The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Volume 27 , Issue 5
Showing 1-24 articles out of 24 articles from the selected issue
  • Mitsunori Ohta, Yoshihisa Kadota, Eiji Okura, Naoto Kitahara, Eriko Fu ...
    2013 Volume 27 Issue 5 Pages 542-546
    Published: July 15, 2013
    Released: July 29, 2013
    JOURNALS FREE ACCESS
    Five patients with advanced lung cancer and one with malignant pleural mesothelioma developed recurrent laryngeal nerve palsy, owing to resection of the intrathoracic vagus nerve along with the complete removal of malignancies. They showed hoarseness, short phonation, and/or swallowing disorder, which were major factors worsening their quality of life. We performed direct anastomosis of the vagus to the recurrent laryngeal nerve at the level of the hypopharynx to improve these phonetic and swallowing impairments 2 to 5 months after the thoracic operation.
    Three to six months after the nerve anastomosis, all patients except one with relapse of mesothelioma had achieved sufficient improvement in phonation and swallowing.
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  • Kenji Tsuboshima, Yasumi Matoba
    2013 Volume 27 Issue 5 Pages 547-552
    Published: July 15, 2013
    Released: July 29, 2013
    JOURNALS FREE ACCESS
    We aimed to assess the perioperative outcomes of single-incision video-assisted thoracoscopic surgery (VATS) using pulley of chest wall for lung excision (PulLE) in patients with primary spontaneous pneumothorax (PSP) compared to conventional two- or three-port VATS in our hospital. Fifty-two patients (10 PulLE and forty-two conventional VATS) were enrolled in this study from 2009.
    The PulLE procedure was performed as follows for straightforward cases: The patient was placed in a lateral position. A 17~25-mm single incision at the level of the 6th intercostal space (ICS) at the median axillary line was made and LAPPROTECTOR (HAKKO CO.) was placed for this procedure. The visceral pleura near the bulla was sutured for traction. The parietal pleura at the level of the 3 ICS at the anterior axillary line was sutured from the thoracic cavity as the pulley of the chest wall, and the traction thread was passed through the pulley. By manipulation of the traction thread, it was possible to move the lesion to an arbitrary place for excision by autosutures. The postoperative wound was almost invisible using this method.
    Compared with conventional VATS, equivalent results were obtained with PulLE: operation time (76.1±25.0 vs. 67.0±22.7 min, NS), blood loss (2.8±1.9 vs. 5.4±4.2 ml, NS), duration of drainage after operation (1.0±0 vs.1.4±1.2 days, NS), postoperative hospital stay (3.8±2.5 vs. 3.9±2.0 days, NS), respectively.In conclusion, PulLE proved to be feasible as a surgical treatment for straightforward PSP.
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  • Kotaro Mizuno, Tsutomu Tatematsu, Risa Oda, Takuya Matsui, Takeshi Yam ...
    2013 Volume 27 Issue 5 Pages 553-557
    Published: July 15, 2013
    Released: July 29, 2013
    JOURNALS FREE ACCESS
    The number of patients with non-tuberculous mycobacteriosis (NTM) has been increasing in recent years. According to the guideline of the Japanese Society for Tuberculosis, a localized lesion and resistance to drug treatment are indications for surgery. We compared lobectomy and segmentectomy for NTM. We investigated four lobectomy cases (A) and seven segmentectomy cases (B) from January 2008 to November 2011. There was no significant difference in the operation time, amount of bleeding, and postoperative days of hospitalization. There was no recurrence in the surgical margin in group B. Since NTM lung disease is benign, minimally invasive surgery is desired. According to this study, segmentectomy for NTM can be a standard surgical procedure.
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  • Taro Ohba, Takashi Seto, Fumihiko Hirai, Gouji Toyokawa, Masafumi Yama ...
