Background. Recently, airway stents can be classified into two types, metallic and silicone. Metallic stents are simple to place however, disadvantages such as stent removal, replacement, and the deterioration of longterm placements are present. In contrast, silicone stents have a higher endurance and stent removal is relatively safe. Rigid bronchoscopy proficiency needs to be high, which can only be achieved through experience. The Silmet stent, a hybrid, both metallic and silicone combined, prove advantageous as unique properties from each make a more superior stent. The Silmet stent will promise for benign stenosis in the future. Patients. The average age is 64.8 years old (48-85). In 9 cases, all primary disease was malignant. Methods. Stenting was performed using general anesthesia in operating rooms. Four cases used laryngeal mask intubations. Results. No complications occurred during stenting, but post-stenting complications such as obstructive pneumonia (1), restenosis from granulations at both ends of the stent (2) occurred. In 1 case, stent removal was possible after radio-chemotherapy. Conclusion. In this study on the Silmet stent, we demonstrated that patients were relieved from dyspnea with minimal complications.

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Background and Purpose. Unilateral atelectasis due to malignant main bronchus obstruction causes severe dyspnea. For such cases, although Nd-YAG laser vaporization was mainly used as a method of re-expansion in an emergency, it was reported that a fire can break out in the airway under hyperdense oxygenation. We analyzed the safety and effectiveness of microwave coagulation therapy to expand and open the occluded airway under the hyperdense oxygenation. Patients and Methods. We analyzed a review of 11 patients with re-expansion of the occluded airway by microwave coagulation therapy who had already had unilateral complete atelectasis due to malignant main bronchus obstruction in the first medical examination, between April 1993 and March 2006. All patients had unilateral complete atelectasis due to complete obstruction of main bronchus. The subjects were 7 men and 4 women between 42 and 75 years of age (median: 64). There were 8 cases of primary lung cancer (6 squamous cell carcinoma, 2 adenocarcinoma), and 1 each of metastasis of renal cancer, colon cancer and esophageal cancer. In primary lung cancer, 6 out of 8 cases occurred in the upper lobe and 2 in the lower lobe. Results. Nine cases had air filling in the upper lobe, lower lobe or middle and lower lobe and 2 cases had air filling in the upper and lower lobes by microwave coagulation therapy from 1 day (time) to 4 days (times). Immediately after re-expansion, there was a great flow of retained sputum. After re-expansion, there was no re-expansion pulmonary edema and stents were inserted in 10 cases. Symptoms in all cases and performance status in 10 cases improved on completion of endoscopic therapy finished. It was possible for 7 cases to undergo secondary treatment of chemotherapy or radiotherapy and for 9 cases to leave hospital. All cases were inoperable. Conclusion. It is possible to expand and open the occluded airway by microwave coagulation under the hyperdense oxygenation. We think microwave coagulation therapy has excellent safety and effectiveness.

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Background. We report a rare case of lung metastases from rectal cancer presenting as cavitary lesions. Case. A 57-year-old man underwent anterior resection for rectal cancer in December 2004. A solitary nodule in his left upper lobe and a tiny thin-walled cavitary lesion in his right lower lobe were found on computed tomography(CT) of the chest in December 2005. Video-assisted thoracoscopic(VATS) wedge resection of the nodule in the left lower lobe was performed and the postoperative histological diagnosis was lung metastasis from rectal cancer. The cavitary lesion in the right lower lobe gradually increased in size over 17 months and positron emission tomography (PET) with ^<18>F-fluorodeoxyglucose(FDG) showed FDG accumulation at the lesion, suggesting that the lesion was a malignant lung tumor. Moreover, another tiny cavitary lesion had emerged in the right upper lobe. Therefore, wedge resections with sufficient surgical margins were performed to obtain a definitive diagnosis for both cavitary lesions by VATS in May 2007. Histopathologically, both tumors were adenocarcinoma, which were consistent with metastases of the rectal cancer. Conclusion. A reasonable suspicion of malignancy is necessary when evaluating tiny solitary cavitary lesions.

