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Article type: Cover
2014 Volume 36 Issue 5 Pages
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Article type: Appendix
2014 Volume 36 Issue 5 Pages
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Article type: Appendix
2014 Volume 36 Issue 5 Pages
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Article type: Index
2014 Volume 36 Issue 5 Pages
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Article type: Index
2014 Volume 36 Issue 5 Pages
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[in Japanese]
Article type: Article
2014 Volume 36 Issue 5 Pages
451-452
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[in Japanese]
Article type: Article
2014 Volume 36 Issue 5 Pages
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[in Japanese]
Article type: Article
2014 Volume 36 Issue 5 Pages
454-455
Published: September 25, 2014
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Ko Sato, Satoshi Watanabe, Masaaki Okajima, Daisuke Ishikawa, Tomohiro ...
Article type: Article
2014 Volume 36 Issue 5 Pages
456-460
Published: September 25, 2014
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Background. Recently, the effectiveness of endobronchial ultrasonography with a guide sheath (EBUS-GS) has been reported for diagnosis of peripheral lung lesions. Accumulating evidence has demonstrated that the treatment for lung cancer patients should be planned based on their histology and status of oncogenic driver mutations. Objective. We assessed the effectiveness of EBUS-GS for peripheral lung lesions. Patients and Methods. We reviewed the medical records of 64 patients who underwent EBUS-GS for peripheral lung lesions from August 2011 to March 2013. Results. Diagnostic accuracy and sensitivity were 72.6% and 66.7%, respectively. The percentage of EGFR-mutations diagnosed by EBUS-GS among patients with adenocarcinoma was 33.3%. Conclusion. EBUS-GS is effective to obtain tissue specimens for diagnosis of peripheral lung lesions. Tumor samples obtained by EBUS-GS were suitable for further examination of oncogenic driver mutations.
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Kazuyoshi Nakamura, Hidenori Ichiyasu, Shiho Ishizuka, Junji Hamamoto, ...
Article type: Article
2014 Volume 36 Issue 5 Pages
461-465
Published: September 25, 2014
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Background. Pleural effusion associated with sarcoidosis is a relatively rare occurrence. We herein report a case of pulmonary sarcoidosis with eosinophilia in pleural effusion and bronchoalveolar lavage fluid (BALF). Case. A 66-year-old man was admitted to our hospital due to right chest pain. Chest CT revealed ground glass opacity, mediastinal and bilateral hilar lymphadenopathy and right pleural effusion. The pleural effusion contained both lymphocyte- and eosinophil-predominant exudate. BALF exhibited increased proportions of lymphocytes (47%) and eosinophils (12%), and the CD4/CD8 ratio was 6.8. A transbronchial lung biopsy showed non-caseating epithelioid cell granuloma, thus strongly suggesting a diagnosis of sarcoidosis. Corticosteroid treatment immediately improved the patient's symptoms and pleural effusion. Conclusion. Pleural effusion associated with sarcoidosis is relatively rare, presenting as lymphocyte-predominant in most cases. The present case of eosinophilia in pleural effusion and BALF in a patient with sarcoidosis is very rare.
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Kazuhiro Sakamoto, Kohei Ando, Daisuke Noma, Shigeto Sudo, Hideto Goto ...
Article type: Article
2014 Volume 36 Issue 5 Pages
466-470
Published: September 25, 2014
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Background. Meningioma, a benign intracranial tumor, is a common brain tumor in middle-aged and elderly patients. The occurence of a meningioma under the age of 15 is rare. Distant metastasis of this tumor is also very rare. Case. A 15-year-old girl was referred to our department because of an abnormal shadow on her chest roentgenogram. She had a past history of an intracranial meningioma 8 cm in size that was resected at the age of 10 but required a reoperation for local recurrence at the age of 14. Pathologically, both tumors were low-grade meningiomas. Chest computed tomography showed 3 nodular lesions with clear margins in the right middle and lower lobes of the lung. Pulmonary metastases of the intracranial meningioma were suspected. We resected all three tumors via thoracoscopic surgery. The resected specimens were white and firm with an elastic consistency. Histopathologically, the tumor was composed of spindle-shaped tumor cells arranged in fascicles and the mitotic index of the tumor cells was under 2%. Pathologically, the resected tumors were diagnosed as metastases from the meningioma. She was discharged on postoperative day 4 uneventfully. She had no evidence of recurrence at 8 months after the operation. Conclusion. Although very rare, we should keep in mind the possibility of pulmonary metastasis even in low-grade meningiomas.
