The subjects of this retrospective study were 628 men and 286 women who underwent surgery for primary lung cancer. The clinicopathological features and surgical outcomes of these 914 patients were reviewed and analyzed in terms of gender. There was no significant difference in the ages of the patients. Adenocarcinoma and pathologic T1 disease were more frequent in women than in men, but there was no significant difference in the distribution of pathologic N-status and operative methods. The 5-year survival rate of the women was significantly higher than that of the men, being 62% vs 44%, respectively (p<0.01). A multivariate analysis of survival revealed that gender was a significant prognostic factor, with a relative risk for women of 0.60 (p<0.01), along with the covariates of age, T-factor, N-factor, pathological type, and operative method. Age, T-factor, and N-factor were all significant prognostic determinants, whereas pathologic type and operative method were insignificant determinants of survival. According to the subset analysis, female gender was a significantly favorable prognostic factor in patients with T1 disease or adenocarcinoma, but it was insignificant in patients with advanced disease or squamous cell carcinoma. In conclusion, women with lung cancer had a more favorable prognosis than men. We attributed this result to the lower malignant potential of the small adenocarcinoma found in women.

View full abstract

Pneumomediastinum secondary to bronchial asthma is common. However, spontaneous pneumomediastinum in a healthy patient without underlying disease is relatively uncommon. Eight patients were admitted to our hospital with a diagnosis of spontaneous pneumomediastinum. Almost all the patients were slender teenaged males. Predisposing episodes for the development of spontaneous pneumomediastinum could be identified in all 8 patients; sports in 5, loud voice in 2, labor in 1. The most common presenting complaint was neck pain in all 8 patients, chest or back pain in 6, dyspnea in 2. All patients responded well to bed rest and antibiotic therapy. No surgical treatment was necessary. Typically, the patient becomes asymptomatic with complete reabsorption of the mediastinal air within a week. No recurrent pneumomediastinum occurred.

View full abstract

A 32-year-old female diagnosed with a severe attack of bronchial asthma was admitted to our affiliated hospital and intubated. She was diagnosed with adenoid cystic carcinoma of the trachea by transcutaneous biopsy and was admitted to our hospital. Bronchofiberscopy revealed invasion of the carcinoma from the 2nd tracheal ring and severe stenosis of the trachea. We failed in stenting the stenotic trachea and operated on her as a semi-emergency. After intraoperative histological diagnosis showed neither residual tumor of the trachea nor metastasis of pretracheal lymphnodes, subtotal resection of the trachea combined with total laryngectomy and subtotal thyroidectomy was performed. According to Grillo's procedure, an anterior mediastinal tracheostomy was performed at the 4th ring from the carina with a pedicled major pectralis musculocutaneous flap.rA newly designed nasal-airway tube was applied to maintain patency of the stoma. In this patient with adenoid cystic carcinoma of the trachea, we consider that complete resection of the tumor should preferably be performed, although this tumor shows low grade malignancy.

View full abstract

A 46-year-old woman with three episodes of right pneumothorax related to onset of menstruation was reported. Video-assisted thoracoscopic surgery (VATS) revealed the presence of some defects in the central tendon of the diaphragm. Partial resection of the diaphragm including the lesions was performed. Histological findings of the resected diaphragm were compatible with catamenial pneumothorax. Leuprorelin as hormonal therapy was administered for 8 months post surgically. Seven months after cessation of the hormonal therapy, right pneumothorax relapsed. Hormonal therapy is necessary for prevention of relapse after VATS of catamenial pneumothorax.

View full abstract

A 48-year-old woman presented swelling of anterior chest wall 10cm in diameter with redness and pain. A hematological examination revealed increased inflammatory response. Chest plain X-ray showed a tumorous mass in the right hilum of the lung. A chest CT scan revealed an irregularly shaped tumor 10cm in diameter with invasion into the chest wall and destruction of the costal cartilage. The tumor was localized between S³ and S⁵, and it was adjacent to the cardiac shadow. Aspiration biopsy was performed to make the final-diagnosis of invasive tumor. A purulent discharge flowed from the punctured site, and open drainage was made. A pathological study revealed sulfur granules composed of filamentous Druse with severe inflammation. The purulent discharge was incubated and Actinomyces israelii was isolated. From these findings, pulmonary actynomycosis was diagnosed, and ABPC administration was started. One month later, the tumor size decreased. The dosage of AMPC was continued for a further 6 months on an outpatient basis, and now the patient was closely followed up.
Actynomycosis should be considered as a differential diagnosis of tumor disease with invasive lesion.

