Mitsuhiro Kamiyoshihara

Clinicopathological features of lung adenocarcinoma with KRAS mutations.

KRAS and epidermal growth factor receptor (EGFR) mutations are thought to play an important role in the carcinogenesis of lung adenocarcinoma. However, clinicopathological findings of KRAS mutated adenocarcinoma cases have not yet been fully clarified. The authors analyzed the relationship between the KRAS mutation and corresponding clinicopathological findings, focusing on nonmucinous and mucinous bronchioloalveolar elements.

Primary adenoid cystic carcinoma in the lung: Report of two cases and therapeutic considerations

Primary adenoid cystic carcinoma in the lung is an uncommon disease, which is regarded as a slow growing low-grade malignancy. However, this disease has a high risk of incomplete resection because of its unique histological invasion patterns. The cases of two patients who recently underwent surgery for adenoid cystic carcinoma in the lung are reported. Both patients received postoperative radiotherapy treatment as a follow-up to a histologically incomplete resection. Both patients have survived for 51 months and 7 months, respectively, with no recurrence. Postoperative radiotherapy is an acceptable treatment of choice to control residual lesions and provides long-term survival even in cases of incomplete resection.

Segmentectomy guided by three-dimensional computed tomography angiography and bronchography

We describe the benefits of a three-dimensional multidetector computed tomography angiography and the bronchography-guided segmentectomy technique. Preoperative determination of the anatomical intersegmental plane is possible by visualizing the segmental branches of the pulmonary veins and segmental bronchi. This new technique may be useful in segmentectomy of the lung.

Primary pulmonary collision tumor including squamous cell carcinoma and T-cell lymphoma

We report a very rare occurrence of a primary collision tumor in the lung consisting of squamous cell carcinoma and T-cell lymphoma. A squamous cell carcinoma was diagnosed histologically following a transbronchial lung biopsy in a 71-year-old woman, but the other component was diagnosed histologically and immunohistochemically only on examination of the resection specimen. The malignant lymphoma was stained by the monoclonal antibody UCHL-1 (anti-D45RO) against T-lymphocytes but was not stained by the L26 (anti-CD20) antibody against B-lymphocytes. Immunostaining for CD3 was positive, confirming a T-cell lineage. Despite systemic chemotherapy, the patient died 7 months after operation, from progression of the lymphoma. Our case, which illustrates interesting attributes of collision tumors, consisted of an ordinary squamous cell carcinoma and a rare T-cell lymphoma arising in the lung, with the latter part of the combination dictating subsequent treatment and outcome.

Video-assisted thoracic lobectomy with bronchoplasty for lung cancer, with special reference to methodology.

Few studies have described video-assisted thoracic surgery (VATS) to bronchoplasty with pulmonary resection. Here, we report the successful implementation of VATS bronchoplasty, as determined retrospectively. Between 2005 and 2010, 362 patients underwent elective lung resection for malignant or benign lung tumors. Of these patients, VATS lobectomy with bronchoplasty was performed in seven patients (four men, three women; median age, 72.9 years). The medical records were retrospectively reviewed. Of the seven patients, six had primary lung cancer (PLC), and one had metastatic cancer of the lung. The surgical procedures were lobectomy with wedge bronchoplasty. The patients with PLC also underwent mediastinal or hilar lymph node dissection. The median total operating time was 230 min, and the median blood loss was 152 ml. The median postoperative hospital stay was seven days, without major postoperative complications. The most important feature of the described method is that the surgeon mainly observes the operative field directly, through a working wound; the surgical team observes via a monitor. An advantage for the surgeon is the ability to use the same instruments in VATS as are used in conventional thoracotomy, as well as the same suturing techniques in vascular reconstruction, especially involving the pulmonary artery.

The clinicopathological significance of preoperative serum-soluble interleukin-2 receptor concentrations in operable non-small-cell lung cancer patients

BackgroundSerum-soluble interleukin-2 receptor (IL-2R) concentrations have been found to be elevated in cancer patients. However, the importance of this finding in patients with non-small-cell lung cancer (NSCLC) has not been previously established.MethodsPreoperative serum-soluble IL-2R concentrations were determined in 65 consecutive patients with operable NSCLC. The correlation of preoperative serum-soluble IL-2R concentrations with various clinicopathological features of this cancer was evaluated to clarify the clinical significance of this parameter.ResultsAlthough serum-soluble IL-2R concentrations were not significantly higher in operable NSCLC patients than in normal controls (P=.1180), serum-soluble IL-2R concentrations were significantly higher in patients with stage IIIB or IV disease than in normal controls (P=.0001). The presence of intrapulmonary metastasis was the only clinicopathological feature that was significantly correlated to serum-soluble IL-2R concentration (P=.0004). The sensitivity of serum-soluble IL-2R concentration in identifying the presence of intrapulmonary metastasis was 87.5%; specificity was 75%.ConclusionsElevated preoperative serum-soluble IL-2R concentrations in patients with operable NSCLC reflect the occurrence of intrapulmonary metastasis. Preoperative examination of serum-soluble IL-2R concentrations may be valuable in the detection of the intrapulmonary metastasis preoperatively.

