Mediastinal tumors are related to various diseases. To appropriately treat these diseases, thoracic surgeons must cooperate with physicians in other departments. Accurate diagnosis with computed tomography, magnetic resonance imaging, and positron-emission tomography are indispensable for these diseases. A thorough assessment of the tumor should include its size, shape, surface, relationship with adjacent organs, and other characteristics, including nodal involvement, remote metastasis, pleural dissemination, pericardial dissemination, pulmonary metastasis, invasion to chest wall, development to the vertebral canal, and hematological studies. Less-invasive procedures by means of video-assisted thoracic surgery is an option for resection of noninvasive tumors, such as Masaoka stage I and II thymomas. Whether video-assisted thoracic surgery is an appropriate surgical procedure for mediastinal tumors depends on accurate imaging diagnosis. In this article, a new method for anatomic compartment classification of the mediastinum for axial computed tomograms and x-ray films is reviewed. Additionally, the characteristics of mediastinal tumors and recent surgical treatments are described.
Type III hiatal hernia (giant hiatal hernia) is a mixture of type I (sliding hernia) and type II (paraesophageal hernia) hiatal hernias and sometimes causes severe complications if stomach necrosis has occurred. Therefore, surgical treatment is recommended. We discuss the available treatments for type III hiatal hernia and describe our procedure for laparoscopic antireflux surgery. We performed Nissen or Toupet fundoplication, depending on the esophageal function of each patient. Crural repair should be performed with calibration using a 56-Fr bougie to avoid postoperative dysphagia. As much as possible of the hernia sac should be removed to prevent hernia recurrence. Some authors have reported that laparoscopic antireflux surgery for type III hiatal hernia is a technically challenging and controversial procedure. However, the outcomes at our hospital have been excellent, and the level of patient satisfaction has been high.
Adenosquamous carcinoma of the colon is rare, accounting for approximately 0.1% of all colon cancers. We present a case of primary adenosquamous carcinoma of the cecum treated with resection. A 73-year-old woman was admitted to the hospital because of abdominal pain and vomiting, and ileus was diagnosed on the basis of colonic obstruction suggested by abdominal X-ray examination. Colonoscopy revealed type 2 advanced cancer of the cecum, and a biopsy confirmed adenocarcinoma. Computed tomography (CT) of the chest and abdomen revealed no distant metastases. The levels of carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) before the operation were 17ng/ml and 101U/ml, respectively. Ileocecal resection (D3) was performed, and the clinical stage of the tumor was IIIb (T3N2H0P0). Pathological examination showed adenosquamous carcinoma (moderately differentiated adenocarcinoma and well-differentiated squamous cell carcinoma) and regional lymph node metastases (No. 201 and 202, positive; No. 203, negative). Adjuvant chemotherapy with 5-fluorouracil (5-FU)/leucovorin (LV) was performed, and the patient was disease-free for 15 months after the operation. However, metastasis to the para-aorta lymph nodes was detected with CT examination 16 months after the operation. The patient received best supportive care and died 22 months after surgery.