Ayako Hirai

Prognostic impact of programmed death-ligand 1 expression in correlation with human leukocyte antigen class I expression status in stage I adenocarcinoma of the lung

Objective The study objective was to investigate the prognostic impact of programmed death‐ligand 1 expression in correlation with human leukocyte antigen class I expression on tumor cells in early‐stage adenocarcinoma of the lung, because both programmed death‐ligand 1 and human leukocyte antigen class I molecules play important roles in cancer immunity. Methods Ninety‐four patients with completely resected pathologic stage I lung adenocarcinoma were retrospectively reviewed. Programmed death‐ligand 1 expression on tumor cells was evaluated with immunohistochemistry in correlation with several clinicopathologic and molecular features, including human leukocyte antigen class I expression on tumor cells. Results Fifteen patients (16.0%) had tumor with positive programmed death‐ligand 1 expression (percentage of tumor cells expressing programmed death‐ligand 1, ≥5%), and the incidence was significantly higher in poorly differentiated tumors. There was no significant correlation between human leukocyte antigen class I expression and programmed death‐ligand 1 expression. Programmed death‐ligand 1 positivity was a significant factor to predict a poor survival (5‐year survival, 66.7% vs 85.9%; P = .049), which was enhanced in tumors with normal human leukocyte antigen class I expression (P = .029) but was not evident in tumors with reduced human leukocyte antigen class I expression (P = .552). Conclusions The prognostic impact of programmed death‐ligand 1 expression on tumor cells in early‐stage lung adenocarcinoma may be distinct according to concurrent human leukocyte antigen class I expression.

The impact of covering the bulla with an absorbable polyglycolic acid (PGA) sheet during pneumothorax surgery

We herein present the pathological findings of a bulla covered using an absorbable polyglycolic acid sheet applied with fibrin glue. These findings indicated that the membrane of the bulla was reinforced. Covering the bulla with an absorbable polyglycolic acid sheet (Neoveil, Gunze Ltd, Kyoto, Japan) and applying fibrin glue was effective to prevent the recurrence of the pneumothorax. Moreover, this report is the first case report showing the pathological findings of a bulla which was covered with an absorbable polyglycolic acid sheet and fibrin glue.

Complete Resection of Thymic Sarcomatoid Carcinoma Through Total Aortic Arch Replacement.

Sarcomatoid carcinoma of the thymus is extremely rare. An operation remains the only effective treatment for this disease. We report a case of complete resection of thymic sarcomatoid carcinoma through a total aortic arch replacement and left upper lobectomy at our institution. Our aggressive operation was very effective, and the patient has experienced no recurrence in the 3 years since his operation.

Total vertebrectomy (Th2) and dissection of the subclavian artery for a superior sulcus tumor invading the spine: A case report

Highlights • The treatment of patients for lung cancer with vertebral body invasion remains challenging.• We reported a case that total vertebrectomy (Th2) and dissection subclavian artery for lung cancer invading spine and subclavian artery.• We experienced complete resected one case that tumor location and invading was very complicated.

Programmed death-ligand 1 (PD-L1) expression in pleomorphic carcinoma of the lung

Pulmonary pleomorphic carcinoma (PPC) is a rare and aggressive subtype of lung cancer. Programmed cell death‐ligand 1 (PD‐L1) expression may be induced in a variety of malignant tumors, but its prognostic implication in PPC remains unclear.

Soluble PD-L1 with PD-1-binding capacity exists in the plasma of patients with non-small cell lung cancer.

PD-L1 is one of the important immune checkpoint molecules that can be targeted by cancer immunotherapies. PD-L1 has a soluble form (sPD-L1) and a membrane-bound form (mPD-L1). Conventional enzyme-linked immunosorbent assay (ELISA) systems can detect sPD-L1 using anti-PD-L1 capture antibody through the antigen-antibody reaction, but cannot evaluate the quality and function of sPD-L1. In this study, we developed a novel ELISA system for the detection and quantification of sPD-L1 with PD-1-binding capacity (bsPD-L1). To capture bsPD-L1 through the ligand-receptor reaction, the anti-PD-L1 capture antibody in the conventional ELISA was replaced with PD-1-Ig fusion protein in the new ELISA. The new ELISA could detect bsPD-L1 in 29 out of 75 plasma samples from patients with non-small cell lung cancer (NSCLC), with higher sensitivity and frequency than the conventional ELISA. The western blot analysis showed that sPD-L1 in the plasma was glycosylated. Treatment of the samples with glycosidase reduced the absorbance determined by the new ELISA but had no effect on the absorbance determined by the conventional ELISA. These results suggest that glycosylation of sPD-L1 is important for its binding to the immobilized PD-1 in the new ELISA. Our new ELISA system may be useful for the evaluation of functional sPD-L1 with PD-1-binding capacity in cancer patients.

