Autologous lymphocytes that were activated and expanded ex vivo following loading MUC1 antigens were adoptively transferred into three patients with metastatic lung cancer. One of the patients acquired MUC1-specific cellular immunity after treatment. Degrees of fatigue and anorexia were reduced in one of the 3 patients. However, clinical responses such as tumor regression or reduced tumor marker levels were not obtained in any patient. Although fever in 2 and shortness of breath in one of the patients were observed as adverse effects, both effects occurred temporarily and were not severe. This treatment, which is tolerable to cancer patients and enables antitumor immunity, is expected to be useful in molecular targeting immunotherapy against metastatic lung cancer.

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Between April 1999 and December 2004, 594 patients underwent mediastinoscopy. In this study, we reviewed 54 non lung cancer patients, with mediastinal lymph node swelling in 30 patients, mediastinal tumors in 11 patients, metastatic lung tumors in 6 patients, lung nodules in 4 patients, mediastinal tumors in 2 patients who underwent extirpation by mediastinoscopy, and mediastinitis in 1 patient who underwent drainage by mediastinoscopy, In 30 patients with lymph node swelling, diagnoses were sarcoidosis in 15 patients, non-specific swelling in 8, malignant lymphoma in 6 and silicosis in 1. In 11 patients with mediastinal tumors, diagnoses were thymoma in 5 patients, lymphatic cysts in 2 and Castleman's disease, esophageal cancer, metastatic ovarian cancer and recurrence of leukemia in one patient. Therapeutic mediastinoscopy for 3 patients was sucessful all cases.
Mediastinoscopy was a useful diagnostic method for mediastinal lymph modes or tumors, and a useful surgical method for mediastinal diseases in selected patients.

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A 13-year-old male presented with a huge mediastinal tumor expanding into the right thoracic cavity. He had been admitted to pediatrics for treatment of the acute myeloid leukemia (AML). Chemotherapy had been performed against the AML, but no response was detected from the mediastinal tumor. Complete tumor resection was performed. The right lung was strongly pressed by the tumor and did not have sufficient expansion, even after tumor resection. Post-operative chest X-ray film showed right pulmonary edema. A diuretic, steroid therapy and positive end-expiratory pressure (PEEP) support were administered. Just after recovery from the right pulmonary edema, left sided pulmonary edema was detected, and temporary artificial ventilation was necessary. Re-expansion pulmonary edema is fatal without suitable therapy. We suggest that long-term pressed lung will always cause pulmonary edema, and aggressive treatment is alway necessary from an early stage.

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A 47-year-old man who had been given a diagnosedis of with myotonic dystrophy was admitted to our hospital because of the presence of dyspnea and facial edema. Chest X-ray filrm showed a mediastinal mass shadow at the mediastinumin the right lung field, and chest CT revealed a cystic mediastinalcystic lesion in the mediastinum mass, suspected to be a benign mediastinaltumorpericardial cyst. PA percutaneous drainage guided by CT was performused and about 100ml of fluid was removevacuated. Cytological analysis of the fluid showexhibited no malignant cells. After drainage, thehis symptoms was improved, but in several days, the symptoms appeared again and the size of the mediastinal masscyst returned to the same as beforeinitial size. We suggestoffereded a thoraocoscopic thoracoscopic operation forto the patient, but the patient rejected the operation because of the high risk of respiratory failure due to myotonic dystrophy. Therefore, So we decided on ethanol injection therapy into for the cystic mediastinal cysttumor as a less invasive treatment. After treatment, the mediastinal cyst tumor disappeared duringover 4 weeks. The pPatient isdied of another disease, but the patient showed no recurrence after ethanol injection treatment. alive without any evidence ofrecurrence. Percutaneous ethanol injection therapy couldan be one of thean effective treatments for mediastinal cystbenign cystic mediastinaltumor.

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An 80-year-old man was admitted because of an abnormal mass on chest X-ray. The chest CT scan showed a 4.0cm-sized tumor in right S5b. Video-assisted partial resection of the middle lobe was performed. The pathological diagnosis was combined large cell neuroendocrine carcinoma (LCNEC) and adenocarcinoma. Two weeks later, middle lobectomy combined with mediastinal lymph node dissection (ND2a) was performed. Pathologically, there was no cancer cell or lymph node metastasis, histological staging grade was I B (T2N0M0). The postoperative course was good, and he was discharged without chemotherapy. The patient has been followed without evidence of recurrence. To the best of our knowledge, only 10 other cases of combined LCNEC have been reported. We present a case together with literature review.

