Kenji Misawa

A case of anaplastic lymphoma kinase (ALK)-positive ciliated muconodular papillary tumor (CMPT) of the lung

Ciliated muconodular papillary tumor (CMPT) is a rare papillary tumor that arises in the peripheral lung fields and is associated with the proliferation of ciliate d and goblet cells and increased mucin production. We report a case of CMPT involving the rearrangement of the anaplastic lymphoma kinase (ALK) gene. The patient was an 84‐year‐old Japanese female who had exhibited a small nodular shadow on chest computed tomography during a regular checkup 10 years ago. She underwent a partial resection of segment S10 of the right lung. The cut surface of the surgical specimen revealed a well‐circumscribed, jelly‐like mass measuring 8 × 8 × 10 mm. Histologically, the tumor was composed of a mixture of ciliated, goblet, and basal cells arranged in a papillary pattern together with pools of mucin. A diagnosis of CMPT was made. The lung tumor cells were subjected to fluorescent in situ hybridization and highly sensitive immunohistochemical staining for the ALK protein, both of which produced positive results. CMPT usually follows a favorable course, but the exact nature of this tumor; i.e., whether it is benign or malignant, has not been established. This is the first reported case of an ALK‐positive CMPT.

Three cases in which preoperative evaluation of pulmonary vessels was useful using Versa Web

当院では，肺葉切除・区域切除症例を対象として，CT angiographyを作成し術前に肺動静脈の同定，variationの有無を確認してきた．2009年1月より320列CTが導入され，以前に比べて詳細な画像をえられるようになり血管走行の確認が容易になったが，CT angiographyの作成は決まった条件により作成されるため，症例によっては手術に必要な血管の描出が不良となり，その走行の確認が困難な場合があった．この問題を解決する目的でWeb browserを利用したVersa WebTM（ザイオソフト社製）を導入したところ（2009年9月），術者自身が簡単にCT angiographyを作成・保存できるようになった．術前に作成したCT angiographyを用いて肺血管の詳細なmappingを行うことで，肺切除術，とりわけ上葉切除や区域切除および不全分葉症例での手術をより安全に迅速に行うことが可能と考えられた．

The surgical and oncological outcomes of conversion surgery for patients with initially unresectable gastric cancer

Background: Conversion therapy is a surgical option for unresectable gastric cancer in cases wherein non-curative factors are initially managed by induction chemotherapy. However, the indications for resection remain unclear. Thus, this study aimed to assess the feasibility and efficacy of conversion therapy, based on the data from our facility. Methods: Patients (n=97) with unresectable gastric cancer received chemotherapy in our facility between January 2010 and August 2016. Surgical resection was performed in 16 of them after chemotherapy had rendered the tumor resectable. We retrospectively examined clinicopathological variables and oncologic outcomes in these 16 cases. Results: Of the 16 patients who underwent resection, R0 resection was possible in 15 patients, whereas R1 resection was performed in the remaining 1 patient. Postoperative complications arose in 6 patients (37.5%) but with no mortality. The median overall survival (OS) in the conversion therapy patients (n=16) was 50 months. Among the patients who underwent conversion therapy, univariate analysis showed that the patients with type 4 gastric cancer had a poor prognosis (P=0.0009). Conclusion: The conversion therapy may improve OS in only some of the patients who responded to induction chemotherapy, our results suggest that conversion therapy does not improve the outcomes in patients with type 4 gastric cancer.

Effectiveness of Thoracic Egg in primary spontaneous pneumothorax-for safer outpatient treatment of pneumothorax-

携帯型気胸ドレナージキット（ソラシックエッグ®：以下TE）の有用性についてretrospectiveに検討した．対象は2007年3月から2008年9月にTEを使用して治療を行った自然気胸患者43例．患者の平均年齢は33歳（13～69歳），男性32例，女性11例，患側は右18例，左25例，初発27例，再発16例であった．17例は外来通院のみで治療が可能であった．空気漏れの持続や気胸の再発で手術を行った症例は18例であった．気胸の悪化により持続吸引やトロッカーカテーテルへの入れ換えが必要な症例は認められなかった．カテーテルの屈曲による閉塞のため1例でTEの再挿入が必要であった．挿入後の自己抜去例は2例であったが，肺の虚脱はなく再挿入は不要であった．TEのカテーテル部分と排液ボトルの間に三方活栓を留置することで抜去前にクランプによる肺瘻確認を容易に行うことが可能であった．TEは排液の多い気胸でも使用可能であり，自然気胸の外来治療に有用と考えられた．