The Journal of the Japanese Association for Chest Surgery
Online ISSN : 1881-4158
Print ISSN : 0919-0945
ISSN-L : 0919-0945
Volume 32 , Issue 5
Showing 1-19 articles out of 19 articles from the selected issue
  • Yasunori Kaminuma, Masayuki Tanahashi, Haruhiro Yukiue, Eriko Suzuki, ...
    2018 Volume 32 Issue 5 Pages 556-563
    Published: July 15, 2018
    Released: July 15, 2018
    JOURNALS FREE ACCESS

    Background: Pulmonary pleomorphic carcinoma (PC) is a primary lung cancer associated with a poor prognosis. We assessed the prognosis and prognostic factors of patients with surgically resected pleomorphic carcinoma. Method: Thirty-one patients with pleomorphic carcinoma (1.8% primary lung carcinoma/2.0% non-small cell carcinoma) among 1,697 cases of resected primary lung carcinoma between January 2007 and February 2017 were retrospectively analyzed. Results: The 5-year overall survival (OS) was 37.6% (median: 23.4 months) and 5-year disease-free survival (DFS) was 33.6% (median: 11.3 month) in the 31 patients with pleomorphic carcinoma. Pleomorphic carcinoma was associated with a poorer prognosis than non-small cell cancer without pleomorphic carcinoma (Non-PC NSCLC), which was resected in the same period. When PC and Non-PC NSCLC were compared in each pathological stage (p-Stage), the prognosis associated with PC was not inferior in p-Stage I, but it was worse than in Non-PC NSCLC in p-Stage II-III. Log-rank tests showed that a tumor size≥4 cm and FDG PET-CT maximum standard uptake values (SUVmax) ≥15 were prognostic factors indicating a poor OS and DFS, and p-Stage≥II and pleural invasion were prognostic factors indicating a poor OS. Furthermore, adjuvant chemotherapy was not a prognostic factor. Conclusion: Pleomorphic carcinoma is lung cancer associated with an unfavorable prognosis except for p-Stage I. The adjuvant chemotherapy provided at present may not improve the prognosis of PC patients, and so a new treatment strategy is needed.

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  • Ken Onodera, Hiroyuki Oura, Itaru Ishida, Masashi Handa, Satoru Shimao ...
    2018 Volume 32 Issue 5 Pages 564-567
    Published: July 15, 2018
    Released: July 15, 2018
    JOURNALS FREE ACCESS

    Empyema in infants is relatively rare. Moreover, few reports have described surgical treatment for the management of refractory empyema in infants. We report the surgical management of acute empyema in a 2-month-old infant.

    A 2-month-old male infant was delivered by cesarean section due to pelvic presentation at 38 weeks and 6 days. His birth weight and neonatal mass screening showed no abnormality. He was treated for cough and nasal discharge and was admitted to our hospital due to fever and feeding problems. Computed tomography showed significant right-sided pleural effusion, collapse of his right lung, and a cavity in the right lower lobe. Empyema caused by perforation of a lung abscess was suspected. He was treated with antibiotics and continuous thoracic cavity drainage and artificial respiration. However, because of marked resistance to these treatments, he required surgical intervention. Intrathoracic curettage, lavage, lung decortication, and resection of the lesion in the right lower lobe were performed. His fever broke and adequate lung expansion was attained, allowing him to be weaned off the ventilator postoperatively. He was discharged from the hospital on the 21st day after the operation.

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  • Yuji Nomata, Shimon Itou, Masashi Nishimura, Takayuki Fukui
    2018 Volume 32 Issue 5 Pages 568-572
    Published: July 15, 2018
    Released: July 15, 2018
    JOURNALS FREE ACCESS

    A 42-year old male with right tension pneumothorax complicated by severe left pneumonia was brought to our hospital by ambulance. Following emergent thoracic drainage, the right lung was expanded and the respiratory state was improved. Two hours after admission, however, the respiratory state worsened again due to developing re-expansion pulmonary edema in a shock state. Then, extracorporeal membrane oxygenation (ECMO) support was initiated with veno-venous bypass.

