The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Volume 23 , Issue 7
Showing 1-23 articles out of 23 articles from the selected issue
  • Hiroyuki Oizumi, Makoto Endoh, Hiroshi Ota, Shinichi Takeda, Jun Suzuk ...
    2009 Volume 23 Issue 7 Pages 912-917
    Published: November 15, 2009
    Released: January 28, 2010
    JOURNALS FREE ACCESS
    We describe the benefits of lung resection simulation using multidetector computed tomography (MDCT). Since 2004, the 1.0-mm slice digital imaging and communications in medicine (DICOM) server has been used for storing data obtained using 64-row MDCT. We observed that an abnormality could not be visualized from the pleural surface in 10 nodules of 18 lesions undergoing wedge lung resection. These 10 nodules were resected through simulation using a three-dimensional (3D) volume-rendering method by considering parameters such as the position, depth, or distance from the interlobar abnormalities, etc., without the need for any marking methods. For lung lobectomy, identification of the branching structures, diameter, and length of the arteries is useful in selecting the procedure for blood vessel treatment. However, in the initial 10 patients of this series, the preoperative identification of 2 small arterial branches was unsuccessful when this method was used. Therefore, it is important to carefully examine the original data in all 3 views, i. e., axial, sagittal, and coronal views. The visualization of venous branches in affected segments and intersegmental veins has facilitated the preoperative determination of the anatomical intersegmental plane. We divided the cases of thoracoscopic lung segmentectomy into 3 groups (level 1: simple, level 2: intermediate, and level 3: complex) on the basis of the technical complexity. Only level 1 segmentectomies were performed without MDCT simulation. Further, level 2 and 3 segmentectomies could be successfully performed because of the introduction of MDCT simulation in 25 of 35 patients. Thus, this simulation technique may be useful during a thoracoscopic procedure for lung surgery.
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  • Jin Sakamoto, Shinji Kosaka, Kyoko Hijiya
    2009 Volume 23 Issue 7 Pages 918-923
    Published: November 15, 2009
    Released: January 28, 2010
    JOURNALS FREE ACCESS
    We reviewed 19 patients with spontaneous pneumomediastinum whom we encountered at our hospital from October 1999 to January 2008. The patients included 11 men and 8 women. There were 7 teenagers and 5 patients in their twenties. The chief complaint was chest symptoms in 15 patients (chest pain in 9, dyspnea in 5, and oppression in 1). Predisposing factors were unknown in 10 patients, while exercise appeared to be the cause in 5 patients, speaking in 2 patients, and several other individual patients were caused by coughing, vomiting, playing a wind instrument, and inhalation of He gas. Treatment involved observation in 10 patients, antibiotic therapy in 6, analgesics in 3, nil oral intake in 3, an antitussive in 1, a cervical skin incision in 2, thoracic drainage in 2, and mediastinal drainage in 2. The outcome was remission in 18 patients and death in 1. There were 2 patients whose condition became severe and required mediastinal drainage. All of the patients who required cervical skin incision and mediastinal drainage as well as the one who died were children. Especially in pediatric cases, spontaneous pneumomediastinum tends to extend to generalized subcutaneous emphysema, resulting in a severe condition such as circulatory dysfunction from compression of the great vessels and airway obstruction from emphysema. Therefore, pediatric cases required careful management and surgical treatment such as cervical skin incision and mediastinal drainage.
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  • Yutaka Takahashi, Takuya Terashi, Shinya Neri, Hiroshi Hamakawa, Teruy ...
    2009 Volume 23 Issue 7 Pages 924-927
    Published: November 15, 2009
    Released: January 28, 2010
    JOURNALS FREE ACCESS
    To evaluate the safety of one-day antibiotic prophylaxis, we retrospectively analyzed 153 consecutive cases of major pulmonary resection for lung cancer. The A group (n=66) received 2 g of cefazolin for four days. The B group (n=87) received 2 g of cefazolin only on the operative day. There was no significant difference concerning the patient characteristics, operation procedures, and postoperative events. No surgical site infection occurred in either group. One-day antibiotic prophylaxis is safe and effective for the pulmonary resection of lung cancer.
