There have been few reports on patients with non-small cell lung cancer (NSCLC) who experienced liver recurrence without recurrence at other sites after lung resection. Herein, we examined 11 patients with NSCLC who experienced liver recurrence without recurrence at other sites after lung resection. Nine patients were men and two were women. The median age was 73 years (range, 45-78 years); 10 patients underwent lobectomy and 1 underwent segmentectomy. Histological types included adenocarcinoma in six patients, squamous cell carcinoma in four, and large cell neuroendocrine carcinoma in one. Ten patients underwent chemotherapy and one underwent liver resection after recurrence in the liver. During the follow-up after treatment for liver metastasis, disease progression was observed in all cases. Median progression-free survival after treatment for liver metastasis was 5 months (range, 1-23 months) and median overall survival was 21 months (range, 8-47 months). During the clinical course after treatment for liver metastasis, four patients (among these, three had squamous cell carcinoma) did not experience recurrence at sites other than the liver, whereas seven patients (among these, six had adenocarcinoma and one had squamous cell carcinoma) experienced recurrence at sites in addition to the liver. Based on these results, the ratio of squamous cell carcinoma tended to be high in patients who did not experience recurrence at sites other than the liver. It was difficult to control liver and brain metastases in all cases. To date, seven patients have died of lung cancer and four are living with the disease. Based on our data and those of previous reports, squamous cell carcinoma is considered a good candidate for the local treatment of liver metastasis; however, future study is needed to determine the indication of local treatment for liver metastasis from NSCLC.

Postoperative patients with primary spontaneous pneumothorax (PSP) often complain of anxiety over the possible occurrence of contralateral pneumothorax in the future. However, recurrence has been investigated in only a few studies. In this study, two hundred and twenty-seven patients with PSP underwent video-assisted thoracoscopic surgery (VATS) between January 2018 and March 2021. The tendency to develop contralateral pneumothorax was investigated. The median age was 22 years. The median maximum diameter of the contralateral bullae was 9.8 mm. Contralateral pneumothorax after surgery occurred in 27 cases (11.9%). Based on uni- and multivariate analyses, significant risk factors for the development of contralateral pneumothorax were: under the age of 25 years, and more than 10-mm maximum diameter contralateral bullae. It was found that 25.7% of patients with ipsilateral PSP involving the two factors developed contralateral pneumothorax postoperatively. In conclusion, those under the age of 25 years as well as with more than 10-mm maximum diameter contralateral bullae at the first VATS are likely to have contralateral pneumothorax in the future.

Methotrexate (MTX) is often prescribed as one of the key therapies for rheumatoid arthritis (RA), but MTX use occasionally leads to MTX-related lymphoproliferative disorder (MTX-LPD). A 79-year-old female taking MTX for RA had undergone breast-conserving surgery for left breast cancer in 200X and had enlarged left axillary lymph nodes in 200X+11. Computed tomography (CT) revealed two tumors (29 mm, 9 mm) in the right lower lobe and an infiltrative shadow in the right upper lobe in 200X+12. Transbronchial lung biopsy was performed, but no definitive diagnosis could be made. Right lower lobe resection was performed. Pathological examination revealed MTX-LPD and lung metastasis of breast cancer. The invasive shadow in the right upper lobe disappeared after the discontinuation of MTX therapy. A pulmonary tumor arising in a patient on MTX therapy should remind all pulmonary physicians of the possibility of MTX-LPD.

Tracheobronchial injuries secondary to penetrating chest trauma are rare; however, associated organ injuries lead to a high mortality rate. We report a case of tracheal injury due to penetrating chest trauma involving a patient who underwent life-saving emergency surgery. A woman aged 59 underwent emergency surgery following knife penetration caudally from the right supraclavicular area. She presented with the knife stuck in her body. Therefore, changing the patient's position was difficult, and we performed a median sternotomy with the patient placed supine. The right tracheal wall was injured; however, we did not identify any adjacent organ injury or complication. Intraoperatively, we created an additional intercostal chest incision, which facilitated optimal visualization of the surgical field. We secured the pulmonary artery and vein, safely removed the knife, and repaired the trachea. Postoperatively, we observed no serious complications, and the patient followed an uneventful course. Surgical repair remains the primary treatment for tracheal injuries. However, the therapeutic approach is individualized and varies based on the site of injury. Surgeons should consider the risk of intraoperative injury to the large blood vessels, heart, and other adjacent organs.

