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There could be two carcinogenetic pathways for lung adenocarcinoma (LADC): the nonsmokers’ pathway and the smokers’ pathway. This review article describes the two pathways with special reference to potential relationships between histological subtypes, malignant grades, and driver mutations. The lung is composed of two different tissue units, the terminal respiratory unit (TRU) and the central airway compartment (CAC). In the nonsmokers’ pathway, LADCs develop from the TRU, and their histological appearances change from lepidic to micropapillary during the progression process. In the smokers’ pathway, LADCs develop from either the TRU or the CAC, and their histological appearances vary among cases in the middle of the progression process, but they are likely converged to acinar/solid at the end. On a molecular genetic level, the nonsmokers’ pathway is mostly driven by EGFR mutations, whereas in the smokers’ pathway, approximately one‐quarter of LADCs have KRAS mutations, but the other three‐quarters have no known driver mutations. p53 mutations are an important factor triggering the progression of both pathways, with unique molecular alterations associated with each, such as MUC21 expression and chromosome 12p13‐21 amplification in the nonsmokers’ pathway, and HNF4α expression and TTF1 mutations in the smokers’ pathway. However, investigation into the relationship between histological progression and genetic alterations is in its infancy. Tight cooperation between traditional histopathological examinations and recent molecular genetics can provide valuable insight to better understand the nature of LADCs., It has been supposed there could be two carcinogenetic pathways for lung adenocarcinoma (LADC): the nonsmokers’ pathway and the smokers’ pathway. This review article describes the two pathways with special reference to potential relationships between histological subtypes, malignant grades, and driver mutations

OBJECTIVES Pleuroparenchymal fibroelastosis (PPFE) is a rare idiopathic interstitial pneumonia characterized by pleural-parenchymal involvement, predominantly in the upper lobes. Unilateral upper lung field pulmonary fibrosis (upper-PF) that is radiologically consistent with PPFE reportedly develops after lung cancer surgery in the operated side and presents many clinical characteristics in common with PPFE. However, the incidence and perioperative associated factors remain unclear. METHODS All consecutive patients with lung cancer resected completely from 2008 to 2016 were investigated retrospectively. Pre-/postoperative characteristics were compared between patients with and without unilateral upper-PF. Cumulative incidence curves were estimated using competing risk analysis. RESULTS Among the 587 included patients, 25 patients (4.3%) were diagnosed as unilateral upper-PF. The 3-, 5- and 10-year cumulative incidence of unilateral upper-PF was 2.3%, 3.3% and 5.3%, respectively. In multivariable analysis, male sex, presence of a pulmonary apical cap, lobar resection and low % vital capacity (%VC CONCLUSIONS Unilateral upper-PF is an occasional but under-recognized late complication after lung cancer surgery.

Interstitial pneumonia (IP) is a major risk factor for lung adenocarcinoma (LADC). IP-related LADC predominantly develops in the bronchiolar metaplasia lining in honeycomb lesions. Kirsten rat sarcoma virus (

The present study aimed to elucidate the mechanisms underlying the histogenesis of interstitial pneumonia (IP)-related lung adenocarcinoma (LADC). We focused on the methylation of thyroid transcription factor 1 (TTF-1). The TTF-1 locus was highly methylated in IP-LADCs compared to non-IP-LADCs. Among the IP-LADCs, the non-terminal respiratory unit (TRU) LADCs showed marked hypermethylation in CpG sites in a particular intragenic region. This region was also found to be highly methylated in the IP lungs. The hierarchical dendrogram based on methylation levels divided the IP lungs into three different clusters. One of them showed a methylation profile similar to that of non-TRU LADCs. The non-TRU LADCs developed from this cluster with a significantly higher frequency. Moreover, bronchiolar metaplasia lining honeycomb/cystic lesions in IP lungs, IP-related non-TRU LADCs, and bronchiolar epithelia in healthy lungs were separately collected by microdissection and examined for methylation. Bronchiolar metaplasia showed hypermethylation, but bronchiolar epithelia did not. The methylation patterns in bronchiolar metaplasia were similar to those in non-TRU LADCs. In summary, a particular region of TTF-1 was highly methylated in IP-related non-TRU LADCs and bronchiolar metaplasia, supporting the theory that IP-related non-TRU LADCs may develop from bronchiolar metaplasia lining honeycomb/cystic lesions.