Middle mediastinal thymic carcinoma with cystic findings in radiologic images: a case report

BackgroundThymic carcinomas are usually detected in the anterior mediastinum. Thymic carcinoma occurring in the middle mediastinum and showing an image of a cyst is extremely rare.Case presentationA 64-year-old man with a middle mediastinal tumor detected incidentally by a CT scan was referred. Chest CT showed an entirely cystic mass in the middle mediastinum between the bilateral brachiocephalic vein and trachea. We resected the tumor completely in the right recurrent nerve because it had invaded the nerve. Immunohistochemical features showed a thymic carcinoma pattern. The final diagnosis was thymic squamous cell carcinoma occurring in the middle mediastinum.ConclusionTo our best knowledge, this is the first report of a thymic carcinoma occurring in the middle mediastinum, as demonstrated by histopathological findings with immunohistochemical features.

Pulmonary artery reconstruction using autologous pulmonary vein for surgical treatment of locally advanced lung cancer: a case report

BackgroundResection and reconstruction of the pulmonary artery during lobectomy is a safe and effective procedure for centrally located lung cancer. We usually choose a pericardial conduit to repair a large defect of the pulmonary artery. The use of an autologous pulmonary vein conduit for reconstruction was first described in 2009.Case presentationA 64-year-old woman with left upper lung adenocarcinoma with mediastinal and hilar adenopathy was referred to our hospital. Hilar nodes had extensively infiltrated the pulmonary artery. We interposed an autologous superior pulmonary vein between the cut ends of the pulmonary artery. She was discharged without any complication on the ninth postoperative day.ConclusionsA pulmonary vein conduit is a good option for reconstruction of the pulmonary artery. We report the successful use of an autologous pulmonary vein conduit.

Total or partial vertebrectomy for lung cancer invading the spine

Background Surgery for lung cancer invading the spine remains challenging associated with high morbidity and mortality. However, recent advances in surgical techniques as well as in perioperative care may improve outcomes of lung cancer surgery with vertebrectomy. We describe our surgical approach and assess the outcome lung cancer invading the spine. Methods We retrospectively reviewed our recent experiences of lung cancer with vertebral invasion, in which we have performed total or partial vertebrectomy from January 2011 through April 2015. Results We experienced eight patients who were treated with partial or total vertebrectomy for lung cancer. Vertebral invasion was evaluated by chest CT and MRI findings. All cases were no distant metastasis. N factors were all patients N0 revealed by chest CT and PET-CT. Two patients were treated preoperative induction therapy (CDDP + TS-1, Radiation 50 Gy). For the surgery, total vertebrectomy was performed two patients, hemi vertebrectomy was two patients, transverse-process resection was four patients. In all of eight cases, complete resection were perfomed with total or partial vertebrectomy. Morbidity was observed in six patients (75%); no mortality occurred. Six patients (75%) were survived after surgery (range: 12–62 months) and four patients (50%) were no recurrence. Five years overall survival rate was 71.4%. Conclusions In our experience, Lung cancer surgery combined with vertebrectomy is highly aggressive surgery associated with high morbidity. But, this procedure is a promising treatment option for selected patients, for example N0M0 disease with lung cancer invading the spine.

We should be done in such a way that patients with stage IV non-small cell lung cancer who would benefit from surgery are not overlooked

The standard treatment for stage IV non-small cell lung cancer (NSCLC) is systemic chemotherapy; however, survival rates are poor (1). Furthermore, most patients with NSCLC have stage IV disease at the time of diagnosis (2). As oncologists, we should consider using the best treatment strategies for stage IV NSCLC patients.