Background
The serum levels of cytokines and growth factors are altered after surgery. It has not been investigated how such alteration affects the metastatic ability of cancer cells.
Methods
The sera of 16 lung cancer patients from before and after surgery was subjected to the in vitro assays for cytotoxic activity, attachment capacity to endothelial cells, and cell proliferation, using human non-small cell lung cancer cells.
Results
The patient sera from after surgery showed higher cytotoxic activity to cancer cells, inhibited cancer cell attachment to vascular endothelial cells, and promoted cancer cell proliferation, compared with the sera from before surgery.
Conclusion
Alteration of serum contents after lung resection may depress the metastatic ability of intravascular lung cancer cells, and promote the cell proliferation of metastatic lesions.

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A 57-year-old woman underwent a mastectomy for left breast cancer (invasive ductal carcinoma, papillotubular type) in July 1997. She revealed an abnormal shadow in the right lung with chest computed tomography in July 2002. It was a ground glass opacity shadow 2cm in diameter. There were no other metastatic lesions detected. Brushing cytology under bronchofiberscopy showed a suspicious lesion. The tumor was resected by video-assisted thoracoscopic surgery in September 2002, and a pathological examination revealed that the tumor was a lepidic metastasis of breast cancer.

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A 53-year-old man underwent operation for right upper lobe lung cancer . Intraoperativery, his left main bronchius was injured by a double-lumen tube. The laceration was safely repaired with interrupted sutures. The outcome was good, however, there were some potential risks. Although one lung ventilation is common procedure in thoracic surgery, it occasionally produces severe complications. Prevention is the most important. Nevertheless, when this kind of accident occurs, immediate action must be taken. Although it is rare, we should always be prepared to cope with this kind of situation.

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We report two cases of radiation ulcer on the chest wall more than 30 years after irradiation therapy. In Case 1, a 57-year-old woman who had been treated for pulmonary metastasis of choriocarcinoma by irradiation about 35 years earlier was admitted to our hospital because of ulceration on the left posterior chest wall. Posterior chest wall resection and reconstruction using a latissimus dorsi myocutaneous flap was performed. About 4 years after the operation, she was re-admitted to our hospital because of ulceration on the left anterior chest wall. Anterior chest wall resection and reconstruction using a pectoralis major muscle flap was performed. In Case 2, a 68-year-old woman who had undergone right radical mastectomy followed by irradiation for breast cancer about 34 years earlier was admitted to our hospital because of recurrence of radiation ulcer. For radiation ulcer on the anterior chest wall, right anterior chest wall resection and reconstruction using a left pectoralis major muscle flap had been performed 9 years earlier. After debridement, reconstruction using a right latissimus dorsi myocutaneous flap was performed. Both patients are alive without any evidence of recurrence.

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A 60-year-old man was admitted to our hospital for further examination of a huge tumor of the right chest and persistent hemoptysis. Radiological examinations revealed chronic empyema and a stenosis of the portal vein at the hepatic hilum. Endoscopic examinations revealed esophageal and bronchial varices. These varices seemed to be caused by portal hypertension due to extrahepatic portal vein stenosis.

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Castleman's disease, otherwise known as benign lymph node hyperplasia, most commonly occurs in the mediastinum. We report two cases of Castleman's disease in the mediastinum, which we successfully resected using video-assisted thoracic surgery (VATS). Patient 1 was a 21-year-old woman referred to us after a routine chest x-ray showed an abnormal shadow in the right upper mediastinum. Chest computed tomography (CT) showed a round mass, 50×42mm in size, in the upper and middle mediastinum. We resected the tumor completely by VATS, and it was diagnosed as the hyaline-vascular type of Castleman's disease . Patient 2 was a 63-year-old woman in whom a chest x-ray, taken during an admission to the dermatology ward for oral erosion, showed an abnormal shadow in the right lower mediastinum. Further examinations suggested a diagnosis of paraneoplastic pemphigus. Chest CT showed a round mass, 60×40mm in size, in the posterior mediastinum. We resected the tumor completely by VATS, and it was diagnosed as the hyaline-vascular type of Castleman's disease.