We herein analyzed the relationships among the immunohistochemical expression of alpha-enolase (ENO1) and clinicopathological factors in order to define the significance of ENO1 in lung adenocarcinomas (ADCs). ENO1 expression was detected in most of the ADCs examined (95.8%), but not in bronchial and alveolar epithelia. ENO1 expression was typically observed in the cytoplasm among most ADCs (95.8%), but was also detected in the nucleus (56.3%). The levels were significantly higher in terminal respiratory unit (TRU) cytological subtype ADCs. Neither cytoplasmic nor nuclear expression was associated with any other clinicopathological factors including post-operative survival and growth activity. These results suggest that ENO1 is a crucial factor promoting neoplastic transformation exclusively in TRU subtype ADCs. We also investigated the potential utility of the immunohistochemical expression of ENO1 to differentiate TRU-type ADC cells from the reactive hyperplasia of pneumocytes and bronchiolar epithelial cells because difficulties are associated with discriminating these lesions in small biopsy specimens. The sensitivity and specificity of ENO1 (cytoplasmic/nuclear) were 87.5%/37.5% and 88.9%/100%, respectively, which are superior to those of p53 (18.8% and 100%). ENO1 has potential as a biomarker to assist in the histopathological detection of TRU subtype ADC cells.

Introduction Acute exacerbation of interstitial pneumonia (AE-IP) is a lethal complication after lung surgery. We conducted a prospective, multi-institutional phase II trial to assess the efficacy and safety of prophylactic measures. Method Patients with lung cancer with dorsal subpleural fibrotic changes occupying three or more segments of both lower lobes and planned anatomical lung resection were enrolled. Prior to surgery, patients received a 125-mg bolus injection of methylprednisolone and continuous intravenous infusion of sivelestat sodium hydrate (sivelestat) for 2 days. Results Sixty-nine patients were analysed. Preoperative high-resolution computed tomography (HRCT) showed 37 (53.6%) cases presented with usual interstitial pneumonia (UIP) and possible UIP pattern. There were 60 lobectomies and 9 segmentectomies. Thirty-eight cases were in clinical stage I. No adverse events associated with prophylaxis were observed. There were four cases of AE-IP (5.8%), higher than the expected 2.0%. Three of the four cases showed inconsistencies with the UIP pattern in preoperative HRCT and were pathologically diagnosed as UIP. All patients died of respiratory failure. Overall, 89.9% were diagnosed as idiopathic interstitial pneumonias; UIP was found in 48 patients (69.6%). Severe post-operative complications occurred in 11.6% of the cases. There were 35 deaths, 17 cases of lung cancer and 11 cases related to interstitial pneumonias. The overall survival rate at 3 years was 41.8% of the total and 47.2% of cases with clinical stage I. Conclusions Perioperative use of sivelestat and low-dose methylprednisolone in patients with anatomical lung resection was safe but did not prove to be a prophylactic effect for AE-IP.

We investigated the significance of MUC21 in EGFR-mutated lung adenocarcinoma (LADC). Two-hundred forty-one surgically resected LADCs (116 EGFR-mutated and 125 wild-type tumors) were examined for immunohistochemical expression of MUC21 protein. A polyclonal antibody and two monoclonal antibodies (heM21C and heM21D) that bind differentially glycosylated MUC21 epitopes were used, and MUC21 proteins detected by these antibodies were named MUC21P, MUC21C, and MUC21D, respectively. MUC21 mRNA levels were semi-quantified and classified into "high" and "low". Among the immunohistochemical expression detected by three different antibodies, high expressors tended to be related to EGFR mutations. The three varieties of the immunohistochemical expressions were related to different histological elements in the EGFR-mutated LADCs. Either MUC21P or MUC21C high expressors had a higher proportion of lepidic elements with low papillary structure and micropapillary elements. MUC21D high expressors had a significantly higher proportion of micropapillary elements (Mann-Whitney test P ≤0.0001). Furthermore, MUC21D high expressors showed high incidence of lymphatic canal invasion and lymph node metastasis (Pearson x2 test, P = 0.0021, P = 0.0125), and a significantly higher recurrence rate (5-year recurrence-free survival 50.7% vs. 73.8%, log-rank test P = 0.0495). MUC21 proteins with a specific glycosylation status may be involved in the progression of EGFR-mutated LADCs, particularly at the stage where tumors are transforming from pure lepidic to micropapillary through low papillary lepidic lesions.

