The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Volume 30 , Issue 4
Showing 1-24 articles out of 24 articles from the selected issue
  • Katsuo Yamada, Yuuta Kawasumi, Tomoshi Sugiyama, Ayuko Yasuda, Yukio S ...
    2016 Volume 30 Issue 4 Pages 404-409
    Published: May 15, 2016
    Released: May 15, 2016
    JOURNALS FREE ACCESS
    [Background] Surgical treatment is sometimes effective for pulmonary nontuberculous mycobacteriosis which is resistant to chemotherapy. Little is known about partial lung resection compared with anatomic resection for pulmonary nontuberculous mycobacteriosis. [Methods] A retrospective review was conducted of 77 consecutive patients who underwent 10 partial resections and 67 anatomic resections, with 41 lobectomies, 19 segmentectomies, and 7 mixed procedures, for pulmonary nontuberculous mycobacteriosis at our institution as part of a multimodality treatment program. All patients were assessed more than a year after the operation. [Results] No significant postoperative difference was noted in relapse between the partial and anatomical resection groups. On the other hand, the operative time and postoperative hospitalization period were significantly shorter in the partial resection group. [Conclusion] Partial lung resection may be considered as an effective therapeutic procedure comparable with anatomic resection for pulmonary nontuberculous mycobacteriosis in selected cases.
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  • Tohru Momozane, Masayoshi Inoue, Masato Minami, Yasushi Shintani, Soic ...
    2016 Volume 30 Issue 4 Pages 410-416
    Published: May 15, 2016
    Released: May 15, 2016
    JOURNALS FREE ACCESS
    Although varicella zoster virus (VZV) infection is frequently found in patients under immunosuppressive treatment, the clinical characteristics of VZV infection after lung transplantation remain poorly defined. The records of all patients who underwent lung or cardiopulmonary transplantation at our institution between January 2000 and December 2014 were reviewed. Out of 50 patients, 11 had post-transplant events of VZV infection. There were 4 men and 7 women, with a median age at onset of 47 years (range: 26-62), and the median time to VZV infection from transplantation was 29 months (range: 14-74). One contiguous dermatome was involved at the initial presentation in 9 patients (facial: 2, thoracic: 4, lumbosacral: 3) and disseminated cutaneous infection was found in 2 patients, associated with complications of eye symptoms in 1, visceral involvement in 1, and postherpetic neuralgia in 5. Two patients received the intravenous administration of acyclovir, and nine had oral valaciclovir or famciclovir. Four patients were hospitalized, and there was no fatal case. VZV infection is one of the late complications after lung transplantation in the presence of an immunosuppressive status. Taking account of the potential for clinical deterioration with VZV infection, early diagnosis and prompt treatment are required.
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  • Yoshifumi Shimada, Jun Kawamukai, Hideki Shinnou, Yoshitaka Itou, Hide ...
    2016 Volume 30 Issue 4 Pages 417-421
    Published: May 15, 2016
    Released: May 15, 2016
    JOURNALS FREE ACCESS
    Airway obstruction can be caused by tracheobronchial stenting when there is severe central tracheal stenosis. In such cases, Extracorporeal Membrane Oxygenation (ECMO) is useful for oxygenation. Cases of applying ECMO involving a danger of suffocation are rare, and there have been few studies on cannulation sites. We examined appropriate cannulation sites of ECMO for oxygenation, especially for the upper body, in the procedure of tracheobronchial stenting. We examined 11 cases of tracheobronchial stenting with ECMO support performed in our facility from November 1998 to August 2014. Severe central stenosis was seen in all 11 cases, and airway obstruction during stenting was considered to be possible. The number of cases which maintained head-SpO2 over 90% was 0/2 in Venous-Venous (V-V) ECMO, 1/5 in Veno-Femoral Artery (V-FA) ECMO, and 4/4 in Veno-Subclavian Artery (V-SA) ECMO. Because of the circuit characteristics, V-SA may be safer than V-V and V-FA in the case of stenting for severe airway stenosis.