    Under intensive treatment, the general condition was improved gradually and ECMO was discontinued on the 5th hospital day. Neither complications nor sequelae were noted.

    On the 28th hospital day, bullectomy and adhesive therapy were performed for right pneumothorax. The patient was discharged on the 43rd hospital day.

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  • Ken Miwa, Wakako Fujiwara, Yoshiteru Kidokoro, Kunio Araki, Yuji Tanig ...
    2018 Volume 32 Issue 5 Pages 573-579
    Published: July 15, 2018
    Released: July 15, 2018
    JOURNALS FREE ACCESS

    A 65-year-old man was refered to our hospital with the diagnosis of lung squamous cell carcinoma of the left upper lobe invading the apical chest wall and mediastinum. His chief complaints were hoarseness and left shoulder pain. Chest CT revealed the tumor of the left upper lobe, invading cartilage of the 1st rib, mediastinal fat, and left brachiocephalic vein, with a size of 6.2×3.9 cm. He was preoperatively treated with four cycles of cisplatin and TS-1 concurrently with 66 Gy of radiation under the diagnosis of superior sulcus tumor (SST). Staging after induction chemoradiotherapy revealed partial regression of the tumor. He was scheduled for surgical resection. Firstly, as the pulmonary hilum was outside the radiation field, we divided the lung-invading part of the tumor to the chest wall, and left upper lobectomy and mediastinal lymph node dissection were performed by video-assisted thoracoscopic surgery (VATS) in the lateral decubitus position. Secondly, resections of the tumor and cartilage of the 1st rib, mediastinal fat, internal thoracic artery, vagal nerve, and phrenic nerve were performed by a transmanubrial approach (TMA) in a supine position. The operative time was 173 minutes for VATS and 168 minutes for TMA, and blood loss was 70 mL. Pathological findings revealed no residual carcinoma, but positive results for ypT0N0M0 and Ef3. Although there are few reports on minimaly invasive surgery for SST after induction chemoradiotherapy, this TMA followed by VATS might be a useful approach from the perspective of minimaly invasive surgery.

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  • Kotaro Matsumoto, Hitoshi Ichimiya
    2018 Volume 32 Issue 5 Pages 580-586
    Published: July 15, 2018
    Released: July 15, 2018
    JOURNALS FREE ACCESS

    Pulmonary paragonimiasis westermani is a relatively rare cause of lung disease with a wide variety of radiologic findings, such as air-space consolidation, nodules, and cysts. Here, we describe a case of pulmonary P. westermani in a 51-year-old man who presented with a persistent cough. A chest radiograph showed a pulmonary nodular shadow in the left middle lung field. When he underwent a check-up at our hospital about a year later, the nodular shadow had increased in size. Chest computed tomography (CT) showed a nodular lesion with a maximal diameter of 40 mm in S4 of the left upper lobe. The pulmonary nodular lesion invaded the adjacent lobe across the interlobar pleura. 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) CT images showed abnormally intense uptake with a standardized uptake volume (SUV) of 10.3 in the left pulmonary lesion, and 2.6 in the left hilar lymph nodes. A specimen obtained by transthoracic computed tomography-guided core needle biopsy (TTNB) showed lymphocytic interstitial pneumonia. Based on chest CT and FDG-PET findings, we could not rule out the possibility of primary lung cancer. He underwent lingulectomy with a partial resection of the left lower lobe. Histological examination of a paraffin section showed a large number of parasite eggs and infiltration of eosinophils with an associated granulomatous reaction. In a postoperative enzyme-linked immunosorbent assay (ELISA), the patient's serum strongly reacted to P. westermani antigen. Based on these findings, the patient was diagnosed with pulmonary P. westermani infection. Following confirmation of the diagnosis, he received praziquantel therapy at 75 mg/kg orally for 3 days. In Japan, paragonimiasis is recently rarely reported; however, P. westermani infection should be considered when abnormal shadows are found on a chest radiopraph and chest CT.

