Bullae-Forming Pulmonary Metastasis from Choriocarcinoma Presenting as Pneumothorax

Gestational trophoblastic disease (GTD) is a condition of uncertain etiology, choriocarcioma, or placental-site hydatidiform moles, invasive moles, choriocarcinoma, and placental-site trophoblastic tumors. It arises from the abnormal proliferation of trophoblastic tissue and spreads beyond the uterus hematogenously. The early diagnosis of GTD is important to ensure timely and successful management and the preservation of fertility. We report the unusual case of a metastatic choriocarcinoma that formed bullae on the lung surface and presented as recurrent pneumothorax in a 38-year-old woman with elevated beta-human chorionic gonadotropin (hCG) levels. She underwent thoracoscopic wedge resection of the involved lung and four subsequent cycles of consolidation chemotherapy. No other evidence of metastatic disease or recurrent pneumothorax was noted during 22 months of follow-up. GTD should be considered in the differential diagnosis of spontaneous pneumothorax in reproductive-age women with an antecedent pregnancy and abnormal beta-hCG levels.

Single Incision Thoracoscopic Left Lower Lobe Superior Segmentectomy for Non-Small Cell Lung Cancer

Lobectomy with mediastinal node dissection has been standard treatment for non-small cell lung cancer (NSCLC). Nowadays, video-assisted thoracoscopic surgery (VATS) is gaining acceptance as an alternative treatment option, given the quality-of-life benefits that it confers. For the VATS procedure, most surgeons create two or three ports with a utility incision of 3 to 5 cm. However, with acquired skill and instrumentation advances, single-incision thoracoscopic surgery has emerged over time. Here, we report the case of an 86-year-old female with NSCLC treated by single-incision segmentectomy.

Total Gastrectomy in Gastric Conduit Cancer

We report a very rare case of surgery on gastric conduit cancer. A 67-year-old male patient underwent esophagectomy and intrathoracic esophagogastrostomy for squamous cell carcinoma of the lower thoracic esophagus 27 months ago. Upon follow-up, a gastric carcinoma at the intra-abdominal part of the gastric conduit was found on an esophagogastroduodenoscopy. We performed total gastrectomy and esophagocolonojejunostomy in the manner of Roux-en-Y anastomosis. The postoperative course was not eventful and an esophagogram on the 10th postoperative day showed no leakage or stenosis of the passage. The patient was discharged on the 17th day with no complications.

Clinical Responses and Prognostic Indicators of Concurrent Chemoradiation for Non-small Cell Lung Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: To evaluate treatment outcomes and prognostic factors in non-small cell lung cancer (NSCLC) patients treated with concurrent chemoradiation. MATERIALS AND METHODS: From January 2005 to June 2009, 51 patients were treated with concurrent chemoradiation for 3 different aims: locally advanced stage III, locally recurrent disease, and postoperative gross residual NSCLC. Median age was 63 years. Distribution of stages by the 6th edition of American Joint Committee on Cancer (AJCC) was as follows: IIIA (37.3%), IIIB (56.9%). Chemotherapy was administered every week concurrently with radiation using one of the following regimens: paclitaxel (60 mg/m2), docetaxel+cisplatin (20 mg/m2+20 mg/m2), cisplatin (30 mg/m2). Total radiation dose was 16-66.4 Gy (median, 59.4 Gy). RESULTS: Median follow-up duration was 40.8 months. The overall response rate was 84.3% with 23 complete responses. The median survival duration for the overall patient group was 17.6 months. The 3-year survival rate was 17.8%. A total of 21 patients had recurrent disease at the following sites: loco-regional sites (23.6%), distant organs (27.5%). In the multivariate analysis of the overall patient group, a clinical tumor response (p=0.002) was the only significant prognostic factor for overall survival (OS). In the multivariate analysis of the definitive chemoradiation arm, the use of consolidation chemotherapy (p=0.022), biologically equivalent dose (BED)10 (p=0.007), and a clinical tumor response (p=0.030) were the significant prognostic factors for OS.The median survival duration of the locally recurrent group and the postoperative gross residual group were 26.4 and 23.9 months, respectively. CONCLUSION: Our study demonstrated that clinical tumor response was significantly associated with OS in the overall patient group. Further investigations regarding the optimal radiation dose in the definitive chemoradiation and the optimal treatment scheme in locally recurrent NSCLC would be required.

