Haruka Takeichi

Tumor budding is a significant indicator of a poor prognosis in lung squamous cell carcinoma patients

Lung cancer is a leading cause of cancer mortality worldwide and patients occasionally develop local recurrence or distant metastasis soon after curative resection. Reports of new therapeutic strategies for lung squamous cell carcinoma (SqCC) are extremely rare, while selective anticancer therapy has been reported for lung adenocarcinoma. The aim of this study was to identify clinicopathological prognostic factors for SqCC. We analyzed tumor budding and infiltrative patterns (INF) in 103 cases of surgically-resected SqCC. Tumor infiltrative patterns were classified into three groups (INFa, b and c) and INFc was infiltrative growth at the tumor invasive front. The cases with an INFc component [INFc(+)]were significantly associated with venous invasion (P=0.014) and the scirrhous stromal type (P<0.001). The overall survival rate of patients with INFc(+) was significantly lower than that of patients without the INFc component [INFc(−); P=0.003]. Tumor budding was defined as a single cancer cell or a small nest of up to four cancer cells within stromal tissue. The cases with tumor budding [Bud(+)] were significantly associated with lymph node metastasis (P=0.001), lymphatic invasion (P=0.002), INFc(+) (P<0.001) and the scirrhous stromal type (P=0.014). Patients with the Bud(+) type had a lower overall survival rate than patients with the Bud(−) type (P<0.001). Multivariate analysis demonstrated that tumor budding [hazard ratio (HR), 2.766; 95% confidence interval (CI), 1.497–5.109] and lymph node metastasis (HR, 1.937; 95% CI, 1.097–3.419) were independent predictors of mortality. In conclusion, tumor budding is a significant indicator of a high malignant potential and poor prognosis in SqCC of the lung.

Liposome‐Encapsulated Hemoglobin Accelerates Bronchial Healing After Pneumonectomy in the Rat With or Without Preoperative Radiotherapy

Liposome-encapsulated hemoglobin (LEH) has been reported to accelerate wound healing in the stomach and skin in an experimental setting. LEH was tested in bronchial anastomotic healing after radiation and pneumonectomy in the rat. Sprague-Dawley rats (n = 61) received preoperative radiation (20 Gy) to the chest and underwent left pneumonectomy with bronchial stump closure using the Sweet method 4 days later, when they were randomized to receive intravenous infusion of LEH with high O2 affinity (P50 O2  = 17 mm Hg, 10 mL/kg, n = 32) or saline (n = 29). Additional rats (n = 18) were treated in the same way without preoperative radiation. Bronchial anastomotic healing was evaluated 2 days after surgery by determining the bursting pressure and infiltration of neutrophils, monocytes, and macrophages. Bronchial bursting pressure was elevated in the rats receiving LEH both in the unirradiated group (LEH 212 ± 78 vs. saline 135 ± 63 mm Hg, P < 0.05) and in rats with preoperative radiation (LEH 162 ± 48 vs. saline 116 ± 56 mm Hg, P < 0.01). Moreover, the percentage of rats with bursting pressure <100 mm Hg tended to be smaller in the unirradiated group (LEH 1/9 [11.1%] vs. saline 4/9 [44.4%], NS) and was significantly reduced in irradiated animals (LEH 3/32 [9.4%] vs. saline 11/29 [38%], P < 0.05). There were no morphological differences except for macrophage infiltration to the anastomotic area, which was significantly prominent in the LEH-treated rats (P < 0.05) regardless of the presence or absence of preoperative irradiation (IR). The results suggest that LEH with high O2 affinity may improve mechanical strength and morphological findings in bronchial anastomosis in rats regardless of the presence or absence of preoperative IR. The irradiated rats later treated with LEH had equivalent or better bronchial healing than that of saline-treated naïve animals undergoing pneumonectomy alone.

Tracheal Bronchus: Beware of Anomalous Venous Drainage!

66-year-old woman was admitted to our hospital Awith bloody sputum. Computed tomography (CT) showed a 6.8-cm mass shadow in the right upper lobe, and examination of a transbronchial lung biopsy specimen revealed it to be a lung adenocarcinoma. Threedimensional CT (3DCT) revealed a tracheal bronchus (Fig 1, arrow). Sagittal images (Supplemental Fig 1) and 3DCT (Fig 2) showed that part of the upper pulmonary vein (PV) was traveling behind the right main pulmonary artery (PA). The patient underwent right upper lobectomy. B1 and B2þ3 could be cut with a stapling device (Supplemental Fig 2). Asc.A2 and A3 were traveling in the normal orientation, but A1 directly arose from the main PA (Supplemental Fig 3). V2t and V2c were also traveling normally in the front of the main PA, but unusually, the

A case of an elderly patient treated for descending necrotizing mediastinitis

We report a case of descending necrotizing mediastinitis (DNM). DNM is a serious infection, and preventing death requires early diagnosis and draining of the infection focus. An 84-year-old man was admitted to our hospital complaining of a swollen neck and pain when swallowing. He had had a tooth extracted at a neighboring dental clinic 2 days previously. Cervicothoracic computed tomography (CT) scan demonstrated gas bubbles and unencapsulated abscesses in the cervical spaces and anterosuperior and posterior mediastinum, extending below the carina. He was diagnosed as DNM caused by odontogenic infection. Cervical drainage was performed, in addition to mediastinal drainage using video-assisted thoracic surgery (VATS). Complications were sepsis, disseminated intravascular coagulation (DIC), and heart failure after surgery, but he recovered following intensive care. This was a lifesaving case of DNM for which mediastinal drainage was performed with VATS.

Intra-pericardial recurrent thymoma presenting with compression of the pulmonary trunk

A patient who had a second recurrent intra-pericardial thymoma is presented. The tumor was expanding in the pericardial space and compressed the pulmonary trunk. The obstruction of the pulmonary trunk could have resulted in a fatal outcome. Surgical management was required, and complete surgical resection and mediastinal adjuvant radiation therapy were effective in this patient’s management.

Video‐assisted segmental resection of an intrapulmonary bronchogenic cyst mimicking a middle mediastinal cystic tumor

We report a case of an intrapulmonary bronchogenic cyst that radiologically mimicked a cystic tumor of the middle mediastinum. During video‐assisted thoracoscopic surgery, the lesion was confirmed to be in the lung parenchyma rather than in the mediastinum. A video‐assisted thoracoscopic anterior basal segmentectomy was eventually performed, and an intrapulmonary bronchogenic cyst was the diagnosis based on histology.

L-shaped mini-sternotomy combined with videoscopic approach for thymoma with invasion of major veins

Abstract It might be possible to remove thymic tumors with minimal invasion of the left brachiocephalic vein (BCV) using an advanced videoscopic technique; simple resection of this vessel can be achieved via such an approach. However, tumor invasion of the superior vena cava or right BCV requires angioplasty or reconstruction, both of which are difficult to perform in videoscopic procedures. We report a case of invasive thymoma with localized invasion of the great vessels at the junction of the left BCV and superior vena cava. An L-shaped mini-sternotomy combined with a videoscopic approach allowed thymectomy with safe vesselplasty of the involved vessels.