Pleuroperitoneal communication is a rare disease associated with the conditions in which ascites accumulates. Although there are some case reports, standard treatment has not been established. We examined seven thoracoscopic surgical cases of pleuroperitoneal communication which we encountered between 2018 and 2022. Six of the patients were male and one was female. The mean age was 56.4 years. The causative diseases were continuous ambulatory peritoneal dialysis (CAPD) in two cases, and hepatic pleural effusion in five cases. All patients had right-sided lesions. The fistulas were detected by the dye method with indigo carmine, or pneumoperitoneum with CO₂. The rate of identifying leakage points was 57.1%. For cases in which the communication lesion was identified, the lesion was resected or sutured, with reinforcement involving a polyglycolic acid sheet and fibrin glue. In cases whereby the communication lesion was not identified, the entire diaphragm was covered with the same material. There was no recurrence case. We discuss the standard strategy for pleuroperitoneal communication syndrome, with a literature review.

The patient was an 80-year-old man who noted a lower back mass measuring 5 cm. The mass rapidly enlarged to 18 cm within five months. The patient was subsequently referred to our hospital. Magnetic resonance imaging showed a subcutaneous mass, measuring 170 × 140 × 80 mm, in the left lower back region. Based on the biopsy results, the patient was diagnosed with a liposarcoma. In coordination with plastic surgeons, excision of the lower back mass and reconstruction of the chest wall were performed.

The parietal pleura was conserved; however, the tumor, overlying skin, muscular layers, and 8^th to 12^th ribs were removed. Two titanium plates, polypropylene mesh, and free latissimus dorsi flaps were used to reconstruct the chest wall. The patient had a favorable postoperative course. Postoperative pathological exam confirmed the diagnosis of pleomorphic sarcoma. In this case, bony thorax and soft tissue reconstructions were performed while preserving the shape of the thoracic cavity in a patient with a large primary malignant soft tissue tumor.

The patient was a 14-year-old female. Contrast-enhanced computed tomography (CT) showed a tumor of 15 cm in diameter in the right chest wall. We performed an incisional biopsy and diagnosed it as a localized Ewing sarcoma of the right chest wall. After preoperative chemotherapy reduced the size of the tumor, we considered that radical resection was possible. We resected the sarcoma combined with the chest wall (from 6th to 11th ribs), a part of the diaphragm, and skin with subcutaneous tissue at the biopsy site. Although the defect of the chest wall was large, we reconstructed it without any artificial materials by drawing the residual ribs closer and covering them with the residual muscles. Postoperative pathological diagnosis showed no tumor cells at the resection margin, and we achieved completely radical resection.

We could conduct postoperative high-dose chemotherapy for the patient with autologous peripheral blood stem cell transplantation, and 36 months have now passed without any signs of recurrence. The patient developed no significant scoliosis or weakness at the reconstructed site and could lead an active life. We recommend reconstructing the chest wall with autologous tissue after extensive resection of the chest wall whenever possible, particularly in young patients, to reduce the risk of infection and faciliate postoperative high-dose chemotherapy.

Intrabronchial granulomas can be caused by various factors. Although there have been reports on conservative, endoscopic, and surgical treatments, there is as yet no consensus regarding an effective treatment strategy. Herein, we report a case of postoperative intrabronchial granuloma as a complication of lung cancer surgery that was successfully treated with steroid inhalation. The patient was an 80-year-old man. He underwent right upper lobectomy with lymph node resection for right upper-lobe lung adenocarcinoma. The right main bronchial membranous portion was partially injured, and repaired by suturing using 4-0 non-absorbable monofilament thread with Teflon pledgets. One year and 3 months after surgery, although hemoptysis appeared, it improved with oral hemostatic agents. One year and 5 months after surgery, the patient experienced recurrence of hemoptysis. Bronchoscopy revealed a Teflon pledget, exposed sutures, and granuloma in the right main bronchus. Since the granuloma was caused by a foreign body, the patient was started on oral tranilast and fluticasone inhalation, wherein the granuloma disappeared within one month. Inhaled steroids were considered effective for the treatment of intrabronchial granuloma.

