A Case of MET Exon 14 Skipping Mutation: Positive Lung Adenocarcinoma Complicated by Paraneoplastic Neurological Syndrome.

A 67-year-old man with cervical spondylotic myelopathy undergoing conservative treatment presented with subacute progression of fine motor and ambulatory disturbances, leading to admission at a previous hospital. Pre-cervical laminoplasty chest computed tomography (CT) revealed a tumor in the left upper lobe of the lung, prompting transfer to our institution. Transbronchial biopsy findings were consistent with adenocarcinoma, diagnosed as clinical stage T2bN0M0, Stage IIA. The neurological abnormalities could not be solely attributed to cervical spondylotic myelopathy, leading to a diagnosis of concurrent paraneoplastic neurological syndrome (PNS). During hospitalization, the patient's condition progressed to a state of constant bed rest within two weeks. On the 17th hospital day, a left upper lobectomy was performed, resulting in significant improvement, allowing the patient to ambulate with assistance after two weeks, and transfer to a convalescent rehabilitation hospital on the 58th hospital day. Subsequent cancer multigene panel testing revealed a positive MET exon 14 skipping mutation. Given the absence of reports on this mutation in lung adenocarcinoma associated with PNS, we consider it rare and thus report this case.

[Gastric Conduit Ulcer Pentration into the Right Middle Lobe after Esophageal Cancer Surgery;Report of a Case].

A 55-year-old man with esophageal cancer underwent esophagectomy along with lymph node dissection and reconstruction with gastric conduit through the sternal route. He developed a continuous cough with sputum production, 3 years postoperatively. Chest radiography revealed a right middle lung field infiltrate. Chest computed tomography revealed communication between the reconstructed esophagus and the gastric conduit( pull-up) and right middle lobe airways. Upper gastrointestinal examination revealed ulcerative lesions involving the gastric mucosa;however, biopsy of the ulcer showed no malignancy. Conservative therapy including fasting and proton-pump inhibitor administration did not improve symptoms caused by gastropleural fistula. Thoracotomy was performed through the anterolateral intercostal space under the right-up supine position, and the partial lung resection and direct closure of the stomach with muscle flap wrapping was performed.

"Selective bronchus-blowing" method for effective inflate-deflate line identification in lung segmentectomy.

BACKGROUND: We examined two methods for the intraoperative selective bronchial delivery of air, and compared their effectiveness. METHODS: We recruited patients undergoing lung resection with the selective bronchus-blowing method in pulmonary segmentectomy for lung tumors. We assessed two types of bronchial ventilation methods: high-frequency jet ventilation (HFJV) and the bronchus-blowing method, which deliver air to target bronchi using HFJV or a 20G cannula inserted directly into the bronchi, respectively. The inflate-deflate line was classified as clear, slightly clear, and unclear. We examined the relationships between clinicopathological findings and the inflate-deflate line classification, as well as group differences in surgical-related factors. RESULTS: Among the 86 patients enrolled, 45 received HFJV ventilation and 41 received the bronchus-blowing method of ventilation. There was a significantly higher incidence of complex-type segmentectomies among patients in the bronchus-blowing group than in the HFJV group. The inflate-deflate line was classified as clear, slightly clear, and unclear in 16/7/11 and 25/3/3 patients in the HFJV and bronchus-blowing groups, respectively, according to the inflate-deflate criteria. The inflate-deflate line was identifiable in more cases in the bronchus-blowing group than in HFJV group (P=0.02). Complete resection was significantly less frequent in the HFJV group (73.5%) than in the bronchus-blowing group (90.3%). The rate of unsuccessful surgery was significantly higher among patients with severe emphysema, interstitial pneumonia, and anthracosis. CONCLUSIONS: Intraoperative selective bronchial air supply was attempted for the safe identification of target lung segments. The bronchus-blowing method easily enabled effective visualization of the segmental area within the operative field.

Pathological evaluation of the visceral pleura in the radical pleurectomy/decortication for malignant pleural mesothelioma patients.

