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BACKGROUND: Although lobectomy is the standard surgical procedure for non-small cell lung cancer (NSCLC), recent studies show favorable outcomes after limited resection in patients with small-sized peripheral tumors. We conducted a randomized controlled trial of such patients to estimate postoperative outcomes and pulmonary function following these surgical techniques. METHODS: Between 2005 and 2008, eligible patients with tumors of 2 cm or less were randomly assigned 1:1 to undergo lobectomy or limited resection; 32 and 33 NSCLC patients in each group, respectively, were analyzed. The primary end points were 5-year overall survival (OS) and disease-free survival (DFS), while the secondary end points were postoperative pulmonary function including forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1). RESULTS: The 5-year OS rates were 93.8% and 90.9% in the lobectomy and limited resection groups, respectively (P=0.921). The 5-year DFS rates were 93.8% and 90.9% in the lobectomy and limited resection groups, respectively (P=0.714). These rates did not differ significantly between the two resection groups. The median postoperative/preoperative FVC ratios were 84.1% and 90.0% in the lobectomy and limited resection groups, respectively, while the median postoperative/preoperative FEV1 ratios were 81.9% and 89.1%, respectively. Both ratios were significantly higher in the limited resection group (P=0.032 and P=0.005 for FVC and FEV1 ratios, respectively). CONCLUSIONS: A similar outcome, with more preserved postoperative pulmonary function, was observed in patients who underwent limited resection compared to those who underwent lobectomy. Ongoing large-scale multi-institutional prospective randomized trials of lobar versus sublobar resection in patients with small peripheral NSCLCs will hopefully provide definitive information about intentional limited resection of small peripheral tumors.

DOI： 10.21037/jtd.2016.11.106

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OBJECTIVES: Combined pulmonary fibrosis and emphysema (CPFE) is a unique disorder. The aim of this study was to compare the surgical outcomes of lung cancer patients with CPFE and those with idiopathic pulmonary fibrosis (IPF) without emphysema. METHODS: A total of 1548 patients who underwent surgery for primary lung cancer between January 2001 and December 2012 were retrospectively reviewed. RESULTS: Of the 1548 patients, 55 (3.6%) had CPFE on computed tomography (CT), and 45 (2.9%) had IPF without emphysema. The overall and disease-free 5-year survival rates for patients with CPFE were not significantly worse than those for patients with IPF without emphysema (24.9% vs. 36.8%, p = 0.814; 39.8% vs. 39.3%, p = 0.653, respectively). Overall, 21 (38.1%) patients with CPFE and nine patients (20.0%) with IPF without emphysema developed postoperative cardiopulmonary complications. Patients with CPFE had significantly more postoperative cardiopulmonary complications involving pulmonary air leakage for >6 days, hypoxemia, and arrhythmia than patients with IPF without emphysema (p = 0.048). CONCLUSIONS: There was no significant difference in survival after surgical treatment between CPFE patients and IPF patients without emphysema, but CPFE patients had significantly higher morbidity than IPF patients without emphysema.

DOI： 10.5761/atcs.oa.15-00315

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BACKGROUND: The indication for limited resection of radiologically pure solid non-small cell lung cancer (NSCLC) is controversial owing to its invasive pathologic characteristics. This study was performed to compare the outcomes after lobectomy and segmentectomy in these NSCLC patients. METHODS: We retrospectively reviewed 251 patients with radiologically pure solid cT1a N0 M0 NSCLC who underwent lobectomy or segmentectomy, and the preoperative characteristics of the patients treated with the two operative techniques were matched using propensity score methods. Overall survival (OS) and disease-free survival (DFS) curves were compared using the log rank test, and differences in survival were also evaluated by the McNemar test. The preoperative factors and surgical procedure were analyzed with the multivariate Cox proportional hazards regression model to identify independent predictors of poor OS and DFS. RESULTS: In the propensity score matched lobectomy and segmentectomy groups (87 patients per group), the 5-year and 10-year OS rates were 85% versus 84% and 66% versus 63%, respectively; and the 5-year and 10-year DFS rates were 80% versus 77% and 64% versus 58%, respectively. There were no significant differences between the two groups in OS or DFS by the log rank test, and also no significant differences in 3-year, 5-year, or 7-year OS or DFS by the McNemar test. Although age, smoking status, pulmonary function, and carcinoembryonic antigen were identified as significant predictors of both OS and DFS, the surgical procedure was not identified. CONCLUSIONS: Similar oncologic outcomes after lobectomy and segmentectomy were indicated among patients with radiologically pure solid small-sized NSCLC.

DOI： 10.1016/j.athoracsur.2015.10.048

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Ectopic adrenocorticotrophic hormone (ACTH)-producing bronchopulmonary carcinoid arising in a bronchopulmonary sequestration is extremely rare. The case of a 67-year-old woman with a 1.7-cm nodule in the mediastinal side of the left lower lobe is presented. At 52 years of age, she was diagnosed as having ACTH-dependent Cushing's syndrome (CS). However, no ectopic source of ACTH-secretion was detected. Seven years later, she underwent a bilateral adrenalectomy because of aggravation of her health condition. This time, tumor excision was performed by thoracoscopic surgery. The tumor adhered sparsely to the mediastinal pleura and the left lower lobe and was bluntly separated from these tissues. Pathologically, the tumor was a typical carcinoid arising in an extralobar pulmonary sequestration. Immunohistochemical staining confirmed the secretion of ACTH by bronchopulmonary carcinoid tumor cells. After surgery, the serum ACTH level was almost normalized, and the dexamethasone (1 mg) suppression test showed significant suppression of ACTH.

DOI： 10.1177/1066896915605615

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INTRODUCTION: Parathyroid adenomas are the most common cause of primary hyperparathyroidism. However, cases of parathyroid adenomas greater than 4cm with osteitis fibrosa cystica are extremely rare. Herein, we report a case of resection of a large ectopic mediastinal parathyroid adenoma. CASE PRESENTATIONS: A 46-year-old female with chief complaints of bone pain and gait disturbance was referred to our hospital. Physical examination revealed many mobile teeth in her oral cavity, distortion of the vertebral body, and bowlegs. Laboratory tests showed hypercalcemia, hypophosphatemia, and elevated serum levels of intact parathyroid hormone. Chest CT revealed a 42-mm well-defined, enhancing mass in front of the left-sided tracheal bifurcation. Her findings were diagnosed as primary hyperparathyroidism due to an ectopic mediastinal parathyroid tumor. We performed a median sternotomy and resected the tumor. The tumor was a solid, yellowish-brown mass measuring 42×42 mm. Pathologically, the tumor consisted mainly of chief cells with some oxyphil cells; there were no necrotic areas or nuclear atypia, and few mitotic figures. We diagnosed the tumor as an ectopic mediastinal parathyroid adenoma. Eight months after the resection, her serum calcium, phosphorus, and intact PTH levels were normal. DISCUSSION AND CONCLUSIONS: Parathyroid adenomas and parathyroid carcinomas have disparate natural histories, but they can be difficult to differentiate on the basis of preoperative clinical characteristics. We believe that long-term follow-up of these cases is required because there have been few reports on the postoperative natural history of large parathyroid adenomas.