    2013 Volume 27 Issue 5 Pages 558-561
    Published: July 15, 2013
    Released: July 29, 2013
    JOURNALS FREE ACCESS
    Tracheobronchial stent insertion is a common treatment for airway obstruction due to a malignant lesion, while the sedation method varies. We have performed tracheobronchial stent insertions using flexible bronchoscopy under general anesthesia with a laryngeal mask. Here, the efficacy of this method is assessed. We examined 23 cases (28 times, 33 stents) from June 2005 to November 2010. There was no treatment-related complication or death. Dyspnea improved in all patients after the treatment, while tumor progression in the stent occurred in one case. Tracheobronchial stent insertion using the laryngeal mask is a safe and efficacious method.
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  • Terumoto Koike, Satoko Yuyama, Seijiro Sato, Takehisa Hashimoto, Masan ...
    2013 Volume 27 Issue 5 Pages 562-568
    Published: July 15, 2013
    Released: July 29, 2013
    JOURNALS FREE ACCESS
    Although acute exacerbation (AE) of interstitial pneumonia (IP) is one of the most severe and fatal complications following surgical treatment in lung cancer patients with underlying IP, identifying a high-risk subgroup for postoperative AE among these patients is still difficult. Recent studies indicated the association between pulmonary hypertension and the severity of IP or increased incidence of AE during follow-up in IP patients. The present study was performed to investigate the impact of pulmonary artery (PA) pressure assessment on postoperative AE in lung cancer patients with underlying IP. We retrospectively reviewed 53 lung cancer patients with underlying IP who underwent pulmonary resection at Niigata University Hospital from 2001 to 2012. The sizes of the PA and aorta (Ao) were measured on computed tomography (CT), and the PA/Ao ratio was calculated. As a control without IP, data on 59 lung cancer patients without underlying IP who underwent pulmonary resection in 2009 were used for comparison. In 14 patients who underwent preoperative echocardiography, the PA pressure was calculated using the modified Bernoulli equation. Postoperative AE developed in 5 patients (9.4%). Although there were no significant differences in the preoperative PA size or PA/Ao ratio on CT between the patients who did and did not develop postoperative AE, both the PA size and PA/Ao ratio on CT were significantly larger in the patients with IP compared to those without IP. Moreover, the differences between the post- and preoperative PA size and PA/Ao ratio on CT were significantly larger in the patients who developed postoperative AE. These results suggest an association between an increased PA size and PA/Ao ratio on CT, and underlying IP or AE of IP. In the patients who underwent preoperative echocardiography, the estimated PA pressure was significantly higher in those who developed postoperative AE. The assessment of PA pressure by monitoring serial changes in the PA size and PA/Ao ratio on CT as well as preoperative echocardiography may be helpful for predicting postoperative AE in lung cancer patients with underlying IP.
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  • Takahito Nakano, Hiroyuki Kaneda, Yohei Taniguchi, Tomohito Saito, Tos ...
    2013 Volume 27 Issue 5 Pages 569-574
    Published: July 15, 2013
    Released: July 29, 2013
    JOURNALS FREE ACCESS
    Background. Pulmonary resection has an impact on the right ventricular function, because of an elevated right ventricular afterload caused by the loss of the lung vascular bed. We examined the relationship between the extent of pulmonary resection and serum concentration of natriuretic peptides, used as a marker of heart failure.
    Methods. We retrospectively analyzed clinical charts and laboratory data, and compared the 63 patients' clinical and surgical data and the measurement of natriuretic peptides; human atrial natriuretic peptide, HANP; N terminal pro brain natriuretic peptide, NT-proBNP, according to the volume of pulmonary resection. The natriuretic peptides were measured before and 7 days after surgery. The elevation was calculated with the value 7 days after surgery divided by that before surgery.
    Results. The HANP level elevated 2.1 times in a group of 25 patients with lobectomy, whereas it elevated 1.5 times in a group of 28 patients with sublobar resection and 1.2 times in a group of 10 patients with non-pulmonary resection (p=0.019). The NT-proBNP level elevated 3.9 times in a group of patients with lobectomy, whereas it elevated 2.8 times in patients with sublobar resection and 1.6 times in patients with non-pulmonary resection. The NT-proBNP level tends to be higher in patients whose surgery involve a greater volume of pulmonary resection (p=0.051).