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  • Kenji Nezu, Maiko Miyoshi, Yoshihisa Hojo, Kenji Nobuhara, Ken Sakai, ...
    2018 Volume 32 Issue 5 Pages 587-593
    Published: July 15, 2018
    Released: July 15, 2018
    JOURNALS FREE ACCESS

    The patient, a 64-year-old woman with a primary complaint of dyspnea, was examined at a local hospital, found to have abnormal thoracic opacity, and referred to this hospital. Three-dimensional computed tomography angiography showed an anomalous artery originating from the descending aorta and flowing into the left lung basal segment with a large aneurysm, approximately 28 mm in diameter. The lung field clearly showed vasodilation and decreased transparency. These signs were associated with calcification of, and thrombus formation in, the arterial wall. The branch of the pulmonary artery leading to the basal segment was absent, the routes of the inferior pulmonary vein and bronchi were normal, and the condition was judged to be anomalous systemic arterial supply to the basal segment of the left lung. In order to prevent the risk of hemorrhage associated with transection of an abnormal aneurysm, the first step was stent-graft insertion in the descending aorta, followed by video-assisted thoracoscopic left lower lobectomy and transection of the abnormal artery.

    Stent-graft insertion is a novel treatment method for an aortic aneurysm, but blood flow to the abnormal aneurysm associated with anomalous systemic arterial supply to the basal segment of the left lung was blocked by the stent graft in this case. This enabled transection of the abnormal artery and pulmonectomy to be carried out safely, making it a very useful technique. Including the present patient, only two cases of stent graft use have been reported to treat this condition. Thus, we consider this to be a very important case study.

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  • Chika Murakami, Takeshi Mimura, Tatsuya Miyamoto, Atsushi Kagimoto, Yo ...
    2018 Volume 32 Issue 5 Pages 594-599
    Published: July 15, 2018
    Released: July 15, 2018
    JOURNALS FREE ACCESS

    An 18-year-old female showed a round 20-mm nodular shadow in the right upper field on a screening chest radiograph. CT showed a 24-mm endobronchial homogeneous nodule in the right upper lobe. She underwent right upper lobectomy by complete video-assisted thoracoscopic surgery. Pathological examination confirmed a diagnosis of myoepithelioma of the lung. Myoepithelioma of the lung is a rare neoplasm and to the best of our knowledge only ten cases have been reported in the literature. Complete resection is mandatory, and it is necessary to investigate the diagnosis, treatment, and prognosis in more patients.

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  • Yoshihito Arimoto, Keigo Sekihara, Fumi Yokote, Satoshi Nagasaka, Sats ...
    2018 Volume 32 Issue 5 Pages 600-605
    Published: July 15, 2018
    Released: July 15, 2018
    JOURNALS FREE ACCESS

    Streptococcus pyogenes is a well-known pathogenic bacteria causing lethal necrotizing fasciitis. There have been few reports about acute pleural empyema. We retrospectively reviewed 2 cases of acute pleural empyema caused by Streptococcus pyogenes with reference to the literature. Case 1: A 36-year-old woman with no medical history of note. Chief complaints were vomiting and diarrhea. Right pleural effusion was detected on a chest radiograph. Streptococcus pyogenes was identified from her pleural effusion and blood culture. She was admitted to our hospital, and we performed thoracoscopic debridement and drainage for pleural empyema and mediastinitis. She was discharged on the 24th day after surgery without any complications. Case 2: A 32-year-old woman with a medical history of uterine myoma. She developed bacterial enteritis and was treated with antibiotics. Streptococcus pyogenes was identified from her blood culture. Right pleural effusion was noted on a chest radiograph. After admission to our hospital, we performed thoracoscopic debridement and drainage. She was discharged on the 22nd day after surgery without any complications. Both cases subsequently developed acute pleural empyema after abdominal symptoms. We emergently performed thoracoscopic debridement and irrigation. We could control their pleural empyema and achieve good results. Infection caused by Streptococcus pyogenes may lead to severe pleural empyema, and so early surgical intervention using thoracoscopy may be critical.

