A remarkable response to combination chemotherapy with nivolumab and ipilimumab in a patient with primary pulmonary choriocarcinoma: a case report.

Background: Primary pulmonary choriocarcinoma (PPC) is a rare malignancy, and only 41 PPC cases have been reported in males up to 2021. Due to its rarity, no standardized treatments for PPC have been established. Cytotoxic chemotherapy has limited efficacy, and the prognosis of advanced PPC is notably poor. Immune checkpoint inhibitors (ICIs) are expected to provide long-term survival for PPC patients, but only a few cases have been reported. The optimal treatment for PPC has not been determined. Case Description: Here, we report a 72-year-old male with post-surgery relapsed PPC, presenting with multiple pulmonary nodules and an intracardiac mass. The OncomineTM Dx target test showed no mutation of cancer-relevant genes, and programmed death-ligand 1 (PD-L1) expression was negative (0%) in the 22C3 assay. He received a combination of carboplatin, paclitaxel, nivolumab, and ipilimumab which is widely used as a first-line treatment for advanced non-small-cell lung cancer (NSCLC). Two months after treatment began, computed tomography (CT) showed multiple lung nodules and an intracardiac mass reduction, which has been sustained for 12 months. Grade 3 febrile neutropenia and grade 2 rash were observed, however, these adverse events were manageable. Conclusions: This is the first case of postoperative relapse PPC that has been successfully treated with the combination of chemotherapy, nivolumab, and ipilimumab. This therapy may be a promising option for advanced PPC.

Financial literacy, behavioral traits, and ePayment adoption and usage in Japan.

This study investigates how financial literacy and behavioral traits affect the adoption of electronic payment (ePayment) services in Japan. We construct a financial literacy index using a representative sample of 25,000 individuals from the Bank of Japan's 2019 Financial Literacy Survey. We then analyze the relationship between this index and the extensive and intensive usage of two types of payment services: electronic money (e-money) and mobile payment apps. Using an instrumental variable approach, we find that higher financial literacy is positively associated with a higher likelihood of adopting ePayment services. The empirical results suggest that individuals with higher financial literacy use payment services more frequently. We also find that risk-averse people are less likely to adopt and use ePayment services, whereas people with herd behavior tend to adopt and use ePayment services more. Our empirical results also suggest that the effects of financial literacy on the adoption and use of ePayment differ among people with different behavioral traits. Supplementary Information: The online version contains supplementary material available at 10.1186/s40854-023-00504-3.

Three-Dimensional Evaluation of Pharyngeal Morphology in Bimaxillary Surgery with and without Horseshoe Osteotomy in Skeletal Class III Cases.

Repositioning of the jaw in orthognathic treatment generates changes in the soft tissues of the maxillofacial region, with consequent changes in the airway. The purpose of this study was to determine how type of orthognathic surgical procedure affected the 3-dimensional morphology of the upper airway. Forty patients were divided into the following 2 groups according to the type of surgical procedure used: a horseshoe osteotomy (HS) group (20 patients, comprising 11 men and 9 women; average age 24.3±4.5 years) who underwent bimaxillary surgery; and a LeFort I osteotomy (LF) group (20 patients, comprising 8 men and 12 women; average age 22.5±4.6 years) who also underwent bimaxillary surgery. Cephalometric measurements were taken and 3-dimensional pharyngeal morphology evaluated in each group. The amounts of maxilla rotation, posterior maxilla impaction, and mandibular setback all revealed a significantly larger value in the HS group. Evaluation of pharyngeal volume revealed a significant decrease in the upper pharyngeal segment in the LF group. A significant decrease in the lower pharyngeal segment was observed in both groups. Differences were noted in postoperative pharyngeal morphology between the two groups. The results of this study suggest that HS has less effect on the upper pharyngeal segment, regardless of the amount of posterior maxilla impaction.

Covid-19 and Optimal Portfolio Selection for Investment in Sustainable Development Goals.

