Tomohiko Ikeya

Smoking-related changes in the background lung of specimens resected for lung cancer : a semiquantitative study with correlation to postoperative course

Aims:  To assess the pathological findings in lobectomy specimens, to correlate them with smoking history and postoperative course and to compare the findings with those in smoking‐related interstitial lung disease.

Survival After Surgery for Pathologic Stage IA Non-Small Cell Lung Cancer Associated With Idiopathic Pulmonary Fibrosis

BACKGROUND Many problems exist in regard to the treatment of lung cancer patients with idiopathic pulmonary fibrosis (IPF), but few reported studies have investigated the long-term prognosis after pulmonary resection in such patients. The purpose of the present study was to determine the postoperative survival of patients with pathologic stage IA non-small cell lung cancer (NSCLC) and IPF. METHODS We retrospectively reviewed 350 patients with pathologic stage IA NSCLC who underwent pulmonary resections at our institution between September 1994 and December 2007. We analyzed and compared 28 of these patients, who had simultaneous lung cancer and IPF, with the remaining 322 lung cancer patients without IPF. RESULTS The 5-year survival rates were 54.2% in pathologic stage IA lung cancer patients with IPF and 88.3% in those without IPF (p < 0.0001). Univariate analyses showed that age, sex, Brinkman Index, limited resection, operation time, adenocarcinoma, and IPF were significant prognostic factors for survival (p < 0.10). By multivariate analysis, however, only IPF was a significant prognostic factor for survival (p = 0.007). Propensity score-matching analysis confirmed that only IPF was significant prognostic factor (p = 0.043). CONCLUSIONS The 5-year survival rate of patients with pathologic stage IA NSCLC and IPF is 54.2%. IPF has independent, adverse effects on survival of pathologic stage IA NSCLC patients treated with pulmonary resection.

Spontaneous hemorrhage of a thymic cyst in an adult: Report of a case

Mediastinal cysts account for about 19% of all mediastinal masses, and thymic cysts represent only about 1.5% of anterior mediastinal masses. Thymic cysts do not usually cause symptoms and are often found incidentally on routine chest radiography. We report the case of a thymic cyst that hemorrhaged into the mediastinum and the right pleural cavity, causing chest pain. The patient, a 55-year-old man, underwent emergency surgical resection and recovered uneventfully.

Placental Transmogrification of the Lung Presenting as a Small Solitary Nodule

Placental transmogrification of the lung is a rare cystic lesion of the lung, which has some histologic resembling to placental tissue. Placental transmogrification of the lung has been considered a variant of unilateral bullous emphysema, but in our case, the patient was a 47-year-old man who had no coexisting emphysema of the lung. Histologically our case showed an interstitial proliferation of clear cells with cystic change interpreted as secondary; we also agree with our colleagues that this proliferation may be the primary event pathogenetically. Surgical resection of this lesion seems to be curative.

Second Primary Digestive Cancer After Resection of Lung Cancer

PurposeWe evaluated the clinical findings of patients with second primary digestive cancers (SPDC) after the resection of lung cancer.MethodsAmong 772 patients who underwent resection of primary lung cancer at Saitama Cardiovascular and Respiratory Center between 1993 and 2002, 10 (1.3%) were diagnosed with SPDC during follow-up. These ten patients were classified into two groups based on whether the SPDC was incidentally (group I) or symptomatically (group S) diagnosed.ResultsThe median interval to the detection of SPDC was 17 months in group I and 66 months in group S, and the disease was at an earlier stage in group I than in group S (P = 0.008). Comparing body weight at the time of lung resection to that at the time of abdominal surgery, significant weight loss was evident in group S (P = 0.009). The postoperative disease-specific survival rate was 100% in group I. No long-term survivor died of lung cancer.ConclusionSpecial attention must be paid to the possibility of SPDC after the resection of lung cancer to improve the prognosis of patients with lung cancer.

A clinicopathological study of surgically resected lung cancer in patients with usual interstitial pneumonia

BACKGROUND The clinicopathological characteristics of lung cancer with concomitant usual interstitial pneumonia (UIP) are insufficiently understood. This study aimed to elucidate a characteristic pathological feature of lung cancer that develops in patients with UIP, with a focus on the location of its onset. METHODS We reviewed surgically obtained specimens, including 547 tumors from 526 patients who underwent lobectomy for lung cancer. Surveyed patients were classified into three groups: patients with UIP (UIP group), patients with lung pathology other than UIP (non-UIP group), and patients without any associated lung pathology (normal group). The histology as well as the lobe and location of the onset of lung cancer were compared among these groups. The peripheral location was subdivided into subpleural, inner and tumor involved centrally secondary to extension. RESULTS The UIP group comprised 82 patients (male, 71 [87%]; mean age, 71 years; smoking rate, 94%), the non-UIP group comprised 334 patients (male, 267 [80%]; mean age, 69 years; smoking rate, 81%), and the normal group comprised 110 patients (male, 33 [30%]; mean age, 63; smoking rate, 29%). No statistical differences were noted in sex, mean age, or smoking index between the UIP and non-UIP groups. Compared with the non-UIP group, the frequency of squamous cell carcinoma (63% vs. 32%), lower lobe origin (76% vs. 32%), and subpleural location (24% vs. 5%) were significantly higher in the UIP group. CONCLUSIONS Lung cancers in patients with UIP show a predilection for the subpleural region, where UIP is also thought to originate.

Acute ischaemic lung injury due to pulmonary vascular obstruction

We have encountered cases of a distinctive myxomatous alveolar wall thickening around pulmonary infarctions, and have termed it ‘acute ischaemic lung injury’ (AILI). In this study we determined if pulmonary infarction is the only cause of AILI and have elucidated its histological features.

A Case of A Long Survival After Resection of A Large Cell Lung Carcinoma Invading the Diaphragm.

背景. 横隔膜に浸潤した肺癌の治療成績は, 一般に不良である. 我々は, 長期生存している横隔膜に浸潤した肺大細胞癌症例を経験したので報告する. 症例. 症例は61歳の男性で血痰を主訴として来院した. 胸部単純写真では左下肺野に心陰影と重なり径5cm大の腫瘤影を認めた. 胸部CTと胸部MRIでは横隔膜への直接浸潤像を認めた. 気管支鏡下の生検で悪性細胞を確認し, 左下葉切除術, 横隔膜・脾臓合併切除術, ND2aリンパ節郭清術を施行した. 術後病理診断は大細胞癌で, リンパ節転移を認めず, pT3N0M0であった. 術後5年目に第2癌 (腺癌) に対して右肺下葉部分切除術を施行した. 結論. 初回手術から6年6ヶ月経過した現在, 再発の所見なく元気に社会生活を送っており, 横隔膜合併切除術が有用であった.