The 5-year survival rate of patients with p-stage I non-small cell lung cancer (NSCLC) is approximately 80%, and tumors can recur after complete resection. Here, we investigated the prognoses of patients with completely resected p-stage I NSCLC to identify factors that could be used to predict recurrence. We focused on patients who underwent lobectomy or more extensive procedures with systematic lymph node dissection. During the follow-up (median, 45 months; range, 1-89 months), 51 patients showed recurrence, the overall 5-year survival rate was 92.1% (95% confidence interval, 88.0-94.8%), and the 5-year survival rate without recurrence was 84.9% (95% confidence interval, 80.3-88.5%). Analysis of the relative risks identified the size and diameter of tumor infiltration (computed tomography), pathological tumor infiltration diameter, pathological T factor, histological type, histological grade, pleural invasion, vascular invasion, lymphatic vessel invasion, and preoperative CEA concentration as indicators of recurrence. Multivariate analysis identified the histological grade as the only independent predictor of recurrence.

We examined 177 malignant pleural mesothelioma patients treated during a period from 1993 through 2016. Results: Of the 177 patients, 100 patients (56%) received chemotherapy, 52 patients (29%) underwent surgery, three patients (2%) received radiotherapy only, and 22 patients (13%) received best supportive care. Regarding the operative method, 43 patients underwent pleural pneumonectomy, and six received pleurectomy/decortication. As chemotherapy, the regimen included gemcitabine in 32 cases, and pemetrexed in 64 cases. The median survival time in the chemotherapy arm was 11.0 months versus 29.0 months in those treated surgically (P<0.01, log-rank test). In the groups receiving/not receiving pemetrexed, the median survival time was in 14.0 and 9.0 months, respectively, showing a significant difference. On multivariable analysis of overall survival, a performance status ≥2, non-epithelial, clinical stage III+V, LMR <2.74, and the absence of surgery were indicators of a poor prognosis. Conclusion: The results suggest the effectiveness of surgery and pemetrexed - based chemotherapy.

Sublobar resection for lung cancer is associated with a higher risk of recurrence than lobectomy; we examined the factors considered to be predictors of recurrence. On analyzing multicenter prospective studies of sublobar resection for c-stage I non-small lung cancer patients unable to undergo lobectomy (KLSG0801), we investigated the relationship between: 1) the tumor location (TL) and margin distance from the stump (MD), 2) the MD/tumor size (TS) ratio and prognosis, 3) and the margin cytology (MC) and prognosis. The correlation between TS and MD was significant in cases of easily resectable regions with Lewis' classification (n=18); however, there was no correlation in difficult-to-resect regions (n=14). Among cases of recurrence, the MD/TS ratio was less than one. The 3-year survival rate was 100% for patients with MD/TS>1 (n=12), 59.7% for patients with MD/TS≤1 (n=20) (p=0.06), 88.1% in cases of negative MC (n=18), and 20% in cases of positive MC (n=5) (p=0.001). It is important that the MD/TS ratio is greater than one; however, it may be difficult to secure an MD greater than the TS in a difficult-to-resect region with Lewis' classification.

A 60-year-old man was referred to his previous doctor for recurrent hemoptysis. He had a history of severe pneumonia in early childhood and was diagnosed with a poor function of the left lung. Chest computed tomography showed cystic change, volume reduction, and a dilated bronchus of the left lung. Several dilated and convoluted bronchial arteries traversing under the aortic arch and around the left hilum were identified. Left pneumonectomy was performed, as bronchial artery embolization was considered to be difficult owing to the marked dilation of the bronchial arteries. The procedure for the pulmonary artery and veins followed by en bloc resection of abnormal vessels reduced both the operative time and blood loss. The bronchial stump was covered by a latissimus dorsi muscle flap. The bleeding volume was 1,040 mL. The postoperative course was uneventful, and no hemoptysis was observed after the surgery. Surgery for racemose hemangioma of the bronchial artery is associated with difficulty in controlling bleeding owing to the fragility of abnormal vessels. In our case, left pneumonectomy was successfully performed with relatively minimal blood loss by devising a procedure for managing abnormal vessels.

We report a surgically treated case of nodular pulmonary mycosis caused by Schizophyllum commune. A 58-year-old woman underwent a medical examination and an abnormal shadow was pointed out on a chest radiograph. She visited a hospital and computed tomography revealed a pulmonary nodule with cavity in the right upper lobe of the lung. She was transferred to our hospital for further examination. A faint accumulation was detected on positron emission tomography and she underwent video-assisted thoracic surgery for both a definitive diagnosis and cure. No sign of malignancy was noted on intraoperative pathological examination, and wedge resection was performed. Pulmonary aspergillosis was initially suspected on further examination after surgery, and she underwent additional segmentectomy of right S¹+S ² to obtain a sufficient surgical margin and resolve the prolonged air leakage. It was not identified as Aspergillus sp. by a bacterial culture, and subsequent genomic analysis diagnosed Schizophyllum commune infection. The postoperative course was uneventful and there has been no sign of mycosis recurrence for five years since the surgery.

