Primary Pulmonary Carcinoma Research Articles

Combined one-stage minimally invasive surgery for primary pulmonary carcinoma and mitral regurgitation

BackgroundWe report the first successful short-term outcome of one-stage minimally invasive surgery (MIS) mitral valve repair and video-assisted thoracoscopic surgery (VATS) lobectomy.Case presentationWe report the first successful short-term outcome of combined one-stage video-assisted thoracoscopic surgery lobectomy and minimally invasive surgery in a patient with operable primary right upper lobe adenocarcinoma and mitral regurgitation. Post- operative recovery was uneventful, and follow-up at 6 weeks confirmed an excellent surgical and oncologic outcome.ConclusionsWe think one-stage minimally invasive surgery (MIS) cardiac surgery and video-assisted thoracoscopic surgery (VATS) lobectomy would benefit patients with satisfactory cardiac and pulmonary function.

A case of resected primary pulmonary pleomorphic carcinoma with long-term survival after multidisciplinary treatment

BackgroundGenerally, primary pulmonary pleomorphic carcinoma is resistant to treatment and has a poor prognosis. We report a case of resected primary pulmonary pleomorphic carcinoma with long-term survival after multidisciplinary treatment.Case presentationA 74-year-old man with a history of emphysema, pneumoconiosis, and chronic bronchitis presented with left lung nodule and left adrenal tumor based on computed tomography. We suspected clinical T1bN0M1b, stage IVB lung cancer. Adrenalectomy of the left adrenal tumor yielded a definitive diagnosis of pleomorphic carcinoma. Chemotherapy was performed despite the spontaneous regression of lung lesions. Since lung lesions re-enlarged 11 months after adrenalectomy, the left lower lobe was partially resected followed by chemotherapy. The lung lesion was the primary lesion of the adrenal tumor. There was no recurrence 100 months after the lung resection.ConclusionsThe patient experienced long-term survival after multidisciplinary treatment. Both multidisciplinary treatment and immunological mechanisms caused spontaneous regression of the primary lesion.

EP1.18-15 Surgical Results of Primary Mucoepidermoid Carcinoma of Lungs: A 9 Years' Experience

Pulmonary mucoepidermoid carcinoma is a rare salivary-gland type lung cancer and accounts for 0.1%–0.2% of all primary lung malignancies. The optimal treatment of pulmonary mucoepidermoid carcinoma is not well determined. The aim of this study was to examine the surgical outcomes for the pulmonary mucoepidermoid carcinoma in our institution. From January 2010 to December 2018, we performed a retrospective review including all patients with primary pulmonary mucoepidermoid carcinoma of lung who underwent pulmonary resections in our institutions. The patients’demographic, clinical, and survival data were analyzed. A total of 3124 primary lung cancer patients underwent surgical resections by the same surgical team during the 8-year study period. 8 cases (0.25%) patients who were diagnosed with primary mucoepidermoid carcinoma of the lung were analyzed in this study. The patients’ characteristics are shown in Table 1. The median age of all patients was 57 year-old (range: 22-75 year-old). Cough is the most common symptom (5 cases, 62.5%). 7 cases had a low-grade tumor, and all the cases were completely resected thoracoscopically. Two cases were resected by wedge resection because peripherally located, and two cases required bronchial reconstruction. There was no adverse effect after the operation. One case recived adjuvent chemotherapy due to nodal invasion. However, this case had disease progression with patella bone metastasis 5 months after opeartion. The other cases were free of malignancy with a median follow-up of 27.2 months. Complete surgical resection of a mucoepidermoid carcinoma of lungs can be atributed to a long-term survival in patients. For an elederly patient with a peripherally located tumor, wedge rsection with mediastinal lymphnode dissection could be an alternative treatment.

