Life-threatening airway obstruction due to retropharyngeal and cervicomediastinal hematomas following stellate ganglion block.

Airway obstruction by retropharyngeal or cervicomediastinal hematomas following stellate ganglion block is life-threatening. The onset of the initial symptoms of retropharyngeal or cervicomediastinal hematoma usually occurs 2 hours or more after stellate ganglion block. We report the rare complication of airway obstruction leading to respiratory arrest caused by retropharyngeal and cervicomediastinal hematomas due to rebleeding of an ascending cervical artery 3 days after stellate ganglion block.

Expression of periostin in patients with non-small cell lung cancer: correlation with angiogenesis and lymphangiogenesis.

The aim of this study was to evaluate periostin expression measured immunohistochemically in patients with non-small cell lung cancer (NSCLC) and to determine its association with clinical features, prognosis, angiogenesis, and lymphangiogenesis. We investigated periostin expression in a series of 88 patients with NSCLC. We also determined whether expression of periostin correlated with microvessel density and lymphatic microvessel density. Periostin was expressed in 42% of 88 patients. Its expression was significantly correlated with tumor size, lymph node metastasis, disease stage, and lymphatic invasion (p=0.0128, 0.0015, 0.0310 and 0.0273, respectively). There also was a significant relation between periostin expression and microvessel density and lymphatic microvessel density (all p<0.0001). Five-year survival rates were better in patients with negative periostin expression than in those with positive periostin expression (p=0.0044). Periostin expression was not significant in a multivariate additive model. Our findings show that periostin correlates with increased tumor progression and a worse prognosis in NSCLC, as well as with angiogenesis and lymphangiogenesis.

[Resected lung cancer with production of CA19-9].

We report 2 cases of resected CA19-9 producing adenocarcinoma of the lung. Immunohistochemical studies of the specimens in 2 cases showed positive staining for CA19-9 in most of tumor cells. The serum CA19-9 levels decreased after operations and effective chemotherapy in these cases. But the serum CA19-9 levels increased with regrowth of tumors or with no therapeutic gain by chemotherapy. The serum CA19-9 level was useful to evaluate the therapeutic effect of surgery and chemotherapy, and may be effective in detecting the recurrence of lung cancer.

Significance of autocrine motility factor receptor gene expression as a prognostic factor in non-small-cell lung cancer.

Autocrine motility factor receptor (AMF-R) has been shown to play an important role in tumor cell migration, invasion and metastasis. We have detected AMF-R expression in tissue specimens from patients with non-small-cell lung cancer (NSCLC) and have assessed their clinical characteristics. Using RT-PCR and immunohistochemistry, we quantified the expression of AMF-R in 47 patients with NSCLC who underwent curative tumor resection, to investigate the relationship between AMF-R expression and clinicopathologic factors and prognosis. RT-PCR results agreed well with the immunohistochemic results (p < 0.0001). In 47 NSCLC patients, 34 (72.3%) samples were evaluated as having high AMF-R gene expression. AMF-R gene expression was significantly associated with lymph node metastasis and stage (p = 0.0295 for lymph node metastasis, p = 0.0152 for stage). The overall survival rate for patients with high AMF-R gene-expressing tumors was significantly worse than for those whose tumors had low AMF-R expression (p = 0.0029). Multivariate analysis also showed that AMF-R gene expression was significantly related to survival (p = 0.0165). These data indicate that AMF-R may contribute to tumor progression and that AMF-R gene expression can serve as a useful prognostic marker in NSCLC.

The prognostic value of natural killer cell infiltration in resected pulmonary adenocarcinoma.