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  • Jin Sakamoto, Shinji Kosaka, Kyoko Hijiya
    2009 Volume 23 Issue 7 Pages 928-931
    Published: November 15, 2009
    Released: January 28, 2010
    JOURNALS FREE ACCESS
    We reviewed 50 neonates with pneumothorax whom we managed at our hospital from March 1999 to September 2008. There were 33 males and 17 females. There were 14 neonates with left pneumothorax, 23 with right pneumothorax, and 13 with bilateral involvement. They included 2 extremely low birth weight infants, 3 very low birth weight infants, 10 low birth weight infants, and 1 giant infant. There were 15 preterm, 35 term, and no postterm infants. Thirty-one infants developed pneumothorax on the day of delivery, which was the most frequent day of onset. The underlying diseases were meconium aspiration syndrome in 17 infants, respiratory distress syndrome in 13, transient tachypnea of the newborn in 12, and pulmonary hypoplasia in 4. Ventilation was being performed in 24 infants before the onset. The treatment included a thoracic tube in 13 infants (bilateral in 2), thoracocentesis in 2, and high concentration oxygen therapy in 4. The course was favorable in 46 infants, but 4 infants died. The 30 infants with a thoracic tube included 10 preterm infants and 12 who were on ventilation before the onset, and the incidence was significantly higher in these infants than in term infants and infants who were not on ventilation. Among the 4 infants who died, 3 were preterm and all 4 were on ventilation before the onset. All of the infants who died had underlying lung diseases. We conclude that thoracic drainage must be considered actively when neonatal pneumothorax occurs in preterm infants or those on ventilation before onset.
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  • Hirohisa Kato, Hiroyuki Oizumi, Naoki Kanauchi, Mitsuaki Sadahiro
    2009 Volume 23 Issue 7 Pages 932-935
    Published: November 15, 2009
    Released: January 28, 2010
    JOURNALS FREE ACCESS
    Pulmonary capillary hemangioma is a rare disease. The findings on computed tomography (CT) are similar to those of bronchioloalveolar carcinoma. We report a case of pulmonary capillary hemangioma. A 55-year-old man was admitted to our hospital with a pulmonary nodule. A chest CT scan revealed a small nodule with ground-glass opacity in the anterior basal segment of the right lung. As the nodule was suspected to be lung cancer, we performed a right anterior basal segmentectomy using a totally thoracoscopic surgical procedure. The pathological diagnosis was pulmonary capillary hemangioma.
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  • Shota Nakamura, Kikuo Shigemitsu, Ryou Ashida
    2009 Volume 23 Issue 7 Pages 936-940
    Published: November 15, 2009
    Released: January 28, 2010
    JOURNALS FREE ACCESS
    We report three cases of delayed diaphragmatic injury associated with lower rib fractures who presented with massive hemothorax on the 10-25th day after the initial events. All patients underwent surgery immediately after the diagnosis, and were discharged with no complications. Careful observation should be performed at least one month after lower rib fracture.
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  • Kunio Araki, Kenichiro Miyoshi, Hiroyuki Metsugi, Takeshi Tokushima
    2009 Volume 23 Issue 7 Pages 941-945
    Published: November 15, 2009
    Released: January 28, 2010
    JOURNALS FREE ACCESS
    We report 4 cases of solitary fibrous tumor of the pleura (SFT), focusing on their malignant potential. All 4 SFTs were removed by video-assisted thoracic surgery. Two SFTs demonstrated pedunculated attachment to the pleura, while the other two were not pedunculated. Three SFTs arose from the visceral pleura, and the other from the parietal pleura. Only one SFT (case 4), a pedunculated tumor arising from the visceral pleura, seemed to have a malignant potential based on its higher cellularity and increased vascularity. The tumor cells demonstrated a higher Ki67 labeling index, but were not immunoreactive for CD34. None of the 4 SFT cases showed recurrence after complete surgical excision.
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  • Gouji Toyokawa, Fumihiro Shoji, Daigo Kawano, Tsukihisa Yoshida, Tokuj ...
