[Show abstract][Hide abstract] ABSTRACT: Eosinophilic angiocentric fibrosis (EAF) is an uncommon inflammatory disease that develops from the respiratory organs and affects them. Almost all reports about EAF describe lesions affecting the upper respiratory tract. We present the first case of EAF of the lung treated by surgical excision. A 69-year-old female consulted our hospital following the detection of an abnormal chest shadow with chronic cough. Chest computed tomography showed a pulmonary growing mass in the right hilar area, which corresponded to an enhanced accumulation on positron emission tomography. We doubted a pulmonary malignant tumor and performed a right upper lobectomy. Pathological and other clinical presentations revealed EAF of the lung without coexisting systemic diseases. The patient had an uncomplicated postoperative course, and the presenting cough had improved. EAF can involve the lung and cause symptomatic airway obstruction. For a hilar region mass with imaging characteristics similar to those of lung cancer, a differential diagnosis must be considered.
[Show abstract][Hide abstract] ABSTRACT: A 69-year-old woman with refractory skin eruptions, which had first appeared 3 years previously, was examined, and an anterior mediastinal tumor was detected. The tumor was resected, and a diagnosis of type B2 thymoma, stage III disease (according to the World Health Organization classification), was made. Retrospectively, histologic findings of the skin before the operation were consistent with graft-versus-host disease. The final diagnosis of her skin lesions was thymoma-associated graft-versus-host-like disease. The skin lesions improved gradually during the 1-month period after resection with only a topical steroid, and further improvement was seen at 3 months.
The Annals of thoracic surgery 09/2015; 100(3):1078-80. DOI:10.1016/j.athoracsur.2014.10.080 · 3.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A 70-year-old man with a history of COPD received chest CT. A small nodule of 7 mm in diameter was detected in segment 1 of the right lung. Retrospectively, the lesion was detectable about one year ago, and had slightly enlarged. Chest and abdominal CT did not show other obvious tumor lesions. PET-CT revealed no abnormal accumulation, including in the right lung nodule. Thoracoscopic partial resection, including the lesion, was performed for diagnosis and treatment. Microscopic examination showed the diffuse proliferation of large atypical lymphoid cells with rough chromatin and prominent nucleoli, and small lymphocytic cells. Immunohistochemically, the tumor cells stained positive for CD20 and CD79a, and high-level Ki67 expression was observed. The lesion was diagnosed as diffuse large B-cell lymphoma (DLBCL). PET-CT taken 5 months after the operation revealed no abnormal findings. The final diagnosis was pulmonary DLBCL presenting as a small solitary nodule.
The Journal of the Japanese Associtation for Chest Surgery 01/2015; 29(2):171-175. DOI:10.2995/jacsurg.29.171
[Show abstract][Hide abstract] ABSTRACT: A 52-year-old woman presented with anterior chest pain and fever. Chest computed tomography revealed a 50-mm, left anterior mediastinal cystic tumor with a thickened wall, and left pleural effusion. A few days after admission, the chest pain, fever, and pleural effusion disappeared. Thymothymectomy was performed to confirm the diagnosis. Histopathologically, the tumor was composed of an extended necrotic area, and some viable tumor cells were observed in the subcapsular region. Therefore, the diagnosis was a stage I (Masaoka staging) type B1 thymoma. No recurrence has been observed for approximately 2 years since the surgery. Thymomas have a variety of pathological features such as cystic and hemorrhagic changes and necrosis. However, thymomas with extended necrosis are very rare. Therefore, we report this case with a review of the literature.
The Journal of the Japanese Associtation for Chest Surgery 01/2015; 29(5):627-631. DOI:10.2995/jacsurg.29.627
[Show abstract][Hide abstract] ABSTRACT: The patient was a 64-year-old woman who underwent pancreatoduodenectomy for lower bile duct carcinoma (tubular adenocarcinoma, moderately differentiated, pT2N2M0 Stage III) four years previously. A follow-up chest CT scan showed a nodular shadow in the right S8, a nodular shadow in the left S9, and a trabecular shadow in the left S3. No other mass lesions were found. Wedge resection of the right lung tumor, suspected to be pulmonary metastasis or primary lung cancer, was performed. Histology showed adenocarcinoma with mucin secretion, similar to the histology of the lower bile duct carcinoma. Immunohistochemistry revealed the neoplasm to be negative for SP-A, TTF-1 and Napsin A. Based on the histopathological findings, we diagnosed the tumor as pulmonary metastasis. Two months after the resection of the right lung tumor, two left lung tumors were resected. The tumors showed the same histopathological features as the tumor in the right lung. Until now, 2 years since the resection of the left lung tumors, no recurrence has been detected. Treatment for pulmonary metastases from bile duct carcinoma is not yet established. In our case, the pulmonary metastases affected the bilateral lungs, however, we considered that surgery would be feasible and resection was successfully performed.