BACKGROUND: Radical pleurectomy/decortication (P/D) is applied as a surgical treatment of resectable malignant pleural mesothelioma (MPM). Although P/D removed visceral pleura, dissection plain was not histologically explored previously. We examined a pathological evaluation of surgically removed visceral pleura in P/D. METHODS: Twenty-five patients with MPM who underwent P/D at the Tokyo Medical and Dental University Hospital between April 2010 and April 2018 were studied. The 25 cases included 20 with epithelioid tumors, 4 with a biphasic tumor and 1 with desmoplastic tumors. Nine, 1, 11 and 4 patients had mesotheliomas of stages I, II, III and IV, respectively. We analyzed the site of the visceral pleural lesions using the HE & Elastica van Gieson (EVG) staining. The tumor involvement of the pleura and the surgical dissection plane were defined using the depth criteria, D0-3. We added survival analyses according to the depth criteria. RESULTS: Ninety-nine lesions in total 45 lobes: 20 upper right, 14 middle, 20 lower, 22 upper left, and 23 lower were examined. Based on the depth D 0-3 criteria, there were 21 type D0, 18 type D1, 22 type D2 and 38 type D3 lesions. The growth of tumor cells in the pleura was partially diffuse or nodular in all cases. While 38 lesions which invaded the lung parenchyma were excised, another 61 lesions that reached within the pleura were dissected from lung parenchyma. Type D2&3 showed poor survivals than type D0&1. CONCLUSIONS: The lung parenchyma was always the dissection plane in P/D, regardless of tumor involvement in the visceral pleura. The depth criteria would help us in classifying pleural invasion histologically and possibly predicting the prognosis.

High expression of P-cadherin is significantly associated with poor prognosis in patients with non-small-cell lung cancer.

OBJECTIVES: Placental (P)-cadherin expression is associated with malignant phenotype of cancer cell. The loss of E-cadherin has been thought to play a key role in tumor progression in several cancers. In this study, we aimed to clarify the role of P-cadherin expression in non-small-cell lung cancer (NSCLC). MATERIALS AND METHODS: NSCLC patients (n = 172) were enrolled in this study; among them, 107 harbored adenocarcinomas, and 65 had squamous cell carcinomas. We examined P-cadherin and E-cadherin expression by immunohistochemical analysis and assessed the associations between each cadherin expression and both cadherin expression patterns with clinicopathological factors and prognosis. To investigate the pathway to acquire tumor progression associated with P-cadherin and E-cadherin, we examined p120 catenin localization by immunohistochemical analysis. RESULTS: High P-cadherin expression was significantly associated with lymphatic metastasis, pathological stage, and Ki-67 proliferation index (P < .05, respectively). Low E-cadherin expression was significantly associated with maximum standardized uptake value, lymphatic metastasis, and pathological stage (P < .05, respectively). The cytoplasmic p120 catenin localization was associated with the low E-cadherin and high P-cadherin expression group (P < .001). High P-cadherin expression was associated with shorter disease-free survival (P = .044) and shorter overall survival (OS; P = .044). The low E-cadherin and high P-cadherin expression group was associated with shorter OS (P = .024). CONCLUSIONS: High P-cadherin expression was associated with tumor progression and poor patient survival in NSCLC. In these patients, the low E-cadherin expression might be associated with tumor progression involving cytoplasmic p120 catenin.

Chylothorax post thoracoscopic surgery for an anterior mediastinal tumor.

Chylothorax after anterior mediastinal surgery is rare. We treated a 39-year-old woman who presented with progressive dyspnea over 6 months. Chest computed tomography revealed a 12-cm round mass in the right anterior mediastinum. She underwent video-assisted thoracoscopic surgery for successful excision of the tumor; however, the surgery was complicated by the development of chylothorax. It was treated surgically with no recurrence of the tumor and/or chylothorax for 2 years. Chylothorax should be recognized as a postsurgical complication of anterior mediastinal tumors.