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  • Keigo Sekihara, Fumi Yokote, Yoshihito Arimoto, Satoshi Nagasaka, Sats ...
    2018 Volume 32 Issue 5 Pages 606-609
    Published: July 15, 2018
    Released: July 15, 2018
    JOURNALS FREE ACCESS

    Traumatic thoracic injury has many causes. Diaphragm injury should be cited as a differential diagnosis. We encountered traumatic diaphragm injury that was not detected by preoperative imaging. The patient was a 32-year-old man with a past medical history of epilepsy. After epileptic seizure, he complained of right chest pain and dyspnea. A chest radiograph revealed a right pneumothorax and he received chest drainage. On the next day, anemia showed progression. Chest CT revealed massive pleural effusion, multiple rib fractures and ascites. Three-dimensional (3D) reconstruction showed 7-9th rib fractures and displacement of the fractured 8th rib. Angiography was performed for hemostasis, although we could not detect active bleeding vessels. Then, we performed an emergency operation to search for intrapleural organ injury and repair the organ. We noted that the displaced 8th rib had entered the intrapleural space. There was diaphragm injury directly under the rib fracture. We carefully looked for other injuries and then closed the chest. He was discharged on the 6th day after surgery without any complications. It was difficult to diagnose diaphragm injury without hernia. Surveillance for organ injuries should not be performed solely based on imaging. Diaphragm injury may be a cause of hematothorax, and careful introperative surveillance is critical.

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  • Satoru Tamagawa, Yasuto Kondo, Mototsugu Ono, Hirotsugu Yamazaki, Yosh ...
    2018 Volume 32 Issue 5 Pages 610-616
    Published: July 15, 2018
    Released: July 15, 2018
    JOURNALS FREE ACCESS

    A 78-year-old man was admitted to our hospital with an abnormal shadow observed on a chest radiograph. The abnormal shadow was followed-up as an anterior mediastinal nodule, which increased in size over 3 years. Chest computed tomography and magnetic resonance imaging revealed an anterior mediastinal cystic lesion measuring 39 mm in diameter. Based on his clinical course and imaging findings, we performed video-assisted thoracoscopic resection of the lesion. Histopathologically, the lesion showed multiple cysts, and immunohistochemical analysis showed that the cells lining the cyst walls were stained positive for D2-40. Based on these findings, the lesion was diagnosed as a cystic lymphangioma. The patient's postoperative course was uneventful without any recurrence noted a year postoperatively.

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  • Sachiko Ota, Tadashi Gomyoda, Shigeyuki Tamari, Takashi Yoshimura, Yas ...
    2018 Volume 32 Issue 5 Pages 617-622
    Published: July 15, 2018
    Released: July 15, 2018
    JOURNALS FREE ACCESS

    Thrombotic thrombocytopenic purpura (TTP) caused by markedly reduced ADAMTS13 activity is a serious systemic disease characterized by microangiopathic hemolytic anemia and platelet thrombosis. There are few reports about postoperative TTP in respiratory surgery. We report a case of TTP followed by bullectomy for pneumothorax. A 62-year-old man underwent uneventful thoracoscopic bullectomy for pneumothorax. With the thrombocytopenia after the surgery, he was diagnosed with disseminated intravascular coagulation (DIC), and treatment was started on the 3rd postoperative day. However, the thrombocytopenia deteriorated, and he developed anemia, renal dysfunction, and delirium. Based on these findings and decreased ADAMTS13 activity, he was diagnosed with postoperative TTP on the 5th operative day. Plasmapheresis and steroid pulse therapy improved the thrombocytopenia and consciousness level, and he recovered without sequelae. In cases with thrombocytopenia after surgery, the possibility of postoperative TTP should be considered.

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  • Yusuke Kita, Yoshimasa Tokunaga, Taku Okamoto
    2018 Volume 32 Issue 5 Pages 623-628
    Published: July 15, 2018
    Released: July 15, 2018
    JOURNALS FREE ACCESS

    Ciliated muconodular papillary tumor (CMPT) is a rare tumor, it occurs in periphery of the lung, and is characterized by pilus cells and goblet cells with mucus production that show papillary proliferation in a lepidic growth pattern. It has characteristics of benign and malignant tumors but remains to be fully uncharacterized.

    A 67-year-old woman underwent computed tomography (CT). A 4-mm diameter nodule was observed in the left lower lobe, and was diagnosed as an inflammatory change. Four years later, CT showed that the nodule had increased to 7 mm in diameter. We performed surgery for diagnosis and treatment. Partial resection was performed by thoracoscopy and the nodule was diagnosed as CMPT. There has been no recurrence in the 2 years since surgery.