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 01/2014; 75(11):3002-3005. DOI:10.3919/jjsa.75.3002
[Show abstract][Hide abstract] ABSTRACT: We report a case of postoperative recurrence of thymic carcinoma that was effectively treated with combination chemotherapy of nedaplatin(NDP)and docetaxel(DOC). We performed thymectomy for thymoma in a 55-year-old man. The pathological diagnosis was squamous cell thymic carcinoma(pT3N0M0, Stage III). The patient was observed without postoperative radiotherapy being administered. Six months after the operation, the patient was admitted to our department with carcinomatous pericarditis. Whole-body examination revealed multiple lung and liver metastases and a left femoral metastasis. After pericardiocentesis, radiation therapy was administered for the left femoral metastasis. Combination chemotherapy (NDP[60mg/m2]/DOC[70mg/m2])was administered for the multiple lung and liver metastases. After 4 cycles of chemotherapy, the multiple lung metastases were completely resolved and the liver metastases were clearly reduced. Partial response and acceptable toxicity were identified. Thymic carcinoma is a rare epithelial neoplasm for which the optimal chemotherapy regimen has not yet been established. Combination chemotherapy with NDP/DOC was effective in the case of our patient with postoperative thymic squamous cell carcinoma recurrence, and it can be considered as a promising regimen for patients from the standpoint of clinical efficacy.
Gan to kagaku ryoho. Cancer & chemotherapy 12/2013; 40(13):2561-2563.
[Show abstract][Hide abstract] ABSTRACT: An abnormal shadow was detected in a 75-year-old man on a chest roentgenogram, and the patient was referred to our institution. A transbronchial biopsy was carried out and the specimen resulted in a diagnosis of organizing pneumonia. During the follow-up period, the left lung lesion became enlarged. Partial resection of the left lung was performed. Postoperatively, pathological examination of the tumor showed an organizing pneumonia. Approximately 3 years later, a new calcified heterogeneous mass shadow was detected in the left lung and left pleura, which had gradually enlarged. Computed tomography (CT)-guided fine-needle biopsy of the nodule of the left pleura was performed. Microscopically, the specimen led to the diagnosis of low-grade osteosarcoma. Re-evaluation of the primary and secondary lesions were confirmed as the same histopathological findings. A further systemic examination was performed. Finally, the lesion was confirmed as low-grade osteosarcoma of the lung. The patient refused further treatment and died due to respiratory failure.
[Show abstract][Hide abstract] ABSTRACT: Background. Non-islet cell tumor hypoglycemia (NICTH) caused by non-pancreatic tumors is rare. Here, we report a case of NICTH that was associated with malignant solitary fibrous tumor (SFT) of the pleura, and was treated with glucocorticoid therapy. Case. A 72-year-old man presented with an abnormal shadow in the chest on medical health examination. A chest computed tomography (CT) scan confirmed the presence of a tumor shadow, approximately 12 x 9 x 8 cm in size, in the right upper lung field. A right upper lobectomy with chest wall resection and lymph node dissection were performed. Pathological findings of the resected specimens revealed malignant SFT arising from the pleura. Three years after the operation, multiple intrathoracic and inguinal lymph node recurrences were detected on CT. We decided to observe the natural course of recurrence without giving chemotherapy. Four years after the operation, he was admitted to our department with recurrent hypoglycemic attacks. Glucose infusion and intravenous hyperalimentation were not effective, and he experienced repeated hypoglycemic attacks. Based on the clinical course and examination results, we diagnosed NICTH associated with malignant SFT. After administration of oral glucocorticoids, the hypoglycemia improved. However, it was slightly difficult to regulate the dose of oral glucocorticoid. Conclusion. Glucocorticoid therapy is useful for treating NICTH with SFT and can be tailored to the individual's needs.
