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Volume 51 (2011)
- Issue 7 Pages 777-
- Issue 6 Pages 689-
- Issue 4 Pages 227-
- Issue 3 Pages 165-
- Issue 2 Pages 63-
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Volume 51, Issue 4
Displaying 1-10 of 10 articles from this issue
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Original Articles
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Fumihiko Hirai, Kaname Nosaki, Taro Ohba, Takuro Kometani, Masafumi Ya ...2011 Volume 51 Issue 4 Pages 227-232
Published: 2011
Released on J-STAGE: September 13, 2011
JOURNAL OPEN ACCESSObjective. We evaluated the feasibility of pemetrexed (PEM) treatment for third-line or higher chemotherapy for non-squamous, non-small cell lung cancer (NSCLC) patients. Methods. We retrospectively analyzed 25 consecutive patients with advanced non-squamous NSCLC who were treated with PEM as third-line or higher chemotherapy between May 2009 and March 2010. Results. Patients composed 15 men and 10 women, with a median age of 67 years (range 51-78 years). The histological subtype was adenocarcinoma in 24 patients and large cell carcinoma in 1 patient. A total of 5 patients had stage IIIB and 20 patients had stage IV disease. The number of prior regimens was 2 in 12 patients, 3 in 4 patients, and 4 or more in 9 patients. The median number of PEM courses was 7. The number of courses was 1 in 3 patients, 2-4 in 7 patients, 5-9 in 7 patients, and 10 or more in 8 patients. Hematological toxicities of grade 3 or more included leukocytopenia in 3 patients (12.0%), neutrocytopenia in 4 patients (16.0%) and anemia in 1 patient (4.0%). Grade 3 non-hematological toxicity included a rash in 2 patients (8.0%), but no other serious adverse events were observed. A partial response (PR) was observed in 1 patient, stable disease (SD) in 18 patients and progressive disease (PD) in 6 patients. The median progression-free survival was 22.0 weeks, and overall survival was 47.8 weeks. Conclusion. PEM treatment might be feasible for third-line or higher chemotherapy for NSCLC patients.
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Makoto Takahama, Ryoji Yamamoto, Takuma Tsukioka, Hirohito Tada2011 Volume 51 Issue 4 Pages 233-236
Published: 2011
Released on J-STAGE: September 13, 2011
JOURNAL OPEN ACCESSObjective. We retrospectively analyzed the results of emergency coring out with a rigid bronchoscope for symptomatic malignant or benign tumors obstructing the central airway prior to radical resection. Patients and Methods. We performed rigid bronchoscopic interventions on 103 patients with symptomatic central airway obstructions from January 2007 to December 2010. Among these, we enrolled 6 patients (5 men; 1 woman; median age, 63 years) who underwent emergency coring out with a rigid bronchoscope of tumors on the day of referral to our institution prior, to radical resection. The primary site of the tumor was the trachea in 4 patients and the left main bronchus in 2. Results. All 6 patients recovered from dyspnea immediately, and none suffered postoperative complications. We histopathologically confirmed that the obstructions comprised adenoid cystic carcinoma (n=5) and neurofibroma (n=1). The second radical procedure was a left sleeve pneumonectomy and tracheal resections in 1 and 3 patients, respectively. The remaining 2 elderly patients declined radical surgery. Conclusion. Emergency coring out with a rigid bronchoscope for malignant or benign neoplastic obstructions of the central airway appears to be a safe initial treatment prior to a radical procedure.
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Case Reports
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Yu Fujita, Satoshi Hirano, Yuichiro Takeda, Haruhito Sugiyama, Nobuyuk ...2011 Volume 51 Issue 4 Pages 237-242
Published: 2011
Released on J-STAGE: September 13, 2011
JOURNAL OPEN ACCESSBackground. Pemetrexed is a multitarget antifolate agent approved for the treatment of patients with malignant pleural mesothelioma and advanced non-small cell lung cancer. The role of pemetrexed, especially in the treatment of lung cancer, continues to expand. Adverse drug reactions are mild, but there have been some reports of pemetrexed inducing interstitial pneumonitis. Case. A 76-year-old woman was admitted to our hospital because of exertional dyspnea. A chest X-ray film revealed a large right pleural effusion. Based on a systemic examination, she was given a diagnosis of non-small cell lung cancer (adenocarcinoma, T3N0M1a). She was given pemetrexed as 1st line chemotherapy. Ten days after the 3rd cycle, she suffered from exertional dyspnea and a dry cough. Chest high-resolution computed tomography findings showed diffuse, ground-glass opacities and interlobular septal thickening, mainly in the left lung. Transbronchial lung biopsy revealed alveolitis, and her bronchoalveolar lavage fluid showed marked lymphocytosis. A drug lymphocyte stimulation test was positive for pemetrexed. We began corticosteroid therapy, and her symptoms and radiographic findings improved. The clinical course suggested pemetrexed-induced interstitial pneumonitis. Conclusion. We present a case of drug-induced interstitial pneumonitis associated with pemetrexed in a patient with advanced non-small cell lung cancer. Because pemetrexed is being prescribed with increasing frequency, especially for non-small cell lung cancer, we believe that clinicians should be aware of this rare but severe pulmonary complication during the management of patients with treatment regimens including pemetrexed.
