The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Volume 28 , Issue 5
Showing 1-25 articles out of 25 articles from the selected issue
  • Souichiro Suzuki, Tadasu Kohno, Sakashi Fujimori, Junji Ichinose, Taka ...
    2014 Volume 28 Issue 5 Pages 552-556
    Published: July 15, 2014
    Released: August 20, 2014
    JOURNALS FREE ACCESS
    We retrospectively reviewed 24 video-assisted thoracic surgeries (VATS) for pulmonary involvement associated with a mediastinal tumor. The average postoperative hospital stay was 5.0±2.5 days. There were no severe postoperative complications. VATS can reduce postoperative complications and the length of hospitalization compared to open-chest surgery. We conclude that one-stage VATS for pulmonary involvement associated with a mediastinal tumor is a feasible therapeutic option.
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  • Teruaki Mizobuchi, Takamasa Yun, Hidemi Suzuki, Terunaga Inage, Takayo ...
    2014 Volume 28 Issue 5 Pages 557-563
    Published: July 15, 2014
    Released: August 20, 2014
    JOURNALS FREE ACCESS
    Objectives: Postoperative pneumonia (POP) is a major cause of mortality in patients who undergo lung cancer surgery. We previously reported that bronchial colonization by potentially pathogenic microorganisms (PPMs) and chronic obstructive pulmonary disease (COPD) were both significant risk factors for POP; subsequently, the prophylactic use of antibiotics according to Centers for Disease Control and Prevention (CDC) guidelines and perioperative treatment for COPD were introduced in our institution. In this study, we investigated if airway colonization surveillance during general anesthesia could predict POP and determined risk factors for POP. Methods: Surveillance and a retrospective chart review were conducted involving 114 lung cancer patients who underwent pulmonary resection at Chiba University Hospital in 2011. For surveillance, postoperative bronchoscopy was performed to collect sputum under general anesthesia, followed by bacterial cultures for which>100-PPM colonies were recorded as positive. Results: Patients with PPM colonization did not show a significantly higher incidence of POP (2/11; 18.2%) than those without PPMs (8/103; 7.8%; p=0.55). Using multivariate analyses for POP risk factors, two significant factors were identified: smoking pack-years (odds ratio=1.04, 95% confidence interval: 1.01-1.07; p=0.009) and restrictive lung disease (odds ratio=11.0, 95% confidence interval: 1.18-102; p=0.035). Conclusions: Due to improved perioperative treatments, bronchial colonization by PPMs and COPD were no longer POP risk factors for lung cancer patients. However, for these patients, a heavy smoking history and restrictive lung disease were newly recognized POP risk factors.
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  • Risa Watanabe, Kiyonori Nishioka, Takashi Iwazawa
    2014 Volume 28 Issue 5 Pages 564-568
    Published: July 15, 2014
    Released: August 20, 2014
    JOURNALS FREE ACCESS
    Drainage and antibiotic administration are the first treatments for acute empyema, but if ineffective, surgery is necessary. Recently, the effectiveness of video-assisted thoracoscopic surgery (VATS) for acute empyema has been reported. We reviewed 7 patients with acute empyema who underwent VATS from January 2008 to February 2013. The median operative time was 158 minutes (range: 120-360) and the blood loss was minimal in all cases. The mean duration of postoperative drainage was 5 days, and the mean hospital stay was 9 days. There was no complication or recurrence of empyema. The mean durations of postoperative drainage and hospital stay in cases of acute empyema treated with VATS reported in Japan were 7.9 and 18.3 days respectively, so our cases showed similar results. VATS can be a less invasive, safe, and effective treatment for acute empyema.
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  • Hirotaka Mikagi, Asahi Nagata, Yasuhiro Yoshida, Jun Yanagisawa, Keita ...
