[Resection of chest wall tumors].

Forty-six consecutive patients with chest wall tumors undergoing resection between 1981 and 2012 were analyzed. There were 29 male and 17 female patients, with ages ranging from 15 to 77 years. Seventeen patients had primary malignant neoplasms, 22 had benign tumors, and 7 metastases. The primary malignant tumors were located in the ribs in 16 patients and sternum in one. They were resected en bloc in all patients. Reconstruction was with Gore-Tex( expanded polytetrafluoroethylene:ePTFE) in 13 patients. There was no operative death and 1 hospital death. All patients with benign tumors survived. All patients with metastases died within 3 years. Seven patients with primary malignant neoplasms without reconstruction survived, while 5 of 10 patients undergoing reconstruction died between 5 and 99 months. Aggressive resection for a chest wall tumor with reliable reconstruction can be accomplished safely, and wide resection is a potentially curative treatment.

Fabrication of Langmuir-Blodgett films using amphiphilic peptides.

To introduce self-organization ability of transmembrane proteins into Langmuir (L) and Langmuir-Blodgett (LB) techniques, we focused on "amphiphilic peptide" (AP) which is composed of two distinct hydrophilic and hydrophobic domains. Three types of APs of different average hydropathies were used to prepare the AP/lipid mixed L and LB films. According to the circular dichroism spectra, the secondary structures of APs were not uniform but were a mixture of alpha-helix, beta-strand and random coil. The fraction of alpha-helix was higher for lower hydropathy AP. The interaction between AP and lipid in the L film and the structure of the LB film were also depended on the APs used.

[Surgical treatment for patients aged 80 years or older with primary lung cancer and differences in outcomes according to sex].

This study investigated the characteristics and long-term results of surgical treatment for primary lung cancer in patients aged 80 years or older, mainly based on difference between the sexes. Seventy-four patients aged 80 years or older who underwent surgical resection for primary lung cancer in our institute between 1986 and 2005 were retrospectively reviewed. Fifty-six patients were male and 18 were female. The median age of all patients was 81 years. Twenty-two males (39%) and 5 females (28%) had co-existing diseases preoperatively. Twenty-nine males (52%) and 17 females (94%) had adenocarcinoma. Forty-four males (79%) and 16 females (89%) had pathological stage I disease. Eleven males (20%) and 1 female (6%) developed postoperative complications that adversely affected the patient's morbidity and mortality. There was 1 surgical mortality (1.4%) and 1 hospital mortality (1.4%). The postoperative 5-year survival rate was 23% in 56 males and 58% in 18 females. The 5-year survival rate was 10% in 35 males underwent lobectomy, 58% in 20 males underwent wedge resection, and 70% in 15 females underwent lobectomy. These findings seems to indicate that long-term outcomes for males were worse than those for females. The data suggest that the indication of lobectomy should be more strictly limited in male patients than in female patients aged 80 years or older.

[Thymoma transformed to thymic carcinoma with brain and bone metastases 6 years after recurrence].

We report a man who developed brain and bone metastases 6 years after resection of recurrent thymoma. The patient underwent surgery for B2-thymoma [World Health Organization (WHO) classification] without microscopic capsular invasion at 50-year-old. The next year, he underwent the second surgery for recurrent B2-thymoma as pleural dissemination. Seven months after the second surgery, he developed recurrence of pleural dissemination. The patient refused any further aggressive treatment, including surgery, chemotherapy, and radiotherapy. The pleural disease did not increase over 6 years, then suddenly enlarged. Thereafter, the patient developed left hemiparesis due to brain metastases, followed by bone metastases. Immunochemical studies of the metastatic tumors demonstrated that these lesions seemed to be poorly differentiated thymic carcinoma (small cell carcinoma) on WHO classification. We concluded that the thymoma transformed to thymic carcinoma with brain and bone metastases during 6 years.

[Suturing left main bronchus in difficult lung resection for repeated and massive hemoptysis].