Clinical Responses and Prognostic Indicators of Concurrent Chemoradiation for Non-small Cell Lung Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: To evaluate treatment outcomes and prognostic factors in non-small cell lung cancer (NSCLC) patients treated with concurrent chemoradiation. MATERIALS AND METHODS: From January 2005 to June 2009, 51 patients were treated with concurrent chemoradiation for 3 different aims: locally advanced stage III, locally recurrent disease, and postoperative gross residual NSCLC. Median age was 63 years. Distribution of stages by the 6th edition of American Joint Committee on Cancer (AJCC) was as follows: IIIA (37.3%), IIIB (56.9%). Chemotherapy was administered every week concurrently with radiation using one of the following regimens: paclitaxel (60 mg/m2), docetaxel+cisplatin (20 mg/m2+20 mg/m2), cisplatin (30 mg/m2). Total radiation dose was 16-66.4 Gy (median, 59.4 Gy). RESULTS: Median follow-up duration was 40.8 months. The overall response rate was 84.3% with 23 complete responses. The median survival duration for the overall patient group was 17.6 months. The 3-year survival rate was 17.8%. A total of 21 patients had recurrent disease at the following sites: loco-regional sites (23.6%), distant organs (27.5%). In the multivariate analysis of the overall patient group, a clinical tumor response (p=0.002) was the only significant prognostic factor for overall survival (OS). In the multivariate analysis of the definitive chemoradiation arm, the use of consolidation chemotherapy (p=0.022), biologically equivalent dose (BED)10 (p=0.007), and a clinical tumor response (p=0.030) were the significant prognostic factors for OS.The median survival duration of the locally recurrent group and the postoperative gross residual group were 26.4 and 23.9 months, respectively. CONCLUSION: Our study demonstrated that clinical tumor response was significantly associated with OS in the overall patient group. Further investigations regarding the optimal radiation dose in the definitive chemoradiation and the optimal treatment scheme in locally recurrent NSCLC would be required.

Lung Cancer Associated with Sarcoidosis: A case report

Sarcoidosis is a somewhat common pulmonary disease, but the concurrence of lung cancer and sarcoidosis in the same patient is very rare. Because sarcoidosis usually presents as mediastinal lymphadenopathies, this concurrence in a lung cancer patient detected radiologically is apt to be misunderstood to be mediastinal metastases, and it is thus considered to be an unresectable disease. We report a case of lung cancer associated with sarcoidosis that developed in a 65-year-old woman who underwent surgery. Radiological studies revealed a 1.9x1.7 cm mass in the left upper lobe with multiple enlarged bilateral mediastinal lymph nodes (2R, 3a, 4R, 4L, 5, 6, 7, 8R). Pathologic findings showed that the mass was a well-differentiated adenocarcinoma and all of the enlarged mediastinal lymph nodes were granulomas without cancer metastasis. We report this case with a review of the literature.

Lung Cancer Associated with Sarcoidosis: A case report

Sarcoidosis is a somewhat common pulmonary disease, but the concurrence of lung cancer and sarcoidosis in the same patient is very rare. Because sarcoidosis usually presents as mediastinal lymphadenopathies, this concurrence in a lung cancer patient detected radiologically is apt to be misunderstood to be mediastinal metastases, and it is thus considered to be an unresectable disease. We report a case of lung cancer associated with sarcoidosis that developed in a 65-year-old woman who underwent surgery. Radiological studies revealed a 1.9x1.7 cm mass in the left upper lobe with multiple enlarged bilateral mediastinal lymph nodes (2R, 3a, 4R, 4L, 5, 6, 7, 8R). Pathologic findings showed that the mass was a well-differentiated adenocarcinoma and all of the enlarged mediastinal lymph nodes were granulomas without cancer metastasis. We report this case with a review of the literature.

ERRATUM: Correction for Mistyped Inequality Sign / Journal of the Korean Cancer Association, 대한암학회지

No abstract available.

