Language：Japanese   Publisher：(NPO)日本肺癌学会  

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Objective: This study was designed to visually represent postoperative recurrence patterns using event dynamics
and to assess sex-based differences in the timing of recurrence for non-small cell lung cancer. Methods: We studied
829 patients (538 men, 291 women) with NSCLC who underwent complete pulmonary resection in 9 hospitals. Event
dynamics with the use of life-table methods were evaluated, and only first events (distant metastases or local recurrence)
were considered. The effects of sex, histological type, pathological stage, and smoking history were studied. Result:
The resulting smoothed hazard rate curves indicated that the recurrence risk pattern definitely correlated with sex, with
a sharp peak in the first year in men and a broad peak during the first 2 to 3 years in women. These findings were also
confirmed by analyses according to pathological stage, histological type, and smoking history. Conclusion: The peak
times of recurrence differed considerably between men and women. The delayed time of peak recurrence in women,
associated with a longer disease-free interval within subsets of patients with similar disease stage, histological type,
and smoking status, might account for the better survival in women.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY  

It currently remains unclear whether tumor spread through airspaces (STAS) actually exist in vivo or are an artifact. The morphologies of STAS and tumor cell clusters in airway secretions collected from the segmental or lobar bronchus of resected lung adenocarcinomas and squamous cell carcinomas were compared among 48 patients. The EGFR status of tumor cell clusters in airway secretions was also compared with that of the main tumor in EGFR mutant adenocarcinomas. Tumor cell clusters were observed in the airway secretion cytology of ten patients (20.8%), and eight patients were adenocarcinoma (20.0% of adenocarcinoma). The morphology of STAS closely resembled that of tumor cell clusters detected in airway secretion cytology. The positive rates of airway secretion cytology were 83.3%, 100%, and 50% in papillary adenocarcinoma, micropapillary adenocarcinoma, and invasive mucinous adenocarcinoma, respectively. Among three EGFR mutant adenocarcinomas, the EGFR mutation subtypes of the main tumors in FFPE sections and tumor cell clusters in airway secretions were identical. These indicate that STAS may be detected in the airway secretion cytology. STAS is common in papillary or micropapillary adenocarcinoma and may spread as far as the segmental or lobar bronchus at the time of surgery.

DOI： 10.1111/pin.12570

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AimWith the advent of the molecular-targeted therapy, rapid progress has been made in the treatment of advanced or recurrent non-small-cell lung cancer (NSCLC). Although surgical complete resection remains the standard and most promising treatment, the clinical significance of epidermal growth factor receptor (EGFR) gene mutations in early-stage NSCLC remains uncertain.
MethodsWe investigated the prognostic value of EGFR mutations in surgically resected pathological stage I NSCLC. A total of 388 consecutive patients with NSCLC who underwent complete tumor resection in our hospital from 2006 through 2008 were studied retrospectively. Formalin-fixed, paraffin-embedded tissue sections were used to isolate DNA from carcinoma lesions. Mutational analyses of EGFR gene were performed by loop-hybrid mobility shift assay, a highly sensitive polymerase chain reaction-based method.
ResultsMutations of EGFR were detected in 185 of the 388 patients (47.7%). EGFR mutations were more frequently found in women (110 of 185, 59.5%), adenocarcinoma (183 of 185, 98.9%), patients with no vascular invasion (139 of 185, 75.1%) and nonsmokers (106 of 185, 57.3%). In patients with pathological stage I adenocarcinoma, both overall survival (OS) and disease-free survival (DFS) were significantly higher in patients with EGFR mutation than in those with wild-type EGFR. Furthermore, patients with exon 21 mutation have better DFS than those with exon 19 mutation in stage IB adenocarcinoma. Cox's proportional hazard model indicated that EGFR status was an independent variable for predicting the OS and DFS in patients with pathological stage IB adenocarcinoma.
ConclusionOur results suggest that EGFR mutations might be a prognostic factor in patients with pathological stage I lung adenocarcinoma.

