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The Janus kinase/signal transducers and activators of transcription signaling pathway induces programmed death ligand-1 (PD-L1) expression. JAK2 mutation at position 617 (JAK2V617) is a frequent driver of myeloproliferative neoplasms (MPN) through PD-L1 expression. Although PD-1 inhibitors should be effective against MPN with JAK2V617F mutation, this has not yet been reported in humans. Thus, we assessed the efficacy of a PD-1 inhibitor in a lung cancer patient with JAK2V617F-positive essential thrombocythemia (ET). A 71-year-old man was diagnosed with ET, and with lung carcinoma 3 years later. After right lobectomy and postoperative chemotherapy, pembrolizumab [a PD-1 inhibitor (200 mg, every 3 weeks)] was initiated for refractory lung carcinoma. Lung cancer progression did not occur for 1.5 years under treatment. Most megakaryocytes were PD-L1-positive, and after pembrolizumab initiation, platelet count remained below 45 × 104/μL without the need for other cytoreductive therapies for ET. The JAK2V617F allele burden gradually decreased from 11.5% at diagnosis to 2.9% after 17 months of pembrolizumab treatment. Other peripheral blood lineages did not decrease, and pembrolizumab treatment was continued without any adverse events. This is the first report demonstrating the effectiveness of pembrolizumab in an MPN patient with JAK2V617F mutation.

Highlights • Granulation or cicatrization on the tracheal lumen increases after injury or ischemia caused by tubes or cuffs, results in narrowing of the trachea within a few months after extubation. • We have described a case of tracheal stenosis that manifested 35 years after endotracheal intubation for neonatal resuscitation. • The scar tissue was ablated using argon plasma coagulation, and no recurrence has been observed for more than 3 years. • Delayed postintubation tracheal stenosis should be taken into consideration, when a patient suffers from suffocating tracheal stenosis., Introduction Postintubation tracheal stenosis involves granulation or cicatrization of the tracheal epithelium. It is progressive and can become life-threatening within a few months after extubation. Presentation of case We here report a case of tracheal stenosis with a delayed manifestation, presenting 35 years after endotracheal intubation for neonatal resuscitation. A female patient complained of dyspnea during pregnancy. Bronchoscopy revealed 75% constriction of the tracheal lumen by cicatrization, from the 2nd to 4th tracheal rings. After child-birth, the scar tissue was ablated using argon plasma coagulation. Discussion The patient had no significant medical history, such as severe airway infection or cervical/chest trauma, which might have caused the circumferential cicatricial tracheal stenosis, other than the endotracheal intubation she had undergone for neonatal resuscitation. Therefore, we considered this to reflect postintubation tracheal stenosis with delayed manifestation. Conclusion Delayed postintubation tracheal stenosis should be taken into consideration, when a patient suffers from suffocating tracheal stenosis.

Glomus tumors are rarely developed in the lung. We report a case of a pulmonary glomus tumor that was observed for a long period. The patient was a 50-year-old man. Chest computed tomography showed a 6 mm nodule in the left lower lobe. The patient requested follow-up observation. The nodule gradually increased and was resected 6 years later. Pulmonary partial resection was performed thoracoscopy. The lesion was diagnosed as a glomus tumor with no malignant features. Pulmonary glomus tumors are rare and difficult to diagnose before resection. However, care is necessary as they may be malignant.

The risk factors for bleomycin-induced lung injury (BLI), a fatal complication of cancer chemotherapy, are not well-established. The renin-angiotensin-aldosterone system (RAAS) has recently been suggested to play a role in the development of lung injury. This study clarified the impact of hypertension (HTN) and the administration of RAAS inhibitors on BLI occurrence in patients treated with bleomycin-containing regimens.We retrospectively analyzed the data of 190 patients treated with a bleomycin-containing regimen for Hodgkin lymphoma or germ cell tumors at our institutions from 2004 to 2018.Overall, 190 patients received bleomycin, and symptomatic BLI occurred in 21 (11.1%) cases. In the multivariate analysis, age ≥ 65 years (odd ratio, 10.90; 95% confidence interval, 3.72-32.20; P .001) and history of HTN (odds ratio, 3.32; 95% confidence interval, 1.07-10.30; P = .04) were found to be significant risk factors for BLI onset. BLI occurred in 3.6% (n = 5) of patients with no risk, 11.8% (n = 2) of those whose only risk factor was HTN, 31.6% (n = 6) of those whose only risk factor was age ≥ 65 years, and 57.1% (n = 8) of those with both risk factors (P .001). BLI-induced mortality rates in each group were 0.0% (n = 0), 5.9% (n = 1), 10.5% (n = 2), and 42.9% (n = 6) (P .001), respectively. Among 31 patients with HTN, BLI incidence was 12.5% in patients who were administered RAAS inhibitors and 53.3% in those who were not (P = .02).Older age and history of HTN were independent risk factors for the development of BLI, and the administration of RAAS inhibitors might reduce the onset of BLI.

