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Traumatic tracheal injuries are rare, but life-threatening. A 20-year-old man who became recluse stabbed in his neck by a kitchin knife for the purpose of suicide and was transferred to our hospital. He had stabbed wound about 8 cm in length in his anterior neck. No injury of lung, esophagus, cervical vessels was seen by cervical and chest enhanced computed tomography (CT). Emergency surgery was performed. Exploration of his neck revealed almost all of cartilage of trachea was cut in the hight just caudal to cricoid cartilage. The membranous portion of trachea was not injured. The cartilage of trachea was sutured. He was extubated on the 6th postoperative day and discharged on the 35th postoperative day. No injuries to his cervical vessels or esophagus must have contributed to his good postoperative course.j.
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Intento de Suicidio , Tráquea , Masculino , Humanos , Adulto Joven , Adulto , Tráquea/diagnóstico por imagen , Tráquea/cirugía , Tráquea/lesiones , Esófago , Tomografía Computarizada por Rayos X , TóraxRESUMEN
AIMS: Podoplanin expression in cancer-associated fibroblasts (CAFs) has been proposed as an unfavourable indicator in squamous cell carcinoma of the lung, but little is known about its clinical significance in early-stage lung adenocarcinoma. We evaluated the prognostic impact of podoplanin expression in patients with pathological stage (p-stage) IA lung adenocarcinoma as categorised by the 8th edition of the tumour-node-metastasis classification for lung cancer. METHODS AND RESULTS: Immunohistochemical analyses using anti-podoplanin antibody were performed on resected specimens from 158 patients with p-stage IA lung adenocarcinoma. When more than 10% of cancer cells or CAFs showed immunoreactivity with podoplanin, the specimens were classified as podoplanin-positive. Podoplanin-positive status in cancer cells (n = 8) was not correlated with clinicopathological factors or with patient prognosis. Podoplanin-positive status in CAFs (n = 41) was correlated significantly with poorer tumour differentiation (P < 0.001), the presence of lymphatic invasion (P < 0.001) and high-grade (solid and/or micropapillary) components constituting ≥1% of the entire tumour (P < 0.001). The log-rank test showed that podoplanin-positive status in CAFs was associated significantly with shorter disease-free survival (DFS) (P < 0.001) and disease-specific survival (P = 0.015). In Cox's multivariate analysis, podoplanin-positive status in CAFs had the most significant effect on shorter DFS [hazard ratio (HR) = 4.411, P = 0.004], followed by the presence of high-grade components (HR = 3.581, P = 0.013). CONCLUSIONS: Podoplanin expression in CAFs could be an independent predictor of increased risk of recurrence in patients with p-stage IA lung adenocarcinoma.
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Adenocarcinoma/patología , Biomarcadores de Tumor/análisis , Fibroblastos Asociados al Cáncer/patología , Neoplasias Pulmonares/patología , Glicoproteínas de Membrana/biosíntesis , Adenocarcinoma/mortalidad , Adenocarcinoma del Pulmón , Anciano , Supervivencia sin Enfermedad , Femenino , Humanos , Estimación de Kaplan-Meier , Neoplasias Pulmonares/mortalidad , Masculino , Glicoproteínas de Membrana/análisis , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , PronósticoRESUMEN
In addition to conventional video-assisted thoracic surgery(VATS)as minimallyinvasive surgeryfor lung cancer, medical insurance system of robot-assisted thoracoscopic surgery(RATS)byusing da Vinci Surgical System®(DVSS)is just adapted from this spring. Although VATS is widelydiffused in clinical practice, it is recommended as grade C1(considerable)in the latest lung cancer medical guideline. On the other hand, it has been noticed that RATS is attractive and expected to cover the disadvantages of conventional VATS. In the comparison of both VATS and RATS lobectomyfor lung cancer, theyhave been reported to be comparable in safetyand efficacy, but RATS is superior at the viewpoint of good operabilityand faster learning curve. However, high costs and the longer operative time in RATS are of a concern. Experience of RATS is still in the initial phase, however from now on RATS is graduallyinfiltrating and expected to demonstrate the improvement of perioperative outcome. Especially, manyinstitutes have just began to introduce robotic surgeryin general thoracic field after the adaption of medical insurance. So, safetyand sure spread of RATS is an urgent and important issue in our field. Of course, while coexisting with VATS, it is important to verifythe efficacyof RATS.
