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1.
Artigo em Inglês | MEDLINE | ID: mdl-34597393

RESUMO

The multilocular thymic cyst (MTC) is a rare, acquired disease caused by inflammatory changes in the thymus, and is associated with autoimmune diseases. We report a case of MTC with thrombocytopaenia, which improved following surgical resection. A 45-year-old man developed thrombocytopaenia with an anterior mediastinal tumour. Thrombocytopaenia due to an autoimmune mechanism, associated with thymoma or thymus-related disease, was suspected. Pathologic analysis following thoracoscopic thymectomy confirmed MTC. The platelet level recovered postoperatively. Our findings suggested a relationship between the acquired formation of MTC and the development of autoimmune antibodies. However, further investigation is needed to obtain more information.

2.
J Cardiothorac Surg ; 16(1): 305, 2021 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-34663384

RESUMO

A novel surgical energy device with high sealing ability using microwave technology has been developed. This novel microwave surgical instrument (MSI) is capable of sealing and dissecting a vessel ≤ 5 mm in diameter. The high sealing ability of the MSI enables fine dissection of the lung parenchyma by a scissor-type blade. This device is particularly useful in situations wherein the use of an automatic suturing instrument is difficult. Here, we describe the dissection of the lung parenchyma using this device in three patients (cases 1-3). This device was used for wedge resection of a tumor located close to the pulmonary hilum, for subsegmentectomy, and for dividing incomplete interlobar fissure (cases 1-3, respectively). In all the cases, the postoperative course was uneventful. This MSI is effective for resection of the lung parenchyma, allowing fine tissue dissection and excellent tissue sealing. This technique could assist surgeons in various lung resection cases.

3.
Kyobu Geka ; 74(9): 720-723, 2021 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-34446630

RESUMO

Primary mediastinal leiomyosarcoma is extremely rare, and few reports in the literature have described the clinical features of this malignancy. We report a case of a small anterior mediastinal leiomyosarcoma that showed rapid growth within a short period. An 85-year-old woman showed a small anterior mediastinal tumor on chest computed tomography (CT), three months prior to presentation. Contrast-enhanced chest CT revealed rapid tumor growth, and positron emission tomography/CT revealed significant 18-fluorodeoxyglucose uptake, suggestive of malignancy. Thoracoscopic tumor resection was performed via the left thoracic approach. In addition to the tumor and surrounding anterior mediastinal tissue, we resected an area of pericardial infiltration. The tumor was diagnosed as a primary mediastinal leiomyosarcoma based on histopathological and immunohistochemical findings.


Assuntos
Leiomiossarcoma , Neoplasias do Mediastino , Idoso de 80 Anos ou mais , Feminino , Fluordesoxiglucose F18 , Humanos , Leiomiossarcoma/diagnóstico por imagem , Leiomiossarcoma/cirurgia , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/cirurgia , Mediastino/diagnóstico por imagem , Mediastino/cirurgia , Tomografia Computadorizada por Raios X
4.
Anticancer Res ; 41(7): 3673-3682, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34230166

RESUMO

AIM: This study aimed to investigate useful prognostic factors of immunotherapy in patients with lung cancer. PATIENTS AND METHODS: We retrospectively observed 73 patients who underwent immunotherapy (nivolumab, pembrolizumab, and atezolizumab) for lung cancer. The systemic inflammatory score (SIS) was calculated as the sum of the following factors scored one point each: Hemoglobin <12.5 g/dl and serum albumin <3.6 g/dl, resulting in scores of 0-2. We examined the correlation between the SIS and initial tumor response and progression-free and overall survival with other existing markers, namely tumor programmed death-ligand 1 (PD-L1) expression level; neutrophil-to-lymphocyte ratio (NLR); modified Glasgow prognostic score; and prognostic nutritional index, etc. Results: SIS ≤1 was significantly associated with better initial tumor response. In multivariate analysis, PD-L1 expression ≥50% (p=0.010), SIS ≤1 (p=0.028) and NLR <5.6 (p=0.047) were significantly associated with longer progression-free survival, and SIS ≤1 (p=0.030) and NLR <5.6 (p=0.037) were associated with longer overall survival. CONCLUSION: SIS is a useful marker of the efficacy of immunotherapy that can be obtained via routine blood tests.


