We report 7 cases of thymic carcinoma (4 squamous cell carcinomas and 3 undifferentiated carcinomas). Two of these patients had complete resection, 4 had partial resection, and 1 biopsy only. Adjuvant therapy consisted of chemotherapy in 5 patients and radiation therapy in 6 patients. A squamous cell carcinoma, a specific type arising in a thymic cyst, was treated with resection followed by radiation at a dose of 50 Gy. The patient is alive and well with no evidence of disease 10 years after treatment. However, the remaining 3 patients with squamous cell carcinoma died within 17 months ; 2 of their disease and one of an unrelated cause. One patient with undifferentiated carcinoma underwent resection of the primary tumor and pulmo-nary metastases, and received 5 cycles of combination chemotherapy with cisplatin, bleomycin and vinblastin. The patient died of malignant lymophoma 8 years after surgery. The remain-ing 2 patiets with undifferentiated carcinoma died of the disease 13 and 23 months after the initial diagnosis.

View full abstract

The effect of electrolyte concentrations in flush solution was studied in an ex vivo perfusing rabbit model (n=16). Flush solutions (n= 11) were composed only of NaCl and KCl, and sobium and potassium concentrations were varied so as always to total 150 mEq/L. After pulmonary flushing, grafts were preserved for 18 hours at 8°C and examind for 60 minutes with a closed circuit sustem.
From flushing we found, using computed regression curves, that the lower the potassium concentration, the greater the volume of flush solution required and the lower the pulmonary pressure.
In the functional assessment, we found, again from computed regression curves, that the lower the potassium concentration, the better the function in terms of blood gas data and perfusion pressure.
We conclude that the optimum composition of flush solutions should contain low posassium and high sodium concentrations.

View full abstract

In a 61-year-old man with MRSA pyothorax with bronchopleural fistula (BPF), open pleural drainage was performed. The BPF was closed successfully with fibrin glueing through the pleural window. The open pleural space was obliterated with a muscle pedicle flap of the latissimus dorsi.

View full abstract

There have been few case reports of metastasis through hematogenous or lymphogenous spread in thymoma. Recently we treated two patients with lung metastasis, one 5 years and 2 months, the other 13 years and 10 months, respectively after thymomectomy and total thymectomy. We could successfully resect these lung metastatases.
Masaoka's pathological staging of these cases were III and IVa, but histologically cell dysplasia and vessel invasion were not prominent in both cases. So, it seemed difficult to predict possibility of distant metastasis during operation.
At present, the mainstays of treatment for distant metastasis from thymoma after surgical resection, are irradiation and chemotherapy. There are, however, a few indications for surgical treatment. But we should operate the metastatic lesions of thymoma, if these lesions are limited to the lung as in our two patients.

View full abstract

The patient was a 17 year-old male. A mediastinal tumor had been detected by CT scan at age 13, but surgical resection was refused by his parents. On admission his chest X-ray and CT scan revealed that the tumor had increased in size. The tumor was composed of cystic and solid components and displayed low enhancement in the CT scan. Venography showed displacement of the SVC and left brachiocephalic vein, but their patency was good. CT scan and venography showed marked deformity of the SVC. During surgery through a median sternotomy tight adhesions were found between the tumor and the SVC. First the left brachiocephalic vein was divided and replaced with an EPTFE graft (12 mm in diameter) to the right atrium. After clamping of the SVC, the involved area was resected completely. The tumor, 7 × 10 × 4 cm in size, was a cavernous hemangioma histologically. When the structure of the mediastinum and the growth potential of this tumor are taken into consideration, we think that complete resection should be performed if possible.

View full abstract

The patient was a 47-year-old woman, whose chest roentgenogram revealed a coin lesion in the right middle lobe. Chest CT scan showed a mass lesion in the right S⁵. The tumor was diagnosed as malignant melanoma by transbronchial lung biopsy. No lesions outside the lung could be found, and right middle and lower bilobectomy with mediastinal dissection were carried out. The lung specimen contained a darkly pigmented tumor measuring 3.3 × 3.0 × 2.7 cm. Histological examination did not reveal so-called junctional changes. Mediastinal lymph nodes (# 4) were positive. The patient died 9 months postoperatively, and autopsy revealed multiple metastases. Only 4 cases of primary malignant melanoma of the lung have been reported in the Japanese literature.

View full abstract

A 52-year-old woman was admitted to our hospital on March 5, 1992 suffering from progressive dyspnea. She had experienced pneumothorax eight times since the age of 40. Chest radiographs demonstrated bilateral diffuse reticulonodular shadows, and a chest CT scan revealed multiple bilateral cystic lesions. Respirator function tests indicated both severe obstruction and restriction. Lymphangioleiomyomatosis was confirmed by open lung biopsy.
Following hospitalization, pneumothorax occurred twice and she was treated with chest tube drainage and pleurodesis. Her pulmonary function continued to decline. Becase she was in a terminal stage in spite of oxygen therapy, and because the estrogen and progestogen receptors were negative in the biopsy lung tissue, hormone therapy was considered to be having no effect.
In this case, we concluded that lung transplantation would be the only effective method of treatment. Lymphangioleiomyomatosis is a rare disease, but due to the lack of response to conventional treatment, lung transplantation should be considered as a possible option.

View full abstract

Extramedullary plasmacytomas are uncommon tumors that affect various tissues, most commonly in the upper airways. We report a case of solitary plasmacytoma of the lung that was difficult to differentiate histopathologically from Castleman's lymphoma.
A 55-year old woman was admitted to our hospital with an abnormal shadow on chest X-ray films but no symptoms. Chest CT scan disclosed a solitary nodule with low density in the right upper lobe. Right upper lobectomy was performed, and histological examination showed diffuse proliferation of plasma cells and lymphoid follicles partially similar to Castleman's lymphoma. Immunohistologically, the plasmacytoma cells were stained with IgA and λ chains in a monoclonal secretory pattern.