EP1.17-28 Electromagnetic Navigation-Guided Preoperative Localization for Small Malignant Pulmonary Tumors

Surgical removal of non-visible, non-palpable small pulmonary nodules is sometimes challenging during video-assisted thoracoscopic surgery (VATS) and preoperative nodule localization is of paramount importance for precise resection. We reported our experience of preoperative localization using the SPiN thoracic electromagnetic navigation system. The inclusion criteria include: 1. Patients with highly suspicious malignant pulmonary nodules according to persistent or progressive nature on follow-up CT scans, or history of extrathoracic malignancy. 2. Target nodule size less than two centimeters. 3. Presumed to be non-visible and non-palpable during VATS according to surgeon`s judgement. 4. Patients who received electromagnetic navigation for preoperative localization. As the SPiN system allows for both transbronchial (endobronchial) and transthoracic (percutaneous) routes, the optimal approach was decided according to the location of target nodule.The preoperative localization and thoracoscopic resection were performed in the same operation room by the same team. The successful localization was defined as successful identification of target tumors during VATS procedure without palpation. From Jun 2018 to March 2019, a total of 30 patients with 35 nodules were included. Thirty-one percutaneous and five endobronchial approaches were performed. One patient received both approaches for the same tumor. Three patients received both percutaneous and endobronchial approaches for multiple targets localization. The mean nodule size was 9.6 ±3.5 mm. The materials used for marking included dye (n = 18), micorcoil (n = 4), indocyanine green (ICG, n = 2), microcoil + dye (n = 8), and microcoil + ICG (n = 3). There was no localization-related adverse event. Successful localization was achieved in 27 of 30 (90.0%) patients and 32 of 33 35 (91.4%) nodules. In three patients, localization failed as dye extravasation in the pleural cavity without any stains in the subpleural parenchyma. The pathological diagnosis included metastatic tumors (n = 6), primary pulmonary squamous cell carcinoma (n = 2), and primary pulmonary adenocarcinoma (invasive adenocarcinoma, n = 9; minimally invasive adenocarcinoma, n = 12; adenocarcinoma in situ, n = 6). We reported our experience of electromagnetic navigation-guided transbronchial and transthoracicpreoperative localization for small malignant pulmonary tumors. Lessons from failed cases were learned and localization techniques were modified to improve successful localization rate.

Pulmonary Carcinoma Metastasis in a Feline Digit

Background: Primary pulmonary neoplasia is rare in domestic cats, with fewer than 1% of all tumors diagnosed in this species. Primary lung tumors have a high percentage of metastases, observed in up to 75% of cases in cats. The lung-digit syndrome is characterized by primary pulmonary neoplasms with metastases to the extremities of the limbs, mainly distal phalanges, possibly involving several digits and more than one limb. This report describes a case of pulmonary carcinoma metastasis in a cat digit.Case: A 16-year-old neutered female cat was showing increased volume of the fourth digit was examined at the University of Caxias do Sul veterinary clinic. The animal also showed signs of progressive weight loss, apathy and limping on the right thoracic limb. After clinical evaluation, the animal was sent for radiographic examination of the right metacarpal/phalangeal region and the thorax. A radiopaque structure was observed with discreet central regions of radiolucency, measuring approximately 3 cm in height, 3.4 cm in length and 2.4 cm in depth in the left caudal lung, suggesting neoplasia or pulmonary abscess. Digit image revealed osteolysis of the right and middle distal phalanx measuring 2 cm in height, 3 cm in breadth and 1 cm in length. In view of these radiographic changes, we performed fine needle aspiration cytology of the digit and a nodule in the region of the skeletal musculature of the right thoracic limb. Cytological evaluation revealed cells had cilia on their surface (compatible with respiratory epithelium). The cytologic findings of the fine-needle biopsy were suggestive of carcinoma. After stabilization, the digit was amputated. The material was sent to the laboratory of the Federal University of Pelotas for histopathological examination. Histological evaluation of a digital pulmonary carcinoma metastasis was confirmed. In view of the prognosis and clinical evolution of the disease, the caretaker chose euthanasia. Necropsy and histopathological evaluation of the lung and other organs were not authorized.Discussion: According to the literature, primary lung tumors have a high percentage of metastases, observed in up to 75% of cases in felines.The size of the tumor mass is associated with its metastatic potential, and lung tumors smaller than 1 cm in diameter usually do not present metastases.In the present case, the mass in the lung was greater than 1 cm in size and the animal already presented metastasis in the digit and in the skeletal musculature. In addition to the thoracic cavity, sites where metastases from lung tumors may occur include regional lymph nodes, skin, eyes, skeletal muscle, multiple abdominal organs, and digits. Cats with pulmonary carcinoma and digital metastasis have a median survival 67 days after diagnosis, with intervals of 6 to 122 days reported. Most patients are euthanized due to persistent symptoms of lameness, lethargy and anorexia or evolution of respiratory signs, in addition to the short survival time associated with poor quality of life. In the case reported here, euthanasia was performed after 40 days of diagnosis due to the worsening of the animal's clinical condition.The combination of radiographic, cytological and histopathological findings suggested a primary lung tumor with digit metastasis, also known as lung-digit syndrome. For felines with claudication or digital inflammation, the lung-digit syndrome should be included in differential diagnosis, even if the animal does not present clinical signs associated with the respiratory system. Primary pulmonary carcinoma should be considered in any middle-aged to elderly cat with digital disease.

