The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Volume 30 , Issue 2
Showing 1-24 articles out of 24 articles from the selected issue
  • Takeshi Kurosaki, Shigeharu Moriyama, Makio Hayama, Kouhei Hashimoto, ...
    2016 Volume 30 Issue 2 Pages 128-135
    Published: March 15, 2016
    Released: March 15, 2016
    JOURNALS FREE ACCESS
    Air leakage is a common complication after pulmonary resection. Pleurodesis or reoperation is performed for prolonged air leak, but it is not clear how to judge the necessity of additional treatment or when it may be needed. This study evaluated the criteria of additional treatment for persistent air leaks using the pulmonary air leak score (PALS) after pulmonary resection. Forty-six patients who underwent lobectomy or segmentectomy and who developed air leaks on postoperative day (POD) 4 were investigated and assigned to 2 groups: Group A (n=24) received additional treatment, pleurodesis or reoperation, for prolonged air leaks, whereas group B (n=22) received no treatment. PALS was higher on POD 4 in group A (p<0.001). We suggest that PALS is useful to evaluate air leaks and to judge the criteria of additional treatment on POD 4 after pulmonary resection.
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  • Naoya Himuro, Takao Minakata, Yutaka Oshima, Daisuke Kataoka, Shigeru ...
    2016 Volume 30 Issue 2 Pages 136-142
    Published: March 15, 2016
    Released: March 15, 2016
    JOURNALS FREE ACCESS
    Opportunities to treat pulmonary metastasis of colorectal cancer have been increasing with a rise in primary diseases and advances in chemotherapy, and the indications are specified in the Japanese Society for Cancer of the Colon and Rectal (JSCCR) Guidelines 2014. However, the mechanism of metastasis may be anatomically different between colon and rectal cancers, and we considered that the indication of lung resection can be more accurately specified by the detailed analysis of prognostic indicators after lung resection. Thus, we divided 53 patients treated with lung resection for pulmonary metastasis of colorectal cancer at our department into 2 groups for comparison: those with metastases of colon and rectal cancers. The 5-year survival rates after resection of pulmonary metastasis were 56.8, 55.0, and 59.1% in all colorectal, colon, and rectal cancer patients, respectively. In the colon cancer patients, the outcome was significantly poorer in those with multiple pulmonary metastases. In the rectal cancer patients, the outcome was significantly poorer in those with a maximum lung tumor diameter of 20 mm or greater, those with an elevated carcinoembryonic antigen (CEA) level before lung resection, and those treated with chemotherapy after lung resection. The surgical indication should be investigated based on these factors.
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  • Tsutomu Marui, Shinji Murakawa
    2016 Volume 30 Issue 2 Pages 143-147
    Published: March 15, 2016
    Released: March 15, 2016
    JOURNALS FREE ACCESS
    A solitary fibrous tumor (SFT) is sometimes complicated by hypoglycemia. A case of a giant SFT with loss of consciousness due to hypoglycemia is reported. The male patient was taken to another hospital due to loss of consciousness. He recovered with an intravenous drip infusion, but was referred to our hospital for an abnormal shadow on chest CT. The chest CT showed a 30-cm tumor in the left thoracic cavity. There was a mediastinal shift and atelectasis of the left lung lobe due to the tumor. The results of needle biopsy suggested SFT. The blood sugar was about 30 mg/dL in the morning, and so the reason for the loss of consciousness was hypoglycemia. Surgery was performed, and the tumor was removed by sternotomy with fifth and eighth inter-costal incisions. The maximum size of the tumor was 41 cm and it weighed 4.5 kg. The pathological diagnosis was SFT. He had no further episodes of unconsciousness or hypoglycemia after the tumor was removed.
