Durvalumab plus carboplatin-etoposide treatment in a patient with small-cell lung cancer on hemodialysis: a case report and literature review.

Little is known about the efficacy and safety of durvalumab plus carboplatin-etoposide treatment in patients with extensive-disease (ED) small-cell lung cancer (SCLC) on hemodialysis. Here, we present a case of a 67-year-old man with pleuroperitoneal communication on continuous ambulatory peritoneal dialysis who was diagnosed with ED-SCLC based on a cytological analysis of the peritoneal fluid. He was switched from peritoneal dialysis to hemodialysis and received durvalumab (1500 mg/body on day 1) plus carboplatin (area under the concentration-time curve = 5, 125 mg on day 1) and etoposide (50 mg/m2 on days 1 and 3) as first-line therapy. During the first cycle, grade 2 anemia, grade 3 neutropenia, and grade 3 upper gastrointestinal bleeding occurred; therefore, durvalumab and reduced doses of carboplatin and etoposide were administered. No other severe adverse events occurred, and a partial response was observed after four cycles. Our findings indicate that durvalumab plus carboplatin-etoposide treatment is safe and effective even in patients on hemodialysis.

Vitiligo and tumor response in a patient with amelanotic melanoma undergoing nivolumab treatment.

Vitiligo, an acquired depigmenting disorder of the skin that reacts against normal melanocytes, sometimes occurs as an immune-related adverse event in the treatment of melanoma with immune checkpoint inhibitors. It has been known that the occurrence of vitiligo is associated with a favorable therapeutic response in patients with melanoma, but it is not yet clear whether the association also applies to amelanotic melanoma, a minor subtype of melanoma with little or no melanin pigmentation. We report a patient with amelanotic melanoma of the esophagus who responded well to nivolumab treatment. Shortly after the tumor response, vitiligo was found on the patient's forearms. This case suggests that the occurrence of vitiligo is associated with a favorable response to nivolumab treatment for amelanotic melanoma.

Correction to: Vitiligo and tumor response in a patient with amelanotic melanoma undergoing nivolumab treatment.

[This corrects the article DOI: 10.1007/s13691-021-00515-w.].

Penetrating nail-gun injury of the thoracic descending aorta.

Penetrating injury of the descending aorta due to accidental discharge of a nail gun.

[Superior Vena Cava Syndrome].

Superior vena cava(SVC)syndrome is a syndrome caused by impaired venous return due to stenosis of the SVC. Most of such cases are due to tumors(non-small cell lungcancer, small cell lungcancer, malignant lymphoma, etc), and the most common cause of SVC syndrome is lungcancer. Symptoms of SVC syndrome are caused by external compression of the SVC, direct invasion, internal thrombus or embolization. Increased venous pressure results in objective findings including edema of the face and neck, edema of the upper limbs, superficial precordial vein distension due to collateral circulation, and hoarseness and subjective symptoms includingcoug h, dyspnea, syncope, headache, and dizziness. SVC syndrome impair the patient's quality of life(QOL). Although there are cases of spontaneous remission, SVC syndrome is recognized as one of the oncologic emergencies because brain and laryngeal edema can be fatal and urgent care should be provided. Therapeutic modalities include radiotherapy, chemotherapy, stent placement and surgery. Treatment should be determined comprehensively based on the severity, histological type, standard therapy for the histological type and its sensitivity. It is necessary to make a definitive histopathological diagnosis as soon as possible and to cooperate with other departments to promptly select the most appropriate treatment.

[Surgery of Papillary Adenoma;Report of a Case].

A 59-year-old man consulted our hospital because of an abnormal shadow on a chest X-ray without any symptoms. A chest computed tomography (CT) revealed growing pulmonary nodule in the right lower lobe. Benign lung tumor was suspected and the patient underwent right lower lobe partial resection. Pathological examination demonstrated the tumor to be pulmonary papillary adenoma within round atelectasis.

Therapeutic strategy for acute pleural empyema: comparison between retrospective study and prospective study.

