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Background The importance of the stromal components in tumour progression has been discussed widely, but their prognostic role in small size tumours with lepidic components is not fully understood. Applying digital tissue image analysis to whole-slide imaging may enhance the accuracy and reproducibility of pathological assessment. This study aimed to evaluate the prognostic value of tumour components of lung adenocarcinoma by measuring the dimensions of the tumour consisting elements separately, using a machine learning algorithm. Methods Between September 2002 and December 2016, 317 patients with surgically resected, pathological stage IA adenocarcinoma with lepidic components were analysed. We assessed the whole tumour area, including the lepidic components, and measured the epithelium, collagen, elastin areas and alveolar air space. We analysed the prognostic impact of each tumour component. Results The dimensions of the epithelium and collagen areas were independent significant risk factors for recurrence-free survival (hazard ratio, 8.38; 95% confidence interval, 1.14–61.88; P = 0.037, and hazard ratio, 2.58; 95% confidence interval, 1.14–5.83; P = 0.022, respectively). According to the subgroup analysis when combining the epithelium and collagen areas as risk factors, patients with tumours consisting of both large epithelium and collagen areas showed significantly poor prognoses (P = 0.002). Conclusions We assessed tumour components using a machine learning algorithm to stratify the post-operative prognosis of surgically resected stage IA adenocarcinomas. This method might guide the selection of patients with a high risk of recurrence.

Background Although oncogene-targeted therapy is a first-line treatment for advanced, unresectable lung adenocarcinoma harboring a target gene mutation, its effect on potentially resectable, locally advanced lung adenocarcinoma remains unclear. Patients and methods Ten patients with clinically diagnosed stage III lung adenocarcinoma harboring a target gene mutation were enrolled in the current feasibility study of targeted therapy followed by cytotoxic chemotherapy (platinum and pemetrexed) before radical surgery. Results Complete resection was accomplished in all nine patients who went on to surgery (one patient refused surgery), and all of these patients recovered without major postoperative complications. Overall, almost all of the patients who underwent surgery remain disease-free after a median follow-up of 22 months since the initial treatment, with only one patient dying of recurrence. Conclusion Radical surgery after the sequential use of cytostatic and cytotoxic drugs resulted in a favorable short-term outcome.

Lobe-specific nodal dissection (LND) is increasingly used for non-small cell lung cancer (NSCLC) in Japan; however, its treatment validity remains unclarified. Since 2013, LND has been used as a standard procedure for clinical stage-I (c-stage-I) NSCLC at our institution. We aimed to evaluate its validity using intraoperative frozen section analysis (FSA) for c-stage-I NSCLC.The participants comprised patients with NSCLC who underwent LND between 2013 and 2016 (n = 307) or systematic nodal dissection (SND) between 2002 and 2013 (n = 367) for c-stage-I disease. FSA was routinely performed in LND to examine at least three stations. Outcomes were compared between the LND and SND groups. Patients in whom LND was converted to SND due to metastasis on FSA of the sampled lymph node were still categorized into the LND group, i.e., intention-to-treat analysis. The prognostic impact was compared using propensity score matching.The rate of conversion from LND to SND was 10.4%. Of the patients converted to SND, 12.5% had metastases outside the LND area. False-negative N2 results were detected in only 0.7% of the LND group patients after FSA. After matching, each group had 220 patients. There were no significant between-group differences in the lymph-node recurrence rate (7% vs. 6%), 5-year recurrence-free survival (80.1% vs. 79.0%), and overall survival (90.4% vs. 90.3%).LND with intraoperative FSA is a valid modality that could serve as a standard surgical procedure for c-stage-I NSCLC. Intraoperative FSA may lower the residual lymph-node metastasis risk in LND.

