Sleeve Lobectomy as an Alternative Procedure to Pneumonectomy for Non-small Cell Lung Cancer

IntroductionThe aim of this study is to compare the outcomes of sleeve lobectomy (SL) and pneumonectomy (PN) and to determine which one is more acceptable standard procedure for patients with non-small cell lung cancer.MethodsFrom 1996 to 2005, 424 patients underwent SL (n = 157) and PN (n = 267) in our institution. Propensity score matching analysis was performed to compare these two groups for mortality, morbidity, survival, recurrence, and postoperative pulmonary function.ResultsIn each group, 105 patients were eligible for analysis. The operative mortality was lower in the SL group (1.0%) than the PN group (8.6%), (p < 0.0001). The morbidity was similar (33.4% versus 29.5%, p = 0.376). The 5-year survival was lower in the PN group (PN, 32.14% versus SL, 58.43%, p = 0.0002). The recurrence pattern (locoregional versus distant) did not differ between two groups (p = 0.180). The mean actual postoperative first second forced expiratory volume in the patients underwent SL was 2.05 ± 0.55 liter, which increased by 7.9% compared with the predicted-postoperative first second forced expiratory volume.ConclusionsOur results showed that the SL can be performed with low operative risk and may offer superior survival and better postoperative pulmonary function compared with the PN in selected patients. If anatomically feasible, a SL must be considered as a favorable alternative to PN in patients with non-small cell lung cancer

Giant Cystic Chondroid Hamartoma

We report a case of huge pulmonary chondroid hamartoma with multilocular cysts in a 38-yr-old male patient. The lobectomy specimen of the left lower lobe showed a large multilocular cystic mass, 11.5 × 10 cm in size. The mass had thin-walled, variable-sized cysts and areas of solid cartilaginous small nodules in the interstitium, which occupied the superior segment and the upper portion of the basal segment. There was no connection with bronchus or vessel. Microscopically, the cysts and cleft-like spaces were lined by ciliated columnar epithelium and the solid components were composed of cartilage, myxohyalinized connective tissue, and adipose tissue. Also seen were foci of calcification within the sclerotic stroma

Pattern of Recurrence after Curative Resection of Local (Stage I and II) Non-Small Cell Lung Cancer: Difference According to the Histologic Type

The aim of the present study was to evaluate the pattern of recurrence after complete resection of pathological stage I, II non-small cell lung cancer, especially according to the cell type. We reviewed the clinical records of 525 patients operated on for pathologic stage I and II lung cancer. The histologic type was found to be squamous in 253 and non-squamous in 229 patients. Median follow-up period was 40 months. Recurrences were identified in 173 (36%) of 482 enrolled patients; distant metastasis in 70%, distant and local recurrence in 11%, and local recurrence in 19%. Distant metastasis was more common in non-squamous than in squamous cell carcinoma (p=0.044). Brain metastasis was more frequently identified in non-squamous mthan in squamous cell carcinoma (24.2% vs. 7.3%. p=0.005). Multivariate analyses showed that cell type is the significant risk factor for recurrence-free survival in stage I and stage II non-small cell lung cancer. Recurrence-free survival curves showed that non-squamous cell carcinoma had similar risks during early periods of follow-up and more risks after 2 yr from the operation compared to squamous cell carcinoma. Pathological stage and histologic type significantly influence recurrence-free survival

Pulmonary Adenocarcinoma with Heterotopic Ossification

Pulmonary adenocarcinoma is a common malignancy that often involves calcification; however, bone formation in primary lung adenocarcinoma is extremely rare. In ten cases of primary pulmonary adenocarcinoma with heterotopic ossification, we detected immunoreactivity against TGF-β1, osteopontin, osteocalcin and Runx2 in the fibroblastic stroma and tumor cells within the area of ossification. Our results suggest that in primary pulmonary adenocarcinoma, heterotopic ossification occurs via intramembranous bone formation. To our knowledge, only 11 other cases of pulmonary adenocarcinoma with heterotopic ossification have been reported. Here, we present ten cases of pulmonary adenocarcinoma showing heterotopic ossification with a description of previously published results and the histogenesis of heterotopic bone formation

HIP1–ALK, a Novel Fusion Protein Identified in Lung Adenocarcinoma

Introduction:The most common mechanism underlying overexpression and activation of anaplastic lymphoma kinase (ALK) in non–small-cell lung carcinoma could be attributed to the formation of a fusion protein. To date, five fusion partners of ALK have been reported, namely, echinoderm microtubule associated protein like 4, tropomyosin-related kinase-fused gene, kinesin family member 5B, kinesin light chain 1, and protein tyrosine phosphatase, nonreceptor type 3.Methods:In this article, we report a novel fusion gene huntingtin interacting protein 1 (HIP1)–ALK, which is conjoined between the huntingtin-interacting protein 1 gene HIP1 and ALK. Reverse-transcriptase polymerase chain reaction and immunohistochemical analysis were used to detect this fusion gene’s transcript and protein expression, respectively. We had amplified the full-length cDNA sequence of this novel fusion gene by using 5′-rapid amplification of cDNA ends. The causative genomic translocation t(2;7)(p23;q11.23) for generating this novel fusion gene was verified by using genomic sequencing.Results:The examined adenocarcinoma showed predominant acinar pattern, and ALK immunostaining was localized to the cytoplasm, with intense staining in the submembrane region. In break-apart, fluorescence in situ hybridization analysis for ALK, split of the 5′ and 3′ probe signals, and isolated 3′ signals were observed. Reverse-transcriptase polymerase chain reaction revealed that the tumor harbored a novel fusion transcript in which exon 21 of HIP1 was fused to exon 20 of ALK in-frame.Conclusion:The novel fusion gene and its protein HIP1–ALK harboring epsin N-terminal homology, coiled-coil, juxtamembrane, and kinase domains, which could play a role in carcinogenesis, could become diagnostic and therapeutic target of the lung adenocarcinoma and deserve a further study in the future