Takahide Kodama

Simultaneous measurements of KL-6 and SP-D in patients undergoing thoracic radiotherapy.

PurposeRadiation pneumonitis (RP) is a serious complication in patients undergoing thoracic radiotherapy (TRT). Serum KL-6 and SP-D have been shown to increase in several kinds of interstitial pneumonia. To evaluate their clinical usefulness in detecting RP, we serially measured them in patients receiving TRT.Materials and MethodsThirty-nine patients, who received TRT for lung cancer between July 1999 and April 2004, were prospectively studied. Serum levels of KL-6 and SP-D were measured using enzyme-linked immunosorbent assays. Patients were followed up until August 2004 or their deaths.ResultsDuring the period, RP occurred in 19 patients. In five patients with diffust RP extended outside the radiation field, serum KL-6 levels increased, reaching more than 1000 U/mL. Serum KL-6 levels at 40 gy in patients who developed RP were higher than those without it (p=0.0363, Mann-Whitney U test). In addition, serum KL-6 levels at 40 Gy in patients who developed RP were higher than those of pretreatment (p=0.0126, Wilcoxon signed rank test). On the other hand, there were no statistical differences between SP-D at 40 Gy and those before TRT (p=0.1165).ConclusionsIncreased KL-6 at 40 Gy compared with those before treatment in patients undergoing TRT may be of clinical significance. KL-6 proved to be a useful indicator for estimating RP, while usefulness of SP-D was not confirmed in this study.

Thymic and pulmonary mucosa-associated lymphoid tissue lymphomas in a patient with Sjögren’s syndrome and literature review

Abstract:  Mucosa‐associated lymphoid tissue lymphoma (MALToma) has been reported in several organs. Among MALTomas, thymic and pulmonary MALTomas are rare. The present report describes a patient with Sjögren’s syndrome who presented thymic and pulmonary MALTomas. Although the exact pathogenetic relationship between these two tumours is uncertain, it is likely that the underlying immune dysregulation related to Sjögren’s syndrome contributed to the occurrence and the unusual manifestation of MALTomas in this patient.

Metacarpal Bone Metastasis from Lung Cancer

complete disappearance of both pain and swelling. Thereafter, the patient received 2 courses of platinum-containing chemotherapy. These therapies resulted in a second CR as no other lesion was detected at that time. Although the We previously read with interest the article by Kouvaris et al. (March 2005) on isolated talus metastasis from breast carcinoma [1]. We would like to share our experience with a patient whose condition was very similar to that reported by Kouvaris et al. [1]. Bone metastasis in distal parts of the extremities is very rare [2–4]. This distant spread may imply that cancer cells may reach many sites of the whole body via the bloodstream and the lymphatic system. Like all other metastatic lesions, bone metastasis in distal parts of the extremities reflects the progression of the primary malignancy. This report describes metastasis to the metacarpal bone in the left hand, arising from an adenocarcinoma of the lung. A 78-year-old man with biopsy-proven lung adenocarcinoma in the left upper lung (fig. 1) was referred to our hospital for further evaluation and treatment. The patient was diagnosed as having resectable disease (UICC stage T1N0M0 stage IA). However, because of poor respiratory condition due to chronic obstructive pulmonary disease and a poor performance status, he was evaluated as being not well enough to receive surgical resection or concurrent chemoradiotherapy. A total dose of 64 Gy of chest irradiation was performed, and the response was evaluated as complete response (CR). Two months after the diagnosis of lung cancer, the patient developed a painful swelling of the left hand. X-ray examination showed an osteolytic lesion in the hamate bone (fig. 2). Magnetic resonance imaging demonstrated a metastatic lesion with low signal intensity on T1 weighted image (fig. 3). Small but hot uptake was observed on fluorodeoxyglucose positron emission tomography (FDG-PET). The histological examination of a specimen obtained by biopsy confirmed metastatic lung adenocarcinoma. Because no other abnormal uptake was detected in FDG-PET, the osteolytic manifestation of the left hand was considered the only metastatic site. A total dose of 27 Gy of irradiation was delivered to the left hand, resulting in Fig. 1. Chest computed tomography showing lung adenocarcinoma in the left upper lung.

Portal Vein Tumor Thrombus of Liver Metastasis from Lung Cancer

We report a case of liver metastasis of lung carcinoma with portal vein tumor thrombus (PVTT). Although the primary lesion of lung tumor remained unchanged, the patient rapidly developed wide-spread metastases and formed PVTT of liver metastasis. The primary lesion showed features of mixed Clara and bronchial surface epithelial cell component type adenocarcinoma with small foci of micropapillary pattern. Micropapillary pattern was observed in the metastatic lesions in the liver and PVTT. Micropapillary pattern lung adenocarcinoma may develop rapid metastases and cause PVTT associated with liver metastasis. We should perform a detailed examination to establish correct diagnosis.

Management of afatinib-induced stomatitis

Severe stomatitis may lead to the need to interrupt or discontinue cancer therapy and, thus, may affect control of the primary disease. Stomatitis may also increase the risk of local and systemic infection and significantly affects the quality of life and the cost of care. The present study was conducted to evaluate the efficacy of two traditional herbal medicines in controlling treatment-induced stomatitis in a small cohort of lung cancer patients treated with afatinib. All patients who were treated with afatinib for epidermal growth factor receptor (EGFR) mutated nonsmallcell lung cancer (NSCLC) between January, 2015 and March, 2016, were included in this study. During the study period, a total of 14 NSCLC patients were treated with afatinib, an EGFR-tyrosine kinase inhibitor (TKI). Two patients already had stomatitis at the time of initiation of afatinib therapy; among the remaining 12 NSCLC patients, 2 (16.7%) developed stomatitis. All the lesions in the 4 patients who developed stomatitis were completely alleviated after 2 weeks of therapy with Aznol mouthwash, a chamomile extract with anti-inflammatory effects, and Hangeshashinto, a traditional herbal (Kampo) medicine. Afatinib therapy was re-initiated, but none of the patients developed stomatitis thereafter. To the best of our knowledge, this is the first report evaluating oral care and management of stomatitis. This type of care and treatment may reduce the incidence of complications associated with EGFR-TKI therapy.

Pancoast's syndrome due to metastatic carcinoma from the stomach

We describe here a case of Pancoasts syndrome due to metastatic carcinoma from the stomach. Although obtaining a tissue diagnosis is often difficult with apical lesions, transbronchial or percutaneous needle biopsy is the procedure of choice since a certain number of these cases are potentially curable.