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  • Yohei Yurugi, Yoshimasa Suzuki, Hiroshige Nakamura
    2016 Volume 30 Issue 2 Pages 148-152
    Published: March 15, 2016
    Released: March 15, 2016
    JOURNALS FREE ACCESS
    A 61-year-old woman, who had been diagnosed with a lung tumor 12 years ago, visited our hospital with an abnormal shadow on a chest radiograph. Computed tomography revealed a lobulated tumor in the left lower lobe of the lung measuring 30×28 mm, and it had enlarged. She refused to undergo biopsy although malignancy was suspected, and she underwent an operation. The pathological diagnosis during surgery was primary lung adenocarcinoma; therefore, we performed left lower lobectomy and lymph node dissection (ND2a-1). However, the postoperative pathological diagnosis was lung metastasis from thyroid papillary carcinoma. Immunohistochemical staining for thyroglobulin was useful to achieve this diagnosis. Ultrasonography revealed a small thyroid nodule, and total thyroidectomy and neck dissection were performed 2 months after the lung resection. The pathological examination demonstrated a papillary carcinoma, measuring 7 mm, in the right lobe and lymph node metastases. Physicians should consider the possibility of metastasis from thyroid papillary carcinoma if a lung tumor with suspected malignancy shows slow growth.
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  • Keiko Ishida, Ryosuke Kaku, Tetsuo Hori, Yo Kawaguchi, Jun Hanaoka, Ko ...
    2016 Volume 30 Issue 2 Pages 153-158
    Published: March 15, 2016
    Released: March 15, 2016
    JOURNALS FREE ACCESS
    In pulmonary pleomorphic carcinomas, some cases with an extremely poor prognosis have been reported with early relapses and metastases even after radical surgery. A 63-year-old man was admitted to our hospital for cardiac failure and renal dysfunction due to diabetic neuropathy. Computed tomography (CT) demonstrated a mass, 33 mm in the longest diameter, in lower lobe S9 of the right lung, suspected of being lung cancer. Two months later, right lower lobectomy plus mediastinal lymph node dissection was performed, and the tumor was diagnosed as pulmonary pleomorphic carcinoma with a pathological stage of IIA (T2bN0M0). He received adjuvant chemotherapy of tegafur-uracil from 31 days after the surgery, but developed anorexia and severe back pain from 46 and 49 days after the surgery, respectively. CT revealed fluid and multiple nodules in the peritoneal space, and multiple gastric tumors were detected on upper gastrointestinal endoscopy. Based on pathological examinations, he was diagnosed with malignant peritonitis due to multiple gastric metastases from pulmonary pleomorphic carcinoma. Thereafter, he died at 63 days after the surgery. In cases of pulmonary pleomorphic carcinoma with an extremely short tumor-doubling time, the prognosis may be poor even after complete surgical resection.
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  • Akira Naomi, Hironori Oyamatsu, Kunio Narita
    2016 Volume 30 Issue 2 Pages 159-163
    Published: March 15, 2016
    Released: March 15, 2016
    JOURNALS FREE ACCESS
    A 39-year man was administered methyl prednisolone due to exacerbation of nephritic syndrome. After a few days, he developed right empyema with a fistula, and therefore we subsequently performed open window thoracostomy for infection control. However, on the 15th post-operative day (POD), MRSA was detected by microbial culture in the pleural cavity and wound. We exchanged the intrathoracic gauze to sterilize MRSA, and then the right middle and lower lung lobes were expanded sufficiently to perform muscle flap plombage and reduce the dead intrathoracic cavity. We performed latissimus dorsi muscle flap plombage for dead space closure in the thoracic cavity. A few days later, his wound was infected by MRSA, and we tried to eradicate MRSA by washing the wound and thoracic cavity with saline, but failed to sterilize it. We then cleaned the wound using methylrosanilin chloride, having a bactericidal effect at a concentration of 0.1%. On the 13th day of using pyoktanin solution, we succeeded in eradicating MRSA from the thoracic cavity and wound without aspiration pneumonia, and then sutured and perfomed debridment of his wound. He was discharged a few days after wound closure. We suggest that it is effective to sterilize MRSA-infected wounds and cavity infections using pyoktanin solution at a concentration of 0.1%.