DOI： 10.1111/ajco.12512

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Language：Japanese   Publisher：(NPO)日本肺癌学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：OXFORD UNIV PRESS INC  

OBJECTIVES: Cachexia has been shown to be related to mortality in patients with advanced cancers and chronic obstructive pulmonary disease. Smokers receiving surgery for lung cancer are thought to be at risk of developing cachexia postoperatively. We aimed to investigate whether 2 surrogate variables for cachexia, body mass index (BMI) and C-reactive protein (CRP) level, are predictive of mortality in smokers after complete resection of non-small-cell lung cancer.
METHODS: We retrospectively examined 678 patients who underwent curative lobar resection for non-small-cell lung cancer at our hospital. Associations between clinicopathological factors and overall survival were assessed in smokers (N=421) and never smokers (N=257).
RESULTS: Multivariate analysis of the smokers group showed that preoperative BMI <= 20.6 kg/m(2) and CRP >= 0.13 ng/ml were risk factors for poorer prognosis, independent of age and pathological stage. In never smokers, BMI and CRP were not significantly associated with survival. Smokers in the high-risk group, defined based on preoperative BMI and CRP, had shorter survival after recurrence, although they did not have an elevated recurrence rate. Despite the absence of recurrence, they died more frequently of pneumonia or other cancers. These observations are consistent with the idea that the poor postoperative prognosis could have resulted from the progression of cachexia.
CONCLUSIONS: In smokers with non-small-cell lung cancer, preoperative low BMI and elevated CRP are predictive factors for poor prognosis after complete resection, probably as a result of cachexia progression. The effective treatment of cachexia might improve postoperative prognosis.

DOI： 10.1093/ejcts/ezx004

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Language：Japanese   Publisher：(NPO)日本肺癌学会  

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INTRODUCTION: Systematic lymph node dissection (SND) is the standard procedure in surgical treatment for NSCLC, but the value of this approach for survival and nodal staging is still uncertain. In this study, we evaluated the potential of lobe-specific lymph node dissection (L-SND) in surgery for NSCLC by using a propensity score matching method. METHODS: From 2005 to 2007, 565 patients with cT1a-2b N0-1 M0 NSCLC underwent lobectomy with lymph node dissection at our 10 affiliated hospitals. Patients were classified into groups that underwent nodal sampling, L-SND, and systematic dissection SND on the basis of pathological data for the number and extent of nodal resection. A total of 77 patients with insufficient pathological data were excluded from the study. RESULTS: Overall, survival did not differ significantly among the groups (p = 0.552), but the rate of detection of pN2 in the SND group (13.1%) was significantly higher than in the nodal sampling (3.3%) and L-SND (9.0%) groups (p = 0.010). However, given the many confounding factors in the patient characteristics in each group, outcomes were reevaluated using a propensity score matching method for the L-SND and SND groups. After matching, the two groups had no significant differences in 5-year overall survival (73.5% for L-SND versus 75.3% for SND, p = 0.977) and pN2 detection (8.2% in both groups, p = 0.779). CONCLUSIONS: These results suggest that lobe-specific lymph node dissection has the potential to be a standard procedure in surgical treatment for NSCLC.

DOI： 10.1016/j.jtho.2016.08.127

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DOI： 10.1177/2050313X17695473

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OBJECTIVES: For highly selected patients with Stage III non-small-cell lung cancer (NSCLC) who relapse or have residual disease after definitive chemoradiotherapy, salvage lung resection is likely to be one of the options for local control and possible better prognosis. However, the long-term benefit has not been verified.
METHODS: We conducted a retrospective study on salvage surgery on a multicentre basis. Patients included in this study met the following criteria: (i) prior treatment of lung cancer with curative-intent radiotherapy (>= 60 Gy); (ii) no a priori plans for induction multimodality therapy; (iii) confirmation of loco-regional recurrence or persistent tumour in the irradiated area; (iv) pretherapeutic pathological results of NSCLC and (v) Stage III disease prior to chemoradiotherapy.
RESULTS: A total of 18 patients were eligible for evaluation (Stage IIIA/IIIB, 14/4). The prior median radiation therapy dose was 60 Gy (6074 Gy), and the median time between the last day of radiotherapy and resection was 38 weeks. The indications for surgery were primary tumour regrowth (10 patients) or tumour persistence (8 patients). Surgical procedures included lobectomy in 13 patients and pneumonectomy in 5 patients. Postoperative complications occurred in 5 patients (28%) without perioperative death. Complete resection was shown in 16 patients (89%) and a complete pathological response in 5 patients (28%). The median follow-up time was 1405 days, and the 3-year overall survival and recurrence-free survival rates were 78 and 72%, respectively.
CONCLUSIONS: In the highly selected Stage III NSCLC after curative-intent chemoradiation therapy, salvage surgery was safely performed and contributed to satisfactory long-term survival.