OBJECTIVES The present study investigated whether or not pleural anthracosis is associated with changes in the pleural lymphatic structures or function, which would interfere with nodal skip metastasis. METHODS This study comprised 2 different case series. In the first series, we observed pleural lymphatic drainage using near-infrared fluorescent endoscopy by the subpleural injection of indocyanine green immediately after thoracotomy for lung cancer. We also performed a histological assessment of the pleura. In the second series, we reviewed the nodal metastatic pattern (skip or non-skip metastasis) in pathological N2 lung cancer involving the pleura. These findings were compared with the severity of pleural anthracosis, which was quantified by thoracoscopic vision and a software-based imaging analysis. RESULTS In the first series (n = 42), pleural lymphatic drainage was not visualized in 19 (45%) patients who had relatively severe anthracosis, while it was visualized in the remaining 23 (55%) patients who had relatively minimal anthracosis. Histologically, severe anthracosis was associated with pleural thickening accompanied by a decreased incidence of straight-running lymphatic vessels and, in turn, an increased incidence of short lymphatic vessels, which was suggested to be the result of pleural remodelling. In the second series (n = 53), a skip metastatic pattern was found in 24 (45%) patients who predominantly had less-severe anthracosis, while a non-skip metastatic pattern was found in 29 (55%) patients who predominantly had severe anthracosis. CONCLUSIONS Pleural anthracosis was associated with pathological changes in the pleural lymphatics and decreased pleural lymphatic drainage, thereby interfering with nodal skip metastasis.

Background: Gene methylation is deeply involved in epigenetics and affects both the development and maintenance of homeostasis and carcinogenesis. ALKBH4 is a member of the AlkB homolog (ALKBH) family that controls demethylation of DNA and RNA.Methods: This study enrolled 160 patients with non-small cell lung cancer (NSCLC) who underwent complete resection. The expression of ALKBH4 in cancer tissue was evaluated by immunohistochemistry. The correlation among the expression of ALKBH4, clinicopathological factors, and prognostic outcome was evaluated.Results: In the NSCLC clinical samples, the expression of ALKBH4 was identified not only in cell membranes but also in the cytoplasm of cancer cells. In 140 of 160 cases, ALKBH4 was more highly expressed in the cancerous tissue than in the surrounding normal tissue. The proportion of cancer cells expressing ALKBH4 was higher in adenocarcinoma than in other histological types. In addition, the expression intensity of ALKBH4 in each cancer cell was also stronger in adenocarcinoma than in squamous cell carcinoma. The expression of ALKBH4 was not associated with clinicopathological factors, except for histological type. In adenocarcinoma, the recurrence-free survival (RFS) and overall survival (OS) rates were significantly lower in the ALKBH4-positive group than in the ALKBH4-negative group (P=0.008, 0.031, respectively). A multivariate logistic regression analysis indicated that the ALKBH4 expression was an independent prognostic factor for RFS (P=0.003) and OS (P=0.013). The expression of ALKBH4 was observed in all four patients with adenocarcinoma in situ.Conclusions: The ALKBH4 expression may be a useful predictor of the postoperative outcomes of lung adenocarcinoma (LUAD) patients.Masaya Aoki, Kazuhiro Ueda, Go Kamimura, Yoshiyuki Iwamoto, Mizuki Ikehata, Keisuke Tabata, Yuri Sakagami, Shoichiro Morizono, Takuya Tokunaga, Tadashi Umehara, Aya Harada-Takeda, Koki Maeda, Toshiyuki Nagata, Kota Kariatsumari, Tatsuhiko Furukawa, Kazutake Tsujikawa, Masami SatoClinical significance of ALKBH4 expression in non-small cell lung cancerTranslational Cancer Research 2022;11(7):2040-2049https://dx.doi.org/10.21037/tcr-22-39

The lung is a major target organ of metastasis in several cancers. To distinguish primary lung cancer from pulmonary metastases is a clinical challenge. Small pulmonary nodules (PNs) are frequently diagnosed by frozen section diagnosis (FSD) intraoperatively after resection. Intraoperative FSD is very important to determine the extent of subsequent surgical procedures. This study aimed to know the validity of surgical decision based on FSD for preoperatively unconfirmed PN with previous malignancy.We retrospectively evaluated 96 patients with suspected malignant PN who underwent intraoperative FSD between 2018 and 2020. Intraoperative FSD, final diagnosis, and surgical procedure data were examined.Surgical procedure adequacy, based on FSD for preoperatively unconfirmed PN with previous malignancy, was 91% (88/96). The overall diagnostic accuracy of FSD was 83.3% (80/96). Discrepancy was noted in two cases (2.1%), and conclusive diagnosis could not be reached intraoperatively in 14 cases (14.6%). A second surgery was required in three patients and no additional excision for primary lung cancer was performed in three patients. Conversely, there were three cases of over-surgery, namely, lobectomy for pulmonary metastasis.Surgical decision-making based on FSD for preoperatively unconfirmed PN in patients with previous malignancy was generally adequate. However, there were inadequate or excessive surgical procedures due to limitations in the accuracy of intraoperative FSD. Improving the accuracy of intraoperative FSD is a necessary step for obtaining adequate surgical decision-making and precision medicine.

