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Volume 47 (2007)
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- Issue 3 Pages 207-
- Issue 2 Pages 97-
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Volume 47, Issue 3
Displaying 1-14 of 14 articles from this issue
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Report
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Takahiro Nakajima, Kazuhiro Yasufuku, Noriaki Kurimoto, Hideo Saka, Ma ...2007 Volume 47 Issue 3 Pages 207-214
Published: 2007
Released on J-STAGE: July 26, 2007
JOURNAL OPEN ACCESSEndobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a new modality for the evaluation of hilar and mediastinal lymph nodes. Although many centers have adopted this new device, little has been described concerning the actual procedure and the systematic mediastinal and hilar lymph node assessment in patients with lung cancer. Here we describe the standard for systematic visualization and biopsy of mediastinal and hilar lymph nodes in patients with primary lung cancer. Lymph node stations were defined based on the General Rules for Clinical and Pathological Recording of Lung Cancer (Sixth edition), by the Japan Lung Cancer Society. Lymph nodes were scanned starting from the hilum, working up to the upper mediastinum. All enlarged lymph nodes or suspicious nodes were biopsied under real time ultrasound guidance. N3 nodes were punctured first followed by N2 and N1 nodes to avoid contamination. The diagnostic accuracy of mediastinal lymph node staging in 105 lung cancer patients was 96.3%. We have never experienced any major complication. In conclusion, EBUS-TBNA is a safe and accurate tool for the assessment of the mediastinum as well as the hilum in patients with lung cancer.
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Takahiro Nakajima, Kiyoshi Shibuya, Hidetoshi Honda, Fumio Imamura, Ma ...2007 Volume 47 Issue 3 Pages 215-221
Published: 2007
Released on J-STAGE: July 26, 2007
JOURNAL OPEN ACCESSAutofluorescence bronchoscopy (AFB) has emerged as a new modality for the detection of preinvasive and early malignant lesions in the central airways. With the advances in technology, fiberoptic bronchoscope has been replaced by the bronchovideoscope which enables a more accurate observation of the airway. The new generation AFB is also a bronchovideoscope with improved image and operability. AFB is applicable not only for screening of high risk patients for the detection of pre-invasive lesions, but also for localizing tumors before photodynamic therapy (PDT) and operation. There has been a growing need for a standard classification of AFB findings based on different pathological findings. In this report, we sought to standardize the AFB findings according to the different types of AFB commercially available.
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Review Article
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Kouki Inai, Yukio Takeshima, Kei Kushitani2007 Volume 47 Issue 3 Pages 223-232
Published: 2007
Released on J-STAGE: July 26, 2007
JOURNAL OPEN ACCESSRecently in Japan, the incidence of mesothelioma has been increasing. This is a reflection of the use of asbestos during the period between 1960's and mid 1990's. The maximum number of mesothelioma case is supposed to reach approximately 1700 cases per year by 2010 to 2015. Last year the law of relief on asbestos exposures was established and therefore, the pathological diagnosis is now very important for the compensation or relief of patients with mesothelioma, however the accuracy of pathological diagnosis as mesothelioma in Japan remains to be established. Immunohistochemical stainings using some precise antibodies according to the histological type of mesothelioma are recommended. The differential diagnosis includes adenocarcinoma of the lung, true sarcoma or sarcomatoid carcinoma of the lung, ovarian and peritoneal serous carcinoma or fibrous pleuritis. The diagnosis of mesothelioma at an early stage by small biopsy specimen is necessary for the cure of patients.
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Original Article
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Masashi Kobayashi, Kenichi Okubo, Hiromasa Morikawa, Eichi Hayatsu2007 Volume 47 Issue 3 Pages 233-238
Published: 2007
Released on J-STAGE: July 26, 2007
JOURNAL OPEN ACCESSObjective. We evaluated the diagnostic capability of PET scan concerning mediastinal lymph node metastasis in lung cancer. Patients and Methods. From January 2003 to May 2005, 100 patients with lung cancer underwent PET scan and subsequent histopathological examination for lymph node metastasis. The accuracy of the diagnostic rate of PET scan for mediastinal node metastasis diagnosis and hilar node metastasis was examined in these patients. Results. PET scan results for mediastinal node metastasis diagnosis yielded nine false positive, and 13 false negative. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of PET scan were 35%, 88.8%, 43.8%, 84.5%, and 78%, respectively. Eight patients shown to be N-disease by PET scan were pathologically diagnosed as N2 diseases in 4, N1 in 1, and N0 in 3, which indicated a 12.5% accuracy rate for PET scan. Conclusion. The diagnostic accuracy of PET scan for mediastinal node metastasis was poor.