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  • Makoto Odaka, Takamasa Shibasaki, Hisatoshi Asano, Hideki Marushima, M ...
    2016 Volume 30 Issue 2 Pages 164-168
    Published: March 15, 2016
    Released: March 15, 2016
    JOURNALS FREE ACCESS
    A 66-year-old man was referred to our institution because of an abnormal shadow of the left lung noted on a chest roentgenogram. Chest CT and MRI demonstrated a 20 mm nodule in the left lower lobe and a well-demarcated 35 mm mass in the subcarinal space. The lung nodule showed high-level accumulation of FDG, but the mediastinal mass showed no accumulation. Based on the diagnostic imaging, we suspected lung cancer and a mediastinal tumor. We performed left lower lobectomy of the lung and extirpation of the mediastinal tumor under thoracoscopic surgery. Histopathological examination showed lung cancer and Schwannoma of the mediastinum. We encountered a surgical case of lung cancer and a rare subcarinal Schwannoma.
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  • Yuki Nakajima, Hiroyasu Kinoshita, Maiko Atari, Atsumori Hamahata, Tak ...
    2016 Volume 30 Issue 2 Pages 169-176
    Published: March 15, 2016
    Released: March 15, 2016
    JOURNALS FREE ACCESS
    A male in his 70s underwent right middle and lower lobectomy and ND2a-2 for right squamous cell carcinoma (cT3N1M0, stage IIIA). There were no problems noted on a chest radiograph obtained immediately after surgery, but decreased permeability of the right upper lobe developed on postoperative day (POD) 1. Bronchoscopy on POD 2 showed almost complete obstruction of the superior lobar branch. Since the volume of the upper lobe was maintained, the patient was diagnosed with pulmonary vascular congestion caused by diminished venous return and obstruction of the superior lobar branch due to edema. He was discharged from hospital on POD 31 after showing improvement. However, he subsequently developed lung suppuration concomitantly with empyema caused by rupture, and underwent fenestration surgery on POD 47. On POD 100, the entire residual lung was removed, and 6 months later the incision for thoracoplasty was closed. The patient is currently alive with no recurrence at 12 months after the first surgery and 4 months after closure of the empyema cavity. Empyema after removal of the right middle and lower lobes is usually caused by a bronchial stump fistula, but the empyema in our case was caused by lung suppuration.
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  • Risa Oda, Motoki Yano, Satoru Moriyama, Hiroshi Haneda, Katsuhiro Okud ...
    2016 Volume 30 Issue 2 Pages 177-181
    Published: March 15, 2016
    Released: March 15, 2016
    JOURNALS FREE ACCESS
    A 72-year-old woman consulted a doctor with palpitation on exertion. Chest radiograph revealed enlargement of the mediastinum, and she was referred to our institution. Chest computed tomography and magnetic resonance imaging revealed a large mediastinal mass which was adjacent to the right hilum and diaphragm. The mass showed fat density and intensity and was diagnosed as mediastinal liposarcoma. Surgery was started in a supine position using carbon dioxide insufflation by video-assisted thoracic surgery to confirm the condition of tumor invasion or adhesion. The tumor projected from the mediastinum and it involved the right phrenic nerve. Thereafter, a right lateral thoracotomy was performed in the left decubitus position. The tumor was diagnosed as liposarcoma by frozen section. We removed the tumor with the involved right phrenic nerve and performed diaphragm plication. The final histopathological diagnosis was atypical lipomatous tumor/well-differentiated liposarcoma. The postoperative course was uneventful. She was discharged on postoperative day 9 and followed up for one year after the surgery without any sign of recurrence.