Bronchogenic cysts that occur within the diaphragm are rare and difficult to diagnose preoperatively. We experienced the case of a patient with an abnormally high serum carbohydrate antigen 19‐9 (CA19‐9) level before surgery. The diagnosis of intradiaphragmatic bronchogenic cyst was made at the time of surgery. The patient was a 50‐year‐old woman with upper abdominal pain with an incidentally elevated serum CA19‐9. Although the tumour location could not be established on images, a tumour within the diaphragm was confirmed during the operation. The diaphragm was incised and the tumour was removed together with the capsule. Bronchial cysts were diagnosed histopathologically, and immunohistochemical examination revealed that the bronchial epithelial cells were positive for CA19‐9. When managing patients with bronchogenic cysts in the diaphragm, it is difficult to make a preoperative diagnosis or determine the location of the tumour; thus, careful planning is required before surgery., Bronchogenic cysts that occur within the diaphragm are rare and difficult to diagnose preoperatively. Here, we report the case of a patient with an abnormally high serum carbohydrate antigen 19‐9 (CA19‐9) level before surgery. The diagnosis of intradiaphragmatic bronchogenic cyst was made during surgery. When managing patients with bronchogenic cysts in the diaphragm, a preoperative diagnosis or location of the tumour can be difficult; thus, careful planning is required before surgery.

Scoliosis can cause various respiratory complications, even in the natural course, because of rearrangement of the intrathoracic anatomy owing to chest wall deformity. We experienced a patient with scoliosis who developed acute respiratory failure owing to bronchial obstruction induced by bronchial compression by the dorsal thoracic vertebra after right upper lobectomy for cancer. The symptom resolved after mobilization of the ipsilateral lower lobe, which was achieved by releasing the inferior pulmonary vein by U-shaped pericardial dissection with division of the pulmonary ligament. When planning lobectomy for patients with severe scoliosis, the anatomic changes caused by pulmonary resection must be considered.

A significant number of non-small cell lung cancer (NSCLC) patients develop osteogenic metastases (OMs) and/or brain metastases (BMs) after surgery, however, routine chest computed tomography (CT) sometimes fails to diagnose these recurrences. We investigated the incidence of BMs and OMs after pulmonary resection and aimed to identify candidates who can benefit from brain magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) in addition to CT. We retrospectively reviewed medical records of 1099 NSCLC patients who underwent pulmonary resection between 2002 and 2013. Clinicopathological factors associated with OM and/or BM were investigated using univariate and multivariate analyses. Postoperative recurrence occurred in 344 patients (32.6%). OMs were diagnosed in 56 patients (5.6%) with 93% within 3 years. BMs were identified in 72 patients (6.6%) with 91.1% within 3 years. Multivariate analysis revealed that poorly differentiated tumor and the presence of pathological nodal metastases were significantly associated with postoperative BM (p = 0.037

There are more than 150 types of naturally occurring modified nucleosides, which are believed to be involved in various biological processes. Recently, an ultrahigh performance liquid chromatography-electrospray ionization-tandem mass spectrometry (UHPLC-ESI-MS/MS) technique has been developed to measure low levels of modified nucleosides. A comprehensive analysis of modified nucleosides will lead to a better understanding of intracellular ribonucleic acid modification, but this analysis requires high-sensitivity measurements. In this perspective, we established a highly sensitive and quantitative method using the newly developed ion source, UniSpray. A mass spectrometer was used with a UniSpray source in positive ion mode. Our UHPLC-UniSpray-MS/MS methodology separated and detected the four major nucleosides, 42 modified nucleosides, and dG15N5 (internal standard) in 15 min. The UniSpray method provided good correlation coefficients (>0.99) for all analyzed nucleosides, and a wide range of linearity for 35 of the 46 nucleosides. Additionally, the accuracy and precision values satisfied the criteria of

Background There have been a number of reports on pulmonary venous anomalies. However, most of the reports focused on the anatomical branching pattern of the peripheral pulmonary veins. Case presentation We report a 75-year-old female whose right superior pulmonary vein V1 existed dorsal to the right main pulmonary artery and V2+3 existed dorsal to V4+5. Thus, we could not find V1 and V2+3 in the hilum just after a thoracotomy to perform right upper lobectomy for lung cancer. Thus, the right main pulmonary artery and the superior trunk (A1+3) were exposed without cutting the superior pulmonary vein. Conclusion There has been no report so far regarding this type of pulmonary vein translocation. Preoperative three-dimensional computed tomography images were helpful to identify this variant.

