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Volume 48 (2008)
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Volume 48, Issue 4
Displaying 1-16 of 16 articles from this issue
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Review Article
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Kentaro Inamura, Yuichi Ishikawa2008 Volume 48 Issue 4 Pages 247-253
Published: 2008
Released on J-STAGE: September 16, 2008
JOURNAL OPEN ACCESSObjective. Since the commencement of human genome projects, molecular analysis of human tissues has become much easier. Now we can monitor expression of most genes simultaneously and comprehensively using microarray technologies. It is well known that cancers develop from accumulations of multiple gene abnormalities and signal pathway alterations, and therefore we must systematically analyze many genes to elucidate the genesis and progression of tumors. Result. In this review article, we describe some results of comprehensive analysis of gene expression that are useful for classification of heterogeneous lung tumors and help to understand their biological natures. We introduced a new clustering technique, called non-negative matrix factorization (NMF) to subclassify squamous cell carcinoma of the lung. We also analyzed neuroendocrine tumors and found a group with very good prognosis, independent of small-cell or large-cell neuroendocrine carcinoma histologies. Further, we described recent studies on metastatic potentials of lung cancer, including our own results on metastatic signature analysis of heterogeneous lung adenocarcinomas as well as some other models of prediction of prognosis or metastasis using small numbers of genes.
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Original Article
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Yoshinori Kawabata, Eishin Hoshi, Katsumi Murai, Tomohiko Ikeya, Nobum ...2008 Volume 48 Issue 4 Pages 254-260
Published: 2008
Released on J-STAGE: September 16, 2008
JOURNAL OPEN ACCESSObjective. We investigated whether low-grade occupational exposure causes asbestosis and the relationship between pleural plaque (PP) and the usual interstitial pneumonia pattern (UIP/P). Study Design. Subjects counted of 1324 subjects (971 men, 353 women) who underwent pulmonary surgery consisting of more than lobectomy. The presence of more than 1.0 asbestos body per 1 histological slide in 3 slides with UIP/P was diagnosed as asbestosis and less than 1.0 asbestos body on 1 slide was diagnosed as suspected asbestosis. Results. Asbestosis was detected in 7 and suspected in 4 cases. There were less than 30 asbestos bodies per 1 slide in all but one case. All cases of asbestosis or suspected asbestosis were men. Centrilobular fibrosis was seen in 4, PP in 8, pleural thickening in 8 and pleural adhesion in 7 cases. Secondary, among 38 patients (36 men, 2 women) demonstrating PP, 17 showed UIP/P among which 7 patients showed either asbestosis or suspected asbestosis. Among 1286 cases without PP, 198 showed UIP/P (including 4 cases of asbestosis). The frequency of UIP/P including and excluding asbestosis was significantly higher in the PP-positive subgroup (<0.01 and <0.05). Conclusion. Asbestosis might be included among idiopathic pulmonary fibrosis cases. Furthermore, the presence of PP might be a risk factor for UIP/P.
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Junzo Shimizu, Makoto Oda, Isao Matsumoto, Yoshihiko Arano, Norihiko I ...2008 Volume 48 Issue 4 Pages 261-265
Published: 2008
Released on J-STAGE: September 16, 2008
JOURNAL OPEN ACCESSObjective. We conducted a clinicopathologic study of surgically treated cases of tracheobronchial adenoid cystic carcinoma (ACC). Materials and Methods. Of the 1,909 patients with lung cancer who underwent resection in our hospital and associated institutes during the 28-year period between 1980 and 2007, five (0.3%) were pathologically diagnosed as ACC of the trachea, bronchus and lung. All 5 patients were women aged from 37 to 67 years, with an average age of 50.8 years. Four tumors were located in the larger airways (one in the carina, one in the right main bronchus, one in the left main bronchus, one in the middle lobe bronchus) and one tumor was located in the peripheral lung of left S4b. The following operations were done: bronchoplastic procedures in 3 (carinal resection with double-barreled carinoplasty in 1, sleeve right pneumonectomy in 1, sleeve middle lobectomy in 1), left pneumonectomy in 1, and left upper lobectomy in 1. Results. Three of 5 patients have survived for 172, 144, and 10 months after surgery, respectively, but 2 of the patients died 15 and 95 months after surgery, respectively (The cause of death of one patient was distant metastases to the skin, breast, and lung, and that of the other patient was colon cancer). Conclusion. For local treatment for ACC of the major airway, the best method is considered to be sleeve resection of the trachea or bronchus in an area where airway reconstruction may not be disturbed and to add postoperative irradiation when there is residual carcinoma at the stump. However, it seems controversial to recommend adjuvant radiotherapy in all patients undergoing resection.