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Hisashi Tanaka, Keita Kudo, Noriko Yanagitani, Atsushi Horiike, Fumiyo ...2011 Volume 51 Issue 4 Pages 243-246
Published: 2011
Released on J-STAGE: September 13, 2011
JOURNAL OPEN ACCESSBackground. Lung cancer can produce extrathoracic metastases to various sites. However, cutaneous metastasis to the finger is extremely rare. Case. A 72-year-old man was found to have a suspected tumor shadow in S10 of the right lung on a chest CT scan on admission. We therefore conducted bronchofiberscopy and made a diagnosis of squamous cell carcinoma of the lung (cT2N2M0 stage IIIA). We administered 1st-line chemotherapy using carboplatin+paclitaxel, for 4 cycles. We then conducted sequential radiotherapy. However, during the treatment course, the patient's right ring finger and little finger were noted to have swelling and erythema, and he reported pain. We therefore conducted fine-needle aspiration of the right ring finger and made a diagnosis of metastatic lung cancer. Palliative radiotherapy of 30-Gy was administered to the patient's hand. Although he reported pain relief, necrosis of the ring finger and little finger progressed. Further metastases developed in his left hand, and we administered 2nd-line chemotherapy using docetaxel. Nevertheless, the primary tumor recurred, and multiple subcutaneous metastases appeared. The patient died 3 months after the diagnosis of metastatic lung cancer. Conclusion. We herein report an extremely rare case of cutaneous metastasis to the finger.
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Takako Inoue-Okuyama, Masahide Mori, Takeshi Uenami, Shin-ichi Kagami, ...2011 Volume 51 Issue 4 Pages 247-252
Published: 2011
Released on J-STAGE: September 13, 2011
JOURNAL OPEN ACCESSBackground. Lung cancer is often accompanied by brain metastases; however, the differential diagnosis is usually made based on imaging findings alone. We treated a patient with multiple brain metastases of lung cancer accompanied by a brain abscess and bacterial meningitis, with a confirmed diagnosis on autopsy. Case. A 57-year-old man was admitted to our hospital for the examination of an abnormal chest shadow. Chest and brain computed tomography (CT) scans led to a clinical diagnosis of lung cancer in the left upper lobe with multiple brain metastases. His consciousness level rapidly deteriorated. He received whole-brain irradiation and steroid therapy, but died 4 days after admission. Autopsy findings revealed squamous cell carcinoma of the left lung with multiple brain metastases, a brain abscess next to a metastatic site, and bacterial meningitis due to infection by Streptococcus pneumoniae. We believed that enlargement of the brain abscess directly induced the consciousness disturbance at the terminal phase because the brain metastases themselves were of a relatively small size. Conclusion. On brain CT, the brain abscess was similar to the carcinomatous metastases. Therefore, diagnosis was difficult. The present case showed a rare but serious complication of lung cancer, with rapidly deteriorating neurological symptoms.
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Rurika Hamanaka, Shuji Murakami, Tomoyuki Yokose, Haruhiko Nakayama, K ...2011 Volume 51 Issue 4 Pages 253-258
Published: 2011
Released on J-STAGE: September 13, 2011
JOURNAL OPEN ACCESSBackground. Remitting seronegative symmetrical synovitis with pitting edema (RS3PE), a paraneoplastic syndrome, has rarely been reported to be associated with lung cancer. We report a case of a patient with RS3PE who recovered after resection of a lung tumor. Case. A 79-year-old man had pitting edema of the lower legs and dorsal areas of the feet since December 2009, and thereafter, swelling in his fingers and wrists, with heat and pain in his wrists and ankles gradually developed. An abnormal shadow was incidentally identified in the left middle lung field on a chest radiograph during a medical examination in April 2010, after which he was referred to our hospital for further evaluation. A chest computed tomography scan showed a 40×37 mm mass in the left lingular segment, which was identified as lung cancer by transbronchial biopsy. We made a diagnosis of RE3PE syndrome associated with primary lung cancer and performed a left upper lobectomy with lymph node dissection. During the postoperative course, his joint symptoms rapidly recovered, and 8 months after the operation, the patient was alive and well. Conclusion. In elderly patients with pitting edema associated with rapidly evolving synovitis, paraneoplastic arthritis should be considered.