    Conclusions. The natriuretic peptide level elevated after lung resection, and the elevation correlated with the volume of lung resection. This is important to consider when we choose limited lung resection for patients with severe cardiac dysfunction.
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  • Yasushi Ikuta, Kazuki Tamura
    2013 Volume 27 Issue 5 Pages 575-579
    Published: July 15, 2013
    Released: July 29, 2013
    JOURNALS FREE ACCESS
    This report describes a case of successful surgical treatment of esophageal perforation and acute mediastinitis arising from endoscopic examination at the time of endoscopic retrograde cholangiopancreatography (ERCP). An 82 year-old female presented complaining of pharyngalgia immediately following ERCP, and was referred to our department after the diagnosis of mediastinal emphysema based on a CT scan. After the diagnosis of acute mediastinitis by CT scan on the following day, we immediately performed emergency thoracoscopic transthoracic mediastinal drainage. Esophageal perforation is often treated surgically. On rare occasions, endoscopic examination can result in esophageal perforation. Because of the potential lethality of acute mediastinitis, early diagnosis and treatment are crucial for a positive prognosis. If acute mediastinitis is suspected, a CT scan should be ordered as it essential for revealing the location, extent, and nature of any mediastinal abscess secondary to neck infection. Primary suturing is possible provided it is performed immediately following the esophageal perforation, and, in the event that acute mediastinitis is diagnosed, abscess drainage should be performed as soon as possible.
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  • Shigeyuki Morino, Akihiro Nakamura, Ryoichiro Doi
    2013 Volume 27 Issue 5 Pages 580-583
    Published: July 15, 2013
    Released: July 29, 2013
    JOURNALS FREE ACCESS
    A 47-year-old woman experienced aspiration while eating shrimp. Her cough persisted, and, after 8 days, she coughed up part of a shrimp leg, followed by strong coughing. As her coughing persisted, and blood-stained sputum during the cough was noted, she presented to our hospital. On chest CT, obstruction at the right bronchus (B9) and peripheral atelectasis were noted, along with a dotted, high-density area inside the lung. As we suspected the presence of a remnant shrimp leg, bronchoscopic examination was performed; however, the presence of a foreign body could not be visibly confirmed. A small thoracotomy was performed and the right inferior lobe was observed; subsequently, removal of a remnant shrimp leg was attempted through the thoracotomy. A 4-cm inflammatory nodule was detected in the basal segment, and a high echo area identical to the size of 2 shrimp leg segments was identified inside. The shrimp leg was removed through incision of the pulmonary parenchyma; however, the length of the removed foreign substance was less than that previously confirmed by echography. Therefore, intraoperative bronchoscopy was performed, which confirmed the presence of an additional segment of a shrimp leg in the right main bronchus. We believe that one shrimp leg segment detached during the removal of the other segment. The shrimp leg segment incarcerated in the bronchus was eventually removed by right thoracotomy combined with bronchoscopy from both directions.
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  • Yumi Hino, Hidenori Mukaida, Wataru Takiyama
    2013 Volume 27 Issue 5 Pages 584-588
    Published: July 15, 2013
    Released: July 29, 2013
    JOURNALS FREE ACCESS
    A 53-year-old man was referred to our hospital because of an abnormal shadow detected on chest radiography. Computed tomography (CT) and magnetic resonance imaging showed tumors in the right superior to middle mediastinal and retroperitoneal areas. We performed a CT-guided biopsy of the retroperitoneal tumor, and schwannoma was diagnosed. Video-assisted thoracic and open abdominal surgeries were performed separately. The tumors arose from the mediastinal vagal and lumbar nerves. The histological diagnosis was schwannoma with no malignant findings. We encountered a rare case of multiple synchronous schwannomas located in the mediastinum and retroperitoneum.
