The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Volume 25 , Issue 7
Showing 1-24 articles out of 24 articles from the selected issue
  • Hisao Asamura, Riken Kawachi, Mayumi Oyama, Hiroyuki Sakurai, Shun-ich ...
    2011 Volume 25 Issue 7 Pages 696-701
    Published: November 15, 2011
    Released: January 16, 2012
    JOURNALS FREE ACCESS
    Intrathoracic bleeding is still one of the serious complications after pulmonary resection for various thoracic malignancies. Appropriate management of postoperative bleeding is comprised of the transfusion of an adequate amount of blood and hemostasis by re-thoracotomy based on an accurate estimation of the total volume of blood loss. Although the amount of blood output through the chest tube can be measured precisely, a reliable measurement of the volume of blood remaining in the thoracic cavity is hardly feasible by any means. The purpose of the present study was to assess the relationship between the volume of chest tube output and that of intrathoracic hematoma which was measured at the time of re-thoracotomy. From October 2004 to September 2008, 2,166 patients with intrathoracic malignancy underwent pulmonary resection at the National Cancer Center Hospital, Tokyo. Among these, 16 patients (0.7%) underwent re-thoracotomy and hemostasis for postoperative bleeding. The mean volumes of chest tube output and intrathoracic hematoma were 700 ml (315-1,525) and 918 ml (78-2,769), respectively. In 10 patients (63%), the volume of intrathoracic hematoma was greater than that of chest tube output. However, there was no correlation between these two parameters (r=0.03, p=0.25). Therefore, it is concluded that the volume of intrathoracic hematoma is more likely to be greater than that of chest tube output in patients who require re-thoracotomy and hemostasis. However, because of the lack of a correlation between these two parameters, the possibility of the existence of a large intrathoracic hematoma still remains even for patients with a small volume of chest tube output. Precise estimation of the total blood loss is, therefore, generally difficult, and the indication of re-thoracotomy as well as adequate transfusion should be determined based on a comprehensive consideration of various parameters.
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  • Joji Samejima, Michihiko Tajiri, Ko Takahashi, Takahiro Omori, Munetak ...
    2011 Volume 25 Issue 7 Pages 702-706
    Published: November 15, 2011
    Released: January 16, 2012
    JOURNALS FREE ACCESS
    We reviewed our video-assisted thoracoscopic surgery experience treating acute empyema thoracis in our institute between April 2007 and December 2010, and analyzed 27 consecutive patients (26 men, 1 woman; mean age, 64.7 years; age range, 32 to 79 years). The mean duration of preoperative symptoms before referral was 37. 1 days (range, 3-88 days). The underlying disease was diabetes mellitus in 9 patients. A total of 9 (33%) patients had positive pleural fluid cultures. The mean operating time was 133.0 minutes (range, 48-250 min), and mean bleeding volume was 148. 7 ml (range, 5-800 ml). According to the American Thoracic Society classification, 8 patients (30%) had fibrinopurulent phase empyema and 19 patients (70%) had the organizing phase type. Outcomes were cure in 23 patients (residual space in 3 patients), repeat procedure in 3 patients (fenestration in 1 patient), and postoperative death in 1 patient. Although organizing phase empyemas accounted for the majority in this study, 83 percent of patients were cured with a primary procedure. However, we need to choose suitable cases, because many perioperative complications develop in the organizing phase.
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  • Toru Kimura, Yukiyasu Takeuchi, Yasunobu Funakoshi, Naoko Ohse, Hideno ...