OBJECTIVE: Natural cytotoxicity caused by mediated natural killer cells is believed to play an important role in host-cancer defense mechanisms. Immunohistochemically, we have detected natural killer cells in tissue specimens from patients with pulmonary adenocarcinoma and have assessed their clinical characteristics. METHODS: Using the monoclonal antibody for CD57 specific marker for natural killer cells, we quantified natural killer cell infiltration in 150 patients with pulmonary adenocarcinoma who underwent curative tumor resection to investigate the relationship between natural killer cell counts and clinicopathologic factors and prognosis. RESULTS: The natural killer cell count was significantly related to the regulation of tumor progression, involving T classification, N classification, and stage (P =.01 for T classification or stage; P =.02 for N classification). A significant difference in the rate of patient survival was detected between those patients whose tumors had either high or low natural killer cell counts in both the overall and stage I groups (P =.0002 for the overall group; P =.049 for the stage I group). CONCLUSION: These data indicate that natural killer infiltration may contribute to the regulation of tumor progression and that the natural killer cell count can serve as a useful prognostic marker in overall and stage I pulmonary adenocarcinoma.

Expression of ETS-1 is correlated with urokinase-type plasminogen activator and poor prognosis in pulmonary adenocarcinoma.

Urokinase-type plasminogen activator (u-PA) is known to be involved in proteolytic degradation of extracellular matrix during carcinoma invasion. Similarly Ets-1, a transcription factor, is also known to be important for carcinoma progression, and has been reported to interact with the u-PA gene enhancer. We used immunohistochemistry to analyze the relationship between Ets-1 and u-PA protein expression in patients with pulmonary adenocarcinoma. A significant association was found between Ets-1 expression and u-PA expression. The Ets-1 expression was correlated with T factor, lymph node metastasis and stage. Kaplan-Meier survival analysis revealed that survival times were longer in patients with Ets-1-negative tumors than in patients with Ets-1-positive tumors. Our results suggest an important role for Ets-1 in tumor progression, and the correlation with u-PA protein expression serves as an important prognostic factor in pulmonary adenocarcinomas.

Favorable results of early diagnosis by cervicothoracic computed tomography scans for descending necrotizing mediastinitis.

OBJECTIVES: We studied results of early diagnosis by cervicothoracic computed tomography and early aggressive surgery for descending necrotizing mediastinitis. METHODS: Between 1990 and 1999, 5 patients with descending necrotizing mediastinitis were surgically treated in our institute. Computed tomography scans confirmed mediastinitis in all cases, even though chest x-ray films demonstrated a widening mediastial shadow in only 2. Soon after surgical drainage of the deep neck infection and diagnosis of descending necrotizing mediastinitis, all patients underwent surgical mediastinal drainage. Mediastinitis was drained by thoracotomy in 1, managed thoracoscopically in 1 and cervicomediastinally drained in 3. RESULTS: The outcome was favorable in all patients. CONCLUSIONS: Early diagnosis by cervicothoracic computed tomography and early aggressive surgery for descending necrotizing mediastinitis are essential to favorable outcome.

An uncommon case of simultaneous malignant tumors: bronchioloalveolar cancer and Ewing's sarcoma in a 17-year-old girl: report of a case.

This report describes a 17-year-old girl with a simultaneous occurrence of bronchioloalveolar cancer and Ewing's sarcoma of the femur, which is a previously unreported association. This case emphasizes the existence of multiple primary malignant neoplasms even in adolescents. Primary lung cancer should therefore be considered in patients under 19 years of age who present with abnormal pulmonary lesions.

Expression and prognostic value of the standard CD44 protein in pulmonary adenocarcinoma.

We examined immunohistochemically the expression of the standard form of CD44 (CD44S) tissue specimens from 164 patients with pulmonary adenocarcinoma. Of the 164 specimens, 79 (48%) expressed CD44S and the incidence of expression correlated with the tumor size. The prognosis for CD44S positive patients was poorer than that of CD44S negative patients. Our findings suggest that CD44S plays an important role in tumor progression and that CD44S expression is a useful prognostic marker for pulmonary adenocarcinomas.

Massive haemoptysis due to chronic pancreatitis: control with inferior phrenic artery embolization.

Massive haemoptysis is a rare complication of chronic pancreatitis. We describe a patient with massive haemoptysis due to chronic pancreatitis who was treated successfully by means of selective inferior phrenic artery embolization.

Mast cell density is associated with angiogenesis and poor prognosis in pulmonary adenocarcinoma.

