A case of early-stage lung cancer detected by autofluorescence bronchoscopy

A 71-year-old man was referred to our hospital for further examination of abnormal sputum cytology. No abnormal nodular shadows were detected in chest X-ray and chest CT. The location of the tumor was clearly identified as a defect of autofluorescence by autofluorescence bronchoscopy at the bifurcation between the left B1+2 and B3 bronchi, whereas it was quite difficult by conventional bronchoscopy. Trans bronchial biopsy revealed squamous cell carcinoma. Further examinations yielded the diagnosis of early-stage lung cancer. Photodynamic therapy was performed and complete response was confirmed. This case indicates the efficacy of auto fluorescence bronchoscopy for detecting early-stage lung cancer

EGFR遺伝子陽性NSCLCにニボルマブが有効であった１例

Nivolumab is approved for the treatment of patients with advanced non-small cell lung cancer （NSCLC）who experience progression of disease on or after standard platinum-based chemotherapy. But there are still a few reports of nivolumab treatment in after EGFR-TKI treatment since NSCLC patients with EGFR mutations has been said to have poor effect on anti-PD-1/PD-L1 agents. Also, there are several reports of severe interstitial pneumonitis when Nivolumab is used after EGFR-TKI treatment. A88‐year‐old woman was diagnosed with lung adenocarcinoma with an EGFR exon21 L861Q mutation（clinical stage ⅢA ; cT4N0M0）. She had received Gefitinib for 18 months, until she had disease progression（PD）. Re-biopsy showed T790M-negative, ALK-negative and PD-L1 0%. Several other drugs were attempted after Gefitinib, but none of them showed any effect. Nivolumab treatment was initiated as her sixth chemotherapy, four and a half years after being diagnosed. Her tumor responded well to Nivolumab treatment and still remains effective without any severe side effects such as interstitial pneumonitis. Our case suggests that Nivolumab treatment is a treatment option for NSCLC patients with EGFR uncommon mutations who are refractory to EGFR-TKI treatment

The experience of a COVID-19 cluster in a clinical training hospital

We experienced a hospital cluster of COVID-19 in April 2021. The index case developed respiratory failure during hospitalization and was diagnosed with COVID-19 on day 8 of admission. Eleven people in the same ward were diagnosed with COVID-19 in relation to the case. All the patient in the ward were isolated. The ward stopped accepting new admissions. A task force was set up to conduct COVID-19 screening, infection control, patients and family support, and public information. No new cases occurred after day 12 of the outbreak. We started accepting new admissions to the ward on day 24, and declared convergence on day 47 of the outbreak. Since COVID-19 epidemic, our hospital had been developing infection control such as preoperative screening and providing education to the medical staff on infection prevention, which was not enough to prevent from the occurrence and spread of the COVID-19 nosocomial infections. The author, who was a clinical resident in the clinical training hospital at the time, experienced the outbreak and the process how it had been converged. From the resident’s perspective, we analyzed the factors that caused the outbreak, and discussed the efforts we had taken to converge it

気管・気管支内腔に多発ポリープ様病変を呈した小細胞癌の１例

It is rare that small cell carcinoma has multiple polypoid lesions. There is few report of small cell carcinoma in trachea and bronchus. We experienced a case of multiple polypoid lesions of small cell carcinoma. In January ２０１X, Woman in ６０s had operation for esophageal squamous cell carcinoma. In July ２０１X, thoracic and abdominal CT for postoperative follow-up revealed many nodules in the trachea, the bronchus, the lungs, and the liver, and mediastinum lymphadenopathy. We examined bronchoscopy and there were multiple polypoid lesions in the trachea and bronchus. Left main bronchus were almost occluded by maximum lesion, and we performed biopsy. We suspected recurrence of esophageal squamous cell carcinoma, therefore quickly started chemotherapy（CDDP＋５‐FU）and radiation for the left main bronchus. However, the pathological diagnosis was small cell carcinoma, we stopped the chemotherapy for esophageal squamous cell carcinoma. This case suggests we should examine to differentiate primary tumor or metastasis when we find a new lesion

An autopsy case of rapid progressive atypical carcinoid of the lung discovered with multiple nodular shadows

We report an autopsy case of rapid progressive atypical carcinoid of the lung discovered as multiple nodular shadows. The patient was an 82-year-old man with nonproductive cough. Both chest radiography and computed tomography revealed multiple nodules in both the lung and pleural effusion. Multiple metastases to bone and liver were also noted. Samples from the wall-side pleural lesion were obtained by videoassisted thoracoscopic surgery under local anesthesia, and histological examination led to a diagnosis of atypical carcinoid. Treatment was ineffective and the patient died on day 39 after admission. The primary site was identified as the lung after autopsy. We believe that early detection is crucial in the treatment of atypical carcinoid due to poor prognosis

Elevation of macrophage-derived chemokine in eosinophilic pneumonia : a role of alveolar macrophages

Macrophage-derived chemokine (MDC/CCL22) and thymus-and activation-regulated chemokine (TARC/CCL17) are ligands for CC chemokine receptor 4. Recently, TARC has been reported to play a role in the pathogenesis of idiopathic eosinophilic pneumonia (IEP). The purpose of this study was to evaluate the role of MDC in IEP and other interstitial lung diseases (ILDs). MDC and TARC in the bronchoalveolar lavage fluid (BALF) were measured by enzymelinked immunosorbent assay in patients with ILDs and healthy volunteers (HV). We also examined the expression of MDC mRNA in alveolar macrophages (AM) by real-time quantitative reverse transcriptase-polymerase chain reaction. Both MDC and TARC were detected only in BALF obtained from IEP patients. The concentration of MDC was higher than that of TARC in all cases. The level of MDC in IEP correlated with that of TARC. AM from IEP patients expressed a significantly higher amount of MDC than that from HV at the levels of protein and mRNA. MDC in BALF from IEP dramatically decreased when patients achieved remission. These findings suggest that MDC, in addition to TARC, might be involved in the pathogenesis of IEP, and AM play a role in the elevation of MDC in IEP

Intestinal ultrasound for intestinal Behçet disease reflects endoscopic activity and histopathological findings

Background/Aims Intestinal Behçet disease is typically associated with ileocecal punched-out ulcers and significant morbidity and mortality. Intestinal ultrasound is a noninvasive imaging technique for disease monitoring. However, no previous reports have compared intestinal ultrasound with endoscopic ulcer activity or histopathological findings for intestinal Behçet disease. We evaluated the usefulness of intestinal ultrasound for assessing the activity of ileocecal ulcers in intestinal Behçet disease. Methods We retrospectively compared intestinal ultrasound findings with 73 corresponding endoscopic images and 6 resected specimens. The intestinal ultrasound findings were assessed for 7 parameters (bowel wall thickness, vascularity [evaluated using the modified Limberg score with color Doppler], bowel wall stratification, white-plaque sign [strong hyperechogenic lines or spots], mesenteric lymphadenopathy, extramural phlegmons, and fistulas), and endoscopic ulcer activity was classified into active, healing, and scar stages. Histopathological findings were evaluated by consensus among experienced pathologists. Results Bowel wall thickness (P 5.5 mm (sensitivity 89.7%, specificity 85.3%) was potentially useful for detecting active lesions. When compared with histopathological findings, an increase in bowel wall thickness reflected the ulcer marginal ridge, and the white-plaque sign reflected the ulcer bottom. Conclusions Intestinal ultrasound is useful for monitoring intestinal ulcer activity in intestinal Behçet disease