    2011 Volume 25 Issue 7 Pages 707-713
    Published: November 15, 2011
    Released: January 16, 2012
    JOURNALS FREE ACCESS
    The prognosis in patients with recurrence after the complete resection of p-N2 non-small cell lung cancer (NSCLC) is poorer than that in postoperative recurrence patients with p-N0-1 disease. The aim of this study was to determine the potential survival time after postoperative recurrence in completely resected p-N2 NSCLC patients with post-recurrent therapy in our department. A retrospective study was performed to establish the prognostic factors in these patients. We studied 59 patients (79.7%) with postoperative recurrence out of the 74 patients who underwent complete resection of p-N2 NSCLC between 1998 and 2007 in our department. The patients included 31 men and 28 women. Their mean age was 64.2 years. The median postoperative recurrence-free survival time was 16.0 months. Forty-five patients (76.2%) had received post-recurrence anticancer medication therapy. The post-recurrence 1- and 3-year cumulative survival rates among all patients were 62.2 and 28.1%, respectively. The median survival time after postoperative recurrence was 17.2 months. Multivariate analysis of prognostic factors indicated that single-station p-N2 disease, a postoperative recurrence-free interval of > 1 year, post-recurrence anticancer medication therapy, and surgical resection or therapeutic irradiation to the metastatic region were significant independent factors of a favorable prognosis. The 1- and 3-year survival rates of patients satisfying 3 or 4 factors were 87.5 and 57.4%, respectively, and their median survival time after postoperative recurrence was 40.4 months. Among patients with recurrence after the complete resection of p-N2 NSCLC, those with single-station p-N2 disease and a postoperative recurrence-free interval of > 1 year can be expected to have a relatively favorable prognosis, and, if feasible, aggressive anticancer therapy for patients with postoperative recurrence may prolong post-recurrence survival.
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  • Yasuaki Iimura, Kichizo Kaga, Yasuhiro Hida, Nobuyuki Shina, Kazuto Ot ...
    2011 Volume 25 Issue 7 Pages 714-718
    Published: November 15, 2011
    Released: January 16, 2012
    JOURNALS FREE ACCESS
    We report the efficacy of training for VATS lobectomy conducted at the regional VATS seminar in Hokkaido. There were 39 participants who were trained and assessed using a dry box and video monitor. The training tasks were suturing and knot tying. We recorded the time taken to complete the tasks both before and after the training. The median time taken to complete the suturing and knot tying significantly reduced after training from 315 to 239 seconds and 359 to 286 seconds, respectively, which showed that all the participants improved in the tasks. We compared the task completion time before training with post-graduate years and the number of cases of VATS lobectomy which the participants experienced. Neither post-graduate years nor the number of cases of VATS lobectomy was correlated with the time to complete the suturing, but both were significantly correlated with the time to complete the knot tying. The median time taken by the participants at the seminar for the second time to complete the knot tying had significantly reduced from 310 to 256 seconds after training. In conclusion, training using a dry box is effective for trainees, and repeated training is necessary to obtain favorable results.
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  • Kazuhito Nii, Taku Okamoto, Takashi Nakashima, Yuuichi Shibuya, Takahi ...
    2011 Volume 25 Issue 7 Pages 719-722
    Published: November 15, 2011
    Released: January 16, 2012
    JOURNALS FREE ACCESS
    A 78-year-old woman was referred to our hospital for further examination after the initial diagnosis of dilatation of the left pulmonary hilum on a chest radiograph. Chest computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated a cystic lesion (35 mm in diameter) located adjacent to the aortic arch in the anterior mediastinum. The uniform interior of the cyst, as well as absence of a wall structure and solid components, strongly suggested a thymic cyst. Video-assisted thoracoscopic surgery was performed in March 2010. The intraoperative finding was a cystic lesion, and cystectomy was performed employing 3 ports. The pathological diagnosis was a parathyroid cyst. Since the patient exhibited no signs of hypercalcemia and hyperparathyroidism, she was diagnosed with a nonfunctional parathyroid cyst. Here, we report the case of a mediastinal parathyroid cyst, along with a literature review.
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  • Takehiko Okagawa, Noriyasu Usami, Toshiki Okasaka, Koji Kawaguchi, Koi ...
    2011 Volume 25 Issue 7 Pages 723-726
    Published: November 15, 2011
    Released: January 16, 2012
    JOURNALS FREE ACCESS
    A 34-year-old man was admitted to our hospital with hemoptysis. He had had a cough for one week before and fever three days before admission. Plain chest CT showed a mass of low intensity in the right lower lobe of the lung and intrathoracic fluid. Initially, the mass was diagnosed as a lung abscess. Enhanced chest CT on the day following admission showed an aberrant artery arising from the descending thoracic aorta to the right lower lobe, and the mass was diagnosed as pulmonary sequestration. Because the disease condition was considered to be hemothorax due to rupture of the sequestration, a right lower lobectomy was carried out emergently. Pulmonary sequestration should be resected when diagnosed, even if asymptomatic.
