Shigeharu Moriyama

Prognostic impact of intratumoral vessel invasion in completely resected pathologic stage I non–small cell lung cancer

OBJECTIVE Intratumoral vessel invasion of non-small cell lung cancer is a readily available tumor-related factor that provides direct evidence of microscopic tumor invasion. We assessed the prognostic influence of intratumoral vessel invasion and its ability to provide a differential prediction of prognosis for completely resected pathologic stage I non-small cell lung cancer. METHODS We analyzed 258 patients with non-small cell lung cancer who underwent complete resection between January of 1996 and December of 2005 and were diagnosed with pathologic stage I disease. In addition to the conventional staging factors, intratumoral vessel invasion in the primary lesion was histologically evaluated by both hematoxylin-eosin and elastic staining. We examined the significance of intratumoral vessel invasion in prognosis and compared the outcomes between patients with and without this factor with stage IA and IB disease, respectively. RESULTS Intratumoral vessel invasion was found in 124 patients (48%). Five-year survival of patients with or without intratumoral vessel invasion was 74% and 93%, respectively. On multivariate analysis, intratumoral vessel invasion and pleural invasion were shown to be independent prognostic factors. Subgroup analyses suggested that patients with pathologic-stage IA with intratumoral vessel invasion and patients with pathologic-stage IB with both intratumoral vessel and pleural invasion had significantly worse prognosis than patients with the same pathologic stage without these factors. CONCLUSION The current study indicated that intratumoral vessel invasion and pleural invasion are independent prognostic factors. Intratumoral vessel invasion status can complement the size-dependent TNM staging system in pathologic stage I non-small cell lung cancer.

Origin of regenerated epithelium in cryopreserved tracheal allotransplantation

BACKGROUND Our previous study showed that a cryopreserved tracheal allograft could be transplanted using omentopexy without immunosuppression. The present study investigated, by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method, whether the regenerated epithelia were of recipient origin or donor origin in a cryopreserved tracheal allotransplantation model. METHODS Twenty-nine mongrel dogs were classified by preoperative peripheral blood PCR-RFLP analysis. The cryopreserved tracheal allografts were implanted into recipient animals that showed a different phenotype from donor animals. A small specimen of epithelia excised from the allograft of animals postmortem was analyzed with the modified PCR-RFLP method. RESULTS The animals were separated into 16 phenotypes by preoperative PCR-RFLP results, and cryopreserved tracheal allografts transplanted into 8 animals. PCR-RFLP analysis of graft epithelia at 10 days after transplantation showed the donor blood phenotype and analysis of graft epithelia taken from the animals that survived more than 20 days after operation showed the recipient blood and epithelial phenotype. CONCLUSIONS The donor epithelia in the grafts were no longer present within about 20 days after transplantation. The recipient epithelia migrated gradually from the anastomotic site, and the regenerated epithelia that are of recipient origin covered the allograft within about 50 days after transplantation.

Bronchial arteriovenous malformation with large aneurysm, resected by video-assisted thoracic surgery.

Bronchial arteriovenous malformation with a large aneurysm appearing as a mass shadow in the right hilum on chest imaging was successfully extirpated thoracoscopically without any lung resection. Preoperative angiography showed tortuous, enlarged right bronchial arteries with an aneurysm connecting to the pulmonary artery, which could not be totally embolized via the transcatheter approach because of the length of the abnormal bronchial artery and possibility of embolotherapy-induced pulmonary infarction. Histological examination revealed defects of the media and internal elastic lamina of the resected bronchial arteries and aneurysm. The patient was free of hemoptysis and other airway symptoms 4 years after surgery.

Restrictive ventilatory impairment is associated with poor outcome in patients with cT1aN0M0 peripheral squamous cell carcinoma of the lung

Background Patients with squamous cell carcinoma (SqCC) of the lung sometimes have a comorbid pulmonary disease such as pulmonary emphysema or an interstitial lung disease (ILD), both of which negatively affect patient outcome. The aim of this study was to determine the outcome of patients in a multicenter database who underwent surgery for cT1aN0M0 peripheral SqCC lung cancer. Methods The medical records of a total of 228 eligible patients from seven institutions were reviewed to evaluate the impact of concomitant impaired pulmonary function and other clinicopathological factors on overall survival (OS) and relapse-free survival (RFS). Results Six patients with positive or unclear tumor margins were excluded. Of the 222 remaining study patients, 42 (18.9%) and 97 (43.7%) patients were found to have coexisting restrictive or obstructive ventilatory impairment, respectively. Over a median follow-up period of 30.6 months, the 5-year OS and RFS were 69.0% and 62.6%, respectively. By multivariate analysis, ILDs identified on high-resolution computed tomography (HRCT), pulmonary function test results indicating a restrictive ventilatory impairment, and wedge resection were found to be independent risk factors for poor OS. An increased level of serum squamous cell carcinoma antigen (SCC-Ag) (>1.5 ng/mL) and the same risk factors for poor OS were independent risk factors for recurrence. Among patients who underwent anatomical lung resection (lobectomy and segmentectomy, n=173), a restrictive ventilatory impairment was an independent risk factor for poor OS, and increased serum SCC-Ag level, ILDs on HRCT, and restrictive ventilatory impairment were independent risk factors for poor RFS by multivariate analysis. Factors such as visceral pleural invasion, and lymphatic or vascular invasion were not significantly associated with outcome. Conclusions A restrictive ventilatory impairment negatively affects the outcome of patients with cT1aN0M0 peripheral SqCC lung cancer.

A Case of Quadruple Cancer with Metachronous Colon Cancer -A Case of Operation for Synchronous Triple Cancer-

重複癌の報告は近年増加しており, 要因の1つに診断機器・技術の向上が考えられる. 今回われわれは, 異時性大腸癌を含む同時性胃癌, 十二指腸癌, 腎癌の4重複癌を経験し, 同時性3重複癌に対し1期的手術を施行した. 平成7年1月S状結腸の上皮内癌に対し, 内視鏡的大腸ポリープ切除術を施行した. 平成12年8月汎発性腹膜炎で緊急手術をした際, 胃癌の穿孔が疑われ, 術後に上部消化管内視鏡検査を施行したところ, 胃癌, 十二指腸癌を発見した. また腹部CTで右腎癌の診断を得て, 平成12年9月胃全摘術・膵頭十二指腸切除術・右腎摘出術を施行した. 病理学的にも3重複癌であったが, 本症例の4重複癌はいずれも根治的に治療できた. 文献上4重複癌の報告は年ごとに増加し, 同時多発癌の報告頻度も近年増加している. 特に共通の危険因子を持つ癌は重複しやすいと考えられ, 今日では重複癌の発生にも注意し診療することが必要と思われた.