BackgroundAlthough development of immune checkpoint inhibitors and various molecular target agents has extended overall survival time (OS) in advanced non-small cell lung cancer (NSCLC), a complete cure remains rare. We aimed to identify features and treatment modalities of complete remission (CR) cases in stages III and IV NSCLC by analyzing long-term survivors whose OS exceeded 3 years.MethodsFrom our hospital database, 1,699 patients, registered as lung cancer between 1stMar 2004 and 30thApr 2011, were retrospectively examined. Stage III or IV histologically or cytologically confirmed NSCLC patients with chemotherapy initiated during this period were enrolled. A Cox proportion hazards regression model was used. Data collection was closed on 13thFeb 2017.ResultsThere were 164 stage III and 279 stage IV patients, including 37 (22.6%) and 51 (18.3%) long-term survivors and 12 (7.3%) and 5 (1.8%) CR patients, respectively. The long-term survivors were divided into three groups: 3 ≤ OS < 5 years, 5 years ≤ OS with tumor, and 5 years ≤ OS without tumor (CR). The median OS of these groups were 1,405, 2,238, and 2,876 days in stage III and 1,368, 2,503, and 2,643 days in stage IV, respectively. The mean chemotherapy cycle numbers were 16, 20, and 10 in stage III and 24, 25, and 5 in stage IV, respectively. In the stage III CR group, all patients received chemoradiation, all oligometastases were controlled by radiation, and none had brain metastases. Compared with non-CR patients, the stage IV CR patients had smaller primary tumors and fewer metastases, which were independent prognostic factors for OS among long-term survivors. The 80% stage IV CR patients received radiation or surgery for controlling primary tumors, and the surgery rate for oligometastases was high. Pathological findings in the stage IV CR patients revealed that numerous inflammatory cells existed around and inside resected lung and brain tumors, indicating strong immune response.ConclusionsMultiple line chemotherapies with primary and oligometastatic controls by surgery and/or radiation might achieve cure in certain advanced NSCLC. Cure strategies must be changed according to stage III or IV.This study was retrospectively registered on 16thJun 2019 in UMIN Clinical Trials Registry (number UMIN000037078).

Congenital cystic adenomatoid malformation (CCAM) is a congenital pulmonary cystic disease that is mostly detected and diagnosed prenatally or during the neonatal period, while rarely being observed in adults. Here, we report an adult case of CCAM that was diagnosed following surgery for a recurrent pneumothorax. We further review 60 case reports on adult CCAM that have been previously published. The patient was a 29-year-old woman with a severe left pneumothorax. Her computed tomography scan showed the presence of multiple pulmonary cysts at the base of the left lower lobe. Since she had experienced a left pneumothorax twice previously, surgery was indicated. A wedge lung resection of the pulmonary cysts was performed thoracoscopically. The postoperative pathological diagnosis was type I CCAM. From the review, 7 adult CCAM patients (11.7%) out of 61, including the patient in the present case, presented with pneumothorax, while 21 patients (35%) presented with infection. Thirty-nine foci of CCAM (65%) were located in lower lobes. Moreover, malignancies were associated in 8 cases (13.3%). We propose that if multicystic lung lesions are found in pneumothorax patients, particularly in lower lobes, CCAM should be considered during the differential diagnosis, even in adults.

