Chronic expanding hematoma of thorax extended to the neck.

We report a rare case of chronic expanding hematoma of thorax extended to the neck. An 83-year-old man with a history of Lucite ball plombage and thoracoplasty of bilateral thorax was admitted with numbness of left upper extremity. In 6 months, left supraclavicular fossa was gradually bulged like tumor. The lesion was diagnosed as chronic expanding hematoma. Surgically, Lucite balls were removed with surrounding hematoma debris and fluid, and neck hematoma, which was slightly communicated to the thorax, was extirpated. We discussed the genesis of this hematoma and its extension to the neck.

Treatment of chronic expanding hematoma of the thorax with median sternotomy.

Chronic expanding hematoma of the thorax is a rare disease. We report a 60-year-old man with chronic expanding hematoma, which occupied the left entire hemithorax. Its hematoma was extirpated with pleuropneumonectomy. It was performed through posterolateral thoracotomy following median sternotomy, through which left hilar structure including inferior pulmonary vein could be accessed and closed. After the operation, he was discharged without any significant complications.

Concurrent chemoradiotherapy using cisplatin plus S-1, an oral fluoropyrimidine, followed by surgery for selected patients with stage III non-small cell lung cancer: a single-center feasibility study.

PURPOSE: This single-institutional study was designed to determine whether S-1, an oral fluoropyrimidine, plus cisplatin with concurrent radiotherapy is feasible as an induction treatment for locally advanced non-small cell lung cancer (NSCLC). METHODS: Eighteen patients were analyzed in this study from July 2005 to March 2008. The patients received 40 mg/m(2) S-1 orally twice per day on days 1 through 14 and 22 through 35, and cisplatin (60 mg/m(2)) was injected intravenously on days 8 and 29. The patients also underwent radiotherapy, and received a total dose of 40 Gy in 20 fractions beginning on day 1. Surgical resection was performed from 3 to 6 weeks after completing the induction treatment. RESULTS: Nine (50%) of the 18 patients who received the induction treatment achieved a partial response. One patient refused to undergo surgery. The remaining 17 patients underwent a complete surgical resection. There were no deaths nor any major morbidities during the perioperative period. The recurrence-free survival and overall survival rate at 2 years for the patients who underwent resection were 63.3% and 88.2%, respectively. CONCLUSION: Induction treatment using S-1 plus cisplatin and concurrent radiotherapy and surgical resection for selected patients with stage III NSCLC is a feasible and promising new treatment modality.

LKB1 mutations frequently detected in mucinous bronchioloalveolar carcinoma.

OBJECTIVE: LKB1 mutations are common in patients with Peutz-Jeghers syndrome, which is characterized by mucocutaneous pigmentation, intestinal polyps and a high incidence of cancers at variable sites. This study investigated the status of the LKB1 gene in mucinous bronchioloalveolar carcinoma with or without Peutz-Jeghers syndrome. METHODS: Three mucinous bronchioloalveolar carcinoma tumors from two Peutz-Jeghers syndrome patients and seven tumors from sporadic mucinous bronchioloalveolar carcinoma patients were collected by surgery between 2002 and 2008, and high molecular weight genomic DNA was extracted from them. The nucleotide sequences in exons 1-9 of LKB1 were determined by genomic polymerase chain reaction-direct sequencing. The loss of heterozygosity was analyzed by high-resolution fluorescent microsatellite analysis using two microsatellite markers that encompass the LKB1 locus, D19S886 and D19S565. The mutations of KRAS, EGFR and p53 were also evaluated. RESULTS: The germline mutation of LKB1 in the Peutz-Jeghers syndrome patients was identified as G215D by analyzing genomic DNA from normal lung tissue specimens. Furthermore, two of the three mucinous bronchioloalveolar carcinomas from these Peutz-Jeghers syndrome patients exhibited additional somatic mutations. On the other hand, four of seven sporadic 'non-Peutz-Jeghers syndrome' mucinous bronchioloalveolar carcinomas had LKB1 mutations. Loss of heterozygosity analyses revealed allelic loss in two tumors with LKB1 mutations. As a result, 70% of the mucinous bronchioloalveolar carcinomas exhibited LKB1 mutations. KRAS, EGFR and p53 mutations were mutually exclusive and observed in four, two and one tumors, respectively. Among them, five mutations occurred concomitantly with LKB1 mutations. CONCLUSIONS: The relatively high frequency of LKB1 mutations in mucinous bronchioloalveolar carcinoma patients may therefore suggest its involvement in lung carcinogenesis, at least in mucinous bronchioloalveolar carcinoma.

