Hiroshi Izumi

Juntendo University, Edo, Tokyo, Japan

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Publications (51)69.89 Total impact

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    ABSTRACT: Background Cotyledonoid dissecting leiomyoma (Sternberg tumor) is a rare variant of the uterine smooth muscle tumor. Although this tumor is a benign tumor clinically and pathologically, the appearance and growth pattern is unusual, so it may be misdiagnosed as malignancy. Case reports We report two cases of cotyledonoid dissecting leiomyoma of the uterus that occurred in two 44- and 31-year-old women, respectively. Total hysterectomy and bilateral salpingo-oophorectomy were performed in one of the patients, and myomectomy was done in the other one. Macroscopically, both tumors were grape-like exophytic masses resembling placental tissue. The patients were well after surgery, and one patient gave birth. To our knowledge, this is the first case report of a successful delivery after myomectomy of this tumor. Conclusion To prevent aggressive surgery it is important to recognize that this tumor is a benign and unusual appearing variant of leiomyoma. A fertility-sparing surgical procedure should be considered if the patient wishes to preserve her fertility.
    No preview · Article · Aug 2014 · Archives of Gynecology and Obstetrics
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    ABSTRACT: Objective: Chondroid chordoma (CC) is a rare but commonest subtype of chordoma with little reported clinical information. The present study summarizes and updates present knowledge of CC. Methods: Literature search for demographic data and clinical appearance of cranial CCs except for those entirely confined to the sinonasal region. Results: A total of 48 English language papers published from 1968-2013 were retrieved describing 132 CCs as skull base tumors. The male-to-female ratio was 1:1. The mean age at diagnosis was 43 years, predisposing to the third to fifth decades of life. The clival (34%) and spheno-occipital (29%) regions were the most frequent sites of origin followed by the sellar (12%) and sphenoid (5%) regions. Intratumoral calcification and bony erosion were identified as the characteristic neuroimaging findings. Surgical resection by the transcranial, transsphenoidal, transnasal, transpharyngeal, or transpalatal route with or without adjuvant radiotherapy was the main treatment option. The initial treatment outcome was satisfactory in 82% of cases with considerably better prognosis compared with typical chordomas. Conclusion: CC is a distinct entity to be discriminated from the typical type of chordoma. There are no distinguishing features on magnetic resonance imaging between CC and typical chordoma. Intratumoral calcification and concurrent bony erosion on neuroimaging should suggest the possibility of CC. Extensive surgical resection and adjuvant radiotherapy can achieve satisfactory outcome.
    No preview · Article · Jul 2014 · Clinical Neuroradiology
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    ABSTRACT: A 67-year-old woman sensed a slowly growing, painless hard mass in the left parietal region. Cranial computed tomography showed focal bony erosion and homogeneous sclerotic change at the affected site. Magnetic resonance (MR) imaging revealed an enhanced subcutaneous mass and irregularly thickened dura mater. Intraoperatively, the subcutaneous tumor was found to be strongly adhered to the temporalis muscle. The outer table was eroded adjacent to the subcutaneous tumor, whereas the bony structures of the inner table were intact. The dura mater underneath had irregular-shaped, yellowish convolutions both on the outer and inner surfaces. The patient underwent total tumor resection with sufficient normal margins. The histological diagnosis was World Health Organization (WHO) grade I meningioma, with finger-like outward extensions through the dura mater and overlying skull, and infiltration among into the temporalis muscle fibers. Meningiomas may form a subcutaneous mass without intracranial growth.