Assuntos
Inflamação/patologia , Neoplasias Pulmonares/patologia , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais Humanizados/uso terapêutico , Antígeno B7-H1/metabolismo , Biomarcadores Tumorais/metabolismo , Feminino , Humanos , Imunoterapia/métodos , Neoplasias Pulmonares/imunologia , Neoplasias Pulmonares/metabolismo , Neoplasias Pulmonares/terapia , Linfócitos/metabolismo , Linfócitos/patologia , Masculino , Pessoa de Meia-Idade , Neutrófilos/metabolismo , Neutrófilos/patologia , Nivolumabe/uso terapêutico , Prognóstico , Intervalo Livre de Progressão , Estudos Retrospectivos
5.
Surg Case Rep ; 7(1): 78, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33770280

RESUMO

BACKGROUND: Thoracic surgeons rarely encounter stab wounds with injury to the intrathoracic organs. However, such sudden and urgent situations could arise; therefore, experiences in managing such cases are invaluable. CASE PRESENTATION: An 84-year-old woman with depression who had a stab injury in the neck caused by a broad-bladed kitchen knife was brought to our facility by ambulance. She was stable in the emergency room; however, a computed tomography scan revealed that the blade had penetrated the right thoracic cavity. A right hemopneumothorax was seen. Considering the possibility of injury to the major vessels, a median sternotomy was performed. During the dissection around the blade, the patient started bleeding profusely, which required repair of an injury to the right internal jugular vein. The blade tip had penetrated the dorsal right upper lung lobe; however, it did not reach the hilum, and the knife was carefully removed. The damaged area of the lung was removed by wedge resection. CONCLUSION: Patients with deep stab wounds from knives are often hemodynamically stable because the blade acts as tamponade and prevents hemorrhage. Therefore, a surgical approach that allows for good visualization should be considered for the extraction of the blade.

6.
Asian J Endosc Surg ; 14(4): 821-823, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33576102

RESUMO

A novel model of a microwave surgical instrument (Acrosurg. Revo) which is an energy device using microwave technology and 2450 MHz microwave has recently been developed for endoscopic surgery. Herein, we describe the technique of pulmonary segmentectomy with a novel device.


Assuntos
Neoplasias Pulmonares , Pneumonectomia , Humanos , Pulmão , Neoplasias Pulmonares/cirurgia , Micro-Ondas , Instrumentos Cirúrgicos
7.
Gen Thorac Cardiovasc Surg ; 69(5): 890-893, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33400203

RESUMO

We present a case of the broncho-pleural fistula with a collapsed lung that was developed 2 weeks after right lower lobectomy. The patient urgently underwent open-window thoracostomy. However, the residual lung remained collapsed. To expand the lung and close the broncho-pleural fistula, negative pressure wound therapy was initiated 20 days after the procedure. The lung expanded within a few days, and the residual thoracic cavity gradually contracted. Subsequently, 2.5 months later, the remaining thoracic cavity was successfully closed using omentoplasty. No recurrence of the broncho-pleural fistula was observed for 1 year. If the lung could be inflated to reduce dead space in the thoracic cavity, broncho-pleural fistula with collapsed lung may be treated with bronchial stump coverage and negative pressure wound therapy.


Assuntos
Fístula Brônquica , Empiema Pleural , Tratamento de Ferimentos com Pressão Negativa , Doenças Pleurais , Fístula Brônquica/diagnóstico por imagem , Fístula Brônquica/etiologia , Fístula Brônquica/cirurgia , Empiema Pleural/cirurgia , Humanos , Pulmão , Doenças Pleurais/diagnóstico , Doenças Pleurais/etiologia , Doenças Pleurais/cirurgia , Pneumonectomia
8.
Gen Thorac Cardiovasc Surg ; 69(3): 511-515, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33040305

