Kunihiko Miyazaki

Metastasis to appendix from lung adenocarcinoma

We previously read with interest the case report by Filik et al. (International Journal of Gastrointestinal Cancer, 2003;34:55-58) on appendicular metastases from pancreatic adenocarcinoma. We would like to share our recent experience.A 64-yr-old man presented with a 2-d history of progressively increasing colicky abdominal pain and fever. His past medical history included a pneumonectomy of the left lung for locally advanced lung adenocarcinoma 9 mo previously. TNM stage of the original lung cancer was T2N2M0. On examination, his abdomen was slightly distended and he had an intermittent metallic bowel sound. Abdominal CT scan showed a low-density mass, 3 cm in diameter, in the right pelvic cavity. Endoscopic evaluation revealed no obstruction, but failed to identify mucosal abnormalities in the ileocecal region. Chest CT scan prior to surgery did not show any evidence of pulmonary recurrence or metastasis. He underwent a laparotomy, and tumor of the appendix, 3 x 3 cm in diameter, adhered to the surrounding tissue, but no perforation was seen. The mass was excised in combination with an ileocecal resection, followed by ileocolic anastomosis. Hisotologically, the neoplastic tumor cells infiltrated the submucosa, muscularis, and serosa, but mucosa of the appendix was intact, unremarkable, with no precursor lesion. The tumor was morphologically similar to the lung primary tumor. The patient had an uneventful postoperative course. He was examined at regular periodic follow-ups, but died from lung cancer 12 mo after the resection of the metastatic tumor to the appendix.

Interstitial lung disease in patients with small cell lung cancer.

Interstitial lung disease (ILD) and lung cancer are two of the most common respiratory diseases. The aim of this study was to demonstrate the prognostic significance of the presence of ILD in patients with small cell lung cancer (SCLC). All the patients with SCLC who were admitted to our hospitals over a 23-year period up to 2008 were retrospectively analyzed. During the study period, 332 SCLC patients were consecutively admitted to our hospitals. Among them, 15 (4.5%) were diagnosed as having both SCLC and ILD. In univariate and multivariate analysis, female sex, early stage, good performance status, and chemotherapy were favorable prognostic factors. The presence of ILD was confirmed as an unfavorable prognostic factor. Existing ILD adversely affects the outcome of SCLC. When deciding whether to offer a standard therapy that may increase treatment-related mortality, the patient’s medical condition, including ILD, should be taken into consideration.

Serum KL-6 levels in lung cancer patients with or without interstitial lung disease

Background: It is not known whether lung cancer patients with interstitial lung disease (ILD) might have higher serum levels of KL‐6, a high molecular weight glycoprotein classified as a polymorphic epithelial mucin. In addition, prognosis of these patients with elevated serum KL‐6 levels might be poorer than that with normal KL‐6 levels, but it has not been well clarified. Methods: Serum KL‐6 levels in 273 lung cancer patients with or without ILD, and prognostic significance of elevated serum KL‐6 levels in these patients were studied using uni‐ and multivariate analyses. Results: Serum KL‐6 levels were elevated (>500 U/ml) in 73.5% of lung cancer patients with ILD and in 33.7% of those without ILD. Serum KL‐6 levels in lung cancer patients with ILD were significantly higher than those without ILD. In lung cancer patients with ILD, elevated serum KL‐6 has no prognostic significance, but in those without ILD, however, it was one of the unfavorable prognostic factors. Conclusions: Elevated serum KL‐6 levels can be observed in lung cancer patients both with and without ILD. Having ILD has strong prognostic impact in patients with lung cancer. In those without ILD, however, elevated KL‐6 levels may be related to poor prognosis. J. Clin. Lab. Anal. 24:295–299, 2010.

Isolated solitary brain metastasis as a relapse of small cell lung cancer

The brain is one of the most common sites for the metastasis of small cell lung cancer (SCLC). The present study describes two cases of an isolated solitary brain metastasis as a relapse of SCLC, which occurred more than one year after the completion of the initial successful treatment for SCLC. The tumors were identified during a regular check-up computed tomography (CT) scan and were successfully treated. To the best of our knowledge, this is the first study to report the cases of two patients with an isolated solitary brain metastasis as a relapse of SCLC. Although extremely rare, the possibility of such recurrences should be considered, particularly in patients who have refused prophylactic cranial irradiation.

