Chest wall and axillary lymph node FDG uptake associated with cancer vaccine therapy for lung cancer.

Cancer vaccines are now undergoing clinical investigations, and clinical trials of therapeutic cancer vaccines have been conducted mainly for advanced cancer patients. We experienced 2 cases of multifocal F-18 fluoro-2-deoxy-D-glucose uptake in the chest wall and axillary lymph nodes associated with personalized peptide vaccine therapy for recurrent lung cancer. In this article, we report fluoro-2-deoxy-D-glucose -positron emission tomography and positron emission tomography/computed tomography findings.

[A case of co-existent disseminated Mycobacterium avium infection and non-Hodgkin's lymphoma].

A 76-year-old man was admitted to our hospital with dyspnea. Chest CT revealed bronchial stenosis caused by mediastinal lymphadenopathy. An FDG-PET scan showed increased FDG uptake in the mediastinal lymph nodes, lumbar vertebrae and left ilium. Neither the first biopsy specimen from the left ilium nor the endobronchial lesion showed malignant cells, but both were positive on acid-fast bacillus staining. Genetic testing found the Mycobacterium avium (MAC) gene. Therefore, we diagnosed disseminated MAC infection, and started antibiotic therapy. However, he did not respond to the therapy, and his bronchial stenosis worsened. We performed a biopsy of the newly-appearing supraclavicular lymph node, and of the left ilium again, and confirmed a new diagnosis; diffuse large B cell lymphoma, coexistent with disseminated MAC infection. This case suggests not only the simultaneous occurrence of disseminated MAC infection and diffuse large B cell lymphoma, but also the coexistence of both diseases within the same organs, and that there may be some relationship between the two diseases.

[Estimation of preoperative induction chemoradiotherapy effectiveness for non small-cell lung cancer].

We have performed the clinical evaluations of preoperative induction chemoradiotherapy (CRTx) for 25 patients with non small-cell lung cancer (male: 19, female: 6, mean age: 66.4-year-old). The clinical stages of these patients were IIA: 1, IIB: 7, IIIA: 14, and IIIB: 3, respectively. In the histological type of lung cancer, there were 12 patients of adenocarcinoma, 7 of squamous cell carcinoma, 1 of adenosquamous carcinoma, 1 of anaplastic carcinoma, and 4 of large cell carcinoma. We applied two courses of regimen as the pre-operative chemotherapy (CDDP+DOC or CBDCA+PTX). Twenty-four patients received radiotherapy as the concurrent radiotherapy (44 Gy: 22 patients, 60 Gy: 2 patients). Among the 25 patients, 16 patients accomplished both chemotherapies, and the effects of the treatment were as follows: CR; none, PR; 15, SD; 9, respectively. And the other patient was not an evaluable case due to atelectasis. Histopathological effects (Ef) were Ef-3: 3, Ef-2: 11, Ef-1: 7, Ef-0: 1 and Ef was not evaluable in 3 cases. Post operative pathological findings showed that 14 patients were down staged. There were no operative mortality associated with the operation, and no serious morbidity case was observed. Eighteen patients were survived and 1 patient was survived with tumor metastases. Only one patient died of recurrence in the upper mediastinal lymph nodes, 3 patients died of the brain metastases, one died of hepatic metastasis, and one died of cryptogenic sudden death. As a result, there was no serious operative morbidity observed in the course of this CRTx. We therefore recommend that induction chemoradiotherapy as a beneficial pre-operative treatment.

[A case of lung cancer producing granulocyte colony-stimulating factor with a significantly high uptake in the bones observed by a FDG-PET scan].

A 57-year-old man complaining of right shoulder pain was admitted. Chest enhanced CT scanning showed a mass shadow in the right upper lobe with chest wall invasion. The laboratory data on admission showed marked leukocytosis. A CT-guided lung biopsy was performed, and a histological examination of the biopsy specimen showed a spindle cell type pleomorphic carcinoma. Immunohistochemistry staining using an anti-granulocyte colony-stimulating factor (G-CSF) monoclonal antibody demonstrated many tumor cells containing G-CSF as well as an increased level of serum G-CSF. The diagnosis was determined to be lung cancer producing G-CSF. FDG-PET scanning showed a significantly high uptake in the right upper field and the bones throughout the body. After chemoradiation therapy, the patient underwent a right upper lobectomy with a chest wall resection. Since then, the leukocytosis and the high level of serum G-CSF normalized and the high uptake in the bones disappeared in the FDG-PET scan.

[An autopsy case of massive hemoptysis due to a rupture of the thoracic aortic aneurysm into the left lung].