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Background. Post-intubation or post-tracheostomy tracheal granulation is considered to be a possible cause of serious central airway stenosis. Case. A 60-year-old woman underwent tracheostomy after subarachnoid hemorrhage. Tracheostomy was closed, however, after 3 years, she again underwent intubation and tracheostomy due to aspiration. She was referred to our hospital for the treatment of difficulty in decannulation. Bronchoscopic examination revealed a 7-mm-long tracheal stenosis, proximal from the tracheostomy site. Considering the risk of perioperative management and her condition after subarachnoid hemorrhage, she underwent endobronchial electrocautery with a direct laryngoscope under general anesthesia. Dumon stent placement was simultaneously conducted to prevent restenosis. She could speak with a speech cannula and the patency of the trachea above the tracheostomy site was good after endobronchial treatment and Dumon stent placement. Conclusion. Endobronchial treatment can become one of the useful procedures for the management of post-intubation or post-tracheostomy tracheal stenosis. The concomitant use of a direct laryngoscope with a bronchoscope makes it possible to safely and easily place a Dumon stent under direct vision for the treatment of tracheal stenosis just below the vocal cord.

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Background. Hypersensitivity pneumonia-like lung disease by nontuberculous mycobacterium has been described in immunocompetent condition, recently. Case. A 65-year-old woman was pointed diffuse lung opacities by chest roentgenogram. Chest CT showed middle lobe atelectasis, tiny nodules with centrilobular distribution, and lymphadenopathy. Those radiologic findings were clearly improved after admission, but, were re-worsened after temporal stay in home. A lung biopsy was performed. Surgical materials revealed epithelioid cell granulomatous inflammation in the both of lymph nodes and lung, and Mycobacterium avium was detected in the middle lobe, but not in the upper lobe. Her clinical condition was similar to hypersensitivity pneumonia. Pulmonary lesions changed better after antimycobacterial therapy and house-changing was introduced. Conclusion. A hypersensitivity pneumonia-like reaction due to nontuberculous mycobacterium can occur in the circumstances other than hot tub. Pulmonary response to Mycobacterium avium in this patient is complicated for both an infection and hypersensitivity-like disease.

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Background. Analysis of tumor markers in the epithelial lining fluid(ELF) is a useful diagnostic method in lung tumors. Case. A 62-year-old man visited our department with an abnormal shadow detected on chest X-ray film at a lung cancer screening. Chest CT showed the 35×35mm mass to be located in the right S^8. We inserted a microsampling probe via the channel of a bronchoscope and collected ELF directly from the right B^8b(tumor area) and left B^8b(contralateral area). The concentration of tumor markers (CEA, CYFRA, SLX) in the ELF was higher in the right B^8b than in the left B^8b. Neither lung biopsy nor brushing cytology could be performed because the X-ray machine broke down just after the ELF sampling. The tumor was diagnosed pathologically as adenocarcinoma and resected. Immunochemical staining with CEA was positive. Conclusion. Tumor markers in the ELF can contribute to the diagnosis of lung cancer prior to surgery. Sampling of ELF was performed easily and safely. This procedure is a useful modality in bronchoscopy.

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Background. Low-grade mucosa-associated lymphoid tissue (MALT) lymphoma is rare pulmonary tumor, accounting for 0.3% of all malignant lymphoma. Case. A 60-year-old woman admitted to our hospital had an abnormal chest shadow at medical checkup. Chest CT showed an ill-defined tumor shadow in the upper lobe of the right lung. On positron emission tomography, the tumor revealed the accumulation of fluorodeoxyglucose. Bronchoscopy revealed an irregular surface and stenosis of B^1, B^3 and middle branch. Transbronchial biopsy showed amyloid deposits under bronchial epithelium. The lesion was diagnosed as plasmacytoma by intraoperative core needle biopsy, and right upper and middle lobectomy was performed for complete resection of the lesions. The pathologic diagnosis was MALT lymphoma with plasma cell differentiation. It was considered that localized amyloid deposits were derived from immunoglobulin produced by plasma cells. The patient is doing well 10 months after operation without recurrence. Conclusion. We report a rare case of MALT lymphoma of the lung with localized amyloid deposits, and reviewed reports.

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Background. Most pulmonary hamartomas are generally seen subpleurally in the peripheral lung parenchyma and few cases originate from the endobronchial wall. Recently, electrocautery therapy through a flexible bronchoscope is performed for patients with airway-obstructing polypoid tumors. Case. A 62-year-old man was hospitalized because of cough and fever. Chest X-ray films on admission showed atelectasis of the left upper lobe. Bronchoscopy revealed a polypoid mass obstructing the surface of the left upper lobe bronchus. Endoscopic Nd-YAG laser and hot biopsy forceps with electrocautery therapy were performed, because the mass was large and its root could not identified. It was completely removed and diagnosed as endobronchial hamartoma-noncartilage by this procedure. He has been well after this treatment, with no evidence of recurrence. Conclusion. Endoscopic therapy using Nd-YAG laser and electrosurgical hot biopsy forceps may be useful in treating an endobronchial hamartoma of sessile type.

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