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  • Toshimasa Okazaki, Satoshi Shiono, Masami Abiko, Toru Sato
    2013 Volume 27 Issue 5 Pages 589-593
    Published: July 15, 2013
    Released: July 29, 2013
    JOURNALS FREE ACCESS
    The patient was a 78-year-old man who had prostate cancer and was undergoing hormone therapy. Chest computed tomography showed a 60-mm mass with an area of calcification in the anterior mediastinum. We performed an ultrasound-guided core needle biopsy, and diagnosed him with a thymoma. The patient underwent thymectomy, and the pathological diagnosis was type AB thymoma (WHO classification). A painless mass appeared in his right anterior chest wall 4 years after thymectomy, and was clinically diagnosed as a recurrence of thymoma. The tumor was excised, and the pathological diagnosis was thymoma. Because the surgical margins were positive, the patient underwent postoperative radiation therapy (60 Gy). The patient has been tumor-free for the past 4 years.
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  • Hidehisa Hoshino, Aki Ishikawa, Chikabumi Kadoyama
    2013 Volume 27 Issue 5 Pages 594-599
    Published: July 15, 2013
    Released: July 29, 2013
    JOURNALS FREE ACCESS
    A 66-year-old man with rectal cancer had undergone low anterior resection followed by chemotherapy using TS-1. He was referred to our hospital because of an elevated serum CEA level, and two nodules in the upper lobe of left lung and a mass shadow in the left parietal pleura on chest computed tomography. Under a radiological diagnosis of metastasis from the previous rectal cancer, we performed a partial resection of the left upper lobe and resection of the chest wall tumor. Histologically, all tumors were confirmed as metastases from rectal cancer. He has been receiving chemotherapy using oxaliplatin with TS-1. Now, at one year after the resection, he shows no signs or symptoms of recurrence. Because few cases of metastatic chest wall tumor from rectal cancer have been reported, we report the case, considering that the accumulation of similar cases is necessary for the establishment of surgical indications.
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  • Yuya Tanaka, Kazuhiro Ueda, Masatarou Hayashi, Toshiki Tanaka, Kimikaz ...
    2013 Volume 27 Issue 5 Pages 600-604
    Published: July 15, 2013
    Released: July 29, 2013
    JOURNALS FREE ACCESS
    A 72-year-old female was referred to our department due to the postoperative local recurrence of an episternal chondrosarcoma, that had been identified on follow-up computed tomography. The patient underwent wide excision of the tumor with combined resection of the upper 2/3 of the sternum, followed by chest wall reconstruction with ePTFE mesh. Postoperatively, the patient did not show paradoxical respiration or deterioration of the pulmonary function. We emphasize the effectiveness of using ePTFE mesh for reconstruction of the chest wall after wide excision.
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  • Hidehisa Hoshino, Kiyoshi Shibuya, Shigetoshi Yoshida, Ichiro Yoshino
    2013 Volume 27 Issue 5 Pages 605-610
    Published: July 15, 2013
    Released: July 29, 2013
    JOURNALS FREE ACCESS
    A 43-year-old man had been treated conservatively for tracheobronchial injury caused by blunt chest trauma. He was brought to our hospital for the treatment of late-onset airway stenosis. Bronchoscopic findings revealed severe cicatric stenosis at the level of the carina and right main bronchus. Initially, we attempted to treat him with repeat bronchoscopic balloon dilatation using a semiconductor laser system, but it was ineffective. Considering the situation caused by the stenosis, we bronchoscopically cauterized the cicatric adhesion between the membranous portion of the trachea and front portion of the right main bronchus using the semiconductor laser system to detach the adhesion. This procedure went well, and the right main bronchus was successfully opened. Directly after the procedure, his symptoms of airway stenosis markedly improved. Four years after the treatment, he has no symptoms of airway stenosis.