An 81-year-old man was admitted to our hospital with aspiration pneumonia and thereafter suddenly died of massive hemoptysis. An autopsy revealed an aortic arch aneurysm which had ruptured into the left lung. This case showed that acute infectious lung diseases, such as aspiration pneumonia, could cause a rupture of thoracic aortic aneurysms. Thoracic aortic aneuysms are uncommom causes of hemoptysis. Their rupture into the left lung is rarer than that into other organs and not many such cases have been previously reported in the literature. Making an accurate diagnosis is also difficult if an aneurysm is not suspected. Delay in surgical treatment could result in a lethal hemorrhage. In conclusion, we suggest that thoracic aortic aneurysms should always be considered and carefully ruled out in patients who present with either massive or minor hemoptysis.

[Case of intractable hemoptysis controlled by bronchial occlusion with an Endobronchial Watanabe Spigot (EWS)].

A man in his eighties with massive hemoptysis was referred to our hospital in order to control the bleeding. Chest computed tomography (CT) indicated that the hemoptysis originated from the right upper lobe. We performed arterial embolization twice, but failed to stop it. A surgical lobectomy was considered to be very difficult to perform because of his poor general condition and the strong adhesions between the right upper lobe and parietal pleura. We therefore performed fiberoptic bronchoscopy and plugged 4 EWS (Endobronchial Watanabe Spigot) into his right B1b, B1, B2, B3, and this procedure was able to successfully and completely control the hemoptysis. Bronchial occlusion with EWS has been developed in order to treat patients with intractable pneumothorax, pyothorax with bronchial fistula and similar problems. Our findings suggest that this method is also highly effective in controlling hemoptysis in cases in which arterial embolization is unable to stop the bleeding or surgery is difficult to perform.

Primary pulmonary hypertension treated with short-term epoprostenol infusion.

We describe the use of short-term epoprostenol in a 61-year-old man with primary pulmonary hypertension. The patient was on a ventilator because of respiratory distress. Continuous infusion of epoprostenol was started and it initially reduced the pulmonary artery pressure by 32%. Epoprostenol was tapered, and even after discontinuation, the pulmonary artery pressure was controlled. The ventilator was removed, and the patient remained well on home oxygen therapy 3 months after discharge.

[Bowel perforation due to metastatic lung cancer: a case report].

We report a case of small bowel perforation secondary to metastasis from a lung squamous cell carcinoma that occurred in a 72-year-old man. He was admitted to the hospital because of remittant hemoptysis after undergoing a right upper lobectomy. Fiberoptic bronchoscopy revealed bleeding from the right upper lobe bronchial stump that was due to recurrence of the tumor. He developed abdominal pain, nausea and vomiting four months after resection of the primary tumor. An abdominal radiograph demonstrated free air in the abdominal cavity. He was diagnosed as having intestinal perforation and was operated on. The operative findings indicated adherence and perforation of the jejunum and ileum. The pathological diagnosis of the removed tumor was poorly differentiated squamous cell carcinoma. The patient died 32 days after the second operation. Although abdominal metastasis from lung cancer is not an unusual postmortem finding, it is rare in clinical situations. If a patient with lung cancer complains of abdominal pain, it is important to consider the possibility of abdominal metastasis.

[A case of benign asbestos pleural effusion suspected on thoracoscopic examination under local anesthesia].

We report the case of a 92-year-old man with a 13-year history of occupational asbestos exposure who presented with a complaint of dyspnea. In September 2001, bilateral pleural effusions were revealed on chest radiography, and continued to progress despite treatment for heart failure. Chest CT revealed calcification of the pleura but no abnormal findings in the lung fields. Both pleural effusions were exudative and lymphocytes were the predominant cells contained in them. Antituberculous chemotherapy had no effect on the exudates. In March 2002, thoracoscopy was performed under local anesthesia (medical thoracoscopy). Plaque was recognized on the parietal pleura; however, the serosal surfaces of the parietal and visceral pleura were smooth, and no evidence of malignancy, especially malignant mesothelioma, was noted. The patient's condition was diagnosed as benign asbestos pleural effusions. Prednisolone was administered, and these effusions gradually decreased. Cases of benign asbestos pleural effusion occurring simultaneously with massive bilateral effusions are rare. Thoracoscopy aided in the differential diagnosis of this case.

Phase I/II study of altered schedule of cisplatin and etoposide administration and concurrent accelerated hyperfractionated thoracic radiotherapy for limited-stage small-cell lung cancer.