Purpose: The diagnostic potential of conventional multi-planar reconstruction (MPR) images, which consist of horizontal, frontal, and sagittal section, in approximating the anatomical distance between tumors and intersegmental planes remains unclear. The aim of the present study was to clarify the validity of decision-making for segmentectomy based on MPR imaging and identify a specific tumor location that is likely to result in the overestimation of the anatomical margin on MPR images.Methods: The study population included 33 patients who were considered eligible for segmentectomy based on the observation of MPR images, and verified using a commercially available image-analysis software whether the decision-making based on MPR images was indeed correct or not.Results: MPR image-based assessment resulted in the overestimation of the anatomical margin in as many as 8 (24%) of the 33 patients. Overestimation predominantly occurred in cases involving patients with tumors at certain segments (right S1, right S2, right S3, left S3, and left S4) that had a complex and oblique intersegmental plane.Conclusion: Conventional MPR image-based assessment frequently resulted in the overestimation of the anatomical margin. We recommend using software-based assessment preoperatively in patients with tumors in the risky segments, particularly in cases involving indistinct tumors.Toshiyuki Nagata, Kazuhiro Ueda, Souichi Suzuki, Yasuhiro Tokuda, Kentaro Yunoki, Satomi Imamura, Masami SatoConventional Multi-Planar Reconstruction Imaging Is Insufficient to Determine the Indication for SegmentectomyAnnals of Thoracic and Cardiovascular Surgery 2020; 26: 256–262https://doi.org/10.5761/atcs.oa.19-00291

Pulmonary lymphatic fluid predominately flows along the bronchi. However, there are reports suggesting that an alternative lymphatic pathway exist, which may result in skip metastases. The aim of this study was to evaluate the subpleural lymph flow in vivo using indocyanine green (ICG) fluorescence. One hundred cases were enrolled. ICG was injected into the macroscopically healthy subpleural space. Intraoperative fluorescence images were then observed in real time. ICG fluorescence was observed moving through subpleural channels in 58/100 cases. ICG flowed into adjacent lobes over interlobar lines in 18 cases and flowed from the visceral pleura directly into the mediastinum in 5 cases. The frequency of mediastinal detection without hilar lymph node detection was significantly higher in the left lung compared to the right (p

Lung cancer constitutes a threat to human health. BHLHE41 plays important roles in circadian rhythm and cell differentiation as a negative regulatory transcription factor. This study investigates the role of BHLHE41 in lung cancer progression. We analyzed BHLHE41 function via in silico and immunohistochemical studies of 177 surgically resected non-small cell lung cancer (NSCLC) samples and 18 early lung squamous cell carcinoma (LUSC) cases. We also examined doxycycline (DOX)-inducible BHLHE41-expressing A549 and H2030 adenocarcinoma cells. BHLHE41 expression was higher in normal lung than in lung adenocarcinoma (LUAD) tissues and was associated with better prognosis for the overall survival (OS) of patients. In total, 15 of 132 LUAD tissues expressed BHLHE41 in normal lung epithelial cells. Staining was mainly observed in adenocarcinoma in situ and the lepidic growth part of invasive cancer tissue. BHLHE41 expression constituted a favorable prognostic factor for OS (p = 0.049) and cause-specific survival (p = 0.042) in patients with LUAD. During early LUSC, 7 of 18 cases expressed BHLHE41, and this expression was inversely correlated with the depth of invasion. DOX suppressed cell proliferation and increased the autophagy protein LC3, while chloroquine enhanced LC3 accumulation and suppressed cell death. In a xenograft model, DOX suppressed tumor growth. Our results indicate that BHLHE41 expression prevents early lung tumor malignant progression by inducing autophagic cell death in NSCLC.

