[Resected pleomorphic carcinoma after long-time follow-up]

We report a case of surgical resection of a pulmonary pleomorphic carcinoma after 6 years follow-up. A 75-year-old male patient was referred to our department for an irregular shadow (32 x 17 mm) in the left upper lung lobe. Chest computed tomography (CT) conducted 6 years before showed an 8 x 5 mm nodule in the same location; after 3 years prior the nodule had a thin wall cavity, and 2 years ago a new nodule was observed within the cavity. The nodule and cavity had been growing gradually as shown by chest CT. The patient underwent wedge resection of the left lung without any adjuvant therapy because of poor physical condition due to right hemiplegia, old myocardial infarction, aortic stenosis, and a poor status after esophageal and colon cancer resection. Histopathology of the resected specimen revealed that the nodule contained a component with spindle cell features while the parenchymal side of the cavity was composed of bronchioalveolar carcinoma (BAC). Immunohistochemistry showed that the adenocarcinoma was positive for AE1/AE3 and thyroid transcription factor (TTF)-1, while the spindle cells were positive for AE1/AE3, with only a small portion being positive for TTF-1. The final diagnosis was pleomorphic carcinoma. His postoperative course has been uneventful over the 4 months since surgery.

Effects of kaempferol on the mechanisms of drug resistance in the human glioblastoma cell line T98G

Food contains components that may either increase or decrease the bioavailability of a drug. In particular, it is known that grapefruit juice and St. John's Wort induce drug interactions via an effect on the drug-metabolizing enzyme cytochrome P450 (CYP). However, interactions with membrane transporters, such as P-glycoprotein and multidrug resistance-related protein (MRP), may also influence drug bioavailability. The objective of the present study was to investigate the effects of kaempferol, a flavonoid present in food, on the cytotoxicity of anticancer drugs and the mechanisms of drug resistance in the human glioblastoma cell line T98G. Acute exposure to kaempferol inhibited the efflux of calcein, a substrate of MRP; however, chronic exposure caused no apparent effect on calcein efflux. The cytotoxicity of doxorubicin was not influenced by chronic exposure of cells to kaempferol, although that of cisplatin was significantly reduced. Multidrug resistance is often associated with increased levels of MRP1, glutathione S-transferase (GST) and activity by chronic exposure to kaempferol, although MRP2 protein levels are decreased. Accordingly, we hypothesized that the cytotoxicity of anticancer drugs that conjugate with glutathione and the substrate of MRPs may be influenced by long-term intake of drugs such as kaempferol, which are substrates of MRPs and GST.

Abstract 1926: Adoptive γδ T cell transfer therapy for non-small cell lung cancer

Human peripheral blood γδ T cells can recognize and kill tumor cells by their Vγ9Vδ2 T cell receptor and/or NKG2D. We have established large-scale ex vivo expansion of γδ T cells from peripheral blood mononuclear cells (PBMC) by zoledronate and IL-2. A clinical study of adoptive γδ T cell transfer therapy has been conducted for the treatment of non-small-cell lung cancer (NSCLC) patients to evaluate the safety profile and potential anti-tumor effects of γδ T cells. Prior to beginning the study, it was registered on a University hospital Medical Information Network Clinical Trials Registry (UMIN-CTR : http://www.umin.ac.jp/ctr/index.htm) on March 1, 2006 (UMIN ID: C00000036).

PBMC were isolated from 67.5 ml of peripheral blood and stimulated with zoledronateand IL-2 for 14 days to obtain γδ T cells. The cultured cells on day 14 consisted mostly of γδ T cells. The predominant populations in fresh peripheral blood were cells with the CD45RA−CD27+ memory phenotype or a CD45RA+CD27− naïve phenotype. In contrast, most γδ T cells were shown to have the CD45RA−CD27− effector memory phenotype after 14 days culture. They expressed NKG2D and up-regulated the expression of activation marker CD69, and had cytotoxicity against allogeneic tumor cell lines. Upon stimulation, γδ T cells produced IL-2, TNF-α and IFN-γ. Though certain patients were refractory to zoledronate stimulation, γδ T cells from patients demonstrated comparable cytotoxic effector activity once they were successfully expanded.

Cultured cells were intravenously administered every 2 weeks for 6 injections. Fifteen patients who were resistant to current standard therapy were enrolled this study. The treatment was well tolerated and no severe adverse events related to γδ T cell therapy were observed. Two patients came off the study at the early stage of the treatment due to the aspiration pneumonia (grade 3) and radiation pneumonitis (grade3). The responses according to RECIST guideline were SD for 7 patients, PD for 6 patients and 2 inevaluable for response due to early drop off the study (The disease control rate was 46.7 %).