RESUMO

OBJECTIVE: The clinical practice of safe and efficient surgery and professional development of general thoracic surgical trainee are both important issues for mentors. We investigated the usefulness of a three-dimensional (3D) endoscopic system application for lung cancer treatment as a tool for training surgical trainees. METHODS: Supervised by mentors, general thoracic surgical trainees were trained with video-assisted thoracoscopic surgery (VATS) for primary lung cancer using a 3D endoscopic system to enable them to become operators. Video clinics using 3D images were held weekly. The group using 3D endoscopic system (66 cases in the 3D-VATS group) was compared with the group using conventional two-dimensional (2D) thoracoscopic system (35 cases in the 2D-VATS group) to perform VATS lobectomies. RESULTS: There was no significant difference in operative time between both groups. However, the 3D-VATS group comprised significantly less experience than the 2D-VATS group. The intraoperative blood loss was significantly reduced for the 3D group (34 mL in the 3D-VATS group vs. 76 mL in the 2D-VATS group, P = 0.0007). There were no cases of conversion from VATS to open thoracotomy and intraoperative transfusion in either group. CONCLUSION: 3D-VATS and video clinics using 3D videos are useful training tools for general thoracic surgical trainees with little experience in open thoracotomy.


Assuntos
Neoplasias Pulmonares , Cirurgia Torácica , Humanos , Neoplasias Pulmonares/cirurgia , Pneumonectomia , Cirurgia Torácica Vídeoassistida , Toracotomia
9.
Jpn J Clin Oncol ; 50(9): 1043-1050, 2020 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-32519745

RESUMO

OBJECTIVES: This study aimed to investigate whether the severity of emphysema as classified by Goddard score influences the prognosis of patients with early lung cancer, there are few reports about that. METHODS: From April 2009 to December 2016, we recruited 412 consecutive patients with completely resected clinical stage 0/IA/IB non-small cell lung cancer. The Goddard score assessed on preoperative computed tomography scan was retrospectively reviewed. Kaplan-Meier and Cox regression analyses were performed to assess the relationship between the Goddard score and early lung cancer prognosis. RESULTS: The patients were classified into two groups: Goddard score ≤ 4 points and ≥5 points according to the results of receiver operating characteristic curve analysis for recurrence events. The 3-year relapse-free survival rate of emphysema with Goddard score ≤ 4 points (88.6%) was higher than that of emphysema with Goddard score ≥ 5 points (60.8%) (P < 0.001). There was a higher proportion of cancer-related deaths in the group with Goddard score ≥ 5 points compared with the group with Goddard score ≤ 4 points (50% and 32.1%, respectively) (P = 0.082). A Goddard score ≥ 5 points was a significant prognostic factor for relapse-free survival in the univariate (P < 0.001) and multivariate (P = 0.022) analyses. A Goddard score ≥ 5 points was also a significant prognostic factor for overall survival in the univariate (P < 0.001) and multivariate (P = 0.041) analyses. CONCLUSION: Our findings suggest that emphysema with a Goddard score of ≥5 points may be a factor that can influence the prognosis of patients with primary lung cancer.


Assuntos
Enfisema/etiologia , Neoplasias Pulmonares/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Enfisema/patologia , Feminino , Humanos , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos
10.
Ann Thorac Surg ; 109(6): 1692-1699, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32057812

RESUMO

BACKGROUND: The choice between electrocautery or automatic suturing instruments for dissection of the lung parenchyma along the intersegmental plane during lung segmentectomy remains controversial. We hypothesized that a novel microwave surgical instrument (MSI) for dissecting the lung parenchyma could have excellent sealing effects. We examined the feasibility and safety of lung parenchymal dissection using a MSI during lung segmentectomy. METHODS: This was a prospective clinical study of lung segmentectomy involving dissection of the entire intersegmental plane using a MSI. Complications related to sealing of the lung parenchyma were evaluated and perioperative outcomes were compared to those of patients who underwent lung segmentectomy using automatic suturing instruments. Propensity score-matched comparisons were used to assess the potential impact of selection bias. RESULTS: Lung segmentectomy using a MSI was successfully performed in 30 patients. According to the propensity score matching analysis, intraoperative blood loss, length of hospital stay, and postoperative complications of the microwave group were significantly lesser (P = .019, .003, and .008, respectively) compared to those of the control group (n = 66). Prolonged air leakage was not observed. There were two cases of subcutaneous emphysema after removal of the chest tube, but no other grade 2 or higher complications were observed. No mortality occurred within 30 or 90 days postoperatively. CONCLUSIONS: The use of a MSI for lung parenchymal dissection was associated with lower blood loss during surgical procedures, reduced air leakage after the operation, and fewer postoperative complications.


