The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Volume 26 , Issue 5
Showing 1-19 articles out of 19 articles from the selected issue
  • Masatsugu Ohuchi, Shuhei Inoue, Yoshitomo Ozaki, Takuya Fujita, Noriak ...
    2012 Volume 26 Issue 5 Pages 490-497
    Published: July 15, 2012
    Released: September 03, 2012
    JOURNALS FREE ACCESS
    This study was performed to analyze the complications and efficacy of perioperative management with corticosteroid and sivelestat sodium to prevent the acute exacerbation of idiopathic interstitial pneumonia (IIP) after lung resection. Methylprednisolone sodium succinate (250 mg, intravenously) was administered to ten cases before the induction of anesthesia and sivelestat sodium (4.8 mg/kg/day, intravenously) was administered before the induction of anesthesia for seven days. Lobectomy with nodal dissection assisted by thoracoscopy was performed in all 10 cases. Sivelestat sodium was discontinued on the third postoperative day in one patient because he had elevations of serum transaminase. No side effects were observed except in this case. No patients with respiratory complications including acute exacerbation of IIP were noted. All 10 cases were followed without local recurrence of lung cancer. We suggest that our perioperative management with corticosteroid and sivelestat is safe and might be effective for the prevention of acute exacerbation.
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  • Yoshitaka Ito, Hiroaki Kobayashi
    2012 Volume 26 Issue 5 Pages 498-502
    Published: July 15, 2012
    Released: September 03, 2012
    JOURNALS FREE ACCESS
    This study investigated the prognostic factors of surgical treatment for primary lung cancer in patients over 80 years.
    From January 1992 to March 2011, 55 patients over 80 years old underwent surgery for primary lung cancer in our hospital.
    The patient group consisted of 29 males and 26 females, and their mean age was 81.9 years old. Lobectomy was performed in 46 patients, segmental resection was performed in 2 patients, and partial resection was performed in 7 patients. In 41 patients, ND2a grade lymph node dissection was performed, ND1 grade lymph node dissection was performed in 7 patients, and ND0 grade lymph node dissection was performed in 7 patients. Regarding the histological type, there were 36 adenocarcinomas, 14 squamous cell carcinomas, and 5 other types. Concerning the pathological stage, there were 30 IA, 12 IB, 7 II, and 6 III. The overall survival rate at 5 years was 60.3%. In the sub groups of males and squamous cell carcinoma, the survival rates were worse than in the other groups. On the other hand, there were no differences in operational procedures and preoperative complications. We concluded that, with the appropriate selection of patients and procedures, surgical treatment results in a favorable prognosis for patients over 80 years.
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  • Masanobu Hayakawa, Emiko Tomita, Kenjiro Fukuhara
    2012 Volume 26 Issue 5 Pages 503-509
    Published: July 15, 2012
    Released: September 03, 2012
    JOURNALS FREE ACCESS
    We report two cases where primary lung cancer coexisted in one location of the resected specimen with multiple lung metastases. Patient 1 was a 68-year-old man. He was diagnosed with multiple lung metastasis of pharyngeal cancer and underwent segmentectomy and partial resection. Two metastases of pharyngeal cancer and one primary lung cancer (adenosquamous carcinoma) were recognized on histopathological diagnosis. Patient 2 was a 61-year-old woman. She was diagnosed with multiple lung metastases of renal cell cancer and underwent partial resection. Four lung metastases of renal cell cancer and one primary lung cancer (typical carcinoid) were detected pathologically. Patients undergoing simultaneous resections of metastatic lung tumor and primary lung cancer are rare; there are only 17 patients including our patients in the literature. It should be considered that primary lung cancer may coexist in patients with multiple lung metastases. However, even if coexisting primary lung cancer is identified intra- or postoperatively, we consider that additional resection of the lung or additional lymph node resection for primary lung cancer will not be required.
