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Volume 55, Issue 1
Displaying 1-12 of 12 articles from this issue
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Original Article
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Hajime Kikuchi, Hajime Asahina, Jun Sakakibara-Konishi, Naofumi Shinag ...2015 Volume 55 Issue 1 Pages 2-8
Published: February 20, 2015
Released on J-STAGE: April 10, 2015
JOURNAL OPEN ACCESSObjective. We reviewed the clinical outcomes of patients with malignant pleural mesothelioma (MPM) treated at our institution. Methods. We conducted a retrospective analysis of 27 patients with MPM treated at our institution in the period from April 2005 to April 2013. Results. The patient characteristics were as follows: male/female=26/1; age=35-76 years (median, 62); histology: epithelioid/biphasic/sarcomatoid=23/2/2; location, right/left=14/13; clinical stage (IMIG) IA/IB/II/III/IV=3/5/4/9/6. The initial treatment was surgery/chemotherapy/best supportive care in 15/11/1 cases, including 14 patients treated with extrapleural pneumonectomy (EPP) and one patient treated with tumor resection. After EPP, three patients received adjuvant chemotherapy, five received hemithoracic radiotherapy (H-RT) and two received both. The median survival time (MST) of all patients was 21.8 months overall, compared to 30.7 months in the patients who received EPP. The patients who received H-RT after EPP demonstrated a significantly longer MST than those who did not (37.3 months vs. 12.0 months; p=0.04). Conclusions. The use of H-RT after EPP is associated with a better prognosis.View full abstractDownload PDF (467K)
Case Reports
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Shin Tanaka, Tsuyoshi Ueno, Hiroshi Suehisa, Shigeki Sawada, Daijirou ...2015 Volume 55 Issue 1 Pages 9-13
Published: February 20, 2015
Released on J-STAGE: April 10, 2015
JOURNAL OPEN ACCESSBackground. The development of radiation-induced cancer is sometimes a problem in cases of long-term survival after radiotherapy. Case. A 59-year-old man with an abnormal shadow on a chest X-ray was admitted to our hospital in 2005, at which time he was diagnosed with squamous cell carcinoma on a further examination (cT2aN2M0, stage IIIA). He was subsequently treated with two courses of chemotherapy (mitomycin, vindesine and cisplatin) and concurrent radiotherapy (60 Gy/30 Fr) and achieved a complete response, with no recurrence for eight years. A follow-up chest X-ray and CT scan revealed a new tumor in the right upper lobe. Under a diagnosis of second primary lung cancer, we performed right upper lobectomy, which showed the tumor to consist of both small and large cell cancer. Since the second tumor received a different histological diagnosis and appeared within the irradiated field of the initial tumor treated eight years previously, we suspected radiation-induced cancer. The patient was therefore treated with four courses of postoperative adjuvant chemotherapy (cisplatin+irinotecan) and has since been free of recurrence for one year. Conclusions. Radiation-induced cancer has a long incubation period. Therefore, careful observation is required after definitive radiation therapy in long-term survivors.View full abstractDownload PDF (703K) -
Shunsuke Ito, Ken Tashiro, Masako Hoshino, Tsutomu Fukuda, Atsushi San ...2015 Volume 55 Issue 1 Pages 14-19
Published: February 20, 2015
Released on J-STAGE: April 10, 2015
JOURNAL OPEN ACCESSBackground. Although distant metastasis of malignant mesothelioma is considered to be rare, there have been sporadic reports in recent years of cases involving metastasis to other organs. In general, distant metastasis of malignant tumors in the skeletal muscle is rare, and there are no reports in Japan of malignant mesothelioma having metastasized to the skeletal muscle. In this paper, we report a case in which metastasis to the gluteus maximus muscle was confirmed. Case. We herein report the case of a 77-year-old male who, in July 2012, was referred to our hospital for left-sided pleural effusion. In August, he underwent a pleuroscopic pleural biopsy, which revealed epithelial malignant pleural mesothelioma (classified as stage IB: AJCC/UICC). Since the patient was of advanced age, he did not wish to undergo extrapleural pneumonectomy and instead primarily received chemotherapy alone with follow-up as an outpatient. He became aware of a mass in the left hip