Significance of stroke volume variation during hepatic resection under infrahepatic inferior vena cava and portal triad clamping.

PURPOSE: Stroke volume variation (SVV), which is measured by analyzing arterial blood pressure waveform characteristics, is a simple and sensitive indicator of fluid responsiveness. The current retrospective study was to investigate SVV and central venous pressure (CVP) during hepatic resection under clamping of both the infrahepatic inferior vena cava (IVC) and the portal triad. METHODS: All hepatic resections performed from December 2009 to February 2010 at the Department of Surgery at Iizuka Hospital in Japan were included in this study. Invasive hemodynamic monitoring including CVP and SVV were performed in 14 patients. RESULTS: CVP was significantly lower in patients with blood loss < or = 486 g than in those with blood loss > 486 g. SVV was significantly higher in patients with blood loss < or = 486 g than those with blood loss > 486 g during both IVC clamping and IVC + portal triad clamping. Estimated blood loss was significantly less in the group with SVV values > 18% compared to the group with values < or = 18%. There was a significant correlation between SVV and CVP (R2 = 0.714; P < .01). CONCLUSION: SVV is a useful indicator of intraoperative blood loss without the monitoring of CVP during hepatic resection under clamping of both the infrahepatic IVC and the portal triad.

Spontaneous regression of multiple pulmonary recurrences of hepatocellular carcinoma after hepatectomy: report of a case.

Spontaneous regression of hepatocellular carcinoma (HCC) is an extremely rare phenomenon. We herein report the case of a 73-year-old man who showed the spontaneous regression of multiple pulmonary recurrences of HCC that had occurred after hepatectomy. The patient was undergoing dialysis due to diabetic renal failure when ultrasonography revealed a liver tumor (diameter ~ 10 cm). A preoperative diagnosis of HCC with hepatic vein thrombosis was made. The liver function was well preserved and then the right hepatic vein area was resected. Two months after hepatectomy the α-fetoprotein level increased, and multiple lung nodules were observed on follow-up computed tomography. A diagnosis of multiple lung metastases was made, but no therapy was started because of the patient's renal failure. Five months after hepatectomy the α-fetoprotein level normalized, and the metastases regressed completely. The patient is now doing well without any recurrence at 13 months after the surgery. The associated literature on spontaneous HCC regression is also reviewed.

Serum total cholesterol in nosocomial infections after gastrointestinal surgery.

BACKGROUND: The profile of lipoprotein expression in plasma is altered by surgical stress. The role of total cholesterol in postsurgical patients with nosocomial infection remains unknown. METHODS: We validated the data from 1,031 patients undergoing open gastrointestinal surgery between December 2006 and November 2008 using a clinical database available from Iizuka Hospital. Biochemical parameters related to plasma total cholesterol were measured. Various parameters predictive of the conditions--e.g., surgical incisional infection, organ space infection, pneumonia within 30 days after surgery--were assessed by multiple logistic regression analyses. RESULTS: The most frequent infection was surgical incisional infection. Serum total cholesterol levels-(1) lowest quartile (<159 mg/dl) vs. reference (200-239 mg/dl): adjusted odds ratio (OR) 5.39, 95% confidence interval (CI) 2.28-12.76; (2) second lowest quartile (160-199 mg/dl) vs. reference: OR 2.76, 95% CI 1.01-7.53-showed a significant inverse relation with surgical incisional infection. Both lowest and highest total cholesterol levels were associated with a higher risk of surgical incisional infection and organ space infection. None of the patients with high (> or =200 mg/dl) total cholesterol levels suffered from pneumonia. CONCLUSIONS: Total cholesterol levels appeared to be one of the risk factors for surgical incisional infection and pneumonia. Patients with borderline blood cholesterol levels (200-239 mg/dl) seemed to be the best candidates for operation.

Surgically resected undifferentiated carcinoma with osteoclast-like giant cells of the periampullary region involving the orifice of the papilla of Vater: Report of a case.

Undifferentiated carcinomas with osteoclast-like giant cells are rare periampullary neoplasms, which morphologically mimic giant cell tumors of the bone. The terminology, histogenesis, biological behavior, and chemosensitivity of these tumors, and their treatment protocol, remain controversial. We report the case of a 71-year-old man with periampullary carcinoma who underwent pancreaticoduodenectomy under the diagnosis of periampullary carcinoma. Histologically, the neoplasm was composed of undifferentiated cells and evenly spaced osteoclast-like giant cells. Liver and paraaortic lymph node metastases were detected 6 months later and were treated effectively with intravenous gemcitabine. The patient remains in remission 2 years after surgery.

