Haigan
Online ISSN : 1348-9992
Print ISSN : 0386-9628
ISSN-L : 0386-9628
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Volume 50, Issue 4
Displaying 1-11 of 11 articles from this issue
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Review Article
  • Molecular Biology of Lung Cancer
    Shinichi Toyooka, Tetsuya Mitsudomi, Junichi Soh, Hiromasa Yamamoto, S ...
    2010 Volume 50 Issue 4 Pages 329-341
    Published: 2010
    Released on J-STAGE: October 05, 2010
    DOIhttps://doi.org/10.2482/haigan.50.329
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    Recent advances in biotechnology have made it possible to explore the molecular pathogenesis of human lung cancer. Since the 1980s, various alterations, including mutations in the P53 and KRAS genes, allelic alterations like loss of heterozygosity, and DNA methylation of tumor-related genes have been extensively studied. In 2004, epidermal growth factor receptor (EGFR) gene mutation was discovered in non-small cell lung cancer (NSCLC) as an alteration that causes oncogene addiction. EGFR mutation is also significantly associated with sensitivity to EGFR-tyrosine kinase inhibitors (TKI), which has encouraged intensive studies not only on the EGFR gene but also on the EGFR family and its downstream genes. Furthermore, EML4-ALK fusion genes have been found in NSCLC, and as in EGFR-TKIs, an ALK inhibitor shows a drastic response in NSCLC with the EML4-ALK fusion gene. These discoveries demonstrate that basic research can develop novel therapeutic strategies to improve the prognosis of lung cancer. In this review, we summarize the crucial findings of molecular pathogenesis in lung cancer, especially NSCLC, and show the possible future direction of related molecular biological research.
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Case Report
  • A Case of Microscopic Lung Cancer Arising from an Intrapulmonary Bronchogenic Cyst
    Isao Sano, Hideki Taniguchi, Kouichi Tomoshige, Osamu Takahara
    2010 Volume 50 Issue 4 Pages 342-346
    Published: 2010
    Released on J-STAGE: October 05, 2010
    DOIhttps://doi.org/10.2482/haigan.50.342
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    Background. Lung cancer associated with a lung cyst in female non-smoking patients is relatively uncommon. Case. A 70-year-old woman, with no smoking history developed a cough in November 2008. On examination at a local hospital, an abnormal opacity was found on her chest radiograph. Computed tomography of the chest revealed a cystic lesion containing fluid in the right middle lobe, and slight pleural thickening. A diagnosis of lung cancer with an infected lung cyst could not be excluded. In January 2009, the patient underwent right middle lobectomy under thoracoscopic observation. A frozen section obtained during surgery revealed evidence of chronic inflammation, but no distinct malignant changes were recognized. However, examination of permanent sections postoperatively revealed multiple disparate lesions of bronchioloalveolar carcinoma (BAC) and atypical adenomatous hyperplasia (AAH) around the intrapulmonary bronchogenic cyst and organizing pneumonia. There were no distinct metastases in the lymph node specimens. At present, 11 months postoperatively, the patient is under observation on an outpatient basis. Conclusion. The present patient was a non-smoking woman with microscopic lung cancer associated with an intrapulmonary bronchogenic cyst, and chronic inflammation associated with the cyst was considered as the underlying carcinogenetic process. It is necessary to consider the possibility of lung cancer coexisting in an intrapulmonary bronchogenic cyst of a non-smoking individual. It is also necessary to recognize the importance of maintaining an adequate stump size in resection of an intrapulmonary bronchogenic cyst, and to pay special attention to histologic features.
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  • A Case of Mediastinal Tumor Resected After Chemotherapy with the CODE Regimen
    Tomoya Kono, Masayuki Kuniyoshi, Hidenori Kawasaki, Tsutomu Kawabata, ...
    2010 Volume 50 Issue 4 Pages 347-352
    Published: 2010
    Released on J-STAGE: October 05, 2010
    DOIhttps://doi.org/10.2482/haigan.50.347
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    Case. A 30-year-old man was pointed out in a mediastinal tumor. Needle biopsy was performed, but the diagnosis was not definitive. We judged there to be no operative indications, and chemotherapy with the CODE regimen (cisplatin, vincristine, doxorubicin, etoposide) was given. Four courses after chemotherapy had been completed, the tumor size had decreased 85% in maximum dimension on chest computed tomography (CT). Therefore, salvage surgery was performed via a median sternotomy. The resected specimen did not show any viable cells. Radiotherapy, of 2 Gy×25 Fr was administered postoperatively. The patient is alive and well 5 years after the operation. Conclusion. It is sometimes difficult to make histologic diagnosis in mediastinal tumors, and CODE therapy may be effective in such cases.
