The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Volume 28 , Issue 4
Showing 1-23 articles out of 23 articles from the selected issue
  • Tetsuya Isaka, Ko Takahashi, Takamitsu Maehara, Munetaka Masuda
    2014 Volume 28 Issue 4 Pages 420-426
    Published: May 15, 2014
    Released: June 13, 2014
    JOURNALS FREE ACCESS
    It is commonly known that late traumatic pneumothorax (LTP) often occurs after the initial traumatic pneumothorax by blunt trauma. This study examines the risk factors of LTP. We reviewed 58 patients with 61 traumatic pneumothoraxes who were treated in Yokohama Rosai Hospital during the period from November 1, 2006 through December 31, 2012. We divided these cases into an LTP group and non-LTP group and statistically compared the patient and clinical backgrounds. The term " lung cyst" used in this report included traumatic pulmonary pseudocyst and bullous emphysema. Ten lung cysts (16.4%) were detected by chest CT on the pneumothorax side. LTP was observed in 7 traumatic pneumothoraxes (11.5%). Univariate and multivariate analyses revealed that the lung cyst was an independent risk factor for LTP. A close follow-up is required after the initial traumatic pneumothorax by blunt trauma, when a lung cyst is detected.
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  • Kenji Tsuboshima, Teppei Wakahara, Yasumi Matoba, Yoshimasa Maniwa
    2014 Volume 28 Issue 4 Pages 427-432
    Published: May 15, 2014
    Released: June 13, 2014
    JOURNALS FREE ACCESS
    No evaluation method has been established for primary spontaneous pneumothorax (PSP). We performed video-assisted thoracoscopic surgery (VATS) for ninety-six patients with PSP in our hospital. PSP patients were enrolled in this study from 2009. The risk factor for postoperative recurrence of PSP was the age: under 24 yo only for both uni- and multivariate analysis. Compared with the Kaplan-Meier method and a simple method which we defined as the recurrent number per objective number, the postoperative recurrence rates of PSP over 25 yo were 2.9 and 4.9%, respectively, with the Kaplan-Meier and simple methods, and that under 24 yo was 26.6%with the Kaplan-Meier method. We clarified a difference in the recurrence rate according to the statistical analysis or backgrounds, and suggest that the Kaplan-Meier method is better than the simple method regarding the accuracy. Depending on the classification for the risk factor of age, the recurrence rates of low- and high-risk groups were significant with the Kaplan-Meier method (0 vs. 22.0%, respectively, p<0.05). In conclusion, we suggest that the Kaplan-Meier method is useful for evaluation of the postoperative recurrence rate. In the near future, we may develop a strategy of individual therapy for PSP using the classification of recurrent risk.
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  • Hidenori Kusumoto, Yasushi Shintani, Tomohiro Kawamura, Soichirou Funa ...
    2014 Volume 28 Issue 4 Pages 433-438
    Published: May 15, 2014
    Released: June 13, 2014
    JOURNALS FREE ACCESS
    The surgical indications for non-small cell lung cancer infiltrating a great vessel are controversial. We assessed the clinical features and surgical outcomes of patients with non-small cell lung cancer histologically diagnosed as T4. Thirteen patients underwent great vessel resection involving lobectomy (n=10) or pneumonectomy (n=3), with resection of the aorta in 6, superior vena cava in 2, another great vessel in 3, right atrium in 1, and left atrium in 1. Two patients had pN1 disease and 2 pN2 disease. Mortality was 7.7%. The 5-year survival rate was 31.2%for all patients, 48.6%for patients with pN0, and 51.4%for patients with adenocarcinoma. Our findings suggest that favorable long-term survival was achieved in patients with an adenocarcinoma or without lymph node metastasis.
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  • Masaaki Sato, Tetsu Yamada, Akihiro Aoyama, Fengshi Chen, Makoto Sonob ...
