Masayuki Iwazaki

Immunohistochemical study of glutathione-related enzymes and proliferative antigens in lung cancer. Relation to cisplatin sensitivity

Background. With resected tumor tissue from 84 patients with lung cancer, the expression of glutathione peroxidase (GPX), glutathione reductase (GR), proliferating cell nuclear antigen (PCNA), and epidermal growth factor receptor (EGFR) was examined in relation to cisdiamminedichloroplatinum (CDDP) sensitivity.

Tumor budding is a significant indicator of a poor prognosis in lung squamous cell carcinoma patients

Lung cancer is a leading cause of cancer mortality worldwide and patients occasionally develop local recurrence or distant metastasis soon after curative resection. Reports of new therapeutic strategies for lung squamous cell carcinoma (SqCC) are extremely rare, while selective anticancer therapy has been reported for lung adenocarcinoma. The aim of this study was to identify clinicopathological prognostic factors for SqCC. We analyzed tumor budding and infiltrative patterns (INF) in 103 cases of surgically-resected SqCC. Tumor infiltrative patterns were classified into three groups (INFa, b and c) and INFc was infiltrative growth at the tumor invasive front. The cases with an INFc component [INFc(+)]were significantly associated with venous invasion (P=0.014) and the scirrhous stromal type (P<0.001). The overall survival rate of patients with INFc(+) was significantly lower than that of patients without the INFc component [INFc(−); P=0.003]. Tumor budding was defined as a single cancer cell or a small nest of up to four cancer cells within stromal tissue. The cases with tumor budding [Bud(+)] were significantly associated with lymph node metastasis (P=0.001), lymphatic invasion (P=0.002), INFc(+) (P<0.001) and the scirrhous stromal type (P=0.014). Patients with the Bud(+) type had a lower overall survival rate than patients with the Bud(−) type (P<0.001). Multivariate analysis demonstrated that tumor budding [hazard ratio (HR), 2.766; 95% confidence interval (CI), 1.497–5.109] and lymph node metastasis (HR, 1.937; 95% CI, 1.097–3.419) were independent predictors of mortality. In conclusion, tumor budding is a significant indicator of a high malignant potential and poor prognosis in SqCC of the lung.

Liposome‐Encapsulated Hemoglobin Accelerates Bronchial Healing After Pneumonectomy in the Rat With or Without Preoperative Radiotherapy

Liposome-encapsulated hemoglobin (LEH) has been reported to accelerate wound healing in the stomach and skin in an experimental setting. LEH was tested in bronchial anastomotic healing after radiation and pneumonectomy in the rat. Sprague-Dawley rats (n = 61) received preoperative radiation (20 Gy) to the chest and underwent left pneumonectomy with bronchial stump closure using the Sweet method 4 days later, when they were randomized to receive intravenous infusion of LEH with high O2 affinity (P50 O2  = 17 mm Hg, 10 mL/kg, n = 32) or saline (n = 29). Additional rats (n = 18) were treated in the same way without preoperative radiation. Bronchial anastomotic healing was evaluated 2 days after surgery by determining the bursting pressure and infiltration of neutrophils, monocytes, and macrophages. Bronchial bursting pressure was elevated in the rats receiving LEH both in the unirradiated group (LEH 212 ± 78 vs. saline 135 ± 63 mm Hg, P < 0.05) and in rats with preoperative radiation (LEH 162 ± 48 vs. saline 116 ± 56 mm Hg, P < 0.01). Moreover, the percentage of rats with bursting pressure <100 mm Hg tended to be smaller in the unirradiated group (LEH 1/9 [11.1%] vs. saline 4/9 [44.4%], NS) and was significantly reduced in irradiated animals (LEH 3/32 [9.4%] vs. saline 11/29 [38%], P < 0.05). There were no morphological differences except for macrophage infiltration to the anastomotic area, which was significantly prominent in the LEH-treated rats (P < 0.05) regardless of the presence or absence of preoperative irradiation (IR). The results suggest that LEH with high O2 affinity may improve mechanical strength and morphological findings in bronchial anastomosis in rats regardless of the presence or absence of preoperative IR. The irradiated rats later treated with LEH had equivalent or better bronchial healing than that of saline-treated naïve animals undergoing pneumonectomy alone.

Prognostic implications of DNA histogram, dna content, and histologic changes of regional lymph nodes in patients with lung cancer

Forty‐six cases of resected lung cancer, including 20 cases at Stages I and II and 26 cases at Stage III (N2), were subdivided into two groups: a good prognosis group with a longer survival period and a poor prognosis group in which the patients died earlier of the cancer. From paraffin‐embedded lymph node tissues of these patients, the authors examined DNA histogram pattern and DNA content, using flow cytometry, and histologic hyperplasia of germinal center and paracortical area; they also evaluated their correlation with the prognosis. In the good prognosis group at Stages I and II, paracortical hyperplasia (PH) of the lymph nodes was observed significantly more frequently. In the good prognosis group at Stage III, the incidence of PH, G2M phase in the DNA histograms, and DNA content were all significantly higher. DNA content was positively correlated with the grade of PH.