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Breast cancer tends to relapse a long time after the primary treatment, compared with other cancers. It is usually difficult to distinguish breast cancer metastases to the lung from primary lung cancers. We employed immuno-histochemical analysis to diagnose two cases of breast cancer metastases to the lung, 13 and 17years after the surgical treatments. Casel was a 52-year-old female presenting a lung tumor 25mm in diameter at left S¹⁺². She had undergone right mastectomy for breast cancer 17years before. Partial resection of her left lung was performed. Case2 was a 53-year-old female with a lung tumor 20mm in diameter at left S³. She had undergone left mastectomy for breast cancer 13years before. Her lung tumor was diagnosed as adenocarcinoma by transbronchial lung biopsy. Left upper lobectomy was performed. Both cases showed positive immunohistochemical staining of GCDFP-15 (gross cystic disease fluid protein-15), and we finally diagnosed them as having breast cancer metastases to the lung.

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A 44-year-old woman had a thymolipoma that was monitored for two and a half years during the postoperative followup for breast cancer. She was admitted to our hospital, because the thymolipoma did not seem to change and the postoperative course of the breast cancer was favorable. Chest CT scan revealed a tumor measuring 4.5×3.0cm with a clear boundary and relatively uniform internal density in the anterior mediastinum with a CT number of-111HU. Chest MRI showed a hyperintense mass on both T1-and T2-weighted images. A median sternotomy was made to remove the thymus gland and thymolipoma. The tumor measured 5.5×3.0×4.5cm in size and was located in the right inferior lobe of the thymus gland. The tumor was elastic soft, and covered with a thin membrane, while its internal part was solid and uniformly yellow. The total weight of the removed thymus gland and thymolipoma was 60 g. Pathological examination revealed a solid tumor covered with a thin fibrous membrane in the thymus gland with Hassall's corpuscles and nodular hyperplasia of mature adipose tissues inside the tumor. We herein report this case along with a literature review since there were no notable changes in the chest CT for approximately two and a half years.

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Sternal fracture is rare among traumatic bone fractures. We reviewed 18 cases of sternal fracture treated during the past ten years. The causes of fracture were traffic accidents in 11, falls in 3 and others in 4. Associated injuries in these patients included rib fractures in 6, hemopneumothorax in 5, fracture of the clavicle in one, thoracic vertebral fracture in one and lumbar vertebral and pelvic fracture in one. Twelve patients were treated by conservative management and 6 by surgery. Surgical procedures were performed with I 3 wires, II one wire and band, III two wires and IV two wires and one absorbable sternal pin. Good results were obtained in 4 patients. Displacements were observed again in two patients probably because our surgical managements were not enough and they could not keep natural posture after operation. Surgery should be indicated for the patients with 1) dislocation of the sternum with severe pain or 2) risk of injury to adjacent organs.

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Mediastinal malignant lymphoma is generally a homogeneous tumor and a cystic variant is ver y rare. We report a rare case of mediastinal malignant lymphoma showing a cystic shadow. A 59-year-old man was referred to our hospital for further examination of tumor shadows in the left mediastinum on chest X-ray film. Chest computed tomography (CT) scan and magnetic resonance imaging (MRI) revealed a cystic shadow in th e left anterior mediastinum and two nodular shadows in the upper mediastinum. We suspected thymus, related anterior mediastinal tumor and lymph node swelling, so we performed resection of the tumor. Histological examination revealed a diffuse large B cell lymphoma, and a cystic part on chest CT scan (and chest MRI) was proved to be a component with necrotic tissue. Adjuvant chemo-radiotherapy was performed and there have been no findings of recurrence 22 months after the operation.