Assuntos
Pneumonectomia/instrumentação , Pneumonectomia/métodos , Idoso , Idoso de 80 Anos ou mais , Dissecação/métodos , Desenho de Equipamento , Estudos de Viabilidade , Feminino , Humanos , Pulmão/cirurgia , Masculino , Micro-Ondas/uso terapêutico , Pessoa de Meia-Idade , Tecido Parenquimatoso/cirurgia , Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Ablação por Radiofrequência , Técnicas de Sutura/instrumentação , Resultado do Tratamento
11.
Gen Thorac Cardiovasc Surg ; 68(4): 357-362, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31650517

RESUMO

OBJECTIVE: We aimed to investigate the efficacy of complete video-assisted thoracoscopic surgery (cVATS) lobectomy using the three-dimensional (3D) endoscopic system in patients with lung cancer and compare it with that of cVATS lobectomy using the conventional two-dimensional (2D) endoscopic system in former consecutive cases. METHODS: We retrospectively analyzed the prospectively collected database of patients with clinical stage I lung cancer who underwent cVATS lobectomy using the 3D endoscopic system; the patients who underwent surgery using the 2D endoscopic system were considered the historical control group. The operative and perioperative data were compared, and propensity-score matched comparisons were used to assess the potential impact of selection bias. RESULTS: We performed 189 cVATS lobectomies. Of these, 105 were performed using the 3D endoscopic system, while 84 were performed using the 2D endoscopic system. After matching, there was no significant difference in the preoperative factors between the two groups. The operation time was significantly shortened (P = 0.003), and the intraoperative blood loss was significantly reduced in the 3D group (P < 0.001). In particular, there was only one case of intraoperative hemorrhage of 201 mL or more in the 3D group, compared to 12 cases in the 2D group (P < 0.001). After matching, the intraoperative blood loss and operation time were significantly reduced in the 3D group. CONCLUSIONS: Our results showed that the 3D endoscopic system for cVATS lobectomy may be a useful surgical tool and switching to it from the 2D endoscopic system can be performed safely.


Assuntos
Endoscopia/métodos , Imageamento Tridimensional/métodos , Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Cirurgia Torácica Vídeoassistida/métodos , Idoso , Bases de Dados Factuais , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/cirurgia , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Período Perioperatório , Pontuação de Propensão , Estudos Retrospectivos
12.
Kyobu Geka ; 72(13): 1076-1079, 2019 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-31879383

RESUMO

An 86-year-old man fell from a farm trolley and presented with chest bruising. Chest computed tomography showed a hemopneumothorax, multiple right rib fractures, and a sternal fracture at the sternal angle. Although he was treated with a chest tube for drainage and external fixation, a flail chest and severe pain continued. We performed a locked plate fixation of the sternal fracture on the 6th day of hospitalization. The postoperative course was favorable and the patient's flail chest improved. In cases of fracture of the sternum, minimally invasive locked plate sternal fixation may lead to early recovery.


Assuntos
Tórax Fundido , Fraturas das Costelas , Idoso de 80 Anos ou mais , Placas Ósseas , Fixação Interna de Fraturas , Humanos , Masculino , Esterno
13.
Oncol Lett ; 17(3): 3607-3614, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30867804

