This report presents the extracorporeal membrane oxygenation (ECMO)-assisted surgical as a treatment of benign double tracheoesophageal fistula. The patient was a 43-year-old woman who presented the airway obstruction for 3 weeks after the esophagus metal stent implantation for the tracheoesophageal fistula 1 year ago. The airway obstruction was due to the expansion and piercing of the metal stent through the upper part of the esophagus into the tracheal cavity. In view of the failure of endotracheal intubation, we finally used ECMO-assisted surgery to remove the stent. And at the same time, cervical esophagostomy externa, exclusion of the thoracic tracheoesophageal fistulas and gastrostomy were performed.

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Solitary fibrous tumor (SFT) is an uncommon mesenchymal neoplasm that arises primarily from the pleura, but recognized also in other tissues. SFT in the thyroid gland is extremely rare. Here we presented the second reported SFT arising in an intrathoracic goiter. The88-year-old woman was referred with a huge goiter involving upper mediastinum accompanied by airway obstruction and tracheostomy. The patient underwent a left subtotal thyroidectomy, which revealed a SFT. No recurrence was noted during 3 years of follow-up.

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Primary pulmonary tumors in small children have remained a challenge for pediatric surgeons. Pneumonectomy and radical lobectomy are limitedly indicated due to surgical difficulties and sequelae. Here, we present our experience with a 4-year-old patient who suffered from an inflammatory myofibroblastic tumor. A left lower sleeve lobectomy was performed, and the patient recovered significantly after surgery. At the last follow-up, the child was growing well without any sequel, which supports our hypothesis that in small children, sleeve resection is the preferred treatment for tumors on the main stem bronchus and presents an alternative to an otherwise unavoidable pneumonectomy.

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Percutaneous needle biopsy, commonly used for a definitive diagnosis of anterior mediastinal tumors, is sometimes inconclusive because of the small size of the biopsy specimens and the histologic heterogeneity of the tumors. We herein report 4 cases of invasive anterior mediastinal tumors, in which the definitive diagnosis was made using the Chamberlain procedure. [Case 1] A 33-year-old man was found to have an anterior mediastinal tumor on chest X-ray and computed tomography (CT). The tumor was histologically diagnosed as thymic carcinoma (squamous cell carcinoma) using the Chamberlain procedure. After 3 courses of preoperative chemotherapy, the patient underwent surgery and postoperative radiotherapy. He remains well, 35 months after the biopsy. [Case 2] A 17-year-old boy was found to have a tumor in the anterior mediastinum on chest CT. His serum alpha-fetoprotein level was elevated to 2,461 ng/mL. Histological diagnosis of yolk sac tumor was confirmed using the Chamberlain procedure. He was treated with one course of chemotherapy, followed by surgery; he remains well 57 months after the biopsy. [Case 3] A 72-year-old man was found, on chest X-ray and CT, to have a left upper anterior mediastinal tumor with invasion of the subclavian vessels. The tumor was confirmed histologically as thymic (sarcomatoid) carcinoma using the Chamberlain procedure. Despite 2 courses of chemotherapy, the tumor continued to enlarge and metastasized to the lung and bone. The patient died 7 months after the biopsy. [Case 4] A 62-year-old woman under treatment for rheumatoid arthritis (RA) was found, on a chest X-ray, to have a right anterior mediastinal tumor. Histological diagnosis using the Chamberlain procedure suggested lymphoproliferative disorder, and the RA medication was discontinued. This was followed by a decrease in the tumor size and avoidance of invasive surgery. The patient remains well, 15 months after the biopsy. [Conclusion] The Chamberlain procedure proved useful for definitive diagnosis in all 4 cases of invasive anterior mediastinal tumors. We recommend the Chamberlain procedure for biopsy since it enables safe, rapid, and successful collection of tissue samples.

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We present 3 cases of solitary fibrous tumors (SFTs) occupying entire hemithorax and resulting in respiratory insufficiency. All patients were treated by complete resection, resulting in immediate re-expansion of the lungs and recovery from respiratory insufficiency. Although, two patients remain alive without recurrence, one patient had pleural recurrences three times over a 20-year period, all of which were treated by surgical resection. All of the primary tumors exhibited areas of hypercellularity, hemorrhage, or necrosis. All of the recurrent tumors in the recurrent case displayed large areas of hypercellularity, similar to the part of primary tumor. Although, the MIB-1 index in primary tumors was less than 5%, the index of the recurrent tumors increased up to 11% with repeated recurrence. Giant SFTs usually display hypercellularity, hemorrhage, or necrosis. Tumors with hypercellularity could recur. MIB-1 index could display malignant characteristics of recurrent tumors. Long-term follow-up for more than 10 years after surgery is necessary, particularly for tumors with areas of hypercellularity.

