Radiofrequency ablation for a liver tumor is a safe procedure and a massive hemothorax is a rare complication. Of 3,228 patients who received radiofrequency ablation for a liver tumor between 2006 and 2015, we encountered five who needed to undergo surgery for a massive hemothorax.

All five patients had liver cirrhosis and liver cancer. One patient had undergone transcatheter embolization of the intercostal artery, and two had received thoracocentensis before the operation. The approaches were thoracotomy in one, mini-thoracotomy in three, and complete videothoracoscopy-assisted surgery in one. Active bleeding was observed in one case. The site of bleeding was estimated in three, involving those in whom active bleeding was not observed.

There were the following complications: afterbleeding in one, transient liver disorder in three, and moderate pleural effusion in three. The median volume of total blood loss was 2,500 mL (1,160-3,190 mL) and blood transfusion was performed in all cases in the perioperative period. All patients were discharged in a good condition. Because of liver cirrhosis, we should pay close attention to perioperative management.

Macrolide-resistant Mycobacterium avium complex pulmonary disease (MAC-PD) is difficult to treat. We have been performing surgical treatment for clarithromycin (CAM) -resistant MAC-PD. This study reviewed 14 patients who underwent pulmonary resection for CAM-resistant MAC-PD between January 2014 and December 2019 at our institution. The median period between the confirmation of CAM-resistance and surgery was 5.0 months. In addition to oral antibiotics, parenteral aminoglycoside was administered to all patients perioperatively. Preoperative sputum culture was positive in 11 patients. All patients underwent anatomical lung resection as follows: 5 lobectomies, 2 segmentectomies, 6 combined resections, and 1 pneumonectomy. One patient developed a bronchopleural fistula. A sputum-negative status was achieved in 12 patients after the surgery, all of whom showed no recurrence during the follow-up period. Two patients with bilateral bronchiectatic lesions failed to achieve negative conversion postoperatively. Both patients underwent contralateral surgery. One patient continued to be sputum-positive, and the other patient achieved a sputum-negative status. Resectional surgery combined with chemotherapy may be effective for patients with CAM-resistant MAC-PD.

An infected aortic aneurysm after thoracic endovascular aneurysm repair (TEVAR) is a life-threatening condition. We present two rare cases of an infected aortic aneurysm that were treated by VATS. Both patients had undergone endovascular repair of a thoracic aortic aneurysm and were given an infected aortic aneurysm. Excision of the infected endgraft, debridment, and reconstructions were considered. However, the patients had a poor clinical status and these were not considered to be tolerable. So, we performed aortotomy by VATS. Both patients underwent drainage of purulent fluid inside the aneurysm. Now they are free from re-infection without the use of any antibiotics. Drainage for aortic infection after TEVAR by VATS is considered to be reliable and useful.

The patient was a 66-year-old female who was found lying immobile in her house and brought to our hospital in an ambulance. Blood tests showed elevated serum adrenocorticotropic hormone (ACTH) and cortisol levels, indicating ACTH-related Cushing's syndrome. Chest computed tomography revealed a 1.3-cm nodule in the inferior lobe of the left lung. The patient underwent surgery for a suspected ACTH-releasing lung tumor. The frozen section diagnosis was a pulmonary carcinoid tumor, and left lower lobectomy with lymph node dissection was performed. The pathological diagnosis was a typical carcinoid with paraesophageal lymph node metastasis. Immunohistochemical staining for ACTH was positive, and she was diagnosed with ACTH-producing pulmonary typical carcinoid, pT1bN2M0, stage IIIA. After surgery, the serum ACTH remained elevated, although postoperative imaging examination did not show any other tumors. After the administration of metyrapone, the serum ACTH and cortisol levels improved to their normal ranges 8 months after resection.

Seven patients who received thymectomy at our hospital between 1998 and 2018 were clinically studied. The average patient age was 58.0 years old, including three males and four females. The average tumor diameter was 6.1 cm. The histological types were squamous cell carcinoma in five cases and undifferentiated carcinoma in two cases. The five-year survival rate was 57.1%. UICC8th p-Stage 1: two cases, 3A: one case, 4A: one case, and 4B: three cases, with only 4B: one case was Ef3. after conducting four courses of preoperative CBDCA+PTX. The operative method was a median sternotomy in all cases, with a left thoracotomy through the fourth rib additionally conducted in one case. Mediastinal lymph node resection was performed in six cases. Extended thymectomy and combined resection of the invaded organs were performed in each case, with postoperative radiation therapy conducted in all cases. Two patients underwent postoperative chemotherapy. We encountered two cases of relapse-free survival, one case of long-term survival following recurrence, and four cases of cancer death. In order to improve the treatment results of thymectomy, complete resection and multidisciplinary therapy are important. CBDCA+PTX is effective for chemotherapy. It is considered that Ef3. may be associated with long-term survival.