The Covid-19 pandemic and global economic recession has shrunk global energy demand and collapsed fossil fuel prices. Therefore, renewable energy projects are losing their competitiveness. This endangers the achievement of several Sustainable Development Goals (SDGs) and the Paris Agreement on Climate Change. Various consulting companies define the SDGs differently. Institutional investors hire consulting companies and allocate their investment based on the consultants' suggestions. This paper theoretically shows that the current allocation of investors by considering SDG based on various consulting companies will lead to distortion in the investment portfolio. The desired portfolio allocation can be achieved by taxing pollution and waste such as CO2, NOx, and plastics, globally with the same tax rate. Global taxation on pollution will lead to the desired portfolio allocation of assets.

Hoarseness as an Initial Symptom of Thymic Carcinoma: A Case Report.

A 65-year-old man was referred to our hospital for evaluation of hoarseness and deteriorating voice. Computed tomography revealed an area of poor contrast enhancement in soft tissue (size, 30 mm) in the inferior pole of the thyroid gland, extending to the upper margin of the sternum. No infiltration of blood vessels or bones, and no significant swelling of neck lymph nodes, was observed. These findings suggested a diagnosis of thymoma, thymic carcinoma, or thyroid tumor. Surgery was performed via median sternotomy, and complete thymectomy and tumor excision accompanied by partial thyroidectomy were performed. Histopathological examination revealed atypical polygonal tumor cells in a sheet-like arrangement, which formed a solid proliferative focus, and squamous cell carcinoma with infiltrative growth was diagnosed. Postoperatively, radiotherapy (60 Gy) was administered to the superior mediastinum. The patient is alive 22 months after surgery, without recurrence.

A Case of Recurrent Pneumothorax Associated with Birt-Hogg-Dubé Syndrome Treated with Bilateral Simultaneous Surgery and Total Pleural Covering.

Birt-Hogg-Dubé syndrome is an autosomal dominant genetic disorder characterized by a triad of skin tumors, renal tumors, and multiple pulmonary cysts. Our patient was a 40-year-old man with a history of recurrent bilateral pneumothorax and a family history of pneumothorax. The patient visited our department with chest pain and was diagnosed with left pneumothorax based on a chest X-ray. Thoracic computed tomography (CT) showed multiple cysts in both lungs. We performed thoracoscopic bilateral bullectomy with curative intent. Intraoperative observation showed numerous cysts in the lung apex, interlobular region, and mediastinum. We resected the cysts that we suspected to be responsible for the symptoms and ligated the lesions, and then performed total pleural covering. After surgery, genetic testing was performed. The result enabled us to diagnose Birt-Hogg-Dubé syndrome in this patient. Although the patient has developed neither recurrent pneumothorax nor any renal tumors, to date, long-term monitoring is necessary.

Primary Pulmonary Mucosa-Associated Lymphoid Tissue Lymphoma with a Nodular Opacity: Report of a Case.

Herein, we describe our experience in treating a case of primary pulmonary mucosa-associated lymphoid tissue lymphoma detected as a nodular opacity. A 79-year-old man was referred to our hospital. Computed tomography showed a nodular opacity measuring 20 mm in diameter with regular margins in segment 5 of the right middle lobe of the lung. Although the bronchoscopic brush cytology result was class III, the patient was tentatively diagnosed with suspected mucosa-associated lymphoid tissue lymphoma. A thoracoscopic right middle lobectomy was performed. The pathological findings showed nodular proliferation of small to medium-sized, mature-appearing atypical lymphoid cells, lymphoepithelial lesions, and vague follicles suggesting follicular colonization in some areas. The patient was diagnosed with low-grade small B-cell lymphoma and mucosa-associated lymphoid tissue lymphoma. He has remained well to date, 23 months after surgery, without evidence of recurrence.

A case of primary pulmonary diffuse large B-cell lymphoma diagnosed by transbronchial biopsy.

