Takehiro Okumura

IgG4-related disease (IgG4-RD) is a systemic fibroinflammatory disorder that typically presents with multiorgan involvement. Herein, we report a rare phenotype in which the disease was confined solely to the kidneys and lungs. A man in his 60s presented with a 6-month history of cough and exertional dyspnoea. Imaging revealed bilateral renal enlargement with decreased enhancement, compatible with IgG4-related kidney disease, whereas the pulmonary findings were atypical for IgG4-related lung disease and radiologically mimicked non-specific interstitial pneumonia, making it difficult to determine whether the pulmonary lesions represented part of the same disease process or a separate interstitial lung disease. Serological findings indicated IgG4-RD. To clarify whether both organs were affected by a single systemic process, a thoracoscopic surgical lung biopsy was performed. The histopathological examination confirmed IgG4-positive plasma cell-rich inflammation establishing the diagnosis of IgG4-RD. Corticosteroid therapy resulted in radiological and clinical improvements of both organs. Histopathological evaluation of the lung lesions enabled a unified diagnosis of both the renal and pulmonary manifestations. A stepwise diagnostic approach using lung biopsy facilitated accurate diagnosis and effective treatment.

Background: The clinical significance of adjuvant chemotherapy after lung metastasectomy for colorectal cancer remains unknown. This phase 2 study evaluated adjuvant chemotherapy with modified 5‐fluorouracil/leucovorin and oxaliplatin (mFOLFOX6) after lung metastasectomy.Methods: Eligibility criteria included colorectal adenocarcinoma, first curative resection of ≤4 lung metastases, and no prior chemotherapy. Treatment consisted of 12 cycles of mFOLFOX6. The primary endpoint was the 5‐year overall survival (OS) rate, with the expectation of 50% (threshold, 35%) and a planned sample size of 100 (90% power; alpha error, 5%).Results: Fifty‐two patients were enrolled between July 2011 and July 2014; patient enrollment was closed prematurely because of slow accrual. Excluding four ineligible patients, the characteristics of the 48 patients in the efficacy analysis set were a median age of 62 years (range, 43–75 years), Eastern Cooperative Oncology Group performance status of 0 in 45 patients, prior resection of extrathoracic metastasis in four patients, and postoperative carcinoembryonic antigen within normal range in 43 patients; the status of lung metastasis was single in 34 patients, unilateral in 40 patients, and metachronous in 41 patients; and a disease‐free interval between primary tumor resection and diagnosis of lung metastasis of <2 years in 33 patients. The 5‐year OS rate was 85.2% (95% confidence interval [CI], 71.4%–92.6%), and the 5‐year disease‐free survival rate was 60.2% (95% CI, 44.9%–72.4%). Forty‐one of the 52 patients (78.8%) in the safety analysis set completed 12 cycles of mFOLFOX6. Grade ≥3 adverse events were neutropenia (50.0%), fatigue (7.7%), peripheral sensory neuropathy (7.7%), and other (<5%).Conclusions: Adjuvant chemotherapy with mFOLFOX6 is feasible, and may be effective after lung metastasectomy for colorectal cancer.

Objective The purpose of this study was to test the hypothesis that apical opacities on computed tomography (CT) are related to occurrence of primary spontaneous pneumothorax (PSP) in young male patients. Methods We compared the frequency of apical opacities on thin-section CT between 70 male patients with PSP (PSP group) and 74 male patients without a history of PSP (non-PSP group). We also evaluated histopathologic findings of 39 specimens from 37 surgical cases in the PSP group. Results Apical opacities were significantly more frequent in the PSP group than in the non-PSP group (right side, P = 0.01; left side, P = 0.005). Histopathologically, subpleural band-like alveolar collapse was seen in 35 specimens (89.7%), which was always accompanied by fibroelastosis and fibroblastic foci. Conclusions Apical opacities on CT were significantly associated with PSP in young male patients. These apical opacities histopathologically correspond to fibrotic pleural thickening with subpleural alveolar collapse.