Joji Samejima

Thoracoscopic lung biopsy in 285 patients with diffuse pulmonary disease

Background Surgical lung biopsy is generally considered the most appropriate method for diagnosing diffuse lung disease. However, there are few reports focusing on only one thoracoscopic technique. This study was designed to determine the morbidity and mortality related to video-assisted thoracoscopic lung biopsy in a single center, thereby providing data on the severity of morbidity and clarifying the risk factors. Methods We analyzed 285 patients with undiagnosed diffuse lung disease who underwent video-assisted thoracoscopic lung biopsy at Kanagawa Cardiovascular and Respiratory Center from February 2007 to April 2012. We recorded the severity of postoperative complications using the Clavien-Dindo classification. Results The surgical morbidity was 7.0% (20/285), including delayed pulmonary fistulas in 11 patients, acute exacerbation in 3, prolonged air leakage (>7 days) in 2, hypoxemia in 2, atrial fibrillation in 1, and premature ventricular contraction in 1. Based on the Clavien-Dindo classification, grade I, II, IIIa, IIIb, and IVa complications accounted for 20%, 10%, 50%, 5%, and 15%, respectively. The 30-day mortality was 0%. The diagnostic yield was 100%. Although acute exacerbation occurred in 2 patients with idiopathic pulmonary fibrosis and 1 with fibrotic nonspecific interstitial pneumonia, there were no distinctive features that allowed preoperative prediction of acute exacerbation. Conclusions Our findings indicate that video-assisted thoracoscopic lung biopsy is a feasible procedure. We hope to clarify risk factors in future research.

Inflammatory malignant fibrous histiocytoma of thymus origin.

A 46-year-old man was referred to our department complaining of anterior chest pain. A chest computed tomographic scan revealed an anterior mediastinal tumor measuring 38 x 35 x 50 mm. Suspecting a thymoma, we performed extended thymectomy through a median sternotomy under general anesthesia. Pathologically, the tumor was composed of pleomorphic spindle-shaped cells arranged in a storiform pattern, with marked inflammatory cell infiltration. The tumor was contiguous with the thymus tissue. Based on these findings, we made the diagnosis of inflammatory malignant fibrous histiocytoma originating from the thymus. Until now, 12 months later, the patient has shown no evidence of tumor recurrence.

Prognostic impact of bulky swollen lymph nodes in cN1 non-small cell lung cancer patients

OBJECTIVE The aim of this study was to analyze clinicopathological backgrounds and prognosis of clinical N1 non-small cell lung cancer and clarify the difference between bulky and non-bulky cN1 diseases. METHODS We reviewed 110 patients with completely resected cN1 non-small cell lung cancer and examined the prognostic impact of lymph node size. We classified the swollen lymph nodes into two groups based on their size on chest computed tomography: short-axis diameter ≥20 mm (=bulky group) or <20 mm (=non-bulky group). RESULTS The bulky group consisted of 10 patients, and the non-bulky group comprised 100 patients. There was no significant difference in the upstaging rate to pathological N2 between the bulky and non-bulky groups (31% vs. 30%; P = 0.63). The 5-year recurrence-free survival rate and 5-year overall survival rate of both groups did not differ significantly (P = 0.36, P = 0.30, respectively). Our results suggested the possibility that the size of the swollen lymph nodes had no impact on the prognosis in cN1 non-small cell lung cancer patients. In comparison of surgical procedure, pneumonectomy was performed in the bulky group more frequently than the non-bulky group (70% vs. 19%; P < 0.01). CONCLUSIONS Bulky cN1 disease was not different from non-bulky disease in the prognosis and the upstaging rate to pN2. Curative resection should be indicated to resectable bulky cN1 disease as with non-bulky disease, with careful pre-operative evaluation and preparation considering the possibility of pneumonectomy.