    2014 Volume 28 Issue 4 Pages 439-445
    Published: May 15, 2014
    Released: June 13, 2014
    JOURNALS FREE ACCESS
    We present techniques for safe and efficient donor operation in living related donor lobar lung transplantation. (1) Preparation for left atrium (LA) clamp slippage: after clamping the LA, we place stitches at each edge of the LA on the graft side of the clamp. In the event of clamp slippage after transecting the LA, the left atrial cut edge can be pulled by the stitches and re-clamped. (2) Bronchoscopic confirmation of bronchial transection site: to prevent separation of the superior segment bronchus and basal segment bronchus on right-side donor operation, a 25-gauge needle is inserted into the planned point of transection in the operative field and the locations of the needle and bronchial orifice are examined bronchoscopically. (3) Pulmonary artery plasty using a pericardial patch. (4) Easy pericardial closure: complications associated with pleural effusion are often encountered after the donor operation for living lung transplantation. Because direct closure of the open pericardium is difficult, a running stitch is placed between the anterior edge of the pericardium and posterior mediastinal pleura covering the esophagus (right) or descending aorta (left). In a retrospective analysis, the closure group (n=6) showed significantly smaller amounts of postoperative pleural effusion compared with the open group (n=13). Further studies evaluating the application of these techniques are necessary to demonstrate their contribution to improved quality and reduced complications in donor operation for living-related donor lobar lung transplantation.
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  • Mototsugu Watanabe, Tsuyoshi Ueno, Hiroshi Suehisa, Shigeki Sawada, Mo ...
    2014 Volume 28 Issue 4 Pages 446-450
    Published: May 15, 2014
    Released: June 13, 2014
    JOURNALS FREE ACCESS
    We report a case of a malignant fibrous histiocytoma involving chest wall resection and chest wall reconstruction using GORE®DUALMESH®. A 67-year-old woman had been aware of a mass on the right inferior chest wall for 3 months. She consulted an outpatient clinic because of a cough, and a chest radiograph showed a large mass on the right inferior chest wall and pleural effusion. Chest computed tomography showed massive pleural effusion and a tumor presenting osteolytic changes in the right seventh and eighth ribs and sticking out into the thoracic cavity. Because the tumor grew rapidly and pleural effusion pooled fast, she was transferred to our hospital. Because the tumor did not invade the adjacent lung, complete en-block resection was achieved by resecting the 6th to 8th ribs, intercostal muscle, and part of the serratus anterior muscle. We reconstructed the chest wall using GORE®DUALMESH®. As a result of immunohistochemical staining, the tumor was diagnosed as a malignant fibrous histiocytoma (MFH). MFH is the most common malignant soft tissue tumor, found most commonly in the extremities, retroperitoneum, and peritoneum, but rarely in the chest wall.
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  • Takefumi Doi, Hidehito Matsuoka
    2014 Volume 28 Issue 4 Pages 451-455
    Published: May 15, 2014
    Released: June 13, 2014
    JOURNALS FREE ACCESS
    A 75-year-old man with primary myelodysplastic syndrome underwent right upper lobectomy for lung adenocarcinoma (cT1bN0M0, cStage1A). Preoperative examination showed severe neutropenia (neutrophils: 280/μl) and mild anemia (hemoglobin: 9.6 g/dl) without thrombocytopenia (15.3×104/μl). We used granulocyte colony-stimulating factor for four days from the day before the operation with anabolic steroid, activated vitamin D3 and vitamin K2. Cefazolin was prophylactically used for three days after the operation. Blood transfusion was not needed. White blood cells rose to 3,030/μl after the operation. He showed no postoperative infection or leukemia, and was discharged on the seventh day after the operation.
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  • Yoshiki Shigematsu, Shoko Kishida, Mamoru Takahashi, Tadashi Matsukura
    2014 Volume 28 Issue 4 Pages 456-460
    Published: May 15, 2014
    Released: June 13, 2014
    JOURNALS FREE ACCESS
    A 57-year-old female who had an abnormal shadow detected by chest radiography was admitted to our hospital. Chest CT showed a tumor of 45×40 mm in the right lower lobe, and two thin-walled cystic tumors located in the area below the carina (#7) and at the bifurcation of the middle and lower lobar bronchi (#11i). Lung cancer and bronchogenic cysts were diagnosed, and surgical resection was performed. The intraoperative findings showed thin-walled cystic tumors. The pathological diagnosis was an adenocarcinoma with mixed subtypes and thin-walled cystic changes due to lymph node metastasis of papillary adenocarcinoma. We herein report the features of a very rare case of lung adenocarcinoma that was associated with thin-walled cystic lymph node metastasis. It is therefore necessary to consider this possibility when making a differential diagnosis of lymph node metastasis when thin-walled cysts are located in the area of the regional lymph nodes.
