The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Volume 24 , Issue 6
Showing 1-22 articles out of 22 articles from the selected issue
  • Takuma Tsukioka, Noritoshi Nishiyama, Takashi Iwata, Koshi Nagano, Nob ...
    2010 Volume 24 Issue 6 Pages 886-890
    Published: September 15, 2010
    Released: February 22, 2011
    JOURNALS FREE ACCESS
    It is well known that nodal extension is diagnosed postoperatively in patients with small-sized non-small cell lung cancer (NSCLC) who exhibit no evidence of nodal extension on chest CT. Nodal extension is a significantly poor prognostic factor. Patients with operable advanced NSCLC are commonly treated with pulmonary resection plus lymph node dissection with pre- or postoperative chemotherapy. Treatments for patients with early-stage NSCLC contain several therapeutic procedures, including lobectomy, segmentectomy, and partial resection, with or without lymph node dissection. The imprecise diagnosis of node-positive NSCLC leads to insufficient treatment, as well as incomplete removal of the lesion. The prediction of nodal extension is therefore particularly important for patients with clinically early stage (but in fact more advanced) NSCLC to receive appropriate treatment. We retrospectively analyzed the relationship between pathologically proven nodal extension and the clinicopathologic features in patients with clinical stage 1A NSCLC. From January 2004 to December 2008, 299 patients with NSCLC underwent pulmonary resection with mediastinal lymph node dissection at Osaka City University Hospital (Osaka, Japan). Of these, 131 patients with clinical stage 1A NSCLC were investigated in this study. The mean age of patients was 67 years (range, 20-93 years). There were 72 males and 59 females. There were 113 patients without nodal extension (107 patients with p-stage 1A disease and 6 patients with stage 1B), 6 patients with pathological N1 nodal extension (3 patients with stage 2A disease and 3 patients with stage 2B disease), and 12 patients with pathological N2 nodal extension (all patients with stage 3A disease). The preoperative serum sialyl Lewis X level (SLX, p = 0.001) was significantly elevated in patients with compared to those without nodal extension. An ROC curve was constructed to determine if serum SLX levels could be used to differentiate between patients with and without nodal extension. The predictive cut-off value for SLX according to the ROC curve was 26 U/ml. On univariate analysis, being SLX-positive (risk ratio = 3.361, p = 0.021) was a significant predictive factor for nodal extension. On multivariate analysis, being SLX-positive was an independent predictive factor for nodal extension (risk ratio = 3.527, p = 0.021). Patients with a serum SLX level of > 26 U/ml were likely to have nodal extension. To decide on appropriate postoperative treatment, patients with a positive level of SLX should be treated with conventional pulmonary resection plus mediastinal lymph node dissection to evaluate the disease extent.
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  • Atsushi Fujita, Hiroshi Tsukada, Kazuharu Suda, Gou Furuyashiki, Tomoy ...
    2010 Volume 24 Issue 6 Pages 891-895
    Published: September 15, 2010
    Released: February 22, 2011
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    This study was performed to analyze complications associated with CT-guided needle lung biopsy in our hospital. In our analysis, we focused on the relationship of both the tumor diameter and length of penetration with the frequency of complications. We found that complications occurred in 59 of 206 CT-guided needle lung biopsies: 35 cases of pneumothorax, 28 cases of hemoptysis, and 4 cases of both pneumothorax and hemoptysis. The average tumor diameter was 2.2±0.9 cm in the cases with and 2.5±1.4 cm in those without complications, with no significant difference between the two groups (p=0.159). Unfortunately, the length of penetration could be measured in only 100 of 206 cases. The average length of penetration was 2.4±1.4 cm in the cases with and 1.3±1.3 cm in those without complications, with a significant difference between the two groups (p<0.05). Complications occurred in 8 of 61 cases in which the length of penetration was less than 2 cm, and in 21 of 39 cases in which the length of penetration was greater than 2 cm (p<0.05). We concluded that, to avoid complications, it is necessary for the length of penetration to be shortened as much as possible.