Transferred γδ T cells gradually accumulated in peripheral blood in patients who received more than 1×109 γδ T cells per injection and accounted for 10 % of PBMC even 2 weeks after the final injection. When PBMC were stimulated with PMA/ionomycin or zoledronate-pulsed Daudi cells, IFN-γ production and surface expression of CD107 were detected on γδ T cells, suggesting that transferred γδ T cells sustained their effector function in vivo.

These results indicated that γδ T cell therapy was well tolerated and feasible for the treatment of NSCLC.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 1926.

Identification of G0S2 as a gene frequently methylated in squamous lung cancer by combination of in silico and experimental approaches

Epigenetic changes can lead to abnormal expression of genes in cancer, and several genes have been reported to have aberrant promoter DNA methylation in non-small-cell lung cancer (NSCLC). We identified aberrantly methylated genes in NSCLC by combination of in silico and experimental approaches. We first applied bioinformatics, and from microarray datasets, we selected genes with low expression and having functions related to cancer. Next, combined bisulfite restriction analysis was carried out in 10 pooled resected lung cancer tissues to screen for genes that were aberrantly methylated, and the methylation ratio (the fraction of methylated DNA in extracted DNA from a cancer tissue sample) was quantified using quantitative analysis of methylated alleles. We identified 8 methylated genes (ARPC1B, DNAH9, FLRT2, G0S2, IRS2, PKP1, SPOCK1 and UCHL1) previously unreported in NSCLC. Analyses of methylation profiles of 101 resected lung cancer tissue samples revealed quantitatively low methylation in whole, methylation ratios were almost less than 30% even in the methylated samples, and no significant correlation to prognosis after 2 years of follow-up using hierarchical clustering. DNA methylation of G0S2 gene was significantly more frequent in squamous lung cancer (n = 18, mean of methylation ratios: 15%) compared with nonsquamous lung cancer (n = 83, mean of methylation ratios: 2.6%) (Mann-Whitney U test, p < 0.001). DNA methylation of G0S2 can be an important biomarker for squamous lung cancer.

Life-threatening tracheal perforation secondary to descending necrotizing mediastinitis

Survival from destruction of the mediastinal structures secondary to descending necrotizing mediastinitis (DNM) is very rare. We present a successfully treated case of tracheal perforation secondary to DNM. A 34-year-old man with a history of type 1 diabetes mellitus, diagnosed as pharyngeal abscess and subsequent DNM affecting the anterior mediastinum and paratracheal space, was referred to our institute. The patient underwent cervico-mediastinal drainage for DNM. Nine days after the drainage operation, the membranous portion of the trachea perforated, resulting in life-threatening ventilation failure. The patient underwent closure of the fistula with the pedicled intercostal muscle flap under posterolateral thoracotomy with veno-venous extracorporeal membranous oxygenation support. Before complete recovery, open window thoracostomy was required to control residual air leak.

[Lung cancer operation in situs inversus totalis patient]

Situs inversus totalis represents a complete mirror image anatomy of the normal arrangement of the thoracic and abdominal viscera. This rare condition may pose possible surgical problems due to anatomical abnormality. There were few reports of surgical treatment for lung cancer patient with situs inversus totalis. In this case report, we describe a 74-year-old patient with situs inversus totalis and primary lung cancer who underwent successful left upper lobectomy and systemic lymph node dissection. For this rare condition, detail preoperative evaluation of mirror image anatomy with computed tomography and bronchofiber optic examination was thought to be a key to carry out safe operative procedure.

Empirical and theoretical challenges in aboveground-belowground ecology

A growing body of evidence shows that aboveground and belowground communities and processes are intrinsically linked, and that feedbacks between these subsystems have important implications for community structure and ecosystem functioning. Almost all studies on this topic have been carried out from an empirical perspective and in specific ecological settings or contexts. Belowground interactions operate at different spatial and temporal scales. Due to the relatively low mobility and high survival of organisms in the soil, plants have longer lasting legacy effects belowground than aboveground. Our current challenge is to understand how aboveground-belowground biotic interactions operate across spatial and temporal scales, and how they depend on, as well as influence, the abiotic environment. Because empirical capacities are too limited to explore all possible combinations of interactions and environmental settings, we explore where and how they can be supported by theoretical approaches to develop testable predictions and to generalise empirical results. We review four key areas where a combined aboveground-belowground approach offers perspectives for enhancing ecological understanding, namely succession, agro-ecosystems, biological invasions and global change impacts on ecosystems. In plant succession, differences in scales between aboveground and belowground biota, as well as between species interactions and ecosystem processes, have important implications for the rate and direction of community change. Aboveground as well as belowground interactions either enhance or reduce rates of plant species replacement. Moreover, the outcomes of the interactions depend on abiotic conditions and plant life history characteristics, which may vary with successional position. We exemplify where translation of the current conceptual succession models into more predictive models can help targeting empirical studies and generalising their results. Then, we discuss how understanding succession may help to enhance managing arable crops, grasslands and invasive plants, as well as provide insights into the effects of global change on community re-organisation and ecosystem processes.