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  • Masahiro Adachi, Isao Sano, Shintaro Hashimoto, Ryoichirou Doi, Hideki ...
    2018 Volume 32 Issue 5 Pages 629-634
    Published: July 15, 2018
    Released: July 15, 2018
    JOURNALS FREE ACCESS

    A 86-year-old man had been pointed out as showing a part-solid nodule in the right upper lobe, which had been diagnosed as malignant lymphoma (DLBCL, FL) and treated. He underwent right upper lobe wedge resection. Pathological findings revealed the nodule to be adenocarcinoma. Two years later, CT showed a nodular lesion near the stump in the right upper lobe and another nodule in the right lower lobe. The right upper lobe nodule had grown, considered to be recurrence at the stump. However the tumor markers SCC and CYFRA slightly increased. Thus, the tumors were suggested to be primary lung cancers. Right upper lobectomy and lower lobe wedge resection were performed. Pathological findings revealed the nodule near the stump to be squamous cell carcinoma and the nodule of the right lower nodule to be small cell carcinoma.

    Metachronous multiple primary lung cancers with three pathological types after treatment of malignant lymphoma have rarely been reported. We report our experience along with a literature review.

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  • Hideto Mei, So Miyahara, Naoko Imamura, Shin-ichi Yamashita, Takeshi S ...
    2018 Volume 32 Issue 5 Pages 635-640
    Published: July 15, 2018
    Released: July 15, 2018
    JOURNALS FREE ACCESS

    According to the Annual report of the Japanese Association for Thoracic Surgery, 649 tracheal or bronchial resections with or without lung resection were performed in Japan in 2014. Of those, only 13 patients (2%) underwent bronchial resection and reconstruction without lung parenchymal resection. In the present study, we reviewed five cases of endobronchial tumor treated by bronchial resection and reconstruction without lung parenchymal resection from 1994 to 2015 in our institution. The histologic types of endobronchial tumor were as follows: 3 typical carcinoids, 1 lipoma, and 1 squamous cell carcinoma. Regarding locations of the tumors, 2 tumors were in the right intermediate bronchus, 2 in the left main bronchus, and 1 in the left lower bronchus. Three tumors were resected with posterolateral thoracotomies and 2 tumors were resected with clamshell incision. The mean operative time was 335±104 minutes. The mean total blood loss was 301±372 mL. The mean duration of chest drainage was 7.0±3.7 days. The period of hospital stay after surgery was 23.8±10.5 days. Postoperative complications were observed in 2 patients: one had respiratory failure that required temporary mechanical ventilation, and the other had anastomotic stenosis that was treated by single balloon dilation. All patients are currently alive without recurrence. The findings suggest that bronchial resection and reconstruction without parenchymal resection is a useful option for endobronchial benign or low-grade malignant tumors to preserve the lung function.

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  • Kenji Inafuku, Hiroyuki Ito, Masaki Suzuki, Tomoyuki Yokose, Haruhiko ...
    2018 Volume 32 Issue 5 Pages 641-646
    Published: July 15, 2018
    Released: July 15, 2018
    JOURNALS FREE ACCESS

    A 51-year-old male with left shoulder pain visited a physician. He was diagnosed with a left superior sulcus tumor, stage IIB (cT3N0M0). Carbon ion radiotherapy (CIRT) was performed at his request. He was given 72 Gray in 16 fractions for the primary tumor. CT after CIRT showed a reduced and scarred primary tumor. However, after one year and two months, he was diagnosed with left mediastinal lymph node (#5) recurrence and transferred to our hospital for chemotherapy. We decided that this case was operable and after one year and four months of CIRT, surgery was performed. Local pleural adhesion between the left apex and chest wall was successfully dissected. Because the #5 lymph node markedly adhered to the pulmonary artery, we performed left upper lobectomy with pulmonary artery plasty. Microscopically, the primary site became a scarred lesion, and no tumor cells were observed. Therefore, we diagnosed his histological response as Ef. 3. There was no evidence of CIRT-related change, such as fibrosis, surrounding the primary site. Only the #5 lymph node had developed a metastasis of squamous cell carcinoma, and we considered it to be ypT0N2M0-Stage IIIA. The surgical and pathological findings confirmed the superior dose localization of CIRT. When patients can be provided with standard therapies, physicians should carefully consider the indications for CIRT.