[Show abstract][Hide abstract] ABSTRACT: Background. Pazopanib is a multitargeted tyrosine kinase inhibitor. Frequent adverse events caused by pazopanib include hypertension, fatigue, nausea, diarrhea, weight loss and liver toxicity. Pneumothorax was reported in a clinical trial of treatment with pazopanib for soft tissue sarcoma; however, this complication has not been reported in detail and its relevance for treatment is unclear. Case. A 73-year-old male with pulmonary metastasis of myxofibrosarcoma originating in the left chest wall underwent systemic chemotherapy with doxorubicin. The pulmonary metastatic lesions were progressive; therefore, treatment with pazopanib (800 mg daily) was initiated. Ten days later, the patient experienced right chest pain and dyspnea. A chest roentgenogram revealed right tension pneumothorax, and chest drainage was performed. Chest computed tomography (CT) showed multiple nodules in the bilateral lungs that were slightly smaller than those observed before the administration of pazopanib. Moreover, the lesion in the right upper lobe was found to be a cavity with a thin wall compared with that observed in the previous CT findings. Massive air leakage was observed, a surgery was performed. The location of the air leak was identified to be the lesion of pulmonary metastasis that had been found to be a cavity in the right upper lobe. Thoracoscopic partial pulmonary resection including the lesion was performed. Pathologically, the specimen was confirmed to be pulmonary metastasis of high-grade myxofibrosarcoma. Microscopically, invasion of tumor cells to the visceral pleura, exposure of tumor cells to the pleural cavity and collapse of the visceral pleura were detected. We speculated that the pneumothorax observed in our patient was likely an adverse event of the treatment with pazopanib. Conclusions. It is necessary to pay attention to the development of pneumothorax when prescribing pazopanib in patients with pulmonary metastasis.
[Show abstract][Hide abstract] ABSTRACT: Nedaplatin is a cisplatin derivative, which has similar activity to cisplatin in non-small-cell lung cancer (NSCLC) when combined with vindesine, and causes less nausea/vomiting and nephrotoxicity compared with cisplatin. The aim of this study was to evaluate the efficacy and safety of combination chemotherapy with docetaxel plus nedaplatin in patients with metastatic NSCLC.
Patients with metastatic stage IIIB excluding locally advanced diseases or stage IV NSCLC were enrolled between March 2004 and March 2006. They were treated with docetaxel (60 mg/m(2)) and nedaplatin (80 mg/m(2)) on day 1 every 3-4 weeks until progression or intolerable toxicity for up to 4 cycles.
Forty-four patients (mean age, 65 years; range, 40-79 years) received a total of 140 treatment cycles. Responses could be assessed in all patients (complete response, 0; partial response, 22; stable disease, 11; and progressive disease, 11). Response rate was 50.0 % (95 % confidence interval [CI], 35.2-64.8 %) with a disease control rate of 75.0 % (95 % CI, 62.2-87.8 %). A high response rate was achieved in patients with squamous cell carcinoma (66.7 %) compared with that in patients with adenocarcinoma (41.4 %). Median survival time from the start of the combination chemotherapy was 13.0 months, and the progression-free survival time was 7.4 months. Grade 3 or 4 hematologic toxicities included leukopenia (28.6 %) and neutropenia (61.4 %). Nonhematologic toxicities were mild.
The combination of docetaxel plus nedaplatin was well tolerated and demonstrated potent activity in patients with metastatic NSCLC, particularly squamous cell carcinoma of the lung.
Cancer Chemotherapy and Pharmacology 08/2012; 70(4):531-7. DOI:10.1007/s00280-012-1941-8 · 2.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In order to achieve sufficient therapeutic potency, it has been proposed that vaccine therapy with dendritic cells needs to be combined with manipulation of immunological checkpoints, such as inhibition of regulatory T cells and blockade of negative signals, and enhancement of T cell trafficking to tumor sites. In the combinatorial cancer immunotherapy, use of matured/activated dendritic cells (DCs) with more potent antigen presenting capacity seems to be essential for eliciting anti-tumor immune responses. We herein established an ex vivo induction strategy for activated DCs capable of eliciting efficient tumor antigen-specific cytotoxic T lymphocytes (CTLs) from patients with metastatic cancer as well as healthy donors. Immature DCs were matured by 48-h culture in the presence of anti-CD40 antibody and penicillin-killed streptococcus pyogenes (OK432). Supplementation with both anti-CD40 and OK432 resulted in induction of activated DCs with higher surface expression of CD80, CD83, CD86 and major histocompatibility complex class II antigens, compared with other mature DCs that were induced by the combination of anti-CD40 with tumor necrosis factor-alpha or lipopolysaccharide. In analysis of the produced cytokine profiles, the activated DCs produced the highest T-helper 1-type cytokines for at least 72 h. Furthermore, the activated DCs, pulsed with tumor-associated antigen peptide, elicited in vitro tumor-specific CTLs, but DCs activated with other combinations did not in cancer patients. Therefore, we suggest that the activated DCs studied here might be used as a basic element for the combinatorial cancer immunotherapy.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to assess quantitatively the impairment of diaphragmatic motion after lung resection, with special reference to the location of the resected lobe, duration of the postoperative period, and patient posture. We used magnetic resonance imaging to make the assessments.
