impairment, and wedge resection were found to be independent risk factors for poor OS. An increased level of serum squamous cell carcinoma antigen (SCC-Ag) (>1.5 ng/mL) and the same risk factors for poor OS were independent risk factors for recurrence. Among patients who underwent anatomical lung resection (lobectomy and segmentectomy, n=173), a restrictive ventilatory impairment was an independent risk factor for poor OS, and increased serum SCC-Ag level, ILDs on HRCT, and restrictive ventilatory impairment were independent risk factors for poor RFS by multivariate analysis. Factors such as visceral pleural invasion, and lymphatic or vascular invasion were not significantly associated with outcome. A restrictive ventilatory impairment negatively affects the outcome of patients with cT1aN0M0 peripheral SqCC lung cancer.

Squamous cell carcinoma of the lung showing a ground glass nodule on high-resolution computed tomography associated with pneumoconiosis: a case report

BackgroundAdenocarcinoma with lepidic growth pattern presents as a ground glass nodule (GGN) on high resolution computed tomography (CT), whereas peripheral pulmonary squamous cell carcinoma (SCC) usually presents as a solid nodule. We herein report a rare case of pulmonary SCC extending along the alveolar lumen representing as a GGN on a CT scan in a patient with pneumoconiosis.Case presentationA 77-year-old man with pneumoconiosis was found to have a gradually enlarging GGN in the right lower lobe of the lung on CT. An adenocarcinoma of the lung was suspected. The GGN was successfully resected by thoracoscopic segmentectomy. Pathological examination of the resected specimen was pathologically diagnosed as a stage IA SCC extending along the alveolar lumen. The patient had no evidence of recurrence 19 months after surgery.ConclusionsSCC should be included in the differential diagnosis of peripherally located GGNs, especially in patients at high risk of SCC of the lung such as those with pneumoconiosis.

Prognostic Factors Based on Clinicopathological Data Among the Patients with Resected Peripheral Squamous Cell Carcinomas of the Lung

Although the incidence of peripheral squamous cell carcinomas (p-SqCCs) of the lung has increased over recent years, clinicopathological factors influencing prognosis of resected p-SqCCs remain unclear. We examined 280 patients who underwent complete resection of SqCCs and analyzed the clinicopathological features in relation to their overall survival (OS) and recurrence-free survival (RFS) according to the primary location. Multivariate analysis of all stages of p-SqCCs patients revealed that high serum squamous cell carcinoma antigen (SCC) level (OS; p < 0.01, RFS; p < 0.01), vascular invasion (OS; p < 0.01, RFS; p < 0.01), pleural invasion (OS; p = 0.03, RFS; p = 0.01), nodal metastasis (OS; p = 0.02) and complication with lung disease (OS; p < 0.01) were independently unfavorable prognostic factors. Among stage I p-SqCCs patients, high serum SCC level (OS; p < 0.01, RFS; p < 0.01), vascular invasion (RFS; p < 0.01) and pleural invasion (RFS; p = 0.01) were also strongly correlated with poor prognosis independently. When we reevaluated the survival rate, T1 p-SqCCs with high serum SCC level or vascular invasion can be upgraded to T2a. Patients with stage IB had a significantly poorer prognosis than stage IA (5-year RFS; 61.4 % versus 76.6 %, p < 0.05). High serum SCC level, pleural and vascular invasions were independent poor prognostic factors for completely resected p-SqCCs. T1 p-SqCCs with high serum SCC level or vascular invasion should be upgraded to T2a, which accurately reflect survival status among patients with p-SqCCs.