A 79-year-old man with repeated and massive hemoptysis due to bronchiectasis was admitted to our department for surgery. The patient had undergone left upper lobectomy for pulmonary tuberculosis, and descending aortic replacement for Stanford type B aortic dissection. The patient underwent occlusion of the left main bronchus by suturing through median sternotomy. The reasons we did not choose completion pneumonectomy were advanced age, poor physical condition immediately after hemorrhagic shock, and the difficulty of performing pneumonectomy due to previous surgery and anastomotic aneurysm of descending aorta. The postoperative course was uneventful and the patient left the hospital on the 16th postoperative day. The patient did not develop pneumonia or empyema thereafter, but died suddenly of unknown etiology 1.5 years postoperatively. Lung exclusion by suturing a bronchus is thought to be a useful alternative for repeated and massive hemoptysis without pneumonia in a case of difficult lung resection.

[Long-term results after recurrence of completely resected primary lung cancer].

The recurrence rate of complete surgical resection and the long-term results following recurrence have rarely been reported. Whether patients with recurrence could be cured is still unknown. Patients who underwent complete surgical resection for lung cancer from 1981 to 1999 (n=945) and were followed-up for more than 5 years were retrospectively reviewed. Recurrent diseases were treated by chemotherapy and/or radiotherapy when surgical treatment was not indicated. Postoperative 5-year survival in 585 patients (62%) without recurrence and in 360 patients (38%) with recurrent diseases were 84 and 27%, respectively. The recurrence rates of stage I patients (n=164), stage II (n=55), stage III (n=127) and stage IV (n=13) were 26, 52, 68 and 93%, respectively. The 5-year survival rates of these patients were 36, 23, 19 and 7%, respectively. The period between the operation and the first recurrence was approximately 2 (0-9) years and the patients with recurrence died in about 1 (0-9) year. Four patients actually survived more than 10 years after the first recurrence. The recurrence rate after complete surgical resection of lung cancer was 38% in all and it increased along with the advanced pathological stages.

Primary mediastinal lymph node malignancy with features suggestive of dendritic cell sarcoma.

A 56-year-old man underwent preoperative chest computed tomography to further evaluate a well defined mass in the middle lobe with subcarinal lymph node swelling. There was no pathological diagnosis established by either bronchoscopic biopsy specimens or computed tomography-guided percutaneous needle biopsy. The middle lobe and mediastinal lymph nodes were excised, then postoperative radiotherapy (60 Gy) was administered to the mediastinum. Results of histological and immunohistochemical study showed that the lung mass consisted of completely necrotic tissue and that the subcarinal lymph node was involved by malignant cells suggestive of dendritic cell sarcoma. Primary dendritic cell sarcoma of the mediastinal lymph node is extremely rare. Dendritic cell sarcoma is a neoplasm of reticular dendritic origin and includes both follicular dendritic cell sarcoma and interdigitating reticulum (or dendritic) cell sarcoma. These rare neoplasms may pose difficulty in pathologic diagnosis and treatment. Although our patient died of hepatic rupture due to dendritic cell sarcoma or gastric cancer metastases one year after surgery, complete surgical resection with or without postoperative radiotherapy may be an acceptable therapeutic option for localized dendritic cell sarcoma.

Comparative analysis of tumor angiogenesis and clinical features of 55 cases of pleomorphic carcinoma and adenocarcinoma of the lung.

BACKGROUND/AIM: Pleomorphic carcinoma (PC) of the lung is a rare tumor that usually has an aggressive clinical course and a poor prognosis. Clinical and pathological features remain unclear. The aim of this study was to determine whether tumor angiogenesis of PC is up-regulated compared to that in adenocarcinoma (AD). MATERIALS AND METHODS: We collected 55 cases of PC and AD in which the patients had undergone either lung resection or autopsy and immunohistochemically examined the expression of vascular endothelial growth factor (VEGF), hypoxia-inducible factor (HIF)-1α and microvessel density (MVD) in tissue specimens. RESULTS: VEGF was expressed in many cases of both PC and AD with no significant differences between the groups. In contrast, the expression of HIF-1α and MVD were significantly greater in PC than AD. Median survival time of the PC group was 14.7 months and significantly shorter than that of the AD group. CONCLUSION: MVD and expression of HIF-1α are associated with angiogenesis in PC and confer a poorer prognosis. Tumor angiogenesis provides significant prognostic information regarding clinical outcome in patients with PC.

Field survey of sex-reversals in the medaka, Oryzias latipes: genotypic sexing of wild populations.

