Kiyotoshi Inoue

Expression of epidermal growth factor receptor (EGFR) and downstream-activated peptides in surgically excised non-small-cell lung cancer (NSCLC)

Extracellular signal-regulated kinases (ERKs), Akt, and signal transducer and activator of transcription 3 (STAT3) are on signal transduction pathways triggered by epidermal growth factor receptor (EGFR). The purpose of this study was to evaluate the expressions of these peptides and to correlate the level of EGFR expression with downstream-activated peptide expression in non-small-cell lung cancer (NSCLC). A total of 60 specimens were studied by immunohistochemistry. EGFR overexpression was detected in 78% of specimens, but no significant relationship was found between it and any clinicopathological factors investigated. Phosphorylated (p)-ERK, p-Akt, and p-STAT3 expressions were observed in 28, 53, and 58% of specimens, respectively, and p-Akt and p-STAT3 expressions were correlated with well-differentiated tumor (P=0.045 and 0.014, respectively). Half of the 60 specimens expressed two or three downstream-activated peptides. The level of EGFR expression was associated with expressions of p-ERK and p-Akt (P=0.045 and 0.020, respectively). In a preliminary analysis, no peptides examined had an impact on relapse-free survival. In summary, various signal transduction pathways appeared frequently to participate in NSCLC, and the level of EGFR expression appeared to correlate with those of activated ERK and Akt, suggesting some role of receptor overexpression in more potent downstream activation.

Percutaneous radiofrequency ablation of lung neoplasms: a minimally invasive strategy for inoperable patients1

Treatment of patients with lung neoplasms, who often suffer from additional medical problems with attendant surgical risk, is controversial. No standard treatment exists, so innovative treatments should be developed to manage patients with this clinical presentation. Radiofrequency (RF) ablation therapy has recently attracted attention with other minimally invasive strategies to treat malignant disease. Although satisfactory clinical results have been reported using this method for liver tumors, only a few reports have been published regarding RF ablation therapy for human lung neoplasms, and its clinical benefit has not been established. We carried out a pilot study on the clinical feasibility and safety of RF ablation therapy for lung neoplasms.

Fluorine-18-fluorodeoxyglucose positron emission tomography for assessment of patients with unresectable recurrent or metastatic lung cancers after CT-guided radiofrequency ablation: Preliminary results

ObjectivesWe compared the diagnostic value of fluorine-18-fiuorodeoxyglucose positron emission tomography (FDG-PET) with that of computed tomography (CT) following radiofrequency ablation (RFA) of inoperable recurrent or metastatic cancers in the lung.MethodsTwelve patients (9 males and 3 females; 5 had recurrent lung cancer and the other 7 had metastatic nodules from a variety of primary cancers) were treated by RFA for 17 pulmonary nodules. FDG-PET was performed before and 2 months after RFA, and the mean standardized uptake value (SUV) was calculated. The response evaluation was based on the percent reduction relative to the baseline and the absolute values of SUV on FDG-PET performed at 2 months after RFA. We compared the response evaluations made based on findings of FDG-PET and CT at 2 and ≥6 months (mean 10.2) after RFA.ResultsThe percent reduction in uptake at 2 months was significantly lower in nodules considered progressive (69.6± 18.6%) than nonprogressive disease (38.7 ± 12.5%; p < 0.01) based on CT findings at >6 months after RFA. The absolute SUV at 2 months was significantly higher in nodules considered progressive (2.61 ±0.75) than nonprogressive disease (1.05 ±0.67; p<0.01) based on CT findings at ≥6 months post-RFA.ConclusionAlthough our pilot study comprised few cases of various histopathological types of cancers in the lung, the results suggest that FDG-PET could predict regrowth on subsequent follow-up CT. Regrowth could be diagnosed earlier by FDG-PET than by CT, and nodules with residual uptake and with <60% reduction of uptake relative to baseline on FDG-PET at 2 months after ablation might require additional therapy.

Benign Esophageal Schwannoma Compressing the Trachea in Pregnancy

A rare case of esophageal schwannoma compressing the trachea in pregnancy is presented. A 29-year-old pregnant woman was hospitalized due to severe dyspnea. Imaging studies revealed a homogeneous tumor (8 cm in diameter) in the posterior mediastinum with compression of the lower trachea. After an uneventful cesarean section, the patient underwent a mini-axillary thoracotomy with video-assisted thoracic surgery. The tumor arose from within the muscular layers of the esophagus and was enucleated by gentle blunt dissection. Pathologic and immunohistochemical examinations revealed a benign esophageal schwannoma.

