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Volume 55, Issue 3
Displaying 1-7 of 7 articles from this issue
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Case Reports
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Atsushi Kitamura, Hiroshi Nakaoka, Kohei Okafuji, Torahiko Jinta, Naok ...2015 Volume 55 Issue 3 Pages 151-154
Published: June 20, 2015
Released on J-STAGE: July 24, 2015
JOURNAL OPEN ACCESSBackground. Myxofibrosarcoma is a relatively rare soft tissue tumor appearing most commonly on the limbs of elderly patients. There are limited reports about its pleural metastasis. Case. An 86-year-old male with a past history of myxofibrosarcoma in the left scapular region visited our department with a chief complaint of dyspnea. A plain chest X-ray showed right pleural effusion and a chest computed tomography (CT) scan revealed pleural tumors with effusion. After admission to hospital, with a cytological analysis of the pleural aspirate, which proved inconclusive, we performed thoracoscopy under local anesthesia, which revealed red pleural nodules. A histopathological examination confirmed that the nodules were composed of metastatic myxofibrosarcoma. Conclusion. When pleural effusion cytology is inconclusive in a patient with a past history of myxofibrosarcoma, thoracoscopy under local anesthesia can be useful for the diagnosis of pleural metastasis.View full abstractDownload PDF (768K) -
Toru Hiura, Yu Saida, Kenichi Koyama, Tetsuya Abe, Hiroshi Tanaka, Aki ...2015 Volume 55 Issue 3 Pages 155-160
Published: June 20, 2015
Released on J-STAGE: July 24, 2015
JOURNAL OPEN ACCESSBackground. The transformation of lung adenocarcinoma by an epidermal growth factor receptor (EGFR)-activating mutation to small-cell lung cancer (SCLC) is one of the resistance mechanisms for EGFR-tyrosine kinase inhibitor (TKI) therapy. Standard chemotherapy for SCLC may prove effective in such cases. Case. A 47-year-old woman, who had never smoked, was admitted to our hospital because of an abnormal shadow observed in a chest X-ray that was taken in 2010. A left upper lobectomy and lymph node dissection were performed in April 2010, and the postoperative definitive diagnosis was of lung adenocarcinoma (pT2aN2M0, stage IIIA). Since the tumor on the left pleura had increased in size by 2012, gefitinib therapy was initiated. Gefitinib was initially effective, however, the volume of the pleural effusion and the size of the left pleural mass rapidly increased, and the tumor marker level of neuron-specific enolase (NSE) was found to be elevated in 2013. The cytological diagnosis of SCLC was confirmed from the pleural effusion specimens. Chemotherapy with carboplatin+etoposide (CBDCA+ETP) was effective, however, after 6 cycles, the mass on the left pleura continued to increase in size, and the tumor marker level of carcinoembryonic antigen (CEA) became elevated. A re-challenge with gefitinib was effective, however, the mass on the pleura became enlarged after 6 months. The mass on the left pleura was diagnosed as SCLC with an EGFR-activating mutation by CT-guided needle biopsy. Conclusion. Physicians should consider the possible transformation of non-small-cell lung cancer to SCLC after patients acquire resistance to EGFR-TKI therapy.View full abstractDownload PDF (1062K) -
Yoshinari Matsuda, Masahiro Kitada, Satoshi Hayashi, Kei Ishibashi, Sh ...2015 Volume 55 Issue 3 Pages 161-165
Published: June 20, 2015
Released on J-STAGE: July 24, 2015
JOURNAL OPEN ACCESSBackground. Hepatoid adenocarcinoma of the lung is a α-fetoprotein-producing lung cancer and a rare disease with a hepatocellular carcinoma-like tissue form. Case. We herein report the case of a 75-year-old man with a α-fetoprotein-producing cancer diagnosed as hepatoid adenocarcinoma of the lung. The patient was referred to our hospital for an investigation of an abnormal shadow in the left lung found on CT of the chest at a group medical examination. He was subsequently diagnosed with primary lung cancer based on an investigation in the respiratory internal medicine department, at which time left lower lobectomy with mediastinal lymph node dissection was performed under thoracoscopic assistance. The histopathological morphology of the resected tumor tissue was similar to that of hepatocellular carcinoma, and the tumor was immunohistochemically positive for α-fetoprotein. Therefore, we diagnosed the α-fetoprotein-producing lung cancer as hepatoid adenocarcinoma of the lung. The patient's postoperative course was uneventful. Although the serum α-fetoprotein level immediately after the operation was abnormally high, it returned to the normal range approximately two months after the surgery. The patient is currently doing well without any signs of recurrence. Conclusions. As the prognosis of hepatoid adenocarcinoma of the lung is poor, long-term follow-up while carefully monitoring the serum α-fetoprotein levels and utilizing various imaging modalities is essential after surgery.View full abstractDownload PDF (877K) -
Asuka Okada, Takahiko Kanokogi, Shinsuke Murakami, Hideaki Takenaka, S ...2015 Volume 55 Issue 3 Pages 166-170
Published: June 20, 2015
Released on J-STAGE: July 24, 2015
