Subacute cor pulmonale due to tumor embolism.

We describe a patient wih subacute cor pulmonale caused by tumor emboli in the lungs. A 64-year-old female suffering from a subacute progressive cough and shortness of breathing died of severe pulmonary hypertension seven days after admission. Neither chest CT scans nor lung perfusion scintigraphy showed any abnormal findings. Microscopic examination after an autopsy revealed diffuse intravascular tumor emboli occluding not only the small pulmonary arteries and arterioles, but also the lymphatic vessels, which were suggested to be metastases of a breast carcinoma resected five years previously. Thus, pulmonary tumor embolism should be considered in the differential diagnosis of primary pulmonary hypertension, particularly in patients with a past history of cancers.

Primary seminoma in the middle mediastinum.

Primary mediastinal seminoma is a relatively rare tumor usually located in the anterior mediastinum. We report here an extremely rare case of a 66-year-old man with primary seminoma in the middle mediastinum. A physical examination showed lymphadenopathy in the right supraclavicular area. A chest CT confirmed the presence of a tumor occupying the retrotracheal space. A histological examination demonstrated metastatic seminoma from the open biopsy of the lymph node. Abdominal, pelvis, and cerebral CT scan and testicular ultrasound were negative. Thus, primary mediastinal seminoma in the middle mediastinum with supraclavicular lymph node metastasis was diagnosed.

Intralobar pulmonary sequestration presenting increased serum CA19-9 and CA125.

A 39-year-old man was admitted to our hospital for further evaluation of a consolidated shadow and clarification of the cause of serum tumor marker elevation (CA19-9 496.2 U/ml, CA125 160.6 U/ml). Chest computed tomography revealed a well-defined homogeneous nodule in the left S(10). Angiography showed one aberrant artery, branching from the ascending aorta. Intralobar pulmonary sequestration was diagnosed and the sequestrated lung was resected. Microscopic findings of the sequestrated lung showed a mucus-containing cystically dilated bronchus, which was covered with ciliated cylindrical epithelium. Immunohistochemical staining showed positive staining for CA19-9 and CA125 in both the ciliated cylindrical epithelium and mucus. Serum values of tumor markers returned to their normal range after surgery.

[Comparative study of bone resorption markers for the diagnosis of bone metastasis in lung cancer].

NTx and I CTP, a metabolite of type I collagen, were compared as to their usefulness as indicators of bone metastasis in lung cancer. The NTx level was significantly higher in lung cancer patients with bone metastasis (107.9 +/- 56.1 nM BCE/mM) than in those without it (p < 0.0001), as was the I CTP level (10.0 +/- 6.5 ng/ml; p < 0.0001). The Z scores of NTx and I CTP were 2.37 and 2.04, respectively, indicating that NTx is superior to I CTP in sensitivity to bone metastasis because of its higher Z score and its higher area under the ROC curve. The cutoff values of these markers were set to produce the highest accuracy/sensitivity rates and to make possible the highest diagnostic efficiency, and then the odds ratios at these cutoff values were calculated. The odds ratios of NTx and I CTP at cutoff values for the highest accuracy were 66.3 and 12.6, respectively; those offering the highest diagnostic efficiency were 46.5 and 10.0, respectively. These results indicated that NTx offers better prediction of bone metastasis in lung cancer than does I CTP.