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We report the case of a 46-year-old Japanese woman with past medical history of right nephrectomy for as sarcomatoid renal cell carcinoma 14 years earlier. A pulmonary nodule was detected in the left upper lobe 7 years after nephrectomy and it had grown slowly for 6 years. We performed wedge resection for the tumor because we suspected that the nodule was metastasis from the renal tumor. But the nodule was diagnosed as epithelioid angiomyolipoma since the nodule was positive for HMB-45 and negative for epithelial markers and S-100 protein by immunohistochemical analysis. Therefore her disease was revised as a solitary pulmonary metastasis from renal epithelioid angiomyolipoma. Epithelioid angiomyolipoma is potential malignant mesenchymal tumor because the tumor recurs or metastasizes, and progresses rapidly on one-third of the cases. This case is the first report that the disease was stable for a long time after late recurrence caused.

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Pulmonary metastases from thyroid cancer usually present with a micronodular or miliary pattern throughout both lungs; pulmonary metastasis with nodules measuring 10 mm in diameter is very rare. We herein present a 74-year-old woman with a history of papillary thyroid cancer treated surgically 17 years previously who presented with pulmonary metastatic nodules measuring 15 mm in diameter on chest radiography. If a pulmonary nodule or nodules are encountered in a patient with a history of thyroid cancer, though very rare, the possibility that it is a metastasis must be borne in mind.

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Clear cell tumor (CCT) of the lung is very rare, and angiomyolipoma (AML) of the liver is also very rare. Both CCT and AML have been identified as a group of neoplasms with perivascular epithelioid cell differentiation (PEComa). We report a case with multiple PEComas of a combination of CCT of the lung and AML of the liver. The patient underwent surgical resection of an abnormal nodule of the lung 5 years after treatment of AML of the liver. The histological diagnosis of the pulmonary nodule was CCT. Neither lesion demonstrated malignant phenotypes, such as high mitotic activity, necrosis, or lymphovascular invasion. Each tumor of the lung and liver was solitary and differed from each other histologically. Therefore, these tumors were considered to be multifocal, not metastatic PEComas. This case is, to our knowledge, the first report of multiple PEComas of pulmonary CCT and hepatic AML. These findings suggest that patients with PEComas may require whole-body follow-up examinations because different subtypes of PEComas may occur multifocally.

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A 64-year-old man with primary lung cancer (cT1aN0M0) was diagnosed as having partial anomalous pulmonary venous connection (PAPVC) in the same lobe by preoperative chest computed tomography (CT). The anomalous vein originated from left upper lobe pulmonary vein and flowed into the left brachiocephalic vein. Although the patient was asymptomatic, cardiac catheterization revealed that pulmonary-systemic blood flow ratio (Qp/Qs ratio) was 2.0, and his pulmonary arterial pressure was marginally elevated (60/18 mmHg). We performed left upper lobectomy as the definitive treatment for both lung cancer and PAPVC. His pulmonary arterial pressure decreased after lobectomy (33/16 mmHg). He is living well without relapse of lung cancer 56 months after surgery. Although PAPVC is detectable on computed tomography, out of 7 previous reports of PAPVC associated with lung cancer, only 2 cases were diagnosed preoperatively. The presence of PAPVC should be kept in mind before major lung resections.

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We present a 76-year-old man who underwent two lung resections for metastases originating from cancer of the Ampulla duodeni, 9 years-after pancreaticoduodenectomy with lymphadenectomy. Pancreaticoduodenectomy was performed in 2002; histological examination of the original tumor revealed a stage III tubular adenocarcinoma (pT3, N0, M0). Repetitive lung resection was performed in 2007 (left S8) and 2011 (right S1 and extirpation of a pericardial cyst). Although rarely performed, resection of bilateral pulmonary metastases from carcinoma of the papilla of Vater was done to improve the patient's chances for longterm survival.