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Neoplasias Pulmonares , Cirugía Torácica Asistida por Video , Humanos , Neoplasias Pulmonares/cirugía , Tempo Operativo , Neumonectomía , Estudios RetrospectivosRESUMEN
PURPOSE: We investigated the efficiency of the Simplified Comorbidity Score (SCS) for predicting postoperative complications and prognosis in elderly patients undergoing video-assisted thoracoscopic surgery (VATS) for lung cancer. METHODS: We reviewed 216 patients aged 75 years or older, who underwent pulmonary resection by VATS for lung cancer between January, 2005 and December, 2012. The SCS assigns different scores to patients' comorbidities; namely, smoking (n = 7); diabetes mellitus (n = 5); renal insufficiency (n = 4); and respiratory, neoplastic, and cardiovascular comorbidities or alcoholism (n = 1 each). Patients were divided into a high SCS group (SCS ≥ 9; n = 154) and a low SCS group (<9; n = 62), for a comparative analysis of differences in perioperative factors and prognoses. RESULTS: Limited resection was more frequent in the high SCS group (58 %) than in the low SCS group (40 %; P = 0.02). Postoperative complications were more frequent in the high SCS group (45 %) than in the low SCS group (15 %; P < 0.01). A logistic regression analysis revealed that a high SCS was significantly predictive of postoperative complications (odds ratio 2.7; P = 0.02). The 5-year overall survival rate was 79 % for the low SCS group and 52 % for the high SCS group (P < 0.01). CONCLUSIONS: The SCS can predict the likelihood of postoperative complications and prognosis of elderly patients with VATS-treated lung cancers.
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Carcinoma de Pulmón de Células no Pequeñas/epidemiología , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Neoplasias Pulmonares/epidemiología , Neoplasias Pulmonares/cirugía , Neumonectomía/métodos , Complicaciones Posoperatorias/epidemiología , Cirugía Torácica Asistida por Video , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/epidemiología , Comorbilidad , Diabetes Mellitus/epidemiología , Femenino , Predicción , Humanos , Masculino , Prevalencia , Pronóstico , Insuficiencia Renal/epidemiología , Estudios Retrospectivos , Fumar/epidemiologíaRESUMEN
We experienced 2 cases of Müllerian cyst. Case 1 was a 48-year-old woman with a paravertebral cystic tumor. The tumor grew from 23 to 31 mm in diameter for the 3 years. She underwent video-assisted thoracic surgery(VATS) for the excision of the tumor. Case 2 was a 40-year-old woman with a paravertebral cystic tumor, who underwent VATS. The Histological finding showed that the tumors of both cases were the cysts lined by non-stratified cuboidal to columnar epithelium and epithelial cells were positive in the nucleus with estrogen receptor immunohistochemically. The resected cysts were finally diagnosed as Müllerian cyst. Twenty four published cases of Müllerian cyst were reported before, including symptomatic and growing cases. There were some reports of malignant transformation in cases of pelvic origin.
