[Acquired Bronchial Atresia due to Endobronchial Tuberculosis].

A 37-year-old woman was re-admitted to our hospital because the recurrence of endobronchial tuberclosis was suspected. Mycobacterium tuberculosis was not detected by culture of sputum and gastric fluid, and computed tomography revealed a left superior segmental bronchus obstruction and pneumonia. Her pneumonia improved by administration of antibiotics, but the strong cough persisted. Bronchoscopic examination revealed that the left superior segmental bronchus was blind. Mycobacterium tuberculosis was not detected from a biopsy of the blind bronchus wall. We diagnosed that her obstructive pneumonia was due to acquired atresia after endobronchial tuberculosis. Because a persistent cough even after the treatment of pneumonia indicated the possibility of recurrent obstructive pneumonia, surgical resection was performed. The postoperative course was uneventful and the patient was discharged on the 8th postoperative day. The atresia of the superior segmental bronchus was histologically considered to be acquired atresia due to the inflammation from tuberculosis.

[Mediastinal lymph node carcinoma of unknown primary site; report of a case].

We experienced a rare case of a 38-year-old man with mediastinal lymph node carcinoma of unknown primary site. He had an abnormal shadow of upper mediastinal mass in a health check, and he was referred to our hospital. Chest computed tomography( CT) showed only one swollen mediastinal lymph node, and positron emission tomography(PET) revealed an accumulation of fluorodeoxyglucose in the nodule. Serum levels of neuron specific enolase (NSE) were found to be elevated. Preoperative examination did not detect the primary lesion. She underwent a mediastinal lymphadenectomy. The pathological diagnosis of the lesion was large cell neuroendocrine carcinoma. He was given platinum-based combined chemotherapy and radiotherapy as adjuvant therapy. He has been well without any sign of recurrence for 1 year after surgery. Surgical resection of mediastinal lymph node carcinoma of unknown primary site has the possibility of a good prognosis.

[Giant hemangioma of the rib].

We experienced a rare case of a 73-year-old woman with giant hemangioma of the left 8th rib. She had an abnormal shadow of left lower lung field in a health check and was referred to our hospital. Preoperative examination suggested malignant rib tumor because of tumor growth beyond the disrupted bony cortex. She underwent resection of the left 8th rib with the 7th rib and the 7th intercostal muscles and reconstruction of the chest wall defect. The pathological diagnosis of the lesion was cavernous hemangioma. She was discharged after an uneventful postoperative course. She has been well without any sign of recurrence for 3 year after surgery.

[Pulmonary mycobacterium intracellulare infection complicated with pneumothorax and chronic empyema].

A 75-year-old woman who had been treated for pulmonary Mycobacterium intracellulare infection was admitted to a nearby hospital because of hemoptysis, right pneumothorax, and empyema. She had been treated by thoracic drainage and pleural lavage, but was reffered to our hospital because of refractory empyema. Her chest radiograph and chest computed tomography( CT) showed right chronic empyema of which pleural aspirate was smear positive for acid-fast bacilli and positive for the polymerase chain reaction method(PCR)-Mycobacterium intracellulare. Serum levels of white blood cell and C-reactive protein(CRP) were found to be slightly elevated. She was treated with combined use of ethambutol, rifampicin, clarithromycin, and kanamycin and with pleural curettage by thoracoscopic surgery. After surgery additional treatment was done using urokinase which was administered into the thoracic cavity via an thoracic tube. Chronic empyema gradually improved with the treatment and the pleural effusion became bacterial free, enabling the patient to discharge from hospital without thoracic drainage.

[Atypical thymic carcinoid with hypercalcemia].

We experienced a rare case of a 76-year-old man with an anterior mediastinal tumor diagnosed postoperatively as atypical thymic carcinoid with hypercalcemia. He was found to have a growing abnormal mediastinal shadow, and admitted. Chest computed tomography scan on admission revealed an anterior mediastinal mass of 4.0 cm in diameter. Extended total thymectomy was performed through a median sternotomy. The histopathological diagnosis was an atypical carcinoid of the thymus. He received adjuvant mediastinal irradiation. Endocrinological tests for preoperative hypercalcemia revealed high levels of serum intact-parathyroid hormone( PTH), prolactin and gastrin. A parathyroid scintigraphy revealed a parathyroid tumor. He has been well without any sign of recurrence for 1 year after surgery and irradiation treatment. When diagnosing anterior mediastinal tumor with hypercalcemia, atypical carcinoid of thymus with hyperparathyroidism should be considered.