Early outcome following hepatic resection in patients older than 80 years of age.

BACKGROUND: We aimed to study the early outcome of patients 80 years of age and older undergoing liver resection and to compare the results with the outcomes of patients younger than 80 years of age. METHODS: All 350 consecutive patients undergoing hepatic resections from 2004 April to 2008 October were included. Patients were divided into two groups: 80 years of age and older (group I; n = 43) and less than 80 years of age (group II; n = 307). Preoperative clinicopathological features, intraoperative factors, in-hospital mortality, postoperative complications, length of hospital stay, operative mortality, morbidity, and prognosis after discharge were analyzed and compared between groups I and II. RESULTS: There was no significant difference between the two groups regarding the indication for hepatic resection. Hepatitis viral status was significantly different between groups: patients without hepatitis B or C viral infection were more common in group I than in group II. Regarding preoperative liver function, serum levels of albumin were significantly lower in group I than in group II. Although the operative time was significantly shorter in group I than in group II, no difference was found between groups regarding such operative factors as type of hepatectomy, blood loss, and rate of blood transfusion. After elimination of 16 patients with extrahepatic bile duct resection and reconstruction, no difference existed between the two groups in operative time. There was no postoperative mortality nor in-hospital mortality in group I; in group II one postoperative death (0.3%) and two in-hospital deaths (0.6%) were recorded. There was no difference between groups in the incidence of morbidity and early prognosis after discharge. CONCLUSIONS: The results indicate that hepatic resection for elderly patients over 80 can be safely performed given careful patient selection.

S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): a phase III trial.

BACKGROUND: Phase I/II clinical trials of S-1 plus cisplatin for advanced gastric cancer have yielded good responses and the treatment was well tolerated. In this S-1 Plus cisplatin versus S-1 In RCT In the Treatment for Stomach cancer (SPIRITS) trial, we aimed to verify that overall survival was better in patients with advanced gastric cancer treated with S-1 plus cisplatin than with S-1 alone. METHODS: In this phase III trial, chemotherapy-naive patients with advanced gastric cancer were enrolled between March 26, 2002, and Nov 30, 2004, at 38 centres in Japan, and randomly assigned to S-1 plus cisplatin or S-1 alone. In patients assigned to S-1 plus cisplatin, S-1 (40-60 mg depending on patient's body surface area) was given orally, twice daily for 3 consecutive weeks, and 60 mg/m(2) cisplatin was given intravenously on day 8, followed by a 2-week rest period, within a 5-week cycle. Those assigned to S-1 alone received the same dose of S-1 twice daily for 4 consecutive weeks, followed by a 2-week rest period, within a 6-week cycle. The primary endpoint was overall survival. Secondary endpoints were progression-free survival, proportions of responders, and safety. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00150670. FINDINGS: 305 patients were enrolled; seven patients were ineligible or withdrew consent, therefore, 148 patients were assigned to S-1 plus cisplatin and 150 patients were assigned to S-1 alone. Median overall survival was significantly longer in patients assigned to S-1 plus cisplatin (13.0 months [IQR 7.6-21.9]) than in those assigned to S-1 alone (11.0 months [5.6-19.8]; hazard ratio for death, 0.77; 95% CI 0.61-0.98; p=0.04). Progression-free survival was significantly longer in patients assigned to S-1 plus cisplatin than in those assigned to S-1 alone (median progression-free survival 6.0 months [3.3-12.9] vs 4.0 months [2.1-6.8]; p<0.0001). Additionally, of 87 patients assigned S-1 plus cisplatin who had target tumours, one patient had a complete response and 46 patients had partial responses, ie, a total of 54% (range 43-65). Of 106 patients assigned S-1 alone who had target tumours, one patient had a complete response and 32 had partial responses, ie, a total of 31% (23-41). We recorded more grade 3 or 4 adverse events including leucopenia, neutropenia, anaemia, nausea, and anorexia, in the group assigned to S-1 plus cisplatin than in the group assigned to S-1 alone. There were no treatment-related deaths in either group. INTERPRETATION: S-1 plus cisplatin holds promise of becoming a standard first-line treatment for patients with advanced gastric cancer.