Background: The development of Castleman’s disease in the pulmonary hilum is extremely rare. Although resection of only the lesion is sufficient because of its benign nature, lobectomy or more extensive procedures performed for the pulmonary hilar tumor have been reported.Case presentation: The patient was a 15-year-old male with a tumor in the right pulmonary hilum. Endobronchial ultrasound-guided transbronchial needle aspiration was performed but no specific findings were obtained from the cytological and histological evaluation. 18F-fluorodeoxyglucose positron emission tomography showed moderate accumulation in the tumor, which suggested potential malignancy. Intraoperative frozen section diagnosis did not show any malignant findings. Thus, we performed only tumor enucleation without any lung resection. The pathological diagnosis was hyaline vascular type Castleman’s disease. No recurrence has been observed for seven years.Conclusion: Because hyaline vascular type Castleman’s disease in solitary pulmonary hilar tumor is one of the benign diseases common in young people, intraoperative frozen section diagnosis is recommended to avoid unnecessary lung resection.Masaya Aoki, Go Kamimura, Tadashi Umehara, Aya Harada Takeda, Yui Watanabe, Koki Maeda, Toshiyuki Nagata, Tsunayuki Otsuka & Masami SatoTumor enucleation for Castleman’s disease in the pulmonary hilum: a case reportSurgical Case Reports (2019) 5:95https://doi.org/10.1186/s40792-019-0652-3

This study describes the formation of somatic embryos directly on the surface of hypocotyl sections of Daucus carota L. after exposure to 450 μM of 2,4-D for 2 h, followed by culturing without 2,4-D for 2 weeks. A search for differentially expressed genes immediately after the 2,4-D treatment resulted in the identification of two genes, Dchsp-1 and Dcarg-1. Dchsp-1 has homology to low-molecular-weight heat-shock proteins, while Dcarg-1 has homology to auxin-regulated genes. Dchsp-1 was expressed upon the exposure to 2,4-D treatment but also responded to general stress responses. Dcarg-1 responded primarily to auxin; however, a parallel relationship between the expression of Dcarg-1 and the formation of somatic embryos on the hypocotyl sections was observed. It seems the exposure to auxin shock could serve as a trigger in inducing cell division in the epidermal cells and promoting their further differentiation to somatic embryos. These results are discussed in relationship to our current understanding of the molecular basis of somatic embryogenesis.

A 46-year-old woman was found to have an aneurysm of the superior segmental pulmonary artery in the right lower lung lobe on computed tomography images. Moreover, angiography revealed dilated bronchial arteries flowing into the aneurysm with neovascularization, and the contrast medium was partially pooled in the basal segment of the same lobe. The patient’s hemoptysis could not be controlled by an interventional radiology procedure. Therefore, lobectomy was carried out instead of aneurysmectomy. There has been no recurrence for 4 years after surgery. We considered that that angiographic information allowed for the most appropriate operation in this case.

Non-small cell lung cancer (NSCLC) is the most frequent cause of cancer-related death worldwide. Although many molecular-targeted drugs for NSCLC have been developed in recent years, the 5-year survival rate of patients with NSCLC remains low. Therefore, an improved understanding of the molecular mechanisms underlying the biology of NSCLC is essential for developing novel therapeutic strategies for the treatment of NSCLC. In this study, we examined the role of miR-130b in NSCLC. Our results showed that high expression of miR-130b in clinical specimens was significantly associated with poor overall survival in patients with NSCLC. Moreover, miR-130b expression was significantly increased in NSCLC clinical specimens from patients with vascular and lymphatic invasion. Consistent with this, overexpression of miR-130b promoted invasion and matrix metalloproteinase-2 (MMP-2) activity in A549 cells. Argonaute2 immunoprecipitation and gene array analysis identified tissue inhibitor of metalloproteinase-2 (TIMP-2) as a target of miR-130b. Invasion activity promoted by miR-130b was attenuated by TIMP-2 overexpression in A549 cells. Furthermore, TIMP-2 concentrations in serum were inversely correlated with relative miR-130b expression in tumor tissues from the same patients with NSCLC. Overall, miR-130b was found to act as an oncomiR, promoting metastasis by downregulating TIMP-2 and invasion activities in NSCLC cells.

