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Volume 53 (2013)
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Volume 53, Issue 6
Displaying 1-15 of 15 articles from this issue
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Original Article
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Kikuo Nakano, Takashi Yoshida, Yoshihiro Kitahara, Yuhsuke Araki2013 Volume 53 Issue 6 Pages 745-750
Published: 2013
Released on J-STAGE: December 26, 2013
JOURNAL OPEN ACCESSObjectives. This study aimed to explore the perceptions of the prognosis and goals of chemotherapy and to evaluate the differences in end-of-life outcomes between advanced non-small-cell lung cancer (NSCLC) patients with accurate perceptions and those with inaccurate perceptions. Methods. This was a longitudinal cohort study. A questionnaire regarding curability and eliminating all cancer was administered to 36 patients with advanced NSCLC who received at least first-line chemotherapy. The outcomes, including chemotherapy use and location of death, were also longitudinally assessed according to accurate or inaccurate perceptions of the prognosis and goals of chemotherapy. Results. The patients' perceptions were assessed at a median of 17.7 months from the initiation of chemotherapy. Fifty-six percent of the patients reported that their cancer was incurable. Only 38% of the patients answered in concordance with the perceptions that their cancer was not curable and that the goal of chemotherapy was not to eliminate all of their cancer. Among the 19 patients who died during follow-up, the median number of days between the last dose of chemotherapy and death and the overall survival did not differ significantly between the patients with accurate perceptions and those with inaccurate perceptions. The patients with accurate perceptions were more likely to discuss their wishes for chemotherapy discontinuation with a physician (64% versus 38%) compared with those with inaccurate perceptions. Moreover, the patients with accurate perceptions were more likely to die in a palliative care unit (31% versus 0%, P=0.055) than those with inaccurate perceptions. Conclusions. Many patients with advanced NSCLC may misunderstand their prognosis and the goals of chemotherapy, which leads to inappropriate decision-making regarding end-of-life care.
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Case Reports
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Tomoyuki Nakano, Shigemi Ishikawa, Noriko Saito, Yasunori Sohara, Haji ...2013 Volume 53 Issue 6 Pages 751-754
Published: 2013
Released on J-STAGE: December 26, 2013
JOURNAL OPEN ACCESSBackground. Thymic cancer is an uncommon neoplasm. In particular, thymic basaloid carcinoma is extremely rare. Case. A 71-year-old male with a history of surgery for primary lung cancer and rectal cancer exhibited an elevated serum level of carcinoembryonic antigen (CEA) with an anterior mediastinal cyst and tumor on a computed tomography scan. Fluorodeoxyglucose-positron emission tomography showed a high standardized uptake value (SUV) max value of 8.4 at the mediastinal tumor site with no additional uptake throughout the body. The patient underwent tumor resection via median sternotomy. The histopathological findings revealed a thymic basaloid carcinoma (pT2N0M0, stage II and Masaoka stage II). Adjuvant radiation therapy was administered, and the patient's CEA level normalized. Unfortunately, multiple bone metastases, right adrenal metastasis and an elevated serum CEA level developed 13 months after resection. The patient is currently undergoing palliative radiotherapy for the bone lesions. Conclusions. We herein reported a rare case of thymic basaloid carcinoma that developed after lung and rectal cancer resection. Solitary lesions with a cystic component in the mediastinum should therefore be accurately diagnosed and resected, even after resection of a prior malignancy.