Diagnosis and Treatment of Deep Pulmonary Laceration With Intrathoracic Hemorrhage From Blunt Trauma

BACKGROUND Blunt chest trauma resulting in massive hemothorax requires immediate attention. We investigated the diagnostic and prognostic utility of various clinical factors in patients with deep pulmonary laceration caused by blunt chest trauma with a view toward interventional treatment. METHODS We reviewed 42 patients with deep pulmonary laceration resulting from blunt chest trauma who were treated between 1988 and 2008. Various clinical factors were compared between survivors and nonsurvivors. RESULTS Of the 42 patients, 29 (69%) survived. Median (25th, 75th percentile) systolic blood pressure at arrival was 102 (76, 121) mm Hg for survivors and 70 (60, 90) mm Hg for nonsurvivors (p = 0.015). The median heart rate at arrival was 107 (98, 120) beats/min for survivors and 130 (120, 140) beats/min for nonsurvivors (p = 0.014). Respiratory rate, Glasgow Coma Scale score, and arterial blood gas values did not affect prognosis. Blood loss through the chest tube at insertion was 500 (400, 700) mL for survivors and 700 (500, 1000) mL for nonsurvivors (p = 0.147) and within 2 hours of arrival was 850 (590, 1100) mm Hg and 1600 (1400, 2000) mL, respectively (p < 0.001). Blood loss during thoracotomy was 1170 (600, 1790) mL and 3500 (2000, 6690), respectively (p < 0.001). CONCLUSIONS In patients with deep pulmonary laceration, hemorrhagic shock with systolic blood pressure less than 80 mm Hg and heart rate more than 120 beats/min leads to a poor prognosis. Emergency thoracotomy and pulmonary lobectomy should be performed before the intrathoracic hemorrhage reaches 1200 mL.

Importance of preoperative assessment of pulmonary venous anomaly for safe video-assisted lobectomy

During the treatment of 86 patients with video-assisted thoracoscopic surgery (VATS) anatomical resection (include segmentectomy) within the last two years, we have encountered five patients (5.8%) with anomalous venous returns. Anomalous returns included: 1) common trunk of the left pulmonary vein; 2) right middle pulmonary vein (V4) draining into the inferior pulmonary vein (IPV); 3) left lingular vein (V4+5) draining into the IPV; 4) right posterior pulmonary vein (V2) draining directly into the left atrium; and 5) left upper lobe vein draining into the left innominate vein. If a surgeon were to perform VATS lobectomy without paying attention to these anomalies according to the affected lobe, serious surgical complications might result. Multi-detector row angiography is useful for recognizing such anomalies before surgery and allow safe VATS lobectomy.

Surgical risk of vessel injury: an unusual anatomical variant of the right medial basal segmental pulmonary artery

Video-assisted right basal segmentectomy was successfully performed on a 72-year-old man with an anomalous pulmonary artery. Multidetector row angiography showed the A7 branch arising from the right main pulmonary artery proximal to the branches of the superior trunks, lying under the middle bronchus, and reaching segment S7. Metastatic tumor (diameter 7 mm) was identified in the periphery of this vessel. This anomaly appears to be rare but seems also to be easily overlooked and could cause serious vessel injury even for video-assisted thoracoscopic right lower lobectomy.

Microthoracoscopic One-Port Method for Lung Cancer

PURPOSE We investigated whether the one-window method for thoracoscopic operations is possible as an operation for early-stage lung cancer. DESCRIPTION The subjects were the 40 patients in whom ND2 lymph node dissection was performed among those with a preoperative diagnosis of stage IA (T1 N0 M0) lung cancer who underwent thoracoscopic operations in our hospital during the 2-year period from January 2001 to December 2002. With the patient in the lateral position, a Thoraco Holder (Fuji Systems Corp, Tokyo, Japan) was inserted between the fourth and fifth intercostal space on the anterior axillary line. The surgeon used it as a port for performing the surgical maneuvers. An access needle was placed in the auscultatory triangle in the fifth intercostal space, and a 3-mm thoracoscope was used. Pulmonary lobectomy and mediastinal dissection were performed in the same manner as the standard thoracoscopic two-windows method. EVALUATION The one-window technique was successful in 38 patients, and conversion to the two-windows method occurred in the other 2. Mean operation time was 2 hours 18 minutes. A mean number of 16.5 lymph nodes were removed, and mean blood loss was 22 mL. All 40 patients are alive and free of recurrence at 5 or more years since the operation. CONCLUSIONS As a result of mastering the operation and developing improved instruments, pulmonary lobectomies can now be performed by the one-window method. This method is the least invasive method of pulmonary cancer surgery available at the present time.

Histiocytic Sarcoma Originating in the Lung in a 16-Year-Old Male.

We report a 16-year-old male with histiocytic sarcoma (HS) originating in the lung. Partial resection of the lung was performed for a 3-cm mass with a clear boundary detected in the right inferior pulmonary lobe on a health checkup. Histologically, the tumor infiltrated into the surrounding tissue, and was comprised of spindle cells, mainly, and foam cells accompanied by mild nuclear atypia. The tumor cells were immunohistochemically positive for CD68 and CD163, indicating histiocytic lineage and the MIB-1-positive rate was low. Spindle cell morphology of HS is quite rare and only 3 cases of pulmonary HS have previously been reported.

Papillary adenoma of the lung with a peculiar raw macroscopic feature

We report a case of papillary adenoma of the lung with a peculiar raw macroscopic feature at intraoperative consultation. A 52‐year‐old man was admitted to our hospital for the evaluation of a solitary peripheral nodule in the left lower lobe which was detected with chest CT. When we took staples off from the stump of the partially resected lung in order to make a frozen section diagnosis, granular fragments leaked out from the stump. On the cut surface, the dark reddish and granular tumor grew expansively; however, hemorrhage and necrosis were absent. Histologically, granular fragments were mainly composed of papillary structures, which consisted of a single layer of cuboidal to low columnar cells with round to oval nuclei lining the surface of the fibrovascular cores. Characteristically, papillary structures lacked elastic fibers in the stroma and were packed within an elastic fiber framework derived from pre‐existing alveolar structures. We considered that high intratumoral pressure might have made the granular fragments leak out of the stump as soon as we removed staples and that peculiar macroscopic findings before fixation may be a diagnostic clue for papillary adenoma.