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Hirofumi Uehara, Sakae Okumura, Yukitoshi Satoh, Yukinori Sakao, Mingy ...2008 Volume 48 Issue 4 Pages 266-272
Published: 2008
Released on J-STAGE: September 16, 2008
JOURNAL OPEN ACCESSBackground. Starting in 1991, we began to omit dissection of the subcarinal lymph node (#7) in patients with non small-cell lung cancer of the right upper lobe and left upper division. Objective. To review the validity of the omission of subcarinal lymph node dissection. Methods. We reviewed 627 patients with resected lung cancer located in the upper lobes or upper division and which took place from 1980 to 2002. Subcarinal lymph node dissection was performed in 335 cases and was omitted in 292 cases. We reviewed metastasis frequency, outcome, recurrence pattern, and relationship of postoperative ischemic changes at the bronchial stumps. Results. There was a low frequency of subcarinal lymph node metastasis occurring in only 11 out of 335 cases (3.3%). The overall 5-year survival rate for subcarinal lymph node positive patients was only 18%. The postoperative ischemic change in the bronchial stumps and the subcarinal lymph node dissection exhibited a close correlation (P=0.001). The 5-year survival rate (%) based on the pathological stage of both groups did not exhibit any significant differences. Results were: stage IA; 87%: 91% (p=0.40), stage IB; 76%: 79% (p=0.75), stageII; 53%: 63% (p=0.33), and stage IIIA; 51%: 37% (p=0.20). Subcarinal lymph node dissection was found not to be an independent prognostic factor. The rate of recurrence in the cases with no subcarinal lymph node dissection cases was 83 out of 292 cases (28.4%). Distant recurrence occurred in 65 cases, while 18 cases had local recurrence. However, in the 18 cases with local recurrence, no subcarinal lymph node onset recurrence was noted. Conclusion. As no significant increase in risk was noted when subcarinal lymph node dissection was not performed in patients with lung cancer of the right upper lobe or left upper division, this may be the correct procedure to follow during lung cancer resection surgeries.
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Case Report
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Yuga Komaki, Takuya Samukawa, Yoichiro Higashi, Masatada Soejima, Hiro ...2008 Volume 48 Issue 4 Pages 273-278
Published: 2008
Released on J-STAGE: September 16, 2008
JOURNAL OPEN ACCESSBackground. Case reports of lung cancer with elevated serum interleukin 6 (IL-6) levels that were successfully treated with gefitinib are rare. Case. A 57-year-old woman visited our hospital in January, 2005 because of high fever, dry cough and chest pain. Leukocytosis, thrombocytosis, elevated serum levels of CRP (8.84 mg/dl) and IL-6 (64.5 pg/ml) were noted. Chest computed tomography revealed a mass (6×5 cm), atelectasis, and pleural effusion in the right lung. Cytological examination of the pleural effusion showed adenocarcinoma (class V) and epidermal growth factor receptor (EGFR) mutation was found in the cells. Distant metastasis was not found by various imaging methods. Based on these findings, we diagnosed stage IIIB adenocarcinoma of the lung and treated the patient with gefitinib. The pleural effusion and atelectasis rapidly improved, and the tumor lesion of the lung almost disappeared. Clinical symptoms, including high fever, also disappeared. In addition, counts of WBC and platelet, and serum CRP and IL-6 levels were normalized. Therefore, the effect of gefitinib was evaluated as a good partial response. One year later, a mass in the lung accompanied by elevation of serum CRP and IL-6 levels were noted despite continuation of gefitinib administration. Partial response was observed by three-cycle chemotherapy using carboplatin (CBDCA) and paclitaxel (PTX) with decrease in serum IL-6 levels; however, multiple lesions suggesting brain metastasis appeared that indicated progressive disease stage. Conclusion. We report a rare case of adenocarcinoma of the lung with malignant pleural effusion and elevated serum IL-6 levels successfully treated with gefitinib for one year.
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Kyohei Kaburaki, Kazutoshi Isobe, Fumiaki Ishida, Shinji Sakaguchi, Yu ...2008 Volume 48 Issue 4 Pages 279-284
Published: 2008
Released on J-STAGE: September 16, 2008
JOURNAL OPEN ACCESSBackground. Intramedullary spinal code metastasis from lung cancer is a rare but serious complication with rapidly progressing neurological disturbances. Case. A 65-year-old man was admitted to our hospital with right submandibular node swelling. Small cell lung cancer in the left lower lobe with right submandibular lymph node metastasis (cT2N1M1, ED) was diagnosed. Four cycles of systemic chemotherapy with cisplatin and irinotecan resulted in a complete response. Muscle weakness and numbness of his leg rapidly progressed one year after of chemotherapy. 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) demonstrated abnormal accumulations in cervical and thoracic spinal lesions. The MRI showed 4 abnormal nodular areas in the intramedullary cervical and thoracic spinal code. He was diagnosed as having multiple intramedullary spinal code metastases from small cell lung cancer. Chemotherapy with carboplatin and etoposide combined with radiotherapy resulted in a partial response. Neurological disturbances such as muscle weakness and numbness of leg were also improved. Conclusion. FDG-PET was useful in detecting the intramedullary spinal code metastases from lung cancer.