Surgical Management of Primary Pulmonary Mucoepidermoid Carcinoma of the Proximal Left Mainstem Bronchus

A 29-year-old non-smoking female with a history of recurrent AML presented with worsening dyspnea. A CT scan revealed an 8 X 7 mm polypoid soft tissue nodule 8 mm distal to the carina in the left mainstem bronchus. She was brought to the operating room and a nearly obstructing soft fleshy tumor in the left mainstem bronchus just distal to the carina was removed with bronchoscopy. Pathology revealed a low grade mucoepidermoid carcinoma 0.8 cm in largest dimension with negative margins. The patient returned for a resection and was intubated with a right mainstem double lumen tube and placed in left lateral decubitus. After posterolateral thoracotomy, the azygos vein was divided to mobilize the esophagus and retract it laterally. Level 4 and 7 lymph node dissection were performed to obtain access to the anterior tracheal and subcarinal spaces. There was minimal dissection lateral to the trachea to minimize risk of ischemia. One centimeter of trachea just proximal to the carina was circumferentially isolated with umbilical tape for retraction. We bronchoscopically confirmed the location for transection and advanced a jet ventilator catheter distally. We resected one centimeter of left mainstem bronchus. We inspected the lumen of the airway to confirm no gross residual disease and confirmed negative pathologic margin before performing an end-to-end anastomosis with interrupted absorbable sutures under both jet and cross-table ventilation. Postoperatively, the patient had an uncomplicated course and was discharged without any supplemental oxygen on postoperative day 6. Final pathology was low grade mucoepidermoid carcinoma, T1aN0.

Primary Pulmonary Acinic Cell Carcinoma: A Clinicopathological Study of 6 Cases and Literature Review.

Primary pulmonary acinic cell carcinoma (ACC) is rare. The clinicopathological features are not identical to that of classic ACC that leads to misdiagnosis. In this article, we summarized the clinicopathological features of 25 such cases, including 6 cases in this series and additional 19 cases in the literature. Pulmonary ACCs showed an overwhelming solid growth pattern. The neoplastic cells had eosinophilic granular and clear cytoplasm in most cases and displayed basophilic cytoplasm in only 4 cases. Intratumoral fibrous septa, mitotic figure, necrosis, and psammoma bodies were observed in some cases. Prominent nuclear atypia and perineural invasion might suggest high-grade transformation, metastasis, and recurrence. The tumor cells were strongly positive for CK8/18 and negative for TTF-1, p63, S-100, mammaglobin, MUC5b, MUC5ac, and DOG1. CK7 was exclusively positive for neoplastic cells with ductal differentiation. Of the 25 included cases, 10 cases were initially misdiagnosed. The tumor was prone to involve the right bronchus. The patient outcome was favorable. The accurate diagnosis of primary pulmonary ACC relies on comprehensive evaluation of histological and immunohistochemical features and realization of the difference from classic ACC.