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Yusuke Moriyama, Keisuke Watanabe, Masaharu Shinkai, Hideto Goto, Yosh ...2013 Volume 53 Issue 6 Pages 755-759
Published: 2013
Released on J-STAGE: December 26, 2013
JOURNAL OPEN ACCESSBackground. Garcin syndrome consists of unilateral palsies of almost all cranial nerves without either sensory or motor long-tract disturbances or intracranial hypertension and can be caused by malignant tumors at the skull base. Only two cases in which lung cancer was detected based on the presence of Garcin syndrome symptoms have been reported. Neither of the patients showed improvements in their neurologic symptoms following chemotherapy or radiation therapy. We herein report the case of a patient with Garcin syndrome due to lung cancer whose neurologic symptoms improved after chemotherapy. Case. A 61-year-old female presented with hoarseness and dysphagia and underwent a neurologic examination. Left IX, X, XI and XII nerve palsies were found, and she was diagnosed with Garcin syndrome. Brain CT showed a tumor at the left skull base, and chest CT revealed a tumor in the right upper lobe. A biopsy specimen obtained from the left skull tumor demonstrated bone metastasis of small cell lung cancer. The patient received chemotherapy with carboplatin+etoposide starting in September 2011, and her hoarseness and dysphagia improved after the first course of therapy. Chest and brain CT also revealed remarkable treatment efficacy. Conclusions. Clinicians should consider the possibility of a tumor at the skull base in patients who demonstrate hemi-multiple cranial nerve dysfunction. This case suggests that when the tumor responds to treatment, it is possible to improve the neurological symptoms caused by the skull base metastasis of lung cancer.
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Toshiya Fujiwara, Hitoshi Nishikawa, Junya Inata, Masashi Kanehara, Ka ...2013 Volume 53 Issue 6 Pages 760-766
Published: 2013
Released on J-STAGE: December 26, 2013
JOURNAL OPEN ACCESSBackground. It is well known that patients undergoing treatment for small cell lung cancer are at a high risk for developing secondary primary tumors. We herein report three resected cases of non-small cell lung cancer that developed following successful treatment for limited-stage small cell lung cancer (LD-SCLC). Case 1. A 63-year-old male received concurrent chemoradiotherapy for LD-SCLC in the middle lobe. He achieved a clinical complete response (CR) and underwent prophylactic cranial irradiation (PCI); he showed no signs of recurrence for five years. On an annual follow-up examination, chest computed tomography (CT) revealed a solid nodule in the left lower lobe. We performed left basal segmentectomy. A histopathological examination of the resected specimen revealed stage IA squamous cell carcinoma. Case 2. An 81-year-old male underwent right lower lobectomy for poorly differentiated carcinoma. He received adjuvant chemotherapy based on a final pathological diagnosis of LD-SCLC. Fifteen years later, chest CT revealed mixed ground glass nodules in the left upper lobe during follow-up for another disease. He underwent left upper segmentectomy. The histopathological diagnosis revealed stage IB multiple adenocarcinoma. Case 3. A 60-year-old woman received chemotherapy and sequential radiotherapy for LD-SCLC in the bronchus intermedius. She achieved a clinical CR and underwent PCI. Eight years later, CT revealed a pulmonary nodule in the right lower lobe. Positron emission tomography demonstrated uptake of fluorodeoxyglucose in the subcarinal lymph node. She underwent right lower lobectomy and was diagnosed with stage IIIA adenocarcinoma. All subjects were in good health, with no episodes of recurrence. Conclusions. Providing careful follow-up is necessary in order to detect second malignancies in patients with small cell lung cancer who survive for longer periods.
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Daisuke Saito, Makoto Oda, Taro Yamato, Tetsuya Imai, Yasuhiko Tatsuza ...2013 Volume 53 Issue 6 Pages 767-770
Published: 2013
Released on J-STAGE: December 26, 2013
JOURNAL OPEN ACCESSBackground. Liposarcoma originating in the thoracic cavity is uncommon. Case. A 70-year-old male presented at our hospital with general malaise and a slight fever. Chest radiography revealed a large tumor in the mediastinum. Computed tomography (CT) showed a mass measuring 13 cm in diameter in the anterior mediastinum. A CT-guided needle biopsy of the anterior mediastinal mass was performed. An examination revealed that the tumor was characterized pathologically by the presence of non-epithelial spindle cells, indicating a sarcoma. The tumor rapidly enlarged over the following month. Surgery was planned, and tumor extirpation was performed with a hemi-clamshell incision (upper median sternotomy and left fourth intercostal thoracotomy). The tumor was found to be smoothly-shaped, and covered by a fibrous capsule and appeared to have originated from the anterior mediastinum. It had not invaded the surrounding structures, such as the lungs and large vessels. An immunostaining revealed dedifferentiated liposarcoma. Six months after surgery, the patient experienced recurrence of the liposarcoma with pleural dissemination. Conclusions. Dedifferentiated liposarcoma is associated with a poor prognosis and carries a high risk of local recurrence and distant metastasis. Patients diagnosed with this tumor should be closely followed to identify any new lesions at an early stage.
