The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Volume 30 , Issue 6
Showing 1-24 articles out of 24 articles from the selected issue
  • Hidenao Kayawake, Norihito Okumura, Takashi Nakashima, Tomoaki Matsuo ...
    2016 Volume 30 Issue 6 Pages 658-663
    Published: September 15, 2016
    Released: September 15, 2016
    JOURNALS FREE ACCESS

    Pleomorphic carcinoma of the lung is a poorly differentiated non-small cell carcinoma, which is relatively rare. We report the results of clinicopathological examination of 27 cases of pleomorphic carcinoma of the lung resected in our institution. Most of the patients were male patients and smokers, and there were more carcinomas in the upper lobes than other lobes. Pleomorphic carcinoma tended to invade adjacent organs easily, so there were nine combined resections of adjacent organs. During the observation period, there were thirteen recurrences and eight cancer deaths. On the other hand, two patients whose cancers had recurred achieved long-term survival without tumor relapse after the local treatment of recurrent lesions and systemic chemotherapy. The three-year overall survival rate was 65.7 percent, and the five-year overall survival rate was 50.0 percent. Since pleomorphic carcinoma of the lung has a strong tendency to directly invade the adjacent organs, the stage of this carcinoma is often more advanced than expected at the operation, and its malignant potential is higher than other histological types, and so its associated prognosis is poor. On the other hand, there are a few recurrent cases involving long-term survival after local treatment and systemic chemotherapy. For improvement of the prognosis associated with this carcinoma, an effective treatment plan should be established.

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  • Kenji Kimura, Norihito Okumura, Tomoaki Matsuoka, Takashi Nakashima, A ...
    2016 Volume 30 Issue 6 Pages 664-668
    Published: September 15, 2016
    Released: September 15, 2016
    JOURNALS FREE ACCESS

    A sarcoid-like reaction was observed in lymph nodes as noncaseating granuloma-like sarcoidosis. We evaluated 7 patients with a sarcoid-like reaction who underwent lung cancer surgery by reviewing the data of 2 men and 5 women, with a median age of 69 (63-80) years. Lung cancer histology included adenocarcinoma (5) and squamous cell carcinoma (2). Procedures included lobectomy (2), segmentectomy (4), and wedge resection (1). One patient had pathological stage 0, and 6 patients had stage IA. There have been few reports of lung cancer with a sarcoid-like reaction. A sarcoid-like reaction in both the lung and lymph nodes was found in 5 of all 7 subjects. FDG uptake in the bilateral hilar lymph nodes was found in 4 of 6 subjects. Lung cancer patients with a sarcoid-like reaction show FDG uptake in the lymph nodes on FDG-PET; we should accurately evaluate staging after confirming the node status by appropriate sampling biopsy.

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  • Hideyuki Nishi, Norichika Iga, Nobuyoshi Shimizu
    2016 Volume 30 Issue 6 Pages 669-679
    Published: September 15, 2016
    Released: September 15, 2016
    JOURNALS FREE ACCESS

    Objective: Inflammation-based prognostic scores including the Glasgow Prognostic Scores (GPS), Modified GPS, Neutrophil-to-lymphocyte ratio (NLR), Platelet-to-lymphocyte ratio (PLR), Lymphocyte-to-monocyte ratio (LMR), Prognostic index (PI), and Prognostic nutrition index (PNI) are associated with survival in surgically treated patients with malignant pleural mesothelioma (MPM). The objective of this study was to investigate the prognostic value of these inflammation-based prognostic scores in patients with MPM. Subjects: In total, 44 surgically treated patients with MPM were retrospectively evaluated. Results: A multivariate analysis showed that ECOG PS, clinical stage, GPS, NLR, LMR, PI, and CALGB were independently associated with overall survival. They consistently had a higher area under the receiver operating characteristics curve (AUC) value at 6 months (0.662), 12 months (0.666), and 24 months (0.609) in comparison with other inflammation-based prognostic scores. A multivariate analysis showed that ECOG PS, clinical stage, NLR, and LMR were independently associated with disease-free survival. Conclusion: This study demonstrated that NLR, an inflammation-based score, is an independent marker of a poor prognosis in surgically treated patients with MPM. NLR was considered an important prognostic indicator after MPM resection.