Background The thymus is associated with an immunodeficient status, autoimmune disease (AD), and the common thymic tumor, thymoma. We encountered two rare thymic tumors, thymic mucosa-associated lymphoid tissue (MALT) lymphoma and localized thymic amyloidosis, both in the presence of Sjögren’s syndrome (SjS). This suggests a possible link between rare thymic tumors and SjS. Therefore, we reviewed cases of thymic tumors to examine the spectrum of these tumors in patients with AD. Methods The clinical information of thymic amyloidosis and MALT lymphoma surgically treated at Kanagawa Cardiovascular and Respiratory Center, and Yokohama City University Hospital from January 2010 to December 2019 were reviewed. The correlation between resected thymic tumors at same period and ADs were also investigated. Results There were 5 cases of thymic amyloidosis and MALT lymphoma. ALL cases had coexistent ADs (4 SjS, 1 SSc). The median age was 66 (38–76) year-old, and 4 of the patients were female. Three cases had already diagnosed as ADs before detection of tumors. Only SSc case was received preceding steroid medication. Two cases diagnosed as SjS at the same time of the operation. The median maximum tumor diameter was 70 mm. On chest computed tomography (CT), tumors contained solid part and some cystic part at various rated. Calcification was recognized with appearance of amyloid deposition. All patients were surgically treated with total thymectomy and they are alive without recurrence. At the same period, there were 163 resected thymic tumors, including amyloidosis, MALT lymphoma, thymoma, thymic cancer, neuroendocrine tumor and so on. Among them, nine patients (5.5%) had ADs. There was a correlation between ADs and thymic MALT lymphoma/amyloidosis (P

Contralateral tension pneumothorax during one-lung ventilation is a rare but catastrophic surgical complication. A 72-year-old Japanese male with lung cancer underwent right upper lobectomy with video-assisted thoracoscopic surgery. Despite use of various methods for maintaining oxygenation during one-lung ventilation, percutaneous oxygen saturation was unstable from the start of surgery and suddenly decreased with a drop in blood pressure. An intraoperative chest X-ray revealed a tension pneumothorax of the dependent lung. Insertion of a chest drain saved the patient's life. This case suggests that a contralateral tension pneumothorax should be considered as a possible cause when adequate oxygenation cannot be maintained during one-lung ventilation.

A 68-year-old man who was on treatment for pulmonary Mycobacterium avium complex complained a worsening of sputum. Although he archived negative sputum culture two months ago, sputum culture tests revealed the newly isolation of Mycobacterium abscessus repeatedly. Chest computed tomography showed newly-appeared extra-pulmonary mass lesion in contact with a cyst at the bottom of his right lung. From the results of contrast-enhanced magnetic resonance imaging, we first suspected loculated pleural effusion due to Mycobacterium abscessus infection. A thoracoscopic examination was performed as the right pneumothorax developed, and the pleural lesion was successfully resected and diagnosed as an intrathoracic desmoid tumor. Intrathoracic desmoid tumor is very rare, and this is the first report of a case with pulmonary Mycobacterium abscessus disease. Keywords: Desmoid, Mycobacterium abscessus, Mycobacterium avium complex