DOI： 10.1093/icvts/ivw245

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE INC  

Background. Advanced unresectable pulmonary adenocarcinoma with the epidermal growth factor receptor (EGFR) exon 21 L858R point mutation (Ex21) is associated with a poor prognosis. However, for early-stage resectable adenocarcinoma, Ex21 tumors have a lower-grade malignancy than exon 19 deleted (Ex19) tumors. We therefore investigated the effect of EGFR mutations on the prognosis in patients with completely resected pN1-N2 adenocarcinoma.
Methods. Five-year disease-free survival (DFS) and overall survival (OS) were analyzed in 202 pN1-N2 pulmonary adenocarcinoma patients, 100 of whom had EGFR mutations, comprising Ex21 in 41 (20.3%), Ex19 in 55 (27.2%), and Ex18 in 4 (2%).
Results. Patients with and without EGFR mutations had similar DFS (26.2% vs 24.6%, respectively; p = 0.280) and OS (64.9% vs 54.2%, respectively; p = 0.564). Patients with Ex19 tumors had significantly better DFS 38.8% vs 11.8%, p = 0.001) and tended to have better OS (78.3% vs 48.3%, p = 0.123) than those with Ex21 tumors. For pN1, patients with Ex19 tumors had a longer disease-free interval (54.0 vs 22.3 months, p = 0.003) and median survival time (81.0 vs 50.6 months, p = 0.022) than those with Ex21 tumors. For pN2, patients with Ex19 tumors had longer disease-free interval than those with Ex21 tumors (43.6 vs 30.1 months, p = 0.109). Multivariate analysis showed Ex21 was a prognosticator of poor DFS (hazard ratio, 2.25; 95% confidence interval, 1.21 to 4.20).
Conclusions. For pN1-N2 pulmonary adenocarcinoma, Ex21 mutation was associated with poorer prognosis than Ex19 mutation. Thus, EGFR mutation status should be considered when predicting prognosis. (C) 2016 by The Society of Thoracic Surgeons

DOI： 10.1016/j.athoracsur.2016.06.001

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Language：Japanese   Publisher：(NPO)日本肺癌学会  

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OBJECTIVES: Our study was designed to visually represent recurrence patterns after surgery for non-small-cell lung cancer (NSCLC) with the use of event dynamics and to clarify postoperative follow-up methods based on the times of recurrence. METHODS: A total of 829 patients with NSCLC who underwent complete pulmonary resection from 2005 to 2007 in 9 hospitals affiliated with the Yokohama Consortium of Thoracic Surgeons were studied. Event dynamics, based on the hazard rate, were evaluated. Only first events involving the development of distant metastases, local recurrence or both were considered. The effects of sex, histological type, pathological stage and age were studied. RESULTS: The hazard rate curve displayed an initial surge that peaked about 6-8 months after surgery. The next distinct peak was noted at the end of the second year of follow-up. On non-parametric kernel smoothing, the maximum peak was found 6-8 months after surgery in men. In women, the highest peak occurred 22-24 months after surgery, which was about 16 months later than the peak in men. The peak timing of the hazard curve was not affected by histological type, pathological stage or age in either sex. CONCLUSIONS: Our results suggest that the timing of recurrence after surgery for lung cancer is characterized by a bimodal pattern, and the times with the highest risk of recurrence were suggested to differ between men and women. Postoperative follow-up strategies should be based on currently recommended follow-up programmes, take into account the recurrence patterns of lung cancer, and be modified as required to meet the needs of individual patients.

DOI： 10.1093/ejcts/ezv462

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Language：Japanese   Publisher：(NPO)日本呼吸器外科学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SAGE Publications Inc.  

Background Palpation is the most important means of locating lung tumors and resecting them with sufficient margins. This study aimed to predict the palpability of pulmonary lesions using high-resolution computed tomography. Methods Eighty-six pulmonary lesions were palpated in fresh resected lung specimens from July 2013 to March 2014. The following parameters were compared between 10 impalpable and 76 palpable lesions: maximum tumor size in pulmonary and bone window level settings, consolidation tumor size in pulmonary window level setting, and pleural-tumor distance. In 54 adenocarcinomas, the lepidic component and fibrosis foci rates were compared between the two groups. Results Tumor size in bone window level setting and the consolidation tumor size were significantly smaller in the impalpable group (both p &lt
0.001), and an operational cutoff of 5 mm was identified by receiver-operating characteristic analysis (sensitivity/specificity was 90.0%/94.7% and 90.0%/86.9%, respectively). Pulmonary lesions were impalpable with 87.5% probability when the tumor size in bone window level setting was ≤5 mm and the pleural-tumor distance was ≤ 5 mm, and with 85.7% probability when the consolidation tumor size was ≤5 mm and the pleural-tumor distance was ≤ 5 mm. Lepidic component and fibrosis foci rates of impalpable/palpable lesions were 96.0%/52.8% and 4.0%/24.7%, respectively (both p
lt&amp
0.001). Conclusions Tumor size in bone window level setting or a consolidation tumor size ≤5 mm and pleural-tumor distance ≤ 5 mm are simple criteria that are potentially useful indicators for preoperative marking to locate small-sized lepidic-predominant adenocarcinomas with few fibrotic foci.