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  • Yasunobu Funakoshi, Kenichi Ohmori, Shin-ichi Takeda
    2016 Volume 30 Issue 6 Pages 680-685
    Published: September 15, 2016
    Released: September 15, 2016
    JOURNALS FREE ACCESS

    Recently, the incidence of surgery for lung cancer patients receiving antithrombotic therapy for cardiovascular or cerebral complications has been increasing. We retrospectively reviewed 120 patients who underwent lung cancer surgery between January 2013 and March 2015. Of these, 37 patients received preoperative antithrombotic therapy, and 23 received bridging with heparin. Preoperative antithrombotic therapy and heparinization were not significantly correlated with the surgical approach, type of resection, operative time, blood loss, or duration of chest tube placement, but were significantly correlated with the total length of hospital stay and postoperative duration of antithrombotic therapy group (p=0.0002 and 0.006, respectively). Postoperative complications were more frequently observed in patients who received antithrombotic therapy than those who did not (57 vs.19%, respectively; p<0.0001). Careful perioperative management is required for lung cancer patients receiving antithrombotic therapy.

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  • Keigo Okamoto, Makoto Motoishi, Ryosuke Kaku, Satoru Sawai, Jun Hanaok ...
    2016 Volume 30 Issue 6 Pages 686-689
    Published: September 15, 2016
    Released: September 15, 2016
    JOURNALS FREE ACCESS

    A 63-year-old man was noted to have an abnormal chest shadow and consulted our hospital. Computed tomography (CT) revealed a non-round mass shadow of 40 mm in diameter with abnormal uptake on positron emission tomography-CT. Although lung cancer was suspected, a bronchoscopic smear did not provide a definite diagnosis. To excise the tumor, we performed VATS right lower lobectomy and node dissection. Histological examination revealed the infiltration of inflammatory cells with the proliferation of fibrin and no malignant finding. Bacteriological culture isolated a periodontal pathogen: Porphyromonas gingivalis, from the excised lung tissue. We finally made a diagnosis of a lung abscess with P. gingivalis. By a polymerase chain reaction method, we analyzed the genetic type of this bacterial fimbriae: fimA was type II. We were able to make a localized diagnosis of periodontal disease, and arrest the progression of the disease by identifying the infecting organism positively and conducting a detailed biological exam. We succeeded in preventing the onset of secondary systemic illness.

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  • Ayaka Asakawa, Masashi Kobayashi, Akiko Ui, Hironori Ishibashi, Kenich ...
    2016 Volume 30 Issue 6 Pages 690-695
    Published: September 15, 2016
    Released: September 15, 2016
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    Tracheal carcinoma is a rare disease, but once it grows, it causes tracheostenosis, which requires emergent securing of the airway. We herein report a case of adenoid cystic carcinoma of the trachea with emergent tracheostomy followed by resection and reconstruction. Case: A 40-year-old woman was admitted to our hospital due to productive cough and hemosputum. Chest computed tomography and bronchofiberscopy showed a tracheal tumor, which occluded 80% of the tracheal lumen. She received a tracheostomy to secure a clear airway and biopsy on the admission day. The tumor was diagnosed as adenoid cystic carcinoma (ACC) of the trachea. She underwent a circumferential resection and end-to-end anastomosis of the trachea. Because of the negative margin, she did not receive adjuvant therapy. Emergent tracheostomy is useful for securing of the airway and biopsy of the tumor.

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  • Takayuki Shiina, Hiroyuki Agatsuma, Gaku Saito, Masayuki Toishi, Ryoic ...
    2016 Volume 30 Issue 6 Pages 696-702
    Published: September 15, 2016
    Released: September 15, 2016
    JOURNALS FREE ACCESS

    Tsao reported primary pulmonary adenocarcinoma with enteric differentiation in 1991, which is a very rare disease with few reports in Japan.