around the time of March 2014, and swelling of the left gluteus maximus muscle was confirmed on CT performed in July 2014. A muscle biopsy led to a diagnosis of malignant mesothelioma with metastasis to the gluteus maximus muscle. Conclusion. We herein reported a case of metastasis of malignant pleural mesothelioma to the left gluteus maximus muscle. Although this disease is extremely rare, it is important to actively biopsy such lesions and take into consideration the possibility of skeletal muscle metastasis in the differential diagnosis. Moreover, it is likely that, in the present case, radiotherapy effectively improved the patient's quality of life.View full abstractDownload PDF (1033K) -
Takahisa Koizumi, Hirohiko Shinohara, Tadashi Aoki, Katsuo Yoshiya, Yu ...2015 Volume 55 Issue 1 Pages 20-23
Published: February 20, 2015
Released on J-STAGE: April 10, 2015
JOURNAL OPEN ACCESSBackground. Surgical treatment for pneumonic-type adenocarcinoma of the lung is rare. Case. A 69-year-old woman presented mainly with expectorated sputum and received treatment for pneumonia; however, her condition was not alleviated. Pulmonary cancer was suspected, and the patient was referred to our hospital. Four months after manifestation of symptoms, the patient was diagnosed with cT4N0M0 stage IIIA pneumonic-type adenocarcinoma of the lung. Because sputum expectoration was significant and her performance status (PS) was poor, treatment with anticancer drugs was withheld. Although low pulmonary function was present, imaging revealed localization of the lesion to the left lung, for which pneumonectomy of the left lung was performed. The postoperative course was promising, with sputum expectoration resolving rapidly and PS improving markedly. Three months after surgery, metastasis was observed in the right lung. However, her PS was favorable, and therefore, treatment with anticancer drugs was initiated. Conclusion. Pneumonectomy of the left lung was performed for resection of a pneumonic-type adenocarcinoma of the lung causing poor lung function and PS, resulting in rapid resolution of the symptoms. Although recurrence occurred at an early stage, improvement in PS enabled treatment with anticancer drugs.View full abstractDownload PDF (363K) -
Ayano Nakazono, Haruhiro Saito, Tomoyuki Yokose, Kouzo Yamada2015 Volume 55 Issue 1 Pages 24-29
Published: February 20, 2015
Released on J-STAGE: April 10, 2015
JOURNAL OPEN ACCESSBackground. Gastric metastasis of primary lung cancer is relatively rare. However, reports of this condition have increased in recent years. Gastric metastatic lesions have the potential to influence the course of treatment and quality of life. Hence, physicians must appropriately examine the treatment options on a case-by-case basis. Case Study. A 65-year-old male diagnosed with adenocarcinoma of the right superior lobe underwent resection of the right superior lobe. One year and four months after the surgery, he was diagnosed with a gastric metastatic tumor related to lung carcinoma. He was started on systemic chemotherapy and subsequently suffered from gastric perforation twice during the course of treatment. The first perforation was treated non-surgically, while the second was treated surgically. Conclusion. In Japan, there are approximately 30 previous reports of cases of comorbid gastric metastasis in which the patient underwent surgery. Among these cases, almost all of the patients exhibited severe clinical symptoms. Identifying asymptomatic cases and determining the timing and indications for surgery for metastatic lesions are difficult problems that must be discussed adequately.View full abstractDownload PDF (1261K) -
Masaru Nishitsuji, Mayuko Tani, Hiroki Matsuoka, Noriyuki Okura, Tomoy ...2015 Volume 55 Issue 1 Pages 30-35
Published: February 20, 2015
Released on J-STAGE: April 10, 2015
JOURNAL OPEN ACCESSBackground. Pulmonary pleomorphic carcinoma is a rare sarcomatoid carcinoma known to be refractory to treatment. Case. A 69-year-old male was admitted with severe dyspnea and stridor exhibiting sudden onset. He had undergone right lower lobectomy for pulmonary pleomorphic carcinoma two years previously. Chest computed tomography performed on the current admission revealed a tracheal tumor, and we removed the mass with a high-frequency electrosurgical snare. A pathological examination showed metastasis of the pulmonary pleomorphic carcinoma, and radiation therapy was added. However, the tumor relapsed 10 and 12 months after the first bronchoscopic resection procedure, and endoscopic resection was repeated. Conclusions. Endoscopic electrosurgery with a high-frequency snare is safe and useful for tracheobronchial tumors.View full abstractDownload PDF (1137K) -
