Primary Extraskeletal Mesenchymal Chondrosarcoma of the Anterior Mediastinum

No abstract available.

Primary Pulmonary Myxoid Liposarcoma with Translocation t(12;16)(q13;p11) in a Young Female Patient: A Brief Case Report

Primary liposarcoma of the lung is an extremely rare disease. To date, only 14 cases have been reported in the literature. We experienced a case of myxoid liposarcoma of the lung treated by surgery. The tumor was well-defined, solid, lobulated mass measuring 3.5x2 cm, involving the bronchus of the left lower lobe. Microscopically, myxoid liposarcoma was identified. The fluorescence in situ hybridization confirmed the presence of a reciprocal translocation involving DNA damage-inducible transcript 3 (DDIT3) and fused in sarcoma (FUS) genes. The patient is still alive with no recurrence or metastasis at the time of writing this report (on 20 months postoperatively). To our knowledge, this is the first cytogenetic case report of pulmonary myxoid liposarcoma.

MDA-7/IL-24 Expression and Its Relation with Clinicopathologic Factors in Lung Adenocarcinomas of 3 cm or Less in Diameter

PURPOSE: The melanoma differentiation-associated gene-7 (MDA-7) protein, also known as interleukin 24 (IL-24), is a novel candidate of tumor suppressor that has been found to experimentally induce apoptosis and growth inhibition in a variety of human malignant cells. However, there have been few studies about its role in lung adenocarcinoma. Even at the same stage and with similar pathologic characteristics, lung adenocarcinomas with a diameter of 3 cm or less can have a variable prognosis depending on their biologic characteristics. The purpose of this study is to define the relationship between MDA-7/IL-24 expression and the progression of small-sized lung adenocarcinomas. MATERIALS AND METHODS: We performed immunohistochemical detection of MDA-7/IL-24 in forty-seven tissue samples from primary lung adenocarcinomas of 2 cm or < or =3 cm in diameter. A statistically significant association was found between MDA-7/IL-24 expression and tumor size (p=0.03). Although this difference did not reach statistical significance, tumors with a negative MDA-7/IL-24 expression tended to more frequently show lymph node metastasis (p=0.07). There were no significant associations for other clinicopathologic characteristics. CONCLUSION: These results suggest the possible involvement of MDA-7/IL-24 in the growth and progression of small-sized lung adenocarcinoma. MDA-7/IL-24 immunoreactivity could be used to identify a subset of adenocarcinomas of the lung of 3 cm or less in diameter that have different biologic behavior.

Comparison of the Macintosh Laryngoscope and the Disposcope Endoscope(R) in Both Normal Airway and Manual In-line Stabilization for Suspected Cervical Spine Injury Patients: A Simulation Study using an Airway Training Manikin

PURPOSE: We conducted a comparative evaluation in the ease of endotracheal intubation when using the Macintosh laryngoscope (ML) versus the new Disposcope endoscope(R) (DE) (Disposcope Taiwan, Hsinchuang city, Taiwan), a video-laryngoscope, during simulated normal airway and manual in-line stabilization of suspected cervical spine injury patients. METHODS: Forty-three medical interns participating in an endotracheal intubation training program used both the DE and the ML as part of their lessons. In each of the two simulated patient scenarios, endotracheal intubation was performed using each endoscope, in random order. The rate of successful intubation, time required for visualizing the glottis, time to complete endotracheal intubation, results of a modified Cormack & Lehane classification (CL grade), and a measure of dental injury were all recorded and analyzed. RESULTS: In the normal airway scenario, there was no difference in the rate of successful completion of intubation (both 100%) between the two endoscopes. Time to complete endotracheal intubation using the DE was shorter than that with the ML (10.7 versus 12.6 sec; p=0 010). In the trauma scenario, despite similar success rates (95.3% in ML versus 100% in DE), the time required to complete endotracheal intubation using the DE was shorter than that with the ML (17.6 versus 24.1 sec; p=0.010). Rate of dental injury using the DE was significantly less than that observed with the ML (0.0% versus 30.2%; p<0.0001). In both scenarios, the DE provided higher achievement of CL grade 1 (93% versus 67.4% in normal airway; p=0.006 and 55.8% versus 0% in trauma airway; p<0.0001). CONCLUSION: Compared to the ML, the DE provided a better view of the glottis, provided decreased dental trauma, and offered faster completion time for endotracheal intubation.