    2014 Volume 28 Issue 5 Pages 569-574
    Published: July 15, 2014
    Released: August 20, 2014
    JOURNALS FREE ACCESS
    Remote metastases of breast cancer occur mainly to bone, the lungs, and liver, but when they are discovered, they often involve many organs, making cure difficult only with topical treatment. However, 15 to 25 percent of remote metastasis cases of breast cancer are limited to the lungs; in such cases, pulmonary resection may promote long-term survival. On the other hand, by examining the biochemical characteristics of a surgically removed metastatic focus, we can reflect the results in postoperative adjuvant treatment. Here, we examined 11 cases of resection for a pulmonary metastatic focus of breast cancer, performed in our facility from April 2002 to March 2012. The average age of patients was 60.1 years old, and the average time between breast cancer surgery and pulmonary resection was 96.7 months. The number of metastases was one in 10 of the 11 cases, and in 9 of the 11 cases, the operative procedure was conducted utilizing video-assisted thoracic surgery (VATS). There were five cases in which we were able to identify the subtype in both the original lesion and metastatic lesion, and a change in the subtype was confirmed in 4. The only case where the subtype could not be confirmed was triple-negative. We performed adjuvant therapy depending on the subtype of the metastatic lesion after the operation: 3 cases of hormone therapy, 4 cases of chemotherapy, 1 case of a combination of hormone therapy and chemotherapy, and 3 cases of follow-up. In 4 of the 11 cases, at a median observation of 49 months, new metastases to remote organs were observed, but all 11 patients remain alive. Regarding an isolated pulmonary tumor occurring after an operation for breast cancer, there are many cases that cannot be verified as pulmonary metastasis, and the treatment policy differs depending on the subtype of breast cancer and pulmonary metastatic lesions. Therefore, because thoracoscopic pulmonary resection, which can serve to provide a diagnosis and as a treatment choice, is relatively safe and low-invasive, we may improve the prognosis by removing pulmonary metastatic lesions when resection is possible.
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  • Yoshiki Shigematsu, Shoko Kishida, Mamoru Takahashi, Tadashi Matsukura
    2014 Volume 28 Issue 5 Pages 575-579
    Published: July 15, 2014
    Released: August 20, 2014
    JOURNALS FREE ACCESS
    A 38-year-old female who suddenly suffered severe back pain was admitted to our hospital. Chest CT showed a right posterior mediastinal mass with a small amount of pleural effusion. Video-assisted thoracic surgery was performed for both diagnostic and treatment purposes. The intraoperative findings showed the presence of a wine-colored mass, and a small amount of sero-bloody pleural effusion with peritumoral inflammation. The pathological finding was infarction of extralobar pulmonary sequestration with bleeding necrosis. The patient's back pain improved, and she was discharged five days after the operation.
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  • Takashi Inoue, Hiroyuki Oizumi, Hirohisa Kato, Hikaru Watarai, Mitsuak ...
    2014 Volume 28 Issue 5 Pages 580-584
    Published: July 15, 2014
    Released: August 20, 2014
    JOURNALS FREE ACCESS
    We report a rare case of IgG4-related multilocular thymic cyst. A 69-year-old woman with a cough was referred to a previous hospital. CT revealed a multilocular cyst in the anterior mediastinum, and she was then referred to our hospital. Radiological examination revealed a mass containing several calcified lesions in the anterior mediastinum. The tumor had some calcifications in its body. Antibody for acethylcholine receptor was 1.4 nmol/L. FDG-PET revealed a mild uptake (SUVmax=4). We suspected the tumor to be a cystic thymoma or teratoma, and surgery was performed. Extended thymothymectomy was conducted. Pathological findings after the operation led to a diagnosis of multilocular thymic cyst. Eight months later, she was diagnosed with IgG4-related disease with retroperitoneal fibrosis. Multilocular thymic cyst is rare. There is a possibility that some multilocular thymic cysts are IgG4-related disease, so we have to be careful regarding this disease.
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  • Hirofumi Matsumoto, Isao Sano, Hideki Taniguchi
    2014 Volume 28 Issue 5 Pages 585-589
    Published: July 15, 2014
    Released: August 20, 2014
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    Myoepithelioma of the lung is extremely rare. Myoepithelioma is common in the salivary and mammary glands. Although it is known as a low-grade malignancy, it sometimes causes recurrence or distant metastasis. A 69-year-old female was referred to our hospital because of a pulmonary nodule detected on chest radiography. Computed tomography showed a round 13-mm nodule in the right upper lobe (S3). There was no evidence of lymph node swelling. Preoperatively, the nodule was suspected to be a benign tumor, and we performed right S3 segmentectomy. No malignancy was found in the frozen section intraoperatively. Considering immunohistochemical as well as histological findings, the pathological examination confirmed a diagnosis of myoepithelioma of the lung. Tumor necrosis and mitotic figures were inconspicuous, and there was no evidence of high-grade malignancy.
