Eriko Atsumi

Acute Respiratory Distress Syndrome due to Strongyloides stercoralis Infection in a Patient with Cervical Cancer

A 62-year-old woman complained of diarrhea and vomiting after receiving chemotherapy for cervical cancer in association with high doses of corticosteroids. Two months later, the patient developed acute respiratory distress syndrome, and numerous Strongyloides stercoralis parasites were found in the intrabronchial discharge. Ivermectin was administered daily until nematodes were no longer detected in the sputum, and the patients condition was successfully rescued. Antibodies for human T-cell lymphotropic virus-1 (HTLV-1) were positive. HTLV-1 infection and the administration of corticosteroids are known risk factors for strongyloides hyperinfection syndrome. Therefore, physicians should consider this disease in the differential diagnosis of patients from endemic areas who present with gastrointestinal symptoms under these risk factors.

Legionella pneumonia caused by Legionella pneumophila serogroup 2: second case report in Japan

A 56-year-old man with a 3-day history of a chilly sensation and general fatigue presented to a hospital in his neighborhood. He was diagnosed as having pneumonia and immediately treated with intravenous ceftriaxone sodium, but his respiratory condition deteriorated and he developed symptoms of restlessness. Although Legionella urinary antigen detection tests were negative, his clinical course suggested Legionella pneumonia. After his treatment was changed to intravenous ciprofloxacin and oral clarithromycin, his general condition gradually improved. Later, Legionella pneumophila serogroup 2 was isolated from a bronchoalveolar lavage specimen. This was considered to be the causative organism. In our literature search, this was only the second case of Legionella pneumonia caused by Legionella pneumophila serogroup 2 in Japan.

Comparison of GLUT-1, SGLT-1, and SGLT-2 expression in false-negative and true-positive lymph nodes during the 18F-FDG PET/CT mediastinal nodal staging of non-small cell lung cancer

INTRODUCTION Although positron emission tomography (PET) with 2-deoxy-2-[fluorine-18]fluoro-d-glucose integrated with computed tomography (CT), (18F-FDG PET/CT), has recently improved the mediastinal nodal staging of non-small cell lung cancer (NSCLC), this method can show false negativity. We immunohistochemically investigated the expression of glucose transporters (GLUT-1, SGLT-1, and SGLT-2) in false negative and true positive mediastinal nodes via 18F-FDG PET/CT. METHODS We investigated patients with clinically-diagnosed N0/pathological N2 diseases and patients with clinically-diagnosed N2/pathological N2 disease. The patients who were included in this study were evaluated using 18F-FDG PET/CT followed by surgical resection between January 2004 and December 2015. The expression of GLUT-1, SGLT-1, and SGLT-2 in the metastatic mediastinal lymph nodes, and clinicopathological variables such as primary tumor size, lymph node size, histological type, and SUVmax of the primary lesion, were compared between false negative nodes and true positive nodes. RESULTS The total number of PET false negative metastatic mediastinal lymph nodes was 22 in the 17 patients who were clinical N0/pathological N2, and the number of PET true positives was 15 in the 11 patients who were clinical N2/pathological N2. GLUT-1 expression was positive in five false negative nodes and 10 true positive nodes. SGLT-2 expression was positive in 12 false negative nodes and one true positive node, whereas both false negative and true positive nodes showed no SGLT-1 staining. Univariate analysis showed that the reduced expression of GLUT-1 (P = 0.015), and overexpression of SGLT-2 (P = 0.004) were the significant causative factors for false negative nodes. Multivariate analysis also showed that the reduced expression of GLUT-1 (P = 0.012) and overexpression of SGLT-2 (P = 0.006) were the significant causative factors for false negative nodes. CONCLUSION It suggests that the reduced expression of GLUT-1 and overexpression of SGLT-2 are associated with false-negative lymph node metastases in NSCLC.

Mucoepidermoid Carcinoma of Arising from a Bronchogenic Cyst of the Diaphragm

Introduction: Bronchogenic cysts may rupture or become infected, and malignant degeneration may occur. Although various types of malignant degeneration have been described, only a few reports of mucoepidermoid carcinoma arising from a bronchogenic cyst have been published. We report such a case. Case: A 77-year-old female was referred to our institution for evaluation of left chest pain. A computed tomography scan showed an enhancing 65 × 70 mm mass of the left diaphragm. Based on the intraoperative findings of an intradiaphragmatic tumor involving the lower lobe of the left lung, the resection of the tumor with the wedge resection of left lower lobe and partial resection of the left diaphragm was performed. Histopathologic examination revealed a mucoepidermoid carcinoma arising from a bronchogenic cyst of the diaphragm with the presence of fibrous adhesion to the lower lobe. Conclusion: We believe that complete resection of any bronchogenic cyst is justified.

A rare case of congenital bronchoesophageal fistula in an adult

Highlights • When congenital bronchoesophageal fistulas exist without atresia of the esophagus, the diagnosis can be delayed.• Typical symptoms include a cough, and recurrent or chronic lung infections.• Despite the benign nature of this malformation, it can cause long-term debilitating respiratory symptoms.• The diagnosis should be considered in the evaluation of recurrent lung infection.

Giant pedunclated lipoma of the esophagus: A case report

Highlights • Although Esophageal lipoma is extremely rare and pathologically benign, surgical excision of the lipoma is recommended when symptomatic or uncertain biological behavior.• Some of the esophageal lipoma has a stalk.• The esophageal lipoma can be removed by stalk ligation, even if the mass is too huge.• An adequate preoperative evaluation to identify the correct origin of the stalk is mandatory for a successful treatment.

Postoperative Lung Torsion With Retained Viability: The Presentation and Surgical Indications

BACKGROUND We review our experience with postoperative lung torsion with retained viability. METHODS A total of 2165 patients underwent pulmonary resection (lobectomy or segmentectomy) at our institution between 1 January, 1986, and 31 March, 2017. Eight (0.3%, six males and two females: median age, 68 years) had lung torsion with retained viability. RESULTS The right upper lobe was resected in seven patients, while the left upper segment was resected in one patient. The lung torsion with retained viability was the right middle lobe in seven patients and the left lingular segment in one patient. A bronchoscopic examination was performed in four patients to diagnose the pulmonary torsion; however, it demonstrated no specific findings. Subsequently, computed tomography (CT) was performed in all the patients, and lung torsion was diagnosed in all the patients based on the CT findings. None of the patients showed any symptoms when lung torsion was diagnosed in them. The diagnosis of pulmonary torsion was made at a median of 4 days (range, 1-22 days) after the initial surgery. Six patients underwent detorsion of the affected lung, while one patient had a lobectomy, and one patient received conservative management. The lungs of all patients in which detorsion was performed adequately re-expanded. Frequent pneumonia in the viable torsed lung was diagnosed as a cause of death in the one patient who received conservative management. CONCLUSION The timely decision to follow a surgical approach for lung torsion with retained viability can lead to a satisfactory outcome.