A 52-year-old woman aged 42 years had undergone breast-conserving surgery after preoperative drug therapy (Fluorouracil/Epirubicin/Cyclophosphamide followed by eight courses of Docetaxel) for luminal HER2-type cancer in the left breast, with the chemotherapeutic grade classified as ypT1aN0M0 (ypStageIA). She underwent postoperative adjuvant hormone therapy (tamoxifen for 5 years and a luteinizing hormone releasing hormone derivative for 2 years) and anti-HER2 therapy (trastuzumab for 1 year) and was being followed up. A 10-mm nodule appeared in the upper lobe of her right lung on computed tomography at her 10-year follow-up examination, which was considered to be breast cancer metastasis. Partial lung resection was performed using thoracoscopy to confirm the diagnosis. Positron emission tomography showed a mass lesion with a standardized uptake value of 4.6 in the right retroperitoneum and upper pelvis, and the urologist resected the right renal ureter on suspicion of retroperitoneal tumor invasion. A diagnosis of metastatic lung tumor of retroperitoneal origin was made. Based on this case, when we suspect a solitary metastatic pulmonary nodule, we should also keep in mind that the nodule may have metastasized from an unexpected tumor.

The patient was a 73-year-old man who showed a nodular lesion in the lower lobe of the left lung on a chest radiograph. Chest computed tomography (CT) revealed a 2.5 cm solid mass in the inferior lobe of the left lung. He was diagnosed with lung cancer (cT1cN0M0, Stage IA3) by transbrochial lung biopsy, but the histological type was unknown. Lung function tests showed a decrease in the diffusion capacity of the lung for carbon monoxide (%DLCO-42.5%). Therefore, stereotactic body radiation therapy (SBRT; 48 Gy) was performed. At 12 months after therapy, the primary lesion had increased in size, and was diagnosed as local recurrence, salvage surgery (video-assisted thoracoscopic left lower lobectomy+ND2a-2) was performed, and a permanent pathological specimen led to diagnoses of basal cell squamous cell carcinoma of the lung. He is currently alive without recurrence at 2 years and 8 months after surgery.

The patient, a 65-year-old man, visited our hospital with chief complaints of cough, hemoptysis, and chest pain. Contrast-enhanced chest computed tomography showed an increase in the size of a previously detected mass in the left thoracic cavity. Chronic expanding hematoma was diagnosed based on imaging findings. The patient underwent surgery after preoperative embolization of the feeding vessels from the chest wall. With the patient placed in the right lateral decubitus position, an arcuate incision was made from the left fifth intercostal space to lower edge of the costal arch. The costal cartilage attached to ribs 6 to 10 was cut, and the 6 to 10th ribs were flipped up to open the chest. This ensured a good visual field around the pulmonary hilum and the left diaphragm. The mass firmly adhered to the chest wall, lung, and the left diaphragm. The left lower lobe, left lingular segment, the left diaphragm, and hematoma were resected en bloc. Since the residual lung was small, there were concerns about postoperative lung torsion and pulmonary fistula. Thus, intrathoracic septation using a polytetrafluoroethylene sheet (ePTFE sheet) and diaphragmatic reconstruction were performed. Since surgery, the patient has been followed up without recurrence for 1 year and 2 months.

The best approach to middle mediastinal tumors has not been clearly determined. Herein, we report a case of complete resection of a giant mediastinal tumor by transecting the right main bronchus. Middle mediastinal tumors appear between the left atrium and right main pulmonary artery. It is often difficult to dissect the tumor from the left atrium, aorta, or left main pulmonary artery. In this case, once we detached the right main bronchus, the view was secured, and the tumor could be successfully removed. After the tumor was removed, the severed right main bronchus was anastomosed. For large mediastinal tumors, transecting the right main bronchus allows good visual field development and safe removal of the tumor.

Benign metastasizing leiomyoma (BML) is a rare disease in which a benign uterine leiomyoma metastasizes and mainly occurs in premenopausal women. It is even more rare for postmenopausal women to present with growing BML nodules.

We report the case of a postmenopausal woman who presented with growing bilateral multiple pulmonary nodules, and BML was diagnosed by surgical resection. A 72-year-old woman was suspected to have a malignant uterine tumor because of a growing uterine mass with a smooth lung tumor. Five years previously, she underwent abdominal total hysterectomy and bilateral salpingo-oophorectomy. Uterine leiomyoma was diagnosed, and the lung tumor was observed. Chest radiograph and computed tomography revealed bilateral multiple pulmonary nodules. There was no fluorodeoxyglucose uptake on positron emission tomography. We conducted wedge resection by video-assisted thoracic surgery for two left lower lobe nodules for diagnosis. The nodules exhibited no malignancy, and their histological features were similar to the uterine leiomyoma resected five years previously. The resected nodules were histologically diagnosed as BML and we conducted observation postoperatively. Six months postoperatively, the pulmonary nodules had grown based on chest computed tomography; however, there were no respiratory symptoms. Currently, we continue observation. It is rare for postmenopausal women to present with growing BML nodules, and pulmonary resection is important for the diagnosis of pulmonary nodules.

