Ryota Masuda

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.

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.

Use of a titanium alloy (Chest Way) in the surgical stabilization of flail chest

To avoid the complications of internal pneumatic stabilization for flail chest, we performed stabilization of the chest wall with a metal bar using the Nuss procedure. Here, we used a highly elastic lightweight biocompatible titanium alloy Chest Way (Solve Corporation, Kanagawa, Japan), enabling magnetic resonance imaging. The patient was a 37-year-old man who sustained injuries in a car crash. Gradually increasing subcutaneous emphysema was present. Bilateral pleural drainage and tracheal intubation were conducted on the scene, and a peripheral venous line was established. The patient was then transferred to our hospital by helicopter. A titanium alloy Chest Way was inserted to manage his flail chest accompanied by multiple rib fractures on the left side. Two days later, artificial respiration was no longer required.

Ki-67 labeling index affects tumor infiltration patterns of lung squamous cell carcinoma

Ki-67 is a nuclear protein that is expressed during the G1, S, G2 and M phases of the mitotic cell cycle. A previous study categorized tumor infiltration patterns (INF), of which INFc indicated cancer nests exhibiting infiltrative growth and an unclear boundary between tumor tissue and surrounding healthy tissue. The present study used the Ki-67 labeling index (Ki-67 LI) as an indicator of cell proliferation, in order to examine the factors affecting INF in lung squamous cell carcinoma (SqCC). SqCC specimens (89) were classified into two groups: High-grade cell proliferation (Ki-67 LI ≥30%) and low-grade cell proliferation (Ki-67 LI <30%). However, a high Ki-67 LI was significantly associated with cases that had an INFc component [INFc(+); P=0.03]. Univariate analyses indicated that INFc(+) was a predictor of venous invasion [P=0.032; odds ratio (OR), 2.615; 95% confidence interval (95% CI), 1.085–6.305], scirrhous stromal type (P<0.001; OR, 6.462; 95% CI, 2.483–16.817) and high Ki-67 LI (P=0.018; OR, 12.543; 95% CI, 1.531–102.777). Multivariate logistic analyses indicated that high Ki-67 LI was the strongest predictor of INFc(+) (P=0.028; OR, 8.027; 95% CI, 1.248–51.624). In conclusion, high-grade cell proliferation activity may contribute to aggressive infiltrative growth of lung SqCC.

Podoplanin expression is correlated with the prognosis of lung squamous cell carcinoma

Podoplanin is a 38 kDa transmembrane protein that is involved in cell migration and cancer cell invasion. Some studies have reported that podoplanin expression was correlated with poor prognosis in lung squamous cell carcinoma (SqCC). However, there have been no clinicopathological studies of podoplanin membrane expression and localization in lung SqCC. In this study, we focused on the intensity and localization of podoplanin membrane expression, and its clinicopathological significance for lung SqCC. Strong membrane expression of podoplanin was significantly associated with lymph node metastasis, lymphatic invasion, and histological differentiation. Cases with strong podoplanin expression at cell membrane showed better prognosis of lung SqCC (HR, 3.301). Peripheral localization of podoplanin was associated with tumor size, lymphatic invasion, and histological differentiation. Cases with peripheral podoplanin expression showed favorable prognosis of lung SqCC (HR, 2.830). Both strong membrane expression and peripheral expression of podoplanin were independent predictors of mortality of lung SqCC (HR, 2.869; HR, 2.443, respectively). The cases with strong or peripheral podoplanin expression showed better overall survival (P = 0.001, both). Podoplanin intensity is significantly associated with podoplanin localization (P < 0.001), and its correlation coefficient was 0.678. We concluded that podoplanin membrane expression, not only its localization, is a useful prognostic indicator of lung SqCC patients.

Endobronchial Hamartoma as a Cause of Pneumonia

Patient: Male, 66 Final Diagnosis: Endobronchial hamartoma Symptoms: Fever Medication: — Clinical Procedure: Flexible bronchoscopy • surgical resection Specialty: Pulmonology Objective: Unusual clinical course Background: Post-obstructive pneumonia occurs in the presence of airway obstruction, usually caused by lung cancer. However, there are cases of bronchial obstruction due to benign origin such as foreign bodies and benign endobronchial tumors, which are often misdiagnosed. Case Report: A 66-year-old man was referred to our hospital due to high fever with abnormal shadow in the right lung. Chest computed tomography after a course of antibiotic treatment showed an intra-bronchial tumor obstructing the right upper bronchus. Part of the tumor was removed with flexible bronchoscopy, and histopathological examination revealed cartilage tissue but not fat or other components. Lobectomy of the right upper lobe of the lung was performed to make a definite diagnosis and prevent recurrent obstructive pneumonia. The resected tumor contained mature cartilage and fat tissues, and was diagnosed as endobronchial hamartoma. Conclusions: Benign endobronchial tumors such as hamartomas should be considered in the differential diagnosis of post-obstructive pneumonia.