In 44 patients (29 men, 15 women; mean age 62.2 years) with lung cancer, diaphragmatic motion was measured during maximum deep, slow breathing using a spoiled gradient-recalled echo sequence before and after lung resection. The study group consisted of 34 patients who were examined using a 1.5-T unit in the supine position and 10 patients using a vertically open 0.5-T unit in both the sitting and supine positions. The influence of surgery site and patient posture on diaphragmatic motion after lung resection was investigated.
In all cases after lung resection, diaphragmatic motion on the operated side was significantly decreased (P < 0.001), and that on the nonoperated side was significantly increased (P = 0.045). After left upper lobectomy and right bilobectomy, the diaphragmatic motion on the operated side was significantly decreased (P < 0.001), and that of the other side was significantly increased (P < 0.001). The diaphragmatic motion was not significantly changed after right middle lobectomy. The diaphragmatic motion on the operated side was impaired significantly more (P = 0.035) in the supine position than in the sitting position.
After lobe resection, diaphragmatic motion was impaired more significantly in the supine than in the sitting position; and it differed according to the location of the resected lobe. The improvement in diaphragmatic function after lobectomy was observed over a period of 3-24 months.
Radiation Medicine 05/2007; 25(4):155-63. DOI:10.1007/s11604-007-0119-5
[Show abstract][Hide abstract] ABSTRACT: We reported previously that pigeon cytochrome c-derived peptides (Pan-IA), which bind broad ranges of MHC class II molecules efficiently, activate T helper (Th) function in mice. In an experimental model, Pan-IA DNA vaccines augmented antitumor immunity in tumor antigen-immunized mice. To elicit more potent antitumor immunity and to eradicate tumors in a therapeutic setting, Pan-IA-loaded dendritic cells (DCs) were inoculated in combination with vaccines including ovalbumin (OVA) antigen DNA in tumor-bearing mice. Seventy percent of the immunized mice survived tumor-free for at least 4 months after treatment. In contrast, mice vaccinated with OVA DNA, either with or without naïve DCs, did not eliminate the tumors and died within 5 weeks. Only in mice vaccinated with OVA DNA and Pan-IA-loaded DCs were both cytotoxic and helper responses specific for OVA induced at the spleen and tumor sites as well as at the vaccination sites. Furthermore, accumulation of OVA-specific CD4(+) and CD8(+) T lymphocytes and interferon-gamma-mediated anti-angiogenesis were observed in the tumors of these mice. Thus, the combined vaccination primed both tumor-specific cytotoxicity and helper immunity resulting in augmented tumor lysis ability and anti-angiogenic effects. This is the first report to show that most established tumors were successfully eradicated by collaboration of potent antitumor immunity and anti-angiogenic effects by vaccination with tumor antigens and helper-activating analogs. This novel vaccination strategy is broadly applicable, regardless of identifying helper epitopes in target molecules, and contributes to the development of therapeutic cancer vaccines.
Cancer Immunology and Immunotherapy 04/2007; 56(3):331-42. DOI:10.1007/s00262-006-0192-0 · 3.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective. To perform a retrospective investigation of alternate-day administration of gefitinib for reduction of side effects and to determine the efficacy of this approach for maintenance therapy. Methods. We gave gefitinib to 50 patients from July 2002 to May 2004. All patients were initially treated with 250 mg gefitinib daily, and with long-term administration 12 patients developed mild side effects. Administration of gefitinib was reduced to alternate days in these patients, and here we report the effects of this dosage in the 12 patients. Results. All patients showed a reduction of adverse events and long-term gefitinib administration became possible again. The average time to treatment failure (TTF) was 18.4 months for daily administration and 10.9 months for alternate-day administration. However, efficacy of the drug has been maintained for over 600 days in 4 women. Conclusion. Alternate-day administration of gefitinib is useful for reduction of adverse reactions and can serve as an effective maintenance therapy; however, a further prospective study is needed for comparison with other administration schedules.