OBJECTIVES: The purpose of this study is to investigate the efficiency of therapeutic strategy for acute pleural empyema. METHODS: We retrospectively reviewed 121 acute empyema patients and evaluated the therapeutic strategy for acute pleural empyema. Then, we prospectively reviewed 114 acute pleural empyema patients based on the strategy. RESULTS: The duration from onset to hospitalization in our hospital is statistically shorter, and the mortality and the rate of stage 3 empyema patients are lower in the prospective study group (PSG) than in the retrospective study group (RSG). Retrospective study and prospective study found that surgical group (SG) had more favorable outcomes than non-surgical group (NSG). Although antibiotic treatment duration, hospital stay, and entire mortality were comparable in NSG of both study groups, mortality of patients with PS grade 4 was significantly lower in PSG. SG in PSG had more favorable outcomes than that in RSG, such as antibiotic treatment duration, hospital stay, complication, and mortality. CONCLUSIONS: The good outcomes may be mainly caused by shorter duration from onset to hospitalization and shorter duration from hospitalization to operation. Operative management is an effective procedure for selected patients, and it is important to refer for thoracic surgical consultation earlier.

Comparison of Acute Gene Expression Profiles of Islet Cells Obtained via Laser Capture Microdissection between Alloxan- and Streptozotocin-treated Rats.

To identify the molecular profiles of islets from alloxan (ALX)- and streptozotocin (STZ)-treated rats, a microarray-based global gene expression analysis was performed on frozen islets isolated via laser capture microdissection. At 6 weeks old, rats were injected with ALX (40 mg/kg) or STZ (50 or 100 mg/kg) and then euthanized 24 hr later. Histopathological analysis showed ß-cell necrosis, macrophage infiltration, and islet atrophy. The extent of these changes was more notable in the STZ groups than in the ALX group. Transcriptome analysis demonstrated a significant up- or downregulation of cell cycle arrest-related genes in the p53 signaling pathway. Cyclin D2 and cyclin-dependent kinase inhibitor 1A, mediators of G1 arrest, were remarkably altered in STZ-treated rats. In contrast, cyclin-B1 and cyclin-dependent kinase 1, mediators of G2 arrest, were remarkably changed in ALX-treated rats. Genes involved in the intrinsic mitochondria-mediated apoptotic pathway were upregulated in the ALX and STZ groups. Moreover, heat-shock 70 kDA protein 1A ( Hspa1a), Hsp90ab1, and Hsph1 were upregulated in ALX-treated rats, suggesting that ALX treatment injures ß cells via endoplasmic reticulum stress. These results contribute to a better understanding of gene expression in the pathogenesis of islet toxicity.

Pathologic Diagnosis and Genetic Analysis of a Lung Tumor Needle Biopsy Specimen Obtained Immediately After Radiofrequency Ablation.

PURPOSE: To evaluate the possibility of pathologic diagnosis and genetic analysis of percutaneous core-needle biopsy (CNB) lung tumor specimens obtained immediately after radiofrequency ablation (RFA). MATERIALS AND METHODS: Patients who underwent CNB of lung tumors immediately after RFA from May 2013 to May 2016 were analyzed. There were 19 patients (8 men and 11 women; median age, 69 years; range, 52-88 years) and 19 lung tumors measuring 0.5-2.6 cm (median, 1.6 cm). Thirteen tumors were solid, and 6 were predominantly ground-glass opacity (GGO) on computed tomography. All specimens were pathologically examined using hematoxylin and eosin (H&E) staining and additional immunostaining, as necessary. The specimens were analyzed for EGFR and KRAS genetic mutations. The safety and technical success rate of the procedure and the possibility of pathologic diagnosis and genetic mutation analysis were evaluated. RESULTS: Major and minor complication rates were 11% (2/19) and 53% (10/19), respectively. Tumor cells were successfully obtained in 16 cases (84%, 16/19), and technical success rate was significantly lower for GGO-dominant tumors (50%, 3/6) compared with solid lesions (100%, 13/13, p = 0.02). Pathologic diagnosis was possible in 79% (15/19) of cases based on H&E staining alone (n = 12) and with additional immunostaining (n = 3). Although atypical cells were obtained, pathologic diagnosis could not be achieved in 1 case (5%, 1/19). Both EGFR and KRAS mutations could be analyzed in 74% (14/19) of the specimens. CONCLUSION: Pathologic diagnosis and genetic analysis could be performed even for lung tumor specimens obtained immediately after RFA.

