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Volume 54 (2014)
- Issue 7 Pages 879-
- Issue 6 Pages 761-
- Issue 4 Pages 173-
- Issue 3 Pages 121-
- Issue 2 Pages 41-
- Issue 1 Pages 1-
Volume 54, Issue 3
Displaying 1-8 of 8 articles from this issue
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Original Articles
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Ayako Fujiwara, Masahiko Higashiyama, Takashi Kanou, Toshiteru Tokunag ...2014 Volume 54 Issue 3 Pages 121-127
Published: 2014
Released on J-STAGE: July 29, 2014
JOURNAL OPEN ACCESSObjective. To review the diagnostic accuracy and surgical outcomes of solitary solid malignant lung nodules diagnosed as either second primary lung cancer (SPLC) or lung metastasis (LM) detected during follow-up after resection of primary lung cancer. Methods. The subjects included 54 primary lung cancer patients who underwent more than one lung resection procedure and were diagnosed with SPLC or LM between January 1976 and December 2010. We performed a retrospective comparative review of these two groups. Results. There were 35 SPLC patients and 19 LM patients. The background factors, including age and smoking history, were similar between the two groups. In 17 patients (31.5%), there were differences between the preoperative clinical diagnosis and postoperative pathological diagnosis. The median survival time for all patients after the second surgery was 61.9 months. The median survival time was 61.6 months in the LM patients and 60.9 months in the SPLC patients, which was not significantly different (P=0.77). The recurrence rate after the second operation was significantly higher in the LM patients (P=0.007). The most common site of recurrence in the LM patients was the pleural space, with repeat lung metastases being especially common. Conclusions. In the present study, the surgical outcomes of solitary solid malignant lung nodules detected during follow-up after primary lung cancer resection were relatively favorable, with a five-year survival rate of 60.8%. Therefore, such patients are considered to be indicated for surgery. The pattern of recurrence after the second surgeries differed between the SPLC and LM patients; therefore, close follow-up is required.
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Toshiya Inui, Takuma Yokoyama, Saori Takata, Aya Hirata, Tomotaka Nish ...2014 Volume 54 Issue 3 Pages 128-134
Published: 2014
Released on J-STAGE: July 29, 2014
JOURNAL OPEN ACCESSObjective. The objective of this study was to evaluate the efficacy and toxicity of cisplatin plus pemetrexed as a first-line therapy in patients with advanced non-squamous non-small cell lung cancer (NSCLC). Methods. A total of 41 patients (31 males and 10 females) with advanced non-squamous NSCLC who received cisplatin plus pemetrexed as first-line therapy at our department were analyzed retrospectively. Results. The median patient age was 66 (range, 44-78) years. Thirty-nine patients had adenocarcinoma and two had non-squamous NSCLC. Grade 3/4 toxicities included leukopenia (12.2%), neutropenia (34.1%), anemia (7.3%), thrombocytopenia (4.9%), hyponatremia (24.4%), anorexia (22.0%), nausea (9.8%) and vomiting (2.4%). The response rate was 35.3%, and the disease-control rate was 76.5%. The median progression-free survival time was 5.2 months, and the median survival time was 22.1 months. Conclusions. The efficacy of cisplatin plus pemetrexed therapy observed in this study is comparable to that reported in large clinical trials. Because digestive symptoms were frequently observed in the patients in our series, providing management for nausea is important in such patients. Hyponatremia was also a frequent complication in our study population.
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Case Reports
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Takehiko Shimoyama, Tsutomu Kawasaki, Masahiko Tanoue, Bumpei Kimura2014 Volume 54 Issue 3 Pages 135-140
Published: 2014
Released on J-STAGE: July 29, 2014
JOURNAL OPEN ACCESSBackground. Multifocal micronodular pneumocyte hyperplasia (MMPH) and pulmonary lymphangiomyomatosis (LAM) are complications of tuberous sclerosis complex (TSC). We herein report a case of pulmonary adenocarcinoma in a patient with TSC and MMPH, along with a review of the literature. Case. A 69-year-old female who had been diagnosed with TSC at 13 years of age was admitted to our hospital for an abnormal chest shadow, which had initially been noticed when she was 21 years old. Computed tomography showed a tumor shadow with a spicular structure in the right upper lung lobe (S3) and multiple small nodules in the whole lung field. An FDG-PET scan showed fluorodeoxyglucose accumulation in the S3 nodule of interest, but not in other nodules. Because she was diagnosed with lung cancer of stage cT1aN0M0 (IA), we performed an S3 segmentectomy. The specimen was found to be adenocarcinoma. Many micronodules were seen in the remaining specimen, most of which were compatible with MMPH, but several adenocarcinomas with a lepidic pattern were also detected. Currently, three years post-surgery, she has shown no signs of recurrence, but as her serum CEA level has been gradually increasing, so we will continue strict observation. Conclusion. Patients with the TSC gene may be at risk for pulmonary adenocarcinoma. Further studies are needed to determine whether this is the case.
