[A case of pulmonary eosinophilic granuloma that remitted after cessation of smoking].

A 43-year-old man was admitted to our hospital because of productive cough and an abnormal chest radiograph. He had smoked one pack of cigarettes per day for 23 years. Chest radiograph on admission showed diffuse reticulo-linear infiltrates, most prominent in both upper lung fields. Chest HRCT scan showed multiple micronodules, cavitated nodules, and thick-walled cysts with ground-glass attenuation. These radiographic findings suggested pulmonary eosinophilic granuloma (PEG). Histological findings of the biopsy specimen obtained from video-assisted thoracoscopy demonstrated granulomatous lesions consisting of S-100 protein-positive Langerhans cells with infiltration of eosinophils and fibrous lesions (starfish-like fibrosis). A definitive diagnosis of PEG was made, and he immediately ceased smoking. The symptoms and radiographic findings markedly improved within 3 months after cessation of smoking. Chest HRCT on the final scan revealed that nodules and almost all cystic lesions vanished. He resumed smoking without any sign of recurrence.

[Outpatient chemotherapy and clinical pathway for non-small cell lung cancer].

We investigated the usefulness of outpatient chemotherapy in 54 cases of non-small cell lung cancer in which outpatient chemotherapy was performed between August 1999 and October 2001. This chemotherapy accounted for 67% of all chemotherapy. Assessment of therapeutic effect revealed a PR in 14 of the 54 cases, and the efficacy rate was 26%. Therapeutic effect according to chemotherapy regimen revealed the highest efficacy rate, 50%, for paclitaxel + CBDCA. The median survival time was 14.7 months, and the 1-year survival rate was 61.1%. On the basis of the above results, a 16-day inpatient clinical pathway using weekly paclitaxel + CBDCA was devised for non-small cell lung cancer. The aim was to shorten the number of inpatient days, standardize treatment, and introduce outpatient chemotherapy. The clinical pathway was introduced in 8 patients with recurrent non-small cell lung cancer between August and October 2002. Variance was found only in one patient whose hospital discharge had to be postponed by two days because of a Grade 3 side effect. Introduction of a clinical pathway with weekly paclitaxel + CBDCA successfully reduced the inpatient days to an average of 16.3 days.

[A case of amylase-producing lung cancer].

A 72-year-old man was admitted to our hospital because of progressive dyspnea due to pulmonary emphysema. Chest CT revealed a nodular lesion in the right S6 and swollen right hilar lymph nodes. The diagnosis was not confirmed bronchoscopically. A subsequent biopsy of a subcutaneous mass in the left lateral pectoral region demonstrated metastatic cancer. Laboratory data on admission showed marked elevation of amylase activity in both serum and urine. Amylase isozyme patterns identified the salivary types. The pancreas and salivary glands were unlikely to have any clinical involvement in the hyperamylasemia, but lung cancer with subcutaneous metastasis was strongly suspected clinically as the source. Chemotherapy failed to prevent tumor progression and the patient eventually died of respiratory failure. Immunohistological examination of the subcutaneous lesion showed positive staining for salivary-type amylase, whereas that of the lung primary lesion disclosed small cell carcinoma and negative staining for amylase. In most cases, amylase-producing lung cancers have been diagnosed as adenocarcinoma. Amylase-producing small cell carcinoma is very rare.

[A case of fibrosing mediastinitis manifesting recurrent nerve palsy].

A 68 year-old man was referred and admitted to our hospital because of hoarseness due to recurrent nerve palsy and an anterior mediastinal tumor detected on chest CT. Chest CT showed a low-density tumor surrounding the aorta and branching arteries. Chest MRI revealed a low-intensity tumor in both T1- and T2-weighted images. The tumor was adjacent to the heart and aorta in the upper anterior mediastinum. A biopsy was performed under minimally invasive video-assisted thoracic surgery (VATS) and a diagnosis of fibrosing mediastinitis was made histopathologically. Oral prednisolone treatment markedly reduced the tumor and improved not only abnormal laboratory data such as C-reactive protein, but also the hoarseness. We report herein that steroid monotherapy was successful in treating a case of fibrosing mediastinitis manifesting recurrent nerve palsy.

[Three cases of metastatic meningeal carcinomatosis from lung cancer].

We report three cases of meningeal carcinomatosis that metastasized from lung cancer. The patients were men of 73, 65 and 77 years old. The histological type was adenocarcinoma in all cases. At the time of emergence of neurological symptoms such as nausea, headache and cataplexy, enhanced CT of the brain did not disclose brain metastasis. Although brain MRI failed to detect abnormal meningeal findings in cases 1 and 2, meningeal carcinomatosis was diagnosed by cerebrospinal fluid cytology in all three cases. As for treatment, in case 1, methotrexate and prednisolone were administered intrathecally, while the optimum supportive care was given in cases 2 and 3. Because it is difficult to detect meningeal carcinomatosis by brain CT and MRI alone, careful neurological observation and cerebrospinal fluid cytology are necessary for its diagnosis.

[A case of adenocarcinoma of the lung with superior vena cava syndrome (SVCS), effectively treated with implantation of intravascular stent and chemotherapy of single agent of docetaxel].

The patient was a 54-year-old woman with adenocarcinoma of the lung (T2N3M1, Stage IV). Although 3 cycles of a combination of gemcitabine (GEM) with vinorelbine (VNR) and one cycle of carboplatin (CBDCA) with weekly paclitaxel (TXL) were administered, the tumor continued to grow with symptomatic progression of superior vena cava syndrome (SVCS). Implantation of an intravascular metallic stent and chemotherapy with the single agent of docetaxel (TXT) were performed. The tumor regressed and symptomatic improvement was achieved. TXT seems to be a promising drug as a second-line chemotherapy for NSCLC.