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A 68-year-old man visited our hospital, due to a well-defined tumor in the lower field of the left lung, detectedly chest X-ray. Adenocarcinoma was the biopsy diagnosis of the lung tumor. The patient also presented with swelling of the bilateral lower extremities, toe clubbing and arthralgia of both knee joints. There was radioisotope accumulation in the bilateral legs. Therefore, we diagnosed his illness as “Marie-Bamberger Syndrome”. Soon after left lower lobectomy, the swelling of the bilateral lower extremities and arthralgia of both knee joints significantly improved.

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A 57-year-old female was admitted to our hospital because of left anterior chest discomfort. Chest X-ray and thoracic computed tomography (CT) showed a 3.5cm mass in the left lower lobe, which was cytologically diagnosed as adenocarcinoma, and abdominal CT revealed a 3.0cm left adrenal mass (AM). The AM was suspected to be a benign tumor, however we could not rule out a metastatic tumor from lung cancer because of an elevated serum CEA level (110ng/ml). Then left lower lobectomy (ND2a) and transdiaphragmatic left adrenalectomy was simultaneously performed. The AM was clearly exposed just under the phrenotomy and resected easily. Postoperative pathological finding of the AM was nonfunctioning adenoma. When an adrenal mass is encountered in a lung cancer patient, both lesions may indicate surgical resection to rule out an adrenal metastasis and for curative resection. If both lesions are synchronous and homolateral, simultaneous transdiaphragmatic adrenalectomy is a feasible method in selected patients.

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A 16 year old male was admitted due to prolonged fever, and atelectasis of the right posterior basal segment on chest X-ray. Bronchoscopy revealed a tumor obstructing the right B¹⁰. A tumor biopsy was taken, and the diagnosis was granular cell tumor. Bronchoscopic laser irradiation was attempted, but the tumor margin could not be adequately identified. Consequently, right lower lobectomy was performed. The resected lower lobe showed obstructive pneumonia, and microscopically, the tumor extended beyond the bronchial lumen. These findings justified lobectomy. The patient remains free of recurrence 9 years after resection.

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A 73-year-old man was admitted to our hospital because of an abnormal shadow in the chest roentogenogram. CT and MRI showed that the tumor was located in the right upper mediasinum. Under the diagnosis of benign mediastinal tumor, the patient underwent the excision through median sternotomy with collar incision. The tumor, 5×3×3.5cm in size, was encapsulated, located in front of the right subclavian artery, and originated from the right vagal nerve proximal to the recurrent laryngeal nerve. The tumor was removed by transection of the vagal nerve. The histological diagnosis was neurinoma. Post operative course was uneventful except for hoarseness due to paralysis of the recurrent laryngeal nerve.

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An anterior mediastinal tumor was identified in a 42-year-old man during an annual health check with computed tomography (CT) about 3 years previously. As the tumor was so small, no further examination was scheduled. He was followed up for three years. As the size of the tumor increased, however, an operation was performed. The tumor was resected with video-assisted thoracoscopic surgery (VATS), and was shown to be thymic cancer with a rapid pathological examination. We subsequently performed an extended thymectomy and mediastinal lymph node dissection.
As annual health check-ups with CT were popular in the recent past, many small mediastinal tumors were identified, but in most of those cases further examination was not scheduled because of the small size of tumors. However, our case demonstrates that it is very important to confirm the diagnosis with VATS or a CT guided needle biopsy in cases of small mediastinal tumors identified with CT.

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Case 1. A 57-year-old woman was admitted due to hemosputum. Chest CT film of case 2 showed a tumor shadow with slow speed growth. She underwent thoracotomy. The histological diagnosis was a sclerosing hemangioma.
Case 2. A 56-year-old man was admitted due to an accumulation in the left lung hilum on FDG-PET. Chest CT film showed a tumor shadow and a hilar mass. We performed thoracotomy with suspicion of primary lung cancer. The histological diagnosis was a fibrous plaque in the lung and a sarcoid reaction with granuloma of the lymph node.
Case 3. A 71-year-old man was admitted due to increase of sputum. Chest CT film showed a tumor shadow and a subaortic lymph node swelling. Thoracic surgery was performed. The histological diagnosis was reactive hyperplasia with proliferation of macrophage in the lymph node. Considering false positive cases on FDG-PET in primary lung cancer, care managements should be taken regarding decisions about operation and staging. Further investigation is required to increase the sensitivity and specificity on FDP-PET.