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  • Adenocarcinoma of the Lung Presenting with Polymyalgia Rheumatica-like Symptoms Resolved After Resection
    Toru Kimura, Yukiyasu Takeuchi, Yasunobu Funakoshi, Hidenori Kusumoto, ...
    2010 Volume 50 Issue 4 Pages 353-356
    Published: 2010
    Released on J-STAGE: October 05, 2010
    DOIhttps://doi.org/10.2482/haigan.50.353
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    Background. Lung cancer is usually associated with a variety of paraneoplastic symptoms, but is rarely associated with proximal musculoskeletal symptoms indicative of polymyalgia rheumatica. We describe a case with polymyalgia rheumatica-like symptoms which recovered after resection of adenocarcinoma of the lung. Case. A 62-year-old man with a history of diabetes mellitus and hypertension was hospitalized in November 2008 because he had experienced bilateral pain and stiffness in his proximal thigh muscle and hip for 3 months. A diagnosis of polymyalgia rheumatica was established, but he did not respond to 180 mg/d loxoprofen. He was referred to our hospital because a chest X-ray film revealed an abnormal shadow. No rheumatoid factors or anti-cyclic citrullinated peptide antibodies were detected. Chest computed tomography revealed a 40×35-mm tumor in the lower lobe of the right lung. The mass was diagnosed as adenocarcinoma by bronchofiberscopy. Right middle and lower lobectomy with ND2a-2 lymph node dissection were performed. The postoperative diagnosis was pT2aN0M0, pStage IB adenocarcinoma. During the postoperative course, his polymyalgia decreased. However, he continued to experience mild stiffness in his fingers, which resolved after the administration of 60 mg/d loxoprofen. Conclusion. Lung cancer should also be considered in patients presenting with polymyalgia rheumatica-like symptoms.
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  • Postoperative Long Survival of a Case of Unknown Primary Carcinoma with Multiple Mediastinal Lymph Node Metastasis
    Kazuhiko Kataoka, Toshio Nishikawa, Toshiya Fujiwara, Motoki Matsuura
    2010 Volume 50 Issue 4 Pages 357-361
    Published: 2010
    Released on J-STAGE: October 05, 2010
    DOIhttps://doi.org/10.2482/haigan.50.357
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    Background. Metastatic mediastinal lymph node carcinoma in which the site of the primary lesion is unknown are rare. Case. Elevated serum CEA was pointed out in a 69-year-old man who had undergone gastrectomy for early gastric cancer 8 years previously. Positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) showed abnormal accumulation in the right upper mediastinal and supraclavicular lymph nodes. Chest CT showed enlarged right upper mediastinal and supraclavicular lymph nodes without any pulmonary nodules. Lymph node metastases were suspected, though no primary lesion was detected. He underwent right mediastinal lymph node dissection and resection of an enlarged supraclavicular lymph node. The histological diagnosis was large cell carcinoma of multiple mediastinal and supraclavicular lymph nodes. Seventeen months later, PET showed abnormal accumulation in a right supraclavicular lymph node. Right neck lymph node dissection was performed, revealing that only 1 lymph node was affected by large cell carcinoma. Postoperative adjuvant chemotherapy with UFT® was given for 2 years. No abnormal accumulation has been revealed on PET, and CEA has not shown any elevation during 53 months since the second operation. Conclusion. We present a long surviving case of unknown primary carcinoma with multiple mediastinal and supraclavicular lymph node metastasis. Surgical therapy may be useful for both solitary and multiple mediastinal lymph node metastasis in cases in which the primary carcinoma is unknown if complete excision is possible.
