Outcomes of surgical resection for pulmonary metastasis from pancreatic cancer.

PURPOSE: As the number of long-term survivors of pancreatic cancer is expected to increase thanks to recent advances in multidisciplinary treatment and earlier diagnoses of pancreatic cancer, we are likely to encounter more cases of postoperative pulmonary nodules. We analyzed the clinical course and prognosis of resection of pulmonary metastases from pancreatic cancer to clarify the prognostic implication of pulmonary metastasectomy for pancreatic cancer. METHOD: We retrospectively analyzed 35 patients who underwent resection of lung metastases after pancreatic cancer surgery. Short- and long-term outcomes and factors associated with the prognosis were analyzed. RESULTS: The observation period was 20 (range, 1-101) months, with 3- and 5-year survival rates of 88.3% and 64.5% from pancreatectomy and 44.1% and 28.3% from lung resection, respectively. A univariate analysis revealed that a period from pancreatic cancer resection to pulmonary nodule shadow detection of < 15 months was associated with a significantly lower overall survival from pancreatic resection than a longer period. Conversely, histological type, stage, size of lung metastases, and resection technique were not associated with the overall survival. CONCLUSION: A long-term prognosis may be expected in some cases with a disease-free interval of ≥ 15 months. Our findings suggest that the disease-free interval may influence the prognosis.

[Lung, Lymph Nodes and Pleural Metastasis of Breast Cancer Developed Thirty-two Years after Radical Mastectomy:Report of a Case].

We report a case of distant metastases developed 32 years after radical mastectomy for right breast cancer. A 70s-year-old women visited the local hospital because of productive cough. Chest computed tomography (CT) showed a 10 mm nodule in the right middle lobe, multiple lymph nodes swelling and small pleural nodules. Surgical biopsy of lung and pleural tumor provides the pathological diagnosis of solid-tubular carcinoma expressing estrogen receptor and progesterone receptor, suggesting metastatic lesions of breast cancer.

[Inflammatory Pulmonary Myofibroblast Tumor Suspected of Pulmonary Metastasis of the Lung Cancer;Report of a Case].

Inflammatory myofibroblastic tumor (IMT) of the lung is a rare disease. The patient underwent the chemoradiotherapy for primary left lung cancer which showed complete responce (CR) by the treatment. A different nodule of 10 mm in diameter was found in the left lung by computed tomography (CT). Positron emission tomography(PET) showed positive detection correspond to the nodule ( SUVmax 4.82). A partial lung resection was carried out, and the tumor was diagnosed as IMT pathologically.

[Hemothorax Occurring after Chest Drainage for Tension Pneumothorax;Report of a Case].

A 23-year-old man was transported to our hospital complaining of chest pain and dyspnea. Chest X-ray revealed the right side tension pneumothorax with pleural effusion. A 12 Fr. chest tube was inserted. After 6 hours of chest drainage, the sign of intrathoracic bleeding appeared and the emergency operation was performed. The bleeding point was successfully coagulated with electrocautery. The postoperative course was uneventful.

[Re-expansion Pulmonary Edema after Surgery for Spontaneous Tension Hemopneumothorax;Report of a Case].

A 23-year-old man was admitted to our hospital because of chest pain and dyspnea. X-ray and computed tomography showed left tension hemopneumothorax. After the emergent surgery, re-expansion pulmonary edema (RPE) occurred. Non-invasive positive pressure ventilation (NPPV) was applied to control RPE and RPE was successfully recovered. NPPV may be useful in managing RPE.

[Thymoma with Pure Red Cell Aplasia;Report of a Case].

A thymoma with pure red cell aplasia (PRCA) is relatively rare. A 71-year-old woman complainted of dizziness and her blood cell count showed a severe anemia. She was diagnosed as PRCA by bone marrow aspiration biopsy, which showed marked decrease in number of erythroblasts. In addition, the chest computed tomography revealed a solid tumor in the anterior mediastinum. She underwent extended thymothymectomy through median sternotomy. The resected specimen was 10.5×9.7 cm in diameter. The pathological diagnosis was type AB thymoma of the World Health Organization classification, and Masaoka stage I. Ciclosporin was started to treat PRCA 3 months after the surgery, and she has been well for about 1 year after surgery without recurrence of thymoma or relapse of anemia.

