Lung adenocarcinoma with micropapillary and solid patterns: Recurrence rate and trends

BACKGROUND

Lung adenocarcinomas with micropapillary pattern (MP) or solid pattern (SP) have poor prognosis with frequent postoperative recurrence. However, treatment strategies for these histological subtypes have not been established. This study examined the recurrence rates and patterns in patients with these histological subtypes.

METHODS

Overall, 238 patients with lung adenocarcinoma who underwent radical resection were included. According to the histological subtypes, the patients were classified into three groups: neither MP nor SP (MP-/SP-), MP (MP+), and SP (SP+). The clinical and pathological characteristics and recurrence-free survival (RFS) were examined in each group. In addition, univariate and multivariate analyses were performed to investigate the recurrence factors. The site of recurrence, PD-L1 expression, and driver mutations were examined in patients with postoperative recurrence.

RESULTS

The recurrence rates were significantly higher in the MP+ and SP+ groups (p = 0.01). The RFS was significantly shorter in the MP+ and SP+ groups (p < 0.001) than in the MP-/SP- group, especially in pStage 1A (p = 0.001). The relationship between recurrence and pathologic factors was significant for pleural, lymphatic, and vascular invasion, as well as MP in univariate analysis and only for MP in multivariate analysis. Most recurrences were distant metastases in the MP+ and SP+ groups. PD-L1 was highly expressed in recurrent SP+ cases.

CONCLUSIONS

Early-stage lung adenocarcinoma with MP or SP frequently has postoperative recurrence. Prevention of distant metastases is important in these patients to improve prognosis, and aggressive postoperative chemotherapy may be considered.

A case of deep femoral artery aneurysm found with superficial femoral artery aneurysm

Objective: Deep femoral artery (DFA) aneurysms are extremely rare cases of aneurysms that are difficult to diagnose. The objective of this report was to discuss the timing and method of surgery for this disease.

Patient: We encountered an asymptomatic left DFA aneurysm that was discovered along with a symptomatic aneurysm of the right superficial femoral artery (SFA). Both sides of the aneurysm were resected with Dacron knitted artificial vascular grafts (Gelsoft™ Plus, Vasctek, UK) simultaneously.

Result: After the operation, the right SFA had good blood flow, but the graft of the left DFA was occluded. The occlusion was considered to be caused by insufficient blood flow in the graft. The patient was discharged without any complications.

Conclusion: The coexistence of DFA aneurysms should be examined if other aneurysms are found. DFA aneurysms are at a high risk of rupture. Careful follow-up is required, and intervention is recommended when the diameter exceeds 35 mm.

Two operative cases of abdominal aortic aneurysm with isolated dissection of the abdominal aorta

Objective: Isolated abdominal aortic dissection (IAAD) co-occurring with an abdominal aortic aneurysm (AAA) is rather rare. The objective of this report was to discuss the adequate timing and method of surgery for this condition.

Patients: We encountered two operative cases, for which we carefully considered the timing and method of surgery. One patient underwent open repair 1 month after the onset, and the other patient underwent endovascular aneurysm repair (EVAR) 3 years after the onset.

Results: Both patients had a good postoperative recovery and are doing well 8 months after the surgery.

Conclusion: The presence of symptoms or an increase in the diameter of an AAA is important in determining the timing of intervention.

The combined flap based on a single vascular source: a clinical experience with 32 cases

This article provides a retrospective review of 32 combined flap transfers. It consists of two or more flaps based on independent vascular branches from a single vascular source. This series included the combined flap based on the subscapular-circumflex scapular-thoracodorsal vascular system in 24 patients and the profunda femorislateral circumflex femoral vascular system in 8 patients. Twenty-four combined flaps were transferred as free flaps and eight as pedicled flaps. The combined flap based on the subscapular system has very good indications for massive and three-dimensional composite defects in the head and neck region. The combined flap based on the lateral circumflex femoral-profunda femoris system is useful for reconstruction of large defects in the groin, perineal, and lower abdominal regions.