[A Case of Multiple Brain Metastases after Surgery for Lung Cancer Successfully Treated with Osimertinib].

Right upper lobectomy and lymph node dissection was performed on an 85-year-old male clinically diagnosed with primary lung cancer at the age of 78 years. His post-operative pathologic staging was adenocarcinoma pT1aN0M0, StageⅠ A1, and he was positive for the epidermal growth factor receptor(EGFR). Two years post-operation, a PET scan revealed cancer recurrence due to mediastinal lymph node metastasis. The patient received mediastinal radiation therapy followed by cytotoxic chemotherapy. Nine months later, a PET scan revealed bilateral intrapulmonary metastases and metastases to the ribs. He was subsequently treated with first-generation EGFR-TKIs and cytotoxic chemotherapy. However, his performance worsened 30 months later(6 years post-surgery)due to multiple brain metastases and tumor hemorrhage. Therefore, invasive biopsy was problematic, and liquid biopsy(LB)was performed instead. The results showed a T790M gene mutation, and osimertinib was administered to treat the metastases. The brain metastasis decreased, and PS improved. Thus, he was discharged from the hospital. Although the multiple brain metastases vanished, a CT scan showed liver metastasis 1 year and 6 months later. As a result, he died 9 years post-surgery. Conclusion: The prognosis for patients with multiple brain metastases after lung cancer surgery is poor. Long-term survival is expected with 3rd generation TKI treatment if LB is performed appropriately, even in post-operative multiple brain metastases of EGFR-positive lung adenocarcinoma with poor PS.

Long-term Outcome of Pulmonary Resection for Nontuberculous Mycobacterial Pulmonary Disease.

BACKGROUND: Pulmonary resection along with multiple antimicrobial therapy has produced favorable outcomes at a few centers. However, little is known regarding the risk factors for long-term survival and microbiological recurrence after pulmonary resection for nontuberculous mycobacterial pulmonary disease (NTMPD). We evaluated the long-term outcomes of pulmonary resection, including microbiological recurrence and survival. METHODS: This retrospective cohort study included 125 patients (median age, 60 years) with NTMPD treated by pulmonary resection at two referral centers between January 1994 and August 2015. RESULTS: Postoperative complications occurred in 27 patients (22%). The complication rate after pneumonectomy was significantly higher than those after other types of pulmonary resection (odds ratio, 4.1; 95% confidence interval [CI], 1.6-10.3; P = .005). The median follow-up period was 7.1 years. While 19 patients experienced microbiological recurrence, 26 died. Multivariate analysis revealed pneumonectomy (adjusted hazard ratio [aHR], 0.12; 95% CI, .007-.66; P = .0098) and cavitary lesions after surgery (aHR, 6.73; 95% CI, 1.68-22.7; P = .0095) to be predictors of microbiological recurrence and old age (aHR, 1.06; 95% CI, 1.01-1.13; P = .016), low body mass index (BMI; aHR for every 1-kg/m2 increase, 0.72; 95% CI, .60-.85; P < .0001), pneumonectomy (aHR, 4.38; 95% CI, 1.78-11.3; P = .014), and remnant cavitary lesions (aHR, 3.53; 95% CI, 1.35-9.57; P = .011) to be predictors of poor prognosis. CONCLUSIONS: Patients who could benefit from pulmonary resection should be carefully selected considering age, BMI, remnant lesions after surgery, and type of pulmonary resection.

[A Case of Long-Term Survival after Resection of Metachronous Metastases to the Liver and Lungs from Primary Rectal Cancer].

A 81-year-old man had undergone high anterior resection for rectalcancer in 20XX. Abdominalcomputed tomography (CT)showed an isolated shadow of 2 cm in size in the liver, 9 years after surgery for colorectal cancer. We performed liver S4 segmental resection and cholecystectomy. Histopathological examination confirmed liver metastases of rectal cancer. On examination of the liver metastasis 5 years after surgery, chest CT showed a shadow of 10mm in size in S6 of the left lung. We performed partialresection via video-assisted thoracic surgery(VATS)in 20XX+14. Histopathological examination revealed lung metastases of rectal cancer. We believe that metachronous metastases from rectal cancer should be removed surgically if radicalcure is possible.

[Achievement of sputum culture negative conversion by minocycline in a case with extensively drug-resistant pulmonary tuberculosis].

A 33-year male was readmitted to our hospital for the treatment of multi-drug resistant pulmonary tuberculosis in February 1993. Six years after the treatment, the left pleuropneumonectomy was done because of the enlargement of cavitary lesions with formation of fluid. Four years after the operation, M. tuberculosis from the patient was resistant to all first- and second-line anti-tuberculosis drugs. Apical lesion and cavitary lesion on the upper lung were still seen on chest X ray and sputum smear and culture were continuously positive. Minocycline and gatifloxacin were prescribed after five years of the operation. Sixteen months after changing the regimen sputum smear and culture converted negative. Chemotherapy was terminated in August 2007, two years after the negative conversion. One year after the termination of treatment no relapse occurred. We considered minocycline was effective in this case, because gatifloxacin was resistant by the drug susceptibility test and was previously used.