The medaka, Oryzias latipes, has an XX/XY sex determination mechanism. A Y-linked DM domain gene, DMY, has been isolated by positional cloning as a prime candidate for the sex-determining gene. Furthermore, the crucial role of DMY during male development was established by studying two wild-derived XY female mutants. In this study, to find new DMY and sex-determination related gene mutations, we conducted a broad survey of the genotypic sex (DMY-negative or DMY-positive) of wild fish. We examined 2274 wild-caught fish from 40 localities throughout Japan, and 730 fish from 69 wild stocks from Japan, Korea, China, and Taiwan. The phenotypic sex type agreed with the genotypic sex of most fish, while 26 DMY-positive (XY) females and 15 DMY-negative (XX) males were found from 13 and 8 localities, respectively. Sixteen XY sex-reversals from 11 localities were mated with XY males of inbred strains, and the genotypic and phenotypic sexes of the F(1) progeny were analyzed. All these XY sex-reversals produced XY females in the F(1) generation, and all F(1) XY females had the maternal Y chromosome. These results show that DMY is a common sex-determining gene in wild populations of O. latipes and that all XY sex-reversals investigated had a DMY or DMY-linked gene mutation.

Cytotoxic T-lymphocyte activity specific for hemagglutinin (H) protein of canine distemper virus in dogs.

Cytotoxic T-lymphocyte (CTL) responses to hemagglutinin (H) protein of canine distemper virus (CDV) were evaluated in dogs using the replication-deficient adenovirus protein expression system. Skin fibroblasts were isolated from two dogs and were infected with recombinant adenovirus bearing the CDV-H gene (Ade-CDVH). CTL assay was performed using fibroblasts expressing CDV-H protein as target cells and peripheral blood lymphocytes (PBL) collected from the same dogs one week after immunization of CDV as effector cells. Specific cytotoxic activity was observed against autologous but not heterologous fibroblasts expressing CDV-H protein. These results indicate that the CTL epitope(s) were localized in the H protein.

Successful surgical management of complete tracheal disruption due to penetrating injury.

Successful management of penetrating injury to the trachea is rare, especially in Japan. A 32-year-old female attempted suicide by stabbing herself in the throat with a knife, and at operation the trachea was found to be completely disrupted. A median sternotomy made possible end-to-end anastomosis of the trachea. All other important organs including the great vessels, esophagus, and lungs were intact, but the pleura was open on the right side. The patient was managed under heavy sedation and with controlled ventilation for more than a week postoperatively, because of her suspected mental condition. She was extubated on postoperative day 13 and transferred to a mental hospital on day 16. We concluded that early diagnosis and surgical repair were important for the successful management of this patient with tracheal disruption.

Primary malignant schwannoma of the lung.

A 72-year-old male referred for surgical treatment underwent chest computed tomography to further investigate a well defined mass with a maximal diameter of 3.2 cm at the left S10. There was no pathological diagnosis established by either bronchoscopic biopsy specimens or computed tomography-guided percutaneous needle biopsy. The lower lobe and mediastinal lymph nodes were excised (complete resection). The 6.5-cm encapsulated grayish mass showed extensive areas of hemorrhage and necrosis on cut surface. Results from histological and immunohistochemical study yielded a definitive diagnosis of malignant schwannoma. Primary malignant schwannomas of the lung are extremely rare and the prognosis is poor in most cases. Our patient is currently well without recurrence more than 2 years after complete resection. Complete surgical resection is the best therapeutic option for primary malignant schwannoma of the lung.

[Surgical treatment of pulmonary metastases from colon and rectal cancer].

We retrospectively studied the surgical treatment for pulmonary metastases from colon and rectal cancer. A total of 24 patients (9 males and 15 females; mean age 61 years) underwent 29 thoracotomies for metastatic colon carcinoma, while 22 patients (16 males and 6 females; mean age 63 years) underwent 29 thoracotomies for metastatic rectal cancer. The median interval between the primary procedure and lung resection for metastases was 26 months in the patients with colon carcinoma and 32 months in the patients with rectal cancer. In the patients with colon carcinoma, 16 underwent wedge resection or segmentectomy (including 4 video-assisted procedures) and 13 (54%) underwent lobectomy or pneumonectomy. In the patients with rectal cancer, 15 underwent wedge or segmentectomy (including 1 video-assisted procedure), 13 (59%) underwent lobectomy or pneumonectomy, and 1 underwent exploratory thoracotomy. All procedures except exploratory thoracotomy were curative operations. There was no mortality. Overall 5-year survival was 56% (n=46). Five-year survival was 65% for patients with colon metastases (n=24) and 45% for patients with rectal metastases (n=22), and there was no significant difference. Recurrent sites were 4 lungs (36%), 4 livers (36%), 1 bone, 1 uterus, and 1 peritoneum in patients with colon carcimoma, and 10 lungs (43%), 5 brains (22%), 3 livers (13%), 1 bone, and 1 vagina in patients with rectal cancer. Pulmonary resection for metastases from colon carcinoma may have better prognosis than that from rectal cancer. However, further investigation may be required to obtain convincing conclusions.