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  • Nahoko Shimizu, Shotaro Hashimoto, Masato Morimoto, Koichi Yoshikawa
    2016 Volume 30 Issue 2 Pages 182-186
    Published: March 15, 2016
    Released: March 15, 2016
    JOURNALS FREE ACCESS
    We report a rare case of IgG4-related disease of the thymus. A 77-year-old man was referred to our hospital because of a mass in the anterior mediastinum detected by thoracic CT. Enhanced CT showed a 53×33-mm mass in the left anterior mediastinum. The tumor in the left thymus had invaded the left phrenic nerve and pleura, and was initially suspected to be a thymoma. We performed extended thymo-thymectomy and lymph node dissection, with excision of the infiltrating surrounding tissues including the left phrenic nerve and pleura. Laryngeal nerve paralysis and chylothorax occurred after the operation. Histological examination revealed that the tumor consisted mainly of IgG4-positive plasma cells, with elevation of the serum IgG4 level. These findings suggested that the tumor was IgG4-related disease of the thymus.
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  • Fumihiro Ishibashi, Yuuki Shiina, Yukiko Matsui, Yasumitsu Moriya, Tos ...
    2016 Volume 30 Issue 2 Pages 187-192
    Published: March 15, 2016
    Released: March 15, 2016
    JOURNALS FREE ACCESS
    Axillary lymph node metastases from non-small-cell lung cancer (NSCLC) are categorized as distant metastases. The involvement of these nodes may spread through the chest wall. We report two patients with resected NSCLC thought to have ipsilateral axillary lymph node metastases on pre-operative positron emission tomography-computed tomography (PET-CT). The first patient was a 70-year-old woman. An abnormal lesion was noted on a screening chest radiograph, and she was referred to our department. Transbronchial aspiration cytology was performed, and she was diagnosed with adenocarcinoma of the right upper lobe of the lung. PET-CT revealed the accumulation of fluorodeoxyglucose in an ipsilateral axillary lymph node. A right upper lobectomy with lymph node dissection and surgical removal of the axillary lymph node were performed. The post-operative histologic diagnosis of the axillary lymph node specimen was hyperplasia with rheumatoid arthritis. The second patient was a 46-year-old woman. She complained of pain extending from the right axilla to the right upper arm. The primary tumor was located in the right upper lobe of the lung, and directly invaded the chest wall. She was diagnosed with adenocarcinoma of the right upper lobe of the lung. Fuorodeoxyglucose uptake was observed in the right axillary lymph nodes on PET-CT. A right upper lobectomy combined with chest wall resection was performed, and the ipsilateral hilar, mediastinal, and axillary lymph nodes were dissected. The post-operative pathologic findings confirmed metastases to the axillary lymph nodes. In this report, we also describe surgical indications for patients suspected to have ipsilateral axillary lymph node metastases.
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  • Mitsuro Fukuhara, Hiroyasu Kinoshita, Yoshihito Iijima, Yuki Nakajima, ...
    2016 Volume 30 Issue 2 Pages 193-197
    Published: March 15, 2016
    Released: March 15, 2016
    JOURNALS FREE ACCESS
    We report two cases of an anomalous pulmonary vein with right V6 flow in the superior pulmonary vein. Case 1: A 70-year-old man presented with a complaint of right chest pain. Chest computed tomography revealed two nodules in the upper and lower lobes of the right lung. Since malignancy could not be ruled out, the tumors were resected. Pre-operative three-dimensional computed tomographic angiography (3D-CT angiography) showed an anomalous pulmonary vein with right V6 flow in the superior pulmonary vein. We performed a wedge resection in the right upper lobe and right lower lobectomy. Case 2: A 65-year-old man was found to have an abnormal shadow in the right middle lobe during post-operative follow-up for colon cancer. Pre-operative 3D-CT angiography showed right V6 flow in the superior pulmonary vein. A complete understanding of the anatomic features of the pulmonary vascular branch prior to surgery is essential for safe and accurate pulmonary operations.
