Primary unknown cancer in pulmonary hilar lymph node with spontaneous transient regression: report of a case

A 69-year-old man was referred to our hospital in December 1993 because an abnormal mass had been detected in the right pulmonary hilum. Computed tomography (CT) of the chest revealed a swollen hilar lymph node between the right middle and lower lobe bronchi, and an adherent tumor in the right ventrobasal segment (S8). Chest roentgenogram in February 1994, however, showed no evident tumor in the right lung field. In March 1996, the mass in the right pulmonary hilum reappeared on chest roentgenogram. Chest CT revealed a swollen hilar lymph node between the right middle and lower lobe bronchi, but there was no tumor in right S8. The patient underwent video-assisted thoracoscopy on 17 May 1996. Intraoperative needle biopsy of the node revealed cancer cells. We performed right middle and lower bilobectomy with mediastinal dissection. Histological diagnosis revealed a large cell carcinoma almost completely occupying a hilar lymph node. The resected middle and lower lobes showed no tumors, except for a coagulation necrosis measuring 1.5 cm in diameter in S8b, corresponding to the site where a tumor shadow had been depicted on the CT image in December 1993. We concluded that the coagulation necrosis might have been the primary site of the tumor, which had spontaneously regressed and then appeared in the metastatic interlobar node.      

A case with juvenile hepatocellular carcinoma without hepatitis underwent right hepatic Trisegmentectomy

A CASE REPORT: A 20-year-old man with juvenile hepatocellular carcinoma (HCC) without HBV, nor HCV infections. A complaint of pain in the right abdomen, wherein a bulky hepatic tumor occupying a large area of the right lobe as well as tumors that were 20 mm and 10 mm in size in liver regions S2 and S3, respectively, were observed via an abdominal CT scan. A biopsy resulted in a diagnosis of well-differentiated hepatocarcinoma. The main voluminous tumor mass in the right lobe was resected, but the tumor still remained in the lateral segment after the surgery. On day 21 after the surgery, we initiated a therapy for the remaining tumor. He is still alive 36 months after surgery.     

Pancreatic resection for metastatic tumors to the pancreas

We report 3 cases of resectable pancreatic metastasis. CASE 1: A 76-year-old woman was followed after nephrectomy for renal cell carcinoma for 13 years. CT examination demonstrated a high vascular lesion in the pancreatic body and tail. We conducted distal pancreatectomy and diagnosed with metastatic tumor from renal cell carcinoma. She died of liver metastasis 8 years after pancreatic resection. CASE 2: A 64-year-old man, who had undergone right lower lobectomy for lung cancer a year ago, was found to have a mass in the pancreatic tail. We performed distal pancreatectomy and diagnosed with metastatic tumor from lung cancer. He died of lung metastasis 12 months after pancreatic resection. CASE 3: A 62- year-old woman, who had undergone left nephrectomy for renal cell carcinoma 3 years ago, was found to have a mass in the pancreatic body. With a diagnosis of metastatic pancreatic tumor from renal cell carcinoma, distal pancreatectomy was done. She died of liver and lung metastases 15 months after pancreatic resection. Long-term survival can be achieved in patients undergoing a pancreatic standard resection including lymphadenectomy for isolated metastasis from nonpancreatic sites.     

Primary clear cell adenocarcinoma of the lung

Primary clear cell adenocarcinoma of the lung is extremely rare. A 63-year-old Japanese man consulted to our hospital because of cough and sputum. Imaging modalities including XP, CT and MRI revealed a tumor of the right middle lobe. They did not identify other tumors in the body. Because clinical cytology and biopsy showed malignant cells, segmentectomy of the lobe was performed. Grossly, the tumor was whitish tan tumor measuring 5 × 6 × 5 cm. Histologically, the tumor was composed entirely of clear cells arranged in papillary and tubular patterns. The tumor cells had hyperchromatic nuclei, and mitotic figure and nuclear stratification were scattered. Histochemically, glycogen and mucins were absent in tumor cell cytoplasm. Immunohistochemically, the tumor cells were positive for pancytokeratin (AE1/3, CAM5.2), cytokeratin (CK) 7, CK 8, CK18, CK19, EMA, CEA, CA19-9, CA125, p53, Ki-67 (labeling = 80%), TTF-1 and surfactant apoprotein A. In contrast, the tumor cells were negative for CK5/6, CK 34βE12, CK 14, CK 20, vimentin, desmin, S100 protein, α-smooth muscle actin, AFP, HMB45, CD10, CD34, HER2/neu, CD56, p63, and synaptophysin. The tumor recurred 6 months after the operation, and right middle lobectomy was performed. Postoperative imaging modalities showed no tumors. The patient is alive free from tumor 9 years after the first manifestation.     