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  • Daisuke Nakamura, Masayuki Toishi, Hirotaka Kumeda, Hiroyuki Agatsuma, ...
    2016 Volume 30 Issue 4 Pages 422-426
    Published: May 15, 2016
    Released: May 15, 2016
    JOURNALS FREE ACCESS
    Herein, we report a case of solitary metastasis of large cell lung carcinoma to the tongue. A 79-year-old man underwent left upper lobectomy for primary left upper lobe non-small cell lung cancer. The pathological diagnosis was large cell carcinoma with a neuroendocrine morphology. After the operation, the patient began to experience pain and induration with rubor at the tip of the tongue. Subsequently, we established that this symptom had existed before the lung operation. At first, we diagnosed the condition as stomatitis and prescribed a topical steroid cream as treatment; however, the symptom did not resolve. After consultation with the oral surgery department, we decided to perform computed tomography (CT) of the head. CT showed a mass located at the tip of the tongue, with capsular enhancement on early-phase images. A biopsy of the tongue showed characteristics of large cell carcinoma with features similar to lung tissue, and was therefore established as metastasis from the lung cancer. Sixteen days later, partial resection of the tongue was performed. Metastasis was not observed in other organs or lymph nodes in the mediastinum, pulmonary hilum, or neck. We concluded that the tongue carcinoma was a solitary metastasis. Tongue metastasis from lung cancer is rare, and most patients typically present with widespread metastases at diagnosis. To the best of our knowledge, there has been no report of a solitary tongue metastasis from lung cancer. Moreover, the patient developed tongue metastasis before the lung operation. Tongue metastasis could be detected upon thorough physical examination. Therefore, we emphasize the importance of diagnostic and physical examination.
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  • Hiroyasu Kinoshita, Hirohiko Akiyama, Yuki Nakajima, Mitsuro Fukuhara, ...
    2016 Volume 30 Issue 4 Pages 427-430
    Published: May 15, 2016
    Released: May 15, 2016
    JOURNALS FREE ACCESS
    A 76-year-old female with a right mediastinal tumor presented at our hospital. She was diagnosed with schwannoma of the right chest wall based on the findings of a CT-guided needle biopsy. At one-and-a-half years after the biopsy, the tumor showed rapid growth. Surgery was indicated because of suspected malignancy. Complete resection was successfully performed. The pathological findings demonstrated the tumor to be a schwannoma with hemorrhaging and cystic changes. Immunohistochemical staining with anti-S-100 protein antibody showed diffusely positive staining for the tumor cells, but the MIB-1 labeling index was much lower than 1%. As a result, it is not always the case that tumors which demonstrate rapid progression are malignant.
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  • Mitsuru Yoshino, Yuki Shiina, Terunaga Inage, Yasuo Sekine, Yukio Sait ...
    2016 Volume 30 Issue 4 Pages 431-436
    Published: May 15, 2016
    Released: May 15, 2016
    JOURNALS FREE ACCESS
    A 51-year-old man was diagnosed with large cell carcinoma of the lung invading to the distal portion of the aortic arch, left subclavian artery, and left vertebral artery (cT4N3M0 stage IIIB). He received concurrent chemoradiotherapy consisting of 4 cycles of cisplatin and vinorelbine with conventional radiation therapy of 60 Gy, which resulted in a partial response. Nine months later, regrowth of the primary tumor was observed. Since there was no lymphatic or distant metastasis and preoperative MR angiography showed that the right vertebral artery was hypoplastic and the blood flow of the basilar artery was mainly supplied from the left vertebral artery, we planned salvage surgery with vascular reconstruction including the left vertebral artery. Thoracotomy was performed through a transmanubrial approach. Because most of the tumor existed in the extra-pleural region, partial lung resection was performed. A bypass graft was established from the ascending aorta to the left common carotid artery and left subclavian artery using a Y-graft. After en-bloc resection, the distal portion of the aortic arch was reconstructed under partial cardiopulmonary bypass. The left vertebral artery was reanastomosed with the subclavian artery graft. The postoperative course was uneventful, and MR angiography revealed that the left vertebral artery was patent.