A 72-year-old woman forcefully struck the front of her chest on a steering wheel in a traffic accident and was transported to our hospital by ambulance. Upon arrival, a chest radiograph showed a left-sided hemothorax, and she underwent chest tube intubation. Computed tomography showed no obvious leakage of the contrast medium, and the blood pressure was normal. Three hours after hospitalization, her vital signs indicated that she had developed shock, and a chest radiograph showed a massive hemothorax with a right-sided mediastinal shift. An emergency operation was performed, and following the thoracotomy, 2,000 g of hematoma was removed from her pleural cavity with recovery of her blood pressure. Rupture of an abnormal vessel that showed cord-like adhesions to the apical parietal pleura was observed to be the source of bleeding. We clipped this blood vessel to ensure hemostasis. No other bleeding sites were identified.

Conclusion: We treated a patient with traumatic hemothorax, which is commonly referred to as tension hemothorax. Abnormal vessel rupture secondary to cord adhesions with the parietal pleura is rare in patients presenting with massive traumatic hemothorax; however, clinicians should be mindful of this possibility in clinical practice.

We report a case of diffuse large B-cell lymphoma after surgery for lung cancer. A-71-year-old man had undergone left upper lobectomy with chest wall resection for lung cancer combined with pre- and post-operative radiotherapy and lived for 19 years without recurrence. He noticed a swelling of his left anterior chest wall one month before readmission to our hospital. CT revealed a soft tissue-like tumor in his left anterior chest wall involving the 3rd rib. Two sessions of percutaneous needle biopsy failed to confirm a pathological diagnosis and he underwent surgical resection. The chest wall was involved with the tumor and was resected with the 3rd to 5th ribs. He was diagnosed with diffuse large B-cell lymphoma on the final pathological examination. The tumor originated from the residual cavity after lobectomy and it was considered to be a pyothorax-associated lymphoma-like disease. He was treated with 6 cycles of R-CHOP postoperatively and no recurrence was detected until he died of another disease.

A 68-year-old man presented with headache and nausea. Hyponatremia was detected by a blood test. He was admitted to our hospital for further examination and treatment. We diagnosed him with syndrome of inappropriate secretion of antidiuretic hormone. Chest computed tomography revealed a solid mass in the anterior mediastinum. The tumor was considered to be the cause of the syndrome of inappropriate secretion of antidiuretic hormone. Thus, he underwent extended thymectomy. The pathological diagnosis was neuroblastoma derived from the thymus. After the operation, hyponatremia was rapidly ameliorated. Also, antidiuretic hormone decreased within the normal range. For these reasons, we considered that the thymic neuroblastoma had produced antidiuretic hormone and caused syndrome of inappropriate secretion of antidiuretic hormone. A mediastinal tumor complicated with syndrome of inappropriate secretion of antidiuretic hormone is extremely rare. According to previous reports, a mediastinal tumor complicated with syndrome of inappropriate secretion of antidiuretic hormone closely associated with malignancy. Therefore, we consider that complete resection of the tumor with careful follow-up is necessary.

A 70-year-old woman was referred to our hospital because of an abnormal shadow on a chest radiograph and hypoxemia. Computed tomography of the chest revealed an enhanced solitary lung nodule which was connected with linear structures suggestive of feeding arteries and a drainage vein in the left upper lobe inferior lingular segment. A total of four afferent feeding arteries originated from different segmental pulmonary arteries (A3, A4, A5, and A8). We made a preoperative diagnosis of complex-type pulmonary arteriovenous fistula (PAVF). Percutaneous image-guided embolotherapy was considered to be inapplicable, so we performed pulmonary resection of the left upper lobe by video-assisted thoracoscopic surgery (VATS). The right-to-left shunt fraction and partial pressure of arterial oxygen (PaO2) were markedly improved after surgery (31.4 to 9.5% and 50.2 to 89.7 mmHg respectively). Here, we describe the case of an elderly patient with complex-type PAVF treated with VATS.