High Serum Concentrations of Sialyl Lewisx Predict Multilevel N2 Disease in Non–Small-Cell Lung Cancer

BackgroundThe purpose of this study was to analyze the clinical significance of serum Sialyl Lewisx (SLX) concentrations as a predictor of N2 disease in patients with non–small-cell lung cancer.MethodsThe study included 272 patients with non–small-cell lung cancer who underwent pulmonary resection in our institution between January 1998 and December 2003. Of 272 patients, the serum concentrations of SLX were measured by using a commercially available radioimmunoassay kit.ResultsThe 5-year survival rates of patients with concentrations of SLX > 38 U/mL and those with lower concentrations were 32% and 69%, respectively (P < .0001). The median serum concentration of SLX in patients with multilevel N2 or N3, single-level N2, and N0/1 disease were 44, 30, and 27 U/mL, respectively. The concentrations of serum SLX in patients with multilevel N2 disease were significantly higher than those in patients with single-level N2 or those with N0/1 disease (Mann-Whitney U-test; P < .0001). Although the sensitivity of SLX for identifying patients with non–small-cell lung cancer was only 24% in all patients, the sensitivity of SLX increased as the N-factor increased; the sensitivity of N0/1 disease was 15%, that of single-level N2 disease was 22%, and that of multilevel N2 or N3 disease was 71%.ConclusionsHigh serum concentrations of SLX predicted multilevel N2 disease and the associated poor outcome. Although the sensitivity of serum SLX is not acceptable for use as a screening tumor marker, we suggest that the serum concentration of SLX is useful as a staging marker to determine the strategy of treatment.

Bronchoscopic Ultrasonography in the Diagnosis of Tracheobronchial Invasion of Esophageal Cancer

Objective. To study the usefulness of bronchoscopic ultrasonography in diagnosing tracheobronchial invasion of esophageal cancer and to compare it with endoscopic ultrasonography, bronchoscopy, and computed tomography. Methods. We prospectively investigated 59 patients with newly diagnosed esophageal cancer located at or above the level of the tracheal bifurcation. A 20‐MHz ultrasonic probe covered by a sheath with a balloon inflated with water was used for bronchoscopic ultrasonography. The presence of tracheobronchial invasion was diagnosed on the basis of an interruption in the most external hyperechoic layer of the tracheal bronchus. Results. Bronchoscopic ultrasonography was completed without complications in all patients, but endoscopic ultrasonography was performed completely in only 44% of them. The overall accuracy rates for diagnosis of tracheobronchial invasion on the basis of bronchoscopy, bronchoscopic ultrasonography, endoscopic ultrasonography, and computed tomography were 78%, 91%, 85%, and 58%, respectively. Statistical examination showed that the accuracy of bronchoscopic ultrasonography and bronchoscopy was significantly greater than that of computed tomography, and the accuracy of bronchoscopic ultrasonography was greater than that of bronchoscopy. Conclusions. Bronchoscopic ultrasonography is useful for evaluating cancer invasion into the tracheal bronchus. It is more accurate than the other methods and could be used to visualize the layered structure of the tracheal bronchus in all patients.

Pleural Dissemination as a Complication of Preoperative Percutaneous Transhepatic Biliary Drainage for Hilar Cholangiocarcinoma: Report of a Case

Abstract One potential risk of percutaneous transhepatic biliary drainage is tumor seeding along the catheter tract. A 57-year-old woman with obstructive jaundice due to hilar cholangiocarcinoma underwent an extended left hepatic lobectomy, a regional lymph node dissection, and a right hepaticojejunostomy 2 weeks after percutaneous transhepatic biliary drainage. Multiple right pleural masses were found on a chest radiogram 14 months after the operation. No recurrent lesions were detected in the abdominal cavity. A right panpleuropneumonectomy was performed; however, the patient died of respiratory failure due to tumor recurrence 9 months after the second operation. Preoperative percutaneous transhepatich biliary drainage was considered to have resulted in pleural implantation.