Background Recently, thoracoscopic resection of pulmonary sequestration has become more common, since resection of an aberrant artery using an end-stapler is a safe maneuver in many cases. However, injury of the vessels can lead to major hemorrhage. We reported our surgical experience based on thoracoscopic surgery, with five cases of interlobar pulmonary sequestration, focusing on precautions for aberrant arterial vessels. Object and methods We performed pulmonary resections for five patients with interlobar pulmonary sequestration in a lower lobe (left, n = 4; right, n = 1) between April 2004 and May 2020. All aberrant vessels were derived from the lower thoracic artery. Two patients had a single aberrant artery and three had multiple. In four patients, these vessels were detected before surgery, and pulmonary sequestration was diagnosed in four. In one elderly patient, the aberrant vessel was overlooked, and lung cancer was suspected before surgery. Angiography or multidetector-row computed tomography was subsequently performed in four cases. The surgical plan was determined according to the location and size of the pulmonary lesion and three-dimensional images of aberrant vessels. Result In all patients, approaches were made thoracoscopically. Hemorrhage from an anomalous vessel was encountered in one case. Pulmonary resections included two lobectomies and three limited resections. Angioplasty for the root of anomalous branches was performed following pulmonary resections under converted minimal lateral thoracotomy in two cases. Conclusion Preoperative assessment of the anatomical variations in abnormal vessels is essential to achieve safe surgical procedures. According to the situation of the aberrant vessels, selecting surgical procedures with consideration of potential subsequent complications arising over a long period of time is important.

We reported a surgical case of methotrexate-associated lymphomatoid granuloma. A 69-year-old female had been treated with methotrexate for rheumatoid arthritis for 35 months. The patient underwent partial resection of the right upper pulmonary lobe for lung cancer when she was 67 years old. A nodule was detected in the left lung field on a chest radiograph performed during the postoperative follow-up period. Computed tomography revealed a 28-mm nodule in the lower left pulmonary lobe. A transbronchial biopsy examination did not lead to a diagnosis. The pulmonary nodule subsequently increased in size. We suspected a malignant tumor and performed lower left lobectomy. A pathological examination revealed lymphomatoid granuloma. Finally, the patient was diagnosed with methotrexate-associated lymphomatoid granuloma based on her history of oral methotrexate treatment.

Sternal bone fractures with bilateral multiple rib fractures cause serious instability of the anterior chest wall, and prolonged mechanical ventilation may be required. A 45-year-old man was injured in a motor vehicle collision. He suffered from a bilateral flail chest injury accompanied by a transverse sternal fracture. Minimally invasive surgical stabilisation of the anterior chest wall was performed using two bars as per the Nuss procedure. Two days after surgery, he was extubated from artificial respiration and was ultimately discharged without any complications.

Pathological stage is the most important prognostic factor in patients with lung cancer, and is defined according to the tumor node metastasis classification system. The present study aimed to investigate the clinicopathological significance of lymphatic invasion in 103 patients who underwent surgical resection of lung squamous cell carcinoma (SqCC). The patients were divided into two groups, according to the degree of lymphatic invasion: Those with no or mild lymphatic invasion (ly0-1) and those with moderate or severe lymphatic invasion (ly2-3). Ly2-3 was associated with tumor size (P=0.028), lymph node metastasis (P

A 54-year-old woman with adenocarcinoma of the lung and lymph node metastasis experienced nystagmus and cerebellar ataxia 2 weeks after initiating nivolumab therapy. An evaluation for several autoimmune-related antibodies and paraneoplastic syndrome yielded negative results. We eventually diagnosed the patient with nivolumab-induced acute cerebellar ataxia, after excluding other potential conditions. Her ataxic gait and nystagmus resolved shortly after intravenous steroid pulse therapy followed by the administration of decreasing doses of oral steroids. Nivolumab, an immune checkpoint inhibitor, is known to induce various neurological adverse events. However, this is the first report of acute cerebellar ataxia associated with nivolumab treatment.

We report a 16-year-old male with histiocytic sarcoma (HS) originating in the lung. Partial resection of the lung was performed for a 3-cm mass with a clear boundary detected in the right inferior pulmonary lobe on a health checkup. Histologically, the tumor infiltrated into the surrounding tissue, and was comprised of spindle cells, mainly, and foam cells accompanied by mild nuclear atypia. The tumor cells were immunohistochemically positive for CD68 and CD163, indicating histiocytic lineage and the MIB-1-positive rate was low. Spindle cell morphology of HS is quite rare and only 3 cases of pulmonary HS have previously been reported.