[Surgical Case of Pulmonary Blastoma;Report of a Case].

A 81-year-old man consulted our hospital because of an abnormal shadow on a chest radiography in the right lower field. Computed tomography of the chest showed a mass shadow measuring 41 mm in diameter in the lower lobe of the right lung. There was no lymph node swelling in the hilum or mediastinum. A diagnosis of the lung cancer was suspected and the patient underwent right lower lobectomy with standard nodal dissection. Microscopically, the tumor revealed the epithelial component mimicking fetal lung tissue and proliferative mesenchymal component consisting of immature and heteromorphic nuclear cells as well. The final diagnosis was pulmonary blastoma classified as pathological stage IIB. He was not scheduled for adjuvant chemotherapy due to his older age.

Predictive clinical parameters for the response of nivolumab in pretreated advanced non-small-cell lung cancer.

BACKGROUND: Nivolumab offers a superior survival benefit over docetaxel in patients with advanced, previously treated non-small-cell lung cancer (NSCLC). An association between programmed cell death ligand-1 (PD-L1) expression and the efficacy of nivolumab has been reported in many studies. However, the association between the clinical parameters and efficacy of nivolumab remains unclear in advanced NSCLC patients. RESULTS: Among 124 patients, 108 (88%) were performance status (PS) 0 to 1. PD-L1 expression was assessed in 89 patients, with 51 (57%) patients having PD-L1 positive expression. In all patients, the objective response rate (ORR) in patients with elevated CRP levels (≥ 1 mg/dl) was significantly worse than those without elevated CRP levels (< 1 mg/dl) (8.3 vs 23.4%, p = 0.0180). The PS (≥ 2), smoking index (< 400), CRP levels (≥ 1 mg/dl) and LDH (≥ 245 IU/L) were significantly associated with a shorter PFS and OS in patients treated with nivolumab. Multivariate analyses showed that the PS (≥ 2), smoking index (< 400), CRP levels (≥ 1 mg/dl) and LDH (≥ 245 IU/L) and PD-L1 expression were significant factors associated with a longer PFS of nivolumab. MATERIALS AND METHODS: We retrospectively analyzed 124 patients who received nivolumab as a subsequent treatment. The patient characteristics, laboratory data at baseline (C-reactive protein [CRP] and lactate dehydrogenase [LDH]), PD-L1 expression, nivolumab response, progression-free survival (PFS), and overall survival (OS) were evaluated. CONCLUSIONS: Clinical parameters, such as PS, serum CRP, serum LDH, and smoking status, were significantly associated with the response duration and survival in patients treated with nivolumab.

[Vacuum-assisted Closure for Mediastinitis Caused by Methicillin-resistant Staphylococcus aureus after Coronary Artery Bypass Grafting;Report of a Case].

A 78-year-old man underwent off-pump coronary artery bypass grafting in our hospital. Purulent discharge from a sternotomy wound appeared 8 days after the operation of sternal re-fixation for sternal fracture. Methicillin-resistant Staphylococcus aureus(MRSA) was identified by the culture of the wound exudate. He underwent a surgical revision with the removal of the sternal wires and necrotic tissues. After sufficient irrigation, vacuum-assisted closure therapy was adopted and finally the wound was naturally healed. Vacuum-assisted closure therapy was an effective treatment for MRSA mediastinitis after coronary artery bypass grafting.

[Pneumothorax Caused by Multiple Pulmonary Metastases of a Uterine Endometrial Stromal Sarcoma;Report of a Case].