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  • Shunsuke Tauchi, Hironobu Sugiyama, Satoshi Tobe, Nobuya Sano
    2016 Volume 30 Issue 2 Pages 198-202
    Published: March 15, 2016
    Released: March 15, 2016
    JOURNALS FREE ACCESS
    A 46-year-old man had a spherical pulmonary tumor located in the right upper lobe on chest CT. No definitive histological diagnosis was obtained with bronchoscopy, and FDG positron emission tomography (PET) showed slight FDG accumulation. However, the tumor increased gradually (to 35 from 23 mm). Therefore, we performed thoracoscopic right upper lobectomy with ND2a-1. Immunohistochemically, the tumor was diagnosed as a solitary fibrous tumor (SFT). Histopathologically, it showed high cellularity and multiple mitoses. We diagnosed it as malignant intrapulmonary SFT. We should consider surgery for tumors that increase in size gradually, even if they are negative for FDG accumulation.
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  • Nahoko Shimizu, Kazuya Uchino, Yusuke Okuda, Kenta Tane, Wataru Nishio ...
    2016 Volume 30 Issue 2 Pages 203-208
    Published: March 15, 2016
    Released: March 15, 2016
    JOURNALS FREE ACCESS
    A 56-year-old man was admitted to the hospital with back pain. A chest radiogragh revealed a mass shadow in the right upper lung field. Chest CT revealed the two masses at the right S2. The smaller one was suspected to be pulmonary metastasis. During bronchoscopy, the larger lesion was diagnosed as adenocarcinoma, and new nodules were found at the right B6, diagnosed as squamous cell carcinoma. We also diagnosed lymph node #4R as metastasis of adenocarcinoma. We performed right upper wedge bronchoplastic lobectomy and right S6 wedge bronchoplastic segmentectomy with ND2a lymph node dissection. His post-operative course was satisfactory, and the patient began 4 courses of chemotherapy (CDDP+GEM) a month after surgery. In the surgical treatment of multiple lung cancer, it is important to preserve the lung volume without decreasing curability as much as possible.
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  • Hitoshi Suzuki, Shin Shomura, Kentaro Inoue, Masaki Yada, Akira Shimam ...
    2016 Volume 30 Issue 2 Pages 209-213
    Published: March 15, 2016
    Released: March 15, 2016
    JOURNALS FREE ACCESS
    Mediastinal cavernous lymphangioma is an extremely rare benign tumor. A 17-year-old female was referred to our hospital due to the finding of a right paratracheal lesion with enlargement of the upper mediastinum on a chest radiograph. Computed tomography of the chest showed a 4-cm, well-circumscribed cystic mass in the anterior mediastinum. We conducted video-assisted thoracoscopic excision of the cyst. The final pathology report revealed a cavernous lymphangioma. As incomplete resection can result in recurrence, an appropriate surgical procedure for complete resection should be performed based on accurate preoperative evaluation. This is the first documented case of a complete mediastinal cavernous lymphangioma resected using the VATS technique.
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  • Yasuhiro Otsuki, Kotaro Kameyama, Tomoaki Matsuoka, Kenji Kimura, Nori ...
    2016 Volume 30 Issue 2 Pages 214-217
    Published: March 15, 2016
    Released: March 15, 2016
    JOURNALS FREE ACCESS
    We report a case of thymoma involving a patient with a history of thymectomy for myasthenia gravis (MG) without thymoma. The patient was an 81-year-old male with a history of MG who initially presented with left ptosis. Crisis occurred and plasmapheresis and steroid pulse therapy were undertaken when he was 64 years old. Extended thymectomy was performed three years later. Pathological analysis showed thymus atrophy, but did not reveal a thymoma, and his symptoms were successfully managed by steroid and immunosuppression therapy. Computed tomography showed a nodule of 17 mm located to the left of his ascending aorta when he was 81 years old. It had been 7 mm in diameter 3 years previously. Acetylcholine receptor (AChR) antibody levels were 91 nmol/L. Video-assisted thoracic surgery was undertaken based on suspected thymoma. Intraoperatively, pericardial invasion was suspected and resection was performed. The histopathological analysis showed invasive thymoma, Masaoka II stage (WHO B3 classification). In this case, we thought that the cause of this recurrence was pleural dissemination from microthymoma. This case also suggests that AChR antibody elevation after extended thymectomy may indicate thymoma.
