A case of matrix-producing carcinoma of the breast

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

ゲカ ニオケル イノベーション

Patients have been relieved from pain by general anesthesia and postoperative mortality has also improved by sterilization in 19th century. Progress in surgical technology improved the patient’ s quality of life. Transthoracic en bloc esophagectomy（TTE）with three-field lymph node dissection is a radical strategy for treatment of esophageal cancer, but the morbidity and mortality are still substantial. With the mediastinoscope, esophagectomy was performed safely under direct vision. There was only a small amount of bleeding, and surgical time was short. Little morbidity and no deaths were recorded. Total mastectomy and pectoral muscle resection with en bloc axillar lymphadenectomy（Halsted operation）has been the gold standard of breast cancer treatment. Now breast conserving operation with sentinel lymph node biopsy（SLNB）has been becoming the new standard. We developed a three-dimensional computed tomography lymphography（3D CT-LG）technique with commercially available iopamidol. Preoperative 3D CT-LG performed in patients with breast cancer and superficial esophageal cancer accurately depicted the lymph vessels and the SLNs in all patients. CT-LG allowed accurate direction of the lymph flow and SLN localization by quickly and adequately visualizing the direct connection between the SLN and its afferent lymphatic vessels on detailed cross-sectional images of lymphatic anatomy during the routine CT scan to evaluate distant metastases, thus resulting in successful SLN navigation with saving time and cost

Lobectomy for lung cancer with a displaced left B1 + 2 and an anomalous pulmonary vein : a case report

Background: A displaced left B1 + 2 accompanied by an anomalous pulmonary vein is a rare condition involving complex structures. There is a risk of unexpected injuries to bronchi and blood vessels when patients with such anomalies undergo surgery for lung cancer. Case presentation: A 59-year-old male with suspected lung cancer in the left lower lobe was scheduled to undergo surgery. Chest computed tomography revealed a displaced B1 + 2 and hyperlobulation between S1 + 2 and S3, while the interlobar fissure between S1 + 2 and S6 was completely fused. Three-dimensional computed tomography (3D-CT) revealed an anomalous V1 + 2 joining the left inferior pulmonary vein and a branch of the V1 + 2 running between S1 + 2 and S6. We performed left lower lobectomy via video-assisted thoracic surgery, while taking care with the abovementioned anatomical structures. The strategy employed in this operation was to preserve V1 + 2 and confirm the locations of B1 + 2 and B6 when dividing the fissure. Conclusion: The aim of the surgical procedure performed in this case was to divide the fissure between S1 + 2 and the inferior lobe to reduce the risk of an unexpected bronchial injury. 3D-CT helps surgeons to understand the stereoscopic positional relationships among anatomical structures

Clinical Anatomy using Cadaver Surgical Training for surgical state of the art

Mouret performed the first laparoscopic cholecystectomy in １９８７ using a charge-coupled device camera system. It was the breakthrough in less invasive endoscopic surgery. I saw the dramatic spread this new technology over the world between １９８９ and １９９１ in United States. We started to develop a new approach to no space anatomical lesions without CO２ inflation in esophageal cancer and breast cancer surgery ; mediastinoscopic esophagectomy and endoscopic axillar lymph nodes dissection from １９９３. But it was not easy to make new state of the art. Toyo Yamawaki performed the first legally sanctioned dissection in １７５４ in Japan. Genpaku Sugita compiled the first Japanese translation of a Dutch（Germany）text on anatomy in １７７４. Surgical strategy has been changed from Halsted operation with enbloc lymph nodes dissection in １８９４ to sentinel lymph node biopsy from １９９２ in breast cancer surgery for example. We have to develop the new strategy to take over cancer for the patients. Clinical anatomy using cadaver surgical training would be essential to develop a surgical state of the art in cancer treatment

Surgical treatment of locally advanced papillary thyroid carcinoma after response to lenvatinib : A case report

INTRODUCTION: Differentiated thyroid carcinomas (DTC) have good prognoses after complete resection. Nevertheless, when DTC is associated with an aerodigestive invasion, curative surgery is difficult to perform. However, there is no established neoadjuvant therapy for advanced DTC. PRESENTATION OF CASE: A 73-year-old man with thyroid papillary carcinoma was referred to our hospital. A computed tomography examination revealed a tumor in the upper right lobe of the thyroid, and multiple bilateral enlarged lymph nodes in the neck, involving the surrounding structures. The enlarged lymph node at the right upper neck was suspected to have invaded the right internal jugular vein, and the left paratracheal lymph node was suspected to have invaded the cervical esophagus and trachea. The tumor was considered resectable; however, surgery would have been highly invasive. Therefore, we initiated neoadjuvant therapy with lenvatinib. After administration of lenvatinib, the tumor decreased in size by 84.3% and the cervical lymph nodes by 56.0%. The patient underwent a total thyroidectomy, modified neck dissection, a resection of the muscular layer of the esophagus, and a tracheal sleeve resection and reconstruction. DISCUSSION: The SELECT trial demonstrated that lenvatinib had high response rate with short response time, in patients with radioiodine-refractory DTC. The results suggested that lenvatinib could be effective as neoadjuvant therapy. CONCLUSION: For an advanced DTC that requires removal through invasive surgery, preoperative lenvatinib treatment might be one of the options for a less invasive surgery