    2009 Volume 23 Issue 7 Pages 946-950
    Published: November 15, 2009
    Released: January 28, 2010
    JOURNALS FREE ACCESS
    A 46-year-old female, with a mass in the right parascapularis area, was admitted to our hospital. Chest radiograph demonstrated a deformity of the left 6th rib and increased permeability of the right 6th rib. Chest computed tomography showed low-density masses under the bilateral scapulas and a deformity of the left 6th rib. T1-weighted magnetic resonance imaging showed hypointense masses along with the bilateral serratus anterior muscles, with marked hyperintensity on T2-weighted sequences. The patient was administered antitubercular drugs for 3 months, but the left mass slowly enlarged. The patient underwent extirpation of the left mass combined with resection of the left 6th rib. Pathological findings revealed this tumor to be a bursitis originating from the scapulothoracic articulation. We experienced an extremely rare case of scapulothoracic bursitis probably due to rheumatoid arthritis.
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  • Mamoru Takahashi, Kotaro Kameyama, Keiji Ohata, Akihiko Yamashina, Tom ...
    2009 Volume 23 Issue 7 Pages 951-954
    Published: November 15, 2009
    Released: January 28, 2010
    JOURNALS FREE ACCESS
    We present a rare case of triple thymoma. Two tumors were detected on a preoperative chest CT image and so total thymectomy was performed. Pathological diagnosis was thymoma. Pathological findings also revealed a small thymoma that measured just 5 mm. The three tumors were encapsulated and showed the same histologic subtype (type B2). These findings suggested the possibility of multicentric genesis rather than intrathymic metastasis. Here, the pathological examination revealed an additional thymoma, one not disclosed during the operation. This suggests that thymomectomy has the possibility that small thymomas are missed. Total thymectomy should therefore be performed for thymoma.
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  • Yoshitaka Ito, Nobuyoshi Tanaka, Hidenori Kinsen, Yasuharu Kaizaki
    2009 Volume 23 Issue 7 Pages 955-958
    Published: November 15, 2009
    Released: January 28, 2010
    JOURNALS FREE ACCESS
    A 53-year-old female consulted our hospital because of tremor. She was pointed out as showing an abnormal shadow on a chest radiograph before an operation for hyperthyroidism. CT revealed a giant mass located in the right mediastinum and compressing one third of the right thoracic cavity. MRI identified a mass consisting of lipoid components exhibiting a high signal intensity on both T1- and T2- weighted imaging. Under a diagnosis of giant lipoma with hyperthyroidism, thyroidectomy and thoracic surgery were performed via a median sternotomy approach. The tumor stemmed from the thymus, weighing 1,050 grams. Histological examination showed that the tumor consisted of mature fatty tissue and scattered thymic lesions. Thymolipomas with hyperthyroidism are very rare.
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  • Shotaro Hashimoto, Ryosuke Kamimura, Masato Morimoto, Koichi Yoshikawa ...
    2009 Volume 23 Issue 7 Pages 959-963
    Published: November 15, 2009
    Released: January 28, 2010
    JOURNALS FREE ACCESS
    The patient was a 58-year-old female. Partial thyroidectomy was performed for a benign thyroid adenoma at 27 years old. Total thyroidectomy was conducted for a thyroid adenocarcinoma and wedge resection of the right lung was carried out for a pulmonary metastatic tumor, diagnosed as poorly differentiated adenocarcinoma of an unknown origin, at 47 years old. Bilateral lung resection was also performed for lung metastases at 52 years old. A single nodule of the right upper lobe near the hilum was not resected at this time. Six years later, this nodule enlarged rapidly. A right upper lobectomy with hilar and mediastinal lymph node dissection was perfomed. The tumor transformed to anaplastic carcinoma. One week after hospital discharge, she was readmitted with complaints of pain and dyspnea. Chest CT revealed compression of the trachea, bilateral main bronchi, and superior vena cava, with marked swelling of the upper mediastinal lymph nodes. The white blood cell count increased to 136,000 per microliter, and granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF) in peripheral blood showed abnormally high levels. Chemoradiation therapy was ineffective, and she died of insufficient systemic venous return 3 weeks after readmission.
