[Postoperatively Diagnosed Pulmonary Actinomycosis;Report of Three Cases].

Three cases of pulmonary actinomycosis have been postoperatively diagnosed in our hospital in the past 3 years. All the cases were preoperatively difficult to differentiate from lung cancer, and all were diagnosed in men. One of the patients was diagnosed on the basis of clinical symptoms, while the other 2 patients were diagnosed during the treatment and follow-up of other diseases. On radiological examination, 2 patients showed mass-like shadows, and the 3rd showed a cavitary lesion; fluorodeoxyglucose (FDG) -positron emission tomography showed high FDG accumulation in all the patients. One of the patients was pathologically suspected with lung cancer on transbronchial lung biopsy. Right upper lobectomy was performed in 2 patients, and right lower lobectomy in 1. One of the patients who underwent right upper lobectomy, also received chest wall resection because of the perioperative finding of chest wall invasion of lung cancer. Clinically, all the cases were preoperatively diagnosed as lung cancer.

Long-term survival with chest wall resection and pulmonary metastasectomy for hepatocellular carcinoma.

A case of rib and pulmonary metastases of hepatocellular carcinoma (HCC) successfully treated with transcatheter arterial embolization (TAE) followed by surgery is reported. A 66-year-old male with a history of HCC treated previously with hepatectomy was admitted to our hospital for examination of a chest wall tumor. Before the admission, TAE targeting the chest wall tumor was performed. TAE followed by surgery for postresection metastases of HCC was performed and provided an excellent result with long-term survival. The combination of TAE plus salvage surgery could be an option in select patients with limited disease.

[Evaluation of 31 cases treated with bevacizumab-based chemotherapy].

The combination of bevacizumab and standard chemotherapy prolongs progression-free survival and improves response rates in advanced nonsquamous non-small-cell lung cancer(NSCLC). We evaluated the efficacy and safety of bevacizumab based chemotherapy in 31 cases of NSCLC. Adverse events occurred in all patients. Grade≥3 hematotoxicities were seen in 27 patients(87. 0%). Grade≥3 non-hematotoxicities were seen in 13 patients(41. 9%). Bevacizumab-related adverse events included epistaxis(74. 2%), hypertension(22. 6%), and proteinuria(22. 6%). Hemoptysis was reported in 9 patients( 29. 0%), but there was no pulmonary hemorrhage or severe hemoptysis. The treatment results of the 18 patients were evaluated as followes: partial response(PR)10, stable disease(SD)7, and progressive disease(PD)1 patient. The response rate(CR+PR)and disease control rate(CR+PR+SD)were 55. 6%and 94. 4%, respectively. The response rates were 66. 7%, 50. 0%, and 57. 1% for 1st-line(6 patients), 2nd-line and later(12 patients), and postoperative recurrence(7 patients all after 2nd-line)patients, respectively. Bevacizumab-based chemotherapy is an efficacious and safe treatment for advanced nonsquamous NSCLC.

Synovial sarcoma of the mediastinum: report of a case.

We report a case of synovial sarcoma of the mediastinum, a very rare tumor, in a 50-year-old man hospitalized with anterior chest pain. Chest X-ray and computed tomography (CT) on admission showed a 10 x 8-cm mass in the right anterior mediastinal space, compressing the superior vena cava. A diagnosis of sarcoma was established by a CT-guided percutaneous needle biopsy. Systemic examination revealed no metastasis to the contralateral pleural cavity or other distant organs, and we resected the mediastinal sarcoma. Pathological and immunohistochemical analyses confirmed a diagnosis of monophasic synovial sarcoma. The patient is alive with recurrence 9 months after his operation, and is receiving chemotherapy with ifosfamide.

Operation for lung cancer in patients with idiopathic pulmonary fibrosis: surgical contraindication?

BACKGROUND: Patients with idiopathic pulmonary fibrosis have an increased incidence of lung cancer. The purpose of this study was to determine the outcome of surgical treatment of lung cancer with idiopathic pulmonary fibrosis. METHODS: From January 1992 through December 2001, 64 patients who had simultaneous lung cancer and idiopathic pulmonary fibrosis were treated. Twenty-one (33%) of them underwent surgical resection of lung cancer, and their data were reviewed. RESULTS: There were 56 men and 8 women with an average age of 69 years (range, 43 to 85 years). In the surgical group, there were no early postoperative deaths, and nonfatal complications occurred in 2 patients (10%). Among the 14 patients with stage I cancer, a second primary lung cancer developed in 5 (36%). The causes of death in the surgical group were cancer related in 7 patients, exacerbation of idiopathic pulmonary fibrosis in 7, and other in 2. Five of the 7 patients who died of a cancer-related cause had development of a second primary lung cancer. The actuarial 2-year survival rate of the surgical group was 52% overall, 58% for patients with N0 or N1 disease and 25% for those with N2 disease (p = 0.05). CONCLUSIONS: The long-term results in one surgical group were poor partly because of the high incidence of a second primary lung cancer and partly because of the poor natural history of idiopathic pulmonary fibrosis. These patients require intensive surveillance even after curative resection of lung cancer.