View full abstract

We encountered a case of lung cancer associated with myelodysplastic syndrome (MDS). A 65-year-old man was admitted in November 1999 because of abnormal shadow on chest X-ray. He was diagnosed as having MDS 4 months before admission. Chest CT scan demonstrated a rapid growth of the tumor in right S¹, which strongly suggested primary lung cancer. Laboratory studies on admission revealed: white blood cell count 2, 510/mm³ with 24.5% neutrophils, hemoglobin 9.2g/dl, and platelet count 8.1×10⁴/mm³. Supportive therapy including administration of granulocyte colony-stimulating factor and transfusion of red blood cells and platelets was performed during perioperative period. Intraoperative aspiration needle biopsy of the tumor demonstrated squamous cell carcinoma. Right upper lobectomy and mediastinal node dissection were carried out safely. There were no postoperative complications, such as infection or bleeding. We discuss the surgical indications and perioperative management of a lung cancer patient with MDS.

View full abstract

We encountered two cases of suspected primary pulmonary aspergilloma occurring in patients with no past pulmonary disease. Radiographic findings disclosed cavity formations in neither patient but nodular shadows. Transbronchial lung biopsies were performed, and the specimens were histologically diagnosed as pulmonary aspergilloma in both cases. In one case, following the oral administration of ITCZ for about 4 months, the radiographic lesion shows no improvement. Then, surgical resection was done. In the other case, surgical resection was done without administration of antifungal agents. The resected lungs contained aspergillus ball formation within enlarged bronchi in both cases. These cases were interesting, being suspected as primary pulmonary aspergilloma with neither past pulmonary disease nor any immunocompromised condition.

View full abstract

A 71-year-old female was pointed out a 2.0-cm right upper lobe nodule on chest roentogenography during mass screening for lung cancer. Chest CT showed a lobulated nodule with cavitation in the superior dorsal segment (S²) of the right lung. The patient underwent video assisted right upper lobectomy. Pathologic analysis demonstrated that the lesion was composed of eosinophilic amorphous material, that was positive for Congo red staining and immunohistochemical staining of the AL λ chain. These findings confirmed the diagnosis of localized nodular pulmonary amyloidosis.
Localized nodular pulmonary amyloidosis is a rare entity and usually identified incidentally by chest radiography. Awareness of this entity is important in the differential diagnosis of pulmonary nodular lesions.

View full abstract

We report two noteworthy cases of lymphatic lesions originating from the thymus. Case 1 was a 29-year-old female. She visited our hospital, complaining of pain and swelling of her wrist and knee joint. She was diagnosed as having Sjogren syndrome and rheumatoid arthritis. Chest CT and ⁶⁷Ga scintigraphy revealed a mass (about 3 cm in diameter) in the thymus. She underwent thymectomy. The lesion resected was histologically evaluated as lymphatic follicular hyperplasia of the thymus. Reconstitution of the tumor tissue gene revealed proliferation of monoclonal lymphocytes. It seemed that the patient was probably in a prodromal state of complication of SjOgren syndrome by malignant lymphoma. Case 2 was a 14-year-old boy who visited our hospital because of precordial pain and fever. By chest plain X-ray and CT examination an irregularly shaped mass (about 10 cm in diameter) in the anterior mediastinum was detected. Because a definite diagnosis could not be done by thoracoscopic biopsy, surgery was conducted. The main tumor was located in the thymus and it had invaded the pericardium and the left brachiocephalic vein. The tumor-invaded region was resected, and the thymus and tumor were removed en bloc. The tumor was judged histologically and immunohistochemically as being diffuse large B cell lymphoma with sclerosis originated from the thymus. Postoperative adjuvant chemotherapy was administered. At present, 12 months after surgery, the patient shows no signs of recurrence.

View full abstract

A 19-year-old male without any clinical manifestations consulted our institution after an abnormal shadow was pointed out in his right lung. Even though he received trans-bronchial lung biopsies twice, we were unable to reach a definitive diagnosis of the mass in his right lung. We conducted a video assisted thoracic surgery, adding a small window to his chest wall for resection of the middle lobe. The resected specimen revealed to be a solitary bronchial papilloma of the middle lobe and was located at the B⁴, B⁵ orifice. The papilloma secreted copious mucus. There was a cluster of tumor cells implanted in the mucus of the peripheral bronchus. This means that endoscopic resection or laser ablation of the bronchial papilloma would not be sufficient. We studied the resected specimen by PCR examination with consensus primers to detect human papilloma virus (HPV), but could not detect HPV type 16 DNA in the tumor. His postoperative course was uneventful, and he was discharged on the 15th post-operative day. He is now followed up periodically and carefully for recurrence.

View full abstract

A 20-year-old man was admitted because of an abnormal shadow on chest X-ray film. Chest CT showed large cystic shadows and many small cystic shadows in the right lower lobe. He underwent right lower lobectomy of the lung under the diagnosis of cystic lung disease. Microscopically, cyst walls were covered by ciliated columnar cells and lacked cartilage. These findings supported the diagnosis of congenital cystic adenomatoid malformation of the lung (CCAM). CCAM presents respiratory distress mainly in neonates and presents pulmonary infectious signs in adults. It is rare for CCAM to be found by a chest X-ray film of medical check-up.

