Resection Of Pulmonary Adenocarcinoma Research Articles

Impact of free tumor clusters on prognosis after resection of pulmonary adenocarcinoma

ObjectivePulmonary adenocarcinoma with a micropapillary component (MPC) has aggressive malignant behavior even if resectable. The aim of this study was to determine clinicopathologic features of patients who underwent surgery for pulmonary adenocarcinoma harboring MPCs, with particular focus on coexistent free tumor clusters (FTCs). MethodsWe retrospectively reviewed 444 patients with pulmonary adenocarcinoma who underwent surgery from March 2007 to July 2013. An MPC was defined as a >5% micropapillary pattern. We also defined FTCs to be a group of more than 3 small clusters containing <20 nonintegrated micropapillary tumor cells that were spreading within air spaces, >3 mm apart from the main tumor. The clinicopathologic characteristics of patients with and without FTCs were retrospectively investigated in MPC-positive patients. ResultsMPCs were identified in 67 patients (15.1%), 31 of whom (46.3%) were positive for FTCs. The distance between the furthest edge of FTCs and main tumors did not exceed the diameter of the main tumor in each case (average, 7.3 mm). Locoregional recurrences were frequently observed in FTC-positive patients. FTC-positive patients experienced a significantly lower 5-year recurrence-free survival rate compared with FTC-negative/MPC-positive patients (20.4% vs 52.2%, P < .001). Recurrence-free survival of FTC-negative and -positive patients was equivalent to that of patients with p-T2 and p-T3 MPC-negative adenocarcinoma, respectively. ConclusionsCoexistence of FTCs resulted in a further negative impact on postoperative prognosis among MPC-positive adenocarcinomas and should be considered for upstaging the p-T factor and during evaluation of surgical margins.

Multiple Ground-Glass Opacities with Different Growth Rates in the Same Lobe of the Lung during the Follow-Up after the Resection of Pulmonary Adenocarcinoma: A Case Report

The patient, a 77-year-old male, underwent right middle lobectomy for adenocarcinoma of the lung, pT1aN0M0, in November 2007. In November 2008, chest CT revealed two ground-glass opacities (GGOs) in the right lower lobe. In October 2009, both of these GGOs had increased in size, and three new GGOs were found. In July 2011, all of the five GGOs had increased in size and three new GGOs were found yet again. Right lower lobe S6 segmentectomy was performed on September 6, 2011, and histopathological examination revealed eight pulmonary adenocarcinomas in the right S6; all of them classified as pl0, ly0, v0, pT1aN0M0. Among the eight lesions, the doubling times of five were measured during the follow-up course, and the mean doubling time was 402 days. The mean doubling time of the lesions showing high c-erbB2 expression was significantly lesser than that of the lesions showing low c-erbB2 expression (273 days vs. 488 days, p = 0.047). Despite being localized GGOs that had arisen in the same individual, it should be noted that the growth rate of the GGO lesions may vary according to the expression level of a molecular markers, and some GGO lesions may show rapid increase in size.

Malignant Pleural Effusions After Resection of Pulmonary Adenocarcinoma

To evaluate the clinicopathologic features of malignant pleural effusions secondary to pulmonary adenocarcinoma in patients who have undergone surgical resection of the primary tumor. Clinical, pathologic and cytologic material from 19 patients who developed malignant pleural effusions after resection of pulmonary adenocarcinoma was reviewed. Malignant effusions developed only in patients with either lymph node or pleural involvement by neoplasm. Time to development of the effusion after resection and overall survival correlated with histologic findings. Malignant effusions in patients who survived > 24 months were secondary to another primary tumor (either breast or a new pulmonary carcinoma). Malignant effusions developed significantly sooner after resection (mean 5.0 +/- 2.0 months, median 5) in patients with lymph nodal metastases than in those with pleural involvement by neoplasm (mean 11.2 +/- 2.5 months, median 12) (Student's t test P = .01, Mann-Whitney U test .04). Nevertheless, survival after resection for patients with lymph node involvement (mean 9.0 +/- 3.6 months, median 8) and those with pleural involvement (mean 12.3 +/- 2.5 months, median 12) was not significantly different. Malignant effusions developing in patients more than two years following resection of a pulmonary adenocarcinoma are likely to be secondary to another primary neoplasm. Lymph node and pleural involvement at the time of resection are risk factors for the development of a malignant effusion. Patients with lymph node involvement develop malignant effusions sooner than those with pleural involvement, but the overall survival is not significantly different.