The Overexpression of Histone Deacetylase 1 and Its Relationship with p16INK4a Gene Hypermethylation in Pulmonary Squamous Cell Carcinoma and Adenocarcinoma

BACKGROUND: DNA methylation and histone modification are dynamically linked in the epigenetic control of gene silencing and they play an important role in tumorigenesis. METHODS: To evaluate the role of histone deacetylase 1 (HDAC1) in the development of lung cancer and the relationship between a HDAC1 overexpression and p16INK4a hypermethylation, we performed immunohistochemical staining for HDAC1 in 76 lung cancer specimens (39 squamous cell carcinomas and 37 adenocarcinomas) that had been previously evaluated for their p16INK4a methylation status by real-time quantitative polymerase chain reaction. RESULTS: A HDAC1 overexpression (>50% of HDAC1 immunoreactive cells) was detected in 65 (85.5%) out of the 76 cases and it was more frequently seen in the squamous cell carcinomas (97.4%) than in the adenocarcinomas (73.0%) (p=0.002). The incidence of HDAC1 overexpression tended to be higher in the heavy smokers with more than 20 pack-years (p=0.067). Although there was no statistical significance, the frequency of p16INK4a hypermethylation in the cases with a HDAC1 overexpression (27.7%) tended to be higher than that in the cases without a HDAC1 overexpression (9.0%) (p=0.175). CONCLUSIONS: A HDAC1 overexpression might be involved in lung carcinogenesis, and especially in a subgroup of smoking and squamous cell carcinoma patients, and a HDAC1 overexpression may be associated with p16INK4a hypermethylation.

Surgical Treatment for Primary Pulmonary Paraganglioma : A case report / 대한흉부외과학회지

We describe the case of primary pulmonary paraganglioma in a 37-year-old woman who presented recurrent, severe cough. Computed tomography revealed a lobulated inhomogeneous enhanced mass with endobronchial protruding lesion suspected to be lung neoplasm, located in the upper lobe of the left lung. Bronchoscopic biopsy showed chronic inflammation with granulation tissue which was not in accord with the radiologic findings. Subsequently, a left lower sleeve lobectomy was performed. Histological analysis of the resected tumor proved to be compatible with pulmonary paraganglioma. Primary pulmonary paragangliomas are very uncommon tumors. So we report this case with literature review.

Immunohistochemical Expression of the Sodium/Iodide Symporter in Patients with Primary Lung Cancer

BACKGROUND: The sodium/iodide symporter (NIS) is a membrane glycoprotein that facilitates the uptake of iodine by thyroid follicular cells. Although the use of radioiodide is essential for the diagnosis and treatment of thyroid diseases, few studies have been conducted to investigate the use of NIS-mediated radioiodide accumulation in lung cancer. We evaluated the expression of NIS by immunohistochemistry in order to examine the diagnostic or therapeutic feasibility of using radioiodide in the treatment of primary lung cancer. METHODS: Immunohistochemistry for NIS was performed in 139 lung cancers. The expression pattern of NIS was compared with the clinicopathological characteristics of the tumors. RESULTS: NIS immunoreactivity was detected in 75 (54.0%) of the 139 cases. Twenty-three (37.7%) of the 61 squamous cell carcinomas, 49 (76.6%) of the 64 adenocarcinomas, 2 (40.0%) of the 5 small cell carcinomas, and 3 (33.3%) of the 9 other carcinomas showed positive NIS immunoreactivity. The expression of NIS was significantly associated with the histologic type (p<0.001), but it did not correlate with tumor size, lymphovascular invasion or lymph node metastasis. CONCLUSIONS: The presence of NIS was detected in lung cancer tissue using immunohistochemistry. Lung cancer potentially could be targeted with radioiodide for both diagnosis and treatment, especially in cases of adenocarcinoma.

