Endoscopic Findings of Post-wedge Bronchoplastic Lobectomy

It is speculated that the advantage of wedge bronchoplastic lobectomy lies in the reduction in the incidence of major anastomotic complications. On the other hand, wedge bronchoscopic lobectomy can result in kinking at the anastomosis site. This study was performed to evaluate the operative outcomes and the postoperative endoscopic findings for wedge resection of the bronchus. From 2004 to 2012, nine patients underwent wedge bronchoplastic lobectomy for lung carcinoma. We evaluated the angles of the wedge and the distance of the preserved parts to the cut line of the bronchus (the so-called bronchial bridge). There were six right upper lobectomies, two middle and lower lobectomies, and one left lower lobectomy. Regarding bronchoscopic findings, five patients who underwent right upper lobectomy showed bulging into the bronchial lumen. There were no anastomotic strictures. Intraoperatively it was noted in these five patients that the bronchial bridge tended to be relatively long and/or the angle of the wedge resection tended to be relatively wide. To prevent bulging into the bronchial lumen after right upper wedge bronchoplastic lobectomy, bronchial wedge excisions should be shaped in order to reduce the length of the bronchial bridge

Long-term Survival of a Patient with Typical Lung Carcinoid Tumor and Supraclavicular Lymph Node Metastasis Treated by Surgical Resection

Herein we report on the long-term survival of a surgical case of typical carcinoid tumor and supraclavicular lymph node metastasis at initial diagnosis. The present study is a follow-up to a previously published case report. Initially, a 73-year-old man was admitted to hospital for evaluation of an enlarged lymph node in his right supraclavicular fossa. Serum progastrin-releasing peptide (ProGRP) concentrations were markedly elevated, and carcinoid was diagnosed by histopathological examination of the excised supraclavicular lymph node. The patient underwent right upper lobectomy and mediastinal lymph node dissection via median sternotomy. The final diagnosis was Stage IIIB (pT1aN3M0) typical carcinoid. Serum ProGRP concentrations decreased to within the normal range, and follow-up computed tomography, performed approximately 10 years after surgery, showed no recurrence. For this patient, radical resection of metastatic lymph nodes was an effective treatment for his typical lung carcinoid

Neutrophil-rich Pulmonary Carcinoma: Clinicopathological Characteristics and Cytokine Expression and Their Relationship with Lymph Node Metastasis

A small subset of carcinomas of various origins are associated with high numbers of tumor-infiltrating neutrophils (TINs). Here, we examined the characteristics of non-small-cell pulmonary carcinomas with high numbers of TINs, and their relationship with lymph node (LN) metastasis. The study included 100 patients diagnosed and treated for primary pulmonary carcinoma at Showa University Northern Yokohama Hospital from 2011 to 2012. We histopathologically defined tumors with > 10 neutrophils per high-power field as neutrophilrich. Among the 100 patients, 40 were classed as having neutrophilrich pulmonary cancer (NRPC), and tissue samples from these patients were prepared for further examination. Comparison of the clinicopathological factors (age, gender, tumor size, histological type, and grade) in NRPC cases with or without LN metastasis showed that none of the above factors was significantly correlated with LN metastasis. Immunohistochemical analysis of two cytokines that play a major role in granulopoiesis, granulocyte-colony stimulating factor (G-CSF) and macrophage-CSF (M-CSF), revealed that the expression of M-CSF, but not G-CSF, was significantly correlated with LN metastasis. Furthermore, coexpression of M-CSF and the M-CSF receptor was significantly correlated with LN metastasis, but coexpression of G-CSF and the G-CSF receptor did not show such a correlation. These findings indicate that M-CSF-producing NRPCs show a significantly high lymph node metastasis potential

Pulmonary lymphoepithelial cyst with no prior HIV infection: A case report

Most lymphoepithelial cysts (LECs) occur in the salivary glands and are considered one of the autoimmune syndromes caused by the human immunodeficiency virus (HIV). In this report, we present a case of pulmonary LEC without prior HIV infection, paying special attention to radiographic features. A chest radiograph revealed an oval mass with a smooth surface, localized in the left lower lung field, which was in direct contact with the diaphragm. Computed tomography showed an oval homogenous mass with a smooth surface in the lower left lobe. Further, magnetic resonance imaging demonstrated that the mass was a homogeneous internal structure with a smooth surface and a slightly high signal in T2-weighted images and a slightly low signal in T1-weighted images. Surgical resection was performed, and pathological examination confirmed the diagnosis of a pulmonary LEC. To the best of our knowledge, no cases of pulmonary LECs without prior HIV infection have been reported in the literature to date, therefore, the case presented here is considered very rare and informative