Kensuke Nakazawa

Characteristics of clinical N0 metastatic non-small cell lung cancer.

OBJECTIVES Non-small cell lung cancer (NSCLC) patients who have clinically no mediastinal lymph node metastasis but have distant metastasis are occasionally found in clinical practice. Such clinical N0 metastatic NSCLC may be a different subtype from the clinical N1-3 patients with regional lymph node metastasis. The aim of this study was to evaluate the prognosis, clinical features, and incidence of clinical N0 NSCLC patients with metastasis. METHODS All metastatic NSCLC patients (n=761) diagnosed at our hospitals from April 1999 to August 2012 were retrospectively analyzed. They were divided into two groups: N0 and N1-3. Staging was recorded according to the UICC 7th edition of the TNM classification. Differences between the two groups were analyzed using a Chi-square test. Prognostic factors were analyzed by the Kaplan-Meier method and Cox proportional hazards analysis. A probability value less than 0.05 was considered to be significant. RESULTS A total of 761 patients with NSCLC were registered. 124 patients (16.3%) were N0 and 637 (83.7%) were N1-3. There were no differences between the two groups in age, sex, smoking history, performance status, and histological type. The ratio of adrenal gland metastasis was low in the N0 group (N0 7.3%, N1-3 13.4%, p=0.002). Median survival time was longer in the N0 group (N0 11.9 months vs N1-3 7.2 months, p<0.001). N0 was an independent favorable prognostic factor. CONCLUSION Metastatic NSCLC patients with clinical N0 had a favorable prognosis and a lower ratio of adrenal gland metastasis than those with clinical N1-3. Our results suggest that a certain type of adrenal metastasis may result from direct lymphatic spread from a primary lung tumor. About one sixth of metastatic NSCLC cases are clinical N0. Therefore, clinical evaluations for detecting metastasis are important even in clinical N0 patients.

Cisplatin for small cell lung cancer: Associated publications in Science Citation Index Expanded

This study was conducted to explore a bibliometric approach to quantitatively assess current research trends in cisplatin-containing chemotherapy for small cell lung cancer (SCLC), using related literature in the Science Citation Index Expanded database from 1992 to 2011. Articles were analyzed by the scientific output and research performances of countries and institutions. The distribution of key words in the article title and author-selected keywords were used to evaluate research trends. It was observed that the number of articles devoted to cisplatin-containing chemotherapy for SCLC did not increase with time. The USA and Japan were the top two countries with the highest number of articles devoted to cisplatin-containing chemotherapy for SCLC. In both countries, the number of articles did not increase with time, and a decreasing trend was identified in the USA over the last 10 years. This study demonstrates trends in cisplatin-containing chemotherapy for SCLC. The clinical application of novel drugs is required for successful SCLC treatment.

Cavitary pulmonary metastases of pancreas cancer.

Multiple cavitary nodules are not generally recognized as a manifestation of pulmonary metastases. We present a case of cavitary pulmonary nodules proved to be metastases from pancreas cancer. Although very rare, cavitary nodules should be considered as a pulmonary involvement by metastatic pancreas cancer. We also recognize the importance of obtaining appropriate specimen to establish correct diagnosis of cavitary nodules. In some cases of metastatic pulmonary tumors, such as ours, enough specimens may be obtained by bronchoscopic biopsy.

Chronic expanding hematoma in the chest: A case report

Chronic expanding hematoma (CEH) is a rare disease that is usually present as a large solitary pulmonary nodule. CEHs are slow growing, but processes underlying their development remain unknown. The present study herein reports the case of a 76-year-old male patient with CEH and discusses a number of CEH cases published in the literature. The majority of these previously described patients were Asians. The CEH in the present case was not a successfully resected one, but the patients clinical course provided information concerning the natural history of the disease. During the clinical course, the patient underwent several chest computed tomography scans. For the present case report, the doubling time and volume change of the mass was calculated, which revealed that the lesion had an inconstant growth rate and that its onset was between 8.2-11.0 years before the patient succumbed to this disease. Accumulation of knowledge about this rare disease will help to elucidate it further.

Rechallenge with First-Line Platinum Chemotherapy for Sensitive-Relapsed Small-Cell Lung Cancer

Background: Sensitive-relapsed small-cell lung cancer (SCLC) is thought to be sensitive to chemotherapy; therefore, second-line chemotherapy is recommended. Although platinum rechallenge is performed in the second-line chemotherapy for sensitive-relapsed SCLC, it remains unclear whether such a strategy is effective. Methods: We retrospectively analyzed the outcome of rechallenge chemotherapy for sensitive-relapsed SCLC. The endpoints of this study were progression-free survival from the time of relapse (PFS-Re) and overall survival from the time of relapse (OS-Re). We also compared the toxicity profile of rechallenge chemotherapy to that of first-line chemotherapy. Results: Of the 133 SCLC patients who received first-line treatment, 20 patients satisfied the definition of sensitive relapse and received rechallenge chemotherapy. Combined carboplatin and etoposide was the most commonly used rechallenge regimen, and 17 (85%) received it at a reduced dose due to hematological toxicity during the first-line treatment. Median PFS-Re and OS-Re were 4.5 months (95% CI: 3.5–5.4) and 10.5 months (95% CI: 7.9–13.0), respectively. There was no association between dose adjustment and survival. The frequency of hematologic toxicity tended to be lower with rechallenge than first-line treatment. The incidence of grade 3 febrile neutropenia decreased from 40% in first-line treatment to 15% in rechallenge. Conclusion: Platinum rechallenge could be a useful second-line option for sensitive-relapsed SCLC, having favorable efficacy and safety. Dose adjustment at rechallenge based on the toxicity profile during the first-line chemotherapy could reduce toxicity without weakening efficacy.