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Chest wall desmoid-type fibromatoses are rare, locally aggressive tumors that occasionally arise from previous thoracotomy sites. Tumors arising from previous sites of thoracotomy to treat malignant disease should be discriminated from the pleural dissemination of the previous malignancy. In this study, we report a case of desmoid-type fibromatosis arising from a site for thoracotomy to treat lung cancer. Additionally we reviewed 15 reported cases of desmoid-type fibromatosis following thoracotomy and summarized their features. A 62-year-old woman was found to have a tumor on computed tomography (CT) at a 1-year routine checkup for lung cancer. The tumor (diameter, 3.4 cm) was located at the previous thoracotomy site. Positron emission tomography (PET) revealed mild ¹⁸F-fluorodeoxyglucose (FDG) accumulation in the tumor, with a maximal standardized uptake value (SUV_max) of 1.9. CT-guided biopsy revealed only fibrous tissue. Eighteen months after the biopsy, CT revealed apparent tumor growth, and a biopsy revealed the same histology observed previously. The tumor was removed and diagnosed as desmoid-type fibromatosis. Currently, the patient is alive without recurrence 4 years after desmoid surgery.

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Despite the fact that non-small-cell lung cancer (NSCLC) is very common in the older population, these patients are frequently underrepresented in clinical and surgical trials and thus it is difficult to reach evidence-based recommendations for this special population. We present a case of a surgical treatment of asymptomatic lung cancer in a very elderly patient. The patient had no recurrence for 4 years after a complete resection.

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Few have reported a concomitant malignant neoplasm with immunoglobulin G4 (IgG4)-related diseases. We describe a case of lung cancer and gastric cancer accompanied with IgG4-related disease. A 78-year-old man had an area of ground-glass opacity with central collapse in right upper lobe and a gastric cancer. The patient underwent a right upper lobectomy following a gastrectomy for the gastric cancer. Histological examination of the resected lung specimen revealed a lepidic pattern of an adenocarcinoma and a large amount of plasmacyte infiltration around the tumor. In immunohistochemical findings, the plasmacytes were stained for IgG4. Therefore, the lung tumor was considered to have associated with IgG4-related interstitial lesions.

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We report a surgical case of tension pyopneumothorax in a patient who was receiving chemotherapy for esophageal cancer. A 68-year-old man who had undergone total gastrectomy with splenectomy for gastric cancer and was receiving chemotherapy for esophageal cancer was presented to our hospital with dyspnea. Left tension pyopneumothorax was diagnosed, and he received left lower lobectomy after pleural drainage. His postoperative course was uneventful, and he is alive without any cancer recurrences 5 years after the lobectomy. Once tension pyopneumothorax has developed from lung abscess, emergent lobectomy may be a useful option to prevent lethal aspiration pneumonia.

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There are few reports of resected cases of second primary lung cancer in post-treatment survivors of small-cell lung cancer. Here, we report a surgical case of a 62-year-old female with second primary lung adenocarcinoma after chemoradiotherapy against small-cell lung cancer. She had been treated for small-cell lung cancer 2 years earlier, and achieved complete response after the treatment. A new nodular lesion was detected at a different segment in the right lower lobe. We performed a right lower lobectomy accompanied with systemic mediastinal nodal dissection. Histopathological findings revealed that the new nodular lesion was a second primary lung adenocarcinoma. No metastatic tumor was seen in the dissected lymph node; the initial tumor had disappeared completely. The postoperative course was uneventful, and she was discharged on day 10 after the operation. Ten months after the operation, she was free of recurrent tumor.

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A 52-year-old man was diagnosed with lung adenocarcinoma in the left upper lobe (c-T1bN0M0). Preoperative bronchoscopy revealed a displaced anomalous B¹⁺² arising from the left main bronchus. Multiplanar reconstruction computed tomography showed that the displaced B¹⁺² was located behind the left main pulmonary artery, and the interlobar fissure was largely fused. Video-assisted thoracic surgery (VATS) left upper lobectomy was performed successfully. The “no-touch fissure” technique was efficient not only for avoiding accidental cutting of the displaced bronchus but also post-operative air leakage. This is the first reported case of VATS lobectomy for lung cancer associated with a displaced B¹⁺².

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Thoracoscopic pulmonary segmentectomy of the lung is sometime adopted for the lung cancer, but a problem with segmentectomy is variable anatomy. Recently, we are exploring the impact of three-dimensional models using rapid-prototyping technique. It is useful for decision making, surgical planning, and intraoperative orientation for surgical treatment in patient with lung cancer who underwent pulmonary segmentectomy. These newly created models allow us to clearly identify the surgical margin and the intersegmental plane, vessels, and bronchi related to the cancer in the posterior segment. To the best of our knowledge, there are few reports describing a pulmonary model so far.