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Hajime Fujimoto, Naoki Furuhashi, Katsutoshi Adachi, Hidenori Ibata, T ...2013 Volume 53 Issue 6 Pages 771-777
Published: 2013
Released on J-STAGE: December 26, 2013
JOURNAL OPEN ACCESSBackground. Pleomorphic carcinoma is considered to be a histologic subset of lung cancer in the revised classification proposed by the WHO in 1999. Although treated as non-small cell lung cancer, the effects are usually limited and the prognosis is poor. On the other hand, metastasis of the palatine tonsils is very rare and considered to be a poor prognostic factor. We experienced a case of pleomorphic carcinoma with tonsillar metastasis that was very effectively treated with S-1 after chemoradiation therapy. Case. A 63-year-old male with an abnormal chest X-ray film shadow visited a general physician and was found to have a chest tumor that was diagnosed as non-small cell lung cancer on a needle biopsy. The patient was referred to our hospital where he underwent resection of the left upper lobe. A pathological examination revealed a histological tumor diagnosis of pleomorphic carcinoma, T2N0M0, stage IB. Tumor recurrence in the left tonsil occurred during uracil-tegafur (UFT) adjuvant chemotherapy, and we administered intravenous chemotherapy consisting of carboplatin and paclitaxel with concurrent radiotherapy; however, the treatment failed to shrink the tumor. Consequently, the patient received oral S-1 therapy, and the tumor disappeared seven months later. He has exhibited progression-free survival for four years and six months on S-1 therapy. Conclusions. In the present case, S-1 therapy achieved a long-term antitumor effect on chemoradiation-refractory pleomorphic carcinoma with tonsillar metastasis. Additional cases are needed to confirm the efficacy of S-1 in patients with pleomorphic carcinoma.
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Yuko Katayama, Toshikatsu Sado, Hiroko Fukata, Yukimasa Hatachi, Hideo ...2013 Volume 53 Issue 6 Pages 778-781
Published: 2013
Released on J-STAGE: December 26, 2013
JOURNAL OPEN ACCESSBackground. The standard chemotherapy regimen for adenoid cystic carcinoma of the lungs has not yet been established, and treatment with pemetrexed has not been previously reported. Case. A 70-year-old female complaining of a cough lasting over six months was admitted to our hospital. She underwent right pneumonectomy and was diagnosed with adenoid cystic carcinoma of the lungs. Twenty-two months after surgery, she exhibited recurrence of the disease. After four cycles of combination chemotherapy with pemetrexed and cisplatin followed by three cycles of maintenance chemotherapy with pemetrexed, the recurrent lesions remarkably diminished. She has been followed up at our outpatient clinic and thus far has shown no recurrence of the disease. Conclusions. Pemetrexed is a possible therapeutic option for treating adenoid cystic carcinoma of the lungs.