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Quiste Mediastínico/cirugía , Conductos Paramesonéfricos/cirugía , Adulto , Femenino , Humanos , Imagen por Resonancia Magnética , Quiste Mediastínico/diagnóstico por imagen , Quiste Mediastínico/patología , Persona de Mediana Edad , Conductos Paramesonéfricos/diagnóstico por imagen , Conductos Paramesonéfricos/patología , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Background The aim of this study is to evaluate cases with locoregional recurrence after video-assisted thoracoscopic surgery (VATS) for primary lung cancer. Methods We reviewed 248 patients with primary lung cancer who underwent lobectomy or segmentectomy with mediastinal lymph node dissection by VATS between January 2005 and December 2011. Locoregional recurrence is defined as per its occurrence in (1) bronchial stump or lung parenchymal cut end, (2) ipsilateral pleura, and (3) ipsilateral hilar and mediastinal lymph nodes, and we analyzed recurrence rate and significant associated factors for locoregional recurrence by logistic regression analysis. Results There were 47 cases of postoperative recurrence, which consisted of 26 distant, 6 locoregional and distant, and 15 locoregional recurrences. The locoregional recurrence rate was 6.0%. Of the 15 locoregional recurrence cases, there were two cases of bronchial stump and lung parenchyma cut end (0.4%), five cases of ipsilateral pleura (2.0%), and eight cases of ipsilateral hilar and mediastinal lymph nodes (3.2%). Pleural and lymphovascular invasion and advanced stages were significant associated factors in univariate analysis. Multivariate analysis revealed that advanced stages were only a significant associated factor for locoregional recurrence (p < 0.01, odds ratio: 3.3). Conclusion Although locoregional recurrence rates of our surgical treatments for primary lung cancer by VATS might be acceptable, we should explore more effective modalities against pathologically proven local advanced lung cancer for preventing not only distant but also locoregional recurrences.
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Adenocarcinoma/cirugía , Carcinoma de Células Escamosas/cirugía , Neoplasias Pulmonares/cirugía , Recurrencia Local de Neoplasia , Neumonectomía/métodos , Cirugía Torácica Asistida por Video , Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/patología , Adenocarcinoma del Pulmón , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/patología , Femenino , Humanos , Modelos Logísticos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/patología , Escisión del Ganglio Linfático , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estadificación de Neoplasias , Oportunidad Relativa , Neumonectomía/efectos adversos , Estudios Retrospectivos , Factores de Riesgo , Cirugía Torácica Asistida por Video/efectos adversos , Factores de Tiempo , Resultado del TratamientoRESUMEN
As the use of robotic surgery has widely spread, its usefulness in the field of general thoracic surgery needs to be verified. The biggest advantage of robotic surgery is the remarkably free movement of joint-equipped robotic forceps under 3-dimensional high vision. An accurate operation makes complex procedures straightforward and may overcome the disadvantages of previous thoracoscopic surgery. Robotic surgery for lung cancer has been safely introduced, and the initial results have been favorable. While still at the stage of clinical research, it is expected to be useful in hilar exposure, lymph node dissection, and suturing of lung parenchyma or bronchus. We considered robotic surgery for lung cancer surgery because of its ability to facilitate both thoracotomy and minimally invasive video-assisted thoracic surgery. Robotic thoracic surgery has not been sufficiently examined for its usefulness, and other major issues such as safety management, education, and significant cost need to be addressed. However, it may become an extension of thoracoscopic surgery, and studies showing its usefulness for primary lung cancer have been increasing. Two urgent issues are its use in advanced medical care and national heal th insurance coverage.
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Neoplasias Pulmonares/cirugía , Procedimientos Quirúrgicos Robotizados , Humanos , Procedimientos Quirúrgicos Mínimamente Invasivos , Procedimientos Quirúrgicos Robotizados/instrumentaciónRESUMEN
A 74-year-old female consulted a local clinic with bloody sputum and dyspnea. Bronchoscopy revealed a tumor with â¼80% stenosis in the trachea. She was referred to our hospital. Biopsy findings suggested primary rhabdomyosarcoma of the trachea. Cervical computed tomography (CT) revealed a tumor involving the 3rd to 9th tracheal cartilages. Tubular resection of the 3rd to 9th tracheal cartilages and tracheal reconstruction were performed. Finally, a pathological diagnosis of rhabdomyosarcoma was made. Primary rhabdomyosarcoma of the trachea is extremely rare.