DOI： 10.1177/0218492315615480

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OBJECTIVES: Although the prognostic implications of visceral pleural invasion (VPI) are well established, it remains controversial whether the extent of VPI affects survival in patients with completely resected non-small-cell lung cancer (NSCLC). In addition, the impact of VPI according to nodal status is unclear. We evaluated the influence of the extent of pleural invasion on survival by analysing a multicentre retrospective database of patients who had undergone surgery for NSCLC. METHODS: We retrospectively reviewed the clinicopathological characteristics and outcomes of 639 patients with NSCLC who underwent anatomic complete resection from 2005 to 2007 at nine hospitals affiliated with the Yokohama Consortium of Thoracic Surgeons. RESULTS: The median follow-up was 65.0 months. The extent of pleural invasion was PL0 in 462 patients, PL1 in 135 and PL2 in 42. The 5-year overall survival rate was significantly higher in patients with PL0 tumours (75.9%) than in those with PL1 (63.6%) or PL2 tumours (54.1%). On subgroup analysis according to nodal status, PL0 was associated with a higher survival rate than that of PL1 or PL2 tumours in patients with N0 or N1 metastasis, but not in those with N2 metastasis. There was no difference between PL1 and PL2 in any subgroup. CONCLUSIONS: Our results suggest that the presence of VPI, rather than the extent, has an impact on postoperative survival in patients with NSCLC who have N0 or N1 metastasis. Because very few previous studies have addressed the effects of VPI in patients with N1 disease, further re-evaluation of the prognostic impact of VPI is necessary in this subgroup of patients.

DOI： 10.1093/ejcts/ezu515

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER  

We report a case of metachronous multiple lung adenocarcinoma at the cut-end, diagnosed 4 years after sublobar resection for adenocarcinoma in situ (AIS), on the basis of discordance of epidermal growth factor receptor (EGFR) mutation status between the first and second tumor. The patient was an 81-year-old Japanese man, whose chest computer tomography (CT) scan showed mixed ground-glass opacity in the right upper lobe of the lung. Wedge resection was performed and a diagnosis of AIS, non-mucinous (18 x 14 mm), with a margin of 6 mm, was made. A tumor at the cut-end was seen on a CT scan 4 years later, and abnormal uptake was identified by fluorine-18 fluorodeoxyglucose-positron emission tomography. Right upper lobectomy and lymph node dissection were performed and the tumor was diagnosed as invasive adenocarcinoma, acinar predominant. Discordance of EGFR mutation status between the first tumor, harboring exon 19 deletion, and the second tumor, having an L858R point mutation in exon 21, revealed that the second tumor was metachronous multiple lung cancer. This case demonstrates the necessity of comparing EGFR mutation status between the first tumor and the second tumor at the cut-end.

DOI： 10.1007/s00595-014-1077-z

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Advanced lung cancers with epidermal growth factor receptor (EGFR) exon 19 deletions (Ex19s) and EGFR exon 21 L858R point mutations (Ex21s) exhibit different clinical behavior. However, these differences are unclear in resectable primary lung tumors.
The clinicopathological features of 88 (20.9%) Ex19, 124 (29.4%) Ex21, and 198 (46.9%) EGFR wild-type (Wt) clinical stage I primary adenocarcinomas resected between January 1, 2012 and October 31, 2014 were compared by using Chi-square tests, residual error analysis, analysis of variance, and Tukey tests.
Ex21 lesions occurred more frequently in women and never-smokers and had a higher tumor disappearance rate (TDR: 59.6% vs 43.9%; P<0.001) and lower maximum standardized uptake value (maxSUV: 2.0 vs 3.5; P<0.01) than Wt lesions; Ex19 lesions had intermediate values (52.8% and 2.6). There was a low frequency of vascular invasion in Ex21 lesions (12.1%; P<0.05) and a high frequency in Wt lesions (22.7%; P<0.05). Most Ex19 lesions were intermediate-grade adenocarcinoma (lepidic, acinar, and papillary predominant: 73.9%; P<0.05). Wt and Ex21 lesions were predominately high-grade (micropapillary or solid predominant, mucinous variant) and low-grade (adenocarcinoma in situ and minimally invasive adenocarcinoma) adenocarcinoma, respectively. Wt lesions had smaller lepidic components (42.1% vs 56.3%; P<0.001) and larger papillary and solid components (papillary: 15.5% vs 9.0%; P<0.05; solid: 13.2% vs 3.2%; P<0.001) than Ex21 lesions.
Most Ex19 lesions had intermediate component rates. Most Ex21 lesions were low-grade adenocarcinoma with lepidic growth patterns. Wt high-grade adenocarcinomas included solid and papillary components with vascular invasion. Ex19 lesions were intermediate grade between Ex21 and Wt.

