A case of lung cancer with specific calcification]

A 67-year-old male was admitted for detailed investigation of an abnormal chest roentgenogram showing a tumor shadow about 3 cm in diameter in the left S1+2. The shadow was surrounded by minute granular and striate shadows. Small cell carcinoma of the lung was diagnosed and chemotherapy was commenced, but without effect. Hypercalcemia and superior vena caval syndrome followed. Autopsy indicated highly specific calcinosis present in the left upper lobe peripheral to the primary disease. This calcinosis was observed subepithelially in bronchi and bronchioles, in the tunica intima of the veins, and in the alveolar septa. It could not be detected in the tumor or arterial or lymphatic systems. The calcinosis had been present prior to the development of hypercalcemia, and the density of the calcinosis was greatest close to the tumor, gradually decreasing with increased distance from the tumor. The calcinosis appeared to have been caused by some substance, and to have been accelerated by venous congestion, resulting in its unique distribution.     

A case of lung cancer with cyst formation]

A 70-year-old man was admitted with a nodule adjacent to a cystic lesion in the right lower lung field. Diagnosis of lung cancer was made by transbronchial biopsy. A series of chest radiographs revealed that a cystic lesion had presented 8 years before, and that a nodule appeared on the hilar side of the cyst 5 years later. The cyst may have been formed by the check-valve mechanism due to the lung cancer.     

A case of amylase-producing lung cancer]

A 72-year-old man was admitted to our hospital because of progressive dyspnea due to pulmonary emphysema. Chest CT revealed a nodular lesion in the right S6 and swollen right hilar lymph nodes. The diagnosis was not confirmed bronchoscopically. A subsequent biopsy of a subcutaneous mass in the left lateral pectoral region demonstrated metastatic cancer. Laboratory data on admission showed marked elevation of amylase activity in both serum and urine. Amylase isozyme patterns identified the salivary types. The pancreas and salivary glands were unlikely to have any clinical involvement in the hyperamylasemia, but lung cancer with subcutaneous metastasis was strongly suspected clinically as the source. Chemotherapy failed to prevent tumor progression and the patient eventually died of respiratory failure. Immunohistological examination of the subcutaneous lesion showed positive staining for salivary-type amylase, whereas that of the lung primary lesion disclosed small cell carcinoma and negative staining for amylase. In most cases, amylase-producing lung cancers have been diagnosed as adenocarcinoma. Amylase-producing small cell carcinoma is very rare.     

A case of synchronous primary lung cancer with hamartoma]

We present a case of a synchronous primary lung cancer adjacent to a hamartoma. In a 48-year-old man, a nodular shadow was found in the right middle lung field in 1990, and had grown slowly for 10 years. Another mass shadow was detected in the right upper lung field in 2000. The patient was admitted to our hospital for further examination of these abnormal shadows. Bronchoscopic examination revealed, in the right upper lobe, a poorly differentiated adenocarcinoma of clinical stage IIIB. Neoadjuvant chemotherapy followed by pneumonectomy was performed. The microscopic findings for the tumor resected from the right S2 showed poorly differentiated adenocarcinoma and those for the other, in the right S3, showed chondromatous hamartoma. Some 50 reports of lung cancer in parents with a chondromatous hamartoma have appeared in the literature. Most of these cases have some common features as follows: 1) men past middle age, 2) adenocarcinoma, and 3) lung cancer and chondromatous hamartoma present in the same lobe. The present case had all of these features, and may assist in the understanding of the process of development of lung cancer adjacent to a hamartoma.     

A case of M. fortuitum lung disease with small-cell lung cancer]

A 58-year-old man was admitted to our hospital because of an abnormal shadow found on chest radiography. Chest radiographs and chest CT on admission showed a bulla with a niveau and infiltration in the right upper lobe. Smear of sputum and bronchial lavage were negative for acid-fast bacilli. Despite treatment with meropenem and clindamycin, the infiltrating shadow worsened. Since bronchial lavage and sputum culture were positive for M. fortuitum, these drugs were replaced with minocycline and imipenem. Thereafter, the shadow on the chest radiograph improved. After discharge, outpatient treatment with clarithromycin and levofloxacin was continued. After 4 months, the residual tumor shadow in the right upper lobe gradually grew. When a CT-guided transcutaneous needle lung biopsy was undertaken, malignant cells were found. Right upper lobectomy was performed. Pathological examination of the lesion demonstrated small-cell lung cancer. If a lesion does not change after nontuberculous mycobacteria treatment, the physician should consider other lesions such as lung cancer.     

