We previously reported on two women with breast lesions in whom radiological examination could not exclude malignancy. In both cases, mastectomy was performed, and histological analyses revealed ...papillary lesions lined by fibrovascular stroma and nuclear inverse polarity. Hematoxylin–eosin, p63, and calponin staining indicated an absence of myoepithelial cells. However, it was concluded that the lesions had been non-malignant. These women have now been under long-term surveillance (74 months for one case and 62 months for the other) and have had no disease recurrence. Mucin (MUC)1, MUC2, MUC4, MUC5AC, MUC5B, and MUC6 immunostaining has also been performed in these women to investigate further whether their tumors were malignant or benign. In both cases, the tumors were only positive for MUC1 in apical luminal apical cells, as in normal breast tissue. MUC5B immunostaining, even when weak, can detect early breast cancer but was completely negative in our two cases. Therefore, both tumors were considered benign. Our findings in these cases suggest that nuclear inverse polarity papillary lesions lacking myoepithelial cells are benign. This knowledge should decrease the number of unnecessary operations performed for this tumor and their negative impact on patients’ quality of life.
Plasma D-dimer level, a marker of hypercoagulation, has been reported to be associated with survival in several types of cancers. The present study aimed to evaluate the prognostic significance of ...preoperative D-dimer levels in patients with surgically resected clinical stage I non-small cell lung cancer (NSCLC).
Participants comprised 237 patients with surgically resected clinical stage I NSCLC. In addition to factors such as age, sex, and smoking status, the association between preoperative D-dimer level and survival was explored.
Patients were divided into two groups according to D-dimer level: Group A, ≤ 1.0 μg/ml (n = 170); and Group B, > 1.0 μg/ml (n = 67). The 5-year recurrence-free survival rate was 81.6% for Group A and 66.6% for Group B (p < 0.001). The 5-year overall survival rate was 93.6% for Group A and 84.7% for Group B (p = 0.002). Multivariate survival analysis identified D-dimer level as an independent prognostic factor, along with age, maximum standardized uptake value of the primary tumor, and pathological stage.
Preoperative D-dimer level is an independent prognostic factor in patients with surgically resected clinical stage I NSCLC.
Background Chest wall hemangiomas account for about 1% of chest wall tumors, and intramuscular hemangioma arising from intercostal muscle is extremely rare, accounting for 0.01% of all hemangiomas. ...Case In a 54-year-old woman, a 3.0-cm chest wall mass was found between the left 3rd and 4th ribs on examination by CT. PET/CT showed FDG accumulation by the mass (SUVmax: 2.3), and CT-guided needle biopsy was performed for a definitive diagnosis, revealing no malignant findings. During a 2-month follow-up, MRI showed that the mass was not growing, a malignant tumor such as desmoid tumor was suspected, and tumor resection was performed. The chest wall mass was a mural extrathoracic lesion consisting of a collection of bluish-purple multilocular nodules under thoracoscopic view. No malignant findings were found by intraoperative biopsy. However, according to previous reports of local recurrence of intercostal hemangiomas, chest wall resection including the third rib was performed. No malignant findings were found in the final pathological diagnosis, and the lesion was diagnosed as intramuscular hemangioma arising from intercostal muscle. Conclusion Although it is difficult to make a definitive diagnosis of intercostal hemangioma before surgery, it is important to list hemangioma as a differential diagnosis based on preoperative radiological findings and to perform complete resection of the tumor.
Background
This study aimed to evaluate mutations of the epidermal growth factor receptor (EGFR) and K‐ras genes and their clinicopathological and prognostic features in patients with resected ...pathological stage I adenocarcinoma.
Methods
We examined 224 patients with surgically resected lung adenocarcinoma and analyzed the prognostic and predictive value of these mutations in 162 patients with pathological stage I adenocarcinoma.