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  • Sachiko Tochii, Shuhei Ashikari, Daisuke Tochii, Takashi Suda, Yasushi ...
    2014 Volume 28 Issue 4 Pages 461-465
    Published: May 15, 2014
    Released: June 13, 2014
    JOURNALS FREE ACCESS
    A woman aged 76 years old with primary lung cancer underwent thoracoscopic surgery for right upper lobectomy with lymph node dissection. After extubation, poor oxygenation and auscultatory findings of bronchial stenosis were observed. CT revealed atelectasis of the right middle lobe and partial atelectasis of the right lower lobe. Bronchoscopy revealed narrowing of the intermediate bronchial trunk and obstruction of the middle lobe bronchus. A second operation was performed 9 days after the initial surgery. Operative findings showed that the middle lobe was displaced in the cranial direction. To prevent further displacement of the remaining middle lobe in the cranial direction, we created a septum in the thoracic cavity with a polytetrafluoroethylene sheet (ePTFE sheet) under thoracoscopy. No bronchial stenosis was apparent postoperatively, and the patient was discharged from hospital 12 days after the second operation. It is likely that the displacement of the remaining middle lobe in the cranial direction caused the intermediate bronchial trunk to be bent inward.
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  • Hidehiko Shimokawa, Takahide Matsumoto, Hidetaka Uramoto, Tomoko So, T ...
    2014 Volume 28 Issue 4 Pages 466-470
    Published: May 15, 2014
    Released: June 13, 2014
    JOURNALS FREE ACCESS
    During the follow-up period for bilateral lung cancer after surgery, we encountered a case of metachronous primary lung cancer showing complete atelectasis of the left residual lung. The left upper bronchus was recanalized by laser ablation of the tumor. After improving the breathing state and mediastinum shift, the patient underwent completion pneumonectomy.
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  • Yoshiko Masuda, Tatsuya Yamada, Takashi Marutsuka, Tetsushi Saisho-ji
    2014 Volume 28 Issue 4 Pages 471-476
    Published: May 15, 2014
    Released: June 13, 2014
    JOURNALS FREE ACCESS
    An 81-year-old woman underwent right lower lobectomy for lung adenocarcinoma at our hospital. We sutured an air leakage point in the right middle lobe and sealed it with a Neoveil sheet and Beriplast P. However, as we could not control air leakage, we also placed a TachoComb on the leakage site. Six days after surgery, the patient had a fever above 38°C. Computed tomography revealed interstitial shadows in the right middle lobe, and postoperative pneumonia was suspected. Although antibiotic drugs were given for 5 days, the fever did not improve, so bronchoscopy was performed. On the basis of bronchoalveolar lavage fluid assessment, which indicated an increase in the eosinophil population, we suspected drug induced-eosinophilic pneumonia, and stopped all drugs. However, her condition remained unimproved. Therefore, we started the administration of corticosteroids, 2 days after which her fever improved without recurrence. Unilateral drug-induced pneumonia is rare, but should be recognized as a differential diagnosis of postoperative pneumonia.
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  • Hiromichi Niikawa, Hiroyuki Oura, Ken Onodera, Itaru Ishida, Masashi H ...
    2014 Volume 28 Issue 4 Pages 477-482
    Published: May 15, 2014
    Released: June 13, 2014
    JOURNALS FREE ACCESS
    We encountered the rare case of a 37-year-old woman with a desmoid tumor (desmoid-type fibromatosis) that originated from a chest wound caused by the insertion of a thoracic drain. The patient was referred to our department with a left chest wall tumor. Radiological examination revealed a 5.2-cm mass with expansive growth involving the left ribs. A needle biopsy revealed a desmoid tumor. Intraoperative findings suggested that the tumor originated from the 5th left intercostal space. The tumor along with the left chest wall was excised and the left chest wall was reconstructed using polytetrafluoroethylene (PTFE, GORE-TEX®) sheets. These data illustrate that the cause of this tumor was a chronic stimulus induced by the insertion of a chest drain, indicating that a desmoid tumor can easily develop in patients with chronic inflammatory diseases, including ulcerative colitis. Therefore, it is essential to consider the necessity of surgical treatment. Furthermore, in such cases, it is necessary to take precautions to decrease the risk of tumor development.
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  • Jun Yanagisawa, Asahi Nagata, Masafumi Hiratsuka, Shinichi Yamashita, ...