DOI： 10.1097/MD.0000000000001784

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Language：Japanese   Publisher：(NPO)日本肺癌学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE INC  

Background. Surgical treatment has become the mainstay of treatment for multiple primary lung cancers. In particular, the prevalence of synchronous primary lung adenocarcinomas (SPLA) has recently increased, but few studies have evaluated surgical outcomes of patients with SPLA. We reviewed the clinicopathologic features and surgical outcomes of SPLA to identify factors related to survival.
Methods. Data on 2,041 consecutive patients with primary non-small cell carcinoma who underwent surgical resection in our hospital from 1995 through 2009 were retrospectively analyzed.
Results. The SPLA was pathologically diagnosed in 93 patients, including 26 with bilateral tumors. The rates of overall survival and recurrence-free survival at 5 years were 87.0% and 81.8%, respectively. There was no surgical mortality at 30 days. On univariate analysis, lymph node metastasis (p = 0.0000), nonlepidic predominant histologic subtype (p = 0.0018), and a solid appearance of the largest tumor on computed tomography (p = 0.0088) were significantly related to poor overall survival. On multivariate analysis, bilateral distribution of tumors (p = 0.031), lymph node metastasis (p = 0.004), and sublobar resection (p = 0.042) were independent predictors of poor survival.
Conclusions. Surgery has good outcomes and should be aggressively performed for patients with SPLA. The evaluation of lymph node status has an important role in deciding whether surgery is indicated. Bilateral tumors are a predictor of poor outcomes, requiring that caution be exercised. Lobectomy has a high cure rate and should be performed whenever possible. However, sublobar resection should be considered for patients likely to have poor residual lung function postoperatively. (C) 2014 by The Society of Thoracic Surgeons.

DOI： 10.1016/j.athoracsur.2014.07.006

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Language：Japanese   Publisher：(NPO)日本肺癌学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BIOMED CENTRAL LTD  

Background: The rapid aging of the population in Japan has been accompanied by an increased rate of surgery for lung cancer among elderly patients. It is thus an urgent priority to map out a treatment strategy for elderly patients with primary lung cancer. Although surgical resection remains standard treatment for early stage non-small-cell lung cancer (NSCLC), it is now essential to confirm the status of epidermal growth factor receptor (EGFR) gene mutations when planning treatment strategies. Furthermore, several studies have reported that EGFR mutations are an independent prognostic marker in NSCLC. However, the relations between age group and the molecular and pathological characteristics of NSCLC remain unclear. We studied the status of EGFR mutations in elderly patients with NSCLC and examined the relations of EGFR mutations to clinicopathological factors and outcomes according to age group.
Methods: A total of 388 consecutive patients with NSCLC who underwent complete tumor resection in our hospital from 2006 through 2008 were studied retrospectively. Formalin-fixed, paraffin-embedded tissue sections were used to isolate DNA from carcinoma lesions. Mutational analyses of EGFR gene exons 19, 20, and 21 and KRAS gene exons 12 and 13 were performed by loop-hybrid mobility shift assay, a highly sensitive polymerase chain reaction-based method.
Results: EGFR mutations were detected in 185 (47.7%) and KRAS mutations were detected in 33 (8.5%) of the 388 patients. EGFR mutations were found in a significantly higher proportion of patients younger than 80 years (younger group; 178/359, 49.6%) than in patients 80 years or older (older group; 7/29, 24.1%) (P = 0.008). In contrast, KRAS mutations were more common in the older group (6/29, 20.7%) than in the younger group (27/359, 7.5%) (P = 0.014). The older group showed a trend toward a higher rate of 5-year overall survival among elderly patients with EGFR mutations (100%) than among those with wild-type EGFR (66.2%), but the difference was not significant.
Conclusions: Our results suggest that the EGFR status of patients with NSCLC differs between patients 80 years or older and those younger than 80 years. EGFR mutation status might be a prognostic marker in elderly patients with completely resected NSCLC.