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Toshiyuki Hirose, Yasushi Nakagawa2008 Volume 48 Issue 4 Pages 285-289
Published: 2008
Released on J-STAGE: September 16, 2008
JOURNAL OPEN ACCESSBackground. Although the number of lung cancer patients on hemodialysis is expected to increase in the future, no treatment regimen has been established yet. Case. A 75-year-old man had been under dialysis for chronic renal failure since the age of 65. An abnormal shadow was detected near the right hilum in a regular medical check-up in April 2005. An infiltrating shadow associated with an air bronchogram was noted in the right upper lobe on chest CT. Among various tumor markers, CYFRA showed an increase to 87 ng/ml. A diagnosis of adenocarcinoma was made based on the findings of cytology by bronchoscopy. Since intrapulmonary metastasis was noted in the right middle lower lobe, a diagnosis of T2N1M1 stage IV was made and we decided to give chemotherapy. Carboplatin (CBDCA) [Area under the curve (AUC) 2.0] and Paclitaxel (PTX) (70 mg/m2) were administered on days 1, 8, and 15 every 28 days. Dialysis was conducted for 4 hours starting 2 hours after completion of administration of CBDCA. Adverse reactions observed included Grade 2 anorexia, nausea and hair loss and Grade 3 neutropenia, anemia, and febrile neutropenia. The dose of CBDCA and PTX was reduced to AUC 1.68 and 65 mg/m2, respectively, in subsequent cycles. Symptoms and shadows showed improvements and CYFRA decreased to the normal level. A pharmacokinetic study during the third course showed that the AUCs of CBDCA and PTX were 1.16 μg-min/ml and 3.49 μg-h/ml, respectively. The patient was observed after completing 4 cycles. However, shadows worsened again and he passed away in September 2006. Conclusion. This paper described a dialysis patient with pulmonary adenocarcinoma who responded to the weekly CBDCA+PTX combination. This regimen in a dialysis patient can be safely conducted as an outpatient basis.
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Aya Sugiyama, Hiromi Egawa, Hiroshi Murai, Kosuke Hamai, Hidenori Muka ...2008 Volume 48 Issue 4 Pages 290-294
Published: 2008
Released on J-STAGE: September 16, 2008
JOURNAL OPEN ACCESSBackground. Adenoid cystic carcinoma (ACC) of salivary-gland origin often metastasizes to the lungs, but discovery of a solitary lung metastasis 14 years after surgical resection of such a tumor is a rare event. Case. A 74-year-old man had undergone surgical removal of a left parotid gland tumor in 1992, with histological diagnosis of ACC. In a 1994 screening, there was no sign of local recurrence or distant metastasis, and subsequently the patient was no longer followed-up. In 2006, however, when the patient underwent computed tomography (CT) scanning, a single round tumor was discovered in the left lower lung measuring 6 cm in diameter with distinct and smooth margins. CT guided needle biopsy was then performed and histological examination of the tumor revealed ACC. Whole body examination revealed no sign of any other metastasis, and segmentectomy of the left lower lung was carried out. Because the resected specimen showed no relationship with any bronchi, we diagnosed the tumor as metastatic lung cancer from the original parotid gland ACC. Conclusion. We reported a case of solitary lung metastasis from a parotid gland ACC, 14 years after resection of the primary tumor. We presented a review of reported cases of ACC metastasizing to the lungs more than 10 years after the initial operarion, and discussed follow-up after surgery for ACC and treatment for the occurrence of metastases.
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The 33rd Diagnostic Imaging Seminar
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Kazuto Ashizawa2008 Volume 48 Issue 4 Pages 295-301
Published: 2008
Released on J-STAGE: September 16, 2008
JOURNAL OPEN ACCESSAlthough low-dose CT screening for lung cancer has become widespread, plain chest radiograph is the first diagnostic step and plays the most important role in the diagnosis of lung cancer. Chest radiographic findings of lung cancer vary, and could be classified into 2 types, namely, proximal and peripheral. In proximal type lung cancer, although hilar abnormality can be detected, bronchial stenosis and associated distal parenchymal changes including obstructive pneumonia and obstructive atelectasis are common findings. Peripheral type lung cancer usually appears as a nodule or mass, but often shows focal linear or irregular opacity. The features suggesting malignancy are ill-defined borders, spicules, vascular convergence, and pleural indentation. In mucin-producing bronchioloalveolar carcinoma, an ill-defined consolidation with air bronchogram is seen, which simulates infectious pneumonia. This form of carcinoma is often multicentric, and cavity is seen within the consolidation.
