[Bronchial artery-pulmonary vein fistula undergoing right upper lobectomy; report of a case].

We report a case of arteriovenous fistula of the bronchial artery. A 42-year-old woman was referred to our hospital because of an abnormal shadow noted on a chest X-ray. A chest computed tomography (CT) scan showed abnormal blood vessels in the right upper lobe. Bronchoscopic examination showed a pulsatile tortuos lesion at the orifice of the right B3 bronchus. Bronchial angiography revealed a convoluted and dilated right bronchial artery and hypervascularization in the right upper lobe. On the basis of a clinical diagnosis of bronchial artery-pulmonary vein fistula, a right upper lobectomy and ligation of the right bronchial artery were successfully performed. Bronchial arteriovenous fistula is rare, and it is risk factor for severe hemoptysis. When the surrounding lung reveals a congestive and organized changes due to the arteriovenous fistula, resection of the affected lung is considered necessary.

Pathological approach to breast conserving therapy.

There is no uniformly accepted definition of a positive margin in breast conserving surgery. In 1999, the Japanese Breast Cancer Society created the Guidelines for Breast-Conserving Treatment (GBCT). At that time, we did a questionnaire survey about the definition of margin status. Although 57.1% of hospitals/institutes used the definition of cancer cells present at the surface, the GBCT adopted the definition of cancer cells present within 5 mm of the surface. Moreover, the GBCT required that the distance between the edge of the cancer cells and the surface be recorded in millimeters when cancer cells were present within 5 mm of the surface. The risk factors for local recurrence after breast-conserving treatment were studied. From 1986 to 1995, 391 patients were treated with breast-conserving surgery at Osaka Medical Center for Cancer and Cardiovascular Diseases. Of these, 35 patients developed local recurrence. Multivariate analysis showed that positive margin (p=0.0002), high degree of ductal proliferative change around the tumor (p=0.0035) and high histological grade (p=0.0041) were significant independent risk factors for local recurrence, while radiation therapy (p=0.0327) significantly reduced local recurrence. There was no significant difference in the risk of local recurrence between the two different definitions of positive margin (tumor present at the surface and tumor present within 5 mm from the surface). It is hoped that more hospitals/institutes will adopt the definition of margin positivity presented by the GBCT and that a practical definition of margin positivity will be established.

Identification of a tumour associated antigen in lung cancer patients with asbestos exposure.

BACKGROUND: This study analysed the humoral immune response in asbestos exposed lung cancer patients to identify new surrogate markers of the carcinogenic risk in populations exposed to asbestos. METHODS AND RESULTS: A serological analysis identified five distinct antigens reactive with IgG derived from a lung cancer patient with high asbestos exposure. In one of the isolated antigens, quantitative RT-PCR indicated that annexin A2 (AnxA2) was overexpressed in lung cancer tissues and normal lung from patients with high asbestos exposure. Antibody against AnxA2 was detected in 9/15 (60%) of lung cancer patients with high asbestos exposure; however, in only 1/12 (8%) of lung cancer patients with low asbestos exposure. AnxA2 was also overexpressed in malignant mesothelioma cells, and the antibody was also positive in 8/15 (53%) of patients with malignant mesothelioma. CONCLUSION: The antibody titer against AnxA2 may be a potentially useful new diagnostic surrogate marker for asbestos-related lung cancer and malignant mesothelioma.