Characteristics of Peripheral versus Central Lung Cancer Since 2000

&lt;title&gt;Abstract&lt;/title&gt;&lt;sec&gt;&lt;title&gt;Objectives&lt;/title&gt;&lt;p&gt;The aim of this study was to explore the changes of bronchoscopic features according to epidemiologic change of lung cancer.&lt;/sec&gt;&lt;sec&gt;&lt;title&gt;Methods&lt;/title&gt;&lt;p&gt;We performed a retrospective review of the clinical characteristics of 1,139 lung cancer patient who underwent bronchoscopy at Kosin University Hospital from January 2000 to December 2010.&lt;/sec&gt;&lt;sec&gt;&lt;title&gt;Results&lt;/title&gt;&lt;p&gt;The age of patients increased significantly during the last decade (&lt;italic&gt;P&lt;/italic&gt; &amp;lt; 0.001). The most common histological type was adenocarcinoma (38.1%), followed by squamous carcinoma (35.7%) and small cell carcinoma (15.3%). There was an increasing incidence of adenocarcinoma over the time (&lt;italic&gt;P&lt;/italic&gt; &amp;lt; 0.001). Bronchoscopic feature were divided into two classes; central type, peripheral type. The peripheral type was predominant (62.3%). The proportion of peripheral type has been increased in process of time (49.7% vs. 63.7% vs. 73.7%; &lt;italic&gt;P&lt;/italic&gt; &amp;lt; 0.01). Among the major histopathologic type of lung cancer, adenocarcinoma (81.3%) and unclassifiable non-small-cell lung cancer (73.4%), small cell carcinoma (56.9%) were associated with preferential occurrence of peripheral type. Squamous cell carcinoma of the lung more often arised in central type (59%). However, the proportion of peripheral squamous cell carcinoma has been increased. On the subgroup analysis, the median survival time of peripheral type with adenocarcinoma and small cell carcinoma were longer than central type (&lt;italic&gt;P&lt;/italic&gt; &amp;lt; 0.05).&lt;/sec&gt;&lt;sec&gt;&lt;title&gt;Conclusions&lt;/title&gt;&lt;p&gt;The age of the lung cancer patients at diagnosis was getting older. The most frequent histopathologic type was adenocarcinoma. The proportion of peripheral type lung cancer gradually increased over the time. The survival time of peripheral type lung cancer was longer than central type.&lt;/sec&gt;

Current State-of-the-Art Therapy for Advanced Squamous Cell Lung Cancer

Squamous cell carcinoma (SCC) represents the second most common histologic subtype of lung cancer (preceded only by adenocarcinoma). SSC of the lung is prevalently diagnosed in smokers and has been described as a preferentially centrally located tumor in which the main airways are commonly involved. Clinically, it presents with predominant locoregional signs and symptoms, but in recent years an increasing frequency of peripheral SCC of the lung has been reported. Pathologic diagnosis can be easily made through light microscopy and immunohistochemistry. The treatment approach for early-stage disease does not differ from that of other histologic subtypes of non-small cell lung cancer; in locally advanced unresectable or metastatic disease, doublet chemotherapy regimens (including cisplatin or carboplatin and a third-generation agent such as gemcitabine, taxanes, or vinorelbine) remain the cornerstone of front-line systemic treatment. Conversely, a single agent, mainly docetaxel, is the preferred treatment in second-line treatment. In unselected patient populations, targeted therapies have been extensively tested in combination with cytotoxic chemotherapy with disappointing results because of increased toxicity or lack of improvement in efficacy outcomes. Genomic alterations in SCC of the lung have not been comprehensively characterized, and no molecularly targeted therapies have been specifically developed for the treatment of this disease, but recently immune checkpoints have emerged as new therapeutic agent.