DOI： 10.1016/j.ijscr.2016.04.007

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Language：Japanese   Publishing type：Research paper (scientific journal)  

The surgical strategy for coexisting lung cancer and aneurysm is controversial owing to the risk of aneurysm rupture during the perioperative period of pulmonary resection. We performed simultaneous pulmonary resection and endovascular repair in 2 patients with coexisting lung cancer and aneurysm. Case 1:A 74-year-old man presented at our hospital with cT2aN0M0 lung cancer and a 5.0 cm abdominal aortic aneurysm. Because computed tomography indicated the possibility of advanced lung cancer, we decided to perform simultaneous surgery for lung cancer and the aneurysm. Under general anesthesia, endovascular aneurysm repair was performed before right lower lobectomy with lymphadenectomy. The postoperative course was uneventful, and the patient was discharged on postoperative day 12. Case 2:A 72-year-old man presented at our hospital with cT2aN1M0 lung cancer, a 5.0 cm left internal iliac artery aneurysm, and right renal cell carcinoma( RCC). Because the lung cancer was advanced and the patients needed following surgical treatment for RCC, we decided to perform simultaneous surgery for lung cancer and the aneurysm. Under general anesthesia, endovascular aneurysm repair was performed before right upper lobectomy with lymphadenectomy. The postoperative course was uneventful, and the patient was discharged on postoperative day 11.

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OBJECTIVES: To assess the prognostic value of combined evaluation of preoperative CT findings and pre/postoperative serum carcinoembryonic antigen (CEA) levels for pathological stage I lung adenocarcinoma. METHODS: This retrospective study included 250 consecutive patients who underwent complete resection for ≤ 3-cm pathological stage I (T1-2aN0M0) adenocarcinomas (132 men, 118 women; mean age, 67.8 years). Radiologists evaluated following CT findings: maximum tumor diameter, percentage of solid component (%solid), air bronchogram, spiculation, adjacency of bullae or interstitial pneumonia (IP) around the tumor, notch, and pleural indent. These CT findings, pre/postoperative CEA levels, age, gender, and Brinkman index were assessed by Cox proportional hazards model to determine the best prognostic model. Prognostic accuracy was examined using the area under the receiver operating characteristic curve (AUC). RESULTS: Median follow-up period was 73.2 months. In multivariate analysis, high %solid, adjacency of bullae or IP around the tumor, and high postoperative CEA levels comprised the best combination for predicting recurrence (P<0.05). A combination of these three findings had a greater accuracy in predicting 5-year disease-free survival than did %solid alone (AUC=0.853 versus 0.792; P=0.023), with a sensitivity of 85.7% and a specificity of 74.3% at the optimal threshold. The best cut-off values of %solid and postoperative CEA levels for predicting high-risk patients were ≥ 48% and ≥ 3.7 ng/mL, respectively. CONCLUSION: Compared to %solid alone, combined evaluation of %solid, adjacency of bullae or IP change around the tumor, and postoperative CEA levels improves recurrence prediction for stage I lung adenocarcinoma.

DOI： 10.1016/j.ejrad.2014.10.009

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Few reports have described surgical resection for second primary lung cancers originating close to the initial surgical margin for lung cancer. A 64-year-old man had undergone left segmentectomy with lymph node dissection for small peripheral squamous cell lung cancer using video-assisted thoracic surgery, with pathology confirming a small tumor 12 mm in diameter identified about 3 cm from the surgical margin. Eighteen months after initial surgery, computed tomography revealed a 30 mm pulmonary nodule close to the initial surgical margin in the residual left upper lobe and the serum level of carcinoembryonic antigen was found to be increased. Local recurrence on the staple-line of the surgical margin was suspected, and completion left upper lobectomy was performed. Histological examination identified not only a squamous cell carcinoma component but also a small cell carcinoma component. The immunohistochemical staining pattern of the second tumor differed from that of the initial resected lung squamous cell carcinoma. The final pathological diagnosis was a second primary tumor with mixed small cell carcinoma and squamous cell carcinoma histology.

DOI： 10.1155/2015/462193

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 65-year-old male with end stage renal failure due to IgA nephritis commenced continuous ambulatory peritoneal dialysis (CAPD). Three weeks after initiation of CAPD, right hydrothorax developed. Then, we strongly assumed pleuroperitoneal communication( PPC) although the pleural effusion did not show high concentration of glucose. He underwent thoracoscopic surgery for PPC. On the inner, central tendons part of the diaphragm, there were a few blebs. One hour after 3 l of peritoneal dialysis solution containing 15 ml indigocarmine was instilled into the abdomen through a CAPD catheter, the blebs were tense and colored blue by the dye solution. The blebs were directly sutured and diaphragm was covered by polyglycolic acid sheet and fibrin glue all over. Since then, he resumed CAPD, without recurrence of hydrothorax. Then we investigated the treatment outcome of video-assisted thoracic surgery (VATS) for PPC in Japan. The outcome was poorer in cases in which communication was not detected intraoperatively. These patients should be given sufficient consideration for surgical procedure.

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Language：Japanese   Publisher：日本胸部外科学会-関東甲信越地方会  

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Language：Japanese   Publisher：(NPO)日本肺癌学会  

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Language：Japanese   Publisher：(NPO)日本肺癌学会  

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Language：Japanese   Publisher：(NPO)日本肺癌学会  

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Language：Japanese   Publisher：(NPO)日本呼吸器外科学会  

間質性肺炎(IP)合併肺癌手術例における肺動脈圧評価による術後IP急性増悪予測の可能性につき検討した。2001-12年に術前画像上IPを認めた肺癌切除例53例を対象とし、CT上肺動脈径(PA径)、肺動脈径/大動脈径比(PA/Ao比)、また、術前心エコーを行った14例では、推定肺動脈圧による肺動脈圧評価を行った。術後急性増悪を認めたAE(+)群5例と、認めなかったAE(-)群48例に分けて比較検討した。術前CT上PA径、PA/Ao比は2群間で差を認めなかったが、IPなしの対照症例と比較しPA径、PA/Ao比ともIP合併例で有意に高値であり、また、急性増悪後のPA径の拡大、PA/Ao比の増加が示された。心エコーによる推定肺動脈圧はAE(+)群で有意に高値であった。IP合併肺癌におけるCT上PA径、PA/Ao比の継時的変化の評価、心エコーでの肺動脈圧評価による術後急性増悪予測の可能性が示された。(著者抄録)

