Bilateral pulmonary metastases from hepatocellular carcinoma successfully treated by surgical resection and stereotactic radiotherapy; report of a case

We report a case of 68-year-old-man with pulmonary metastases from hepatocellular carcinoma (HCC). Following right hepatic lobectomy in January 2005, 4 pulmonary metastases in the right lung were detected by chest computed tomography (CT) in September 2007. As chemotherapy was not effective, surgical resection (right upper lobectomy, partial resection of middle and lower lobe ) was performed. Secondary metastases in the left lung was detected in March 2008, and stereotactic radiotherapy was performed considering the site of tumor location and poor pulmonary function. Two years after radiotherapy, the patient is alive without recurrence.     

Surgical treatment for small bowel metastasis of pleomorphic carcinoma 6 months after pulmonary resection

The prognosis of patients with distant metastases of pulmonary pleomorphic carcinoma is poor. We report a case of pulmonary pleomorphic carcinoma patient who underwent surgical resection of small bowel metastasis. A 69-year-old man developed anemia secondary to melena 6 months after right upper lobectomy for pulmonary pleomorphic carcinoma and small bowel metastasis was detected endoscopically. He underwent laparoscopic ileocecal resection and has survived for 2 years after lung cancer resection without any other recurrence or metastasis.     

电视胸腔镜辅助小切口肺叶切除术63例报告

目的探讨电视胸腔镜（video—assisted thoracoscopic surgery，VATS）辅助小切口肺叶切除术在肺部疾病和非小细胞肺癌治疗中的适应证、安全性。方法1996年5月～2007年4月，VATS辅助小切口行肺叶切除术63例，其中术前诊断肺良性病变18例，肺实质性占位或恶性病变45例，行右肺上叶切除术12例，右肺中叶切除8例，右肺下叶切除27例，左肺上叶切除5例，左肺下叶切除11例。结果63例均成功行胸腔镜肺叶切除术（其中延长切口6例）。无围手术死亡。胸腔闭式引流时间4～7d，平均4．5d。术后病理诊断：原发性非小细胞肺癌（NSCLC）37例（58．7％），转移癌1例（1．6％），类癌1例（1．6％）；良性病变24例（38．1％）。37例NSCLC中术后病理临床分期：Ⅰa期8例，Ⅰb期13例，Ⅱa期4例，Ⅱb期3例，Ⅲa期6例，Ⅲb期1例，Ⅳ期2例。恶性肿瘤随访34例（87．2％），其中2～12个月7例，13～24个月10例，25～36个月6例，37～48个月6例，49～60个月3例，2例生存11年。因肿瘤复发或转移死亡5例（14．7％），带瘤生存1例（2．9％），无瘤生存28例（82．4％）。Ⅰ、Ⅱ期肺癌1年和3年生存率为100％（19／19）、90％（9／10）；Ⅲ期肺癌随访5例，3例死于肿瘤复发或转移；Ⅳ期2例中1例死于转移。结论VATS辅助小切口肺叶切除术安全，可达到彻底切除目的，其适应证为肺良性疾病和Ⅰ、Ⅱ期周边型非小细胞肺癌，可作为其常规手术之一。     

Metastatic renal tumor of esophageal carcinoma: report of a case

In August 1987, a 66-year-old man was hospitalized because of macrohematuria and right flank pain. He had undergone resection of middle and lower part of the esophagus with esophagogastrostomy for esophageal carcinoma on April 16, 1984. Computed tomography revealed a solid, irregular, low density area in the upper pole of the right kidney and the right lobe of the liver. Arteriography showed a hypovascular mass in the upper pole of the right kidney, and several small tumor stains in the liver. At cystoscopic examination, the urinary bladder was normal and blood flowing from bilateral ureters was not seen. Cytological study of urine sediment disclosed squamous cell carcinoma. The patient was treated with systemic chemotherapy, but not improved. He died 6 months later, and the autopsy demonstrated widespread metastasis in various organs including the right kidney and liver. No recurrence was found in the residual esophagus. The kidney is the sixth organ of metastasis following the lung, liver, bone, adrenal, peritoneum and mesenterium. Although metastasis to the kidney is relatively common in autopsy, it is uncommon to be manifest clinically.     

Small size lung adenocarcinoma with rocal recurrence and port site recurrence 56 months after partial resection

A lobectomy with systemic lymphadenectomy is a standard surgical procedure for a resectable lung cancer. However there is not a consensus on the limited surgery. A 60-year-old man underwent left upper lobe partial resection for small size lung adenocarcinoma under video assisted thoracic surgery (VATS). Fifty-six months after the operation, a computed tomography (CT) scan showed a local recurrence on the staple-line. A positron emission tomography (PET) scan showed an additional port site recurrence, which wasn't showed by a CT scan. He underwent left upper lobectomy and port site resection.     