Differential Expression of CD34 and Smooth Muscle Actin in the Stroma of Small Lung Adenocarcinoma with Mixed Bronchioloalveolar and Invasive Components

BACKGROUND: Absence of CD34-positive fibroblasts was reported within the stroma associated with invasive carcinomas. Conversely, tumor-associated desmoplastic stroma is characterized by the presence of smooth muscle actin (SMA)-reactive myofibroblasts. The present study was undertaken in order to elucidate whether the different distributions of stromal CD34-positive fibroblasts and SMA-reactive myofibroblasts are sensitive or specific markers of tumor invasion in small lung adenocarcinomas. METHODS: Immunohistochemical stainings for CD34 and SMA were done in 37 peripheral adenocarcinomas less than 3.0 cm in diameter, including 16 adenocarcinomas with bronchioloalveolar carcinoma (BAC) and invasive components (mixed), and 21 invasive adenocarcinomas without BAC components (invasive). RESULTS: The fibroblasts within the BAC components of the mixed group were mainly CD34-positive (81.2%) and preferentially SMA-negative (56.3%). In contrast, the fibroblasts within the invasive components of the mixed group were mainly CD34-negative (75.0%) and SMApositive (87.5%). The stromal cells of the invasive group were mostly negative for CD34 (90.5%) and positive for SMA (95.3%). CONCLUSIONS: The loss of CD34 and the acquisition of SMA in the stromal cells within the tumor were related to tumor invasion (p<0.05). Thus, expression patterns of CD34 and SMA can be used to detect small foci of early stromal invasion in adenocarcinomas of the lung.

Peripheral Micronodular Squamous Cell Carcinoma of the Lung Unexpectedly Discovered after an Operation for Spontaneous Pneumothorax: A Case Report

The occurrence of lung cancer in patients suffering with pneumothorax is very rare, especially in the absence of any radiological changes that would suggest neoplasia after the pulmonary reexpansion. We have experienced a case of a 60-year-old male who presented with lung cancer that was discovered by chance after an operation for his pneumothorax. The resected lung tissue showed a 0.3 cm-sized, peripheral squamous cell carcinoma associated with a bulla. The tumor was not macroscopically detected on the first thoracotomy that was performed for the treatment of the pneumothorax. The micronodular cancer was diagnosed after the histological examination of the resected bulla. The patient has been doing well with no evidence of tumor recurrence during the fifteen months follow-up. This case shows that we should always be vigilant for associated lung cancer when we examine the lung tissue after the operation for pneumotherax.

Significance of Circumferential Resection Margin Involvement Following Esophagectomy for Esophageal Cancer

BACKGROUND: This study was performed to examine the significance of the circumferential resection margin (CRM) involvement by a tumor on the postoperative survival after esophageal cancer surgery. METHODS: Fifty nine resected cases of esophageal cancers were retrospectively reviewed. The presence of a tumor either at, or within 1 mm of, the CRM was recorded. By an immunohistochemical study for Ki-67, the Ki-67 differential grades (Ki-67 DG) were defined according to the differences between the Ki-67 labeling indices of the central and of peripheral areas of the tumor nearest to the CRM: Ki-67 DG 0 (10%). The CRM involvement was correlated with the clinicopathological factors, Ki-67 DG and survival data. RESULTS: CRM involvement was found in 26 (44.1%) of the 59 cases. There were significant differences in the cases, both with and without CRM involvement of tumor cells, in relation to lymph node metastasis, lymphovascular, perineural invasions and tumor stage (p<0.05). Ten (38.3%) of the 26 with, and 3 (9.1%) of 33 cases without, CRM involvement, showed Ki-67 DG 1 (p=0.007). The 3-year survivals of patients with and without CRM involvement were 26.8 and 61.8%, respectively (p=0.003). CONCLUSIONS: These results show that the CRM involvement status may be used as a predictor of survival after esophageal cancer surgery, and CRM involvement is more an indicator of an advanced disease than of an incomplete resection.