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Spinal epidural hematoma (SEH) is rare but causes neurological disorders. Rapid diagnosis and treatment maximize neurological recovery. We present the case of SEH after lung cancer surgery under epidural and general anesthesia. A 64-year-old man underwent right upper lobectomy. Pulmonary embolism occurred on postoperative day 2. Anticoagulant therapy with fondaparinux and warfarin was started 2 hours after epidural catheter removal and he gradually recovered. On postoperative day 13, the level of prothrombin time-international normalized ratio reached 1.47 and fondaparinux administration was stopped. The next day, he developed back pain and paraplegia, and magnetic resonance imaging revealed a mass between Th4 and Th7 compressing the spinal cord. Emergency decompression laminectomy and hematoma evacuation were performed. After 2.5 months of rehabilitation, he regained almost all motor function and sensation. Late after epidural anesthesia, attention should be paid to possible SEH even though appropriate anticoagulant therapy had been initiated after epidural catheter removal.

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Lung cancer surgery in octogenarians has already become common in Japan due to the high proportion of elderly people and the progress in perioperative management, including anesthesia and video-assisted thoracic surgery. However, there have been few reports about the surgical treatment of lung cancer in nonagenarians. Five cases (mean age: 91.2 years; 3 men, 2 women) of non-small cell lung cancer in nonagenarians in whom pulmonary resection was performed are reported. All were adenocarcinomas; three were clinical stage IA, and two were IB. Three patients underwent lobectomy, and two underwent wedge resection. Mediastinal lymph node dissection was omitted in all patients. There were no fatal postoperative complications. During follow-up, one patient died due to fatal arrhythmia, and one patient who underwent wedge resection had local recurrence, but the others are alive in good condition. Pulmonary resection of lung cancer is possible for highly selected, nonagenarian patients without lymph node metastasis.

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Carbon ion radiotherapy (CIRT) for patients with early-stage non-small cell lung cancer (NSCLC) has recently provided favorable local control with very few toxic reactions. Because CIRT for NSCLC has been mostly performed for elderly or inoperable patients, salvage surgery for NSCLC after CIRT has rarely been reported. We describe a case of complete thoracoscopic right upper lobectomy with mediastinal lymphadenectomy performed as salvage surgery for local recurrence of stage IA NSCLC after CIRT in an initially operable patient who had refused surgery 27 months previously. Pleural adhesions caused by CIRT were localized to the pulmonary apex and the central pulmonary structures were intact at the time of the salvage surgery, which allowed us to successfully perform thoracoscopic lobectomy without any complications. Thus, salvage surgery for NSCLC after CIRT may be feasible in an initially operable patient, as CIRT appears to be unlikely to cause any difficulties in the salvage surgery.

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In radical pulmonary resection for advanced lung cancer, reconstruction of the pulmonary artery (PA) can preserve the lung parenchyma. Reconstruction techniques have gained acceptance because they enable the surgeon to avoid pneumonectomy. Various techniques have been documented, such as direct suturing, end-to-end anastomosis, and a patch or conduit reconstruction. We present two lobectomy cases in which the patients underwent PA reconstruction with prosthetic conduits because they were unfit for other procedures. In both cases, the conduits showed good postoperative patency. When interposition of a conduit is required for PA reconstruction, the use of a prosthetic conduit should be considered in selected cases.

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We herein report a case of an intrathoracic low-grade fibromyxoid sarcoma arising from the chest wall and associated with massive pleural effusion. A 70-year-old man presented with a persistent cough. A chest computed tomography scan revealed a large mass in the right pleural cavity with massive pleural effusion. No malignant cells were recognized in the pleural effusion by thoracentesis. A malignant soft tissue tumor was suspected, and surgery was performed. The tumor arose from the posterior chest wall and was resected with the connected chest wall. The definitive diagnosis was a low grade fibromyxoid sarcoma. Because the posterior margin of the chest wall was microscopically tumor positive, postoperative irradiation was performed. The patient has now been followed up for 30 months with no evidence of recurrence.

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Five months after the treatment for acute empyema, a 75-year-old woman was referred to our hospital because of marked elevation of the white blood cell (WBC) count and C-reactive protein (CRP) level, and a right pleural mass detected by chest computed tomography. At this time, the WBC count and CRP level had increased to 60400/microl and 18.2 mg/dl, respectively. We performed biopsy and the tumor was diagnosed as sarcomatoid malignant pleural mesothelioma. Malignant pleural mesothelioma occasionally presents the symptoms and findings like an acute empyema. We demonstrated the case of malignant pleural mesothelioma which had presented the symptoms and laboratory findings very similar to acute empyema and had treated as acute empyema.

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Spontaneous pneumomediastinum (SPM) is an uncommonly encountered entity. In addition, due to its rarity, little is known about recurrent SPM. We report on two exceptional cases of recurrent pneumomediastinum. One was a 16-year-old male whose first episode was accompanied by blunt chest trauma followed by a spontaneous second episode with a free interval of 17 months. The other case was a 17-year-old male whose presenting symptom was right and left pleuritic chest pain, respectively, without any predisposing or precipitating factors. We diagnosed these patients without performing invasive procedures and administered conservative management with success.