[Thymoma with Multilocular Cystic Change;Report of a Case].

A 21-year-old male was pointed out an abnormal shadow on chest X-ray. Chest computed tomography showed a multilocular cystic mass of 10×4×4 cm in size in the anterior mediastinum. The tumor and the left lobe of the thymus was resected by median sternotomy. Pathologically, type AB thymoma as found in the wall of the cyst.

[Schwannoma in the Middle Mediastinum Originating from the Vagal Nerve；Report of a Case].

A 44-year-old woman was referred to our department with a mediastinal tumor detected by computed tomography performed as a preoperative examination for cervical cancer. There was a 32 mm solid mass in the area surrounded by the descending thoracic aorta, esophagus, left atrium, left lower lobe, and mediastinal pleura. The tumor was removed thoracoscopically. The mass was regarded as a neurogenic tumor arisen from the branch of the vagus nerve. Neither symptoms of postoperative neurological disorders nor signs of recurrence have been noted to date. The histopathological diagnosis was schwannoma.

[Thymoma showing enlargement and reduction in size with inflammatory events;report of a case].

An 87-year-old male who had gone surgery for bladder cancer in 1994, was pointed out a mass in the anterior mediastinum by follow up in May 2007. Thereafter, no change in size of the mass had been noted. In February 2011, however, enlargement of the tumor with inflammation and right pleural effusion was found. While waiting for surgery, the patient experienced regression of the tumor, and the pleural effusion disappeared. Tumor excision and combined resection of the lung and pericardium were performed. Postoperative histopathological findings showed Masaoka stageI thymoma of type B1 according to the World Health Organization( WHO) Classification. Granulation due to old inflammation, precipitation of cholesterin crystals, hemorrhages, and necrosis were noted in the tumor. In the differential diagnosis of tumors in the anterior mediastinum with spontaneous regression, thymoma should be considered.

[Report of a successful case of multidisciplinary therapy for a patient with lung and liver metastasis from rectal adenocarcinoma].

A strategy of multidisciplinary therapy is considered necessary for the longer survival of a patient diagnosed with advanced colorectal cancer. We report a successful multi-disciplinary therapy case of a 70's-year-old male who received pulmonary resection for metastatic lung cancer twice after primary resection for rectal cancer. Solitary metastatic liver cancer with portal vein tumor thrombus (PVTT) was diagnosed 5 years and 4 months after primary surgery. Although systemic chemotherapy was started immediately, disease control was poor and local pulmonary recurrence appeared. Although intrahepatic metastasis was considered the most important prognostic factor, radiation therapy against PVTT (50 Gy) was initially performed to control disease. After verifying that no new recurrent lesions had arisen during radiation therapy, a third pulmonary resection (in the left upper remnant lobectomy)was performed. Hepatectomy(in the right lobectomy)was then performed for curative purposes. Pathological efficacy of radiation therapy to PVTT was revealed as GradeIb according to Evans' classification. In accordance with the patient's request, no adjuvant treatment was planned. Seven years after primary resection no sign of recurrence is evident. Radiation therapy is suggested to be most useful for disease control and patient selection.

[Benign clear cell tumor of the lung; report of a case].

A 59-year-old woman was found to have an abnormal shadow on chest X-ray film during a general medical examination. A nodule with homogenous density and clear margin was seen in the lingular segment of the left lung. Since this shadow gradually enlarged during a 1.8 year follow up period, she was admitted to our hospital. A wedge resection was carried out by video-assisted thoracotomy. The resected tumor was histologically diagnosed as a benign clear cell tumor of the lung. Immunohistochemically, the tumor cells showed strong anti-melanoma monoclonal antibody (HMB-45) expression. This disease is extremely rare and only 31 cases including the present case have been reported in Japan.

Efficacy of pleural coverage with polyglycolic acid sheet after bullectomy for postoperative recurrence of spontaneous pneumothorax in young patients: a multi-institutional cohort study.