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  • Hiroyuki Agatsuma, Masahisa Miyazawa, Nobutaka Kobayashi
    2010 Volume 24 Issue 6 Pages 896-900
    Published: September 15, 2010
    Released: February 22, 2011
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    We report a case of pulmonary sclerosing hemangioma involving a 19-year-old male. He was referred to our hospital because of an abnormal shadow on a chest radiograph and a complaint of bloody sputum. Chest radiograph revealed a mass shadow in the right hilum, apparently increasing in size over two years. Chest CT scan showed a round mass shadow in the right S6 region measuring 38×32 mm. Pathological and immunohistochemical examination of the transbronchial lung biopsy specimens confirmed sclerosing hemangioma. We performed a right lower lobectomy, and the postoperative diagnosis was sclerosing hemangioma.
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  • Toshinori Hashizume, Jun Yamamoto, Masaoki Shimanouchi, Atsushi Hamamo ...
    2010 Volume 24 Issue 6 Pages 901-905
    Published: September 15, 2010
    Released: February 22, 2011
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    Desmoid tumors rarely arise from the anterior mediastinum. We report such a case. A 53-year-old man with a 5-month history of anterior chest pain was admitted to our hospital. Computed tomography and magnetic resonance imaging showed an abnormal shadow in the anterior mediastinum. The tumor showed marked uptake on FDG positron emission tomography. We performed thoracotomy with a median sternotomy. The tumor involved the bilateral mediastinal pleura and pericardium. Bloody pericardial effusion was recognized. We excised the tumor with bilateral mediastinal pleura and pericardium. The pericardium was reconstructed with a Gore-Tex® soft tissue patch. The histological diagnosis was a desmoid tumor, 9.0×8.8×4.5 cm, and the cytology of the bloody pericardial effusion was class II. Additional therapy was performed with 50 Gy of irradiation for the mediastinum. About 1 year and 9 months later, local recurrence occurred in the upper mediastinum. He received hormonal therapy, but died 2 years and 4 months after the operation.
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  • Kenji Misawa, Yasunori Nishida, Osamu Mishima, Morihisa Kitano, Tsutom ...
    2010 Volume 24 Issue 6 Pages 906-910
    Published: September 15, 2010
    Released: February 22, 2011
    JOURNALS FREE ACCESS
    We have been using CT angiography to locate evaluate pulmonary vessels for the identification of factors such as the presence of variations prior to pulmonary lobectomy or segmentectomy. A 320-row area detector CT scanner was installed in January 2009, allowing for the more detailed imaging of vessels. However, CT angiography is performed using a standard protocol, which may result in poor images of key vessels in some cases. Versa WebTM client software (Ziosoft Inc., Tokyo, Japan) was installed in September 2009, which allows the surgeon to easily manipulate and save CT angiography images via a web browser. The detailed mapping of pulmonary vessels by preoperative CT angiography should make pulmonary lobectomy safer and faster, particularly upper lobectomy, segmentectomy, and cases of incomplete lobulation.
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  • Ken Takeuchi, Ryoichi Kato, Arafumi Maeshima
    2010 Volume 24 Issue 6 Pages 911-915
    Published: September 15, 2010
    Released: February 22, 2011
    JOURNALS FREE ACCESS
    An 88-year-old man was referred to our hospital due to an abnormal shadow found on a chest radiograph in 2006. Chest CT showed nodules in the periphery of the right upper lobe, hilum of the right upper lobe, and periphery of the left upper lobe. The lesion of the right upper lobe was cytologically diagnosed as non-small cell cancer by bronchoscopy. Positron emission tomography of the three lesions showed malignant findings. Initially, we performed right upper lobectomy with mediastinal lymph node resection, and, then, performed left lower lung partial resection three weeks later. All three lesions showed a different histology. Each tumor was p-stage I A. There was no tumor recurrence as of 3 years and 7 months after the operations. Synchronous triple primary lung carcinomas successfully treated by surgery are rare. We reported a patient with synchronous triple elderly primary lung carcinomas successfully treated by surgical resection, and reviewed the literature.
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  • Takashi Ono, Yoshihiro Minamiya, Hajime Saito, Manabu Ito, Jun-ichi Og ...