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  • Takashi Semba, Toshihiro Osaki, Mantaro Kodate
    2011 Volume 25 Issue 7 Pages 727-731
    Published: November 15, 2011
    Released: January 16, 2012
    JOURNALS FREE ACCESS
    We report a case of myelolipoma arising from the posterior mediastinum in a 67-year-old man with an abnormal shadow detected on routine chest radiograph. Chest radiograph showed a right mediastinal mass shadow without a silhouette sign of the heart. Chest computed tomography and magnetic resonance imaging showed a well circumscribed tumor with fat and soft tissue components adjacent to the 8th to 10th thoracic vertebrae, suggesting mediastinal liposarcoma. We performed complete resection of the tumor. Macroscopically, it was a 53×38×25-mm solid tumor. Histologically, the tumor had a thin fibrous capsule and was composed of focal hematopoietic elements and mature adipocytes. We diagnosed it as a myelolipoma. We report a rare case of mediastinal myelolipoma, and review 15 cases reported over the past two decades.
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  • Shotaro Hashimoto, Wataru Nishio, Shinya Tane, Yoshimasa Maniwa, Masah ...
    2011 Volume 25 Issue 7 Pages 732-735
    Published: November 15, 2011
    Released: January 16, 2012
    JOURNALS FREE ACCESS
    A 34-year-old man showed a gradually increasing mass of the right neck. Chest CT demonstrated a huge tumor expanding from the right neck to the right thoracic cavity. It was diagnosed as a suspected solitary fibrous tumor on tumor biopsy. Surgical resection of the tumor and reconstruction of the right subclavian artery were performed through a modified hemi-clamshell approach. The tumor close to the 5th, 7th, and 8th cervical intervertebral foramina could not be resected because of nerve preservation. Histological and immunohistochemical findings led to the diagnosis of a desmoid tumor. He received adjuvant radiotherapy for the residual tumor. No relapse had been observed as of one year after the surgery.
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  • Shigeo Imai, Rie Matsumoto
    2011 Volume 25 Issue 7 Pages 736-740
    Published: November 15, 2011
    Released: January 16, 2012
    JOURNALS FREE ACCESS
    An 81-year-old woman presented with fever, left chest pain, and swelling of the right gingiva. Laboratory examination revealed leukocytosis and C-reactive protein elevation. A chest radiograph showed left pleural effusion. A computed tomographic scan showed multiloculated empyemic fluid in the left pleural space and multiple nodular shadows suggesting septic pulmonary embolism (SPE) in both lung fields. Probable predisposing factors for SPE were absent except for periodontal disease. Based on these findings, we diagnosed the patient with acute empyema due to SPE from the lesion of periodontal disease. Because of the unsuccessful pleural drainage, we performed video-assisted thoracoscopic surgery (VATS) after the instillation of urokinase, and removed the causative impacted tooth. She recovered without major complications. We encountered a rare case of acute empyema due to SPE. VATS was a safe and effective therapy for acute empyema in a patient in whom chest drainage failed.
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  • Tomoya Kono, Chisato Matsui, Yasuji Terada
    2011 Volume 25 Issue 7 Pages 741-746
    Published: November 15, 2011
    Released: January 16, 2012
    JOURNALS FREE ACCESS
    A 64-year-old female had undergone the resection of a thigh tumor in 1990, and the tumor was diagnosed as a schwannoma. She was pointed out as having a nodule in the left lower lung field on chest radiograph in 2001. Chest computed tomography (CT) showed the nodule of 20 mm in diameter with a plain border. The tumor was resected with video-assisted thoracic surgery (VATS). The histological diagnosis was a solitary fibrous tumor (SFT). The nodule was pointed out again in the same area in 2006 on chest radiograph. The tumor was resected employing a small thoracotomy with VATS. The histological diagnosis was SFT; however, the increased nuclear fission suggested malignancy. By the second histological examination, the thigh tumor was diagnosed as SFT. Patients with a resected SFT have to be followed up for recurrence for a long period. Also, more attention is needed when we resect the tumor because it may recur from residual cells.