    A 66-year-old man was referred to our hospital's Department of Respiratory Medicine due to abnormal shadows on a chest radiograph. Chest computed tomography (CT) revealed a 3 cm nodule in the right lower lung lobe, FDG-PET showed abnormal uptake in the tumor with a maximal standardized uptake value (SUVmax) of 8.1, and bronchoscopy revealed adenocarcinoma cells. A right lower lobe lobectomy and ND2a-1 were performed. Macroscopic findings revealed a tumor measuring 4.5×4.5×2.1 cm in diameter, and histological analysis revealed tumors comprising tall columnar cells and necrotic areas. Metastatic colorectal cancer was initially considered, but immunohistochemical staining led to suspected pulmonary enteric adenocarcinoma. He did not have colorectal cancer, and was followed-up for a metastatic lung tumor.

    After 3.5 years from lung resection, he showed recurrence of metastasis to the thoracic vertebra, and was diagnosed with pulmonary enteric adenocarcinoma based on immunopathology of a bone specimen and the clinical progress. He was treated with systemic chemotherapy; however, it was not effective, and he died 4.5 years after the lung operation.

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  • Yukihiro Terada, Takayuki Shiina, Hiroyuki Agatsuma, Masayuki Toishi, ...
    2016 Volume 30 Issue 6 Pages 703-709
    Published: September 15, 2016
    Released: September 15, 2016
    JOURNALS FREE ACCESS

    Background. Congenital cystic adenomatoid malformation (CCAM) / Congenital pulmonary airway malformation (CPAM) is mainly treated in the neonatal period, and so diagnosis after infancy is relatively rare.

    Case. A 14-year-old boy was referred to our hospital for the further examination of right chest pain. He had been pointed out as showing a cystic mass in the right thorax prenatally, but the lesion had vanished just before birth. He had not suffered from any pulmonary disorder after birth. Chest CT showed a cavity lesion containing purulent fluid in the right lower lobe. Under a diagnosis of CCAM/CPAM accompanied by pleuritis, he was treated with antibiotics, and right lower lobectomy was performed by VATS. He has not suffered from any respiratory disease for two years since the surgery.

    Conclusion. Prenatal CCAM/CPAM sometimes undergoes spontaneous regression, but close investigation should be conducted in order to detect a remaining lesion.

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  • Hironori Oyamatsu, Norihisa Ohata, Kunio Narita
    2016 Volume 30 Issue 6 Pages 710-715
    Published: September 15, 2016
    Released: September 15, 2016
    JOURNALS FREE ACCESS

    A middle mediastinal tumor was found incidentally in a 78-year-old man during a follow-up examination for early gastric cancer after endoscopic resection. The tumor was 2.7×1.6 cm in size and grew rapidly to 5.5×3.1 cm over a 3-month period. He underwent resection of the tumor together with a part of the pericardium because of adhesion. The tumor was completely resected. Pathological examination showed that the tumor was a benign solitary fibrous tumor (SFT) with no histological evidence of pericardial invasion. He was free from recurrence 12 months after surgery. Malignant SFT tends to have a short tumor doubling time (TDT), and TDT may be a prognostic factor in SFT. In this case, the tumor existed in the middle mediastinum, a rare region, and had a short TDT; therefore, careful follow-up will be required.

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  • Yuichiro Onuki, Yoshihiro Miyauchi, Naoko Kimura, Hiroyasu Matsuoka, T ...
    2016 Volume 30 Issue 6 Pages 716-720
    Published: September 15, 2016
    Released: September 15, 2016
    JOURNALS FREE ACCESS

    We report a case of thymolipoma with a characteristic bilobed structure. A 21-year-old man was referred to our hospital because of an anterior mediastinal tumor simulating cardiomegaly on a screening chest radiograph. Chest computed tomography revealed a huge anterior mediastinal mass with isodensity similar to that of fat tissue. Median sternotomy and extended thymectomy were performed. The resected specimen had a bilobed structure, measured 24×18×5 cm, and weighed 670 g. The histopathological diagnosis was thymolipoma. The characteristic structure suggests that the pathogenesis of thymolipoma is a lipoma consisting of thymic fat tissue with involution of the thymus gland.