OBJECTIVE: Various surgical procedures have been performed to decrease the recurrence of primary spontaneous pneumothorax after video-assisted thoracic surgery. This study aimed to examine the efficiency of pleural coverage for the prevention of postoperative recurrence in relatively young patients. METHODS: Between January 2008 and December 2012, a total of 357 cases of 345 patients (age 15-29 years) with primary spontaneous pneumothorax who underwent bullectomy at 13 institutions were enrolled in this multi-institutional retrospective cohort study. A concurrent bilateral operation was counted as two cases. Polyglycolic acid sheets were used in 238 cases, and oxidized regenerated cellulose sheets were used in 37 cases to cover the visceral pleura, with no pleural coverage in 82 cases. The average observation period was 4.2 ± 2.0 years. RESULTS: Postoperative recurrence was observed in 50 cases (14.0%) after video-assisted thoracic surgery. Twenty-six cases (10.9%) in the polyglycolic acid group, eight (21.6%) in the oxidized regenerated cellulose group, and sixteen (19.5%) in the non-coverage group experienced postoperative recurrence. Kaplan-Meier analysis revealed that the rate of freedom from postoperative recurrence in the polyglycolic acid group was significantly higher than that in the non-coverage group. Multivariate analysis showed that age ≥ 20 years and coverage with polyglycolic acid sheets were associated with reduced risk factors for postoperative recurrence. CONCLUSION: Pleural coverage with a polyglycolic acid sheet is suggested to be effective in preventing postoperative recurrence of pneumothorax compared with non-coverage in relatively young patients.

[Pleural lipoma: report of a case].

Although lipomas are the most common form of the benign neoplasm, occurrence within the thoracic cage is uncommon, and lipomas originating from the pleura are very rare. We report an unusual case of a 63-year-old male whose serial chest X-ray demonstrated an abnormal shadow of which size was increasing. A chest wall tumor was suspected based on the findings of computed tomography (CT) of the thorax. The tumor was resected by video-assisted thoracoscopic surgery and the patient remains well with no recurrence 4 years postoperatively. The resected tumor was a yellowish pleural mass and the pathological diagnosis was a benign lipoma. It is possible to make a diagnosis of lipoma preoperatively by CT and magnetic resonance imaging (MRI), however, the correct differential diagnosis of lipoma and liposarcoma is imperfect only by radiological findings necessitating surgical removal if possible. However, in view of the imperfect differentiation between lipoma and liposarcoma, surgical treatment should be considered.

Relationship between 2-deoxy-2-[(18)F]-fluoro-d-glucose uptake and clinicopathological factors in patients with diffuse large B-cell lymphoma.

The aim of this study was to investigate correlations between the standardized uptake value of the biopsy site (BSUVmax) and levels of glucose transporter (GLUT)-1, GLUT-3 and hexokinase-II (HK-II), between BSUVmax and the Ki-67 proliferation index (MIB-1), and between BSUVmax and clinicopathological factors. Sixty-eight patients with diffuse large B-cell lymphoma (DLBCL) were included in this study. BSUVmax was significantly correlated with GLUT-1, GLUT-3 and the International Prognostic Index (IPI) (GLUT-1: r = 0.584, IPI: r = 0.363, p < 0.001; GLUT-3: r = 0.369, p = 0.009; IPI: r = 0.363, p = 0.004), but not with MIB-1 and HK-II. A statistically significant correlation was observed between GLUT-3 expression and each of IPI and gene expression profiling (GEP) (IPI: p = 0.0186; GEP: p = 0.0179). 2-Deoxy-2-[(18)F]-fluoro-d-glucose (FDG) uptake was significantly correlated with the levels of GLUT-1 and GLUT-3 and with IPI. The results indicated that GLUT-3 expression is related to GEP and IPI, and that BSUVmax and GLUT-3 may have a relationship with the prognosis of DLBCL.

The difference in relationship between 18F-FDG uptake and clinicopathological factors on thyroid, esophageal, and lung cancers.

