[Intrapulmonary Solitary Fibrous Tumor;Report of a Case].

An abnormal lung shadow was detected in a 39-year-old woman at physical examination and she was followed-up carefully at a nearby hospital. After 5 years follow-up, the patient was referred to our hospital for further examination of the abnormal shadow. A chest computed tomography(CT) scan revealed a 12 mm well-circumscribed nodular shadow in the right lower lobe. A benign tumor such as a hamartoma was suspected preoperatively;video-assisted thoracic surgery was performed for both diagnosis and treatment. Partial resection of the right lower lobe was performed and the tumor was diagnosed as an intrapulmonary solitary fibrous tumor (SFT). No malignant features, such as nuclear atypia, necrosis, or mitotic activity, were identified. Careful observation will be necessary, because a few SFTs have a propensity to recur or metastasize. The post-operative course was uneventful and there has been no recurrence at 7 years after surgery.

[Lung Adenocarcinoma with Pulmonary Aspergillosis Showing Cavity Disappearance;Report of a Case].

A 49-year-old man complaining of fever, chest pain, and hemosputum was examined at a local hospital. A chest computed tomography (CT) scan revealed a 35 mm mass shadow with cavity in the right upper lobe, but a transbronchial lung biopsy could not establish a complete diagnosis. After 1 month follow-up, the patient was referred to our hospital because the mass shadow wall remained thick despite the cavity shrinking. The mass shadow cavity disappeared 2 months after the 1st CT at our hospital. Video-assisted thoracic surgery was performed for both making diagnosis and treatment. The patient was diagnosed with non-small cell lung cancer with pulmonary aspergillosis during surgery, and a right upper lobectomy with systematic lymph node dissection was performed. Pathological examinations revealed that the tumor was a T3N0M0 stage II B adenocarcinoma with pulmonary aspergillosis. The patient was treated with adjuvant chemotherapy 4 months after surgery and is under follow-up.

[Pulmonary Metastasis from a Phyllodes Tumor of the Breast Developing Sixteen Years after Initial Surgery].

We report a case of solitary pulmonary metastasis from a phyllodes tumor of the breast appearing 16 years after initial surgery. The patient was a 56-year-old woman who had undergone surgical extirpation of a left breast tumor diagnosed as phyllodes tumor (borderline malignancy) in 1998, and a right breast tumor diagnosed as fibromatosis in 2000. Sixteen years after the initial operation, she consulted our hospital because of a chest X-ray abnormality detected at a screening examination. Chest computed tomography revealed a well defined nodular shadow in the left upper lobe of the lung. Surgery was done since primary lung cancer was suspected. However, pathological diagnosis was a pulmonary metastasis from the phyllodes tumor of the left breast. Right breast tumor was also diagnosed as a metastasis from the left breast tumor by histopathological re-evaluation.

Biomarkers as prognostic factors for cN2 or 3 non-small cell lung cancer treated by induction chemoradiotherapy and surgery.

BACKGROUND: We have reported promising results of surgery after induction chemoradiotherapy (carboplatin-taxane, 50 Gy radiation) for cN2,3 non-small cell lung cancer (NSCLC). In order to understand the underlying mechanism, expression of excision repair cross-complementing 1 (ERCC1), class III ß-tubulin (tubulin), thymidylate synthase (TYMS), and ribonucleotide reductase M1 (RRM1) were investigated. PATIENTS AND METHODS: Immunohistochemistry was performed in 45 patients with cN2,3 NSCLC, but only in twelve pathologically-complete response cases to evaluate intratumoral expression of these biomarkers. RESULTS: High expression of ERCC1, tubulin, TYMS and RRM1 was observed in 25 (55.6%), 19 (42.2%), 20 (44.4%) and 25 (55.6%) patients, respectively. Low expressions of ERCC1, tubulin, TYMS and RRM1 were favorable prognostic factors (p=0.044, p=0.025, p=0.039 and p=0.037, respectively). The simultaneously low expression of ERCC1 and tubulin was observed to be the most significant prognostic factor, by Cox regression analysis (hazard ratio=2.381; p=0.0059). CONCLUSION: Patients with simultaneous low expression of ERCC1 and tubulin are promising candidates for surgery after carboplatin-taxane chemoradiotherapy. For patients with high expression of ERCC1 and tubulin, uracil-tegafur, pemetrexed, and gemcitabine may be the alternative agents for personalized chemotherapy.

[Prognosis of surgically treated large cell neuroendocrine carcinoma].

Large cell neuroendocrine carcinoma (LCNEC) is a relatively rare tumor in malignant lung neoplasms. The prognosis of LCNEC is poor and there is no consensus on the treatment for LCNEC. We report our retrospective assessment of 11 patients of LCNEC from 1999 to 2008. Three of 11 patients had malignant exudate at thoracotomy. Seven patients received limited resection. There was a recurrence even after complete surgical resection in its early stage. Four patients received platinum-based chemotherapy for adjuvant therapy or recurrence. The response to platinum-based chemotherapy was relatively good and may be comparable to that of small cell lung cancer. The overall 5-year survival rate was 30.3%. Pulmonary LCNEC represents an aggressive tumor and multimodal treatment is required.

Progressive growth of primary synovial sarcoma of the lung.