A case of hepatocellular carcinoma of the caudate lobe relapsing with variable patterns after hepatectomy

A 61-year-old man was referred for evaluation of positive HBs-Ag and an unusually high level (28,396 ng/mL) of serum alpha-fetoprotein in serum. Computed tomography of the abdomen revealed a huge extrahepatically growing tumor which was originating from the caudate lobe and extended to the posterior segment of the right lobe of the liver and encircled the anterior half of inferior vena cava. Biochemical examination showed a good liver function with 8% of ICG R15 and 103% of prothrombin time. Total resection of the caudate lobe with posterior segmentectomy was performed. Relapsing tumors, which metastasized to the liver in 9 months, the right lung in 15 months and the left lung in 20 months after initial surgery, were totally resected, respectively. Radiation therapy was effective to mediastinal lymph nodes metastasized in 25 months after the initial surgery. He survived with good quality of life for 46 months until he died from brain metastasis. Therefore, the multidisplinary therapy combined with radiation and surgery for hepatocellular carcinoma of the caudate lobe may have improved a long-term survival.     

A case report of intrahepatic cholangiocarcinoma diagnosed as lung cancer with liver metastasis treated with radiofrequency ablation

In December 2008, a 43-year-old male who had been pointed out a nodular shadow in the right upper field on a chest radiography was admitted to hospital. A 35 mm mass infiltrating to superior vena cava in the right upper lobe of the lung, and 32 mm mass in the liver at S7 were detected by CT. Pathological diagnosis of the liver tumor was adenocarcinoma. Under the diagnosis of lung carcinoma and liver metastasis, systemic chemotherapy was started from January 2009. Radiofrequency ablation (RFA) therapy was added for liver S7 mass in February, and radiation therapy was performed for lung mass in December. The lung lesion has markedly reduced, but the liver lesion recurred in October 2009, which continued to grow up to 80 mm until August 2010. He presented to our hospital with the diagnosis of liver metastasis of controlled primary lung cancer. In October, we performed right hepatectomy with diaphragma and right lung resection. The pathological diagnosis was intrahepatic cholangiocarcinoma. Multiple recurrences in remnant liver, lung and peritoneal metastasis were detected in January 2011. For intrahepatic cholangiocarcinoma, hepatectomy is the only established treatment, and RFA treatment remains controversial. Clinical diagnosis of multiple cancers should be decided with caution.     

Extended sleeve pulmonary resection in a patient with synchronous triple bronchogenic squamous cell carcinoma

A 58-year-old male was admitted to our hospital for evaluation of bloody sputum. He was diagnosed as having synchronous triple bronchogenic squamous cell carcinomas in the right upper lobe, from the right B(6) segmental bronchus to the intermediate trunk and the middle lobar bronchus, and in the spur of the left B(1+2)/B(3) segmental bronchus. He underwent sleeve resection of the right upper lobe, right middle lobe, and right S(6) segment, with an anastomosis between the right main and right basal bronchi. This was followed by YAG-laser treatment and external irradiation for the left tumour and the residual right tumour. Postoperatively, chest X-ray revealed adequate expansion of the right basal segment, and pulmonary function testing showed satisfactory results. Recurrence was not detected during an initial 6-month period, however careful follow-up is required.     