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  • Takuya Okamoto, Kazuhito Funai, Keigo Sekihara, Kei Shimizu, Norihiko ...
    2012 Volume 26 Issue 5 Pages 510-514
    Published: July 15, 2012
    Released: September 03, 2012
    JOURNALS FREE ACCESS
    A 77-year-old man complained of pharyngalgia and dysphagia, and he consulted a family doctor because ingestion gradually became impossible. He was given an antibiotic, but the symptoms did not improve, and he was referred to otolaryngology in our hospital. Chest CT scan showed a mediastinal abscess. He was diagnosed with descending necrotizing mediastinitis (DNM) and referred to our department. We performed thoracoscopic transthoracic mediastinal drainage on the day following admission. DNM is a serious infection, whereby the abscess of the neck reaches the mediastinum along a muscular fasciae gap. The case fatality rate in the absence of surgery is very high, at 40-50%. The fatality rate on performing surgery, however, can be reduced to 10-20%. Therefore, if DNM is suspected, it is important to perform an early examination for CT and the debridement of necrotic tissue and drainage.
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  • Atsushi Gabe, Tsutomu Kawabata, Takao Teruya, Hidenori Kawasaki, Masay ...
    2012 Volume 26 Issue 5 Pages 515-519
    Published: July 15, 2012
    Released: September 03, 2012
    JOURNALS FREE ACCESS
    Colon metastasis from lung cancer is reported to be rare and lead to a very poor prognosis. A 57-year-old male underwent right upper lobectomy for primary lung cancer. One year later, he was evaluated because of an elevation of his tumor marker level. PET/CT (Positron Emission Tomography/Computed Tomography) revealed a mass with uptake of 18F-fluorodeoxyglucose (FDG) in the ascending colon, which was resected and diagnosed as colon metastasis from the lung. Furthermore, one year and nine months later, a mass in the liver was detected on a CT scan, which was also resected and diagnosed to be a metastasis from the lung cancer. As of the most recent follow-up examination at three years and nine months after the latter operation (five and a half years after the colon resection), he is alive and healthy with no recurrence. We herein describe this rare case of colon metastasis from lung cancer with a long survival time, and provide a review of the pertinent literature.
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  • Hitoshi Suzuki, Ryou Maeshiro, Kentaro Inoue, Chiaki Kondo
    2012 Volume 26 Issue 5 Pages 520-523
    Published: July 15, 2012
    Released: September 03, 2012
    JOURNALS FREE ACCESS
    A 51-year-old female was admitted to our hospital with dysphagia. Chest computed tomography (CT) scan revealed a round mass, measuring 5 cm, in the upper mediastinum. A mediastinal lymphangioma was suspected based on a CT scan, MRI, and lymph scintigraphy, and a CT-guided biopsy confirmed it to be a mediastinal lymphangioma preoperatively. Surgery was performed through a left upper partial sternotomy extended to the left supraclavicular space. The postoperative course was uneventful. Mediastinal lymphangioma is rare, and a preoperative diagnosis is very difficult. Lymph scintigraphy helps determine the site of draining lymphatic vessels and may be effective for preventing chylothorax.
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  • Fumito Imamura, Masaharu Inagaki
    2012 Volume 26 Issue 5 Pages 524-528
    Published: July 15, 2012
    Released: September 03, 2012
    JOURNALS FREE ACCESS
    A 60-year-old Japanese woman was found during chest radiograph in an annual physical checkup to show an abnormal shadow. Chest CT scan showed a 4×3-cm mass in the right middle lobe. A transbronchial lung biopsy of the tumor comfirmed the presence of an undifferentiated lung cancer. She underwent right middle lobectomy+ND2a. The postoperative pathological examination revealed and comfirmed the diagnosis of lymphoepithelioma-like carcinoma, pT2N0M0, stage IIB. An association with Epstein-Barr virus was demonstrated by EBER in situ hybridization. Neither latent membrane protein (LMP) nor EB nuclear antigen-2 (EBER-2) were immunohistochemically detected in this case. Two years after the operation, CT scan showed right hilar lymph node swelling, diagnosed as recurrence of LELC. Radiation therapy and carboplatin/paclitaxel combined chemotherapy was effective. The patient has survived for 10 years since the operation.
