[Clinical Analysis of Pulmonary Pleomorphic Carcinoma:Report of Four Cases].

Of 243 resected cases of primary non-small cell lung cancer for ten years in our hospital, we experienced 4 patients (1.6%) of pulmonary pleomorphic carcinoma. All patients were males and heavy smokers. Histologically, the vascular invasion was showed in 3 of 4 patients. In only one patient, recurrence was recognized, and he died 18 months after surgery. The other 3 patients were alive without recurrence for 86, 92, and 60 months after surgery. In general, prognosis of pulmonary pleomorphic carcinoma is very poor. But in my study, 3 of 4 patients of pulmonary pleomorphic carcinoma survive from this disease. As the planning of an appropriate treatment strategy of pulmonary pleomorphic carcinoma,further detailed assessment of adjuvant chemotherapy, such as immune check point inhibitors, will be considered to be necessary.

[Dedifferentiated Chondrosarcoma of the Chest Wall].

A 79-year-old man complaining of an anterior chest mass with pain had an abnormal shadow on chest X-ray. A mass, 7 cm in size, with destruction of the right 4th rib was found on chest computed tomography. A F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) corresponding to the lesion showed an abnormal accumulation of FDG with the standardized uptake value(SUV) max=16.19. A malignant tumor of the chest wall origin was suspected and the tumor was resected with the 3th, 4th, and 5th ribs. Histologically, the tumor was diagnosed as dedifferentiated chondrosarcoma. He died of local recurrence about 5 months after the operation.

[Resected Pulmonary Cryptococcosis Suspected as Lung Cancer;Report of a Case].

We report a case of pulmonary cryptococcosis suspected of lung cancer. A 65-year-old woman had an abnormal shadow on chest X-ray. A solitary nodule, 12 mm in size, with pleural indentation and spicula in S3 of the left lung was found on chest computed tomography. A serum cryptococcal antigen was negative. An abnormal accumulation of fluoro-2-deoxy-D-glucose(FDG)in the nodule was found with the standardized uptake value (SUV) max 5.04, suggesting lung cancer. The nodule was diagnosed as pulmonary cryptococcosis by surgical resection.

Treatment of the postoperative recurrence of lung cancer in octogenarians.

PURPOSE: Guidelines for the treatment of postoperative recurrent lung cancer in octogenarians do not exist. In this study, we investigated the prognosis of patients with recurrence after the resection of lung cancer and discuss the management of recurrent tumors in octogenarians. METHODS: This study clinicopathologically evaluated 135 octogenarians who underwent resections for lung cancer at a single institution between 1992 and 2010. We retrospectively reviewed the clinical records of 37 patients with confirmed recurrence. The overall survival of the patients and the treatments used for postoperative recurrence were evaluated. RESULTS: Among 37 patients, six underwent intensive treatment, 14 underwent palliative treatment and 17 received supportive care only. The overall survival rates of the patients in the antitumor treatment groups tended to be associated with a better prognoses than those of the patients in the supportive care only group, but they did not exhibit significantly better prognoses at 1 year (p = 0.202). However, among the patients with a good performance status, the intensive treatment group tended to exhibit prolonged survival. Of the 37 patients with recurrent tumors, five (14%) died of other diseases. CONCLUSIONS: Antitumor treatment of postoperative recurrent lung cancer in octogenarians may not always improve the survival rate. However, carefully selecting patients for intensive therapy, such as those with a good performance status, may lead to longer survival rates after postoperative recurrence in octogenarians.

[Multimodality therapy containing hepatic arterial infusion chemotherapy for liver metastasis of esophageal cancer-a case report].

A 60-year-old man who had had a subtotal esophagectomy for esophageal cancer was given the diagnosis of hepatic metastases ten months after his operation. Systemic chemotherapy was stopped after a short time because of adverse effects. He refused to continue any other systemic chemotherapy. He was going to receive hepatic arterial infusion chemotherapy(HAI)with the prospect of having less systemic effects. Combination regimen of 5-FU with low-dose CDDP was administered for five days every three weeks. Hepatic metastases decreased markedly without adverse effects. The tumor was well controlled for two years until occlusion of hepatic artery. Radiation therapy and liver resection were performed subsequently. The patient lived more than 4 years after the diagnosis of hepatic metastases. HAI can be a treatment of choice for esophageal cancer when metastasis is limited to the liver.

[Delayed massive hemothorax due to diaphragmatic injury by lower rib fracture].

We report a case of delayed massive hemothorax, a 72-year-old women, due to diaphragmatic injury by multiple lower rib fracture on 4th day aftrer traffic injury. We tried to stop bleeding by transcatheter arterial embolization, but the control of bleeding was difficult, necessitating the emergency surgery. The diaphragmatic injury about 3 cm diameter was found, and was sutured with absorption thread. The post operative course was uncomplicated. Patient was discharged on 51th day after injury. Careful observation is important for delayed hemothorax after lower rib fracture.

Four-year natural clinical course of pulmonary epithelioid hemangioendothelioma without therapy.

Pulmonary epithelial hemangioendothelioma is a rare low to intermediate malignant vascular tumor originating from vascular endothelial cells. The therapy for this disease, if possible, is surgical resection. However, there is no standard treatment for patients with multiple unresectable lesions. We present the case of a 42-year-old woman treated with a natural clinical course of hemangioendothelioma for four years without therapy. The nodules have increased in number and size extremely slowly, and the patient is alive and asymptomatic four years after diagnosis.

How should synchronous multiple primary adenocarcinomas of the lung be resected?

We often encounter patients with multiple primary lung cancers with ground-glass opacity. However, there are no established guidelines regarding the optimal extent of resection for multifocal lung adenocarcinoma, so it is necessary to determine the most suitable strategy for each case. A 62-year-old man visited our hospital with 7 lesions in the lung field. We evaluated the structural information using high-resolution computed tomography (HRCT) and the aggressiveness of the tumors using fluorodeoxyglucose-positron emission tomography/CT (FDG-PET/CT) and then developed a surgical strategy. Using FDG-PET/CT in addition to HRCT might improve the selection of appropriate surgical strategies for patients with multifocal lung adenocarcinoma.

Aspergilloma mimicking a lung cancer.

INTRODUCTION: Pulmonary aspergillosis occurs in the parenchymal cavities or ectatic airways. It rarely affects healthy people with an intact immune response. There have been few reports describing an aspergilloma mimicking a lung cancer. PRESENTATION OF CASE: We experienced the case of an asymptomatic healthy 71-year-old female who was admitted with an abnormal lung shadow. Chest CT revealed an irregularly shaped solid lung nodule in the left upper lobe, which increased in size during the follow-up at a regional hospital. The pathology of the bronchial biopsy was negative for malignant cells, and the cultures were negative. Because a lung cancer was strongly suspected, video-assisted thoracic surgery was performed. Aspergillus was detected by a pathological study of the excised specimen, with no evidence of lung cancer. DISCUSSION: It is difficult to make an accurate diagnosis of aspergilloma by imaging findings in healthy people with an intact immune response, and therefore a surgical resection allows both the pathological diagnosis and treatment to be performed concurrently. CONCLUSION: An aspergilloma presenting a mass shadow on imaging may mimic a lung cancer in healthy people with intact immune response.