JOURNAL OPEN ACCESSBackground. It has been reported that mucinous adenocarcinomas frequently exhibit KRAS mutations or anaplastic lymphoma kinase (ALK) rearrangements. Rarely do mucinous adenocarcinomas exhibit EGFR mutations. We herein present such a case. Case. A 62-year-old woman was admitted to our hospital because of cough and dyspnea on exertion. Chest X-ray revealed dense consolidation on right middle lung field, and multiple nodules in both lungs, predominantly upper lobes. Imaging and histological examinations showed EGFR-mutant mucinous adenocarcinoma cT4N3M1b (bilateral lung metastases, right pleural effusion, and multiple bone metastases). Gefitinib was administered. Gefitinib showed partial response (RECIST v1.1), but pleuritis and pericarditis carcinomatosa appeared approximately 4 months after gefitinib administration. She died of respiratory failure 198 days after gefitinib administration. Conclusion. We experienced a rare case of EGFR-mutant mucinous adenocarcinoma poorly responding to gefitinib. No definite conclusions can be drawn about the relationship between gefitinib's limited efficacy and the immuno-histological features of this tumor. Perhaps some feature of mucinous adenocarcinoma prevented gefitinib from exerting its usual efficacy, and more studies evaluating the pharmacokinetics are required at this time.View full abstractDownload PDF (740K) -
Shin Tanaka, Tsuyoshi Ueno, Hiroshi Suehisa, Shigeki Sawada, Toshiyuki ...2015 Volume 55 Issue 3 Pages 171-175
Published: June 20, 2015
Released on J-STAGE: July 24, 2015
JOURNAL OPEN ACCESSBackground. Recently, long-term surviving patients with small cell lung cancer have been increasing owing to improvements in combined modality therapy. Subsequently, however, an increasing number of second primary malignancy cases have been reported. Case. A 77-year-old man with an abnormal shadow on chest X-rays was referred to our hospital. Further examination revealed that he had small cell lung cancer (cT1aN3M0, Stage IIIB). The patient received four courses of chemotherapy (cisplatin and etoposide) and concurrent radiotherapy (46 Gy). After 11 years without any recurrence since starting the chemoradiotherapy, he complained of productive cough and back pain. CT scans and a transbronchial lung biopsy revealed new tumors in the right upper lobe (cT2aN0M0, cStage IB), left upper lobe (cT1aN0M0, cStage IA) and larynx (cT1N0M0, cStage IA). With a diagnosis of second primary lung cancers, we first of all performed a right upper lobectomy (pT4N0M0, Stage IIIA). Due to the patient's postoperative deterioration of his pulmonary function, the left lung and laryngeal cancers were treated with radiotherapy (66 Gy each). Conclusion. We reviewed the therapeutic strategy followed for the present case by referring to previous case reports, and suggest further improvements to be made when treating such cases.View full abstractDownload PDF (586K) -
A Suspected Case of Pulmonary Pleomorphic Carcinoma Diagnosed by Resected Small Intestine MetastasisKyoko Gocho, Kazutoshi Isobe, Hiroshige Shimizu, Satoshi Matsuda, Naob ...2015 Volume 55 Issue 3 Pages 176-182
Published: June 20, 2015
Released on J-STAGE: July 24, 2015
JOURNAL OPEN ACCESSBackground. Pulmonary pleomorphic carcinoma, a rare form of poorly differentiated carcinoma, has sarcomatoid components, including spindle cells and giant cells. Making a definite pathological diagnosis is difficult using transbronchial biopsied specimens. Case. A 73-year-old man was admitted to our hospital with a fever and abdominal pain. Computed tomography showed a mass shadow in the left upper lobe of the lung and multiple masses in the small intestine. A bronchoscopic biopsy of the lung mass revealed poorly differentiated carcinoma. An endoscopic biopsy of the abdominal tumors revealed poorly differentiated carcinoma in the small intestine. Immunostaining confirmed that the lung lesion was the primary cancer site. Because of the high risk of ileus and perforation, partial resection of the small intestine was performed. Surgery revealed three metastases in the small intestine, one of which showed penetration and invasion of the transverse colon and invasion to the urinary bladder and abdominal wall. A histopathological analysis showed that the metastases in the small intestine had sarcomatous components, consisted of spindle cells and giant cells, and poorly differentiated carcinoma cells, which confirmed the diagnosis of pulmonary pleomorphic carcinoma. Conclusion. In this case, it was difficult to diagnose this patient based on a transbronchial tumor biopsy of the primary site alone. Pulmonary pleomorphic carcinoma should be considered in the differential diagnosis in the cases with a persistent antibiotic-resistant fever and gastrointestinal metastasis with an increase in the levels of inflammatory markers. Resection of the metastasis is necessary before the patient develops a severe condition.View full abstractDownload PDF (1289K) -
Emi Umeshita, Osamu Takakuwa, Tetsuya Oguri, Masashi Shimohira, Takehi ...2015 Volume 55 Issue 3 Pages 183-187
Published: June 20, 2015
Released on J-STAGE: July 24, 2015
JOURNAL OPEN ACCESSBackground. Adrenal hemorrhage due to lung cancer metastasis is rare. We experienced a patient who exhibited short-term survival with massive adrenal hemorrhage secondary to lung cancer metastasis. Case. A 68-year-old man with a cough and fatigue was referred to our hospital. Computed tomography (CT) and 18F-fluorodeoxy glucose positron emission tomography (FDG-PET) showed a nodule in the right upper lobe, right-sided pleural effusion, multiple osteolytic bone metastases and metastasis to the bilateral adrenal glands. A cytological examination of the right-sided pleural effusion showed lung adenocarcinoma. Chemotherapy was planned; however, urgent hospitalization became necessary because of subcutaneous hemorrhage around the back of the patient's abdomen on the right side at the level of the waist. He was found to have anemia on blood tests in addition to right adrenal hemorrhage secondary to lung cancer metastasis on CT. He was observed conservatively. Nevertheless, re-bleeding occurred on the 9th day, and embolization was performed. Because the lung cancer progressed rapidly, he chose supportive care and ultimately died 25 days after hospitalization. Conclusions. Adrenal hemorrhage due to lung cancer metastasis is rare. However, physicians must be aware that the prognosis for such cases is very poor.View full abstractDownload PDF (454K)
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