[Two cases of long-term response treated by S-1 with concurrent radiotherapy followed by S-1 treatment for non-small cell lung cancer patients].

In a previous study, we reported a patient who responded to non-small cell lung cancer treatment with S-1 and concurrent radiotherapy over an extended period. This time, we report a long-term follow-up of the same case, and a new case which had a complete response to S-1 and concurrent radiotherapy. Case 1 is a 35-year-old woman with a pathological diagnosis of stage T2N2M0 lung adenocarcinoma. This case was already reported till 36 months postoperatively. 71 months postoperatively, PET-CT inspection revealed no obvious metastasis, unusual accumulations of FDG, or unusual shadows which may suggest recurrence. Case 2 is a 37-year-old woman with a pathological diagnosis of stage T2N2M0 right lung adenocarcinoma. After CBDCA/GEM and gefitinib were used as anterior chemotherapies, the right lung was partially resected. However, since the metastasis was developed, a total amount of 60 Gy/30 Fr was used to irradiate the mediastinum of the right cervix. Around the same time, S-1 treatment was started[a dose of 50mg/day(35m2/day)in two divided doses for 2 weeks, followed by 1 week of rest). As a result of S-1 treatment with concurrent radiotherapy, the patient had a long-term response. Sixteen months postoperatively, there has been no observable recurrence by CT inspection.

A decrease in lung cancer mortality following the introduction of low-dose chest CT screening in Hitachi, Japan.

Recent US clinical trial demonstrated that CT screening prevents lung cancer death among high risk individuals. However, it remains unclear whether wide implementation of low-dose CT screening for lung cancer can decrease mortality in the community. Among residents in Hitachi City (Japan), where nearly 40% of inhabitants aged 50-69 years were estimated to have participated in the screening at least once from 1998 through 2009, the trend of lung cancer mortality was described in relation to the timing of implementation of the CT screening. Cancer mortality data were obtained from regional cancer registry and standardized mortality ratio (SMR) of lung cancer was calculated for each 5-year period during 1995-2009. In both men and women aged 60 years or older, age-specific lung cancer mortality rates were generally lower during 2005-2009 as compared with those during 1995-2004. For combined men and women aged 50-79 years, SMR was nearly unity prior to or during introductory phase of CT screening and during early period of implementation; however, it was significantly decreased during 2005-2009, well after the implementation of CT screening, with SMR (95% confidence interval) being 0.76 (0.67-0.86). Results suggest that wide implementation of low-dose chest CT screening may decrease lung cancer mortality in the community 4-8 years after introduction of the screening.

[Chest wall lipoma mimicking a well differentiated liposarcoma; report of two cases].

We experienced 2 cases of chest wall lipoma mimicking a well differentiated liposarcoma. The 1st case was a 60-year-old female. She admitted to our hospital with abnormal shadow detected by chest X-ray. Positron emission tomography combined with computed tomography (PET-CT) revealed fatty tumor penetrating left chest wall without significant accumulation of fluoro-2-deoxy-D-glucose (FDG). Resection of the tumor with partial resection of the 6th and 7th ribs with were performed, because the tumor was suspected to invade surrounding tissues by surgical findings. The other case was a 41-year-old male. He admitted to our hospital with abnormal shadow detected by chest X-ray. PET-CT revealed fatty tumor penetrating left chest wall and its standard uptake value (SUV) was 1.2. The tumor was resected with surrounding periosteum and intercostal muscle without thoracotomy. Both cases were diagnosed as lipoma by pathology.

[Pulmonary cryptococcosis preoperatively diagnosed as lung cancer].

A 60-year-old woman was referred to our hospital with an abnormal shadow on chest radiography. Chest computed tomography( CT) showed a nodular shadow 1 cm in diameter with spiculation at S6a of the right inferior lobe. The patient was diagnosed as having a class V squamous cell carcinoma by bronchoscopic exfoliative cytology and was thus hospitalized for surgery. The nodule was resected by partial resection of the lung for intraoperative rapid pathology. Since the diagnosis was an inflammatory node, further procedure was not performed. Histopathological examination of the permanent specimen revealed a diagnosis of pulmonary cryptococcosis.

Adenosquamous carcinoma of the lung: surgical results as compared with squamous cell and adenocarcinoma cases.