Limited Value of Transbronchial Lung Biopsy for Diagnosing Mycobacterium avium Complex Lung Disease

It remains unclear whether transbronchial lung biopsy (TBLB) is useful for diagnosing Mycobacterium avium complex (MAC) lung disease.

Peritoneal and meningeal relapse from lung adenocarcinoma after a response to gefitinib: A case report

The prognosis of carcinomatous peritonitis and meningitis is poor since ascites and focal neurological dysfunctions usually do not improve despite the available treatment options for this devastating disease. This is a case report of peritoneal and meningeal relapse from lung adenocarcinoma following a response to gefitinib. A 72-year-old woman was diagnosed with adenocarcinoma in the upper lobe of the left lung, accompanied by a massive carcinomatous pleural effusion. Following a cisplati-based chemotherapy, gefitinib was initiated, achieving satisfactory disease control. At 8 months after gefitinib initiation, the patient developed abdominal distension, gait disturbance and visual disorder of the right eye. Adenocarcinoma cells were detected in the ascitic and pleural fluids. The findings of this case report suggest that clinicians should remain vigilant for this type of metastasis, although it is rarely encountered.

Comorbidity in elderly NSCLC patients

We read with interest the report by Janssen-Heijnen and associates on the effect of comorbidity on the treatment and prognosis of elderly patients with non-small cell lung cancer (NSCLC).1 The authors concluded that the number of comorbid conditions had no significant influence on the treatment chosen for patients with non-localised disease. We share the authors’ opinion that “comorbidity had no independent prognostic effect”. In their report, the authors used the Charlson comorbidity index and analysed the number of comorbid …

A case study of bofutsushosan‑induced pulmonary injury in a patient: Case report

Bofutsushosan, a herbal (traditional Kampo) medicine, is administered to obese patients in North-East Asia. Bofutsushosan has been reported to exert various anti-obesity effects by stimulating the adipose tissue. The present study describes the case of a patient who developed a severe pulmonary injury that was potentially associated with bofutsushosan therapy. A 52-year-old woman was admitted to Mito Medical Center, University of Tsukuba, Mito Kyodo General Hospital (Mito, Japan) due to progressive dyspnea. Two months previously, bofutsushosan had been newly prescribed for her obesity. Bilateral ground-glass opacities and progressive respiratory deterioration suggested respiratory failure due to a therapeutic agent-induced lung injury. With discontinuation of bofutsushosan and the administration of a corticosteroid, an improvement in her respiratory condition was achieved, although sequelae remained in certain areas of the lungs. Resumption of other therapeutic agents did not reinduce the lung injury. Therefore, a diagnosis of bofutsushosan-induced lung injury was made. Although bofutsushosan-induced lung injury is particularly rare, clinicians should consider it when bofutsushosan is used.

Ossification and increased bone mineral density with zoledronic acid in a patient with lung adenocarcinoma: A case report

Cases of ossification and increased bone mineral density (BMD) at sites of bone metastasis following zoledronic acid (ZA) treatment have not been reported. The current study presents the case of a 65-year-old patient with lung adenocarcinoma and bone metastases in the lumbar vertebrae and femurs. Ossification and an increase in BMD at the metastatic sites was achieved following treatment with ZA and irradiation of the bone metastatic sites. The patient was able to maintain a normal lifestyle for over two years, despite the bone metastases. Therefore, as treatment with ZA was demonstrated to improve patient quality of life, physicians should consider this treatment strategy, particularly for the treatment of metastasis in weight-bearing bones.

Small cell lung cancer with endobronchial growth: A case report

The current study presents a rare case of small cell lung cancer (SCLC) with endobronchial growth in a 68-year-old male. Chest CT scans revealed an ill-defined mass in the upper lobe of the right lung, with ipsilateral mediastinial lymph node swelling. An endobronchial polypoid tumor in the right B3 bronchus was located by bronchoscopic examination. The analysis of a biopsy specimen obtained from the tumor resulted in a diagnosis of SCLC. Although extremely rare, this case highlights the importance of considering a diagnosis of SCLC in patients presenting with a pulmonary tumor adjacent to the bronchus, with an endobronchial polypoid lesion.