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J02256&link_issn=&doc_id=20130723260005&doc_link_id=10.2995%2Fjacsurg.27.562&url=https%3A%2F%2Fdoi.org%2F10.2995%2Fjacsurg.27.562&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(公社)日本医学放射線学会  

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器内視鏡学会  

DOI： 10.18907/jjsre.34.Special_S139_3

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器内視鏡学会  

DOI： 10.18907/jjsre.34.1_89

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器内視鏡学会  

DOI： 10.18907/jjsre.34.4_408_2

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AIMS: To investigate TTF-1-negative pulmonary adenocarcinoma, focusing upon mucin production and the expression of hepatocyte nuclear factor-4α (HNF4α). MATERIALS AND METHODS: Two hundred and sixty-two cases of pulmonary adenocarcinoma were examined histologically and immunohistochemically; TTF-1 was expressed in 222 cases (84.7%), and 40 cases (15.3%) were negative. Among TTF-1-negative cases there were 31 mucinous-type tumours, and HNF4α, MUC5AC and MUC2 were expressed in 34 cases (85%), 29 cases (72.5%) and four cases (10%), respectively. In contrast, their expression was rare in TTF-1-positive tumours. A statistically inverse correlation was confirmed between the expression of TTF-1 and that of HNF4α and MUC5AC. CONCLUSION: Most TTF-1-negative pulmonary adenocarcinomas are mucinous lesions with the predominant expression of HNF4α and MUC5AC.

DOI： 10.1111/j.1365-2559.2011.03764.x

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器内視鏡学会  

DOI： 10.18907/jjsre.33.1_63_1

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器内視鏡学会  

DOI： 10.18907/jjsre.33.4_297_2

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器内視鏡学会  

DOI： 10.18907/jjsre.33.Special_S128_4

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We performed a retrospective review of 45 consecutive patients with metachronous multiple primary lung cancer who underwent resection between 1990 and 2009. Surgical treatment of the 1st tumor consisted of 39 lobectomies and 3 segmentectomies, and 3 wedge resections. The 2nd tumor was removed by means of a lobectomy in 9 patients, a segmentectomy in 17 patients, a wedge resection in 19 patients. No postoperative mortality was observed. Histologic classification was similar in 86.4% of patients and different in 13.6%. Postoperative stage of the 2nd tumor was IA in 31 patients, IB in 7, IIA in 1, IIIA in 3, IIIB in 3. Median follow-up was 48.4 months after 2nd operation. The 5-year survival rate was 90.8% after 1st operation and 85.6% after 2nd operation. The 5-year survival rate in patients with p-stage IA was 96.4%. Patients with metachronous lung cancer could have a favorable outcome. Thus we need careful follow-up of the patients after treatment on the 1st lung cancer, and moreover an aggressive surgical treatment is recommended as long as their performance state or residual pulmonary function allows.

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Thymic carcinoma is a rare tumor. The most common histological subtype is squamous cell carcinoma, and only a few cases of thymic adenocarcinoma have been reported. A case of papillary adenocarcinoma of thymic origin that coexisted with type AB thymoma as a separate nodule is presented herein. The patient was found to have an abnormal mediastinal shadow on chest X-ray. A computed tomography scan revealed a round, 6.5-cm-diameter mass in the right anterior mediastinum. The preoperative diagnosis was thymoma, and thymothymectomy was performed. On pathological examination, two tumors, which were diagnosed as papillary adenocarcinoma and type AB thymoma, respectively, were present in the thymus without any connection with each other. The patient has been alive without any signs of recurrence for 11 years after surgery. We diagnosed the adenocarcinoma in this case was a primary thymic carcinoma.

DOI： 10.1007/s11748-009-0580-4

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We analyzed relationships between histological subtypes of pulmonary adenocarcinomas and three gene alterations (p53, K-ras, and epidermal growth factor receptor gene), or thyroid transcription factor-1 (TTF-1) expression, and also studied prognoses by the subtypes, with or without combined multiple gene mutation status. Our purpose was to clearly determine pathogenesis, along with the best predictive value for biology and therapy-related traits. A total of 223 consecutively resected pulmonary adenocarcinomas were sub-classified using either the World Health Organization (WHO) or our five-cell type (FCT) classification system (hobnail, columnar/cuboidal, mixed, polygonal/oval, and goblet cell types). DNAs extracted from frozen samples of the adenocarcinomas were examined for gene alterations, and TTF-1 expressions were determined using immunohistochemistry. Next, relationships among the various data and clinicopathological factors were analyzed. The most striking result was: while almost 70% of adenocarcinomas were sub-classified as a mixed subtype by WHO, the FCT classified many of them as other cell subtypes. The FCT closely reflected differences in etiological factors, cellular lineages, and frequencies of gene mutations; and whether the data from combined gene mutations were used or not, differences among the cell types in postoperative survivals appeared. In contrast, subtypes of WHO did not show any association with the gene alteration or prognosis, and the FCT more suitably indicated sensitivity to gefitinib therapy than did WHO. The FCT combined with multiple gene mutation status appears to be useful in indicating pathogenesis and predicting the biological nature of pulmonary adenocarcinomas, and it could facilitate development of new therapies for each subtype.

DOI： 10.1111/j.1349-7006.2010.01585.x

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Language：Japanese   Publisher：The Japanese Association for Chest Surgery  

Thymic carcinoid is a rare tumor. A case of atypical carcinoid of the thymic is presented. A 77-year-old man, who was found to have an abnormal mediastinal shadow on a chest radiograph, was admitted. A computed tomography scan revealed a 16-cm mass shadow, which was hypervascular, in the anterior mediastinum. Tumor resection was performed through a median sternotomy. The phrenic nerve was resected due to tumor invasion. The histopathological diagnosis was an atypical carcinoma of the thymus. After the operation, the patient received radiation therapy (60 Gy) to the mediastinum. He has been well without any sign of recurrence for 2 and half years after surgery and irradiation treatment.

DOI： 10.2995/jacsurg.24.674

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Other Link： http://search.jamas.or.jp/link/ui/2010208821

Language：Japanese   Publisher：The Japanese Association for Chest Surgery  

Sleeve segmentectomy for central-type squamous cell carcinoma of the lung was performed in three patients with impaired lung function. All patients were male, and their preoperative FEV<SUB>1.0</SUB> (FEV<SUB>1.0%</SUB>) was 1,070 ml (37.8%), 1,020 ml (41.0%), and 1,240 ml (51.2%), respectively. Since the predicted postoperative FEV<SUB>1.0</SUB> after lobectomy was estimated to be less than 700 ml/m<SUP>2</SUP> in each case, sleeve segmentectomy was performed to preserve the lung function as much as possible. The surgical procedures were S<SUP>6</SUP> segmentectomy with bronchoplasty, sleeve segmentectomy of the left superior segment, and sleeve segmentectomy of the left apical segment (S<SUP>1+2</SUP>). The pathological stage was I B, II B, and I A. Two patients were alive without any evidence of recurrence fifty and eighty-one months after surgery. One patient died of gastric cancer without the recurrence of lung cancer.

