Huang-Chou Chang

Risk of p53 gene mutation in esophageal squamous cell carcinoma and habit of betel quid chewing in Taiwanese.

A recent report suggested that BQ (BQ) chewing significantly correlated with the occurrence of esophageal squamous cell carcinoma (ESCC) in Taiwanese. BQ chewing was shown to be associated with p53 mutation in oral cancers. However, the relationship between BQ chewing and p53 mutation in ESCC is unclear. Seventy‐five primary ESCC patients were enrolled for mutational analysis of the p53 gene using polymerase chain amplification and direct sequencing of amplified product. Thirty‐seven mutations of the p53 gene were detected in 45.5% (34/75) of tumor specimens. These mutations significantly clustered in exon 5 (21/37) of the p53 gene. The incidence of p53 mutations did not associate with clinicopathological characteristics or the habits of cigarette smoking or alcohol consumption. However, BQ chewers exhibited significantly higher incidence of p53 gene mutations than non‐chewers (67.6% vs 32.4%, P = 0.007). After controlling the confounding factors of cigarette smoking and alcohol intake, BQ chewing still showed significant association with the incidence of p53 mutation in ESCCs (RR = 4.23; 95% CI, 1.317–13.60). The A:T to G:C transition (8/37, 21.6%) and G:C to T:A transversion (5/23, 13.5%) were the prevalent spectrum of p53 gene mutations. All A:T to G:C transitional mutations occurred in patients with the habits of BQ chewing and cigarette smoking. Noticeably, alcohol consumption could enhance this peculiar spectrum of p53 mutation in ESCC. Accordingly, p53 might be an important molecular target of BQ carcinogens in the development of ESCC in Taiwanese. (Cancer Sci 2005; 96: 758–765)

Large Pedunculated Lipoma of the Esophagus

Pedunculated lipoma of the esophagus is rare and easily misdiagnosed in clinical practice. The presenting symptoms of esophageal lipoma are dysphagia, regurgitated mass and persistent sensation of a lump in the throat. The most frequent location of the tumor pedicle is the upper esophageal sphincter. Although the lipoma is pathologically benign, if it is large enough, it may cause airway obstruction secondary to the mechanical pressure to the larynx when the tumor is regurgitated. We present the case of a 67-year-old man who had the symptoms of dysphagia, nausea and vomiting. Esophagography and chest computed tomography revealed that he might have an esophageal submucosal or intraluminal tumor mass. Panendoscopy showed a pedunculated tumor mass within the esophageal lumen with its peduncle arising from the cervical esophagus. The tumor mass measured 9.0 x 4.7 x 2.5 cm in size. Thoracic approach via the right chest wall was performed for confirmation. After removal of the intraluminal mass, the patients symptoms dramatically improved. Pathology showed a lipoma arising from the submucosa of the esophagus.

Non-endemic Pulmonary Coccidioidomycosis in Taiwan-A Case Report

Coccidioidomycosis is a dustborne infection caused by the dimorphic fungus Coccidioides immitis. Infections are endemic to certain regions of the southwestern United States. Most patients with primary pulmonary coccidioidomycosis are asymptomatic. Inhalation of fungal spores is the only established mode of infection, and spores may be carried on dust particles. Coccidioidomycosis is frequently unrecognized as a diagnosis because of the lack of suspicion in a non-endemic area. We described a case of coccidioidomycosis manifesting as a persistent pulmonary mass and diagnosed in Taiwan, a non-endemic area. This patient initially was treated with anti-tuberculosis drugs owing to the presence of necrotizing granulomatous inflammation on repetitive lung biopsies. The diagnosis of coccidioidomycosis was confirmed after wedge resection of the right middle lobe of the lung through minithoracotomy. We also reviewed the related literature concerning the epidemiology, clinical manifestations, diagnosis and treatment of coccidioidomycosis.

Surgical Treatment of Metastatic Pulmonary Tumors

Background: Metastasectomy has been proved to be an opportunity for long-term survival for patients with various neoplasms with pulmonary metastases. A retrospective study was performed to analyze the results and identify the prognostic factors of surgical treatment for pulmonary metastases. Methods: From 1991 to 2003, a total of 73 patients who underwent surgical treatment for pulmonary metastases at the Kaohsiung Veterans General Hospital were enrolled for analysis. Results: The overall 5-year survival rate was 25.1%. The operation-related mortality rate was 2.74%. Gender, origins of the primary cancers, number of pulmonary metastases, and surgical procedures had no significant effect for those patients who underwent pulmonary metastasectomies. However, patients who had a disease-free interval longer than 36 months had a better 5-year survival rate than those who had a shorter disease-free interval (29.6% vs. 10.5%). Conclusion: Pulmonary metastasectomy is a safe and potentially curative procedure. The disease-free interval is an important prognostic factor for patients with pulmonary metastases.

Solitary Chest Wall Tumor Is the Initial Clinical Manifestation of Multiple Myeloma: Report A Case and Review Literature

A 57 year-old male patient suffered from a progressive enlarged tender mass lesion over right anterior chest wall for half year. Initial chest roentgenogram and computed tomography only demonstrated a solitary osteolytic lesion with bony expansion and destruction over right 5 rib. Whole body bone scan showed a segmental hot spot over anterior aspect of right 5th rib without associating with other suspected lesions. Malignant disease of unknown origin with rib metastasis was impressed initially. Therefore, en-block resection of chest wall was performed for tissue diagnosis. The result of histopathologic examination presented a picture of plasmacytoma. Immunohistochemistry disclosed positive stain of kappa chain. The urinary Bence-Jones protein was negative. As the supplementary roentgenography exhibited multiple pouch-out lesions over limbs, skull as well as spine, multiple myeloma was diagnosed finally.

Removal of Airway Foreign Body by Fiberoptic Bronchoscopy through a Laryngeal Mask Airway

A male patient, 78 years old, was referred to our emergency department (ED) for what was thought to be a foreign body in the right bronchial tree. The chest roentgenogram revealed a denture (3.6×1 cm) impacted in the right main bronchus with distal consolidation. A fiberoptic bronchoscope was used in an attempt to remove the foreign body at a local hospital, but failed. After admission to our hospital, a repeat flexible bronchoscopy was performed to retrieve the foreign body under topical anesthesia, but also failed. A chest surgeon was consulted. Another bronchoscopy was performed under general anesthesia with a laryngeal mask airway. Grasping forceps were inserted through the working channel of the bronchoscope to capture the denture. The denture contained 5 false teeth. Increased experience and the development of better accessories has advanced the acceptance of the flexible bronchoscope as the preferred initial instrument for both the diagnosis and removal of airway foreign bodies in adults. With the development of the laryngeal mask airway, a flexible bronchoscopy can be performed with reasonable airway control, even with deeper sedation. For patients who cannot tolerate a fiberoptic bronchoscopy under topical anesthesia, we advise using the laryngeal mask airway with general anesthesia, because it offers a larger diameter and less resistance than an endotracheal tube, thus facilitating the bronchoscopy and the removal of the airway foreign body.

Ectopic Pleura-based Thymoma Mimicking Mesothelioma: Report of a Case

Ectopic thymoma is rare, especially when it arises in the pleural cavity. We report a 32-year-old female patient with diffuse pleural thickening. Computed tomography(CT)-guided needle biopsy was done before operation and mesothelioma was impressed. Left pleuropneumonectomy was performed. After operation pathologic diagnosis of ectopic pleural thymoma was made.