Pleural dedifferentiated liposarcoma: A case report.

The present case report describes a rare case of pleural liposarcoma. A 45-year-old Japanese man was hospitalized for increasing left chest pain. Imaging revealed a 10-cm pleural tumor and a 1.7-cm contralateral right pulmonary nodule. Biopsy specimens of the pleural tumor showed undifferentiated spindle-shaped and/or rounded sarcomatous features with myxoid stroma. The patient underwent embolization of the arteries feeding the left pleural tumor and palliative partial resection of the pleural tumor. The surgically removed specimens exhibited similar undifferentiated sarcomatous features. The left pleural tumor regrew aggressively, and the patient succumbed to mortality ~4.2 months following hospitalization. Autopsy demonstrated a 35-cm left pleural tumor, metastasizing to both adrenal glands and lumbar vertebral bones, and a 2.2-cm primary adenocarcinoma of the right lung. The majority of the left pleural tumor and its metastases consisted of undifferentiated sarcomatous elements, however, scattered or aggregated lipoblasts were identified in localized areas adjacent to the diaphragm. Immunohistochemically, these lipoblasts were diffusely positive for MDM2 and focally positive for S-100 protein. Undifferentiated sarcomatous tumor cells were focally positive for MDM2 but negative for S-100 protein. This case was diagnosed as pleural dedifferentiated liposarcoma. The local aggressiveness of the pleural liposarcoma directly contributed to the patient's mortality. A review of the literature indicated that the dedifferentiated subtype may serve as a factor that is indicative of a poor prognosis for pleural liposarcoma.

Focal positivity of immunohistochemical markers for pulmonary squamous cell carcinoma in primary pulmonary choriocarcinoma: A histopathological study.

Cytokeratin 5/6 (CK5/6), p63, and p40 are commonly used as immunohistochemical markers for squamous cell carcinoma (SqCC) of the lung. To elucidate their positivity in primary pulmonary choriocarcinoma (PPC), the present study examined 4 PPCs, including 1 surgically removed PPC and 3 postmortem PPCs. All PPCs consisted of nested cytotrophoblastic tumor cells and occasional syncytiotrophoblastic tumor cells although 1 surgically removed PPC was markedly affected by pre-operative therapy-associated necrosis and 3 postmortem PPCs coexisted with adenocarcinoma. In 1 surgical case, a pre-operative biopsy specimen of PPC contained a few polygonal tumor cells, which mimicked SqCC and exhibited focal p40+ features. Nuclear p63+ and p40+ features of cytotrophoblast-like polygonal tumor cells were focally observed in 3 PPCs (75%) and 2 PPCs (50%), respectively. CK5/6+ trophoblastic tumor cells were focally identified in 1 PPC. Additionally, in 2 other PPCs, CK5/6+ tumor cells were scattered in choriocarcinomatous areas, but possible intermingling of CK5/6+ adenocarcinoma cells could not be ruled out. The results emphasized that PPCs could mimic SqCC morphologically and immunohistochemically, although PPC was an extremely rare neoplasm. Surgical pathologists should be aware of this diagnostic pitfall when encountering a few squamous marker-positive polygonal tumor cells within hemorrhagic necrotic biopsy specimens from lung tumors.

[Bronchial carcinoid discovered due to repeated pneumonia in the lingular division of the left lung; report of a case].

Bronchial carcinoids are relatively rare, low-grade malignancies. Here we report a case of a bronchial carcinoid found by repeated pneumonia in the lingular division of the left lung. A 34-year-old man was referred to our hospital because of an abnormal shadow detected in an annual checkup. A chest computed tomography (CT) showed an infiltrative shadow in the lingular division. Two months later, a follow-up CT showed the shadow had remarkably improved. Two years after the 1st detection, an annual checkup revealed an abnormal shadow in the same lesion again. A chest CT showed not only an infiltrative shadow in the lingular division, but also a solid mass with calcification in the lingular bronchus. A bronchoscopy revealed an obstruction of the left upper lobe bronchus by a vascularized polypoid tumor. A transbronchial biopsy indicated a presence of a carcinoid, and a resection of the left upper lobe was performed. A histopathological examination showed that it was a typical carcinoid. The patient has been free of recurrence for 2 years since surgery. This is a case with repeated pneumonia and atelectasis caused by a bronchial carcinoid.

[A dialysis patient with advanced lung adenocarcinoma who was safely given biweekly gemcitabine therapy].

BACKGROUND: Although the number of advanced lung cancer patients on hemodialysis is expected to increase in the future, there has been no established treatment regimen yet. We report our experience with gemcitabine safely administered to an elderly patient requiring hemodialysis who had advanced lung adenocarcinoma. CASE: A 87-year-old man had been on dialysis for chronic renal failure. Left pleural effusions were detected in November 2007 and he was admitted to our hospital in January 2008. A diagnosis of Stage IIIB lung adenocarcinoma was made based on the findings of cytology from the pleural effusions and radiological examinations. After intrapleural cisplatin administration, he was given outpatient chemotherapy. Gemcitabine was administered every 14 days for 20 months. Adverse reactions observed included grade 1 neutropenia and grade 1 appetite loss. CONCLUSION: We described a dialysis patient with advanced non-small cell lung cancer who was given biweekly gemcitabine for 20 months. This regimen in a dialysis patient can be safely conducted on an outpatient basis.

Intercostal venous hemangioma presenting as a chest wall tumor.

Chest wall tumors are uncommon, but intercostal hemangioma is even more so: There have been only a handful of reports on it to date. We report on a 32-year-old man with a left-side chest wall mass detected on a chest roentgenogram and computed tomography scans. The tumor was completely resected by means of video-assisted thoracic surgery. Two years after the surgery, the patient is doing well with no evidence of recurrence.

Biphagic pulmonary blastoma with a lesion of yolk sac tumor.

Biphagic pulmonary blastoma (BPB) is one of the rare pulmonary malignant neoplasms. Here, we describe a case of BPB with a histological feature of yolk sac tumor, accompanied with an elevated serum alpha-fetoprotein level (531.1 ng/ml). The tumor was detected in the right upper lobe as a 10-cm mass. The patient underwent right upper lobectomy and mediastinal lymph node dissection. Histological examination revealed that the tumor was composed of immature mesenchymal and epithelial elements, and it was accompanied by foci of yolk sac tumor-like features that showed positive staining for alpha-fetoprotein antibody. Adjuvant chemotherapy consisted of cisplatin and etoposide. After surgery, the serum level of alpha-fetoprotein decreased below normal. Local recurrence was disclosed 27 months after surgery, and radiation therapy was performed. The patient is currently alive 70 months after surgery.

Ribozyme mediated cleavage of cell-associated isoform of vascular endothelial growth factor inhibits liver metastasis of a pancreatic cancer cell line.

Stromal angiogenesis is an important factor for progression of malignant neoplasms. We used hammerhead ribozymes against vascular endothelial growth factor (VEGF) gene transcripts to down-regulate cell-associated VEGF189 isoform function in the pancreatic cancer cell line MIA PaCa2. MIA PaCa2 transfected with anti-VEGF189 ribozyme did not show any alteration of growth rate under tissue culture. When the transformants were subcutaneously transplanted, tumour volume of the ribozyme-transfected MIA PaCa2 xenografts was significantly smaller (P<0.01). No metastasis of MIA PaCa2 transfected with anti-VEGF189 was apparent, while disabled ribozyme-transfected MIA PaCa2 showed significant liver metastasis (P<0.05). These results suggested that VEGF189 plays an important role in growth and metastatic potential through alteration of angiogenic balance in cancer.