Clinical Analysis for the Result after Curative Resection of Esophageal Cancer / 대한흉부외과학회지

BACKGROUND: Esophageal cancer is an aggressive disease with a poor prognosis. Recently, every effort has been made to improve the long term survival, but the general prognosis for patients with this disease remains poor. In this study, we reviewed 8 years of experiences with esophageal cancer patients managed in our department at Dong-A University Hospital and evaluated the effectiveness of cervical lymph node dissection performed selectively. MATERIAL AND METHOD: From January 1995 to August 2003, 70 patients underwent esophagectomy for esophageal cancer in our department. Among them, 51 patients who underwent curative resection, had no double primary tumors and no neoadjuvant therapy were analyzed retrospectively. In most patients, intrathoracic esophagectomy and cervical esophago-gastrostomy was performed. Since 1997, 3-field lymph node dissection was performed selectively. RESULT: There were 46 men and 15 women. The median age was 60 years. The tumor was located in the upper third part in 10 patients (19%), middle third in 21 (41%), and lower third in 20 (40%). Majority of the patients (90%) had squamous cell carcinoma. Cervical anastomosis was made in 41 patients, and intrathoracic anastomosis in 10. 2-field lymph node dissection was done in 40 patients, and 3-field lymph node dissection in 11. The pathologic staging were as follows: stage I in 9 patients (17.6%), IIA in 20 (39.2%), IIB in 7 (13.7%), III in 11 (21.6%), IVA in 2 (3.9%), and IVB in 2 (3.9%). The in-hospital mortality was 3.9% (2 patients) and complications occurred in 24 patients (47%). Overall actuarial 1, 3, and 5-year survival rates were 74.4%, 48.4%, and 48.4% including operative mortality. The 4-year survival rate did not differ significantly between 3-field lymph node dissection group (50.5%) and 2-field lymph node dissection group (48.9%). In 3-field lymph node dissection group, the respiratory complications were more frequent and operative time was significantly longer. CONCLUSION: We think that curative resection for esophageal cancer can be performed with acceptable mortality, and aggressive surgical approach may improve the long term survival. even for advanced stages. Effectiveness of 3-field lymph node dissection needs further investigations.

A case of mycoplasma pneumonia associated with pulmonary and bronchial eosinophilia / 천식및알레르기

Epidemiologic evidences suggest a close linking exist between Mycoplasma infection and asthma exacerbation, and possibly as a factor in the pathogenesis of asthma. However, little is known about the pathogenetic mechanism of respiratory M. pneumonia infection on airway inflammation. We report a case of mycoplasma pneumonia associated with pulmonary and bronchial eosinophilia. A 25-year-old man developed fever, coughing and dyspnea for 5 days prior to the admission. Initial chest x-ray showed bilateral interstitial or nodular infiltration and right pleural effusion. In High-resolution chest CT, demonstrated bilateral interstitial thickening with perivascular blurring. Pulmonary function test showed mild restrictive ventilatory pattern. Differential cell count in induced sputum showed marked eosinophilia(70% of non-squamous cells). Furthermore, bronchoalveolar lavage fluid analysis showed excessive eosinophils(39%). Mycoplasmal antibody was detected in patient's serum in titer of 1 to 160 by indirect hemagglutination method. Methacholine PC20 was 11.4 mg/ml. After treatment with macrolide antibiotics only, patient's subjective symptoms, abnormalities in chest x-ray film and bronchial hyperreactivity were disappeared.

