Background. Despite worldwide increase of patients with malignant pleural mesothelioma, few definitive treatment strategies have been developed in the last decade. The effects of chemotherapy reach its ceiling and multi-modal therapy candidates are strictly selected due to the stress of treatment. Purpose. We need a concise review that summarizes the results of clinical trials with each therapy in the past decade. Methods. The reports of clinical trials with any medicine for malignant pleural mesothelioma were searched and summarized. We also showed the on-going clinical trials that have been presented at annual meetings. Results and Conclusion. In contrast to non-small cell lung cancer, no specific genetic mutations or driver-oncogenes have been identified which has resulted in the failure of molecular target therapy for malignant pleural mesothelioma. However clinical trials with other promising medicine such as anti-angiogenic inhibitors, gene therapy and immune checkpoint inhibitors are still on-going.

Background. Primary tracheal tumors are a relatively rare occurrence. However, these tumors can cause severe respiratory deficiencies due to airway stenosis, requiring urgent medical attention. Appropriate airway management is also needed during operations attempting at tumor resection. Here we report a case of adenoid cystic carcinoma of the trachea that was resected using a flexible bronchoscope followed by circumferential tracheal resection. Case. A woman in her forties had complained of a persistent cough accompanied by wheezing for four months. She also had had exertional dyspnea two months earlier. It was revealed that a tracheal tumor was blocking most of the inferior tracheal lumen and she was then referred to our hospital. Tumor resection using a flexible bronchoscope was performed for airway management and pathological diagnosis. Her symptoms disappeared immediately and her respiratory function improved dramatically. A circumferential resection was performed one month later and no complications occurred during the perioperative period. Conclusion. In this case of severe airway stenosis due to a bronchial tumor, tumor resection using bronchoscopy followed by radical surgery was effective in airway management.

Background. Myeloid sarcoma, which is defined as an extramedullary tumor-forming neoplasm that consists of immature myeloid cells, is a rare disease. Some reports have described patients with mediastinal myeloid sarcoma with a malignant pleural effusion. We herein describe the case of a patient with mediastinal myeloid sarcoma presenting with pleural dissemination. Case. A 26-year-old man presented with cough and exertional dyspnea. Chest CT on admission revealed a massive left pleural effusion and an anterior mediastinal mass. We performed medical thoracoscopy in order to obtain a diagnosis and perform pleural drainage. Thoracoscopy revealed a large number of small nodules that were diffusely distributed on the parietal pleura. He was diagnosed with myeloid sarcoma based on the results of a cytological examination of the pleural effusion and a pleural biopsy. Conclusion. To the best of our knowledge, this is the first report to describe the pleural lesions of myeloid sarcoma that were identified by thoracoscopy. Medical thoracoscopy was useful in the diagnosis of the present patient.

Background. Ventilation failure during airway intervention for airway constriction can be a fatal complication. Management of this complication is important. Case. A 68-year-old woman developed acute severe respiratory failure and could not breathe in the supine position. Stenosis from above the carina to both sides of the main bronchi was present due to thymic cancer oppression and infiltration. Under veno-venous extracorporeal membrane oxygenation (V-V ECMO), Dumon Y-stent placement was carried out using high frequency jet ventilation. Conclusion. V-V ECMO and the high frequency jet ventilation method can be a useful auxiliary means for airway intervention even in the presence of severe airway stenosis.

Background. Recent reports on lodged bronchial foreign bodies suggest that the proportion of such cases has increased among the elderly. Although flexible bronchoscopy is the first choice for such patients, removal using a flexible bronchoscope is difficult in some cases. Subjects and Methods. We reviewed nine cases of lodged bronchial foreign body at our hospital between April 2010 and October 2015 and studied the patient age, type, site, and method of removal. Results. The patients (1 child and 8 adults; 6 male, and 3 female patients) ranged in age from 3 to 96 years, with a median age of 74 years. When performing flexible bronchoscopy, all patients were sedated by the intravenous administration of midazolam. The foreign body was removed using a flexible bronchoscope in six cases, and there were no complications. A rigid bronchoscope was needed in two cases: owing to granulation in one case and difficulty with oxygenation in the pediatric patient. Conclusion. Lodging of a bronchial foreign body is a critical condition in adults and both the proper method of sedation and the appropriate treatment method must be chosen on a case by case basis.