Podoplanin is a 38 kDa transmembrane protein that is involved in cell migration and cancer cell invasion. Some studies have reported that podoplanin expression was correlated with poor prognosis in lung squamous cell carcinoma (SqCC). However, there have been no clinicopathological studies of podoplanin membrane expression and localization in lung SqCC. In this study, we focused on the intensity and localization of podoplanin membrane expression, and its clinicopathological significance for lung SqCC. Strong membrane expression of podoplanin was significantly associated with lymph node metastasis, lymphatic invasion, and histological differentiation. Cases with strong podoplanin expression at cell membrane showed better prognosis of lung SqCC (HR, 3.301). Peripheral localization of podoplanin was associated with tumor size, lymphatic invasion, and histological differentiation. Cases with peripheral podoplanin expression showed favorable prognosis of lung SqCC (HR, 2.830). Both strong membrane expression and peripheral expression of podoplanin were independent predictors of mortality of lung SqCC (HR, 2.869; HR, 2.443, respectively). The cases with strong or peripheral podoplanin expression showed better overall survival (P = 0.001, both). Podoplanin intensity is significantly associated with podoplanin localization (P < 0.001), and its correlation coefficient was 0.678. We concluded that podoplanin membrane expression, not only its localization, is a useful prognostic indicator of lung SqCC patients.

Steroid hormones regulate life stage transitions, allowing animals to appropriately follow a developmental timeline. During insect development, the steroid hormone ecdysone is synthesized and released in a regulated manner by the prothoracic gland (PG) and then hydroxylated to the active molting hormone, 20-hydroxyecdysone (20E), in peripheral tissues. We manipulated ecdysteroid titers, through temporally controlled over-expression of the ecdysteroid-inactivating enzyme, CYP18A1, in the PG using the GeneSwitch-GAL4 system in the fruit fly Drosophila melanogaster. We monitored expression of a 20E-inducible glue protein gene, Salivary gland secretion 3 (Sgs3), using a Sgs3:GFP fusion transgene. In wild type larvae, Sgs3-GFP expression is activated at the midpoint of the third larval instar stage in response to the rising endogenous level of 20E. By first knocking down endogenous 20E levels during larval development and then feeding 20E to these larvae at various stages, we found that Sgs3-GFP expression could be triggered at an inappropriate developmental stage after a certain time lag. This stage-precocious activation of Sgs3 required expression of the Broad-complex, similar to normal Sgs3 developmental regulation, and a small level of nutritional input. We suggest that these studies provide evidence for a tissue-autonomic regulatory system for a metamorphic event independent from the primary 20E driven developmental progression.

A 14-year-old girl presented with progressively worsening intermittent orthopnea. Imaging studies showed cardiomegaly, extensive pericardial effusion, and a mediastinal tumor. By pericardial drainage, approximately 8,000-mL fluid was collected over 10 days. Left thoracoscopic pericardial fenestration and mediastinal tumor biopsy were performed, revealing lymphangiomatosis. Chylous pleural effusion developed post-surgery. Although control was attempted, her condition worsened. Eight months later, she died of sudden cardiopulmonary arrest. Autopsy revealed systemic spread of the primary lesion from the hyperplastic lymph ducts to the parietal pleura and mediastinum confirming systemic lymphangiomatosis.

Patient: Male, 66 Final Diagnosis: Endobronchial hamartoma Symptoms: Fever Medication: — Clinical Procedure: Flexible bronchoscopy • surgical resection Specialty: Pulmonology Objective: Unusual clinical course Background: Post-obstructive pneumonia occurs in the presence of airway obstruction, usually caused by lung cancer. However, there are cases of bronchial obstruction due to benign origin such as foreign bodies and benign endobronchial tumors, which are often misdiagnosed. Case Report: A 66-year-old man was referred to our hospital due to high fever with abnormal shadow in the right lung. Chest computed tomography after a course of antibiotic treatment showed an intra-bronchial tumor obstructing the right upper bronchus. Part of the tumor was removed with flexible bronchoscopy, and histopathological examination revealed cartilage tissue but not fat or other components. Lobectomy of the right upper lobe of the lung was performed to make a definite diagnosis and prevent recurrent obstructive pneumonia. The resected tumor contained mature cartilage and fat tissues, and was diagnosed as endobronchial hamartoma. Conclusions: Benign endobronchial tumors such as hamartomas should be considered in the differential diagnosis of post-obstructive pneumonia.

