Probably the Mycobacterium avium Complex around the Staple Line Exacerbated after Radiation Therapy.

The space around the staple line after lung surgery is at high risk of nontuberculosis Mycobacterium pulmonary disease (NTM-PD). Solitary nodules of NTM-PD around the staple line are difficult to distinguish from lung cancer. There is no clear identification from laboratory data and radiologic findings without histological examination. In the present case, we misdiagnosed the pulmonary granulomas with Mycobacterium avium complex pulmonary disease (MAC-PD) as a recurrence of lung cancer. We conducted radiation therapy. The pulmonary granulomas with MAC-PD were exacerbated by irradiation. The effects of radiation therapy for MAC-PD are unknown. When radiation therapy is performed for the patient coexistence with MAC-PD, we should pay attention to exacerbation of MAC-PD.

An aberrant medial basal segmental pulmonary artery (A7b) behind the superior segmental pulmonary vein (V6) in a patient undergoing right superior segment (S6) segmentectomy.

Herein, we report the first case of a patient with lung cancer with an aberrant medial basal segmental pulmonary artery (A7b) behind the superior segmental pulmonary vein (V6) who underwent right superior segment (S6) segmentectomy via uniportal video-assisted thoracoscopic surgery (uVATS). A 56-year-old man with a right lower lobe pure ground-glass nodule (GGN), measuring 12 mm in diameter on computed tomography (CT) had an aberrant A7b branching from the basal pulmonary artery, which was located behind the V6 as detected on 3D CT. The right S6 segmentectomy, via uVATS, for the GGN was performed. The postoperative course was uneventful. The final pathological diagnosis was invasive adenocarcinoma (p-T1bN0M0, stage IA2) with no evidence of disease recurrence at 3-month follow-up. Thoracic surgeons should be aware of the possibility of damaging the A7b when dividing the V6 for S6 segmentectomy, especially during uVATS because of insufficient dorsal visibility.

Pulmonary arteriovenous malformation with metal allergy.

We present a rare case of single pulmonary arteriovenous malformation (PAVM) with multiple metal allergies, including for platinum. A 47-year-old woman presented to our hospital without any symptoms. Enhanced computed tomography showed a single PAVM in S6 of the right lung. Interviews prompted us to suspect a history of palmoplantar pustulosis associated with metal dental filling. Dermatology patch tests for metal allergy were positive for platinum, cobalt, tin and potassium dichromate. The first choice of treatment for PAVM is endovascular treatment using a metal coil. Since the coil is composed of platinum alloy, we performed partial lung resection for PAVM without metal implants. Although metal allergy is rare for endovascular treatment, it causes an additional stress of removal of causative metal or long-term steroidal treatment. Therefore, for single PAVM with multiple metal allergies to the implants, surgical treatment without metal implants should be considered.

An aberrant mediastinal medial basal segmental pulmonary artery (A7a) in a patient with lung cancer: a case report.

BACKGROUND: Mediastinal branching of the A7a from the right main pulmonary artery (PA) is extremely rare. Herein, we report a patient with an aberrant mediastinal A7a who underwent right basal segmentectomy for lung cancer. CASE PRESENTATION: A 73-year-old man was referred to our department for a right lower lobe nodule measuring 18 mm in diameter on computed tomography (CT). Three-dimensional (3D) CT revealed mediastinal A7a branching from the right main PA. As the patient had undergone colectomy for advanced ascending colon cancer, the nodule was suspected to be a metastasis from the colon primary, and thus, basal segmentectomy of the right lung was performed. Intraoperatively, the A7a was observed behind the V4+5 and middle lobe bronchus. The pathological diagnosis was combined small cell carcinoma with an adenocarcinoma component (p-T1cN0M0, stage IA3). The patient subsequently received adjuvant chemotherapy for colon cancer. At 1-year postoperative follow-up, there was no evidence of disease. CONCLUSION: This is the first report describing an aberrant mediastinal A7a branching from the right main PA. It is important to obtain accurate information about variations of the PA using 3D-CT for safe anatomical pulmonary resection.

Advantages of additional PET vs. MRI in the clinical diagnosis of anterior mediastinal tumors.

