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Volume 53 (2013)
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Volume 53, Issue 2
Displaying 1-13 of 13 articles from this issue
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Original Article
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Kenji Tomizawa, Noriyasu Usami, Koichi Fukumoto, Noriaki Sakakura, Tak ...2013 Volume 53 Issue 2 Pages 93-98
Published: 2013
Released on J-STAGE: July 26, 2013
JOURNAL OPEN ACCESSObjective. Thirty-day mortality is adapted to the evaluation of perioperative mortality following pulmonary resection of primary lung cancer. However, whether 90-day mortality adequately evaluates perioperative mortality remains unknown. In this study, we analyzed the 30- and 90-day mortality following pulmonary resection of primary lung cancer at our institution. Methods. A total of 2207 pulmonary resections of primary lung cancer performed between 1996 and 2010 at Aichi Cancer Center Hospital were analyzed and divided into two groups of almost equal number: the early period (1070 patients treated between 1996 and 2004) and the late period (1137 patients treated between 2005 and 2010). Sixty-six and 34 postoperative deaths occurred within one year during the early and late periods, respectively. The causes of death (recurrence, bleeding, sudden death, respiratory failure and adverse events of chemotherapy) and 30- and 90-day mortality rates were investigated. Results. The 30- and 90-day mortality rates were 0.56% and 0.35%, respectively, during the early period and 0.75% and 0.79%, respectively, during the late period. Among the patients who died within one year after undergoing pulmonary resection, the postoperative survival of the patients with death due to recurrence (75 patients) and death due to bleeding or sudden death (seven patients) was >91 days and <30 days, respectively. The postoperative survival of the patients with death due to bleeding or sudden death (seven patients) was <30 days. The median postoperative survival of the patients with respiratory failure was 67 days (range: 20-142 days) in the early period and 100 days (range: 47-149 days) in the late period. In the late period, adequately assessing perioperative mortality using 30-day mortality was difficult due to pulmonary complications. Conclusions. A risk assessment of perioperative mortality following pulmonary resection of primary lung cancer should be performed using 90- and 30-day mortality.
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Case Reports
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Kakuhiro Yamaguchi, Soichi Kitaguchi, Mayuko Kagawa, Takashi Ogawa, Fu ...2013 Volume 53 Issue 2 Pages 99-103
Published: 2013
Released on J-STAGE: July 26, 2013
JOURNAL OPEN ACCESSObjective. We herein report a case of Asian variant intravascular large B-cell lymphoma which was diagnosed based on the results of a thoracoscopic lung biopsy that exhibited remission and exacerbation on computed tomography (CT). Case. A 53-year-old male presented to our hospital with dyspnea. On a routine examination, chest radiography showed an abnormal shadow. Chest CT revealed areas of diffuse ground-glass opacity in the bilateral lungs. We suspected a diagnosis of hypersensitivity pneumonitis because the patient was in remission without receiving treatment. Eleven months later, he again presented with dyspnea at our hospital. Repeat chest CT revealed areas of diffuse ground-glass opacity in the bilateral lungs, and the patient experienced high fever spikes during the following month. He was diagnosed with Asian variant intravascular large B-cell lymphoma, as the laboratory data met the diagnostic criteria for hemophagocytic syndrome and a thoracoscopic lung biopsy revealed atypical cells in small vessels. The cells were positive for CD79α, MUM1, CD10 and BCL6 based on immunohistochemistry, and IgH gene rearrangement was observed. Conclusion. We diagnosed a case of Asian variant intravascular large B-cell lymphoma with spontaneous remission. We herein discuss the imaging findings, mechanisms and treatment with a review of the pertinent literature.