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Makoto Nagamata, Yusuke Okuma, Yukio Hosomi, Tsunekazu Hishima, Tatsur ...2013 Volume 53 Issue 6 Pages 782-786
Published: 2013
Released on J-STAGE: December 26, 2013
JOURNAL OPEN ACCESSBackground. Although several guidelines recommend first-line treatment with crizotinib for echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase (EML4-ALK)-positive lung cancer, there have been few reports of the use of first-line treatment with crizotinib in elderly patients or patients with a poor performance status. Case. A 77-year-old female presented with left femoral pain. Magnetic resonance imaging (MRI) of the pelvis and lower bone showed a left femoral mass. Bronchofiberscopy was performed, and the patient was subsequently diagnosed with adenocarcinoma in the lower lobe of the right lung. Immunohistochemical staining and fluorescence in situ hybridization revealed that the tumor was harboring the EML4-ALK fusion oncogene. The patient was elderly and had a poor performance status (PS 3); therefore, the administration of cytotoxic chemotherapy was inappropriate, and crizotinib was chosen as the first-line chemotherapy. The dose of crizotinib had to be reduced from 250 mg twice daily to 200 mg twice daily with five days on/two days off each week due to nausea and prolonged QT syndrome. The crizotinib treatment led to a tumor response and an improvement in the patient's performance status, which has been sustained. Conclusions. In the present case, crizotinib demonstrated effectiveness and tolerability in an elderly patient with EML4-ALK-positive lung cancer and a poor performance status.
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Hidehisa Hoshino, Aki Ishikawa, Hidekazu Matsushima, Akiko Adachi, Chi ...2013 Volume 53 Issue 6 Pages 787-792
Published: 2013
Released on J-STAGE: December 26, 2013
JOURNAL OPEN ACCESSBackground. Inflammatory myofibroblastic tumor (IMT) is a rare pulmonary tumor, accounting for only 0.04-1% of all lung tumors, that exhibits the characteristics of myofibroblast proliferation with infiltration of inflammatory cells, such as lymphocytes and plasma cells. Case. A 63-year-old male was referred to our hospital because chest computed tomography performed as a detailed examination for hemoptysis revealed a nodule in the S1+2 of the left upper lobe. Bronchoscopy showed a polypoid lesion in the left B1+2b. A definitive diagnosis was not obtained from transbronchial biopsies. Because positron emission tomography (PET) demonstrated an abnormal uptake in the nodule with an SUVmax of 13.61, suggestive of a malignant lung tumor, we performed video-assisted thoracoscopic left upper lobectomy with lymph node dissection (ND2a). Histologically, the tumor was diagnosed as IMT, having the characteristics of spindle cell proliferation with an infiltration of lymphocytes and plasma cells, and also showing the tumor cells to be positive for anaplastic lymphoma kinase (ALK). Conclusions. In cases of PET-positive endobronchial tumors, physicians should consider IMT as a differential diagnosis. In the present case, the results of immunostaining for ALK were useful for making the definitive diagnosis.
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Toshiyuki Sumi, Tetsuya Taya, Kaku Sawada, Hiroki Takahashi2013 Volume 53 Issue 6 Pages 793-798
Published: 2013
Released on J-STAGE: December 26, 2013
JOURNAL OPEN ACCESSBackground. Gefitinib and erlotinib, tyrosine kinase inhibitors (TKI) that target the epidermal growth factor receptor (EGFR), are anti-cancer agents for unresectable non-small cell lung cancer or recurrent lung cancer. There are a few articles that report successful treatment with erlotinib following gefitinib-induced severe hepatotoxicity. Cases. We herein present three patients with non-small cell lung cancer harboring EGFR mutations. These patients were treated with gefitinib therapy and developed grade 3 or higher hepatotoxicity after several weeks. All of the patients were successfully switched to erlotinib, another EGFR-TKI, without hepatotoxicity. Conclusion. When gefitinib causes severe hepatotoxicity, switching to erlotinib is therefore a possible therapeutic option for lung cancer treatment.