Limited resection for noninvasive bronchioloalveolar carcinoma diagnosed by intraoperative pathologic examination.

BACKGROUND: The establishment of limited resection procedures for non-small cell lung cancer is expected. Many groups have suggested noninvasive bronchioloalveolar carcinoma (BAC) to be a potential indication for limited resection. METHODS: We designed a prospective phase II study evaluating limited resection for noninvasive BAC diagnosed by intraoperative pathologic examination. From 1999 to 2007, limited resection was the procedure in 46 patients (16 men and 30 women; median age, 69 years; range, 49 to 83) who were diagnosed intraoperatively as having noninvasive BAC. The first end point was the predictive value of the intraoperative pathologic examination for noninvasive BAC diagnosis. The second end point was overall survival, disease-free survival, and cancer-specific survival, calculated using the Kaplan-Meier method. RESULTS: We performed wedge resections for 44 patients and segmentectomy for 2 patients. Permanent pathologic examination revealed 3 patients had primary lung adenocarcinomas other than noninvasive BAC. The predictive value of intraoperative pathologic examination for noninvasive BAC diagnosis was 94%. During a median 51-month follow-up, there were only 2 cancer unrelated deaths. The 5-year overall survival rate and the disease-free survival rate were 93%, and the 5-year cancer-specific survival rate was 100%. CONCLUSIONS: The results of our prospective phase II study indicate that limited resection, mainly by wedge resection, is a potentially curative surgical procedure and may be an acceptable alternative to lobectomy for patients with noninvasive BAC. Furthermore, an intraoperative pathologic diagnosis of noninvasive BAC is strongly predictive and allows for an intraoperative decision to perform a limited resection in these patients.

Multiple brown tumors in primary hyperparathyroidism caused by an adenoma mimicking metastatic bone disease with false positive results on computed tomography and Tc-99m sestamibi imaging: MR findings.

We encountered an unusual case of hyperparathyroidism with both hemosiderin deposits on the ribs and low intensity on T2-weighted magnetic resonance imaging (MRI) caused by a parathyroid adenoma with multiple brown tumors that mimicked metastatic bone tumor due to false positive results on computed tomography (CT) and Tc-99m sestamibi (MIBI) imaging. The patient, a middle-aged woman, had very high serum levels of calcium (14.1 mg/dl), alkaline phosphatase (9,369 IU/l) and intact-PTH (12,400 pg/ml), and a large tumor (2.5 cm in diameter) in the lower portion of the left lobe of the thyroid. Plain X-ray revealed a soft tumor in the left chest wall. On CT scan, there were multiple destructive masses in the ribs, including large intramedullary masses on both 3rd ribs. On MIBI scintigraphy, there was strong late uptake in the lower portion of the left cervical region, both 3rd ribs, and the left 7th, 8th, and 10th ribs. T2-weighted image MRI scans showed that both 3rd ribs had a low intensity with hemosiderin deposits. These findings suggested that the patient had hyperparathyroidism with multiple bone metastases due to carcinoma of the parathyroid gland. However, on pathology, the resected tumor of lower portion of the left lobe of thyroid was diagnosed as a parathyroid adenoma, and the tumors of the left 3rd and 7th ribs, as well as the right 2nd rib, were shown to be brown tumors. After resection, the patient's serum levels of calcium, alkaline phosphatase, and intact-PTH normalized. At 1.5-years follow-up, CT, MIBI, and MRI scans showed no abnormal findings. It is necessary to determine whether MRI can be used to distinguish between brown tumors and metastases caused by carcinoma of the parathyroid gland.