Systemic-to-pulmonary artery shunt treated with transcatheter arterial embolization and subsequent lung segmentectomy

Abstract Background Systemic-to-pulmonary artery shunt (SPAS) is a rare condition that can occur as a result of congenital heart disease or chronic pulmonary inflammation, occasionally leading to life-threatening hemoptysis. Computed tomography (CT) imaging is crucial in the diagnosis of SPAS, and the optimal management approach for SPAS remains uncertain. This case report presents a novel approach to the treatment of SPAS, consisting of transcatheter arterial embolization of the systemic artery followed by lung segmentectomy. Case presentation A 42-year-old man with abnormal chest findings was referred to us and a diagnosis of SPAS was established based on the CT findings showing a blood flow regurgitation from the dilated left 4th intercostal artery to the Lt. A6. The patient was asymptomatic but we decided to treat him to prevent a risk of future hemoptysis. Transcatheter arterial embolization (TAE) of systemic arteries followed by S6 segmentectomy was successfully performed with minimal blood loss and complete removal of the dilated intra-pulmonary blood vessels. Histological analysis confirmed the diagnosis of SPAS. Conclusion We reported a case of SPAS, who was successfully treated with the combination of TAE and subsequent segmentectomy. The blood loss during surgery was minimal and this strategy appeared to minimize future recanalization and hemoptysis. Further studies and long-term follow-up of SPAS patients are required to establish standardized management guidelines for this rare condition

Prognostic impact of LILRB4 expression on tumor‐infiltrating cells in resected non‐small cell lung cancer

Abstract Background Leukocyte immunoglobulin‐like receptor subfamily B member 4 (LILRB4/ILT3) is an up‐and‐coming molecule that promotes immune evasion. We have previously reported that LILRB4 facilitates myeloid‐derived suppressor cells (MDSCs)‐mediated tumor metastasis in mice. This study aimed to investigate the impact of the LILRB4 expression levels on tumor‐infiltrating cells on the prognosis of non‐small cell lung cancer (NSCLC) patients. Methods We immunohistochemically evaluated the LILRB4 expression levels of completely resected 239 NSCLC specimens. Whether the blocking of LILRB4 on human PBMC‐derived CD33+ MDSCs inhibited the migration ability of lung cancer cells was also examined using transwell migration assay. Results The LILRB4 high group, in which patients with a high LILRB4 expression level on tumor‐infiltrating cells, showed a shorter overall survival (OS) (p = 0.013) and relapse‐free survival (RFS) (p = 0.0017) compared to the LILRB4 low group. Multivariate analyses revealed that a high LILRB4 expression was an independent factor for postoperative recurrence, poor OS and RFS. Even in the cohort background aligned by propensity score matching, OS (p = 0.023) and RFS (p = 0.0046) in the LILRB4 high group were shorter than in the LILRB4 low group. Some of the LILRB4 positive cells were positive for MDSC markers, CD33 and CD14. Transwell migration assay demonstrated that blocking LILRB4 significantly inhibited the migration of human lung cancer cells cocultured with CD33+ MDSCs. Conclusion Together, signals through LILRB4 on tumor‐infiltrating cells, including MDSCs, play an essential role in promoting tumor evasion and cancer progression, impacting the recurrence and poor prognosis of patients with resected NSCLC