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  • Keiji Yamanashi, Tetsu Yamada, Akihiro Aoyama, Toru Bando, Hiroshi Dat ...
    2014 Volume 28 Issue 5 Pages 590-595
    Published: July 15, 2014
    Released: August 20, 2014
    JOURNALS FREE ACCESS
    A 59-year-old man with a complaint of hemosputum was diagnosed with squamous cell carcinoma of the lung in the right upper lobe invading the trachea. After induction chemoradiotherapy, chest CT and FDG-PET showed a partial response. He underwent a right upper lobectomy and tracheobronchoplasty through a median sternotomy and right anterolateral thoracotomy. Because atypical cells were found in the margin of the proximal right main bronchus, additional resection of the right tracheal wall was required. After the tracheobronchial aperture was reduced in size, the bronchus intermedius was anastomosed to the smaller orifice. A pedicled omentum was prepared for wrapping the tracheobronchial anastomosis. The final pathological diagnosis was therapeutic effect Grade 3, and the postoperative course was uneventful except for transient atrial fibrillation.
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  • Toshiya Bessho
    2014 Volume 28 Issue 5 Pages 596-600
    Published: July 15, 2014
    Released: August 20, 2014
    JOURNALS FREE ACCESS
    We report a rare case of lung cancer arising in a bronchogenic cyst diagnosed preoperatively. A 64-year-old man was referred to our hospital with diplopia. Multiplanar reconstruction (MPR) of multi-detector row CT (MDCT) revealed a 4.3-cm pulmonary cyst with an irregular wall thickness in the right lower lobe. FDG-PET showed abnormal accumulation in the thickened wall of the pulmonary cyst (SUVmax=10.1). The diagnosis based on sputum cytology was squamous cell carcinoma. Right lower lobectomy (pT1aN0M0) was performed, and the final diagnosis was lung cancer arising in a bronchogenic cyst (air-filled type). The patient was alive 6 months after surgery without recurrence. MPR of MDCT, FDG-PET, and sputum cytology were useful for the preoperative diagnosis of lung cancer arising in a bronchogenic cyst in our case.
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  • Masafumi Matsui, Hisashi Iwata, Koyo Shirahashi, Yoshimasa Mizuno, Yuk ...
    2014 Volume 28 Issue 5 Pages 601-607
    Published: July 15, 2014
    Released: August 20, 2014
    JOURNALS FREE ACCESS
    We report a case of successful treatment using a vacuum-assisted closure (VAC) therapy system in a patient with deep surgical-site infection after pulmonary resection. An 80-year-old man underwent right S9+10 segmentectomy for primary lung cancer. On postoperative day 25, the thoracotomy scar showed a serous putrid dehiscence due to deep surgical-site infection. Although the wound cavity was an enclosed space, the cavity led to the thoracic cavity. After 30 days of irrigation with saline, the VAC therapy system was applied to the wound with very low suction. The patient was subsequently discharged within a month. The VAC therapy system appears to be a safe, useful device that can achieve almost complete wound healing.
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  • Tomofumi Ichihara, Satoshi Nagasaka, Takuro Tasaki, Fumi Yokote, Hirom ...
    2014 Volume 28 Issue 5 Pages 608-613
    Published: July 15, 2014
    Released: August 20, 2014
    JOURNALS FREE ACCESS
    The patient was a 74-year-old woman who had undergone an operation for cutaneous malignant melanoma of the right thumb 16 years ago. She consulted a neurosurgery for dizziness and staggering. Brain magnetic resonance imaging revealed a tumor in the right frontal lobe, and chest computed tomography also showed a tumor in the middle lobe of the right lung. The brain tumor was surgically removed for improvement of the symptoms and a definitive diagnosis. It was histopathologically diagnosed as a metastasis of the melanoma. The tumor in the right lung received the same diagnosis as the brain tumor based on bronchoscopic biopsy. We judged that surgical resection of the pulmonary metastasis would cure the obstructive pneumonia and achieve complete resection of the metastases. We performed video-assisted bilobectomy for the right middle and lower lobes and mediastinal lymph node dissection. The postoperative course was uneventful. However, the tumor showed local recurrence in the brain, trachea, and right bronchus 2 months after the operation, and she died 4 months later. Surgical procedures for the brain and pulmonary metastases were not able to improve the prognosis, but were effective for histopathological diagnosis and improvement of the patient symptoms. Solitary pulmonary metastasis of malignant melanoma as ultra-late recurrence is uncommon, but should be considered when a patient has a history of the disease. Further study of surgical treatment of metastatic melanoma is required.