RESUMO

The present study analyzed surgical results in patients with malignant pleural mesothelioma (MPM) who underwent extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D). Data for 44 patients who achieved macroscopic complete resection following neoadjuvant chemotherapy followed by EPP (n=29) or P/D (n=15) were reviewed. Patient demographics and oncological outcomes were compared between the EPP and P/D groups. The median overall (OS) and progression-free survival (PFS) times were 22 and 14 months, respectively. OS was significantly different between the EPP and P/D groups (median OS, 17 vs. 34 months; 5-year OS, 11 vs. 44%; P=0.019); no difference was noted in PFS (median PFS, 13 vs. 21 months; 5-year PFS, 11 vs. 17%; P=0.373). Univariate analysis demonstrated that epithelial histology (P=0.0003) and P/D (P=0.018) were significant favorable prognostic factors for OS. Using multivariate analysis, epithelial histology (P=0.001) remained the only significant factor. Post-recurrence survival (PRS) among all patients was significantly longer in the P/D group (median PRS, 3 vs. 20 months; 1.5-year PRS, 5 vs. 54%; P=0.003), even among patients with epithelial-type MPM (median PRS, 6 s vs. 20 months; 1.5-year PRS, 8 vs. 61%; P=0.012). Chemotherapy following recurrence (P=0.033) was significantly associated with superior PRS in multivariate analysis. Postoperative pulmonary function was significantly improved in the P/D group. In summary, P/D may be an alternative procedure to EPP for resectable MPM providing similar PFS and improved PRS.

14.
Ann Thorac Surg ; 107(1): e1-e3, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30558734

RESUMO

Pleurectomy/decortication is a surgical procedure for malignant pleural mesothelioma (MPM) and has been proposed as an alternative to extrapleural pneumonectomy. We report a second primary lung cancer developing after pleurectomy/decortication for MPM. A 59-year-old man was diagnosed with MPM on the right side and underwent pleurectomy/decortication. Follow-up computed tomography detected a nodule in the right upper lobe that was diagnosed as adenocarcinoma by wedge resection. Lung cancer and MPM are associated with asbestos exposure. However, predicting lung cancer after treatment for MPM is difficult. Careful follow-up of the spared lung is necessary for detecting second primary lung cancer or MPM recurrence.

15.
Thorac Cancer ; 9(12): 1594-1602, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30298562

RESUMO

BACKGROUND: This study was conducted to evaluate the prognostic and recurrent impact of EGFR mutation status in resected pN0M0 lung adenocarcinoma with consideration of the histological subtype. METHODS: Following retrospective analysis of whole 474 consecutive pathological N0M0 lung adenocarcinoma patients, the prognostic significance of EGFR mutation status was evaluated in limited 394 subjects. Overall survival and recurrence-free interval (RFI) were estimated using the Kaplan-Meier method and compared using a log-rank test. Univariate and multivariate analyses were performed using Cox proportional hazard models. RESULTS: The five-year RFI was 85.7% and 93.3% for EGFR positive (n = 176) and negative (n = 218) cases, respectively (hazard ratio [HR] 1.992, 95% confidence interval [CI] 1.005-3.982; P = 0.048). Following the exclusion of specific subtypes free from recurrence or EGFR mutation (adenocarcinoma in situ, minimally invasive adenocarcinoma, and invasive mucinous adenocarcinoma), the five-year RFI was obviously poorer in EGFR positive compared to negative cases (80.7% and 92.1%, respectively; HR 2.163, 95% CI 1.055-4.341; P = 0.035). Multivariate analysis excluding the specific subtypes confirmed that male sex, age, current or Ex-smoking status, pleural invasion, and EGFR-positive status were independently associated with shorter RFI. No significant differences in five-year overall survival were found between the EGFR mutation positive and negative groups (88.7% and 93.7%, respectively; HR 1.630, 95% CI 0.787-3.432; P = 0.2). CONCLUSION: EGFR mutations are associated with recurrence in pN0M0 lung adenocarcinoma. EGFR mutation status and histological subtype should be considered when evaluating the risk of recurrence in resected lung adenocarcinoma patients.


Assuntos
Adenocarcinoma de Pulmão/metabolismo , Adenocarcinoma de Pulmão/patologia , Adenocarcinoma de Pulmão/mortalidade , Adenocarcinoma de Pulmão/cirurgia , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais , Análise Mutacional de DNA , Receptores ErbB/genética , Receptores ErbB/metabolismo , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Prognóstico , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
16.
J Thorac Cardiovasc Surg ; 154(3): 1089-1096.e1, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28483268