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  • Norihisa Ohata, Noriyasu Usami, Tetsuo Taniguchi, Takahiro Souma, Kohe ...
    2009 Volume 23 Issue 7 Pages 964-968
    Published: November 15, 2009
    Released: January 28, 2010
    JOURNALS FREE ACCESS
    A 34-year-old man was admitted to our hospital for the resection of a large bulla. The bulla, which was 15 cm in diameter, existed in his left upper lung, with fluid retention. The patient was placed in the right lateral decubitus position with the upper arm abducted to 120 degrees and externally rotated, and we excised the bulla via a left anteroaxillary thoracotomy. The operation time was more than four hours because of the presence of strong adhesion. His left upper extremity was paralyzed immediately after the operation, and the intensity of his left brachial plexus incresed in the STIR image of MRI. Hyperabduction and external rotation of his left upper extremity were believed to have caused the brachial plexus injury based on the findings of neurological examination and MRI, and the prolonged operation time had a negative influence. His neurological symptoms were relieved after steroid therapy. To avoid brachial plexus injury, it is important to bring the upper arm into a more anterior plane than the body in the lateral decubitus position, and hyperabduction of the arm should be avoided as much as possible.
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  • Masao Kinoshita, Hidehiro Inada, Tetsushi Ito, Jun Matsubayashi, Masah ...
    2009 Volume 23 Issue 7 Pages 969-973
    Published: November 15, 2009
    Released: January 28, 2010
    JOURNALS FREE ACCESS
    A 49-year-old man was found to have a nodular shadow in the right upper lung field on a routine chest radiograph. He was referred to our hospital for further examinations. A somewhat flat and solid tumor of about 5 cm in the anterior mediastinum was noted by chest CT scan. Myasthenia and anemia were not present, and acetylcholine receptor antibodies increased slightly. We suspected thymoma, and performed an extended thymothymomectomy with combined partial resection of the right lung due to marked adhesion. The operative findings showed two separate tumors, the right tumor represented previously and a left tumor that couldn't be indicated preoperatively, in the thymus. The histopathological diagnosis revealed that the right tumor was Type B2+B3 thymoma and the left was Type B1 thymoma according to the WHO classification. Therefore, each tumor was of a different histologic type and considered to be of a multi-centric origin.
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  • Jun Suzuki, Hiroyuki Oizumi, Makoto Endoh, Shin-ichi Takeda, Ken Fukay ...
    2009 Volume 23 Issue 7 Pages 974-976
    Published: November 15, 2009
    Released: January 28, 2010
    JOURNALS FREE ACCESS
    A 27-year-old man who was diagnosed with atheroma underwent surgical resection of an anterior chest wall tumor. Pathological examination revealed a malignant fibrous histiocytoma and indicated wide anterior chest wall resection. En bloc resection of the skin, soft tissue, and anterior cortex of the sternum was performed. The posterior cortex of the sternum was preserved in order to maintain the rigidity of the thoracic wall. The defect was reconstructed with a latissimus dorsi musculocutaneous flap. Preservation of the posterior sternal cortex provided sufficient stability of the thoracic wall in this case of soft tissue sarcoma.
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  • Tomohiro Maniwa, Tomohito Saito, Hiroyuki Kaneda, Kenichiro Minami, Yu ...
    2009 Volume 23 Issue 7 Pages 977-980
    Published: November 15, 2009
    Released: January 28, 2010
    JOURNALS FREE ACCESS
    The case was a 63-year-old male with severe respiratory failure caused by an emphysematous bulla present for several years. He was admitted to a nearby hospital with pneumothorax of the left side. The left thorax was drained. He was transfered to our hospital because air leakage continued for one month, and he developed empyema. The left thorax was additionally drained twice, and the air leakage stopped. However, the blood gas results were poor (PaO2: 58.2 Torr, PaCO2: 81.8 Torr). We planned bullectomy because there was a giant bulla under the right lower lobe. The respiratory function improved after surgery. Antibacterial drugs were effective and empyema improved. He left the hospital on the 49th postoperative day.