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A 37-year-old woman noticed a right anterior chest mass and pain. The mass had been rapidly growing and she visited our hospital. The mass was hard and 8 × 7 cm in size. It was detected in the upper inner quadrant of her anterior chest wall. A computed tomography (CT) examination and magnetic resonance imaging (MRI) of the chest revealed a large heterogeneously enhanced mass arising from the right chest wall with lytic destruction of the rib and coarse calcification. An image diagnosis of osteogenic sarcoma originating from a rib was made. She underwent surgical excision of the tumor and chest wall reconstruction. Microscopic examination of the resected tumor showed multiple neoplastic cells accompanied by osteoid formation within the tumor. The tumor was diagnosed as high-grade malignant osteosarcoma of the rib. Primary osteosarcoma commonly originates in the long bone in children and adolescents, but it occurs very rarely in the ribs in adults. Surgical resection plays an important role in the treatment for this disease. We report a case of primary osteosarcoma that originated in the rib of a young woman and was treated successfully by surgery.

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Post-pneumonectomy syndrome (PPS) is a rare late complication of pneumonectomy, and diverse treatments have been employed. We herein present a useful technique for right-sided PPS. The patient was a 53-year-old female who underwent a right pneumonectomy for locally advanced squamous cell lung cancer (pT2N2M0). Mild dyspnea and stridor developed and progressed 1 year after surgery. A chest roentgenogram and computed tomography (CT) scan showed a right-sided mediastinal shift. Under local anesthesia, a chest tube with a balloon was inserted into the right thoracic cavity, and the balloon was inflated with air. Dyspnea and stridor improved and disappeared as the balloon expanded. Then, mediastinal fixation was performed under general anesthesia. Mediastinal fixation involved a PTFE (polytetrafluoroethylene) sheet which was sewn on the sternum and costal cartilage anteriorly, on the vertebra posteriorly, and covered the azygos vein level superiorly and two thirds of the pericardium inferiorly using nonabsorbable sutures. A post-operative chest roentgenogram and CT scan showed improvement of the right-sided mediastinal shift. The post-operative course was uneventful, and dyspnea and stridor were improved and became stable. In conclusion, the presented method is a useful procedure for right-sided PPS.

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Multiple exostosis is associated with the autosomal dominant disorder and hereditary multiple exostoses (HMEs), are rarely growing around the ribs and the formation of a large lump into the thoracic cavity. It's generally agreed that when there are no symptoms present, a HME patient could either avoid any treatment or postpone the operation until adolescence. We present a 5-year-old boy with 4 cm × 3.5 cm HMEs lump invasion into the thoracic cavity, with symptoms of chest distress and right chest pain. This patient received video-assisted thoracoscopic surgery (VATS) and a the lump and 1 cm rib involved was resected. During a 2 years follow-up, the patient remained in good condition without recurrence and complications.

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Ectopic cervical thymoma (ECT) is a rare tumor that is frequently misdiagnosed as a thyroid tumor or other malignancy. A 34-year-old male with a right palpable neck mass had been mistakenly diagnosed with T-cell lymphoblastic lymphoma even after an open biopsy. The atypical clinical course, including hypogammaglobulinemia, led us to the correct diagnosis; ECT accompanied by Good's syndrome (GS). After the intravenous infusion of gammaglobulin, tumor resection and a subsequent video-assisted thoracoscopic extended thymectomy were performed. The final diagnosis was type AB thymoma, Masaoka stage I. This report is, to the best of our knowledge, the first description of this extremely rare combination.

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We report a rare case of chronic expanding hematoma of thorax extended to the neck. An 83-year-old man with a history of Lucite ball plombage and thoracoplasty of bilateral thorax was admitted with numbness of left upper extremity. In 6 months, left supraclavicular fossa was gradually bulged like tumor. The lesion was diagnosed as chronic expanding hematoma. Surgically, Lucite balls were removed with surrounding hematoma debris and fl uid, and neck hematoma, which was slightly communicated to the thorax, was extirpated. We discussed the genesis of this hematoma and its extension to the neck.