Pulmonary inflammatory pseudotumor observed by bronchoscopy and resected using video-assisted thoracic surgery

Pulmonary inflammatory pseudotumor is rare. A 34-year-old woman visited our hospital due to an abnormal chest shadow. Computed tomograhy showed a nodule in the right upper lobe. Bronchoscopy showed a polypoid endobronchial nodule obstructing most of the orifice of B2a. The nodule was white, glossy, and smooth, and it seemed to be covered with bronchial mucosa. However, transbronchial biopsy could not facilitate a diagnosis. To obtain a definitive diagnosis, we performed lobectomy of the right upper lobe using video-assisted thoracic surgery and removed the nodule completely. The pathologic diagnosis made during surgery was inflammatory pseudotumor. Immunohistochemical examination showed proliferating spindle cells were positive for vimentin and smooth muscle actin, but negative for epithelial markers. These findings were consistent with the staining pattern of inflammatory pseudotumor previously reported. Careful follow-up is necessary to detect any sign of local recurrence and distant metastases.

Lymphatic invasion is a significant indicator of poor patient prognosis in lung squamous cell carcinoma

Pathological stage is the most important prognostic factor in patients with lung cancer, and is defined according to the tumor node metastasis classification system. The present study aimed to investigate the clinicopathological significance of lymphatic invasion in 103 patients who underwent surgical resection of lung squamous cell carcinoma (SqCC). The patients were divided into two groups, according to the degree of lymphatic invasion: Those with no or mild lymphatic invasion (ly0-1) and those with moderate or severe lymphatic invasion (ly2-3). Ly2-3 was associated with tumor size (P=0.028), lymph node metastasis (P<0.001), venous invasion (P=0.001) and histological differentiation (P=0.047). Statistical analysis using the Kaplan-Meier method and the log-rank test indicated that overall survival was significantly reduced in patients with ly2-3 compared with those with ly0-1 (P<0.001). Multivariate analysis identified ly2-3 as an independent predictor of mortality (hazard ratio, 2.580; 95% confidence interval, 1.376–4.839). In conclusion, moderate or severe lymphatic invasion (ly2-3) indicated a high malignant potential and may be considered an independent predictor of poor prognosis in patients with SqCC of the lung.

Periodic appearance and disappearance of a chest wall (serratus anterior development) cavernous hemangioma that was finally resected in a child

Primary chest wall tumors occur infrequently; in particular, cavernous hemangioma of the chest wall is an extremely rare disease. We report a case of child with cavernous hemangioma of the chest wall, which was successfully resected. Obvious enlargement of the tumor and the appearance of pain were observed during a 2-year follow-up. In the present case, transcutaneous ultrasonography showed the appearance and disappearance of the mass. This was considered to be caused by the transfer of contents between the shallow and deep parts of the tumor. This may have resulted from serratus anterior muscle movement between the two-layered tumor. Transcutaneous ultrasonography, as well as magnetic resonance imaging, was therefore extremely effective for preoperative diagnosis. Transcutaneous ultrasonography is easily performed, even in children, such as in the present case. Because of its simplicity and usefulness, transcutaneous ultrasonography may be considered as the first-line imaging modality for diagnosis.

Diaphragmatic repair of hepatic hydrothorax with VATS after abdominal insufflation with CO(2)

Hepatic hydrothorax is defined as the presence of a significant pleural effusion that develops in a patient with cirrhosis of the liver who does not have an underlying cardiac or pulmonary disease. There have been few published case reports dealing with hepatic hydrothorax treated surgically. Recently, we treated a patient with refractory hepatic hydrothorax by directly suturing the diaphragmatic defect during VATS. During surgery, the diaphragmatic defect was identified by using abdominal insufflation with CO 2. The defect was sutured and the diaphragm was covered by polyglycolic acid felt and fibrin glue. After surgery, the patients pleural effusion improved, his postoperative course was uneventful and he did not require a drainage tube at discharge.