The present study retrospectively examined the diagnostic utility of adding positron emission tomography (PET) or magnetic resonance imaging (MRI) to computed tomography (CT) alone for preoperative diagnosis of anterior mediastinal tumors. A total of 104 consecutive patients who had undergone surgical resection of anterior mediastinal tumors were divided into two groups: Additional PET to another modality and no additional PET to another modality, and further subdivided into three groups: CT alone, additional MRI to CT and additional PET to CT. The sensitivity, specificity, and accuracy for diagnosing malignant tumors in each subgroup was calculated. Comparing the two groups, the diagnostic sensitivity was similar for additional PET (98.0%) and no additional PET (95.2%) groups; however, the specificity and accuracy for additional PET (75.0 and 92.2%, respectively) were significantly improved compared with no additional PET (31.6 and 65.0%, respectively). In the subgroup analysis, adding PET to CT showed an improvement in specificity and positive predictive value for detecting malignant tumors, compared with either additional MRI to CT or CT alone. Additional PET, but not MRI, has advantages over CT alone in clinically distinguishing benign from malignant tumors of the mediastinum.

Long-term complete response in a patient with postoperative recurrent ALK-rearranged lung adenocarcinoma treated with crizotinib: A case report.

Anaplastic lymphoma kinase (ALK) gene rearrangements are identified in approximately 5% of patients with non-small cell lung cancer (NSCLC). Despite initial dramatic responses to ALK inhibitors, the majority of patients relapse within 1 year, owing to the development of resistance. Herein we present a case of variant type 2 ALK-rearranged lung adenocarcinoma recurrence with multiple lung metastasis that maintained complete response over 5 years with crizotinib, which is the first approved ALK inhibitor. The efficacy of crizotinib may vary among ALK fusion variants and thus, variant type may represent an important factor in guiding the treatment strategy for ALK-rearranged lung adenocarcinoma.

Fas/FasL signaling is critical for the survival of exhausted antigen-specific CD8+ T cells during tumor immune response.

Antigen (Ag)-specific activated CD8+ T cells are critical for tumor elimination but become exhausted, and thus, dysfunctional during immune response against the tumor due to chronic antigen stimulation. The signaling of immune checkpoint receptors is known to be a critical component in this exhaustion; however, the fate of these exhausted CD8+ T cells remains unclear. Therefore, to elucidate this, we followed the fate of Ag-specific CD8+ T cells by directly visualizing them using MHC class I tetramers coupled with ovoalubumin257-264 in C57BL/6 mice inoculated with EG.7. We found that the number of generated Ag-specific activated CD8+ T cells decreased via apoptosis during a prolonged tumor immune response. However, the number of Ag-specific CD8+ T cells was significantly higher in Fas ligand (FasL)-dysfunctional gld mice than in control mice, resulting in suppressed tumor growth. In contrast, the enforced expression of Bcl-2 failed to rescue apoptosis of the exhausted CD8+ T cells following EG.7 inoculation. These results suggest that Fas/FasL signaling is critical for the survival of exhausted CD8+ T cells during the tumor immune response.

SIRT6 expression is associated with poor prognosis and chemosensitivity in patients with non-small cell lung cancer.

BACKGROUND: Despite advances in the development of various therapeutic agents, non-small cell lung cancer (NSCLC) is associated with a poor prognosis. To improve the prognosis of patients with NSCLC, new therapeutic targets for overcoming drug resistance are required. The process of autophagy is required to support the tumorigenesis and drug resistance of cancer cells. We investigated the clinical significance of SIRT6, a member of the NAD(+) -dependent deacetylase family, which regulates a variety of cancer-related processes, including autophagy. METHODS: Immunohistochemistry analysis of SIRT6 expression and localization in 98 NSCLC clinical specimens and in vitro analysis using SIRT6-knockout lung carcinoma cell lines were performed. RESULTS: Patients with high cytoplasmic expression and low nuclear expression of SIRT6 (n = 33) had more aggressive cancer, shorter overall survival, and shorter recurrence-free survival than did patients with different SIRT6 expression profiles (P < 0.05). In vitro analysis revealed that SIRT6 knockdown lung adenocarcinoma cell line improved paclitaxel sensitivity (P < 0.05) and reduced the expression levels of both nuclear factor kappaB and autophagy marker Beclin1. CONCLUSION: Our data demonstrated that SIRT6 expression in NSCLC could be a useful prognostic marker and that SIRT6 might represent a novel target gene for predicting sensitivity of chemotherapy in lung adenocarcinoma.