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A 21-year-old man with a history of bronchial asthma during childhood presented with left recurrent pneumothorax. Chest x-ray showed collapse of the left lung. Computed tomography showed hyperlucency and some bullae in the left upper lobe. Thoracoscopic bullectomy and pleurodesis were performed. Pneumothorax recurred twice, for which thoracoscopic bullectomy and pleurodesis were performed. During the third operation, pleurodesis of almost the entire left upper lobe was performed. Since this third operation, the patient has been free from recurrences of pneumothorax for three years. The lung perfusion scintigram performed during the absence of pneumothorax showed a lack of accumulation in the left upper lobe. The lung ventilation scintigram performed during the absence of pneumothorax showed low accumulation and delay of washout in the left upper lobe. These findings are compatible with Swyer-James syndrome. To prevent the recurrence of pneumothorax related to Swyer-James syndrome, some kind of procedure, such as extensive pleurodesis, is necessary.

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Complex regional pain syndrome (CRPS) is not an uncommon complication after surgery, but has never been reported after the Nuss procedure for repairing pectus excavatum. A 22-year-old man with pectus excavatum had type I CRPS that developed 2 weeks after the Nuss procedure. He complained of persistent pain, hyperalgesia, weakness, edema, and color and temperature changes on right upper extremity. Following intensive rehabilitation, the degree of pain, weakness and edema were ameliorated. He recovered 6 months after surgery and the pectus bars were removed uneventfully 3 years after the repair.

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A rare case of a patient with primary adenocarcinoma of the middle lobe bronchus that was successfully treated with rigid bronchoscopy followed by middle sleeve lobectomy is reported. The patient was a 75-year-old man who presented with low-grade fever and cough. Chest computed tomography showed obstructive pneumonia of the lower lobe and a polypoid lesion in the truncus intermedius. Middle sleeve lobectomy and mediastinal lymphadenectomy were performed following recovery of respiratory function after partial resection of the tumor with rigid bronchoscopy. There was no sign of tumor recurrence and metastasis over 32 months of follow-up. We should be aware of tracheal or bronchial tumor in patients with prolonged asthma-like symptoms. Palliative resection with rigid bronchoscopy was useful to make the correct diagnosis, evaluate the extent of the tumor, and protect the right lower lobe.

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Diaphragmatic rupture is usually an immediate, left-sided complication of high-velocity thoraco-abdominal trauma. Here we present a rare case of delayed, right-sided diaphragmatic rupture and its laparoscopic mesh repair.

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An 86-year-old woman with a history of right breast cancer resected seven years ago had a small pulmonary nodule located in left S5. Diagnosis was made by bronchoscopy using the endobronchial ultrasonography-guided sheath (EBUS-GS) method, but a histological diagnosis was not obtained. Wedge resection was performed due to suspicion of a metastatic lesion from breast cancer based on radiological findings. The tumor was subsequently found to be malignant melanoma of the lung. An initial diagnosis of primary melanoma of the lung was made because a melanoma lesion at another site was not seen despite a detailed work up. However, 8 months after surgery, a malignant melanoma appeared at the tip of the right index finger. We rediagnosed the lung lesion as a metastatic malignant melanoma based on the low incidence of primary melanoma of the lung and on the pathological features.

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We report the first case of the intercostal neurilemmoma showing a unique growth pattern in the lateral chest wall (both inside and outside the thoracic cavity). Usually, intrathoracic neurilemmoma is found in the posterior mediastinum and bulge from the inner surface of the bony thorax toward the thoracic cavity. This unique growing pattern of neurilemmoma arising from intercostal nerve was clearly demonstrated by computed tomography and ultrasonography.

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Pulmonary sequestration is a rare developmental abnormality where pulmonary tissue lacks normal connections to the tracheobronchial tree, in addition to its having an anomalous systemic blood supply. Lobectomy via open thoracotomy has long been the procedure of choice for the resection of pulmonary sequestration. We present three cases of thoracoscopic lobectomies performed using video-assisted thoracic surgery (VATS). Transection of the associated aberrant artery was performed using only a single staple.

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Pulmonary sequestration is a rare congenital lung malformation that more commonly occurs in the left lung, mainly near the lower mediastinum. It is rarely observed in patients with extralobar sequestration in adulthood. We report the case of a 55-year-old man with recurrent fever and cough lasting for about 1 month, who was admitted to our hospital. His past history was unremarkable. The final diagnosis of extralobar sequestration was dependent on three-dimensional computed tomography angiography (3D CTA), which showed an abnormal blood supply vessel to the consolidation from the aortic arch. The patient underwent a left pulmonary sequestration resection, and the pathological examination also verified the diagnosis postoperatively. 3D CTA images can provide an aberrant vessel anatomy map for the surgeon and play a decisive role in the detection of pulmonary sequestration.

