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Masanori Shimomura



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    EP1.01 - Advanced NSCLC (ID 150)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Advanced NSCLC
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.01-73 - Trousseau's Syndrome Associated with Pulmonary Pleomorphic Carcinoma Showing Aggressive Features: A Case Report (Now Available) (ID 3122)

      08:00 - 18:00  |  Author(s): Masanori Shimomura

      • Abstract
      • Slides

      Background

      Trousseau's syndrome is characterized as an unexpected cancer-related thrombotic event, such as a cerebral infarction or a deep vein thrombosis/pulmonary embolism. The histology of most reported cases of lung cancer with Trousseau's syndrome involves adenocarcinoma. We describe the first reported case of Trousseau's syndrome with pulmonary pleomorphic carcinoma and aggressive features.

      Method

      A 74-year-old man, a current heavy smoker (38 pack-years), presented with a well-circumscribed peripheral mass (diameter: 38 mm) in the lower lobe of the left lung. A fluorine-18-fluorodeoxyglucose (FDG) positron-emission tomography scan showed a strong accumulation of FDG in the mass. Serum carcinoembryonic antigen (CEA) and D-dimer levels were 16.0 ng/mL and 0.6 µg/mL, respectively. A left lower lobectomy with systemic mediastinal lymph node dissection revealed the tumor was pleomorphic carcinoma with extensive lymph node involvement and was graded as pT3N2M0, pStage IIIB (pm1, pl1, ly1, v1, br+). The tumor mainly comprised giant cells with high-grade pleomorphism, admixed with a solid adenocarcinoma component and papillary growth pattern. The adenocarcinoma component was positive for periodic acid-Schiff (PAS) stain and resistant to diastase, suggesting mucin production. Moreover, most of the tumor cells were strongly positive for tissue factor (clone TF (H-9)).

      Result

      Three months postoperatively, diffuse infiltration rapidly appeared in plain chest radiographs of the left lung, which was identified as lymphangitic carcinomatosis via bronchoscopy. Prior to treatment for cancer recurrence, the patient suddenly presented with dysarthria and left hemiplegia. Magnetic resonance imaging revealed acute ischemic stroke in the right hemisphere accompanied with subacute small infarcts in the left hemisphere and bilateral cerebellum. Magnetic resonance angiography revealed a right middle cerebral artery M2 segment occlusion. An echography and a chest CT showed no evidence of atherosclerotic thrombus or cardiac thrombus in the left atrium or in the stump of the resected pulmonary vein. Plasma D-dimer level was elevated at 17.6 µg/mL, as were the CEA and carbohydrate antigen 125 (CA125) levels (73.4 ng/mL and 331 U/mL), respectively. He underwent mechanical thrombectomy with a stent retriever, and partial recanalization was achieved. The pathology of the retrieved thrombus showed that almost all parts consisted of fibrin without red blood cells. These findings and pathological findings of the primary lung cancer suggested Trousseau’s syndrome as the etiology of the cerebral infarction.

      Conclusion

      A hypercoagulable state, due to aggressive recurrence of pulmonary pleomorphic carcinoma accompanying with cancer cell production of mucin and tissue factor, may be a potential mechanism for cancer-related thrombosis.

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    EP1.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 206)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Treatment in the Real World - Support, Survivorship, Systems Research
    • Presentations: 2
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.16-29 - Clinical Characteristics and Outcomes of Postoperative Empyema Following Lung Surgery (Now Available) (ID 1645)

      08:00 - 18:00  |  Author(s): Masanori Shimomura

      • Abstract
      • Slides

      Background

      Postoperative empyema prolongs hospital-stay durations and may lead to mortality. However, clinical risk factors for postoperative empyema have been insufficiently investigated. This study explored the relevant characteristics and outcomes of postoperative empyema after lung surgery.

      Method

      A retrospective study of 16 cases of postoperative empyema after lung surgery between April 2008 and December 2018 was conducted. The inclusion criteria were patients who had fever and bacterial pleural effusion confirmed by culture within the first 30 postoperative days. Preoperative patient characteristics, operative findings, and postoperative course were evaluated.