A 37-year-old pregnant woman presented to the emergency department with dyspnea and chest pain. A chest radiograph showed complete atelectasis in the right lung due to pleural effusion. The pleural effusion was bloody. Because of eyelid conjunctiva telangiectasia, a history of recurrent epistaxis, and lesions with blood vessel inflow on CT, we diagnosed her with hemothorax due to intrathoracic rupture of a pulmonary arteriovenous fistula associated with hereditary hemorrhagic telangiectasia, and we decided to perform emergency surgery. After consultation with gynecology, pediatrics, and anesthesiology, a cesarean section under lumbar anesthesia was performed first, followed by thoracoscopic hemostasis under general anesthesia. Postoperatively, both the mother and child progressed well, and the contralateral lesion was operated on at a later date.

Background. Pulmonary carcinosarcoma is a mixture of non-small cell carcinoma (epithelial component) and sarcoma (non-epithelial component) containing heterotopic elements. It accounts for only 4% of sarcomatoid carcinomas, which comprise 0.1-0.4% of malignant lung tumors. The blastomatoid variant of carcinosarcoma contains high-grade fetal lung adenocarcinoma as an epithelial component and should be distinguished from pulmonary blastoma. Case. An 81-year-old man presented with abnormalities on a chest radiograph during a medical checkup. Computed tomography-guided needle lung biopsy suggested squamous cell carcinoma, partially containing small cell carcinoma. We preoperatively diagnosed the patient with right lower lobe lung cancer (cT4N0M0, stage IIIA) and performed right lower lobectomy and lymph node dissection (ND2a-2). The pathological diagnosis was carcinosarcoma (pT4N0M0, stage IIIA) composed of squamous cell carcinoma, high-grade fetal lung adenocarcinoma, and rhabdomyosarcoma. The patient was followed up without postoperative therapy. He developed multiple bone metastases at 28 months and died at 33 months after the surgery. Conclusion. We report a case of resection of blastomatoid pulmonary carcinosarcoma involving an elderly man.

A man in his forties presented with facial and upper extremity edema. Chest computed tomography (CT) revealed a huge anterior mediastinal mass with a right pulmonary artery embolus, which infiltrated the lumen of the superior vena cava (SVC) and extended into the right atrium (RA). Based on CT-guided biopsy findings, we diagnosed the patient with an invasive thymoma (type B2 per the World Health Organization [WHO] classification and stage III per the Masaoka staging system). Evaluation revealed an unresectable tumor owing to infiltration of the heart, and the patient was administered chemotherapy. However, we observed a poor therapeutic effect with tumor invasion of the right ventricle, which necessitated extended thymothymomectomy including combined resection of the other infiltrated organ except the heart. Preoperative ¹⁸F-fluorodeoxyglucose positron emission tomography revealed left pulmonary artery embolism with high tracer uptake in this vessel, and we performed pulmonary artery embolectomy of the tumor embolus. Histopathological evaluation of the resected specimen confirmed an invasive thymoma (type B3 and stage III) and a left pulmonary artery tumor embolus. Currently, the patient is being administered chemotherapy owing to lung metastasis. We report a case of resection of invasive thymoma directly invading SVC and RA with a pulmonary artery tumor embolus.

An 82-year-old man visited the clinic because of dyspnea on exertion and in the recumbent position. Chest CT showed elevation of the right diaphragm. Spirometry showed mixed ventilatory impairment with %VC: 79.3% and FEV_1%: 51.5%. Chest CT showed a solid nodule in the right segment S6, which was suspected to be lung cancer, with a size of 15 mm. Cine MRI showed that the right diaphragm lowered in the expiratory phase and elevated in the inspiratory phase, and the patient was diagnosed with right diaphragmatic eventration. Partial lung resection and diaphragmatic plication were performed for the nodule, suspected to be lung cancer, in the right lower lobe and right diaphragmatic eventration. After the operation, despite pulmonary resection, spirometry showed that %VC and FEV_1% improved to 84.5 and 57.8%, respectively and dyspnea disappeared. Cine MRI confirmed normalization of diaphragmatic movement.

A 62-year-old man was examined by our hospital for pulmonary coin shadows in both lungs, as disclosed on chest radiographs. He had no subjective complaints. Although transbronchial and percutaneous CT-guided fine-needle biopsies failed to obtain enough specimens because of the wandering shadow, thoracoscopic lung biopsy was effective because of the subpleural location of the target lesions. The histologic findings were consistent with pulmonary hyalinizing granuloma, with extensive, hyalinized lamellar collagen bundles arranged haphazardly in the central area. Infiltration by lymphocytes and plasma cells and destruction of bronchiolar and vessel walls were observed in the marginal areas. No amyloid deposit or lymphcytic monoclonality was observed in the lesion. Eighth months after biopsy, the patient's clinical and radiographic data showed no change.

We report a case of mediastinal liposarcoma simulating a malignant cystic tumor. Case. A 72-year-old male was pointed out as showing an abnormal shadow on a chest radiograph. Radiological findings showed a cystic mediastinal tumor with septum and a solid part in the caudal end of the tumor. We performed a complete resection of the tumor through a left lateral thoracotomy. The tumor was solid and did not directly invade surrounding tissues. The postoperative pathological diagnosis was mediastinal liposarcoma, myxoid type. At follow-up, three years after surgery, the patient was well without any adjuvant therapy.

