Background and Purpose. Bronchofiberscopy is usually performed for a definitive diagnosis of lung cancer. However, because the number of patients with small peripheral lung cancer has increased, we must sometimes perform an operation as preoperative bronchofiberscopy does not always provide a definitive diagnosis. Because the indications for bronchofiberscopy for the diagnosis of small peripheral pulmonary nodules are not clearly defined, we attempted to determine them. Patients and Methods. We evaluated 111 cases with primary lung cancers who underwent pulmonary surgery after bronchofiberscopies for peripheral pulmonary nodules from January 2004 through December 2005. Results. The diagnostic rate for lung cancer by bronchofiberscopy was 62%. There was no difference in diagnostic rates according to tumor location or patient background. Diagnosis by bronchofiberscopy depended on tumor size. In particular, it was very difficult to diagnose tumors less than 2cm in diameter and those with a tumor shadow disappearance rate (TDR) of 50%. Conclusion. It is suggested that preoperative bronchofiberscopic biopsy for a tumor less than 2cm in diameter and a TDR of 50% is not indicated.

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Background. A large amount of bleeding can be expected during surgery for chronic expanding hematoma. Case. A 72-year-old man with a history of operation for tuberculosis at the age of 28 was referred to our hospital with a complaint of bloody sputum. Chest X-ray film showed a mass shadow with calcification in the right lower lung field. CT scan and MRI of his chest showed a tumor shadow measuring 13cm in diameter above the right diaphragm. Chronic expanding hematoma was diagnosed. The preoperative embolization of the right tenth intercostal artery and right inferior phrenic artery were performed. The patient underwent extirpation of the hematoma with the whole capsule. The intraoperative bleeding was 850ml and only autologous blood transfusion was performed. The postoperative course was uneventful. Conclusion. We reported a case of chronic expanding hematoma extirpated with autologous blood transfusion after embolization of feeding arteries.

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Background. Pulmonary Langerhans cell histiocytosis (LCH) is a comparatively rare unidentified disorder characterized by nonneoplastic proliferation and granuloma formation of the Langerhans cells. It is reported in more than 100 cases in Japan, and the contribution of smoking is strongly suggested. Case. A 51-year-old man, who smoked 30 cigarettes per day for 30 years, chest abnormal shadow in health screening of autumn, 2007 and he was transferred to our hospital. Chest CT scan revealed centrilobular small nodular shadows, so we performed bronchoalveolar lavage (BAL) for right B^3_b and transbronchial lung biopsy (TBLB) for right B^2 via bronchoscopy. Histopathological findings revealed small histiocytic colonization staining with CD1a and S-100 protein, and cell classification of the BAL fluid revealed 5.6% positive CD1a cells, immunocytochemically. We therefore diagnosed pulmonary LCH, and most of the shadow on chest CT scan had disappeared after cessation of smoking for 6 weeks. Conclusion. Although it is said that the diagnosis rate of pulmonary LCH by bronchoscopy is low, we report a case diagnosed with BAL and TBLB, and this case was thought to be a case of early stage onset and remission was obtained after cessation of smoking for a short term.

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Background. Metastatic recurrence of completely resected colon cancer in the lung accounts for 9.4-13.4% of all cases with recurrence, and 85% of these cases recur within 5 years after resection. Case. A 71-year-old man presented with dyspnea in March, 2007. He had a history of colon cancer for which right hemi-colectomy was performed at another hospital in 1996. He was admitted to our department, since his chest X-ray showed a mass in the right hilum. Chest CT revealed a mass in the right anterior upper lobe (S^3) and hilar/mediastinal lymphadenopathies. A polypoid lesion protruding from the right anterior upper bronchus (B^3) to the right main bronchus was observed under bronchoscopy. Since histological examination revealed similarity of the biopsied specimen from the polypoid lesion to the previously resected colon cancer and immunohistochemistry was positive for cytokeratin (CK) 20, but negative for CK7 and thyroid transcription factor-1, we diagnosed metastatic colon cancer in the lung, as well as the hilar and mediastinal lymph nodes. Conclusion. we report a case of colon cancer with metastatic recurrence in the lung, the hilar and mediastinal lymph nodes 11 years after colectomy.

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Background. Among bronchogenic cyst cases, intrapulmonary cysts have been recognized as rare. Hence, an intrapulmonary cyst with an opening into the main airway is extremely rare. We report a lesion that was removed by lingulectomy. Case. A 36-year-old woman had suffered cough, sputum, fever and left chest pain frequently for several years. Chest CT showed a cystic lesion in the left hilum with emphysematous change in the surrounding lung. Three-dimensional CT showed that the cystic lesion was connected to the spur between the upper and lower lobe bronchus. Bronchoscopy revealed a 3mm-diameter opening between the upper and lower lobe bronchus from which mucous fluid was being discharged. We performed a lingulectomy but the inflammatory change of the perivascular tissue was severe. Pathological examination revealed bronchial mucosa without cartilage, so we diagnosed an intrapulmonary bronchogenic cyst. Conclusion. Multi-slice CT and bronchoscopy were useful for the differential diagnosis of an intrapulmonary bronchogenic cyst with frequent inflammatory symptoms because of the opening into the main airway. Cure was achieved by lingulectomy.

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Background. Malignant lymphoma with endobronchial involvement is rare. Case. A 58-year-old man was admitted due to chronic cough and bloody sputum. Chest X-ray and chest CT showed enlarged lymph nodes in the mediastinum and stenosis of the left main bronchus. Bronchoscopic findings showed a widened angle at the carina and multiple, polypoid masses with reddish, glossy mucosa at the left main bronchus. Transbronchial biopsy specimens were interpreted as T-cell type, non-Hodgkin's lymphoma. The patient was positive for human T-cell leukemia virus type 1 (HTLV-1). A clinical diagnosis of adult T-cell leukemia/lymphoma (ATLL) was established. Conclusion. This is a very rare case of T-cell type, non-Hodgkin's lymphoma with endobronchial involvement in an HTLV-1 carrier.

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Background. There are a variety of foreign bodies that may obstruct the respiratory tract and we are required to manage them carefully after fully recognizing their properties, number, and location. In a case of airway foreign body presenting with severe respiratory failure, however, prompt treatment is critical. Case. The patient was a 32-year-old man who was buried alive in a large quantity of chaff dropped accidentally while he was working inside a chaff tank. Since he could not cough up the chaff immediately after rescue, he lost consciousness, and developed cyanosis and orthopnea with wheezing. Bronchoscopic examination conducted while the patient was on a respirator with tracheal intubation confirmed a large amount of the chaff filling the lumen of the trachea. Five to ten flakes of the chaff were removed in one examination using a quinque-pod grasping forceps (designed for gastrointestinal tract management). This procedure was repeated until the main bronchi became visible bilaterally, at which time the patient could cough-up the foreign bodies by himself leading to extubation. Conclusion. We report this rare case of tracheobronchial foreign body consisting of chaff causing acute respiratory failure, which was quickly managed by bronchoscopic removal of the foreign body under ventilatory support with tracheal intubation, resulting in a lifesaving outcome.

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