Modified risk scoring system for acute exacerbation of interstitial lung disease.

BACKGROUND: Lung cancer patients with interstitial lung disease often develop acute exacerbation of their interstitial lung disease after lung resection. Special care is needed in selection of the surgical procedure to reduce acute exacerbation and provide long-term survival. METHODS: The Japanese Association for Chest Surgery devised a risk scoring system based on 7 risk factors to predict the probability of postoperative acute exacerbation. We excluded surgical procedures and used a modified system categorizing 4 groups: group A (risk score 0-6), group B (risk score 7-10), group C (risk score 11-14), and group D (risk score 15-18). We retrospectively examined 60 lung cancer patients with interstitial lung disease to determine whether the modified risk scoring system is useful for selecting the optimal surgical procedure in anticipation of curability and risk of postoperative acute exacerbation. RESULTS: Eight (13.3%) patients experienced postoperative acute exacerbation. In group A ( n = 20), there was no difference in the incidence of acute exacerbation between wedge (0%) and anatomic resection (6.3%, p = 0.800). In group B ( n = 40), the incidence was significantly higher after anatomic resection (5.0% vs. 30.0%, p = 0.046). Thus group A had high-quality outcomes with anatomic resection, and in group B, the incidence of postoperative acute exacerbation can be reduced if wedge resection is performed. CONCLUSIONS: Our modified risk scoring can be useful for selecting the optimal surgical procedure in anticipation of curability and the risk of acute exacerbation of interstitial lung disease after lung cancer surgery.

Idiopathic spontaneous pulmonary torsion of the lingula: A case report.

INTRODUCTION: Spontaneous pulmonary torsion is an extremely rare event and is known to occur as a complication of thoracic surgery and traumatic injuries. PRESENTATION OF CASE: An 18-year-old man presented to our hospital with pain in the left back region. Clinical examination, computed tomography and bronchoscopy are crucial for diagnosis of pulmonary torsion. During thoracotomy, the lingula segment was observed to be bent on the head side and turned 180° counterclockwise; subsequently, lingulectomy was performed. DISCUSSION: Spontaneous pulmonary torsion may occur in pulmonary conditions such as pneumothorax, atelectasis, infection, pleural effusion, congenital defect, or tumor. Furthermore, it can be speculated that torsion of the segment is possible only in the patients with an accessory fissure or those who have undergone a segmentectomy. CONCLUSION: We have reported an extremely rare case with respect to the fact that the pulmonary torsion occurred spontaneously in an unseparated segment, and that the etiological factor could not be identified.

Video-assisted thoracic surgery lobectomy for right lung cancer in a patient with right aortic arch: report of a case.

A 57-year-old man with an anomalous right aortic arch presented with cancer of the right lung. The right recurrent laryngeal nerve was found to be hooked around the right aortic arch. Right lower lobectomy with systematic mediastinal lymph node dissection was successfully performed using video-assisted thoracic surgery to provide close intraoperative attention to the branching of recurrent laryngeal nerve.

Spindle cell carcinoma of the lung.

We report a rare case of spindle cell carcinoma in the lung. A 73-year-old woman was admitted because of a lung tumor, which was indicated during a group examination. Chest computed tomography revealed a tumor located in the right lung accompanied by spiculation. Right upper lobectomy with lymph nodal dissection was performed. Histological findings revealed only spindle-shaped tumor cells, and immunohistochemical stain showed that they were cytokeratin-positive. We diagnosed it as a pulmonary spindle cell carcinoma.

Unique extralobar sequestration with atypical location and aberrant vessels.

We report a unique extralobar pulmonary sequestration in the upper thoracic region with 3 aberrant vessels connecting to the right subclavian artery, right superior pulmonary vein, and right pulmonary artery in a 20-year-old man. The sequestered lung was completely excised using a video-assisted thoracoscopic approach.

[Plasmacytoma of chest wall].