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  • Hitoshi Nishikawa, Ryuji Nakamura, Kouta Araki, Masanori Okada, Toshiy ...
    2016 Volume 30 Issue 2 Pages 218-222
    Published: March 15, 2016
    Released: March 15, 2016
    JOURNALS FREE ACCESS
    Myelolipoma is a benign tumor characterized by mature adipocytes and normal myeloid cells. Myelolipoma mainly involves the adrenal gland and very rarely involves the mediastinum. Imaging features show lipid components. Here, we present an extremely rare case in which lipid components were not observed on computed tomography (CT) or magnetic resonance (MR) imaging; however, the results of a post-operative pathological examination led to the diagnosis of a posterior mediastinal myelolipoma. A 65-year-old man who was treated for hypertension and osteoporosis showed an abnormal shadow on a chest radiograph. A posterior mediastinal tumor of 27 mm in diameter was detected on chest CT, and a decreased signal intensity was not clearly observed on fat-suppressed MR imaging. The tumor was suspected to be a neurogenic tumor, and, therefore, thoracoscopic tumor extirpation was performed. On the basis of the results of the histopathological examination, the tumor was diagnosed as a myelolipoma. A follow-up examination showed no recurrence or hematologic abnormality for 14 months after the operation.
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  • Osamu Araki, Yoko Karube, Motohiko Tamura, Satoru Kobayashi, Masayuki ...
    2016 Volume 30 Issue 2 Pages 223-228
    Published: March 15, 2016
    Released: March 15, 2016
    JOURNALS FREE ACCESS
    A 55-year-old male with bilateral pulmonary giant bullae had been treated with home oxygen therapy for several years. Dyspnea on effort worsened and he was introduced to our hospital to investigate operability. Upon admission, the percent vital capacity was 38.7% and forced expiratory volume in 1 second was 470 mL, indicating a nearly inoperable condition due to severe pulmonary dysfunction. Nevertheless, we considered surgery to be possible because the pulmonary vascular bed was preserved. We performed a sequential bilateral bullectomy using percutaneous cardiopulmonary support, and the pulmonary functions significantly improved.
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  • Hiroaki Harada, Makoto Wakahara, Keizo Misumi, Norifumi Tsubokawa, Tsu ...
    2016 Volume 30 Issue 2 Pages 229-235
    Published: March 15, 2016
    Released: March 15, 2016
    JOURNALS FREE ACCESS
    A 46-year-old woman was referred to our hospital due to an abnormal chest shadow detected during a medical examination. Chest CT revealed a nodule of 0.7 cm in diameter at the right upper lobe. For diagnosis and treatment, lung wedge resection was performed and the pathological examination revealed pulmonary cryptococcosis covered by inflammatory granulation tissue, but no apparent fungus body was detected outside the inflammatory granulation tissue. Since the immunocompetence of the patient was normal and serum antigen for Cryptococcus became negative after the resection, adjuvant antifungal drug therapy was not administered. Four months after surgery, the patient presented with complaints of headache and fever. Chest CT revealed a large mass of 5 cm in diameter at the right upper lobe, and Cryptococcus antigens in both serum and cerebrospinal fluid were elevated. The patient was diagnosed with recurrence of pulmonary cryptococcosis concomitant with meningitis. After treatment with antifungal drugs, the patient underwent a completion right upper lobectomy. After 1 year of adjuvant antifungal drug therapy, the patient has remained disease-free. We present this very rare case of pulmonary cryptococcosis that developed a recurrent focus and meningitis after the resection of a single small pulmonary nodule of Cryptococcus in a patient with normal immunocompetence and negative for serum Cryptococcus antigen, and who was not initially considered as a candidate for adjuvant antifungal drug therapy.