    No preview · Article · Sep 2013 · Neurologia medico-chirurgica
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    ABSTRACT: Ovarian carcinoma has been difficult to diagnose at an early stage. Recently, it has been recognized that the measurement of blood N-ERC/mesothelin levels aids early detection in and postoperative therapeutic monitoring of patients with mesothelioma, who have been exposed to asbestos. ERC/mesothelin has also been reported to be expressed in ovarian carcinoma. We determined serum N-ERC/mesothelin levels in patients with ovarian carcinoma using an enzyme-linked immunosorbent assay (ELISA). In addition, we immunohistochemically evaluated surgically resected specimens for C-ERC/mesothelin expression. As a result, of the 32 patients with ovarian tumors (18 carcinoma, 2 borderline tumors), one patient with serous adenocarcinoma showed increased N-ERC/ mesothelin levels. Immunohistochemically, of the 20 ovarian tumor (carcinoma and borderline tumor) specimens evaluated for serum N-ERC/mesothelin, 9 (45.0%) were positive for C-ERC/mesothelin. The C-ERC/mesothelin-positive specimens were found to be serous and clear cell adenocarcinomas. If serum N-ERC/mesothelin, which is considered useful for early detection in and therapeutic monitoring of patients with mesothelioma, may also be used for ovarian carcinoma monitoring, it may be a valuable serum tumor marker for the early detection of ovarian carcinoma.
    Preview · Article · Oct 2012 · Oncology letters
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    ABSTRACT: A 46-year-old man was admitted to the hospital with a recurrent giant-cell tumor of the distal femur. This was his fourth recurrence, and it had occurred 16 years after his last treatment. The resected recurrent tumor was histologically determined to be a conventional giant-cell tumor. However, a single lung metastatic lesion and local recurrence were noticed 6 months after the resection, both of which were surgically excised. The lung lesion was histologically determined to be an implantation of giant-cell tumor, whereas the local recurrent lesion contained a clearly separated fibrosarcomatous area within the conventional giant-cell tumor. Immunohistochemistry showed diffuse and strong p53 expression in the fibrosarcomatous area. Direct sequencing revealed a p53 mutation in the sarcomatous area and a recessive mutant signal in the conventional area. The lung lesion also contained the same p53 mutation. Identification of the p53 mutation may help in diagnosing potential malignant transformation of giant-cell tumor.
    Full-text · Article · May 2011 · Human pathology
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    ABSTRACT: Renal cell carcinoma commonly metastasizes to lung, liver, and bone. Small intestinal metastases are exceedingly rare. A 75-year-old man presented at our hospital with tarry stools. He had undergone a right nephrectomy for renal cell carcinoma (RCC) 6 years previously; in addition, he had received antiplatelet treatment for ischemic heart disease. Esophagogastroduodenoscopy, total colonoscopy, and computed tomography did not identify any cause for the gastrointestinal bleeding. He underwent capsule endoscopy (CE), which revealed an ulcerated submucosal tumor in the jejunum. We performed a double-balloon endoscopy (DBE), and histological findings identified a clear cell carcinoma. We diagnosed metastasis from the RCC. We performed a jejunectomy to resect the tumor and thus eliminate the source of the bleeding. CE and DBE are useful diagnostic tools. We recommend investigating the possibility of small intestinal metastases in cases of intestinal bleeding or anemia in patients with a history of malignant tumor.
    Full-text · Article · Feb 2011 · Medical science monitor: international medical journal of experimental and clinical research
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    ABSTRACT: Gene methylation leads to malignant progression in some tumors. The mechanism by which mesothelin is expressed in malignant mesothelioma (MM) is not well understood. MM is histologically divided into 3 subtypes, that is, the epithelioid, sarcomatoid, and biphasic types, and it was shown that mesothelin expression was restricted to the epithelioid type and the epithelioid component of the biphasic type of MM. However, its regulatory mechanism of expression has not been clarified. Here, we studied the expression of mesothelin by immunohistochemistry along with the methylation status of 20 CpG sites in the promoter of the mesothelin gene (MSLN) in 118 lung specimens, including 39 MM, 41 lung carcinoma, 26 nonneoplastic pulmonary lesions, and 12 normal lung tissue samples by the methylation-sensitive single nucleotide primer extension technique. We confirmed that mesothelin was expressed in the epithelioid type and epithelioid component of the biphasic type of MM but neither in the sarcomatoid type nor sarcomatous component of the biphasic type. Surprisingly, the MSLN promoter was significantly hypomethylated in the MM cases regardless of its subtype, compared with the other pulmonary lesions and normal lung tissue samples. These findings suggested that hypomethylation of the MSLN promoter may be specifically associated with the formation of MM, regardless of its expression status, and that the expression of mesothelin protein was lost in the sarcomatoid type by some unknown posttranscriptional regulatory mechanism. We also identified 4 CpG sites, among the 20 sites studied, to be more specifically hypomethylated in MM cases.