Basaloid carcinoma of the thymus

A 58-year-old man was found to have a basaloid carcinoma of the thymus, initially detected as an abnormal shadow on chest radiograph. The patient underwent resection followed by radiotherapy, and has survived 25 months without recurrence. Although this rare tumor may be related to multilocular thymic cyst, its pathogenesis is obscure. We discuss clinicopathologic features of our case and others.

Establishment of a human lung cancer cell line with high metastatic potential to multiple organs: gene expression associated with metastatic potential in human lung cancer

Convenient and reliable multiple organ metastasis model systems might contribute to understanding the mechanism(s) of metastasis of lung cancer, which may lead to overcoming metastasis and improvement in the treatment outcome of lung cancer. We isolated a highly metastatic subline, PC14HM, from the human pulmonary adenocarcinoma cell line, PC14, using an in vivo selection method. The expression of 34,580 genes was compared between PC14HM and parental PC14 by cDNA microarray analysis. Among the differentially expressed genes, expression of four genes in human lung cancer tissues and adjacent normal lung tissues were compared using real-time reverse transcription polymerase chain reaction. Although BALB/c nude mice inoculated with parental PC14 cells had few metastases, almost all mice inoculated with PC14HM cells developed metastases in multiple organs, including the lung, bone and adrenal gland, the same progression seen in human lung cancer. cDNA microarray analysis revealed that 981 genes were differentially (more than 3-fold) expressed between the two cell lines. Functional classification revealed that many of those genes were associated with cell growth, cell communication, development and transcription. Expression of three upregulated genes (HRB-2, HS3ST3A1 and RAB7) was higher in human cancer tissue compared to normal lung tissue, while expression of EDG1, which was downregulated, was lower in the cancer tissue compared to the normal lung. These results suggest that the newly established PC14HM cell line may provide a mouse model of widespread metastasis of lung cancer. This model system may provide insights into the key genetic determinants of widespread metastasis of lung cancer.

Primary Thymic Mucosa-Associated Lymphoid Tissue Lymphoma: Diagnostic Tips

Mucosa-associated lymphoid tissue (MALT) lymphoma arising in the thymus is extremely rare and little is known regarding its clinicopathological features. This study examined the clinicopathological features of nine cases of thymic MALT lymphoma. Most patients had autoimmune disease or hyperglobulinemia, and they also had cysts in the tumors. Both increased serum autoantibody levels and polyclonal serum immunoglobulin levels remained essentially unchanged after total thymectomy in all patients. Thymic MALT lymphoma needs to be included in the differential diagnosis in Asian patients with a cystic thymic mass accompanied by autoimmune disease or hyperglobulinemia.

Is epidural analgesia necessary after video-assisted thoracoscopic lobectomy?

Most studies have shown that thoracic epidural analgesia reduces postoperative pain, but it carries potential risks. Recently, video-assisted thoracoscopic surgery has become an established technique that causes minimal postoperative pain. This report shows that thoracic epidural analgesia is not always necessary after video-assisted thoracoscopic lobectomy. From January to December 2007, 30 consecutive patients who underwent video-assisted thoracoscopic lobectomy were examined retrospectively. We analyzed the necessity for routine thoracic epidural analgesia. The continuous subcutaneous analgesia catheter for morphine (2 mg in 48 h) was removed from 15 patients on postoperative day 1, and from the other 15 on day 2. We administered loxoprofen sodium hydrate, diclofenac sodium suppository, pentazocine hydrochloride, and mexiletine hydrochloride for postoperative analgesia, as needed. The mean pain score was no more than 1.0. The maximum score was 3.0 on day 0, and 2.0 on day 14; subsequently, no pain score exceeded 2.0. The postoperative hospital stay was 8.7 ± 0.8 days. All patients made uneventful postoperative recoveries. There is no need for thoracic epidural analgesia after every video-assisted thoracoscopic lobectomy because our patients recovered with no serious complication. Less invasive surgical approaches should require simpler postoperative pain management.