Hepatocellular Carcinoma (HCC) rarely metastasizes to bone or mediastinum. In some patients, surgical treatment of oligometastatic lesions from colorectal cancer, breast cancer, or non-small cell lung cancer results i...Hepatocellular Carcinoma (HCC) rarely metastasizes to bone or mediastinum. In some patients, surgical treatment of oligometastatic lesions from colorectal cancer, breast cancer, or non-small cell lung cancer results in satisfactory survival. However, data concerning oligometastatic lesions from HCC are scarce. We report the case of a patient with long-term survival after resection of metachronous oligometastases of HCC. A 54-year-old woman underwent hepatic resection for non-B, non-C HCC. A solitary left tenth rib tumor was detected 20 months after initial surgery and was surgically resected. A solitary mediastinal tumor was detected 6 months after the second operation and the patient again underwent surgical resection. Histopathological examination of both lesions confirmed metastasis of HCC. The patient has had no further recurrence 7 years after initial surgery without chemotherapy or radiotherapy.展开更多
Objective: Advances in diagnostic imaging techniques, such as 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), have led to greater accuracy in preoperative mediastinal staging for patients with non-small...Objective: Advances in diagnostic imaging techniques, such as 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), have led to greater accuracy in preoperative mediastinal staging for patients with non-small-cell lung cancer (NSCLC), but surgical staging remains the “gold standard” for diagnosis. A proper understanding of the current accuracy of diagnostic imaging is needed for further improvements. Methods: Forty-three patients who underwent resection for NSCLC involving mediastinal lymph node (MLN) metastasis at our hospital between June 2003 and May 2011 were enrolled in this study. We conducted a retrospective study of the radiological and pathological findings for 53 metastatic MLNs in the 43 patients. Results: The preoperative imaging modality was computed tomography (CT) alone for 18 patients (22 MLNs) and CT and FDG-PET for 25 patients (31 MLNs). The sensitivities of CT and FDG-PET were 41.5% and 58.0%, respectively. The sensitivity of CT did not differ according to any clinicopathological factors, but the sensitivity of FDG-PET tended to be higher for primary tumors with high SUVmax values and for non-adenocarcinomas. In the lymph nodes, all micrometastatic foci ≤ 2 mm were PET-negative, but 4 lymph nodes with metastatic foci larger than 10 mm were also PET-negative. Conclusions: For the diagnostic imaging of MLN, FDG-PET has a greater sensitivity than contrast-enhanced CT based on “size criteria”, but it is still not sufficiently sensitive and is influenced by various factors. At present, histological confirmation of MLNs is necessary when making decisions regarding treatment plans and the type of surgical procedure that should be performed.展开更多
A 67-year-old man was referred for further evaluation of an abnormal chest roentgenogram. Computed tomography showed a 40 × 30 mm mass in the left upper lobe. A giant bulla occupying about two-thirds of the right...A 67-year-old man was referred for further evaluation of an abnormal chest roentgenogram. Computed tomography showed a 40 × 30 mm mass in the left upper lobe. A giant bulla occupying about two-thirds of the right thorax was found compressing the adjacent lung parenchyma, shifting the mediastinum to the left. The mass was a primary lung cancer, clinical T2aN0M0, stage IB. Preoperative respiratory function evaluation showed poor pulmonary function, with a forced expiratory volume in 1 second of 1070 ml (29.2% of predicted). Therefore, we first performed giant bullectomy by video-assisted thoracoscopic surgery. At 1 month after this operation, improvement of the forced expiratory volume in 1 second significantly to 2140 ml (80.1% of predicted) was observed. Therefore, we performed resection for the tumor. He was discharged after an uneventful postoperative course, and has remained in good condition for 6 months after the operation.展开更多