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  • Daisuke Okutani, Shigeharu Moriyama
    2011 Volume 25 Issue 7 Pages 747-750
    Published: November 15, 2011
    Released: January 16, 2012
    JOURNALS FREE ACCESS
    We report a case of delayed massive hemothorax due to diaphragm injury caused by a lower rib fracture. A 22-year-old male was admitted to our hospital for the treatment of hypovolemic shock on the 37th day after the initial event, involving left multiple rib fractures. As transcatheter arterial embolization was not sufficient to stop the bleeding in the left chest cavity, an emergency operation was performed employing VATS. An about 15-mm diaphragm laceration was found and repaired with a nonabsorbable polypropylene suture. The postoperative course was uneventful, and the patient was discharged on the 12th day after the operation.
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  • Naoaki Maeda, Masahumi Kataoka, Toshinori Ohara
    2011 Volume 25 Issue 7 Pages 751-755
    Published: November 15, 2011
    Released: January 16, 2012
    JOURNALS FREE ACCESS
    The patient was a 73-year-old man who had been treated for renal dysfunction due to Wegener's granulomatosis in our hospital's Department of Internal Medicine. His chief complaint was a cough, and a thorough chest examination was conducted. An abnormal left upper lung shadow was noted on a chest radiograph, and occlusion of the left upper division bronchus, with atelectasis of the left superior lung segment, was observed on chest CT. Bronchoscopy showed bronchial occlusion and hemorrhage, in which squamous metaplasia was detected employing biopsy. An accumulation of fluorodeoxyglucose (FDG) was noted in the left upper lobe on PET. From these findings, left upper lung cancer was strongly suspected, for which we subsequently performed a left upper lobectomy. However, the post-operative pathology disclosed that an abscess had formed due to bronchodilatation with airway infection caused by Wegener's granulomatosis.
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  • Yoshitomo Ozaki, Shuhei Inoue, Takuya Fujita, Masatsugu Ouchi, Akihiro ...
    2011 Volume 25 Issue 7 Pages 756-760
    Published: November 15, 2011
    Released: January 16, 2012
    JOURNALS FREE ACCESS
    The patient was a 24-year-old male of US nationality. He had been in Arizona in the US for 5 years before visiting Japan as an English teacher. Chest CT showed a well-defined round nodule measuring 2.0 cm in diameter in the right lower lobe. He underwent partial resection of the lung employing VATS. Coccidioides immitis was detected in the resected specimen, and he was diagnosed with chronic pulmonary coccidioidomycosis (Coccidioidoma). Although the incidence of coccidioidomycosis has increased in Japan, the overall level of awareness of this type of afferent mycosis is still unsatisfactory. The careful examination of patients with a history of visiting or living in endemic areas is therefore warranted.
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  • Masayuki Toishi, Ryoichi Kondo, Takeshi Yamanda
    2011 Volume 25 Issue 7 Pages 761-766
    Published: November 15, 2011
    Released: January 16, 2012
    JOURNALS FREE ACCESS
    The patient was a 70-year-old-woman. She underwent total hysterectomy and bilateral salpingo-oophorectomy following a diagnosis of ovarian cancer in December 1996. The pathological diagnosis was mucinous cystadenocarcinoma, p-stage IIIc. In July 1999, she received chemotherapy due to a diagnosis of liver metastasis, with a complete response. Furthermore, in February 2003, she underwent chemotherapy based on a diagnosis of carcinomatous peritonitis, again showing a complete response. After that, she was followed up without recurrence in the outpatient department. A nodule of 1.5 cm with cavitation developed in the right S3a in October 2009. This led to a diagnosis of primary lung cancer as a result of close inspection. In January 2010, we performed right upper lobectomy. The histology resembled the ovarian cancer primary tumor, and the pathological diagnosis was pulmonary metastasis from ovarian cancer. We found one similar report in a literature search. Because it was thought to be a rare case, we reported it.
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  • Keiji Inoue, Masachika Kitajima, Norihiro Kohara, Ryouji Hirose, Minor ...
    2011 Volume 25 Issue 7 Pages 767-772
    Published: November 15, 2011
    Released: January 16, 2012
    JOURNALS FREE ACCESS
    A 64-year-old woman was admitted to the Department of Dermatology of our hospital with eruption and dysphagia in March 2009. Dermatomyositis was diagnosed because of a skin rash, proximal muscle weakness, CPK elevation, muscle pain, and CRP elevation. Further examination for malignancy revealed lung cancer in the right lower lobe. Steroid pulse therapy was performed because of dysphagia before the lung operation. A right lower lobectomy with lymph node dissection was conducted. On the ninth day after the lobectomy, pneumothorax occurred. Chest computed tomography and bronchoscopy revealed a bronchial stump fistula. On the 17th day after the operation, we closed the stump and covered it with omentum. The patient was transfered to the Department of Internal Medicine on the 26th hospital day for the treatment of dermatomyositis. We should take care of a bronchial fistula after lobectomy for lung cancer with dermatomyositis. Omentopexy was useful for the bronchial fistula.
