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Volume 47 (2007)
- Issue 7 Pages 837-
- Issue 6 Pages 689-
- Issue 4 Pages 299-
- Issue 3 Pages 207-
- Issue 2 Pages 97-
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Volume 47, Issue 2
Displaying 1-13 of 13 articles from this issue
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Original Article
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Keishi Sugino, Sakae Homma, Atsushi Miyamoto, Hisashi Takaya, Susumu S ...2007 Volume 47 Issue 2 Pages 97-103
Published: 2007
Released on J-STAGE: May 21, 2007
JOURNAL OPEN ACCESSObjective. The aim of this study was to assess the characteristic clinical features of lung cancer associated with pulmonary tuberculosis. Patients and Methods. Among 1,028 patients with pulmonary tuberculosis admitted in our hospital between 1985 and 2005, 17 (15 men, 2 women; mean age 73±8) were diagnosed as having lung cancer. Patient characteristics, clinical features, radiographic images, treatment and prognosis were evaluated retrospectively. Results. Patients were classified into 2 groups: group A (n=5), lung cancer complicated by active tuberculosis, and group B (n=12), lung cancer with tuberculosis sequelae. All patients in group A and 8 patients (33%) in group B had either stage III or IV lung cancer, whereas 4 patients in group B had stage I lung cancer. Coexistence of lung cancer and pulmonary tuberculosis in the same segment or lobe was seen in 80% (n=4) or 60% (n=3) of group A cases, respectively, and in 67% (n=8) or 8% (n=1) respectively, in group B. Mean survival in group A and group B was 9.2 months and 26.8 months, respectively. Conclusions. More attention should be paid to the possibility of development of lung cancer in individuals with a history of pulmonary tuberculosis or who have had tuberculosis sequelae revealed by chest radiography. Also, the possible coexistence of lung cancer must be carefully examined in patients with active pulmonary tuberculosis.
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Case Report
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Makoto Tsumura, Keigo Kimura, Hiromasa Takeda, Takuya Nagata, Masashi ...2007 Volume 47 Issue 2 Pages 105-111
Published: 2007
Released on J-STAGE: May 21, 2007
JOURNAL OPEN ACCESSBackground. Sarcomatoid carcinoma of the thymus is a very rare malignant tumor. No methods for the treatment of this carcinoma have been established, and the prognosis is poor. We encountered a patient with sarcomatoid carcinoma of the thymus, and performed combined modality therapy. Case. The patient, a 54-year-old male, was admitted to our hospital because a large tumor shadow was observed in the left thoracic region by radiography in October 2002. The lesion was suspected to be a malignant teratoma by percutaneous biopsy under ultrasonography. Since the tumor was very large, we perfomed chemotherapy, and a 61 percent tumor reduction (partial response) was obtained. After chemotherapy, the entire tumor was removed by excision of the left upper lobe and the pericardium in Feburary 2003. Histologically, the patient was diagnosed as sarcomatoid carcinoma of the thymus. Postoperative radiotherapy (60 Gy) was performed in the mediastinal space. In September 2003, disseminated recurrence was observed in the thoracic cavity, and re-excision was performed under thoracoscopy. Since metastasis was detected in the posterior head (meninx), whole-brain irradiation (40 Gy) was performed. Then disseminated recurrence was detected in the thoracic cavity, and second chemotherapy was performed, but it was not effective. The patient died in December 2004 (22 months after surgery). Conclusion. We encountered a patient with sarcomatoid carcinoma of the thymus, of which the prognosis is very poor, and the incidence is very low. After examination of whole body and definitive diagnosis by tumor biopsy are performed, it is recommended that radio-chemotherapy followed by surgery should be done. Therefore, we hope the development of an effective chemotherapy.
