[Clinical study of forty-two patients who underwent resection for pulmonary adenosquamous carcinoma].

Pulmonary adenosquamous carcinoma is a rare malignant tumor as defined by the Japan Lung Cancer Society Classification. At our institution, of the 1,023 patients who underwent resection for primary lung cancer, 42 (4.0%) had adenosquamous carcinoma. Here, we present the clinical features of this malignant tumor. The male : female ratio was low. Many tumors were located peripherally, and the positive rate for carcinoembryonic antigen (CEA) was 54.8%; these clinical findings were similar to those of adenocarcinoma. On the other hand, many tumors had relatively large diameter, and most of the patients were heavy smokers; these findings were consistent with those of squamous cell carcinoma. Hence, the cases of adenosquamous carcinoma had the characteristics of both adenocarcinoma and squamous cell carcinoma. The prognosis of patients with adenosquamous carcinoma was poorer than those of patients with adenocarcinoma and those with squamous cell carcinoma, irrespective of whether it was stages I or II. Adenosquamous carcinoma is characterized by a highly aggressive biological behavior and a high rate of early metastasis. Therefore, even if the diagnosis is made at an early phase, an aggressive approach, including adjuvant chemotherapy, might be necessary for adenosquamous carcinoma.

Lymphatic vessel invasion is a significant prognostic indicator in stage IA lung adenocarcinoma.

BACKGROUND: A radical resection is considered to be the most effective treatment for resectable non-small cell lung cancer. However, even when resected in early stages (T1aN0, T1bN0) up to 20% of patients will experience recurrence. The aim of this retrospective study was to evaluate the prognostic influence of lymphatic vessel invasion (LVI) in stage IA adenocarcinoma patients. METHODS: From January 1983 to June 2003, a total of 229 consecutive patients with pT1a or T1b N0 M0 lung adenocarcinoma who had undergone radical resection and lymph node dissection were retrospectively reviewed. Sections stained by the hematoxylin-eosin and the Elastica van Gieson method were examined for the presence of LVI. The overall survival was estimated using the Kaplan-Meier method, log-rank test, and the Cox proportional hazards analysis. RESULTS: The median follow-up was 81 months. A total of 143 patients (62%) were able to be diagnosed with regard to the presence of LVI, while information was not provided for 86 patients (38%), who were therefore excluded from the study. LVI was noted in 22 of the evaluable patients (15%) and was not seen in the other 121 patients (85%). The 5-year overall survival rate of the LVI-negative group and the LVI-positive group was 94.5 and 70.9%, respectively (P = .003). A multivariate analysis revealed LVI to be an independent predictive factor (hazard ratio: 0.202; P = .001). CONCLUSION: LVI is an independent poor prognostic factor in patients with pathologic stage IA adenocarcinoma. The T1a and T1b patients with LVI both might benefit from adjuvant chemotherapy.

[Superior vena cava thrombosis in a case with low serum factor XII].

The present case is 74 years old man who was hospitalized to treat lung tumor suspected of malignancy. Because the superior vena cava thrombus was also revealed by radiological examination, he was performed lobectomy and thrombectomy at the same time. He has past history of intravenous hyperalimentation for 15 days, and we supposed the event to be the cause of the thrombus. Venous thrombus has developed again in the left subclavian vein in spite of the anticoagulant therapy at the early postoperative period. The level of serum factor XII turned out to be low by the precise examination, of which possible contribution to thrombus formation was suspected.

[Sudden death due to massive pulmonary thromboembolism after pneumonectomy; report of a case].

A 76-year-old woman underwent a left pneumonectomy for a primary adenocarcinoma. On the fourth postoperative day, when walking to the toilet, she suddenly developed syncope followed by dyspnea and cardiopulmonary arrest. Although we performed cardiopulmonary resusciation, she died 1 hour later. With her family's approval, we performed autopsy. We found massive pulmonary thromboembolism was identified in the right main artery. To prevent postoperative thromboembolic complications, we use postoperatively continuous intravenous heparin sodium infusion (5,000-6,000/24 h) for the patients underwent thoracotomy and examine the ultrasonography for deep vein thrombosis before they begin to walk.

[Solitary papilloma of the lung; report of a case].

A 66-year-old woman admitted our hospital due to an abnormal shadow in the right lung field on a routine chest X-ray film. Preoperative diagnosis was not made, we didn't have correct diagnosis of benign or malignancy by intraoperative frozen-section specimen, so segmentectomy without lymph nodes dissection was performed. The histopathological diagnosis was glandular papilloma. A solitary papilloma in the lung field is rare, it is considered to be difficult to differentiate malignancy or benign clinically.

Spontaneous parathyroid adenoma hemorrhage.

We report a case of spontaneous parathyroid adenoma hemorrhage. A 50-year-old man with a sore throat, and swelling and ecchymosis of the entire anterior neck was found in cervical and chest computed tomography revealed to have a low-density area extending from the parapharyngeal region to below the carina, Suspecting descending necrotizing mediastinitis secondary to a peritonsillar abscess, we conducted mediastinal and cervical drainage, but found no abscess. No evidence was found, either, in bacteriological culture of sputum and pleural effusion. After the hematoma disappeared, cervical ultrasonography indicated parathyroid adenoma. Serum calcium was marginally increased, indicating that serum calcium should be determined if cervical or mediastinal hematoma develops without an obvious cause.

[Occluding spiral embolus for treatment of refractory pulmonary fistula].

A 57-year-old man was admitted for pulmonary emphysema. Volume-reduction-surgery (VRS) was performed. Three days later, after he coughed hard, the right lung collapsed. Although surgery was repeated, the air leakage continued. Air leakage was immediately reduced by means of bronchial embolization with a spiral embolus. We suggest that bronchial embolization with a spiral embolus causes little harm and is an effective treatment for refractory pulmonary fistula in poor-risk patients.