Seiya Momosaki

Lung CT: Part 1, Mimickers of Lung Cancer—Spectrum of CT Findings With Pathologic Correlation

OBJECTIVEnThe purpose of this article is to describe CT findings of miscellaneous pulmonary conditions that mimic lung cancers, especially primary cancers, to improve diagnosis of pulmonary lesions. Brief descriptions of patient clinical information and pathologic findings will be included and correlated with imaging findings in actual cases.nnnCONCLUSIONnA wide variety of pulmonary conditions present imaging features that mimic those of primary lung cancers and are difficult to differentiate from cancer. Awareness of these conditions with an understanding of their pathologic background and careful attention to the clinical information will help achieve correct diagnoses.

Case report of pseudoaneurysm caused by core needle biopsy of the breast.

We treated a patient with a pseudoaneurysm caused by core needle biopsy (CNB), in which both the cancer and the aneurysm were excised by breast conservation therapy. A 51-year-old woman attended a local hospital because of a 25-mm mass in the upper outer quadrant of the right breast. CNB was performed, and brisk bleeding occurred at the biopsy site. Immediate hemostasis was achieved with direct manual compression. CNB detected fatty tissue, and a diagnosis could not be made. When she presented at our hospital 6xa0weeks later, there was a 25-mm pulsating mass at the biopsy site. Color-flow Doppler US and dynamic MRI showed a breast tumor and pseudoaneurysm formation. For the purpose of diagnosis and treatment of the breast tumor and pseudoaneurysm, lumpectomy of the right breast was performed. Histological diagnosis was papillotubular carcinoma and pseudoaneurysm. Although this condition is relatively rare, it is important to be aware of the possibility of complications, such as pseudoaneurysms, which require treatment.

Primary intrapulmonary thymoma

Primary intrapulmonary thymoma (PIT), which is an intrapulmonary tumor without an associated mediastinal component, is rare. We herein report a resected case of PIT in a 55-year-old female who presented with a 2.5xa0×xa02.4xa0cm mass in the left upper lobe. We also summarize the clinicopathological features and discuss the diagnosis, pathogenesis, and treatment of PIT.

Huge inflammatory pseudotumor of the spleen with postoperative portal vein thrombosis: report of a case

We report the rare case of a splenic inflammatory pseudotumor associated with massive splenomegaly, diagnosed after surgery. A 51-year-old woman was admitted to our hospital for investigation of anemia. Physical examination revealed a palpable left upper quadrant mass. Computed tomography and magnetic resonance imaging showed a splenic mass, 20xa0cm in diameter. We performed splenectomy for both diagnosis and treatment. The spleen weighed 2400xa0g, and histologic examination of the mass confirmed an inflammatory pseudotumor. Portal vein thrombosis (PVT) developed the day after surgery, but resolved with anticoagulation therapy. This case highlights that there is a risk of PVT after splenectomy in patients with massive splenomegaly, and that anticoagulant therapy should be initiated promptly.

Complication of bovine pericardial buttress: pulmonary pseudotumor.

A 38-year-old man reported progressive back pain 4 years after undergoing partial resection of the lung for spontaneous pneumothorax, using staples buttressed with bovine pericardium. Chest computed tomography detected a mass near the staple line. Resection of the mass was performed successfully and the pain was relieved. The excised material was identified as an inflammatory pulmonary pseudotumor caused by the buttressing material.

Can a Thoracic Surgeon Identify Lymph Node Metastases during Surgery Based on Their Size?: Analysis of 844 Metastatic and 10,462 Nonmetastatic Lymph Nodes

Objective: A metastatic lymph node commonly becomes enlarge; however, there is limited data available with regard to the direct measurement of lymph nodes and their clinicopathologic characteristics. Methods: The size of dissected lymph node was quantified in a total of 848 nodes with metastasis and 10,462 nodes without metastasis from 454 patients with lung cancer who underwent a pulmonary resection with lymph node dissection. Results: The short axis and the volume of the metastatic lymph nodes were significantly greater than those of the nonmetastatic ones. The smaller the lymph node, the less frequently the lymph nodes were metastatic; however, the ratios of nodes smaller than the fifth largest lymph node with metastasis of adenocarcinoma and squamous cell carcinoma were 21.8 to 26.2%, respectively. When the hilar and mediastinal lymph node stations were examined, 1.14 to 4.00% of the lung cancer patients had lymph node metastasis in small lymph node despite having no metastases in the largest and second largest lymph nodes. Conclusions: The small lymph nodes in the hilar or mediastinal stations frequently had metastases of carcinoma even though largest and second largest lymph nodes were negative for metastases, especially in adenocarcinoma cases. Surgical oncologists should, therefore, perform systemic lymph node dissection, and not sampling, during a pulmonary resection of lung cancer.