Clinicopathological features and prognostic factors of primary pulmonary adenoid cystic carcinoma: a study of 59 cases

Objective: To investigate the clinicopathological features and prognostic indicators of primary pulmonary adenoid cystic carcinoma. Methods: Fifty-nine cases of primary pulmonary adenoid cystic carcinoma were collected from August 2011 to December 2017 at the First Affiliated Hospital of Zhengzhou University. All cases were retrospectively studied by hematoxylin-eosin staining and immunohistochemistry. The clinicopathological features were reviewed and patient survival analysis was performed using Kaplan-Meier method and Cox regression model. Status of epidermal growth factor receptor (EGFR), KRAS, BRAF genes was analyzed in 15 of the 59 study cases. Results: Among 59 cases, there were 25 males and 34 females with male to female ratio of 1.0 to 1.4. The patient age ranged from 29 to 81 years with a mean age of 55 years. The tumor max diameters ranged from 1.0 to 9.6 cm with an average diameter of 2.8 cm. Fifteen (25.4%) patients were smokers while 44 patients (74.6%) were non-smokers. Tumors predominantly occurred in the trachea (28/59,47.5%), the left main bronchus (7/59,11.9%) and the right bronchus (5/59,8.5%). Grossly, the tumors were well circumscribed, greyish-white nodules. Microscopically the tumor cells were small and uniform, and arranged in tubular, cribriform, and solid patterns. Immunohistochemistry showed that the tumor cells were positive for CK7, S-100 protein, Sox-10, CD117 and p63. TTF1 was only positive in 2 cases and Ki-67 index ranged from 3% to 40%. Eighteen cases (30.5%) were gradeⅠ, 26 cases (40.1%) grade Ⅱ, and 15 cases (25.4%) grade Ⅲ. Overall, 39 cases (66.1%), 7 cases (11.9%), 10 cases (16.9%), and 3 cases (5.1%) were at stages Ⅰ, Ⅱ, Ⅲ, and Ⅳ, respectively. Twenty-three patients (39.0%) received surgical therapy, 3 patients (5.1%) surgery combined with radiotherapy, 9 patients (15.2%) surgery combined with chemotherapy, and 24 cases (40.7%) chemotherapy only. No mutation of EGFR, KRAS and BRAF was detected in all 15 tested cases. The overall survival rate at the first, third and fifth years was 94.9%, 86.4% and 84.7%, respectively. Prognostic analysis showed that patient's age and tumor size were statistically associated with the survival (P<0.05). Conclusions: Majority of the patients with primary pulmonary adenoid cystic carcinoma are at an early clinical stage with a favorable prognosis. The size of the tumor and the age of the patients are independent prognostic indicators.

Perioperative change in neutrophil-to-lymphocyte ratio (NLR) is a prognostic factor in patients with completely resected primary pulmonary sarcomatoid carcinoma.

There has been controversy regarding prognostic factors for surgically resected primary pulmonary sarcomatoid carcinoma (PSC). Recently, several studies have shown that neutrophil-to-lymphocyte ratio (NLR) was a prognostic factor for various types of cancers from multiple organs. Therefore, we performed this study to evaluate whether NLR is related to prognosis after complete surgical resection of primary PSC. From Oct. 2003 to Sep. 2015, a total of 50 patients underwent surgical resection for primary PSC. After excluding patients with any history of other malignancy and incompletely resected cases, a total of 37 patients were included, and data were retrospectively collected and analyzed. Change in postoperative NLR and the initial NLR (ΔNLR) was calculated from the perioperative complete blood count (CBC) results. Mean age of the cohort was 62.2±1.9 years, and 31 patients (83.8%) were male. Twenty patients (54.1%) were revealed as pN0. Overall 5-year survival rate was 50.3%. Seventeen patients (45.9%) had locoregional or distant metastases. Univariate survival analysis revealed age >70, ΔNLR >17 as risk factors for overall survival (P=0.009, 0.005) and disease-free survival (P=0.036, 0.018). Multivariate Cox-regression analysis revealed age >70 and ΔNLR >17 as independent risk factors for overall survival and ΔNLR >17 as the only independent risk factor for the disease-free survival. In patients with completely resected primary PSC, perioperative ΔNLR had a significant effect on the overall survival and disease-free survival. Older age was also an independent risk factor for overall survival.