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Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is now becoming a widely accepted procedure to investigate the mediastinum for the staging of non-small-cell lung cancer and diagnosing mediastinal lesions. During the intervention, some minor or major complications may occasionally occur. The present case report describes the first reported case of needle breakage during EBUS-TBNA.

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Systemic artery to pulmonary vessel fistula (SAPVF) is an uncommon condition, which is congenital or acquired. We recently encountered a patient with acquired axillary artery to pulmonary artery fistula detected by dual-source 64-slice computed tomography (DSCT) angiography who had a Nuss surgical procedure for pectus excavatum. He suffered from wound infection following bar removal. Conventional angiography also demonstrated the SAPVF and successful embolization for treatment was carried out using microcoils and polyvinyl alcohol particles. To our knowledge, there has been no report of an axillary artery to pulmonary artery fistula associated with wound infection following a Nuss procedure.

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Secondary spontaneous pneumothorax (SSP) caused by malignant tumors is rare, which often makes the choice of treatment difficult. In our hospital, we performed radical surgery for all pulmonary metastases arising from osteosarcoma (OS) in seven patients with SSP from February 1988 to February 2008 and retrospectively examined the clinicopathological features and postoperative outcomes. The common SSP etiology was tumor tissue rupture at the lung periphery. All patients died of OS recurrence within 18 months. A short disease-free interval (DFI) and a short interval to the second recurrence were the common clinical risk factors of poor prognosis. Curative surgery for pulmonary metastases in OS with SSP is unlikely, but in OS patients with peripheral metastatic lesions that are not accompanied by SSP and have a satisfactory DFI and few lesions, surgical resection should be strongly considered.

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A 53-year-old Japanese woman was referred to our hospital for pure ground glass opacity (GGO) in the left upper lung on computed tomography. 18F-fluorodeoxyglucose positron emission tomography revealed no abnormal uptake in the lesion. After 4 months of follow-up, we strongly suspected the lesion to be a bronchioloalveolar carcinoma and decided to perform a surgery for diagnosis. Planning to perform lingual segmentectomy by video-assisted thoracic surgery (VATS) with mini thoracotomy, we finally performed the left upper lobectomy to guarantee the optimal margin by VATS, because the lesion was not identified by palpation. Final pathological diagnosis was a solitary pulmonary capillary hemangioma (SPCH). We herein report a resected case of SPCH showing pure GGO and review all reported SPCH cases.

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A female patient in her sixties, who had never smoked, was found to have a 5-mm nodule in a computed tomography (CT) scan. The follow-up CT scan after 19 months showed that the nodule had grown to 26 mm. We performed a left upper lobectomy. Pathological examination revealed a combined large cell neuroendocrine carcinoma (LCNEC) and adenocarcinoma with components of large cell carcinoma and bronchioloalveolar carcinoma (BAC). Tumor cells were separately collected from components of both the LCNEC and adenocarcinoma, and a mutational analysis of the epidermal growth factor receptor (EGFR) gene demonstrated that both components had the same L861Q mutation at exon 21. We assume that the LCNEC originated from the adenocarcinoma based on the fact that the patient was a non-smoking female, the tumor was located in the periphery, the tumor had a BAC component, and the same EGFR mutation was found in both the LCNEC and adenocarcinoma components.

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A rare case of Castleman's disease with myasthenia gravis is reported. A 55-year-old woman with bilateral ptosis, speech impairment, and severe dyspnea had been previously diagnosed with myasthenia gravis. Computed tomography showed a 5 cm × 3 cm paratracheal mass in the mediastinum, thought to be an ectopic thymoma. Two days after surgical resection, the patient suddenly developed dyspnea. Postoperative myasthenic crisis was diagnosed, and plasmapheresis was performed. Her general condition improved, and her subsequent course was uneventful. The final pathological diagnosis was mediastinal solitary Castleman's disease, hyaline vascular type. Castleman's disease with myasthenia gravis is especially rare. One of the serious complications is postoperative myasthenic crisis. For patients with myasthenia gravis, the rate of postoperative myasthenic crisis seems significantly higher in Castleman's disease patients than in patients with thymic epithelial tumors. Castleman's disease with myasthenia gravis is discussed along with a review of the literature.

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A lung squamous cell carcinoma complicated by lung abscess was found in a 38-year-old female never smoker. After a transbronchial lung biopsy, she complained of chest pain and had a persistent fever. A right middle lobectomy was performed to alleviate her symptoms and complete surgical resection was achieved. She reported no exposure to factors that increase the likelihood of lung cancer. Unknown factors or the patient's lung cancer susceptibility might cause the disease. Survival time is generally shorter in young patients than old patients, but careful observation and aggressive treatment can improve prognoses. A case such as this is rare in the extant literature.

