Clinicopathological features and prognostic impact of dirty necrosis in metastatic lung cancers from the colon and rectum.

Dirty necrosis (DN) is a form of tumor necrosis (TN) with prominent neutrophil infiltration and cell detritus in the necrotic foci. This study aimed to characterize the clinicopathological features of DN in metastatic lung cancers of the colon and rectum (MLCRs). A total of 227 patients who underwent pulmonary metastasectomy and complete resection for MLCR were included in this study. TN was evaluated using digitally scanned resection specimens. These slides were immunostained for biomarkers of NETosis (citrullinated histone H3 [citH3] and myeloperoxidase [MPO]), and the area positive for citH3 and MPO was further quantified. TN was observed in 216 cases (95.2%), and 54 (25.0%) of these cases had DN. The presence of TN was not associated with a worse prognosis; however, patients with DN had a significantly shorter overall survival than those without DN (p < 0.01). Furthermore, the presence of DN was a poor prognostic factor in both the univariate and multivariate analyses. Immunohistochemical analysis revealed that the percentage of citH3-positive and MPO-positive areas in the DN-positive cases was significantly higher than that in the DN-negative cases (p < 0.01 and p < 0.01, respectively). In surgically resected MLCR, DN is the characteristic TN subtype associated with poor prognosis and neutrophil extracellular traps (NETs).

Penetrating chest trauma in Sauer's danger zone without serious heart or lung damage: An unusual case report.

INTRODUCTION AND IMPORTANCE: Sauer's danger zone is an area on the anterior chest where trauma is considered to cause heart and macrovascular injury. Herein, we report the case of an injured patient showing evidently fatal findings on chest radiography and computed tomography (CT) presenting almost no actual fatal injuries on surgical examination. CASE PRESENTATION: The patient was an 86-year-old man who was found by a family member with a 30-cm knife blade stuck in his left front chest (Sauer's danger zone). On chest CT findings, the knife was observed to be inserted through the 4th intercostal space, penetrating the lungs. The tip of the knife appeared to be anchored to the dorsal side of the 9th intercostal space. CLINICAL DISCUSSION: We found no damage to the heart, only a 2-cm-long and 1-cm-deep cut in the lingular segment area. CONCLUSION: We confirmed that the amount of bleeding in the inserted drain was an indicator of non-macrovascular injury. In cases of chest trauma, chest tube drainage and hemodynamics should always be observed, and the potential need for emergency surgery should be considered.