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Yuki Tomita, Yuko Shima, Yuichiro Araki, Yukari Sakurai, Akiko Harada, ...
Article type: Article
2014 Volume 36 Issue 5 Pages
471-474
Published: September 25, 2014
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Background. Idiopathic bronchial varix is very rare. Case. A 70-year-old woman presented with a history of 4 decades of bloody sputum and hemoptysis. Bronchoscopy revealed marked dilatation of submucosal vessels without pulsation, in the lower trachea and bilateral main bronchi. Bronchial arteriography also revealed the dilatation of vessels in the venous phase, and we made a diagnosis of bronchial varices. Conclusion. So far, only a small number of bronchial varices have been reported. We present a case of idiopathic bronchial varices with characteristic findings on bronchoscopy.
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Taro Yoneda, Hiroki Shirasaki, Hiroaki Kobayashi, Satoshi Watanabe, Ak ...
Article type: Article
2014 Volume 36 Issue 5 Pages
475-480
Published: September 25, 2014
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Background. It is difficult to diagnose pulmonary actinomycosis via trans-bronchial lung biopsy. Case. A 52-year-old woman complaining of a cough and chest pain was referred to our hospital. Chest X-ray films and CT scans showed a nodular shadow with infiltration in the left lung. A trans-bronchial lung biopsy failed to obtain sufficient material for diagnosis, and the bronchoalveolar lavage fluid was negative for both bacteria and malignant cells, with no abnormalities. The nodular shadow did not respond to treatment with penicillin. A microscopic examination of the nodular lesion obtained via left upper lobectomy showed branching filamentous bacteria, compatible with a diagnosis of actinomycosis. Conclusions. Pulmonary actinomycosis should therefore be considered in the differential diagnosis of nodular shadows on chest X-ray films and CT scans.
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Kotaro Miyake, Kiyoharu Fukushima, Yoshiko Takeuchi, Yoshitomo Hayama, ...
Article type: Article
2014 Volume 36 Issue 5 Pages
481-486
Published: September 25, 2014
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Background. We developed the "Switch Oblique Method (SOM)", a novel technique that enables the navigation of a bronchoscope through all bronchi visible on CT. Case. A 75-year-old woman presented with CT findings showing an enlarging small area of ground glass opacity with a high density core, the largest diameter of which was 6 mm. Using the SOM technique, we estimated that the left B^3aiiαxy bronchus reached the target, branching at the target's center. The left B^3aiiαxy was sampled with an ultrathin bronchoscope, enabling a biopsy to be performed under direct bronchoscopic view. The lesion was diagnosed as atypical adenomatous hyperplasia (AAH). Conclusion. Using SOM, a biopsy of a small peripheral lesion was successfully performed under direct view with an ultrathin bronchoscope.
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Taisuke Tsuji, Chikatoshi Sugimoto, Satomi Yamamoto, Sayoko Tokura, Na ...
Article type: Article
2014 Volume 36 Issue 5 Pages
487-491
Published: September 25, 2014
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Background. We herein report a case of a bronchial foreign body (a dowel crown) that was easily extracted using a balloon catheter after short-term corticosteroid administration. Case. A 64-year-old woman was referred to our hospital for treatment of a bronchial foreign body that was detected in the right lower lung field on chest radiography after consulting her primary care physician with complaints of fever and fatigue. Initial bronchoscopy revealed that the material was embedded in the bronchial mucosa, which was granulated and edematous, and could not be removed due to ready bleeding. We administered antibiotics and short-term corticosteroids in order to improve the edema and granulation. On a second bronchoscopy procedure, we were still unable to grasp the invaginated foreign body with forceps; however, it was easily removed following extraction with a balloon catheter. We identified the foreign body as a dowel crown. Conclusions. Physicians may consider this unique method in cases of bronchial foreign bodies with long-term invagination.