    No preview · Article · Sep 2010 · Human pathology
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    ABSTRACT: A 61-year-old man presented with a rare pleural malignant mesothelioma of the spine manifesting as progressive weakness of the bilateral lower extremities, numbness in the body and both legs, and dysfunction of the bladder and bowel. He had previous occupational exposure to asbestos while working at a car repair shop and had undergone right panpleuropneumonectomy under a diagnosis of sarcomatous type mesothelioma in the right pleural space. Magnetic resonance imaging of the spine with gadolinium showed an enhanced intramedullary tumor at the T4 level. Operative findings disclosed the clouded and swollen right posterior nerve root, and the pial surface was covered by clouded arachnoid-like membrane. The removed part of the T4 posterior nerve root and intramedullary tumor revealed malignant mesothelioma with invasion spreading along the posterior nerve root. He died of respiratory failure 3 months after the diagnosis. This case shows that spinal metastasis must be considered if a patient with pleural malignant mesothelioma shows neurological worsening and neuroimaging shows an abnormal lesion in the thoracic spinal cord. However, the patient's neurological condition is very difficult to improve in the presence of spinal cord infiltration.
    No preview · Article · May 2009 · Neurologia medico-chirurgica
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    ABSTRACT: The patient was 54-year-old woman diagnosed as recurrent invasive thymoma (type B3; WHO classification). Although partial response was obtained by systemic chemotherapy (PAC: cisplatin, doxorubicin, cyclophosphamide), the tumor started to become enlarged after cessation of chemotherapy. Combined treatment of octreotide and prednisolone was administrated because various chemotherapies, including PAC, were not effective. After seven months, the tumor size was markedly decreased. The combination of octreotide and prednisolone should be considered as one of the choices of treatment in patients with recurrent thymoma.
    No preview · Article · Feb 2009 · Internal Medicine
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    ABSTRACT: Because mesothelioma initially progresses on the surface of the pleura and peritoneum without forming masses, it has been difficult to diagnose at an early stage. It would be very useful to identify a tumor marker that could be used for screening to enable more diagnoses to be made at an early, treatable stage. We had previously identified N-ERC/mesothelin as a potential biomarker for mesothelioma. In the current work, we used a newly developed ELISA system to gain data on N-ERC/mesothelin levels in various clinical settings. A total of 102 healthy volunteers were recruited. In addition, 39 patients were diagnosed with mesothelioma, 53 patients were diagnosed with diseases that should be distinguished from mesothelioma, and 201 subjects were diagnosed with asbestos-related nonmalignant diseases (including simple exposure to asbestosis) who were treated at any of the cooperating hospitals were enrolled. Serum N-ERC/mesothelin levels measured by a new ELISA system showed that the median values from patients with mesothelioma were extremely high compared with levels obtained from other patients. Analysis in terms of histologic type showed that serum levels of N-ERC/mesothelin were elevated in epithelioid type mesothelioma, especially. In four important models of clinical settings, the sensitivity and specificity of N-ERC/mesothelin were about 71% to 90% and 88% to 93%, respectively. N-ERC/mesothelin is a very promising tumor marker for mesothelioma, especially epithelioid mesothelioma.
    Preview · Article · Apr 2008 · Clinical Cancer Research
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    ABSTRACT: We report a case of thymic carcinoma associated with dermatomyositis (DM) in a 53-year-old man. The patient presented with the characteristic features of a skin rash with Gottron's papules, proximal muscle weakness, and increased serum levels of the muscle-associated enzymes. Comprehensive clinical examinations revealed an anterior mediastinal tumor. We resected the tumor and histological examination confirmed squamous cell carcinoma of the thymus. Thereafter, his clinical symptoms improved dramatically and his serum levels of muscle-associated enzymes dropped, indicating that the DM was a paraneoplastic phenomenon. Our search of the literature found only one other case report of DM accompanied by thymic carcinoma, and to our knowledge, this is the fi rst documented case of dramatic improvement of DM after resection of thymic carcinoma. We propose that thymic carcinoma should be added to the list of malignancies that can complicate DM as a paraneoplastic disease.