    2014 Volume 28 Issue 4 Pages 483-487
    Published: May 15, 2014
    Released: June 13, 2014
    JOURNALS FREE ACCESS
    Tension cyst of the lung is a severe disease which causes critical respiratory and circulatory disturbance due to the increase of intrathoracic pressure induced by rapid and excessive inflation of the cyst. The disease mostly occurs during infancy and requires urgent surgical treatment because of exacerbation in many cases. A low-birth-weight infant was on an artificial ventilator at birth. On the seventh day after birth, a cyst appeared in the left lung and increased gradually. A chest radiograph showed hyperlucency of the left lung field and mediastinum shift to the right side. His circulo-respiratory condition deteriorated despite intensified treatment and, finally, he was referred to be considered for surgical treatment at the age of 7 months. Cyst resection of the lung was performed. After surgery, the residual lung expansion was favorable and preoperative symptoms improved. When a pulmonary cyst continues to increase during infancy, early surgery before cardio-pulmonary distress becomes critical is considered important.
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  • Takeo Hasegawa, Naoyuki Okabe, Hiroshi Yaginuma, Jun Ohsugi, Mitsunori ...
    2014 Volume 28 Issue 4 Pages 488-494
    Published: May 15, 2014
    Released: June 13, 2014
    JOURNALS FREE ACCESS
    Primary pulmonary synovial sarcoma is a rare tumor, and only approximately have 110 reports been published in the literature. Here, we report a 68-year-old male who was initially diagnosed with a benign lung tumor due to the existence of calcification in the tumor. He was referred to our hospital after an abnormal shadow was detected on a chest radiograph. Chest CT showed a solid tumor with calcification, which was 2 cm in diameter, in the left S8 segment. Bronchoscopic examination revealed no malignancy. Seven months later, a chest CT showed an increase in the tumor size, and he again underwent bronchoscopic examination. Histological examination of the biopsy specimen from the left B8 revealed a spindle cell sarcoma; therefore, he underwent left lower lobectomy with ND2a lymph node dissection. Pathological findings of hematoxylin-eosin staining showed spindle cells. Immunohistochemical staining showed positive cytokeratin, while vimentin, s-100 protein, desmin, and CD34 were negative. Furthermore, SYT-SSX1 fusion gene transcripts were amplified by RT-PCR analysis. These findings led to the diagnosis of monophasic synovial sarcoma with pT1bN0M0 stage IA. A recurrence on the chest wall was identified 2 years after surgery. The recurrent tumor grew aggressively despite radiation therapy and chest wall resection, and the patient died 4 years after the initial surgery.
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  • Masashi Mikubo, Masahito Naito, Fumihiro Ogawa, Yoshio Matsui, Kazu Sh ...
    2014 Volume 28 Issue 4 Pages 495-500
    Published: May 15, 2014
    Released: June 13, 2014
    JOURNALS FREE ACCESS
    A 64-year-old asymptomatic woman was referred to our hospital for further investigation of a right breast mass. A core needle biopsy was performed, and the mass was histologically diagnosed as an invasive ductal carcinoma of the breast. A chest CT scan revealed multiple pulmonary and pleural nodules and bilateral hilar and mediastinal lymph adenopathy. Although immunological analyses indicated elevations in soluble IL-2 receptor, tumor makers, ACE, and lysozymes levels were not elevated. Sarcoidosis, pleural dissemination of the breast cancer, and malignant lymphoma were included in the differential diagnosis. Thoracoscopy demonstrated multiple white nodules on the parietal and visceral pleura and diaphragm. Resected pleural specimens demonstrated non-caseous epithelioid cell granulomas, and a diagnosis of pleural sarcoidosis was established. The patient has been observed without treatment. Four years later, pulmonary and pleural nodules and enlargement of the bilateral hilar and mediastinal lymph nodes had disappeared. Sarcoidosis with pleural involvement is rare, and so we present this case with a review of the literature.