    2010 Volume 24 Issue 6 Pages 916-919
    Published: September 15, 2010
    Released: February 22, 2011
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    We encountered a rare case of squamous cell carcinoma (SCC) of the chest wall involving a patient with chronic empyema. The patient was a 75-year-old male who showed a long interval of 16 years between the development of empyema and onset of carcinoma with a draining cutaneous fistula. In a review of the literature, we found 13 cases of SCC arising from a chronic empyema cavity in Japan. Most chronic empyema-associated malignant tumors are malignant lymphomas; however SCC comprises 20% of all empyema-associated malignancies. They reportedly have a poor prognosis; therefore, periodic medical examination with the possibility of malignancy in mind is important.
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  • Ken Fukaya, Hiroyuki Oizumi, Makoto Endoh, Jun Suzuki, Mitsuaki Sadahi ...
    2010 Volume 24 Issue 6 Pages 920-923
    Published: September 15, 2010
    Released: February 22, 2011
    JOURNALS FREE ACCESS
    A 32-year-old man who complained of persistent fever and cervical swelling was referred to our hospital. Computed tomography of the chest revealed a mediastinal abscess extending from the cervix to the retromanubrial space. We performed partial resection of the sternum and open drainage of the mediastinal abscess based on a diagnosis of sternoclavicular infectious arthritis. After open-wound management for several days, vacuum-assisted wound closure (VAC) therapy was introduced. This therapy accelerated the formation of granulation tissue, with the wound showing excellent closure, without the use of any muscle flap materials.
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  • Junichi Arai, Naoya Yamasaki, Tsutomu Tagawa, Tomoshi Tsuchiya, Takuro ...
    2010 Volume 24 Issue 6 Pages 924-928
    Published: September 15, 2010
    Released: February 22, 2011
    JOURNALS FREE ACCESS
    A 60-year-old man was admitted to our hospital with a 15-cm mass in the lower lobe of the left lung. Although he was diagnosed with pleomorphic carcinoma clinical stage IIIA (T3N2M0), we performed surgery because of rapid tumor progression and recurrent bloody sputum. The lower pulmonary vein was cut using a stapling device (Multifire Endo GIA 30, 2.5 mm; Auto Suture, Tyco Healthcare, Norwalk, CT, USA) due to poor mobility of the left lower lobe. After stapling, we stopped monitoring the right radial artery, and coldness of the arm appeared. Post-operative angiography revealed occlusion of the right brachial artery, and embolectomy was performed 3.5 hours after the surgery. The pathological diagnosis was tumor embolism due to lung cancer. Although tumor embolism is rare, it should be considered during preoperative assessment and surgery when invasion of the pulmonary vein is suspected.
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  • Ryo Takahashi, Takahiro Nakajima, Yuuichi Sakairi, Yukiko Matsui, Tosh ...
    2010 Volume 24 Issue 6 Pages 929-933
    Published: September 15, 2010
    Released: February 22, 2011
    JOURNALS FREE ACCESS
    A 60-year-old man with a metastatic lung tumor from rectal cancer was referred to our hospital. At the time of the diagnosis of rectal cancer, an abnormal shadow suggestive of a metastatic lung tumor was detected during routine metastasis check up. The initial surgery for rectal cancer was performed in a nearby hospital. During follow-up for the pulmonary lesion, the tumor enlarged, suggestive of malignancy. The patient underwent CT-guided percutaneous needle biopsy, and a histological core was obtained. The pulmonary tumor was histologically diagnosed as a metastatic lung tumor of rectal cancer, and the patient was referred to our hospital for surgical resection of the metastatic lung tumor. Partial resection of the right lower lobe was performed. During follow-up after the thoracotomy, chest CT showed an abnormal shadow in the right lower lobe and an abnormal low-density area was also observed in the chest wall adjacent to the pulmonary lesion. FDG-PET-CT showed an abnormal accumulation in the same lesion suggestive of a recurrence of the metastatic lung tumor from the rectal cancer. We performed a partial resection of the right lower lobe with chest wall resection. The 8th rib and chest wall, including the lattisimus dorsi muscle, were removed. The histology showed tumor cells in both intra- and extra-pulmonary regions, with no findings of pleural invasion. This unusual growth pattern suggested the possibility of tumor seeding during CT-guided biopsy. Clinicians should pay attention to the possibility of tumor seeding in patients after percutaneous needle biopsy. Careful observation of the puncture site may be mandatory.