We report a 53-year-old man with metastases of alveolar soft-part sarcoma originated from the mediastinum. He was hospitalized due to lower extremities’ paralysis. Computed tomography scan findings revealed multiple nodules of bilateral lungs, swollen mediastinal lymph nodes, and osteolysis of thoracic vertebrae. We performed spinal decompression and biopsy from vertebra. And, we finally diagnosed this case as metastases of mediastinal alveolar soft-part sarcoma which was removed 10 years ago. Alveolar soft-part sarcoma is rare tumor accounted for 0.5%–1.0% of soft tissue sarcoma that often occurs primarily in the lower extremities and trunk. It is difficult to distinguish between alveolar soft-part sarcoma and paraganglioma, renal cell carcinoma and granular cell tumor morphologically. Periodic acid–Schiff stain and immunohistochemical staining of ASPL-TFE3 are useful in making a definitive diagnosis of alveolar soft-part sarcoma. This case is a rare case of alveolar soft-part sarcoma originated in the mediastinum with local recurrence and distant metastases 10 years after the initial surgery.

With the progress of antibiotic therapy, the mortality of lung abscess has been improved, and surgical intervention has declined. However, surgery is still required in selected cases that are intractable to antibiotic treatment. Video-assisted thoracoscopic surgery (VATS) is beneficial for treatment and/or diagnosis of pulmonary disease as it provides a less invasive surgical technique and reduces prolongation of post-operative recovery. However, the indication of VATS lobectomy for lung abscess is controversial as a result of particular complications, i.e. wet lung, intrapleural adhesion and ease of bleeding. We herein report a rare combination of lung abscess and osteomyelitis of mandible resulting from the same pathogen successfully treated with VATS lobectomy. We propose VATS lobectomy for lung abscess. This procedure might be the best treatment candidate for selected cases of lung abscess.

Purpose The aim of this study was to evaluate the efficacy of the Thopaz system, a new drainage system in management of general thoracic surgery, based on a review of our clinical practice and a comparison of the utility of the Thopaz device compared with a standard drainage system. Methods A review of 540 thoracic surgeries at our hospital was performed. These cases were divided into 275 treated with the Thopaz system from April 2014 to March 2015, and 265 treated with a standard system from April 2013 to March 2014. The characteristics of patients and outcomes after surgery were compared in these two groups. Results The characteristics of the patients were similar in the two groups. Outcomes after surgery, including types of operation, period of chest tube placement, chest tube reinsertion rate, and clamping test rate also did not differ significantly between the groups. Conclusions The non-inferiority of the Thopaz system compared to a standard system was verified statistically. With advantages of providing objective data as a small portable system, in addition to the quietness of the unit and the ease of setup and operation, Thopaz system is likely to become mainstream in postoperative management in general thoracic surgery. This article is protected by copyright. All rights reserved.

Identifying a small number of features that can represent the data is believed to be NP-hard. Previous approaches exploit algebraic structure and use randomization. We propose an algorithm based on ideas similar to the Weighted A* algorithm in heuristic search. Our experiments show this new algorithm to be more accurate than the current state of the art.

Identifying a small number of features that can represent the data is a known problem that comes up in areas such as machine learning, knowledge representation, data mining, and numerical linear algebra. Computing an optimal solution is believed to be NP-hard, and there is extensive work on approximation algorithms. Classic approaches exploit the algebraic structure of the underlying matrix, while more recent approaches use randomization. An entirely different approach that uses the A* heuristic search algorithm to find an optimal solution was recently proposed. Not surprisingly it is limited to effectively selecting only a small number of features. We propose a similar approach related to the Weighted A* algorithm. This gives algorithms that are not guaranteed to find an optimal solution but run much faster than the A* approach, enabling effective selection of many features from large datasets. We demonstrate experimentally that these new algorithms are more accurate than the current state-of-the-art while still being practical. Furthermore, they come with an adjustable guarantee on how different their error may be from the smallest possible (optimal) error. Their accuracy can always be increased at the expense of a longer running time.