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Procedimientos de Cirugía Plástica/métodos , Rabdomiosarcoma/diagnóstico , Rabdomiosarcoma/cirugía , Neoplasias de la Tráquea/diagnóstico , Neoplasias de la Tráquea/cirugía , Traqueotomía/métodos , Anciano , Broncoscopía/métodos , Disnea/etiología , Femenino , Hemoptisis/etiología , Humanos , Rabdomiosarcoma/complicaciones , Tomografía Computarizada por Rayos X , Neoplasias de la Tráquea/complicaciones , Resultado del TratamientoRESUMEN
Intractable pneumothorax with poor lung function that has received multiple conservative treatments may occur. Case 1 was a 70-year-old woman with aspergilloma who was admitted for pneumothorax. Case 2 was a 68-year-old man with acute exacerbation of interstitial pneumonia who developed pneumothorax. In both cases, multiple conservative therapies were administered, but the leak continued; thus, operations using veno-venous extracorporeal membrane oxygenation (ECMO) were planned. By video-assisted thoracoscopic surgery (VATS), we obtained the optimal surgical field by lung collapse. We removed many blood clots that were used for pleurodesis, ligated the bulla in case 1, and covered the leak point with strengthening agents in case 2. For cases of intractable pneumothorax, lung collapse by ECMO is advantageous because we can check details and leak points even in blood clots or in poor condition of the lung, and we can maneuver the lung in poor condition with a clear surgical field.
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A 51-year-old woman was admitted to our hospital because of pneumonia after chemotherapy with doxorubicin and cyclophosphamide for left breast cancer. The patient was diagnosed with Mycobacterium abscessus pulmonary infection by the detection of M. abscessus complex (MABC) in sputum cultures. However, MABC is intrinsically resistant to most of the antibacterial agents, and MABC pulmonary disease outcomes with modern antibiotic treatment are currently the worst among all mycobacterial species. We herein report the successful treatment of M. abscessus pulmonary infection by a combination treatment with antibiotics and surgical lung resection.
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BACKGROUND AND OBJECTIVE: The Japanese Respiratory Society recently proposed 'lung age' as an easily understood concept of respiratory function. In this study, we evaluated whether 'lung age' could be a useful predictor of post-operative respiratory complications and survival patients with lung cancer treated surgically. METHODS: The study recruited 308 patients who underwent surgery for primary non-small-cell lung cancer. All patients had preoperative pulmonary function testing. 'Lung age' was determined using the methods advocated by the Japanese Respiratory Society. Based on the difference between 'real age' (R) and 'lung age' (L), patients were classified into five groups: group A: R-L > 15 (n = 37), B: 5 < R-L
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Envejecimiento/patología , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/cirugía , Pulmón/patología , Complicaciones Posoperatorias/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Envejecimiento/fisiología , Carcinoma de Pulmón de Células no Pequeñas/patología , Femenino , Volumen Espiratorio Forzado , Humanos , Incidencia , Japón , Pulmón/fisiopatología , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Análisis Multivariante , Valor Predictivo de las Pruebas , Pronóstico , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
This report presents a rare case of lung adenocarcinoma accompanied by partial spontaneous regression (SR). A 69-year-old woman with an abnormal shadow on chest X-ray was admitted to the hospital. She was diagnosed to have lung adenocarcinoma with right adrenal metastasis based on a thorough examination. However, a month after the diagnosis, the primary and metastatic lesions markedly shrank on the following computed tomography scan and (18)F-fluorodeoxyglucose positron emission tomograph. This was thought to be a partial SR of the cancer, and she was treated with a surgical procedure. She has since remained free of disease for 14 months after the surgery.