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  • Hiroshi Matsui, Hyung-Eun Yoon, Tomoki Utsumi, Emiko Tomita, Masanori ...
    2016 Volume 30 Issue 4 Pages 437-442
    Published: May 15, 2016
    Released: May 15, 2016
    JOURNALS FREE ACCESS
    We herein report two cases of sleeve resection of the left main bronchus for salivary gland-type tumors. Case 1 involved a 53-year-old woman and case 2 involved a 64-year-old woman. In case 1, we detected a shadow indicating chest abnormalities, and the tumor was subsequently diagnosed as adenoma based on a preoperative bronchoscopic biopsy; however, it was revealed to be mucoepidermoid carcinoma after surgery. There were positive margins in both the proximal and distal tracheal walls; therefore, adjuvant radiotherapy was performed. In case 2, the chief complaint was coughing, and the patient also showed an exacerbation of dyspnea. Surgery was performed without a preoperative biopsy of the hypervascular tumor due to the risk of bleeding. The lesion was determined to be adenoid cystic carcinoma based on the intraoperative rapid pathological diagnosis. There was a positive margin in the proximal bronchial wall; therefore, we performed additional resection of the proximal bronchial margin. However, the proximal bronchial margin remained malignant, and adjuvant radiotherapy was performed. Both patients are doing well, without recurrence, after undergoing surgery.
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  • Yoshihito Iijima, Hirohiko Akiyama, Yuki Nakajima, Hiroyasu Kinoshita, ...
    2016 Volume 30 Issue 4 Pages 443-447
    Published: May 15, 2016
    Released: May 15, 2016
    JOURNALS FREE ACCESS
    A case of multiple sclerosing hemangioma in the left lung was suspected in a 23-year-old male. He was referred to our department for a definitive diagnosis. We performed extended S6 segmentectomy to prevent obstructive pneumonia, and lingular segmentectomy was conducted due to multiple nodules and the second largest nodule in S5. Other nodules which were pointed out by computed tomography were excised by wedge resection. The tumors were pathologically diagnosed as multiple sclerosing hemangioma. He has survived for seven years since surgery without progression or recurrence. We report a very rare case of sclerosing hemangioma that arose in a young man with multiple lung nodules. A polypoid lesion with protrusion into the segmental bronchus was demonstrated. The associated literature was also reviewed.
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  • Yoshihito Iijima, Hirohiko Akiyama, Yuki Nakajima, Hiroyasu Kinoshita, ...
    2016 Volume 30 Issue 4 Pages 448-453
    Published: May 15, 2016
    Released: May 15, 2016
    JOURNALS FREE ACCESS
    A 67-year-old woman was pointed out to have nodular shadows on both sides of lower lung fields on a chest radiograph. The tumor in the left lung was diagnosed as typical carcinoid (TC) based on bronchoscopy, and the other tumor in the right lung could not be diagnosed from bronchoscopy preoperatively, and so we could not rule out a malignant tumor. We scheduled a two-stage operation, knowing that the right tumor might be more malignant than TC of the left lung. We performed right middle lobectomy and mediastinal lymph node dissection first. Then, we performed left lower lobectomy and mediastinal lymph node dissection two weeks after the first operation. Both tumors were diagnosed as TC. The right one was staged IIB with T3N0 pathologically, and the left one was staged IIIA with T2aN2. We report a very rare case of synchronous bilateral bronchopulmonary typical carcinoids with a literature review and clinical analysis at our institute.
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  • Hironobu Osumi, Tatsuya Yamada, Takashi Semba, Kouji Hayashi
    2016 Volume 30 Issue 4 Pages 454-457
    Published: May 15, 2016
    Released: May 15, 2016
    JOURNALS FREE ACCESS
    Computed tomography (CT) showed multiple rib fractures, hemopneumothorax, aerodermectasia, and mediastinal emphysema in a 73-year-old man who was hospitalized due to blunt trauma to the chest. The aerodermectasia increased and oxygenation worsened on the following day. CT confirmed the increasing aerodermectasia and revealed an incarcerated lung hernia, which we repaired during emergency surgery. The patient remains well without complications at two years after surgery.