Preoperative diagnosis of gastrointestinal stromal tumor by endoscopic ultrasound-guided fine needle aspiration.

AIM: To evaluate the role of endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) in the preoperative diagnosis of gastrointestinal stromal tumor (GIST). METHODS: From September 2002 to June 2006, Fifty-three consecutive EUS-FNAs of GI tract subepithelial hypoechoic tumors with continuity to proper muscle layer suspected as GIST by standard EUS were evaluated prospectively. The reference standards for the final diagnosis were surgery (n = 31), or clinical follow-up (n=22). Additionally, immunophenotyping of specimens obtained by EUS-FNA and surgical resection specimens were compared. RESULTS: In 2 cases puncture was not performed because of anatomical problems. The collection rate of adequate specimens from the GI tract subepithelial hypoechoic tumor with continuity to proper muscle layer was 82% (42/51). The diagnostic rate for the tumor less than 2 cm, 2 to 4 cm, and 4 cm or more were 71% (15/21), 86% (18/21), and 100% (9/9), respectively. In 29 surgically resected cases, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of EUS-FNA using immunohistochemical analysis of GIST were 100% (24/24), 80% (4/5), 96% (24/25), 100% (4/4), and 97% (28/29), respectively. No major complications were encountered. CONCLUSION: EUS-FNA with immunohistochemical analysis is a safe and accurate method in the pretherapeutic diagnosis of GIST. It should be taken into consideration in decision making, especially in early diagnosis following minimal invasive surgery for GIST.

Clinicopathological risk factors linked to recurrence pattern after curative hepatic resection for hepatocellular carcinoma--results of 152 resected cases.

BACKGROUND/AIMS: The recurrence rate after hepatectomy of hepatocellular carcinoma (HCC) remains high. Although the cause of recurrence seems to be the multicentric occurrence and metastasis of cancer cells in the patients after curative resection of HCC, the mechanism of HCC recurrence in each case is still uncertain. The recurrence pattern may illuminate these mechanisms. METHODOLOGY: A data analysis of 152 patients who underwent HCC resection, and had observed for more than 5 years was conducted. These patients were divided into three groups; group I (n=32), the patients without HCC recurrence, group II (n=86), the patients with fewer than four recurrent nodules of HCC, group III (n=34), the patients with four or more recurrent nodules of HCC. We compared the clinicopathological data of groups I and II, and of groups I and III. The linkage of risk factors linked to recurrence patterns was clarified. RESULTS: The risk factors linked to group II by comparison with group I were high serum levels of alanine aminotransferase, low serum levels of albumin, high values in the indocyanine green retention test at fifteen minutes, hepatitis C antibody positivity. low platelet counts, and high histological hepatitis activity. The risk factors linked to group III were large tumor size, histological presence of portal vein invasion by cancer cells, intrahepatic metastasis, and poor differentiation of cancer cells. CONCLUSIONS: The risk factors linked to recurrence with no more than three HCC nodules recurrence were related to host-related factors such as hepatic function, and hepatitis activity, but not tumor related. The risk factors linked to multiple recurrence were tumor related. The analysis of recurrence patterns revealed that completely different mechanisms exist in the patients with recurrence involving no more than four nodules, which may be related to multicentric occurrence, and patients with multiple recurrence, which may be related to the metastasis of cancer cells.

[A case of carcinomatous cardiac tamponade due to breast cancer treated with OK-432 and mitomycin C].

The patient was a 40-year-old woman who was admitted to our hospital because of severe cough and dyspnea due to multiple lung metastases from breast cancer, who had undergone Auchincloss operation for right breast cancer about five years earlier. While systemic chemotherapy (CAF) was started after admission,she presented with cardiac tamponade. A cardiac echogram revealed marked retention of pericardial effusion. Pericardiocentesis was carried out, and the cytology of the effusion showed class V, resulting in the diagnosis of carcinomatous cardiac tamponade due to breast cancer. She was treated with intrapericardial chemotherapy using OK-432 and mitomycin C (MMC), and has not suffered from pericardial effusion after the intrapericardial chemotherapy. Intrapericardial chemotherapy using OK-432 and MMC may be very useful for malignant pericardial effusion.

Changes in hepatic parenchymal ultrasound images in tamoxifen medication patients.

