The Journal of the Japan Society for Respiratory Endoscopy

Background. Malignant airway stenosis can cause severe dyspnea and easily result in suffocation due to secretions or bleeding. Purpose. We reported our experience using Dynamic stents for stenosis of carina in our institution. Subject. Between 1994 and 2003, we implanted 10 Dynamic stents in patients with malignant stenosis of the carina. Procedure. These Dynamic stents were inserted under general anesthesia using specially designed forceps. The prosthesis is inserted orally like an endobronchial tube. Results. All but 2 patients had relief of respiratory symptoms, one of whom had lymphangitis carcinomatosis of the lung, and the other had pneumonia. The mean survival after stenting was 5.7 months. There were two complications (pulmonary edema, laryngeal edema), but they were tolerated. Conclusion. Dynamic stents were effective for malignant stenosis of carina and needs technical skill to insert safely.

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Background/purpose. The correct evaluation of mediastinal/hilar lymph node metastasis allows appropriate therapy for patients with lung cancer. We applied real time endobronchial ultrasound-guided fine needle aspiration (EBUS-FNA) to patients with lung cancer for pathological diagnosis of mediastinal/hilar lymph node metastasis. The aim of the present report is to retrospectively evaluate early results of EBUS-FNA. Method. We conducted a retrospective review of 19 patients with lung cancer who underwent EBUS-FNA for mediastinal/hilar lymph nodes between March 2003 and January 2004. Results. No patients developed serious complications during or after EBUS-FNA. Of 19 patients, 8 were positive, 11 were negative for malignant cells. Sixteen patients underwent subsequent mediastinoscopy or surgical therapy. The results of EBUS-FNAS for 22 lymph nodes in these 16 patients were compared with the final surgical result, and the diagnostic accuracies were calculated. The sensitivity for the pretracheal lymph node (# 3 lymph node) was 25%, whereas the sensitivities for other lymph node levels were all 100%. The total sensitivity and specificity of EBUS-FNA are 73% and 100%, respectively. Conclusion. We were safely able to perform EBUS-FNA for mediastinal/hilar lymph nodes with satisfactory diagnostic accuracies. However, we need some technical improvement in the application of EBUS-FNA to #3 lymph node.

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Background. Granular cell tumor, the histologicai origin of which is considerd to be Schwann cells, is found in various organs but is rare in the trachea. Case. A-55-year-old man with granular cell tumor in the membranous wall of the trachea was reported. He was admitted with no complaints but an abnormal shadow of on his CT. The chest CT and MRI showed a tumor in the membranous portion of the trachea. Bronchoscopy revealed a submucosal tumor with smooth surface in the membranous portion of the cervical trachea. Endotracheal ultrasonography showed that the tumor did not invade the mucosal layer. Fine needle biopsy revealed class II cells. Operation was performed on a diagnosis of benign submucosal tumor of the trachea. The tumor was easily enuculated without resection of the layer. The defect of the muscle layer of the membranous wall was covered by esophageal wall. Three years and two months after the operation, no recurrence of the tumor was seen. Conclusion. In this case, endotracheal ultrasonography was helpful to decide on the surgical approach.

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Background. Even at present, when therapeutic choices for tuberculosis are well established, bronchial tuberculosis remains a condition deserving special attention. Some of the reasons for this are as follows: the diagnosis often tends to be delayed, residual bronchial narrowing tends to frequently occur even after treatment of the infection, and in the early stage the condition often tends to be mistaken for bronchial asthma or bronchial tumor. Patient. A 27-year-old Indonesian man presented with a history of dry cough since December 2003; he received treatment at another hospital, but since no improvement was noted, he was referred to our hospital. A chest CT revealed huge hilar and mediastinal lymphadenopathy, and the tuberculin test reaction was positive. Bronchoscopy revealed a longitudinal ulcer on the lateral wall of the right truncus intermedius. Bronchial biopsy revealed granulomatous inflammation with epithelioid cells and a central area of caseous necrosis, however, smears of sputum and bronchoscopy were negative for acid-fast bacilli smears and PCR. The QuantiFERON-TB (QFT) test, conducted as an adjunctive test, was positive. Results. Based on the above observations, the patient was clinically diagnosed to have bronchial tuberculosis. Treatment with oral anti-tuberculous drugs induced improvement of the membranous findings. Subsequently, culture of the bronchial washings was also found to be positive for tubercle bacilli, leading to a definitive diagnosis of bronchial tuberculosis. Conclusion. The present case is considered noteworthy, in that early diagnosis of bronchial tuberculosis was made, despite the presence of relatively uncommon bronchoscopic findings.

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