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  • Tomoko Hosaka, Chiaki Endo, Motohiko Miura, Noriyuki Iwama, Yoshinori ...
    2016 Volume 30 Issue 4 Pages 458-462
    Published: May 15, 2016
    Released: May 15, 2016
    JOURNALS FREE ACCESS
    A 15-year-old male was referred to our hospital due to cough, left shoulder pain, and left chest pain that had persisted for two weeks. A chest ragiograph revealed an abnormal shadow on the left side of the mediastinum. Both CT and MRI examinations of the chest revealed an anterior mediastinal, well-defined, cystic, and solid mass that was 15 cm in diameter. Chest CT also revealed a small lung tumor in the right middle lobe. The ultrasound-guided needle biopsy specimen was not diagnostic. To achieve a precise diagnosis, the mediastinal and lung tumors were completely resected by median sternotomy. On pathologic examination, the mediastinal tumor was diagnosed as cystic and cavernous lymphangioma, and the lung tumor was finally diagnosed as lymphangioma. Mediastinal cystic and cavernous lymphangioma is very rare. Calcification or contrast enhancement on CT is atypical for lymphangioma and suggests hemangioma. Although the mediastinal tumor in our case showed granular calcifications, the final diagnosis was lymphangioma, which cannot be made on the basis of radiological studies alone.
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  • Daisuke Okutani, Kenji Takahashi, Go Nishii
    2016 Volume 30 Issue 4 Pages 463-466
    Published: May 15, 2016
    Released: May 15, 2016
    JOURNALS FREE ACCESS
    A 48-year-old man was referred to our hospital with right empyema. A tube was inserted into the chest for drainage and antibiotics were started. Chest CT images acquired three days later confirmed two independent empyema chest cavities. The larger cavity comprised the lower lobe, diaphragm, and chest wall, and the smaller cavity comprised the middle lobe and chest wall. Both cavities were debrided and irrigated under video-assisted thoracic surgery. The larger cavity contained cloudy, serous effusions and the smaller contained pus effusions. As a 5-mm fistula was seen on the surface of the middle lobe in the small cavity, it was closed by a direct suture followed by coverage with fibrin glue and a polyglycolic acid sheet. Careful CT assessment is essential because acute empyema could consist of multiple chest cavities.
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  • Go Kanazawa, Kiyohiko In, Tomoki Utsumi, Emiko Tomita, Hiroshi Matsui, ...
    2016 Volume 30 Issue 4 Pages 467-471
    Published: May 15, 2016
    Released: May 15, 2016
    JOURNALS FREE ACCESS
    The patient was a 73-year-old woman previously diagnosed with rheumatoid arthritis who had taken immunosuppressants and steroids for ten years. Mycobacterium avium was detected by examination of sputum, she was diagnosed with nontuberculous disease, and had been observed in February 2014. She was referred to hospital because of fever, and diagnosed with right pneumothorax due to M. avium infection. She underwent drainage, and then fiberoptic bronchoscopy with endoscopic bronchial occlusion using silicone fillers (Endobronchial Watanabe Spigot: EWS). At the same time, she underwent chemotherapy, but showed no improvement, and she was transferred to our hospital. After we improved her nutritional health and appropriately controlled her medication, we performed surgery. An air leakage in S6 was detected, so we closed the pulmonary fistula with a free fat graft and pedicled intercostal muscle flap. After surgery, expansion of the right lower lobe was insufficient, and the dead space remained. We removed the thoracic drain, but recurrence of empyema was observed. We removed EWS under fiberoptic bronchoscopy and achieved full right lower lobe expansion, and so the dead space was successfully resolved.
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  • Yukiyasu Takeuchi, Seiji Taniguchi, Yoshiyuki Susaki, Naoko Ose, Akio ...