原发性中叶肺癌的特征及外科治疗

目的 回顾分析原发性中叶肺癌的临床特征及外科治疗结果。方法从1976年至1998年，治疗原发性中叶肺癌123例，均采取手术治疗。结果手术方式：单纯中叶切除32例，中叶袖状切除5例，中上叶切除或中下叶切除术86例。结论中叶原发性肺癌发病率低(10．4％)，多见于女性。病变常累及上叶或下叶，中叶支气管旁淋巴结转移常见。单纯中叶切除难度大，常需行中上叶或中下叶切除，中叶袖状切除由于并发症多宜慎用。     

Two resected cases of pulmonary adenocarcinoma with intralober metastasis diagnosed by the pathological diagnosis during the operation

We described two resected cases of pulmonary adenocarcinomas with intralober pulmonary metastasis diagnosed by the frozen section diagnosis. The first case was a 61-year-old female who underwent an operation as a left S4 pulmonary adenocarcinoma which was 2 cm in size, and a left S3 pulmonary nodule which was 3 mm in size, was suspected pulmonary metastasis by CT scan. In September 2007, a partial resection of the left lung S3 was performed at first and the result of the frozen section diagnosis of this tumor was adenocarcinoma. The segmentectomy of the left lung S4, a partial resection of the left lung S6 and S3, and dissection of the lymphnodes (#6, 11) were performed. The final pathological diagnosis was pulmonary adenocarcinoma pT3N0M0=Stage IIB, pm1. The new metastasis of the right lung occurred in 2009, a partial resection of the right lung and systemic chemotherapy were performed. The second case was a 60-year-old female who underwent an operation as a right S10, S6, S2 pulmonary ground grass opacity (GGO) nodules which were 0.5 to 1 cm in size, was suspected pulmonary adenocarcinoma by CT scan. In June 2009, a partial resection of the right lung S10 was performed at first and the result of the frozen section diagnosis of this tumor was adenocarcinoma. Following this diagnosis, a partial resection of the right lung S6, and dissection of the lymphnodes (#7, 10) were performed and these results of the frozen section diagnosis were lung S6 tumor: adenocarcinoma, and the lymphnodes: no malignancy. The additional resection of the right lung S2, S8 was performed, the final pathological diagnosis was pulmonary adenocarcinoma pT-3N0M0=Stage IIB, pm1. After the operation, a systemic chemotherapy was performed.     

Sigmoid colon metastasis from sarcomatoid renal cell carcinoma

The sarcomatoid histological type of renal cell carcinoma is a clinically aggressive variant of parenchymal tumor, typically resistant to systemic treatment. We report the case of a 65-year-old female patient who had undergone a left radical nephrectomy for a sarcomatoid renal cell carcinoma together with enucleation of a mass of the right kidney and a contralateral nodule diagnosed as clear cell carcinoma. One year later lung, adrenal and sigmoid colon metastases from sarcomatoid renal cell carcinoma were detected and the patient was started on systemic immunotherapy with interleukin-2 and interferon-alpha. Computed tomography showed marked disease progression and the patient died 3 weeks later. Sigmoid colon metastasis from a primary sarcomatoid renal cell carcinoma has never been described in the literature.     

A case of non-small-cell lung cancer successfully treated using combination chemotherapy with CDDP and vinorelbine

A 67-year-old woman presented to our hospital with a chief complaint of bloody sputum. A plain chest X-ray a CT scan revealed a tumor shadow 3 cm in size in the middle lobe of the right lung, multiple nodular shadows in the bilateral lung fields and enlarged hilar and mediastinal lymph nodes. A tumor biopsy done under bronchoscopy revealed poorly differentiated adenocarcinoma of the lungs (cT2N3M1). She was given two courses of combination therapy consisting of cisplatin (80 mg/m2) and vinorelbine (20 mg/m2). The primary tumor in the middle lobe of the right lung and the lung metastases were markedly reduced in size, and a complete response was obtained. The only adverse events were grade 4 neutropenia and grade 2 nausea and vomiting.     

A long-term survivor of extensive-stage small cell lung cancer

A 53-year-old man was admitted for evaluation of multiple hepatic tumors. A thoracic CT scan revealed a mass lesion in the right middle lobe. Transcutaneous needle aspiration cytology from the lung tumor and transcutaneous hepatic tumor biopsy were performed, from which the cytohistological diagnosis was small cell lung cancer with liver metastasis. The patient was treated with 3 courses of high dose cisplatin with vindesine and mitomycin and 5 courses of carboplatin with etoposide, and achieved a complete response. We herein report a long-term survivor of extensive-stage small cell lung cancer.     