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  • Mitsuhiro Isaka, Kazuo Nakagawa, Shinsuke Saisho, Yasuhisa Ohde, Takeh ...
    2009 Volume 23 Issue 7 Pages 981-985
    Published: November 15, 2009
    Released: January 28, 2010
    JOURNALS FREE ACCESS
    Most synovial sarcomas affect deep soft tissues of the extremities. Primary pulmonary synovial sarcoma is extremely rare. We report a case of primary pulmonary synovial sarcoma. A 59-year-old woman was admitted to our hospital for the treatment of a tumor of the left lung, which showed rapid growth over a period of 4 months on CT images. We diagnosed the tumor as a primary lung cancer with a rare histological subtype before surgery based on a cytological specimen obtained by bronchoscopy, composed of atypical spindle cells. We performed a left lower lobectomy with lymph node dissection. The tumor showed the proliferation of spindle cells, and the final diagnosis was confirmed by immunohistologic findings and genetic analysis for the detection of SYT gene rearrangement using fluorescence in situ hybridization (FISH). The patient was alive as of 18 months after surgery without recurrence.
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  • Yasuhiro Chikaishi, Manabu Yasuda, Masaaki Inoue, Takeshi Hanagiri, Ke ...
    2009 Volume 23 Issue 7 Pages 986-991
    Published: November 15, 2009
    Released: January 28, 2010
    JOURNALS FREE ACCESS
    A 69-year-old man complaining of a cough showed left pleural effusion with high hyaluronic acid levels. Percutaneous biopsy of the left pleura demonstrated epithelioid-type malignant pleural mesothelioma. He showed nephrotic syndrome at the same time. Extrapleural pneumonectomy was performed without the improvement of nephrotic syndrome, in spite of the intravenous administration of albumin. The levels of serum protein and albumin improved 70 days after surgery. Pathological examination showed epithelioid-type malignant pleural mesothelioma (p-T3N2M0 stage III). We report a case of malignant pleural mesothelioma, in which concomitant nephrotic syndrome improved after extrapleural pneumonectomy.
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  • Kazumasa Okumura, Kiyoshi Yoshizawa, Masafumi Tamaki, Kazumasa Miura
    2009 Volume 23 Issue 7 Pages 992-996
    Published: November 15, 2009
    Released: January 28, 2010
    JOURNALS FREE ACCESS
    A 69-year-old woman with cervical bronchial cyst treated by resection is described. The patient was essentially healthy, but was susceptible to catching colds. Computed tomography revealed an abnormal shadow on the right side of the trachea in the lower neck. It resembled a cystic mass with a heterogeneous component inside. An operation was performed for diagnosis and treatment, revealing a bronchial cyst with fungus ball packed inside. Bronchial cyst development in the cervical area is rare, and a case with fungal infection has never been reported. We report this case along with a consideration of the disease.
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  • Naoko Wachi, Masato Kanzaki, Toshihide Shimizu, Kei Sakamoto, Masahide ...
    2009 Volume 23 Issue 7 Pages 997-1001
    Published: November 15, 2009
    Released: January 28, 2010
    JOURNALS FREE ACCESS
    In March 2008, follow-up chest computed tomography (CT) after surgery for sigmoid colon cancer in a 58-year-old male patient revealed a 10-mm node in the S1 subsection of the right upper lobe and a 16-mm node in the S3 subsection of the left upper lobe of the lung; these tumors were suspected of being pulmonary metastases. Thoracoscopic wedge resection of the tumor in the right lung led to a diagnosis of pulmonary metastasis. The tumor in the left lung was also assumed to be a pulmonary metastasis, and surgery was planned. Although it was adjacent to the pleura, the tumor was located rather deeply. A preoperative pulmonary function test revealed a markedly decreased diffusion capacity, and therefore, surgery was performed for segmental resection with minimal loss of functioning lung parenchyma were studied. High-resolution CT was performed with 2-mm slice. On the basis of the images obtained, the anatomy of the left upper lobe was reconstructed in 3-D on a personal computer (PC). The tumor was located near the A3c and, along with A1+2a, A3a and A3c, was found to branch from the left main pulmonary artery. About 1 month after surgery on the right lung, subsegmental resection of the S3b and S3c of the left lung was performed thoracoscopically. The perioperative findings were considerably similar to those obtained from the simulation. Simulation obtained using 3-D images reconstructed on a PC allowed the surgery to be performed smoothly.