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Masatsugu Ohuchi, Shuhei Inoue, Yoshitomo Ozaki, Shoji Kitamura, Keiko ...
Article type: Article
2014 Volume 36 Issue 5 Pages
492-497
Published: September 25, 2014
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Background. The development of endobronchial actinomycosis associated with a foreign body is rare. Case. A 77-year-old man with a history of right lower lobectomy for primary lung cancer suffered from a productive cough and fever 55 months after undergoing lung resection. A chest computed tomography scan revealed an infiltrative shadow in the middle lobe and endobronchial mass in the bronchial stump. Synthetic non-absorbable sutures had been used for the previous right lower lobectomy, and a bronchoscopic examination demonstrated exposure of the sutures with purulent exudates at the bronchial stump. Actinomyces was identified in a biopsy specimen, and the patient was diagnosed with endobronchial actinomycosis of the bronchial stump sutures as well as obstructive pneumonia caused by an inflammatory polyp. His condition improved, without any signs of recurrence for five years after removing the sutures and administering amoxicillin for six months. Conclusions. This is a very rare case of actinomycosis associated with bronchial stump suture. In this case, symptom relief was obtained following suture removal and the administration of antibiotic therapy. Absorbable materials and/or non-absorbable monofilament sutures should be used to suture and reinforce bronchial stumps following closure with a stapler.
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Tsutomu Marui, Shinji Murakawa, Takaaki Hasegawa, Youhei Futamura, Aka ...
Article type: Article
2014 Volume 36 Issue 5 Pages
498-503
Published: September 25, 2014
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Background. A rare case of primary pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma and hepatic MALT lymphoma are in the lung and liver is reported. Case. A 76-year-old man was referred because a chest tumor was found on computed tomography (CT) during investigation for hepatitis C. Chest CT showed a 1.2×1.0 cm tumor in the right middle lobe. The tumor was bigger than seen on his previous CT and showed accumulation on positron emission tomography (PET), therefore a malignant tumor was suspected. Contrast-enhanced magnetic resonance imaging (MRI) findings showed a 4.2-cm tumor and a 1.9-cm tumor in the right lobe of the liver, suspicious of hepatocellular carcinoma. A liver tumor biopsy was then performed, followed by right middle lobectomy for the lung tumor. The diagnosis on frozen section showed MALT lymphoma of the lung. The diagnosis of the liver tumor was also MALT lymphoma; therefore, a bone marrow biopsy was performed, revealing bone marrow involvement. Multiple organ MALT lymphomas were diagnosed, and chemotherapy was subsequently performed. Conclusion. A case of MALT lymphoma of the lung, liver, and bone marrow was reported.
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Toshiaki Yano, Shuichi Matsuda, Kazuki Tanaka, Shimpei Kato, Takashi O ...
Article type: Article
2014 Volume 36 Issue 5 Pages
504-508
Published: September 25, 2014
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Background. Acute sarcoidosis is a rare disease in Japan. We report a case of acute sarcoidosis diagnosed by EBUS-TBNA (endobronchial ultrasound guided transbronchial needle aspiration). Case. A 55-year-old woman who had a history of bilateral mammoplasty at the age of 23 developed fever and bilateral knee joint pain in February 20XX. Pointed out of bilateral hilar lymphadenopathy on chest X-ray, she was referred to our hospital. Chest enhanced computed tomography revealed mediastinal and bilateral hilar lymphadenopathy, and gallium scintigraphy showed multiple accumulations on major joints, mediastinal and bilateral hilar lymph node. A hilar lymph node specimen obtained by EBUS-TBNA revealed non-caseating epithelioid cell granulomas typical of sarcoidosis histologically. There are few reports of acute sarcoidosis with joint involvement in Japan. Moreover the association between sarcoidosis and mammoplasty was indicated. Conclusion. We report a case of acute sarcoidosis with fever and joint involvement after bilateral mammoplasty diagnosed by EBUS-TBNA.