Incidentally proven pulmonary "ALKoma".

Genetic alterations of echinoderm microtubule-associated protein-like 4 (EML4)-anaplastic lymphoma kinase (ALK) inversion were recently found in lung cancer. A 39-year-old woman with multiple brain metastases and bulky mediastinal lymph node metastases was admitted. Biopsy from her supraclavicular lymph nodes was performed to differentiate the diagnosis between lymphoma and lung cancer. Pathologically, the lymph nodes had a feature of adenocarcinoma. On the other hand, the commercially available chromosomal fluorescent in situ hybridization (FISH) analysis showed split signals of ALK, which was confirmed to be the EML4-ALK inversion. The commercial-based ALK FISH is useful for screening pulmonary ALKoma.

Favorable surgical results for patients with nonsmall cell lung cancer over 80 years old: a multicenter survey.

BACKGROUND: Surgery for elderly patients, especially those over 80 years old, with primary lung neoplasms is a relatively common treatment according to the increasing elderly population. We reviewed our experiences to evaluate surgical outcomes in over-80-year-old patients with nonsmall cell lung cancer (NSCLC). PATIENTS AND METHODS: We reviewed and analyzed the clinical records of 146 consecutive over-80-year-old patients (Group 1) and 926 control patients (65 years old and younger) (Group 2) with NSCLC who underwent surgical resections from 1981 to 2006. RESULTS: The mean ages of Group 1 and Group 2 were 82.6 and 56.2 years old, respectively. The ratio of the clinical and pathological Stage I was higher than the Stages II-IV in Group 1, and that of pathological Stage III was higher in Group 2. Segmental and wedge resection were selected more frequently in Group 1, otherwise, pneumonectomy and lobectomy were selected more frequently in Group 2. The ratio of squamous cell carcinoma was higher in Group 1 than in Group 2. When we divided the time of surgeries into decades, the 1980s, 1990s, and 2000s, the ratio of elder to younger patients was clearly increased according to era: 6.6%, 13.7%, and 18.8%. Furthermore, incomplete operation cases were significantly decreased in the two groups. There was no difference of overall survival in either. When examined for overall survival, except for patients with incomplete resection, there was no significant difference between the two groups. CONCLUSIONS: Surgery is the convenient treatment for elderly NSCLC patients, especially, for those who can undergo complete resection.

Resection of mediastinal granulocytic sarcoma triggered the rapid progression of acute myeloid leukemia.

Mediastinal granulocytic sarcoma (GS) is a relatively rare disease. We experienced a case of acute myeloid leukemia (AML) that took a rapid turn for the worse after the resection of a mediastinal GS. A healthy 60-year-old man had been in good general health all his life, but was diagnosed with a mediastinal tumor by his family physician and was referred to our department. The patient underwent resection of the mediastinal tumor because thymoma was highly suspected. On postoperative day (POD) 3, the patient suffered a fever as well as an elevated white blood cell (WBC) count and a high C-reactive protein level. His WBC count was 77,240 at its peak on POD 9, at which point the patient was diagnosed with AML by bone marrow aspiration. The immunohistological findings showed the features of leukemia, and GS was diagnosed. Despite chemotherapy, the patient died on POD 28 as a result of rapid disease progression.

Late-period-onset chylothorax after a pulmonary resection for lung cancer: a case report.