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  • Satona Tanaka, Minoru Aoki, Hiroyuki Ishikawa, Yosuke Otake
    2013 Volume 27 Issue 5 Pages 611-615
    Published: July 15, 2013
    Released: July 29, 2013
    JOURNALS FREE ACCESS
    The patient was a 64-year-old female, receiving bevacizumab-containing chemotherapy for the treatment of colon cancer with multiple lung metastases. She was referred to our hospital due to the recurrence of pneumothorax in spite of pleural drainage and pleurodesis. Computed tomography (CT) showed a fistula on the surface of the left lower lobe. Air leakage from the fistula was confirmed during surgery, and direct suture with coverage using polyglycolic acid felt and fibrin glue was performed. However, pneumothorax recurred after discharge. In the reoperation, air leakage was noted from the fistula, which had been closed during the first operation. A pedicled flap of serratus anterior muscle was harvested, and the fistula was covered with the flap. Pneumothorax did not recur after the reoperation. A retrospective review of the CT findings revealed that the subpleural tumor showed cavitation during chemotherapy and the pleural fistula formed with rupture of the cavity. The anti-angiogenetic effect of bevacizumab can be a cause of this refractory pneumothorax. Coverage with the pedicled flap was effective in this patient. We should have considered this method earlier.
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  • Yuichi Ozeki, Shoko Kadoma, Kazuyuki Komori, Takefumi Nakayama, Hirosh ...
    2013 Volume 27 Issue 5 Pages 616-620
    Published: July 15, 2013
    Released: July 29, 2013
    JOURNALS FREE ACCESS
    We report a case of Morgagni hernia treated by video-assisted thoracic surgery (VATS). A 67-year-old female was referred to our hospital because of an abnormal shadow in the right lower lung field. She had a past history of blunt trauma to the chest five years earlier. Chest CT and MRI revealed herniation of the omentum into the right hemithorax through a retrosternal defect. She was diagnosed with Morgagni hernia, and successfully treated by VATS with a small thoracotomy. The diaphragm defect was closed with coated, braided nylon sutures under direct vision. VATS is considered to be a useful procedure for Morgagni hernia.
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  • Hitoshi Suzuki, Ryou Maeshiro, Kentaro Inoue, Chiaki Kondo, Motoshi Ta ...
    2013 Volume 27 Issue 5 Pages 621-624
    Published: July 15, 2013
    Released: July 29, 2013
    JOURNALS FREE ACCESS
    The patient was a 52-year-old female. Left hemithyroidectomy was performed for a papillary thyroid carcinoma at 44 years old. She was referred to our hospital due to an abnormality on a chest radiograph. A chest computed tomography scan (CT) showed a round mass (3 cm) in the right middle lobe (S4) and multiple small nodules in both lungs. Surgery was performed with a preoperative diagnosis of co-existent lung metastases and primary lung carcinoma. Intraoperative histological examination showed papillary and squamous structures, and a right middle lobectomy with hilar and mediastinal lymph node dissection was performed. Transitional foci were noted between the papillary carcinoma and squamous cell carcinoma as postoperative histological findings, and we diagnosed her with pulmonary metastases of thyroid carcinoma. Therefore, it is necessary to be aware that papillary carcinoma sometimes changes into squamous cell carcinoma.
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  • Ryosuke Kaku, Keiko Ishida, Keiko Ueda, Keigo Okamoto, Koji Teramoto, ...