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The patient was a 66-year-old woman with bronchial asthma. During a routine follow-up examination, chest X-ray revealed a nodular shadow in the right lower lung field, and she was referred to our hospital for thorough investigation. Computed tomography (CT) scanning of her chest demonstrated a well defined nodular shadow measuring 10×8 mm with a surrounding ground glass-like infiltration shadow extending from S⁴ to S⁵ in the right lung. After a one-month follow-up, the shadow showed no tendency of regression, and the possibility of malignant tumor could not be ruled out, either. Consequently, a lung biopsy was performed using a thoracoscope. In thoracoscopy, a dark red nodule with pleural indentation was seen. Intraoperatively, rapid-freeze biopsy revealed moderate infiltration with lymphocytes and thickening of the blood vessel walls, suggesting an old inflammatory lesion. Histopathological examination of the resected lung tissue indicated remarkable thickening of the walls of the pulmonary alveoli and blood vessels, dilatation of the vessels, and hemorrhage inside the alveoli. Accordingly, we diagnosed the lesion as an old hemorrhagic pulmonary infarct. Herein, we report this case of an old hemorrhagic pulmonary infarct that presented radiologically with a nodular shadow and was surgically resected in a woman without underlying diseases except bronchial asthma.

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A 30-year-old woman with a history of resection of pulmonary carcinoid, who was in the seventh month of pregnancy, complained of cough, dyspnea, and chest pain. The chest X-ray and CT after delivery showed a large soft tissue mass occupying the bulk of the left hemithorax and displacement of the mediastinum to the right. Tumorectomy and intrathoracic hyperthermo-chemotherapy were performed through a thoracotomy. Pathological diagnosis of the tumor was pleomorphic liposarcoma of the pleura. She died 5 months after surgery for progressive local recurrence. To our knowledge, pleural liposarcoma is rare and only 13 cases of the disease have been reported in the English literature.

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Benign mediastinal tumor is usually resected with thoracotomy or VATS by an intercostal approach. We resected a thymic cyst by a subxiphoid approach with a flexible thoracoscope. An 80-year-old man was referred to our department for evaluation of dry cough. Chest CT and MRI revealed a rounded cystic mass 44×42×38mm in diameter with a clear margin, located at the left side of the anterior mediastinum . It was removed successfully by thoracoscpic technique through the subxiphoid approach with sternum lifting . Histopathologic examination revealed the diagnosis of a thymic cyst . We conclude that this approach is effective for the resection of benign tumors located at the anterior mediastinum.

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We experienced a case of congenital cystic adenomatoid malformation (CCAM) of the left lung with intralobar pulmonary sequestration in a 3-month-old boy. Antenatal ultrasonography at 22 weeks of gestation showed a multiple cystic lesion of the left lung. A multiple cystic lesion in the lower portion of the left lung was identified on chest radiography and computed tomography at birth. The infant developed no immediate signs of respiratory distress after birth. At 3 months of age the infant underwent left lower lobectomy because of enlargement of the cystic lesion. The specimen had an aberrant artery originating from the descending aorta and cystic lesion. Histopathologic examination showed a type II CCAM with a diameter of 4-5mm intralobar pulmonary sequestration.

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We experienced two cases of congenital cystic adenomatoid malformation (CCAM).
Case 1. A 5-year-old female was admitted to the hospital with fever and cough. Chest X-ray showed cysts with an air-fluid level in the right lower lung field. Chest CT revealed multiple cysts in the right lower lobe. We performed partial resection of the lower lobe and plication of the remaining cysts. Histologic evaluation was compatible with CCAM type 1. After the operation, she complained of fever and cough again and relapse of CCAM was observed. Right comple lower lobectomy was performed and she has been well postoperatively. Case 2. An 8-year-old male with a history of pneumonia when he was 2 years old was admitted to the hospital because of fever. Chest X-ray showed a mass shadow in the right upper lung field. Chest CT revealed a cystic mass between the superior edge of the right upper bronchus and the right apex bordering on the mediastinum. Right upper lobectomy was performed and histologic evaluation was compatible with CCAM type 1. He has been well postoperatively.

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