DOI： 10.2995/jacsurg.24.229

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器内視鏡学会  

DOI： 10.18907/jjsre.32.1_84_4

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器内視鏡学会  

DOI： 10.18907/jjsre.32.Special_S163_2

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We report a 20-year-old woman who underwent complete resection of a granular cell tumor (GCT). On chest computed tomography (CT) scan, a mass with a maximum diameter of 36 mm at the lower bronchus with atelectasis of the right lower lobe was noted. Bronchoscopic examination revealed a whitish mass in the truncus intermedius, and the middle and lower bronchus were unable to be seen. A cytopathological examination of the mass revealed GCT. A right middle and lower lobectomy was performed via a posterolateral thoracotomy. Microscopically, the tumor was composed of polygonal cells with oxyphilic granular cytoplasm and small ovoid nuclei. The cytoplasm of the neoplastic cells was positive for S-100 protein and neuron-specific enolase. The patient's postoperative course was uneventful, and she was asymptomatic after 4 months. A large bronchial GCT is rare, which is why we report this case.

DOI： 10.1007/s11748-009-0428-y

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Language：Japanese   Publisher：(一社)日本移植学会  

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The enzymes thymidylate synthase (TS), dihydropyrimidine dehydrogenase (DPD) and orotate phosphoribosyl transferase (OPRT) are involved in the metabolism of the anticancer drug 5-fluorouracil (FU). Expression of TS, DPD and OPRT in cancer tissue has been reported to be associated with sensitivity and/or resistance to 5-FU therapy. However, the role of TS, DPD and OPRT expression in lung cancer has not been fully established. Furthermore, among several measuring methods, it is not clear which method effectively predicts the response to 5-FU therapy. The aim of this study was to analyze the expression of 5-FU-related enzymes using enzyme-linked immunosorbent assay (ELISA) and to examine the correlation of ELISA and the results obtained using different measuring methods such as reverse transcript polymerase chain reaction (RT-PCR), immunohistochemistry, and enzymatic activity. Lung cancer specimens were obtained from 134 patients who underwent curative resection for lung cancer. As a pilot study, enzyme expression of 11 samples was measured using 4 different methods for DPD: RT-PCR, immunohistochemistry, enzymatic activity and ELISA. The relationships between pairs of results were compared, and then enzyme protein expression was measured using ELISA in 119 patients with adenocarcinoma. Of the 4 independent methods, the highest correlation was observed between protein expression measured by ELISA and enzyme activity. The correlation of gene expression and ELISA was also significant. The protein level in stage I adenocarcinoma measured using ELISA was 13.0+/-24.8 ng/mg protein for TS, 362.2+/-264.3 ng/mg protein for DPD and 4.5+/-2.0 ng/mg protein for OPRT. The predictive value of the enzymes for prognosis and the effectiveness of 5-FU was not determined as few recurrences were observed during the short follow-up period. In conclusion, ELISA is a simple and reliable method to measure key enzymes related to 5-FU therapy.

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Language：Japanese   Publisher：(NPO)日本呼吸器外科学会  

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We performed a right upper lobectomy with prosthetic replacement of the superior vena cava (SVC) through a posterolateral thoracotomy in a 65-year-old man undergoing complete resection of a locally advanced non-small-cell lung cancer with invasion of the SVC. Instead of using a vascular shunt, the right atrium and a right brachiocephalic vein (BCV) were anastomosed using a ringed polytetrafluoroethylene (PTFE) graft. During the anastomosis, vascular flow was maintained through the left BCV. By using this technique, SVC resection and reconstruction during lung cancer surgery can be safely performed through a posterolateral thoracotomy without blood flow interruption.

DOI： 10.1007/s00595-008-3927-z

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器内視鏡学会  

DOI： 10.18907/jjsre.31.1_43_2

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器内視鏡学会  

DOI： 10.18907/jjsre.31.Special_S99_2

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DOI： 10.18907/jjsre.31.4_266_1

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BACKGROUND: Overexpression of KIT, a tyrosine kinase receptor protein encoded by the proto-oncogene c-kit, is observed in human neoplasms such as gastrointestinal stromal tumors (GISTs), myeloproliferative disorders, melanoma and seminoma. In patients with GIST, overexpression of mutated KIT within the tumor is predictive of response to molecular targeted therapy using imatinib. However, the role of KIT expression in thymic carcinoma is not fully understood. METHODS: Thymic epithelial tumors from 37 patients (17 thymic carcinomas and 20 thymomas) were examined. Immunohistochemical staining with anti-KIT polyclonal antibody and anti-CD5 was performed. Mutation analyses in the juxtamembrane domains, exons 9 and 11, and in the tyrosine kinase domains, exons 13 and 17, were undertaken using polymerase chain reaction (PCR) and direct DNA sequencing in KIT-positive samples. RESULTS: KIT- and CD5-positive staining was observed only in thymic carcinoma. Percentage of positive staining was 100% in squamous cell carcinoma, with no positive staining in other histologies, including atypical carcinoid. Mutation analysis of the KIT gene was performed in 11 squamous cell carcinomas, 1 adenocarcinoma and 1 adenosquamous cell carcinoma. None of the tested samples showed mutations in any of the four exons. CONCLUSIONS: Squamous cell carcinoma of the thymus frequently expressed KIT and CD5 proteins, whereas other tumors did not. Unlike GIST, overexpression of KIT does not necessarily indicate gene mutation in thymic carcinoma. KIT and CD5 appear useful for evaluating and subtyping thymic epithelial tumors.

DOI： 10.1016/j.lungcan.2008.03.035

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Language：Japanese   Publisher：日本胸部外科学会-関東甲信越地方会  

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During follow-up of patients after primary lung cancer resections, small nodules or ground-glass opacities (GGOs) are sometimes detected on chest computed tomography. We report a case with multiple GGOs that were noted after primary lung cancer resection. A 76-year-old woman, who had undergone right upper lobectomy, middle lobe partial resection, and mediastinal lymph node dissection 3 years earlier, was admitted owing to five GGOs in the right lower lobe that had been increasing in size or density. A right S6+10 segmentectomy was performed. On histology, one adenocarcinoma and four bronchioloalveolar carcinomas (BACs), as well as two additional BACs that had not been detected preoperatively, were identified. No complications occurred postoperatively. Three years 4 months later, no tumor recurrence or new lesions have been found. Given the high possibility of malignancy, the appearance of new GGOs in patients with a history of lung cancer requires appropriate investigation.