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Masatsugu Nakagawa, Masayoshi Teramachi2013 Volume 53 Issue 6 Pages 799-802
Published: 2013
Released on J-STAGE: December 26, 2013
JOURNAL OPEN ACCESSBackground. Complete situs inversus is a congenital, autosomal recessive genetic condition with a prevalence of 1 to 2 in 10,000 people. Case reports of lung cancer in patients with complete situs inversus are rare. Case. A 76-year-old male with complete situs inversus was referred to our hospital due to an abnormal shadow on a chest X-ray. Chest CT revealed a nodule measuring 2.5 cm in diameter in the right lower lobe and complete situs inversus. Because we were unable to obtain a definitive diagnosis using a bronchoscopic approach, video-assisted thoracic surgery (VATS) aspiration cytology was performed under a preoperative diagnosis of suspicious stage IA lung cancer using a bronchial blocker for differential lung ventilation. We used 3D-CT angiography for the preoperative evaluation of the pulmonary arterial system. The intraoperative diagnosis was non-small cell carcinoma; therefore, we performed VATS right lower lobectomy and nodal dissection. The right lung possessed 2 lobes, and the pulmonary arteries and veins corresponded to the usual left-sided pattern. The final diagnosis was poorly differentiated squamous cell carcinoma, pT1bN0M0. Conclusions. Preoperative 3D-CT angiography is useful for evaluating the pulmonary arterial system and safely performing surgery for complete situs inversus. Bronchial blockers are useful for administering differential lung ventilation in patients with complete situs inversus.
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Tomotaka Nishizawa, Takuma Yokoyama, Saori Takata, Hiroaki Shimoyamada ...2013 Volume 53 Issue 6 Pages 803-808
Published: 2013
Released on J-STAGE: December 26, 2013
JOURNAL OPEN ACCESSBackground. This report describes a case of primary lung carcinoma that initially presented as a pineal region tumor, an extremely rare region for metastasis. Case. A 68-year-old female was found to have headache, vomiting and consciousness disturbance, and a pineal region tumor was discovered on brain CT. Systematic investigations showed an abnormal lung tumor on chest imaging. We performed endoscopic third ventriculostomy and a biopsy in order to make a definitive diagnosis and provide symptomatic treatment. A histological examination revealed the tumor to consist of dysplastic cells with scanty cytoplasm. Based on the findings of immunostaining, we made a final diagnosis of small cell lung carcinoma metastasis presenting as a pineal region tumor. We administered chemotherapy and radiation therapy, with a marked improvement in the pulmonary and intracranial lesions. Conclusions. We herein present an extremely rare case of small cell lung carcinoma metastasis presenting as a pineal region tumor.
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Nobuyasu Awano, Keisuke Kondoh, Tsunehiro Andoh, Soichiro Ikushima, To ...2013 Volume 53 Issue 6 Pages 809-814
Published: 2013
Released on J-STAGE: December 26, 2013
JOURNAL OPEN ACCESSBackground. Gastrointestinal necrosis and perforation rarely occur in patients with lung carcinoma. Case. The causes of necrosis and perforation in our cases were variegated, including small intestinal metastasis, amebic dysentery and non-occlusive mesenteric infarction. Conclusions. We experienced three cases of gastrointestinal necrosis and perforation resulting from various causes during the treatment of lung carcinoma. The prognosis of this condition is poor, sometimes resulting in death; therefore, assessing such patients while keeping various potential causes in mind is important.
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Short Reports
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Mitsuru Yoshino, Eitetsu Koh, Sayuri Tsubomizu, Mizue Hasegawa, Hideki ...2013 Volume 53 Issue 6 Pages 815-816
Published: 2013
Released on J-STAGE: December 26, 2013
JOURNAL OPEN ACCESS -
A Case of Ciliated Muconodular Papillary Tumor of the Peripheral Lung Originating in Left Lower LobeYoshihiro Ishikawa, Youichi Kameda, Michihiko Tajiri, Takahiro Omori, ...2013 Volume 53 Issue 6 Pages 817-818
Published: 2013
Released on J-STAGE: December 26, 2013
JOURNAL OPEN ACCESS
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