Intra-abdominal metastases from primary carcinoma of the lung

The case of a 56-year old male with an intra-abdominal metastasis from a primary lung cancer is presented. He was admitted for abdominal obstruction, toxic syndrome and paraumbilical pain. He had a previous history of squamous cell carcinoma of the right lung, for which he had undergone a right upper lobectomy in 1995, four years prior to the development of the abdominal obstruction. A debulking operation and bowel resection for the intestinal metastasis was performed. Eleven months after this operation the patient developed a recurrence: he underwent another debulking operation with resection of the sigmoid colon, jejunal segment and a small part of the bladder. The patient is alive and well 13 months after the initial operation. Intra-abdominal metastases of bronchial carcinoma may be observed with greater frequency, because of the improved survival of the patients with lung cancer. Metastatic small bowel carcinomas are rare and should be considered in the differential diagnosis of acute abdominal syndromes of patients with known history of the lung cancer. Bowel resection and debulking of the metastatic tumour mass give the best palliation and improve short-term survival.     

Aggressive Surgical Treatment of Multiple Primary Lung Cancers

A case of triple primary lung cancers - squamous cell carcinoma, adenocarcinoma and large-cell carcinoma - is presented. Surgical treatment comprised, respectively, left pneumonectomy, partial resection of the right upper lobe and completion right upper lobectomy. The postoperative courses were uneventful and the patient remains well, with no sign of recurrence, 20 months after the third operation.     

直径≤3cm的周围型非小细胞肺癌纵隔淋巴结转移规律的初步研究

目的探讨直径≤3cm的周围型非小细胞肺癌(non-small cell lung cancer,NSCLC)纵隔淋巴结转移的情况,分析早期周围型NSCLC纵隔淋巴结转移的规律。方法 2000年1月1日～2008年12月31日治疗直径≤3cm的周围型NSCLC161例,男89例,女72例,年龄(63.4±10.7)岁,行肺叶切除或肺局限性切除加系统性纵隔淋巴结清扫术,分析其临床特征、病理特点及纵隔淋巴结转移规律。结果全组手术顺利,无死亡及严重并发症发生。肺叶切除153例,肺楔形切除7例,肺段切除1例。全组共清扫淋巴结2456枚,平均每例4.5±1.6组、13.1±7.3枚。术后病理:腺癌99例,鳞癌30例,肺泡细胞癌19例,其他类型肺癌13例。术后TNM分期:ⅠA期50例,ⅠB期62例,ⅡA期6例,ⅡB期10例,ⅢA期33例。N1组淋巴结转移率为23.6%(38/161),N2组转移率为20.5%(33/161),其中隆突下淋巴结转移率为8.1%(13/161),跳跃式纵隔转移率为6.8%(11/161),全组未发现下纵隔淋巴结转移。肺泡细胞癌及直径≤2cm的鳞癌、直径≤1cm的腺癌均无pN2转移。上肺癌发生pN2转移时上纵隔100%(19/19)受累,其中21.1%(4/19)同时伴有隆突下淋巴结转移;下肺癌则除主要转移至隆突下外(64.3%,9/14),还常直接单独转移至上纵隔(35.7%,5/14)。转移的纵隔淋巴结左肺癌主要分布在第5、6、7组,右肺癌主要分布在第3、4、7组。结论对于直径≤3cm的周围型NSCLC,肿瘤直径越大,其纵隔淋巴结转移率越高,肺泡细胞癌、直径≤2cm的鳞癌和≤1cm的腺癌其纵隔淋巴结转移率相对较低;上肺癌主要转移在上纵隔,下肺癌则隆突下及上纵隔均可转移;第5、6、7组淋巴结是左肺癌主要转移的位置,第3、4、7组是右肺癌主要转移的位置,术中应重点清扫。     

Three pulmonary resections for metastatic lung cancer from hepatocellular carcinoma

We describe a patient who underwent pulmonary resection three times for metastatic lung cancer from hepatocellular carcinoma (HCC). A 56-year-old man, who had a past history of right hepatic lobectomy for HCC, was referred to our department with an abnormal finding on chest computed tomography (CT). Chest CT showed three abnormal shadows, in the right upper lobe (S3b), right middle lobe (S5), and right lower lobe (S10), respectively, and there was no evidence of intrahepatic recurrence. He underwent surgical resections (right upper lobectomy and partial resections) for the metastatic lung cancer from HCC. Subsequently, 12 and 16 months after the first pulmonary resection, metastatic lung cancer recurred, in right S6 and S9, respectively. Because there was no evidence of intrahepatic recurrence and because of the feasibility of curative resection, we performed partial pulmonary resections. He had no postoperative morbidity, and is alive with no evidence of disease 60 months after the first pulmonary resection. Twelve cases of repeat pulmonary resections for metastatic lung cancer from HCC have been reported in the literature, and the authors of these reports described that repeated pulmonary resections for metastatic lung cancer from HCC resulted in long-term survival. Repeat pulmonary resections for metastatic lung cancer from HCC can be an effective treatment for patients with such metastases.     