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Mitsuhiro Tada, Takashige Kuraki, Maki Hanada, Hibiki Kanda, Akihisa S ...2013 Volume 53 Issue 2 Pages 104-108
Published: 2013
Released on J-STAGE: July 26, 2013
JOURNAL OPEN ACCESSBackground. Malignant lung cancer tumors easily metastasize to the brain and cause carcinomatous meningitis. In cases of carcinomatous meningitis, disseminated intradural extramedullary spinal cord metastasis spreading via the cerebrospinal fluid (CSF) from a brain tumor is an important condition that is called drop metastasis. Drop metastasis involves the gravity and flow of the CSF and affects sensory nerves. It is typical for such a patient to present with back and buttock pain, in addition to bladder and rectal disturbance. Case. A 60-year-old male (cT2aN2M0, stage IIIA) with lung adenocarcinoma and multiple brain metastases presented with spinal cord symptoms of cauda equina syndrome. Gadolinium (Gd)-enhanced spinal magnetic resonance imaging (MRI) showed the presence of an enhanced nodule at the S1/2 level and enhancement of the cauda equina. We diagnosed the patient with drop metastasis originating from brain metastasis. The risk factors for drop metastasis include the presence of brain tumors in the posterior fossa. The type of cancer and histological tumor classification are unimportant. Gd-enhanced spinal MRI (T1-weighted image) is useful for diagnosing drop metastasis. Conclusion. When lung cancer patients with brain metastasis in the posterior fossa present with neurological symptoms unlike those of brain metastasis, then Gd-enhanced spinal MRI should be performed as soon as possible.
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Kyukwang Chung, Takashi Iwata, Shoji Hanada, Hidetoshi Inoue, Michihit ...2013 Volume 53 Issue 2 Pages 109-113
Published: 2013
Released on J-STAGE: July 26, 2013
JOURNAL OPEN ACCESSBackground. Basaloid carcinoma is a rare histological subtype of large cell carcinoma. It has been reported that making a preoperative diagnosis of this disease is often difficult and the prognosis is poor. We herein report a case of basaloid carcinoma of the lungs with a review of the literature. Case. An 84-year-old male who presented with dyspnea was referred to our hospital for a nodular lesion in the right upper lung on a chest radiograph. Wedge resection of the lung was performed, and frozen sectioning disclosed poorly differentiated carcinoma. Basaloid carcinoma of the lungs was diagnosed based on the histopathological findings. The patient did not receive adjuvant chemotherapy due to his poor general condition and is presently alive without recurrent disease 10 months after undergoing surgery. Conclusion. Basaloid carcinoma is often inadequately diagnosed as poorly differentiated or undifferentiated carcinoma because a detailed immunohistochemical assessment is needed to make a diagnosis and many characteristics of the disease are still unknown, including the prognosis. Therefore, further studies to identify effective treatment modalities are needed.
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Yasutaka Watanabe, Fumiaki Kudo, Mamoru Shiraishi, Chihiro Miwa, Kenji ...2013 Volume 53 Issue 2 Pages 114-120
Published: 2013
Released on J-STAGE: July 26, 2013
JOURNAL OPEN ACCESSBackground. Therapy for carcinomatous meningitis due to lung cancer has not been established. We experienced a case of lung adenocarcinoma that developed carcinomatous meningitis during gefitinib treatment and improved after changing the medication to erlotinib. Case. The patient was a 69-year-old male who underwent thoracoscopic right lower lobectomy for lung adenocarcinoma with an epidermal growth factor receptor (EGFR) mutation. The pathological staging was IA (pT1N0M0). Multiple bone metastases developed 19 months after surgery. Systemic chemotherapy was initiated, then stopped after only one course due to the patient's request. The patient complained of a headache 23 months after undergoing surgery and was diagnosed as having carcinomatous meningitis. He was prescribed gefitinib, and the headache and radiologic findings of multiple bone metastases improved. Four months after the initiation of gefitinib treatment; however, the headache and disorientation reappeared. The findings of contrast-enhanced magnetic resonance imaging (MRI) of the brain and a lumbar cerebrospinal fluid (CSF) examination confirmed the diagnosis of carcinomatous meningitis. Gefitinib was changed to erlotinib, and the patient's symptoms and MRI and CSF findings markedly improved. Conclusions. This case suggests that erlotinib is effective in cases of recurrence in the central nerve system in patients with lung cancer and EGFR mutations receiving gefitinib treatment.
