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Volume 43, Issue 1
Displaying 1-12 of 12 articles from this issue
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Yoshinobu Ichiki, Toshihiro Osaki, Makiko Mizukami, Tomohiro Yamashita ...2003 Volume 43 Issue 1 Pages 1-6
Published: February 20, 2003
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSObjective. We investigated the T factors, lymph node metastasis in patients with resected T3 nonsmall cell lung cancer (NSCLC), and the influences of these factors on prognosis. Study Design. Of 851 patients with NSCLC who underwent surgery between August 1979 and April 2000, this study included 107 patients with T3 lung cancer. Patient ages ranged from 33 to 85 years, with a mean of 65.0 years. The subjects consisted of 97 men and 10 women. The histopathological type was squamous cell carcinoma in 56 patients, adenocarcinoma in 27 patients, large cell carcinoma in 16 patients, and others in 8 patients. Results. In 107 patients with T3 NSCLC, the 5-year survival rate was 32.7%(MST: 672 days). T factors consisted of chest wall invasion in 40 patients, parietal pleural infiltration in 31 patients, pericardial infiltration in 18 patients, infiltration within 2 cm from the tracheal bifurcation area in 12 patients, and others in 7 patients. The status of lymph node metastasis was evaluated as NO in 55 patients, N1 in 21 patients, and N2 in 31 patients. Five-year survival rates were 48.4%, 27.1%, and 8.1% in the NO, N1, and N2 groups, respectively showing a significant difference. In stage IIB (T3NOMO) and stage IIIA (T3N 1-2M0) patients, 5-year survival rates were 48.4% and 16.6%, respectively, which was significantly different. In T3NOMO and T2N1M0 (stage IIB) patients, 5-year survival rates were 48.4% and 45.1%, which was very similar. Complete resection was performed in 87 patients, and incomplete resection in the remaining 20. Five-year survival rates were 36.6% and 15.8%, respectively, showing a significant difference. With respect to T factors, there were no significant differences in prognosis. Patients in whom the stage was evaluated as T3NOMO had a similar prognosis as patients in whom the stage was evaluated as T2N IMO (stage IIB), and were considered appropriate as stage IIB. In the surgical treatment of T3 NSCLC, complete resection may improve the prognosis.View full abstractDownload PDF (609K) -
Ryota Tanaka, Yoshihiko Koshiishi, Yoko Ono, Hozumi Tanaka, Toshimichi ...2003 Volume 43 Issue 1 Pages 7-12
Published: February 20, 2003
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSObjective. To examine the value of cervical ultrasonography for staging of lung cancer, we analyzed the relationship between ultrasonography findings and pathological diagnosis. Material and Methods. Findings in 68 patients (136 stations) who underwent cervical ultrasonography and scalene node biopsy for staging of lung cancer from July 1995 to October 2001 were analyzed. We analyzed the difference in ultrasonographic findings between 28 stations with metastasis and 108 stations without metastasis. In the group with scalene nodes positive for metastasis, the histologic type of the tumor was adenocarcinoma in 16 cases, squamous cell carcinoma in three cases, and large cell carcinoma in three cases. Statistical analysis was performed using Student's t test and using Fisher's test for the nominal variable. Results. Of the 52 stations in which it was possible to make measurements of the lymph node diameter by ultrasonography, the maximum mean size of 16 positive stations was 13 ± 6mm; and in 36 negative stations, it was 12 ± 4mm. However, a significant difference was not recognized. Between scalene-positive nodes (mean 0.68 ± 0.17 mm) and scalene-negative nodes (mean 0.42 ± 0.21 mm), statistically significant differences in minimum/maximum ratio were seen. In the scalene positive group, it was not possible to detect lymph nodes by ultrasonography in 11 out of 28 stations (39.3%), and in 10 stations (35.7%) one to three lymph nodes were detected. In the scalene negative group, it was not possible to detect lymph nodes in 71 out of 108 stations (65.7%). Conclusion. In a metastatic lymph node, the minimum/maximum ratio is comparatively high and it can be assumed to grow in a spherical shape. Therefore, by utilizing ultrasonography in the diagnosis of metastatic lymph nodes, the minimum/maximum ratio could be valuable as a supporting tool.View full abstractDownload PDF (918K) -
Clinicopathological Study on Type B3 Thymoma and Thymic Carcinoma (Type C) of the WHO ClassificationTakashi Suzuki, Akihiko Kitami, Shuichi Suzuki, Mikio Masuda, Atsuko M ...2003 Volume 43 Issue 1 Pages 13-16
Published: February 20, 2003