Treatment of colorectal liver metastasis with biliary and portal vein tumor thrombi by hepatopancreatoduodenectomy

We present a case of a large colorectal liver metastasis with portal vein and biliary tumor thrombi and duodenal and jejunal direct invasion that required hepatopancreatoduodenectomy. A 38-year-old woman presented to her local hospital with right back pain and jaundice. She had undergone transverse colectomy and limited liver resection for transverse colon cancer with a synchronous liver metastasis in September 1991, and low anterior resection for rectal carcinoma in January 1996. She was diagnosed as having colorectal liver metastasis and was referred to our hospital for possible surgery. Radiologic and endoscopic examinations revealed a large liver tumor occupying the right lobe, biliary dilation in the left lateral section, and a portal vein tumor thrombus. Invasion of the inferior vena cava and the right renal vein were also suspected. Intraoperative findings revealed a large liver tumor that occupied the right lobe and invaded the duodenum and jejunum. The tumor was resected successfully by right trisectionectomy, caudate lobectomy, pancreatoduodenectomy, partial resection of the jejunum, and combined portal vein resection and reconstruction. The inferior vena cava, right kidney, and renal vein could be detached from the tumor. The patient has enjoyed an active life without recurrence for 2 years since the operation.     

Role of surgery in the treatment of primary carcinoma of the liver: a 31-year experience

During the 31 year period 1954 to 1985, 225 major hepatic resections have been performed for symptomatic primary carcinoma of the liver, of which right hepatic lobectomy was performed in 115, extended right hepatic lobectomy in 11, trisegmentectomy in 2, left hepatic lobectomy in 94, and middle hepatectomy in 3. In addition there were 107 partial hepatic resections for 89 asymptomatic small hepatocellular carcinomas. In the 225 patients undergoing major hepatic resection, the operative mortality was 8.0 per cent. In the 107 patients undergoing partial hepatic resection, the operative mortality was 5.6 per cent. Of the total of 314 hepatic resections for primary carcinoma of the liver, 309 were undertaken for hepatocellular carcinoma and the remaining 5 were carried out for cholangiocarcinoma. All hepatic resections in this series were performed with the finger fracture technique without controlling the hepatic hilar vessels, hepatic ducts or hepatic veins outside the liver, although hepatic clamping and the Pringle manoeuvre were also used in selective cases. Of 207 cases who survived major hepatic resection, 119 cases died within one year after the operation, mainly due to recurrence of cancer in the remaining residual lobe, lung metastasis or late hepatic failure. The 5 year survival rate is 18.0 per cent, 12 patients are still alive and well after more than 5 years and the longest survival is 23 years. Of the 89 patients with small asymptomatic hepatocellular carcinomas, 28 died within one to four years of surgery because of a second new growth.     

Aggressive surgical treatment of multiple primary lung cancers

A case of triple primary lung cancers--squamous cell carcinoma, adenocarcinoma and large-cell carcinoma--is presented. Surgical treatment comprised, respectively, left pneumonectomy, partial resection of the right upper lobe and completion right upper lobectomy. The postoperative courses were uneventful and the patient remains well, with no sign of recurrence, 20 months after the third operation.     

Primitive chest wall neuroectodermal tumor in a pediatric patient

A 13-year-old boy with a primitive neuroectodermal tumor of the chest wall is presented. After four cycles of chemotherapy, a computed tomography scan of his chest showed a larger mass invading the left upper lobe of the lung. He underwent resection of the left chest wall from the left fourth to sixth ribs, including the tumor, combined with left upper lobectomy and lymph node dissection. A diagnosis of primitive neuroectodermal tumor was confirmed histopathologically and immunohistochemically. After surgery, four cycles of chemotherapy with ifosfamide and etoposide were given. One year after treatment, the patient is currently doing well without evidence of recurrence.     

Successful treatment of mucoepidermoid carcinoma of the carina

We successfully treated a 33-year-old man with mucoepidermoid carcinoma at the carina. Through preoperative spiral computed tomography with multiplanar and three-dimensional reconstructions, the lesion extended along the right main bronchus across the orifice of the right upper lobe. He underwent a carinal resection plus right upper lobectomy and reconstruction of the carina. He shows neither anastomotic complication nor recurrence of disease 1 year after surgery. Spiral computed tomography was used to evaluate the preoperative and postoperative state of the central airway.     

