Yui Watanabe

A potent anti-angiogenic factor, vasohibin-1, ameliorates experimental bronchiolitis obliterans.

BACKGROUND Bronchiolitis obliterans (BO) is a major cause of morbidity and mortality after lung transplantation. BO is pathologically characterized by neovascularized fibro-obliteration of the allograft airway. A recent study has shown that aberrant angiogenesis during fibro-obliteration contributes to the pathogenesis of BO. Vasohibin-1 (VASH1) has been isolated as a vascular endothelial growth factor-inducible gene in endothelial cells (ECs) that inhibits migration and proliferation of ECs and exhibits anti-angiogenic activity in vivo. PURPOSE This study examines whether VASH1 inhibits fibro-obliteration of the allograft in a murine intrapulmonary tracheal transplantation model. METHOD Tracheal allografts of BALB/c mouse were transplanted into the left lung of recipient C57BL/6J mouse. We performed gene transfer to the recipient lungs using an adenovirus vector encoding human VASH1 (Ad-VASH1) or beta- garactosidase (Ad-LacZ) as the control. Tracheal allografts were harvested and pathological on days 21 and 28. RESULT Ad-VASH1 treatment reduced the vascular area on day 21 (4.6% versus 13.0%, P = .037) and day 28 (5.4% versus 13.4%, P = .022) compared with the control group. This was accompanied by significantly inhibited luminal obliteration of the tracheal allografts in the animals transferred with Ad-VASH1 compared with the control (69% versus 93%, P = .028) on day 21. We were not able to observe this effect on day 28 (92% versus 97%, P = .48). CONCLUSION Transgene expression of VASH1 in the recipient lung significantly attenuated luminal obliteration of the tracheal allograft; this was associated with significantly reduced aberrant angiogenesis in the fibro-obliterative tissue in a murine model intrapulmonary tracheal transplantation.

Right Lower Lobe Autotransplantation for Locally Advanced Central Lung Cancer

A 44-year-old man with locally advanced central lung cancer was treated by right lower lobe lung autotransplantation after pneumonectomy using an extracellular phosphate-buffered solution for cold lung preservation. The advantage of the ex vivo operation made it possible to perform safe and definitive cancer resection without massive bleeding. Cold lung preservation brought some advantages, such as reducing the risk of ischemia-reperfusion injury compared with warm ischemia and allowing enough time to achieve microscopically negative margins. The patient returned to normal life with minimum loss of pulmonary reserve and no recurrence of lung cancer for 6 months.

Lymphangioleiomyomatosis in a Male.

We report a 17-year-old male with a histopathologic diagnosis of lymphangioleiomyomatosis after surgery for a pneumothorax. In general, lymphangioleiomyomatosis has been considered a female-specific disease. However, there are a few lymphangioleiomyomatosis cases reported in males, and our patient is the youngest case reported. Spontaneous pneumothorax occurs most commonly in males in their late teens and early twenties. Histopathologic diagnosis cannot always be performed in young males with pneumothorax. However, simple diagnosis should be avoided, and lymphangioleiomyomatosis should be considered as an underlying disease. This remarkable case provides new and valuable clinical insights into young male pneumothorax.

Pulmonary Metastasectomy 31 Years After Surgery for Renal Cell Carcinoma

An 82-year-old man underwent a left upper lobectomy for a solitary tumor on suspicion of lung cancer. Histopathologic findings of the resected specimen showed clear cell renal cell carcinoma, which was diagnosed as a metastasis from kidney cancer concealed for 31 years after nephrectomy. The Ki-67 labeling index of the metastatic tumor was high (36.1%). A few cases of recurrent renal cell carcinoma after a long interval from initial diagnosis have been seen. However, pulmonary metastasectomy more than 30 years after radical nephrectomy for renal cell carcinoma has not been reported. This remarkable case provides new and valuable clinical insights into metastatic renal cell carcinoma.

A Case of Nontuberculous Mycobacteria Highly Suspected as Lung Cancer Invading the Aortic Arch.