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  • Fumito Imamura, Kentaro Mase
    2012 Volume 26 Issue 5 Pages 529-532
    Published: July 15, 2012
    Released: September 03, 2012
    JOURNALS FREE ACCESS
    A 65-year-old man with a 9-year history of articular rheumatism complained of cough and chest pain. He was referred to our hospital with a diagnosis of left pneumothorax. Chest CT scan showed left pneumothorax and a 3-cm nodular shadow with cavitation in the left S6. He underwent video-assisted thoracic surgery. The nodule with cavitation in the left S6 was excised. The histopathology of the excised nodule showed the typical features of a rheumatoid nodule.
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  • Naoko Miura, Kensaku Ito, Chizuru Hamada, Koutarou Kajiwara, Hideki Yo ...
    2012 Volume 26 Issue 5 Pages 533-535
    Published: July 15, 2012
    Released: September 03, 2012
    JOURNALS FREE ACCESS
    Alveolar soft part sarcoma (ASPS) is a rare soft tissue tumor, typically affecting young patients. Although it shows a relatively indolent clinical course without metastases, the ultimate prognosis in patients with metastases is poor. This report presents a female patient with pulmonary metastases who survived without recurrence following pulmonary metastasectomies for 21 years. She underwent surgery to remove a mass in her abdominal wall at 12 years old. The pathologic diagnosis was ASPS. She was referred to our department to undergo surgery for metastases occurring in both lungs 2 years later. She underwent surgery twice to remove the metastases. The pathologic diagnosis was metastatic ASPS. She has remained recurrence-free for 21 years since the metastasectomies.
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  • Aya Harada, Yoshihiro Nakamura, Toshiyuki Nagata, Tsunayuki Otsuka, Ko ...
    2012 Volume 26 Issue 5 Pages 536-541
    Published: July 15, 2012
    Released: September 03, 2012
    JOURNALS FREE ACCESS
    We report a case of a solitary fibrous tumor (SFT) associated with hypoglycemia. A 54-year-old woman experienced loss of consciousness and dysarthria when awakening. On an investigation, hypoglycemia and a huge intrathoracic mass were detected, which was diagnosed as SFT by needle biopsy. Other endocrinological investigations were normal except for low values of immunoreactive insulin and C-peptide. Since the symptoms were suspected to be related to the tumor, she underwent complete resection of the tumor. After the operation, all symptoms disappeared, and insulin-like growth factor II (IGF-II) was stained positive by immunohistochemistry. High molecular weight IGF-II was also detected from a preoperative blood sample. We propose that high molecular weight IGF-II produced by SFT caused the hypoglycemia. There have been no signs of recurrence for one year since the operation.
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  • Ryo Miyata, Fengshi Chen, Tsuyoshi Shoji, Ryo Miyahara, Hiroshi Date
    2012 Volume 26 Issue 5 Pages 542-546
    Published: July 15, 2012
    Released: September 03, 2012
    JOURNALS FREE ACCESS
    Cancer-associated retinopathy (CAR) is most commonly associated with small cell lung cancer, leading to the progressive loss of visual functions. We herein report two patients that initially presented with CAR for more than 6 months and were successfully diagnosed with small cell lung cancer by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). One case was a 65-year-old woman, who had a swollen subcarinal lymph node. The other was an 84-year-old man, who had a posterior mediastinal mass and also had a history of resection of a giant liposarcoma in the right posterior mediastinum three years previously. Both patients started chemotherapy soon after the diagnosis. Although mediastinoscopy is the gold standard for histologic mediastinal lymph node assessment, EBUS could take the place of mediastinoscopy due to its minimal invasiveness and lower incidence of complications.