A case of severe pneumoconiosis with synchronous triple lung cancer]

A 70-year-old man who had worked in a stonepit for about fifty years was admitted to our hospital for detailed examination of the signs of pneumoconiosis (3/3, q) and a nodular shadow in the right upper lung field. Under a clinical diagnosis of lung cancer complicated with pneumoconiosis, right upper lobectomy with a right S6 resection was performed. Pathological examination revealed moderately differentiated adenocarcinoma of the right S2, well-differentiated adenocarcinoma of the right S6, and a squamous cell carcinoma of the right S1 which was not detected by chest CT. In addition to the difficulty of diagnosing lung cancer in a patient with severe pneumoconiosis, treatment for lung cancer may be limited by the poor pulmonary function that results from pneumoconiosis. Although the labor administration's decision that lung cancer patients with concomitant pneumoconiosis deserve compensation can be evaluated as a good one, the study of the relationship between pneumoconiosis and lung cancer needs further study through follow-up examination of pneumoconiosis cases.     

A case of primary lung cancer with cervical tuberculous lymphadenitis]

A 66-year-old woman was admitted due to right cervical lymphadenopathy and an abnormal chest radiograph. Acid-fast bacilli smear of fine needle aspiration from a right cervical lymph node was positive. Histopathological examination of the specimen obtained by percutaneous right cervical lymph node biopsy showed necrotizing epithelioid granulomas and no malignant cells. Therefore, right cervical tuberculous lymphadenitis was diagnosed. Partial lung resection of the right S4 was carried out by video-assisted thoracoscopic surgery and primary lung cancer was diagnosed. To our knowledge, there has been no previous report of both primary lung cancer and cervical tuberculous lymphadenitis being present at the time of the first examination. We report this very rare case.     

A case of spontaneous regression of lung cancer with skin metastasis]

Spontaneous regression of a malignant tumor is a rare phenomenon, especially in advanced lung cancer. We reported a case of spontaneous regression of lung cancer with tracheal stenosis due to tumor invasion and multiple skin metastases. A 60-year-old man was admitted to our hospital on September 10, 1985, because of a dry cough. A chest roentgenogram showed a mass shadow in the right upper lung field. Bronchoscopic examination revealed tracheal stenosis due to the tumor mass, and transbronchial aspiration cytology (TBAC) yielded a diagnosis of large cell carcinoma of the lung. In spite of treatment by chemotherapy with cisplatin and vindesin and irradiation, dyspnea deteriorated and multiple skin metastases appeared. After Nd-YAG laser irradiation via a broncho-fiberscope to maintain his airway and ethanol injection into the skin metastases, his dyspnea improved and he was discharged on February 6, 1986. Two months after discharge all skin metastasis had completely disappeared, and the primary lesion also regressed and finally disappeared on chest roentgenogram until August, 1986. The mechanism of regression is unclear, but now he has been free of tumor clinically for four years.     

A case of primary lung cancer in a young female with tongue cancer]

We describe a case of lung tumor in a 33-year-old woman with tongue cancer. She had noticed a painful sensation in her tongue in April 2000. The results of a physical examination showed a 22 x 11 mm ulcerated lesion on the right side of her tongue. A biopsy specimen showed a moderately differentiated squamous cell carcinoma. A preoperative chest radiograph showed no evidence of pulmonary metastasis. No neck lymphadenopathy was found. The tongue cancer was resected in September 2000, and the pathological stage was T2 N0 M0. A solitary pulmonary lesion appeared 8 months after the surgery. A Histological examination of a transbronchial lung biopsy specimen showed a moderately differentiated squamous cell carcinoma. It was difficult to distinguish histopathologically or immunohistochemically between a second primary tumor and a metastasis, but the pulmonary lesion was considered to be a second primary tumor on the basis of a single endobronchial lesion that appeared after the T2 tongue cancer with no regional recurrence or cervical lymphadenopathy. Treatment with chemotherapy and irradiation was not effective and the patient died 3 months after the diagnosis of lung cancer.     