A 53-year-old woman who had undergone hystero-oophorectomy for uterine endometrial stromal sarcoma in our hospital 9 months previously was referred to our hospital because of bilateral pneumothorax. Chest computed tomography scan on admission revealed multiple thin-walled cavity nodules in both lung and a bilateral pneumothorax, suggesting pulmonary metastases of the uterine endometrial stromal sarcoma. We surgically treated the pneumothorax and diagnosed the nodules as metastatic lesions. They were pathologically diagnosed as metastatic uterine endometrial stromal sarcoma.

[Surgical Case of Pulmonary Enteric Adenocarcinoma].

A 59-year-old man consulted our hospital because of an abnormal shadow on a chest computed tomography, located in the right lower lobe. Fluorodeoxyglucose-positron emission tomography showed abnormal uptake in the tumor suggesting lung cancer and right lower lobectomy was performed. Pathological the tumor was diagnosed as lung cancer comprising tall columnar cells. Immunohistochemical staining was positive for TTF-1, CK-7 and CK-20. Postoperative screening of the abdomen revealed no suspicious primary lesion in the colon and the tumor was diagnosed as a pulmonary enteric adenocarcinoma.

[Pulmonary Alveolar Proteinosis Observed in the Subpleural Area;Report of a Case].

A 39-year-old man consulted our hospital because of an abnormal shadow on a chest X-ray without any symptoms. A chest computed tomography revealed patchy peripheral ground-glass attenuation, in the subpleural area. Bronchoalveolar lavage fluid was clear and transbronchial lung biopsy findings were inconclutive. A video-assisted thoracic surgery-biopsy was performed. The specimens demonstrated accumulation of proteinaceous materials within alveolar spaces. The patient was given a diagnosis of pulmonary alveolar proteinosis.

[Emergency Surgery for Intercostal Lung Hernia after Right Upper Lobe Resection for Lung Cancer;Report of a Case].

We report an operative case of intercostal lung hernia after resection of a Lung cancer. A 60-year-old man with asthma consulted our hospital because of an abnormal shadow on a chest X-ray. A chest computed tomography revealed a tumor in the right upper lobe. A diagnosis of lung cancer was suspected and the patient underwent right upper lobectomy with standard nodal dissection from 4th intercostal space with right anterolateral incision. Intercostal space was directly closed by three stitches. A chest drain was removed on the 5th operative day. On the 6th operative day, the patient suddenly developed asthma attack and radiologically, the middle lobe was found to prolapse from the chest wall. An emergency surgery was performed, and the intercostal space was closed by approximating the ribs with 6 stitches. The patient was discharged from our hospital on the 26th postoperative day.

Diagnostic Ability of Percutaneous Needle Biopsy Immediately After Radiofrequency Ablation for Malignant Lung Tumors: An Initial Experience.

PURPOSE: To evaluate the safety and diagnostic ability of percutaneous needle biopsy performed immediately after lung radiofrequency ablation (RFA). MATERIALS AND METHODS: From May 2013 to April 2014, percutaneous needle biopsy was performed immediately after RFA for 3 patients (2 men and 1 woman, aged 57-76 years) who had lung tumors measuring 1.3-2.6 cm in diameter. All patients had prior history of malignancy, and all tumors were radiologically diagnosed as malignant. Obtained specimens were pathologically classified using standard hematoxylin and eosin staining. RESULTS: We completed three planned sessions of RFA followed by percutaneous needle biopsy, all of which obtained tumor tissue that could be pathologically diagnosed. Two tumors were metastatic from renal clear cell carcinoma and rectal adenocarcinoma, respectively; one tumor was primary lung adenocarcinoma. There was no death or major complication related to the procedures. Although pneumothorax occurred in two patients, these resolved without the need for aspiration or chest tube placement. Tumor seeding was not observed, but 21 months after the procedure, one case developed local tumor progression that was treated by additional RFA. CONCLUSION: Pathologic diagnosis was possible by needle biopsy immediately after RFA for lung tumors. This technique may reduce the risks and efforts of performing biopsy and RFA on separate occasions.