We experienced changes in ultrasonographic features of hepatic parenchyma in 156 patients treated with Tamoxifen (TAM) as an adjuvant hormonal therapy for breast cancer. After the treatment with TAM subsequent to the surgery for breast cancer, 36% of patients showed changes in ultrasonographic features of the liver more than Grade 2, despite no obvious hepatic involvement at the start of the medication. Forty-five percent of affected patients showed Grade 2 or 3 changes in hepatic parenchymal images within the first 6 months of TAM medication, while the average interval of change was 11.3 months. Abdominal ultrasound inspection should be undertaken within 6 months of surgery to aid the early detection of liver metastasis and fatty liver changes, which may play an important role in determining postoperative follow-up care for breast cancer patients.

Serum Total Cholesterol Levels Would Predict Nosocomial Infections After Gastrointestinal Surgery.

It has been suggested that total cholesterol levels and the use of statin medications are associated with the incidence of complications after gastrointestinal surgery. The aim of this study was to determine if preoperative total cholesterol levels are associated with a higher risk of postoperative infections and mortality. A total of 2211 patients undergoing general surgical procedures between December 2006 and November 2008 at Iizuka Hospital and between January 2010 and March 2012 at Jichi Medical University Hospital were reviewed. Multiple logistic regression models were used to evaluate serum total cholesterol and other variables as predictors of postoperative nosocomial infections. Serum total cholesterol concentrations lower than 160 mg/dl were associated with an increased incidence of superficial and deep incisional surgical site infections. Serum total cholesterol levels showed a reverse J-shaped relationship with the development of organ space surgical site infection and pneumonia. There was no discernible effect of serum cholesterol levels on the postoperative mortality observed in this cohort of patients. Decreased serum albumin was one of the strongest risk factors for the development of nosocomial infection after surgery. Postoperative pneumonia was not observed in patients taking statin medications whose cholesterol levels were <200 mg/dl. Serum total cholesterol may be a valid predictor of surgical outcome. Preoperative statin use may affect the development of postoperative pneumonia in patients with total cholesterol levels below 200 mg/dl.

Invasive micropapillary carcinoma of the breast with minimal regional lymph node metastasis regardless of the huge size: report of a case.

We present a 38-year-old premenopausal Japanese woman with invasive micropapillary carcinoma (IMC) of the left breast with minimal lymph node metastasis despite a huge size. The patient noticed a left breast mass and a bloody nipple discharge 2 years before admission. On admission, physical examination revealed a huge, elastic hard mass with skin ulcer 12x12 cm in diameter occupying the entire left breast. The patient underwent modified radical mastectomy with level III lymph node dissection, and the defect was reconstructed with a vertical rectus abdominis myocutaneous flap. Histopathologically, IMC comprised about 60% of the tumor, admixed with papillotubular and mucinous carcinoma. Only one of twenty-five lymph nodes had tumor metastasis. The patient remains well 8 months postoperatively without any signs of recurrence.

Composite adeno-endocrine carcinoma of the gallbladder with long-term survival.

INTRODUCTION: Primary endocrine cell tumors in the gallbladder are uncommon, and the coexistence of an endocrine cell tumor and adenocarcinoma, squamous cell carcinoma, and sarcomatoid components is extremely rare. PRESENTATION OF CASE: A rare case of adeno-endocrine cell carcinoma of the gallbladder in an 81-year-old woman is reported. Abdominal ultrasonography (US) revealed a hypo-echoic, solid tumor, 2.0cm×1.8cm in size, at the fundus of the gallbladder. On computed tomography (CT), the tumor was well-enhanced, well-demarcated, and homogeneous. The tumor, which was papillary, protruded into the gallbladder with no direct invasion to the liver. The tumor was diagnosed as gallbladder carcinoma; its depth appeared not to pass the subserosa layer. A cholecystectomy and hepatic bed resection with regional lymph node dissection were performed. Histologically, the tumor consisted of several components, including well to poorly differentiated papillary and tubular adenocarcinoma with squamous and sarcomatoid differentiations, and endocrine cell carcinoma. Histochemical studies of these tumor cells were positive for chromogranin A, synaptophysin, and cluster of differentiation 56 (CD56). The lymph node consisted of metastatic adeno-endocrine carcinoma. The patient survived and has remained disease-free for 4 years without adjuvant chemotherapy. DISCUSSION: Adeno-endocrine cell carcinoma of the gallbladder generally has a poor prognosis. CONCLUSION: The present case suggests that adeno-endocrine cell carcinoma with various components may be derived from a common precursor cell. This observation would require further investigation.