Diagnostic and prognostic implications of MAML2 gene translocation in primary pulmonary mucoepidermoid carcinoma

Objective: To investigate MAML2 gene-translocation in primary pulmonary mucoepidermoid carcinoma (PMEC) and pulmanary adenosquamous carcinoma, and the optimal diagnostic immunohistiochemical (IHC) panel in distinguishing PMEC from adenosqumous carcinoma. Methods: Twenty-four cases of PMEC and 44 adenosqumous carcinoma diagnosed in the Guangdong General Hospital were tested for MAML2 translocation by fluorescent in-situ hybridization (FISH) using tissue array. An IHC panel including TTF1, Napsin A, CK5/6, p63, p40 and Ki-67 was performed on the cohort. The clinical data for all cases were collected and all PMEC patients had follow-up information. Results: The patients' age ranged form 6 to 73 years, with a median age of 32 years. The male to female ratio was 1.4∶1.0. MAML2 translocation was found in 16/24 (66.7%) cases of PMEC whereas all 44 cases adenosqumous carcinoma were negative for translocation. All the cases of the PMEC were negative for TTF1 and Napsin A but positive for CK5/6, p63 and p40 in the intermediate cells and epidermal-like cells. In most PMEC cases, the Ki-67 expression index was lower than 10%. In contrast, most cases of adenosqumous carcinomas expressed TTF1 and Napsin A in the adenomatous component and CK5/6, p63 and p40 in the squamous component, which expression pattern was different from that of PMEC. Based on IHC staining, 2 cases of highly invasive ALK-positive adenocarcinoma mimicing PMEC were also found in the study. Conclusions: MAML2 gene translocation can be detected in about two-third of PMEC. Translocation of MAML2 gene and lower morphology grading are associated with good prognosis. The combined use of IHC antibodies panel is helpful to distinguish PMEC from the adenosqumous carcinoma and adenocarcinoma mimicing PMEC.

CT features and differential diagnosis of primary pulmonary mucoepidermoid carcinoma and pulmonary adenoid cystic carcinoma.

The differential diagnosis of primary pulmonary mucoepidermoid carcinoma (PMEC) and pulmonary adenoid cystic carcinoma (PACC) is difficult, because both tumors could be similar in terms of certain characteristics on CT. The CT findings from 24 cases of PMEC and 30 cases of PACC were retrospectively analyzed. According to the position of the lesion in airway, we divided these cases into three types: central, hilar, and peripheral. In PMEC, there were 7 cases of central type, 14 cases of hilar type, and 3 cases of peripheral type. And, 57.1% PMEC cases of the hilar type were accompanied by distal bronchial dilatation with mucoid impaction. Patchy areas of low density were observed in 79.2% cases of PMEC. The solid part of most lesions showed moderate (37.5%) or severe enhancement (45.8%). However, in PACC, there were 24 cases of central type, 3 cases of hilar type, and 3 cases of peripheral type. PACC had more cases of central type than PMEC. Moreover, longitudinal extent greater than 3 cm was observed in 62.5% PACC cases of the central type, while infiltration of the luminal perimeter more than 1/2 perimeter was observed in 95.8% PACC cases of the central type. Patchy areas of low density were observed in 26.7% cases of PMEC. In PACC cases, the solid part of 76.7% lesions showed slight enhancement. Cavities could be observed in PMEC, but not in PACC. PMEC and PACC have different CT features in various airway locations. PMEC is usually the hilar type, accompanied by distal bronchial dilatation with mucoid impaction. However, PACC is usually the central type, with longitudinal extent greater than 3 cm and infiltration of the luminal wall more than 1/2 perimeter. Patchy areas of low density and moderate or severe enhancement are more prominent in PMEC. However, slight enhancement is more common in PACC.