A case of adrenal metastasis of lung cancer treated by carboplatin and docetaxel]

A 42-year-old male was referred to our hospital in October 1998, suffering from severe cough accompanied by repeated hemosputa. Serum NSE slightly increased and cytology of sputum indicated class V. Chest X-P and CT revealed a large tumor in the right upper lobe and hilar lymphadenopathy. Abdominal CT revealed bilateral adrenal tumors. For continuous bloody sputum, a right upper lobectomy and lymphadenectomy were performed and the pathologic diagnosis was large cell carcinoma. After surgery, we chose radiation and chemotherapy. The new chemotherapeutic agent docetaxel (60 mg/m2 in combination with carboplatin (CBDCA: AUC 6,800 mg/m2) was administered, resulting in the remarkable reduction in the size of adrenal metastasis by 50% after 3 courses of chemotherapy. Furthermore, 12 months later, the right adrenal metastasis was remarkably reduced (5 x 3 cm-> 0.5 x 1.0 cm), and the left adrenal metastasis had disappeared on abdominal CT. These findings may suggest the efficacy of newly developed docetaxel in cases of non-small cell lung cancer.     

Tegafur-uracil markedly reduced pulmonary metastasis from renal cell carcinoma refractory to sorafenib, interferon and interleukin 2

In September 2003, a 68-year-old man was with renal cell carcinoma(RCC)underwent left radical nephrectomy. The pathological diagnosis was renal cell carcinoma, clear cell type, grade 1, pT3bNxMx stage III. Seventeen months later, lung metastasis was detected by CT and treated with recombinant interferon(IFN) -α2b (Intron A?) 600×10? units until the regrowth lung metastasis in May, 2008. Sorafenib, an antiangiogenic molecular-targeted agent, at a dose of 800 mg per day, was administered as the second time treatment. Nevertheless, it was discontinued in 2 months because of an increase in tumor size, severe hand-foot syndrome and thrombocytopenia. Therefore, the treatment was switched to natural human IFNa with tegafur-uracil at 300 mg per day since February 2009. After that, a nearly complete disappearance of the lung lesion was obtained 7 months later and maintained for 9 months.     

肺瘢痕癌的CT诊断及误漏诊分析

目的探讨肺瘢痕癌的CT表现,分析其误诊原因,以便提高早期诊断率。方法回顾性分析经病理或临床随访证实的31例肺瘢痕癌的CT表现。结果 31例瘢痕癌均为单发病灶,位于左上肺12例,左下肺3例,右上肺8例,右下肺5例,右肺中叶2例,同时累及右上下肺1例。31例患者X线诊断肺癌8例,误诊率74.2%(23/31);CT首次检查,主要表现纤维条索状,或模糊斑片状,或不成形云雾样阴影,或结节状及球形病灶等,准确诊断15例,误诊率为51.6%(16/31),早期病灶主要误诊为陈旧性或活动性肺结核、结核球、慢性感染、肺纤维化等。结论肺瘢痕癌因与原有瘢痕组织部位重叠、影像学表现相似而容易误诊,密切注意患者的临床症状及病灶的CT影像变化,有助于提高早期诊断。     

Synchronous four primary lung adenocarcinoma associated with multiple atypical adenomatous hyperplasia

A 69-year-old woman with synchronous bilateral 4 primary lung adenocarcinoma accompanied by multiple atypical adenomatous hyperplasia (AAH) is described. The patient was found to have bilateral multiple tumors during a preoperative chest CT evaluation which was performed for the previously-diagnosed adenocarcinoma of the right middle lobe. Since intraoperative diagnosis of the left nodular lesion was adenocarcinoma and judged to be a pulmonary metastasis, a lobectomy of the right middle lobe only was performed. Postoperative pathological diagnosis including immunohistochemical findings demonstrated that the bilateral lesions were synchronous multiple primary adenocarcinoma, independent of each other and associated with multiple AAH. This case suggests the possibility of the AAH-adenocarcinoma sequence in the development of lung cancer. In addition, the strategy of treatment for synchronous multiple adenocarcinoma should be considered.     