We report a rare case of right middle lobectomy with a right aberrant mediastinal mediobasal segmental pulmonary artery (A^7+8b+9+10b). A 61-year-old male was diagnosed with a nodule in S4 of the right middle lobe on computed tomography (CT). Preoperative three-dimensional CT (3D-CT) revealed that A^7+8b+9+10b originating directly from the right main pulmonary artery passed behind the superior pulmonary vein, through the mediastinal side of the middle-lobe bronchus, and finally into the lower lobe. The patient underwent a middle lobectomy+ND2a-2 (cT1cN0M0 Stage IA3). Intraoperatively, two thin branches of the pulmonary artery from A^7+8b+9+10b were found to flow into the middle lobe, and these branches were severed. This case is one of only two reported cases of middle lobectomy with a right mediastinal basal pulmonary artery in Japan. By confirming the aberrant pulmonary artery preoperatively with 3D-CT, we were able to ensure the safety of the surgery.

The patient was a 55-year-old man presenting with the initial symptoms of bloody sputum and left chest pain. Due to suspected anomalous systemic arterial supply to the normal basal segment of the left lung based on chest CT by a previous doctor, the patient was referred to our department. The patient was scheduled for left basal segmentectomy. We exfoliated the sheaths from the aberrant artery, inter-lobar pulmonary artery, and basal bronchus, before transecting the aberrant artery, A8, and basal bronchus. Subsequently, we exfoliated the sheaths from the inferior pulmonary vein, although the inferior pulmonary vein was not divided into V6 and the common basal vein. Notably, two pulmonary veins ran into S6; drainage to the common basal vein and drainage to V1+2 beyond the interlobar fissure were observed. We judged that basal segmentectomy would be associated with a high risk of congestion in the lungs, and so decided to convert to left lower lobectomy. The patient's postoperative course was uneventful. We report a rare case of anomalous systemic arterial supply to the normal basal segments of the lung with conversion to lower lobectomy from segmentectomy, with an anomalous V6.

An anterior mediastinal tumor was incidentally found in a 27-year-old man. Computed tomography showed a solitary mass measuring 46 mm in maximum diameter in the anterior mediastinum. Laboratory tests revealed elevated levels of serum HCG-β (24.1 ng/mL) and anti-acetylcholine receptor antibodies (0.4 nmol/L). Seminoma or thymoma with asymptomatic myasthenia gravis (MG) was included as a differential diagnosis. The tumor was completely resected with a thoracoscopic extended thymectomy, and diagnosed as a mixed germ cell tumor composed of seminoma and choriocarinoma after pathological examination. The postoperative course without adjuvant therapy was uneventful, with no evidence of tumor recurrence or MG for 115 months after surgery, and so the follow-up was then terminated. The present case represents a rare case of a patient with mediastinal choriocarcinoma with no signs of recurrence in the nearly 10 years since surgery.

We report a case of lung cancer with Crigler Najjar syndrome type II, a rare constitutional jaundice with genetic disorder of UGT1A1. An 80-year-old female who had been diagnosed with right lung adenocarcinoma was referred to our hospital for an operation. She had jaundice of the whole body from birth; however, she had no hepatic dysfunction. The diagnosis was Crigler Najjar syndrome type II, and we performed thoracoscopic right middle-lobe lobectomy with lymphadenectomy after multi-disciplinary discussion. We removed her chest drain and started meals one day after surgery. She was discharged from our hospital 4 days after surgery without deterioration of jaundice. She was administered UFT, and is currently doing well 4 years after surgery.

A 31-year-old man with osteosarcoma of the left femur underwent pulmonary metastasectomy after primary tumor resection and systemic chemotherapy. Since chemotherapy for recurrence with multiple bilateral pulmonary metastases was ineffective, pazopanib was administered (600 mg/day). The left pneumothorax was monitored, it worsened 4 days after pazopanib administration, and chest drainage and pleurodesis using talc and OK-432 were performed. Due to the failure of conservative therapy, surgical intervention was indicated. Although the visceral pleura was thickened after pleurodesis, the pleural adhesion was mild. Massive air leak was observed in the vicinity of the tumor. Partial resection including the air leak point and suture repair were performed. Without postoperative air leakage, the patient was discharged on postoperative day nine. The histological findings revealed that the visceral pleura at the tumor site was destroyed with necrosis and the tumor was exposed outside of the pleura. Silica deposition and granulation were observed in the area of pleural thickening, but pleural thickening in the area of pleural collapse near the tumor was not found. Thus, the visceral pleura might be severely injured in patients with prolonged air leak during pazopanib administration for pulmonary metastases from soft tissue sarcoma, and surgical intervention could be considered.