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSObject. The aim of the study was to investigate similarities and differences between the features of type B3 and type C of the WHO classification of thymic tumors. Methods. We retrospectively studied 23 patients treated in our hospital in the past 14 years. There were 11 cases of type B3 (8 males and 3 females) and 12 cases of type C (11 males and one female). The mean age of each group was 51 and 54 years old at tumor detection. There was no statistically significant difference in age between the two groups. We performed surgery on 10 patients of type B3 and 8 of type C. Although the number of the cases was not large, we evaluated the results by statistical analysis. Results.. No significant difference was found between type B3 and type C in terms of the distribution of Masaoka's clinicopathological classification. The mean survival of all cases of types B3 and C were 1916 and 987 days, respectively (median: 1673 and 466 days). The log rank test indicated a statistically significant difference between the two types. There was no difference in the resection ratio between type B3 and type C. The mean survival days of resected cases of types B3 and C were 2088 and 1410 days, respectively (median: 1673 and 1425 days). There was no significant difference between the two types. Myasthenia gravis did not accompany type C, but was exclusively associated with type B3. Conclusion. Type B3 and type C were similar with regard to gender, distribution on Masaoka's clinicopathological classification, and resection ratio, however, there was a difference in the ratio of accompanying myasthenia gravis and in overall survival between the two types.View full abstractDownload PDF (694K) -
Hiroshi Kumagai, Yuji Mori, Hisashi Nakata, Hirofumi Ohuchi, Eiji Niga ...2003 Volume 43 Issue 1 Pages 17-21
Published: February 20, 2003
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSBackground. We report a case of primary pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma. Case. A 62-year-old man was admitted because of an abnormal shadow on a chest X-ray film. Chest X-ray films and chest computed tomography (CT) scans revealed a mass in the left S10 of the lung. Diagnosis could not be bronchoscopically confirmed and MALT lymphoma was suggested by ultrasound-guided percutaneous lung biopsy. Left lower lobectomy was performed. Surgical paraffin-embedded materials showed a sharp monoclonal band of immunoglobulin heavy chain (IgH) gene rearrangement on electrophoresis of polymerase chain reaction (PCR) products. These findings yielded a diagnosis of MALT lymphoma. Conclusion. The diagnosis of MALT lymphoma was confirmed on surgical paraffin-embedded materials by use of this technique.View full abstractDownload PDF (3455K) -
Hiroyuki Oura, Mikihito Ishiki, Masahide Hirose, Nobukazu Tomichi, Kaz ...2003 Volume 43 Issue 1 Pages 23-27
Published: February 20, 2003
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSBackground. Intraosseous well-differentiated osteosarcomas (IWDOS) are rare and commonly originate in the extremities as conventional osteosarcoma. We reported a very rare case of IWDOS of the right rib. Case. A 45-year-old man was admitted to our hospital because of an abnormal shadow on chest roentgenogram in April, 1995. He had once been examined at another hospital because of abnormal findings on the chest X-ray film detected by a mass screening program in November, 1988. His chest X-ray film showed a tumor shadow (4.0 × 5.0 cm) on the chest wall protruding into the upper right lung field. The tumor shadow had slightly enlarged in size compared to previous examinations. Chest CT revealed a heterogeneous tumor with calcification fixed on the 4th rib, but which did not infiltrate the surrounding tissues. Bone scintigram showed an abnormal accumulation at the site of the chest wall tumor. Because of the possibility of malignancy, an en bloc excision of the tumor was performed, including the right 4th rib and surrounding intercostal muscles with a sufficient surgical margin on July 18, 1995. The histologic examination revealed IWDOS of the right 4th rib. The patient underwent no additional adjuvant chemotherapy nor radiation therapy postoperatively and is now alive and well, without any sign of recurrence, 7 years after the operation. Conclusion. It was very difficult to diagnose IWDOS histologically. In this case, the infiltrative feature of tumor was an important finding in dif-ferentiating IWDOS from fibrous dysplasia. Moreover, wide excision at initial operation seemed to correlate with longterm survival in this case of a rare variant of osteosarcoma.View full abstractDownload PDF (4089K) -
Kenji Iino, Yasuhiko Ohta, Masaya Tamura, Hideo Sato, Kazuyoshi Kataya ...2003 Volume 43 Issue 1 Pages 29-34
Published: February 20, 2003