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  • Sumitaka Yamanaka, Hiroshi Tomoyasu, Atsuhiko Sakamoto
    2014 Volume 28 Issue 4 Pages 501-504
    Published: May 15, 2014
    Released: June 13, 2014
    JOURNALS FREE ACCESS
    We herein report a surgical case of asbestos-related lung cancer involving a plasterer. A 65-year-old man, who had worked as a plasterer for approximately 50 years, with a smoking history, was incidentally diagnosed with a lung neoplasm. Chest computed tomography (CT) revealed a nodule with a diameter of 3 cm in the right lower lung and pleural plaques. No other extraplumonary metastatic lesions were present. With a diagnosis of lung cancer after CT-guided percutaneous needle biopsy, we performed right lower lobectomy with lymph node dissection. This nodule was pathologically diagnosed as adenocarcinoma, and found to contain a mass of asbestos bodies. It was pathologically discovered that this tumor was an asbestos-related lung cancer. He has not had any recurrence of the lesions for 7 years after the operation.
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  • Daigo Kawano
    2014 Volume 28 Issue 4 Pages 505-508
    Published: May 15, 2014
    Released: June 13, 2014
    JOURNALS FREE ACCESS
    A 59-year-old male consulted our hospital due to an abnormal shadow in the left upper lobe on chest CT. We diagnosed the nodule as lung cancer. A preoperative bronchoscopic examination revealed a displaced anomalous right upper bronchus branching from the trachea and left B4+5 branching from the stem of the left lower lobe bronchus. Chest CT with multiplanar reconstruction revealed an abnormal distribution of the left main pulmonary artery, which descended without passing over the left main bronchus. Hyperlobulated areas between the upper and lingular divisions were noted during surgery, without normal upper-lower areas of lobulation. Therefore, we performed left upper segmentectomy. The tumor was histologically diagnosed as squamous cell carcinoma (pT1aN0M0, stage IA).
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  • Hiroshi Tsukada, Yasuhiro Tezuka, Sayaka Mitsuda, Yoshihiko Kanai, Ken ...
    2014 Volume 28 Issue 4 Pages 509-514
    Published: May 15, 2014
    Released: June 13, 2014
    JOURNALS FREE ACCESS
    A 65-year-old man with a history of thoracic contusion due to a traffic accident 15 years ago was admitted to our hospital because of dyspnea on effort and an abnormal shadow on a chest radiograph. Multiplanar reconstruction (MPR) of multi-detector CT clearly revealed a right diaphragmatic rupture and intrathoracic hernia containing the whole liver, gallbladder, distal stomach, duodenum, and portions of the ileum and colon. Thoracoscopic observation followed by an operation involving a thoracoabdominal approach confirmed the condition of the hernia. The ruptured diaphragm was repaired using an expanded polytetrafluoroethylene (ePTFE) patch. Intensive respiratory care was required during the postoperative course because of insufficient spontaneous ventilation and increased abdominal pressure secondary to paralytic ileus.
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  • Nobuo Tsunooka, Kyo Hirayama, Keitaro Inazawa
    2014 Volume 28 Issue 4 Pages 515-520
    Published: May 15, 2014
    Released: June 13, 2014
    JOURNALS FREE ACCESS
    A 62-year-old man experiencing anterior chest pain was hospitalized at our institution. Computed tomography and magnetic resonance imaging showed an 85×44-mm tumor pressing against the left side of the heart in the left anterior mediastinum; the tumor showed a homogeneous fat density. The tumor, covered by a capsule, was completely removed with sufficient surrounding adipose tissue by video-assisted thoracic surgery (VATS). We diagnosed it as an atypical lipomatous tumor (well-differentiated liposarcoma). The patient was discharged and followed-up as an outpatient. Six months later, a new tumor in the right anterior mediastinum with features similar to those of the previous tumor was noted. The second tumor was successfully removed by VATS. This tumor was also diagnosed as an atypical lipomatous tumor with its own capsule, and was not connected to the left anterior mediastinum. Therefore, bilateral early multicentric development was indicated.
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  • Kimihisa Shiino, Takahiro Mitsubori, Masahiro Tsuboi, Kenji Inui, Mune ...
    2014 Volume 28 Issue 4 Pages 521-525
    Published: May 15, 2014
    Released: June 13, 2014
    JOURNALS FREE ACCESS
    We report a very rare case of pulmonary lipomatous hamartoma with cystic change. A 67-year-old female underwent bilateral partial mastectomy and thyroidectomy at our hospital, and was admitted to our division because of a pulmonary nodule in the left lower lung and a pulmonary cystic lesion in the lower left lung detected by postoperative follow-up chest computed tomography (CT) scan. The operation was performed under video-assisted thoracoscopic surgery. The cystic lesion was resected from the peripheral part of the lingula of the left upper lung before partial resection of the lower left lung, including a lung tumor suspected of being a metastasis. The cystic lesion was diagnosed as pulmonary lipomatous hamartoma with cystic change based on the pathological findings.