    2016 Volume 30 Issue 4 Pages 472-475
    Published: May 15, 2016
    Released: May 15, 2016
    JOURNALS FREE ACCESS
    Birt-Hogg-Dubé syndrome is an autosomal dominant inherited disorder characterized by skin lesions, renal tumors, and pneumothorax. A woman in her forties underwent an operation for pulmonary cysts and suturing and covering a relapsing pneumothorax. She had a previous history of simultaneous left renal cancer and left pneumothorax six years ago. Her mother, uncle, aunt, and cousin had a history of pneumothorax. Birt-Hogg-Dubé syndrome was suspected, and a genetic examination was performed. The examination revealed mutation of the FLCN gene and she was diagnosed with Birt-Hogg-Dubé syndrome. Because the long-term prognosis associated with Birt-Hogg-Dubé syndrome has not been fully clarified, long-term follow-up is necessary.
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  • Akira Naomi, Hiroaki Kuroda, Tetsuya Mizuno, Noriaki Sakakura, Yukinor ...
    2016 Volume 30 Issue 4 Pages 476-481
    Published: May 15, 2016
    Released: May 15, 2016
    JOURNALS FREE ACCESS
    A 50's Japanese woman had lived in Arizona, United States, for about 30 years. A chest radiograph during a health examination in Japan revealed an abnormal shadow in the right lower lung field, and chest CT showed a 9-mm, smooth, rounded nodule located in segment 8 of the right lower lung. She was referred to our hospital, with no complaints and normal blood examination results. We performed right lower wedge resection with video-assisted thoracoscopic surgery (VATS) for the purpose of definitive or adjunctive treatment. She was histopathologically diagnosed with chronic pulmonary coccidioidomycosis with caseous necrosis of a granuloma containing numerous transparent pathogens with the shape of a large sphere. This was supported by consideration of her previous history of having lived in the United States. It is necessary to suspect coccidioidomycosis from previous travel histories to the United States and preoperative imaging findings before tissue culture or surgery because of the mycosis infection risk to surrounding people. Coccidioides species have the most infectious capacity of all fungi, but it is difficult to detect them using culture and serologic tests in the absence of symptoms. We must suspect chronic coccidiomycosis on considering travel to endemic areas and imaging findings of small nodules, and so must be careful to prevent occupationally acquired infection.
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  • Takuma Tsukioka, Makoto Takahama, Ryu Nakajima, Michitaka Kimura, Hide ...
    2016 Volume 30 Issue 4 Pages 482-487
    Published: May 15, 2016
    Released: May 15, 2016
    JOURNALS FREE ACCESS
    A 76-year-old male suddenly suffered cardiopulmonary arrest. He was diagnosed with tracheobronchial malacia in the postresuscitation period. He was treated with stabilization of the membranous portion using polypropylene mesh. Now, he is leading a normal life at two years after treatment. A 65-year-old male had dyspnea on effort and was diagnosed with tracheobronchial malacia. The symptom was immediately resolved after airway stent placement in the trachea. However, restenosis caused by granulation tissue was observed 6 months after the airway stent placement. He was treated with removal of the airway stent and stabilization of the membranous portion using polypropylene mesh. Inflammation around the airway stent might induce severe airway edema, preventing recovery of the respiratory condition after treatment. He was discharged home 56 days after treatment, and is now leading a normal life at 14 months after treatment. Tracheobronchial malacia was observed in 4.5 to 8.2% of patients who underwent bronchoscopic examination. Surgical treatments are indicated for symptomatic tracheobronchial malacia. Stabilization of the membranous portion using polypropylene mesh may be an acceptable treatment for tracheobronchial malacia.
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  • Shinji Matsui, Kunio Araki, Yuki Matsuoka, Ken Miwa, Yuji Taniguchi, H ...