RESUMO

OBJECTIVE: Since the prognosis after standard lobectomy for non-small cell lung cancer (NSCLC) in patients with interstitial lung disease (ILD) is poor, we investigated the possibility of sublobar resection for the improvement of the surgical results in such patients. METHODS: Of 796 consecutive patients with clinical stage I NSCLC who underwent pulmonary resection, 107 were diagnosed with ILD using high-resolution computed tomography (HRCT). Overall survivals (OS) were compared between patients with non-ILD and those with ILD or between patients with ILD who underwent lobectomy and those who underwent sublobar resection. ILD patterns consisted of usual interstitial pneumonia (UIP), possible UIP, and inconsistent with UIP. The log-rank statistics and Cox proportional hazard models were used to test for survival differences. RESULTS: OS was significantly lower in patients with "ILD inconsistent with UIP" pattern (hazard ratio [HR], 2.66; 95% confidence interval [CI], 1.19-5.97; P = .014), or "ILD with possible UIP or UIP" patterns (HR, 2.38; 95% CI, 1.76-3.21; P < .001) compared with patients with non-ILD. No significant difference in OS was observed between patients with ILD who underwent either lobectomy or sublobar resection (HR, 1.82; 95% CI, 0.81-4.06; P = .19). Multivariable Cox analysis demonstrated diffusing capacity of the lung for carbon monoxide (HR, 0.95; 95% CI, 0.91-0.99; P = .009) and not surgical procedure (HR, 2.76; 95% CI, 0.83-9.16; P = .099), as an independent prognostic factor for OS. CONCLUSIONS: Sublobar resection may be a potential alternative choice for clinical stage I NSCLC with ILD on HRCT.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Doenças Pulmonares Intersticiais/epidemiologia , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/patologia , Feminino , Seguimentos , Humanos , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Duração da Cirurgia , Pneumonectomia/mortalidade , Complicações Pós-Operatórias/epidemiologia , Prognóstico , Capacidade de Difusão Pulmonar , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Estados Unidos/epidemiologia
17.
Eur J Cardiothorac Surg ; 51(2): 218-222, 2017 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-28186287

RESUMO

OBJECTIVES: Acinar predominant and papillary predominant invasive adenocarcinomas are likely to be classified as intermediate-malignant types. Although these two types of adenocarcinoma are distinguished morphologically, the differences between their malignant behaviours and prognoses are not clear. The aim of this study is to provide a prognostically relevant stratification of these similar subtypes based on pathological features. METHODS: We retrospectively reviewed 347 consecutive clinically N0M0 lung adenocarcinomas of ≤3 cm in diameter that were resected between April 2006 and December 2010 at two institutes. Acinar and papillary predominant adenocarcinomas were classified into acinar/papillary-lepidic type and acinar/papillary-non-lepidic type according to whether the second predominant component was a lepidic or invasive component. RESULTS: Fifty-four acinar and 59 papillary predominant adenocarcinoma cases were classified as acinar/papillary-lepidic type (n = 65) or acinar/papillary-non-lepidic type (n = 48) cases. Acinar/papillary-non-lepidic type cases were accompanied by more vascular invasion (13.8% vs 31.3%, P = 0.0451) and pleural invasion (9.2% vs 25.0%, P = 0.0450) than were acinar/papillary-lepidic type cases. Five-year overall survival (OS) and recurrence-free survival (RFS) also differed significantly between these types (5-year OS: acinar/papillary-lepidic type, 96.3% vs acinar/papillary-non-lepidic type, 61.8%, hazard ratio = 6.315, P = 0.00650; 5-year RFS: acinar/papillary-lepidic type, 91.4% vs acinar/papillary-non-lepidic type, 68.8%, hazard ratio = 2.967, P = 0.0210). Multivariate analysis revealed that a second predominant component was an independent prognostic factor for RFS (acinar/papillary-non-lepidic type: hazard ratio = 3.784, 95% confidence interval 1.091­13.128, P = 0.036). CONCLUSIONS: The pathological second predominant component allows intermediate-malignant adenocarcinomas to be subclassified with prognostic significance. It can be utilized when assessing postoperative risks for recurrence and when considering therapeutic strategies.