The efficacy of landiolol hydrochloride, an ultrashort-acting b-blocker with high b1 selectivity, has been confirmed in patients undergoing cardiac surgery in Japan, but there have been few reports about its use for patients having lung resection. We investigated the safety of continuous infusion of landiolol in patients undergoing lung resection. Between May 2008 and May 2011, 200 patients scheduled for lung resection were enrolled. Patients who underwent surgery before the introduction of landiolol in February 2010 were studied retrospectively (Group C) and were compared with those who received landiolol along with surgery (Group L). During the 48-hour study period, the incidence of arrhythmias, changes in heart rate and blood pressure, and occurrence of adverse reactions were examined. The white blood cell count and C-reactive protein level were measured before and after surgery to assess the anti-inflammatory effect. The heart rate was significantly lower in Group L throughout the study period. No patient in Group L developed hypotension requiring discontinuation of landiolol therapy, and no respiratory symptoms (including asthma or hypoxemia) were observed. White blood cell and C-reactive protein were significantly increased after surgery in both groups, and there were no between-group differences. Arrhythmic events occurred in 1.1% (1/99) and 9.2% (7/76) of Group L and Group C, respectively. One patient in Group C developed ventricular tachycardia. Landiolol can be administered safely during the perioperative period in patients undergoing lung resection.

The incidence, risk factors, and consequences of pneumonia after flexible bronchoscopy in patients with lung cancer have not been studied in detail.We retrospectively analyzed the data from 237 patients with lung cancer who underwent diagnostic bronchoscopy between April 2012 and July 2013 (derivation sample) and 241 patients diagnosed between August 2013 and July 2014 (validation sample) in a tertiary referral hospital in Japan. A score predictive of post-bronchoscopy pneumonia was developed in the derivation sample and tested in the validation sample.Pneumonia developed after bronchoscopy in 6.3% and 4.1% of patients in the derivation and validation samples, respectively. Patients who developed post-bronchoscopy pneumonia needed to change or cancel their planned cancer therapy more frequently than those without pneumonia (56% vs. 6%, p0.001). Age ≥70 years, current smoking, and central location of the tumor were independent predictors of pneumonia, which we added to develop our predictive score. The incidence of pneumonia associated with scores=0, 1, and ≥2 was 0, 3.7, and 13.4% respectively in the derivation sample (p=0.003), and 0, 2.9, and 9.7% respectively in the validation sample (p=0.016).The incidence of post-bronchoscopy pneumonia in patients with lung cancer was not rare and associated with adverse effects on the clinical course. A simple 3-point predictive score identified patients with lung cancer at high risk of post-bronchoscopy pneumonia prior to the procedure.

Primary chest wall tumors occur infrequently; in particular, cavernous hemangioma of the chest wall is an extremely rare disease. We report a case of child with cavernous hemangioma of the chest wall, which was successfully resected. Obvious enlargement of the tumor and the appearance of pain were observed during a 2-year follow-up. In the present case, transcutaneous ultrasonography showed the appearance and disappearance of the mass. This was considered to be caused by the transfer of contents between the shallow and deep parts of the tumor. This may have resulted from serratus anterior muscle movement between the two-layered tumor. Transcutaneous ultrasonography, as well as magnetic resonance imaging, was therefore extremely effective for preoperative diagnosis. Transcutaneous ultrasonography is easily performed, even in children, such as in the present case. Because of its simplicity and usefulness, transcutaneous ultrasonography may be considered as the first-line imaging modality for diagnosis.

We present the case of a patient with malignant lymphoma resulting from chronic pyothorax after artificial pneumothorax for pulmonary tuberculosis. The 81-year-old female patient had a medical history of artificial pneumothorax from left pulmonary tuberculosis when she was 23 years old and subsequent chronic pyothorax. She had become aware of pain in the left back from October 2008. Chest computed tomography revealed a tumor measuring 61 mm × 27 mm behind the left sixth and seventh ribs. After biopsy revealed pyothorax-associated lymphoma, 4 courses of R-CHOP therapy were administered, leading to complete remission. No recurrences were noted during follow-up over a 4-year period after the initiation of therapy.