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  • Takeo Nakada, Makoto Odaka, Mitsuo Yabe, Noriki Kamiya, Jun Hirano, To ...
    2010 Volume 24 Issue 6 Pages 934-939
    Published: September 15, 2010
    Released: February 22, 2011
    JOURNALS FREE ACCESS
    The patient was a 47-year-old man with a chief complaint of general fatigue. After medical examinations, he was diagnosed with pure red cell aplasia (PRCA), hypogammaglobulinemia, and thymoma. PRCA and hypogammaglobu-linemia are very rare refractory auto-immune diseases. He underwent complete video-assisted thoracoscopic thymo-thymectomy. The operation took 255 minutes, and the volume of blood loss was 100 ml. The resected specimen was 88×53×30 mm. The histological diagnosis was type AB thymoma of the WHO classification, and Masaoka stage II . On postoperative day 42, he received transfusion because of severe anemia. He then underwent treatment for PRCA. Thymomectomy or thymectomy alone was insufficient to restore the hemopoiesis for PRCA with thymoma, but both surgical and internal treatment together could improve PRCA. In consideration of less invasive surgery, a more favorable postoperative quality of life, and more esthetic appearance compared to open surgery, VATS thymo-thymectomy should be adopted for thymoma related to auto-immune disease.
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  • Hiromitsu Domen, Nozomu Iwashiro, Yoshitsugu Nakanishi, Kazuteru Komur ...
    2010 Volume 24 Issue 6 Pages 940-944
    Published: September 15, 2010
    Released: February 22, 2011
    JOURNALS FREE ACCESS
    A 71-year-old man presented 6 years previously with a slowly developing mass on the right side of his chest. He had been diagnosed with von Recklinghausen's disease in infancy due to multiple skin nodules and chloasma. During follow-up at another clinic, a 2-cm ground-glass opacity in the right lung was detected on CT. A further CT performed in March 2009 revealed the size and extent of the opacity to be increasing, and the patient was referred to our department with suspected lung adenocarcinoma. Resection of the chest wall tumor was performed under general anesthesia, and histopathological analysis revealed no malignancy. The patient was diagnosed with primary lung adenocarcinoma based on bronchoscopy and biopsy findings from the right lung lesion. Thoracoscopic right lower lobectomy and systematic mediastinal lymph node dissection were subsequently performed. Macroscopic observation of the resected lung sample revealed marked emphysematous changes in addition to a 2.1×1.5-cm white tumor exhibiting coal dust accumulation. The tumor was histopathologically classified as lung adenocarcinoma, pT1b, pN0, pStage I A. The postoperative course was generally favorable, and no signs of relapse have been observed to date.
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  • Yuichi Sakairi, Chikabumi Kadoyama, Hironobu Wada, Yoshito Yamada, Ich ...
    2010 Volume 24 Issue 6 Pages 945-9448
    Published: September 15, 2010
    Released: February 22, 2011
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    A 44-year-old female experienced fever and subcutaneous bleeding. She was referred to our hospital for further investigation because of leukocytosis, and was diagnosed with leukemia. After the initial chemotherapy, an enlarged lung infiltration shadow was pointed out on a computed tomogram. Clinically, she was diagnosed with invasive pulmonary aspergillosis. Because the lung lesion was uncontrollable with anti-fungal drugs, which prevented the continuation of chemotherapy for the remaining leukemia, a right upper-lobe lobectomy was performed. During the operation, an inflammatory mass strongly adhered to the chest wall and so dorsal parietal pleura resection was added. The definitive diagnosis of invasive pulmonary aspergillosis was established from a surgical specimen. Her clinical course was favorable, she could finally receive additional chemotherapy and bone marrow transplantation. Invasive pulmonary aspergillosis in a leukemia patient undergoing treatment is a severe condition. Surgery is a viable treatment option, and not just the use of anti-fungal agents. In the literature, alveolar hemorrhage is a major fatal post-operative complication. However, we could effectively treat both leukemia and invasive pulmonary aspergillosis while sufficiently considering thrombocyte presence before the operation.