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  • Ryo Wakejima, Hironori Ishibashi, Hirotomo Takahara, Chihiro Takasaki, ...
    2018 Volume 32 Issue 5 Pages 647-653
    Published: July 15, 2018
    Released: July 15, 2018
    JOURNALS FREE ACCESS

    A 55-year-old male was referred to our hospital with a complaint of left shoulder pain. Chest CT showed that the tumor existed in the left upper lobe and involved the 1st rib, 1st thoracic vertebral body, and subclavian artery (SCA). The tumor was diagnosed as left upper lobe non-small cell lung cancer (cT4N0M0 Stage IIIA). After the induction of concurrent chemo-radiotherapy, we performed complete resection in three steps as follows: first, through a transmanubrial approach (TMA), the tumor was dissected from SCA and excised with the 1st vertebral body by orthopedic surgeons; next, through a midposterior approach, the left 1st vertebral arch was resected and the vertebral body was fixed by a plate to achieve stability of the vertebral body by orthopedic surgeons; finally, through lateral thoracotomy, the left upper lobe was removed with the divisions of hilar structures. In this case, the tumor invaded the left SCA and 1st thoracic vertebral body. TMA is useful to achieve a favorable surgical field in apex-invading lung cancer patients requiring vertebrectomy.

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  • Shun Iwai, Aika Funasaki, Nozomu Motono, Atsushi Sekimura, Katsuo Usud ...
    2018 Volume 32 Issue 5 Pages 654-658
    Published: July 15, 2018
    Released: July 15, 2018
    JOURNALS FREE ACCESS

    An anterior mediastinal mass was pointed out on computed tomography of a 65-year-old man during follow-up observation for another disease, and he was introduced to our department. Chest CT revealed a solid lesion of 35 mm in the anterior mediastinum, and the boundary with the pericardium was unclear. Thymoma or thymic carcinoma was suspected; thus, surgery was planned according to our policy. We performed total anterior mediastinal tumor removal, thymectomy, pericardial combined resection, and pericardial reconstruction by video-assisted thoracic surgery with a right-sided approach. Pathological examination revealed tumor cells with small- to medium-sized nuclei with the proliferation of large and small nuclei in a solidified alveolar form, fibrotic septal walls, necrotic nests, and scattered calcification. Immunostaining was positive for nervous system markers (synaptophysin and chromogranin A), as well as CD56. Based on these findings, the patient was diagnosed with neuroblastoma. Neuroblastoma is extremely rare in adults, and there are no established treatment guidelines. We herein report on the diagnosis and treatment as well as discuss similar cases that have been reported in the pertinent literature.

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  • Atsushi Kamigaichi, Norifumi Tsubokawa, Hidenori Mukaida, Mayumi Kanek ...
    2018 Volume 32 Issue 5 Pages 659-666
    Published: July 15, 2018
    Released: July 15, 2018
    JOURNALS FREE ACCESS

    Mucoepidermoid carcinoma is common in the salivary glands and bronchus, but extremely rare in the thymus, which composes 4.6% of thymic carcinoma.

    A 37-year-old woman had an abnormal shadow pointed out on a chest roentgenogram. CT and MRI of the chest showed a well-circumscribed solid cystic mass with eggshell-like calcification in the anterior mediastinum.

    The maximum SUV was 2.65 on 18F-FDG PET/CT. She underwent surgical resection by complete video-assisted thoracic surgery with both diagnostic and curative intent. The tumor showed no invasion of neighboring organs and the resected specimen was very hard, with peripheral calcification. The pathological diagnosis was mucoepidermoid carcinoma of the thymus (Stage I using Masaoka staging system).

    We report a case of mucoepidermoid carcinoma of the thymus with eggshell-like calcification, along with a review of the literature.

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