DOI： 10.1007/s11748-008-0257-4

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Language：Japanese   Publishing type：Research paper (scientific journal)  

DOI： 10.2482/haigan.48.339

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Language：Japanese   Publisher：日本胸部外科学会-関東甲信越地方会  

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Language：Japanese   Publisher：The Japanese Association for Chest Surgery  

We report a case of osteomyelitis on the anterior chest wall after resection and radiation therapy for breast cancer. A 65-year-old woman underwent radical mastectomy with postoperative irradiation for breast cancer 24 years ago. A radiation-induced ulcer on the right anterior chest wall was noted. About 2 years ago, a full-thickness ulcer with rib exposure developed, and bleeding was seen 3 months ago, and so she was admitted to our hospital. Anterior chest wall resection and reconstruction using a latissimus dorsi myocutaneous flap was performed. She is currently well without any evidence of recurrence.

DOI： 10.2995/jacsurg.22.705

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Other Link： http://search.jamas.or.jp/link/ui/2008239085

Language：English   Publishing type：Research paper (scientific journal)  

A total of 297 resected Japanese non-small cell lung cancers (74 squamous cell carcinomas and 223 adenocarcinomas) were analyzed to evaluate the validity of the p53 mutation spectrum as a fingerprint for mutagenic substances as etiological factors. Frequencies of G-->T transversions in smokers were significantly higher than in non-smokers (P = 0.003) and the average incidence of G-->T at hot spot codons of adduct formation was higher than that in other codons in smokers and in the hot spots in non-smokers. Further, the mutation showed a marked strand bias. G-->A transitions at CpG sites (CpG-->CpA) were equally distributed in smokers and non-smokers, and on both strands. A-->G transitions did not show any variation with smoking status in terms of frequency, but exhibited a marked strand bias. Taken together, the G-->T may be a fingerprint of direct mutagenic action of tobacco-related compounds, the A-->G being a new marker for other environmental chemicals, while the CpG-->CpA may be attributable to endogenous spontaneous mutation, for active in lung carcinogenesis.

DOI： 10.1111/j.1349-7006.2007.00686.x

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Language：Japanese   Publisher：(一社)日本移植学会  

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器内視鏡学会  

DOI： 10.18907/jjsre.30.Special_S135_3

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器外科学会  

DOI： 10.2995/jacsurg.22.378_4

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器外科学会  

DOI： 10.2995/jacsurg.22.542_2

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器外科学会  

DOI： 10.2995/jacsurg.22.520_4

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器外科学会  

DOI： 10.2995/jacsurg.22.523_2

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器外科学会  

DOI： 10.2995/jacsurg.22.461_4

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Language：Japanese   Publisher：The Japan Society for Respiratory Endoscopy  

Background. Spontaneous hemopneumothorax is a rare clinical entity, defined as the accumulation of blood in the pleural cavity in association with spontaneous pneumothorax. Since over 30% of spontaneous hemopneumothorax develops hemorrhage shock, early diagnosis and treatment is required. Case. We report 2 cases of spontaneous hemopneumothorax. A 20-year-old man (Case 1) and a 29-year-old man (Case 2) presented at our hospital with right-sided chest pain and dyspnea. After tubal thoracostomy, collapsed lung was not reinflated in Case 1 and bloody fluid was drained continuously in Case 2. So the patients eventually underwent emergency VATS. Results. In both cases, damaged aberrant vessels between the bullae and apical portion of the parietal pleura was noted. Bullectomy and clipping of the aberrant vessels were performed. The postoperative course was uneventful. Conclusion. Spontaneous hemopneumothorax consists of 3% of pneumothorax. It has the risk of hemorrhage shock due to massive bleeding. Therefore, prompt diagnosis and treatment are essential for this life-threatening condition.

DOI： 10.18907/jjsre.30.5_278

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器内視鏡学会  

DOI： 10.18907/jjsre.30.4_235_2

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Language：Japanese   Publisher：(一社)日本移植学会  

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: To assess the benefit of video-assisted thoracic surgery (VATS), we compared time-related quality of life (QOL) after lobectomy performed by VATS to that performed by thoracotomy. METHODS: Thirty-three patients underwent surgery for lung cancer during the period April 2001 through November 2002 completed a mailed questionnaire after surgery. RESULTS: Over time, improved QOL was reported in six dimensions by VATS patients but in only two dimensions by thoracotomy patients. There was significant improvement in bodily pain subscores in both groups during the 36 months after surgery. At 3 months after surgery, QOL scores for all eight dimensions were lower in the VATS group, but QOL scores for all eight dimensions did not differ significant between groups at 3 or 12 months after surgery. At 36 months after surgery, QOL scores for six dimensions were higher in the VATS group, and the difference was significant in scores for two dimensions. CONCLUSION: We found recovery was quicker in patients who underwent VATS than in those who underwent thoracotomy.

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Treatment of concomitant severe coronary artery disease and lung cancer is a complicated issue. The present study describes a case of a 65-year-old man with coronary artery disease and primary lung cancer that was successfully treated with lung resection and percutaneous coronary intervention (PCI) using Cypher stents. Prior to lung resection, the patient underwent a PCI for diffuse stenosis of the right coronary artery and the circumflex artery. Cypher stents were deployed for both lesions. Five days after stent implantation, a right lower lobectomy was performed successfully. To the best of our knowledge, this is the first report of lung resection and PCI using Cypher stents.

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Language：Japanese   Publisher：(一社)日本移植学会  

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Language：Japanese   Publisher：The Japanese Association for Chest Surgery  

We report a case of pulmonary cryptococcosis in a renal transplant recipient. A 53-year-old woman with living kidney transplantation had been receiving immunosuppressive therapy with tacrolimus and methylprednisolone. During a regular checkup, a nodular shadow was detected on her chest X-ray film. The chest CT scan revealed a solid nodule in the region of rt. S<SUP>2</SUP> and showed a slightly increased diameter during follow-up. FDG-PET demonstrated an accumulation corresponding to the lesion with an SUV of 3.7 at 60min and 4.2 at 120min post-injection, indicating a possible malignancy. The nodule was resected under video-assisted thoracoscopic surgery and a diagnosis of pulmonary cryptococcosis was obtained. It is sometimes difficult to distinguish lung cancer from pulmonary cryptococcosis because pulmonary cryptococcosis often shows similar image characteristics to lung cancer. In this case, the increased diameter and positive accumulation on FDG-PET suggested malignancy rather than inflammation. Careful differentiation between malignancy and inflammation are necessary in post-transplant patients with abnormal chest shadows.