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A 54-year-old man underwent left upper lobectomy with c-stage IIIA lung squamous cell carcinoma after concurrent chemo-radiotherapy. Radiation pneumonitis focusing on the residual left S⁶ appeared after operation. Following steroid pulse treatment, the pneumonitic focus was cavitated and proceeded to pulmonary abscess. Although chest drainage was performed, control of the pulmonary fistula was poor, so an operation was performed. Pulmonary decortication and pleurodesis were performed, but failed to control the fistula and infection. Finally, thoracoplasty, omentoplasty and free rectus abdominis musculocutaneous flap were filled in intrathorasic to manage the fistula. In this case of operation following concurrent chemo-radiotherapy, the original recovery power declined. We therefore conclude this was an intractable case of empyema.

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We encountered a case of pleural metastasis from breast cancer with 16-year disease-free interval. A 71-year-old woman was admitted to our hospital because of dry cough. She had undergone modified radical mastectomy. A chest radiography revealed right pleural effusion, so Video-assisted thoracoscopic pleural biopsy was performed and we diagnosed pleural metastasis of breast cancer. Intrapleural chemotherapy and hormonal therapy were performed. In 55 months of follow-up since pleural biopsy, pleural effusion has not recurred.

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A 67-year-old man complaining of a tumor in his right back had a biopsy performed in a previous hospital and was diagnosed with leiomyosarcoma. He was referred to our department for further examination and treatment. As the CT and MRI revealed the localization of the tumor in the latissimus dorsi muscle, the operation was performed. We resected the tumor including the latissimus dorsi muscle with its fascia and anterior serratus muscle with a wide margin. We prescribed a radiation therapy after the operation (total 50Gy).
We experienced a rare case of leiomyosarcoma arising from the latissimus dorsi muscle.

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A 21-year-old man was admitted to our hospital with a complaint of chest pain. Chest X-ray showed left pneumothorax. Because of persistent air leak, he underwent a videothoracoscopic wedge resection of the lung. Operating time was twenty six minutes and perioperative water balance was +687ml. On the first postoperative day the patient had difficulty in breathing when he moved. Arterial blood gas analysis showed hypoxemia. Chest CT revealed a contrast defect in the right basal pulmonary artery. Pulmonary perfusion scan showed a defect in the right lower lung. Under the diagnosis of pulmonary thromboembolism, he received anticoagulant therapy; intravenous heparin followed by oral warfarin. The hypoxemia improved gradually and oxygen administration was stopped on the sixth operative day. On the following day, re-perfusion scan showed no defect left in the right lung. Although hematological investigation revealed positive anticardiopilin antibody at the onset of pulmonary thromboembolism, this case did not meet the diagnostic criteria for antiphospholipid syndrome. Attention should be paid to postoperative pulmonary thromboembolism even in a low-risk young patient with pneumothorax.

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The patients was a 71-year-old man. During his hospital stay, routine chest High-Resolution Computed Tomography (HRCT) revealed a 10mm ground glass opacity in the left lung (S⁴). During follow up by chest HRCT, the GGO showed gradually increased density. We suspected pulmonary adenocarcinoma, and, therefore, performed left segmentectomy (S⁴⁺⁵) for diagnosis and cure on 22nd June 2004. The pathologic sample revealed Cryptococcus neoformans.
We found this case was difficult to differentiate between adenocarcinoma and pulmonary cryptococcosis by chest HRCT. If GGO changes rapidly, we should suspect that it may be not only adenocarcinoma but also pulmonary cryptococcosis.

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An abnormal mass shadow was found on the chest X-ray of a 73-year-old Japanese male who had a history of operation for hepatocellular carcinoma. Bronchoscopy revealed a tumor in the right upper bronchus. After right upper lobectomy and lymph node dissection, the resected tumor was found to measure 8×4×4cm in size and to extend through the endobronchial surface. It was diagnosed as a metastatic carcinoma from a hepatocellular carcinoma. It is uncommon that a metastatic carcinoma from hepatocellular carcinoma extends endobronchially.

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