Intimal sarcoma of the pulmonary artery is a rare disease associated with a poor prognosis. We report the case of a 64-year-old female who was admitted to our hospital with atypical genital bleeding caused by endometrial cancer. Computed tomography revealed deep vein thrombosis, right pulmonary artery thrombi, and a left pulmonary artery mass. Post hysterectomy, the insertion of an IVC filter and anticoagulant therapy were performed. Although the right pulmonary artery thrombi were diminished, the size of the left pulmonary artery mass increased gradually. Positron emission tomography-CT showed abnormal FDG uptake in the mass. Biopsy of the mass via cardiac catheterization indicated pulmonary artery intimal sarcoma. A left pneumonectomy with pulmonary aterioplasty was performed under cardiopulmonary bypass via median sternotomy. Pathological examination confirmed a diagnosis of intimal sarcoma of the pulmonary artery. Eight months after pneumonectomy, the tumor relapsed in the right lung. Nine months after the operation, she died of pneumonia.

A 66-year-old man was admitted to our hospital due to mediastinal lymphadenopathy. EBUS-TBNA was performed, and the diagnosis was carcinoma. In spite of various preoperative clinical examinations, the primary site was not determined. We preoperatively diagnosed him with mediastinal lymph node carcinoma of unknown primary site. Dissection of the right superior mediastinum was carried out through video-assisted thoracic surgery. The intraoperative histological diagnosis was poorly differentiated carcinoma of the lymph node. The final diagnosis was small cell carcinoma of the lymph node, and he received adjuvant concurrent chemoradiotherapy. He was alive and well without recurrence or abnormal appearance of the primary site 2 years after the operation. Small cell carcinoma in mediastinal lymph nodes without a recognizable primary site is extremely rare, but it was considered that aggressive multimodal therapy including surgical resection is effective.

We herein report the case of a 49-year-old man who presented with an abnormal shadow in the right mediastinum on a chest radiograph. Computed tomography findings revealed a teardrop-shaped, cystic-like, enhanced cervico-mediastinal tumor, of 3.5×3.5×9.5 cm in diameter. The tumor exhibited a high signal intensity on T2-weighted images, and a structure with mixed low and high signals was recognized internally. The patient underwent surgery, and on the -basis of the intraoperative findings, the tumor was pathologically diagnosed as a schwannoma derived from the right vagus nerve. To preserve the vagus nerve, the tumor between the capsules was resected using a cervical approach. Specifically, the neural epithelium was dissected, and only the tumorous nerve fiber bundle was removed. The patient post-surgically suffered from a mildly hoarse voice that he recovered from after one month, and did not suffer from any major complications such as recurrent laryngeal nerve paralysis or Horner's syndrome. Intercapsular resection using a cervical approach should be considered to avoid complications and any deterioration in the quality of life of patients with cervico-mediastinal schwannoma of the vagus nerve.

Carninosarcoma of the lung is a rare malignant tumor associated with a poor prognosis.

A 68-year-old male was admitted to our hospital because of cough and phlegm. A chest radiogram revealed a nodular shadow in the left middle-lung field. Chest CT showed a 30 mm-diameter mass accompanied by pleural indentation in S3 of the left lung, and PET revealed FDG accumulation in the tumor. The biopsy findings suggested squamous cell carcinoma. The patient underwent left upper lobectomy and lymph node dissection. The histopathological diagnosis was carcinosarcoma involving adenocarcinoma, squamous cell carcinoma, and chondrosarcoma with lymph node metastasis. Two months later, he was found to have bone metastasis on MRI, and irradiation was initiated. Five months after surgery, multiple lung and liver metastases were noted. Chemotherapy was administered but the patient died 13 months after surgery.

[Introduction] Lung hypoplasia causes respiratory disturbances during the neonatal period; however, in rare cases, it may be detected during adulthood and can accompany malignant tumors. [Cases] We encountered four patients with right middle lobe hypoplasia complicated by lung cancer. They were three men and one woman, and all were in their sixties. CT volumetry revealed that the average rate of the middle lobe volume to whole lung one was 0.24%. Based on histological analyses, the diagnoses were typical carcinoid in three patients and small cell lung cancer in one patient. All four patients underwent right middle lobe resection. [Discussion] Although lung hypoplasia is typically secondary to a congenital abnormality, the four patients reported here had primary pulmonary hypoplasia with no complications, and the lesions were exclusively found in the right middle lobe. This may be the reason why the patients had not experienced any respiratory disturbances until adulthood. Although all patients had neuroendocrine tumors, the causal relationship between lung hypoplasia and neuroendocrine tumors is unknown. [Conclusion] We treated four patients with right middle lobe hypoplasia complicated by lung cancer.

We report a case of pulmonary collision cancer consisting of squamous cell carcinoma and small cell carcinoma. A 72-year-old male was admitted to our hospital with general malaise. Chest computed tomography showed a snowman-shaped mass (41×35 mm) in the right lower lobe. On CT-guided biopsy, the caudal part of the tumor was punctured, and the resulting diagnosis was squamous cell carcinoma. The patient underwent right lower lobectomy. Pathological examination revealed collision cancer consisting of squamous cell carcinoma and small cell carcinoma. When encountering a snowman-shaped pulmonary mass, the possibility of lung collision cancer should be considered.