DOI： 10.2995/jacsurg.21.080

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Other Link： http://search.jamas.or.jp/link/ui/2007149475

Language：Japanese   Publisher：The Japanese Association for Chest Surgery  

A 57-year-old man with a chest wall tumor and right pleural effusion was referred to our hospital. Cytological analysis of the pleural effusion and biopsy of the parietal pleura had already been performed, but no fixed diagnosis was made. The chest wall tumor and the tissue along the tracts of the biopsy needles were removed, and a subsequent thoracoscopic examination was performed. The histological findings of the chest wall tumor led to a diagnosis of biphasic malignant mesothelioma. The clinical stage was T3N0M0 stage III on IMIG-TNM classification. A right extrapleural pneumonectomy was performed. In this case, the histological findings of the chest wall tumor facilitated the final diagnosis.

DOI： 10.2995/jacsurg.21.085

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Other Link： http://search.jamas.or.jp/link/ui/2007149476

Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器内視鏡学会  

DOI： 10.18907/jjsre.29.3_212_2

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器外科学会  

DOI： 10.2995/jacsurg.21.430_1

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器外科学会  

DOI： 10.2995/jacsurg.21.353_4

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器外科学会  

DOI： 10.2995/jacsurg.21.426_1

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器外科学会  

DOI： 10.2995/jacsurg.21.334_3

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Language：Japanese   Publisher：日本胸部外科学会-関東甲信越地方会  

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Language：Japanese   Publisher：シュプリンガー・ジャパン(株)  

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Language：English   Publishing type：Research paper (scientific journal)  

The question of whether squamous cell carcinomas (SCCs) arising in different sites of lung are caused by different etiological factors is of obvious importance for prevention, early detection and effective treatment. We here subclassified a large series of resected SCCs (74 cases) into 3 tumor-sites, central (main to segmental bronchi), intermediate (subsegmental to sub-subsegmental) and peripheral (distal to sub-subsegmental bronchi), and examined relationships with p53 mutational spectra and smoking history to provide clues to etiological factors. The rate for G-->A transitions at CpG sites considered to be caused by endogenous mechanism was higher in central (40%) than in intermediate (0%) and peripheral (14%) lesions, in spite of highest percentage of heavy smokers. In contrast, G-->T transversions associated with tobacco smoke carcinogens were most frequent (50%) in the intermediate location, although proportions of heavy smoker's ratio were the same among the locations when confined to p53 mutation cases. In the periphery, other mutations were highest (67%) compared with 33 and 50% in the central and intermediate regions, respectively. Thus, different etiological factors may be playing causal roles in the development of SCCs in different locations of bronchial tree. Furthermore, the results suggest that more extensive study of the influence of tobacco smoke carcinogens on endogenous mechanisms is warranted.

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Language：Japanese   Publisher：The Japan Lung Cancer Society  

DOI： 10.2482/haigan.46.169

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Other Link： http://search.jamas.or.jp/link/ui/2006227494

Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: It is well known that the serum level of KL-6 can be an indicator of disease activity in patients with interstitial pneumonia (IP). However, surgical lung biopsy is often required for the diagnosis of IP, although this can result in IP exacerbation. METHODS: The effect of surgical lung biopsy on the serum level of KL-6 in patients with IP was analyzed. Thirty-two cases of IP were examined in this study. There were no cases showing exacerbation of IP. RESULTS: The serum level of KL-6 demonstrated 1067+/-550 U/ml (mean+/-SD) before lung biopsy, 991+/-471 U/ml a day, 824+/-377 U/ml 4 days and 826+/-384 U/ml 7 days after lung biopsy. The serum KL-6 levels on the 1st, 4th, 7th day after the lung biopsy were significantly lower than that before the lung biopsy (P<0.05, P<0.01 and P<0.01, respectively). The percent decrease of the serum KL-6 levels on the 4th day (the lowest level) was dependent on the urine volume, and the analysis of the urinary levels of KL-6 showed a transient increase in urinary KL-6 excretion, suggesting that the decrease in serum KL-6 levels associated with surgical lung biopsy may be caused by this increase in urinary KL-6 excretion. CONCLUSION: Surgical lung biopsy of patients with IP has little effect on the increase in serum KL-6 levels. An elevation of serum KL-6 after surgical lung biopsy may indicate exacerbation of IP.

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器外科学会  

DOI： 10.2995/jacsurg.20.851_4

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器外科学会  

DOI： 10.2995/jacsurg.20.829_4

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器外科学会  

DOI： 10.2995/jacsurg.20.833_1

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器外科学会  

DOI： 10.2995/jacsurg.20.912_2

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器外科学会  

DOI： 10.2995/jacsurg.20.807_4

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Language：English   Publishing type：Research paper (scientific journal)  

Presented herein is a case of combined small cell and squamous cell carcinoma in a polypoid bronchial tumor, showing a histologically unique progression, in a 76-year-old Japanese man. A bronchofiberscopic examination revealed that the bronchus (left B3) was occluded by the polypoid tumor. Biopsies were performed, and the pathological diagnosis was poorly differentiated squamous cell carcinoma. The patient consequently underwent a left upper lung lobectomy. The surgical specimen was described as a 24 x 8 x 8 mm soft tumor, emanating from the bronchial wall (left B3). Histologically, the tumor had two distinct components: (i) nearly the entire tumor was composed of atypical small round cells, with a high nuclear-cytoplasmic ratio, in the lamina propria, under the basement membrane; and (ii) the surface of the tumor was composed of poorly differentiated squamous cell carcinoma that had proliferated primarily above the basement membrane but there was also some proliferation, seen as island-like formations, below the basement membrane. The histological diagnosis was combined small cell and squamous cell carcinoma. It was suspected that poorly differentiated squamous cell carcinoma, generated in the bronchial epithelium, had caused small cell carcinoma resulting from neuroendocrine differentiation during its invasion into the lamina propria.

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Language：Japanese   Publisher：シュプリンガー・ジャパン(株)  

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Language：Japanese   Publisher：(一社)日本移植学会  

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器外科学会  

DOI： 10.2995/jacsurg.19.430_3

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器外科学会  

DOI： 10.2995/jacsurg.19.362_2

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器外科学会  

DOI： 10.2995/jacsurg.19.475_2

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器外科学会  

DOI： 10.2995/jacsurg.19.296_1

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Language：Japanese   Publisher：シュプリンガー・ジャパン(株)  

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Language：Japanese   Publisher：シュプリンガー・ジャパン(株)  

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Language：Japanese   Publisher：(一社)日本移植学会  

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Language：English   Publishing type：Research paper (scientific journal)  

The degree of malignancy of neuroendocrine lung tumors (NEs) increases in this order: from typical carcinoids (TCs) through atypical carcinoids (ACs) to large cell neuroendocrine carcinomas (LCNECs) and small cell lung carcinomas (SCLCs). However, histological classification has sometimes proved difficult. We here investigated loss of heterozygosity (LOH) using eight microsatellite markers and expression of p53, Bcl-2 and Bax proteins using immunohistochemical methods in 57 NEs (19 TCs, 5 ACs, 14 LCNECs and 19 SCLCs), looking for objective genetic markers to distinguish between subtypes. The frequencies of LOHs on D3S1300, RBi2 and TP53, the combinations of LOH status for RBi2 and TP53, and the immunohistochemically demonstrated Bcl-2/Bax ratios and p53-positive rates significantly differed among histopathologically diagnosed NEs. Differentiation between TC and AC was possible with reference to LOH on D3S1300, RBi2 and TP53, and the combined LOH status on RBi2 and TP53 (i.e., both LOH(-) versus one LOH(+)). For comparison between AC and LCNEC + SCLC, LOH on TP53 or the combination of two markers--one LOH(+) versus both LOH(+)--was applied. Furthermore, in three discordant cases of diagnoses based on histology and LOH markers, diagnoses using the latter were considered to be more probable by survival analysis. The present study indicated that assessment of LOHs using microsatellite markers could provide objective markers that can distinguish subtypes of NEs, for which histological assessment may commonly result in disagreement.