MUCOEPIDERMOID CARCINOMA: A RARE MALIGNANCY TREATED ENDOBRONCHIALLY

SESSION TITLE: Procedures SESSION TYPE: Fellow Case Reports PRESENTED ON: 10/10/2018 10:45 AM - 11:45 AM INTRODUCTION: Pulmonary mucoepidermoid carcinomas are quite rare. CASE PRESENTATION: A 22 y/o male with no significant PMH presented with chronic cough, wheezing and left sided chest pain. He described the wheezing as more of a whistling noise. He denied unintentional weight loss, night sweats or hemoptysis. He was never a smoker. On physical exam he had wheezing localized to the left upper lung regions. CXR was unremarkable but Chest CT revealed a 10.7mm endobronchial lesion in the left mainstem bronchus. He underwent bronchoscopy which showed a large, polypoid endobronchial mass obstructing the LUL orifice. Biopsy of this mass returned as low grade pulmonary mucoepidermoid carcinoma. A surgical consult recommended LUL lobectomy. He sought pulmonology evaluation for possible endobronchial management. The patient underwent successful bronchoscopic removal of this endobronchial mass using a hot snare. The base of the tumor was treated with cryotherapy. After bronchoscopy he had significant improvement in his symptoms and has remained very active. The patient has been monitored with surveillance bronchoscopies and chest CTs for 6 years, all negative for recurrent disease. DISCUSSION: Mucoepidermoid carcinoma (MEC) is the most common type of primary pulmonary salivary gland tumor, but it still only accounts for 0.1-0.2% of all lung tumors.1 This tumor is primarily seen in patients under the age of 30, but can occur at almost any age.1 It is seen equally in males and females.1 Most develop endobronchially in more central airways with no real predilection for specific lobes.2,3 Patients usually present with symptoms of large airway obstruction such as: cough, wheezing, hemoptysis, recurrent bronchitis and post-obstructive pneumonia.1,3 Chest imaging often shows a pulmonary nodule or mass with possible post-obstructive changes.1,3 Histologically, MECs usually consist of three main cell types: mucin-secreting, squamous and intermediate cells.3 MECs are divided into low and high-grade tumors. Low-grade MECs are mostly confined to the bronchus and rarely metastasize. High-grade MECs are aggressive and have a tendency for local invasion and early metastasis.3 Bronchoscopy with inspection and biopsy is helpful in diagnosing MEC.3 Standard treatment of this tumor is complete surgical resection with lymph node evaluation, especially for high grade MECs.2,3 Bronchoscopic management is a potential alternative treatment for low-grade MECs with no evidence of metastasis.3 CONCLUSIONS: Historically, cases of mucoepidermoid carcinoma are treated with complete surgical resection. Bronchoscopic management of this tumor is a potentially viable treatment option. This method can provide rapid improvement in symptoms, preservation of pulmonary function and can be repeated, if necessary.3 Our case illustrates that this method of treatment may be a safe option for patients with low-grade MEC. Reference #1: Horst M, Dekker M, Braak S. Mucoepidermoid carcinoma of the airways in a young adult male. Journal of Radiology Case Reports. 2017;11(2):8-15. https://doi.org/10.3941/jrcr.v11i2.3061. Reference #2: Li X, et al. “Clinicopathological Characteristics and Molecular Analysis of Primary Pulmonary Mucoepidermoid Carcinoma: Case Report and Literature Review.” Thoracic Cancer, vol. 9, no. 2, 2017, pp. 316-323., https://doi.org/10.1111/1759-7714.12565. Reference #3: Zhang J, et al. “Interventional Bronchoscopic Therapy in Adult Patients with Tracheobronchial Mucoepidermoid Carcinoma.” Chinese Medical Journal, vol. 130, no. 20, 2017, p. 2453., https://doi.org/10.4103/0366-6999.216417. DISCLOSURES: No relevant relationships by Raed Alalawi, source=Web Response No relevant relationships by Audra Schwalk, source=Web Response

Thoracoscopic Right Middle Lung Lobectomy in a Maltese Dog with Primary Pulmonary Bronchoalveolar Carcinoma

Thoracoscopic Right Middle Lung Lobectomy in a Maltese Dog with Primary Pulmonary Bronchoalveolar Carcinoma

ALK-rearrangement neuroendocrine carcinoma of the lung: a comprehensive study of a rare case series and review of literature.