OBJECTIVES: The aim of this study was to reveal the differences in clinicopathological factors affecting maximum standardized uptake value (SUVmax) between esophageal squamous cell carcinoma (ESCC), non-small-cell lung cancer (NSCLC), and papillary thyroid cancer (PTC). METHODS: This study consisted of 119 patients with ESCC (n=43), PTC (n=40), or NSCLC (n=36). We investigated the correlations between SUVmax and clinicopathological factors by using Spearman's correlation coefficient and the Kruskal-Wallis test. Multiple regression analysis was used to investigate which clinicopathological factors significantly affected SUVmax in each cancer type. RESULTS: The SUVmax correlated with glucose transporter-1 (GLUT-1) expression in NSCLC (r=0.536, P=0.007) and ESCC (r=0.597, P<0.001) but not in PTC. The SUVmax correlated with Ki-67 expression in NSCLC (r=0.381, P=0.022) and PTC (r=0.374, P=0.017) but not in ESCC. A high SUVmax was correlated with a higher pathological T stage (p-T stage) in NSCLC (r=0.536) and ESCC (r=0.597, both P<0.001) but not in PTC. An elevated SUVmax was significantly associated with pathological lymph node status (p-N) in NSCLC, but not in ESCC and PTC. In multiple regression analysis, p-T stage and GLUT-1 expression were statistically significant factors in ESCC, and p-T stage was a statistically significant factor in NSCLC. In PTC, Ki-67 showed a statistically significant association with SUVmax. CONCLUSION: SUVmax in NSCLC depended on the tumor invasion area; SUVmax in ESCC depended on tumor depth and GLUT-1 expression; and SUVmax in PTC might be associated with cell proliferation. The biological factors affecting SUVmax differ according to tumor type.

The relationship between 18F-FDG metabolic volumetric parameters and clinicopathological factors of breast cancer.

OBJECTIVES: This study was conducted to evaluate the relationship between fluorine-18 fluorodeoxyglucose metabolic parameters [maximum standardized uptake value (SUV(max)), metabolic tumor volume (MTV), and total lesion glycolysis (TLG)] and clinicopathological factors of breast cancer. METHODS: The study comprised 93 patients. A volumetric region of interest was drawn over the abnormal focal uptake of breast cancer. Spearman's rank correlation, the Kruskal-Wallis test, and receiver operating characteristic analysis were used to investigate the relationship between clinicopathological factors and metabolic parameters and determine which metabolic parameters were most highly associated with clinicopathological factors. RESULTS: All parameters had a statistically significant relationship with pathological T stage (p-T stage), pathological N status (p-N status), pathological stage (p-stage), and triple-negative type (TN) (all P values were <0.05). There were statistically significant differences between SUV(max) and TLG in relation to lymphatic invasion, estrogen receptor, and nuclear grade (P<0.05). High MTV showed a tendency toward association with estrogen receptor negativity, but the relation did not reach the level of statistical significance (P=0.056). No statistically significant relationship was observed between MTV and lymphatic invasion or nuclear grade. In the receiver operating characteristic analysis of p-T stage and p-stage, the AUC for TLG was significantly larger than that for SUV(max) (P=0.0003 and 0.048, respectively). There were marginally significant differences between TLG and MTV in relation to p-stage (P=0.058). CONCLUSION: TLG may reflect tumor metabolism for clinicopathological factors of breast cancer better than SUV(max) or MTV.

The relationship between GLUT-1 and vascular endothelial growth factor expression and 18F-FDG uptake in esophageal squamous cell cancer patients.

PURPOSE: To examine the relationship between glucose transporter-1 (GLUT-1) and vascular endothelial growth factor (VEGF) expression and (18)F-FDG uptake in esophageal squamous cell cancer patients. MATERIALS AND METHODS: Fifty-seven patients (52 male and 5 female) were included in this study. (18)F-FDG PET/CT was performed prior to the surgery. Immunohistochemistry was performed using postoperative histopathological specimens. The estimation of immunohistochemistry was conducted using scoring analysis. We investigated the correlations between maximum standardized uptake value (SUV(max)) and GLUT-1/VEGF expressions/pathologic tumor length (p-tumor length), and the relationships between pathologic T (p-T) stage and GLUT-1/VEGF expressions/SUV(max) and between lymph node metastasis (p-N) stage and GLUT-1/VEGF expressions/SUV(max). RESULTS: SUV(max) significantly correlated with GLUT-1 expressions and p-tumor length (GLUT-1: r = 0.475, P < 0.001; p-tumor length: r = 0.475, P < 0.001). SUV(max) of the primary tumor had a significant relationship with p-T stage, p-N stage, and VEGF expression (p-T stage: P < 0.001; p-N stage: P = 0.037; VEGF expression: P = 0.009). There was a statistically significant difference between GLUT-1 expression and p-T stage/VEGF expression, but not p-N stage (p-T stage: P = 0.012; VEGF expression: P = 0.01; p-N stage: P = 0.572). VEGF expression had a significant relationship with p-T stage, but not with p-N stage (p-T stage: P = 0.032; p-N stage: P = 0.763). CONCLUSION: (18)F-FDG uptake can be determined by GLUT-1 and VEGF. SUV(max) would have a connection with the tumor progression and lymph node metastasis.