Empirical and theoretical challenges in aboveground-belowground ecology

A growing body of evidence shows that aboveground and belowground communities and processes are intrinsically linked, and that feedbacks between these subsystems have important implications for community structure and ecosystem functioning. Almost all studies on this topic have been carried out from an empirical perspective and in specific ecological settings or contexts. Belowground interactions operate at different spatial and temporal scales. Due to the relatively low mobility and high survival of organisms in the soil, plants have longer lasting legacy effects belowground than aboveground. Our current challenge is to understand how aboveground-belowground biotic interactions operate across spatial and temporal scales, and how they depend on, as well as influence, the abiotic environment. Because empirical capacities are too limited to explore all possible combinations of interactions and environmental settings, we explore where and how they can be supported by theoretical approaches to develop testable predictions and to generalise empirical results. We review four key areas where a combined aboveground-belowground approach offers perspectives for enhancing ecological understanding, namely succession, agro-ecosystems, biological invasions and global change impacts on ecosystems. In plant succession, differences in scales between aboveground and belowground biota, as well as between species interactions and ecosystem processes, have important implications for the rate and direction of community change. Aboveground as well as belowground interactions either enhance or reduce rates of plant species replacement. Moreover, the outcomes of the interactions depend on abiotic conditions and plant life history characteristics, which may vary with successional position. We exemplify where translation of the current conceptual succession models into more predictive models can help targeting empirical studies and generalising their results. Then, we discuss how understanding succession may help to enhance managing arable crops, grasslands and invasive plants, as well as provide insights into the effects of global change on community re-organisation and ecosystem processes.

Effectiveness of mechanochemical treatment with cyclodextrins on increasing solubility of glimepiride

We investigated the enhancement of the solubility of glimepiride (GLM), a poorly water soluble anti-diabetes drug, by cogrinding it with various cyclodextrins (CDs) using a ball mill. The phase solubility profiles of GLM with beta-CD and its derivatives were classified as A(L)-type, indicating the formation of a 1 : 1 stoichiometric water-soluble complex. When GLM crystals were coground with beta-CD using a ball mill for 48 h, the aqueous solubility of GLM increased to approximately 250 microg/mL. The powder X-ray diffraction pattern showed that the peak intensity of crystalline GLM decreased after cogrinding. Endothermic peaks of around 208 degrees C, which were assigned to the fusion of GLM crystals, disappeared in the DSC measurement of the ground mixture. After cogrinding, two sharp peaks assigned to sulfonylurea and benzoyl carbonyl stretching bands varied to broaden the peak to around 1700 cm(-1) in the C=O stretching region. These results suggested the formation of a complex between GLM and beta-CD during cogrinding.

Thoracoscopic surgery for pulmonary arteriovenous malformation

We report 6 consecutive cases of pulmonary arteriovenous malformation in the periphery of the lung, which were treated successfully by thoracoscopy. Pulmonary wedge resection was performed with a linear cutting stapler to divide the feeding artery, drainage vein, and aneurysmal lesion of the arteriovenous malformation. Operative time ranged from 30 to 95 min (mean, 50 min). Bleeding was minimal in all cases. No major surgery-related complications were observed. Postoperative hospital stay was limited to one week except for one patient who had experienced a brain infarction preoperatively, caused by migration of an embolization coil. Histological examination confirmed that the arteriovenous malformation foci were completely removed. Pulmonary wedge resection through thoracoscopy is feasible as an alternative treatment for arteriovenous malformation located in the periphery of the lung parenchyma when pulmonary embolization therapy is difficult or unsuccessful.