A case of small cell lung cancer associated with pulmonary sarcoidosis]

A 63-year-old man with pulmonary sarcoidosis, diagnosed by mediastinal lymph node biopsy in 1977, was admitted in Feb. 1987 because of shortness of breath and cough. Chest X-ray showed bilateral hilar lymphadenopathy and a tumor shadow in the right lung field. Histological examination of specimens biopsied from the right lung revealed small cell carcinoma (S.C.C.). Bronchoalveolar lavage was performed to evaluate the disease activity of sarcoidosis, and the total number of cells and T-lymphocytes; the ratio of CD4+ cells to CD8+ cells was not increased. He was treated with combination chemotherapy, however, he died of respiratory failure after 7 months. An autopsy was performed, and the lesions were examined histologically. The sarcoid lesion in a lymph node obtained at autopsy was not active, in contrast to that obtained by mediastinal lymph node biopsy. Lung cancer and sarcoidosis are both common diseases, but their coexistence in the same patient is not common, and autopsied cases are rare. In this case, an autopsy was performed, and BAL had been performed prior to his death. The relationship between the BAL findings and the histology of sarcoidosis was examined. Based on the results of autopsy and BAL, the sarcoidosis was inactive prior to death, but had been histologically active 10 years previously. Therefore, this is a very interesting case, since we can examine the relationship between the two diseases, and the progression of each disease. This case also provides an interesting example of differentiation of sarcoidosis from S.C.C. Metastatic invasion of the hilar lymph nodes without bronchial stenosis and changes secondary to stenosis may often occur in patients with small cell lung cancer. Such metastatic invasion closely resembles the bilateral hilar lymphadenopathy of sarcoidosis; therefore, in some cases, it may be extremely difficult to differentiate the two diseases.     

A case of surgically treated primary lung cancer with myasthenia gravis]

A 62-year-old woman, who had received immunosuppressive treatment for myasthenia gravis, was admitted to our hospital for the treatment of a right pulmonary tumor. In October 2003, a chest computed tomography showed a nodule-like lesion in the right lung. Two years later, the lesion was shown to have increased in size, and a right upper lobectomy was performed using video-assisted thoracic surgery. A tumor biopsy showed histological features of bronchioloalveolar carcinoma. It has been reported that malignant tumors occur more frequently in patients with myasthenia gravis with concurrent thymoma. Therefore, such patients need to be followed closely for a long period of time for any possible malignant tumor occurring in different organs. In addition, protection of the bronchial stump may be necessary to prevent a bronchial fistula, because wound healing can be delayed due to immunosuppressive treatment.     

A case of paraneoplastic cerebellar degeneration associated with small cell lung cancer]

Paraneoplastic cerebellar degeneration (PCD) is a clinical syndrome and known to be occasionally associated with small cell carcinoma of the lung (SCLC). PCD usually affects patients before the cancer is evident. The disorder evolves subacutely, and causes severe pancerebellar dysfunction. In this paper, we report a case of PCD associated with SCLC. A 65-year-old man presenting with 2 weeks of progressive vertigo, gait ataxia, and speech disturbance, was readmitted to our hospital. He had earlier been given a diagnosis of SCLC, oat cell carcinoma, and had undergone high-dose chemotherapy with peripheral blood stem cell transplantation during his first admission. Following that treatment regimen, the tumor disappeared completely and the patient had been in remission. Based on neurological findings and the presence of anti-neuronal antibodies a diagnosis of PCD was made. Although cyclophosphamide (500 mg/m2) was administered, the patient experienced no relief of his cerebellar ataxia. Six months afer readmission, he died of cardiac tamponade due to malignant pericarditis. A histological examination at autopsy found few Purkinje cells and a proliferation of Bergmann's astrocytes in the cerebellar cortex. These findings were consistent with the diagnosis of PCD.     

A case of lung cancer in a patient with von Recklinghausen's disease]

A 57-year-old man was admitted to our hospital for further investigation of an abnormal shadow in his chest X-ray. He had cafe-au-lait spots and multiple subcutaneous neurofibromas and was diagnosed as having von Recklinghausen's disease. Bronchofiberscopy was performed, but an adequate specimen was not obtained. Therefore, percutaneous needle biopsy was performed, and the specimen showed poorly-differentiated adenocarcinoma. The left subclavian artery was deviated on aortography, therefore, neoadjuvant chemotherapy with CDDP & VDS was performed. He subsequently underwent left upper lobectomy. Pathologically, the tumor cell showed necrosis and scarring. Including this case, there have been 11 reports of von Recklinghausen's disease associated with lung cancer in the Japanese literature. Adenocarcinoma was observed in 72.9% of cases, and poorly-differentiated tumor was observed in 7 out of 8 patients with distinct tumor differentiation.     