Relationship between Tumor Angiogenesis and Micrometastases in The Regional Lymph Nodes of Patient with Stage I Non-Small Cell Lung Cancer

PURPOSE: This study was performed to evaluate the relation between nodal micrometastasis and tumor angiogenesis, and to assess potential molecular markers pertaining to the development of nodal micrometastasis. MATERIALS AND METHODS: Immunohistochemical studies were performed to evaluate the expression patterns of Phosphatase, and its Tensin homolog, deleted from chromosome TEN (PTEN), and the vascular endothelial growth factor (VEGF) and microvessel density (MVD) in 41 stage I non-small cell lung cancer (NSCLC), using anti-PTEN monoclonal, anti-VEGF polyclonal and anti-CD34 monoclonal antibodies, respectively. The occult micrometastasis in 503 dissected regional lymph nodes were also evaluated using anti-cytokeratin (CK) monoclonal antibody. RESULTS: CK positive cells were identified in 13 (31.7%) of the 41 cases and in 23 (4.6%) of the 503 lymph nodes. There were 19 and 22 cases with positive and negative VEGF expressions, respectively, and 10 (52.7%) and 3 (13.6%) of these, respectively, showed nodal micrometastasis (p<0.05). There were 9 cases with loss of PTEN expression, and 4 of these showed nodal micrometastasis, whereas 9 (21.8%) of 32 positive PTEN expression cases showed nodal micrometastasis (p<0.05). The MVD in the tumors with nodal micrometastasis was 60.4+/-22.6, whereas that in the tumors without nodal micrometastasis was 52.0+/-18.2. The loss of PTEN expression, an increased VEGF expression and a high MVD, within primary tumors, were significantly associated with nodal micrometastasis. CONCLUSION: The results indicate a possible value in using these biological markers, associated with tumor angiogenesis, for predicting the risk of nodal micrometastasis in NSCLC.

Gene Expression Profiling of Non-Small Cell Lung Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: cDNA microarray provided a powerful alternative, with an unprecedented view scope, in monitoring gene expression levels, and led to the discovery of regulatory pathways involved in complicated biological processes. This study was performed to gain better understanding of the molecular mechanisms underlying the carcinogenesis and progression of lung cancer. MATERIALS AND METHODS: Using a cDNA microarray, representing 4, 600 cDNA clusters, we studied the expression profiles in 10 non-small cell lung cancer (NSCLC) samples and the adjacent noncancerous lung tissues form the same patients. The alterations in the levels of gene expression were confirmed by reverse-transcription PCR in 10 randomly selected genes. RESULTS: Genes that were differently expressed in the cancerous and noncancerous tissues were identified. One hundred and nine genes (of which 68 were known) and 69 cDNAs (of which 32 were known) were up- and down-regulated in>70% of the NSCLC samples, respectively. In the cancerous tissues, the genes related to the cell cycle, metabolism, cell structure and signal transduction, were mostly up-regulated. Furthermore, we identified a few putative tumor suppressor genes that had previously been proposed by other workers. CONCLUSIONS: These results provide, not only a new molecular basis for understanding the biological properties of NSCLC, but also useful resources for the future development of diagnostic markers and therapeutic targets for NSCLC.

Clinical Significance of Lymph Node Micrometastasis in Patients with Stage I Non-Small Cell Lung Cancer / 대한흉부외과학회지

BACKGROUND: The prognostic significance of lymph node micrometastasis in non-small cell lung cancer remains controversial. We therefore investigated the clinicopathologic factors related to lymph node micrometastsis and evaluated the clinical relevance of micrometastasis with regard to recurrence. MATERIAL AND METHOD: Five hundred six lymph nodes were obtained from 41 patients with stage I non-small cell lung cancer who underwent curative resection between 1994 and 1998. Immunohistochemical staining using anticytokeratin Ab was used to detect micrometastasis in these lymph nodes. RESULT: Micrometastatic tumor cells were identified in pN0 lymph nodes in 14 (34.1%) of 41 patients. The presence of lymph node micrometastasis was not related to any clinicopathologic factor (p>0.05). The recurrence rate was higher in patients with micrometastasis (57.1%) than in those without (37.0%), but the difference was not significant (p=0.22). Patients with micrometastasis had a lower 5-year recurrence-free survival rate (48.2%) than those without micrometastasis (64.1%), with a borderline significance (p=0.11). The 5-year recurrence-free survival rate (25.0%) in the patients with 2 or more micrometastatic lymph nodes was significantly lower than that in the patients with no or single micrometastasis (p=0.02). In multivariate analysis, multiple lymph node micrometastasis was a significant independent predictor of recurrence (p=0.028, Risk ratio=3.568). CONCLUSION: Immunohistochemical anti-cytokeratin staining was a rapid, sensitive, and easy way of detecting lymph node micrometastasis. The presence of lymph node micrometastasis was not significnatly associtated with the recurrence, but had a tendency toward a poor prognosis in stage I non-small cell lung cancer. Especially, the presence of multiple micrometastatic lymph nodes was a significant and independent predictor of recurrence.