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSBackground. Reports of alpha-fetoprotein (AFP)-producing primary lung cancer are very rare. The clinical features and prognosis remain obscure. We report here a rare case of AFP-producing primary lung cancer diagnosed as hepatoid adenocarcinoma. Case. The patient was a 63-year-old man who underwent a right upper lobe lobectomy via VATS for primary lung cancer (c T1NOMO, stage IA) located in the right S2 region. Histologically, the tumor was diagnosed as hepatoid adenocarcinoma consisting of sheet-like or trabecular proliferation of neoplastic cells and tubular or papillary adenocarcinoma. AFP protein was detected in tumor cells by immunohistochemical staining. There was no lymph node metastasis or vessel invasion. Conclusion. The patient was followed for 5 months after surgery without postoperative adjuvant therapy and there has not been any sign of recurrence. We reviewed a total of 59 lung cancer patients with AFP expression reported in Japan including this case.View full abstractDownload PDF (3316K) -
Mitsunori Higuchi, Yutaka Shio, Hiroyuki Suzuki, Koichi Fujiu, Ryuzo K ...2003 Volume 43 Issue 1 Pages 35-39
Published: February 20, 2003
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSBackground. Type A and type B adenocarcinomas in Noguchi's classification have good prognoses and there have been no reports of malignant effusion with these types. Case. Left lung nodule was detected in a 42- year-old woman by mass screening. Her chest CT scan showed a ground glass opacity (GGO) in the left S1+2 which was 4 mm in size. Preoperative examinations revealed no malignant lesions in any other organs. Immediately before surgery, we performed CT-guided marking of the tumor. Left upper division segmentectomy was performed. On that occasion, slight pleural effusion was recognized and was diagnosed as class V. The primary tumor proved to be well differentiated, localized bronchioloalveolar carcinoma which was classified as type A of Noguchi's classification. Postoperative adjuvant chemotherapy was done. The patient has been well without any symptoms for 21 months after surgery. The cause of the pleural effusion in this case is doubtful. The malignancy of the pleural effusion specimen was thought to be positive because of epithelial immunocytochemical staining. Conclusion. Data contradictory to clinico-pathological findings must be evaluated again by other methods, e. g. immunological methods, and finally the data should be interpreted as an integrated whole including information from the clinical course.View full abstractDownload PDF (3177K) -
Junko Akaishi, Kiyoshi Koizumi, Kyoji Hirai, Shuji Haraguchi, Shigeo T ...2003 Volume 43 Issue 1 Pages 41-45
Published: February 20, 2003
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSBackground. Primary pulmonary malignant lymphoma (ML) is rare, progresses very slowly and has a good long-term outcome. The treatment of primary ML remains controversial. Case. A 72-year-old man was referred to our hospital for diagnosis of an abnormal shadow on chest X-ray film. Lungbiopsy by video-assisted thoracic surgery was performed for an abnormal mass in the right lower lobe. Intraoperative pathological examination showed either malignant lymphoma or inflammatory pseudotumor. Therefore right lower lobectomy and lymph node dissection were performed. According to immunohistochemical examination and gene analysis, the diagnosis of the tumor was primary pulmonary B-cell lymphoma of mucosa-associated lymphoid tissue. Subsequently, postoperative chemotherapy(COP) was carried out. The patient has been doing well without evidence of recurrence for 1 year after operation. Conclusion. We reported a case with primary MALT lymphoma of the lung surgically resected, and reviewed Japanese case reports.View full abstractDownload PDF (3086K) -
Naofumi Shinagawa, Koichi Yamazaki, Yoko Ishibashi, Yuya Onodera, Hiro ...2003 Volume 43 Issue 1 Pages 47-51
Published: February 20, 2003
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSBackground. We present two cases of small peripheral adenocarcinoma of the lung diagnosed by CT-guided transbronchial biopsy using an ultra-thin bronchoscope with virtual bronchoscopic navigation that were treated with stereotactic radiotherapy (SRT). Cases. Case 1: A 68-year-old man was admitted to our hospital because of acute myocardial infarction. Chest CT showed a small nodular shadow in the left S1+2b, which was 18×16 mm in size. Case 2: An 82-year-old woman had a 22×18 mm ground glass opacity (GGO) in the right S2 which was detected when she was admitted to a local hospital because of bronchitis. Both lesions were diagnosed as adenocarcinoma by CT-guided transbronchial biopsy using an ultra-thin bronchoscope with virtual bronchoscopic navigation. In both cases surgery was considered contraindicated because of heart failure in case 1 and age and multiple GGOs in case 2, and they were therefore treated with SRT. No complications or side effects were observed during the examination and treatment and no signs of recurrence have been observed so far. Conclusion. Definitive diagnoses and curable treatment with low risk are possible for patients who cannot tolerate operation by the combination of the examination and treatmentdescribed here.View full abstractDownload PDF (3838K) -