Insulin-like growth factor-1 receptor (IGF-1R) and matrix metalloproteinase-7 (MMP-7) have been reported to be related to tumor invasion and metastasis in various malignancies. The aim of this study was to evaluate the expression levels of IGF-1R and MMP-7 in resected non-small cell lung cancer (NSCLC) and to examine the relationship of such levels to clinical characteristics and survival. Expression was measured immunohistochemically. The percentage of stained cells was multiplied by the staining intensity. The sample was classified as high when the score was equal or higher than the median value or was otherwise considered to be low. High IGF-1R expression was associated with nodal metastasis and recurrence (P=0.034 and 0.006, respectively). High IGF-1R expression was associated with significantly poorer overall survival than low IGF-1R expression (P=0.011). MMP-7 expression did not significantly correlate with any clinicopathological factor. There was a trend toward slightly, but not significantly poorer survival in patients with MMP-7-high tumors than in those with MMP-7-low tumors (P=0.220). There was no significant correlation between IGF-1R expression and MMP-7 expression (P=0.184). Upon multivariate analysis, IGF-1R expression was independently related to the outcomes of patients with NSCLC. Overexpression of IGF-1R may be a useful predictor of lymph node metastasis, recurrence and post-surgical outcomes in patients with NSCLC.

背景．稀ではあるが，臓側胸膜浸潤のない肺癌症例でも，術中に存在する胸水中に癌細胞が証明されることがある．臨床病理学的にも病期診断に極めて重要な所見であり，癌進展の自然史としても興味深い病態であるが，その機序は明らかでない．症例．血痰を契機に発見された左上葉原発，肺腺癌の68歳・男性．臨床病期はstage IAであった．術中所見では，少量の漿液性胸水を認めた他は，臓側胸膜面の変化や播種巣などはなく，sT1bN0M0D0E1（+）少量・漿液性PL0PM0：stage IAと診断した．術後病理診断では葉気管支間リンパ節に転移を認めた．癌組織の臓側胸膜浸潤は認めなかったが，胸水細胞診にて癌性胸水と診断され，最終的にpT1bN1（#11）M1a（E+）：stage IVの診断となった．結論．癌性胸水の存在は，病期診断，術後の治療戦略上，極めて重要な所見である．術中に臓側胸膜表面に変化のない症例であっても洗浄細胞診を，また少量でも胸水が存在すれば胸水細胞診を積極的に施行すべきである．

Feature selection is a common dimensionality reduction technique of fundamental importance in big data. A common approach for reducing the running time of feature selection is to perform it in two stages. In the first stage a fast and simple filter is applied to select good candidates. The number of candidates is further reduced in the second stage by an accurate algorithm that may run significantly slower. There are two main variants of feature selection: unsupervised and supervised. In the supervised variant features are selected for predicting labels, while the unsupervised variant does not use labels at all. We describe a general framework that can use an arbitrary off-the-shelf unsupervised algorithm for the second stage. The algorithm is applied to the selection obtained in the first stage weighted appropriately. Our main technical result is a method for calculating weights for the columns that need to be selected in the second stage. We show that these weights can be computed as the solution to a constrained quadratic optimization problem. The solution is deterministic, and improves on previously published studies that use probabilistic ideas to compute similar weights. To the best of our knowledge our approach is the first technique for converting a supervised feature selection problem into an unsupervised problem. Complexity analysis shows that the proposed technique is very fast, can be implemented in a single pass over the data, and can take advantage of data sparsity. Experimental results show that the accuracy of the proposed method is comparable to that of much slower techniques.

症例は65歳，男性．胸腺腫を合併した重症筋無力症（MGFA分類IIIb期）の診断で当院神経内科に入院．抗コリンエステラーゼ薬内服，血漿交換療法，メチルプレドニゾロン1000mg/日×3日間のステロイドパルス療法を施行し，以後ステロイド50mg/日の内服となった．ステロイド導入後約1カ月の胸部CTでは指摘された腫瘤は画像上消失していた．拡大胸腺摘出術を施行し，術後病理診断は胸腺腫（Muller-Hermelink分類混合型，WHO分類Type B2）の退行性変化であった．術前にステロイド導入を行った胸腺腫合併重症筋無力症においては，胸腺腫の退縮の可能性もあることを念頭に置くことが肝要である．

