[Bronchial Occlusion with Endobronchial Watanabe Spigot for Massive Pulmonary Hemorrhage during Heart Surgery;Report of a Case].

Massive pulmonary hemorrhage, although rare, is a potentially life-threatening complications during heart surgery. We herein present 1 such case successfully treated by selective bronchial occlusion using an Endobronchial Watanabe Spigot (EWS). The 82-year-old female underwent mitral valve replacement, tricuspid annuloplasty, and maze procedure. An hour and a half after cessation of cardiopulmonary bypass, the patient suffered a massive pulmonary hemorrhage. A subsequent bronchoscopy identified the hemorrhage site at the right middle lobe bronchus (B5b), and an EWS was then selectively deployed into this bronchus to block the hemorrhage. The following day, bronchial arterial embolization was performed, enabling the removal of the spigot on the next day. The patient's respiratory condition gradually improved, allowing for extubation on the 21st postoperative day. By preventing bleeding into neighboring bronchi, which, in turn, avoids the risk of exacerbating hypoxia, bronchial occlusion with EWSs is highly effective in managing massive pulmonary hemorrhage during heart surgery.

[Congenitial Pulmonary Airway Malformation in an Adult with Pneumonia].

Congenitial pulmonary airway malformation (CPAM) most commonly present respiratory distress in the prenatal or neonatal period, but may rarely be asymptomatic and is incidentally found in adult patients with acute or recurrent pneumonia. Herein, we report a case of a 26-year-old asymptomatic adult male patient with pneumonia of the right lower lobe. He was also found to have multiple cystic lesions in the same lobe which was suspected to be CPAM, and the right lower lobectomy was performed.

[Bronchial Typical Carcinoid Tumor Treated with Two-stage Resection;Report of a Case].

A 45-year-old woman, who had been treated for bronchial asthma, was referred to our hospital with symptoms of dyspnea. Upon examination, we found the right main bronchus to be almost completely occluded by an endobronchial tumor. For the purpose of diagnosis and relieving the dyspnea, we performed a rigid bronchoscopic tumor resection with a high frequency snare. The tumor was pathologically diagnosed as a typical bronchial carcinoid, and a right upper lobectomy and wedge resection of the right main bronchus was carried out 1 month later.

A case of multiple pulmonary cavernous hemangioma.

A 61-year-old male who originally visited a different hospital, underwent a health checkup in which multiple lung nodules were detected. Multiple well-defined small nodules were observed in both lungs, with lesions reaching the arteries. Metastatic lung cancer, with unknown origin, was suspected. A computed tomography-guided percutaneous lung biopsy was performed; however, a pathological diagnosis could not be established. Then the patient was referred to our hospital for surgical lung biopsy. Macroscopically, the nodule was dark-red in color and solid without a capsule. Microscopically, the nodule was composed of dilated vascular spaces lined by flattened bland cells. They were positive for CD34, but were negative for TTF-1, consistent with lesions of endothelial origin. Microscopic and immunohistochemical findings supported the diagnosis of multiple pulmonary cavernous hemangiomas. After diagnosis, the lesions were left untreated and thereafter showed no signs of deterioration.

[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.

Hsp90 inhibitors cause G2/M arrest associated with the reduction of Cdc25C and Cdc2 in lung cancer cell lines.

PURPOSE: Hsp90, a molecular chaperone, is involved in folding, assembly, maturation, and stabilization of the client proteins which regulate survival of cancer cells, and thus Hsp90 inhibitors may be potential molecular targeting agents for cancer treatment. We investigated whether Hsp90 inhibitors have therapeutic value in lung cancer. METHODS: First, expression levels of Hsp90 in lung cancer cells were examined by western blotting and immunohistochemical analyses. Next, the effect of Hsp90 inhibitors, geldanamycin and 17-allylaminogeldanamycin (17-AAG), on lung cancer cell growth was examined. RESULTS: Remarkable high expression of Hsp90 protein in lung cancer cell lines and a more intense signal for Hsp90 by immunohistochemistry in males, patients with smoking index over 600, and squamous cell carcinoma were observed. Both Hsp90 inhibitors dose dependently inhibited the growth of lung cancer cell lines and induced G2/M arrest concomitant with decreased protein levels of Cdc25C and Cdc2. Moreover, combination of an Hsp90 inhibitor and irradiation had an additive effect on cell growth inhibition and reduction of Cdc25C and Cdc2 protein levels. CONCLUSION: Hsp90 inhibitor is thus a therapeutic tool for lung cancer based on its target proteins, which are involved in tumor progression and antiproliferative activity in lung cancer cells.