DOI： 10.1186/1471-2407-14-610

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER IRELAND LTD  

Objective: We examined the appropriate measurement for pathological tumor size by comparing radiological and pathological tumor size of resected lung adenocarcinoma in FSE.
Materials and methods: We reviewed records of 59 resected specimens of lung adenocarcinoma for FSE from January to December 2008. Specimens were well-inflated with saline by using an injector before cutting into segments. After selecting the tumor segment of maximal diameter, we compared three ways of measuring pathological tumor size by using paired t-test: (I) macroscopic tumor size (MTS), measured with a metal straight ruler, (II) microscopic frozen section tumor size (FSTS), and (III) microscopic paraffin section tumor size (PSTS). We compared each discrepancy rate (DR) [DR = (CT tumor size - pathological tumor size)/CT tumor size x 100] (%) between tumors that were air-containing type and solid-density type on CT scans, and also compared the tumors with lepidic component rates (LCR) >= 50% and LCR <50%, by using Mann-Whitney U-tests.
Results: FSE could diagnose malignancy with 100% accuracy. The mean Cf tumor size was 18.36 mm, and the mean pathological tumor sizes (MTS, FSTS, and PSTS) were 17.81, 14.29, and 14.23 mm, respectively. FSTS and PSTS were significantly smaller than CT tumor size (p < 0.001). The DR calculated with PSTS was significantly larger in air-containing than in solid-density tumors, and also larger in LCR >= 50% than in LCR <50% tumors.
Conclusion: FSE with the inflation method diagnosed malignancy with 100% accuracy. The lung specimen must be sufficiently inflated to prevent tissue shrinking, and we propose MTS as the definition for pathological tumor size in FSE. The greater discordance observed between CT tumor size and microscopic tumor size was assumed to be due to shrinkage of the lepidic component in the tumor. (C) 2014 Elsevier Ireland Ltd. All rights reserved.

DOI： 10.1016/j.lungcan.2014.03.023

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-BLACKWELL  

Solitary pulmonary capillary hemangioma (SPCH) is a rare benign lung tumor that must be distinguished from small and early lung cancers. Here, we report a case of SPCH for which we performed frozen section diagnosis. The patient was a 55-year-old Japanese woman. Five years before the operation, mixed ground-glass opacity was detected by computed tomography in the left posterior basal segment of the lower lobe (S10). Because the interior tumor density of the ground-glass opacity increased slightly, video-assisted thoracic surgery wedge resection was performed. Frozen section diagnosis revealed a benign tumor without proliferation of atypical epithelial cells. The tumor had narrow alveolar lumens, thickened alveolar septa and a clear boundary separating it from normal lung tissue. The proliferated lumens varied in size and were lined with single layers of flat cells. After the operation, immunohistochemical staining of a paraffin section revealed that the thickened alveolar septa resulted from the proliferation of capillary vessels, the flat cells of which were positive for CD31 and CD34 and negative for podoplanin; the tumor was diagnosed as SPCH. Here, we discuss the pathological features of SPCH on frozen sections with reference to this case and review previous related reports.

DOI： 10.1111/pin.12120

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Language：Japanese   Publisher：(NPO)日本肺癌学会  

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Language：Japanese   Publisher：日本胸部外科学会-関東甲信越地方会  

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DOI： 10.1111/pin.12028

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DOI： 10.1177/0218492311435687

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Language：Japanese   Publisher：Japan Surgical Association  

A 75-year-old man developed a left middle finger tumor. The tumor was diagnosed as malignant eccrine spiradenoma, and he underwent amputation of the left middle finger ; a lymph node resection of the left axilla was also done. One year later, a chest CT scan revealed a small nodule in the apex of the left lung. To confirm the diagnosis, a partial resection of the left lung was performed during video-assisted thoracoscopic surgery. On histopathology, the pulmonary tumor was diagnosed as a metastasis of the malignant eccrine spiradenoma. Subsequently, 5 years after the left lung resection a partial resection of the right lung was required due to the presence of a metastasis. Currently, the patient is alive without evidence of recurrence. We report this rare case, together with a review of the relevant literature.

DOI： 10.3919/jjsa.73.2231

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Other Link： http://search.jamas.or.jp/link/ui/2013009140

Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: Lambert-Eaton myasthenic syndrome is a rare disorder and it is known as a paraneoplastic neurological syndrome. Small cell lung cancer often accompanies this syndrome. Lambert-Eaton myasthenic syndrome associated with lung adenocarcinoma is extremely rare; there are only a few reported cases worldwide. CASE PRESENTATION: A 75-year-old Japanese man with a past history of chronic rheumatoid arthritis and Sjögren syndrome was diagnosed with Lambert-Eaton myasthenic syndrome by electromyography and serum anti-P/Q-type voltage-gated calcium channel antibody level preceding the diagnosis of lung cancer. A chest computed tomography to screen for malignant lesions revealed an abnormal shadow in the lung. Although a histopathological examination by bronchoscopic study could not reveal the malignancy, lung cancer was mostly suspected after the results of a chest computed tomography and [18F]-fluorodeoxyglucose positron emission tomography. An intraoperative diagnosis based on the frozen section obtained by tumor biopsy was adenocarcinoma so the patient underwent a lobectomy of the right lower lobe and lymph node dissection with video-assisted thoracoscopic surgery. The permanent pathological examination was the same as the frozen diagnosis (pT2aN1M0: Stage IIa: TNM staging 7th edition). Immunohistochemistry revealed that most of the cancer cells were positive for P/Q-type voltage-gated calcium channel. CONCLUSIONS: Our case is a rare combination of Lambert-Eaton myasthenic syndrome associated with lung adenocarcinoma, rheumatoid arthritis and Sjögren syndrome, and to the best of our knowledge it is the first report that indicates the presence of voltage-gated calcium channel in lung adenocarcinoma by immunostaining.

DOI： 10.1186/1752-1947-6-281

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DOI： 10.1093/ejcts/ezr323

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DOI： 10.1111/j.1758-5910.2011.00125.x

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Language：English   Publisher：The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery  

Purpose: to evaluate the efficacy and safety of intrapleural analgesia (IPA) using ropivacaine after thoracoscopic surgery, compared with thoracic epidural analgesia (TEA) using ropivacaine.<br>Methods: forty patients undergoing thoracoscopic bullectomy for spontaneous pneumothorax were randomly assigned to one of two groups. IPA group (n = 20) received intermittent bolus injection of 0.375% ropivacaine into intrapleural space two times; at the end of operation and one more time as the pain increased. TEA group (n = 20) received continuous epidural analgesia with 0.375% ropivacaine. Transrectal diclofenac was administered as an additional analgesic. Pain was assessed on the basis of additional analgesics requirements and by using a visual analog scale (VAS).<br>Results: the time courses of VAS scores along the postoperative time course were not significantly different (p = 0.175). Consumption of transrectal diclofenac was significantly smaller in IPA group (p = 0.025). No major complications appeared in both groups, and incidence of adverse symptoms was not different.<br>Conclusions: in IPA group, pain was managed with less consumption of additional analgesics. IPA could be one of the good choices after thoracoscopic surgery for its efficacy, safety, and benefit of easy placement of the catheter.

DOI： 10.5761/atcs.oa.11.01854

PubMed

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Other Link： http://search.jamas.or.jp/link/ui/2013324182

Language：Japanese   Publisher：(NPO)日本肺癌学会  

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Language：Japanese   Publisher：(NPO)日本肺癌学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：The Japan Lung Cancer Society  

<i><b>Background</b></i>. In primary lung cancer cases without visceral pleura invasion or dissemination, cancer cells are rarely confirmed in the pleural effusion intraoperatively. The clinicopathologic findings are thus important for TNM staging by providing the natural history of the disease progression, although the precise mechanisms remain unclear. <i><b>Case</b></i>. A 68-year-old man with bloody sputum was given a diagnosis of lung adenocarcinoma arising from the left upper lobe. The clinical TNM stage was IA (cT1bN0M0). He underwent left upper lobe lobectomy and lymph node dissection (ND2a) with video-assisted thoracoscopic surgery. The intraoperative findings revealed minor serous pleural effusion, but there was no pleural invasion or pleural dissemination. His surgical diagnosis was sT1bN0M0D0E1 (+) serousPL0PM0: stage IA, and the histopathologic diagnosis was mixed adenocarcinoma with hilar lymph node metastasis (N1). No extra-nodal invasion was observed. Microscopic examination did not show any invasion of the visceral pleura (PL0), but cancer cells were noted in the pleural effusion on cytological examination. The final histopathologic TNM stage was determined as pT1bN1 (#11) M1a (E+), stage IV. <i><b>Conclusion</b></i>. We report a rare case of primary lung cancer with malignant pleural effusion but without visceral pleural invasion. Malignant pleural effusion is an important factor for TNM staging and for determining the treatment strategies for lung cancer. During surgery, even if no visceral pleura invasion is noted, intraoperative lavage or pleural effusion cytology should be routinely performed.<br>

DOI： 10.2482/haigan.51.793

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Other Link： http://search.jamas.or.jp/link/ui/2012173863

Language：English   Publishing type：Research paper (scientific journal)  

Claudin-7 is a tight junction protein that plays an important role in tumorigenesis, tumor invasion and metastasis. We examined the clinical significance of claudin-7 expression in 75 postsurgical non-small cell lung cancer (NSCLC) patients. Claudin-7 expression was measured immunohistochemically and was found to be high in 25 patients (33.3%) and low in 50 (66.7%). Survival was significantly poorer in patients with claudin-7-low than in those with claudin-7-high NSCLCs (P=0.024). In particular, survival was significantly poorer in patients with claudin-7-low than in those with claudin-7-high squamous cell carcinomas (P=0.011). A reduced expression of claudin-7 was associated with poor outcome in NSCLCs. Claudin-7 may thus be a useful biomarker and a potential therapeutic target in patients with NSCLC.