Takuma Kanzaki, Yasuhiro Yoshii, Kazuma Sekine, Naoko Harada, Kohichi ...2015 Volume 55 Issue 1 Pages 36-41
Published: February 20, 2015
Released on J-STAGE: April 10, 2015
JOURNAL OPEN ACCESSBackground. Paraneoplastic neurological syndrome (PNS) is mostly associated with small cell lung cancer and rarely associated with squamous cell lung cancer. We experienced a rare case of PNS with squamous cell lung cancer. Case. A 60-year-old male visited the neurological department in January 2011 due to numbness in the hands and feet. Since he was found to have lung cancer, he was suspected of having PNS and subsequently referred to our hospital for chemotherapy and a neurological evaluation. Histopathological studies revealed squamous cell lung cancer. Although the size of the tumor decreased after two courses of chemotherapy with docetaxel and carboplatin, the patient developed pneumonia before the third course of chemotherapy. Since the neurological symptoms worsened, as the tumor was growing, and an anti-Hu antibody test turned positive, he was treated with seven courses of plasmapheresis. Despite this therapy, the neurological symptoms did not improve, and he died due to progression of lung cancer. An autopsy revealed demyelination of the posterior funiculus and neuronal loss in the dorsal horn of the spinal cord. Conclusions. Although rare, squamous cell lung cancer may cause PNS. In cases with a possibility of PNS, it is necessary to diagnose the disease precisely and start anti-cancer treatment and immunotherapy as soon as possible.View full abstractDownload PDF (1023K) -
Akira Kameyama, Takashi Iwazawa, Kiyonori Nishioka, Shiro Adachi, Ken ...2015 Volume 55 Issue 1 Pages 42-47
Published: February 20, 2015
Released on J-STAGE: April 10, 2015
JOURNAL OPEN ACCESSBackground. Thymomas usually grow slowly, and recurrence is often diagnosed several years after resection. We encountered a case of recurrent thymoma that showed rapid progression within four months after the first operation. Case. A woman in her 70s underwent resection of a thymoma together with a part of the pericardium and left lung in July 2011. The histological diagnosis was type B3 according to the WHO classification and stage III thymoma according to the Masaoka classification. Four months after the first operation, chest XP showed a mass measuring 60 mm in diameter in the left middle lung field. As the mass did not shrink over the initial six months after the operation, PET-CT and aspiration needle cytology were performed, and the mass was diagnosed as recurrent thymoma. We performed reoperation eight months after the initial surgery. The tumor showed adhesion to the chest wall and a portion of the left lung; therefore, we resected it in addition to the 6-9th ribs of the left back and the inferior lobe of the left lung simultaneously. The pathological findings of the resected specimen of the second operation also showed type B3 thymoma. The thymoma did not directly invade the ribs or lung, although there was solo lung metastasis. The patient did not receive adjuvant therapy, such as chemotherapy or radiation, and survived for two years after the operation, without any signs of tumor recurrence. Conclusions. We experienced a rare case of recurrent thymoma displaying rapid progression after resection. This case is considered to be valuable for discussing the mechanisms underlying the recurrence and progression of thymoma.View full abstractDownload PDF (926K) -
Hitoshi Oonuma, Jin-ichi Kato, Kazuyuki Oyama, Ritsuko Kawahara, Kunih ...2015 Volume 55 Issue 1 Pages 48-52
Published: February 20, 2015
Released on J-STAGE: April 10, 2015