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An AIDS Patient with Lung Pleomorphic Carcinoma Treated with Carboplatin, Paclitaxel and BevacizumabHaruka Chino, Satoshi Hirano, Masahiro Ichikawa, Yuichiro Takeda, Haru ...2013 Volume 53 Issue 2 Pages 121-126
Published: 2013
Released on J-STAGE: July 26, 2013
JOURNAL OPEN ACCESSBackground. Pulmonary pleomorphic carcinoma is a rare tumor with a poor prognosis that is refractory to both chemotherapy and radiotherapy. Case. A 52-year-old male HIV carrier was admitted with right back pain and an abnormal chest X-ray. A radiogram revealed a large mass in the right lung field. The patient underwent bronchoscopy; however, the lesion remained undiagnosed. Chest computed tomography showed a 8.6-cm mass extending from the right upper lobe to the lower lobe of the lungs that had invaded the right posterior thoracic wall. A percutaneous CT-guided fine-needle biopsy was performed, which demonstrated pulmonary pleomorphic carcinoma in the specimen. The patient was clinically diagnosed with cT4N0M0 stage IIIA disease. Following initial treatment with highly active antiretroviral therapy (HAART), the patient underwent 4 courses of carboplatin (CBDCA AUC 5), paclitaxel (PTX 200 mg/m2) and bevacizumab (Bev 15 mg/kg) combination therapy, thus demonstrating a partial response (reduction ratio: 50.5%). Subsequently, he was administered radiation therapy (60 Gy/30 Fr). He is currently being followed for 12 months after diagnosis. Conclusion. We herein report a case of pulmonary pleomorphic carcinoma and AIDS that was successfully treated with CBDCA, PTX and Bev combination therapy. This combination regimen is a safe and effective therapeutic option for treating pulmonary pleomorphic carcinoma associated with AIDS.
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Takatoshi Abe, Isao Matsumoto, Makoto Oda, Kazuo Kasahara, Takashi Son ...2013 Volume 53 Issue 2 Pages 127-131
Published: 2013
Released on J-STAGE: July 26, 2013
JOURNAL OPEN ACCESSBackground. Small-cell lung cancer is usually centrally located and grows rapidly, often metastasizing to the lymph nodes and other organs. Case. An 82-year-old male received chemoradiotherapy for laryngeal cancer. Five years after treatment, follow-up chest CT revealed a number of small areas of nodular opacity (maximum size: 0.5 cm) clustered at the periphery of the middle lobe of the right lung. Since inflammatory changes were suspected, periodic CT examinations were performed. However, the lung nodules slowly grew, and a year and a half later, all of the nodules were found to have consolidated into one large nodule measuring 2.4 cm in size; therefore, malignancy was suspected. The pathological findings obtained using a CT-guided needle biopsy of the lungs led to a diagnosis of small-cell cancer. Brain MRI and FDG-PET scans revealed no clinical metastasis (clinical stage IA: T1bN0M0). The patient underwent video-assisted right middle lobectomy of the lungs and lymph node dissection, and a definitive diagnosis of pathological stage IA (T1aN0M0) disease was made. Conclusion. We herein reported a case of small-cell lung cancer with a peculiar progressive pattern.
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Kotaro Matsumoto, Masato Katoh, Hitoshi Ichimiya2013 Volume 53 Issue 2 Pages 132-137
Published: 2013
Released on J-STAGE: July 26, 2013
JOURNAL OPEN ACCESSBackground. We herein report the cases of two patients with stage III non-small-cell lung cancer (NSCLC) who were treated with preoperative concurrent chemoradiotherapy (CCRT) containing CDDP plus S-1 with concurrent radiation therapy followed by surgery. Both patients underwent curative resection with a pathological CR (complete response). Case 1. Patient 1 was a 50-year-old male with adenocarcinoma (cT4N2M0) of the left lung. Following the administration of CCRT, a partial response was achieved, and the patient underwent left upper lobectomy with pulmonary angioplasty. Case 2. Patient 2 was a 49-year-old female with squamous cell carcinoma (cT3N1M0) of the right lung. Following the administration of CCRT, a partial response was achieved, and right upper lobectomy was performed with partial resection of the 2nd, 3rd and 4th ribs and reconstruction of the chest wall using Composix mesh. Both cases were proven to be a pathological CR based on the findings of surgical specimens, and the patients are currently alive without recurrence more than one year after undergoing surgery. Conclusions. Preoperative concurrent chemoradiotherapy with CDDP plus S-1 is useful for treating locally advanced non-small-cell lung cancer.