[Surgically Treated Clear Cell Carcinoma of the Lung; Report of a Case].

We report an operative case of primary clear cell carcinoma of the lung. A 47-year-old man consulted our hospital because of back pain and an abnormal shadow on a chest computed tomography(CT). A chest CT revealed a nodule in the lung cyst. A diagnosis of lung cancer was suspected and the patient underwent right upper lobectomy with standard nodal dissection. Pathological findings are the lung cancer spreading along the cysts' inner walls. Most of the tumor cells were characterized as having large clear cytoplasm. Screening of the abdomen performed pre- and post-operatively revealed no suspected primary lesion in the kidney, and the tumor was diagnosed as clear cell carcinoma of the lung. Postoperative adjuvant chemotherapy with cisplatin and vinorelbine ditartrate was performed. Patient is well without reccurence 3 years after surgery.

EGFR Exon 18 Mutations in Lung Cancer: Molecular Predictors of Augmented Sensitivity to Afatinib or Neratinib as Compared with First- or Third-Generation TKIs.

PURPOSE: Lung cancers harboring common EGFR mutations respond to EGFR tyrosine kinase inhibitors (TKI), whereas exon 20 insertions (Ins20) are resistant to them. However, little is known about mutations in exon 18. EXPERIMENTAL DESIGN: Mutational status of lung cancers between 2001 and 2015 was reviewed. Three representative mutations in exon 18, G719A, E709K, and exon 18 deletion (Del18: delE709_T710insD) were retrovirally introduced into Ba/F3 and NIH/3T3 cells. The 90% inhibitory concentrations (IC90s) of first-generation (1G; gefitinib and erlotinib), second-generation (2G; afatinib, dacomitinib, and neratinib), and third-generation TKIs (3G; AZD9291 and CO1686) were determined. RESULTS: Among 1,402 EGFR mutations, Del19, L858R, and Ins20 were detected in 40%, 47%, and 4%, respectively. Exon 18 mutations, including G719X, E709X, and Del18, were present in 3.2%. Transfected Ba/F3 cells grew in the absence of IL3, and NIH/3T3 cells formed foci with marked pile-up, indicating their oncogenic abilities. IC90s of 1G and 3G TKIs in G719A, E709K, and Del18 were much higher than those in Del19 (by >11-50-fold), whereas IC90s of afatinib were only 3- to 7-fold greater than those for Del19. Notably, cells transfected with G719A and E709K exhibited higher sensitivity to neratinib (by 5-25-fold) than those expressing Del19. Patients with lung cancers harboring G719X exhibited higher response rate to afatinib or neratinib (∼ 80%) than to 1G TKIs (35%-56%) by compilation of data in the literature. CONCLUSIONS: Lung cancers harboring exon 18 mutations should not be overlooked in clinical practice. These cases can be best treated with afatinib or neratinib, although the currently available in vitro diagnostic kits cannot detect all exon 18 mutations.

[Lung Abscess Diagnosed as Adenocarcinoma by Needle Biopsy;Report of a Case].

We report a case of lung abscess misdiagnosed as adenocarcinoma based on cytologic findings of the sample obtained from needle biopsy. A 45-year-old man consulted our hospital because of fever, wet cough and an abnormal shadow on a chest X-ray film. A chest computed tomography revealed gradually enlarging pulmonary mass in the left S6 infiltrating the S5. A diagnosis of lung cancer was suspected and surgery was performed. Pathological findings of the specimen showed atypical cells with a large nucleus and a gross papillary neoplasm by needle biopsy. The patient underwent left lower lobectomy and partial resection of upper lobe with standard nodal dissection. The final diagnosis was a lung abscess with pneumonia without evidence of malignancy. When an indeterminate pulmonary tumor must be diagnosed during an operation, we should perform partial resection if possible.