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  • Go Hatachi, Isao Sano, Shinsuke Hara, Takahiro Sawada, Takeshi Nagayas ...
    2010 Volume 24 Issue 6 Pages 949-953
    Published: September 15, 2010
    Released: February 22, 2011
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    Nodular fasciitis is a benign reactive proliferation of myofibroblasts, and is clinically often difficult to distinguish from a malignant soft tissue tumor. It is categorized as one kind of subtype of fibroma. It most commonly occurs as a ‘rapid-growth mass' in the head, neck, and upper extremities in children or young adults. We report a thirty-five-year-old woman who noticed a ‘rapid-growth mass' in her supra-clavicular fossa, diagnosed with nodular fasciitis surgically.
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  • Takashi Anayama, Hironobu Okada, Motohiko Kume, Shiro Sasaguri
    2010 Volume 24 Issue 6 Pages 954-958
    Published: September 15, 2010
    Released: February 22, 2011
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    Most pulmonary hamartomas are seen in the peripheral lung parenchyma, and endobronchial hamartomas are very rare. We encountered the case of a 61-year-old man who had experienced several episodes of left pneumonia over the last 7 years. Chest CT showed the presence of an intra-bronchial mass lesion occluding B6, with partial atelectasis in the left S6 segment. Based on transbronchial biopsy, the tumor was diagnosed as an endobronchial hamartoma. The total content of the tumor was not observed on bronchoscopy, and so surgical treatment comprising S6 segementectomy was performed rather than endobronchial intervention. Surgical findings indicated that the tumor occluded and dilated the B6 segmental bronchus. Pathological examination revealed that the tumor was a chondromatous hamartoma of 1.6 cm. The tumor completely blocked the orifice of the B6 segmental bronchus. A favorable therapeutic result was achieved through segmentectomy for this type of hamartoma.
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  • Eiki Mizutani, Riichiro Morita, Toru Akaishi
    2010 Volume 24 Issue 6 Pages 959-962
    Published: September 15, 2010
    Released: February 22, 2011
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    We report the rare case of a giant pulmonary bulla with an interlobar part of the pulmonary artery exposed at the bottom. A 40-year-old male demonstrated a giant pulmonary bulla in the right thorax on radiographic screening in 2009. Computed tomography showed a giant pulmonary bulla, with about 50 % in the right pleural cavity. He had never smoked. He was introduced to our hospital for surgery. During the surgery, a thoracoscope showed that the bottom of the bulla was in an interlobar position, and the basal border extended to the superior and lower lobes. When we cut the wall of the bulla and observed the lumen, an interlobar part of the pulmonary artery was exposed at the bottom. We ligated several points of major air leakage in the bottom below a small thoracotomy, and then covered the cyst bottom with a polyglycolic acid sheet and fibrin glue. The chest drain was removed on the second postoperative day, and he was discharged from the hospital on the ninth day.
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  • Hiroshi Yabuki, Satoshi Shiono, Masami Abiko, Toshimasa Okazaki, Masat ...
    2010 Volume 24 Issue 6 Pages 963-966
    Published: September 15, 2010
    Released: February 22, 2011
    JOURNALS FREE ACCESS
    Renal cell carcinoma (RCC) is rarely associated with mediastinal and hilar lymph node metastasis without lung metastasis. We report a 42-year-old man with metastatic RCC who subsequently underwent surgery for lymph node metastasis. Initially, a right nephrectomy had been performed for RCC. At follow-up five years later, a left lower mediastinal tumor of 2.5 cm was identified on surveillance computed tomography (CT). This tumor was surgically excised. The pathological diagnosis was lymph node metastasis from RCC. However, follow-up chest CT several months later revealed right hilar lymph node enlargement without evidence of systemic metastasis. The hilar lymph node was then removed by thoracotomy. The pathological diagnosis was also lymph node metastasis from RCC. Now, at two years after his last surgery, the patient is doing well. This case suggests that even with isolated mediastinal and hilar lymph node metastasis from RCC, favorable outcomes are possible with surgical resection.