A 60-year-old male patient presenting with bilateral nodules and multiple ground-glass opacities (GGO) was referred to our department in December of X−7 year. Two-stage bilateral pulmonary resections were carried out in February and June of X−6 year. The diagnosis was synchronous bilateral multiple lung adenocarcinoma. In June of X−4 year, treatment with afatinib was initiated due to left mediastinal lymph node recurrence. By October of X year, rapid increases in size were observed in GGO in S⁹ and the nodule in S¹⁰ of the right lung and a region along with wedge resection margins in S¹ of the same lung, which were deemed the most significant prognostic determinants. Salvage surgery with right lower-lobe wedge resection and right S¹ segmentectomy was performed. The postoperative pathological diagnoses were metachronous bilateral multiple lung adenocarcinoma and recurrence at the surgical margin after wedge resection, respectively. The patient was well without disease progression while receiving afatinib 10 months after the salvage surgery.

The patient was a 64-year-old man. Chest computed tomography (CT) showed a fungus ball at S1+2 of the left upper lobe, being treated by another hospital with a diagnosis of simple pulmonary aspergilloma (SPA). Since it was gradually increasing in size, he was introduced to our hospital for surgery. We performed left upper lobectomy based on a diagnosis of SPA from inspection before the operation. In the intraoperative findings, a cord that flowed into the left brachiocephalic vein from the left upper S1+2 was observed. We recognized the absence of the superior pulmonary vein flowing from the upper lobe to left atrium by searching the hilum. The left superior pulmonary vein was diagnosed as a partial pulmonary venous connection (PAPVC) flowing into the left brachiocephalic vein, and when preoperative CT was re-evaluated, it was possible to confirm reflux abnormality where the left superior pulmonary vein flowed into the left brachiocephalic vein. This time, PAPVC in resected lobes did not lead to serious complications; however, preoperative evaluation of various image findings is very important.

A 75-year-old male patient presented to our hospital with abdominal distension and anorexia. Computed tomography (CT) revealed left pleural effusion and a mass showing suspicious involvement with the seventh rib. On thoracic drainage, bloody pleural effusion was observed: primary lung cancer was suspected. Thoracoscopic partial resection of the left lung and needle biopsy of the ribs were performed for diagnosing primary lung cancer. Although the pulmonary mass was found to be a hematoma, needle biopsy of the rib lesion revealed angiosarcoma. Positron emission tomography (PET) -CT showed ¹⁸F-fluorodeoxyglucose (FDG) accumulation due to the tumor in the chest wall and left axillary lymph node. Radical surgery was performed, comprising resection of the tumor in the left chest wall and axillary lymph node dissection. Histological examination revealed an epithelioid angiosarcoma with a maximum diameter of 2.1 cm in the chest wall and numerous metastases in the left axillary lymph node. Postoperatively, the left axillary and supraclavicular lymph nodes were irradiated with 50 Gy of additional radiotherapy. Three months after surgery, PET-CT showed FDG accumulation in the left parasternal lymph node, which was determined to be due to metastasis. Therefore, 50 Gy of radiotherapy was also administered to the left internal sternal region. The patient has been under observation for 5 years without signs of recurrence since then. Radiotherapy was considered an effective treatment for the patient with lymph node metastasis from hemangiosarcoma.

Communicating bronchopulmonary foregut malformation (CBPFM) is a rare congenital anomaly characterized by a fistula between an isolated portion of respiratory tissue and the esophagus or stomach. Cases of CBPFM diagnosed in adulthood are even rarer.

A man in his thirties experienced a coughing and sptum episode that lasted approximately 30 min for several years. The patient was referred to our hospital after chest computed tomography (CT) revealed a soft mass on the left side of the esophagus below the tracheal bifurcation. No significant accumulation of [18F]-fluoro-2-deoxy-D-glucose was observed on positron-emission tomography/CT. However, we decided to perform surgery because a malignant tumor could not be ruled out.

Intraoperatively, an atelectasis-like structure, independent from the normal lung, was found in the left thoracic cavity, which was contiguous with a bronchial-like structure originating from the esophagus. The bronchial-like structure was cut using an automatic suturing instrument, and the lesion was removed. The tumor was diagnosed as CBPFM and categorized as Group III according to the Srikanth classification based on the presence of alveolar structures and bronchial structures originating from the esophagus in the resected specimen.