Surgical Resection of Pulmonary Metastasis from Renal Cell Carcinoma

BACKGROUND: Renal cell carcinoma has shown less response to systemic therapies including chemotherapy, radiation, and immunotherapy than other cancers. Surgery has therefore become an important treatment tool. The protocol for treatment is the same for pulmonary metastasis of renal cell carcinoma. We performed surgery for pulmonary metastatic renal cell carcinomas and analyzed the results. MATERIALS AND METHODS: We retrospectively analyzed 15 patients who had undergone pulmonary metastasectomy from renal cell carcinoma at our hospital from January 2005 to December 2009. RESULTS: No patients had extrathoracic metastatsis. The mean age was 60.2 years (range 35~73). There were 12 male and 3 female patients. The number of synchronous and metachronous patients were 8 and 7, respectively. The mean survival times of synchronous and metachronous patients were 32.6 and 42.9 months, respectively. 6 patients had single lesions and 9 patients had multiple (more than 3) lesions. The surgical procedures included wedge resection (10), lobectomy (2), wedge resection with segmentectomy (2), and segmentectomy (1). Median observation and survival time were 54.1 and 34.9 months. The 1-year and 3-year survival rates were 80% and 50%, respectively. CONCLUSION: Pulmonary resection for pulmonary metastatic renal cell carcinoma was found to be a safe and effective treatment modality when complete resection was performed.

Complete Resection of Pulmonary Metastatic Melanoma

BACKGROUND: The prognosis of melanoma metastasized to other organs is very poor. There have been many studies on metastatic melanoma in Western society, but there have been few studies done in Korea because of the small number of cases. MATERIALS AND METHODS: A retrospective review of 7 patients who underwent complete resection of pulmonary metastases from melanoma from January 2005 to December 2009 was performed. When the primary lesion was controlled or simultaneously controllable and no other metastatic lesion was found, pulmonary resections were performed. We analyzed the clinical prognoses after the initial melanoma diagnosis. RESULTS: Of the seven patients, one was male and six were female. The mean age was 58.2 years (range 45~71). Six patients had a single pulmonary lesion and one patient had three lesions confined to the same lobe. The mean disease-free interval was 43.5 months (0~146 months). Before pulmonary resection, 4 patients had received systemic therapy. After pulmonary resection, 6 patients received systemic therapy. Complete resection was confirmed histologically. The metastasectomy was performed by wedge resection (6 patients) or lobectomy (1 patient). There were no mortalities or complications. After pulmonary resection, 1 patient had recurrent multiple lesions in the lung and 4 patients had metastases to other organs. The organs were the liver, brain, pleura, and lymph nodes. The mean observation time was 31.6 months and 3 patients died during observation. The mean survival was 27.7 months (14~60 months) and the 1-year and 3-year survival rates were 100% and 42%, respectively. CONCLUSION: When patients were selected carefully, the complete resection of pulmonary metastatic lesions was considered a major therapeutic tool.

Diffuse Alveolar Hemorrhage in a 39-year-old Woman: Unusual Initial Presentation of Microscopic Polyangiitis

Microscopic polyangiitis (MPA) is a necrotizing vasculitis involving the small vessels without granulomatous inflammation. Most MPA initially presents with renal involvement without pulmonary involvement. Isolated and initially presenting alveolar hemorrhage is very rare. The patient was a 39-year-old female with a progressive cough, dyspnea, and blood-tinged sputum for the previous 5 days. We determined that her condition was MPA though VATS lung biopsy and renal biopsy. After 2 months of steroid therapy, the chest lesions had improved. We report here a rare case of MPA with isolated and initial involvement of the lung with a review of the literature.

Gemcitabine Plus Platinum Combination Chemotherapy for Elderly Patients with Advanced Non-small Cell Lung Cancer: A Retrospective Analysis / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: This study aimed to analyze the efficacy and toxicity of gemcitabine plus platinum chemotherapy for patients aged 70 years or older with advanced non-small-cell lung cancer (NSCLC). MATERIALS AND METHODS: We reviewed the records of stage IIIB, IV NSCLC patients or surgically inoperable stage II, IIIA NSCLC patients who were aged 70 years or older when treated with gemcitabine (1,250 mg/m2) plus cisplatin (75 mg/m2) or carboplatin (AUC5) chemotherapy from 2001 to 2010 at Seoul St. Mary's Hospital, Uijeongbu St. Mary's Hospital and St. Vincent's Hospital. Gemcitabine was administered on days 1 and 8, and cisplatin or carboplatin was administered on day 1. Treatments were repeated every 3 weeks for a maximum of 4 cycles. RESULTS: The median age of the 62 patients was 73.5 years (range, 70 to 84 years). Forty-one (66%) patients exhibited comorbidity. The mean number of treatment cycles was 3.9. The compared average relative dose intensity of gemcitabine plus platinum chemotherapy was 84.8%. The median progression-free survival and overall survival (OS) were 5.0 months and 9.4 months, respectively. Reduced Eastern Cooperative Oncology Group (ECOG) performance status (none vs. > or =1) and weight loss ( or =5%) after treatment were found to have a significant effect on OS (p=0.01). CONCLUSION: Gemcitabine plus platinum chemotherapy is an effective treatment option with an acceptable level of toxicity in patients aged 70 years or older with good performance status in advanced NSCLC.