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  • Kazuhito Nii, Taku Okamoto, Takashi Nakashima, Yuuichi Shibuya, Takahi ...
    2012 Volume 26 Issue 5 Pages 547-552
    Published: July 15, 2012
    Released: September 03, 2012
    JOURNALS FREE ACCESS
    Primary lymphoepithelioma-like carcinoma (LELC) of the lungs is a rare disease, and is classified as a variant of large cell carcinoma.
    The patient in this study was a 73-year-old man who underwent a preoperative examination for another disease. Chest CT revealed a nodule of 10 mm in diameter in S1 of the right lung. A definite diagnosis was not obtained despite several transbronchial and CT-guided lung biopsies. Therefore, partial resection of the right upper lobe was performed under video-assisted thoracoscopic surgery. A definite diagnosis was obtained postoperatively and the nodule was identified as LELC, cT1N2M0 stage IIIA. An association with the Epstein-Barr virus infection could not be confirmed by EBER in situ hybridization. Although chemotherapy was performed, there was no positive response. The patient died one year after the first treatment intervention.
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  • Kohei Aoki, Yoshiaki Inoue, Hiroki Fukuda, Masatoshi Gika, Keisuke Egu ...
    2012 Volume 26 Issue 5 Pages 553-558
    Published: July 15, 2012
    Released: September 03, 2012
    JOURNALS FREE ACCESS
    Case 1: A 42-year-old female was referred to our department with dyspnea and pressure in the chest. She had a mass in the left supraclavicular fossa. CT scan showed a tumor from the lower pole of the left lobe of the thyroid to superior mediastinum. The tumor was diagnosed as a thymoma by needle biopsy. We performed extended thymothymectomy. The tumor was a non-invasive thymoma developing from the left upper pole of the thymus. Case 2: A 40-year-old female was referred to our department with a tumor under the left costal arch and hepatitis B surface antigen positivity. She had a palpable mass in the epigastrium. CT scan showed a tumor behind the left rectus abdominis, and it compressed the right ventricle and lateral segment of the liver. It was considered a chest wall tumor, and resected with the invaded ribs and rectus abdominis. Intraoperative frozen section examination of the tumor revealed thymoma. Histopathologically, it was diagnosed as invasive-thymoma developing from the antero-inferior mediastinum; therefore, we performed radiation therapy. We should keep thymoma in mind when we examine a patient with a palpable mass in the neck or epigastrium.
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  • Hideyasu Omiya, Koji Takami, Keiko Kuriyama, Masayuki Mano
    2012 Volume 26 Issue 5 Pages 559-562
    Published: July 15, 2012
    Released: September 03, 2012
    JOURNALS FREE ACCESS
    A 79-year-old male, who suffered from spontaneous pneumothorax of the left lung, underwent chest tube drainage in May 2007; however, the patient was readmitted because of a recurrence of the pneumothorax 1 month later. While a chest tube was placed again, the air-leakage prolonged; thus, a surgical procedure was required. Histological examination of the resected lung showed an adenocarcinoma of 7 mm in diameter beside a bulla. He was diagnosed with primary lung cancer (pT1a), and has been free from recurrence for 55 months after the operation without any additional treatment. In patients with spontaneous pneumothorax who have risk factors, such as an advanced age, heavy smoking, or emphysematous lung cysts, the importance of careful assessment for occult lung cancer through the perioperative period is emphasized.
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  • Kazuhiro Imai, Satoko Takahara, Yoshihiro Minamiya, Hajime Saito, Masa ...