Risk factors of converting to laparotomy in laparoscopic appendectomy for acute appendicitis.

PURPOSE: Laparoscopic appendectomy (LA) for acute appendicitis has several advantages over open appendectomy (OA). In cases of complicated appendicitis, LA is converted to OA at a constant rate, though converting appendectomy (CA) has several disadvantages. We retrospectively determined preoperative risk factors for failure of LA and subsequent conversion to OA. METHODS: Consecutive cases of preoperative computed tomography (CT) and attempted LA were retrieved from our hospital database and grouped by procedure (LA versus CA). Patients with negative appendectomies (n = 28), opened appendectomy (n = 210), delayed interval appendectomy (n = 3), or who were <14 years of age were excluded. RESULTS: Average patient age, preoperative C-reactive protein (CRP) level, and diffuse peritonitis were significantly different between the groups. CT inflammation and occurrence of complicated appendicitis were significantly higher in CA than LA. Conversion to OA was mostly because of dense adhesions, diffuse peritonitis, and difficulties in excision of the appendix due to perforation or severe inflammation from surgical point of view. Postoperative complications were significantly lower in LA than CA, although the rate of intraoperative abscess was not different. CONCLUSION: Most patients with acute appendicitis can be successfully treated with LA. We identified the following significant risk factors of CA: CT inflammation grade 4 or 5; complicated appendicitis; higher preoperative CRP level; and diffuse peritonitis.

Diffusion-weighted imaging (b value = 1500 s/mm(2)) is useful to decrease false-positive breast cancer cases due to fibrocystic changes.

BACKGROUND: We aimed to evaluate the application of apparent diffusion coefficient (ADC) values calculated from diffusion-weighted imaging (DWI) (b value = 1500 s/mm(2)) in the breast imaging reporting and data system (BI-RADS). METHODS: For 104 cases of breast lesions with definitive histology diagnosis (45 benign cases, 59 malignant cases) in which breast magnetic resonance imaging was performed, ADC values were compared between benign and malignant cases, between ductal carcinoma in situ (DCIS) and fibrocystic changes, and between DCIS and ductal hyperplasia (one type of fibrocystic change). Diagnostic accuracy was compared for a total of 101 images and for 34 images including only nine DCIS and 25 fibrocystic changes between BI-RADS alone (with categories 4a, 4b, and 5 defined as malignancies) and BI-RADS plus ADC. RESULTS: There were significant differences in mean ADC values between malignant and benign cases (p < 0.0001) and between DCIS and fibrocystic changes (p < 0.002), but not between DCIS and ductal hyperplasia. Positive predictive values were significantly greater for BI-RADS plus ADC than for BI-RADS alone in all cases (70.5% for BI-RADS alone, 81.3% for BI-RADS plus ADC) and in cases of DCIS versus fibrocystic changes (40.9% for BI-RADS alone, 64.3% for BI-RADS plus ADC), resulting in a significant improvement in diagnostic accuracy with the addition of ADC. CONCLUSION: Adding ADC values calculated from DWI (b value = 1500 s/mm(2)) to BI-RADS is a useful way to improve differential diagnostic accuracy for malignant tumors and benign lesions, especially for DCIS versus fibrocystic changes, except in cases of ductal hyperplasia.

Laparoscopic omentectomy for preoperative diagnosis of torsion of the greater omentum.

INTRODUCTION: Torsion of the greater omentum is unusual. In most cases, the preoperative diagnosis was difficult due to the non-specific clinical presentation. PRESENTATION OF CASE: We present a case of greater omental torsion in a 28-year-old man with an untreated right inguinal hernia since childhood. Computed tomography (CT) revealed characteristic signs of omental torsion, which was important in making correct diagnosis. We made correct preoperative diagnosis and performed laparoscopic omentecomy. The greater omentum distal to the twisted part was dark red and showed necrotic change. This case was secondary omental torsion associated with a right inguinal hernia. DISCUSSION: Omental torsion should always be included in the differential diagnosis of acute abdomen. CONCLUSION: CT multi-planar reconstruction (MPR) imaging played a particularly important role in making a precise diagnosis. Laparoscopic approach could be useful in both diagnostic and therapeutic intervention. A successful laparoscopic omentectomy was performed in the present case.