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Yasuki Hachisuka, Masashi Uomoto2007 Volume 47 Issue 2 Pages 113-118
Published: 2007
Released on J-STAGE: May 21, 2007
JOURNAL OPEN ACCESSBackground. Noncaseating epithelioid cell granulomas are rarely observed in patients with malignant tumor without sarcoidosis. It is called sarcoid-like reaction. Case. A 82-year-old woman had been followed up by the cardiology department of our hospital because of dilated cardiomyopathy. In May 2006 a chest CT showed a 1.5 cm nodule in the right lung S4. The nodule was not diagnosed by brushing cytology under bronchofiberscopy. Pulmonary wedge resection for biopsy by video-assisted thoracoscopic surgery was performed. Intraoperative histopathological examination showed a pulmonary adenocarcinoma. Middle lobectomy with lymph node dissection was then performed. The histopathological findings of the resected lung specimen showed many granuloma formations in the tumor. We concluded that the granulomatous lesion was a sarcoid-like reaction related to lung cancer. No metastasis or sarcoid-like reaction was found in the dissected lymph nodes. Conclusion. When pulmonary nodules which appear malignant on diagnostic imaging show only epithelioid cell granuloma on histopathological study under bronchofiberscopy, a close follow up or pulmonary wedge resection for biopsy is recommended with sarcoid-like reaction in mind.
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Makoto Nakagawa, Toshihiro Osaki, Miiru Izumi, Takahiro Minami, Saiko ...2007 Volume 47 Issue 2 Pages 119-123
Published: 2007
Released on J-STAGE: May 21, 2007
JOURNAL OPEN ACCESSBackground. Multiple mucosa-associated lymphoid tissue (MALT) lymphomas arising from the lung and bronchus are rare. Case. A 48-year-old woman was admitted to our hospital with a complaint of dry cough of 3 months duration and abnormal chest X-ray shadow. Chest CT showed multiple nodules, large and small, with an air bronchogram and ill-defined margin in both lungs. Bronchoscopy showed an edematous and hypertrophic mucosa stenosis of the right middle lobe bronchus and the left lingular bronchus. The biopsy specimen from the bronchus suggested lymphoproliferative disease. To confirm the histologic diagnosis, partial resections of the right upper and middle lobe were performed. Histological examination showed the MALT lymphoma. She has been followed up closely as an outpatient without chemotherapy. Conclusion. We report a rare case of multiple MALT lymphomas arising from both lungs and bronchi.
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Takashi Ishiguro, Kazuo Kasahara, Hideharu Kimura, Masahide Yasui, Mas ...2007 Volume 47 Issue 2 Pages 125-130
Published: 2007
Released on J-STAGE: May 21, 2007
JOURNAL OPEN ACCESSBackground. Brain metastasis is often seen in patients with lung cancer; however, the reported incidence of pituitary metastasis is rare. We present a case with central hypopituitarism secondary to pituitary metastasis from lung cancer. Case. A 78-year-old woman had been receiving treatment on an outpatient basis at a local hospital for the control of diabetes mellitus since 1998. A chest roentgenogram revealed a huge mass in the middle lung field of the left lung in February, 2006 and she was referred to us. A bronchoscopic biopsy in March revealed adenocarcinoma. Systemic examinations showed multiple lung metastases and bone metastases, and brain MRI also showed focal metastasis to the right occipital lobe, thus indicating a clinical stage of T4N3M1 (stage IV). She was admitted to our department due to severe appetite loss for 1 week. She complained of polyuria, thirst, and polydipsia. We performed a hematological examination including basal endocrinological conditions, a high concentration saline loading test, the response to desmopressin administration, and the findings of brain MRI, which led to a diagnosis of metastasis of lung cancer to the pituitary gland with central diabetes insipidus. Although chemotherapy did not improve the symptoms of diabetes insipidus, the intranasal administration of desmopressin improved them. Her appetite loss promptly improved after the administration of desmopressin. Conclusion. We should suspect the possibility of a metastatic pituitary tumor in a patient has diabetes insipidus. If such tumors can be accurately identified, appropriate treatment can result in an improvement in the quality of life for patients with advanced lung cancer.