JOURNAL OPEN ACCESSBackground. Crizotinib, an anaplastic lymphoma kinase (ALK) inhibitor used to treat ALK-positive lung adenocarcinoma, has been shown to cause hepatic dysfunction; however, the appropriate treatment for crizotinib-induced hepatic injury has not yet been established. Case. We describe a case involving a 68-year-old woman with lung adenocarcinoma (cT4N3M1b, brain metastasis). After treatment for the brain metastasis, she was prescribed 500 mg/day of crizotinib. A drug eruption and elevation of the serum hepatic enzyme levels (aspartate transaminase [AST] 44 IU/l, alanine transaminase [ALT] 43 IU/l) and peripheral blood eosinophil ratio (7.0%) were noted on day 13 after beginning crizotinib treatment. On day 21, crizotinib was discontinued due to deterioration of the patient's hepatic function (AST 134 IU/l, ALT 207 IU/l). Four days later, she presented with a fever, worsening of the drug eruption and aggravation of the hepatic injury (AST 1823 IU/l, ALT 2756 IU/l), suggesting drug-induced, allergy-mediated liver injury. Subsequently, 250 mg/day of methylprednisolone was administered intravenously for three days, and her symptoms and the hepatic injury rapidly improved. Conclusions. Corticosteroids represent a promising treatment for crizotinib-related, allergy-mediated liver injury. Because crizotinib is a key drug for treating ALK-positive lung adenocarcinoma, further studies are needed to establish the most appropriate management strategy for crizotinib-induced liver injury.View full abstractDownload PDF (468K) -
Takeshi Uenami, Fumitaka Ageshio, Hideki Matsui, Akitoshi Satomi, Tsut ...2015 Volume 55 Issue 1 Pages 53-58
Published: February 20, 2015
Released on J-STAGE: April 10, 2015
JOURNAL OPEN ACCESSBackground. Crizotinib is an ALK-inhibitor with a promising anti-tumor activity in patients with ALK-rearranged non-small cell lung cancer; however, severe liver dysfunction is a well-known complication of treatment with this drug. Case. A 70-year-old female with ALK-rearranged squamous cell lung cancer was treated with crizotinib as a first-line chemotherapy. Severe liver dysfunction occurred one month after treatment initiation, and the administration of crizotinib was therefore interrupted. Three weeks later, therapy with a half-dose of crizotinib was restarted, which enabled continuous administration. Nine months later, the dose of crizotinib was discontinued due to tumor progression. The administration of alectinib as a second-line chemotherapy successfully induced tumor regression without causing liver dysfunction. Conclusions. The onset of liver dysfunction caused by crizotinib may be resolved with the use of drug holidays and dose reduction and/or switching to alectinib.View full abstractDownload PDF (757K) -
Yuka Kadomatsu, Kiyoshi Nakashima, Harushi Ueno, Toshiki Okasaka, Shoi ...2015 Volume 55 Issue 1 Pages 59-64
Published: February 20, 2015
Released on J-STAGE: April 10, 2015
JOURNAL OPEN ACCESSBackground. We herein report a case of micronodular thymic carcinoma with lymphoid stroma. Case. The patient was a 45-year-old woman who was being followed up for an anterior mediastinal nodule, which had increased in size from 14 mm to 18 mm over four years. The tumor showed no accumulation on a positron emission tomography scan. With a suspected diagnosis of thymoma, video-assisted partial thymectomy was performed. The tumor was yellowish-white and histologically composed of epithelial tumor cells arranged in a micronodular growth pattern. The tumor also displayed florid lymphoid hyperplasia with lymph follicles in the stroma. The histological findings revealed a superficial resemblance to micronodular thymoma with lymphoid stroma. The tumor cells, however, displayed large hyperchromatic nuclei, prominent nucleoli and anisokaryosis and were positive for CD5, bcl-2, c-kit, CK5/6 and p40. The lymphoid stroma was mainly composed of CD20-positive B-lymphocytes, and the germinal center was negative for the bcl-2 expression. The lymphocytes inside the tumor were negative for TdT. We therefore considered the lymphoid stroma to be reactive follicular hyperplasia. Overall, we recognized the tumor to be micronodular thymic carcinoma. Conclusions. To our knowledge, cases of micronodular thymic carcinoma with lymphoid stroma have not been previously reported in our country and this lesion has not been addressed by the General Rules for the Study of Mediastinal Tumors. This case report raises awareness regarding the possibility of micronodular thymic carcinoma with lymphoid stroma.View full abstractDownload PDF (1881K)
Proceedings of Regional Scientific Meetings
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2015 Volume 55 Issue 1 Pages 65-80
Published: February 20, 2015
Released on J-STAGE: April 10, 2015
JOURNAL OPEN ACCESSDownload PDF (740K)
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