Differential Regulation of Gene Expression of Alveolar Epithelial Cell Markers in Human Lung Adenocarcinoma-Derived A549 Clones

Stem cell therapy appears to be promising for restoring damaged or irreparable lung tissue. However, establishing a simple and reproducible protocol for preparing lung progenitor populations is difficult because the molecular basis for alveolar epithelial cell differentiation is not fully understood. We investigated an in vitro system to analyze the regulatory mechanisms of alveolus-specific gene expression using a human alveolar epithelial type II (ATII) cell line, A549. After cloning A549 subpopulations, each clone was classified into five groups according to cellmorphology andmarker gene expression. Two clones (B7 and H12)were further analyzed. Under serum-free culture conditions, surfactant protein C (SPC), an ATII marker, was upregulated in both H12 and B7. Aquaporin 5 (AQP5), an ATI marker, was upregulated in H12 and significantly induced in B7. When the RAS/MAPK pathway was inhibited, SPC and thyroid transcription factor-1 (TTF-1) expression levels were enhanced. After treatment with dexamethasone (DEX), 8-bromoadenosine 3’5’-cyclic monophosphate (8-Br-cAMP), 3-isobutyl-1-methylxanthine (IBMX), and keratinocyte growth factor (KGF), surfactant protein B and TTF-1 expression levels were enhanced. We found that A549-derived clones have plasticity in gene expression of alveolar epithelial differentiation markers and could be useful in studying ATII maintenance and differentiation

A case of thoracoscopic medial basal segmentectomy

INTRODUCTION: Isolated resection of the medial basal segment (S7) is uncommon because of its small volume, and S7 segmentectomy is considered to be difficult due to anatomical variation. We report a case of successful thoracoscopic S7 segmentectomy. PRESENTATION OF CASE: A 56-year-old man was referred to our hospital with suspected pulmonary metastasis of rectal cancer. A 6-mm nodule was detected in S7. A7 and B7 branched from the basal segmental artery and bronchus, respectively, to run ventral to the inferior pulmonary vein. This made it possible to isolate A7 and B7 by an approach via the interlobar fissure. In addition, V7a and V7b were easily isolated from inferior pulmonary vein. The intersegmental plane was indicated by V7b and was transected along a demarcation line identified by using selective oxygenation via B7. DISCUSSION: B7 most commonly branches from the basal bronchus and A7 from the basal artery to run ventral to the inferior pulmonary vein. With this anatomical type, when the surgeon approaches via the interlobar fissure during surgery, A7 is identified first, B7 is seen behind A7, and the IPV is posterior to B7. Since the intersegmental plane is located ventral to the IPV, segmentectomy can be completed via the interlobar fissure approach. CONCLUSION: In patients with this pattern of pulmonary artery and bronchial anatomy, isolated S7 segmentectomy is a feasible treatment option

Macroscopic findings for breast VAB specimens

Purpose : Ultrasound-guided breast tissue biopsy is an essential technique for diagnosing breast disease, but sample errors reduce its accuracy. This study investigated whether the histopathological results can be inferred from the macroscopic findings for Ultrasound-guided breast Vacuum Assisted Biopsy (VAB) specimens. Methods: Biopsy specimens from 101 patients who underwent mammary gland VAB were photographed with a smartphone, and the relationships between the macroscopic findings and the pathological results were examined. Results : A significant difference was observed with regard to the presence / absence of turbidity: malignancy was detected in 33 / 37 (89%) specimens with turbidity and in 2 / 47 (4%) cases without turbidity (p < 0.001). A significant difference was also observed regarding the surface properties : malignancy was detected in 14 / 70 (19%) smooth specimens and in 24 / 29 (83%) rough specimens (p < 0.001). Also, malignancy was detected in 11 / 13 (85%) specimens with white spots, and the difference was significant (p < 0.001). In addition, the characteristics of intraductal papilloma, fibroadenoma, and mastopathy could be confirmed by macroscopic findings. Conclusions : When needle–biopsy of a lesion that is targeted for resection yields macroscopic findings that match the predicted histopathological findings, it can be thought that the biopsy had been properly performed. This means that false–negatives due to poor specimens can be prevented