View full abstract

A 64-year-old female was admitted to our hospital with complaints of cough, dyspnea and bloody sputum. A chest x-ray film revealed atelectasis in the left lung, and tomography, CT and MRI showed a nodular mass, measuring 58 × 33 mm in diameter, at the left pulmonary hilum. Biopsy specimens taken from a mass protruding and obstructing the lumen of left main bronchus demonstrated angiosarcoma. Left pneumonectomy, including the tumor, with regional lymph node dissection was performed. However, local recurrence at the stump of left pulmonary artery and blood-borne metastases to both adrenals and the brain occurred postoper-atively. Irradiation and IL-2 administration were performed to control these recurrent lesions, but the patient died of the disease 284 days after operation. Angiosarcoma of the lung, although very rare, grows very rapidly and gives rise to blood-borne metastasis at an early stage. In addition to curative resection of the tumor, careful follow-up of the patient and effective adjuvant therapy are mandatory.

View full abstract

We treated 22-year-old female with intrapulmonary schwannoma. The patient had no complaints. Chent X-ray and computed tomogramphy findings did not demonstrate that the mass was of pulmonary or mediastinal origin. The tumor was found during surgery to be in the upper lobe of the right lung. Partial resection of the right upper lobe was perfomed. The histological diagnosis was schwannoma.
We summarize the clinical features and treatment of 20 patients with intrapulmonary or bronchial schwannoma reported in the Japanese literature.

View full abstract

A 30-year old woman was admitted to our hospital in the 16th week of her first pregnancy with a diagnosis of pulmonary cancer.
She underwent right middle lobectomy with mediastinal dissection in the 24th week of gestation without undue complications. She developed toxemia at 35 weeks of gestation so underwent Cesarean section. A healthy baby was delivered.
Both patient and child are doing well two years postoperatively. We feel that pregnancy should be maintained after careful radical surgery for pulmonary cancer.

View full abstract

We treated two patients with mediastinal mature teratoma with elevated serum CA19-9 levels. One was a 24-year-old woman, who consulted us, complaining of fever, cough and anterior chest pain. Her chest X-ray showed an abnormal mediastinal shadow. Her serum CA19-9 level was 958.0 U/ml, but AFP, HCG and CEA were normal. The other was a 23-year-old man who consulted us because an abnormal shadow had been found in a chest X-ray film taken during a routine physical check up. His serum CA19-9 level was 47.5 U/ml. Chest CTs of both patients showed cystic masses in the anterior mediastinum. we operated on both patients. Histological examination revealed a cystic mature teratomas, both contained pancreatic tissue. Postoperatively, their serum CA19-9 levels returned to normal. Immunohistological examinations showed strongly positive CA19-9 staing demonstrated in the pancreatic duct and the epithelium of the cysts.
We conclude that CA19-9 may be helpful in the diagnosis of teratomas, but cannot determine whether they are benign or malignant.

View full abstract

Two cases of diffuse panbronchiolitis have been presented focused on the potential recipients for lung transplantation. The patients, 55 and 60 year old women, were admitted to our hospital suffering from productive cough and dyspnea. Their symptoms deteriorated in spite of chemotherapy, including erythromicin, resulted in home oxygen therapy under the necessity for severe respiratory failure. They are now in a terminal stage.
Diffuse panbronchiolitis is not so rare disease in Japan. To date, conventional treatment of this disease is still limited, and lung transplantation might be considered as a possible option.

View full abstract

We treated a patient with esophageal perforation caused by a fish bone, complicated by acute mediastinitis and empyema. A 58-year-old female was hospitalized with the chief complaints of fever and severe pharyngalgia caused by a fish bone which had stuck in her throat. Acute mediastinitis and left empyema were diagnosed. Pus with a foul odor was discharged by left thoracic drainage. Gram-negative anaerobic rods were identified on culture. Right thoracotomy was done, and debridement of the mediastinum and irrigation of the thoracic cavity were performed. Three double-lumen drainage tubes were inserted, 2 in the mediastinum (to the right of the trachea and below the tracheal bifurcation) and 1 in the right thoracic cavity. Clindamycin was then sprayed over the thoracic cavity. After operation, 0.6% povidone-iodine solution was infused continuously through the drain at the right of the trachea for 22 days for lavage of the mediastinum and thoracic cavity. Her temperature fell to normal 3 days after operation, and signs of inflammation disappeared.
Since mediastinitis is a very serious disease, it should be diagnosed as soon as possible and treated not only with antibiotics, but also with open-chest drainage for mediastinal lavage.

View full abstract

Recently we operated on a patient with triple primary lung cancers : adenocarcinoma in left S¹⁺²a and squamous cell carcinomas at the ostium of left B³ and at the spur between right B² and B³. The patient also had impaired pulmonary function, VC 2.1l (63%), FEV _1.0 0.7l (40 %), RV 4.6l (74%), VO₂max 408 ml/min and VO₂/V_E 20 ml/l. On the basis of these results bilateral upper lobectomies were judged to be impossible. Upper left lobectomy and limited radiation to the right lung were planned. After the operation marked dyspnea on light exercise continued and his ECOG performance status scale was grade four for more than half a year. Limited radiation was applied about 12 months after surgery, but his respiratory function deteriorated and he died.
There are many studies correlating preoperative respiratory function and postoperative complications, but there has been no precise description of the limit of lung resection. We conclude that this patient illustrates the limit of pulmonary resection.

View full abstract