Identification of Genomic Aberrations by Array Comparative Genomic Hybridization in Patients with Aortic Dissections

BACKGROUND: The aim of the present study was to identify chromosomal loci that contribute to the pathogenesis of aortic dissection (AD) in a Korean population using array comparative genomic hybridization (CGH) and to confirm the results using real-time polymerase chain reaction (PCR). MATERIALS AND METHODS: Eighteen patients with ADs were enrolled in this study. Genomic DNA was extracted from individual blood samples, and array CGH analyses were performed. Four corresponding genes with obvious genomic changes were analyzed using real-time PCR in order to assess the level of genomic imbalance identified by array CGH. RESULTS: Genomic gains were most frequently detected at 8q24.3 (56%), followed by regions 7q35, 11q12.2, and 15q25.2 (50%). Genomic losses were most frequently observed at 4q35.2 (56%). Real-time PCR confirmed the results of the array CGH studies of the COL6A2, DGCR14, PCSK6, and SDHA genes. CONCLUSION: This is the first study to identify candidate regions by array CGH in patients with ADs. The identification of genes that may predispose an individual to AD may lead to a better understanding of the mechanism of AD formation. Further multicenter studies comparing cohorts of patients of different ethnicities are warranted.

Primary Pleural Small Cell Carcinoma: A case report / 대한흉부외과학회지

A primary pleural small cell carcinoma is an extremely rare disease. Because of a newly developed metastatic lesion, we performed an operation on a patient who had undergone a right upper lobe lobectomy for adenocarcinoma 3 years previously. We resected the pleural lesion and the pathology report showed that it was not a metastatic lesion, but rather, it was a primary pleural small cell carcinoma. So we reported this case and we review the relevant literature.

Open Embolectomy of an Acute Pulmonary Artery Embolism after Pulmonary Lobectomy / 대한흉부외과학회지

Acute massive pulmonary artery embolism after pulmonary resection is very rare, but has a high mortality rate. This is one of the most severe complications after pulmonary resection. Acute pulmonary artery embolism developed suddenly in a patient who underwent lobectomy and was recovering without complications. Because the patient's condition was aggravated after conservative treatment, we did emergency open embolectomy which was successful. Hence, we report this case with a literature review.

Simple Congenital Cystic Adenomatoid Malformation with a Feeding Artery: A case report / 대한흉부외과학회지

CCAM with no other anomalies such as sequestration receives its blood supply from the pulmonary artery. Our case presented with a simple CCAM and no other anomalies but with a feeding artery. Although preoperative evaluation may not show feeding arteries, they may exist in congenital cystic lung diseases.

Thoracoscopic Splanchnicectomy forRelief of Intractable Pain in Pancreatic Cancer: 2 case reports / 대한흉부외과학회지

Many patients with upper abdominal organ cancers, including pancreatic cancer, suffer from severe pain, and various methods and techniques have been used for relieving this pain. We present here two cases of patients with pancreatic cancer and they were both successfully relieved of their abdominal pain by performing video-assisted thoracoscopic sympathectomy and splanchnicectomy. This minimally invasive procedure offers promise in carefully selected patients with severe pain from pancreatic cancer and other conditions.