    2013 Volume 27 Issue 5 Pages 625-631
    Published: July 15, 2013
    Released: July 29, 2013
    JOURNALS FREE ACCESS
    We report a rare case of synovial sarcoma involving the extrathoracic chest wall. A 31-year-old woman was admitted to our hospital for the treatment of a tumor of the right anterior chest, which had enlarged from 5 to 50 mm during a period of 8 months. Enhanced chest computed tomography (CT) scans showed that the tumor was well-defined, homogenous inside, and, existed between the third rib and major pectoral muscle. Chest magnetic resonance imaging (MRI) revealed that the tumor showed low and high signal intensities on T1- and T2-weighted images, respectively, and possibly invaded the minor pectoral muscle. Based on these findings, we suspected the tumor to be a soft tissue sarcoma originating from the minor pectoral muscle. During surgery, the tumor was removed from adjacent tissues comparatively easily, and diagnosed as a soft tissue sarcoma. The anterior chest wall including the third rib and intercostal muscles was partially resected with a surgical margin of 4 cm from the tumor. The tumor, measuring 51×45×37 mm, was rough-surfaced, and diagnosed as a synovial sarcoma pathologically. Synovial sarcomas mainly originate from the lower extremities, and those from the extrathoracic chest wall are extremely rare. In this case, tumor growth had been quite rapid, with a tumor-doubling time of 63 days. Considering the nature of the tumor, resection of this type of sarcoma should be performed with a sufficient surgical margin.
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  • Nozomu Motono, Makoto Tanaka, Yuichiro Machida, Katsuo Usuda, Motoyasu ...
    2013 Volume 27 Issue 5 Pages 632-636
    Published: July 15, 2013
    Released: July 29, 2013
    JOURNALS FREE ACCESS
    Background. The diagnosis of a cavitating pulmonary disease is occasionally difficult. Case. A 59-year-old male was noted to have an abnormal shadow on a chest radiograph. Chest CT showed a cavity lesion, as well as an infiltrative shadow that had first been noticed two years earlier. Transbronchial lung biopsy could not reveal any malignant cells; therefore, the cavity was suspected to be a lung abscess. However diffusion-weighted magnetic resonance imaging (DWI) suggested the possibility of malignancy. Histological examination of frozen sections obtained during the operation revealed adenocarcinoma. The patient underwent left lower lobectomy with hilar and mediastinal lymphadenectomy. The final pathological diagnosis was adenocarcinoma with mixed subtypes, predominantly acinar and mucinous bronchioloalveolar carcinoma. The pathological stage was T2aN2M0 stage IIIA. Conclusion. DWI may be useful for the diagnosis of a malignant lung tumor.
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  • Sachiko Kumazawa, Hironori Ishibashi, Ken Takahashi, Ryo Maeda, Kenich ...
    2013 Volume 27 Issue 5 Pages 637-641
    Published: July 15, 2013
    Released: July 29, 2013
    JOURNALS FREE ACCESS
    We report a case of congenital esophagobronchial fistula. A 72-year-old female had experienced frequent coughing attacks during meals for more than fifty years. Chest CT and esophagography showed an esophagobronchial fistula and atelectasis of the left lower lung. She underwent a left lower lobectomy with dividing of the fistula. Although the left lower lobe severely adhered to the chest wall, the fistula could be easily dissected from the surrounding tissue. The fistula was transected using a stapler and reinforced with interrupted sutures. Histopathological findings revealed the fistula to be a true diverticulum, and she was diagnosed with a congenital esophagobronchial fistula. The postoperative course was uneventful.
    A congenital esophagobronchial fistula without tracheal atresia is sometimes detected in elderly patients.
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  • Kohei Aoki, Makoto Sawafuji, Ikuo Kamiyama, Keisuke Eguchi, Tai Omori, ...
    2013 Volume 27 Issue 5 Pages 642-649
    Published: July 15, 2013
    Released: July 29, 2013
    JOURNALS FREE ACCESS
    A 62-year-old man with superior vena cava (SVC) syndrome due to idiopathic fibrosing mediastinitis underwent the insertion of a self-expanding metallic stent (SEMS) in the SVC. Thirty months after the procedure, recurrence of SVC syndrome with complete obstruction of the SVC was recognized. At around the same time, gastrointestinal endoscopy showed varices involving almost the entire esophagus (F2, Cb, RC (-), Lsmi, Lg (-), E (-)). He had no portal hypertension; therefore, we diagnosed him with downhill esophageal varices due to SVC syndrome. Because there was no bleeding sign, he has been carefully followed up with no medication for 9 years, and no marked change has been observed. Downhill esophageal varices is rare, but it sometimes complicates hematemesis. We should keep downhill esophageal varices in mind when we examine a patient with SVC syndrome.
