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Micrometastasis to lymph nodes in stage I left lung cancer patients

BACKGROUND To evaluate the frequency and clinicopathological characteristics of lymph node micrometastasis in left lung cancer patients diagnosed to be stage IA and IB based on routine histopathologic examinations, we examined the lymph nodes in patients who had undergone an extended mediastinal lymphadenectomy, using immunohistochemical methods. METHODS Paraffin-embedded tissue sections from the lymph nodes in 49 patients with stage I left lung cancers were studied. We used AE1/AE3 as the anticytokeratin and Ber-EP4 as the antiepithelial cell antibodies when performing immunohistochemical staining. RESULTS We identified micrometastasis of the lymph nodes in 13 (26.5%) of 49 patients with stage I left lung cancer. NO disease was reclassified as N1 disease in 5 cases, N2 disease in 6 cases, and N3 disease in 2 cases. The location of the micrometastatic lymph nodes proved to be wide regions including the contralateral and highest mediastinal nodes, and 6 (46.2%) out of the 13 patients with micrometastasis were thus presumed not to be completely eliminated by a standard lymphadenectomy through an ipsilateral thoracotomy. The five year survival rate of patients with reclassified N1 to N3 disease was 74%, and the presence of micrometastasis was found to have no significant effect on the outcomes. CONCLUSIONS The micrometastatic involvement of the lymph nodes was both more frequent and extensive than expected even in stage I left lung cancer. These results suggest that an extended mediastinal lymphadenectomy may therefore be required for the locoregional control of stage I left lung cancer patients.

Mucinous adenocarcinoma of the thymus: A distinct variant of thymic carcinoma

BACKGROUND Primary thymic mucinous adenocarcinoma is a recently described subtype of thymic carcinoma, which behaves aggressively. METHODS The authors analyzed the clinical and pathological findings of three cases of thymic mucinous adenocarcinoma, and reviewed five cases previously reported in the English literature. RESULTS The patients were two males and one female between the ages of 38 and 55 years. Macroscopically, the tumors were mostly solid and white to yellowish-white. Areas with a gelatinous appearance were present. Histologically, all of the tumors were adenocarcinomas with abundant mucin production, which resembled the mucinous adenocarcinomas of other organs. Malignant tumor cells in nests, tubules and cribriform structures floated in pools of extracellular mucin. In one case, associated thymic cysts were found at the periphery of the tumor. The cyst wall was partially lined by malignant mucinous epithelium, which showed transition from benign thymic epithelium. Immunohistochemically, all of the tumors showed positive immunoreactivity for cytokeratin (CK) 20 and carcinoembryonic antigen (CEA). CD5 was diffusely positive in one case, and focally positive in the other two cases. The prognoses of these cases were extremely poor, and two of the patients died within 24 months. CONCLUSION Growing evidence suggests that mucinous adenocarcinoma is a distinct morphological variant of primary thymic carcinoma. We believe that clinicians and surgical pathologists should include thymic mucinous adenocarcinoma in the differential diagnosis of mediastinal adenocarcinoma.

Pleural adenosine deaminase levels in tuberculous pleurisy —Its diagnostic performance under the different prevalences in the different age of population—

In the diagnosis of pleural effusion, tuberculous pleurisy should always be considered because the prevalence of tuberculosis in Japan remains high. The measurement of adenosine deaminase (ADA) levels in pleural fluid is useful for the diagnosis of the tuberculous pleurisy because of its high sensitivity and specificity. However, no studies have addressed the post-test probability (= positive predictive value; PPV) of the test. Since the PPV depends on the pre-test probability (= prevalence) of the tuberculous pleurisy that varies with age, we have retrospectively evaluated the PPV in the different age population; the young (-35 years of age), the middle (36-65 years), and the old (66-years). A total of 208 data sets were collected; the tuberculosis (n = 52), malignancy (n = 34), non-specific infection (n = 31), transudates (n = 45), the others (n = 36), and unknown causes (n = 10). It was found that 1) the prevalence of tuberculous pleurisy was decreased with age, (70% in the young, 28.7% in the middle, and 8.5% in the old), 2) the PPV was the lowest in the old (53.8%), while the highest in the young (95.0%), and 3) no significant correlation was found between age and the ADA activity in pleural effusion.

Angiomyolipoma in the Lung Detected 15 Years After a Nephrectomy for Renal Angiomyolipoma

Angiomyolipoma is generally found in the kidney, but is especially rare in the lung. Nine cases of angiomyolipoma in the lung have been reported previously, and in 3 of these patients it was involved with nephrectomy for renal angiomyolipoma. The origination of the tumor was not completely recognized, but lymphangioleiomyomatosis and angiomyolipoma are known to have a common feature. The pathogenesis of angiomyolipoma in the lung has recently been researched in relation with lymphangioleiomyomatosis. We review these case reports of angiomyolipoma in the lung and discuss the clinical features and the generation of these tumors.

Langerhans cell histiocytosis: coexistence of bronchogenic and thymic cysts in the thymus.

Langerhans cell histiocytosis (LCH) is a disease caused by the proliferation of Langerhans cells in various tissues or organs. A 43-year-old male patient presented with an anterior mediastinal mass in the thymus. Histological examination after a thymectomy revealed a bronchogenic cyst in the thymus, and multiple LCH and small thymic cysts were also incidentally observed in the thymus. Unifocal LCH in an adult occurring in the thymus is extremely rare. Furthermore, no cases of LCH with the coexistence of bronchogenic and thymic cysts in the thymus have been previously reported.

A Resected Case of Left Apical Invading Lung Cancer with Isolated Adrenal Metastasis.

症例は54歳, 男性.主訴は左前胸部痛と左上肢鈍重感.精査上, 左肺尖部胸壁浸潤肺腺癌, 左副腎転移 (臨床病期T3N0M1-IV期) と診断.まず原発巣に対して放射線照射 (30Gy/15回) を行い, 腫瘍は5.0×4.2cm大から3.6×2.5cm大に縮小した.次いで原発巣切除, 即ち左肺上葉切除, 左鎖骨下動脈, 腕神経叢合併切除, 人工血管再建, および左R3γ郭清を施行.左副腎は5.8×4.2cm大で, 第28病日に後腹膜アプローチで左副腎摘出術を施行. さらに原発巣切除部の左胸郭上口に放射線照射 (20Gy/10回) を追加した. 病理組織学的に原発巣および副腎転移巣は低分化腺癌で, 原発巣は左鎖骨下動脈および腕神経叢への浸潤を認め, 病理病期はT3N0M1-IV期であった. 左副腎摘出から12ヵ月後の現在, 再発を認めず社会復帰している. IV期肺癌の中でも片側副腎単独転移症例では, 原発巣および転移巣に対する積極的な外科治療により予後の向上が期待できる.

A case of Mallory-Weiss syndrome in a case of small cell lung cancer of the lung treated by chemotherapy.

肺癌化学療法に伴う嘔気・嘔吐が原因と考えられるMallory-Weiss症候群の1例を経験した. 本例は大量の吐血のために死亡した. 剖検所見では胃内腔の凝血塊と胃粘膜に数カ所の裂創がみられたが, 気管支, 肺をはじめ他の臓器には出血の原因となる異常は認めなかった. 癌化学療法後に起こる本症候群の報告は9例と稀であるが, シスプラチンの導入以後漸増傾向にあり, 化学療法施行時には念頭におくべき病態の一つと思われた.