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  • Yoshihito Iijima, Maiko Atari, Mituro Fukuhara, Yuki Nakajima, Hiroyas ...
    2016 Volume 30 Issue 6 Pages 721-725
    Published: September 15, 2016
    Released: September 15, 2016
    JOURNALS FREE ACCESS

    A 38-year-old man was identified as having a nodular shadow in the right lower lung field on a chest radiograph, with a tendency towards an increase in size. He was referred to our institute for detailed examination. Chest CT revealed a smooth, well-defined nodular shadow in S10 of the right lung. The tumor was suspected as lung cancer stage IA, clinical T1bN0M0, but we could not reach a pathological diagnosis. Therefore, he was referred to our department for surgery. We performed thoracoscopic partial resection of the right lower lobe. On frozen-section examination, the tumor was suspected to be derived from the bronchial glands. We performed right lower lobectomy and mediastinal node dissection, as it was difficult to exclude lung cancer from the preoperative imaging findings. The tumor was histopathologically diagnosed as an adenoid cystic carcinoma. We report a rare case of adenoid cystic carcinoma arising in the peripheral lung. The literature is reviewed.

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  • Shinsuke Kitazawa, Naohiro Kobayashi, Kentaro Araki, Shinji Kikuchi, Y ...
    2016 Volume 30 Issue 6 Pages 726-730
    Published: September 15, 2016
    Released: September 15, 2016
    JOURNALS FREE ACCESS

    We describe a 68-year-old woman with preoperatively suspected BHD syndrome, who underwent the total pleural covering technique to prevent recurrent pneumothorax. She presented with dry cough, and right pneumothorax was diagnosed. Since the lung collapse had not improved over the course of 1 month, surgical pulmonary fistula closure was required. Her daughter also had a history of pneumothorax. Chest CT showed a collapsed right lung and bilateral multiple lung cysts, predominantly in the middle and lower lobes. Owing to the characteristic pulmonary cysts and family history, BHD syndrome was primarily suspected. Although she had no previous episode of pneumothorax, we considered that the possibility of recurrent pneumothorax was high. Therefore, to prevent such recurrence, we performed resection of the pulmonary cysts and additional total pleural covering. Postoperatively, genomic testing confirmed the diagnosis of BHD syndrome. In cases of pneumothorax with BHD syndrome, resection of all the pulmonary cysts is difficult and the possibility of recurrence is high. Therefore, if BHD syndrome is suspected preoperatively, a surgical procedure to reduce the subsequent recurrence of pneumothorax is needed.

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  • Naoko Izawa, Yotaro Izumi, Hiroki Fukuda, Masatoshi Gika, Mitsuo Nakay ...
    2016 Volume 30 Issue 6 Pages 731-736
    Published: September 15, 2016
    Released: September 15, 2016
    JOURNALS FREE ACCESS

    The case involved a 45-year-old male. He had a low-grade fever and cough, and was pointed out as showing a mass of approximately 10 cm in diameter in the left lower lung field on a chest radiograph. A diagnosis of intralobar pulmonary sequestration was made because feeding arteries from the aorta to the mass were seen on enhanced CT. Although the serum SCC value was high, bronchoscopy revealed no indication of malignancy. Because the sequestration was considered to be accompanied by infection, resection was conducted. In the resected specimen, squamous cell carcinoma, of 8 cm in size, was seen within the sequestration. The serum SCC value was normalized after resection. The patient has remained recurrence-free for 2 years since the resection. When a mass is seen inside a sequestration, the coexistence of lung cancer should be suspected.