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Kazutoshi Isobe, Yoshinobu Hata, Kyohei Kaburaki, Keishi Sugino, Aki M ...2013 Volume 53 Issue 2 Pages 138-143
Published: 2013
Released on J-STAGE: July 26, 2013
JOURNAL OPEN ACCESSBackground. The majority of lung cancer patients with an epidermal growth factor receptor (EGFR) mutation develop resistance to EGFR-tyrosine kinase inhibitors within 1 year. Case. A 70-year-old female with an abnormal shadow in the right lower lobe was referred to our hospital in October 2006 and diagnosed with lung adenocarcinoma harboring an EGFR L858R mutation, stage IV (T1aN0M1b, BRA). She was treated with erlotinib as fourth-line chemotherapy starting in March 2009. Although she achieved a stable disease status for approximately 2-1/2 years, the patient exhibited cancer regrowth at the site of the primary tumor as the serum level of CEA became elevated. We then performed right lower lobectomy as salvage surgery. An EGFR T790M resistance mutation was found in the resected specimen. The patient is still alive 15 months after surgery, although a solitary brain metastasis has developed. Conclusions. Salvage resection of tumors with acquired resistance to EGFR-TKI is therefore considered to be an acceptable option for salvage treatment.
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A Case of Pneumatosis Cystoides Intestinalis During Systemic Chemotherapy for Small-cell Lung CancerTsukasa Ishiwata, Akira Suda, Mitsuhiro Abe, Masashi Kantake, Toshihid ...2013 Volume 53 Issue 2 Pages 144-149
Published: 2013
Released on J-STAGE: July 26, 2013
JOURNAL OPEN ACCESSBackground. Pneumatosis cystoides intestinalis (PCI) is a relatively uncommon disease characterized by the development of emphysematous cysts beneath the serosa and mucosa of the intestines. One of the reported types of PCI is "drug-induced"; however, there are few case reports of this condition developing during chemotherapy for lung cancer. Case. An 83-year-old male was treated with amrubicin as second-line therapy for small-cell lung cancer (cT4N3M1b: Stage IV). He developed diarrhea on the 7th day after the initiation of therapy and grade 3 neutropenia on the 9th day of therapy. On the 10th day, he complained of abdominal distension, and a chest X-ray showed the presence of free gas under the right diaphragm. An abdominal CT scan revealed free gas in the abdomen and gas in the wall of the ileum. We diagnosed the patient with PCI and chose conservative therapy because a physical examination did not reveal any signs of peritonitis. Subsequently, a marked improvement of the abdominal distension was observed on the 14th day. A follow-up abdominal CT scan performed on the 15th day showed almost a complete resolution of the extraintestinal free gas and gas in the wall of the ileum. No recurrence of PCI was observed following repeat treatment with amrubicin. Conclusions. This case highlights the fact that PCI can develop during chemotherapy for lung cancer. Clinicians should be cognizant of the possibility of PCI in patients who develop abdominal symptoms after the start of chemotherapy.
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Hideki Ota, Hideki Kawai, Tsubasa Matsuo2013 Volume 53 Issue 2 Pages 150-153
Published: 2013
Released on J-STAGE: July 26, 2013
JOURNAL OPEN ACCESSBackground. Solitary papillomas occurring in the peripheral region of the lungs are rare. Case. A 61-year-old woman was referred to our department for surgical treatment of a nodular lesion in the right lower lung that was incidentally detected on chest computed tomography. She underwent video-assisted thoracoscopic surgery (VATS) segmentectomy of right S8-9. The intraoperative diagnosis revealed a typical papillary growth pattern of glandular epithelial cells without cytologic atypia. The tumor was histologically diagnosed as a solitary glandular papilloma of the lungs. The patient's postoperative course was uneventful, and no recurrence was observed for 15 months postoperatively. Discussion. Solitary papillomas of the lungs are benign epithelial tumors. Complete surgical resection is currently the standard treatment for such tumors. However, this operative procedure remains controversial due to the tumor's malignant potential. Some physicians prefer to use local excision, while others perform lobectomy with mediastinal lymph node dissection. In our case, the patient was successfully treated with local excision. To the best of our knowledge, malignant transformation has been reported in the squamous variant only. The glandular variant does not tend to recur locally after local excision and has no proven malignant potential. Conclusions. We recommend performing local excision to treat solitary glandular papillomas in order to preserve the pulmonary function.