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  • Yosuke Matsuura, Masanobu Watari
    2010 Volume 24 Issue 6 Pages 967-971
    Published: September 15, 2010
    Released: February 22, 2011
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    Increasing numbers of peripheral and small lung tumors are being detected, and cases of computed tomography (CT)-guided lung puncture, for example, needle biopsy and marking, are growing. Air embolism is a rare but critical complication of CT-guided lung puncture. We report two cases of an air bubble in the intracardiac cavity after CT-guided lung puncture, which disappeared after about 60 minutes of posture control. We suggest that CT-guided lung puncture should be carried out carefully with the appropriate selection of cases.
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  • Tatsuhiko Nishii, Takashi Muramatsu, Mie Shimamura, Motohiko Furuichi, ...
    2010 Volume 24 Issue 6 Pages 972-975
    Published: September 15, 2010
    Released: February 22, 2011
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    Spinal cord infarction is a rare postoperative complication. We report a case of spinal cord infarction diagnosed postoperatively. A 70-year-old man underwent left upper lobectomy for lung cancer under combined general and epidural anesthesia. An epidural infusion was used for intra-and postoperative analgesia. From 3 postoperative hours, the patient complained of right extremity and right hand paraplegia. It was thought that this was due to the influence of the epidural catheter, and we promptly discontinued the epidural infusion. On the next day, the paralysis worsened, and a wide-range spinal cord infarction in the region of the cervical and thoracic cord was diagnosed with magnetic resonance imaging on postoperative day 3. The cause of the spinal cord infarction was unclear. As the paralysis improved by conservative therapy, the patient was transferred from our hospital to a rehabilitation hospital on the 27th postoperative day.
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  • Fumihiko Muta, Yoshinori Nagamatsu, Yasunori Iwasaki, Masaki Kashihara ...
    2010 Volume 24 Issue 6 Pages 976-979
    Published: September 15, 2010
    Released: February 22, 2011
    JOURNALS FREE ACCESS
    We describe a 59-year-old man who was found by chest computed tomography to have a 3.0-cm tumorlike lesion in the right lung (in segment S8), and 1. 0-cm nodule in the same lung (in S2). After careful evaluation, the right S8 mass was found to be lung cancer; the S2 nodule was suspected to be an intrapulmonary metastasis, but a definite diagnosis could not be made. Partial resection of the lung was performed for the S2 nodule; however, an intraoperative cytologic examination was negative for malignant cells. Then, a right lower lobectomy (ND2a) was carried out. Postoperative pathologic examination of the resected specimen revealed the S2 lesion to be a cryptococcosis. This case of lung cancer accompanied by pulmonary cryptococcosis, that was originally thought to be an intrapulmonary metastasis, illustrates the need for open lung biopsy to obtain a pathologic diagnosis based on a single nodule suspected to be a lung metastasis.
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  • Ryo Ashida, Kikuo Shigemitsu, Yukifusa Yokoyama
    2010 Volume 24 Issue 6 Pages 980-986
    Published: September 15, 2010
    Released: February 22, 2011
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    A 59-year-old man with left lung cancer coughed up a massive amount of blood before elective surgery. An emergent left upper lobectomy with bronchoplasty was performed under percutaneous cardiopulmonary support (PCPS) for respiratory failure due to airway bleeding. Nafamostat mesilate was used as an anticoagulant during PCPS. Withdrawal from PCPS was carried out immediately after surgery, and respiratory support was not necessary on the 5th post-operative day (POD). Unfortunately, deep venous thrombosis in the left lower limb, in which the PCPS catheter had been set up, forced us to perform filter placement in the vena cava on POD 14. The patient was discharged on POD 29 with a favorable clinical condition, and is currently alive and well without tumor recurrence at 1 year.
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