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  • Hitoshi Nishikawa, Ryuji Nakamura, Kouta Araki, Masanori Okada, Toshiy ...
    2016 Volume 30 Issue 6 Pages 737-741
    Published: September 15, 2016
    Released: September 15, 2016
    JOURNALS FREE ACCESS

    Adrenocortical carcinomas are relatively difficult to definitively diagnose histopathologically. We report a case of a metastatic lung tumor of adrenocortical carcinoma that was difficult to differentiate from primary lung cancer. A 65-year-old man complained of chest and back pain. A 37-mm mass in the right lower lobe and 58-mm mass in the right adrenal grand were pointed out. Pro-gastrin-releasing peptide was slightly elevated. Bronchoscopy and CT-guided lung biopsy could not provide a definitive diagnosis. Although he was diagnosed with suspected stage IV lung cancer and we performed a right lower lobectomy for the purpose of a definitive diagnosis and the choice of an anti-cancer drug, a definitive diagnosis was still not possible. He underwent a right adrenalectomy, and the adrenal tumor was diagnosed as adrenocortical carcinoma and the lung tumor was a metastasis. Soon afterward, multiple metastases were revealed, so he received chemotherapy, but died 9 months after his first admission.

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  • Daisuke Okutani, Kenji Takahashi, Go Nishii
    2016 Volume 30 Issue 6 Pages 742-746
    Published: September 15, 2016
    Released: September 15, 2016
    JOURNALS FREE ACCESS

    Urachal cancer is a rare form of bladder cancer, and a solitary pulmonary metastasis from urachal cancer is rare. We report a case of metastatic pulmonary cancer with cavitation from urachal carcinoma. The patient was a 55-year-old man who had undergone partial bladder resection for pStage I urachal carcinoma at the age of 51 years. Chest computed tomography 2 years after the operation detected a 7-mm cavitary nodule in the left S1+2. The nodule size increased gradually during the 2-year observation period to a diameter of 13 mm, with thickening of the cavitary wall. Thoracoscopic partial resection was performed, and the lesion was diagnosed as metastatic pulmonary cancer from urachal carcinoma. No similar case has been reported in the literature. The possibility of malignancy should be considered in patients with cavitary nodules in the lung.

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  • Hideyuki Nishi, Norichika Iga, Nobuyoshi Shimizu
    2016 Volume 30 Issue 6 Pages 747-754
    Published: September 15, 2016
    Released: September 15, 2016
    JOURNALS FREE ACCESS

    We report the case of a patient with lymphohistiocytoid mesothelioma (LHM). A 73-year-old man was referred to our hospital because of pleural effusion seen on chest radiographs. He had been exposed to asbestos during power distribution work. Computed tomography (CT) images of the chest showed thickening of the left parietal pleura. Biopsy with a thoracic scope did not lead to a definitive diagnosis. A mass showing fallacious internal heterogeneity by the superior mediastinum of 32 mm was pointed out on a medical check-up five months later. We resected the mass by thoracoscopic surgery. Histopathologically, round and spindle-type cells were present in the mass as the main constituent with abundant lymphocyte infiltration. Immunohistochemical analyses revealed that the cells were positive for calretinin, WT-1, EMA, D2-40, CAM5.2, and AE1/AE3, and negative for desmin, p63, p40, TTF-1, napsinA, Claudin4 cytoplasmic, CD30, and CEA. Based on these findings, the diagnosis was confirmed as LHM. We performed pleurectomy/decortication. There had been no recurrence as of 17 months postoperatively.

