Enhancing identification of early-stage lung adenocarcinomas through solid component analysis of three-dimensional computed tomography images.

OBJECTIVES: As the role of segmentectomy expands in managing early-stage lung adenocarcinoma, precise preoperative assessments of tumor invasiveness via computed tomography become crucial. This study aimed to evaluate the effectiveness of solid component analysis of three-dimensional (3D) computed tomography images and establish segmentectomy criteria for early-stage lung adenocarcinomas. METHODS: This retrospective study included 101 cases with adenocarcinoma diagnoses, with patients undergoing segmentectomy for clinical stage 0 or IA between 2012 and 2017. The solid component volume (3D-volume) and solid component ratio (3D-ratio) of tumors were calculated using 3D computed tomography. Additionally, based on two-dimensional (2D) computed tomography, the solid component diameter (2D-diameter) and solid component ratio (2D-ratio) were calculated. The area under the receiver-operating characteristic curve (AUC) was calculated for each method, facilitating predictions of mortality and recurrence within 5 years. The AUC of each measurement was compared with those of invasive component diameter (path-diameter) and invasive component ratio (path-ratio) obtained through pathology analysis. RESULTS: The predictive performance of 3D-volume did not differ significantly from that of path-diameter, whereas 2D-diameter exhibited less predictive accuracy (AUC: 3D-volume, 2D-diameter, and path-diameter: 0.772, 0.624, and 0.747, respectively; 3D-volume vs. path-diameter: p = 0.697; 2D-diameter vs. path-diameter: p = 0.048). Results were similar for the solid component ratio (AUC: 3D-ratio, 2D-ratio, path-ratio: 0.707, 0.534, and 0.698, respectively; 3D-ratio vs. path-ratio: p = 0.882; 2D-ratio vs. path-ratio: p = 0.038). CONCLUSION: Solid component analysis using 3D computed tomography offers advantages in prognostic prediction for early-stage lung adenocarcinomas.

[Adenocarcinoma with Aplastic Anemia as an Immune-related Adverse Event Caused by Pembrolizumab: Report of a Case].

A 74-year-old man was found a left completely atelectasis on chest X-ray. He had undergone left lower lobe resection because of an adenocarcinoma at the age of 58. Bronchoscopy revealed a tumor near the left upper lobe branch entry that obstructed the lumen, and a biopsy confirmed the diagnosis of adenocarcinoma. A left completion pneumonectomy was performed, but #4L and #10 lymph nodes could not be completely resected. Programmed cell death 1-ligand 1( PD-L1) was positive with tumor proportion score (TPS) 15%, so chemotherapy with pembrolizumab+pemetrexed+carboplatin was started about 1.5 months after surgery. Pancytopenia appeared from the seventh course and did not improve after discontinuation of chemotherapy, so we consulted to the hematologist. He was diagnosed as aplastic anemia by bone marrow biopsy. Aplastic anemia was unresponsive to treatment and chemotherapy could not be resumed. He died of exacerbation of lung cancer.

[Multiple Pulmonary Metastases Seven Years After Transurethral Bladder Tumor Resection for Non-muscle Invasion Bladder Cancer:Report of a Case].

A 64-year-old man was admitted because of multiple pulmonary nodules in right upper lobe on chest computed tomography (CT). He had non-muscle invasion bladder cancer resected by transurethral bladder tumor resection seven years ago. Partial resections of the right upper lobe were carried out at the video assisted thracoscopic surgery (VATS) for diagnostic purposes. The postoperative pathological examination revealed featuraes of pulmonary metastasis of bladder cancer. Although chemotherapy after biopsy was performed, a residual tumor in right S3 has grown. Partial resection of residual tumor was carried out thracoscopically and the tumor was diagnosed as metastasis of bladder cancer. He has been without recurrence for 1 year after the operation.

[Solitary Mixed Squamous and Glandular Papilloma of the Peripheral Lung:Report of a Case].

A 76-year-old woman was admitted because of a 25 mm solitary nodule in right S10 on chest computed tomography (CT). 18 fluoro deoxyglucose-positron emission tomography (FDG-PET) indicated accumulation with standardized uptake value( SUV) max 5.2. The serum carcinoembryonic antigen( CEA) and squamous cell carcinoma antigen( SCC) level was elevated. Although the diagnosis was not established by bronchofiberscopy, lung cancer was suspected and the video assisted thoracoscopic surgery (VATS) was carried out. Since no malignant cells were detected by intra-operative pathology, partial resection of the right lower lobe was performed. The postoperative pathological examination revealed features of mixed squamous and glandular papilloma.

[Vagal Schwannoma in the Middle Mediastinum Found by Atelectasis on Chest X-ray:Report of a Case].

An 70-year-old woman was reffered to our hospital to examine for a left lower lobe atelectasis on chest X-ray. Chest computed tomography (CT) showed the mass in middle mediastinum. The video-assisted thoracoscopic surgery( VATS) was performed to establish diagnosis and treat. 50 mm mass was found in the area surrounded by the descending thorasic aorta, esophagus, left atrium, left lower lobe, and mesiastinal pleura, and was regarded as a neurogenic tumor originating from the pulmonary branch of the vagal nerve. The histopathological diagnosis was benign schwannoma. She was dischraged on the seventh postoperative day, without any neurological complications.

[Basaloid Squamous Cell Carcinoma;Report of a Case].

We report a resected case of basaloid squamous cell carcinoma (BSC). BSC is a rare type of malignant lung tumor. A 79-year-old woman had a 13 mm tumor in the left upper lobe on chest computed tomography (CT). On fluorodeoxyglucose-position emission tomography (FDG-PET), the tumor showed the accumulation of FDG with an SUVmax of 14.7. A left upper lobectomy with lymph node dissection was performed by video-assisted thoracoscopic surgery. The pathological diagnosis was BSC (pT2aN0M0, stage IB). There was no recurrence following lung cancer resection for 12 months. BSC is generally poor prognosis.