Malignant fibrous histiocytoma of the trachea.

We experienced a rare case of malignant fibrous histiocytoma (MFH) arising in the trachea. A 24-year-old man with severe dyspnea had a well-defined mass in the cervical trachea on chest X-ray examination. Chest computed tomography showed a 2.0-cm diameter mass originating in the right-posterior wall of the trachea. The tumor occupied over 90% of the lumen. A radical excision of the tumor (tracheal resection) with tracheal plasty was performed. The microscopic diagnosis was MFH. The patient remains well, without evidence of recurrence, 3 months after surgery.

Lung adenocarcinoma can be subtyped according to tumor dimension by computed tomography mediastinal-window setting. Additional size criteria for clinical T1 adenocarcinoma.

OBJECTIVE: We sought to verify that the size of the solid component, which can be evaluated using the computed tomography mediastinal-window setting, provides new criteria for CT classification of lung adenocarcinoma. METHODS: Between 1994 and September 2002, we examined 60 patients who were clinically classified with stage T1 adenocarcinoma of the lung and normal serum CEA, who underwent standard surgical procedures. Tumor maximum dimension was evaluated using two different CT-imaging settings: the lung window (lDmax), and the mediastinal window (mDmax). We analyzed the relationships between prognosis or lymph node involvement and tumor dimensions. RESULTS: The mDmax was a significant (OR 1.11, P=0.02) predictive factor for lymph node metastasis. However, lDmax was not significant (P=0.83). Age, gender, lDmax, mDmax, and lymph node involvement were analyzed as predictive factors for prognosis. In univariate analysis, mDmax and lymph node involvement were significant predictive factors for prognosis (OR 1.07, P=0.01; OR 2.56, P=0.04; respectively). In multivariate analysis, mDmax was a significant predictive factor for prognosis (OR 1.06, P=0.04). We then classified the C-T1 adenocarcinoma patients into three groups according to mDmax: T1a (< or =10 mm), T1b (from 11 to 20 mm), and T1c (from 21 to 30 mm). There was a significant difference between the three groups: the disease-free 5-year survivals were 93.3, 58.1, and 32.7%, respectively (P=0.01). CONCLUSIONS: The mDmax can give additional, useful prognostic data. This finding may provide new criteria for CT classification of lung adenocarcinoma.

Carcinoembryonic antigen as a predictive factor for postoperative tumor relapse in early-stage lung adenocarcinoma.

OBJECTIVES: To clarify the usefulness of measuring serum carcinoembryonic antigen (CEA) preoperatively to detect patients who will have a poor outcome after surgery, and who cannot be selected by conventional staging modalities. METHODS: One hundred patients with adenocarcinoma of the lung underwent standard surgical procedures between 1994 and April 2001 at our institution. Preoperative staging was assessed according to the TNM classification of the International Union Against Cancer. The associations between preoperative serum CEA level and the postoperative recurrence or lymph node metastasis were examined. The serum CEA level was classified into two groups according to concentration of CEA level: low (normal) CEA (5.0 ng/ml). RESULTS: The high CEA level was associated with tumor relapse (P=0.01). According to the preoperative staging, the increased CEA was associated with tumor relapse only in stage C-IA (P=0.001). Stage C-IB and more advanced stages did not show an association between increased CEA and tumor relapse. In C-IA, risk for lymph node involvement was significantly higher in the high CEA group (4/9; 44.4%) than in the low CEA group (6/47; 12.8%, P=0.03). Furthermore, the rate of tumor relapse in C-IA-pN0 was significantly higher in the high CEA group (4 of the 5, 80%) than in the low CEA group (9 of the 41, 22.0%, P=0.018). The 5-year disease-free survival rate for patients with a high serum CEA level (N=9) was 22.2%, and 75.0% for patients with a normal CEA (N=47) level (P=0.0004). CONCLUSIONS: Increased serum CEA is an important predictive factor for poor outcome after surgery in early-stage (C-IA) lung adenocarcinoma.