Background: Some studies have suggested that among all cases of lung cancer, the outcome of lung cancer located in the right middle lobe (RML) is the worst. However, with the advances in the diagnosis and treatment me...Background: Some studies have suggested that among all cases of lung cancer, the outcome of lung cancer located in the right middle lobe (RML) is the worst. However, with the advances in the diagnosis and treatment methods of lung cancer over the last couple of decades, we investigated whether the prognosis of primary lung cancer located in the RML still remains inferior to that of lung cancer arising from other lobes. Methods: Between July 2003 and December 2011, 505 consecutive patients with non-small cell lung cancer (NSCLC) underwent surgical resection at our institution. Of these, 32 patients (6.3%) had tumors arising from the RML. Results: The rate of incomplete resection was higher for cancer located in the RML than that for cancer arising from other lobes. Significant associations were noted between cancer located in the RML and the rate of lymph node metastasis and initial locoregional recurrence. Multivariate analysis identified lymph node metastasis and location in the RML as independent risk factors influencing the recurrence-free survival (p = 0.006), although location in the RML was not extracted as an independent risk factor influenceing the overall survival (p = 0.060). Conclusion: Despite the recent advances in the treatment of lung cancer, evaluation of complete resection revealed that the outcome of cancer located in the RML is still the worst among cancer of all the lobes. Further early diagnosis and adjuvant therapy are needed for improving the prognosis of cancer located in the RML.展开更多
The patient, a 77-year-old male, underwent right middle lobectomy for adenocarcinoma of the lung, pT1aN0M0, in November 2007. In November 2008, chest CT revealed two ground-glass opacities (GGOs) in the right lower lo...The patient, a 77-year-old male, underwent right middle lobectomy for adenocarcinoma of the lung, pT1aN0M0, in November 2007. In November 2008, chest CT revealed two ground-glass opacities (GGOs) in the right lower lobe. In October 2009, both of these GGOs had increased in size, and three new GGOs were found. In July 2011, all of the five GGOs had increased in size and three new GGOs were found yet again. Right lower lobe S6 segmentectomy was performed on September 6, 2011, and histopathological examination revealed eight pulmonary adenocarcinomas in the right S6;all of them classified as pl0, ly0, v0, pT1aN0M0. Among the eight lesions, the doubling times of five were measured during the follow-up course, and the mean doubling time was 402 days. The mean doubling time of the lesions showing high c-erbB2 expression was significantly lesser than that of the lesions showing low c-erbB2 expression (273 days vs. 488 days, p = 0.047). Despite being localized GGOs that had arisen in the same individual, it should be noted that the growth rate of the GGO lesions may vary according to the expression level of a molecular markers, and some GGO lesions may show rapid increase in size.展开更多
文摘Hepatocellular Carcinoma (HCC) rarely metastasizes to bone or mediastinum. In some patients, surgical treatment of oligometastatic lesions from colorectal cancer, breast cancer, or non-small cell lung cancer results in satisfactory survival. However, data concerning oligometastatic lesions from HCC are scarce. We report the case of a patient with long-term survival after resection of metachronous oligometastases of HCC. A 54-year-old woman underwent hepatic resection for non-B, non-C HCC. A solitary left tenth rib tumor was detected 20 months after initial surgery and was surgically resected. A solitary mediastinal tumor was detected 6 months after the second operation and the patient again underwent surgical resection. Histopathological examination of both lesions confirmed metastasis of HCC. The patient has had no further recurrence 7 years after initial surgery without chemotherapy or radiotherapy.