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Language：Japanese   Publisher：(一社)日本移植学会  

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Language：Japanese   Publisher：シュプリンガー・ジャパン(株)  

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Language：Japanese   Publisher：(一社)日本胸部外科学会  

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Language：Japanese   Publisher：(株)南江堂  

すりガラス状陰影(GGO)を主体とする細気管支肺胞型腺癌に対する縮小手術の成績とその妥当性を検討した.1996年10月から2003年4月までに細気管支肺胞型腺癌の疑いにて縮小手術を施行した症例のうち,CT上腫瘍径20mm以下かつ腫瘍全体に対するGGO領域の比率が50%以上の58例を対象とした.58例中48例に部分切除,2例に区域切除が行われ,8例は浸潤性増殖や高度線維化などにより肺葉切除へ移行した.術中迅速病理診断と術後病理標本の対比では56例の結果は一致したが2例は過小評価であった.また,術後合併症は肺胞瘻1例を認めたのみであり,術後2〜80ヵ月間の観察では肺葉切除に移行した症例を含め57例が無再発生存中である.HRCTと病理所見を野口分類で対比するとtypeA+Bでは腫瘍最大径が有意に小さく,高濃度部分や線状陰影の有無についても有意に少なかった.線状陰影のない10mm以下の病変では縮小手術の対象と考えられた

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2004&ichushi_jid=J00349&link_issn=&doc_id=20040416170010&doc_link_id=1390282763052636160&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390282763052636160&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_2.gif

Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器外科学会  

DOI： 10.2995/jacsurg.18.369_2

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器外科学会  

DOI： 10.2995/jacsurg.18.442_1

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Language：Japanese   Publisher：シュプリンガー・ジャパン(株)  

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: The purpose of this study was to determine whether lobectomy without radical systematic mediastinal lymphadenectomy (LA) is a satisfactory alternative surgical treatment for octogenarians with clinical stage I non-small cell lung cancer (NSCLC). METHODS: From April 1985 through December 2001, 49 patients aged 80 years and older who underwent surgical treatment for clinical stage I NSCLC were reviewed. Lobectomy without radical systematic mediastinal LA was performed for 27 patients (LA0 group) and lobectomy with radical systematic mediastinal LA was performed for 22 patients (LA group). RESULTS: The mortality rate was 0% in the LA0 group and 4.5% in the LA group. Five-year survival rate according to the type of surgery was 44.8% in the LA0 group and 55.5% in the LA group, a difference that was not significant (P=0.88). Although there was no significant statistical difference, postoperative pulmonary complication was more frequent in the LA group than in the LA0 group (32% in the LA group versus 11% in the LA0 group P=0.07). Five-year survival rates according to serum carcinoembryonic antigen (CEA) levels were 0% for patients with elevated CEA levels (n=9) and 56.5% for patients with normal CEA levels (n=40) (P<0.01). CONCLUSION: Lobectomy without radical systematic mediastinal LA appears to be a satisfactory surgical procedure for octogenarians with clinical stage I NSCLC. However, mediastinoscopy is necessary in such octogenarians if their serum CEA level is elevated so that the precise clinical stage can be determined and an accurate prognosis can be given.

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器外科学会  

DOI： 10.2995/jacsurg.17.293_1

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器外科学会  

DOI： 10.2995/jacsurg.17.366_2

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器内視鏡学会  

DOI： 10.18907/jjsre.24.3_202_3

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器内視鏡学会  

DOI： 10.18907/jjsre.24.3_206_1

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Language：Japanese   Publisher：The Japanese Association for Chest Surgery  

Most cases of pulmonary aspergilloma are believed to arise from colonization and proliferation of Aspergillus in a preexisting pulmonary cavity ("secondary aspergilloma"). Tuberculosis is by far the most common condition associated with aspergilloma. The most common symptom is hemoptysis, with others including cough, dyspnea, and weight loss. In recent years, some cases of pulmonary aspergilloma are recognized to arise as a direct result of the intrabronchial proliferation of the fungus, with subsequent bronchial dilatation ("primary aspergilloma"). A 19-year-old man was referred to our hospital due to an abnormal shadow in the left lower lung on chest X-ray. Chest X-ray and chest CT scan showed a cavity with a fungus ball, but the patient complained of no symptoms. Surgical resection was performed, and the postoperative course was uneventful. The possibility of primary aspergilloma may be considered in this case.

DOI： 10.2995/jacsurg.15.140

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器内視鏡学会  

DOI： 10.18907/jjsre.23.3_265_3

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Language：Japanese   Publisher：The Japanese Association for Chest Surgery  

We report a case of multiple tuberculous tracheal stenosis improved by step by step treatment.<BR>A 33-year-old female complaining of increasing dyspnea was admitted to our hospital. Multiple tracheal stenosis due to tuberculosis was observed. A veno-venous ECMO was first established under local anesthesia. A tracheostomy was then performed under the ECMO followed by a bougie with a intubation cannule. Laser ablation was performed to release the stenosis of oral side.<BR>After the operation, stenosis of the right main bronchus was dilated gradually using an angioplastic balloon under a broncho-scope. The patient has been doing well with a T-tube through the tracheostomy. Although it is difficult to treat long segment tracheo-bronchial stenosis, we believe that treatment can be performed safely under appropriate supporting methods, such as using ECMO and multi-staged management.

