Nodular lymphoid hyperplasia (NLH), a rare disease, is classified as a reactive lymphoproliferative disease, making differentiation from malignancy challenging. In this study, we reviewed the clinical characteristics of NLH resection cases. Eight patients who underwent surgery between 2014 and 2022 and were diagnosed with NLH based on pathological findings were included in the study. The patient sample consisted of 4 men and 4 women, with a median age of 67 years (51-83 years). Four of the patients had a history of smoking and 3 had an autoimmune disease. Ground glass and solid nodules were observed on computed tomography in 4 men and 3 women, with a median tumor diameter of 15 mm (11-38 mm). In all cases, the preoperative diagnosis was primary lung cancer. Patients' background and imaging findings were similar to those in previous reports; however, a larger proportion of patients had a comorbid autoimmune disease. Consequently, preoperative diagnosis was difficult, and aggressive surgical biopsy was desirable for pulmonary nodules that presented with enlargement tendencies. Therefore, further case studies are warranted to determine the relationship between autoimmune disease and NLH.

A 79-year-old man presented with hoarseness, fever, and pharyngal pain, and was referred to our hospital. Computed tomography showed a left pharyngeal abscess and infection spreading to the lower mediastinum, and we diagnosed him with descending necrotizing mediastinitis (DNM). It was determined that DNM could be controlled by cervical drainage because the infection was localized in the lower posterior mediastinum. Incisional drainage of the deep neck abscess was performed, and a drain tube was placed in the mediastinum via cervix. On postoperative day 7, computed tomography revealed resolution of the infection in the lower mediastinum and a slight residual abscess in the upper mediastinum. Therefore, additional thoracoscopic mediastinal drainage was performed. The patient's condition improved steadily, and he was discharged 40 days after the initial surgery. This case suggests that even if the infection extends to the lower posterior mediastinum, sufficient treatment can be achieved with initial cervical drainage and staged mediastinal drainage if the infection is localized in the mediastinum.

A 70-year-old man underwent chest computed tomography (CT), which revealed a rapidly growing tumor in the left upper lobe. The tumor was diagnosed as pulmonary pleomorphic carcinoma by CT-guided biopsy (cT3N0M0; PD-L1 100%). Since a superior sulcus tumor was suspected, multimodal therapy was considered. However, an implantable cardioverter-defibrillator on the ventral side of the tumor was also considered when determining treatment options. The tumor was progressing rapidly, making it necessary to expedite the initiation of treatment. Thus, combination chemotherapy including pembrolizumab was initiated. The patient developed interstitial pneumonia, which was suspected to be drug-related, making it difficult to continue chemotherapy. However, the tumor had regressed and we decided to perform surgery. Ultimately, the tumor was diagnosed as pulmonary pleomorphic carcinoma (ypT1miN0M0) with Ef2. Four years after surgery, the patient was alive, had not experienced recurrence, and required no additional treatment.

In this study, we present a patient with locally advanced pulmonary pleomorphic carcinoma characterized by high PD-L1 expression who underwent surgery after pembrolizumab combination chemotherapy, resulting in long-term recurrence-free survival. Preoperative PD-1/PD-L1 inhibitor therapy may be effective for perioperative treatment of locally advanced pleomorphic pulmonary carcinoma with high PD-L1 expression.

Primary benign tracheal tumors are rare. The patient was a woman in her 60s. Computed tomography was performed for close examination of pyelonephritis, revealing a left renal tumor, tracheal tumor, and small nodule in the right lung. Bronchoscopy identified a tracheal tumor with vascular growth, leading us to suspect left renal carcinoma, with tracheal and pulmonary metastases. First, the left renal tumor was removed. The pathological diagnosis was clear cell carcinoma. Subsequently, tracheal and pulmonary resections were performed for the suspected metastasis. The patient was placed in a left lateral position and intubated into the left main bronchus. We opened the right posterolateral chest and performed a 3-cm tracheal resection and reconstruction, including a tumor on the right wall of the trachea. The right pulmonary nodule was partially resected using staplers. Pathological examination of the right lung specimen revealed a tracheal leiomyoma, with no malignant findings. Bronchoscopic treatment is the first choice for benign tracheal tumors, while complete surgical resection is the first choice for malignant tumors. As tracheal metastases from renal cancer are relatively common, and primary benign tumors are extremely rare, the possibility of malignancy could not be ruled out in this case. Therefore, tracheal resection was performed. Although postoperative analyses ultimately revealed a benign tumor, this case highlights the fact that the possibility of malignancy should be considered when making treatment decisions.