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Masayuki Tanahashi, Takeshi Yamada, Satoru Moriyama, Eriko Suzuki, Hir ...2007 Volume 47 Issue 2 Pages 131-136
Published: 2007
Released on J-STAGE: May 21, 2007
JOURNAL OPEN ACCESSBackground. Since locally advanced lung cancer treated by surgical therapy alone has poor prognosis, we studied multimodality treatment with induction chemotherapy to improve survival. We report 3 patients of stage III lung cancer which were completely resected in whom we obtained pathological CR (complete response) after induction chemotherapy with carboplatin and paclitaxel. Case 1. Patient 1 was a 65-year-old man with adenocarcinoma (cT4N0M0) in the right lung. After chemoradiotherapy, partial response was achieved and he underwent right upper lobectomy combined resection with the superior vena cava and brachiocephalic artery. Case 2. Patient 2 was a 72-year-old man with squamous cell carcinoma (cT4 (PM1) N2M0) in the right lung. After chemotherapy, partial response was achieved and he underwent right lower lobectomy. Case 3. Patient 3 was a 57-year-old man with middle mediastinal tumor. The examination of resected specimens revealed adenocarcinoma metastatic to the lymph node. FDG-PET was performed and showed high FDG accumulation at the site of a small bulla with a thick wall in the right lung apex by CT, so the disease was diagnosed as primary lung adenocarcinoma (cT1N2M0). After chemotherapy, complete response was achieved and he underwent right upper lobectomy. All 3 patients were proved to be pathological CR by surgical specimens, and are alive without recurrence for more than 2 years. Conclusion. Induction chemotherapy or chemoradiotherapy with carboplatin and paclitaxel can be useful for treatment of locally advanced lung cancer.
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Yuichi Ozawa, Takafumi Suda, Hirotsugu Hasegawa, Hiroshi Nogimura, Mas ...2007 Volume 47 Issue 2 Pages 137-142
Published: 2007
Released on J-STAGE: May 21, 2007
JOURNAL OPEN ACCESSBackground. Primary pericardial mesothelioma is a rare disease occurring in 0.7-2.0% among all mesothelioma and has a very poor prognosis. We report a case of primary pericardial mesothelioma who could survive for more than 26 months after local hyperthermochemotherapy and systemic chemotherapy with vinorelbine (VNR). Case. A 72-year-old woman was admitted to our hospital with orthopnea. Her chest X-ray and CT showed a large mass at the base of the heart with enlarged mediastinal lymph nodes and massive pericardial and bilateral pleural effusion. Mediastinal lymph node biopsy by mediastinoscopy confirmed the diagnosis of biphasic malignant mesothelioma. She underwent pericardial instillation of mitomycin as a sclerosing agent after pericardial drainage, and subsequently hyperthermochemotherapy with cisplatin and pleurodesis with talc. After those treatment, we administered VNR (20 mg/m2, 3wq). She has been alive for more than 26 months since her first visit without any remarkable complaints. Conclusion. We consider this as a valuable case of primary pericardial mesothelioma in which combination of local hyperthermochemotherapy and systemic chemotherapy with VNR was effective.
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Tomoe Sawazumi, Haruhiko Aisaka, Junya Kitada, Hiroki Takahashi, Shosa ...2007 Volume 47 Issue 2 Pages 143-147
Published: 2007
Released on J-STAGE: May 21, 2007
JOURNAL OPEN ACCESSBackground. Ameloblastoma is one of the odontogenic tumors, and accounts for about 60% of all odontogenic tumors. Malignant ameloblastoma with distant metastasis is rare. We present here a patient who had a mandibular ameloblastoma with multiple pulmonary metastases. Cases. A 65-year-old woman was referred to our hospital in December 1987 because of a chest abnormal shadow. The chest radiograph showed multiple nodules in both lungs. A thorough examination failed to reach a diagnosis. She was followed up until 2001, because she had no symptom until that time. She was referred to our hospital again because of hemoptysis and was admitted in October 2002. The multiple lung nodules had increased on the chest radiography. She underwent an operation for lung biopsy by video-assisted thoracoscopy (VATS) to establish a definitive diagnosis in November 2002. Pathologically, they were diagnosed as metastatic ameloblastoma, for which she had been operated in August 1965. Conclusion. Metastatic ameloblastoma arose after more than 20 years since her operation for primary mandibular ameloblastoma. This case is also rare because she is alive at over 15 years from when the pulmonary metastasis was pointed out.
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The 32nd Diagnostic Imaging Seminar
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Hironobu Ohmatsu2007 Volume 47 Issue 2 Pages 149-154
Published: 2007
Released on J-STAGE: May 21, 2007
JOURNAL OPEN ACCESSLung cancer screening using helical computed tomography (CT) has been carried out at the "Anti-lung cancer association, Tokyo" since 1993. We found 43 lung cancer cases (0.163%) during the 18-year period before introducing helical CT, but 76 lung cancer cases (0.436%) in 11 years after introducing helical CT. Among the cases detected in the screening period using helical CT, 74% were in stage IA, and the average size of the primary tumors was 17.3 mm. These data were better than in the screening period without helical CT. Of the 76 lung cancer cases detected after the introduction of helical CT, 19 cases (25%) were visible chest X-ray films, but 70 cases (92%) were visible on CT. We had 52 cases detected on repeated CT screenings, 41 cases (79%) of these cases were retrospectively found to have had a primary tumor overlooked previous CT screening images. In this seminar, former CT screening images of lung cancer cases were presented and we discussed how to improve earlier diagnosis.