Immunohistochemical Assessment of Peripheral Squamous Lung Cancer: Comparison to Central Squamous Cell Carcinoma and Peripheral Adenocarcinoma

PURPOSE: Incidence of peripheral squamous cell carcinoma (pSCCs) of the lung has increased over recent years, but the immunohistochemical factors involved in pSCCs have not been well established. The aim of this study was to analyze the immunohistochemical differences between pSCCs and central-type SCCs (cSCCs), and similarities between pSCCs and peripheral adenocarcinomas (pADCs). MATERIALS AND METHODS: In this retrospective study, we investigated the expression of three potential prognostic factors (p53, Ki-67, t-CEA), and two potential therapeutic targets (epidermal growth factor receptor [EGFR], and c-erbB-2) in 263 surgically resected cases of primary SCC and pADCs of the lung from January 2001 to July 2008. We divided the SCCs between peripheral and central types, and compared the expression rates of markers between pSCCs and cSCCs, and between pSCCs and pADCs. RESULTS: In this study, there were 149 pADC cases, and among the 114 SCC cases, there were 41 pSCCs (36.0%). There were significantly higher expression rates of Ki-67 and EGFR in pSCCs than in cSCCs or pADCs (p=0.003, p=0.039, respectively). CONCLUSION: We found immunohistochemical differencies in pSCCs from cSCCs and pADCs.

The Effect of Chlamydia pneumoniae on the Expression of Peroxisome Proliferator-Activated Receptor-gamma in Vascular Smooth Muscle Cells

PURPOSE: This study was designed to investigate the change of peroxisome proliferator-activated receptor gamma (PPARgamma) after the infection of the human coronary artery smooth muscle cells (HCSMCs) with Chlamydia pneumoniae (C. pneumoniae) and the effect of PPARgamma agonist on the expression of PPARgamma of C. pneumoniae-infected HCSMCs. MATERIALS AND METHODS: To determine the effect of PPARgamma agonist on the proliferation of C. pneumoniae-infected HCSMCs, rosiglitazone at various concentrations was applied 1 hour before inoculation of HCSMCs. RESULTS: The expression of PPARgamma mRNA in HCSMCs increased from 3 hours after C. pneumoniae infection and reached that of noninfected HCSMCs at 24 hours (p < 0.05). The expression of PPARgamma protein in HCSMCs also increased from 3 hours after C. pneumoniae and persisted until 24 hours as compared with that of noninfected HCSMCs (p < 0.05). The pretreatment of HCSMCs with rosiglitazone followed by the infection with C. pneumoniae augmented the expression of PPARgamma mRNA and protein (p < 0.05) and decreased cell proliferation. CONCLUSION: Our results showed that the expression of PPARgamma increases in response to C. pneumoniae infection and rosiglitazone further augmented the expression of PPARgamma. It is suggested that rosiglitazone could ameliorate the chronic inflammation in the vessel wall induced by C. pneumoniae by augmenting PPARgamma expression.

Clinical Significance of Vascular Endothelial Growth Factors (VEGF)-C and -D in Resected Non-Small Cell Lung Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Lymphatic spread of tumor is an important prognostic factor for patients with non-small cell lung carcinoma (NSCLC). Vascular endothelial growth factor-C (VEGF-C) and VEGF-D play important roles in lymphangiogenesis via the VEGF receptor 3 (VEGFR-3). We sought to determine whether VEGF-C, VEGF-D and VEGFR-3 are involved in the clinical outcomes of patients with resected NSCLC. MATERIALS AND METHODS: Using immunohistochemical staining, we investigated the protein expressions of VEGF-C, VEGF-D and VEGFR-3 in the tissue array specimens from patients who underwent resection for NSCLC. The immunoreactivity for p53 was also examined. The clinicopathological implications of these molecules were statistically analyzed. RESULTS: Analysis of a total of 118 specimens showed that VEGF-C, VEGF-D and their co-expression were significantly associated with more advanced regional lymph node metastasis (p=0.019, p=0.044 and p=0.026, respectively, N2 versus N0 and N1). A VEGFR-3 expression had a strong correlation with peritumoral lymphatic invasion (p=0.047). On the multivariate analysis for survival and recurrence, pathologic N2 lymph node metastasis was the only independent prognostic factor, but none of the investigated molecules showed any statistical correlation with recurrence and survival. CONCLUSIONS: The present study revealed that high expressions of VEGF-C and VEGF-D were strongly associated with more advanced regional lymph node metastasis in patients with resected NSCLC.