Background. Discribing different causes for pleural effusion in sarcoidosis patients and the need to make a differential diagnosis would be more appropriate. Case. A 63-year-old man with skin sarcoidosis and abnormal chest shadow, was transferred to our hospital due to exacerbation of lower leg edema and bilateral pleural effusion. We initially used diuretics to treat heart failure but left predominant pleural effusion did not completely improve. We subsequently performed thoracoscopy under local anesthesia, which showed multiple small nodules and partial black pigmentation on the visceral pleura. Pleural specimens demonstrated adenocarcinoma and a diagnosis of carcinomatous pleuritis was established. Conclusion. Thoracoscopy under local anesthesia can aid in the differential diagnosis of pleural effusion in a patient with sarcoidosis.

Background. We report a case of mediastinal tuberculous lymphadenitis with atelectasis and bronchial polyp caused by a paradoxical reaction. Case. A 46-year-old woman undergoing mediastinal tuberculous lymphadenopathy treatment was admitted to our hospital because of effort dyspnea and right-middle lobe atelectasis after receiving antituberculosis drugs for 3 months. Bronchoscopy revealed a polypoid lesion at the orifice of the right-middle lobe. Histological examination of the lesion revealed an epithelioid-cell granuloma; she was diagnosed with a paradoxical reaction. Furthermore, bronchoscopy revealed a small, red polypoid lesion in the truncus intermedius. The middle lobe polyp decreased in size after continuously receiving antituberculosis drugs. However, the polyp in the truncus intermedius remained enlarged and was eventually diagnosed as an inflammatory polyp by biopsy. Conclusion. Bronchoscopy is useful for detecting the cause of atelectasis during mediastinal tuberculous lymphadenitis treatment.

Background. Previous broncholithiasis reports from Japan show that calcified lymph nodes following tuberculosis can be a major cause for disease. However, the number of cases of broncholiths derived from respiratory tract secretions are recently increasing. We herein describe a case of broncholith caused by secretions which required repeated bronchoscopic removal. Case. A 51-year-old female, with neither any history of tuberculosis infection or calcification of the mediastinal lymph nodes, presented with a history of severe scoliosis, and multiple, consecutive lower respiratory infections from a young age. Bronchiectasis and a broncolith was detected at age 38, and first bronchoscopic removal was performed at 43 years of age to improve her respiratory function. Bronchoscopic removal was performed seven times for same purpose during an 8-year period without any complications. The composition of the removed broncholith was primarily calcium carbonate. The broncholith has not recurred for more than two years after initiating medical enhancements to airway humidification and carrying out sputum removal techniques. Conclusion. Lingering secretions due to airway clearance dysfunction as a result of scoliosis and bronchiectasis was presumably the source of this broncholith. In this case, bronchoscopic removal was found to be a safe and practical treatment for extracting an unattached broncholith.

Background. Colloid adenocarcinoma consists of large amount of mucin and little of cancer, so its pathological diagnosis is difficult, not only preoperatively but also intraoperatively. Case. A 73-year-old woman was admitted to our hospital because of an abnormal opacity, on chest X-ray, which was suspected to be a lung cancer. But the diagnosis was not defined by twice transbronchial lung biopsy, and a CT-guided needle biopsy. So, we performed a laparoscopic operation for definite diagnosis and treatment. Though the intraoperative histopathological diagnosis did not show a malignant tumor, postoperative pathologic examination diagnosis was a colloid adenocarcinoma, finally. Conclusions. Colloid adenocarcinoma of the lung is a rare malignancy. When we face a type of tumor that contains a lot of mucins, and it is difficult to diagnose, we should take colloid adenocarcinoma into consideration.