      Result

      There were eight cases of empyema with fistula (six with pulmonary fistula and two with bronchopleural fistula) and eight without fistula. Patients included 15 men and one woman. Median (range) age, body mass index, and Brinkman index were 68 (20-84) years, 22.9 (14.5-27) kg/m2, and 650 (0-2320), respectively. Nine patients were operatively diagnosed with primary lung cancer (p-stage I, three cases; p-stage ≥II, six), six with metastatic lung cancer, and one with pneumothorax. Co-morbidities included chronic obstructive pulmonary disease (COPD) (eight cases; incidence, 50%); diabetes mellitus (five cases; 31%), and history of preoperative chemotherapy (seven cases; 44%). Operative procedures were as follows: two pneumonectomies, five lobectomies, two segmentectomies, six wedge resections, and one bulla suturing. Surgical approaches included 12 thoracoscopic surgeries and four open thoracotomies. Median (range) operative time and bleeding volume was 219 (92-739) minutes and 21 (0-1400) g, respectively. Surgery-to-empyema-onset duration was 12 (4-30) days. Before empyema onset, postoperative complications developed in 14 cases (88%) as follows: four, surgical-site infection; four, prolonged pulmonary air leak; two, pneumonia; two, bronchopleural fistula; one, both prolonged pulmonary air leak and surgical-site infection; and one, both pneumonia and surgical-site infection. Organisms cultured from empyema cases included Staphylococcus aureus (12 cases; MRSA, one), oral resident bacteria (three), and others (one). Postoperatively, five cases required treatment with antibiotics only; five, both antibiotics and chest drainage; and six, surgery with the aforementioned treatments. Surgical procedures for empyema included thoracoscopic debridement and/or pleural irrigation (four cases) and fenestration (two cases). The hospital-stay duration after first surgery was 30 (12-99) days. There were no postoperative mortalities.

      Conclusion

      Diabetes mellitus, preoperative chemotherapy, and COPD could be significant risk factors for postoperative empyema. Infecting organisms associated with postoperative empyema were related to preceding postoperative complications. Therefore, emphasis on controlling factors that contribute to pulmonary and surgical-site infection and pulmonary air leak is important to prevent postoperative empyema.

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      EP1.16-36 - A Good Intestinal Bacterial Environment Can Reduce the Side Effects of Tyrosine Kinase Inhibitors and Enhance Their Anti-Cancer Effects (Now Available) (ID 511)

      08:00 - 18:00  |  Author(s): Masanori Shimomura

      • Abstract
      • Slides

      Background

      We live in symbiosis with a huge number of microorganisms. Recently, analysis of intestinal bacterial layer has been analyzed in detail in the clinical field by the development of 16S next-generation sequencer. Furthermore, in the lung cancer region, various tyrosine kinase inhibitors are being administered based on gene mutations of EGF receptor of lung cancer.

      In this case, an elderly female patient with EGFR gene mutation who was p-stage IVa at the time of surgery was appropriately treated with anticancer agents after surgery and a long-term survival of 14 years after surgery was obtained with a good intestinal bacterial environment.

      Method

      The case was a 78-year-old woman at the first treatment in 2004. There was a tumor in the left S4, pleural effusion was positive, and numerous pleural disseminations were observed during surgery (stage Iva). She was treated with vinorelbine alone, taking into consideration her age. The treatment was successful with caution for hematopoietic disorders. She was treated at home, but in October 2011, she observed an increase in CEA and confirmed that the focal gene mutation was the exon 19 deletion E746-A750 deletion type 1. Then, she had multiple systemic metastasis when CEA rose to 63.0ng/mL, gefitinib was introduced in January 2013. Gefitinib responded dramatically, then CEA dropped to 2.8ng/mL and metastases also became CR with dermatitis as an adverse effect. Although she had paronychia in her extremities, she had no gastrointestinal symptoms such as diarrhea and constipation, and her appetite was good. Since there were no digestive tract symptoms at all, analysis of the intestinal flora was analyzed by the next-generation sequencer.

      Result

      20190328commensal microbiota can.jpgThe next-generation sequencer has detected no microbiota-disturbing bacteria and balance-regulating bacteria such as Ficarra, fragilis, bifidobacterial, lactic acid bacteria, and equal-producing bacteria.

      Respiratory distress appeared in November 2017 and a large pleural effusion was noted in the left thoracic cavity. At the same time, CEA rose to 25.9 ng/mL. After genetic mutation check of the pleural effusion, the T790M mutation was confirmed. At this point CEA had risen to 87.4 ng/mL. At this time, Osimertinib was administered, and CEA decreased to about 1⁄4 to 20.3 ng/mL in two weeks. There were no digestive tract symptoms such as diarrhea and vomiting constipation, and the appetite was also a normal amount.

      Conclusion

      A good intestinal bacterial environment can reduce the side effects of tyrosine kinase inhibitors and enhance their anti-cancer effects.

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