    2016 Volume 30 Issue 4 Pages 488-491
    Published: May 15, 2016
    Released: May 15, 2016
    JOURNALS FREE ACCESS
    The patient was a 70-year-old male. After surgery for esophageal cancer, a 7-mm pure ground glass nodule appeared in the left lower lobe of the lung. After four years, a solid component appeared in the center of the GGN, and the nodule increased slowly to 11 mm. We suspected lung adenocarcinoma and performed partial resection by thoracoscopic surgery. Histopathologically, columnar ciliated cells or cuboidal cells lined the alveolar walls, and the cells had mild atypia with metaplasia. From these findings, it was diagnosed as peribronchiolar metaplasia (PBM). Since PBM has exhibited such CT findings, the differentiation between PBM and early-stage lung adenocarcinoma was thought to be important.
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  • Yoichi Hanawa, Kuniharu Miyajima, Takafumi Kono, Keiichi Iwaya, Harubu ...
    2016 Volume 30 Issue 4 Pages 492-497
    Published: May 15, 2016
    Released: May 15, 2016
    JOURNALS FREE ACCESS
    A 60-year-old woman showed an abnormal lung shadow on mass screening. Chest computed tomography (CT) showed a 12×10-mm ground glass opacity (GGO) with interlobular pleural indentation in S1+2 of the left lung and the right aortic arch. 3D-CT showed that the left common carotid artery was the first branch of the right aortic arch, followed by the right common carotid artery, the right subclavian artery, and the aortic diverticulum bound to the left subclavian artery. We diagnosed the tumor as adenocarcinoma during surgery, and performed a left upper lobectomy and lymph node dissection. During dissection of the left upper mediastinal lymph nodes, we found that the left recurrent nerve encircled the left subclavian artery. No postoperative complications such as recurrent nerve paralysis were observed. A right aortic arch is a rare congenital vascular malformation, with retention of the 4th branchial arch artery on the right side and the right dorsal aorta; this condition has been reported to exist in approximately 0.1% of the population. We consider that during lung surgery in a patient with a right aortic arch, close attention should be paid to the anatomical displacement of the recurrent nerve when dissecting the upper mediastinal lymph nodes.
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  • Daisuke Miyasaka, Hiroto Niizeki, Junichi Ikeda, Nobutaka Ebata, Takeo ...
    2016 Volume 30 Issue 4 Pages 498-502
    Published: May 15, 2016
    Released: May 15, 2016
    JOURNALS FREE ACCESS
    Here, we report a rare case of cavernous hemangioma in the chest wall. A 60-year-old man visited our hospital due to an enlarging tumor in the chest wall. Unenhanced chest CT revealed an extrapulmonary soft tissue tumor with a smooth and clear boundary adjacent to the left forth intercostal space measuring 2.2×1.6 cm. Chest MRI revealed a low-intensity area on T1-weighted images with a high-intensity on T2, and an enhanced margin on a dynamic study. Therefore, with the suspicion of a neurogenic tumor, thoracoscopic tumorectomy was performed. However, the tumor was histopathologically diagnosed as cavernous hemangioma.
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  • Tomokazu Ito, Kozo Nakanishi, Hidenori Goto
    2016 Volume 30 Issue 4 Pages 503-509
    Published: May 15, 2016
    Released: May 15, 2016
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    A 60-year-old man was being followed-up for a dissecting aortic aneurysm. He had not been exposed to asbestos. He had a small, part-solid, ground-glass nodule of 0.6 cm in diameter, which was detected in the left lower lung lobe 6 years previously. The nodule grew to 1.4 cm and was almost entirely occupied by the solid part. It was suspected to be primary lung cancer, and a curative operation was scheduled. A partial resection of the left lower lobe was performed thoracoscopically, and the intra-operative histological examination of a frozen section revealed primary lung adenocarcinoma. During the surgery, several white spots on the parietal pleura and hemidiaphragm were noted. Some of the pleural lesions were resected, and intra-operative histological examination revealed malignancy. The pleural lesions were determined to be disseminations from the lung cancer. Radical surgery for the lung cancer was canceled because it was assessed to be stage IV. Histological examination of the permanent preparation revealed malignant pleural mesothelioma (MPM), epithelial subtype, stage Ia. The diameter of the largest pleural lesion was 2 mm. The lung lesion was 1.2 cm and diagnosed as papillary predominant invasive adenocarcinoma, stage IA. An additional pleural pneumonectomy was performed for the MPM and lung cancer. The final diagnoses were pT1aN0M0 stage IA lung adenocarcinoma and pT1aN0M0 stage Ia MPM. The patient has been alive for over 18 months since the surgery without recurrence of the disease.