The unusual spelling of the genus Ginkgo has long attracted scholarly interest. It is well known that Linnaeus took the name from the Amoenitatum exoticarum of Kaempfer, and that Kaempfer relied on the 17th century Japanese illustrated encyclopedia Kinmo Zui for some of the names he took for Japanese plants. But why Kaempfer transliterated the name as "Ginkgo", a pronunciation that does not exist in contemporary Japanese, has been debated. The recognition that Kaempfer's young assistant was Genemon Imamura, a native of Nagasaki, provides a new perspective. Analysis of the plant names in the Amoenitatum exoticarum and comparison with the names in the Kinmo Zui shows that Kaempfer sought to faithfully transcribe the pronunciations of Genemon's late medieval Nagasaki dialect into his transliterations. Ginkgo is one of several examples for which transliteration of the Nagasaki dialect accounts for Kaempfer's unusual spelling of a word or name.

A 68-year-old male with a tracheostoma due to hypopharyngeal cancer was admitted because his chest computed tomography (CT) showed a small nodule in the right middle lobe. Following a partial resection of the right middle lobe, histopathological diagnosis of the resected sample was that of organizing pneumonia. Eleven months later, chest CT showed a mass with pleural indentation and spiculation in the right middle lobe. 18-Fluorodeoxyglucose-positron emission tomography showed significant accumulation in the middle lobe tumor mass shadow. The abnormal chest shadow that had developed around surgical staples suggested inadequate resection and tumor recurrence. As the abnormal radiological shadow was enlarging, middle lobectomy was carried out. Histological examination revealed that the tumor was a lung abscess without malignant features. This is a unique case of lung abscess mimicking lung cancer which developed around staples used during partial resection of the lung.

Background: Video-assisted thoracoscopic surgery (VATS) for organizing empyema is challenging because fibrous septa and peel within the cavity are thickened and hardened. Some patients have multiple isolated empyema cavities that require debridement individually because firm intrathoracic adhesion was developed during this phase. If the debridement was incomplete as a result of worrying about an accidental injury of the surrounding organ, additional interventions may be required due to the persistent empyema cavity or insufficient expansion of the ipsilateral lung. We here describe a representative case with multiple loculated organizing empyema that could safely and reliably perform VATS debridement under C-arm cone-beam computed tomography (CBCT).Case presentation: A 67-year-old woman was admitted to our department for the treatment of right empyema. Chest computed tomography showed fluid collection in three independent spaces within the right thoracic cavity. It was assumed that a firm adhesion between the lung and chest wall was developed because about 7 weeks passed since the onset. Therefore, we decided to use CBCT to completely debride three empyema cavities separately by VATS. One cavity was only in a narrow range with the chest wall, and it was located on the back of cost rib cartilage. By clicking any intended anatomical structures on CBCT images, the position was readily depicted by lase projection on the body surface, which helped to place the best skin incision. Moreover, in other cavities, CBCT after initial debridement showed insufficiently dissected cavity. Additional debridement resulted in a successful shrinkage of the empyema cavity.Conclusion: We believe that VATS debridement under CBCT guidance is one of the useful treatment options for multiple loculated organizing empyema.Masaya Aoki, Tadashi Umehara, Shoichiro Morizono, Yasuhiro Tokuda, Go Kamimura, Takuya Tokunaga, Souichi Suzuki, Aya Harada Takeda, Koki Maeda, Toshiyuki Nagata, Naoya Yokomakura, Kota Kariatsumari, Kazuhiro Ueda & Masami SatoComputed tomography-guided thoracoscopic debridement for multiple loculated organizing empyema: a case reportSurgical Case Reports (2019) 5:174https://doi.org/10.1186/s40792-019-0731-5