    2012 Volume 26 Issue 5 Pages 563-567
    Published: July 15, 2012
    Released: September 03, 2012
    JOURNALS FREE ACCESS
    Solitary lymphangioma of the lung is extremely rare. We report the case of a 15-year-old girl who underwent thoracoscopic extirpation of an intrapulmonary lymphangioma located in the left lower lobe. Chest radiograph showed a well-circumscribed spherical mass measuring 17 mm in the left lower lung field when she had a checkup for the first time in her life. Computed tomography revealed a mass lesion with clear borders and a homogeneous shadow in the left S9. Histological examination revealed thickening of the alveolar walls and expansion of lymphatic vessels, and fibrotic changes in the interstitial space of the lung. Immunohistochemically, cells lining the thickened alveolar wall were positive for D2-40, CD34, and weakly positive for α-smooth muscle actin, but negative for AE1/AE3, desmin, HMB4, and ER, PgR. Solitary lymphangioma was diagnosed based on the results of immunohistochemical studies. A monoclonal antibody, D2-40, which reacts with the lymphatic endothelium, is useful for establishing the pathological diagnosis of lymphangioma. Careful follow-up may be necessary even though recurrence has not been described, because cases of re-growth have been reported.
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  • Kousuke Fujino, Kouji Hayashi
    2012 Volume 26 Issue 5 Pages 568-571
    Published: July 15, 2012
    Released: September 03, 2012
    JOURNALS FREE ACCESS
    We herein report a case of bleeding from the chest wall that had been injured by the use of tissue reinforcement material, after a bulla in a lingular segment was resected with a stapler that had been preloaded with tissue reinforcement material (Duet TRSTM, COVIDIEN). The end of the tissue reinforcement material was considered to have slowly damaged the chest wall due to respiratory displacement.
    Therefore, when using a stapler preloaded with tissue reinforcement material, such measures as trimming the surplus of the tissue reinforcement material and rounding it off, and also refraining from using such material in the middle lung, lower lung, or lingular segment in order to avoid causing a large degree of respiratory displacement, are thus considered to be necessary.
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  • Yasushi Ikuta, Daisuke Taniguchi, Ryouichirou Doi, Yoshiyuki Kondo, Sh ...
    2012 Volume 26 Issue 5 Pages 571-576
    Published: July 15, 2012
    Released: September 03, 2012
    JOURNALS FREE ACCESS
    A 72-year-old man complaining of dyspnea was referred to our hospital for further examination of a huge mass in the anterior mediastinum. Chest computed tomography disclosed a 24×20×9-cm mass, which extended to the bilateral thoracic cavities and compressed the heart. We performed a resection of the mass by Clamshell incision combined with a lower vertical sternotomy. The mass weighed 3,500 g. Histopathological findings showed the mass to be a myxofibrosarcoma. Dyspnea was resolved, and he was discharged on postoperative day 24. Pleural dissemination was detected 6 months after the surgery. However, the patient remains alive, without any respiratory symptom for 15 months after the operation. We suggest that Clamshell incision combined with a lower vertical sternotomy is a useful approach to secure a wide operative field for the complete resection of such a huge mediastinal tumor that widely extends to the bilateral thoracic cavities, and is a safe approach for avoiding perioperative critical circulatory failure in the presence of a huge mediastinal tumor.
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  • Tamami Nakamura, Kazuhiro Ueda, Toshiki Tanaka, Masataro Hayashi, Kimi ...
    2012 Volume 26 Issue 5 Pages 577-583
    Published: July 15, 2012
    Released: September 03, 2012
    JOURNALS FREE ACCESS
    We report two cases of large cell neuroendocrine carcinoma (LCNEC) combined with adenocarcinoma (Case 1) or squamous cell carcinoma (Case 2); namely, " combined LCNEC". Despite three courses of adjuvant chemotherapy with CBDCA and CPT-11 and complete resection of stage IIA LCNEC, multiple distant metastases developed in the first patient (case 1). In contrast, the second patient (case 2) was alive without recurrence 30 months after complete resection of stage IA LCNEC without adjuvant chemotherapy. Because combined LCNEC is a rare histological type of primary lung cancer, the clinical entity remains unclear. Further study is needed to establish the optimal therapeutic strategy for this rare disease.
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