    No preview · Article · Feb 2008 · Surgery Today
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    ABSTRACT: Solid pseudopapillary tumor of the pancreas (SPTP) is a rare neoplasia of uncertain histogenesis, which usually occur in young females and is regarded as a tumor of low malignancy potential. We describe the histopathological features of four cases of this tumor and review the literature. All patients were female with ages ranging from 18 to 60 years (mean 35.2 years). Grossly, the tumors appeared as a solid cystic mass, frequently with hemorrhagic and necrotic areas; however, with a predominantly cystic formation in 1 case and of noncystic type in 1 case. The histological findings of the tumor cells were relatively uniform, showing solid and pseudopapillary or pseudoglandular proliferation and having few mitotic figures or nuclear pleomorphism. On immunohistochemical examination, all cases were similar to those previously reported as SPTP. In addition, all tumors showed low a Ki-67 index (1.0% of all tumor cells). One of four cases proved to be metastatic to lymph nodes. Despite metastasis, the proliferating ability of the tumor cells was relatively low and this patient is alive with no evidence of recurrence since surgery. SPTPs have distinctive morphologic and biologic features; therefore, it may be difficult to evaluate the malignancy potential by histological and immunohistochemical examination.
    No preview · Chapter · Mar 2007
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    ABSTRACT: In patients with acute pancreatitis, reparative changes of frank parenchymal necrosis, divided into granulation tissue, fibro-granulation tissue and fibrosis, occur depending on the duration and severity of the illness. Fibrosis in the apparently uninvolved areas in patients with acute pancreatitis develops in relation to frank parenchymal necrosis, and may consist of type I collagen in patients surviving longer. The role of fat necrosis in acute pancreatitis could be explained as follows: when extensive fibrin thrombi in the fat necrosis are resolved before the reparative change is accomplished, hemorrhage may extend into the surrounding tissue.
    No preview · Article · Feb 2007
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    ABSTRACT: We tried to clarify whether the histologic subtypes and the size of the solid component of an adenocarcinoma are more important predictive factors for invasiveness or prognosis than is total tumor size, even in lung adenocarcinomas that were 2 cm or smaller. Between 1996 and December 2005, after standard surgical treatment, 82 patients were diagnosed as having adenocarcinoma with a maximum diameter of 2 cm or less. The group comprised 37 females and 45 males, with ages ranging from 41 to 80 years (median, 64). The clinicopathologic records of the patients were examined with regard to age, sex, nodal status, tumor size (largest diameter of the total tumor as well as the largest diameter without the bronchioloalveolar carcinoma [BAC] component [solid component]), serum carcinoembryonic antigen level, and histologic type. These variables were analyzed as risk factors for vascular or lymphatic invasion, lymph node metastasis, and prognosis. Histologic subtype was classified into two groups: mixed BAC (mixed adenocarcinoma with BAC) and minimal or non-BAC (tumors with little or no BAC component). Histologic subtype was a significant predictive factor both for invasiveness (vascular or lymph vessels) and lymph node metastasis, in both univariate and multivariate analysis. Tumor diameter was not a significant factor in either univariate or multivariate analysis (p = 0.28, 0.15, respectively). However, diameter excluding the BAC component was a significant factor for invasiveness in mixed BAC type (p = 0.035), whereas total diameter was not significant (p = 0.28). Finally, histologic subtype and lymph node metastasis were significant prognostic factors for survival in both univariate (p = 0.03, 0.05, respectively) and multivariate (p = 0.04, 0.05, respectively) analyses. The 5-year survival rate was 94.4% (94.1% for pN0) for the mixed BAC type and 71.4% (78.7% for pN0) for the minimal or non-BAC type (p = 0.009; p = 0.04 for pN0 nodes). Small adenocarcinomas can be classified into two categories. The first category is a minimal or non-BAC adenocarcinoma that shows aggressive biological behavior. The second category is a mixed BAC, which demonstrates less invasive or aggressive biological behavior than the minimal or non-BAC type, with the degree of invasiveness being associated with the size of the non-BAC component.