Paraneoplastic limbic encephalitis with late‑onset magnetic resonance imaging findings: A case report

Paraneoplastic limbic encephalitis (PLE), a paraneoplastic neurological syndrome (PNS), is a rare nervous system disorder that results from the indirect effects of tumors and is commonly associated with small-cell lung cancer (SCLC). Previous studies have reported that magnetic resonance imaging (MRI) may be useful for diagnosing LE. Temporal lobe abnormalities are observed using T2-weighted and fluid-attenuated inversion recovery sequences; however, such abnormalities are detected in only 60% of patients with PLE. The present study describes a case of PLE associated with SCLC, in which LE was observed using MRI 26 days after the first convulsive seizure. Although the serum and cerebrospinal fluid analyses for onconeural antibodies were negative, the findings of this case indicate that PLE should be considered in the differential diagnosis, and that repeated brain MRI may be more helpful for diagnosis, as the brain MRI findings may be normal during the early stages of PLE.

Osimertinib-Induced Interstitial Lung Disease Presenting as Eosinophilic Pneumonia

rearrangement could also be found in a small number of MM cases. With regard to ALK, our data are consistent with those reported by Varesano et al., who did not find the rearrangement of this gene in MM. Although Loharamtaweethong et al. have reported ALK translocation in one case of pediatric malignant peritoneal MM, this remains the only case described in the literature. However,ALK translocation inMMappears a very rare event. In conclusion, as crizotinib is a potent TKI of anaplastic lymphoma kinase, mesenchymal-to-epithelial transition, and ROS1 tyrosine kinases, we carried out our study to verify the gene status of all the three protooncogenes in MM. In light of our findings, we can reasonably consider only MET as a candidate target gene to select patients with MM for treatment with crizotinib.

Hoarseness Due to Subcutaneous Emphysema and Pneumomediastinum

We read with interest the article by Zaia and Wheeler (February 2010) on hoarseness due to pneumomediastinum after inhalation of helium gas from party balloons (1). We would like to share our experience. Although the patient did not inhale party balloons, she had hoarseness due to pneumomediastinum, which was similar to the patient reported by Zaia and Wheeler (1). An 80-year-old woman presented with complaints of gradual onset of hoarseness for a week. There was no history of trauma, retrosternal pain, or shortness of breath. The patient had no smoking habit. She had a history of idiopathic pulmonary fibrosis for which she had been diagnosed a year prior. On examination, the patient was conscious and oriented. There was swelling over the face, neck, and upper half of the chest. On examination of the chest, there were no dilatated veins. Crepitus was present over the chest and neck on palpation. There was no evidence of mediastinal shift. Computed tomography of the thorax and neck revealed pneumomediastinum and neck subcutaneous emphysema (Figure 1). There was diffuse pulmonary fibrosis with contraction bronchiectasis in both lungs. On laryngoscopy, neither vocal cord lesion nor recurrent nerve palsy was observed. The patient was treated with no surgical procedure. The hoarseness improved as subcutaneous emphysema and pneumomediastinum disappeared. Hoarseness in association with subcutaneous emphysema and pneumomediastinum has rarely been reported,

Spontaneous contralateral pneumothorax in a patient with low Body Mass Index

Spontaneous pneumothorax is most common in adolescents and young adults. Some of them develop contralateral pneumothorax. In this paper, we report the case of a patient with spontaneous contralateral pneumothorax, whose body mass index (BMI) was 18.8 kg/m2. For either chest physicians or thoracic surgeons, follow up with recognition of increased risk of the contralateral pneumothorax is important especially in patients with contralateral bullous lesions and low BMI.

Skip Metastasis to Abdominal Lymph Nodes from Lung Adenocarcinoma

lymphatic metastasis to abdominal lymph nodes. The patient received 1 course of platinum-containing chemotherapy, but the response was evaluated as progressive disease. The abdominal lymph nodes grew up to 30 mm in size. She died of lung cancer 2 months after the chemotherapy. Direct lymphatic metastasis to abdominal lymph nodes without involvement of lobar, hilar, or mediastinal lymph nodes is very rare [1–3]. The condition of our patient was very similar to that of the patient reported by Huang et al. [1], and we can fully share their observations. The similar points in both patients were as follows: i) isolated skip metastasis to an abdominal lymph node from adenocarcinoma of the left lung; ii) detection of metastasis by PET/CT; and iii) pathological confirmation using specimen obtained by surgical exploration or percutaneous biopsy. PET/CT may provide useful information regarding the location of metastasis as observed in the patient reported by Huang et al. [1] as well as our patient. Although very rare, the cases reported by Huang et al. [1] and ourselves suggest that there may be a certain type of lung adenocar cinoma that metastasizes to abdominal lymph nodes without involvement of regional lymph nodes. Dear Editors, We read with interest the article by Huang et al. (July 2007) [1] on lung cancer with isolated skip metastasis to an abdominal lymph node. We would like to share our experience regarding a patient whose condition was very similar to that reported by Huang et al. [1]. A 55-year-old woman was admitted to our hospital because of a nodular lesion that was detected incidentally by a chest radiograph. She had smoked 20 cigarettes per day for 20 years. The patient was totally asymptomatic with unremarkable physical examination. A computed tomography (CT) scan of the chest revealed a 50-mm nodule in the left upper lobe of the lung, which had invaded into the mediastinum. Pathology samples obtained by transbronchial biopsy confirmed adenocarcinoma of the lung. She received thoracic irradiation, and the response was evaluated as complete response. 4 months after completion of the irradiation, (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET)/CT showed iso lated lymphatic metastasis to perigastric and para-aortic lymph nodes without recurrence of lobar, hilar, or mediastinal lymph nodes. Echo-guided percutaneous biopsy confirmed