Jotaro Shibuya

Primary intrapulmonary thymoma successfully resected with vascular reconstruction

Primary intrapulmonary thymomas are defined as intrapulmonary tumors without an associated mediastinal component and are very rare. We report a resected case of primary intrapulmonary thymoma with dissection of mediastinal lymph nodes and vascular reconstruction. Because the tumor directly invaded the right brachiocephalic vein, the vein was reconstructed with a graft, and then adjuvant radiation was performed postoperatively. The tumor was diagnosed as a lymphocyte dominant thymoma and B2 type thymoma in the WHO classification. There has been no evidence of recurrence in 6 years. Complete resection of the tumor with vascular reconstruction and adjuvant radiation should be considered in invasive intrapulmonary thymoma.

A prospective 5-year follow-up study after limited resection for lung cancer with ground-glass opacity

OBJECTIVES The incidence of small-sized pulmonary adenocarcinomas with ground-glass opacity (GGO) has recently increased, with excellent postoperative prognosis. The limited resection of such cancers has been deemed to be acceptable based on retrospective studies. We conducted a prospective multi-institutional study evaluating the validity of limited resection for small-sized pulmonary adenocarcinoma with GGO. METHODS The inclusion criteria were 25-80 years of age, no prior treatment, a maximum tumour diameter of 8-20 mm, a GGO ratio of ≥ 80%, clinical T1N0M0, lower 18F-fluorodeoxyglucose accumulation than the mediastinum, resectable by sublobar resection, pulmonary lobectomy tolerable and an intraoperative pathological diagnosis of bronchiloalveolar carcinoma. Wedge resection was preferred, but segmentectomy was permitted. Disease-specific survival and overall survival were analysed. RESULTS From November 2006 to April 2012, 73 patients were enrolled from 13 institutions. One patient was ineligible, and the remaining 72 patients were preregistered. The tumours of 3 and 14 patients were intraoperatively diagnosed as benign lesions and adenocarcinomas with mixed subtype, respectively. Intraoperative cytological/histological examination of surgical margin was not performed in 2 patients, and the remaining 53 patients were ultimately eligible for this study. The mean tumour size was 14.0 mm and the mean GGO ratio was 95.9%. Thirty-nine and 14 patients underwent wedge resection and segmentectomy, respectively. Although all tumours were intraoperatively diagnosed as bronchioloalveolar carcinomas, 6 were ultimately diagnosed as adenocarcinoma with a mixed subtype. No completion lobectomy was performed. As of 1 May 2017, no recurrence of the original lung cancer was observed during 60.0-126.3 months after surgery. Two patients died from other diseases. The 5-year disease-specific and overall survival rates were 100% and 98.1%, respectively. The reduction in the pulmonary function after limited resection was minimal. CONCLUSIONS With these criteria, limited resection was performed safely without any recurrence, and the postoperative pulmonary function was well preserved. The outcomes of limited resection for small-sized lung cancer with GGOs that met the criteria of this study were satisfactory.

Role of pulmonary intravascular macrophages activation in increased pulmonary microvascular permeability.

Pulmonary intravascular macrophages reside in the alveolar capillaries of sheep lung. We tested the effects of pulmonary intravascular mcrophages activation on pulmonary microvascular permeability.Sheep were divided into 3 groups; latex group, indomethacin group and OKY-046 (thromboxane A2 synthetase inhibitor) group. In each group, we infused latex beads emulsion, 1 μm in diameter, 5.46×1010 beads/kg, intraarterially. In latex group, lymph protein clearance increased significantly during and after the infusion period. In indomethacin group, increases in lymph protein clearance were blocked completely. However, in OKY-046 group, lymph protein clearance increased significantly 3 hours after the infusion period. In each group, peripheral white blood cell counts decreased significantly during the infusion period, and recovered to the baseline valeus after the infusion. Many latex beads were caught by pulmonary intrvascular macrophages selectively.These results suggest that pulmonary intravascular macrophages activation through their phagocytic uptake of microparticles is essential to increase in pulmonary microvascular permeability in sheep.