    No preview · Article · Feb 2007 · The Annals of thoracic surgery
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    ABSTRACT: Pulmonary lymphangioleiomyomatosis (LAM) is a rare and progressive disease of young women that usually causes death from respiratory failure. Here we report an early case that was diagnosed by thoracoscopy. A 28-year-old woman presented to a local clinic with chest pain and her chest X-ray film showed left pneumothorax. After placement of a chest tube, the lung re-expanded fully. Following the recurrence of left pneumothorax, she was referred to our hospital and underwent video-assisted thoracoscopic surgery (VATS). However, left pneumothorax recurred again one month later. She underwent a second thoracoscopic operation, during which a bulla was recognized in the lingular segment of the left lung and was resected. On histological examination of the surgical specimen findings consistent with LAM were obtained. Taking the preoperative imaging findings and the thoracoscopic findings into consideration, a diagnosis of early lymphangioleiomyomatosis was made. Thoracoscopic management of pneumothorax in young women can facilitate the early diagnosis of this condition.
    Full-text · Article · Jan 2006 · Annals of thoracic and cardiovascular surgery: official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia
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    ABSTRACT: Rosai et al. published the World Health Organization (WHO) classification of thymic epithelial tumors in 1999, and its clinical usefulness seems to be established. It is our purpose to find the clinically relevant diagnostic points in the WHO Histological Classification of Thymoma. Thymomas surgically removed from 100 consecutive patients at Juntendo University Hospital between October 1983 and February 2002 were classified according to the WHO histological classification. We assessed overall survival and recurrence-free rate calculated for each tumor type in the WHO classification compared with those of tumors classified by the Masaoka system. The thymic epithelial tumors in this series comprised 10 type A, 15 type AB, 18 type B1, 21 type B2, 33 type B3, and 3 type C tumors according to the WHO classification. Based on the Masaoka system, the disease was stage I in 53 patients, stage II in 30, stage III in 15, and stage IV in 2. The 15-year recurrence-free rate was 100% for type A, AB and B1, while the rates for types B2 and B3 were 66.7% and 54.5%, respectively. The 10-year recurrence-free rate was 66.7% for type C. The 15-year recurrence-free rate of the 64 patients with type A, AB, B1, and B2 thymomas was significantly higher from that of the 33 patients with type B3 thymoma (p=0.0026). When using the WHO classification, it is critical to distinguish type B3 thymoma from other tumor types.
    Full-text · Article · Jan 2006 · Annals of thoracic and cardiovascular surgery: official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia
  • HIROSHI IZUMI · KOICHI SUDA
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    ABSTRACT: アスベスト (石綿) は, その曝露により組織に線維化や発がん性という性格をもち, 非腫瘍性疾患として石綿肺, 良性石綿胸水, 胸膜肥厚斑 (びまん性胸膜肥厚) などを, 腫瘍性疾患としては肺癌, 中皮腫を発症する. これらアスベスト関連疾患は潜伏期間が長く, 本邦でのアスベスト使用量との関係から, 今後増加すると予想されている. アスベスト関連腫瘍の代表である, 胸膜中皮腫は早期例では壁側胸膜上に多発小結節状に出現し, その後, 肺を包み込むように肥厚性に増殖し, 残存肺は胸膜面全体から圧迫され縮小する. 進行例では周囲組織への浸潤, リンパ節転移や血行性に転移する. 中皮腫の確定診断は, 病理組織学的になされるが, その組織像は多彩で上皮型, 肉腫型および両成分が混在する二相型の3つの基本組織型に分類され, さらに各型は幾つかの組織構造を呈する. 病理組織学的診断には通常のヘマトキシリン・エオジン (H. E) 染色とともに肺腺癌や他の腫瘍との鑑別に組織化学や免疫組織化学が用いられている. 中皮腫の組織化学的特徴は細胞表面にアルシアン・ブルー染色やコロイド鉄染色により陽性を示すヒアルロン酸を認める. 肺腺癌との鑑別では, カルレチニン, サイトケラチン5/6, WT1, D2-40が中皮腫に陽性, 肺腺癌には陰性を示し, これらは感受性, 特異性に優れている. また中皮腫はケラチンとビメンチン両方の陽性率が高く, 肉腫との鑑別に有用である. 胸膜中皮腫は体腔液を伴うことが多く, 上皮型中皮腫では, 胸水からの細胞診断が可能であるが, 腺癌との鑑別が困難なこともある. 二相型や肉腫型では胸水中に異型細胞を認めないことも多い.