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The incidence of a fractured humeral head penetrating into the thoracic cavity is extremely rare. A 46-year-old woman presented with moderate respiratory distress at the emergency department after being involved in a motor vehicle accident. Radiographic examinations revealed fractures of the second to fifth ribs on the left side along with hemopneumothorax and fracture-dislocation of the humeral head into the thoracic cavity. After initial stabilization, video-assisted thoracic surgery (VATS) was performed to remove the fractured humeral head, and this was followed by a hemiarthroplasty. In this case report, we have discussed significant aspects of this uncommon finding in order to alert surgeons of the potential risks associated with intrathoracic displacement of the fractured humeral bone in trauma patients.

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An abnormal shadow was detected in a 75-year-old man on a chest roentgenogram, and the patient was referred to our institution. A transbronchial biopsy was carried out and the specimen resulted in a diagnosis of organizing pneumonia. During the follow-up period, the left lung lesion became enlarged. Partial resection of the left lung was performed. Postoperatively, pathological examination of the tumor showed an organizing pneumonia. Approximately 3 years later, a new calcified heterogeneous mass shadow was detected in the left lung and left pleura, which had gradually enlarged. Computed tomography (CT)-guided fine-needle biopsy of the nodule of the left pleura was performed. Microscopically, the specimen led to the diagnosis of low-grade osteosarcoma. Re-evaluation of the primary and secondary lesions were confirmed as the same histopathological findings. A further systemic examination was performed. Finally, the lesion was confirmed as low-grade osteosarcoma of the lung. The patient refused further treatment and died due to respiratory failure.

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Non-Hodgkin's lymphoma involving the tracheobronchial tree is uncommon. A 60-year-old man presented with severe cough for two months. Bronchoscopy disclosed an ulcerative lesion at the lower trachea and carina with anterior tracheomediastinal fistula, and biopsy revealed tracheal wall B-cell lymphoma. After chemo-radiotherapy, the tracheomediastinal fistula healed, but eight months later, tracheal stenosis was diagnosed by bronchoscopy. A self-expansible metallic stent was placed, which successfully maintained the airway.

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Primary tracheal tumors are uncommon, making up only 0.2% of all respiratory malignancies. Adenoid cystic carcinoma (ACC) is the most common tumor, accounting for about 30% of primary tracheal tumors. It is often difficult to manage these tumors surgically, due to its expansion and submucosal invasion, and furthermore, due to the patient's condition. Thus, it is essential to perform palliative treatment in order to maintain the airway through and to control the progress. Herein, we report a case of ACC treated by repeated bronchoscopic argon plasma coagulation (APC) as palliative therapy.
A 71-year-old Japanese male was referred to our hospital's emergency department for dyspnea. Bronchoscopic examination revealed expanded intraluminal obstructive bronchial tumors from the left bronchus to right. The patient had undergone bronchoscopic APC treatment several times. The obstruction was improved, and no worsening was seen for 26 months. Repeated bronchoscopic APC as a palliative therapy is promising and useful therapy without heavy adverse reactions to control the tumor growth.

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We experienced a case of massive mediastinal liposarcoma expanding to the bilateral pleural cavities. Preoperative positron emission tomography-computed tomography scan showed that the uptake of ¹⁸F-fluorodeoxyglucose (FDG) into the tumor was slight for its size. Clamshell incision together with lower median sternotomy provided the excellent visualization and the complete resection of the tumor. The surgical resection should be performed even for a massive liposarcoma, especially if the uptake of F-FDG into the tumor is low, as complete surgical resection is the only definitive treatment for liposarcoma.

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Plasma cell neoplasms can present as a single lesion (solitary plasmacytoma) or as multiple lesions (multiple myeloma). Solitary plasmacytoma is a rare plasma cell neoplasm. There are 2 separate entities, dependent on the location of the lesion originating in either bone or extramedullary soft tissue. It is defined as a proliferation of monoclonal plasma cells without evidence of significant bone-marrow plasma-cell infiltration. We present a 71-year-old woman who was diagnosed with a solitary plasmacytoma of the bone located in the right third rib after surgical resection. A chest roentgenogram showed a solitary expanding lesion in the right third rib. Chest computed tomography (CT) revealed an osteolytic chest wall tumor. Fluorodeoxyglucose positron emission tomography and CT (PET-CT) showed no abnormal uptake in the whole body, except for the third rib lesion. The patient underwent complete en-bloc resection of the chest wall including ribs, muscle, and parietal pleura. The patient is asymptomatic without any recurrence after one and a half years of follow up.

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