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  • Shunsuke Iimori, Shinichi Sumitomo, Kazuya Matumoto, Masaya Okuda, Tak ...
    2011 Volume 25 Issue 7 Pages 773-775
    Published: November 15, 2011
    Released: January 16, 2012
    JOURNALS FREE ACCESS
    We report a case of chylothorax caused by thoracic duct cyst rupture. A 59-year-old woman was referred to our hospital. She had experienced difficulty in breathing for two days. Chest radiograph film and CT showed massive right pleural effusion with complete collapse of the right lung and deviation of the mediastinum to the left. White-yellowish effusion flowed out after chest drainage. The effusion contained high levels of triglycerides and was diagnosed as chylothorax. We performed thoracotomy because the chylothorax persisted even with treatment of fat-free alimentation. On thoracotomy, the thoracic duct extended like a cyst and chile was discharged on compression of the cyst. Ligation of the cyst and connected lymph ducts was performed. There has been no recurrence of the chylothorax since the operation. Only 32 cases of thoracic duct cyst of the mediastinum have been reported, but we should consider the possibility of chylothorax in cases of pleural effusion.
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  • Akihiro Takahagi, Naoki Yamashita, Koji Takahashi, Shinya Ito, Takashi ...
    2011 Volume 25 Issue 7 Pages 776-781
    Published: November 15, 2011
    Released: January 16, 2012
    JOURNALS FREE ACCESS
    We report a case of pulmonary actinomycosis diagnosed after left pneumonectomy for recurrent hemoptysis. A 62-year-old man presented with hemoptysis despite arterial embolization. We performed a left pneumonectomy, and the histological diagnosis was pulmonary actinomycosis. Pulmonary actinomycosis is a chronic inflammatory granulomatous disease caused by anaerobic bacteria; however, microbiological diagnosis is difficult. Although these anaerobic bacteria exhibit sensitivity to penicillin, they cause intractable hemoptysis through symbiosis with resistant bacteria; thus, they frequently necessitate surgical intervention. We report the clinical course, surgical procedure, and pathological findings of this case, along with a discussion of the literature.
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  • Masayuki Toishi, Ryoichi Kondo, Takeshi Yamanda
    2011 Volume 25 Issue 7 Pages 782-788
    Published: November 15, 2011
    Released: January 16, 2012
    JOURNALS FREE ACCESS
    A 73-year-old-man was referred to our hospital due to an anterior mediastinal mass detected on CT examination. Chest CT showed a heterogeneously enhanced mass measuring 3 cm in diameter on the left side of the anterior mediastinum. The mass did not show a marked change in size on follow-up CT, and we suspected a thymoma with cystic change. Thoracoscopic surgery was performed through the left pleural cavity, and the left lobe of the thymus was resected along with the mass, which was dark-red and elastic-soft. The tumor was diagnosed as a capillary hemangioma histopathologically. Mediastinal hemangioma is rare, but, by carefully considering the indications and devising an appropriate position and approach, we were able to diagnose this case as a mediastinal hemangioma and safely treat the lesion by employing thoracoscopic surgery.
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  • Jun Arikura, Hirofumi Adachi, Keishi Kondo
    2011 Volume 25 Issue 7 Pages 789-793
    Published: November 15, 2011
    Released: January 16, 2012
    JOURNALS FREE ACCESS
    We report the very rare case of a primary pleural leiomyoma. A mass in the right hilum was detected by chest radiography in a 52-year-old woman. A thoracic CT scan revealed a clearly smooth-shaped tumor (5.8×4.6 cm) with heterogeneous enhancement lying against the right pulmonary artery. We could not diagnose the tumor preoperatively. We performed tumor resection with open thoracotomy. The yellow-white and firm tumor was located in the minor fissure, and was resected easily from the surrounding tissues. Histologically, the tumor was diagnosed as a leiomyoma. Because we could identify no organ of origin of the leiomyoma other than the pleura, we finally diagnosed the tumor as a primary pleural leiomyoma.