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Susumu Hoshi, Keisuke Kureya, Kanako Satou, Hiroki Fujimoto, Haruhiko ...
Article type: Article
2014 Volume 36 Issue 5 Pages
509-513
Published: September 25, 2014
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Background. Bronchial artery aneurysm (BAA), especially mediastinal BAA is very rare and difficult to diagnose with conventional chest CT. However, recent advances in image processing has enabled us to diagnose mediastinal BAA. Case. A 67-year-old woman was referred to our hospital for hemoptysis. A chest plain CT showed bronchiectasis in the left lower lobe and tumor-like lesion in the mediastinum. Bronchoscopy showed bleeding from the left basal bronchus, so we diagnosed bleeding due to bronchiectasis and planned to perform bronchial artery embolization (BAE). Chest 3DCT reconstructed from dynamic CT prior to BAE revealed the left BAA shaped like a hanging bell, and hyperplastic left bronchial arteries dilating and winding toward the left lower lobe. We performed embolization of BAA with coil following BAE. After successful BAE and BAA embolization, she had no recurrent hemoptysis. Conclusion. Mediastinal BAA is very rare, and 47% (32/68) of the reported cases is presented as rupture of aneurysm with mortality of 6.3% (2/32). Therefore, it is very important to examine for BAA by means of 3DCT actively in patients suspected of aneurysm.
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Hirotoshi Yasui, Kazuhide Sato, Yoshihiro Takeyama, Toshio Kato, Hiroy ...
Article type: Article
2014 Volume 36 Issue 5 Pages
514-518
Published: September 25, 2014
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Background. Although pleomorphic adenoma is a common type of tumor of the salivary glands, tracheobronchial pleomorphic adenoma is extremely rare. We herein report a case of tracheal pleomorphic adenoma treated with bronchoscopic electrosurgical snaring and argon plasma coagulation. Case. A 65-year-old man visited a medical clinic for treatment of a frequent cough. A subsequent CT scan revealed a tracheal tumor, and a bronchoscopic examination showed a lobulated tumor with a yellowish-white, smooth surface and capillary dilatation located approximately 4 cm under the glottis. The lesion which was diagnosed as pleomorphic adenoma based on a pathological analysis and resected with high-frequency electrocautery and argon plasma coagulation. No evidence of recurrence was detected for one year and six months after therapy. Conclusions. We herein report a case of tracheal pleomorphic adenoma treated with bronchoscopic electrosurgical snaring and argon plasma coagulation.
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Tomoko Shiraishi, Hiroshi Ishimoto, Kei Yamasaki, Chinatsu Nishida, To ...
Article type: Article
2014 Volume 36 Issue 5 Pages
519-524
Published: September 25, 2014
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Background. Pneumonic-type adenocarcinoma (P-ADC) is known as a subtype of pulmonary adenocarcinoma, which usually shows unilateral or bilateral aerogenic dissemination. Some reports have demonstrated that various cytokines produced by cancer cells participate in fibrotic changes around the tumor. Case. A 76-year-old man was referred to our hospital with a 2-month history of dry cough. Chest computed tomography demonstrated bilateral diffuse ground-glass attenuations, consolidations, and honeycombing with traction bronchiectasis. These radiological findings were compatible with interstitial pneumonia. Bronchoscopic examination was performed, and cytology of the right middle lobe revealed adenocarcinoma, and also transbronchial lung biopsy specimens obtained from the left lung demonstrated adenocarcinoma with lepidic and papillary growth pattern. Therefore, we diagnosed this case as P-ADC with aerogenous dissemination. Conclusion. This case showed that P-ADC occasionally emerges pulmonary fibrotic changes and can resemble radiological findings of interstitial pneumonia.
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Keigo Okamoto, Youko Kataoka, Makoto Motoishi, Satoru Sawai, Jun Hanao ...