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Kenji Ono, Kenji Sugio, Manabu Yasuda, Masakazu Sugaya, Hidetaka Uramo ...2007 Volume 47 Issue 3 Pages 239-244
Published: 2007
Released on J-STAGE: July 26, 2007
JOURNAL OPEN ACCESSObjective. Surgical treatment for metachronous lung cancers should be determined based on curability as well as residual pulmonary function. We reviewed the clinicopathological background, surgical procedure, and corresponding prognoses of patients with metachronous lung cancers. Patients. Of 815 consecutive patients who underwent pulmonary resection for primary lung cancer between April 1994 and December 2005, 22 patients (2.7%) were found to have metachronous lung cancers. Results. The first primary cancer was p-stage IA in 11 patients, p-stage IB in 5, p-stage IIB in 1, p-stage IIIA in 4, and p-stage IV in 1. The second primary cancer was p-stage IA in 14 patients, p-stage IB in 3, p-stage IIB in 2, p-stage IIIA in 1, and p-stage IIIB in 2. Average maximal tumor diameter of the first primary cancer (31.8 mm; 12-77 mm) was greater than that of the second primary cancer (19.3 mm; 5-50 mm) with statistical significance (p=0.001). The surgical procedures for the first primary cancer were lobectomy or more extensive resection in all patients, while those for the second primary cancer were limited operation in 15 patients in order to retain residual pulmonary function. The 5-year survival rate after the second resection was 63.9%. When patients were classified into 2 groups by the pathological stage of the second primary cancer, the 5-year survival rate of patients with a second primary cancer of p-stage IA (92.9%) was greater than that of patients with the second primary cancer of p-stage IB or more advanced diseases (0%), with a significance level of p<0.001. Conclusion. Patients with the second primary cancer of p-stage IA can have a favorable outcome even when they have metachronous lung cancers. Thus we conclude that careful follow up should be continued after the first pulmonary resection, and moreover an aggressive surgical treatment is recommended as long as their performance status or residual pulmonary function allows.
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Kentaroh Miyoshi, Norihito Okumura, Yujiro Kokado, Tomoaki Matsuoka, K ...2007 Volume 47 Issue 3 Pages 245-250
Published: 2007
Released on J-STAGE: July 26, 2007
JOURNAL OPEN ACCESSObjective. Metastatic thoracic lymph node carcinoma of unknown origin is rare. Some surgical cases which had better outcome than expected were reported in the literature. However, the reason for this unexpected outcome, the etiology, and preferable treatment are unclear. We present a review of our cases. Methods. In the past 20 years, we encountered 8 cases of thoracic lymph node carcinoma of unknown origin. Here we review the clinical course, treatment, and outcome. Results. Four out of 8 patients had single station lymph node carcinoma (SS). Three patients had multistation lesions (MS). One patient had single station lesion with malignant pleural effusion (SS+MPE). SS cases underwent complete excision of the focal lymph node without additional therapy. MS cases underwent chemotherapy or radiation therapy after biopsy. The SS+MPE case received excision of the focal lymph node with additional chemotherapy. All patients in the SS group had long day survival without carcinoma bearing (21-108 months). All patients in the MS group died due to cancer within 1 year (mean survival time: 9.3 months). The SS+MPE patient survived 17 months with carcinoma. Conclusion. A single hilar lesion and complete excision may lead to a good outcome. Thoracic lymph node lesions should be surgically excised if complete excision is possible.