Role of pulmonary resection in the diagnosis and treatment of limited-stage small cell lung cancer: revision of clinical diagnosis based on findings of resected specimen and its influence on survival

PurposeOur aims were to evaluate (1) the result of surgical treatment of limited-stage small cell lung cancer (SCLC) by examining long-term survival and prognostic factors, (2) the diagnostic role of surgery by comparing clinical and histopathological diagnoses and staging, and (3) the impact of preoperative diagnostic accuracy on survival.MethodsWe retrospectively reviewed the clinical profiles of 37 patients treated at our institution between January 1990 and December 2007 for SCLC diagnosed using surgical specimens.ResultsThe median follow-up period was 41.2 months, and the 5-year survival rate was 57.5%. Lobectomy or wider resection was performed alone in 33 cases and with mediastinal dissection in 29 cases. Fifteen patients did not receive chemotherapy. SCLC was diagnosed preoperatively or intraoperatively in 75% and non-SCLC in 25%. Clinical stage 1 disease was diagnosed in 29 patients; however, pathological stage 1 was seen in only 20. Patients at pathological stage 1 disease showed better survival than those at stage 2, but a similar result was not obtained in the case of clinical stage of the disease. Tumor size and nodal stage were the only significant factors influencing survival in a multivariate analysis. The adequacy of preoperative clinical diagnosis of tumor extensiveness, nodal involvement, and clinical stage did not significantly influence survival.ConclusionSurgery for limited-stage SCLC was associated with a favorable survival rate and provided important pathological information that can help predict survival. Accuracy of preoperative diagnoses showed no apparent impact on survival for surgically treated SCLC patients.

Impact of mediastinal lymph node dissection on octogenarians with non-small cell lung cancer

OBJECTIVE Impacts of mediastinal lymph node dissection on a patients course after pulmonary resection is unclear in octogenarians with non-small cell lung cancer. METHODS Retrospectively identified subjects included 39 octogenarians and 1 nonagenarian, with grades according to the Charlson Comorbidity Index ranging from only 0 to 2. We performed mediastinal lymph node dissection in 19 patients (D group), and just lymph node sampling biopsy in the other 21 (S group). We compared clinicopathologic features and outcome after surgery between both groups. RESULTS Deterioration of performance status at the time of discharge, evident in 17 patients overall, was significantly more frequent in the D group. Postoperative complications occurred in 27 patients overall and there was no significant difference between the two groups. Survival rates in younger patients at 1, 3, and 5 years were 86, 59, and 49%, respectively; in octogenarians these were 83, 58, and 42% (no significant difference). Nor did survival differ significantly by surgical management of mediastinal lymph nodes; 1-, 3-, and 5-year survival rates were 94, 63, and 40%, respectively in the D group and 78, 66, and 43%, respectively in the S group. CONCLUSION Octogenarians with non-small cell lung cancer should be treated by urgent pulmonary resection whenever possible. Since mediastinal lymph node dissection has little effect on long-term survival or the carried risk of worsening performance status at discharge, pulmonary resection without complete mediastinal lymph node dissection should be considered.

Primary lymphoma of bone originating in a rib

Malignant lymphoma originating in the bone is rare and is now recognized as being an independent clinicopathologic entity known as primary lymphoma of bone. A 60-year-old man complaining of right chest and back pain consulted our hospital for further examination. Chest X-ray and computed tomogram revealed osteolysis and a surrounding soft tissue mass in the sixth right rib. An ultrasonically-guided needle biopsy of the tumor was performed, and histologic examination indicated the dense proliferation of similar-sized atypical cells with nucleoli and an irregular nuclear border. A diagnosis of diffuse, medium-sized non-Hodgkins lymphoma, B-cell type was made. En block resection of the tumor and chest wall was performed. Macroscopically, the tumor measured 7.5 x 4.8 x 3.0 cm in diameter, and the histologic findings were similar to those of the preoperative needle biopsy. Unfortunately, postoperative treatment with radiation therapy and chemotherapy was ultimately unsuccessful, and a local recurrence and metastatic lesions appeared in the stomach and para-aortic abdominal lymph nodes 7 months after the first symptom appeared. The patient died 3 months later. Surgery was chosen as the initial therapy as it was considered that a rib resection would not result in serious respiratory compromise and the complete resection of the tumor would be superior to radiation therapy for local control. Some authors have reported that the surgical resection of a primary lymphoma of the bone originating in a rib can yield a good prognosis. However, it is a systemic disease and a more effective therapeutic strategy should be developed.