Cholesteroloma is a foreign-body-type granuloma that forms in reaction to cholesterol crystals. It is a commonly described as a benign condition affecting the middle ear and paranasal sinus disease. We report a rare case of cholesteroloma in the anterior mediastinum involving a 56-year-old asymptomatic man. Chest computed tomography showed a 2.0-cm nodular lesion in the anterior mediastinum. T1- and T2-weighted magnetic resonance images revealed hypo-intense signals. Therefore, a thymoma, bronchiogenic cyst, or lymphangioma was considered as a preoperative diagnosis. Video-assisted thoracic surgery (VATS) was performed for therapeutic purposes. The pathological diagnosis was a cholesteroloma, which originated from the thymus.

In cases of surgery for a mediastinal tumor invading the superior vena cava (SVC), SVC reconstruction is sometimes needed including the replacement of artificial blood vessels. We encountered a successfully resected case of a mediastinal tumor invading SVC, involving the placement of a temporal internal shunt. A 46-year-old man was referred to our hospital because of a mediastinal tumor detected on computed tomography (CT), which invaded the junction of the left brachiocephalic vein to SVC. A percutaneous biopsy failed to confirm the pathological diagnosis, and surgical resection was performed with median sternotomy. A venous cannula with side holes opened was inserted from the right atrial appendage up to the right brachiocephalic vein with its tip beyond the invasion and the vein was occluded with the vessel loop maintaining blood flow. The mediastinal tumor was resected en bloc with the invaded vein wall, and the defect of the SVC was repaired using a pericardial patch. The final pathological diagnosis was seminoma. We report the case along with technical considerations.

A 69-year-old man who underwent transverse colectomy for transverse colon cancer at the age of 65 years was referred to our hospital for the examination and treatment of a tracheal tumor detected by computed tomography. Bronchoscopic examination revealed the tumor to be hemorrhagic and biopsy specimens led to a diagnosis of a glomus tumor. Tracheal resection and reconstruction were performed via right thoracotomy. The postoperative course was uneventful and the patient was alive without recurrence 1.5 years after surgery. Tracheobronchial glomus tumor is rare. We should be careful on conducting biopsy because of the ease of hemorrhage. After evaluating whether it is benign or malignant, and whether it has invaded the tracheal wall, we should decide on the course of treatment.

Case 1: A 28-year-old female was referred to our hospital for a pulmonary tumor located in the right pulmonary artery. She had undergone surgical resection of a retroperitoneal leiomyoma that invaded the inferior vena cava 4 years previously. She also subsequently underwent resection and radiofrequency ablation (RFA) for pulmonary metastases. We considered the tumor to be a new metastasis to the lung, and performed right lower lobectomy. Pathological examination revealed a macroscopic tumor embolus in the right pulmonary artery (A9+10). Case 2: A 74-year-old male was referred to our hospital for a possible thromboembolism of the right pulmonary artery. He had undergone transcatheter arterial chemoembolization (TACE) and RFA for a hepatocellular carcinoma three years ago. Extended posterior segmentectomy of the liver had been performed for S6 hepatic metastasis involving the right hepatic vein five months prior to presentation. He received anticoagulant therapy under the suspicion of thromboembolism in the previous hospital. Since the lesion had gradually enlarged, right lower lobectomy was performed. Macroscopic tumor embolus in the right A9+10 was diagnosed. Although the occurrence of a macroscopic tumor embolus of the pulmonary artery is caused by direct invasion of the tumor into the inferior vena cava, the mechanism of implantation has yet to be clarified. Differential diagnosis of pulmonary artery thromboembolism is important.

Case 1 was a 60-year-old man and case 2 was a 73-year-old man. They were referred to our hospital because of abnormal chest radiographs. Chest computed tomography (CT) showed reticular shadows in the bilateral lung, suggesting interstitial pneumonia (IP).

We performed a lung biopsy (lung wedge resection) with video-assisted thoracoscopic surgery for accurate pathological subtype analysis of IP. A few days after the removal of a chest tube, subcutaneous emphysema at the surgical site could be observed on a chest radiograph. Although lung collapse was not seen, marked mediastinal emphysema and subcutaneous emphysema were observed on CT.

Management with a tube was not performed since there were no space for chest tube insertion in the thoracic cavity. Careful observation by chest radiograph indicated spontaneous improvement in a few days.

This condition is considered to occur via air leakage due to subpleural alveolar damage caused by the endostaplars that pass through the hilum, leading to subcutaneous emphysema following mediastinal emphysema.

Generally, secondary mediastinal emphysema has been reported as a complication of IP. Subcutaneous/mediastinal emphysema without lung collapse should also be considered as one of the complications of lung biopsy for IP.