We performed surgical resection of synchronous multiple primary lung cancer, comprising adenocarcinoma and carcinoid components. The latter tumor was located within the central scar tissue formed by the adenocarcinoma (cancer-in-cancer). The patient was a 67-year-old Japanese woman who had a nodular lesion in the right S1 on chest computed tomography. Lung cancer was diagnosed intraoperatively by rapid needle aspiration cytology, and right upper lobectomy with mediastinal lymph node dissection was performed. Histological examination of the resected specimen revealed cancer-in-cancer, consisting of adenocarcinoma and a carcinoid tumor. The carcinoid component was localized within the central fibrous scar of the dominant adenocarcinoma component.
OBJECTIVES: Neutrophil elastase has been reported to play an important role in acute lung injury, which is a major cause of postoperative mortality after pulmonary resection. Neutrophil elastase released in the lungs reaches the peripheral circulation via the pulmonary veins. This study was performed to compare neutrophil elastase activity in pulmonary venous blood (collected during lobectomy) with that in the peripheral blood, and to determine the perioperative changes of neutrophil elastase activity.
METHODS:In 34 patients undergoing lobectomy with mediastinal lymph node dissection, the leucocyte count, neutrophil count, neutrophil elastase activity and levels of tumour necrosis factor-α, interleukin-6 and interleukin-8 were measured in the pulmonary venous blood and peripheral arterial blood before and after surgery. Then, these parameters were compared between before and after surgery with peripheral and pulmonary blood.RESULTS: Neutrophil elastase activity was found to be significantly higher in pulmonary venous blood at the completion of surgery than at the start (during thoracotomy), while the neutrophil elastase activity of peripheral arterial blood showed no significant change between the start and completion of surgery.
CONCLUSIONS:In conclusion, measurement of neutrophil elastase activity in pulmonary venous blood revealed changes associated with lobectomy.
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