Prognosis of smokers following resection of pathological stage I non-small-cell lung carcinoma.

OBJECTIVE: Many patients who undergo surgery for non small-cell lung cancer (NSCLC) have a smoking habit, which is a risk factor for NSCLC and chronic obstructive pulmonary disease (COPD). In addition, both smoking habits and COPD has been revealed to be a prognostic indicator following surgery for NSCLC. We conducted a multicenter retrospective observational study to address these issues. METHODS: Cigarette smoking and airway obstruction severity were chosen as variables to assess overall and disease-specific survival of 169 patients with pathological stage I primary NSCLC (119 stage IA, 50 stage IB) who underwent resection in 2000. RESULTS: The overall 5-year survival rates were 91% for patients who had never smoked (n=66), 88% for ex-smokers (n=36), and 72% for current smokers (n=67) (P=0.04). The never-smoked group had higher ratios for the factors female, pathological IA, adenocarcinoma, and favorable airway obstruction. In a nested analysis of smokers (ex-smokers and current smokers), smoking status and age were independent factors in a multivariate analysis of disease-specific survival, whereas the degree of airway obstruction was not significant. CONCLUSION: For smokers who underwent resection of p-stage I NSCLC, current smoking was an unfavorable prognostic factor in an analysis containing the degree of airway obstruction as a variable.

Current surgical intervention for pulmonary tuberculosis.

BACKGROUND: Surgery for pulmonary tuberculosis now plays a role in facing the emergence of complicated and multidrug resistant tuberculosis (MDR-TB), and it still remains a challenge for thoracic surgeons. We report on our 16 years of experience with lung resection for pulmonary tuberculosis. METHODS: We retrospectively reviewed the surgical results of 35 patients (23 males and 12 females: mean age, 47.8 years) who underwent therapeutic surgical resection for pulmonary tuberculosis from 1988 to 2003. RESULTS: Indications for surgery were MDR-TB in 26 patients, hemoptysis in 7, destroyed lung in 1, and drug allergy in 1. Thirty patients (85.7%) had fibrocavitary lesions seen radiologically, and 16 (61.5%) MDR-TB patients showed sputum-positive preoperatively. Operative procedures included 22 lobectomies, 7 pneumonectomies, 5 lobectomy plus segmentectomy procedures, and 1 segmentectomy. There was one operation-related death (2.9%) and 5 major postoperative complications (14.3%). Overall, 32 of 35 (91.4%) patients including 23 of 26 (88.5%) of the MDR-TB patients remained free of TB following surgery. Preoperative comorbidity, Aspergillus coinfection, operation time, transfusion, and male were the factors shown to be predictive of an unfavorable outcome. CONCLUSIONS: Surgery remains a crucial adjunct to medical therapy for the treatment of MDR-TB and medical failure lesions. Treatment success was obtained in cases with MDR-TB with few and incomplete sensitive drugs, and the early morbidity and mortality were acceptable in the current series. Proper selection of the patients and early decision for surgical intervention can achieve a high success rate and the salvage of lung parenchyma in this difficult group of patients.

Pulmonary benign metastasizing leiomyoma from the uterus in a postmenopausal woman: report of a case.

We report a case of pulmonary benign metastasizing leiomyoma (BML) from the uterus in a 77-year-old woman. The patient presented for investigation of multiple pulmonary nodules on a routine chest roentgenogram. Because a preoperative diagnosis could not be made, the largest tumor, 3.5 cm in diameter, was resected from the right lower lobe, and histological examination confirmed BML. She had undergone hysterectomy with oophorectomy for uterine leiomyomas 12 years earlier, at the age of 65. The microscopic findings of the lung tumor were similar to those of the uterine leiomyoma, and both lesions were histologically benign. Although this disease is considered to be hormone-dependent, metastasis was found in this elderly postmenopausal woman whose tumor was negative for estrogen receptor.