OBJECTIVES: An adenosquamous carcinoma (ASC) of the lung is a relatively rare tumor. In this multi-institutional cohort study, we tested the hypothesis that an ASC exhibits more aggressive clinical behavior as compared to adenocarcinoma (AC) and squamous cell carcinoma (SC). METHODS: This retrospective cohort study used a prospective database produced by the Japan National Hospital Organization Study Group for Lung Cancer over a 7-year period (operations from 1997 to 2003, follow-up data until March 2010). During that period, 4668 cases underwent an operation for various types of primary malignant lung tumors. When a sample from a tumor comprised at least 20% each of SC and AC, the case was classified as ASC. Pathologic staging was done according to the seventh edition of the International Union against Cancer (UICC) Tumor Node Matastasis (TNM) classification of malignant tumors. RESULTS: We identified 114 patients with ASC (2.4%), 2993 with AC (64.2%), and 1369 with SC (29.3%). Kaplan-Meier survival curves for all stage cases, p-stage IA, IB, and IIIA tumors indicated that ASC cases had the least favorable survival. The 5-year survival rates for all stage cases were 23.3% for ASC, 58.0% for AC (p < 0.0001), and 40.8% for SC (p < 0.0001). The 5-year survival rates for p-stage IA were 42.0% for ASC, 81.8% for AC (p = 0.0005), and 63.4% for SC not significant (NS), while those for p-stage IB were 19.3%, 65.3% (p = 0.0024), and 46.8% (NS), respectively, and those for p-stage IIIA were 17.8%, 24.8% (p = 0.0154), and 18.8% (NS), respectively. There was a tendency for greater survival differences between ASC and AC in earlier tumor stages. A step-wise multivariable model demonstrated that sex, age, performance status, histology, tumor size, p-stage, operative method, and neoadjuvant/adjuvant therapy were independent prognostic factors. CONCLUSION: ASC of the lung is more aggressive than AC and SC. The decreased survival of patients with ASC as compared with either of those single histology tumors suggests the need for a clinical trial of adjuvant chemotherapy that includes early-stage patients.

[Surgical treatment of pulmonary mycobacteriosis for the past 10 years].

For the past 10 years (2000-2009), 50 patients of pulmonary mycobacteriosis underwent surgical treatment at Ibarakihigashi National Hospital. Three MDR-TB cases received lobectomy and one case of MDR-TB received intracavity aspiration and thoracoplasty. One bronchial tuberculosis received sleeve lobectomy. Two cases with hemoptysis due to M. avium pulmonary disease underwent pulmonary resection (lobectomy and completion pneumonectomy). One nontuberculous mycobacteriosis case accompanied by lung cancer received lobectomy. In one case because cavity lesion remained after chemotherapy she received lobectomy. All of patients were discharged without complication after operation. For the purpose of definite diagnosis 41 cases (38 cases with a solitary pulmonary nodule and 3 cases with multiple pulmonary nodules) were received surgical procedures. Results of culture examination for the resected lesion were 4 M. tuberculosis complex, 8 M. avium and 4 M. intracellulare. There was only one case with M. avium who needed additional lobectomy because scattered lesions became worse after the previous pulmonary partial resection. The remaining patients were discharged without complication.

[A case of complete response treated by S-1 with concurrent radiotherapy for a gefitinib-resistant non-small cell lung cancer patient].

A 35-year-old woman with a clinical diagnosis of stage T2N2M0 lung adenocarcinoma received 3 courses of preoperative chemotherapy with cisplatin and docetaxel. The treatment response was no change. A left inferior lobectomy with mediastinal and hilar lymph-node dissection (ND2a) was performed. The pathological diagnosis was stage T2N2M0 lung cancer. Gefitinib was administered postoperatively. After 2 months of oral treatment, gefitinib was discontinued because of enlarged subcarinal lymph nodes and an elevated level of serum Sialyl LewisX-i antigen (SLX). Starting 4 months after surgery, the mediastinum was irradiated with a total dose of 50 Gy. Chemotherapy with S-1 was started 5 months after surgery. S-1 was administered in a dose of 100 mg/day in two divided doses for 4 weeks, followed by 2 weeks of rest. The patient received 6 courses of chemotherapy with S-1, without increasing the dose. The enlarged mediastinal lymph nodes disappeared, and the serum SLX level returned to normal. The patient had a complete response, and was subsequently followed on an outpatient basis while receiving oral UFT. More than 36 months have elapsed since surgery, with no evidence of recurrence.