Driver mutations involving tyrosine kinase receptors play crucial roles in the oncogenesis of lung adenocarcinoma. However, receptor tyrosine kinase mutations are extremely rare events in primary pulmonary neuroendocrine carcinoma (NEC), which is a molecular heterogeneous entity. In this study, we examined 4 cases of NEC with anaplastic lymphoma kinase (ALK) rearrangement between 2008 and 2018 at our hospital. We comprehensively analyzed the carcinomas’ clinicopathological features, genetic alterations, and response to ALK inhibitor. One case of atypical carcinoid tumor and 1 case of large cell NEC (LCNEC) achieved response to ALK inhibitor (crizotinib) treatment. One case of combined LCNEC with adenocarcinoma harboring KLC1-ALK (K9:A20) fusion genes was confirmed by NGS of both components, while only the LCNEC component presented RB1 mutation. Notably, tumor cells of different components exhibited different ALK-positive signal patterns by fluorescence in situ hybridization, which revealed isolated 3′ signals in the adenocarcinoma component but split signals in the LCNEC. As the largest case series study, our findings suggested that preliminary screening for ALK rearrangement should also be considered in atypical carcinoid and high-grade NEC. Patients with ALK rearrangement-positive NEC would benefit from ALK inhibitor intervention.

Survival analysis of dogs with advanced primary lung carcinoma treated by metronomic cyclophosphamide, piroxicam and thalidomide.

Unresectable or metastatic (advanced) primary pulmonary carcinoma (PPC) represents a therapeutic challenge where surgery may be contraindicated and the therapeutic role of maximum-tolerated dose (MTD) chemotherapy remains uncertain. This study was undertaken to explore the impact of metronomic chemotherapy (MC) in dogs with advanced PPC. Previously untreated dogs with advanced (T3 or N1 or M1) PPC, with complete staging work-up and follow-up data, receiving MC (comprising low-dose cyclophosphamide, piroxicam and thalidomide), surgery, MTD chemotherapy or no oncologic treatment were eligible for inclusion. For all patients, time to progression (TTP) and survival time (ST) were evaluated. Quality-of-life (QoL) was only evaluated in patients receiving MC. To assess QoL, owners of dogs receiving MC were asked to complete a questionnaire before and during treatment. Ninety-one dogs were included: 25 received MC, 36 were treated with surgery, 11 with MTD chemotherapy and 19 received no treatment. QoL was improved in dogs receiving MC. Median TTP was significantly longer in patients receiving MC (172 days) than patients undergoing surgery (87 days), receiving MTD chemotherapy (22 days), or no oncologic treatment (20 days). Median ST was similarly longer in patients receiving MC (139 days) than those undergoing surgery (92 days), MTD chemotherapy (61 days) and no oncologic treatment (60 days). In dogs with advanced PPC, MC achieved a measurable clinical benefit without significant risk or toxicity. This makes MC a potential alternative to other recognized management approaches.

Pulmonary Basaloid Squamous Cell Carcinoma in a Dog

A 9-year-old neutered male crossbred dog with a 4-week history of progressive vestibulocerebellar signs was presented for necropsy examination. Gross examination revealed neoplastic growth in the lungs, thoracic lymph nodes, left kidney and cerebellum. Microscopically, the tumour consisted of an infiltrative, densely cellular, basaloid epithelial neoplastic growth with extensive areas of abrupt keratinization. Immunohistochemically, neoplastic cells expressed p63 and partially expressed cytokeratins 5/6. Based on these findings, the tumour was diagnosed as a primary pulmonary basaloid squamous cell carcinoma (BSSC) with metastasis to regional lymph nodes, kidney and brain. As far as the authors are aware, this is the first description of BSCC in an animal species.