We report a 70-year-old man who suffered from right anterior chest wall tumor. Physical examination revealed an elastic hard mass at the right 4th rib measured 6 cm in diameter. Chest X-ray and computed tomography (CT) revealed enhanced mass and destruction of the 4th rib. As needle aspiration cytology did not define the diagnosis, we performed a chest wall resection and reconstruction. Histological diagnosis of the tumor was plasmacytoma (IgG lambda type). Five months after the operation, the tumor recurred at the right anterior chest wall. Radiotherapy was performed with dose of 50 Gy. Fourteen months after the operation, the tumor recurred at the lower sternum, and the chemotherapy was performed using ranimustine, vincristine, melpharan and dexamethasone. He is doing well 2 years and 9 months after surgery without signs of progressive disease or conversion to myeloma

Huge mediastinal cystic tumor penetrating the sternum.

We report a very rare case of a huge anterior mediastinal tumor penetrating the sternum that was diagnosed in a 59-year-old woman. The tumor was completely resected en bloc with the manubrium sterni, and the chest wall defect was closed with a pectoralis major muscle flap. Histologic examination of the cystic mass revealed the diagnosis of a benign mediastinal cystic tumor, most likely a benign cystic mature teratoma.

Thymoma with Lambert-Eaton myasthenic syndrome.

We describe a rare case of thymoma with Lambert-Eaton myasthenic syndrome. A 62-year-old woman reporting weakness in her legs and arms was found to have an anterior mediastinal mass on computed tomography. Electromyography showed incremental response to repeated stimulations, and thymoma with Lambert-Eaton myasthenic syndrome was diagnosed. The patient was successfully treated with video-assisted thoracoscopic extended thymectomy.

Leiomyoma originating from the extrapleural tissue of the chest wall.

We describe a rare case of leiomyoma of the chest wall in a 55-year-old female. Computed tomography showed a well-circumscribed neoplasm with a diameter of 2 cm in the right chest wall. The tumor was excised with video-assisted thoracic surgery. Histopathology confirmed that the tumor was leiomyoma arising from the microvascular smooth muscle in the chest wall. We present the immunohistochemical profiles of the tumor in detail, critically reviewing the previously reported cases.

Detection of micrometastatic tumor cells in pN0 lymph nodes of patients with completely resected nonsmall cell lung cancer: impact on recurrence and Survival.

OBJECTIVE: To detect occult micrometastatic tumor cells in pN0 lymph nodes of nonsmall cell lung cancer (NSCLC) by a combination of cytokeratin and p53 immunohistochemistry staining, and to evaluate the relation between the micrometastasis in pN0 lymph nodes and the prognosis of patients with completely resected stage 1 NSCLC. SUMMARY BACKGROUND DATA: The average 5-year survival rate for patients with completely resected stage 1 NSCLC is only about 70%; thus, about 30% of these patients have recurrent disease. This suggests that occult micrometastasis may exist at the time of surgery; the rate is clearly underestimated by current clinical staging examinations and conventional histopathologic methods. METHODS: A total of 474 hilar and mediastinal lymph nodes were removed during surgery from 49 patients with completely resected stage 1 NSCLC. The lymph nodes analyzed for micrometastasis using immunohistochemical staining with the biclonal anticytokeratin antibody, AE1/AE3. Of these 474 lymph nodes from 49 patients, 263 lymph nodes from 25 patients, whose primary tumors were positive for the p53 protein, were subjected to immunohistochemical staining with the monoclonal anti-p53 protein antibody DO-1. RESULTS: Cells positive for cytokeratin and p53 protein were found in 35 (7.4%) of 474 and 20 (7.6%) of 263 lymph nodes, respectively; 17 (34.7%) of 49 patients had cytokeratin-positive cells and 10 (40.0%) of 25 patients had p53-positive cells in their pN0 lymph nodes. By a combination of cytokeratin and p53 protein immunohistochemical staining, micrometastatic tumor cells were identified in pN0 lymph nodes in 22 (44.9%) of 49 patients. The patients with lymph node micrometastasis identified by a combination of cytokeratin and p53 protein immunohistochemical staining had a poorer prognosis than those without micrometastasis on both univariate and multivariate analyses (overall survival, P =.0003 and 0.013, respectively). CONCLUSIONS: The detection of lymph nodal micrometastasis by cytokeratin and p53 protein immunohistochemical staining will be helpful to predict the recurrence and prognosis of patients with completely resected stage 1 NSCLC.