ABSTRACT
A 60-year-old man complaining of right shoulder pain and numbness of right arm was diagnosed with Pancoast tumor (invasive right apical lung cancer). Chest CT scan showed a tumor, 5 cm in diameter, in the right apex invading the right posterior chest wall. The patient received preoperative CCRT (RT: 40 Gy/20 Fr, cisplatin: CDDP and etoposide: ETP), resulting in tumor regression (PR). The patient underwent right upper lobectomy (ND 2a), partial resection of the 1st-3rd ribs and Th 1 nerve. Pathological examination demonstrated no live cancer cells and organization of necrotic tissue in the lung and intercostal region (Ef. 3). The patient received postoperative chemotherapy (CDDP+ETP) and was discharged. He did well without any tumor recurrence for 1 year postoperatively. CCRT seems effective and is one of the standard treatments for Pancoast tumor.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Lung Neoplasms/drug therapy , Lung Neoplasms/radiotherapy , Pancoast Syndrome/drug therapy , Pancoast Syndrome/radiotherapy , Pneumonectomy , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Cisplatin/administration & dosage , Combined Modality Therapy , Drug Administration Schedule , Etoposide/administration & dosage , Humans , Lung Neoplasms/surgery , Male , Middle Aged , Pancoast Syndrome/surgery , Pneumonectomy/methods , Preoperative Care , Remission InductionABSTRACT
A 69-year-old woman complaining of a cough was admitted to our hospital. Chest X-ray showed a mass in the right lower lung field. Chest computed tomography (CT) showed a tumor with notch, 3 cm in diameter, in the right lower lobe (S9-S10). The tumor was diagnosed as adenocarcinoma by the biopsy under chest CT. The patient underwent right lower lobectomy (ND2a). The tumor was whitish solid mass, 35 x 34 x 29 mm in size. Histopathologically, the tumor was diagnosed as clear cell adenocarcinoma with a component of well-differentiated fetal adenocarcinoma (WDFA), pT2N0M0, stage IB. The patient was discharged and received postoperative chemotherapy (UFT). The patient has been doing well without any tumor recurrence for 1 year postoperatively.
Subject(s)
Adenocarcinoma, Clear Cell/pathology , Adenocarcinoma/pathology , Lung Neoplasms/pathology , Neoplasms, Multiple Primary/pathology , Aged , Female , HumansABSTRACT
OBJECTIVE: The aim of the present study was to investigate the safety and acceptability of a new method of visualizing lymphatics, including sentinel lymph nodes (SNs), in lung cancer patients using multidetector computed tomography (MDCT). METHODS: Images were obtained using an MDCT scanner (Asteion Multi 4 Detector-Row; Toshiba) at 1, 2, and 3 minutes after percutaneous injection of 1 mL contrast medium (iohexol) near the tumor in 15 patients with small peripheral lung cancers (cT1N0M0). A lymph node was confirmed to be an SN if the attenuation was more than 30 Hounsfield units greater on postcontrast images than on precontrast images. All patients underwent surgery, and definitive lymph node staging was assessed. RESULTS: The procedure was performed safely in all patients without significant complications. Lymphatic ducts or lymph nodes were visualized in all 15 patients. The SN was identified in 14 of 15 patients (93.3%) at lymph node 14 in 4 patients, lymph node 13 in 7, lymph node 12 in 6, and lymph node 6 in 1. In 1 remaining patient, the lymphatic duct running from the tumor toward the pleura was visualized. CONCLUSIONS: Lymphatics were visualized by this method in all patients without significant complications. This method should be useful not only to detect the SNs but to visualize pathways other than through the hilar lymph nodes.
Subject(s)
Carcinoma, Non-Small-Cell Lung/diagnostic imaging , Image Enhancement/methods , Image Processing, Computer-Assisted/methods , Imaging, Three-Dimensional/methods , Lung Neoplasms/diagnostic imaging , Lymphatic Metastasis/diagnostic imaging , Lymphography/methods , Tomography, Spiral Computed/methods , Aged , Carcinoma, Non-Small-Cell Lung/pathology , Carcinoma, Non-Small-Cell Lung/surgery , Contrast Media/administration & dosage , Female , Humans , Injections, Intravenous , Iohexol , Lung Neoplasms/pathology , Lung Neoplasms/surgery , Lymph Nodes/diagnostic imaging , Lymph Nodes/pathology , Lymphatic Metastasis/pathology , Lymphatic Vessels/diagnostic imaging , Lymphatic Vessels/pathology , Male , Middle Aged , Neoplasm Staging , Pneumonectomy , Sensitivity and Specificity , Sentinel Lymph Node BiopsyABSTRACT
Sentinel node navigation surgery (SNNS) for lung caner has not yet been established. Sentinel node (SN) identification using dye or radioisotope has been developed; however, the SN identification rate was less than 50% in the dye method and use of radioisotopes is strongly restricted in Japan. The novel method using a CT or MRI contrast medium are expected. A study of local immune reaction for lung cancer in SN is also a very interesting issue.