We report a rare case of resection of solitary pulmonary metastasis from intraductal papillary mucinous carcinoma (IPMC) of the pancreas. The patient was a 79-year-old woman who underwent pylorus-preserving pancreaticoduodenectomy due to pancreatic head cancer at the age of 77. The pathological diagnosis was invasive IPMC, and she was followed by postoperative administration of S-1. Follow-up CT performed 16 months after the operation revealed a pulmonary nodule in the left lower lobe (S6). A metastatic lung tumor was suspected because of growth of the nodule and slight elevation of CA19-9, and left S6 segmentectomy was performed for both diagnostic and therapeutic purposes. Histopathologically, the lung tumor was adenocarcinoma with invasive proliferation of high columnar epithelium that was similar to the primary lesion of the pancreas. Immunohistochemical staining for TTF-1 and Napsin A was negative. Based on these findings, the tumor was diagnosed as metastasis from IPMC of the pancreas.

We report the rare case of a pulmonary preinvasive lesion incidentally detected in the resected specimen of spontaneous pneumothorax. A 19-year-old man was referred to our hospital due to left spontaneous pneumothorax. Air leakage had prolonged despite the insertion of a chest tube, and chest CT showed bullae in the bilateral lungs with no other abnormal shadows. He underwent bullectomy of the left lung under uniportal video-assisted thoracoscopic surgery, and the postoperative course was uneventful. Histopathological examination of the resected specimen revealed a lesion with lepidic proliferation of atypical alveolar epithelial cells apart from bullae, that was diagnosed as atypical adenomatous hyperplasia (AAH). Atypical cells were not found in the resected margin and no additional resection was performed. Routine follow-up was selected as a management policy.

Careful evaluation of chest CT and pathological analysis of the resected specimen are important because tiny or occult lesions composed of atypical cells may incidentally coexist with benign diseases such as pneumothorax even in young patients.

Massive hydrothorax secondary to pleuroperitoneal communication occurs as a complication of CAPD. The key to successful surgical therapy depends on the precise detection of the transdiaphragmatic route of dialysate leakage. In this report, we present the case of a 56-year-old woman successfully treated with thoracoscopic closure. Although only a subtle change was noted under white-light thoracoscopy, the route of fluorescence leakage of ICG administered from the peritoneal catheter clearly seen under infrared thoracoscopy and hiatus of the diaphragm were closed by excision and suturing. The patient could resume CAPD 40 days after surgery without recurrence of hydrothorax.

Case 1: A 23-year-old woman was referred to our hospital for back pain. MRI demonstrated a 4.0×4.0×4.0-cm dumbbell-shaped tumor. Case 2: A 68-year-old woman was admitted to our hospital for the treatment of a 7.0×6.7×5.3-cm posterior mediastinal tumor, which grew slowly during the follow-up period of 12 years.

We performed surgical treatment. First, laminectomy was carried out in a prone position by an orthopedic surgical procedure, and it was confirmed that the tumor did not invade the dura. The nerve root was dissected and the tumor was detached from the spinal canal. Next, we changed the patient to a left lateral position, and removed the mediastinal tumor using a thoracoscopic approach. Video-assisted thoracic surgery (VATS) with an anterior approach is safe and effective for dumbbell-shaped tumors.

An 80-year-old woman underwent examination for an anterior mediastinal tumor and a part-solid nodule of the upper left lobe of the lung at our hospital. The anterior mediastinal tumor was diagnosed as a thymoma, and subxiphoid robotic thymectomy was performed. Six months later, the part-solid nodule of the upper left lobe of the lung had grown larger; therefore, thoracoscopic lobectomy was conducted. During lobectomy, water used to test for air leaks escaped from the left to right pleural cavities, and right pleural effusion was confirmed in a postoperative chest roentgenogram. These findings suggested the existence of pleuro-pleural communication. Pleuro-pleural communication is rare, but it is a cause of bilateral pneumothorax. Considering the risk of bilateral pneumothorax before surgery, we selected thoracoscopic lobectomy. It is important to consider the surgical plan and potential complications when treating a patient who has undergone mediastinal surgery.

Gallbladder metastasis of lung cancer is a rare disease. Only seven cases have been reported in the literature excluding autopsy cases. We report two additional surgical cases.

Case 1: An 80-year-old male underwent right upper lobectomy and lymph node dissection for squamous cell lung carcinoma at the age of 70. FDG / PET-CT at 6 years after the operation showed accumulation in the gallbladder. He underwent laparoscopic cholecystectomy. Histological findings of the gallbladder showed squamous cell carcinoma, being identical to the primary lung cancer.

Case 2: A 78-year-old female underwent left upper lobectomy and lymph node dissection for lung adenocarcinoma. She had hemorrhagic cholecystitis 6 months after the operation and underwent laparoscopic cholecystectomy. Histological findings of the gallbladder showed ALK-positive adenocarcinoma, similarly to the previous lung cancer.

Long-term use of tracheostomy may result in a persistent tracheocutaneous fistula after tracheostomy decannulation. Herein, we report a method to close a tracheocutaneous fistula using two hinged turnover skin flaps. This is a safe and simple procedure that needs no fistulectomy nor tracheoplasty.