BACKGROUND: Angiogenesis in individuals with various solid tumors has provided useful information on tumor progression and prognosis, and many examples of mast cell (MC) accumulation coupled with angiogenesis can be found in the literature. METHODS: Utilizing monoclonal antibodies for tryptase that are specific markers for MC and for the endothelial surface marker CD34, the authors quantified MC infiltration in 180 patients with pulmonary adenocarcinoma who underwent curative tumor resection, to investigate the relation between mast cell density (MCD) and microvessel density (MVD), clinicopathologic factors, and prognosis. RESULTS: A significant association was found between MCD and MVD (P < 0.0001). The MC count was significantly related to tumor progression, involving N classification and stage (P = 0.0002 for N classification and P = 0. 0015 for stage). A significant difference in the rate of patient survival was detected between patients whose tumors had an MCD defined as high and those whose tumors had an MCD defined as low (P < 0.0001). Multivariate analysis also showed that MCD was significantly related to survival (P = 0.0378). CONCLUSIONS: These data indicate that MC infiltration may contribute to tumor angiogenesis and tumor progression, and that MCD is a useful prognostic marker in pulmonary adenocarcinoma.

Tumor-associated macrophage infiltration in pulmonary adenocarcinoma: association with angiogenesis and poor prognosis.

The relation between tumor-associated macrophage (TAM) density and the density of microvessels was investigated in specimens from 113 patients with pulmonary adenocarcinoma, as was the influence of TAM density on prognosis. The rank correlation test revealed a significant relation between TAM density and microvessel density (y = 14.418 + 0.863x, r = 0.454, p > 0.0001). A significant difference in patient survival rate was detected between tumors with a TAM density defined as high and those with a TAM density defined as low (p < 0.01). Multivariate analysis also showed that TAM density was significantly related to survival (p < 0.05). These data indicate that TAM infiltration may contribute to tumor angiogenesis, and that TAM density is a useful prognostic marker in pulmonary adenocarcinoma.

Expression of Thomsen-Friedenreich antigen as a marker of poor prognosis in pulmonary adenocarcinoma.

The prognostic significance of Thomsen-Frienden-reich antigen (T antigen) expression was investigated in 126 patients with pulmonary adenocarcinoma by immunohistochemical staining of tumor specimens with a monoclonal antibody specific for T antigen. T antigen immunoreactivity was detected in tumor tissue from 60 (48%) patients. T antigen expression did not correlate with gender, tumor size, presence of lymph node or distant metastasis, stage of disease, or degree of tumor cell differentiation. However, the presence of T antigen immunoreactivity correlated significantly with overall survival. The presence of T antigen immunoreactivity in tumor cells is a useful marker of prognosis in patients with pulmonary adenocarcinoma.

The surgical approach for descending necrotizing mediastinitis: report of two cases.

Descending necrotizing mediastinitis (DNM) is a potentially life-threatening complication that can develop after an oropharyngeal infection. Patients with DNM are usually treated with mediastinal drainage through a cervical or transthoracic approach, as well as by the systemic administration of antibiotics. We report herein the cases of two patients we recently treated for DNM. In the first patient, the DNM was limited to the upper mediastinum, and cervicomediastinal drainage was performed. In the second patient, the mediastinitis spread below the tracheal bifurcation down into the lower mediastinum, and an abscess was drained through a thoracotomy approach. The principles of the surgical approach for DNM are discussed, with a brief review of the literature following these case reports.

The use of transbronchial lung biopsy to establish a diagnosis of benign clear cell tumor of the lung: report of a case.

Benign clear cell tumor (BCCT) is an extremely rare pulmonary neoplasm. We report herein a case of BCCT of the lung that was diagnosed by a transbronchial lung biopsy (TBLB). The findings of hematoxylin-eosin and immunohistochemistry obtained by the TBLB were consistent with a diagnosis of BCCT of the lung. Wedge resection was subsequently performed by video-assisted thoracotomy. To the best of our knowledge, this is the first reported case of BCCT diagnosed by TBLB.