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Adenocarcinoma/diagnóstico por imagen , Neoplasias Pulmonares/diagnóstico por imagen , Remisión Espontánea , Adenocarcinoma/cirugía , Anciano , Femenino , Humanos , Neoplasias Pulmonares/cirugía , Radiografía , CintigrafíaRESUMEN
The Japanese Respiratory Society (JRS) recently proposed 'lung age' as an easily understood concept of respiratory function. In this study, we evaluated whether 'lung age' could be a useful predictor of post-operative respiratory complications and survival patients with lung cancer treated surgically. The study recruited 308 patients who underwent surgery for primary non-small cell lung cancer. All patients had pre-operative pulmonary function testing. 'Lung age' was determined using the methods advocated by the JRS. Based on the difference between real age' (R) and 'lung age' (L), patients were classified into five groups: group A: R-L > 15 (n = 37), B: 5 < R-L < or = 15 (n = 50), C: -5 < or = R-L < or = 5 (n = 73), D: -15 < or = R-L < -5 (n = 54), E: -15 > R-L (n = 94). Clinicopathological factors, post-operative respiratory complications and survival were compared between the groups. Gender, smoking status and index, histology, operative approach and FEV1 were significantly associated with the group classification. The incidence of complications was significantly higher in group E compared with other groups (p < 0.01). Multivariate analysis showed that the group classification by 'lung age' was an independent predictor of postoperative respiratory complications (p = 0.02). Overall survival differed significantly between the groups (p = 0.03). 'Lung age' could be useful for the prediction of post-operative respiratory complications and survival in patients with lung cancer treated surgically.
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Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/cirugía , Pruebas de Función Respiratoria , Anciano , Femenino , Humanos , Masculino , Complicaciones PosoperatoriasRESUMEN
OBJECTIVES: Robot-assisted thoracoscopic surgery (RATS) for primary lung cancer has been spreading rapidly in Japan. While RATS has various technical advantages over video-assisted thoracoscopic surgery (VATS), the quality of surgery from an oncologic viewpoint must be maintained, and the evaluation of medium- to long-term survival outcomes is momentous. METHODS: This study included 299 patients with primary lung cancer (VATS, n = 246; RATS, n = 53) who underwent lobectomy and mediastinal lymph node dissection at our hospital. We reviewed and compared perioperative factors, the number of dissected lymph nodes, and postoperative recurrence between the VATS and RATS groups. We also compared the postoperative survival rates among 98 patients (49 patients in each group) whose background factors were adjusted by propensity score matching (PSM). RESULTS: After PSM, a significant difference was found in the total operative time between the two groups (p < 0.01); however, no difference was found between the RATS console time and VATS total operative time (p = 0.68). Postoperative recurrence was not significantly different between the groups (VATS, 14%; RATS, 6%; p = 0.18). The 3-year recurrence-free survival rate was not significantly different between the groups (VATS, 91.7%; RATS, 91.2%; p = 0.21). CONCLUSIONS: RATS had promising survival results, which were similar to those of VATS even after PSM. Further case series and longer observation periods are needed to determine what technical benefits of RATS may affect the prognosis of lung cancer.
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Neoplasias Pulmonares/cirugía , Neumonectomía/métodos , Robótica/instrumentación , Cirugía Torácica Asistida por Video/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Japón/epidemiología , Neoplasias Pulmonares/mortalidad , Masculino , Persona de Mediana Edad , Tempo Operativo , Periodo Posoperatorio , Pronóstico , Puntaje de Propensión , Tasa de Supervivencia/tendencias , Factores de TiempoRESUMEN
BACKGROUND: The purpose of this study was to investigate the relationship between preoperative FDG-PET parameters and the World Health Organization (WHO) classification or Masaoka staging system of thymic epithelial tumors. METHODS: We retrospectively reviewed 32 patients with histologically proven thymic epithelial tumors who underwent FDG-PET/CT before surgical resection. FDG-PET parameters, including the maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolytic activity (TLG), were measured. These PET parameters were compared in the Masaoka staging system and WHO classification. A receiver operating characteristics (ROC) analysis was performed to identify the cut-off values of PET parameters for the accurate differentiation of early and advanced stages in the Masaoka staging system. RESULTS: There were 17 low-risk thymomas (1 type A, 9 type AB, and 7 type B1), 8 high-risk thymomas (4 type B2 and 4 type B3), and 7 thymic carcinomas (7 squamous cell carcinoma). Their Masaoka stages were as follows: 24 in the early stage (stages I and II) and 8 in the advanced stage (stage III). Regarding the WHO classification, only SUVmax showed a significant difference (P < 0.05). In the Masaoka stage, all PET parameters were significantly higher in the advanced stage than in the early stage (P < 0.05). In the ROC analysis to predict the early and advanced stages in thymic epithelial tumors, the area under the curve was the highest for TLG among the PET parameters examined and the cut-off value of TLG for discriminating the early from advanced stage with maximal sensitivity and specificity was 30.735. CONCLUSION: Although volumetric PET parameters, such as MTV and TLG, did not correlate with the WHO classification, a significant correlation was observed between SUVmax and the WHO classification. In the Masaoka staging system, volumetric PET parameters may achieve more precise staging than SUVmax.