View full abstract

SF₆ gas has hither to been used for the purpose of preventing excessive expansion of contralateral lung after pneumonectomy. However, to make maintenance period longer, C₃F₈ gas used in the ophthalmological field was applied, and comparison was made with SF₆ gas. Selected for the present study were 5 patients who underwent left pneumonectomy. They consisted of 3 males and 2 females, and the period of thoracic cavity volume control ranged from one year to 8 years and 6 months. Period of observation from initiating the use of C₃F₈ gas was about one year and 6 months. SF₆ gas was switched over to C₃F₈ gas in 3 patients, and C₃F₈ gas was used from the beginning in 2 patients. The period of maintenance with SF6 gas was 5 to 6 months. However, with the use of C₃F₈ gas, it was possible to make the maintenance twice as long. Besides, the amount of C₃F₈ gas needed was about half the amount of SF₆ gas. Thus, the use of C₃F₈ gas made it possible to achieve longer maintenance with less amount of gas as compared with SF₆ gas. Therefore, as a gas for thoracic cavity volume control, C₃F₈ gas was considered more effective than SF₆ gas.

View full abstract

We report a case of pulmonary arteriovenous fistula (PAVF), which merged with brain abscess. A 38-year-old male had been pointed out an abnormality on a chest X-ray by medical checkup.rHe was admitted to an other hospital for headache and semicoma following an evidence of fever. Brain abscess was revealed, and medical treatment was administered. One of causes of the brain abscess was considered as PAF. He was admitted to our hospital for radical cure. He had dyspnea on exertion and hypoxemia. As allergy to contrast materials was detected, embolotherapy was evaluated to be contraindicated. Segmentectomy of left segment 9+10 was performed. Postoperative course was satisfactory, and he was discharged 14 days later. Dyspnea on exertion and hypoxemia were improved. In this case, surgical resection was considered to be appropriate indication.

View full abstract

A successfully treated case of postoperative chylothorax is herein reported. Lymphoscintigraphy with orally administered 123 I-BMIPP showed a marked pooling of the isotope near the azygos vein in the right mediastinum, indicating chylothorax caused by injury to the lymphatic vessels. Low fat diet therapy failed to alleviate the chylothorax, but the chyle disappeared as a result of Macton oil ^® diet therapy. Macton oil ^® consists of 85% Medium Chain Triglyceride (MCT) and 15% Long Chain Triglyceride. MCT is absorbed in the small intestine and travels directly to the liver via the portal vein. MCT does not travel in the lymphatic vessels. Macton oil^® diet therapy is thought to be effective for treatment of postoperative chylothorax.

View full abstract

Primary Spontaneous hemopneumothorax, a disease rarely encountered in clinical practice, is characterized by the accumulation of air and blood in the pleural space without any apparent cause. However, bilateral cases have never been reported. We encountered bilateral spontaneous hemopneumothorax, which was managed by emergency video-assisted thoracoscopic surgery (VATS). A 28-year-old male complained of left chest pain, and his chest X-ray revealed left pneumothorax. Approximately 400ml of blood was drained from the left thoracic cavity. Because of drainage of blood, emergency surgery was performed with VATS. A funicular structure was noted on the pleural cupula and on the apex of the lung with an emphysematous change. Bleeding was seen from the funicular structure on the pleural cupula. The bleeding point was clipped, and the lung tissue with the funicular structure was resected partially. Total blood loss was 1030g, and blood transfusion was not required. Postoperative course was uneventful and discharged on the fourth day after surgery. Four months later, the patient developed right chest pain, and right hemopneumothorax was diagnosed. An emergency VATS was performed again. A funicular structure with blood clot was noted on the pleural cupula and the apex of the lung without an emphysematous change. The root of the funicular structure on the lung was torn 1 to 2mm in length. The funicular structure was clipped, and the lung tissue with the funicular structure was resected partially. Total blood loss was 150g and blood transfusion was not required. He was discharged on the third day after surgery.

View full abstract

Mediastinal liposarcoma is a rare tumor, We encountered five patients with mediastinal liposarcoma who underwent surgical treatment in our department between January 1992-December 1999. These 5 patients were all men, and mean age was 43 years old (ranging from 12-75). 3 underwent right posterolateral incision, 1 left posterolateral incision and 1 median-sternal incision. complete resection were performed for 2 patients, palliative resection for 2 because of infiltration of tumor to other organs and exploratory incision for 1. Pathological types: well-differentiated type in 1 and myxoid type in 4. One patient who underwent exploratory incision died 5 months postoperatively, Two who underwent palliative resection died of recurrence and metastasis 10 months and 65 months postoperatively, respectively, while the 2 who underwent complete resection are alive at 23 months and 48 months, respectively. We conclude that complete resection is a very important prognostic factor in liposarcoma cases.

View full abstract