Epithelial-myoepithelial carcinoma of the lung: a case report.

BACKGROUND: Pulmonary epithelial-myoepithelial carcinoma (P-EMC) is a rare subset of salivary gland-type tumors of the lung. Because of its rarity and unproven malignant potential, the optimal therapy for P-EMC has not been defined. Here, we report a typical case of P-EMC and a review of the literature to consider appropriate treatment. CASE PRESENTATION: A 54-year-old woman presented with an abnormal lung shadow on a routine chest X-ray. A chest computed tomography (CT) scan verified an 18-mm endobronchial nodule on the middle lobe. We performed a bronchoscopic biopsy, and the patient was diagnosed with P-EMC. After confirming the absence of tumors in the salivary glands, she underwent a right middle lobectomy along with hilar and mediastinal lymph node dissections. Currently, the patient is doing well, without any sign of recurrence 3 years after surgery. CONCLUSIONS: Although a majority of P-EMC cases, as in our case, behave indolently, several poor progression cases have been reported. For distinguishing the minor malignancy cases from others, histological findings such as myoepithelial anaplasia could be a predictive factor. Complete resection is needed to evaluate the whole tumor, because P-EMCs often show histological heterogeneity. Moreover, incomplete excision may be a poor prognostic factor. Although lobectomies as well as lymph node dissections, sleeve lobectomies, or pneumonectomies are routinely performed for complete resection, further investigation is required to establish the optimal treatment strategy.

Interrelationships Between Job Resources, Vigor, Exercise Habit, and Serum Lipids in Japanese Employees: a Multiple Group Path Analysis Using Medical Checkup Data.

BACKGROUND: Physical inactivity is one of the major risk factors for dyslipidemia and coronary heart disease. Job resources have been identified as determinants of employees' vigor and physical activity habits. PURPOSE: Our first purpose was to comprehensively analyze the series of relationships of job resources, through vigor and exercise habit (i.e., one aspect of physical activity), to serum lipid levels in a sample of Japanese employees in a manufacturing company. Our second purpose was to investigate sex differences in these relationships using a multiple-group path analysis. METHODS: Data were collected from 4543 employees (men = 4018, women = 525) during a medical checkup conducted in February and March 2012. Job resources (job control, skill utilization, suitable jobs, and meaningfulness of work), vigor, exercise habit, triglyceride, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were measured cross-sectionally. RESULTS: Job resources and vigor were positively associated with exercise habit in both sexes. Exercise habit was inversely associated with triglyceride (-0.03 in men and -0.01 in women, ps < 0.05) and LDL-C (-0.07 in both sexes, ps < 0.05). HDL-C was positively associated with exercise habit (0.03 in both sexes, ps < 0.05). There was no significant difference by sex in path coefficients, except for the covariance between suitable jobs and meaningfulness of work. CONCLUSION: Higher levels of job resources were associated with greater vigor, leading to exercise habit, which in turn, improved serum lipid levels. Longitudinal studies are required to demonstrate causality.

[Pulmonary metastasis of sarcomatous component of adrenocortical carcinoma].

A 43-year-old man presented with a pulmonary nodule in the left lower lobe and he consulted our hospital one year after resection of left adrenocortical carcinoma. We performed a wedge resection of the left lower pulmonary lobe for diagnosis. The tumor was diagnosed as a metastatic sarcoma, but the primary site could not be resolved. We assessed the histopathology of the adrenal tumor, which was obtained from the patient's former hospital, and it showed that the tumor consisted of both carcinomatous and sarcomatous components. This enabled us to diagnose the nodule as a pulmonary metastasis from the adrenocortical carcinoma. Adrenocortical carcinoma with a sarcomatous component is very rare. This case is a first report of a resected pulmonary metastasis of sarcomatous component of adrenocortical carcinoma.

Azygos flap as a novel method for superior vena cava reconstruction.

In the surgical treatment of lung cancers invading the superior vena cava (SVC), primary closure is preferred for reconstruction when the resected area is small, but the repaired vessel can become constricted. A novel method for SVC repair with azygos flap, which is a longitudinally opened azygos arch, is a facile and effective treatment, and may prevent a reduction in the lumen if the area of tumor invasion is small and close to the azygos arch. When the azygos arch is not invaded by the tumor, this procedure should therefore be considered as one alternative method for SVC reconstruction.

Transmanubrial osteomuscular sparing approach for lung cancer invading the anterior part of the thoracic inlet.

Standard treatment for lung cancer presenting as a superior sulcus tumor is induction chemoradiotherapy followed by surgery, which yields rates of about 70% complete resection and 50% 5-year survival rate. However, the surgical technique to achieve complete resection for superior sulcus tumor invading major anatomical sites including the subclavian artery is challenging. The anterior transcervical thoracic approach applied by Dartevelle and colleagues provides excellent exposure of the subclavian vessels. Grunenwald and associates have improved on this approach to preserve the clavicle and sternoclavicular joint. We applied the transmanubrial osteomuscular-sparing approach in two patients. In both cases, exposure of the subclavian vessels was excellent. In one case, the subclavian artery was resected and reconstructed with a polytetrafl uoroethylene graft. This patient has continued to show recurrence-free survival for more than 5 years. We outline our experience and review the literature on the surgical approach for superior sulcus tumor invading the anterior part of the thoracic inlet.

Multimodality therapy for patients with invasive thymoma disseminated into the pleural cavity: the potential role of extrapleural pneumonectomy.

BACKGROUND: The optimal treatment method for thymoma with pleural dissemination remains controversial. We analyzed our experience with a multimodality approach and evaluated the role of extrapleural pneumonectomy (EPP) in the treatment of disseminated thymoma. METHODS: Multimodality therapy was used to treat 11 consecutive patients with invasive thymoma disseminated into the pleural cavity. Disease was stage IVa in 9 and stage IVb disease with lymph node metastasis in 2. Our treatment strategy for those patients was induction chemotherapy with cisplatin, doxorubicin, and methylprednisolone (CAMP therapy), followed by thymectomy combined with resection of the visible disseminated nodules and postoperative radiotherapy. EPP was applied for 4 patients who had chemoresistant tumors or pleural refractory recurrence. RESULTS: Eight patients underwent induction chemotherapy. The response rate to CAMP was 85%. Thymectomy with or without the resection of disseminated pleural tumors was performed in 7 patients and EPP in 3. Postoperative radiotherapy was administered in 6. All patients except 1 with EPP had recurrence: pleural recurrence in 7, lung in 1, and multiple organs in 2. Nine patients were retreated with chemotherapy, radiotherapy, pulmonary metastasectomy, or pleurectomy. One underwent EPP for pleural recurrence. Consequently, among the 7 patients without EPP, only 1 was alive without disease and 4 were alive with pleural recurrence. In contrast, 3 of the 4 patients with EPP had no local failure and were alive without recurrence. CONCLUSIONS: In multimodality therapy for thymoma with pleural dissemination, EPP offers good local control and may lead to cure.