Improvement of solubility of C70 by complexation with cyclomaltononaose (delta-cyclodextrin)

We investigated the solubilizing effects of cyclomaltononaose (delta-CD), a cyclic oligosaccharide composed of nine alpha-1,4-linked D-glucose units, on C70 by using the ball-milling method based on a solid-solid mechanochemical reaction. The complex between C70 and delta-CD was characterized by UV-VIS spectrometry and fast atom bombardment mass spectrometry (FAB-MS). Coloration of the C70/delta-CD system was red-brown in aqueous solution, and the UV-VIS spectrum was in agreement with that of C70 in hexane solution. The FAB-MS spectrum of the C70/delta-CD system showed a negative ion peak corresponding to the molecular weight of a complex between two delta-CD and one C70. These findings suggest that the solubilization of C70 in water was due to complex formation of C70 with delta-CD, and the stoichiometric ratio of this complex was 1: 2 (C70: delta-CD).

Is thoracoscopic surgery justified to treat pulmonary metastasis from colorectal cancer?

We retrospectively analyzed 143 consecutive patients undergoing pulmonary resection for metastasis from colorectal cancer, either through thoracotomy or thoracoscopy from 1987 to 2005. Patients with incomplete resection were excluded. Patients were divided into two groups, based on whether or not they underwent thoracoscopy (n=72) or open thoracotomy (n=71) at the first pulmonary metastasectomy. Two patients undergoing thoracoscopy died postoperatively (one from pulmonary thromboembolism and one from gastrointestinal bleeding). Factors influencing postoperative recurrence-free or overall survival were multiple pulmonary metastasis and history of liver metastasis by univariate analysis, and multiple pulmonary metastasis, hilar or mediastinal nodal metastasis, larger diameter of the pulmonary metastasis, and surgery by wedge resection by multivariate analysis. Five-year recurrence-free rates after the first pulmonary metastasectomy were 34.4% in thoracoscopy and 21.1% in thoracotomy, respectively (P=0.047). Overall 5-year survival rates were 49.3% in thoracoscopy and 39.5% in thoracotomy, respectively (not significant). We found no significant difference in the survival rates between the thoracotomy and thoracoscopy groups, even with elimination of the patients with multiple pulmonary metastases in both groups. We suggest that thoracoscopic surgery for pulmonary metastasectomy from colorectal cancer may be justified if the surgical treatment is indicated.

[Posterior mediastinal hemangioma successfully resected with cardiopulmonary bypass; report of a case]

Mediastinal hemangioma is a rare tumor. We report a case of a 62-year-old woman with a posterior mediastinal hemangioma. She had a history of right breast cancer and a follow-up chest radiography revealed a mass located in the left posterior mediastinum. The size was about 80 mm in diameter. The tumor surrounded the descending thoracic aorta and involved intercostal arteries. Complete excision could be achieved by decompressing the descending aorta with the aid of partial cardiopulmonary bypass and the aortic cross-clamp. Histologically, the tumor was diagnosed as a benign hemangioma. It was reported that hemangioma would reccur after subtotal excision. To employ cardiopulmonary bypass was a very effective approach for the purpose of complete excision in our case.

Pulmonary Intimal Sarcoma Treated by a Left Pneumonectomy with Pulmonary Arterioplasty Under Cardiopulmonary Bypass: Report of a Case

Intimal sarcoma of the pulmonary artery is a rare disease. This neoplasm was characterized by an aggressive extension to the lumen of the pulmonary artery, thus mimicking a pulmonary thromboembolism. We herein report a 44-year-old woman who was diagnosed as having primary intimal sarcoma of the left lung preoperatively by transbronchial biopsy. The tumor originated in the pulmonary artery in the left lung, extending to the main pulmonary trunk via the pulmonary arterial lumen, thus resulting in stenosis of the main pulmonary trunk. A complete resection of the tumor with the left pneumonectomy and the pulmonary arterioplasty was successfully performed under cardiopulmonary bypass with vacuum assisted venous drainage.

Invasive Lymphangioma of the Lung Manifesting as a Large Pulmonary Mass with Hemoptysis: Report of a Case

Solitary lymphangioma of the lung is rare. We report a case of invasive lymphangioma of the lung, diagnosed in a 9-year-old girl who presented with intractable hemoptysis and a large pulmonary mass, 10 cm in diameter. We performed left lower lobectomy and lingular segmentectomy to remove the mass completely and the patient has been well for 3 years since. Pathologically, the mass was partly polycystic and partly solid. Irregular and dilated vascular and lymphatic vessels, as well as fibrosis of the interstitium, were spreading into the adjacent lung parenchyma, demonstrating their invasive nature. A new monoclonal antibody, D2-40, which reacts with lymphatic endothelium, proved useful for establishing the pathological diagnosis. We suggest that these pathological findings might be consistent with the intermediate type of localized lymphangioma of the lung and diffuse lymphangiomatosis.