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  • Hikaru Watanabe, Naoki Kanauchi
    2016 Volume 30 Issue 6 Pages 755-759
    Published: September 15, 2016
    Released: September 15, 2016
    JOURNALS FREE ACCESS

    A 92-year-old woman, with a history of diabetes mellitus and hypertension, presented to our emergency room with chest pain and fever. Chest CT revealed necrotic mediastinum lymph nodes and an abnormal appearance of the epicardium. Despite antibiotic treatment, the mediastinal lymphadenitis worsened, and the pericardial effusion increased in size. A pericardial window was created and a drainage tube was inserted on day three of admission. Surgical exploration revealed the presence of a white substance over the entire surface of the myocardium, indicating an infection. In addition, an abscess cavity was identified in a mediastinal lymph node, between the superior vena cava and aorta. This cavity communicated with the pericardial space. Haemophilus aphrophilus was isolated on the culture of purulent matter from the pericardial effusion. The final diagnosis was purulent pericarditis caused by perforation of an infected mediastinal lymph node. Purulent pericarditis is a life-threatening disease. This case was successfully treated by means of a pericardial window and adequate post-operative antibiotic therapy.

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  • Ryoichiro Doi, Ryusuke Machino, Shigeyuki Morino, Hiroharu Tsuji, Tsut ...
    2016 Volume 30 Issue 6 Pages 760-766
    Published: September 15, 2016
    Released: September 15, 2016
    JOURNALS FREE ACCESS

    Pulmonary resection of lung cancer after surgery for esophageal cancer is difficult because of severe adhesion between the lung, thorax, and mediastinum. We acquired knowledge about thoracoscopic adhesiolysis involving two cases of pulmonary resection for lung cancer after video-assisted thoracoscopic esophagectomy (VATS-E) for esophageal cancer. Case 1: A 75-year-old man underwent VATS-E with lymph node dissection and gastric tract reconstruction via a posterior mediastinum route. Nine months after VATS-E, he was treated for lung cancer with right upper lobectomy and upper mediastinum dissection. Case 2: A 60-year-old woman underwent VATS-E with lymph node dissection and gastric tract reconstruction via a poststernum route. Sixteen months after the esophagectomy, she was treated for lung cancer with right upper lobectomy and upper mediastinum dissection. Characteristically, there was no adhesion between the chest wall and lung after VATS-E. Adhesion between the lung and mediastinum was different depending on the routes of gastric tract reconstruction. The tightest adhesion existed at the right bronchus and proximal stump of the azygos vein resected in the esophagectomy, but there was no problem regarding dissection of #4 and #10 lymph nodes. Dissection of #2 and #7 lymph nodes could be omitted, as this had been completed during VATS-E.

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  • Nobusuke Kato, Kenei Nakazato, Tomoki Nakagawa, Ryota Masuda, Shinkich ...
    2016 Volume 30 Issue 6 Pages 767-771
    Published: September 15, 2016
    Released: September 15, 2016
    JOURNALS FREE ACCESS

    A 78-year-old woman was diagnosed with endometrial carcinoma due to irregular vaginal bleeding that occurred in August 2009. Therefore, abdominal total hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy were performed. Histopathologically, the tumor was diagnosed as squamous cell carcinoma of the endometrium, pT1b M0M0, pStage Ib. Adjuvant therapy was not administered. Six months later, chest computed tomography revealed two nodules in the left lower lobe of the lung. On preoperative examination, no distal metastasis was detected, except in the left lower lobe. Therefore, we performed partial resection of the left lower lobe via video-assisted thoracic surgery to confirm the diagnosis and with curative intent. The histopathological diagnosis was pulmonary metastases of primary squamous cell carcinoma of the endometrium.

    Primary squamous cell carcinoma of the endometrium is extremely rare, and there has been no previous report of pulmonary metastasis from primary squamous cell carcinoma of the endometrium. Herein, we describe our experience involving this case.