Adverse prognostic value of PD-L1 expression in primary resected pulmonary squamous cell carcinomas and paired mediastinal lymph node metastases

Immunohistochemical assessment of programmed cell death (PD)-ligand 1 (PD-L1) expression in lung cancer in the context of therapeutically targeting the PD1/PD-L1 axis is still controversially discussed. This includes the comparability of antibody clones, prognostic value, and discrepancies between primary tumors and metastases. We assessed tumoral PD-L1 expression using clones E1L3N and SP142 in 372 primary resected pulmonary squamous cell carcinomas, including 40 paired N2 lymph node metastases, in relation with clinico-pathological parameters. PD-L1 expression was negative (<1%) in 163/372 (44%, E1L3N) or 231/370 patients (62%, SP142). Positivity of 1–<50% was observed in 135 (36%, E1L3N) or 92 patients (25%, SP142) and ≥50% in 74 (20%, E1L3N) or 47 patients (13%, SP142). PD-L1 staining correlated significantly between both antibodies (r=0.781; P<0.001). Scores correlated significantly between full-slide sections (N=40) and tissue microarrays, and between primaries and N2 metastases (P<0.001 all). CD8+ tumor infiltrating lymphocyte counts positively correlated with PD-L1 expression (P<0.001). PD-L1 ≥50% showed the best prognostic discrimination using the split-sample validation method. It was associated with shorter disease-specific survival in the observation group (E1L3N: P=0.035, SP142: P=0.002) and validation group (E1L3N: P=0.024, SP142: P=0.101) and shorter time to recurrence (observation group: E1L3N: P=0.056, SP142: P<0.001; validation group: E1L3N: P=0.036, SP142: P=0.247). Multivariate analysis showed that PD-L1 expression ≥50% determined by clone E1L3N was an independent prognostic factor in the observation group regarding disease-specific survival (HR=2.768; 95% CI=1.149–6.666; P=0.023) and time to recurrence (HR=2.164; 95% CI=1.056–4.436; P=0.035) and in the validation group (disease-specific survival: HR=1.978; 95% CI=0.928–4.214; P=0.077 and time to recurrence: HR=1.571; 95% CI=0.838–2.944; P=0.159). High PD-L1 expression was associated with adverse prognosis in pulmonary squamous cell carcinoma. Clone E1L3N was more sensitive than SP142 and superior regarding prognostication. PD-L1 expression correlated significantly between primary tumor and N2 metastases, rendering mediastinal lymph node metastases adequate for immunohistochemical assessment.

Primary pulmonary spindle cell carcinoma in a young nonsmoker patient

Spindle cell carcinoma (SCC) is a very rare type of tumor. Very few case reports of primary pulmonary SCC have been reported in the literature. It is a type of sarcomatoid carcinoma with very poor prognosis. It is usually seen in patients in the age group of 50–80 years. Exact etiology is unknown till now. We report a rare case of primary pulmonary SCC in a young nonsmoker patient who presented in a very advanced stage.

肺原発上皮筋上皮癌の一切除例

58歳，男性．健診の胸部Xpにて左下肺野に結節影を指摘された．胸部CTにて左S8に20 mm大の充実性陰影を認めた．気管支鏡ではB8b入口部に表面平滑な腫瘤を視認でき，同部からの生検では唾液腺型の腫瘍と診断された．手術は胸腔鏡下左下葉切除術を行った．切除標本では，腫瘍径は27×18 mm，境界明瞭，白色充実性で気管支壁に浸潤し，一部は内腔へ突出していた．組織学的には，淡明な胞体をもつ異型細胞が，小管状構造，胞巣状構造を密に形成し，周囲圧排性に増殖していた．管腔内腔には好酸性の腺上皮も見られ，筋上皮・腺上皮の2相性の増殖が確認された．免疫染色では，多くの腺上皮でサイトケラチンAE1/AE3が陽性，多くの筋上皮でp63陽性，一部の筋上皮でSMAおよびS-100陽性であった．以上から上皮筋上皮癌と診断された．術後経過は良好で，術後第14病日に退院した．術後1年が経過したが再発は認めていない．

Correction to: Abstracts : 29th European Congress of Pathology.

In Oral Free Paper Sessions, the first-author name was missing from the authorship group originally listed for Abstract OFP-04-012 (page S14), entitled "Differentiating primary pulmonary squamous cell carcinoma from squamous cell carcinoma of the cervix metastatic to the lung: Histological and immunohistochemistry study".