Correlation of Pulmonary Vascular Dilatation on HRCT to Expression of eNOS in a Rabbit Model of Hepatopulmonary Syndrome

PURPOSE: To investigate the correlation between pulmonary vascular dilatation on high-resolution computed tomography (HRCT) and expression of endothelial nitric oxide synthase (eNOS) after common bile duct ligation (CBDL) in the rabbit as a model of hepatopulmonary syndrome. MATERIALS AND METHODS: CBDL was done in 11 rabbits (2 weeks after CBDL, n = 5; 3 weeks after CBDL, n = 6). Four rabbits were done by abdominal incision with peritoneal suture only as a control group. HRCT scans were performed in the both groups. We evaluated peripheral pulmonary vascular dilatation in the upper and lower lobe. Tissue samples were immediately obtained from both upper and lower lobes of the lung and the liver after sacrifice. Dilatation of peripheral pulmonary vessel was correlated with the expression of endothelial nitric oxide synthase (eNOS) determined by Western blot. We also compared the degree of pulmonary vascular dilatation between the groups with administration of L-arginine (n = 5) and without administration of L-arginine (n = 6) after CBDL. RESULTS: Two weeks after CBDL, pulmonary vascular dilatation on HRCT was seen in three rabbits (60%) and the increase of eNOS expression was shown in two rabbits (40%) in the lower lobe. Three weeks after CBDL, pulmonary vascular dilatation on HRCT was seen in four rabbits (66.7%) and five rabbits (83.3%) each upper and lower lobe, respectively. Expression of eNOS was coincidently increased. The pulmonary vascular dilatation was noted more frequently in the lower lobe than in the upper lobe. Pulmonary vascular dilatation on HRCT was highly correlated with increase of expression of eNOS in the upper (r = 1.00, p = .0001) and lower lobe (r = .83, p = .0015). In contrast, control group of four rabbits developed neither pulmonary vascular dilatation on HRCT nor increase of eNOS expression. The grade of pulmonary vascular dilatation in the group with L-arginine administration was higher than that without administration of L-arginine (p < .05). CONCLUSION: Pulmonary vascular dilatation on HRCT is significantly correlated with increase of eNOS expression in a rabbit lung after CBDL. These results suggest that NO, derived from pulmonary eNOS, contributes to pulmonary vascular dilatation in a rabbit model of hepatopulmonary syndrome. Index words : Lung, CT Lung, effect of drugs on Lung, vascular disease

Iatrogenic Aspiration of a Broken Metallic Stylet: A case report / 대한마취과학회지

Complications of tracheal intubation are well documented. However, iatrogenic aspiration of a broken metallic stylet following tracheal intubation has been infrequently reported. A 60-year-old woman, 10 days after shoulder arthroscopic surgery under endotracheal general anesthesia, was admitted to our hospital because of right chest pain. Chest radiographs showed a 8 cm length of metallic foreign body in the lower lobe of the right lung. Attempts at retrieval, including thoracoscopy, were unsuccessful. Open thoracostomy was performed. The removed foreign body was a part of metallic stylet. We report a case of iatrogenic aspiration of a broken metallic stylet.