Ciliated muconodular papillary tumor (CMPT) is a rare papillary tumor that arises in the peripheral lung fields and is associated with the proliferation of ciliated and goblet cells and increased mucin production. We report a case of CMPT involving the rearrangement of the anaplastic lymphoma kinase (ALK) gene. The patient was an 84-year-old Japanese female who had exhibited a small nodular shadow on chest computed tomography during a regular checkup 10 years ago. She underwent a partial resection of segment S10 of the right lung. The cut surface of the surgical specimen revealed a well-circumscribed, jelly-like mass measuring 8 Â 8 Â 10 mm. Histologically, the tumor was composed of a mixture of ciliated, goblet, and basal cells arranged in a papillary pattern together with pools of mucin. A diagnosis of CMPT was made. The lung tumor cells were subjected to fluorescent in situ hybridization and highly sensitive immunohistochemical staining for the ALK protein, both of which produced positive results. CMPT usually follows a favorable course, but the exact nature of this tumor; i.e., whether it is benign or malignant, has not been established. This is the first reported case of an ALK-positive CMPT.

Plombage methods were designed for treating pulmonary tuberculosis surgically around 1945 when pulmonary tuberculosis was regarded as a "traitor disease" in Japan. Nagaishi had reported extrapleural synthetic resin ball plombage in 1948 as the world's first case, but it was complicated by empyema due to perforation of cavities and rupture of lesions because the resin ball was hard. Later, fillers were improved by using soft material. At the present time, only air plombage and omentoplasty remain. Especially the latter has gained widespread use in the thoracic surgery field and become a standard procedure. Chronic empyema with bronchopleural fistula sometime requires surgical treatment despite the development of various antibiotics, but highly stressful surgery that can cause reduced pulmonary function or thoracic deformity must be avoided. Therefore, one-stage omentoplasty utilizing such omental multi-functions as hose action, angiogenesis, sucker action, and the immune reaction has been found to have clinical significance for thoracic empyema and its complications. This method is described in detail.

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Anti-cancer drugs generally have immunosuppressive effects (1), which presents a serious clinical problem. Under selected conditions, cyclophosphamide (CPM) has an immunopotentiating effect on the delayed hypersensitivity reaction (DHR; 2-4). This effect has been attributable to the interruption of a feedback control to the effector T cells by B cells (2, 5) and/or by suppressor T cells (4, 5). Recently, similar phenomena have been reported in other cell-mediated (6, 7) and tumor immunities (8-10). Immunopotentiating effects of CPM appear to take place preferentially in vivo, suggesting that such effects may be due to a biological consequence of diffuse cell damage with CPM, rather than to a unique biochemical action on selected populations of lymphoid cells.The presence of naturally occurring suppressor T cells (11) and the effect of CPM on them have been reported previously (4, 12). Here, we report that anti-cancer agents other than CPM also exhibit potentiating effects on the DHR when they are administered according to schedules of current clinical anti-cancer therapy.

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