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Haruhiro Saito2008 Volume 48 Issue 4 Pages 302-311
Published: 2008
Released on J-STAGE: September 16, 2008
JOURNAL OPEN ACCESSWe are now able to more precisely diagnose small pulmonary nodules by using thin-section CT images. Pulmonary nodules are classified as either 'Air-containing type (Air-type)' or 'Solid-density type (Solid-type)' by comparing lung window images and mediastinal window images. The lung window images of pulmonary nodules are classified as: (1) Non-solid nodule (GGO: ground-glass opacity), (2) Part-solid nodule, (3) Solid nodule. GGO findings usually correspond to Noguchi's type A adenocarcinoma or atypical adenomatous hyperplasia (AAH). Part-solid nodules correspond to Noguchi's type B or type C adenocarcinoma. The solid part of part-solid nodules corresponds to the histopathological findings of collapse in 'Air-type'. These correspond to cancer cells that disrupt alveolar structures and proliferate in 'Solid-type'. The prognosis of 'Air-type' is better than that of 'Solid-type' after resection. Solid nodules correspond to Noguchi's type D adenocarcinoma, squamous cell carcinoma and small cell carcinoma. We can diagnose small pulmonary nodules more precisely by using multiplanar reformation images, enhanced CT images and follow-up of CT findings.
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Yasuyuki Kurihara, Kunihiro Yagihashi, Shin Matsuoka, Yoshiko Yakushij ...2008 Volume 48 Issue 4 Pages 312-317
Published: 2008
Released on J-STAGE: September 16, 2008
JOURNAL OPEN ACCESSIn daily practice, computed tomography (CT) plays a primary role in the assessment of lung cancer. Magnetic resonance imaging (MRI) has rarely been used to view the lung parenchyma, however, recent advances in the software and hardware of MR systems have resulted in better image quality. In this review, we describe several solutions for the problems related to chest MRI, specific signal intensity patterns of various focal pulmonary lesions, evaluation of the chest wall and cardiovascular invasion, and several new topics.
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Noriaki Kurimoto, Hiroaki Osada2008 Volume 48 Issue 4 Pages 318-326
Published: 2008
Released on J-STAGE: September 16, 2008
JOURNAL OPEN ACCESSThe applications of EBUS are 1) determination of the depth of tracheobronchial tumors, 2) EBUS-guided trans-bronchial needle aspiration (TBNA), 3) differential diagnosis of peripheral lung lesions, 4) detection of the precise location of peripheral pulmonary lesions. We evaluated 150 lesions by EBUS using a thick guide sheath (GS) (2.5 mm in diameter) covering a miniature probe, in a prospective open study. In the procedure of EBUS-GS, the probe covered by a guide sheath is introduced into the lesion via the working channel of a bronchoscope. The probe is withdrawn, while the guide sheath is left in place. A brush or biopsy forceps is then introduced through the guide sheath into the lesion. EBUS visualized the image in 93% of the peripheral pulmonary lesions. Diagnosis was made in 116 (77%) of the 150 EBUS-GS procedures. Cases in which the probe was located within the lesion, had a significantly higher diagnostic yield (105/121, 87%) than when the probe was located adjacent to it (8/19, 42%). Diagnostic yield from EBUS-GS in lesions ≤10 mm (16/21, 76%), 10< ≤ 15 mm (19/25, 76%, p=0.99, χ2), 15< ≤20 mm (24/35, 69%, p=0.41, χ2), and 20< ≤30 mm (33/43, 77%, p=0.96, χ2) were similar, demonstrating the efficacy of EBUS-GS even in lesions ≤10 mm in diameter.
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Tomoyuki Yokose2008 Volume 48 Issue 4 Pages 327-336
Published: 2008
Released on J-STAGE: September 16, 2008
JOURNAL OPEN ACCESSOncologists for lung cancer should have good communication with a pathologist and understand caveats and information associated with pathology. This article explains how to prepare an application format, handle cytological, biopsy or surgical materials, read pathological reports of lung cancer and use a pathological consultation system.
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Short Report
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Hideki Fujimori, Koichiro Kobayashi, Yoshinobu Maeda, Hiroshi Minato2008 Volume 48 Issue 4 Pages 337-338
Published: 2008
Released on J-STAGE: September 16, 2008
JOURNAL OPEN ACCESS -
Seijiro Sato, Masanori Tsuchida, Mariko Takeshige, Hirohiko Shinohara, ...2008 Volume 48 Issue 4 Pages 339-340
Published: 2008
Released on J-STAGE: September 16, 2008
JOURNAL OPEN ACCESS -
Misa Hirukawa, Seiichi Nobuyama, Junko Saji, Masahiro Hoshikawa, Masay ...2008 Volume 48 Issue 4 Pages 341-342
Published: 2008
Released on J-STAGE: September 16, 2008
JOURNAL OPEN ACCESS
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