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  • Shinkichi Takamori, Yosuke Morodomi, Kazuki Takada, Tetsuzo Tagawa, Ta ...
    2016 Volume 30 Issue 2 Pages 236-242
    Published: March 15, 2016
    Released: March 15, 2016
    JOURNALS FREE ACCESS
    A 23-year-old man had been aware of bloody phlegm and a cough. Chest computed tomography showed an abnormal artery running to the left lower lobe. He was transferred to our hospital, and diagnosed with a systemic arterial supply to the basal segment of the lower lobe. Resection of the abnormal artery was achieved with a mechanical stapler after ligation of the center side. No symptom such as bloody phlegm was apparent postoperatively. We report a case of systemic arterial supply to the basal segment of the lower lobe and a review of the literature about the treatment of such an aberrant artery.
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  • Mitsuro Fukuhara, Hiroyasu Kinoshita, Yoshihito Iijima, Yuki Nakajima, ...
    2016 Volume 30 Issue 2 Pages 243-247
    Published: March 15, 2016
    Released: March 15, 2016
    JOURNALS FREE ACCESS
    A 48-year-old woman with an incidentally diagnosed mediastinal mass was referred to our department. Chest computed tomography showed a well-defined monolocular tumor located in the middle mediastinum, at a site 72 mm from the right subclavian artery and right pulmonary artery. An FDG-PET scan showed no abnormal uptake in the tumor. We performed surgical resection using video-assisted surgery. The tumor was confirmed to be a cystic lesion of the thymus that had spread. A pathological examination revealed fragments of a fibrotic cystic wall with sections of thymic tissue, thus confirming the diagnosis of a thymic cyst. Thymic cysts in the middle mediastinum are extremely rare. We suspected that this was a case involving an ectopic thymus, but the thymus-derived cyst was believed to extend to the middle mediastinum in this disorder.
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  • Souichiro Suzuki, Hirozo Sakaguchi, Hiroyuki Nitanda, Nobuhiro Yamazak ...
    2016 Volume 30 Issue 2 Pages 248-254
    Published: March 15, 2016
    Released: March 15, 2016
    JOURNALS FREE ACCESS
    A 62-year-old male who had a history of asbestos exposure was referred to our center because of an abnormal mass shadow in the right upper field on plain chest radiograph. Computed tomography showed an 11-cm right chest wall tumor attached to the 2nd-4th ribs and results of a biopsy performed under CT yielded a sarcomatoid type of mesothelioma. Systematic examinations did not show any metastasis and the patient underwent six courses of Cisplatin and Pemetrexed chemotherapy. After chemotherapy, a partial response was achieved and he underwent right extrapleural pneumonectomy. Pathological examinations revealed localized malignant mesothelioma (pT2N0M0) and the surgical margin was negative. After the operation, radiotherapy was performed for the right chest wall and no relapse had been observed as of about six months. This is a very rare and important operative case of localized malignant mesothelioma markedly responsive to chemotherapy.
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  • Jun Miyagi, Seiji Nagayoshi
    2016 Volume 30 Issue 2 Pages 255-258
    Published: March 15, 2016
    Released: March 15, 2016
    JOURNALS FREE ACCESS
    We report the rare complication of the thoracic first trocar going through the diaphragm into the abdominal cavity. The first trocar was inserted through the 7th intercostal space for tumor biopsy. A small incision was made and the diaphragm with a small rupture was repaired. A linear structure between the lower lung and diaphragm was observed. After the thoracic operation was finished, intra-abdominal bleeding was noted. Emergency surgery was performed. We opened the upper abdominal wall. The trocar penetrated the diaphragm and caused liver injury. It has been reported that adhesion of the chest wall and diaphragm is a cause of injury of the diaphragm. In our case, adhesion in the thoracic cavity was not observed. Before the endoscopic surgery, the lungs were collapsed to achive a space. The linear structure of the lower lung lifted the diaphragm. So, the diaphragm existed at a higher position compared with the typical position.
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