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  • Nobuyuki Sato, Naoya Ishibashi, Koutarou Abe
    2016 Volume 30 Issue 4 Pages 510-513
    Published: May 15, 2016
    Released: May 15, 2016
    JOURNALS FREE ACCESS
    A 26-year-old man underwent a medical check, and a tumor of the left pulmonary hilum was found. Chest CT showed a 4-cm round tumor adjacent to the pericardium with marked calcification. The tumor was regarded as a teratoma, and surgery using a thoracoscopic procedure was conducted. Operative findings demonstrated that the tumor was enveloped in parietal pleura linking to the pericardium, with no relation to the surrounding tissue. The tumor was resected easily, and a benign leiomyoma was diagnosed by immunohistochemical examination. Mediastinal leiomyoma is very rare, particularly in the anterior mediastinum.
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  • Mitsuro Fukuhara, Hiroyasu Kinoshita, Yoshihito Iijima, Yuki Nakajima, ...
    2016 Volume 30 Issue 4 Pages 514-518
    Published: May 15, 2016
    Released: May 15, 2016
    JOURNALS FREE ACCESS
    The patient was a 71-year-old female. The patient visited our department after an abnormality was detected in a chest radiograph while the patient was undergoing a detailed examination for another disease. CT revealed a 23-mm node in the middle lobe of the right lung. In addition, back-flow findings for the right V1+2+3 and V4 to the azygos vein and right V5 to the inferior pulmonary vein were observed, and the case was diagnosed as a partial anomalous pulmonary venous connection (PAPVC). The pulmonary blood flow/systemic blood flow ratio (Qp/Qs) measured by a Swan-Ganz catheter was 1.16, revascularization was considered unnecessary, and a surgical course was taken under a diagnosis of suspected cancer in the middle lobe of the right lung cT1bN0M0 Stage IA. Pre- and postoperative findings in the abnormal blood vessels were similar, with no angiectopia in either the pulmonary artery or bronchi. V4 and V5 were each clamped and treated upon confirming that there were no changes in the circulation dynamics, after which resection of the middle lobe of the right lung was completed. The pathological diagnosis was adenocarcinoma, pT1bN0M0 Stage IA. The postoperative course has remained favorable and there are currently no symptoms of cardiac failure. PAPVC cases without associated malformation or pulmonary hypertension tend to be asymptomatic; however, resection of lung parts without any anomalous connection may change the shunt fraction, leading to serious complications, and, therefore, it is a disease that requires careful preoperative evaluation.
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  • Kanetaka Maeshiro, Kumiko Kyoda, Kyouko Arakaki, Shinzo Takamori
    2016 Volume 30 Issue 4 Pages 519-524
    Published: May 15, 2016
    Released: May 15, 2016
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    A 68-year-old woman was admitted to our hospital for evaluation of increasing abnormal shadows on chest CT. Chest CT showed a solid nodule of 1.2 cm in diameter in the middle lobe of the right lung and lobar hypoplasia of the right middle lobe. A malignant lung tumor was suspected, and VATS right middle lobectomy was performed. Postoperative examination of the resected specimens demonstrated histological findings compatible with diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) with typical carcinoid. DIPNECH is recognized as a preinvasive lesion for pulmonary carcinoid. DIPNECH and the the relations of lobar hypoplasia is not clear, but chronic inflammation due to lobar hypoplasia cause the DIPNECH onset. It is suggested that the reporting of DIPNECH will increase in the future because DIPNECH was included in neuroendocrine tumors in the fourth edition of the WHO classification, 2015.
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