Kanae Fukushima

Prognostic significance of thrombomodulin expression and vascular invasion in stage I squamous cell carcinoma of the lung

Thrombomodulin (TM) is an important modulator of intravascular coagulation. TM exists on endothelial cells and on several types of tumor cells, especially squamous cell carcinoma cells. Tumor cell TM is thought to be associated with progression and metastasis of the tumor. To evaluate the prognostic significance of TM in lung cancer, we examined TM expression and vascular invasion in surgical specimens obtained from 90 patients with completely resected stage I non-small cell lung cancer (NSCLC). In addition, we correlate these pathologic data to other clinicopathologic data, including the outcome of the patients. Squamous cell carcinomas had a significantly higher incidence (P<0.0001) of TM expression (22/36 cases, 61%) than adenocarcinomas (9/54 cases, 17%). In 36 squamous cell carcinoma patients, both vascular invasion (P=0.0153; risk ratio 6.507) and TM non-expression (P=0.0282; risk ratio 3.584) were significant for a poor prognosis. Univariate analysis of patient survival rates also revealed that vascular invasion and TM expression were significant prognostic factors (P=0.0036 and 0.012, respectively). Further, combination analysis of vascular invasion and TM expression in the squamous cell carcinoma patients showed that the 5-year survival rate was 90% in patients with TM expression and without vascular invasion, but 21% in patients with vascular invasion and without TM expression (P=0.0004). Since our results suggest that vascular invasion and TM expression are independent prognostic factors of stage I squamous cell carcinoma of the lung, and since the two factors play different roles in the metastatic process of cancers (promotion of metastasis by vascular invasion and inhibition of metastasis by TM expression), the combination evaluation of vascular invasion and TM expression may be very significant in evaluating the prognosis of patients with completely resected stage I squamous cell carcinoma.

EBER-1 expression in thymic carcinoma

The Epstein‐Barr virus‐encoded small nuclear RNA, EBER‐1, has been shown to be a suitable target for the in situ hybridization detection of EBV in routinely processed tissue specimens. We evaluated the presence of EBV in thymic carcinoma and invasive thymoma using EBER‐1 in situ hybridization on formalin‐fixed paraffin‐embedded tissue sections. EBER‐1 expression was demonstrated in a case of lymphoepithelioma‐like thymic carcinoma, but was not detectable in other thymic carcinomas including six squamous cell carcinomas, a clear cell carcinoma and seven invasive thymomas. As reported in three previous cases of EBV‐associated thymic carcinoma, lymphoepithelioma‐like thymic carcinoma was shown to be closely associated with EBV in our series.

Surgical Treatment for Patients With Lung Cancer Complicated by Severe Pulmonary Emphysema

Ten patients with lung cancer complicated by severe pulmonary emphysema, underwent lung reduction surgery between 1995 and 1997. Patients meeting the following criteria were defined as having severe pulmonary emphysema: (1) forced expiratory volume in 1 s (FEV1%) of < 55% and (2) characteristic, severe findings of emphysema in chest x-rays and chest computed tomography scans. 9 men and 1 woman (mean age: 70.8; range: 59-78 years), were all smokers (smoking index: 500-2450). Preoperative lung function showed an average percent vital capacity of 87.8% (range: 67-108%) and an average FEV1% of 35.9% (range: 27-54%). The histological types of lung cancer were squamous cell carcinoma (4 patients), adenocarcinoma (5 patients), and large cell carcinoma (1 patient). Four patients were in clinical stage IA, 3 in stage IB, and 1 each was in stages IIA, IIIA, and IIIB. Lobectomy was conducted in 3 cases and partial resection in the remaining 7. Five of the 10 patients underwent thoracoscopic resection. After surgery, patients died one at 2 months and the other at 17; 3 survived but 3 suffered cancer recurred; and 5 patients without recurrence. In complications, bronchial air leakage requiring postoperative treatment. Postoperative lung function showed an average percent vital capacity of 71.4% (range: 41-90%) and an average FEV1% of 41.3% (range: 28-61%). We found an important relationship between the location of the perfusion defect (target area) in pulmonary perfusion scintigram in relation to the lung cancer site and postoperative improvement of lung function. One patient with lung cancer associated with severe respiratory obstruction underwent lobectomy after confirmation of the perfusion defect by pulmonary perfusion scintigram. Postoperative FEV1% in this patient was restored to the preoperative level. In general, partial thoracoscopic resection was effective in patients with early-stage lung cancer.

Giant benign mesenchymoma of the mediastinum causing superior vena cava syndrome : report of a case

The surgical resection of a giant primary mediastinal mesenchymoma causing superior vena cava syndrome is herein described. A 53-year-old man was admitted to the hospital complaining of severe dyspnea. A chest roentgenogram showed a large mediastinal mass shadow compressing the superior vena cava. At surgery, a yellow tumor measuring 27×25×12 cm and weighing 3,620 g was resected. The histological diagnosis was benign mesenchymoma. The patients postoperative course was uneventful with a successful resolution of his superior vena cava syndrome.

Rapidly growing mural thrombus in an abdominal aortic aneurysm

SummaryWhile mural thrombus accompanied by an abdominal aortic aneurysm (AAA) is not rare, the growth rate of such a thrombus has not yet been adequately documented. We present here a very rare case of a 62-year-old female patient with an AAA in whom the mural thrombus in the aneurysm grew very rapidly over a short period. We could follow the growth of the mural thrombus in the AAA by two-dimensional (2-D) abdominal echography. Patients with an AAA must be closely monitored by this technique which is able to detect the presence of the thrombus and allow evaluation of its growth.

How to select the optimal diagnostic criteria for detection of mediastinal lymph node metastasis by computed tomography

CTによる, 肺癌の縦隔リンパ節転移の最適な診断基準について, ROCカーブを用いて検討した.切除肺癌156症例の検討では, CT上のリンパ節の長径+短径が指標として最も診断率に優れていた.診断率, 診断基準値は組織型により異なり, 類表皮癌は腺癌に比し良好な結果が得られた.また上縦隔では下縦隔に比しより小さな基準値を用いる必要性が示唆された.組織型とリンパ節領域とを組み合わせた診断基準の検討が重要と考えられた.

The clinical usefulness of magnetic resonance imaging for lung cancer.

静磁場強度0.22Teslaの常電導型MRI装置の, 肺癌の進展評価に対する有用性を, 切除例35例を含む60例の肺癌症例で検討した. 肺門および縦隔の気管支, 肺動静脈, リンパ節は高率に描出可能で, 病変と血管系との関連, 肺門リンパ節, および無気肺の評価に有用であった. 従来報告を見ない, 無気肺内での肺動脈を示す線状構造の存在と, 肺動脈のパラドキシカルエンハンスメントの所見とが注目された.