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Case Report
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Satoshi Ikegame, Ichiro Inoshima, Hiroshi Ouchi, Eiji Harada, Masaki F ...2007 Volume 47 Issue 3 Pages 251-255
Published: 2007
Released on J-STAGE: July 26, 2007
JOURNAL OPEN ACCESSBackground. Pulmonary cryptococcosis sometimes presents as a solitary pulmonary nodule, therefore problems in distinguishing lung cancer and cryptococcosis often arises. The usefulness of serum cryptococcal antigen for the diagnosis of pulmonary cryptococcosis has been emphasized. However there are not a few cases negative for serum antigen when pulmonary cryptococcosis appeared as a solitary lung nodule. Recently we encountered 2 cases of serum antigen-negative pulmonary cryptococcosis. Cases. Case 1 was found on a chest radiograph in an annual medical checkup and case 2 complained of low grade fever. Solitary pulmonary nodules were pointed out in both cases. Chest CT revealed spiculation of these nodules, but no daughter lesion. Therefore these nodules were strongly suspected to be lung cancer. Case 1 was diagnosed as cryptococcosis by fiber-optic bronchoscopy, case 2 was diagnosed by lung biopsy via thoracoscopy, and both cases were successfully treated by fluconazole. Conclusion. Serum cryptococcal antigen may not be detected in cases of pulmonary cryptococcosis presenting as a solitary lung nodule, therefore the development of more effective examinations is required.
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Mayumi Ohshio, Akihiro Takahagi, Yoshitomo Ozaki, Satoru Sawai, Noriak ...2007 Volume 47 Issue 3 Pages 257-261
Published: 2007
Released on J-STAGE: July 26, 2007
JOURNAL OPEN ACCESSBackground. Skeletal muscle and myocardial metastases from primary lung cancer are relatively rare. Case. A 81-year-old woman underwent right upper lobectomy for squamous cell carcinoma of the lung in July 2005. The pathological stage was T2N1M0, and the postoperative course was uneventful. In August 2005, a hard subcutaneous mass was detected in her left shoulder. FDG-PET demonstrated high uptake in the left trapezius muscle and left ventricle and chest CT revealed tumors in both regions. Echocardiography on re-admission demonstrated no tumor. In September 2005, the mass in the left trapezius muscle was resected and diagnosed as a metastasis from the lung cancer. The tumor of left ventricle enlarged gradually, and was diagnosed as a myocardial metastasis clinically. Conclusion. Skeletal muscle and myocardial metastases from primary lung cancer are relatively rare. In addition, in almost all cases, myocardial metastases are found at autopsy, so it is especially rare to be able to establish a diagnosis when alive, as in this case. FDG-PET and MDCT were very useful for the purpose of diagnosis in this case.
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Marina Kiso, Nobuyuki Kondo, Ryo Miyahara, Toru Bando, Makoto Sonobe, ...2007 Volume 47 Issue 3 Pages 263-267
Published: 2007
Released on J-STAGE: July 26, 2007
JOURNAL OPEN ACCESSBackground. In a case of a endobronchial tumor originating from a main bronchus presenting complete lung atelectasis, it is sometimes difficult to decide the peripheral resection line even with detailed imaging including multidimensional CT scan and MRI. Case. A 20-year-old woman with persistent hemoptysis was referred to our hospital because an occlusive tumor in the left main bronchus was detected with computed tomography. Fiberoptic bronchoscopy revealed that the tumor was 3 cm distal to the carina. The tumor was diagnosed as mucoepidermoid carcinoma pathologically. It was difficult to confirm the peripheral margin of the tumor, even with detailed imaging, because of the complete left lung atelectasis with mucoid-impaction. In the operative field, we opened a small window on the left upper lobe bronchus to confirm the peripheral margin of the tumor using a thin thoracoscope which revealed the extension of the tumor into the left upper lobe bronchus without invasion into the lower lobe bronchus. We performed left upper sleeve lobectomy, and achieved complete resection. Conclusion. When it is difficult to confirm the peripheral margin of the tumor, even with detailed imaging because of atelectasis, the method putting a thin thoracoscope or thin bronchoscope through a small bronchial incision during the operation is helpful to confirm the peripheral margin of the tumor and to decide the peripheral resection line.