A 76-year-old man took a chest X-ray for his medical checkup and an abnormal shadow was detected in the right lower lung field. For more detailed examination, he was referred to our hospital. Chest computed tomography showed a 20-mm nodule with relatively regular margins in the right lower lobe. A compact proliferation of circular to polygonal cells with a high nucleus-cytoplasm ratio was evident in a transbronchial lung biopsy. Based on pathological findings, a mature large B-cell lymphoma was diagnosed. Thoracoscopic right lower lobectomy and mediastinal lymphadenectomy were performed. The post-surgical pathological examination showed that the tumor consisted of diffuse to compact proliferation of medium to large atypical lymphocyte-like cells. Immunohistochemical staining yielded positive results for B-cell lineage markers. Five months after surgical resection, neither local recurrence nor accumulation in remote organs was observed on gallium scintigraphy. The diagnosis of primary pulmonary diffuse large B-cell lymphoma was established.

Intramuscular myxoma in the chest wall.

Intramuscular myxomas are benign soft-tissue tumors that often develop in the thigh. A 66-year-old woman was referred with an abnormal shadow on chest roentgenogram. The tumor was well defined and smooth and originated from the second intercostal space. Positron emission tomography showed no accumulation of 18F-fluorodeoxyglucose in the tumor. The patient attended the outpatient department for follow-up care. Because the mass grew slightly after 52 months, the patient underwent complete removal by video-assisted thoracoscopic surgery. On histopathological examination, the tumor was diagnosed as an intramuscular myxoma in the chest wall. The patient has had no recurrence 3 years after surgery. A case of intramuscular myxoma in the chest wall, completely resected by video-assisted thoracoscopic surgery, is reported. A well-defined, smooth, homogeneous mass in the chest wall may therefore be intramuscular myxoma.

Serum hepatocyte growth factor and interleukin-6 are effective prognostic markers for non-small cell lung cancer.

AIM: We surveyed prognostic biomarkers for resectable non-small cell lung cancer (NSCLC). PATIENTS AND METHODS: We obtained preoperative serum from 109 patients, and measured the levels of hepatocyte growth factor (HGF), interleukin-6 (IL-6), and nicotinamide N-methytransferase (NNMT) in the sera. RESULTS: The median HGF and IL-6 contents were 860 pg/ml and 2.7 pg/ml, respectively. Analysis of survival curves indicated that an HGF or IL-6 level higher than the median was associated with poor overall survival (HGF, p=0.019; IL-6, p=0.002). In addition, we analyzed stage III lung cancer alone. Higher HGF and IL-6 levels were associated with poor overall survival (HGF, p=0.016; IL-6, p=0.013). Disease-free survival was not statistically significantly affected by these cytokine contents. The tumor status (pT factor) and nodal status (pN factor) were not associated with the survival of stage III patients. CONCLUSION: The levels of HGF and IL-6 in serum could be useful prognostic indicators of the survival of patients with stage III NSCLC undergoing surgery and chemotherapy.

A case of primary solitary pulmonary plasmacytoma.

Most solitary extramedullary plasmacytomas are plasma cell tumors that tend to develop in mucosa-associated lymphoid tissues including the upper respiratory tract. We present a 43-year-old patient who was diagnosed with a solitary plasmacytoma in the lung. Primary plasmacytoma of the lung is exceedingly rare, and the treatment is surgical excision. This malignancy advances to multiple myeloma in a minority of patients. Multiple myeloma is a plasma cell malignancy that typically presents in the bone marrow.

Venous hemangioma of the posterior mediastinum.

Here, we describe our experience in treating a patient with mediastinal hemangioma, a rare neoplasm. An abnormal shadow was noted in the thoracic region of a 54-year-old woman at a health checkup, and she was referred to our hospital. A neurogenic tumor was suspected based on the findings of the chest X-ray and computed tomography scan. Thoracoscopic tumorectomy was performed. The tumor surface was smooth with a reddish-dark reddish color, and capillary blood vessels showed marked growth around the tumor. The tumor was composed of medium or large blood vessels with a relatively thick vascular wall containing smooth muscle. On immunostaining, anti-CD34 antibody and Factor VIII were positive and D2-40 was negative. Based on these findings, the tumor was diagnosed as mediastinal venous hemangioma.

Unification of T2a and T2b tumors to T2 tumors in non-small cell lung cancer staging.