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Keiko Kuriyama2007 Volume 47 Issue 2 Pages 155-159
Published: 2007
Released on J-STAGE: May 21, 2007
JOURNAL OPEN ACCESSThe radiographic assessment of patients with solitary or multiple lung nodules is a common clinical problem. Primary or metastatic tumor usually is the main consideration in patients with these findings. However, many other diseases or abnormalities may present with focal lung abnormalities. The differential diagnosis of a solitary pulmonary nodule (SPN) is extensive. Some have specific appearances that may suggest the correct diagnosis (i.e., mucous plug, arteriovenous fistula, rounded atelectasis, mycetoma, and focal pleural lesions) or limit the differential diagnosis. In patients with a SPN, computed tomography (CT) is used to determine the nodule's morphologic characteristics; density (i.e., calcium deposit, fat, or contrast-enhancement); and growth rate.
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Yoshiharu Ohno, Hisanobu Koyama, Munenobu Nogami, Sumiaki Matsumoto, D ...2007 Volume 47 Issue 2 Pages 161-167
Published: 2007
Released on J-STAGE: May 21, 2007
JOURNAL OPEN ACCESSRecent advances in computed tomography (CT) such as the multi-slice CT system provide new information from various reconstructed CT images for diagnosis of TNM staging. However, capability of these images for improvement of diagnostic accuracy of T-factor has not been determined. In this review, we describe recent advancement of T-stage diagnosis on CT in lung cancer patients and its limitations.
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Masaki Hara, Keita Sakurai, Motoo Nakagawa, Yoshiyuki Ozawa, Yuta Shib ...2007 Volume 47 Issue 2 Pages 169-180
Published: 2007
Released on J-STAGE: May 21, 2007
JOURNAL OPEN ACCESSRecently PET/CT systems have become popular and been introduced at many institutions throughout Japan and the clinical importance should increase for managing many kinds of malignant diseases including lung cancers. A 2- [fluorine-18] fluoro-2-deoxy-D-glucose (FDG) has been the most important tracer in clinical usage and seems to play a major role during these several years. Since March 2004 we began operating the first PET/CT scanner in Japan with a 4-slice multi-detector CT (MDCT) and we have now introduced a second PET/CT scanner with 8-slice MDCT and have been performing 25 to 30 PET studies per day. Although some problems have been reported based on extensive experience, the ability of FDG-PET for staging lung cancers is still indispensable, like other conventional modalities such as CT, MRI and SPECT. It is usually hard to differentiate malignant from benign lesions except for lesions with markedly elevated FDG accumulation. FDG accumulation in macrophages and sarcoid reaction may lead to false positive results. It is essential to interpret FDG-PET findings with the morphological characteristics of CT and/or MRI. FDG-PET has been considered superior to CT for evaluating N factor. However recent studies mention that FDG-PET might show considerable both false-positive and false-negative results particularly in patients with small primary nodules. FDG-PET is useful for integrating and simplifying many kinds of examination methods to determine the existence of distant metastases. Physiological FDG accumulation in brown fat and skeletal muscles, misregistration artifacts between CT and PET and metal devices such as pace-makers might cause incorrect results. In this paper we demonstrate the pitfalls of FDG-PET in managing patients with lung cancer.
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Noriyuki Tomiyama2007 Volume 47 Issue 2 Pages 181-185
Published: 2007
Released on J-STAGE: May 21, 2007
JOURNAL OPEN ACCESSIn 1999 the World Health Organization (WHO) proposed a consensus classification of the thymic epithelial tumors. The WHO histologic classification has been shown to reflect the clinical features of thymic epithelial tumors and to correlate with prognosis. Type A tumors are more likely to have smooth contour, round shape, and homogeneous enhancement on CT than any other type of thymic epithelial tumor. The prevalence of plaque shape, irregular contour, and calcification increase through types AB, B1, B2, and B3. It is important to know these findings based on WHO classification because this classification system is supposed to have an implication in determining treatment strategy.
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