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  • Hiroshi Toda, Yoshihiko Kimura
    2009 Volume 23 Issue 7 Pages 1002-1005
    Published: November 15, 2009
    Released: January 28, 2010
    JOURNALS FREE ACCESS
    An 81-year-old man was brought to our hospital for left hemiplegia. The patient previously underwent fenestration for chronic empyema with pulmonary fistula following artificial pneumothorax for the treatment of pulmonary tuberculosis at the age of 20. Brain CT on arrival showed air embolism in cerebral veins from the right occipital to right frontal lobe. We diagnosed air embolism, and started treatment immediately involving oxygen inhalation, intravenous drip infusion, and administration of a free radical scavenger. The following day, the air embolism disappeared on brain CT, and left hemiplegia slowly improved. Although brain MRI showed a small area of infarction in the right occipital lobe at 2 days after onset, his movement of the upper and lower extremities improved almost completely through rehabilitation. The patient was discharged from hospital without left hemiplegia 46 days after onset.
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  • Mitsunori Higuchi, Takumi Yamaura, Yutaka Shio, Shigeyuki Asano, Ryuzo ...
    2009 Volume 23 Issue 7 Pages 1006-1010
    Published: November 15, 2009
    Released: January 28, 2010
    JOURNALS FREE ACCESS
    A 50-year-old male was pointed out as showing a tumor shadow in the anterior mediastinum, which was irregularly enhanced. The tumor was diagnosed as a liposarcoma by CT-guided needle biopsy. No systemic metastases were found. We performed a complete resection of the tumor through a median sternotomy. The tumor was encapsulated and did not directly invade surrounding tissues. The tumor was 14×11×6 cm in size. The postoperative pathological diagnosis was mediastinal liposarcoma, myxoid type. He was well without adjuvant therapy at 8 months after surgery. The incidence of mediastinal liposarcoma is only 0.1% of all mediastinal tumors. Although he is expected to show long-term survival following complete resection, we have to follow his clinical course for a long period because this tumor often shows local recurrence.
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  • Toshio Fukasawa, Hirotaka Okamoto
    2009 Volume 23 Issue 7 Pages 1011-1014
    Published: November 15, 2009
    Released: January 28, 2010
    JOURNALS FREE ACCESS
    We encountered a high-risk empyema patient with heart failure after rt. pneumonectomy due to lung cancer. Surgery was performed while awake, employing epidural anesthesia and local nerve block. After fenestration, we wrapped the wound using Lap-protector® and performed decortication. We wrapped the wound for 5 days after the operation. The patient didn't complain of wound-related pain. Severe pneumonia developed on the 19th postoperative day, but he soon recovered. Five months after the operation he was discharged. Two years later, no recurrence of the empyema or lung cancer was noted.
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  • Takao Sakaizawa, Keiichiro Takasuna, Gaku Saito, Masayuki Fujiwara
    2009 Volume 23 Issue 7 Pages 1015-1018
    Published: November 15, 2009
    Released: January 28, 2010
    JOURNALS FREE ACCESS
    An 83-year-old man was referred to our hospital complaining of pain and swelling of the right chest wall. Chest radiograph and CT revealed a tumor shadow in the right chest wall. It was diagnosed as malignant lymphoma by incisional biopsy. Firstly, radiation therapy was conducted, and an operation was performed. Histopathologically, this tumor was diagnosed as a malignant lymphoma (non-Hodgkin, diffuse lymphoma, large cell anaplastic type). We herein report a rare case of malignant lymphoma from the chest wall without preceding chronic pyothorax. It is necessary to accumulate more cases to investigate tumor development and establish treatment.
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