Lung cancer is a leading cause of cancer mortality worldwide and patients occasionally develop local recurrence or distant metastasis soon after curative resection. Reports of new therapeutic strategies for lung squamous cell carcinoma (SqCC) are extremely rare, while selective anticancer therapy has been reported for lung adenocarcinoma. The aim of this study was to identify clinicopathological prognostic factors for SqCC. We analyzed tumor budding and infiltrative patterns (INF) in 103 cases of surgically-resected SqCC. Tumor infiltrative patterns were classified into three groups (INFa, b and c) and INFc was infiltrative growth at the tumor invasive front. The cases with an INFc component [INFc(+)]were significantly associated with venous invasion (P=0.014) and the scirrhous stromal type (P0.001). The overall survival rate of patients with INFc(+) was significantly lower than that of patients without the INFc component [INFc(-); P=0.003]. Tumor budding was defined as a single cancer cell or a small nest of up to four cancer cells within stromal tissue. The cases with tumor budding [Bud(+)] were significantly associated with lymph node metastasis (P=0.001), lymphatic invasion (P=0.002), INFc(+) (P0.001) and the scirrhous stromal type (P=0.014). Patients with the Bud(+) type had a lower overall survival rate than patients with the Bud(-) type (P0.001). Multivariate analysis demonstrated that tumor budding [hazard ratio (HR), 2.766; 95% confidence interval (CI), 1.497-5.109] and lymph node metastasis (HR, 1.937; 95% CI, 1.097-3.419) were independent predictors of mortality. In conclusion, tumor budding is a significant indicator of a high malignant potential and poor prognosis in SqCC of the lung.

Pulmonary inflammatory pseudotumor is rare. A 34-year-old woman visited our hospital due to an abnormal chest shadow. Computed tomograhy showed a nodule in the right upper lobe. Bronchoscopy showed a polypoid endobronchial nodule obstructing most of the orifice of B2a. The nodule was white, glossy, and smooth, and it seemed to be covered with bronchial mucosa. However, transbronchial biopsy could not facilitate a diagnosis. To obtain a definitive diagnosis, we performed lobectomy of the right upper lobe using video-assisted thoracic surgery and removed the nodule completely. The pathologic diagnosis made during surgery was inflammatory pseudotumor. Immunohistochemical examination showed proliferating spindle cells were positive for vimentin and smooth muscle actin, but negative for epithelial markers. These findings were consistent with the staining pattern of inflammatory pseudotumor previously reported. Careful follow-up is necessary to detect any sign of local recurrence and distant metastases.

Localized malignant pleural mesothelioma (LMPM) is a rare tumor; previously only 52 cases have been reported in the English literature. This type of tumor should be distinguished from diffuse malignant pleural mesothelioma, because a good outcome may be obtained by surgical resection. We report a case of LMPM which grew rapidly within 1 year. Surgical resection was performed, and at present, 6 months since the operation, the patient remains free of the disease.

症例は57歳男性．健診で胸部異常陰影を指摘された．胸部CTにて右第5肋骨後方に骨皮質を外側へ圧排する55×18 mmの腫瘤を認め，骨シンチでは99mTc-HMDPの異常集積を認めなかったが，PET-CTではSUV max 58.0の18F-FDG集積がみられた．他部位には異常集積は認めなかった．肋骨悪性腫瘍の可能性を否定できず，右第5肋骨切除術を施行した．病理組織学的に形質細胞腫との診断であった．多発性骨髄腫を否定するために術後腸骨より骨髄穿刺を施行するも異常所見は認めず，最終的に肋骨原発の孤立性形質細胞腫と診断された．追加治療は施行せず，術後32ヵ月経過した現在，無再発生存中である．肋骨に原発した孤立性形質細胞腫は稀な疾患であり，報告する．

74歳女性．約50年前に肺結核で治療歴がある（詳細不明）．2010年3月，糖尿病治療中の胸部単純X線写真で異常陰影を指摘された．精査の胸部CT検査で重複大動脈弓と右S5に結節影を認め，悪性腫瘍の合併を疑った．気管支鏡検査で異常分岐は認めず，TBLBで腺癌の診断であった．cT1bN0M0の診断で，胸腔鏡下に手術を行ったが，肺尖部を中心に強固な癒着が認められ，後側方開胸に移行した．不全分葉があり，腫瘍は一部上中葉間に渡って存在し，右上中葉切除＋ND1bを行った．切除標本の病理組織学的診断では，混合型腺癌t2an0m0であった．無症状で経過し，成人期に発見される重複大動脈弓は稀であり，重複大動脈弓を伴う肺癌切除例は検索した限りでは本例のみであった．