A case of lung adenocarcinoma with postoperative recurrence of multiple bone metastases that showed a gradual complete response to combined administration of erlotinib and zoledronic acid.

We describe a case of lung adenocarcinoma with multiple postoperative bone metastases that showed a gradual but complete response to combined administration of erlotinib and zoledronic acid. A 76-year-old man with moderately differentiated adenocarcinoma underwent a radical left upper lobectomy and mediastinal lymph node dissection. Three and a half years after the operation, serum carcinoembryonic antigen (CEA) was elevated and 18F-fluorodeoxyglucose positron emission tomography (18FDG-PET) revealed multiple bone metastases. Pretreatment evaluation of EGFR mutations in the resected primary adenocarcinoma specimen showed an L858R mutation in exon 21. Gefitinib was started as first-line treatment. However, evaluation 1 month after administration revealed progressive disease. Erlotinib was started as second-line treatment, and evaluation 1 month after administration revealed that the disease was stable. Administration of zoledronic acid was then begun with continuation of erlotinib. After 2 courses of zoledronic acid, the serum CEA level had not changed but the maximum standardized uptake values of each region uniformly decreased. Furthermore, the uptake of 18FDG completely disappeared after 6 courses. Subsequently, the serum CEA level continued to decrease and the disappearance of 18FDG uptake was confirmed after 10 courses (12 months after initiation of erlotinib administration). Our results suggest that the combined administration of both drugs is effective against bone metastases.We experienced a case of lung adenocarcinoma with postoperative recurrence of multiple bone metastases that showed a gradual but complete response to combined administration of erlotinib and zoledronic acid. Our results suggest that the combined treatment of both drugs is an effective therapy against bone metastases.

Thoracoscopic wedge resection through a single incision using a thin puncture device.

Video-assisted thoracic surgery (VATS) has been enthusiastically used as a less-invasive diagnostic or therapeutic surgical procedure in recent years. VATS results in considerably less postoperative pain than traditional thoracotomy incisions. The current trend is to reduce the number of ports and minimize the length of incisions to further reduce postoperative pain, chest wall paresthesia, and length of hospitalization. Although several accounts of reduced port surgery, such as single-incision laparoscopic surgery (SILS), have been reported, there are few descriptions of single-incision thoracoscopic surgery (SITS) using a thin puncture device for a variety of diseases. Herein, we describe a minimally invasive SITS technique using a thin puncture device.

FBXW7 mediates chemotherapeutic sensitivity and prognosis in NSCLCs.

UNLABELLED: Non-small cell lung cancer (NSCLC) is a leading cause of cancer-related deaths worldwide. To improve the prognosis of patients with NSCLCs, new and validated therapeutic targets are critically needed. In this study, we focused on F-box and WD repeat domain containing-7 (FBXW7), an E3 ubiquitin ligase, that regulates the degradation of MCL1, Myc, cyclin E, and TOP2A. Importantly, loss of FBXW7 was associated with increased sensitivity of tumors to a class I-specific histone deacetylase (HDAC) inhibitor, MS-275. Immunohistochemical analysis revealed increased expression of FBXW7 targets, MCL1 and TOP2A, in NSCLC tumors with low expression of FBXW7. Moreover, clinical specimens exhibiting low FBXW7 expression presented with more progressive cancer and significantly shorter cancer-specific survival than patients with high FBXW7 expression. Mechanistic study of NSCLC cell lines with silenced FBXW7 revealed enhanced MS-275 sensitivity and taxol resistance. Interestingly, taxol resistance was eliminated by MS-275 treatment, suggesting the potential of HDAC inhibitors for the treatment of aggressive taxol-resistant NSCLCs that lack FBXW7. IMPLICATIONS: FBXW7 status impacts chemosensitivity and is a prognostic marker in NSCLCs. VISUAL OVERVIEW: http://mcr.aacrjournals.org/content/early/2013/12/19/1541-7786.MCR-13-0341/F1.large.jpg.