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  • A Case of Lung Cancer with an Extremely Rare Branching Pattern of the Left A5+8+9+10 Pulmonary Artery
    Kazuhiko Kataoka, Toshio Nishikawa, Toshiya Fujiwara, Motoki Matsuura
    2010 Volume 50 Issue 4 Pages 362-365
    Published: 2010
    Released on J-STAGE: October 05, 2010
    DOIhttps://doi.org/10.2482/haigan.50.362
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    Background. There are few reports about branching variation of the left lower pulmonary arteries. Case. A 67-year-old man underwent left upper lobectomy for clinical T1aN0M0 primary lung cancer. Pulmonary A5+8+9+10 was the first branch of the left main pulmonary artery, which descended between the left upper pulmonary vein and left upper bronchus. This variation was confirmed by postoperative three-dimensional computed tomographic pulmonary angiography (3D-CTPA) obtained by multidetector-row computed tomography (MDCT). Although this is the fifth reported case of branching variation of the left basal pulmonary artery which branched from the left main pulmonary artery in Japan, this type of variation has never been reported in the international literature. Pre-operative 3D-CTPA by MDCT may be useful to detect branching variation in pulmonary vessels. Conclusion. We report a case of lung cancer showing an extremely rare branching pattern of the left A5+8+9+10 pulmonary artery.
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  • VATS Lobectomy in a Lung Cancer Patient with HIV Infection
    Daisuke Taniguchi, Naoya Yamasaki, Tsutomu Tagawa, Tomoshi Tsuchiya, T ...
    2010 Volume 50 Issue 4 Pages 366-370
    Published: 2010
    Released on J-STAGE: October 05, 2010
    DOIhttps://doi.org/10.2482/haigan.50.366
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    Background. Although the incidence of lung cancer in patients with HIV infection is increasing, case reports of surgery performed on such patients are rare in Japan. Case. A 57-year-old man was given a diagnosis of previously unrecognized HIV infection during hospitalization for pneumonia. Highly active antiretroviral therapy was started at that time. Five years later, a chest radiograph revealed an abnormal shadow in his left upper lung field. A computed tomography (CT) scan of the chest showed a pulmonary nodule with spicule formation and pleural indentation in the left upper lobe. 18-fluorodeoxyglucose positron emission tomography (FDG-PET) showed abnormal uptake in the pulmonary nodule and left hilar lymph nodes, and lung cancer was suspected. We used video-assisted thoracic surgery (VATS) to perform a left upper lobectomy and mediastinal lymph node dissection. His postoperative course was uneventful. Pathological diagnosis was adenocarcinoma (pT1N2M0, stage IIIA). We tried to reduce the perioperative risk of acquiring a blood-borne infection by reducing the frequency of contact with his blood. Conclusion. We can operate on HIV-infected individuals as well as non-infected patients if their general condition is good. VATS is useful, because the risk of coming into contact with the patient's blood is lower than with open surgery.
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  • A Case of Extranodal Marginal Zone Lymphoma in the Chest Wall
    Takashi Marutsuka, Masako Maruyama, Megumi Inaba, Sunao Ushijima, Naom ...
    2010 Volume 50 Issue 4 Pages 371-376
    Published: 2010
    Released on J-STAGE: October 05, 2010
    DOIhttps://doi.org/10.2482/haigan.50.371
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    Background. We report an extremely rare case of extranodal marginal zone lymphoma (EMZL) which developed in the chest wall. Case. A 62-year-old man was receiving treatment for left thigh cellulitis in hospital, underwent regular measurement of his serum D-dimer level. Because of an elevated level, chest CT was performed to locate a suspected pulmonary thromboembolism. However chest CT disclosed a solitary tumor, 15 mm in maximum dimension in the right chest wall, and a solitary liver tumor, but not a pulmonary thromboembolism. A percutaneous needle biopsy of the liver tumor excluded the possibility of a malignant tumor, but did not yield a definite diagnosis either. Magnetic resonance imaging (MRI) showed that the tumors of the liver and the chest wall had similar characteristics, especially according to a dynamic study. We observed the course of this case carefully. At a 1-year follow-up examination, since the chest wall tumor had increased in size, it was resected with video-assisted thoracoscopic surgery (VATS). Histological and immunohistochemical examinations revealed the chest wall tumor to be an EMZL. The similar characteristics on MRI studies, and the histological findings of both tumors suggested that their origin might be identical. Conclusions. We report an extremely rare case of EMZL which developed from the chest wall. MRI was necessary to identify the origin of the multiple organ lesions.
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Short Report
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