Masahisa Miyazawa

Is postoperative radiotherapy for thymoma effective

OBJECTIVE The authors determined the effect of postoperative mediastinal irradiation in preventing local and pleural recurrence of thymoma. SUMMARY BACKGROUND DATA The role of mediastinal irradiation after incomplete resection or biopsy of an invasive thymoma is well established. However, routine use of adjuvant mediastinal irradiation for patients with thymoma after complete resection remains controversial. METHODS During the 19-year period from 1973 to 1992, operations were performed on 89 patients with thymoma. Of these 89 patients, 80 patients who underwent gross complete tumor resection including adjacent tissues that appeared to be invaded by tumor were selected for this study. The effects of postoperative mediastinal irradiation on the recurrence rate of thymoma were analyzed according to histologic type, clinical stage, and whether adhesions to or invasion of the pleura or pericardium were present. RESULTS Recurrence of thymoma was observed in 13 of 80 (16.3%) patients. No recurrence was observed in 23 patients with noninvasive thymoma. In patients with invasive thymoma whose tumor was macroscopically adherent to the pleura but not microscopically invasive (p1), recurrence was observed in 4 of 11 patients (36.4%) when mediastinal irradiation was not performed, but in none of 10 patients who received mediastinal irradiation. However, in patients with microscopic pleural invasion (p2), a high recurrence rate was observed with mediastinal irradiation (40%, 6/15 patients) or without mediastinal irradiation (30%, 3/10 patients). Postoperative mediastinal irradiation for patients with microscopical invasion to pericardium (c2) did not decrease the recurrence rate. Analysis of the mode of recurrence showed that mediastinal irradiation may have been effective in preventing local recurrence, but it did not control the pleural dissemination that was observed in 12 of 13 recurrent cases. CONCLUSIONS Mediastinal irradiation is not necessary for patients with noninvasive thymoma. In patients with invasive thymoma, postoperative mediastinal irradiation is effective in preventing recurrence in patients with p1 thymoma, but not in patients with p2 or c2 tumors. Further adjuvant therapy should be performed to supplement mediastinal irradiation in patients with p2 or c2 thymoma, even after complete resection.

Clinicopathologic features of submucosal carcinoma of the stomach.

A retrospective study of 155 patients with submucosal gastric carcinoma compared the clinicopathologic features with mucosal and muscularis proprial gastric carcinoma. Fifty-seven percent of the patients presented with gastrointestinal symptoms, whereas 36.1% had been detected by mass screening. The incidence of curative resection, lymph node metastasis, and complications were 96.1, 20.6, and 14.8%, respectively. Two patients died of sepsis and pulmonary infarction 30 days post-operatively. Five patients died of recurrent gastric cancer 1-5 years postresection. The overall 5-year survival rate was 90.2%. Recurrence patterns, histologic type, lymph node metastasis, lymphatic and venous infiltration, and growth pattern were similar to those of muscularis proprial carcinoma rather than mucosal carcinoma. Therefore, curative gastrectomy with extended lymphadenectomy (D2) may be feasible for submucosal carcinoma of the stomach.

Localized mucinous bronchioloalveolar carcinoma of the lung: thin-section computed tomography and fluorodeoxyglucose positron emission tomography findings

PurposeThe aim of this study was to evaluate thinsection computed tomography (CT) and fluorodeoxyglucose positron emission tomography (FDG-PET) findings of localized pulmonary mucinous bronchioloalveolar carcinomas (BACs).Methods and materialsFrom February 2000 to February 2009, there were seven patients with pulmonary localized mucinous BACs that were pathologically confirmed in the surgical specimens. Their CT findings were assessed regarding location, extent (percent) of groundglass opacity (GGO), margin characteristics, and the presence of air-containing spaces and contractive changes. We evaluated the presence of the “angiogram sign” in the patients who underwent enhanced CT. The maximum standardized uptake value (SUVmax) on FDG-PET was measured in four cases.ResultsAll tumors were located in the lower lobes. The percentages of GGOs ranged from 0% to 70% (average 20%). The tumor margins were well defined in five cases and ill-defined in two cases. Air-containing spaces were seen in all cases. Evidence of contractive change was seen in two of the seven cases. The angiogram sign was identified in one of five patients who underwent enhanced CT. The SUVmax on FDG-PET ranged from 0.93 to 1.97 (mean 1.53).ConclusionThe imaging features of localized mucinous BACs include solid or partly solid attenuation, the presence of air-containing spaces, lack of contractive changes, and lower lobe predominance. Additionally, the SUVmax is markedly low on FDG-PET.