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  • Yosuke Matsuura, Masayuki Nakao, Hirofumi Uehara, Mingyon Mun, Ken Nak ...
    2014 Volume 28 Issue 4 Pages 526-531
    Published: May 15, 2014
    Released: June 13, 2014
    JOURNALS FREE ACCESS
    A 35-year-old man was referred to our hospital with a dry cough, and chest radiography showed an infiltrative shadow in the right upper lung field. A transbronchial lung biopsy specimen revealed mucosa-associated lymphoid tissue (MALT) lymphoma. Because of the lesion widely spreading from the right upper lobe to the middle lobe, at first, systemic chemotherapy was performed. After the chemotherapy, a CT scan showed that the lesion had reduced in size and was localized in the right upper lobe, but an FDG-PET scan showed a strong increase in uptake, and so an operation was performed. We recognized pleural dissemination-like lesions in the visceral and parietal pleura during the operation. Therefore, we performed bi-lobectomy for the purpose of tumor volume reduction. We performed adjuvant chemotherapy, and achieved complete remission. The pathological findings of the pleural tumor did not show pleural dissemination but lymphatic invasion of the pleura. We herein report a rare case of MALT lymphoma of the lung with lymphatic invasion of the pleura.
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  • Takashi Yoshimura, Jitian Zhang, Keiji Ohata, Shinya Ito, Yoshito Mats ...
    2014 Volume 28 Issue 4 Pages 532-537
    Published: May 15, 2014
    Released: June 13, 2014
    JOURNALS FREE ACCESS
    Although pulmonary histoplasmosis is rare in Japan, the number of reports of it as imported mycoses has recently been increasing. A 55-year-old woman was found to have an abnormal shadow on a chest radiograph done as part of a medical checkup after a two-year-stay in Honduras. Chest CT showed a nodule in the left lower lobe adjacent to the visceral pleura. Bronchoscopic examination could not yield a diagnosis. Thoracoscopic partial pulmonary resection was performed. On histopathology, the nodule showed a round lesion with a concentric laminar pattern, which consisted of coagulation necrosis. As a number of oval-shaped yeast-like forms were found in the central lesion with Grocott staining, it was dignosed as pulmonary histoplasmosis.
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  • Kenji Misawa, Osamu Mishima, Yusuke Takahashi, Shigenori Tani, Yasushi ...
    2014 Volume 28 Issue 4 Pages 538-541
    Published: May 15, 2014
    Released: June 13, 2014
    JOURNALS FREE ACCESS
    We produce a combined 3-D reconstruction image with CT angiography (CTA) and CT bronchography (CTB) as a preoperative imaging study for lung cancer, and confirm whether pulmonary blood vessels and bronchi show abnormality or variation. We report 2 cases of lung cancer in which anomalous branches of B2, branching from the intermediate bronchus, were clearly depicted with this method. The accurate, preoperative recognition of pulmonary blood vessels and branching bronchi is necessary for a safe operation, and a combined 3-D reconstruction image using CTA and CTB facilitates this.
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  • Keigo Okamoto, Youko Kataoka, Makoto Motoishi, Satoru Sawai, Jun Hanao ...
    2014 Volume 28 Issue 4 Pages 542-547
    Published: May 15, 2014
    Released: June 13, 2014
    JOURNALS FREE ACCESS
    A 62-year-old man was admitted to our hospital with an abnormal shadow observed on a chest radiograph. CT revealed lesions that had spread extensively in the anterior mediastinum and were located near both hila, surrounding the pericardium. At 15 months after his first visit, chest pain had appeared and the lesions had enlarged; hence, we performed surgery through a median sternotomy approach. There were numerous, multilocular, cystic lesions in the thymus and circumferential adipose tissues; these cysts were filled with a light yellow, serous liquid. We performed complete resection using a thoracoscope. Immunohistochemically, the cells lining the cyst were positive for D2-40, which reacts with the lymphatic endothelium. These results combined with the macroscopic findings helped us diagnose him with cystic lymphangioma. This cystic lymphangioma, localized extensively in the thymus and circumferential adipose tissue, was considered an extremely rare case with a continually expanding tumor.
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