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  • Koichiro Shimoyama, Shinji Akamine, Kazuki Tamura, Yasushi Ikuta, Shig ...
    2013 Volume 27 Issue 5 Pages 650-655
    Published: July 15, 2013
    Released: July 29, 2013
    JOURNALS FREE ACCESS
    Paragangliomas (PG) of the post-mediastinum are rare neoplasms. Herein, we report a case of post-mediastinal PG with abnormal blood pressure and unexpected massive bleeding during surgery. The patient was a 60-year-old man with an abnormal shadow observed on chest radiography during a routine medical check-up. Computed tomography and magnetic resonance imaging showed the presence of a right posterior mediastinal tumor. With the diagnosis of a posterior mediastinal neurogenic tumor, video-assisted thoracic surgery (VATS) was performed. During the surgery, his systolic blood pressure increased to over 220 mmHg and he bled easily. We had convert to a standard thoracotomy due to the poor control of massive bleeding (over 200 ml). After tumor resection, his blood pressure stabilized. The tumor was pathologically diagnosed as a PG. Post-mediastinal PG has been reported in only 28 cases in Japan. It is difficult to preoperatively diagnose. If PG is diagnosed during surgery, this case suggests the importance of prompt consultation with an anesthesiologist and immediate resection.
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  • Seishi Nosaka, Katsuhiko Morita, Masaki Murayama
    2013 Volume 27 Issue 5 Pages 656-661
    Published: July 15, 2013
    Released: July 29, 2013
    JOURNALS FREE ACCESS
    The patient was an 80-year-old man. Previous history included a right lower lobectomy for a lung adenocarcinoma accompanied with partial parietal pleurectomy on September 2010. The tumor was a poorly differentiated acinar adenocarcinoma with abundant necrotic lesions. One year later, as a metastatic work-up, an 18-fluorodeoxyglucose positron emission tomography (FDG-PET) scan was performed. It showed abnormal uptakes in the spleen, without other organ abnormalities. Abdominal CT scan with contrast enhancement showed a 4.5×4.0-cm splenic tumor. Clinically, we diagnosed it a solitary splenic metastasis from primary lung cancer, and recommended the patient to have a splenectomy. However, he elected to have the splenic lesion followed with subsequent CT scans rather than undergo surgery. Six months later, a follow-up CT scan showed the splenic lesion had enlarged to 8.0×6.5-cm, and splenectomy was advised again. On June 2012, he underwent exploratory laparotomy and splenectomy. There was no other intra-abdominal pathology evident. The resected spleen was occupied with the tumor, and it was diagnosed as a poorly differentiated acinar adenocarcinoma, corresponding to the histological findings of the primary lung cancer. Splenic metastases from lung cancer are considered very rare. In most cases, these represent diffuse disease and widespread hematologic dissemination. Isolated splenic metastases in the absence of widespread disease are considered extremely rare. We report such a rare case and provide a review of the literature.
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  • Hiroaki Komatsu, Shinjiro Mizuguchi, Nobuhiro Izumi, Shoji Hanada, Hid ...
    2013 Volume 27 Issue 5 Pages 662-667
    Published: July 15, 2013
    Released: July 29, 2013
    JOURNALS FREE ACCESS
    We report a rare case of benign mediastinal schwannoma ruptured into the pleural cavity. A 51-year-old male was referred to our hospital with a complaint of chest pain. He had undergone needle biopsy for a mediastinal tumor 5 years ago. An imaging study revealed a huge posterior mediastinal tumor with high uptake on FDG-PET, penetrating the posterior chest wall, with massive left pleural effusion. Possible malignant transformation was considered, and the tumor was resected with the 9th rib. Histological findings of the resected specimen showed benign schwannoma with no invasion to the chest wall.
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