An 80-year-old male was admitted because of a giant mass in the left lower lobe of the lung on a routine chest X-ray. Chest computed tomography verified this to be a well-defined heterogeneous mass as described with no associated lymphadenopathy. FDG-PET depicted moderately marginal FDG uptake. The patient underwent a left lower lobectomy and lymphadenectomy. Grossly, the tumor measured 60 × 50 mm and was uniformly filled with a pure white, pudding-like friable substance. No lymph node metastasis was observed microscopically. Histologically, the tumor showed a dense proliferation of rounded or spindled malignant cells with a frequent mitotic activity and an increased nuclear-to-cytoplasmic ratio. The immunohistochemical staining was positive for vimentin, negative for cytokeratin, keratin-wide, EMA, CD34. A SYT-SSX2 fusion gene transcript was detected as a result of RT-PCR analysis. Because of these results, the tumor was diagnosed as a monophasic synovial sarcoma.

Expression of ERCC1 and class III ß-tubulin is associated with the survival of resected stage III non-small cell lung cancer patients treated with induction chemoradiotherapy using carboplatin-taxane.

Several molecules have been proven to be associated with responsiveness to chemotherapy. A clinical study on the expression of excision repair cross-complementing (ERCC)-1 and class III ß-tubulin was conducted in advanced stage non-small cell lung cancer (NSCLC) patients. We investigated 34 resected stage III NSCLC patients treated with induction chemoradiotherapy using carboplatin-taxane. Immunohistochemistry was performed to evaluate the intratumoral expression of ERCC1 and class III ß-tubulin. Nineteen tumors (55.9%) were ERCC1-high and 11 (32.4%) were class III ß-tubulin-high. There was no correlation between ERCC1 and class III ß-tubulin expression (r=0.208). Regarding the pathological effect of induction therapy, the percentage of ERCC1-positive tumor cells was lower in tumors with a major response than in tumors with a minor response (P=0.0851). The percentage of class III ß-tubulin-positive tumor cells was significantly lower in tumors with a major response than in tumors with a minor response (P=0.0105). Regarding patient survival, the overall survival was significantly higher in patients with ERCC1-low tumors than in those with ERCC1-high tumors (P=0.0034). The overall survival was also significantly higher in patients with class III ß-tubulin-low tumors than in those with class III ß-tubulin-high tumors (P=0.0185). Cox regression analysis also demonstrated that ERCC1 (P=0.0467) and class III ß-tubulin statuses (P=0.0237) were significant prognostic factors. Co-evaluations of the intratumoral expression of ERCC1 and class III ß-tubulin are clinically useful for identifying patient populations responsive to chemotherapy using carboplatin-taxane.

Solitary fibrous tumor of the pleura presenting dry cough induced by postural position.

Solitary fibrous tumor of the pleura is one of the uncommon diseases. About 40% of solitary fibrous tumors of the pleura are of a visceral and peduncled type. Several visceral pleural tumors have motility. A proof of motility of the intrathoracic tumor is useful for preoperative diagnosis. We report a resected case of solitary fibrous tumor of the pleura presenting dry cough induced by postural position.

Mediastinal metastasis of the thyroid papillary carcinoma mimicking thymoma.

Mediastinal tumors are a common condition encountered by general thoracic surgeons, and the most frequent of such tumors is thymoma. However, metastatic mediastinal tumors are rare. Here we report a case of papillary carcinoma of the thyroid to the mediastinum that mimicked thymoma. The patient, a 60-year-old woman who had been treated for thyroid cancer 6 years previously, visited our hospital because of an abnormal shadow in the anterior mediastinum. Radiological findings and laboratory data did not suggest any recurrence of the thyroid cancer, but computed tomography examination revealed a thymoma-like mass. (18)F-Fluoro-2-deoxy-D: -glucose positron emission tomography revealed two lesions: an anterior mediastinal mass and a right breast nodule. We resected both tumors. Histological examination revealed that the mediastinal mass was a metastasis from the thyroid papillary carcinoma, whereas the nodule was an early breast cancer. At the 9-month follow-up examination the patient was well without evidence of recurrence of either cancer.

Clinical application of infrared thoracoscopy to detect bullous or emphysematous lesions of the lung.

OBJECTIVE: We have previously reported that infrared thoracoscopy was useful in detecting emphysematous lesions in a canine model of lung emphysema. We applied infrared thoracoscopy to determine the feasibility and efficacy of planning bullectomy for patients with spontaneous pneumothorax. METHODS: A total of 8 patients with spontaneous pneumothorax were included in the study. No procedure-related complications were observed. Infrared thoracoscopy with a single injection of indocyanine green (3.0 mg/kg) was used to detect bullous lesions of the lung during surgical intervention. Partial lung resections of the bullous lesions were performed after image analysis based on color density data obtained by means of infrared thoracoscopy. RESULTS: Bullous or emphysematous lesions of the lung were demonstrated in white, whereas normal lung tissue was imaged in blue, under infrared thoracoscopy. We were able to detect small bullous lesions with infrared thoracoscopy because of its clearer visualization compared with thoracoscopy. Quantitative color-density analysis revealed a marked decrease of indocyanine green intensity, which reflected decreased blood flow of bullous lesions. All resected specimens were confirmed as bullous lesions based on microscopic examinations. CONCLUSION: Infrared thoracoscopy-guided lung resection is a safe and useful procedure in detecting small bullous lesions.