Background: Bone morphogenetic protein-7 (BMP-7) is a signaling molecule belonging to the transforming growth factor-β superfamily. Recent studies have demonstrated that BMP-7 is expressed in various human cancers and plays an important role in the progression of their cancers. The purpose of this study was to investigate the clinicopathologic and prognostic impact of BMP-7 expression in clinical samples of non-small cell lung cancer.Methods: This study enrolled 160 patients with non-small cell lung cancer who underwent complete resection. Expression of BMP-7 in cancer tissue was evaluated by immunohistochemistry. Correlations between expression of BMP-7 and clinicopathologic factors and prognosis were analyzed.Results: In non-small cell lung cancer, BMP-7 expression was identified not only in cell membranes but also in the cytoplasm of cancer cells. Expression of BMP-7 correlated with p-T (P = .047), N factor (P = .013), and p-stage (P = .046). Overall survival rate was significantly lower in the BMP-7-positive group than in the BMP-7-negative group (P = .004). Multivariate analysis indicated that BMP-7 expression was one of the independent prognosis factors of overall survival (P = .021). Furthermore, among patients with postoperative recurrence (n = 58), the BMP-7-positive group (n = 29) had a significantly poorer prognosis than the BMP-7-negative group (n = 29) (P = .012).Conclusions: Expression of BMP-7 in non-small cell lung cancer was correlated with clinicopathologic factors and poorer prognosis. BMP-7 expression may be a useful predictor of aggressive activity of tumor behavior and postoperative outcome of patients with non-small cell lung cancer.Masaya Aoki, Tadashi Umehara, Go Kamimura, Nobuhiro Imamura, Shoichiro Morizono, Yuto Nonaka, Takuya Tokunaga, Aya Harada Takeda, Koki Maeda, Yui Watanabe, Toshiyuki Nagata, Tsunayuki Otsuka, Naoya Yokomakura, Kota Kariatsumari, Masakazu Yanagi and Masami SatoExpression of Bone Morphogenetic Protein-7 Significantly Correlates With Non-small Cell Lung Cancer Progression and Prognosis: A Retrospective Cohort StudyClinical Medicine Insights: Oncology Volume 13: 1–6https://doi.org/10.1177/1179554919852087

We report a 17-year-old male with a histopathologic diagnosis of lymphangioleiomyomatosis after surgery for a pneumothorax. In general, lymphangioleiomyomatosis has been considered a female-specific disease. However, there are a few lymphangioleiomyomatosis cases reported in males, and our patient is the youngest case reported. Spontaneous pneumothorax occurs most commonly in males in their late teens and early twenties. Histopathologic diagnosis cannot always be performed in young males with pneumothorax. However, simple diagnosis should be avoided, and lymphangioleiomyomatosis should be considered as an underlying disease. This remarkable case provides new and valuable clinical insights into young male pneumothorax.

An 82-year-old man underwent a left upper lobectomy for a solitary tumor on suspicion of lung cancer. Histopathologic findings of the resected specimen showed clear cell renal cell carcinoma, which was diagnosed as a metastasis from kidney cancer concealed for 31 years after nephrectomy. The Ki-67 labeling index of the metastatic tumor was high (36.1%). A few cases of recurrent renal cell carcinoma after a long interval from initial diagnosis have been seen. However, pulmonary metastasectomy more than 30 years after radical nephrectomy for renal cell carcinoma has not been reported. This remarkable case provides new and valuable clinical insights into metastatic renal cell carcinoma.

Summary. WereviewtherepresentationofGinkgobilobaL.,aquintessentially Chinese plant, in the art of those Western botanists who first encountered it in China and Japan. We also show how several later representations of Ginkgo ,i n both the West and the East, were inspired and made possible by specimens of Ginkgo in cultivation. In a rapidly changing world, a thousand years seems a vast span of time. Yet Ginkgo biloba L. has seen thousands of millennia come and go. In the past, Ginkgo and its fossil cousins were widespread: fossil Ginkgo leaves are known from every continent. Just a few million years ago Ginkgo grew in Europe and also in North America (Crane, 2013). Today, however, Ginkgo is a botanical oddity, a single species with no close living relatives. With its iconic fan shaped leaves, and twigs that show strong differentiation into long and short shoots, it is one of the most distinctive of China’s deciduous trees. The association of Ginkgo with people is documented for about a thousand years in China, where Ginkgo survives in a few potentially relict populations. The early cultivation of Ginkgo focused on its use as a nut tree, and it was probably for this purpose that the tree was grown widely, and then later transplanted to Japan and Korea. One of the Chinese common names for Ginkgo is ‘silver apricot’. Ginkgo was introduced into the West in the mid-18th century and the ‘Old Lion’ at Kew, which dates from the early 1760s, is one of the oldest in cultivation (Crane, 2013). By the mid 19th century Ginkgo was widely grown in Europe, and as early as 1815 Ginkgo was celebratedbyJohannWolfgangvonGoetheinoneofhismostfamous poems (Unseld, 2003). In the late 19th and early 20th centuries, with the recognition that fertilization in Ginkgo differed from that in other trees in being mediated by motile sperm rather than a pollen tube, and with growing recognition of its long fossil record, it became clear that Ginkgo was important in plant evolution and a living link to primeval landscapes that have long since disappeared.

