A case of primary lung adenocarcinoma mimicking metastatic papillary thyroid carcinoma.

A 61-year-old woman, who had a history of total thyroidectomy for follicular variant of papillary thyroid carcinoma (PTC), visited our hospital for assessment of an enlarging nodule which appeared in the lung with multiple metastatic lesions of PTC which had been stable for 17 years. Wedge resection of the lung was performed. Miliary nodules were confirmed to be metastatic PTCs based on their morphological as well as immunohistochemical findings. As for the main nodule, its morphological features suggested a diagnosis of metastatic PTC, while its immunohistochemical findings were identical with primary lung adenocarcinoma. Further genetic analysis provided no definitive information for the diagnosis of the main nodule. The present case shows the need of comprehensive analyses for differentiation between primary lung adenocarcinoma and metastatic PTCs.

Fibrin glue-induced eosinophilic pleural effusion after pulmonary resection: A case report.

INTRODUCTION AND IMPORTANCE: Prolonged air leakage after pulmonary resection is a common complication, and fibrin glue is used as a sealant to reduce this. Fibrin glue-induced adverse events are generally rare. Herein, we describe a rare case of fibrin glue-induced eosinophilic pleural effusion (EPE). CASE PRESENTATION: A 77-year-old man underwent partial pulmonary resection for right lower lobe lung cancer, and the pulmonary staple stump was subsequently covered with fibrin glue. Antibacterial drugs were administered for the treatment of postoperative pneumonia. However, re-elevation of the inflammatory cell number was observed, and computed tomography revealed an increase in right pleural effusion. Although thoracoscopy was performed based on a possibility of empyema, no empyema was observed. The eosinophil count in the pleural effusion was 11%; thus, the patient was diagnosed with EPE, which was resolved after thoracic drainage, without corticosteroid administration. Fibrin glue was identified as the causative agent, using a drug-induced lymphocyte stimulation test. CLINICAL DISCUSSION: EPE is defined as an eosinophil count of ≥10% in the pleural effusion. If pleural effusion on the surgical side, with fever or an elevated inflammatory cell number, is observed in the early postoperative period after pulmonary resection, empyema should be considered foremost. In this case, the administration of antibacterial drugs was ineffective, and the patient was eventually diagnosed with EPE. CONCLUSION: EPE should be considered as a rare fibrin glue-induced adverse event after pulmonary resection. It is recommended that the leukocyte fraction be examined, if pleural effusion is collected for postoperative pleural effusion.

[Clinical assessment of granulocyte colony-stimulating factor producing lung cancer].

OBJECTIVE: The aim of this study was to reveal the clinicopathological feature of granulocyte colony-stimulating factor (G-CSF) producing lung cancer. METHOD: Nine cases of G-CSF producing lung cancer from July 2003 to July 2008 were retrospectively evaluated. RESULTS: All cases were male, 8 cases were poorly differentiated carcinoma. Average of leucocyte and serum G-CSF were 23,378/microl and 128.6 pg/ml respectively. Five cases had febrile symptom, average of serum C-reactive protein (CRP) was 13.37 mg/dl. Immunohistological examination showed positive staining for G-CSF in 6 cases. Serum interleukin-6 (IL-6) level was elevated in 3 cases. Clinical stages were IB in 2, IIB in 2, IIIA in 3 and IIIB in 2 patients. Chemotherapy was performed for patients with stage IIIB. Operation was performed for the other cases. Five cases were died within 12 months, whereas 4 cases are surviving for 6 to 16 months. CONCLUSION: Generally, the prognosis of G-CSF producing lung cancer seems to be poor, but in our institute there were 2 cases who lived over 1 year without disease. It is important to establish more effective adjuvant therapy for G-CSF producing tumor.

[Pulmonary hamartoma associated with lung cancer].

Pulmonary hamartoma is most common benign tumor of the lung and is not recognised as having a character of malignant transformation. So, longtime radiological observation is not uncommon for patients with diagnosis of pulmonary hamartoma from computed tomography (CT) finding. Although pulmonary hamartoma does not transform to malignancy, high frequency of coexistence hamartoma and lung cancer has been reported. We experienced 14 cases of resected pulmonary hamartoma, and 3 of them had lung cancer, showing that 21.4% of pulmonary hamartoma coexisted with lung cancer. Patients with pulmonary hamartoma should undergo sufficient evaluations for malignancy.

[Pericardial cyst that involved thoracic duct].

A 79-year-old man was admitted to our hospital because of swallowing disturbance. Chest X-ray and computed tomography (CT) scan revealed 7 x 6 cm cystic shadow in posterior mediastinum. We diagnosed that swallowing disturbance caused by pericardial cyst. Cysticotmy was performed. Three days after operation, chylothorax occurred. Conservative therapy was not effective, we performed re-operation 28 days later from the 1st operation. There was aperture of thoracic duct inside of cyst, and thoracic duct was ligated. After the 2nd operation, chylothorax was cured.

[Complete resection of Pancoast tumor while receiving preoperative concurrent chemoradiotherapy (CCRT) as an induction therapy--report of a case].

A 60-year-old man complaining of right shoulder pain and numbness of right arm was diagnosed with Pancoast tumor (invasive right apical lung cancer). Chest CT scan showed a tumor, 5 cm in diameter, in the right apex invading the right posterior chest wall. The patient received preoperative CCRT (RT: 40 Gy/20 Fr, cisplatin: CDDP and etoposide: ETP), resulting in tumor regression (PR). The patient underwent right upper lobectomy (ND 2a), partial resection of the 1st-3rd ribs and Th 1 nerve. Pathological examination demonstrated no live cancer cells and organization of necrotic tissue in the lung and intercostal region (Ef. 3). The patient received postoperative chemotherapy (CDDP+ETP) and was discharged. He did well without any tumor recurrence for 1 year postoperatively. CCRT seems effective and is one of the standard treatments for Pancoast tumor.