    No preview · Article · Jan 2006
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    ABSTRACT: Diffuse pleural mesothelioma is a rare condition with a poor prognosis. Recent reports have indicated that extensive surgery combined with chemotherapy and radiotherapy prolongs the survival of selected patients with early disease. Thoracoscopy allows complete visualization of the pleural cavity and provides high-quality biopsy samples. We present a case of successful diagnosis of bilateral pleural mesothelioma by thoracoscopy. It is important to observe the contralateral pleural cavity by thoracoscopy to confirm the presence or absence of a tumor before considering extrapleural pneumonectomy for mesothelioma.
    Preview · Article · Sep 2005 · Annals of thoracic and cardiovascular surgery: official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia
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    ABSTRACT: We report here 4 cases of multilocular thymic cysts (MTCs) with reactive lymphoid follicular hyperplasia. They were admitted to our hospital to examine anterior mediastinal masses demonstrated on chest computed tomographic scans. Three patients presented high-grade intermittent fever, and 2 patients were associated with Sjogren syndrome with elevated serum antinuclear antibody levels. All patients were subjected to extended thymectomy. Interestingly, their fever disappeared immediately after surgery. Histologically, the lesions were characterized by several cystic spaces separated by various thick walls with dense lymphoid tissue containing large reactive germinal centers. The inner cyst walls were lined by flattened cuboidal epithelia in some portions. Columnar epithelia with focal cilia were partially observed in 2 cases. These pathological findings led to a diagnosis of MTCs that were thought to result from cystic transformation of medullary duct derivatives by acquired inflammatory processes. The pathological findings, together with clinical courses of our cases, suggest that inflammation accompanied by autoimmune diseases may play, in part, an important role in the development of MTCs.
    No preview · Article · Aug 2005 · Human Pathlogy
  • Atsushi Morio · Hideaki Miyamoto · Hiroshi Izumi
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    ABSTRACT: It has been reported that small-sized invasive lung adenocarcinomas, i.e., those classified as type C through type F according to Noguchi's classification, may also recur even after complete resection. We evaluated the prognostic value of molecular biologic markers (apoptosis, Ki-67, p53, epidermal growth factor) and clinicopathological factors in patients with small-sized invasive lung adenocarcinomas. The clinical records of all patients who had had a peripheral adenocarcinoma surgically resected between 1996 and 2002, and histologically diagnosed as type C through type F according to Noguchi's classification were retrospectively reviewed. The apoptotic index (AI) was determined by the triphosphate biotin nick end-labeling method and the expression of Ki-67, aberrant p53 protein and epidermal growth factor receptor was determined by immunohistochemical staining. Data from 28 patients who had been followed up for a mean period of 41.8 months (range: 16 to 89 months) were evaluated. During the follow-up period, recurrence was seen in 6 patients. The log-rank test showed that AI was a significant predictor of cancer recurrence. The 5-year disease-free survival rate of the 10 patients in the high AI group (AI > 0.3%) was 100%; while that of the 18 patients in the low AI group (AI < or = 0.3%) was 50.5% (p = 0.036). None of the other molecular biologic markers or clinicopathological factors were found to be a significant predictor of cancer recurrence. Peripheral small-sized invasive lung adenocarcinomas with a low AI carry an increased risk of distant metastases, indicating that adjuvant chemotherapy after complete resection might be needed.
    No preview · Article · Jul 2005 · The Japanese Journal of Thoracic and Cardiovascular Surgery

Publication Stats

284 Citations
69.89 Total Impact Points

Institutions

  • 1990-2014
    • Juntendo University
      • • Department of Human Pathology
      • • Department of General Thoracic Surgery
      • • Department of Pathology and Oncology
      • • Division of Respiratory Medicine
      Edo, Tokyo, Japan