1118 Journal of Thoracic Oncology ® • Volume 10, Number 7, July 2015 CASE PRESENTATION A 65-year-old man presented with cough and hoarseness for 3 months and was admitted to our hospital. Chest computed tomography revealed tumor around the aortic arch. Fluorodeoxyglucose positron emission tomography showed an accumulation in the same area of maximum standardized uptake value of 10.8 (Figs. 1, 2). Although endobronchial ultrasound-guided transbronchial needle aspiration failed to obtain a histological diagnosis, mediastinal type lung cancer with aortic invasion was strongly suspected. Therefore, videoassisted thoracoscopic surgery was conducted. Because of lung adhesions, both the aortic arch and left main pulmonary artery were difficult to identify. Therefore, to avoid aortic injury, biopsy sites were restricted. We obtained two puncture biopsies, but could not obtain a histological diagnosis. Moreover, we could not obtain a diagnosis by permanent specimen. However, polymerase chain reaction using a biopsy specimen revealed the presence of Mycobacterium intracellulare deoxyribonucleic acid. Mycobacterial culture also showed the same result. Thus, we started to treat the patient for nontuberculous mycobacteria (NTM) with clarithromycin 800 mg, rifampicin 450 mg, and ethambutol 750 mg on a daily basis. As shown in Figure 3, the abnormal shadow was significantly improved. Mycobacterium intracellulare is one cause of NTM. Polymerase chain reaction can lead to a rapid confirmation of the pathogen. NTM is an atypical mycobacterial infection that can occur in both immunocompromised and immunocompetent patients. The prevalence of NTM in Japan is 5.7 people for a population of 100,000 people. Every year approximately 1000 human deaths are reported, and the NTM is the disease that we usually see in Japan. As Maekawa et al. already reported, soil exposure is one of the environmental risk factors in immunocompetent patients. As a therapeutic drug for NTM, unlike tuberculosis, multidrug therapy containing clarithromycin or azithromycin, ethambutol and rifamycin is used without using isoniazid. The sputum conversion rate in clarythromycin and azithromycin were 68 and 56%, respectively, and the efficacy is more restrictive than tuberculosis. We experienced a case that was highly suspected as mediastinal type lung cancer invading the aortic arch based on computed tomography images but turned out to be NTM. Not only malignancy but

Detection of alternative subpleural lymph flow pathways using indocyanine green fluorescence

PurposePulmonary lymphatic fluid predominately flows along the bronchi. However, there are reports suggesting that an alternative lymphatic pathway exist, which may result in skip metastases. The aim of this study was to evaluate the subpleural lymph flow in vivo using indocyanine green (ICG) fluorescence.MethodsOne hundred cases were enrolled. ICG was injected into the macroscopically healthy subpleural space. Intraoperative fluorescence images were then observed in real time.ResultsICG fluorescence was observed moving through subpleural channels in 58/100 cases. ICG flowed into adjacent lobes over interlobar lines in 18 cases and flowed from the visceral pleura directly into the mediastinum in 5 cases. The frequency of mediastinal detection without hilar lymph node detection was significantly higher in the left lung compared to the right (p < 0.05). The subpleural lymph flow detection rates were significantly lower in patients with smoking pack-years ≥ 40 than those with < 40 (p < 0.05).ConclusionsThe flow of lymphatic fluid directly into the mediastinum suggests one mechanism of skip metastasis. In addition, the reduction of the subpleural lymph flows in smokers with ≥ 40 pack-years suggests that smoking might modify lymph flow patterns. These findings may assist in selecting the optimal therapy for patients with possible skip metastasis.

Lung abscess mimicking lung cancer developed around staples in a patient with permanent tracheostoma

Abstract A 68-year-old male with a tracheostoma due to hypopharyngeal cancer was admitted because his chest computed tomography (CT) showed a small nodule in the right middle lobe. Following a partial resection of the right middle lobe, histopathological diagnosis of the resected sample was that of organizing pneumonia. Eleven months later, chest CT showed a mass with pleural indentation and spiculation in the right middle lobe. 18-Fluorodeoxyglucose-positron emission tomography showed significant accumulation in the middle lobe tumor mass shadow. The abnormal chest shadow that had developed around surgical staples suggested inadequate resection and tumor recurrence. As the abnormal radiological shadow was enlarging, middle lobectomy was carried out. Histological examination revealed that the tumor was a lung abscess without malignant features. This is a unique case of lung abscess mimicking lung cancer which developed around staples used during partial resection of the lung.

Successful closure of a tracheocutaneous fistula after tracheostomy using two skin flaps: a case report.

A tracheocutaneous fistula may develop when a tracheostomy orifice epithelializes during a prolonged course of healing or undernutrition. Various techniques for closing such fistulae have been reported. However, a standard procedure has not yet been established. We, herein, present a case involving a 35-year-old woman who developed a tracheocutaneous fistula after tracheostomy. We closed the fistula using two skin flaps to cover the tracheal lumen and skin defect, respectively. The advantage of this technique is that it allows the tracheal lumen to be covered by inversed skin epithelium and ensures that the suture line of the skin does not match up with that of the subcutaneous tissue.