Difference of Morphology and Immunophenotype between Central and Peripheral Squamous Cell Carcinomas of the Lung

Background. Recent agents, that is, pemetrexed and bevacizumab, have shown reproductive negative association between squamous histology. According to these agents' effectiveness, ruling out of the squamous histology is a significant issue for surgical pathologists. Several articles have proposed the distinction of peripheral type from central type of squamous cell carcinoma (SqCC) due to its similarity to adenocarcinoma, although little evidence to support the difference between these two types was published. In this study, we compared the clinicopathologic findings of central and peripheral pulmonary SqCCs. Material and Methods. 15 central and 35 peripheral types of SqCC from 2005 to 2010 were examined. Twelve morphological features were scored based on their intensity in the original H&E slides, and then, tissue microarray holding triplicated cores from 43 cases was immunohistochemically examined for cytokeratin (CK)7, CK14, TTF-1, Napsin A, p63, CK34βE12, CK5/6, and p53. Result. Most of the histological findings did not separate central and peripheral SqCCs; only the presence of emphysema, interstitial fibrosis, and entrapped pneumocytes inside the tumor showed statistic predominance in peripheral SqCC. This is the first immunophenotypic research in the central and peripheral types of SqCC.

Current State-of-the-Art Therapy for Advanced Squamous Cell Lung Cancer

Squamous cell carcinoma (SCC) represents the second most common histologic subtype of lung cancer (preceded only by adenocarcinoma). SSC of the lung is prevalently diagnosed in smokers and has been described as a preferentially centrally located tumor in which the main airways are commonly involved. Clinically, it presents with predominant locoregional signs and symptoms, but in recent years an increasing frequency of peripheral SCC of the lung has been reported. Pathologic diagnosis can be easily made through light microscopy and immunohistochemistry. The treatment approach for early-stage disease does not differ from that of other histologic subtypes of non–small cell lung cancer; in locally advanced unresectable or metastatic disease, doublet chemotherapy regimens (including cisplatin or carboplatin and a third-generation agent such as gemcitabine, taxanes, or vinorelbine) remain the cornerstone of front-line systemic treatment. Conversely, a single agent, mainly docetaxel, is the preferred treatment in second-line treatment. In unselected patient populations, targeted therapies have been extensively tested in combination with cytotoxic chemotherapy with disappointing results because of increased toxicity or lack of improvement in efficacy outcomes. Genomic alterations in SCC of the lung have not been comprehensively characterized, and no molecularly targeted therapies have been specifically developed for the treatment of this disease, but recently immune checkpoints have emerged as new therapeutic agent.

A Clinicopathological Study of Resected Small-Sized Squamous Cell Carcinomas of the Peripheral Lung: Prognostic Significance of Serum Carcinoembryonic Antigen Levels

The purpose of this retrospective study was to evaluate common clinicopathological factors and clarify the prognostic factors of small-sized peripheral-lung squamous cell carcinomas. We retrospectively reviewed 71 patients with peripheral squamous cell carcinoma ≤3 cm in diameter, who were surgically treated between January 1989 and December 2010. Patients undergoing partial lung resection without lymph node dissection were excluded. The median follow-up for living patients was 63 months. The overall 3- and 5-year survival rates were 83.9% and 74.7%, respectively.Although the ROC curve of serum carcinoembryonic antigen (CEA) levels showed marginally significance (P = 0.050), multivariate analyses revealed that age (P = 0.043), lymph node metastasis (P = 0.004), and preoperative serum carcinoembryonic antigen (CEA) level (P = 0.037) were independent prognostic factors. For pathologic N0 patients, there was a significant difference for recurrence-free survival based on CEA levels: patients with normal CEA levels (n = 40), 5-year-recurrence-free rate = 93.5%;elevated CEA (n = 14), 5-year-recurrence-free rate = 72.7% (P = 0.0160). The distribution of tumor cells immunoreactive for CEA was significantly associated with serum CEA levels (P = 0.033). Age, lymph node metastasis, and serum CEA level are independent prognostic factors for small-sized peripheral-lung squamous cell carcinoma.

肺癌検診喀痰細胞診で発見された末梢型肺扁平上皮癌の細胞像の検討

肺癌検診喀痰細胞診で発見された末梢型肺扁平上皮癌の細胞像の検討

Peripheral Squamous Cell Carcinoma of the Lung

Peripheral Squamous Cell Carcinoma of the Lung