Favorable control of rapidly progressive retroperitoneal pleomorphic leiomyosarcoma with multimodality therapy: a case report

BackgroundRetroperitoneal sarcomas (RPS), such as pleomorphic leiomyosarcoma, often invade or displace vital organs in the abdominal cavity and exhibit an aggressive clinical course. Complete surgical resection of the tumor and preoperative radiotherapy and chemotherapies can be used for non-metastatic RPS. However, in case of huge retroperitoneal sarcoma fully occupying the abdominal cavity, surgical resection tends to be insufficient, resulting in poor outcomes. This report describes a case of rapidly progressive retroperitoneal pleomorphic leiomyosarcoma that was favorably controlled by debulking surgery followed by combination chemotherapy and radiotherapy.Case presentationA 65-year-old Japanese woman developed abdominal discomfort due to a huge retroperitoneal tumor fully occupying the abdominal cavity. The immunohistochemical diagnosis was pleomorphic leiomyosarcoma with high-grade malignancy and aggressive proliferative features. Debulking surgery could be performed, but the small residual tumor had rapidly grown to an approximately 22xa0cm in length on the major axis within 38xa0days after the operation. The patient’s general condition progressively declined. Combination chemotherapy, consisting of doxorubicin and ifosfamide, was successfully administered for six cycles while maintaining dose intensity. The best objective response was a partial response, and the chemotherapy was well tolerated. Approximately 50xa0Gy of radiotherapy was delivered to the remaining tumor. This multimodal strategy resulted in progression-free survival for more than 17xa0months and achieved sustained symptomatic relief.ConclusionsMultimodal therapy with debulking surgery, combination chemotherapy and radiotherapy controlled a rapidly progressive retroperitoneal pleomorphic leiomyosarcoma. Maintaining dose intensity of the chemotherapy and radiotherapy might contribute to overall tumor control.

Predictive factors of biochemical recurrence after radical prostatectomy for high-risk prostate cancer

To identify risk factors of biochemical recurrence after radical prostatectomy in high‐risk patients.

Stage IV pleomorphic carcinoma of the lung without recurrence for 6 years: a case report

BackgroundPleomorphic carcinoma is a rare primary lung carcinoma that occurs at a rate of about 0.3%. Even with complete resection, the tumor usually recurs aggressively, resulting in a poor prognosis. Herein, we report a case of advanced pleomorphic carcinoma of the lung who had a long survival time after resection of the primary and metastatic sites.Case presentationA 48-year-old man was admitted to our hospital due to abdominal pain. Systemic examination revealed a lung mass on the right and a tumor in the jejunum. Surgical resection of both tumors revealed pleomorphic carcinoma of the lung with metastasis to the jejunum. Follow-up after 6xa0years showed that the patient remained recurrence-free, without the need for additional postoperative treatment.ConclusionsA vigorous treatment strategy that included surgery had the potential to offer long-term survival, despite an advanced pleomorphic carcinoma with distant metastasis to other organs. Reports on more similar cases are needed to evaluate the value of this treatment option.

Second Primary Lung Adenocarcinoma Harboring EML4-ALK After Surgically Resected EGFR Positive Lung Adenocarcinoma

The occurrence of metachronous epidermal growth factor receptor (EGFR) mutated and echinoderm microtubule-associated protein-like 4 gene, the anaplastic lymphoma kinase (EML4-ALK) fusion lung cancers are extremely rare. The diagnosis of metachronous primary lung cancers is sometime difficult because of the difficulty in differentiating metachronous primary lung cancers from metastasis. The accurate differentiation of metachronous primary lung cancers from intrapulmonary metastasis is essential to obtain a good outcome. Aggressive repeat biopsy and genetic testing should thus be conducted to clarify the difference between metachronous primary lung cancers and metastasis.