Surgical resection of a solitary pulmonary metastasis from basaloid squamous cell carcinoma of the esophagus: a case report.

Basaloid squamous cell carcinoma (BSCC) of the esophagus is a relatively rare variant of esophageal malignancies. It is regarded as a disease with a poor prognosis because of the high frequency of distant metastases. We managed a case of resected solitary pulmonary metastasis of BSCC of the esophagus in a 78-year-old female. We performed curative thoracic esophagectomy with three-field lymph node dissection for her disease. After two years and nine months, a thoracoscopic partial resection of the left lung was performed for the solitary pulmonary metastasis. At present, one year after the surgery, the patient is doing well without any recurrence. There have been few reports of case of resected pulmonary metastases. In addition, no treatment strategy for pulmonary metastases from BSCC of the esophagus has been established because of the limited number of cases. Additional cases are required to determine the treatment method.

Preoperative 18F-fluorodeoxyglucose positron emission tomography can predict the tumor malignancy of small peripheral lung cancer.

PURPOSE: Recent advances in image diagnostic technology have enhanced the discovery of peripheral small size lung cancers. Here, we examined the utility of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) for the evaluation of grade of tumor malignant potency. METHODS: Seventy-nine patients with peripheral small lung cancers (≤2 cm) who underwent surgical resections and preoperative FDG-PET were enrolled. The correlations between the maximum standardized uptake value (SUVmax) and various clinicopathological features related to tumor invasiveness, nodal metastasis, and recurrence were analyzed. RESULTS: The median SUVmax of all tumors was 2.4 (range, 0-16.1). The SUVmax was significantly higher in patients with vascular invasion (5.6 ± 3.5 vs. 2.4 ± 2.4; P <0.0001), lymphatic invasion (4.9 ± 3.7 vs. 2.7 ± 2.6; P = 0.0029), lymph node metastasis (6.1 ± 4.4 vs. 3.0 ± 2.7; P = 0.0022), and recurrences (5.8 ± 3.3 vs. 3.1 ± 3.1; P = 0.0219). Patients with SUVmax ≥2.5 had a significantly higher incidence rate of vascular invasion (56% vs. 7%; P <0.0001), lymphatic invasion (51% vs. 15%; P = 0.0006), lymph node metastasis (26% vs. 3%; P = 0.0033), and recurrence (18% vs. 3%; P = 0.0289). The patients with SUVmax ≥1.5 also had a significantly higher incidence of vascular invasion, lymphatic invasion, lymph node metastasis, and recurrence. It is particularly worth noting that patients with SUVmax <1.5 had no vascular invasion, lymph node metastasis, or recurrence. CONCLUSION: Preoperative SUVmax of peripheral small lung cancers were significantly associated with tumor malignancy.

Podoplanin overexpression in human mesothelioma cell lines enhances the tumorigenic phenotype.

Podoplanin, a small type I integral membrane mucin-type sialoglycoprotein, serves as a useful marker for diagnosing malignant pleural mesothelioma (MPM); however, the physiological function of podoplanin in mesothelioma cells is not known. To elucidate the role of podoplanin in the pathogenesis of MPM, we generated two mesothelioma cell lines (PODO1 and PODO2) that stably express high levels of podoplanin. Although PODO1 cells proliferated to the same extent in culture or in nude mice, the survival rate of the mice was significantly reduced compared with that of the controls. We demonstrated that PODO1 and PODO2 cells had increased invasive ability in in vitro assays and induced upregulation of matrix metalloproteinase-1. PODO1 and PODO2 cultures could not be induced to undergo apoptosis when starved or treated with cis-diamminedichloroplatinum(II) (CDDP) compared with the controls. Moreover, silencing of podoplanin expression using RNA interference restored the ability of CDDP to induce apoptosis. Consistent with their growth properties, we detected constitutive activation of extracellular signal-regulated kinase in PODO1 and PODO2 cultures. These findings suggest that constitutive expression of podoplanin contributes to the invasive growth properties of mesothelioma cells and their resistance to apoptosis. Moreover, our data suggest that podoplanin or components of its signaling pathway, or both, may serve as important targets for developing novel treatments for MPM.

Benign metastasizing leiomyoma of the lung: report of a case.