Case. A 56-year-old woman consulted an ophthalmologist due to right eye pain in September 2012. She was diagnosed with right-sided iritis and glaucoma. Based on the ophthalmologic findings and negativity for Mantoux reaction, she was referred to our hospital with suspected sarcoidosis. Chest computed tomography showed seventeen small irregular nodular shadows of 5-8 mm in size in the lungs without bilateral hilar or mediastinal lymphadenopathy. A definitive diagnosis could not be obtained by bronchoscopy with transbronchial biopsy. Thus, in February 2013, she underwent a surgical lung biopsy from left segment 8, which included two black nodules in order to obtain a definitive diagnosis. Histologically, the two black nodules were intrapulmonary lymph nodes containing non-caseating epithelioid cell granulomas. In addition, the lung tissue showed non-caseating epithelioid and giant cell granulomas in the pulmonary interstitium. We made a diagnosis of sarcoidosis. Conclusion. We reported a rare case of sarcoidosis involving the intrapulmonary lymph nodes without bilateral hilar or mediastinal lymphadenopathy.

Background. Endobronchial metastasis from a prostate cancer is very rare. Case. A 67-year-old man, who had been complaining of dyspnea and cough, presented to a community hospital. Antimicrobial therapy was initiated with a diagnosis of community-acquired pneumonia, however, it did not improve and he visited our hospital. Multiple polypoid lesions in the tracheobronchial trees were revealed by chest computed tomography. We confirmed the polypoid lesion to be an adenocarcinoma by bronchoscopic biopsy. A result of systemic search, found prostate tumor. Prostatic puncture pathology proved prostate cancer. Performed a maximum androgen inhibition therapy, both the prostate and respiratory tract lesions were reduced. Conclusion. Endobronchial metastasis of prostate cancer is uncommon but it is necessary to consider its existence.

Background. Empyema with bronchial fistula due to a ruptured lung abscess is a rare occurrence which frequently requires surgical management. Case. A 48-year-old man with dyspnea and general fatigue was admitted to our hospital. We diagnosed him as having empyema with bronchial fistula due to a ruptured lung abscess. Following chest drainage and the administration of intravenous antibiotics, his symptoms improved; however, pulmonary air leakage continued. Therefore, we performed endoscopic bronchial occlusion using Endobronchial Watanabe Spigot (EWS) and fibrin glue. Subsequently, the air leakage stopped and his chest tube was removed. Conclusion. Endoscopic bronchial occlusion using a combination of EWS and fibrin glue can be an effective treatment option for treating empyema with bronchial fistula due to a ruptured lung abscess.

Background. In the field of respiratory surgery, tracheal mature teratomas are rarely reported, while mediastinal mature teratomas are quite common. Case. A 43-year-old man was treated for bronchial asthma at another hospital; chest computed tomography (CT) revealed an intratracheal mass on the left side, approximately 2 cm in size, and it invaded the tracheal lumen by approximately 50%. Furthermore, there was a 4-cm cervical tumor on the left side of the thyroid gland, which was not continuous with the tracheal mass. The patient was referred to our hospital where he underwent bronchoscopy; there was a tumor protruding from the left side of the tracheal wall to the tracheal lumen, 5 cm from the vocal cords. While the levels of tumor markers were normal, positron emission tomography-CT revealed a tracheal tumor and a cervical tumor with 18F-fluorodeoxyglucose uptake; the corresponding standardized uptake values were 3.6 and 8.3, respectively. Therefore we suspected primary malignant tracheal tumor and lymph node metastasis. The patient underwent resection, during which 2 cm of the tracheal wall was resected. The results of the rapid intraoperative pathological diagnosis indicated a teratoma. We did not perform cervical lymph node dissection because we suspected it to be inflammatory lymphadenopathy. Conclusion. We encountered a case of a tracheal teratoma with cervical lymphadenopathy that was suspected to be a malignant tumor.