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  • Michiyo Miyawaki, Yohei Takumi, Takafumi Hashimoto, Shuji Suehiro, Ats ...
    2014 Volume 28 Issue 5 Pages 614-619
    Published: July 15, 2014
    Released: August 20, 2014
    JOURNALS FREE ACCESS
    The patient was a 51-year-old female. The chief complaint was atypical genital bleeding. Pelvic CT showed a tumor in the pelvis, and thoracic CT showed a posterior mediastinal tumor. She was recferred to gynecological and thoracic surgery departments for further examination. The preoperative diagnosis was a mature teratoma of the ovary and benign posterior mediastinal cyst. The patient underwent posterior mediastinal tumor resection following laparoscopic simple total hysterectomy and bilateral adnexotomy for the ovarian tumor. The mediastinal tumor had a thin wall and showed no adhesion to surrounding tissue. Pathological examination showed a mature teratoma of the ovary and a posterior mediastinal mullerian cyst, in which estrogen and progesterone receptors were positive on immunohistoligical examination. A Mullerian cyst in the posterior mediastinum is a new category of mediastinal cyst, initially reported by Hattori et al. in 2005. It occurs in perimenopusal females, especially in those with obesity or a gynecological history, but preoperative definitive diagnosis is difficult.
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  • Junko Kawata, Masato Kanzaki, Takuma Kikkawa, Hideyuki Maeda, Masahide ...
    2014 Volume 28 Issue 5 Pages 620-625
    Published: July 15, 2014
    Released: August 20, 2014
    JOURNALS FREE ACCESS
    We report robot-assisted thoracoscopic extended thymo-thymectomy (rThx) for myasthenia gravis (MG) with thymoma. The patient was a 50-year-old woman who complained of right-side ptosis and muscular weakness of the bilateral upper extremities, and a diagnosis of MG (MGFA class IIa) was made after several examinations. She was referred to our hospital for further evaluation and treatment. Chest computed tomography revealed an anterior mediastinal tumor (diameter: 46×35 mm). RThx with a left approach was performed with a surgical system. After three ports and an assist port were placed, CO2 insufflation was performed. At first, fatty tissue was resected around the left phrenic nerve, and from the left lower pole to the upper pole of the thymus was removed. Next, the contralateral pleura was cut and the right phrenic nerve was identified, and from the right lower pole to the upper pole of the thymus was removed. The thymus including thymoma and surrounding fatty tissue were completely removed. The pathological diagnosis was World Health Organization type B2 noninavasive thymoma, and the Masaoka classification was stage I. On CO2 insufflation into the thorax, RThx with a left approach was performed safely with good visualization.
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  • Takaaki Arimura, Takao Sakaizawa, Nobutaka Kobayashi, Keisuke Ozawa, H ...
    2014 Volume 28 Issue 5 Pages 626-632
    Published: July 15, 2014
    Released: August 20, 2014
    JOURNALS FREE ACCESS
    Case A 70-year-old woman was found to have an abnormal shadow on chest radiography. Computed tomography revealed a well-circumscribed superior mediastinal tumor with a longitudinal diameter of 71 mm. Further, [18F]-fluorodeoxyglucose positron emission tomography showed abnormal accumulation in the detected tumor. Fine needle aspiration cytology of the supraclavicular lymph node failed to yield a definitive diagnosis. A biopsy sample was obtained by video-assisted thoracic surgery, and the tumor was diagnosed as an extramedullary plasmacytoma (EMP). The patient underwent resection via a median sternotomy. The tumor was found to be completely encapsulated and 70 mm. Pathological examination revealed a plasmacytoma producing a monoclonal IgG kappa component. Therefore, a final diagnosis of EMP was made. Herein, we report a rare case of EMP occurring in the mediastinum.