A 54-year-old woman underwent robot-assisted thoracoscopic right upper lobectomy for lung cancer. On postoperative day 1, her chest radiograph revealed decreased permeability of the right upper lung field on the mediastinal side. Contrast-enhanced CT performed on postoperative day 2 suggested middle lobe atelectasis. The patient was carefully followed up due to no abnormal findings in the general condition or blood samples. Unfortunately, no improvement in atelectasis was detected, and a re-thoracotomy was performed on postoperative day 5. Venous congestion was observed in the right middle lobe. The lower lobe dilation may have caused cranial retraction of the middle lobe vein, resulting in venous return failure. We report on the mechanism of this extremely rare complication, along with additional literature analyses.

There are various types of plasma cell tumor, and most of them are multiple myeloma (MM). Multiple myeloma is characterized by plasma cell proliferation in the bone marrow and systemic organ dysfunction, and is sometimes observed outside the bone marrow. Solitary plasmacytoma is a disease that shows isolated plasma cell proliferation outside the bone marrow without that of bone marrow. A pulmonary origin is rare and difficult to differentiate from other diseases due to non-specific findings. During a routine check-up for hepatocellular carcinoma, a 72-year-old woman presented with a 3.3-cm mass, with a wall-thickening cavity in the right upper lobe.

Video-assisted wedge resection of the right upper lobe was performed due to the suspicion of lung cancer or fungal infection. Pathological examination of the surgical specimen led to a diagnosis of pulmonary plasmacytoma. Bone marrow examination after discharge showed no plasma cell proliferation in the bone marrow, no serum M protein, no urinary protein, and no Bence-Jones protein. Based on these findings, the patient was diagnosed with primary pulmonary plasmacytoma. When suspecting pulmonary plasmacytoma, bone marrow examination, a blood test, and urinalysis should be performed for definitive diagnosis and exclusion of MM. If pulmonary plasmacytoma is diagnosed, exclusion of extramedullary lesions of MM is necessary. Since solitary pulmonary plasmacytoma often progresses to MM, intense follow-up, including biochemical examinations such as serum proteins, is necessary.

Apart from detection using computed tomography, primary lung cancer can also be incidentally diagnosed during pneumothorax treatment. We report a case in which lung cancer diagnosis was made via an intraoperative biopsy for pneumothorax. The patient's preoperative radiograph and intraoperative thoracoscopic findings did not suggest lung cancer. A 75-year-old male presented to our department with dyspnea. He underwent surgery for pneumothorax due to persistent air leak. The thoracic cavity showed pleural thickening and adhesions. No nodular lesions suspicious of lung cancer were observed. During the water-seal test, multiple air leaks were found from the lung surface, despite the absence of pleural lesions. Considering the possibility of malignant disease, the parietal pleura and lung tissues were biopsied; subsequently, a diagnosis of carcinomatous pleurisy due to lung adenocarcinoma was made. Although the patient's thoracoscopic findings were consistent with inflammatory changes attributable to pneumothorax, a leak from the lung surface without apparent abnormalities was unusual. Even in the absence of abnormal findings on preoperative imaging studies, it is essential to consider performing tissue biopsy, depending on the patient's intraoperative findings.

This report describes a case of postoperative wound complication of the sternum after the transmanubrial osteomuscular sparing approach (TMA).

The case was a 48-year-old man diagnosed with adenosquamous carcinoma of the right upper lobe of the lung. After induction chemoradiation therapy, right upper lobectomy with combined resection of the right brachiocephalic vein by TMA was performed. The sternum was closed using sternal wires. Postoperatively, he recovered well and was able to engage in manual labor. After 2 years and 9 months, he developed a wound infection and sternal osteomyelitis caused by breakage of the wires. We removed the wires and drained a subcutaneous abscess. Intraoperatively, two of the wires were found to have broken into three parts.

The sternal wound after TMA tends to be unstable. Younger patients with high activity levels could develop complications related to the sternum after TMA. We need to identify issues of the sternum in patients with a history of surgery through TMA.

Bronchial injuries account for approximately 0.2% of intraoperative complications occurring during robot-assisted thoracic surgery (RATS) lobectomy. We report two cases of bronchial injury caused during RATS lobectomy in patients who underwent robot-assisted repair and provide an overview of the literature. Case 1: A 71-year-old woman with right upper lobe adenocarcinoma underwent RATS right upper lobectomy and ND2a-1. Intraoperatively, the right main membranous bronchus was injured during upper and lower interlobar dissection. Case 2: A 68-year-old woman with left upper lobe adenocarcinoma underwent RATS for left upper lobectomy and ND2a-1. The marginal membranous bronchus close to the bronchial stump was injured during lymph node and bronchus dissection. Both patients were classified as early cases. In the first case, the injury was thought to be caused by poor deployment and anatomic error during dissection of the peribronchial tissue, and in the second, it was thought to be caused by improper energization or stapler insertion. In both cases, the fistulae were sutured closed under RATS. Although avoidance of airway injury is necessary in robot-assisted lobectomy, robotic-assisted repair of airway injuries during RATS is safe.