A case of primary lung cancer with initial symptoms due to orbital metastases]

We encountered a case of lung cancer in which symptoms due to orbital metastasis were recognized. A 55-year-old man presented with a chief complaint of double vision. Orbital MR image demonstrated a right intraorbital mass with bone destruction, which resulted in oculomotor nerve palsy and optic nerve disturbance. Chest CT scan showed a 4 cm mass in the right S6, which was diagnosed on biopsy as a poorly differentiated adenocarcinoma. A whole-body scintigram revealed multiple bone metastases: the right orbital wall, the lower cervical spine, the left knee joint, and so on. Based on the clinical findings, we believed that the orbital tumor was a metastasis from the lung. Systemic chemotherapy and irradiation of the right orbital tumor and the left knee joint were performed. Though a favorable response was achieved in ocular movement, the patient died 3 months after initial treatment because of progression of the primary lesion. Including this case, seventeen reported cases in which lung cancer metastasized to the orbit in Japan were also reviewed.     

A case of lung cancer with alkaline phosphatase flare phenomenon during gefitinib therapy]

A 79-year-old woman with adenocarcinoma of the lung almost fully obstructing the right main bronchus and with multiple bone and brain metastases was admitted to our hospital in March 2005. Irradiation was considered to be successful. Since subsequent vinorelbine chemotherapy was futile, it was changed to gefitinib in June. A week after gefitinib therapy, serum alkaline phosphatase (ALP) began to increase from about 400 IU/l to 1247 IU/l, to 3470 IU/l after two weeks, and up to 3527 IU/l after three weeks. The levels then decreased to within the normal range after nine weeks. ALP isozyme showed a peak composed of ALP2 and ALP3, and the levels of other enzymes (GOT, GPT, gamma-GTP) were normal. Hence, increased ALP was thought to be derived from the bones. The patient's performance status and metastases improved during this phenomenon. Bone scintigraphy findings one month after beginning gefitinib therapy worsened, but improved after four months. Bone ALP represents osteoblastic activity. We believe that in this case bone formation became dominant because of the favorable response to gefitinib therapy.     

A case of primary lung cancer complicated with hypothyroidism by diffuse thyroid metastasis]

A 56-year-old woman with hypothyroidism was admitted to our hospital because of an abnormal chest X-ray film. The chest CT showed a 3-cm spiculated tumor in the left lingual branch, and multiple nodular shadows with random distribution. Cervical CT showed diffuse enlargement of the thyroid gland with low density. The cytology of the tumor in the left lingular branch revealed adenocarcinoma, and ultrasound-guided fine needle aspiration cytology of the thyroid gland revealed adenocarcinoma, cytologically identical to the cells from bronchoscopic examination. Immunochemically, specimens obtained from both bronchoscopy and the thyroid gland were negative for thyroglobulin. Therefore, we diagnosed this case as primary lung cancer complicated with hypothyroidism by diffuse metastasis of the thyroid gland. Metastatic thyroid tumor is rarely diagnosed clinically. Furthermore, metastatic thyroid tumor complicated with thyroid dysfunction is extremely rare. We conclude that in patients with both diffuse thyroid swelling and thyroid dysfunction, the possibility of metastatic thyroid tumor should be considered.     

A case of HLA-B54 positive silicosis with rheumatoid arthritis and lung cancer]

In the same environment or workplace, some people contract pneumoconiosis, including silicosis, and some do not. This suggests the important role of constitutional predisposition. In Japanese cases with silicosis, the frequency of HLA-B54 was increased and disease susceptibility gene (s) may exist near the HLA-B locus. It is well known that silicosis is frequently accompanied with rheumatoid arthritis, probably due to the effects of silica on the immunological system. We encountered a case of silicosis with rheumatoid arthritis and lung cancer, who was found to have HLA-B54.     

A case of juvenile lung cancer with suspected progeroid syndrome and mental retardation]

A 28-year old woman developed juvenile lung cancer. Cockayne syndrome, one of the progeroid syndromes, was suspected because of mental retardation, renal disfunction, photosensitivity, and the characteristic physical appearance such as low set ears, microcephaly, senile face, short stature, and cachectic habitus. We tried chemotherapy with gefitinib and docetaxel, but they were ineffective and she was found to have multiple extraocular muscle metastasis. CT scan showed carcinomatous lymphangiosis findings, her respiratory condition worsened gradually and she died about 7 months after the diagnosis of lung cancer. Some progeroid syndromes are known for their high incidence of juvenile cancres, and the responsible genes are gradually coming to light. However, concerning the relationship between lung cancer and progeroid syndromes, our investigations revealed only one case report of Werner syndrome, one of the progeroid syndromes, accompanied by lung cancer. Progeroid syndromes with lung cancer are thought to be very rare. We expect collection of data on cases like the present case will help to clarify the mechanism of aging and carcinogenesis.