症例は22歳，男性．平成18年9月頃から呂律が回りづらく徐々に悪化していた．筋力の低下も出現し，当院神経内科紹介され精査を施行され筋緊張性ジストロフィーと診断された．スクリーニングの為撮影した胸部CTにて前縦隔腫瘍を指摘され平成19年2月当科紹介となった．確定診断を得るため摘出生検を施行した．術後は手術室にて抜管可能であったが喀痰が多く，喀出も不良であり高炭酸ガス血症を生じ，胸部X線写真上無気肺を認め気管支鏡下に喀痰吸引を施行した．第4病日より歩行を開始してから喀痰も自己喀出可能となり術後12日目に退院となった．筋緊張性ジストロフィーは周術期管理に関して注意が必要とされ，術前に十分な説明と対処法を考慮しておくことが重要であると考えられた．

検診を契機に発見された淡明細胞腺癌の1例を経験したので報告する．症例は76歳，男性で，胸部CT上，左肺S3末梢に単発性の腫瘤性病変を認めた．経気管支肺生検等で確定診断に至らず，左肺部分切除術を施行した．術中迅速凍結組織診断で腺癌が疑われたため，左肺上葉切除術及び縦隔リンパ節郭清に術式を変更した．術前術後の全身の画像診断にて他臓器に腫瘍性病変を認めなかったため，臨床的に原発性肺腫瘍を考えた．術後の病理学的検索で，病変の90％以上を淡明細胞が占め，ごくわずかに乳頭状構造を呈することが分かった．免疫組織化学的にはケラチン陽性，EMA陽性，Thyroid transcription factor-1陽性，Surfactant apoprotein A陽性，HMB45陰性を示し，肺原発の淡明細胞腺癌の診断を得た．術後22ヵ月間経過しているが，再発はなく，健康である．

症例は36歳の女性. 出産を契機に全身性エリテマトーデス (systemic lupus erythematosus : SLE) を発症, 治療経過中に両側肺化膿症を合併した. 左肺病変は舌区域気管支の胸膜腔への開存による気胸となり, さらに膿胸へと進展した. 胸水培養からはStaphylococcus aureus (MRSA) が検出された. 胸腔ドレーンを挿入し, 抗生剤による洗浄を繰り返したが改善を認めず, 当科を紹介された. 手術を施行し, 術後9病日に胸腔ドレーンを抜去, その後退院した. SLEに合併した膿胸に対する1手術例を報告する.

虫垂粘液嚢胞腺腫は稀な疾患である. 今回, われわれは高CEA血症を呈し術後正常化した虫垂粘液嚢胞腺腫の2例を経験したので報告する.症例1 : 58歳, 女性. 2005年3月近医にて右卵巣腫大を指摘され, 婦人科を受診しCTにて右卵巣腫瘍が疑われ12月当院婦人科を受診し入院. CEA=9.3と高値を示し, CT, MRI, USで右下腹部に嚢胞状腫瘤を認めた. 2006年2月当科で回盲部切除術施行. 術後CEA=1.8と正常化した.症例2 : 50歳, 女性. 2005年4月悪性リンパ腫の経過観察中のCTで回盲部に腫瘤を指摘された. 11月のCTで増大が認められ2006年3月入院となった. CEA=5.9と高値を示した. CT, USで右下腹部に嚢胞状腫瘤を認めた. 2006年3月盲腸部分切除術施行. 術後CEA=1.6と正常化した.いずれも病理検査で虫垂粘液嚢胞腺腫と診断され, 免疫染色ではCEA陽性であった.88年以降本邦で原著として報告されCEA高値を示す虫垂粘液嚢胞腺腫は自験例を含め40例であった.

症例は68歳男性. 胸部異常陰影を指摘される4ヵ月前より乾性咳嗽と両側の下腿浮腫, 関節痛が出現, また指趾のバチ状指を自覚するも放置していた. 健康診断で胸部異常陰影を指摘され当科を受診, 左下葉肺腺癌と診断した. 骨シンチグラムでは両大腿骨, 頸骨の骨皮質に沿った線路状の病的集積像を認め, 肺癌に伴ったMarie-Bamberger症候群と診断した. 左下葉切除後より膝関節痛は消失, 下腿浮腫も軽減した. 指趾のバチ状指や関節炎症状等を認めた際には, 常に本症を鑑別疾患の1つにおいて精査を進めていくことが重要である.