Background: Pulmonary infarction is a vascular disorder that occurs mainly due to peripherally localized pulmonary thromboembolism. However, hemothorax is rarely caused by hemorrhagic pulmonary infarction. Case: A 49-year-old female. She developed right chest pain while visiting a nearby hospital for myoma uteri. Two weeks later, fever, cough, and pleural effusion appeared, so she was referred to our hospital. Chest CT revealed right pleural effusion and a hypovascular nodule in the right lower lobe of the lung. Bloody pleural effusion with hematoma was suspected by thoracentesis, so thoracoscopic hematoma removal was performed. The thoracic cavity was filled with hematoma, but no active bleeding site was found. A white nodule was observed in the lower lobe and considered to be the responsible lesion, so wedge resection was performed. The lesion was pathologically diagnosed as hemorrhagic pulmonary infarction. The cause of the thrombus was screened postoperatively, but no causative abnormality was identified. Careful follow-up was performed at the outpatient clinic, without embolism recurrence. Conclusion: Diagnosing pulmonary infarction accompanied by hemothorax may prove challenging in cases without typical CT findings. Although rupture of the visceral pleura due to pulmonary infarction is rare, it is a condition that requires caution.

Sheet-like tissue such as mesh is commonly used for reconstruction after sternal tumor resection. However, sufficient thoracic stability is not always achieved, resulting in a flail chest postoperatively. We performed sternal tumor resection in a 76-year-old man who developed sternal metastasis after renal cell carcinoma surgery. The patient had undergone radiotherapy, and we were concerned about the risk of infection; therefore, chest wall reconstruction was performed using biological tissue (fascia lata). Because the chest wall defect was extensive, the left and right ribs and sternum were fixed in a lattice pattern using absorbable sutures to stabilize the thorax. No flail chest was observed postoperatively, and the patient was discharged on the 16th postoperative day. We report the usefulness of lattice pattern fixation using absorbable sutures during chest wall reconstruction, along with a discussion.

A 73-year-old male was referred to our hospital from another physician due to elevation of the left diaphragm on a chest radiograph with increasing dyspnea on effort. Chest CT did not show any abnormal findings in either the thoracic or abdominal cavity. A pulmonary function test (PFT) revealed decreases in the volume capacity and forced expiratory volume in one second over time compared with prior PFT, performed previously due to other diseases. His PFT showed mixed pulmonary dysfunction. A radiograph showed the Kienboeck phenomenon, he was diagnosed with eventration of the left diaphragm, and underwent surgery. We performed video-assisted partial resection of the left thin and stretched diaphragm using staplers. The Mercedez-Benz mark signed staple line was reinforced with absorbable thread. Pathological findings of the resected diaphragm showed thin muscle tissue, which indicated muscular degenerative changes. A postoperative radiograph showed flattening of the left diaphragm and left lung expansion was improved. Postoperative PFT showed improvement of both the volume capacity and forced expiratory volume in one second. He was well with mild dyspnea on effort and his radiograph showed a flattening diaphragm twelve months after surgery.

In the field of general thoracic surgery, multi-port robotic surgery and single-port thoracoscopic surgery have widely spread. The da Vinci SP surgical system, approved in September 2022, is a single-port system with only one robotic arm that is expected to further reduce invasiveness. The system is contra-indicated for cardiac surgery and an intercostal approach, and we report the first case of lung cancer surgery without an intercostal approach in Japan using this system. The patient was a 68-year-old man with 1.4 cm lung cancer, cT1bN0M0, in the lower lobe of his right lung. The operation was performed in a left lateral recumbent position, a 4 cm skin incision was placed below the costal arch, and an access port was created via the diaphragm. Three instruments and a camera were inserted from there, and a stapler was operated by an assistant with one instrument removed. The console time was 139 minutes with a small amount of blood loss, and the postoperative pain measured using a numeric rating scale was 0 to 1 from the first postoperative day. Lung cancer surgery using the da Vinci SP without intercostal sites was easy to perform and exhibited advantages in terms of postoperative pain and cosmetics.