Hepatocellular carcinoma with tumor thrombus in the portal and hepatic veins treated successfully with hepatectomy and chemotherapy--a case report

A 39-year-old woman was admitted to our hospital because of advanced hepatocellular carcinoma. She had good liver function with clinical Stage I. Abdominal ultrasonographic study and CT scan revealed a huge tumor of 12 cm in diameter in the left lobe of the liver, with tumor thrombi in the portal and hepatic veins. A chest CT scan demonstrated multiple bilateral lung metastases from 5 to 10 mm in size. An extended left hemihepatectomy with extirpation of the portal and hepatic venous tumor thrombi was performed. On postoperative day 7, low-dose cisplatin (10 mg/day-5 days/week) and 5-fluorouracil (250 mg/day-continuous for 7 days/week) were administered intravenously. Four weeks after chemotherapy, CT scan revealed no recurrence in the liver and no change in the lung metastases. The patient is now being treated on an outpatient basis with no change in the metastatic tumors.     

Assessment of future remnant liver regeneration after portal vein embolization using three‐dimensional CT and MR volumetric analyses

The purpose of this study is to portray right portal vein embolization (PVE) as a valuable technique that helps in expanding the volume of the left liver lobe and discuss the relevant published work. We describe our experience with four patients who underwent PVE and analyse the value of CT and MRI in the preoperative evaluation of these patients. Four patients with hepatic malignancy (hepatocellular carcinoma) (n = 2) and metastatic liver disease (n = 2) underwent portal vein occlusion. PVE was carried out in three patients using polyvinyl alcohol and stainless steel coils. Portal vein ligation was carried out in the fourth patient. In patients who were candidates for right hepatectomy, CT volumetric analysis was carried out before the surgery to assess the total liver volume and the future remnant liver, which is the residual left hepatic volume (in cases of right hepatectomy) or left lateral segment volume (in cases of right tri‐segmentectomy). Because the left lobe volumes were insufficient, patients were selected to undergo right PVE. Computed tomography volumetry was carried out 2–4 weeks after embolization to assess left hepatic lobe regeneration. Magnetic resonance volumetric analysis was carried out in two patients before and after embolization. All four patients had significant regeneration of the left lobe and tolerated the surgery with uneventful postoperative recovery.     

Intersegmental attenuation difference on CT caused by partial Budd-Chiari syndrome secondary to hepatocellular carcinoma: report of two cases

For two patients with partial Budd-Chiari syndrome secondary to hepatocellular carcinoma, dynamic CT was evaluated. The obstructed hepatic veins were both the middle and left hepatic veins in Case 1 and the right hepatic vein in Case 2. The area affected by obstructed hepatic vein(s) was seen as low density on both unenhanced and contrast enhanced CT in Case 1 and as high density on enhanced CT in Case 2. The border of attenuation differences caused by the obstruction of the middle (Case 1) or right (Case 2) hepatic vein was intersegmental planes of the anterior segment of the right lobe, and that caused by the obstruction of the left hepatic vein was the intersegmental plane of the medial third of the left lateral segment. Once intersegmental attenuation difference is recognized on CT, partial Budd-Chiari syndrome should be considered.      

左肾黏液样小管状和梭形细胞癌1例并文献复习

目的:探讨肾黏液样小管状和梭形细胞癌患者的临床病理特征、治疗方法、疗效评价及预后。方法:回顾性分析我们收治的1例左肾黏液样小管状和梭形细胞癌患者的临床病理资料,并复习相关文献。患者女,54岁。因左侧腰部疼痛就诊,CT检查提示左肾下极见大小约44 mm×37 mm×31 mm团块样影。结果:行左肾部分切除术,术后病理诊断:左肾黏液样小管状和梭形细胞癌。免疫组化:肿瘤细胞P-CK（+）,EMA（+）,CD68（PGM1）（-）,CK7（+）,CAM5.2（-）,PAX-8（+）,CK20（-）,Inhibin-a（-）,RCC（-）,Vimentin（+）,CD10（-）。术后患者恢复良好,康复出院,随访至今未见复发及转移。结论:肾黏液样小管状和梭形细胞癌是一类罕见的肾细胞癌,恶性程度相对较低,预后相对较好,治疗方法目前主张手术治疗,但术后仍需注意规律随访。