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According to the World Health Organization classification, neoplasms with perivascular epithelioid cell differentiation (PEComas) are mesenchymal tumors composed of histologically and immunohistochemically distinctive PEC. Generally, nearly all PEComas have immunoreactivity for both melanocytic (HMB-45 and/or melan A) and smooth muscle (actin (SMA) and/or desmin) markers. Recently the authors reported that benign clear cell sugar tumor of the lung, one of the PEComas, expressed CD1a. Therefore the purpose of the present study was to investigate the relationship between PEComas and CD1a expression. Nineteen PEComas were obtained, which included angiomyolipoma of the kidney or liver, lymphangiomyomatosis of the uterus or lung and clear cell sugar tumor of the lung. Eighteen tumors had alpha-SMA and HMB-45 expression and 16 had melan A expression. In contrast, all 19 tumors had CD1a expression. The present study confirms CD1a expression in many cases of PEComa. These data suggest that CD1a expression can be an additional new marker for PEComas and also supports the distinct and integrated disease entity of PEComas.
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Antígenos CD1/metabolismo , Biomarcadores de Tumor/metabolismo , Células Epitelioides/metabolismo , Neoplasias de los Tejidos Conjuntivo y Blando/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Células Epitelioides/patología , Femenino , Humanos , Técnicas para Inmunoenzimas , Masculino , Persona de Mediana Edad , Neoplasias de los Tejidos Conjuntivo y Blando/patologíaRESUMEN
BACKGROUND/AIMS: The aim of this study was to clarify the role of the additional Hassab's operation to hepatectomy in cirrhotic patients with resectable hepatocellular carcinomas and esophagogastric varices. METHODOLOGY: Subjects were 36 cirrhotic patients with hepatocellular carcinomas and concomitant esophagogastric varices: 20 underwent hepatectomy alone (non-Hassab group) and 16 underwent hepatectomy with Hassab's operation (Hassab group). RESULTS: Patients in the Hassab group had more advanced esophageal varices and the accompanied gastric varices, preoperatively (p<0.01). Both preoperative platelet counts (p<0.01) and prothrombin time (p<0.05) were significantly lower in the Hassab group, and serum albumin level also tended to be worse than those in the non-Hassab group. Portal pressure was significantly higher in the Hassab group (p<0.01). Despite these disadvantages, no significant differences were found in operative mortality, postoperative courses and long-term prognosis between the two groups. Comparing the cause of death, the incidence of the fatal variceal hemorrhage was significantly lower (0%) in the Hassab group than that (25%) in the non-Hassab group (p<0.05). CONCLUSIONS: This study suggested that additional Hassab's operation to hepatectomy might have reduced the risk of variceal hemorrhage after hepatectomy.
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Carcinoma Hepatocelular/cirugía , Várices Esofágicas y Gástricas/cirugía , Hepatectomía , Cirrosis Hepática/cirugía , Neoplasias Hepáticas/cirugía , Esplenectomía , Anciano , Carcinoma Hepatocelular/patología , Causas de Muerte , Várices Esofágicas y Gástricas/mortalidad , Várices Esofágicas y Gástricas/patología , Femenino , Humanos , Cirrosis Hepática/mortalidad , Cirrosis Hepática/patología , Neoplasias Hepáticas/patología , Masculino , Persona de Mediana Edad , Estómago/irrigación sanguínea , Resultado del TratamientoRESUMEN
We experienced a case in which a pulmonary arteriovenous fistula was found due to the occurrence of cerebral infarction. The patient was a 65-year-old female who had seen a local doctor for lightheadedness occurring upon rising in the morning. She underwent a cerebral MRI and was diagnosed to have a cerebral infarction. Upon closer examination, a chest radiograph revealed an abnormal shadow and a three-dimensional computed tomography (3D-CT) chest angiography detected a pulmonary arteriovenous fistula 32x30 mm in size with the feeder blood vessel A10 and drainer blood vessel V10 in the left inferior lobe S10, which was considered to be the cause of the cerebral infarction. Video-assisted thoracic surgery (VATS) was conducted for a segmental resection of the basal segment of the left lung. The patient's postoperative progress was good and there was no reoccurrence of the cerebral infarction. The rate of occurrence of cerebral infarction along with pulmonary arteriovenous fistula is considered to be 11.4%; however, cerebral infarction may be an early indicator of pulmonary arteriovenous fistula, and therefore, due attention must be paid.