Hiroyuki Oura, Mikihito Ishiki, Masahide Hirose, Kenichi Takeuchi, Har ...2003 Volume 43 Issue 1 Pages 53-58
Published: February 20, 2003
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSBackground. Among elderly patients with lung cancers, there are many patients who have a history of cerebrovascular events (CVE). However, surgery is not indicated for some of these patients because of their poor performance status (PS). In this study, we encountered 2 surgically resected cases of primary lung cancers incidentally detected after the onset of cerebral infarction. Case 1. Patient 1 was a 68-year-old man who developed cerebral infarction in August 2000, and was undergoing continuous rehabilitation for right hemiplegia. Chest CT demonstrated a tumorous lesion in the left S9. His PS was degree III, and he could wheel himself around. Based on the clinical diagnosis of stage IA lung adenocarcinoma, left inferior lobectomy and ND2a were performed in September 2000. Although postoperative complication by MRSA pneumonia was observed in the contralateral inferior lobe, it was soon relieved. On the 9th hospital day, the patient was transferred to another hospital for rehabilitation. Case 2. Patient 2 was a 74-year-old man who developed cerebral infarction in October 2000, and was undergoing continuous rehabilitation for left hemiplegia. Chest CT demonstrated a tumorous lesion in the right S6. A Clinical diagnosis of stage IA squamous cell carcinoma was made. His PS was degree IV, and he required complete assistance. In addition, since several abnormal florae were detected by preoperative examinations of sputum, the development of postoperative respiratory complications was suspected. In April 2000, thoracoscopy-assisted right inferior lobectomy and ND 1 were performed. Although the patient developed bronchial stump fistula on the 6th hospital day, it was successfully treated by conservative procedures after a second surgery. Conclusion. Postoperative respiratory complications frequently occur in elderly lung cancer patients showing poor PS due to a past history of CVE. However, the indications of surgical treatment should be considered in those with early lung cancers based on careful perioperative management.View full abstractDownload PDF (4791K) -
Keiichirou Takasuna, Yutsuki Nakajima, Yuji Shiraishi, Naoya Katsuragi ...2003 Volume 43 Issue 1 Pages 59-63
Published: February 20, 2003
Released on J-STAGE: August 10, 2011
JOURNAL FREE ACCESSBackground. Acinetobacter baumannii is a well recognized pathogen causing nosocomial infection in intensive care units in Europe and Asia except Japan. The prognosis of Acinetobacter infection is dismal. Case. A 76-year-old man who had received regular outpatient treatment in our hospital for pulmonary emphysema had received detailed examinations because of an abnormal shadow on chest CT scan. Clinical diagnosis was primary lung cancer (squamous cell carcinoma) in the right lower lobe. He underwent right lower lobectomy with lymph node dissection. He entered a state of shock on postoperative day (POD) 2 and chest radiograph showed diffuse infiltrative shadows in the right upper lung field. CT scan showed dense opacification and conspicuous air bronchogram. His laboratory data on POD 2 showed sepsis and pre-DIC (disseminated intravascular coagulation). We began treatment with Imipenem and ABPC/SBT because sputum and pleural effusion culture identified Acinetobacter baumannii. However his condition continued to deteriorate. Infiltrative shadows extended to the right middle lobe and he had high fever, so he underwent completion pneumonectomy to prevent discharge of necrotizing tissue from the remnant lung on POD 8. After that his general condition tended to improve but he suddenly died of ventricular tachycardia on POD 12. Microscopic examination of the resected lung tissue showed infiltration of neutrophils and lobar pneumonia.Conclusion.In Japan, we should pay attention to nosocomial infection of Acinetobacter baumannii.View full abstractDownload PDF (3143K) -
2003 Volume 43 Issue 1 Pages 64-81
Published: February 20, 2003
Released on J-STAGE: August 10, 2011
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