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  • Yusuke Kita, Noriyuki Misaki
    2014 Volume 28 Issue 5 Pages 633-639
    Published: July 15, 2014
    Released: August 20, 2014
    JOURNALS FREE ACCESS
    We describe a 76-year-old male patient who had undergone surgery previously for liver cirrhosis and liver cancer. He developed congestion and was admitted because of fluid collection in the left thoracic cavity. The hematocrit of the pleural effusion was 29.4%. CT of the chest wall demonstrated pleural thickening and a nodular shadow. Thoracostomy drained about 2,000 ml of bloody fluid in a period of about 2 hours, and emergent surgery was performed to arrest the hemorrhage and obtain a biopsy sample. Bleeding from the entire chest wall was evident, and a tumor infiltrating the chest wall and lung parenchyma, with dissemination to the chest wall, was observed. The tumor was very friable and easily hemorrhagic. Pathologic examination demonstrated a solid tumor with clear cells showing atypia with an epithelium-like appearance. The final diagnosis was clear cell-type malignant pleural mesothelioma on the basis of immunohistochemistry. Although chemotherapy with carboplatin and pemetrexed was performed twice, the patient died 111 days after the diagnosis. This was considered to have been a case of clear cell-type malignant pleural mesothelioma presenting as hemothorax. Some relevant previous reports are cited and discussed.
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  • Masahito Naito, Hiroyasu Nakashima, Fumihiro Ogawa, Yoshio Matsui, Kaz ...
    2014 Volume 28 Issue 5 Pages 640-645
    Published: July 15, 2014
    Released: August 20, 2014
    JOURNALS FREE ACCESS
    A 77-year-old man complaining of chronic cough was referred to our hospital for further examination of a 35-mm mass in the left S10 on chest CT. A definite diagnosis of squamous cell carcinoma was made by TBLB, and left lower lobectomy (ND2a-1) was performed. Under thoracotomy, an aberrant artery arising from the descending thoracic aorta was found feeding the S10 of the left lower lobe, and the diagnosis was pulmonary sequestration (Pryce type I) complicated by lung cancer. Here, we describe a rare case of lung cancer involving pulmonary sequestration (Pryce type I), with reference to the literature.
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  • Hitoshi Suzuki, Shin Shomura, Masaki Yada, Chiaki Kondo, Akira Shimamo ...
    2014 Volume 28 Issue 5 Pages 646-650
    Published: July 15, 2014
    Released: August 20, 2014
    JOURNALS FREE ACCESS
    A 66-year-old female undergone parathyroidecomy for primary hyperparathyroidism at 54 years old. She was admitted to our hospital with an abnormal shadow in the right middle lung field detected on chest radiograph on an annual check-up. Chest computed tomography revealed atelectasis of the right middle lobe and a pancreatic tumor. The diagnosis of multiple endocrine neoplasm type 1 (MEN 1) was confirmed. Bronchoscopy revealed a polypoid tumor in the middle lobe bronchus, and a biopsy specimen yielded a histological diagnosis of typical carcinoid. Then, a right middle lobectomy with lymph node resection was performed, and postoperative examination of permanent sections revealed an atypical bronchial carcinoid. She is currently alive and no sign of recurrence has occurred to date at 3 years after the right middle lobectomy. It is rare for multiple endocrine neoplasia type 1 to be associated with atypical bronchial carcinoid, and so this case is reported with a review of the literature.
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  • Hiroshi Yaginuma, Koichi Fujiu, Ryozo Kanno, Hideaki Miyamoto, Hiroyuk ...
    2014 Volume 28 Issue 5 Pages 651-656
    Published: July 15, 2014
    Released: August 20, 2014
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    Background. Benign metastasizing leiomyoma (BML) is a rare entity in which a benign uterine leiomyoma causes metastasis to the lung. Herein, we report 2 cases of BML and review the previous literature. Case 1. A 52-year-old woman was identified as having multiple lung tumors during a preoperative examination for uterine leiomyoma. After hysterectomy, she underwent thoracoscopic resection of the tumor. The histological diagnosis was BML, and immunohistochemical staining was positive for estrogen receptor but negative for progesterone receptor. The patient received hormonal therapy for 7 months after the surgery. At 11 years after the surgery, we observed a slowly growing tumor in the right upper lobe. Case 2. A 51-year-old woman who underwent hysterectomy for uterine leiomyoma was identified as having multiple lung tumors, during a medical check-up. She underwent thoracoscopic resection of the tumor, and was diagnosed with BML. Immunohistochemical staining revealed that the tumor cells were positive for estrogen and progesterone receptors. The patient did not receive hormonal therapy, and no changes in the tumors were noted at 6 months after surgery.