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Fístula Arteriovenosa/cirugía , Infarto Cerebral/etiología , Cirugía Torácica Asistida por Video , Anciano , Fístula Arteriovenosa/complicaciones , Fístula Arteriovenosa/diagnóstico por imagen , Infarto Cerebral/diagnóstico , Angiografía Coronaria , Femenino , Humanos , Imagenología Tridimensional , Imagen por Resonancia Magnética , Arteria Pulmonar , Venas Pulmonares , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Ectopic ACTH-producing thymic carcinoid tumors are rare, but often behave aggressively with local invasion and distant metastasis. We herein report a case of ACTH-producing thymic typical carcinoid tumor with lymph node metastasis treated by surgery and postoperative radiation therapy. CASE PRESENTATION: A 61-year-old woman was admitted to be evaluated for hypoglycemia and hypokalemia. Laboratory data revealed elevation of serum cortisol and ACTH levels. Overnight administration of 8 mg dexamethasone did not suppress plasma ACTH. Chest CT demonstrated a tumor of 30 mm in diameter and enlargement of the lymph node at the anterior mediastinum. Ectopic ACTH syndrome was suspected and total thymectomy and lymph node dissection were performed. The histopathological examination indicated typical carcinoid tumor and mediastinal lymph node metastasis, and immunohistochemical staining was positive for ACTH. The plasma ACTH level decreased immediately after surgery. She received postoperative radiation therapy of 60 Gy. CONCLUSION: Ectopic ACTH-producing thymic typical carcinoid tumors are rare, and it is important to consider this disease and perform appropriate treatment.
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BACKGROUND/AIM: Maspin is a tumor-suppressor protein and its prognostic value in lung adenocarcinoma has been reported. However, little is known about the clinical impact of subcellular localization of maspin in early-stage lung adenocarcinoma. We aimed to evaluate the clinical significance of subcellular localization of maspin in patients with pathological stage (p-stage) IA lung adenocarcinoma categorized by the new eighth edition TNM classification. PATIENTS AND METHODS: We immunohistochemically analyzed 181 tissue samples from p-stage IA1 (n=37), IA2 (n=92) and IA3 (n=52) lung adenocarcinomas using antibody for maspin. RESULTS: The 181 cases fell into five predominant subtypes: lepidic (n=32), acinar (n=97), papillary (n=30), solid (n=20) and micropapillary (n=2). The frequencies of maspin staining were: cytoplasmic-only in 24.9%; pancellular (nuclear and cytoplasmic) in 8.8%; nuclear-only in 0.6%; no staining in 65.7%. Cytoplasmic-only staining significantly correlated with high pathological T-classification (p=0.039), lymphatic invasion (p=0.002) and poorer tumor differentiation (p=0.002). The patients were followed-up for 12-151 months (median=74 months), and the cytoplasmic-only staining significantly correlated with shorter disease-free survival (DFS) (p=0.034) and disease-specific survival (DSS) (p=0.036) by log-rank tests. In Cox's multivariate analysis, lymphatic invasion had the most significant effect on shorter DFS and DSS. CONCLUSION: The expression of maspin in the cytoplasm alone could be useful for predicting unfavorable prognoses in patients with p-stage IA lung adenocarcinoma.