Resection of metastatic liver cancer in a patient with a left-sided gallbladder and intrahepatic portal vein and bile duct anomalies: A case report.

INTRODUCTION: The presence of left-sided gallbladder is closely associated with multiple combined anomalies of the portal vein, hepatic vein, hepatic artery, and bile duct. This requires special attention for preoperative evaluation for the purpose of preventing postoperative complications. PRESENTATION OF CASE: A 70-year-old woman with metastatic liver cancer and intrahepatic portal vein, biliary system and hepatic artery anomalies with left-sided gallbladder is reported. On computed tomography (CT), a solitary low density mass occupied from the right anterior to the posterior segment of the liver. The gallbladder bed was on the left of the hepatic fissure. On drip-infusion-cholangiography (DIC) CT three-dimensional (3D) reconstruction, the left medial bile duct arose from the right umbilical portion after arising from the left lateral bile duct. Following a right hepatectomy and lymph node dissection of the hepatoduodenal ligament, hepaticojejunostomy was conducted separately to the left medial and left lateral bile duct. DISCUSSION: The left-sided gallbladder accompanies with several anomalies of hepatic vascular and bile duct anomalies in a frequent manner. A safe hepatectomy needs accurate operative plans to ascertain the range of hepatectomy, because it often has the diversity of a combined anomaly. CONCLUSION: Preoperative DIC-CT 3D reconstruction was extremely useful because it provided an important information that could not be obtained with 2D-DIC-CT. 3D imaging has the ability to demonstrate complex anatomical relationships, this devise is a effective new tool for making appropriate preoperative strategy.

Intrahepatic bile duct recurrence of hepatocellular carcinoma without a detectable liver tumor.

INTRODUCTION: Invasion of the portal and hepatic veins by hepatocellular carcinoma (HCC) is common, but macroscopic bile duct invasion is rare. Once a tumor thrombus completely obstructs the main bile duct, it causes obstructive jaundice. This type of HCC, known as icteric-type HCC (IHCC), has a poor prognosis. PRESENTATION OF CASE: A 72-year-old woman had been treated for chronic hepatitis C since 1997. In 2002, percutaneous ethanol injection therapy was performed for HCC in segment 8. HCC recurrence occurred in 2004, and she underwent transarterial embolization (TAE) and radiofrequency ablation (RFA). In 2006, an S8 segmentectomy was performed for re-recurrence of HCC. Three years after surgery, computed tomography (CT) revealed a tumor occupying the right anterior intrahepatic bile duct and extending into its right main branch. With a preoperative diagnosis of HCC recurrence in the bile duct, we performed a right hepatectomy and thrombectomy. Histological examination showed moderately to poorly differentiated HCC. No tumor tissue other than the intrahepatic bile duct tumor was detected in the resected liver specimen. DISCUSSION: HCC with biliary tumor thrombus is associated with a poor prognosis. In general, IHCC is difficult to diagnose and treat in the early stages. A characteristic radiological finding for this type of IHCC is the hypervascularity of the tumor thrombus. CONCLUSION: To the best of our knowledge, this is a rare case of IHCC recurrence as a tumor thrombus without recurrence in the resected liver specimen.

Long-term survivor of primary anorectal malignant melanoma by a multi-disciplinary approach.

Anorectal malignant melanoma tends to show an aggressive biological behaviour. Therefore, the 5-year survival rate is limited. We herein present a successful case of a super-long-term survivor (20 years) who underwent multi-disciplinary treatment. The present case suggests that a multi-disciplinary approach may be beneficial for patients with thick and extensively sized lesions after radical resection for primary anorectal malignant melanoma.

Spindle cell carcinoma of the lung.

We report a rare case of spindle cell carcinoma in the lung. A 73-year-old woman was admitted because of a lung tumor, which was indicated during a group examination. Chest computed tomography revealed a tumor located in the right lung accompanied by spiculation. Right upper lobectomy with lymph nodal dissection was performed. Histological findings revealed only spindle-shaped tumor cells, and immunohistochemical stain showed that they were cytokeratin-positive. We diagnosed it as a pulmonary spindle cell carcinoma.