症例は29歳男性.胸痛を契機に前縦隔腫瘍を指摘され当院を受診.腫瘍は大きさ11.5×8.5cmで右房へと突出し, 血清AFPは9, 600ng/mlと高値であったが, hCGβ を含めた他の腫瘍マーカーは正常値であった.CTガイド下針生検でembryonal carcinomaとteratomaの混在した腫瘍と診断.直ちに化学療法 (PEB療法: cisplatin+etoposide+bleomycin) を2コース, その後末梢血幹細胞移植併用大量化学療法 (PBSCT+ICE療法: carboplatin+etoposide+ifosfamide) を2コース行い, AFPは44.3ng/mlに減少, 大きさは10.0×6.0cmに縮小した.胸骨縦切開で腫瘍摘出術, 心膜合併切除, 右中葉切除術を施行した.摘出標本はimmmature teratomaであった.術後PE療法 (cisplatin+etoposide) を開始し, AFPは11.1ng/mlと正常範囲となった.さらに2コース追加し, 6月25日に退院した.術後6ヶ月経過するが, 再発なく外来にて経過観察中である.

With the progress of antibiotic therapy, the mortality of lung abscess has been improved, and surgical intervention has declined. However, surgery is still required in selected cases that are intractable to antibiotic treatment. Video-assisted thoracoscopic surgery (VATS) is beneficial for treatment and/or diagnosis of pulmonary disease as it provides a less invasive surgical technique and reduces prolongation of post-operative recovery. However, the indication of VATS lobectomy for lung abscess is controversial as a result of particular complications, i.e. wet lung, intrapleural adhesion and ease of bleeding. We herein report a rare combination of lung abscess and osteomyelitis of mandible resulting from the same pathogen successfully treated with VATS lobectomy. We propose VATS lobectomy for lung abscess. This procedure might be the best treatment candidate for selected cases of lung abscess.

The purpose of this study was to define histological features determining the malignant potential of EGFR-mutated lung adenocarcinoma (LADC). Surgically resected tumors (EGFR-mutated LADCs with (21) and without (79) lymph node metastasis and EGFR wild-type LADCs with (26) and without (108) lymph node metastasis) and biopsy samples from inoperably advanced tumors (EGFR-mutated LADCs (78) and EGFR wild-type LADCs (99)) were examined. In surgically resected tumors, the EGFR-mutated LADCs with lymph node metastasis had the micropapillary element in a significantly greater proportion than others (Mann-Whitney tests P ≤0.026). The proportion of micropapillary element was higher in the EGFR-mutated LADC at the advanced stage (stage II, III, or IV) than in the tumor at the early stage (stage I) (Mann-Whitney test, P

The present study evaluated the potential clinicopathologic significance of elevated microsatellite alteration at selected tetra-nucleotide (EMAST) in non-small cell lung cancer (NSCLC). Sixty-five NSCLCs (19 squamous cell carcinomas, 39 adenocarcinomas, one adenosquamous cell carcinoma, and 6 large cell carcinomas) were examined for EMAST in the ten selected tetra-nucleotide markers. Traditional microsatellite instability (MSI) in the five mono- or di-nucleotide markers of the Bethesda panel was also examined, and compared with EMAST. The incidence of EMAST was higher than that of traditional MSI, as 64.6% (42/65) and 12.3% (8/65) tumors respectively exhibited EMAST and traditional MSI in at least one marker. EMAST and traditional MSI appear to occur independently, as no significant association in their incidence was found (Fisher’s exact test, P = 0.146). Subjects who exhibited EMAST in two or more markers had a significantly higher incidence of history of other malignant neoplasms (42.9% [9/21]), compared to those with less than two markers (16.3% [7/43] (Chi-square test, P = 0.021)). Taken together, impairment of molecular machinery for maintaining stable replication of the tetra-nucleotide-repeating regions, which would differ from machinery for mono- or di-nucleotide-repeating regions, may elevate susceptibility to NSCLCs and certain neoplastic diseases. Elucidation of the potential molecular mechanism of EMAST is expected to lead to a discovery of a novel genetic background determining susceptibility to NSCLC and other multiple neoplasms. This is the first report describing a clinicopathologic significance of EMAST in NSCLC.