INTRODUCTION: We investigated the validation of the seventh edition of the TNM staging (2009) system for lung cancer, retrospectively. METHODS: From January 1990 to March 2004, 1629 patients who underwent lung resection with systemic lymph node dissection for non-small cell lung cancer at Nippon Medical School and Saitama Cancer Center were included. The overall survivals after surgery by each pathological stage according to the 1997 and 2009 systems were statistically analyzed using Kaplan-Meier estimated survival curves, and the significance of the difference was analyzed by the log-rank test. RESULTS: The 2009 system had significant prognostic distinction between each T descriptor except for T2a and T2b, and between each M descriptor. The 2009 system had better prognostic distinction between each pathological stage except for stages IB and IIA, and stages IIIB and IV. In the simulation, we unified T2a and T2b tumors into T2 tumors, and T2bN0M0 and T2bN1M0 were moved to stages IB and IIA, respectively. This proposed system had significant prognostic distinction between the proposed IB, IIA, and IIB stages. CONCLUSIONS: The 2009 system provides better patient selection for surgery and prognostic distinction between each stage except for stages IB and IIA, and stages IIIB and IV, compared with the 1997 system. Unification of T2a and T2b tumors to T2 tumors can improve prognostic distinction between stages IB and IIA.

Locally infiltrative glomus tumor of the bronchus: a case report.

We report a glomus tumor of the bronchus that showed invasion of the neural area and extrabronchial extension without significant histological malignancy. The patient was a male in his late 30s with the chief complaint being hemosputum. CT revealed a nodal shadow 15 mm in diameter in the right bronchus intermedius. An irregularly protruding lesion on the tumor surface was observed by bronchoscopy immediately under the second carina in the right truncus intermedius, but could not be diagnosed because of bleeding. Sleeve lobectomy of the right upper lobe was performed, since carcinoid tumor was suspected in open chest biopsy and intraoperative frozen section diagnosis. A solid growth of spherical and cubic uniform cells with a clear eosinophilic cytoplasm and spherical nuclei was observed. Immunohistochemistry was positive for α-smooth muscle actin and type IV collagen, weakly positive for synaptophysin, and negative for keratin, neural cell adhesion molecule, chromogranin A, desmin, CD34, and S100, leading to a diagnosis of glomus tumor. Neuroinvasion and extrabronchial tumor extension were observed, but an atypical cytology, bleeding, or necrosis was found histologically. This is the first description of infiltrative glomus tumor of the bronchus.

Type B3 thymic epithelial tumor in an adolescent detected by immunohistochemical staining for CD5, CD99, and KIT (CD117): a case report.

A 16-year-old male patient was admitted to the hospital for a medical workup to examine an anterior mediastinal tumor in April 2000. A tumor excision and a right lower lung lobe nodule resection were performed in June 2000. The tumor tissue showed a cobblestone-like proliferation of atypical cells containing a discrete nucleolus that were aligned in an epithelial fashion against mainly lymphocytic inflammatory cells in the background; also shown were undifferentiated tumor cells with epithelioid characteristics. Immunohistochemical staining for CD5, CD99, and KIT (CD117) revealed that the tumor cells were CD5-negative and that some of the lymphocytes infiltrating the tumor tissue stained positive for CD99 and negative for KIT. The lesion was therefore diagnosed to be a type B3 thymic epithelial tumor.

A true pulmonary carcinosarcoma that required diagnostic differentiation from a pleomorphic adenoma: a case report.

Pulmonary carcinosarcoma is a rarely encountered tumor. We treated a patient who had an intrabronchial polypoid lesion that required a diagnostic differentiation from epithelial-mesenchymal mixed neoplasms inclusive of pleomorphic adenoma, and that was diagnosed by immunohistochemical staining to be a true carcinosarcoma. A 69-year-old man underwent left pneumonectomy in November 2000 with a diagnosis of atelectasis resulting from a tumor obstructing the left lower lobar bronchus, and also a lung abscess. The tumor was initially diagnosed as pleomorphic adenoma, since it contained both benign-looking epithelial and mesenchymal elements, but immunohistochemical staining demonstrated myoglobin-positive rhabdomyosarcomatous elements along with cytokeratin-positive squamous cell carcinoma elements. A definite diagnosis of pulmonary carcinosarcoma was confirmed.