Summary Paulownia tomentosa (Thunb.) Steud., though native to China first came to the attention of Western explorers and naturalists in Japan. It is of cultural importance both in mainland Asia and also in Japan. We describe the early Western encounters with Paulownia tomentosa highlighting in particular a lineage of early illustrations made in Japan and Europe between the mid-1820s and 1878 that reflect the fusion of Japanese art and Western science.

An Unusual Xylotheque with Plant Illustrations from Early Meiji Japan. Two unusual wood collections, reported previously in the collections of the Botanical Museum at Berlin-Dahlem and the Royal Botanic Gardens, Kew, take the form of framed plant illustrations painted on boards made from the wood of the species illustrated. We present new finds of very similar wood collections in the Economic Botany Collection of the Harvard University Herbaria, a private collection in the U.K. (Loudon collection), and at the Koishikawa Botanical Garden of the University of Tokyo. A stamp on the reverse of the boards links all five collections to Chikusai Kato, an artist working at Tokyo University (now the University of Tokyo) in early Meiji Japan, under the direction of the preeminent nineteenth century Japanese botanist Keisuke Ito. New evidence from contemporary historical accounts indicates that more than 100 boards were ordered in June 1878 by Hiroyuki Katō, the first president of Tokyo University, most likely to support the early teaching of Western-influenced botanical science in Japan. However, while the boards had clear value for teaching, especially about useful plants, their unusual fusion of Western and Japanese influences also made them desirable craft objects that were collected and given as gifts during the early Meiji era.

We reported a case of metastatic lung tumor, which was suspected as being a primary lung cancer because of its accompanying lesion mimicking atypical adenomatous hyperplasia(AAH) based on intraoperative needle biopsy findings. AAH is a preinvasive lesion or marginal lesion of primary lung cancer that is not accompanied by metastatic tumor. However, it needs to be distinguished pathologically from secondary changes of inflammation or fibrosis. In our case, the needle biopsy revealed AAH-like pathological findings, which indicates a primary lung cancer, and the standard lobectomy with lymph node dissection was performed, however, the final diagnosis turned out to be metastatic tumor. The rapidly enlarging tumor led to surrounding obstructive pneumonitis, which may have caused pathological changes mimicking AAH findings. In the case of obstructive pneumonitis, we must be careful to diagnose AAH, in addition to decisions about the surgical procedure especially when based on frozen section diagnosis.

Background During pulmonary resection, we sometimes encounter “pitfall branches” of the pulmonary artery, which could cause serious vessel injury. Current computed tomography and computer-processing technology can identify the pulmonary artery along the peripheral bronchus, thereby revealing the true rates of different pulmonary artery branching patterns. Knowledge of these branching patterns allows safe and definitive surgery. Methods In 186 cases of left lung resection performed at our institution from January 2006 to September 2011, two general thoracic surgeons and one radiologist independently reviewed computed tomography images and examined the branches of the pulmonary artery arising from the pars mediastinalis. Results Branching patterns of the lingular artery included 17 (9.2%) cases with mediastinal origin, 50 (26.9%) with interlobar and mediastinal origin, and 119 (63.9%) with interlobar origin. The 2 types of lingular artery of mediastinal origin, which were potentially overlooked during surgery, were observed in 36.1% of cases. This was a higher rate than previously reported. Moreover, a mediastinal basal pulmonary artery (A5+8+10 abnormal branching) was seen in one case. Conclusion Potentially overlooked branches of the left pulmonary artery arising from the pars mediastinalis are much more frequent than we expected. It is crucial to understand the branching pattern of the pulmonary artery by preoperative computed tomography assessment.

We report on the effects of exogenously applied hormones on the lateral and apical dominance that governs morphogenesis in the unifoliate Streptocarpus wendlandii. In this phenotype, lateral dominance is extreme as the plants only retain a macrocotyledon that develops into a leaf-like phyllomorph by means of a basal meristem and do not show apical growth. Gibberellin applications suppressed the basal meristem activity of the macrocotyledon resulting in an isocotylous seedling with two microcotyledons and caused the formation of a primary phyllomorph, which suggests that the groove meristem, a shoot apical meristem equivalent, is released from apical suppression by the basal meristem. Interestingly, uniconazol, a gibberellin biosynthesis inhibitor, also caused a reduction in basal meristem activity, but without primary phyllomorph formation, suggesting that some gibberellin is required for proper function of the basal meristem. Co-application of gibberellin and cytokinin resulted in two macrocotyl...