flail chestは治療に難渋することが多く，治療期間の短縮が患者の生命予後を左右する．一般的な治療法は内固定法と外固定法であるが，flail chestは多発外傷に伴うことが多く，われわれは侵襲の少ない内固定法を第1選択としてきた．しかし，長期人工呼吸器管理に伴う肺炎，それに伴う気管切開，長期鎮静剤投与による薬剤性肝障害等を多く認めた．これらの不都合を回避する為，1999年以降，内固定にNuss法を併用する治療法を選択することで，人工呼吸器使用期間を短縮し，患者の早期社会復帰が可能となった．症例は男性3名，女性2名，平均年齢41歳．受傷機転は転落外傷2例，交通外傷2例，胸骨圧迫心マッサージ後1例であった．内固定にNuss法を併用した平均内固定期間は5.6日，平均人工呼吸器使用期間は10.2日であった．Nuss法併用に伴う合併症は認めなかった．

胸膜孤立性線維腫瘍（Solitary Fibrous Tumor of Pleura：以下SFTPと略す）の外科切除症例3例に対し胸腔鏡操作が，又巨大SFTP症例での術前の血管造影が，腫瘍切除のアプローチの選択に有用であったので報告する．症例1：75歳，女性．胸部X線およびCTで右胸膜腫瘍（3cm）を疑い，胸腔鏡手術を施行した．右中葉臓側胸膜より発生したSFTPに対し，VATS（Video-Assisted Thoracic Surgery）腫瘍摘出術を施行した．症例2：67歳．女性．胸部CTおよびMRI上で右胸膜腫瘍（5.7×4.7cm）を疑った．胸腔鏡下に，壁側胸膜に有茎性のSFTPを確認し，小開胸を設置して鏡視下に腫瘍摘出術を施行した．症例3：59歳，女性．労作性呼吸困を伴った，診断未定の胸腔内巨大腫瘍（22×11cm）に対し，血管造影後にVATSを先行した．横隔膜部に有茎性のSFTPを確認し，後側方開胸に移行し，横隔膜と肺を一部分含んだ腫瘍摘出術を施行した．

肺硬化性血管腫の多くが中年以降の女性に発症し，大部分は単発である．男性発症の多発例は非常にまれである．今回我々は，若年男性に発症した多発性肺硬化性血管腫を経験したので報告する．症例は22歳，男性．検診で右下肺野の異常陰影を指摘され，当科を受診した．胸部CTで右下葉に限局して多発する辺縁明瞭な類円形の腫瘤陰影を認めた．大きさは最大で約1cmであった．全身検索で他の病変は認めなかったが，転移性肺腫瘍の可能性を考慮し診断目的で胸腔鏡下生検を施行した．胸腔内観察時，CTで指摘された腫瘤に加え下葉胸膜表面に径数ミリの微小な結節を多数認めた．上・中葉には肉眼で観察可能な病変は存在しなかった．病理診断で多発性硬化性肺血管腫の確定診断を得た．現在，術後14ヵ月で，残存病変の明らかな増大所見はなく，経過観察中である．

Background Patients with pathologic stage (p-Stage) IA non-small cell lung cancer (NSCLC) have a good survival rate because of possible curative resection. However, up to 10% of these patients relapse postoperatively. To identify unfavorable prognostic factors, we retrospectively analyzed the clinicopathological features of p-Stage IA disease, focusing on vascular invasion. Methods Of 467 patients with p-Stage I NSCLC, 335 were diagnosed with p-Stage IA or IB disease based on a lesion size ≤3 cm and the presence of pleural invasion (PL). Univariate and multivariate analyses of recurrence-free survival (RFS) were performed with age, sex, PL, and vascular invasion (blood vessel invasion [v] and lymphatic vessel invasion [ly]) as variables. To examine vascular invasion, hematoxylin-eosin (HE), Elastica van Gieson staining, and immunostaining with anti-podoplanin antibody were performed. The presence or absence of v and ly was recorded; the number of involved vessels was counted. Survival rates were obtained using the Kaplan–Meier method and log-rank test. Multivariate analyses were performed using the Cox proportional hazards model. Results RFS differed significantly between patients with no or one involved blood vessel (0 v or 1 v) and those with ≥2 involved vessels (≥2 v). Similarly, RFS differed significantly between patients with no lymphatic vessel involvement (0 ly) and those with one involved lymphatic vessel (1 ly). Thus, BVI(+) and BVI(−) were defined as ≥2 v and 0 v + 1 v, and LVI(+) and LVI(−) as ≥1 ly and 0 ly, respectively. BVI and LVI together represented tumor vessel invasion (TVI). On multivariate analyses, PL and TVI were independently associated with recurrence. Additionally, patients with p-Stage IA TVI(+) disease had a comparable recurrence rate to those with p-Stage IB disease. Conclusions Similar to PL, TVI is an important factor increasing the likelihood of recurrence. As HE staining alone is insufficient for evaluating vascular invasion, specific staining is necessary. Moreover, patients with p-Stage IA TVI(+) disease had a recurrence rate comparable to those with p-Stage IB disease; therefore, further studies should aim to elucidate whether patients with p-Stage IA TVI(+) disease should be administered postoperative chemotherapy similar to that received by p-Stage IB patients. Virtual Slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/5213064891369688