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  • Shin Tanaka, Hidetoshi Inokawa, Kouhei Hashimoto, Hiroya Maeda
    2014 Volume 28 Issue 5 Pages 657-661
    Published: July 15, 2014
    Released: August 20, 2014
    JOURNALS FREE ACCESS
    A 19-year-old-man was diagnosed with pulmonary sequestration which deteriorated rapidly, and referred for surgery. He underwent a left lower lobectomy. On postoperative day 1, he had chest pain, and 500 mL of dark red pleural effusion was drained form the chest tube. Vital signs were stable. An upper gastrointestinal series and chest computed tomography revealed diaphragmatic hernia complicated by intrathoracic gastric perforation. Partial gastrectomy was performed, and the hiatal hernia was repaired. In the first operation, we may injure tissue surrounding the esophageal hiatus. Surgeons should recognize the possibility of serious complications associated with this procedure.
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  • Kozo Yamamoto, Hiroki Kai, Ryuichiro Hirose, Shin-ichi Yamashita, Take ...
    2014 Volume 28 Issue 5 Pages 662-667
    Published: July 15, 2014
    Released: August 20, 2014
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    Pleuropulmonary blastoma is a rare malignant neoplasm of childhood. Tumors can arise from the lung, pleura, or both sites. The standard treatment is surgical resection. The value of chemotherapy and radiotherapy has not yet been evaluated because of the rarity of the disease. Despite aggressive treatment, pulmonary blastoma is still associated with a poor prognosis. Case 1: A four-year-old female with a cough and hemoptysis was admitted to our hospital. Chest CT showed a tumor measuring 7.0 cm at the right lower lobe. Right lower lobectomy was performed. The patient was diagnosed with pleuropulmonary blastoma Type III, and chemotherapy was initiated after surgical treatment. Nine months after surgery, two brain metastases were found and removed surgically. Case 2: A four-year-old female with a cough, fever, and left-sided chest pain was admitted to our hospital. Chest CT showed a large tumor filling the left hemithorax. Left upper lobectomy was performed. The patient was diagnosed with pleuropulmonary blastoma Type II. After surgery, chemotherapy was initiated, and there has been no recurrence during the 10 months since the procedure.
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  • Kazuo Inada, Akinori Iwasaki
    2014 Volume 28 Issue 5 Pages 668-675
    Published: July 15, 2014
    Released: August 20, 2014
    JOURNALS FREE ACCESS
    A 60-year-old man with a history of chronic alcoholic pancreatitis was referred to us for progressive dyspnea. Computed tomography (CT) revealed large bilateral pleural effusion and a cystic lesion in the posterior mediastinal compartment extending to the retroperitoneal cavity through the esophageal hiatus. The pleural effusion had a high amylase content. We diagnosed the patient with mediastinal pancreatic pseudocyst and pancreatic pleural effusion, which was treated with medication and drainage of the effusion. After two weeks, the inflammatory response gradually increased, and a follow-up CT showed that the left pleural effusion was resistant to conservative treatment, although the mediastinal pancreatic pseudocyst had disappeared. Empyema due to rupture of the mediastinal pancreatic pseudocyst was suspected. Therefore, emergency video-assisted thoracoscopic surgery was performed for debridement and drainage of the thoracic and mediastinal cavities. Post-treatment CT images showed that the inflammatory response had decreased, and the effusion had disappeared. The patient recovered uneventfully, without the appearance of another pseudocyst in the abdominal cavity. Because mediastinal pancreatic pseudocysts are resistant to medical treatment and likely to cause critical pulmonary complications, intensive follow-up should be performed to minimize or prevent chest complications, and appropriate surgical or interventional treatment should be performed.