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Naoki Hino, Masaru Tsuyuguchi, Yasushi Nakagawa2007 Volume 47 Issue 3 Pages 269-272
Published: 2007
Released on J-STAGE: July 26, 2007
JOURNAL OPEN ACCESSBackground. In 1999, pulmonary large cell neuroendocrine carcinoma (LCNEC) was categorized as new histologic type by the World Health Organization (WHO) classification. It is known that the prognosis of LCNEC is worse than that of the other non-small cell lung carcinomas. We report a resected case of LCNEC with metastasis to the brain, in which the patient is alive for 2 years after the surgery with no recurrence. Case. A 39-year-old woman underwent an operation for breast cancer in December 2001. In May 2003 we recognized a small tumor in the right upper lung. Although hormone therapy was given since it was thought to be a hematogenous metastasis from the breast cancer, it grew gradually, and a cerebellar tumor was found in October 2004. It was removed surgically and diagnosed as a metastatic brain tumor from LCNEC. We performed right upper lobectomy for primary lesion in January 2005. The postoperative stage was IV, pT4N0M1, and chemotherapy was performed postoperatively. For 2 years since this operation, she has been alive without any recurrence and has returned to work. Conclusion. We encountered a rare case of LCNEC in which the primary lesion and brain metastasis were removed surgically. If appropriate choice of case is done, operation may prolong survival time.
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Keiko Saiki, Yoshirou Mochizuki, Yasuharu Nakahara, Tetsuji Kawamura, ...2007 Volume 47 Issue 3 Pages 273-276
Published: 2007
Released on J-STAGE: July 26, 2007
JOURNAL OPEN ACCESSBackground. When chest radiographs of lung cancer patients undergoing chemotherapy show diffuse light interstitial infiltrates, we have difficulty in distinguishing the pneumonia from a drug allergy. Cases. We reported 3 occurrences of Pneumocystis pneumonia in lung cancer patients. The patients, 73-, 72-, and 55-year-old men, were undergoing chemotherapy. One had received long-term corticosteroid treatment. The others had received only chemotherapy, so we hypothesized chemotherapy was also a risk factor in the occurrence of Pneumocystis pneumonia. All had fevers, but only 1 developed respiratory failure. All chest radiographs showed diffuse light interstitial infiltrates. In all cases Pneumocystis was detected in bronchoalveolar lavage fluid or sputum by polymerase chain reaction. β-D-glucan concentrations were elevated high. The patients were treated with sulfamethoxazole-trimethoprim, and all showed marked improvement. Conclusion. When chest radiographs of lung cancer patients undergoing chemotherapy show diffuse light interstitial infiltrates, Pneumocystis pneumonia should be considered.
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Masatsugu Ohuchi, Shuhei Inoue, Jun Hanaoka, Tomoyuki Igarashi, Shozo ...2007 Volume 47 Issue 3 Pages 277-283
Published: 2007
Released on J-STAGE: July 26, 2007
JOURNAL OPEN ACCESSBackground. In the anterior mediastinum, tumors originated from various tissue may occur such as thymic, epithelial, germinal or lymphoproliferative disorders. It is sometimes difficult to differentiate lymphoblastic lymphoma from lymphocyte-rich thymoma. Case. An anterior mediastinal tumor was noted in a 65-year-old man by chest roentgenogram and he was admitted to our hospital. Chest CT revealed a mass protruding into the left pleural cavity from the anterior mediastinum. We suspected thymoma and performed total thymectomy. The tumor was found to be the lymphocyte-rich thymoma (WHO type B1), Masaoka's stage I by pathological examination. He was admitted to our hospital again 1 month later after surgery, because of pleural effusion, ascites, systemic lymphadenopathy and splenomegaly. The diagnosis of T-cell lymphoblastic lymphoma was made by left inguinal lymph node biopsy. Systemic chemotherapy was performed, but he died due to multiple organ failure. Conclusion. It is considered that lymphoma requiring immediate intensive chemotherapy is included in mediastinal tumors, so if lymphocyte-rich thymoma is suspected, further examination to differentiate lymphoma, as well as histologic diagnosis of the tumor, are necessary to confirm correct diagnosis promptly.
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Short Report
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Kesato Iguchi, Masaharu Inagaki, Takuya Onuki, Keisuke Kobayashi, Keik ...2007 Volume 47 Issue 3 Pages 285-286
Published: 2007
Released on J-STAGE: July 26, 2007
JOURNAL OPEN ACCESS -
Takashi Ibe, Mitsuhiro Kamiyoshihara, Atsushi Takise, Yasuki Iwasaki, ...2007 Volume 47 Issue 3 Pages 287-288
Published: 2007
Released on J-STAGE: July 26, 2007
JOURNAL OPEN ACCESS
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