DOI： 10.2995/jacsurg.14.666

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Other Link： http://search.jamas.or.jp/link/ui/2001005963

Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器内視鏡学会  

DOI： 10.18907/jjsre.20.3_290

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器内視鏡学会  

DOI： 10.18907/jjsre.20.3_294_3

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器外科学会  

DOI： 10.2995/jacsurg.11.376_3

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器外科学会  

DOI： 10.2995/jacsurg.11.317_2

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器外科学会  

DOI： 10.2995/jacsurg.11.392_1

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Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器内視鏡学会  

DOI： 10.18907/jjsre.19.4_316_1

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Language：Japanese   Publisher：(公社)日本薬学会  

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Language：Japanese   Publisher：(NPO)日本肺癌学会  

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Language：Japanese   Publisher：(NPO)日本呼吸器内視鏡学会  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J00298&link_issn=&doc_id=20150818320026&doc_link_id=%2Fcf0brond%2F2015%2Fs03704%2F004%2F0480-0480%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcf0brond%2F2015%2Fs03704%2F004%2F0480-0480%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：新潟医学会  

甲状腺癌のうち乳頭癌(papillary carcinoma)の頻度は90%と大部分を占め、頸部リンパ節転移の頻度が高く、高齢者では未分化癌に転化することもある。今回、結腸癌術後の全身検索で発見され、胸骨縦切開を追加して切除可能であった無症候性進行甲状腺癌の1例を経験したので文献的考察を加えて報告する。症例は76歳、女性。上行結腸癌手術後7年目にCA19-9値の上昇傾向を指摘され、CT検査では上縦隔へ進展した7cm大の甲状腺腫瘤と1.5cm大の右頸部リンパ節腫大を認めた。穿刺吸引細胞診ではclass IIIであったが甲状腺癌が強く疑われたため、手術目的に当科入院となった。術前の頸部CTおよびMRI検査では、甲状腺腫瘍は上縦隔まで進展していたが、明らかな血管への浸潤所見は認めず、気管支鏡検査では明らかな気管浸潤は認めなかった。手術を施行し、右頸部リンパ節を摘出し術中迅速病理診断に提出したところ乳頭癌の診断が得られたため、甲状腺全摘術および頸部リンパ節郭清の方針となった。術中所見では、上縦隔内の無名静脈および右頸動脈への浸潤が疑われ、切除可能か否かの判定が困難であった。視野を確保し、血管等への浸潤の有無を判定するために胸骨縦切開を追加した。その結果、良好な視野が得られ、無名静脈、右左総頸動脈への直接浸潤を認めず、腫瘍の切離が可能となり、甲状腺全摘術および頸部リンパ節郭清を施行した。甲状腺癌、特に乳頭癌は10年生存率が80〜90%と良好であり、また、放置した場合に気管浸潤、血管浸潤を伴うと、生命予後のみならず、患者QOLも著しく損なわれるので、可能であるならば積極的に切除を行うことが望ましい。(著者抄録)

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動脈瘤合併肺癌例に対するステントグラフト内挿術・肺切除同時手術の2例を経験した。症例1は74歳男で、腹部CTにて腎動脈分岐部以下に最大短径50.cmの腹部大動脈瘤1を指摘された。右胸水貯溜を指摘され、気管支鏡下細胞診で悪性細胞を検出し、右原発性肺癌、腹部大動脈瘤と診断した。肺切除、ステントグラフト内挿術の同時手術の方針となった。第12病日に軽快退院となった。症例2は72歳男で、胸部CTで右肺の異常陰影を指摘された。精査の胸腹部CTで右上葉に肺野弓リンパ節と一塊となった腫瘤性病変、右腎に腫瘍性病変、左内腸骨動脈瘤を指摘された。経皮的冠状動脈形成術後に、ステントグラフト内挿術と同時手術で肺癌外科治療を先行、その後腎細胞癌の外科治療を行う方針となった。第11病日に軽快退院となった。

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症例は65歳男性で、IgA腎症により慢性腎不全となり、持続腹膜透析(CAPD)が導入され、3週間後より呼吸困難が出現し、胸部X線で大量の右胸水貯留を認め、横隔膜交通症が疑われた。聴診で収縮期雑音、右側呼吸音の減弱を認めた。胸部X線で右胸水貯留を、胸部CTで右側の大量胸水を認めたが横隔膜面に異常所見は認めなかった。胸水穿刺により胸水中のグルコース濃度は154mg/dlと血糖測定値118mg/dlと比べ高値でなかったが胸水ドレナージ後にCAPDをいったん中止したところ胸水貯留を認め、横隔膜交通症と診断し、交通部の閉鎖のため胸腔鏡下手術を行った。術後第3病日にドレーンを抜去し、CAPDを再開した。術後1年3ヵ月経過したが再発を認めていない。

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A44-year-old man was admitted with thymic carcinoma. Chest CT scans revealed an anterior mediastinal tumor invading upon brachiocephalic artery. The patient was treated 4 cycles of chemotherapy of cisplatin, doxorubicin, cyclophosphamide and etoposide. At achievement of partial response, the tumor was safely resected without angioplasty, and postoperative radiotherapy was added. A combination of neoadjuvant chemotherapy, surgery and postoperative radiotherapy was seemed to be useful for advanced thymic carcinoma.

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Objective : The objective of this study was to evaluate perioperative problems in patients who underwent lung surgery for lung cancer associated with interstitial pneu monia (IP). Study desigu : Retrospective study. Results : There were 8 patients who underwent pulmonary resection for lung cancer associated with IP. Most were male heavy smokers. None had active IP at the time of operation. Standard surgery was performed in 4 patients, extended resection in 2, and limited resection in 2 patients. There was no correlation between surgical invasiveness and postoperative complications. There was one case of acute exacerbation of interstitial pneumonia, which developed into acute respiratory failure. That patient was treated with steroid pulse therapy and recovered. It seemed difficult to anticipate postoperative exacerbation of IP based on preoperative patient evaluation and the degree of surgical invasiveness. Conclusion : We propose following points to prevent complications associated with surgery for lung cancer patients with IP : 1) appropriate evaluation of activity of IP, 2) selection of appropriate operative procedure, 3) oxygen supplementation should be limited, 4) careful observation of respiratory state after surgery. We believe that surgical treatment taking these points into consideration may improve survival in case of lung cancer associated with IP.

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Twenty-eight pulmonary bronchiolo-alveolar type adenocarcinoma with minimal fibrotic foci resected from 1987 through 1996 were reviewed retrospectively. They consisted of 9 men and 19 women with a mean age of 64.7 years. Twenty-four patients underwent lobectomy and four underwent wedge resection. Chest roentgenogram and computed tomography showed that the tumors had a distinct or indistinct boundary and homogeneously low density with a mean tumor diarneter of 21.9 mm (range 12-35 mm ). Histopathologically, these tumors showed a growth pattern of replacement of alveolar epithelial cells with minimal fibrotic foci. No tumors showed vessel invasion, Iymph node or intrapulmonary metastasis. Twenty-six patients are alive without reccurence and 17 of them have survived more than five years. There were two cancer unrelated deaths : one died of renal failure and the other died of unknown cause. The 5-year survival rate was 90.1%. In conclusion, when small peripheral pulmonary tumors are diagnosed as bronchiolo-alveolar type adenocarcinoma with minimal fibrotic foci and show non-invasive signs on intraoperative frozen section, our results suggest that limited pulmonary resection could be a curative operation.

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