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Hiroyasu Ueno, Aritoshi Hattori, Takamitsu Banno, Kenji Suzuki2014 Volume 54 Issue 3 Pages 141-145
Published: 2014
Released on J-STAGE: July 29, 2014
JOURNAL OPEN ACCESSBackground. Benign emptying of the postpneumonectomy space (BEPS) is considered to be a rare complication following pneumonectomy. BEPS is defined as an asymptomatic status even with a decrease in the fluid level in the postpneumonectomy thoracic space on chest X-ray, which cannot be explained by a bronchopleural fistula (BPF) or postpneumonectomy empyema. Case. An abnormal shadow was pointed out in a female in her 60's on a plain chest roentgenogram. Computerized axial tomography (CAT) revealed a nodule measuring 16 mm in maximum dimension in the left upper lobe, as well as swollen hilar nodes suspected to be metastatic. Because the hilar nodes, which were suspected to be metastatic, invaded the pulmonary artery, left upper lobectomy was technically impossible for complete resection. Therefore, a left pneumonectomy was performed, which revealed pathological adenocarcinoma of the lung with pStage IIA. A month later, adjuvant chemotherapy was administered. Following the first cycle of the chemotherapy, a decrease in the fluid level in the left thoracic cavity was noted on chest X-ray. There was no apparent fistula on bronchoscopy, nor an elevated inflammatory response. Thus, we diagnosed this status as having BEPS, and no additional treatment was administered. The patient remains alive, without any evidence of disease for 1.5 years since the surgery. Conclusion. BEPS is a relatively rare complication after pneumonectomy. Although ruling out a BPF and empyema is important, this rare complication should be taken into consideration following pneumonectomy.
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Hidenori Goto, Hirofumi Uehara, Yuichi Saito, Noriko Motoi, Yuichi Ish ...2014 Volume 54 Issue 3 Pages 146-152
Published: 2014
Released on J-STAGE: July 29, 2014
JOURNAL OPEN ACCESSBackground. There have so far been few case reports of the resection of synchronous multiple lung cancers harboring different mutations involving the epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK). Case 1. A 61-year-old female was pointed out to have an opaque tumor in the left upper lobe (LUL) and a solid tumor in the left lower lobe (LLL) of the lung on CT scans which were taken during a follow-up visit after left breast cancer surgery. She was diagnosed with multiple primary lung cancers: stage IB (cT2aN0M0) in the LUL and stage IA (cT1aN0M0) in the LLL, and underwent left pneumonectomy with lymphadenectomy. The pathological diagnosis was double adenocarcinoma of the left lung. A genetic test revealed that the LUL cancer was positive for an EGFR mutation. By an immunohistochemical (IHC) analysis, the LLL cancer was positive for ALK. Case 2. A 56-year-old female showed an abnormal tumor with opacity in the right upper lobe (RUL) of the lung on CT. The patient was diagnosed to have stage IIIA (cT2aN2M0) pulmonary adenocarcinoma by bronchoscopy. The patient underwent neoadjuvant chemotherapy and subsequent right upper lobectomy with lymphadenectomy. A pathological examination showed double adenocarcinoma of the RUL (S2 and S1). IHC revealed the right S2 cancer to be positive for ALK. On the other hand, the right S1 cancer was positive for an EGFR mutation by a genetic test. Interestingly, a small cluster of ALK-positive cancer cells were detected within the pleural surface of the EGFR-positive tumor by IHC. Conclusions. We herein reported two cases of synchronous multiple lung cancers harboring different mutations in EGFR and ALK. Clinicians should be cognizant of the possibility that patients with multiple lung cancer may harbor different mutations within the different tumors.
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Hitoshi Oonuma, Yuzuru Inoue, Jin-ichi Kato, Kunihiko Seki2014 Volume 54 Issue 3 Pages 153-157
Published: 2014
Released on J-STAGE: July 29, 2014
JOURNAL OPEN ACCESSBackground. Echinoderm microtubule-associated protein-like 4 (EML4)-anaplastic lymphoma kinase (ALK) was recently identified to be a potent fusion oncoprotein. A clinical feature of EML4-ALK-positive lung adenocarcinoma is its early onset. We herein report a case of lung EML4-ALK-positive adenocarcinoma in a very young person who was treated with the ALK inhibitor crizotinib. Case. An 18-year-old female presented with cough and bloody sputum. Computed tomography findings revealed a 9.5-cm mass in the right lower lobe of the lungs with multiple bilateral pulmonary nodules, enlargement of the mediastinum and hilar lymph nodes and bilateral enlargement of the adrenal glands. The pathological diagnosis was poorly differentiated lung adenocarcinoma with signet-ring cells. The patient was positive for the EML4-ALK fusion gene, as identified according to the reverse transcriptase-polymerase chain reaction method. After the patient received treatment with crizotinib as the first-line chemotherapeutic agent, her symptoms and chest radiograph findings improved. Conclusions. This is a rare case of EML4-ALK-positive lung adenocarcinoma in a very young person. Further studies are required to clarify the genetic profile of lung cancer in young people.
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Rinako Yamashita, Meiyo Tamaoka, Reiko Taki, Yasunari Miyazaki, Naohik ...2014 Volume 54 Issue 3 Pages 158-164
Published: 2014
Released on J-STAGE: July 29, 2014
JOURNAL OPEN ACCESSBackground. Primary pericardial malignant mesothelioma is a rare disease with a poor prognosis. Case. A 64-year-old male, a former electrical worker with a history of exposure to asbestos, was found to have a thickened pericardium and pleural effusion in the left lung on a chest X-ray obtained during outpatient treatment for nephrotic syndrome and diagnosed with constrictive pericarditis. He was treated with oral medication, however, he gradually developed dyspnea on effort and hoarseness and was subsequently admitted to our hospital. He ultimately died of rapidly progressive heart failure, and an autopsy confirmed a diagnosis of primary pericardial malignant mesothelioma (epithelioid type). Conclusions. Although making an early diagnosis of pericardial mesothelioma is difficult, physicians must be aware of this disease in cases of constricted pericarditis.
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Proceeding of Regional Scientific Meeting
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2014 Volume 54 Issue 3 Pages 165-172
Published: 2014
Released on J-STAGE: July 29, 2014
JOURNAL OPEN ACCESSDownload PDF (580K)
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