Influence of background cardiovascular risk factors on VEGF inhibitor-related adverse vascular events in patients with non-small cell lung cancer: a retrospective study.

PURPOSE: Vascular endothelial growth factor (VEGF) inhibitors are widely used in chemotherapy for non-small lung cancer (NSCLC). The purpose of the current study was to examine the impact of background cardiovascular risk factors on VEGF inhibitor-related adverse vascular events (VEGF-related AVEs) in patients with NSCLC who also had comorbidities. METHODS: We conducted a retrospective study of 118 NSCLC patients treated with bevacizumab or ramucirumab from April 2010 to December 2022. We compared baseline cardiovascular risk factors with VEGF-related AVEs. RESULTS: VEGF-related AVEs and discontinuation due to VEGF-related AVEs were reported in 54 patients and 21 patients, respectively. VEGF-related AVEs were significantly more common with male sex, smoking history, history of hypertension, dyslipidemia, diabetes mellitus, or cardiovascular disease. Discontinuation due to VEGF-related AVEs was significantly more common in patients with history of hypertension or chronic kidney disease. VEGF-related AVEs were significantly more common in patients with ≥ 3 cardiovascular risk factors than patients with < 3. Discontinuation due to VEGF-related AVEs was significantly more common in patients with ≥ 4 cardiovascular risk factors than patients with < 4. Multivariate analysis demonstrated that male sex, hypertension, and ≥ 6 cycles of VEGF inhibitors were each associated with VEGF-related AVEs and hypertension was associated with discontinuation due to VEGF-related AVEs. CONCLUSION: Our study demonstrated that history of hypertension was independently associated with increased risk of both VEGF-related AVEs and discontinuation due to VEGF-related AVEs. In conclusion, we need to be aware of VEGF-related AVEs when using VEGF inhibitors for patients with ≥ 3 cardiovascular risk factors.

Anatomical consideration of the cardiac plexus to prevent grave bradycardiac arrhythmias associated with lung cancer surgery: a case report.

BACKGROUND: Arrhythmias are known as one of the complications of lung cancer surgery, and most of them are not lethal. Life-threatening arrhythmias have been reported in the literature but in reality very rare. CASE PRESENTATION: A 67-year-old Japanese man with a history of hypertension was diagnosed with squamous cell carcinoma in left lower lobe underwent a left lower lobectomy and bilateral mediastinal lymph node dissection through a median sternotomy. During lymph node dissection along the right vagus nerve, the patient's heart rate and blood pressure dropped suddenly and an electrocardiogram monitor showed ST elevation. These abnormalities returned to normal soon after cardiac massage was performed and a coronary vasodilator was given. A temporary pacing wire was inserted at the end of the surgery. The postoperative course was uneventful and the patient was discharged on postoperative day 11 without a need for permanent pacemaker. CONCLUSIONS: We present a patient who was complicated with lethal arrhythmias during lung cancer surgery for the purpose of elucidating, from anatomical viewpoint, the relationship between arrhythmias and the involvement of cardiac plexus during lymph node dissection. The result showed that arrhythmia was inadvertently elicited by cardiac plexus stimulation during lymph nodes dissection around the vagus nerve. It is important to be familiar not only with the course of phrenic, vagus, and recurrent laryngeal nerve but also the anatomy of cardiac plexus to prevent arrhythmic complications in lung cancer surgery.

Nivolumab-induced myocardial necrosis in a patient with lung cancer: A case report.

A 74-year-old man with lung adenocarcinoma recurrence was admitted to our hospital because of dyspnea 7 days after receiving initial immunotherapy with nivolumab. Electrocardiography revealed ST-segment elevation in V1-6 and echocardiography showed a markedly reduced left ventricular ejection fraction of 9% and akinesis of the anteroseptal wall and apex. He died from acute heart failure 3 days after admission. Microscopically, multiple small foci of myocardial necrosis with few inflammatory cells were scattered in both ventricles. Obstruction of the coronary artery was not identified. We believed that the cause of death was acute heart failure possibly due to nivolumab-induced myocardial necrosis.

Transcatheter aortic valve implantation for patients with lung cancer and aortic valve stenosis.

Many patients who require lung resection have cardiovascular and cerebrovascular comorbidities. It has been recommended that surgical aortic valve replacement (SAVR) should precede lung resection in patients with severe aortic valve stenosis (AS). However, by first undergoing transcatheter aortic valve implantation (TAVI), the patient may undergo lung resection more safely. We present two patients with both severe AS and lung cancer who underwent TAVI and lung resection without any complications.

[A Surgical Case of Intrapulmonary Bronchogenic Cyst Treated by Left Lower Lobectomy for Hemopneumothorax and Repeated Hemoptysis].

A 79-year-old female visited a hospital because of high fever and computed tomography(CT)showed a cystic lesion with fluid accumulation in her left lung. She had hemoptysis and left chest pain 3 days after antibiotic therapy was started. Chest CT demonstrated the cystic lesion rupturing and causing hemopneumothorax. Then she was referred to our department and thoracic drainage was performed. However, a week after the drainage, she had hemoptysis and chest pain again, and the left lower lobectomy was performed. Histopathological findings showed the cystic lesion was intrapulmonary bronchogenic cyst. We describe a rare case of the hemopneumothorax due to the hemorrhage in the bronchogenic cyst.