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  • Hiroshi Katsumata, Eiji Yatsuyanagi
    2014 Volume 28 Issue 5 Pages 676-681
    Published: July 15, 2014
    Released: August 20, 2014
    JOURNALS FREE ACCESS
    A 70-year-old male was pointed out as showing a high serum level of CEA and bilateral lung shadows on chest CT during a medical checkup. He was referred to our hospital to investigate the lung shadows. Chest CT showed a 15×10-mm ground-glass opacity in S2a and a 16×13-mm tumor shadow with spiculation in S2b of the right lung. Chest CT also showed a 35×23-mm tumor shadow with spiculation and cavitation in S6 of the left lung. Although a histopathological diagnosis of the abnormal shadow in the right lung S2a could not be made, both shadows in the right S2b and left S6 were diagnosed as adenocarcinoma by transbronchial lung biopsy. They were thought to be synchronous triple primary lung cancers based on CT findings. Lower lobectomy with mediastinal dissection was first performed because the left S6 tumor was thought to be the most advanced cancer. The right S2a and S2b tumors were resected by partial lung resection, respectively, because he refused a segmentectomy at 3 months after the first operation. The left S6 tumor was histopathologically diagnosed as papillary adenocarcinoma (pT2aN0M0). The right lung tumors in S2b and S2a were histopathologically diagnosed as adenosquamous carcinoma (pT1aN0M0) and adenocarcinoma with a mixed subtype (pT1bN0M0), respectively. Both the left S6 and right S2a tumors had in situ components. So, these tumors were histopathologically confirmed as synchronous triple primary lung cancers. His postoperative course was uneventful. He was alive without any evidence of recurrence as of 6 years after surgery.
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  • Megumi Watanabe, Dofu Hayashi, Yasuhiro Kubota, Takayoshi Miyake
    2014 Volume 28 Issue 5 Pages 682-687
    Published: July 15, 2014
    Released: August 20, 2014
    JOURNALS FREE ACCESS
    We report a rare case of small intestinal metastasis from thymic carcinoma in a 78-year-old man. The patient was admitted to our hospital because of edema of the face and arms. Computed tomography (CT) revealed a mass on the right side of the superior mediastinum and stenosis of the superior vena cava. Using percutaneus needle biopsy, the mass was diagnosed as poorly differentiated thymic carcinoma. The patient received combination chemotherapy with cisplatin, vincristine, doxorubicin, and etoposide (CODE). After induction chemotherapy, he underwent total thymectomy combined with partial resection of the sternum and right upper lobe, which was followed by a right brachiocephalic vein-superior vena cava bypass. The pathological stage was T3N1M0 stage III. One year and 6 months after the surgery, the patient showed relapse involving the right chest wall. As treatment, he underwent surgical resection and radiotherapy of 60 Gy. Two years and 11 months later (4 years and 5 months after the first surgery), small intestinal bleeding occurred. The bleeding was controlled by endoscopic clipping. However, bleeding from the same site of the ileum recurred. Because of the recurrence of bleeding, partial resection of the ileum was performed. A white tumor was observed in the resected ileum. The histopathological diagnosis of the resected ileum was a metastasis of the thymic carcinoma. The patient died of stroke 1 year and 2 months after this third surgery without additional recurrence, surviving a total of 6 years and 1 month after the first medical examination. The prognosis of patients with thymic carcinoma is generally poor; however, combined modality therapy can lead to long-term survival in some cases.
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  • Daisuke Okutani, Akio Andou, Ryohei Higashi
    2014 Volume 28 Issue 5 Pages 688-692
    Published: July 15, 2014
    Released: August 20, 2014
    JOURNALS FREE ACCESS
    Surgical resection of solitary pulmonary metastases from both breast pancreatic and cancer in a single patient is very rare, and has not been reported so far. The patient was a 75-year-old female with a surgical history of breast cancer at 65 and pancreatic cancer at 69 respectively. At age 73, chest computed tomography (CT) confirmed two nodules measuring about 10 mm in diameter in the left lung: one was in the S4 segment, the other in the S8 segment. These nodules were removed by partial pulmonary resection under video-assisted thoracoscopic surgery (VATS) and were pathologically proven to be metastases from pancreatic cancer. At age75, chest CT showed a well-marginated nodule measuring 12 mm in diameter in the right S5 segment. Right middle lobectomy under VATS was performed, and pathological examination of the surgical specimen showed metastasis from breast cancer.
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