Article type: Article
2014 Volume 36 Issue 5 Pages
525-529
Published: September 25, 2014
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Case. A 74-year-old man who underwent central bisegmentectomy of the liver as radical treatment for hepatocellular carcinoma (HCC). Even one year after surgery, right pleural effusion was noted on a chest computed tomography scan. Two pleural aspiration procedures failed reveal any significant findings. Subsequently, a tumor shadow was identified in the right lung field with accumulation of contrast on ^<18>F-fluorodeoxy glucose positron emission tomography. One month later, nodules newly appeared on the right pleura. Therefore, we suspected a malignant tumor on the pleura, and performed an operation for diagnostic purposes. Thoracoscopy revealed some hemorrhagic tumors on the chest wall, in addition to a lung tumor. A few chest wall tumors were resected, and the histopathological findings revealed metastatic HCC. Conclusion. Pleural metastasis from HCC is very rare, and few cases have been reported. We report a case of pleural metastases of HCC diagnosed by thoracoscopy.
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Takahiro Haga, Kouhei Cho
Article type: Article
2014 Volume 36 Issue 5 Pages
530-534
Published: September 25, 2014
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Background. Pulmonary metastasis presenting as lymphangitis carcinomatosis arising from the cervix is rare. Case. The patient was a 39-year-old woman who presented with a 1-month history of cough and fever. A chest X-ray and chest CT scan showed diffuse interstitial thickening in both lungs and enlarged mediastinal and hilar lymph nodes. Bronchoscopy was performed, and a transbronchial lung biopsy revealed neoplastic cells in the lymphatics. These neoplastic cells were confirmed to be metastasis from a cervical cancer that had been diagnosed and treated two years earlier. Conclusions. Although pulmonary lymphangitis carcinomatosis arising from cervical cancer is rare, clinicians should take this condition into consideration in the differential diagnosis of interstitial shadows in a patient with a history of cervical cancer. A transbronchial lung biopsy is useful for the diagnosis.
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Hideki Miyazawa, Jun Kawamukai, Yoshifumi Shimada, Hideki Shinno
Article type: Article
2014 Volume 36 Issue 5 Pages
535-537
Published: September 25, 2014
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Makoto Sakugawa, Kazuya Nishii, Nobuaki Fukamatsu, Yosuke Toyota, Naoh ...
Article type: Article
2014 Volume 36 Issue 5 Pages
538-541
Published: September 25, 2014
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Taiki Fujiwara, Takahiro Nakajima, Mitsutoshi Shiba, Ichiro Yoshino
Article type: Article
2014 Volume 36 Issue 5 Pages
542-546
Published: September 25, 2014
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Takehiro Izumo, Shinji Sasada, Yuji Matsumoto, Motohisa Takai, Masahir ...
Article type: Article
2014 Volume 36 Issue 5 Pages
547-554
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2014 Volume 36 Issue 5 Pages
555-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2014 Volume 36 Issue 5 Pages
555-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2014 Volume 36 Issue 5 Pages
555-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2014 Volume 36 Issue 5 Pages
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2014 Volume 36 Issue 5 Pages
555-556
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2014 Volume 36 Issue 5 Pages
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2014 Volume 36 Issue 5 Pages
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[in Japanese], [in Japanese], [in Japanese], [in Japanese]
Article type: Article
2014 Volume 36 Issue 5 Pages
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2014 Volume 36 Issue 5 Pages
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2014 Volume 36 Issue 5 Pages
556-557
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[in Japanese], [in Japanese]
Article type: Article
2014 Volume 36 Issue 5 Pages
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[in Japanese], [in Japanese], [in Japanese]
Article type: Article
2014 Volume 36 Issue 5 Pages
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2014 Volume 36 Issue 5 Pages
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Article type: Article
2014 Volume 36 Issue 5 Pages
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[in Japanese], [in Japanese], [in Japanese], [in Japanese]
Article type: Article
2014 Volume 36 Issue 5 Pages
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2014 Volume 36 Issue 5 Pages
557-558
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2014 Volume 36 Issue 5 Pages
558-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2014 Volume 36 Issue 5 Pages
558-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2014 Volume 36 Issue 5 Pages
558-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2014 Volume 36 Issue 5 Pages
558-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2014 Volume 36 Issue 5 Pages
558-559
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2014 Volume 36 Issue 5 Pages
559-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2014 Volume 36 Issue 5 Pages
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