我々は1994年より胸部外傷に対して積極的に胸腔鏡下手術を行ってきた．2005年6月まで34件の胸部外傷に対し胸腔鏡下手術を行った．年令は6から90歳（平均40.7歳），受傷原因は刺創21例，交通外傷11例，転落外傷2例であった．34例中2例は出血コントロール不良のため，標準開胸に切りかえた．胸腔鏡下手術を完遂できた32例の術式は，部分切除14例，止血7例，肺縫合もしくは修復術5例，審査胸腔鏡5例，気管支縫合術1例であった．鈍的外傷では（1）横隔膜破裂，血管損傷に対する審査胸腔鏡（2）持続する胸腔内気瘻（3）6時間で500ml以上の血胸，鋭的外傷では（1）刺創（2）汚染に対する胸腔洗浄，を手術適応とした．胸部外傷に対する手術療法はあくまで緊急開胸手術が主体であるが，その中に胸腔鏡下手術でも充分対応できる症例は存在する．

To avoid the complications of internal pneumatic stabilization for flail chest, we performed stabilization of the chest wall with a metal bar using the Nuss procedure. Here, we used a highly elastic lightweight biocompatible titanium alloy Chest Way (Solve Corporation, Kanagawa, Japan), enabling magnetic resonance imaging. The patient was a 37-year-old man who sustained injuries in a car crash. Gradually increasing subcutaneous emphysema was present. Bilateral pleural drainage and tracheal intubation were conducted on the scene, and a peripheral venous line was established. The patient was then transferred to our hospital by helicopter. A titanium alloy Chest Way was inserted to manage his flail chest accompanied by multiple rib fractures on the left side. Two days later, artificial respiration was no longer required.

Ki-67 is a nuclear protein that is expressed during the G1, S, G2 and M phases of the mitotic cell cycle. A previous study categorized tumor infiltration patterns (INF), of which INFc indicated cancer nests exhibiting infiltrative growth and an unclear boundary between tumor tissue and surrounding healthy tissue. The present study used the Ki‑67 labeling index (Ki‑67 LI) as an indicator of cell proliferation, in order to examine the factors affecting INF in lung squamous cell carcinoma (SqCC). SqCC specimens (89) were classified into two groups: High‑grade cell proliferation (Ki‑67 LI ≥30%) and low‑grade cell proliferation (Ki‑67 LI

Copper-transporting P-type adenosine triphosphatase (ATP7B) is reportedly associated with platinum drug resistance in various solid carcinomas. However, the impact of ATP7B on platinum drug resistance in non-small cell lung cancer (NSCLC) remains unknown. We investigated ATP7B expression in nine human NSCLC xenografts using real-time polymerase chain reaction (PCR) and immunohistochemistry, and examined the relationship between the expression level of ATP7B and in vivo cisplatin (CDDP) sensitivity. ATP7B mRNA expression was significantly correlated with in vivo cisplatin sensitivity [coefficient of determination (R 2 )=0.949, p=0.005]. ATP7B protein was detected in the nine xenografts. The ATP7B protein expression level was comparable to that of ATP7B mRNA. ATP7B mRNA and protein expression levels in the CDDP-resistant xenografts were significantly higher than those in the CDDP-sensitive xenografts (p=0.0389 and p=0.0357, respectively, Mann-Whitney U test). These results suggest that ATP7B is a CDDP-resistance marker in human NSCLC xenografts in vivo.