An 84-year-old man developed late-onset cardiac tamponade on the 22nd day after robot-assisted right inferior lobectomy, and subsequently underwent pericardiotomy. After drainage, the hemodynamics stabilized rapidly, and the pericardial drain was removed on the first day after pericardiotomy. CT prior to pericardiotomy showed that the staple line of the right inferior pulmonary vein had deviated to the right thoracic cavity, and an intra-operative video revealed that the pericardium was involved in the staple line of the right inferior pulmonary vein. Depending on the surgical approach and patient factors, the pulmonary vein resection site may be limited. Careful observation of the relationship between the pulmonary vein and pericardium may prevent this complication.

This case involved a 57-year-old female. She visited her family doctor with a complaint of sustained fever persisting for the previous 2 months. Laboratory data revealed hypogammaglobulinemia, and chest CT showed an anterior mediastinal tumor. Since her skin rash was rapidly worsening, skin biopsy was performed, and a graft-versus-host disease (GVHD) -like reaction was noted. Steroid pulse therapy was administered, and the skin lesions gradually reduced. Thoracoscopic thymothymectomy was carried out. The pathological diagnosis was type B1 thymoma, and we made a diagnosis of Good's syndrome complicated with TAMA. This patient recovered without postoperative infection or relapse of skin lesions. A case of Good's syndrome complicated with TAMA is extremely rare.

We report the case of a patient who underwent sternal resection for a metastatic sternal tumor and sternal reconstruction with a titanium plate and polypropylene mesh to correct the sternal defect. The patient was a 76-year-old man. Chest computed tomography incidentally revealed a sternal mass. Biopsy led to the diagnosis of a metastatic sternal tumor originating from papillary thyroid carcinoma. As this tumor was resistant to medical treatment, surgical resection was planned. Extensive sternal defects may lead to physical fragility or paradoxical respiration, and sternal reconstruction is considered useful to prevent such conditions. At present, there are no established guidelines for reconstruction techniques, and various techniques have been reported. The reconstruction technique used in our department was effective for maintaining the respiratory function.

Coincidental and heterochronic double cancer frequency in resected lung cancer cases is reportedly 7-15%, among which overlap with malignant lymphoma is rare, accounting for less than 5%. We encountered an overlapping case of adenocarcinoma in situ (AIS) and follicular lymphoma (FL) at the same site. The patient was a 75-year-old woman. We performed computed tomography (CT) of her chest, revealing an enlarged solid nodule in the left upper lobe. Next, we conducted CT-guided biopsy, leading to the diagnosis of adenocarcinoma. Subsequently, we performed thoracoscopic resection of the left upper lobe plus ND2a-1. Our histopathological results revealed AIS and a pTisN0M0 stage of 0. Moreover, we observed lymphoid tissue with lymph follicles in the tumor stroma. The follicular structure of the tumor stroma was composed of abnormal CD10 and bcl-2-positive B lymphocytes. Chromosome analysis of the patient (using fluorescence in situ hybridization) indicated bcl-2 translocation, leading to the diagnosis of FL. To the best of our knowledge, no studies have described AIS and FL in the same lesion to date. Thus, we report this case and provide a review of the relevant literature.

A mass in the right superior mediastinum was detected on a chest radiograph in a 70-year-old man. Thoracic computed tomography (CT) revealed a superior mediastinal tumor. Positron emission tomography CT revealed a superior mediastinal tumor and suspected gastric cancer. EBUS-TBNA and upper gastrointestinal endoscopy were also performed. Although only smooth muscle was observed in the middle mediastinal tumor, upper gastrointestinal endoscopy revealed advanced gastric cancer. Therefore, distal gastrectomy was performed at our hospital. Postoperative contrast-enhanced CT revealed that the superior vena cava was almost completely occluded because of displacement by the superior mediastinal tumor. Considering the possibility of angioplasty, surgery was performed through median sternotomy. During the operation, securing the field of view was difficult, and hemorrhage from the azygos vein occurred. A hemi-clamshell incision was made to stop the bleeding and complete the tumor resection. The postoperative pathological results confirmed the diagnosis of a smooth muscle tumor with uncertain malignant potential. Herein, we report a case of surgically resected smooth muscle carcinoma, a rare mediastinal tumor.