A 35-year-old female presented with multiple bilateral pulmonary nodules on a chest X-ray during a regular health checkup. Chest computed tomography revealed multiple well-defined nodular shadows in the lung. She had undergone a myomectomy 7 years previously for leiomyoma of the uterus. Thoracoscopic resection of one of the nodules was performed to establish a pathological diagnosis. Pathological findings were consistent with benign metastasizing leiomyoma. Estrogen and progesterone receptors showed strong positives by immunohistostaining of the tumor. The patient is currently receiving outpatient treatment for a benign metastasizing leiomyoma by administration of a GnRH analog drug.

Pulmonary aspergilloma in patient with anorexia nervosa: case report.

A 31-year old female with anorexia nervosa was referred to the Department of General Surgical Science at Gunma University for a surgical resection of a pulmonary aspergilloma. The patient had received treatment for anorexia nervosa at the Department of Psychiatry of the Hospital of Gunma University Graduate School of Medicine. A chest radiograph showed an infiltrative shadow with apical pleural thickening in the left upper lung field. A contrast enhanced computed tomography showed an irregular mass shadow with cavity formation that involved spherical clusters in the left upper lobe. The patient was diagnosed with pulmonary aspergilloma by serological studies and radiological features. A pulmonary segmentectomy of the left apical segment (S1 + 2) through a lateral thoracotomy was successfully performed. She had an uneventful postoperative recovery, and the final histopathological examination confirmed the diagnosis of pulmonary aspergilloma. This is a rare case study of a young female patient with anorexia nervosa who developed pulmonary aspergilloma.

Successful resection of stage IV non-small cell lung cancer with muscle metastasis as the initial manifestation: a case report.

Here, we report a rare case of a 39-year-old male who presented with left forearm pain and swelling as the initial manifestation of non-small cell lung cancer (NSCLC). The patient underwent chemoradiotherapy followed by surgical resection of the primary lesion as a salvage treatment. Four years and 7 months after his first presentation, the patient is alive with no symptoms of recurrence or metastasis. Although the optimal treatment for skeletal muscle metastasis from NSCLC has not been determined, aggressive treatment for the primary and the solitary metastatic lesion could be considered as a potentially successful treatment option.

Surgical resection and reconstruction for a giant cell tumor of the anterior rib.

Giant cell tumors (GCTs) are rare neoplasms, most commonly arising in the metaphysis/epiphysis of long bones. They consist of multinucleated giant cells with surrounding spindle-shaped mononuclear stromal cells. GCTs rarely appear in the ribs. We report a case of a GCT originating from the anterior arc of the fourth rib in a 31-year-old man who presented with a progressively growing thoracic mass in the left anterior chest wall. Thoracotomy involving en bloc resection of the chest wall and tumor and a reconstruction of the chest wall were performed.

Primary mediastinal atypical meningioma: report of a case and literature review.

Meningiomas are common neoplasms arising from the central nervous system meninges. On the other hand, primary ectopic meningiomas are extremely rare and usually limited to the head and neck region or to the paravertebral soft tissues. Their occurrence in the mediastinum is even rarer. Until now, only 4 cases of primary mediastinal meningioma have been reported in the literature searched on Medline. Because of its rarity and intriguing pathogenesis, we report here a case of primary mediastinal meningioma that was treated by surgical resection. The clinical features, treatment, pathological findings, and prognosis are analyzed, and the literature on ectopic meningioma is reviewed.

Pulmonary metastasis from breast cancer with an 18-year disease-free interval: implication of the role of surgery.

The appearance of pulmonary metastasis more than 15 years after primary treatment for breast cancer is rare. We herein report the case of a breast cancer patient with solitary pulmonary metastasis, after an 18-year disease-free period, treated with resection. A 66-year-old Japanese woman was found to exhibit an abnormal shadow on a chest X-ray. She had undergone a left mastectomy for breast cancer 18 years previously. The nodule was suspected to be either metastatic or primary lung cancer, and thus thoracoscopic surgery was performed. The histologic diagnosis was metastasis from breast cancer. Pulmonary resection in breast cancer recurrence is an important diagnostic tool that allows for a differential diagnosis with primary lung cancer. The clinical implication of surgery for a solitary pulmonary metastasis from breast cancer is discussed in this report.