Sclerosing rhabdomyosarcoma of a chest wall in an adult: a case report and review of the literature.

Sclerosing rhabdomyosarcoma (SRMS) is a newly recognized and rare variant of rhabdomyosarcoma. This soft tissue tumor has not yet been reported as a thoracic lesion. We report a case of a 26-year-old woman who presented with a large chest wall tumor. The tumor originated from the right anterior chest wall and protruded into the intra- and extrapleural cavity. A transcutaneous needle biopsy revealed spindle cells in an abundant hyalinized and fibrous stroma. Although the tumor was considered as a malignant soft-tissue neoplasm, a definitive diagnosis could not be established. A wide excision of the chest wall including the second, third and fourth rib and a part of sternum was performed. Histologically, cytoplasmic cross-striations were found in a portion of the tumor cells. The tumor cells were positive for muscle markers, and the tumor was diagnosed as rhabdomyosarcoma consistent with a sclerosing type of rhabdomyosarcoma. Eighteen months after the complete resection, the patient has pleural disseminations but is alive and undergoing chemotherapy. This case highlights the histologic features of a rare form of rhabdomyosarcoma, and emphasizes the importance of awareness of its existence and the utility of skeletal muscle markers in distinguishing sclerosing rhabdomyosarcoma from its mimics.

Pulmonary resection of lung cancer in a patient with partial anomalous pulmonary venous connection.

We report a case of a 64-year-old man in whom a partial anomalous pulmonary venous connection (PAPVC) was found before right lower lobectomy for lung cancer. In addition to lung cancer, there was a right superior pulmonary vein that drained into the superior vena cava (SVC). There was a concern of right ventricular heart failure resulting from increased left-to-right shunt flow after lobectomy. Therefore cardiac catheterization was performed to calculate the pulmonary-to-systemic flow rate in the presence of blocked blood flow to the lower lobe pulmonary artery. As a result, we successfully performed lobectomy without correcting the PAPVC.

Angiomyolipoma in the lung detected 15 years after a nephrectomy for renal angiomyolipoma.

Angiomyolipoma is generally found in the kidney, but is especially rare in the lung. Nine cases of angiomyolipoma in the lung have been reported previously, and in 3 of these patients it was involved with nephrectomy for renal angiomyolipoma. The origination of the tumor was not completely recognized, but lymphangioleiomyomatosis and angiomyolipoma are known to have a common feature. The pathogenesis of angiomyolipoma in the lung has recently been researched in relation with lymphangioleiomyomatosis. We review these case reports of angiomyolipoma in the lung and discuss the clinical features and the generation of these tumors.

Lobe-specific skip nodal metastasis in non-small cell lung cancer patients.

PURPOSE: The purpose of this study is to clarify the lobe-specific nodal metastasis and optimal range of mediastinal nodal dissection in lung cancer patients with skip metastasis. MATERIALS AND METHODS: A total of 136 patients with pN2/3 disease were treated between 1988 and 2002, and these patients were divided into two groups according to whether skip metastasis was identified or not. We drew a comparison of the lobe specificity of mediastinal nodal involvement between skip positive and negative groups. RESULTS: Skip metastasis was identified in 48 (35.3%) of 136 pN2/3 patients. The lymph nodal regions most frequently found (target nodes) were as follows: right upper-#3 and right #4, middle & lower-#3, right #4 and #7, left upper-left #4, #5, and #6, and left lower-#7, #8, and #9. Skip metastasis can be detected at a rate of 82.6% to 91.7% by means of a histological examination of these target nodes. However, the frequency of skip metastasis in other mediastinal nodal regions excluding the target nodes was found to progress to a level of 33.3% to 57.1% insofar as tumor metastasis to these target nodes was identified. CONCLUSIONS: The examination of lobe-specific nodal regions may be helpful for determining patients with skip metastasis. If metastasis is found somewhere in these target nodes, then a systematic nodal dissection may be acceptable for a complete resection even if N1 metastasis is not identified.

Langerhans cell histiocytosis: coexistence of bronchogenic and thymic cysts in the thymus.

Langerhans cell histiocytosis (LCH) is a disease caused by the proliferation of Langerhans cells in various tissues or organs. A 43-year-old male patient presented with an anterior mediastinal mass in the thymus. Histological examination after a thymectomy revealed a bronchogenic cyst in the thymus, and multiple LCH and small thymic cysts were also incidentally observed in the thymus. Unifocal LCH in an adult occurring in the thymus is extremely rare. Furthermore, no cases of LCH with the coexistence of bronchogenic and thymic cysts in the thymus have been previously reported.

Pulmonary blastoma.

We describe a resected pulmonary blastoma in an 84-year-old male, the oldest of previously reported patients. A chest X-ray showed a 2 cm-sized abnormal shadow in the left lung field. Five months later computed tomography demonstrated a well-demarcated heterogenous mass, measuring 12 cm in diameter, in the left lower lobe of the lung. This mass was diagnosed as a carcinoma using echo-guided percutaneous biopsy. The patient underwent a left lower lobectomy. The resected specimen revealed the tumor to be a pulmonary blastoma arising from lung tissue. Preoperative diagnosis of pulmonary blastoma is extremely difficult because of the histological heterogeneity of tumor. Since it has been noted that pulmonary blastoma rapidly progresses in a short period of time, surgical treatment should be undertaken as quickly as possible when such a tumor is suspected.