Longterm effects of pulmonary resection on cardiopulmonary function.

BACKGROUND Major lung resection decreases ventilatory capacity and reduces exercise tolerance, impairing postoperative quality of life. But we have often seen respiratory symptoms improve during several years of postoperative followup. In the current study, we evaluated postoperative changes in cardiopulmonary function on exertion of patients with lung cancer surviving for more than three years, and the corresponding changes of their respiratory symptoms. METHODS The effects of pulmonary resection on cardiopulmonary function were evaluated in eight patients with lung cancer. Pulmonary function tests and hemodynamic study at rest and during exercise were performed before, in the early (4 to 6 months) and late (42 to 48 months) postoperative phases after major lung resection. RESULTS None of the eight patients had any remarkable symptoms before lung resection. In the early postoperative study, the general condition of five patients deteriorated compared with their preoperative status. In the late postoperative study, four patients showed an improvement of their daily activities from the early postoperative phase. Pulmonary function in the late postoperative phase did not show major changes except for airway resistance and percentage of carbon monoxide diffusing capacity as compared with the early phase, which showed deterioration as compared with the preoperative period. Cardiac index and stroke volume index were significantly decreased during exercise on maximal effort in the late postoperative phase compared with other phases. These results suggest that the peak blood flow per unit of remaining lung during exercise becomes lower with time after lung resection, indicating deterioration of the condition of the pulmonary vascular bed. The deterioration was also revealed from the pressure-flow curve. CONCLUSIONS The condition of the pulmonary vascular bed after major lung resection does not improve, even in the late postoperative phase, although clinical symptoms were sometimes improved compared with the early postoperative period.

Mediastinal Mature Teratoma With Rupture Into Pleural Cavity Due to Blunt Trauma

We report a rare case of mediastinal mature teratoma with rupture due to blunt trauma. A 15-year-old boy had received a strong head-butt in the left upper chest wall and was admitted with the sudden onset of left-sided severe chest pain and dyspnea. Chest computed tomography (CT) scan on admission revealed a heterogeneous mass lesion in the anterior mediastinum. The contrast-enhanced CT scans obtained 2 days after admission showed not only mediastinal mass lesion but also left pleural effusion. On the radiologic finding at 5 months later, the lesion became larger and was thought to be a typical mediastinal mature teratoma. The patient underwent extirpation of the tumor. Microscopically, the tumor was typically composed of adult-type tissues and was confirmed to be mature teratoma.

A Case of Pulmonary Hypertrophic Osteoarthropathy Associated with Bronchogenic Carcinoma.

症例は42歳男性.両下腿の浮腫, 四肢関節痛を主訴に他院を受診した.入院時現症では, 四肢関節痛および運動障害, 下腿の浮腫, 手指のばち状指がみられた.胸部X線上, 左上肺野の腫瘤影を認め, 気管支鏡検査の結果, S1+2原発の肺癌と判明した.骨シンチグラムでは, 両側対称性に下肢長幹骨および中足骨の異常集積を認めた.以上より, 肺癌に随伴した肺性肥大性骨関節症 (Pulmonary hypertrophic osteoarthropathy: PHO) と診断し, 胸腔鏡補助下左肺上葉切除術を施行した.四肢関節痛は術直後より消失, 術後5ヵ月目の骨シンチグラムでも, 術前にみられた異常集積は消失していた.

A Case of Malignant Salivary Gland Type Mixed Tumor of the Bronchus.

症例は69歳の女性で, 血疾を訴え来院した. 胸部単純X線, CT検査で右S7に腫瘤陰影を認め, 気管支鏡検査でB7を閉塞する腫瘍を認めたため, 肺癌を疑って下葉切除および縦隔リンパ節廓清を行った. 病理組織学的所見では, 腫瘍組織の大部分は腺管構造を伴う筋上皮様腫瘍細胞の増殖と周囲の粘液腫状の間質からなり, 腺上皮の一部は明瞭な扁平上皮化生を呈し, さらに高分化型扁平上皮癌の部分も認めたため唾液腺型悪性混合腫瘍と診断された. 気管支原発唾液腺型混合腫瘍の本邦報告例は本症例も含め20例しかなく, なかでも悪性例は7例のみで, きわめてまれな腫瘍である.