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  • Fumiho Sano, Manabu Sudo, Kouichi Ueki, Toshiki Tanaka, Kazuhiro Ueda, ...
    2011 Volume 25 Issue 7 Pages 794-799
    Published: November 15, 2011
    Released: January 16, 2012
    JOURNALS FREE ACCESS
    We treated a pleuroperitoneal communication successfully by performing thoracoscopic resection and suturing of the diaphragm in two patients on continuous ambulatory peritoneal dialysis (CAPD). In both patients, the pleuroperitoneal communication occurred within 1 year after the commencement of CAPD. The CAPD was able to be resumed soon after surgery. This minimally invasive form of surgery could be the most effective way of treating pleuroperitoneal communications.
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  • Yosuke Matsuura, Masanobu Watari
    2011 Volume 25 Issue 7 Pages 800-805
    Published: November 15, 2011
    Released: January 16, 2012
    JOURNALS FREE ACCESS
    Operations for lung cancer at an advanced age are increasing. Advanced-age patients with lung cancer often have COPD as an underlying disease. As cases of lung cancer with COPD frequently involve postoperative complications, it is important to perform perioperative management. From 2009 Oct., in our hospital, we started perioperative support for chest surgery in liaison with multiple disciplines. The aim was a reduction of postoperative complications. We report two cases of lung cancer with COPD at an advanced age, and the effectiveness of perioperative management in our hospital.
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  • Hiroyuki Agatsuma, Shuhei Hakiri, Hiromu Yoshioka
    2011 Volume 25 Issue 7 Pages 806-808
    Published: November 15, 2011
    Released: January 16, 2012
    JOURNALS FREE ACCESS
    The patient was a 57-year-old man who had undergone high anterior resection and lymph node dissection in February 2007 for rectal cancer (pT3N1M0, stage IIIA) followed by UFT administration for one year postoperatively. A thin-walled cavity was detected in the posterior basal segment (S10) of the right lung on chest CT in July 2008, and the lesion exhibited a tendency to increase in size as well as uneven wall thickening. Although a diagnosis could not be made based on transbronchial lung biopsy, malignancy was suspected and surgery was performed to determine the diagnosis and treatment strategy. An excision biopsy was performed during thoracoscopic surgery, and the patient was diagnosed with lung metastasis of rectal cancer. A thin-walled cavity requires careful observation, and diagnosis must be confirmed by biopsy or other means in cases where findings suggest malignancy.
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  • Takahiro Okabayashi, Yuichi Shibuya, Taku Okamoto, Takashi Nakashima
    2011 Volume 25 Issue 7 Pages 809-814
    Published: November 15, 2011
    Released: January 16, 2012
    JOURNALS FREE ACCESS
    A 68-year-old man underwent right completion pneumonectomy for lung cancer. Eleven months later, he was admitted because of dyspnea and a cough. A chest roentogenogram, computed tomography, and a bronchoscopic study revealed an endotracheal polypoid tumor arising from the right bronchial stump obstructing the central airway.
    Laser abrasion and coring out through the rigid bronchoscopy were performed, followed by placement of a covered Ultraflex nitinol stent for palliation of the airway obstruction.
    After the resolution of symptoms of airway obstruction, no other recurrent tumors were noted on an exploratory thoracoscopy.
    Twenty-three days after airway stenting, under general anesthesia, the Ultraflex stent was retrieved employing rigid bronchoscopy. Then, radical carinal resection followed by tracheo-bronchial end-to-end anastomosis through a right thoracotomy was performed. The anastomosed region was wrapped with a right diaphragmatic flap.
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  • Hideki Ujiie, Naoyuki Yoshino, Yuki Nakajima, Daisuke Okada, Hirohiko ...
    2011 Volume 25 Issue 7 Pages 815-819
    Published: November 15, 2011
    Released: January 16, 2012
    JOURNALS FREE ACCESS
    Pulmonary benign clear cell tumors are very rare. A 57-year-old woman with a round and well marginated nodule in the right middle lobe of the lung underwent thoracoscopic partial lung resection. Histopathological specimens of the resected tumor revealed cells with an abundant, clear cytoplasm containing glycogen. Immunohistochemical staining was positive for PAS and HMB-45. The tumor was diagnosed as a primary pulmonary clear cell tumor.
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