Motohiko Tamura

Comparison of 5-Fluorouracil-related Gene Expression Levels Between Adenocarcinomas and Squamous Cell Carcinomas of the Lung

BACKGROUND A recent meta-analysis study showed that post-operative adjuvant chemotherapy with UFT, an oral combination drug composed of tegafur [prodrug of 5-fluorouracil (5-FU)] and uracil [inhibitor of dihydropyrimidine dehydrogenase (DPD)] was associated with improved survival in patients with lung adenocarcinomas, but not in those with lung squamous cell carcinomas. METHODS We investigated the 5-FU-related gene expression levels of thymidylate synthase (TS), DPD, thymidine phosphorylase (TP) and orotate phosphoribosyl transferase (OPRT) in resected tumor specimens from 51 patients with adenocarcinomas and 47 with squamous cell carcinomas using quantitative reverse transcription-PCR, and compared those levels between the two histological types. RESULTS The relative gene expression values of TS, TP and OPRT were significantly lower in adenocarcinomas compared with squamous cell carcinomas, 1.60 +/- 0.86 versus 4.33 +/- 3.40 (P < 0.001), 0.84 +/- 0.52 versus 2.27 +/- 1.16 (P = 0.006) and 9.59 +/- 6.30 versus 16.94 +/- 12.04 (P < 0.001), respectively. The relative gene expression value of DPD was significantly greater in adenocarcinomas than those in squamous cell carcinomas, 2.33 +/- 1.22 versus 1.50 +/- 1.20 (P = 0.01). Lower expressions of TS and TP were observed more in adenocarcinomas (89.8%) than in squamous cell carcinomas (48.9%) (P < 0.001). CONCLUSION These data may explain that post-operative adjuvant chemotherapy with UFT was associated with improved survival in stage I patients with adenocarcinoma, but less with squamous cell carcinoma.

Sarcoidosis development during induction chemotherapy for lung cancer mimicked progressive disease.

We report a rare case of sarcoidosis that developed during induction chemotherapy for primary lung cancer, mimicking progressive disease. A 63-year-old man had an abnormal shadow in the right upper lung, and a bronchoscopic examination revealed a squamous cell carcinoma. Swelling of a pretracheal lymph node was also noted. Thus, we gave induction chemotherapy consisting of paclitaxel (days 1, 8) + carboplatin (days 1, 8) for two cycles under clinical staging of T2N2M0. After induction chemotherapy, 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) showed positive accumulation of FDG in mediastinal and bilateral hilar lymph nodes that had been negative in a previous FDG-PET examination, which led us to suspect disease progression. Transbronchial lymph node biopsy results showed sarcoid granulomas in the specimens. Following complete resection of the lung cancer, sarcoid granulomas were revealed in both nonneoplastic lung tissue and lymph nodes, which resulted in a diagnosis of lung cancer accompanied with sarcoidosis.

Efficacy of functional operability algorithm for octogenarians with primary lung cancer

PurposeThe number of lung cancer patients is increasing in association with the aging of society, and age is associated with the risk of undergoing a thoracotomy procedure. We prospectively investigated the efficacy of a functional operability algorithm that included pulmonary function and exercise test results for determining the indication for surgery in octogenarians.MethodsFrom April 2001 to October 2008, surgical indications for a total of 45 octogenarians were assessed using our algorithm, including forced expiratory volume in 1 s/forced vital capacity ratio, predicted postoperative percent of forced expiratory volume in 1 s, Hugh-Jones dyspneic index, and empirical anaerobic threshold obtained during an exercise test. Then the surgical results were reviewed.ResultsThoracotomy was contraindicated in one patient; the remaining 44 patients underwent surgery. Axilloanterior thoracotomy (75%), lobectomy (84%), and mediastinal lymph node dissection (73%) were the major procedures. Altogether, 37 postthoracotomy complica-Received: 13 February 2011 / Accepted: 30 May 2011

Lung transplantation for aspiration-induced silicosis of the lung

Silicosis, a slowly progressing chronic disease, is rare in lung transplantation patients. Herein, we report a case of single lung transplantation in a 35-year-old man for acute and accelerated silicosis, without a history of inhalation of silicium. A pathology examination of the explanted lung revealed that aspiration of a scouring powder was the cause of lung silicosis. Aspiration-induced lung silicosis is rare.

Molecular biological analysis in a patient with multiple lung adenocarcinomas: Molecular analysis in lung ADC

The utility of molecular biological analysis in lung adenocarcinoma has been demonstrated. Herein we report a rare case presenting as multiple lung adenocarcinomas with four different EGFR gene mutations detected in three lung tumors. After opacification was detected by routine chest X‐ray, the patient, a 64‐year‐old woman, underwent chest computed tomography which revealed a right lung segment S4 ground‐glass nodule (GGN). Follow‐up computed tomography revealed a 42 mm GGN nodule with a 26 mm nodule (S6) and a 20 mm GGN (S10). Histopathology of resected specimens from the right middle and lower lobes revealed all three nodules were adenocarcinomas. Four EGFR mutations were detected; no three tumors had the same mutations. Molecular biological analysis is a promising tool for the diagnosis of primary tumors in patients with multiple lung carcinomas of the same histotype, enabling appropriate treatment.

Intractable pneumothorax with empyema in a patient with interstitial pneumonia

Secondary pneumothorax occurring in interstitial lung disease cases is a refractory and life-threatening condition, because of compromised lung function. A 70-year-old woman with interstitial pneumonia was referred to our hospital after treatment failure for pneumothorax associated with empyema. An open window thoracostomy was created, and mechanical irrigation and dressing changes of the pleural cavity were performed. Then, the lung was widely covered with the latissimus dorsi and serratus anterior muscles because there were multiple fistulae on the lung surface. After the covering muscles were completely adhered to the lung surface and stopped air leaking, the chest was successfully closed. The wide covering technique of the lung with chest wall muscles is effective for intractable pneumothorax with multiple fistulae.