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  • Shunichi Nagata, Ryo Miyata, Mitsugu Omasa, Kimihide Tada, Kimio Hashi ...
    2016 Volume 30 Issue 6 Pages 772-776
    Published: September 15, 2016
    Released: September 15, 2016
    JOURNALS FREE ACCESS

    We report a rare case of pleural tuberculosis after a lobectomy for lung cancer. An 82-year-old man with a history of pleural tuberculosis developed lung cancer in the right lower lobe following the treatment of paranasal sinus malignant melanoma. We performed thoracoscopic right lower lobectomy with the dissection of lymph nodes. The early postoperative course was uneventful until the sudden onset of high fever accompanied by right pleural effusion on the 20th postoperative day. Anti-tuberculosis drugs were administered after the positive findings of pleural effusion culture and a pleural effusion polymerase chain reaction test for Mycobacterium tuberculosis. He has been followed up without the relapse of pleural tuberculosis and lung cancer. The relapse of pleural tuberculosis might occur in a lung cancer patient with a history of pleural tuberculosis postoperatively. We recommend preoperative screening of IFN-γ release assays for patients with a high risk of the reactivation of latent pleural tuberculosis.

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  • Jun Suzuki, Hiroyuki Oizumi, Hirohisa Kato, Hikaru Watarai, Akira Hama ...
    2016 Volume 30 Issue 6 Pages 777-781
    Published: September 15, 2016
    Released: September 15, 2016
    JOURNALS FREE ACCESS

    A 65-year-old female who was diagnosed with empyema underwent thoracoscopic debridement. She was admitted to our hospital because of high fever and severe cough at 52 days after surgery. Chest CT showed loculated pleural effusion and pleural thickening with air accumulation. The diagnosis was empyema with a pulmonary fistula, and re-operation was performed. We identified a bronchopleural fistula at the bottom in the dome-shaped empyema cavity near the diaphragm. It was considered to be difficult to directly suture the lung parenchyma to close the fistula; therefore, we closed it with a pedicled diaphragm flap, preserving the peritoneum. Since her discharge, the patient has shown a favorable course.

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  • Masahiko Takahashi, Kenji Takahashi, Daisuke Okutani, Toshio Nishikawa ...
    2016 Volume 30 Issue 6 Pages 782-787
    Published: September 15, 2016
    Released: September 15, 2016
    JOURNALS FREE ACCESS

    Endobronchial hamartoma is a comparatively rare disease. We encounted a patient with endobronchial hamartoma showing repeated obstructive pneumonia. A 57-year-old man had been treated for pneumonia several times in the previous three years. He was admitted to our hospital with a diagnosis of obstructive pneumonia and intra-bronchial tumor in June 2010. A chest radiograph showed an about 10-cm mass in the left lower lung field. Computed tomography showed the presence of an intra-bronchial mass lesion occluding the left lower lobe bronchus and complete atelectasis of the left lower lobe. Bronchoscopic examination demonstrated the tumor obstructing the left lower lobe bronchus. The total content of the tumor could not be observed on bronchoscopy, and so surgical treatment comprising left lower lobectomy was performed rather than endobronchial intervention. In this case, because of the irreversible change in the left lower lobe, we performed left lower lobectomy. Pathological examination revealed that the tumor was a chondromatous hamartoma.

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  • Yuichiro Ueda, Tatsuo Nakagawa, Toshiya Toyazaki, Naohisa Chiba, Masas ...
    2016 Volume 30 Issue 6 Pages 788-792
    Published: September 15, 2016
    Released: September 15, 2016
    JOURNALS FREE ACCESS

    Identification of the intersegmental plane is one of the important techniques for thoracoscopic pulmonary segmentectomy. In this report, we introduce our technique of intersegmental identification with a low flow air-inflation using a thin bronchoscope and the subsequent consolidation of the line using a SOFT coagulator. Firstly, the air-flow pressure was adjusted and the connecting tube was attached to a thin bronchoscope and then clamped. The bronchoscope was inserted into the orifice of the bronchus and the clamp of the tube was opened. The segment to be resected was expanded with low-flow air injection until an inflation-deflation line appeared. Neighboring segments were sufficiently collapsed with air suction to make the inflation-deflation line more clear. Any incomplete inflation-deflation line was then consolidated using a SOFT coagulator to be maintained clearly even after the manipulation of the lung. Our method is easy to perform and useful for the identification of the intersegmental line in thorcoscopic pulmonary segmentectomy.

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