Mediastinal lymph node metastasis of lung cancer with an unknown primary lesion having concurrent endocrine abnormality and acanthosis nigricans: report of a case.

We herein describe a patient we encountered in whom mediastinal lymph node metastasis of lung cancer with an unknown primary lesion was complicated by both an endocrine abnormality and acanthosis nigricans. A 66-year-old male visited a local hospital and was diagnosed as having acanthosis nigricans. The patient was referred to our hospital for further examination. Computed tomography scans of the chest and the abdomen showed no adverse findings except for an enlargement of the mediastinal lymph node. No malignant lesions were detected in examinations of the upper gastrointestinal tract. Based on the above findings, the lesion was thus considered to possibly be mediastinal lymph node metastasis of an unknown primary tumor or malignant lymphoma. A thoracoscopic biopsy of the mediastinal lymph node was performed. The patient was diagnosed to have mediastinal lymph node metastasis of lung cancer with an unknown primary lesion and endocrine abnormality resulting from paraneoplastic syndrome. Palliative radiation therapy was initiated to prevent superior vena cava syndrome and esophageal passage failure or dysphagia. The cutaneous lesions markedly improved thereafter. The serum levels of adrenocorticotropic hormone decreased.

A case report: thoracic extramedullary hematopoiesis found by occurring spontaneous pneumothorax.

Extramedullary hematopoiesis (EMH) is a rare disease associated with hematologic disorders. This report describes a case of posterior mediastinal mass found by occurring spontaneous pneumothorax in a 48-year-old male. The intrathoracic mass resected using video-assisted thoracic surgery (VATS) was diagnosed thoracic EMH (TEMH). No disorders were found by hematologic exams before or after surgery. This report suggests that such lesions must therefore be considered in the differential diagnosis of posterior mediastinal tumors presenting with no hematologic disorders.

Mucinous carcinoma identified as lung metastasis from an early rectal cancer with submucosal invasion by immunohistochemical detection of villin.

We encountered a male patient aged 64 with pulmonary mucinous carcinoma in whom a diagnosis of pulmonary metastasis from early rectal cancer with submucosal invasion was made based on an immunohistochemical examination. A rectal cancer was detected together with a mass in the lung. The mass in the lung was consistent with mucinous adenocarcinoma, whereas the invasion of rectal cancer was confined to the submucosa; thus, distant metastases appeared unlikely. These lesions were assessed using immunohistochemical staining for cytokeratin and thyroid transcription factor-1, which failed to make a definite diagnosis. A further assessment was made by staining for villin. Both neoplasms were positive for this protein, demonstrating a common brush-border pattern. A lung metastasis from rectal cancer with submucosal invasion was diagnosed. Villin is considered useful for detecting primary neoplastic lesions based not only on its specificity but also on its staining pattern, which is different from that of other proteins.

Metastatic thoracic lymph node carcinoma of unknown origin on which we performed two kinds of immunohistochemical examinations.

Metastatic cancers of the thoracic lymph nodes without primary sites are rare. Such cancers are difficult for clinicians to manage as identifying the primary sites is difficult in using routine histologic examinations alone. We searched for the site of the primary lesion using immunohistochemical exploration of cytokeratin (CK) and thyroid transcription factors 1 (TTF-1), and 2-[18F] and fluorodeoxyglucose positron emission tomography (FDG PET) in a patient with cancer of the hilar lymph node without any known primary site. To our knowledge, there are no previous similar reports. A 45-year-old man presenting with a tumor in the right hilar region, underwent surgical resection of the tumor, resulting in a diagnosis of metastatic cancer of the bronchopulmonary lymph nodes. An immunohistochemical examination revealed the neoplastic lesion to be positive for CK7, negative for CK20, and negative for TTF-1. Repeated searches to identify the site of the primary lesion by FDG PET over the 35 months since operation have failed to locate a primary site.