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Tetsuya Yokosuka, Toshiko Kobayashi2013 Volume 53 Issue 2 Pages 154-158
Published: 2013
Released on J-STAGE: July 26, 2013
JOURNAL OPEN ACCESSBackground. We experienced a very rare case of synchronous multiple lung adenocarcinomas and double thymic tumors, including a typical thymic carcinoid tumor. Case. A 68-year-old female was admitted to our hospital due to the presence of multiple areas of mixed ground glass opacity and anterior mediastinal masses on chest computed tomography (CT). FDG-PET/CT showed abnormal accumulation in the right anterior mediastinal tumor; however, no significant uptake was observed in the left mediastinal tumor, multiple lung nodules or hilar and mediastinal lymph nodes. The lung nodule at S2 of the right upper lobe was diagnosed to be adenocarcinoma based on the findings of a transbronchial lung biopsy (TBLB). A percutaneous CT-guided fine needle biopsy (CTNB) of the right mediastinal mass was performed, and a pathological examination revealed a carcinoid tumor. No biopsy of the left tumor was performed. Right upper lobectomy of the lung with lymph node dissection and total thymectomy were performed via bilateral video-assisted thoracic surgery. Microscopically, there were 3 lepidic predominant invasive adenocarcinomas in the right upper lobe without lymph node metastasis. Concerning the mediastinal tumors, the right side tumor was diagnosed to be a thymic typical carcinoid tumor and the left side tumor was diagnosed as a combined thymic epithelial tumor containing type B3 and B2 thymoma in a ratio of 2:1, according to the World Health Organization (WHO) classification of the thymus. Under the administration of adjuvant chemotherapy for lung adenocarcinoma with oral uracil-tegafur (UFT), the patient is currently doing well without recurrence 20 months after undergoing surgery. Conclusions. A complete resection was performed in this case. However, various malignancies were present, including thymic epithelial tumors; therefore, providing strict postoperative follow-up for recurrence and the development of other primary cancers is necessary.
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Takuma Tsukioka, Ryoji Yamamoto, Makoto Takahama, Keiko Tei, Satoshi O ...2013 Volume 53 Issue 2 Pages 159-164
Published: 2013
Released on J-STAGE: July 26, 2013
JOURNAL OPEN ACCESSBackground. Adult-onset tuberculous lymphadenitis is a rare disease that, in many cases, is diagnosed during examinations of and treatment for primary lung cancer. Case. A 51-year-old male with contralateral second lung cancer and mediastinal tuberculous lymphadenitis was treated at our institute. He had received induction chemoradiotherapy followed by right upper lobectomy with chest wall resection for a right lung adenocarcinoma. Four years after treatment for the initial lung cancer, 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) revealed abnormal accumulation in the apex of the left lung and left lower paratracheal lymph node. The preoperative diagnosis was contralateral pulmonary metastasis and mediastinal lymph node recurrence of the initial lung cancer or second primary lung cancer with mediastinal lymph node metastasis. Left upper division segmentectomy and mediastinal lymph node dissection were performed. A histological examination of the pulmonary tumor revealed large-cell lung carcinoma. The mediastinal lymph node contained an epithelioid granuloma with caseous necrosis. There were Langhans giant cells observed in the granulation tissue. Therefore, mediastinal tuberculous lymphadenitis was diagnosed, and tuberculosis treatment was administered postoperatively. Conclusions. Tuberculous lymphadenitis is recognized to be a mediastinal disease associated with abnormal accumulation on FDG-PET scanning. In this case, an aggressive approach led to the correct diagnosis, allowing appropriate treatment to be administered.
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