A 65-year-old female had been diagnosed with right lung cancer by her family physician, and she was introduced to our Department of Thoracic Surgery at Matsuyama Red Cross Hospital in May 2004. She underwent a right upper lobectomy and wedge resection of S6 with the systematic dissection of her mediastinal lymph nodes. The patient made an uneventful recovery and was discharged on postoperative day 19. However, chylothorax was detected on a chest roentgenogram when she consulted our outpatient clinic again for dyspnea on exertion and chest pain. Chylothorax occurred in postoperative day 34. The patient initially received conservative therapy, but subsequently underwent surgical treatment and fibrin glue intubation when conservative therapy proved to be unsuccessful.

Relationship of tumor size to survival in patients with pT2N0 lung cancer.

Lung cancer extending beyond 3 cm in diameter without lymph node or distant metastasis is defined as T2. The purpose of this study was to analyze the prognosis based on tumor size for patients with resected T2N0M0 non-small cell lung cancer. The 268 patients who underwent complete resection of a lung tumor > 3 cm in diameter were reviewed retrospectively. They were divided into 3 groups based on tumor size: 3-5 cm, > 5-7 cm, and > 7 cm. There were significant differences in the 5-year survival rates of 61.4%, 47.9%, and 21.9% in each group, respectively. In the two subgroups with tumor sizes 3-4 cm and > 4 cm, the 5-year survival was 63.8% and 48.1%, respectively. Tumors > 4 cm in diameter indicate a poor long-term prognosis.

Outcome of a pulmonary metastasectomy for an orthopedic malignancy.

OBJECTIVE: The purpose of this study was to examine the pulmonary metastatic results in patients with orthopedic malignancies. METHODS: Forty-three consecutive patients who underwent a resection of a pulmonary metastasis from an orthopedic malignancy in our hospital were retrospectively investigated. The survival following the resection of a pulmonary metastatic tumor was then analyzed using the Kaplan-Meier method. The impact of clinicopathologic variables on the prognosis including gender, patient age, primary tumor type, the number of the pulmonary metastases, the number of metastasectomies, the operation-era, and the disease-free interval was examined by the Logrank test and Cox's proportional hazards model. RESULTS: The 5-year overall survivals after a pulmonary metastasectomy were 20.7%. A univariate analysis revealed a significant benefit in the post-metastasectomy survival based on the patients age and the disease-free interval. A multivariate analysis demonstrated patient age to be an independent factor for the prognosis with a hazard ratio of 4.873 (p = 0.0373). When only young (less than 40 years of age) patients were investigated, the histologic type was revealed to be related to the prognosis (p = 0.0004). CONCLUSION: Pulmonary metastasis from soft tissue tumors is considered to lead to a poor prognosis for younger patients and a metastasectomy for such patients should be considered as one of the potentially effective treatments.

The significance of serum active matrix metalloproteinase-9 in patients with non-small cell lung cancer.

Matrix metalloproteinase-9 (MMP-9) plays an essential role for metastasis. The purpose of this study is to investigate the significance of active MMP-9 quantified in serum of patients with non-small cell lung cancer. Immunohistochemical staining of the primary tumors was also performed to analyze how much the secretion of MMP-9 from cancer cells influences the concentration of MMP-9 in serum. The preoperative sera of 39 patients with NSCLC, who underwent an operation at our institution from 1996 to 1999, were taken before the operation. Forty-three samples of sera were drawn postoperatively. Of these 43 samples, 16 sera were taken from patients who suffered with recurrence, 27 sera were taken from patients who did not suffer with recurrence. The serum level of active MMP-9 of preoperative state was 24.3 +/- 21.2 ng/ml, which was higher than that of control was 14.6 +/- 18.8 ng/ml, but no significance was recognized statistically between them (P = 0.0666). The immunoreactivity of MMP-9 was not correlated statistically with serum level of total MMP-9 and active MMP-9. The activity ratio of non-recurrent group was also a lower level than that of recurrent group (P = 0.0082). In conclusion, our results suggest that the concentration of serum active MMP-9 has a possibility of being an available marker to detect a recurrent disease. Our findings strongly suggest that measuring the activity ratio of serum MMP-9 appears to be a potentially useful tumor maker.

Slowly progressive adenocarcinoma of the lung: report of a case.