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Koichi Onaru, Kayo Ota, Koji Nishida, Kotaro Miyake, Iwao Goma, Hirosh ...2011 Volume 51 Issue 4 Pages 259-264
Published: 2011
Released on J-STAGE: September 13, 2011
JOURNAL OPEN ACCESSBackground. If complete remission (CR) is achieved in limited-disease (LD) small cell lung cancer (SCLC) with no signs of recurrence for 5 years, it is considered rare to subsequently show recurrence. Case. A 72-year-old man was introduced to our hospital because of an abnormal shadow in his chest X-ray, which was diagnosed as LD-SCLC in the proximal site of the left lingular lobe. Concurrent chemoradiotherapy with carboplatin and etoposide resulted in CR, after which he was followed by periodical outpatient clinic visits. After 3 years, a prostate cancer was diagnosed which was completely controlled by hormone therapy. Five years and 4 months after CR had been recognized, advanced gastric stump cancer was found with multiple metastases. Despite 6 months of systemic chemotherapy with S-1, the gastric tumor exhibited further progression. When he was admitted to our hospital due to gastric stenosis caused by the gastric stump cancer, a new lung mass lesion was detected on his chest X-ray. Biopsy samples from the left lingular lobe revealed the tumor as SCLC, compatible with local recurrence of his primary lung cancer. Because of the aggressive progression of the lung cancer, a palliative care was provided and he died 6 years after the first chemotherapy for his lung cancer. The autopsy revealed multiple systemic metastases of the gastric cancer and a local recurrence of SCLC accompanied by ipsilateral lung metastases, without any indication of recurrence of the prostate cancer. Conclusion. Although it is known that long-time survivors of LD-SCLCs may well develop metachronous multiple cancers, the present case exhibited recurrence of primary SCLC even after over 5 years of CR, pointing to the clinical importance of careful monitoring for possible local recurrence of SCLC.
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Toshiya Fujiwara, Atsushi Shimoda, Toshio Nishikawa, Kazuhiko Kataoka, ...2011 Volume 51 Issue 4 Pages 265-269
Published: 2011
Released on J-STAGE: September 13, 2011
JOURNAL OPEN ACCESSBackground. We report a rare case of thoracic lymph node large cell carcinoma of unknown origin. Case. A 65-year-old man complained of left hypochondralgia and underwent a medical check-up at a clinic. Tests revealed an elevated serum carcinoembryonic antigen level and a hilar nodule approximately 13 mm in diameter. Positron-emission tomography revealed an accumulation of fluorodeoxyglucose in the nodule and left 10th rib. Because there were no evident osteolytic or osteoblastic findings in the bone lesion on magnetic resonance imaging, we diagnosed the lesion as traumatic change rather than metastasis. Preoperatively, we diagnosed lung cancer of unknown origin with a single-station lymph node metastasis. We performed a left upper lobectomy with hilar and mediastinal lymph node dissection. The histopathological diagnosis was large cell carcinoma. The patient was given platinum-based combined chemotherapy as adjuvant therapy, and is currently free from disease 3 years after surgery. Conclusion. Complete surgical resection combined with adjuvant chemotherapy can be benefical for single-station lymph node carcinoma of unknown origin, if complete resection is possible.
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Hiroyuki Agatsuma, Hiromu Yoshioka, Hisaaki Kato, Tomohiko Ogasawara, ...2011 Volume 51 Issue 4 Pages 270-273
Published: 2011
Released on J-STAGE: September 13, 2011
JOURNAL OPEN ACCESSBackground. Tracheal salivary gland-type adenocarcinoma is quite rare. We report the case of a patient who was successfully treated by surgery with extracorporeal membrane oxygenation (ECMO). Case. A 48-year-old woman with a 2-year history of hemoptysis was referred to our hospital. Bronchoscopic examination revealed a polypoid tumor occupying 2/3 of the tracheal lumen in the mid-trachea. The lesion was histologically identified as salivary gland-type adenocarcinoma. We performed complete resection of the tumor by tracheal wedge resection under veno-venous ECMO. We discuss the benefits of ECMO between the right atrial appendage and pulmonary artery for such operations.
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Takashi Iwanami, Masaaki Inoue, Teruo Iwata, Souichi Oka, Makoto Kawag ...2011 Volume 51 Issue 4 Pages 274-278
Published: 2011
Released on J-STAGE: September 13, 2011
JOURNAL OPEN ACCESSBackground. We report 2 cases of myasthenia gravis (MG) after extended thymo-thymectomy for thymoma without MG. Case 1. A 57-year-old woman was admitted to our hospital with a diagnosis of thymoma but with no symptoms of MG, and an extended thymo-thymectomy was performed. The histological diagnosis was thymoma, WHO type B2 and stage III according to the Masaoka criteria. The symptoms of MG appeared 25 months postoperatively. Her titer of anti-acetylcholine receptor (AchR) antibody was high and MG was eventually diagnosed. Case 2. An 82-year-old woman was given a diagnosis of thymoma during treat for another disease. She did not have any symptoms of MG, but her anti-AchR antibody level was high. We performed an extended thymo-thymectomy. The histological diagnosis was thymoma, WHO type AB and stage I according to the Masaoka criteria. The symptoms of MG appeared 13 months after the operation, but without relapse of her thymoma. Her titer of anti-AchR antibody was high, and therefore MG was diagnosed. Conclusion. It is necessary to exclude the possibility of MG by analyzing the anti-AchR antibody level before the treatment of thymoma. Moreover, patients with high anti-AchR antibody levels should be considered at risk for post-thymectomy MG (PTMG). The current late onset cases required consideration of the possibility of treatment for the relapse of thymoma. The treatment of PTMG should be decided after the evaluation of MG status, and the causes of any relapse of the thymoma examined.
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