文摘Objective: Advances in diagnostic imaging techniques, such as 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), have led to greater accuracy in preoperative mediastinal staging for patients with non-small-cell lung cancer (NSCLC), but surgical staging remains the “gold standard” for diagnosis. A proper understanding of the current accuracy of diagnostic imaging is needed for further improvements. Methods: Forty-three patients who underwent resection for NSCLC involving mediastinal lymph node (MLN) metastasis at our hospital between June 2003 and May 2011 were enrolled in this study. We conducted a retrospective study of the radiological and pathological findings for 53 metastatic MLNs in the 43 patients. Results: The preoperative imaging modality was computed tomography (CT) alone for 18 patients (22 MLNs) and CT and FDG-PET for 25 patients (31 MLNs). The sensitivities of CT and FDG-PET were 41.5% and 58.0%, respectively. The sensitivity of CT did not differ according to any clinicopathological factors, but the sensitivity of FDG-PET tended to be higher for primary tumors with high SUVmax values and for non-adenocarcinomas. In the lymph nodes, all micrometastatic foci ≤ 2 mm were PET-negative, but 4 lymph nodes with metastatic foci larger than 10 mm were also PET-negative. Conclusions: For the diagnostic imaging of MLN, FDG-PET has a greater sensitivity than contrast-enhanced CT based on “size criteria”, but it is still not sufficiently sensitive and is influenced by various factors. At present, histological confirmation of MLNs is necessary when making decisions regarding treatment plans and the type of surgical procedure that should be performed.
文摘A 67-year-old man was referred for further evaluation of an abnormal chest roentgenogram. Computed tomography showed a 40 × 30 mm mass in the left upper lobe. A giant bulla occupying about two-thirds of the right thorax was found compressing the adjacent lung parenchyma, shifting the mediastinum to the left. The mass was a primary lung cancer, clinical T2aN0M0, stage IB. Preoperative respiratory function evaluation showed poor pulmonary function, with a forced expiratory volume in 1 second of 1070 ml (29.2% of predicted). Therefore, we first performed giant bullectomy by video-assisted thoracoscopic surgery. At 1 month after this operation, improvement of the forced expiratory volume in 1 second significantly to 2140 ml (80.1% of predicted) was observed. Therefore, we performed resection for the tumor. He was discharged after an uneventful postoperative course, and has remained in good condition for 6 months after the operation.
文摘Background: Some studies have suggested that among all cases of lung cancer, the outcome of lung cancer located in the right middle lobe (RML) is the worst. However, with the advances in the diagnosis and treatment methods of lung cancer over the last couple of decades, we investigated whether the prognosis of primary lung cancer located in the RML still remains inferior to that of lung cancer arising from other lobes. Methods: Between July 2003 and December 2011, 505 consecutive patients with non-small cell lung cancer (NSCLC) underwent surgical resection at our institution. Of these, 32 patients (6.3%) had tumors arising from the RML. Results: The rate of incomplete resection was higher for cancer located in the RML than that for cancer arising from other lobes. Significant associations were noted between cancer located in the RML and the rate of lymph node metastasis and initial locoregional recurrence. Multivariate analysis identified lymph node metastasis and location in the RML as independent risk factors influencing the recurrence-free survival (p = 0.006), although location in the RML was not extracted as an independent risk factor influenceing the overall survival (p = 0.060). Conclusion: Despite the recent advances in the treatment of lung cancer, evaluation of complete resection revealed that the outcome of cancer located in the RML is still the worst among cancer of all the lobes. Further early diagnosis and adjuvant therapy are needed for improving the prognosis of cancer located in the RML.
文摘The patient, a 77-year-old male, underwent right middle lobectomy for adenocarcinoma of the lung, pT1aN0M0, in November 2007. In November 2008, chest CT revealed two ground-glass opacities (GGOs) in the right lower lobe. In October 2009, both of these GGOs had increased in size, and three new GGOs were found. In July 2011, all of the five GGOs had increased in size and three new GGOs were found yet again. Right lower lobe S6 segmentectomy was performed on September 6, 2011, and histopathological examination revealed eight pulmonary adenocarcinomas in the right S6;all of them classified as pl0, ly0, v0, pT1aN0M0. Among the eight lesions, the doubling times of five were measured during the follow-up course, and the mean doubling time was 402 days. The mean doubling time of the lesions showing high c-erbB2 expression was significantly lesser than that of the lesions showing low c-erbB2 expression (273 days vs. 488 days, p = 0.047). Despite being localized GGOs that had arisen in the same individual, it should be noted that the growth rate of the GGO lesions may vary according to the expression level of a molecular markers, and some GGO lesions may show rapid increase in size.