A case report of a slowly progressive adenocarcinoma of the lung, followed by computed tomography is herein discussed. The patient was a 76-year-old woman, who was operated on about four years after a small lung nodule on her left upper lobe was discovered. The tumor was suspected to be either well differentiated adenocarcinoma or atypical adenomatous hyperplasia (AAH) by the findings of chest computed tomography before the operation, and the resected specimen demonstrated well differentiated adenocarcinoma, without lymph node metastasis. This case demonstrates the possibility that some adenocarcinomas with particular histology are slowly progressive, and also there might be the option of lobectomy or segmentectomy for treating such tumors.

Reduced expression of thrombospondin-1 correlates with a poor prognosis in patients with non-small cell lung cancer.

Thorombospondin-1 (TSP-1) is a 450 kDa extracellular matrix glycoprotein, with anti-angiogenic activity. We analyzed the relationship in TSP-1 expression and Microvessel count (MVC), and also clinical factors, using immunohistochemical methods for non-small cell cancer (NSCLC). Histopathologically, there was inverse correlation between TSP-1 expression and MVC for squamous cell carcinoma, but not for adenocarcinoma cases. Among 199 completely resected cases of NSCLC, the 5-year survival was 77.0% when the expression of TSP-1 was maintained and 55.1% when the expression were reduced, respectively (P=0.0046). When compared with TSP-1 expression in the high MVC subgroup, there was significantly shorter survival time when TSP-1 expression was reduced (P=0.0091), and no significant difference was seen for the low MVC subgroup. Multivariate analysis revealed that expression of TSP-1 is as a prognostic factor of NSCLC. Our present data suggest that TSP-1 might not be a direct anti-angiogenic factor and the TSP-1 expression is a prognostic indicator of NSCLC.

Subcarinal bronchogenic cyst with high carbohydrate antigen 19-9 production.

In a rare case of bronchogenic cyst with high carbohydrate antigen (CA) 19-9 production, a 57-year-old man with coughing and chest pain was diagnosed with a subcarinal mediastinal tumor. Fiberoptic bronchoscopy showed an erosive mucosal lesion overlying the area of extrinsic compression at the membranous of the right mainstem bronchus. Serum carbohydrate antigen 19-9 was elevated at 1300 U/ml. Thoracotomy showed an encapsulated cyst tightly adhering to the right main bronchus. The cyst was extirpated after ablation at the adherent cystic wall by electrocautery. Although intracystic carbohydrate antigen 19-9 concentration was very high, serum carbohydrate antigen 19-9 and bronchoscopic findings returned to normal postoperatively. The histological diagnosis was consistent with a bronchogenic cyst and carbohydrate antigen 19-9 could be immunohistochemically demonstrated within its epithelium.

Micrometastasis in the bone marrow of patients with lung cancer associated with a reduced expression of E-cadherin and beta-catenin: risk assessment by immunohistochemistry.

BACKGROUND: The presence of disseminated tumor cells in bone marrow is considered to be a premetastatic state, which is called micrometastasis. To evaluate the relationship between micrometastasis and cellular adhesion molecules in the primary lesion, E-cadherin and beta-catenin were immunohistochemically investigated. Methods. Fifty-eight patients with non-small cell lung cancer who underwent a complete resection were entered into this study. Tumor cells in bone marrow aspirates were detected by immunohistochemistry using cytokeratin (CK) 18. Immunohistochemical studies of E-cadherin and beta-catenin were performed in the corresponding primary tumor. RESULTS: CK-positive cells were detected in the bone marrow aspirates from 27 of 58 patients. A reduced expression of the E-cadherin and beta-catenin was found in 16 (27.6%) and in 22 (37.9%) of 58 patients, respectively. In 26 cases with a reduced expression of E-cadherin and/or beta-catenin, 16 cases had CK-positive cells, whereas 11 of 32 cases with normal expression of both factors had CK-positive cells (P=.0392). The patients with micrometastasis demonstrated an earlier recurrence (P =.0642) and a significantly poorer survival (P =.0437) than those without such cells. CONCLUSIONS: Micrometastasis in the bone marrow might be a significant predictor of poor prognosis, and a reduced expression of E-cadherin and beta-catenin are important determinants for the metastatic capability of individual cancer cells.