Assuntos
Adenocarcinoma Papilar/patologia , Adenocarcinoma/patologia , Carcinoma de Células Acinares/patologia , Neoplasias Pulmonares/patologia , Adenocarcinoma/classificação , Adenocarcinoma/cirurgia , Adenocarcinoma de Pulmão , Adenocarcinoma Papilar/classificação , Adenocarcinoma Papilar/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Vasos Sanguíneos/patologia , Carcinoma de Células Acinares/classificação , Carcinoma de Células Acinares/cirurgia , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/classificação , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Pleura/patologia , Pneumonectomia/métodos , Prognóstico , Recidiva , Estudos Retrospectivos , Resultado do Tratamento
18.
Kyobu Geka ; 69(12): 1003-1007, 2016 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-27821825

RESUMO

A 40-year-old woman was noted to have clubbing of the nails during an outpatient service for smoking cessation. Chest computed tomography showed an aneurysm of an aberrant artery running from the descending aorta to the left lower lobe. Hence, we diagnosed anomalous systemic arterialization of the lung. The proximal part of the aberrant artery measured 13 mm in diameter;moreover, it had developed an aneurysm(17 mm in diameter) in the lung parenchyma. The aberrant artery was ligated with a covering material (absorbable felt) and cut via a small access thoracotomy by a cardiovascular surgeon;subsequently, left lower lobectomy was performed. Pathological examination revealed significant atherosclerosis in the aberrant artery, demonstrating its severe fragility. To apply appropriate safety procedures and approaches are recommended when treating an aberrant artery to the lung, especially in the presence of an aneurysm.


Assuntos
Fístula Arteriovenosa/cirurgia , Pulmão/cirurgia , Artéria Pulmonar/cirurgia , Adulto , Fístula Arteriovenosa/diagnóstico por imagem , Feminino , Humanos , Imageamento Tridimensional , Pulmão/irrigação sanguínea , Pulmão/diagnóstico por imagem , Neovascularização Patológica , Artéria Pulmonar/diagnóstico por imagem , Toracotomia , Tomografia Computadorizada por Raios X
19.
Clin Lung Cancer ; 17(5): 433-440.e1, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-26725850

RESUMO

BACKGROUND: In the present study we aimed to investigate whether the predominance of the lepidic component in tumors was associated with the outcome of postoperative adjuvant chemotherapy for stage I lung adenocarcinoma. PATIENTS AND METHODS: Charts for patients with pathological stage I lung adenocarcinoma were retrospectively reviewed and then outcomes of adjuvant chemotherapy were assessed according to the lepidic component predominance in tumors. Prognostic factors were evaluated using a Cox proportional hazard model. Propensity scores were determined using the optimal matching method on the basis of Cox modeling and matched (1:1) analysis was applied after classification into lepidic and nonlepidic predominant tumors. RESULTS: Among 798 patients with stage I lung adenocarcinoma, 168 received adjuvant chemotherapy. Although adjuvant chemotherapy conferred no disease-free survival (DFS) advantage upon patients with lepidic predominant tumors, it improved DFS in T1b and T2a nonlepidic predominant tumors (P = .045 and P = .029, respectively). Propensity score matched analysis revealed no survival benefits of adjuvant oral fluoropyrimidines in lepidic predominant tumors (DFS, P = .461 and overall survival, P = .983) and the positive survival advantages in nonlepidic predominant tumors (DFS, P = .015 and overall survival, P = .027). CONCLUSION: Adjuvant oral fluoropyrimidines conferred a better survival advantage upon patients with nonlepidic predominant tumors than patients with lepidic predominant tumors. The predominance of a lepidic component could serve as an indicator of adjuvant chemotherapy with oral fluoropyrimidines in stage I lung adenocarcinoma.


Assuntos
Adenocarcinoma/tratamento farmacológico , Antineoplásicos/uso terapêutico , Neoplasias Pulmonares/tratamento farmacológico , Pirimidinas/uso terapêutico , Adenocarcinoma/patologia , Adenocarcinoma de Pulmão , Administração Oral , Idoso , Antineoplásicos/administração & dosagem , Quimioterapia Adjuvante/métodos , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Modelos de Riscos Proporcionais , Pirimidinas/administração & dosagem , Estudos Retrospectivos , Resultado do Tratamento
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