Takeshi Hanawa

Operation for lung cancer in patients with idiopathic pulmonary fibrosis: surgical contraindication?

BACKGROUND Patients with idiopathic pulmonary fibrosis have an increased incidence of lung cancer. The purpose of this study was to determine the outcome of surgical treatment of lung cancer with idiopathic pulmonary fibrosis. METHODS From January 1992 through December 2001, 64 patients who had simultaneous lung cancer and idiopathic pulmonary fibrosis were treated. Twenty-one (33%) of them underwent surgical resection of lung cancer, and their data were reviewed. RESULTS There were 56 men and 8 women with an average age of 69 years (range, 43 to 85 years). In the surgical group, there were no early postoperative deaths, and nonfatal complications occurred in 2 patients (10%). Among the 14 patients with stage I cancer, a second primary lung cancer developed in 5 (36%). The causes of death in the surgical group were cancer related in 7 patients, exacerbation of idiopathic pulmonary fibrosis in 7, and other in 2. Five of the 7 patients who died of a cancer-related cause had development of a second primary lung cancer. The actuarial 2-year survival rate of the surgical group was 52% overall, 58% for patients with N0 or N1 disease and 25% for those with N2 disease (p = 0.05). CONCLUSIONS The long-term results in one surgical group were poor partly because of the high incidence of a second primary lung cancer and partly because of the poor natural history of idiopathic pulmonary fibrosis. These patients require intensive surveillance even after curative resection of lung cancer.

Synovial Sarcoma of the Mediastinum: Report of a Case

We report a case of synovial sarcoma of the mediastinum, a very rare tumor, in a 50-year-old man hos-pitalized with anterior chest pain. Chest X-ray and computed tomography (CT) on admission showed a 10 × 8-cm mass in the right anterior mediastinal space, compressing the superior vena cava. A diagnosis of sarcoma was established by a CT-guided percutaneous needle biopsy. Systemic examination revealed no metastasis to the contralateral pleural cavity or other distant organs, and we resected the mediastinal sarcoma. Pathological and immunohistochemical analyses confirmed a diagnosis of monophasic synovial sarcoma. The patient is alive with recurrence 9 months after his operation, and is receiving chemotherapy with ifosfamide.

An Amebic Lung Abscess: Report of a Case

Abstract Recently the number of amebiasis cases has increased in Japan. Pleuropulmonary amebiasis is a very rare complication of liver amebiasis. We report herein the case of a 54-year-old man presenting with an amebic lung abscess in his right lower lung. The diagnosis of lung amebiasis was established from a direct examination of the pus in which trophozoites of Entamoeba histolytica were detected. After the oral administration of metronidazole, the laboratory findings improved and he thus underwent a right lower lobectomy. He was discharged without any relapse of infection 20 days after a thoracotomy. We conclude that a protozoan infection should thus be suspected in the case of a pleuropulmonary infection in which several types of antibiotics prove to be ineffective.

Long-Term Survival With Chest Wall Resection and Pulmonary Metastasectomy for Hepatocellular Carcinoma

A case of rib and pulmonary metastases of hepatocellular carcinoma (HCC) successfully treated with transcatheter arterial embolization (TAE) followed by surgery is reported. A 66-year-old male with a history of HCC treated previously with hepatectomy was admitted to our hospital for examination of a chest wall tumor. Before the admission, TAE targeting the chest wall tumor was performed. TAE followed by surgery for postresection metastases of HCC was performed and provided an excellent result with long-term survival. The combination of TAE plus salvage surgery could be an option in select patients with limited disease.

Correlation between Loss of Heterozygosity of p53 Gene and Amplification of Oncogenes in Cases of Resected Lung Cancer.

凍結保存していた切除肺癌組織と同一患者の正常肺組織60例を用いて, p53遺伝子の腫瘍特異的多型性喪失 (LOH) と, myc系, ras系, c-erbB-2遺伝子の増幅について検討した. 対立遺伝子がhomozygote (HOMO) であったのは37例, heterozygote (HETERO) であったのは23例で, このうち7例でLOHを認めた. LOHのあった症例のうち他の癌遺伝子に増幅を認めたのは1例だけであり, HOMO症例では12例 (46%) で他の癌遺伝子の増幅を認めた. LOHは病期別ではI期2例 (8%), IIIA期3例 (19%), IV期2例 (25%) で認め, 組織型別では腺癌5例 (15%), 扁平上皮癌2例 (9%) で認めた. HETERO症例のうち, LOHのあった症例の平均生存期間 (MST) は22カ月, LOHの無かった症例のMSTは19カ月で有意差はなかった. p53のLOHは病期が進むほど増加するが予後との関連性は無く, 組織型との関連性も無かった. 癌遺伝子の増幅はLOHを認めない症例で多くみられた.