Results
Mutations of the EGFR and K‐ras genes were detected in 100 (44.6%) and 19 (8.5%) of all tumors, and in 81 (50.0%) and 17 (10.5%) of the pathological stage I tumors, respectively. EGFR mutations were significantly associated with female gender, smoking habit (never smoker), and low grade. By contrast, K‐ras mutations were significantly associated with male gender, smoking habit (ever smoker), and the presence of mucinous components. No significant differences were observed in recurrence‐free or overall survival between the EGFR‐mutant, K‐ras‐mutant, and wild‐type groups (five‐year recurrence‐free survival 77.8% vs. 87.8% vs. 79.5%; five‐year overall survival 82.8% vs. 82.4% vs. 79.2%, respectively). Multivariate analysis showed that neither EGFR nor K‐ras mutation was an independent prognostic factor.
Conclusions
The present study demonstrated that pathological stage I adenocarcinoma harboring EGFR and K‐ras gene mutations have distinct clinicopathological features. The presence of these mutations alone were not prognostic factors in patients with resected pathological stage I adenocarcinoma.
Here, cases of a 68‐ (Case 1) and a 44‐year‐old (Case 2) female are presented. They had an abnormality in the breast, and came to our hospital for further examination and treatment. Radiologically, ...malignancy could not completely excluded so breast excision was performed. Histologically, both cases revealed papillary neoplastic lesions lined by fibrovascular core and nuclear inverse polarity without atypia. Loss of myoepithelial cells was observed by HE, p63, and calponin. Previous report indicate CK5/6, ER, p63 and MUC3 are important for distinguishing between papillary lesions according to the differential index (based on Allred score) of (ER total score + MUC3 total score)/(CK5/6 total score + p63 total score + 1). Based on this analysis, our two cases had benign lesions. However, based on immunopositivity for cell‐cycle marker Cyclin‐D1, Case 1 was negative, and Case 2 was about 70% positive. Additionally, the Ki‐67 index was <1% in both cases, and no evidence of disease was observed after a maximum 62 months of follow‐up in both cases, despite lack of additional treatment. Thus, we propose that lack of myoepithelial cells in papillary lesions do not necessarily indicate malignancy and are thought to be, at the most, uncertain malignant potential.
We report a rare case of classic pulmonary blastema (CPB) without recurrence for 3 years after the operation. A 70-year-old man presented with cough and sputum for a month. Chest computed tomography ...(CT) showed a 5cm-sized mass in the right middle lobe. Bronchoscopic examination was performed, and the mass was suspected as adenocarcinoma of the lung. Right middle lobectomy and lymph node dissection were performed. The pathologic histology diagnosis was classic pulmonary blastoma, a subtype of biphasic pulmonary blastoma.
Background
Lymph nodes in patients with non-small cell lung cancer (NSCLC) are often staged using integrated 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT). ...However, this modality has limited ability to detect micrometastases. We aimed to define risk factors for occult lymph node metastasis in patients with clinical stage I NSCLC diagnosed by preoperative integrated FDG-PET/CT.
Methods
We retrospectively reviewed the records of 246 patients diagnosed with clinical stage I NSCLC based on integrated FDG-PET/CT between April 2007 and May 2015. All patients were treated by complete surgical resection. The prevalence of occult lymph node metastasis in patients with clinical stage I NSCLC was analysed according to clinicopathological factors. Risk factors for occult lymph node metastasis were defined using univariate and multivariate analyses.
Results
Occult lymph node metastasis was detected in 31 patients (12.6 %). Univariate analysis revealed CEA (
P
= 0.04), SUV
max
of the primary tumour (
P
= 0.031), adenocarcinoma (
P
= 0.023), tumour size (
P
= 0.002) and pleural invasion (
P
= 0.046) as significant predictors of occult lymph node metastasis. Multivariate analysis selected SUV
max
of the primary tumour (
P
= 0.049), adenocarcinoma (
P
= 0.003) and tumour size (
P
= 0.019) as independent predictors of occult lymph node metastasis.
Conclusions
The SUV
max
of the primary tumour, adenocarcinoma and tumour size were risk factors for occult lymph node metastasis in patients with NSCLC diagnosed as clinical stage I by preoperative integrated FDG-PET/CT. These findings would be helpful in selecting candidates for mediastinoscopy or endobronchial ultrasound-guided transbronchial needle aspiration.
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