DOI： 10.3892/ol_00000088

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Patients with advanced or recurrent cancer often develop pain and gastrointestinal obstruction, requiring symptom relief. Drug therapy is one important option. Another is surgery, for example, a bypass operation or colostomy. Compared with colostomy, ileostomy - a procedure commonly employed to create a covering stoma for rectal resection - seems technically easier and less invasive. However, there are few reports on the utility of ileostomy in patients with advanced or recurrent cancer. We had three cases of palliative ileostomy for qualityof-life (QOL) improvement in patients with advanced digestive system cancer. After the procedure, all three patients were relieved from gastrointestinal obstruction and pain and infection was controlled, thus achieving improvement in QOL. This result suggests that palliative ileostomy may be helpful for patients with advanced digestive system cancer.

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DOI： 10.1155/2010/327591

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：4  

We experienced five cases of pulmonary arteriovenous malformations (PAVMs) that were successfully treated by video-assisted thoracoscopic surgery. Four malformations were treated by local wedge resection and one was treated by segmentectomy. Criteria for patient selection for surgery were peripheral and solitary lesions, with feeding arteries larger than 3 mm. Postoperative hospital stays were 1-7 days (median, 2 days). All patients showed unchanged or increased values of PaO2 in arterial blood after operation. No major postoperative complication occurred in any patient, but a persistent air leak for 5 days occurred in the one patient who was treated by segmentectomy. No growth of accessory vessels or untreated malformations were seen in any patient throughout the follow-up period of 14-54 months. Thoracoscopic surgical resection for well-selected patients provides a high certainty of eliminating fistulae and was associated with lower morbidity, lower mortality, and shorter hospital stays. © 2008 The Japanese Association for Thoracic Surgery.

DOI： 10.1007/s11748-007-0215-6

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Language：Japanese   Publisher：The Japanese Association for Chest Surgery  

We report a 76-year-old man who underwent surgery for a clear cell adenocarcinoma detected on a health checkup. Chest computed tomography (CT) revealed a tumor at the S<SUP>3</SUP> of the left lung. Transbronchial lung biopsy did not lead to a definitive diagnosis, and partial resection of the left lung was performed. Because rapid pathological diagnosis using a frozen specimen suggested adenocarcinoma, superior lobectomy of the left lung and mediastinal lymph node dissection were performed. Systemic diagnostic imaging before and after surgery did not reveal any tumorous lesion in other organs, and the clinical findings suggested a primary tumor of the lung. Postoperative pathological investigation showed that clear cells comprised 90% or more of the lesion, with small foci of papillary structure. Immunohistochemically, the tumor was positive for keratin, EMA, thyroid transcription factor-1, and surfactant apoprotein A, and negative for HMB45, suggesting a primary clear cell adenocarcinoma of the lung. There has been no recurrence during the 22 months of postoperative follow-up.

DOI： 10.2995/jacsurg.21.165

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER  

We report the successful management of multiple small-bowel perforations caused by cytomegalovirus (CMV) infection in a 60-year-old man, 1 day after CHOP (cyclophosphamide/doxorubicin/vincristine/prednisone) therapy induction for malignant lymphoma. Emergency laparotomy was performed for perforative peritonitis, but we did not resect the lesions at this time. Instead, we exteriorized the small bowel and then irrigated the peritoneal cavity and intestinal tract. His white blood cell count was low, at 200 cells/mu l, so this therapy was continued until it recovered. The intestine was highly edematous, but it improved after irrigation with peritoneal dialysis solution. In the second-stage procedure, we resected the small bowel with the perforations, and constructed a jejunostomy and colostomy, then closed the abdominal cavity. Although the patient needed central venous hyperalimentation, he had a favorable postoperative course and started treatment again for the malignant lymphoma.

DOI： 10.1007/s00595-006-3274-x

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Language：Japanese   Publisher：一般社団法人日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

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Language：Japanese   Publisher：(一社)日本病理学会  

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Language：Japanese  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

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Language：Japanese   Publisher：日本肺癌学会  

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