Mucoepidermoid carcinoma in a young man treated by bronchoplasty

A 17-year-old man in whom mucoepidermoid carcinoma of the left upper lobe bronchus was successfully treated by bronchoplasty. The patient has been suffered from relapsing respiratory infections over the past 2 years. Bronchoscopic examination revealed a tumor at the orifice of the left upper lobe bronchus. Thus, left upper sleeve lobectomy was carried out. The tumor was 18 x 15 x 14 mm in size and obstructed left upper bronchus with mucoid impaction peripherally. Hystological examination confirmed a diagnosis of low grade malignant mucoepidermoid carcinoma without lymph node metastasis. The patient has been well and free from recurrence for 4 years postoperatively.     

Pulmonary pleomorphic carcinoma

Pleomorphic carcinoma is a rare primary pulmonary malignancy. We report 2 surgical cases of pulmonary pleomorphic carcinoma. The first case was a 71-year-old male. Chest computed tomography (CT) showed a rapidly growing tumor with irregular density. Transbronchial lung biopsy revealed the tumor to be malignant. Left lower lobectomy was performed. Pathological diagnosis was pleomorphic carcinoma (pT2N2M0, stage IIIA). He died 8 months after surgery due to brain metastasis and mediastinal lymph node metastasis. The second case was a 74-year-old male who complained of bloody sputum. Chest CT showed a tumor with cavity in the right middle lobe. Brushing cytology under bronchofiberscopy revealed atypical cell. Right middle lobectomy and partial resection of the right lower lobe were performed. Pathological diagnosis was also pleomorphic carcinoma (pT2N0M0, stage IB). He has no findings of recurrence nor metastasis 15 months after the operation.     

Bilateral sleeve lobectomy for metachronous multiple primary lung cancer

In a patient with metachronous multiple primary lung cancer, bilateral lobectomy was performed, using bronchoplastic procedures. This case may be one of very few such cases reported in the literature. A 56-year-old man with squamous cell carcinoma was surgically treated for lung cancer. At the first operation, right upper lobectomy with wedge resection of the right main bronchus was performed, as the tumor occupied the orifice of the right main bronchus. Six months later, re-operation for stricture at the anastomotic line was done because of granulation. By means of sleeve resection of the strictured right main bronchus, the airway was reconstructed. The patient remained well for five years, then a similar cancer at the orifice of the left lower lobe and bulging into the left main bronchus became evident. Left lower sleeve lobectomy was done for the second primary cancer. The postoperative course was uneventful and he is well with no signs of recurrence 6 years and 10 months after the first operation and 19 months after the second sleeve lobectomy.     

Bilateral sleeve lobectomy for metachronous multiple primary lung cancer

In a patient with metachronous multiple primary lung cancer, bilateral lobectomy was performed, using bronchoplastic procedures. This case may be one of very few such cases reported in the literature. A 56-year-old man with squamous cell carcinoma was surgically treated for lung cancer. At the first operation, right upper lobectomy with wedge resection of the right main bronchus was performed, as the tumor occupied the orifice of the right main bronchus. Six months later, re-operation for stricture at the anastomotic line was done because of granulation. By means of sleeve resection of the strictured right main bronchus, the airway was reconstructed. The patient remained well for five years, then a similar cancer at the orifice of the left lower lobe and bulging into the left main bronchus became evident. Left lower sleeve lobectomy was done for the second primary cancer. The postoperative course was uneventful and he is well with no signs of recurrence 6 years and 10 months after the first operation and 19 months after the second sleeve lobectomy     

Non-small cell lung cancer simultaneously metastatic to the brain treated by lobectomy and stereotactic irradiation

We performed left upper lobectomy in 64-year-old man with non-small cell lung cancer (NSCLC) simultaneously metastatic to the brain. He was treated by stereotactic irradiation (STI) 2 months later after lobectomy. He has been doing well now without recurrence for 5 years after the operation. We think that STI and radical lobectomy are good alternatives for patients with NSCLC metastatic to the brain.     

Bronchoplastic lobectomy with wide wedge resection for lung cancer with long-term steroid medication

A 57-year-old man with erythrodermia, who was given 5-10 mg/day of prednisolone for 2.5 years, was admitted to our hospital for squamous cell lung carcinoma of the right upper lobe. A bronchoscopy revealed a tumor nearly obstructing the right upper lobe bronchus. A bronchoplastic lobectomy was performed with wide wedge resection of the main bronchus and truncus intermedius. A postoperative bronchoscopy revealed good healing of the anastomosis and a 3-dimensional construction of the bronchus with chest computed tomography demonstrated no stenotic change and no kinking change in the anastomosis. One year and 6 months after surgery, no local recurrence was seen in the region of bronchoplasty. Bronchoplastic lobectomy with wide wedge resection is a useful procedure in cases with risk factors of anastomotic dehiscence, such as after induction therapy or during long-term administration of adrenal cortical steroids.