To improve the efficacy of a combination of cisplatin and etoposide and concurrent accelerated twice-daily thoracic radiotherapy against limited-stage small-cell lung cancer, we conducted a phase I/II study using an altered schedule of chemotherapy administration. Chemotherapy consisted of four cycles of cisplatin (days 1 and 8) and etoposide (days 1, 2, 8, and 9) every 4 weeks. Accelerated hyperfractionated thoracic radiation (1.5 Gy twice daily x 30 fractions, total dose of 45 Gy) was concurrently given with the first cycle of chemotherapy. The recommended doses of cisplatin and etoposide determined in the phase I study were 40 and 80 mg/m(2), respectively. In the phase II study, the overall response rate was 100% (complete response: 32%, partial response: 68%). By a median follow-up time of 29 months, median radiation-outfield progression-free survival was 13.4 months, while radiation-infield progression-free survival did not reach median value. The median overall survival time was 22.9 months, with survival rate of 48.4% at 2 years. Major toxicities were leukopenia and neutropenia (>/=grade 3, 92% each). The local control and overall survival demonstrated in this study were excellent. However, the insufficient distant control suggests a need for development of more active chemotherapy regimens.

Pulmonary sequestration associated by Mycobacterium intracellulare infection.

A case of a 29-year-old woman with intralobar pulmonary sequestration infected with Mycobacterium intracellulare is presented. A chest CT scan revealed a density in the posterior segment of the left lower lobe, and an acid-fast bacillus sputum culture yielded Mycobacterium intracellulare. After 3 months of treatment with clarithromycin, streptomycin, rifampicin and ethambutol, the patient underwent partial resection of the left lower lobe. At the 6-month follow-up the patient's clinical status is excellent. A review of the literature revealed only three case reports of pulmonary sequestration associated with Mycobacterium avium-intracellulare complex infection.

[Combination chemotherapy with carboplatin and etoposide for elderly patients aged 76 years or older with small cell lung cancer].

Eighteen elderly patients aged 76 years or older with small cell lung cancer were treated with carboplatin (AUC = 4 mg/ml.min, i.v. day 1) and etoposide (70 mg/m2 i.v. day 1-3) and 17 patients were evaluable. The median age of the study population was 77 years (range: 76-81). Eight patients had limited disease (LD) and nine did extensive disease (ED). The overall response rate was 88% for LD patients and 67% for ED patients. Median survival time was 219 days for LD patients and 158 days for ED patients. Grade 3 and 4 leukopenia, neutropenia, thrombocytopenia and anemia occurred in 41%, 76%, 24% and 6% of patients, respectively. There was one treatment-related death due to pneumonitis.

Septic pulmonary embolism associated with periodontal disease: reports of two cases and review of the literature.

We report two cases of septic pulmonary embolism associated with periodontitis. Chest CT revealed multiple nodular shadows with features characteristic of septic pulmonary embolism in both patients. Both patients had toothache, fever, and chest pain, and showed findings of periodontitis at initial presentation. Antimicrobial agents combined with dental surgery were successful in treatment. While septic pulmonary embolism from the lesions of periodontitis appears to be rare, periodontitis remains important in the differential diagnosis of septic pulmonary embolism.

Intracellular IL-5 and T-lymphocyte subsets in atopic and nonatopic bronchial asthma.

BACKGROUND: Allergen-stimulated IL-5 production by CD4+ T cells is the key issue in atopic asthma. On the other hand, virus-specific CD8+ T cells produce IL-5 and might play an important role in the pathogenesis of nonatopic asthma. OBJECTIVES: We sought to compare the IL-5-producing T-lymphocyte subsets in the peripheral blood of atopic and nonatopic asthmatic subjects, especially the contribution of IL-5-producing CD8(+) T cells in nonatopic asthma. METHODS: Heparinized blood samples were obtained from subjects with atopic asthma (n = 10), subjects with nonatopic asthma (n = 10), and healthy subjects (n = 10) and stimulated with ionomycin and phorbol myristate acetate in the presence of brefeldin A. Two-color flow cytometric analysis with mAbs to cell-surface antigens and intracellular IL-5 was used to detect the IL-5-producing T-cell subsets. RESULTS: A higher percentage of IL-5-producing CD3(+) T cells was detected in subjects with atopic and nonatopic asthma than that seen in the healthy subjects. The percentage of IL-5-producing CD4(+) T cells was significantly higher in subjects with atopic asthma than in the healthy subjects. The percentage of IL-5-producing CD8(+) T cells was significantly higher in subjects with nonatopic asthma than in the healthy subjects. The percentage of IL-5-producing CD8(+) T cells was higher in subjects with nonatopic asthma than in those with atopic asthma, but the difference was not statistically significant. CONCLUSIONS: CD4(+) T cells are the major source of IL-5 among CD3(+) lymphocytes in subjects with atopic asthma. On the other hand, increased IL-5 production by CD8(+) T cells, as well as by CD4(+) T cells, is a characteristic feature of nonatopic asthma.